I ' NRLF Fagge w W MEDICAL *CH(DL Gift of ALICE F. MAXWELL, M.D, THE POCKET ANATOMY SIXTH EDITION, REVISED AND EDITED BY C. H.1FAGGE, M.B., M.S. LOND., F.R.C.S. THIRTIETH THOUSAND N E W YORK WILLIAM WOOD & COMPANY MDCCCCVIII PREFACE IN compiling this edition I have borrowed from Quain's 'Anatomy,' Cunningham's 'Text-book of Anatomy,' and Morris's 'Treatise of Anatomy.' It therefore seems that the old name of ' The Pocket Gray ' no longer accurately describes this little volume, so on the advice of the pub- lishers it has been altered to that of ' The Pocket Anatomy.' The whole book has been carefully revised, and many descriptions have been changed, among which the chief is the substitution of Jonnesco's account of the iliac and pelvic colon and rectum for that of the sigmoid and rectum of previous editions. C. H. FAGGE. 3, DEVONSHIRE PLACE, LONDON, W. 5954". THE POCKET ANATOMY THE ARTICULATIONS. The Classification of Joints. Synarthrosis (Immovable Joint). Varieties : Sutura. Suit-varieties : S. Dentata. S. Serrata. S. Limbosa. S. Squamosa. S. Harmonia. Synchondrosis may become a Synostosis. Schindylesis. Gomphosis. Amphiarthrosis (allowing slight movement). Varieties : Symphysis. Syndesmosis. Diarthrosis (Movable Joint). Varieties : Arthrodia, or Gliding Joint. Enarthrosis, or Ball-and-Socket Joint. Ginglymus, or Hinge Joint. Condyloid. Reciprocal Reception, or Saddle Joint. Trochoid, or Pivot Joint. ARTICULATIONS OF THE TRUNK. I. ARTICULATIONS OF THE VERTEBRAL COLUMN. (A ) Joints between the bodies which are amphiarthroses. (J3) Joints between the neural arches by means of the 2 THE POCKET ANATOMY articular processes which are diarthroses of the arthrodial variety. (A) The Ligaments of the Bodies. The anterior common ligament : a broad band of fibres, extending along front of bodies of vertebras, from axis to sacrum. It consists of two sets of fibres, superficial and deep ; the former extending between the bodies of two or more vertebras, the latter only between adjacent vertebras. The fibres are attached principally to the intervertebral sub- stances. The posterior common ligament is within the spinal canal, and extends along back of bodies of the vertebras from axis to sacrum, being broad opposite the intervertebral discs, and narrow opposite the bodies, except in the neck, where it is as wide as the bodies. It is attached to the discs and contiguous parts of the bodies of the vertebrae. The intervertebral substances, found between the vertebrae from axis to sacrum. The circumference of each consists of layers of oblique parallel fibres of white fibrous tissue, en- closing a central part of pulpy elastic material. They are thickest in the lumbar region, and they give the peculiar curves to the column by their differences in thickness. (B) The Ligaments of the Lamina. The ligamenta subflava connect the laminae of the vertebrae from the axis to the sacrum. Each ligament is attached to the anterior inferior edge of the lamina above, and to thf posterior superior edge of the lamina below. The Ligaments of the Articular Processes. Capsular ligaments surround the articular processes, those in the cervical region being the loosest. Each is lined by a synovial membrane. The Ligaments of the Spinous Processes. The interspinous ligaments extend in all regions of the vertebral column between the spinous processes of the ver- tebras, running from root to apex. The supraspinous ligament: a fibrous cord, joining the tips of the vertebrae, and extending from the seventh cervical to the first sacral. The ligamentum nuchse continues the supraspinous liga- ment upwards. It consists of a superficial layer, extending from the spine of the seventh cervical to the external occipital protuberance, and a deep layer attached to the spines of the cervical vertebrae and the occipital crest. The Ligaments of the Transverse Processes. Intertransverse ligaments extend between the transverse A RTIC ULA TIONS 3 processes, often absent in the cervical, thin in the lumbar, but round and well marked in the dorsal region. II. ARTICULATION OF ATLAS WITH AXIS. The atlo-axoid articulation consists of four joints (a) a pivot joint consisting of two parts, (i.) between odontoid pro- cess and anterior arch of atlas, and (ii.) between odontoid process and transverse ligament ; (b) two arthrodial, between the articular processes. The anterior atlo-axoid ligament consists of a superficial and a deep part. The superficial part continues the anterior common ligament. It is attached above to the anterior tubercle of the atlas ; and below to the body of the axis and base of the odontoid process. The deep part is broad, and reaches from the lower border of the anterior arch of atlas to the base of odontoid process and body of axis. The posterior atlo-axoid ligament : a thin layer, connected above to the lower border of the posterior arch of atlas, and below to the upper edge of laminas of axis, pierced by the second cervical nerve. The transverse ligament keeps the odontoid process in its place ; it is attached on each side to a tubercle on the inner surface of the superior auricular process of the atlas. A thin bundle of fibres passes upwards from the middle of the pos- terior surface to the basilar process, and a like process down- wards to the body of the axis. These two processes, together with the transverse ligament, form the cruciform ligament. Capsular ligaments as in ordinary vertebrae, but supple- mented at the posterior and inner part by an accessory liga- ment passing downwards and inwards to the base of the odontoid process (accessory atlo-axoid ligaments'). Synovial membranes : besides those of capsular ligaments, two ; one in front and one behind the odontoid process, the latter often communicating laterally with one of the occipito- atloid joints. HI. ARTICULATION OF ATLAS WITH OCCIPITAL BONE. The anterior occipito-atloid ligament consists of a super- ficial and a deep part. The superficial, rounded, pa'sses from the basilar process of the occiput to the anterior tubercle of the atlas. The deep part is broad, and attached above to the anterioredge of the foramen magnum, and below to the upper margin of anterior arch of atlas. X 2 4 THE POCKET ANATOMY The posterior occipito-atloid ligament, thin and mem- branous, is attached above to posterior margin of foramen magnum ; below, to upper border of posterior arch of atlas. (Perforated on each side by vertebral artery and subocdpital or first cervical nerve. ) The lateral occipito-atloid ligaments : one on each side ; attached above to the jugular process of occiput, and below to the base of atlantal transverse process. Capsular ligaments as in ordinary vertebrae. IV. LIGAMENTS BETWEEN THE AXIS AND OCCIPITAL BONE. The occipito-axoid ligament (apparatus ligamentosus colli) : a continuation of the posterior common ligament, connected above with basilar groove of occiput, and below to posterior surface of the body of axis. The odontoid or check ligaments consist of two cords passing from the sides of the apex of the odontoid process to the rough surface on the inner side of each condyle of the occipital bone. In the interval between the two the ligamen- tum suspensorium dentis passes from the apex of the odontoid process to the anterior margin of the foramen magnum. V. TEMPORO-M AXILLARY ARTICULATION. The condyle of the lower jaw articulates with the anterior part of the glenoid fossa, and with the eminentia articularis of the temporal bone, the joint being divided into an upper and a lower synovial cavity by an interarticular fibro-cartilage. The external lateral ligament, attached above to tubercle and lower border of zygoma ; below, to outer surface and posterior edge of neck of lower jaw. The internal lateral ligament is attached above to the spinous process of the sphenoid, and below to the inner margin or lingula of the dental foramen of lower jaw. The capsular ligament : thin and loose, attached above to the edge of anterior half of glenoid cavity and articular eminence ; below, it surrounds neck of the condyle. The interarticular fibro-cartilage has an oval shape ; the upper surface is concavo-convex from before backwards, and slightly convex transversely ; the lower surface is concave ; the edge 4 is attached to the capsule, and part of the external pterygoid muscle is inserted into its anterior margin. Synovial membranes, two in number, one above and one below the fibro-cartilage ; the upper being the larger. The stylo-maxillary ligament: a band of fibrous tissue ARTICULATIONS 5 extending from the styloid process to angle and posterior border of ramus of the jaw, which is derived from the deep cervical fascia (p. 26). (Stylo -hyoid ligament: a fibrous cord extending from the styloid process to small cornu of hyoid bone). VI. ARTICULATION OF THE RIBS WITH THE VERTEBRA. (a) Articulations between the Heads of the Ribs and the Bodies of the Vertebra. Arthrodial joints held together by the following ligaments : The anterior costo-vertebral or stellate ligament is com- posed of three fasciculi, which radiate from the anterior surface of the head of the rib. The superior fasciculus passes to the body of the vertebra above ; the inferior fasciculus to the body of the vertebra below ; the middle fasciculus to the interverte- bral substance. A capsular ligament surrounds articulation between the head of the rib and the articular surface formed by two vertebrae. The interarticular ligament divides the joint into two parts, each of which has a separate synovial membrane. It passes between ridge on head of rib and intervertebral substance. (Absent in the ist, loth, nth, and iath ribs.) (b) Articulations of the Necks and Tubercles of the Ribs with the Transverse Processes of the Vertebra. Arthrodial joints held together by the following ligaments: The anterior or superior costo-transverse ligament passes from the upper border of neck of rib, to lower border of transverse process above. (Absent in ist rib.) The middle costo-transverse or interosseous ligament : a short thick band passing from the anterior surface of the transverse process to the posterior surface of neck of corre- sponding rib. (Rudimentary in nth and iath ribs.) The posterior costo-transverse ligament passes from apex of transverse process to rough non-articular part of tubercle of rib. (Absent in nth and i2th ribs.) The capsular ligament surrounds articular surfaces, en- closing a small synovial membrane. (This articulation is absent in the nth and i2th ribs.) VII. ARTICULATION OF THE UPPER SEVEN COSTAL CARTILAGES WITH THE STERNUM. The anterior chondro-sternal ligament : a broad thin band, radiating from extremity of the rib cartilage to the sternum. 6 THE POCKET ANATOMY The superior fasciculi pass obliquely upwards, the inferior downwards, and the middle horizontally. The posterior chondro-sternal ligament is an indistinct band of fibres radiating from the posterior surface of the inner end of the costal cartilage to the back of the sternum. The capsular ligament surrounds the joint, and encloses a synovial membrane (In the ist there is no synovial mem- brane ; in the 2nd and 3rd there are 2, the joint being divided by an interarticular ligament passing between end of the costal cartilage and cartilage between adjacent pieces of the sternum. (The 4th, 5th, 6th, and yth have one each.) VIII. ARTICULATIONS OF THE CARTILAGES OF THE RIBS WITH EACH OTHER. The cartilages of the 6th, yth, and 8th ribs articulate with each other by an oval shaped facet, each having a capsule enclosing a synovial membrane. IX. ARTICULATIONS OF THE RIBS WITH THEIR CARTILAGES. The costal end of each cartilage fits into a depression in the sternal end of the rib, and is bound down by periosteum. X. ARTICULATIONS OF THE STERNUM. The ist and 2nd pieces are united by a piece of cartilage, kept together by the following two ligaments : The anterior intersternal ligament consists of longitudinal fibres, which blend with the costo-sternal ligaments. The posterior intersternal ligament: similar to the pre- ceding, placed on the back of the sternum. XI. ARTICULATION OF THE PELVIS WITH THE SPINE. The following ligamentsconnect the 5th lumbar vertebra with the sacrum, and are similar to the common vertebral ones : 1. The continuations of the anterior and posterior common ligaments. 2. The intervertebral substance between the last lumbar vertebra and the sacrum. 3. The ligamenta subflava between the laminae of the last lumbar vertebra and the margins of upper opening of the sacral canal. 4. Capsular ligaments, between the articular processes. 5. Interspinous and supraspinous ligaments. Besides these, there are the following special ligaments : The lumbo-sacral or sacro-vertebral ligament: attached above to the front of tip of transverse process of the 5th ARTICULATIONS 7 lumbar vertebra; below, to the outer border of the front of the lateral mass of the sacrum. The ilio-lumbar ligament passes from the tip of transverse process of 5th lumbar vertebra, to the crest of L.um in front of sacro-iliac articulation. XII. ARTICULATIONS OF THE PELVIS. (a) Sacro-iliac Joint. The sacro-iliac articulation is an amphiarthrosis, formed between the lateral surfaces of the sacrum and ilium. The auricular or anterior parts of the articular surfaces are covered with cartilage, and connected by the two following ligaments : The anterior sacro-iliac ligament : small bands passing obliquely from sacrum to ilium on the anterior surface. The posterior sacro-iliac ligament consists of strong inter- osseous bands passing chiefly downwards and inwards from the rough part of the ilium behind the cartilage, to the posterior part of the sacrum. There are two superior, passing from the ist and 2nd transverse sacral tubercles, and one sometimes called the oblique sacro-iliac ligament, which reaches from the posterior superior iliac spine to the 3rd transverse sacral tubercle. (b) Ligaments between the Sacrum and Ischium. The great (or posterior] sacro-sciatic ligament, attached by its base to the posterior inferior iliac spine, to the 4th and 5th transverse sacral tubercles, and to the lower part of the edge of the sacrum and coccyx ; passes downwards, outwards, and forwards, to be attached to the inner edge of the ischial tuberosity and to the inner margin of the ramus, forming the falciform ligament. The small (or anterior] sacrp-sciatic ligament, attached by its apex to the spine of the ischium, and by its base to the lateral margin of the coccyx and sacrum. Foramina. Between the great sacro-sciatic ligament and the innominate bone is a space divided into two by the small sacro-sciatic ligament ; the part above this ligament being the great sacro-sciatic foramen, and the part between the two liga- ments the small sacro-sciatic foramen. The large foramen transmits pyriformis, together with superior gluteal, sciatic and internal pudic vessels, the superior gluteal, great and small sciatic, pudic and inferior gluteal nerves, and nerves to the obturator internus, quadratus, and gemelli. The small foramen transmits the obturator internus, whilst its nerve, together with the internal pudic vessels and pudic nerve, re- enters the pelvis by it. 8 THE POCKET ANATOMY (c) Articulation of the Sacrum and Coccyx. Araphiarthrodial joint. The anterior sacro-coccygeal ligament, very indistinct, passes from anterior surface of sacrum to that of the coccyx. The posterior sacro-coccygeal ligament passes from the margin of the lower orifice of the sacral canal to the posterior surface of the coccyx. Interarticular ligaments between the cornua. Lateral ligaments, passing from the lower lateral angle of sacrum to transverse process of ist piece of coccyx. A fibro-cartilage is placed between the sacrum and the coccyx. (d) Symphysis Pubis. Amphiarthrodial joint bound together by the following ligaments : The anterior pubic ligament consists of several layers of fibres crossing the symphysis horizontally in front. The posterior pubic ligament resembles the anterior, but is much less distinct, and connects the bones posteriorly. The superior pubic ligament connects the bones superiorly. The sub-pubic ligament, forming the upper boundary of the pubic arch, is a thick triangular arch of fibres, attached above to the fibro-cartilage, and laterally to the rami. The fibro-cartilage consists of two parts, one on each bone ; the two are united in front, but posteriorly they are separated by a small cavity lined by a synovial membrane. ARTICULATIONS OF THE UPPER EXTREMITY. I. STERNO-CLAVICULAR ARTICULATION. An arthrodial joint between the inner end of the clavicle and the ist piece of sternum and ist costal cartilage, con- nected together by the following ligaments : The anterior sterno-clavicular ligament is attached to upper and anterior part of the inner end of the clavicle, and to the upper and anterior part of the ist piece of the sternum. The posterior sterno-clavicular ligament passes between the inner end of the clavicle and the sternum on the posterior surface. The interclavicular ligament passes along the top of the sternum from the inner end of one clavicle to the other. ARTICULATIONS 9 The costo-clavicular or rhomboid ligament : a strong band of fibres passing backwards, upwards, and outwards from the upper surface of the sternal end of ist costal cartilage, to a rough marking on the under surface of the inner end of the clavicle. The interarticular fibro-cartilage is a nearly circular plate, thicker at the circumference than in the centre. It is attached above to the upper border of the clavicle, and below to the ist costal cartilage at its junction with the sternum. There are two synovial membranes, one on each side of the cartilage. II. SCAPULO-CLAVICULAR ARTICULATION. (a) Acrormo-clavicular, an arthrodial joint held together by the following ligaments : The superior acromio-clavicular ligament passes between the outer end of the clavicle and the upper surface of the acromion. The inferior acromio-clavicular ligament covers the joint below, being attached to the clavicle internally, and the acro- mion externally. An interarticular fibro-cartilage, rarely complete, usually occupies the upper half of the joint. When it is complete, there are two synovial membranes. (ft) The toraco-clavicular ligaments connect the clavicle and the coracoid process of the scapula ; they are : The trapezoid ligament (the anterior and external one) : attached below to the posterior half of the upper surface of the coracoid process, and above to the oblique line on the under service of the clavicle. It is in contact posteriorly with the conoid ligament. The conoid ligament (the posterior and internal one) is attached above by its base, to the conoid tubercle on the inferior surface of the clavicle, and the contiguous part ; by its apex to a rough depression at the base of the coracoid process. III. PROPER SCAPULAR LIGAMENTS. The coraco-acromial ligament passes over the shoulder- joint between the coracoid and acromion processes. Ex- ternally it is attached to the tip of the acromion, and internally to all the outer border of the coracoid process. The transverse or suprascapular ligament stretches over the notch on the upper border of the scapula, and converts it into a foramen. 10 THE POCKET ANATOMY IV. THE SHOULDER-JOINT. This joint between the head of the humerus and the glenoid cavity is an enarthrodial or ball-and-socket joint. The long tendon of the biceps acts as a ligament to this joint. The capsular ligament is attached to the circumference of the glenoid cavity, and to the neck (anatomical) of the humerus. It is very loose, and permits free movement of the joint. There is generally an aperture on the inner side, through which a piece of the synovial pouch protrudes to form the bursa under the subscapularis. The coraco humeral or accessory ligament helps to strengthen the capsule ; it is attached to the outer border and base of the coracoid process, and below to the neck of humerus, above great tuberosity, and it blends with the cap- sule at the margins of the bicipital groove. Gleno-humeral ligaments, seen as three folds on inner aspect of joint : The superior or Flood's ligament passes along inner edge of biceps tendon from glenoid ligament to depression on lesser tuberosity at inner margin of the bicipital groove. Middle : oblique, arises with superior, runs downwards forming lower margin of aperture for subscapularis bursa to lesser tuberosity. The inferior or Schlemm's ligament passes from the lower part of the glenoid cavity to the neck of humerus on the inner side of the small tuberosity. The glenoid ligament is a dense fibrous band attached to the edge of the glenoid. cavity to deepen it, and is con- tinuous with tendon of the long head of the biceps. Transverse over bicipital groove. A synovial membrane lines the joint, and protrudes to form the bursa under the subscapularis. It is reflected round the tendon of the biceps, and lines the bicipital groove. Subacromial bursa beneath acromion and deltoid, and over supraspinatus and capsule. V. THE ELBOW-JOINT. The elbow is a ginglymus or hinge-joint, between the trochlear surface of the humerus and the greater sigmoid cavity of the ulna, combined with an arthrodial joint between the capitellum of the humerus and the upper end of the radius. The anterior ligament is attached, above to the front of ARTICULATIONS i, the humerus just above the coronoid fossa ; and below to the coronoid process, and the front of orbicular ligament. The posterior ligament is attached, above to the upper border of the olecranon fossa ; below, to the margin of the olecranon. The internal lateral ligament is triangular in shape ; it is attached, above to the inner condyle of the humerus ; the fibres diverge as they descend, the anterior ones going to the inner margin of the coronoid process, the posterior to the inner margin of the olecranon. The external lateral ligament, smaller than the preceding, is attached, above to a depression below the external condyle, and below to the orbicular ligament, some of the fibres being prolonged to the outer edge of the ulna. The synovial membrane is very large, covering the articular surfaces of the humerus, ulna, and radius ; it also serves for the upper radio-ulnar articulation. VI. THE RADIO-ULNAR ARTICULATIONS. (a) Superior Radio-ulnar Articulation (lateral ginglyinus). The orbicular ligament surrounds the head of the radius. It is attached to the two ends of the lesser sigmoid cavity, and is wider above than below. The outer surface is con- nected with the external lateral ligament. The internal surface is lined with synovial membrane continuous with that of the elbow-joint. (b) Middle Radio-ulnar Articulation. The oblique or round ligament is a fibrous cord passing downwards and outwards from the tubercle at the base of the coronoid process, to a little below the tubercle of the radius. The interosseous membrane passes downwards and inwards (the opposite to the preceding) from the radius to the ulna ; it is attached to the interosseous border of each bone. (c) Inferior Radio-ulnar Articulation (lateral ginglymus). The anterior radio ulnar ligament passes from the anterior edge of the radial sigmoid cavity to the anterior surface of the head of ulna. The posterior radio-ulnar ligament extends similarly upon the posterior surface. The triangular fibro cartilage passes transversely beneath the lower end of the ulna, between its styloid process and the radius. Its apex is attached to the outer side of base of the styloid process of ulna, and the base to the edge of the radius between the sigmoid cavity and the lower articular surface. 12 THE POCKET ANATOMY The synovial membrane (membrana sacciformis) is very loose, and lines the contiguous surfaces of the radius and ulna, together with the upper surface of the triangular cartilage ; sometimes communicates with the synovial sac of wrist-joint. ,' ' VII. THE WRIST-JOINT. The wrist-joint is a condyloid joint, formed by the lower end of the radius and the triangular fibro-cartilage above ; and by the scaphoid, semilunar and cuneiform bones below. It is united by the following ligaments : The external lateral ligament passes from the tip of the styloid process of the radius to a depression on the outer surface of the scaphoid bone. The internal lateral ligament, a fibrous cord, passes from the end of the styloid process of the ulna, and dividing into two, one part is attached to the pisiform bone, and the other to the inner side of the cuneiform bone. The anterior ligament, broad and membranous, consists of three bundles of fibres, springing from the anterior edge of the lower end of radius, and the styloid process of the ulna ; below it is fixed into the anterior surfaces of the scaphoid, semilunar and cuneiform bones, some fibres being continued to the os magnum. The posterior ligament, weaker than the preceding, springs from the posterior margin of the lower end of the radius, and is attached to the dorsal surfaces of the scaphoid, semilunar, and cuneiform bones. A synovial membrane lines the joint. VIII. ARTICULATIONS OF THE CARPUS. Articulations of the ist Row of Carpal Bones, the pisiform excepted (arthrodial) . The dorsal ligaments pass transversely between the scaphoid and semilunar, the semilunar and the cuneiform. The palmar ligaments connect the bones similarly upon the anterior surface. The interosseous ligaments (2) close the upper part of the intervals between the scaphoid and semilunar, the semilunar and cuneiform bones. Articulations of the 2nd Row of Carpal Bones (arthrodial). The dorsal ligaments (3) pass transversely from bone to hone as in the ist row. The palmar ligaments (3), similar to those of the ist row ARTICULATIONS 13 The interosseoue ligaments (3) are thicker than those of the ist row, and connect the os magnum and the trapezoid, the os magnum and the unciform bones and the trapezium and trapezoid. A rticulations of the two Rows of Carpal Bones together. The anterior or palmar ligaments pass from the front of the ist row to the palmar surface of the os magnum. The posterior or dorsal ligaments are similarly placed upon the dorsal surface. The lateral ligaments : the external connects the scaphoid and trapezium bones ; the internal the cuneiform and unciform. The synovial membrane is large ; it lines the under surface of the bones of the ist row, except the pisiform bone, and is reflected between their contiguous surfaces; it then passes between the bones of the 2nd row, and lines their contiguous surfaces, usually giving reflections between the carpal ends of the four inner metacarpal i bones, and between the con- tiguous surfaces of the trapezium and 2nd metacarpal bone. The pisiform bone is connected to the cuneiform by a thin capsule lined by a synovial membrane ; and inferiorly to the unciform and 5th metacarpal bones. The anterior annular ligament extends from the trapezium and scaphoid across to the unciform process and pisiform bone. The posterior annular ligament extends from the outer border of lower end of radius, to inner side of cuneiform and pisiform bones. IX. CARPO-METACARPAL ARTICULATION. The Articulation of the Trapezium and ist Metacarpal. Reciprocal reception joint. The capsular ligament, thick and loose, passes from the upper end of the ist metacarpal to the rough edge round the articular surface of the trapezium. It is lined by a separate synovial membrane. Articulations of the Carpus and the rest of the Metacarpus. The dorsal ligaments connect the carpal with the meta- carpal bones on the posterior surface ; each metacarpal receives two fasciculi, except the 5th, which has only one. The palmar ligaments are similarly arranged on the anterior surface, except that the 3rd metacarpal has three fasciculi. The interosseous ligaments connect the os magnum and unciform bones to the 3rd and 4th metacarpal bones. The synovial membrane is continuous with that between ;he two rows of carpal bones, and has been described above. 14 THE POCKET ANATOMY Articulations of the Metacarpal Bones with each other. The carpal ends are united by dorsal and palmar ligaments passing transversely. The interosseous ligaments pass between the bones beneath the level of the articular facets. The synovial membrane is con- tinuous with that between the two rows of carpal bones. The digital extremities of the four inner metacarpals are connected by the transverse metacarpal ligament, which blends with the palmar surface of each metacarpo-phalangeal articu- lation. X. METACARPO-PHALANGEAL ARTICULATIONS. Condyloid joint. The palmar ligament is a thick plate of fibro-cartilage, at- tached to the head of the metacarpal bone and the base of the ist phalanx : laterally it blends with the lateral ligaments. The lateral ligaments, one on each side, attached above to the posterior tubercle and depression on the side of the head of the metacarpal bone, and below to the side of the ist phalanx. A synovial membrane lines the joint. XI. ARTICULATIONS OF THE PHALANGES. Each of these is a small ginglymus or hinge joint, con- nected by a palmar and two lateral ligaments, and lined by a synovial membrane. ARTICULATIONS OF THE LOWER LIMB. I. THE HIP-JOINT. This is an enarthrodial joint, formed by the head of the femur and the acetabulum. The ligaments are : The capsular ligament, very strong and fibrous, arises above from the rim of the acetabulum, just external to the cotyloid ligament, and from the transverse ligament as it bridges the cotyloid notch : below it is attached to the neck of the femur, in front to the anterior intertrochanteric line, superiorly to the root of the neck, and posteriorly to the middle of the neck of the bone, where many of its fibres are reflected upwards upon the neck as the retinacula. The fibres are circular and longitudinal. The circular are most distinct at the lower and posterior part, forming a collar at the lower and back part of the joint, known as the zona orbicularis. The longitudinal fibres form thick bands known as accessory liga- ments. There is often an opening in front of the capsule for ARTICULATIONS 15 * a protrusion of the synovial membrane to form the bursa under the psoas. The ilio-femoral ligament ( Y ligament of Bigelow] is accessory to the capsule. It is attached above to the anterior inferior iliac spine, and below it bifurcates and is attached to the anterior intertrochanteric line at its outer and inner parts. Ischio-capsular ligament (accessory), from ischium below acetabulum, to the circular fibres at the lower and back part of the capsule. Pubo-femoral ligament (accessory) passes from the ilio- pectineal eminence to the rough tubercle in front of the trochanter minor. The ligamentum teres passes from the depression on the head of the femur and spreads out to be attached to the margins of the rough depression at the bottom of the aceta- bulum. It consists of connective tissue and vessels, covered with a reflection of synovial membrane. The cotyloid ligament, a dense fibre-cartilaginous rim, prismatic on section, is attached to the edge of the aceta- bulum, and to the transverse ligament. The transverse ligament is a narrow band which crosses the cotyloid notch ; the nutrient vessels to the joint pass under it. The synovial membrane is single, and is reflected over the inner surface of the capsule on to the neck of the femur, thence over the ligamentum teres to the bottom of the acetabulum, where it loosely covers some fat. (Frequently communicates with bursa under ilio-psoas tendon.) II. THE KNEE-JOINT. This is a ginglymus, and is formed by the condyles of the femur, the head of the tibia, and the patella. The anterior or ligamentum patellae is the continuation of the tendon of the quadriceps extensor. Above it arises from the apex and rough marking on the lower and posterior sur- face of the patella ; below it is attached to the lower part of the tubercle of the tibia. There is a bursa between the upper part of the tubercle and the ligament. The posterior ligament (ligamentum posticum Winslowii], broad and thin, covers the back of the joint : it springs above from the femur above the condyles, and is attached below to the head of the tibia. From the semi-membranosus tendon it receives a strong expansion, which passes superficially from the inner tuberosity of the tibia to the inner side of the upper part of the outer condyle of the femur. 16 THE POCKET ANATOMY The internal lateral ligament, broad and flat, is attached above to the inner condyle of the femur ; below to the margin of the inner tuberosity, and to the inner surface of the shaft of the tibia for i inches. The long external lateral ligament, a rounded cord, is attached above to the external condyle of the femur, and below to the external part of the head of the fibula, dividing the biceps tendon into two parts, a bursa intervening. The short external lateral ligament, very indistinct, lies parallel and behind the preceding, attached above to the outer condyle of the femur, and below to the styloid process of the fibula. The capsular ligament, thin, fills up the intervals between the special ligaments ; it is attached to the margins of the articular surfaces of the bones, and blends with the fascia lata of the thigh : above it receives expansions from the vasti (lateral patellar ligaments). Inter articular Structures : The anterior or external crucial ligament is attached to the depression in front of the spine of the tibia and to the external semilunar fibro-cartilage ; it passes upwards, back- wards, and outwards to the posterior part of the inner side of the external condyle of the femur. The posterior or internal crucial ligament is attached to a depression behind the spine of the tibia, to the popliteal notch, and the posterior border of external semilunar fibro- cartilage, this latter slip being sometimes called the ligament of Wrisberg ; it passes upwards, forwards, and inwards, the posterior fibres attached by side of oblique curve of inner con- dyle, the anterior ones to fore part of intercondylar fossa and to the anterior part of the outer surface of the inner condyle. The semilunar cartilages are thicker at the circumferences than at the central margins, and serve to deepen the cavities for the head of the femur. The internal semilunar cartilage is oval in shape, the antero-posterior diameter being the longer. Its anterior ex- tremity is attached to the tibia in front of the anterior crucial ligament, and the posterior extremity in front of the posterior crucial ligament. The external semilunar cartilage is nearly circular : its anterior extremity is attached to the tibia in front of the spine, the posterior extremity to the back of the spine. In shape the cartilages may be described thus : the internal as a smaller segment of a larger circle, and the external as a larger segment of a smaller circle. ARTICULATIONS 17 Structures on the Head of the Tibia in the middle line from before backwards : 1. Transverse ligament. 2. Anterior extremity of in- ternal semilunar cartilage. 3. Anterior crucial ligament. 4. Anterior extremity of ex- ternal semilunar cartilage. 5. The spine of tibia. 6. Posterior extremity of ex- ternal semilunar cartilage. 7. Posterior extremity of in- ternal semilunar cartilage. 8. Posterior crucial ligament. The transverse ligament is a band of fibres which passes between the anterior extremities of the semilunar cartilages. The coronary ligaments bind down the circumferences of the semilunar cartilages to the head of the tibia. The synovial membrane is the largest in the body. It ex- tends 2 inches above the articular end of femur under the extensors ; thence it passes over the crucial ligaments to the head of the tibia, where it covers both surfaces of the semi- lunar cartilages, and lastly it lines the capsule. It also gives a covering to the popliteus tendon, where it lies within the capsule, and usually communicates with a bursa under the inner tendon of the gastrocnemius and between this tendon and that of the semi-membranosus. The ligamentum mucosum is a triangular fold of the synovial membrane, attached to the intercondyloid notch, and reaching to the patella. The ligamenta alaria are two fringes of the synovial mem- brane, seen on either side of the ligamentum mucosum. III. THE TIBIO-FIBULAR ARTICULATIONS. (a) The Superior Tibio-fibular Articulations (arthrodial). The anterior superior ligament passes from the head of the fibula upwards and inwards to the external tuberosity of the tibia. The posterior superior ligament passes from the back part of the head of the fibula to the back part of the external tuberosity of the fibula. A synovial membrane lines the joint. (b) The Middle Tibio-fibular A rticulation consists of the inter- osseous membrane, the fibres passing down from the tibia to the fibula, being attached to the interosseous ridges on the bones. Superiorly, there is an opening for the anterior tibial vessels ; and inferiorly, one for the anterior peroneal vessels. (c) The Inferior Tibio-fibular Articulation. The inferior interosseous ligament passes between the contiguous rough surfaces of the tibia and fibula, and is con- tinuous above with the interosseous membrane. 1 8 THE POCKET ANATOMY The anterior ligament is triangular in shape, and passes' between the adjacent margins of the tibia and fibula. The posterior ligament is similarly placed upon the posterior part of the articulation. The transverse or inferior ligament lies deep to the pre- ceding, passing transversely across the back of the joint, from (lie external malleolus nearly to the internal malleolus, and s jrves to deepen the ankle-joint. The synovial membrane is continuous with that of the ankle-joint. IV. THE ANKLE-JOINT. This is a ginglymus or hinge joint ; the lower ends of the nbia and fibula embracing the upper articular surface of the astragalus. The anterior ligament, broad and thin, is connected above with the edge of the articular surface of the tibia, and below with the margin of the superior articular surface of the astra- galus. The posterior ligament consists principally of transverse fibres, which blend above with the transverse ligament of the inferiortibio-fibular articulation, and are attached to the back part of the upper articular surface of the astragalus. The internal lateral or deltoid ligament consists of two parts. The superficial part is attached by its apex to the internal malleolus, and by its base posteriorly to the inner side of the astragalus, the sustentaculi tali, and anteriorly to the tuberosity of the scaphoid, blending with the inferior calcaneo-scaphoid ligament. The deep part passes from the apex of the inner malleolus to the inner side of the astragalus. The external lateral ligament consists of three bundles of fibres. The anterior slip passes between the front of the external malleolus and the side of the astragalus in front of the superior articular process. The middle passes from the apex of the outer malleolus to the middle of the outer side of the os calcis. The posterior is attached to the bone just behind the deep groove on the posterior part of the outer malleolus, running transversely inwards to a depression on the posterior surface of the astragalus. The synovial membrane lines the inner surface of the ligaments, and is reflected on to the articular surfaces of" the bones. It also lines the inferior tibio-fibular articula- tion. ARTICULATIONS 19 V. ARTICULATIONS OF THE TARSUS. These are arthrodial joints. Articulations between the Cakanewn and Astragalus. There are two articulations between the calcaneum and the astragalus : a posterior one, peculiar to the two bones, and an anterior one, common to them and the scaphoid bone ; they are separated by the interosseous ligament. The external calcaneo-astragaloid ligament passes from outer surface of the astragalus just below the external malle- olus, to the outer surface of the os calcis. The posterior calcaneo-astragaloid ligament connects the posterior parts of the two bones. The interosseous ligament consists of a strong thick band passing from the groove between the articulating surfaces of the astragalus to a corresponding groove on the os calcis. Articulation between Calcaneum and Scaphoid. The superior calcaneo-scaphoid ligament arises from the groove between the astragalus and os calcis, being blended here with the internal calcaneo-cuboid ligament, and passes upwards and inwards to the outer side of the scaphoid bone. The inferior calcaneo-scaphoid is a broad strong band passing from the anterior and inner end of the sustentaculum tali of the os calcis to the hollow on the under surface of the scaphoid bone. It supports the head of the astragalus, and its plantar surface is in contact with the tendon of the tibialis posticus. _ Articulation between the astragalus and scaphoid. The only ligament is The superior astragalo-scaphoid, passing from the neck of the astragalus to the upper surface of the scaphoid bone. Articulations between the Scaphoid, Cuboid, and Three Cuneiform Bones are connected by the following ligaments : Dorsal ligaments, which pass from one bone to the other. Plantar ligaments, similarly arranged upon the sole. Interosseous ligaments (4), strong fibres passing between the rough non-articulating surfaces of the bones. Articulation between Calcaneum and Cuboid. The superior calcaneo-cuboid ligament passes between the dorsal surfaces of the os calcis and cuboid bones. The internal calcaneo-cuboid or interosseous ligament attached to a deep groove on the os calcis between it and the astragalus, here blending with the superior calcaneo-scaphoid ligament, and passing to the inner side of the cuboid bone. The Inferior ligaments are two : The long calcaneo-cuboid (long plantar) ligament, attached 22 20 THE POCKET ANATOMY to the under surface of the os calcis in front of the tuberosities ; it passes to the posterior margin of the peroneal groove of the cuboid ; some of the fibres arch over the sheath of the tendon, and are attached to the bases of the and, 3rd and 4th meta- tarsal bones. The short calcaneo-cuboid ligament is more deeply placed , it reaches from the tubercle and depression on the under surface of the os calcis to the under surface of the cuboid behind the peroneal groove. VI . T ARSO-METATARSAL ARTICULATIONS. The metatarsal bones are connected to the tarsus by : Dorsal ligaments, one to each metatarsal bone from the tarsal bone it articulates with. The 2nd metatarsal has a slip from each cuneiform bone. The plantar ligaments, disposed irregularly. The interosseous ligaments, strong bands, three in number. The internal one passes from internal cuneiform to the 2nd metatarsal. The middle one passes between the external cuneiform and the 2nd metatarsal. The external connects the external cuneiform and the 3rd metatarsal. The synovial membranes of the tarsus and metatarsus are six in number : One for the posterior calcaneo-astragaloid articulation. One for the anterior calcaneo-astragaloid articulation and the scapho-astragaloid articulation. One for the calcaneo-cuboid articulation. One for the articulations of the scaphoid, and the three cuneiform bones ; the cuneiform bones with each other ; the external cuneiform and the cuboid ; and the middle and external cuneiform bones with the bases of the 2nd and 3rd metatarsal bones. One between ist metatarsal and internal cuneiform. One for 4th and sth metatarsal with cuboid. VII. ARTICULATIONS OF THE METATARSAL BONES WITH EACH OTHER. The bases of the metatarsal bones are connected by dorsal, plantar, and interosseous ligaments. The digital ends are united by the transverse metatarsal liga- ment, which on the plantar aspect connects the ist metatarsal with the others (compare with hand). VIII. METATARSO-PHALANGEAL ARTICULATIONS. These articulations are precisely similar to the correspond- ing parts of the hand. MUSCLES 21 IX. ARTICULATIONS OF THE PHALANGES. The preceding remark equally applies to these articula- tions. THE MUSCLES. Explanation. The dash divides the origin from the insertion. Nervous supply is indicated by ( ) brackets. Action of muscle is indicated by [ ] brackets, and if a muscle has two points on which it acts, A applies to action from origin on point of insertion, and B applies to action from insertion on point of origin. F signifies that the attachment is fleshy. T ,, ,, tendinous. A ,, ,, aponeurotic. A combination of any of these attachments may occur. MUSCLES AND FASCLE OF THE HEAD AND NECK. The superficial fascia in the epicranial region and on the face is closely united to the skin, slightly developed, except between bellies of occipito-frontalis muscle. At the back part it becomes continuous with superficial fascia of posterior muscles of the neck, and descends laterally over the temporal fascia, where it envelops the external muscles of auricle, and the superficial temporal vessels and nerves. In the neck it is loose and fatty, as over rest of body. EPICRANIAL REGION. Occipito-frontalis : Frontal part. Has no bony attach- ments, blends with orbicularis palpebrarum, pyramidalis nasi and corrugator supercilii(p) epicranial aponeurosis(A) (Facial). Occipital part. Outer superior curved occi- pital lines, mastoid processes(FT) epicranial aponeurosis, which is attached behind to curved line between fleshy heads(A). (Posterior auricular branch of facial.) [Frontal part wrinkles forehead horizontally. Occipital part removes the wrinkles; acting alternately the two parts move scalp.] Epicranial aponeurosis unites frontal and occipital muscles, 22 THE POCKET ANATOMY and is also attached to inner of superior curved line of occipital behind. Laterally it is lost over temporal fascia, where it gives origin to attrahens and attollens aurem. AURICULAR REGION. Attrahens aurem : fore part of epicranial aponeurosis(F) fore part of helix, and eminence on back of pinna, corre- sponding to the fossa of the antihelix(x) (Temporal branch of facial). [Very little ; draws ear forward.] Attollens aurem: epicranial aponeurosis(p) cranial surface pinna, corresponding to fossa of antihelix(T) (Temporal branch of facial). [Very little ; raises ears.] Eetrahens aurem: root of mastoid process(A) lower part of cranial surface of concha(A) (Posterior auricular). [Very little ; draws ear back.] PALPEBRAL REGION. Orbicularis palpebrarum : Sphincter of eyelids. Orbital part. Internal angular process of frontal, internal tarsal ligament, nasal process of superior maxilla(F). Palp ebral part. Internal tarsal ligament(F) external tarsal ligament(F) (Facial). Ciliary part. Marginal portion of preceding ; lies along bases of eye- lashes. [Closes eye ; maintains apposition of eyelids to eyeball.] Tensor tarsi (Horner's muscle) : ridge of os lachrymalis(F) joins with ciliary part of orbicularis internal to the punctum(p) (Facial). [Acting with orbicularis empties lach. rymal sac.] Internal tarsal ligament (tendo oculi) is attached to ridge on nasal process of superior maxilla in front of lachrymal groove, divides into two slips, each joining the inner end of the corresponding tarsal cartilage. External tarsal ligament, connects the tarsal cartilages to outer part of orbit. Corrugator supercilii : inner part of superciliary ridge of frontal(F) under surface of orbicularis, opposite middle of orbital arch(p) (Facial). [Wrinkles forehead vertically.] ORBITAL REGION. Levator palpebrse superioris : inferior surface of small wing of sphenoid, anterior to foramen opticum and external to superior oblique(x) anterior part of superior tarsal plate, also superiorly to join orbicularis and inferiorly to superior MUSCLES 23 fornix of conjunctiva(A) (Upper division of 3rd). [Raises upper eyelid.] The four recti arise from two common tendons superior and inferior. Superior common tendon (ligament of Lock wood) rises above and outside optic foramen and gives origin to superior, internal and external recti (upper head). The inferior common tendon (ligament of Zinn) below and outside optic foramen goes to inferior, internal, and lower head of external recti. Rectus superior : upper margin of optic foramen(T) sclerotic(x) (Upper division of 3rd). [Rotates cornea up- wards and inwards.] Rectus inferior : margin of optic foramen(T) sclerotic(x) (Lower division of 3rd). [Rotates cornea downwards and inwards.] Rectus interims : optic foramen(x) sclerotic(T) (Lower division of 3rd). [Rotates cornea inwards]. Rectus externus: Upper head. Optic foramen(T). Lower head. Optic foramen and process of bone at the lower margin of spheroidal fissure(x) sclerotic(x) (6th). [Rotates cornea outwards.] Between the two heads pass ^rd, 6th, nasal branch oj 5/A nerve and ophthalmic vein. Obliquus superior : inner part of optic foramen(x) passes through "pulley," thence reflected backwards and outwards between superior rectus and eyeball to be attached to scle- rotic between superior and external recti (x) (4th). [Rotates cornea downwards and outwards.] The qth nerve enters its upper surface. Obliquus inferior : depression on orbital plate of superior maxilla(F) external surface of sclerotic under cover of external rectus(x). (Lower division of 3rd). [Rotates cornea upwards and outwards.] Passes outivards from origin beneath inferior rectus and between eyeball and external rectus to its in- sertion. NASAL REGION. Pyramidalisnasi : occipito-frontalis(F) compressor naris(A) (Facial). [Wrinkles skin over nose.] Compressor naris : facial surface of superior maxilla by side of anterior nares(p) its fellow of side(A) (Facial). [Closes anterior nares.] Levator labii superioris alseque nasi : root of nasal process of superior maxilla(F) ist slip, cartilage of ala ; 2nd slip, orbicularis oris(p) (Facial). [Raises ala of nose and upper lip.] Depressor al nasi : incisor fossa of superior maxilla(F) septum and ala of nose(p) (Facial). [Very little ; depresses ala.] 24 THE POCKET ANATOMY Dilatator naris: Anterior slip. Cartilage of ala(p) inner border of integument of ala(p). Posterior slip. Nasal notch of superior maxilla(F) inner border of integument of ala(F) (Facial). [Dilates anterior nares.] SUPERIOR MAXILLARY REGION. Levator labii superioris : superior maxilla and malar above infra-orbital foramen (F) orbicularis oris(F) (Facial). [Raises upper lip.] Levator anguli oris: canine fossa of superior maxilla, beneath infra-orbital foramen(p) angle of mouth(p) (Facial). [Raises angle of mouth, as in smiling.] Zygomaticus major: malar bone in front of zygoma(p) angle of mouth(F) (Facial). [Raises angle of mouth.] Zygomaticus minor : malar bone near maxillary suture(p) angle of mouth(p) (Facial). [Raises angle of mouth.] INFERIOR MAXILLARY REGION. Levator labii inferioris, vel levator menti : incisor fossa of inferior maxilla(F) integument of chin(p) (Facial). [Raises skin of chin.] Depressor labii inferioris, vel quadratus menti : external oblique line of inferior maxilla from symphysis to mental foramen(p) orbicularis oris(p) (Facial). [Draws down lower lip, everting it.] Depressor anguli oris, vel triangularis menti : external oblique line of inferior maxilla(p) angle of mouth (F) (Facial). [Depresses angle of mouth, as in crying.] INTER-MAXILLARY REGION. Orbicularis oris : sphincter of mouth. The labial part is free from attachment to bone, and forms red part of lips. The outer or facial part is connected with the muscles which converge to the angles of the mouth, and is attached in the upper lip to septum nasi and incisive fossa of superior maxilla, and in the lower lip to canine fossa of inferior maxilla(p) (Facial). [Closes oral fissure, producing radiating wrinkles.] Buccinator: external surfaces of alveolar processes of superior and inferior maxillae, as far forwards as ist molar ; pterygo-maxillary ligament(p) angle of mouth where fibres decussate(p) (Facial). [Closes mouth, also prevents food col- lecting between teeth and lips ; maintains tone of cheeks, as in whistling. MUSCLES 25 The pterygo-maxillary ligament extends from the hamular process to the posterior edge of the mylo-hyoid ridge of inferior maxilla. It separates buccinator from superior con- strictor of pharynx, giving origin to both. Risorius : fascia covering masseter(F) apex of depressor anguli oris(F) (Facial). [Draws angle of mouth back.] (This muscle is part of the platysma of neck.) TEMPORO-MAXILLARY REGION. Masseter : Superficial part. Malar process of superior maxilla. Anterior of lower border of zygoma(TA) angle and lower of outer surface of ramus(p). Deep part. Posterior lower border and inner surface of zygoma (F) upper of ramus and outer surface of coronoid process(p) (Inferior maxillary). [Muscle of mastication; elevates lower jaw and draws it forward.] The masseteric fascia, a continuation of the deep cervical fascia, is attached above to the zygoma; continuing back- wards it invests parotid gland (parotid fascia), from the deep surface of which the stylo-maxillary ligament proceeds. Temporal: temporal fascia and fossa(F) internal surface and fore part of coronoid process of inferior maxilla as far as last molar(AT) (Inferior maxillary). [Muscle of mastication, closing mouth ; anterior fibres protrude jaw, posterior retract.] The temporal fascia is attached above to the temporal ridge, and divides below into two layers, which are attached to inner and outer edges of superior border of zygoma. It covers the temporal muscle, and between the two layers are the temporal branch of temporo-malar nerve, and the orbital branch of superficial temporal artery. PTERYGO-MAXILLARY REGION. External pterygoid : pterygoid ridge and surface below on great wing of sphenoid, outer surface of external pterygoid plate(r) pterygoid depression in front of neck of inferior maxilla and inter-articular fibro-cartilage of temporo-maxillary joint(p) (Inferior maxillary). [Muscle of mastication ; both acting together protrude lower jaw : acting alternately cause grinding movements, each moving jaw to opposite side.] Between sphenoidal and pterygoid attachments, the internal maxillary artery dips down to reach spheno-maxillary fossa, and the buccal and anterior deep temporal nerves appear. Internal pterygoid : inner surface of external pterygoid plate, tuberosity of palate bone, and tuberosity of superior 26 THE POCKET ANATOMY maxilla(F) angle and inner surface of ramus of inferior maxilla(TA) (Inferior maxillary). [Muscle of mastication; elevates and draws lower jaw forward.] On muscle are inferior dental and gustatory nerves, internal maxillary and inferior dental arteries, and internal lateral ligament of jaw. SUPERFICIAL CERVICAL REGION. Platysma myoides : clavicle and acromion, fascia covering deltoid, pectoralis major, and trapezius(p) Inner fibres. Blend with opposite platysma. Outer fibres. Lower jaw, prolonged to angle of mouth and cheek(p) (Facial). [Feeble depressor of jaw ; moves skin of neck and maintains its contour.] The higher fibres of this muscle form the risorius. Sterno-cleido-mastoid : Inner head. Upper and anterior part of ist piece of sternum(T). Outer head. Inner ^ of superior surface clavicle(F) external surface of mastoid pro- cess from base to apex(i), and outer of superior curved line of the occiput(A) (Spinal accessory, Deep branch of 2nd cervical). [(A) Each side acting alone rotates face to opposite shoulder and bends neck to same side ; (B) raises clavicle, and so aids forced inspiration.] Forms anterior boundary of posterior, and posterior boundary of anterior triangles of neck. Clavicular origin conceals : anterior scalenus, omo-hyoid. Sternal origin conceals: depressors of hyoid bone, cervical lymphatic glands, great cervical vessels and pneumogastric nerve. Union of two heads conceals : middle scalenus, levator anguli scapulas, cervical plexus. Near in- sertion conceals : splenius, trachelo-mastoid, digastric, occipital artery, part of parotid. The deep cervical fascia is attached behind to the superior curved line of the occiput, to the ligamentum nuchae and to the spine of yth cervical vertebra. It passes forwards enclosing the trapezius, and then over the posterior triangle as a single layer (where external jugular vein pierces it) until it reaches the posterior border of the sterno-mastoid, where it divides into two layers to enclose that muscle : in this area it is attached below to the clavicle At the anterior border of the sterno-mastoid the two layers again blend together (except for about one inch above the sternum), and passing forwards, over the anterior triangle, it blends with the fascia of opposite side in the middle line. Below where the two layers do not blend together, tbe anterior one is attached to the front of the upper part MUSCLES 27 of the sternum and to the interclavicular ligament, whilst the posterior one is connected to the posterior edge of the upper part of the same bone. A small interval (Burn's space) is thus left, triangular in vertical section with the base at upper border of the sternum, which contains some loose areolar tissue, some fat, and often a lymphatic gland, with the anterior jugular veins. Superiorly this anterior layer passes over the parotid and masseter, forming the parotid, and masseteric fascia, and is attached above and behind to the lower border of the zygoma, and below and in front to the lower edge of the body of the lower jaw. From the posterior surface of the fascia covering the anterior triangle a septum passes inwards, separating the submaxillary and parotid glands, and forms the stylo- maxillary ligament. Processes given off from the deep cervical fascia. From the layer passing behind the sterno-mastoid there proceed : 1. A layer which passes behind carotid vessels. 