ANATOMY

IN A

NUTSHELL

LAUGHLIN
(Second Edition.)

Poor Humanty.

try was found in the pocketbook of the lute G. H. Laughlin.

The following
More than half a century since the following lines were found in the Royal College of
Surgeons, London, beside a skeleton, remarkable for its symmetry of form. They were subsequently published in the London Morning Chronicle, and a vain effort made to ascertain
|

tuthor,

even offering a reward of

fifty

guineas.

II.

I.

Behold this ruin!

<

'Twas

Mice of ethereal spirit

Beneath this moulding canopy

dice shone the bright and busy

a skull

full.

This narrow cell was Life's retreat,

This space was Thought's mysterious seat.
\\

hat beauteous visions filled this spot

But
If

social love that eye

If

with no lawless

emplox >'d;
gleamed,

fire it

Hut through the dews of kindness beamed,

That eye shall be forever bright
When sun and stars are sunk in night.

With dreams of pleasures long forgot

Nor hope, nor joy, nor love, nor fear.
Have left one trace of record here.

[V.

111.

Within

this

hollow cavern hung

Say, did these lingers delve the mine,

and tuneful tongue.

If Falsehood's honey it disdained.
And when it could not praise was chain*
If bold in Yin lie's cause it spoke,
^ et gentle concord never broke
Thai silent tongue shall plead lor thee,

The ready,

\\

eye.

start not at the dismal void!

swift

)r

with the envied ruby shine?

To hew
(

now

avail to

>r

if the page of truth they sought,

comfort to the mourner brought

These hands
all

a richer

who

meed

wait on

seek Affliction's

humble shed;

Grandeur's guilty bribe they Spurned,

And home to Virtue's cot returned
These feet with angel's wings shall vie.
If

And

tread the palace of the skies.

Anonymi

shall claim

Weal or fame.

Avails it whether bare 01 shod,

These feet the path of duty trod'.'
If from the bowers of ease they lied.

To

he gem,

them.

Hut
(

Than

hen time unveils eternitv!

the rock or wear

'an little

m -

ANATOMY

IN A

NUTSHELL

A TREATISE ON HUMAN ANATOMY

IN ITS RELATION TO OSTEOPATHY

WILLIAM ROSS LAUGHLIN,

M.

S.,

D. 0.

PROFESSOR OF DESCRIPTIVE ANATOMY, NEUROLOGY AXD OSTEOPATHIC TECHNIQUE

IN

THE AMERICAN SCHOOL OF OSTEOPATHY, KIRKSVILLE. MO.

IX

OXE VOLUME.

ILLUSTRATED BY TWO HUNDRED AND NINETY PLATES.

KIRKSVILI.I

WILLIAM ROSS LAUGHLIN,

611

M.S.. D. 0.

East Harrison Street

1905.

QS

*f

3'

Copyright, L905, by William Rosa Laughlin.

\lii\.

pb

<

IS1

ION

PRESS OF in' RN \l. PR] \ im. CO

KIRKSVILLE, MISSOURI
I

TO
fll>

present ano former Stuoents of Enatomp

THIS
IS

WORK

AFFECTIONATELY DEDICATED

BY
THEIR FELLOW WORKER,

THE AUTHOR.

(Qui

ram

prafirit, deficit.

List of Illustrations.

Page

Plate

III.

The Bony Man

The Muscular Man
Showing the Origin and

IV.

A Transverse Section of Spinal

I.

II.

V.
VI.

VII.
VIII.

IX.

X.
XI.

XII.
XIII.

XIV.

XV.

Mew

Posterior

is
21

Insertion of Biceps

Cord
of the Spinal Cord

29

Brachial Plexus

81

Hand
Position of Vessels Above and Below Diaphragm

Nutrient Arteries of Bones of the

Relative

The Fetal Circulation and the Adult

The Left Clavicle, Inferior Surface
The Left Clavicle, Superior Surface
The Sterno-Clavicular Articulation

33
30

Circulation

39
41

41

43

and Shoulder-Joint
Muscles of Face and Triangles of Xeck
External >blique Muscle of Abdomen and Numerous

44

Acroinio-( "lavicular Articulation

47
*

>ther

Structures

XVI.
XVII.
XVIII.

XIX.

XX.
XXI.
XXII.
XXIII.

XXIV.

XXV.
XXVI.
XXVII.
XXVIII.

XXIX.

XXX.
X XXI.

Internal

4!)

Numerous >ther St ructures

Abdomen, Numerous Other Structures

>blique Muscle of Abdomen,,

Transversalis Muscle of

51

53

Muscles of the Back. Superficial Layers

57

The Hyoid Bone

The Left Scapula, Posterior Surface or Dorsum
The Left Scapula. Anterior Surface or Venter
The Left Humerus, Posterior View
The Left Humerus, Anterior View
The Left Radius and Ulna, Posterior View
The Left Radius and Tina, Anterior View

59

63
6
1

70
71

Bones of Left Hand, Posterior View

Bones of Left Maud. Anterior View
Showing Quadrilateral Space, Struct ures Passing Through it
Muscles of Left Forearm
First Layer
Anterior View
Muscles of Left Forearm Second Layer Anterior View
Muscles of Left Forearm
Third and Fourth Layers Anterior

XXXIV.

7:;

74

SO
83

86

Muscles of the Left ForearmSuperficial Layer

Posterior View.
Muscles of he Left Forearm
Peep Layer Posterior Vie\*
The Four Dorsal Interossei

89

...

90

93

XXXV. The
XXXVI.
XXXVII.

XX XVIII.
XXXIX.
XL.
XI. I.

XLII.
XLIII.

17

lis

View

XXXII.
XXXIII.

25

Three Palmar Interossi

Showing he Cutaneous Nerve Supply of Upper Extremity
Lymphatics and Veins of he Upper Extremity Superficial
The Elbow Joint External View
The Elbow-Joint, Internal View
The Wrist-Joint Posterior View
The Wrist-Joint, Anterior View
Showing the Synovial Membranes of the Wrisl
Externa] Mew of the Left [nnominate Bone

'.il

07
00

03

in

i\

IS

...

1
1
1

07
us
1

[.1ST

OF ILLUSTRATIONS.
Page

Plate

XLIV.

X l.\

XLVI.
X

I.

VI

XLVIII.

XLIX.
I.

LI.

Id

I.

III.

LIV.

LV.
LVI.

LVII.

I.

139

142

Anterior

145

Fibula

Anterior View of Lett Tibia and Fibula

148

Dorsum of Left Fool

151

Plantar Surface of Left loot

155

Showing the

red ion of Nutrient Arteries of Bones of Fool

Plant 'ii' Fascia and First Layer of Muscles of Foot
First Layer of Muscles of the Foot, Also Internal and External Plan-

159

tar Arteries

163

I.umliricale.-..

>i

Internal and External Plantar Vessels

and Nerves

161

165
167

Flexor Longus Digitorum Tendon and Four Lumbricales

169

I.X.

Third Layer of Muscle- of Foot

171

XL

The Four Dorsal Interossei

The Three Plantar Interossei
Lumbar, Sacral and 'occvyeal Plexuses

173

and Profunda Femoral Arteries

Muscle- in (luteal Region and Hack of Thigh
Superficial Lymphatic Vessels and Veins of Leg
External or Short Saphenous Vein
Anterior View of Entire Lower Limb
Showing Arteries and Nerves of Hack of Leg
Showing Muscles of Hack of Ley;
Showing Muscles of unci and Anterior Part of the Thigh
The Arteries of Entire Lower Extremity
The Diaphragm, Psoas Magnus and Parvus
The Muscles in Front oftheThigh

179

1.

1.

I.X IV.

LXV.
LXVI.

LXV]

I.

LXVIII.
I.X IX.

LX X.

LXX

I.

LXXII.
I.XXIII.

LXXIV.
LXXV.
LXXVI.
LXXVII.

LXX VIII.
LX NIX.
L.N N.N.
I.

View of Left Femur

Posterior View of Lefl Tibia and

133

136

IX.

LXII.
I.X

127

130

Accessorius Mi ode and Plantar Vessels

I.YI
I.

View <>f Lefl Innominate Bone

Posterior View of Sacrum and Coccyx
Anterior View <>l Sacrum and Coccyx
Anterior and Superior View of Pelvis
Posterior View of Lefl Femur
Internal

XXX

I.

I.NNXII.

175
177

'otninon. Superficial
(

XCV.
I.

XCVII.

195
197

199

Posterior View of Entire Leg

Musclesol Back of Leg
>eep Layer)

207
209

Cutaneous Nerve Supply of the Lower Extremity

Cutaneous Nerve Supply of the Plantar Surface of the Foot
Ligaments of Hip-Joinl

211

Knee. loin
Showing !ondyles and Ligaments of Knee-Join1 Anterior View

X('\

191

193

203
205

Ligamentum

XC.
XCI.
XCII.
XCIII.
N< TV.

187
189

201

LXXXIV.
LXXXV.
LXXXVI.
LXXXVII.
I..N.N.NI.N

183

185

Musclesin Front of Ley

Arteries and Nerves in Front of Leg
Muscles in Hack of Ley (Superficial Layer)

LXXXIII.

LXXXVIII.

181

Patella

Posterior Ligamenl of
(

213
215
217
219
221

Semilunar Fibro-< 'art la ye of Knee-Joint

Ligaments oi Ankle-External View
Ligaments of Ankle
[nternalView
Forms of Club Fool
Showing Great Vessels Belowthe Diaphragm
Showing Abdominal Arota and its Terminal Branches

226
228
229

Anterior View of Sternum

231

View of Sternum
Bones of the Thorax

233
235
237
239
241

Posterior

The Atlas
Posterior View of Axis
Anterior View of Axis

222
223
224

LIST OF

ILLUSTRATIONS.

XI

Page

Plate

XCVIII.

XCIX.
C.

CI.

CII.

CIII.

CIV.
<

VI.

Posterior

CXIY.
'XV.

CXVL
CXVH.
Will.
CXIX.

CXX.

(XXL
CXXII.
CXXIII.
XXIV.
'XXV.
(

CXXVL
CXXVII.
(

XX VIII.
('XXIX.

CX XX.
WXXI.

<

CXXXII.
CXXXIII.

(XXXIV.

CXXXV.
CXXXVI.
CXXXVII.
CXXXVIII.
(

XXX IX.
('XI..
(

Mew of Cervical

Anterior

CIX.
CX.
CXI.
CXLT.
CXIII.

(A'.

CVII.
CVTLT.

The Fifth Cervical Vertebra

A Dorsal Vertebra with Long Spine
A Lumbar Vertebra
Veins of Spinal Cord and Column (Transverse View)
Veins of Spinal '<>nl and Column (Sagittal View)
The Spinal Column
Ligaments of Spinal Column

XLI.

CXLII.
CXLIII.

CXLIV.
CXLV.

CXLVI
CXLVII.
CXLVIII.

CXLIX.
('!..

CLE
CLII.

View

243
245
247

249
251

253

255
257

Vertebrae

of Cervical Vertebrae

259

The Peculiar tarsal Vertebras

The Second and Seventh Ribs
Ligaments of Upper Cervical Vertebrae

261

263
265

Muscles of Anterior Cervical Region

Muscles of Back (Dee]) Layer)
The Posterior Cervical Plexus

267
269

The Cervical Plexus

27:1

Thyroid axis and Cords of Brachial Plexus

Lymphatics of Neck and Face

27.">

-'71

277

The External Carotid Artery

The Internal Carotid Artery
The Arteries from Arch of Aorta to Circle of Willis
The Cervical Fascia
The Trachea
The Heart, Thyroid Claud, and Lungs (Turned Downward)

Mew of

Lungs
Posterior View of Lungs
Showing the Capacity of the Lungs
Showing Pleura- and Roof of the Lungs
Air Cells of the Lungs
A Transverse Section of the Pleurae Through Root of Lungs
Arch of Aorta and Heart
Showing Circulation of the Blood Through Heart
Semilunar Valve (Aortic)
The Thoracic Duct and Azygos Veins
Thyroid Gland of Fetus
Thyroid Cartilage (Anterior View)
Eyoid Bone/Thyroid and Cricoid Cartilages (Anterior View)
Thyroid 'artilage (Posterior View)
Arytenoid Cartilage and Epiglottis
True and False Vocal Cords
Showing the Entire Alimentary Canal and Portal Circulation
Anterior and Posterior Pi Hal's of Fauces and 'artilages of Nose
Anterior

The Salivary Glands

Showing Muscles

279
281

283

285
287
289
290
291

292
293

294
295
296
297
298
299
300
301

302
303
304
305
308
310
312
314

Pharynx
A Sagittal Section of Head and Neck showing Pharynx
The Dorsum of the Tongue

31

Circumvallate Papilla-

321

of the

The Extrinsic Muscles of the Tongue

The (Esophagus and Stomach
Showing Viscera Below Diaphragm
Showing Blood Supply of Stomach
Showing Muscular 'oats and Relations of Stomach
Showing Peritoneum Closed Sac
Sagittal Section of Trunk Showing Peritoneum.
<

Relationsof Liver

316

-'.:

325
321

328
329
330
"

:;|

LIST OF

Xll

ILLUSTRATION'S.
Page

Plate

CLIII.
ci l\

CLV.
CLVI.

CIA

II.

CLVIII.

CLIX.

CLX.
CI. XI.

CLXII.
CI. XIII.
CI. XIV.
CI. XV.
CI. XVI.
CI. XVII.

CI. XVIII.

CLX IX.
CI.XX.

CLXXI.
CLXXII.
CLXXIII.

CI.WIN
CLXXV.
CLXXVI.

The Superior Surface of Liver

The [nferior Surface of Liver
The Vessels of a Lobule of Liver
Showing Blood Supply to Small Intestine
Showing Blood Supply to Large Intestine
Showing the Vermiform Appendix and Four Forms

333
334
335

of

Caecum

336
337
33S

Valve
A Transverse Section of the Large Intestine

34o

The Pancreas, Juodenum, and Kidney

341

339

[leo-Caecal

Lobes and Fissures of Liver

Showing the Four Coats of Stomach and Pyloric
Showing terminal Area

342
>ririee

Showing >evelopmen1 of lie Sympathetic Nerve

A Horizontal Section of Vertebrate Brain
A Sagittal Section of Vertebrate Brain
A Sagittal Section of the Brain
A Coronal Section Through Anterior Horn of Lateral Ventricle
A Coronal Section Through Middle Commissure of Brain
A 'oronal Section Through Posterior Horn of Laterial Ventricles
A 'ast of Ventricles of the Brain
The Circle of Willis
Showing Blood Supply on External Surface of Brain
Showing Distribution of Middle cerebral Artery
Showing Blood Supply on Mesial (Sagittal Surface) of Brain
Showing Blood Supply at Base of Brain
Showing Falx Cerebri, etc
1

343
344

345
346
347
348
340
350
351

352
353
354

Sagittal Section of Brain

355
356
357
358
359
360

CI. XXXI.

Sagittal Section of

361

CLXXXII.

Sagittal Section of

CLXXVII.
CLXXVIII.
CI. XXIX.
CI.

XXX.

(I. XXXIII.

CI.

XXX IV.
XXXV

CI.

CLXXXVI.
CLXXXVII.
CI.XX.W
CI.

III.

XXXIX.
CXC.
CXCI.
CXCII.
CXCIII.

CXCIV.
cxcv.
CXCVI.
CXCVII.
CXCVIII.

CXCIX.
cr.

Sinuses

OCIII.

CCIV.
cc\.
CCVI.
CCVII.

the Base of Brain

Showing Third and Fourth Ventricles

BrainShowing Fibers
Brain Showing Centers of Smell and Taste

Location of Centers

in

Brain

A Sagittal Section of the Brain

Showing Long and Short Association Fibers of the Brain
A Horizontal Section of the Brain
Showing Superficial origin of Cranial Nerves
Superior View of he lerebellum
Inferior View of he Cerebellum
Showing lie Writing Center in the Brain
Anterior View of 'auda Equina
Showing Dura Mater, Arachnoid and Piamater
I

<

Transverse Section of the Con

at Different Levels

Transverse Sect ions of he ( !ord Shewing Tracts, hseases, etc

Vena Azygos Major, Abdominal Aorta and Sympathetic Nerve
Anterior View of Sympathetic Nerve and Spinal Cord
1

Side View of S\ mpat hetic System

Showing Kami !ommunicantes
The Ufactory or First Cranial Nerve
The Layers of Retina
(

Blood Supply to Eye-Ball

CCI.

ecu.

at

Showing Venae
I

distribution of
Iptical

Nasal

<

Vorticosae

(phthalmic Artery

Axis and Visual Line

>UC1

<

lonjunctiva and Lachrymal

The Muscles of the

Showing Directions

iland

Region
that Muscles of Eve-Ball move Eve
Irbital

362
363
364
365
366
367
368
369
370
371

372
373
374
375
377
379
380
381
382
383
384
386
388
390
391

392

OF ILLUSTRATION--,

LIST

xill

Plate

Page

CCVIII.

CCIX.
ccx.
('('XI.

('('XII.

('('XIII.

CCXIV.

ccxv.
CCXVI.
CCXVII.
CCXVIII.

CCX IX.
ccxx.
CCXXI.

CCXX

1.

CCXXIII.

(XXIV.

(XXV.
CCXXVI.
(

CCXX VI I.
((

XXVIII.

CCXXIX.
CCX XX.
CCXXXI.
CCXXXII.
CCXXXIII.

CCXXXIV.
(

(XXXV.

CCXXXVI.
('( XXXVII.
C(

XXXVIII.

CCXXXIX.
CCX

I..

CCXLI.
CCXLII.
CCXLIII.

CCX

I.

IV.

CCXLV.
CCXLVI.
CCXLVII.
CCXLVIII.

CCXLIX.
CCL.
CCLI.
CCLII.
CCLIII.

CCLIV.
CCLV.
CCLVI.
CCLVII,
CCLVIII.

CCLIX.
CCLX.
CCLXI.
CCLXII.

Showing Refraction of Light Through Crystalline Lens

Superior Fornix and Inferior Fornix of Conjunctiva

393
304

Crystalline Lens

395
396
397
398
399
400
401

A Horizontal Section of the Eye-Ball

The Third Cranial or Motor )culi Nerve
The Fourth Cranial or Trochlear Nerve
Showing Brandies of Fifth Xerve
Show Distribution of Filth Nerve in Reference
Cutaneous Xerve Supply of Head and Neck
(

Meckel's Ganglion and

The Sixth

>tic

to

>t

her Structures.

Ganglion

Cranial or Abducens Xerve

Branches of Facial Xerve

Showing Facial Xerve and Superficial Cervical Plexus
Origin and Distribution of Auditory Xerve
Showing Distribution of Xinth, Tenth, Eleventh Cranial Nerves
Showing Pneumogastric Xerve and Sympathetic Ganglia
Showing Si ructures Passing Through the Sphenoidal Fissure
Showing the Abdominal Areas
The Permanent Teeth
A Vertical Section of Canine Tooth
The Hard Palate
The Bones of Orbit
Showing the Sensory Pathways to Brain
Showing the Motor Pathways from Brain
The Cavernous Sinus (Modified from Cunningham)
Showing Both Sensory and Motor Pathways

The Sutures of Skull

Showing Foramina at Base of Skull
The Inferior Surface of Base of Skull
Internal Surface of Frontal Bone
External Surface of Frontal Bone
Internal Surface of Parietal Bone
External Surface of Parietal Bone
External Surface of Occipital Bone
Internal Surface of >ccipital Bone
Posterior View of the Sphenoid Bone
Anterior View of Sphenoid Bone
The Pterygoid Processes
The External Surface of Temporal Pone
The Petrous Portion of the Temporal Hone
The Temporal Pone Laid >pen
The Inferior Surface of Petrous Portion of Temporal Pone
The Nasal Bone
The Lachrymal Pone
The Internal Surface of Superior Maxillary Hone
<

External Surface of Superior Maxillary Bone

Internal Surface of Malar Bone

|(i:;

405
407
109

411

413

415
117

419
421

424
426
128

430
432
434
430
438
440
442

444
446
448
450
452
15

455
450
457
1">

159

400
461
162
163
10

107

170

External Surface of Malar Bone

17:;

External Surface of Inferior Maxillary Bone.

Interna] Surface of Inferior Maxillary Hone.

176

View of the Ft hmoid

Superior View of he Ft hmoid
Inferior Turbinated Hone
The Vomer
The Palate Bone Posterior Views)

182

Lateral

170

is.".

188

491
10

LIST OF ILLUSTRATIOXS.

XIV

Page

Plate

CCLXIII.
(CI. XIV.

CCLXV.
CCLXVI.
CCLXVII.
(CI. XVIII.
(CI. XIX.

(CI. XX.
CCLXXI.
CCLXXII.
(CI. XXIII.

CCLXXIV.
(CI. XXV.
CCLXXVI.
(CI. XXVII.

CCLXXVII1.
(CI. XXIX.
(CI. XXX.
(CI. XXXI.
(CI. XXXII.
(CI. XXXIII.
('('I.

XXXIV.

CCLXXXV.
CCLXXXVI.
(CI.

XXX VII.

(CI. XXXVIII.

CCLXXXIX.
ccxc.

The Lateral Mew of the Palate Bone

The Meatuses
The Uriniferous Tubules
Sagittal Section of Kidney
The Female External Organs of Generation
Colles' Fascia and the Triangular Ligaments of Perineum
The White Line and Ischio Rectal Fossa
Showing the Muscles of Perineum
The Uterus, Horizontal Section
A Sagittal Section of the Female >rgans of feneration
The Uterus with Vagina Laid Open
(

497
500
503
506
509
512
515
518
521

524
527

A Transverse Section of Penis

530

A Horizontal Section of Penis

533

Testicle

The

and Spermatic Cord

53(i

539
542
545
548

Testicle

Sagittal Section of the Male

)rgans of Generation

The Mammary Gland

The 'uter Surface of the Left Pinna
Diagrammatic View of the Organs of Hearing
(

Posterior

View

of the

551

Far with Auricular Muscles

The Bony Cochlea

The Bony Cochlea Cut Through
The Interior of the Labyrinth with
Interior of Bony Labyrinth
Malleus, Incus and Stapes

Forms of Congenital Hernia?

The Lamphatic Man
A Lymphatic Xode

554
557
560

Distribution of Auditory Xerve.

563
566

569
572
575
576

Preface.
Preface to Second Edition.
little book of one hundred and fifty
which was the outgrowth of his studying
and teaching anatomy in the American School of Osteopathy. It filled its
place as it was intended only as an aid to the student in preparing his work.
There seemed to be no work upon anatomy taken up in a teachable and sys-

Six years ago the author compiled a

pages called

Anatomy

in a

Nut

Shell,

manner and the student complained that it took more time to find his
hand than to learn it when found.
In presenting the subject of anatomy to the student, we first teach a few
rules and fundamental principles to give him a working knowledge of the subject, and then we take up the work complete as it comes in the human body.
For instance in teaching the anatomy of the arm we take the clavicle, giving
its ossification, articulations, attachment of muscles and blood supply.
Then
the origin and insertion with action, blood supply and nerve supply of these
tematic

lesson in the books at

it is with every bone of the upper extremity and the entire body.
gained by saying that the greater tuberosity of the humerus has
three muscles attached to it, namely the Supraspinatus, Infraspinatus and Teres

So

muscles.

What

is

we learn the functions of these muscles? By this method of teachanatomy we find it to be one of the most interesting of all subjects both to
teacher and pupil.
The original book of one hundred and fifty pages has been revised ami

minor, unless
ing

name Anatomy in a Nut Shell is

hundred pages covering such an inexhaustible
subject as human anatomy would be a Nut Shell indeed.
In preparing this work the following authors, through their writings, have
been my constant companions: Gray, Gerrish, Morris, Denver. Potter, Holden,
Heath, Cunningham, McClellan, Eckley, Rockwell, Butler, Hale, ami last but
not least, Dr. A. T. Still has been my inspiration and best teacher.
The entire work is given in lessons so that each day the student has some

enlarged to over six hundred pages, but the

retained, because

any book

of six

thing definite to do.

"He who
that

every morning plans the transactions of the day, and follows out

plan, carries on a thread which will guide

the most busy life."

"The

chief art of learning

What was
muscles,

is

him through the Labyrinth

of

Blair.

omitted

in

the

is

first

to

attempt

here given, so that the work

masters this work can justly

feel

but

little

at

edition, such as the origin

is

proud of
\v

time."

complete in itself.
anatomical knowledge.

his

Locke.

ami insertion of
Ami any one who

PREFACE.

Xvi

The author was most fortunate

of tin'

American School

of

in

securing Dr. Win. Most, a senior student

Osteopathy, in make the drawings, and he is especCash Laughlin for writingthe entire manu-

ially grateful to his wife. Dr. Isabel

scripl

the

lasl

time over and assisting

editor of the A. S.

().

Dr. A. E. Daugherty,
mention
making the index.
for
Student, deserves special
in

proof-reading.

Preface to First Edition.

This book

anatomy, hut
of the muscles
In

is

is

noi intended to lake the place of

to

he used as an aid for the student.

have noi been given, as that

is

any standard text-book in

The origin and insertion

ou1 of the province of this book.

preparing this hook, several authorities have keen consulted, as A. T.

Still,

Gray's Anatomy, Morris' Anatomy, Gerrish's Anatomy, Century Dictionary, etc.

ANATOMY

IN

A NUTSHELL.

LESSON
Anatomy

is

of the body.

I.

concerned with the form, structure and connections of the parts

has the following divisions:

It

anatomy

1.

Osteology (os-te-ol-o-je)

2.

Syndesmology (sin-dez-mol-o-je) is the anatomy of the

Myology (mi-ol-o-je) is the anatomy of the muscles.

3.

is

the

of the bones.
joints.

Angiology (an-je-ol-o-je) is the anatomy of the vessels.

Neurology (nu-rol-o-je) is the anatomy of the nerves.
Splanchnology (splangk-nol-o-je) is the anatomy of the viscera.

4.
5.
6.

8.

Adenology (ad-en-ol-o-je) is the anatomy of the glands.

Dermatology (der-mat-ol-o-je) is the anatomy of the skin.

9.

Genesiology (jen-e-ze-ol-o-je)

7.

Aponeurosis (ap-on-u-ro-sis)

is

is

the

anatomy

of the generative organs.

the end of a muscle where

it

becomes a

tendon.
(a)

It is

when broad,

any

fascia or fascial structure, especially the tendons of a muscle

thin, flat

(b)

It

is

(c)

It

is

and

of a glistening white color.

the expansion of a tendon covering

more or

less of a

muscle.

a thin, whitish ligament.

The name was given to these structures when they were supposed to be
any hard, whitish tissue being then considered nervous.
In present tisage aponeurosis is nearly synonymous with fascia, but it is oftener

expansions of nerves

applied to the fascia like tendons of muscles; as the aponeurosis of the external
oblique of the abdomen.

Fascia
of the

body

is
is

(Plate

XV.)

a sheet or layer of dense connective tissue.

The general contour

invested, just beneath the skin, with a thin, light fascia, as dis-

from the thicker, tougher and more densely fibrous deep fascia
which invests and forms sheaths for muscles and dips down among the mustinguished

and bundles of muscular fibers forming intermuscular septa.

A tendon is a hand or layer of dense fibrous tissue at the end of a muscle
for attachment to a hard part.
A very hard flat tendon is called fascia and
aponeurosis.
Tendons are directly continuous at one end with the periosteum
and at the other end with the' fascial tissue which invests the muscle.
A sinus means a cavity in hone or other tissue. The sinus of the superior
The veins of the dura mater
maxillary hone is called the antrum of Highmore.
cles

are called sinuses.

17

PLATE

I.

THERE ARE 200 BONES IN THE BODY EXCLUDING

THE BONES OF THE MIDDLE EAR -MALLEUS. INCUS.
BONES
STAPES, ALSO THE SESAMOID AND THE WORMIAN BONES.
THE SESAMOID BONES ARE FOUNO IN TENDONS OF
SUTURES
IN
THE
ARE
BONES
WORMIAN
MUSCLES. THE

'

V^_j

^-^^fc

^^t^"^/
:

OF THE SKULL.

MANUBRIUM
GLADIOLUS

ENSIFORM APPENDIX

OLECRANON

The Bony Max.

18

J"

fr

ANATOMY
All processes of

IN A NUTSHELL.

19

bone are either apophyses or epiphyses.

An apophysis is
An

a process that has grown from the bone and has no separate ossific center.

epiphysis has a separate ossific center and

This cartilage becomes ossified but

tilage.

joined to another bone by car-

is

this

change does not make the

Once an epiphysis always an epiphysis. The head

of the femur is an epiphysis ami the neck of the femur is an apophysis.
The nutrient arteries of the bones of the arm and forearm run towards
the elbow: in bones of the lower extremity they run from the knee.
Rule 1. The epiphysis towards which the nutrient artery runs joins the
bone first always, but ossifies last in all bones except the fibula.
epiphysis

an apophysis.

Rule 2. When there is but one epiphysis then the nutrient artery runs
towards the end of the bone which has no epiphysis; e. g., the clavicle and metacarpals and metatarsals.

Rule

3.

When

(Plate VII.)

there are two or

more

nucleii in an epiphysis they con-

solidate before the epiphysis joins the diaphysis.

Rule 4. The epiphysis which ossifies first is the larger, and the cartilage
between it and the diaphysis grows longer and faster than the cartilage at the
other extremity of the bone.
An epiphysis may become separated from the diaphysis and such an injury may be mistaken for a fracture or dislocation. A knowledge of this principle is of great importance in medical jurisprudence; e. g.. the epiphysis at the
distal end of the femur ossifies at the ninth month of fetal life.
The covering of bone is called periosteum. It covers all the bone except
the articular cartilage and uives attachment to tendons.
Periosteum besides
giving attachment to the tendons of muscles;
Gives nutrition to the bone.

1.

2.

Forms

all

.'!.

Tends

to hold the

4.

From

5.

It

it

capsular ligaments.

end

of

the bone grows

broken bones.
in

thickness.

hinders the progress of contiguous inflammation.

A long bone grows

in

length

age and interstitial deposits;

periosteum and

interstitial

in

by the development of the epiphyseal

cartil-

thickness from the osteogenetic layer of the

deposits.

There are 300 bones in the body (Platel.)

They are divided into long,
short flat and irregular ones.
90 of the bones are Long ones and are found
in the extremities.
In reality a long bone may not be :is long as a Hat or irregular one o]- even a short bone. e. g., the last phlanx is shorter than the os calcis.
.

The long bones

and

shaft

act as lexers

called

and have

medullary canal

diaphysis. and two extremities.

in

They

the center of each

are developed

by

osseous deposits

in cartilage.
In each upper extremity there is a clavicle,
humerus, ulna, radius, five metacarpal and fourteen phalanges, making 23 long
bones in each upper extremity, then in both extremities there are 2x23 or 16
In each lower extremity there is a femur, tibia, fibula, five metlong bono.

atarsals

then
in

in

ami fourteen phalanges, making 22 long bones in each lower extremity,

both extremities there are 2x22, or II long bono.
The 46 long bone-

the upper extremity and the 44 long ones

in

the lower extremities

make

IN A NUTSHELL.

ANATOMY

_>()

There are 30 short bones. They also are developed by osseous

and arc found in the extremities. They are found where
In each carpus (Plate XXVI.) there
strength but no1 much motion is required.
ones, viz., scaphoid, semi-lunar, cuneiform, pisiform, trapezium, trapezoid,
08 magnum and unciform, making 8 hones: 2x8 are 16, the number of short
90 Long bones.
in

it

cartilage

bonesinthe two upper extremities.

each ankle. (Plate LIV.)there are 7 bones,

In

os calcis, astragalus, navicular or scaphoid, cuboid, external cuneiform,

viz..

middle cuneiform, and internal cuneiform, making 7 short bones in each tarsus;
then in the two tarsi there are 2x7 or 14 short bones; the 14 short bones in
the lower extremity and the 16 short ones in the upper extremity make the
bones.

30 short

LESSON

II.

flat bones, all of which are found in the trunk, and head exand these are in the extremities. They are the two patellae and two
The flat bones in the trunk protect the viscera. They are developscapulae.
ed by osseous deposits in membranes and consist of two dense layers separated
by cellular or cancellated osseous tissue, the diploe. There are the two parieIn the face there are two nasal, two
tal, frontal and occipital in the cranium.
In the thorax 24 ribs and the sternum; then there
lachrymal and the vomer.
ate the tun innominata, two patellae, two scapulae, making 40 Hat bones in the

There are 40

cept four

body.

There are

They

io

They

Irregular bones.

are found

in

two

the trunk

and head.

ethmoid.
and the hones of the face except the two nasal, two lachrymal and
the Vomer.
Then the hvoid holie.
There are s hones in the cranium. The 4 flat ones are the frontal, two
parietal and occipital: the 4 irregular ones are two temporal, sphenoid and
are the 24

vertebrae,

the sacrum,

coccyx,

temporal,

sphenoid

ethmoid.
hones in the face; the 5 tlat ones are the two nasal, two lachryThere are
mal ami vomer. The 9 irregular ones are the two superior maxillary, two
malar, two palate, two inferior turbinated and the inferior maxillary.
I

cranium and the face together there are 8 plus 14. making 22
s. if the 22 of the head are included.
In
the trunk without the head there are 53 hones, which are 24 vertebrae, 24 ribs,
sternum, sacrum, coccyx and
wo innominata. In the extremities there are
12
is, 64 in the upper and 60 in thelower.
In the pelvis there are 4 bones,
two innominata. sacrum and coccyx. \oi counting the vertebra' in the cranium

Then

hone.-.

in

the

In the

trunk there are 75 hon<

there

an-

coccyx.

:::;

vertebra?; 7 cervical,

There are 12 pairs

of

12

iil>-.

dorsal, 5 lumbar. 5 sacral

7 of

which are true and 5

and

4 in

false. 2 of

the

which

are float Lng.

Besides the 200 hones mentioned there are sesamoid bone- which are dein tendons such as the patellae, but these on account of their size ami

veloped

shape are called

flat

ones; and the

wormian bones, which are found

sutures of the skull; and the malleus, incus and stapes found

in

in

the

the middle ear.

PLATE

The Muscul
21

\i;

.Max.

II.

WAToUY
There are 32 teeth:

IN

each jaw there

in

NUTSHELL.

one pair

is

<>!'

canine, two pairs of incisors

two pairs of bicuspids, ami three pairs of molars.

The eminences
1.
Apophyses
2.

of bones are:

an example, neck of the femur.

Condyles, which mean irregular heads example, lower part of the

femur.

ti.

example, head of femur.

Heads, smooth ami convex, found in joints mi femur and humerus.
on vertebrae.
Spines, sharp and slender
joints
on the femur.
for
turning
Trochanters,

7.

Tubercles, -mall tuberosities

:;.

\.

0.

Epiphyses

deltoid tubercle on clavicle.

Tuberosities, broad prominenceson the humerus.

8,
Besides these s there are 11 other prominences on hones.
.

1.
_'.

Azygos, without a fellowodontoid on axis.

on the sphenoid hone.
Clinoid, like a bed
crow's beak- on the scapula.

:;.

Coracoid, like

-1.

Coronoid, like

crown

llaninlar,

ii.

Malleolar, mallet-like

7.

Mastoid, nipple-like

8.

Odontoid, tooth-lik<

9.

Pterygoid, wing-like

10.

mm,

Spinous,

12.

Squamous,

]'.'>.

14

1.

:;.

I.

5.

face

tooth

the jaw.

in

hip-joint.

on the reat tuberosity.

Trochlear, pulley-like

in

mm -articular

Aqueducts
Canal-

:'..

(ell-

'>.

on temporal.

Glenoid, shallow- shoulder-joint.

1.

temporal.

Alveolar, socket-like-

2.

5.

on

articular cavities in bones.

">

There arc 10

1.

on sphenoid.

on temporal.

scaly

Cotyloid, cup-lik(
I'acet

axis.

on sphenoid.

Vaginal, ensheathing

There arc
'_'.

on

on sphenoid.

beak

Styloid, pen-like

lower part of fibula.

on temporal hone.

thorn-like

11.

on the ulna.

on sphenoid.

hook-like

5.

Aqueduct

Vidian canal

Mastoid

the orbit.

cavities.

of Fallopii in temporal hone.

in

sphenoid hone.

mastoid process of temporal bone.

Meckel's cave on petrous portion of temporal bone.
Depressions
Sphenoidal fissure in sphenoid hone.
Fissures
Foramina
Base of skull.

7.

Fossae; also at

Grooves

On

cells in

base of skull.
inner

surface of

Parietal

bone for middle meningeal

artery.
!.

10.

of

Notches
Sinusi

Highmore.

Ethmoid notch on

frontal

hone.

Frontal -inn-, superior maxillary sinus which

is

called

Antrum

ANATOMY

A NUTSHELL.

IX

23

Radius means spoke

Carpus wrist

27.

2.

28.

3.

Scaphoidboat

29.

Frontal forehead

4.

Semilunar
Cuneiform

30.

Occipital

31.

Parietal

1.

Cuboid cube
Cranium helmel

19.

clasp.
Obturator closed
Glenoid shallow

20.

Cotyloid cup-like

46.

21.

Tarus ankle

47.

22.

48.

23.

Os calcisheel
Astragalus die

against the head

wall
Ethmoid sieve
Sphenoid wedge
Temporal time
Nasal nose
Superior Maxillary jaw bone
Inferior Maxillary mandible
Lachrymal tear
Malar cheek
Palate palate
Turbinated whirl
Vomer ploughshare
Vertebra to turn
Thorax chest
Sacrum sacred
loccyx cuckoo
Innominata without name
Clavicle key

49.

Scapula

24.

Navicular or scaphoid

50.

Humerus

26.

Cuneiform

25.

Thyroidshield.

12.

half moon
wedge-like
Pisiform pea-like
Trapezium table
Trapezoid table shape
Os Magnum large bone
Unciform hook
Metacarpus beyond the wrist
Phalanges fingers and toes

13.

Pelvis basin

14.

Femur

15.

Patella

41.

16.

Tibia flute

42.

17.

Fibula

.").

6.
7.

5.
9.

10.
11.

18.

32.

33.
o4.
35.
36.
37.

3S.

39.

thigh
small pan

40.

43.
44.
45.

boat

wedge-like

We have said

spade
arm

elbow
breast plate

51.

Ulna

52.

Sternum

LESSON
Muscles.

III.

there are 200

bones in the body, but the num-

ber of muscles cannot be given exactly, for there are some which at times are
absent and again double. There are, ordinarily, thirteen muscles from the knee
to the ankle, but there

may

Plantaris

The

may

be only twelve or there

may

be fourteen, as the

be absent or double.

[nfracostals vary in

number, however, there are generally ten pairs.

in the forearm, sometimes nineteen, other

Ordinarily there are twenty muscles

times twenty-one as the Palmaris longus

possible to give the exact
in
it

the

human body.

from place
1.

muscle
cess of

to place.

Plate

II.)

They take

may

be absent or double.

So

it

is

im-

However, there are more than 550 muscles

The muscles give form to the body and move
their

names

in

various ways.

mastoid, which mean- this

attached to the sternum, and the clavicle (key) and the mastoid pro-

From
is

number.

the attachment,

the temporal

bone.

as Sterno-cleido

ANATnMV

24

Triceps,

NUTSHELL.

number of parts, as Biceps, which means Two heads, and

which means three head-.
From the shape, as Deltoid, like the Greek letter delta, inverted.
From the function, as Levator anguli scapulae, which means to lift

From

2.

IN A

the

the angle of the scapula.

From

the position, as Subclavius and Subscapularis

which means under

the clavicle and under the scapula.

From the function, attachment and shape, as Pronator radii teres,
6.
which means this muscle first pronates, second it is attached to the radius, and
third

it

is

round

stationary

teres

have

.Muscle*,
is

tv\<>

I.

or

more points of attachments; the part which is most

and is generally the larger; the most movable

called the "origin"

PLATE

III.

Showing the Origin and Ensertion op the Biceps.

part

is

called the "insertion"

and

is

generally the smaller

pan

of the attach-

have a blood and nerve

supply in order to be in a healthly condition. Principle: Function makes strucFor
ture and the cessation of function leads to the disappearance of structure.
instance, in the primative man the Pectorialis minormuscle was continued from
the coraciod process of the scapula to the humerus; now this part of the muscle
Again, the internal lateral ligament of the knee was at one time
is a Ligament.
Thelong external lateral Ligament of
a part of the Adductor magnus muscle.
ment of the muscle.

the knee was

teres

one time

must

pari of the Peroneus Longus,

and the ligamentum

belonged to the Pectineus muscle.

A joint is
Joints \m> Ligaments.

ovial

and

at

Muscle-

(Plate ill.)

is

membrane,
for the

articular cartilage,

purpose of motion.

made up of two or more hones, a synwhite fibrous cartilage, and ligaments,

The bones

are larger

where they enter into

A.NATOMY IN A NUTSHELL.

25

the joint and are covered with articular cartilage. This cartilage has no blood
These bones are
vessels, is a hylaine variety, and is nourished by the lymph.
held together by ligaments (to bind) which are flexible but not extensible.

must have blood and nerve supply.

nerve trunk which snpplies a joint supplies the muscle
joint
moves
and the integument over the fullest insertion of the musthe
which
to the shoulder joint is a good example of this law.
The
Circumflex
nerve
cle
Joints, like muscles

Hilton's

Law A

There are three great classes of joints

in the

body:

A. Immovable or Synarthrosis.
B. Partly movable or Amphiarthrosis.
('.

Freely movable or Diarthrosis.

PLATE

IV.

R00T-M0TUR

ANT OR VENTRAL

ANT. PRIMARY

BRANCH

SPINAL

NtHvb

POSTERIOR PRIMARY BRANCH

- GALL

- BURDACK

- MARGINAL

VENTRO LATERAL ASSOCIATION

- DEEP LATERAL ASSOCIATION

INT DIVISION

EXT. DIVISION

DIRECT

9 - DIRECT

CEREBELLAR

-ASCENDING LATERAL

9 -

TRACT

A Transverse Section of the Spinal

Under
1.

2.

we have the

(GOWERSt

10

COMMA

Cord.

following:

vera.

a.

Dentata

b.

Serrata as interfrontal.

c.

Limbosa

interparietal.

;is

as fronto-parietal.

Sutura notha.
a.

b.
3.

(A) Synarthrosis

True sutures or sutura

PYRAMIDAL

CROSSED PYRA MIOAL

Squamosa
Harmonia

as squamo-parietal.
as intermaxillary.

Schindylesis as the sphenoid with the vomer.

4.

Gomphosis,

5.

Synchondrosis, which means the union of bones by mean- of fibrous

or elastic cartilage,

as the teeth.

e.

g. ;

epiphyseal

line.-.

WATiiMV

IN

NUTSHELL.

Amphiarthrosis.

I'..

Symphysis, as between bodies of vertebrae and the anterior part of

symphysis pubes. This kind of joint has no synovial membrane.
;

I.

the innominata

as the inferior tibio-fibular articulation.

Syndesmosis,

_'.

c.

All

Dlarthrosis.

the diarthrosis or

movable

joints are represented in

the shoulder girdle and the upper extremity.

A.rthrodia (gliding) in the acromio-clavicular-joint.
1.

Enarthrodia, (ball-and-socket) in the shoulder-joint.

iinglymus (hinge) in the elbow.

2.
:;.

Trochoides or Pivet-joint,

\.

in

the superior radio-ulnar joint.

movements except

5.

Condyloid, as the wrist-joint, having

6.

Reciprocal Reception (saddle shaped-joint)

all

axial

rotation.

the carpo-metacarpal

in

thumb.
Ligaments take their names from the bones they join, as sterno-clavicuWhen it goes across
lar ligamenl which joins the sternum and the clavicle.
and
when
it goes around a
a notch or groove it is called a transverse ligament
composed
mostly of white
are
Ligaments
joint it is culled a capsular ligament.
of the lower
nucha'
ligamentum
fibrous tissue; the ligaments subflava,and the
of the

joint

animals arc yellow elastic

Nerves.

If

tissue.

nerve goes to integument

it

is

called cutaneous;"'

if it

goes

to muscles, i1 is called "muscular;" if it goes to muscles and integument, it is

n There are twelve pairs of cranial nerves and
called " musculocutaneous.

compound nerves

thirty-one pair- of spinal nerves.

All spinal nerves are

came they have an

motor and a posterior root which is

form the nerve which contain- both motor
it
leaves the spinal foramen divides into an

anterior root which

These two roots unite

and sensory fibers.
Bach nerve
anterior and posterior branch.

sensory.

Principle

l.

(Plate

IV.)

to

as

Posterior nerve roots are larger than anterior

nerve roots, with the single exception of the

and one-half to three times as large.
Principle

II.

Principle

division
!

in

III.

all

cervical.

They

are

from one

and second cervical nerves.

posterior branches divide into an internal

the

firsl

cervical, fourth

and

and external
and coc-

fifth sacral,

nerve-.

Principle V.

cept

firsl

The

cases except

Principle IV.

which

first

The anterior branches are larger than the posterior branches

cases except the

in all

be-

is

lies

in

The anterior branches make the plexuses.

The posterior nerve root has a ganglion upon

(Plate V)

it

the intervertebral foramen, outside the sac of the dura mater, ex-

one which

is not
always present, and when present is situated
This one. and the second, are placed on the arches of
the vertebra over which the nerves pass.
The ganglia of the last four sacral

the

first

within the dura mater.

nerves are situated outside the dura mater bu1 in the spinal canal; the coccygeal ganglion when presenl is within the dura muter.
The nervi nervorum are
nerve filament^ going to the nerves and the nerve sheaths.

ANATOMY

IN A

LESSON

NUTSHELL.

27

[V.

and second spinal nerves pass outward at right anglesdownward and outward, and as the cord ends at the
second lumbar, the lower roots have a long course before they leave the canal,
and are situated around the filnni terminale of the spinal cord forming the
cauda equina.
A motor nerve is any nerve whose function is to excite muscular conn-action, anil thus effect movement in an animal body.
Most nerves are mixed in
character or sensorimotor, effecting both motion and sensation.
A sensory nerve is a nerve conveying sensory impulses, or more strictly,
one composed exclusively of sensory fibers; nearly equivalent to afferent nerve.
Vasomotor nerves are those which supply the muscular coats of the blood-

The

roots of the

first

All the rest pass obliquely

vessels.

A nerve center is a group of ganglion-cells closely connected with one another and acting together in the performance of some function, as the cerebral
centers,

Of the cranial nerves, some are compound, some are motor and others are
They take their names, olfactory, optic, etc., from
their function, but the names, first, second, etc., from the order of piercing the
dura mater from before backward.
nerves of special sense.

TABLE OF CRANIAL NERVES.

Name.
1st.

Olfactory.

Distribution.

Fitncton.

Mktiiod of Ex it

ANAIOMV

28

TABLE OF CRAN1
Name.

NERVES Continued

M-

boid

Method of

Function.

KIBUTION.

muscles <>f lace,

Platysma, Styloand posterior belly or Motor,

Superficial
Frontalis,

Facial.

7th.

>l-l

NUTSHELL.

IX A

Internal Auditory Meatus

a n (1 leaves l>y Stylo-

mastoid Foramen.

Digastric.

Auditorx

8th.

Membranous

labyrinth

oi

ear.

Exit.

Special sense, Internal Auditory Meatus;

remains in ear.
(hearing) and

Equilibrium.
Ulosso-

9th.

Pharyngeal

Pneumo,,.,s.iri,. or
oi \'-i
_asun
a-

loth

mis
-"

in external ear, motor

8en sory to pharynx <>rdinar\ sense
Jugular Foramen,
larynx, trachea, lungs, oesoand motor.
phagus, stomach, heart, and
pm

and

ii

tli.

,i.i

'

sometimes

jugular Foramen.

Ord'y

(taste).

Sense, Motor.

S< M-' 'iy

Special sense

Pharynx and hind partof ton

gue; some motor fibers.

to

li\

er

Spinal
Accessory. Motor

to Trapezius and Sternomastoid muscles. Rest is ac- Motor,

cessory t<> the pneumogastric.

lJth.

Hypoglossal

Motor.

Muscles of tongue.

.1

ugular Foramen.

Anterior Condyloid Fora-

men.

LESSON
ART

I.

V.

K II.-.

The arterial system consists of two separate divisions of circulations. The

pulmonary arterywith its branches forms the lesser or pulmonary circulation,
and the aorta with its branches forms the greater or systemic circulation.
Blood vessels.
Vasa vasorum are blood vessels which supply the larger
arteries.
The blood circulates through the body to nourish the various parts.
The circulation of the blood was demonstrated by Harvey in 1628. All ves
sels which carry 1>I
from the heart are arteries, and those which carry blood
The connecting link between the arteries and the veins
to the heaii are veins.
is the capillaries.
Harvey was not able to sec these connecting links for they
are microscopic and the microscope was no1 invented until some years later.
filtered through the tissues from the arteries to the veins,
Harvey said the l>l
1

which
As

is

not

rule the

very

far

wrong.

arteries carry

Malpighi

pure or

discovered the capillaries in 1661.

oxygenized blood, and the

veins carry

impure or non-oxygenized blood, but there are exceptions to this rule forthe
pulmonary artery carries impure blood and the pulmonary veins carry pure
blood.
Perhaps the puresl Mood in the body is in the right renal vein.
When the blood enters the kidney it is as pure as when it left the left ventricle
of the heart and in the kidney it throws off more impurities than it takes
from the kidney. The left renal vein receives the spermatic vein in the male

and the ovarian vein

in

the female,

SO

it

contains

blood

less

pure

than

the

PLATE V
SUPERIOR

GLOSSOPHARYNGEAL

IDDLE

CEREBELLAR PEDUNCLt

CEREBELLAR PEDUNCLE

PNEUMOGASTRIC
SPINAL ACCESSOR

CERVICAL

CKvV
_j~V

~_~"

1st

<

V-

in
NFERIOR

CEREBELLAR

PCQUNCLE

'

VENTRAL ROOTS

TERMINAL CONE

TERMINAll

FILUH

Posterior View of the Spin

29

w.

<

'<

\N V.TOM1

30

These veins

vein.

renal

righl

1\

A NUTSHELL.

of the righl

side enter into

the inferior

vena

have valves.
The heart is a voluntary muscle (straited) in structure bill is presided over
by the sympathetic nerve which makes it involuntary in action. The average
Its covering is called pericardium, its
weighl of the heart is about 11 ounces.

cava

:iinl

endocardium, and the muscle itself is called myocardium. It has four

chambers, the two upper ones arc the auricles (ears) and the two lowerones
The two auricles contract at the same time that the venventricles (bellies).
The contraction is called the systole and the
tricle- expand, and vice versa.
The
systole is the work, and the diastole is the rest.
expansion the diastole.
lining

Capillaries

work

adipose tissue

found

not

arc

of capillaries

and

in

The net
epidermis.
mucous membrane muscle and
The capillary
the brain and cord.

cartilage- epithelium

very close in the lungs

is

in

the gray matter of

tendons
aponeurose
meshes an' wider and the vessels fewer in the fascia
their simplest form the capillaries consisl only of endoIn
and ligaments.
thelial lining of the arteries and veins with which they are connected, being
both elastic ami contractile, their lumen varies under pressure.
microscopic and in order to get a drop of blood
ies

many musl

They

be ruptured.

and veins have nerves called vaso-motor which forms

are

Arter-

net-work around

the muscular coat, especially of the arteries.

\

Veins are found

to

illaries

in

the heart.

almosl
A.s

all

EINS.

the tissues

and carry the blood from the capnumerous than

they are generally larger and more

the arteries, their total capacity greatly exceed- that of the arterial system.

Not only the smaller branches, but even the larger trunks communicate with

The venous system has two distind subdivisions, the

pulmonary ami the systemic.
The pulmonarj veins aid in the pulmonary circulation and convey arterial
to the left auricle; they are but slightly larger than their arteries, and have
bl

each other very freely.

no valvt

s.

The systemic veins aid in the general circulation and convey venous blood
to the righl auricle.
They are divided (systemically) into three sets; superficial, deep, and sinuses.
The superficial or cutaneous veins lie just under the
skin between the layers of the superficial fascia; they pierce the deep fascia to

empty

the deep veins.

The deep veins usually accompany the arteries

same -heath. There i- generally only one vein with
each of the larger arteries as the subclavian
but two (venae comites) accompany each of the -mailer arteries as the radial, and all the arteries of the
into

and are enclosed

in

the

lower extremities excepl the femoral artery, one lying on each side of them in
regions they do nol accompanythe arteries.
The sinuses are venous
channels which are found only in the skull ami are formed by a separation of
;

certain

the layer- of the dura mater: they are lined by endothelium.

The

and veins have threecoats; fir-t the tunica intima, second the
and
third the tunica externa (adventitia).
tunica media
This third coat is the
"tily one not ruptured in ligation of an arterv.
The tunica media has muscular
arteries

PLATE

The Brachial Plexi

31

s.

VI.

ANATOMY

32

fillers

and supplied with vasomotor nerve- (vaso-constrictor and vasoThese nerves run in the same -heath and are part of the sympathet-

in

it

dilator).

The vaso-constrictor

nervous system.

ic

all

A NUTSHELL.

IN

acts to a greater or lesser degree at

times; the vaso-dilator acts upon the constrictor and inhibits

and these branches run towards the

the joint

joining

its

action.

and below
one another. This

artery which passes over a joint gives off branches above

The

called anatsomosis.

is

arteries as a

culation

i-

mean-

Its

purpose

and

for the

is

when

of passing the joint

the

join

blood to run

main one

and veins hear

Arteries

called collateral.

joint

in

these small

This

cir-

a certain relation to

one

is

closed.

another.

Rule. (Plate

Above

VIII.)

level, or in front of their

same
Below the diaphragm the artercompanion veins, excepting the

the diaphragm veins are are on the

companion

arteries.

same level, or in front of their

and the profunda.
The tYtiis gets it- food and oxygen from the placenta, while after birth the
food come- through the alimentary canal and the oxygen through the lungs.
In tracing the circulation after birth we start with the blood in the right auricle:
ies

are on the

renal

systole of the heart -ends

tricle;

here a systole sends

it

artery ami the lungs, where

through the tricuspid valve into the right venthrough the semilunar valves into the pulmonary

it

it

carbon dioxid and receives oxygen;

gives n{]

it

continued from the lungs through the pulmonary veins (three to five) to the
left auricle of the heart, then a systole sends it through the bicuspid valve into

i<

the

left

ventricle; from here a systole sends

the body,

and
All

to pas-

it

through the aorta

to all parts of

through the capillaries and to be collected into the superior

which empty into the right auricle of the heart.

inferior vena- cava-

Veins have valves which keep the blood from running back in its course.
veins do not have valves; some of those which do not have valves are the

veins of the dura mater, or sinuses, the pulmonary veins, veins of the portal
system and those of the spinal cord. The others will be mentioned when

described.
Arteries a- a rule do not

the
ies

have valves, but there

pulmonary artery has

valves.

break into branches.

The

and the vertebral arteries

veins are in two -el-; the
the superficial

fascia,

The deep

accompany

veins

but

join

is

an exception to this also;

Veins receive tributaries, or radicles; arter-

portal vein breaks into branches

like a

superficial

vein to

make

and the deep; the

in

an artery

The

superficial ones are in

send communicating branches

the arteries

like

the basilar artery.

to

the deep

veins.

the extremities and there are two for

each artery: they are called vena' comites.

They are presenl in the arm and
forearm and from the knee to the ankle, but not from the hip to the knee. The
veins are larger than the arteries.
If they were all put into one vessel it would
be the shape of

cone with the apex

body because the combined area
the main veins.
tli.'

;1

at

the heart ami

its

of the tributaries

is

base

at

the surface of

greater than that of

AXATOMY

IN A NUTSHELL.

LESSON

33

VI.

The foramen ovale

large.
communication between them until
at which time a valve grows from the posterior wall of
the right auricle to the left of the foramen ovale, and prevents the blood from
In twenty per cenl of the cases the
passing through except from right to left.
open
throughout
ovale
remains
life.
(Plate IX.)
foramen
In the fetal heart the Eusatchian valve

is

which joins the two

the middle of fetal life,

auricles gives a free

PLATE
PHALANGES. TWO
CENTERS FOR EACH BONE. ONE FOR SHAFT. ONE FOR
METACARPAL EXTREMITY.

VII.

APPEAR BETWEEN THE

THIRD AND

FIFTH YEAR

CONSOLIDATE

EIGHTEENTH

APPEAR

IN

IN

THE

YEAR.

THE THIRD

CONSOLIDATE

IN

THE

TWENTIETH YEAR

METACARPUS

TWO

CENTERS FOR EACH

ONE FOR SHAFT.

BC

ONE FOR

DIGITAL EXTREMITY EXCEPT FIRST

APPEARS

IN

THE THIRD YEAR.

'

CONSOLIDATES
CARPUS.
ONE CENTER FOR EACH BONE

ALL CARTILAGINOUS

AT

IN

THE

TWENTIETH YEAR.

BIRTH

Nutrient Arteries of Hoxk.s ok 1Iwi>.

The ductus arteriosus

which

is

aboul

scending aorta just below the origin of the

It

arises

from the

left

half an inch
lefl

pulmonary artery

long joins the

de-

subclavian artery.
at

first

from the

common

pul-

monary.

The hypogastric

or umbilical arteries arise from the internal

after passing beside the bladder

a

go through the umbilicus

to

iliac,

and

the placenta

IN A NUTSHELL.

ANATOMY

34

The umbilical win passes from the placenta to the under surface of the
liver going through the umbilicus and the free margin of the suspensory ligaA large
At the transverse fissure this vein divides into two branches.
ment.
right
lobe
of
and
enters
the
the
liver.
vein
portal
is
joined by the
<ne which
the ductus venosus

A smaller one

joins

Before

vena cava.

with the interim'

it

the

hepatic vein at

left

its

junction

divides the umbilical vein gives branches

quadrate, and Spigelian lobes.

blood coming from the placenta in the umbilical vein reaches the
pure
The

to the left,

interim- vena cava in three

A small quantity

1.

ways;

via

ductus

venosus into the hepatic veins and in-

vena cava.

ferior
2.

Smne

:!.

Most of

enters the liver directly and then passes through the hepatic veins.
it

passes through the liver with the portal venous blood

and

then through the hepatic veins.

In the inferior vena cava

all

this blood

mixes with venous blood from the

It now enters the right auricle from

lower extremities and abdominal wall.
which it passes to the lefl auricle through the foramen ovale being guided by

In the lefl auricle it mixes with the blood which comes

the Eustachian valve.
It now passes
from the pulmonary veins, which is venous and a small amount.
through the auriculo-ventricular opening into the left ventricle, from here
through the aorta to the head and upper extremity, some passing into the de-

The venous blood from the upper extremities and head deand here it

scending aorta.
scends

the superior vena cava into the right auricle of the heart

in

From

mixes with a small pari of the blood from the inferior vena cava.
passes through the auriculo-ventricular opening to the right
systole sends the blood from the right ventricle into the

here

pulmonary

it

ventricle.

artery, a

small pari of the blood passing into the lungs and the remainder goes through
the ductus arteriosus to the descending aorta, where
the

left

the

lil

and the
The

in

rest

acts both as a nutritive

and

the head, and the upper extremities are large

liver,

mixes with blood from

it

adult gets nourishment from the alimentary canal

The placenta

lungs.

it

has passed through the arch of the aorta.

Most of
the descending aoria passes through the umbilicus to the placenta,
to the lower limbs and viscera.

ventricle after

purely arterial blood passes to these organs.

and oxygen from the

respiratory organ.
in

The other

viscera

extremities are small because the blood which passes to them

The

because the

the fetus

and the lower

is

practically

venous.
At
is

birth

the placental circulation stops, while the

increased and the lungs expand.

The foramen ovale

day and the valvular folds adhers to

ovale remains open throughoul life

its

margin.

pulmonary circulation
closes about the tenth

As said before, the foramen

in one case ou1 of five.

The umbilical
become obliterated beyond the bladder in from two to five days. The
umbilical vein and ductus venosus dose about thesame time as the umbiliThe ductus arteriosus closes in from four to ten days.
cal arteries.

arteries

plexus

i-

nerves situated

a
in

net-work.
the axilla.

(Plate VI.)
It

is

The Brachial Plexus

called brachial because

its

is

a net

work

of

branches supply

A.NATOMY IN A NUTSHELL.
the

arm

other half

made

On

or brachium.

We

five pairs in all.

each side of the spinal cord are

learn the

anatomy

making
body and the

five plexuses,

of the lateral half of the

few exceptions

similar, with a

is

35

The first plexus is

and is called the
the Brachial, and is com-

in the viscera.

of the anterior divisions of the first four cervical nerves

The next plexus

Cervical Plexus.

in order

posed of the anterior branches of the

nerves and part of the

first

is

called

fifth, sixth,

dorsal nerve.

seventh and eighth cervical

In the dorsal or thoracic region there

There are plexuses of nerves where there

done by the nerves. The next plexus is the Lumbar which
is composed of the anterior branches of the first, second, third and part of the
The part of the fourth lumbar nerve which does not
fourth lumbar nerves.
enter into the formation of this plexus joins the fifth lumbar nerve and these
two nerves make the lumbo-sacral cord which, although it has lumbar nerves in
This cord with the anterior divisions of the
it, belongs to the sacral plexus.
first, second, third and part of the fourth sacral nerves make the Sacral Plexus.
The remaining part of the fourth nerve with the fifth and coccygeal nerve, make
the Coccygeal Plexus. As the spinal cord is so much shorter than the spinal
canal, the nerves leave the cord above the foramina where they leave the spinal
are no plexuses, except sympathetic.
is

much work

to be

canal.

There are eight cervical nerves although only seven cervical vertebra?, as
is above the atlas and the eighth cervinerve below the seventh cervical vertebra, or vertebra prominens.
The

the first cervical, or suboccipital nerve,

cal

eight cervical nerves leave the cord

above the spinous process

of the sixth cer-

vical vertebra.

There are twelve pairs of dorsal or thoracic nerves; the

lea 1,!'

first

six

of these

the cord between the spinous processes of the sixth cervical and the fourth

dorsal vertebra; the lower six dorsal or thoracic nerves leave the cord

the spinous processes of the fourth and eleventh dorsal.

The

five

between

Lumbar

nerves leave the cord between the spinous processes of the eleventh and twelfth

The

nerves leave the cord between the spinous processes of

and the first lumbar. The lower nerve roots have such a
long course between the cord and the foramina that they are called cauda equina

dorsal.

five sacral

the twelfth dorsal

(horse

tail.)

LESSON
Clavicle

(Key.) This

is

VII.
it
has no medullary canal as (he
and with the scapula acts ;is a cush-

long bone but

other long bones have.

It

ion to lessen the force of

blows upon the shoulder.

articulate with

is

quite elastic,

any other bone, but

is

held

in

In sonic

animals

does not

it

position by the muscles.

This

bone and the scapula make the shoulder girdle.

It is present in those animals
which have claws and use the upper or front extremity for other purposes than
that of progression. It acts as a fulcrum for he various movements of he upper
t

extremity.

manubrium

It

is

situated

of the

at the upper anterior part of the chest, between the

sternum and the acromion process

double curve with the convexity anterior

at

of the scapula.

It

has

the sternal extremity and the con-

PLATE

VII.

4
COMMON

CAROTID

INNOMINATE

A.

ARTERY
SUB- CLAVIAN VEIN AND

'

ANTERIOR

JUGOLCR-

4NTERN6L

JUGULAR,

EXTERNAL JUGULAR.

VENA AZYGOS TERTIUS.

INTERCOSTAL VEIN

INTERCOSTAL AJITEHT

VENA-AZYGOS MAJOR

VENA-AZTGOS MINOR.

Relative Position of Vwssles Above wi> Below the Diaphragm.

ANATOMY

IN A NUTSHELL.

cavity anterior at the acromial extremity.

other bone in the body and

when broken

producing temporary paralysis.

It

It is

37

more often broken than any

upon the Brachial Plexus

will press

has but one epiphysis, which

is

at

the

towards the acromial extrem(Rule 2, Lesson 1.)

The bone is divided into an inner two-thirds
ity
which is somewhat triangular on cross-section, and an outer one-third which
is more flattened from above downward; the coracoid process of the scapula is
under this division of the clavicle. (Plates X-XI.)
sternal extremity, hence the nutrient artery runs

Outer one-third.
of the Deltoid

The upper extremity of this portion has the

muscle

in front

attachment
and the Trapezius behind, with a small interval

between them. The under surface has first a conoid tubercle near the posterborder and internal boundary of this part of the bone. The conoid ligament passes from this tubercle to the coracoid process of the scapula, which is

ior

immediately under

it.

Second, the trapezoid, or oblique

line,

sometimes a

furrow, passes from the conoid process forward and outward and gives attach-

The conoid and trapezoid ligaments make

The anterior border is concave and gives attachment to the Deltoid; this border has a deltoid tubercle. The posterior
border is broader than the anterior one; it is convex and gives attachment to
ment

to the trapezoid ligament.

the coraco-clavicular ligament.

the Trapezius.

Inner two-thirds.

This part may be described as having three borders and

The

anterior border extends from the anterior border of the

three surfaces.

outer one-third to the inner extremity of the bone, separating the anterior and

The superior border extends from the upper part

inferior surfaces.
terior

of the pos-

border of the outer one- third to the inner extremity of the bone, separat-

um the anterior and posterior surfaces of the clavicle. The posterior border
extends from the conoid tubercle to the rhomboid impression, separating the
and inferior surfaces. The anterior surface gives attachment to the
major and the Sterno-cleido-mastoid muscles. The posterior surface gives attachment to the Sterno-hyoid and occasionally the Sterno-thyroid.
It has a nutrient foramen which is directed outward according
to
Rule 2,
Lesson ].
Sometimes there are two foramina, one of which may be mi the
inferior surface.
The inferior or subclavian surface has near its inner part the
rhomboid impression which gives attachment to the costo-clavicular or rhoThe subclavian groove
boid ligament; this impression is about as inch long.
occupies about the middle' one-third of the under surface of the clavicle and
posterior

Pectoralis

The

gives attachment to the Subclavius muscle.

lar,

with one angle above and two below;

it

sternal extremity

looks

inward,

is

triangu-

downward and

convex from above down and concave antero-posteriorily.

It articulates with the manubrium and its circumference is rough for the
attachment of the ligaments of this joint. The acromial extremity has an oval

little

forward.

articular facet

It

is

somewhat convex, which

articulate with the acromion;

the ligaments of this joint.

than the

left.

Those

of the

than those of the female.

its

The

is

directed

circumference

is

clavicle

is

righl

downward and forward

to

rough for the attachment of

longer, thicker, and rougher

male are longer, thicker, rougher ami more curved

ANATOMY

38

IN

NUTSHELL.

Ossification. Its ossification is from two centers, one for the diaphysis,
the sixth week, or may be as early as the thirtieth day. which is the first in the
body, and the other a1 the sternal extremity, about the eighteenth or twentieth year,

begins as

It
complete ossification taking place about the twenty-fifth year.
membranous bone, but the ossification later extends into the under

lying cartilage.

(Plate XII.)

Articulation.
of the

rib

first

It

articulates with the sternum, the cartilage

and the acromion process

The

of the scapula.

lar articulation is a reciprocal reception (saddle shaped-joint,)

and has

the diarthrodial class

all

the

movements except

sterno-olavicu-

which belongs

rotation.

to

The blood

supply of this joint

(1) the internal mammary from the subclavian. (2)
suprascapular from the thyroid axis. (3) superior thoracic from the first portion
of the axillary, and occasionally twigs from a muscular branch from the subi:

clavian which crosses the intersternal notch.

i~

the subclavian from the Brachial plexus

The nerve supply to this joint

and (2) the suprasternal from

The ligaments are the anterior sterno-clavicular ligament

attached to the upper and anterior part of the manubrium; from here
it passes to be attached to the upper and anterior part of the sternal extremity
The posterior sterno-clavicular ligament ha- a similar attachof the clavicle.
ment from the posterior surfaces of the same hones. These two make the cap-

the Cervical plexus.

which

is

The

sular ligament.
at

interarticular fibro-cartilage

is

thinner in the center than

the circumference and gives attachment to the sternal

above and the

firsl

costal cartilage at

junction with the

its

end

of the clavicle

manubrium below;

it
divides the synovial membrane, having one on each side.
The costo-clavicular or rhomboid ligament passes upward, backward and
outward from the sternal end of the cartilage of the first rib to the rhomboid
The inter-clavicular ligament is a flat cross-band
impression of the clavicle.
attached to the upper margin of the manubrium, connecting the upper parts

thus

of the inner end- of the clavicle.

The acromlo-clavicular

The

blood supply

is

(1)

articulation

is

anarthrodial joint.

(Plate XIII.)

the suprascapular from the thyroid axis. (2)theacromio-

and (3) posterior circumflex. The nerve supply is (1) circumfrom the posterior cord of the Brachial plexus, (2) suprascapular, from

thoracic
flex

Brachial plexus and (3) supra-acromial from the Cervical plexns.

The ligaments are the superior acromio-clavicular ligament, a quadrilateral band
which passes between ihe otiier end of the upper surface of the clavicle and the
upper surface of the acromion process. The inferior acromio-clavicular ligament covers the joint below, but is thinner than the superior one. These two

make

the capsular ligament.

present;

it

may

fill

the

The

interarticular fibro-cartilage

articulation,

then

there

are

is

two

not always

synovial

membrane-; more often it only occupies the upper part of the joint, then there
i> only one synovial membrane.
The trapezoid ligament is the anterior and
externa] part of the coraco-clavicular ligament and is attached above to the
oblique line of the under surface of ihe clavicle and below to the posterior half
upper surface of the coracoid process. The conoid ligament is the pos-

of the
terior

and internal pari

of ihe coraco-clavicular ligament

and

is

attached above

PLATE

39

IX.

ANATOMY

40

IX

NUTSHELL.

base to the conoid tubercle of the clavicle and a line running internally
for half an inch: below by its apex to the rough impression at the base of the

by

its

coracoid process.

Blood Supply.- The nutrient artery of the clavicle is from the supraThe acromial end receives a branch from the acromial thoracic
scapular.
artery and twigs from the arteries

in

the muscles attached to

LESSON

it.

VIII.

Muscles.
'The

the clavicle are six. viz., Sterno-cleido-mastoid. Sterno-

of

muscles

hyoid, Subclavius, Pectoralis major. Deltoid, Trapezius, and occasionally the

Sterno-thyroid.

Sterno-cleido-mastoid;

Description.

(Plate

(XIV.)

This muscle passes

and is enclosed between the two layers of

It is broad and thin at each extremity, hut is thicker
the deep cervical fascia.
mm.
narrower at the central portion. The portion which is attached to the
sternum is directed upward, backward and outward. This attachment is tenThe portion which is attached to the clavdinous in front and fleshy behind.
icle is directed almosl vertically upward and is composed of fleshy and aponeurotic fibers.
These two portions are separated at their origin, but become
gradually Mended below the middle of the neck into a thick, round muscle.
The attachment of this muscle to the clavicle may he as small as the sternal
attachment or it may extend to the attachment of the trapezius muscle at the

obliquely across the side of die neck

This muscle divides the quadrilateral space

outer portion of the clavicle.

the side of the neck into two triangles, an anterior

and

By two heads; first from the anterior

manubrium of the sternum; the second from

Origin.
of the

superior border ami anterior surface of the clavicle.

at

posterior.

surface of the upper part

the inner one-third of the

(Plate XI.)

Insertion.
Mastoid process of temporial bone and the outer two-thirds
or one half of the superior curved line of the occipital bone.

Action.

To depress and

Nerve Supply.

Spinal

of the cervical plexus (second

Blood Supply.

rotate head and elevate the thorax.

accessory

and

(eleventh cranial)

(third'.')

and deep branches

nerves.)

The superior sterno-mastoid artery from the

occipital

artery, the middle sterno-mastoid artery from the superior thyroid artery, the
inferior sterno-mastoid artery from the suprascapular artery, also branches
from the posterior auricular artery.

Sterno-hyoid.

and upper

Description.

pari of

the trachea,

The sterno-hyoid covers the thyroid gland

and

narrow muscle, its lower portion

This muscle comes in contact
course, and from there on lie side by side,

is

thin

being immediately beneath the Sterno-mastoid.

with

its

fellow

the middle of their

in

but they are separated below from each other by a considerable interval.

Origin,
Posterior surface of the manubrium of the sternum.
end of the clavicle and posterior sterno-clavicular ligament.
i

nal

(2)

ster-

ANATOMY

IX A XUTSUhLL.

Body of the hyoid bone.

To depress the hyoid bone.
Supply. Branches from Loop

Insertion.

Action.

Nerve

cervical plexus

and the twelfth

LI

XIX.)

communication

of

between

the

cranial nerve.

PLATE
TUBEROSITY FOR CONOID

(Plate

41

X.

POSTERIOR

GMT

STERNO-THYROiD.

STERNO HYOID.

SUBCLAVIU5

OBLIQUE VINE FOR

TRAPEZOID LICKT.
ARTIC.

WITH THE
SCAPULA.

pectoral1s major.

capsular lkvm-t

anterior.

Left Clavicle.

Ixferioh Surface.

Lingual, inferior and superior thyroid

Origin. Posterior surface of the

Blood Supply.
Sterno-thyroid.

(1)

sternum and the cartilage of the first

-ometimes from the clavicle.

rib,

arteries.

manubrium

of the

occasionally from the second rib and

_'

Insertion.

Oblique

line of ala of

thyroid cartilage.

Depressor of larynx.
Nerve Supply. Branches from
Action.

the loop of communication between the

and the twelfth cranial nerve.
Blood Supply. Lin qual, inferior and superior thyroid arteries.

cervical plexus

PLATE XL
-ANTERIOR.
PECTORALIS
MAJOF

acromial end

trapezius

posterior.Left Clavicle.

Superior Surface.

Description. (Plate

XV.)- This muscle is situated

P is trianupper and foreparl of the chest.
gular, being both broad and thick.
From it s origin the fibers nil pa-- towards
its insertion, giving it the shape of a fan.
tts tendon, which i- flat, is aboul
two inches in breadth. The tendon i> made of two layers placed one in front
of the other and usually blended together below.
The anterior layer which is
thicker receives the clavicular and upper half of the sternal portion of the musPectoralis major.

in

cle

front of the axilla, also on the

and

its fibers

are inserted

in

the

same order

a- that in

which they

arise.

The

ANATOMY

42

JX

NUTSHELL.

tendon receives the attachment of the lower half of the

These
the
pari of the muscle from the costal cartilages.
and
deeper
sternum
deep fibers, and particularly those of the lower costal cartilages ascend, the
higher turning backward successively behind the superficial and upper ones, so
rior layer of the

the anterior one

humerus than

the

The

the tendon appears to be twisted.

thai

and from

posterior layer reaches higher on

it

an expansion

is

given

off

that

covers the bicipital groove and blends with the capsule of the shoulder- joint.
An expansion is given off, which lines the bicipital groove, from the inseriton

An expansion passes downward to the fascia of the arm

from the lower part of tendon. This muscle is separated from the Deltoid by
slight interspaces in which lie the cephalic vein and the humeral branch of the
of the deeper fibers.

acromio-thoracic artery.

ORIGIN.

Its

border forms the anterior margin of the

The anterior surface

(1)

axilla.

of the sternal half of the clavicle.

Half the breadth of the anterior surface

of the

sternum

down

as far

as

(2)

the

attachment of the cartilages of the sixth and seventh ribs.

(3) Cartilages of
all the true ribs, excepting the first and seventh, or both, and aponeurosis of

abdomen. (Plate XI.)

The fibers which arise from the the clavicle pass obliquely
outward and downward: those from the lower part of the sternum and cartilages of the lower true ribs upward and outward, whilst the middle fibers pass
horizontally.
The tendon of termination is inserted into the outer bicipital
the External oblique of the

Insertion.

(Plate XXIII.)
Draws the arm forward and downward,

ridge of the humerus.

Action.
in

also elevated the ribs

forced inspiration.
\'i.i;\ e

Si ri ia

filaments from

--.

External and internal anterior thoracic. The nerves receive

spinal nerves entering into the format ion of the brachial plexus.

all

The costo-coracoid membrane

is

strong fascia situated in the interval

between the Pectoralis minor and Subclavius muscles and protects the axillary
It divides above to enclose the Subclavius muscle and its
els and nerves.
two layers are attached to the clavicle, one in front of and the other behind
the muscle.

The

latter

fascia of the axilla

the

the

r i

layer fuses with the deep clavicular fascia

vessels.

Internally,

two intercostal spaces and

firsl
<

r\

of the

is

Subclavius muscle.

it

and with

blends with the fascia covering

also attached to the first rib,

Externally

it

internal to

very thick and dense and

is

attached to the coracoid process.

This membrane is pierced by two arteries,
two nerves, and two veins. The superior and acromial thoracic arteries, the
external and internal anterior thoracic nerves, and the acromial ihoracic and
is

cephalic veins.

Blood

Supply.

Internal

mammary,

intercostals,

superior

thoracic,

acromial thoracic, am! long thoracic.

LESSON
(Plate XV).

Subclavius.
le

placed

from the

in
firsl

VIII.

Des< ription.- This

is

the interval between the clavicle ami the

rib

interior surface

i-

a small triangular
firsl

rib.

It

is

mus-

separated

by the subclavian vessels and brachial plexus of nerves.

Its
separated from the Pectoralis major by the costo-coracoid

membrane, which with

the clavicle, forms an osseo-fibrous sheath

in

which the

ANATOMY

IN A

NUTSHELL.

43

muscle is enclosed. The insertion of this muscle is larger than the origin.
Origin. By strong tendon from the first rib and its cartilage at their

junction in front of the rhomboid ligament.

Insertion.
(Plate

third.

Action.

Under surface of the clavicle

in a

deep groove about

its

middle

XL)

Depresses

downward and

shoulder by drawing the clavicle

for-

ward.

and sixth cervical.

Filaments from the
First intercostal and short thoracic

Nerve Supply.
Blood Supply.

fifth

arteries.

Deltoid. Description. (Plates XYIII-XIY-XY-XYI. i The Deltoid

It
a triangular muscle which gives the rounded outline to the shoulder.

PLATE
ANTERIOR

THE INTERARTICULAR

THE

is
i-

XII.
STERNO-CLAUCULAR LIGAMENT

FIBRO-CARTILAGE

BETWEEN THE STERNUM

JOINT

A\D SECOND COSTAL

CARTILAGE

Sterno-Claviculak Articulation.
surrounds the shoulder-joint

large

and

of

extent, covering

its

surface

is

thick.

It

it-

major by a
humeral branch of
its

border

i-

separated at

greater part of

a large

It-

its

sacculated syn-

its

texture.

Origin. (Plate.- XI-XX.> (1) Outer

surface of clavicle.

Lower

the

upper part from the Peccellular interspace which lodges the cephalic vein and the
This muscle i- remarkably
the acromial thoracic artery.

It- anterior

toralLs

(3)

in

outer >ide and in front and behind.

separated from the head of the humerus by

ovial bursa.

coarse in

on

it

(2)

of

and upper

acromion

proc<

border of -pine of scapula as far back as the trianThe part arising from the acromion process
the inner end.

lip of posterior

gular surface at

thiol of anterior border

Outer margin and upper surface

ANATOMY

44

IX A

NUTSHELL.

manner from the sides

number, which are attached above
id the acromion process and pass downward parallel t<> one another in the subThe portion of the muscle which arises from the clavicle
stance of the muscle.
consists of oblique fibers which arise in a bipenniform

of tendinous intersections, generally four in

and the -pine

from

of the scapula are no1

arranged

in this

manner, bu1 pass directly

heir origin to their insertion.

The fibers of this muscle converge to(Plate XXIII.)

Insertion.
wards their insertion, the middle passing vertically, the anterior obliquely
backward, and the posterior obliquely forward; they unite to form a thick ten-

PLATE

XIII

TRANSVERSE LIGAMENT

Acromio-Clavicular Articulation and Shoulder-Joint.

don which is inserted into a rough triangular prominence on the middle of the
outer side of the shafl of the humerus.
At its insertion is given oft' an expant<> the deep fascia of the arm.
nous intersections, generally three

sion

in

The oblique filters arising from the tendinumber, pass upward from the intersec-

muscle ami alternate with the descending septa.

To raise the arm ami helps to draw it forward ami backward.

tion of the

Action.
Xi.i;\

i.

Si ppli

Blood Supply.

Jircumfiex.

rPosterior circumflex

ami acromial thoracic

arteries.

ANATOMY

Trapeszius.

IX a NUTSHELL.

Description. (Plate

XVIII.)

45

This

is

a broad, Hat.

trian-

gular muscle, placed immediately beneath the skin and fascia, and covering
the upper and back part of the neck and shoulders.

It

is

fleshy in the

At its origin, from

its origin and insertion.
connected to the bones by means of broad semielliptical aponeurosis, which occupies the space between the sixth cervical and
the third dorsal vertebra, and tonus, with the aponeurosis of the opposite side,
a tendinous ellipse.
Origin.
(1) by thin fibrous lamina' from the external occipital protuberpart of its extent, but tendinous at

the spines of the vertebrae,

it

is

ance and the inner one-third or one-half of the superior curved line of the occipital bone. (2)from the ligamentum nuchas. (3)from spinous processes of the seventh

and

cervical

the dorsal vertebra

11

all

(4)

and from the corresponding portion

of

the supraspinous ligament.

Insertion (PlateXI-XX) Thesuperior fibers pass downward and outward and are inserted into the outer one- third of the posterior border of the clavicle
varing greatly in the extent of its attachment, sometimes advancing as far as
the middle of the clavicle, and may even become blended with the posterior
edge of the Sterno-mastoid oroverlapingit. The middle fibers pass horizontally
outward and are inserted into the inner margin of the acromion process and
superior

lip of

the posterior border or crest of the spine of the scapula.

inferior fibers pass

upward and outward, converging near

The

the scapula, and ter-

minate in a triangular aponeurosis which glides over a smooth surface at the

inner extremity ofthe spine, to be inserted into a tubercle at the outer part of
this

smooth

surface.

Action".

When

this

muscle acts as a whole

tates the lower angle of the scapula

outward.

it

lifts

The upper

the shoulder ami ro-

part raises the shoulder,

toward the spine, and the lower pan in pulling the

If the shoulder
tilts the acromion process upward.
girdle i> fixed, this muscle will draw the head backward.
Nerve Supply. Spina! accessory and third and fourth cervical.
Blood Supply. Princeps cervicis from occipital, superficial cervical ami
posterior scapular from transversalis colli.
the middle

scapula

part

draws

it

down and inward

LESSON
Scapula

(Spade.) (Plates XX-XXI.)

pari of the shoulder-girdle,

is

IX.

The scapula makes

the

posterior

situated on the upper posterior part of the

thorax, between the second lib above and the seventh or eighth ribs
articulating with the clavicle by

made up

its

acromion process

laterally.

'This

below,

bone

is

main pari of the bone i> triangular with

two angles above and one below; the one n< \t to the vertebral column is called
the superior angle; the one n< ar< s1 the clavicle is called the anterior or external
angle and articulates with the humerus; the one near the seventh or eighth rib
is the inferior angle.
Being a triangle it will have two surfaces and three borof several triangles;

ders, as well as three angles.

first,

the

The anterior surface or venter

where the upper one-fourth joins the lower three-fourths;

is

concave, deepest

this is to give

more room.

WATOMY

{li

Subscapulars muscle;

for the

this surface

this surface there arc several

On

JX A NUTSHELL.

also called the subscapular fossa-

is

oblique lines running from the vertebral bor-

der upward and outward, for the attachment of the fascia of the Subscapulars.
The vertebral asped of this surface gives attachment to the Serratus magnus,

which attachment is triangular above and below with a long narrow attachment between. The posterior surface, or dorsum, as a whole is convex. It is
separated into two parts by a second triangle, which is called the spine of the

above the spine is called the supraspinous fossa and is for

and the part below is the infraspinous fossa and is
'This spine separates the upper one-fourth from
I'm- the Infraspinatus muscle.
the lower three-fourth- opposite the deepest part of the subscapular fossa.
The superior border is the shortest and has a notch called the suprascapular
scapula.

The

part

the Supraspinatus muscle,

notch, which

i-

about

at

the junction of the external one-third with the in-

This notch transmits the suprascapular nerve and

ternal two-thirds.

The outer extremity

is

crossed

border
continued as the coracoid process which may be called a third triangle or
rather pyramid; it gives attachment to three muscles, the short head of the Biby the transverse ligament of the scapula.

of this

i-

ceps, Coraco-brachialis,

the longest and

The

and Pectoralis minor.

vertebral or posterior bor-

has three muscles attached to

it, the
minor
the
and
major.
The
axillary
and
Rhomboideus
Levator anguli scapulae,
border is the thickest of the three and would be the longest of the borders if

der

were continued

it

is

to

i.-

called,

the base;

it

meet the superior bonier.

It

has three muscles attached,

he Teres major and minor and the long head of the Triceps.

Then with the

axillary border continued to meet the superior border we have a triangle whose

base is the vertebral border, whose altitude is the superior border and whose
hypotenuse is the axillary border continued, and in this case would be the
There is a groove on the axillary border at the junction of the upper
longest.
one-third with the lower two-thirds, for the dorsalis scapulae artery, and an
The
oblique line separating the attachments of the Teres minor and major.
spine represented a- a triangle will have its base, the anterior border, attached
io the dorsum of the scapula from a point about one-fourth the distance from
the vertebral border to the glenoid fossa to within half an inch of the glenoid

between the spine and the glenoid fossa is the great scapular
fossa is the deficiency between the superior and axillary borders,
with which the head of the humerus articulates.
The altitude is the external

fossa; the portion

notch.

The glenoid

some author.- the base; the posterior border or crest reprehypontenuse of the triangle. The crest, posterior border, or hypotenuse is continued outward a- he acromion process of the scapula and is somewhat triangular.
Its upper lip gives attachment
for the Trapezius and the
lower lip to the Deltoid muscle.
This process articulates with the clavicle and
gives attachment for theligaments of that articulation, beside- to the coracoacromial ligament, between the spine of the scapula and the vertebral border
border, called by
the

is

it

smooth surface for the Trapezius to glide over.

The scapula ha- seven centers of
Ossification.

has nine center-.

the eighth

week

One

for the

body

of the scapula

of intrauterine life; the

one

ossification, occasionally

makes

its

appearance about
border and also

for the posterior

PLATE XIV
|

OCCIPITO FRONTALIS.

31-STERNO CLEIOO MASTOID.

35- STERNO

ORBICULARIS PALPEBRARUM.

32-STERNO HYOID

36- INF. CONSTRICTOR.

33-OMO HYOIO.

37-

3 - CORRUGATOR SUPERCIlll.
4- PYRAVUOALIS.

COMPRESSOR NAR1S.

COMPRESSOR NARIUM

7 -

34-THYRO HYOID.

SCALENUS MEDIUS.
SCALENUS POSTICUS
LEVATOR ANGULI SCAPUL/t.

MINOR.

SPLENIUS CAPITIS ET-COLLI.

DILATOR NARIS ANT.

41-TRAPEZIUS.

-DILATOR

42-APONEUROSIS

NARIS POST
9 -

10-

THYROID

43 -EXT. LATERAL

DEPRESSOR
ALA NAS

LI

44- HYOID BONE

4S-ZYG0MA.

LEVATOR

46 INF.MAXILARV.

LABIISUP.

47 CLAVICLE.

ALfcQUE
NASI.

48 PECTORALIS

MAJOR.

49 DELTOID.

II

LEVATOR
LABII-SUP.PROP.

12-LEVATOP ANGUL

I3-2YGOMAT1CUS MINOR.

I4-2YG0MATICUS MAJOR.
15

-ORBICULARIS ORIS.

1617

RISORIUS.

-BUCCINATOR.

18-MASSETER.
19-

LEVATOR LABII

20-

DEPRESSOR

INF.

LABII INF.

2I-0EPRESSOR ANCULI
22-

ORIS.

PLATYSMA-MYOIDES.

23-ATTRAHENS AUREM.
24-

ATTOLENS AUREM.

25-RETRAHENS AUREM
26- DIGASTRIC.
27-

STYLO HYOIO.

2S-MYL0-HY0ID.
29-HYO-GLOSSUS.
30- MID.

W*

CONSTRICTOR

Muscles ok Face

\i>

17

'I'.m

vngli

!'

ANATOMY

is

the one for the inferior angle

the scapula the 25th year.

NUTSHELL.

IX A

appear aboul the 15th year and join the body of

There are two for the acromion process which ap-

The corpear the l">tli year and join the body of the scapula the 20th year.
acoid process has two centers, the one a1 the base of the process appearsatthe
linh year and the other during the 1st year; they both join the body of the scapula the 25th year.

Articulation.

articulates with the clavicle, (a description of

It

which

is

This
given in Lesson Vll.) and with the humerus, making the shoulder-joint.
joint is a diarthro dial joint and belongs to the sub-class enarthrodial (ball-andPlate XIII.)

socket.)

Blood supply of the shoulder-joint

axis,

The

anterior circumflex,

('_)

is

(3)

suprascapular from the thyroid

circumflex, and (4)

posterior

subscapular.

three are from the third part of the axillary artery.

last

Nerve supply.

Suprascapular and

(1)

circumflex, both

(2)

are branches

plexus.

formthe Brachial

The true ligaments of the scapula are the transverse or suprawhich

passes o\cr the suprascapular notch separating the suprascapscapular
The coraco-acromial ligfrom
the suprascapular vessels above.
ular nerve
its
base
the
entire outer border of
attached
which
is
is
to
by
triangular,
ament,
Ligaments.

and by

the coracoid process,

The ligaments
loose and permits

apex to the

its

free

movements

tip of the

acromion process.

The capsular which

are (1)

of the shoulder- joint

of the joint.

It

is

is

ference of the glenoid cavity and to the anatomical neck of the humerus.

may have

very

attached to the circumThis

one for the long head of

is
he Biceps between the two tuberosities, another below the coracoid process,
partially filled by the tendon of the Subscapulars and a third (which is not
always present) for the tendon of the Infraspinatus muscle. These openings
thickesl above.

It

three openings

in

it.

communication between the synovial membranes

are for the

A bursa

the bursa' beneath the tendons.

The long head

pect

of the Biceps

the capsular ligament

of

is

are

portions of the capsular ligament,

the middle one

ligament, (b)
inferior

is

called

the

or accessory ligament,

is

a sac

On

ligament.

The upper one

'j

men

fossa
tin'

i- a

deeper

down

continuation of
;i

it

join.-

membrane

to the ureal

(3)

the long head of the Biceps.

the long head of the Triceps below.

circumference, but broad at

synovia!

attached to

is

it

above and

The transverse ligament passes over the

(4) The glenoid
the long head of the Biceps which makes the glenoid

tuberosity of the humerus below.

called Flood's

is

Schlemm and (e) the

(2) The coraco-humeral

also a part of the capsular ligament;

the outer border of the base of the coracoid process

bicipital groove, holding

ligaments, thickened

of these

the interna] brachial of

is

broad ligament of Schlemm.

is

and

the inner and anterior as-

three gleno-humeral
(a)

of the joint

or pouch.

its

base.

lines these joints

ami

It

is

is

It

is

narrow

fibro-cartilaginous

reflected through the

the capsule and oxer the long head of the Biceps in the groove.

rim.

opening

at

A
in

PLATE XV

MEDIAN

NERVE.

