11! I i Hi '^lljllililii j : 'jffJii;! .it uji'i ' 'if PI '!: i f mm 11181 IflllS Ifilililj lil'ilili IftaliK'Ii Ilill li iiiil 4 II lliiiliii "fpilii THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA PRESENTED BY PROF. CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID THE ANATOMY OF THE ARTERIES THE HUMAN BODY. 1 THE ANATOMY OF THE ARTERIES THE HUMAN BODY AND ITS APPLICATIONS TO PATHOLOGY AND OPERATIVE SURGERY A SERIES OF LITHOGRAPHIC DRAWINGS RICHARD QUAIN, F.R.S. PROFESSOR OF ANATOMY IN UNIVERSITY COLLEGE AND SURGEON TO UNIVERSITY COLLEGE HOSPITAL THE DRAWINGS FROM NATURE AND ON STONE BY JOSEPH MACLISE, ESQ. SURGEON. LONDON PRINTED FOR TAYLOR AND WALTON BOOKSELLERS AND PUBLISHERS TO UNIVERSITY COLLEGE UPPER GOWER STREET MDCCCXL1V PREFACE. SEVERAL years have elapsed since I became impressed with the belief that the difficulties which have often occurred in the performance of those surgical operations in which the larger arteries are concerned, have arisen in great part from want 6f sufficient acquaintance with the differences in anatomical disposition to which these vessels are subject not merely the deviations in the origin of large branches, which are usually named varieties, but other peculiarities of various kinds which are liable to occur, such as those which affect the length, position, or direction of the vessels. Under that impression I was led to observe these circumstances more closely, and finally determined to obtain a record of the con- dition, whatever it might be, of the more important vessels in a considerable number of cases. With this view, I examined with more or less attention the bodies which were received during a series of years for the study of anatomy into the School of Medicine in University College. These bodies, to the number of 1040, were, with rare exceptions, so inspected with reference to the subject of my inquiries, that anything very unusual could not escape notice ; and, in order to insure accuracy, when other occupations allowed, the arteries were carefully examined and their con- dition noted at the time, attention being always particularly directed to those vessels and to the points in their history which seemed to be of importance in the practice of surgery. This detailed investigation was continued until the number of cases observed appeared such as would afford grounds for fixing what should be considered the most frequent or stan- dard conformation of the vessels, and for forming at the same MS70530 vi PREFACE. time reasonable conclusions both as to the limits of the deviations from that standard and the relative frequency of their occurrence. While the observations thus made were written down, drawings were obtained of all the important peculiarities which presented themselves, and when it was practicable the preparations were preserved. The varieties in the arrangement of the blood-vessels thus noted grew, as may be supposed, to be very numerous ; but instead of difficulties multiplying with the number of observa- tions, it was usually found that as the facts accumulated, the transition from one state to a very different one ceased to be abrupt or without method, for others from time to time inter- posed which served to link them together. Originally these observations were intended exclusively for the benefit of my class ; but as their number and connexion seemed likely to render them more extensively useful, I resolved to publish them. On examining with a view to pub- lication the materials which I had collected, it became obvious that their utility would be very limited, unless as a part of a full history of the arteries with adequate delineations. In consequence, a series of drawings, showing the arteries accord- ing to their usual arrangement, has been prepared, and to these are appended the observations previously alluded to. The work has thus grown under my hands, and has gradually assumed its present form. To carry out my views as to the delineations, I obtained the assistance of my friend and former pupil, Mr. Joseph Maclise. In reference to that gentleman's labours, it may be allowed me to say, that while I have had the co-operation of an anatomist and surgeon, obviously a great advantage, the drawings will, I believe, be found not to have lost in spirit or effect. It affords me much gratification to render my acknowledgments to Mr. Maclise, for the readiness with which he acceded to my wishes, and undertook so arduous a task, and the zeal with which he has devoted himself to it in the intervals of application to the duties of his profession. Before I explain the plan pursued in this publication, it may be permitted me to advert shortly to the distinguishing PREFACE. vii features of the principal works' 'hitherto published on the Arteries, because it will thus be apparent in what respects this publication differs from others. The work of Haller *, the first in point of time which deserves notice, and still in many respects the best on the Anatomy of the Arterial System, is characterised by vast learning, by candour in the appreciation of the labours of others, and accurate observation in short, by those high qualities which distinguish all the writings of that illustrious author. The written descriptions, especially those of the branches, have perhaps never been equalled for copiousness and accuracy. But the drawings were in many instances taken from the bodies of very young children; and the treatise alto- gether is deficient in systematic arrangement and continuity, probably in consequence of the desultory manner of its pre- paration, and the length of time which intervened between the publication of its parts. On the whole, though not suited to general use, the " Icones Anatomicse " are, and will con- tinue to be, to the diligent inquirer a most valuable contribution to the history of the arteries. The representations of the arteries contained in Scarpa's work on Aneurism f, like all the delineations published by the same author, are most carefully and beautifully executed. They comprehend, however, but a small portion of the arterial system, and have obviously been intended to show not so much the position and connexions of the arteries, as the branches by which the circulation was likely to be carried on after an operation for aneurism an object which the results since obtained in the treatment of aneurism have fully demonstrated to be unnecessary. TiedemannJ has given, in the "Tabulae Arteriarum," systematic and clear delineations of the arteries, with many of their so-named varieties. To this valuable work the modern student of anatomy is almost exclusively indebted for representations of the arterial system. In it, however, as in * Icones Anatomicae, quibus prsecipuse aliquse partes Corporis human! delineates proponuntur et Arteriarum potissimum historia continetur. Gottingse 1804. f Sull' Anetirisma-Riflessioni ed Osservazioni Anatomico-chirurgiche. Pavia 1756. J Tabulae Arteriarum Corporis Humani. Carlsruhse 1822. Tiii PREFACE. the other treatises referred to, the veins and nerves are not shown in connexion with the arteries, and those modifications or peculiarities of the vessels alluded to at the commence- ment of these observations are not taken into account. In the present work the arteries are represented 1st. According to their most frequent arrangement, without the accompanying veins. 2ndly. They are shown in connexion with the larger veins and the nerves. Srdly. The deviations from that which has been taken as the standard because the most frequent condition of the arteries, are illustrated in a series of sketches. 4thly. Such peculiarities of the veins, and occasionally of the nerves and muscles, as appeared likely to be of import- ance in surgical operations, are represented on a reduced scale. The letter-press, besides an explanation of the drawings and remarks on them, contains A series of Tables, showing, in a considerable number of cases, the condition of the arteries as to some of the points of most importance in their anatomy ; A connected view of their anatomical history, the details being arranged in systematic order ; And Practical Commentaries : which consist, for the most part, of inferences from the facts previously set forth, and their application in performing surgical operations. R. Q. REFERENCE TO THE PLATES AND EXPLANATION. PLATE I. PAGE The large Arteries of the Thorax and the Neck, viz. : the Arch and the Thoracic part of the Aorta, the Innominate, Left Carotid, Left Subclavian, together with the Left Axillary, Bronchial, yEsophageal, and the origin of the Coronary arteries 9 PLATE II. The Heart, and the large Arteries of the Thorax and the Neck, with the accompanying Veins and Nerves. ARTERIES. The Arch of the Aorta, the Innominate, Right Carotid, Right Subclavian, Left Carotid, Left Subclavian. VEINS. The Jugular, Subclavian, Innominate, Superior Vena Cava. NERVES. The Pneumo-Gastric, Phrenic, Brachial plexus. PLATE III. The more superficial Arteries of the Neck on the right side, viz. : the end of the Common Carotid, the beginning of the External and of the Internal Carotid, the Subclavian beyond the anterior scalenus muscle 12 PLATE IV. FIG. 1. The end of the Left Common Carotid, in connexion with the i Fascia, and the Veins and Nerves. FIGS. 2 & 3. Peculiarities of the Veins in connexion with the Common ) 18 Carotid arteries. FIG. 4. A peculiarity of the Vagus Nerve. I PLATE V. Peculiarities of the commencement of the Aorta affecting its position, direction, and shape . . . . . . . .15 PLATES VI. AND VII. Peculiarities of the large branches, taking origin from the Arch of the Aorta 41 PLATE VIII. The External Carotid artery, and its branches 87 PLATE IX. The Internal Maxillary artery 88 x REFERENCE TO THE PLATES AND EXPLANATION. PLATE X. PAGE The Lingual, the Pharyngeal, and the Internal Carotid arteries . . 89 PLATE XI. The External Carotid artery of the right side, with the accompanying Veins and Nerves 91 PLATE XII. Peculiarities of the Common Carotid arteries, of the External Carotid, and of the branches of the latter 92 PLATES XIII., XIV., XV. Peculiarities of the branches of the External Carotid arteries . . 96 PLATE XVI. The Right Common Carotid artery; the Right Subclavian, and its branches 131 PLATE XVII. FIG. 1. The commencement of the Right Subclavian artery, with its'] accompanying Veins and Nerves. >133 FIG. 2. The end of the Right Subclavian artery, with its accompanying Veins and Nerves. PLATE XVIII. FIG. 1. The Superior Intercostal artery, and the Deep Cervical (ar. prof. T cerv.) of the left side. I 133 FIG. 2. The Vertebral artery of the right side its cervical part. J PLATE XIX. The Arteries of the side and the back part of the Head, with those of the back part of the Neck and the Shoulder, viz. : the Superficial Temporal, Posterior Auricular, Occipital, Supra-Scapular, Posterior Scapular, Dorsal Scapular, &c. . . . . . . .135 PLATE xx. Peculiarities of the Subclavian arteries affecting the trunk . .136 PLATE XXI. Peculiarities of the Subclavian arteries affecting the trunk and the origin of the branches 139 PLATE XXII. Peculiarities of the Vertebral arteries 141 PLATE XXIII. Peculiarities of the Thyroid arteries 143 PLATE XXIV. Peculiarities of the Internal Mammary, and of some other branches of the Subclavian arteries .145 PLATE xxv. Peculiarities of the Deep Cervical arteries. Peculiarities of the Nerves, the Veins, the Muscles and the Bones, in connexion with the Subclavian arteries .... 147 REFERENCE TO THE PLATES AND EXPLANATION. xi PLATE XX7I. PAGB The Axillary and the Brachial arteries, with their branches . .211 PLATE XXVII. The Axillary and the Brachial arteries, with the accompanying Veins and Nerves 212 PLATE XXVIII. The Axilla seen from below showing the Arteries, the Veins, the Nerves, and the Lymphatic glands 213 PLATE XXIX. FIG. 1. The Posterior Circumflex artery. The dorsal branch of the~j Subscapular. >213 FIG. 2. The Anterior Circumflex, and the arteries on the ventral surface I of the Scapula. PLATE XXX. Peculiarities of the Axillary artery, and of its branches . . .214 PLATE XXXI. Peculiarities of the Radial artery affecting the position of its origin . 216 PLATE XXXII. Peculiarities of the Ulnar artery affecting the position of its origin, and its course . 217 PLATE XXXIII. Peculiarities of the Interosseous artery affecting the position of its origin 218 PLATE xxxiv. The Axillary, and the Brachial arteries, divided into two branches, which re-unite or communicate one with the other at the bend of the elbow 220 PLATE xxxv. Various examples of " Vasa Aberrantia," extending from the Axillary, or Brachial arteries, to those of the fore-arm 221 PLATE XXXVI. FIGS. 1 & 2. Rare deviations of the Uluar artery. 1 FIGS. 3 & 4. Peculiarities of the Brachial artery. / PLATE XXXVII. FIGS. 1 & 2. Deviations of one of the two arteries representing the Brachial. All the figm'es illustrate peculiarities of the Muscles in the neigh- bourhood of the same artery 224 PLATE XXXVIII. Views of the anterior Arteries of the fore-arm and hand : their usual arrangement 305 PLATE xxxix. The deep Arteries on the anterior surface of the fore-arm and hand : their usual conformation 306 xii REFERENCE TO THE PLATES AND EXPLANATION. PLATE XL. PACK FIG. 1. The Arteries on the back part of the fore-arm and hand. FIG. 2. The Superficial Veins and Nerves in front of the elbow joint, and f 30 ? a small part of the Deep vessels and nerves. PLATE XLI. Views of the Superficial Veins in front of the elbow joint, in connexion with several variations of the arteries 308 PLATE XLII. FIGS. 1 & 2. The Arterial Branches anastomosing about the elbow joint. FIGS. 3, 4, & 5. Peculiarities of the Radial artery .... 309 PLATE XLIII. Peculiar forms of the Radial, Ulnar, and 'Interosseous arteries in the fore- arm and hand 311 PLATE XLIV. The Interosseous joins in different cases with the other two arteries of the fore-arm, and compensates for their small size . . . .312 PLATE XLV. FIG. 1. A rare form of Median artery. FIG. 2. A peculiar muscle connected with the Ulnar artery. FIGS. 3 to 6. Various states of the Superficial Volar and Palmar arteries. ies. J PLATE XLVI. Various conditions of the Arteries of the hand . . . . .315 PLATE XLVII. The Thoracic Aorta and the Intercostal arteries, with the Intercostal Veins, Vena Azygos, the Thoracic duct, &c., seen in connexion with the parietes of the thorax .338 PLATE XLVIII. The entire of the Aorta, with the branches springing from it. The Heart and the Vessels connected with it. The Coronary arteries . 339 PLATE XL1X. The Abdomen opened, and the Cseliac axis with its branches, viz., Coronary (of Stomach), Hepatic, and Splenic ... . 340 PLATE L. FIG. 1. The branches of the Cseliac axis more fully displayed. -i FIGS. 2 & 3. Some branches of the Superior and the Inferior Mesenteric 1 341 arteries : to show their arrangement as they approach the intestine J PLATE LT. The Superior Mesenteric artery and its branches 343 PLATE LII. The Inferior Mesenteric artery and its branches . . . . .343 REFERENCE TO THE PLATES AND EXPLANATION. xiii PLATE L1II. PAGE The Abdominal Aorta and the branches arising in its course. The Iliac arteries 344 PLATE LIV. The Abdominal Aorta. Some of its branches more fully displayed than in the preceding plate 345 PLATE LV. The Iliac arteries in connexion with the Veins . . . ... 346 PLATE LVI. Peculiarities of the Abdominal Aorta, and of some of its branches . 365 PLATE LVI I. Peculiarities of some of the branches of the Abdominal Aorta, and of the Iliac arteries 366 PLATE LVIII. FIG. 1. Unusual conformation of the Iliac arteries. -> FIGS. 2 to 10. Examples of peculiar dispositions of the large Veins of the Ls69 Abdomen and Thorax. J PLATE LIX. The Arteries distributed to the female Pelvic organs .... 372 PLATE LX. The Arteries of the Pelvis of the male 373 PLATE LXI. A view of the Arteries and other structures displayed in a superficial dissection of the Perineum ... . . . . 393 PLATE LX1I. A deeper dissection of the Perineum. The Pudic artery and the artery of the Bulb are shown 393 PLATE LXIII. FIG. 1. The Uterine and Ovarian branches. -\ H FIG. 2. The Pudic artery, and the branches of the Pelvic Viscera of the I 394 male fully dissected out. FIGS. 3, 4, & 5. Peculiar forms of the Pudic branches. J PLATE LXIV. Various forms of the Pudic branches seen in the Perineum . . . 397 PLATE LXV. FIG. 1. A peculiarity of one of the Pudic branches. FIGS. 2 & 3. Enlarged Veins of the Prostate Gland and Urinary Bladder. I 3Q9 FIGS. 4 to 7. Variations of the branches taking rise from the External J Iliac and Internal Iliac arteries. PLATE LXVI. FIGS. 1 , 2, and 3. Various conditions of the Obturator artery. "1 Fio. 4. The Epigastric in connexion with a Hernia. J xiv REFERENCE TO THE PLATES AND EXPLANATION. PLATE LXVII. PAGE The position of the Epigastric artery with reference to different kinds of Hernia illustrated 402 PLATE LXVIII. The various relations of the Obturator artery to different kinds of Hernia 403 PLATE LXIX. The Femoral artery, and its branches .463 PLATE LXX. A view of the Femoral artery, with the Veins, Nerves, and Fascia . 463 PLATE LXXI. FIG. 1. The Femoral artery, with Nerves and Veins more fully shown. 1 FIG. 2. Double Femoral artery. 3. 1 & 2 are supplemental to a former Plate, giving additional illus--^ tration of the peculiarities of the Epigastric artery, and of the I position of the Obturator in reference to Crural Hernia. FIGS. 3 to 6. Various forms of the Deep Femoral artery. PLATE LXXIII. Peculiarities of the branches of the Deep Femoral, especially the External Circumflex 466 PLATE LXXIV. The branches of the Deep Femoral further illustrated, and especially the Internal Circumflex 468 PLATE LXXV. Various forms of the Veins connected with the Femoral artery , . . 469 PLATE LXXVI. The Arteries on the posterior surface of the Pelvis , . . .471 PLATE LXXVII. The Arteries on the Pelvis more completely exposed than in the foregoing plate ; together with the termination of the Internal Circumflex and perforating branches. The Popliteal artery its upper part . . 472 PLATE LXXVI1I. FIG. 1. The Artery, with the Veins and Nerves of the Popliteal space. -j FIGS. 2 & 3. Different views of the Popliteal artery in its whole 1-472 length, and of the branches. J PLATE LXXIX. The Popliteal artery, and its peculiarities : 473 PLATE LXXX. Various arrangements of the Veins and the Muscles connected with the Popliteal artery 474 REFERENCE TO THE PLATES AND EXPLANATION. xv PLATE LXXXI. PAGE Views of the Arteries on the back part of the Leg : Popliteal, Posterior Tibial and Peroneal 500 PLATE LXXXII. The Anterior Tibial artery .... ... PLATE LXXXIII. FIG. 1. Part of the Posterior Tibial, with the Veins, Nerve, and Fascia-- exposed without removing any muscle. 1.501 FIG. 2. The Peroneal artery. FIG. 3. The Dorsal artery of the foot. PLATE LXXXIV. The Dorsal Artery of the Foot, and some peculiarities of the Posterior Tibial, and Peroneal ... 503 PLATE LXXXV. FIG. 1 . Unusual conformation of a Muscle over the Posterior Tibial. FIGS. 2 to 5. Different forms of the Anterior Tibial and Dorsal Artery of J-504 the foot. of I; PLATE LXXXVI. The Plantar arteries : their usual arrangement and some deviations from it 506 PLATE LXXXVII. The ordinary disposition of the Cerebral and Spinal arteries, and some peculiarities of the former 507 EXPLANATION OF PLATES. EXPLANATION OF PLATE I. THE body of which this plate is a representation was placed in the sitting posture, the head thrown back and inclined to the right side, the left arm raised and supported. The anterior wall of the chest was removed to a greater extent on the left than the right side, the heart and the lungs taken out, some of the muscles of the neck were cut away, viz. the sterno-hyoid, sterno-thyroid, and greater part of the sterno-mastoid. The pectoral muscles are seen to have been divided and their external attachments turned aside. By these means the arch of the aorta, its continuation in the thorax, and its large branches, were exposed. a Lower maxillary bone. b Submaxillary gland. c Digastric muscle. d Mylo-hyoid, the muscles of oppo- site sides are seen to join ; a lymphatic gland * has been acci- dentally allowed to remain. e Os hyoides. e l Hyoglossus muscle. / Thyroid cartilage. / Thyro-hyoid muscle. g Thyroid body. h Cricoid cartilage, from it are seen diverging upwards to the thyroid cartilage, the crico-thyroid mus- cles. i Trachea. j Pleura. k Clavicle. / Sterno-mastoid muscle. m Anterior scalenus. n Posterior scalenus. o Greater pectoral. p Smaller pectoral. q Biceps brachialis with coraco-bra- chialis to its inner side. r Subscapular. s Tendon of latissimus dorsi. s 1 Teres major. t Serratus magnus. v Bronchus of left side. w (Esophagus. x Sternum. 10 EXPLANATION OF THE SECOND PLATE. ARTERIES. J. Aorta. 2. Coronary. 3. Innominate. 4. Carotid. 5. Subclavian. 6. Beginning of axillary. 7. Internal mammary. 7*. Vertebral. 8. Thyroid axis. 9. Supra-scapular. 10. Superficialis colli. 10*. Posterior scapular. 11. Ascending cervical. 12. The largest of three thoracic branches. 13. Subscapular : from this artery branches are given to each side ; the largest, which is directed backwards, is the dorsal artery of the scapula. 14. The origin of the posterior cir- cumflex. 15. Superior-thyroid : from it the la- ryngeal is directed in wards beneath the thyro-hyoid muscle, and a su- perficial branch outwards over the carotid artery. 16. Lingual. 17. Facial : this artery, after emerg- ing from the submaxillary gland, is seen to give its submental branch, and then to turn over the maxillary bone. 17*. Occipital. 18. Internal carotid. 1 9. Left bronchial. 20. (Esophageal : below this is an- other, which is also an oesophageal branch ; it passed behind the oeso- phagus, and ramified in its sub- stance. EXPLANATION OF PLATE II. THE body from which this drawing was taken was placed on a chair in the sitting posture ; the left fore-arm happened to rest on the arm of the chair. The plate shows that a considerable part of the anterior wall of the chest has been removed, and the pericardium laid open to expose the heart and the great vessels. The large branches of these are shown in the neck by the removal of a part of the muscles attached to the sternum and clavicle. a Thyroid cartilage. b Sterno-hyoid muscle. c Sterno-thyroid. d Omo-hyoid. e Sterno-mastoid. / Scalenus anticus. g Thyroid body. 1. Aorta. 2. Right coronary. 2 1 . Branch of left coronary. 3. Innominate. h Trachea. i Trapezius muscle. k Clavicle. / Greater pectoral muscle. m Pleura. n Pericardium. ARTERIES. 4. Common carotid. 5. Subclavian. 6. Internal mammary. The artery of left side rests on a portion of EXPLANATION OF THE SECOND PLATE. 11 pleura, and is cut short. That of the right side has behind it the pleura, from which it is separated at the lower part of the thorax by some fibres of the triangularis sterni. From its outer side are given anterior intercostal branches : in- wards are sent two mediastinal arteries ; over the lowest exposed . rib is seen a perforating branch. The mammary artery is accom- panied below by two veins, by the junction of which is formed the single internal mammary vein. Supra-scapular. Transversalis colli. Pulmonary artery. VEINS. 10. External jugular of right side. It is joined near the clavicle by the supra-scapular and by the anterior jugular, part of which remains. 11. The anterior jugular, cut. This vein descended superficially to the sterno-hyoid and sterno-thyroid muscles, and crossing outwards beneath the sterno-mastoid, ended with the external jugular in the subclavian. 12. Internal jugular. The vein of the right side receives internally a middle thyroid vein, which is fre- quently present, though perhaps not usually so ; from without it receives a transverse vein, which comes from beneath the trapezius muscle, and usually ends in the external jugular ; this branch may be regarded as corresponding to the transversalis colli ar.tery. The internal jugular vein of the left side (12) is held aside to expose arterial branches which arise be- hind it. 13. The subclavian veins seen to join with the internal jugular and form the innominate veins (14) on each side. The innominate veins are unequal in length, and different in direction ; each of these veins receives from above at its commencement the vertebral vein, which is seen to cross the subclavian artery after coming from behind the vagus nerve ; on the right side the vertebral vein escapes from behind, also a portion of the fascia or sheath, which sepa- rates the large cervical vessels from the spine. The innominate vein of the right side receives the internal mammary of the same side close to its end ; that of the left side receives from the thyroid body two branches (inferior thy- roid), and from below two veins, which are represented cut ; of the latter, the branch next to the junction of the subclavian and in- ternal jugular veins, is the left internal mammary ; that which is nearer to the vena cava, and rests against the origin of the innomi- nate artery, is a mediastinal vein. 15. Vena cava. NERVES. 16. Vagus. The nerve of the right side sends its recurrent laryngeal branch behind the commencement of the subclavian artery. On the left side the vagus is seen to be directed down over the arch of the aorta, and below this to give two branches. Of these, one (the recurrent laryngeal) turns inwards against the ligamentum arteriosum, which, in consequence of the deep shadow in which the part lay, is indistinctly seen. The lower and smaller branch of the nerve is the anterior pulmonary ; the vagus itself is directed back- wards. 17. Phrenic. The nerve of the left side, after entering the chest, lies at a considerably greater depth than the internal mammary artery ; lower down it is seen between the pleura and pericar- dium, and turning round the point of the heart. 1 8. The nerves of the brachial plexus. 12 EXPLANATION OF THE THIRD PLATE. EXPLANATION OF PLATE III. THE integuments have been turned aside ; the platysma- myoides and cervical fascia, with the veins and the nerves, except those of the brachial plexus, are removed from the side of the neck. a The masseter muscle, covering the inferior maxillary bone; on it a branch of the facial artery is seen to ramify. b Parotid gland. c Digastric muscle. d Stylo-hyoid muscle. e Submaxillary gland. / Mylo-hyoid muscle : it is seen to join with the muscle of the oppo- site side above g. /* Hyoglossus muscle. g Hyoid bone. h Thyroid cartilage. * Omo-hyoid muscle : in this case the tendinous part of the muscle is very small, and is seen only at the upper margin of the muscle, immediately behind the sterno- mastoid. j Sterno-hyoid muscle. k Sterno-thyroid muscle. I Sterno-mastoid muscle. m Anterior scalenus muscle. n Posterior scalenus muscle. o Levator anguli scapulae. p Trapezius muscle. q Clavicle. r Larger pectoral muscle. s Deltoid muscle. ARTERIES. 1. Common carotid. 2. External carotid. 3. Internal carotid. 4. Superior thyroid ; its hyoid branch is seen to ramify in the muscles attached to the hyoid bone. 5. Lingual : this artery usually makes the curve represented here, before it becomes covered by the hyo- glossus muscle. 6. Facial : a branch (lower masse- teric) is shown on the masseter muscle ; the end of its submental branch is seen on the mylo-hyoid muscle, emerging from under the anterior belly of the digastric. 7. Occipital : a small artery (sterno- mastoid) given off with the occi- pital, is directed back to the sterno-mastoid muscle. 8. Subclavian. 9. Supra-scapular : a branch of this artery supplies the muscles above the inner end of the clavicle. 10. Superficialis colli. 1 1 . Posterior scapular. NERVES. 12. Brachial plexus. The common carotid artery, which in the lower part of the neck is covered by the omo-hyoid, sterno-thyroid, sterno-hyoid, and sterno-cleido mastoid, is at its upper part exposed, by EXPLANATION OF THE FOURTH PLATE. 13 reason of the divergence of the muscles towards their superior attachment. The vessel just named, with the two into which it divides, (external carotid and internal carotid,) with the commencement of some of the branches of the former (superior thyroid, lingual, facial, and occipital), are seen to lie in a triangular space, the sides of which are formed by the sterno- mastoid, the omo-hyoid, and digastric muscles. This triangle and those elsewhere noticed, are apparent only in the dissected neck, and they are referred to in this work not because of any real or practical importance attached to such modes of descrip- tion, but in deference to the practice of writers of anatomical works. At the lower part of the neck is another triangular space, bounded by the clavicle, the omo-hyoid muscle, and the sterno-mastoid or anterior scalenus. In this, the subclavian artery is seen to lie with the anterior scalenus muscle to its inner side, and the brachial plexus of nerves to its outer side. The arteries which cross the neck between the trapezius and sterno-mastoid muscles have important relation to operations performed on the subclavian artery, and will be again referred to in treating of that artery and its branches. EXPLANATION OF PLATE IV. NEARLY the same view of the carotid artery and its branches is given in this plate as in the preceding ; but here it is seen in relation with the veins, the nerves, and the fascia of the neck. a Masseter muscle, at the anterior margin of which the facial artery is seen after escaping from under the submaxillary gland, to wind upwards over the lower maxillary bone. b Parotid gland, partly covered by cer- vical fascia. d Digastric muscle. e Submaxillary gland. / Cervical fascia. g Sheath of the vessels. h Sterno-mastoid muscle. i Thyroid cartilage. j Omo-hyoid muscle. k Sterno-hyoid muscle. I Sterno-thyroid muscle. 14 EXPLANATION OF THE FOURTH PLATE. 1 . Common carotid artery. 2. Internal carotid. 3. External carotid. 4. Internal jugular vein. 5. Vagus nerve. 6. 9th or hypoglossal nerve. 