2. A layer which passes in front of carotid vessels. These two layers blend together at the inner border of the carotid artery, forming the carotid sheath to enclose carotid artery, internal jugular, and pneumogastric nerve. The united layers pass upwards and inwards in front of the longns colli and behind the pharynx and O3sophagus, to blend with like process from opposite side and form the prevertebral fascia. This layer separates the prevertebral muscles from the pharyngeal fascia on the pharynx and oasophagus (retro- pharyngeal space continuous with the posterior mediastinum) and is prolonged laterally over the scaleni, brachial plexus, and subclavian vessels to help form the axillary sheath. The cervical fascia is attached in the middle line to the symphysis menti, the hyoid bone, and the anterior edge of the upper border of the sternum. 3. A layer in front of thyroid body and trachea, but behind the sterno-hyoid and thyroid muscles, which joins with a corresponding process of the opposite side, and passing down to the root of the neck in front of the trachea and large vessels, blends with the fibrous layer of the pericardium. 4. A process to enclose the omo-hyoid tendon, which binds it down to the clavicle and first rib, blending with the costo- coracoid membrane. 28 THE POCKET ANATOMY INFRA-HYOID REGION. Sterno-hyoid : posterior surface of sternum, clavicle and intervening ligament (F) lower border of body of hyoid bone (A) (ist, 2nd and 3rd cervical through ansa hypoglossi). [Depresses hyoid bone.] Sterno-thyroid : posterior surface of sternum, cartilage of ist rib(F) oblique line on side of thyroid cartilage(p) (ist, 2nd and 3rd cervical through ansa hypoglossi). [Depresses thyroid cartilage.] Thyro-hyoid : oblique line on side of thyroid cartilage(p) internal half of greater cornu and outer part of body of hyoid bone(p) (ist and 2nd cervical). [Depresses hyoid on thyroid.] Omo-hyoid: upper border of scapula behind notch, and transverse ligament(A) lower part of body of hyoid bonefp) (ist, 2nd and 3rd cervical through ansa hypoglossi). [A de- presses hyoid, B very feebly raises shoulder.] Consists of two bellies united by an intervening tendon. The tendon and posterior belly is bound down to clavicle and cartilage of ist rib by a process of deep cervical fascia. SUPRA-HYO1D REGION. Digastric : Posterior belly. Groove on internal surface of mastoid process(p). Anterior belly. Posterior surface of in- ferior maxilla, by side of symphysis(p) intervening tendon (T), which is bound down to hyoid bone by process of deep cervical fascia (anterior, Mylo-hyoid of inferior dental ; posterior, Facial). [With posterior belly fixed and hyoid bone depressed, it depresses mandible; with the lower jaw fixed, it raises hyoid.] Stylo-hyoid : posterior aspect of styloid process near root(x) body of hyoid bone at union of great cornu and body(x) (Facial) . [Raises and draws back hyoid bone, and so tongue.] Perforated by tendon of digastric. Mylo-hyoid : mylo-hyoid ridge on inner surface of inferior maxilla(F) middle of body of hyoid bone(T), and joins fellow in median line(A) (Mylo-hyoid of inferior dental). [A raises and draws forwards hyoid under mandible ; B depresses jaw.] Parts beneath the mylo-hyoid: sublingual and part of sub- maxillary gland, with Wharton's duct; genio-hyoid, genio- hyo-glossus, hyo-glossus, stylo-glossus muscles, sublingual and ranine arteries ; gustatory, and hypoglossal nerves ; sub- maxillary ganglion . MUSCLES 29 Genio-hyoid : inferior genial tubercle on posterior surface of inferior maxilla near symphysis(T) middle of body of hyoid bone(p) (ist and 2nd cervical). [Raises and draws forward hyoid.] LINGUAL REGION. Genio-hyo-glossus : superior genial tubercle on posterior surface of inferior maxilla near symphysis(T) body of hyoid bone(p) (posterior fibres) : inferior surface of tongue from root to tip(p) (anterior fibres) (Hypoglossal). [Raises tongue and hyoid bone, draws tongue forwards and protrudes it to opposite side.] Hyo-glossus : side of body, from all great cornu of hyoid and from smaller cornu(p) back and side of tongue(p) (Hypo- glossal). [Depresses sides of tongue, making surface convex laterally.] Parts beneath hyo-glossus : inferior lingualis, genio-hyo-glossKS and middle constrictor muscles, lingual vessels, stylo-hyoid ligament, glosso-pharyngeal nerve. Stylo-glossus : external surface of apex of styloid process and stylo-maxillary ligament (A) dorsum and tip of tongue(p) (Hypoglossal). [Draws tongue upwards and backwards, makes Miperior surface concave laterally.] PHARYNGEAL REGION. Inferior constrictor : side of cricoid cartilage ; oblique line on thyroid and surface behind it, inferior cornu of thyroid cartilage(p) fibrous raphe in posterior median line of pharynx(p) (Pharyngeal plexus, External laryngeal, Re- current laryngeal). [Squeezes food towards oesophagus in swallowing. 3 Middle constrictor : great and small cornua of hyoid bone, stylo-hyoid ligament (F) fibrous raphe in posterior median line of pharynx(p) (Pharyngeal plexus). [Squeezes food towards oesophagus in swallowing.] Superior laryngeal vessels and internal laryngeal nerve pass between this muscle and the inferior, near origin. Superior constrictor : lower 3rd of posterior margin of in- ternal pterygoid plate, hamular process, pterygo-maxillary ligament, posterior part of mylo-hyoid ridge of inferior maxilla, mucous membrane of mouth and side of tongue(F) fibrous raphe in posterior median line of pharynx(p), and pharyngeal spine on basilar process(p) (Pharyngeal plexus). [Squeezes food towards oesophagus in swallowing.] Internal 30 THE POCKET ANATOMY carotid artery, pneumogastric and sympathetic nerves, middle con- stricter and stylo-pharyngeus, etc., lie on outer surface. Stylo-pharyngeus : inner surface of base of styloid pro- cess^) pharynx and posterior border of thyroid carti- lage^) (Glosso-pharyngeal). [Raises pharynx over food in swallowing.] Passes between external and internal carotid arteries. PALATAL REGION. Levator palati sunder surface of apex of petrous portion of temporal, lower margin of cartilage of Eustachian tube(T) middle line of soft palate(p) (Pharyngeal plexus). [Raises palate, shutting off naso-pharynx.] Tensor vel circumflexus palati : scaphoid fossa of sphenoid, outer side of Eustachian tube, spine of sphenoid(F) (turns round hamular process] posterior border of hard palate, aponeurosis of soft palate(A) (Otic ganglion). [Raises and makes tense soft palate.] Azygos uvulae : posterior nasal spine of palate bone(p) tip of uvula(F) (Pharyngeal plexus). [Shortens uvula.] Palato-glossus (anterior pillar of soft palate] : side and dorsum of tongue (F) anterior and lateral surface of soft palate(p) (Pharyngeal plexus). [Tends to approximate back of tongue and soft palate.] Palatp-pharyngeus (posterior pillar of soft palate] : Anterior fibres join opposite muscle at middle line lying between the levator and tensor. Posterior fibres join opposite fellow at middle line(p) (Pharyngeal plexus). Salpingo-pharyngeus : lower edge of cartilage of Eustachian tube posterior border of thyroid cartilage, side of pharynx(p). [A raises pharynx ; B will, with palato-glossus, shut off mouth from naso- pharynx.] INTRA-LARYNGEAL REGION. Crico-thyroideus : lower cornu and lower border of thyroid cartilage(p) front and side of cricoid cartilage(p) (External laryngeal). [Rotates posterior part of cricoid downwards and backwards, and so makes vocal cords tense.] Thyro-arytenoideus : lower half of receding angle of thyroid cartilage, crico-thyroid membrane(p). Two sets of fibres. Internal, edge of vocal process(F) External, outer surface of arytenoid cartilage(p) (Recurrent laryngeal). [Slackens vocal cords.] MUSCLES 31 Crico-arytenoideus lateralis: side of superior border of cricoid cartilage(F) projection at external angle of base of arytenoid cartilage, and contiguous external surface(p) (Re- current laryngeal j. [Adducts cords.] Cricp - arytenoideus posticus : depression near ridge on posterior surface of cricoid cartilage(p) projection at external angle of base of arytenoid cartilage(p) (Recurrent laryngeal). [Abducts cords.] Arytenoideus : single muscle in the median line, fills up posterior concave surface of arytenoid cartilages. Superficial fibres pass from apex of one cartilage to base of other. Deep fibres pass between posterior surfaces of the cartilages (Re- current laryngeal). [Approximates cords.] ANTERIOR VERTEBRAL REGION. Rectus capitis anticus major: four tendinous slips from anterior tubercles of transverse processes of 6th, 5th, 4th, 3rd cervical vertebrae(T) basilar process of occipital(p) (ist, 2nd. 3rd and 4th cervical). [Flexes head and cervical spine.] Rectus capitis anticu?j minor: root of transverse process and lateral mass of atlas(p) basilar process of occipital(p) (ist cervical). [Flexes head.] Rectus lateralis : superior surface of transverse process of atlas(F) jugular process of occipital(p) (ist cervical). [Flexes head to same side.] Highest intertransverse muscle. Longus colli : Superior oblique part. Anterior tubercles of transverse processes of 3rd, 4th, 5th cervical vertebrae(T) tubercle on anterior arch of atlas(T). Inferior oblique part. Bodies of first three dorsal(p) anterior tubercles of trans- verse processes of 5th and 6th cervical(T). Vertical part. Bodies of lower two cervical and upper three dorsal and itranverse processes of 4th, 5th, 6th, 7th cervical vertebrae(FT) bodies of and, 3rd and 4th cervical vertebrae(T) (Cervical nerves). [Flexes cervical spine.] LATERAL VERTEBRAL REGION. Scalenus anticus : anterior tubercles of transverse pro- cesses of 3rd, 4th, 5th, 6th cervical vertebrae(T) scalene tubercle on inner border and superior surface of ist rib(T) (Branches of lower cervical) . [A raises ribs as in forced inspira- tion, B flexes spine and bends neck to same side.] Phrenic nerve lies along anterior surface; subclavian artery passes behind at origin. Scalenus medius : posterior tubercles of transverse pro- cesses of lower six cervical vertebrae(T) rough elevation on 32 THE POCKET ANATOMY superior border of istrib, behind groove for subclavian artery (F) (Branches of lower cervical). [A raises ribs as in forced inspiration, B flexes spine laterally.] Scalenus posticus : posterior tubercles of transverse pro- cesses of lower two or three cervical vertebrae(x) superior border of 2nd rib(x) (Branches of lower cervical). [A raises ribs, B flexes cervical spine laterally.] POSTERIOR VERTEBRAL REGION. Rectus capitis posticus major : spinous process of axis(T) outer J inferior curved line of occiput and bone below(F) (ist cervical, posterior primary division). [Extends head on spine.] Rectus capitis posticus minor : posterior tubercle of neural arch of atlas(T) inner part of inferior curved line of occiput and bone between this and foramen magnum(F) (ist cervical, posterior primary division). [Extends head on spine.] Obliquus inferior : spinous process of axis(p) transverse process of atlas(T) (ist cervical, posterior primary division). [Rotates face to same side.] Obliquus superior : superior surface of transverse process of atlas(T) occipital bone, between the two curved lines(p) (ist cervical, posterior primary division). [Rotates face to oppo- site side.] MUSCLES AND FASCLE OF UPPER EXTREMITY. ANTERIOR THORACIC REGION. The deep fascia of the pectoral region covers the large pectoral muscle, is attached above to the clavicle, internally to the sternum, becoming continuous externally with fascia? of shoulder, axilla, and lateral thoracic region. The costo-coracoid membrane, continuous with the deep fascia of this part, is attached above to the clavicle so as to enclose the subclavius muscle ; the posterior layer is continuous with the axillary sheath derived from the deep cervical fascia. The lower edge (costo-coracoid ligament) reaches from the ist costal cartilage to the coracoid process, and passes down- wards over pectoralis minor. It is pierced by cephalic vein, acromio-thoracic vessels, and external anterior thoracic nerve. The axillary fascia is placed across the axilla; it is derived in front from the sheaths of the pectoral muscles, and joins, at the posterior border of the axilla, the sheaths of the latis- simus dorsi and teres major. MUSCLES 33 Pectoralis major : superiorly, sternal half of clavicle(p) ; in- ternally, front of sternum, cartilages of upper six ribs(F) ; in- fer iorly aponeurosis of external oblique muscle of abdomen (F) outer ridge of bicipital groove of humerus(T) (External and internal anterior thoracic). [A adducts humerus, flexes shoulder; B raises ribs in forced inspiration.] Anterior boundary of axilla, separated front the deltoid above by cephalic vein and branch of acromio - thoracic artery. Pectoralis minor : 3rd, 4th, and 5th ribs outside cartilages, aponeurosis over intercostal muscles(F) anterior* of superior surface and inner border of coracoid process of scapula(x) (Internal anterior thoracic). [Draws scapula forwards and depresses it.] Forms middle of anterior axillary boundary, and conceals 2nd part of axillary artery. Subclavius : ist rib at junction of bone and cartilage(x) groove on under surface of clavicle between the two tubercles(F) (Branch from 5th and 6th cervical). [Depresses clavicle.] Encased by costo-coracoid sheath. LATERAL THORACIC REGION. Serratus magnus : eight or nine digitations from as many ribs, the ist digitation being attached to ist and 2nd ribs; aponeurosis over intercostal muscles ; lower four slips digitate with external oblique muscle of abdomen(F) vertebral border of ventral surface of scapula; viz., ist digitation from ist and 2nd ribs to upper angle, from 2nd and 3rd ribs to base ; the rest to inferior angle(p) (Posterior thoracic). [Draws scapula forwards, and by rotating inferior angle forwards and upwards, raises arm.] ACROMIAL REGION. The deep fascia over the shoulder conceals the back part of the deltoid and the infra-spinatus muscle, and is attached to the clavicle, acromion, and spine of scapula. Deltoid : outer anterior border of clavicle, anterior edge of acromion, all lower edge of spine of scapula(F) rough deltoid impression on outer surface of humerus just above the middle(T) (Circumflex). [Abducts arm; anterior fibres flex shoulder, posterior extend.] Parts covered by deltoid : head and neck of humerus ; bursa between head of humerus and muscle; tendons of insertion of subscapularis, pectorales major and minor, teretes naajor and minor, latissimus dorsi, supra- spinatus, infra-spinatus. Origins of coraco-brachialis, biceps (two heads), triceps (long 3 34 THE POCKET ANATOMY and outer heads): capsular, coraco - acromial, humeral, clavicular, costo-coracoid (external part) ligaments ; coracoid process : acromio-thoracic, supra-scapular, branch of superior profunda, and circumflex vessels ; circumflex nerve. ANTERIOR SCAPULAR REGION. Subscapularis : all subscapular fossa, except at neck, angles, and inner border(p T A) small tuberosity of humerus(T) and neck of humerus for one inch below(F) (Short subscapular and branch from lower subscapular). [Flexes and inwardly rotates shoulder-joint.] Bursa placed between the tendon and root of coracoid process, communicating with shoulder-joint. POSTERIOR SCAPULAR REGION. Supra-spinatus : supra-spinous fossa, except near neck of scapula ; upper surface of spine, and fascia covering muscle(F) upper of three facets upon great tuberosity of humerus(T) (Supra-scapular). [Abducts humerus.] Infra-spinatus : infra-spinous fossa, except at neck, axillary border, and inferior angle ; from inferior surface of spine of scapula, and fascia covering muscle(F) middle of three facets on great tuberosity of humerus(T) (Suprascapular). [Extends and externally rotates shoulder-joint.] Teres minor : from superior of axillary border of dorsum of scapula, its investing fascia(p) lowest of three facets upon great tuberosity of humerus(T), and bone below(p) (Circum- flex ; has a gangliform swelling on it}. [Adducts and externally rotates humerus.] Dorsal branch of subscapular artery bends backwards in front of this muscle to reach infra-spinous fossa. Teres major : from rough surface at inferior angle of dorsum of scapula, and axillary border for lower ^, septum between it and teres minor(p) inner edge of bicipital groove of humerus (T) (Lower subscapular). [Adducts and internally rotates humerus.] A bursa is sometimes placed between tendon and humerus posteriorly , and between ten don and latissimus dor si insertion an teriorly . ANTERIOR HUMERAL REGION. The deep fascia of the arm is continuous with that of the shoulder, investing the muscles of this region. It gives off on either side an intermuscular septum, which is attached to the^condyle and supra-condylar ridge. Coraco -brachialis: apex of coracoid process of scapula, tendon of coracoid head of biceps(F) rough ridge near middle MUSCLES 35 of inner surface of humerus ; some of the upper fibres join a fibrous arch which is attached above to the small tuberosity(x) (Musculo-cutaneous). [Flexes and adducts shoulder-joint.] Brachial vessels to inner side. Biceps : Long or glenoid head. From scapula at upper border of glenoid cavity, and from glenoid ligament, within the shoulder-joint(T). Short or coracoid head. Apex of coracoid process of scapula(x) rough and hinder part of tubercle of radius(i) and fascia of forearm (Musculo-cutaneous). [Flexes shoulder, flexes elbow, supinates radius.] A bursa is placed on the smooth and fore part of tubercle. Inner border, the guide to brachial vessels below middle of humerus. A broad band, the semilunar fascia, is given off from inner side of tendon opposite the elbow-joint, covering brachial artery and joining deep fascia of fore- arm. Brachialis anticus : lower half of outer and inner surfaces of shaft of humerus, embracing insertion of deltoid, all inner intermuscular septum, and upper part of outer intermuscular septum (F) rough surface in front of coronoid process of ulna(T) (Musculo-cutaneous, Musculo-spiral). [Flexes elbow.] Brachial artery, median, musculo - spiral and musculo - cutaneous nerves lie on it. POSTERIOR HUMERAL REGION. Triceps : Long or middle head. Depression on axillary border of scapula, close beneath glenoid cavity(x). External head. From root of great tuberosity to musculo-spiral groove on posterior surface of humerus(p). Internal head. Posterior surface of shaft of humerus, by side of and below musculo- spiral groove, internal and external intermuscular septa(p) posterior surface of olecranon process of ulna(x) (Musculo- spiral). [Extends and adducts shoulder, extends elbow.] Bursa is placed between the tip of process and tendon. Sub-anconeus : by two fasciculi just above olecranon fossa of humerus(F) synovial sac of elbow-joint(F) (Musculo-spiral). [Raises synovial membrane out of olecranon fossa in extension of elbow.] OF FOREARM ANTERIOR, (a) Superficial Layer. The deep fascia of the forearm, continuous above with fascia of arm, is attached posteriorly to subcutaneous edge of ulna, and invests the muscles in this region. Anterior annular ligament (v. p. 13) is continuous by its upper border with the deep fascia of the forearm. 3-2 36 THE POCKET ANATOMY Posterior annular ligament (v. p. 13) is the thickened lower part of the posterior part of the deep fascia. Pronotor radii teres : Humeral head. Internal supra-condylar ridge of humerus, internal condyle of humerus by common flexor tendon. Ulnar head. Inner border of coronoid process of ulna, fascia and septum (F) rough impression about middle of outer surface of radius(x) (Median) .7 [Flexes elbow and pronates forearm.] Median nerve enters forearm between the two heads of origin. Flexor carpi radialis : common flexor tendon from internal condyle of humerus(T), aponeurosis of forearm, intermuscular septa(p) bases of palmar aspect of 2nd and 3rd metacarpal bones(x) (Median)*,? [Flexes elbow and wrist, abducts hand.] External edge of muscle, guide to radial artery. Passes through groove in trapezium, and has special sheath externally under annular ligament. Palmaris longus : common flexor tendon from internal con- dyle of humerus(x), aponeurosis of forearm(F), intermuscular septa(F) Palmar fascia, and a slip to short muscles of thumb (T) (Median).? [Flexes wrist, makes tense palmar fascia.] Passes over annular ligament. Flexor carpi ulnaris : Humeral head. Common flexor tendon, from internal condyle of humerus(T). Ulnar head. Inner side of olecranon, upper f of posterior border of ulna(A) Pisiform bone and prolonged to base of 5th metacarpal and hook of Cuneiform bone(x) (Ulnar)j8,J [Flexes elbow and wrist, adducts hand.] Radial side of muscle, guide to ulnar artery. Ulnar nerve enters forearm between two heads of origin. Flexor sublimis digitorum, vel perforatus : Humeral head. Common flexor tendon from internal condyle of humerus(x), internal lateral ligament(F), intermus^ula^sejjtaCFV Ulnar head. Inner border of coronoid processoiulna. ' Radial head. Oblique line of radius below tubercle, and part of anterior border(A) sides of middle phalanges of ringers, tendon being split for flexor profundus digitorum(x) ( Median ).^| ; /[Flexes elbow, wrist, carpal, metacarpal, and ist interphalangeal joints.] Tendons pass under annular ligament, in pairs, those of middle and ring-finger being anterior to those of index and little fingers. (b) Deep Layer. Flexor profundus digitorum, w/perforans : upperf of anterior and internal surfaces of shaft of ulna, upper f of ulnar half of interosseous membrane, aponeurosis from posterior border of ulna(p) palmar surfaces of bases of last phalanges(xj. (Inner MUSCLES 37 half, Ulnar ; Outer half, Anterior interosseous of median.) [Flexes wrist, metacarpal, phalangeal, and all interphalangeal joints.] Tendons pass beneath annular ligament. Flexor longus pollicis : hollow on upper of anterior sur- face of shaft of radius, outer of interosseous membrane for same distance(p) ; base of coronoid process of ulna by a separate slip(p) base of last phalanx of thumb(T) (Anterior interosseous)^ ) [Flexes wrist and all joints of thumb.] Tendon passes beneath the annular ligament. Pronator quadratus : anterior surface and anterior border of shaft of ulna, for lower fourth(p) for two inches into lower end of anterior surface and anterior border of radius(p) (Anterior interosseous).^ /[Pronates radius.] POSTERIOR, (a) Superficial layer. Supinator longus : upper external supra-condylar ridge ofhumerus, external intermuscular septum(p) root of styloid process of radius(x) (Musculo-spiral). [Flexes elbow and pronates or supinates radius from extreme position to midway between pronation and supination.] Extensor carpi radialis longior : lower of external supra- condylar ridge of humerus, external intermuscular septum(p) base of posterior surface of 2nd raetacarpal(x) (Musculo- spiral). [Extends elbow, extends and abducts hand.] Passes in groove, posterior to styloid process of radius. Extensor carpi radialis brevior : common extensor tendon from external condyle of humerus(x), external lateral ligament, intermuscular septum (F) base of posterior surface of 3rd metacarpal(x) (Posterior interosseous). [Extends elbow and wrist, abducts hand.] Extensor communis digitorum : common extensor tendon from external condyle of humerus(x) ; intermuscular septum(F) dorsa of last two phalanges of fingers(x) (Posterior in- terosseous). [Extends wrists and all joints of carpus and fingers.] The four tendons pass through a separate compartment of the posterior annular ligament with the extensor indicts. The tendons of the middle, ring, and little finger are connected by tendinous slips. Extensor minimi digiti : common extensor tendon from external condyle of humerus, deep fascia and intermuscular septum(x) 2nd and 3rd phalanges of little finger joining common expansion(x) (Posterior interrosseous). [Extends wrist and all joints of little finger.] Tendon passes through separate sheath of posterior annular ligament, below which it splits into two, the external one being united by a cross-piece with the tendon of common extensor going to little finger. 38 THE POCKET ANATOMY Extensor carpi ulnaris: common extensor tendon from external condyle of humerus(T), intermuscular septum (F) by aponeurosis from upper of posterior border of ulna(A) prominence on ulnar side of base of 5th metacarpal bone (T) (Posterior interosseous). [Extends wrist, carpal joints and 5th metacarpo-phalangeal joint, adducts hand.] Has separate sheath in posterior annular ligament. Anconeus : posterior surface of external condyle of humerus (T) and deep fascia(F) outer side of olecranon, impression on upper J of posterior surface of ulna limited by oblique line(p) (Musculo-spiral). [Extends elbow.] The recurrent interosseous vessels lie beneath this muscle. (b) Deep Layer. Supinator brevis : external condyle, external lateraf liga- ment of elbow-joint, orbicular ligament of radius, depression below lesser sigmoid cavity, external edge of ulna for 2 inches (F) surrounds upper of radius, is attached to all the neck, except at inner side, to the upper of posterior, and upper of external surfaces(F) (Posterior interosseous). [Extends elbow, supinates radius.] Extensor ossis metacarpi ppllicis : middle of posterior surface of shaft of radius, special impression on superior and external part of posterior surface of ulna for same length, intervening interosseous membrane(F) dorsal aspect of base of ist metacarpal (Posterior interosseous). [Extends ist carpo-metacarpal joint abducts hand.] The radial artery winds backwards beneath tendon near carpus. Extensor brevis pollicis : posterior surface of radius and interosseous membrane below preceding muscle for about i inches(F) dorsal aspect of base of ist phalanx of thumb (T) (Posterior interosseous). [As preceding ; also extends ist metacarpo-phalangeal joint ] Goes through groove under posterior annular ligament with extensor ossis metacarpi pollicis. Extensor longus pollicis : posterior surface of ulna, on inner side and below extensor ossis metacarpi pollicis for 4 inches, interosseous membrane(F) dorsal aspect of base of last phalanx of thumb(x) (Posterior interosseous). [Ex- tends wrist and all joints of thumb.] Tendon goes through separate sheath of posterior annular ligament, and below is separated from other extensors of thumb by a triangular interval, which con- tains the radial artery. Extensor indicis : internal part of posterior surface of shaft of ulna for about 3 inches just below middle, and interosseous MUSCLES 39 membrane(p) joins tendon of extensor communis digitorum to 2nd and 3rd phalanges of index-finger(x) (Posterior inter- osseous). [Extends wrist and all joints of index.] THUMB, THENAR EMINENCE. Abductor pollicis : ridge of trapezium, sometimes scaphoid, upner part of annular ligament(p) outer side of base of ist phalanx of thumb(x) (Median). [Abducts thumb.] Opponens pollicis : anterior surface and ridge of trapezium, annular ligament(p) whole length of radial border of shaft of ist metacarpal(F) ("Median). [Opposes thumb to palm.] Flexor brevis pollicis : Outer head. Lower border of annular ligament outer margin of the base of ist phalanx of thumb (Median). Inner head. Inner side of base of tst metacarpal bone inner side of base of ist phalanx of thumb (Ulnar). [Flexes metacarpo-phalangeal and ist interphalangeal joint of thumb.] A sesamoid bone developed in each tendon of insertion. Deep palmar arch of radial, issues from behind inner head. Adductor obliquus pollicis : sheath of flexor carpi radialis, anterior carpal ligaments, os magnum, bases of 2nd and 3rd metacarpal bones inner side of base of ist phalanx of thumb (Ulnar). [Adducts and flexes thumb.] Adductor transversus pollicis : ridge on lower of anterior surface of shaft of 3rd metacarpal(p) ulnar side of base of ist phalanx of thumb(x) (Ulnar). [Adducts and flexes thumb.] LITTLE FINGER, HYPOTHENAR EMINENCE. Palmaris brevis : annular ligament, palmar fascia(p) skin on ulnar side of palm(p) (Ulnar). [Corrugates skin on ulnar side of palm.] Opponens minimi digiti : process of unciform bone, lower part of annular ligament(p) ulnar edge of 5th metacarpal(F) ( Ulnar). [Opposes little finger to palm.] Flexor brevis minimi digiti : tip of process of unciform, annular ligament(p) ulnar side of base of ist phalanx of little finger(T) (Ulnar). [Flexes little finger.] Abductor minimi digiti : pisiform bone, tendon of flexor carpi ulnaris(p) ulnar side of base of ist phalanx of little finger(T) (Ulnar). [Abducts little finger.] DEEP PALMAR REGION. Lumbricales (4) : radial side of deep flexor tendons (2 inner from ulnar margins of and and 3rd tendons also) (K) radial 40 THE POCKET ANATOMY side of tendinous expansion on dorsa of ist phalanges of fingers(r) (2 outer median, 2 inner ulnar). [Flex metacarpo- phalangeal and extend interphalangeal joints.] Interossei dorsales (4) : ist muscle (abductor indicts). Outer head. From upper ^ of ulnar border of ist metacarpal(F). Inner head. Radial border of 2nd metacarpal(F). The others from posterior part of lateral surfaces of both metacarpals, between which they lie ist and 2nd muscles to radial side of ist phalanx of index and middle fingers respectively, 3rd and 4th in similar manner to ulnar side of middle and ring fingers (T). Each is inserted partly into base of ist phalanx, and partly into expansion of common extensor on ist phalanx(x) (Ulnar). [Abduct fingers from middle line of hand i.e., 3rd (middle) finger ; also same action as lumbricales.] Interossei palmares (3) : ist from ulnar side of 2nd meta- carpal, 2nd and 3rd from radial sides of 4th and 5th meta- carpals respectively (F) ist phalanx of finger from which they arise and on the same side as the origin, and into extensor tendon expansion(x) (Ulnar). [Adduct fingers towards middle line, and same action as lumbricales.] MUSCLES AND FASCIA OF BODY. BACK, IST LAYER. Trapezius : spinous processes of all dorsal and 7th cervical vertebrae, with supra-spinous ligaments, ligamentum nuchas, inner Jrd of superior curved line of occiput(T) outer rd of posterior border of clavicle, superior edge of acromion, superior lip of posterior border of spine of scapula(F), and rough im- pression on spine about i inch from root(T) (Spinal accessory, 3rd and 4th cervical by cervical plexus.) [A Upper fibres draw scapula and clavicle upwards, lower fibres downwards, all backwards ; B pulls head backwards, and also flexes to same side.] Anterior margin forms posterior boundary of posterior triangle of neck. Latissimus dorsi: spinous processes of lower 6 dorsal, supra-spinous ligaments(A) ; from the posterior layer of the lumbar aponeurosis, by which it is attached to all the lumbar and sacral spines, and posterior of outer edge of iliac crest, beyond this for i inch(p), lower 3 or 4 ribs(F), and occasionally a slip from angle of scapula bottom of bicipital groove of humerus(x) (Long subscapular). [Draws arm down and back- wards, rotating inwards.] In the back the latissimus is posterior to MUSCLES 4 the teres major, but twisting upon itself it is inserted anteriorly to teres, and lowest fibres are inserted highest. BACK, 2ND LAYER. Levator anguli scapulae : posterior tubercles of transverse processes of upper three or four cervical vertebrae (T) verte- bral border of scapula between spine and superior angle (F) (5th cervical [nerve to rhomboidei] and deep branches from 3rd and 4th cervical). [Elevates scapula.] Forms part oj floor of posterior triangle of neck. Rhomboideus minor : ligamentum nuchae, spinous processes of yth cervical and ist dorsal vertebrae(T) vertebral border of scapula, opposite root of spine(p) (sth cervical). [Elevates and draws back scapula.] Rhomboideus major : spines and supra-spinous ligaments of upper 4 or 5 dorsal vertebrae, below preceding(x) vertebral border of scapula between spine and inferior angle (F) (5th cervical). [Elevates and draws back scapula.] Sometimes the fibres end in a tendinous arch near the bone. BACK, 3RD LAYER. Serratus posticus superior: ligamentum nuchae, spinous processes of yth cervical and two or three superior dorsal vertebrae, supra-spinous ligament(A) upper borders and outer surfaces of 2nd, 3rd, 4th, and 5th ribs external to angle(p) (External posterior branches of dorsal). [Elevates upper ribs.] Serratus posticus inferior: spinous processes of nth and 1 2th dorsal, and ist and 2nd lumbar vertebrae, and from tendon of origin of latissimus dorsi and the fascia lum- borum(A) inferior borders of lower four ribs external to angle(p) (External posterior branches of dorsal). [Draws lower ribs downwards and backwards, fixing them for dia- phragm to act from.] The vertebral aponeurosis. A thin membrane, attached to the spines of the dorsal vertebrae, and passing outwards to the angles of the ribs. Below it is joined to the upper edge of the inferior serratus and the tendon of latissimus, whilst above it passes beneath the superior serratus and splenius to become continuous with the deep fascia of the neck. It binds down the erector spinae in the groove between the vertebral spines and the angles of the ribs. Splenius : lower of ligamentum nuchae, spinous processes of yth cervical and upper 6 dorsal vertebrae, supra-spinous 42 THE POCKET ANATOMY ligaments(A) Capitis, apex and hinder border of mastoid process, outer superior curved line of occiput(T) ; Colli, posterior tubercles of transverse processes of ist, 2nd, and 3rd cervical vertebrae (T) (External posterior branches of cer- vical). [Extends spine and head ; laterally flexes head and rotates face to the same side.] BACK, 4TH LAYER. Erector spinse : Outer mass. Ilio-costalis, musculus ac- cessorius, cervicalis ascendens. Inner mass. Longissimus dorsi, transversalis colli, trachelo-mastoid. [In all its parts extends spine.] Erector spinse : posterior ith inner lip of iliac crest, from the sacral transverse processes, and lower part of posterior surface of sacrum, from the sacral, lumbar and lower 3 dorsal spines, with supra-spinous ligaments(x). Divides opposite last rib into sacro-lumbalis and longissimus dorsi (External posterior branches of sacral and lumbar). Ilio-costalis : erector spinas(F) angles of lower 6 or 7 ribs (T) (External posterior branches of lumbar and dorsal). Musculus accessorius : angles of lower 6 ribs(x) angles of upper 6 ribs, and transverse process of 7th cervical(x) (External posterior branches of dorsal). Cervicalis ascendens : angles of 3rd, 4th, 5th, and 6th ribs ( T ) Posterior transverse tubercles of 6th, 5th, and 4th cervical vertebrae(x) (External posterior branches of cervical). Longissimus dorsi. (See erector spines, of which it forms nearly the whole of the inner mass.) Internally. Accessory processes of lumbar and transverse processes of dorsal vertebrae(XF). Externally. Lumbar transverse processes(p), middle layer of fascia lumborum : to all the ribs except first two or three by fleshy processes between tubercle and angle(p) (External posterior branches of lumbar and dorsal). Transversalis colli : transverse processes of upper 5 dorsal vertebrae(x) Posterior tubercles of transverse processes of 6th, 5th, 4th, 3rd, and and cervical vertebrae (x) (External posterior branches of cervical). Trachelo-mastoideus: transverse processes of upper 4 dorsal vertebrae(x), articular processes of 7th, 6th, 5th, and 4th cervical vertebrae (x) posterior edge of mastoid process (F) (External posterior branches of cervical). Spinalis dorsi : spinous processes of nth and i2th dorsal and ist and 2nd lumbar vertebras (FX) Spinous processes of MUSCLES 43 upper 4 or 8 dorsal vertebrae(T) (External posterior branches of dorsal and lumbar). Complexus : transverse processes of upper 6 dorsal and yth cervical, articular processes of inferior 3 or 4 cervical, and spinous process of yth cervical vertebrae(T) Impression between superior and inferior curved lines of occiput(F) (Suboccipital, internal posterior branches of cervical). [Ex- tends head, and rotates face to the opposite side.] The inner part of this muscle is sometimes described as a separate muscle, called biv enter cervicis. BACK, 5TH LAYER. Semi-spinalis dorsi : transverse processes of loth, gth, 8th, 7th, and 6th dorsal vertebrae(x) Spinous processes of upper four dorsal and last two cervical vertebrae(T) (Internal pos- terior branches of dorsal). [Extends spine.] Semi-spinalis colli : transverse processes of upper 6 dorsal (FT) spinous processes of and, 3rd, 4th, and 5th cervical vertebrae(T) (Internal posterior branches of cervical). [Ex- tends spine.] Multifidus spinse : back of sacrum as low as 4th sacral foramen; inner surface of posterior superior iliac spine, posterior sacro-iliac ligament, mammillary processes of lum- bar, transverse processes of dorsal, articular processes of lower 5 cervical vertebrae(Fx) spines and neural arches of vertebrae from 3rd sacral to and cervical(p) (Internal posterior branches of sacral, lumbar, dorsal and cervical). [Extends spine.] Fills groove on either side of spinous processes of vertebra. Rotatores spinse, vel dorsi (eleven in number) : tip and upper edge of transverse process of a dorsal vertebra(p) lower border of lamina of vertebra next above (A) (Internal posterior branches of dorsal). [Rotate spine.] Inter-spinales : placed in pairs, one on each side of inter- spinous ligament between spinous processes (Internal posterior branches of cervical, dorsal, and lumbar). [Extend spine.] These muscles are wanting between ist and 2nd cervical, and all the dorsal except first and last two pairs. Inter - transversales : lie between transverse processes. Cervical (seven pairs, two sets). One set attached to anterior, the other to the posterior tubercles. Dorsal. Single sets, from three to six in number, attached to the processes of the lower vertebrae. Lumbar. Four in number, the lower ones filling up the spaces between processes entirely. A second set here pass between adjacent accessory processes. (Internal posterior branches of cervical, dorsal, and lumbar). [Laterally flex spine.] 44 THE POCKET ANATOMY ABDOMINAL REGION. Obliquus abdominis externus: eight digitations from in- ferior borders and outer surface of eight lower ribs, upper five digitating with serratus magnus, lower three with latis- simus dorsi(p) Anterior half of external lip of iliac crest, and aponeurosis in front of belly, which is attached to pubic spine and symphysis below(A), blends above with the fascia over the pectoralis major, and joins in the middle line with the opposite aponeurosis, forming the linea alba ; the rest of the fibres forming Poupart's and Gimbernat's ligaments (A) (Lower intercostals.Ilio-hypogastric, and Ilio-inguinal). [Sup ports and compresses viscera, draws down lower ribs, and laterally flexes thorax.] The external abdominal ring is an opening formed by a diver- gence of some of the lower fibres of the aponeurosis of the external oblique muscle ; it is situated just above the crest of the pubes, and transmits spermatic cord in male and round ligament in female. Boundaries Below. Pubic crest. Above. Arched fibres. Laterally. External and internal pillars ; the external pillar is attached below to pubic spine, the internal pillar to pubic symphysis. The intercolumnar fascia passes between the pillars, and is prolonged downwards over the cord. Poupart's Ligament. The part of the aponeurosis of the ex- ternal oblique extending between anterior superior iliac spine and pubic spine. The inner attachment is prolonged along the pectineal line, forming Gimbernat's ligament, of which some fibres are again reflected upwards and inwards to linea alba, forming triangular fascia. Obliquus interims : outer of Poupart's ligament, anterior middle lip of iliac crest, fascia lumborum between iliac crest and I2th rib(p) inferior edges of cartilages of lower three ribs on posterior surface, aponeurosis blending with its fellow at linea alba; some of the lower fibres of the aponeurosis arch over spermatic cord, join tendon of transversalis just above pectineal line, forming the conjoined tendon, which is attached to pectineal line, and crest of pubes(T) (Lower inter- costals, Ilio-hypogastric). [As externus.] Aponeurosis forms sheath to encase the rectus except at lower fourth posteriorly. Cremaster (peculiar to male) : middle of Poupart's ligament and internal oblique(p) crest of os pubis(x) (Genito-crural). [Supports and raises testis.] Fibres embedded in fascia (cremas- teric) derived from internal oblique, covering cord and testis. Transversalis : outer Poupart's ligament, anterior f inner lip iliac crest, inner surfaces of cartilages of lower six ribs(p) MUSCLES 45 fascia lumborum(T) lower fibres end in the conjoined tendon, inserted into pubes and pectineal line(x) ; rest of fibres ter- minate in an aponeurosis attached to linea alba(A) (Lower intercostals, Ilio-hypogastric, Ilio-inguinal) . [Supports and compresses viscera.] As low as midway between pubes and umbilicus, the aponeurosis is posterior to the rectus, but below this level it is anterior. The Posterior aponeurosis of the Transversalis or fascia lumborum is attached to the lower border of the last rib above, and to the ilio-lumbar ligament and posterior part of the iliac crest below. Tracing it towards the spine, it splits to enclose the quadratus, and becomes attached to the lumbar transverse processes. From the posterior of these layers a process is given off to the lumbar spines, enclosing the erector spinse. Rectus abdominis : pubic crest and symphysis(x) ensiform appendix, cartilages of 5th, 6th, and yth ribs, bone and cartilage of 5th rib(FT) (Lower intercostals Ilio-hypogastric). [Supports viscera, flexes spine, A drawing down thorax, B drawing up pelvis, as in climbing.] Traversed by three or four tendinous intersections, linea transverse. Sheath of rectus. Aponeurosis of internal oblique splits at outer edge of muscle, one piece passing anteriorly, the other posteriorly. The posterior part is joined by aponeurosis of transversalis, and is deficient at lower fourth ; the lower free border forms the Fold of Douglas. The anterior part blends with aponeurosis of the external oblique. Pyramidalis : front of pubes and anterior pubic ligament(x) linea alba(x) midway between umbilicus and pubes (i2th intercostal). [Makes linea alba tense.] Enclosed in sheath of rectus, and frequently absent. Quadratus lumborum : Anterior part. Upper edge of trans- verse processes of 3rd, 4th and 5th lumbar vertebrae inner lower border 1 2th rib. Posterior part. Ilio-lumbar ligament, and inner lip of iliac crest for 2 inches external to it (A) apices of transverse processes of upper four lumbar (T), inner in- ferior border of i2th rib(p) (Anterior branches of lumbar). [Flexes spine laterally, draws down last rib and with its fellow extends spine.] THORACIC REGION. Intercostales extern! (n): outer lip of groove on inferior border of rib, from the tubercle to costal cartilage(K) outer -edge of superior border of rib belo W(F) (Intercostals) . [Elevate Tibs and aid inspiration.] Fibres run downwards ana forwards. 