RACHIAL ARTERY

Mk

BSSIL.C

.;

BRACHIAUS AMICUS.

SUPINATOR LONGUS

External Oblique Muscle of Abdomen and Numerous other Structures.

19

ANATOMY

50

IN A

LESSON

NUTSHELL

X.

Mus< i.i.-. There are seventeen muscles attached to the scapula.

Three to the fossae
Three to the vertebral border-

Supraspinatus

Levator anguli scapulae;

Rhomboideus minor;

TWO

A(

in

the supraspinous

fossa-;

Infraspinatus

Ethomboideus major.
L'O

ROMION PRO< ESS

in the infraspinous

fossa;

Subscapularisin the subscapular

Trapezius;.

fossa.

Deltoid.

Three to the axillary

Long head

Three to the coracoid process

bori>eh

Short head of Biceps;

of the Triceps;

Teres minor:

Coraco-brachialis

Teres major.

Three irregularly arranged

Pectoralis minor.

Omo-hyoid, near transverse ligament;

Serratus magnus, on the vertebral aspect

of the venter;

Latissimus dorsi, on the interim' angle, dorsal aspect.

When all the muscles of the clavicle ami scapula are uiven. we have
muscles
ticus.

in

all

the upper extremity as far as the elbow, except the Brachialis

the
an-

(Plate XVI.)

Pectoralis minor.

Description. (Plate

angular muscle situated

at

XVI.)

This

a thin.

is

flat,

tri-

the upper part of the thorax beneath the Pectoralis

Its upper border is separated from the clavicle by a triangular interbroad internally, narrow externally, which is occupied by the costo-corIn this space is the first part of the axillary vessels ami
acoid membrane.

major.

val,

nerves.

Running

parallel to the lower

border of the muscle

is

the long thoracic

artery.

Origin. Upper margin ami outer surface of the third, fourth and
ribs

fifth

near cartilages, and aponeurosis covering the Intercostal muscles.

Insertion.

The

into the inner horde!'

fillers converge and form a flat tendon which is inserted

and upper surface of the coracoid process of the scapula.

(Plate XXI.)

To depress

Action.-

the point of the shoulder

and aids

in

forced inspira-

tion.

Nerve

Si

pply.

-Internal anterior thoracic, the filaments being

derived

from the eighth cervical and first dorsal nerves.

Blood Supply is from the internal mammary, intercostals, superior thoracic, acromial thoracic, and long thoracic.
Description.
Triceps.
hack of the arm. extending

humerus.

It

is

of large size

The-.- portions have been

(Plate

XVIII.)The

Triceps

is

situated at the

the entire length of the posterior surface of the

and divided above

named

(1)

into three parts, hence its

name.

the middle, scapular, or long head; (2)

PLATE XVI

OF

BICEPS ANO

COMCO

BRtCMIA

CUTANEOUS NERV.

^PRONATOR RAOM TERES

OMEN AND Numerous Other Structures

Internal Oblique Muscle of Abdome
51

ANATOMY

52

IN A NUTSHELL.

and

the external, or long humeral;

(3)

the internal, or short humeral head.

of the back
two aponeurotic lamina', one of which is subcutaneous and covers the posterior surface of the muscle for the lower half of
After
it- extenl
the other is more deeply seated in the substance of the muscle.
receiving the attachment of the muscular fibers they join together above the

The common

tendon of the

part of the muscle;

commences about the middle

Triceps

consists of

it

elbow, forming the tendon of Insertion.

small bursa

is

situated beneath the

tendon.

Origin.- The middle or long head arises from a rough triangular depresbelow the glenoid cavity, being blended at its upper

sion on the scapula, just

part

with the capsular ligament.

(Plate

XXI.)

from the posterior surface of the shaft of humerus,

between the insertion of the Teres minor and the upper pari of the musculospiral groove; also from the external border of the humerus and external in-

The external head

arises

termuscular septum.

The

(Plate

XXII.)

internal head arises from the posterior surface of shaft of

humerus,

below the groove for the musculo-spiral nerve, extending from the insertionof
the Teres major to within an inch of the trochlear surface; also from the internal
borderof the humerus andfrom the back of the whole length ofthe internal and
lower part of the external intermuscular septum.
Insertion.-

Upper end

XXII.)
band of fibers being

(Plate

of olecranon process of ulna, a

continued downward to blend with the deep fascia of forearm.

Action- Extensor of forearm.

Nerve Supply- Seventh and

Blood Si pply Brachial and

(Plate

XXIV.)

eighth cervical through musculo-spiral.

superior profunda.

(Plate XYIII.)
This is a broad, flat
Latissimus dorsi. Description.
muscle which rovers the lumbar and lower half of the dorsal regions and is

gradually contracted into a narrow fasciculus which passes upward across the
interior angle of the scapula,

belongs to the

first

and occasionally receives a few

The muscle then curves around the lower border

twisted upon

fibers

from

it.

It

layer of muscles in the back.

itself.

It

terminates

in a

of the Teres major,

and

is

short, quadrilateral tendon, about three

in length, which, as it passes in front of the tendon of the Teres major

becomes united with it. the surfaces of the two being separated by a bursa;
another bursa is sometimes interposed between the muscle and the inferior
At the insertion of this muscle an expansion is given off
angle of the scapula.
to the deep fascia of the arm.
There IS usually a fibrous slip which passes from
the lower border of the tendon of the Latissimus dorsi. near its insertion, to the

inches

long head of die Triceps.

This

tive of the Dorso-epitrochlearis

is

occasionally muscular and

is

the representa-

muscle of apes.

From the spinous processes of die six inferior dorsal vertebra?,

Origin.
and from the posterior layer of the lumbar fascia, by which it is attached to the
spines of die lumbar ami sacral vertebrae, and to the supraspinous ligament,
also from the external lip of the cresl of the ilium behind theorigin of the external oblique,

and bv

fleshy digitations

from the three or four lower

ribs,

which

PLATE XVI]
5TH CElWlCAL N
6TH
7TH

CERVICAL

N.

CERVICAL N

ACROM'AL THORACIC.

CORO.

ANT. CIRCUMFLEX.

-POST. CIRCUMFLEX.

SUPERIOR PROFUNDA.

DCPSALIS

DIGITAL BRANCHES.

Transversalis Muscle op Abdomen

53

\\i>

Numerous Otheb Structures

ANATOMY

54

NUTSHELL.

IN A

The

are interposed between similar processes of the External oblique muscle.

upper fibers pass longitudinally outward, the middle fibers obliquely upward,
and ihc lower fibers vertically upward, converging at the inferior angle of the
scapula.

Plate

XX.)
Into the

Insertion.-

bottom

insertion extending higherthan that

of the bicipital

its

(Plate XXIII.)

Pectoralis major.

of the

Draws the arm down and hack,

A' riON.-

groove of the humerus,

raises the lower ribs,

and draws

the trunk forward.

Nerve Supply.- Middle

Blood Supply.

or long subscapular.

Subscapular artery.

Description. (Plates XV-XVI1I.) This is a thin irregularly quadrilateral muscle situated between the ribs and scapula at the upper
and lateral part of the chest. It is partly covered in front by the Pectoral
The axillary vessels and nerves lie
muscles, behind by the Subscapulars.
Serratus magnus.

upon

its

upper part, while

its

deep surface rests upon the ribs and intercostal

muscles.

By nine

Origin.-

digitations or slips from the outer surface

border of the eight upper ribs (the second rib giving origin to two

and upper

and

slips,)

from the aponeurosis covering the corresponding intercostal muscles. The

fiber- pass backward closely applying the chest wall and the vertebral border of
The lower four slips interdigitate at their origin with the upper
the scapula.
External oblique muscle of the abdomen.
Insertion. The slips from the first and the higher of the two from the
second rib. converge to be inserted into the triangular area on the ventral

five slips of the

aspect of the superior angle of the scapula.

form

a thin

The next two

triangular -heath, the base of which

is

directed

slips

spread out to

backward and

is

in-

serted into nearly the whole length of the ventral aspect of the vertebral border

The lower slips converge as they pass backward from the ribs
and form a fan-shaped structure, the apex of which is inserted, partly by muscular and partly by tendinous fibers, into the triangular impression on the ven-

of the scapula.

tral

aspect
\<

of

tion.

Xi:i;\

i.

and seventh

the inferior angle.

pushing muscle.

SUPPLY.

(Plate

XXI.)

It also raises the point of the shoulder.

Posterior thoracic

which

is

derived from the

Blood Supply,

[ntercostals, long

and short thoracic

LESSON

XI.

jusl

fifth, sixth,

cervical nerves.

Levator angull scapulae.

Description. (1'late XVIII.) This muscle
beneath the Trapezius at the back part and side of the neck.

lies

Origin.
By tendinous -lips from the transverse process of the atlas, and
from the posterior tubercle- of the transverse processes of the second, third,

and fourth cervical vertebras. These slips become fleshy and unite so as to
form a flat muscle which passes downward and backward to its insertion.
Into the posterior border of the scapula between the superior
Insertion.


ANATOMY

IN A NUTSHELL.

55

angle and the triangular smooth surface at the root of the spine.

(Plate

To raise the superior angle of the scapula.

XeryeSupply. Third and fourth cervical, and frequently by a

XX.)

Action.

branch from

the nerve to the Rhomboidei.

Vertebral, ascending
minor. (Plate XVIII.)

Blood Supply.
posterior scapular.

Rhomboideus

cervical,

Origin.

spinous processes of the seventh cervical and

Insertion.

Smooth

To

Action.

first

superficial

and

cervical,

Ligamentum

nucha and
1

dorsal vertebrae.

surface at root of spine of scapula.

(Plate

XX.)

draw the scapula backward and upward.

Fifth cervical.
Posterior scapular.
major. (Plate XVIII.)

Nerve Supply.
Blood Supply.
Rhomboideus

Description.

This

muscle

is

situated immediately below the minor, the adjacent margins of the two being

occasionally united.

Spinous

Origin.

processes of

the four or five

upper dorsal

vertebrae

and the supra-spinous ligament.

Insertion. Into a narrow tendinous arch attached above to the lower
part of the triangular surface at the root of the spine, and below to the inferior
angle, the arch being connected to the border of the scapula by a thin mem-

brane.

When

the arch extends but

a short distance, as

the muscular fibers are inserted into the scapula

itself.

it

occasionally does,

(Plate

XX.)

To

draw scapula backward and upward.

Nerve Supply. The fifth cervical.

Action.

Posterior scapular.
Supraspinatus. Description. (Plates
Blood Supply.

XXYIII-XY111.)

The

supra-

whole of the supraspinous fossa. The fibers

converge to a tendon which pas>e> across the upper part of the capsular ligament of the shoulder joint.. to which it is intimately adherent.
two-thirds
of
Origin.
supraspinous fossa.
(1) Internal
(2) Strong

spinatus muscle occupies the

(Plate XX.)
Upper facet of greater tuberosity of humerus.
Raises arm and supports tuberosity of humerus.

fascia covering surface of fossa.

Insertion.
A< tion.

(Plate XXIII.)

Fifth and sixth cervical through the suprascapular nerve.

Suprascapular artery.
This
thick,
Infraspinatus. Description. (Plates XXVII1-XVIII.)
Xf.rve Supply.

Blood Supply.

is

triangular muscle which occupies the chief part of the infraspinous fossa.

The

converge to a tendon which glides over the external border of the spine
of the scapula and passes over the posterior part of he capsular ligamenl of the
fibers

shoulder-joint.

This tendon

is

occasionally separated from the -pine of the

scapula by a synovial bursa which communicates with the synovial cavity of

the shoulder-joint.

of infraspinous fossa;
tendinous
Origin.
(1) Internal two-thirds
(2)
from ridges on its surface; (3) strong fascia covering it externally ami

fibers

separating

it

from the Teres major and minor.

Insertion. Middle

(Plate \ \

facet of greater tuberosity of

humerus.

(Plate

XXII.)


ANAloMY

56

head

A.ction.- -Rotates

Nerve Slpply.

humerus outward.

Fifth and Sixth cervical through

Blood Supply.

The

subscapular

to the entire circu inference

brane attached

attachment by

the suprascapular nerve.

Suprascapular artery.

Description.

Subscapulars.

in--

of

NUTSHELL.

IX A

its

inner surface to

fascia

is

some

mem-

thin

of the fibers of the Subscapularis

The Subscapularis
a large triangular muscle which
terminates
in a tendon which is
muscle
The
scapular fossa.
muscle.

of the subscapular fossa, and afford-

is

fills

up the sub-

in close

contact

with the anterior part of the capsular Ligament of the shoulder-joint and glides

over

which separates

large bursa,

it

from the base of the coracoid process.

This bursa communicates with the cavity

capsular ligament.

It-

terior wall of the axilla,

by an aperature

of the joint

in the

anterior surface forms a considerable part of the pos-

and

its

lower border

is

contiguous with the Teres major

and Latissimus dorsi muscles.

From the inner two-thirds of the subscapular
Origin.
(Plate XXI.)
fossa, with the exception of a narrow margin along the posterior border, and the
surface- at the superior and inferior angles; also from the lower two-thirds of
the groove on the axillary border of the bone.
Some fibers arise from tendinous
lamina', which intersect the muscle, and are attached to ridges on the bone,
and others form an aponeurosis which separates the muscle from the Teres
major and the long head of the Triceps.
Lesser tuberosity of the humerus.
Insertion.
(Plate XXIII.)
Rotates head of humerus inward.
A.CTION.

Nerve Supply.

Upper and lower subscapular (first and third.)

Blood Supply. Subscapular artery.
Teres minor. (Plates XXVIII-XVIII.)
Description. This is a narrow,
elongated muscle lying between the Infraspinatus and Teres major, being separated from the latter anteriority by the long head of the Triceps.
Origin.Upper two-thirds of dorsal surface of axillary border of the
scapula and from the two aponeurotic laminae, one of which separates it from

the Infraspinatus, the other from the Teres major.

Insertion.- bower
low.

(Plate

facet

Rotates head of humerus outward.

Xi:i;\i.Si

pply.Fifth

cervical through the circumflex.

LESSON
Teres major.

somewhat

mus

in

dorsalis scapulae, circumflex arteries.

XII.

Description. (Plates XXVIII-XVIII.)This

a thick,

upward and outward and terminate

in a

Its

tendon about two

This tendon, at its insertion, lies behind that of the Latissifrom which it is separated by a synovial bursa, the two tendons,

length.

dorsi,

however, being united along their borders

and the brachial plexus of nerves

vessels

is

flattened muscle, lying immediately below the Teres minor.

fibers are directed

inches

XX.)

XXII.)

A.CTION.

Blood Supply. -Infrascapular from

but

(Plate

on greater tuberosity of humerus and bone be-

for a short
lie

upon

distance.

its

The

axillary

anterior surface.

Its

PLATE XVIII

;Tsf

SERRATUS

NTERNAL

GREAT SACROSCIATIC LIG

Muscles of Back -Superficial Layers

57

MAGNUS

OBLIQUE

ANATOMY

5S
lower border tonus,

boundary

terior

NUTSHELL.

conjunction with the Latissimus dorsi, part of the pos-

of the axilla.

From

Origin.

in

IN A

the oval surface on the dorsal aspect of the inferior angle

and from the fibrous septa interposed between it and the Teres
minor and Infraspinatus. (Plate XX.)
[nner bicipital ridge of humerus.
(Plate XXIII.)
Insertion,
Assists Lattissimus dorsi in drawing humerus downward and
A.CTION.

of the scapula,

backward.

Nerve Supply. Fifth and sixth cervical through

Blood Si pply. Subscapular artery.

the lower subscapular.

This is the smallest of the three musand is situated at the upper and inner part of
Its fibers pass downward, backward, and a little outward, and terthe arm.
minate in a Hat tendon. This muscle is perforated l>y the musculo-cutaneous
nerve and its inner border forms a guide to the position of the brachial artery
The brachial vessels and
in tying this vessel in the upper part of its course.
median nerve lie upon its anterior surface at its insertion. (Plate XVI.)
Apex of coracoid process in common with short head of Biceps.
Origin.

Description.

Coraco-brachialis.

cle- in the

(Plate

hum<

ant.

XX

ral

region,

1.)

INSERTION.Ridge on inner

humerus about

side of shaft of

its

middle,

(Plate XXIII.)
between the origins of the Triceps and Brachialis anticus.
Action. Draws the humerus forward and inward and assits in elevating

the same.

Nerve Supply.Seventh cervical through the Musculo-cutaneous.

Blood Supply. Brachial, muscular branches.
Biceps.
Description. (Plates III-XY-XYI.) The Biceps is a long

fusiform muscle, occupying the whole of the anterior surface of the arm,

divided above into two portions or heads, from which circumstance

ceived

its

muscular

may

name.
belly,

Each head
and the two

it

and

has re-

is succeeded by an elongated
although closely applied to each other,

tendinous but

is

bellies,

readily be separated until within

about three inches of the elbow-joint.

Here they end in a flattened tendon, a synovial bursa being interposed between
it
and the front of the tuberosity of the radius. As this tendon approaches the
radius
ternal.

become.- twisted

it

>pposite the

aponeurosis,

the

downward and

is

bend

bicipital

that

itself so

U]

of the

fascia

elbow

it

its

gives

anterior surface becomes ex-

from its inner side, a broad

which passes obliquely
of the forearm.
The Biceps
consist of two slips passing

off.

(semilunar fascia,)

continuous with the deep fascia

muscle occasionally has a third head which may

down, one in front of the other behind the brachial artery, concealing this vessel in the lower half of the arm.
The inner border of the Biceps froms a guide to the position of the artery
in

tying that vessel

in

the middle of the arm.

ORIGIN. (Plates XX-XXI.)

The long head arises from the upper marcontinuous with the glenoid ligament. The
tendon arches over the head of the humerus, being enclosed in a special sheath
of synovial membrane, passes through an opening in the capsular ligament and
gin of the glenoid cavity

and

is


ANATOMY
descends
tion

in the bicipital

from the tendon

The short head

groove,

in

IX A NUTSHELL.

which

it

is

59

retained by a fibrous prolonga-

of the Pectoralis major.

arises

from the apex

of the coracoid process in

common

with the Coraco-brachialis.

Insertion. Back of tuberosity of radius; fascia of forearm.

(Plate XXV.)

Flexes and supinates forearm, and tenses

Nerve Supply. Fifth and sixth cervical through the musculo-cutaneous.
Blood Supply. Brachial artery, muscular branches.
Omo-hyoid Description. This muscle passes from near the suprascapular
fascia.

Action.

notch of the scapula to the hyoid bone, thus dividing the anterior and posterior
(Plate XIV.)
triangles of the neck into two triangles each.
Origin. From the superior border of the scapula, internal to the supra-

scapular notch.

(Plate

XX.)

PLATE XIX.
MIDDLE

CONSTRICTOR

LESSER

OF

PHARYNX.

CORNU.

GREATER CORNU
\

f/

1/1

'If

HYO-GLOSSUS.

STYLO- HYOID.

THYRO-HYOID.
GENIO-HYOID

MYLO-HYOID
STERNO-HYOID.

The Hyoid Bone

Into the lower borderof the bgdy of hyoid bone. (Plate XIX.)
Blood Supply. Lingual and superior thyroid from the external carotid,
Insertion.

and the

inferior thyroid

from the thyroid

axis.

Depresses hyoid bone.

Nerve Supply. Branches from the loop
12th cranial nerve.
Blood Supply of Scapula. The glenoid
Action.

the

betweenthe

cervical plexus

and

supraspinous fossa, infraBpinous fossa and the spine all get the suprascapular artery from the thyroid
axis. The infraspinous fossa, in addition, receives the dorsails scapula? which is
he
a branch of the subscapular, from the third portion of the axillary.
fossa,

by branches from the arcomial thoracic artery. The

venter receives the subscapular, and a subscapular branch from the suprascapular;
andthe vertebral border receives the posterior scapularfrom the suprascapular.
acromion process

is supplied

ANATOMY

60

IN A NUTSHELL.

LESSON

XIII.

XXII-XXIII.) The humerus is the longest bone in

hs upper extremity conthe upper extremity, and is the only one in the arm.
lesser.
ami
The head is
a
two
greater
tuberosities,
i n head, neck ami
one
account
can
lift his arm
on
this
backward:
and
upward
directed inward,
to
the
when
angles
body; the
than
at
right
little
forward
higher when broughl a
below
is
the
head
called
the
contracted
pari
The
about
a hemisphere.
head iHumerus.-

(Plates

broken, while the part below the tuberosity is

is rarely
of it being the seat of fracture.
Between
on
neck
accounl
called the surgical
outer
aspect
of
the
the
bone,
the
on
greater
the
tuberosities,
two
neckare
the
which
for
long
head
the
of
bicipital
is
groove
the
the
from
lesser
by
separated

anatomical neck;

it

the Biceps.

The greater tuberosity has three

upper one for the Supraspin-

facets, the

atus muscle, the middle one tor the Infraspinatus muscle, and the lowerone for
The lesser tuberosity is in the form of a cone and has atthe Teres minor.

tached to
the

the Subscapulars.

it

menl
ment

the bone;

of tin'
is

its

bicipital

outer ridge

is

groove extends about one-fourth

also anterior

major: the inner ridge

of the Pectoralis

diaphysis

The

and is for the attachand is for the attachToo- major; the groove has the Latissimus dorsi attached. The
somewhat triangular on cross section and has three surfaces and

way down

posterior

is

three borders.

The anterior border extends from the front

of the great tuberosity to the

coronoid depression below, separating the external from the internal surface.-;

upper part is the external bicipital ridge for the insertion of the Pectoralis
major muscle; the lower part is covered by the Brachialis anticus. The external border extends from the posterior part of the great tuberosity to the excondyle, and separate- the external and posterior surfaces; its lower part
it-

From above downward it has attached the lower

minor on the posterior aspect, the middle or long humeral
head of the Tricep.- separated from the short head of the same by the musculospiral groove which transmits the musculo-spiral nerve and the superior profunda artery. The external supracondylar ridge has attached the external
intermuscular septum which gives attachment to five muscles, viz., Deltoid,
Brachialis anticus, Triceps, Supinator longus, and Extensor carpi radialis
The internal border extends from the inner part of the lesser tuberlongior.
i-

the supracondylar ridge.

pari of the Teres

osity to the internal condyle, separating the internal

From above downward

|{el<>\\

the Insertion

artery, which run-

3econd canal

it

of the Coraco-brachialis

towardi-

and posterior surfaces.

has the Teres major, and Coraco-brachialis.

is

the canal for the nutrient

the distal extremity of the

bone (Page

often presenl on the posterior surface;

its

19,

Lesson

artery comes

from the superior profunda. The internal intermuscular septum is attached to

the internal supracondylar ridge and has attached to it three muscles, viz.,
Tricep-. Brachialis anticus, Coraco-brachialis,

and occasionally

a fourth

mus-

Pronator radii teres. The external surface gives attachment to the Deltoid about two-fifth- or one-half the way down the hone, andbelow this to the
cle.

ANATOMY

IN A NUTSHELL.

The

external part of the Brachialis anticus.

to the Coraco-brachialis opposite the Deltoid,

61

internal surface gives attachment

and below

this to the

internal

part of the Brachialis anticus.

The

posterior surface has the

culo-spiral groove separating

two lower heads

The lower

them.

and the mushone articulates

of the Triceps

part

of the

with the radius and ulna: the part which articulates with the radius is called
is on a higher level than the part which artic-

the radial head or capitellum and

ulates with the ulna

which

ing surfaces are separated

is

by

These two articula-

called the trochlear surface.

a ridge.

Above

the radial head on the external

the radial depression for the head of the radius to

fit into when the

above the trochlear surface on the internal surface is the
coronoid depression for the coronoid process of the ulna; above the trochlear
surface on the posterior surface is the olecranon depression for the olecranon

surface

is

forearm

is

flexed;

process of the ulna.

The
a

internal condyle

lower level.

It gives

is more prominent than the external one. and is on

attachment to the Pronator radii teres, the common

tendon for some of the flexors of the forearm, and the internal lateral ligament.
The external condyle is less prominent than the internal one and gives attachment to the common tendon for the attachment of some of the extensors of the
forearm as well as the Supinator longus and external lateral ligament.
Ossification. The ossification is from seven centers, occasionally eight.
One for the shaft appears about the eighth week of intrauterine life. The one

head the first year, one for the great tuberosity the third year; occasionone for the lesser tuberosity. These three coalesce at the 17th year and join
the shaft about the 20th year.
At the distal extremity there are four centers
for the
al]}'

of ossification;

one for the capitellum appears at the 3rd year; one for the
one for the trochlear at the 10th year; one

in-

ternal condyle at the 5th year;

for

the external condyle at the 14th year.

The nucleus
i

lie

of the internal condyle joins the shaft in the 18th year, while

other three nuclei coalesce and join the shaft the 17th year.

Articulation.

It

articulates with the scapula, radius,

ulation with the scapula

given

Lesson IX; and

in

makes
its

the

shoulder-joint,

articulation

with the

and ulna.

Its artic-

description of

radius and ulna

which

makes

is

the

elbow-joint.

Elbow-joint. (Plates XXXVIII-XXXIX.)This is a movable joint (diaand belongs to the sub-class ginglymus (hinge-joint.) The part between the trochlear surface of the humerus and ihe greal sigmoid cavity of the
throsis)

ulna is a ginglymus joint, but the part between the capitellum of the humerus
and the head of ihe radius is an arthrodial join! (gliding.)
The pari between
the lesser cavity of the ulna ami the head of ihe radius

is

a trochoides.

The

continuous with the internal and external lateral ligaments

covering the joint in froni and being itself covered by the Brachialis amicus;

anterior ligament

is

attached to the humerus above the coronoid and radial fossae and
it
is attached to the anterior surface of
the coronoid process of the ulna and the orbicular ligamenl and the neck of the
above,

in front

radius.

it

is

of the internal condyle; below,

ANATOMY

62

The

internal lateral ligament

ligaments;

is

it

is

NUTSHELL.

IX A

continuous with the anterior and posterior

triangular in shape, with the apex above, attached to the in-

humerus; the anterior angle below is attached to the inner

Its posterior angle below is attached to the inner
There are filters running from the apex to eaeh
the olecranon process.

ternal condyle of the

edge

<>t'

edge of

the coronoid process.

The Flexor

inferior angle, also fibers connecting the inferior angles.

digitorum

is

sublimits

attached to this ligament.

is

The posterior ligament is continuous with the two lateral ligaments; it

attached above to the margin of the olecranon fossa and below to the ole-

cranon process ami orbicular ligament.

The external lateral ligament is attached above to the depression below the
external condyle of the humerus; below, it is attached to the orbicular liga-

ment, head of the radius and the outer side of the ulna: there are two muscles
attached to this ligament, the Extensor carpi radialis brevior and Supinator

These four ligaments make

brevis.

brane

lines that portion of the

capsular ligament.

ligaments and bones which

Synovial

make

mem-

the joint and

sends a part into the superior radio-ulnar articulation.

The ligamentous muscles

chials anticus and

of the elbow-joint are the Biceps, Triceps. Bra-

the muscles in the forearm except, the Flexor profundus

all

digitorum, Flexor longus

Pronator quadratus and Extensor ossis met-

pollicis.

acarpi pollicis. Extensor brevis pollicis. Extensor longus pollicis

and Extensor

indicis.

supply.Musculo-spiral,

Nerve

musculo-cutaneous,

median

and

ulnar

nerve-.

Blood supply.

Anterior

recurrent,

interosseous

and posterior ulnar recurrent,

radial recurrent.

anastomatica magna, superior profunda and inferior

profunda.

LESSON XIV.
ARTERIES.
Axillary artery.

the
it

firsl

rib,

The subclavian artery passes under the

from the lower surface

of

which

it

is

clavicle

and over

called the Axillary artery until

leaves the axillary space at the lower border of the tendon of the Teres major,

then
alis

name

take.- the

it

This artery

Brachial artery.

minor muscle which divides the artery

called

below

the
it

is

firsl

pari, the part

behind

called the third part (Plate

it

is

is

crossed by the Pector-

above it is
ami the part

into three (tarts; the pari

called the second part

XVI.)

This artery has seven branches, (Plate XVII) two from the

Branches.

portion, the superior thoracic and the acromial thoracic;

two from the secami the long thoracic or external mammary, and
three from the third portion, the subscapular, anterior circumflex, and posterfirst

ond portion, the

alar thoracic

ior circumflex.

The superior
artery that

it

is

thoracic arises so close to the upper border of the axillary

sometimes given

from the acromial thoracic

axis.

as a
It

i>

branch of the subclavian. It may come

between the Pectoralis major and minor.

ANATOMY

IN A NUTSHELL.

63

along the upper border of the latter, supplying both these muscles, the Serratus magnus and the chest wall.
It anastomoses with the internal mammary,
intercostal arteries

and the long

thoracic.

It

helps to supply the sterno-clav-

icnlar joint.

The acromial thoracic

arises just

above the Pectoralis minor from the front

PLATE XX
CORACO-ACROMIAl LIG'T.
0M0-HY0 D AND TRANSVERSE

SUP. ANGLE.

LIGAMENT.(O)

LEVATOR ANGUU
SCAPULAE. (I)
SUPRASPINATUS(O).

NECK
NOTCH
GLENOID FOSSA AND HEAD

CAPSULAR LIGAMENT.

GROOVE FOR DORSAL

ARTERY OF THE SCAPULA.

TERES MINOR.(O)

RHOMBOIDEUS
MAJOR.(I).

TERES MAJOR.(O)

lattissimus dorsi.(o)

^^t^j^'

inf.

angle.

The Left Scapula Posterior Surface, or Dorsum

pari of the artery.

It

or descending branch

has an axis and gives off three branches.

(1) humeral
which passes down bet ween the Pectoralis major and

Deltoid with the cephalic vein, supplying both these muscles; it anastomoses
with the anterior and posterior circumflex arteries.
(2) the acromial branch
which supplies the Deltoid muscle and the acromio-clavicular joint, anastom-

osing with

the anterior and

posterior circumflex and suprascapular arteries

ANATOMY

1.1

making

the acromial rete.

IX A

NUTSHELL.

we substitute

rete or net-work of arterhave the blood supply to the

shoulder-joint. (3) The thoracic branches supply the Pectoral muscles and the
Serratus magnus, and anastomoses with the intercostal arteries both from the
aorta and the internal mammary.
There are two or three of these branches.
\ clavicular branch may pass to the Subclavius muscle.
[f

thisbranch for the subscapular artery we

ies,

in this

will

PLATE XX]
CONOID

LIG'T.

TRAPEZOID LIGT

BICEPS AND CORACOBRACHIALIS

RIOCES

SERRATUS
MAGNUS.

Tin

The

I.i

alar thoracic

of the axillary space.

of

Si

is

V>

\n

no1

hen

Anterior Surface, or Venter

i.\

a
ii

constanl branch;
is

absenl

its

ii

place

supplies the glands and half

is

filled

by

branch from

on.'

the other thoracic arteries.

The anterior

or ion- thoracic, oi external

border of the Pectoralis minor muscle

plying the Pectoral and Serratus

h anastomoses with the

to

mammary passes along the lower

about the sixth intercostal space, sup-

magnus muscles, and

intercostal, internal

the

mammary, and

mammary

gland.

superior thoracic

ANATOMY
There

arteries.

is

IN A NUTSHELL.

often an accessory external

65

mammary

which

is

behind the

main branch.
anterior circumflex arises from the outer side of the axillary artery,

The

passing between the Coraco-brachialis and the short head of the Biceps around

humerus to the under surf ace of the Deltoid, which

from
this artery passes up the bicipital groove, with the
branch
A
it supplies.
to
supply
Biceps,
the shoulder-joint;,
of
[ts anastomoses with the
longhead
the
cut mucous branch
occasional
acromial
thoracic.
An
and
circumflex
posterior
the anatomical neck of the

is

often given to the floor of the axilla.

comes from the posterior part of the artery, below

through
the quadrilateral space which is bounded
the subscapular.
minor,
below
the
Teres major, on the inner side by the
Teres
by
above by the
long head of the Triceps and on the other side by the humerus; its veins and

The

posterior circumflex
It passes

the circumflex nerve go with

it.

It

anastomoses with the anterior circumflex,

subscapular, suprascapular, acromial thoracic, and a branch from the superior

profunda.
or

toid, long

maybe a branch from the brachial,

common trunk with the subscapular.

This artery

may come from

head

of the Triceps,

superior profunda,
It

goes to the Del-

Teres minor, shoulder-joint and head of the

humerus.

The subscapular

artery runs along the lower border of the Subscapularis

muscle with the subscapular nerve to the inferior angle of the scapula, where

it

anastomoses with the posterior scapular and a terminal branch of the transversalis colli; it also anatomoses with the intercostal and long thoracic arteries.
It gives branches to the glands and areolar tissue of the axilla, to the
Teres major, Latissimus dorsi. Subscapular which passes through the triangular space bounded above and internally by the Subscapularis, below by the
Teres major, and externally by the long head of the Triceps.
with the suprascapular and posterior scapular arteries.

It

It

anastomoses

gives branches to

the Subscapularis and Infraspinatus muscles.

First Portion of Axillary Artery.

Pectoralis major, Costo-coracoid

Relations.
In Front.

(1)

(2)

membrane,

(3)

Ex-

ternal anterior thoracic nerve, (4) Acromio-thoracic vein, (5) Cephalic vein.

Behind. (1) First intercostal space, (2)

Second and third serrations of Serratus magnus.
and (5) Internal anterior thoracic nerve.

Outer

Brachial

Side.

First
(4)

intercostal

muscle,

(3)

Posterior thoracic nerve,

plexus.

[nnee Side. Axillary vein.

Second Portion of Axillary Artery.
Ix Front.
(1) Pectoralis major. (2) Pectoralis minor.
BEHIND. (1) Subscapularis, (2) Posterior cord of plexus.
Outer Side. Outer cord of plexus.
Ixwkk Side. (1) Axillary vein, (2) Inner cord of plexus, and

(3)

Inter-

nal anterior thoracic nerve.

Third Portion of Axillary Artery.

Ix Front.
(1) Integument and

head of median nerve, and

(4)

fascia.

(2)

Pectoralis

Internal cutaneous nerve.

major,

(">")

Inner

ANATOMY IN A NUTSHELL

66

Behind.

Subscapular^,

(1)

(2)

Tendon
and

of Teres major, (4; Musculo-spiral nerve,

Side. (1)

Outer

Coraco-brachialis,

of Latissimus dorsi, (3)

(5)

(2)

Tendon

Circumflex nerve.

Median

nerve.

Musculo-

(3)

cutaneous nerve.

Inner Side. (1) Tina nerve.

(3)

(2)

Lesser internal cutaneous nerve, and

Axillary veins.

LESSON XV.
Brachial artery.

Plato

XYI-XYII.)

The

brachial artery extend- from

the lower border of the Teres major, above which it is called Axillary, to about
one and a half inches below the elbow where it divides into the Radial and
Ulnar.

It

passes along the inner and fore part of the arm. being

by venae comites and

is

comparatively superficial.

It

accompanied

has the following rela-

tions:

Front.

1\

basilic vein,

(1)

(4)

Integument and fascia. (2) Bicipital fascia. (3) Median

Median nerve, and (5) Overlapped by Coraco-brachialis and

Biceps.

Behind.

(1)

Triceps,

(2)

Musculo-spiral

nerve.

(3)

Superior profunda

and (5) Brachialis anticus.

Vena comes. (2) Median nerve (above),

artery, (4) Coraco-brachialis (insertion),

Outer
brachial'^,

Side.

and

(4)

(1)

(3)

Coraco-

Biceps.

[nner Side. (1) Vena come-. (2) Internal cutaneous nerve.

b Median nerve (below), and (5) Basilic vein (upper half).
nerve,

(3)

Ulnar

branches are the superior profunda, inferior profunda, nutrient, musanastomotica magna, and occasionally the vasa aberrantia.
The superior profunda, the largest branch, arises from the inner and back
[ts

cular,

pari of the artery opposite the lower border of the Teres major.
It winds backward and outward with the musculo-spiral nerve in the musculo-spiral groove.
It gives off an anterior branch which pierces the external intermuscular septum
to anastomose with the radial recurrent.
It
continues behind the external
intermuscular septum with a branch of the musculo-spiral nerve to the Anconeus, where it anastomoses with the anastomotica magna and interosseous recurrent.
It
supplies the Triceps and Anconeus.
The anterior branch which
it gives off passes to the front of the elbow in the groove between the Supinator
longus ami the Brachialis amicus to the front of the external condyle.
It gives
branches to the Deltoid, Brachialis anticus, and Triceps, and a branch to anastomose with the circumflex artery. The artery continues as the posterior

branch.

The inferior profunda may come from the superior profunda, but generally
comes from the brachial opposite the insertion of the Coraco-brachialis. It
accompanies the ulnar nerve to the back of the internal condyle, having pierced
the internal intermuscular septum from before backward. It anastomoses with
tin- anastomotica magna ami posterior ulnar recurrent.
lt> anterior branch
extends to the front of the internal condyle to anastomose with the anastomotica magna and anterior ulnar recurrent.

PLATE XXII.

CAPSULAR LIGAMENT

INFRASPINATUS

(I).

.HEAO.

TERES MINOR

(I)

(RICEPS (EXT. HEAO)

(0)

MUSCULO-SPIRAL GROOVE

TRICEPS

(INT. HEAD).(OJ.

CAPSULAR LIGAMENT.

OLECRANON FOSSA.

ANCONEUS

-FLEXOR CARPI ULNARIS

(0).

EXTERNAL CONDYLE.
EXT.

INT.

LATERAL LIGAMENT

CONDYLE.

GROOVE FOR ULNAR NERVE.

The Left Bumerus Posterior

67

uw

(0)

PLATE

XXIII.

SUPRASPINOUS

HEAD.

SUBSCAPULAR

(I).

GREATER TUBEROSITY.

(I)

TRANSVERSE HUMERAL LIGAMENT.

CAPSULAR LIGAMENT
LESSER TUBEROSITY.*!.)

LATISSIMUSDORSI
BICIPITAL UI.OOVE.

TERES MAJOR

PECTORALIS MAJOR

(I)

(I).

ROUGH SURFACE FOR DELTOID.

CORACOBRACHIAL^

IBRACHIALIS ANTICUS

(I)

(I)

NUTRIENT FORAMEN

SUPINATOR LONGUS.

(0).

CONDYLAR RIOGE

EXT.

fSUPRACONDYLOID PROC

EXTENSOR CARPI RADIALIS LONGIOR

(0)

CORONOiD rossA
PRONATOR

TERES

RADII

FLEXOR CARPI RADIALIS

PALMARIS LONGUS

INT.

(0).

EXTENSOR COMMUNIS DIGITORUM

(0)

LEXOR CARPI UNARIS

INT.

EXTtNSOR CARPI RADIALIS BREVIOR

(0)

FLEXOR SUBLIMIS DIGITORUM

r

RADIAL DEPRFSSION

(0).

EXTENSOR MINIMI

(0)

EXTENSOR CARPI ULNARIS

(01

SUPINATOR 8REVIS

CONDYLE.

EXTERNAL CONDYLE.

LATERAL LIGAMENT

EXT. LAItHAL LIGAMENT.

CAPSULAR LIGAMENT

The

OlGlTI (0).

Left Hi merus
68

Anterior View

(0)

(0).

(U)


ANATOMY

IN A NUTSHELL.

69

The nutrient artery comes from the brachial about the middle of the forearm; it pierces the tendon of the Coraco-brachialis to enter the nutrient canal
which is below the insertion of the Coraco-brachialis; It is directed towards
A branch from the musculo-cutaneous
the elbow (page 19. Lesson 1.)
The artery may be a branch of the
nerve enters the bone with this artery.
superior profunda.

The muscular branches are three or four in number and arise from the outer
and supply the Bicep-. Coraco-brachialis, and Brachialis
amicus. The same muscles are supplied by the musculo-cutaneous nerve.
The anastomotica magna arises two inches above the elbow-joint, passing
>ide of the artery

inward over the Brachialis anticus to pierce the internal intermuscular septum
to pass to the back of the internal and external condyles.
It anastomoses in
front of the internal condyle with a branch from the inferior profunda and anIt anastomoses behind the internal condyle with the
terior ulnar recurrent.
sterior branch of the inferior profunda and the posterior ulnar recurrent.
It anastomoses behind the external condyle with the posterior branch of the
superior profunda and the interosseous recurrent.

The vasa aberrantia

are collateral branches

which connect the brachial

or axillary artery with the arteries of the forearm, generally with the radial.

Forearm.

There are twenty muscles

in the forearm, eight in the anterior

(radio-ulnar) region arranged in four layers: in the

I

Plate

XXIX) The Pronator

and Flexor carpi

first

layer there are four

radii teres. Flexor carpi radialis, Palmaris longus,

The

three of these are supplied by the median

and inner cords of the brachial plexus. The
Flexor carpi ulnaris is supplied by the ulnar nerve, which comes from the inner
cord.
(Plate VI.)
In the second layer there is one muscle, the Flexor sublimis
digitorum.
(Plate XXX.)
It is supplied by the median nerve. In the third
layer there are two muscles. (Plate XXXI.) Flexor longus pollicis and the Flexor
profundus digitorum. The first is supplied by the anterior interosseous,, which
is a branch of the median; the second one by the anterior interosseous and the
ulnar.
In the fourth layer there is one muscle, the Pronator quadratus, which
is supplied by the anterior interosseous nerve.
ulnaris.

first

nerve, which conies from the outer

In the radial region there are threemuscles (Plate XXXII) Brachio-radialis

(Supinator longus,) Extensor carpi radialis longior, and the Extensor carpi
radialis brevior.
The first two are supplied by the musculo-spiral nerve: the
last

one by theposterior interosseous aervewhich Lsa branch of the musculo-

spiral

nerve.

In the posterior radio-ulnar region there are nine muscles,

four in the superficial layer andfive

Plate

XXXII,)

Thefour in the superficial

layer are the Extensor communis digitorum, Extensor minimi digiti, Extensor
carpi ulnaris, and Anconeus.
The fust three are supplied by the posterior interosseous nerve; theAnconeus by the musculo-spiral nerve.
(Plate XXXIII).
The five muscles in the deep layer are the Supinator brevis, Extensor ossis metacarpi pollicis. Extensor brevis pollicis. Extensor longus pollicis, and the Extensor indicis; they are all supplied by the posterior interosseous nerve.
The bones of the forearm are the radius and ulna: the radius has nine musin

the deep layer.

PLATE XXIV

GROOVES FOR

1ST.-

EXTENSOR OSSIS METACARPI POLLICIS AND EXTENSOR PRIMI INTERNODII POLLICIS.

2ND. -EXTENSOR CARPI RADIALIS LONGIOR AND BREVIOR.
3RD.

EXTENSOR SECUNDI INTERNODII POLLICIS

4TH.-EXTENS0R COMMUNIS DIGITORUM AND EXTENSOR

5TH.-EXTENS0R MINIMI

INDICIS.

DIGITI.

6 TH.- EXTENSOR CARPI ULNARIS.

POSTERIOR RADIO-ULNAR LIGAMENT

IAL

POSTERIOR

LATERAL LIGAMENT

RADIO-CARPAL LIGAMENT.

SUPINATOR BREVIS

BICEPS

LOWER

TRICEPS

(I).

LIMIT OF ORBICULAR LIGAMENT;

(I)

CAPSULAR LIGAMENT.

I.i

ii

Radius and

Ulna Posterior
70

(I).

View.

PLATE XXV.

INTER- ARTieULAft-FIBHO-CARTIUCE.

ANTERIOR RADIO-CARPAL LIGAMENT.

IlXT. LATERAL LIGAMENT

LATERAL LIGAMENT

INT

SUPINATOR LONGUS.lll

PRONATOR QUAORATUS

ANT. RADIO-ULNAR LIGAMEN

PRONATOR QUADRATUS. 'O

(I).

FLEXOR LONGUS POLLICIS.(O),

INTEROSSEOUS MEMBRANl.

RADIUS

PRONAIOR

RADII TERES/1)

FLEXOR PROFUNDUS DIGITORUM.iO

FLEXOR SUBLIMISDIGITORUM.

(0

NUTRIENT FORAMEN.

OBLIQUE LINE.

OBLIQUE LIGAMENT
SUPINATOR

FLEXOR LONGUS POLLlClS(O)

BICIPITAL

TUBERCLE

BICEPS. (I)""

LOWER

LIMIT OF ORBICULAR LIGAMENT

(ACCESSORY HEAD).

BRACHIALIS ANTICUS.

NECK OF RADIUS

PRONATOR

RADII

TERESILESSER HEAD)(0)

HEAD OF RADIUS

TUBERCLE FOR FLEXOR SUBLIMIS

DIGITORUM.

GREATER SIGMOID FOSSA.

INT.

LATERAL LIGAMENT

CAPSULAR LIGAMENT

Left Radius and

UlnaAnterior
71

View.

ANATOMY

72

A NUTSHELL.

IN"

and the ulna fourteen. Although there are twenty-three

two bones, yet there are but twenty muscles in the
forearm, the Triceps, Biceps, and Brachialis anticus are in the arm (between
The elbow-joint isdescribed in Lesson XIII.
the shoulder and elbow.)
attached

cles

to

it

to these

muscles attached

LESSON XVI.
The Radius (Plates XX IV-XXV)

is theshorterof thetwo bones of the foreextremity is larger than that of the ulna, while its proximal extremity is smaller than that of the ulna. Thesetwo boneslie parallel. The proximal
extremity has a head, neck, and tuberosity; the circumference of the head is
tts inner portion which articulates with the lesser sigmoid cavity of
concave,

arm.

Its distal

the ulna
lar

is

broader than the remaining portion which articulates in the orbicu-

Ligament.

tion of the

The upper surface

of the

head

is

also

capatellum or radial head of the humerus;

concave for the articulait is covered with cartil-

in the recent state.

The neck is the constricted part below the head; the
proximal part of the neck is surrounded by the distal part of the orbicular lig-

age

ament and

distally

it

The

gives attachment to the Supinator brevis externally.

from the neck at the antero-internal aspect of the

bone.
It has a rough posterior portion for the insertion of the tendon of the
Biceps, and a smooth anterior portion for a bursa which is between the tendon
and the bone. The shaft is triangular on cross section and has three borders
and three surfaces. The anterior border extends from the bicipital tuberosity
bicipital tuberosity

is

distally

distally to the outer aspect of the bone,

loid

process.

The proximal one-third

border

is

the oblique line of the

separates the Supinator brevis from the Flexor longus pollicis,

radius;

it

gives

tachmenl

a1

then to the anterior border of the sty-

of this

to the third

head

of the

Flexor sublimis digitorum

it

and

separates

The inner or interosseous borextends from the posterior pail of the bicipital tuberosity proximally to
the sigmoid cavity of the radius; its distal part divides into an anterior and
the anterior surface from theexternal surface.

der,

posterior portion and has the interosseous

extent;

it

separates

border which

is

well

the anterior from

marked

in

membrane attached

the posterior surface.

the middle one-third, extends

to

most

The

of its

posterior

from the back

pari of the neck of the radius to the

middle tubercle on the posterior aspect of

the distal extremity; it separates the posterior from the external surface.
The
anterior surface is concave at the proximal extremity and smooth at the distal
extremity.

The proximal three-fourth gives attachment to the Flexor longus pollicis,

and the distal one-fourth to the Pronator quadratus. Where the proximal onethird joins the middle one-third, is the nutrient foramen which is directed towards the elbow. The nutrient artery is a branch of the anterior interosseous.
'I'h.
posterior surface is convex from the proximal to the distal extremity; it
is covered by the Supinator brevis. Extensor ossis
metacarpi pollicis, Extensor
brevis pollicis. and the distal one-third is covered by tendons. The oblique line
marks the proximal limit of the Extensor ossis metacarpi pollicis. The exter-

ANATOMY
nal surface

is

IN A NUTSHELL.

convex from the proximal

73

to the distal extremity;

it

has attached

the Supinator brevis, and about the center the Pronator radii teres, and
distally it is covered by the Extensor carpi radialis longior and Extensor carpi

to

it

radialis brevior

which are crossed by the Extensor

Extensor brevis pollicis.

The lower extremity

is

quadilateral.

articulates with the scaphoid

ossis

metacarpi

pollicis

and

The lower surface which is concave,

The part which articulates with

and semilunar.

PLATE XXVI
EXTENSOR COMMUNIS DIGITORUM

(I)

(I)

EXTENSOR

INOICIS.

EXTENSOR
MINIMI DIGITI

(I),

EXTENSOR
SECUNDI INTFRNODII
POLLICIS.

il)

EXTENSOR

PRIMI INTERNOOII
POLLICIS.

EXTENSOR
CARPI UL:.ARIS.

(I)

r\

1ST METACARPUS.

EXTENSOR CARPI
RADIALIS LONGIOR
AND BREVIOR.
PISIFROM

Bones of Left
the scaphoid

is

Hand Posterior View

triangular, while that which articulates with the

quadrilateral. These part- are separated by a ridge.

semilunar

is

The inner surface is concave

and articulates with the head of the ulna. The interarticular fibro-cartilage
attached to the border between the sigmoid cavity and the semilunar sur-

is

faces.

The perimeter

is

triangular,

having an anterior, external, and posterior

ANATOMY

74

IN A

NUTSHELL.

The anterior surface gives attachment to the anterior ligament of

process to
is prolonged downward making the styloid
the base of which is attached the Supinator longus and to the apex externally
This process has a groove passing distally and forward for
the lateral ligament.
the Extensor ossis metacarpi pollicis and Extensor brevis pollicis. The posterior surface gives attachment to the posterior ligament and has three grooves*
which are lir>t. for the Extensor carpi radialis lorigior and brevior, the second
for the Extensor longus pollicis. and the third for the Extensor communis
surfaces.

the wrist, the external

digitorum ami Extensor

indicis.

PLATE XXVII
(I)

(I)

FLEXOR PROFUNDUS DIGITORUM.

FLEXOR

SUBLIMUS DIGITORUM

I 1

'

FLEXOR LONGUS
POLLICIS

(I)

ABDUCTOR AND
FLEXOR BREVIS MINIMI

DIGIT!

FLEXOR BREVIS ANO

ADDUCTOR POLLICIS.

(I)

(I)

A30UCTOR POLLICIS. ANt

(I)
FLEXOR BREVIS
(0)

OPPONENS MINIMI

DIGITI.

ABDUCTOR TRANSVERSUS POLUCIS.

OPPONENS POLLICIS
(I)

FLEXOR CARPI ULNARIS.

FLEXOR CARPI RADIALIS.

Ml
HI

OPPONENS MINIMI DIGITI (0.)

FLEXOR BREVIS MINIMI DIGITI (0)."

EXTENSOR
OSSIS METACARPI POLLICIS

(0)

(0)

OPPONENS POLLICIS
ABDUCTOR POLLICIS.

(I)

(0)

FLEXOR BREVIS POLLICIS.

(0)

Bones
Ossification.

oi

From

eighth week of intrauterine

ABDUCTOR MINIMI DIGTI

FLEXOR CARPI ULNARIS.

(0)

ADDUCTOR 0BLIQUUS

POLLICIS.

Left Hand- Anterior View

three
life,

centers,

one

one

for

the

diaphysis

for the distal epiphysis

about

the

about the second

year which join- the bone aboul the twentieth year, and one for the proximal
fifth year, which joins the bone about the seventeenth year.

extremity, the

grooves correspond to the second, third, and fourth of the posterior annular ligament
oi tin- wrist-joint

ANATOMY

IN A NUTSHELL.

75

Articulation. It articulates with four bones, the humerus, ulna, scaphoid and semilunar.
Muscles. It has nine muscles attached, the Biceps, third head of the
Flexor sublimis digitorum. Supinator brevis, Flexor longus pollicis, Pronator
quadratus, Pronator radii teres. Supinator longus, Extensor ossis metacarpi
pollicis and Extensor brevis pollicis.
Blood Supply. The nutrient artery is derived from the anterior interosseous trunk: it enters the shaft near the middle of the anterior surface, and
runs towards the proximal end of the bone. The head of the hone is supplied
by the radial recurrent and interosseous recurrent arteries. The lower end is
supplied by the anterior and posterior interosseous arteries and numerous
twigs from carpal arches.

LESSON XVII
The Ulna

(Plates

XXIY-XXY.)

is

the longer of the two bones of the fore-

proximal extremity islarger than that of the radius, while its distal extremity is smaller than that of the radius. On cross section it is triangular, but its

arm;

its

It has a proximal and distal extremity and a diais more circular.

The proximal extremity has the olecranon process and the greater
and lesser sigmoid cavities. The olecranon (meaning head of elbow) is concave from above down, and convex transversely on its articular surface which

distal part

physis.

is

covered with cartilage

in

the recent state.

On

the greater sigmoid cavity.

Its

margins give attachment

to

This surface makes the greater part of

capsular ligament of the elbow.

the

inner surface

its

is

a tubercle for the ulnar

The internal lateral ligament has an attachThe other surface gives attachment to part of

origin of the Flexor carpi ulnaris.

ment

in front of the tubercle.

the Anconeus.

The extremity of
arm is extended.

the process

fits

into the olecranon fossa of the ulna

when

upper surface has a concave impression for the tendon of the Triceps and the anterior margin for the posterior ligament. The
posterior surface is covered by a bursa.
The coronoid (like a crown) makes
the lower part of the greater sigmoid cavity and the upper pari of the bone.
When the
Its upper surface is covered with cartilage in the recent state.
arm is flexed it fits in the coronoid impression of the humerus. <>n its outer
The orbicular
surface is the lesser sigmoid cavity for the head of the radius.
ligament is attached to the margin of the lesser sigmoid cavity.

the

On

it>

ment

inferior surface

Where

anticus.

Its

it

is

an impression for the insertion of the Brachialis

is the tubercle
for the attach-

joins the shaft of the ulna

of the oblique ligament.

On

internal ligament, one attachment

this

is

the inner surface

for tin-

is

the attachment of the

Flexor sublimis digitorum; Behind

depression for the attachment of the flexor profundus digitorum, anddis-

lally

from

ment

for the

this

one

for the

Flexor longus

Pronator

radii

teres,

and occasionally one attach-

pollicis.

The greater and lesser sigmoid cavities have been described with these two
The diaphysis has three borders and three surfaces. The anterior

processes.

border extends from the inner angle of the coronoid process

styloid process; for most of the extent

it

is

to the

smooth and rounded.

from of the
It

separates

the anterior and internal surfaces andgives attachment to the Flexor profundus

ANATOMY

76

digitorum proximally, and the

IN A NUTSHELL.

Pronator quadratus

The

distally.

posterior

back
back part of the styloid process. It is
well marked in the proximal three-fourths and gives attachment to the common
aponeurosis which has three muscles attached to it. viz.. the Extensor carpi

commences

border

the apex of a triangular subcutaneous surface at the

at

and continues

of the olecranon

to the

This border
ulnaris, Flexor carpi ulnaris and Flexor profundus digitorum.
The outer or interosseous borseparates the internal and posterior surfaces.
der, is divided above, extending to the anterior and posterior extremities of
the sigmoid cavity; embracing the triangular depression (the bicipital hollow).
In the trout part of this impression lodges the tubercle and tendon of the Biceps, when the arm is pronated, and the back part gives attachment to the

Supinator
distal

face

brevis.

four-fifths
is

grooved

It

attached the interosseous

is

The

membrane.

the proximal three-fourths of

in

To

separates the anterior and posterior surfaces.

its

its

anterior sur-

extent, which

is

broader

than the distal portion, and gives attachment to the Flexor profundus digiIts distal one-fourth gives attachment to the Pronator quadratus.
torum.

The pronator

ridge, or oblique line,

is

directed distally and inward at the prox-

imal limit of the Pronator quadratus.

The

nutrient foramen

on

is

third with the middle one-third,

ent artery

The

is

branch

this surface at the junction of the

and

is

proximal one-

directed towards the elbow.

The

nutri-

of the anterior interosseous.

internal surface

is

broad and concave proximally. narrow and convex

distally.
The proximal three-fourths gives attachment to the Flexor profunThe posterior
dus digitorum, whereas the distal one-fourth is subcutaneous.

surface

broad and concave proximally, narrow and convex in the middle.

is

It> oblique line runs from the posterior

extremity of the lesser cavity distally to the posterior border. The first part
The triangular surface
of this line gives attachment to the Supinator brevis.

narrow, smooth, and round distally.

between

this line

and the elbow receives the insertion of the Anconeus.

The

"Uter portion of this surface gives attachment to the Supinator brevis. Ex-

and Extensor indicis.

smooth, being covered with the Extensor carpi ulnaris. A
perpendicular ridge separates these two portions of this surface.
The lower extremity is small ami consists of two parts, a head and styloid
m the articular surface they are separated by a groove which reprocess.
ceive- the apex of the interarticular fibro-cartilage, thus separating the ulna
tensor ossis metacarpi pollicis, Extensor Longus pollicis,

The inner portion

is

'

from the wrist-joint. The margin of the head is received in the sigmoid cavity
and the styloid process is a continuation of the posterior border
projecting from the inner and back part of the bone.
Its apex gives attach-

of the radius

ment

to the internal lateral

Extensor minimi

ligament;

it>

posterior surface

is

grooved

for the

digiti.

Ossifk ITION.
From three center-, one for the shaft about the eighth
week, one tor the distal extremity about the fourth year which joins the shaft
the eighteenth or twentieth

year,

and one

tor the

proximal extremity

tenth year which join- the shaft the sixteenth or seventeenth year.
Ai:t)<

lation.-

It

articulates with the

humerus and

radius.

the

ANATOMY
Muscles.

It

IN A NUTSHELL.

77

has fourteen muscles attached, Triceps, Anconeus, Flexor

carpi ulnaris, Brachialis anticus, Supinator brevis. Flexor sublimis digitorum,

Flexor profundus digitorum,

Pronator quadratus,
Extensor carpi ulnaris
Pronator radii teres, Extensor ossis metacarpi pollicis, Extensor longus
pollicis, Extensor indicis, and Flexor longus pollicis.

PLATE XXV III

DORSALIS

SCAPULAE

ARTERY

GREAT TUBEROSITY

POST.

CIRCUMFLEX ARTERY

CIRCUMFLEX N

MUSCULO-SPIRAL N

THE QUADRILATERAL

SPACE

IS

BOUNOED ABOVE BY THE TERES MINOR; BELOW BY THE

TERES MAJOR; EXTERNALLY BY THE HUMERUS; INTERNALLY BY THE LONG HEAD OF THE TRICEPS.

CIRCUMFLEX

N.

PASSING THROUGH

IT.

THERE

SPACES FORMED BY THESE

HAS THE

TRIANGLE

THROUGH

IT.

IT

HAS THE

AND THE POST. CIRCUMFLEX ARTERY

AND

IS

TWO TRIANGUAL

ARE

SAME

BOUNDARIES.

MUSCULO-SPIRAL

BOUNDED ABOVE

N.

BY THE

ONE

PASSING

TERES

MAJOR, EXTERNALLY BY THE HUMERUS. INTERNALLY BY

THE LONG HEAD OF TRICEPS. THE OTHER TRIANGLE HAS

THE DORSALIS SCAPULAE ARTERY PASSING PARTLY

THROUGH

IT

AND THEN PASSING BETWEEN THE SCAPULA

AND THE TERES MAJOR INTO THE INFRASPINOUS FOSSA.

Showing the Quadrilateral Space and Structures Passing Through

Blood Supply.

The

the anterior surface;

nutrienl

vessel enters the shaft

it

near the middle of

derived from the anterior interosseous trunk, and is

directed towards the proximal end.
The upper extremity receives branches
it

is

from the anterior and posterior ulnar recurrent and from the interosseous recurrent.
The lower end receives twigs from the anterior and posterior interosseous arteries.

ANATOMY

7S

IN A

NUTSHELL.

LESSON XVIII.
The

wrist-joint

cept axial rotation.

is

It

condyloid joint (Plate XL) having all movements exformed by the lower head of the radius and the inter-

is

and
The ulna docs not go

articular fibro-cartilage proximally

the scaphoid, semilunar,

bones distally.

into

and cuneiform

the joint, being separated by the

interarticular fibro-cartilage from the done- of the wrist.

The ligaments

and
The anterior ligament ex-

of this joint arc the anterior, posterior, internal lateral,

external lateral which

make

capsular ligament.

tend- from the anterior surface of the lower border of the ulna to the front of
the interarticular fibro-cartilage, also from the anterior surface of the lower

border of the radius and its styloid process, to the palmar surface of the scapand cuneiform bones distally, some fibers continuing to the c*

hoid, semilunar,

magnum and the unciform hones. There are some superficial fibers passing
from the styloid process ^i the ulna to the semilunar and cuneiform. This
The posterior ligament is weaker than the
ligamenl is pierced by small vessels.
anterior one: it extend- from the posterior surface of the lower part of the radius
and the triangular interarticular fibro-cartilage
scaphoid, semilunar and cuneiform

to the posterior surface of

The

bones.

the

internal lateral ligament ex-

tends from the tip of the styloid process of the ulna to the inner surface of the
cuneiform, by one of its divisions, and to the pisiform and annular ligament by
the other.

The

external lateral ligament extends

the radius to the outer side of the scaphoid,

some

from the styloid process of

fibers

continuing to the trape-

zium and annular ligament.

A synovial membrane which is very lax and does not communicate with
(Plate XLII.)
the joint above and below, lines the ligaments of this joint.
The nerve supply is the ulnar, anterior and posterior interosseous.
The blood supply is the anterior and posterior interosseous, anterior and
erior carpal arches, and
recurrent branches from the dee]) palmar arch.
The superior radio-ulnar articulation is a trochoides, and is formed by the
head of the radius and the lesser sigmoid cavity of the ulna.
Its only ligamenl i- the orbicular, which surrounds the head of the raidus. It is connected
io the anterior and posterior borders of the lesser sigmoid cavity, and with it
make- a complete ring. It- lower circumference is less than that of the upper,
thus holding the head <<\ the radius in position.
It blends with all the ligaments

of the elbow, except the internal: the synovial

membrane continues with

that of the elbow.

The middle radio-ulnar

..i-

two ligaments:
and outward from

articulation has

round ligament which passes distally

first,

the oblique

the base of the

coronoid process to the bicipital tuberosity of the radius.

This ligament is
Second, the interosseous membrane, passing between the two
adjacent border- of the radius and ulna: its liber- pass distally and inward. It

often absent.

commences beyond

and extends almost to

attachment to the muscles.
the back of the forearm, between the

the bicipital tuberosity of the radius

the di-tal extremity of the two bones.

The anterior interosseous

artery passes to

radius and ulna beyondthis

It

affords

membrane. The posterior interosseous

vessels pass

ANATOMY

IN A NUTSHELL.

79

back of the forearm between the radius and ulna above this membrane.
inferior radio-ulnar articulation is a trochoides, and is formed by the
head of the ulna and the sigmoid cavity of the raidus and fibro-cartilage. Its
ligaments are the anterior and posterior radio-ulnar which make the capsular
The anterior radio-ulnar ligament passes from the front border of
ligament.
the sigmoid cavity of the radius to the anterior surface of the head of the ulna.
The posterior one is a similar ligament on the posterior surface. The triangular
interartieular fibro-cartilage is at the lower end of the ulna, between the styloid
Its perimeter is attached to the ligaments of the wrist;
process and the radius.
it is attached by its apex to the depression between the head and styloid process of the ulna, by its base to the lower end of the radius.
Sometimes it is
perforated, in such a case the synovial membrane communicates with that of
to the

The

the wrist.

The blood supply is the anterior interosseous and anterior carpal arch.
The nerve supply is the anterior and posterior interosseous. Synovial
membrane, the membrana sacciformis, lines the adjacent surfaces of the ulna
and the interartieular fibro-cartilage. and the ulna and the radius. As stated
before, it sometimes communicates with the wrist-joint.

Brachialis amicus.
Description.
(Plate XVI.)
This is a broad muscle
which covers the elbow-joint and the lower half of the front of the humerus.
It is somewhat compressed from before backward and is broader in the middle
than at either extremity. Its fibers converge to a thick tendon. The outer
border of the muscle is in relation with the musculo-spiral nerve and radial rej

current artery.

Origin.

(1)

Lower

half of outer

and inner surfaces

of shaft of humerus;

(2) intermuscular septa; (3) commences above at insertion of Deltoid and extends below to within one inch of margin of articular surface.
(Plate XXIII.)
Insertion.
Into a rough depression on the anterior surface of the coron-

noid process of the ulna, being received into an

slips of

the Flexor profundus digitorum,

Action.

(Plate

Flexor of forearm.
Fifth and sixth cervical

Nerve Supply.

interval between

two

fleshy

XXV.)

through the

musculo-cutaneous

and musculo-spiral.

Blood

Si

pply.-

Brachial artery.

Subanconeus.
Description.- The Subanconeus is a name given to a few
under
from the
surface of the lower pai of the Triceps muscle.
By some
authors it is regarded as the analogue of the Stfbcrureus in the lower limb, but
fibers

it

is

not a separate muscle.

Origin.

Humerus

Insertion.
A< tion.

fossa.

Posterior ligament of elbow-joint.

>raws up posterior ligamenl during extension of forearm.

Nerve Supply.
Blood Supply.

Musculo-spiral.
Brachial artery.

teres.
Description.
(Plate
KXIX.) This muscle
beiween which the median nerve enters the forearm.
passes obliquely across the forearm from the inner to the outer side, and ter-

Pronator

arises
It

above olecranon

radii

by two heads,

PLATE XXIX

LEXOR PROFUNDUS
DIGITORUM.

FLEXOR SUBLIMIS
DIGITORUM

LUMBRICALES

ABDUCTOR

INDICIS

DIGITAL ARTERIES^DIGITALtJEKVE

FLEXOR LONG

SUPERFICIAL TRANSVERSE LIGT.

US POLLICIS

FLEXOR BREVIS MINIMI

DI&ITI.

ADDUCTOR IRANS
ABDUCTOR

VETSE POLLICIS

FLEXOR BREYIS
POLLICIS

MINIMI DIGIT!.

PALMARIS BREVIS
PISIFORM BONE

ABDUCTOR POLLICIS

OPPONENS

ANT.

POLLICIS

ANNULAR

LIG-'T-

POST. ANNULAR LIGT

EXTENSOR BREVIS POLLICtS

EXTENSOR OSSIS
METACARPI POLLICIS
FLEXOR LONGUS POLLICIS

FLEXOR SUBLIMIS DIGITORUM:

-FLEXOR CARPI ULNARIS

PALMARIS LONGUS.
SUPINATOR

LONGUS

FLEXOR CARPI RADIALIS.

PRONATOR

RADII TERES.

BRACHIALIS ANTICUS.

TRICEPS.

BICEPS

Muscles of the Left Forearm

80

First

Layer Anterior View


ANATOMY

IN A NUTSHELL.

81

tendon which turns over the outer margin of the radius.

head. (1) immediately above internal condyle of humerus:
The other head,
(2) common tendon: (3) fascia; i4i intermuscular septum.
thin fasciculus from inner side of coronoid process of ulna, joining first head at
an acute angle.
(Plate XXIII.)
Insertion. Rough impression on middle of outer surface of shaft of
minates

in a flat

One

Origin.

XXV.)

(Plate

radius.

To pronate hand.
Nerve Supply. Median.
Blood Supply. Radial artery.
A' tiin.

Description.
(Plate XXIX.)
This muscle lies
on the inner side of the preceding muscle.
It is slender and
aponeurotic in
Flexor carpi

radialis.

its commencement above, but increases in size and

terminates in
tendon which forms rather more than the lower half of its length. This tendon
canal on the outer side of the annular ligament and runs
3 s through a
through a groove in the os trapezium. The radial artery lies between the tendon and the Supinator longus muscle, and may easily be tied in this situation.
Origin.
(1) Internal condyle by common tendon: (2) fascia; (3) intermuscular septum. (Plate XXIII.
Insertion.
Bases of metacarpals of index and middle
(Plate XXYII.)

structure at
a

finger.-.

Action.

Flexor of

wrist.

Nerve Supply. Median.

Blood Supply. Radial arterv.

LESSON XIX.
Palmaris

Description.

longus.

fusiform muscle lying on the inner

and

is

subject to

below: or
or

it

may

may

may

it

Origin.

be muscular

XXIX.) Thi-

it

may

It is

often

tedinous above and

be

the center with a tendon above

a central

slender,

is

absent

muscular
and below;

tendon: or

finally,

it

simply of a mere tendinous band.

(1)

Inner condyle of humerus by the

Insertion.

Palmar fascia

muscles of thumb.
\<

in

intermuscular septa.

(3)

tion.

(Plate

Tenses

Supply.
Blood Supply.

\i:i;\

variation:

present two muscular bundles with

consist

fascia:

much

(Plate

side of the preceding.

i:

(Plate

common

tendon:

(2)

deep

XXIII.)

and occasionally

Tendinous ligamenl to shorl

XXIX

palmar

fascia.

Median.

Radial

and ulnar arteries.

Description.- Tins muscle lie- along the ulnar
It arises by two head- connected by a tendinous arch,
Bide ^i the forearm.
beneath which pass the ulnar nerve and posterior ulnar recurrent artery. The
fibers terminate in a tendon which occupies the anterior part of the lower half
Flexor carpi

of the muscle.

ulnarls.

The ulnar artery

lower two-thirds of the forearm.

lies

on the outer side of this tendon,

(Plate-

XXIX-.W

in

the

ANATOMY

82

Origin.One head from

IN A NUTSHELL.

internal condyle of

humerus by common tendon;

the other from inner margin of olecranon, upper two-thirds of posterior border
of ulna by an aponeurosis common to it, the Extensor carpi ulnaris, and Flexor

profundus digitorum, and also from the intermuscular septum. (Plate XXIII.)
Pisiform bone, annular ligament, and base of fifth metaInsertion.
(Plate XXVII.)
carpal and unciform bones.
Ai in

\'u;\

Flexes wrisi

i\.

Si imma

i:

Ulnar.

Blood Supply.
sublimis

Flexor

This

Ulnar artery.

muscle

digitorum

lies just

(perforatus).

Description. (Plates XXX.)

preceding and

beneath the

is

the

largest

of

the

The fibers
by three heads.
pass vertically downward, forming a broad and thick muscle which speedily
The superlivides into two planes of muscular fibers, superficial and deep.
ficial plane divides into two parts which end in tendonsfor the middle and ring
fingers; the deep plane also divides into two parts which end in tendons for the
index and little fingers, hut previous to having done so it gives off a muscular
slip which joins that part of the superficial plane which is intended for the ring
finger.
As the four tendons thus formed pass beneath the annular ligament
superficial layer.

muscles of the

It

arises

hand they are arranged in pairs, the superficial pair cormiddle and ring fingers, the deep pair to the index and little
responding
The
tendons
Opposite the bases of
diverge as they pass onward.
fingers.
the first phalanges each tendon divides into two slips to allow the passage of
the corresponding tendon of the Flexor profundus digitorum: the two portions
then unite and form a grooved channel for the reception of the deep flexor

into the

palm

of the

to the

tendon.

Finally they subdivide a second time prior to their insertion.

(By three heads)

Origin.

common

tendon;

(2)

muscular septum.

first

head,

(1)

Second head, inner side

humerus by
ami (3) inter-

internal condyle of

internal lateral ligament of elbow-joint;

of coronoid process of ulna.

Third

head, oblique line of radius, from the tubercle to the insertion of the Pronator
radii ten-.
1

XXV-XXIII.)

(Plates

nsertion.

Plate

XXVII.)- Lateral margins

of

second phalanges about

their middle.

Action.
\'u;\

i.

Flexes second phalanges.

Si ppl"5

Median.

Supply.
Radial and ulnar arteries.
Flexor profundus digitorum.
Description. (Plate
Hi.<

situated on

the ulnar

side of

the

XXXI.)

This muscle

forearm, immediately

beneath the super fiicial flexors.

Its fibers
form a fleshy belly of considerable size which
divides into four tendons; these pass under the annular ligament beneath the
tendons of the Flexor sublimis digitorum. Opposite the first phalanges the

is

tendons pass through the openings

sublimis digitorum.

The portion

in

the two slips of the tendons of the Flexor

muscle for the index finger is usually

throughout, bu1 the tendons for the three inner fingers are connected
together by cellular tissue and tendinous slips as far as the palm of the hand.
of the

distinct

Four Bmall muscles, the Lumbricales, are connected with the tendons of the
Flexor profundus in the palm.

PLATE

XXX

SUPERFICIAL TRANSVERSE LIGAMENT

LUMBRICALIS.

RADIAL PORTION OF PALMAR BURSA,

DEEP TRANSVERSE LIGAMENT.

ULNAR PORTION OF PALMAR BURSA.

PALMARIS BREVIS.

INNER

FLEXOR BREVIS P0LLIC1S.

OUTER HEAD

CPPONENS MINIMI
ADDUCTOR MINIMI

tBDUCTOR POLLICIS.

OIGITI

DIGIT!

ANTERiOR ANNULAR LIGAMENT.

DEEP FASCIA OF FOREARM.

EXTENSOR

BRE'.IS POLLICIS

EXTENSOR OSSIS WETACARPI POLLICIS

FLEXUS LONGUS POLLICIS

FLEXOR V.BLIMlSDIWTORUM.

EXTENSOR CARPI RAO.ALIS LONGIOR

SUPINATOR BREVIS

RSDIAU

Wi

'

',J.

Vim

I.

FLEXOR CARPI ULNARls

u
FLEXOR CARPI RADlAllS

PRONATOR RAlu

BRALhIALIS AMICUS

[bicep: _

Muscles op the Left Forearm

Second Layer
83

Anterior

n\\

ANATOMY
Origin.
faces;

Upper three-fourths

(1)

depression ob

(2)

IN A NUTSHELL.

inner side of coronoid process; (3)

from upper three-fourths of posterior border of ulna; and

membrane.

terosseous

Insertion.
\.

noN.

(4)

ulnar half of in-

XXV.)

(Plate

Bases of

and inner surby aponeurosis

of shaft of ulna, anterior

phalanges.

last

XXVII.)

(Plate

Flexes phalanges.

Eighth cervical and

branch
of median.
anterior interosseous
Si
ppli
Ulnar
artery.
Blood
\ii;\i

Supply.

first

dorsal through ulnar,

and the

Flexor

Longus

pollicis.

Description.

(Plate

preceding

The

pass

fibers

XXXI.)

downward and terminate

This

muscle

same plane

lying on the

situated od the radial side of the forearm,

in a flattened

is

as the

tendon

which passes beneath the annular ligament and is then lodged in the interspace
between the outer head of the Flexor brevis pollicis and the Adductor obliqus

The anterior interosseous vessels and nerve lie between this muscle
pollicis.
and the Flexor profudus digitorum.
Origin.- Front the grooved anterior surface of the shaft of the radius,
from the tuberosity and oblique line to within a short distance of the Pronator
quadratus; also from the adjacent part of the interosseous membrane, and generally by a fleshy slip from the inner border of the coronoid process of ulna, or
from the internal condyle of the humerus.
(Plate XXV.)
Insertion.- Base of last phalanx of thumb.
(Plate XXVII.)
\ tion.
Flexes thumb.
Nerve Supply.- Eighth cervical and first dorsal through the anterior
interosseous branch of the median.
Blood Supply.- Radial artery.
Pronator quadratus.Description.
This is a small,
(Plate XXXI.)
flat, quadrilateral muscle extending transversely across the front of the radius
and ulna, above their carpal extremities.
Origin.
(1) Oblique ridge on lower part of anterior surface of ulna; (2)
l"\\er fourth of anterior surface and anterior border of ulna; and (3) strong

aponeurosis covering inner third of muscle.

(Plate XXV.)
Insertion.
(Plate XXV.)- Lower fourth of anterior surf ace and anterior
border of shaft of radius.
\<

Pronates the hand.

[ON.

Nerve Supply.
branch

interosseous

Eighth
<<\'

Blood Supply.

and

cervical

first

dorsal

through

anterior

median.
Radial

and ulnar

arteries.

LESSON XX.
Supinator longus.
(Brachio-radialis)

forearm;

is

Description.
the mosl

(Plate

superficial

XXXII.)The

muscle on

Supinator longus

the radial

side of

the

fleshy for the

upper two-thirds of its extent, tendinous below, the

tendon commencing above the middle of the forearm.
Its inner border, above
it

is

the elbow,

is

artery,

and

in

in

relation

with the musculo-spiral

nerve and radial recurrent

the forearm with the radial vessels and nerve.

ANATOMY

IN A NUTSHELL.

85

Upper two-thirds of external supracondylar ridge of humerus

Origin.
and external intermuscular septum. (Plate XXIII.)
Insertion. Outer side of base of styloid process of raidus.
(Plate XXV.
Action. Supinates hand.
Nerve Supply. Sixth cervical through the musculo-spiral nerve.
Blood Supply. Brachial and radial arteries.
Extensor carpi radialis
longior.
Description.
(Plate
XXXII.)
This muscle lies partly beneath the Supinator longus, its fibers terminating
at the upper third of the forearm in a flat tendon which runs along the
outer border of the radius beneath the extensor tendons of the thumb.
It
then passes through a groove common to it and the Ex'.ensor carpi radialis
brevior. immediately behind the styloid process of the radius.

From the

Origin.

lower third of the external supracondylar ridge of the hu-

merus and from the external intermuscular septum by a few fibers from the
common tendon of origin of the extensor muscles of the forearm. (Plate XXIII.)
Insertion. Base of metacarpal of index finger, radial side. (Plate XXVI.)
Action. Extends the wrist.
Xerve Supply. Sixth and seventh cervical through the musculo-spiral.

Radial

Blood Supply.
Extensor
This muscle

carpi

artery.

radialis

and

brevior.

Description.

thicker than the

(Plates

XXXII.)

beneath which it is
Its fibers terminate about the middle of the forearm in a flat tenplaced.
don which is closely connected with that of the Longior, and accompanies
it to the wrist, lying in the same groove on the posterior surface of the radius;
it passes beneath the extensor tendons of the thumb, then beneath the annular
shorter

is

preceding,

ligament.

The tendons
partment

of the two preceding muscles pass through the same comannular ligament and are lubricated by a single synovial mem-

of the

brane, but are separated from each other by a small vertical ridge of bone as

they

lie

groove at the back of the radius.

in the

Origin.

From

the external condyle of the humerus by a tendon

common

to it and the three following muscles: from the external lateral ligament of the
elbow-joint, from a strong aponeurosis which covers its surfaces, and from the

(Plate XXIII.)

intermuscular septa.

Insertion.

on

its

(Plate

XXVT.) Base

of metacarpal

bone of middle

finger

radial side.

Action.

It

assists

and may
Nerve Supply.

the Extensor carpi radialis longior in extending the

also act slightly as an

wrist

Sixth

abductor of the hand.

and seventh cervical through the posterior

inter-

osseous.

Blood Supply. Radial artery.

Extensor communis dijritoruni.
muscle

is

Description.

(Plates

XXXII.)

This

situated at the back part of the forearm and divides just below

the

middle into three fleshy masses, from which tendons proceed; these pass together with the Extensor indicis through a separate compartment of the annular ligament.

The tendons then

diverge, the innermost one dividing into

two.

PLATE XXXI
FLEXOR PRORINOUS DtGITORUM
FLEXOR SUBLIMIS WGITOHtM

U6A*ENTUm VA6INALE,
FIRST LUMBRICALIS
FIRST DORSAL INTEROSSEOUS

TRANSVERSE
ADDUCTOR POLLICIS.
OBLIQUE

FLEXOR BREVIS MINIMI

(OUTER HEAD)

FLEXOR BRE\

IS

DIGJTI

(0)

POLLICIS

(INNER MtADI

(I,.

PALMARIS BREVIS

FLEXOR SUBLIHtUS WGITOROW

ABDUCTOR MINIMI

DIGITI

/.BDUCTOR POLUCIS

DEEP FASCIA OF FORLARM

fl/j,

Mtt'<

EKTINSCR CARPI RADVALIS

\\m :\\
1

.it

(ill :.!'>

FUXOR PROFUNDUS DI&ITORUM

V
:

LONGIOR.

J.JPINATOS BREVIS

FLEXOR SUBLIMIS DIGITORIUM

FLEXOR CARPI ULNARIS

BRACHlO-RI.DIALlS

PALMARIS LONGUS.

'X

m
I

MuscLES OF theJLept

m
m

m
I jfl

F(

BRACHIALIS

Li

v.-

ANTIC!';,

',1

FLEXOR CARPI RADIALIS

PRONATOR

RADII

TERES

Ml, K

T'4 M

"'

-^TRICEPS

m uimThird and Fourth Layers Anterior View

i,

86

ANATOMY

IN A NUTSHELL.

87

Each tendon opposite the metacarpophalangeal articulation becomes narrow and thickened and gives off a thin fasciculus upon each side of the
blends with the lateral ligament and serves as a posterior ligjoint, which
ament; after having passed the joint it spreads out into a broad aponeurosis
which covers the whole of the dorsal surface of the first phalanx, being reinforced in this situation by the tendons of the Interossei and Lnmbricales.
Opposite the

first

middle and two

Origin.
fascia;

(3)

phalangeal joint this aponeurosis divides into three

(1)

External condyle of humerus by

Into the

common

tendon;

(2)

deep

(Plate XXIII.)

intermuscular septum.

Insertion.

slips,

lateral.

second and third phalanges of the fingers in the

fol-

lowing manner; the outermost tendon accompanied by the Extensor indicis,

goes to the index finger; the second tendon is sometimes attached to the first by a
thin transverse

band and

receives

a slip from the third tendon

the middle finger; the third tendon gives off a slip to the second
a very

considerable part

the fourth

of

tendon, after dividing, sends one

tendon

slip to join

the

it

goes to

fourth or

innermost

the third tendon; the other, rein-

forced by the Extensor minimi digiti, goes to the

vision of the aponeurosis opposite

and receives

After the

little finger.

the phalangeal joint, the middle slip

is

di-

in-

serted into the base of the second phalanx, while the two lateral

onward along the

sides of the second

surface of the last phalanx.

Action.

To

(Plate

are continued
phalanx and are inserted into the dorsal

XXVI.)

extend the fingers.

Suplpy. Seventh cervical through the posterior interosseous.

Nerve
Blood Supply.

Posterior interosseous.

minimi

Extensor

digiti.

Description. (Plate

XXXII.) This is a
communis digitorum

slender muscle placed on the inner side of the Extensor

with which

it

compartment

is

generally connected.

Its

tendon runs through a separate

annular ligament behind the inferior radio-ulnar joint,

then divides into two as it crosses the hand, the outermost division being joined
by the slip from the innermost tendon of the common extensor. The two slips
in the

thus formed spread into a broad aponeurosis and receive

ductor minimi

from the Ab-

a slip

digiti.

Common

tendon by a thin tendinous slip and intermuscular

XXIII.)
Insertion. Second ami third phalanges of the little finger. Plate XXVI.)
Action. Extends the little finger.
Nerve Supply. Seventh cervical through the posterior interosseous.
Blood Supply. Posterior interosseous and radial.
Anconeus. Description. This is a small triangular muscle placed behind and below the elbow-joint, and appears to be a continuation of the external
Its filters diverge from their origin, the upper ones
portion of the Triceps.
Origin.

septa.

(Plate

being directed transversely, the lower obliquely inward.

External

(Plate

XXXII.)

(Plate XXII.)
condyle of humerus posteriorly.
of posterior surupper
process
of
olecranon
and
fourth
Insertion. Side

Origin.

face of shaft of ulna.

(Plate

XXIV.)


ANATOMY

8S

Extends forearm.
Seventh and eighth cervical through the musculo-spiral,
Radial and superior profunda.

riON.

A.<

IN A NUTSHELL.

Supply.
Blood Supply.

\i.i,\

i.

LESSON XXI.
Supinator brevis.
cle
It

of

hollow

consists of

Description. (Plate

cylindrical

XXXIII.)

form, curved round

two distinct planes

muscular

of

The two planes

posterior interosseous nerve.

This

the upper

broad mus-

between which

fibers,

arise

is

third of the radius.

in

common.

lies

The

the

fibers

which encircles the neck of

Between the insertion of the two planes
the posterior interosseous nerve lies on the shaft of the bone.
OriginThe superficial plane by tendinous and the deep by muscular
fibers from tl) the external condyle of the humerus; (2) external lateral ligament of elbow-joint; (3) orbicular ligament of radius; (4) oblique ridge of

of the deeper plane

form

the radius above the

ulna; (5)

a sling-like fasciculus,

tuberosity.

triangular depression in front of the ridge; (6) tendinous expansion

covering the surface of the muscle.

The

Insertion.

superficial

(Plates

fibers

into

XXIII-XXIV.)
the outer edge of the bicipital

tuberosity and oblique line of the radius; the deeper fibers into the posterior

and external surface

of the shaft,

midway between

the bone, except the sling-like fasciculous which

the inner surface of the radius.

(Plate

is

the oblique line and head of

attached to the back part of

XXIV.)

A.CTION. Stipulates hand.

Nerve Supply.
Blood Supply

Posterior interosseous.

Interosseous and radial arteries.

Description. (Plate XXXIII). This

deep extensor muscles. It lies imFrom
mediately below the supinator brevis, with which it is sometimes united.
its
origin it
passes obliquely
downward and outward and terminates in a
tendon which runs through a groove on the outer side of the styloid processof
the radius. The tendon of the Extensor brevis pollicislies in the samegroove.
The Extensor pollicis occasionally gives off two slips near its insertion, one
to the trape/.ium.
and the other to blend with the origin of the Abductor
Extensor ossis metacarpi

is

the mosl external

pollicis.

and the largest

of the

pollicis.

Origin.
From outer part of posterior surface of shaft of ulna below inAnconeus, from the interosseous membrane, and from the middle

sertion of

third of the posterior surface of shafl of radius.

Insertion.

Bl<

XXIV.)
(Plate XXVII.)

Extends thumb.

Action.

Nerve

(Plate

Base of metacarpal bone of thumb.

Si pply.
Si pply.

Extensor brevis

Posterior interosseous.
Posterior interosseous.
pollicis.

Description.

sor brevis pollicis (Extensor primi

this group, lies

(Plate

XXXIII.)

internodii pollicis,)

The

Exten-

the smallest muscle of

on the inner side of the preceding, having a similar direction

and passing through the same groove on

tin

outer side of the styloid

process.

PLATE XXXII
ATTACHMENT

OF

EXTENSOR COMMUNIS DIGITORUM

TO

tffc

THIRI

!&)
ATTACH JI

EXTENSOR CO
TO

EXTENSOR

SEC

INCMCIS

EXTENSOR MINIM:

/-

J.

DIGIT!

adductoh

fl

i-ul

EXTENSOR COMMUNIS CIGlTORUM

POSTERIOR ANNULAR LIGAMENT.

EXTENSOR BREVIS POUICIS.

EXTENSOR MINIMI

EXTENSOR CSSiS METJCARP1 POLLiClS.

DIGITI

EXTENSOR CARPI RSDIALIS BREvlOR.

EXTENSOR CARPI ULNARIS.

EXTENSOR

COMMUNIS

QiGITORuM.

FLEXOR CARPI ULNARIS.

EXTENSOR CARPI RAOIALIS LONGIOR,

SUPINATOR LONGUS

BRACHIALIS ANIICUS.

Muscles of the Left Forearm

'

it]

Superficial
89

__

biceps.

Layer Posterior

iew

PLATE XXXI 11

-.'!,

DR MINIM

L'iG'T

ABDUCTOR MINIMI

DIGITI

EXTENSOR CARPI ULNARIS.

RAOIAUS.EXTENSORS.

EXTENSOR

IND4CIS.

FLEXOR PROFUNDUS OIGITOBUM

ETtTENSOR OSSIS METACARPI POLLICIS.

FLEXOR CARPI ULNARIS

SUPINATOR BREVIS.

EXTENSOR CARPI RAOIALIS LONGIOR.

-SUPINATOR

ONGUS

BRACHIAUS ANTICUS.

Muscles op the Left Forearm

Deep

90

Layer

Postesior

View

ANATOMY
Origin.

Posterior surface of

IX A NUTSHELL.

'.'1

Xerye Supply. Seventh cervical through the

Blood Supply. Posterior interosseous artery.
Extensor

longus

Description.

pollicis.

meta-

shaft of radius, below Extensor ossis

-(Plate
- membrane.
and from the int<
(Plate
Insertion. Base of first phalanx of thumb.
Ai tion.
Extends the proximal phalanx of thumb.

carpi pollicis

tensor longus pollicis (Extensor secundi

than the preceding muscle, the origin of which

it

XW

1.

posterior inter ss

(Plate

internodii

XXH

The

XXXIII.)
pollicis)

is

much

parti}' covers in.

It

Exlarger

termi-

nates in a tendon which passes through a separate compartment in the annu-

narrow, oblique groove at the back part of the lower end

then crosses obliquely the tendons of the Extensor carpi
radialis longior and brevior. being separated from the other extensor tendons of
the thumb by a triangular interval in which the radial artery is found.

lar ligament, lying in a

of the radius.

Origin.

It

Outer part

of

posterior surface of shaft of ulna distally from

and from interosseous membrane.

origin of Extensor ossi< metacarpi pollicis

(Plate

XXIV.)

(Plate XX\ I.
Base of last phalanx of thumb.
Insertion.
Action. Extends thumb.
Nerve Supply. Seventh cervical through posterior interosseous.

Blood Supply.

Posterior

interosseous artery.

XXXIII.) This is a narrow,

and parallel with the preceding.
Its tendon passes with the Exten.-or communis digitorum through the same
canal in the posterior annular ligament and subsequently joins the tendon
the Extensor communis digitorum which belongs to the index finger, opposite
the lower end of the corresponding metacarpal bone, lying to the ulnar side of
the tendon from the common extensor.
Origin. Shaft of ulna posteriorly, and distally from Extensor longus
(Plate XXIV.
pollicis and from interosseous membrane.
Insertion. Second and third phalanges of index finger with tendon
Extensor

indicis.

Description.

Plate

elongated muscle placed on the inner side

of.

common

extensor.

(Plate

XXVI.)

Extends index
Nerve Supply. Seventh cervical through posterior
artery.
Blood Supply. Posterior inter
A' tion.

ring

inter

ss

LESSON XXII.

The radial artery

extends from the bifurcation of thebrachIt- course i- shown by a line from a

ial and ends in the deep palmar arch.
point about half an inch below the middle of the bend of the elbow to the inner
Tin- artery is more a conside of the base of the styloid process of the radius.
It is actinuation of the brachial than the ulnar, which is more of a branch.
Radial artery.

companied by venae comites.

It-

branches

in

the forearm an- radial recurrent,

muscular, superficialis volae, and anterior carpal.

ANATOMY

IX A

NUTSHELL.

The radial recurrent arises from the radial just below the elbow, passes
outward between the Supinator brevis and Supinator longus, also separating
the radial and posterior interosseous uerves; it then runs towards the elbow
between the Supinator longus and the Brachialis anticus to supply these muscles and to anastomose with the anterior terminal branch of the superior profunda.

The muscular branches supply the muscles on the

radial side of the fore-

arm.

The anterior carpal

ii

border of the Pronator quadratus;

arises near the lower

passes to the ulnar side

the forearm under the tendons to anastomose with

^\

anterior carpal of ulnar, thus forming the loop which gives branches to the
wrist-joint.
superficialis volae arises from the artery near the wrist where it is
It passes between the muscles of the ball of
wind around the carpus.
It anastomoses with the ulnar, completing
the thumb, sometime- over them.
The pulse may often be felt in this artery, as
the superficial palmar arch.