7. Junction of the descending branch of 9th or hypoglossal nerve (n. descendens noni.) with a branch from the cervical nerves. The form of the union between these nerves varies in different bodies. In that of which this plate is a representation, two cervical nerves united into a single branch, which is seen to turn round the internal jugular vein, and join with the branch descending over the carotid artery from the ninth. FIG. 1. On turning aside the integuments and the platysma-myoides, a portion of which (latter) remains upon the inferior maxilla and below that bone, the cervical fascia is seen to cover the sterno-hyoid, sterno-thyroid, and omo-hyoid muscles, and to encase the lower part of the sterno-mastoid. The same membrane binds into its place the parotid gland, on which a portion has been left. The " sheath of the vessels " covers the artery, vein, vagus nerve, and in this case also the branch descending from the ninth nerve, together with that which joins it from the cervical nerves. The smaller veins and arteries, which branch out over the upper part of the common carotid, are a source of difficulty in the operation for placing a ligature on that vessel in this situation. In some cases the number of veins is greater than here represented, so as occasionally to amount even to the condition of a plexus ; and the difficulty from this cause is proportionably increased. FIGS. 2 AND 3. The second and third drawings show peculiarities of the veins ; in the former, the internal jugular covers the common carotid artery to such an extent that the vein must, in such a case, have been turned aside, in order to expose the artery. In the latter, the large vein covers the common carotid at its bifurcation, and an additional vein of smaller size (anterior jugular) is seen to the inner side of the artery. The anterior jugular vein, which is frequently found, is sometimes close to the middle line, and is occasionally joined to the EXPLANATION OF THE FIFTH PLATE. 15 external jugular by transverse .communicating branches. After turning outwards at the lower part of the neck between the sterno-mastoid and the muscles beneath it, the anterior jugular ends in the subclavian vein, or in the external jugular. (See plate 2). FIG. 4. In this sketch the vagus nerve lies over the carotid artery. The caution suggested to the surgeon by this position of the nerve is obvious. EXPLANATION OF PLATE V. ARCH OF THE AORTA. THE same parts are marked with the same letters or numerals in all the figures of this plate. a The heart. b Trachea. c Bronchus. d (Esophagus. ARTERIES. 1. Arch of Aorta. 2. The descending part of Aorta. 3. Innominate. 4. Right carotid. 4 1 . Left carotid. 5. Right subclavian. 9. Innominate of right side. 9 1 . Innominate of left side. 10. V. Azygos. 5 l . Left subclavian. 6. Right external carotid. 6 1 . Left external carotid. 7. Right internal carotid. 7 1 . Left internal carotid. 8. Pulmonary. VEINS. 11. V. Cava superior. 12. Hepatic veins. Some of the peculiarities of the arch of the aorta are illus- trated in this plate. POSITION OF THE ARCH. The most frequent changes of the arch, independently of slight varieties of shape, take place in its position with reference to the upper part of the walls of the chest. Its top or highest part is usually somewhat less than an inch from the upper margin of the sternum. 16 ARCH OF THE AORTA POSITION. Figure 1 is taken from a body in which the arch was exactly opposite the interval between the first and second dorsal ver- tebrae, and but a little below the level of the top of the sternum. In Figure 2 the arch is seen to be deeply placed in the chest ; its upper margin being as low as the middle of the fourth vertebra. In the first case the innominate artery rose high into the neck. In the second, that artery divided within the chest, and the subclavian artery too, lay within that cavity, from which it ascended perpendicularly and close to the carotid. The cases delineated may be considered as oppo- site extremes, between which there are many intermediate degrees. (See table.) The influence of the position of the arch of the aorta here referred to on the accessibility of the innominate artery in a surgical operation, and on the size which aneurism of the aorta directed upwards would attain before making its appearance at the bottom of the neck, is so obvious as not to require comment. In the notes taken of the condition of the arch of the aorta it is stated in many cases that its position is higher and in others that it is lower than usual. The exact distance was ascertained in but a few cases, which are here subjoined Distance in inches between the Distance in inches between the No. highest part of the arch and the top of the sternum. No. highest part of the arch and the top of the sternum. 53 1| 96 i 58 98 59 1* 117 H 67 1 121 73 u 142 nearly 3. 74 f 249 ( nearly on a level with 80 4 I sternum. 89 $ nearly on a level with \ top of sternum. 250 ^ arch opposite middle I of 4th dorsal vertebra. 90 262 H 91 1 272 H 92 3 289 94 f ABSTRACT OF THE TABLE. Cases, in which the highest part of the arch was distant less than 1 inch from the upper margin of the sternum . . . .11 1 inch, not exceeding 1 9 more than l 2 RELATION TO THE STERNUM UNUSUAL DIRECTION. 17 RELATION OF THE ARCH TO THE POSTERIOR SURFACE OF THE STERNUM. The ascending part or right side of the arch, it is well known, is separated by only a small interval from the sternum. The following fact may be mentioned as illustrative of this point : In some bodies in which the arteries had been injected from the abdominal aorta, the ascending part of the arch was found to be slightly flattened in nearly its whole length, doubtless in consequence of pressure against the sternum, while the injection became solid. The artery did not appear to be unusually distended, though it must have been so in some degree, and there was not any perceptible change of the shape of the arch. UNUSUAL DIRECTION OF THE ARCH. Figure 3 is drawn from a preparation in the Museum of University College, taken from the body of a person who was condemned to death for arson. It shows the arch of the aorta and the large veins in the state which accompanies transposition of the viscera. The aorta curves to the right side, turning over the root of the right instead of that of the left lung, at the same time that the vena azygos has suffered a similar change from the right, its usual course, to the left side*. In Figure 4, taken from a preparation in the Museum of St. Bartholomew's Hospital ( ; the aorta corresponds in its dispo- sition to the preceding case, but the vena azygos, instead of being of the usual size, is here continued from the inferior cava. A full description of this case has been published by Mr. McWhinnieJ, who says of the veins "A remarkable * Cases of this kind are not very uncommon. This, however, is the only one observed in University College amongst 930 bodies. For a drawing of another case, which occurred in the "Westminster Hospital, I am indebted to my friend Mr. Thurnam. t The permission to have this and some other draAvings made from preparations in the same museum, I owe to the kindness of Mr. Paget. A case of transposition of the thoracic and abdominal viscera, accompanied with an unusual variety in the venous svstem. London Medical Gazette, 27th March 1840. 18 ARCH OF THE AORTA feature in the case is the disposition of the vena cava inferior, which after being formed by the union of the common iliac veins (in this instance as high as the first lumbar vertebrae), and receiving the lumbar, renal, spermatic, and phrenic veins, entered the chest through the diaphragm, close to the left of the aortic opening. From this point it continued to ascend parallel with and to the left of the aorta, and arriving on a level with the arch of this vessel, curved forward over the left pulmonary vessels to join the vena cava superior. 1 " " The vense cavse hepaticse united to form a trunk, which entering the chest through the left of the tendinous centre of the diaphragm, terminated separately in the reversed right auricle." FIG. 5. Cases are recorded by Abernethy*, Fiorati*)*, Sandifort^ Cailliot, J. F. Meokel||, BernhardU, Otto**, and others, in which the aorta arched over the right bronchus with the vena azygos, (see fig. 5, and plate 7, fig. 1 & 3,) and after- wards resumed its usual situation on the vertebrae. This con- dition contrasts with that illustrated in the two preceding figures, in this respect, that the aorta and vena azygos are here side by side, whereas in the cases alluded to in the preceding sections these vessels are transposed or change places one with the other. The aorta, in some of the cases above referred to, after turning over the bronchus speedily inclined to its usual situa- tion on the bodies of the vertebrseff, in others the inclina- * Account of two instances of uncommon formation in the viscera of the human body. Philosophical Transactions, 1793, p. 59. "I" Osservazione Anatomica del Signer Girolamo Fiorati. Tnsolita posizione dell' Aorta e Stravagante origine de' suoi primi rami in Saggi scientific! e letterari dell' Acad. diPadova,1786. J Museum Anatom. torn. 1, partes molles morbosse, p. 79. Extrait de trois Observations, &c. in Bulletin de la Faculte de Medecine de Paris, torn. i. 1812. [| Handbuch der Pathologischen Anatomic, zweiter Band, erste Abtheilung, s. 97, Leipzig 1816. ^| De Arteriarum e Corde prodeuntium aberrationibus. Berolini, 1818. ** Seltene Beobachtungen. Th. 2, s. 61. "f"f After describing the curve of the arch over the right bronchus, Mr. Abernethy continues, " The aorta afterwards pursued its ordinary course." In the account of one of Cailliot's cases it is said, " L'aorte embrassait dans sacourbure la bronche droite et passait derriere 1'extremite inferieure de la trachee artere, pour aller gagner le cote gauche de la colonne vertdbrale." UNUSUAL DIRECTION. 19 tion to the left side occurred considerably lower down*, but in every instance the vessel appears to have gained its ordinary position before reaching the abdomen. It is mentioned by Otto, a learned anatomist and acute observer, in his statement of the examination of the body before referred to, that on directing attention to the vertebral column at the upper part of its dorsal division, he found the convexity of the slight lateral curve which exists in that situa- tion directed to the right side, i. e. towards the point at which the arch of the aorta was applied to the vertebrae. This fact militates against the opinion that the inclination of the spine is referable to the action of the heart and the contact of the large artery, and affords an argument scarcely perhaps needed, in favour of the influence of muscular action, as the cause of the deviation in question, a view which gains further support from the additional observation that the right arm was more muscular than the left. In Mr. Abernethy's case, which was that of a foetus at the usual period of birth, the condition of the vena azygos requires notice. In the figure (No. 5) which has been sketched from the preparation preserved in St. Bartholomew's Hospital, the vena azygos is seen to be of unusual size : it continued from the vena cava inferior as in the case delineated in fig. 4, from which, however, it differs in its relation to the aorta and to the bronchus. In his account of the case, Mr. Abernethy says, " The situation of the heart was reversed, the basis of that organ was placed a little to the left of the sternum, whilst its apex extended considerably to the right, and pointed against the space between the sixth and seventh * Bernhard follows up his account of the course of the arch over the right branch of the trachea thus : " Turn pone dextrutn ramum arterise asperse in latere dextro ver- tebrarum corporum descendit, quo in situ vena quoque azyga, ut solet, huic ad dextrum posita erat et oesophagus ad sinistrum latus, ita tamen, ut ilia simul ante earn positus esset. Denique in regione septimce vel octaves dorsi vertebras sinistrorsum inclinata in decursu solito per hiatum aorticum in cavum abdominis descendit, in quo a normali positura haud amplius recessit." Lib. cit. 7. Aorta jam inde a basi cordis egressa, solitumque emensa spatiura, versus dextras in arcum sese flectens progrediebatur, ita ut truncus ejus descendens latus fere dextrum vertebrarum legeret, usque dum, e diaphragmate in abdomen emergens, sinisterius, quemadmodum assolet, se converteret. Aglietti in Sandifort loco citato. Of the same caseFiorati says, " Cosi seguia suo cammino, che non mi parve importante di far desegnare,./mo all 'ultima vertebra del dorsonel qual sito inclinandosi a sinistra prendeva il suo posto ordinario," &c. In Otto's case the artery did not incline to the left side till it approached the Diaphragm. c 2 20 ARCH OF THE AORTA ribs. The cavities usually called the right auricle and ventricle were consequently inclined to the left side of the body. The inferior vena cava passed as usual through a tendinous ring in the right side of the centre of the diaphragm, it afterwards pursued the course of the vena azygos, the place of which it supplied, &c. The veins returning the blood from the liver united into one trunk which passed through a tendinous aperture' in the left of the centre of the diaphragm, and terminated immediately in the anterior auricle." UNUSUAL CONFORMATION OF THE COMMENCEMENT OF THE AORTA. FlGS. 6 AND 7. The arrangement of the great artery represented in these drawings has been very rarely met with in man, though it corresponds to that which is usual in many mammalia. The case here delineated was observed by Klinz * in the body of a young soldier, Paul Markow, who appears to have been healthy up to the period of being attacked with an acute inflammatory disease of the chest, which caused his death. In Figure 6, the aorta, without forming an arch, divides into an ascending and a descending branch. The former was directed vertically upwards to the length of four inches, and then divided in form of a cross into three principal branches. The right horizontal branch is the innominate, and from it arose the right carotid artery. The perpendicular branch became the left carotid, and the left horizontal one is the left subclavian. J. F. Meckel, in noticing the case, remarks on the vertical direction of the heart, seeming to consider this circumstance as an additional approximation to the state of the organs in lower animals *f. This fact may, however, be reasonably attributed to the accumulation of fluid found in the left cavity of the chest, which is stated in the report to have been so great as to have forced the mediastinum towards the right side. In the same manner may the condition of the left pulmonary * In Abhandlungcn der Josephinischen Med.-Chirurg. Acad. zu Wien. Band 1, S. 271, 1787. f Merkwtirdig ist dabei, dass auch das Herz, wiebei den meisten Thieren, senlcrecht stand. Handbuch der Pathol. Anat. Band 2, S. 94. UNUSUAL CONFORMATION. 21 artery be accounted for. That branch is not delineated in the plate (Fig. 7), and it is said to have been absent, as well as all trace of the lung and the bronchus. But it is highly pro- bable that these parts were merely so compressed and altered by the disease, (pleurisy) as not to have been recognised. An example of similar conformation of the aorta was found by M. Troussieres in the body of a child aged five years. The account given of the appearances sets forth that the vessels were in their usual situation, except that the aorta did not form an arch, but divided into two large branches at three fingers 1 breadth from the origin *. In dismissing this curious disposition of the aorta, it may be observed that the contemplation of it is calculated to recall to mind the origin of the terms " ascending" and " descend- ing" aorta. These words were introduced into anatomical language at a time when the systemic artery was supposed to divide, as shown in Fig. 6, into two parts, which took opposite directions, and were properly named ascending and descend- ing. The idea of the form of the aorta was then taken, as is generally known, from its state in quadrupeds ; but the terms were retained even when the error as to the fact had been removed. As an evidence of the late origin of correct anatomical knowledge, it is worthy of remark to how advanced a period of the history of mankind the error alluded to con- tinued. Even the great leader in the regeneration of anatomy, who observed so much and so well, and removed so many errors, delineated and described the aorta as dividing into two parts f. The modern understanding of the words applied to the right and left sides of the aortic arch is well stated by Ruysch J ; but the real condition of the artery in the human body had been known before that distinguished anatomist wrote. * The examination of the body was made *' par M. Troussieres maistrc chirurgien, en presence de Messieurs Gamier et Spon, Docteurs en Medecine." Extrait d'line lettre ecrite de Lyon, 4 Nov. 1667, in Le Journal des Sgavans, 1668. Nouv. Edit. a Paris, 1729. f" Postquam vero magna arteria coronales deprompsit, k cordis basis centro sursum quodauimodo sub venae arterialis caudice conscendit : ac cordis involucrum perforans, bipartite scinditur, &c. Andrese Vesalii Opera oin. Anat. et Chirurg. cap. xii. J Ita ut Aorta proprie; in duos truncos k natura haud sit divisa, unus idemque truucus ascendens et descendens : siquis tamen hanc aortam, quatenus ascendit, ascen- dentem, et quatenus descendit, descendentcm nominare velit, nonrenuam. Rcsponsio ad eruditum Dnum Johannem Gaubium 1695. 22 ARCH OF THE AORTA FIG. 8. Hommel, who had been the assistant of Haller *, described the very remarkable preparation represented in this figure, and gave a delineation, from which this is copied, with the omission of the heart and right lung, which are shown in the original drawing. " The aorta," says the author, " divided at the beginning of the arch (at the beginning of that which is called the transverse part of the arch ?), and was again united at its end. Through the sort of island constructed by the bifurcation pass the trachea and oesophagus ; a disposition, he correctly adds, perhaps never previously observed *f*. FIGS. 9 AND 10. These are taken from drawings given by Malacarne J, of a variety found in the body of an old man, and of which he has published a detailed account. The aorta arose by a single trunk, which was of large size, and contained five valves. At the distance of three lines and a third from the base of the heart, and after having given off the coronary arteries, it divided into two unequal parts, by the reunion of which the descending aorta was formed . From the two lateral vessels arose the cervical arteries, which presented the remarkable pecu- liarity that, instead of an innominate, and a common carotid artery, the external and internal carotids of both sides were given separately from the aorta. On each side three branches are seen, of which the first is the subclavian, the second the external, and the third the internal carotid artery. The course of the two carotid arteries in this case will be reverted to when the vessels of that name are specially under con- sideration. Deviations from the usual conformation of important parts of the circulating system, so remarkable as those represented in the several figures which have here been passed in review, are calculated to suggest to every inquiring mind the question in what manner is their occurrence to be accounted for ? or how are they produced ? * Optimus Hummel meus olim Bernse incisor. Haller Elem. Physiol. t. 2, p. Ifi2. f Comnaercium literarium. Hebdom 21. Norimbergse 1737. J Delle osservazioni in chirurgia &c,, parte 2, 119. UNUSUAL CONFORMATION. 23 The investigations of anatomists have shown that the vessels, after their first appearance in the embryo, undergo a series of changes which lead to that which is considered their ordinary or natural condition, and that the variations from that condition are for the most part referable to an arrest or deviation in the process of change. To demonstrate this by a series of instances, or rather to trace the changes which take place in the various phases of development, and to connect these with such aberrations as those referred to in the foregoing pages, would be an object of the highest interest. It is, however, one which would require much research, and would perhaps properly form matter for separate investigation. It is, moreover, altogether beyond the limits of practical utility, within which it is proposed to circumscribe this work. A few remarks may, however, be made on the subject as regards some of the peculiarities of the aorta and great vein, seen in the figures of plate 5. As regards the aorta at an early period of existence branches are given to each side from the parent vessel, which after embracing the trachea and oasophagus, meet at the vertebrae and constitute a single vessel, being analogous at this period to the permanent condition in fishes and reptiles. In the usual course of development one of these vascular arches on the left side forms the aorta, the others, with the exception of that connected to the pulmonary artery, being wholly or partially obliterated. To the persistence of a branch on both sides may the arrangement of the great artery in figures 8 and 9 be referred. The state represented in figure 5, in which the aorta turns to the right side, may be conceived to result from the con- tinuance of a branch on that, the right side, the usual one on the left being removed. It may be observed that the direction of the aorta over the right bronchus is that usual in birds. Lastly, in the great size of the vena azygos, as seen in figures 4 and 5, may be recognised the continuance of that which, in the first periods of development, is the chief vein of the trunk. 24 EXPLANATION IN REFERENCE TO THE TABULAR VIEWS OF THE ARTERIES. The number in the first column marks the same body in all the tables ; so that the condition of all the arteries of any body, at least of all those noted, may be ascertained by reference to its number in the different tables. The name, age, and sex, are not included except in the first table that of the arch of the aorta but by means of the number and a reference to that table these particulars may be ascertained for any other artery. In every instance in which the condition of the vessel has happened not to be noted, the number of the body is omitted, except in the case of the arch of the aorta, in which the number is retained because of its connexion with the name, age, and sex, in that table. EXPLANATION CONCERNING THE TABLE OF THE BRANCHES OF THE ARCH OF THE AORTA. By the statement that the branches presented the usual arrangement, is im- plied that they were three in number : viz. Innominate, Left Carotid, and Left Subclavian ; that these arose from the middle or highest part of the arch or nearly so ; that the Left Carotid was somewhat closer to the Innominate than to the Left Subclavian. Slight deviations from the disposition here described have not been considered sufficient to justify any special notice. The foregoing condition of the branches, for shortness' sake, is generally indicated by the word " usual. 1 ' The following are some of the abbreviations made use of : Br. Branch ; R. Right ; L. Left ; fr. from ; trans, transverse. The names of the vessels are for the most part shortened by the omission of some of the last letters, thus : Car. stands for Carotid ; Vert, for Vertebral \ and so in other cases. ARCH OF THE AORTA. BRANCHES. No. Name. d GO Age. Number and Arrangement of the Branches. No. Name 1 Age. Number and Arrangement of the Branches. 1 M G f. 41 J" 2 Brs. (L. Car. fr. lower \end of Innom.) 16 PO m. 40 Usual. 17 A M m. 59 2 JC m. 63 f 2 Brs. , same arrange- \ ment as No. 1 . 18 SH f. 81 Usual. 3 PP m. 61 Usual arrangement of Brs. 19 JK m. 72 Usual. 4 ER f. 84 Usual. 20 WH m. 47 Usual. 5 JL m. 72 Usual. 21 A B f. 85 4 Brs. (L. Vert. fr. arch.) 6 M N f. 52 Usual. 22 MW f. 54 7 S T f. 60 Usual. 23 EO f. 92 8 M A f. 40 Usual. 24 M M f. 23 Usual. 9 SS m. 45 J2 Brs. (L. Car. fr. glower end of Innom.) 25 MP f. 75 Usual. 26 MH f. 75 Usual. f~'2 Brs. close together 10 EC f. 73 I and given fr. : R. end | of trans, part of Arch 27 M B f. 40 Usual. l^(L. Car. fr. Innom.) 28 CH f. adult [firs, arise fr. R. curve 29 CB f. 83 Usual. 11 AC f. 64 < of arch, and lower than [ usual. ("Brs. take origin fr. R. 30 HW f. 60 < end of trans, part of arch, 12 CB f. 80 Usual. |_and lower than usual. 13 MR f. 50 Usual. 31 AW u. 18 14 JH m. 60 Usual. 32 MM f. 78 Usual. 15 JG 111. 50 {Brs. spring fr. R. curve of arch, and lower than 33 EH f. 30 Usual. usual. 34 MF f. 50 J L. Car. at origin very \ close to Innom. ARCH OF THE AORTABRANCHES. No. Name. 1 Age. Number and Arrangement of the Branches. No. Name. I Age. Number and Arrangement of the Branches. 35 M S f. 68 59 WL m. 77 Usual arrangement of Brs. 36 WL in. 69 Usual arrangement of Brs. 60 DF m. 40 Usual. 37 M K f. 66 Usual. 61 N A m. 50 Usual. 38 W L in. 53 Usual. 62 JS m. 51 39 RK m. 45 Usual. {Brs. spring from R. end 63 ww m. 60 of trans, part of arch 40 C H m. 26 Usual. and close together. about {3 Brs. unusually arrang- 64 m. 50 Usual. 41 CC f. 50 ed (1st. Coin, trunk of Carotids. 2nd. L. Sub- clav. 3rd. R. Subclav.) 65 SB f. 35 T2 Brs. (L. Car. from \ beginning of Innom.) 42 EC f. 58 {3 Brs. unusually arrang- ed (1st. Com. trunk of Carotids. 2nd. L. Sub- 66 M N f. 57 J" Brs. arise fr. R. end of \ trans, part of Arch. clav. 3rd. R. subclav.) 67 M A f. 18 2 Brs. (L. Car. fr. Innom.) 43 J M ru. 81 Usual. 68 J K m. 62 44 MP f. 25 2 Brs. (L. Car. fr. Innom.) T4 Brs. (L. Vert. fr. 69 JM m. 22 < arch and runs superf. 45 J J in. 20 2 Brs. (L. Car. fr. Innom.) |_to the Infer. Thyroid.) 46 SE ID. 56 Usual. 70 TC m. 70 47 WD 111. 43 Usual. 71 we 111. 52 48 A J f. 18 Usual. /Brs. arise fr. R. end of J trans, part of arch and 49 J T m. 20 72 A H f. 66 < close one to the other. I Left Innom. vein crosses /Brs. given from R. end V. them higher than usual . 50 in. adult 1 of the trans, part of arch I and close as possible. L. 73 WW m. 70 Usual. V.Subclav. very oblique. 51 SB f. 65 Usual. 74 C B f. 60 J" L. Car. very close to \ Innom. at origin. 52 ES f. f L. Car. at origin is very |_close to Innom. 75 A T in. 60 Same as No. 74. 76 EM f. 47 Usual. 53 T D in. Usual. 77 A A f. 52 Usual. 54 VVR in. 66 Usual. 78 D C in. 46 Usual. 55 G S in. 30 Usual. 79 JH in. 65 56 MR f. 76 80 CN in. 27 Brs. equidistant at origin. 57 M C f. 85 4 Brs. (L. Vert. fr. arch.) 81 ET f. 76 Usual. 58 M K f. 31 Usual. ARCH OF THE AORTA: BRANCHES. 27 No. Name. 3 ^ Number and Arrangement of the Branches. No. Name. 1 Age. Number and Arrangement of the Branches. 82 JN m. 72 f L Car. touches Innom. \at origin. 104 GL m. 50 Usual. 105 E W m. 19 2 Brs. (L. Car. fr. Innom.) {2 Bra. (L. Car. fr. In- 83 EP in. 60 noui.) given fr. R. end 106 JD f. 80 Usual. of trans, part of arch. 107 C M f. 75 84 MR f. 36 J2 Brs. (L. Car. fr. \beginning of Innom.) 108 GP m. adult 85 W F ra. 63 109 JL ru. adult 86 M B t 48 {2 Brs. (L. Car. fr. In- nom.) given fr. beginning of trans, part of arch. 110 EF f. 70 J L. Car. very close to \ Innom. at origin. 111 EH f. 58 Usual. 87 EC f. 40 88 E R f. 68 Usual. 112 MS< f. 83 f L. Car. very close to \ Innom. at origin. 89 T f. 40 f L. Car. joined to Innom. \at origin. 113 J W m. 48 Usual. 114 H M m. 30 Usual. fBrs. take origin to R. 90 JR m. 85 ) of usual situation and j below the highest pail 115 J A in. 18 Usual. i^of arch. 116 P R m. 67 Usual. 91 SB m. 45 117 JS m. 30 Usual. fBrs. very close, and 118 PL m. 29 Usual. 92 E T f. 81 < their origin is to R. of [usual position. 119 E Y f. 49 ("Brs. arise to R. of usual 120 SC f. 45 Usual. 93 MM f. 42 < position, and lower on L the arch than ordinary. 121 ss f. 32 Usual. 94 J K m. 55 Usual. 122 WR ni. 66 Usual. 95 MH f. 28 123 WM in. 68 96 H V f. 60 Usual. 124 CR f. 76 Usual. 97 ES m. 27 Usual. 125 J W in. 57 98 M B f. 76 126 J W m. 48 99 AF f. 85 Usual. 127 CH f. 35 Usual. 100 CB m. 26 Usual. 128 H C in. 44 101 M G 79 Usual. {Brs. are given from R. end of the trans, part 102 WJ m. 75 129 EH f. 64 of arch, and the origins of Innom. and L. Car. 103 AW f. 45 f L. Car. joined to Innom. \ at origin. are lower than usual and close together. 28 ARCH OF THE AORTA BRANCHES. No. Name B V) Age. Number and Arrangement of the Branches. No. Name. 1 Age. Number and Arrangement of the Branches. 130 J D m 61 Usual. fBrs. given fr. R. end 131 RC m 51 f L. Car. very close to \Innom. at origin. 151 JT m. 69 J of trans, part. L. Car. 1 and Innom. joined at {_ origin. 132 J T w 82 152 SH m. 38 Usual. 133 RH m 30 153 J A m. 70 134 EC m 66 Usual. 154 MM f. adult 135 AC f. 89 Usual. 155 DC m. 70 f L. Car. and Innom. (_ joined at origin. 136 W J in. 40 Usual. 156 ET f. 35 Usual. (4 Brs. the Carotids I and Stibclavians arise 157 C D m. 38 137 JN f. 56 { separately from arch j R. Subclav. given from (3 Brs. unusually arrang- ^descending part of aorta. 158 AF f. 56 1 ed (1st. Com. trunk of \ Carotids. 2nd. L. Sub- 138 M B m. 75 Usual. V clav. 3rd. R. Subclav.) TBrs. arise close together 159 M L f. 60 2 Brs. (L. Car. fr. Innom.) 139 A C f. 63 J fr. right end of trans. j part, and lower than {L. Vert, and L. Sub- ^ usual on arch. 160 m. adult clav. rise in conjunction fr. arch. 140 M L f. 68 161 H H f. 73 141 W B m. 66 r 142 SM f. 81 Usual. 162 CS f. 22 f L. Car. very close to \ Innom. at origin. 143 TG m. 72 163 M S f. 70 J Brs. derived fr. R. end \ of trans, part of arch. ;Brs. arise fr. R. end of 144 MC f. 80 trans, part of arch. \Innom. and L. Car. 164 M N f. adult joined at origin. 165 SL f. 93 Usual. I" Brs. very close and arise 166 E W f. 91 Usual. 145 WN U1. 59 1 fr. R. end of the trans. 146 m. 55 [part of arch. 167 JL f. 50 f Brs. fr. R. -end of trans. \ part of arch . 168 AF f. 30 (" Considerable and equal 147 M J f. 19 < spaces between Brs. at 169 EC f. 63 Usual. (_ their origin. 170 AC f. 34 148 EC f. 60 149 MB f. adult 171 A R f. 54 f Brs. arise fr. R. end of \ trans, part of arch. {Brs. spring fr. R. end of fBrs. close and given fr. 150 SF f. 54 the trans, part of arch, 172 SD f. 31 < beginning of trans, part and very close together. [of arch. ARCH OF THE AORTA BRANCHES. 29 No. Name. 1 Age. Number and Arrangement of the Branches. No. Name. 1 Age. Number and Arrangement of the Branches. 173 JS n. 56 {Brs. close, and given fr. beginning of trans, part 195 D D m. 41 2 Brs. (L.Car. fr. Innom.) of arch. 196 F W in. adult Usual. 174 ww n. 65 {Brs. arise fr. beginning of trans, part of arch. 197 T P m. 20 175 MW n. 36 198 RN m. 41 {L. Car. close to Innom. at origin. 176 AS f. 38 Usual arrangement of Brs. 199 J B in. 61 Usual. 177 w c D. 30 J 4 Brs. equidistant at \ origin (L.Vert. fr. arch.) 200 JD m. 43 Usual. 201 MH f. 40 Usual. 178 MW f. 33 2 Brs. (L. Car. fr. Innom.) 202 WO m. 32 Usual. /'Arch broad, trans, part 179 HG f. 33 j long and straight L. | Car. very close to Tn- 203 SB f. 69 {2 Brs. given fr. R. end of trans, part of arch V^nom. at origin. (L. Car. fr. Innom.) 180 M R f. 52 f Brs. given fr. R. end of \ trans, part of arch. 204 JC m. 60 Usual. 205 SE f. 65 Usual. [" Brs. fr. R. end of trans. 181 J B rn. 55 < part. Much of arch to 206 MM f. 60 Usual. [left of L. Subclav. 207 JH m. 68 Usual. 182 J J in. 50 Usual arrangement of Brs. 208 SR f. 68 Usual. 183 CF f. 52 Usual. /'Brs. take origin fr. R. 184 WH m. 54 Usual. 209 EM f. 80 I end of trans, part of \ arch much of it to their 185 JB f. 18 fL. Car. at origin very \ close to Innom. (jeft. 210 M F f. 29 186 EH f. 18 L. Car. close to Innom. 