46 THE POCKET ANATOMY The corresponding spaces between the rib cartilages are occupied by th* anterior intercostal aponeurosis. Intercostales intern! (n) : inner lip of groove on inferior border of rib, extending from angle to sternum(F) inner edge of superior border of rib below (Intercostals). [Probably ele- vate ribs and aid inspiration.] Fibres run downwards and back- wards, but not so obliquely as the external muscles. The inner surface of each intercostal space between the tubercle and angle is occupied by the posterior intercostal aponeurosis. The intercostal vessels and nerve lie between the external and internal muscles. Subcostales (10) : inner surface of a rib, near angle(p) inner surface of ist, 2nd, or 3rd ribs below(FT) (Intercostals). [Elevate ribs.] Triangularis aterni : side of ensiform appendix and sternum, as high as 3rd intercostal space, posterior surfaces of cartilages of 7th, 6th, and 5th ribs(F) posterior surfaces of 2nd, 3rd, 4th, 5th and 6th ribs at junction of bone and cartilage(TF) (Anterior branches of intercostals). [Draws down ribs.] Levatores costamm (12) : apex and lower border of trans- verse processes of yth cervical and upper n dorsal vertebrse (T) superior border of rib below, extending from tubercle to angle(F) (Intercostals). [Raise ribs.] DIAPHRAGMATIC REGION. Diaphragma : posterior surface of ensiform appendix, in- ternal surfaces of lower six costal cartilages(F), ligamenta arcuata (externa et interna) (A). Right crus, from bodies and intervertebral substances of ist, 2nd, 3rd lumbar vertebrae(T). Left crus, from bodies and intervertebral substances of ist and 2nd lumbar vertebrae(T) central tendon (Phrenics). [En- larges vertical diameter of thorax, so aids inspiration.] The ligamentum arcuatum internum arches over psoas, attached to body of ist lumbar vertebra internally and to transverse pro- cess of ist lumbar vertebra externally. The ligamentum arcuatum externum reaches from transverse process of ist lumbar ver- tebra to lower border and apex of last rib, arching over quadratus. Openings. AORTIC(F) : between the crura and spine, trans- mits aorta, thoracic duct, and vena azygos major. CESOPHA- GEAL(F) : above and little to left of aortic, transmits 0330- phagus and pneumogastric nerves. CAVAL(T) : in the right leaflet of tendon, transmits vena cava inferior, which is in- separably united to it. In each crus there is a fissure for the three splanchnic nerves, the left one transmitting in addition MUSCLES 47 the vena azygos minor. The cord of the sympathetic per- forates the outer part of the crus. PERINEAL REGION. Superficial Fascia. In the anterior half of the perineum this consists of two layers, the superficial fatty and the deep layer fibrous and well marked (fascia of Colles) : the latter is attached to rami of pubes and ischium, and from ischial tuberosity to central point of perineum ; here it joins the triangular liga- ment, by turning round the transversus perinei. It is con- tinuous in front with the dartos. and from its deep surface there is a septum passing forwards to scrotum in the middle line. Triangular Ligament of the Urethra, or Deep Perineal Fascia, consists of two layers. The anterior layer is attached to the symphysis and to rami of pubes and ischium on each side, and joins the superficial fascia where this curves over the transversus perinei. About an inch below the symphysis it is perforated by the urethra, and above this by the dorsal vein of the penis, and on either side of this opening the dorsal artery and nerve of penis are transmitted. The posterior layer consists of two lateral portions separated in the median line by the urethra, and continuous with the recto-vesical fascia in the middle line, which here invests the prostate ; exter- nally it joins the obturator fascia on the pubic and ischial rami, and is really the subpubic part of the parietal pelvic fascia. Parts between the two layers of the triangular ligament. Sub- pubic ligament, dorsal vein of penis, membranous part of urethra, compressor urethrae. Cowper's glands and ducts, internal pudic arteries giving off branches to bulb, to glands of Cowper, and the artery to corpus cavernosum, and the dorsal nerves of penis. THE PELVIC FASCIA. Lines muscles of pelvis and forms f oor of outlet of pelvis. Consists of parietal and visceral layers. Parietal Layer, (a) The Obturator Fascia. Covers inner surface of obturator internus. It is attached above to ilio- pectineal line, to oblique line on posterior surface of body of pubes from symphysis to upper part of thyroid foramen. Posteriorly it is attached to the anterior edge of the sacro- sciatic notch and large sacro-sciatic ligament, whilst below it is attached to the rami of pubis and ischium, and in front in the subpubic angle is continuous with the posterior layer of the triangular ligament. At th^ top of the thyroid foramen 48 THE POCKET ANATOMY the fascia joins the obturator membrane, its bony attachment being here interrupted, and forms thus the floor of the short canal which transmits the obturator vessels and nerve. The upper part of the fascia is in the pelvic cavity, and is lined by peritoneum, whilst the lower part forms the outer boundary of the ischio-rectal fossa, and encases the internal pudic vessels and pudic nerve as they pass forwards. (b) The Fascia of the Pyriformis is the continuation of the obturator fascia to the sacrum, and lies anterior to the pyri- formis and sacral plexus. Visceral Layer. The Recto-vesical Fascia is attached in front to the posterior surface of the pubis, close to the obturator fascia, the origin of the levator ani intervening. Laterally it is attached to the obturator fascia along a line from the upper part ol the thyroid foramen to the ischial spine, whilst behind it joins the lower part of the pyriformis fascia. From these attachments it passes downwards and inwards over the upper surface of the levator ani to the prostate, bladder and rectum, joining the fascia of the opposite side in front of the bladder, and between the bladder and the rectum, thus form- ing the floor of the pelvis. Along the attachment of the recto- vesical to the obturator fascia is a thickened band, the white line of the pelvic fascia. Processes from the recto-vesical fascia : Pubo -pro static ligaments or anterior true ligaments of the bladder. Narrow fasciculi, one on each side, passing from the back of the pubes to the front of the prostate and neck of the bladder. Lateral true ligaments of the bladder. This is the anterior ligament prolonged laterally, and passes to the side of the prostate, and to the side of the bladder above the vesiculae seminalis, enclosing the prostatic plexus, whilst posteriorly it is attached to the bladder between the vesiculae, and is pro- longed downwards over and enclosing them, being joined to a like process from the opposite side. Ligament of the rectum. A piece of fascia descends from the ischium and is attached to the rectum on each side. In the female the vagina receives a prolongation of the recto-vesical fascia corresponding to the prostatic sheath. Sphincter ani externus : tip and back of coccyx and sub- cutaneous fatty layer on either side(TF) central perineal tendon(F) (4th sacral and inferior haemorrhoidal of pudic). [Closes anus.] Sphincter ani internus : the involuntary muscular fibres of the large intestine thickened about \ inch deep. [Closes anus.] MUSCLES 49 Bulbo-cavernosus, vel accelerator, vel ejaculator uriuae : central perineal tendon and raphe(v) Posterior fibres. Under surface of triangular ligament(F). Middle fibres surround bulb and corpus spongiosum. Anterior fibres. Side of corpus cavernosum, and united with one on opposite side it encases dorsal vessels(A) (Deep perineal of pudic). [Compresses bulbous urethra, discharging its contents.] Erector penis, vel ischio-cavernosus : internal surface of tuber ischii(TF) internal and external surfaces of crus penis (T) (Deep perineal of pudic). [Compresses crus and produces erection.] Transversus perinaei : internal surface of tuber ischii(T) central perineal tendon(p) (Deep perineal of pudic). [Draws back and fixes central point of perineum.] Levator ani : posterior surface of pubis near symphysis, spine of ischium, and between these two points from recto- vesical fascia, along attachment of obturator fascia(T) central perineal tendon, sides of rectum and coccyx(p) (Perineal of pudic and Anterior division of 4th sacral). [Supports pelvic viscera, compresses and raises lower part of rectum in defaeca- tion.] Forms floor of pelvic cavity. Compressor vel constrictor urethras : internal surface of pubic arch, posterior surface of triangular ligament(A) muscle of opposite side(x) (Deep perineal of pudic). [Constricts urethra and expels contents.] Surrounds membranous portion of urethra. Coccygeus : upper part of ischial spine, small sacro-sciatic ligament(TF) side and anterior surface of coccyx and last piece of sacrum(p) (Anterior division of 4th sacral). [Supports pelvic floor.] Note. In the female the perineal muscles are essentially the same : for erector penis, read erector clitoridis, inserted into side of clitoris. The sphincter vagina, corresponding to ejaculator urinae, is attached to the central tendon of the perineum, and passing forwards on each side of the vagina corpora cavernosa and body of clitoris. MUSCLES AND FASCIAE OF LOWER EXTREMITY. The FASCIA LATA of the thigh envelops the muscles and surrounds the limb. Above it is attached to the back of the sacrum and coccyx, to the iliac crest, to Poupart's ligament, pubic body and ramus, ischial tuberosity and ramus, and to the lower edge of the great sacro-sciatic ligament. The tlio- tibial band is a thickened part attached above to the iliac crest 4 5 o THE POCKET ANATOMY and below to the head of the fibula and outer tuberosity of the tibia. The fascia lata is attached below to the head of the tibia and sides of the patella, being strengthened by aponeuroses from the vasti muscles. Behind the fascia passes across between the hamstring muscles, enclosing the popliteal space. The Saphenous Opening. This is an aperture in the fascia lata in upper and inner part of the thigh, through which the internal saphenous vein passes. It is covered by the cribri- form fascia. To describe it, the fascia is spoken of as con- sisting of two parts, of pubic portion on the inner side of the opening and continuous below with the iliac portion. The pubic portion passes up over the pectineus, adductor longus and gracilis, and behind the femoral sheath, blending externally with sheath of psoas and attached internally to the pectineal line (Cooper ' s ligament) and to Gimbernat ' s ligament. The iliac portion, on the outer side of the saphenous opening, and covering the femoral vessels, is attached exter- nally to the iliac crest, Poupart's ligament, and pubic spine, joining here the pubic portion. From the pubic spine it passes down and out with a free margin, the superior cornu or falciform process of Burns, forming the outer margin of the saphenous opening, and becoming continuous below and internally with the pubic portion, the margin here being well defined and named the inferior cornu. Sheath of the Femoral Vessels. The upper part of the sheath surrounding the femoral vessels is called the crural sheath, which is formed by a prolongation from the transversalis fascia in front, and from the fascia covering the iliacus behind. It is divided into three compartments, the outer containing the artery, the middle one the vein, and the inner one, or crural canal, a lymphatic gland. The crural canal, the innermost compartment of the femoral sheath, is about inch long, reaching from Gimbernat's liga- ment to the saphenous opening. The upper opening of the crural canal is called the crural ring, which is on a level with Gimbernat's ligament, and is closed by a layer of sub-peritoneal fascia, the septum crurale. Boundaries of the crural ring : In front, superficial (Poupart's ligament) and deep crural arches. Behind, pubis, covered by pectineus ; pubic portion of fascia lata. Internallv, Gimbernat's ligament, conjoined tendon. Externally, femoral vein. MUSCLES 51 The dsep crural arch is a thickened bundle of fibres of the transversalis fascia, attached to Poupart's ligament outside the femoral vessels, and passing across the femoral sheath to the ilio-pectineal line behind Gimbernat's ligament. ILIAC REGION. Psoas magnus : transverse processes and sides of bodies of all the lumbar and body of iath dorsal vertebrae(p) (the fleshy fibres are only attached to upper and lower margins of bodies, and intervertebral substances, being connected by a tendinous arch between) small trochanter of femur, receiv- ing some fibres from the iliacus(T) (Branches from lumbar plexus). [A flexes thigh on trunk, and rotates femur out- wards; B flexes trunk on thigh.] Psoas parvus : bodies of i2th dorsal and ist lumbar vertebrae and intervertebral disc(F) ilio-pectineal line(T) (Branch from lumbar plexus). [Flexes lumbar spine.] Fre- quently absent. Iliacus : upper half of iliac fossa, ilio-lumbar ligament, ala of sacrum, and capsule of hip-joint(F) tendon of psoas, triangular surface anterior to and below the small trochanter (F) (Anterior crural). [A flexes hip-joint and rotates femur outwards ; B flexes trunk on thigh.] Passes beneath Poupart's ligament with the psoas. ANTERIOR FEMORAL REGION. Tensor fasciae femoris : outer edge of iliac crest for one inch, anterior superior iliac spine, and half notch below it(A) fascia lata(ilio-tibial band) about down thigh, anterior to great trochanter(p) (Superior gluteal). [Makes fascia lata tense, rotates inwards, and abducts femur.] Sartorius : anterior superior iliac spine and half notch below (A) inner side of tibia, by side of tubercle, reaching by its upper edge as far back as internal lateral ligament(AT) (Middle cutaneous or special branch from anterior division of anterior crural). [Flexes hip and knee, abducts and rotates thigh out.] Longest muscle of body, crosses thigh obliquely, forming outer boundary of Scarpa's triangle; lies over the roof of Hunter's canal; lower tendon pierced by patellar branch of long saphenous nerve. Quadriceps extensor composed of: Vastus externus : upper half of shaft of femur, thus : from base of neck, anterior and outer parts of base of great' tro- chanter. and line from great trochanter to linea aspera, upper half of external lip of linea aspera, external intermuscular 42 52 THE POCKET ANATOMY septum(AF) common extensor tendon, and slip to outer side ofpatella(x) (Anterior crural). Vastus internus : inner lip of linea aspera, lower part of spiral line, tendons of adductores longus and magnus(TA) common tendon and inner side of patella(x) (Anterior crural). Crureus : upper anterior and outer surfaces of shaft of femur, lower half external intermuscular septum(p) common tendon (A) (Anterior crural). Rectus femoris : ist head. Anterior inferior iliac spine(x). 2nd head. Groove above acetabulum(T) common extensor tendon into upper border of patella(x) (Anterior crural). THE COMMON EXXENSOR XENDON is inserted into the upper and lateral edges of the patella, very few fibres being prolonged over bone to help form the ligamentum patellae. [Extends knee ; rectus also flexes hip.] Subcrureus : two slips from anterior surface of shaft of femur in lower fourth(p) synovial sac of knee-joint(F) (An- terior crural). [Pulls up synovial expansion of knee-joint in extension.] INXERNAL FEMORAL REGION. Gracilis : internal margin of anterior surface of descending pubic ramus inner side of tibia superior to semi-tendinosus, but inferior to backward prolongation of insertion of sartorius (x) (Anterior branch of obturator). [Adducts thigh, flexes knee.] Pectineus : ilio-pectineal line and triangular surface anterioi to it(p) posterior to small trochanter and upper half of line leading from it to linea aspera(x) (Anterior crural, and Acces- sory obturator or Obturator). [Adducts thigh, flexes hip, rotates thigh out.] Adductor longus : anterior surface of pubes below angle of crest and symphysis(x) inner lip of linea aspera(F) (Anterior division of obturator). [Adducts thigh, flexes hip, rotates thigh out.] Forms internal boundary of Scarpa's triangle. Adductor brevis : body and ramus of pubis, extending from adductor longus to middle of ramus(FA) behind pectineus into line leading from small trochanter to linea aspera(r) (Obturator, generally anterior branch). [Adducts thigh, flexes hip, rotates thigh out.] Anterior division of obturatornerve placed in front and posterior part behind, the internal circumflex artery between upper border and obturator externus. Adductor magnus : pubic arch, from body of pubis to tuber ischii(A) Anterior part. Line from great trochanter to linea aspera, inner lip of linea aspera, upper half of line leading MUSCLES 53 to inner condyle(p). Posterior part. Tubercle above inner condyle(x) (Posterior division of obturator, Great sciatic). [Adducts thigh ; rotates thigh out ; posterior fibres extend hip- joint.] Between the two parts of the muscle there is an interval, the femoral opening, which transmits the femoral vessels. HUNTER'S CANAL. Extends from the apex of Scarpa's triangle to the opening in the adductor magnus, containing the superficial femoral vessels and long saphenous nerve. It is formed by aponeurotic fibres passing from the adductores magnus and longus to the vastus internus, and is covered by sartorius. GLUTEAL REGION. Gluteusmaximus : external surface of ilium between superior curved line and posterior of outer lip of crest, aponeurosis over erector spinae, posterior surfaces of coccyx, and of last 2 pieces of sacrum, and great sacro sciatic ligament(F) gluteal ridge between linea aspera and great trochanter(AF), fascia lata^F) (Inferior gluteal). [A, extensor and rotator out- wards of thigh ; B, after stooping, extends trunk on thigh.] Parts beneath the glutens maximus : part of gluteus mediua the pyriformis, superior and inferior gemelli, tendon of obturator internus, quadratus femoris, upper part of adductor magnus, origins of semi-membranosus, semi-tendinosus, and biceps and part of vastus externus. Superficial branch of gluteal artery and superior gluteal nerve, sciatic vessels, and great and small sciatic nerves, internal pudic vessels and pudic nerve, nerve to obturator internus, inferior gluteal nerve, branches of external and internal circumflex and ist per- forating arteries. Three bursae, one over great trochanter, one over tuber ischii, one over vastus externus. Great sacro- sciatic ligament. Great trochanter and tuber ischii. Gluteus medius : bone between iliac crest and superior curved line above, and middle curved line below, fascia(p) outer surface of great trochanter from tip posteriorly to base anteriorly(p) (Superior gluteal). [Extends and abducts thigh : anterior fibres rotate thigh inwards, posterior out- wards.] Conceals gluteal vessels and nerve. Gluteus minimus : posterior surface of hip-bone between middle and inferior curved lines(p) impression on anterior part of great trochanter(p) (Superior gluteal). [Abducts and rotates thigh inwards.] Pyriformis : anterior surface of sacrum, from 2nd, 3rd, and 4th pieces between anterior foramina, upper margin of great sciatic notch, great sacro-sciatic ligament(p) posterior part 54 THE POCKET ANATOMY of upper edge of great trochanter(x) (ist and and Sacral). [Rotates the thigh outwards.] Goes through great sacro-sciatic foramen. Obturator interims : posterior surfaces of pubic arch, obtu- rator membrane, and ischium behind ; from great sciatic notch, fascia(F) front of upper border of great trochanter with the gemelli(T) (Sacral plexus). [External rotator of thigh.] Passes through small sacro-sciatic foramen. The obturator membrane closes the thyroid foramen, except at the upper and outer part, where a canal is left for the obturator vessels and nerve. Gemellus superior : outer surface of ischial spine(F) superior border of great trochanter anterior to the pyriformis with obturator internus(x) (Sacral plexus). [Rotates thigh outwards.] Gemellus inferior : superior and outer border of tuber ischii (F) superior border of great trochanter with obturator in- ternus(T) (Sacral plexus). [Rotates thigh outwards.] Obturator externus : anterior half of outer surface of obtu- rator membrane, rami of pubis and ischium(F) digital fossa at root of great trochanter(x) (Posterior division of obturator). [Rotates thigh outwards.] Quadratus femoris : external border of tuber ischii(F) tubercle on posterior inter-trochanteric ridge, and downwards as far as insertion of adductor magnus(p) (Sacral plexus). [External rotator and adductor of thigh.] POSTERIOR FEMORAL REGION. Biceps : Long head. Lower and inner impression on tuber ischii, and great sacro-sciatic ligament(T). Short head. Outer lip of linea aspera in the lower half, upper part of line to ex- ternal condyle, external inter-muscular septum(F) by two slips embracing the external lateral ligament upon the outer side of head of fibula(T) (Great sciatic). [Flexes knee and extends thigh, rotates leg outwards.] Forms outer hamstring. Semi-tendinosus : lower and inner impression on tuber ischii with the biceps(x), tendon of biceps(p) upper part of internal surface of tibia, under cover of the sartorius(x) (Great sciatic). [Extends thigh, flexes knee, and rotates leg inwards.] Semi-membranosus : upper and outer impression on the tuber ischii(x) (i) hinder part of lower lip of groove on internal tibial tuberosity(x) beneath internal lateral ligament (2) forms principal part of posterior ligament of knee (3) into fascia over popliteus (Great sciatic). [Extends thigh, flexes knee, and rotates leg inwards.] MUSCLES 55 ANTERIOR TIBIO-FIBULAR REGION. Tibialis anticus : external tuberosity and upper of external surface of shaft of tibia, contiguous interosseous membrane, fascia and intermuscular septum (F) inner surface of internal cuneiform ; base of metatarsal bone of great toe(r) (Anterior tibial). [Flexes ankle and extends tarsal joints, adducts and inverts foot.] Passes through innermost compartment of anterior annular ligament. Outer border conceals anterior tibial vessels. Extensor proprius hallucis : middle f of anterior surface of shaft of fibula, contiguous interosseous membrane(F) base of last phalanx of great toe(x) (Anterior tibial). [Flexes ankle, extends tarsal joints and great toe.] Anterior tibial vessels lie on the inner side, but the tendon crosses to inner side of vessels under anterior annular ligament. Extensor longus digitorum : external tuberosity of tibia, head and upper of anterior surface of shaft of fibula, inter- osseous membrane(F) by four tendons into the middle and last phalanges of four outer toes(x) (Anterior tibial). [Flexes ankle, extends joints of tarsus and toes.] Peroneus tertius : lower of anterior surface of shaft of fibula, interosseous membrane, intermuscular septum(F) base of 5th metatarsal on dorsal surface(x) (Anterior tibial). [Flexes ankle and extends tarsal joints, everting the foot.] POSTERIOR TIBIO-FIBULAR REGION, SUPERFICIAL LAYER. Gastrocnemius : Inner head. Impression on upper and posterior part of. inner condyle(T), line above condyle(F). Outer head. Impression on external surface of outer con- dyle(x), upper and posterior part of condyle(F) unites with tendon of soleus to form tendo Achillis, inserted into lower half of posterior surface of os calcis(T) (Internal popliteal). [Flexes knee and extends ankle.] Soleus : posterior surface of head, and upper J of posterior surface of shaft of fibula, oblique line and middle of internal border of tibia, fibrous arch over vessels(A) tendo Achillis (Internal popliteal and posterior tibial). [Extends ankle.] Posterior tibial vessels and nerve lie beneath. Plantaris : line above outer condyle, posterior ligament of knee-joint(F) tuber calcis, with or by inner side of tendo Achillis(x) (Internal popliteal). [Flexes knee and extends ankle.] Tendon, longest in body. 56 THE POCKET ANATOMY POSTERIOR TIBIO-FIBULAR REGION, DEEP LAYER. The FASCIA of the leg invests the limb except where the inner surface of the tibia is subcutaneous ; it is continuous above with the fascia lata of the thigh, and below with the annular ligaments of the ankle, being attached in front to the anterior and inner borders of the tibia, and to the antero- and postero-external borders of the fibula, forming inter- muscular septa. Popliteus : anterior half of impression on external surface of outer condyle(T), posterior ligament of knee-joint(p) triangular space on posterior surface of shaft of tibia above oblique line(p) (Internal popliteal). [Flexes knee and rotates leg inwards.] Forms floor of popliteal stace ; arises in capsule of joint but outside synovial membrane. Flexor longus hallucis : lower of posterior surface of shaft of fibula, intermuscular septum (F) base of last phalanx of great toe(x) (Posterior tibial). [Extends ankle, flexes tarsal joints and joints of great toe.] Grooves astragalus. Flexor longus digitomm : inner part of posterior surface of shaft of tibia, from oblique line to 3 inches from lower end, aponeurosis over tibialis posticus(F) four tendons, joined by flexor accessorius, passing through slits in tendons of flexor brevis digitorum, to bases of last phalanges of four outer toes (T) (Posterior tibial). [Extends ankle, flexes joints of tarsus and four outer toes.] Tibialis posticus : posterior surface of interosseous mem- brane except below, and aponeurosis superficial to muscle, external part of posterior surface of tibia from head to 2 inches from lower end, internal surface of shaft of fibula(r) tubercle on scaphoid bone, slips to cuneiform, cuboid, bases of and, 3rd, and 4th metatarsals, and sustentaculum tali(T) (Posterior tibial). [Extends ankle, flexes and supports tarsal joints, inverts foot.] FIBULAR REGION. Peroneus longus : upper | external surface of shaft of fibula, fascia, intermuscu lar septum(p) outer part of plantar sur face of internal cuneiform and of base of ist metatarsal(T ) (Musculo-cutaneous). [Extends ankle-joint and everts foot.] Winds round grooves behind external malleolus and outer border of cuboid bone. Peroneus brevis : lower $ external surface shaft of fibula, intermuscular septum(F) projection at base of 5th meta- tarsal(x) (Musculo-cutaneous). [Extends ankle-joint and everts foot.] MUSCLES 57 THE ANTERIOR ANNULAR LIGAMENT consists of two parts. A superior or vertical part, attached to the anterior border of the tibia internally, and to the anterior border of the fibula externally, being continuous above with the fascia of the leg, and divided into two compartments, the internal one for the tibialis anticus tendon, which alone has a synovial sheath, the outer one for the extensor longus digitorum and peroneus tertius tendons. An inferior or horizontal part, which is attached externally to the upper surface of the os calcis, passes inwards across the foot and divides, the upper band being attached to the inner malleolus, the lower to the fascia over the foot. It contains three compartments, with separate synovial sacs, the internal one for the tibialis anticus tendon, the middle one for the extensor proprius hallucis tendon, and the external one for the extensor longus digitorum and peroneus tertius tendons. THE INTERNAL ANNULAR LIGAMENT passes between the inner malleolus and the inner margin of the os calcis, being continuous above with the deep fascia, and below with the plantar fascia. It is divided into three compartments. The one next the malleolus transmits the tibialis posticus tendon, the next one the flexor longus digitorum, and the lowest, on the astragalus, the flexor longus hallucis. Between these last two canals the posterior tibial vessels and nerve pass under the ligament. THE EXTERNAL ANNULAR LIGAMENT passes from the outer malleolus to the os calcis, binding down the peronei tendons. THE PLANTAR FASCIA consists of a central and two lateral parts. The inner part covers the abductor hallucis, and is con- tinuous with the dorsal fascia. The outer part covers the abductor minimi digiti, and ex- tends from the external tubercle of the os calcis to the base of the 5th metatarsal. The central part is attached behind to the internal tubercle of the os calcis, and, extending forwards, splits up into five parts at the heads of the metatarsal bones, one part passing to each of the toes. FOOT, DORSAL REGION. Extensor brevis digitorum : superior surface of os calcis in front of groove, anterior annular ligament(F) four tendons, inner one to base of ist phalanx of great toe, rest to outer side of tendons of long extensor to 2nd, 3rd, and 4th toes(T) 58 THE POCKET ANATOMY (Anterior tibial). [Extends toes and flexes tarsal joints.] Inner tendon crosses dorsalis pedis artery. FOOT, PLANTAR REGION, 1ST LAYER. Abductor hallucis : inner side of large tubercle on under surface of os calcis, plantar fasci-a, internal annular ligament (p)--inner side of base of ist phalanx of great toe(-r) (Internal plantar). [Abducts great toe.] Flexor brevis digitorum : front part of inner tubercle of os calcis(T), plantar fascia(F), intermuscular septa(p) four tendons, which on the ist phalanx divide into two, allowing long flexor tendons to pass through ; the slips then reunite and are inserted, again separating, into the sides of the bases to middle phalanges of four outer toes(T) (Internal plantar) [Flexes tarsal joints and first interphalangeal joint of toes.] Abductor minimi digiti: outer tubercle and fore part of inner tubercle of os calcis, plantar fascia, intermuscular septa(r) outer side of base of ist phalanx of little toe (External plantar). [Abducts little toe.] - FOOT, PLANTAR REGION, 2ND LAYER. Flexor accessorius : Inner head. Inner concave surface of os calcis(p). Outer head. Outer surface of os calcis in front of outer tubercle, long plantar ligament (T) long flexor t-ndons(p) (External plantar). [Flexes toes, correcting obliquity of pull of the flexor longus digitorum.] Lumbricales : long flexor tendons, from adjacent sides of two tendons, except most internal one, which arises from inner side of ist flexor tendon (F) inner sides of bases of ist phalanx of four outer toes, and dorsal expansion of extensor tendon(T) (Internal plantar, ist ; External plantar, 2nd, 3rd, and 4th). [Flex metatarso-phalangeal and extend inter- phalangeal joints.] FOOT, PLANTAR REGION, 3RD LAYER. Flexor brevis hallucis: internal border of cuboid and adjacent part of external cuneiform(T), tendon of tibialis posticus(T) outer and inner sides of base of ist phalanx of great toe(T) (Internal plantar). [Flexes great toe and adducts it to middle line of foot.] Adductor obliquus hallucis ; bases of 2nd, 3rd, and 4th metatarsals, sheath of peroneus longus(p) outer side of base of ist phalanx of great toe(T) (External plantar). [Adducts great toe.] Adductor transversus pollicis : capsules of metatarso- ARTERIES 59 phalangeal joints of three outer toes(p) outer side of base of ist phalanx of great toe (x) (External plantar). [Binds toes together and adducts great toe.] Flexor brevis minimi digiti : base of 5th metatarsal, sheath of peroneus longus(p) outer side of base of ist phalanx of little toe(T) (External plantar). [Flexes metatarso-phalangeal joint of the little toe.] FOOT, PLANTAR AND DORSAL INTEROSSEOUS REGION. Interossei dorsales (4) : by two heads from adjacent sides of metatarsal bones(p) side of and dorsal extensor expansion on tst phalanx thus : the inner two go to and toe, one on each side, outer two to outer sides of 3rd and 4th toes respec- tively^) (External plantar). [Abduct from middle line of 2nd toe.] Interossei plantares (3) : under and inner surfaces of three outer metatarsal bones(p) inner side of base of ist phalanx of same toes(T), and dorsal expansion on ist phalanx(T) (External plantar). [Adduct to middle line of 2nd toe.] THE ARTERIES. ARTERIES OF HEAD AND NECK. THE SUBCLAVIAN ARTERIES. Extent : Right, from innomi- nate opposite right sterno-clavicular articulation. Left, from transverse part of arch of aorta. Both pass into neck, arching outwards over pleura; lying on first rib, between scalenus anticus and medius, to end at outer border of it. Divisions : The scalenus anticus, passing anteriorly to artery, 'is 'used to divide it into three parts, viz. : ist part, from origin of vessel to inner border of scalenus anticus. 2nd part, portion posterior to scalenus anticus. 3rd part, from outer edge of scalenus to external border of ist rib. 5o THE POCKET ANATOMY RELATIONS OF THE 1ST PART OF THE RIGHT SUBCLAVIAN. In Front. Below. Behind. Skin. Internal ju- Pleura. Pleura. Superficial fascia. Platysma. Deep fascia. gular Vertebral Anterior ju- 5 Rscurrent laryn- Recurrent \ 3 geal nerve. laryngeal > and cardiac Sterno-mas- > ,- gular branches of toid JJ Sterno-hyoid V Pneumogas- tric vagus. Sympathetic Sterno-thy- 1 4j Sympathetic u5 loop with roid ) loop and . > lower Below and in superior cervical u cardiac ^ branches. / Front. cardiac Longus colli Subclavian ^ rf Commence- 1 c mentofin- f'% branch. muscle. nominate J RELATIONS OF 1ST PART OF LEFT SUBCLAVIAN. In Front. Inner Side. Behind. Skin. Superficial fascia. Manubrium Anterior ju- " gular Internal ju- Left carotid. Trachea. (Esophagus. Longus colli. (Esophagus. Thoracic duct sterni. gular Thoracic duct (below). Platysma. Left innomi- > Pneumogastric. Inferior cervical Deep fascia. nate Lower cardiac ganglion. Sterno-mas- ^ . Vertebral branches of Cord of sympa- toid JJ Sterno-hyoid V " Left phrenic " Left vagus i sympathetic. Left recurrent thetic. Pleura. Sterno-thy- I M roid J * Sympathetic loop % laryngeal nerve. Outer Side and Left common Thoracic duct Behind. carotid artery. (above). Left lung. Pleura. RELATIONS OF 2ND PART OF SUBCLAVIAN. In Front. Behind. Below Skin. Subclavian vein Pleura and lung. Pleura. Superficial fascia. Platysma. Deep fascia. (below level). Phrenic nerve (on right side). Above. Brachial plexus. Sterno-mas- ^ ^ toid (clavi- 1 J" cular origin) V & Scalenus anti- 1 ARTERIES 61 RELATIONS OF 3RD PART OF SUBCLAVIAN. Contained in subclavian triangle, and enclosed in tube 01 deep cervical fascia. lit Front. Below. Skin. Supra-scapular artery. ist rib. Superficial fascia. Clavicle. Descending cutaneous Subclavius. tientnd. branches of cervical Nerve to subclavius. Scalenus medius. plexus. Lowest bracliial Platysma. Above. aerve trunk. Deep fascia. Brachial plexus. External jugular - Subclavian Branch from cephalic to external jugular Supra-scapular Transverse cervical Anterior jugular BRANCHES FROM THE IST PART. VERTEBRAL : from upper and back part. Passes upwards and backwards, behind inferior thyroid artery and internal jugular and vertebral veins, then between scalenus anticus and longus colli, to enter foramen in transverse process of 6th cervical vertebra. Ascends in corresponding foramina as far as axis, having vertebral vein in front, and cervical nerves behind. It then passes outwards and upwards, through foramen in atlas, and winds backwards and inwards in verte- bral groove of atlas, lying on the floor of the suboccipital triangle, having the trunk of the ist cervical nerve beneath it, and the posterior branch of same nerve crossing it behind. It pierces posterior occipito-atloid ligament and dura mater, and enters skull through foramen magnum. It then winds round bulb, passing between hypoglossal and anterior root of ist cervical nerve to front of medulla, uniting with fellow, to form the basilar artery (p. 73), at the lower border of the pons. Cervical Branches : Lateral spinal : each enters spinal canal through an inter- vertebral foramen, dividing into posterior to supply cord and membranes, and anterior to supply bodies of vertebrae. Muscular : to deep cervical muscles. Cranial Branches : Posterior meningeal : arises before vertebral pierces dura mater opposite foramen magnum, to falx cerebelli. and dura in posterior fossa 62 THE POCKET ANATOMY Posterior spinal : arises opposite posterior part of medulla, passes down back of cord behind roots of nerves, anasto- mising with spinal branches coming through intervertebral foramina. Anterior spinal : given off near end of artery, descends in front of medulla, unites with opposite fellow just below fora- men magnum to form a single artery, which is continued along the cord, anastomosing like the posterior artery ; sup- plies pia mater and cord. Posterior inferior cerebellar : arising near pons, passes backwards and outwards between roots of hypoglossal and then between spinal accessory and pneumogastric nerves, to reach under surface of cerebellum ; divides into two branches, one continuing backwards in sulcus between two hemispheres, the other outwards to supply under surface of cerebellum ; anas, superior cerebellar. Supplies hemisphere, vermiform process, and choroid plexus of 4th ventricle. Bulbar arteries enter medulla. THYROID AXIS : a short thick trunk from front of artery near scalenus anticus, quickly dividing into : Inferior thyroid : passes upwards on vertebral artery and under internal jugular vein ; then inwards and downwards behind sheath of carotid and sympathetic (middle cervical ganglion), finally outwards and upwards to under part of thy- roid body ; anas, opposite fellow and superior thyroid. Branches : Ascending cervical: arises as inferior thyroid turns behind carotid sheath, ascends parallel to phrenic nerve and between scalenus anticus and rectus anticus major, supplying them, the cord and its membranes. Inferior laryngeal : upwards on trachea to back of larynx, with recurrent laryngeal nerve. Tracheal : to trachea ; anas, bronchial. CEsophageal : to supply resophagus. Thyroid : to gland. Muscular. Supra- scapular : runs downwards at first, over scalenus anticus and phrenic nerve, crosses 3rd part of subclavian, then runs transversely outwards, behind and parallel to clavicle, to upper edge of scapula under cover of trapezius ; inclining downwards with nerve to pass over transverse liga- ment on supra-scapular notch, enters supra-spinous fossa in contact with the bone beneath supra-spinatus, which it sup- plies. It then winds over neck of scapula to infra-spinous fossa ; anas, with posterior scapular and dorsalis scapulae. ARTERIES 63 Branches : Muscular: to neighbouring muscles, ^ecially sterno- mastoid. Supra-acromial : through trapezius to acromion ; anas, acro- mio-thoracic. Subscapular : arises as suprascapular passes over notch ; anas, in subscapular fossa with posterior scapular and sub- scapular of axillary. Injra-spinous : descends on neck of scapula to fossa ; anas. dorsal of subscapular and posterior scapular. Articular: to shoulder-joint. Nutrient: to scapula. Transverse cervical : over scaleni muscles, phrenic nerve, and brachial plexus, under omohyoid, to outer edge of levator anguli scapulae, there dividing into : Superficial cervical : ascends beneath anterior edge of tra- pezius, supplying it together with glands, integuments and muscles of that region ; anas, superficial branch of arteria princeps cervicis. Posterior scapular : backwards to superior angle of scapula beneath levator anguli scapula?, then downwards along verte- bral border of scapula under the rhomboids supplying sur- rounding muscles ; anas, supra-scapular, subscapular. INTERNAL MAMMARY: from under surface of suDclavian just below thyroid axis, runs down behind clavicle and subclavian vein to posterior surface of ist costal cartilage, being crossed here by phrenic nerve; downwards between pleura and costal cartilages, crossed by intercostal nerves and lying on tri- angularis sterni as far as the 6th space, there dividing into two terminal branches. Branches : Comes nervi phrenici (superior phrenic) : arises high in chest, accompanies phrenic nerve between pleura and pericardium to diaphragm, supplying it; anas, musculo-phrenic, inferior phrenic. Mediastinal : to areolar tissue of anterior mediastinum and thymus gland. Pericardiac : to upper part of pericardium. Sternal : to triangularis sterni and sternum. A nterior Intercostal : to upper five or six intercostal spaces, two in each space ; anastomose with aortic intercostal. Perforating : perforate upper five or six intercostal spaces to supply pectoral muscles and mammary gland. Musculo-phrenic : external of two terminal branches per forates diaphragm about gth intercostal space, supplying dia- phragm, and branches to lower intercostal spaces. <>4 THE POCKET ANATOMY Superior epigastric : internal terminal branch passes behind yth costal cartilage and pierces diaphragm, lies posterior to rectus within the sheath, terminating in that muscle; anas. deep epigastric of external iliac. BRANCH FROM THE 2ND PART. SUPERIOR INTERCOSTAL : from upper and back part behind scalenus anticus, bends backwards over pleural dome in front of neck of ist rib to ist and 2nd intercostal spaces, supplies small branches to cord and deep spinal muscles. On the neck of the ist rib, the ist intercostal nerve is external, and ist thoracic ganglion of sympathetic, internal to artery. Branch : Deep cervical : corresponds to posterior branch of an aortic intercostal ; passes between transverse process of yth cervical vertebra and ist rib, ascending beneath complexus to axis ; anas, vertebral, and deep branch of arteria princeps cervicis of occipital. THE COMMON CAROTID ARTERY. THE COMMON CAROTID ARTERY : On the right side, arises from the innominate, at its bifurcation behind the right sterno-clavicular articulation. On the left side, from the highest or transverse part of aortic arch, and is consequently longer than the right artery, and more deeply placed in the thorax at its origin. It ascends obliquely to the neck. Relations of the Left Common Carotid in the Thorax. In Front. Behind. Left Side. Skin. Superficial fascia. Deep fascia. Part of pectoralis Sterno-hyoid and Sterno-thyroid muscles. Left innominate Trachea. (Esophagus. Thoracic duct. Left recurrent Left subclavian artery. Left pneuraogas- tric and phrenic major, ist piece of ster- vein. Thymus gland. laryngeal nerve. nerves. Left pleura and num. Right Side. lung. Innominate artery. Extent. In the neck the common carotid of either side ex- tends from sterno-clavicular articulation to opposite upper border of thyroid cartilage, there dividing into external and internal carotids. Course. A line drawn from sterno-clavicular articulation, to point midway between mastoid process ajad angle of irA- tprior maxilla. ARTERIES Relations of both Common Carotids in the Neck. Crossed about midway by omo-hyoid, and enclosed in same sheath of deep cervical fascia as internal jugular vein and pneumogastric nerve. Part below Superior Border of Omo-hyoid. In Front. Behind. Inner Side. Skin. Internal ju- "" Scalenus anticus. Trachea. Superficial fascia. Platysma. Deep fascia. gular (over- laps on left side) Longus colli. Inferior thyroid 5 artery. CEsophagus. Recurrent laryn- geal nerve. Sterno-mas- \ ioid (sternal J ^ origin) 1 , Sterno-hyoid V Sterno-thy- ,5 roid 1 ^ Superior and middle thy- roid Anterior ju- gular j Descendens and >- Vertebral artery. > Sympathetic ~\ . Recurrent 1 $ laryngeal v fc Pneumogas- j trie Thyroid body. Superior thyroid artery. Omo-hyoid / communicans hypoglossi. Outer Sid*. Internal jugular. Pneumogastric. Behind. Rectus capitis anticns major. Pneumogastric nerve. Sympathetic ,, Inntr Side. Larynx. Pharynx. Superior thyroid artery. Outer Side. | Internal jugular. Part above Omo-hyoid. In Front. Platysma. Deep fascia. Sterno-mastoid. Dcendens hypo- glossi. Sterno-mastoid branch of superior thyroid. BRANCHES of the Common Carotid Artery. Terminal only, viz., external and internal carotid. EXTERNAL CAROTID. Extent. From bifurcation of com- mon carotid opposite upper border of thyroid cartilage, to level of neck of condyle of inferior maxilla, there dividing into superficial temporal and internal maxillary. Course. Line of artery same as common carotid. RELATIONS. Superficial. Behind. Inner Sidt. Skin. Facial \ Pharynx. Pharynx. Superficial fascia. Platysma. Deep fascia. Sterno-mas- ~\ j toid ha Digastric J 3 Stylo-hyoid J 3 Lingual Temporo- maxillary Hyp^glossal \l h Styloid process. Stylo-glossus. Stylo-pharyn- geus. Glosso-pharyn- geal nerve Internal carotid Ramus of jaw. Stylo-maxillary ligament. Parotid gland. Superior ^j .% laryngeal I External j !j Parotid gland- artery. laryngeal J f 5 66 THE POCKET ANATOMY Anterior Branches of External Carotid. Superior thyroid : given off just below great cornu of hyoid, curves downwards and forwards to thyroid body ; anas, fellow of opposite side, inferior thyroid. Branches : Muscular: to muscles covering it. Sterna -mastoid branch passes downwards and outwards across sheath of common carotid, supplying sterno-mastoid and integument. Infra hyoid : runs transversely inwards, along inferior border of hyoid ; anas, with opposite fellow. Superior laryngeal : accompanies superior laryngeal nerve, pierceo thyro-hyoid membrane, supplies muscles, glands, and mucous membrane of larynx ; anas, opposite fellow. Crico-thyroid : crosses crico-thyroid membrane transversely , anas, opposite fellow. Thyroid : to upper and anterior part of gland. Lingual : arises from anterior part of artery between superior thyroid and facial arteries, curves upwards and forwards on middle constrictor to tip of great cornu of hyoid, where it is crossed by hypoglossal nerve, thence forwards under hyo- glossus muscle, digastric and stylo-hyoid, parallel with hypo- glossal nerve, finally on genio-hyo-glossus upwards and for- wards to tip of tongue as ranine. Branches : Supra-hyoid : along superior border of hyoid, supplying muscles, etc. ; anas, opposite fellow. Dorsalis lingua: ascends to dorsum of tongue; anas, oppo- site fellow, supplies mucous membrane, tonsil, epiglottis, soft palate, etc. Sublingtial : runs forwards and outwards to supply sub- lingual gland, adjacent muscles and mucous membrane. Ranine : continuation of the lingual to tip of tongue, accom- panies gustatory nerve ; anas, opposite fellow. Facial : arises near angle of inferior maxilla, directed for- wards and upwards beneath digastric and stylo-hyoid muscles in groove on deep surface of submaxillary gland to base of lower jaw, over which it ascends to face, being anterior tc masseter muscle ; ascending to inner canthus, imbedded in levator labii superioris alaeque nasi, where it takes name of angular, it rests successively upon lower jaw, buccinator, and levator anguli oris, with vein to outer side, and crossed by platysma, risorius, zygomaticus major, and sometimes by the levator labii superioris ; anas, ophthalmic ARTERIES 67 Cervical Branches : Ascending or inferior palatine : between stylo-glossus and stylo-pharyngeus to pharynx near border of internal ptery- goid muscle ; after supplying muscles, tonsil, Eustachian tube, divides near levator palati into two branches, one going to supply soft palate, glands, etc. , the other to tonsil ; anas. tonsillar and artery of opposite side. Tonsillar : penetrates superior constrictor of pharynx to supply tonsil and root of tongue; anas, ascending palatine. Submaxillary (three or four) to supply submaxillary gland. Submental : arises as artery turns round base of jaw, and runs forwards over mylo-hyoid, supplying it and digastric, then to symphysis, there dividing into superficial, which turns round chin ; anas, inferior labial and mental, and a deep branch perforates mylo-hyoid, supplying deep muscles ; anas. sublingual. Facial Branches : Muscular : to masseter, buccinator, etc. Inferior labial : runs beneath depressor anguli oris, to supply lower lip ; anas, inferior coronary, submental, mental. Inferior coronary : arises near angle of mouth, tortuous course between mucous membrane of lower lip and orbicularis oris ; anastomoses with opposite fellow. Superior coronary : arises with or near preceding, having corresponding course in upper lip ; anastomoses with opposite fellow, supplies a branch, artery of septum, to collu- mella of nose. Lateral nasal : turns inwards beneath levator labii superioris alaeque nasi to supply ala and dorsum of nose ; anas, opposite fellow, nasal of ophthalmic, and infra-orbital. Angular: terminal branch; anastomoses at inner canthus with nasal of ophthalmic. Posterior Branches of External Carotid : Occipital : arising from the posterior part of artery, about opposite the facial, runs upwards and backwards beneath digastric, stylo-hyoid, sterno-mastoid, splenius, and trachelo- mastoid to interval between transverse process of atlas and mastoid process, then backwards in the occipital groove, and lying on rectus capitis lateralis, superior oblique and com- plexus ; lastly, piercing the trapezius near insertion, it ascends in company with the great occipital nerve to the back of scalp. Hypoglo^al nerve hooks round it at origin, and the artery crosses in the neck the internal carotid artery, pneumogastric and spinal accessory nerves and internal jugular vein. 52 68 THE POCKET ANATOMY Branches : Muscular to digastric, stylo-hyoid ; stcrno-mastoid branch to supply that muscle. Mastoid : through mastoid foramen to dura mater. Posterior meningeal: ascends, in company with internal jugular vein, through jugular foramen to dura mater in posterior fossa. Cervical (ramus princess cervicis) : at outer border of corn- plexus ; descends at back of neck ; superficial branch passes beneath splenius, supplying it and the trapezius, anas. superficial cervical ; deep branch, goes beneath complexus, anas, vertebral, deep cervical of superior intercostal. Cranial : to muscles and integuments of occiput ; anas. opposite fellow, posterior auricular and superficial tem- poral. Posterior auricular : arises opposite apex of styloid process, ascends in parotid to groove between pinna and mastoid pro- cess, dividing into anterior or auricular, anas, posterior division of temporal ; and. posterior or mastoid, anas, occipital. Joined near mastoid process by posterior auricular branch of the 7th nerve. Branches : Stylo-mastoid : enters stylo-mastoid foramen, supplying tym- panum, mastoid cells, etc. Auricular : to posterior part of concha. Ascending branch of External Carotid : Ascending Pharyngeal : smallest branch, arising half an inch above origin of trunk, ascends between internal carotid and pharynx to base of skull. Branches : Prevertebral : to rectus anticus, ist cervical ganglion, and gth, loth and nth nerves, glands, etc. Pharyngeal (three or four) : inwards to pharynx, supplying constrictors, Eustachian tube, and a palatine branch to soft palate and tonsil. Meningeal : one through foramen jugulare, another through anterior condylar foramen, and a third through foramen lacerum medium to supply dura mater. Terminal Branches of External Carotid : Superficial temporal : smaller of two terminal branches, continues in the line of external carotid. Imbedded at first in parotid, crosses over root of zygoma in -front of auriculo- temporal nerve, upwards under skin fora inches, dividing intq two terminal branches. ARTERIES 69 Branches : Parotid to gland. Transverse facial : arises in parotid, accompanies transverse branches of facial nerve and parotid duct across face, lies above the duct, supplying muscles, glands, etc. ; anas, facial, infra-orbital. Middle temporal : arises just above zygoma, perforates tem- poral fascia, supplying muscle ; anas, deep temporal. Orbital (may come from middle temporal) : along zygoma between layers of temporal fascia to outer can thus. Anterior auricular : to anterior portion of external ear ; anas. posterior auricular. A nterior temporal : one of terminal branches, ascends over tero - poralfascia, supplying muscles, etc.; anas, frontal, supra- orbital. Posterior temporal: curves backwards over temporal fascia and inosculates with opposite fellow; anas, posterior auricular, occipital. Internal maxillary : larger of terminal branches, arises in parotid, at first (maxillary portion) curving forwards between jaw and internal lateral ligament, parallel with auriculo- temporal nerve and lying on internal pterygoid muscle and inferior dental nerve, then (pterygoid portion) forwards and outwards on outer (frequently on inner) surface of lower head of external pterygoid, finally (spheno - maxillary portion) enters spheno-maxillary fossa between two heads of origin of external pterygoid. Branches from Maxillary portion : Tympanic : enters Glaserian fissure, supplies tympanum, and membrana tympani, generally gives off deep auricular to external auditory meatus ; anas, vidian, stylo-mastoid. (May come from middle meningeal.) Middle or great meningeal : arises between internal lateral ligament and neck of conclyle, passes between two roots of auriculo-temporal nerve, through foramen spinosum of the sphenoid, dividing on great wing of sphenoid into anterior and posterior branches ; anterior going to anterior inferior angle of parietal, posterior to squamous of temporal ; anas, opposite fellow, anterior and posterior meningeal. The trunk of the artery gives off Gasserian, to ganglion. Petrosal : enters hiatus Fallopii ; anas, stylo-mastoid of posterior auricular. Orbital : through sphenoidal fissure to orbit. Temporal : through foramen in bone to join branches from deep temporal. Small meningeal : through foramen ovale, supplies Gasserian ganglion and dura mater. (Generally a branch of the middle meningeal.) 