The

about

well

to

a.-

the radial,

in

The branches
sal

it

arises higher than usual.

dorsales pollicis, and dorsalis indicis.

interosseous,

off the

when

in the wrist are the posterior carpal,

anterior

carpal

it

metacarpal or

first

dor-

After the radial gives

crosses the external lateral ligament to the base ofthe

In this
metarcapal of the thumb, lying upon the scaphoid and trapezium.
situation it is crossed by the three extensors of the thumb, viz., Extensorossis

muscle and comes from both bones,

comes from the long bone or ulna, and the ExIt then passes
tensor brevis pollicis which comes from the short bone or radius.
between the two heads of the first dorsal interosseous or Abductor indicis, into
two reasons, first to supply
tin' palm.
It passes to the back of the hand for
tin' hack of the hand on the radial side, and second for protection.
The posterior carpal arises beneath the extensors of the thumb, passing

metacarpi

which

pollicis

is

broad

the Extensor longus pollicis which

beneath the extensor tendon- of the forearm

ulnar,

making the posterior carpal

sal interossei

cles to the

which pass on the

metacarpophalangeal

arch.

It

to join

the posterior carpal of the

uives off the second

and third dor-

back of the Third and Fourth interossei musjoint

where

it

divides into digital branches to

supply the contiguous sides of the middle, ring, and little fingers. At their
proximal extremity they receive perforating branches from the deep palmar
At the distal extremity they give perforating branches to the digital
arch.
branches

to join

the palmar digital arteries.

The metacarpal
carpal, bu1

it

or

first

dorsal interosseous

generally arises from the radial.

may
It

conn' from the posterior

passes over the Second dorsal

interosseous muscle to the metacarpophalangeal joint where it is divided to

supply thr contiguous side- of the index and middle finders.
At its proximal

extremity it receives perforating branches from the deep palmar arch; at its
distal extremity it gives branches to join the corresponding digital arteries.
The digital arteries end at the firsl interphalangeal joint where they join the
posterior branch of the collateral digital branches.

The dorsales
the base of the

the thumb.

two in number; they arise from the radial near

metacarpal bone and pass along the sides of the dorsum of

pollicis are

first

ANATOMY

IN A NUTSHELL.

93

The dorsalis indicis arises from the radial just before it passes between the
two heads of the Abductor indicis; it then passes over the dorsum of this muscle, which it supplies, to the radial side of the index finger.
At the first interphalangeal joint it anastomoses with the posterior branch of the radialis indicis.

PLATK XXXIV

THIRD DORSAL INTEROSSEOUS

lill-fij

FOURTH DORSAL INTEROSSEOUS

The Four Dorsal

SECOND DORSAL

INTEROSSEOUS

FIRST DORSAL

INTEROSSEOUS

Enterossej

The deep palmar arch is formed by the radial, after it pusses between the
two heads of the Abductor indicis, and a terminal branch of the ulnar. This
arch has its convexity distally; it lies upon the bases of the metacarpal bones.
It has five branches, four from the convexity and one from the
concavity.
The princeps polllcis first passes between the Abductor indicis and the

ANATOMY

94
n-

ffh

ti

,,,.,'

/I", palmar
indicis

Abductor

IX A NUTSHELL.

of the
thP distal extremity of the metacarpal

i.

thumb

along the ra<h

from the convexity; H passes

-I

surface of the Index finger, at

firsl

it

passes between the

and Adductor polhcis.

PLATE XXXV

SECOND PALMAR INTEROSSEOUS

PALMAR INTEROSSEOUS

FIRST

THIRD PALMAR INTEROSSEOUS

I'ii i:

Three Palmar [nterossei

Second.

They pass over the

her.
m. .......
in num
mihv m
are three
Interossei anmar muTO>M'i
palmar
T
The na
they divide mto collateral
before
just
anrTourth palmar Inter
Th
branches of the super,

,,.

,,;:;,',

branches.

They

^tSX^'i

join

,1

ling digital

""""

'

'

They

pass """"""

ANATOMY

IN A NUTSHELL.

two heads of the Three inner dorsal interossei

95

to join the dorsal interosseous

arteries.

The palmar

two or three, pass towards the wrist and join the

t<> supply the wrist-joint.
the Radial Artery in the Forearm.
and deep fasciae, 3 Supinator
(1) Skin.
(2) Superficial

recurrent,

anterior carpal and anterior interosseous

Relations of

In

Front.

Longus.

Behind.
teres,

(4)

quadratus,

(1)

Tendon

of Biceps, (2) Supinator brevis, (3)

Flexor sublimis digitorum,

(7)

(5)

Flexor longus

pollicis,

Pronator radii
(6)

Pronator

radius.

Outp:r Side.

(1)

Inner Side.

(1)

Supinator longus, (2) Radial nerve (middle thir

Pronator radii teres. (2) rdexor carpi radialis.

LESSON XXIII.

Ulnar artery. The ulnar artery

an inch below the bend of the elbow.
to be a continuation of the brachial

is

branch

It is
.

It

of the brachial about one-half

larger than the raidal. which seems

passes over the anterior annular

lig-

ament on the radial or outer side of the pisiform bone.

The anterior ulnar recurrent arises from the ulnar just below its origin.
Pro11 passes towards the elbow upon the Brachialis anticus and under the
nator radii teres to the front of the internal condyle to anastomose with the anterior branch of the inferior profunda and the anastomotica magna.
The posterior ulnar recurrent is the larger of the vessels and has its origin
It passes backward and inward upon the Flexor sublimis
below the anterior.
digitorum.
It passes between the two heads of Flexor carpi ulnaris, with the
ulnar nerve, to the back of the internal condyle to anastomose with the
posterior branch of the inferior profunda and the anastomotica magna.
The common interosseous is the next in order, having its origin opposite
the bicipital tuberosity.
It passes upward and distally to the beginning of the
interosseous membrane where it divides into anterior interosseous and posThe lumen of this branch is the largest of the branches.
terior interosseous.
The anterior interosseous passes to the distal extremity of the interosseous
- nerve, where il pass
membrane in company with the anterior int<
the back of the forearm.

It sends a branch with the

It has venae comites.
median nerve called the median artery or conn.- nervi mediani. At the wrist it
anastomoses with the anterior carpal artery and recurrent branches from the
It gives
deep palmar arch.
It may help to form the superficial palmar arch.
nutrient branches to both the radius and ulna.
The posterior nterosseous artery passesto the back of the forearm between
the oblique ligamenl and inl
membrane. It passes between the
Supinator brevis and the Extensor ossis metacarpi pollicis, then lies between

the two layers of muscles on posterior part of forearm as far as the wrist.
lies

internal to posterior interosseous nerve.

It

It

anastomoses with the carpal

and ulnar, and anterior interosseous arteries. It gives off the posterior
which passes under the Anconeus to the interval between olecranon and external condyle, where it anastomoses with the superior
profunda, the anastomotica magna and posterior ulnar recurrent.
The muscular branches vary in number and supply the adjacent muscles.
of radial

interosseous recurrent

ANATOMY

96

The anterior carpal

is

IN A NUTSHELL.

branch which has itsorigin

a small

near the anterior annular ligament.

of the ulnar artery

It

at the distal part

passes outward to

anastomose with the anterior carpal of the radial. These two arteries make
It
anastomoses with the anterior interosseous, and
the anterior carpal arch.
It lies beneath the tendons of
recurrent branches from the deep palmar arch.
the

Flexor profundus digitorum.

arise- a little

'The posterior carpal

proximally of the pisiform hone.

passes beneath the Extensor carpi ulnaris to the hack of the wrist to

It

join the

posterior carpal of the radial under the extensor tendons.

palmar arch

'The superficial

is

made by

the continuation of the ulnar in

the hand, joining the superficialis volae, or the radialis indicis, or the princeps

joining a large median artery.

The deep ulnar branch passes between the Abductor minimi digiti and the
The convexity of
Flexor brevis minimi digiti to make the deep palmar arch.
the superficial palmar arch gives four digital branches, one to the ulnar side and
palmar aspect of the little finger, and the other three to the adjacent sides of
On the fingers these arteries are posthe little, ring, middle and index fingers.
pollicis, rarely

terior to the nerves.

Relations of the Ulnar Artery

1\

Upper half.
Lower half (3)

Front.

dian nerve.

(1)

the Forearm.

in

Superficial layer of flexor muscles.

Superficial

fascia.

(4)

Deep

(2)

Me-

fascia.

Behind. (1) Brachialis anticus, (2) Flexor profundus digitorum.

Outer Side. Flexor sublimis digitorum.
Inner Side. -(1) Flexor carpi ulnaris. (2) Ulnar nerve (lower two-thirds.)
Relations of the Superficial

Palmar Arch.

Front. (1) Skin. (2) Palmaris brevis, (3) Palmar fascia.

Behind. (1) Annular ligament, (2) Flexor brevis minimi
Superficial flexor tendons. (4) Divisions of median and ulnar nerves.
1\

digiti,

(3)

net-work of nerves

sit-

BRACHIAL PLEXUS.
LESSON XXIV.
A plexus
uated

in

the

is

net-work.

Its

axilla.

The Brachial Plexus

is

branches supply the upper extremity.

It
"brachial" because it supplies the arm or brachium.
anterior primary branches (Principle IV Lesson III) of the

is

is

called

composed

of the

It

fifth, sixth,

seventh,

The anterior branches of the fifth and

The anterior branch of the seventh
The anterior branches of the eighth
cervical nerve makes the second trunk.
These
cervical nerve and part of the first dorsal nerve make the third trunk.
trunks divide into anterior and posterior branches (secondary).
The anterior
branches of the firsl and second trunk make the outer cord; the anterior branch
of the third trunk make- the inner cord; and the posterior branches of all three
They are called outer, inner, and posterior
trunks make the posterior cord.
eighth cervical and

first

sixth cervical nerves

dorsal nerves.

make

the

first

trunk.

cords of the brachial plexus <m account of occupying that relation to the second
part

of the axillary

artery.

(Plates

VI-XVI-XVII.)

PLATE XXXVI

Showing the Cutaneous Nerve Supply of the Upper

Extremity
97

ANATOMY

'.s

The

axillary artery

is

IN A NUTSHELL.

parts by the Pectoralis

divided into three

muscle, the part above the muscle

is

called the

first

part, the part

minor

behind

it

is

and the part below it is called the third part. A branch

from the outer cord joins one from the inner cord to make the median nerve.
The outer cord gives off the external anterior thoracic and the musculo-cutane-

called the second part,

'The inner cord gives off the ulnar, internal cutaneous, lesser in-

ous nerves.

The posterior
cutaneous, and the internal anterior thoracic nerves.
cord gives off the three subscapular and divides into the circumflex and musculoternal

The musculo-spiral divides

spinal nerves.

and posterior

into the radial

inter-

isseous.

This plexus is situated in the posterior triangle of the neck between the
Scalenus anticus and the Scalenus medius, being covered by the skin. Platysma
myoides, and deep fascia; the posterior belly of the Omo-hyoid and the trans\

ersalis colli artery cross

clavian artery:

it

outer side of the

internally,

it.

It

next

lies

above and

passes behind the clavicle

first

in

to the

portion of the axillary artery, then

and posteriorly

to the

outer side of thesub-

the axilla where

its

it first

cords

lie

second part of the axillary artery.

lies to

the

externally.

From

the

third part branches are given to the upper extremity.

The
below
acic,

it.

clavicle divides the brachial plexus into

branches above

The branches above are communicating, muscular,

it

and branches

posterior thor-

and suprascapular.

The communicating branches

are. (1) one from the fifth cervical or from

and sixth cervical to the phrenic, which union takes
place on the Scalenus anticus muscle.
(2) A sympathetic connection.
The muscular branchesare, (1 those to the Longus colli whichcome from
the fifth, sixth, seventh, and eighth cervical before they enter into the brachial
(2) Those to the Scaleni which also come from the fifth, sixth, seventh,
plexus.
and eighth cervical before they enter into the brachial plexus. (3) Those to
the Rhomboidei, which come from the fifth cervical and pass through the
Scalenus medius beneath the Levator anguli scapulae, which it sometimessup(4) The nerve to the Subclavius which comes from
plies, to tiie Rhomboidei.
the fifth and sometimes the sixth cervical.
It often communicates with the

the loop between the

fifth

phrenic.

The
from the

posterior thoracic of long thoracic (external respiratory of Hell)

fifth, sixth,

and seventh

cervical.

It

is

formed

in

comes

the substance of the

Scalenus medius, then passes behind the brachial plexus and axillary artery to

supply the digitations of the Serratus magnus.

The suprascapular i- formed by the fifth and sixth: it passe> beneath the
Trapezius and Omo-hyoid to pass through the suprascapular notch into the
supraspinous fossa where ii gives two branches to the Supraspinatus muscle

and
into

branch

to the shoulder-joint,

then passes around the greal scapular notch

the infraspinous fossa, giving two branches to the Infraspinatus muscle

and one
All

to

the scapula

itself.

the other branches are below the clavicle.

The external or

superficial anterior thoracic

cord jusl below the clavicle and

it-

fibers

may

nerve comes from the outer

he traced to the

fifth, sixth,

and

ANATOMY
seventh cervical nerves.
the costo-coracoid

It passes

membrane and

IN A NUTSHELL.

99

inward across the axillary

vessels, pierces

supplies the Pectoralis major.

This loop

nicates with the internal or deep anterior thoracic.

It

commu-

around the
front and inner side of the axillary artery and branches are often given from it
to

is

the Pectoralis major.

comes from the inner cord and

It passes
its fibers may be traced to the eighth cervical and first dorsal nerves.
between the axillary artery and vein, sometimes piercing the sheath of the vein.
It gives a filament to a branch from the external or superficial anterior thoracic

The

Internal or deep anterior thoracic nerve

then pierces the costo-coracoid membrane to supply the Pectoralis minor; after
passing through the substance of this muscle it supplies the Pectoralis major.
The subscapular nerves are three in number, the upper, the middle, and

from the posterior cord, as a rule, although the upper one

may come from the posterior branch of the first trunk before it enters into tinThe upper one may be traced to the fifth and sixth cervical:
posterior cord.
it supplies the Subscapulars muscle.
The middle or long subscapular may be traced to the seventh, occasionally
The lower one may be
to the fifth and sixth; it supplies the Latissimus dorsi.
border of the Subaxillary
traced to the fifth and sixth cervical and supplies the
scapularis and the 'Feres major. The Teres major may be supplied by a separate
the lower.

All are

branch.

The circumflex comes from

spiral.

It

is

traced to the

the posterior cord in

common

and seventh
the axillary artery where
fifth,

sixth,

with the musculo-

cervical nerves.

It

lies

it passes downward and

behind the third portion of
outward to the lower border of the Subscapularis muscle; it then passes through
This space is
the quadrilateral space with the posterior circumflex artery.
hounded above by the Teres minor, below by the Teres major, on the outside
by the Humerus, and on the inside by the long head of the Triceps. It gives

an articular branch to the shoulder-joint which pierces the capsular ligament

The -ulterior branch winds
it then divides into a superior and inferior branch.

around the surgical neck

along the Deltoid to

its

of the

humerus with the

posterior circumflex vessels.,

anterior border, supplying the muscle and the integu-

ment over its lower part. The inferior branch supplies the Deltoid and Teres
minor.
The part supplying the Teres minor has a ganglion upon it. It then
pierces the deep fascia to supply the integument on the lower two-thirds of the

posterior surface of the Deltoid

and the integument over the long head

of the

branch from the circumflex nerve supplies the long head ol the
Biceps, the head of the humerus and the shoulder joint.
The median nerve is formed by a branch from the outer cord and one from

Triceps.

the inner cord.

cervical

and

of the Teres

first

Its fillers

may

dorsal nerves.

minor

be traced to the

fifth, sixth,

This junction takes place

as a rule, although

it

may

seventh and eighth

a1

the lower border

The

be almost to the elbow-joint.

branch from the inner cord crosses the third pari of the axillary artery; the
nerve lies then to the outer side of axillary artery, passing to the distal extremity
of the
axilla

arm
it

to pass

lies first

When the long

between the two heads of the Pronator

radii teres.

to the

outer side of the third part of the axillary artery,

head

the

ol

and produces pain "Glass .inn."

Biceps slips from Its normal position

This can be cured osteopathlcally.

11

presses

In the
in

the

on this nerve

PLATE

WWII
DEEP

CERVICAL

NODE

AXILLARY NODES

EPICONDYLAR

NODE

OR

GLAND

MEDIAN

Lymphatics \m> Veins oi the Qppee Extremity

100

CEPHALIC

Superficiai

ANATOMY
arm

it

IN A NUTSHELL.

101

the side of the brachial artery and after crossing

lies to

side of the artery.

It lias

no branches

in

the arm: at the elbow

it

t<>

the inner

gives off two

it

articular branches to the joint.

After passing between the two heads of the Pronator radii teres it passes
extremity of the forearm where it passes under the anterior annular

to the distal

ligament.

In its course, in the forearm.it first lies between the Flexor sublimis
digitorum ami Flexor profundus digitorum, then between the tendon.- of the
Flexor sublimis digitorum and Flexor longus pollicis.
It supplies all the muscles in

the

first

layer of the forearm except the Flexor carpi ulnaris. which are

the Pronator radii teres. Flexor carpi radialis. and Palmaris longus:
plies the

one muscle

in the

second layer which

is

it

also sup-

the Flexor sublimis digitorum.

LESSON XXV.
The anterior interosseous nerve is given off just below and is accompanied
by the anterior interosseous artery to the distal extremity of the forearm lying
on the interosseous membrane. The nerve is external to the artery being between the Flexor profundus digitorum and Flexor longus pollicis. This branch
supplies the Flexor longus pollicis, Pronator quadratus, and the outer side of
the Flexor profundus digitorum.

It

to the anterior interosseous artery

send- a branch to the wrist-joint, also one

and

to the interosseous

membrane,

medullar}- arteries and to the periosteum of the radius and ulna.

while to note that the anterior interosseous nerve

is

to the

worth
branch from the median.
It

i>

and the posterior Interosseous nerve is a branch of the musculo-spiral nerve,

while the anterior ami posterior interosseous arteries are both branches of the
same artery, viz.. the common interosseous.
The palmar cutaneous branch of the median nerve arises in the distal third
of the forearm, passes between the Flexor carpi radialis and Palmaris longus,
pierces the deep fascia proximally to the anterior annular ligament and passes
over that ligament to the integument and fascia on the palmar surface of the
It divides into two divisions, external and internal.
The external one
hand.
supplies the skin over the ball of the thumb ami anastomoses with the anterior
cutaneous branches of the musculo-spiral and radial nerves.
The internal
division supplies the integumenl on the palm, except that on the ulnar side and
anastomoses with the palmar cutaneous branches of the ulnar nerve.
The median nerve then enters the hand beneath the anterior annular ligament.
It spreads out and is of a reddish color.
It divides into external and
internal divisions.
It lies upon the flexor tendons and is covered by integument, palmar fascia, and the superficial palmar arch. The external division
supplies the Abductor pollicis. Opponens pollicis. ami superficial head ^\ the
Flexor brevis pollicis. and occasionally the deep head of that muscle.
The
other muscles of the
first,

thumb

are supplied by the ulnar.

second, and third digital branches for the

internal division gives off the fourth

and

It

then divides into

thumb and index

fifth digital

finger.

contiguous sides of the index and middle fingers and the middle ami ring

then there are

five digital

The

branches which supply the

branches from the median nerve.

fi]

ANATOMY

L02

IN A NUTSHELL.

The ulnar nerve arises a little below the lower border of the Pectoralis
Its fibers may be traced to
minor, from the inner cord of the brachial plexus.
lies on the inner side of the axillary
It
the eighth cervical and firsl dorsal.
it passes below the insertion of the Coracoforms an acute angle, and, in company with the posterior
branch of the inferior profunda artery, pierces the internal intermuscular septum,
then passing down to the groove between the internal condyle and the ole-

artery, also of brachial artery, until

brachialis where

it

cranon process

gives off two or three branches to the elbow-joint, then passes

it

between the two heads

of the Flexor carpi ulnaris in

forearm

company with

the pos-

between the Flexor profundus digitorum ami Flexor carpi ulnaris; in the middle third of the forearm
between the same two muscles with the Flexor sublimis digitorum on the other
It is situated on the inner side of the ulnar artery and crosses the anterior
side.
In the forearm it gives off
annular ligament on the radial side of the pisiform.
branches near the elbow-joint which supply the Flexor carpi ulnaris and the
inner part of the Flexor profundus digitorum.
The cutaneous branches arise about the middle of the forearm; there are
two of these branches. The one most superficial pierces the deep fascia near
the wrist to supply the integument and anastomose with the internal cutaneThe other branch, which is the deeper one, is called the palmar cutaneous.
It accompanies the ulnar artery, being upon its anterior surface, to the
ous.
he dorsal cutaneous arises about two or three inches from the wrist;
hand.
terior ulnar recurrent artery.

In the

it

lies

it

passes to the dorsal aspect of the wrist under the Flexor carpi ulnaris, super-

Extensor carpi ulnaris to supply the integument on the ulnar asof the hand and that of the little and half of the ring fingers.
The superficial terminal or palmar branch supplies the Palmaris brevis,
the hypothenar eminence, the inner side of the little finger on its volar aspect,
ficial

to the

pect of the

dorsum

and the contiguous sides of the

little and ring fingers.

The deep palmar arch
Abductor minimi digiti and Flexor brevis minimi
digiti. then through the Opponens minimi digiti to the deep surf ace of the flexor
tendons and their synovial sheaths.
supplies the Abductor minimi digiti,
It
Flexor brevis minimi digiti. opponens minimi digiti, two inner Lumbricales,
all the [nterossei, Adductor transversus pollicis, Adductor obliqus pollicis, and
inner head of the Flexor brevis pollicis and occasionally the outer head.
The ulnar nerve SUppileS eighteen muscles.

or branch passes between the

The musculO-CUtaneOUS or external cutaneous (perforans Casserii) comes

from the outer cord and its fibers may be traced to the fifth, sixth, and seventh
It supplies muscles in the arm but no integument, whereas it
cervical nerves.
supplies integument in the forearm but no muscles.
begins opposite the
It
lower border of the Vctoralis minor, passing outward and downward to pirece
I

which it supplies.
It
divides in the substance of this
muscle and passes to the outer side of the arm between the Biceps and the
Brachialis amicus, supplying these muscles.
It sends a branch with the nutri-

the Coraco-brachialis

artery into the bone.

The branch to the Coraco-brachialis is given off
from the nerve close to its origin. Occasionally this muscle is supplied by a
separate branch from the outer cord.
The branch to the Brachialis amicus
ent

ANATOMY

IN A NUTSHELL.

103

Near the outer border of the arm and a

sends filaments to the elbow-joint.
little above the tendon of the Biceps the nerve pierces the deep fascia, anastomosing with the proximal external cutaneous branch of the musculo-spiral,
passing below the median cephalic vein where it divides into anterior and posIt then becomes cutaneous.
terior.
The anterior branch passes along the radial side of the forearm to supply
the integument on the outer half of the anterior surface, ending in the thenar
It anastomoses with the radial and the palmar cutaneous branch of
eminence.

PLAT
i

OBLIQUE. LIGAMENT

POST. LIGAMENT

The Elbow-Joint External View

It gives off an articular branch to the carpal bones which pierces
the deep fascia to pass with the radial artery to the back of the wrist.
The posterior branch is smaller than the anterior one. It passes along the

the median.

It anastomoses
posterior aspect on the radial side of the forearm to the wrist.
musculo-spiral.
of
the
with the radial and the distal external cutaneous

LESSON XXVI.
The musculo-spiral is the largest branch of the brachial plexus. It mid the
supplies musIt
circumflex are the terminal branches of the posterior cord.
Its libers may be traced
cles and integument both above and below the elbow
.

ANATOMY

104
to the fifth, sixth, seventh,
It

commences

IX A NUTSHELL.

and eighth

cervica] nerves

and the

a1 the lower border of the Pectoralis major.

the third part of the axillary artery in front of the

first

dorsal nerve.

behind
Subscapulars. Teres major,
lies on the inner side of the
It first lies

and Latissimus dorsi. After leaving the axilla it

upper one-third of the humerus behind the brachial artery and in front of the
passes between the two humeral heads of the
li
long head of the 'Triceps,
Triceps in the musculo-spiraJ groove in company with the superior profunda
This nerve and the anterior branch of the superior profunda artery
artery.
perforate the externa! intermuscular

septum and pass

the groove between

in

the Supinator longus and Extensor carpi radialis longior on the outer side,

and

PLATE XXXIX

8'ceps

,'0BLlQ Ut

T ND0N

0AB/

UGAM Elu r

CUUfi

L 'GAMEH

J"

The Elbow-Joint Internal View

the Brachialis anticus on the inner side.

In

the lower part of this gr00V<

divides into the posterior interosseous and radial nerves.

nerve supplies

five

muscles

vi/...

longior, Triceps, Brachialis anticus

for

heboid we

cular septum.

will

This

have the

Supinator longus, Extensor carpi radialis

and Anconeus.
If we substitute Anconeus

muscles attached to the external

nerve has muscular branches

branch, cutaneous branches

seous and radial.

live

it

The musculo-spiral

(just

and two terminal branches,

intermus-

given), an articular

viz.,

posterior interos-

ANATOMY
Its articular

branch

is

IN A NUTSHELL.

105

given off from one of the branches to the Supinator

longus, Extensor carpi radians longior, or Brachialis anticus to the elbow-joint.

Its

cutaneous branches supply the integumenl of the arm over the musculoforearm over the radial aspect of the dorsum of the forearm

spiral groove; in the

as far as the wrist.

The

internal cutaneous branch given off

in

the axilla crosses

the tendon of the Latissimus dorsi, then passes behind the intercosto-humeral
nerve, pierces the dee]) fascia to supply the integument on the middle of the

back of the arm nearly

ternal cutaneous before

to the olecranon.
it

Ii

gives off

its

upper and lower ex-

pierces the external intermuscular septum; the upper

one perforates the outer head of the Triceps, accompanies the cephalic vein to
the elbow and supplies the integument over the lower half of the outer and inner
aspect of the arm.
The lower one is the larger. It arises behind the external
condyle to simply the integument on the lower part of the arm and radial asIt anastomoses with
pect of posterior surface of forearm as far as the wrist.
the musculo-spiral and internal cutaneous.
The radial nerve is the smaller of the two terminal branches of the musculoIt runs towards the wrist under the Supinator
spiral and is purely cutaneous.
longus. It passes in front of the elbow. radial recurrent a., and Supinator bre vis.
In the middle third of the forearm it lies parallel to. and on the outer side of.

The nerve

the radial artery, superficial to the Pronator radii teres muscle.

turns backward beneath the tendon of the Supinator longus and becomes cu-

taneous by piercing the deep fascia of the outer side of the forearm about three
its distal extremity: here it divides into two branches, external
and internal. The externa! one supplies the integument on ball and outer

inches from

border of thumb, anastomosing with the musculo-cutaneous. The inner one

anastomoses with the musculo-cutaneous and dorsal branch of the ulnar, supin a manner somewhat
median nerve on the palmar surface, the first branch to
the inner side of the thumb, the second to the radial side of the index finger,
the third to the adjacent sides of the index and middle fingers, and the fourth
to the adjacent sides of the middle and ring fingers.
The posterior-interovseous nerve passes around the outer side of the proximal end of the radius, through the substance of the Supinator brevis to the
back of the forearm, then passe> between the superficial and deep layers to
about the middle of the forearm where it passes beneath the Extensor longus

plying integument on the dorsum of the hand and fingers

similar to that of the

pollicis to lie

wrisl in

on the interosseous

company with

membrane on which

the posterior interosseous artery.

it

passes almosl to the

At the the distal ex-

accompanies the terminal branch of the anterior interosseous artery.

It then passes through the rourth opening of the posterior annular ligament to
the back of the wrist where it has a ganglion upon it. from which are given oft
tremity

its

it

branches of distribution

to the wrist-joint

and carpal

joint.-.

the muscles on the back of the forearm excepl the Anconeus.

muscles

in

all.

Extensor carpi
Extensor longus

It
It

supplies

all

supplies nine

Extensor communis digitorum, Extensor minimi digiti,

Supinator brevis, Extensor ossis metacarpi pollicis,
pollicis, Extensor brevis pollicis, Extensor indicis, all ol which

viz.,

ulnaris,

ANATOMY

106

IN A NUTSHELL.

and Extensor carpi

are on the back of the forearm,

radialis brevior in the radial

region.

internal cutaneous nerve

The

comes from the inner cord and

its fibers

may

The cutaneous branch

be traced to the eighth cervical and first dorsal nerves.
perforates the deep fascia in the axilla to supply integument over the back of
the
it

arm

About

nearly to the elbow.

half

way along

the inner side of the

pierces the deep fascia with the basilic vein, dividing into anterior

arm

and pos-

The anterior branch passes to the forearm either in front of,

terior branches.
or behind the median basilic vein, supplies integument of the ulnar aspect of the
anterior surface of the forearm as far as the wrist and communicates with the
posterior branch

The

ulnar.

forearm where

passes

in

front of the internal condyle to the

supplies integument on the ulnar aspect of the

it

the elbow

dorsum

of the

anastomoses with the lesser

internal cutaneous and at the wrist with the dorsal cutaneous of the ulnar.
The lesser internal cutaneous (nerve of Wrisberg) is the smallest branch of

forearm as far as the wrist.

the brachial plexus.

the

It

Above

it

comes from the inner cord and

its fibers

dorsal and sometimes the eight cervical in addition.

first

are traced to

In the axilla

it

communicates with the intercosto-humeral forming one or two loops. It is situated on the inner side of the axillary often being separated from the vein by
About the middle of the arm it pierces the dee]> fascia supplythe ulnar nerve.
ing integument over the olecranon.

LESSON XXVII.
The hand. (Plates XXVI-XXVII.)

There

are twenty-seven

bones in

the hand while there are but twenty-six in the foot, there being one more bone
The number of muscles in the
in the carpus (wrist
than in the tarsus (ankle.)
)

hand

twenty, the same as

is

forearm.

ductor

In

pollicis,

<

in

the foot.

thumb

(thenar

>pponens

pollicis

the

There are also twenty muscles

eminence) there are

(

in the

five muscles, viz.,

Ab-

Flexorossis metacarpi pollicis.) Flexor brevis

Adductor obliquus pollicis, and Adductor transversus pollicis. The first

the median nerve, the third one gets both the median and the ulnar
nerves, while the last two get the ulnar.
On the ulnar side of the hand there is
the Palmaris brevis and the three muscles of the little finger (hypothenar eminence!, viz.. A lull ict or minimi digit Flexor brevis minimi digiti, and theOpponens
minimi digiti (Flexor ossis metacarpi minimi digiti). All these are supplied by
In the middle palmar legion there are four Lumbricales, f our
the ulnar nerve.
Dorsal interossei, and three Palmar interossei. The two outer Lumbricales are
supplied by the median nerve, and the two inner ones and the seven Interossei
by the ulnar nerve. The bones in the carpus are in two rows, those of the first
row. beginning on the radial side are the scaphoid, semilunar, cuneiform, and
pisiform, and those in the second row beginning on the radial side are the trapezium, trapezoid, os magnum, and unciform.
The five beyond the carpus are
called the metacarpals, and the fourteen in the fingers and thumb are the phalThen the eighl carpal, plus the five metacarpal, plus the fourteen
langes.

pollicis,

two

gel

i.

phalanges,

make

the twenty-seven bones of the hand.

ANATOMY
The scaphoid

ossifies

IN A NUTSHELL.

the sixth year.

It

107

articulates with five bones,

viz..

magnum and

semi-

radius proximally. trapezium and trapezoid distallv. and os

lunar internally.

has one muscle attached, the Abductor

It

blood supply of the carpal bones

a large

is

pollicis.

The

the anterior and posterior carpal arch, and

branch from the anterior interosseous, and small branches from the pos-

terior interosseous.

The semilunar

fourth year.

ossifies the

radius proximally. os

magnum and

articulates with five bones, viz..

It

unciform

distallv.

scaphoid and cuneiform

CAPSULAR LIGAMENT

INT.

LATERAL

\\\ X

LISA! -1ENT

P0
.-X

\]^2i^A *l'^\
1

EXT. LATERAL LIGAMENT.

It','

POST. RADIO-ULNAR LIGAMENT

Tin: Wrist-Joint

on either

side.

It

Posterior

has no muscle attached.

View

The blood supply

i-

the

same

as

the carpus.

The cuneiform
viz.,

ossifies

the third year.

semilunar externally, pisiform

in

front,

It

articulates with

and unciform

the triangular interarticular fibro-cartilage which separates

end

of the ulna.

The

pisiform ossifies the twelfth year.

cuneiform.

minimi

There are no muscles attached

It

diuiti.

It

to this

three bone-.

distally,
it

and with

from the

distal

bone.

articulates with one bone, the

has two muscles attached. Flexor carpi ulnaris and Abductor

ANATOMY

108

IN A NUTSHELL.

The trapezium ossifies the fifth year, and articulates with four bones, viz.,
scaphoid proximally, trapezoid and second metacarpal internally, and the first
It has three muscles attached, Abductor pollicis, Flexor
metacarpal distally.
brevis pollicis,

metacarpi

ossis

Flexor ossis metacarpi

pollicis.

and occasionally the Extensor

pollicis.

'The trapezoid ossifies the eighth year.

articulates with four hones, the

It

scaphoid proximally, second metacarpal distally, trapezium externally, and the

It
may have a few fibers of the Adductor obliquus
os magnum internally.
pollicis

attached.

PLATE XLI

CAPSULAR LIGAMENT

EXTERNAL LATERAL LIGAMEN1

Tiii:

Wrist-Joint

Anterior

View

The OS magnum ossifies the first year. It articulates with seven bones,
scaphoid and semilunar proximally, second, third, and fourth metacarpal distally, trapezoid on the radial side, and the unciform on the ulnar side.
It has
one muscle attached, the Adductor obliquus pollicis.

The unciform

ossifies the

second year.

lunar proximally, the fourth and

nally

and the os magnum

It

articulates with five bones, semi-

metacarpal distally, the cuneiform interIt

externally.
has three muscles attached, Flexor
fifth

ANATOMY

IN A NUTSHELL.

109

and Flexor brevis minimi

carpi ulnaris, Flexor ossis metacarpi minimi digiti,

digiti.

Metacarpal bones.

and one

shaft
it

(Plate

VII.)

Each

one has two centers, one for the

thumb and
The nucleus for the shaft appears about

for the distal extremity, except the metacarpal of the

has one for the proximal extremity.

the eighth or tenth

week

of intrauterine

life,

and that

for the diaphysis the third

Each phalanx has two

one for the shaft "which appears the eighth or tenth week, and one for
the epiphysis between the third and fifth year, and joins the shaft the eighteenth
The epiphysis for each phalanx is proximal, so the nutrient artery runs
year.
towards the distal end (Principle III, Lesson I). The center for the distal phalanx
while that for the other phalanges is at
is at the distal extremity of the shaft,
The metacarpal of the thumb articulates with two
the center of the shaft.
bones, viz.. trapezium proximally. and the first phalanx of the thumb distally.
It has four muscles attached, Extensor ossis metacarpi pollicis, Flexor ossis
year, uniting with the shaft about the twentieth year.
centers,

metacarpi pollicis, Flexor brevis pollicis, and the First dorsal interosseous. The
second metacarpal articulates with five bones, the trapezium, trapezoid, and os
magnum proximally, the third metacarpal internally, and the first phalanx of
the index finger distally.

It

has six muscles attached, the First and Second

dorsal interossei. Extensor carpi radialis longior on the dorsal aspect of the bone

and the Extensor carpi

radialis, First

palmar interosseous, and the Adductor

obliquus pollicis on the palmar aspect of the bone.

ticulates with four bones, os
ternally, the fourth
finger distally.

It

magnum

The

third metacarpal artic-

proximally, the second metacarpal ex-

metacarpal internally, and the

first

phalanx

of the

middle

has six muscles attached; on the dorsal aspect the Second

and Third dorsal interossei, and the Extensor carpi radialis brevior and on
the palmar aspect the Adductor transversus pollicis. Adductor obliquus pollicis,
The fourth metacarpal articulates with five bones.
and Flexor carpi radialis.
os magnum and unciform proximally, os magnum and third metacarpal externally, the fifth metacarpal internally and the first phalanx of the ring finger
It has three muscles attached; on the dorsal aspect the Third and
distally.
Fourth dorsal interossei, and on the palmar aspect the Second palmar interosseous.
The fifth metacarpal articulates with three hones, the unciform proximally, the unciform and fourth metacarpal externally, and the lirst phalanx
of the little finger distally.
It has five muscles attached; the Extensor carpi
ulnaris, Plexor carpi ulnaris, Third palmar Interosseous, Fourth dorsal interosseous, and Plexor ossis metacarpi minimi digiti.
Flood supply of the first metacarpal bone is derived from the princeps
pollicis artery; it enters on the ulnar side, and is directed towards the head
of the

hone.

For

the

second

metacarpal bone, the nutrient artery P derived from

It enters on the ulnar side, and is directed towards

palmar interosseous.
the proximal end or base
lirsl

of the bone.

For the third metacarpal hone ih< nutrient artery is derived from the
interosseous; il enters as a rule, on the radial side and is directed towards
the base.

ANATOMY

110

IX A NUTSHELL.

For the fourth metacarpal bone the nutrient artery

second interosseous;

it

is

furnished by the

is

directed towards

enters on radial side of shaft, and

the proximal end.

metacarpal bone the nutrient artery is derived from the

it
enters the shaft on the radial side, and is directed to(Plate VI
page 33.)
wards the proximal end.
For the

fifth

third interosseous;

LESSON XXVIII.
first phalanx of the thumb articulates with two bones, the metacarpal
thumb proximally, and the second phalanx distally. It has five muscles

The
of the

Adductor obliquus, Adductor transversus

and the Flexor brevis pollicis.
The second,
or Last phalanx of the thumb articulates with one bone, the first phalanx of the
thumb. It has two muscles attached, the Extensor longus pollicis and the
attached,
pollicis.

the

Al idiictor

Extensor brevis

flexor longus

pollicis,

pollicis.

pollicis.

phalanx of the index finger articulates with two bones the second
metacarpal proximally. and the second phalanx of the index finger distally.
It
has two muscles attached, the First dorsal interosseous, and the First palmar inThe second phalanx of the index finger articulates with two bones,
terosseous.
the

The

first

first

phalanx proximally, and the

third phalanx distally.

It

has

three

muscles attached, the Extensor communis digitorum Extensor indicis. and the

The

phalanx of the index finger articulates

It has three muscles attached,
the Extensor communis digitorum, Extensor indicis. and Flexor profundus
The first phalanx of the middle finger articulates with two hones,
digitorum.
the metacarpal of the middle finger proximally. and the second phalanx of the
middle finger distally.
It has two
muscles attached, the Second and Third
The second phalanx of the middle finger articulates with
dorsal interossei.
two bones, the first phalanx proximally. and the third phalanx distally.
In has
two muscles attached, the Extensor communis digitorum and Flexor sublimis
The third phalanx articulates with one hone, the second phalanx
digitorum.
It
proximally.
has two muscles attached, the Extensor communis digitorum
and flexor profundus digitorum.
The lir>t phalanx of the ring finger articulates with two bones, the fourth
metacarpal proximally. and the second phalanx of the ring finger distally.
It
ha- two muscles attached, the Fourthdorsal interosseous and the Third palmar
flexor sublimis digitorum.

last

with one bone, the second phalanx proximally.

The second phalanx of the ring finger articulates with two bones.
phalanx of the ring finger proximally, and the third phalanx distally.
It
has two muscles attached, the Extensor communis digitorum and Flexor
The third phalanx of the ring finger articulates with one
sublimis digitorum.
hone, the second phalanx proximally. and has two muscles attached, the Exinterosseous.

the

first

communis digitorum ami flexor profundus digitorum.

The first phalanx of the little finger articulates with two bones, the

tensor

metacarpal proximally. and the second phalanx of the

ha- three muscles attached, the Extensorbrevis minimi

little

finger distally.

dieiti,

fifth
It

Abductor minimi

ANATOMY

IN A

NUTSHELL.

Ill

and the Third palmar interosseous. Thesecond phalanx of the little

two hones, the first phalanx proximally and the third
phalanx distally. It has three muscles attached, the Extensor communis
digitorum. Extensor minimi digiti, and Flexor sublimis digitorum.
The third
phalanx of the little finger articulates with one hone, the second phalanx proximally, and has three muscles attached, the Extensor communis digitorum
Extensor minimi digiti. and Flexor profundus digitorum.
Description.
(Plate XXXI.)- This is a thin flat
Abductor pollicis.
muscle placed immediately beneath the integument.
It
passes outward and
digiti,

finger articulates with

PLATE XLII

Showing the Synovial Membranes of the Wrist

downward and terminates
the

in a flat tendon, sending a slip to join the tendon of

Extensor longus pollicis.
ORIGIN.
Ridge of trapezium and annular ligament.
(Plate XXVII.)
Insertion.- Radial side at base of first phalanx of thumb. (Plate XXVII.)

Action. Abducts the thumb.

Nerve Supply.

Sixth cervical through the median.

ANATOMY

112

From

Blood Supply.

pollicis. -(

Opponent

XXXI.)
Origin. (Plate

This

(Plate

is

IN A NUTSHELL.

superficialis volae artery.

metacarpi

Flexor ossis

Description.

pollieis.)

a small triangular muscle placed beneath the preceding.

XXVI.) Palmar

surface

trapezium and

of

annular

ligament.
I

nsertii

Whole length

in.

of

metacarpal of

thumb on

(Plate

radial side.

XXVI.
Flexes metacarpal of thumb.

Action.

Nerve Supply.
Blood Supply.
Flexor brevis

Sixth cervical through the median.

From

pollicis.

radial

and

superficialis volse arteries.

Description.

(Plate

XXXI.)

This

muscle con-

two portions outer and inner, having separate origins and insertions.
The outer portion is the more superficial and has a sesamoid hone developed in
The inner and deeper portion is very small.
its tendon.
sists of

Origin.- (Outer portion) Trapezium and outer two-thirds of annular

ament.

Inner portion) Ulnar side of

Insertion.

Both

metacarpal bone.

first

sides of base of

(Plate

lig-

XXVIII.)

phalanx of thumb by two tendons.

first

XXVII.)

(Plate

Action.- Flexes thumb.

Nerve Supply. Outer portion, sixth
portion, eighth cervical through ulnar.

through

cervical

Blood Supply. From radial artery.

Adductor obliquus pollicis. Description.

(Plate

median;

XXXI.)

This

inner

muscle

The greater number of fillers pass obliquely downward

a tendon which mutes with the tendons of the deeper portion
flexor brevis and Adductor transversus pollicis, a sesamoid bone being

by several
and converge to
arises

of the

developed

slips.

the tendon of insertion.

in

considerable fasciculus passes ob-

outward beneath the tendon of the long flexors to join the superficial
portion of the short flexor and the Abductor pollicis.
This muscle was formerly

liquely

described as the deep portion of the Flexor brevis pollicis.

Origin. (1) Os magnum;

bones;

(3)

radialis.

anterior carpal

(Plate

(2)

bases

ligaments;

(4)

of

second

and third metacarpal

sheath of tendon of Flexor carpi

XXVII.)

Insertion.- Inner side of base of first phalanx of thumb. (Plate XXVII.)

Action.
Moves thumb inward toward index finger.

Nerve Supply.

Eighth cervical through ulnar.

Blood Supply.- From the palmar

Adductor

transversus

pollicis.

arches.

Description.

the mosl deeply seated of tins group of muscles;

by

its

mon

The

broad base.

libers

it

(Plate
is

XXXI.) This

triangular

in

is

form, arising

converge toward their insertion which

is

in

com-

with the inner part of the Flexor brevis pollicis and the Adductor obliquus

pollicis.

From

this

common tendon

a slip

is

prolonged

to the

Extensor longus

pollicis.

Origin.
face.

(Plate

bower tw<
XXVII.)

Insertion.
don.

(Plate

-thirds of metacarpal of middle finger on

Ulnar side of base of

XXVU

firsl

phalanx

of

palmar sur-

thumb by common

ten-

ANATOMY

IN A NUTSHELL.

113

Draws thumb towards median line.

Xerye Supply. Eighth cervical through ulnar.
Blood Supply. From the palmar arches.
Action.

LESSOX XXIX.

Description. (Plate XXXI.) This is a thin, quadmuscle placed beneath the integument on the ulnar side of the hand.
The palmar fascia is in relation with its deep surface and separates it from the
Palmaris brevis.

rilateral

ulnar vessels and nerve.

Annular ligament by tendinous fasciculi and palmar

Insertion. Skin on inner border of palm.
(Plate XXXI.)
Action. Corrugates skin of hand.
Origin.

fascia.

Xera'e Supply. Eighth cervical through the ulnar.

Blood Supply. The ulnar artery.
Abductor minimi digiti. Description. (Plate XXXI.) This muscle is
situa ted on the ulnar border of the palm of the hand.
Origin. Pisiform bone and from the tendon of the Flexor carpi ulnaris.
Insertion. By two slips, the one into ulnar side of base of first phalanx
of little finger: the other into ulnar border of the aponeurosis of the Extensor

minimi digiti. (Plate XXVII.)

Action. Abducts little finger from middle line of hand.
Xerye Supply. Eighth cervical through the ulnar.
Blood Supply. The ulnar artery.
(Plate XXXI-XXVII.)
Flexor brevis minimi digiti. Description.
The
Flexor brevis minimi digiti lies on the same plane as the preceding muscle, on
It is separated from the Abductor at its origin by the deep
its radial side.
This muscle is sometimes wanting;
branches of the ulnar artery and nerve.
the Abductor is then usually of large size.
Origin. From the convex aspect of the hook of the unciform bone and

anterior surface of annular ligament.

Insertion. Inner side of base of first phalanx of little

Action. Flexes little finger.
Nerve Supply. Eighth cervical through the ulnar.
Blood Supply. The ulnar artery.
Opponens minimi digiti (Flexor ossis metacarpi minimi

tion.

(Plate

finger.

XXXI.)

This

is

a triangular

muscle

Descripimmediately

digiti).

placed

beneath the preceding

Origin. From convexity of hook of unciform bone and contiguous portion of annular ligament.
(Plate XXVII.)
Insertion. Whole length of metacarpal of Little finger along ulnar mar.

gin.

XXVII.)
Action. Draws fifth metacarpal forward
(Plate

Nerve Supply.
Blood Supply.
Lumbrieales.

Eighth cervical
Ulnar artery.

Description.

so as to

deepen hollow of palm.

through ulnar.

(Plate

XXXI) The

Lumbricales

small fleshy fasciculi, accessories to the deep Flexor muscle.

are

four

ANATOMY

14

NUTSHELL.

IN A

Tendons of deep flexor. (Plate XXXI.)

Tendinous expansion from Extensor communis digitorum on

Origin.

[nsertion.-

hack

each finger.

of
\i

To

ion.

Nerve

flex

firsl

phalanges.

The two

Si pply.

outer

Lumbricales by

the

sixth

cervical

through the third and fourth digital branches of the median; the two inner by
The third lnmthe eighth cervical through deep palmar branch of ulnar.
brical receives the median in almost half the cases.

Blood Si pply. From digital branches of the superficial palmar arch

and the interosseous branches of the deep palmar arch.
XXXI Y-XXX [II.) These
dates
Description.
Dorsal Interossei.
small muscles, four in number, occupy the intervals between the metacarpal
They are bipenniform. Between the double origin of each is a narrow
bones.
triangular interval, through the firsl of which passes the radial artery; through
each of the miter three passes a perforating branch from the deep palmar arch.

The Abductor

indicis or the Firsl dorsal interosseous

is

the largest of these

muscles.

by

two heads; (1) Outer head from upper half of ulnar border
of first metacarpal hone. ('_') Inner head from almost the whole length of the
(Plate XXVI.)
radial border of the second metacarpal bone.
side
Into
radial
of
of
first phalanx of index finger.
the
base
Insertion.
Origin.

Second dorsal interosseous.

Origin.
By two heads from the adjacent sides

'The

metacarpal.

Plate

of the

second and third

XXVI.

Insertion into the radial side of the first phalanx of middle finger.
The Third dorsal interosseous.
ORIGIN.
By two heads from the adjacent sides of the third and fourth metacarpal bones.

(Plate

XXVI.)

Insertion. -Into the ulnar side of the

firsl

The Fourth dorsal interosseous.

Origin.
By two heads from the adjacent
(Plate

carpal bones.

phalanx

of

middle

sides of the fourth

and

finger.

fifth

meta-

XXVI.)

first phalanx of ring finger.

Extend the last two phalanges. (2) Flex the metacarpophalangeal joints, (3) Ahdnct the fingers.
Blood Supply. From deep palmar and posterior carpal arches.
Nerve Supply. Deep branches of the ulnar nerve.
The Palmar interossei which are placed on the palmar surface of the second. Fourth and fifth metacarpal bones are three in number.
Their insertion
besides being into the bone is into the aponeurotic expansion ^( the common
tendon of the same finger, the same as the dorsal interossei.
(Plate XXXV.)
Firsl palmar interosseous.
Origin.
By one head from the ulnar side of the second metacarpal hone.
Insertion.
Into the ulnar side of the firsl phalanx of index finger.
Second palmar interosseous.

Insertion.

Action.

<

>RIGIN.

Into the ulnar side of the

(1)

By one head from

the radial side of the fourth metacarpal hone

ANATOMY

IN

A NUTSHELL.

115

Insertion. Into the radial side of the first phalanx of ring finger.
Third palmar interosseous.
Origin.
By one head from the radial side of the fifth metacarpal bone.
Into the radial side of the first phalanx of little finger.
Insertion.

Each

finger has

ductor minimi

two [nterossei muscles except the

one of the pair.

little

The Ab-

finger.

digiti takes the place of

Nerve Supply.
Blood Supply.
Action. Same

Ulnar.
Deep palmar

arch.

as the Dorsal interossei,bu1 these adduct instead of abduct.

LKSSOX XXX.

Fascia of the arm. Just beneath the skin is the superficial fascia which
has two layers, a superficial one consisting mainly of adipose tissue, and a deep
one which is fibrous in structure and is in contact with the deep fascia. The

and lymphatics lie between these two layers.

deep
of
fascia
the
arm forms a sleeve which encloses the muscles and
The
most of the vessels and nerves.
It is continuous with the fascia of the chest.

superficial nerves; vessels

back, shoulder above by being attached to the clavicle, the scapula ami the

and to that of the forearm by being attached to the condyles of the humerus and olecranon of the ulna. It is thin over the Biceps, thick over the
Triceps; strengthened on the inner side by fibers from the tendon of the Pectoralis major and Latissimus dorsi, on the outer side by fiber- from the tendon
of the Deltoid; the axillary fascia is also continuous with it.
The external intermuscular septum extending from the insertion of the Deltoid to the External
condyle and attached to the superior condylar ridge joins the inner surface of
spine,

the deep fascia, thus dividing the sleeve or cylinder of fascia into an anterior

and posterior compartment, the anterior one having flexor muscles in it and the
This septum is pierced by the musculothe posterior one extensor muscle.-.
It has five
spiral nerve and superior profunda artery from behind forward.
muscles attached to

it,

viz..

Deltoid,

Brachialis anticus, Triceps. Supinator

longus, and Extensor carpi radialis longior.

stitute the Deltoid for Anconeus

we

will

In these five

have the

five

muscles

if

we sub-

muscles supplied by the

musculo-spiral nerve.

The

internal intermuscular septum i- thicker than the external one: it

from
the insertion of the Coraco-brachialis to the internal condyle ^\
extends
the humerus, being attached to the supracondylar ridge to the inner surface of
the sleeve of fascia of the forearm.
It also divides the muscles into an anterior

and posterior

division.

Brachialis anticus,

Il

has three muscles attached to

ii.

vi/...

the Triceps,

and Coraco-brachialis, and occasionally the Pronator radii

If we stubsitute the Triceps for Biceps in this group of muscles we will

teres.
have the muscles supplied by the niusculo-cutaneotis nerve. The basilic vein
pierces the deep fascia at the junction n\' the lower third with the middle third
of the humerus.
The deep fascia of the forearm is continuous with thai of the arm at the
It
passes over the anterior anelbow and with that of the hand ;it the wrist.

ANATOMY

lit)

IN A NUTSHELL.

nular ligament which is in reality the aponeurosis which separates the first and
It passes from the pisiform bone
second layers of the muscles of the forearm.
and unciform process to the scaphoid and trapezium; it is a strong fibrous band.

At the posterior aspect it is thickest where it is attached to the sides of the

triangluar posterior surface of the olecranon and to all of the posterior ridge of
the ulna.

dyle
is

It

in front,

communicating vein

pierced by a

The

band from the

bicipital fascia below the internal confrom

insertion of the Triceps behind.
the
It
and an aponeurosis

receives a

posterior annular ligament

at
is

the cubital fossa.

strengthened by transverse fibers and

passes from the outer border of the lower end of the radius across to the inner
side of the pisiform and cuneiform bones, its inner surface being attached to the
ridge on the posterior surface of the radius.
(if

the extensor tendons; the

first

It

makes

six canals for the passage

canal has the Extensor ossis metacarpi pol-

and Extensor brevis pollicis; the second the Extensor carpi radialis longior
and Extensor carpi radialis brevior; the third the Extensor longus pollicis; the
fourth the Extensor communis digitorum, which is in the superficial layer,
and the Extensor indicis, which is in the deep layer; the fifth, the Extensor
minimi digiti which is in the superficial layer; the sixth, the Extensor carpi

licis

ulnaris which,

is

the superficial layer.

in

The anterior annular ligament has nine muscles attached to

the

thumb except

the Adductor transv< rsus pollicis, and

those of

it, all

those of the

all

the Abductor minimi digiti; then there are four of the

finger except

little

thumb

and two

of the little finger, making six

ulnaris,

Palmaris longus, and Palmaris brevis, making the nine. The tendon of

besides these six

it

has the Flexor carpi

he Flexor carpi radialis pierces the anterior annular ligament and the Palmaris
The median nerve and the
Longus passes over it. but is also attached to it.
tendon- of three muscles pass under it; the muscles are the Flexor sublimis
i

digitorum, flexor profundus digitorum, and Flexor longus

Fascia of the hand.

The

hand.

It

Between the

pollicis.

thehand isthinand

is

com-

a continuation of the posterior

connects the extensor tendons together on the back of the

posed mostly of transverse

annular ligament.

fascia on the back of

fingers

the bases of the fingers.

fibers.

it

This fascia

dips

The deep

down

layer

is

is

to

join

the

web which

connects

attached to the back of the meta-

and covers the Dorsal intemssei.

Palmar Fascia. The deep palmar fascia consists of strong fibrous tissue
covering the palmar surface of the hand.
It is for the most part formed by the
expansion of the tendons of the Palmaris longus.
is also continuous with
It
the anterior annular ligamenl
It has a central and two lateral
proximally.
portions.
The central portion is triangular with the apex towards the wrist
and base towards the fingers. The superficial part is formed by longitudinal
filier- and the deep part bytransverse fibers.
Its base is divided into four procarpal.-

cesses wh'n h

j<

in

the ligamenta vaginalis of the finger tendons.

(Plates

XXIX-

XX XI o
Ligamenta vaginalis are fibrous -heaths or theca over the flexor tendons.
are so attached to the phalanges as to form osseo-aponeurotic canals
These -heaths are strong opposite the middle of the first and second phalanges,

They

ANATOMY
but

much

IN A NUTSHELL.

117

Each sheath is lined by a synovial memupon the tendons. The synovial sheaths for the tenthe thumb and little finger are continuous with the two synovial bursa'
thinner opposite the joints.

brane, which

is

reflected

dons of
beneath the anterior annular ligament, but those for the intervening digits
terminate in a sac near the metacarpophalangeal articulation. The outer portion (thenar fascia) covers the ball of the

thumb.

Proximally

it is

attached to

Palmaris brevis and aponeurosis from the tendons of the Extensor ossis metacarpi pollicis.
It continues distally with the ligamenta vaginalia of the Flexor longus pollicis.
The inner
portion or hypothenar fascia, is triangular with the apex proximally and atthe anterior annular ligament, the tendons of

the

tached to the anterior annular ligament and deep fascia of the forearm at the
inner side of the wrist distally it is covered above by the Palmaris brevis.
:

(Plate

XXX.)

LESSON XXXI.
Besides the arterial, venous and capillary circulation there
circulation extending over the

body by beginning

is

lymphatic

in microscopical spaces

and

These vessels are enlarged by

receiving radicles or tributaries in a like manner to the veins.
Along the course
There
of the lymphatic vessels are lymphatic nodes, sometimes called glands.
They are situated
are in the neighborhood of seven hundred of these nodes.
In the upper extremity
principally in the abdominal and thoracic cavities.
they are found no farther than the elbow. In the lower extremity they are
found no farther than the popliteal space, as a rule: however, a few may be
extending until they form lymphatic vessels.

found on the anterior tibial artery. These nodes manufacture the white blood
There are four other places in the body where they are manucorpuscles.
factured. viz.. spleen, thymus gland, thyroid gland and the red marrow of b

The lymph

of all the

body, except the right side of the head, the right side

of the thorax, the right arm,

and the upper surface

large duct, the left lymphatic or thoracic duct.

cause

it

passes through the thorax.

It is

of the liver collects into a

thoracic duct beabout fifteen or eighteen inches long.

It is called

begins in front of the second lumbar vertebra

where it is enlarged (recepand extends through the thorax, through the superior opening
of the thorax, and empties into the left subclavian or innominate vein.
The heart is the main factor in the circulation of the lymph. The other
The lymphatic vessels and nodes, like
factors will be learned in physiology.
After the blood
the veins of the arm, are in two sets, a superficial and deep set.
has passed through the arteries and capillaries, nourishing the various parts, it
comes back by means of the vein.-.
The superficial veins of the distal extremity receive the name radial, anThey lie between the two layers of
terior and posterior ulnar, and median.
It

taculum

chyli)

the superficial fascia.

The

side of the

bend

(Plate

anterior ulnar

of the

hand and

is

a network of veins at the anterior and ulnar

extends on this aspect of the forearm t<> the
joins the posterior ulnar to form the common ulnar.

wrist.

elbow where

XXXVII.)

formed by
it

It

ANATOMY

lis

The

IN A

NUTSHELL.

posterior ulnar begins a1 the ulnar aspecl of the wrist,

passes to the bend of the elbow to join the anterior ulnar.

The common ulnar runs upward and outward to join the

from which

median

it

basilic to

form the basilic, which pierces the deep fascia in the inner side and below the
middle of the forearm to ascend with the brachial artery and continues as the
axillary vein.

At times the

common

ulnar

is

absent, the anterior and posterior

ulnar joining the median basilic separately.

The median vein is formed on the palmar surface of the hand and passes to
the bend of the elbow where it divides into two branches, median basilic and
venae comites of the ulnar beIt communicates with the
median cephalic.
This
link is called the deep median
elbow.
communicating
fore it reaches the
vein.

The
ii

radial begins

on the dorsum of the thumb and radial aspect of the hand;

it joins the
median cephalic forming the

passes to the elbow-joint where

cephalic.

The

cephalic vein passes on the outer side of the Biceps to the groove be-

tween the Heboid and the Pectoralis major;

membrane

it

perforates the deep fascia

and

below the clavicle.

connects
external
jugular
or
subclavian
the
by a branch
with
occasionally
the costo-coracoid

front

to

end

in the axillary vein

It
in

of the clavicle called the jugular cephalic.

accompany the arteries; they are

and are connected along their course by transverse branches.
The digital arteries have venae comites which unite at the base of the fingers to
end in venae comites of the superficial palmar arch. Those of the radial side
accompany the superficialis volae,while those of the ulnar side end in the deep
ulnar veins.
The veme comites of the ulnar and radial unite to form the
brachial venae comites.
The venae comites of the anterior and posterior interosseous unite at the proximal extremity of the forearm, ending in the ulnar
The deep palmar veme comites empty into the radial externally
venae comites.
and the ulnar internally. The brachial veme comites are formed by those of
the forearm; they accompany the artery and empty into the axillary just above
the lower border of the tendon of the Latissimus dorsi.
The axillary vein is a continuation of the basilic. It accompanies the axillary artery and becomes the subclavian vein at the upper extremity of the axilla.
The deep

veins of the upper extremity

called venae comites

It

has a pair of valves opposite the lower border of

receives radicles

corresponding

receives the cephalic vein.

to the

the

Subscapularis.

branches of the axillary artery.

It

It also

ANATOMY

IN A NUTSHELL.

119

The axilla is the anatomical space through which passes the brachial plexus
and the axillary vessels. It is filled with lymphatic vessels and nodes and areolar tissue. It is pyramidal in shape,having four sides, a base. and an apex. The
apex corresponds to

a point

between the

upper part of the scapula

fascia passing from
the lower borders of the Latissimus dorsi behind and the Pectoraiis major in
front.
The anterior margin of the base is higher than the posterior margin.
This space is narrow externally, but broad internally.

and the

The base

first rib.

is

clavicle, the

the arm-pit which

is

made by

Plate XVI.
Its boundaries are as follows:
In Front: (1) Pectoraiis major. (2) Pectoraiis minor.
Behind: (1) Subscapulars (above,) (2) Teres major and

(3)

Latissimus

dorsi (below.)

Outer

Side:
(1) Humerus, 2) Biceps, (3) Coraco-brachialis.
Ennek Side: (1) First four ribs and their intercostal spaces. (2) a part of
the Serratus magnus.
The axillary vessels, brachial plexus, branches of the intercostal nerves,
lymphatic nodes, all connected by areolar tissue and fat lie in this space.
In finishing the

hand which

is

arm

as follows:

it is

well to review the cutaneous nerve supply of the

Plate

XXXVI.

All the integument on the ulnar side of the middle line of the ring finger on

both palmar and dorsal surfaces of the hand is supplied by the ulnar nerve.
This line on the dorsum of the hand may be drawn through the middle
OF THE MIDDLE FINGER INSTEAD OF THE RING FINGER. All (ill the radial side of
this line on palmar surface is supplied by the median, on the dorsal surface by
the radial.
The radial nerve extends to the base of the thumb nail, to the distal
interphalangeal joint of index finger and not quite to the proximal interphalangeal joint of middle finger, and sends a few twigs to the skin of the metaphalangeal articulation of ring finger. The parts of the dorsal of the thumb, index.
middle and ring fingers not supplied by the radial get the median.
The synovial membrane of the wrist (Plate XLII.) This membrane consists of five portions.
First portion is called membrana sacciformis and is
between the interarticular fibro-cartilage and the ulna, also extending between
The second portiox is between the radius and interthe radius and ulna.
articular fibro-cartilage proximally and the scaphoid, semilunar and cuneiform
The third portion is between the trapezium and metacarpal nl the
distally.
thumb. The fourth portion is large and extends between the scaphoid,
semilunar and cuneiform proximally and after sending septa between the bones
of the second row of the wrist ends by separating this second row from the second, third, fourth and fifth metacarpal bones distally.
also sends projecIt
bones
mentioned.
Tim:
just
fifth PORTION is
tions between the metacarpal
between the cuneiform and pisiform bones.

ANATOMY

120

IN A NUTSHELL.

REVIEW QUESTIONS.
1.

2.
:;.

I.
.",.

ft.

7.

8.
!t.

10.

Anatomy.

trim.-

Define each of

its

nine divisions.

rive three definitions for

What

IS

Aponeurosis.

tendon?

Give two definitions for Sinus,

Define Apophysis
Define Epiphysis.

Which way do the nutrient arteries run in the bones of the arm?
Which way do the nutrient arteries run in the bones of the leg?
rive four rules tor

Epiphysis.

ll.i rive functions of Periosteum.

12.
L3.

11.
1.").

lfi.

7.

18.
19.
l'ii.

21.

22.
23.

1.

25.

How does a long hone grow in length, also in thickness?

Name the ninety long hones.
Name the forty flat horn-.
Name the forty irregular bones,
Name the thirty short bones.
Name eight eminences on bones.
Name fourteen prominences on bones.
Name five articular cavities in bones.
Name ten non-articular cavities in bones.
Name the bones of the body and tell what each means.
Now many muscles in the body?
Name six ways in which muscles take their names.
What
Whal

is

the origin of a muscle?

is

the insertion of a muscle?

26.

Give parts thai make a

27.

<

28.

'

29.
30.
31.

32.
.",:;.

34.

joint.

rive Hilton's law.

uve

all

subdivisions of synarthrosis and an example of each.

Same of A.MPHIARTHROSIS.
Same of DIARTHROSIS.
How do ligaments take their names?
What is a muscular nerve?
What is a cutaneous nerve?
What is a musculo-cutaneous nerve?
concerning nerve roots and their branches.

:;.".

Give

36.

Give definition

:;7.

Give name, distribution, function ami method of exit of the

live principles

for

nerve center.

nerve.
38.
.'!'.).

Hi.

II.
12.

Same
Same
Same
Same
Same

of

2nd cranial nerve.

of 3rd cranial nerve.

of

1th cranial nerve.

of 6th cranial nerve.

of tith cranial nerve.

1st cranial

ANATOMY

50.

Same
Same
Same
Same
Same
Same
What
What

51.

Who

52.

Where

53.

What kind

54.

Capillaries are not

55.

Which are the larger, arteries or veins?

What do you understand by anastomosis?

43.
44.
4o.

46.
47.

48.
49.

56.
57.
58.

121

IN A NUTSHELL.

of 7th cranial nerve.

of 8th cranial nerve.

of 9th cranial nerve.
of 10th cranial nerve.
of 11th cranial nerve.

of 12th cranial nerve.

is

the lesser circulation of the blood?

is

the greater circulation of the blood?

demonstrated the circulation

is

of the blood?

the purest blood in the body found?

of

muscle is the heart?

found in what structures'.'

Give rule for arteries and veins above and below the diaphragm.
Name >ome of the veins that do not have valves.

59. Trace the fetal circulation.

60.

Name

61.

The

62.

The

the things obliterated at birth in the fetal circulation.

eight cervical nerves leave the spinal cord above the spinous

process of what cervical vertebra?

first six

dorsal nerves leave the spinal cord between the spinous

processes of what vertebrae?

63.

The lower

64.

The

six dorsal nerves leave the spinal cord

between the spinous

processes of what vertebrae?

five

lumbar nerves leave the spinal cord between the spinous

processes of what vertebrae?

65.

The

five sacral

cesses of
66.
Ii7.

68.

nerves leave the spinal cord between the spinous pro-

what vertebrae?

Bound the Axilla.

Bound the Quadrilateral Space.
What pierces the Costo-coracoid .Membrane?

69. Describe the Costo-coracoid

70.

71.
72.

73.

.Membrane.

What structures lie in the Axilla'.'

What structure- pass through the Quadrilateral Space?
What nerves branch from each cord of the Brachial Plexus?
What and how many muscles are supplied by the musculocutaneous?

74.
75.

70.

77.
78.
7'.i.

What and how

What and how
What and how
What and how
What and how
The Rhomboid

80.

The

81.

What

82.

many
many
many
many
many

muscles are supplied by the median?

muscle- are supplied by the circumflex?
muscles are supplied by the musculo-spiral?

muscles are supplied by the ulnar?

muscles are supplied by the Subscapular nerves?
nerves come from which one'.'

Posterior Thoracic comes from which

one-'.'

another mime tor this nerve?

The Supra-scapular come- from which ones?
is

ANATOMY

22

IN A NUTSHELL.

86.

rive the nerve supply of integument of hand.

Give the nerve supply of Lumbricales.
live the nerve supply of [nterossei.
Group the musch son forearm; give nerve supply.

87.

Wha1 muscles

ss.

\\ lint

83.
84.
85.

<

<

muscl<

are attached to the External Lateral

Ligament?
Septum?

are attached to the Internal Intermuscular

95.

Wha1 muscles arc attached to the Externa] Int< rmuscular Septum?

What thr< e muscL s are attached to the Common Aponeurosis?
What passes under the Anterior Annular Ligament?
What passes through the Anterior Annular Ligament?
W Mat musclt s are attached to Ann Lor Annular Ligament?
What muscles pass through the six openings in Posterior Annular

96.

Ligament ?
Give the three divisions of Axillary Artery.

89.
90.
91.
92.
94.

.i7.

Give the relations of the

98.

rive the relations of the

first

part of Axillary Artery.

second part of Axillary Artery.

the third part of Axillary Artery.

99.

<

rive the relations of

LOO.

<

rive the

101.

Give relations of Brachial Artery.

102.

Name the branches of Brachial Artery.

Give the relations of Radial Artery.
Name the branches of the Radial Artery.

L03.

lo

I.

branches of each part of Axillary artery.

L06.

Give relations of Ulnar Artery.

Give the branches of Ulnar Artery.

107.

Give relations of Superficial Palmar Arch.

ins.

What
What
What
Whai
What

in.").

109.
110.
111.

112.
13.

I.

15.

16.

17.

lis.
1

19.

pierces the Coraco-brachialis?

passes between the two heads of the Pronator radii teres?

passes between the two heads of Flexor carpi ulnaris?
pierces the Internal intermuscular

Desci Lbe
\\

he

lubital fossa?

through the Cubital fossa?

"hat passes

Name

be bon< sof

be Carpus.

rive articulation of

septum?
septum?

pierces the External intermuscular

each hone.

Which ones have muscles attached to them?

What muscles are attached to the Trapezium?

hat muscles are attached to the

0s magnum?
Unciform?

are attached to the

121.

What musclt
What muscles

122.

are attached to the .Metacarpal (each hone)?

120.

23.

P_' 1.

125.

hat musclt

arc attached to the Pisiform?

What muscles are attached

What muscles are attached

How many

bones

in

live

ligamenl

127.

<

rive

Ligaments of scapula.

128.

Give ligaments

'jt\.

to the

the hand?

to the

of clavicle.

of shoulder.

Phalanges of the thumb?

Phalanges of the fingers?

ANATOMY

NUTSHELL.

IN A

123

Give ligaments of elbow.

Give ligaments of forearm.
131. Give ligaments of wrist.
132. What kind of joint is Sterno-clavicular?
133. What kind of joint is Acromio-clavicular?
129.

130.

134.

135.
136.
137.

138.
139.
140.
141.
142.

143.
144.

What
What
What
From
What
What
What
What
What
What
What

kind of joint

is

kind of joint

the elbow?

is

what do cords
(-(inverts

the shoulder?

is

kind of joint

the wrist?

of Brachial plexus take their

names?

the Supra-scapular notch into a foramen?

vessels pass

above the Transverse Ligament?

structure passes below the Transverse ligament?

structures go through the Musculo-spiral groove?

holds the

arm

in position?

forms the Superficial palmar arch?

forms the deep palmar arch?

Give the Anastomosis of elbow-joint.

How many muscles are attached to the clavicle?
147. How many muscles are attached to the scapula?
148. How many muscles are attached to the humerus?
145.
146.

150.

How many
How many

151.

Name

152.

Describe the deep fascia of arm.

149.

muscles are attached to the ulna?

muscles are attached to the radius?

the muscles lacking origin or insertion into bone.

153. Describe the deep fascia of forearm.

154.

Describe the Anterior and Posterior Annular ligaments.

membranes

155.

Describe synovial

156.

Name principal Flexor and Extensor muscles of hand.

What muscles are attached to the greater tuberosity?

157.

of wrist.

158.

What muscle

159.

The pulse

160.
161.

How does the radial artery get into the palm

How many muscles from elbow to wrist?

162.

What

163.
164.
165.

is

is felt

attached to the lesser tuberosity?

between what two tendons?
of the

hand?

nerve lies in the substance of the Supinator brevis?

Pronators and flexors are attached to which condyle of humerus?

Extensors and supinators to which condyle?

What muscles attached to external or anterior bicipital ridge?

1(19.

To the posterior or internal bicipital ridge?

What one is inserted in the groove?
The Musculo-spiral nerve divides into what branches?
What kind of nerve is the radial?

170.

Give Anterior carpal

166.
167.

168.

arch.

171. Give Posterior carpal arch.

172.

How

does the posterior interosseous artery gel

forearm?
173.

How many

muscles

in

the

hand?

to

the back of the

ANATOMY

124

What

171.

IN A NUTSHELL.

relation does the posterior interosseous artery bear to the deep

layer of muscles of the forearm?

I

7").

humerus.

describe the

With what does

176.

articulate?

it

PLATE

XLIII.

POSTERIOR LIMIT OF EXTERNAL OBLIQUE.

LUTEUS KESIUS

INSERTION OF EXTERNAL OBLIQUE

LATISSIMUS DORS!.

INTERNAL OBLIQUE

CREST OF ILIUM

GLUTEUS MAXIMUS.

TENSOR VAGINAE
FEMORIS

POSTERIOR
SUPERIOR
ILIAC SPINE.

SAflTORIUS

GLUTEUS MINIMUS

POSTERIOR INFERIOR

GREATER SCIATIC

REFLECTEO TENDON OF RECTUS

INTERNA,. ILIAC

ILIAC SPINE

(ILIO-SCIATIC)

NOTCH

CAPSULE.
ISCHIUM

NOTCH

SYNOVIAL MEMBRANE

PECTINEAL RIDGE

GEMELLUS SUPERIOR
SPINE OF ISCHIUM

"ECTINEUS
-

LESSER SCIATIC NOTCH

RECTI S ABOOMINIS.

PYRAMIOALIS

-fT
ODIir.TnR

-GEMELLUS INFERIOR

OBTURAT

0NK5li'>

V'n
ADOIlCTfUl RRFVIS

OESCFuomr. niMif.

THYROID ^^

T&-

'

'3 ' I {*

-"""^

if

'

OBTURATOR NOTCH

SEMIMEMBRANOSUS

QtlADRATUS FEMORIS

"USES

'SEMITENDINOSUS AND BICEPS.

GRACILIS

ADDUCTOR MAGNUS

G8TURAT0R EXTERMUS

177.

17s.

179.
L80.

181.

External View of Left Innominate Hone.

How many and what muscles attached to humerus, ulna and
What is the tongesl muscle inserted on the humerus?
What muscles have attachment to both ulna and radius?
With how many bones does the radius articulate?
With how many bones doe- the ulna articulate?

radius?

ANATOMY

IN A NUTSHELL.

182.

What

183.

Which one

184.

185.

What
What

186.

How many

187.

Where are the greater and lesser sigmoid

With what does each articulate?

188.
189.
190.
191.

192.
193.

194.
195.

196.
197.
198.

199.

200.
201.

202.
203.
204.

205.
206.
207.

Why
Why

are the two principal veins of the

125

arm?

passes through the Axilla?

veins form each?

is

is

the longest nerve in the arm?

openings

in the

capsular ligament of the shoulder-joint?

cavities?

the cephalic vein so called?

are the Lymphatics so called?

What is lymph?
What else are lymphatics called?
What does the lymphatic system include?
Over how much of the body does it extend?
How many coats have the lymphatics?
The lymphatic glands of the arm are divided into how many
The lymphatic vessels are how divided?
Give blood supply and ossification of clavicle.
The same of Scapula.
The same of Humerus.
The same of Radius.
The same of Ulna.
The same of Carpus.
The same of Metacarpus.
The same of Phalanges.

What
What

is

sets?

the largest nerve of Brachial plexus?

separates median basilic vein from brachial artery?

name for Supinator longus.

name for Extensor brevis pollicis.
Give another name for Extensor longus pollicis.
Give another name for First dorsal interosseous.

208. Give another

209. Give another
210.
211.

212. Give Acromial rete.

213.

Deep branch

of ulna passes

name for
Give another name for
On which side of the

between what muscles?

cutaneous nerve.

214. Give another

lesser internal

215.

the long thoracic artery.

216.

pisiform bone does the ulnar artery cross the

anterior annular ligament?

LESSON
Tin: [lium.

XXX II.

(Plates

XLIII-XL1V.)

The ilium which forms less than two-fifths of the acetabulum is the superior
expanded portion of the innominate bone. This portion is limited superiorly
by the arched crest of the ilium, but anteriorly and posteriorly by margins which
diverge at right angles from each other.
The crest is concave inward in front
and is concave outward behind.
is much narrower in its middle than near
It

its

IN A NUTSHELL.

ANATOMY

126
extremities, and there

On

third.

often a

is

The anterior superior spine

below which

is

is

the projection

concavity, the lesser

The

anterior Inferior spine.

and

posterior inferior spine below which

the external

lip

Tensor vaginae femoris,

P Gluteus maximus,

the anterior

at

i-

is

extremity.

notch, and below this notch

iliac

posterior superior spine

posterior extremity of the crest,

To

marked external projection in its anterior

lips and an
intermediate space.

and internal

the cresl are external

is

separated by

the projection

is

at

the
the

small notch from the

the great sciatic notch.

from before backward (Plate XLIII) are attached (1)

External oblique of abdomen, (3) Latissimus dorsi,
(5) The fascia lata throughout the entire length of the
(2)

lip.

To

the internal

lip

from before backward (Plate XLIV.) are attached

(2) Quadratus lumborum, (3) Erector spina'.

Transversalis abdominalis,

The

[liacus

muscle and

iliac fascia to

(1)
(4)

that part of this lip corresponding to the

interna] iliac fossa.

To the intermediate space i> attached the Internal oblique of the abdomen.
T< nsor vaginae femoris externally.
The anterior superior spine has attached
1

Sartorius

(2)

The

in front. (3)

Qii

head of the Rectus femoris

straight

spine of the

Poupart's ligament internally.

from the anterior

arises

inferior

m.

Tin external surface or dorsum

ilii,

has three curved lines called the gluteal

The superior or POSTERIOR gluteal link begins two inches in front of

the post< rior superior spine and curves down and forward to the hack part of
The middle gluteal link begins in front about an inch
the ilio-sciatic notch.
and a half b< hind the ant< rior superior spine, and arches hack and down to the
upper part of die notch. The inferior gluteal link, not so well marked.
begins jusl above the anterior inferior spin< and passes hack to the fore pari of
-.

!iii'

the notch.

The Gluteus maximus

lunararea which

is

attach* d

is

bi

hind

th<

superior gluteal line to a semi-

rough above. The falciform space between the superior and

middle curved lines and the iliac cresl is occupied by the Gluteus medius. The
Gluteus minimus i< between the middle and inferior curved lines. The reflected head of the Rectus femoris is attached just abov< tin cotyloid cavity to
.mi

oblong mark.

face
I

The
and

iliac fossa
is

ilii

is

the ant( ro-sup< nor pari of the internal sur-

larger than the postero-inferior part.

muscle exc<

liacus

or venter

The ilio-pt ctineal line s< parat< s this pai

To the inner side of the anterior inf< rior -pine

concave.

iliac

It

notch, which lodges the Qio-psoas muscle as

vi

attachment
nter

from the true

is
it

,<dv< s

The

pi at its ant< ro-inf< rior portion.

is

to the

smooth and

pelvis.

a shallow groove, the great

passes under Poupart's

lig-

making
boundary f the groove
the ili<
is
the junction of the pubis ami ilium.
The p< stero-inferior part
again divided,
mi below upward (1) a smooth curved surface in the true pelvis,
giving attachment in part to a portion of the Obturator interims, separated from
the iliac fossa by the iliac portion of the i!io-p< ctineal line: (2) the auricular
surface, for articulation with the sacrum; (3) depr( ssion for the posterior -aeroam<

nt

the inni

-pectineal eminence,

is

<

ANATOMY
ligament;

iliac

127

IN A NUTSHELL.

and Multifidus

a rough surface giving origin to the Erector

(4)

spinae muscles.

Blood Supply: The

ilium receives on

anterior surface twigs from the

its

On

ilio-lumbar, deep circumflex iliac, and obturator arteries.

ies enter it from the gluteal and sciatic funks.

dorsum

the

arter-

PLATE XLIV.
QUAORATUS LUMBORUM.
TRANSVERSALISAND

s6 'l^^-fr^W^^ltffc^X-?*

THE

ILIAC FASCIA.

ERECTOR SPINAE.L

I,

INTERNAL

ILIAC

MULTIFIDUS SPINAE.

E?W

POST.

INF.

v'
I

;'.'

FOSS/L"^

'>/.4>1 ^\

'(/-.;.

>Jfc

*Tfc

AURICULAR SURFACE;

ANT SUP SPINE OF ILIUM.

SPINE OF ILIUM.

ANT

INF

SPINE OF ILIUM.

OBTURATOR INTERNUS.

PSOAS PARVUS

ILIO-PECTINEAL EMINENCE

GROOVE FOR OBTURATOR

NERVE AND VESSELS.

'
'

,.

<f$r

/j

08TIIRAT0R

/
I

JM

'

U'-B

'

JJk

'

''

"'.
.

S.

'^'^ i^4^WL
'

SYMPHYSIAL SUR C CE

/?$

GROOVE FOR PUDIC VESSELS AND NERVE

GREAT SACRO-SCIATIC LIGAMENT

FORAMEN.

/;"/'.'(

>

;R"
'

'

/H

^
^"LEVATOR ANI

TUBEROSITY OF ISCHIUM.
SUBPUBIC LIGAMENT

TRANSVERSUS PERINEI
JUNCTION OF PUBES AND ISCHIUM

COMPRESSOR URETHRAL

CRUS

PENIS'

ANO ERECTOR PENIS.

[nternal View of Left [nnominate Bone.

flex,

The ischium is supplied by the obturator, internal and ext< rnal circumflex.
The pubis receives twigs from the obturator, internal and external circumdeep epigastric, and pubic branch of the common femoral artery.
These three bones form the is innominatum.

ANATOMY

128

IN A

NUTSHELL

Ossification from eight centers.

There is one primary center for the ilium which appears at the eighth or
One for the ischium at about the third month, and one for the os
ninth week.
These three primary centers unite
pubis between the fourth and fifth month.
through a Y-shaped piece at about the age of puberty. There are five secondary
centers- one for the crest of the ilium, one for the anterior inferior spin01 - proi ess, one for the tuberosity of the ischium, one for the symphysis

Epiphyses appear
pubis, and one or more for the bottom of the acetabulum.
about the age of puberty and unite with the rest of the bone between the
twentieth and twenty-fifth years.
Articulates with its fellow of the opposite side, the sacrum and femur.
Attachment ok muscles to the ilium, sixteen. To the outer lip of crest,
the (1) Tensor vagina femoris, (2) Obliquus externus abdominis, and (3) Lat1

issimus dorsi; to the internal

lumborum, and

lip.

the

(4)

Iliacus, (5)

Transversalis, (6)

Erector spina?; to the interspace between the

Quad-

the
Obliquus internus. To the outer surface of the ilium, the (9) Gluteus maxinii!-. (10) Gluteus medius, (11) Gluteus minimus, reflected tendon of the (12)
Meet ns; to the upper part of the great sacro-sciatic notch, a portion of the (13)

rants

(7)

lips,

(8)

Pyriformis; to the internal surface, the Iliacus, to that portion of the internal
surface below the linea ilio-pectinea, the (14) Obturator internus

and the

(15)

Multifidus spina' to the internal surface of the posterior superior spine; to the

and straight tendon of the Rectus.

fourteen: To the outer surface of the ramus, the (1) Obturator externus and (2) Adductor magnus; to the internal surface, the (3) ObTo the spine, the (5) Gemellus superior,
turator internus and (4) Erector penis.
To
the tuberosity, the (8) Biceps, (9) Semi(6) Levator ani, ami (7) Coccygeus.
tendinosug, (KM Semimembranosus, (11) Quadratus femoris, (12) Adductor
magnus, (13) Gemellus inferior, (14) Transversus perinsei, Erector penis.
To the os pubis, sixteen: (l)Obliquus externus, (2) Obliquus internus, (3)
.interior border, (16) the Sartorius

To

the ischium,

Transversalis. (4) Rectus, (5) Pvramidalis, (6) Psoas parvus, (7) Peetincus, (8)

Adductor magnus. (9) Adductor longus, (10) Adductor brevis, (11) Gracilis,
(12) Obturator externus, (13) Obturator internus, (14) Levator ani, (15) Compressor met In a', and occasionally a few filters of the (16) Accelerator urinae.

LESSON XXXI II.

Tin:

The

Os Pubis.

body and two rami forms the anterior wall

and bounds the obturator foramen above and partly in front. The
SYMPHYSIS PUBIS is the junction of this bono with its fellow. It is the inner extremity of the bone fat Lng inward b< ing of an oblong surface marked by trans\ erse ridg< s.
The des< ending r \.\us pass< s down and out from the symphysis.
It is thin and Hat ami joins the ramus of the ischium at
a point little more than
The
half way from the body of the pelvis to the tuberosity of the ischium.
superior or ascending ramus is the upper part of the bone. This ramus ends
os pubis which consists of a

of the pelvis,

ANATOMY

IX A NUTSHELL.

129

externally at the cotyloid cavity and forms more than one-fifth of

perior border of this

ramus forms the pubic portion

it.

The

su-

of the ilio-pectineal line,

running from the spine of the pubis to the internal aspect of the ilio-pectineal
eminence.

The part between the two rami is the body of the os pubis. Its anterior
is rough and its pelvic surface is smooth.
The Pectineus muscle has its
origin from the ilio-pectineal line and the triangular surface in front of it.
The
obturator crest extends from the pubic spine to the acetabulum below the
The obturator groove is on the inferior surface of the
ilio-pectineal line.
ramus behind the outer part of the crest. It is directed from behind forward
and inward.
The pubic crest gives origin to part of the (1) Conjoined tendon, (2) the
Pyramidalis and (3) Rectus abdominis. To the pubic spine are inserted (1)
Poupart's ligament and the (2) outer pillar of the external abdominal ring.
From the front of the pubis, in the angle between the crest and the symphysis, arises the (1) Adductor longus muscle, and below this the (2) Adductor
Internal to these the (1)
brevis and part of the (3) Adductor magnus.
Gracilis is attached, and external the (2) Obturator externus.
Posteriorly
surface

the pubis gives attachment to the

(1)

Obturator internus; above

this

is

some-

times a flat line passing from the upper margin of the obturator foramen to
the lower end of the symphysis; the (1) Levator ani muscle is attached to it. and
the Obturator and recto-vesical

(2)

fasciae.

The Ischium.
The ischium forms the lower and back part of the innominate bone. It
forms a little more than two-fifths of the cotyloid cavity and bounds the obturator foramen below.
The body has three surand posterior.

This bone has a body, a tuberosity, and a ramus.

faces

and three borders.

The

surfaces are external, internal

The borders are also external, internal and posterior.

The external surface helps form the acetabulum, and this part is smooth
and concave. Immediately below the acetabulum is a horizontal groove for the
Ten Ion of the Obturator externus.
i

The
is

internal surface forms part of the wall of the true pelvis.

showing

its

junction with the ilium

is

its

upper

limit.

junction with the os pubis and the obturator foramen.

the anterior margin of the great sciatic notch.

In

roughly quadrilateral, also smooth and concave to a small degree.

part of the Oubtrator internus muscle

Posterior surface
limited behind

is

is

Its

Its

anterior limit

Its

lower limit

attached to

shape

is

posterior limit
is

it

ridge
its
is

the tuberosity.

this surface.

limited in front by the margin of the cotyloid cavity.

by the posterior margin

of the bone.

It is limited above by
below
its
it is limited
by the tuberischii. This
surface supports the two Gemelli, the Pyriformis and the Obturator internus.
Below it presents a pari of the groove tor the Obturator externus.

It is

connection with the ilium, and

The external border is synonymous with

bulum which belongs to the ischium.

that part of the rim of the Aceta-

ANATOMY

130

The

internal border

is

IN A NUTSHELL.

synoynmous with

the outer boundary of the obtura-

tor foramen.

posterior border has the spine of the ischium a little below its middle.

The

This spine which extends backward and inward marks the lower limit of the
to the Levator ani and (occygeus
It gives attachment
greal sciatic notch.

Between

muscles, externally to the Gemellus superior.

osity

the lesser sciatic notch.

is

this spine

and the tuber-

The tuberosity has three surfaces ex-

and postero-inferior.
The external SURFACE of the tuberosity

ternal, internal,

is lost below in the ramus and

above with the groove for the tendons of the Obturator externus. It is limited
in front by posterior margin of the thyroid foramen, and externally by the pos-

PLATE XLV.
ARTICULAR
PROCESS.

SACRAL

FORAMEN

ERECTOR
SPINA!.

MULTIF1DUS

HIATUS

SPINA!.

SACRALIS,

LEADING INTO
SACRAL CANAL

GLUTEU
MAXI

SACRAL CORNU

GLUTEUS MAXIMUS

COCCYX.

SPHINCTER ANI
Posterior View of Sacrum and Coccyx.

The muscks attached to this surface are the Quadratus

tero-inferior surface.
femoris on the posterior aspect, the Obturator externus on the antero-inferior
aspect, and the Adductor magnUS below these two.
The [NTERNAL SURFACE
in

front.

of the tuberosity extends to the thyroid

Behind and below

it

ends

in

foramen

prolongation tor the attachment of

the greal sciatic ligament.

The

bro-inferior surface of he tuberosity has the Semimembranosus

upper and outer portion, while the Biceps and Semitendinosus
are attached to its lower and inner portion.
The ramus of the ischium is not as long as the ramus of the OS pubis which
attached

i'o-i

to its

ANATOMY

IN A NUTSHELL.

131

joins at a little less than half the distance between the body of the os pubis
and the tuberosity of the ischium. The Obturator externus, the Adductor
magnus and the Gracilis are attached to its outer surface. The Crus penis and
it

Transversus perinei are attached to its inner border.

The cotyloid cavity, or acetabulum, is cup shaped.

It

looks outward, for-

ward and downward. The Ilium forms a little less than two-fifths of the acetabulum. The os pubis forms a little more than one-fifth of the acetabulum.
The Ischium forms a little more than two-fifths of the acetabulum. The rim
of this cavity is prominent, but it is slightly lower in front and behind and has
The depression in the center is
a large notch below called the cotyloid notch.
called the cotyloid fossa, around which is the articular portion of the cotyloid
cavity.

The thyroid

or obturator foramen

sometimes

male

is

leaving a space for the obturator groove in

brane,

this

foramen

is

foramen ovale is beby a fibrous memupper margin. In the

called

low and internal to the acetabulum. This foramen

closed

its

nearly oval, while in the female

it is

more

triangular.

LESSON XXXIV.
The Pelvis

as a

Whole.

The word pelvis means basin. It is composed of four bones, the sacrum,
coccyx, and the two innominate. If we pass a plane through the sacral promontory, ilio-pectineal line and the upper border of the symphysis, we divide
the pelvis into an upper or false pelvis and a lower or true pelvis. The upper
The sacrum looks downward and forpelvis really belongs to the abdomen.
It is held in
ward. Its anterior surface is broader than its posterior surface.
place by ligaments and the projections into the

iliac articular

surface.

The

plane separating the true and false pelvis marks an angle of 60 degrees with the
horizontal.

The plane

of this outlet

makes an angle

of 16 degrees with the hor-

izontal.

The base of the sacrum is about three and one-half inches above the upper
margin of the symphysis. The tip of the coccyx is one-half inch above the apex
of the subpubic arch.

The ANTEROPOSTERIOR DIAMETER, CALLED THE CONJUGATE DIAMETER, LS

measured from the sacro-vertebral angle to the symphysis.
The transverse diameter represents the greatest width of the pelvic cavity.