211 EH f. 45 Usual. 187 E N f. 73 f Brs. arise fr. R. end of \ trans, part of arch. 212 JE in. 59 188 M C f. 55 Innom. takes origin much lower than usual, 189 TS m. adult and at nearly 1 inch 190 M D f. 60, 213 JE m. adult dist. from L. Car. The latter and L. Subclav. rise close together fr. 191 RK m. 68 {2 Brs. given fr. R. end of trans, part of arch. middle of trans, part of arch. (L. Car. fr. Innom.) 214 AH f. 51 Usual. 192 S W f. 46 Usual. 215 T T tn. 18 Usual. 193 ES f. 37 Usual. 216 MB f. 81 Usual. 194 JC m. 46 Usual. 30 ARCH OF THE AORTABRANCHES. No. Name I Age. Number and Arrangement of the Branches. No. Name I Age. Number and Arrangement of the Branches. ("L. Car. at origin close 242 TB m. 55 Usual. 217 TH m 60 < to Innom., widely sepa- [ rated fr. L. Subclav. ("Brs. arise fr. R. curve 243 JC m. 58 < of arch, and lower than 218 SS f. 50 Usual. |_ usual. 219 J W m. 29 Usual. 244 J L m. 64 220 J C m. 70 I* Brs. given fr. mid. of a \long trans, part of arch. 245 WF m. 60 246 S W f. 37 221 JF m. 2 2 Brs. L. Car. fr. Innom. 247 S W f. adult Usual. 222 SS f. 18 Usual. 248 EW m. 35 Usual. 223 MU m. 28 Jsual. 249 M M f. 40 Usual. 224 WG m. 25 250 J H m. 60 2 Brs. (L. Car. fr. Innom/ 225 H K f. 20 Brs. equidistant at origin. 226 EB m. 70 251 AL f. 64 f L. Car. slightly joined \ to Innom. at origin. 227 M T f. 80 252 JB f. 24 Usual. 228 EK f. 59 Usual. 253 WH m. 71 Usual. 229 AD f. 50 254 TL m. 75 Usual. 230 J L m. 57 Brs. equidistant at origin. 255 M J f. 71 f Brs. arise fr. R. end of L trans, part of arch. 231 TB n. adult Usual. 256 M H f. 6 Usual. 232 JB in. 48 257 T M m. adult Usual. 233 EB f. 60 Brs. equidistant at origin. 234 ER f. 50 ("& Brs. unusually arrang- J ed (1st. Com. trunk of \ Carotids. 2nd. L. Sub- 258 259 MK HC f. f. 70 64 / Brs. fr. R. curve of arch, \and lower than usual. Usual. l^clav. 3rd. R. Subclav.) 260 SB f. 75 Usual. 235 W J m. 19 2 Brs. (L. Car. fr. Innom.) 261 R W m. 38 Usual . 23G AK f. 45 JBrs. close together at \origin, and equally so. 262 M S f. 60 Usual. 237 ET f. 70 Usual. 263 P M n. 65 238 AM f. 80 J Brs. given from R. end \ of trans, part of arch. 264 MR n. 54 265 JC n. 52 2 Brs. (L. Car. fr. Innom.) 239 R W m. 14 266 HC f. 19 240 SP f. 27 Usual. 267 M H f. 33 Usual. 241 JH n. 69 268 JC n. 57 2 Brs. (L. Car. fr. Innom.) ARCH OF THE AORTA BRANCHES. 31 No. Name. 3 Age. Number and Arrangement of the Branches. No. Name. I Age. Number and Arrangement of the Branches. 269 J M m. 84 279 J W f. 29 Usual. {2 Brs. Innom. & L. Car. 280 JR m. 65 270 UF f. 42 joined at origin, and form one thick trunk. 281 D D m 35 (2 Brs. Innom. arises 282 C F f. 72 fr. mid. of trans, part, 271 E A f. 22 and gives L. Car. L. 283 MM f. 70 Subclav. given fr. left curve of arch. 284 R M m. 68 {Brs. arise fr. R. curve 285 E W m. 30 272 S A in. adult of arch. Origin of In- nom. lower than usual. 286 S D f. adult 273 M R f. 45 287 ED f. 45 274 MP f. 72 288 E F f. 75 275 JC f. 25 Usual. 289 A J f. 23 Usual. 276 WO m. 20 290 FH f. 28 2 Brs. (L. Car. fr. Innom.) 277 EG f. 52 291 M H f 28 Usual. fL. Car. at origin close 278 SC f. 86 J to Innom., and at a | greater dist. than usual [_fr. L. Snbclav. 32 ARCH OF THE AORTA BRANCHES ABSTRACT OF THE FOREGOING TABLE. Cases in which the branches arose to the right of the usual situation, see plate 6, fig. 1 and 2 35 Left Carotid more than usually close to Innominate, plate 6, fig. 5 15 Left Carotid joined with Innominate, plate 6, fig. 6 ... 7 Left Carotid given from Innominate or both vessels united so as to form one large trunk, plate 6, fig. 7 .... 25 Left Vertebral given from the Arch of Aorta .... 5* 3 brs. unusually arranged. 1st. Common trunk of both common Carotid arteries. 2nd. Left Subclavian. 3rd. Right Sub- clavian . . . 3 The Carotid and the Subclavian arteries spring separately from the arch , 1 The usual arrangement of the branches ..... 121 There did not occur any more remarkable deviation from the usual arrange- ment of the branches in 930 bodies except that represented in plate 7, fig. 2. * Judging by the preparations in my collection and the general impression on my mind, I should be disposed to regard this as an under-statement of the frequency of the occurrence of this variety. And though there is no doubt of the accuracy of the table, I should not be surprised to find the Vertebral artery given from the Aorta in a larger proportion of another series of cases. INNOMINATE OR BRACHIO-CEPHALIC ARTERY. IN the following table the word " usual" is sometimes applied to the length of the artery and to the place of division in the former case, it implies that the vessel, which was not measured, appeared to be from one and a half to two inches in length ; when applied to the place of division, it is to be understood that this was situated behind the inner end of the Clavicle, or nearly on a level with its upper margin. The abbreviations are similar to those explained at the beginning of the preceding table. Length Length | No. in Place of Division. Peculiarities. No. in Place of Division. Peculiarities. Inches. Inches. 1 1* ("gives L. Ca- < rotid close to [ origin. 16 f opposite up- < per margin of [ Clavicle. 2 H / gives L. Ca- \ rotid as No. 1 . 18 k J 1 inch above \ Clavicle. /gives a Thy- \roid branch. 3 H 19 2i f not above Cla- |_ vicle. (""opposite upper 4 ?f J margin of the | sternal end of 20 /not above Cla- \ vicle. [_ Clavicle. 5 H 22 /opposite Cla- \ vicle. 6 2 23 same. 7 2 24 li Tabove the up- 25 li 8 1* J per margin ol | the sternal end L of Clavicle. 26 usual. f opposite Cla- \ vicle. 9 H gives L. Carotid. 27 usual. same. 10 gives L. Carotid. 28 usual. same. 11 fgives a small J branch which | descends on L Trachea. 29 30 usual. longer than same.. /not above Cla- \ vicle. usual. 12 f opposite up- tper margin o1 31 /opposite Cla- \ vicle. Clavicle. 30 f behind Cla- greater f below Sterno- o \ vicle. 15 than < clavicular Ar- usual. Lticulation. 35 same. ' 34 INNOMINATE OR BRACHIO-CEPHALIC ARTERY. Length Length No in Place of Division Peculiarities. N in Place of Division. Peculiarities. Inches. Inches 3( f gives a Thy \ roid branch . 6 14 usual. 6 2 usual. 38 usual. usual. 6 2 usual. gives L. Carotic 3 usual. usual. ("opposite uppe 4C usual. usual. 6 2 I margin of th j sternal end o 41 ;no Innomin ata. See th [.Clavicle. 4 J 1 arch of th f gives L. Car. 42 [_ Aorta, same as No. 41 6 If 1 close to origin, < and a Thyroic 1 branch at bi- i^furcation. 43 usual. usual. 6 H usual. 44 usual. usual. gives L. Carotic {left Innom. 45 usual. usual. gives L. Carotic vein crosses 7 if usual. the artery 46 usual. usual. higher than 7 2 usual. 47 usual. usual. |"L. Carotid is 48 usual. usual. 74 2 i usual. I close to it .at [origin. f considerably 49 < above Clavi- 75 2 sual. Ida. 76 2 sual. 50 usual. sual. 77 2 sual. f not above Cla- 5] f [ vicle. 78 usual. sual. 52 2 sual. f L. Car. very t close at origin. 80 2 81 H 53 2 sual. 54 If sual. 82 H sual. PL. Carotid 1 touches it at [origin. 55 ji sual. "opposite upper 83 if r gives L. Car. close to origin. 57 If margin of the sternal end of Tgives L. Car. ^Clavicle. 84 H J at lower end, ] or both united 58 li sual. [_ at their origin. 59 If sual ("gives L. Car., J which takes 60 i| sual. 86 2 | its rise higher (^than usual. 61 2 sual. INNOMINATE OR BRACHIO-CEPHALIC ARTERY. 35 No. Length in Place of Division. Peculiarities. No. ' Length in Place of Division. Peculiarities. Inches. - Inches. 88 f (""opposite upper 89 u ("joined at ori- \ gin to L. Car. 121 * I margin of the | sternal end of [Clavicle. 90 2 122 H usual. 91 2 124 11 usual. 92 If usual. 127 if usual. 93 2 usual. (" rises low down I on the arch of 129 11 usual. f L. Car. close \ to its origin. L Aorta. 130 H usual. 94 ji usual. 131 |i usual. 96 ]_1 usual. 134 2 usual . 97 2 usual. 135 usual. usual. 98 21 usual. 136 2 usual. 99 24 usual. (R. Car. and 100 2 R. Subclavian 101 11 usual. 137 1 arise separate- | ly fr. Aorta. (See the Arch 103 If usual. ("joined at ori- \ gin by L. Car. I of Aorta.) ("opposite lower 104 2 usual. 138 2* J margin of the ] sternal end of 105 2? lives L. Carotid. [Clavicle. 106 11 usual. 139 2* /joined to L. \ Car. at origin. 110 If usual. / close to L. l_ Car. at origin. f considerably 142 2 < below the top 111 1 usual. Lof sternum. 112 2 usual. 144 If usual. /joined at ori- \ gin to L. Car. 113 11 145 If within Thorax. 114 ftjk usual. 147 ordiny. usual. 115 H usual. 150 ],i 116 2 117 1* usual. 151 4 ("joined to L. \ Car. at origin 118 H usual. 152 H 120 il usual. 155 a usual. 36 INNOMINATE OR BRACHIO-CEPHALIC ARTERY. Length Length No. in Place of Division. Peculiarities. No. in Place of Division. Peculiarities. Inches. Inches. 156 li usual. |"L. Car. close 179 f low in chest. < to Innom. at instead of an {_ origin. Innom., the first branch of (""opposite upper 158 the trans, pt. < of the Arch 180 H J margin of the "^ inner end of of Aorta is a [Clavicle. short trunk com. to both 181 *i usual. Carotids. 159 jives L. Carotid. 182 if f notabove Cla- (^ vicle. 160 usual. usual. 183 H 162 usual. usual. ( L. Car. very \closeatorigin. 184 if usual. Abe Innoin. 185 ii f L. Car. close [at origin. 1 and Subclav. 163 2i {higher than usual. J arch upwards j considerably 186 li 1 above first rib 187 if l^and Clavicle. Ogives L. Car. 165 !J usual. j near origin, 191 *i not above Clav. I and a Thyrou 166 2 usual. j br. near bi- V. furcation. 167 H usual. 192 if 169 2 8 193 H 171 usual. usual. 194 if 172 usual. usual. Ogives L. Car. 173 2 usual. at lower enc andaThyroid, 174 2 f not above Cla- \ vide . ("rises lower J than usual on ] the Arch of 195 11 J which sup- \ plies place o the R. infer. L Aorta. Thyroid, near ^bifurcation. 176 H usual. 196 if usual. 177 i J not above Cla- \vicle. 198 ordiny. usual. 'gives L. Car. 199 H / in the chest From the L. 1 some distance Car. to its bi- 200 if 178 i I below the up- | per part of its furcation the Innom. mea- 201 2 usual. j osseous boun- sures three- V.daries. quarters of an inch. 202 2 f L. Car. close |_ at origin. INNOMINATE OR BRACHIO-CEPHALIC ARTERY. 37 No. Length in Place of Division. Peculiarities. No. lAngth in Place of Division. Peculiarities. Inches. Inches. f gives L, Car. 223 H usual. 203 If <( a little above V.ovigin. 225 ii usual. 204 *l 228 H usual. 205 usual. usual. 230 2| C above sternal t end of Clav. 206 If usual. 231 H 207 i* usual. gives at the 208 1* distance of | inch from its 209 1 bifurcation a small branch, 210 usual. usual . 233 2 t which runs up- wards under 211 li the muscles, and does not 'the origin is reach theThy- considerably joid body. lower than usual fr. the fno Innom. end of the as- I in place of it cending part 234 < is a trunk 213 If of the arch and at dis- I common to V both Carotids. tance of half an inch from 235 H usual. gives L. Carotid. origin of L. Car., which 236 If usual. is close to L. ^Subclav. 237 H usual. 214 If usual. 238 H usual. 215 1* 240 4 usual. 216 2 242 if 217 1ft f L. Car. close \at origin. 243 2 $ joined to L. Car. at origin. 218 i fin chest, near- J ly opposite | lower margin 247 2 /'gives a Thy- < roid br. near ^bifurcation. Lof Clavicle. 248 H usual. 219 H same as 218 220 if 249 II fa little above < the margin of l^Clav. 221 . (gives L. Car. at origin. ^low in thorax 222 if 250 I* ) oppos. mid. j of 2nd. dors. $ joined to L. i Car. at origin. ^ vcrteb. 38 INNOMINATE OR BRACHIO-CEPHALIC ARTERY. No. Length in Inches. Place of Division. Peculiarities. No. Length in Inches. Place of Division. Peculiarities. 251 If usual. (joined to L. ( Car. at origin. 267 H usual. {gives L. Car. 252 H from this 268 If to bifurcation 253 If of Innom. 1 inch. 254 usual. usual. f Innom. and 255 If 270 li ( L. Car. united \^at origin. Ogives a Thy- 256 i J roid branch at j junction with 271 If gives L. Car. 258 H usual. V^the com. Car. 272 2i 5 \ inch above I Clavicle. Arises low on \ the Arch of ^ Aorta. 259 if usual. 275 usual. usual. 260 11 usual. 070 2 1 S close to L. A 1 O I Car. at origin. 261 II (joined to L. | Car. at origin. 279 2 262 if 288 Ii below Clavicle. (gives L. Car., 289 H usual. above which 265 2 it measures 290 H usual. gives L. Carotid. to bifurcation 1^ inch. 291 H isual. 266 39 INNOMINATE, OR BRACHIO-CEPHALIC ARTERY. ABSTRACT OF THE TABLE. Number of Cases in which the Artery measured 1 inch and under . . 8 Above 1, not exceeding 11 81 Half of those marked usual . . * . . . .24 . 105 Above 1, not exceeding 2 . . . . . 66 Half of those marked usual 24 90 Above 2 . . . .-.'... . . . 16 PLACE OF DIVISION. Number in which the bifurcation of the Artery took place considerably above the Clavicle ........ 7 At some distance below that bone .9 Behind the Sterno Clavicular-joint, on a level with the upper margin of the Clavicle, or nearly so 121 Innominate gave L. Carotid, or both vessels united into one large trunk . 25 A Thyroid branch . 7 A small Artery which ramified downwards over the Trachea . . 2 ARCH OF THE AORTA. BRANCHES. EXPLANATION OF PLATE VI. THE parts bear the same marks wherever they occur in the same plate. a Larynx. | b Trachea. d (Esophagus. ARTERIES. 1 . The commencement of the arch of the aorta. 2. The descending aorta. 3. Innominate. 4. hight carotid. 4 1 . Left carotid. 5. Right subclavian. 5 ! . Left subclavian. 6. Vertebral. a Heart. ft Trachea. li } Larynx. EXPLANATION OF PLATE VII. c Bronchus. d (Esophagus. e The thyroid body. ARTERIES. 1. The arch of the aorta. I 6. Left vertebral. 2. The descending aorta. G 1 . Right vertebral. + A pouch projecting from the ! 7. Thyroid. aorta. 8. Internal mammary of the right I). Innominate. side. 4. Right carotid. 4 l . Lett carotid. 5. Right subclavian. o ' . Left subclavian. E 9. Pulmonary. 10. Ligarnentumarteriosum, or Duc- tus arteriosus. 42 ARCH OF THE AORTA BRANCHES. VEINS. 11. V. cava superior. | 12. V. azygos. NERVES. 13. N. vagus of the right side. | 13 l . N. vagus of the left side. THE BRANCHES GIVEN FROM THE ARCH. The deviations from the ordinary disposition of the arch of the aorta referred to in the preceding pages, and represented in the majority of the figures in the fifth plate, are of very rare occurrence, insomuch, that in the number of bodies (nearly a thousand) over which my observation has extended with a special view to the subject, no important changes were found in the arch, with the exception of those which occur in its position or height within the chest, and the single case of transposed aorta accompanying transposition of the viscera (ante #, pages 15 and 16, and plate 5, figures 1, 2, and 3). But the variations in the large branches given upwards from the arch are not unfrequent, as will be apparent on reference to the table, page 15 et seq., or to the abstract of it at page 32. The repeated statement of Haller *, that * After enumerating some of the previously recorded variations in the arch of the aorta and its branches, he remarks " Natura hanc principem arteriarum originem fahricata est, adeo tamen hasc rara sunt, ut in quadringentorum cadaverum incisione nihil ejusmodi viderim, neque ante me, Celebris olim ex manus medicantis et dissecantis solertia, Gulielmus Cheselden." Elem. Physiol. t. ii. p. 162. The statement of Cheselden runs thus : " By some authors these vessels have been described in a different manner ; but I believe these descriptions were, for want of human bodies, taken from brutes ; for I have never yet seen any variety in these vessels in humane bodies, though I have in the veins nearer the heart." The Anatomy of the Human Body, 4th ed. 1730, chap. viii. p. 175. On the same subject Haller elsewhere writes thus : " Nullum in eo arcu unquam varietatis, genus reperi, nisi quod earn saepe varietatem vidi quam," &c. &c. ; referring to several papers containing accounts of the origin of the vertebral artery from the aorta. He continues thus: " Satis nempe frequenter vertebralem arteriam ex arcus parte sinistra inter subclaviam et carotidcm prodiisse vidi." And after alluding to the descriptions of several varieties contained in various works, he adds, " Rara vero hsec omnia esse si dixero, cum quadringenta nunc cadavera humana dissecuerim, fidem forte invcniam. Iconum Anatom. fascic. vi. p. 1." It is worthy of remark, that the learned Dr. Barclay committed the oversight of mistaking the word quadringenta for quadraginta. In reference to the last-cited passage, he says, " Haller, remarking that all such cases are extremely rare, expresses a hope that after dissecting forty (ought to be four hundred) bodies, he may be allowed to obtain some credit for his assertion." A Description of the Arteries of the Human Body, p. 9, note. Edinburgh, 1820. THEIR VARIATIONS. 43 notwithstanding his large experience, he had witnessed no other arrangement of the arch and its branches than the ordinary one, with the exception of the left vertebral artery arising from the aorta, is to be attributed partly to the cir- cumstance of his not having directed attention to some changes recorded in this work ; partly, also, to the vague- ness and want of accuracy which are inseparable from a reliance on general impressions only, where facts are con- cerned. Before entering on the consideration of the variations which take place in the branches of the arch of the aorta, it is necessary in the first place to state, that the coronary and bronchial arteries will not be referred to under this head ; secondly, it is necessary to determine that standard condition from which others are said to vary, viz. the most frequent, and therefore the usual condition of the vessels. It is universally and correctly stated by anatomists, that the most frequent arrangement is that in which the innominate, the left carotid, and the left subclavian arteries are derived from the middle or the top of the arch ; the left carotid being somewhat nearer to the common trunk of the arteries of the right side, than to the vessel destined to its own side. CLASSIFICATION OF THE VARIATIONS IN THE BRANCHES. So numerous are the forms of deviation from the standard condition, that some arrangement or classification is indis- pensably necessary. They admit at the outset of being separated into two classes : 1 . The first, to comprise the cases in which the primary branches, viz. the carotid and subclavian arteries, or the innominate, the common trunk of two of these, are concerned. 2. The second to include those in which one or more secondary branches, usually given from the subclavian, take origin directly from the aorta. E 2 44 ARCH OF THE AORTA BRANCHES. CLASS I. The variations included in the first class, namely those in which the primary branches are concerned, affect a The situation which the vessels occupy on the arch. b The contiguity of the branches one to another ; (in both of tfoese cases the vessels retain the order in which they usually take their origin). c Their number, relative position, and arrangement. a VARIATIONS IN THE SITUATION WHICH THE VESSELS OCCUPY ON THE ARCH. PLATE 6 FIGURES 1 AND 2 *. Instead of being given from the middle or highest part of the arch, the branches frequently are moved towards the right side, taking rise from the right end of the transverse part of the arch, or the curve on that side. When such a change occurs, their origin is, in consequence of the arched shape of the great parent vessel, almost necessarily lower than ordi- nary, and that of the innominate must obviously be lower than either of the other arteries. It is apparent that the length of the last-named vessel, which would be requisite to reach above the clavicle, and cause it to be accessible in the neck when it takes origin in the usual situation, would be insufficient to extend to the same point under the circum- stances here alluded to. When the arteries arise, as indicated, on the right of their usual situation, they are generally close one to the other, and appear as it were crowded together on the aorta (fig. 1). Occasionally, however, they are not so, as is exemplified in fig. 2, which shows the innominate removed from the other arteries, the left carotid being closer to the left subclavian than to it. b VARIATIONS IN THE CONTIGUITY OF THE PRIMARY BRANCHES ONE TO THE OTHER. The branches sometimes take their rise at equal distances one from the other (fig. 3) ; and the distance between them * Taken from preparations 253 a & b in my collection. THEIR VARIATIONS SIXTH PLATE. 45 is occasionally, but rarely, much greater than in this figure, or than is usual. The change most frequently observed in the position of the branches, results from the tendency which it may be said the left carotid has to approach, and even to join the innominate. In figures 3, 4, 5, 6*, that vessel undergoes a gradual transi- tion towards the innominate, until, in figure 7 * } it arises from that artery. c. VARIATIONS IN THE NUMBER, THE RELATIVE POSITION, AND ARRANGEMENT OF THE PRIMARY BRANCHES. The primary branches may be decreased from their usual number to two, or augmented to four. There is no example with which I am acquainted of a greater extent of departure from the usual number than those here stated, with the exception of two cases f, in which it was increased to six. An additional source of variation in the primary branches arises from a difference in their arrangement, the number being unchanged from that which is usual. Reduction of the number of the primary branches. Of this variety three examples are given in figures 7, 8, and 9. In figure 7 ? the left carotid is derived from the innominate. The observations recorded above show this to be by much the most frequent change which occurs in the number of the branches. This statement is not in accordance with that usually made by anatomical writers, who are almost unanimous in regarding the increase of the number by the origin of the left vertebral artery from the arch as the most frequent source of change in the branches f. Figure 8 is sketched from the work of Tiedemann, (plate 4, * Drawn from preparations 127 and 129 a b c in my collection. f Malacarne's case, plate^5, fig. 9, and another which will be referred to under the head of the Carotid Arteries. J Haller, in a passage of the Icon. Anatom. previously cited. J. F. Meckel observes " Haufiger vermehrt sich die Zahl der Stamme, als dass sie sich verminderte. Am gewohnlichsten iibersteigt die Zahl der Stamme die regelmassige nur um eine, so dass sich vier finden. Dies geschieht nicht immer auf dieselbe Weise. Meinen Erfahrungen nach wird es am haufigsten dadurch bewirkt dass die linke Wirbelpulsader, der Regel nach ein Ast der Schliisselpulsader^unmittelbar ausder Aorte entsteht." Handbuch der menschlichen Anatomic, Band 3 Halle und Berlin, 1817. Professor Harrison says, " Exceptions to this (the usual) order frequently occur : the most common one is that of four arteries arising from the middle of the arch, the additional branch being generally the left vertebral," &c. The Surgical Anatomy of the Arteries, vol. i., p. 11. 46 ARCH OF THE AORTA BRANCHES. fig. 8,) in which it is stated of the case merely that it was observed by Zagorsky. Now, on reference to the essay of the Russian anatomist, I find that he has not illustrated the description by a drawing : the representation given by Tiede- mann is, in consequence, to be regarded as a plan made in conformity with the description in the original paper. It must further be remarked, that the account of the pre- paration published by Zagorsky is defective, inasmuch as it contains no allusion to the state of the aorta*. This omis- sion diminishes considerably the value of the case ; for with such an arrangement of the branches, our experience would lead us to expect that the arch should be directed to the right side, seeing that the tendency of the branches is to approach and to join one to another towards the beginning of the aorta, for such the right side may be considered when the great vessel has its usual course. In the absence, therefore, of in- formation as to the aortic arch, the case in question will be regarded as of doubtful value. Figure 9 is also taken from Tiedemann. He observed an example of this arrangement of the vessels in the Museum of Berlin. Similar cases had been previously described but not figured by Malacarnef and BiumiJ. Increase of the number of the primary branches. This variety may be said to arise from the decomposition or division of the innominate trunk ; the right carotid and subclavian taking their rise directly from the arch of the aorta. The figures 10, 11, 12 and 13, show the two carotid and the left subclavian arteries arising from the arch in the usual order. But the right subclavian artery undergoes a gradual transition from the right to the left side ; thus in figure 10 the right subclavian and carotid have the relation, which may * After describing the arrangement most usual when two branches arise from the aorta, the author continues in these words " In nostro autem subjecto vice versa res se habebat ; truncus enim dexter pergebat, pectore egressus, ad solam extremitatem dextram, sinister vero spargebat utramque arteriam carotidem et subclaviam sinistram." Meui. de I'Acad. Imperiale de St. Petersbourg, torn, i., St. Petersbourg, 1809. f " Ho pero negli anni seguenti veduto in due cadaveri umani dall' arco dell' aorta a nascere le due sole succlavie, e da caduna di questa una carotide." Osservazioni in Chirurgia, parte ii., p. 128, Torino 1784. J " Subclavia sinistra orta est singulari plane exemplo ex carotide sinistra. Itaque duae tantum arterise ex arcu prodibant. Nil tale unquam vidi." Francisci Biumi, Philosophi et Medici, Observat. Anatom. ; tomus primus, observat. 10. THEIR VARIATIONS SEVENTH PLATE. 47 be supposed to result from a simple division of the innominate ; in the eleventh figure the subclavian is seen to have passed to the left of one carotid ; figure 12 shows it beyond the other carotid, and in figure 13 it has proceeded beyond, or to the left side of the left subclavian artery. It is remarkable that when the four primary branches are given separately from the arch of the aorta, the arrangement which apparently deviates most from the usual disposition, that, namely, in which the right subclavian arises from the left side of the aorta, is of much the most frequent occurrence. That vessel, when it does not spring from the innominate, is usually given at the point indicated. Some instances are published of the arrangement repre- sented in figure 10 *, but of the variations shown in figures 11-f- and 12^ I have not seen an account of any other examples than those from which were taken the original representations here copied. In plate 7, figures 1 and I 1 , is represented an arrangement of the vessels the reverse of that in the last figure of the preceding plate. The left carotid is the first branch, the carotid of the right side the second, the right subclavian follows emanating from the highest part of the arch ; lastly, * " When there are four, the two middle branches are termed Arteriae Carotides ; the other two Subclavise ; and both are distinguished into right and left." An anatomical exposition of the structure of the human body by James Benignus Winslow, transl. by G. Douglas, M.D. Vol. 2, p. 3. London, 1776. " Weniger vom Normal abweichend ist die Spaltung der aus dem Aortenbogen entspringenden Starame, wo alle an ihrer normalen Stelle bleiben, die rechte Schliissel- pulsader also zuerst entsteht. Diese beobachteten * * * und ich in zwei Fallen." J. F. Meckel Handbuch der Pathol. Anatom. band, 2, 8. 107. f The figure has been slightly modified from that published by Httber. Of the case he observes "Nulluin exhibebat cadaverculum puellse in partu extinctae innomi- natam arteriam. * * Seorsim enim e central! quasi arcus parte prodibat arteria Sub- clavia dextra, latens primo intuitu, et pone Carotidem sui lateris incedens, suara versus claviculam mox obliquato incessu tendebat, in consuetos ibidem ramos divisa. Sola nempe exibat ex arcu Carotis dextra, recta adscendens, ortu suo prima, s. dextima." Acta Helvetica, &c. vol. viii. observat. iv. p. 74. Basilese 1777. J This representation is copied from one of several published with the descriptions of the cases by Walter in the Nouveaux Memoires de 1' Acad. des Sciences & Belles Lettres, Berlin, 1785. Of the case represented in these figures Fiorati and Sandifort published repre- sentations at different times, the preparation having been taken from Italy to Leyden and presented to Sandifort by Aglietti, who had been a pupil of the Italian professor. The former figure is taken from Fiorati without other alteration than the omission of the larynx, and a little addition made to the distinctness of some of the parts. The latter sketch is copied from one of those contained in the valuable work of Sandifort. See ante a, page 18. 48 ARCH OF THE AORTA BRANCHES. the left subclavian is connected to the descending aorta, or the end of the arch. This alteration of the origin in the branches accompanies the reversed course of the arch of the aorta, which was directed over the right bronchus. The case also presents an example of a remarkable peculiarity in the mode of origin of one of the branches, namely the left sub- clavian artery, which is here the last branch. That vessel does not take its rise immediately from the aorta, but from a projection from it or pouch (f ), which at nearly the same point receives the attachment of the ligamentum arteriosum (10) and gives origin to the subclavian artery (5 1 ). In figure 1. b. the pouch is more clearly marked than in the larger drawing. Though it is not distinctly stated in the account published of the preparation by Fiorati, or in that by Sandi- fort, there is little doubt that the trachea and oesophagus were anterior to the pouch, between it and the aortic arch. The recurrent laryngeal nerves are singularly disposed in this case. The nerve of the right side is seen to turn round the aorta in the same manner that it does on the opposite side when the great vessel arches in the usual direction ; on the left side the nerve winds round the ligamentum arteriosum. The preparation (No. 72 in my collection) represented in figure 2 was found in the body of a male idiot of about 20 years of age. The arrangement of the branches at their origin may be said to be very irregular. Thus the left carotid arising as the first branch crosses by the two arteries of the right side, and the right subclavian, from the position at which it arises from the aorta, is directed behind the carotid to its usual position under the clavicle. In this case, as in that represented in the preceding figures, the left subclavian takes its origin at a considerable distance beyond the other arteries from a pouch : this is more clearly seen in the profile view of it, figure 2. b., which is taken from the same prepa- ration. The carotid arteries in figure 2 are of very unequal size, that of the right side is much smaller than usual. From the examination, not a very careful one, which was made of the artery in the neck the skull was not permitted to be opened it was concluded that there was no internal carotid artery; but it was not ascertained how the deficiency was THEIR VARIATIONS SEVENTH PLATE. 