7 o THE POCKET ANATOMY Inferior dental: descends with and behind inferior dental nerve through dental foramen on inner side of ramus of inferior maxilla, divides opposite ist bicuspid into incisor and mental, the former going to incisor teeth ; anas, opposite fellow : the latter comes out through mental foramen ; anas. sub-mental, inferior labial, inferior coronary. Mylo-hyoid branch given off as artery enters dental foramen, runs in mylo- hyoid groove to muscle. Lingual branch accompanies lingual nerve. Branches from Pterygoid portion : Deep temporal (2) : anterior and posterior to temporal fossa between muscle and cranium ; anas, other temporal, lachrymal through foramina in malar bone. Pterygoid : to pterygoid muscles. Masseteric : passes over sigmoid notch to deep surface of masseter ; also supplies temporo-maxillary articulation. Buccal: runs forward with buccal nerve between internal pterygoid and jaw to buccinator; anas, facial. Branches of Spheno-M axillary Portion : Posterior superior dental, or alveolar : given off as artery passes into spheno-maxillary fossa ; descends on posterior aspect of maxilla with branch of superior maxillary nerve, enters posterior dental canals, supplying molars, bicuspids, antrum, gums, etc. Infra-orbital: continuation of trunk, accompanies superior maxillary nerve through infra-orbital canal, appearing on face beneath levator labii superioris ; anas, facial and buccal. In the canal it gives off branches to orbit, and an anterior dental branch goes with nerve to supply front teeth ; anas. posterior dental. On the face it supplies lachrymal sac and inner canthus ; anas, ophthalmic ; and gives branches down- wards ; anas, transverse facial, buccal and facial. Descending, or superior palatine : through posterior palatine canal with large palatine nerve, along hard palate, and through foramen of Stenson in anterior palatine fossa ; anas. artery of septum from facial and naso-palatine. Vidian : through vidian canal with nerve, supplies Eusta- chian tube and tympanum. Pterygo-palatine : backwards through pterygo-palatine canal with pharyngeal nerve to upper part of pharynx. Nasal, or spheno-palatine : enters spheno-palatine foramen, supplying posterior ethmoidal cells, etc. Branch. Naso-pala- tine or artery of septum, runs along vomer; anas, descending palatine. INTERNAL CAROTID. Extent. From superior border of ARTERIES 71 thyroid cartilage to Sylvian fissure of brain, there dividing into anterior and middle cerebral. Course. Extends directly upwards from common carotid to carotid canal of temporal bone ; entering canal passes upwards, internal to and then above Eustachian tube, then forwards and inwards, then alongside of sella Turcica in the cavernous sinus, having the 6th nerve on the outer side ; it turns upwards on inner side of anterior clinoid process, pierces dura mater, and divides between and and 3rd cranial nerves at anterior perforated spot into branches. No branches given off from cervical part. RELATIONS IN THE NECK. Superficial. Inner Side. Behind. Skin. Pharynx. Internal jugular veil . Superficial fascia. Ascending pharyngeal Rectus capitis anticus Platysma. artery. major. Deep fascia. Superior and external Sympathetic. Sterno-mastoid. laryngeal nerves. Pneumogastric. Parotid gland. External carotid. Digastric. Stylo-hyoid. Stylo-glossus. Stylo-pharyngeus. Occipital ) .,,**- Posterior auricular J ar1 Hypoglossal \ Glosso-pharyngeal l_-___ Pharyngeal branch f ne of vagus J Outer Side. Internal jugular vein. Branch from Petrous portion : Tympanic : inconstant : through a foramen in carotid canal to tympanum ; anas, tympanic of internal maxillary and stylo- mastoid. Branches from Cavernous portion : Pituitary : small branches to pituitary body, etc. Meningeal : to dura mater in middle fossa. Ophthalmic : arises at inner side of anterior clinoid process, enters orbit through optic foramen, external and below optic nerve ; it then crosses over nerve to inner angle of orbit to divide into two terminal branches, frontal and nasal. Branches arising outside Optic Nerve : Lachrymal : accompanies lachrymal nerve over external rectus to lachrymal gland, gives off malar branches ; anas. 72 THE POCKET ANATOMY deep temporal and transverse facial. Branch sent back to anas, middle meningeal through sphenoid fissure Central of retina : pierces optic nerve, runs in its substance to retina (vide Eye) . Branches arising over Optic Nerve : Posterior ciliary : divided into two sets. Short (10) perforate sclerotic and supply choroid. Long (2) pass forward between choroid and sclerotic; anas, anterior ciliary and supply iris and ciliary processes. Supra-orbital : ascends with frontal nerve over muscles, etc., to supra-orbital foramen ; passing out, ascends over frontal bone ; anas, temporal, facial and frontal. Branches arising internal to Optic Nerve : Muscular, superior and inferior : to muscles of orbit, give off anterior ciliary (6-8), which pierce sclerotic behind cornea. Ethmoidal : anterior and posterior to ethmoidal cells, through anterior and posterior internal orbital canals respectively, supplying also dura mater, the anterior accompanying nasal nerve to skin of nose (anterior nasal branch). Palpebral (2) : one for each lid, arise near pulley, form an arch in each lid, and supply lachrymal apparatus. Terminal Branches : Frontal : turns upwards round inner margin of orbit ; anas. supra-orbital. Nasal : over tendo oculi to root of nose ; anas, nasal and angular of facial. Branches from Cerebral Portion of Internal Carotid : Anterior cerebral : arises at inner extremity of fissure of Sylvius, passes forwards in great longitudinal fissure. Oppo- site arteries united by anterior communicating. It then curves round fore part of corpus callosum, supplying offsets to corpus callosum, frontal and parieto-occipital sulci, and to anterior perforated spot. Middle cerebral: largest offset, enters fissure of Sylvius, dividing into branches for external surface of hemisphere, and interior of brain, the latter entering anterior perforated spot. Internal branches: Caudate, thalamic, and lenticulo- striate. External branches: Frontal, parietal, parieto-tem- poral, and temporal. Posterior communicating: from posterior part of artery, runs backwards ; anas, posterior cerebral of basilar. Anterior choroid : from back part of artery, passes backwards and outwards to enter descending horn of lateral ventricle, just beneath edge of middle lobe ; supplies ARTERIES 73 hippocampus major, corpus fimbriatum, and choroid plexus. THE BASILAR ARTERY : formed by union of the two ver- tebral arteries. Extent, from lower to upper border of pons, there dividing into posterior cerebrals. Branches : Transverse (4 or 6) : twigs to supply pons and internal auditory, an offset to internal ear, with auditory nerve. Anterior inferior cerebellar : backwards to anterior part of inferior surface of cerebellum ; anas, posterior inferior cere- bellar of vertebral. Superior cerebellar: arises near termination, to upper surface of cerebellum, winding round crus cerebri behind 3rd nerve ; anas, opposite fellow, inferior cerebellar. Posterior cerebral (2) : one on each side, terminal of basilar, winds backwards round crus in front of 3rd nerve, passes upwards to under surface of posterior cerebral lobes, joined near crus by posterior communicating, and gives off : Postero- median to posterior perforated spot ; Posterior choroid to choroid plexus through transverse fissure ; Postero-lateral to optic thalamus ; Cortical branches : temporal, calcarine, parieto- occipital ; anas, anterior and middle cerebral. CIRCLE OF WILLIS : a name given to the anastomoses between the vertebral and internal carotid arteries at base of brain. The internal carotid sends forward the anterior cerebrals, which are connected by the anterior communi- cating. The basilar sends forwards the posterior cerebrals, which are joined to the carotid by the posterior communicating arteries. ARTERIES OF UPPER LIMB. THE AXILLARY ARTERY. Extent. From outer border of ist rib to lower border of teres major insertion. Divided into three parts : IST PART. Extent. From outer border of ist rib to upper border of pectoralis minor. Relations. In front. Pectoralis major, costo-coracoid mem- brane, cephalic vein, external anterior thoracic nerve, and branches of acromio-thoracic artery and vein. Behind, ist intercostal space and muscle, ist serration of serratus magnus, posterior thoracic nerve. Inner side. Internal anterior thoracic nerve and axillarj vein. Outer side. Brachial plexus. 74 THE POCKET ANATOMY 2ND PART. Extent. From superior to inferior border oi pectoralis minor. Relations. In front. Pectorales major and minor. Behind. Subscapularis, posterior cord of plexus. Outer side. Outer cord of plexus. Inner side. Inner cord of plexus, separating artery from 3RD PART. Extent. From inferior border of pectoralis minor to lower border of teres major. Relations. In front. Pectoralis major, inner head of median and internal cutaneous nerves ; below, skin and fasciae. Behind. Subscapularis, tendons of latissimus dorsi and teres major, musculo-spiral and circumflex nerves. Inner side. Uln'ar nerve, axillary vein, and lesser internal cutaneous nerve. Outer side. Coraco - brachialis, median and musculo- cutaneous nerves. Branches : Superior thoracic (ist part) : arises opposite ist intercostal space, supplies pectorales ; anas, internal mammary, inter- costals. Acromio-thoracic (ist part) : arises from front of artery just above pectoralis minor. Branches : Acromial : supply and perforate deltoid; anas, branch of supra-scapular and posterior circumflex. Humeral : accompanies cephalic vein ; anas, anterior circumflex. Thoracic : two or three branches to supply side of thorax ; anas, intercostal, Clavicular : one or two twigs to clavicle and subclavius. Long thoracic (and part) : passes downwards along inferior border of pectoralis minor to about 6th intercostal space, supplies pectorales and serratus magnus ; anas, intercostal and other thoracic branches. In female gives branches to mammary gland : external mammary. Alar thoracic (and part) : supplies glands and fat of the axilla ; not a constant separate branch. Subscapular (3rd part) : arises opposite lower border of Subscapularis muscle, and courses with the long subscapular nerve to lower angle of scapula. Branch : Dorsalis scapula : given off near origin to dorsum of scapula, passes backwards to the infraspinous fossa through triangular ARTERIES 75 interval, bounded above and internally by the subscapularis, below by teres major, and externally by the long head of the triceps. In the triangular interval it gives off ventral branches to subscapular fossa, and a descending branch which runs down between the two teres muscles to the angle. Supplies sub- scapularis, latissimus dorsi, teres major, serratus magnus ; anas, supra-scapular and posterior scapular. Posterior circumflex (3rd part) : arises from back of artery opposite lower border of subscapularis, winds backwards through quadrilateral space, bounded above by the teres minor, below by the teres major, internally by the long head of the triceps, and externally by the neck of the humerus. Supplies deltoid, head of humerus, shoulder-joint, teres minor, and long head of triceps ; anas, acromio - thoracic, anterior circumflex and superior profunda. Anterior circumflex (3rd part) : arises from outer side of artery, one branch ascends bicipital groove to shoulder-joint, another winds round surgical neck of humerus ; anas, posterior circumflex. THE BRACHIAL ARTERY. Extent. From lower border of teres major to half an inch below bend of elbow, runs along inner borders of coraco- brachialis and biceps, accompanied by venae comites. Relations. In front. Integument, fascia, coraco-brachialis, biceps and bicipital fascia, median basilic vein. Crossed by median nerve at insertion of coraco-brachialis. Behind. Long and inner heads of triceps, musculo-spiral nerve, superior profunda vessels, coraco-brachialis, brachialis anticus. Inner side. Internal cutaneous nerve to about middle of arm, r.lnar nerve to insertion of coraco-brachialis, median nerve from insertion of coraco-brachialis to elbow. Outer side. Coraco-brachialis and biceps. Median nerve from origin of artery of insertion of coraco-brachialis. Branches : Superior profunda : arises opposite lower border of teres major, winds backwards and outwards with musculo-spiral nerve in the groove to triceps; gives off anterior branch which pierces external intermuscular septum (anas, radial recurrent) ; and ends as posterior branch behind external condyle ; anas, posterior circumflex, interosseous recurrent, anastomotic. Supplies triceps, anconeus. Nutrient : arises about middle of humerus, and enters medullary foramen near insertion of coraco-brachialis. 76 THE POCKET ANATOMY Inferior profuuda: arises opposite insertion of coraco- brachialis, accompanies ulnar nerve, pierces internal inter- muscular septum ; anas, posterior ulnar recurrent and anas- tomotic at elbow. Anastomotica magna: arises 2 inches above elbow-joint, courses to hollow between olecranon and inner condyle of humerus; anas, inferior profunda, anterior and posterior ulnar recurrent, and a branch across the back of olecranon with superior profunda. Supplies elbow-joint. Muscular : to coraco-brachialis, biceps, brachialis anticus. THE RADIAL ARTERY. Extent. From bifurcation of the brachial to ending of the deep palmar arch of hand ; accompanied by venae comites. Relations in the forearm. In front. Integument, fascia, supinator longus. Behind. Tendon of biceps, supinator brevis, pronator radii teres, flexores sublimis digitorum et longus pollicis, pronator quadratus, lower end of radius. Inner side. Pronator radii teres, flexor carpi radialis. Outer side. Supinator longus tendon, and for middle rd, radial nerve. The artery courses along inner border of supinator longus tendon to carpus, winds round carpus beneath extensors of thumb and radial nerve, lying on external lateral ligament of wrist, scaphoid and trapezium, enters palm of hand through the heads of the ist dorsal interosseous muscle, forming deep palmar arch. Branches : Radial recurrent: arises just below elbow, ascends to between brachialis anticus and supinator longus, supplying them and the elbow-joint ; anas, superior profunda. Muscular : to muscles attached to radial side of forearm. Superficial volar : arises when the artery is about to wind round carpus, passes between muscles of ball of thumb; anas. with ulnar, completing superficial palmar arch. Anterior carpal : arises near lower border of pronator quadratus, passes inwards under tendons ; anas, anterior carpal of ulnar. Posterior carpal : arises beneath extensor tendons of thumb : mas. posterior carpal of ulnar, forming posterior carpal arch , which gives off 2nd and 3rd dorsal interosseous to 3rd and 4th spaces ; and anas, with superior perforating of deep arch, and at lower end of interosseous space gives off inferior per- forating to join palmar digital arteries. ARTERIES 77 Metaearpal (ist dorsal interosseous) : arises near or with the posterior carpal ; anas, superior perforating of deep arch, digital of superficial arch ; supplies adjoining sides of index and middle fingers. Dorsalis pollicis (2) : arising near base of ist metacarpal, course along sides of dorsum of thumb. Dorsalis indicis : courses along radial side of dorsum of index, supplying abductor indicis. Princeps pollicis : arising as the artery enters palm, courses between ist metacarpal and abductor obliquus pollicis to the base of ist phalanx, where it divides into two terminal branches, which run along the sides of the palmar surface of thumb. Radialis indicis : arising near the preceding, passes between ist dorsal interosseous and adductor transversus pollicis to outer side of index-finger, sends a branch to superficial palmar arch ; anas, digital of superficial arch. Deep palmar arch : Extent, from upper end of ist interos- seous space to base of 5th metacarpal. It lies over the bases of the metacarpal bones, and terminates by inosculating with the deep branch of the ulnar. Branches : Recurrent : to front of carpus ; anas, carpal arteries. Palmar interossei (3) : in the three inner interosseous spaces join digital of superficial arch at cleft of fingers, and an offset from inner branch joins digital branch to inner side of 5th finger. Superior perforating : pierce three inner dorsal interossei ; anas, dorsal interosseous. THE ULNAR ARTERY. Extent. From bifurcation of brachial to end in superficial palmar arch, coursing along outer side of flexor carpi ulnaris to the palm ; accompanied by venae comites. Relations in the forearm. In front. Pronator radii teres, flexor carpi radialis, palmaris longus, flexor sublimis, median nerve in upper half; lower half, overlapped by flexor carpi ulnaris tendon. Behind, Brachialis anticus, flexor profundus digitorum. Inner side. Flexor carpi ulnaris, the ulnar nerve in the lower . Outer side. Flexor sublimis digitorum. Lies upon anterior annular ligament at wrist, external to the ulnar nerve and pisiform bone. 78 THE POCKET ANATOMY Branches : Anterior ulnar recurrent : arises near bifurcation of brachial, ascends between brachialis anticus and pronator radii teres, supplying them ; anas, inferior p'rofunda, anas- tomotic. Posterior ulnar recurrent : arising below the anterior, passes beneath flexor sublimis, ascends behind inner condyle, thence between heads of flexor carpi ulnaris, supplying joint and muscles around; anas, inferior profunda, anastomotic. Common interosseous : about half an inch long, arising just below radial tubercle, passes to interosseous membrane, there dividing into two terminal branches. Branches : Anterior interosseous : passes down forearm, resting upon anterior surface of interosseous membrane, accompanied by and internal to interosseous branch of median nerve. At upper border of pronator quadratus one branch, the anterior communicating, goes downwards beneath quadratus to anas. with anterior carpal and deep arch : the other piercing in- terosseous membrane descends to back of carpus ; anas, pos- terior interosseous, posterior carpal of radial and ulnar. Supplies nutrient branches to radius and ulna, and branch to median nerve : comes nervi mediani. Posterior interosseous : passes backwards between oblique ligament and interosseous membrane, and between supinator brevis and extensor ossis metacarpi pollicis, runs down back of forearm, lying internal to posterior interosseous nerve, between superficial and deep muscular layers as far as the wrist ; anas, posterior carpal of radial and ulnar, anterior interosseous. Branch : Posterior interosseous recurrent : given off near origin, passes under anconeus to interval between olecranon and external condyle ; anas, superior profunda, anastomotic. Muscular : to muscles on ulnar side of forearm. Anterior carpal : courses beneath tendons of flexor pro- fundus ; anas, anterior carpal of radial. Posterior carpal : arises just above pisiform, winds back beneath flexor carpi ulnaris tendon, gives branch to inner side of 5th metacarpal, and then passes outwards to anas. with posterior carpal of radial, forming posterior carpal arch (vide Radial Artery). Superficial palmar arch : continues the ulnar in the hand, lying immediately under palmar fascia and on digital nerves and flexor tendons. It turns outwards a little below the ARTERIES 79 anterior annular ligament, and, forming an arch with the con- vexity downwards, is directed to the thumb, where the arch becomes completed by joining the superficialis volae, radialis indicis, or princeps pollicis. From the convex side of the arch it gives off four digital branches to supply three inner fingers and inner side of index-finger ; anas, palmar interossei of deep arch, inferior perforating of dorsal interosseous. The deep branch of ulnar artery or communicating branch is given off at commencement of arch, passes down with the deep branch of ulnar nerve between abductor and short flexor of little finger to complete deep palmar arch. ARTERIES OF BODY. THE AORTA. Large main trunk of systemic arteries, situated partly in thorax and partly in abdomen, commences at left ventricle, arches over root of left lung, descends in front of vertebral column, through diaphragm into abdomen, ending opposite body of 4th lumbar vertebra by bifurcating into two common iliacs. Conveniently divided into three parts: arch of aorta, descending thoracic aorta, abdominal aorta. ARCH OF AORTA : divided, according to the direction, into ascending and transverse portions. In the concavity of the arch are contained root of left lung, branching of pulmonary artery with ductus arteriosus, cardiac plexuses, left recurrent laryngeal nerve, oesophagus and thoracic duct. Ascending part : Extent and Course. Two inches in length. From base of left ventricle, opposite lower border of 3rd left costal cartilage, passing behind pulmonary artery, upwards and to the right, crossing the posterior surface of the sternum obliquely, and extending as high as superior border of 2nd right costal cartilage. At its root it presents three bulgings, the sinuses of Valsalva, and along the right side is a dilatation, the great sinus of the aorta. Relations. Is contained nearly completely in pericardium. In Front. Behind. Right Side. Left Sidt. Pulmonary artery. Left auricle. Superior cava. Pulmonary ar Right auricular ap- Right pulmonary Right auricle. tery. pendix. vessels. Pericardium. Root of right lung. Right lung and pleura. Sternum. So THE POCKET ANATOMY Branches. Right and left coronary arteries distributed to heart (vide Heart). Transverse part, which runs much more from before back- wards than from right to left, so that relations in front are also to the left, and those behind to the right, commences at upper border of 2nd right costal cartilage, arching backwards over root of left lung, as far as inferior border of left side of body of 4th dorsal vertebra. Relations. In Front and A , to Left. Abave ' Below. Behind and to Right. Manubrium. Left innominate Bifurcation of pul- Trachea. Thymus. vein. monary artery. Deep cardiac I .eft pleura and Ductus arteriosus. plexus. lung. Left bronchus. (Esophagus. Left phrenic \ Inferior car- J Left recurrent laryngeal nerve. Thoracic duct. Left recurrent diac of left I j, laryngeal nerve. vagus 1 Superior car- f J g 8 ,}' 1 -- " k fet-i, lid. C, tMiddl. trunk {!? P c The plexus lies between scalenus anticus and medius, and divides into branches for the upper limb below tlu pectoralis minor. ii 162 THE POCKET ANATOMY Branches above the Clavicle : Muscular : to the longus colli and scaleni. Nerve to the rhomboidei, from the 5th cervical, passes through scalenus medius to the base of the scapula, then under levator anguli scapulae, supplying it, and ending on the anterior surface of the rhomboid muscles. Nerve to the subclavius, from the trunk formed by the 5th and 6th cervical, passes downwards in front of the 3rd part of the subclavian artery to the deep surface of the subclavius, often communicates with phrenic. Communicating : from the 5th to join the phrenic on the scalenus anticus. Posterior thoracic, or external respiratory nerve of Bell : from 5th, 6th and yth, pierces scalenus medius and then descends behind the plexus and ist part of axillary artery nearly to the lower border of the serratus magnus, which it supplies. Supra-scapular: from the union of the 5th and 6th cervical, passes beneath trapezius to upper border of scapula, enters supra-spinous fossa through supra-scapular notch, gives off two branches to the supra-spinatus, and an articular one to the shoulder-joint ; thence it passes to the infra-spinous fossa, and ends in the infra-spinatus. Branches below the Clavicle : The several nerves are given off as follows : Outer Cord. Inner Cord. Posterior Cord. External anterior thoracic. Internal anterior thoracic. Subscapular. Musculo-cutaneous. Lesser internal cutaneous. Circumflex. Outer head of median. Internal cutaneous. Musculo-spiral. Ulnar. Inner head of median. External anterior thoracic (outer cord) : crosses over axillary artery to under surface of the pectoralis major, in which it communicates with internal anterior thoracic. Internal anterior thoracic (inner cord) : passes between axillary artery and vein to the two pectoral muscles. Subscapular : three (posterior cord). Upper : the smallest, perforates upper part of subscapularis. Lower : ends in the teres major, having previously given a filament to the subscapularis. ' Middle or long : runs along lower border of subscapularis with the subscapular vessels to supply the latissimus dorsi. Circumflex (posterior cord) : passes backwards with pos- terior circumflex vessels at the lower border of the sub- scapularis, through quadrilateral space formed by teres major, NERVES 163 scapula, long head of the triceps and humerus, and, having given an articular branch to the shoulder-joint, divides into Anterior branch : winds round neck of the humerus, supply- ing deltoid and skin. Posterior branch : gives a branch to teres minot, which has a gangliform swelling upon it ; also branches to deltoid and integument. Cutaneous appears at posterior border of deltoid, supplies skin over lower of muscle. Internal cutaneous (inner cord) : lies in front of 3rd part of axillary artery, becomes cutaneous about middle of arm, and divides into two branches Anterior : passes behind median basilic vein, supplies front of inner side of forearm as low as wrist. Posterior : winds over internal condyle, supplying the back of inner side of forearm to about the middle. Lesser internal cutaneous (nerve of Wrisberg) (inner cord) : lies to inner side of axillary vein, communicates with the intercosto-humeral, and then descends along inner side of brachial vessels to middle of the arm, where it becomes cutaneous and supplies integument of inner side as far as inner condyle. It communicates with the posterior branch of the larger internal cutaneous. Musculp-cutaneous (outer cord) : perforates coraco-brachi- alis, passing to outer side of arm between biceps and brachialis anticus, supplying the three named muscles ; fila- ments also are given to the elbow-joint ; becomes cutaneous just above elbow, and, passing behind median cephalic vein, divides into Anterior cutaneous branch: passes along radial border of forearm, supplying ball of thumb and joining the radial. Posterior cutaneous branch : supplies integument of lower 3rd of back of forearm on the radial side ; joins branches of radial and musculo-spiral (external cutaneous branch). Median : arises by two roots, one from the outer cord, the other from the inner cord of the plexus, which cresses 3rd part of axillary artery to join the outer head. At first the nerve lies to the outer side of the axillary artery, but about the middle of the arm it crosses the brachial artery to reach the 'inner side ; it then passes between the two heads of the pronator radii teres, and is continued straight down the forearm upon the flexor profundus, and beneath the flexor sublimis ; at the wrist it lies between the tendons of the flexor sublimis and flexor carpi radialis. Passing beneath the annular ligament, it becomes somewhat 1 64 THE POCKET ANATOMY flattened, and divides into two parts to supply the outer 31 fingers. Branches in the Forearm : Articular: to elbow-joint. Muscular : to pronator radii teres, flexor carpi radialis, palmaris longus, and flexor sublimis digitorum. Anterior interosseous : is given off just below the elbow-joint. It, passes down external to the anterior interosseous artery on the membrane, between the flexor profundus and flexor longus pollicis, to end in the deep surface of pronator quad- ratus. Supplies flexor longus pollicis, pronator quadratus, and outer half of flexor profundus digitorum. Palmar cutaneous : pierces fascia just above angular ligament, ends in the integument of the palm, joining the palmar cutaneous of the ulnar nerve. Terminal branches in the Hand : Muscular to thumb : supplies abductor, opponens, and outer head of flexor brevis pollicis. Digital : five in number, supplying outer 3^ fingers, ist and and supply the thumb, 3rd to radial side of index finger also supplies ist lumbrical; 4th supplies and lumbrical and adjacent side of index and middle fingers ; 5th supplies adjacent sides of ring and middle fingers, and joins a branch of the ulnar, giving sometimes a branch to the 3rd lumbrical. Ulnar (inner cord) : passes down the inner side of axillary and brachial arteries to middle of arm ; it then runs with inferior profunda artery through internal intermuscular septum to groove between olecranon and internal condyle. Thence it passes through the two heads of the flexor carpi ulnaris and descends under cover of that muscle, along ulnar side of forearm and internal to ulnar artery, as far as the pisiform bone ; it then courses over the annular ligament external to that bone, and divides into superficial and deep palmar branches. Branches in the Forearm : Articular : to elbow and wrist joints. Muscular : to flexor carpi ulnaris and inner half of flexor profundus digitorum. Cutaneous : arises near middle of forearm, and divides into: superficial to integument of forearm, and palmar, accompanies ulnar artery to hand, supplying the palm : joins the cutaneous of median. Dorsal cutaneous : comes off about 3 inches above pisiform bone, winds round ulna beneath flexor carpi ulnaris, supplies inner side of little finger, and adjacent sides of ring and little fingers on the dorsal aspect. NER VES 165 Palmar branches Superficial : supplies palmaris brevis, ends in two digital branches for inner i fingers the outer one communicating with the median. Deep : accompanies deep palmar arch ; it supplies the small muscles of the 5th finger, and gives two branches to each interosseous space, one for each set of interossei ; branches are also given to the two inner lumbrical muscles. In the space between the thumb and index finger the nerve ends by supplying the adductor obliquus, adductor transversus, and inner head of the flexor brevis pollicis. Musculo-spiral (posterior cord) : winds round between outer and inner heads of triceps in the musculo-spiral groove with superior profuncla artery to the outer side of arm. Piercing the external intermuscular septum, it passes to the external condyle between the supinator longus and brachialis anticus, where it divides into radial and posterior interosseous nerves. Branches in the Arm : Muscular : to the three heads of the triceps, to the anconeus, supinator longus, extensor carpi radialis longior, and brachialis anticus. Cutaneous : Internal, comes off near axilla, supplies integu- ment on back of arm to near olecranon. External (2), upper one perforates outer head of triceps, accompanies cephalic vein to elbow, supplying the integument of the lower half of arm in front. Lower one supplies integument of lower part of arm, and back part of radial side of forearm as far as the wrist. Terminal branches : Radial : passes down by outer side of radial artery, under cover of the supinator longus, till within 3 inches of the lower end of the radius, where the nerve passes backwards beneath the tendon of the supinator longus, and, becoming cutaneous by piercing the fascia on outer side of forearm, divides into two branches : External : supplies ball and outer border of thumb, joining with the external cutaneous nerve. Internal : joins a branch of the external cutaneous and dorsal of ulnar. It gives off four dorsal digital nerves, thus : ist to inner side of thumb, 2nd to outer side of index, 3rd to adjacent sides of index and middle, 4th to adjacent sides of middle and ring fingers. It thus corresponds in its distribu- tion with the median nerve. Posterior interosseous : reaches the back of the forearm by piercing the supinator brevis ; there it passes between the superficial and deep layers of muscles to about middle of 1 66 THE POCKET ANATOMY forearm, where it passes deep to extensor longus pollicis to reach the interosseous membrane, on which it lies, as far as the wrist ; it there ends in a gangliform enlargement, from which there are given off filaments to the ligaments, etc. Supplies supinator brevis, extensores carpi radialis brevior, communis digitorum, minimi digiti, carpi ulnaris, ossis meta- carpi pollicis, longus and brevis pollicis, and indicis. NERVES OF THE TRUNK. DORSAL : twelve in number. The ist comes out between the ist and and dorsal vertebrae, and the greater part joins the brachial plexus. The last nerve emerges from between the i ath dorsal and ist lumbar vertebrae. Each nerve at its exit from the intervertebral foramen divides into an anterior and posterior primary division. The ist and I2th nerves, however, require a separate description. The POSTERIOR* PRIMARY DIVISIONS, or dorsal branches, pass backwards between the transverse processes and divide into external and internal branches, which emerge on either side of the middle division of the erector spinse (longissimus dorsi), and supply the muscles of the back. Cutaneous branches are derived from each of these sets, the six upper ones coming from the internal branches and the six lower ones from the external branches. The ANTERIOR PRIMARY DIVISIONS, or intercostal nerves, are twelve in number on each side ; each communicates with the corresponding ganglion of the sympathetic chain. The UPPER six pass forwards in the intercostal spaces below the vessels, lying at first between the pleura and external intercostal muscle, then between the external and internal intercostal muscles ; after giving off the lateral cutaneous branches, they lie in the internal intercostal muscle, and then between that muscle and pleura, extending forwards to the sternum, and crossing the internal mammary artery, to end as the anterior cutaneous nerves of the thorax by perforating internal intercostal and pectoralis major. Branches : Lateral cutaneous : given off midway between head of rib and sternum. .The ist intercostal nerve has generally no lateral cutaneous branch. Each branch, except that from the 2nd nerve, then pierces the external intercostal muscle, and divides into anterior and posterior branches, which supply the muscles, mammary gland, and integument. The lateral cutaneous branch of the 2nd nerve, or intercosto- NER VES 167 humeral, has no anterior branch ; the posterior branch crosses the axilla, joins the lesser internal cutaneous nerve, and supplies the integument of the inner side of the arm. The LOWER six pass like the upper ones to the. front of the intercostal spaces, thence between the internal oblique and transversalis to the sheath of the rectus, which they perforate, and terminate near the middle line as anterior cutaneous branches of the abdominal wall. Branches : Lateral cutaneous: supply the integument of the abdomen, having anterior and posterior branches. PECULIAR DORSAL NERVES : The ist nerve : its anterior primary division is mostly consumed in the brachial plexus, but a small branch is given off to the ist intercostal space, which has no lateral cutaneous branch. The i2th nerve does not lie in an intercostal space, but below the I2th rib in front of the quadratus lumborum ; it then pierces the posterior aponeurosis of the transversalis, passing forwards between transversalis and internal oblique to end by perforating rectus ; is remarkable for the large size of its lateral cutaneous branch, which does not divide, but, piercing internal and external obliques, passes over iliac crest and supplies skin over gluteal region as far down as great trochanter. LUMBAR : five on each side. The ANTERIOR PRIMARY DIVI- SIONS increase in size from above downwards, and near their origin communicate with the sympathetic ganglia, the upper four forming the lumbar plexus ; that of the 5th joins with the ist sacral to form the lumbo-sacral cord. The POSTERIOR PRIMARY DIVISIONS pass backwards between the transverse processes and divide into internal and external branches. These are seen to be separated by the longissimus dorsi. The internal branches end in the muscles, and all the external gjve muscular branches; the upper three also give cutaneous branches to gluteal region. NERVES OF THE LOWER EXTREMITY. LUMBAR PLEXUS : formed in the psoas by the communica- tions of the anterior primary divisions o the four upper lumbar nerves in the following manner : The ist gives off the ilio-hypogastric, the ilio-inguinal, a branch to the genito-crural, and a communicating branch to the 1 2th dorsal and 2nd lumbar. The 2nd gives off branches to the genito-crural, and external 168 THE POCKET ANATOMY cutaneous, and a communicating branch to the 3rd, which also forms part of the anterior crural and obturator. The 3rd gives off part of the external cutaneous, of the anterior crural, and of the obturator. The 4th gives off a branch to the anterior crural, one to the obturator, and a communicating one to the 5th. Muscular branches are also supplied to the psoas and quad- ratus lumborum. BRANCHES OF THE LUMBAR PLEXUS. Ilio-hypogastric : from ist lumbar, appears at upper part of outer border ot psoas, crosses quadratus lumborum to iliac crest, and, piercing the trans versalis, divides into: Iliac branch: pierces two oblique muscles, crosses iliac crest behind lateral cutaneous of last dorsal to integument of buttock. Hyfiogastric branch : pierces internal oblique and then ex- ternal oblique aponeurosis above abdominal ring to integument of hypogastric region. Ilio-inguinal : from ist lumbar ; passes over quadratus lumborum and iliacus to iliac crest, pierces the transversalis and internal oblique ; it then accompanies the cord through canal and external ring, and is distributed to the integument of the groin and the scrotum. Genito-crural : from 2nd lumbar, with a branch from ist. Passes on the psoas to Poupart's ligament to divide into : Genital branch : crosses external iliac, enters inguinal canal through internal abdominal ring, accompanies spermatic cord, and supplies the cremaster muscle. In the female it accom- panies the round ligament of the uterus. Cmral branch : passes beneath Poupart's ligament, perforates fascia on outer side of femoral artery, communicates with middle cutaneous nerve, supplies integument of upper and front of thigh. External cutaneous : from loop between 2nd and 3rd lumbar ; perforates middle of outer border of psoas, and enters thigh just below anterior superior iliac spine, where it divides into : Anterior branch: contained at first in a tube of the fascia lata ; supplies outer part of anterior surface of thigh. Posterior branch : supplies outer surface of thigh to the middle. Obturator : from 2nd, 3rd, and 4th lumbar ; passes from inner border of psoas, near brim of pelvis and above obturator artery, but below external iliac, to canal in upper part of thyroid foramen. In this canal it divides into : NERVES 169 Anterior or superficial part: descends in front of adductor brevis, behind pectineus and adductor longus ; it supplies the hip-joint, gracilis, adductor longus, adductor brevis, femoral artery, and a branch to plexus near sartorius ; rarely the pectineus ; communicates with accessory obturator when this is present. Posterior or deep part: passes through obturator externus and behind adductor brevis ; it supplies a large branch to adductor magnus, and gives branches also to obturator ex- ternus, adductor brevis when this latter is not supplied by the anterior branch, and a branch along popliteal artery to knee-joint. Accessory obturator : from 3rd and 4th lumbar or from obturator trunk ; when present it passes down on inner side of psoas, over horizontal ramus of pubes, under pectineus, and supplies pectineus and hip-joint ; communicates with the anterior branch of the obturator. Anterior crural : from 3rd and 4th, and partly from the 2nd lumbar ; emerges from lower part of outer border of psoas, and descends between that muscle and the iliacus, lying on the outer side of the iliac vessels. It supplies the iliacus and femoral artery whilst in the pelvis, and on emerging from it beneath Poupart's ligament, it divides into : Anterior or superficial portion : which gives off : Middle cutaneous : pierces fascia lata 3 inches below Poupart's ligament, dividing into two branches to supply the integument of the front of the thigh as far as the knee. Communicates with crural of genito-crural and internal cutaneous, and gives a branch to the sartorius. Internal cutaneous : passes obliquely across to inner side of femoral artery, and divides into: Anterior branch: pierces fascia lata in lower J of thigh ; supplies integument of the lower of inner side of thigh ; communicates near the knee with -long saphenous. Posterior branch : passes down posterior border of sartorius to knee, giving branches to plexus near that muscle, and finally is distributed to integu- ment of the leg; communicates in the thigh with the obturator and the internal saphenous nerves, forming in Hunter's canal a plexiform interlacement, the subsartorial plexus. Nerve to pectineus : generally two, which pass inwards under femoral vessels to muscle. Nerves to sartorius : given off with middle cutaneous. Plexus patella : the patellar plexus is formed by communica- tions between the anterior branch of the internal cutaneous, branches of the middle and external cutaneous nerves, together i yo THE POCKET ANATOMY with the patellar branch of the internal or long saphenous nerve. Deep or posterior part : which gives off : Internal or long saphenous : accompanies, lying on outer side of, femoral vessels as far as Hunter's canal, where it crosses, artery, and leaves it at opening in adductor magnus by passing inwards beneath sartorius. Here it. becomes subcutaneous, and is continued with the internal saphenous vein along inner side of leg, behind inner border of tibia, and, passing in front of inner ankle, is distributed on inner side of foot as far as ball of great toe. In its course it gives off a branch to plexus under sartorius formed by obturator and internal cutaneous nerves, to patellar plexus, and below the knee to the integu- ment on the anterior and inner surfaces of the leg. Muscular. To the rectus, which gives branch to hip-joint. To the vastus externus, which gives an articular branch to the knee-joint, and accompanies descending branch of the external circumflex artery. To the vastus internus, which gives off an articular branch to the knee-joint, and accompanies the deep branch of the anastomotica magna artery. To crureus, two or three, the internal one supplying sub- crureus and knee-joint. SACRAL NERVES, five in number. The roots of origin form the cauda equina, and in this region t.he posterior root ganglia are placed inside the spinal canal, though outside the dura mater. Each nerve divides into anterior and posterior primary branches. The posterior primary branches of the upper four emerge from the posterior sacral foramina, the fifth at the lower end of the spinal canal ; the upper three nerves divide into internal and external branches, the former supplying the multifidus spinae, the latter the integument over sacrum, coccyx, and posterior gluteal region ; the two lower nerves do not divide, and supply filaments to integument over coccyx, the 5th com- municating with the coccygeal. COCCYGEAL NERVE : this nerve divides into an anterior branch, which pierces sacro-sciatic ligament and coccygeus, supplies integument over coccyx, and communicates with the 5th sacral, forming part of ano-coccygeal plexus ; and a posterior, to supply coccygeal integument. The ANTERIOR PRIMARY BRANCHES decrease in size from above downwards. The upper four issue from the anterior sacral foramina, the 5th emerging between sacrum and coccyx. Each nerve communicates with the sympathetic. The first NERVES 171 three and part of the 4th nerves enter the sacral plexus, whilst the lower part of the 4th, the 5th, and the coccygeal nerve form a small plexus, ano-coccygeal, which lies on the pelvic surface of the coccygeus. The ano-coccygeal plexus : formed as described above. Branches : Muscular to : Coccygeus. Levator ani. Sphincter ani externus (usually called the perinea) branch of the 4th sacral). Visceral. Vesical. Rectal. Vaginal (in female). Cutaneous : perforating cutaneous of 4th sacral to integu- ment over coccyx. The SACRAL PLEXUS is formed by the lumbo-sacral cord (p. 167), anterior primary branches of the upper three and part of that of the 4th sacral nerves. Lies on anterior surface of pyriformis, behind the sciatic and internal pudic arteries. Branches : Muscular: To pyriformis, from ist and and. To obturator internus and gemellus superior, from 5th lumbar, ist and 2nd sacral, emerges from pelvis through great sacro-sciatic foramen, winds over ischial spine outside the internal pudic artery, passes in through small sacro-sciatic foramen to inner surface of muscle, having first supplied superior gemellus. To quadratus femoris and gemellus inferior, given off from lumbo-sacral cord and ist sacral, passes anterior to gemelli and obturator internus tendon to anterior surface of quadratus, giving on its way a branch to gemellus inferior, and an articular branch to the hip-joint. Superior gluteal : from lumbo-sacral cord and ist sacral, passes out of great sacro-sciatic foramen, above the pyriformis, with the gluteal vessels ; divides into a superior branch, which passes between the two smaller glutei, supplying the medius, and an inferior branch, supplying the gluteus minimus and the tensor fasciae femoris. Pudic : comes off from the 2nd, 3rd, and 4th nerves, passes out of great sacro-sciatic notch between pyriformis and coccygeus internal to great sciatic nerve, winds over ischial 172 THE POCKET ANATOMY spine internal to pudic artery, and re-enters pelvis through the small notch lying on inner side of internal pudic artery ; it then enters, with accompanying vessels, a sheath of the obturator fascia in the outer wall of the ischio-rectal fossa and divides into its three branches. Branches : Inferior h&morrhoidal : crosses ischio-rectal fossa to supply external sphincter, skin of anus ; communicates with inferior pudendal of small sciatic and superficial perineal nerves. Perineal : largest terminal branch, accompanies perineal artery, and divides into : Cutaneous or superficial perineal, two in number : the internal passes with superficial perineal artery either under or over the transversus perinaei to supply the scrotum ; the external gives a branch to the anus, and, piercing the deep layer of the superficial fascia, supplies the scrotum, joining the inferior pudendal. Muscular branches supply transversus perinaei, erector penis, ejaculator urinas, compressor urethras, sphincter and levator ani. Nerve to bulb : pierces ejaculator urinaa and supplies bulb. Dorsal nerve of the penis : accompanies internal pudic artery between the layers of the triangular ligament lying on the outer side of the artery, pierces the anterior layer of the liga- ment, and the suspensory ligament to reach dorsum of penis, along which it runs as far as the glans, gives off many branches to supply the organ, and joins branches of the sympathetic. In the female this nerve is distributed to the clitoris. Inferior gluteal : from the lumbo-sacral cord, ist and 2nd sacral nerves ; passes out of pelvis below the pyriformis, at the lower border of which it turns backwards, and, dividing into numerous branches, enters deep surface of gluteus maximus. Communicates near origin with the small sciatic. Small sciatic : a cutaneous nerve to lower part of buttock and back of thigh ; it comes off from 2nd and 3rd sacral nerves. It passes below the pyriformis with the sciatic artery, and runs down the back of the thigh beneath the gluteus maximus, and below this beneath the fascia lata, which it pierces in the popliteal space. Branches : Internal cutaneous ; to integument of upper and inner side of thigh : one larger one, the inferior pitdendal, turnj inwards over hamstrings, supplies scrotum, and joins the external superficial perineal nerve. NERVES 173 External cutaneous : winds round ghueus maximus, supplies the integument over lower part of buttock. Terminal: to integument of thigh, popliteal region, and calf of leg. GREAT SCIATIC : the largest nerve in the body, and is the main continuation of the sacral plexus, lies in pelvis on pyri- formis ; it is derived from the lumbo-sacral cord, the ist, 2nd, and 3rd sacral nerves. It passes out of pelvis below the pyrifoimis, and between the tuber ischii and great trochanter. resting upon the gemelli, obturator internus, quadratus femoris, and adductor magnus. It is at first external to the biceps, then between its two heads of origin, finally between it and semi-membranosus, and is accompanied by the sciatic artery, which supplies a branch to its substance (comes nervi ischiadici). At a variable distance between the sacral plexus and lower part of the thigh, but generally about the middle of the thigh, the nerve bifurcates into external and internal popliteal. Branches of the Trunk : Muscular : given off under biceps to semi-membranosus, semi-tendinosus, both heads of biceps, and to the inner part of adductor magnus. INTERNAL POPLITEAL: larger terminal branch, passes along middle of popliteal space to lower border of popliteus, where it gets the name of posterior tibial; it is at first superficial to and outside the artery, but at the lower end of the space, under the gastrocnemius, crosses to the inner side. Branches : Articular (3) : one accompanies each of the upper and lower internal articular arteries, the third the azygos. Muscular : to the gastrocnemius, one for each head, the outer one supplying also the plantaris. To the soleus and to the Popliteus ; the nerve to the latter turns round lower border of muscle and enters it upon its anterior surface. Tibial communicating : passes down leg superficially between two heads of the gastrocnemius, pierces the deep fascia about middle of leg, there joining the peroneal communicating from the external popliteal, and is now known as the external or short saphenous nerve ; it then follows the course of the external saphenous vein round outer malleolus, and supplies integu- ment of outejr side of foot and little toe, communicating with the musculo-cutaneous on the dorsum. POSTERIOR TIBIAL (continuation of internal popliteal): begins at the lower border of the popliteus, and runs with 174 THE POCKET AN ATOM? the posterior tibial vessels to interval between the external malleolus and heel, where it divides into external and internal plantar. It is at first inside the artery, but afterwards crosses to the outer side. Branches : Kluscular : to soleus, tibialis posticus, flexor longus digi- torum, and flexor longus hallucis, the latter accompanying the peroneal artery. Internal calcanean : pierces internal annular ligament, to supply integument of heel and inner side of sole of foot. Internal plantar : larger terminal branch of the posterior tibial ; accompanies internal plantar artery along inner side of foot : the larger nerve thus accompanies the smaller artery. Corresponds in distribution to median nerve of hand. It passes between the abductor hallucis and flexor brevis digi- torum to divide opposite the bases of the metatarsal bones into four branches, the outermost of which communicates with the external plantar. Branches : Cutaneous : to sole of foot. Muscular: to abductor hallucis and flexor brevis digi- torum. Articular : to tarsal and metatarsal articulations. Digital (4) : the ist supplies inner border of ist toe and the flexor brevis hallucis, the 2nd supplies the adjacent sides of the ist and 2nd toes and the ist lumbrical, the 3rd supplies the adjacent sides of the 2nd and 3rd toes, and the 4th supplies the adjacent sides of the 3rd and 4th toes and joins a branch from the external plantar. External plantar : passes across to outer side of foot with external plantar artery, supplying on its way the abductor minimi digiti and flexor accessorius ; at the outer border of the latter muscle it divides into two branches : Superficial : which divides into two digital nerves, one sup- plying the outer side of the little toe, the flexor brevis minimi digiti, and the two interossei of the 4th space ; the other supplies the adjacent sides of the 4th and 5th toes and com- municates with the internal plantar. Deep or muscular: accompanies deep part of external plantar artery, supplying the adductor obliquus hallucis, adductor transversus Jhallucis, three outer lumbricals and interossei of inner three spaces. EXTERNAL POPLITEAL OR PERONEAL : passes along the popliteal space under cover of and inside biceps tendon, then over outer head of gastrocnemius to the fibula ; NERVES 175 i inch below head of that bone it pierces the peroneus longus, and in that muscle divides into anterior tibial and musculo- cutaneous nerves. Branches : Articular (2) : generally given off together, accompany superior and inferior external articular arteries. Cutaneous : supply integument of back and outer side of leg in upper third. Peroneal or fibular communicating : arises close to head of fibula and joins the tibial communicating, the two forming the short saphenous nerve. Anterior tibial : passes to front of interosseous membrane by piercing extensor longus digitorum to reach outer side of anterior tibial artery, with which it descends to the ankle- joint, where it bifurcates into an internal and external branch ; it lies in middle J of leg, in front of artery, and in lowest ^, again, outside it. Branches : Recurrent articular: sends a branch to knee, which accom- panies anterior tibial recurrent artery to joint. Muscular : to tibialis anticus, extensor longus digitorum, peroneus tertius, and extensor proprius hallucis. External or tarsal : passes outwards beneath the extensor brevis digitorum and becomes ganglionic, supplies the extensor brevis, and the articulations of the tarsus and metatarsus. Internal: accompanies dorsalis pedis to ist interosseous space, lying outside it, supplies adjacent sides of ist and 2nd toes, communicating with the musculo-cutaneous. Musculo-cutaneous : supplies peroneus longus and brevis, and dorsal integument of foot. It passes down between peronei and the long extensor of toes, piercing deep fascia at lower of leg. Branches : Muscular : to peroneus longus and peroneus brevis. Cutaneous : to lower part of leg. Internal: passes over ankle to inner side of ist toe and adjacent sides of 2nd and 3rd toes, communicates with internal saphenous and anterior tibial nerves. External : supplies adjoining sides of 3rd, 4th, and 5th toes; communicates with short saphenous. SYMPATHETIC NERVES The sympathetic system consists of 1. The great gangliated cords. 