The oblique diamkteh

to the ilio-pectineal

The average

is

measured from the

sacro-iliac joint of

eminence of the other.

measurements of the diameters

of

pelvis

the

one side
in

three planes are as follows:

oblique.

antero-posterior.
Inlet

4 1-4 inches

Cavity

4 3-4 inches

Outlet

.3

3-4 inches

5
">

inches
1-4 inches

..4 1-2 inches

i;

\\s\ i:nsK.

1-1

inches

:^-4

inches

1-4 inches

the

ANATOMY

132

THE FEMALE
RESPE'

PELVIS DIFFERS

IN A NUTSHELL.

FROM THE MALE PELVIS IN THE FOLLOWING

s:

The bones are more

I
|

shallower, (4) false pelvis

is

slender. (2)

more

ilia

vertical, (3) iliac fossa is

relatively narrower, (5) the true pelvis

more

is

shallower,

symphysis is shallower,
i'.ii
tuberosities of ischia are everted. (10) pubic arch is wider and more rounded, ill) margins of ischio-pubic rami are less everted, (12) obturator foramen
is triangular, while in the male it is oval, (13) sacrum is wider and less curved,
true pelvis

also (6)

and

(14)

is

wider,

(7)

inlet is

the capacity of the true pelvis

is

oval, (8)

greater.

The Sacrum.
The sacrum

is

formed by the coalescence of

five

segments. It forms the

upper and back part of the pelvis, being placed between the two innominate
It is a wedge shaped bone with its apex below, and its anterior surface
bones.
wider than

its

posterior surface.

The anterior border of the upper portion or base is called the promontory.
It has four surfaces, a base, an apex, and a central canal.
The anterior surface has four ridges marking the junction of the five segments.
This surface is concave, both vertically and transversely (less so.)
The five segments or vertebras decrease from above downward. At the ends of
the transverse ridges are foramina for the transmission of the sacral nerves.

These

f<

ramina are directed forward and outward.

are the lateral masses

At the

sides of the foramina

formed by the transverse processes

of the vertebrae of

the sacrum.

The

posterior surface

is

not as wide as the anterior one and

has rudimentary spinous processes in

median

is

convex.

It

There are usually

three orfour of these, the fifth one being undeveloped. External to the processes
are the i.amive. the first three are well marked; the fourth is not well developed
and the fifth is rarely so. The fifth ones are prolonged downward forming the
sacral cornua.
External to the laminae are the articular processes, the first
pair are Large, the second and third small, and fourth and fifth are most always
fused.

its

line.

Externa] to the articular processes are the foramina for the posterior

External to the foramina are the transverse

divisions of the sacral nerves.

processes.

The sacral groove is wide and shallow lodging the Erector spinas. It lies
between the spinous and transverse processes.
The lateral surface is narrow behind but broad above. The upper half of
this surface is called the auricular surface.
It articulates with the ilium and is
covered with fibro-cartilage in the recent state.
Behind this articular surface
are deep impressions for the attachment of the posterior sacro-iliac ligaments.
The lower half of this surface is called the tuberosity, and the borders of this

half of the surface give

the

attachment

to the sacro-sciatic ligaments

and part

of

rluteus maxiinus.

The base is the pari which articulates with the last lumbar vertebra. It is
broad and look- upward and forward.
Its anterior part is for the interarticular
fibro-cartilage

and

is

oval.

Its

posterior part has the sacral canal which

is

ANATOMY

IN A NUTSHELL.

133

formed by the laminae and spinous process. The superior articular processes are
They are situated on each side of the sacral canal and are
oval and concave.
The intervertebral notches are in front of these
directed backward and inward.
processes.

The al.e are flat triangular areas on each side of the articular processes,
and are continuous with the iliac fossa. The Iliacus muscle has a \'v\v fibers of
origin from the ala.
The apex articulates with the coccyx and is directed downward and forward.

PLATE XLVI.
PROMONTORY.
ARTIC.WITH

LAST LUMBAR.

COCCYGE

LEVATOR ANl

Anterior View of Sacrum and Coccyx.

The spinal canal is larger and triangular above, but*below it is ilattened
from before backward. The lower part of its posterior wall is incomplete. This
is caused by the non-development of the laminse and spinous processes.
Ossification

Thirty-five

centers.

Articulation: With four bones; the lasl Lumbar vertebra, coccyx,

the two ossa innominata.
Attachment of Muscles: Eight pairs; in front, the Pyriformis
Coccygeus, and a portion of the Iliacus to the base of the bone: behind,
Gluteus maximus, Latissinnis dorsi. Multifidus spinse, and Erector spinae,
sometimes the Extensor coccveeus.

and
and
the

and

anatomy

i;^4

in a nutshell.

The Coccyx.
The coccyx is formed by four and sometimes five segments. It has no
SPINAL CANAL, [NTERVERTEBRAL FORAMINA. SPINOUS PROCESSES, LAMIN.E, PEDThe firsl segmenl may be separate bu1 the rest are united and run to a
[CLES.
This bone has an anterior and posterior surface, two borders, a base,
point.
and an apex.
The anterior surface has three transverse grooves marking the union
This surface

ments.

The

posterior surface

The upper cornua

terior.

making the

The

fifth

is

is

of the

concave.

convex and has grooves similar to those on the anand articulate with thecornua of the sacrum

are large

posterior sacral foramina.

and present small eminences the rudimentary

The upper pair of the processes may articulate with the

lateral borders are thin

transverse processes.

inferior lateral angles of the

sacrum, thus forming the

fifth

anterior sacral for-

The other processes are small and may be absent.

Blood Supply: Sacra media.
Four centers.
)ssification:
Articulation: With the sacrum.
Attachment of Muscles: Four pairs and one single muscle; on either
side, the Coccygeus; behind, the Gluteus maximus and Extensor coccygeus,
when preseni at the apex, the Sphincter ani; and in front, the Levator ani.
amina.

LESSON XXXV.

(Plate

LXXIII.) In the posterior part of

This muscle, which
the substance of this muscle, the lumbar plexus is situated.
side
region
and the margin of the
of the spine in the lumbar
is placed on each
is
and
fusiform
five
slips to the interverteone.
It is attached by
a Long
pelvis,
and
adjacent
the
vertebra
above
and below. Bebral substance
the
parts of
slips
arches
which
concave
part of the body
the
are tendinous
with
tween these
make
and filaments of
for
lumbar
vessels
lumbar
vertebra
passage
the
a
of each
nerve.
the
in size and
down
it
decreases
sympathetic
As
muscle
passes
the
Psoas magnus.

Description.

passing under Poupart's ligament,

reived nearly

Origin:

all

(Plate

the

all

Lumbar

Insertion:

RVE

terminates in a tendon after having re-

Front of bases of lumbar vertebrae by

and intervertebral substances of last dorsal

(1)

vertebrae.

(Plates

XLVIII-XLIX.)

Lesser trochanter of the femur.

on pelvis; maintains erect posture.

Anterior branches of second and third lumbar nerves.

1'lexes thigh

A( pion:

LXXIII.)

-ides of bodies

live fleshy slips; (2)

and

it

the fibers of the Iliacus.

Si

I'i'iA

Blood Si pply: Dio-lumbar from posterior branch of internal iliac, and

lumbar from abdominal aorta.
Psoas parvus.
Description. (Plate LXXIII.) This muscle may be
It
is situated in front of the Psoas and ends in a long flat
absenl or double.
tendon.
it

It

is

well

flexes the pelvis

developed in those animals which are swift runners, in that

and arches the Lumbar spine.

ANATOMY

IN

A NUTSHELL.

135

Sides of bodies of last dorsal and first Lumbar

(Plate LXXIII.)
and substance between.
Insertion: (Plate XLIV.)
Ilio-pectineal eminence and by its outer

Origin:
vertebra?

border into the

iliac fascia.

Action: Same as Psoas magnus, also makes tense the iliac fascia.
Nerve Supply: Anterior branch of first lumbar.
Blood Supply: Lumbar from abdominal aorta.
Description.
(Plate LXXIII.)
The Iliacus and the Psoas
Iliacus.
magnus are sometimes regarded as one muscle, the Ilio-psoas, since they have
one insertion. The Iliacus which is flat and triangular fills the whole of the

iliac fossa.

(Plates

Origin.

XLIV-XLVL) (1) Upper

two-thirds of

fossa

iliac

and

inner margin of crest of ilium; (2) in front, anterior superior and inferior spin-

behind, ilio-lumbar ligament and

ous process of ilium and notch between:
base of sacrum; (4) fibers from capsule of hip-joint.
(.'->)

Insertion.

(Plate XLVIII.) Outer side of tendon of Psoas

muscle and

into oblique line extending from lesser trochanter to linea aspera.

Action.

Flexes

thigh on pelvis and rotates femur outward; also aids

in

maintaining erect posture.

Nerve Supply. Anterior branches of second and third lumbar through

the anterior crural.

Blood Supply. Ilio-lumbar.

Tensor vagina3 femoris. Description.

(Plate

LXIV.)

This

muscle

lies

along the outer side of the thigh and extends from the crest of the ilium to about
one-fourth the distance to the knee.

(Plate

Origin.

Anterior

XLIII.)

portion of outer lip of crest of ilium

and outer surface of anterior superior spinous process between Gluteus medius
and Sartorius muscle, and from fascia covering the Gluteus medius.
Insertion.
(Plate LXIV.)
Between the two layers of the fascia lata.
The fascia is continued downward to external tuberosity of the tibia as a thick-

ened band, the ilio-tibial band.

Action. Tenses fascia lata.
Nerve Supply. Fourth and

fifth

lumbar and

first

sacral

through

the

superior gluteal.

Blood Supply. Superior

Sartorius.

from the ilium

the body.

gluteal

Description. (Plate
to the tibia,

In the

pa's triangle.

It

is flat,

upper part of
passes

and external circumflex.

LXXIY.)

This

muscle, which extends

narrow, ribbon-like, and

its

course

it

i<

the longest one in

forms the outer boundary of Scar-

downward, then obliquely inward, then downward

to

the insertion.

Scarpa's triangle (Plates

ligament.

On

ductor longus.
it-

LXIV-LXXIV.)

Is

bounded above by Pouparl

the outer side by the Sartorius and on

The femoral

center from above down.

vessels

its

'a

inner side by the Ad-

and the anterior crural nerve pass through

Their position from within outward

is

femoral

and anterior crural nerve (V. A. N.).

The floor of this triangle from
without inward is formed by the Iliacus, Psoas, IVctineus, (Adductor brevis?)

vein, artery,

ANATOMY

136

In the

and Adductor longus.

first

IN A NUTSHELL.

middle third of the thigh the femoral artery

lies

along the inner border and then behind the Sartorius.

Anterior superior spinous process of ilium and
(Plate XLIII).
Origin.

upper half of notch below.

The muscle passes behind the inner condyle of
Insertion.- (Plate LI.)
the femur and terminates in a tendon which, curving obliquely forward, expands into a broad aponeurosis and is inserted into the upper part of the inner
An offset is
surface of the shaft of the tibia, nearly as far forward as the crest.

PLATE XLVII.

Anterior and Superior View of the Pelvis.

derived from the upper margin of this aponeurosis which blends with the

brous capsule of the knee-joint, and another, given off from

blend.- with the fascia OH

A(

u )\.

lie

its

fi-

lower border,

inner side of the leg.

Flexes leu on thigh and continuing to act flexes the thigh on the

pelvis; also rotates the thigh outward.

\i.i;\

i.

Si pply.

Blood Supply.Rectus

lemons.

Branch

of anterior crural.

Femora] artery.

Description. (Plates

LXIV-LXV111-LXXIV.) The

Rectus fenioris together with the Vastus externus, Vastus interims, and the


ANATOMY
Crureus, form one muscle

IN A NUTSHELL.

137

the Quadriceps extensor, which

is

the great extensor

This might be called one muscle with four heads and one insertion.

of the leg.

is situated in the middle and anterior part of the group and has two
These heads join at an acute angle. Its superficial fibers are bipenniform. and its deep ones run straight down to the deep aponeurosis. The broad
and thick aponeurosis which occupies the lower two-thirds of the posterior surface of the muscle gradually ends in a flattened tendon.

The Rectus

heads.

LESSON XXXVI.

(Plate

Origin.

XLIII.)

The

anterior or straight tendon, from the an-

terior inferior spinous process of ilium; the posterior, or reflected tendon,

from

a groove above the brim of the acetabulum.

Insertion.

(Plate LXXIV.) Into the patella

in

common

with the Vasti

and Crureus.
Action.
port

Assists

Psoas muscle to bend pelvis and trunk forward and sup-

them upon the femur.

Anterior crural.
Femoral artery.
Description. (Plates
externus.

Nerve Supply.
Blood Supply.
Vastus

muscle

is

LXIV-LXVIII-LXXIV.)

the largest part of the Quadriceps extensor.

This

The strong aponeurosis

on the under surface at the lower part of this muscle receives the fillers which
form a large fleshy mass. The tendon of this muscle gives an expansion to the
capsule of the knee-joint.

Origin.

(Plate XLVIII.) By a broad aponeurosis attached

half of anterior intertrochanteric line, to the anterior

and

to ihe

upper

inferior borders of the

root of the great trochanter, to the outer lip of the gluteal ridge, and to the

upper half of the outer lip of the linea aspera. This aponeurosis covers the
upper three-fourths of the muscle and from its inner surface many fibers take
origin.
A few additional fibers arise from the tendon of the Gluteus maximus,
and from the external intermuscular septum between the Vastus externus and
short head of Biceps.

(Plate LXXIV.)
Insertion.
Action. Extends knee.

Nerve Supply. Anterior

Blood Supply. External

Into

patella.

crural.

circumflex.

interims. Description.
LXIV-LXVIII-LXXIV.) If
(Plates
the Rectus is reflected a narrow space is seen between the Vastus interim- and
At this
the Crureus extending upward from the inner border of the patella.
The aponeurospace they can lie separated, bin they arc in reality one muscle.
sis which lies on the deep surface of the muscle receives fibers from the muscle,
Vastus

which are directed downward and forward.

(Plate XLVIII.)
Origin.
Lower one-half of anterior intertrochanteric
line,, the spiral line, the inner lip of the linea aspera, the upper pari of the internal supracondylar line, and the tendon of the Adductor magnus and internal

intermuscular septum.

ANATOMY IN A NUTSHELL.

138

LXXIV.)

Insertion. -(Plate

By

common

Tendon

extensor

into

the

expansion being sent to capsule of knee-joint.

Extends leg and draws patella inward.
ion.

patella, an
A.<

Branches of anterior crural.

Femoral artery.
Description. Given with Vastus internus.
(Plate XLIX.) From front and outer aspect

N i;\ e Suppli
Blood Supply.

Crurcus.

Origin.
in

of shaft of

femur

upper two-thirds and from the lower part of the external intermuscular

its

septum.

Insertion. (Plate LXXIV.)

Its fibers

end

in a superficial

aponeurosis

which forms the deep part of the Quadriceps extensor tendon.

A. tion.
Extends leg and draws patella inward.
Nerve Si pply. Branches of anterior crural.

BLOOD

bundles, but
bu1

may

Plate

I\-i rtion.

This

small muscle.

be attached to
I

artery.

Description.

is

it

Origin.

<

Femoral

Si PPLY.

Subcrureus.

muscle

is

may

consist of several muscular

most always

distinct

from the Crureus,

it.

XLIV.)

(Plate

It

Anterior surface of lower part of shaft of femur.

Upper part of eul de sac of capsular

LXXIV.)

lig-

ament.

tion. Lifts capsule.

Supply. Branches of anterior
BlOod Supply. Femoral artery.

A<

\'i.k\

is

i.

crural.

Gracilis.Description. (Plates LX1V-LXV1II-LXXIV.) This muscle

Its fibers after
broad above, narrow below, thin and flattened as a whole.

downward end

rounded tendon, then passes behind the internal

tibia.
It becomes
flattened before its insertion.
It is the most superficial muscle in the Internal
Femora] Region.
Its tendon which is just above that of the Semitendinosus
and below that of the Sartorius joins the latter. It is separated from the internal lateral ligament of the knee-joint by a synovial bursa which is common to
it and the Semitendinosus.
Origin.
Plate X F II.)
Lower half of margin of symphysis and anterior
passing

condyle of femur

<

to

in a

curve round the inner tuberosity of the

half of the pubic arch.

Insertion.

(Plate LI.)-

Upper

part of inner surface of shaft of tibia be-

low the tuberosity.

Assists Sartorius in flexing leg; also adducts thigh.

A< tion.

Nerve
Blood

Third and fourth lumbar through the obturator nerve.

Obturator and femoral arteries.
Description.
(Plates LXIV-LXVIII-LXXIV.)This mus-

Si pply.

Si pply.

Pectineus.
cle

which

thigh

is

situated

is

flat

Origin.
front of

at

the anterior part of the upper

and inner aspect

of

the

and quadrilateral.
(Plate

it

Insertion.lines aspera.

scia

XLIII.) (1)

Uio-pectineaJ

line;

(2)

surface of bone in

covering anterior surface of muscle.

(Plate XLVIII.)

Rough

line

between

lesser trochanter

and

PLATE
OBTURATOR EXTERNUS

GUITEOUS MEOIUS

(I).

(I).

LIGAMENTUM TERES.

TUBERCLE OF THE

OUADRATUS FEMOfllS

(I)

POST INTERTROCHANTERIC
.VASTUS EXTERNUS

(0)

PSOAS

LIKE.

Jl).

GLUTEAL RIDGE.

GLUTEUS MAXIMUS

(I)

ADDUCTOR MAGNUS

INTERVENING SPACE OF THE LINEA ASPER*.

(I)

ADDUCTOR LONGUS

OUTER
BICFJS

LIP OF LINE* ASPERA.

INNER LIP OF LINEA ASPERA.

(0).

VASTUS EXTERNUS

(0).

CRUREUS

tXT.

(I).

SUPRA CONDYLAR

(0)

FOR FEMORAL ARTERY

LINE.

INT.

SUPRACONDYLAR

LINE.

POPUTEAI SURFACE
ADDUCTOR MAGNUS

II).

ADDUCTOR TUBERCLE.

GASTROCNEMIUS

GASTROCNEMIUS

(0)

(0).

CAPSULl.

ANT CRUCIAL LIGAMENT

INT

LATERAL LIGAMENT.

EXT CONDYLE.

INTERCONDYLAR NOTCH
POST CRUCIAL LIGAMENT

Posterior View of Left Femur.

139

XLVIII.

ANATOMY

140

IN A NUTSHELL.

Adducts thigh.

Action.

Anterior

Nerve Supply.

crural, obturator accessory,

branch from the obturator.

Blood Supply. Femoral and obturator

and occasionally a

arteries.

Adductor Longus
Description. Plates LXIV-LXVIII-LXXI-LXXIV)
This muscle forms the inner boundary of Scarpa's triangle and is the most
It lies on the same plane as the Pectineus.
superficial one of the Adductors.
It

triangular muscle.

a flat,

is

Origin.

(Plate

XL111.)

Front

of OS

pubis, at junction of crest with

symphysis.
Insertion.

(Plate XLVIII.) By aponeurosis into linea aspera.

Adducts thigh powerfully.

\'i w\
Supply. Obturator.
Blood Supply. Obturator and perforating branches of profunda.
Adductor brevis.
Ascription. (Plates LXIV-LXVIII-LXXI-LXXIV.)
The Adductor brevis, which is somewhat triangular, is situated immediately
beneath the Adductor longus and the Pectineus. The second and sometimes
the first perforating branches of the profunda femoris artery pierces this muscle
Action.

r.

near

it-

insertion.

Origin.

(Plate

XLIII.)

Outer

surface of

body and descending ramus

between Gracilis and Obturator extern us.

Insertion.
(Plate XLVIII.)
By an aponeurosis into lower part of line
Leading from the lesser trochanter to the linea aspera and the upper part of the

of os pubis,

same

immediately behind the Pectineus and upper part of the Adductor

line,

longus.
Assists in flexing thigh

A( tion.
in

upon

pelvis; also in

drawing leg forward

walking.
\ki;\

i:

Third and fourth lumbar through the obturator.

Obturator and perforating branches of the profunda.

Supply.

Blood Supply.

LESSON XXXVII.
Adductor magnus. Description. (Plates LXIV-LXVIII-LXXI-LXXIV.)
The muscles of the Anterior Femoral Region are separated from the remaining muscles of

the Internal Femoral Region by the

Adductor magnus.
Along the attachment of this muscle there are three and sometimes four openLngs Formed by tendinous arches attached to the femur for the passage of the
three perforating branches of the profunda artery.

ent,

The fourth

one,

when

pres-

for the terminal

branch of the profunda.

Origin.
(Plate XLIII.)
(1) Descending ramus of os pubis; (2) ascending ramus of ischium ;(3) outer margin of under surface of tuberosity of ischium.
[nseri con.
Plate XLVIII.)
The fibers from the ramus of the os pubis
is

are vi'vy short, horizontal in direction,

and are inserted into the rough

line lead-

ing from the greal trochanter to the linea aspera,internal to the Gluteus

max-

Lmus; those from the ramus of the ischium are directed downward and outward
to be inserted by mean- of a broad aponeurosis into the linea aspera and the


ANATOMY
upper part of

its

IN A NUTSHELL.

The

internal prolongation below.

141

internal portion of the

mus-

cle, consisting principally of those fibers which arise from the tuberosity of the

ischium, forms a thick, fleshy mass, descends almost vertically and terminates

about the lower third of the thigh in a rounded tendon which is inserted into the
adductor tubercle on the inner condyle of the femur, being connected by a
fibrous expansion to the line leading upward from the tubercle to the linea
aspera.

Adductor

Action.

of thigh.

Nerve Supply.- Obturator and branch of great sciatic.

Blood Supply. The femoral and perforating branches

of profunda.

Description. (Plate LXV.) This muscle, which is

made up of fasciculi lying parallel with one another, is very coarse in structure.
These fasciculi are collected together into large bundles, which are separated by
Gluteus maximus.

It is a thick

deep cellular intervals.

hold the trunk erect.

It

is

and quadrilateral muscle and helps

to

the most superficial muscle in the Gluteal Region.

There is a synovial bursa between this muscle and the great trochanter, one
between its tendon and the Vastus externus, and often one is situated on the
tuberosity of the ischium.

(Plates

Origin.

XLIII-XLV.)

(1)

and

Superior curved line

crest of

ilium; (2) posterior surface of lower part of sacrum; (3) side of coccyx; (4)
aponeurosis of Erector spina?; (5) great sacro-sciatic ligament and fascia covering Gluteus medius.

Insertion.

(Plate

XLVIII.)

The

fibers

forming the upper and larger

portion of the muscle, together with the superficial fibers of the lower portion,

terminate in a thick tendinous lamina, which passes across the great trochanter

and

is

inserted into the fascia lata covering the outer side of the thigh the deeper
;

fibers of the lower portion are inserted into the rough line leading from the great

trochanter to the linea aspera between the Vastus externus and Adductor magnus.

Extends, adducts, and rotates the thigh outward.

Nerve Supply. Inferior gluteal and small
Blood Supply. Superior and inferior gluteal.
Description. (Plate LXV.) The posterior
Gluteus medius.
Action.

sciatic.

this

muscle

lies parallel

The

the gluteal vessels.

Gluteus maximus,

with the Pyriformis muscle but

its

posterior one-third of

its

is

separated from

by
under the
This is a broad

external surface

anterior two-thirds under the fascia lata.

thick, radiating muscle situated on the outer surface of the ilium.

bursa

is

situated between the tendon of this

trochanter

in

Origin.

front of

(Plates

its

border of
it

lies

synovial

muscle and the surface of the great

insertion.

XLIII-XLV.)

Outer

surface of ilium between superior

and middle curved lines; (2) crest of ilium; (3) fascia covering outer surface.
Insertion.
Oblique line of great trochanter.
(Plate XLIX.)
Action. Adducts the extended thigh, rotates same and supports body
on limb.

Nerve Supply.
Blood Supply.

Superior gluteal.
Superior gluteal.

PLATE XLIX.
GEMELLI
OBTURATOR INTERNUS AND

HI.

GREATER TROCHANTER.

PTRIFORMIS

-'
-

TO ANT. INTER,, 10 INT ATTACHED

TROCHANTERIC LINE.
LESSEB TROCHANTER

<^''4Mi

ji .",,> ;ft\
,
\* i%<lttJ-'Jk 4

seck.

"*"^^i^i
-

CAPSULE OF

(I).

^g^flM
JjgSft j

'Aj?

to!

1O0UCTOR TUBERCLE.

IOOUCTOR MAGNUS

EXT LATERAL LKSAMEMT.

(I)

POPLITEUS

CAPSULAR

INT

LINE.

CONDYLE

PATELLAR FACET

A.NTERIOR VlKW OF LEFT FEMUR.

142

EXT CONOTLE

(0).

ANATOMY

IN A NUTSHELL.

Description. (Plate

143

LXV.) This muscle is situated

immediately beneath the Gluteus medius. It is the smallest of the three Gluteal
There is a synovial bursa between its tendon and the great trochanter.
muscles.
(Plates XLI1I-XLV.)
Outer surface of ilium, between the middle
Origin.
and inferior curved lines, and from the margin of the sacro-sciatic notch.
Gluteus minimus.

Insertion.

(Plate

XLVIII.)

Into

an impression on anterior border of

great trochanter.

Action.

Adducts

the extended thigh, rotates same and supports body

on limb.

Superior gluteal.
Superior gluteal and external circumflex.
Pyriformis. Description. (Plate LXV.) This muscle
Nerve Supply.
Blood Supply.

is

midal one situated partly within the pelvis at

the back of the hip-joint.
teus medius.

It

its

posterior part

flat

pyra-

and partly

at

with the posterior borderof the Glupasses out of the pelvis through the great sacro-sciatic foramen,
It lies parallel

The superior gluteal nerve and the

Below this muscle the inferior gluteal nerve, the sciatic vessels and nerves, internal pudic vessels and
nerve, and nerves to the Obturator internus and the Quadratus femoris leave
thus dividing

it

two compartments.

into

gluteal vessels leave the pelvis above this muscle.

the pelvis.

Origin.

(Plate XLVI.) Front of sacrum by three

tached to the portions of the bone between the

and

anterior sacral foramina,

also

from the margin

also

first,

fleshy digitations at-

second, third and fourth

from the groove leading from the foramina;

and from the anterior

of the great sacro-sciatic foramen,

surface of the great sacro-sciatic ligament.

Insertion.
(Plate XLIX.)
Upper border of great trochanter behind,
and partly blended with, the tendon of the Obturator interims and (iemelli
muscles.

Draws pelvis forward when inclined backward and

upon the head of the femur."
Nerve Supply. First and second sacral nerves.

Action.
steadying

assists

in

it

Sciatic.
internus. Description. (Plate

Blood Supply.
Obturator
Pyriformis,
joint.

is

LXV.)

This

muscle, like the

situated partly within the pelvis and partly at the hack of the hip-

The inner surface

of the tuberosity of the ischium

is

grooved

for the re-

ception of the four or five tendinous bands which are on the deep surface of the

These grooves are covered with cartilage and lined by a synovia] bursa.
These tendinous bands unite into a flattened tendon which passes horizontally

muscle.

outward

Between the capsular ligament of the hip and the

communicates with the bursa
between the tendon and the tuberosity of the ischium, the two bursa making
to its insertion.

tendon of this muscle

one

sac.

It

Origin.

leaves the

(PL-

wall of pelvis.

attached to the

bursa, which generally

dvis through the lesser sacro-sciatic foramen.

XLIY.)

e
it

'i

is

From

the inner surface of anterior and external

surrounds the greater part of the obturator foramen being

scending ramus of the os pubis and ramus of ischium, and

at

theside to the inner surface of the innominate bone below andbehind thepelvic


ANATOMY

144

IN A

NUTSHELL

brim, reaching from the upper part of the great sacro-sciatie foramen above and
It also arises from the inner
behind to the thyroid foramen below and in front.
surface of obturator

membrane except

at its

posterior part,

from the tendinous

arch which completes the canal for the passage of the obturator vessels and
nerve, and to a slight extent from the obturator layer of the pelvic fascia which
covers

it.

Insertion.

(Plate

XLIX.)

Into

the fore part of the inner surface of

great trochanter in front of obturator externus, together with the Gemelli.

Action.Rotates and abducts

Nerve Supply. Fifth lumbar,

Bi.<

>(

id

thigh.

and second

first

sacral.

Supply. Sciatic

LESSON XXXVIII.

(Plate LXY.)
This muscle is not
Gemellus superior. Description.
It has a common tendon
It is an aid to the Obturator internus.
always present.
with the Obturator internus. It is smaller than the Gemellus inferior.
Outer surface of spine of ischium and blends
(Plate XLIY.)
Origin.

with tendon of Obturator internus.

(Plate XLIX.) Inner surface of great trochanter.
nsertion.

Rotates the extended thigh, abducts the flexed thigh.

and second sacral.
Nerve Supply. Fifth lumbar,
Blood Supply. Sciatic and external circumflex.
Gemellus inferior. Description. (Plate LXY.) This muscle
I

A.<

tion.

first

than the Gemellus superior and like that muscle

terims.

(Plate

Origin.

with tendon of

Insertion.

Action.

LXIII.)

Upper part

is

is

larger

an aid to the Obturator

of tuberosity of

in-

ischium and blends

>bturator internus below.

(Plate

XLIX.)

Inner surface of great

trochanter.

Rotates extended thigh, abducts flexed thigh.

Supply. Fourth and fifth lumbar and first sacral.

Blood Supply. Sciatic and external circumflex.
Quadrat us femoris. )ks<ription.
This muscle is sit(Plate XLY.)
uated between the upper margin of the Adductor magnus and the Gemellus inferior.
is flat and quadrilateral. The terminal branches of the internal cirIt
cumflex vessels lie between the Adductor magnus and this muscle.
Origin.
(Plate XLIII.)
Upper part of external lip of tuberosity of
\'u;\ e

ischium.

Insertion.
A'

(Plate

XLVIII.)

Quadrate

Nerve Supply.

Las1

Blood

Sciatic

Si pply.

femur, upper part.

Obturator externus.

lumbar and first sacral.

and internal circumflex.
Description.- (Plate LXXI.)

The obturator

vessels

lie

The deep branches

muscle while the superficial ones pass above
between this muscle and the obturator membrane.

of the obturator nerve perforate tins

it.

line of

tion.- Rotates thigh outward.

PLATE

L.

POPLITEAL NOTCH.

EXTERNAL FIBRO-CARTILAGE.

INT.

FIBRO CARTILAGE?

POST. CRUCIAL LIGAMENT.

XAPSUL'E.

SEMIMEMBRANOSUS)
CAPSULE.

STYLOID PROCESS.

POST. TIBIO-FIBULAR

LIGAMENT

SOLEUS

POPLITEUS

(I).

(0)

OBLIQUE LINE.

_SOLEUS

(0).

NUTRIENT FORAMEN.

TIBIALIS POSTICUS
'

Plexor longus hallucis

(0).

<o).

flexor surface of fibula

FLEXOR LONGUS DIGITORUM

(0).

NUTRIENT FORAMEN

'ERONEUS BREVIS

(0)..

POST. TIBIO-FIBULAR
i

GROOVE FOR

IGAMENT,

TIBIALIS POSTICUS AND FLEXOR'

LONGUS DIGITORUM

EXT. LATERAL LIGAMENT.

(POST. FASCICULUS)'

NT.

LATERAL LIGAMENT.

EXT. LATERAL LIGAMENT

(MIDDLE FASCICULUsT

GROOVE FOR FLEXOR LONGUS HALLUCIS.

POST. LIGAMENT OF ANKLE JOINT.

Postkkiok View of Left Tibia and Fibula.

145

ANATOMY

146

IN A NUTSHELL.

This muscle, which covers the outer surface of the anterior wall of the pelvis,
Ls

and triangular.

flat

(Plate XL1II.)
(1) Margin of inner boundary of obturator
foramen: (2) inner two-thirds of outer surface of obturator membrane; (3) tendinous arch of obturator canal.

Origin.

Digital fossa of femur.

(Plate XLVIII.)
Insertion.
ACTION.- Rotates thigh outward and assists in holding head of femur

in

place.

Second, third, and fourth lumbar through obturator.

\ i.i;\ Supply.
Blood Supply.
i.

Obturator and
Weeps. Description. (Plate
cruris-

femoral.

LXY.)

This

muscle-

Biceps

situated on the posterior and outer aspect of the thigh.

is

The tendons

tendon forms the outer hamstring.

flexor

It is

quite

Semimembranosus, Semitendinosus, Gracilis and Sartorius form the inner hamstring,

and

large

and

lie

its

of the

to the inner side of the knee-joint.

(Plate XLIII.)
By two heads; the long head from the lower
and inner impression on the back part of the tuberosity of the ischium, by a
tendon common to it and the Semitendinosus, and from the lower part of the
The femoral, or short head, from the outer lip
greal sacro-sciatic ligament.

Origin.

between the Adductor magnus and Vastus externus, ex-

of the linea aspera,

tending almost as high as the insertion of the Gluteus maximus; also from the

outer prolongation of the linea aspera to within two inches of the outer condyle,

and from the external intermuscular septum.

Insertion.

(Plate LI.) The

fibers of the

downward and

which, pnssing obliquely

long head form a fusiform belly,

little

outward, terminates

in

an

aponeurosis which covers the posterior surface of the muscle and receives the
fibers of the short

tendon which

is

head;

this

aponeurosis becomes gradually contracted into a

inserted into the outer side of head of fibula,

and by

a small slip

into lateral surface of external tuberosity of tibia.

A.CTION.

Ilexes leg on thigh; rotates semi-flexed knee outward.

Nerve Supply.
Blood Supply.
Semitendinosus.
at

the posterior

which
joined.

lies

First,

second, and third sacral through the great sciatic.

Perforating branches of the profunda.

DESCRIPTION.

and inner aspect

(Plate

of the thigh.

LXY.)
It

This

muscle

is

situated

has a remarkably long tendon,

behind the Sartorius. and below that of the Gracilis to which it is

tendon is separated from the internal lateral ligament of the knee-

Its

by a bursa.
nous intersection.

joint

Origin.

About the middle

From

(Plate XLIII.)

osity of ischim by tendon

common

of the

muscle there

is

generally a tendi-

the lower and inner impression on tuber-

it and the long head of Biceps; also from

aponeurosis which connect- the adjacent surface of the two muscles to the ex-

tent of

about three inches

[N8ERTION.

their origin.

ft ei-

(Plate LI.)

ward and inward, terminates

to

form-

It

;i

fusiform muscle which, passing down-

below the middle of the thigh in a long,

round tendon which li< s along the inner side of the popliteal space, then curves
around the inner tuberosity of the tibia and is inserted into the upper part so
;i

little

ANATOMY IN A NUTSHELL.
the inner surface of shaft of that bone.

At

its

147

insertion

it

gives off a prolonga-

tion to the deep fascia of the leg.

Action.

Flexes leg on thigh and

rotates

it

inward.

Nerve Supply. First, second, and third sacral through

Blood Supply. Perforating branches of the profunda.

great sciatic.

Semimembranosus. Description. (Plate LXY.) This muscle is membranous above and muscular below. It is situated at the back part and inner
At its origin the aponeurosis covers the upper and anterior
side of the thigh.
part of the muscle, and from this aponeurosis muscular fibers arise and converge to another aponeurosis which covers the lower part of
face

and contract into the tendon

Origin.

its

posterior sur-

of insertion.

(Plate XLIII.) By thick tendon

from upper and outer impress-

sion on back part of tuberosity of ischium above and to the outer side of the

Biceps and Semitendinosus.

(Plate

Groove

on inner and back part of inner tuberAt its insertion fibrous

expansions are given off; one of these, of considerable size, passes upward and
outward to be inserted into the back part of outer condyle of femur, forming
part of posterior ligament of knee-joint; a second is continued downward to the
The tendon also sends a few fibers
fascia which covers the Popliteus muscle.
Insertion.

L.)

osity of tibia, beneath the internal lateral ligament.

to join the internal lateral ligament.

Action.

Flexes leg and rotates inward.

Pdrst. second and third sacral through
Perforating branches of the profunda.
it

Nerve Supply.
Blood Supply.

the great sciatic.

LESSON XXXIX.
Femur.
The femur (Plates XLYIII-XLIX) is about one-fourth the length of the
body and is the longest and strongest as well as the largest bone in the body.
When one is standing it inclines inward and a little backward. The main part
Its upper part has a head, neck, a greater trois the shaft or diaphysis.
chanter, and a LESSER TROCHANTER. Its lower part is expanded into TWO
CONDYLES an external one and an internal one. Above each one of these is a
SUPRACONDYLAR LINK.
The neck makes an angle of 12.") degrees with the diaphysis. It i> directed
upward. inward and a little forward, bein^ broad and compressed at the base Inn

becomes rounded at its junction with the head.

It is longer below and behind
joins the greater tr< than above and in front.
Posteriorly and above where
chanter is a depression (digital fossa) for the insertion of the Obturator exterWhere it joins the shaft between the two trochanters is tile POSTERIOR
nals.
INTERTROCHANTERIC LINE. About half an inch above this line the capsular ligit

ainent of the hip-joint

isphere.

It

is

attached to the neck.

an expanded portion of the neck, and forms more than a hemarticulates witli the acetabulum of the innominate bone.
The

The bead

Fossa CAPITIS

is

is

depression

a little

below and behind the center of the head.

LATE

LI.

SPINE.
INT.

EXTERNAL FIBRO-CARTILAGE.

FIBRO CARTILAGE.

CAPSULE.

OUTER TUBEROSITY.

CORONARY LIGAMENT
ANT. CRUCIAL LIGAMENT

).

BICEPS AND ANT.

TIBIO-FIBULAR LIGAMENT.
KA<

INNER TUBEROSITY.

INT.

LATERAL LIGAMENT

LIGAMENTUM PATELLAE

EXT.

LATERAL LIGAMENT.

(l) ;

(QUADRICEPS EXTENSOR).
GRACILIS

(I)

SARTORIUS

(ij

EXTENSOR LONGUS WGITORUM

(0),

SEMI-TENDINOSUS(/

PERONEUS LONGUS
EXT.

SURFACE OF

(0).

TIBIA.

TIBIALIS ANTICUS (0)

EXTENSOR LONGUS DIGITORUM

ANT.

BORDEROR CREST OF

TIBIA

PFRONEAL SURFACF
INT.

(0),

SURFACE OF

flF

FIBULA

TIBIA.

EXTENSOR SURFACE Of FIBULA

INTEROSSEOUS MEMBRANE

'.

EXTENSOR PROPRIUS HALLUCIS

(0;

PERONEUS BREVIS<0).

FIBULA.

PERONEUS TERTIUS

(0).

- SUBCUTANEUS PORTION.

ANT. LICAMENT OF ANKLE JOINT.

INT.

ANT. TIBIO-FIBULAR LIGAMENT.

LATERAL LIGAMENT

EXTERNAL MALLEOUS.
INTERNAL MALLEOLUS.

EXTERNAL LATERAL. LIGAMENT.

(ANT. FASCICULUS).

Anterior View of Left Tibia and Fibula.

148

ANATOMY

IN A NUTSHELL.

149

attachment to the ligamentum teres of

two vascular foramina.
The greater trochanter is an expanded portion of the upper part of the bone
opposite the head, its upper limit being about half or two-thirds of an inch below
The word trochanter means, to turn. The
the upper limit of the head.

The

fore part of this depression gives

The

the hip-joint.

Gluteus minimus

is

The Gluteus medius

fossa capitis has one or

attached to
is

its

anterior surface in a

broad depression.

attached to ax oblique link, which runs downward and

forward from the posterior aspect

of the greater trochanter

is

of its

upper border.

the superior cervical

On

the anterior surface

tubercle

of the

femur.

which marks the JUNCTION of the following muscles: Vastus externus. Gluteus
minimus. Obturator interims, and the two Gemelli. Above and external to
the insertion of the Obturator interims and the Gemelli is the INSERTION of the

About the center of the posterior intertrochanteric line is the

Quadratus femoris.
The linea quadkati, when present,
passes vertically down from this tubercle.
The lesser trochanter is a pyramidal projection at the junction of the lower
Its direction
part of the posterior intertrochanteric line and the diaphysis.
is inward and backward, and its apex gives attachment to the Ilio-psoas muscle.
In front the neck is separated from the shaft by the anterior intertrochanteric line, which is the upper part of the spiral line. This line commences
at the tubercle of the femur, and runs down in front of the lesser trochanter.
It gives attachment to the capsular ligament and the Vastus interims and CruPyriformis.

tubercle

of the

reus muscles.

The
it is

shaft

its middle is somewhat cylinderical, but below

has an anterior and two lateral surfaces which are not sep-

arched forward;

is

expanded.

It

lines.
The two Yasti and the Crureus muscles cover
The linea aspera separates the two surfaces posteriorly. This
marked in the middle third of the thigh, bifurcating both above and

arated by well defined

these surfaces.
line

is

well

Of

below.

its

two upper divisions the external one extends

to the greater tro-

chanter making the gluteal ridge for the attachment of the Gluteus maximus.

The

internal division winds around below the lesser trochanter, passing into the

anterior intertrochanteric line,

Another line

and forming the lower part

of the spiral line.

passes from this line to the lesser trochanter for the attachment

of the Pect incus.

Below the

linea aspera divides into

two

lines

which extend

to

the two

condyles, thus forming the supracondylar lines, which enclose the popliteal sur-

The inner line ends at the Adductor tubercle, ami i- broken

where the femoral vessels lie on the bone. Above the middle of the
linea aspera is a NUTRIENT foramen, which is directed from the knee. (Page
A SECOND foramen inav exist nearer the distal end of the bone.
P.).)
The inner lip of the linea aspera gives attachment to the Vasius interims,

face of the femur.

above

this

The Adductor
the Vastus externus.
Between the Adductor magnus ami the
Vastus externus are the Gluteus maximus and the short head of the Biceps.
Between the Adductor magnus and the Vastus internus are the Qiacus, Pecti
At the lower pari of the poplitea
neus, Adductor brevis, and Adductor Longus.

and the outer

magnus

is

lip

gives attachment

attached between the two.

to

ANATOMY IN A NUTSHELL.

150

space above each condyle is the origin of one head of the Gastrocnemius.
The distal extremity has two condyles, which are united anteriorly but
The external condyle
separated posteriorly by the intercondylar notch.

broader and more prominenl anteriorly, while the internal one is more
prominent internally, and it extends to a lower level, when the femur is taken
When the femur articulates with the tibia the two condyles
from the body.
is

Both condyles are convex for the articulation of the

tibia, and between these two anteriorly is a concave strface for the articulaThe patellar surface has a vertical hollow and two lips.
tion of the patella.
The external portion which is wider and more prominent than the internal por.,,,.

(l|1

the -mum' level.

The

tion rises higher.

tibial

anteriorly than posteriorly.

surfaces are almost parallel being a

The

lateral surface of

little

closer

each condyle extends into

Above the
tuberosity or epicondyle, which gives attachments to ligaments.
The
of
Gastrocnemius.
the
head
outer
for
the
depression
is
a
external condyle
:i

hisirocnenhns arises from the upper part of the inner condyle.

[ntercondyleae fossa has two depressions for the crucial ligaments.

inner head of the

The
The ONE FOE

<

wtkkiok ligament is on the posterior part of the inner surThe one for the posterior ligament is on the
The angle of the
of the inner condyle.
surface
external
of
anterior part
the
neck of femur with the shaft makes no changes after growth is completed.
Blood Supply. The head and neck of the femur receive branches from
The trochanter receives twigs
the sciatic, obturator and circumflex arteries.
tin.

face of thf external condyle.

from the circumflex

second perforating;

arteries.
it

The nutrient

vessel for the shaft

enters near the linea aspera and

is

is

derived from

directed towards the

head of the bone. Condyles are nourished by articular branches from the
popliteal and the anastomotic of femoral.
Ossifk \'i ION. - From five centers. The one for the shaft is a primary
center and begins to ossify in the

other four are epiphyseal centers.

the NINTH

MONTH and

joins the

seventh week of intra-uterine life. The

The one for the lower extremity appears in

bone

in

the twentieth year.

This

is

the only

some observers say the proxifhal

end of the tibia ossifies before birth. The one for the head appears in the first
The one for the greater troyi.ai; and joins the bone in the nineteenth year.
chanter appears the fourth yi.ai; and joins the bone in the eighteenth year.
for the lesser trochanter appears in the thirteenth or fourteenth
The
epiphysis which ossifies before birth, although

eab and join- the bone the seventeenth year.

Articulates.- With three bones: os innominatum, tibia and patella.

\ii M HMENT "i MuS( LES.
Twenty-three. To the great trochanter, the
Gluteus medius, Gluteus minimus, Pyriformis, Obturator externus. Obturator
To
interim.-. Gemellus superior, Gemellus inferior, and Quadratus femoris.

the lesser trochanter, the Psoas

magnus and the

Iliacus

below

it.

To the

shaft,

Vastus externus, Gluteus maximus, short head of Biceps, Vastus internus,

Adductor magnus, Pectineus, Adductor brevis, Adductor longus, Crureus and
tin'

Subcrureus.

To

the condyles, the Gastrocnemius, Plantaris

and Popliteus.

PLATE

EXTENSOR LONGUS HALLUCIS

EXTENSOR LONGUS

THIRD PHALANX

-H

DIGITOfillM

(1)

fl

SECOND PHALANX

FIRST PHALANX

EXTENSOR
BficViS DIGITORUM

(0)

TENDO ACHILLIS.

Dorsum of Left Foot.

151

(1).

LI I.

ANATOMY

152

IN A NUTSHELL.

LESSON XL.

(Plate LXXV.)
Description.
The anterior tibial
anticus.
and nerve run along the outer border of this muscle, which is just beIt is thick and fleshy above, but
neath the fascia on the outer side of the tibia.
tendinous below where it passes through the innermost compartment of the
Tibialis

vessels

anterior annular ligament.

tibia;

of

(Plate LI.)

Origin.
of shafl

(">)

Outer tuberosity of

(1)

interosseous

membrane

tibia; (2)

upper two-thirds

adjoining; (4) deep surface

of

intermuscular septum.

fascia; (5)

(Plate LIII).
Inner and under surface of internal cuneiform
Insertion.
bone and base of metatarsal of great toe.

Action.

Flexes tarsus upon leg and assists in inverting the foot.

Nerve Supply.

Fourth

and

fifth

lumbar and

first

sacral through anterior

tibial.

Blood Supply.

Anterior

tibial artery.

This

Description. (Plate LXXV.)

amicus and Extensor longus digitorum.

Extensor propius hallucls.

muscle

between the Tibialis

It is a thin,
Hat muscle and hs tendon occupies its anterior border below.
This tendon
passes through a distinct compartment in the lower portion of the annular ligament, it also crosses the anterior tibial vessels near the ankle-joint and then
It gives a thin prolongation on each side
lies on the inner side of these vessels.
lies

of the metatarso-phalangeal articulation,

Origin.- -(Plate LI.)

(1)

which covers the surface

of the joint.

Anterior surface of fibula, middle two-fourths

same; (2) part of interosseous membrane.

(Plate I.I I.)
Base of last phalanx of great toe. It usually
Insertion.
sends an expansion from the inner side of the tendon to be inserted into base of

of

6rs1

phalanx.

Action.Extends great toe and flexes tarsus.

\'i.i;\
Supply.Fourth and fifth lumbar and
i:

first

sacral through anterior

tibial.

Blood Supply.Anterior

tibial.

Extensor Longus digitorum. Description. (Plate

lies

external

to

the other muscles in

this region.

It

LXXV.) This
is

muscle

enlongated and

flat-

and the Peroneus tertius enter the same canal in annular ligament.
It
divides into four slip-, one for each of the four inner toes.
A tendon from
the Extensor brevis digitorum join- the three inner of these tendons on their
tened.

It

outer side opposite the metatarso-phalangeal articulation.

All four slips receive fibrous expansions from the Interossei and Lumbricales, after which they
a broad aponeurosis which covers the dorsal surface of the first
This aponeursosis divides Into three slips at the articulation of the
with the second phalanx.

spread out into

phalanx.
first

Origin. (Plate

LI.)

(1)

Outer tuberosity of

tibia;

(2)

fourths of anterior surface of shafl of fibula; (3) interosseous

deep surface of Fascia; (5) intermuscular septa.

upper three-

membrane;

(4)

ANATOMY
Insertion.

IN A NUTSHELL.

(Plate LII.) The middle

slip

is

153

Inserted into the base of the

second phalanx: the two lateral slips, after uniting on the dorsal surface of the
second phalanx, are continued onward and inserted into base of the third.

Extends toes and flexes foot.

Action.
Nekve Supply. Fourth and fifth lumbar and

sacral through anterior

first

tibial.

Blood Supply. Anterior tibial.

This muscle is some(Plate LXXV.)
Peroneus tertius. Description.
times wanting. sometimes it is described as a fifth tendon of the Extensor longus
digitorum with which it is joined, and their tendons pass through the same

canal in the anterior annular ligament.

Origin.

(Plate

LI.)

(1)

Lower fourth

lower part of interosseous membrane:

Insertion.

(Plate

LII.)

Inner

(o)

of anterior surface of fibula;

intermuscular septum.

side of dorsal surface at base of meta-

tarsal of little toe.

Action.

Flexes and everts

Fourth and

foot.

Nerve Supply.

fifth

lumbar and

sacral through anterior

first

tibial.

Anterior
Description. (Plate

Blood Supply.
Gastrocnemius.

tibial.

has two heads the inner of which

part of the calf of the

leg

and

is

is

LXXVII.)

the larger.

The

Gastrocnemius

This muscle forms the greater

the most superficial one in this region.

An

aponeurosis spreads out from each tendon to cover the posterior part of that

The muscular fibers of the outer

portion of the muscle to which it belongs.
head are thinner and do not extend as low as those of the inner. Muscular
fibers are given off from the anterior surface of these tendinous expansions.
This muscle gradually gets smaller and its tendon with that of the Soleus forms
the tendo Achillis.
In the tendon of the outer head there is a sesamoid
fibro-cartilage (very seldom osseous): and one is occasionally found in the tendon of the inner head.
Origin.
(Plate L.)
Inner and larger head from depression at upper and
back part of inner condyle and from adjacent part of femur. The outer head

from impression on outer side of external condyle and from posterior surface oi
femur immediately above the condyle. Both heads also arise by a few fibers
from the ridges which are continued upward from the condyle- to the linea a-pera.

(Plate LII.)
Insertion.
Os calcis by tendo Achillis.
Actiox.
Extends foot and flexes leg.
Nerve Supply. First and second sacral through internal popliteal (from

greal

sciatic.)

Blood Supply. Popliteal.

Description. (Plate LXXVII.)Situated beneath

Soleus.

cnemius

this

the Soldi-, which

i>

broad

flat

muscle.

In

shape

it

the Gastro-

resembles a

hence its name.

The deep transverse fascia of the leg, separates
mucle from the posterior vessels and nerve.
A- -aid before the tendon of
muscle and that of the Gastrocnemius make the tendo Achillis.

sole fish,
this

is


ANATOMY

154

Origin.

(Plato

L.)

IS A NUTSHELL.

Back part

(1)

of

head

of fibula

upper 'hird of

(2)

rior surface of shaft of fibula; (3) oblique line of tibia; (4) middle third of

internal border of tibia; (5) tendinous arch

gin-,

between the

and

tibial

fibular ori-

beneath which the popliteal vessels and internal popliteal nerve pass.
[nsertion. (Plate LII.) Os calcis by tendo Achillis.
A* HON. Steadies leg on foot prevents body from falling.

Internal popliteal and posterior tibial.

Suppli
Popliteal.
'u.oDi) Supply.
This muscle is sometimes
(Plate LXXVII.)
Plantaris.- Description.
It has the longest tendon of any muscle
absent and again it may be double.
It takes its name because it is sometimes inserted into the plantar
in the body.

N era

i.

The muscular

fascia.

or four inches

and the tendon

may

be

lost in

part of the Plantaris

length.

in

is

running along the inner side of the tendo

finally

about three

a small fusiform belly

situated between the Gastrocnemius and Soleus

It is

Achillis.

It

the fascia of the leg or the internal annular ligaments.

(Plate

XLVIII.) From the lower part of outer prolongation of

and from posterior ligament of knee-joint.
Os calcis with tendo Achillis.
(Plate LII.)
Insertion.
Action.
Flexes leu- and extends foot.
Origin.

linea aspera

Internal popliteal.
Popliteal.

Nerve Supply.
Blood Supply.

LESSON XLI.
Popliteus. Description.
the popliteal space.
nio-t other

popliteal

muscles

It

in

(Plate

LXXIX.)

This

a thin flat triangular

is

that

its

origin

is

muscle forms part of

muscle, and

smaller than

is

different

The

its insertion.

from

internal

nerve and the popliteal vessels cross the superficial surface of this

muscle.

Origin.

(Plate XLIX.) Deep depression on outer condyle of femur and

posterior ligament of knee.

Insertion.- (Plate L.) Inner two-thirds of triangular surface above

oblique line on posterior surface of shaft of tibia ami tendinous expansion covering surface of muscle.

Flexes and rotates leg inward.

Action.
Xi:i;\

i;

fourth and

Supply.-

fifth

lumbar and

first

sacral

through internal

popliteal.

Blood Suppli

Popliteal.

Flexor longua hallucis.

on the

fibular side of the

occupies most
three grooves

all

lei:

Description.
although

it

(Plate

LXXIX.) This musch/is

passes to the great toe.

of the posterior surface of the muscle,

three different

bono,

one

then

it

Its

tendon

passes through

is on the posterior surface of

on the posterior surface of the
astragalus; and the third one is beneath the sustentaculum tali of the os calcis.
The tendon finally passes between the two heads of the Flexor brevis hallucis

in

first

the lower end of the tibia; the second one

to its insertion.

is

PLATE

FLEXCI* L8NGUS HALLUCIS

LIU.

<1).

FLEXOR LONGUS DIGITORUM

tf)

(I).

4DQUCT0 HLLUCIS

ELEXOR BREVIS
Ha LLUCISMi
'OUTER PORTION!
(INNER PORTION

ABDUCTOR HALLUCIS (l/

LANTAR INTEROSSEOUS

(1).

ABDUCTOR
WIN Ml DIGITI
I

(1)

FLEXOR BREVIS

PERONEUS

LONGUS

H)

NTAR INTEROSSEOUS
TIBIALIS AUTICUS

(0).

(1

DDUCTOR HALLUCIS

(0).

_FLEXOR BREVIS
MINIMI DIGITI
TIBIALIS POSTICUS

(0)

(1)

FLEXOR BREVIS HALLUCIS

(0)

ACCESSORIUS (OUTER HEAD)

(0)

ACCESSORIUS (INNER HEAD)

FLEXOR BREVIS DIGITORUM

(0)

ABDUCTOR MINIMI
ABDUCTOR HALLUCIS

\0)

POSTERO INFERIOR SURFACE OF THE CALCANEUM.

Plantar Surface of Left Foot.

155

DlGlTl

,0|


ANATOMY

156

Origin. (Plate

L.)

IN A NUTSHELL.

Lower two-thirds

(1)

of posterior surface of shaft

mem-

lower part of interosseous

of fibula except an inch at lowest part: (2)

(3) intermuscular septum; (4) fascia covering Tibialis posticus.

Base of last phalanx of great toe.
(Plate LIII.)
Insertion.

brane;

Flexes ureal toe and extends foot.

Action.

Nerve Supply.

Fifth

lumbar and

and second

first

sacral through pos-

terior tibial.

Blood Supply.

Posterior

tibial.

Flexor Longus digitorum.Description.

is

small

its

at

occupies nearly

all

Tibialis posticus

internal

(Plate

origin but gradually increases in size as

LXXIX.)
it

this

muscle pass through a

malleolus, but each tendon has

its

own

Its

muscle

tendon

The tendons

of the posterior surface of the muscle.

and

This

descends.

common

of the

groove behind the

synovial sheath.

They

are

As the tendon crosses the sole

separated from each other by a fibrous septum.
of the foot obliquely forward and outward, it divides into four tendons each of
which passes through the tendons of the Flexor brevis digitorum opposite the
base of the first phalanx.
Just before it divides it is joined by the Flexor accessories.

Origin.- -(Piatt L.)

1

lie

Posterior surface of shaft of tibia,

oblique line to within three inches of

immediately below

extremity internal to the

its

tibial

origin of the Tibialis posticus.

Insertion.

(Plate

LIII.)

Into

bases of last phalanges of the four lesser

toes.

A.CTION.

Flexes

Nerve Supply.
Blood Supply.

toes

posticus.

Tibialis

and extends foot.

and first

Fifth lumbar
Posterior

sacral through posterior tibial.

tibial.

Description.

(Plate

LXXIX.) This muscle

the

is

and it lies between the Flexor

Longus hallucis and the flexor longus digitorum.
Between its two heads pass
the anterior tibial vessels to the front of the leg.
Its tendon passes through a
mosl deeply seated of

all

the muscles of the leg.

in its own sheath.

It then passes through
another sheath over the internal lateral ligament into the foot and then beneath

groove behind the internal malleolus

the inferior calcaneonavicular ligament to

sertion to

all

its

insertion.

It

sends fibers of

in-

the bones of the tarsus except the astragalus, also to second, third,

and fourth metatarsal bones.

(

>rigin.

Plate L.)

Whole of posterior surface of interosseous membrane,

excepting lowesl part; from outer portion of posterior surface of shaft of

tibia,

between commencement of oblique line above and junction of middle and lower
third of shaft below; from upper two-thirds of the internal surface of fibula;
some fibers a bo from deep transverse fascia and intermuscular septa.
I

nsertion.

bono and

(Plate bill.) Tuberosity of navicular and internal cuneiform

bases of second, third, ami fourth metatarsal.

Action.

Extends tarsus; turns

sole inward.

Nerve Supply.Fifth lumbar and

Blood

Si pply.

Peroneus longus.-

Posterior tibial.

Description.

first

(Plate

sacral through posterior tibial.

LXXIX.) The Peroneus

Ion-

ANATOMY

IN A NUTSHELL.

the Peroneus brevis.

tins is superficial to

The

outside of the leg.

It is

1 ")7

situated at the upper part and

external popliteal or peroneal nerve passes between

the fibula and this muscle near the upper part of the bone between the head and
As its tendon passes behind the external malleolus it lies behind the
the shaft.

tendon of the Peroneus brevis in a common groove which is converted into a

These two tendons have synovial membranes. Its
tendon passes across the outer side of the os calcis, below its peroneal tubercle,
then it runs in a groove on the under surface of the cuboid bone after which it
Behind the external malleolus and on
crosses the sole of the foot obliquely.
canal by a fibrous band.

the outer side of the cuboid bone the tendon changes

places

it is

substance where

it

and

in

these

bone)

is

in its

its direction,

sesamoid fibro-eartilage (sometimes

crosses the cuboid bone.

thickened.

(Plate LI.)

(1) Head and upper two-thirds of outer surface of

deep surface of fascia; (3) intermuscular septa and occasionally by
few fibers from outer tuberosity of tibia.
Outer side of base of metatarsal of meat toe
Insertion.
(Plate LIII.)
and internal cuneiform. Occasionally send- dip to base of second metatarsal

Origin.

fibula; (2)

bone.

Action. Extends and everts foot and steadies leg upon foot.
Nerve Supply. Fourth and fifth lumbar and first sacral through musculocutaneous branch of the external popliteal.
Blood Supply. Peroneal.
This muscle is shorter
(Plate LXXIX.)
Peroneus brevis. Description.
and smaller than the Peroneus longus and lies behind it. Its tendon passes
behind the external malleolus in front of that of the Peroneus longus. On the
outer side of the os calcis it is separated from the tendon of the Peroneus longus

by the peroneal tubercle.

Lower two-thirds of external surface
(Plate L.)
Origin.
fibula, and intermuscular septa.
(Plate LIII.)
Tuberosity at base of metatarsal
Insertion.

on

its

of shaft

of

of little tee

outer side.

Action.

Extends foot and helps steady leg

lumbar and
Fourth and
to

\ki;\ e Supply.

upon

foot.

hist sacral

fifth

through musculo-

cutaneous branch of external popliteal.

Blood Supply.

Peroneal.
LESSON

Xidl.

digitoruin. Description. (Plate

LXXV.)This is a
Extensor brevis
broad, thin muscle which passes obliquely across the dorsum of the foot and
divides into four tendons.
Beneath this muscle lie the tarsal and metatarsal
arteries

and bones and the Dorsal

interossei muscles.

The innermost tendon

crosses the dorsalis pedis artery.

(2)

(1) Fore part of upper and outer surface of s calcis;

(Plate LI I.)
Origin.
external calcaneo-astragaloid ligament; (3) horizontal portion of anterior

annular ligament.

<

ANATOMY

158

IN A NUTSHELL.

Innermost tendon into dorsal surface of base

(Plato LIU.)
[nsertion.
phalanx of great toe; the other three into outer sides of long extensor
tendons of second, third and fourth toes.

of

first

Extends phalanges of four inner toes acting only on

Action.

first

phalanx

of ilif great toe.

N kve Supply.Anterior
Blood Supply. Dorsalis

tibial.

pedis.

Abductor hallucis. Description.

one
is

"t'

the three muscles of the

(Plate

protected by the plantar fascia. This fascia

fool

is

on the

LV.)

This

muscle

is

the inner

layer of the plantar surface of the foot.

first

is

It

beneath the muscle when one's

floor.

(Plate LI 11.)

Origin.-

Inner tubercle of under surface of os calcis;(2)

(1)

internal annular ligament; (3) plantar fascia; (4) intermuscular septum.

Insertion.

Actiox.

(Plate

Nerve Supply.
Blood Supply.
Abductor

Inner side of base of

LIII.)

Abducts great

toe; flexes

Internal
Internal

minimi

first

phalanx

of greattoe.

proximal phalanx.

plantar.

plantar.

Description.

digiti.

(Plate

LV.)

This

muscle

is

separated from the Flexor brevis digitorum by a vertical septum of fascia, and
has along
first

its

inner border the plantar vessels

Layer of the foot bear the

Origin.

(Plate

LIII.)

of os calcic in front of

same

and nerve.

Outer tubercle of os

(1)

All the muscles of the

relation to the plantar fascia.

both tubercles;

(3)

calcis; (2)

under surface

fore part of inner tubercle; (4) plantar

intermsucular septum.

fascia: (5)

Insertion.

(Plate

LIII.)

Its

tendon, after gliding over a smooth facet

on the under surface of the base of the

with the short Plexor of the

metatarsal bone,

fifth

little toe, into

is

inserted, together

the outer side of base of

first

phalanx

of little toe.

Action.

Abducts

little

toe; flexes

Nerve Supply. External

proximal phalanx.

plantar.

External plantar.
Flexor brevis digitorum. (Perforatus.)
Blood Supply.

muscle

called

is

Perforatus because

Flexor longus digitorum

its

(Perforans.)

Description.

(Plate LV.) This

tendons are perforated by those of the

After the muscle divides into four

tendons, one for cadi of the four outer toes, these tendons themselves divide

opposite bases of the

longus digitorum.

first

for the passage of the tendons of the Flexor

second time to be inserted into the sides of

phalanges

They divide

the second phalanx of the four outer toes.

This muscle

is

separated from the

externa] plantar vessels and nerve by a thin layer of fascia.

ORIGIN.
of plant a

i-

(Plate bill.) (1)

fascia; (3)

Insertion.- (Plate LIII.)

\ii [on.

Inner tubercle of os calcis; (2) central part

intermuscular septa.
Sides of second phalanges of four lesser toes.

Flexes toes.

Supply.
Internal plantar.
SUPPLY.- Plantar arteries.
Adductor obliquus hallucis.- Description.
\i:i;\

i:

P>!.(oi>

(Plate

LX.)

This

muscle

PLATE LIV

BONE.

PHALANGES. TWO CENTERS FOR EACH

ONE FOR SHAFT. ONE FOR METATARSAL EXTREM ITY

THE CENTERS FOR THE BASE OF THE TERMINAL PHALANGES APPEAR AT THE SIXTH YEAR. CONSOLIDATE AT
THE EIGHTEENTH YEAR.

METATARSUS

TWO CENTERS

FOR

ONE FOR SHAFT

EXTREMITY

EACH

BONE.

ONE FOR DIGITAL

EXCEPT FIRST

THE CENTERS FOR THE HEADS

OF THE METATARSALS APPEAR

THE CENTER hOR THE EPIPHYSIS

AT THE THIRD YEAR, AND

FOR THE METATARSAL OF THE HALLUX

CONSOLIDATE AT THE

APPEARS AT THE

THIRD YEAR.

CONSOLIDATES AT THE TWENTIETH YEAR.

TWENTIETH YEAR.

ONE CENTER FOR EACH BONE. EXCEPT OS CALCIS

THE CENTER FOR THE EPIPHYSIS FOR THE CALCANEUM APPEARS AT THE TENTH YEAR. CONSOLIDATES
AT SIXTEENTH YEAR.

Showing the Direction op Nutrient Arteries of Bones of the Foot.

159

ANATOMY

160

IN A

NUTSHELL

occupies the hollow space between the four inner metatarsal bones.
large, thick, fleshy mass passing obliquely across the foot.

Origin.

(Plate

LIII.)

Tarsal

first

phalanx of great

toe,

muscles of the great

fibrous expansions at their insertion to blend with the long extensor
All the small

with outer portion of Flexor brevis hallucis.

toe give off

extremities of second, third, and fourth

metatarsals and sheath of tendon of Peroneus longus.

Outer side of base of
Plate LIII.)
Insertion.

It is

tendon.

Abducts great toe.

External plantar.
Blood Supply. Plantar arteries.
Adductor transversus hallucis. Description. (Plate
Action.

Nerve Supply.

LX.) This muscle

of
bones,
crosses
the
metatarsal
and
heads
lying between
is narrow ami fiat,
for
tendons.
name
this
is
Another
muscle
(Transversus
them and the flexor
pe<

lis.)

Origin.

(Plate

LIII.)

Inferior

metatarso-phalangeal ligaments of three

outer toes.

Insertion.

(Plate

LIII.)

Outer

side of

first

fibers being blended with the tendon of insertion

phalanx of great toe, its

Adductor obhquus

of the

hallucis.

Adducts great toe.

External plantar.
Sipply.
Xi;i;\ e
External
plantar.
Blood Supply.
Description.
(Plate LXI.)
The Dorsal interossei
interossei.
Dorsal
to
those
the
hand
with
the
foot
similar
in
exception
that they are
are
of the
grouped around the middle line of the second toe, while those of the hand are
A< tion.

grouped around the middle line of the middle finger. Each one lias two heads
between which pass the perforating arteries to the dorsum of the foot, except in
the hirst dorsal interosseous between the two heads of which passes the communicating branch
ORIGIN.

Insertion.

common

of the dorsalis pedis artery.

(Plate LXI.)

(Plate

From adjacent
Bases of

extensor tendon;

sides of metatarsal bones.

phalanges and aponeurosis of

muscle inserted into inner side of second toe,

LXI.)

first

first

the other three into outer side of second, third, and fourth toes.

Action.Flex

first and extend second and third phalanges adduct second,

ami fourth tin-.
Nerve Supply. External plantar. First and second dorsal also receive
extra filaments from anterior tibial nerve.
Blood Supply. The Plantar interossei receive the external plantar, and
;

third,

the Dorsal interossei receive the plantar arteries both external

and internal; ex-

cept the third dorsal interosseous which receives the external only.

Plantar

""i

;ire

three

interossei.
in

DESCRIPTION. (Plate

number, the same

have one head apiece.

They

ORIGIN. (Plate LXII.)

and

fifth

metatarsal bones.

as the

palmar

LXII.)

The

plantar

interossei of the

inter-

hand and

also

beneath the metatarsal bones.

Base ami inner side of shaft of third, fourth.

lie

ANATOMY IN A NUTSHELL.

161

Insertion. (Plate LXII.) Inner sides of bases of first phalanges of same

toes and aponeurosis of common extensor tendon.
Action. Adduct first phalanges of three outer toes; also flex first phalanges,

but extend the rest.

Nerve Supply.
Blood Supply.

External plantar.
Plantar arteries.
PLATE

LV.

EXTERNAL
NERVE

.PLANTAR

Plantar Fascia and First Layer of Muscles of Foot.

LESSON

XLII1.

(Plate LIX.)
The two heads of this
Flexor accessorius.
Description.
muscle are separated from each other by the Long plantar Ligament. The external plantar vessels and nerve lie beneath it when one is standing.
.


ANATOMY

162

(Plate

Origin.

L1II.)

below groove

of os calcis

IN A NUTSHELL.

Inner

or larger head from inner concave surface

tendon of Flexor longus

for

hallucis.

Outer head from

outer surface of OS calcis and long plantar ligament.

Outer margin, upper and under surfaces of

(Plate LIX.)
[nsertion.
tendon of Flexor Longus digitorum.
Assists long flexors of toes.
A< pion.

Nerve Supply.
Bl

Si ppli

External

plantar.

External plantar.

Lumbricales. Description.

(Plate

LIX.)

These

are accessory to ten-

dons of the Flexor Longus digitorum.

Tendons of long flexors.
Origin. -(Plate LIX.)
Expansion of long extensors and base of
(Plate LIX.)
Insertion.

first

phalanx of corresponding toe.

Accessory to flexors and extensors.
A< riON.
\i

i;\

Supply.

i.

Two

inner muscles get the internal plantar.

Two

outer

muscles gel the external plantar.

Note. The first inner lumbricalis has internal plantar and the three outer
have external plantar in one out of ten cases.
Blood Supply. Plantar arteries.
Description. (Plate LX.) This muscle has one
Flexor brevis hallucis.
origin and two insertions, and is situated along the inner and under surfaces of
The inner tendon joins that of the Abductor
the metatarsal of the great toe.
lialluci-. while the outer one joins the tendons of the Adductor transversus
hallucis and the Adductor obliquus hallucis prior to their common insertion in a
Between these two heads the Flexor longus hallucis lies in a
sesamoid bone.

ive.

Origin.
cuneiform;

(Plate

LIII.)

Inner border of cuboid bone;

(1)

(2)

external

first

phalanx

prolongation of tendon of Tibialis posticus.

(3)

Insertion.
of greal

(Plate LIII.)

Inner and outer sides of base of

toe.

Action. Flexes and abducts great

N i:i;\ Supply.
Blood Supply.
i.

toe.

Internal plantar.

Internal plantar.

Astragalus, supplied by dorsalis pedis.

With four bones:

Artici LATION.

(1)

One

or two centers of ossification.

tibia, (2)

fibula; (3)

os calcis,

and

navicular.

Astragalus has no muscles attached.

Os

calcis,

supplied by posterior

centers of ossifk

tibial, internal

Two

For ossification of tarsus see Plate LIY.

With two bones: (1) the astragalus and (2) cuboid.

Artk LATION.
Attachment oi Muscles.
i

Eight: (1)

the tendon

Achillis; (3)

digiti;

Flexor brevis digitorum;

(6)

and external malleolar.

moN.

Plantaris; (4)

part

Abductor

(7)

of the Tibialis posticus; (2)

hallucis; (5)

Abductor minimi
(8) Extensor

Plexor accessorius, and

brevis digitorum.

Cuboid, supplied by the dorsalis pedis, as are the remaining bones of tarsus.
(

>ssn

[(

vi

[on.

me

center.

ANATOMY
Articulation.
form, and

With

IN A NUTSHELL.

163

four bones; (1) the os calcis; (2) external cunei(4) fifth metatarsal bones; occasionally with the

(3) the fourth and

navicular.

Attachment of Muscles. (1)

part of the Flexor brevis hallucis and (2)

PLATE

LVI.

First Layer of Muscles of the Foot, Also [nternal wi> External

Plantar Arteri es.
a slip from the tendon of the Tibialis posticus.

Navicular, supplied by dorsalis pedis.

Ossification.
One center.
Articulation.With four hones:
(

(1)

astragalus

and

occasionally the cuboid.

Attachment of Muscles.

Pari of the Tibialis posticus.

Internal cuneiform, supplied by dorsalis pedis.

three

cuneiform;

ANATOMY

164
Ossification.

(3)

One

IN A NUTSHELL.

center.

Articulation. With four bones: (1) navicular, (2) middle cuneiform;

first and (4) second metatarsal bones.
Attachment of Muscles. (1) Tibialis anticus and (2) posticus and (3)

Peroneus longus.
Middle cuneiform, supplied by dorsalis pedis.
i

>ssification.

One center.
With four bones,

form and second metatarsal bone.

Attachment of Muscles. A

is

navicular, internal

qlation.

Ai;ii<

attached

from the tendon

slip

and external cunei-

of the Tibialis posticus

bone.

to this

External cuneiform, supplied by dorsalis pedis.

Ossification.

One center.

Articulation. With six bones; the navicular, middle cuneiform, cuboid,

second, third, and fourth metatarsal bones.
Attachment of Muscles. Two: part of Tibialis posticus, Flexor brevis

hallucis.

Metatarsus.

Plates LII-LIII.

They have small nutrient branches from interosseous.

Each metatarsal bone has two centers. Plate LIV.
Articulation. Each bone articulates with the tarsal bones by one ex-

Blood Supply.

all

Ossification.
tremity, and

by the other with the

first

row

of phalanges.

The number

bones with which each metatarsal articulates is one for the

second, one for the third, two for the fourth, and one for the

Attachment of Muscles.

To the

first

first,

of tarsal

three for the

fifth.

metatarsal bone, three, part of the

Peroneus longus, and First dorsal interosseous. To the

and Second dorsal interfrom the tendon of the Tibialis posticus, and occasionally a

Tibialis anticus, the

second, four, the Adductor obliquus hallucis and First

osseous, and silp

from the Peroneus longus. To the third, five, the Adductor obliquus hallucis,
Second and Third dorsal and Plrst plantar interosseous, and a slip from the
tendon of the Tibialis posticus. To the fourth, five, the Adductor obliquus
hallucis. Third and fourth dorsal, and Second plantar interosseous, and a slip
from the tendon of the Tibialis posticus. To the fifth, six, the Peroneus brevis
slip

Peroneus

tertius,

Flexor brevis minimi

digiti,

Adductor transversus

hallucis.

Fourth dorsal and Third plantar interosseous.

Phalanges.

Blood Supply.

They

Plates

LII-LIII.

have small nutrient branches from digital.

Plate LIV.
Artk LATION. The first row, with the metatarsal bones behind and second phalanges in front ;the second row of the four outer toes, with the first and
third phalanges; of the great toe, with the first phalanx: the third row of the
all

Ossification.- From two centers.

i

loin-

outer toes, with the second phalanges.

Attachment ok Muscles.- To

the first phalanges.

Great toe, five musinnermosl tendon of Extensor brevis digitorum, Abductor hallucis, Adductor obliquus hallucis, flexor brevis hallucis, Adductor transversus hallucis.
cles;

165

IN A NUTSHELL.

ANATOMY

muscles First and Second dorsal interosseous and First

Third toe, three muscles Third dorsal and First plantar interosseous
lumbrical.
Fourth toe, three muscles; Fourth dorsal and Second
lumbrical.
Second
and
Fifth toe, four muscles; Flexor brevis
plantar interosseous and Third lumbrical.

Second

toe, three

minimi

digiti.

Abductor minimi

digiti,

PLATE

and Third plantar interosseous, and

LVII.

INTERNAL PLANTAR

EXTERNAL

PLANTAR

LUMBRICALES

COMMUNICATING
TO INTERNAL PLANTAR

NERVE

EXTERNAL PLANTAR
INTERNAL

ARTERY
PLANTAR

ARTERY

NERVE.

ARTERY.
POST. TIBIAL

NERVE

NERVES.
LUMBRICALES, INTERNAL AND EXTERNAL PLANTAH VESSELS AND
Longus hallucis,
Fourth lumbrical. Second phalanges. Great toe; Extensor
one slip ol the
Flexor longus hallucis. Other toes; Flexor brevis digitorum;
phalanges;
common tendon of the Extensor longus and brevis digitorum. Third
brevis
Extensor
and
two slips from the common tendon of the Extensor longus
digitorum, and the Flexor longus digitorum.

ANATOMY

166

IN A NUTSHELL.

LESSON XL1Y.
The

Tibia.

The word tibia means flute. It is also called the shin bone and is situated
It articulates with the
on a plane anterior to and on the inner side of the fibula.
lemur above, tin astragalus below, and the fibula externally. It sustains the
uri'Jn of the entire body above the knee-joint as the fibula does not enter into
1

this articulation.
is called the head, each side of which is a
These tuberosities are continuous in front but are separated behind by the popliteal notch. The upper surface of each tuberosity is concave

The superior expanded portion

tuberosity.

to receive the condyles of the femur.

The
surface

internal tuberosity

branosus muscle

The

is

larger than the external one,

is

more concave and

is

Longer.

and

its

horizontal groove for the

behind this articular surface close to

its

articular

Semimem-

inner border.

external tuberosity gives attachment to the ilio-tibial

band

at the junc-

and outer surfaces, at which place there is a prominent tubercle.

The Extensor Longus digitorum and the Biceps have a \'v\\ fibers of attachment immediately below and in front. The fibula articulates with the
posterior and under part in a flat facet which looks downward, outward, and
backward. The articular surface of this tuberosity is concave from side to side,
but convex from before backward, and its circumference is almost circular.
The semilunar fibro-cartilages are situated around the circumference of each
of these articular surfaces where they are flattened.
The spine is an elevation between these articular surfaces. The summit of
the spine has two tubercles with an intervening space.
The depressions in
iVi .lit
and behind the spine are for the attachment of the crucial ligaments.
This posterior depression is continuous into the popliteal notch, which separates
tion of the anterior

The anterior

the tuberosities posteriorly.

tion of the

head and the -haft anteriorly.

attachment

The

to

the

ligamentum

shaft which

is

tuberosity or tubercle

The lower

is

at the junc-

half of this tubercle gives

patellae.

triangular on cross section

the upper two-thirds with the lower one-third.

is

It

smallest at the junction of

has three borders and three

The anterior border separates the internal and external surfaces and
surfaces.
extends from the anterior tuberosity or tubercle to the front of the inner malThe

leolus.

The lower
The internal border separates the internal
commences above at the back of the inner tuberosity

crest of the tibia

one-third of this border

is

i>

the upper two-thirds of this border.

smooth.

and posterior surfaces.

It
and extends below to the posterior border
border

ie

rnos1 distind in the

of the internal

middle third of the bone.

also called interosseous ridge, separate- the external

gives attachment to the interosseous

malleolus.

The

This

external border,

and posterior surfaces.

sharp in
is thin and

membrane and

It
its

middle portion.

The

internal surface

is

nearly subcutaneous and

is

convex.

The

insertion

ANATOMY
of the Gracilis

is

NUTSHELL.

IN A

at the inner side of the tubercle,

167

having the insertion of the

Semitendinosus below it. the two being surrounded by the double insertion of
The external surface has on it- upper two-thirds,
the Sartorius. except below.
which is concave, the Tibialis anticus. The lower part of its surface runs for-

ward and

is

covered by the extensor tendons.

PLATE

The

posterior surface has an

LVIII.

Accessorius Muscle and Plantar Vessels.

oblique line running

down and inward

one-third of the bone.

This line

giv<

the junction of the upper and middle

The popliteus
the origin of the Soleus.

a1

attached to the triangular area above this line. The middle onethird of the bone is divided into two portion- by a longitudinal ridge, the inner
one of which is for the origin of the Flexor longus digitorum, and the outer one

muscle

is

ANATOMY

168

is

of

IN

A NUTSHELL.

for the origin of the Tibialis posticus.

nutrient foramen

is

on

this portion

the bone and is directed towards the distal extremity.

The lower portion of the bone is broad transversely, and extends downward

On the posterior portion of this malleointernally to form the inner malleolus.

posticus, and externally to this is
Tibialis
tendon
the
of
lus is a groove for the
tendon of the Flexor longus hallucis. The fibula articulates with the
external portion of the lower extremity of the bone in a concave surface, which
border.
The
is rough for the attachment of ligaments, except along its lower
being
broader
which
is
concave,
articular
surface
has
an
tibia
of
the
end
lower

one

in

for the

than behind.

front

thi> surface

The

is

tibia

articulates with the astragalus.

It

is

The nutrient artery

very vascular bone.

In the middle of

separating two lateral depression-.

a slight elevation

furnished by the posterior tibial,

for the shaft

is

enters the bone near the interosseous border

it

and middle third, and is directed downward. The

bone receives numerous branches from the inferior articular arteries
of the popliteal, and the recurrent branches of the anterior and posterior tibial
The lower extremity receives twigs from the posterior and anterior
arteries.
at

the junction of the upper

head

of the

and the internal malleolar arteries.

The center for the shaft appears in
the eighth week of intra-uterine life. The center for the proximal extremity
appears at the end of the ninth month of intra-uterine life, and joins the shaft
The center for the distal extremity apat the twenty-first year or even later.
pears during the second year and unites with the shaft at the eighteenth year.
Articulation. With three bones; femur, fibula and astragalus.
Attachment of Muscles. Twelve; to the inner tuberosity, the Semimembranosus; to the outer tuberosity, the Tibialis anticus and Extensor longus
digitorum and Biceps; to the shaft, its internal surface, the Sartorius, Gracilis,
and Semitendinosus; to its external surface, the Tibialis anticus; to its posterior
surface, the Popliteus, Soleus, Flexor longus digitorum, and Tibialis posticus;
tibial,

the anterior peroneal,

Ossificatiox.

From

three centers.

hgamentum

to the tubercle, the

patellae.

LESSON XLY.
The Patella.
The sesamoid bone which
extensor muscle

is

is

developed

in

the patella (knee-pan.)

Its

the tendon of the Quadriceps

anterior surface

is

pierced

by

h> superior border has the Rectus and Crureus attached

it.
The posterior margin of this border is higher than the anterior margin.
The externa] part of the posterior surface is concave transversely, and the

vascular foramina.
to

interna] pari

i-

convex.

When

the leg

is

extended the lower one-sixth

three-sixths of the articular surface

is

in

When it

flexed

the upper two-sixths of the articular surface

also in

this position

The Ugamentum

the marginal facet

patellae springs

of

mid-flexed the middle

contact with the femur.
When fully

articular surface is in contact withthe femur.

is

in

from the apex.

is

is

in

contact with the femur,

contact with the inner condyle.

If

the patella

is

placed upon a

ANATOMY
plain surface,

its

IN A NUTSHELL.

apex away from you and

the side to which

it

its

169

anterior surface up,

it

will tip to

belong?.

Blood Supply. The

patella receives twigs from the superficial

of the anastomotica, anterior tibial recurrent,

and the

branch

inferior articular of the

popliteal.

'ft

|t

'

LUMBRICALIS_

/
|

iff

Flexor Lonqtjs Digitorum Tendon and Foub Lumbricales.

Ossification.

One

center.

It

begins during the third year and

is

com-

pleted aboul the age of puberty.

Articulation.With two condyles of femur.

Attachment of Muscles. Four the Rectus, Crureus, Vastus interims
:

and Vastus externus.

Quadriceps extensor

These muscles, joined

cruris.

at

their insertion, constitute the

anatomy

170

in a nutshell.

The Fibula.
The word
and

Lies

extends
1

at

its

1-

fibula

means

clasp or pin.

almost parallel with the

to a

Lower

Its

Level.

tibia.

It

It

is

main purpose

upper expanded portion

is

also called the peroneal bone,

not quite as long as the tibia, but

is

to give elasticity to the leg.

which is prolonged upward

The inner surface of the head
which looks upward, inward, and forward to
called the head,

is

posterior part into the styloid process.

and styloid process has a

facet

articulate with the tibia.

This styloid processgives attachment to the Biceps.

The Soleus muscle

The neck
front.

is

is

attached behind and the Peroneus longus

the constricted part below the head.

is

attached in

The lower extremity

extends into the external malleolus which is lower than the internal malleolus.
.Man i- the only animal in which this is true.
It articulates with the astragalus

and behind there is a depression for the posterior fasciculus of the

There is a slight groove posteriorly for the Peroneus
This extremity is convex and subcutaneous externally.
longus and brevis.
The shaft has four surfaces which are anterior, internal, posterior, and
external; and it has four borders which are antero-external, antero-internal, postero-external, and postero-internal. To its anterior surface
are attached the Extensor proprius hallucis, Extensor longus digitorum, and
Peroneus tertius. This surface is broad and grooved below but narrow above.
The internal surface is grooved for the Tibialis posticus. The posterior surface
has attached to its upper third the Soleus, below this the Flexor longus hallucis.
The nutrient canal is on this surface and is directed downward. The Peroneus
brevis and longus are attached to the external surface, which is directed outward above and backward below.
The antero-external border is between the peroneal muscles and the extensor muscles, and extends from the front of the head of the fibula to the external malleolus, where it divides to embrace a triangular subcutaneous surface.
The antero-internal border, called interosseous ridge, gives attachment to
the interosseous membrane and separates the extensor muscles in front from
internally,

external lateral ligament.

the Tibialis posticus behind.

in

it-

upper

third.

It

It lies parallel with the antero-external border

ends below just above the articular facet. The pos-

tero-external border separate- the peroneal muscles

commences

a1

from theflexor muscles.

It

the base of the styloid process and ends below in the posterior

border of the external malleolus.

This is not a straight line for at first it is
directed outward, then backward, then inward.
The postero-internal border,
called the oblique line,

below

in

commences above the inner

the lower one-fourth of the bone where

it

side of the heads

and ends

joins the interosseous ridge,

or antero-internal border.
lb
Supply. The fibula receives the nutrient artery of its shaft from
the peroneal branch of the posterior tibial.
The head is nourished by branches
>

from the

inferior external

malleolus

i-

Ossification.
in

the eighth

articular branch of the popliteal artery,

and the

supplied mainly by the peroneal and external malleolar arteries.

week

From

three

The center for the shaft appears

The center for the proximal extremity

centers.

of intra-uterine

life.

AXATOMY

appears
year or

in

the fourth or

IN A NUTSHELL.

and

fifth year,

171

joins the shaft at the twenty-second

The center

for the distal extremity appears during the second

unites with the shaft at the twentieth year.

later.

and
Articulation-. With two bones: the tibia and the astragalus.
Attachment of Muscles.Nine to the head, the Biceps.

year,

Sol.-us.

and

PLATE LX.

FLEXOR LONGUS HALLUCIS

SESAMOID BONE:

&

ec

j fV t? >N

i,

'

FLEXOR BREVIS HALLUCIS

?- \

GROOVE FOR PERONEUS LONGUS

TIBIALIS POSTICUS

FLEXOR LONGUS DIGITORUM -

FLEXOR LONGUS HALLUCIS

Third Later of Must les of the Foot.

Peroneus Iongus; to the shaft, its anterior surface, the Extensor longus digitorum, Peroneus tertius, and Extensor proprius hallucis; to the internal surface,
the Tibialis posticus; to the posterior surface, the Soleus and Flexor longus hallucis: to the external surface, the Peroneus longus and brevis.

The fibula

is

a vestigial

the excessive development of

bone
its

in

man and

malleolus.

survives mainly on account of

This accounts for the fad thai the

ANATOMY IN A NUTSHELL.

172

lower epiphysis, through appearing first, unites with the shaft before the upper
In birds, the head of the bone is large, and enters into the formation
epiphysis.

ses

The

end atrophies.

of the knee-joint, while the lower

which are the last to form are

Rule 1, page 19.

rule

first

is

The

to join the bone.

this:

fibula

Those ephyis an excep-

tion.

LESSOX XLVI.
Arteries

The abdominal aorta

common

lumbar vertebra.
Each
of the ilii.

This division
of these

LXXII-XC)

(Plates

the

iliac arteries a little to

on a

is

common

level

iliac arteries

The internal
long and divides
branches:

left

divides into an external

The branches

and an
com-

of these

supply the peritoneum, ureter. Psoas magnus.

iliac

branch (Plates LXXII-XCI) is about an inch and a half

and posterior trunk at the upper margin of

into an anterior

The

the great sacro-sciatic foramen.

lowing

and

the median line of the fourth

with the highest points of the crest

iliac arteries

internal iliac branch at the lumbo-sacral joint.

mon

divides into the right

left side of

(1)

Ilio-hmibar,

posterior trunk gives off the three folsacral,

lateral

(2)

(3)

gluteal.

The

ilio-

lumbar branch divides into an iliac branch for the Iliacus muscle and the ilium
and a lumbar branch for the Psoas magnus and Quadratus lumborum. The
branch to the Quadratus lumborum semis a spinal branch to the spinal cord
through the last intervertebral foramen. The lateral sacral branch divides
into a superior and inferior division.
The superior one, after anastomosing
with the sacro-media, passes through the first or second anterior sacral foramen
to supply the canal, after which it passes through the corresponding posterior
foramen to the back. The inferior branch, after descending on the sacrum and
coccyx, anastomoses with the sacro-media and has a similar route as the superior

branch.

The gluteal branch passes out of the pelvis through the great sacro-sciatic
foramen, above the Pyriformis muscle. While in the pelvis, it gives branches
and adjacent muscles. Outside of the pelvis it divides into superbranch which passes undes the Gluteus maximus, and deep branch which

to the ilium
ficial

passes between the Gluteus medius and Gluteus minimus, and then divides into
an upper branch which runs along the upper border of the Gluteus minimus,
and a lower branch which runs downward.

The anterior trunk

(!)

Superior vesical,

orrhoidal.

(2)

(Plate-

LXXII-XC)

middle vesical,

(3)

uives off the following branches:

inferior vesical. (4)

middle hem-

obturator. (Co internal pudic, (7) sciatic; and in the female (8)
uterine, ami (9) vaginal.
The superior vesical branch is that portion of the
fetal

(.">)

hypogastric artery which

is

still

used alter birth.

It

runs to the side of

the bladder and gives off the artery to the vas deferens, which artery runs with
tin-

spermatic cord.

In the fetus the

external

half as large a- this hypogastric artery

iliac

(umbilical).

artery

is

only about one-

This artery in the fetus

runs to the bladder and from there along the abominal wall to pass through the

ANATOMY

IN A

NUTSHELL

173

umbilicus to the umbilical cord and the placenta, (Plate IX). The middle
vesical branch passes to the base of the bladder and is generally a branch of the
The inferior vesical branch runs to the base of the bladder,
superior vesical.
prostate gland and seminal vesicales in the male and to the vagina, rectum, and
neck of the bladder in the female. In the female it is called vaginal. The

middle hemorrhoidal branch passes to the rectum and generally arises with the

PLATE

LXI.

The Four Dorsal

inferior vesical.

The obturator branch

lies

after passing through the obturator canal

it

Interossei.

and
and an ex-

inferior to the obturator nerve,

divide

into an internal

which branches wind around either margin of the obturator

foramen under the Obturator externns muscle. This branch arises from the
d( ep epigastric once in three and a half cases, and pass* > over the outer margin
Inside the pelvis it sends branches
of the femoral ring to the obturator foramen.
ternal branch,

muscle and iliac fossa, branches to the bladder, and pubic branches
back of the OS pubis. The internal puttie branch is the -mailer of the
terminal branches of the anterior trunk, and passes ou1 of the pelvis below the

to the Iliacus
to the

ANATOMY

174

IN A NUTSHELL.

Pyriformis muscle, lying between this muscle and the Cuccygeus.