49 supplied. It will, however, be noticed that the internal carotid of the opposite side is unusually large, and the size of this artery suggests- the probability that it compensated for the absence of the vessel of the right side. The number of the branches the same as usual, but their arrangement is altered. The third source of variation in the primary branches arises from a difference in their arrangement, the number continuing three, the usual one. Different forms of the condition are represented in figures 3, 4, 5, and 6. The three branches given from the aorta in figure 3* are obviously the reverse of the usual arrangement, consequent on the altered direction of the arch of the aorta, which is curved to the right side. Other examples of the same arrangement of the branches and the arch of the aorta are contained in the fifth plate, figures 3, 4, and 5. In the case before us, the ductus arteriosus, which was pervious, is seen to end in a very unusual manner, inasmuch as it joins the left subclavian artery a little beyond the innominate, without forming any connexion with the aorta. The recurrent laryngeal nerve at the left side is directed behind the ductus arteriosus, and it is probable that the nerve of the opposite side turned round the arch of the aorta ; but the written description contains no allusion to the nerves. The interesting facts in reference to the origin of the left subclavian artery and its connexion with the pulmonary artery, illustrated in this and the preceding figures of the same plate, will come under consideration when the anatomy* of the subclavian arteries is being discussed. The conditions of the large branches represented in figures 4f and 5 J, have some analogy one to the other. In both the * Copied from Bernhard's drawing (loco citat.), the lungs and the trunk of the body, which are represented in the original, heing omitted. It is necessary to observe that the description given of this case hy Tiedemann is cor- rect so far as it goes, but the drawing (Tab. iv. Fig. 9) differs from the desciiption, and does not correspond with Bernhard's original figure. ~\" Of the figure given in his third plate, from which this has been taken, Tiedemann observes, " Proponit rarissimam varietatem, quse mihi in dissecando cadavere juvenis viginti duorum annorum occurreb.it." Portal met with a case of the same kind, which he thus refers to, " J'ai vu les deux carotides reunies en un seul tronc dans un sujet chez lequel les deux sous- davieres aboutissoient imme'diatement et separe'uient dans la cavite' de 1'aorte." Cours d'Anatomie Medicale, t. iii. p. 155. 1 From a preparation (No. 401) in my collection. 50 ARCH OF THE AORTA BRANCHES. carotid arteries are joined, and the right subclavian arises separately ; but in the one that vessel issues from the com- mencement of the transverse part of the arch before the other branches ; in the other, it is given from the end of the same part, and beyond the left subclavian. Figure 6*, which also represents an example of three primary branches, the unusual circumstance of the junction of the left carotid and the subclavian of the same side is to be noticed. A junction of the same kind is exemplified in plate 6, figure 9. Considering, however, that when the aorta arches over the root of the right lung, the carotid and subclavian arteries are usually joined on the left side (see pi. 5, figs. 3, 4, 5, and pi. 7, fig. 3), it would be more correct to say, in reference to the disposition of the vessels represented in the figure under obser- vation, that it exemplified the unusual circumstance of a junction between the carotid and subclavian arteries, which arise most remotely from the origin of the aorta. CLASS II. CASES IN WHICH ONE OR MORE SECONDARY BRANCHES USUALLY GIVEN FROM THE SUBCLAVIAN ARTERY TAKE ORIGIN DIRECTLY FROM THE AORTA. In Figures 7, 8, and 9, the origin of a secondary branch from the aortic arch coincides with the ordinary disposition of the primary branches. The origin of a secondary branch from the arch accom- panying a diminution in the number of the primary branches is illustrated in figure 10. In figure 11, it is seen to coexist with an increase in the number of the larger branches. The instances recorded of two secondary branches arising directly from the aorta are very few. The figure 12 shows two such vessels, the internal mammary of the right side, and the vertebral of the left, in conjunction with the usual primary branches. * The variety represented in this figure was observed by Tiedemann in the body of an eight months' foetus which had hare-lip. THEIR VARIATIONSSEVENTH PLATE. 51 In figure 13, two secondary branches, the right and the left vertebral, are seen, with the four primary branches, to occupy the upper part of the arch. The descent to the aorta so to express the fact of their connexion with it of the smaller arteries represented in the figures which have here been reviewed, is of very rare occur- rence, with the exception of the left vertebral, as represented in figures 7 and 10. The origin of the left vertebral from the aorta, in com- bination with the arrangement of the primary branches seen in the figures just referred to, is so often met with that, as has been previously stated, it is commonly considered to constitute the most frequent source of alteration from the usual arrangement of the branches of the arch, and when it takes its rise from the aorta, it is almost invariably placed between the carotid and subclavian of the left side. In figure 8, the origin of the left vertebral artery occupies a very rare position *. Figure 1 1 f. The combination of a left vertebral with the four primary branches is not of very rare occurrence. I have seen two preparations in which the arrangement was the same as that presented in the figure before us. Koberwein J describes a case which differs from that here represented in the circumstance of the right subclavian taking origin from the right side of the arch before the other branches. * A preparation in which the left vertebral arose from the aorta in this very unusual situation, is mentioned by Walter : " Arcus arterise aortse, cera flava impletus, ex quo tres prodeunttrunci ; primus, arteriam carotidem sinistram, dextram et subclaviam dextram, edit. Secundus est ipsa subclavia sinistra ; tertius, vertebralis sinistra. Ex adulto." Museum Anatomicum, p. 237. Berolini, 1805. J. F. Meckel remarks, " Unter den vielen Fallen, die ich sahe, fand ich nur in einem einzigen die linke W irbelarterie mehr nach aussen liegend, uls die Schliisselpulsader." Pathol. Anat. band ii. s. 109. Tiedemann, from whose figure ours is copied, states that he observed the anomaly in the body of a man thirty years of age. f This figure is taken from a drawing made of a preparation which is in the Museum of the Royal College of Surgeons in Ireland, by Mr. Kirwau, under the direction of my friend Professor Hart. It affords me much pleasure to acknowledge the great kindness with which Dr. Hart has consented to aid me by the inspection of the museums in Dublin, and the superintendence of any drawing which may be required. " Surgunt in nostro, ex arcu aortae justo minori, carolis dextra solum et carotis sinistra, ex descendente dein ante vertebram dorsi secundam, vertebralis sinistra, infra hanc, subclavia sinistra, ante cartilaginem tandem vertebris tertiae et quartae interme- diam, subclavia dextra." De Vasorum decursu abnormi, &c. 52 ARCH OF THE AORTABRANCHES. Otto has given the description of a case previously referred to, in which the branches presented an arrangement that may be regarded as the reverse of that delineated in figure 1 1 . The aorta arched to the right side ; the primary branches arose separately, the left carotid being given first, and the left subclavian the last. The vertebral artery took its rise between the carotid and subclavian of the right side, and was distributed to that the right side. Figure 9. The origin of a thyroid artery from the aorta is of very rare occurrence * ; the only case which has fallen under my observation is represented in this figure. In most of the examples recorded of this variety, the unusual artery was seen, as in the figure before us, to arise between the innominate and the left carotid. It was so placed in Neubauer's preparation, which is described and figured in the inaugural dissertation of his pupil Erdmann f . Nicolai saw the artery given from the aortic arch between the carotid and subclavian of the left side }, in the situation in which the vertebral takes its rise when derived from the aorta. * It is difficult to account for the statement made in Bichat's Anatomy, that the thyroid artery arises from the aorta more frequently than the left vertebral does ; the words are " Quelquefois on a vu la vertebrale gauche naitre immediatement de 1'aorte et former un quatrithne tronc primitif. Plus souvent on trouve une petite artre nee de 1'aorte entre 1'innominee et la carotide gauche, et remontant verti- calement stir la trachee pour aller se rendre k la glande thyroide." Anatomic Descrip- tive de Xavier Bichat, torn. iv. p. 147 ; nouv. edit. Paris, 1829. The error contained in this passage, for such it must be considered,. is remarked on by Meckel (Handbuch der menschlich. Anatom,, b. 3, s. 80). The distinguished writer last referred to, has, in his admirable work on Pathological Anatomy, fallen into the mistake of assigning six examples of the variety to the obser- vation of one anatomist ; " Hiiber sahe sie sechsmal unmittelbar aus dem Bogen der Aorta entstehen." On consulting Hiiber's Essay, I find that he does not make any mention of a thyroid artery arising from the aorta, but that in the page referred to by Meckel, he describes it as given from the innominate. "Singularem plane arteriam, altius paulum, quam dicta mox thymica, exire vidi ex innomiuata ; incurvato, pro indole harum arteriarum, reptatu adscendentem et brevi itinere glandulse thyroidis partem infimam adeuntem. In aliis cadaveribus (pluries enim illam observuvi, bis in Goettengensi et quater Cassellano theatre Anatomico) &c. &c." Observationes aliquot &c. in the Acta Helvet. vol. viii p. 83. Tiedemann also, apparently following Meckel, gives the same reference to HUber in his account of the variety now under observation. f Descriptio Anatomica Arterise innominate et Thyroideae imse. Jense 1772. J Preterita tamen hyeme in theatre nostro anatomico, quatuor observavi ramos. Horum tres majores eo, ut descripsi, i. e. ordinario modo collocabantur, quartus vero diametri longe angustioris, inter carotidem et subclaviam sinistram ex ipso arcu emergent, ad glandulae thyroidese partem infimam flexuoso decnrsu properabat, &c. De directione vasorum, &c. H. A. Nicolai, Argentorati 17'-25, in HaUer Dissertat. Anatom. Select, vol. ii., p. 497. THEIR VARIATIONS SEVENTH PLATE. 53 The figure 12 is copied from that published by Boehmer *, of a case observed and prepared by Cassebohm. One additional example of two secondary branches in conjunction with the ordinary condition of the larger arteries may be cited. Meckel gives an account of a preparation, which differed from that delineated by Boehmer only in the circumstance of the right vertebral artery being given instead of the internal mammary "f". The 13th figure shows a most unusual condition of the vessels. Meckel and Tiedemann have each recorded a single instance of this variety. The figure is taken from that given in the " Tabulae Arteriarum." It may be said that this case is remarkable by several cir- cumstances : 1st. The primary branches arise separately. 2ndly. The right subclavian is given on the right side ; when freed from the innominate that vessel is usually derived from the left side of the aorta. 3rdly. The left vertebral is conjoined to the unusual arrangement of the primary branches. Lastly. The right vertebral, which arises from the aorta with extreme rarity, is here added to the list of deviations from the usual arrangement of the branches, furnished from the arch of the aorta. * Observations binas anatom. &c. in Haller Dissertat. Anatom. vol. ii. p. 451. f- " In eiuem Falle den ich vor mir habe, entspringen beide Vertebralarterien mit Ubrigens norrnaler Vertheilung der grossen Aeste aus dem Bogen, die rechte zwischen dem ungenanntcn Stamme und der linken Carotis, die linke zwischen dieser und der linken Schllisselbeinarterie." Ueber die Bildungsfehler des Herzens, Meckel in Reil's Arcliiv. fur die Physiologic, band 6, p. 571. Halle, 1805. THE CAROTID ARTERIES. THE following are a few of the abbreviations used in this table in addition to those previously explained i Th. or Thyr, for Thyroid ; H. for Hyoid ; Cart, for Cartilage. The word "usual" implies that, on examination, the vessels seemed not to depart from the usual disposition to such an extent as to require comment. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. *> Side of the Body. Length in Inches. Place of Division. Peculiarities. R r opposite the upper margin - "] of the Thy- [_roid Cartilage. L Th. Cart. f rises from In- L nominate. 2 L Th. Cart. J rises from In- |_ nominate. ["opposite mid- 3 R H < die of Thyroid |_ Cartilage. L 4 J opposite Cri- \ coid Cart. 4 R 4 Th. Cart. L 5 Th. Cart. 4a R Th. Cart. 6 R Th. Cart. L 5 Th. Cart. 7 R 3* Th. Cart. L 5 Th. Cart. 8 R 3 Th. Cart. L tid. See 1 the Arch of V. Aorta. 43 R Th. Cart. THE CAROTID ARTERIES. 59 COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. 44 R Os H. J" Thyr., Lingl. and Faol. arise by a \ common trunk. The other Brs. usual. L fr. Innom. 45 R Th. Cart. L fr. Innom. /"crossed at the 46 R /lower margin \ of Th. Cart. I end or divi- | sion by Omo- (_hyoid muscle. 47 R f below upper < margin of Th. I Cart. L above Th. Cart. 47a L Th. Cart. 50 R OsH. {Lingl. and Facl. fr. a com. trunk. Infer. Palat. given from Ext. Car. Other Brs usual. 51 R Th. Cart. usual. L Th. Cart. usual. 'Anter.jugular vein commu- 52 R Th. Cart. nicates over < St. Mast.mns- cle with Ext. jugular, which is small. ["Thyr. and Lingl. united into one < trunk at their origin. Other Brs. (_ usual. L Th. Cart. fvcry close to < Innom. at usual. [origin. 53 R Th. Cart. usual. L Th. Cart. usual. 54 R H Th. Cart. L 5i Th. Cart. usual. 55 R 3J Th. Cart. f Anter. Jugr. \ vein large. usual. L Th. Cart. usual. 60 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTIDBRANCHES. No. Side of the Body. Length Inches. Place of Division. Peculiarities. 57 R si above Th. Cart. I" Occipl. gives the only Sterno-Mastoid \br. Brs. usual. L Th. Cart. 58 R above Th. Cart. fLaryngl. abr. of Ext. Car. : greatest I part of Occipl. runs superficially to j the upper end of the St.-Mastoid [_ muscle. Other Brs. usual. L 41 Th. Cart. usual. 59 R Os H. usual. L 5 Os II. usual. 60 R Th. Cart. ["Facl. gives Sublingl. wh. follows I Submaxilly. duct to the Sublingl. [gland. The other Brs. usual. 61 R Th. Cart. Lingl. and Facl. arise by a com. trunk. L H Th. Cart. usual. 63 R 4| OsH. usual. L 6 OsH. usual. 64 R 31 mid. Th. Cart. {Lingl. and Facl. arise by a single trunk. Other Brs. usual. 65 R 4 Th. Cart. {A long interval betw. Thyr. and Lingl. Brs. usual. L fr. Innom. 66 R 4 above Th. Cart. {Laryngl. br. enters Larynx betw. Thyr. and Cric. cartilages. The Super. Lar. nerve enters in the usual situation. Sublingl. is a br. of Facl. The other Brs. usual. L Th. Cart. 67 L fr. Innom. 68 L Th. Cart. 69 L above Th. Cart. f Th. Lingl. and Facl. arise very close < one to the other fr. the beginning of [ Ext. Car. The other Brs. usual. 71 R OsH. TLingl. and Facl. arise by a single I trunk. Thyr. rises higher than usual ] and descends to its destination. The Bother Brs. usual. THE CAROTID ARTERIES. 61 COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. 72 R 4 Th. Cart. ( Lingl. and Facl. by a com. origin. \ Other Brs. usual. ["Lingl. and Facl. by a com. origin. L 4 < Trans. Facl., Int. Maxil., and Temp. (_ arise together. Other Brs. usual. f Facl. arises above the angle of lower 73 R H Os H. < Maxilla and descends to usual position. I The other Brs. usual. TFacl. arises opposite the middle of L 6 Os H. I the Ramus Maxillae Infer., and de- 1 cends below its angle to usual situ- ^ation. The other Brs. as usual. f Anter. jugu- 74 R < lar vein pre- [sent. L 5f [ below upper \ margin of Th. [ Cart. !very close to Innom. at ori- gin : Anter. Jugular vein present. CA separate br. of Ext. Car. gives I Infer. Palat. and Tonsill. The only | Sterno-Mastoid br. fr. Occipl. Other [_Brs. usual. 75 R 4 Th. Cart. usual. ("very close to L 51 Th. Cart. < Innom. at usual. |_ origin. 76 R Os H. usual. L OsH. f gives Super. \Thyr. J Lingl. and Facl. by a com. origin. \ Other Brs. usual. 77 R a* J Lower part of \ Th. Cart. usual. (~ below upper L 5 < margin of Th. usual. [Cart. 78 R 5 Os H. C Large Super- L H Th. Cart. J ficial veins ] (Ant. & Ext. L Jugular.) {Laryngl. given fr. Ext. Car. Other Brs. usual. fThyr., Lingl., FacL, Pharyngl. and J Occipl. arise very close together fr. 81 R ** Os H. ( beginning of Ext. Car. The only ^ - J Sterno - Mastoid br. is fr. Occipl. (^Other Brs, usual. 62 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. L the Super. Thyr. JPharyngl, gives Palat. Other Brs. \ usual. 82 R k OsH. ("Large Sterno-Mastoid br. Other [Brs. usual. L 6 J a little above \0s H. fits origin < touches that (_of Innom. f Occipl. arises 1 inch, above Facl., < and gives Poster. Auricr. Other (_ Brs. usual. 83 R H Th. Cart. f Lingl. and Facl. arise by a com. \ trunk. Other Brs. usual. f Liugl. and Facl. fr. a com. origin. L ** OsH. fr. Innom. < Poster. Auricr. fr. Occipl. Other [_Brs. usual. 84 R 4 Th. Cart. f Super. Thyr. and Lingl. arise by a \ com. trunk. Other Brs. usual. TLaryngl. is given as a separate br. of L 6 OsH. fr. Innom. \ Ext. Car. The origin of Post. | Auricr. much higher than ordinary. LThe other Brs. usual. 86 R 8* {below upper margin of Th. Cart. J" Three small separate brs. instead of \ Super. Thyr. Other Brs. usual. !Thyr. of large size. Lingl. and {a little below Facl. given fr. a com. origin. La- L *i upper margin fr. Innom. ryngl. and Palat. are given each of Th. Cart. separately from Ext. Car. Other Brs. usual. TLingl. and Facl. by common origin. 88 R 4 f a little above \ Th. Cart. J Laryngl. arises separately from Ext. j Car. The only Sterno-Mastoid from [Occipl. Other Brs. usual. rSterno-Mastoid br. from Ext. Car., f gives Super. j and has 9th nerve winding round it. L H OsH. { Thyr. at bi- < 2 small Phatyngl. brs., one fr. Ext. [_ furcation. I Car., the other fr. Occipl. Other ^Brs. usual. {fr. Innom. 89 R 3 mid. Th. Cart, gives Super. Thyr. fh&s close be- L 41 Th. Cart. 1 hind it the < Left Vert., j which is 4 f The only Sterno-Mastoid br. is fr. \Occipl. Other Brs. usual. finches long. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID-BRANCHES. No. Side f the Body. Length in Inches. Place of Division. Peculiarities. 90 R 4 OsH. usual. L 6 Os H. Lingl. and Facl. by a com. origin. 91 R 4 above Th. Cart. usual. L 4* Th. Cart. f Lingl. and Facl. fr. a com. trunk of \ origin. ["distance between Super. Thyr. and 92 R 3 Th. Cart. I the next brs. 1 inch. Lingl. and 1 Facl. close at their origin. Other [_Brs. usual. L 5 OsH. f Super. Thyr. <. given at the I bifurcation. {space between Brs. as on R. side. Lingl., Facl. and Occipl. close together at their origin. Other Brs. usual. 93 R Th. Cart. ("Super. Thyr. < given at the |_ bifurcation. Lingl. and Facl. arise by a com. origin. (" a little below 94 R 3* < upper margin Laryngl. a separate br. of Ext. Car. 1 of Th. Cart. L Th. Cart. usual. 96 R % <* Th. Cart. usual. L 4i nearly usual. /'Laryngl. a separate br. of Ext. Car. Lingl. and Facl. by a common 97 R Si 1" below upper < margin of Th. [Cart. origin rather the former given from 1 the latter. A small artery given fr. | Ext. Car., in the usual position o1 the Lingual, ramifies over the Mylo- hyoid muscle (it corresponds to ^Hyoid br. of Lingl. ?) L f below upper 4 margin of Th. [ Cart. f gives Super \Thyr. f Laryngl. a separate br. of Ext. Car. \ Other Brs. usual. 98 R 4f above Os H. ("gives Pharyn- < gl. in the bi [ furcation. ["the Brs. given close to origin of Ext. I Car. Super. Thyr. and Lingl. j descend to their destination. Brs. I |Jn other respects usual. L 6ft above Os H. ("gives Pharyn < gl. in the bi (_ furcation. f arrangement of Brs. same as on the Bright side. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. 99 R 3f OsH. fRegular intervals between the Brs. J at their origin, but considerable ppace j between the terminal Brs. and those [_below : in other respects usual. L 5 the Super. -Thyr. usual. 100 R H Usual. L 5 Th. Cart. nearly usual. 101 R 4 the Super. Thyr. usual. L 5 Os H. Tgives a small I Super. Thyr. | and a separate [_Laryngl. br. usual. 103 R Si Th. Cart. {Pharyngl. and the only Sterno- -j Mastoid br. fr. Occipl. Other Brs. ( usual. {"joined to In- nom . at its L Th. Cart. origin. Pha- ryngl. fr. the bifurcation. 104 R 3* above Th. Cart. C Lingl. and Facl. by a com. origin. I Other Brs. usual. L 5* ( Lingl. and Facl. arise by a com. trunk. | Other Brs. usual. 105 L 5| f given from I Innom. usual. 106 R 4 Th. Cart. ( St.-Mastoid a separate br. of Ext. < Car. Post. Auvicr. arises close to the C terminal brs. Other Brs. usual. L Th. Cart. usual. 107 R Th. Cart. nearly usual. L the Super. Thyr. ( Laryngl. given separately from Ext. ( Car. Other Brs. usual. 110 R 4 Th. Cart. (Thyr. very small. Facl. gives a large Palat. br., which supplies de- ficiency of a small Pharyngl. Oc- cipl. continued from the " cervicalis ascendens " (br. of the Infer. Thyr.) Other Brs. nearly usual. THE CAROTID ARTERIES. 65 f*- COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length Inches. Place of Division. Peculiarities. < very close to L ^ Innom. at ori- Igin. ( The Brs. arise at regular intervals. Ill R 4 Th. Cart. -< and are nearly as usual in their dis- ( tributions. /^5 Brs., viz. Lingl., Facl., Pharyngl., Sterno-Mast., and Occipl., arise close to origin of Ext. Car. A L 5 OsH. the Super. Thyr. \ second Sterno-Mast. br. fr. Occipl. Palat. br. of Facl. large, and does not pass between the Stylo-Gloss, and \^Stylo-Pharyng. muscles. f Thyr., Lingl., Facl. and Occipl. arise j close to beginning of Ext. Cart. 112 R 4| OsH. < Post. Auricr. arises in mid. of interval j between the preceding and the two ^terminal brs. ( very close to L < Innom. atori- 113 R 4* Th. Cart. /Lingl. and Facl. by a com. origin. \ Other Brs. nearly usual. L 5 {Lingl. and Facl. by one origin. Other Brs. nearly usual. 114 R f The only St.-Mastoid br. is given \fr. Occipl. Other Brs. usual, {Thyr. unusually small. Lingl. and K C a little above Facl. by one origin. Only St.-Mas- O 1 Th. Cart. toid br. is fr. Occipl. Pharyngl. fr. Intern. Carotid. (The Brs., except the Post. Auricr. and the terminal ones, arise close to 115 R 4 the beginning of Ext. Car. Lingl. and Facl. fr. a com. origin. St.- Mastoid a separate br. of Ext. Car. 116 R H f below upper < margin of Th. f Occipl. and Pharyngl. arise consider- < ably higher than usual j the former CCart. C gives P. Auricr. L 4* Th. Cart. same arrangement as on the right side. 117 R 4| Os H. - } Occipl. gives Pharyngl. Other Brs. ^ usual. 66 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length Inches. Place of Division. Peculiarities. L 5 ("gives Pharyn- < gl. from bifur- 1 catioD. fLaryngl. a separate br. of Ext. Car. J Occipl. arises fr. beginning of Ext. j Car. and gives P. Auricr. In other [_ respects the Brs. usual. 118 R Th. Cart. usual. L Th. Cart. ^ Lingl. and Facl. by one origin. 1 Other Brs. nearly usual. ("Occipl. and Pharyngl. by a com. 120 R 4 4 trunk fr. Intern. Carotid. Other [_Brs. usual. 121 R 4* C'2 Super. Thyroid brs. of equal size 122 R 3| J arise close one to the other, and both j arch downwards in the same way as [ the single Br. usually does. L mid. Th. Cart. nearly usual. 123 L 5 TThyr. very small. 2 small unusual 124 L J Brs. arise close to it, (their destina- j tion is not noted). Other Brs. (^ usual. 127 R Os H. fOccipl. arises much higher than usual L the Super. Thyr. I and gives Post. Auricr. Other Brs., | except the terminal, arise close to the [_beginning of Ext. Car. 129 R 4 Th. Cart. nearly usual. (rises lower than usual on fThyr. given immediately at the origin L ** Th. Cart. the Arch of Aorta, and J of Ext. Car. Lingl., Facl. and Oc- ] cipl. 1 inch higher. Pharyngl. fr. close to the L Occipl. Innom. 131 R 3 } opposite the I Cricoid Cart. i Thyr. arises one inch above Com. < Car. The other Brs. are given in ^ succession at considerable intervals. L 4 ( opposite the I Cricoid Cart. [" the origin is < very close to L that of Innom. { Brs. arise at a considerable distance \ fr. the beginning of Ext. Car. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. 135 Side f the Body. R Length Inches. Place of Division. Peculiarities. above Th. Cart. Sterno-Mastoid br. given separately fr. Ext. Car. Sublingl. br. arises fr. Facl., and perforates the Mylo- Hyoid muscle. Occipl. superficial to Trachelo-Mastoid muscle, and per- forates the Splenius and Sterno- Mastoid near their inner or posterior ^margins. Other Brs. usual. L OsH. the Super. Thyr. 136 R *i Th. Cart. usual. L 6 above Th. Cart. (Ext. Car. passes between Digastric and Stylo-Hyoid muscles covered by former, superficial to the latter. The Brs. arise at considerable in- tervals one from the other ; in other respects they are nearly as usual. 137 R ("given fr. the [Arch of Aorta. L origin is L J close to In- | nom. and to [_the L. Suhcl. 174 R 3f Th. Cart. f Lingl. and Facl. very close at their \origin. Brs. usual. L 4 Th. Cart. nearly usual. 176 R 3 Th. Cart. f Infer. Palat. a separate br. of Ext. L Car. Other Brs. nearly usual. L Th. Cart. f gives Pharyn. \atbifurcation. ( Lingl. and Facl. by one trunk o < origin, which is close to Thyr. am ( Pharyngl. Other Brs. usual. 177 L ft /gives Pharyn. \ at bifurcation. usual. {Ext. Car. measures 3 inches. Lingl. and Facl. by a com. origin, which, 178 R 2f flower part of \ Th. Cart. with Pharyngl. and Occipl., arise close together at ^ inch from begin- ning of Ext. Car. Brs. in other respects usual. C Ext. Car. measures 3 inches ; at 1 fjoined to In- I inch from its commencement arise the L 41 J~ lower part of \ Th. Cart. " J nom. or given 1 fr. it; gives J Lingl. and Facl., (by a com. trunk^ | with the Occipl., Palat., Pharyngl., l_Super. Thyr. 1 and a Muscular br., all close to- Vgether. Post. Auricr. fr. Occipl. fExt. Car. 2f inches in length. I Thyr., Lingl., Facl., Occipl. and 179 R 3f Th. Cart. < Post. Auricr. arise at nearly equal 1 distances one fr. the other. Pharyngl. (jr. Occipl. ( very close to -. L -c Innom. at ori- (gin. /'Ext. Car. 2| inches long. Thyr. given at beginning of Ext. Car. as usual. Lingl., Facl., Occipl. and 180 R Th. Cart. Pharyngl. arise all together 1 inch higher up. Stylo-Mastoid br. of Post. Auricr. larger than the con- tinued vessel. 2 Pharyngl. brs., ^the second given by Occipl. TExt. Car. 2^ inches in length. Brs. L J same as on opposite side, except that 1 Occipl. does not give a Pharyngl. br. [_and Post. Auricr. is disposed as usual. THE CAROTID ARTERIES. 71 COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. {Ext. and Int. Carotids very tortuous. Ext. Car. 2 inches long. Lingl., 181 R 51 the Super.Thyr. Facl. (given fr. a com. origin), Palat. and 2 Pharyngl. brs. arise fr. begin- ning of Ext. Car. Post. Auricr. fr. the beginning of Occipl. TExt. Car. measures 2^- inches, and j is superficial to Stylo-Hyoid muscle. L < Thyr., Lingl., Facl. and Occipl. given j close to origin of Ext. Car. Brs. in Bother respects usual. f Ext. Car. 2^ inches long. It gives j Thyr., Lingl., Facl., Pharyngl. and 182 R 5 Os H. <( Occipl. in succession within f- inch j of origin. The other Brs. and the ^distribution usual. 'inclines from Innom., near wh. it arises, towards L. Subclav., and L Th. Cart. < is unusually usual. close to that artery as far as the upper margin of the ^ Thorax. f Ext. Car. 2 inches long. Thyr., 1 Lingl., Facl., Occipl. and Pharyngl. 183 R Os H. t arise all within % inch fr. beginning j of Ext. Car. Post. Auricr. midway ^higher up. | Brs. very nearly as on the right side L Os H. < 2 Palat. brs., one from Facl., as (usual, the other fr. Lingl. {Ext. Car. 3 inches long. Thyr., Lingl., Facl. and Occipl. arise within 184 R 1 inch fr. beginning of Ext. Car. Pharyngl. given fr. Int. Car. Other Brs. usual. f the Brs., except the Post. Auricr. and L < the terminal ones, arise fr. Ext. Car. (within % inch of its origin. ^Ext. Cart. 2 inches long. It gives 2 Super. Thyr., a separate Laryngl., Lingl., Facl., Occipl. and Pharyngl., all within | inch of its origin. Post. 185 R 3 s Th. Cart. I Auricr. rises beyond the preceding * | brs., midway to end of Ex. Car. The Thyr. brs. are of nearly equal size, and both arch downwards and supply the Thyroid body ; the lower Vone furnishes brs. to the muscles. 72 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length Inches. Place of Division. Peculiarities. L Th. Cart. r rises vcryclose J tolnnom. and | gives Super. [Th. TLingl., Facl., Occipl. and Pharyngl. J arise together at f inch from 1 origin of Ext. Car. P. Auricr. as [_ usual. 186 R Os H. (Ext. Car. 2f inches long. Thyr., j Lingl., Facl., Occipl. and Pharyngl. < arise at intervals within 1^ inch fr 1 commencement of Ext. Car. Post. V. Auricr. fr. Occipl. L ' Th. Cart. fExt. Car. 2f inches long. The Brs., 1 except the terminal ones, given at ^ intervals within 1 inch of the origin j of the Ext. Car. Thyr. and Lingl. ^arise by a common origin. 'very close to R. Subclav. for some dis- 187 R tance from < origin ; gives Super. Thyr. ; all the arte- | Ext. Car. 2 inches long. Lingl. < and Facl. by a com. origin. Other (firs, usual. ries are much ^curved. L the Super. Thyr. f Ext. Car. 2 inches in length. Lingl., J Facl., Occipl. and Pharyngl. given | very close one to the other. Brs. in Bother respects usual. 188 R !Ext. Car. 2 inches long. Thyr., Lingl., Facl., Occipl. and Pharyngl. arise within -^ an inch fr. origin of Ext. Car. In other respects the Brs; are usual. L (Ext. Car. 2 inches long-. Thyr., Lingl., Facl., Occipl. and Pharyngl. arise within ^ inch of beginning of Ext. Car. P. Auricr. 1 inch h'gher. 191 R the Super. Thyr. /'Ext. Car. 3^- inches in length. Lingl., Facl., Occipl. and Pharyngl. given together at 1 inch fr. origin < of Ext. Car. Lingl. and Facl. by a com. origin. Palatine is a sepa- rate br of Ext. Car. In other respects V^Brs. usual. L | arises fr. In- < nom ; gives (Super. Thyr. t Ext. Car. 3^ inches long. Lingl. < nnd Facl. arise by a com. trunk. (Other Brs. usual. THE CAROTID ARTERIES. 