2. The prevertebral plexuses, and branches proceeding from them. 176 THE POCKET ANATOMY 3. Ganglia of union with cranial nerves viz., ophthal- mic, spheno-palatine, otic, and submaxillary. These have been described with the 5th nerve. THE GREAT GANGLIATED CORDS, two in number, extend the whole length of the vertebral column. They consist of ganglia, united by intervening cords, and are placed partly in front and partly by the side of the vertebras. Above they are connected with two plexuses entering the cranium, and below they join together in a loop over the coccyx. The parts of the cords are named accord- ing to the region they occupy viz., cervical, dorsal, lumbar, and sacral. The cervical portion has three ganglia, whilst in the rest of its extent each cord contains ganglia equal in number to the vertebrae. Each ganglion is connected with the anterior primary division of the corresponding spinal nerve by an afferent (white) filament, and an efferent (grey) connecting branch. The interganglionic cords are composed of white and grey fibres, the former being continuous with the filaments from the spinal nerves. The CERVICAL PART of the gangliated cord lies behind the carotid sheath, just in front of the prevertebral muscles, and contains three ganglia. i. The SUPERIOR CERVICAL GANGLION lies on the rectus capitis anticus major behind carotid sheath, opposite the and and 3rd cervical vertebras. Branches : Connecting : with the anterior primary divisions of ist, 2nd, 3rd, and 4th cervical nerves : with the ganglion of trunk and the ganglion of the root of the pneumogastric, with the hypo- glossal, with the petrous ganglion of the glosso-pharyngeal. Pharyngeal nerves and plexus : the pharyngeal nerves are given off from the front of the superior cervical ganglion, and pass forwards and downwards. They join with branches from the pneumogastric and glosso-pharyngeal nerves forming the pharyngeal plexus, which lies on the middle constrictor muscle. Branches from the plexus supply the constrictors, levator palati, palato-glossus, palato-pharyngeus, andazygos uvulae muscles : the motor fibres are derived from the bulbar part of spinal accessory, and reach plexus through pharyngeal branch of vagus. The upper cardiac nerves : the right upper cardiac nerve comes off by two roots from the upper cervical ganglion. It passes downwards behind the carotid sheath, but in front of the inferior thyroid artery and recurrent laryngeal nerve. It NERVES 177 then goes either behind or in front of the subclavian artery, and, coursing along the innominate, ends in the deep cardiac plexus behind the arch of the aorta. In the middle of the neck it communicates with the external laryngeal, lower down with the upper cardiac branches of the pneumogastric, in the thorax with the recurrent laryngeal, and with other sympa- thetic branches in its whole course. The left upper cardiac nerve has the same connections in the neck as the right nerve. On entering the thorax, it passes along left common carotid artery, and, crossing the arch of the aorta, joins the superficial cardiac plexus. Branches to Vessels. Branches are given to the external carotid artery, which are prolonged to its branches. Ascending or carotid branch lies behind internal carotid artery, enters carotid canal, and divides into: (a) External division : distributed to internal carotid ; communicates with tympanic branch of glosso- pharyngeal, and forms the carotid plexus. (b) Internal division : distributed over internal carotid artery, thus communicating with the external division, and prolonged to form the cavernous plexus. The carotid plexus lies on the outer side of the internal carotid artery at its 2nd bend. Branches : Connecting : to the 6th nerve and Gasserian ganglion. The large deep petrosal nerve passes from the plexus through the hiatus Fallopii, to join the large superficial petrosal nerve at the Vidian canal, the junction of the two forming the Vidian nerve. The small deep petrosal nerve passes backwards in a small canal in the processus cochleariformis, to join the tympanic plexus. The cavernous plexus lies below and to the inner side of last bend of the internal carotid artery. Branches : Connecting : to the 3rd, 4th, and ophthalmic division of 5th nerve. Ganghonic : the sympathetic root of the ophthalmic or lenti- cular ganglion passes into the orbit. It is generally joined to the branch of the 3rd nerve supplying the inferior oblique. Pituitary : to that body. 2. The MIDDLE CERVICAL GANGLION generally lies on the inferior thyroid artery, opposite the 6th cervical vertebra. Branches : Connecting : to the 5th and 6th cervical nerves. Thyroid: to the thyroid body, communicating with external 12 T7* THE POCKET ANATOMY and recurrent laryngeal nerves, and with the upper cardiac nerve from the superior ganglion. Middle or great cardiac nerve : on the right side passes in front or behind subclavian artery to the front of the trachea, and joins the deep cardiac plexus. Communicates in the neck with the upper cardiac and recurrent laryngeal nerves. On the left side it lies between the left carotid and left subclavian arteries, and joins the deep cardiac plexus. 3. The LOWER CERVICAL GANGLION lies between the transverse process of the yth cervical and the neck of the ist rib, behind the vertebral artery, internal to the superior intercostal artery. Branches : Connecting : to the 7th and 8th cervical nerves. Lower cardiac nerve : passes behind the subclavian artery, joins recurrent laryngeal, and enters the deep cardiac plexus. Branches to vessels : branches are given to form a plexus round the vertebral artery. The THORACIC PART of the gangliated cord lies by the side of the vertebrae in a line corresponding to the heads of the ribs. The ganglia are usually twelve in number, and each com- municates with the corresponding intercostal nerve. Branches of the upper 6 ganglia are given off to the thoracic aorta, vertebras, ligaments, and from the third and fourth to the posterior pulmonary plexus. Branches from the lower 6 ganglia : The great splanchnic nerve : formed by the union of branches from the 6th, yth, 8th, gth, and loth ganglia. It passes inwards over the bodies of the vertebras, perforates the crus of the diaphragm, and ends in the semilunar ganglion. The small splanchnic nerve comes from the loth and nth ganglia, passes with the great splanchnic nerve, and ends in the solar plexus. The smallest splanchnic nerve comes from the i2th ganglion. It pierces the crus of the diaphragm, and ends in the renal plexus, and partly in the coeliac plexus. The LUMBAR PART of the gangliated cord lies nearer the middle line than the thoracic on the bodies of the vertebrae. Each ganglion communicates with the anterior division of a lumbar nerve by branches which pass under fibrous arches of psoas. The ganglia give off branches to the aorta, and other branches to form the hypogastric plexus. The SACRAL PART of the gangliated cord lies to the inner side of the anterior sacral foramina, and is united with its opposite fellow at the lower end of the sacrum by a cord, in NERVES 179 the middle of which there is sometimes found a coccygeal ganglion or ganglion impar. Branches are given from the ganglia to the pelvic plexus, and to the middle sacral plexus. THE PREVERTEBRAL PLEXUSES OF THE SYMPATHETIC. The CARDIAC PLEXUS lies against the aorta and pulmonary artery. It is divided into two parts, superficial and deep. The superficial cardiac plexus lies in concavity of the arch of the aorta on the right of the ductus arteriosus. It is com- posed of the left upper cardiac nerve of the sympathetic, the lower cervical cardiac of the left vagus nerve, and branches from the deep plexus. In the plexus is the small ganglion oj Wrisberg. The plexus gives branches to the anterior pul- monary plexus of the left side, and ends in the right coronary plexus which accompanies the right coronary artery. The deep cardiac plexus lies between the arch of the aorta and the trachea. It consists of right and left halves united by branches. The right half lies above the right branch of the pulmonary artery; the left half lies on the left of the trachea, close to the ductus arteriosus. Afferent branches : a. All the cardiac branches from the cervical ganglia of the sympathetic, except the left upper nerve. b. All the cardiac of pneumogastrics and recurrent laryn- geals, except the lower cervical cardiac of the left vagus. Efferent branches from the right side join the superficial cardiac plexus to form the right coronary plexus, and others are distributed to the right auricle. Efferent branches of the left side mostly end in the left coronary plexus, which accompanies the left coronary artery, and in the superficial cardiac plexus. The SOLAR PLEXUS is the largest prevertebral plexus. It lies behind the pancreas and inferior vena cava, in front of the aorta and crura of the diaphragm. It surrounds the origin of the coeliac axis, extending laterally to the supra-renal bodies. It receives the large and small splanchnic nerves and part of the right pneumogastric. It contains several ganglia, and branches are given off from it to accompany the bloodvessels to the viscera, and to form secondary plexuses on these arteries. The semilunar ganglia, one in each half of the solar plexus, lie on the inner side of the supra-renal bodies, the left one 122 i8o THE POCKET ANATOMY lying behind inferior vena cava. The great splanchnic nerve enters its upper end. The diaphragmatic or phrenic plexus accompanies the arteries to the diaphragm. On the right side near the supra- enal body is the phrenic ganglion, connecting together the phrenic nerves of the spinal and sympathetic systems. The supra-renal plexus is derived from the solar plexus and the outer part of the semilunar ganglion. It is joined by branches of one of the splanchnic nerves. The renal plexus is derived from the semilunar ganglion, and partly from the solar and aortic plexuses, and receives the smallest splanchnic nerve. It lies along the renal artery, and contains numerous small ganglia. The spermatic plexus comes off from the renal and aortic plexuses. The cceliac plexus is derived from the solar plexus. It surrounds the coeliac axis, and subdivides into : The coronary plexus accompanies coronary artery along the smaller curvature of the stomach, communicating with the pneumogastric nerves. The hepatic plexus accompanies hepatic artery into the sub- stance of the liver. Communicates with the left vagus, and the right supra-renal plexus. Gives off the cystic, pyloric, right gastro-epiploic and pancreatico-duodenal plexuses. The splenic plexus accompanies splenic artery to the spleen, and is joined by the right pneumogastric. It gives off the left gastro-epiploic and pancreatic plexuses. The superior mesenteric plexus accompanies superior mesenteric artery. The aortic plexus lies on the anterior surface of the abdominal aorta. It gives off the inferior mesenteric and part of the spermatic plexuses. It ends in the hypogastric plexus. The HYPOGASTRIC PLEXUS lies between the two common iliac arteries ; it is formed by the terminations of the aortic plexus, together with branches from the lumbar ganglia. It divides below into two parts, which form the pelvic plexuses. The PELVIC PLEXUSES : two in number. Each is com- posed of a division of the hypogastric plexus, joined with some branches from the 3rd and 4th sacral nerves and ganglia. The following plexuses are derived from the pelvic plexuses : The hsemorrhoidal plexus to the rectum and anal canal. The vesical plexus to the bladder, with secondary plexuses in the male to the vas deferens and to the vesiculae seminales. THE ORGANS OF DIGESTION 181 The prostatic plexus to the prostate gland, giving off the cavernous nerves of the penis. (The vaginal plexus to the vagina. The uterine plexus accompanying the uterine artery to the uterus.) THE ORGANS OF DIGESTION. THE TEETH. Temporary teeth : the following is the dental formula for the temporary teeth, with the dates in months of their eruption : Mo. Mo. Ca. In. In. In. In. Ca. Mo. Mo. ( Upper ..i i i i i i i i i i = io"\ ( Lower . . i i i i i i i i i i = ioj 24 12 18 9 7 7 9 18 12 24 months. Permanent teeth : subjoined is the dental formula for the permanent teeth, with the date in years of their eruption : Wis. Mo. Mo. Bi. Bi. Ca. In. In. In. In. Ca. Bi. Bi. Mo. Mo. Wis. I Upper ixxiiixxiiiiiiii = i61 I Lower ixixiixxiixixii i = 16 ) 18 xa 6 10 9 ii 8 7 7 8 n 9 10 6 12 18 years. THE TONGUE. The tongue occupies the floor of the mouth ; its base is connected with the hyoid bone, the epiglottis, the pillars of the soft palate, and with the pharynx ; along its inferior surface the genio-glossus runs from base to tip, connecting it to the lower jaw and hyoid bone. The mucous membrane on the under surface is smooth, forming in front a median fold, the franum lingua; on the sides it is continuous with the mucous membrane of the mouth. On the dorsum there is a rapht along the middle line, which ends posteriorly in the foramen ccecum. Posteriorly the epiglottis is connected to the tongue by three glosso-epiglottic folds, the middle one being called the fr&num epiglottidis . The anterior two-thirds of the dorsum of the tongue is covered with papillae ; they are of three kinds : The circumvallate papillae (seven to ten) form a row on each side at the back of the tongue, meeting in the middle line thus, A, in front of the foramen caecum. The fungiform papilla: found principally at the apex ^nd on the sides. i8 2 THE POCKET ANATOMY The filiform papilla are numerous, and are arranged in rows parallel to the circumvallate, but towards the tip of the tongue their direction becomes more transverse. Glands : near the circumvallate papillae are found numerous mucous glands, known as the lingual glands. THE MUSCLES OF THE TONGUE. The extrinsic muscles of the tongue are the hyo-glossus, genio-hyo-glossus, palato- glossus, and the stylo-glossus. These have been described (vide pp. 29 and 30). The intrinsic muscles are entirely contained within the sub- stance of the tongue, and are as follows : The superior lingualis: one on each side. Longitudinal fibres lying under the mucous membrane. It arises from the fraenum epiglottidis, and from the fascia along the middle line ; the fibres pass obliquely outwards, the anterior fibres being longitudinal, to the side of the tongue. The inferior lingualis (2) is a bundle of muscular fibres running along the under surface of the tongue from base to tip. It lies between the genio-hyo-glossus and hyo-glossus muscles. It arises from the fascia at the base of the tongue, is joined anteriorly with some fibres of the stylo-glossus, and passes to the apex. Transverse fibres form a horizontal layer of muscular fibres 'between the superior and inferior linguales. The fibres spring from the septum and pass outwards to the sides of the tongue. Vertical fibres arise from dorsum, and mingle with trans- verse fibres. The septum of the tongue is a vertical fibrous partition, extending, in the muscular portion, from the hyoid bone to the apex. Arteries : lingual, tonsillar of facial. Nerves : lingual or gustatory to anterior two - thirds ; glosso-pharyngeal to side and posterior third ; hypoglossal to muscles. THE PALATE. The palate forms the roof of the mouth, and consists of two parts the front being the hard palate, and the back the soft palate. The hard palate consists of the palatal processes of the superior maxillae and palate-bones, together with the mucous membrane and the periosteum covering them . The descending palatine artery and anterior palatine nerve run forwards under cover of alveolus. THE ORGANS OF DIGESTION 183 The soft palate, consisting of muscles, aponeurosis, vessels, nerves, etc., enclosed between two layers of mucous mem- brane, is attached in front to the posterior margin of the hard palate, the sides blending with the pharynx ; from the middle of the posterior edge the uvula projects, and from the bases of this arch, on each side, there are two folds of mucous membrane enclosing muscular fibres the pillars, anterior and posterior, between which the tonsil lies. The narrowed passage between the anterior pillars, leading from the mouth to the pharynx, is called the isthmus faucium. The aponeurosis of the soft palate is attached to the posterior edge of the hard palate, is joined by the tendon of the tensor palati, and becomes lost between the muscles. Structure of the palate from before backwards : 1. Oral mucous membrane and mucous glands. 2. Palato-glossus. 3. Aponeurosis. 4. Tensor palati. 5. Anterior fibres of palato-pharyngeus. 6. Levator palati. 7. Azygos uvulae in middle line. 8. Posterior fibres of the palato-pharyngeus. 9. Mucous glands and pharyngeal mucous membrane. The tonsils occupy the recesses between the pillars of the fauces, the anterior pillar being formed by the palato-glossus and the posterior by the palato-pharyngeus. On the outer side of each is the superior constrictor, and internally the buccal mucous membrane. Their arterial supply is large, from the ascending pharyngeal, ascending and descending palatine, tonsiilar, and dorsalis linguae arteries. THE SALIVARY GLANDS. The PAROTID GLAND is the largest, and lies between the external auditory meatus and mastoid process behind, and the vertical ramus of the jaw in front. Anteriorly, it overlaps the hinder part of the masseter. Boundaries : Ex- ternally. Above. Below. Anteriorly and Below, Behind, Skin. Zygoma. Line from angle Stylo-maxil- External audi- Platysma. Cervical of jaw to mas- toid process. lary liga- ment. tory meatus. Mastoid process. fascia. Posterior belly of Sterno-mastoid. digastric [84 THE POCKET ANATOMY The deep surface is irregular, and lies on the styloid process and its attached muscles, the internal jugular vein, the vagus, spinal accessory and hypoglossal nerves, and is divided into three lobes : The glenoid lobe fills up glenoid cavity behind Glaserian fissure. The pterygoid lobe passes forwards internal to the ramus of the jaw between the external and internal pterygoid muscles. The carotid lobe surrounds the styloid process, and lies between the external and internal carotid artery. The socia parotidis is a separate lobe projecting from the anterior surface. Relations of the Socia Parotidis : Above. Below. Zygoma. Duct. Cervico-facial divi- sion of facial nerve. Internally. Masseter. Transverse facial artery. The duct (Stenson's) is 2 inches long ; comes off from the anterior border and crosses the masseter to pierce the buccinator and buccal mucous membrane. Its opening in the mouth is opposite the 2nd upper molar tooth. Course of the duct: line from bottom of lobule of ear to middle of upper lip. The transverse facial artery lies above the duct, and the buccal branches of the yth nerve below. The parotid gland is traversed by the following, of which the arteries lie deep and the nerves most superficial. Veins. Nerves. Internal maxillary. Facial. Temporal. Auriculo-temporal. Temporo-maxillary . Facial of great auri- cular. Arteries. External carotid. Posterior auricular. Internal maxillary. Superficial tem- poral. Transverse facial. Nerve supply of gland : sympathetic and glosso-pharyngeal. The latter branch may be traced as follows : The tympanic (Jacobson) branch gives off small superficial petrosal, which passes through otic ganglion and joins the auriculo-temporal trunk, thus supplying the gland. THE SUBMAXILLARY GLAND lies under cover of the body oi the lower jaw. Superficial lobe: separated by stylo - maxillary ligament from parotid, grooved above and behind by facial artery. THE ORGANS OF DIGESTION 185 Lies upon. Superficial Coverings. Below. Mylo-hyoid. Platysma. Tendon of Stylo-hyoid. Deep fascia. digastric. Hyo-glossus. Facial vein. Deep lobe : passes with duct between mylo-hyoid and hyo- glossus. The duct of Wharton : passes with deep lobe of gland beneath mylo-hyoid, resting on the hyo-glossns. At first the lingual nerve lies above the duct and the hypoglossal nerve below, but the duct, crossing over the nerve, passes up- wards and forwards on genio-hyo-glossus to open on the papilla by the side of the fraenum linguae. Nerves : sympathetic, and chorda tympani through sub- maxillary ganglion. THE SUBLINGUAL GLAND occupies the sublingual fossa of lower jaw, lying under mucous membrane of floor of mouth, and having its anterior extremity close to the fraenum. Below is the mylo-hyoid, and internally is the genio-hyo-glossus. Ducts of Rivini (18 to 20) : open separately in the floor of the mouth. One larger one from the posterior part opens into or by the side of Wharton's duct, and is called the duct of Bartholin. Nerves : sympathetic, and from chorda tympani through submaxillary ganglion. THE PHARYNX. The Pharynx is an oval musculo-membranous bag lying behind the nose, mouth, and larynx. It is about 4^ inches long, and extends from the base of the skull to the lower border of the cricoid cartilage in front, and to the lower border of the 5th cervical vertebra behind. It is widest opposite the hyoid bone. Behind, it is separated by a pre- vertebral layer of the deep cervical fascia from the longus colli and rectus capitis anticus muscles of each side. Below, it is continuous with the resophagus. A ttachments : Above : under surface of body of sphenoid, under surface of petrous of temporal. In front: internal pterygoid plate, pterygo-maxillary liga- me%. lower jaw, base of tongue, cornua of hyoid bone, and styj \ hyoid ligament ; thyroid and cricoid cartilages, corre- sponding to attachments of constrictor muscles. 1 86 THE POCKET ANATOMY Behind. Longi colli. Recti capitis antici. Upper 5 cervical vertebrae. Prevertebral fascia. Below. (Esophagus Relations : Laterally. Styloid process. Stylo-hyoid. ^ ^ Stylo-pharyngeus. jo Internal pterygoid. I & Sterno-thyroid. I Sterno-hyoid. J ^ Internal and common > carotid. Ascending pharyngeal. Ascending palatine. Tonsillar. Internal jugular vein. Glosso-phary ngeal . Pneumogastric. Sympathetic. Spinal accessory. Hypoglossal. Superior laryngeal. Thyroid gland. Muscles : inferior, middle and superior constrictors, stylo- pharyngeus, palato-pharyngeus, salpingo-pharyngeus. (Vide pp. 29 and 30.) A runes : Ascending pharyngeal ; pterygo-palatine ; ascend- ing and descending palatine ; dorsalis linguae ; tonsillar. Openings : the posterior nares (2), placed in the upper part of the anterior wall ; Eustachian tubes (2), open one on each side at the upper part; the mouth, situated just below the posterior nares ; the laryngeal and cesophageal openings. The pharyngeal wall consists of 4 layers : (i) internally a striated squamous epithelium with submucous tissue ; (2) pharyngeal aponeurosis ; (3) muscular ; (4) an indistinct layer of fascia called the bucco-pharyngeal fascia, derived from the deep cervical fascia. The pharyngeal aponeurosis forms the base of the walls of the pharynx, lying between the mucous membrane, and the muscles. It is thin below, but strong above, where it fills in the space above the upper crescentic margin of the superior constrictor (sinus of Morgagni), over which the Eustachian tube passes. It is attached above to the body of the sphenoid and petrous portion of the temporal, being strengthened in the middle line by a process of fascia attached to the pharyngeal tubercle on the basilar part of the occipital bone. Inferiorly it becomes lost between the muscular and mucous strata. THE ORGANS OF DIGESTION 187 THE (ESOPHAGUS. The oesophagus extends from pharynx to stomach, and is 9 inches long. It begins at the lower border of cricoid cartilage opposite the 5th cervical vertebra, and ends opposite the loth dorsal. Course and relations : In the neck : passes downwards and to the left. In Front. Trachea. Thyroid gland. Left recurrent 1 a r y n g e a 1 nerve. Behind. Vertebrae. Left longus colli muscle. Left Sidt. Left inferior thy- roid. Left carotid. Left subclavian. Thoracic duct. Right Side. Right carotid. Right recurrent 1 a r y n g e a 1 nerve. In the chest. In the superior mediastinum passes down- wards to the right to reach middle line opposite 5th dorsal vertebra. In the posterior mediastinum : passes forwards and down- wards to the left, with the two pneumogastrics, which form a plexus on its surface ; the left nerve is anterior, and the right is posterior. Behind. In Front. Left carotid artery. Longus colli. bifurcation of Vertebra. trachea. Thoracic duct. Right pulmonary Venae azygo artery. Left bronchus. Left recurrent laryn- vessels. geal nerve. Aorta (below). Pericardium and left auricle. 1 liaphragm. inores. Right intercostal Thoracic aorta. Left pleura. Left Side. Right Side. Left subclavian Right pleura. artery. Vena azygos Left pneumogas- major. trie nerve. Arch of aorta. In the abdomen : passes through cesophageal opening in diaphragm opposite the disc between the gth and roth dorsal vertebrse, to end at the cardiac opening of the stomach opposite the loth dorsal vertebra. THE STOMACH. Form : conical, with base or fundus to left side ; the upper border is concave, and is called the lesser curvature ; the lower border is convex, and is named the greater curvature. The left extremity is known as the fundus, above and to the right of which is the cardiac orifice, and the right or small end is termed the pyloric extremity. i88 THE POCKET ANATOMY Position : occupies left hypochondriac and epigastric regions. Orifices : cardiac, above, communicating with the oeso- phagus; pyloric, at the right extremity, passing into the duodenum. Dimensions : 10 to 12 inches long ; 4 to 5 inches in diameter at widest part. Relations : Left or cardiac end : fixed by oesophagus and gastro-phrenic ligament to diaphragm, lying beneath the yth left costal cartilage, i inch from sternum : it is connected with the spleen by the gastro-splenic omentum. Right or pyloric end .- reaches gall-bladder, touching under part of quadrate lobe of liver ; is very movable, when stomach is empty is in mid-line on line midway between upper border of sternum and upper border of pubis, over ist lumbar vertebra. Anterior surface, which also looks upwards, is in contact with, from left to right, diaphragm, abdominal parietes (epi- gastric region), under surface of liver. Posterior surface is separated from diaphragm, aorta, pan- creas, spleen, left kidney, and supra-renal, transverse meso- colon and colon, by lesser sac of peritoneum. Superior border : attached to liver by small omentum. Inferior border : gives attachment to great omentum. ARTERIES. Coronary and pyloric run along lesser curvature ; right and left gastro-epiploic, along inferior or greater curvature ; vasa brevia, from the splenic to fundus. NERVES. Right pneumogastric, to posterior surface; left [neumogastric, to anterior surface ; sympathetic, from the solar plexus to both surfaces. THE SMALL INTESTINES. THE DUODENUM. Length : 8 to 10 inches. Shape : horse-shoe, with the convexity to the right side, the concavity enclosing the head of the pancreas. Position : occupies epigastric and umbilical regions. Has no mesentery, and is only partially invested by peri- toneum. Divided into three parts. Relations : 1st part : 2 inches long ; directed from pylorus upwards, backwards, and to the right, reaching the neck of the gall- THE SMALL INTESTINES 189 bladder. The ist inch is invested with peritoneum, but the 2nd inch is covered in front only. In front. Liver, gallbladder. Behind. Bile - duct, 'vena portae, hepatic artery, gastro- duodenal artery. Below. Head of pancreas. 2nd part : 3^ inches long ; is vertical ; passes from opposite neck of gall-bladder down to 3rd lumbar vertebra. Ducts of liver and pancreas enter this part. Covered in front by peritoneum. In front. Transverse colon, liver and gall-bladder, small intestines. Behind. Right kidney, supra-renal capsule, renal vessels, and inferior vena cava. Left side. Head of pancreas, common bile - duct, and pancreatic duct. Right side. Hepatic flexure of colon. On the inner aspect, 3^ or 4 inches from the pylorus, is the bile papilla, on which is the orifice for both the common bile and pancreatic ducts. 3rd part : about 4^ inches long ; passes from right to left across spine, ascending from 3rd to and lumbar vertebra, ends in jejunum on left side of spinal column ; lies below transverse meso-colon, and is covered in front by peritoneum, except where root of mesentery crosses it. In front. Superior mesenteric vessels and plexus. Behind. Aorta, inferior vena cava, crura of diaphragm, left psoas, and left renal vessels. Above. Pancreas. ARTERIES. Pyloric, and superior pancreatico-duodenal of hepatic, inferior pancreatico-duodenal of superior mesenteric. NERVES, from solar plexus. THE JEJUNUM AND ILEUM. The jejunum forms f of the rest of the small intestines, which are 23 feet long ; commencing on the left side of the 2nd lumbar vertebra, it terminates in the ileum ; it is wider, and its coats are thicker, more vascular, and of a deeper colour than the ileum. The ileum consists of the remaining f of the small intestines, and terminates in the right iliac fossa by opening into the caecum. The ileum with the jejunum is suspended from the posterior abdominal wall by the mesentery (p. 196). The vessels are derived from the superior mesenteric artery, and the veins drain into the vein of the same name. i go THE POCKET ANATOMY The following characteristics will serve to distinguish the three parts of the small intestines : Duodenum. The largest part. Thickest coats. Brunner's glands. Valvular conniventes. No mesentery. Jejunum. More vascular than ileum. Valvulae conniventes. Villi, well marked. Ileum. Villi, small. Valvulae conniventes, not present or only slightly. Peyer's patches. THE LARGE INTESTINE. Extent .- from the ileum to the anus. Length : 5 or 6 feet. Characteristics of Ccecum and, Colon. Larger size, more fixed than the small intestine ; has appendices epiplo'icse. The longitudinal muscular fibres are arranged in three bands, which, being shorter than the other coats, cause sacculation. The caecum is a dilated pouch in which the large intestine commences, situated in the right iliac fossa, and completely covered by peritoneum ; at the lower, inner, and back part, and generally attached by a mesentery to the caecum, is the appendix vermiformis, a blind tubular projection, about 3 inches long, and about the size of a large quill. The ileo-ccscal valve lies on the left side of the caecum ; is formed by the two inner coats of the ileum passing through the wall of the caecum. The upper fold is horizontal, and called the ileo-colic. The lower is vertical, and termed the ileo-caecal. The ridge on either side is called the frcznum. The COLON is divided into ascending, transverse, descend- ing, iliac and pelvic. The ascending colon extends from the caecum to the under surface of the liver to the right of the gall-bladder, where it turns to the left, forming the hepatic flexure. It lies in the right lumbar and right hypochondriac regions. The peritoneum covers the anterior and lateral surfaces. Length, 8 inches. Relations. In front. The convolutions of the ileum. Behind. Iliacus, quadratus lumborum, outer side of right kidney. The transverse colon passes in the umbilical region from right to left, from the gall-bladder to the spleen. It forms an arch, convex anteriorly and below : the transverse arch of the colon. It is entirely surrounded by peritoneum, which is attached posteriorly to the spine, forming the meso-colon. Length, 20 inches. Relations. Above. Liver, gall-bladder, large curvature of stomach, lower end of spleen. Below. Small intestines. Anteriorly. Anterior layers of great omentum, anterior abdominal wall. THE LARGE INTESTINE 191 Posteriorly. Right kidney, 2nd part of duodenum, transverse meso-colon, pancreas, and small intestines. The descending colon passes from the end ot the transverse colon by a bend, the splenic flexure. Between the splenic flexure and the diaphragm, opposite the roth left rib, is a fold of the peritoneum, the costo-colic ligament, which slings up the spleen. The gut then passes downwards to the left iliac crest, ending in the iliac colon. The peritoneum invests its anterior and lateral surfaces. Length, 4 to 6 inches. Relations. Behind. Left kidney, quadratus lumborum, and psoas. In front. Small intestine. Inner side. Outer border of left kidney. The iliac colon is continuous with the descending colon at the left iliac crest, and ends at the inner border of the left psoas. Peritoneum invests its anterior and lateral surfaces ; it has no mesentery. Relations. In front. Small intestines; when distended, the anterior abdominal wall. Behind. Left ilio-psoas. Length. 5 to 6 inches. The pelvic colon extends from the inner border of the psoas to the level of the 3rd sacral vertebra. Length. 16 or 17 inches ; very variable. It has an extensive mesentery. Relations. Passing over left brim of pelvis, it crosses left external iliac vessels and left ureter, and passes to right margin of pelvis, resting on bladder in male and uterus in female ; above lie coils of small intestine. It then turns back to mid-line on posterior wall of pelvis, and, forming a second bend, descends to end in the rectum. The rectum : Extent. From the 3rd sacral vertebra to the tip of the coccyx (5 to 6 inches long). Relations. It has peritoneum on the upper of anterior surface only, and no mesentery. In front. Recto-vesical pouch : triangular area at base of bladder, vesiculaeseminales, vasa deferentia, posterior surface of prostate (male), posterior wall of vagina (female). Behind. Sacrum, coccyx, levatores ani. Laterally. Pararectal fossa, below coccygeus. The anal canal : Extent. From the tip of the coccyx to anus (i to i inches Jong). Direction. Downwards and backwards. Relations : In front. Membranous part of the urethra, bulb of corpus 192 THE POCKET ANATOMY spongiosum (male), posterior wall of vagina, the perineum intervening (female). Laterally and behind. Levatores ani, which, uniting, support it as in a sling. Internal and external sphincters. Ischio- rectal fossa. THE LIVER. Situation. Right and left hypochondriac and epigastric regions. Average weight. 50 ounces. Upper surface. Convex, covered by peritoneum; above is the diaphragm. It is divided into two unequal lobes (right and left) by a fold of peritoneum, called the suspensory or broad ligament. In relation with the diaphragm, Under surface. Concave, and is in relation with the stomach, pylorus, duodenum, hepatic flexure, right kidney, and right supra-renal body ; is covered with peritoneum, except where gall-bladder is attached, and at the transverse fissure, and at the fissure for ductus venosus, which give attachment to the lesser omentum. Posterior surface. Is broad and round : connected to dia- phragm over right lobe by the coronary ligament, (between the two layers of which its surface is non-peritoneal. On this surface, opposite the loth and nth dorsal vertebrae, is the Spigelian lobe, which bounds the lesser sac in front. Right supra-renal capsule, inferior vena cava, aorta, oeso- phagus, and lesser peritoneal sac lie behind. Anterior surface. Triangular, and marked by a notch opposite the attachment of the suspensory ligament. In relation with diaphragm and anterior abdominal wall. Right surface. Convex and in relation with diaphragm. The LIGAMENTS are five in number ; four are composed of peritoneum, and are : The suspensory, falciform, or broad ligament, sickle-shaped, with the base forward. It is attached above to the diaphragm, extending on to the sheath of rectus as far as the umbilicus, and below from the notch in front, to the posterior edge of the liver. The inferior edge encloses the round ligament. The lateral ligaments, right and left, extend from the sides of the diaphragm to the posterior border of the liver. The coronary ligament is continuous with the lateral liga- ments, and attaches the posterior surface of right lobe of the liver to the diaphragm. The round ligament is the obliterated umbilical vein and ductus venosus contained within the posterior or free edge of the suspensory ligament. THE LIVER 193 FISSURES : The longitudinal fissure is occupied by the round ligament, and divides the organ into right and left lobes ; it is separated into two parts by its union with the transverse fissure. The anterior part or umbilical fissure contains the remains of the umbilical vein, and lies between the left lobe and the lobus quadratus. The posterior part or fissure of the ductus venosus lies between the left lobe and the lobus Spigelii, and contains the remains of the ductus venosus. The transverse or portal fissure is placed at right angles to the longitudinal fissure, between the lobus quadratus and the lobus Spigelii, and lodges the hepatic ducts, artery, and portal vein, nerves and lymphatics. The artery lies between the duct in front, and the vein behind. The fissure for the inferior vena cava is placed obliquely at the posterior margin of the liver, behind the gall-bladder, lying between the right lobe and the lobus Spigelii, and sepa- rated from the transverse fissure by the lobus caudatus. The hepatic veins enter the vena cava at the bottom of this fissure. LOBES : Right and left lobes are separated from each other by the umbilical fissure on the under surface, and posteriorly by th^ fissure of the ductus venosus. The right is the larger, ami contains the transverse fissure and fissure for the inferior vena cava ; is subdivided into the three following lobes : Tiie lobus quadratus : bounded by the umbilical and trans- verse fissures and the fossa of the gall-bladder. The lobus Spigelii is on the posterior surface, and is the projection between fissures for the inferior vena cava and ductus venosus, behind the transverse fissure. The lobus caudatus connects the preceding lobe with the main mass of the right lobe, and lies behind the transverse fissure. FOSSA : The fossa for the gall-bladder lies on the under surface of the right lobe, parallel to the umbilical fissure, and separates the quadrate lobe from the main mass of the right lobe. THE GALL-BLADDER AND BILE-DUCTS. The gall-bladder is a conical bag placed in a fossa on the under surface of the right lobe of the liver. Its upper surface is attached to the liver, and its fundus and posterior surfaces are invested by peritoneum reflected from the adjacent surface of the liver. Relations. The body is in relation in front with the liver 13 194 THE POCKET ANATOMY and behind with the ist part of duodenum, and the hepatic flexure of colon. The fundus is in contact with the parietes opposite the gth right costal cartilage. The cystic duct passes from the neck of the gall-bladder downwards, backwards, and to the left, to join the hepatic duct at the mouth of the portal fissure. The hepatic duct, formed by union of ducts from right and left lobes, issues from the liver at the bottom of the transverse fissure. It joins the cystic duct, the two forming the common bile-duct. Its length is i inch, and it lies entirely within the portal fissure. The ductus communis ckoledoclms or common bile-duct results from the union of the hepatic and cystic ducts. It passes downwards in front of the foramen of Winslow in the layers of the gastro-hepatic omentum, having the vena porta behind, and the hepatic artery on the left. It then descends behind the ist part of the duodenum, and, passing between the pancreas and 2nd part of the duodenum where it lies on the inferior vena cava, it enters the small intestine obliquely, a little below the middle of the descending part of the duo- denum, by an opening on the biliary papilla (p. 189) common to it and the pancreatic duct. Length 3 inches. Vessels of the liver : The hepatic artery from the coeliac axis enters the trans- verse fissure and divides into two branches for the right and left lobes. The right branch gives off the cystic branch to the gall-bladder. The portal vein, having the hepatic artery on the left and in front, and the common bile-duct on the right, ascends between the layers of the gastro-hepatic omentum, in front of the fora- men of Winslow, to the transverse fissure. The vessels, accom- panied by nerves and lymphatics, are surrounded by areolar tissue, the capsule of Glisson, which passes with them into the liver. The hepatic veins pass out of the liver at the bottom of the fissure of the inferior vena cava, immediately joining that vessel. THE PANCREAS. Length : 6 to 8 inches. Consists of a body, enlarged to the right at its head, with which the body is connected by a narrow part or neck, and narrowed to the left, where it ends as the tail. Position. Placed in the epigastric and left hypochondriac regions, directed transversely across posterior wall of abdomen. THE PANCREAS 195 Relations of the body : Upper surface. Stomach and small omentum : covered by peritoneum. Posterior surface. Aorta, crura of diaphragm, splenic vein, left kidney, left supra-renal body and left renal vessels. Upper border. From right to left ; creliac axis, splenic artery. Inferior surface. From right to left ; duodeno-jejunal flexure, splenic flexure, and small intestines : covered by peritoneum. Left end or tail. Touches lower part of internal surface of spleen. Right end or head. Embraced by three parts of duodenum, from which it is partly separated, behind by common bile- duct, and in front by pancreatico-duodenal arteries. Is covered in front by transverse colon : the superior mesen- teric vessels overlap the left end of the head, lying in a groove on the anterior surface. Behind are inferior vena cava and right renal vessels. Neck lies on the 1st and 2nd lumbar vertebrae, from which it is separated by the crura of the diaphragm, superior mesen- teric vessels, and portal vein. Duct (canal of Wirsung) : extends transversely from left to right, opens into 2nd part of the duodenum in common with the ductus communis choledochus. Arteries: pancreatic of splenic, superior pancreatico-duo- denal of hepatic, and inferior pancreatico-duodenal of superior mesenteric. Veins : open into splenic and superior mesenteric. Nerves : from the solar plexus. THE SPLEEN situated in the left hypochondrium and epigastrium, is of an oblong, flattened form, the external surface being convex ; on the inner surface is a vertical ridge dividing it into two parts, the posterior of which is applied to the outer surface of the left kidney, whilst the anterior receives the tail of the pancreas, and lies against the fundus of the stomach. Near this ridge is a fissure, the hilum, where the vessels enter. The anterior border is notched, and the inferior or basal sur- face is triangular, and rests on the costo-colic ligament (vide S. 191) and the splenic flexure. It is covered, except at the ilum, by peritoneum, which here passes forwards and inwards in a double line enclosing the vessels, as the gastro-splenic 132 ig6 THE POCKET ANATOMY omentum, to the fundus of the stomach: behind the hilum two layers pass on to the left kidney as lieno-renal ligament. Relations. External surface. Diaphragm, which separates it from the gth, ioth, and nth left ribs and pleura. Internal surface. In front of the hilum. Fundus of stomach . Behind the hilum. Left kidney, left supra-renal body. Below the hilum. Tail of pancreas. Inferior surface. Costo-colic ligament and splenic flexure. Arteries: Splenic. Nerves : Branches from solar plexus of the sympathetic. THE PERITONEUM. The peritoneum is the serous membrane of the abdominal cavity. It consists of a parietal layer lining the abdominal and pelvic walls, and a visceral layer reflected more or less over the contained organs. In the male it is a closed sac, but in the female the free extremities of the Fallopian tubes open into the cavity. The continuity of the peritoneum may bt, traced in the following manner. Commencing at the middle line and passing horizontally, the peritoneum lines the right half of the abdominal wall, as far as the lumbar region, where it entirely surrounds the caecum and vermiform appendix. It only invests the front and sides of the ascending colon, though occasionally the whole circumference of the gut is enclosed, a meso-colon being then formed. The peritoneum then passes inwards, covering the lower part of the anterior surface of the right kidney, the front of the 3rd part of duodenum, and goes downward over the front of the vessels of the small intestines, encloses the small intestines, and is reflected upwards on the posterior surface of the vessels to the spine, thus forming the mesentery. From the spine it may be traced to the left over the lower part of the anterior surface of the left kidney to the descending and iliac colon, and thence on to the abdominal parietes to the middle line. The descending and iliac colon is invested in a similar manner to the ascending. The peritoneum of the pelvis is continuous with that of the abdominal cavity. It encloses completely the pelvic colon, and forms the pelvic meso-colon. It is applied to the front and sides, and lower down to the front only of the rectum, whence it is reflected in the male on to the base and upper part of the bladder, forming the recto-vesical pouch ; this is bounded on each side by the peritoneum THE PERITONEUM 197 reflected forwards from the sides of the rectum over the obliterated hypogastric artery and ureter,lformingthe/>osten'or false ligament of the bladder. From the apex of the bladder the peritoneum passes upwards on to the anterior abdominal wall, enclosing the remains of the urachus and constituting the anterior false ligament of the bladder ; whilst laterally it is reflected from the bladder along the line of the obliterated hypogastric artery to the iliac fossa, forming the lateral false ligaments of that viscus. Where the obliterated hypogastric artery passes between the abdominal wall and the side of the bladder it raises the peritoneum into a fold, which separates two shallow fossae, the internal and external inguinal fosses, which correspond respectively to the internal and external abdominal rings. In the female the peritoneum is reflected from the sides and front of the rectum to the upper part of the posterior wall of the vagina, and thence over posterior, upper, and anterior surfaces of the uterus to the bladder. Between the uterus and rectum is the recto-vaginal or Douglas's pouch, corresponding to the recto-vesical pouch in the male. The peritoneum passes off from the lateral margins of the uterus to the pelvic wall, forming the broad ligaments, in the upper border of which folds the Fallopian tubes run, the peri- toneum being continuous with their open fimbriated ex- tremities. In the upper part of the abdomen the peritoneum is attached to the under surface of the diaphragm as far back- wards as the posterior surface of the liver, and the oesophageal opening of the stomach. It is then reflected forwards on the upper surface of the liver, forming the ligaments of that organ ; and passing round the anterior border it is applied to the under surface as far as the transverse fissure, where, meeting a peritoneal layer from the posterior surface (from the smaller sac), the two descend to the stomach to form the small or gastro-hepatic omentum. Tracing it to the right from the longitudinal fissure, it invests the gall-bladder, under surface of the right lobe, and the front of the 2nd part of the duodenum, passing to the anterior surface of the right kidney, where it becomes continuous with the part already traced. To the left of the longitudinal fissure the peritoneum covers the left lobe of the liver, and is reflected over the front of the cardiac end and fundus of the stomach, whence it passes off to invest the spleen, forming a reduplicature, the gastro- splenic omentum. From the spleen it is continued over the anterior surface of the left kidney, forming the posterior i 9 8 THE POCKET ANATOMY layer of the lieno-renal ligament, and over the descending colon to join the part already described. Between the liver, stomach, and transverse colon is a diverticulum of the main peritoneal sac, which communicates with the larger peritoneal cavity through the foramen of Win- slow. To understand the disposition of the layers one has only to imagine the smaller sac to have been invaginated through the foramen of Winslow inwards and behind the stomach, and the arrangement becomes clear. The two sacs traced vertically. From transverse fissure of liver, two layers pass : To small curvature of stomach. Two layers separate, one passing in front and the other behind stomach, thus enclosing it. Join together at great curvature, forming anterior layers of great omentum. Pass down in front of and beyond transverse colon. Bend upwards and backwards, and separate to enclose transverse colon ; continue together to the posterior abdominal wall, until opposite the anterior border of the pancreas, where they part, one layer passing upwards, and the other down- wards. The ascending layer passes : Over upper surface of pancreas and posterior part of diaphragm. Then on to posterior surface of liver to the transverse fissure. The descending layer passes : Along superior mesenteric vessels, round jejunum and ileum, and back to spine, forming mesentery. Downwards in front of spine, lower part of aorta and sacral promontory. Over pelvic colon, forming pelvic meso-colon. Forwards. Male. To bladder, forming recto-vesical pouch and posterior false ligaments. Female. To vagina and uterus, forming posterior liga- ments of uterus and recto-vaginal pouch. Then over uterus to bladder, forming utero-vesical pouch and posterior vesical ligaments. Over bladder to anterior abdominal wall, covering urachus and obliterated hypogastric arteries as far as umbilicus. Over under surface of diaphragm. Reflected over upper surface of liver. THE PERITONEUM 199 Round anterior border of liver to under surface as far as transverse fissure. The two sacs traced horizontally, at the level oj the foramen of Winslow. From falciform ligament of liver : Over anterior abdominal wall and diaphragm. Over outer part of left kidney. Reflected outwards behind splenic vessels to spleen, forming posterior layer of lieno-renal ligament. Over spleen as far as hilum. To stomach, forming anterior layer of gastro-splenic omentum. Over anterior wall of stomach into anterior layer of gastro- hepatic omentum. Turns round hepatic artery, forming anterior edge of foramen of Winslow (here the smaller sac commences). Passing from right to left : Forms posterior layer of small omentum. Over posterior surface of stomach. Forms posterior layer of gastro-splenic omentum, reaching hilum of spleen. Forms anterior layer of lieno-renal ligament. Passing now from left to right : Continues over left kidney, aorta, and inferior vena cava, here forming posterior boundary of foramen of Winslow (here smaller sac ends, and large sac again commences). Over right kidney to liver. Over under-surface of liver to left border, round which it may be traced over anterior surface, to falciform ligament. SYNOPSIS OF PROCESSES OF THE PERITONEUM. Omenta folds connected with the stomach. Lesser or Gastro-hepatic Omentum. From transverse fissure and fissure for ductus venosus on liver to small curvature of stomach and ist part of duodenum. Right border free, forming anterior boundary of foramen of Winslow. Great or Gastro-colic Omentum. Formed, as shown above, by the passing downwards and then folding upwards of the two layers passing from stomach, and thus encloses the lower part of the cavity of the smaller sac of the peritoneum. Gastro-splenic Omentum. Passes from fundus of stomach to hilum of spleen, and contains the splenic vessels be- tween its layers. Below it is continuous with the great omentum. 