After cross-

ing the spine of the ischium, external to the nerve, it passes through the lesser
sacro-sciatic foramen into the pelvis, it now passes through Aleock's canal

about an inch and a half above the tuberosity of the ischium, it now pierces the
triangular ligament where it divides into the dorsal artery of the penis and the
Besides these two terminal branches it has
artery of the corpus cavernosum.
the (1) muscular, (2) inferior hemorrhoidal. (3) superficial perineal, (4) transperineal, (5)

The

artery of the bulb.

sciatic

branch

is

the larger of the

terminal branches of the anterior trunk and passes through the great sacrosciatic foramen below the Pyriformis, then descends between the tuberosity of
the ischium and the trochanter of the femur under the Gluteus maximus, and
then helps to form the crucial anastomosis which is made by four branches, the
first three of which are branches of the profunda artery and the fourth is the

The first three branches are named internal circumflex,

[atii BRANCH.
external circumflex, and superior perforating. Inside the pelvis the
sciatic artery gives branches to the rectum, neck and base of bladder, prostate
S<

gland, and muscle- of the floor of the pelvis.

Outside the pelvis the sciatic

artery gives anastomotic and coccygeal branches, which run through the great
sacro-sciatic ligament to the back of the coccyx, and inferior gluteal branches

(which are three or four) to the Gluteus maximus. and muscular branches to
It sends articular branches to the hip-joint

the muscles on the back of the hip.

The uterine branch

and comes nekyi ischiadici to the great sciatic nerve.
runs to the cervix of the uterus and then along its sides in the broad ligament
This artery is above and in front of the ureter.
to anastomose with the ovarian.
The Relations

common

right

In Front.

and

iliac

of the

Common

Iliac Arteries.

LXXII-XCI.)

(Plates

The

artery has the following relations:

(1)

Peritoneum,

Small intestine,

(2)

Sympathetic nerves,

(3)

Ureter.

(4)

Behind. (1) Fourth and fifth lumbar vertebrae, (2) Right common iliac
vein, (3) Lef1 common iliac vein.
Outer Side. (1) Vena cava. (2) Right common iliac vein, (3) Psoas

muscle.

Inner Side. (1)

The Left Common
I\
I

Front.-

(1)

Left

common

Iliac

Artery has the following relations:

Peritoneum,

(1)

vein.
(

>i

m.i;

Side.

Fourth and

Psoas
Left

The Relations

of the

In Front.

Behind.

(1)

(1)

(5)

fifth

(3)

Sympathetic nerves,

Ureter.

lumbar

vertebra?,

(2)

Left

iliac

)ii

i;i;

iliac

vein.

Internal Iliac

Peritoneum, and

Interna]

iliac

vein,

Artery. (Plates LXXII-XCT.)

(2)
(2)

Ureter.

Lumbo-sacral cord.

muscle.

Side. Psoas magnus.

The Relations

common

magnus muscle.

common

Iwi.i; Side.

Small intestine,

(2)

Superior hemorrhoidal artery.

Behind."

iliac vein.

of the External Iliac Artery.

(Plate XCI.)

(3)

Pyriformis

ANATOMY
In Front.

IN A NUTSHELL.

175

(1) Peritoneum, (2) Intestines, (3) Fascia, (4) Lymphatic

Lymphatic glands, (6) Spermatic vessels, (7) Genito-crural nerve
(genital branch.) (8) Deep circumflex iliac vein.
Behind. (1) External iliac vein, _ Psoas magnus.
Outer Side. (1) Psoas magnus, (2) Iliac fascia.
Inner Side. (1) External Iliac vein, (2) vas deferens near Poupart's lig-

vessels, (5)

ament.

PLATE

Tin.

LXII.

Three Plantah

rossi

i.

LESSON XLVII.
The external

iliac

artery passes from

its

origin,

articulation, along the inner border of the Psoas

Poupart's ligamenl

after which

gives branches to the Psoas

gastric

is

branch of

it

is

called

magnus and

this artery

the

which

i-

a1

the lumbo-sacral

magnus muscle

common

the lymphatic nodes.

and after descending

i<>

to pass

under

femoral artery.

The deep

11

epi-

Poupart's ligamenl

it

ANATOMY

176

IN A NUTSHELL.

between the peritoneum and the transversalis fascia. After passing under
the vas deferens in the male or the round ligament in the female it curves around
the lower and inner margin of the internal abdominal ring, then ascending it
lies

and the sheath of the Rectus muscle to enter

in the body by anastomosing with the
It gives the cremassuperior epigastric branch of internal mammary artery.
ii.i.ii
branch t<> the Cremasteric muscle on spermatic cord, pubic branch to
the hack of the pubes, and MUSCULAR branches to the adjacent muscles and
pierce-

the transversalis fascia

the longesl

inin

anastomosis

arterial

integument.

The deep circumflex

alter

iliac

artery

is

also a

passing along Poupart's ligament

tinues to the crest of the ilium.

branch of the external

iliac

and

to the anterior superior spine it con-

The femoral

artery

is

a continuation of the ex-

and passes through the middle of Scarpa's triangle just internal to

This artery is an inch or two in length and here
the head of the femur.
The
it gives off the profunda artery and continues as the superficial femoral.
superficial femoral passes to the apex of Scarpa's triangle then through Hunter's
canal, and after passing through an opening in the Adductor magnus, at the
ternal iliac

junction of the middle and lower third of the thigh close to the bone,

it is

called

the popliteal artery.

(Plate LXXIV.) is bounded above by Poupart's ligScarpa's triangle.

ament, externally by the Sartorius muscle, and internally by the Adductor
Its floor is formed from without inward by the Iliacus, Psoas,
longus.
Pectineus, Adductor brevis (?) and Adductor longus. The femoral vein
lies "ii the inner side of the femoral artery and the anterior crural nerve lies on
ii< outer side.
Lymphatics and fat are behind the nerve.
Hunter's canal. (Plates LXIV-LXXVUI.) occupies the middle third of
This canal is
the thigh, while Scarpa's triangle occupies the upper third.
bounded externally by the Vastus internus and antero-internally by ax
aponeurosis passing from the Vastus internus to the Adductor longus and
magnus which form its posterior boundary. This aponeurosis has above it
the Sartorius.
The femoral vessels and long saphenous nerve pass through
tins canal.
The nerve is external to and the vein postero-external to the artery.
The Relations of the Common Femoral Artery. (Plates LXXII-LXIVLXVIII-)

[n Front.(4)

Iliac

(1)

Skin, (2) Superficial fascia, (3) Superficial inguinal glands,

portion of fascia lata, (5)

Crural branch

Prolongation of transversalis

of genito-crural nerve, (7)

Superficial circumflex

fascia, (6)

iliac vein,

(8)

Superficial epigastric vein.

Behind.

(1)

Prolongation of fascia covering Iliacus muscle,

portion of fascia lata, (3)

muscle.

(6)

OUTEB

Nerve

to Pectineus, (4)

Capsule of hip-joint.
SlDE.
(1) Anterior crural nerve,

(2)

Psoas muscle,

(5)

(2)

Pubic

Pectineus

Small part of Psoas muscle.

Inner Side. Femoral vein.

The Relations of the Superficial Femoral Artery. (Plates LXXII-LXIV.)
In Front. (1) Skin, (2) Superficial and deep fasciae, (3) Internal cutane-

PLATE

LXIII.

TWELFTH THORACIC

EXTERNAL CUTANEOUS

THE TWO INNER

LUMBRICALES.

FLEXOR

SOLEUS

BREVIS

.HALLUCIS.

ABDUCTOR

TIBIALIS POSTICUS

MINIMI

FLEXOR LONGUS DIGITORUM

OIGITI.

THE TWO OUTER

LUMBRICALES
FLEXOR ACCESSORIUS
FLEXOR BREVIS

FLFXriR LONGUS HALLUCIS

MINIMI OIGITI
SEVEN INTEROSSEI.
ACO. TRANS. HALLUCIS.
HALtuClS.
AOD. npi
.

Lumbar, Sacral and Coccygeal Plexuses.

177

ANATOMY

178
mis nerve,
(6)

IN A NUTSHELL.

Sartorius muscle, (5)

(4)

Aponeurostic covering of Hunter's canal,

Internal saphenous nerve.

vein, (2) Profunda artery. (3) Profunda vein, (4)
Adductor longus, (6) Adductor magnus.
Outer Side. (1) Long saphenous nerve, (2) Nerve to Vastus interims,

Behind. (1) Femoral

Pectineus muscle,

,::

(5)

Vastus internus,

Inner Side.
The Relations

(1)

(3)

Sartorius.

(Plates LXXII-LXIV.)
Profunda Artery.
Profunda
vein, (3) Superficial femoral
Femoral vein. (2)

of the

Front. (1)
Adductor longus muscle.

I\

arten\

Femoral vein (below.)

Adductor longus, (2) Adductor magnus,

(4)

(4)

Behind.

Qiacus,

(1)

(2)

Pectineus,

Adductor

(3)

brevis,

(4)

Adductor

magnus.

Outer Side.Vastus
1

\\ ER SlDE.-

internus.

Pectineus.

The Relations of the Popliteal Artery. (Plates LXXII-LXIX-LXX.)

In Front.
(1) Femur, (2) Ligamentum posticum, (3) Popliteus.
Behind. (1) Semimembranosus, (2) Fascia, (3) Popliteal vein, (4) In-

ternal popliteal artery, (5)

Outer
head,)

(4)

Inner

Side.

Plantaris,

Side.

Gastrocnemius,

(6)

Plantaris, (7) Soleus.

(2) Outer condyle. (3) Gastrocnemius (outer

Internal popliteal nerve (above.)

(1) Biceps,
(5)

(1)

Semimembranosus.

(2)

Internal

condyle.

(3)

Gas-

trocnemius (inner head.)

LESSOX XL VI II.
The branches
_'

of the

common

superficial circumflex iliac, (3)

pudic.

The branches

anastomotica magna.

femoral artery are,

(1)

superficial epigastric,

deep external
muscular branches, (2)

superficial external pudic, (4)

of the superficial femoral are, (1)

The branches

of the profunda femoral are, (1)

internal

circumflex, (2) external circumflex. (3) perforating.

The superficial epigastric artery passes through the saphenous opening

and

ascends almost to the umbilicus, lying in the superficial fascia on the external
It
anastomoses with branches of the deep epigastric artery.
oblique muscle.
The superficial circumflex iliac artery, after piercing the fascia lata, runs to the
anterior superior spine and crest of the ilium below Poupart's ligament.
It
anastomoses with the deep circumflex iliac and with the gluteal and external

circumflex arteries.

The

superficial external pudic artery, also called

passes through the saphenous opening across the spermatic cord

in

superior,

the male

and round ligament in the female to the lower part of the abdominal wall, penis,
scrotum in the male, and the labium in the female.
anastomoses with
It
branches of the internal pudic. The deep external pudic artery, also called inPectineus muscle then pierces the fascia lata to pass to the
perineum and scrotum in the male or labium in the female.
It anastomoses with branches of superficial perineal artery. The muscular branches of
ferior, crosses the

slrin of

the superficial femoral artery vary

to the Sartorius

in

number from two to seven and go mainly

The anastomotica magna which

and Vastus internus muscles.

PLATE LXIV

SUPERFICIAL

EPIGASTR

SUPERFICIAL CIRCUMFLEX ilIAC

ANT CRUAL
SUPERFICIAL EXTERNAL PUDIC

ARTERr

NERVE

COMMON FEMORAL
FEMORAL VEIN

ADDUCTOR BREVIS

EXTERNAL

CIRCUMFLEX

DEEP EXTERNAL PUDIC

SCROTUM

JNTERNAL OR LONG
SAPHENOUS

ANASTOMOTICA

ANASTOMOTICA

SUP.

INT.

INF. INT

MAGNA

ILIO-TIBIAL

BAND OF FASCIA LATA

MAGNA

SUP. EXT. ARTICULAR

ANTICULAR

ARTICULAR

A.

INF. EXT.

ARTICULAR

A.

Common, Superficial and Profunda Femoral Arteries.

179

ANATOMY

ISO

end

arises near the

IN A NUTSHELL.

of the femoral divides into a

superficial

branch which passes

with the long saphenous nerve, and adeep branch which runs in front of the
tendon of the Adductor magnus to the inner side of the knee-joint, where it

anastomoses with the anterior tibial recurrent and the superior internal articThe profunda artery itself passes behind the superficial femoral
ular arteries.
vessels od the inner side of the femur and then behind the Adductor longus to
This is sometimes
pierce the Adductor magnus at the lower third of the thigh.
The internal circumflex of the profunda
called the fourth perforating branch.
passes between the Psoas magnus and the Pectineus to the upper border of the
Adductor brevis, at this point it sends one branch inward to the Adductor
muscles and another branch downward under the Adductor brevis. The internal circumflex artery itself now passes between the Quadratus femoris and
the Adductor magnus to join the crucial anastomosis which is formed by the
[NTERNAL CIRCUMFLEX ARTERY, THE EXTERNAL CIRCUMFLEX ARTERY and THE
Si periob perforating all of which are branches of the profunda, and the

one of the terminal branches of the anterior trunk of

The external circumflex of the profunda passes outward
the internal iliac.
under the Sartorius and Rectus muscles where it divides into ascending branches,
descending branches, transverse branches. The ascending branches run upBCIATIC arter*s which

is

ward under the Tensor vagina femoris. The descending branches run under
The
the Rectus as far asthe kneeto enter into the circumpatellar anastomosis.
over
pass
outward
the
Crureus
muscle
and
through
the
trans^ erse branches
back
thigh
enter
the
crucial
anastomosis.
of
the
into
to
Vastus externus to the
This external circumflex artery passes between the anterior and posterior divis-

The three perforating branches of the proAdductor magnus to reach the back of the thigh.
The supeRiob ONE passes above the Adductor brevis to join the crucial anastomosis.
The middle one pienes the Adductor brevis. The inferior one
below
the Adductor brevis.
passes
The popliteal artery is a continuation of the femoral and passes through the
popliteal space downward and outward.
At the lower border of the Popliteus
mi scle it gives off the anterior tibial artery and continues as the posterior tibial
ions of the anterior crural nerve.

funda pierce the tendon of the

artery.

The
-pace has

popliteal space lies b< hind the knee-joint

\

FLOOR,

and

ROOF, and LATERAL BOUNDARIES.

is

diamond shaped. This

bounded above the

It IS

and below the joint by the Plantaris and

It is bounded above the joint internally
by the Sen in
branosus and below the joint by the inner head of the Gaslis floor is formed by bones, ligament and muscle.
trocnemius,
The bones
are the femur and tibia, the ligament is the posterior ligament of the knee-joint,
and the muscle is the Popliteus. The popliteal artery passes obliquely across
the spa< e b< ing surrounded by popliteal nodes, and has the articular branch of
The popliteal veins are superficial and exthe obturator nerve lying upon it.
knee-joinl externally by the Biceps,

the outer

h<

ad of the Gastrocnemius.
<

ternal to the artery.

found deep

in

An

this space.

articular filament of the great sciatic nerve

The

is

often

internal popliteal or popliteal nerve crosses

all

PLATE LXY

SUPERIOR GLUTEAL

IffJ

^'^4~

INFERI0R

GLorEAL

GEMEUiJS

CRUREUS

SHORT HEAD

OF

BICEPS

PUNTARIS

Of GASTROCNEMIUS

Muscles in thk Gluteal Region and Back of Thigh.

181

ANATOMY

182

NUTSHELL.

IN A

these structures superficially in the median lint', and the external popliteal or
peroneal nerve lies close to the tendon of the Biceps.
of the popliteal artery are, (1)

The branches

number which descend

in

These branches

to the calf of the leg.

rocnemius

cutaneous branches, three in

the median line and on each side run across the Gast-

may

arise

from other branches.

Superior muscular branches, two or three in number pass to the Vastus

(3) Inferior muscular or sural branches
externus ami flexors of the thigh.
to
and Plantaris muscles. (4)
the
Gastrocnemius
pass
two
branches
generally
under
which
passes
the tendon of the Adbranch
articular
internal
Superior
(_)

ductor magnus muscle divides, one of the branches joining the superior external
articular artery and the other branch joining the anastomotic^ magna and the
inferior internal articular artery.

Superior external articular artery which

(5)

passes above the outer condyle under the tendon of the Biceps divides into a
dt ep branch which joins the inferior internal articular artery, and anastomotic^

artery and a superficial branch which joins the inferior external articand the descending branch of the external circumflex artery. (6) The

magna
ular

azygos articular
thai

joint.

7)

pierces

ligament of the

the posterior
internal

Inferior

articular

passes

knee-joint to supply
below the inner tuber-

under the internal lateral ligament to join the inferior external

and superior internal articular arteries. (8) Inferior external articular artery
passes above the fibula under the tendon of the Biceps and external lateral
ligament to join the anterior tibial recurrent ami the inferior internal articular
osity of the tibia

and the superior external articular

arteries.

The circumpatellar anastomosis

(Plates

LXXII-LXXYI)

is

formed by

(2) superior internal articular, (3) inferior

(4) inferior internal articular, (5) fourth perforating or

the (1) superior external articular,

external

articular.

terminal branch of the profunda,

branch

of the external circumflex,

(6)

and

anastomotica magna,
(8)

(7)

descending
This

the anterior tibial recurrent.

anastomosis has superficial and deep portions. If we substitute in this anastomosis the fourth perforating or terminal branch of the profunda for the posterior tibial recurrent

and azygos

articular,

we

will

have the blood supply

to

the knee-joint.

LESSON XLIX.
The

anterior tibial artery (Plates

LXXII-LXXVI)

runs forward between

the two heads of the Tibialis posticus above the interosseous

now descends on

the anterior surface of this

membrane and

membrane.

surface of the tibia distally and the anterior ligament of the ankle-joint.
this joint

it

called dorsalis pedis artery.

i-

The branches

It

crosses the anterior

Below

of the anterior tibial

muscular, which go to the muscles of the leg. (2) Posterior

tibial recurrent branch (which i> not always present
passes under the Popliteus
muscle. (3) Superior fibular branch which passes around the neck of the fibula
artery

are,

and through the Soleus muscle to the Peroneus longus. (4) Anterior tibial
recurrent which passesupward through the Tibialis anticus to go to the circumpatellar anastomosis. (5) Internal malleolar branch passes under the tendons

PLATE LXVI.

SUPERFICIAL EPIGASTRIC
SUPERF.CIAL
SUPERFICIAL INGUINAL NODES

CIRCUMFLEX

EXTERNAL

ILIAC

FEMORAL

CUTANEOUS VEIN

Superficial Lymphatic Vessels

183

\\i>

Veins

<>f

Leg

VEIN.

ANATOMY

184
of the

IN A NUTSHELL.

Extensor proprius hallucis and Tibialis anticus to the inner malleolus.

Extensor longus
6) The cMcrnal malleolar passes under the tendons of the
digitorum and Peroneus tertius to the outer malleolus.
The Relations of the Anterior Tibial Artery.
l.\
Front.- -(1) Integument, (2) Superficial and deep fascia, (3) Anterior tibial nerve, (4) Tibialis anticus (overlaps it in the upper part of the leg),
(5)

Extensor longus digitorum (overlaps

hallucis (overlaps

BEHIND.

Outeb
1

Side.

it-

The

mvat

(1)

Anterior

tibial

(1)

Tibia,

(2)

Extensor proprius

(3)

ligament

Anterior

Extensor proprius hallucis (crosses

It

tibial.

intermetatarsal space, where

to the first

communicating

artery.

dorsal interosseous, passes in the

toe

where

LXXII-LXXYI.)

is

the continuation of

passes along the inner side of the foot from the ankle-

The

it

divides into dorsalis hallucis

dorsalis hallucis artery, also called

interosseous space to the base of the

first

divides into two branches which pass to the dorsal aspect of

it

the adjacent sides of the great and second toes.

off a

(6)

nerve, (2) Extensor longus digitorum,

Tibialis anticus, (2)

dorsalis pedis artery (Plates

artery and the

firsi

slightly,)

it

Anterior annular ligament.

lower part).

the anterior
joint

(7)

Jxtensor proprius hallucis.

Iwii; Side.
at

it

slightly).

Interosseous membrane,

(1)

of ankle-joint.

(3)

it

Prior to this division

it

gives

branch which passes under the Extensor proprius hallucis tendon and runs

along the dorsal aspect of the inner side of the great toe.

The communicating

branch, also called the plantar digital, passes between the two heads of the First
dorsal interosseous muscle to join the external plantar artery, thus

the plantar arch,

it

now

gives off the

arteria princeps hallucis

completing

which runs

first interosseous space and divides at the base

two branches for the plantar aspect of the sides of the great toe.
Besides these terminal branches it gives off (1) external tarsal, (2) internal
tarsal.
These branches run outward and inward across the cuboid and scaphoid
bones. (3) Metatarsal which passes across the base of the metatarsal bones exThis artery gives off three interosseous arteries which pass in
ternally.
the three outer interosseous spaces to the base of the toes where they divide

along the plantar surface of the

of the toes into

into internaland external

branches for the dorsalaspect of adjacentsides of the

its division at the base

The outer interosseous branch before

four outer toes.

branch along the dorsal aspect of the outer side of the little
These three arterieseach receives aposterior perforating branch from the
plantar arch a1 the base of the space, also an anterior perforating branch from

ofthetoes sends

:i

toe.

the digital artery

the front of the space.

;it

The Relations

of the Dorsalis Pedis Artery.

I\ Front.
(1) [ntegument, (2) Fascia, (3) Anterior annular ligament,
Innermost tendon of Extensor brevis digitorum.

Behind.ligament-

to

Outeb

(1)

Astragalus, (2)

Navicular,

(3)

Middle cuneiform,

(4)

The

these bones.

Side.

Iwii; Side.

Extensor longus digitorum,

(1)
Extensor proprius hallucis.

(2)

Anterior

tibial

nerve.

ANATOMY

IN A NUTSHELL.

LESSON
The

posterior tibial artery (Plates

popliteal artery

from here

it

and commences

at the

185

L.

LXIX-LXX)

is a continuatioD of the
lower border of the Popliteus muscle,

passes to the interval between the heel and the internal malleolus

PLATE LXVII.

Jii

External or Shout Sapiienoi

where

it

divides into the internal and

course

it

lies

ankle-joint.

upon the

Tibialis posticus.

The branches

Vein.

external plantar arteries.

Flexor longus digitorum,

of the posterior tibial artery are. (1)

Along
tibia,

its

and

The peroneal

186

ANATOMY

artery which arises about

an inch below the Popliteus and passes along the

NUTSHELL.

IN A

inner side of the fibula to the lower third of the leg where it divides into an
The peroneal artery itself gives off (a) musanterior and posterior peroneal.

culab branches to the muscles at the hack and outer side of the leg, (b) nutrient to fibula, (c) INTERIOR PERONEAL which runs through the interosseous
membrane and then descends to the outer ankle, (d) Communicating branch
(e) Posruns inward to unite with a similar branch of the posterior tibial,
terior PERONEAL continues with the main artery to the outer side of the os
external calcanean sends several branches to the outer
(f) The
calcis.
(2) Muscular branch* s which pass to the muscles on the back
side of the heel.
of the leg.

branches.

with

Nutrient

(3)
(4)

to

This branch also gives

the tibia.

muscular
and unites
Internal calcanean which sends

Communicating branch which runs across the

a similar

branch from the peroneal.

(5)

off

tibia

several branches to the internal side of the heel.

external plantar artery

Flu

LV-LVI-LVIII) passes between the

(Plates

Flexor brevis digitorum and Flexor accessorius to the base of the fifth metaIt now bends inward and arches across the bases of the fourth,
tarsal bone.

ami second metatarsals to the interval between the second and first metawhere it joins the communicating branch of the dorsalis pedis to comThe branches of the external plantar are (1) posterior
plete the plantar arch.
perforating: which are three in number and run between the heads of the three
outer Dorsal mterossei to join the interosseous branches of the metatarsal
third,

tarsal,

Digital branches are four.

arteries. (2)

plantar aspect of the

little toe,

The

first

runs along the outer side and

the outer branches run along the three outer in-

terosseous spaces to the base of the toes where each one sends an anterior per-

and then
and plantar aspects of the toes.
The internal plantar artery (Plates LV-LVI-LVIII) passes above the Abductor hallucis, then between it and the Flexor brevis digitorum, and from here
along the inner side of the great toe to anastomose with the digital branch from

forating branch

join

to

an interosseous branch of the metatarsal,

divides into two brandies for the adjacent sides

the princeps hallucis.

The Relations
1\
I

(5

Front.

of the Posterior Tibial Artery.

(1)

Flexor longus digitorum,

Tibialis posticus, (2)

(3)

Tibia,

Ankle-joint.

Behind. (1) Integument, (2) Fascia. (3) Gastrocnemius, (4) Soleus,

Deep transverse fascia, (6) Posterior tibial nerve, (7) Abductor hallucis.

Outer

Posterior tibial nerve, lower two-thirds.

Side.

Inner Side.
Posterior tibial nerve, upper third.
The Relations of the Peroneal Artery. (Plate LXIX.)
In Front,

Behind.

Outer

fit

Side.

Inner Side.

Flexor longus hallucis.

Tibialis posticus, (2)

(1) Soleus, (2)

(1)

Deep transverse fascia,

Fibula, (2)

(3)

Flexor longus hallucis

flexor longus hallucis.

Flexor longus hallucis.

Veins.

The

external

iliac

vein (Plate

XC)

is

continuation of the femoral vein

PLATE

EXTERNAL
SPERMATIC

LXVIII.

CUTANEOUS

CORD
ANTERIOR CURAL NERVE

-EMORAL ARTERY

FEMORAL VEIN
PECTINEUS

ADDUCTOR

LONGUS

SCROTUM

OBTURATOR.

ADDUCTOR

MAGNUS
INTERNAL CUTANEOUS

SUB- SARTORIAL

PLEXUS

PATELLAR BRANCH OF

LONG

SAPHENOUS

INTtHNAL CUTANEOUS

SARTORIUS

EXTERNAL POPLITEAL
LONG

OR PERONEAL

MUSCULOCUTANEOUS

SAPHENOUS.

PERONEUS 1LONGUS

THE ANTERIOR TIBIAL ARTERY

AND

EXTENSOR LONGUS DIGITORUM

NERVE

CUTANEOUS BRANCH OF
MUSCULO -CUTANEOUS

PERONEUS. BREVIS

PERONEUS TERTIUS

ANT.

ANNULAR

LIG.

Anterior View of Entire Lower

L87

Limp..

NERVI

ANATOMY

1SS

A NUTSHELL.

IN"

to the sacro-iliac articulation,

above Poupart's ligament

where

it

joins the in-

common iliac vein. The right common iliac vein

ternal
common iliac artery, but as it passes upward it
right
on
outer
of
the
side
the
is
common iliac vein is on the inner side of the
The
left
artery.
behind
the
goes
The radicles of the external
left common iliac artery throughout its course.
iliac

iliac

make

vein to

the

vein arc the deep epigastric

The external

small pubic vein.

The

which unites with the external

form the common iliac vein, lies at

internal iliac vein,

sacro-iliac articulation

side of

to

ami then behind the artery.

the branches of the internal

Jt

and the deep circumflex iliac veins, and a

vein may have one or two valves.

iliac

iliac

It

iliac

vein at the

first

on the inner

receives radicles corresponding to

all

artery except the umbilical (hypogastric.)

drain- the viscera in the pelvis in the following manner:

pudlc vein receives radicles which corresponds to

all

(1)

the internal

the branches of the internal

pudic artery except the dorsal artery of the penis.

(2) Around the lower end
of the rectum there is a hemorrhoidal plexus which is formed by the hemorrhoidal veins. (3) The blood which passes through the superior hemorrhoidal
vein empties into the inferior mesenteric vein, while the blood which empties

ami

into the middle

inferior veins passes into the internal iliac vein, thus is

established a free communication between the portal venous system

The

general venous system. (4)

membrane and
vesical

and

is

well

plexus, which surrounds the vaginal

developed near the

hemorrhoidal plexuses before

The plexus which

lies at

layers of the broad

orifice,
it

and anastomoses with the

joins the internal iliac vein.

iliac

The common

(5)

the sides and upper angles of the uterus between the

ligament

is

called uterine plexus,

and

it

drains the sub-

stance of 4ie uterus and communicates with the ovarian veins before
the internal

and the
mucous

it

joins

vein.

by the external and internal iliac veins

from which point they ascend obliquely upward to
the righl >ide of the median line of the spine between the fourth and fifth lumbal- vertebra where they join one another to form the inferior vena cava.
The
right one, which is more vertical than the left, passes at first behind and then
to the outer side of the cuimnon iliac artery.
The left one, which is more oblique and longer than the right, passes, for the most part, to the right side of the
left common iliac artery but passes behind its artery above.
Each of these
veins receives the ilio-lumbar vein and occasionally the lateral sacral vein.
The
left one. in addition, receives the middle sacral vein.
No valves are found in
iliac

veins are formed

at the sacro-iliac articulation

these veins.

The

inferior

vena cava, (Plate XC) which ends

of the righl auricle of the heart near the

passes from the

the Diaphragm.

It

the righl and

common

lefi

iliac

in the

lower and back part

Eustachian valve, has no length above

lumbar vertebra where it is formed by

upward in front of the spine on the right

fifth

veins

and in it> course it passe^ in a groove on the posterior surface

and pierces the central tendon of the Diaphragm. At this point
enters the fibrous pericardium and is partially invested by the serous peri-

side of the aorta,

of the liver
it

cardium.

The lumbar

veins, (Plate

XC) which drain the structures

of the

abdominal

PLATE LXIX.

w///h
si
-,POPL'TEAL

&i

I\

BICEPS

SUPERIOR

EXTERNAL

ARTICULAR

SUPERIOR

ARTERY

ARTICULAR

CUTER HEAD

INTERNAL

ARTERY

GASTROCNEMIUS
INNER HEAD GASTROCNEMIUS

A2YG0S ARTICULAR ARTERY

GRACILIS
INFERIOR

ARTICULAR

EXTERNAL
ARTERY

SEMI-TENOINOSUS

SEMIMEMBRANOSUS
INFERIOR

A' T ERIOr TIBIAL

INTERNAL

ARTICULAR

ARTERY

POSTERIOR TIBIAL NERVE

LEXC.1

LOnUS

HALLUCIS

FLEXOR LONGUS DIGITORIUM

PERONEUS LONGUS

POSTERIOR TIBIAL ARTERY

PERONEAL ARTERY

FLXOR

LONGUS

HALLUCIS

PEBCMEOUS LONGUS

PEROHEOUS

BREVIS

INTERNAL

CONTINUATION

ANNULAR LIGAMENT"

OF

TENDO

PERONEAL ARTERY-

ACHILLIS

INTERNAL

Showing Arteries and Nerves of Back of

189

CALCANEAL

Leo.

ARTERY

ANATOMY

HJO

and the

walls

loins, arc four

on each side, and they arc

tudinal ascending lumbar veins.

transverse processes
of

it

own

connected by longi-

all

This ascending vein passes in front of the

the lumbar region and gives origin

in

The

side.

IN A NUTSHELL.

left

to the

azygos vein

The pampinivas deferens and is

lumbar veins pass behindthe aorta.

form plexus lies around the spermatic cord in front of the

formed by the spermatic veins which drain the testis and epididymis. This
plexus forms three or four main trunks which pass through the inguinal canal
These veins accompany the spermatic artery and finally
to form two veins.
make one trunk. The SPERMATIC VEINS ox the right side empties into the
inferior vena cava, while the one ox the left side passes behind the sigmoid flexure to enter the left renal vein. The one on the right side has a valve.
in the broad ligament near the ovary and around the fallopian
formed by the ovarian veins and communicates with the uterine plexus.
These ovarian veins are similar to tin- spermatic veins, that is the one on the
light side empties into the inferior vena cava, while the one on the left side

The plexus

tube

i>

empties into the

The

left

renal veins

renal vein.

lie in

front of their

companion

arteries

which

is

an exception

below the Diaphragm. The left vein passes in front of the aorta
empiii s into the inft rior vena cava at a higher level than the right, and

for the veins

w lute

it

Its radicles are the left spermatic or ovartwo renal veins.

and most always the left suprarenal.
The left suprarenal vein empties into the left renal or phrenic while the
tight empties into the inferior vena cava.
The two superior phrenic veins end in the internal mammary vein, after
accompanying the phrenic nerve and comes nervi phrenici artery. The two
im'i rior phrenic veins accompany the phrenic arteries and join the inferior vena
cava on the righl side and the left renal V( in on the left side.
is

the longer of

ian,

Li

f1

tin-

inferior phrenic,

LESSON
v<

LI.

The hepatic veins begin in the liver in the capillaries of the intralobular
and form three main v< ins which empty into the inferior vena cava as it

in-

the groove on the posterior surface of the liver.

lies in

these

The blood which passes Lhrough the

v< ins.

following vessels: those on

while

hoe

the'

left;

before

it

n the righl represent the vessels

There

are'

no valves

in

portal vein goes through the

reaches the inferior vena cava:

used by the Hepatic artery.

Hepatic artery

Portal vein

1.

2.

Interlobular vein

2.

Interlobular artery

.'!.

Intralobular capillary plexus

3.

Its

4.

Intralobular vein

4.

Portal intralobular capillary plexus

1.

own

intralobular capillaries

5.

Sublobular vein

5.

Intralobular vein

6.

Hepatic vein

6.

Sublobular vein

7.

Inferior

7.

Hepatic vein

8.

Inferior

It

he

vena cava

will

h pat

ic

vena cava.

be noticed that the blood which passe-s through the Portal vein and
artery has

similar route through

the> last five vessels.

PLATE LXX

SUPERIOR

EXTERNAL
SUPERIOR

ARTICULAR

INTERNAL

ARTtHT
ARTICULAR

POPITEAL

POPLITEAL

ARTEt.

ARTERY.

NERVE
POSTERIOR LIGAM:

INFERIOR

,'T

OF KNEE

EXTERNAL

ARTICULAR

ARTERY

SEMI-MEMBRANOStl*

INFERIOR

INTERNAL

ARTICULAR

ANTERIOR TIBIAL ARTERY

PERONEAL

POSTERIOR TIBIAL ?:ERVE

ARTERY

POSTERIOR TIBIAL ARTERY

FLEXOR

LONGUS

DIGITORUn

TIBI4LIS POSTICUS

COMMUNICATING BRANCH

PERONEUS
CONTINUATION

BREVIS

ANNULAR LIGAMENT

INTERNAL

OF

-TEN00

ACHILLIS

PERONEAL ARTERY
INTERNAL

CALCANEAL

Showing Muscles of Back of Leg.

191

AST^RY

ANATOMY

192

The

IN A NUTSHELL.

veins of the lower extremity are divided into a superficial

and deep

set

The
those of the upper extremity, but the valves are more numerous.
superficial veins of the lower extremity lie between the two layers of the superlike

ficial

has

The

fascia.

ii-

veins on the

of the iocs,

and

dorsum

of the foot

form

venous arch, which

This arch receives digital radicles from the dorsum

concavity backward.

crosses the anterior extremities of the metatarsal bones.

ii

This arch ends externally

the short saphenous vein and internally in the long

in

saphenous.

The external or short saphenous vein (Plate LXVII)

this

tendo Achillis, from here

leg

is

a continuation

of

arch and ascends behind the outer malleolus along the outer border of the
it

crosses to the inner border in the

median

line of the

posteriorly to perforate the deep fascia in the lower part of the popliteal

space where

it

ends

in the popliteal

vein between the two heads of theGastroc-

its course and it sends a communiend upward and inward to the long saphenous vein.
It
communicates with the dee}) veins below and accompanies the external
This vein has from nine to fourteen valves in it.
saphenous uerve.
The internal or long saphenous vein (Plate LXVI) is a continuation of the

nemius.

It

receives cutaneous radicles in

cating branch from near

arch and ascends

leg.

From

in front of

this point

it

inner margin of the tibia

dyle of the femur.

its

the internal malleolus along the inner side of the

accompanies the internal saphenous nerve behind the

and at the knee it runs backward behind the inner con-

From

here

it

passes along the inner side of the thigh to pass

through the saphenous opening where it ends in the femoral vein about an inch
and a half below 1'oiipart's ligament. It communicates with the deep veins

and receives cutaneous

radicles in its course.

It

receives the superficial epigas-

and external pudic veins at the saphenous

opening. This vein maybe doubleand it has fromseven to twenty valves in it.
The deep veins of the lower extremity accompany their arteries and are
Yeme comites are not found
called venae co mites and have numerous valves.
tric,

superficial

from the knee

The

circumflex

iliac,

is but one vein for the artery.

formed by the internal and external plantar,

to the hip. for in this region there

posterior tibial veins are

and are joined by the peroneal veins.

The anterior tibial veins accompany the anterior tibial artery and join the
posterior tibial veins to form the popliteal vein.
The popliteal vein passes through the popliteal space, passing from the
lower to the upper boundary obliquely outward ami becomes the femoral vein
at the aperature in the Adductor magnus muscle.
This vein receives the external saphenous vein, articular and sural veins.
The femoral vein accompanies the femora! artery and passes under the
artery from

its

iliac after

passes under Poupart's ligament.

it

outer to

its

inner side.

This vein
It

continues as the external

five valves and
and the internal saphen-

has four or

receives radicle- corresponding to the arterial branches

ous vein.
Talipes comes from two words, talus which

means

foot.

means

ankle,

and pes which

Tin- deformity, called club-foot, depends upon the contraction of

muscles or tendons, and this contraction

may

either be congenital or acquired.

PLATE

LX.\r.

LUMBAR LIGAMENT

LAST LUMBAR
VERTEBRA,

RECTUS TENDON

GREATER
SACRO- SCIATIC

LIGAMENT

RECTUS TENDON

GLUTEUS MEOIUS

GLUTEUS MINIMUS

VASTUS EXTERNUS

VASTUS INTERNUS

RECTUS FEMORIS

ILIO-TIBIAL

BAND

LIGAMENTUM PATELLAE

Showing Muscles of

I.wki;

and Anterior Part op the Thigh.

193

ANATOMY

194

We
heel

have the following forms

is elevated and the weight

the foot.

(1) Talipes equinus in which the

body thrown upon the anterior portion of
which the patient walks upon the heel. (3)

of club-foot:
of the

Talipes calcaneus in

(2)

IN A NUTSHELL.

Talipes cavus or arcuatus in which there

the foot.

is

an increased curvature in the arch of

Talipes varus in which the footis turned inward the patient walk-

(4)

ing on the outer border.

(5)

Talipes valgus

(flat

or splay foot) in which the

everted or distorted outward. Combinations of these may occur, such as

Talipes equino-varus, Talipes ealcaneo-varus, Talipes calcaneo-valgus, Talipes
foot

is

LXXXIX.)

(Plate

equino-valgus.

The following are some

of the foot.

(1)

of the principal

amputations of the whole or part

made

at the ankle-joint, leaving a large

Syme's amputation

is

and removing the internal malleolus and the external malleolus and
sometimes a slice from the lower part of the tibia. (2) Roux's amputation is
made at the ankle-joint, leaving a large internal flap. (3) Pirogoff's amputation is made by removing all the tarsal bones, except the posterior part of the os
calcis, and a thin slice from the tibia and fibula including the two malleoli. The
small portion of the os calcis which remains is then turned up and united to the
lower surface of the tibia.
(4) Sub-astragaloid amputation is made by removing
heel flap

all

the bones of the foot except the astragalus.

formed.

(5)

Chopart's amputation

all

This operation

made by removing

and astragulas.

foot except the os calcis

removing

is

(6)

all

is

rarely per-

the bones of the

Lisfranc's amputation

made by

is

the metatarsals and phalanges, but not cutting any of the bones.

(7) Hey's amputation is a modification of Lisfranc's amputation by sawing

through the internal cuneiform bone. (8) Skey's amputation is a modification
of Lisfranc's amputation by sawing off the base of the second metatarsal bone.
A combination of Pirogoff's and the sub-astragaloid is Hancock's amputation.

LESSON
Hip-Joint.
This joint
It

has

is

(Plate

a diarthrodial joint

LXXXII.)

and belongs

to the subclass enarthrodial.

The capsular ligament, which

is very strong and

surrounds the brim of the acetabulum, beingjust external to the coty-

five ligaments.

fibrous,

LI I.

Below

loid ligament.

(1)

it

is

attached to the neck of the femur into the anterior

intertrochanteric line anteriorly, to the root of the neck of the femur superiorly,

middle of the neck of the femur posteriorly. It has two sets of fiand longitudinal. The circular are best developed at the lower
and posterior part where they form a collar called the zona orbicularis or liga-

and

to the

bers, circular

ment

of Bertin.

time- there

synovial

is

The longitudinal

an opening

membrane

to

femoral or V ligament

and

is

in

fibers

form the accessory ligaments.

Some-

the front of the capsular ligament for the passage of

form

a bursa

under the Psoas magnus.

accessory to the capsular ligament,

it is

(2)

The

ilio-

bifurcated below

connected to the anterior intertrochanteric line at its outer and inner

portions and it is attached above to the anterior inferior spine of the ilium.
(a) The ischio-capsulab ligament is an accessory ligament being attached
to the ischium below the acetabulum and passing through the circular fibers
is

PLATE LXXII.
ABDOMINAL AORTA

DEEP EPIGASTRIC

LIO

COMMON

ILIAC

SACRA

LUMBAR

MEDIA

INTERNAL ILIAC

DEEP CIRCUMFLEX

ILIAC A

A.

GLUTEAL
EXTERNAL

A.

A.

A.

ILIAC A.

COMMON FEMORAL
OBTURATOR
SCIATIC

PUDIC

A.

PROFUNDA FEMORAL

A.

EXTERNAL CIRCUMFLEX

ARTERY
CIRCUMFLEX A

INTERNAL

CRUCIAL ANASTOMOSIS
SUPERFICIAL FEMORAL

A.

PERFORATING

ANASTOMOTICA

MAGNA

TERMINAL BRANCH OF PROFUNDA

ANASTOMOSING WITH POPLITEAL

SUP.

LATERAL

INF. INT.

SOP EXT. AflTICULAR

ANT1CULAR

INT.

INT.

POPLITEAL

EXT.

UG.

INF. EXT.

ARTICULAR

TIBIAL

POST.

TIBIAL

LATERAL

ARTICULAR.

RECURRENT

A.

PERONEAL

INT.

MALLEOLAR

TARSAL

A.

EXT.

MALLEOLI

ANT.

PERONEAL

BRANCH
POST.

DORSALIS

LIG,

PERONEAL

A.

A.

PEDIS

METATARSAL

EXT.

PLANTAR

The Arteries of the Entire Lower Extremity

195

ANATOMY

196
at the lower

IN A NUTSHELL.

of the capsular ligament,

and hack part

The pubofemoral

(b)

ligament is an accessory ligament and passes from the ilio-pectineal eminence

to the rough tubercle in fronl of the lesser trochanter.
:;
The ligamentum teres passes from the margins of the notch at the
bottom

covered by

and

acetabulum

of the

on the head of the femur. It is

consists of connective tissue

to a depression

membrane and

synovial

a n flection of

vessels.
1

The

cotyloid ligament surrounds the

this cavity deeper.

thus making

broad

is

at

its

brim

acetabulum, making

of the

and runs

point of attachment

a portion of the cotyloid

is

under

to the joint pass

ligament which

The nutrient

the notch at the lower portion of the acetabulum.

to apoint,

triangular on cross section.

The transverse ligament

5)

crossi

it

It

vessels

this ligament.

The synovial membrane

of the capsular ligament

of the hip-joint

is

reflected over the inner surface

on to the neck of the femur, and from here over to the

ligamentum teres to the bottom of the acetabulum. At this point it covers

some fat. As said before it frequently communicates with the bursa which is
under the Psoas muscle.
flexors of the hip-joint are all the

The

The

longus.

and

muscles

in

the floor of Scarpa's

tri-

Psoas magnus, Pectineus, Adductor brevis, Adductor

angle, viz.. the Qiacus,

Sartorius, the R( ctus

and the anterior

fibers of the

Gluteus niedius

Uuteus minimus are also flexors of the hip-joint.

The extensors of this joint are the Gluteus maximus, Biceps,

Semimem-

branosus, and Sen itendinosus.

magnus
maximus.
Tin abductors of this joint are the Gluteus medius, and Gluteus minimus.
and the up] r pan f tin Glut< us maximus.
Th< internal rotators an the anterior fibers of the Gluteus medius, Gluteus
'1

adductors are the Addu<

Ik

plus the Bic< ps, Gracilis,

excepl
tin

T< nsor fas< ia

external rotators

Th(

tin

1<

ngus, Adductor brevis, Adductor

of the Gluteus

<

f<

moris.

this joint are all the

muscles

posterior fibers cf the Gluteus medius

in the gluteal region

and Gluteus minimus, plus

tin three Adductors, the Feetineus and the Sartorius.

The tendino-trochanteric band is a str< ngthening band of the hip-joint.
Thi ligamentum teres is an incorporated tendon of the P< ctineus muscle.
Neiaton's line is a line drawn fr< m the anterior superior spineof the ilium

lliacus,

to tin

tuberischii.

Bryant's triangle
tin

<

minimus, and

t<

and lower part

ant*

tor su]

responding
Th(

<

to the

tor

is

a triangle

s]

in<

long axis of the

mad< by N<

f<

blood supply of the hip-joint

lat< n's line

of the ilium whi< h

and
nn

<

a line
ts a

drawn from

third line cor-

mur continued.
is

theinternal circumflex, gluteal, sciatic,

and ob
Th<

nerve supply

is

the anterior crural, the obturator, the obturator access-

ory, greal sciatic, and branches from the sacral plexus.

PLATE LXXIII.

ILIO

INGUINAL

EXTERNAL
CUTANEOUS

The Diaphragm, Psoas Magnus

197

\m> Parvus.

ANATOMY

198

IN A NUTSHELL.

LESSON
Knee-Joint.

The knee-joint
It is a

is

LI II.

(Plates

a diarthrodial joint

and belongs

This joint

modified ginglymus joint.

LXXXIII.)
to the subclass ginglymus.

lias flexion,

extension,

and a

slight

rotation externally and internally.

Ligainentus muscles are those that cross a joint, they are also called elastic
The ligamentous muscles of the knee-joint are Biceps,

ligaments of the joint.

Quadriceps, Semimembranosus, Semitendinosus, Gracilis, Sartorius, Gastrocnemius, Plantaris, and Popliteus.

The nerve supply of this joint is the anterior crural, the obturator, the inand external popliteal.
The blood supply of the knee-joint is the anastomotica magna, the five
articular branches of the popliteal, the anterior and posterior tibial recurrent,
and the terminal branches of the profunda.
The flexors of this joint are the Biceps, the Semimembranosus, Semitendinous. Gracilis, Sartorius, and indirectly the Gastrocnemius, Popliteus, and
ternal

Plantaris.

The extensors

of this joint are the Quadriceps, plus outer rotation

by the

Biceps and inner rotation by the Popliteus and Semitendinosus, and to a slight
degree by the Semimembranosus, Sartorius and Gracilis.

The strengthening bands are the Biceps, Sartorius, and Semimembranosus.

The incorporated tendons are the Peroneus longus and Adductor magnus.
The incorporated tendon of thePeroneus longus makesthe external lateral ligament of the knee-joint, and that of the Adductor magnus makes the internal
lateral ligament.

The knee-joint

is formed by the condyles of the femur, the head of the

and the patella, It has fourteen ligaments, an external set in which there
are six, and an interna] set hi which there are eight.
The first of the external
Ligaments is the anterior or ligamentum patella, which is a continuation of the
tendon of the Quadriceps extensor.
It is attached above
(Plate LXXXIII.)
to the apex ami rough surface on the lower and posterior portions of the patella,
and below it is attached to the lower part of the tubercle of the tibia. A bursa

tibia,

found bei w< en the upper pail of the tubercle and the ligament.
The second ligamenl of this set is the posterior ligament, called the ligamentum posticum Winslowii, which is broad and thin and covers the back of
is

(Plate LXXXVI.)
It has a central and two lateral portions,
the lateral portion- are attached above the condyles of the femur superiorly,

the knee-joint.

and

to the head of the tibia inferiorly.

The central portion which is derived
from an expansion of the Semimembranosus tendon and passes from the inner

tuberosity of the tibia to the inner side of the upper part of the outer condyle
of the femur.

The
and

flat

third ligamenl ni thissel

and

i-

attached above

is

the internal lateral ligament, which

to the inner

is broad
condyle of the femur and below to

the margin of the inner tuberosity, to the internal fibro-cartilage,

and

to the

PLATK LXXIY.

GLUTEUS

SPERMATIC

MEDIUS

GLUTEUS

CORD

MINIMUS

ADDUCTOR

ILIO-TIBiAL

BANO

OF FASCIA LATA

V'

lIM LIGAMENTUM
PATELLAE

The .Muscles

ix

Front of the Thigh.

199

ANATOMY

200

IN A NUTSHELL.

and one-half

inner surface of the shaft of the fibula extending one

inches.

(Plates

LXXXIII-LXXXVL)
The fourth ligamenl
is

of this set

the Ions external lateral ligament, which

is

the divorced tendon of the Peroneus longus

and

is

nowa rounded

cord, being

attached above to the external condyle of the femur and below to the external
It divides the tendon of the Biceps into two
pari of the head of the fibula.

The

LXXXIV-LXXXVI.)

(Plates

portions.

fifth

ligament of this set

the short external lateral ligament, which

is

behind and almost parallel with the long external lateral ligament and it
very indistinct, being attached above to the outer condyle of the femur and

lies
is

to the styloid process of the fibula.

below

The

sixth ligament of this set

by the>e other ligaments.

left

It

a capsular ligament.

is

is

thin

and

It blends

articular surfaces of the bones.

is

It fills the spaces

attached to the margins of the

with the fascia of the thigh and re-

ceives expansions from the Vast! muscles above,

ments.

on the head of the

'The following structures are

median

in the
1.

2.

called lateral patellar liga-

LXXXIII.)

(Plate

(Plate

line.

tibia

from before backward

LXXXY.)

Transverse ligament.
Anterior extremity of internal semilunar cartilage.

3.

Anterior crucial ligament.

4.

Anterior extremity of external semilunar cartilage.

5.

The spine

6.

Posterior extremity of external semilunar cartilage.

7.

Posterior extremity of internal semilunar cartilage.

8.

Posterior crucial ligament.

of tibia.

The ligaments of the internal set are eight in number.

The first ligament is the anterior or external crucial, which is attached to
the depression in front of the spine of the tibia and to the external semilunar
now passes upward, backward, and outward to the posIt
fibro-cartilage.
of

pint

terior

the inner side of the external condyle of the femur.

(Plate

LXXXV.)
The second ligament
attached

and

to a

also to the posterior

here

of this set

of the inui

the posterior or internal crucial, which

border of the external semilunar fibro-cartilage.

passes upward, forward,

it

is

is

depression behind the spine of the tibia, to the popliteal notch,

and inward

to

From

be attached to the oblique curve

condyle, to the fore part of the intercondylar fossa, also to the an-

terior part of the outer surface of the inner condyle.

The semilunar

fibro-cartilages help to

They

the condyle of the femur.

central

portion.

The

internal semilunar fibro-cartilage

teriorly than transversely.

anterior crucial ligamenl

in

lis

anterior extremity

to the tibia

is

nearly circular, and

its

LXXXV.)

The

anterior extremity

to the tibia, its posterior extremity

is

is

is

longer antero-pos-

attached in front of the

and the posterior extremity

front of the posterior crucial ligament.

age

deepen the cavities which receive

are thicker at the circumference than at the

is

attached

external semilunar fibro-cartilis

attached in front of the spine

attached to the back of the spine.

(Plate

PLATE LXXV

\\

patIllaCj

v,

V!

'

V\

PERONEUS LONGUS
GASTROCNEMIUS

SOLEUS.

EXTENSOR KKUHRIUS HALLUCIS

PERONEUS TERTIUS

*NT. ANNULAR LIG

PERONEUS TERTIUS

XTENSOR
DORSAL

INTER02SB.

Muscles

ix

Front
201

oi

Leg.

BREVIS

WGITORUM

ANATOMY

202

IN A NUTSHELL.

The transverse ligament passes between the anterior extremities of the

(Plate LXXXIV.)
semilunar fibro-cartilages and is a hand of broad fibers.
The coronary ligaments hold the circumferences
cartilages bo the

head of the

The synovial membrane

of the semilunar fibro-

LXXXIV.)

(Plate

tibia.

of the knee-joint

is

the largest in the body.

It ex-

tends over two inches above the joint under the extensor muscles and it passes
It covers both surfaces of
over the crucial ligaments to the head of the tibia.
the semilunar fibro-cartilages and lines the capsular ligament.

It gives

a cover-

ing to the tendon of the Popliteus muscle.

The ligamentum mucosum

is

a fold of this

membrane.

It

is

triangular in

shape, being attached to the intercondylar notch and extending to the patella.
The ligamenta alalia are two processes of this membrane which are on either
side of the

ligamentum mucosum.

LESSON

LIV.

The Superior Tibio-Fibular

This joint

is

an arthro dial joint.

the head of the fibula

upward and inward

Its posterior superior ligament

fibula

extends from the back part of the head of the

is

of this

tibio-flbular articulation

of the Popliteus

(Plate

part of the outer tuberosity of the tibia.

The middle

ligament extends from

to the external tuberosity of the tibia.

upward and inward under the tendon

which

Joint.

Its anterior superior

is

muscle to the back

LXXXVI.)

formed by the interosseous membrane

attached to the interosseous ridges of the tibia and fibula.

membrane

brane there

is

pass

down from

the tibia to the fibula.

Above

an opening for the anterior tibial vessels, and below

it

The

fibers

this

mem-

one for the

anterior peroneal vessels.

The

inferior tibio-flbular arctiulation

is

a syndesmosis joint.

The

inferior

interosseous (igament which passes between the adjacent rough surfaces of the
tibia

and

The

fibula

is

continuous above with the interosseous membrane.

anterior ligament of this joint passes between the adjacent margins of

the tibia and fibula and

similar

hand

posteriorly.

is

It

triangular in shape.
is

The

posterior ligament

smaller than the anterior one.

The

is

transverse

is a narrow band which is continuous with these

two ligaments and extends from the back of the external malleolus nearly to
the internal malleolus and helps to deepen the ankle-joint.
(Plate LXXXYII.)
The Ankle-Joint. (Plates LXXXVII-LXXXVIII.)
This joint is a ginglymus or hinge-joint, and is formed by the lower ends
of the tibia and fibula and the upper surface of the astragalus.
The anterior ligament of this joint 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 astragalus.
This ligament is thin and broad.
The posterior ligament is attached above to the transverse ligament of
the inferior tibio-fibular articulation and below to the back of the upper articular surface of the astragalus, most of the fibers of this ligament are transverse.
The internal lateral ligament is called the deltoid ligament and consists

or inferior ligament of this joint

PLATE LXXVI.
SUPERIOR INTERNAL
ARTICULAR

ARTERY

INFERIOR

INTERNAL

SUPERIOR EXTERNAL
ARTICULAR APTERY

INFERIOR

EXTERNAL
ARTICULAR ARTERY

ARTERY

ARTICULAR

ANTERIOR

TIBIAL

RECURRENT ARTERY

GASTROCNEMIUS

LONGUS

H
SOLEUS
til

\S

')'i^^

l"-i
BREVIS

ANTERIOR TIBIAL ARTERY

TERTIUS

INTERNAL

ARTERY

MALLEOLAR

ANTERIOR PERONEAL ARTERY

M
>EDIS

ARTERY-

-AfilMLARi.

[^ Hh'
TENDON

OF

BREVIS

DIGITORUM

EXTENSOR

TARSAL BRANCH
.

METATARSAL 3RANCH

COMMUNICATING BRANCH
DORSALIS

HALLUCIS ARTERY

DORSAL INTEROSSEUS ARTERY

Arteries and Nerves in Front of Leg.

203

ANATOMY

21)4

of

two main

First a superficial part

parts.

internal malleolus

IN A NUTSHELL.

and by

its

which

is

attached by

its

apex to the

base to the inner side of the astragalus

and the

sustentaculum tali posteriorly, while anteriorly it is attached to the tuberosity

The
of the scaphoid and blends with the inferior calcaneo-scaphoid ligament.
second, a deep portion which passes from the apex of the malleolus to the side
of the astragalus.

The first is an
external
which
front
of
malleolus and
between
the
the
passes
anterior fasciculus
external lateral ligament consists of three portions.

The

the side of the astragalus in front of the superior articular process.

The second

is

middle fasciculus which passes from the apex of the external

malleolus to the outer side of the os

calcis.

a posterior fasciculus which

is attached behind the deep groove

The third
on the posterior part of the outer malleous and from this point passes inward
to a depression on the posterior surface of the astragalus.

is

The synovial membrane

ligaments, and from there it
hones forming the

joint.

It

of the ankle-joint lines the inner surfaces of its

is

reflected

on the two articular surfaces of the

sends a prolongation into the inferior tibio-fibular

articulation.

The ligamentous muscles

knee

of the ankle-joint are all the muscles

from the

ankle except the Popliteus.

to the

The nerve supply

is

the anterior tibial, posterior tibial and internal saphen-

The blood supply

is

the anterior tibial, posterior tibial

ous.

LESSOX
Tin. Joints of

the Tarsus.

All these joints are arthrodial

lar

and the astragalus, which

Till. LIG

WIE.XTS

is

l.V.

(Plates

LXXXVII-LXXXVIII.)

except the articulation between the navicu-

an enarthrodia!

BETWEEN THE

and peroneal.

<

>S

joint.

CALCIS AND THE ASTRAGALUS ARE:

Anterior calcaneo-astragaloid ligament.

(3)

'

sseous calcaneo-astragaloid ligament.

Externa] calcaneo-astragaloid ligament.

THE LIGAMENTS BETWEEN THE

(1)

OS CALCIS AND SCAPHOID ARE:

Superior or dorsal calcaneo-scaphoid ligament.

(2)

Inferior calcaneo-scaphoid ligament.

l.l.X THE ASTRAGALUS AXH THE SCAPHOID THERE IS RUT ONE LIGAMENT.
The superior or dorsal astragalo-scaphoid ligament.
Till. LIGAMENTS BETWEEN THE SCAPHOID, CUBOID, AND THE THREE CUNEIORM are:

Ib.TU
1

(1)
-'

(3)
1

(5)

Superior or Dorsal scapho-cuboid ligament.

Superior or Dorsal scapho-cuneiform ligament.
Superior or Dorsal intercuneiform ligament.
Superior or Dorsal cubo-cuneiform ligament.
Internal lateral scapho-cuneiform ligament.

The plantar ligaments are similarly arranged upon the bottom of the
foot.

PLATE LXXVII.

GASTROCNEMIUS
INNER HEAD

SEMI-MEM3RAN0SUS

POSTERIOR

PERONEJS

TIBIAL NERVE

LONtiUS

Muscles

in

Hack of Leg (Superficial Laykkj

205

ANATOMY

206
(7)

IN A NUTSHELL.

There are four strong interosseous ligaments passing between the rough

non-articular surfaces of these bones.

THE LIGAMENTS BETWEEN THE OS CALCIS AND CUBOID ARE:

(1)

Superior or dorsal calcaneo-cuboid ligament.

(3)

Internal calcaneo-cuboid ligament.

Inferior calcaneo-cuboid ligament.

(4)

External calcaneo-cuboid ligament.

is the long calcaneo-cuboid ligament also called ligamentum longum

There

This ligament passes between the under surface of the os calcis in

plantar.

front of the tuberosities to the posterior

margin

of the peroneal

groove of the

Sonic of the fibers pass over the sheath of the tendon of the Peroneus

cuboid.

longus and are attached to the bases of the second, third, and fourth metacarpal bones.

short calcaneo-cuboid ligament passes

The
uii

from the tubercle and depression

the under surface of the os calcis to the under surface of the cuboid behind

the peroneal groove.

The Joints of the Tarsus and Metatarsus.

The ligaments of these joints are:
(1)

Dorsal tarso-metatarsal ligament.

(2)

Dorsal intermetatarsal ligaments.

(3)

Internal lateral tarso-metatarsal ligaments.

The plantar ligaments are arranged irregularly between these bones.

The [nterosseous ligaments which are strong bands are three in
number:
(1) The internal one passes from internal cuneiform to the second meta(4)

tarsal.
(2)

The middle one passes between the external cuneiform and the second

metatarsal.
(3)

The external one connects the external cuneiform and the

third meta-

tarsal.

There auk
(1)
(2)

One
One

six

synovial membranes of the tarsus and metatarsus:

for the posterior calcaneo-astragaloid articulation.

for the anterior calcaneo-astragaloid articulation

and the scapho-

as1 ragaloid articulation.

(3)

(4)

One
(

for the

calcaneo-cuboid artciulation.

)ne for the articulation 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 second and
third metatarsal bones.

me

ween the first metatarsal and internal cuneiform bones.

and fifth metatarsal with the cuboid.
The bases of the metatarsal bones are joined by dorsal, plantar, and
<

()'))

One

>et

for fourth

in-

terosseous Ligaments!

The

digital

connect- the

ends are joined by the transverse metatarsal ligament, which

metatarsal with the others, similar to those in the hand.

firsl

The metatarso-phalangeal and phalangeal articulation are similar to the

corresponding parts of the hand.

PLATK LXXVUIGLUTEUS

MINIMUS

SUPERIOR GLUTEAL ARTERY

SUPERIOR GLUTEAL

OBTURATOR
INFERIOR

NERVE

INTERNUS

SMALL

ARTERY

PUDIC

GLUTEAL

PUDIC NERVE.
nglj

SCIATIC

SCIATIC

ARTERY

-- COCCYGEAL BRANCH

GREAT_ SCIATIC NERVE

TUBERISCHII

GLUTEUS MAXIMUS

INFERIOR PUDENDAL

ADDUCTOR MAGNUS
DESCENDING CUTANEOUS

GRACILIS

EXTERNAL

POPLITEAL

OR

PERONEAL

NTERNAL

POPLITEAL

SOLEUi

POSTERIOR

TIBIAL

NERVE

SOLEUS

POSTERIOR TIBIAL ARTERY

PERONEAL ARTERY
INTERNAL CALCANEAN

PLANTAR

Posterior View
207

<k

Entire Leg.

CUTANEOUS

ANATOMY

208

IN A NUTSHELL.

LESSON
Lumbar Plexus.
The lumbar plexus is made of
third,

and

lies in

(Plates

LXIII-LXXIII.)

the anterior branches of the

greater part of the fourth lumbar nerves.

nerve scuds

LVI.

communicating branch

the posterior pari of the Psoas

to the

first

lumbar nerve.

magnus muscle

first,

The twelfth

in front of

second,
dorsal

This plexus
the transverse

lumbar vertebrae.
lumbar nerve divides into two branches, the ilio-hypogastric and
The ilio-hypogastric nerve passes through
(Plate LXX11I.)
the ilio-inguinal.
Psoas
magnus in front of the Quadratus iumborum and
the outer border of the
behind the kidney and the large intestine. It pierces the Transversalis muscle
at the outer border of the Quadratus Iumborum to enter the areolar tissue between the transversalis muscle and the Internal oblique. At this point it freIt divides into a hypogastric
quently joins the last dorsal and inguinal nerve.
branch
hypogastric
passes between the TransThe
branch and an iliac branch.
downward and gives
muscles
forward
and
versalis and the Internal oblique
joins
ilio-inguinal
It
the
nerve and pierces
of
these
muscles.
branches to each
anterior
superior
spine
of the ilium and
near
the
the Internal oblique muscle
of
aponeurosis
the
the median line.
External
oblique
towards
passes beneath the
about
an inch above
of
External
oblique
muscle
aponeurosis
the
It pierces the
to
skin over the
cutaneous
the
abdominal
ring
and
.becomes
supply
the externa]
muscle
pierces
both
Internal
oblique
and the
iliac
branch
the
The
symphysis.
The
point
pierces
the
External
muscle
is
where
it
oblique
Externa] oblique.
front
middle
It
supplies
little
its
portion.
crest
a
in
of
of the ilium
above the
the integument near the Gluteus medius muscle and the Tensor fascia femoris.
The ilio-inguinal nerve passes out of the Psoas magnus muscle a little below
the hypogastric, and thin crosses the Quadratus Iumborum to pass behind the
large intestine, after which it crosses the inner lip of the crest of the ilium posIt now takes a forward course on the upper part of the Iliacus muscle
teriorly.
processes of the

The

first

to pierce the Transversalis

where

muscle near the anterior part of the crest of the ilium

communicates with the hypogastric branch of the ilio-hypogastric

It
pass< s through the inguinal canal and gives a branch to the spernerve.
matic cord, and to the skin of the upper and middle part of the thigh and to
the scrotum and penis in the male, or to the mons veneris and the major lip in
1

1n'

it

female.

The second nerve

of the lumbar plexus is the genito-crural, which conies

and second lumbar nerves, mostly from the second.
It passes
through the Psoas magnus muscle coming out on the anterior surface of this
muscle at the level of the lower border of the third lumbar vertebra.
It now
passes downward on the outer side of the abdominal aorta and the common
iliac artery, then behind the meter where it divides into an external or genital
branch and an internal or crural branch. The EXTERNAL or GENITAL BRANCH

from the

firsl

gives a branch to the external

tric

artery

at

spermatic cord

iliac

Poupart's ligament.
in

artery ami
It

now

it

turns round the deep epigas-

enters the inguinal canal with the

the male or the round ligament

in

the female.

The Cremas-

PLATE LXXIX.

PtANTARIS

OUTER HEAD OF GASTROCNEMIUS

INNER HEAD

BICEPS

OF GASTROCNEMIUS

TENDON OF SEMIMEMBRANOSUS

ANTERIOR TIBIAL ARTERY

TIBIALIS

POSTICUS.

PERONEUS

POSTERIOR TIBIAL

NERVE

POSTERIOR TIBIAL

ARTERY

BREVIS

TENOO

Muscles of Back of Leg (Deel Layer).

209

ACHILLIS

ANATOMY

210

IN A NUTSHELL.

it also sends branches to the integument

The internal or
or
the
major
male
lip in the female.
of the scrotum in the
on
the
outer side of the
branch
passes
beneath
Poupart's
ligament
crural
pierces
the
lata
to
supply
the
integument
in
It
fascia
the
artery.
femoral

tciic

muscle

is

supplied by this nerve,

middle of the upper third of the thigh.

The third nerve of the lumbar plexus
conies from the second and third

the

is

external cutaneous,

which

After passing from the outer

lumbar nerves.

border of the Psoas magiius muscle it crosses the Iliacus muscle, prior to this
pa>ses behind the caecum on the right side and the iliac colon on the left.
it

Below the anterior superior spine

iniiii

of the ilium

it

the outer border of Scarpa's triangle.

in

It

passes under Poupart's liga

now

crosses in front of the

and a posterior
BRANCH, after passing in the deep fascia for about
becomes cutaneous, and most always divides into an external

Sartorius muscle where

it

divides into two branches, an anterior

Tin: anterior

brunch.

four inches,

branch which supplies the skin of the lower half of the outer side of the thigh.
and an internal branch which is distributed to the skin of the outer side of the

The posterior branch supplies the integument of the outer side of the thigh from the greater trochanter to the middle

front of the thigh as far as the knee.

of the thigh.

The

is formed by branches from the long saphenous and

and middle cutaneous, and external cutaneous.

patellar plexus

internal cutaneous

LESSON

fourth nerve of the lumbar plexus

Tlu
largesl

LVII.

n<

rve of this plexus.

It

is the anterior crural, which is the

comes from the anterior branches of the sec-

ond, third, and fourth nerve, and after passing through the outer border of the
Psoas

magnus muscle, it passes tinder Poupart's ligament in a groove between

magnus and Iliacus muscle into Scarpa's triangle. In this triangle

the Psoas
lit

it

io the

outer side of the femora! artery from which

magnus.

of the P>o;i>
twi

which pass<

Hue

it

it

is

separated by part

divides into superficial and deep branches, be-

die external circumflex artery.

The superficial branches

supply the Pectineus and Sartorius muscle and give off two cutaneous branches,
middle and internal. The deep branches supply the Iliacus. the Rectus
femoris, Vastus interims. Vastus externus, Crueus

and Subcrureus muscle, and

gives off the internal or long saphenous nerve which

terior crural nerve passes to eight muscles, all the

is cutaneous.
This anmuscles on the front of the

except

tin Tensor fascia femoris, and in its place it supplies the Iliacus of
abdominal
It
the deep
region.
supplies the Pectineus of the internal femoral
The nerve to the Pectineus passes behind the femoral sheath and in
region.
fiont of the Psoas magnus to end in the anterior surface of the Pectineus.
The
nerve to the Sartorius ends in the upper part of the muscle.
The middle

leg

<

utaneoi

- \i

Sartorius and

u\
it

i;

third of the thigh,

<

nt( r into

an

ai

divides into two branches, the outer one of which pierces the

together with the inner branch becomes cutaneous at the upper

and the two pass down as far as the knee-joint where they

the patellar plexus.

i

Tin; internal

d post< rior division

cutaneous branch

divides into

and supplies integument on the inner

side of

PLATE LXXX.
THORACIC

MUSCULOCUTANEOUS
SHORT

SAPHENOUS

EXTERNAL

PLANTAR

S IHUSLULUCUIANbOUS
INTERNAL CALCANEAN

ANTERIOR
internal plantar

Cutaneous Nerve Supply of the Lowkf. Extremity

211

TIBIAL

ANATOMY

212

IN A NUTSHELL.

the thigh from the middle of the thigh to the knee.

branches helps to form the subsartorial plexus which

The other nerves

canal.

The posterior one of these

on the roof of Hunter's

lies

the subsartorial plexus are the long saphenous,

in

and branches from the obturator.

The muscular branch which passes to the Rectus muscle sends an articular branch to the hip-joint, while the muscular branch to the Vastus internus
The long saphenous nerve sends
sends an articular branch to the knee-joint.
an articular branch to the ankle-joint.
The blood supply of the lumbar plexus comes from the ilio-lumbar arteries.
The obturator nerve is derived from the second, third and fourth sacral
After it passes from the subIts largest root is from the third nerve.
nerves.
si ance of the inner border of the Psoas magnus muscle at the posterior part of
the brim of the pelvis, the ilio-lumbar artery separates it from the lumbo-sacral
cord.
It now crosses the internal iliac vessels and the ureter, passing in the
extraperitoneal fat below the obliterated umbilical (hypogastric) artery, along
It now
the inner surface and upper part of the Obturator internus muscle.
In the
passes through the obturator foramen above the obturator membrane.
After passing out of the pelvis it
pelvis it lies above the obturator artery.
The anterior
divides into two branches, an anterior and a posterior division.
division crosses the Obturator externus muscle and passes between the Pectineus
and Adductor brevis. It sends (1) an articular branch to the hip-joint. (2) a
branch to the femoral artery, which is an example of the gray rami. (3) Cutaneous branch to the subsartorial plexus. (4) muscular branches to the Adductor
The poslongus, Adductor brevis, the Gracilis and the Pectineus muscle.
terior division passes between the Adductor brevis and Adductor magnus
after piercing the upper part of the Obturator externus.
It gives off (a) muscular 'ranches to the Obturator externus and Adductor magnus, and (b) articular branches to the hip-joint and knee-joint.
Obturator accessory nerve, which is present in a little more than one-fourth
of the cases, comes from the second and third lumbar nerves.
It passes along
the inner border of the Psoas muscle between the roots of the anterior crural
and obturator nerves. It does not pass through the obturator foramen, but
passes in front of the brim of the pelvis beneath the Pectineus muscle.
Its
branches are (1) a communicating branch to the obturator nerve. (2) an articular branch to the hip-joint, and (3) a muscular branch to the Pectineus.
1

LESSON
Sacral Plexus.

The

first,

the

fifth

This plexus
(A)

formed by

is

a part of

the fourth lumbar nerve

and

lumbar nerve.
is

situated

and behind the pelvic

gives >>^

LXIII-LXXIII.)

is

Tin- lumbi -sacral cord

all

(Plates

formed by the lumbo-sacral cord and the anterior

second, third, and a part of the fourth sacral nerves.

sacral plexus

branches of the

LVI1I.

viscera]

fascia

<

the anterior surface of the Piriformis muscle

and the branches of the internal

branches,

branches. (E) Greal sciatic and

(B)

its

muscular.

branches.

iliac artery.

It

(C) cutaneous, (D) terminal

ANATOMY

IN A NUTSHELL.

213

Under (A) visceral branches, we have branches to the pelvic viscera from
Under (B) muscular branches.
third, and fourth sacral nerves.
second,
the
from
first and second sacral nerves.
comes
the
Pyriformis
the
nerve
to
The
(1)
This nerve leaves the pelvis through the great sacro-sciatic foramen, and after
crossing the spine of the ischium enters the Pyriformis muscle on its internal
surface.

PLATE LXXX1.

Cutaneous Nerve Supply of the Plantab Surface of the Foot.

(2)

The superior gluteal nerve

is

derived from the fourth and

fifth

lumbar and first sacral nerve. It leaves the pelvis above the Pyriformis muscle
and
with the gluteal vessles. It supplies the Gluteus medius, Gluteus minimus
which
are
gray
branches,
Tensor fascia femoris. It also sends sympathetic
nerve.
rami, to the bone, ligament, fascia, and vessels - see sympathetic

ANATOMY

214

IN A NUTSHELL.

(3) The inferior gluteal nerve is derived from the fifth lumbar, first
It leaves the pelvis below the Pyriformis muscle
and second sacral nerves.
It gives muscular branches to
with the sciatic and pudic vessels and nerves.

the

Huteus maximus.

(4)

The nerve

lumbar, and
muscle.

first

to the

sacral

Quadratus femoris

nerves.

It

is

derived from the fourth,

fifth

leaves the pelvis below the Pyriformis

sends a branch to the Gemellus inferior, and also one to the hip-

It

joint.

The nerve i< the Obturator interims is derived from the fifth lumbar,
and second sacral nerves. It leaves the pelvis below the Pyriformis muscle and re-enters the pelvis through the lesser sacrc -sciatic foramen to be disIt gives a branch to the Gemellus
tributed to the inner surface of this muscle.
i.")i

tirst

superior.

Under ((') cutaneous branches we have, (Plate LXXYIII.)

(1) The small sciatic is derived from the first, second, and third sacral
It leaves the pelvis through the great sacro-sciatic foramen below the
nerves.
Pyriformis muscle with the sciatic vessels and the great sciatic nerve, inferior
At the lower border of the
gluteal nerve, internal pudic nerve and vessels.
behind
long
the
head of the Biceps and descends
Glutens maximus it passes
beneath the deep fascia to the popliteal space. Some say it supplies the Gluteus
maximus, bu1 outside of supplying this one muscle it is cutaneous. Its branches
are first; peroneal cutaneous which supplies the skin of the upper, inner, and
posterior aspects of the thigh

and perineum.

One

of these branches, the in-

and perand Colles' fascia to enter the anterior compartment of

the perineum.
In the perineum it communicates with the superficial perineal
and
sends
branches to the skin of the scrotum in the male, and to the
nerves
major lip in the female. Second; Femoral cutaneous branch which supplies
the integumenl on the central, inner and outer aspects of the posterior partof

ferior or long pudendal nerve, crosses the tuberosity of the ischium

forates the fascia lata

the thigh.
Third; Gluteal or ascending cutaneous branches to supply the skin
over the lower and outer part of the Gluteus maximus.
(2)

Perforating cutaneous nerve

is

derived from the second and third sacral

and supplies the skin

over the lower and inner part of the Gluteus maximus.
Under D) terminal branches we have.
(1) The pudic nerve is derived from the second, third and fourth sacral
nerves.

perforates the greater sacro-sciatic ligament

It

It
haves the pelvis below the Pyrifomis muscle. It now crosses the
nerves.
spine of the ischium, being on the inner side of the internal pudic artery, which
it

it

accompanies through the

lesser sacro-sciatic

divides into three branches.

notch into Alcock's canal where

First; the inferior

hemorrhoidal nerve which

passes through the inner wall of Alcock's canal towards the anus to supply the

and the adjacent integument. Second; the perineal branch

which has a cutaneous branch called the superficial perineal. It leaves Alcock's
canal ami pierces the base of the triangular ligament and is distributed to the
skin of the scrotum in the mule or the major lip in the female.
Third; the dorsal nerve of the penis, pierces the posterior layer of the triangular ligament and
sphincter ani

ANATOMY

IN A NUTSHELL.

215

passes through the deep perineal space along the inner margin of the ramus of
It now pierces the anterior layer of the triangular ligament,

the pubic bone.

between the cms penis and the pubic hone, and gives a vaso-motor branch
corpus cavernosum, and passes to the dorsum of the penis to supply the
integument, glans and prepuce in the maleor clitoris in the female.
It is called
the dorsal nerve of the clitoris in the female and is much smaller.
Lying

to the

PLATE LXXXII.

CAPSU LAR LIGAMENT DIVIDED

UUI SURFACE OF CAPSULAR LIGAMENT

Ligaments of Hip-Joint.

LESSON LIX.
Under (E) great sciatic nerve and its branches we have, (Plate LX Will.)
(1) The great sciatic nerve and its branches which supply both muscles ami
integument below the knee-joint but muscles only above this joint.
plies thirty-seven muscles in all.
It isthe largest nerve in the body and

It
is

sup-

a con-

tinuation of the sacral plexus, except the fourth sacral nerve, since thegreal sciatic

isformed by thelumbo-sacral cord and the anterior branches of the first, second
and third sacral nerves. After passing out of the pelvis below the Pyriformis
muscle
It

may

it

passes between the great trochanter and the tuberosity ^i the ischium.
It generally divides at the lower one-

perforate the Pyriformis muscle.

third of the thigh into an external popliteal or peroneal and an internal popliteal

or popliteal nerve.
leaves the pelvis.

This division
In its course

may

down

take place immediately after the nerve

the hack of the thigh (Plate

LXXVIII)

it

ANATOMY

216

Quadratus femoris. the Gemelli

l>ack of the ischium, the nerve to

upon the

lies

IX A NUTSHELL.

muscles, Obturator interims. Quadratus femoris. and Adductor magnus muscles.

and the small sciatic nerve.
In the
It i- accompanied by the sciatic artery
tipper part of

its

course

it

is

covered by the Gluteus maximus and in

part by the long head of the Biceps.

branches

it

divides

it

gives, (a)

its

lower

articular

the hip-joint which perforates the capsular ligament posteriorly.

t<>

branches beneath the long head

ri. ak

(b) MUS<

Before

of the Biceps to the Biceps.

Semitendinosus, Semimembranosus, and Adductor magnus. The fibers in the

internal popliteal or popliteal are from the fourth and fifth Lumbar, first, second.

ami third

LXXVII.)

(Plate

sacral.

This

muscle

arm
on

it

is

in that

its

the larger of the two divisions,

is

At the lower border

passes through the popliteal space.

it

called the posterior tibial nerve.

it

It

gives off the following branches. (1)

which are three

to the knee-joint

of the Popliteus

the median nerve of

on the outer side of the artery, then crosses it to lie

articular branches

lies at first

inner side.

It is like

number:

in

first,

superior internal; second,

superior external, and third, azygos.

Muscular branches

(2)

and

to the Gastrocnemius. Plantaris, Popliteus.

Soleus.

Communicans poplitei which

(3)

joins the

communicans peronei

to

form

the short saphenous nerve, which supplies integument on the posterior part of
the Leg and on the outer side of the foot.

posterior tibial after

it

(4)

This nerve continues as the

posterior tibial nerve crosses the posterior tibial vessels

opposite from the median and popliteal nerves.

from within out.

(Plate

the inner border of the tendo Achillis.

just the

LXXVIII.)

lower part of the leg these posterior tibial vessels and the nerve

cular

The

passes the lower border of the Popliteus muscle.

lie

In the

parallel

The branches of this nerve are.

(1)

with
mus-

the Soleus. Tibialis posticus. Flexor longus hallucis. Flexor longus

to

Internal calcanean (cutaneous) which passes with the inIt supplies the integument and fascia of the heel and
a part of the sole.
(3) Articular branches to the ankle.
(4) Internal
axd external plantar nerves, which are formed by the division of the posdigitorum.

(2)

ternal calcaneal) artery.

midway between the internal malleolus and inner

These nerves accompany the internal and external
While the internal plantar nerve islarger than the external plantar, the

terior tibial nerve at a point

tubercle of the os calcis.

arteries.

arteries are just the reverse. the external being Larger than the internal.

ternal nerve supplies the following five muscles. (1)

brevis digitorum, (3)

hallucis.

It

face of the

and

also supplies

(Plate

fo.t.

Abductor

The

hallucis, (2)

in-

Flexor

(4) the two inner Lumbricales.

(5) Flexor brevis
integument on the inner aspect of the plantar sur-

LXXXI.)

The external plantar nerve supplies the

following fourteen

muscles. (1) Abductor minimi digiti, (2) and (3) the two
outer Lumbricales, (4) Flexor accessorius, (5) Flexor brevis minimi digiti. the

seven [nterossei
1

make

twelve. (13)

the Adductor obliquus hallucis.

the plantar surface of the foot.

the

Adductor transversus

hallucis.

and

This nerve also supplies integument on

ANATOMY IN A NUTSHELL.

217

LESSON LX.
The

external popliteal or peroneal nerve passes along the outer part of the

popliteal space close to the tendon of the Biceps muscle as far as the
fibula.

head of the

LXXVIII.) It is about half as large as the popliteal nerve.

articular branches to the knee-joint (superior and inferior

(Plate

gives (1)

It

ex-

ternal) also recurrent articular branch to the superior tibio-fibular articulation

(2) Cutaneous branches which supply the integument along the back part
and outer side of the leg. (3) Communicans peronei which joins the communicans poplitei to form the short saphenous nerve. Museulo-eutaneous

PLATE LXXXIIL

INTERNAL TUBEROSITY

EXT LATERAL LIGAMENT

LlG AMENTUM PATELLA.

which begins on the head of the fibula and passes down between the Peronei
muscles and the Extensor brevis digitorum pierces the deep fascia a1 the lower
This nerve supplies the I'erone-third of the leg on its front and outer side.
oneus Longus, Peroneus brevis, and the integumenl mi the dorsum of the foot.
of the nuiselilo-rutaneous nerve passes in

The INTERNAL TERMINAL BRANCH

front of the ankle-joint and divides into two branches.

The inner branch

passes to the inner side of the great toe and sends twigs to the integumenl on

the inner side of the foot.

The outer branch passes

to the

base of the cleft

ANATOMY

218

IX A

NUTSHELL.

between the second and third toes and divides to supply the adjacent sides of
the cleft.

The external terminal branch

the outer side of the
inner one suppli*

the smaller of the two and passes along

is

of the toot

and divides

into

two branches.

The

he integument of the adjacent sides of the third and fourth

The outer one supplies the integument on the adjacent sides of the fourth
toes.
The outer side of the fifth toe receives the short saphenous

toes.

and

dorsum

fifth

nerve.

The

comes from the end of the peroneal nerve just

between the Peroneus longus and the neck
It passe- forward and inward beneath the Extensor longus digIt
in the interval between this muscle and the Tibialis anticus.

anterior tibial nerve

internal to the musculo-cutaneous

of the fibula.

itorum

to lie

descends on the interosseous

membrane with

the anterior tibial artery to the

and an outer terminal

The inner terminal branch passes down along the dorsalis pedis artery
and supplies the integument along the adjacent sides of the first and second
front of the ankle-joinl

where

divides into an inner

it

branch.

toes.

also supplies the

It

periosteum of the adjacent bones, the

phalangeal and inter-phalangeal joints.

interosseous muscle.

It

metatarso-

helps to supply the First dorsal

The outer terminal branch passes under the Extensor

This branch has a ganglion upon it which supplies
digitorum,
tarsal joints and the bones, periosteum, and

brevis digitorum outward.

the Extensor brevis

joints of the three outer intermetatarsal spaces.

It

helps to supply the Second

dorsal interosseous muscle.

The

anterior tibial nerve gives

muscular branches

to Tibialis anticus.

Extensor longus digitorum, Extensor proprius hallucis, Peroneus tertius, Extensor brevis digitorum, and as said before helps to supply two inner Dorsal

Articular branches to the inferior tibio-fibular articulation

(Plate LXXY1.)
The coccygeal plexus (Plate LXIII-LXXIII.) is formed by the anterior
branches of part of the fourth sacral nerve, the fifth sacral and the coccygeal
It is situated on the inner surface of the Coccygeus muscle and behind
nerve.

interossei.

(2)

and the ankle-joint.

the Second portion of the rectum.

muscle and Levator

Its

muscular branches supply the Coccygeus

branches together with the sympa-

aid. while its visceral

thetic supply the pelvis viscera.

For the complete distribution of the cutaneous nerve supply of the lower limb see (Plates LXXX-LXXXI.)

LESSOX LXI.
Thk Superficial
the

Fascia of the Thigh.

The superficial fascia i> continuous with that

abdomen above. It has an superficial and

layers are

die superficial

vessels

and nerves.

of the leg

Really these structures are in

the deep layer but the line of distinction cannot be closely

superficial

deep layers.

This fascia

is

beneath

below and that of

a deep layer, between which

drawn between the

he integument and forms an

investment for the entire thigh.

It is attached (1)
to the margin of the saphenous opening, (2) to the femoral sheath through the saphenous opening, (3)
to the fascia lata below Poupart's ligament.
The cribriform fascia, which
form- one of the coverings of
femoral hernia, is that part of the superficial
;)

ANATOMY
fascia

IX A

NUTSHELL.

which covers the saphenous opening.

long saphenous vein and a

number

<>f

vessels.

219

This fascia

The

is

perforated by the

superficial fascia has a very

intimate attachment to the deep fascia below Poupart's Ligament, thus in extravasation of urine,

cannot pass down into the superficial fascia of the thigh.

it

PLATK LXXXIV
TENDON OF ADDUCTOR MAGN05

PLANTARIS

OUTER HEAD OF

GASTROCNEMIUS
NNER HEAD OF GASTROCNEMIUS

TENDON

OF

POPLITEUS v

EXTERNAL LATE"al

'

m\

LIGAMENTS

'

Q *^^^ fl

TENDON OF BICEPS

.;:.*7V-

~~TEf;20'J OF SEMI-MEWSRANOSUS WITH

ITS

SLIP

TD

THICKENED

THE

POSTERIOR

LIGAMENT

f4

mi

/HEAD P

'
'

POSTERIOR SUPERIOR
TIBIOFIBULAR

LIGAMENT^

,',|

\\\ }

T B A
'

'

INTEROSSEOUS

MEMBRNE

Posterior Ligament of Knee-Joint.

Deep Fascia of the Thigh.

The deep

fascia of the thigh

is

called fascia lata,

and form-

strong cover-

It is thick in front
beneath the skin and superficial fascia.
and externally, but thin behind and internally. The Gluteus maximus, the
Tensor fascia femoris, the Biceps, the Sartorius, and Quadriceps extensor musThe fascia lata is attached to Poupart's
cles give expansions to the fascia lata.
ligament and the body of the pubic bone anteriorly, to the tuberosity of the
ischium and the rami of the pubes and ischium internally, to the back of the

ing lor the thigh

sacrum and coccyx posteriorly, to the head of the fibula, tuberosities of the
tibia, and condyles of the femur distally.
The external Intermuscular septum

ANATOMY

220

IN A NUTSHELL.

attached to the linea aspera and extends from the insertion of the Gluteus
maximus to the outer condyle of the femur. It separates the Vastus externus
is

from the short head of the Biceps and gives attachment to both of these musThe internal intermuscular septum is attached to the linea aspera and
cles.
extends from the lesser trochanter to the adductor tubercle, thus separating
This intermuscular
the Vastus in tenuis from the Pectineus and Adductors.
is perforated by branches of the profunda artery which pass to the
hamstring muscles and by the superficial femoral artery which passes into the
Smaller septa
popliteal space through an opening in the Adductor magnus.

septum

from the fascia lata to ensheath each muscle.

band (Plate LXXIV.) is a special part of the fascia lata
which passes from the front part of the crest of the ilium down the thigh as two
layers, one superficial to and the other beneath the Tensor fascia femoris, at
the lower end of which muscle these two layers become blended and having
received the insertion of this muscle it passes down to be inserted into the external tuberosity of the tibia.
Another special portion of the fascia lata is
called the gluteal aponeurosis and takes its origin from the outer lip of the crest
are given off

The

ilio-tibial

of the ilium posterior to the ilio-tibial band.

This fascia covers the Gluteus

medius muscle and divides at the anterior border of the Gluteus maximus to
The iliac portion of the fascia lata is behind the femoral vessels but
enclose it.
This portion is attached to the crest of the ilium
whole length of Poupart's ligament and to the ilio-pectineal line with
Gimbernat's ligament where ^continuous with the iliac fascia. The pubic portion of the fascia is attached above to the ilio-pectineal line.
It passes beneath
the femoral vessels to which it is attached and crosses the Gracilis, Adductor

in front of the pubic portion.

and

to the

longus and Pectineus muscles.

and pubic portions

The saphenous opening is between the iliac

and leads from the space of the superficial

of the fascia lata

an oval shaped aperature which is about an

an inch in width. It is directed obliquely
downward and outward at the upper and inner part of the thigh just below
Poupart's ligament. The inner boundary of the opening is posterior to the
outer margin and behind the femoral vessels.
It is through the saphenous
opening that a femoral hernia passes after descending along the crural canal.
The outer margin of this opening forms the falciform process which passes in
fronl of the femoral vessels and is attached to Poupart's ligament and the spine
of the os pubes and the pectineal line where it is continuous with the pubic
fascia to the femoral vessels.

inch and a half in length

and

It is

half

portion.

LESSON

LXII.

The Fascia of the Leg.

The

continuous with that of the thigh and

which forms an investment for the muscles but is not continued over the subcutaneous surfaces of the bone.
Above
it
joins the fascia lata and receives an expansion from the tendon of the Biceps
externally and from the tendons of the Sartorius, Gracilis, Semitendinosus internally.
Anteriorly it blends with the periosteum covering the subcutaneous
surface of the tibia and with that covering the head and the external malleolus

beneath

superficial fascia of the leg

it

i-

is

the deep fascia of the leg,

AXATOMY
of the fibula.

ankle.

It is

Below

it is

thin where

it

IX A XUTSHELL.

221

continuous with the anterior annular ligament of the

covers the Gastrocnemius and Soleus but thick and

dense in the upper and anterior part of the leg where

it gives attachment to the

amicus and Extensor longus digitorum. At the lower part of the popliteal space it is strengthened by transverse fibers and is perforated by the
short saphenous vein.
The deep fascia of the leg gives off several small septa which enclose each
muscle and externally it gives off two strong intermuscular septa which enclose

Tibialis

PLATE LXXXV.
APERTURE LEADING INTO THE
QUADRICEPS EXTENSOR.

BURSA

BENEATH

THE
ATTACHMENT OF CAPSULAR. OR
'

ANTERIOR

LIGAMENT

TO

FEMUR

POSTERIOR CRUCIAL

LIGAMENT

EXTERNAL LATERAL
LIGAMENT
EXTERNAL

SEMILUNAR

ANTERIOR CRUCIAL-

LIGAMENT

INTERNAL
INTERNAL

SEMILUNAR
LATERAL
LIGAMENT

TRANSVERSE

LIGAMENT

Showing Condyles and Ligaments of Knee-Joint Anterior View.

the peronei muscles, thus separating them from the muscles on the anterior
It also gives off a
tibial region and the muscles on the posterior tibial region.
deep transverse fascia of the leg which passes between the superficial and deep

muscles in the posterior tibio-fibular region.