73 COMMON CAROTID. * EXTERNAL CAROTID BRANCHES. Side Length No. of the in Place of Division. Peculiarities. Body. Inches. Ext. Car. 2 inches long and divides lower than usual. Thyr. small. Lingl., Facl., Pharyngl. and Oc- cipl. arise close one to the other, at 1 inch distance fr. beginning of ! Ext. Car. Post. Auricr. arises with 192 R i the terminal brs. Trans. Facl., ol large size, springs from the Temporal 1 inch above the Intern. Maxillary, . and inclines downwards and inwards j over the Masseter muscle to supply the upper lip and side of the nose. Facl. ends in the lower lip. 1 Ej^^Car. 2^ inches long. Lingl., OcapT; and Pharyngl. arise at the distance of inch above the Coin. ("gives Super. Car. Facl. at 1 inch. Post. Auricr. L 0H. 1 Thyr. and j Laryngl. se- arises still higher, as usual. Trans. Facl. is given at the end of the Ext. (^parately. Car., and, as on the right side, sup- plies the upper lip and the nose instead of the Facl., which does not ascend so far. 'Ext. Car. 2 inches long. The 193 R (the Carotid partly covers the R. Subcl. near the ori- Branches arise at considerable in- tervals one from the ether ; may be , said to be diffused over the parent vessel. The origin of the Facl. is higher than usual, and close to the gin. Post. Auricr. Brs. in other respects usual. L J [" Pharyngl. is < given fr. the \_ hi furcation. {Thyr., Laryngl., Lingl. and Occipl. are given close together fr. the origin of Ext. Car. In other respects Brs. usual. TExt. Car. 2^ inches in length; tor- j tuous. Thyr. and Occipl. arise at 194 R H Th. Cart. J distance of ^ inch above Com. Car. j Lingl. and Facl. by a com. trunk 1 above preceding. Pharyngl. is given \^fr. Occipl. Other Brs. usual. 'Ext. Car. gives no brs. except at its upper and lower ends. Thyr., Lingl., Facl. and Occipl. arise close to the j Com. Car. Lingl. and Facl. are given fr. acorn, trunk, to the begin- ning of wh. the Thyr. is joined. Ext. Car. divides into Post. Auricr. Tempi, and Int. Maxillary. 74 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Sid of th Bodj Length e in r. Inches. Place of Division Peculiarities. (Ext. Car. 2| inches long. Thyr. is ' - 1 larger than usual, and sends a thic 195 j R Th. Cart. Ahe artery \ j an inch fro 1 its origin c br. , which crosses obliquely over the Crico-Thyr. membrane to the o < posite side of the Thyr. body. Ling 1 vers, or Ij J anteriorto,th Facl., Occipl. and Pharyngl. are inch distant from Com. -Car. in their VR. Subclav. origins, which are all close together. ^Post. Auricr. usual. f rises from In ("Facl., though of good size, is ex- L Th. Cart. < nom. & gives < pended chiefly below the Inferior (.Super. Thyr. L Maxilla. Other Brs. nearly usual. (Ext. Car. 2^- inches in length. Ling] 196 L the Super. Thyr. Facl. and Occipl. arise close together at distance of % inch fr. Com. Car. P. Auricr. higher in origin, as usual. Brs. in other respects usual. (Ext. Car. measures 2 inches. The j Branches are given at considerable 197 L Th. Cart. ^ intervals one after the other, am j present the usual disposition in their ^distribution. 198 R Os H. ("gives Super. Thyr. at junc- tion with Ext. f Ext. Car. 2 inches in length. Brs. \ usual. ^.Car. "at its origin is 198 a L closer to L. Subclav. than /Intern. Maxillary arises by a com. \ trunk with Facl. Other Brs. usual. _to Innom. 199 R 'almost com- pletely covers the R. Subcl. f Ext. Car. 2f . Lingl. gives Palat. | artery. 2 Pharyngl. (one is given fr. bifurcation of Com. Car., the for some dis- tance above other ^ inch higher up). Other Brs. Jnnom. i^ usual. fExt. Car. 2^ long. Lingl., Facl., Occipl. and Phar. arise close one to L the other at the distance of $ inch fr. Com. Car., close to wh. is the origin ^ of Thyr., as usual. Post. Auricr. usual. 'Ext. Car. measures 3 inches. Thyr. very small. Lingl. and Facl. by a com. origin. The foregoing, with 200 R Pharyngl. and a muscular br., arise within the space of ^ inch fr. Com. Car. Occipl. at 2 inches fr. same, and gives Post. Auricr. THE CAROTID ARTERIES. 75 COMMON CAROTID. EXTERNAL CAROTID BRANCHES. Side No. of the ! Body. Length in Inches. Place of Division. Peculiarities. Tthe Brs. arise at considerable in- 201 R Th. Cart. J tervals one fr. the other. The origin | of Thyr. higher than usual. Brs. (jn other respects usual. L Th. Cart. Brs. nearly usual. 202 R Th. Cart. I" Ext. Car. 2 inches long. 2 small L Th. Cart. I Pharyngl. brs. Thyr., Lingl., Facl. [and Post. Auricr. usual.j 'the com. Car. is altogether covered in the neck by the 202 a Intern, jug. (male Os H. - vein; and the adt.) Vagus also lies on or anterior to it for the greater part of its extent. "covers origin of R. Subcl. and is crossed f Ext. Car. 2| inches in length. Thyr. 203 R by a br. from < infer. Thyr., j and Lingl. usual former is small. < Facl., Occipl. and Pharyngl. are wh. also gives j given at distance of 1 inch fr. Com. the usual Th. V^Car. P. Auricr. usuaL. artery behind the Com ..Car. L Th. Cart. jrises fr. Innom. 204 R ("partly covers < the beginning [ofR.Subclav. TExt. Car. 2 inches long. Thyr.. J Lingl., &Post. Auricr. usual ; Facl., \Oceipl., and Pharyngl. arise together at ^ inch distance from Com. Car. L Th. Curt. ; Ext. Car. measures 2f inches in length Thyr., Lingl., Facl. and Post. Auricr. \usual. Occipl. arises in bifurcation of the Com. Car. and gives Pharyngl. 205 R Th. Cart. 3rs. usual. L Th. Cart. rhyr. very small. Other Brs. usual. fExt. Car. 2 inches long. Thyr., 206 R Th. Cart. J Lingl. and Post. Auricr. usual. Facl., j Occipl. and Pharyngl. arise inch l^above Com. Car. 7 THE CAROTID ARTERIES. 81* R ltaerfl * {itCtat Ik Cart. Ik Cart. Ik A ffcuCart, TluCart. 2f iadkcsmlcagtk. Est. Car. tatSaaCT.TjE. r Gnu. Car. iada aWre CM. Car. (tw by a caau traak). Past. Anier. Oar. FaeL, f Elt. Car. seance k* tka 2 Fad. oA as lafoal aaaL Tk af OeriaL k k%kcr tkaa Car. fa&m. fr. Est. Mia bfc Oat ^ iadcs laag. Ifcyr. L Lia^., Fad. aad OcoaL "^" """ vUdkigpicaithen 2 sanQ Pknp^L IOL fr. Ext. Car. .Car. FaA, OedaL bL Car. F_E-.. Car, -^ Fad. fr. ca4 f THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. Side No. of the Bod jr. Lenjrth in Place of Division. Inches. Peculiarities. fExt. Car. 2f inches long. Brs. 212 R Th. Cart. I usual, except Pharv ngl., which arises 1 at a distance of 1 inch fr. Com. [_Car. L Th. Cart. JExt. Car. 2f inches long. Bre. \ usual. f arises close to JL. Subclav. * 213 L < and at distance I of 1 inch fr. ^Innom. 214 R Th. Cart. f Ext. Car. 3 inches long. The Brs. < separated by large intervals at their [ origin. L the Super. Thyr. {Lingl. and Facl. arise above Occipl., at the distance of 1 J and 1^ inches fr. Com. Car. 215 I" Ext. Car. 2| inches in length. Thyr., < Lingl. and Facl. arise immediately [fr. beginning of Ext. Car. {Ext. Car. 3A inches long. Thyr., Lingl. and Facl. usual. Occipl. 216 J* Th. Cart. gives Pharyngl. Post, Auricr. arises within inch of upper end of Ext Car., and approaches Occipl. on the Scull. ' fall except Post. Auricr. and the ter- minal brs. arise fr. the beginning of Ext. Car. Lingl. and Facl. by one L usual. < trunk. 3 small Pharyngl., one of which is given at bifurcation of Com. Car. Occipl. is superficial to the ^Trachelo-Mastoid muscle. f Ext. Car. has the Stylo-Hyoid muscle I under it. The Brs. arise close to the 217 R 0* H. the Super. Thyr. < origin of the parent vessel, except 1 the Post. Auricr. and the terminal ihe origin is close to In- uom., and at L 4 greater dis- tance than usual from L. ^Subclav. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No Side of the Body. Length in Inches. Place of Division. Peculiarities. 218 R Th. Cart. Ogives Super. Thyr.,of wh. a large br. is { directed to the opp. side over the Crico-Tb. ^membrane. {Lingl. and Facl. are given fr. a com. origin. Laryngl. is a separate br. of Ext. Car. Facl. gives an unusually large Infer. Labial br. Temporal furnishes a large br. over the orbit. In otber respects Brs. usual. fThyr., Lingl., Facl. and Occipl. are 219 R usual. I given immediately at origin of Ext. J Car. Three first nearly joined toge- l_ther. Other Brs. usual. L f higher than \ usual. / Ext. Car. 2 inches in length. Brs. \ usual. 220 R usual. f gives Super. \fiijr. [ Ext. Car. 3 inches long. Brs. usual, l_ except absence of Thyr. {Ext. Car. 2f inches long. Lingl. and Facl. arise close together at dis- L usual. tance of 1 inch above Com. Car. Occipl. and Phar. at -J inch distance fr. same. Other Brs. usual. 221 L fr. innom. f Ext. Car. 2| inches long. Thyr. is very small. Laryngl. arises sepa- rately fr. Ext. Car. above preceding. 222 L usual. J Lingl. and Facl. given fr. a com. J trunk, which, with Occipl., Pharyngl. and a Hyoid br., arise close together at 1 inch distance above Com. Car. l^Post. Auricr. usual. fThyr. and P. Auricr. usual. Lingl. 223 R usual. 1 J and Facl. arise by a com. trunk. | Occipl. gives Pharyngl. Palat. is a (_ separate br. of Ext. Car. fThyr. small (the Infer, is larger than j usual). Lingl. and Facl. are close L 4* J above Thyr. t Cart. J in their origin. Laryngl. is given j separately fr. Ext. Car. Intern. j Maxillary under the Ext. Pterygoid (^muscle. 225 R usual. f gives Super. \Thyr. ("Ext. Car. 2 inches long. Lingl. < and Facl. given by a com. origin. (_ Other Brs. nearly usual. fExt. Car. 2f inches long. The Brs. L J arise at considerable intervals, and in | other respects present the usual ar- l_rangement. THE CAROTID ARTERIES. 7'J T^ COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side >f the Body. Length Inches. P)ae of Division. Peculiarities. 1" Ext. Car. 2- inches long. Sterno- 226 R 41 OsH. < Mastoid br. given fr. Ext. Cat. |_ The Brs. usual. fLingl. and Facl. rise higher than usual and descend to their destination. Occipl. is directed backwards beneath 227 R Os H. 1 the trans, process of the first Cervical Vertebra. Intern. Maxillary is under Ext. Pterygoid muscle, close to Infer. Maxillary division of the 5th V^nerve. f On this side the Intern. Maxillary is L superficial to Ext. Pterygoid muscle. 228 R f Facl. supplies the Sublingl. gland. \ Other Brs. usual. {Ext. Car. measures 2^ inches. La- ryngl. arises fr. Ext. Car. above 230 R 3f J above the Th. \ Cart. Thyr.; Occipl. gives Pharyngl. In- tern. Maxilly. under Extern. Ptery- goid muscle. In other respects the Brs. are as usual. ff hyr. smaller and its deficiency sup- 233 R J plied by the Infer. Thyr. Laryngl. ] arises fir. Ext. Car. Pharyngl. fr. [_ Occipl. f~2 Thyroid brs., which are smaller L close to Os H. J than the Inferior. Laryngl. is a | separate br. of Ext. Car. Occipl. (^gives Pharyngl. 234 R above Th. Cart. {rises in com- mon with L. Car. {Lingl. and Facl. given fr. a com. origin. Occipl. is continued from the ascending cervical br. of the Infer. Thyroid. ! rises by 11 trunk com- Tint. Maxillary under Ext. Pterygoid Os II. mon to it, J muscle : on the right side it is over and R. Car. ; j or superficial to that muscle. Other gives Super. [_Brs. usual. Thjr. !Lingl. and Facl. fr. a com. trunk,, the former ends at the side of the nose. 235 R above Th. Cart. Pharyngl. and Infer. Palat. arise as separate brs. of Ext. Car. at the distance of 1 inch fr. the Com. Car. Other Brs. usual. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of th Body LenKth Inche.. Place of Division. Peculiarities. L fr. Tnnom. 236 L Th. Cart. Tclose to In- J nom. and to | L. Subclav. at (^origin. {Ext. Car. 2| inches long. Laryngl. is very small and rises fr. Ext. Car. Occipl. and Pharyngl. are slightly joined at their origin. Other Brs. usual. 237 R Th. Cart, f gives Pharyn. < in the bifur- (_ cation. J" Occipl. rises higher than usual am \ give Post. Auricr. Other Brs. usual. fThyr. very small. Facl. ends at the 238 R 0H. I side of the nose, and is assisted by | the Intern. Maxillary. In other (^respects the Brs. usual". 240 f Occipl. gives Pharyngl. The other (_ Brs. usual. 241 R above Th. Cart. J arises within \ the cheat. Brs. usual. 242 R Th. Cart. / Ext. Car. 3^ inches long. Pharyngl. \fr. Occipl. Other Brs. usual. {opposite the 244 R Cricoid carti- lage. f opposite the L < Cricoid carti - |>ge. f Occipl. arises fr. Intern. Carotid and 245 R usual. s gives Pharyngl. Brs. nearly usual L in other respects. f Facl. is smaller than ordinary. Infer. 246 R usual. < Palat. is given fr. Ext. Car. Other [Bra. usual. L usual. I" Thyr. very small. Lingl. and Facl. < by a single trunk of origin. Palat. [ arises separately fr. Ext. Car. 247 R 8* I" below upper < margiu of Th. [Cart. r covers or lies anterior to R. ^ Subclav. after [_ origin. fExt. Car. 2 inches long. Pharyngl. 1 absent. Palat. a separate br. and runs between the Stylo-Glossus and ^Stylo-Pharyngeus muscles. L su al. sual. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. (Ext. Car. 2 inches long. Lingl. and Facl. arise by a com. trunk. Thyr., Pharyngl., Occipl. and Post. Auricr. usual. Intern. Maxilly. is 248 R 3* Th. Cart. for a short space beyond the condyle \ of the lower Maxilla, covered by the Ext. Pterygoid, the middle of which it perforates from within outwards, and then inclining forward over or superficially to the muscle, is disposec V^as usual. 'the Ant. Jug. vein is very large, & com- municates g with the Int. Jugular over 1- L the External | I 1 and Internal Carotid arte- ries. The Int. Jugular vein covers the Com. Car. for some space. 249 R H Th. Cart. Brs. usual. {Lingl. and Facl. from a com. trunk. L l above Th. Cart. Occipl. is unusually high in its origin. Pharyngl. fr. Intern. Car. 250 R 31 J middle of Th. JBrs. of Ext. Car. usual. Intern. 8 \ Cart. \ Carotid measures 3^- inches. ("middle of Th. \ Cart. /'Occipl. arises opposite Thyr. Pha- ryngl. given by Intern. Car. Intern. Maxillary passes under Ext. Pterv- ("covered at its goid muscle and between the Gus- 251 R usual. J upper part by | the Ant. Jug. [^ vein. 1 tatory and Dental bis. of the 5th j nerve, which are connected by a transverse Branch below the vessel. At the anterior part of the muscle. the artery is seen to curve forwards ^and inwards, as usual. (gives Super. Thyroid and [" Sterno-Mast. and Palat. are separate L usual. Pharyn. ; the j brs. of Ext. Car. Post. Auricr. fr. latter in the [ Occipl. Other Brs. nearly usual. bifurcation, j r,2 THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of th Body Length Inches. Place of Division. Peculiarities. fExt. Car. 2| inches long. Pharyngl. 252 R H / middle of Th. I Cart. 1 is given fr. Occipl., and crosses over | the Intern. Car. in its course in- [_ wards. 253 R usual. L usual. Thyr. of small size. Other Brs. usual. ( Lateral nasal br. is given from the Ophthalmic artery. Infer. Palat. arises separately fr. Ext. Car. In- tern. Maxillary is at first under Ext. Pterygoid ; it perforates the middle of the muscle, and after coursing forward or superficially to it, enters 254 R 3f above Th. Cart 1 the Spheno-Maxillary fossa in the \ usual way, while, concealed by the Pterygoid muscle, the artery is ex- ternal (superficial) to the Infer. Max- illary division of the 5th nerve, and is crossed by a Branch which com- municates between the Temporo- Auricr.and the Dental nerves. Other vBrs. usual. ( Lingl. and Pharyngl. joined at their (origin. Intern. Maxillary is under L usual. he Super. Thyr. Extern. Pterygoid muscle, and runs | through the brs. of the Infer. Max- 1 illary division of the 5th nerve. Bother Brs. usual. 256 R J Lingl. and Facl. fr, a com., origin. \ Other Brs. usual. fa Thyr. br. (the 5th in L isual. 1 this case) ari- j sesatthejunc- J Lingl. and Facl. by a com. origin. \ Other Brs. usual. 1 tion of L. Car. ^and Innoin. f Intern. Maxillary lies under cover of the Extern. Pterygoid muscle ; it 257 R usual. curves in a small space outwards, and | then forwards and inwards to the Spheno-Maxillary fossa, more dis- ( tinctly than usual. ["Intern. Maxillary on this side is Ex- L siial. ternal or superficial to the Extern. Pterygoid muscle. Pharyngl. arises Jr. Occipl. THE CAROTID ARTERIES. 83 COMMON CAROTID. EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. Tgives Super. fExt. Car. gives a br., -which ramifies 258 R Th. Cart. 1 Thyr. at the j point of bifur- l^cation. J in the Stylo-Glossus and Stylo-Pha- j ryngeus muscles. Thyr. small. Other (_Brs. usual. L usual. C Thyr. small. Lingl. and Facl. by a fc. ( com. origin. 259 R usual. 260 R usual. j Thyr. a small br. Lingl. and Facl. 1 by a com. origin. Other Brs. usual. fPalat. given separately fr. Ext. Car. Intern. Maxillary under the Ext. Pterygoid muscle which it perforates L the Super. Thyr. < exactly at the middle, and then, after coursing forwards and inwards over the muscle, ie disposed in the usual V^way. Other Brs. usual. 261 R usual. Fhyr. a large br. Other Brs. usual. L above Th. Cart. the Super. Thyr. Brs. usual. 262 R Os H. {gives Super. Thyr. and one of two Pha- ("2 Pharyngl. brs. in this case. The J smaller is given in the bifurcation of | Com. Car. The larger arises fr. t ryngl. brs. [^Ext. Car. 1 inch above the Com. Car. 264 R Os H. f gives Super; < Thyr. at point [of bifurcation. TLingl. and Facl. fr. a com. origin. I Pharyngl. fr. Oceipl., which arises | below preceding br. Other Brs. (^usual. /'Thyr. small. Lingl. and Facl. by a com. origin ; fir. Facl. are given two brs., one very small, after passing betw. the Stylo-Gloss, and Stylo - 265 L '*l fr. Innom. ( Pharyngl. is soon lost in the muscles; the second larger, runs anteriorly to the first named muscle and ramifies in the Intern. Pterygoid. Other ^Brs. usual. {Lingl. gives the Submental, which - pierces the Mylo-Hyoid muscle fr. 269 R usual. within outwards. Pharyngl. arises fr. Occipl., and is large at the same time that the Infer. Palat. is a small br. Other Brs. usual. 270 R f Thyr. larger than usual. Other Brs. \ usual. THE CAROTID ARTERIES. COMMON CAROTID. EXTERNAL CAROTID-BRANCHES. No. Side of th Body Length in Inches. Place of Division. Peculiarities. fThyr. large and gives a considerable I br., which crosses to the opposite side ] over the Crico-Thyroid membrane. ^Other Brs. nearly as usual. ["The Brs., except Post. Auricr.and the 271 R the Super. Thyr I terminal, arise close to the beginning | of Ext. Car. Lingl. and Facl. given |^fr. a com. origin. Other. Brs. usual. f Several Brs. arise from the beginning of the Ext. Car. The Soft Palate is supplied fr. the Pharyngl. Facl. L OsH. the Super. Thyr I gives brs. to Intern. Pterygoid 1 muscle in the place of Palat. Sub- inaxillary gland receives a br. fr. the Lingl. as well as brs. from the ^Facl. Other Bra. usual. /'Palat. br. of Facl. ends on the Tonsil. I Pharyngl. larger, and supplies the 272 R < Soft Palate. Intern. Maxillary under I Extern. Pterygoid muscle. Other l^Brs. usual. r Laryngl. and Palat. are separate brs. 273 R isual. 1 of Ext. Car. Pharyngl. arises fr. | Occipl. ; does not supply the Soft (_ Palate. f Laryngl. and Palat. each separately L he Super. Thyr. 1 fr. Ext. Car. Pharyngl. fr. Occipl. j Intern Maxillary under the Extern. (^ Pterygoid muscle. ("Lingl. and Facl. fr. a com. origin. 274 R feal. - < Intern. Maxillary under Extern. [_ Pterygoid muscle. Other Brs. usual. 275 R ("gives Super. I Thyroid anc | Laryngl. sepa- f Palat. a separate br. of Ext. Car. ]_ Other Brs. nearly usual. (j-atcly. f" Palat. a separate br. of Ext. Car. L < Tonsil receives a distinct Br. fr. [Facl. Other Brs. nearly usual. 276 L TLingl. and Facl. by a com." origin. I A distinct Br. is given to the Tonsil. 1 Intern. Maxillary under Extern. [_ Pterygoid muscle. 277 R f The Facl. arises above the Digastric \ muscle. THE CAROTID ARTERIES. COMMON CAROTID. f + EXTERNAL CAROTID BRANCHES. No. Side of the Body. Length in Inches. Place of Division. Peculiarities. 'Lingl. and Facl. by a com. origin ; the latter gives besides the Palat. a distinct br. to the Tonsil. Pharyngl. 278 R U3lial. < arises fr. the origin of the Linguo- Facl. trunk, and does not send any br. to the Soft Palate. Other Brs. usual. ("Facl. gives Palat. and Tonsil, brs., 281 R I which supply respectively the Soft | Palate and the Tonsil. Pharyngl. [does not supply the Palate. 290 L usual. /Left Palat. (fr. Facl.) supplies the \ Soft Palate. ' Other Brs. usual. . f Thyr. sends a large br. over the 291 R usual. < Crico-Thyr. membrane to the opposite [side. Other Brs. usual. Bti COMMON CAROTID ARTERIES. ABSTRACT OF THE TABLE. Right side. . NUMBER less than 3 inches ...... ... 2 3 inches, not exceeding 3 . . ..... 21 more than 3, not exceeding 4 ...... 24 more than 4, not exceeding 4| ....... 15 more than 4^, not exceeding 5 ...... 5 more than 5, not exceeding o ....... 1 Left side. less than 4 inches . . . . . * . .0 4 inches, not exceeding 4^ . ...... 11 more than 4-|, not exceeding 5 . . . . * . .18 more than 5, not exceeding 5 ...... 9 more than 5, not exceeding 6 ........ 9 more than 6, not exceeding 6 ..... . .2 PLACE OF DIVISION. Opposite the Cricoid Cartilage R ..... 2 L ...... 3 Below upper margin of the Thyroid Cartilage R. 17 L. . . . 9 -- 26 Opposite upper margin of the Thy. Cartilage R. . .105 L. . . . 79 -- 104 Above Thyr. Cartilage R. . ..... 15 L ........ 8 -- 23 Opposite Os Hyoides R ........ 29 L ......... 18 -- 47 Above Os Hyoides R ........ 3 L. . . . . ... 7 -- 10 EXTERNAL CAROTID ARTERIES BRANCHES. The facts contained in the part of the table which refers to the External Carotid Arteries and their Branches, will be made use of in the observations on those vessels. 17 EXPLANATION OF PLATE VIII. THIS plate shows the arteries at the upper part of the neck, and the side of the face and head. The tendinous fibres in which the occipital part of the occipito- frontal muscle ends ; in front this tendon is continued by a mem- branous structure to the fibres of . the frontal part of the same mus- cle, arid at the side it receives the attachment of the upper muscle of the pinna of the ear. Frontal part of the occipito-frontal muscle. The superior muscle of the ear ; below it are a few muscular fibres the anterior muscle of the same part ; and both are connected by a membranous, or, as it appeared, a musculo-membranous structure, to the outer margin of the muscle marked b. Orbicularis palpebrarum ; from it a few pale fibres descend to the lip in connexion with its Levator. Levator Labii superioris. / Levator anguli oris. g Zygomaticus. h Orbicularis oris. i Depressor labii inferioris. k Depressor anguli oris. / A portion of the Platysma myoides. m Buccinator. n Masseter. o A little of the parotid gland and the duct. p Digastric. q Stylo-hyoid. r Mylo-hyoid. s Hyo-glossus. t Os Hyoides. u Thyroid cartilage. v Sterno-hyoid. w Omo-hyoid. x Sterno-thyroid. a? 1 Thyro-hyoid. y Sterno-cleido-mastoid. z Thyroid body. ARTERIES. 1. Common cai'otid. 2. External carotid. 3. Internal carotid. 4. Superior thyroid. From this artery a branch is given back- wards to the sterno-mastoid, and the lymphatic glands beneath it ; another, the laryngeal, is directed under the thyro-hyoid ; the hyoid branch ramifies over the os hyoi- des, supplying the muscles at- tached to that bone and the in- teguments over them. The rest of the artery is distributed to the muscles and the thyroid body. 5. Lingual. It usually curves up- wards and inwards as seen here, before entering under cover of the hyoglossus and mylo-hyoid muscle, and sometimes gives a hyoid branch to the muscles in the neighbourhood. 6. Facial exposed beneath the max- illa by the removal of the sub- maxillary gland. 7. A sterno-mastoid branch given frequently as here from the ex- ternal carotid. 8. Occipital. 9. Posterior auricular. 10. Beginning of internal maxillary. 11. Temporal giving forward a small branch, superior masseteric, to the masseter muscle ; and back- EXPLANATION OF THE TENTH PLATE. wards another, the anterior au- ricular. 12; Transverse facial, usually derived from the temporal. 12'. Middle temporal. 13. Submental. 14. Inferior labial. 1 5. Inferior coronary. 16. Superior coronary. 17. Lateral nasal. 18. A branch of the ophthalmic artery escaping from the inner side of the orbit, and freely communi- cating with the end of the facial artery. 19. A branch of the same artery frontal which also ascends from the orbit over the frontalis mus.- cle, and anastomoses with the anterior temporal. 20. Anterior temporal, from which some branches extend forward towards the orbit, and others at small intervals are directed in a .peculiar manner backwards, and to the opposite side. 22. Internal jugular. VEINS. | 23. Facial. EXPLANATION OF PLATE IX. THIS plate is intended to show the internal maxillary artery. The masseter muscle was removed, except a small part of its lower end. The zygoma is seen to have been divided and a portion taken away ; the condyle, neck, and part of the ramus of the lower maxilla remain in their natural position ; the coronoid process and a considerable portion of the ramus are turned up on the temple with the temporal muscle. Temporal muscle. b External pterygoid. c. Internal pterygoid. d Buccinator, into which the duct of the parotid gland enters. e A small part of the masseter. / Digastric. g Sterno-cleido mastoid. h Zygoma. i Lower maxillary bone. ARTERIES. Common carotid. External carotid. Internal carotid. Occipital. Posterior auricular. Temporal. Internal maxillary. Inferior dental. 9. Middle meningeal sinking beneath the external pterygoid muscle. 10. Deep temporal anterior branch. 10'. Deep temporal posterior branch *. 11. Buccal. 12. Superior maxillary alveolar or dental branch. * In the third figure of his seventh plate, Tiedemann places the deep temporal arteries over or superficially to the temporal muscle. EXPLANATION OF THE TENTH PLATE. 89 NERVES. The nerves here seen are all branches of the third or inferior maxillary division of the fifth nerve. 13. Inferior dental. I 15. Masseteric. 14. Lingual or gustatory. ) 16. Buccal. The temporal nerve is directed upwards near the posterior deep temporal artery, and there exists in this case another branch situated farther forward, and furnished by the buccal nerve. The second temporal nerve, though not constant, is not unfrequently met with. EXPLANATION OF PLATE X. VIEW OF PHARYNGEAL AND LINGUAL ARTERIES. THE lower maxillary bone was divided near its middle, and its left side removed as well as the muscles connected to it, with the exception of those attached to the bone near its symphysis. The temporal muscle was divided above the zygoma, and cleared from under it in order to show the process more fully. The buccinator muscle was cut away, and with the intention of displaying the pharynx more clearly, it was distended and the os hyoides hooked forward. a External pterygoid process of the sphenoid bone. I Tensor v. circumflexus palati muscle. c Levator palati. d Superior constrictor of the pharynx. d 1 Tonsil. e Middle constrictor of the pharynx. / Inferior constrictor. y Hyoglossus. k Mylo-hyoid, turned down after separation from the lower maxilla. / Digastric. The attachment to the maxillary bone is left, the greater part of the muscle is turned to the back part of the neck. m Styloid process of the temporal bone. n Stylo-glossus muscle. o Stylo -pharyngeus. p Os hyoides. h Genio-hyoglossus. I q Thyroid cartilage. 7i> Sublingual gland ; on which lies a j r Sterno-hyoid muscle. part of the duct of the submax- illary gland. Genio-hyoid. Omo-hyoid. Sterno-thyroid. Thyro-hyoid. Sterno-cleido-mastoid. 5'U EXPLANATION OF THE TENTH PLATE. ARTERIES. 1. Common carotid. 2. External carotid. 3. Internal carotid. 4. Superior thyroid, giving among others the 4 1 . Laryngeal. 5. Lingual. The peculiar curve of this artery is removed by the traction on the os hyoides, and the distension of the pharynx. It is seen to give, behind the hyo- glossus muscle, a small artery directed downwards to the muscles connected to the hyoid bone (hyoid branch) and upwards an- other (arter. dorsalis linguae). Anteriorly to the hyoglossus muscle, the sublingual branch is seen to ramify on the gland ; the Ranine artery is directed on- wards to the end of the tongue, decreasing in size ; and, in this case, several of the muscular branches emanate from a common trunk, which is seen below the artery last named. 6. Facial. Its palatine branch was, in the body from which the draw- ing was taken, very small, and ended in the tonsil. 7. Pharyngeal. Here of large size, and its upper part giving a con- siderable branch, which arches downwards and is directed to the soft palate over the margin of the superior constrictor of the pharynx, and in company with the tensor and the levator palati. 8. Occipital. 9. The end of the internal maxillary in the spheno-palatine fossa. 10. The middle meningeal branch of the preceding ; from it is given forwards a small artery, which ramifies over the large plexus of veins found in this situation, after having furnished a menin- geal branch through the foramen ovale of the sphenoid bone (art. meningia parva) ; this is seen beside the inferior maxillary nerve. 11. Temporal. NERVES. 12. Inferior maxillary division of the fifth. 12 1 . Lingual or gustatory branch of preceding. 13. Hypoglossal, or 9th ; the two last have a branch of communi- cation extending between them. 14. Pneumogastric or N. vagus. 14 1 . Its superior laryngeal branch. 15. Glosso-pharyngeal. EXPLANATION OF PLATE XL THE integuments, platysma myoides, and cervical fascia, were removed from the upper part of the neck of the body of which this drawing is a representation. The parotid gland was also taken from the fossa behind the branch of the lower maxillary bone and the greater part cut away. a Masseter muscle. I Digastric. c Duct of parotid gland. c 1 Sub-maxillary gland. d Thyroid cartilage. e Sterno-hyoid muscle. f Omo-hyoid. g Sterno-thyroid. g^ Thyro-hyoid. h Sterno-cleido-mastoid. h l Part of the same muscle turned back. * * Lymphatic glands. ARTERIES. 1. Common carotid. 2. External carotid. 3. Internal carotid. 4. Superior thyroid. This vessel gives the following offsets : viz. a laryngeal branch which is seen to sink under the thyro-hyoid muscle (#') ; a small hyoid (?) branch over that muscle; an artery which, after crossing over the large vessels, is distributed to the lym- phatic glands and the sterno- mastoid muscle. The remaining division of the thyroid artery ramifies in the thyroid body and the muscles which cover it. 5. Lingual. The hyoid branch of this artery is here very distinct. 6. Facial : as it emerges from the sub-maxillary gland, this artery seuds off the inferior masseteric branch which is directed upwards on the muscle, and farther forward the submental artery which supplies the lymphatic glands and the contiguous muscles. 7. Temporal ; from which near its origin are derived two branches, viz. superior masseteric and transverse facial. 