200 THE POCKET ANATOMY Mesenteries folds connecting intestine to posterior ab- dominal wall. The Mesentery. Attached behind to left side of 2nd lumbar vertebra, passing downwards across vertebras to right sacro- iliac synchondrosis. Contains superior mesenteric vessels, jejunum and ileum between its layers. The upper layer is continuous with inferior layer of transverse meso-colon, the lower layer with peritoneum on posterior abdominal wall. Transverse Meso-colon. Formed by junction of two ascend- ing layers of great omentum after they have enclosed transverse colon; at the spine the two layers separate, as explained, into ascending and descending layers. Pelvic Meso-colon. A long process attached to brim of pelvis. Ligaments. The peritoneum, as explained, is reflected from the abdominal walls to viscera, forming ligaments. Ligaments of the Liver : Suspensory or Falciform. Sickle-shaped fold passing from anterior abdominal wall to upper and anterior surfaces of liver. The inferior free border contains obliterated umbilical vein or round ligament. Coronary. Connects right lobe to diaphragm ; consists of two layers, the anterior being derived from greater sac, and the posterior from lesser sac. Lateral (2). These are the right and left ends of the coronary ligament. Ligaments (False) of the Bladder : Posterior False Ligaments (2). The edges of the recto-vesical pouch. Lateral False Ligaments (2). Reflection from sides of bladder. Superior False Ligament. Reflection from bladder to anterior abdominal wall along urachus. Ligaments of the Uterus : Broad Ligaments (2). Each passes from side of uterus to lateral pelvic wall : contains between its folds the round ligament, Fallopian tube, the ovary, and its ligament and branches of ovarian and uterine vessels. Anterior Ligaments (2). Margins of utero-vesical pouch. Posterior Ligaments (2). Margins of recto-vaginal pouch. Ligament of Spleen, or lieno-renal ligament, passes from left kidney to spleen ; the right or anterior layer is formed by the lesser sac, and the left or posterior by the larger one. Behind, Above. Below. Between the layers of the Inferior vena cava. Right crus of Caudate lobe. ist part of duodenum. Commence- ment of small omentum. diaphragm. hepatic ar- tery. THE MEDIASTINA 201 Costo-colic ligament (vide p. 191.) The foramen of Winslow is the orifice behind the right free margin of the small omentum, by which the smaller peritoneal sac communicates with the general peritoneal cavity. Relations : In Front. Hepatic artery. Portal vt-.in. Common bile-duct. THE MEDIASTINA. The superior mediastinum is the space above the peri- cardium extending upwards to the root of the neck. Boundaries : Above. Superior aperture of the thorax. Below. Plane passing from lower part of body of 4th dorsal vertebra, to the junction of the gladiolus and manubrium of sternum. In front. Manubrium and origins of sterno-hyoid and sterno- thyroid muscles. Behind. First four dorsal vertebrae, and lower ends of longi coin. Laterally. The parietal or mediastinal pleura, passing back from posterior surface of sternum to vertebrae. Contents. Trachea (lower end), oesophagus, thoracic duct, transverse part of arch of aorta, innominate artery, thoracic part of left carotid and subclavian arteries, innominate veins, upper part of superior vena cava, phrenic and pneumogastnc nerves, left recurrent laryngeal and the cardiac nerves, lymphatic glands and remains of thymus gland. The anterior mediastinum is the space between the two pleurae in front of the pericardium ; it is narrow above, but broader below. Boundaries : In front. Sternum, with 5th, 6th, and part of yth left costal cartilages, triangularis sterni, and left internal mammary vessels. Behind Pericardium. T..iterallv Pleura 202 THE POCKET ANATOMY Contents. Anterior mediastinal glands. The middle mediastinum contains the pericardium with its contents, the phrenic nerves and accompanying vessels, the arch of the vena azygos major, the roots of the lungs and bronchial lymphatic glands. The posterior mediastinum lies behind the pericardium. Boundaries : In front. Pericardium and roots of lungs, and diaphragm (below). Behind. Spinal column, from the lower border of the 4th dorsal to the i2th dorsal vertebra. Laterally. Pleura. Below. Diaphragm covered by pleura. Above. Plane passing forwards from lower border of 4th dorsal vertebra. Contents. Descending thoracic aorta and some of its right intercostal branches, ossophagus, pneumogastric and great splanchnic nerves, the three azygos veins, thoracic duct, and posterior mediastinal glands. THE HEART AND PERICARDIUM THE PERICARDIUM. The pericardium is a nbro-serous membrane, containing the heart and the commencement of the great vessels. The apex points upwards and surrounds the ascending aorta, superior vena cava, and pulmonary artery for about 2 inches i.e., to the level of the lower border of the aortic arch. The base is fixed to the central tendon and adjoining muscular fibres of the diaphragm. In front. Behtnd. Laterally. Gladiolus. Roots of lungs. Pleura. Left costal car- CEsophagus. Comes nervi phre- tilages (4th to Descending aorta. nici vessels. yth). Phrenic nerve. Remains of thy- mus gland. Overlapped by both lungs and pleurae. THE HEART AND PERICARDIUM 203 The serous layer of the pericardium lines the inner surface of the pericardium, and is continued on to the surface of the heart, being also prolonged over the vessels in the pericar- dium. The aorta and pulmonary artery are enclosed in one sheath, and it surrounds the ends of the four pulmonary veins, forming a pouch posteriorly between the veins of the right and left sides. The part of the superior vena cava within the pericardium is also invested by it. The serous layer forms a reduplicature above and in front of the root of the left lung, enclosing the hbrous remains of the left superior vena cava ; it reaches from the left superior inter- costal vein downwards to the side of the left auricle, where it joins the serous investment round the left upper pulmonary vein. This reduplicature is known as the vestigial fold of Marshall. THE HEART. The heart is a hollow muscular organ enclosed in the pericardium, and having an irregular conical shape. It is attached at its base to the great bloodvessels, being otherwise free within the pericardial sac. Position. The heart is placed obliquely, the base being directed upwards, backwards, and to the right; the apex downwards, forwards, and to the left. The apex corresponds to a point in the 5th left intercostal space 3^ inches from the mid-line. The Limits of the Heart. Superior. Line from lower border of 2nd left, to upper border of 3rd right costal cartilage. Inferior. Line from yth right chondro-sternal articulation to apex. Right side. Line drawn nearly vertically i inches from mid-line of sternum, from upper to lower limit. Left side. Line from lower border of 2nd left costal cartilage, i inch from sternum, downwards and to the left to apex. Position of the Valves. Pulmonary. Opposite upper border of 3rd left costal carti- lage near sternum. Aortic. Opposite left of sternum, on level with lower border of 3rd costal cartilage. Tricuspid. Opposite right of sternum, on level with 4th intercostal space 204 THE POCKET ANATOMY Mitral. Opposite junction of 4th left costal cartilage with sternum. Divisions. The heart is divided longitudinally by a septum into two halves, right and left, each of which is subdivided transversely into two cavities. Those four divisions are indicated on the heart's surface by grooves. Two longitudinal grooves, one situated on the anterior and the other on the posterior surface, indicate the lateral division, whilst a trans- verse furrow, the auricula-ventricular groove, indicates its separa- tion into auricles above the furrow and ventricles below it. The Circulation. The right auricle receives venous blood from the vense cavae and coronary sinus ; thence it passes into the right ventricle, whence it is conveyed to the lungs by the pulmonary artery. After being oxygenized the blood passes into the left auricle by the pulmonary veins ; thence it is conveyed into the left ventricle, and from there to the aorta, whence it passes through the body. THE CAVITIES OF THE HEART. The RIGHT AURICLE consists of a principal cavity and an appendix auriculae. The principal cavity, or sinus venosus, is of an irregular form. The appendix auricula is a small muscular pouch projecting from the anterior and upper angle of the auricle overlapping the root of the pulmonary artery. At the junction externally of the two cavities is seen a well-marked groove (sulcus terminalis), which on the interior appears as a ridge (crista terminalis of His) . Openings in the sinus. Superior vena cava, in the upper and front part. Inferior vena cava, at the lower and back part of the auricle. Between the openings of the two cavae is a muscular projection, the tubercle of Lower. The coronary sinus opens between the inferior vena cava and the auric ulo-ventricular opening. Foramina Thebesii are the mouths of small cardiac veins. The auricula-ventricular opening is in front of the inferior cava. Openings of anterior cardiac veins (2 or 3) from the surface of the right ventricle. Valves. The Eustachian valve is a semilunar fold of endo- cardium in front of the anterior margin of the inferior vena cava ; passes upwards and to the left to anterior margin of annulus ovalis. THE HEART AND PERICARDIUM 205 The coronary valve, or valve of Thcbesius, protects the open- ing of the coronary sinus. Remnants of foetal structures. The Fossa ovalis is the remains of the foramen ovale on the lower and posterior part of the septum auricularum, just above and to the left of the opening of the inferior vena cava. The annulus ovalis is the upper crescentic elevated margin of the fossa. The musculi pectinati are the prominent muscular columns running over the surface of the appendix auriculae. The endocardium is smooth in the main part of the cavit)', but irregular over the musculi pectinati of the auricu- lar appendix. The RIGHT VENTRICLE consists of a cavity, the upper and left angle of which is prolonged into a funnel-shaped canal, the infundibulum or conus arteriosus, leading to the pulmonary artery. On the wall (except in the infundibulum, which is smooth) are projections, column carnea, formed of muscular bundles, of which there are three varieties : the first are merely prominent ridges ; the second are attached at the ends, being free in the middle ; the third are the musculi papillares, which project inwards, and are attached by their bases to the wall of the ventricle, the other end being connected with the chorda tendinea, or cords attached to the flaps of the auriculo- ventricular valve. The tricuspid valve, which guards the right auriculo-ventricu- lar opening, consists of three cusps, formed by a reduplication of the endocardium, with some fibrous tissue enclosed. The bases of the flaps are attached to the fibrous ring of the auriculo- ventricular orifice, while to their free ends are attached the chordae tendineae. Position of cusps. Right one against right wall of ventricle (marginal cusp). Posterior one between auriculo-ventricular opening and septum (septal cusp). Left between auriculo ventricular and pulmonary orifices (infundibular cusp). The valve prevents regurgitation of blood into the auricle during the heart's contraction. The opening of the pulmonary artery is at the summit of the funnel-shaped infundibulum, and is guarded by the pulmonary semilunar valves. The semilunar valves are three folds of the lining membrane, aright, left, and posterior, which guard the orifice of the pulmonary artery. The free margin of each has in its middle a small fibrous nodule, the corpus Arantii, and between each valve and the beginning of the pulmonary artery is a dilatation called the pulmonary sinus, or sinus of 206 THE POCKET ANATOMY Valsalva. The point corresponding externally to these valves is the upper border of the junction of the third left costal cartilage with the sternum. The LEFT AURICLE consists of a principal cavity and an appendix auriculae ; the latter extends forwards and to the right side, projecting over the commencement of the pul- monary artery. Its interior presents musculi pectinati as on the right side. OPENINGS. The pulmonary veins (4) open into the cavity, two on either side. The auricula-ventricular opening is smaller than that on the right side. On the septum may be seen a shallow depression, the re- mains of the foramen ovale. The LEFT VENTRICLE is longer and more conical than the right, with its walls nearly three times as thick. The interior contains columnae carneae, musculi papillares, and chordae tendineae, as on the right side. OPENINGS. The auricula-ventricular opening corresponds to the junction of 4th left costal cartilage with the sternum ; it is closed by the mitral valve, which is attached to the circum- ference at the opening, similarly to the tricuspid. It consists of two flaps, the larger being anterior (aortic cusp). The aortic opening is placed in front and to the right side of the preceding, and its position may be marked externally by a line drawn through left half of the sternum, on a level with the lower border of the 3rd left costal cartilage. The orifice is guarded by three semilunar valves, which are precisely similar to those on the pulmonary artery, the characteristics of which are, however, better marked ; they are named from their position anterior, right posterior and left posterior. The endocardium is the serous membrane lining the whole of the interior of the heart, and is continuous with the lining membrane of the bloodvessels. The coronary arteries supply the substance of the heart. The right coronary artery comes off from the anterior sinus of Valsalva (aortic), passes on the right side of the pulmonary artery, between it and the right appendix, then backwards along the right auriculo-ventricular groove as far as the posterior inter-ventricular groove, where it divides into two branches, one of which passes transversely in the left auriculo- ventricular groove and joins branch of left artery, whilst the other passes downwards in the posterior inter-ventricular groove to supply the ventricles and septum ; anas descending branch of left artery ORGANS OF VOICE AND RESPIRATION 207 The left coronary artery arises from the left posterior sinus of Valsalva. It passes behind and then to the left of the pul- monary artery, and divides it into two branches, one of which passes forwards and downwards in the anterior inter-ventri- cular groove, and the other to the left and backwards along the left auriculo-ventricular groove. The cardiac veins return the blood from the muscular wall mainly through the coronary sinus into the right auricle (p. 106). The nerves come from the cardiac plexuses. ORGANS OF VOICE AND RESPIRATION. THE LARYNX. The larynx lies in the front and upper part of the neck, being placed below the tongue and hyoid bone and between the large vessels of the neck. It opens above into the pharynx and below into the trachea. It is subcutaneous in the middle line, being covered only by skin and cervical fascia ; but laterally it is overlaid by the insertions of the sterno-hyoid and sterno-thyroid, by the thyro-hyoid and origin of the inferior constrictor. Is composed of cartilages held together by ligaments, and moved by muscles, the whole being lined with mucous membrane. The cartilages of the larynx : The thyroid cartilage is the largest, consists of two wings or alae united in front at an acute angle, and forming the projection known as the pomum Adami. Outer surface : traversed by oblique line, passing upwards and backwards, giving attachment to sterno-thyroid and Ihyro-hyoid muscles, and below oblique line to inferior constrictor. Inner surface : presents in the middle line at the junction of right and left ala, the receding angle, to which are attached the root of the epiglottis, the superior and inferior thyro-aryte- noid ligaments, the thyro - arytenoidei and thyro-epiglottidei muscles. Superior border ; sinuous ; connected to hyoid bone by thyro-hyoid membrane ; the two meeting together anteriorly in the mid-line form notch above pomum Adami. Inferior border : connected with upper border of cricoid by crico- thyroid membrane anteriorly, and by crico-thyroid muscle laterally. Posterior border : thick and rounded, receives insertion of 2o8 THE POCKET ANATOMY stylo- and palato-pharyngei muscles, prolonged upwards into superior cornu, which passes up wards, backwards, and inwards, having lateral thyro-hyoid ligament attached to tip ; and downwards into inferior cornu, shorter, passing downwards, forwards, and inwards, presenting on inner surface a small facet to articulate with cricoid. The cricoid cartilage : shaped like signet ring, deep behind and shallow in front. Outer surface: anterior half gives attachment to crico- thyroid muscles, and behind this to part of inferior con- strictor. Posterior half, broad and thick, presents ridge in middle line for attachment of some longitudinal fibres of oesophagus ; on each side of ridge, a depression giving attach- ment to the crico-arytenoideus posticus, and external to this a small facet for articulation with inferior cornu of thyroid. Inner surface : smooth, lined with mucous membrane. Superior border : inclines from the front, upwards and back- wards, gives attachment anteriorly and laterally to crico- thyroid membrane and crico-arytenoideus lateralis. Presents posteriorly in mid-line a notch, on each side of which is a facet for articulation with arytenoid cartilage. Inferior border: horizontal, connected with ist ring of trachea by intervening membrane. Arytenoid cartilages : are two small pyramidal cartilages, articulating with posterior part of upper border of cricoid. Antero-external surface : convex and rough, receives attach- ment of thyro-arytenoideus muscle and false vocal cord. At upper end is a tubercle for superior thyro-arytenoid ligament, and below an oblique ridge. Posterior surface : hollowed for attachment of arytenoideus muscle. Internal surface : narrow and smooth, covered with mucous membrane. Base : has concave facet on under surface for articulation with cricoid cartilage, and prolonged into three angles. External or muscular process : short and prominent, gives attachment to lateral and posterior crico-arytenoid muscles. Anterior or vocal process : long and pointed, gives attach- ment to true vocal cord. Internal : rounded. Apex : looks backwards and inwards, surmounted by the cartilage of Santorini. Cartilages of Santorini or cornicula laryngis : two small cartilages- of conical shape, each attached to the apex of an arytenoid cartilage, and giving attachment to the aryteno- epiglottidean fold. ORGANS OF VOICE AND RESPIRATION 209 Cuneiform cartilages, or cartilages of Wrisberg, are two small cartilages, one on each side, found in the aryteno- epiglottidean fold. The epiglottis covers the superior aperture of the larynx ; it is a leaf-shaped lamina of yellow nbro-cartilage. Apex: attached to receding angle of thyroid by thyro epiglottic ligament. Base : broad, rounded, and free ; directed upwards. Anterior surface: covered in upper part by mucous mem- brane, which passes forwards as the three glosso-epiglottic folds to connect it with the tongue ; below it is attached to the hyoid bone by hyo-epiglottic ligament. Posterior surface : covered by mucous membrane, concave from side to side, concavo-convex from above downwards; the convex part is known as the cushion or tubercle of the epiglottis. The LIGAMENTS of the larynx are : The thyro-hyoid membrane : passes from the upper border of the thyroid cartilage to the upper border of the posterior surface of the hyoid bone: between it and the posterior surface of the hyoid bone is a synovial bursa. It is pierced by the superior laryngeal vessels and internal laryngeal nerve of each side. (The lateral thyro-hyoid membrane is the posterior edge of the preceding, passes from the superior cornu of the thyroid to the tip of the great cornu of the hyoid bone, in which is found a small cartilaginous nodule, the cartilage triticea.) The crico-thyroid membrane connects the thyroid and cricoid cartilages. Consists of two parts : Central: thick, triangular, with base down wards, passingfrom lower border of thyroid to upper border of cricoid cartilage. Lateral : thinner, passes from upper border of cricoid car- tilage internally to ala of thyroid, ending in a free border, the true vocal cord, or inferior thyro-arytenoid ligament. The superior thyro - arytenoid ligaments are attached anteriorly to the angle between the alae of the thyroid cartilage, just below the epiglottis, and posteriorly to the anterior surface of the arytenoid cartilage. They lie within the mucous membrane, forming the false vocal cords. The inferior thyro-arytenoid ligaments are attached an- teriorly to the angle between the alae of the thyroid cartilage, and posteriorly to the anterior process at the base of the arytenoid cartilage. The inner free edge, covered with mucous membrane, forms the true vocal cord, and below it is continuous with the lateral part of the crico-thyroid ligament. 210 THE POCKET ANATOMY Capsular ligaments, lined with synovial membrane, sur- round the articulations between the cricoid and inferior cornua of the thyroid, and also between the cricoid and two arytenoid cartilages. The hyo-epiglottic ligament connects the lower part of the anterior surface of the epiglottis to the upper border of hyoid bone. The thyro-epiglottic ligament connects the apex of the epiglottis to the upper part of the receding angle of the thyroid cartilage. THE INTERIOR OF THE LARYNX. The cavity of the larynx extends from the superior aperture to the lower border of the cricoid cartilage. The vocal cords form an imperfect diaphragm, dividing the cavity into two parts. The chink between the true vocal cords is the glottis or rima glottidis, which is the narrowest part of the larynx. The whole is lined by mucous membrane. The superior aperture of the larynx is triangular in shape. with base directed forwards. In front is the epiglottis, behind are the summits of the arytenoid cartilages and cornicula, and, laterally, the aryteno-epiglottic folds pass between the lateral edges of the epiglottis backwards to the tips of the arytenoid cartilages and cornicula, enclosing the cuneiform cartilages. The superior or false vocal cords, one on each side, are two folds of mucous membrane enclosing the superior thyro- arytenoid ligaments ; each is placed above the corresponding ventricle. The inferior or true vocal cords, one on each side, are attached in front to the receding angle of the thyroid carti- lage, and behind to the anterior angle or vocal process at the base of the arytenoid cartilage. They are formed of mucous membrane, enclosing the inferior thyro-arytenoid ligaments. The ventricles of the larynx are the fossae between the false and true vocal cords ; the anterior part of each ventricle is prolonged upwards between the false vocal cord and the ala of the thyroid cartilage into a pouch, the sacculus laryngis. The opening of the sacculus into the ventricle is narrow, and its cavity contains numerous small glands. The muscles of the larynx have been described (vide pp. 30 and 31). The arteries of the larynx are the laryngeal branches of the superior and inferior thyroid. ORGANS OF VOICE AND RESPIRATION 211 The nerves are the superior laryngeal, the inferior or recurrent laryngeal, and branches of the sympathetic of each side. THE TRACHEA. The trachea extends from the lower border of the larynx (opposite the lower border of 5th cervical vertebra) to the level of the disc between the 4th and 5th dorsal vertebrae, there dividing into the two bronchi. In length it measures 4^ inches. Relations in the Neck. In front. Skin. Superficial and deep fasciae. Anastomosis of anterior jugular veins. Isthmus of thyroid gland. Inferior thyroid veins. Laterally. Cervical fascia. Common carotid artery. Lateral lobe of thyroid gland. Inferior thyroid artery. Recurrent laryn- geal nerve. Behind. QEsophagrs. In the Thorax. In Front. Right Side. Manubrium Right pneumo- sterni. gastric nerve. Innominate ar- tery. Pleura. Left Side. Left cardiac nerves. Left pneumogastric nerve. Left recurrent laryngeal nerve. Aortic arch. Left subclavian m- tery. Pleura. Posteriorly. (Esophagus. Origin of sterno mastoid. Origins of sterno- t hy roid and sterno-hyoid. Remains of thymus gland. Left innominate vein. Commencements of innominate and left carotid ar- teries. Arch of aorta. Deep cardiac plexus. The cartilages, from sixteen to twenty in number, are U-shaped, the anterior or convex part being cartilage, the posterior j fibrous membrane. 142 212 THE POCKET ANATOMY The right bronchus, about i inch long, is shorter, more vertical in direction, and of larger calibre than the left. It passes from the trachea downwards and to the right on a level with the 5th dorsal vertebra to the root of the corre- sponding lung, lying at first above and then behind the right pulmonary artery. The superior vena cava and right phrenic nerve lie in front, and the venaazygos major arches forwards above it. The left bronchus is nearly 2 inches long, and passes down- wards and forwards under the arch of the aorta to the root of the left lung, joining it at the level of the upper border of 6th dorsal vertebra. Behind it are the oesophagus, thoracic duct, and descending aorta. It lies at first behind, and then below, the left pulmonary artery. THE LUNGS AND THE PLEURAE. The lungs, two in number, occupy the whole of the thorax except the mediastina (vide pp. 201 and 202), which separate them from each other. They are conical in shape, and are covered with pleura. Each lung is free except at the median part or root, where it is attached to the bloodvessels and bronchi. The pleurae are two serous sacs enclosing and investing the lungs. Each pleura consists of a visceral and parietal layer. The visceral portion covers the lung, and the parietal layer lines the inner surface of the chest walls, the upper surface of the diaphragm, and the sides of the pericardium. The visceral layer of each pleura becomes continuous with the parietal layer in front and behind the root of the lung ; and below the root a fold, the ligamentum latum pulmonis, extends down- wards along the inner surface of the lung to the diaphragm. The mediastina are formed by the visceral layers of each side approaching one another towards the median line. The limits of the parietal pleurae are as follows: each extends upwards into the neck, forming a dome-like process over the apex of the lung about 2 inches above the anterior end of the first rib ; from this each pleura passes down- wards and forwards to the posterior aspect of the sterno- clavicular joint and meets its fellow in the mid-line at the manubrio-gladiolar articulation ; they pass down together to level of 4th costal cartilages, where right pleura passes verti- cally to level of yth right costal cartilage in mid-line ; then outwards, crossing gth rib in mid-axillary line ; then down- wards and backwards along nth rib to reach spine at neck of ORGANS OF VOICE AND RESPIRATION 213 rath rib. Behind, it passes upwards on right side of bodies of vertebras to apex. At level of 4th costal cartilage the left pleura arches outwards, leaving uncovered part of anterior surface of pericardium, and lying about f inch from the margin of sternum, to reach yth left costal cartilage, below which it follows same line as on right, but is placed at a slightly lower level. THE LUNGS. Each lung is cone-shaped, with the base downwards. The apex projects upwards into the root of the neck behind the clavicle and anterior scalene muscle. Above the first rib, the first part of the subclavian artery lies in front, being separated from it by the pleura. The base is concave, resting upon the diaphragm, and following the attachment of the midriff is placed lower ex- ternally and posteriorly than anteriorly. The outer surface is convex, and corresponds to the chest wall. The inner surface is concave, corresponding in part to the convex outer surface of the pericardium. It presents about its middle, and towards the posterior part, a slit, the hilum pulmonis, where the bronchi and vessels pass in to form the root. The anterior margin is thin, and overlaps the pericardium, and presents on the left side a notch for the apex of the heart. The posterior margin is rounded, and occupies the groove by the side of the vertebrae. Fissures and Lobes. The left lung is smaller and narrower than the right, and is divided into an upper and lower lobe by a fissure, which passes upwards and backwards from the anterior border nearly to the root. The right lung is larger and shorter than the left, and is divided into three lobes, upper, middle, and lower, by two fissures. One fissure passes obliquely from the outer surface upwards and inwards nearly to the root, and the second passes horizontally from the middle of the first, forwards to the anterior margin, cutting off a middle triangular lobe. Each root consists of the corresponding bronchus, a branch of the pulmonary artery, two pulmonary veins, nutritive bronchial vessels, anterior and posterior pulmonary plexuses, lymphatic vessels and glands, all held together by areolar tissue, and covered by the pleura. 2i 4 THE POCKET ANATOMY Relations of the right root : In Front. Behind. Atm*. Below. Right phrenic Right pneumogas- Vena azygos Ligament -.im nerve. trie nerve. major. latum pu : . Superior vena cava. Vena azygos major. m o n i s. Part of right auricle. Relations of the left root : In Front. Behind. Above. Below. Left phrenic nerve. Descending thoracic Arch of Ligamenturr aorta. aoita, latum pul- CEsophagus. munis. Thoracic duct. Left pneumogastric Position of the constituents of the root : From before backwards in each lung : Pulmonary veins. Pulmonary artery. Bronchus. From above downwards : - Right side. Left side. Bronchus. Pulmonary artery. Pulmonary artery. Bronchus. Pulmonary veins. Pulmonary veins. THE PULMONARY ARTERY. The pulmonary artery conveys venous blood from the right side of the heart to the lungs. It is 2 inches long, and com- mencing at the infundibulum of the right ventricle, is directed upwards in front of ascending part of aorta, and in same tube of pericardium, then passes upwards and backwards on left of ascending aorta to reach the concavity of the aortic arch, where it divides into right and left branches for the lungs. Near the bifurcation a fibrous cord, the ligamentwn arteriosum, passes from the left branch to the under surface of the aorta. It is the remains of the ductus arteriosus in the foetus. Relations (contained in same sheath of pericardium with ascending aorta) : DUCTLESS GLANDS ON THE TRACHEA 215 In Front. Pericardium. Left pleura and lung. Behind. Ascending aorta. Left auricle. Above. Transverse aorta. Ligamentum ar- teriosum. Laterally. Coronary artery. Auricular appen- dix. Ascending aorta (right side). The right pulmonary artery is longer than the left, passes to the root of the right lung, behind the ascending aorta and superior vena cava, where it divides into three primary branches, one for each lobe. The left pulmonary artery is connected at origin with arch of aorta by ligamentum arteriosum, and passes in front of the descending aorta and left bronchus to the root of the left lung, there dividing into two primary branches for the two lobes. DUCTLESS GLANDS ON THE TRACHEA. THE THYROID GLAND. The thyroid gland is situated on the upper part of the trachea, and consists of two lateral lobes united at lower part by neck or isthmus, which lies over 2nd, 3rd, and 4th rings of trachea and is covered by skin, superficial and deep fasciae, and anterior jugular veins. Each lobe is conical, with smaller end upwards. Dimensions. Vertical, i inches ; transverse, inch ; thick, inch. Relations : Antero-external (convex), surface. Deep cervical fascia, sterno- mastoid, sterno - thyroid, sterno - hyoid, and omo-hyoid muscles. Postero-internal (concave), surface. Upper six rings of trachea, cricoid and thyroid (below oblique line), crico-thyroid and inferior constrictor muscles, inferior thyroid artery, recurrent laryngeal and external laryngeal nerves, oesophagus (on left side) . Postero-external (convex] surface. Sheath of carotid vessels. Vessels. Arteries, superior and inferior thyroid ; veins, superior, middle, and inferior thyroid. THE THYMUS GLAND. The thymus gland attains its full size at two years, after which it gradually shrinks away. It is situated partly in the anterior mediastinum, and partly in the neck, reaching from level of 4th costal cartilage upwards on trachea as high as 216 THE POCKET ANATOMY lower border of thyroid gland. It consists of two lateral lobes with occasionally a middle connecting one. Relations in early life : Base. Pericardium. Behind. Trachea, pericardium, and great thoracic vessels. In front. Sternum as low as 4th costal cartilages, origins of sterno-hyoid and sterno- thyroid muscles. Externally. Pleura, sheath of carotid. Internally. Opposite lobe and side of trachea. THE URINARY ORGANS. THE KIDNEYS. The kidneys secrete the urine, and are situated for the most part in the hypochondriac and epigastric regions of the abdomen behind the peritoneum, extending from the nth rib to within an inch of the crista ilii, the right being placed lower than the left, and lying slightly in the right lumbar and umbilical regions. The average length of each kidney is 4 inches, breadth 2 inches, and thickness i inch. Weight 4^ ounces. Relations. The relations of the two kidneys differ some- what ; each is placed so that its anterior surface looks out- wards and the posterior inwards, the upper end being nearer the mid-line than the lower. Each kidney is covered partly on its anterior surface by peritoneum. Relations of the Right Kidney. In front. Behind. Right lobe of liver. Diaphragm, znd part of duodenum. Quadratus lumborum. Hepatic flexure of colon. Psoas. (Of which the last two Fasciae covering these areas are non-peritoneal.) muscles. Anterior lamella of lumbar aponeurosis. Last dorsal. \ Ilio-hypogastric, I Nerves. ilio- inguinal, J ist lumbar artery. Pleura. Last intercostal space and I2th rib. THE URINARY ORGANS 217 Relations of the Left Kidney. In front. Behind. Fundus of stomach. As on right, except that left Fostero-internal surface of kidney, lying rather higher, spleen. lies over nth rib. Tail of pancreas. Descending colon. (Of which last two are non- peritoneal.) 9 Above each kidney is the supra-renal body. Below each kidney is the iliac crest. The external border is convex, and is directed outwards and backwards. The internal border is concave, directed well forwards, and at the centre is the fissure or hilum, where the vessels enter and the ureter leaves, lying from before backwards as follows : renal vein, renal artery, ureter. Each kidney is connected with the bladder by a ureter, which serves to convey urine to the latter viscus ; the top of each ureter is expanded, and forms the pelvis of the kidney, which is divided into three parts called infundibnla, which are subdivided into about 12 calyces. Into these calyces small papilla project, which are the apices of the pyramids of Malpighi. These latter form the medullary substance of the kidney, and are imbedded in the cortical substance, which encloses them completely except at the papillae. SUPRA-RENAL CAPSULES. These are ductless glands, resembling in shape a cocked hat, and which embrace the upper extremity of each kidney. The right usually has no peritoneum in front, but the left is covered in front by peritoneum, except where the pancreas crosses it. Relations : A nteriorly Right. Liver, inferior vena cava, and duodenum. Left. Stomach and lesser sac of peritoneum, pancreas and spleen. Posteriorly. Diaphragm. Below. Top of kidney. THE URETERS. The ureters connect the kidneys with the bladder, forming the excretory ducts of the former, 12 to 14 inches long. 2i8 THE POCKET ANATOMY Relations of the Ureter in the Abdomen. Behind. In front. Psoas. Peritoneum. Genito-crural nerve. Colic vessels. Common or external iliac Spermatic vessels, artery. Ileum (right side). Pelvic colon (left side). The right ureter lies close to the outer side of the inferior vena cava. in the pelvis. In the Male. Each ureter enters the fold of peritoneum limiting laterally the recto - vesical pouch (posterior false ligament of bladder) and reaches the base of the bladder, below which it runs downwards and forwards under the obliterated hypogastric artery, crossing the vas deferens externally ; it reaches bladder 2 inches from its fellow and the same distance from prostate ; finally it enters the interiro of the bladder by passing very obliquely through its coats at the posterior angle of the base. In the Female. Passes in posterior false ligament of uterus, over side of cervix below uterine artery and lateral to upper part of vagina, to posterior part of base of bladder, and ends as in the male. THE BLADDER. The bladder receives the urine from the kidneys by the ureters. Position. In infancy it lies partly in the abdomen. In the adult it lies in the pelvis behind the pubes ; in the male in front of the rectum ; in the female it is placed in front of the uterus and vagina. Differences in the sexes : the female bladder is larger trans- versely. The apex is connected to the umbilicus by the urachus and by the obliterated hypogastric arteries, the part posterior to the urachus being covered with peritoneum. The body is uncovered anteriorly by peritoneum, and in front are the triangular ligament, the symphysis and body of the pubis, and pubo-prostatic ligaments. Superiorly it is covered by peritoneum in the upper part, and is in relation with the pelvic colon in the male, and uterus in the female, and with small intestines in both. Crossing THE URINARY ORGANS 219 obliquely on each side of the bladder is the obliterated hypogastric artery, which marks the lateral limit of its peri- toneal covering ; the vas deferens crosses obliquely the lower part of the lateral surface along the inner side of the ureter and obliterated hypogastric artery. The base or fundus is directed backwards and downwards. In the Rectum, from which it is separated by Relations of the Base. Male. Above. Recto - vesical pouch of peri- toneum. Below. Recto-vesical fascia. Vasadeferentia and vesiculae semin- , ales. In the Female. Pouch of Douglas Cervix uteri and anterior vaginal wall. The cervix or neck of the bladder is the part continuous with the urethra, and is embraced in the male by the prostate. LIGAMENTS. There are two sets of ligaments of the bladder true and false. The true ligaments are two anterior and two posterior. These are formed of recto-vesical fascia, and are described on p. 48. The urachus is usually described as the 5th or superior true ligament. The false ligaments, five in number, are formed of peri- toneum ; there are two posterior, two lateral, and an anterior, the latter covering the urachus. They have been described on p. 200. Interior of the Bladder. Upon the inner surface of the base of the bladder, just behind the urethral orifice, is a triangular smooth surface or trigone, with the apex looking forwards. It is bounded laterally by two ridges passing to. the openings of the ureters, the posterior angles being formed by those openings, placed i inches apart; at its apex there is an eJevation, formed by the prostate, called the uvula vesicce, which is i^ inches from the ureters. The mucous membrane over the trigone is smooth, but everywhere else elevated upon the irregular muscular wall and is rugose. 220 THE POCKET ANATOMY THE MALE ORGANS OF GENERATION. THE PROSTATE GLAND. The prostate gland adjoins the neck of the bladder and surrounds the beginning of the urethra, which is placed nearer the anterior than the posterior surface of the gland. It is said to resemble a horse-chestnut in shape, with the apex directed downwards. It measures about i^ inches across its base and i^ inches in depth, and i inch from before backwards, and is held in position by the anterior true ligaments of the bladder. The prostate is perforated from base to apex by the urethra, into which, as it lies in the gland, the common ejaeulatory ducts open. Relations : Anterior or Pubic Posterior Base. Apex. Surface. Surface. Symphysis pubis. Rectum. Surrounds bladder- Rests on uppei Anterior ligaments .. . .. neck. layer of tnan- of bladder. Laterally^ Vesiculae semin- gular ligament. Dorsal vein of Levator ani. ales. pens. Vasa deferentia. The prostate is surrounded by a sheath derived from the recto-vesical fascia (vide p. 48) and by the prostatic plexus of veins, and is supported by the levator ani. COWPER'S GLANDS. Cowper's glands are two small round bodies about the size of a pea, placed behind the membranous part of the urethra, between the two layers of the triangular ligament. Their ducts are about I inch long, and pass forwards, piercing anterior layer of triangular ligament, to open in the bulbous part of the urethra. THE PENIS. The penis is divided into a root, body, and glans. The root is connected to the pubic rami by two strong pro- cesses, the crura, and to the symphysis pubis by the sus- pensory ligament. The glans forms the extremity ; at its summit is the opening MALE ORGANS OF GENERATION 221 of the urethra, the meatus urinarius; passing from the lower margin of this is a fold of mucous membrane continuous with the prepuce and called the frenum prtzputii. At the base of the glans is a projecting edge or corona, and behind that a constriction, the cervix. Sebaceous glands (of Tyson) are found on both. The integument of the penis, attached to the neck of the glans, is doubled upon itself, forming the prepuce or foreskin. The body is the part between the root and the glans, the upper surface being the dor sum. The corpora cavernosa form the greater part of the body of the penis; they are two cylindrical columns placed side by side, connected together for the anterior f ths, the septum pectiniforme intervening, but separated behind to form the two crura, which are attached to the inner margins of the ischial and pubic rami ; anteriorly the corpora cavernosa fit into the base of the glans. There is a groove on the upper surface for the dorsal vein of the penis and another groove on the lower surface for the corpus spongiosum ; the corpora are attached to the pubic symphysis by the suspensory liga- ment. The corpus spongiosum commences at the triangular liga- ment by an enlargement, the bulb, and runs forward in the groove on the under surface of the corpora cavernosa, ex- panding over their extremities to form the glans. The bulb lies below the anterior or lower layer of the triangular ligament, and is embraced by the accelerator urinae muscle. The urethra pierces the bulb near its upper surface, and then runs forward in the middle of the corpus spongiosum. The URETHRA in the male extends from the neck of the bladder to the end of the penis, and has a length of from 6 to 8 inches. It is divided into three parts, according to the structures through which it passes. (1) The prostatic portion passes through the prostate gland from base to apex ; this part is ij inches long and spindle- shaped : in cross-section it is horseshoe-shaped, with the convexity forwards. On the posterior wall is a longitudinal ridge, the verumontanum or caput gallinaginis, and on each side of this promontory is a depression, the prostatic sinus, into which the prostatic ducts open. Towards the anterior part of the verumontanum is a depression, the sinus pocularis, vesicula prostatica, or utricle, upon the elevated edges of which the ejaculatory ducts open. (2) The membranous portion extends from the apex of the prostate to the bulb, and is inch long anteriorly, but only 222 THE POCKET ANATOMY inch posteriorly from the bulb projecting backwards; it is contained between the layers of the triangular ligament, and is surrounded by the compressor urethrae. (3) The spongy portion is contained in the corpus spongiosum and occupies the rest of the canal, being from 4 to 6 inches long ; the portion contained in the bulb is somewhat dilated, and the ducts of Cowper's glands open on the floor ; the canal enlarges again iust behind the meatus urinarius, which enlarge- ment is named the fossa navicularis. The lumen of this part of the urethra is transverse, except at the meatus (its narrowest part), where it is vertical. The floor of the urethra is sprinkled with lacuna, which are the openings of the glands of Littre ; one large one in the fossa navicularis is called the lacuna magna. THE SCROTUM. The scrotum contains the testicles and spermatic cords. It is divided in the middle line by a raphe ; the left half is longer than the right, as the left testicle hangs down lower, the left spermatic cord being longer than its fellow. Coverings of the Testis in the Scrotum : 1. Skin. 2. Superficial fascia and dartos muscle. 3. Inter-columnar or spermatic fascia. 4. Cremaster muscle and fascia. 5. Infundibuliform fascia, continuous with the transversalis fascia. 