The

anterior annular ligament (Plate

superior or a vertical portion, and an

LXXV.)

consists of

inferior or

horizontal

two portions,
portion.

The

superior portion passes across the front of the leg between the anterior borders

ANATOMY

222

IN A

XITSHELL.

and the fibula just above the malleoli and binds down the extensor
tendons as they descend on the front of the tibia and fibula. The inferior
portion begins on the outer side of the calcaneum and divides into two layers

of the tibia

the outer border of the Peroneus tertius, one passing in front, the other be-

at

hind ami

the inner border of the Extensor longus digitorum these layers

at

mute thus forming

a canal

through which these muscles pass. This inferior

now divides into two branches one of

portion of the anterior annular ligament

which passes upward to be inserted in the front of the internal malleolus and
the other passes across to be inserted on the scaphoid
bon<

and the plantar

fascia.

The tendon

and internal cuneiform

of the Tibialis anticus has a synovial

PLATE LXXXYI
EXPANSION FROM QUADRICEPS EXTENSOR TENDON

ANTERIOR CRUCIAL

POSTERIOR

EXTERNAL LATERAL LIGAMENT

CRUCIAL LIGAMENT

Semilunab Fibro-Cartjlage of Knee-Joint.

-heath

in

the superior portion of the anterior annular ligament

the upper limb of the inferior portion, but

is

and

also

one

passes under the lower limb

in

of

the inferior portion.

|

lus

The external annular Ligament runs from the extremity

to

the outer side of the os calcis binding

Peroneus brevis, which are enclosed

The internal annular Ligament

in

a single synovial

(Plate

LXIX.)

malleolus to the internal margin of the os calcis.

over which

it

of the outer malleo-

the Peroneus longus and

down

membrane.

passes from the internal

It

thus makes the grooves

passes into canals for the passage of the tendons of the flexor

muscles and vessels into the sole of the foot.

It joins the deep fascia of the leg
above and the plantar fascia below at the origin of the Abductor hallucis.
It
has three canals which from within outward transmit (1) the Tibialis posticus,
udon of the Flexor longus digitorum, then the posterior tibial vessels

and nerve, (3) the tendon of the Flexor longus

is lined by synovial m< mbrane.

hallucis.

Each

of these canals

ANATOMY
The
and

fascia

on the

the densest of

is

IX A

sole of the foot

all

is

223

NUTSHELL.

called the plantar fascia (Plate LV.)

the fibrous membranes.

It

is

divided into three por-

attached to the inner tuberosity of the OS

calcis and runs forward below the Flexor brevis digitorum and ends in front in
At its sides it joins the lateral
a process for each toe and in slips for the skin.

tions.

(1)

central portion which

is

At the junction of the

portions which extends around the margins of the foot.
(2) The excentral with the two lateral portions expansions pass upward.

PLATE LXXXVII.
IIBin- FIBULAR

LIGAMENT.

POST INF TIBIOFIBULAR

LIGAMENT.

ANT
ANTERIOR

LIGAMENT

OF

INF

ANKLE

CALCANEO- SCAPHOID- LIGAMENT

DORSAL SCAPHO-CUBOID- LIGAMENTS

ANTERIOR

DORSAL

DORSAL

FASCICULUS

OF

EXTERNAL LATERAL LIGAMENT

LIGAMENTS

SCAPHO-CUNEIFORM

POST. LIGAMENT OF ANKLE JOINT

INTER CUNEIFORM-LIGAMENTS.

EXT.

* WV
LATERAL LIGAMENT
(POST. FASCICULUS)

DORSAL CUBO-CUNEIFORM LIGAMENT

TENDO ACHILLIS
DORSAL TARSO- METATARSAL LIGAMENTS

DORSAL INTER METATARSAL LIGAMENTS

MIDDLE FASCICULUS OF
EXTERNAL LATERAL LIGAMENT
INTERNAL CALCANEOCUBOID LIGAMENT
LIGAMENT
DORSAL CALCANEOCUBOID

CALCANEO- CUBOID LIGAMENT

EXTERNAL CALCANEO- CUBOID LIGAMENT

ANTERIOR CALCANEO-ASTRAGALOID LIGAMENT

INTEROSSEOUS CALCANEO-ASTRAGALOID LIGAMENT

INFERIOR

Ligaments of Ankle
tenia] portion
io the

which

is

base of the fifth

ductor minimi

digiti.

EXTERNAL CALCANEO-AS TRAGALOIU LIGAMENT

External

View.

and thick behind extends from the os calcis

It coversthe nude'- surface ofthe Abmetacarpal hone.
It is continuous with the fascia on the hack of the fool

thin in front

and with the central portion of the plantar fascia. (3) The internal lateral
Posteriorly it
portion covers the Abductor hallucis muscle and is quite thin.
is attached to the internal annular ligamenl and continues around the side of the
foot with the dorsal fascia, and e\l< rnally with the middle portion of the plantar
fascia.

ANATOMY

224

IX A NUTSHELL.

REVIEW QUESTIONS.
1.

2.
3.

4.
.">.

(').

How many
How many
Name

muscles
of

in

them

the Gluteal region?

are attached to the great trochanter?

the muscles in the Gluteal region.

What nerves supplies the Gluteus maximus?

What nerve supplies the Gluteus minimus and medius?
What other muscle does this nerve supply?
Quadratus femoris comes from which ones?

7.

Nerve

8.

What other muscle does

9.

10.

11.
12.

13.

to the

it supply?
Nerve to Obturator interims comes from which ones?
What other muscle does it supply?

What ligaments make the greater and lesser Sacro-sciatic foramina?

What muscle goes through the Greater?
What goes through above the Pyriformis muscle?

PLATE LXXXV1II.
DORSAL ASTRAGALO- SCAPHOID LIGAMENT
DORSAL AND

INT.

LATERAL SCAPH0-CUNEIF0RM LIGAMENTS

DORSAL INTERCUNEIFORM LIGAMENTS

DORSAL AND

INT.

LATERAL TARSO-

METATARSAL
DORSAL AND

INT.

LIGAMENT

LATERAL METATARSO-

PHALANGEAL

DORSAL AND
LATERAL

LIGAMENTS

INTERNAL

INTER

PHALANGEAL

OS CALCIS

LIGAMENTS
TIBIO-ASTRAGALOID

INF.CALCANEO-

LIGAMENT

scaphoid ligament

Ligaments of Ankle
1

1.

Wha1

]>:i>ses

Internal View.

through below the Pyriformis muscle?

passes through the lesser Sacro-sciatic foramen?

15.

What muscle

16.

The Obturator interims is supplied from what plexus?

The 5th lumbal- nerve belongs to what plexus?
The Obturator externus is supplied from what plexus?

17.

18.
19.

20.
21.
22.
_':;.

24.
_'.">.

26.
27.

How
How
How
How

many muscles are attached to the Ischium?

many muscles are attached to the Ilium?
many muscles are attached to the Os Pubis?
many bones in the pelvis?
Name them.
Name the divisions of the Innominate.
What bones form

the acetabulum?

Name the ligaments of the hip-joint.

How many muscles are attached to the femur?

ANATOMY
28.
29.
30.

IN A NUTSHELL.

225

What nerve supplies the muscles in the anterior femoral region?

What nerve supples the muscles in the internal femoral region?
What nerve supplies the muscles in the posterior femoral region?
The anterior

crural and obturator nerves come from what plexus?

muscles on the posterior part of femur and from knee down are
supplied by what nerve and its branches?

31.

32. All the

33.

34.
35.
36.
37.
38.

39.
40.

How
How
How
How
How

many muscles are there from the knee to the

many on the anterior tibio-fibular region?
many in the outer fibular region?
many in the posterior region?
many layers in the posterior region?

What
Name
Name

ankle?

separates these two layers?

the seven muscles.
the deep layer.

41.

Give nerve supply.

42.

Name

those in superficial layer.

Give nerve supply.

Which muscles are attached to the tibia and fibula?
45. What long bone has the insertion of only one muscle?
46. What is that muscle?
43.
44.

47.
48.

Name
Name

the outer hamstring.

the inner hamstring.

49.

Bound

50.

Who

Scarpa's triangle.

was Scarpa?

Italian Anatomist.
51.

Give the

52.

What

53.

How

1747-1832.

He was

floor of Scarpa's triangle

physician to Napoleon.

from without inward.

structure passes through the center of this triangle?

long

is

the

common

femoral artery?

what branch?
Passes through what canal?
Then through what space?
Then gives off what branches?
Where does this division take place?

54. It gives off

55.
56.
57.

58.

59. Anterior tibial passes to the front of the leg

between the two heads of

what muscle?
60. Anterior tibial continues
61.
(i2.

The
The

below the ankle as what artery?

posterior tibial artery gives off what large branch?

posterior artery divides into what as

it

passes

into

the plantar

surface of the foot?

Describe the Anterior annular Ligament.

Describe the Internal annular ligament.
65. Describe the External annular Ligament.
63.

64.

(if).

Describe the Plantar fascia.

()7.

Name

the muscles the Great

Sciatic supplies on posterior part of the

Leg.

68.

It

divides into

what branches?

PLATE L XX XIX.

TALI

PES""

CAVUS-OR-ARC^U

TAL

P E S

E~QU INO-VALG.U'S*

Forms of

Cub

220

Foot.

TUS

ANATOMY

70.

The external
The anterior

71.

What

69.

IX A NUTSHELL.

popliteal nerve divides into

what

tibial supplies

227

what branches?

muscle-'.'

75.

else dues it supply besides these five muscle-?

Musculo-cutaneous nerve supplies how many muse
Name them.
'What else does it supply besides these muscle-'.'
What nerve supplies the integument on external border of the foot?

76.

From what

77.

How

78.

80.

The
The
The

81.

How many

82.

Xame
Xame

72.

73.
74.

79.

83.

is

plexu.-?

the short saphenous formed?

how many muscles?

how many?
into how many branches?

internal popliteal nerve supplies

posterior tibial supplies

posterior tibial divides

muscles does the internal plantar supply?

those

it

supplies in the 1st,

2nd and 3rd

layers.

those supplied by the external plantar.

Give the cutaneous nerve supply of the foot.

arises just below the insertion of the Gluteus maximus?
86. The small sciatic comes from what nerve-?
87. The pudic comes from what nerves?
84.

85.

What muscle

88.

The great sciatic comes from what nerves?

The superior gluteal comes from what nerves?
The inferior gluteal comes from what nerves?

89.
90.

92.

What
What

93.

Give the relations of the

94.

(Jive the relations of the superficial femoral artery.

95.

Give the relations of the profunda artery.

What are the divisions of the abdominal aorta?

91.

96.
97.
98.

other nerve comes from the same?

other one comes from the same one as the superior gluteal?

The common
The internal

100.

Xame
Xame

101.

The external

102.

What

99.

common

femoral artery.

iliac

divides into what branches?

iliac

divides into what?

the branches of the anterior trunk.

the branches of the posterior trunk.

continues as what?

iliac

structures

]>a>-

out of the Greater and into the Lesser sacro-

foramen?
103. What passes through the obturator foramen?
sciatic

104.

What

is

105.

Xame

the ligaments of the knee-joint.

loti.

What

structures pass under Poupart's ligament?

inserted into the digital fossa?

"Who was Poupart?

Ih was a Frenchman.

107.

108.

What

Who

i'.i.

Lived 1661-1709.

structures pass through Hunter's canal?

was Hunter?

Wa- British, 172s-17'.i::.

110. Hound Hunter's canal.
111. Hound the popliteal space.

ANATOMY

228
112.

WhyJ

113. Give
114.

115.
116.

called popliteal?

contents.

Name the Ligaments of the ankle.

What forms the crucial anastomosis?
What muscles form the tendo Achillis?

118.

Why is the
How many

Hi).

Describe the fascia lata.

117.

IN A NUTSHELL.

Plantaris so called?

bones

in

the foot?

PLATE

XC.

LEFT

PHRENIC

HEPATIC
GASTRIC

ARTERY

-SPLENIC ARTERY
LEFT SUPRARENAL

RENAL ARTERY,

RENAL VEIN

SUPERIOR

MESENTERY,

'

SPERMATIC VEIN

SPERMATIC

ARTERY

RIGHT LUMBAR ARTERY

INFERIOR

EXTERNAL

MESENTERY ARTERY

ILIAC^
'

^INTERNAL

ILIAC

Showing the Great Vessels Below the Diaphragm.

L20.

Describe the deep fascia of the

l_'l.

Describe the

122.

What muscles compose the Quadriceps extensor cruris?

The tendon of what long muscle passes directly across the

J.'!.

ilio-tibia)

leg.

band.

foot?
L24.

Describe the saphenous opening.

125.

Why

120.

Describe the external abdominal ring.

called

saphenous?

sole of

the

ANATOMY
127. Describe

IN A NUTSHELL.

229

Poupart's ligament,

128. Describe Gimbernat's ligament.

PLATE

X(T.

SUPRARENAL CAPSULE

LUMBAR GLANDS

COMMON

ILIAC

ARTERY

SACRAL GLANDS.

t!

EXTERNAL

ILIAC

INTERNAL ILIAC

GLANDS.

GLANDS

,DEEP INGUINAL GLANDS

V
LYMPHATICS

Showing the Abdominal Aorta and

its

OF

PENIS

Terminal Branches.

129. Describe Petit 's triangle.

130. Describe the trianglar
131.

What

ligament of the abdomen.

muscles are attached to the intermuscular
septa of fascia' lata?
'

WAToMY

230
:'.'_'.

IX A

NUTSHELL.

Describe interna] abdominal ring.

L36.

What does the word hernia mean?

What muscles make the external rotators of hip?
What muscles make the internal rotators of hip?
Show how the external popliteal nerve gets to the

137.

The length

133.

134.
135.

of the

femur

is

138.

Describe the linca asju ra

139.

At what angle dots

li).

141.

tin

front of the leg.

what part of the agth of the body?

and what muscles are attached to it.
[<

neck join with shaft of femur?

Give function and location of patella.

Describe the knee-joint.
passes through the Obturator forami n?

l'_\

What

13.

Why

II.

Give dimensions of pelvic cavity.

lo.

Hi.

so called?

)escribe the lumbal' fascia.

The

sacral plexus continu.es as what'.'

147. Great sciatic divides into

what nerves?

IV .Name four kinds of hernia.

149.
50.

151.

152.
153.
154.
1.").").

156.

Name

Why

the different kind of joints

does the

arm admit

found in the body.

motion than the leu'.'

of greatf r

What is the sustentaculum tali?

What is the receptaculum chyli?
Where are the anterior and posterior circumflex arteries?
Where are the internal and externa! circumflex arteries?
What is the Biceps cubiti?
What muscle is attached to all tarsal bones but one?

157.

-Name the muscles attached to each tarsal bone.

158.

Give articulation of each tarsal bone.

159.

Name

the spinous processes of the ilium.

160.

What

is

ltd.

Give meaning of trochanter.

attached to each?

162. (live blood supply, ossification, articulation

cle,lii:i.

Same

io the os

innominatum.

for femur.

164. Sin ne for tibia.

171.

Same
Same
Same
Same
Same
Same
Same

172.

Give branches of femoral artery.

165.
166.
167.
L68.
169.

170.

for

fibula.

for tarsus.
for

metatarsus.

for

phalanges.

tor patella.
for

sacrum.

for coccyx.

branches of popliteal artery.

Give branches of anterior tibial artery.
175. Give branches of posterior tibial.
1

7:;.

rive

17-1.

176.

Give branches of dorsalis pedis.

and attachment

of

mus-

ANATOMY

231

IN A NUTSHELL.

177. Give branches of peroneal artery.

178. Give plantar arch.
179. This arch gives off

what branches?

PLATE

XCII.
STERNO-MASTUIU.

INTERCLAVICULAR NOTCH.

COSTAL

APONEUROSES

OF

ABDOMINAL

CARTILAGE

MUSCLES.

Anterior View of Sternum.

L80.

181.

Which
Which

is

the larger

is

the larger

external or internal plantar artery?

the external or internal plantar nerve?

182. Give relation of popliteal artery.

ANATOMY

232

IN A NUTSHELL.

183. Give relation of anterior tibial artery.

184. Give relation of posterior tibial artery.
185.

Give relation of peroneal artery.

186.

Give relations of dorsalis pedis artery.

LESSON
The Thorax.

LXIII.
(Plate

XC1V.)

formed by thirty-seven bones, namely, the twenty-four ribs

and the sternum. The thorax is a conical cavity,
broad below, narrow above, flattened from before backward, and longest posteriorly.
Its posterior boundary is formed by the bodies of the dorsal vertebrae and the posterior portion of the ribs, thus making it concave vertiThe lateral boundaries are convex,
cally with a high ridges on either side.
The anterior boundary,
being formed by the ribs and Intercostal muscles.
which slopes down and forward, is formed by the sternum and the costal car-

The thorax

is

the twelve dorsal vertebrae,

tilages.

The upper opening

broadest transversely and

is formed by
and the upper margin
The upper border of the manubrium is on a
of the manubrium anteriorly.
In the female the sternum is shorter
level with the second dorsal vertebra.
than in the male, the ribs more movable, and the thorax is smaller. The upper
margin of the manubrium is on a lower level than in the male. There are forty

the

first

of the thorax

is

dorsal vertebra posteriorly, first ribs laterally,

structures

passing

through the superior opening of the thorax.

three pairs of muscles that pass through this upper opening in

Sterno-thyroid, Sterno-hyoid and Longus

The

arteries that pass

innominate,
internal

(2) left

colli

There are
the thorax.

muscles, making six muscles.

through the superior opening of the thorax are the

common

mammary and

(6)

carotid

and

(7)

and

(3) left

(1)

subclavian, (4) and (5) the two

the two superior intercostal.

There are

and (2) the two Pneumogastric, (3) and (4) the two phrenic, the six cardiac and the two sympathetic
nerves, the anterior branches of the two first dorsal nerves, and the recurrent
laryngeal nerve of the left side make fifteen.
The veins that pass through this
superior opening are the right and left innominate and the inferior thyroid
veins, making four veins.
There are eight unclassified structures that pass
through this opening in the thorax: Remains of thymus gland, trachea, oesophagus, thoracic duct, apex of each lung, and pleurae.
Then the six muscles,
fifteen nerves that

pass through this opening:

(1)

fifteen nerves, seven arteries, four veins, and eight unclassified structures make
the forty structures which pass through the superior opening of the thorax.

The Lower opening of the thorax is widest transversely and slopes downward and backward. It is formed by the last dorsal vertebra posteriorly, and
the seventh to the eleventh costal cartilages laterally, and the ensiform cartilage anteriorly.
The Diaphragm separates the thoracic cavity from the
abdominal cavity.

ANATOMY

IN A XUTSHELL.

Diaphragm.

The word diaphragm

is

(Plate

233

LXXII.)

Greek word meaning

a partition wall.

It is

musculo-fibrous septum, situated between the upper one-third and the lower
two-thirds of the trunk.

cavity/

It is

It

separates the thoracic cavity from the abdominal

the floor of the former and the roof of the latter,

PLATE

its

general shape

XCTII.

CLAVICULAR NOTCH

STERNO

HYOID,

FIRST

TRIANGULARIS

COSTAL

CARTILAGE

STERNO THYRO

STERNI

ENSIFORM APPENDIX

Posterior View of Sternum.

is

somewhat

of

it is

like that of

The upper surface

an umbrella or an irregular dome.
left pleura, he! ween the two pleura' it is cover-

covered with the right and

ed with the pericardium.

ensiform cartilage.

The

Its

circumference

highest part of

all

is

elliptical in

the diaphragm

form, highesl at the

is

od the

righl

side

ANATOMY
immediately above the
lowest part of

it

The under surface

Ik Ui<
musch s.
(I

is
1

This

liver.

cov< red with

has

its

is

NUTSHELL.

a litth

crus which reaches

the righl

is

IX

p( ritone

origin in

frorrt

um.
from

higher than the

in the fourth
1

th<

is
<

left

The

One of the so-called double

asiform cartilage, from the

from the under surfaces of the cartilages and bony portion of the six or

sides,

seven lower ribs interdigitating

the Transversalis muscle, also from the

with

two aponeurotic arches called the ligamentum arcuatum externum

The

side.

lumbar vertebra.

last

one

is

the Quadratus

the covering of the Psoas magnus, the

lumborum.

or legs, the right one

is

Behind

the longer

first

one

is

el

internum.

the covering of

is connected to the spine by two crura

xtending from the anterior surface of the

ii

and intervertebral substance of the thrc e or four upp< r lumbar vertebrae;

From this origin it
left one from the anterior surfaces of th< two upper ones.
to the central or cordiform tendon which consists of three leaflets, the
righl one is the largest, the left on< the smallest, and the middle one is interim diate in size. On each sid( of tin ensiform attachment tin re is a weak place
which may be brok< n; th< n we nay have what is called a phrenic or diaphragmatic hernia. Some of the contents of the abdomen protrude into the chest,
or ptts in the mediastinum may descend through it into the abdominal cavity.
The diaphragm has three large and several small natural foramina. The one
mosl posterior is really not in the diaphragm bui between the two crura which
bodi<

tin

by a tendinous band. This is called the aortic opening,

and transmits the aorta, vena azygos major, the thoracic duct, and sometimes
the left sympathetic nerve; when this nerve does not pass through this openThe vena azygos major occasionally goes
ing it goes through the left crus.
through the right crus. The second large opening is in front, and a little to the
left of the aortic opening; it transmits the oesophagus and the pneumogastric
The right
oerves.
Th< left pneumogastric passes in front of the oesophagus.
one, which passes b; hind it, goes into the solar plexus, which is situated behind
the stomach.
The third large opening is farther in front than the others and
Ii
is son u what quadrilateral in form and is called
lies in the c< ntral tendon.
the foramen quadratum; the inf< rior v< na cava passes through it.
The smaller openings are through the crura. Those in the right crus transmit
the great* r and less* r splanchnics and the sympathetic nerves of the right side,
occasionally the vena azygos major.
The left cms transmit the vena azygos
minor, the greater or lesser splanchnic nerves of the left side and the sympathetic nerve of the left side when it does not pass through the aortic opening.
The
blood supply of the diaphragm is derived from the two phrenic, the internal
mammary, and the lower intercostal arteries. The phrenic arteries are two
small arteries which may arise separately from the aorta above the coeliac axis.
hien .me is derived from the aorta and the other from the renal arteries. They
very rarely arise as two separate vessels from the aorta.
The nerve supply is
the phrenic which comes from the third, fourth, and fifth cervical nerves.
The
phrenic plexus also helps to supply it.
This plexus is made by the phrenic
nerve and branches from the semilunar ganglion of the solar plexus.
The
arc joined posteriorly

<

laity call the

mean

diaphragm the

midriff,

the middle of the belly.

The

which comes from the Saxon words which

solar plexus or abdominal brain and the

ANATOMY
phrenic

plexus

NUTSHELL

235

situated near

the diaphragm.
The former behind the
formed by branches from it. These plexus or plexuses
the great sympathetic system, which govt rns tl
ritary actions.

stomach and the

belong to

are

IV A

latter

PLATE XClV.

FLOA-

Boxes of

he Thorax.

blow on the head may knock a man senseless bul he Mill lives.
still ad. being governed by the sympathetic system,
but
receive^ a severe blow upon the diaphragm it may
produce instant death.
ere

heart ami lungs

pugilist has learned this

much about anatomy and

if

His
if

he

The

he were not trained to the

ANATOMY

236

IN A NUTSHELL.

than are by this so-called solar plexus blow. The

diaphragm is the chief muscle of respiration. The lower ribs may fall down
thus drawing the diaphragm out of its natural position, in this way somewhat
I have known of one
obstructing the passing of the blood through the aorta.
ribs causing an
the
lower
pulled
down
by
case in which the diaphragm was

hour more would be

killed

As soon as they were replaced the heart acted in

Tight lacing, or any cause whatsoever which will impair
a natural manner.
Man is the only
the natural action of the diaphragm will cause much pain.
than the
diaphragm
greater
of
the
is
animal in which the transverse diameter
week
of
fetal life
about
the
ninth
It begins to be developed
antero-posterior.

irregular action of the heart.

and grows from the circumference to the central tendon. All mammals or
Man and horse are examples of land
milk-giving animals have a diaphragm.
animals, the whale and the sea cow are examples of water animals which have
diaphragms. Birds possess a rudimentary form, which is best shown in the
abteryx.

LESSON LXIV.
The muscles which help the Diaphragm in
and (3) The

Intercostals, (2) Levatores costarum,

it

in forced inspiration are (1) Trapezius,

major

(?)

(4)

Serratus posticus superior,

Rhomboideus major,

(7)

(2)
(5)

Rhomboideus minor,

tranquil inspiration are

Scaleni.

(1)

Those which help

Pectoralis minor, (3) Pectoralis

Serratus posticus inferior,

(8)

cleido-mastoid, (10) Ilio-costalis, (11) Quadratus

Serratus magnus,

(9)

(6)

Sterno-

lumborum.

caused by the elasticity of the lungs and that of the

chest walls.
The muscles of forced expiration are (1) External oblique, (2) Internal oblique, (3) Transversalis, (4) Rectus abdominis, (5) Internal interTranquil expiration

is

costals, (6) Triangularis sterni.

The sternum (Plates XCTI-XCIII.) is about six inches long and is situated
median line of the thorax in front. It is flat anteriorly and concave posteriorly.
It is broadest above and pointed below, and constricted at the junction of the manubrium with the gladiolus.
The manubrium or first piece of the
sternum is narrow below, but broad above. The anterior surface of the manubrium is concave vertically but convex transversely. The Pectoralis major

in the

and Sterno-cleido-mastoid are attached to the lateral aspect of this surface.

of this part forms the interclavicular notch, on each side of
which is an oval facet for the articulation of the clavicle. The lateral border
articulates above with the cartilage of the first rib and below with the upper

The upper border

The low er border articulates with

The posterior surface is concave and gives attachment to the
Sterno-hyoid and Sterno-thyroid muscles. The gladiolus or second portion is
longer, narrower and thinner than the manubrium.
It is broadest below.
The anterior surface gives attachment to the Pectoralis major. Three transpoit ion of the cartilage of the

second

rib.

the gladiolus.

verse lines, indicating the original divisions of the gladiolus into four portions,
pass from the third, fourth,
lines are not so well

and fifth articular facets across the bone. These

marked on the posterior surface. This surface is concave

ANATOMY IN A NUTSHELL.
and gives attachment

237

The

to the Triangularis sterni muscle.

lateral border

of the gladiolus articulates with the cartilages of the second, third, fourth, fifth,
sixth,

and seventh

rib;

however the second and seventh

cartilages articulate

partly with the bones above and below.

This portion of the bone articulates

above and the ensiform or xiphoid appendix below.

manubrium
The ensiform appendix, cartilaginous hi youth but is partly ossified above
The chondro-xiphoid ligament is attached to its anterior surface,
in the adult.
while the Diaphragm and the Triangularis sterni are attached to its posterior
with the

surface.

of the

It articulates above with the gladiolus.

Laterally the aponeurosis
abdominal muscles are attached.
The superior angle of the lateral

border has a demi-facet for the cartilage of the seventh

below or

bifid

may

present a foramen, and

it

rib.

Its

apex may be

gives attachment to the linea

alba.

Attachment of Muscles:
Pectoralis

major,

Nine

Sterno-cleido-mastoid,

pairs

and one

Sterno-hyoid,

single

muscle.

Sterno-thyroid,

The
Tri-

PLATE XCV.

LATERAL MASS
COSTOTRANSVERSE
FORAMEN

SURFACE

FORAMEN FOR
VERTEBRAL ARTERY

The Atlas
annularis sterni, aponeurosis of the External oblique, Internal oblique, Transversalis,

Rectus muscles, and Diaphragm.

Ossification:

sixth month.)

From

One

six

centers.

One

for the

for each of the four pieces of

manubrium (fifth or
The ones
the gladiolus.

of the gladiolus appear at the sixth or SEVENTH

month. The one for the third piece appears at the ninth month, and the
one for the fourth piece appears during the first year after birth. The
one for the ensiform appendix appears between the SECOND and eighteenth
years. The manubrium and the lower three pieces of the gladiolus may have
two centers each, thus making ten centers of ossification for the sternum.
The pieces of the gladiolus join at about the age of puberty, while the gladiolus rarely joins the manubrium and the ensiform remains cartilaginous even
in advance life.
Articulation. With the clavicles and seven costal cartilages on each

for the

first

two pieces

side.

ANATOMY

238

IN A NUTSHELL.

Blood Supply. Internal mammary arteries through its sternal and perforatum branches, also twigs from the aortic intercostal arteries.
Heart.

The covering
lu ait

it

of the heart

is

called the Pericardium.

encloses the origin of the great vessels.

It is

Besides covering the

situated behind the sternum

from the third to the seventh costal cartilages (inclusive) and between the two
It forms a closed sac. the base of which is attached to the central

pleurae.

tendon and adjoining muscular substance of the Diaphragm, and it extends

more to the ft than to the right. The apex of the pericardium is directed up1<

ward and surrounds the great vessels for about two inches. Behind the perIn
icardium are (1) the two bronchi. (2) the esophagus, (3) descending aorta.
front are
the margin of the lungs, (2) remains of the thymus gland (above),
On the sides it is covered by the
(3) areolar tissue (below). (4) the sternum.
pleura and the phrenic nerve.
The pericardium is composed of two layers, first a fibrous, second a serous.
It sends prolongations
Tin: fibrous OB external layer is strong and dense.
around the gr< at vessels which join their external coats. It also sends a diverticulum upward on each side of the ascending aorta. The one on the left side of
the ascending aorta passes between the left pulmonary artery and the arch of
The one
the aorta to the ductus arteriosus where it ends in a blind extremity.
on the light side of the ascending aorta passes between this vessel and the superior vena cava, and it also ends in a blind extremity.
This fibrous layer is attached below to the central tendon and muscular substance of the Diaphragm.
Two ligaments, the superior sterno-pericardial and the inferior sterno-pericardial, connect it with the sternum anteriorly.
Tin. serous ok internal layer consists of two portions, first a visceral,
and second a paiital. The visceral layer covers the heart and the great v< ssels
for about an inch and a half and then is reflected upon the inner surface of the
The pulmonary artery and the
fibrous layer forming the parietal portion.
aorta are enclosed in a single tube of pericardium.
Behind this tube there is a
f

passagi

called the transv< rse

p<

ricardial sinus.

The pericardium only

covers the vena cava and pulmonary veins, so that on each

tures

iIk re

.-iin s,

lies

i-

the one

a cul-de-sac.
(.n

between the

The one on the

left

is

intercostal vein
v< in

of these struc-

known

as the oblique

side

is

The

vestigial fold of Marshall

pulmonary artery and the subadjacent pulmonary

thus enclosing the remains of the

vena cava

left

the righi as the straight sinus.

partially

si le

lefl

This

left

vein,

superior

may

fibrous cord which

and downward

superior vena cava.

to the

be traced upward te> the left superior

coronary sinus and known as the oblique

of Marshall.

Blood Supply.

The

art<

thoracic aorta and the internal

ri<

to the

mammary

pericardium come from the descending

with its musculo-phrenic branch.

Nerve Supply. Xerxes to the pericardium are from the tenth, phrenic,
and sympath) tic. The' nerve supply to the pericardium, the heart, the pleurae,
and the lungs, is derived from these three sources. As said above' they all go
tei

the

(
|

ricardium.

The- tenth, the

sympathetic and

pe>ssibly the phrenic pass

ANATOMY
to the heart.

IN A NUTSHELL.

The tenth and sympathetic go

239

to the lungs substance, while the

phrenic and sympatheic pass to the pleura.

LESSON LXV.
The heart (Plate CXXVIII.) is situated in the middle mediastinum between the spinous processes of the fourth dorsal and eighth dorsal vertebra
Its apex is directed downward and forward to the left, and lies
posteriorly.
against the fifth intercostal space three -quarters of an inch to the inn<

sid

of

PLATE XCVI.
ROUGH SURFACE
FOR
CHECK LJGAMEW.
SUP. ARTIC.

ODONTOID
PROC.
ARTIC. GROOVE FOR

TRANSVERSE

LIG.

PROC.

LAMI

SPINOUS PROC

Posterior View of Axis.

the

left

nipple and an inch and a half below the same.

The heart

lies

obliquely

behind the lower tw< -thirds of the sternum, extending about three inches to
the left of the median line and one and a half inches to the right.
Its anterior

and a part of the left ventricle.

convex and looks upward and forward. Its posterior surface consists
mostly of the left ventricle and rests upon the Diaphragm. This surface is
flattened.
The right border of the heart is long and thin, while the left is short
and thick.
The average weight of the heart is about eleven ounces. In the male
weighs from ten to twelve ounces, while in the female its weight is from eight
to ten.
The adult heart is five inches long by three and a half wide, by two
and a half thick.
It is divided into four chambers, namely, the right and left
The right side of the heart, which is
auricles and the right and left ventricles.
more superficial and is called the venous heart, is separated from the left side
of the heart, which is deeper and is called the arterial heart, by a longitudinal
septum, and each of these lateral halves are divi led bya transverse septum,thus
making the auricles and ventricles.
These four divisions of the heart are indicated by grooves on its surface.
The apex of the heart is formed entirely by the left ventricle. These grooves
surface consists mostly of the light ventricle
It is

it

on the surface of the heart contain the coronary

ics, nerves and fat.

arteries, cardiac veins, lymphat-

ANATOMY

240

auricle but

walls arc thinner.

its

or atrium which

is

large

and

lies

about two ounces.

It is larger than the

two main parts, first a sinus
between the superior vena cava above and the

right auricle has a capacity of

The
left

IN A NUTSHELL.

It

consists of

vena cava below and has postero-internally to it the left auricle. The
second pari is the auricular appendix, which is small and conical projecting forward and to the left over the root of the aorta. The inner surface of the auricle
inferior

is

smooth except

At

(Plate

pectinati.

this auricular

in

wall of the sinus.

this point

it

appendix and the adjacent part of the right

is thrown into parallel ridges called musculi

CXXIX.)

The right auricle has the following points for consideration:

1. The opening of the superior vena cava, which is at the upper and back
The blood from the
part of the auricle and is directed downward and forward.
superior vena cava flows toward the auriculo-ventricular opening.
2. The opening of the inferior vena cava is larger than the superior and is
The blood from the
at the lower part of the auricle near the auricular septum.
inferior vena cava is directed upward and inward towards the auricular septum.
3. There is small projection between the superior vena cava and the invena cava called the tubercle of Lower. Its function is to direct the blood
from the superior vena cava towards the auriculo-ventricular opening.
4. There is an opening between the inferior vena cava and the auriculoIt is guarded by a valve called
ventricular opening called the coronary sinus.
coronary or Thebesii. It receives blood from the substance of the heart and it
ferior

is

constricted where
5.

in

it

joins the great coronary vein.

The auriculo-ventricular opening

diameter and

rounded by

lies

is

somewhat oval and about an inch

between the right auricle and right

a fibrous ring

covered by the lining

ventricle.

membrane and

is

It is sur-

guarded by

the Tricuspid valve.

6.

The foramina

of Thebesii are small openings of the venae cordis

minima?

which return blood from the substance of the heart.

7. A semilunar fold of the endocardium which lies between the auriculoventricular opening and the anterior margin of the opening of the inferior vena
cava

is

called the Eustachian valve.

In the fetus this valve

is

large

and

directs

the blood from the inferior vena cava through the foramen ovale into the
auricle.

It

may

be present or

it

may

left

be absent in the adult.

8. The coronary valve also called Thebesii is a semicircular fold of endocardium which guards the opening of the coronary sinus. This valve may be
double and it prevents regurgitation into it (hiring systole of the auricle.
9. The fossa ovalis is a remains of fetal life.
It is an oval depression lying
on the lower part of the auricular septum marking the position of the foramen
There may be a small foramen in this fossa throughout life.
ovale.
10. The annulus ovalis is a prominent margin of the foramen ovale and is
best marked above and at the sides, while below it is wanting.
11. The musculi pectinati are small muscular folds which are found in the
auricular appendix and the adjacent pari of the sinus venosum.
They end in
1

a vertical ridge posteriorly called

The

right venrtiele extends

the crista terminalis of His.

from the right auricle nearly to the apex of the

ANATOMY
Its walls are

heart.

IN A NUTSHELL.

241

one-third as thick as those of the

left

ventricle,

and

it

Its posterior surface rests upon the Diaphragm

holds about three ounces.
forming a small part of the back of the heart, while its anterior surface forms

most of the front of the heart.

1. The conus arteriosus or infundibulum is a conical pouch at the upper
and left angle of the ventricle, from which the pulmonary artery arises.

The auriculo-ventrieular opening has been described with the auricle.

The opening of the pulmonary artery which lies at the summit of the
infundibulum is circular. It is guarded by the pulmonary semilunar valves.
The largest of these
4. The tricuspid valve consists of three portions.
segments, called the left or infundibular flap, lies at the left and front of the
The right flap is to the front and right, while the third, called the
opening.
The center of each of these flaps is thick,
posterior or septal flap, is posteriorly.
2.

3.

the lateral margins are thin.

5.

The chorda?

tendinae are fibrous cords which are attached to the mar-

PLATE XCVII.
A,
U^t?

ARTIC.WVTH
ANT. ARCH 0FA7LA5.

BODY.

Anterior View of Axis.

and ventricular surfaces of each of these flaps. Three or four are attached
the liases of each flap and are continuous with the fibrous ring which surrounds
the auriculo-ventrieular opening.
Four to six pass to the central part of these
flaps, and the finest and most numerous go to the free margins of these flaps.
6. Column;? earneae project from the walls of the ventricle except near the
pulmonary opening. They are divided into three sets, the first set are attached throughout their length thus forming mere ridges. The second sel called

gins
t<>

forming arches, while the third

<;tlled musculi papillares, are attached to one end only, thus forming pillars.
3e1
These musculi papillares are two in number, an anterior and a posterior, and
Those from
they give attachment by their free ends to the chor.hr tendinae.
trabecular, are attached to their ends only, thus
.

the anterior one pass to the right and

left
7.

ber.

flaps,

and septal flaps. A few

and septal flaps from the septum.

one pass
the

left

to the right

The semilunar

Two

valves (Plate

anterior, (a righl

and

of the

chordae tendinae pass to

(pulmonary) are three in numand one posterior. They are formed by

XCXXX.)

left),

while those from the posterior

ANATOMY

242

IN A NUTSHELL.

membrane, covered by endocardium below and by the inner

The convex margin of each valve is attached to the inner

folds of fibrous

arterial coat above.

coal of the artery

and

free

is

where

it

joins the ventricle, while its double crescentic border

directed upward.

is

The corpus

arantii are small nodules situated

Tendinous

fibers radiate from the corpus

margin of the valve, passing throughout the entire
small portion on each side of the corpus arantii called the

at the center of each free margin.

arantii to the attached

valve excepting a
At this point the valve consists of lining

lunula.

membrane

only.

When

the

valve closes the surfaces of the lunula come in contact and the copora arantii
Sinus of valsalva is a pouch behind each valve.
fill the interval at the center.

The moderator band

8.

is

a muscular

beam running

across the left ventricle

obliquely.

LESSON LXVI
The

auricle like the right auricle has

left

an auricular appendix.

The atrium

right one.

This auricle
lies

is

two

parts, a sinus or atrium

and

smaller but has thicker walls than the

behind the aorta and the pulmonary artery and

separated from the right auricle by the auricular septum internally.

The

is

left

is longer and narrower, and more curved than the right

and it projects forward to the right over the root of the pulmonary artery.
The left auricle presents the following points:
The openings of the four pulmonary veins, two on each side. These
There may be five pulmonary veins
veins have no valves and carry pure blood.

auricular appendix

one,

or only three.

The auriculo-ventricular opening

2.

side.

is

smaller than the one on the right

surrounded by a fibrous ring covered by endocardium and guarded

It is

by the mitral valve.

The musculi

3.

and are confined

and smaller than those on the right

side

On

4.

there

pectinati are fewer

to the auricular appendix.

is

the auricular septum, just above the fossa ovalis of the right auricle,
an impression which is bounded below by a crescentic ridge whose con-

cavity looks upward.

The

left

as thick.

It

is longer than the right and its walls are about three times
forms most of the posterior surface of the heart, all the apex, and

ventricle

small part of the

left

side of the anterior surface.

The left ventricle presents the following points:

The auriculo-ventricular opening which is below and
1.
aortic opening
2.
It

i>

The

described with the

aortic opening

situated
3.

is

The

in

front

and

is

circular

left

and

to the left of the

auricle.
is

guarded by the semilunar valves.

to the right of the auriculo-ventricular

mitral or bicuspid valve

is

opening.

attached to the margin of the auriculo-

ventricular opening similar to the tricuspid valve on the right side of the heart,
luit

is

stronger and thicker than the tricuspid valve.

covered by
to

<

the right

Its segments or flaps are

ndocardium ami contain a few muscle fibers. The larger flap lies
and in front between the auriculo-ventricular opening and the

ANATOMY

EN A NUTSHELL.

243

The smaller flap lies to the left and behind. The smaller
flaps are usually found where the two larger flaps meet.
4. The chordae tendinae are thicker, stronger, and less numerous, but have
aortic opening.

a similar attachment as those on the right side

5. The semilunar valves (aortic) are three in number, a right posterior, a
left

posterior,

and an anterior one.

They

are larger, thicker,

and stronger

and attachment. Their

than those on
distinct
than
more
those
of
and
lunula
are
the pulmonary semicorpora arantii
valsalva
are
larger
than
of
those
on the right side.
Their
sinuses
lunar valves.
from
the
anterior
sinus
arises
the
coronary
artery
and
left coronary
The right
posterior
sinus.
artery arises from the left
6. The columns? carnea? are smaller and more numerous than those on the
the right side, but are similar in structure

PLATE
ANT.

XCVIII.
fORAUEN FOP
VERTEBRAL ARTERY.

TUBERCLE

TRANSVERSE
PEDICLE.

PROC.

SPINOUS
PROC.

The Fifth Cervical Vertebra.

manner. On the posterior wall and at
The musculi papillares are larger than those on
the apex they are interlaced.
the right side, one of which comes from the anterior wall, the other from the
posterior wall.
The chorda' tendinae arise from their free ends.
right side

7.

and are arranged

in a similar

Just under the aortic opening there

is

small cavity called the aortic

vestibule.
8.

losing

The ventricular septum

its

muscular

is

thick below but above

it

becomes thinner and

fibers consists only of fibrous tissue covered

by endothelium.

For position of valves of the heart in reference to the chest wall, see Plate

XVII.
The structures of the heart consists of muscular fiber- and fibrous rii gs
The muscular structure called myocardium Ls formed from small striated, and
quadrangular muscular cells which have nude joined end to end to form fibers
and tend to branch, anastomosing with other cells. Some say the heart Is a
voluntary muscle because it has striated fiber-, but l1 is governed by the symi

pathetic nerve thus

The

making

it

involuntary

fibrous rings are stronger on the

in
left

action.
side than on the right.

Thev

ANATOMY

244

IN A NUTSHELL.

surround the auriculo-ventricular openings and the arterial openings, giving

attachment: to the muscle fibers, valves, and great vessels.
The endocardium is a smooth, thin membrane which lines the heart and is

more opaque on the

than

left auricle

in

left

side

and

thickest in the auricles, being thicker in the

is

the right,

Blood Supply. The arteries are the right and left coronary. The right
coronary artery arises from the anterior sinus of valsalva and passes forward
between the pulmonary artery and the auricular appendix. From this point it
runs in the right auriculo-ventricular groove to the posterior interventricular
groove, and here

it

divides into a transverse branch which runs in the left auricu-

lo-ventricular groove and a descending branch which runs in the posterior

interventricular groove to the apex of the heart.

comes from

margin

this artery runs along the

gives infundibular branches to the right auricle

marginal branch which

of the right ventricle.

and

right ventricle

It also

and the pul-

monary artery. (Plate CXXVIII.)

The left coronary artery, which is larger than the right, arises from the left
posterior sinus of valsalva and passes forward between the pulmonary artery
and the left auricular appendix. At this point it divides into a transverse
branch, which runs outward in the left auriculo-ventricular groove and a descending branch which runs to the apex of the heart in the anterior interven-

The coronary

tricular groove.

may

there

arteries

may come from

be one or two small additional branches.

common

(Plate

The cardiac veins return the blood from the substance

trunk and

CXXVII.)

of the heart into the

auricle.

righl

The

1.

anterior cardiac vein, also called great cardiac vein, ascends from

the apex of the heart to the base of the ventricle in the anterior interventricular groove.

opens

at

valves,

It

turns to the

left

into the left auriculo-ventricular groove

the back of the heart into the great coronary sinus where
it

drains both ventricles (more the left than

it

and

has two

the right), and the left

auricle.
2. The middle cardiac vein ends in the great coronary sinus after running
from the apex of the heart to its base in the posterior interventricular groove.
It has one valve at its orifice and it drains the posterior part of both ventri-

cles.
:;.

The

left ventricle is drained by the left or poswhich empty into the great coronary sinus.
or anterior cardiac veins receive the blood from the anterior

posterior surface of the

terior cardiac veins

1.

The

right

surface of the right ventricle and open separately into the lower part of the

The

righl auricle.

of the heart,

is

largest

5.

The

right or

auricle

and

right

and end(').

in

The

vein which

one of these veins, which runs along the right border

called the vein of Galen.

small coronary sinus drains the back part of the right

ventricle

and

it

runs

in

the right auriculo-ventricular groove

the righl end of the gr< at coronary sinus.

or great coronary sinus is then a portion of the great cardiac

about an inch long and occupies the posterior part of the left auri-

left
is

culo-ventricular groove.

It

receives

the

veins just

mentioned and

also

an

ANATOMY

IX A NUTSHELL.

245

oblique vein from the back of the left auricle which is the remnant of the obliterThis great coronary sinus ends in
ated left vena cava called duct of Cuvier.

the right auricle between the inferior vena cava and the auriculo-ventricular
The opening of this sinus is guarded by a semilunar fold of the lining
opening.

membrane

of the heart called the coronary valve or Thebesii.

Venae Thebesii are minute veins which drain the cardiac muscular substance and open directly into the right auricle by the foramina of Thebesii.
7.

LESSON LXVII.
Nerve Supply. The

nerves to the heart are derived from the cardiac

pneumogastric
and sympathetic nerves. Its actions
the
formed
by
plexuses,
The
heart
are derived from three sources:
nerves
of
the
involuntary.
are

PLATE XCIX.
UPPER INTERVERTEBRAL NOTCH

SUP.ARTICPROC'S.

TRANSVERSE
PROC'S.

OEMIFACET FUR HEAD OF RIB.

LOWER INTERVERTEBRAL NOTCH.

A Dorsal
1.

From nerve

cells

Vertebra, With Long Spine.

buried

in its

own substance and known

as the intrinsic

ganglia.
2.

3.

From
From

The

the tenth pair (pneumogastric) of cranial nerves.

the sympathetic nervous system.

intrinsic ganglia

keep the heart beating, and the other two sets of

nerves control the rate and force of the beat.

Systole

is

contraction of the heart

and arteries

tor

propelling the blood

is called diastole.
and thus carrying on circulation. The expansion
lower in pitch
duration
and
The heart has two sounds. The first is longer in
ventriplace
take
which
during
sounds
than the second. It is made by those
blood
of
rushing
through
cular systole.
(1) Muscular contractions. (2) friction

of the hearl

ANATOMY

24')

the

s<

IN A NUTSHELL.

n.ilunar valves, (3) friction of the heart within the pericardium, (4) fric-

tion of heart against neighboring structures.

It is

of

importance to study the

sounds for any of these four factors may be modified by various

The second sound of the heart is made by those sounds which occur
dis< ases.
during the closure of the aortic semilunar valves and the pulmonary semilunar

norma]

hi art

valves.

The

position for hearing the

first

sound

is

at the apex, while the sec-

heard over the base of the heart.

The tricuspid and pulmonary valves are on a superficial plane to the aortic
and bicuspid valves, thus a circle of one inch in diameter includes a part of all
The tricuspid valve is situated behind the
the valves of the healthy heart.

ond sound

is

more

easily

median line of the sternum between the fourth costo-sternal articulations. The
sound of this valve is best heard at the base of the ensiform cartilage.
The aortic valve is situated behind the left edge of the sternum on a level with
the lower border of the third rib, and although this valve is on the left side of
the heart we listen to its sounds in the second right or aortic interspace
where they are conveyed. The pulmonary valve is situated behind the junction of the third costal cartilage with the sternum, and although it is situated on
the righl side of the heart its sounds are best heard in the second left or
pulmonary interspace where the sounds are conveyed.
The mitral valve is situated between the left edge of the sternum and the
third and fourth costal cartilages.
We listen at the apex for this sound.
Plate XVII.

The Thyroid Gland.

There are several organs
bodies.

They

are the

suprarenal capsules.
less

in

(Plates

CXXI-CXXII-CXXXII.)

the body that

are called ductless glands or

thymus gland, the thyroid gland, the

Some anatomists name

spleen,

and the

the additional organs as duct-

"lands; the tonsils, the epiphysis, the hypophysis, the coccygeal glands

and carotid glands. A gland is an organ which secrets and pours forth fluid from
one or more ducts, and since these bodies just named have no ducts it would
seem that they could not be called glands, however they have an internal seThe thyroid gland has a duct in the fetus which leads to the base of
cretion.
This gland is very vascular and is situated upon the larynx and
upper part of the trachea. Although closely associated with the trachea, yet
it takes no pari in respiration.
It is the seat of the disease known as bron-

the tongue.

The following are the main forms of

Exophthalmic (Grave's disease.) Where there

chocele or goiter.
1.

and often

pulsation,

goiter:
is

a great vascularity

accompanied by exophthalmus, palpitation, and rapid

pulse.
2.

Fibroid.

3.

Cystic.

Where there is an increase of the interstitial tissue.

Where there are one or more cysts formed from dilatation

and possibly coalescence of adjacent follicles.

4. Pulsating.
Where vascular changes predominate.
.").

Parenchymatous.

Where

the follicles are enlarged.

This gland consists of two lobes, which are pyriform in shape, and an
The dimensions of the lobes are two inches in length, three-quarters
isthmus.

ANATOMY
of an inch in thickness,

IX A NUTSHELL.

and an inch and

a quarter in breadth.

247
It

extends from

the middle of the thyroid cartilage to the sixth ring of the trachea, and the

isthmus crosses the trachea about the third ring. The isthmus may. in rare
cases, pass behind the trachea in front of the oesophagus. This gland weighs
from one to two ounces. It is larger in the female and is increased in size during menstruation.

Blood Supply.

The

superior thyroid arteries, which are branches of the

external carotid, supply the apex and inner and fore parts of the lateral lobes.

The

inferior thyroid arteries,

which come from the thyroid

PLATE

axis,

supply the

C.

A Lumbar Vertebra.
outer and posterior portion of the lateral lobes.

The thyroidea ima. which is

derived either from the innominate artery or from the arch of the anna, ascends

on the front

anastomose with the superior and inferior thyand helps to supply the isthmus. The veins arc the superior
thyroid which empties into the internal jugular, and the middle thyroid which
empties into the same, and the inferior thyroid which empties into the innomof the trachea to

roid arteries

inate of the corresponding side.

Nerve Supply.

From

the superior and middle cervical ganglion of the

branch from the tenth.
be distinguished from a cervical tumor by the fact thai it

sympathetic, and possibly

A
rises

goiter

ami

may

falls

on deglutition.

ANATOMY

248

IN A NUTSHELL.

The Spleen.
The dimensions
aboul five ounces.

of the spleen are

It

(Plate

CXLVI1.)

one by three by

ternal portion called the medullary portion.

a

five inches,

and it weighs
and an in-

consists of an external portion called cortex,

honey-combed arrangement and

This internal portion consists of

in these cells are the

MaJpighian corpuscles

The spleen manuand has no true set of capillaries, the blood

emptying into these spaces from which it is collected into the veins. There
may be numerous accessory spleens. The spleen has no excretory duct and
The Ancients thought the spleen to be the seat
therefore no proper secretion.
which arc about one-twenty-fifth of an inch in diameter.

factures white blood corpuscles

of various emotions.

The

It

is

situated in the

left

hypochondriac region.

relations of the spleen are as follows:

Front. Stomach and splenic flexor of colon.

Behind. The Diaphragm.
Outer Side. Diaphragm, ninth to eleventh ribs between the axillary line.
Inner Side. Stomach, pancreas, left kidney, and suprarenal capsule.
Blood Supply. The splenic artery, which is a branch of the cceliac
This artery
axis, divides before entering the spleen into about six branches.
The spleen is enis tortuous and large in porpotion to the body it supplies.
tirely covered by peritoneum beneath which there is a plexus of lymphatic
In

The lymphatics of the spleen are divided into a superficial and a deep
The veins of the spleen form one main vein called the splenic which empties

vessels.
set.

into the portal vein.

Nerve Supply.

The

and passes along the

which comes from the

splenic plexus

solar plexus

splenic artery.

LESSON LXVIII.
The Thymus Gland.
This gland
It

a fetal

is

is

(Plate

CXXXII.)

situated within the thorax behind the sternum near the neck.

structure and begins to disappear about the second year after birth.

The thymus gland

of the sheep is called throat, or neck, sweet bread to distinfrom the pancreas, or stomach sweet breath This gland reaches its
highest development about the second year and its weight it is six drachms.

guish

it

Internal

veins

Blood Supply.
empty into the

mammary,

superior and inferior thyroid.

The

innominate vein and thyroid veins.

Sympathetic and pneumogastric.

left

Nerve Supply.
Suprarenal Capsules.

(Adrenal Bodies.)

(Plate

CXLVII.)

on the upper extremity of each kidney.

They are richly supplied with vessels and nerves. Dimensions are two
inches by one-half by one-half.
Weight is one drachm. They are not invested by peritoneum.
Blood Supply. Suprarenal, phrenic, and renal arteries, which pierce the
organs chiefly on the anterior surface along a furrow called the hilum. The
veins empty on the rigb.1 side into the vena cava and occasionally by means of
These bodies are

solid viscera situated

ANATOMY

IN A NUTSHELL.

249

Those on the left side empty

organ pass into the renal glands.
The renal glands, as well as the suprarenal capsule, contain a good deal of pigsmall branches into the phrenic and renal veins.
into the renal vein.

The lymphatics

of this

ment.

Nerve Supply. Solar and

renal plexuses,

and the pneumogastric nerves.

The other ductless glands mentioned

and possibly the splanchnic,

phrenic,

will

be described in their proper

places.

PLATE

CI.

DORSI-SPINAL VEINS

INTERCOSTAL

INTERCOSTAL

VEI

VENAE

VEIN

BASIS VERTEBRARUM.

ANTERIOR LONGITUDINAL
MENINGO-RACHIDIAN.

Veins of Spinal Cord and Column (Transverse View.)

Larynx.

The larynx
vocal sound

is

(Plate

(the organ of phonation)

made and modulated.

enlarged and modified.

It

It

is

opens by the

CXXIL)

is

thai part of the trachea in which

the upper end of the trachea which

glottis into (he

pharynx and

is

is

con-

The larynx is larger in men than in women

by about one-third. In some animals the larynx may be situated any where
In birds there are two
along the wind pipe or even in the bronchial tubes.
larynges, one at the top of the trachea ami the other, at the bottom of the
The opening of the trachea is called the glottis.
trachea, which is called syrinx.
The word glottis is sometimes applied to this opening with the contiguous

tinuous below with the trachea.

ANATOMY

250

IN A NUTSHELL.

structures as one mighl say oedema of the glottis just as he would say mouth to
The anterior part of the glottis is called glottis vocalis and is
include the lips.

hounded by the true vocal cords, while the posterior part is called glottis respiratoria and is hounded by the internal margins of the arytenoid cartilages.
The epiglottis (Plates CXXII-CXXXIV-CXXXV-CXXXVI-CXXXVIL)
i> a valve-like organ which prevents the food from entering into the glottis during
The superior or false vocal cords are two folds of mucous memdeglutition.
Inane which enclose a delicate rounded hand, the superior thyro-arytenoid
ligament. They are called false vocal cords because they are not directly conThe inferior or true vocal cords are two
cerned in the production of the voice.
strong fibrous bands, inferior thyrc-arytenoid ligament, which are covered by
They are called true vocal cords because
a thin layer of mucous membrane.
they are concerned

in

the production of the voice.

of the larynx, (Plate CXXXVII) which is situated between the

and true vocal cords on each side, leads into the sacculus laryngis (sinus
Morgagni.)
There are nine cartilages of the larynx, three of which are single
and three are in pairs. The single ones are (1) epiglottis, (2) thyroid, (3) criThose in paris are (1) the two arytenoid, (2) two
coid.
(Plate CXXXVI.)
The cricoid and thyroid and
cornicula laryngis, and (3) the two cuneiform,

The sinus

false

the arytenoid

(excepting tin

are hyaline in structure.

tip)

The

tip of the

and the cuneiform are yellow

The ligaments of the larynx are arranged in two sets, the extrinsic
which are three in number, connect the larynx to the hyoid bone, and the intrinsic, which are sixteen in number, connect the cartilages of the larynx to one

arytenoid, the epiglottis, the cornicula laryngis,

elastic.

another.

The

extrinsic ones are:

Thyro-hyoid membrane.

Two

lateral

(Plate

CXXXIV.)

thyro-hyoid ligaments, each of which contains a nodule

cartil-

age, (the cartilage triticea.)

The

sixteen intrinsic ligaments are:

Crico- thyroid

Two
Two
Two
Two
Two

membrane.

(Plate

CXXXIV.)

crico-thyroid capsular ligaments.

crico-arytenoid ligaments.
crico-arytenoid capsular ligaments.

superior thyro-arytenoid (situated in the false vocal cords.)

inferior thyro-arytenoid (situated in the true vocal cords.)

Hyo-epiglottic ligament.

Thyro-epiglottic ligament.

Three glosso-epiglottic folds.

The muscles of the larynx are as follows;
arytenoideus
Doideus
superior.

(5)
(8)

posticus.

(3)

Arytenoideus,

Crico-arytenoideus

(6)

long to the epiglottis.

(Plate

is

Crico-thyroid,

lateralis,

Thyro-epiglottideus,

Aryteno-epiglottideus

excepi the Arytenoideus, which

(1)

(7)

(4)

(2)

Crico-

Thyro-aryte-

Aryteno epiglottideus

All

these muscles are in pairs

single muscle.

Three of these muscles be-

inferior.

CXXXVI.)

ANATOMY

IN A NUTSHELL.

251

LESSON LXIX.
Cricothyroid Muscle.
Origin.

From the side of the cricoid

Into the interior border

Insertion.

cartilage.

and lower cornu

of thyroid

cartil

age.

Action. Rotates the posterior part of cricoid cartilage downward and

backward, and thus tightens the vocal cords.
Nerve Supply. External laryngeal from the superior laryngeal.
Blood Supply. The superior laryngeal from the superior thyroid, and
The veins have the same name
the inferior larvngeal from the inferior thyroid.

PLATE

CTI.
ANTERIOR LONGITUDINAL
WENINGO-RACHIDIAN.

POSTERIOR LONGITUDINAL.
YENINCO-RACHIDIAN

VENAE

BASIS VERTEBRARUM

Veins of Spinal Cord axd Column (Sagittal View.)

as the arteries
cles of

and accompany them.

This

is

the blood supply of

all

the mus-

the larynx.

Crico-arytenoideus Posticus.
Origin.

From

posterior surface of the cricoid cartilage.

Insertion.
Into the outer angle of the base of the arytenoid cartilage.
Action. It dilates the glottis bv rotating the arytenoid cartilage outward.

Nerve

Supply'.

Recurrent

laryngeal from the pneumogastric nerve.

Crico-arytenoideus Lateralis.
Origin.

From the upper border of the sides of the

cricoid cartilage.

ANATOMY

252

Insertion.

IN A NUTSHELL.

Into the external angle of the base of the arytenoid cartilage

in front of the Crico-arytenoideus posticus.

Action.

contract the glottis by rotating the arytenoid cartilage in-

T<>

ward.
\i

i;\

Supply.

Recurrent

laryngeal from the pneumogastric.

Thyro -arytenoideus.
Origin.

From the side of the angle of the thyroid cartilage and the crico-

thyroid membrane.

[nsertion.- Into the anterior surface and base of the arytenoid cartilage.
Action. Relaxes the vocal cords by drawing the arytenoid cartilage for-

ward.

Nerve Supply.

Recurrent

laryngeal from the pneumogastric.

Arytenoideus Muscle.
Origin.

This

is

the single muscle of the larynx and comes from the pos-

terior surface of the arytenoid cartilage, its fillers

running

in a transverse direc-

tion pass from one cartilage to the other.

Insertion. Into the posterior surface of the arytenoid cartilage.

Action. It assists in contracting the glottis by approximating the aryten-

noid cartilages.

Nerve Supply.

Recurrent

laryngeal from the pneumogastric, and the

superior laryngeal.

Thyro-Epiglottideus.
Origin.

From

the angle of the thyroid cartilage just above the Thyro-

arytenoideus.

Insertion.

Into the lower border of the epiglottis and into

the aryteno-

epiglottic fold.

Action.

To compress the sacculus laryngis and to

Recurrent laryngeal nerve.

depress the epiglottis.

Nerve Supply.

Aryteno-Epiglottideus Superior.
Origin. From
[nsertion.

the tip of the arytenoid cartilage.

Into the

mucous membrane attached

to the side of the epi-

glottic

Action.

Contracts the superior opening

Recurrent laryngeal.

of the larynx.

Nerve Supply.

Aryteno-Epiglottideus Inferior.
Origin.

From

the anterior surface of the arytenoid cartilage.

[nsertion. Into the upper and inner part of the epiglottis. This muscle
separated from the superior muscle by a distinct interval.
It is often called
the Compressor sacculus laryngis of Hilton.
The Triticeo-glottis muscle is a
is

small muscle which

ticeuni,

and

is

frequently present.

after passing forward

inserted into the tongue.

Its origin

and upward

is

from the corpus

tri-

to join the Cerato-glossus, it

is

PLATE
m> VC.

;,

4n

tf?

The Spinal Column.

253

CIII.

ANATOMY

254

IN A NUTSHELL.

- Contracts the superior opening

A< tii in.

of the larynx.

Nerve Supply. Recurrent laryngeal nerve.

Nerve Supply. The Crico-thyroid muscles and mucous membrane

of the

larynx receive the superior laryngeal nerves, all the remaining muscles receive
The Arytenoideus receives both
the inferior <>r recurrent laryngeal nerves.
superior and inferior laryngeal nerves.
1

The laryngeal branches from the superior thyroid and

The veins, which accompany the

Supply.

;;.oi in

inferior thyroid arteries pass to the larynx.

superior laryngeal artery, join the superior thyroid vein which empties into the

jugular

internal

vein.

The veins which accompany the

inferior

laryngeal

artery join the interior thyroid vein which empties into the innominate vein.

The lymphatics

pass into the deep cervical nodes.

Trachea.

The word trachea comes from

(Plate

CXX.)

Greek word which means rough.

It is also

wind pipe and is the air passage of the body beginning at the larynx
and ending in the bronchial tubes. It is composed of sixteen to twenty cartilages or osseous rings.
The first ring is called the cricoid cartilage, and the
last one is called the pessulus.
This last one is situated at the forking of the
trachea into the right and left bronchial tubes.
The trachea is a musculomembranous tube and it communicates with the mouth and nose through the
larynx, and with the lungs through the bronchial tubes.
All vertebrates, which
breathe air with lungs, have a trachea which is subject to very little variation
in character.
The human trachea is about four and one-half inches long, extending from the sixth cervical vertebra to the fourth dorsal vertebra where it
branches into the two bronchi. The oesophagus is between the trachea and the
spinal column.
The average diameter of the trachea is about four-fifths of an
inch in the cadaver.
The antero-posterior diameter is somewhat less. Durcalled the

life these dimensions are smaller.

The rings of the trachea are incomplete
behind where they join the (esophagus.

ing

Blood Supply. Inferior thyroid

arteries.

The veins terminate

in

the

thyroid venous plexus.

Nerve Supply. Pneumogastric and sympathetic.

The
than
is

Nft

lie

about an inch

and

divi les into three

nearly tun inches in length

which
In

is

is

lung.

behind

it

in

length and in direction

passage to the rool of the lung than the

its

righl one.

bronchus

right

izontal in

is

is

bronchus.

more horIt is

wider

The left bronchus

and more oblique than the

branches to the lung.

smaller, longer,

enters the root of the lung opposite the sixth dorsal vertebra,

It

alioiii
It

and

left

an inch lower than the point whe'e the right bronchus enters

divides into two branches.

It

has above

it

the arch of the aorta.

the (esophagus, thoracic duct, and the descending aorta.

pulmonary artery

is

a1

first

above, then

in

front of the

left

The

left

bronchus.

LESSON LXX.
Lungs.
Tin

(Plates

CXXI-CXXII-CXXIII.)

word Lung comes from the Latin pulmones, from which comes

pul-

ANATOMY

IX A NUTSHELL.

255

The lungs are two large organs which occupy a great part of the chest
The heart, oesophagus, and the great vessels separate them. They
are the organs of respiration in air breathing vertebrates and communicate
with the pharynx through the trachea. The air cells (alveoli) are from one
The lungs are formed by refiftieth to one-seventieth of an inch in diameter.

monary.
cavity.

peated subdivisions of the bronchial tubes which

tions called infundibula.

The

air cells are in

PLATE
UPPER

_-*->

OR

in

saccular dilata-

CIV.

THREE SLIPS OF THE

STELLATE

LIGAMENT

ANTERIOR COSTOVERTEBRAL

FASCICULUS.

ANTERIOR

end

FASCICULUS

MIDDLE FASCICULUS.

.OWER

finally

the infundibula and the air pass-

LIGAMENT

SUPERIOR COSTOTRANSVERSE LIGAMENT

Ligaments of Spinal Column.

These cells have
branches of the pulmonary art< ry nd and

ages leading to them.

<

capillary

In re

net-work

the blood

is s<

in

which the
from the

parat< d

by the capillary wall and the thin alveolar epithelium of the air cells. The
is comparatively compact, being composed of air breathing tubes bound
tip by connective tissue.
Blood Supply. From the bronchial arteries which vary in number, size.
and origin. The one on the right side may conic from (1) the first aortic inof the
tercostal. (2) by a common trunk with the lefl bronchial from the f
thoracic aorta.
On the left side ther< are generally two which conic from the

air

lung

thoracic aorta.

The bronchial veins do

not return

all

the blood carried to the

ANATOMY

256

IN A NUTSHELL.

lungs by the bronchial arteries, for that part which

distributed to the smaller

is

brought back by the pulmonary veins. The

right bronchial vein empties into the vena azygos major just before that vein
empties into the superior vena cava. The left bronchial vein empties into the
Small
lower left superior intercostal vein or into the vena azygos tertius.
veins from the bronchial glands, from the trachea, and from the posterior medbronchial tubes and alveolae

is

The lymphatics
numerous.
The base of each lung rests upon the Diaphragm and its apex passes through
Each
the superior opening of the thorax about an inch above the clavicle.
lung is pyramidal in form and the right one is divided into an upper lobe, a
middle lobe, and a lower lobe, while the left lung is divided into an upper lobe
and a lower lobe. The root of each lung is little above the middle at the inner
side and except for this attachment the lung lies free in the pleural cavity which
The lung is elastic and always on a tension. The blood in
it completely fills.
passing through the lungs gives off carbon dioxide to the air in the alveolae and
This process which takes place in the lung is a simple physical
receives oxygen.
change and has nothing to do with any secreting or other activity of the epiiastinum empty into the bronchial veins at the root of the lung.

of the lungs are

thelial

cells.

Nerve Supply.

It is from the anterior and posterior pulmonary plexuses,

which are formed from the sympathetic and pneumogastric. Filaments from
these plexuses accompany the bronchial tubes upon which they are lost.
Small
ganglia are formed upon these nerves.
The right lung (Plates CXXI-CXXII-CXXIII.) weighs twenty-two ounces
and the left one twenty. Their capacity is nearly seven and a half pints. The
is more than eight hundred and seventy square feet.
At birth the lungs are a reddish brown and change to a rose pink on inflation.
They are grayish white in adult life and brownish in middle life and bluish

entire respiratory surface

in old age. The specific gravity varies from 345 to 746, water being 1000.
The serous membrane which covers the lung is the pleura (Plates CXXY-CXXVL)
Each pleura is an inclosed sac and they do not touch each other. Each has a
parietal layer called a costal, and a visceral layer called pulmonary.
The
movements of the lungs in the chest are facilitated by serous secretion in the
The parietal pleura has different names for its various portions.
pleura.
1. Tin-: costal pleura is that which lines the ribs, costal cartilages, and

black

intermediate muscles.
2.
3.

The diaphragm \tic pleura is that which is attached to the Diaphragm.

The mediastinal pleura is that which is attached to the adjacent

structures
4.

the mediastinum.

in

The

<

i;k\

ecal pleura

Blood Supply.

Internal

pericardiac, bronchial.

is

that which covers the

mammary,

dome

of the lung.

intercostal, musculo-phrenic, thymic,

The veins correspond

to the arteries.

The lymphatics

are numerous.

Nerve Supply.

Sympathetic

The broad ligamenl

which after covering the

of the lung
root

and phrenic.
is

a fold of the visceral layer of

of the lung

comes together

the pleura

directly beneath

it

ANATOMY

IX A NUTSHELL.

257

forming a triangular sheet, passing vertically from the root of the lung to the
Diaphragm, and laterally from the lung to the mediastinal pleura.
The root of the lung is composed of (1) the pulmonary artery, (2) pulmonary

pulmonary plexus,

veins, (3) bronchial tube, (4) bronchial vessels, (5) anterior

PLATE
ANTERIOR TUBERCLE

OF ATLAS

TO

CV.

WHICH THE LONGU COLLI

IS

INSERTED

RECTUS CAPITIS

ANTICUS

MINOR

ORIGIN

THIS AND THE THREE SUCCEEDING

THE

ORIGIN OF

PROCESSES GIVE ORIGIN TO THE

THE UPPER OBLIQUE

RECTUS CAPITIS
AND

ANTICUS MAJOR

THE SCALENUS ANTICUS

PORTION OFLONGUS COLLI

INSERTION OF INFERIOR

OBLIQUE PORTION
OF LONGUS COLLI

ORIGIN OF VERTICAL PORTION OF THE LONGUS COLLI.

ITS INSERTION IS

INTO THE SECOND. THIRD AND FOURTH VERTEBRAE

Anterior View of Cervical Vertebra.

(6)

posterior

pulmonary plexus,

are the

main structures

from before backward

down

(7)

bronchial lymphatic nodes,

All these are enclosed in the pleural covering.

tissue.

in

in

in

The

first

(8)

areola!

three of these

the root of the lung and bear the following relations

each lung:

Vein, artery, and bronchus.

the left root we have artery, bronchus, and vein.

from above down we have bronchus, artery and vein.

Relations of the root of the right lung.

(Plate

CXXVII.)

In

From above
the righl one

ANATOMY

258

In Front.

IN A NUTSHELL.

.Superior vena cava. (2) upper portion of right auricle of

pulmonary plexus, (4) right phrenic nerve.
Posterior pulmonary plexus, (2) pneumogastric nerve, (3)

(1)

heart. (3) anterior

Behind. (1)
vena azygos major.
Above. (1) Vena azygos major.
Below. Broad ligament (ligamentum latum pulmonis.)

Relations of the

Behind. The
In Front.

(1)

left root.

(Plate

CXXVIL)

The anterior pulmonary

descending aorta,

(2)

plexus. (2) the left phrenic nerve.

pneumogastric nerve,

(3)

posterior

pulmonary plexus.
Above. The arch of the aorta.
Below. The broad ligament (ligamentum latum pulmonis.)
About one hundred cubic inches of air remains in the lungs which cannot
This is called residual air. After an ordinary
(Plate CXXIY.)
be expelled.
expiration one hundred cubic inches of air can be expelled by forced expiration, this is called reserve air.
About twenty or thirty cubic inches of air which
After an
passes in and out during the ordinary breathing is called tidal air.
ordinary inspiration one can inhale one hundred and twenty cubic inches of air,
which is called eomplemental air. After the complemental air has been taken
into the lungs then one may expell all the air, except the residual air, and this

is

called vital capacity.

LESSON LXXI.
A vertebra (Plate XC1X) consists of a body and an arch, the latter being
formed by two pedicles ami two laminae which support the seven processes.
The body is thick and spongy, convex in front from side to side and concave
vertically on the upper and lower surfaces which are surrounded by bony rims.
Anteriorly are small foramina for nutrient vessels, posteriorly a large foramen
for the exit of the venae basis vertebrarum. The pedicles project backward from
the body, inclining outward; they are noticed above and below, thus forming,
with the adjacent notches, the intervertebral foramina for the entrance of vesThe laminae are two broad plates meeting
sels and the exit of spinal nerves.
in the spinous process belaud and rough on the upper and lower borders for the
attachment of the ligamenta subfiava. The transverse processes, one on each
vide, project outward.
The articular processes, two on each side, superior and
inferior, project from the junction of the lamina? and the pedicles, articulating
above and below with the articular processes of the adjacent vertebrae. Their
upward

in the cervical region,

outward

in the dorsal region,

the lumbar.

The spinous process

projects

backward from the

superior facets look

and inward

in

junction of the lamina?, sometimes very obliquely.

The spinal foramen is the
-pace enclosed by the body, pedicles, and lamina?, and each foramen when the
vertebrae are articulated, form part of the spinal canal.

There are thirty-three vertebra?

which form
and
the position which they occupy, seven being found in

the skull, having received the

coccygeal, according to

in

names

number, exclusive

of those

of cervical, dorsal, lumbar, sacral,

ANATOMY

IN A NUTSHELL.

259

the cervical region, twelve in the dorsal, five in the lumbar, five in the sacral,

Their number is sometimes increased

one region, or the number may be diminished in
one region, the deficiency being supplied by an additional vertebra in another.
These observations do not apply to the cervical portion of the spine, the number

and four in the coccygeal.

by an additional vertebra

(Plate CIII.)

in

PLATE

CVI.

RECTUS CAPITIS POSTICUS MINOR

TRANSVERSE PROCESS OF ATLAS

RECTUS CAPITIS LATERALIS

LEVATOR ANGULI SCAPULAE

SUPERIOR

OBLIQUE

ORIGIN

SPLENIUS

INFERIOR

OBLIQUE

COLLI

.INSERTION

RECTUS CAPITIS POSTICUS MAJOR

THE POINTER CROSSES THE ORIGIN
OF THE INFERIOR OBLIQUE

LEVATOR ANGULI SCAPULAE

SPLENIC COLLI

SCALENUS MEDIUS

.INSERTION

SEMISPINALS COLLI

SCAPULAE

LEVATOR ANGULI
SPlfNIUS COLLI

SCALENUS

CERVICAUS TRANSVERSUS

MEDIUS

COMPLEXUS
LEVATOR ANGULI
SPLENIUS COLLI

SCAPULAE

SEMISPINALS COLLI

CERVICAUS TRANSVERSUS
CERVICAUS ASCENDENS

SOMETIMES
SCALENUS

MEDIUS

COMPLEXUS AND
MULTIFIDUS

SEMISPINALS COLLI
CERVICAUS ASCENDENS
CERVICAUS TRANSVERSUS

SPINAE

SCALENUS MEDIUS
SCALENUS POSTICUS
COMPLEXUS AND TRACHELO
MASTOID. MULTIFIDUS SPINAE

CERVICAUS TRANSVERSUS
CERViCALiS ASCE\0ENS

SCALENUS MEDIUS
SCALENUS POSTICUS
COMPLEXUS AND TRACHELOMASTOID.

- 3

COLLI

MULTIFIDUS SPINAE

SCALENUS MEDIUS
SCALENUS POSTICUS
COMPLEXUS AND TRACHELOMASTOID. MULTIFIDUS SPINAE

j&j*

'

LEVATOR COSTAE ORIGIN

ACCESSORIUS INSERTION

,'

INTERSPINALES

MULTIFIDUS
lAND TO EACH SPINOUS

SPINAE

TRAPEZIUS.

PROCESS AS HIGH AS THE SECOND

POSTICUS

RHOMBOIDEUS

SUPERIOR.

SPLENIUS.

SERRATUS
COMPLEXUS

MINOR.

Postekiob View uf Cervical Vertebrae.

of

bones forming which

The

is

seldom

incr<

ased or diminished.

peculiar vertebra' are the first cervical or atlas, SE<

OND CERVU al

and THE SEVENTH CERVICAL Or VERTEBRA PROMINENS. (Plates XCVXCVI-XCVII.) The great modifications in the form of the atlas and axis arc
d( signed to admit of nodding and rotary movements of the head.
The peculiar vertebra* in the dorsal region are the first, ninth, tenth,
Eleventh, and twelfth. (Plate CVII.) In the lumbar region the fifth is

or AXIS,

ANATOMY

260

IN A NUTSHELL.

The peculiarity of the first dorsal is that it has one facet and a demiThe ninth dorsal has a demi-facet only. The tenth has but one facet
mi its body and one on the transverse process. The eleventh and twelfth have
The
each but one facet on the body, and none on the transverse process.
twelfth resembles a lumbar vertebra in size and shape. The fifth lumbar is much
peculiar.
facet.

deeper

than behind.

in front

Its

spinous process

small, but its

is

transverse

processes are large and thick and point slightly upward.

The
I'm

To

atlas has ten pairs of muscles attached to

anterior arch.

posterior arch.

To transverse

pro-

cess.

Longus Colli.
Rectus capitis posticus minor.

it.

Ant. vertebral region.

2 Fifth layer of back.

Rectus capitis anticus minor.

Rectus capitis lateralis.

3 Ant. vertebral region.

Inferior oblique.

5 Fifth layer of back.

Superior oblique.

6 Fifth layer of back,

Splenius

7 Third layer of back.

4 Ant. vertebral region.

colli.

8 Second layer of back-

Levator anguli scapula?.

Anterior intertransversalis.

9 Fifth layer of back.

Posterior intertransversalis.

10 Fifth layer of back.

The atlas

has a small spinous process, large lateral masses, and no body.

The anterior arch forms one-fifth of the circumference, the posterior arch twothe circumference, and the lateral masses one-fifth each.

fifths of

ment of muscles

is

There

given above.

is

The attach-

a groove on the posterior surface of

the anterior arch for the articulation of the odontoid process of the axis.
process

is

held in place by the transverse ligament which passes across

teriorly, being

attached to the inner surface of the lateral masses.

posterior arch joins the lateral masses there

vertebral artery and suboccipital nerve

neath the artery.

joint, subclass

The

(first

This
it

Where

pos-

the

is a groove (sinus atlantis) for the

spinal nerve), the nerve lying be-

articulation of the atlas with the occiput

double condylar arthrosis, having

all

the

is

a diarthrosis

movements of
(Plate XCV.)

the ball-

and socket joint (enarthrosis) except axial rotation.

The blood supply of this joint is the vertebral artery and sometimes the
ascending pharyngeal artery.

The nerve supply is the anterior division of the suboccipital (first cervical.)
The ligaments are the anterior occipito-atlantal, posterior occipito-atlantal,
two capsular, two anterior oblique or

The

lateral occipito-atlantal.

anterior occipito-atlantal ligament

is

(Plate CIX.)

attached above to the anterior

margin of the foramen magnum, below to the upper margin of the anterior arch
The central part, which is a continuation of the anterior common

of the atlas.

ligamenl of the vertebral column,

this ligament.

The

lateral

ligament, form the deep part.

antici

minores muscles.

is

sometimes called the

superficial part of

portions, which are continuous with the capsular

H( hind

In front of this
is

ligament are the Recti capitis

the central odontoid or suspensory ligament.

ANATOMY

IN A NUTSHELL.

261

LESSON LXXII.
The

posterior oceipito-atlantal ligament

margin of the foramen

magnum from

PLATE

is

attached above to the posterior

condyle to condyle, below to the pos-

CVII.

AN ENTIRE PACET ABOVE

DEMI-FACET

BELOW

DEMI-FACET ABOVE

ONE ENTIRE FACET

AN

ENTIRE FACET.

NO FACET ON TRANSVERSE

PROCESS. WHICH

IS

RUDIMENTARY

AN ENTIRE FACE1
NO FACET ON TRANSVERSE PROCESS

INFERIOR

ARTICULA PROCESS

CONVEX AND TURNED OUTWARD

The Peculiar Dorsal Vert k hi;

b.

and upper margin of the posterior arch of the atlas. This ligaincomplete on each side for the passage of the vertebra] artery into,
and the suboccipital nerve from, the spinal canal.
In position ii corresponds

terior surface

ment

is

ANATOMY

262

IN A NUTSHELL.

ligamenta subflava which are below the axis but has no elastic tissue in
In front this ligament is attached to the dura mater and behind are the Rectus capitis posticus minor and Superior oblique muscles.
The two capsular ligaments are attached above to the margins of the conto the
its

composition.

bone and below

to the margins of the articular surfaces of

is
lined with synovial membrane which
ligament
Each capsular
the atlas.
synovial
with
the
membrane of the transverse odonsometimes communicates
toid ligament.
The two anterior oblique or lateral occipito-atlantal ligaments are situated

dyL

of the occipital

in front of

the external part of the capsular ligament.

They

are attached above

to the jugular process of the occipital bone, and below to the base of the transTheir direction is forward, upward, and inward.
verse process of the atlas.

The
axis

articulation of the lower part of the atlas with the upper part of the

The nerve supply is the loop

The blood supply is the vertebral

a diarthrodiaJ joint, subclass arthrodial.

is

between the
artery.

first

and second cervical nerves.

The ligaments

are

anterior

atlanto-axial,

posterior

atlanto-axial,

transverse, and two capsular.

The anterior atlanto-axial ligament is attached above to the anterior surface and lower border of the anterior arch of the atlas, and below to the base
of the odontoid process and the transverse ridge on the front of the body of the
In front in
axis.
It is continuous on each side with the capsular ligaments.
the median line is the anterior common ligament of the vertebral column which
is

sometimes called the superficial anterior atlanto-axial ligament.

mediately

The

in front the

Longus

colli,

It

has im-

then the Recti capitis antici minores.

posterior atlanto-axial ligament takes the place of the ligamenta sub-

flava of the joints below the axis.

It is attached above to the posterior surface

and lower edge of the posterior arch of the atlas and below to the dorsal aspect
of the upper edge of the lamina of the axis. It is continuous with the capsular
Ligament on each side.
It is perforated on each side by the second cervical

In front

nerve.

it

is

connected to the dura mater, behind

is

the Inferior ob-

lique muscle.

The two capsular

ligaments.

articular surfaces of the axis

and

These articulations are between the superior

inferior articular surface of the atlas.

has a loose capsular ligament and synovial sac.

joint

strengthened

in

front

Each

These ligaments are

and behind by the anterior and posterior atlanto-axial

ligaments.

The transverse ligament is a strong fibrous band passing from the tubercles
on the inner side of the lateral masses of the atlas, holding the odontoid process
in place.
It is thicker in the center and gives fibers which pass above to the
basilar process of the occipital and some passing below to the base of the odontoid process and body of the axis, thus forming a crucial ligament.
This ligament divides the canal of the atlas into two parts, a small anterior one which
is for the odontoid process and a large posterior one for the spinal cord, the spinal
acci ssory nerves, the spinal arteries, vertebral arteries, and the meninges of the
cord.

The

articulation of the posterior surface of the anterior arch of the atlas

PLATE

CVIII.

TUBERCLE
ARTICULAR PART OF TUBERCLE

SECOND AND THIRD DICTATIONS

OF

STERNAL END FOR COSTAL

SERRATUS

CARTILAGE

The Second and Skykxth

263

Ribs.

MAGNUS

(0)

ANATOMY

264

with the odontoid process

IN A NUTSHELL.

a diarthrosis joint, subclass trochoides.

is

Blood

and ascending pharyngeal arteries. Nerve supply, loop between the first and second cervical nerves. The part between the posterior
surface of the odontoid process and the transverse ligament is a syndesmoodontoid joint. Each of these joints has a synovial membrane. The synovial
membrane of the atlanto-odontoid is surrounded by a capsular ligament of the
same name and is continued with the occipito-atlantal capsular ligament. It
blends with the anterior occipito-atlantal, atlanto-axial, and the central odonThe synovial sac of the syndesmo-odontoid joint is surrounded
toid ligaments.
by a capsule. This sac often communicates with the occipito-atlantal synovial
supply, vertebral

sac.

The ligaments attached to the odontoid process are (1) Occipito-axial ligament (apparatus ligamentosus colli) which is a continuation of the posterior
common Ligament of the vertebral column, some of the fibers continuing to the
anterior margin of the foramen magnum to be continued by the dura mater.
This cuvcrs the odontoid process and its ligaments.
(2) Crucial ligament, the same as the transverse ligament.
(3) Two lateral odontoid or check ligaments passing from the sides of the
apex of the odontoid process to the inner surface of the condyles of the occipital
bone, their direction being outward, upward, and forward.

The

(4)

central odontoid or suspensory ligament

and

the odontoid process below,

the foramen

magnum

ament ami behind

is

above.

to the

It

under surface

is

attached to the tip of

of the anterior

margin of

has in front the anterior occipito-atlantal

lig-

the upper division of the crucial ligament.

LESSON LXXIII.
The

axis

peculiarity
Its

atlas.

is

the second

is

that

it

spinous process

To body

To spinous

Longus

process

cervical

vertebra.

has an odontoid process which

is bifid.

It

transverse pro-

Rectus capitis posticus major

Semispinals colli

3 Fifth layer of back.

Fifth layer of back.

4 Fifth layer of back.

Spinalis colli

5 Fourth layer of back.

[nterspinales

6 Fifth layer of back.

Multifidus spinae

7 Fifth layer of back.

Supraspinales

8 Fifth layer of back.

9 Third layer of back.
10 Fifth layer of back.

Posterior intertransversalis

11 Fifth layer of back.

Levator anguli scapulae

12 Second layer of back.

Transversalis

The seventh

Ant. vertebral region.

colli

or cervicis

Scalenus medius

vical

XCVI-XCVII.) Its
body of the

in reality the

Inferior oblique

Anterior intertransversalis

cess.

is

has fourteen pairs of muscles attached.

colli

Splenitis colli

To

(Plates

cervical

is

and dorsal vertebrae.

the last cervical

It

is

13 Fourth layer of back.

14 Lateral vertebral region.

and has characteristics of both cerprominens on account of its

called vertebra

ANATOMY

IN A NUTSHELL.

265

Its transverse process may, or may not, have the costoThe vertebral artery and vein more often pass in front
of the transverse process than through its foramen: they more often pass
through the left foramen than the right one and the vein more often than the

large spinous process.

transverse foramina.

artery.

the

The anterior tubercle of the transverse process, which

may be enlarged, making a rudely developed cervical

rib,

has eighteen pairs of muscles attached to

PLATE
POST. 0CC1PIT0-AXIAL

is

an analogue of
This vertebra

rib.

it.

CIX.

LIG.

VERTICAL

ACCESSORY

ATLANTO- AXIAL

LIG.

LIG.

Ligaments of Upper Cervical Ykktebr.e.

To bodv

Longus

colli

2 First layer of back.

Trapezius

.'!

Serratus posticus superior

4 Third layer of back,

capitis

f)

of hack.

Third layer of back,

Mnltifidus spina'

(i

Fifth layer of hack.

[nterspinales

Fifth layer of hack.

S(

8 fifth layer of hack.

mispinalis dorsi

Spinalis

colli

!>

Fourth layer of back.

10

Fifth layer of back.

Posterior Lntertransversalis

Fifth layer of hack.

Levatores costarum

12 Thoracic region.

Anterior inter! ransversalis

process

Second layer

Rhomboideus minor
To spinous process Splenius

To transverse

Ant. vertebral region.

Scalenus posticus

13

Lateral vertebral region

Scalenus medius

11

Lateral vertebral region.

ANATOMY

266

To

transverse

process.

To

art icular

process

IN A NUTSHELL.

Musculus accessories

15 Fourth layer of back.

Complexus

16 Fourth layer of back.

Multifidus spina?

17 Fifth layer of back.

Trachelo-mastoid

18 Fourth layer of back.

LESSON LXIV.
The ligaments
1.

of the vertebral

column

(Plate CIV.)

are:

Ligaments of the body:

common.
common.

a.

Anterior

1).

Posterior

c.

Intervertebral substance.

el.

Lateral or short ligament.

2.

Ligaments connecting the laminae:

a. Ligamenta subflava.

3.

Ligaments connecting the articular processes:

4.

Ligaments connecting the spinous processes.

Capsular.

a.

5.

a.

Supraspinous.

b.

Interspinous.

Ligaments connecting the transverse processes

a.

The

Intertransverse.

anterior

common

ligament

is

a fibrous band extending from the an-

terior tubercle of the atlas to the base of the sacrum.

anterior atlanto-axial ligament and

sacro-coccygeal ligament.
dorsal region

It is

and thinnest

its

Its

upper part makes the

lower part extends to

make

the anterior

broader below than above and thickest in the

in the cervical.

It

is

thicker over the bodies of the

The interarticular substance

and the margins of the bodies of the vertebra? give attachment to the ligament
more than the anterior surface of the bodies. There are aperatures at the sides
This ligament
of the median position of the body for the passage of vessels.

vertebra? than over the intervertebral substance.

consists of three layers of various lengths closely intermingled; the superficial

layer passes from one vertebra to the fourth or fifth above; the second layer

from one vertebra

to the second or third above;

and the third layer connect

adjacent vertebra?.

The

posterior

common

ligament

is

situated along the anterior part of the

upon the posterior surface of the bodies of the vertebra?, extending

from the basilar process of the occipital above, to the coccyx below, its upper
pari making the posterior occipito-axial ligament.
It is broader above (which

spinal canal

is

the reverse of the .'interior

and, like

he anterior one,

ii

is

common

Ligament,) thickest in the dorsal region,

attached to the intervertebral discs and adjacent

It is narrow and thick over the bodies from which it

separated by adipose tissue and the venae basis vertebrarum. Opposite the in-

margins of the vertebrae.

is

tervertebral substance

it

gives off dentated processes.

the spinal cord blends with this ligament

Its fibers nre not so

at

The filum terminale

of

the back of the base of the coccyx.

bitenningled as those of the anterior

common

ligament and

ANATOMY

IN A NUTSHELL.

267

two layers; the superficial extends from one vertebra to the third or
and the deeper connect adjacent vertebrae.
The intervertebral substance or discs forms about one-fourth of the spinal
column. They conform to the shape of the bones adjacent. They are thicker
at the anterior than at the posterior border in the cervical and lumbar regions,
consist of

fourth,

PLATE

CX.

BASILAR PROCESS OF OCCIPITAL

RECTUS

CAPITIS

ANTICUS

_\

MINOR

RECTUS CAPITIS LATERALIS

2ND RIB

SCALENUS ANTICUS

Muscles of Anterior Vertebral Region.

thus helping to form the curve in these regions, while in the dorsal or thoracic
region they are of a uniform thickness, the difference in the thickness of the

bodies of the vertebra? making the curve in this region.

bond

They form

the

main

between the bodies of the vertebra?; they are compressible, elastic, and

number they are twenty-three, extending from the axis to the

sacrum. They consist of an outer ring and an inner substance, the ring is composed of fibro-cartilagenous tissue of concentric layers. The fibers of the layers
tough.