8. Internal maxillary. VEINS. 9. Temporo-maxillary vein, result- ing from the union of the temporal and the internal maxillary, and ending as external jugular. Internal jugular. It receives on its inner side two, which may be called thyroid veins, and above these the facial (12). External jugular, descending over the sterno-mastoid muscle to ter- minate in the subclavian vein. There is a branch of communica- tion between the external and the internal jugular veins opposite the angle of the maxilla . The branch in this case joins the facial as that 10. 11 12. vein is about to enter in the inter- nal jugular. Facial. This vein receives the submental from below the base of the maxillary bone ; and where it crosses the external carotid artery another vein is seen to enter it from above. The vessel last referred to results from the junction of two small veins (one of them is ob- servable in the drawing above the digastric muscle, the other lay concealed by the artery) which accompany the carotid in the manner of venae comites. EXPLANATION OF THE TWELFTH PLATE. NERVES. 13. Pneumogastric or n. vagus. 14. Portio dura of seventh ; the branches have been cut and re- moved. 15. Descending branch of the ninth (n. descendens noni), forming with a branch derived from the cervical nerves, a loop from which filaments are given to the muscles, 16. Auricular, from the cervical plexus, seen to communicate with the portio dura. 17. Spinal accessory. EXPLANATION OF PLATE XII. a Thyroid cartilage. b Trachea. d Thyroid body. e Masseter muscle . / Digastric. g (Esophagus. 1. Aorta its ascending part. 2. Aorta its descending part. 3. Innominate. 4. Right common carotid. 4 1 . Left common carotid. 5. Right subclavian. 5 ' . Left subclavian. 6. Right external carotid. 6 l . Left external carotid. 7. Right internal carotid. 7 1 . Left internal carotid. ARTERIES. 8. Superior thyroid. 8 1 . Laryngeal. 9. Lingual. 10. Facial. 10'. Ascending palatine. 11. Occipital. II 1 . Pharyngeal. 12. Posterior auricular. 13. Thyroid axis. 13 l . Inferior thyroid . 14. Pneumogastric or n. vagus. NERVES. | 14 1 . Inferior laryrigeal. The plate is intended to show some of the variations of the common carotid and the external carotid arteries. Those which occur in the origin of the former, are illustrated in the plates in which the arch of the aorta and its branches are represented. In Figure 1, the common carotid of the right side is seen to extend much higher than usual considerably above the hyoid bone. In Figure 2, the external and internal carotid arteries are seen to separate from the common carotid, opposite the cricoid cartilage. EXPLANATION OF THE TWELFTH PLATE. 93 The common carotid is altogether wanting on the right side in figure 3 ; and the external and internal carotid are seen to take origin directly from the aorta. Figure 4. The common carotid gives the superior and the inferior thyroid arteries. The branch directed inwards under the carotid from the thyroid axis was distributed to the oeso- phagus and the trachea. In the preparation from which the sketch has been taken*, both carotid arteries are derived from the aorta by a short common trunk, and the right subclavian, taking its rise to the left of the other branches crosses to the first rib immediately in front of the vertebral column. The inferior laryngeal nerve, instead of turning upwards behind the subclavian artery, branches from the pneumogastric opposite the lower end of the larynx. These facts will be further noticed under the head of the subclavian artery. In Figure 5, the external carotid of the right side is placed between the digastric and the stylo-hyoid muscles, instead of being covered by both. Figures 6, 7, and 8, are intended to illustrate peculiarities often noticed in the place of origin of the branches of the external carotid. In the first of the sketches, the branches are seen to be given off only at the lower and the upper ends of the main vessel ; in the second, they arise close together below its middle ; and in the third case they are given in succession at nearly regular intervals. Figure 9. The superior thyroid artery is derived from the common carotid at a considerable distance from its division, and the laryngeal is a distinct branch of the carotid. * No. 239, in my collection. i 2 94 EXPLANATION OF THE THIRTEENTH PLATE. EXPLANATION OF PLATE XIII. Temporal muscle. External pterygoid. Internal pterygoid. 1. Common carotid. 2. External carotid. 3. Internal carotid. 4. Superior thyroid. 4 1 . Laryngeal. 5- Lingual. 6. Facial. 7. Occipital. 8. Temporal. 9. Internal maxillary. 9 1 . Middle meningeal (fig. 7). 10. Posterior auricular. 1 1 . Pharyngeal. 12. Middle meningeal(fig. 8). d Styloid process of the temporal bone. ARTERIES. 13. A branch of the internal maxil- lary which enters the skull through the foramen ovale, and joins that marked 15. 14. Infra-orbital. 15. A branch of the internal maxil- lary, entering the cranium through the foramen rotundum, and join- ing the vessel marked 13, to form a considerable trunk, which gives the ophthalmic and a cerebral artery. 16. Ophthalmic. 17- Inferior dental. 18. Optic nerve. Figure 1 shows the superior thyroid and lingual arteries united at their origin ; and there are two pharyngeal branches. In Figure 2, the superior thyroid is joined to the common trunk of the lingual and facial. In Figure 3, two superior thyroid arteries and the laryn- geal are seen to arise separately from the external carotid ; the occipital and pharyngeal branches take origin above their most frequent position. The lingual and facial arise by a common trunk in figure 4. The facial (in figure 5) is given off considerably higher than usual, and descends behind the angle of the lower maxilla to gain its ordinary situation. Figure 6. The facial and internal maxillary arise by one trunk in the usual position of the former, so that it may be said the internal maxillary is derived from the facial. In Figure 7, the internal maxillary is covered by the external pterygoid muscle. EXPLANATION OF THE FOURTEENTH PLATE. 95 Figure 8. In the preparation here represented*, the internal carotid artery and the carotid canal of the temporal bone are absent. The place of the carotid artery is supplied by two branches of the internal maxillary which enter the cavity of the cranium through the foramen rotundum and the foramen ovale. The vessel constructed by the junction of the two branches indicated, are seen in the preparation to lie to the inner side of the nervus trigeminus; and it may be added, that the unusual arteries are more tortuous than they are repre- sented in the drawing. The internal carotid artery of the right side is larger than usual, and doubtless compensated for the small size of the cerebral artery shown on the left side. EXPLANATION OF PLATE XIV. ARTERIES. Common carotid. External carotid. Internal carotid. Superior thyroid. Lingual. Facial. Occipital. A large branch of the occipital taking an unusual course over the sterno-mastoid muscle. Temporal. A large branch of the preceding directed over the orbit. Internal maxillary. 10. Transverse facial. 11. A large branch of the internal maxillary. 12. Infra-orbital branch of the inter- nal maxillary. 13. Supra-orbital branch of the ophthalmic, giving upwards a considerable frontal artery, and downwards another branch which ramifies on the nose. 14. Pharyngeal. 15. External jugular vein. 16. Pneumogastric nerve orn. vagus. This plate illustrates some of the variations of the facial, the temporal, and the occipital arteries. The facial artery is shown in figure 1 to end in the inferior masseteric and the submental branches. Its place is taken on the face by branches of the internal maxillary (11 and 12), and by the inferior coronary of the left side. Figure 2 shows the deficiency of the facial supplied by the transverse facial (10). In Figure 3, the transverse facial artery (10) and a branch of the ophthalmic are seen to compensate for the small size of the facial. No. 357. 96 EXPLANATION OF THE FIFTEENTH PLATE. Figure 4 is a representation of a large branch of the tem- poral artery directed along the upper margin of the orbit, where it joins with a small branch of the ophthalmic, and furnishes the frontal arteries. Figure 5. The greater part of the occipital artery is seen in this figure to be directed to the occiput over all the muscles, while but a small branch follows the usual course of that vessel. The occipital is shown in figure 6 taking origin from the internal carotid artery. EXPLANATION OF PLATE XV. Temporal muscle. Pterygoid process of the sphenoid bone. Circumflexus, or tensor palati muscle. Levator palati. Superior constrictor of the pharynx. Middle constrictor. Hyo-glossus. Genio-hyoglossus. Genio-hyoid. Mylo-hyoid. Sublingual gland. m Hyoid bone. n Thyroid cartilage. o Styloid process of the temporal bone. p Stylo-glossus muscle. q Stylo-pharyngeus. r Stylo-hyoid. 5 Digastric. t Sterno-cleido-mastoid. v Transverse process of the atlas. w Duct of parotid gland. x M. rectus anticus capitis major. y Submaxillary gland. ARTERIES. 1. 2. ;-5. 4. 5. (>. 6. 7. B. Common carotid. External carotid. Internal carotid. Superior thyroid. Lingual. Facial. Inferior palatine. Occipital. Temporal. 9. 9 1 . & 10. 11. 12. 13. Internal maxillary. Middle tneningeal. Small meningeal. Posterior auricular. Pharyngeal. Vertebral. Inferior maxillary division of the fifth nerve. The fifteenth plate is intended chiefly to show some of various conditions of the pharyngeal artery. Figure 1. The arrangement of the pharyngeal and the inferior palatine arteries in this figure contrasts with that represented in the ninth plate. Here the pharyngeal ends in three branches, one of which continues close by the internal carotid artery and enters the cranium ; the two others arch COMMON CAROTID ARTERIES. 97 down to the pharynx on which they are distributed. The inferior palatine, after furnishing many branches to the pharynx, in front 6*f the pharyngeal, and to the tonsil, arches over the superior constrictor to the soft palate, in which it ramifies. The lingual artery (5) in this plate preserves its usual curve towards the hyoid bone. The sublingual branch- is small, but on the lower part of the gland is seen part of another artery, which was probably derived from the facial, and penetrated the mylo-hyoid muscle. The peculiar mode of ramification of the artery, and its gradual decrease in size, are well shown in front of the hyoglossus muscle. The internal maxillary artery (9) in this case was covered by the external pterygoid muscle as in plate 13, figure 7, and in consequence of the removal of the muscle, that part of the internal maxillary which had been covered by it, and the branches given from the artery in this situation, are exposed. In Figure 2, the pharyngeal is represented arising from the occipital artery. Figure 3, shows it taking origin from the internal carotid artery. Figure 4. The occipital artery springs from the internal carotid and gives the pharyngeal. THE COMMON CAROTID ARTERIES. Inasmuch as the arteries of both sides differ one from the other in their origin and length, they will be treated of sepa- rately in reference to these points. The origin of the right common carotid was found to be in common with that of the subclavian, from the innominate, in all the cases observed (930) with the exception of five*. In two of these it was given separately from the arch of the aorta -f- ; and in the others it was conjoined with the left carotid, both vessels arising from a short common trunk j. When not united with the subclavian, the vessel under con- * See abstract of the table, ante p. 32. -f- Plate 7, figure 2. The other case differed from that represented in plate 6, figure 13, only in the right vertebral having its usual origin. Plate 7, figures 4. See also same plate, fig. 5. 98 COMMON CAROTID ARTERIES. sideration is usually the first branch of the aortic arch* ; it is however occasionally preceded by the right subclavianf, and very rarely by the left carotid J. The usual situation of the commencement of the right carotid / O artery, when derived from the innominate, is behind the inner end of the clavicle, or on a level with the upper margin of that bone or nearly so ; but the origin is not unfrequently found to be higher or lower than the point indicated. The place of division of the innominate, which obviously is coincident with the beginning of the carotid, was noted in 137 bodies ; in 7 of these the carotid separated from the innominate in the neck considerably above the clavicle ; in 9 it arose below that bone; and in 121 the origin of the artery occupied the usual situation. The deviations, therefore, in this respect were about 1 in 87, and they were more frequently above than below the ordinary position. The length of the common carotid of the right side was noted in 68 bodies. For the details of these cases, reference may be made to the table, ante p. 55 et seq., or to the ab- stract p. 86. From the latter it appears that in 60 cases the length varied between 3 and 4-J inches ; 2 measured less than 3 inches ; and the remaining 6 varied between 4-J- and 5 inches. The average length may be stated to be from 3^- to 4 inches. The origin of the left common carotid deviates from the usual position much more frequently than that of the artery of the right side. In 25 out of 219 instances in which the exami- nation was made, the left carotid was derived from the innominate, or was joined with that vessel so as to form with it one large trunk . The proportion, therefore, of variations from the usual origin, dependent on this source, was nearly 1 in 8^. It is to be observed, however, that the left carotid not only takes its origin in common with both the vessels of the oppo- site side, but that in the greater number of cases in which the right subclavian is a distinct branch of the aorta it arises in * Plate 5, fig. 8; plate 6, figs. 11, 12, and 13; plate 7, figs. 5, 6, and 11. f Plate 6, fig. 10 ; plate 7, figs. 4 and 13 ; and to these may be added the remark- able cases represented in plate 5, fig. 9, and plate 12, fig. 3. * Ante p. 48, and plate 7, fig. 2 ; and a nearly similar case described and delineated by Walter in Nouv. Mem. cle 1'Acad. dcs Sciences, &c. Berlin, 1/85. Ante p. 45, and plate 6, fig. 7. COMMON CAROTID ARTERIES. 99 conjunction with the carotid of the right side (PL 7, figs. 4 and 5). In the foregoing the artery is seen tending towards the vessels of the right side ; and in two cases its origin was placed even to the right of both of them*. It is remarkable that the instances which are recorded of a junction between this vessel and the subclavian at its own side are very few. Only three cases are referred to in which the carotid and sub- clavian arteries were derived from a common or innominate trunk on the left as well as on the right side*f- ; and one is recorded in which the only innominate existed on the left sidej. The foregoing remarks on the origin of the common carotid arteries apply to those vessels when the arch of the aorta has the usual course to the left side ; when the great artery arches to the right side the branches must be considered as reversed || . Place of division of the common carotid arteries. Under this head the vessels of both sides will be treated of together. The bifurcation of the arteries was noted in 295 cases ; in 184 it was situated opposite the upper margin of the thyroid cartilage which is therefore considered the usual position and in the remaining 111 cases the division occurred at different and more or less distant points. The deviations from the usual place of division, were consequently as 1 in about 2-J. The cases of deviation, 111 in number, were distributed as follows : A Those in which the bifurcation occurred above the usual position. Above the thyroid cartilage, or opposite the hyoid bone 60 about 1 in 5 Above the hyoid bone, considerably higher than usual 10 1 in 29- Total above the ordinary place of division . . 70 about 1 in 4 * Ante p. 48, and plate 7, fig. 2 ; and a nearly similar case described and delineated by Walter in Nouv. Mem. de 1'Acad. des Sciences, &c. Berlin, 1785. f- Ante p. 46, and plate 6, fig. 9. t Plate 7, fig. 6. || Plate 5, figs. 3, 4, and 5 ; and plate 7, fig. 3. 100 COMMON CAROTID ARTERIES. B Cases in which the division was situated below the usual position. Beneath the upper margin or opposite the middle of the thyroid cartilage .... 26 about 1 in 11 Opposite the cricoid cartilage . . . . 5 1 in 59 Total below the usual place of division . .31 about 1 in 9^ No example has occurred in my experience of a higher division of the common carotid than that delineated in the first figure of the twelfth plate, in which the thyroid, lingual and facial arteries are seen to descend from the external carotid to their destinations, instead of being directed imme- diately inwards, as is usual when the common carotid divides opposite the thyroid cartilage. Allan Burns describes an instance in which the common carotid appears to have ex- tended still nearer to the base of the skull, but several of the branches ordinarily furnished by the external carotid, were given by the common carotid in its ascent*. The case last referred to, may be regarded in some degree as a transition to the entire absence of a division of the common carotid into two large vessels the internal carotid being altogether wanting. The carotid artery is seen in one preparation in my possession (see plate 13, fig. 8), to furnish, as it ascends along the neck, the usual branches of the external carotid, and to divide into the temporal and internal maxil- lary arteries. In the place of an internal carotid, of which there is no trace, two tortuous branches derived from the internal maxillary join within the skull and form a single vessel ; this had been distributed to the brain and orbit. The artery so constructed being however smaller than the usual size of the internal carotid, the deficiency is compensated for by the artery of the opposite side, which is of large size. A case is described by Todef, in which the right internal carotid was absent, and the carotid canal was very small sufficient only to allow the passage of a bristle. * " In a preparation which was in my possession, the common carotid, instead of dividing in the neck, sends off lateral branches, till it reaches considerably beyond tho angle of the jaw. Opposite to the root of the styloid process it divided into two branches, one formed the internal carotid, the other was the conjoined trunk of the temporal and internal maxillary arteries." Loco citato, p. 125. f Mcdicinisch-chirurgischc Dibliothck, B. 10. S. 408, Kopenhagen, 1787. COMMON CAROTID ARTERIES. 101 Instances are on record in which the carotid divided lower down than any referred to above. An example is described by Morgagni, in which the left common carotid was but one inch and a half in length *. It may be inferred that the external and internal carotids must in this case have been given off at the bottom of the neck ; and most probably the common trunk would not have been accessible above the clavicle. Reference is made by Allan Burns to an instance of division of the artery opposite the sixth cervical vertebra ; but the length of the vessel, or the side of the body on which it occurred, is not stated f. Absence of the common carotid. The . early division of this artery conducts to that condition in which the external and internal carotids, instead of being derived from a common trunk, arise separately from the aorta. This variety was observed by Dr. Power, of Dublin, who states that, "on examining the subject" (one brought for anatomical purposes into the dissecting-room), " I found that the arch of the aorta had ascended unusually high towards the summit of the thorax ; there was no arteria innominata, but in the situation usually occupied by this vessel the two vessels we have here delineated arose : the cerebral carotid lying internally but closely related to the external carotid artery, to the outer side of which next arose the right subclavian.f See the sketch, plate 12, figure 3. * " Nam preeter coronariam illam de qua dictum est, cum arterias carotides inter se compararem, evidenter major latitudo occurrebat sinistrae, quam dextrsc. Cumque ilia, vix sesquipollicis ab origine spatio emenso, in duos, insolito exemplo, dividiretur ramos," &c. The observation was made in the body of an aged female, " Paupercula, rusticana fcsmina, annorum ut \idebatur circiter quinquaginta," &c. De Sedibus et Causis Morb. per Anatomen indagatis. Epist. 29, art. 20. f " In one of our subjects the common carotid separated into two trunks low in the neck. The division took place opposite the upper margin of the sixth cervical vertebra and about three inches Jbelow the angle of the jaw. The two vessels mounted along the side of the larynx parallel to each other, and enveloped in the same sheath with the internal jugular vein and nervus vagus." Observations on the surgical anatomy of the head and neck, p. 124, 2nd Edit, by G. S. Pattison, Glasgow, 1824 ; also in Observations on some of the Diseases of the Heart, &c. by the same author. Edinburgh, 1809, p. 285. $ Extract from remarks on the preparation, very obligingly communicated by Dr. Power, lecturer on Anatomy and Physiology in the school of Medicine, Richmond Hospital, Dublin. The drawing was taken by Mr. Kirwan, from the preparation in the Museum of the hospital, and has been furnished to me through the good offices of Professor Hart. The preparation had been inadvertently removed from the body with- out Dr. Power's knowledge, and the connexion with the aorta severed. The larynx, trachea, and part of the rosophagus, are however preserved in connexion with the two 102 COMMON CAROTID ARTERIES. In Malacarne's case, which has been previously referred to for a remarkable peculiarity of the aorta*, the external and internal carotid arteries of both sides took origin separately from the divisions of the double aorta, and are described as ascending parallel one to the other close to the trachea to the level of the cricoid cartilage. In this situation the external carotid inclined forward, and curving over the internal carotid approached the larynx f. It is to be inferred that the internal carotid lay next the trachea in this as in the case just referred to. Both cases appear to correspond also in the inclination of the external carotid inwards over the other vessel. They differ in the disposition of the aorta, and in the circumstance that in the one case the unusual state of the vessels existed at both sides ; while in the other it is seen only on the right side. Tortuous state of the Arteries. The carotid like some other arteries, instead of having the usual straight direction, are occasionally found to be much curved ; and my observation inclines me to state that, of the carotid arteries, the internal is the most frequently affected in this way. ' The vessels thus changed are usually, if not exclusively, met with in the bodies of persons of advanced age. An example of the condition alluded to, which was observed by Morgagni in the body of an old man, is worthy of particular notice. The common carotids, though quite straight in other parts, were at the middle coiled up in the manner of a spiral shell, and when the vessels were artificially untwisted, they immediately resumed the curved state on the removal of the extending force J. unusual vessels. It must be added that in the sketch (plate 12, fig. 3) made from the original drawing, the liberty, I hope not altogether an unwarrantable one, has been taken to represent the larynx with more distinctness than it is seen in the preparation, and to add or restore in outline the aorta and the subclavian arteries. By the difference in drawing it may be at once discerned how much belongs to the preparation. * Ante p. 22, and pi. 5, figs. 9 and 10. f After describing the peculiarities of the aorta and the origin of subclavian arteries, the author proceeds : " I second! tronchi che formavano le sole carotidi esterne e gli ultimi piu alti e posteriori, che constituivano le sole carotidi interne salivano paralelli ai lati della trachea prendendosi in mezzo le jugulari interne fino all' altczza della cartilagine cricoidea. La i tronchi delle carotidi esterne portandosi piu iunanzi con le jugulari, s' iucrocicchiavano con le carotidi interne per avvicinarsi maggiormente alia laringe," &c. &c. Osservazioni in chirurgia, p. 2, 119. J Nee singulare quoddam carotidum vitiumest rcticendum : quse cum ad suaslongi- tudinis medium ascendissent,ibi seintorqnebant cochleae instar,statimque ad rectitudinctn redibant ; eratque ille flexus adeo pertinax ut si in rectum artcrias extenderes, mox amota manu, in eandem se ctmtorsionem restitucrent. De Sedibus et Causis Morbor. &c. Epist. 49, Art. 18. COMMON CAROTID ARTERIES. 103 Veins and Nerves. The position which the anterior and the internal jugular veins occasionally bear with reference to the carotid arteries, has been mentioned and illustrated in a former part of this work ; and a variety in the position of the nervus vagus is shown in the same place *. It will here only be added, that I have frequently seen the internal jugular vein cover the carotid artery : and in two bodies the vein and nerve lay distinctly over it. The unusual situation of the vein occurs much more frequently and to the greatest extent on the left side ; this fact may, perhaps, be owing to the inclination the veins have towards the right side of the heart. Branches are very unfrequently given in the course of the common carotid arteries, except near the bifurcation, where the superior-thyroid is frequently seen to arise. That vessel was derived from the common carotid in 41 of the cases noted in the table, giving a proportion of 1 in 7i- The laryngeal artery was also a distinct branch of the same trunk in three instances, and in but two of all the cases (930) was the com- mon carotid observed to give an offset in any other situation. In both the instances last referred to, an inferior or an additional thyroid was the unusual branch : one is represented in plate 12, figure 4, in the other the branch was given from the com- mon carotid near its origin. Examples of the thyroid arising from the lower part of the carotid are noticed by several observers; e. g. Nicolaif, ErdmannJ, Haller, and Huber||. The vertebral artery has been seen to take origin from the common carotid. This rare variety is shown in plate 6, fig. 13, which is taken from a preparation in the Museum of St. Bartholomew's Hospital. Other examples are described by Murray and Green ^f. In these cases the variety occurred on the right side of the body, and the right subclavian artery arose from the left side of the aorta. * Page 14, and plate 4. f De direct. Vasor. 1725, in Haller Disp. Anatom. Select, vol. ii. p. 499. J Descript. Anatom. Art. innom. et thyroideae imso, p. 31. Jense 1772. This Essay contains the observations of Neubauer, whose pupil the author was. Elem. Physiol. vol. Hi. p. 404. || Acta. Helvet. t. 8. p. 84. ^[ Der. K. Schwedischen Acad. der Wissenschaften Abhandl. aus dem Schwedis- chen ubersetzt von A. G. Kastner, b. 30. s. 92. " All the vessels arise from the left side of the arch. First, the right carotid, which crosses the lower part of the trachea, giving off the right vertebral," &c. An Account of the Varieties in the Arterial System of the Human Body, p. 7. Dublin, 1830, 104 EXTERNAL CAROTID ARTERIES. EXTERNAL CAROTID ARTERIES. But few peculiarities requiring notice occur in the anatomy of the external carotid independently of the branches. In reference to its connexions, it requires only to be stated that the artery is sometimes directed upwards between the stylo- hyoid and digastric (plate 12, fig. 5), instead of being as usual covered by both these muscles. The Lenyth. On referring to the table it is found that the length was noted in 61 cases, which may be set down under the three following heads, viz. : From 2 to 2f inches, inclusive . . . . . .44 From 3 to 3, inclusive 12 Below those contained in the first division, and not less than 2 inches . 5 61 The branches of the external carotid vary to a great extent in the position at which they are given off, and in their number. Origin of the branches. The variations which take place in the origin of the branches will be noticed as each comes under consideration ; the observations to be made on the subject in this place will therefore have reference only to pecu- liarities observed in the position of the branches generally or taken together. In some cases recorded above, the origins of several branches were crowded together at the beginning of the parent vessel (plate 12, fig. 6 *) ; in other cases the arteries were seen to arise close together at some distance higher up (plate 12, fig. 7) ; lastly, they were sometimes observed, as shown in fig. 8 of the same plate, to take origin at nearly regular intervals. Number of the branches. Independently of several small vessels furnished to the parotid gland, &c., the usual number of the branches derived from the external carotid, and to which names are assigned, may be stated to be eight, viz. the superior thyroid, lingual, facial, occipital, posterior auri- cular, internal maxillary, temporal, and pharyngeal. I am * " In a preparation of the vessels of the head and neck which is in my possession," says Allan Burns, " the external carotid is a short thick stump, resembling the axis arterise caliaca?, and like it, from the top of this, the large branches take their origin." Observations on the Surg. Anat. of the Head and Neck, p. 125. SUPERIOR THYROID ARTERY. 