6. Tunica vaginalis, consisting of a parietal and visceral layer, forms a closed sac. The visceral layer invests the body and epididymis of the testicle except behind, where the duct and vessels are attached ; at its lateral reflection it is continuous with the parietal layer. It passes, on the outer side, a little between epididymis and body, forming the digital fossa. THE SPERMATIC CORD. The spermatic cord consists of the vas deferens with artery to the vas, spermatic artery and pampiniform plexus of veins forming spermatic vein above, sympathetic nerves, the cremasteric artery, the genital branch of the genito-crural nerve, lymphatics, together with some areolar tissue; it extends from the internal abdominal ring to the testis, passing in its course along the inguinal canal, from which it emerges by the external abdominal ring, and thence in front of the MALE ORGANS OF GENERATION 223 pubes to the scrotum. The vas deferens is placed at the back of the cord, and may be recognised by its hard and cord-like feeling. Boundaries of the Inguinal or Spermatic Canal : Extent : i inches long, from the internal to the external abdominal ring Behind. Peritoneum and fascia trans- versalis for whole length. Conjoined ten- don (inner two-thirds). Triangular fascia. In Front. Floor formed by Internal oblique Meeting of Pou- (outer third). Aponeurosis of external ob- lique (for whole length). part's liga- ment and fascia trans- versalis. Rooffonned by Arched fibres of internal oblique and trans versalis, and apposition of layers of abdo- minal wall. THE TESTES. The testes are two glandular organs ; each is suspended in the scrotum by the spermatic cord, which is attached to the posterior border. Each testis consists of two parts : the body, which is anterior, and the epididymis, placed posteriorly; to the lower end of this latter the duct or vas deferens is attached. Coverings of the Testis : 1. Serous or tunica vaginalis is derived from the peritoneum, and consists of two layers, the visceral and parietal. 2. Fibrous or tunica albuginea covers the body of the testicle, sending in a vertical septum the mediastinum or corpus High- ntori : this latter gives off secondary processes or septa, which serve to separate the lobules of the testicle. 3. Tunica vasculosa consists of the bloodvessels, connected together with areolar tissue. The epididymis is a long narrow body, consisting of three parts, viz. : a superior portion projecting forwards on the upper end of the body, the head or globus major ; a lower, the tail or globus minor, with which the vas deferens is continuous ; and between these two, the body or central portion. The epididymis consists of a duct 20 feet long, exceedingly con- voluted, and bound together by areolar tissue ; it receives the coni vasculosi at the upper part of the testicle. The body of the testicle consists of numerous lobules of pyramidal shape, which are formed by trabeculae, mediastinum, and tunica albuginea, the base of the lobule being directed 10 the circumference of the testis, and the apex towards the mediastinum. Each lobule contains one or more tubuli semini- /eri held together by areolar tissue. Each tubule commences 224 THE POCKET ANATOMY near the base, in either a blind extremity or by anastomotic loops, becoming straighter near the apex ; as they enter the mediastinum, they coalesce together to form twenty or thirty tubuli recti. The tubuli recti or vasa recta pierce the mediastinum, inter- lace, and form the vete testis. Above twelve to twenty tubules pass from the upper part of the rete as the vasa efferentia. The vasa efferentia perforate tunica albuginea, being at first straight, then convoluted, and as the coni vasculosi form the globus major. The coni open into the excretory duct at intervals (when unravelled) of about 3 inches. The vas deferens commences at the lower part of the globus minor, and ascends along the inner side of the posterior part of the epididymis ; thence it follows the spermatic cord through the inguinal canal and internal abdominal ring. Here it lies under the peritoneum and passes inwards, crossing to the inner side of the external iliac artery, and, entering the pelvis, arches over the superior surface of the bladder, crossing the obliterated hypogastric artery and ureter. At the base of the bladder it runs along the inner side of the vesiculas seminales and loses its peritoneal covering, being separated from the rectum by the recto-vesical fascia, here becoming sacculated ; narrowing again at the base of the prostate, it unites with the duct of the vesicula seminalis of the same side, and forms the common ejaculatoiy duct, which passes forwards through the prostate and opens on the lateral margin of the sinus pocularis into the prostatic urethra. THE VESICULA SEMINALES. The vesiculse seminales are two sacculated pouches, placed between the base of the bladder in front and the rectum behind. They are pyramidal in shape, the posterior part being the wider ; anteriorly they converge to enter the prostate near the middle line. The corresponding vas deierens lies on the inner side. THE FEMALE ORGANS OF GENERATION. The external organs of generation in the female are : the mons veneris, the labia majora, the labia minora, the clitoris, the meatus urinarius, and the orifice of the vagina. The term vulva includes the whole of these. FEMALE ORGANS OF GENERATION 225 The mons veneris is the eminence in front of the pubes, covered with hair. The labia majora are two prominent folds extending from the mons to the perineum. Externally they are covered with hair and integument, internally with mucous membrane; the labia are joined together anteriorly and posteriorly, forming commissures. A small transverse fold of mucous membrane is found in the posterior commissure called the fourchette ; the space between this and the posterior commissure is known as the fossa navicularis . The labia minora or nymphse are two folds of mucous membrane, extending for i\ inches downwards and outwards from the clitoris, finally losing themselves below in the labia majora. They surround the clitoris, the upper folds forming the preputium clitoridis, the lower ones, attached o the glands, being the fmnum. The clitoris, corresponding somewhat in structure to' the penis, is placed just below the anterior commissure. It con- sists of two corpora cavernosa attached to the pubic rami by two crura ; the free extremity or glans is formed by the corpus spongiosum. Between the nymphae, and bounded anteriorly by the clitoris, is the vestibule, at the back part of which the meatus urinanus opens, being about i inch below the clitoris. The Bulb of the Vestibule. A mass of erectile tissue lying internal to the nymphas, and resting on the inferior surface of the triangular ligament. Below the meatus is the orifice of the vagina, closed more or less in the virgin by the hymen, which is a duplicature of mucous membrane, generally semilunar in shape. After its rupture small elevations, carunculcs myrtiformes, only remain. The glands of Bartholin, analogous to Cowper's glands in the male, are situated on each side near the entrance of the vagina, and their ducts open on the nymphae, external to the hymen. The urethra in the female is only i inches long, and is embedded in the anterior wall of the vagina ; it perforates the triangular ligament, as in the mala. The meatus urinarius, the external orifice of the urethra, opens between the nymphae, about an inch below and behind the clitoris. The vagina is a dilatable canal, the axis of which is naturally transverse, extending from the vulva to the uterus ; the an- terior wall is about 3^ inches and the posterior wall 4^ inches long. The upper end widens to receive the neck of the uterus, which it meeis at an anglu anteriorly of about 90 degrees. 15 226 THE POCKET ANATOMY The relations are : Anteriorly. Posteriorly. Laterally. Base of bladder. Perineal body. Broad ligament and Urethra. Rectum and anal ureter. canal. Levator ani, Pouch of Douglas Sphincter vaginse. (upper inch). There is a ridge or raphe along the middle of the inner surface of both the anterior and posterior walls. The walls likewise present many transverse ridges or ruga. The lower end of the vagina is embraced by the sphincter vaginae. THE UTERUS. The uterus or womb is a pear-shaped body, flattened from before backwards, placed in the pelvis between the bladder and rectum ; superiorly it does not reach above the brim of the pelvis. The position corresponds to the pelvic axis. The uterus is covered by peritoneum behind, above, and in front except where it is attached to the base of the bladder ; the peritoneum is reflected from off the sides to the pelvis, forming the broad ligaments. The average length of the uterus is 3 inches, breadth 2 inches, and thickness i inch, and it is, for the pur- pose of description, divided into three parts : (1) The fundus is the broad upper end of the body, projecting into the abdomen between the attachments of the Fallopian tubes. (2) The body extends from the fundus to the neck, narrowing as it approaches the latter ; at the junction of the fundus and body is an angle to which the Fallopian tube is attached ; a little anteriorly to this the round ligament is connected, below and behind this the ovarian ligament is attached. (3) The neck or cervix uteri is surrounded below by the vagina, into which it projects, forming a vaginal part, which presents a transverse opening, the os uteri externum, bounded by two thick lips, anterior and posterior, of which the anterior is the thicker and the posterior the longer. The part pro- jecting into the vagina is called the portio vaginalis. The sulci in front of the anterior and behind the posterior lips are the anterior and posterior fornices, of which the posterior is much the deeper, and behind is in direct relation with peritoneum (pouch of Douglas). The cavity of the uterus, flattened from before backwards, is triangular in shape, the superior angles leading to tht. FEMALE ORGANS OF GENERATION 227 Fallopian tubes. Where the body joins the neck there is a constriction, the os uteri internum. The ligaments are two anterior or utero-vesical, two pos- terior or recto- vaginal, and two lateral or broad ligaments, all formed of peritoneum. The broad ligaments are formed of a double layer of peri- toneum passing from the lateral margins of the uterus to the sides of the pelvis. Between the two layers of this ligament on each side are the Fallopian tube, the round ligament, the parovarium, the ovary and its ligament, uterine and ovarian vessels, nerves and lymphatics. The round ligament is a cord placed between the layers of the broad ligament, extending from the superior angle of the uterus to the internal abdominal ring ; thence it passes into the inguinal canal to lose itself in the labium. It is enclosed for some part of the way in peritoneum, which is known as the canal of Nuck. THE APPENDAGES OF THE UTERUS. The Fallopian tubes are two in number, placed in the upper margin of the broad ligament. Each tube measures about 4 inches in length. The cavity commences by a narrow orifice called the ostium internum, and terminates in a fimbriated extremity, which passes over the superior and posterior borders of the ovary, and is attached by the fimbria ovarica to the superior pole of the ovary. The ovaries are two in number, and correspond to the testes in the male ; they are of a flattened ovoid form, vertically placed in the posterior part of the broad ligament. By its anterior border the ovary is connected to the broad ligament, and by its lower pole to the uterus by a proper ligament, extending to the superior angle of the uterus, and called the ligament of the ovary. The lateral surfaces and posterior border are free. The superior pole and posterior border are embraced by the Fallopian tube ; on its inner surface it is in relation with small intestine in Douglas' pouch, and exter- nally lies in a peritoneal fossa between the external and internal iliac vessels as they diverge. The vessels enter the hilum at the attached anterior border. The parovarium lies between the Fallopian tube and ovary, and is the remains of the Wolffian body. 15-* 228 THE POCKET ANATOMY THE NOSE. The organ of smell consists of an anterior prominent part, situated on the face, and composed of bones, cartilages, muscles, and integument, and two nasal fosses. The cartilages of the nose are five in number : The upper lateral cartilages (2) : situated just below the free margins of the nasal bones. Each cartilage is triangular in shape ; anteriorly it joins its fellow and the cartilage of the septum ; posteriorly it is in connection with the nasal process of the superior maxilla, and inferiorly it joins the lower lateral cartilage. The lower lateral cartilages (2) are peculiarly curved to form the nostrils, laterally and mesially, being open behind; laterally each cartilage is connected to the nasal process of the superior maxilla by fibrous membrane, in which are two or three sesamoid cartilages ; above it joins the upper cartilage and the cartilage of the septum. The cartilage of the septum is thicker at the edges than at the centre ; its connections are : anteriorly, with the nasal bones, the two upper lateral cartilages and the lower lateral carti- lages ; posteriorly, with the perpendicular plate of the ethmoid ; inferiorly, with the vomer and the palatal processes of the superior maxillae. The nasal fossae, separated from each other by the septum nasi, open in front by the anterior nares and behind by the posterior nares. Each fossa may be described as possessing a roof, a floor, an inner and an outer wall. The roof is formed by the nasal bones, the nasal spine of the frontal, the cribriform plate of the ethmoid, the under surface of the body of the sphenoid, alae of the vomer, sphenoidal processes of the palate bones. The floor consists of the palatal processes of the superior maxillae and of the palate bones. The inner wall is made up of the cartilage of the septum, the crest of the nasal bones, the nasal spine of the frontal, the perpendicular plate of the ethmoid, the vomer, the rostrum of the sphenoid, and the crests of the superior maxillary and palate bones. The outer wall is formed by the nasal process of the superior maxilla, the lachrymal bone, the ethmoid, inner surface of the superior maxilla, the inferior turbinate bone, the vertical plate of the palate bone, and the internal pterygoid plate of the sphenoid. Meatuso* The superior and middle turbinate processes of THE NOSE 229 the ethmoid and the inferior turbinate bone project inwards from the outer wall, dividing each fossa into a superior, a middle, and an inferior meatus. Openings : Superior meatus : sphenoidal and posterior ethmoidal cells. Middle meatus : anterior ethmoidal cells and frontal sinus, by a common orifice the infundibulum, and antrum of High- more. Inferior meatus : nasal duct. The septum is the partition separating the two fossae. It is formed by the perpendicular plate of the ethmoid, the vomer, crest of nasal bones, the nasal spine of the frontal, the rostrum of the sphenoid, the crests of the superior maxillary and palate bones, and the cartilage of the septum. The space between the anterior nares and the anterior edge of the cartilage of the septum is filled by membrane, the columna nasi. The anterior nares are the anterior openings of the nasal fossae. They are separated from each other by the columna nasi, and within the margin are arranged short stiff hairs, vibrissa. The posterior nares open backwards into the pharynx. They are oval in shape, being about I inch vertically and inch transversely. Sinuses. The nasal fossae communicate with the following sinuses in the neighbouring bones, the mucous membrane of the nose being continued into them : r. Sphenoidal sinus. 2. Posterior ethmoidal cells. 3. Anterior ethmoidal cells. 4. Frontal sinus. 5. Maxillary antrum. The mucous membrane lining the cavity of the nose is called the Schneiderian membrane. It is continuous with that of the various sinuses communicating with the nasal fossae, with the conjunctiva through the nasal duct and lachrymal canals, with the mucous membrane of the pharynx through the posterior nares, and with the skin of the face through the anterior nares. On the outer wall, as on the septum, the mucous membrane is inappreciably divided into an upper, olfactory, and a lower, respiratory, part ; the olfactory part consists of the mucosa over the superior and upper part of the middle turbinated, the corresponding part of the septum and the roof of the nose ; the remainder being respiratory. The epithelium covering the surface consists of three varieties : 2 jo THE POCKET ANATOMY 1. Stratified squamous, in the region of the nostrils. 2. Columnar, in the olfactory region. 3. Ciliated columnar, in the respiratory region and the sinuses. The vessels to the nose are the following arteries and veins : spheno-palatine, branches of descending palatine, and arteria septi nasi from facial. The nerves are : olfactory, nasal (first division 5th), naso-palatine, nasal branch of Vidian, nasal branch from anterior palatine and from Meckel's ganglion. The Olfactory Nerve. From the olfactory lobe there pro- ceed about twenty branches through the cribriform plate of the ethmoid, which may be divided into three sets : 1. Inner : pass along the grooves on the septum. 2. Middle : distributed to the roof. 3. Outer: passing to the upper turbinate bone, the anterior part of plain surface of the ethmoid and the middle turbinate bones. THE EAR. The ear is divided, for the purpose of description, into three parts, external, middle, and internal. THE EXTERNAL EAR. The external er>r consists of the auricle or pinna, and the external auditory meat us. The pinna is a plate of cartilage covered with integument, and attached to the commencement of the meatus ; it has numerous ridges and depressions, as follows : the external rim is the helix, and anterior and parallel to it is another ridge, the anti helix, which bifurcates above to enclose the fossa of the anti-helix ; between the helix and anti-helix is the fossa of the helix . Anterior to the anti-helix is a depression, the concha; projecting backwards over the meatus is the tragus, and opposite to the latter is the anti-tragus. The lowest part of the pinna, which contains no cartilage, is called the lobule. It is controlled by three muscles (p. 22). The external auditory meatus reaches from the bottom of the concha to the membrana tympani ; it is i inches long. It is arched slightly upwards, and is directed forwards and inwards ; it is formed partly by cartilage and partly by bone. The outer or cartilaginous part is continuous with the pinna, and is about inch long. The cartilage does not form a THE EAR 231 complete tube, being deficient at the upper and back part, the interval being filled by fibrous tissue. One or two fissures (fissures of Santorini) partially traverse the tube. The inner or osseous part is longer than the preceding, and at its inner end there is a groove round the sides and floor for the insertion of the membrana tympani. In the cartilaginous part of the meatus are hairs and ceruminous glands, which latter secrete the ear-wax. THE MIDDLE EAR OR TYMPANUM. The tympanum is contained in the temporal bone. It com- municates with the pharynx by the Eustachian tube, and is traversed by a chain of bones, which connect the membrana tympani with the internal ear. The cavity of the tympanum is bounded externally by the meatus and membrana tympani, internally by the external surface of the internal ear, and it communicates posteriorly with the mastoid antrum. Thereof (tegmen tympani) is formed by a thin plate of bone separating the tympanum from the middle fossa of the skull. The floor is formed by the roof of the jugular fossa. The outer wall is formed by the membrana tympani and the bone around it ; the following fissures are seen : The Glaserian fissure : through which the processus gracilis of the malleus and tympanic branch of internal maxillary artery pass. Aperture of the iter chorda posterius : leading to a canal which opens into the aquseductus Fallopii. Aperture of the iter chorda anterius : leading to the canal of Huguier, and transmitting the chorda tympani. The inner wall presents the following : The fenestra ovalis : leading into the vestibule, closed by a membrane and the base of the stapes. The ridge of the aquaductus Fallopii : for the facial nerve placed just above the preceding ; posteriorly it passes down- wards and backwards on the mesial aspect of the large opening of the aditus ad annim. The promontory : placed below the fenestra ovalis, formed by the projection of the first turn of the cochlea. The fenestra rotunda lies at the bottom of a funnel-shaped depression behind the promontory. It is closed by a mem- brane, the secondary membrane of the tympanum of Scarp a, which closes an aperture in the bone leading to the scala tympani of the cochlea. 23 2 THE POCKET ANATOMY The posterior wall presents above the large aperture of the mastoid antrum (aditus ad antrum} and below : The pyramid which is placed just behind the fenestra ovalis ; it contains the stapedius, the tendon of which projects through the apex. The anterior wall shows the following : The canal for the tensor tympani, opening just anteriorly to the fenestra ovalis. The processus cochleariformis : a process of bone lying be- tween and separating the canal for the tensor tympani and the Eustachian tube. The Eustachian tube leads into the pharynx, is partly carti- laginous and partly osseous ; the internal or cartilaginous part is trumpet-shaped, and terminates in an oval opening at the side and upper part of the naso-pharynx. The osseous portion is placed along the angle of union of the squamous and petrous portions of the temporal bone, and is about inch long. Below this a thin plate of bone separates the tympanum from the carotid canal. The membrana tympani is the membrane which separates the external and middle ears. It is inserted into the groove in the osseous portion of the external meatus, and is placed obliquely across the opening, forming with the floor of the meatus an angle of 45. It contains the handle of the malleus between its layers, which makes the membrane concave ex- ternally. There is a small notch in the upper and anterior part of the groove of insertion known as the notch of Rivini, which is closed by a loose portion of the membrane, the membrana ftaccida of Shrapnell. Structure of the membrane, from without inwards: 1. Prolongation of skin of meatus. 2. Fibrous tissue or membrana propria. 3. Mucous membrane of the tympanum. The ossicles of the tympanum are : 1. The Malleus. 2. The Incus. 3. The Stapes. The malleus, or hammer, consists of : The head: the thickened upper part, presenting on tne posterior surface a facet for articulation with the body of the i-icus. The neck : a constriction below the head. THE EAR 233 The handle: a long tapering process passing downward, and attached by its outer side to the membrana tympani. The processus gracilis : a slender spicule passing from the neck downwards and forwards into the Glaserian fissure. The processus brevis : arises from the root of the handle and projects outwards to be attached to the membrana tympani by the anterior and posterior malleal folds which bound the notch of Rivini. The incus, or anvil, consists of : The body : articulating in front by a saddle-shaped facet with the head of the malleus. The processus brevis : attached to the margin of the mastoid aditus. The processus longus : passes downwards, behind and parallel to the handle of the malleus. The tip projects inwards, and ends in the orbicular process, which articulates with the head of the stapes. The stapes closely resembles a stirrup. It consists of: The head: looking outwards, and articulating with the orbicular process of the incus. The base : fixed to the margins of the fenestra ovalis. The crura : arising from a constricted part, the neck, pass inwards to the extremities of the base. The anterior crus is shorter r-xd straighter than the posterior, and between the two a th.n membrane is stretched. The ligaments unite the chain of bones to the adjacent walls of the tympanum. They are : The anterior ligament of the malleus : passing between the root of the processus gracilis and the edge of the Glaserian fissure. This ligament was formerly described as a muscle passing from the malleus out of the Glaserian fissure, and termed the laxator tympani. The external ligament of the malleus : passing between the processus brevis and notch of Rivini. The superior ligament of the malleus : passing between the head of the malleus and the roof of the tympanum. The ligament of the incus : passing between the processus brevis and the posterior wall of the tympanum. The annular ligament of the stapes connects the base of the stapes with the edge of the fenestra ovalis. The muscles : The tensor tympani arises from cartilage of the Eustachian tube, and from the bony canal in which it lies. The tendon turns round the end of the processus cochleariformis, and is inserted into the inner border of the handle of the malleus, near its root. 234 THE POCKET ANATOMY The stapedius is lodged in the aquaeductus Fallopii and pyramid. The tendon issues from the apex of the pyramid, and is inserted in the posterior part of the neck of the stapes. The mastoid antrum is a large recess placed behind and rather above the tympanum, with which it is connected by the large opening (aditus) before mentioned on the upper part of the posterior tympanic wall ; it is developed with the tympanum and lined by a continuation of its mucous mem- brane. Into it open the mastoid pneumatic cells. THE INTERNAL EAR OR LABYRINTH. Within the internal ear are the terminal ramifications oi the auditory nerve. The internal ear or labyrinth is divided into osseous and membranous parts, the former enclosing the latter. Within the membranous labyrinth is a fluid, the endolymph ; arid outside, between the membranous and osseous labyrinths, is a fluid, theperilymph or liquor Cotunnii. The OSSEOUS LABYRINTH consists of the vestibule, the cochlea, and the semicircular canals. The vestibule is the central part of the labyrinth. Its outer wall corresponds to the inner wall of the tympanum, and in it is thefenestra ovalis, closed by the base of the stapes ; on its inner wall is a depression, the fovea hemispherica, per- forated by several holes for the branches of the auditory nerve; behind this is a ridge, the crista vestibuli ; and still further back is the internal opening of the aqueduct of the vestibule. On the roof is a depression, the fovea hemi-elliptica. At the posterior part are the five openings of the semicircular canals, and at the anterior part is the apertura scales vestibuli. The semicircular canals are three arched osseous canals placed above and behind the vestibule, opening into that chamber by five rounded apertures, two adjacent canals having a common opening. Each canal forms about two- thirds of a circle, and presents at one end a dilated part, the ampulla. Two of the canals are vertical, and the third is horizontal. The siip erior canal is vertical, and forms a projection on the upper surface of the petrous part of the temporal bone. The inner extremity joins the opening of the posterior canal. The posterior canal is vertical, its upper end being joined to the lower opening of the superior canal. The horizontal or external canal is the smallest of the three, and lies horizontally just above the level of the fenestra ovalis. The cochlea is cone-shaped, with the base turned to the THE EAR 235 internal meatus, nd the apex opposite the canal for the tensor tympani, and consists of a tapering spiral canal of 2^ turns, with the inner wall formed by its axis or modiolus : the canal is divided into two scalae by a partition of bone and membrane, the lamina spiralis. The enclosed arched extremity of the cochlea is called the cupola, and the first turn of the canal bulging into the tympanum forms the promontory. The lamina spiralis ossea ends at the apex of the cochlea in a small point, the hamulus, between which and the modiolus is a small opening, the helicotrema, by which the two scalae communicate. The modiolus is pierced by small canals for the passage of nerves, and one larger one, the central canal of the modiolus, passes from the base to the last half-turn of the cochlea. At the base of the lamina spiralis is a small canal, the spiral canal of the modiolus, which winds round the axis, and contains a spiral ganglionated cord, the ganglion spirale. The scalse are known respectively as the scala tympani and the scala vestibuli. The scala tympani is the lower one , it commences at the fenestra rotunda. The scala vestibuli commences at the cavity of the vestibule, and communicates at the apex of the modiolus with the scala tympani, by the helicotrema. The MEMBRANOUS LABYRINTH consists of sacs containing fluid (endolymph). The ramifications of the auditory nerve are distributed on the wall. These membranous sacs com- plete the septum between the scala tympani and the scala vestibuli, besides enclosing a third space, the scala media or membranous canal of the cochlea. The membranous vestibule consists of two sacs, the utricle and the saccule. The utricle or common sinus is larger than the saccule, and is situated in the posterior and upper part of the vestibule, being contained in the fovea hemi-elliptica. The apertures of the membranous semicircular canals open in the posterior part. At the anterior part is a thickened spot, the macula acustica, where the nerves enter. The interior contains, opposite the macula, attached to the wall, a small mass of calcareous grains, known as otoliths, otoconia, or ear sand. Below there is a canal, which, joined to a similar tube from the saccule, extends along the aqueduct of the vestibule, and ends in a dilated pouch, the saccus endo-lymphaticus. The saccule is smaller and rounder than the utricle, and lies in the fovea hemispherica. Like the utricle, it contains 236 THE POCKET ANATOMY a macula and a collection of otoliths. Below there is a small canal, canalis reuniens, which connects it with the membranous canal of the cochlea. The membranous semicircular canals are about one-third the size of the osseous ones, except at the ampullae, where they dilate to nearly fill the bony canal. Each membranous canal is free on the convex surface, the concavity being fixed to the osseous canal. On the part of the internal surface of the ampulla, corresponding to the attachment to the bony canal, is a transverse projection, the crista acustica, in which some filaments of the auditory nerve end. The membranous cochlea consists of a membranous tube divided into three parts the scala tympani, scala vestibuli, and canal of the cochlea (ductus cochlearis), which latter contains the organ of Corti, to which the auditory nerve is chiefly distributed. The lamina spiralis ossea partly divides the spiral canal into the scala tympani and scala vestibuli, the latter being superior. The septum is completed by the membrana basilaris, which is attached to the outer free edge of the lamina spiralis ossea, and passed outwards to the wall of the cochlea, where it is fixed to a thickening of the periosteum called the spiral ligament. The canal of the cochlea contains the organ of Corti. It lies on the outer part of the scala vestibuli, and is separated from it by the membrane of Reissner, which passes from the lamina spiralis upwards and outwards to the roof of the scala. Thus a triangular piece is cut off, bounded internally by the membrane of Reissner, externally and above by the outer wall of the cochlea, and below by the basilar membrane. The canal of the cochlea is connected below with the saccule by the canalis reuniens, and above it terminates in a blind cone- shaped extremity, partly bounding the helicotrema and fixed to the cupola. The part of the lamina spiralis within the canal of the cochlea becomes thickened, and is called the limbus, and terminates in a concave border, the sulcus spiralis. The basilar membrane is attached to the lower margin of the sulcus spiralis. The Auditory Nerve. The auditory nerve divides in the in- ternal auditory meatus into two branches, which perforate the cribriform plate, and are distributed to the cochlea and the vestibule. The superior or vestibular branch supplies : 1. The utricle. 2. The ampulla of the superior semicircular canal. 3. The ampulla of the horizontal semicircular canal. THE EYE AND ITS APPENDAGES 237 The inferior or cochlsar branch is distributed to : 1. The cochlea. 2. The saccule. 3. The ampulla of the posterior semicircular canal. Nerves of the Cochlea. The branches of the auditory nerve destined for the cochlea perforate a number of foramina at the bottom of a spiral groove, the tractus spiralis foraminulen- ttis, placed in the centre of the base of the cochlea. These foramina lead to small canals, which at first pass through the modiolus, and then radiate outwards between the bony layers of the lamina spiralis, so passing to the organ of Corti. In the centre of the tractus spiralis foraminulentus is a larger foramen leading to the central canal of the modiolus, and transmitting nerve filaments for the last half-turn of the cochlea. THE EYE AND ITS APPENDAGES. THE APPENDAGES OF THE EYE. The eye-brows are two arched eminences over each orbit consisting of thickened integuments and muscles, surmounted by hairs. The eye-lids are two movable folds, an upper and a lower, the upper one being more movable, which by their closure protect the eye from injury. When the eye-lids are open the angles of junction of the upper and lower lids are called re- spectively the external and the internal canthus. In the inner canthus the lids are separated by a small triangular area, the lacus lachrymalis, in which is seen a pink mass of fat and connective - tissue, the caruncula lachrymalis, and which is separated from the eye-ball by a vertical fold of conjunctiva, the plica semilunaris, a rudimentary third eye-lid; opposite the outer edge of the caruncle, on each lid, is the lachrymal papilla, which is pierced by the punctum lachrymals, the external open- ing of the lachrymal canal. Structure from without inwards : skin, areolar tissue, orbicu- laris muscle (p. 22), tarsal plate, and palpebral ligament, Meibomian glands, and conjunctiva; the upper lid also con- tains the aponeurosis of the levator palpebrse, which is 'attached along the upper margin of the tarsal plate. The tarsal plates are laminae of condensed connective- tissue found in each lid ; the superior, the larger, is half oval 238 THE POCKET ANATOMY in shape, the lower a narrow oblong strip. In their substance are lodged the Meibomian follicles. Each tarsal plate is at its edge (except towards the ocular fissure, where it is free) continuous with the membranous sheet known as the palpebral ligament, while internally and externally it receives the tarsal ligaments (p. 22). The superior tarsal plate re- ceives above the main insertion of the levator palpebrse superioris. The palpebral ligaments form an incomplete diaphragm for the anterior orifice of the orbit ; peripherally they are attached to orbital margin and centrally to edge of tarsal plates. The conjunctiva is the membrane which forms the most posterior layer of both eye-lids, at the free edges of which it joins the skin. At the base of each eye-lid, where the structures enter its layers, the conjunctiva is reflected on to the eye-ball, the lines of reflection being known as the fomices, of which the superior is the deeper ; into it some fibres of the levator palpebrae superioris are inserted. Over the eye-ball, where it covers the sclerotic, the conjunctiva is loosely connected, some connective-tissue and Tenon's capsule intervening ; but at the corneo-sclerotic margin the conjunctiva is firmly adherent, covering the cornea as its anterior epithelial layer. The conjunctival sac has opening into it above the ducts of the lachrymal gland, and below the openings of the lachrymal canaliculi at the puncta lachrymalia. The lachrymal gland occupies a depression in the supero- external angle of the orbit ; the anterior margin is connected to the back part of the upper eye-lid. The ducts (12 or 14) open by apertures, placed in a row, on the inner surface of the upper lid. The lachrymal canals commence at the puncta lachrymalia, which are the openings of the canaliculi, and, arching in the free edge of the lid, pass inwards to open into the lachrymal sac. The lachrymal sac is placed in a groove formed by the lachrymal bone and the nasal process of the superior maxilla, being behind the tendo oculi, and in front of the tensor tarsi ; it is the dilated upper end of the nasal duct. The nasal duct, formed by the lachrymal, superior maxilla and inferior turbinal bones, leads from the lachrymal sac to the inferior meatus of the nose, where it opens, the aperture being partly guarded by a valve formed of the mucous mem- brane. It is about inch long, and is directed downwards, and slightly outwards and backwards. THE EYE AND ITS APPENDAGES 239 THE BYE. The eye-ball is contained within the orbit; its shape is spherical, with the segment of a smaller sphere, corresponding to the cornea, superimposed anteriorly. The eye-ball consists of three coats enclosing three re- fractive media : IChoroid. Ciliary body. Iris. yd coat ... ... ... Retina. The refractive media are : 1. Aqueous humour. 2. Vitreous body. 3. The lens. Covering the posterior of the eye-ball is a layer of fascia, the capsule of Tenon, continuous posteriorly with the sclerotic at the entrance of the optic nerve, whilst anteriorly at the corneo-sclerotic junction it is connected with it by loose tissue only, and is pierced by the tendons of the muscles of the eye- ball. It is connected with the eye-ball only by delicate con- nective-tissue, the interval constituting an extensive lymph- spa^e and forming a free socket in which the eye-ball glides. The sclerotic coat is opaque and fibrous, and occupies the posterior of the eye-ball, being continuous in front with the cornea, at the corneo-sclerotic junction. The outer surface is white and smooth, receiving the inser- tions of the recti and obliqui muscles. The inner surface is of a light-brown colour, due to a lining of pigmented connective-tissue, the membrana fusca, which is connected by fine filaments to the choroid coat. Between the sclerotic and choroid coats is a lymph-space transmitting branches of the ciliary vessels and nerves. The optic nerve passes through the posterior part of the sclerotic, about $ inch internal to the axis of the eye-ball, the point of perforation being called the lamina cribrosa. At its entrance, the outer sheath of the nerve blends with the sclerotic coat. The sclerotic is thickest at its posterior part, gradually thinning until about inch from the cornea, where it thickens hgain. 240 THE POCKET ANATOMY Close to the junction of the cornea with the sclerotic is a small circumferential lymph -space, called the canal oj Schlemm. The bloodvessels of the sclerotic are few in number, but near its junction with the cornea there is a vascular zone derived from the anterior ciliary branches of the ophthalmic artery. The cornea is the anterior transparent part of the outer coat of the eye-ball, occupying about fc of the circumference of the globe. It projects forward beyond the curvature of the sclerotic, being the segment of a smaller sphere. The posterior surface is concave, and projects further backwards than the anterior convex surface, being overlapped by the edge of the sclerotic ; this surface forms the anterior boundary of the anterior chamber of the eye, containing the aqueous humou-r. The cornea is clothed on its anterior convex surface by the conjunctiva, which here consists only of an epithelial layer. At the circumference of the cornea some of the fibres which form its stroma are continued backwards and outwards into the choroid, sclerotic, and iris; those going to the iris are called the ligamentum pectinatum iridis or the pillars of the iris; they form an annular meshwork enclosing a series of lymph-spaces (spaces of Fontana) which communicate with the anterior chamber. The choroid coat is situated between the sclerotic and the retina, and is the vascular tunic of the eye-ball. It is con- tinued anteriorly into the iris, but before its junction it forms a number of projections, folding inwards, and arranged in a circle, known as the ciliary processes. The choroid coat is thickest behind, where it is pierced by the optic nerve. Externally it is connected to the sclerotic by loose connec- tive-tissue traversed by vessels and nerves as before described. Internally it is covered by the pigmented cells of the retina. The choroid consists of bloodvessels connected together by loose connective-tissue, and containing large branched and pigmented cells. It is made up of two layers, an outer and an inner. The outer part contains the larger branches of the vessels. The arteries, the short posterior ciliary, pierce the sclerotic coat close to the optic nerve, pass forwards, and bend inwards to end in the inner layer. The veins, vasa vorticosa, are external to the arteries and join together into four or five principal trunks, which pierce the sclerotic midway between the cornea and the optic nerve The inner coat, or tunica Ruyschiana, is formed by the THE EYE AND ITS ATPENI'-IGES 241 capillary endings of the vessels of the outer coat ; they pass forwards to inch from the cornea, joining those of the ciliary processes. The Ciliary Body consists of the ciliary processes and the ciliary muscle. The ciliary processes are of the same structure as the rest of the choroid. They are about seventy in number, and are placed in corresponding depressions upon the surface of the vitreous humour, and upon the suspensory ligament of the lens. The bloodvessels are derived from the anterior ciliary branches. The ciliary muscle consists of two sets of involuntary muscular fibres, radiating and circular. (Nerve supply from 3rd cranial.) The radiating arise by tendon from the sclerotic close to the junction with the cornea, between the spaces of Fontana and the canal of Schlemm, and are inserted into the choroid opposite the ciliary processes. The circular: a zone of circular fibres internal to the radiating, at the base of the ciliary processes. The iris is the coloured membrane suspended in the aque- ous humour behind the cornea and in front of the lens. In the centre is an aperture, the pupil. It is connected at its circumference to the choroid, being continuous with it ; and anterior to this it is attached to the cornea by the pillars of the iris, or ligamentum pec- tinatum. The anterior surface is coloured and marked by wavy lines converging towards the free edge of the pupil. The posterior surface is darkly pigmented (uvea] and marked with folds prolonged from the ciliary processes. The framework of the iris is a delicate stroma of connec- tive-tissue, containing bloodvessels, nerves, pigment cells, and two groups of involuntary muscular fibres : The sphincter, a narrow band of fibres placed posteriorly close to the pupil (3rd nerve) . The dilator, commencing at the outer margin of the iris, with the fibres converging towards the pupil (sympathetic nerve). The bloodvessels of the iris consist of the two long ciliary and the anterior ciliary arteries ; the former pierce the sclerotic close to the optic nerve, and pass forwards in the lymph- space between the lamina fusca of the sclerotic and the lamina supra-choroidea of the choroid to enter the outer surface of the iris, having previously divided into two branches. They anastomose with the corresponding vessels of the opposite 10 242 THE POCKET ANATOMY side, and with those from the vascular zone of the sclerotic, formed by the anterior ciliary arteries. These form the circulus iridis major. Small branches from this circle converge towards the pupil, and freely anastomose with one another, forming the circulus iridis minor. The veins follow the same arrangement as the arteries, and communicate with the canal of Schlemm. The nerves of the choroid and iris are about fifteen in number, and are the ciliary nerves, from the lenticular ganglion and the nasal branch of the 5th ; they follow very closely the course of the bloodvessels, and, reaching the ciliary body, form a plexus, sending twigs to the ciliary muscle, iris, and cornea. The retina is the expanded termination of the optic nerve, and forms the innermost tunic of the eye. It reaches forwards nearly as far as the ciliary processes, where it ends in a saw- edged border, the ora serrata, and from this border there is prolonged a thin layer as far as the ciliary processes, which blends with the uvea of the iris. This prolongation contains no nerve-fibres, and is called the pars ciliaris retina. The outer surface is covered with uveal pigment -cells (formerly described as part of the choroid). The inner surface contains : The macula lutea, or yellow spot, situated in the axis of the globe. Thefovea centralis, a depression in the preceding. Theporus opticus, or disc, about ^ inch to the inner side of the yellow spot, where the optic nerve enters, and from which its fibres radiate ; coursing over the optic disc may be seen the central vessels of the retina. Bloodvessels of the retina : The central artery of the retina passes through the optic nerve, and reaches the inner surface of the retina through the disc. It here divides into two branches, an ascending and descending, and each of these, again, into an outer or temporal division, and an inner or nasal. The outer branches give small offsets to end in capillaries round the fovea. The rest of the branches are distributed, as capillaries, to the retina, as far as the ora serrata, but the smaller branches do not anastomose with one another or with any other vessels. The veins follow the same distribu- tion as the arteries. The vitreous body is a soft gelatinous substance occupying about $ of the eye-ball. It supports the retina behind, and is hollowed out in front for the lens THE EYE AND ITS APPENDAGES 243 Between the retina and the vitreous, and enclosing the latter except in front, is a thin capsule, the hyaloid membrane. This membrane passes forwards in front to the anterior part of the margin of the lens. It becomes stronger in this part, and is called the zonule of Zinn, the zonula ciliaris, or the suspensory ligament of the lens. The zonule commences near the ciliary processes, and passes forwards to the front of the lens, and is attached in front to the lens capsule. In addition some fibres are attached to the extreme edge of the lens, and others become continuous with the posterior part of the capsule. The interstices between these fibres are occupied by fluid, but after death they may be distended with air, and an appearance of a canal (canal of Petit) encircling the lens is produced. Extending forwards from the optic disc through the vitreous, as far as the capsule of the lens, is the canal of Stilling, or hyaloid canal, which is the remains of a passage for a branch from the central artery of the retina in the foetus. The lens is a transparent bi-convex body enclosed in a transparent membrane, the lens capsule. It is in contact anteriorly with the iris ; posteriorly it rests in a depression in the vitreous body, and it is surrounded by the suspensory ligament or zonule of Zinn. It is about inch in diameter, and about \ inch thick. The lens capsule is the structureless membrane enclosing the lens, thick in front near its circumference, where it is strengthened by the fibres of the zonule, but very thin posteriorly. The aqueous humour and the aqueous chambers. The aqueous humour occupies the space between the anterior surface of the lens capsule and the posterior surface of the cornea. The iris divides the chamber into two parts, known as the anterior and posterior chambers. The anterior chamber is bounded in front by the cornea, behind by the iris, and opposite the pupil by the anterior part of the lens. The posterior chamber is the triangular interval at the cir- cumference of the lens between the ciliary processes, the iris, and the zonule of Zinn, 16 a INDEX ABDOMINAL aorta, 82 ring, external, 44 internal, 223 Abducens nerve, 151 Abductor indicis muscle, 40 hallucis muscle, 58 minimi digiti muscle 39 pedis muscle, 58 pollicis muscle, 39 Accessorius muscle, 58 ad sacro-lumbalem, 42 Accessory obturator nerve, 169 Acromio-clavicular articulation, 9 Acromio-thoracic artery, 74 Aditus ad antrum, 232 Adductor brevis muscle, 52 obliquus hallucis muscle, 58 longus muscle, 52 magnus muscle, 52 obliquus pollicis muscle, 39 transversus hallucis muscle, 5 8 . pollicis muscle, 39 Alar ligaments of the knee, 17 Ampulla, membranous, 235 of the semicircular canals, Amygdaloid lobe of cerebellum, 124 Anastomotic artery of brachial, 76 femoral, 92 Anconeus muscle, 38 Angular artery, 67 vein, 99 Ankle-joint, 18 Annular ligament of ankle, anterior, 57 external, 57 internal, 57 of wrist, anterior, 13,35 posterior, 13,36 Annulus ovahs, 205 Anterior commissure of brain, 138 Anti-helix, 230 Anti-tragus, 230 Aorta, 79 Aorta, abdominal, 82 thoracic, 80 Aortic arch, 79 opening, 46 plexus, 180 sinus, 79 Aperture of the aorta, 46 inferior vena cava, 46 coronary Arteries, 206 Eustachian tube, 232 for the femoral artery, 53 of the larynx, 210 nares, 186, 229 oesophagus, 187 pulmonary artery, 205 veins, 206 Aponeurosis, epicranial, 21 of external oblique, 44 over femoral artery, 53 of internal oblique, 44 lumbar, 45 of the pharynx, 186 plantar, 57 of the soft palate, 183 temporal, 25 of the transversalis muscle, 44 vertebral, 41 Appendages of the eye, 237 Appendix auriculae, 200, 204, 206 vermiformis, 190 Aqueduct of Sylvius, 126 of the vestibule, 234 Aqueous humour, 243 Arachnoid membrane of the brain, 140 of cord, 116 Arbor vitae cerebelli, 126 Arch, crural or femoral, 50 of aorta, 79 of diaphragm, 46 palmar deep, 77 superficial, 78 plantar, 97 Arciform fibres, 119 Arteria acromialis thoracica, 74 anastomotica brachialis, 76 magna, 90 angularis faciei. 