In

are not parallel but pass into the layers

above and below.

The

central sub-

stance has cartilage cells set in fine connective tissue matrix.

The

lateral or short vertebral Ligaments connect

the adjacent

the bodies of the vertebra? between the anterior and posterior

margins

common

of.

liga-

In the dorsal region they overlie the

ments with which they are continuous.
they
stellate ligaments and in the lumbar
radiate towards the transverse prowell marked.
less
In the cervical region they are
cesses.
The Ligamenta subflava conned the lamina between the axis and the sac-

ANATOMY

268

They

rum.
thicker

in

arc very thin, but broad

IN A NUTSHELL.

and long in the cervical region; they are

lumbar region. They consist of

the dorsal, being very thick in the

Their fibers are almost perpendicular.

Yellow elastic tissue.

tached above

to the inner

surface of the inferior articular process

They are atand the inner

surface of the lower margin of the lamina of the vertebrae; below to the inner

and the upper margin

surface of the superior articular process

They

of the lamina.

are continuous with the interspinous ligament at the root of the spinous

processes and help to form the capsular ligament.

The capsular ligaments connect the

articular processes, being attached along

the margins of the articular surfaces; the lateral part of the ligamenta subflava

Each

forms their inner portion.

ligaments are short and tight

intermediate

in

joint

is

lined

by a synovial membrane.

These

the thoracic region, loose in the cervical,

in

and

the lumbar.

The supraspinous ligaments

are fibrous bands connecting the tips of the

from the tip of the vertebra prominens to the first sacral.
continued above as the ligamentum nuchae and below along the spines of

processes, extending
It

is

the sacrum.

The interspinous ligaments extend in all regions of the vertebral column

betweeB the spinous processes of the vertebrae, running from root to apex.
In the cervical region

The

they are very delicate and are separated by the Inter1

They

spinales muscles.

lumbar than in the dorsal region.

between the transverse processes of

are stronger in the

intertransverse ligaments extend

the vertebrae; in the cervical region they are often absent, the Intertransversales

muscles taking their place. They are better marked

lumbar region thev are weak and membranous.

in the dorsal region; in the

LESSON LXXV.
Each rib has the following points: (Plate CVIII.)
Head which is divided by a ridge into two facets, and these

articulate with

the facets on the bodies of the dorsal vertebrae ;the ridge giving attachment to
the interarticular ligament.

Neck, about an inch long, having attached to

costo-transverse ligament, to

ligament;

its

its

anterior surface

Tuberosity,

at

is

its

upper border the anterior

posterior surface the middle costo-transverse

smooth.

the junction of the neck with the shaft, has a facet for artic-

ulation with the transverse process of the next lower vertebra,

and

a rough

surface for the posterior costo-transverse ligament.

Shaft, twisted on itself,

border round and smooth,

and nerves.

A.1

its

is

its

concave internally, convex externally,

its

upper

lower border grooved for the intercostal vessels

external extremity

is

an oval depression for the insertion

of the costal cartilage.

Angle, just

in

front of the tuberosity,

is

marked by

rough

line, to

which

nre attached the muscles of the deep layer of the back.

Bach
Each

rib

is

developed

in

the following manner:

rib has thri e centers,

one for the head, one for the shaft, and one for

PLATE
BIVENTER CERVICIS

RECTUS CAPITIS POSTICUS MINOR

OBLIQUES CAPITIS SUPERIOR

RECTUS CAPITUS POSTICUS MAJOR

OBLIQUES CAPITIS INFERIOR

TRACHELO

SCALENI

MASTOID

MEDIUS AND POSTICUS

VERTEBRAL APONEUROSIS

OBLIQUE

INTERNUS

ORIGIN

OF

ABDOMINIS

ERECTOR SPINAE

Muscles of Back (Deep Layer).

269

CXI.

ANATOMY

270

The

the tuberosity.

last

two

ribs,

IN A NUTSHELL.

having no tuberosity, are developed each

by two centers.

The peculiar

ribs are the first, second, tenth, eleventh,

and

twelfth.

They

the following peculiarities, viz:

present

respectively

broad, short, not twisted, has no angle, only one facet on

its upper surface are seen two grooves for the subclavian
artery and vein, and between them a tubercle for the Scalenus anticus muscle.
Second Rib is not twisted, its tuberosity and angle are very close together, and its upper surface presents rough surfaces for the Serratus magnus

Rib

First

is

the head, but on

and Scalenus posticus muscles.

Tenth Rib has but one facet on its head.
Eleventh Rib has no neck, no tuberosity, and but one facet on its head.
Twelfth Rib has neither neck, angle, tuberosity nor groove, and but

one facet.
Muscles of the Back.
back are arranged in five layers. (Plates XVIII-CXI)
Those in the fourth layer get both the internal and external divisions of the
The external divisions supply those
posterior tranches of the spinal nerves.
divisions
The internal
together with the sub-occipital and
in the third layer.

The muscles

of the

great occipital supply those in the fifth layer.

(Plates

NERYKS.

First layer.

Spinal accessory; 3rd and 4th cervical.

See page 45.

Trapezius.

2 Latissimus dorsi.

Second

Middle or long subscapular.

See page 52.

layer.

Page
Page
2 Rhombodideus minor.
Rhomboideus major. Page 55.
Levator angulae scapulae.

XVIII-CXI.)

54.

.1.").

:'>

3rd and 4th cervical; sometimes 5th.

5th cervical.
5th cervical.

Third layer.
Serratus posticus superior.

External

divisions of the posterior

2 Serratus posticus inferior.

branches of the spinal nerves,

3 Splenius capitis.

k spective regions.

Splenius

in their

colli.

Fourth layer.
S \cr.\l

AND LUMBAR REGIONS.

All the muscles in the fourth layer

get the external divisions of posterior

Erector spina'.

DORSAL REGION.
2 Dio-costalis.

branches except the Spinalis dorsi and

and the Complexus.

Spinalis colli

Musculus accessorius ad ilio-costalem

Longissimus dorsi.

.'5

5 Spinalis dorsi.
I

i.i;\

[CAL REGION.

6 Cervicalis ascendens.
7 Transversalia

colli.

8 Trachelo-mastoid.
!

Complexus.

They
the

get

the

posterior

internal

branches.

divisions

The

of

Com-

plexus also gets the sub-occipital and

the great oc( ipital nerves.

ANATOMY

IX A NUTSHELL.

271

10 Biventer cervicis.
11 .Spinalis

colli.

Fifth layer.
1

Semispinalis dorsi.

2 Semispinalis

All these muscles in the fifth layer

are supplied

colli.

of the posterior

4 Rotatores spina?.

the Recti andObliqui, and they

5 Supraspinales.

cept

6 Interspinales.

are supplied

by the internal divisions

branches of the spinal

nerves in their respective regions, ex-

3 Multifidus spinae.

Extensor coccygis.

by the sub-occipital. The

Inferior oblique

8 Intertransversales.

takes the great

also

occipital nerve.

9 Rectus capitis posticus major.

10 Rectus capitis posticus minor.

11 Obliquus capitis superior.

12 Obliquus capitis inferior.

PLATE CXI
TO

I.

SCALP

CUTANEOUS

OCCIPITALIS

WITH

AURICULAR

Ml

SUPERIOR OBLIQUE

COMPLEXUS

RECTUS CAP.
POSTERIOR
ST.

INF.

DIV

CERVICAL

OBLIQUE

POSTERIOR
-ND.

DIVISION OF

CERVICAL

POSTERIOR
RD

OF

DIVISION

CERVICAL

ssss^-ti

SPLENIUS

COMPLEXUS.

=3^

TRACHELO-MASTdlO
SKIN OVER

TRAPEZIUS

The Posterior Cervical Plexus.

Muscles of the Third L
Serratus posticus

and has

superior. Description.

a serrated outer

theouter half isfleshy.

Origin.

(1)

margin.
It

The inner

takes its

Ligamentum

(2)

This

muscle

half of the muscle

name from

nuchse,

wi:i;.

its serrated

is
is

quadrilateral

tendinous and

edgeand

its

position.

spinous processes of the seventh


ANATOMY

272

and

cervical

IN A NUTSHELL.

second, third, and fourth dorsal vertebrae, (3) supraspinous

first,

ligament.

Insertion.
ribs

Into the upper borders of the second, third, fourth, and

beyond

their angles.

Action.

To

\i:i;\

Supply.

i:

by raising the

assist in inspiration

serted.

External

ribs into

which

fifth

it is

in-

divisions of the posterior branches of the spinal

nerves.

The

Blood Supply.
(2)

muscles

in the

back are supplied by

vertebral, (3) intercostal, (4) subclavian (thyroid axis), (5)

This applies to

ies.

Serratus

from

all

posticus

inferior.
its

Description. This

position.

More than

muscle takes

its

half of this muscle

eurosis,

which blends with the posterior layer of the lumbar

portion

is

arter-

fascia.

name

is

apon-

Its

outer

fleshy.

Origin.
first,

occipital,

the muscles in the back.

serrated edge and

its

(1)

lumbar

Spinous processes of the eleventh and twelfth dorsal, and

(1)

second, and third lumbar vertebrae, (2) supraspinous ligament.

Insertion. Into the lower borders of the ninth, tenth, eleventh, and

twelfth ribs

beyond

Action.

them

their angles.

It assists in

a fixed point so the

Nerve Supply.

inspiration by depressing the lower

diaphragm can contract.

and making

External divisions of the posterior branches of the spinal

nerves.

The nerve supply

the

part of this lesson.

first

ribs,

remaining muscles of the

of the

back

is

given in

Splenius capitis and Splenius colli.

Description. This is a broad muscle
which divides above into two portions for insertion.
It takes its name (bandon
account
holding
down
age)
of it
the Complexus and other muscles.

This

muscle has one origin and two insertions and may be called
Lower one-half of the ligamentum nuchas, (2) spinous prothe seventh cervical, and upper six dorsal vertebrae, (3) supraspinous

Origin.
two muscles.
cesses of

(1)

ligament.

Insertion.

(Capitis portion).
(1) mastoid process of temporal bone,
bone beneath the superior curved line. (Colli portion) into the
transverse processes of the first, second, and third cervical vertebra? (posterior
(2) occipital

tubercles.

Action. It
the face to same

flexes the

head and neck,

laterally,

extends them, and rotates

side.

LESSON LXXVI.
Muscles of the Fourth Layer of the Back.
Erector Spinae.

Description.

This

muscle and

the vertebral groove on each side of the spine.

is

primed and tendinous.

the dorsal region

muscle

is

covered

it

in

its

continuations

fill

up

In the sacral region this muscle

lumbar region it is larger and fleshy. In

This
branches, and these sub-divide.
the lumbar region bythe lumbar fascia; in the dorsal region
In

the

divides into

its

ANATOMY

IN A NUTSHELL.

by the Serrati muscles, and the vertebral

fascia,

273

and in the

cervical

region by a

laver of cervical fascia.

+.

Spines of the eleventh and twelfth dorsal vertebrae, (2) all

the lumbar and sacral spines, (3) supraspinous ligament of all these, (4) back

Origin.

(1)

PLATE CXI

1 1.

TWEIPTH NERVE
MAJOR

RECTUS LAKIIUS ANTICUS

FIRST CERVICAL NERVE.

RECTUS CAPITIS ANTICUS MINOR

RECTUS CAPITIS LATERALIS

LONGUS
RECTUS

COLLI
CAPITIS

ANTICUS

MAJOR

GENIO-HYOID

THYRO-HYOID

LONGUS
RECTUS

COLLI

CAPITIS

MAJOR

A'.TlCLiS

DESCENnENS CERVICIS
COMMUNICANS

CERVICIS

OMO-HYOID
LONGUS COLL

RECTUS

CAPITIS

ANTICUS

MAJOR

SCALENUS

ANTICUS

STERNO-HYOID

STERNO

THYROIO

TRAPEZIUS

TRAPEZIUS

SUPRA
clavicular

supra-sternal

SUPRA- ACROMIAL

The Cervical Plexus.

part of the inner lip of

lie

cresl of the ilium

(.">)

posterior surface of the sacrum

external to the spinous processes.

This muscle extends clear to the head by

ami these are its insertion.
Action. To extend the Lumbar spine on the pelvis.
Insertion.-

it-

numerous sub-

divisions

Iilo-costalis.

name from

its

Origin.

(Sacro-lumbalis.)

attachments

From

to

Description. This
the ilium and the ril>s.

the outer part of the Erector spina'.

muscle

take-

its

ANATOMY

274

Into

Insertion.
Lower

IN A NUTSHELL.

the inferior borders of the angles of the six or seven

sometimes may include

It

ribs.

all

the ribs.

Action. To draw down the chest and spine.

Musculus accessorius ad ilio-costalom (ad sacro-lumbalem.) Description.
This muscle is narrow with a serrated margin on each side. It takes its name
from being an accessory to the Ilio-costalis.
Ork;ix. From the upper borders of the angles of the six lower ribs by

separate tendons.

Insertion.
(1) Upper borders of the angles of the six upper ribs,
back of transverse process of the seventh cervical vertebra.
Action. To assist the Erector spina3
Longissimus dorsi. Description. This muscle takes its name from

(2)

its

length and position.

Origin.

Insertion.
(2)

From

(1)

lumbar

processes of the

(1)

the middle part of the Erector spina?, (2) transverse

vertebra*, (3) middle

lamina of lumbar

Tips of transverse processes of

all

fascia.

the dorsal vertebras,

between the tubercles and angles of the lower ribs (seventh to eleventh.)
Action. To draw down the chest and spine.
Description. This muscle takes its name from its atSpinalis dorsi.

to the spines in the dorsal region.

tachment

Origin.

From spinous processes of eleventh

and second lumbar

Insertion.
vertebra

and twelfth dorsal and

Into

the spinous processes of the six or eight upper dorsal

Action.

To extend the dorsal region of the spine.

Description. This muscle takes

Cervicalis ascendens.

position

and

Origin.

its

From angles of the four or upper

Posterior tubercles of transverse processes
five

and sixth cervical vertebrae.

Action. Elevates the ribs,

extends the neck,

to

own

its

name from

its

direction.
ribs.

Insertion.

neck

first

vertebra?.

if

if

of fourth,

fifth

the cervical vertebrae are the fixed point.

the ribs are the fixed point.

If

only one acts

it

It

pulls the

side.

colli (cervicis.)
Description. This muscle takes its name
attachment
to
the
transverse
from
processes, and its insertion in the neck.
Origin. From upper portion of transverse processes of six upper dorsal

Transversalis
its

vertebrae.

Insertion. Posterior tubercles

of transverse processes of the second to

the sixth cervical vertebrae (inclusive.)

Action.
backward.

If

both ad, and the fixed point

Trachelo-mastoid.
origin

and

its

Origin.

DESCRIPTION. This

is

below, they extend the neck

muscle takes

its

name from

its

insertion.
(1)

Transverse processes of

first

five or six dorsal vertebrae, (2)

articular processes of the three or four lower cervical vertebra?.

Insertion.-

Posterior margin of mastoid process of temporal bone be-

ANATOMY

IX A NUTSHELL.

275

neath the insertion of the Splenitis capitis and the Sterno-cleido-mastoid.

Action. If both act, they extend the head backward.
If only one acts it
turns the face toward the shoulder of same side.
Complexus. Description. This muscle takes its name from the complicated arrangement of its muscular bundles.

Origix.
vertebra?

and

Tips

of transverse processes of

and seventh

cervical vertebra

1
,

from two

upper dorsal

to seven

(2) articular processes of fourth, fifth,

sixth cervical vertebrae.

PLATE CXIV.
PHRENIC NERVE

SUPaAST'PULAR HERVE
PNEUMOGASTRIC

SUBCLAVIAN

ARTERY

INNOMINATE

ARTERY

EXTERNAL JUGULAR VEIN

ARTERY

AXILLARY

MUSCULOCUTANEOUS

MEDIAN

SUBSCAPULAR

ARTERY.

*WSOil 0-SP1RAL N

vpROFimni

ARTERY

Thyroid Axis axd Cords of Brachial Plexus.

Insertion.

Into

of the occipital

bone

the innermost depression between the two curved lines

ACTION. If both act they draw the head backward, if only one ads it
draws the head to one side, and with the face turned to the opposite side.
Biventer cervicis.
Description. This muscle is one of the so-called
double bellied muscles, and is situated on the Inner side of the Complexus.
Origin. Transverse processes of from two to four upper dorsal vertebrae.

Insertion. Superior curved line of the occipital bone.

Action. This muscle is a helper to the Complexus.
Spinalis colli.
Description. This muscle is snail and

connects

tic


ANATOMY

276

IN A NUTSHELL.

spinous processes in the cervical region.

This muscle

is

absent in about twenty

per cent of the cases.

(1) Spinous processes of the fifth, sixth, and seventh cervical

occasionally from the first and second dorsal vertebras.
and
vertebrae, (2)
Insertion. Spine of axis and third and fourth cervical vertebrae.
Action. To approximate the spines of the vertebrae.

Origin.

LESSON LXXVII.
Fifth Layer of Muscles of Back.
Description.

Semispinalis dorsi.

This muscle takes

of its inner half being attached to the spine,

and

its

name on account

its

situation in the dorsal

region.

From transverse processes of

Origin.

fifth, sixth,

seventh, eighth, ninth,

and tenth dorsal vertebra?.

Ixskrtion.

Into

the spinous processes of seventh and eighth cervical,

second, third, and fourth dorsal vertebrse.

first,

To erect the

Action.

Semispinalis

spinal column.
Description. This muscle takes

colli.

name from the

its

of its one-half to the spines in the cervical region.

attachment
Origin. Transverse processes of the upper five or six dorsal vertebra?.
Insertion. Into the spinous processes of the second, third, fourth, and

fifth cervical vertebrse.

Action.

To

erect the spinal column.

Description.

Multindus spinas

many

This

muscle takes

name from

its

its

clefts.

Origin.

(1)

Back

of

sacrum

as far as the fourth sacral foramen,

aponeurosis of the Erector spina? muscle,

(3)

posterior sacrc-iliac ligament, (5) articular processes of

ilium, (4)

(2)

Posterior superior spine of the

lumbar ver-

tebras (6) transverse processes of dorsal vertebras, (7) articular prosesses of

three or four lower cervical vertebra?.

Insertion.

Into

the lamina?, and spinous processes of

all

the vertebra?

except the atlas.

Action.

To

preserve the erect position of the spine and to rotate

Description.

Rotatores spinae.

This

muscle takes

its

it.

name from

its

There are generally eleven pairs, but they may be found in the
cervical and lumbar regions.
Origin.- Upper and hack parts of the transverse processes in the dorsal
functions.

region

he

inc.

S]

Insertion.-

Lower border and outer surface

of the first

lamina above the

oi igin.

Action.
to

Assists the

he opposite

Mrlli.idus spina? to rotate the spine, turning the trunk

si le.

Suprasplnales. Description.c(

sses in

he cervical

r<

eion.

These

muscles

lie

on

the

spinous

pro-

PLATE CXV.

FRONTAL

ANT,

TEMPORAL

SUPRAORBITAL

COMMUNICATING
WITH OPHTHALMIC

POST. TEMPORAL

ANGULAR

LATERAL

NASAL-

DEEP TEMPORAL

TRANSVERSE FACIAL
INTERNAL MAXILLARY
OCCIPITAL
INFERIOR

u-

TEMPORO- MAXILLARY

CORONARY

JUGULO -CEPHALIC

Lymphatics and Veins of Neck

277

\\i>

Kace.

ANATOMY

278

IN A NUTSHELL.

Spinous process and external to the process immediately above.

Spinous processes immediately above.
Action. Approximate the spinous processes.
Description. These muscles are six pairs in the cervical
Interspinales.

Origin.

Insertion.

They are in the upper and

There are four pairs between
the five lumbar vertebrae, sometimes one above and one below these pairs.
Origin. Spinous process below.
Insertion. Spinous process above.
region

pair between axis

(first

and third

cervical.)

lower dorsal, but absent in the middle dorsal.

Action.

Approximate

Intertransversales.

the spinous processes.

Description.

In

the cervical region these are best

developed, and are in pairs (anterior and posterior) passing between the anterior

and posterior tubercles

of the tranverse processes.

Between these muscles

There are seven pairs

pass the anterior division of the spinal nerve.

in the cer-

vical region.

In the dorsal region they are not well developed.

middle dorsal.

They

In the lumbar region they are in pairs

are absent in the

one

intertransversales laterales, which are situated between the

cesses.

The other

set called intertransversales

set called the

transverse

pro-

mediales are situated between

the accessory process of one vertebra and the mammillary

process of the next.

In a transverse process below.

Insertion. Transverse process immediately above.
Action. Approximate the transverse processes.
Extensor coccygis. Description. This muscle extends
Origin.

part of the posterior surface of

Origin.

over the lower

sacrum and coccyx.

Last sacral or first coccygeal vertebra.

Insertion. Lower part of the coccyx.

Action.

To extend

the coccyx.

Rectus capitis posticus major.

as

it

Description.

This muscle becomes broad

ascends.

Spinous process of
Inferior curved of the occipital bone and surface of bone
below.
Action. To rotate the cranium with
around the odontoid process
Origin.

axis.

Insertion.

line

atlas,

of the axis.

Rectus capitis posticus minor.

Description.

This muscle

is

the smallest

of the muscles in this region.

Tubercle on posterior arch of

Occipital bone beneath the
Action. To draw the head backward.

Origin.

atlas.

Insertion.

Obliquus capitis superior.

Description.

inferior

This

curved
muscle

line.

is

narrow below

but wide above.

Origin.

Upper surface of transverse process of

Occipital bone between the superior and inferior curved
atlas.

Insertion.
external

to

ACTION.

the Complexus.

To

draw the head backward and rotate cranium.

lines

PLATE CXVI.

PALPEBRASUM

ORBICULARIS

ANGULAR
NASI

LATERALIS

ORBICULARIS
ORIS

.N^-

#Hs

Mmm
Ir^T
ASCENDING

HYPO-GLOSSAL

WWi'M

-'7

i.'-V

PHARYNGEAL

'A

LOOP OF COMMUNICATION BETWEEN

HYPO-

STERNO HYOIDGLOSSAL
CRICOID

THYROID

A.

'

*~

<

Or "l\\\ \C

STERNO THYROID-

The External Carotid Artery.

279

N.

AND

CERVICAL

PLEXU!

ANATOMY

280

IX A NUTSHELL.

Description.

Obliquus capitis inferior.

This

muscle

is

larger than the

superior one.

Origin.Apex
Insertion.
A.<

riON.

To

The -kin
The

of axis.

Lower and back

part of transverse process of atlas.

rotate the arias with cranium.

of the

back

is

supplied by posterior divisions of spinal nerves.

internal branch of the posterior divisions of the upper six dorsal uerves are

cutaneous, while the external branches of the posterior divisions of the lower
The external divisions of the upper and
six dorsal nerves are cutaneous.
the internal divisions of the lower six have no cutaneous distribution.
The sacro-vertebral articulation is supplied by the fourth and fifth lumbar and

sympathetic nerves.

The

costo-central articulations are supplied by the an-

The costotransverse articulations are supThe sacro-iliac articulations are supplied by the posterior divisions of the first and second sacral
The saero-eoccygeal
nerves, the superior gluteal nerve, and sacral plexus.
articulation is supplied by the fourth and fifth sacral and coccygeal nerves.
The ribs and vertebra' an- supplied by the gray rami communicantes.
terior divisions of the spinal nerves.

the posterior division- of the spinal nerves.

plied by

LESSON LXXVIII.
Triaxoles of the Neck.

The

side of the

neck

is

in

(Plate XIV.)

the form of a rectangle, bounded, above by the

lower margin of the jaw-bone and a line continued from the angle of the jaw to
the mastoid process; below, by the clavicle; posteriorly, by the Trapezius; and

median line of the neck. This rectangle is divided into two

by the Sterno-cleido-mastoid. The anterior one is bounded in front
by an imaginary line behind by the Sterno-cleido-mastoid. and above by the
lower jaw-bone.
The posterior one i- bounded in front by the Sterno-cleido-

anteriorly by the
triangles

mastoid, behind by the Trapezius, and below by the clavicle.

The Omo-hyoid

divide- these triangles into two others

and the Digastric divides the upper one

of the anterior triangles into two other triangles.
The Digastric pierces the
Stylo-hyoid which help- to make the boundary line of the sub-maxillary triangle.
Then these muscles divide the rectangle on the side of the neck into five
(li Tin. [nferiok carotid triangle, or triangle of necessity,
triangles,
of Ml -(
I.\i; TRIANGLE.
(2) TtlE SUPERIOR CAROTID TRIANGLE, or TRIANGLE
01 ELECTION.
SUBMAXILLARY, Or DIGASTRIC TRIANGLE. (4) THE
(3) Till.
OCCIPITAL TRIANGLE.
(5) Till. SUBCLAVIAN, Or SUPRACLAVICULAR TRIANGLE.
All these five triangles have a roof, boundary lines, and contents.
The roof of
them b made by skin, superficial fascia. Platysma myoides, and deep fascia.
The Inferior carotid triangle in addition to this has the superficial cervical nerve
!

ramifying

in

it-

roof.

Righl beneath this roof are the Sterno-hyoid and Sterno-

By -one these two muscles are called the floor, hut the Longus colli
and Scalenus amicus and pari of the Rectus capitis anticus major form the floor.
This triangle is bounded in fhont by the median line. above by the anterior
thyroid.

PLATE

CXVII.

FRONTAL SINUS

PRINCIPES CERVK.S
A

BRANCH OF OCC.PITAL

ASCENDING PHARYNGEAL

PROFUNDA CERVi:iS
STERNO-MAS'OiD

CRICOID

CARTILAGE

FIRST RIB

TRACHEA
SUP. INTERCOSTAL

1ST

AORTIC

SECOND

Til E

[NTERNAL

'

VROTID A.RTERY.

2.SI

RIB.

INTERCObML

ANATOMY

282
belly nf the

IN A NUTSHELL.

Omohyoid, and below by

the inferior part of the Sterno-cleido-

beneath the anterior border of the Sterno-cleido-mastoid is the

common carotid sheath which is described in connection with this triangle,
although it is under this muscle. This sheath contains the common carotid
artery internally, the internal jugular vein externally, and the pneumogastric
nerve between the two but on a plane posterior to them. This sheath is boundmastoid.

.lust

i\ front by branches from the loop of communication; on the inner side

by the trachea, thyroid gland, and the lower part of the larynx; behind by
the inferior thyroid artery, re< urrent laryngeal nerve and the sympathetic nerve.

ed

The second

is bounded
Omo-hyoid; behind by the Sterno-cleido

triangle, superior carotid, or triangle of election,

below by the anterior

mastoid; above by the

belly of the

Digastric.

Platysma myoides, and deep

fascia.

Its roof

is

made of skin, superficial fascia,

made of four muscles, Thyro-

Its floor is

hyoid. Hyo-glossus, Inferior constrictor, and Middle constrictor.

The external

carotid artery has eight branches, five of which are in this triangle, viz., superior

and occipital, with their correswhich empty into the internal jugular, except the occipital

thyroid, lingual, facial, ascending pharyngeal,

ponding

veins,

all

of

may empty into the external jugular.

The third triangle, or digastric, or submaxillary niangle, is bounded in fkont
by the anterior belly of the Digastric; behind by the Stylo-hyoid perforated by
the posterior belly of the Digastric; and above by the mandible and a line drawn
from the angle of the jaw to the mastoid process. Its roof is made of the skin,
superficial fascia, Platysma myoides, deep fascia, with the seventh nerve ramifying in it.
Its Moor is formed by the Mylo-hyoid ami Hyo-glossus.
This
triangle is divided into two other triangles by the Stylo-maxillary ligament,
the anterior one of which contains the submaxillary gland and the posterior
which

one contains the parotid gland.

The

bounded in front by the Sterno-cleido-mastoid,

and behind by the Trapezius.
Its roof is made of the skin, superficial fascia, Platysma myoides, and deep
fascia.
Its floor from above downward and inward is formed by the Splenius
capitis, Levator anguli scapulae, Scalenus posticus and Scalenus medius.
The
spinal accessory nerve crosses this triangle from the Sterno-cleido-mastoid to
the Trapezius.
A row of lymphatic nodes lie along the posterior border of the
occipital triangle

below by

is

the posterior belly of the Omo-hyoid,

Sterno-cleido-mastoid

in

this

triangle.

The subclavian or supraclavicular triangle is bounded above by the posterior belly of the )mo-h void. in front by the Sterno-cleido-mastoid, and below
by the clavicle.
Its roof is made by the skin, superficial fascia, Platysma
myoides, and deep fascia and has the suprascapular vessels and nerve lying in
Its floor is made of the digitations of the Serratus magnus, Scalenus posit.
<

ticus.
in

Scalenus medius, and part of the

first rib.

It

has a few lymphatic glands

it.

Tiir.

Suboccipital Triangle.

(Plate CXI.)

The suboccipital triangle is bounded EXTENALLY by the Superior oblique;

below by the Inferior oblique,and internally by the Rectus capitis posticus
major.
The floor of this triangle is formed by the posterior occipito-atlantal

PLATE

CXVIII.

POSTERIOR COMMUNICATING
RIGHT POSTERIOR

CEREBRAL

MIDDLE CEREBRAL
LEFT POSTERIOR

CEREBRAL

RIGHT ANTERIOR CEREBRAL

OPHTHALMIC

OCCIPITAL

ARTERY

ARTERY

PRINCEPS CERVICIS

BRANCH

SUPERFICIAL

OF

PRINCEPS

CERVICIS

ASCENDING CERVICAL

TRANSVERSE CERVICAL
POSTERIOR SCAPULAR

ACROMIAL

BRANCH
BRANCH

SUBSCAPULAR
SUPRASPINOUS
ANTERIOR

BRANCH

CIRCUMFLEX
'"

INFRASPINOUS BRANCH
POSTERIOR CIRCUMFLEX

LONG

THORACIC

SUBSCAPULAR
DORSAL SCAPULAR
INFRA SCAPULAR

BRANCH

SUBSCAPULAR

SECOND

AORTIC

NTERCOSTAL
THIRD

AORTIC
INTERCOSTAL.

The Arteries From Arch of Aokta to Circle of

283

Willis.

ANATOMY

284

IN A NUTSHELL.

ligament and the posterior arch of the atlas, and its roof is made by the ComThe vertebral artery lies in a groove on the upper surface of
plexus muscle.

The suboccipital nerve enters

the posterior arch of the atlas in this triangle.
and
the
arch of the atlas.
The deep
artery
this triangle between the vertebral
cervical vein begins in this triangle.

LESSON LXXIX.
Arteries.

The pulmonary

artery (Plate

base of the right ventricle

'XXVIII)

in front of

from the

arises

the aorta.

ward,beingtotheleftsideandin front of the ascending aorta.

inches long and ends under the transverse aorta where

pulmonary artery and the

left

ing aorta are enclosed in a

pulmonary

common

artery.

it

left

side of the

upward and back-

passes

It

It is

about two

divides into the right

This artery and the ascend-

prolongation of the serous pericardium.

right pulmonary artery, which is larger and longer than the left, passes
behind the ascending aorta and the superior vena cava where it pierces the
It divides into the branches at the root of the lung, one branch
pericardium.
being for the upper lobe of the light lung and the other for the lower lobe.
The branch which passes to the middle lobe is derived from the upper branch.

The

pulmonary artery passes in front of the descending aorta and the

to end in the root of the left lung where it divides into an upper
branch for the upper lobe and a lower branch for the lower lobe.
The remains of the ductus arteriosus passes from the left pulmonary artery

The

left

left

bronchus

to the inferior surface of the transverse aorta.

The aorta begins

to the right,
lefl

at

the upper part

then arches to the

it

side of the vertebral

column

left

e>f

the

'

Ascending,

(2)

It

now

elescends on the

through the aortic opening of the

fourth lumbar vertebra where it elivides

Diaphragm and it ends opposite the'

and left common iliac artery.
1

and passes upward

ventricle

to pass

The aorta has the following

into a right
sions;

left

and backward.

divi-

Transverse, (3) Descending, and this elescending por-

The part above the Diaphragm

below the Diaphragm is the abdominal aorta.
The ascending portion commences behind the left half of the sternum at the
It passes obliquely uplevel of the lower border of the third costal cartilage.

tion
is

is

divided into thoracic and abdominal.

the thoracic aorta

ward and forward

and the

pari

to the righl

where

righl chondro-sternal articulation.

The Relations
I.\

of the

it

ends

is

at the

upper boreler

about two inches

second

of the

in length.

Ascending Aorta are:

Front. (1) Pulmonary

Pericardium,

It

artery,

(2)

Righl pleura and lung, (5)

Right

auricular

Remains

Behind. (1) Righl pulmonary artery. (2) Left

Righi Side.
(1) Superior vena cava, (2) Right
Left Side.- Pulmonary artery.

of

appendix.

(3)

thymus gland.

auricle.

auricle.

The Transverse aorta (arch) (Plate CXXVIII) is a continuation of the

ascending aorta from the upper bonier of the second right e'hondro-sternal
articulation.

It

arches to the

left

and backward with

its

e-onvexity

upward

ANATOMY

2v")

IN A NUTSHELL.

lower border of the fourth dorsal vertebra from

which place it is called thoracic aorta. The upper border of the arch is about
an inch below the upper margin of the sternum.
Relations of the Arch of the Aorta.

and ends

at the left side of the

Above.

Left innominate vein. (2) Innominate artery. (3) Left caro-

(1)

Left subclavian artery.

tid artery. (4)

PLATE CXIX.
ANTERIOR JUGULAR VEIN

OUTER

COMMON CAROTID ARTERY

INTERNAL

JUGULAR

CERVICAL FASCIA.

MIDDLE CERVICAL FASCIA.

VE

.COMMON CAROTID ARTERY

UGULAR

VEIN

PNEUMOGASTRIC
NERVE

The Cervical

Below. (1)
arteriosus,

(3)

and

f1

(5)

[n

L<

Eifurcaticn

Superficial

Fascia.

pulircnary

cf

cardiac

plexus,

(4)

artery.
Lef1

(2)

Remains

cf

.hums

recurrent laryngeal nerve,

bronchus.

Front. (1)

Pleurae

and

lungs, (2)

Remains

of

thymus

gland,

(3)

Left,

ANATOMY

286

pneumogastric nerve,

(4)

IN A NUTSHELL.

Left phrenic nerve, (5) Superficial cardiac

nerves

(6) Left superior intercostal vein.

Behind.

Trachea,

(1)

(2)

Deep cardiac

plexus,

(5) Left recurrent laryngeal nerve.

The Relations of the Thoracic Aorta are: (Plate

Oesophagus,

(3)

(4)

Thoracic duct.

Front.

I\
]

Haphragm.
Behind.

(1)

Root

of left lung,

(2)

CXXVIII.)

Pericardium,

(3)

Oesophagus,

(4)

Vertebral column, (2) Superior and inferior azygos minor

(1)

veins.

Right Side. (1) Oesophagus (above), (2) Vena azygos major, (3) Thoracdud.
Left Side. (1) Pleura, (2) Left lung, (3) Oesophagus (below.)
The ascending aorta has the right coronary and the left coronary artery
which have been described with the heart. The branches of the arch of the
ic

aorta arc (1) innominate, (2)

common

left

branches of the thoracic aorta are

geal.

(4)

carotid, (3) left subclavian.

The

pericardiac, (2) bronchial, (3) oesopha-

(1)

posterior mediastinal, (o) intercostal.

LESSON LXXX.
The innominate artery often

called

brachio-cephalic

opposite the fourth dorsal vertebra just in front of the

It is

the largest of the branches of the arch of the aorta.

of the right

sterno-clavicular articulation

carotid and the right subclavian.

its

beginning

common

carotid.

At the upper border

divides into the right

common

from an inch and a half to two inches

but the thyroidea ima may arise from it.

It is

long and has no branches as a rule,

The Relations

it

has

left

innominate artery are as follows;

Sternum. (2) Sterno-hyoid and (3) Sterno-thyroid muscles,
(4) Remains of the thymus gland. (5) Left innominate vein, (6) Right inferior
thyroid vein, (7) Inferior cervical cardiac branch from right pneumogastric
1\

Front.

of the

(1)

nerve.

Behind.

Trachea.
Right

Right Side.

(1)

innominate vein,

(2)

Right pneumogastric nerve.

Pleura.

Left Side.
Lef1

(1)

Remains

inferior thyroid vein,

The

rijrht

innominate

at

common

(4)

of

thymus gland.

(2)

Left carotid artery,

carotid artery (Plates

CXVI-CXVII)

arises

from the

the upper border of the right sterno-clavicular articulation.

passes obliquely

(3)

Trachea.

upward and divides

into the external carotid

and

It

internal

carotid at the upper border of the thyroid cartilage opposite the fourth cervical
vertebra.

The

left

common

the aorta and passes

carotid artery comes from the highest part of the arch of

upward behind the left slerno-calvicular articulation to

divide into the external carotid and internal carotid at the upper border of the

thyroid cartilage opposite the fourth

enclosed

in

common

cervical

vertebra.

These arteries are

sheath of cervical fascia with the internal jugular vein

ANATOMY
and pneumogastric nerve.

The

IX A NUTSHELL.

287

internal jugular vein lies external to the artery

while the pneumogastric nerve is between the internal jugular vein and common carotid artery but on a plane posterior to them. Occasionally a thyroid

branch passes from

The Relations

this artery.

of the Left

Common

Carotid Artery in the thorax

is

as fol-

lows:

Ix Front.

Sternum,

(1)

(2)

Sterno-hyoid and

(3)

Sterno-thyroid muscles.

PLATE CXX.
SUPERIOR CORNU

THYROID

OF

CARTILAGE

CRICOID CARTILAGE

The Trachea.
(4)

Left innominate vein, (5)

Behind. (1) Trachea.

clavian

of

thymus gland.

Oesophagus,

(1)

Innominate

artery,

Remains of thymus gland.

Externally. (1) Left pneumogastric

lung. (4)

(3)

Thoracic duct.

(2)

Inferior

Left sub-

(4)

artery.

Internally.
(3)

Remains

(2)

Left subclavian artery.

nerve,

(2)

thyroid

Left

veins.

pleura,

(.'!)

(3)

Left

ANATOMY

288

NUTSHELL

IN A

LESSON LXXXI
The Relations
arteries

of the

Right

Common

Carotid and the Left

Common

Carotid

the neck).

tin

Front. (1) Integument, (2) Superficial fascia, (3) Deep cervical

fascia, (4) Platysma myoides, (5) Sterno-mastoid, (6) Sternohyoid. (7) Sternothyroid. (8) Omo -hyoid, (9) Descendens and Communicans nerves. (10
Sterno-mastoid artery. (11) Superior thyroid vein, (12) Middle thyroid vein..
I\

Anterior jugular

13)

Behind.

(1)

vein.

Longus

pathetic nerve, (4)

colli,

Rectus capitis amicus major,

(2)

Inferior thyroid artery.

(.">)

Sym-

(3)

Recurrent laryngeal nerve.

(2) Pneumogastric nerve.

gland,
Thyroid
(1)
(3) Recurrent laryngeal
(2)
Pharynx.
Larynx.
artery.
(6)
(5)
nerve. (4) Inferior thyroid
The common carotid arteries at the root of the neck are close together and

Externally. (1)
Internally.

iii

Internal

jugular vein.

Trachea,

neck they become separated and are more

and the pneu-

ply situated, but higher in the

superficial.

The common

mogastric nerve

all lie in

carotid artery, internal jugular vein

a

common

sheath.

branch from the common carotid artery at

The
from which place it runs upward
cartilage,
thyroid
border
of the
the upper
between
external
the
auditory meatus and the
then
backward
and forward,
now divides into a superIt
jaw).
mandible
(lower
of
the
neck of the c< ndyle
external carotid artery

is

temporal and internal maxillary

ficial

arteries.

It lies in

the superior caroitd

and passes through the substance of the parotid

It is superficial to
and nearer to the median line of the neck than the
The branches f the external carotid
carotid artery at its beginning.

triangle (triangle of (lection)

gland.
internal

artey

are,

branches;

<

(1)
(4)

superior
occipital

thyroid.
,(5)

(8)

interna]

(2)

(3)

which are anterior

facial,

posterior auricular, which are posterior branches;

-rending pharyngeal, which

poral,

lingual.

an ascending branch;

is

maxillary, which

are'

(7)

superficial

tem-

terminal branches.

LESSON LXXXI I.
The superior thyroid branch

(Plate

CXVI.)

arises

just

below the great

cornu of the hyoid bone, and passes inward and upward across the superior

downward and forward to the upper

under the Sterno-hyoid, Sterno-thyroid
and Omo-hyoid muscles. Besides giving branches to these muscle's and the
thyroid gland,
gives off (1) a hyoid branch which passes along the' lower
border of the' hyoid bone'.
(2) Sterno-mastoid branch, also called superficial des< ending, which passes to the Sterno-mastoid muscle after running
downward and outward across the sheath of the' common carotid artery. (3)
carotid triangle from which place

it

passes

part of the thyroid gland, after passing

it

Superior laryngeal, which passes with the superior laryngeal nerve

to the

PLATE CXXI.

BAND
HTOID

CONNECTING

THYMUS WITH

BONE

The Heart, Thyroid Gland (and Lungs Turned Outward).

289

ANATOMY

290

IX A NUTSHELL.

(4) Cricothyroid branch which

membrane.
runs across the cricothyroid
The lingual artery (Plate CXVI.) first passes obliquely upward and inward across the Middle constrictor muscle to the greater cornu of the hyoid

larynx

under the Thyro-hyoid muscle.

bone.

It

now

passes horizontally forward on the Middle constrictor muscle

PLATE CXXII.
GRFATER CORNU OF HYOID BONELESSER CORNU OF HYOID BONE
MEDIAN
PORTION
OF
THYRO-HYOID
MEMBRANE

K'F> GHIT!-S //

INTERNAL

LARYNGEAL NERVE

SUPERIOR LARYNGEAL ARTERY

SUPERIOR

POMUN ADAM

THYROID
THYROID

CRICO-THYROID

LEVATOR

GROOVE FOR SUBCLAVIAN

ARTERY

GLANDULAE

ARTERY
CARTILAGE

MEMBRANE
THYROIDEA MUSCLE

GROOVE FOR SUBCLAVIAN

ARTERY

Anterior View of Lungs.

under the tendon of the Digastric muscle. Stylo-hyoid and the Hyo-glossus
The Hyo-glossus muscle separates the lingual artery and the twelfth
muscle.
cranial nerve (hypoglossal).
The artery now passes vertically upward between
the Hyo-glossus and Genio-hyo-glossus to the under surface of the tongue where
it takes the name of ranine artery.
In this position it accompanies the lingual
nerve, lying on or internal to the Lingualis muscle.
It gives off (1) a hyoid

ANATOMY

IN A NUTSHELL.

291

branch, which runs along the upper border of the hyoid bone, (2) dorsalis
lingile branch, which passes upward under the Hyo-glossus muscle to the
dorsum of the tongue, (3) a sublingual branch, which passes on the Geniohyo-glossus muscle to the sublingual gland, (4) the ranine branch.

CXVI.) comes from the external carotid just above

upward under the Digastric
and Stylo-hyoid muscles, it then passes forward in a groove on the posterior
The

fascial artery (Plate

the origin of the lingual artery and passes obliquely

surface of the submaxillary gland.

much

This

of the artery

is

called the cer-

then passes upward over the lower jaw at the anterior margin
of the Masseter muscle to the angle of the mouth.
This portion of the artery
vical portion.

is

It

called the facial portion.

It

now

runs upward along the nose and ends at the

PLATE CXXIII.

fe't^

'

UPPER
'" LOB

Rft&nefl

'

/Vj-OWER LOBEJ, f,

will
Posterior.
inner canthus of the eye.
tion.

The

View of Lungs.

This portion of the artery

facial artery lies just

under the

is

called angular

superficial muscles

and has

por-

very

tortuous course.

The branches

of the facial artery given off in the neck arc (I)

[NFERIOR

or ascending palatine, which passes between the Stylo-glossus and Stylo-

pharyngeus muscles to the outer side of the pharynx where it divides into two
branches, one of which runs through the Superior constrictor muscle and the
other branch passes over this muscle.
(2) The tonsillar branch which
passes between the Internal pterygoid and Stylo-glossus muscles and after
piercing the Superior constrictor passes to the tonsil.

(3)

The submaxillary

ANATOMY

292

IN A NUTSHELL.

branches, which are three or four in number, pass to the submaxillary gland.
(4) the submental branch, which runs forward on the Mylo-hyoid muscle
and under the Digastric muscle to the symphysis where it divides into a superficial and deep branch which pass over and under the Depressor labii inferioria
muscle to the lip.
(5) Muscular branches which pass to the adjacent muscles.

The branches

of the facial artery given off on the face are, (1) inferior
which runs under the Depressor anguli oris muscle to the lower lip, (2)
[NFERIOR CORONARY which runs in a very tortuous course along the edge of

lab]

\i.

PLATE CXXIV.
COMPLEMENTAl

12
AIR

CUBIC INCHES

THAT CAN BE.BUT SELDOM IS.TAKEN

TIDAL
T0

20
AIR

30

TAKEN AND SENT

J0
AIR

Showing
the lower

lip,

(3)

AIR

CAN BE.BUT SELDOM

BREATH

CUBIC INCHES

THAT

IN

AIR

CUBIC INCHES
OUT AT EACH

RESERVE

AIR

A|R

IS

DRIVEN OUT

AIR.

CUBIC INCHES

THAT CANNOT BE DRIVEN OUT

tin:

Capacity of the Luncs.

SUPERIOR CORONARY, which

is

larger anil

than the inferior coronary, runsalong the edge of the upper

more tortuous even

lip andgives branches

and (c) the artery of the
il' Lateralis nasi which passes to the ala and dorsum of the nose.
ala.
(5)
angular which passes to the inner angle of the orbit, (6) muscular which

(a) to

tIi*

nose, (b) the inferior artery of the septum,

pass to the adjacent muscles.

ANATOMY

IN A NUTSHELL.

293

LESSON LXXXIII.
The

posterior belly of the

glossal)

winds around

CXVI)

is a branch from the external carotid

passes under the Stylo-hyoid muscle and the
Digastric muscle.
The twelfth cranial nerve (hypo-

occipital artery (Plate

opposite the facial artery and

it.

it

This artery passes upward across the spinal acces-

sory nerve and the internal carotid sheath to the space between the mastoid
process of the temporal bone and the transverse process of the atlas.
It now

runs backward in the occipital groove on the mastoid process and pierces the
and passes upward in a tortuous course to the

origin of the Trapezius muscle

PLATE CXXV.

PLEURA

Showing Pleur.e and Root of the Lungs.

accompanied by the greal occipital nerve in the last part of its
Complexus muscle separates the artery and nerve at the
beginninu'.
Its branches are, (1) sterno-mastoid, which passes over the hypoglossal nerve to the Sterno-cleido-mastoid muscle, (2) AURICULAR, which passes
vertex, being

while the

course,

to the

men

hack of the concha, and

it

may

send a branch through the mastoid fora-

meningeal, which passes through the jugular

foramen to the dura mater. t) ARTERIA PRIN< EPS CERVIGIS, which descends
along the back of the neck ami divides into two branches, (a) the superficial
<me which passes under the Splenius to anastomose with the superficial cervical
from the transversalis colli, (b) the deep branch runs under the Complexus
to

the dura

mater.

(3)

ANATOMY

294
muscle
(5)

to

anastomose with the deep cervical from the superior intercostal.

Muscular branches
The

IX A NUTSHELL.

to the adjacent muscles.

posterior auricular artery (Plate

CXVI.)

is

branch of the external

carotid which arises opposite the apex of the styloid process of the temporal

bone and passes between the facial nerve and spinal accessory nerve under the
parotid gland into the groove between the mastoid process of the temporal
In me and the cartilages of the ear where it divides into auricular and mastoid
(parotid), (3)
Its branches are (1) muscular,
branches.
(2) glandular
stylomastoid which passes through the stylo-mastoid foramen to (a) the
tympanum, (b) mastoid cells, (c) semicircular canals, and it anastomoses with
the tympanic branch of the internal maxillary and the petrosal branch of the

middle meningeal, (4) Auricular branch to back of the ear, (5) mastoid to
the scalp above and behind the ear.
The ascending pharyngeal branch (Plate CXVI.) is the smallest and most
deeply seated of the branches of the external carotid and arises from near the
It passes upbeginning of the artery (sometimes from the internal carotid).

PLATE CXXVI.
BRONCHIAL TUBE

Air Cells of the Lungs.

ward to the base

pharynx and the

of the skull

on the Rectus

internal carotid artery.

major between the

(1) prevertebral,
the spine, (2) pharyngeal,

capitis anticus

Its

branches are

which passes to the structures on the front of

which pass to the Constrictor muscles and one of its branches passes along the
Eustachian tube to the tympanum. (3) Meningeal branches which pass to
the dura mater through (a) middle lacerated foramen, (b) posterior lacerated
foramen,

The

(c)

anterior condyloid foramen.

superficial temporal

parotid gland and passes

branch arises from the external carotid in the

the posterior root of the zygoma above

upward over

Its
temporal and posterior temporal.
small ones to the parotid gland. (2) articular ones to the
lower jaw, (3) muscular ones to the muscles, (4) anterior temporal which
runs forward to structures on the frontal bone, (5) posterior temporal which

which

it

divides into the anterior

branches are

(1)

ANATOMY

IN A NUTSHELL.

295

runs upward and backward to structures on the side of the parietal bone, (6)
transverse facial branch which crosses the Masseter muscle and passes be-

tween the zygoma and the duct of the parotid gland (Stenson's) to the side of
the face. (7) middle temporal which passes just below the zygoma through the
temporal fascia to the muscle, and sometimes it sends an orbital branch along
the upper border of the zygoma, (8) an auricular branch which passes to the
external meatus and the front of the ear.

PLATE CXXVII.
S

INTERNAL MAMMARY

TE

= '.-'

VESSELS

INTERNAL MAMMARY

VESSELS

LEFT PHRENIC NERVE

PHRENIC

RIGHT

PARIETAL PLEURA

NERVE

PNEUMOGASTRIC NERVES

VISCERAL PLEURA

OESOPHAGUS

VENA AZYGOS MAJOR

THORACIC DUCT

BODY OF DORSAL VERTEBRA

A Transverse

Section of the Pleur.e Through Root of Lungs.

LESSON LXXXIV.
The

internal maxillary artery (Plate

CXV1)

passes from the external carotid

artery through the parotid gland to the inner side of the neck of the condyle
of the lower jaw.

It

now

passes forward and inward along the lower border of

the external pterygoid muscle and crosses the inferior dental nerve and

uated between the internal

much

of the artery

is

lateral

called maxillary portion.

ward over the outer surface

of the artery

is

its

called pterygoid portion.

terminal branches.

It

now

passes

of the Internal pterygoid muscle

It

now

is

sit-

This

upward and forand this portion

passes between the heads of

the spheno-maxillary fossa where it divides

This portion of the artery is called spheno-maxillary

the external pterygoid muscle

into

ligament and the ramus of the jaw.

in

portion.

The branches of the maxillary portion are (1) tympanic which passes upward behind the articulation of the lower jaw through the Glasserian fissure
to the ear

drum.

This artery together with the Stylo-mastoid artery forms a

vascular circle around the ear drum.

(2)

A DEEP auriculae branch which

296

ANATOMY

IN A NUTSHELL.

passes to the externa]

M,A,X " :u
,

meatus and outer surface of the drum

BRANCH which P^es upward between the
roots

temporal uerve
,

(a) a posterior

(3)

Middlb

of the auriculo*
divides into two branches

to enter the foramen spinosum. It

uow
one which crosses the squamous portion
of the temporal bone.

PLATE CXXVIII.
WGHT

COMMON CAROTID ARTERY

RIGHT INTERNAL JUGULAR

INFERIOR THYROID

LEFT
RIGHT VERTEBRAL

VEINS

VEIN

COMMON

CAROTID

VEIN

LEFT INTERNAL JUGULAR

RIGHT

j^EFT

SUBCLAVIAN

VERTEBRAL

VEIN

ARTERY
LEFT SUBCLAVIAN

R'GHT

INTERNAL

MAMMARr"VEIN

LEFT

INTERNAL

MAMMARY

VEIN

LEFT SUPERIOR
INTERCOSTAL VEIN

ARTERIOUS

RIGHT PULMONARY

LEFT PULMONARY

AURICULAR

APPENDIX

AURICULAR APPENDIX

Arch of Aorta and Heart.

(b) the

,n "

IarSer

and

crosses the great wing of the sphenoid

to the
the anterior inferior angle of the parietal
where it divides into branches
7 ^
*'" ''" dura mater and inner
surface of the cranium, it also sends
branches to
the Gassenan ganglion and the dura mater,
and a branch to the facial nerve
through the hiatus Fallopii, this branch is
called petrosal.
It has orbital

00

:"";

ta

ANATOMY

IN A NUTSHELL.

297

branches which pass through the sphenoidal fissure and temporal branches
which pass through foramina in the great wing of the sphenoid to the temporal
fossa.
It
(4) Small meningeal may be a branch of the middle meningeal.
passes through the foramen ovale to the Gasserian ganglion.
(5) Inferior

dental passes with the

interior dental nerve of the fifth cranial nerve into the

inferior dental canal to the

(a)

mental foramen where

it

divides into two branches,

the incisor branch which passes to the incisor teeth and adjacent structures,

and (b) mental branch which runs through the mental foramen
A mylo-hyoid which arises at the inferior dental foramen passes
hyoid groove of the lower jaw to the Mylo-hyoid muscle.

to the chin.
in

the mylo-

PLATE CXXIX.

Showing Circulation of the Blood Through the Heart.

Pterygoid portion gives off (1) ANTERIOR DEEP TEMPORAL and (2) POSTERIOR deep temporal, which branches pass under the temporal muscle to the
temporal fossa, (3) pterygoid branches to the Pterygoid muscles. (4) M w-

BETERIC branches which pass through the sigmoid notch to the Masseter musBUCCAL branch which passes between the ramus and the Internal pterygoid muscle to the outer surface of the Buccinator muscle.
The spheno-inaxillary portion gives off (1) alveolar or POSTERIOR dental
cle, (5)

branch, which runs

to (a) the tuberosity of the superior maxillary hone, (b)

posterior dental canals, (c) alveolar process, (d) gums.

which

arises

with the posterior dental runs

in

(2)

[nferior orbital

the inferior orbital canal to the

ANATOMY

298

and

face

gives off in the canal orbital branches to the orbit

it

to the anterior

branches

IN A NUTSHELL.

dental canals, to the

antrum and

and anterior dental

teeth.

(3.)

Descend-

ing palatine which d( Mends in the posterior palatine canal and runs forward
in a groove on the hard palate then up through the foramen of Stenson.
(4)
Vidian branch passes backward through the vidian canal to the pharynx and

Eustachian tube, sending a branch to thetypanum.

(5)

Pteh * go-palatine which

runs through the pterygo-palatine canal to the pharynx and Eustachian tube.
(6)

Spheno-palatine which runs through the spheno-palatine foramen

to the

divides into external branches which pass to the lateral

of the

Dose.

It

walls

nose and the nasi -palatine branch which descends on the septum to the fora-

men

of Stenson.

PLATE CXXX.

DECUSSATING

FIBROUS

TISSUE OF VALVE

CORPUS ARANTII

FREE EDGE OF VALVE

Semilunar Valves. (Aortic.)

LESSON LXXXV.
The
The
canal

in

the atlas and

the

This

lateralis,

From

the atlas.

it

Three Cervical Nerves.

the sinus atlantis beneath the vertebral artery, to the inner side of the

Rectus capitis

with

First

anterior branch of the First Spinal nerve (suboccipital) leaves the spinal

and

this point

to the
it

outer side of the upper articular process of

descends to the front of the transverse process of

mutes with the upper branch

first,

loop of the Cervical plexus.

nerve receives

of the

second nerve thus making

(Plate (XIII).

from the sympathetic as it crosses the

foramen in the transverse process of the atlas. Prom the loop between the
lii-l and second libers pass to the twelfth cranial nerve, which unite with fibers
from it and descend to form the descendens hypoglossi. Other fibers from this
first

a filament,

loop join the tenth cranial nerve and the sympathetic, also pass to the Rectus
capitis lateral)-

and the Rectus capitus anticus major and minor.

The

anterior

PLATE CXXXI.

INTERNAL JUGULAR VEIN

SUBCLAVIAN VEIN

INTERCOSTAL NODES

INTERCOSTAL ARTERY
VEIN AND
NERVE

RECEPJACULUM 'CHYL

mx

mm
flyf

LUMBAR GLANDS OR NODES

Ijgjn
,

;A

W^

ya|*TH

LUMBAR

Hff

"I

The Thoracic Duct and Azygos

'299

Veins.

ANATOMY

300

IN A

NUTSHELL.

division of the suboccipital nerve sends filaments to the occipito-atlantal articulation and the mastoid cells of the temporal hone.

The posterior branch of the suboccipital nerve is larger than the anterior
branch and does not divide into interna] and external divisions, (Principle II, Page
does the anterior branch, in the sinus atlantis
26). h leaves the spinal canal, as
beneath the vertebral artery, then

it

PLAT!-:

passes

backward

into the suboccipital

(XXXII.

THYROHYOID MUSCLE

MEMBRANE

THYROHYOID

THYROID CARTILAGE
t

OMO-HTOID

STERNO THYROID
STERNO-MASTCID

CRICOTHYROID MEMBRANE

CRIC0- THYROID

RIGHT

CRICOID

MUSCLE

OESOPHAGUS

CAROTID ARTERY

COMMON

LEFT

FIFTH

INNOMINATE

LEFT

OF CLAVICLE

SECTION OF

RECURRENT NERVE
SUSPENSORY LIGAMENT

LEFT

RIGHT PNEUMOSASTRIC NERVE.

INTERNAL JUGULAR VEIN
RIGHT

btCIION

CARTILAGE

VEIN

RIB

SECTION IF FIRST niR

LEFT INTERNAL

MAMMARY ARTERY

Thymus Gland of Fetus.

t

riangle

and supplies the musch

Inferior oblique, Rectus ca]

ti!-

Ltis

whi< h form the triangle, viz.. Superior oblique,

posticus major.

capitis posticus minor, also to the

triangle.

It

join,-

it

sends a branch to the Recof the

the internal division of the posterior branch of the second

cervical nerve which

oblique, and

It

Complexus which makes the roof

communicate

sometimes gives

:i

through or over the Inferior

cutaneous branch to the skin of the lower

n pass< s either

ANATOMY

IX A NUTSHELL.

301

part of the scalp and the upper part of the neck; this cutaneous branch accompanies the occipital artery and communicates with thegreat occipital and small
(Plate CXII).

occipital nerves.

The superficial origin of the Second Spinal nerve may be as high as a little
above the posterior arch of the atlas or as low as midway between the
posterior arch of the atlas and spine of the axis. The anterior branch
between the posterior arch
behind the vertebral artery and in front

of the second cervical nerve leaves the spinal canal

of the atlas

and the lamina

of the axis,

Then

of the posterior Intertransverse muscle.

it

passes to the interval between

the Scalenus medius and Rectus capitis amicus major where

ascending branch which joins the

or

two descending branches which

loop of the cervical plexus.

It

runs upwards and backwards

where

it

cervical to

first

make

the

it

join the third cervical to

gives off

(1

divides into an

first

loop,

make

and one

the second

the small occipital nerve, which

to the posterior border of the Sterno-mastoid,

crosses the lower border of the spinal accessory nerve after

which

it

PLATE CXXXIII.
SUPERIOR CORNU

OF

HYOID BONE

MEDIAN

PORTION

OF

CRICO-THYROID MEMBRANE

CRICC- THYROID
MUSCLE

THIRD

RING OF TRACHEA

Thyroid Cartilage. (Anterior View.)

ascends along the posterior border to the mastoid process.
Here it pierc<
deep fascia and crosses the upper pan of the Sterno-cleido-mastoid into the

where it divides into three branches, (a) auricular, which runs

upwards and forward to supply the integum< m on the inner and upper pan of
the pina, (b) a mastoid branch which is distributed to the skin on the' base of
the mastoid pre>cess, (c) the- occipital branches which passover the Occipitalis
muscle and are distributed to the' skin of the scalp.
Plate' (X II).
These branches communicate with the great occipital, small occipital.
great auricular, all of the cervical plexus, and with the posterior auricular
of the fifth nerve-.
(2) A branch helps to form the greal auricular, its other
branch comes from the cervical nerve.
The meat auricular nerve passes with
superficial fascia

the small occipital nerve to the posterior border of the Sterno-cleido-mastoid,

ANATOMY

302

IN A NUTSHELL.

and passes across the muscle towards the angle of

While crossing the muscle it lies in the deep fascia almost
It divides into (a) the
parallel with but behind the external jugular vein.
mastoid branch which is distributed to the skin on the mastoid process, (b) the
auricular branches which are distributed to the integument on the pin a
some of these branches are distributed to the integuIts upper part,
at
ment on the outer surface of the lobule and the outer surface of the lower part
whore

it

leaves this nerve

the mandible.

of the helix

and antihelix, (c) the facial branches pass to the superficial lobules
and the integument over and in front of the gland. In the

of the parotid gland

substance of the gland they unite with the cervico-facial division of the facial

PLATE (XXXIV.

FORAMEN FOR SUPERIOR LARYNGEAL NERVE

MEDIAN

SUPERIOR CORNU

THYROID

MEMBRANE

THYRO-HYG

OF

PORTION

y\

OF

_ MEDIAN

NOTCH OF

CARTILAGE

THYROID

CRICO-THYROID

CARTILAGE

MEMBRANE

INFERIOR CORNU OF

THYROID CARTILAGE.

II

nerve.

com<

void Bone, Thyroid

and Cricoid Cartilages. (Anterior View.)

branch to help from the superficial cervical nerve which

(3) It gives
from the second and third cervical nerves. It appears a little below the
v.

at the posterior border of the Sterno-cleido-mastoid and crosses

muscle lying under the external jugular vein, although it may perforate it

great auricular
tld-

or pass

in

front.

This nerve divides into ascending and descending branches.

integument on the upper half of the neck

branch which accompanies the external jugular
vein and another which unites with the facial.
The descending branches sup-

Tin' ascending branches supply the

as high as the chin.

ply the integument

One

It

<>n

sends

the lower half of the neck as far as the sternum.

(4)

of the communicans hypoglossi, and a filament to the SternoCLEIDO-mastoid. This filament communicates with the spinal accessory in
the substance of the muscle.

ANATOMY

IN A NUTSHELL.

303

The posterior branch of the second cervical nerve leaves the spinal (anal
below the Inferior oblique between the posterior arch of the atlas and the
lamina of the axis. This branch is larger than any other posterior branch in
the cervical region and
It
It

is three or four times as large as the anterior branches.

sends a twig to the Inferior and receives a branch from the first cervical nerve.
divides into a small external division wihch supplies tin- Complexus and

Trachelo-mastoid and Splenius and gives

twig to the Inferior oblique, and

PLATE (XXXV.
EPIGLOTTIS

THYROID

ARYTENO-EPIGLOjTTIDEAN

FOLD^t"^

ARYTENOIDEUS

OBLIQUUS

ARYTENOIDEUS

TRANSVERSUS?

^C^-

/~f
(

CARTILAGE

SANTORINI

MUSCULAR PROCESS
OF

ARYTENOID CARTILAGE.

o
'

CRICOID

x
-

&

'
;

-.,

"'

CARTILAGE

==

-'//^

CR1C0- ARYTENOIDEUS
POSTICUS

Thyroid Cartilages. (Posterior View.)

very large internal division which

is

the

great occipital nerve

the

internal

After this nerve

branch of the second cervical nerve.
crosses the Inferor oblique it pierces the Complexus, the Trapezius and the
It joins a
deep fascia beneath the superior curved line of the occipital bone.
filament from the posterior branch of the third cervical nerve and ascends on
the back of the head with the occiptial artery and supplies the integument as
It gives a muscular
far as the vertex, communicating with the small occipital.
branch to the Complexus and an auricular branch to the back part of the ear.
division of the posterior

CCXVI).
The superficial origin of the third cervical nerve may be as high as a little
below THE POSTERIOR ARCH OF THE ATLAS OT as low as THE 3\ NOTION OF THE
upper two-thirds and lower third of spine of \xis. The anterior branch
(Plate

of this nerve

is

larger than the posterior one. (Principle [I,Page 26).

It

is

also

branch of the second cervical nerve (double the size.)

After leaving the intervertebral foramen, it passes downward and outward beneath the Sterno-cleido-mastoid and divides into an ascending branch
and a descending one. The ascending branch joins the anterior branch of
The most of the great
second cervical nerve, in front of the Scalenus anticus.
larger than the anterior

ANATOMY

304

IX A

auricular, superficial cervical, one of the

NUTSHELL.

communicans hypoglossi,

branch to

the supraclavicular nerves, a filament to the phrenic, and muscular branches to

the Levator anguli scapula and Trapezius, and sometimes a branch to the
1

Scalenus medius.

The

come from

all

this nerve.

posterior branch of the third cervical nerve

second, but larger than that of the fourth.

It

is

smaller than that of the

divides at the outer border of

The greater portion

the Semispinalis colli into internal and external divisions.

branch of the third cervical nerve is the

The internal division runs between the Complexus

of the internal division of the posterior

smallest or third occipital.

and Semispinalis muscles, supplying them, th< n pierces the Trapezius to supply
It communicates with the great occipithe integumenl of the back of tin n< ck.

PLATE CXXXVI.

TRITICEA

CARTILAGO

THYRO-EPIGLOTTlDEAN
LIGAMENT
SUPERIOR
THYROID

CORNU

OF

CARTILAGE

CARTILAGE OF SAN-TOR

SCULAR PROCESS

Nl

OF

CARTILAGE

RYTEN0I0

INFERIOR CORNU OF

THYROID

CARTILAGE

Arytenoid Caktilage and Epiglottis.

tal

nerve and supplies the skin of the scalp

protuberance.
to

The external

in

the region of the external occipital

division joins the posterior

branch

supply the Splenius, Trachelo-mastoid and Complexus.

of the

second

(Plate CXII.)

LESSON LXXXVI.
<i

i,\

[cal Plexus.

(Plate CXIll).

is formed by the anterior branches of the first four

Each of these four nerves receives a gray ramus communicans
from the si perior ervical ganglion. This plexus is situated in the upper
part of the side of the neck opposite the four upper cervical vertebrae, and upon

The

Cervical plexus

cervical nerves.

ANATOMY IN A NUTSHELL.

305

the Levator anguli scapulae and the Scalenus medius muscles and under the
Sterno-cleiclo-m ast o id

The branches of

this plexus are

The

superficial and deep.

superficial

ones divide into ascending and descending, while the deep divide into internal

and external.

The ascending branches

are,

transverse cervical (this branch

is

(1)

small occipital. (2) great auricular, (3)

a transverse branch instead

sometimes called

of an ascending branch).

The descending branches

These branches

the supraclavicular.

and

(3)

The

are also three,

which come from one main trunk

are, (1) suprasternal, (2) supraclavicular,

supra-acromial.
internal branches are, (1)

cans hypoglossi,

communicating,

(2)

muscular,

(3)

communi-

(4) phrenic.

PLATE CXXXVII.
EPIGLOTTIS

BONE

HYOID

'CUSHION

OF

EPIGLOTTIS

li|j_FALSE VOCAL
THYROID

CARTILAGE

LARYNGEAL

TRUE

CORD

SINUS

VOCAL

CORD

THYRO- ARYTENOID

CRICOID

CARTILAGE

True and False Vocal Cords.

The external branches are, (1) communicating, (2) muscular.
The small occipital nerve (Plate CCXVI) is sometimes double and

it

varies

derived from the second cervical nerve (and third) and

:it'u
passing to the back of the posterior border of the Sterno-cleido-mastoid,
it
passes along this muscle to the mastoid process of the temporal bone where

in size.

This nerve

is

it

It

perforates the deep fascia and passes into the superficial fascia of the scalp.
the
breaks up into three branches.
(1) An auricular branch which supplies

(2) A mastoid branch

integument on the inner and upper part of the pina.
(3) Occipital
which is distributed to the integument on the mastoid process.
branches which are distributed to the integument of the scalp and communi-

and posterior auricular nerves.

The great auricular nerve (Plate CCXVI) is derived from the second and
third cervical nerves and after passing to the posterior borderof the Sternodeido-mastoid, it perforates the deep fascia and ascends upon this muscle be-

cate with the great occipital, great auricular,

neath the Platysma to the parotid gland.

This nerve

lies

almost parallel with

ANATOMY

306

and behind the external jugular

IN A NUTSHELL.

vein.

It

divides into three branches,

(1)

auricular, which are three or four, anastomose with the auricular branches of
It is distributed to the integument of
the facial and pneumogastric nerves.
(2) A mastoid branch which is
the lobule and the lower part of the concha.

This branch anastodistributed to the integument over the mastoid process.

posterior
occipital
and
auricular
nerves.
small
the
with
(3) The facial
moses

branch crosses the parotid gland and supplies the integument covering the gland.
1:
communicates with the seventh nerve in the gland.
The transverse cervical nerve (superficialis colli) (Plate CCXVI) comes

from the second and third cervical nerves and passes around the posterior border of the Sterno-cleido-mastoid near its middle a little below the great auricular
nerve.

It

now

passes across the neck beneath the integument, Platysma, and

externa] jugular vein (sometimes over the vein) to spread out into an ascending

and a descending branch. The ascending branch joins the cervical branches
from the facial nerve and supplies integument of the upper part of the neck as
The descending branch supplies the integument of the lower
high as the chin.
half of the neck as far as the sternum.
The communicating branches of the external division of the deep branches
are, (1) a communicating branch from the second cervical nerve to the Sternocleido-mastoid. (2) Those from the third and fourth cervical nerves are distributed to the Trapezius.

Muscular branches to (1) the Sterno-cleido-mastoid come from the second

and joins the spinal accessory nerve in the substance of the
(2) To the Scalenus medius, which comes from the third and fourth
muscle.
cervical nerves and the loop between them.
(3) To the Levator anguli scap-

cervical nerves

ulae,
It

which comes from the

third, fourth,

and sometimes the fifth cervical nerves.

(4) To the Trapezius which

occasionally comes from the second also.

coin,- from the third

and fourth cervical nerves.

The communicating branches of the internal division of the deep branches
aie. !l
gray rami communicantes from the superior cervical ganglion to each
of the first four cervical nerves, (2) a communicating branch to the pneumogastric, also one to the hypoglossal, (3) communicating branches, which passto
the descendens hypoglossi from the second and third cervical nerves, (4) a
|

branch from the fourth cervical nerve to the fifth cervical nerve.
.Muscular branches pass to the (1) Rectus capitis anticus minor,
capitis anticus major, (3)

(2) Rectus
Longus colli.
formed by branches from the second and third

Rectus capitis

lateralis, (4)

Communicans hypoglossi is
and pass down on the outer

cervical nerves

side of the internal jugular vein to

the middle of the neck where they join the descendens hypoglossi.

This loop

is

called ansa hypoglossi.

to the Sterno-hyoid, Sterno-thyroid,

The phrenic nerve

Branches are given

and Omo-hyoid.

off

from

this

ansa

is derived from the third

mainly from the fourth. As it descends in the
neck it has behind it the Scalenus anticus and in front of it (1) the Sterno-cleido-mastoid. (2) the posterior belly of the Omo-hyoid, (3) the transversalis colli

fourth,

and

fifth

(internal respiratory of Bell)

cervical nerves,

ANATOMY

IN A NUTSHELL.

vessels, (4) the suprascapular vessels.

It

now

307

passes between the

the subclavian artery and the subclavian vein, and as

it

crosses the beginning of the internal

tically

downward

mammary

in front of the root of the

the mediastinal portion of the pleura.

spread out on

its

it

first

part of

passes into the chest

artery.

It

now

passes ver-

lung between the pericardium and

It perforates the

Diaphragm and

is

under surface.

The right phrenic nerve lies on the outer side of the right innominate vein
and the superior vena cava. It is not as long as the left phrenic nerve and is
more vertical in direction, also seated deeper.
The left phrenic nerve is longer than the right phrenic nerve for two reasons, (1)

it

has further to go, because the Diaphragm

is

lower on the

left side,

and (2) it goes in a less direct route, because the heart inclines to the left side.
As it enters the thorax it lies behind the left innominate vein and in front of the
pneumogastric nerve, the arch of the aorta, and the root of the lung. The
comes nervi phrenici, which is a branch of the internal mammary artery, passes
to the phrenic nerve.

The pericardium, pleura, (and peritoneum?) are supplied by the phrenic

The nerve to the subclavius muscle sends a branch to the phrenic
nerve, a branch from the sympathetic and one from the junction of the denerve.

scendens hypoglossi with the cervical nerves pass to the phrenic nerve.

The right phrenic nerve, after it passes through the Diaphragm, joins a
branch from the solar plexus to form a ganglion, which gives branches to the
hepatic plexus, the suprarenal capsule, and the inferior vena cava.

The

left

phrenic nerve has no ganglion upon

but joins the phrenic plexus.

it,

LESSON LXXXVII.
The abdominal wall is divided into nine arbitrary areas by four lines; first
circle
around the body connecting the anterior superior spinous processes of
a
the crest of the ilia; a second line drawn around the body connecting the tips
of the ninth or tenth ribs; the other two lines are drawn at right angles to these
from the middle of Poupart's ligament, thus dividing the abdominal wall into
nine areas.

The

Plate

CCXXV.

one above and on the right side is called the right hypochondriac;
the middle one above is the epigastric; the third one the left hypochondriac. The
first one in the middle row on the left side is the left lumbar; the next one is the
umbilical; and the third is the right lumbar.
The one below the right lumbaris
the right iliac or inguinal; the next one in the third row is the hypogastric; and
first

the third one

is

the

left iliac

or inguinal.

Epigastric ("upon the stomach"). Hypochondriac ("under the cartilage.")

Hypogastric ("under the stomach.")
The right hypochondriac contains the right lobe of the liver, gall-bladder,
hepatic flexure of the colon, and upper part of the right kidney.
Right lumbar contains the ascending colon, lower part of the righ.1 kidney.
and some coils of the small intestine (ileum.)
Right inguinal

and the end

(iliac)

of the ileum.

contains the caecum, often the appendix vermiformis,

PLATE CXXXVIII.

JALL BLADDER

SPLEEN

LIVER

SPLENIC

VEIN

PANCREAS

TRANSVERSE COLON

DESCENDING

ASCENOING

COLON

COLON,

SMALL INTESTINE

Showing the Entire Alimentary Canal and the Portal Circulation-.

308

ANATOMY

IN A NUTSHELL.

309

Epigastric contains part of the right lobe of the liver, greater part of the

stomach, middle and pyloric portions, both

two parts of the duodenum, duodeno-jejunal junction, pancreas,
except the tail, upper part of the spleen, part of the kidneys, suprarenal capleft lobe,

part of the gall-bladder

orifices, first

sules.

Umbilical contains the transverse colon, part of the great omentum and
mesentery, transverse portion of the duodenum, and some coils of the jejunum

and ileum, part

both kidneys with ureters, and the receptaculum

of

Hypogastric contains
or

when distended

coils of

chyli.

the small intestine, the bladder in children,

in adults, ureters,

the uterus during the latter month-

<>t'

pregnancy, often the caecum, appendix vermiformis, sigmoid flexure of the colon,
and the upper part of the rectum.
Left hypochondriac contains the fundus of the stomach, greater part of the
spleen, tail of the pancreas, splenic flexure of the colon,

kidney, and part of the

left

upper part of the

left

lobe of the liver.

lumbar contains the descending colon, part of the omentum, sigmoid

and some coils of the jejunum.
Left inguinal (iliac) contains the sigmoid flexure of the colon and convolutions of the jejunum and ileum.
Left

flexure, lower part of the left kidney,

Alimentary Canal.
The alimentary canal
mouth to the anus. It is

(Plate

about thirty

is

CXXXVIII).

feet in length,

extending from the

musculo-membranous tube and

consists of the following portions: mouth, pharynx, cesophagus. stomach, small intestine which

has the following

divisions, (1)

duodenum,

(2)

then comes the large intestine which has the

flexure,

atic

transverse colon,

splenic

jejunum, and

(3)

and

ileum,

caecum, ascending colon, hep-

descending

flexure,

colon,

sigmoid

The accessory organs to the alimentary canal are the

teeth, salivary glands, liver, spleen, and pancreas.
A viscus is any internal organ of the body. The viscera are situated in
the cranium, thorax, abdomen, and pelvis.
The Diaphragm lies immediately
above the stomach. All of the canal above the Diaphragm has three coats
which are from within outward the mucous membrane, areolar tissue or submucous and muscular. That portion of the canal which lies below the >iaphragm has a fourth coat called the serous membrane, which is external to
and rectum.

flexure,

the muscular coat.

The

teeth (Plate

CCXXVI)

are dense white structures firmly implanted in

sockets in the alveolar processes of the jaw bones.

tions

A ROOT or

PANG,

NECK, and A CROWN.

Each consists of three porteeth grow in two sets,

The
The

first set are called temone in infancy, the other in childhood and youth.
porary, milk, deciduous teeth and are twenty in number, there being five in
each lateral half jaw, namely two incisors, one canine, and two molars.
In

this set there are

manent

no bicuspids and no third molar.

temporary molars.

The bicuspids

of the

In the second or permanent set there are thirty-two teeth: eighl

lateral

per-

set take the place of the

half jaw,

two

incisors,

in

one canine, two bicuspids, and three molars.

each

ANATOMY

310

IN A NUTSHELL.

The arteries to the teeth are derived from the inferior dental and from
the alveolar and infraorbital branches of the internal maxillary.
The nerves are from the inferior dental branch of the inferior maxillary

PLATE CXXXIX.
ORIFICE OF LACHRYMAL CANAL

GROOVE ON
ANTERIOR BORDER OF
SEPTAL CARTILAGE.
LATERAL CARTILAGE

ACCESSORY CARTILAGE.

SEPTAL CARTILAGE

SESAMOID CARTILAGF
ALAR CARTILAGE

CELLULAR TISSUE OF ALA

The Anterior and Posterior Pillars of the Fauces and Cartilages

of Nose.
division of the

fifth,

and

also

from the anterior and posterior dental branches of

the superior maxillary division of the same nerve.

Just before the six-year molars are erupted from the gum, forty-eight
teeth in various stages of formation and retrogression can be recognized in the

ANATOMY

twenty

IN A NUTSHELL.

311

temporary set and twenty-eight of the permanent

at this time are only embryonic buds.
In a sagittal sectionof a tooth we see first the enamel (Plate CCXXVII) which
is the hardest structure in the body, consisting of 96.5 per cent earthy and 3.5
Its individual tubules are 55V0 of an inch in diaper cent animal matter.
Beneath the enamel is the dentine or ivory. The amount of earthy
meter.
matter is 72 per cent and the animal matter 28 per cent. Its tubules are
4^70 of an inch in diameter and are covered by the sheath of Neumann, which
The cavity in the tooth is called the pulp
protects it from the action of acids.
cavity and contains the blood vessels but no lymphatics.
The tissue in the
The part which surrounds the root as the enamel
cavity is called myxomatous.
surrounds the crowm is called the crusta petrosa (Plate CCXXVII).
There are two kinds of muscles found in the tongue (Plate CXLV) intrinThe intrinsic are the Superior lingualis, Inferior lingualis,
sic and extrinsic.
Transverse lingualis, and Vertical lingualis. They are all supplied by the
hypoglossal nerve.
Some say the Inferior lingualis gets the Chorda-tympani
branch of the the seventh nerve. The extrinsic muscles are the Genio-hyoglossus, Palato-glossus, Hyo-glossus, Stylo-glossus, and Chondro-glossus.
The

two jaws

set.

of the

The four wisdom teeth

nerve to these

is

the hypoglossal.

Papilla means a bud, a nipple, a teat, a pimple. The lingual mucous

membrane of the dorsum of the tongue is peculiar in several respects. It consists of a layer of connective tissue forming a corium supporting special papilla?
covered with epithelium. The corium is a network in which ramify numerous
vessels and nerves.
The papillae are of three kinds.

LESSON LXXXVIII.
1. Large circumvallate ("walled around") papillae seven
in number set
an inverted V at the back of the tongue and shaped like truncated cones set
on end in cup-like depressions, whence the name. (Plate CXLIII).
2. Middie-sized fungiform ("mushroom shaped") papillae scattered irregularly over the surface, forming rounded red eminences like mushrooms, whence
their name.
3. Small conical or filiform ("thread-shaped") papillae covering the an-

in

terior two-thirds of the surface,

is

each ending

in a

number

of little processes.

these that are concerned in the whitish coating or furring of the tongue.

It

Be-

sides these papilla? there are several other simple ones.

Occupying the entire thickness

composed
closely

of the epithelium of the lateral surface of

They are
two kinds of epithelial cells, gustatory and sustentacular, packed
together.
The microscopic structure of some papillae include certain

the papilla?

is

a multitude of flack-shaped bodies, called tatse-buds.

of

bodies called taste-buds.

Taste-buds are scattered also over the dorsal surface

independently of

and are

papilla?,

the motor nerve to the tongue.

numerous
four pairs.

especially

The nerves of the tongue are

in

in

the posterior part.

1.

The hypoglossal

is

AXATOMr

312
2.

The

lingual (gustatory) of trifacial

of sensation,

(gustatory,) which

The

is

distributed to the anterior two-

dorsum of tongue and also to sides of tongue. This nerve is one

Formerly it was thought to be a nerve of taste, whence the name

thirds of the

3.

IX A NUTriHKLL.

it still

retains.

branch of glosso-pharyngeal

lingual

is

especially concerned in gus-

PLATE CXL.

FRAENUM LINGUAL

DUCT. OF RiVINUS

ANTERIOR

BELLr

DIGASTRIC

Showing the Salivary Glands

tatlon (taste)

of tongue.
4.

is

The function

still in (p lest

fifth.

and

Some

distributed to the posterior one-third of

dorsum and

sides

(Plate CXLIII).

ion.

say

Others say that

branch of the facial (Chorda-tympani) is

about the same as the lingual -branch of the
is a nerve of taste for the anterior two-thirds of the tongue.
supplies the Inferior lingualis muscle.
Still others say that

Its
it

it

of the lingual

distribution

is

ANATOMY

IN A NUTSHELL.

the anterior two-thirds of the tongue

through the chroda-tympani.

The blood supply of the tongue

is

supplied by the glosso-pharyngeal

derived from the lingual, the

is

The veins

ascending pharyngeal arteries.

313

of the tongue

and

facial,

accompany the

arter-

ies.

There are two kinds of glands in the tongue. (Plate CXL). the mucous and
The mucous glands are found all over the surface of the mucous mem-

serous.

The serous

brane of the tongue.

The fraenum

down

binds

is

are found only at the back of the tongue.

a fold of the

mucous membrane

mouth which

of the

the under surface of the tongue and sometimes requires to be cut

from too great

ject to

linguae

from extension too

restriction or

Fraenum

be tongue-tied.

The dorsum

of the

raphe, which divides

it

tongue

far forward, causing the sub-

means bridle of tongue.

convex, marked along the middle

linguae

is

line

by

into symmetrical halves; this raphe terminates behind,

about an inch, from the base of the organ, in a depression, the foramen caecum,
The tongue is not the only organ of taste as taste-buds are found on the
back part of the hard palate, on anterior part of the soft palate, and to some
extent in other parts of the pharynx.

The lymphatic

vessels

from the tongue pass

uated on the Hyo-glossus muscle

to the

in

to

one or two small glands

sit-

the sub-maxillary region, and from thence

deep glands of the neck.

The pharynx (Plate CXLII)is bounded above by(l)the base of the sephnoid
bone and (2) the basilar process of the occipital; behind by (1) the vertebral
column. (2) Longus colli and (3) the Recti capitis antici muscles: it is incomplete in front being bounded by the (1) internal pterygoid plate, (2) pterygothe lower jaw.

maxillary ligament.

(3)

the thyroid and

cricoid cartilages.

and

(2)

its

(7)

muscles, (3) the

common

(4)

On

the tongue, (5) the hyoid bone, (6)

the sides by (1) the styloid process

carotid

and

(4)

internal carotid arteries,

the internal jugular vein, (6) ninth, (7) tenth, (8) twelfth, and (9) sympathetic nerves and (10) a portion of the Internal pterygoid muscle.
It has
(5)

seven openings, two posterior nares, two Eustachian tubes, the oesophagus, the

mouth, and the larynx.

tubes there

is

On

its

posterior wail

between the two Eustachian

a collection of lymphoid tissue similar to that found

which forms the pharyngeal tonsil or the third tonsil.

pharyngea, which some authors think has something

ment

of the anterior part of the pituitary

Above
to

in

this

is

the tonsils
the bursa

do with the develop-

body and others think

it

has some-

thing to do with the development of the third tonsil.

The pharnyx, the throat, technically the joint opening of the gullet and the
is a musculo-membranons pouch situated at the back of the nasal
cavities, mouth and larynx and extending from base of skull to the cricoid cartilage.
It is about five inches long.
It
i- widest (nearly one inch and a half
windpipe,

in the

upper pharyngeal portion, and narrow above and below, having

diameter (half an inch) at

measurement
four-fifths

its

junction with

the gullet.

its least

Ventro-dorsally

its

everywhere small, only opposite the mouth being more than

of an inch.
It is a cavity situated in front of the upper live cervical
is

ANATOMY

314

IN A NUTSHELL.

vertebrae.
The pharynx also belongs to the respiratory system. The middle
segmenl of the pharynx is common to the alimentary and respiratory systems,
and the tracts followed by the food and air cross obliquely in it. The pharynx
lias three tunics, the mucous, areolar, and muscular.

PLATE

CXI. I.

TENSOR

PALATI.

EUSTACHIAN TUBE

LEVATOR

PALATI

PTERYGOMANDIBULAR LIGAMENT
STYLO-PHARYNGEUS.
9TH NERVE-GLOSS O-PHARYNGEAL
"STYLO-GLOSSUS

STYLOHYOID LIGAMENT
MYLO-HYOID

HYO-GLOSSUS

HYPOGLOSSAL

T
S YL0-HYOID
D

GASTRIC
SUPERIOR

LARYNGEAL

N.

THYROID CARTILAGE

CURRENT LARYNGEAL NERVE

Showing the Muscles of the Pharynx.

The muscles
constrictor,

of the

Inferior

Salpingo-pharyngeus.

pharyngeal

plexus.

pharnyx

constrictor,

Plate

CXLI)

arc Superior constrictor, Middle

Stylo-pharyngeus,

Palato-pharyngeus, and
The Constrictors are supplied by branches from the
The Stylo-pharyngeus by the glosso-pharyngeal nerve

ANATOMY IX A NUTSHELL.
and the

315

from the external larynand the recurrent laryngeal.

The Palato-pharyngeus probably
nerve supply from the internal branch of the spinal accessory, whose
Inferior constrictor gets, in addition, branches

geal nerve

gets

its

along with certain branches of the pneumogastric through

fibers are distributed

the pharyngeal plexus.

The pharyngeal plexus

glossc-pharyngeal.

It

formed by branches of the vagus, sympathetic and

the muscles and mucous membrane of the

is

supplies

pharynx.

The blood supply

of the

pharynx

is

from the superior thyroid branches,

ascending pharyngeal, pterygopalatine, and descending palatine.

two are branches

of the external carotid, the last

two are branches

The

first

of the internal

maxillary.

The

sinus of 3Iorgagni

a space at the

is

upper and back part

of the Superior

constrictor of the pharynx, just under the base of the skull where the muscular

pharynx being consequently walled

Here the Eustachian tube opens into the

fibers of the Constrictor are deficient, the

behind by its own aponeurosis.

pharynx, one on each side.
in

LESSON LXXXIX.
The tonsils (Plate CXXXIX) are two prominent oval bodies situated in thereformed one on each side of the fauces, between the anterior and posThey are composed of lymphoid follicles, surrounded by
terior palatine arches.
They lie near
less dense lymphoid tissue arranged around the walls of crypts.
The blood supply is from the dorsalis lingua? from
the internal carotid artery.
cesses

the lingual; ascending

from

facial

tonsillar

pharyngeal from external carotid; ascending palatine

from

facial

descending palatine from internal maxillary.

(Plate

CXVI) The veins of the

of the

gland and opens externally into the pharyngeal plexus.

the

tonsils

come from the

tonsil

fifth

form

upon the outer side

The nerves to
Meckel's ganglion and from the

a plexus

by means

of

which

lies

glosso-pharyngeal nerve.

CXL) is a duct of the parotid gland conveynamed from the Danish anatomist, Nicholas Steno,

Steno's duct (Stenson's) (Plate

ing saliva into the

mouth;

so

Copenhagen (1638-86). This duct is also called parotid duct.

Wharton's duct named from Thomas Wharton, an English physician, 1656.
The duct of the submaxillary gland, conveying saliva into the mouth, about
two inches long, opening on a papilla at the sideof the fraenum linguae, or bridle
of

of the tongue.

The ducts

of Rivinus are those ducts of the sublingual gland which

open

apart from one another and from Wharton's duct.

The duct

of Bartholin

is

one of the ducts of the sublingual gland running

along side of Wharton's duct, and opening into

it

or close to

its orifice

into the

mouth.

Thehardpalate(PlateCC.WYIII)

isin the roof of the mouth and is formed

the palate processes of the superior maxillary and palate bones.

is

The

soft

by

palate

a movable fold suspended from the posterior bonier of the hard palate, form-

ANATOMY

IX

NUTSHELL

and pharynx. The muscles oi

incomplete septum between the mouth
PalatoLevator palati, Tensor palati, AzygOs uvula,
the sofl palate are the
the
Otafl
by
supplied
is
The Tensor palati
glossus and Palato-pharyngeus.
supplied
probability
all
in
are
The remaining muscles of this group
ganglion.

,u

PLATE CX LI

PROBE

PASSED FROM FRONTAL^SINUS

THROUGH INFL'NDIBULUM

Hi

0PE\;NGS OF POSTERIOR ETHMO

VESTIGULE

the Pharynx.
Sagittal Section of the Head and Neck Showing
by

the internal branch of the spinal accessory,

whose

fibers are distributed

along

pharyngeal plexus.
with certain branches of the pneumogastic through the
anterior pillars of the
The isthmus of the fauces is called the throat. The
the two Palamembrane,
mucous
fan.-.- art in:. Me by two muscles covered with
Palato-pharyngei.
the two
to-glossi, and the posterior pillars are made by

ANATOMY
The next part

IN A NUTSHELL.

of the alimentary canal

is

317

called the oesophagus (Plate CXLVI)

which extends from the spinous process of the sixth cervical vertebra to the
cardiac end of the stomach opposite the spinous process of the ninth dorsal.
It
consists of three coats, an outer or muscular, a middle or areolar, and an internal
All of the alimentary canal above the diaphragm has three coats,
or mucous.
below
it has four coats, these three just mentioned and a serous coat or
and all
peritoneum.