105 under the impression that most frequently there is no separate sterno-mastoid branch. The number stated may be diminished or increased, or by the coincidence of a source of diminution with one of increase, may continue unaltered though the branches of which it is made up are in some respects dif- ferent. The following are the sources of decrease of the number of branches : Absence of the superior thyroid artery, which is often derived from the common carotid ; the union of the same artery with the lingual or with the common trunk of the lin- gual and facial. Union of the lingual and facial. Absence of the occipital ; this artery being in some cases given from the internal carotid, and occasionally from the subclavian. The origin of the posterior auricular from the occipital. The junction of the internal maxillary to the facial. The origin of the pharyngeal from the occipital or from the internal carotid ; or its entire absence. The increase of the number is owing either to the fact that arteries usually given from another source are supplied directly by the external carotid, or to the existence of an additional artery. The branches mentioned in the table as thus changed in their origin, are : the laryngeal, ascending palatine, and transverse facial. The unusual or additional branches to which an increase of the number is occasionally owing, are : the sterno-mastoid, a second superior thyroid, a second or even a third pharyngeal. SUPERIOR THYROID ARTERY. The condition of the superior thyroid artery was noted in 292 cases ; in the computation the vessels of the right and the left side have been added together. Independently of variations in size, the examples of which were very numerous, the most remarkable peculiarities met with are as follows : 106 LINGUAL ARTERY. In several cases the artery supplied the thyroid body on the opposite side ; the branch following this unusual course was observed to be of large size, and to cross the crico- thyroid membrane in 5 The super, thyroid was derived from the common carotid in 41 1 in 7 The origin was joined to that of the lingual artery in . 2 to the common trunk of the lingual and facial in . . . . 1 There were two thyroid arteries (the laryngeal being a separate branch in 2 of these) in .... 3 The hyoid branch is often very small, or even wanted altogether. The laryngeal artery arose separately from the exter- nal carotid in ...... 24 from the common carotid in 2 , about 26 }lin H Some other peculiarities of the last named branch will be noticed when the superior and inferior thyroid arteries are under consideration. The thyroid did not supply the thyroid body ; the small artery occupying its situation, ended in branches to the sterno-mastoid muscle and the larynx, in ... 3 LINGUAL ARTERY. Origin. The lingual artery frequently takes rise not singly or directly from the external carotid, but through the medium of a trunk common to it and the facial. This mode of origin was found in 61 of 302 cases noted in the table or about 1 in 5. In two cases it was joined with the thyroid, pi. 1 3, fig. 1 . Branches. The hyoid branch is not unfrequently deficient ; and it appears to me that in general when a hyoid artery of good size is given from the lingual, the thyroid supplies none, or a very small one, and the converse. See plates 3, 8, 10 and 11, in which different conditions of the hyoid branches are illustrated. The sublingual, ordinarily a branch of the lingual artery, is occasionally derived from the facial. When it has this unusual origin, its course to the gland is either through the mylo- hyoid muscle, or with the duct of the submaxillary gland behind and beneath the muscle. The sublingual gland was seen in one case to be furnished from both the lingual and the facial arteries. The lingual artery has been observed to furnish the submental artery and the ascending palatine. FACIAL ARTERY. 107 FACIAL OR LABIAL ARTERY*. The most frequent change in the origin of the artery is its junction with the lingual (see the observations on the origin of that artery and of the superior thyroid). Occasionally it takes its rise above the usual position, even as high as the middle of the ramus of the lower maxilla, and thence descends beneath the angle of this bone to assume the usual course (pi. 13, fig. 5). In size this artery is very variable also in the extent to which it reaches. In the case delineated in plate 14, fig. 1, the vessel is expended almost altogether beneath the maxilla, ending as the submental ; figs. 2 and 3 show it reaching to the lower lip and the side of the mouth. The sketches just referred to serve to illustrate the various means by which the deficiency alluded to is supplied. The vessels which take the place of the facial when deficient are derived either from the ophthalmic, the transverse facial, or the internal maxillary ; the first mentioned is that most frequently thus supplemental, and it generally descends to the nose from the inner side of the orbit, and not, as represented in the third figure of the plate, in common with the frontal artery. Brandies. Ascending palatine artery (. This vessel was found, instead of being a branch of the facial, to be derived from the external carotid in 21 of the cases detailed in the table, or about 1 in 14. Its size varies considerably the variations in this respect being dependent on the extent to which it reaches and the parts which it supplies ; thus, in some cases it supplies the soft palate, in others, on the con- trary, it is expended on the pharynx and tonsil, and in one case a considerable branch was given to the tongue. It may be asked, why is the artery named palatine when it does not extend beyond the tonsil ? We can only say, that the shorter * Labialem arteriaru voco, quam vulgo vel maxillarem externam vocant, vel max- illarem, vel denique ob supremos ramos, angularem. Maxillaris enim noinen mihi ambiguum videtur, angularis plerumque non verum ; labia vero vix unquam non adit. Haller. Icon. Ana torn. Fascic. 3, n. 10. f Palatinam adscendentem vocavi, vix descriptam hactenus, ut a palatina descen- dente separarem, quaj ramus est maxillaris internse. Icon. Anatom. fascic. 3, n. 11. 108 OCCIPITAL ARTERY. vessel occupies the position between the muscles of the styloid process, and has the direction which belongs to the artery when it reaches the palate. A special tonsillar branch of the facial is often found, but is still more frequently absent. Further observations on the palatine and tonsillar branches are placed under the head of the pharyngeal artery. A branch of the facial is occasionally given to the sublingual gland, and this unusual vessel either follows the duct of the submaxillary gland inwards, or per- forates the mylo-hyoid muscle this variety was noted in five cases. On the other hand, the lingual occasionally sends branches to some of the parts, which ordinarily derive their supply from the facial. Thus the submental was seen in one case to be derived from the lingual ; a supplemental palatine artery and a branch to the submaxillary gland were observed in two other cases to be derived from the same source. THE OCCIPITAL ARTERY. The origin of the artery is usually opposite the facial, at the distance of about an inch from the division of the common carotid, but several cases are mentioned in the table in which it was higher or lower than this point. In plate 13, figures 3 and 6, the occipital artery is seen to arise above the ordinary situation, while in plate 15, fig. 2, it is given off from the bifurcation of the common carotid. The occipital is occa- sionally derived from the internal carotid (plate 14, fig. 6, and plate 15, fig. 4), and a few cases have occurred in which it continued from the ascending cervical branch of the inferior thyroid, and was thus derived from the subclavian artery (see the plates illustrative of the peculiarities of that artery). The sterno-mastoid, splenius, and trachelo-mastoid muscles, cover the occipital artery in the course backwards to the occi- put ; it is, however, sometimes superficial to the last-named muscle, and in one or two cases it perforated the two first muscles, near their inner or posterior margins (table No. 135 R). A very rare variety is represented in plate 14, fig. 5, in which the chief branch of the occipital is superficial to the sterno-mastoid muscle, and but a very small artery is TEMPORAL AND INTERNAL MAXILLARY ARTERIES. 109 deeply placed in the usual situation. The artery in a few cases turned backwards beneath the transverse process of the atlas, above which it usually lies. Branches. The variations of most importance to be noticed under this head, are the occasional origin of the posterior auricular and the pharyngeal from the occipital artery. POSTERIOR AURICULAR ARTERY. This artery is frequently very small in size, and I have seen it end as the stylo-mastoid branch. It is often a branch of the occipital. TEMPORAL ARTERY. The temporal artery is frequently tortuous ; always so, to a certain extent, in aged persons. But few observations have been made on peculiarities of this vessel. The branches vary in size, and occasionally a very large one is directed forward above the zygoma to the upper part of the 'orbit. This un- usual artery is seen in plate 14, fig. 4, to join with a small branch of the ophthalmic, aud furnish large frontal branches. INTERNAL MAXILLARY ARTERY. This artery and the preceding are very constant in their origin. It was observed in two instances to take origin from the facial, from which it coursed upwards to pass beneath the ramus of the maxillary bone in the usual situation. The internal maxillary artery is very frequently covered by the external pterygoid in the manner delineated in plate 13, fig. 7, instead of lying superficially to that muscle as shown in the ninth plate. In a few cases e. g. 248, 254, 260, in the table the vessel was seen to perforate the muscle exactly at the middle, after having been for a very short space covered by it, and then to incline forwards on the outer surface to enter the spheno- maxillary fossa in the usual way. It may be added, that I have seen the artery lodged in a notch which is often observable on the margin of the exter- nal pterygoid process of the sphenoid bone, and bound into it by a little fibrous structure. 110 PHARYNGEAL ARTERY. Branches. The only reference which is necessary to be made in this work to the branches is to their state in the remarkable case represented in plate 13, fig. 8. Two tortuous branches of the internal maxillary are there seen to enter the skull through the foramen rotundum and foramen ovale, and form an artery in the place of the internal carotid, which is altogether wanting ; the internal carotid of the opposite side is considerably larger than usual. PHARYNGEAL ARTERY. The origin of this vessel was noted in 144 cases, which admit of being classified as follows : Cases in which the Artery arose from the bifurcation of Common Carotid 6 Within an inch above this point 20 At ^ an inch 27 Above ^ an inch, not exceeding 1 inch 50 Above I inch (extreme height 2 inches) .... 9 112 Cases in which the Artery was given from an unusual source. From the Occipital . . 19 From the Internal Carotid 9 From a Linguo- facial branch 1 29 Cases in which there were more than one Pharyngeal branch Two brs. from Ext. Carotid ....... 4 Three brs. from Ext. Carotid 2 Two brs., one from Occipital, 2nd from Ext. Carotid . . 2 _. 8 Absence of the Pharyngeal Artery This variety was observed in 1 The pharyngeal artery and the inferior palatine branch of the facial co-operate in supplying the upper part of the pharynx, and sometimes the one, sometimes the other, is dis- tributed to the soft palate. When the pharyngeal artery supplies the palate, the branch given from the facial in the usual situation of the palatine ends in the tonsil and in the neighbouring muscular structure. The tonsil is, according to the observations I have made, more frequently supplied by the inferior palatine or the artery in its situation, than by a separate offset of the facial. The distribution of the pharyngeal artery to the soft palate, and the small size of the ascending palatine, are illustrated in PHAilYNGEAL AND ASCENDING PALATINE ARTERIES. Ill plate 10. In that figure the vessel is seen to divide into two branches immediately above the styloglossus muscle. The anterior and deeper branch was found on examination to ramify in the rectus major muscle and other structures in front of the vertebral column. The other branch, the larger of the two, subdivides into two parts, having different direc- tions, the one vertical, the other horizontal ; the former ascends to the cranial bones, the latter, which in the draw- ing arches inwards above the margin of the superior con- strictor of the pharynx, supplied the soft palate, the Eustachian tube, and the tonsil. To these parts the horizontal branch was, on prosecuting the dissection, found to be dis- tributed thus : The higher division separated into two branches, which ramified under the mucous membrane of the fore part of the soft palate, in the glandular and muscular structure ; the lower division in like manner furnished branches to the soft palate under the mucous membrane of its posterior surface, and also supplied the Eustachian tube and the tonsil. The branch of the facial, which occupies the position of the inferior palatine, ended in the tonsil, as shown in the plate. In plate 15, fig. 1, that which may be considered the oppo- site arrangement of the vessels is seen, for the inferior palatine extends to the soft palate, while the branches drooping inwards from the pharyngeal end on the side of the pharynx. To afford an opportunity of repeatedly observing the distri- bution of the arteries in question, several careful dissections were made at different times ; and from the notes of them taken at the moment, the following extracts are made. (1.) The pharyngeal arises from the external carotid artery, and ascends vertically to the base of the skull, close to the internal carotid ; in this course two branches are given inwards to the pharynx, and one to the rectus and longus colli muscles; at about the distance of an inch from the skull, the artery subdivides into three slender vessels. Of these one inclines back to the bone which it penetrates, the others arch down to the side of the pharynx. The inferior palatine artery ascends from the beginning of the facial, between the stylo-glossus and the stylo-pharyngeus muscles, and soon divides into two parts : the anterior of 112 PHARYNGEAL AND ASCENDING PALATINE ARTERIES. these spreads out in branches on the tonsil ; the posterior, the larger of the two, arches over the superior constrictor of the pharynx to the soft palate. From the curve formed by the latter branch where it enters the pharynx a small artery is directed upwards to the Eustachian tube in which it ramifies together with an offset from the pharyngeal. (2.) The pharyngeal of large size divides into two branches, one of which ascends behind the internal carotid artery to the bones of the skull, distributing branches to the nerves in its course upwards; the other branch, situated to the inner side of the internal carotid, supplies the side of the pharynx and enters to the soft palate above the superior constrictor. A branch of the facial, the only one given in this situation, is directed upwards between the stylo-glossus and the stylo- pharyngeus muscles, and ends in the tonsil. This is the representative of the inferior palatine. (3.) The arteries have the same disposition as in case 1, except that a separate branch is given from the facial to the tonsiL (4.) The arrangement is the same as in the second case, with the exception that the facial artery distributes a small additional branch to the tonsil, so that here the gland receives two separate branches of the facial, viz. that which occupies the place of the ascending palatine, and that usually called tonsillar. All the cases observed were either the same as the foregoing those corresponding to the two first being the most frequent or, as they presented but slight modifications, were easily referred to one or other of those conditions. The modifica- tions of most frequency were those affecting the places of origin of the pharyngeal and the inferior palatine arteries, points previously referred to. It may be added, that the last-named artery was occasionally seen behind and under the two muscles of the styloid process, and not as usual between them. Lastly, the disposition of the vessels was in some cases found to be exactly the same on both sides of the body, while others presented examples of the opposite arrangements on the two sides. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. THE abbreviations which occur in the following table consist, as in the foregoing, in the omission of the last letters of the word: e. g. P. Scap. stands for Posterior Scapular ; S. Scap. for Supra Scapular ; Tr. Col. for Transversalis Colli ; seal, for scalenus ; m. for muscle, &c. The word "usual," applied to the branches which arise to the inner side of the Scalenus muscle, implies that the Vertebral, Mammary, and Thyroid arteries were given off in that situation. In reference to the branches given under the muscle on the right side, it denotes that the Intercostal took origin there. No. Side of the Body. L Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. la J~ usual ex- \ cept Vert. Vert, arises from the Aorta. 2a L usual. Mam. from Th. axis. 3a R f usual ex- Lcept Th. Infer. Th. absent. L J" usual ex- \ cept Th. Infer. Th. absent. 11 R usual. usual. P. Scap. 13a R P. Scap. Subclav. ascends 11 inch above clav. 13b R Vert, enters third cerv. verteb. 15 R usual. usual. none. 15a R f Subclav. is not higher than clav. ; it < is covered in its whole length by st. I mast, muscle. 16 R usual. usual. a branch. Subclav. not above clav. 19 usual. usual. P. Scap. Subclav. little above clav. 19a R usual. usual. none. Subclav. not above clav. 19b L usual. tntercost. none. f Subclav. not above clav. St. mast. < muscle unusually thick at lower end, [_ and broad at upper. 21 R usual. usual. none. {Infer. Th. very large (Super. Th. small). L / usual ex- \ cept Vert. [ntercost. none. f Infer. Th. small (Super. Th. large) : \ Vert, from Aorta. 26 L usual. [ntercost. none. Infer. Th. large. (See Table, p. 57). 114 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 28 R usual. usual. none. Subclav. ascends 1 inch above clav. 29 a R Th. large. Thyroid body enlarged. L J" Th. absent, but a br. is given, \ instead, from Innom. 30 a R usual. usual. none. Cerv. ascend, becomes Occipl. 33 R Scap. brs. are not given from Th. 41 R J" usual ex- \ cept Th. rSubclav. given from descending j Aorta, and crosses behind the 1 cesoph. and the Com. Car. Th. \ is from Com. Car. ; the br. in j usual situation of Th., ramifies on V^trachea and oesophagus. 42 R f Subclav. fr. descending Aorta and j crosses behind cesoph. and Com. I Car. ; no Infer. Th. (Super. Th. 1 large). Infer, lar. nerve not re- ^ current, and not behind Subclav. L usual. Infer. Th. small. 45 R usual. usual. large P. Scap. 47 a usual. usual. J St. mast, muscle 3 inches broad at \ lower end. 48 R usual. usual. JS. Scap. & \P. Scap. f S. Scap. and P. Scap. arise by a < com. trunk on outer margin of 1st [rib. L usual. Intercost. P. Scap. Mam. from Th. 50 L ("Subclav. given from left side of < Aortic arch, and directed very ob- |_liquely across to 1st rib. 51 R usual. usual. none. 52 R usual. usual . P. Scap. P. Scap. gives Prof. L /large P. \Scap. P. Scap. gives Prof. 53 R usual. usual. none. L a large br. 54 R usual. usiial. P. Scap. L none. f Vert, rises at dist. of inch fr. \ origin of Subclav. 55 R P. Sc. & Prof. none. Vert, small. Intercost. absent. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 115 No. Side of the Body. Brs. internal to he anterior Sea- lenus muscle. Bra. under the anterior Scalenus muscle. Bra. leyond the .interior Scalenus muscle. Peculiarities 57 R usual. a small br. I" Subclav. does not ascend above i clav. ; S. Scap. and Tr. Col. by L one trunk close to Th. 58 R none. Subclav. does not ascend above clav. L usual. !ntercost. none. 59 R usual. usual. none. Subclav. ascends 1 inch above clav. L usual. [ntercost. none. 60 R none. Subclav. ascends 1 inch above clav. 61 R usual. usual. a large br. L a large br. 63 R usual. usual. loue. L ("usual and \ Intercost. P. Scap. none. 64 R Tr. Col. 65 R none. Subclav. ascends a little above clav. 66 R J usual and \ P. Scap. fSubclav. arches 1-J inch above J clav. ; Tr. Col. by two brs. Su- ] perfic. Cer. with P. Scap. by one L trunk close to Th. 67 R |~ usual, with I S.Scap. and LSuperf.Cer. J usual and IP. Scap. J* Vert, large. S. Scap. and Superf. \Cerv. by a com. trunk. L ["usual, with J Intercost., 1 S. Scap., & LSuperf.Cer. P. Scap. f Vert, small. S. Scap. and Superf. \ Cerv. by a com. trunk. 68 R usual. usual. none. L usual. Intercost. none. 69 R f usual and \P. Scap. none. Subclav. ascends a little above clav. L J Intercost. & \P. Scap. none. J" Subclav. ascends a little above clav. \ Vert, very small,andgivenfromTh. 70 R usual. usual. P. Scap. L usual. Intercost. P, Scap. 72 R {usual an dS Scap. usual. J P. Scap. and \ another br. [" Tr. Col. in two parts ; Superfic. < Cer. from Th. S. Scap. from Sub- [ clav. near Th. L 2 116 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. L / usual and \ Intercost. f Tr. Col. \andS.Scap. / No Scap. br. from Th. ; 3 small \ separate brs. instead of Prof. r usual and 74 L \ Intercost. none. none. Intercost. close to Vert. I" Subclav. ascends little above clav. ; 75 R usual. usual. none. < Vert, from lower aspect of Subclav., (_ and turns up behind it. L / usual and \ S. Scap. Intercost. P. Scap. [" Vert, as at R. ; S. Scap. and 1 Superfic. Cer. fr. Subclav. by a |_com. trunk which is close to Th. 76 L usual. Intercost. none. 77 R fboth Scap. < by common [ trunk. fSubclav. ascends little above clav. ; J it perforates scal.m. ; 2 small brs. j fr. Th. in place of Scap. brs. ; S. [_Scap. under ligt. of scap. L all brs. none. none. Intercost. intern, to seal. m. 78 R {usual ex- cept Scap. brs. usual. fTr. Col. & I S. Scap. by | a common Ltrimk. {Subclav. ascends little above clav. ; Scap. brs. directly from Subclav. Vert, rises close to Innom. r USUtll CX- {S. Scap. & L < cept Scap. [bra. Intercost. Tr. Col. by a common trunk. / Scap. arteries arise directly from \Subclav. 80 R all brs. none. none. / Tr. Col. separ. br. intern, to seal. \ m. ; Intercost. intern, to same. L fall except 1 Tr. Col. Tr. Col. none. Tr. Col. separ. br. fP. Scap. & 82 R < Prof, by a {_ com. trunk. ("Subclav. perforates seal. m. Mam. L < gives a br. across the lower part of [ the neck. 83 R usual. / usual and \P. Scap. none. Subclav. arches little above clav. / usual and L \ Intercost. Tr. Col. none. 84 R usual. / usual and \ Tr. Col. none. Prof, ascends from beneath the 1st rib. L /Tr. Col. & f No. Scap. br. from Th. ; Prof. \ S. Scap. \ascends from beneath the 1st rib. 86 R ("usual and \ Intercost. none. P. Scap. Vert, arises near the origin of Subclav. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 117 No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyotft the anterior Scalenus muscle. Peculiarities. 88 L R usual. f usual and \ Intercost. Intercost. P. Scap. none, none. J Th. small and gives no br. to thy- \roidbody. L f usual and \ Intercost. P. Scap. none. 89 R usual . usual. ' none. L f usual ex- l cept Vert. f Intercost.& \P. Scap. I ' Vert, from Aorta. 90 R usual. f usual and \Tr. Col. none. L usual. [ntercost. none. 91 R usual. fTr.Col.and \ usual. none. f Subclav. ascends little above clav. ; \ Intercost. and Prof, are separ. brs. L J" all except \ Tr\ Col. Tr. Col. none. 93 R usual. f P. Scap. and \ usual. none. 94 R all. none. none. {Tr. Col. a separ. br. of Subclav. ; Prof, is directed backwards between 6th and 7th vertebrae. L / all except t Tr. Col. Tr. Col. none. 96 R usual. f P. Scap. and \ usual. none. Cerv. ascend, from Superf. Cerv. L all. none. none. 97 R usual. usual. none. Mam. from Th. axis. 99 R J* usual except \ S. Scap. usual. none. S. Scap. rises from the Axillary artery. 100 R J~ usual and 1_ Scap. brs. usual. none. f Tr. Col. and S. Scap. arise fr. < Subclav. by a com. trunk which [gives Cerv. ascend. L I" usual and \ Intercost. P. Scap. none. 101 R f usual with \Scap. brs. usual. none. fTr. Col. and S. Scap. arise fr. I Subclav. by a com. trunk ; Prof. J continued from Ascend, cerv. and | directed backwards betw. 4th and 1 5th vertebrse ; Intercost. gives no l^Prof. br. 118 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 101 L all. none. none. Mam. arises from Th. axis. 103 R Tr. Col. none. ( Vert, arises close to origin of Sub- ] clav. ; Th. gives Intercost. but not ) the Scap. brs., or Cerv. ascend., \ which (latter) is from Tr. Col. S. 1 Scap. arises fr. Axillary and passes Bunder lig. of scap. 104 R f usual and \ Intercost, ("none but J small brs. ] tointervert. [_foram. f a branch, t (P. Scap.?) L f usual and \ Intercost. P. Scap. none. 105 R usual. usual. none. 106 R usual. usual. P. Scap. f Subclav. arches ! inch above \ clav. ; Cerv. ascend, from Tr. Col. L usual. tntercost. P. Scap. P. Scap. rises on the 1st rib. 110 R J" usual and \ Intercost. none. none. ("The brs. are given at the distance J of 1 inch fr. origin of Subclav. ; | Cerv. ascend, becomes Occipl. ; (^ Intercost. gives a br. to trachea. L all. none. none. Cerv. ascend, becomes the Occipl. 111 R J" usual and \ Intercost. {small brs. tointervert. foram. P. Scap. Cerv. ascend, fr. S. Scap. L J usual and \ Intercost. none. P. Scap. Main, arises from Th. axis. 112 R usual. usual. P. Scap. 113 R usual. usual. P. Scap. L usual. Intercost. P. Scap. 114 R f usual and \ Scap. brs. usual. none. f Vert, gives Th. ; Tr. Col. and P. < Scap. arise from Subclav. by a com. |_ trunk. L f Th. is a separ. br. ; Mam., Tr. Col., < S. Scap. and Cerv. ascend, are [ given fr. one trunk. 116 R f" usual with < Intercost. [ and Prof. none. P. Scap. (" Intercost. and Prof, are separ. brs. < latter passes between 6th and |_ 7th vert. L usual. Intercost. P. Scap. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenu? muscle. Brs. beyond^the anterior SdUenus muscle. Peculiarities. 117 R f usual and \ Intercost. none. f a br. to \ muscles. f Intercost. from Vert, and gives Prof. {_ as usual. L ("usual with < Intercost. [and Prof. none. P. Scap. f Prof, a separ.br. and passes between \ 6th and 7th vert. 119 L S. Scap. S. Scap. rises fr. Subclav. on 1st rib. 120 R usual. usual. none. S. Scap. from Axillary. 121 R usual. usual. none. f Prof, from Ascend, cerv. br. of Th. \ and passes between 4th and 5th vert. L usual. Intercost. none. Prof, same as on the right side. 122 R usual. usual. P. Scap. Prof, between 6th and 7th vert. 123 L usual. Intercost. none. f Prof, small deficiency compen- \ sated for by Cerv. ascend. 124 L usual. Intercost. none. 127 R \ usual and 1 S. Scap. usual . P. Scap. S. Scap. a separ. br. (fr. Subclav.) L usual. Intercost. none. 129 R usual. usual. P. Scap. L usual. Intercost. P. Scap. 130 R Mam. from Th. axis. [Prof., In- J31 R usual. < tercost. and [ P. Scap. none. Intercost. and Prof, are separate brs. 134 R isual. usual. P. Scap. L usual. fntercost. P. Scap. 135 R f usual and \ Intercost. P. Scap. none. L isual. [ntercost. none. {S. Scap. by a com. trunk with Tr. Col. (from Th.) and crosses the neck higher than usual. 136 R usual. usual. none. Prof, small. L / usual and \ Intercost. none. P. Scap. f Th. gives Mam. and a br. to trachea \ and oesophagus within the chest. 137 R J~ usual and \ Intercost. none. P. Scap. f Subclav. from descending Aorta < and crosses behind oesophagus; [Mam. from Th. 120 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 138 R ("usual with I S. Scap. | and Cerv. (^ascend. usual. Tr. Col. f Vert, rises near origin of Subclav. ; < S. Scap. and Cerv. ascend, are [separ. brs. of Subclav. 139 L usual. Intercost. none. Vert, small. 140 R usual. usual. none. 142 R usual. usual. P. Scap. Origin of Subclav. is low inthe thorax. 145 R f usual and \ Intercost. none. P. Scap. 145 L usual. Intercost. P. Scap. 146 R J usual and \ S. Scap. usual. none. . S. Scap. a separ. br. of Subclav. 147 L Vert. Intercost. Th. and Mam. |~ Th. axis and Mam. are directed 4 inwards over the anterior scalenus |_ muscle. 149 L J usual and \ Intercost. none. none. 150 R usual. usual. P. Scap. 151 R usual. usual. a large br. 153 R f" usual, with < Intercost. |_andS. Scap. none. P. Scap. f Th. is a separ. br. ; Marn. and S. \ Scap. arise by a com. trunk. 155 R usual. usual. P. Scap. 160 L f usual, with j Intercost. & 4 3 small brs. j tointervert. ^foram. none. P. Scap. J" Vert, from near origin of Subclav. \ and enters 3rd vert. 167 R usual. usual. P. Scap. L usual. Intercost. P. Scap. 169 R usual. usual. P. Scap. 170 R usual. usual. P. Scap. Subclav. arches 1 inch above clav. L f usual and \ Intercost. none. none. Vert, from near origin of Subclav. 173 R usual. usual. none. 173a R J usual and \ Intercost. none. P. Scap. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 121 No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 174 L usual. flntercost. J and a br. to | intervert. l^foram. none. 176 R usual. f usual and 2 \ small brs. R Scap. Distance to origin of brs. -| inch. L f usual and \ Intercost. f 1 br. of Tr. I Col. (Su- [perf. Cerv.) fa f2nd br. 4 of Tr. Col. L (P. Scap.?) Prof, ascends from below 1 st rib. 177 R usual. f usual and IP. Scap. none* J Th . divides into 2 brs. before crossing \ beneath the Com. Car. L fMam., Th. < and Inter - L coat. f 1 br/of Tr. 1 Col. ' (Su- |_perf. Cerv.) J2nd br. of \ Tr. Col. Vert, from Aorta. 178 R usual . f usual and \ P. Scap. Distance to origin of brs. inch. L J~ usual and \ Intercost. P. Scap. none. 179 R usual. J~ Intercost. & \P. Scap. ("Sterno-mastoid m. is 3 inches broad J at lower end and extends outside j Subclav. artery. Distance to origin l^of brs. -^ inch 180 R usual. usual. P. Scap. f Distance to origin of brs. f inch. < Intercost. ascends from beneath 1st L f usual and \ Intercost. P. Scap. none. P. Scap. perforates post, scalen. m. 181 R f usual and \ Intercost. f small brs. < to intervert. [foram. P. Scap. Distance to origin of brs. 1 inch. 182 R usual. usual. P. Scap. Distance to origin of brs. 1 inch. L usual. Intercost. P. Scap. 183 R usual. usual. P. Scap. /'Subclav. perforates the anterior j scalenus. Omo-hyoid m. arises <{ from middle of clav. Distance to j origin of brs. 1 inch. Superficial ^Cerv. from S. Scap. L / usual and \ Intercost. P. Scap. none. Superficial Cerv. from S. Scap. 184 R usual. J Intercost. & \ P. Scap. none. Distance to origin of brs. f inch. 122 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of th Body L Brs. internal to the anterior Sea lenus muscle- Brs. under the anterior Scalenu muscle. Brs. beyond the anterior Scalenu muscle. Peculiarities. J" usual and \ Intercost. none. none. ("Common trunk of Scnpular arteries J and the Mammary arise from Th. j axis which is much dilated; Th. (^artery crosses behind Vert. 185 R usual. usual. P. Scap. Distance to origin of brs. ^ inch. L f usual anc |_ Intercost. P. Scap. none. {Prof, is at first placed between the neck of 1st rib and tras. process of 1st dorsal vertebra. 186 R usual. Prof. P. Scap. f Distance to origin of brs. % inch. 1 Intercost. given from Vert., descends I through foramen in tras. process ol j 7th cerv. vert, and between necks 1 of 3 ribs and tras. processes of 3 ^dorsal vertebrae. L J usual and \ Intercost. P. Scap. rVert. through foramen of 7th cerv. J vert. ; Intercost. between the necks ^ of 2 ribs and tras. processes of dor- [_sal vertebrae. 