67 INDEX 245 \rter., aorta abdominalis, 82 thoracica, 80 articulates inferipres, 93 superiores, 93 articularis azygos, 93 auricularis posterior, 68 auditoria, 73 axillaris, 73 basilaris, 73 brachiahs, 75 bronchiales, 81 buccalis, 70 capsularis inferior, 84 media, 83 superior, 82 carotis communis dextra, 64 sinistra, 64 externa, 65 interna, 73 carpi ulnaris anterior, 78 posterior, 78 radialis anterior, 76 posterior, 76 centralis retinae, 72 cerebelli inferior, 62 anterior, 73 superior, 73 cerebri anterior, 72 media, 72 posterior, 73 cervical is ascendens, 62 profunda, 64 choroidea cerebri, 72 ciliares anteripres, 72 posteriores, 72 circumflexa anterior, 75 externa, 91 ilii interna, 89 superficialis, 91 interna, 91 posterior, 75 coeliaca, 82 colica dextra, 84 media, 84 sinistra, 84 comes nervi ischiadici, 89 phrenici, 63 communicans cerebri anterior, 72 posterior, 72 palmaris, 79 plantaris, 96 coronaria dextra, 206 labii inferipris, 67 superioris, 67 sinistra, 207 ventriculi, 82 corporis bulbosi, 88 Arter., corporis cavernosi, 88 cremasterica, 89 crico-thyroidea, 66 cystica, 83 deferentialis, 86 dentalis anterior, 70 inferior, 70 superior, 70 diapbragmatica, 63, 82 digitales manus, 79 pedis, 96, 97 dorsales pollicis, 77 dorsalis carpi radialis, 77 ulnaris, 78 hallucis, 95 indicis, 77 lingua?, 66 pedis, 94 penis, 88 scapulae, 74 epigastrica, 89 superficialis, 90 ethmoidalis anterior, 72 posterior, 72 facialis, 66 femoralis, 90 frontalis, 72 gastricae, 87 gastro-duodenalis, 83 epiploica dextra, 83 sinistra, 83 glutea, go haemorrboidalis inferior, 87 media, 86 superior, 85 hepatica, 82 hyoidea lingualis, 66 thyroideae, 66 hypogastrica, 86 ileo-colica, 84 lumbalis, 88 iliaca communis, 85 externa, 88 interna, 86 incisoria, 70 infra-orbitalis, 70 scapularis, 63 innoroinata, 80 intercostales anteriores, 63, 81 rami anteriores, 81 posteriores, 81 intercostalis superior, 64 interossea, 78 anterior, 78 posterior, 7-; interosseas manus, 77 pedis, 95 246 INDEX Artei., intestinales, 84 ischiadica, 89 labialis inferior, 67 lachrymalisj 71 laryngealis inferior, 62 superior, 66 Hngualis, 66 lumbales, 85 rami anteripres, 85 posteriores, 85 malleolares, 94 mammaria, externa, 74 interna, 63 masseterica, 70 maxillaris interim, 69 mediana, 78 mediastinae, 81 rneningea media, 69 parva, 69 meningeae anteriores, 71 posteriores, 61 mesenterica inferior, 84 superior, 83 metacarpa radialis, 77 ulnaris, 78 metatarsea, 95 musculo-phrenica, 63 mylo-hyoidea, 70 nasalis, 72 lateralis, 67 septi, 70 nutntia femoris, 92 humeri, 75 tibiae, 96 obturatoria, 86 occipitalis, 67 oesophageales, 81 ophthalmic;!, 71 ovariana, 84 palatina inferior, 67 superior, 70 palmaris prpfunda, 77 palpebrahs inferior, 72 superior, 72 pancreaticae, 83 pancreatico-duodenalis, 83 perforantes femorales, 92 mam ma rise in- ternal, 63 manus, 77 . pencardiacae, 81 perinaei superficialis, 87 pronea, 96 anterior, 96 pharyngea ascendens, 68 phrenicae inferipres, 82 superiores, 63 Arter. , plantaris externa, 97 interna, 96 poplitea, 92 princeps cervicalis, 68 pollicis, 77 profunda cervicis, 64 femoris, QI inferior, 76 superior, 75 pterygoideas, 70 pterygo-palatina, 70 pudenda externa, 91 interna, 87 pulmonalis, 214 dextra, 215 sinistra, 215 pylori ca, 83 radialis, 76 mdicis, 77 ranina, 66 recurrens interossea posterior, radialis, 76 tibialis, 97 ulnaris anterior, 78 posterior, 7! renales, 84 sacra-media, 85 lateralis, 88 scapularis posterior, 63 sciatica, 89 sigmoidea, 85 spermatica, 84 spheno-palatina, 70 spinales posteriores, 6i spinalis anterior, 62 splenica, 83 sterno-mastoidea, 66 stylo-mastoidea, 68 subclavia dextra, 59 sinistra, 59 sublingualis, 66 submentalis, 67 subscapularis, 74 superficialis cervicalis, 63 perinaei, 88 vola^, 76 supra-orbitalis, 72 scapularis, 62 tarsea, 94 temporales profundae, 69 temporalis, anterior, 69 deep, 70 media, 69 posterior, 69 superficialis, 68 thoracica acromialis, 74 alaris, 74 INDEX 247 After., thoracica longa, 74 superior, 74 tbyroidea ima, 80 inferior, 62 superior, 66 tibialis antica, 93 postica, 94 tonsillaris, 67 transversalis colii, 63 facie i, 69 perina-i, 87 pontis, 73 tympanica, 69, 71 ulnaris, 77 uterina, 86 vaginalis, 86 vertebralis, 61 vesicalis inferior, 86 media, 86 superior, 86 vidiana, 70 Articular popliteal arteries, 93 nerves, 173, 174 Articulation, acromio-clavicular, 9 astragalo-scaphoid, 19 atlo-axoid, 3 of bones of the tym- panum, 231 calcaneo-astragaloid, 19 cuboid, 19 scaphoid, 19 of carpal bones, 12 carpo-metacarpal, 13 of cervical vertebra, 2 chondro-costal, 6 sternal, 5 of coccygeal bones, 8 coraco-clavicular, 9 of costal cartilages, 6 costo-clavicular, 9 vertebral, 5 crico-aryteiT'id, 208 thyroid, 209 of cuneiform bones, 19 cuneiform to cuboid, 19 to scaphoid, of dorsal vertebrae, 3 femoro-tibial or knee, 15 humero - cubital or elbow, 10 ilio-femoral or hip, 14 of lower jaw, 4 of lumbar vertebrae, 2 of the metacarpal bones, metacarpo - phalangeal, 14 Articulation, metatarsal, 20 metatarso - phalangeal, 20 occipito-atlpid, 3 axial, 4 os calcis to cuboid, 19 to scaphoid, 19 peroneo-tibial, 17 phalangeal of fingers, 14 of toes, 21 of pubic symphysis, 8 radio-carpal or wrist, 12 cubital inferior, n superior, 1 1 sacro-coccygeal, 8 iliac, 7 vertebral, 6 scaphoid to cuboid, 19 to cuneiform, T 9 scapulo-humeral, 10 sterno-clavicular, 8 tarso- metatarsal, 20 temporo-maxillary, 4 of the thumb, 13 tibio-tarsal or ankle, 18 of vertebrae, 2 Arcus externus diaphragmatis, 46 internus diaphragmatis, 46 Aryteno-epiglottidean folds, 209 Arytenoid cartilages, 208 muscle, 31 Ascending cervical artery, 62 vein, 10 1 colon, 190 pharyngeal artery, 68 vein, 10* Attollens aurem muscle, 22 Attrahens aurem muscle, 22 Auditory artery, 73 nerve, 153, 236 nucleus, 123 Auricle of the ear, 230 Auricles of the heart, 204 left, 206 right, 204 Auricular artery, posterior, 68 nerve of vagus, 155 nerves, great, 160 inferior, 147 superior, 147 posterior, 152 vein, loo Auriculo-temporal nerve, 147 ventricular aperture, left, 206 ventricular aperture, right, 205 248 INDEX Auricularis magnus nerve, 160 Axillary artery, 73 fascia, 32 vein, 102 Axis, coeliac, of artery, 8a of cochlea, 235 thyroid, 62 Azygos, artery, 93 veins, 104 uvulae muscle, 30 Base of brain, 129 Basilar artery, 73 membrane, 237 Basilic vein, 102 Biceps femoris muscle, 54 flexor cubiti muscle, 35 Bicuspid teeth, 181 Bile ducts, 193 Biventral lobe, 125 Bladder, 218 interior of, 219 connections of, 219 ligaments of, 48, 191 Bones of the ear, 232 Brachial aponeurosis, 35 artery, 75 plexus, i6x veins, 102 Brachialis anticus muscle, 35 Brain, base of, 129 membranes of, 139 Broad uterine ligament, 227 Bronchial arteries, 81 glands, 113 veins, 105 Bronchus, left, 212 right, 212 Brunner's glands, 190 Buccal artery, 70 nerve, 146 Buccinator muscle, 24 Bulb of the urethra, 221 artery of, 88 Bulbus olfactorius, 141 Caecum coli, 190 connections of, 190 Calamus scriptorius, 120 Calices of the kidney, 217 Calciform papillae, 217 Canal, Hunter's, 53 of cochlea, 236 of Petit, 243 of spinal cord, 116 of Stilling, 243 of the tensor tympani, 232 Canine teeth, 181 Capsular arteries, inferior, 84 middle, 83 superior, 8 a ligament of the hip, 14 knee, 16 shoulder, 10 thumb, 13 Capsule of crystalline lens, 243 of Glisson. 194 suprarenal, 217 Caput gallinaginis, 221 Cardiac nerve, inferior, 178 middle, 178 of pneumogastric, 156 superior, 176 plexus, 179 veins, 106 Carneae columnse, 199 Carotid artery, external, 65 internal, 73 left common, 64 right common, 64 Carpal artery, radial anterior, 76 posterior, 76 ulnar anterior, 78 posterior, 78 Carpo-metacarpal articulation, 13 Cartilage, arytenoid, 208 cricoid, 208 cuneiform, 209 of the ear, 230 thyroid, 207 triangular of the nose, 228 Cartilages of the nose, 228 of Santorini, 208 of trachea, 211 Caruncula lachrymalis, 237 Carunculae myrtiformes, 225 Cauda equina, 1 14 Cava inferior, 105 superior, 103 Cavernous body, 221 artery of, 88 plexus, 177 sinus, 98 Central artery of the retina, 73 passage of cochlea, 235 lobe of brain, 133 Centrum ovale cerebri, 134 Cephalic vein, 102 Cerebellar arteries, inferior, 62 superior, 73 Cerebellum, form of, 124 lobes of, 12 4 structure of, 125 Cerebral artery, anterior, 72 INDEX 249 Cerebral artery, middle, 72 posterior, 73 Cerebrum, division into lobes, 131 form of, 130 interior, 134 structure, 138 <"'Tvical fascia, 26 ganglion, inferior, 178 middle, 177 superior, 176 glands, in nerves, anterior branches, 159 posterior branches, 159 plexus of nerves, 159 plexus of nerves, deep branches, 161 plexus of nerves, superficial, 160 Cervical is, ascendens artery, 62 muscle, 42 . vein, 101 profunda artery, 64 vein, 101 superficialis nerve, 160 Cervico-facial nerve, 153 Cervix uteri, 226 Chamber of the eye, anterior, 243 posterior, 2(3 Check ligaments, 4 Chiasma of the optic nerves, 129 Chondro-costal articulations, 6 sternal articulations, 5 Chorda tympani nerve, 152 Chordae tendineae, 205 Chordae vocales, 210 Chorda: Willisii, 98 Choroid arteries of the brain, 72 coat of the eye, 240 plexuses of the brain, 137 veins of the eye ; 240 brain, 97 Ciliary arteries, 72 muscle, 241 processes of the choroid, 241 nerves of nasal, 143 of lenticular ganglion, Circle of Willis, 7^ Circular sinus, 98 Circumflex artery, anterior, 75 external, 91 internal, 91 posterior, 75 iliac artery, deep, 89 superficial, 91 e, 162 Clavicular cutaneous nerves, 160 Clitoris, 225 Coccygeal muscle, 49 nerve, 170 Cochlea, canal of, 236 nerves of, 237 Coeliac artery, 82 plexus, 1 80 Colic artery, left, 84 middle, 84 right, 84 veins, 108 Colon, 190, ic i Columnar carneae, 205 Columns of the cord, 115 Comes nervi ischiadici artery, 89 phrenici artery, 63 Commissure, anterior, 138 of the cerebellum, 125 of the cord, 116 great, 135 of the optic nerves, 129 posterior, 128 soft, 128 Commissural fibres of the medulla, 119 Communicating artery of anterior cerebral, 72 Communicating artery of posterior cerebral, 72 Communicating artery in the palm, Communicating peroneal nerve, 175 Compressor muscle of the nose, 23 of the urethra, 49 Concha, 230 Conjoined tendon, 44 Conjunctiva, 238 Conoid ligament, 9 Constrictor muscle, inferior, 29 . middle, 29 superior, 29 Conus arteriosus, 205 medullaris, 114 Convolutions of the brain, 131 of hemisphere, 131 of longitudinal fissure, 132 Coraco-brachialis muscle, 34 clavicular articulation, 9 humeral ligament, 9 Cornea, 240 Cornicula laryngis, 210 Cornua of gray crescent, 116 of lateral ventricles, 135 Corona glandis, 221 Coronary vessels of the heart, 206 of the lips, 67 2 5 INDEX Coronary artery of the stomach, 82 ligament of the liver, 192 plexus of the stomach, 1 80 plexus of the heart, 1 80 sinus, 106 Corpora albicantia, 129 Arantii, 205 cavernosa, 221 geniculata, 128 olivaria, 120 quadrigemina, 127 restiformia, 119 striata, 137 Corpus callosum, 134 dentatum cerebelli, 126 fimbriatum uteri, 227 geniculatum externum, 128 internum, 128 Highraori, 223 olivare, 120 spongiosum urethrae, 221 thyroideum, 215 Corrugator supercilii muscle, 22 Costo-clavicular ligament, 9 coracoid membrane, 32 transverse ligaments. 5 Cotunnius, nerve of, 145 Cotyloid ligament, 15 ( 'overed band of Reil, 135 Cowper's glands, 220 Cremaster muscle, 44 Cremasteric artery, 89 fascia, 222 Cribriform fascia, 50 Crico-arytenoid artirulation, 208 muscle, lateral, 31 posterior, 31 thyroid articulation, 208 membrane, 209 muscle, 30 Cricoid cartilage, 209 Crista vestibuli, 236 Crucial ligaments, 16 Crura cerebelli, 125 cerebri, 126 of the diaphragm, 46 of the fornix, 136, 1 37 Crural arch, 50 deep, 51 canal, 50 nerve, 169 ring, 50 sheath, 50 Cystic artery, 83 duct, 194 plexus of nerves, 180 Decussation of the pyramids, io Deep cervical artery, 64 crural arch, 51 transverse muscle of perinaeun^ 49 Deferential artery, 36 Deltoid ligament, 18 muscle, 33 Dental artery, anterior, 70 inferior, 70 superior, 70 Dental nerve, superior, 144, 145 inferior, 147 posterior, 144 Dentate ligament, 117 Depressor anguh oris muscle, 24 labii inferioris muscle, 24 alee nasi muscle, 23 Descendens hypoglossi nerve, 158 Descending colon, 191 Diaphragm, 46 arteries, 62, 83 plexus of, 1 80 Digastric muscle, 28 nerve, 152 Digital arteries of plantar, 97 of radial, 77 of ulnar, 79 nerves of median, 164 of plantar, 174 of radial, 165 of ulnar, 164 Dilatator muscle of the n 'f,e, 24 of the pupil, 241 Dorsal artery of the foot, 94 of the penis, 88 of the scapula, 74 of the tongue, 66 nerves, anterior branches, *59 posterior branches, 158 cutaneous of the hand, 164 of the penis, 172 Dorsi-spinal veins, 105 Douglas's fold, 45 Ductus ad nasum, 239 arteriosus, 214 communis choledochus, 194 cysticus, 194 ejacularorius, 224 hepaticus, 194 lymphaticus, in pancreaticus, 195 reunions, 236 Riviniani, 185 Stensonis, 184 thoracicus. no INDEX 251 Ductus Whartonii, 185 Duodenum, connections, 188 Dura mater, 139 of the cord, 116 Ear, external, 230 internal, 234 Eighth nerve, 153 Ejaculator urinae muscle, 49 Elbow joint, 10 Eminentia collaterals, 136 Encephalon, 117 Endocardium, 205 Endolymph, 234 Epididymis, 223 Epigastric artery, 89 superficial, 90 veins, 109 Epiglottis, 210 Erector clitoridis muscle, 49 penis muscle, 49 spinae muscle, 42 Ethmoidal arteries, 72 Eustachian tube, cartilaginous part, 232 osseous part, 232 valve, 204 Extensor carpi radialis brevior muscle, 37 Extensor carpi radialis longior muscle, 37 carpi ulnaris muscle, 38 digiti minimi muscle, 37 Extensor digitorum brevis muscle, 57 communis muscle, 37 1 o n gu s pedis muscle, 55 indicis muscle, 38 ossis metacarpi muscle, -;8 proprius hallucis muscle^ 5. brevis pollicis muscle, 38 longus pollicis muscle, 38 External cutaneous nerves of arm 163 of thigh, i6, c saphenous nerve, 173 vein, 108 Eye-ball, 239 brows, 237 lashes, 237 lids, 237 muscles of, n structure, 237 Facial artery, 66 nerve, 151 vein, 99 Falciform ligament of the liver, 192 border of saphenous open ing, 50 Fallopian tube, 227 Falx cerebelli, 140 cerebri, 139 Fascia, axillary, 32 brachial, 35 cervical, deep, 26 costo-coracoid, 32 cremasteric, 222 cribriform, 501 of Colles, 47 of the forearm, 35 iliac, 50 intermuscular of the humerus, of the thigh, 49 lata, 49 lumborum, 45 masseteric, 25 obturator, 47 of the leg, 56 of the pyriformis, 48 perinaeal, deep, 47 superficial, 47 plantar, deep, 57 recto-vesical, 48 temporal, 25 transversalis, 222 triangularis, 44 Fasciculus teres, 121 Femoral artery, 90 vein, 109 Femoro-tibial articulation, 15 Fenestra ovalis, 231 rotunda, 232 Fibres of the cerebrum, 138 of the cerebellum, 1 24 Fifth nerve, 142 ventricle of brain, 136 Filiform papillae, 182 Fillet of the olivary body, 120 Filum terminate, 114 First nerve, 141 Fissure, longitudinal, 130 paneto-occipital, 130 of Rolando, 130 of Sylvius, 130 transverse, 130 Fissures of Santorini, 231 of the cord, 115 of the cerebrum , 130 Flexor accessorius muscle, 58 brevis minimi digiti muscle, ^9 pedis muscle, carpi radialis muscle, 36 ulnaris muscle, 36 digitorum brevis pedis muscle, 58 longus pedis muscle, 56 252 INDEX Flexor digitorumprofundusmuscle,36 sublimis muscle, 36 hallucis longus muscle, 56 brevis muscle, 58 pollicis longus muscle, 37 brevis muscle, 39 Flocculus cerebelli, 124 Fold of Douglas, 45 Follicles, Meibomian, 238 Foramen of Monro, 137 for inferior vena cava, 46 of Winslow, 201 ovale, 206 Foramina Thebesii, 204 Fornix, 136 Fossa navicular of the urethra, 221 of the pudendum, 225 ovalis, 205 Fossae of abdominal wall, 198 Fourth nerve, 142 ventricle, 120 Fovea centralis, 242 hemispherica, 234 hemi-elliptica, 234 Foveae of fourth ventricle, 121 Fraenum linguae, 18 c praeputii, 221 Frontal artery, 72 lobe, 131 nerve, 143 vein, 98 Fungiform papillae, 181 Funiculus cuneatus, 119 gracilts, 119 of Rolando, 119 Galen, veins of, 97, 137 Gall bladder, 193 Ganglia, cervical, inferior, 178 middle, 177 superior, 176 lumbar, 178 of spinal nerves, 158 sacral, 178 semilunar, 179 thoracic, 178 Ganglion of the vagus, 155 Gasserian, 142 impar, 179 jugular, 154 lenticular, 143 Meckel's, 145 ophthalmic, 150 otic, 148 petrosal, 154 spheno-palatine, 145 submaxillary, 148 Gastric arteries, 83 Gastric plexus, 180 vein, 107 Gastro-colic omentum, 199 epiploic arteries, 83 vein, 108 hepatic omentum, 199 Gastrocnemius muscle, 55 Gemellus inferior muscle, 54 superior muscle, 54 Geniculate bodies, 128 Genio-hyo-glossus muscle, 29 hyoid muscle, 29 Genital organs, 220 Genito-crural nerve, 168 Gimbernat's ligament, 44 Gland, lachrymal, 238 parotid, 183 pineal, 129 pituitary, 129 prostate, 220 sublingual, 185 submaxillary, 184 Glands, axillary. 112 Bartholm's, 225 bronchial, 113 Brunner's, 190 cardiac, 113 cervical, in concatenate, in Cowper's, 220 inguinal, 113 intercostal, 113 intestinal, 112 lingual, 182 lumbar, 112 mediastinal, 113 Meibomian, 237 mesenteric, 112 oesophageal, 113 of Pacchioni, 139 pelvic, 112 Peyer's, 190 popliteal, 113 sternal, 113 Glans of the clitoris, 225 of the penis, 220 Glenoid ligament, 10 Glisson's capsule, 194 Globus major epididymis, 2*3 minor epididymis, 223 Glosso-pharyngeal nerve, 153 nucleus, 122 Glottis, 210 Gluteal artery, 90 nerve, superior, 171 nerves, inferior, 171 Glutens maximus muscle, 53 medius muscle, 53 INDEX Glutens minimus muscle, 53 Gracilis muscle, 52 Grey commissure of llie cord, 116 crescent of the cord, 1 15 substance of the corpus stria - turn, 137 substance of the medulla ob- longata, 123 substance of the third ventricle, 128 tubercle of Rolando, 119 Great omentum, 199 Gustatory nerve, 147 Gyrus fornicatus, 134 Hittnorrhoidal artery, inferior, 87 middle, 86 superior, 85 nerve, inferior, 172 plexus, 180 veins, 109 Hamulus laminae spiralis, 235 Heart, 202 Helicotrema, 235 Helix,_230 Hepatic artery, 82 duct, 194 plexus, 180 veins, 106 Hip-joint, 14 Hippocampus major, 136 minor, 136 Hunter's canal, 53 Hyaloid membrane, 243 Hymen, 225 Hyo-glossus muscle, 29 Hypogastric artery, 86 plexus of nerves, 180 Hypoglossal nerve, 157 nucleus, 13* Ileo-caecal valve, 190 Ileo-colic artery, 84 lleum, 189 Iliac artery, common, 85 external, 88 internal, 86 colon, 191 fascia, 50 vein, common, no external, 109 internal, 109 Iliacus muscle, 51 Ilio-costalis muscle, 42 Ilio-femoral articulation, 15 hypogastric nerve, 168 inguinal nerve, 168 lumbar artery, 88 Incisor branch of nerve, 147 teeth, 181 Incus, 233 Inferior cornu of the lateral ventricle, i3S maxillary nerve, 148 Infra-orbital artery, 70 nerves, 144, 153 vein, 99 scapular artery, 03 spinatus muscle, 34 trochlear nerve, 143 Infundibulum of the brain, 129 Inguinal canal, 223 glands, 113 Innominate artery, 80 veins, 103 Interarticular cartilage of the jaw, 4 of the hip, 14 of the knee, 15 of the ribs, 5 of the scapula, 9 sacro-iliac, 7 sterno-clavicular, 8 of the symphysis, 8 of the vertebrae, 2 of the wrist, 12 Interclavicular ligament, 8 Intel-columnar fascia, 44 [81 Intercostal arteries, anterior branches, posterior branches, artery, superior, 64 [81 muscle, external, 45 internal, 46 nerves, 166 cutaneous anterior, 1 66 lateral, 166 veins, superior, 104 Intercosto-humeral nerve, 166 Intermuscular septa of the arm, 34 of the foot, 57 of the thigh, 50 Internal cutaneous nerve of the arm, 163 of the thigh. 169 sapbenous nerve, 170 vein, 108 Interosseous arteries of the foot, 95 of the hand, 77 artery, anterior, 78 posterior, 78 ligament of the arm, n of the leg, 17 muscles of the foot, 59 of the hand, 40 nerve, anterior, 164 posterior, 165 254 INDEX Interspinal muscles, 43 Intertransverse muscles, 43 Intervertebral substances, 2 Intestinal arteries, 84 Intestine, large, 190 small, 1 83 Iris, 241 nerves of, 242 structure of, 241 vessels of, 241 Island of Reil, 133 Isthmus of the thyroid body, 215 Iter a tertio ad quartum ventriculum, 126 Jacobson's nerve, 154 Jejunum, 189 Joint, ankle, 18 elbow, 10 hip, 14 knee, 15 lower jaw, 4 shoulder, 10 thumb, 13 wrist, 12 Jugular ganglion, 154 vein, anterior, 100 external, 100 internal, 101 Kidney, 2x6 connections of, 216 Knee of the corpus callosum, 135 joint, 15 Labia pudendi externa, 225 interna, 235 Labial artery, inferior, 67 Labyrinth, 234 membranous, 235 osseous, 234 Lachrymal artery, 71 canals, 238 duct, 238 gland, 238 nerve, 143 sac, 238 Lacunae of the urethra, aaa Lamina cinerea, 129 spiralis cochlea;, 235 Laminae of cerebellum, 124 Large intestine, connections, 190 Laryngeal arteries, 62, 66 nerve, external, 156 inferior, 156 superior, 156 pouch, ?TO Larynx, 207 Larynx, aperture of, 209 cartilages of 207 interior of, 210 ligaments, 209 muscles, 30 nerves, 156] ventricle, 210 vessels, 62, 66 Lateral column of the medulla, 119 of the cord, 115 sinus, 98 ventricles, 135 Latissimus dorsi muscle, 40 Lens, 243 Lenticular ganglion, 143 Levator anguli oris muscle, 24 scapulae muscle, 41 ani muscle, 49 labii superioris muscle, 24 alaeque nasi, muscle, 23 inferioris muscle, 24 palati muscle, 30 palpcbras superioris muscle, 22 Levatores costarum muscle, 46 Ligament of the lung, 212 Ligaments of the bladder, 48, 197 of the larynx, 209 of the ovary, 227 of the uterus, 227 Ligament, acromio clavicular, 9 alar of the knee, 17 annular, anterior of the ankle, 57 external of the ankle, 57 anterior of the Wris - t>I3 r v posterior of the wrist, 13 anterior of ankle, 18 of elbow-joint, 10 of knee-join*, 16 of wrist -joint, *a of carpus, 13 astragalp-scaphoid, 19 atlo-axoid, anterior, 3 posterior, j transverse, 3 calcaneo-astragaloid, 19 cuboid, 19 scaphoid, 19 capsular of the hip, 14 of the knee, 16 of the shoulder, to of the thumb, 13 carpal, dorsal, 12 INDEX 255 Ligament, carpal, palmar, 12 carpo-metacarpal, 13 check, 4 common, anterior of ver- tebrae, 2 common, posterior, 2 conoid, 9 coraco-acromial, 9 clavicular, 9 humeral, 10 coronary, 17 costo-clavicular, 9 coracoid, 32 transverse, anterior, 5 middle, 5 posterior 5 vertebral, 5 cotyloid, 15 crico-thyroid, 209 crucial, 16 deltoid, 18 dorsal of the carpus, 12 of Gimbernat, 44 plenoid, 10 ilio-femoral, 15 lumbar, 6 interartieular of the cla- vicle, 9 of the hip, 15 of the jaw, 4 of the knee, 16 of the pubes, 8 of the ribs, 5 interclavicular, 8 interosseous of astragalus and os calcis, 19 of carpus, 13 of cuneiform bones, 19 of metacarpal bones, 13 of metatarsal bones, 20 of radius and ulna, n of the scaphoid and cuboid, 19 of the tibia and fibula, 17 inferior, of the tibia and fibula, 18 interspinous, 2 intertransverse, 3 intervertebral, 2 ischio-capsular, 15 lateral, external of the ankle, 18 internal of the ankle, 18 external of the carpui, 13 Ligament, lateral, internal of the carpus, 13 external of the elbow, ii internal of the elbow, ii pnalangeal of the foot, 20 phalangeal of the hand, 14 external of the jaw, 4 internal of the jaw, 4 external of the knee, 16 internal of the knee, 16 external of th*; wrist, 12 internal of the wrist, 12 long plantar, 19 lumbo-sacral, 6 metacarpal, dorsal, 13 palmar, 13 metacarpo-phalangeal, 14 metatarsal, dorsal, 20 plantar, 30 mucous, 17 obturator, 8 occipito-atloid, anterior, 3 lateral, 4 posterior, 4 occipito-axoid, 4 odontoid, 4 orbicular of the radius, ii of the patella, 15 peroneo-tibial, 17 of Poupart, 44 posterior of carpus, 13 of elbow, ii of knee, 15 of scapula, 9 of wrist, 12 proper of the scapula, 9 pubic, anterior, 8 posterior, 8 superior, 8 pubp- femoral, 15 radio-ulnar, ii rhomboid, 9 round of the hip, 15 round of the radius and ulna, ii sacro-coccygeal, anterior, 8 posterior, sacro-iliac, anterior, 7 2 5 6 INDEX Ligament, sacro-iliac, posterior, 7 sacro-sciatic, great, 7 small, 7 sacro-vertebral, 6 of the scapula, transverse, 9 sternal, anterior, 6 posterior, 6 sterno-clavicular, 8 stylo-hyoid, 5 maxillary, 4 sub-pubic, 8 supraspinous, 2 suspensory of penis, 220 tarso-metatarsal, dorsal, 20 plantar, 20 thyro-arytenoid, 209 epiglottidean, 210 hyoid, 209 tibio-fibular, 17 transverse of the atlas, 3 of the fingers, of the hip, 15 of the knee, 17 of metacarpus, 14 of metatarsus, 20 of scapula, 9 trapezoid, 9 Ligament, triangular of the urethra, of Winslow, posterior, 15 Ligamenta alaria, 17 subflava, 2 Ligamentum arcuatum, 46 denticulatum, 116 arteriosum, 215 latum pulmonis, 214 longum plantae, 19 mucosum, 17 nuchse, 2 patellae, 15 posticum Winslowii, 15 spirale, 236 subflavum, a teres, 15 Limbus, 236 Linea alba, 44 Linear transversae, 45 Lingual artery, 66 glands, in nerve, 147, 154 vein, 101 Linguales muscles, 182 Liquor Cotunnii, 234 Liver, 192 connections of, 192 ligaments, 192 vessels, 194 Lobes of the cerebellum, 1 24 of the cerebrum, 131 of the testis, 223 of the liver, 193 Lobus auris, 230 caudatus, 193 quadratus, 193 Spigelii, 193 Locus niger, 126 perforatus anticus, 129 posticus. 120 Longissimus dorsi muscle, 42 Longitudinal fibres of the brain, 135 fissure of the liver, 193 sinus, inferior, 98 superior, 97 Longus colli muscle, 31 Lumbar aponeurosis, 45 arteries, 85 anterior branches, 85 posterior branches, 85 ganglia, 178 glands, 112 nerves, anterior branches, 167 posterior branches, 167 plexus, 167 veins, 105 Lumbo-sacral nerve, 167 Lumbricales muscles of the foot, 56 of the hand, 39 Lungs, 212 connections, 213 Lymphatic duct, right, in Lymphatics of the arm, 112 of the axilla, na of the groin, 113 of the lungs, 113 of the mesentery, 112 of the neck, in of the pelvis, 112 of the popliteal space, 113 of the thorax, 113 Lyra, 137 Malleolar arteries, 94 Malleus, 232 muscles of, 233 Mammary artery, internal, 63 Masseter muscle. 25 Masseteric artery, 70 nerve, 146 Maxillary artery, internal, 69 nerve, inferior. 146. INDEX 257 Ma .illary nerve, superior, 144 vein, internal, 100 Meatus auditorius ex t emus, 230 urinarius, 221, 225 Meatuses of the nose, 228 Meckel's ganglion, 145 Median basilic vein, 102 cephalic vein, ioa nerve, 163 vein, IDS Mediastinal arteries, 81 Mediastinum of thorax, 201 of testis, 223 Medulla oblongata, 118 grey matter, 122 structure of, 118 Medullary subiiance of the kidney, 217 Medullary velum, inferior, 125 superior, 122 Meibomian follicles, 238 Membrana basilaris, 237 sacciformis, 12 tympani, 233 Membrane, hyaloid, 243 of the labyrinth, 235 obturator, 8 of Reissner, 236 Membranes of the brain, 139 of spinal cord, 116 Membranous labyrinth, 235 part of the cochlea, 236 part of the urethra, 221 Meningeal artery, anterior, 71 middle, 69 posterior, 61 small, 69 Mesenteric artery, inferior, 84 superior, 83 glands, ii2 plexus, inferior, 180 superior, 180 vein, inferior, 107 superior, 107 Meso-caecum. 200 colon, pelvic, 194 transverse, 200 Metacarpal arteries, 77, 78 Metatarsal artery, 95 Mitral valve, 206 Modiolus of the cochlea, 235 Molar teeth, 181 Mons Veneris, 295 Motor oculi nerve, 142 Mucous ligament, 17 Multifidus spinae muscle, 43 Musculi papillares, 205 Musculi pectinati, 205 Muscnlo-cutaneous nerve of the arm, 163 phrenic artery, 63 spiral nerve, 165 Muse., abductor digiti minimi, 39 digi ti minimi pedis, 58 hallucis, 58 indicis, 40 pollicis, 39 accessorius pedis, 58 accessorius ad sacro-lumba- lem, 42 adductor breyis, 52 obliquus hallucis, longus, 52 magnus, 52 obliquus pollicis, 39 transver- sus, 39 transversus hallu- cis, 58 anconeus, 38 arytenoideus, 31 attollens aurem, 22 attrahens aurem, 22 azygos uvulae, 30 biceps fempris, 54 cubiti, 35 biventer cervicis, 43 brachialis anticus, 35 buccinator, 24 cervicalis ascendens, 41 ciliaris, 241 coccygeus, 49 complexus, 43 compressor naris, 23 constrictor, inferior, 29 medius, 29 superior, 29 coraco-brachialis, 34 oorrugator supercilii, 22 cremastericus, 44 cricu - arytenoideus latera- l's, 3i crico - arytenoideus posti- cus, 31 crico-thyroideus, 30 cnireus, 52 deltoideus, 33 depressor anguli oris, 24 depressor labii infenoris, alas nasi, 23 diaphragma, 46 INDEX Muse., digastricus, 28 dilatator naris, 24 vlusc. , infra-spinatus, 34 intercostales extcrm, 4\, pupillae, 241 interni, 46 ejaculator urinse, 49 interossei manus dorsales, erector clitoridis, 49 40 penis, 49 interossei manus palmares, spinae, 42 4 extensor carpi radialis interossei pedis dorsales, 59 brevior, 37 carpi radialis interossei pedis plantares, 59 inter-spmales, 43 longior, 37 inter-transversales, 43 carpi ulnaris, 38 digitorum brevis latissimus dorsi, 40 levator anguli oris, 24 pedis, 57 scapula:, 41 digitorum corn- ani, 49 munis, 37 labii superioris, 24 digitorum longus labii superioris alas- pedis, 55 que nasi, 23 indicis, 38 minimi digiti, 37 ossis metacarpi pol- palati, 30 paipebrffi superioris, 22 licis, 38 levatores costarum, 46 proprius hallucis, 55 linguales, 182 brevis pollicis, longissimus dorsi, 42 38 longus colli, 31 longus pollicis, lumbricales manus, 39 38 pedis, 58 flexor accessorius, 58 massetericus, 25 brevis digiti minimi, multindus spinae, 43 39 brevis digiti minimi mylo-hyoideus, 28 obliquus abdominis exter- pedis, 59 nus, 44 brevis hallucis, 58 obliquus abdominus inter- brevis pollicis, 39 nus, 44 carpi radialis, 36 obliquus capitis inferior, 32 ulnaris, 36 superior, 32 digitorum brevis oculi inferior, 23 pedis, 58 superior, 23 digitorum longus obturator externus, 54 pedis, 56 internus, 54 digitorum profundus, occipi to-frontal is, 21 36 omo-hyoideus, 28 digitorum sublimis, opponens minimi digiti, 39 hallucis longus, 56 pollicis, 39 orbicularis oris, 24 pollicis longus, 37 palpebrarum, 23 pastrocnemius, 55 gemellus inferior, 54 palato-glossus, 30 pharyngeus, 30 superior, 54 palmaris brevis, 39 genio-hyo-glossus, 29 longus, 36 hyoideus, 29 pectin eus, 52 gluteus maximus, 53 pectoralis major, 33 medius, 53 minor, 33 minimus, 53 peroneus brevis, 56 gracilis, 52 hyo-glossus, 29 longus, 56 tertius, 55 ihacus, 51 plantaris, 55 ilio-costalis, 4.* platysma myoides, 26 INDEX 25$ Muse., popliteus, 56 pronator, quadratus, 37 Muse., sterno-thyroideus, 28 stylo-glossus, 29 radii teres, 36 hyoideus, 28 psoas ma gnus, 51 parvus, 51 pharyngeus, 30 subanconeus, 35 pterygoideus externus, 25 internus, 25 subclavius, 33 subcostales, 46 pyramidal is abdominis, 45 nasi, 23 subcrureus, 52 subscapularis, 34 pyriformis, 53 supinator brevis, 38 quadratus femoris, 54 longus, 37 luiuborum, 45 supra-spinatus, 34 quadriceps extensor, 51 rectus. abdominis, 45 temporalis, 25 tensor palati, 30 capitis anticus major, tarsi, 22 3i capitis anticus minor, tympani, 233 fasciae femoris, 51 3* terei major, 34 lateralis, 31 minor, 34 posticus major, thyro-arytenoideus, 30 3 a . posticus minor, hyoideus, 28 tibialis anticus, 55 3 2 posticus, 56 femoris, 52 trachelo-mastoideus, 42 oculi externus, 23 transversalis abdominis, inferior, 23 44 internus, 23 coin, 42 superior, 23 transversus perinan, 49 retraheus aurem, 22 trapezius, 40 rhomboideus major, 41 triangularis sterni, 46 minor, 41 triceps extensor, 35 riorius, 25 vastus externus, 51 roiatores dorsi, 43 internus, 52 salpingo-pliaryngeus, 30 zygomaticus major, 24 sartonus, 51 minor, 24 scalenus anticus, 31 Mylo-hyoid artery, 70 medius, 31 muscle, 28 posticus, 32 nerve, 147 emi-membranosus, 54 spinalis colli, 43 Nares, 229 dorsi, 43 tendinosus, 54 Nasal artery, 72 lateral, 67 serratus magnus, 33 posticus inferior, 41 cartilages, 228 duct, 238 superior, 4 1 fossae, 228 soleus, 55 nerve, 143 sphincter am externus, 48 Naso-palatine artery, 70 internus, 48 nerve, 145 pupillae, 241 Nerve of Jacobson, 154 vaginae, 49 spinalis dorsi, 42 splenius capitis, 41 of Wrisberg, 163 Nerve to the inferior gemellus and quadratus, 171 colli, 42 latissimus, 163 stapedius. 234 sterno - cleido - mastoideus, levator anguli scapulae, 162 6 hyoideus, s% longus colli, 162 obturator internus, 171 172 260 INDEX Nerve to the pectineus, 169 pterygoid, internal, 146 pyriformis, 171 rhomboid muscles, 162 scaleni, 162 serratus magnus, 163 subclavius, 162 superior gemellus, 171 tensor palati, 148 tympani, 148 fasciae femoris, 172 teres major, 103 minor, 163 vastus externus, 170 interims, 170 Nervous tunic of eyeball, 242 Nerv., abducens, 151 accessories obturator! us, 169 spinalis, 157 acromiales cutanei, 160 articularis poplitei, 173 articularis obturatorius, 169 auditorius, 153 auricularis inferior, 147 magnus, 160 pneumogastrici, 1 55 posterior, 152 auriculo-temporalis, 147 buccales, 146, 152 buccinatorius, 152 cardiacus inferior, 178 medius, 178 pneumogastrici, 156 superior, 176 cervicales nervi facialis, 153 rami anteriores, 1 59 posteriores, 1 59 cervicalis superficialis, 160 cervico-facialis, 153 chorda tympani, 152 ciliaris ganglii ophthalmici, 43. nasal is, 143 circumilexus, 162 claviculares cutanei, 160 coccygealis, 170 cochlearis, 237 communicans fibularis, 175 tibialis, 173 cruralis, 169 cutanei abdominis anteriores, 167 abdominis laterales, 167 Cutaneus dorsalis mauds, 164 externus brachialis, 163 Nerv., cutaneus externus lumbalis, 168 externus musculo- spiralis, 165 infra-maxillar., 153 interims brachialis major, 163 internus brachialis minor, 163 internus femoris, 169 internus muv.ulo- spiralis, 165 medius femoris, 169 muse. -cutanei, 163 palmaris, 164 plan tar is, 174 radialis, 165 supra-maxillar., 153 dentales posteriores, 144 dentalis, superior, 144, 145 inferior, 147 descendens hypoglossi, 158 diaphragmaticus, 160, 180 >ligastricus, 152 digitales median!, 164 plantares, 170 radiales, 164 ulnares, 164 dorsales, rami ante: lores, 166 posteriores, 166 dorsalis penis, 172 ulnaris, 164 facialis, 151 frontalis, 143 genito-cruralis, 168 ramus fempralis, 168 ramus genitalis, 168 glosso-pharyngeus, 153 glutei mfenores, 171 gluteus superior, 171 gustatorius, 1^7 haemorrhoidahs inferior, 17* hepatici, 180 hypoglossalis, 157 iho-hypogastricus, 1 68 inguinalis, 168 incisorius, 147 infra-mandibularis facialis, 153 orbitales nervi facialis. X 53 orbitalis, 144 trochlearis, 143 intei costales, 166 iotercosto-cutanei anteriores, 166 intercosto cutanei laterales 166 intercosto humer.Uis, 166 INDEX 261 interosseous anticus, 164 posticus, 165 ischiaticus magnus, 173 par v us, 172 labialis, 1^5 lachrymahs, 143 laryngeus externus, 156 inferior, 156 superior, 156 Hngualis, 147, 154 iumbales rami anteriores, 167 posteriores, 167 lombo-sacralis, 167 malaris nervi facialis, 153 raassetericus, 146 maxillaris inferior, 146 superior, 144 median us, 163 motor oculi, 143 musculo-cutaneus brachii, 163 cruris, 175 spiralis, 165 mylo-hyoideus, 147 nasalis, 143 naso-palatmus, 145 obturatorius, 168 articularis, 169 occipitalis major, 159 minor, 160 ffisophageales, 15: olfactorius, 141, 230 ophthalmicus, 143 opticus, 141 orbitalis, 144 palatinus magnus, 145 externus, 145 minor, 145 palmaris cutaneus, 164 ulnaris profundus, 165 superficialis, 166 palpebrales, 145 patellaris, 170 perforans Casserii, 164 perinaeales superficiales, 173 peronealis, 175 petrosus superficialis externus, 152 petrosns superficialis magnus, 152 petrosus superficialis parvus, u 148 pharyngei, 134 pharyngeus, 146, 154, 156 phremcus, 160 plantaris externus, 174 profundus, 174 internus, 174 pneumogastricus, 155 Nerv., popliteus externus, 174 internus, 173 pterygoidei, 146 pudendus inferior, 171 internus, 171 pulmonares anteriores, 1 56 posteriores, 156 radialis, 165 recurrens articularis, 175 renales, 176 sacrales, rami anteriores, 170 posteriores, 170 saphenus externus, 174 internus, 170 sciaticus magnus, 173 parvus, 172 spermatici, ifo spheno-palati ii, 144 splanchnicus major, 178 minor, 178 minimus, 178 splenici, 180 stylo-hyoideus, 152 suboccipitalis, ratnu s anterior, 159 suboccipitalis, ramus pos- terior, 158 subscapulares, 162 superficialis cordis dexter, 17(8 sinister, ijj supra - mandibularis nervi facialis, 153 supra-orbitalis, 143 scapnlaris, 162 trochlearis, 143 sympatheticus abdominis, 180 cervicis, 176 pelvis, 180 thoracis, 178 temporales nervi facialis, 152 profundi, 146 superficialis, 152 temporo-facialis, 152 malar. 144 thoracic! anteriores, 162 laterales, 163 thoracicus posterior, 1 62 thyro-hyoideus, 158 tibialis anticus, 175 posticus, 173 trigeminus, 142 trochlearis, 143 tympanicus, 157, 154 ulnaris, 164 uterini, 181 vaginales, 181 Vidianus, 146 Ninth nerve, 153 262 INDEX Nodule, 125 Nose, cartilages, 228 cavity of, 228 meatuses of, 228 Nuclei of medulla oblongata, 123 Nucleus caudatus, 138 lenticularis, 138 Nutritious artery of femur, 92 of humerus, 75 of tibia, 96 Nyraphae, 225 Obliquus abdominis externus muscle, 44 mternus muscle, capitis inferior muscle, 32 superior muscle, 32 oculi inferior muscle, 23 superior muscle, 23 Obturator artery, 86 fascia, 47 membrane, 54 muscle, external, 54 internal, 54 nerve, 168 Occipital artery, 67 lobe, 131 Occipital vein, 100 sinus, 97 nerves, 159. 160 Occipito-atloid articulation, 3 ligaments, 3 axial ligaments, 3 frpntalis muscle, 21 Odontoid ligaments, 4 (Esophagus, connections of, 187 CEsophageal arteries, 81 nerves, 157 rninjj of diaphragm, 46 , X 34 nerve, 141 Olivary body, 120 fasciculus, 121 Omentum, great, 199 lesser, 199 splenic, 199 Omo-hyoid muscle, 28 Ophthalmic artery, 71 ganglion, 150 nerve, 143 veins, 98 _ Opponens minimi digiti muscle, 39 pollicis muscle, 39 Optic commissure, 129 nerve, 141 thalamus, 128 tract, 129 Ora serrata, 242 Orbicular ligament of the radius, n Orbicularis oris muscle, 24 palpebrarum muscle, 22 Organ of Corti, 236 Orifice of the urethra, 227 of the uterus, 227 of the vagina, 225 Ossicles of the tympanum, 23? Os uteri, externum, 226 internum, 227 Otic ganglion, 148 Otoliths, 236 Ovaries, 227 Palate, soft, 183 Palatine, arteries, superior, 70 artery, inferior, 67 nerve, external, 145 large, 145 small, 145 Palato-glossus muscle, -3.0 pharyngeus muscle, 30 Palmar arch, deep, 77 superficial, 78 nerve of the ulnar, deep, 164 superficial, 164 fascia, 36 Palmaris brevis muscle, 39 longus muscle, 36 Palpebrae, 237 Palpebral arteries, 72 ligament, 238 Pancreas, 194 connections, iv Pancreatic arteries, 83 duct, 195 Pancreatico-duodenal arteries, 83 Papilla lachrymalis, 237 Papillse of the tongue, i3t Parietal lobe, 132 Parotid gland, 183 Patellar nerve, 170 plexus, 169 Pectineus muscle, 52 Pectoralis major muscle, 33 minor muscle, 3 3 Peduncle of the cerebellum, inferior, 125 Peduncle of the cerebellum, middle, 125 Peduncle of the cerebellum, superior, 125 Peduncle of the cerebrum, 126 of the pineal body, 129 Peduncular fibres, 138 Pelvic colon, 191 fascia, 47 plexus, 180 Penis, 220 Perforating arteries, of femoral, 92 of internal mammary, 6j INDEX 263 Perforating arteries of the palm, 77 of the sole, 95 Perforans Casserii nerve, 164 Pericardium, 202 Perilymph, 234 Perinaeal artery, superficial, 87 fascia, deep, 47 superficial, 47 nerves, superficial, 172 Peritoneum, 196 of female pelvis, 197 of male pelvis, 190 Peroneal artery, 96 anterior, 96 nerve, 171 Peroneus brevis muscle, 56 longus muscle, 56 tertius muscle, 55 Peroneo-tibial articulations, 17 Pes hippocampi, 136 Petrosal ganglion, 154 sinus, inferior, 98 superior, 98 Petrosal nerve, external, 152 large, 152 small, 148 Peyer's glands, 190 Pharyngeal ascending artery, 68 nerve, 154 vein, 101 Pharynx, 185 muscles of, 29 openings of, 186 Phrenic artery, 63, 82 nerve, 160 Pia mater of the brain, 140 of the cord, 116 Pigment cells of choroid, 240 of iris, 241 Pillars of the abdominal ring, 44 of the fornix, 136 of the iris, 240 of the soft palate, 183 Pineal body, 129 Pinna, or auricle of the ear, 230 Pituitary body, 129 Plantar arch, artery of the, 97 arteries, 96, 97 fascia, 57 ligament, long, 19 nerve, external, 174 internal, 174 Plantaris muscle, 55 Platysma myoides muscle, 26 Pleurae, 212 Plexus, aortic, 180 brachial, 161 cardiac, superficial, 179 Plexus, cardiac, deep, 179 carotid, 177 cavernous, 177 cervical, 159 choroides cerebri, 137 coeliac, 180 coronary, anterior, 180 posterior, 180 of the stomach, 1 80 diaphragmatic, 180 gulae, 155 hamorrhoidal, 180 hepatic, 180 hypogastric, 180 lumbar, 167 mesenteric, inferior, 180 superior, 180 oesophageal, 155 ovarian, 181 patellar, 169 pelvic, 180 pharyngeal, 176 prostatic, 181 pterygoid of veins, too pulmonary, anterior, 15^ posterior, 157 renal, 180 supra, 180 sacral, 171 solar, 179 spermatic of nerves, 180 of veins, 106 splenic, 180 tympanic, 154, 177 uterine, 181 vaginal, 181 vesical, 180 Plica semilunaris, 237 Pneumogastric nerve, 155 Pomum Adami, 207 Pons Varolii, 122 structure of, 1 2 3 Popliteal artery, 92 glands, 113 nerve, external, 174 internal, 173 vein, 109 Popliteus muscle, 56 Portal vein, 107 Porus ppticus, 242 Posterior commissure, 128 ligament of the knee, pyramid, 120 Poupart's ligament, 44 Pouch, laryngeal, 210 Prepuce, 221 26 4 INDEX Princeps cprvicalis artery, 63 pollicis artery, 77 Processus cochleariformis, 233 vermiformis, 124 Pi ofunda artery, inferior, 76 of the neck, 64 of the thigh, 91 superior, 75 Promontory, 231 Pronator quadratus muscle, 37 radii teres muscle, 36 Prostatic gland, 220 connections, 220 urethra, 221 sinuses, 221 Psoas magnus muscle, 51 parvus muscle, 5 i Pterygoid arteries, 70 nerve, external, 146 internal, 146 plexus of veins, 100 Pterygoideus externus muscle, 25 internal muscle. 25 Pterygo-maxillary ligament, 25 palatine artery, 70 Pubp-prostatic ligaments, 48 Pudic arteries, external, 91 artery, internal, 87 nerve, internal, 171 Pulmonary artery, 214 nerves, 156 veins, 106 Pylorus, 187 Pyloric arteries, 83 Pyramid, anterior, 120 decussation of, 120 of the cerebellum, 125 of the tympanum, 232 posterior, 119 Pyramidal fibres of the medulla, 12 masses of kidney, 217 i'yi amidalis abdominis muscle, 45 nasi muscle, 23 Pyramids of Malpighi, 217 Pyriformis muscle, 53 Quadratus femoris muscle, 54 lumborum muscle, 45 Radial artery, 76 nerve, 165 veins, 102 Radialis indi^is artery, 77 Radio-carpal articulation, 12 Radio-ulnar articulations, n Ranine artery, 66 vein, 101 Raph6 of the corpus callosum, 135 of the medulla, 118 Keceptaculum chyli, no Recto-resical fascia, 48 pouch, 197 Rectus abdominis muscle, 45 capitis anticus major muscle, 31 minor muscle, 31 lateralis muscle, 31 posticus major muscle, 32 minor muscle, 32 femoris muscle, 52 oculi externus muscle, 23 inferior muscle, 23 internus muscle, 23 superior muscle, 23 Rectum, connections of, in the female, 191 Rectum, connections of, in the male, 191 Recurrent interos&tous artery, 78 radial, 76 tibia!, 97 ulnar, anterior, 78 posterior, 78 Recurrent nerve of pneumogastric, *55 Recurrent nerve of the tibial, 175 Renal artery, 84 plexus, 180 vein, 106 Restiform body, 119 Kete testis, 224 Retina, 242 Retrahens aurem muscle, 22 Rhomboideus major muscle, 41 minor muscle, 41 Rima of the glottis, 210 Risorius muscle, 25 Root of the lung, 213 Rotatores dorsi muscles, 43 Round ligament of the hip-joint, 14 of the liver, 192 of the uterus, 227 Saccule of the ear, 235 Sacculus laryngis, 210 vestibuli, 235 Sacral artery, lateral, S3 middle, 85 ganglia, 180 nerves, anterior branches, 170 posterior branches, 170 plexus, 171 Sacro-coccygeal articulation, 8 iliac articulation, 7 vertebral articulation, 6 INDEX 265 Sacro-sciatk ligament, large, 7 small, 7 Salpingo-pharyngeus muscle, 30 Salvatella vein, 101 Saphenous vein, external, 108 internal, 108 opening, 50 nerve, external, 174 internal, 170 Sartorious muscle, 51 Scala tynipani, 235 vestibuli, 235 Scalenus anticns muscle, 31 medius muscle, 31 posticus muscle, 3* Scapular artery, posterior, 63 ligaments, 9 muscles, 34 Scapulo-clavicular articulation, 9 humeral articulation, 10 Schneiderian membrane, 229 Sciatic artery, 89 nerve, large, 173 small, 172 Sclerotic coat of the eye, 239 Scrotum, 222 Second nerve, 141 Secondary membrane of the tym- panum, 231 Semicircular canals, 234 Semilunar cartilages, 16 ganglia, 179 valves of aorta, 206 of pulmonary ar- tery, 205 Semi-membranosus muscles, 54 Seminal ducts, 224 Seminiferal tubes, 223 Semi spinalis coli muscle, 43 dorsi muscle, 43 Semi-tendinosus muscle, 54 Septum auricularum, 204 cochleae, 236 crurale, 50 intermuscular, of the arm, 34 of the thigh, 49 iucidum, 136 nasi, 229 pec tini forme, 221 scroti, 222 of the tongue, 182 ventriculorum, 204 Serratus magnus muscle, 33 posticus inferior, 41 superior, 41 Seventh nerve, 151 Sheath of the rectus, 45 Shoulder-joint, 10 Sigmoid artery, 85 Sinus, cavernous, 98 circular, 98 coronary, 106 lateral, 98 longitudinal, inferior, 98 superior, 97 occipital, 98 petrosal, inferior, 98 superior, 98 pocularis, 221 prostaticus, 221 straight, of the skull, 98 transverse, 98 of Valsalva, 205 Sixth nerve, 151 Small intestine, 188 omentum, 199 Socia parotidis, 184 Soft commissure, 128 Soft palate, 183 muscles of, 30 Solar plexus, 179 Soleus muscle, 55 Spermatic artery, 84 cord, 2*2 plexus, 180 veins, 106 Spheno-palatine artery, 70 ganglion, 145 nerves, 144 Sphincter ani externus muscle, 48 internus muscle, 48 of the pupil, 241 vaginae, 49 Spigelian lobe, 192 Spinal accessory nerve, 157 arteries, 61 cord, 114 membtane of, 116 structure, 115 nerves, 158 roots of, 158 veins, 105 Spinalis dorsi muscle, 42 Spiral tube of the cochlea, 235 Splanchnic nerve, large, 178 small, 178 smallest, 178 Spleen, 195 connections, 195 Splenic artery, 83 omentum, 199 plexus of nerves, 180 vein, 107 266 INDEX Splenius capitis muscle, 41 colli muscle, 42 Spongy bones, 228 part ofjthe urethra, 223 Stapedius muscle, 234 Stapes bone, 233 Stellate ligament, 5 Stenson's duct, 184 Sterno-clavicular articulation, 8 cleido-mastoid muscle, 26 hyoid muscle. 28 thyroid muscle, 28 St9mach, form and divisions, 187 connections of, 188 Straight sinus, 98 Striate body, 137 Stylo-glossus muscle, 29 hyoid ligament, 5 muscle, 28 nerve, 152 mastoid artery, 68 maxillary ligament, 25 pharyngeus muscle, 30 Subanconeus muscle, 35 Subarachnoid space, 140 Subclavian artery, left, 59 right, 59 vein, 103 Subclavius muscle, 33 Subcostales muscles, 46 Subcrureus muscle, 52 Subcutaneous mala? nerve, 144 Sublingual artery, 66 gland, 185 Submaxillary ganglion, 148 gland, 184 Submental artery, 67 Suboccipit a 1 nerve, anterior branch, 159 Suboccipital nerve, posterior branch, 158 Subpeduncular lobe, 124 Subpubic ligament, Subscapular artery, 74 nerves, 162 Subscapularis muscle, 34 Sulci of brain, 131 Sulcus, longitudinal, of the liver, 193 spiralis, 236 transverse, 193 Superficialis cervicahs artery, 63 volae artery, 76 Supinator radii brevis muscle, 38 longus muscle, 37 Supra-orbital artery, 72 nerve, 143 renal capsule, 217 plexus, i So Supra-scapular artery, 62 nerve, 162 spinatus muscle, 34 trochlear nerve, 143 Suspensory ligament of the lens, 243 of the liver, 192 ^ of the penis, 220 Sympathetic nerve in the abdomen, 1 80 in the head, 176 in the neck, 176 in the pelvis, 180 in the thorax. 178 Symphysis pubis, 8 Synarthrosis, i Taenia hippocampi, 136 semicircularis, 138 Tarsal artery, 94 plates, 237 Tarso-metatarsal articulations, 20 Teeth, 181 Tegmentum, 127 Temporal aponeurosis, 25 arteries, deep, 69 middle, 69 superficial, 68 fascia, 25 muscle, 25 nerves, deep, 146 superficial, 152 vein, 99 Temporo-fascial nerve, 152 malar nerve, 144 maxillary articulation, 4 sphenoidal lobe, 133 Tendo Achillis, 55 palpebrarurn, 228 Tendon of quadriceps extensor muscle, 52 Tensor fasciae femoris muscle. 51 palati muscle, 30 tarsi muscle, 22 tympani muscle, 224 Tentorium cerebelli, 139 Teres major muscle, 34 minor muscle, 34 Testes, 223 Thalamus opticus, 128 Thebesian foramina, 204 valve, 205 Third nerve, 142 ventricle, 127 Thoracic duct, no ganglia, 178 acromial artery, 74 alar artery, 74 long artery, 74 INDEX 267 Thoracic superior artery, 74 Tbymus body, 215 Thyro-arytenoid articulation, 209 ligaments, 209 Thyro-arytenoideus muscle, 30 epiglottidean ligament, 209 hyoid membrane, 209 muscle, 28 nerve, 158 Thyroid artery, inferior, 62 lowest, 80 superior, 66 axis, 62 body, 215 cartilage, 207 plexus of veins, 104 vein, inferior, 104 middle, 101 superior, 101 Tibial artery, anterior, 93 posterior, 94 nerve, anterior, 175 posterior, 173 veins, anterior, 109 posterior, 109 Tibialis anticus muscle, 55 posticus muscle, 56 Tibio-tarsal articulation, 19 Tongue, 181 muscles of, 29, 183 Tonsil, 183 Tonsillitic artery, 67 Torcular Herophili, 98 Trabeculae rarneae, 205 Trachea, 211 Trachelo-mastoid muscle, 41 Tragus, 230 Transverse colon, 190 fissure of the cerebrum, 130 of the liver, 193 ligament of the aceiabu- lum, 14 of the atlas, 3 of the fingers, 14 of the knee, 17 of the meta- carpus, 14 of the meta- tarsus, 20 of the toes, 21 perineal artery, 87 sinus, 98 tarsal articulation, 20 Transversalis abdominis muscle, 44 cervicalis artery, 65 colli muscle, 42 ' Transversalis faciei artery, 69 Transversus perinaei muscle, 49 Trapezius muscle, 40 Trapezoid ligament, 9 Triangular cartilage of the nose, 228 fascia, 44 nbro-cartilage of wrist, 12 ligament of urethra, 49 surface of bladder, 210 Triangularis sterni muscle, 46 Triceps extensor cubiti muscle, 35 Tricuspid valve, 203 Trigeminal nerve, 142 Trigonum vesicae, 219 | Trochlear nerve, infra, 142 supra, 143 Tube of the cochlea, 235 Tuber cinereum, 129 Tubercle of Rolando, 119 Tubuli seminiferi, 223 Tunica albuginea testis, 223 Ruyschiana, 240 vaginalis, 223 vasculosa testis, 223 Turbinate bones, 228 Twelfth intercostal nerve, 167 Tympanic artery, 6p, 71 Tympanum, 231 Ulnar artery, 77 nerve, 164 veins, 101 cutaneous anterior, 101 posterior, TOI Ureter, 217 Urethra, female, 225 orifice of, 225 male, interior, 221 Uterine arteries, 86 plexus of nerves, 181 veins and sinuses, 109 Uterus, 226 interior of, 226 ligaments of, 227 connections of, 226 Utricle of the ear, 235 Uvea iridis, 241 Uvula cerebelii, 125 palati, 183 Vagina. 225 Vaginal arteries, 86 plexus, 181 veins, 109 Vagus nerve, 155 nucleus u? 268 INDEX Vallecula, 124 Valve, Eustachian, 204 of caecum, 125 mitral, 206 semilunar, 204 of Thebesius, 205 tricuspid, 205 ofVieussens, 124 Valvulae conniventes, 185 Vas deferens, 223 Vasa brevia, 188 efierentia testis, 224 rete testis, 224 vorticosa, 240 Vascular coat of eye, 240 Vastus externus muscle, 51 internus muscle, 52 Vein, alveolar, 99 angular, 99 ascending cervical, 101 lumbar, 104 pharyngeal, 102 auricular posterior, 100 axillary, 102 azygos, large, 104 small, 104 superior, 105 basilic, 102 brachial, 102 bronchial, left, 105 right, 105 cardiac, anterior, 106 great, 106 small, 1 06 cava, inferior, 105 superior, 103 cephalic, 102 cerebellar, 97 cerebral, 97 chproid, 97 ciliary, anterior, 98 posterior, 98 circumflex iliac, 108, 109 coronary of the heart, 106 of the stomach, 107 ,1 the corpus striatum, 97 deep cervical, 101 dorsal of the penis, 109 dorsi spinal, 105 emissary, 99 epigastric, deep, 109 superficial, 108 facial, 99 femoral, 109 frontal, 98 of Galen, 97 gastro-epiploic, 108 hacmorrhoidal, 109 Vein, hepatic, 106 iliac, common, no external, 109 internal, 109 infra-orbital, 99 innominate, 103 intercostal, 105 superior, left, 104 right, 104 jugular, anterior, 100 external, 100 internal, left, 101 right, 101 laryngeal, 101 lingual, loi longitudinal of the spine, an- terior, 105 lumbar, 105 mammary, internal, 104 maxillary, internal, 100 median of the arm, 102 basilic, 102 cephalic, 102 mesenteric, inferior, 107 superior, 107 occipital, TOO ophthalmic, 98 ovarian, 106 palpebral, inferior, 99 superior, 99 pancreatic, 108 perineal, superficial, no pharyngeal, 101 phrenic, inferior, 106 popliteal, 109 portal, 107 posterior, spinal plexus of, 105 profunda, of the thigh, 109 pterygoid plexus, 100 pudic external, 108 internal, no pulmonary, 106 radial cutaneous, ioa ranine, 101 renal, 106 sacral, lateral, no middle, no saphenous, external, 108 internal, 108 spermatic, 106 spinal, 105 splenic, 107 subclavian, 103 supra-orbital 99 renal, 106 scapular, 100 thyroid, inferior, 104 INDEX 269 Vein, thyroid, middle, 101 superior, 101 tibia!, anterior, 109 posterior, 109 transverse-cervical, 100 ainar, 101 cutaneous, anterior, xoz posterior, 101 uterine, 109 vaginal, 109 of the vertebrae, 105 vertebral, 101 vesical, 109 Velum interpositum, 137 Vena cava, inferior, 105 superior, 104 portas, 107 Ventricles of the brain, 127, 135 fifth, 136 fourth, 120 lateral, 135 third, 127 of the heart, 205 left, 206 right, 205 of the larynx, 210 Vermiform appendix, 190 processes, 124 Vertebral artery, 61 . vein, 101 Verumontanum, 221 Vesica urinaria, 218 Vesical artery, inferior, 86 superior, 86 plexus of nerves, 180 of veins, 109 Vesicula prostatica, 221 Vesiculae seminales, 224 Vestibule of the ear, 234 of the vulva, 225 Vestigial fold of the pericardium, 203 Vidian artery, 70 nerve, 146 Vitreous body, 242 Vocal cords, 210 Vulva, 224 Wharton's duct, 185 White commissure of the cord, 116 Winslow's foramen, 201 Wrisberg's nerve, 163 Wrist-joint, 12 Yellow spot of eye-ball, 242 Zygomaticus major muscle, 24 minor muscle, 24 THE END Bailliere, Tindall and Cox, 8, Henrietta Street, UNIVERSITY OF CALIFORNIA MEDICAL CENTER LIBRARY THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW Books not returned on time are subject to a fine of 50c per volume after the third day overdue, increasing to $1.00 per volume after the sixth day. 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