187 R usual. usual. none. f S. Scap. very small : its place on < scapula is supplied by dorsal br. of L Sub. Scap. L ("usual and \ Intercost. none. P. Scap. J" Th. very small not supplying Th. \ body ; S. Scap. not given from Th. 188 R f usual and < com. trunk [ of Scap. brs. f usual and 2 J small brs., < which enter | intervert. ^foramina. none. f Scap. brs. by a common trunk \ which is joined to Mam. L usual. ntercost. none. Mam. united to Th. axis. 191 R usual. usual. P. Scap. Distance to Istbr. (Mam.) \ inch. L isual. flntercost.& \sj. large br. none. JThe br. under seal. m. supplies \ muscles and gives the Prof. 192 R usual. usual. P. Scap. I" Distance to 1st br. (Vert.) | inch : < to others 1 inch. S. Scap. from [Mam. L isual. J Intercost. & \ P. Scap. lone. f Th. crosses behind Vert. ; S. Scap. \ from Mam. 193 R usual. usual. , T a br. on < 1st rib to [muscles. L / usual and \ Intercost. / br. to inter- \vert.foram. Vlam. joined to Th. axis at origin. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 123 No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle- Brs. beyond the anterior Scalenus muscle. Peculiarities. 194 R usual. USUal. P. Scap. fBrs. internal to seal. m. arise at J nearly regular intervals ; Prof. | double, one above, the other below List rib. L usual. {a large br. (P. Scap.?) none. 195 R f Subclav. is covered by Carotid for < 1 inch of its length ; Th. absent |_(a br. from Innom. instead). L usual. Prof, ascends from beneath 1st rib. 196 R J~ usual and \ Prof. Intercost. none. f Mam. gives a br. directed trans- \ versely behind clav. L J" usual and \ Prof. {a large br. (P. Scap.?) none. J The br. under seal. m. gives In- \ tercost. and P. Scap. 198 L f usual, In- < tercost. and [P. Scap. none. none. 199 R usual. usual. none. Th. axis much enlarged. L f usual and \ Intercost. / a large br. t (P. Scap.?) 200 R usual. usual. P. Scap. Distance to origin of brs. inch. 201 R usual. usual. P. Scap. L usual. Intercost. none. 202 L J usual and \ Intercost. none. none. TTh. small and does not supply th. J body, which receives a br. from | Innom. (Superior and Inferior Th. (^arteries on right side are of full size). 203 R usual. usual. P. Scap. TDistanre to origin of brs. nearly 1 I inch ; besides the usual br. Th. axis | gives another br. to th. body over [_Com. Carotid. 204 R L usual. ["usual \vith < Intercost. & (_ Scap. brs. usual, none. fa large br. \ (P. Scap.?) none. J" Scap brs. arise by a com. trunk \ from Subclav. 205 L f usual and \ Intercost. none. none. 206 R usual. usual. none. Distance to origin of t.rs. inch. L usual. Intercost. P. Scap. 124 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus . muscle. Peculiarities. 207 R usual. usual. none. Distance to origin of brs. 1| inch. L J~ usual and \ Intercost. none. none. J Intercost. arises from Subclav. \ before the other brs. 208 R usual. / usual anc \ Tr. Col. none. /"Distance to origin of brs. l inch. I Intercost. gives an unusual br., < which runs along the oesophag. am I trachea. Mam. furnishes a large ^Bronchial artery. 209 R J" usual and \ Intercost. none. P. Scap. Distance to origin of brs. 1^ inch. 210 R usual. usual. P. Scap. TDistance to origin of brs. -|- inch. I Intercost. supplies one intercost. | space. Prof, ascends from beneath List rib. L usual. J" Intercost. & \P. Scap. none. f Intercost. very small; Prof.ascends \from beneath 1st rib. 211 R usual. usual. none. Distance to origin of brs. % inch. L f usual and \ Intercost. none. P. Scap. 213 R usual. usual. P. Scap. TDistance to origin of brs. -| inch ; I a small separate br. to trachea ; | Mam. from Th. axis ; Intercost. Land Prof, separate brs. L f usual and \ lutercost. none. none. 214 R usual. usual. P. Scap. Distance to origin of brs. f inch. L / usual and \ Intercost. none. P. Scap. 215 R usual. usual. P. Scap. I" Distance to origin of brs. 1 inch ; < two brs. for Prof. 1 st from Inter- (_cost., 2nd from Cerv. ascend. L usual. fntercost. none. f Th. gives a br. turning inwards to \ oesophag. 216 R L usual. f usual and \ Intercost. usual. none. P. Scap. P. Scap. f Th. arises separately at beginning \ of Subclav. 217 R J usual and \ Intercost. none. none. Vtam. from Th. axis. 218 R / usual and \ Intercost. none. none. f Distance to origin of 1st br. (Vert.) liinch. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 125 No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 219 R usual. usual. P. Scap. ("Distance to origin of brs. inch ; J Th. a separate br. ; Mam. joined ] to Scap. brs. ; Intercost. and Prof. (_ separate brs. L f usual and \ Intercost. none. P. Scap. f Th. a separate br. Soap. brs. by \a com. trunk. 220 R usual. usual. P. Scap. L f usual and \ Intercost. P. Scap. none. 221 R usual. usual. P. Scap. Distance to origin of brs. f inch. 222 R usual. two brs. J P. Scap. & \S. Scap. f S. Scap. on 1st rib and passes under \ ligament of scapula. 223 R usual. usual. P. Scap. Distance to origin of brs. % inch. L usual. Intercost. none. Mam. from Th. axis. 225 R usual. usual. none. {Distance to 1st br. ^ inch ; a separate br. from Subclav. to tra- chea ; Prof, ascends from beneath 1st rib ; S. Scap. given from Sub- Scap. 226 R usual. usual. P. Scap. Distance to origin of brs. 1-f inch. 228 R usual. usual. none. Distance to origin of brs. % inch. 229 R f Omo-hyoid m. arises from clavicle < and covers the Subclav. artery (_ beyond the scalenus m. 230 R /usual and \ Intercost. none. P. Scap. Distance to origin of brs. f inch. L usual. Intercost. none. 231 R usual. usual. P. Scap. Distance to origin of brs. 1-J- inch. 233 R f usual and \ Intercost. Distance to origin of brs. % inch. L usual. Intercost. 234 R J" usual and \ Intercost. f Subclav. arises to left of other brs. < and crosses behind cesopbag. ; L Cerv. ascend, becomes Occipl. L J usual and \ Intercost. none. P. Scap. [" Cerv. ascend, becomes Occipl. ; < and on both sides it turns back [beneath transverse process of atlas. 235 R usual. usual. J Distance to origin of brs. l inch ; \ Prof, ascends from beneath 1st rib. 126 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to he anterior Sca- lenus muscle. Brs. under the nterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 236 R f usual and \ Intercost. none. none. TDistance to origin of 1st br. f I inch ; two brs. from Th. axis to j tb. body one under, the other [^over, Com. Carotid. L j" usual and \ Intercost. none. none. 237 R usual. usual. a small br. C Distance to origin of brs. 1 inch ; j Prof, as two brs. one from In- \ tercost., the other from Th. (the j latter is close at first to Cerv. V^ascend.) 238 R usual. usual. usual. Distance to origin of brs. 1^ inch. L usual. Intercost. none. {Prof, passes between transverse process of 1st dorsal verteb. and 1st rib. 240 R usual. usual. none. Distance to origin of brs. ^ inch. 242 R f usual and \ Intercost. P. Scap. none. f Distance to origin of brs. -^ inch ; < Tntercost. arises with the first brs. ; |_P. Scap. through p. seal. m. 243 R L usual. J" usual and \ Intercost. J usual and IP. Scap. none. S. Scap. P. Scap. [" Distance to origin of brs. 1 inch ; < S. Scap. on 1st rib and passes [_ under lig. of scapula. Mam. from Th. axis. 246 R usual. usual. none. Distance to origin of brs. ^ inch. L f usual and \ Intercost. none. P. Scap. 247 R usual. usual. P. Scap. Distance to origin of brs. |- inch. L f usual and \ Intercost. none. P. Scap. 248 R usual. usual. none. [" Distance to origin of brs. 1 inch ; < the Scap. brs. scarcely joined to [Th. L f usual and I Intercost. none. none. Scap. and Th. arteries arise separately. 249 R usual. usual. none. Distance to origin of brs. -g- inch. L f usual and \ Intercost. none. P. Scap. 250 R usual. usual. fSubclav. arises low in chest and < ascends close to Com. Car. ; dis- [_ tance to origin of brs. 1| inch. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 127 No. Side of the Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 251 L J usual and \ Intercost. none. none. 252 R usual. J~ usual and \P. Scap. none. ("Distance to origin of brs. | inch ; J Prof, as two brs. one from In. | tercost., the other from the begin- l_ning of P. Scap. 253 R usual. usual. none. L f usual and \ Intercost. none. none. 24 L f usual and \ Intercost. P. Scap. none. JProf. ascends from beneath 1st \ rib. 255 R usual. usual. P. Scap. [" Distance to origin of brs. ]|- inch ; < Th. a separate br. ; S. Scap. and " |_ Superficial cerv. by a com . trunk. 256 R usual. usual. P. Scap. r Th. a separate br. from beginning oi < Subclav. ; a. second Th. from Com. I Carotid near origin. L usual. Intercost. P. Scap. 257 R usual. usual. (" Distance to origin of brs. 1 inch ; < Prof, as two brs. one above, the Bother below the 1st rib. L usual. J" Intercost. & \ Prof. none. Intercost. and Prof, separate brs. 258 R usual. usual. Tr. Col. Distance to origin of brs. 1 inch. L usual. Intercost. P. Scap. ("Inferior Th. on both sides large, < supplying the deficiency of Superior [Th. 260 R usual. usual. none. Distance to origin of brs. 1^- inch. L usual. J" Intercost. \ and Prof. none. 1" Intercost. and Prof, merely joined < at oiigin ; Cerv. ascend, given [ from Tr. Col. 261 R usual. usual. none. J Distance to origin of brs. % inch. \ Vert, small. 262 L usual. Intercost. none. 264 R usual. / Intorcost. & 1 P. Scap. f Distance to origin of brs. % inch ; j Prof, as two brs. one from In- ( tercost. (small), the other (large) j from Cerv. ascend. : latter turns V^back below 3rd vert. 265 R usual. usual. none. f Distance to origin of brs. 1 inch ; \ Intercost. supplies three spaces. 128 SUBCLAVIAN ARTERIES AND THEIR BRANCHES. No. Side of the Body. Brs. internal to ', the anterior Sea- lemis muscle. I Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 265 L r usual with 1 Intercost.& [ Prof. none. P. Scap. / Intercost. and Prof, joined at origin (_ former supplies one space. ( Distance to origin of hrs. 1^- inch ; j S. Scap. from Mam., which gives 268 R usual. usual. none. < another branch ramifying on tra- 1 chea and bronchial glands ; Inter - V^cost. ramifies in three spaces. (" Mam. gives a br. into chest as on L usual. [ntercost. P. Scap. < right side. Prof, ascends from [_ beneath 1st rib. /"Distance to origin of brs. 1 inch ; [" Intercost. & j Intercost. supplies a branch wh. 269 R usual. < a branch to none. { runs on the trachea to become a L muscles. j bronchial artery ; Prof, ascends ^ from beneath 1 st rib. 270 R usual. J" usual and 1 P. Scap. none. Distance to origin of brs. 1 inch. L I" usual and \ Intercost. none. S. Scap. J" A br. arches beneath Th. artery to \ oesophagus. r usual and 271 L \Intercost. P. Scap. none. Prof, ascends from beneath 1st rib. 272 R usual. usual. none. ("Intercost. gives a br. to oesophag. \ and trachea. r Distance to origin of 1st br. (Th.) 273 R usual. usual. none. J 3 inch ; Prof, as two brs. one j from Tntercost. (small), the other (^from Cerv. ascend. f Th. gives no Scap. br. ; S. Scap. L ("usual ex- < cept Scap. [_ arteries. small Prof. P. Scap. 1 from Axillary ; Prof, as two brs. 1 one from Subclav. (small), the other j from Cerv. ascend. : latter turns I back below 3rd cerv. vert. these V^brs. anastomose together. 275 R Th. and Vert. usual. J P. Scap. & \Marn. ("Distance to origin of brs. ^ inch. < P. Scap. is close to seal. m. Mam. (_ one inch beyond it on 1 st rib. L J usual exc. \Marn. [ntercost. fa small P. < Scap. and |_Mam. ("P. Scap. touches outer margin of J scalen. m. ; Mam. arises from end ] of Subclav. and turns inwards under [_clav. and subclavius in. 276 L usual. Intercost. none. f Vert, very close to Innom. at origin 277 R usual. usual. P. Scap. < and it enters 4th vert. ; Th. crosses [ behind it. SUBCLAVIAN ARTERIES AND THEIR BRANCHES. 129 No. Side of the 'Body. Brs. internal to the anterior Sca- lenus muscle. Brs. under the anterior Scalenus muscle. Brs. beyond the anterior Scalenus muscle. Peculiarities. 278 R usual. usual. P. Scap. f Distance to- origin of brs. 1 inch ; < Subclav. at first covered by Com. I Carotid. 279 R J" usual exc. \Marn. f usual and \P. Scap. Mam. f Distance to origin of brs. If inch ; < Subclav. behind Com. Carotid at [ origin ; Vert, arises close to Innom. 288 R usual. usual. none. f Distance to origin of 1st br. (Vert.) < 1^- inch , Subclav. at origin covered [ by Com. Carotid. 289 R usual. usual. none. Distance to origin of brs. f inch. 291 R usual. J usual and \ P. Scap. none. Distance to origin of brs. inch. 292 L / Vert, and \ Intercost. none. f P. Scap., 293 L JVert.&abr. \ to cesophag. Intercost. TScap. brs., J Cerv. as- 1 cend. and [" Th. art. absent, deficiency is com- < pensated for by Super. Th. and a [ br. from Innom. {Intercost. TVert. from Aorta and in front of 294 L Th. with Mam., S. Scap. & Tr. Col. J Th. ; Scap. brs. and Mam. arise | from a short trunk which perforates (jcal. muscle. Th. a separ. br. 295 296 Tin both these bodies the phrenic J nerve, instead of being between the | Subclav. artery and vein, is placed [^in front of the latter vessel. ABSTRACT of die foregoing table, so Cur as regards the branches which derived from die Subclarian artery, where it is covered by die Scalenus, where it is beyond or external to that muscle. BRANCHES UNDER SCALENUS MUSCLE. "-ST* 16 3450 . * . about lin. 5i O" ^ 112 68180 . . . ,. lin. H * I2T 21 9 30 . . lin. 8f "HS* 3 1 4 lm-66 264 BRANCHES BEYOND SCALENUS MUSCLE. None \ j"jT 76 66142 . . about lin. If -1ST 72 40112 . . . , 1 in. 2 *-J2T 4 37 . n lin. 37^ *~ J2f 2 2 . lin. 131 oco The observations contained in die table on die origin, die position, and course of die Snbdavian arteries, as well as on die peculiarities of die branches, are uDUi tbej are severally under 131 EXPLANATION OF PLATE XVI. THE preparation to show the parts as they are represented in this plate consisted in the removal of the platjsma myoides, the cervical fascia, with part of the sterno-cleido-mastoid, sterno-hyoid, omo-hyoid, and sterno-thyroid muscles. At the same time, the clavicular attachment of the trapezras was divided and the muscle turned back ; a portion of the clavicle, after separation from the larger pectoral muscle, was removed, and, in consequence, the subclavius muscle lay exposed. The first rib was brought into view by detaching from it the inner end of the last-named muscle. 6 Parotidgland. c Digastric mud d Stylo-hyoid. e Sterno-dado-fl / Sub-maxillary gland. g Mylo-hyoid muscle. A Hyoidbone. i Thyroid cartilage. k Sterno-hyoid musde. I Omo-hyoid. Sterao-thyroid. -Crico-thyroid. Thyroid body. ARTERIES. 1. Innominate. 2. Common carotid. 3. Snbdarian. 4. External carotid. 5. Internal carotid. 6. Superior thyroid, of the artery reprea Tr.e :..: :.v;:.. :,:;:_-;:.--- orer the muscles below the hyoid bone; the laryngeal, which is concealed except at its origin by the thyro-hyoid musde ; a lar bianch the omo-hyoid muscle; continuation of the artery which the thyroid body and the constrictor muscle of the Another tike crico-thyroid mem- md one given from the inferior thyroid _ from under the thyroid body to _" J m-t _- *m_ , _.*.' ?,-_ .! UO CDC ; >*|PTI MH LDTTOM1 ID SapptT- ing the anterior surtace of that 7. LingnaL 8. FaciaL 9. OcdpitaL 10. Temporal 11. TertebraL In front of the artery is a portion of the accompanying 12. 12*. Thyroid axis. Inferior thyroid artery. :: 132 EXPLANATION OF THE SEVENTEENTH PLATE. 13. 13'. 14. 15. Internal mammary. One of the perforating branches of the last-named artery. Ascending cervical. Supra-scapular. The branch which turns inwards from this artery over the sternal end of the clavicle is generally, if not con- stantly, found and is distributed to the muscles in this situation. I5 1 . A branch (acromial) of the pre- ceding : it crosses the supra-spi- natus muscle (w.) and ramifies about the acromion. 16. A. Superficialis colli. 17. Posterior scapular. VEINS. 18. Subclavian. | 19. Internal jugular. 20. External j ug ular. NERVES, 21. Pneumogastric or n. vagus. 22. Phrenic. 23. Cervical part of those which formed the cervical plexus. 34. Anterior branches of the lower cervical and first dorsal, directed outwards to form the brachial plexus. 25. A small branch which supplies the subclavius muscle, and give* a slender offset to join the phrenic nerve within the thorax. EXPLANATION OF PLATE XVII. THE figure marked No. I is intended to show the innomi- nate artery at its bifurcation, and the common carotid and subclavian arteries immediately after their origin, together with the veins and nerves which are in connexion with them above the sternum and the inner end of the clavicle. The sterno-cleido-mastoid muscle has been divided, one part is reflected upwards on the neck, and the lower end being turned down the sternal and clavicular attachments of the muscle, fall separately on the thorax. By the removal of a portion of the sterno-hyoid and of the sterno-thyroid muscle, the deep layer of the cervical fascia, which descends behind the sternum after covering the trachea and the large vessels, is exposed, and, by the excision of a portion of it, the vessels and nerves have been brought into view. The disposition of the more superficial part of the fascia on the muscles is also displayed. In the figure No. 2, the third part of the subclavian artery is represented in connexion with the veins and nerves which are found in its neighbourhood. The common integument together with a part of the EXPLANATION OF THE EIGHTEENTH PLATE. 133 platysma myoides and the cervical fascia being removed, the supra-clavicular triangular space of anatomical writers is displayed ; the sides of it are formed by the clavicle, the omo-hyoid muscle, and the sterno-cleido-mastoid or anterior scalenus. a The cervical fascia. b Sterno-cleido-mastoid muscle. b ' Sterno-cleido-mastoid muscle of the left side. c Sterno-thyroid. d Sterno-hyoid. d l Left sterno-hyoid. e Omo-hyoid. / Anterior scalenus. g Trapezius. ARTERIES. 1. Innominate. 2. Common carotid. 3. Subclavian. VEINS. 6. Internal jugular. 7. Anterior jugular. 8. The preceding vein terminating with the external jugular in the subclavian : the last-named vein is seen to a small extent above the clavicle. 9. Vertebral. 10. External jugular slightly drawn backwards to expose the subcla- vian artery : it receives, from under the trapezius muscle, the veins which correspond to the supra scapular and the transverse cervical (transversalis colli) arte- 11 Supra-scapular. A. Transversalis colli. ries, and ends in the subclavian vein close to or in connexion with the anterior jugular (see also plate 2). A small vein which lies close to the subclavian artery, is in this case, joined to the external jugu- lar ; it is often present, but seldom of so large size as is here repre- sented. Supra-scapular ; it follows the course of the artery of that name. The vein which accompanies the transverse cervical (transversalis colli) artery. NERVES. 1'2. Pneumo-gastricor n. vagus; a car- diac nerve is seen to descend from it along the innominate artery. 13. Small branches of the sympa- thetic nerve. 14. The common trunk of some of the superficial branches of the cervical plexus. 15. The nerves descending to form the brachial plexus, f. Lymphatic glands. EXPLANATION OF PLATE XVIII. a Masseter muscle. b Digastric. c Superior oblique (m. obliquus capitis superior). d Inferior oblique (m. obi. cap. in- ferior). e M. rectus cap. poslicus major. / Sterno-cleido-mastoid muscle. Anterior scalenus. Posterior scalenus. M. semi-spinalis colli. A small part of the trapezius. Clavicle. Acromion (process of the scapula), Part of the omo-hyoid muscle. M. longus colli. 134 EXPLANATION OF THE EIGHTEENTH PLATE. ARTERIES. 1. Arch of the aorta. 2. Innominate. 3. Right common carotid* 3 l . Left common carotid. 4. Right subclavian. 4 l . Left subclavian. 5. Right vertebral. 51. Left vertebral. 5f. Branch of the vertebral inoscu- lating with the " Profunda cer- vicis." 5J. A cervical branch of the same artery, of larger size than usual. 6. Internal mammary. 7. Thyroid axis. 7 1 . Supra- scapular. 8. Superior intercostal of the right side. 81. Ditto of the left side. 8f. Posterior branch of the pre- ceding. 9. " Profunda cervicis" of the right side. 9 1 . Ditto of the left side. 10. Posterior scapular of the right side. 10 1 . Ditto of the left side. 11. A small artery which distributes branches to the muscles, and along the nerves to the inter- vertebral foramina. 12. External carotid. 13. Internal carotid. 14. Facial. 15. Occipital. 15f. A branch of the preceding, with anastomoses with the vertebral and the " Profunda cervicis." 16. Posterior auricular. 17. NERVES. One of the lower cervical placed between the anterior and posterior scalenus muscle. 18. Pneumogastric or n. vagus. Figure 1. During the delineation of this figure, the body was viewed from above. The appearance of the clavicle and scapula contrasts with that of the same parts in the succeed- ing plate where the delineation was made from a subject which had been raised more nearly to the level of the eye. The deep artery of the neck (Ar. Profunda cervicis) of the left side is represented together with its inosculations with the vertebral and occipital arteries. To expose the vessel, the trapezius, the upper part of the sterno-cleido-mastoid, together with the splenius, the complexus, the trachelo-mastoid, and a portion of the lower end of the posterior scalenus muscles, were removed. The subclavian artery crosses over the first rib and under the clavicle. The intercostal artery takes origin from the subclavian behind the anterior scalenus muscle, and arches downwards into the thorax, after giving near its origin the " Profunda cervicis." The latter, being in this body at the origin of somewhat more than the usual size, inclines backwards between the neck of the first rib and the EXPLANATION OF THE NINETEENTH PLATE. 135 transverse process of the seventh cervical vertebra, and is directed upwards on the semispinalis colli, distributing branches on each side, and approaching the spinous processes of the ver- tebrae. The veins which accompanied the artery, and the nerves (posterior branches of the cervical) which crossed it, were removed in the dissection. Figure 2. In this figure the cervical part of the right vertebral artery is shown, together with the small branches given from it in this situation -exclusively of those which enter the spinal canal. On the left side, a portion of the rectus capitis anticus major (muscle) having been unintentionally left in connexion with the longus colli, the upper part of this muscle has the appearance of reaching to the base of the cranium. In con- sequence of this circumstance, that small part of the figure is in the state which Haller would have called " minus nitida." EXPLANATION OF PLATE XIX. Superior muscle of the ear. Posterior. Occipital part of the occipito- frontal muscle. Tendinous expansion, in which the fibres of the preceding end. Sterno-cleido-mastoid. M. splenius capitis. Splenius colli. Trachelo-mastoid. M. obliquus capitis superior. Complexus. i Levator anguli scapulae. k Serratus posticus superior. / Rhomboid. m Omohyoid. Spine of the scapula. Deltoid muscle. M. infra-spinatus. Long head of the m. triceps ex- tensor brachii. M. teres major. Latissimus dorsi. Trapezius. ARTERIES. 1. Temporal. 2. Posterior auricular. 3. Occipital. 3 1 . Cervical branch of the preceding ; this artery descends along the trachelo-mastoid muscle under the splenius, and ramifies in the muscles near the transverse pro- cesses of the vertebrae. 3f. An offset from the last .branch, which, after penetrating in the angular space bounded by the trachelo-mastoid, superior oblique, and complexus muscles (f, g, h), 6. anastomoses with the vertebral artery and the t( profunda cervi- cis," see plate 18, fig. 1. Supra- scapular, exposed by the removal of the trapezius and the supra-spinatus muscles. Superficialis colli, distributed be- neath the trapezius. A branch of the last-named artery ramifying under the integument. Posterior scapular, which, in this case, divides into three branches under the levator anguli scapulae muscle (6', 6f, 6J). 136 EXPLANATION OF THE TWENTIETH PLATE. This is the proper posterior sca- pular artery. It usually becomes concealed, as is represented in this plate, by the scapula, and ends beneath it in the serratus magnus muscle. Where it returns to view from under the scapula, the artery has been accidentally marked thus 6 nl . " Dorsalis scapulae " division of the subscapular artery. 7'. Another dorsal branch of the same. 7f. A small artery which communi- cates between the subscapular and the supra-scapular arteries in front of the spine of the scapula. 8. The three lowest vessels th-.s marked are the posterior branches of intercostal arteries ; the highest is derived from the " Profunda cervicis.'' 9. " N. occipitalis major " cut., being the large occipital branch of the first proper cervical. NERVES. 10. The nerves which form the bra- chial plexus. 11. Supra-scapular. By the separation of the integument from the greater part of the left side of the head, the superficial temporal, posterior auricular arteries, and a considerable part of the occipital have been exposed. The last-named artery is shown to a further extent by the excision of a small part of the sterno-cleido- mastoid and of the splenius muscles. It must be stated that the communicating branches between the arteries behind the ear are larger in this representation than they usually occur. The trapezius being divided close to its attachment to the clavicle and the spine of the scapula (to which bones a small portion of the muscle remains connected), and being then reflected towards the spine, the superficialis colli (5), with a larger transverse artery 6f, and the posterior branches of some of the intercostals,came into view. Finally, the scapular arteries namely, the posterior scapular, the suprascapular, and the dorsal branch of the subscapular have been shown by the removal to a greater or less extent of the rhomboid for the first-named, the supra-spinatus for the second, and the infra- spinatus and teres minor muscles for the third. EXPLANATION OF PLATE XX. a Thyroid cartilage. b Trachea. c Bronchus in some cases the root of the lung. d (Esophagus. e Anterior scalenus muscle. . / Clavicle of the right side. / l Clavicle of the left side. g Sterno-cleido-mastoid muscle. h Heart. EXPLANATION OF THE TWENTIETH PLATE. ARTERIES Arch of the aorta its ascending part 1. 2. Descending part of the aorta, 3. Innominate. 4. Right carotid. 4 1 . Left carotid. 5. Right subclavian. 5 1 . Left subclavian. 6. Vertebral. 7. Thyroid. 7*f. Ascending cervical branch of thyroid. 8. Internal mammary. 9. Supra-scapular. 10. Posterior scapular. Hi. 2 Intercostal branches of the left VEINS. 15. V. cava superior. 16. Right subclavian. ) 7. End of the internal jugular. Near 12. 12 1 . 13. 13 1 . 13f. 14. 14f. 14k side, given from the right sub- clavian. Right intercostal branches of the aorta. Left intercostal branches of the aorta. Pulmonary. Left pulmonary. Right pulmonary. Canalis V. Ductus arteriosus. Ligamentum arteriosum. A pouch, which ends in the left subclavian artery, and receives the attachment of the ligamentum arteriosum . to this is the vertebral vein, which, in this case, has an unusual course behind the subclavian artery. NERVES. 18. Pneumo-gastric, or n. vagus. 18t- Inferior laryngeal branch of the preceding. 19. 20. Phrenic . The branches which form brachial plexus. the The figures of this plate illustrate some peculiarities of the innominate and the subclavian arteries. Figure 1. The left carotid is joined to a very short inno- minate artery. Figure 2. The innominate is not seen in the neck, and the right subclavian is but very slightly above the clavicle. Figure 8. The innominate and the right subclavian arteries contrast strongly with those in the figure immediately preceding. Figure 4. The right subclavian is covered at and imme- diately after its origin by the carotid. Figure 5. The right subclavian artery arises to the left of the other branches, and crosses obliquely to the first rib, immediately in front of the vertebral column, behind the oesophagus. The inferior laryngeal nerve has its usual course on the left side : it is seen to be directed transversely inwards to the larynx on the right side. The common carotid arteries take origin from a common trunk. Figure 6 is taken from an essay by Adolphus Murray *. * Anatomische Bemerkungen bey einer sonderbaren Stellung einiger grb'ssern Puls- adernstamme unweit des Herzens, wie man solche in einem Leichname gefunden hat. In " Der K. Schwed. Acad. der Wissenschaften Abhandl. iibersetzt von A. G. Kastner," B. 30. * N 138 EXPLANATION OF THE TWENTIETH PLATE. It shows the right subclavian artery arising lower down than in the preceding figure, and two intercostal branches of the left side (1 1 ! ) given from it. The other intercostal arteries (12 and 12 1 ) are branches of the aorta. In the original drawing, the internal mammary artery of the right side is delineated, and, in the accompanying essay, is described as arising from the axillary (end of the subclavian ?) artery, at the same time that the right vertebral is derived from the com- mon carotid. It has not been considered necessary to extend the delineation so as to include the origin of the vessels referred to, inasmuch as facts of the same kind are shown in other plates. The representation of the heart being unnecessary for our purpose, that organ has been omitted, and the appearance of the trachea, which in the original is so unlike that structure as to require comment by the author *, has been altered. In Figure 7, the right subclavian artery passes from the left side of the aorta, between the trachea and oesophagus, to its usual position on the first rib. It is copied from one of those given of a remarkable case reported by Dr. Bayford^. Figures 8 and 9 are introduced to illustrate a 3 ery unusual mode of origin of the left subclavian artery. They have been drawn from a preparation in the museum of Guy's Hospital j . Figures 10 and 11, which also have reference to the origin of the left subclavian artery, are taken from an essay by Klinkosch. All the figures of this plate will be farther described, and the objects of their introduction will be more fully stated, in the observations on the innominate and the subclavian arteries. * " Besonders erinnere ich dass in der Abzeichnung der Theile die Luftrohre und der Larynx, weil der Zeichner solche Theile zu betrachten weniger gewohnt war, anders sind vorgestellt worden, als die Natur sie zeigt ; welches ich doch habe dabey bewenden lassen, weil meine Anmerkungen diese Theile nicht betreffen." f "An account of a singular case of obstructed deglutition" in " Memoirs of the Medical Society of London," vol. ii. p. 275. London, 1794. % The preparation has been with much liberality placed at my disposal by direction of the Treasurer, Mr. Harrison.