The oesophagus

(Plate

CXLVI)

in the neck,

is

On

trachea, the thyroid gland, and the thoracic duct.

boundeb!

in

front

each side by the

by the

common

part of the lobes of the thyroid gland, and the reBehind by the vertebral column and the Longus colli.
In the thorax it is bounded in front by the trachea, arch of the aorta, left
common carotid artery, left subclavian artery, left bronchus, pericardium, and
Diaphragm. Behind by the vertebral column, Longus colli, vena azygos minor,
right intercostal arteries, thoracic duct, aorta, and the abdominal aorta.
On
the right side by the right lung and pleura, vena azygos major, and the thoracic
duct.
On the left side by the left lung and pleura, and thoracic aorta. The
and right pneumogastric surround the oesophagus, the right
pneumogastric
left
being situated behind it and the left in front, forming the plexus of Gula? in the
muscular coat.
The muscular coat consists at first of three perpendicular bands, the anterior
one being attached to the posterior part of the cricoid cartilage and the lateral
ones being continuous with the Inferior constrictor of the pharynx. These
three bands gradually blend and make a circular muscular band around the
oesophagus.
The next coat is the circular coat which is continuous with the
fibers of the Inferior constrictor and at the upper part of the oesophagus they are
parallel and at the lower part they are parallel, but in the intermediate portion
The upper ones are striped or voluntary muscles, while the
they are oblique.
The glands of the esophagus are compound racelower ones are involuntary.
mose glands which empty by long tubes on the mucous membrane.
The oesophagus (carrying eatables) or gullet is a tube connecting the pharynx
and stomach.
It is about ten inches long.
The blood supply is from the Inferior thyroid which comes from the thyroid axis of the subclavian; branches from
he d( sc< oding thora< ic aorta and from the gast ic branches of the coeliac axis
of abdominal aorta.
The nerve supply is from th< pneumogastric and sympathetic.
They form a plexus in which are groups of ganglion-cells between the
two layers of the muscular coats, and also a second plexus in the submucous

carotid artery, the lateral

current laryngeal nerve.

tissue.

ANATOMY

318

IN A NUTSHELL.

LESSON XC.
The stomach

Plate

the alimentary canal.

CXLYI) is the most dilated and most

It

distensible part of

occupies parts of the left hypochondriac and epigas-

abdomen, immediately within the abdominal walls below the

diaphragm and partly under the liver to the right of the spleen and above the
In form it is irregularly conoidal and curved upon itself.
transverse colon.
When moderately distended it is about twelve inches long and four inches wide;
it
weighs three or four ounces. The size, shape, and hence anatomical relatric regions of the

tion.^, differ

greatly in different states of distension.

It is

somewhat

like a pear

The fundus
omentum. We

with the large end up and the small end bent side wise to the right.
or splenic end

is

connected to the spleen by the gastro-splenic

omentum is a special mesentery connecting the stomach

and colon respectively. The one that connects it to the
The one that connects it to the liver
spleen is called gastro-splenic omentum.
is called the gastro-hepatic omentum, and the one to the colon is called the
The pylorus or lesser end lies near the cartilage of the
gastro-colic omentum.
The stomach has two
eighth rib, in contact with the under surface of the liver.
The greater is convex and is connected to the
curves, a greater and a lesser.
colon by the gastro-colic omentum.
The lesser one is concave and is connected
to the liver by the gastro-hepatic omentum, and to the Diaphragm by the gastrophrenic ligament. The oesophageal or cardiac orifice is situated between
the fundus and the lesser curvature.
The pyloric (janitor) is situated at the extreme right and is more anterior
in position than the cardiac orifice.
The stomach has four tunics, serous, muscular, areolar or submucous, and mucous.
The serous coat (peritoneum) encloses the stomach between two layers, derived from the lesser omentum.
Tha
lesser omentum, omentum minimus, or gastro-hepatic is a single fold (two
layers) of peritoneum, extending between the transverse fissure of the liver and
the lessee curvature of the stomach.
It might be well to explain the greater
omentum, omentum magnus or gastro-colic omentum also called epiploon, It
is the largest of all peritoneal duplications, and consists of four layers of peritoneum attached to the greater curvature of the stomach and to the transverse
colon, whence
is looped down freely upon the intestines, forming a great flap
The muscular coat has two distinct layers an outer, longitudinal,
or apron.
and an inner, circular.
Besides these two distinct layers some oblique fasciculi are found internal to the circular.
The areolar, submucous, also called
vascular, is loose, and its meshes are largely occupied with the vessels and nerves
going to and from the coats between which it lies. The mucous coat is thrown
into irregular Longitudinal folds called rugae.
The rugse invade the mucous
and submucous coats.
There are two kinds of glands in the stomach, the cardiac or proper gastric
glands also called peptic (digest), and the pyloric glands
The aerve supply to the stomach is the right and left pneumogastric and
niiuht

mention that an

with the

liver, spleen,

it

branches from the solar plexus of sympathetic nerves.

The blood

supply

to

stomach (Plate CXLVIII)

is

from the

coeliac axis.

ANATOMY

IN A NUTSHELL.

319

(1) the gastric artery which runs along the lesser curve from left to right anastomosing with the (2) pyloric branch of the hepatic. Along the greater curve
run the (3) right and (4) left gastro-epiploic arteries, anastomosing at the
middle of the border, the left being a branch of the splenic, the right a branch of
the hepatic through the gastro-duodenalis artery.
The stomach also receives
branches from the splenic (5) vasa brevia at the fundus. The blood of the
stomach is returned into the portal vein; the right gastro-epiploic vein opens

into the superior mesenteric, the left into

PLATE

the splenic.

The lymphatics are

CXLIII.

PHARYNX
;

...:-.

\'

:,

<i''i??'i

:^yj

Wm

*'* :'; ii'-'-T

Hi^t

'St-

The Dorsum of the Tongue.

numerous; they consist

of a superficial and deep set which pass through

lymphatic glands forward along the two curvatures of the stomach.

the

The stomach has above it,(Plate CXLIX),the Diaphragm,lesser omentum,

and the liver; in front, the Diaphragm, the liver, and the anterior abdominal
wall; below it, the great omentum, the transverse colon, and the gastros-plenic
omentum; behind it, the kidney, suprarenal capsule, pancreas and spleen, which
are called the "Big-four," The "Little-four" which are the great vessels, solar
transverse meso-colon, and crura of the diaphragm aie also behind it.

ANATOMY IN A NUTSHELL.

320

LESSON XCI.
The
meaning

part of the small

first

of

which

intestine

is

called the

twelve finger lengths, hut this

is

is

duodenum; the

literal

not twelve finger lengths or

The duodenum may consist of

It has a mesentery.
twelve finger breadths.
descending,
inferior
transverse, ascending, and
the
portions,
transverse,
five

duodeno-jejunal flexure.
glands.
duodenal
glands or
the

flexure

The next
called

part of the small intestine

The

ileum.

first

has glands

It

is

in

called jejunum,

it

called

and the

portion consists of about three-fifths of

Brunner's

third part
it

is

below the

duodenum, and the ileum about two-fifths. The glands in the ileum are called
Peyer's pan lies winch are about thirty in number; the intestine is thinner here
The small intestine straightened out would be in the shape
than in other parts.
cone,
with
the base corresponding to the stomach end, and its apex
slender
of a
corresponding to the point where

The

it

caecum.

joins the

cecum which may

be various shapes
and is partly covered with peritoneum; the next part is the ASCENDING COLON
which in 27 per cent of casts is covered with peritoneum; it is about eight and
The next portion is the hepatic flexure which joins
one-half inches long.
This transverse colon is about
the ascending with the transverse colon.
twenty inches long, and is covered with peritoneum. The next part is the
The
splenic flexure which joins the transverse with the descending colon.
descending colon is about nine inch's in length and in 37 per cent of cases is
covered with peritoneum. The next part is called the sigmoid flexure, which
The last part is the rectum (which means
is about fourteen inches in length.
large intestine consists of

straight):

it

not

is

first,

the

straight but relatively straight

compared with the

rest of

the alimentary canal.

The glands

of the large

intestine are

less

numerous,

vascular arches of the arteries or even upon the gut

itself;

and

lie

along the

they are fewest along

the transverse colon.

The lymphatic

vessels of the large intestine

form two

sets, viz.,

those of the

caecum, ascending and transverse colon, which pass through their proper glands
to the

mesenteric glands; and those of the descending colon, sigmoid flexure,

and rectum which pass

to the lumbar glands.

The small intestine (intestinum tenue,) (Plate CL VI) extends between the
stomach above and the large intestine below.
Its average length is about
,

twenty-two
in

length.

fe<

[ts

t.

It

may

be as

many

diameter diminishes

few as eight
from about two inches above to

as thirty-four feet or as

in size

feet
less

huge extent within the area bounded by the

colon, occupying the umbilical and hypogastric regions and the adjacent porIt
tions of the lumbar.
has four coats which correspond in general arrangement and character to those of the stomach. They are the serous, muscular,
areolar, and mucous.
The divisions of the small intestine are the duodenum
(twelve finger intestine,) jejunum (empty intestine.) and ileum (curved or
The villi are small projections on the mucous membrane of
twisted intestine.)
than oik

inch below.

It

is

to

ANATOMY
the small intestine, which are so

Thev

are

from four to ten millions

IN A NUTSHELL.

321

numerous as to give it a velvety appearance.

They collectively constitute the
in number.

beginning of the absorbent or lacteal vessels of the intestine.

The valvular eonniventes are transverse folds of the mucous

membrane and

underlying tissues found throughout a large extent of the small intestine.

Their use is probably to retard somewhat the passage of alimentary mass, and

same time to offer a greater surface for absorption.

Lieberkuhn glaxds, crypts, are the simple or solitary glands of the inBrunner glands (so-called from J. K.
testine, also in large intestine.
and

at the

Brunner,

1653-1727).

sometimes

called

duodenal

glands,

are

small

com-

PLATE CXLIV.

Circum vallate Papill.e.

pound glands of the duodenum and upper part of the jejunum, embedded in the
submucous tissue, opening by minute orifices into the lumen of the intestine.
Then there are the solitary lymph-nodules, which are more frequently
called solitary glands, though no more entitled to the name than the nodes
which occur in the course of lymphatic vessels, having no secretive apparatus.
Beyer's Patches are found in the lower ileum. They are oval, are from
They are
one-half to three inches in length, and about an inch in breadth.
These patches were named after J. K. Peyer,
placed in long axis of the bowel.
A lesion of these patches is one of the most
a Swiss anatomist (1653-1712).
constant signs of typhoid fever.

LESSON
The small

intestine receives the blood

XCII.

from the superior mesenteric artery,

a branch coming indirectly from the hepatic, the superior pancreaticoduodenalis. The superior mesenteric runs between the layers of the mesentery
and gives off twelve or fifteen branches running downwards and to the left

and

(vasa intestini tenuis,) which break up ami form a series of arches, finally encircling the intestine as small branches.

It

also gives off

small branch

at

the

ANATOMY

322

IN A NUTSHELL.

beginning, the inferior pancreatico-duodenalis, which, with the superior pancreatico-duodenaJis, forms as arch which lies in the concavity of the duodenum
and which supplies it.
The blood is returned by means of the superior mesenteric vein which,

with the splenic forms the portal vein.

The lymphatics form a continuous series, which is divided into two sets
The lymphthai of the mucous membrane and that of the muscular coat.
and
end
copious
plexus
in
the
mesenteric
form
a
lacteals.
vessels of both sets
small
intestine
is
means
of
the
superior
supply
the
by
mesenteric
nerve
of
The
The
plexus, which is continuous with the lower part of the solar plexus.
and
finally
form
two
plexuses,
one
blood
vessels,
(Auerfollow
the
branches
bach's) which lies between the muscular coats; and another (Meissner's) in the
submucous coat.
The follicles of Lieberkuhn are found in the large and small intestine.
The large intestine (intestinum crassum) is about a quarter as long as the
It is called large on account of its diameter, being about two
small intestine.
It begins at the right and lower portion
in its broadest part.
inches
half
and a
of the abdomen, passes upward and backward to the under surface of the liver,
thence across the belly to the spleen, from this point downward and forward to
the left and lower part of the abdomen, here it makes a number of curves, and
finally plunges into the pelvis at its back part, and ends close to the perineum,
near the inner opening of the anal colon. Its divisions are the caecum, ascending, transverse, descending colon, sigmoid flexure, and rectum.

The glands

of the small intestines or mesenteric glands (100-150) lie

the layers of the mesentery

vessels, their size

among

between

the meshes formed by the superior mesenteric

varying from that of a pea to that of a small almond. They

numerous near the duodenum and the ileo-colic valve.

or lacteals, are of two kinds, viz., superficial, placed between the layers of the muscular coat, or between the muscular
ami peritoneal coats, and running longitudinally; and deep, placed in the submucous tissue and running transversely around the gut with the mesenteric
They pass between the layers of the mesentery and then, in two or
vessels.
are largest and most

The

\csscls of the small intestine

three large trunks, into the thoracic duct.

Tho caecum

the right iliac fossa; from this point the ascending colon
Here it forms the hepatic flexure, then passes transversely
across the belly below the stomach, and here the splenic flexure is formed,
then ii passes downward, forming the descending colon.
In the left iliac fossa it
forms the sigmoid flexure, and then passes through the pelvis as the rectum.
The large intestine has four coats with the same arrangement as the stomach
and small intestine: serous, muscular, areolar, mucous.
The large intestine has the crypts of Lieberkuhn and solitary glands. It
has no villi, no valvulse conniventes, no glands of Brunner, no patches of Peyer.
The vermiform appendix is a blind process given off from the caecum, varyin man from three to six inches.
(Plate CLLY.)
lies

in

passes to the liver.

The opening
nent

lips

of the small intestine into the large

which project into the cavity of the

latter,

is

provided with promi-

and oppose the passage

of

ANATOMY
matter from

it

other way.

This

The

IN A NUTSHELL.

323

into the small intestine, while they readily allow of a passage the
is

the ileo-caeeal valve or valve of Bauhini.

large intestine

is

supplied with blood by the branches of the superior

PLATE CXLV.
LIFT MASTOID PROCESS

GUST'

TWELFTH NERVE.

INT.

LARYNGEAL

N.

HYOIDBONE

The Extrinsic Muscles of the Tongue.

mesenteric and inferior mesenteric arteries, while
ply from the internal

iliac at

the rectum.

The

it

also receives a

vessels

form

blood sup-

contiunous series

from the caecum, where the vasa intestini tenuis anastomose with
first branch of the superior mesenteric given to the huge intestine.
The blood supply of the rectum is from the inferior mesenteric by the
Superior hemorrhoidal, from the internal iliac, by the middle hemorrhoidal, and
from the internal pudic by the inferior hemorrhoidal. The vessels at the lower
end of the rectum assume a longitudinal direction, communicating freely at the
anus and less freely above. The blood of the large intestine is turned into the
portal vein by means of the superior mesenteric and inferior mesenteric veins.
At the rectum a communication is se1 up between the systemic and portal system of veins, since some of the Mood of that pari of the intestine is returned into
the internal iliac veins.
In the lower end of the rectum the vein.-, like the arteries, are arranged longitudinally.
This arrangement is called the hemorrhoidal
of arches

the ileo-colic, the

plexus.

ANATOMY

324

The nerves and lymphatics

IN A NUTSHELL.

no particular from those of the small

differ in

intestine.

The rectum (intestinum rectum) extends from the sacro-iliac joint to the
It better deserves the name rectum (straight,) when we say it begins at

amis.

the front of the third sacral vertebra, for then

it is

nearer straight.

has the

It

same four coats that the intestine has. Its walls are thicker than those of the
The muscular coat and mucous coat differ from those of the outer porcolon.
The peritoneum of the upper part of the rectum is thrown
tions of the canal.
There are three semilunar transverse
upper part of the rectum on the right side, another about the
middle on the left side, and a third in front, opposite the base of the bladder.
They are called the folds of Houston.
The muscles of the rectum are the Sphincter ani, Internal sphincter, and
Sphincter tertius of Hyrtl. The rectum is supported by proper duplications of
peritoneum, the meso-rectum, and other fasciae.
into folds called appendices epiploic.

one

folds,

in the

Liver.

The Liver

(Plate CLIII)

about one-third of

its

is

the largest gland in the body, in the fetus

situated in the right hypochondriac and epigastric regions and

into the left hypochondriac region.

and inferior.
and two extremities.
terior,

It

It

it

forms

weight, and in the adult about one-thirty-sixth.

It

has three surfaces,

has three borders,

It is entirely

has in relation with

it,

may

viz., anterior,

viz., superior, inferior,

It is

extend over
pos-

and posterior;

covered with peritoneum.

(Plate CLII) above, the

Diaphragm and

anterior

abdominal wall; BELOw,the cardiac end of the stomach, hepatic flexure of colon,
right kidney, and first and second portions of the duodenum; behind, the tenth
and eleventh thoracic vertebra?, crura of Diaphragm,lower end of the oesophagus,
right suprarental capsule, and great vessels.
It has five lobes, (Plate CLXII) five fissures, five vessels, and five ligaments,
Its lobes are the right, left, caudate, quadrate, and Spigelian.
The ligaments
are the coronary, the right and left lateral or triangular, the suspensory, broad
or falciform, and the round ligament.
The round ligament is the remains of
the umbilical vein;

all

the other ligaments are folds of peritoneum.

sels are the hepatic artery, hepatic veins, the bile ducts,

and the portal vein which breaks up into

capillaries like

an artery.

are the transverse, fissure for the gall-bladder, fissure for the inferior

ductus venosus, and the umbilical

The

made up

The ves-

lymphatic vessels,
Its fissures

vena cava,

fissure.

which are about one-twelfth of an inch in

it manufactures bile and sugar
and has other metabolic functions. It is nourished by the hepatic artery which
carries food to the cells and by the portal vein which carries raw material to be
worked over by the cells.
The nerve supply to the liver is from the hepatic plexus, which is an offset
from the coeliac plexus and receives filaments from the left pneumogastric and
diameter.

righl

liver

is

The

of lobules

liver has various functions

phrenic.

The

portal veins

may

be told from the hepatic as the portal veins remain

325

ANATOMY IN A NUTSHELL.

Glisson while the hepatic

closed because they are surrounded by the capsule of
substance.
liver
the
to
adherent
veins gape open, being
right and
gall-bladder retains the bile and is situated between the

The

PLATE CXLVI.

THYROID CARTILAGE.

CRICOID

FIRST

THORACICT

RIGHT BRONCHUS

LFFT BRONCHUS

CASuiAC END

TflflFTH THORACIC VERTEBRA

CAELIAC AXIS

PYLORIC

END

DUODENUM

1IGHT

COMMON

ILIAC

LEFT

COMMON

ILIAC

The (Esophagus and Stomach.

it is of pyriform outline, and
liver,
border
of the liver, coming to
anterior
the
beyond
when full is seen projecting
It excostal
cartilage.
ninth
the
opposite
wall
contact with the abdominal
long
four
inches
or
about
three
It
is
fissure.
transverse
tends as far back as the
gall-bladder
vessels
of
the
The
ounces.
one-half
and
and will hold about one

quadrate lobes of the under surface of the

Two cystic veins usually

are the cystic arterv from the right branch of hepatic
fifteen from the fundus
or
vein,
twelve
portal
of
the
empty into the right branch

ANATOMY

326
go directly into the liver.

IN A NUTSHELL.

The nerves

of the gall-bladder are

from the

coeliac

plexus.

The hepatic duct is formed by the right and left bile ducts descending from
The biliary ducts are the cystic ducts which come from the neck of
It joins the hepatic forming the ductus communis cholethe gall-bladder.
dochus. These three are called the biliary ducts. The ductus communis choledochus empties into the descending duodenum about three inches from the

the

liver.

pyloric end of the stomach.

Pancreas means "all

it

is

known

flesh,

" (Plate CXLVIII). Insomeof the lower animals

On

as the sweetbread.

account of closely resembling the parotid

abdominal salivary gland. It is situated in front of the

It has a head,
first and second lumbar vertebrse and behind the stomach.
neck, a body and a tail.
It varies considerably in size, it is about six inches
long, from half an inch to one inch in thickness and weighs about three ounces.
The pancreatic duct, also called the duct of Wirsung, extends the whole length
of the pancreas and opens into the duodenum about three inches below the
The head
pylorus often in common with the ductus communis choledochus.
or right extremity is surrounded by the curve of the duodenum, ductus communis
choledochus, and the pancreatico-duodenalis arteries. The tail or left extremity
lies above the left kidney and in contact with the lower end of the spleen.
glands

it

is

called the

LESSON
The pancreas

receives blood

XCIII.

from the splenic artery through

its

pancreatic

branches, and from the superior mesenteric and hepatic by the inferior and
superior pancreatico-duodenalis arteries, which form a loop running round, below,

and to the right of its head. The blood is returned into the portal vein by
means of the splenic and superior mesenteric veins. The lymphatics terminate
in two glands which lie on the superior mesenteric veins.
The nerve supply of
the pancreas is branches of the solar plexus which accompany the arteries entering the gland.
Sometimes a lobe of the head is detached and has a duct of
its own opening into the duodenum about an inch above the pancreatic duct.
This

In

be

is

called the lesser pancreas.

appendage of the systemic system) is a single large

trunk which carries venous blood from viscera to the liver; there it splits up
into capillaries, which then unite to form the hepatic veins, which empty into
Tin- portal vein (an

the inferior vena cava.

The

portal system

(Plate

CXXXVIII)

consists of four large veins

which

drain the viscera of digestion and unite to form the portal vein; the branches

correspond

to those of

the arteries, are always single, and have no valves.

four veins are the splenic, gastric,

Si

and superior and

The

inferior mesenteric.

perior mesentkkic, ascends along the right side and in front of the

in fronl of the transverse duodenum, and joins with the splenic

behind the upper bolder of the pancreas, forming the portal vein; it receives the
pancreatico-duodenalis and right gastroepiploic veins, and drains the csecum,

artery, passes

ascending and transverse colon, and small intestine.

ANATOMY

IX A NUTSHELL.

327

Splenic, drains the spleen by several branches, which soon unite into one,
this runs

from

left to right,

below the artery,

in a

groove on the upper and back

part of the pancreas and unites with the superior mesenteric at the greater end
of the pancreas forming the portal vein.

pancreatic, left gastro-epiploic

and

It receives

the vasa brevia (gastric,)

inferior mesenteric veins.

PLATE CXLVIT.

mm t
Showing the Viscera Below the Diaphragm.
Ineerior mesenteric, passes upward behind the transverse duodenum
and pancreas to end in the splenic; drains the rectum, sigmoid flexure, and descending colon; and lies to the left of the artery; its hemorrhoidal branches
1

inosculate with those of the internal

Gastric, two

in

number

as

iliac.

follows:

The

pyloric,

corresponding to the

pyloric branch of the hepatic artery, runs on the lesser curvature towards the

ANATOMY

328

and ends

pylorus,
tric

in the portal vein.

artery,runs on

IN A NUTSHELL.

The coronary, corresponding to the gastoward the oesophagus, and then curves

the lesser curvature

downward and backward

Portal vein three

in

the lesser

omentum

to

end

in the portal vein.

or four inches long, begins behind the upper border of

the right end of the pancreas by the union of the splenic and superior mesenteric.
11

ascends

in the right

border of the lesser omentum, between and behind the

PLATE CXLVIII.

SUPERIOR
PANCREATICO DUODENAUS
INFERIOR

ABDOMINAL AORTA

Showing Blood Supply of Stomach.

and duct (to the right,) enters the transverse fissure
Left
becomes a dilated (sinus); it then divides into two branches (the
larger but shorter) which enter the two main lobes of the liver and split

hepatic artery (to the

of the liver,and

right

is

and cystic veins, the latter from the gall-bladder.

two sets: The superficial vessels arise, over
the entire surface, in the subperitoneal areolar tissue.
Those on the convex
surface form four groups, viz.. (1) three or four branches which run forward
up.

It

The

receives the gastric

vessels of the liver form

ANATOMY

IX A NUTSHELL.

329

and then upward in the longitudinal ligament, and, as a single trunk, through
the Diaphragm to the anterior mediastinal glands and thence to the right lymphatic duct: (2) branches which run forward and around the anterior margin to
the under surface, and thence in the longitudinal fissure to glands in the lesser
omentum; (3) branches which pass outward to the right lateral ligament and
thence, coalescing, either through the Diaphragm to the anterior mediastinal
glands, or inward, across the crus. to the thoracic duct: and (4) branches which

PLATE CXLIX

ABOVE
DIAPHRAGM

LESSER OMENTUM

LIVER

M
IN

C^HRAGM

FRONT
LIVER

ABDOMINAL WALL

LEFT

KIDNE1

=>/ CAPSULE

aV-PANCREAS
l.

w c
-

\plEEN

GREAT VESSELS

a/ SOLAR

PLEXUS

t oVTRANSVERSE
CRURA OF
Z
*-

MESO COLON
DIAPHRAGM

BELOW
'eat

omentum

transverse colon

3astr0- splenic

omeutum

Showing the Muscular Coats and Relations of the Stomach.

run outward from the
the

Diaphragm

left

lobe to the

left lateral

ligament, and thence through

to the anterior mediastinal glands.

Those on the under surface form three groups, viz., (1) branches arising
and passing to the lumbar glands; (2) branches
Burroduning the gall-bladder in a plexus and passing, with the hepatic Vessels
to glands in the lesser omentum and (3) branches arising to the left of the gallbladder and passing to the oesophageal glands or glands along the lesser curvato the right of the gall-bladder

ture of the stomach.

The deep

accompany

vessels of the liver

and hepatic duct and artery: they escape

a1

the branches of the

portal vein

the transverse fissure and

either

enter glands placed along the lesser curvature or the stomach and behind the
pancreas, or join a lacteal before

it

enters the thoracic duct.

ANATOMY

330

IX A NUTSHELL.

LESSON XCIV.
1V-V-CXCII-CXCIII-CXCIV).
cerebrospinal
or central nervous sysThe
tem, which ('(insists of the brain and spinal cord. The twelve pairs of cranial
nerves, and thirty-one pairs of spinal nerves make the peripheral system.
Besides these two systems there is the sympathetic system which is connected
Spinal Cord.

(Plates

spinal cord belongs to the

with these two and closely associated with the vessels, viscera, and glands.
The spinal cord extends from the level of the foramen magnum (below the
decussation of the pyramids of the medulla) to the level of the upper border of
Its
the second lumbar vertebra, sometimes only to the first lumbar vertebrae.
length

is

from

fifteen to eighteen inches

one-half ounces.

It

is

somewhat

and

its

average weight about one and

flattened cylinder, wider in the transverse

column in which it is lodged. It

and gray matter, the white on the exterior, and the gray
on the interior. The gray matter of the cord consists of two kinds. (1) SUBSTANTIA GELATINOSA (RoLAXDI and CENTRALIS) and (2) SUBSTANTIA SPONRolandi forms A cap to the posterior horn. It extends the whole
GIOSA.
length of the cord into the medulla where it becomes enlarged and has large
diameter.
is

It

composed

follows the curves of the spinal

of white

PLATE
SMALL

CL.

INTESTINE

ASCENDING COLON
Ot'SCENDISG

COLON

NFERIOR VENA CAVA

AORTA

THEMESSENTERY

Showing the Peritoneum as a Closed

Sac.

and forms one of the end stations for the sensory divisions of the
The substantia gelatinosa Rolandi was formerly thought to be
rich in neruoglia tissue, but in fad it is vert poor in this tissue.
The cord
has two enlargements, he i:i;\ ecal ami the lumbar.
The former is between
the third cervical and the second thoracic vertebra, reaching its greatest diameter,
which is transverse, in the sixth cervical, The latter is between the ninth thoracic and 6rs1 lumbar; its greatesl diameter, which is antero-posterior, is opposite
the twelfth thoracic vertebra.
These enlargements occur where the nerves are
given off to supply the extremities.
A- the cord is shorter than the canal, the
lumbar, sacral, and coccygeal nerve roots have a longer course than the nerve
nerve
fifth

cells

nerve.

<

ANATOMY
roots above them.

The

last

331

IN A NUTSHELL.

nerve roots have the appearance of a horse's

tail (cam la equina).

The neuroglia consists of a homogenous transparent matrix of a network
of very (1) delicate fibrillar and of (2) small stellate or branched cells, the
Formerly it was considered connective tissue but neuroglia
neuroglia cells.

PLATE

FORAMEN OF WINSLOW

OMENTUM

LESSER

CLI.

SPINAL

PARIETAL PERITONEUM

/ISCERAL

COLUMN

KANCREAS

PERITONEUM

OUOCENUM
TRANSVERSE MESOCOLON
TRANSVERSE COLON

GREAT OMENTUM

THE MESSENTERY

GREAT

CAVITY OF PERITONEUM

POUCH
(I

OF
(i

A S

Sagittal Section of the Trunk Showing the Peritoneum.

In addideveloped from the epiblast and connective tissue from mesoblast.

cells,
nerve
the
fibers,
which
nerve
tion to forming a ground substance in
takes
neuroglia
of
accumulation
and blood vessels are imbedded, a considerable
place in these situations; (1) ox the OUTER SURFACE OF the CORD, beneath the
pia mater, (2) around the central canal, and (3) i\ the anterior born.

is

The conus

inedullaris

is

the coin-like termination of the cord, and this

ANATOMY

332
terminates

thread,

in a .slender

IN A NUTSHELL.

The filum terminate

the filum terminale.

is

continuation of the pia mater as far as the base of the coccyx, to the periosteum
It contains very litttle nervous matter, and is distinof which it is attached.
a

guished from the nerves of the cauda equina by its glistening white appearance.
The membranes of the cord are the same as those of the brain, viz., dura
The dura mater of the cord differs from that
mater, arachnoid, and pia mater.
it does not form (1) the internal periosteum, does not
to the walls, does not contain (3) sinuses, and does not send (4)
infoldings into the fissures of the cord. The nerve supply of the dura
mater is from the spinal nerves and filaments from the sympathetic. The dura
mater of both brain and cord send tubular prolongations over the nerves.

of the brain, in that

adhere

(2)

PLATE

behind

DIAPHRAGM

AND

CLII.

ANTERIOR

WALL OF

ABDOMEN

TENTH AND ELEVENTH

THORACIC VERTEBRAE

RIGHT

SUPRARENAL
CAPSULE

GREAT VESSELS

CARDIAC END OF

STOMACH

is

SECOND

COLON

RIP^-

OF

DUODENUM

The Relations of the

Liver.

FIRST

It

HEPATIC FLEXURE OF

AND

PORTIONS

separated from the walls of the spinal canal by

KIDNEY

fat, loose

areolar tissue,

and

foramen
magnum, to the axis and the third cervical vertebra, and below to the
posterior surface of BASE of the cocgyx. The subdural space is between the

anterior and posterior plexuses of veins.

It is

attached above to the

dura mater and the arachnoid and contains a small quantity of cerebro-spinal
The inner surface of the dura mater is lined with endothelium, and is
fluid.

abundantly supplied with nerves and blood

The arachnoid
sembles

it

in

of the cord

is

more

vessels.

delicate than that of the brain, but re-

sending tubular prolongations over the nerves.

nerves and has bu1

slight

blood supply.

It

It

is

devoid of

extends as far as the second or

It forms a long sac and the space between it and the

mater is called the subarachnoid space. This space contains cerebro-spinal
fluid, which is about one ounce in this space and two ounces in the ventricles.

third sacral vertebra.

pia

ANATOMY
The

pia mater

is

the inner

IN A NUTSHELL.

membrane

of the cord.

333
It is closely

adherent

and sends septa into the anterior and posterior fissures of the cord.
The linea splendens is the thickened line of pia mater along the anterior median
The ligamenta denticulata are fibrous bands which are attached to the
line.
median lateral aspect of the pia mater from the level of the foramen magnum to
The ligaments are midway between the
the level of the first lumbar vertebra.
There are about twenty-one ligaments on
anterior and posterior nerve roots.
each side, extending from the pia mater to the dura mater, carrying the arachnoid along which it, not piercing it. The highest one of the processes is placed
between the hypoglossal nerve and the vertebral artery.
to the cord

PLATE

CLIII.

LEFT

LATERAL

LIGAMENT

SITE OF THE SPIGELIAN

LOBE
INFERIOR VENA CAVA

The Superior Surface of the

The

Liver.

is a network of gray matter, enclosing white fibers in its meshes.

the base of the posterior horn externally, directly opposite the
columns of Clarke. The columns of Clarke are two symmetrically placed tracts

reticula

It is situated at

of

medium

sized nerve cells of thespinal cord, latero-dorsal of the central canal,

confined chiefly to the dorsal region, but also extending a little above and below

LESSON XCV.
The

it.

'

anterior and posterior nerve roots of the spinal cord emerge from the

and postore -lateral aspects of the cord respectively, and form a

The anterior roots arise from the anterior horn
it.
of the gray matter and contain motor fibers; the posterior roots arise from the
posterior horn and contain sensory fibers.
The central canal is in the centre of the gray commissure, and is lined with
antero-lateral

double row on each side of

ANATOMY IN A NUTSHELL.

334

columnar ciliated epithelium in the fetus, but

appeared and fill the canal with their remains.
This canal

fourth ventricle of the brain.

is

in the adult the cilia

sinus rhomboidalis inferior or ventricularis terminalis

tral canal in the conus medullaris.

portions of

ward

or

it

in

may

varying lengths, or

downward,

in

which

dis-

the remains of the original neural

canal of the embryo, from the walls of which the spinal cord

Diseases of the spinal cord

have

continuous above with the

It is

is

is

formed.

The

a dilatation of the cen-

affect its entire transverse area, or certain

it

may

begin at any level and extend up-

case, being designated as ascending or descending.

PLATE

CL1V.
RIGHT LOBE'

BILE DUCT

The Inferior Surface of the

Liver.

A tumor

would be an example of a focal disease, or disease of one of the segments (a portion of the cord with a pair of nerves). Locomotor ataxia is an
example of a systemic disease.
Fractures of the spinal column above the fifth cervical vertebra
above the
origirj of the phrenic nerve, are almost always fatal because of paralysis of the
diaphragm. Fractures of the fifth, sixth, and seventh vertebrae cause paralysis of the intercostal and abdominal
muscles and death usually results.

In fractures of the Lower

part of the thoracic

region the

prognosis

is

not

motor tracts of the cord descend, and

This is due to the fact that the trophic centers of
the sensory tracts ascend.
the m>tir tracts are in the okay matter of the brain, while those of the sensory iraci- arc in the G \m.li upon the posterior roots of the spinal nerves.
In the crossed pyramidal tracts we find three sets of fibers, motor, vasomotor,
so

unfavorable.

Degenerations

in

ANATOMY

IN A NUTSHELL.

335

and fibers which carry impulses for inhibition of reflex action. The vasomotor
and inhibitory fibers pass to the motor cells of the anterior horn. When the
crossed pyramidal tract degenerates these inhibitory and vasomotor fibers are
included, and dilatation of the blood vessels and increased reflexes result.
In spina bifida there is an overbundance of cerebro-spinal fluid with faulty
development of the posterior walls of the lumbar portion of the spinal canal.
In this condition the membranes are pushed through the opening in the spinal
canal by the weight of the cerebro-spinal fluid.
The subarachnoid spaces of the cord and brain are continuous and connected

PLATE
3.

1.

PLEXIUS OF CAPILLARY

INTERLOBULAR VEINS

4.

TWIGS

OF

INTERLOBULAR

BLOOD-VESSELS WITHIN THE LOBULE.

V.

VEIN, PASSING

The Vessels of

CLY.

TO

THE

2.

ADJACENT

INTRALOBULAR

VEIN.

LOBULES.

a Lobule of the Liver.

with the fourth ventricle by the foramina of Magendie, Key, and Retzius.
The opening of a spina bifida may drain the cerebro-spinal fluid from the brain
and result in fatal convulsions.
The fissures of the cord are antero-median. postero-median, two anteroThese fissures
lateral, two postero-lateral. and two dorso-intermediate fissures.
divide the cord into eight columns, viz.. ventral, lateral, "Goll, ami Burdack
(posterior.)"

These are on each

side.

The ascending and descending

fibers of the

white matter of the cord

arranged in tracts, but these tract- are not recognizable in the adult cord, but
The
only during development or when affected with disease or degeneration.
facts concerning the tracts have been ascertained by embryologies! and pathological research.

This division of fissures

is

somewhat

arbitrary, a- the place

where the anterior nerve roots leave the cord i> not always called a fissure, and
If we lake this dithe dorso-intermediate one is only in the cervical region.
The
vision there are only eight fissures and eighl columns in the spinal cord.
antero-median fissure extends about one-third the diameter of the cord, toward

ANATOMY

336

the anterior white commissure.

It

IN A NUTSHELL.

has

in

it

a pro cess of pia mater which conducts

Although there are only eight columns in the whole cord,

tracts
in
the white matter of each lateral half of the cord.
ten
there are
As a
blood to the cord.

rule the tracts are

equal, as in Goll

much

smaller than the columns, but sometimes they are

Tracts one, two, three, four, and five are ascend-

and Burdack.

PLATE

CLVI.

Showing the Blood Supply to the Small Intestine.

ing tracts; eight, nine, and ten are descending tracts, and six and seven are
association tracts.

the portion

in

in

The gray matter

the horizontal portion

front of the central canal

the portion behind

matter

(Plate IV).

"H;"

a capital letter

front

it

of the

is

form of
and
the anterior gray commissure, and
is

in the

the posterior gray commissure.

gray commissure

supply of the spinal cord and

its

is

membranes

are branches from the subclavian,

cord

is

in the

called the gray commissure,

The portion

the white commissure.

of white

The blood

is (1) from the lateral spinal, which

from thoracic intercostals of the aorta, from

ANATOMY

337

IN A NUTSHELL.

(2) From the anterior and

the lumbar, and from the internal iliac arteries.
The anterior spinal arterposterior spinal branches of the vertebral arteries.
two in number; and come from the vertebrate, just before they unite

ies are

to

make the basilar at the foramen magnum, the

artery, the anterior

median

artery.

anterior spinals unite to

This artery

PLATE

lies

make one

in the pia mater, which

it

CLVII.

LEFT COMMON
ILIAC VEIN

MIDDLE

SACRAL ARTERY AND VEIN

Showing the Blood Supply to the Large [ntestine.

from the

branches
and extends the wholelength of the cord. It recieves
oi the spinal cord.
thesubstance
into
branches
sends
lateral spinal arteries, and it
vertebral arteries
The posterior spinals are also two in number; they come from the
from the posterior inferior cerebellar);
a, the side of the medulla (occasionally

supplies,

there is another
the posterior nerve roots (occasionally
cauda equina. Each Begbranch in front of the posterior nerve roots) to the

they pass

down behind

PLATE CLVIH.

NO. 2.

NO. 3.

the Cecum,
Showing the Vermiform Appendix and Four Forms of
338

ANATOMY
nient

IN A NUTSHELL.

339

a part of the cord with a pair or nerves

) has a blood supply which is

the anterior and posterior spinal, reinforced by the lateral spinal,
making a ring around the segment. Branches are given from each segment
(

made by
to the
its

segment above and below. The blood supply of the vertebral column and

ariculation

the vertebral,

is

cervical, intercostal,

nerve supply

is

occipital, ascending pharyngeal, ascending

lumbar, ilio-lumbar, sacra media, and lateral sacral. The

from the spinal nerves.

LESSON XCVI.
Brain.

(Plates

CLXVIII -CLXXXIII.)

but one nervous system, consisting of three great divisions.

The
brain and spinal cord make the central system, the twelve pairs of cranial

There

is

and the thirty-one

third division

is

pairs of spinal nerves

called

make

the peripheral system, and the

the sympathktic system.

This

last

svsteni

is

called

PLATE CLIX.

ASCENDING

CAECUM.

'

The
the nerve of organic

animal

life.

The

life

^^-=^^5^

4PPFN0IX

Ileo-Ctecal Valve.

while the central one

specific gravity of the

is

called the nervous system of

nervous system

and the spinal cord 1.034. The reaction is

activity, owing to lactic acid being developed.
alkaline than the gray.
The brain is a collection
1.038

COLON

alkaline,

is

1.

principal transverse commissures!

Anterior commissure.

2.

Middle commissure.

3.

Posterior commissure;

4.

Corpus callosum.

5.

Optic commissure.

6.

Pons

Varolii.

is

the brain

Lessened by

The white matter

of gray ganglia

white commissures.

The following are the

L.036,

which

is

more

connected by

ANATOMY

340
7.

Fornix, which

IN A NUTSHELL.

a longitudinal commissure also.

is

8. Posterior or inferior medullary velum.

9. Valve of Vieussens, anterior or superior medullary velum.

The following

are the principal longitudinal commissures:

1.

Olfactory tracts.

2.

Taenia semicircularis.

3.

Crura cerebri.

4.

Processus-e-cerebello ad testes.

5.

Peduncles of the pineal gland.

6.

Fornix.

7.

Infundibuluni.

8.

Lamina

0.

Gyrus fornicatus.

10.

Cinerea.

Fasciculus unciformis.

LESSON XCVII.
is

The extensor of the brain,

The average weight

white.

in the male, while

it is

Avhich

is

is gray, while the interior

forty-nine and one-half-ounces.

called cortex,

of the brain

is

a little lighter in the female.

PLATE CLX.

MUSCULAR BANDS

TAENIAfc

COLI

Transverse Skction of the Large Ixtkstine.

The nervous system

CLXV-CLXVI-CLXV1
a

is
).

(Plates CLXIVdeveloped from the neural tube.

cord
brain
and
are made from
of the

The substance

thickening of the walls of the tube; the hollow of the tube makes the central

canal of the cord and the ventricles of the brain.

the brain are

filled

brain and cord.

the cord

is

There are

dilated as

The rooms, or

ventricles in

with cerebro-S] Lnal fluid which acts as a cushion for the

it

five ventricles in

and the pons wi) medulla

front;

The central canal in

the cerebellum behind,

the brain.

passes into the brain, between

this dilatation is called the fourth ven-

ANATOMY

IN A

NUTSHELL

341

tricle; as this passage goes forward between the crura cerebri in front, and
the corpora quadrigemina behind, it is contracted and is called the aqueduct of Sylvius (iter e tertio ad quartum ventriculum) from here it passes into
a narrow but high room, called the third ventricle, which is between the optic
;

in the median line of the brain.

There are
each hemisphere, which are connected with
There is the fifth ventricle not conthe third one by the foramen of Monro.
nected with the others; it is situated in the septum lucidum.

thalami; these two ventricles are

two lateral ventricles, one

The brain
mid-brain, and

consists of four
(4)

hind-brain.

in

main parts,
The brain

(1)
is

fore-brain, (2) inter-brain, (3)

called encephalon; the cerebral

PLATE CLXI.

CYSTIC

SPLENIC ARTERY

DUCT

SUPRARENAL

CAPSULE

ORIFICE

OF ACCESSORY

PANCREATIC

DUCT.
SUP.

ORIFICE OF BILE AND PANCREATIC DUCTS

interior

MESENTERIC ARTERY

vena cava.

Pancreas, Duodenum and Kidney.

hemispheres are called prosencephalon; the parts around the third ventricle
are called the thalamencephalon

the parts around the aqueduct of Sylvius arc

mesencephalon; the pons and cerebellum, are called the epencephalon;
the medulla is called the metencephalon the olfactory tract is called the rhinencephalon. The spinal cord is called the myelon. The encephalon and the
;

called the

myelon constitute the neuron.

The

brain, like the spinal cord, has three coats.

dura mater, arachnoid, and pia mater. The arteries which supply the
dura mater are derived chiefly from the anterior, middle, and posterior menin-

viz.,

The nerve supply

of the dura mater is the sympathetic,* rasserian ganglion,

and twelfth. The arachnoid has but a limited blood supply, and the nerve supply is from the motor division of the fifth, the seventh,
and the spinal accessory. The pia mater receives blood supply from the ni-

geal.

fourth, fifth, tenth,

ANATOMY

342
ternal carotid

The

and vertebral

arteries.

A NUTSHELL.

The nerve supply

is

from the sympathetic,

seventh, ninth, tenth, and eleventh cranial nerves.

fifth, sixth,

the third,

IX

exterior of the

cerebrum

is

uneven, having

hills

and

valleys.

The

hills

The
secondary. The primary are
complete Assure makes an impression in a

are called gyri, or convolutions; the valleys are called sulci, or Assures.
larger fissures are called primary, the others
either

complete

or incomplete.

They are all on the mesial surface of the brain. They

are (1) the dentate, which makes the hippocampus major in the descending
lioiii
(2) the ealcarine, which makes the hippocampus minor in the posterior
ventricle of the brain.

PLATECLXII.
UUCTUS VENOSUS FISSURE
RIGHT LOBE

LEFT LOBE

VENA CAVA FISSURE

UM B,LICAL FISSURE

-GALLBLADDER

F.-SSl).

Lobes and Fissuses of the Liver.

horn; and (3) the collateral, which makes the eminentia collaterals in the descending horn. There are two others which are sometimes called complete
fissures,

the transverse, which has opposite

fissure of Sylvius,

which has opposite

it

it

the choroid plexus, and the

the corpora striata.

The

last

two

are not on the mesial surface.

LESSON XCVIII.
The right and left lobes of the cerebrum are connected by the corpus
CALLOSUM. There are five lobes in each hemisphere of the brain.
The brain is the encephalon; the part of the cerebro-spinal axis which is
contained

the cranium.

cerebrum or brain proper, the

and the medulla oblongata. The
average weighl of the brain in the male is forty-nine and one-half ounces, in
the female forty-four ounces.
Cuvier's brain weighed more than sixty-four
ounces.
The human brain weighs more than that of any other animal, except
the elephant and whale.
The elephant's brain weighs about ten pounds; that
in

cerebellum or

of the

whale

little

five

Its

divisions are the

brain, the pons Varolii,

pounds.

Like the bark (cortex) of a tree the cortical layer of the brain covers the
surfaces of the brain.
It
is composed of cellular nerve-material.

ANATOMY

IN A NUTSHELL.

343

The Assures or sulci of the brain are infoldings of the cortex and the more
numerous and deeper they are, the greater is the amount of the peripheral gray
substance.

which invests the cerebellum and cerebrum,

from the white or medullary
substance of the interior. There are several ganglia or collections of gray matter in the interior, as the corpora striata, the optic thalami, the optic
lobes or corpora quadrigemina,the corpora dentata of the cerebellum, and
the corpora olivaria of the medulla oblongata. There are two non-nervous structures connected with the brain, the conarium or epiphpsis cerebri
and the pituitary body or hypophysis cerebri.
The principal fissures of the cerebrum are: (Plates CLXXV-CLXIX),
(a) The longitudinal fissure which separates the two hemispheres.

The gray matter

is

of the brain

also called the cortical substance, in distinction

PLATE

CLXIII.
SEROUS COAT
LONGITUDINAL MUSCULAR LAYER

CIRCULAR MUSCULAR

AREOLAR

MUCOUS

LAYER

COAT
COAT

DUODENUM

The Four Coats of the Stomach and the Pyloric

The Sylvian

Orifice.

and most constant of the

has a short anterior and long posterior branch, the
latter separating the temporal from the parietal lobes.
It has the middle cere(b)

fissure is the largest, deepest,

fissures of the brain.

It

bral artery in

wing

it,

lesser

of sphenoid

and central lobe or

The fissure of Rolando or central fissure is a deep

the frontal and parietal lobes of the cerebrum on each side.

isle of Reil.

(c)

sulcus separating

(d)

Parieto-occipital fissure extends from the longitudinal fissure outwards

between the parietal and occipital lobes.

fissure is a crevice through which the invagination of
the pia mater is effected, it starts from the porta (foramen of Monro) nearly
to the distal end of the middle horn on each side.
It is at the base of the brain.

for about, one inch

(e)

It

is

The transverse

also called choroid fissure.

Calloso -marginal fissure is nearly concentric with the callosal and also
with that of the margin of the hemisphere until a point above the hind end of
(f)

the callosum

ward

to the

is

reached, at which the fissure turns and runs upward and back-

upper border.

ANATOMY

344

IN A NUTSHELL.

(g) Calcarine fissure (from calcar, "a spur"), runs from near the rather
pointed hind end of the hemisphere upward and forward, and just beyond the
middle at the point where it receives the parieto-occipital, binds downward

and terminates beneath the rear end

is

fissure,

(h)

lateral

of the callosum.

Encircling the callosum

called the callosal.

First tempro-sphenc tidal fissure

is

below the

fissure of Sylvius

on the

surface of the brain.

LESSON XCIX
TllK PRINCIPAL LOBES OF
1.

parietal
2.

Frontal lobe

by the

is

fissure of

Parietal lobe

is

THE CEREBRUM ARE:

(Plates

CLXXV).

the anterior one of the cerebrum, separated from the

Rolando or central

fissure.

the middle one of the vault of the cerebrum, separated

PLATE CLXIV
FORE- BRAIN

(RUDIMENT OF CEREBRAL HEMISPrtEKtS

OPTIC

GERMINAL

NEURAL GROOVE
PRIMITIVE

VESICLE

AREA

FIRST CEREBRAL VESICLE

SECOND CEREBRAL

STREAK

VESICLE

THIRD CEREBRAL VESICLE

MESODERM

NEURAL CREST

Showing Germinal Area.

from the frontal by the central fissure. or fissureof Rolando and marked off from
the occipital by the parito-occipital fissure.
It is divided by an intra-parietal
fissure int" a superior and inferior parietal lobe.
is the posterior portion of the cerebrum marked off from
by the parieto-< iccipital fissure.
4. Temporo-sphenoidal lobe, also called temporal, is the lobe of cerebrum
which occupies the middle cerebral fossa of the skull, it is separated from the
frontal and parietal lobes by the fissure of Sylvius.
''<.

tin

Occipital lobe

parietal lobe

.">.

The Central lobe or

fissure, lobule of

island of lb

the corpus striatum

il

is

also called the lobule of the Sylvian

is

portion of the cerebral cortex con-

ANATOMY

IN A NUTSHELL.

345

cealed in the Sylvian fissure, consisting of five or six radiations, convolutions,

or the gyri operti ("covered gyrus").

human brains vary in details of the gyri. and the same brain may
on its opposite sides. The gyri are best marked when one reaches his
highest mental development.
The principal gyri or convolutions are: (Plate CLXXV-CLXXXIIIDifferent

differ

CLXXXIV).
1.

Angular gyrus

a short one, arching over the upper extremity of the

is

superior temporal fissure, the hindmost one of the four parietal gyri, separated

from the supra-marginal gyrus.

a small fold wich may connect large or primary convolutions; applied to several such gyri on the occipital lobe, as those forming

by a short
2.

vertical sulcus

Annectent gyrus

is

the connections of the cuneus or occipital lobule.

Ascending frontal gyrus

is

the one bounding the fissure of Rolando in

front.

PLATE CLXV.
SURFACE ECTODERM

^^

NEURAL CREST (DISAPPEARING)

CREST

TJEURAL

GANGLION
POSTERIOR

SPINAL

NERve

GANGLION

SYMPATHETIC

GANGLION

ANTERIOR NERVE ROOT

Showing the Development of the Sympathetic Nerve.

As ascending
5.

is the one bounding the fissure of Rolando behind.

of the median surface of the cerebrum
convolution
a

parietal

Calossal gyrus

is

immedately over the corpus callosum and below the calloso-marginal fissure.
It is continuous behind with the gyrus hippocampi, and ends in the gyrus uncinatus, also called gyrus fornicatus, convolution of the corpus callosum.

Cuneate gyrus is one of the occipital lobe appealing as a wedge-shaped

figure on the median aspect of the cerebrum in the fork between the parietooccipital sulcus and the calcarine sulcus, also called occipital lobule and cuneus.
7. External orbital gyrus is that part of the orbital surface which lies out6.

side of the triradiate sulcus.

8.

The

frontal gyri, three gyri

surface of the frontal lobe of the

frontal gyrus.

by

They

are

which compose the superior and lateral

all lying in front of the ascending

cerebrum,

denned by the superior and

inferior frontal sulci,

and

the vertical fissure or precental sulcus.

The hippocampal gyrus is the continuation of the gyrus fornicatus

where it dips down behind and below the corpus callosum, and continues forward to the uncinate gyrus: so-called from its relation to the hippocampus.
9.

ANATOMY

346

IN A NUTSHELL.

That part of the first frontal convolution which appears on the median
the hemisphere is the marginal gyrus, or it is that gyrus which arches

10.

side of

over the extremity of the fissure of Sylvius.

11. Occipital gvri are the three principal convolutions of the occipital lobe
of the cerebrum, separated by two small transverse sulci, and distinguished as

downward, superior, middle, and inferior.

upon the under or orbital surface of the frontal
the cerebrum, which rest upon the orbital plate of the frontal bone.
Lobe
are
three in number, directly continuous with and corresponding to the
They
The two which are best marked are sometimes called internal
frontal gyri.
first,

second, and third; from above

The

12.

orbital gyri are

<>!'

and external.

The

13.

parietal gyri are four

well-marked convolutions upon the superior

PLATE CLXVI.
OPTIC THALAMUS

EPENCEPHALON

MEDULLA OBLONGATA

TERMINALS

CEREBRAL

&

MID

BRAIN

\ OLFACTORY

DIVERTICULUM

HEMISPHERE

FORAMEN OF MONRO

A Horizontal Section of

a Vertebrate Brain.

and especially two of these distinguished

and the superior parietal, the
other two being commonly known as the supramarginal and angular gyrus.
14. Quadrate, or quadrate gyrus, is a convolution of somewhat square
figure appearing on the median surface of the cerebrum between the callosum
marginal sulcus in front and the parietooccipital sulcus behind, and continu-

and

lateral surface of the parietal lobe;

as the ascending parietal or

posterior central

ous below with the gyrus fornicatus, also called precuneus.

L5.

Lateral

Sigmoid gyrus is the somewhat S-shaped fold which curves about the
end of the cruciate fissure and whose surface includes several constant

and well-marked "motor areas."

lii.

The temporal

17.

Uncinate gyrus

gyri, a general
is

in

name

the median

of the temporal convolutions.

surface of the cerebrum nearly op-

posite the gyrus fornicatus.

Is.

Gyri operti ("covered gyrus")

L9.

The dentate gyrus

slender

roll of

is

lodged

in

is

the insula.

the hippocampus fissure, and

gray substance, notched upon

its

exposed surface.

is

a long

ANATOMY

347

IN A NUTSHELL.

LESSON

C.

Besides the gray matter of the cerebral hemispheres of the cerebellum and

the meddulla oblongata, and the ganglia at the base of the brain are:
(a) Olfactory bulb which is the anterior enlargement of the olfactory-

from the which olfactory nerves are sent off.

Corpora striata (striped bodies) are large ganglia of the brain, of mixed
white and gray substance, situated beneath the anterior horn of each lateral
tract

(b)

ventricle of the cerebrum.

(c)

Optic thalamus

is

a large ganglion of the thalamencephalon, situated

upon the crus and separated from the

sule; also called thalamus.

lenticular nucleus

It gives origin to

some

by the

internal cap-

of the fibers of the optic

nerve.

Tubercula quadrigemina are on the dorsal part of the mid-brain.

The lobes are paired, right and left, and hence called corpora bigemina in ani(d)

PLATE CLXVII.

PINEAL

CORPRA

BODY

fe

%,

QUADRIGEMINA

CEREBELLUM

MEDULLA OBLONGATA

OLFACTORY DIVERTICULUM

THALAMUS

Sagitaal Section of a Vertebrate Brain.

mals below mammals. In man they are marked by a cross-furrow so they are
called corpora quadrigemina, and constitutute what are called the nates or
The optic nerve arises in part from the optic lobes.
testes of the brain.
(e) Tuber annulare is the annular tuber of the brain, the pons Varolii.

The

anterior commissure

terior pillars of the fornix.

is

white and situated directly

(Plate

CLXXX).

It

in

front of the an-

connects those parts of the

hemispheres not connected by the corpus callosum,

viz., in

man

the temporal

forms a curve with the

convexity forward and slightly upward and its extremities are spread on! Ianshaped. Its center forms the anterior boundary of the third ventricle between

lobes and in osmaties the entire rhinencephalon.

the anterior pillars of the fornix.

It

It

passes beneath or through the bead of

the caudate nucleus and the posterior two-thirds of the lenticular nucleus where
The A.NTERIOB comit is spread out in the substance of the temporal lobe.

missure

is

a more primitive commissure than the corpus callosum and de-

ANATOMY

348
creases
terior

and

in size

IN A NUTSHELL.

The

as the corpus callosum increases.

man

in

is

very small, but

in

osmatics

it

is

large, being twice as large as the

posterior portion or hemispheral bundle of fibers.

in

anterior fibers of the an-

commissure (pars olfactoria) connect the olfactory bulbs of opposite sides

This anterior portion

is

large

The posterior portion of the anterior commissure connects the temlobes and the amygdalae nucleus of opposite sides.
The middle fibers

fishes.

poral

through the olfactory bulb of one side to the temporal lobe of the opposite
Thus we may have a lesion on one temporal lobe producing loss of smell
of the opposite side of the nose called crossed anosmia.
The middle or soft commissure is gray; it is very delicate, though somepas

side.

time-

it

is

double.

connects the two optic thalami, which takes place about

It

PLATE CLXVI1I.
EPIPHYSIS

CORPORA QUAORIGEMINA

5TH VENTRICLE
IN

SEPTUM LUCIDUM

FORAMEN

Of

MONRO
HYPOPHYSIS

A
the

month

of intra-uterine life.
It is not really a commissure as no fibers
from one side of the brain to the other.
The posterior commissure is white and is situated behind the upper end of

fifth

pass from

the

Sagittal Section of the Brain.

it

aquedud of
The

ventricle.

Sylvius.

It

pineal gland

forms part of the posterior boundary of the third

Most
is just above and slightly posterior to it.

commissure are a continuation of the fibres of the fillet,

which after decussation, pass through the optic thalamus into the corona radiata
of the opposite side.
The anterior fibres pass from the root of the pineal gland

of the fibers of this

to the nucleus of the

trigonum habenulse on one side and the nucleus of the

third nerve of the opposite side.

The

fornix

is

composed

of

Longitudinally

arched

bundles of

fibers.

It

ANATOMY
consists of a

IN A NUTSHELL.

body and two anterior

pillars

349

and two posterior

pillars

It is sit-

uated just beneath the corpus callosum. its posterior part being attached to the
corpus callosum. The body is triangular with the apex in front and base be-

forms one of the boundaries of the roof of the third ventricle and part
The anterior pillars or columx.e forNICES, descend from the gray matter of the third ventricle behind the anterior
commissure and in front of the foramen of Monro.
As they descend they
spread out. leaving an interval which is occupied by the septum lucidum.
hind.

It

of the floor of the lateral ventricle.

They

receive reinforcements

from the

and the crura of

They form loops around the cor-

tsenia semicircularis

the pineal gland and the septum lucidum.

PLATE CLXIX.
GREAT

LONGITUDINAL

FISSURE

j&M

OLFACTORY TRACT

A Coronal Section Through the Anterior Horns of the Lateral

Ventricles.
jiora albicantia,

making the stroma zonale

or white portion.- of these bodies.

Fibres continue from the corpora albicantia and

filn rs

of Vizq'd'azyr.

The posterior pill

the optic

thalamus called

uts of the fornix descend from the sides

body of the fornix and between the diverging crura and the splenium of the
corpus callosum is the psalterium or lyra consisting of white matter and having
on its surface some transverse oblique, and longitudinal line-.
From it- fancied

of the

''

semblance

to

the strings of a harp this area

is

called a lyra.

Bach

passes around the pulvinar of the optic thalamus and then descends

pillar
in

the

While there they send libers t<> the

hippocampus major ami end in the gyrus hippocampus and the uncinate gyrus.
The corpus callosum (callous body) is the great white commissure of the
descending horn of the lateral ventricle.

ANATOMY

350

IN A NUTSHELL.

hemisphere of the brain: the commissure magna or trabs cerebri. This strucis peculiar to the mammalia; it is first found in a rudimentary state in the
implacentals, and increases in size and complexity to the highest mammals,

ture

coincidentally with a degree of other special cerebral commissures.

It is also

called callosum.

The corpus callosum connects the

lobes.

It

is

frontal, parietal, central

the great transverse commissure of the brain.

and

occipital

It is three

and

one-half inches long on the superior surface and two and one-half inches on the
inferior.
<>f

It

the brain

extends within one and one-fourth inches of the anterior boundary

and within two inches

of the posterior

boundary

of the brain.

It

PLATE CLXX.
BODY Cr LATERAL VENTRICLE.
CHOROID PLEXUS0F CAUDATE NUCLEUS

EXTERNAL CAPSULE

OPTIC TRACT

HlPPOCAMPAL FISSURE

A Coronal

ur.. uri

ALBICANTIA

Section Through Middle Commissure of Brain.

convex above and concave below, thinner in the center of body than at either
Tin: posteriob end is called the splenium or ped.
The anterior end
which is between the frontal lobes is called the genu or Knee. The rostrum is
is

end.

the continuation of the genu

and

joins the

lamina cinerea.

On

the superior

median line called the raphe and on each

side of tlii- are the stride longitudinales or nerves of Lancisi.
These
nerves are two distind white bands given off to the termination of the corpus
callosum and culled the peduncles of the corpus callosum. They pass across
the anterior perforated space to end in the temporal lobes, uniting with the
inner root of the olfactory tract.
The forceps minor are fibers which go forsurface a groove extends along the

ANATOMY
ward from the
major are

IN A NUTSHELL.

351

and lateral angles into the frontal lobes. The forceps

which continue backward through the posterior angles into the

anterior

fibers

occipital lobe.

LESSON

CI.

The septum lucidum forms the inner boundary of the lateral ventricle and
genu and rostrum of the corpus callosum.
Posteriorly
and inferiorly it is united with the fornix and its anterior peduncles. (Plate
CLXXXIV). It consists of two laminae which enclose the fifth ventricle. It is
unites in front with the

PLATE CLXXI.

LATERAL

SINUS

A Coronal Section Through the Posterior Horns of Lateral Ventricles.

area of gray matter.

This ventricle was originally a part of the

two hemispheres are united above by the corpus callosum and below by the fornix, and the space betwe<
them becames a
distinct cavity with walls of its own
lamina or septum Lucidum. The Loner
layer is gray, middle white, and external one ependymal or ependyml tissue
covered by the epithelial layer continuous with that lining the lateral ventricle.
Velum interpositum or tela choroidea superior the word tela means a web
and is applied to a membrane formed by the position of the pia mater and
a triangular

great longitudinal fissure but the

;>

ependyma when

the intervening layer of nerve tissue has disappeared.

It

is

mater which is prolonged through the transverse

fissure and lies over the third ventricle and upper surface of the op1 ic thalamus.
from its under surface it supplies two vascular processes which form the
a triangular process of pia

ANATOMY

352

IN A NUTSHELL.

choroid plexus of the third ventricle and each, side the

formed.

choroid

plexus

of

the

lateral ventricles are

The

optic thalami are

bounary

lateral

mostly gray matter but are white exterally and are

of the cms. The inner surface of each forms the

tegmentum

situated above the

of the third ventricle

and the upper suiface forms part

of the

floor of the lateral ventricle.

The

internal capsule (fibres of the crusta or pes) separate the outer sur-

face of each optic

thalamus from the lenticular nucleus.

Each

optic thalamus

superior or dorsal (2) inferior or ventral, (3) internal or

The taenia semicircularis separates the
mesial, and (4) external or lateral.

has four surfaces.

(1)

PLATE CLXXI1.

ANTERIOR CORNU

FORAMEN OF MONRO

POSTERIOR CORNU

Cast of the Ventricles of the Brain.

superior surface from the caudate nucleus.

This surface

sulcus choroidens into mesial and lateral portions.

depression

is

in the floor of the lateral ventricle.

prominence, the anterior tubercle.

The

is

Anteriorly

The superior surface

divided by the

lateral portion of this

is

it

grows

into a

separated from the

The posterior surface

The trigonum habenulae is a
depressed area of gray matter between the pulvinar and the beginning of the
peduncles of the pineal gland.
The ganglia of habenulae is anterior to the trimesial surface by the peduncles of the pineal gland.

divides into a large prominence, the pulvinar.

gonum

habenulae.

The

internal

and external geniculate bodies are elevations

on the posterior and inferior surface of the pulvinar.

body

is

The

of gray

matter

internal geniculate

situated on the inferior and inner side of the pulvinar, between the

brachia of the corpora quadrigemina.

The external geniculate body

is

It is

covered" with a layer of white fibers.

below and external

to the internal geniculate.

353

ANATOMY IN A NUTSHELL.

The projection system of fibers which pass

a yellowish-gray color.
of the optic thalathrough the internal capsule and bundles are the peduncles

It is of

mus
The

pineal gland, also called conarium

and

epiplysis, is a small reddish

body

PLATE CLXXIII.
ANT COMMUNICATING

CIRCLE OF WILLIS AND ARTERIES OF BRAIN.

The Circle of
developed from the hind*
in

par! of the roof of the

and above the nates.

and its t'nnction.if it

by some (as the Cartesians)

ture,

first

cerebral vesicle, and lying

substance consists mainly of epithelial

strucand connective tissue; there is no evidence thai it is a nervous
possesses anv.is unknown. It was formerly supposed

front of

follicles

Willis.

to

Its

be the scat of the soul.

(Plate

CL XXX).

ANATOMY

354

NUTSHELL

IN A

Then' arc numerous peduncles of the brain. Those of the cerebellum are
three pairs and are stout bundles of nerve fibres which connect the cerebellum

They

with other chief divisions of the brain.

tion as superior, middle,

and

are distinguished

inferior peduncles or crura.

The

by

their posi-

superior pair

emerge from the mesial part of the medullary substance of the hemispheres, and
run forward upward to reach the nuclei tegmenti of the opposite sides, after
decussation under the formatio reticularis. Also called (1) crura ad corpora
quadrigemina,

(2) crura

ad cerebrum,

processus-e-cerebello ad testes.
junctoria).

(Plate

(.">)

processus cerebelli ad cerebrum,

(3)

branchia conjunctiva, and

(6)

(4)

branchia con-

CLXXXVIII).

PLATE CLXXIV.

Showing; Blood Supply of the External Surface of the Brain.

The middle
from the

pair

from the ventral transverse

lateral part of the

crura or processus ad uiedullani).

The

fissures of the

The

CI

I.

cerebellum are three

great horizontal fissure

emerging

(Also called

CLXXXVIII).

(Plate

LESSON
horizontal.

fibres of the pons,

white substance of the hemispheres.

is

in

number

two

vertical

and one

a continuous fissure which separates

the cerebellum into upper and lower portions.

It begins in front at the

middle

peduncles, and extend- around the outer and posterior border of each hemisphere.

The vertical ones are

median notch of the cerebellum,

quadrigemina arc received.
2. Incisura cerebelli posterior, the median notch on the posterior outline
of the cerebellum, formed by the projection of the cerebellar hemispheres be1.

Incisura cerebelli anterior, the anterior

into which the corpora

yond the vermis.

(Plate

CLXXXVIII).

ANATOMY
The vermis
the cerebellum

is

is

IN A NUTSHELL.

255

the median lobe of the cerebellum; the vermiform process of

divided into

The olivary body

is

the prevermis and the postvermis.

the ganglion of the oblongata lying on either side just

pyramid, and forming an oval projection on the surface just below

the nucleus olivaris inferior with a covering and filling
of white matter, also called inferior olivary body, or inferior olive, and corpus
lateral of the

the pons.

It consists of

semiovale.

The corpus dentatum

teriorily, situated

is

(a)

Also called ganglion of the cerebellum and nucleus dentatus.

similar

mass

open an-

a plicated capsule of gray matter,

within the white substance of each cerebellar hemisphere.

of gray matter in each olivary body.

(b)

A somewhat

Also called corpus

ciliare.

PLATE CLXXV.
FISSURE OF ROLANDO.

PERFORATING BRANCHES

MIDDLE

CEREBRAL

A.

IN

FISSURE.

OF SYLVIUS.

Showing Distribution of Middle Cerebral Artery.

lies

The lateral tract is continuous with the lateral column of the spinal cord,
behind the olivary body and in front of the restiform.
The restiform body is the inferior peduncle of the cerebellum, by which it

connects with the oblongata and parts below.

bellar-tract fibres, crossed

and

It

contains the direcl

and uncrossed from the posterior columns

cere-

of thecord,

from the centra-lateral (lower) olive

some special bundle of nerve-fibres; especially, a band of Longitudinal fibres lying in the ventral and outer parts of the tegmental region of
the brain.
Its distribution is not known, bu1 it seems to conned below with the
posterior columns of the spinal cord and above with the corpora quadrigemina,
fibres

The

fillet is

optic thalami, lenticular nucleus,

A vesicle is

and cortex

cerebri.

It

is

also called lemniscus.

a small, bladder-like structure, cavity cell, or the like,

There are three vesicles in the brain, anterior, middle, and posterior.

in a

body.

They

are

I
ANATOMY

356

so transitory,

embryonic and

IN A NUTSHELL.

and have other names when matured

They

are

midand posterior, corresponding to the fore-brain,

called anterior, middle,
pmnitive structures and become the ven-

^d

braiD

They are
The three commonly form

hind-brain.

tricles of the brain.

five

by the subdivision

of

partition of the lateral ventricles of the

Tbe septum lucidum is the median
Also called
or so-called fifth ventricle.
,,,. ^dosing the camera, pseudocele,
ventnculorum,
(4)
septum
medium,
(3)
septum
,,, septum pellucidum, (2)
tnangulare.
medullare
ventricular septum. (5) septum
'

The

fornix

bundles of
up. as

is

fibres,

Longitudinal
In the human brain it consists of two
an arch.
albicantia pass
corpora
the
from
rise
which
one on each side,
of Monro
pillars of the fornix in front of the foramina

the anteriob

PLATE CLXXVI.

ARR

SUPPl.kD BY M D3LE CEREBRAL ARTERY.

Section^f Brain).
Showing Blood Supply on Mesial Surface, (Sagittal
somewhat flattened and in apposiand behmd the anterior commissure, these
the corpus callosum and above the
tion to each other, arch backward beneath
fornix and then diverge toward
velum interpositum, forming the body of the
turn down, as the posteriok pillars
the back pari of die corpus callosum, to
cornua of the
fornices), into the floor of the descending
f

the fornix (crura

lateral ventricles,

The fimbria
concave side
the fornix.

The

where their free edges form the fimbriae.

running along the median
a narrow band of white fibres

is

pillars of

hippocampus major. It is a continuation of the

Also called taenia hippocampa and corpus fimbriatum.
the corpus
semilunaris consists of commissural fibres between
of the

taenia

striatum and the optic thalamus.

lies in front of the cereThe cerebrum is thai portion of the brain which
oi
It
comprises aboul seven-eighths of the weight
bellum ami pons Varolii.
the brain.

It

is

the center of intelligence

and thought

ANATOMY
The cerebellum

is

IX A NUTSHELL.

called the arbor-vita1 or tree of

357
life.

It is

the center for

between the corpora qnadrigemina in front and

the medulla oblongata behind, and forming part of the roof of the fourth ven-

the control of muscles.

It

is

tricle.

The pons, also called pons Varolii and pons cerebelli, is a great transverse
commissure seen at the base of the brain in front of the medulla. Its fibres
connect the hemispheres of the cerebellum with each other and the medulla.
The medulla oblongata is (a) marrow; (b) the so-called spinal nervous system; the myelon; more fully called medulla spinalis: (c) the hindmost segment
of the brain, continuous with the spinal cord.

PLATE CLXXVII.

area supplied by middle cerebral artery.

Showing Blood Supply at Base of Brain.

ventricle (literally a belly, a

stomach)

is

a small cavity.

Those of the

brain are a series of connecting cavities, containing fluids, within the brain,

continuous with the central cavity of the spinal cord.

of the original neural canal,

formed by

a folding

They

are the remains

over of the epiblast.

The optic commissure or chiasma, somewhat quadrilateral in form, rests

upon the optic groove of the sphenoid bone, being bounded, above, by the
lamina cinerea; behind, by the tuber cinereum; on either side, by the anterior
perforated -pace.
Within the commissure the optic nerves of the two sides
undergo a partial decussation. The fibres which form the inner margin (inferior commissure of Gudden) of each trad are continuous across from one to
the other side of the brain.
These may be regarded as commissural fibres
Some fibres are con(intercerebral) between the interna] geniculate bodies.
tinued across the anterior border of the chiasma, and connect the optic uerves
of the two sides, having no relation with the optic tracts.
They may be regarded as commissural fibres between the two retinae (inter-retinal fibres').
The outer fibres of each tract are continued into the optic nerve of the -nine side.

ANATOMY

358

The
side,

IN A NUTSHELL.

central fibres of each tract are continued into the optic nerve of the opposite
decussating in the commissure with similar fibres of the opposite tract.

The

ventricles arc

two lateral, third ventricle, fourth ventricle,

ENTRICLE, and THE VENTRICLE OF THE CORPUS CALLOSUM.

The lateral ventricles arc found one in each hemisphere; they communicate

FIFTH

with each other and with the third ventricle through the foramen of Monro.

PLATE CLXXVIII.

NINTH

TENTH
AND ELEVENTH

LIGAMENTMM DENTICULATUM

Showing Falx Cerebri, Etc.

The

third ventricle lie-

the aqueduct

between the cerebellum and the

tricle, (n-

of a

communicates with the

The fourth ventricle/lies
pons and medulla. The so-called fifth ven-

between the optic thalami.

fourth ventricle through

It

of Sylvius.

pgeudocele, has no connection with the other cerebral ventricles, being

different

layers of the

nature and simply

septum lucidum.

small interval between the right

and

left

ANATOMY

IN A NUTSHELL.

359

LESSON cm.
about one and one-half inches long and threeIt extends
from the foramen magnum inferiorly to the pons superiority. It is the smallest
part of the main divisions of the brain but the largest from a physiological

The Medulla Oblongata

is

fourths of an inch wide and one-half of an inch antero-posteriorily.

standpoint.

It has five

inhibitory, (3)

main centers

Vasomotor,

in

(4) Diabetic,

it,

and

viz.,

(1)

Respiratory,

(5) Salivary.

(Plate

Cardio-

(2)

CLXXXV1I).

PLATE CLXXIX.

OPHTHALMIC

VEIN-

OLFACTORY BULB

CAVERNOUS SINUS.
OPTIC
OPTIC
|NT.

NERVE

COMMISSURE

CAROTID

ARTERY

OPHTHALMIC DIVISION
OF FIFTH N

THIRD N

FOURTH

BASILAR

SIXTH N

VERTEBRAL

AUDITORY ARTERY,

ANTERIOR
.AUDITORY AND FACIAL

AND

PNEUMOGASTRIC

HYPOGLOSSAL

PETROSAL

STRAIGHT

A.

GLOSSOPHARYNGEAL

SUPERIOR PETROSAL
INFERIOR

A.

SPINAL

SPINAL ACCESSORY

SINUS.

OCCIPITAL SINUS

TORCULAR

HEROPHlLl

RIGHT

LATERAL

SINUS,

SINUS.
>jPERI0R LONGITUDINAL

Sinuses at the Base of the Brain.

Its posterior SURIt is gray on the outer side and white on the inner.
FACE makes the lower part of the anterior boundary or the floor of the fourth
ventricle.
Its anterior surface rests upon the basilar process of theoccipital
In the median line of the anterior surface is the antero-median fissure
bone.
which is continuous with the antero-median fissure of the cord. On each side
of this fissure there is a pyramid.
This pyramid has fibres next to the fissure
which are derived from the crossed pyramidal tracts after they push the gray

matter of the anterior horn of the cord superficially.

Next to this it has the
fibres of the direct pyramidal tract.
External to the pyramid we have the
olivary

body

superiority

and the

lateral tract infcriorily.

This olivary body has

ANATOMY

360

IN A NUTSHELL.

The olivary nucleus

the inferior olivary nucleus and the dentates nucleus.

hollow and gives

off,

from

an opening

Next

uncles of the olivary body.

have part

of the restiform

body.

ferior pedicles of the cerebellum.

postero-median
(2)

funiculus

to the olivary

cuneatus,

(3)

the

and

Another name

The

and on each

fissure

fibres called the

in its side, little

lateral tract external

side'

of

it

we

body is inthe medulla has the

for the restiform

posterior surface of

funiculus

is

ped-

is

(1)

Rolando.

the funiculus gracilis,

(4)

lateral

The

tract.

upper portion of the posterior surface makes the restiform body or the inferior
peduncles of the cerebellum.

PLATE CLXXX.
POST. COMMISSURE.

EPIPHYSIS

OR

PINEAL GLAND.

SPLENIUM OF CORPUS CALLQSUM

ANT v COMMISSURE.

U "^FORAMEN

OF MONRO.

OPTIC NERVE.

INFUNDIBULUM.

HYPOPHYSIS

OR

PITUITARY BODY.

A Sagittal Section of Brain, Showing the Third and Fourth Ventricles

The fibres in the cold which travel through the direct cerebellar tract,
which is in the lateral column of the cord, pass up into the medulla into the restiform body, instead of passing straight into the lateral column. The funiculus
Rolando is a continuation of the gray matter from the posterior horn of the
where it is called substantia gelatinosa Rolando, up into the medulla
where it is situated between the funiculus cuneatus and lateral column.

cord,

Cerebellum
about

five

In early child]

situated

in

(little

ounces.

It
1

it

brain)

is

about one-tenth of the entire brain.

It

weighs

about one-eighth as large as the cerebrum in the adult.

may he as small as one-twentieth of the cerebrum. It is
is

from the
two hemispheres connected

the posterior fossa at the base of the skull, being separated

cerebrum by the tentorium cerebelli.

by the worm (vermiform process).

It

consists of

The medulla

is

situated in the anterior

ANATOMY IN A NUTSHELL.
inferior portion in a groove called the vallecula.
in a

worm between

groove posterior to the

The

361
falx cerebelli

the two hemispheres.

is

situated

The hemi-

spheres have fissures like the cerebrum but do not have convolutions like the
cerebium but instead have folia. The cerebellum is gray on the outer side and

white on the inner side.

It

forms the roof or posterior boundary of the fourth

ventricle.

PLATE CLXXXL

CORPORA
QUADRIGEMINA

TRACT
SUPERIOR

CEREBELLAR
PEDUNCLE

FOURTH
VENTRI CLE

^?^^^^ (^^^n;
x

HIDDLE CEREBELLAR

PEDUNCLE

INFERIOR

% ^2f*73
^%l\\ ^
-^>
:

CEREBELLAR

PEDUNCLE

Ml

EIGHTH NERVE
NUCLEUS

A Sagittal Section of Brain Showing

Fibers.

The worm, commencing with the anterior superior

part, and passing

backward consists op the following parts:

Frenulum

(1)

Lingular

Fraenulum

Precentral fissure

Ala lobulus centralis

(2)

Lobulus centralis

Ala lobulus centralis

Post-central fissure

Anterior crescentic-lobule

(3)

Oilmen monticuli

Anterior crescentic lobule

Preclival fissure

Posterior erescentic lobule

(4)

Clivus

Post-clival fissure

Posterior superior lobule

(5)

Folium cacuminis

Posterior erescentic
lobule.

Posterior superior lobule

ANATOMY

3(52

IN A NUTSHELL.

The lower worm from before backward

consists of the following

parts:
Flocculus

(2)

Nodule
Uvula

(3)

Pyramid

Biventral

(4)

Tuber valvulae

Post-gracile fissure

Flocculus

(1)

Amygdala
BiventraJ

Amygadala
Slender lobe

Sledner lobe
Post-gracile fissure

Postero-inf erior lobe

Postero-inf erior lobe

(Inferior semilunar)

(Inferior semilunar)

There are four sets of gray nuclei in the white matter of each hemisphere
called (1) Corpus dentatum. (2) Nucleus emboliformis. (3) Nucleus globosis.
(Plate CLNXI).
h Nucleus fastigii.
I

PLATE CLXXXII.

A Sagittal Section of Brain, Showing Centers of Smell and Taste.

The cerebellum has

three sets of peduncles,

the superior ones pass from

the cerebellum to the corpora quadrigemina (processes-e-cerebelli ad testes)

and have efferent fibres in them.* The middle ones connect the middle part
of the cerebellum with the pons

and have both

afferent

and efferent

fibres.

The

[NFERIOK ONES connect the cerebrum with the cord and are called the restiform
bodies.

LESSON
The pons

is

CIV.

the connecting link for the other parts of the brain.

It is

con-

nected to the cerebellumby the middle peduncles of the cerebellum.

It is connected to the cerebrum by the crus cerebri or the peduncles of the cerebrum.
It

is

connected

to the

medulla by

fibres

through the pyramidal tract.

situated on the basilar process of the occipital bone

the sphenoid bone.

There

It

is

It is

and the posterior part

one inch long and one and one-half inches wide.

are afferent fibres immediately beneath the superior peduncle in the valve of Vieussens.

of
Its

ANATOMY

IX A NUTSHELL.

363

convex from side to side and slightly convex from above

border is longer than the lower border and Is convex,
In the median line on the anterior
while the lower border Is almost straight.
Its posterior surface is concave
surface there is a groove for the basilar artery.
A
and forms the upper part of the floor of the fourth ventricle.
coronal section will divide it into an anterior or inferior portion and a posterior
The posterior part is called tegmentum. The anterior
or superior portion.
part consists of three main divisions (1) superficial transverse fibres which pass
from the middle peduncles of the cerebrum and give the pons its name., (2)
deep transverse fibres which decussate in the pons connecting one side of the
cerebellum with the opposite side of the cerebrum. (3) is longitudinal fibres which
intermingle with the deep transverse fibres and pass through the medulla into
anterior surface

downward.

is

Its superior

PLATE CLXXXIH.

Location of Centers of the Brain.

the crust a or pes of the crus.
part,

has four main parts.

The tegmental portion

Anteriorly

(1)

the

fillet.

of the pons, or posteior

(2)

formatio reticularis,

(3) posterior longitudinal bundle-, and (4) superior olivary nucleus.

A hemorrhage in the pons, if it is above the decussation of the seventh nerve

will

cause paralysis of the opposite side of the face and opposite side of the body

below the decussation of the seventh nerve it will cause paralysis of

and opposite side of the body, producing what is known
The sixth nerve, seventh nerve, and par' of the
as crossed hemisphlegia.
The crus cerebri
eighth nerve have their deep origin in this part of the pons.
or the peduncles of the cerebrum pass upward and outward from the upper
margin of the pons into the substance of the cerebrum. They are about threefourths of an inch long.
A cononal section will divide this into an anterior or
The anterior is called crusta
inferior and a posterior or tegmental portion.
but
the

if it is

same

side of the face

ANATOMY

364

or pes and has motor fibres in

tion and has sensory fibres in

it.

IN A NUTSHELL.

The

posterior portion

the tegmental por-

is

it.

or inferior peduncles of the cerebellum receives

The Restiform body

its

from four main sources (1) from the nucleus gracilis et cuneatus of the
same side. (2) from nucleus gracilis et cuneatus of opposite side, (3) from the
(4) from the
lateral column of the cord through the direct cerebellar tract,
fibres

nucleus of the olivary body of the opposite side.

PLATE CLXXXIV.

Sagittal Section ok the Brain.

The area where the cranial nerves leave the brain substance is called the
The group of cells from which the fibers spring or in which
they end is the deep origin.
(Plate CLXXXVII).
Rule.
The deep origin of all the cranial nerves, except the first and second ;ind a part of the eleventh, is in the floor of the aqueduct of Sylvius or
in the floor of the fourth ventriclk.
The third and fourth have their deep
origin in the aqueduct of Sylvius.
The fifth, sixth, seventh, eighth, ninth,
tenth, pari of the eleveth, and twelfth have their deep origin in the floor of the
Si

perficial ORIGIN.

fourth ventricle.
Definition

for

centre.

which control function.

(2)

ulating or inhibitory office.

Any ganglion or plexus giving off nerves

Any GROUP of ganglion tells which has a stim(3) It is a group of GANGLION CELLS closely con-

(1)

nected with one another and acting together

in

the performance of

some func-

tion, as the cerebral centers, psychical centers; respiratory or vaso-rnotor center-.

The

and second cranial nerves are processes of the brain and therefore
superficial nor deep origin.
We say there are twelve pairs of
cranial nerves; it would be better to say twelve sets for in the first or olfactory
nerves there are twenty or thirty nerves.
The first nerve is one of special sense,
first

have neither

thai of smell.

The primary center

for smell

is

in

the olfactory lobe.

(Plate

ANATOMY

IN A NUTSHELL.

365

CXCIX) the secondary center in the uncinate gyrus of the temporal lobe
This has been demonstrated
on the mesial surface. (Plate CLXXXII).
by experiments upon animals and by pathological research on the brain of man.
In osmatic animals these lobes (gyrus hypoeampus, uncinate, and hippocampus
major) where the center of smell is located, are well defined. In anosmatic
they aresmall. If the olfactory tract be removed these lobes will atrophy and in
case of lesion in these lobes the loss of smell (anosmia) will follow.
factory tracts, which are white,

lie

The

ol-

almost parallel to one another, extending

from the under surface of the frontal lobe. The bulb is reddish-gray in color
and lies on the cribriform plate of the ethmoid. From the bottom of these bulbs the
olfactory nerves are given off, twenty or thirty in number, to be distributed to
The three roots
the cells of Schultze in the Schneiderian membraxk.
from the tracts are the external, middle, and internal. The external root

PLATE CLXXXV.

Showing Long and Short Association Fibers of the Brain.

is

white and extends into the anterior end of the hippocampus gyrus of the tem-

The middle one is gray and ends in the trigonum olThe inner one, or mesial hoot, is white and passes backward and
end in the anterior extremity of the gyrus fornicatus. The mesial

poro-sphenoidal lobe.
factorium.

inward

to

root

continuous with one end of the limbic lobe and the external root with
This nerve is made up exclusively of non-medullated fibers.
They

is

the other.

are deficient
a

in

the white substance of S<

hwann and consist

of axis-cylinders with

distant nucleated sheath in which there are, however, fewer nuclei than

ordinary non-medullated
1.

2.

in

the

fibers.

Anosmia is the loss of smell.

Hyperosmia is increased sensitiveness.

3.

Parosmia

is

4.

Kakosmia

is a

the odor

is

perversion of the Function of smell.

condition where everything smells alike to the patient and

a peculiar or offensive one.

ANATOMY

366

IN A NUTSHELL.

The arachnoid holds the tracts in position in the sulci. The dura mater
covers the nerves and is continuous with the periosteum of the nasal fossa. The
pia

mater

is

continuous with the neurilemma.

PLATE CLXXXYI.
CuHNU OF

LE.-T

ROSTRUM OF CORPUS CALLOSUM

LATERAL VENTRICLE

TENIA SEMICIRCULARIS

ANTERIOR PILLAR OF FORNIX

EXTERNAL CAPSULE

CLAUSTRUM

IN

PIA MATER
HIPPOCAMPAL FISSURE

OF CORPUS CALLOSUM

POSTERIOR CORNU OF LEFT LATERAL VENTRICLE

A Horizontal Section (5fthe Brain.

The second cranial nerve or optic nerve is a process of the brain like the
The center for sigh* bin the cuneate lobule of the occipital lobe. The
optic aerve extend- forward and outward from the optic commissure or chiasma

olfactory.

to the posterior part of the eye-ball,entering a little to the inner side of

ter to

spread out into the retina. The chiasma or commissure

upon the olivary eminence

of the

is

the cen-

rectangular and

sphenoid bone and on the anterior part

ANATOMY
diaphragma

of the

tuber cinereum.
tracts

sella.

On

Above

either side

is

it

IN A NUTSHELL

is

367

the lamina cinerea, behind

the anterior perforated space.

it

is

The

the
optic

extend outward and backward from the chiasma to (1) the external genbody.
(2) The posterior or inferior quadiigeminal body.
(3) The

iculate

PLATE CLXXXVII.

DESCUSSATION OF PYRAMIDS.

Showing Superficial Origin of the Cranial Nerves.

internal geniculate body.

mus.

From

(4)

Under part

of the pulvinar of the optic thala-

these four parts the optic radiations extend to the center of sight.

Those

fibers which do not decussate at the OPTIC COMMISSURE have already

decussated in the corpora quadrigemina. This is the reason that a lesion of
one center of sight will cause blindness in the opposite eye and vice versa, for

both sets of decussating fibers are destroyed.

lesion

through the middle of

ANATOMY

368

IN A NUTSHELL.

inner half of each eye. A lesion of

produce blindness in the left eye and vice versa. A
the left optic nerve
will produce blindness in the left half of each eye
optic
tract
lesion of the left
As
this
nerve
pass< s from the brain it receives coverings from
and vice versa.
pia
mater.
It passes through the optic foramen
arachnoid,
and
mater,
the dura
being
above
on the inner side of the artery.
ophthalmic
and
artery,
with the
trochlear,
motor
trifacial,
oculi,
and the abducent nerves
The optic,
with
the
-ball
and
eye
its
apparatus,
thus making all the of
are all concerned
the chiasms will produce blindness in the
will

PLATE CLXXXVIII.

INTERNAL

GCNICULATE

BODY

4TH CRANIAL N
SUPERIOR PEDUNCLE

MEUDLLART VELUM

great horizontal fissure.

Tim: Superior
first

six cranial nerves,

The motor
eyeball,
lion

The
frontal,

and the
eyeball
(2)

malar, and

excepting the

oculi, trochlear,

with one of

fifth
iis
is

first.

The

and abducent are

optic nerve

th<

is

the nerve of sight.

nerves to the mnscles of the

nerve supplies the ophthalmic, lenticular, or ciliary gang-

roots,

from which ganglion nerves pass to the

Located

ethmoid,

View of the Cerebellum.

(3)

in

iris.

the orbit which consists of seven bones, viz., (1)

sphenoid,

(4)

lachrymal,

(5)

superior maxillary, (6)

two orbits there arc but eleven bones, the frontal,

ethmoid and sphenoid being common to the two. The orbit is somewhat
pyramidal in shape with the base forward and apex backward. (Plate CCXXIX
The axial lines, if extended, would meei on the sella turcica of the sphenoid.
(7) palate.

In the

ANATOMY

IN A NUTSHELL.

369

communicates with the cavity of the cranium by (1) the optic foraIt communicates with four fossa?, (1) with
the sphenoidal fissure.
the nasal fossa by the nasal duct. (2) with the temporal fossa, (3) with the
zygomatic fossa. (4) and with the spheno-maxillary fossa. These last three by

The

orbit

men and

(2)

the spheno-maxillary fissure.

Each

has nine foramina.

orbit

(1)

supraorbital,

(2)

infraorbital. (3) an-

terior ethmoidal, (4) posterior ethmoidal. (5) optic. (6) sphenoidal fissure, (7)

spheno-maxillary

fissure. (8) nasal duct, (9)

LESSON
The

floor

maxillary;

formed by three bones,

is

malar foramina.

CV.

(1)

the orbital surface of the superior

the orbital process of the malar;

(2)

(3)

the

orbital process of the

PLATE CLXXXIX.
CPTIC TRACT

3RD CRANIAL

-OPTIC TRACT.

N.

4TH CRANIAL NERVE.

EXTERNAL GENICULATE BODY.

MIDDLE PEDUNCLE

-EXTERNAL GENICULATE
MOTOR RCOT OF bTH N.

SENSORY RCOT OF 5TH

BODY.

N.

"GREAT HORIZONTAL FISSURE'

The Inferioe View of the Cerebellum.

The floor

palate.

is

somewhat

fiat

and has

(1)

the infraorbital canal;

depression for the Inferior oblique muscle anteriorly;

posteriorly; (4) the palato-maxillary

by
ly;

At
for

the
(2)
its

bones.

two

(1)

the

is

It

the

bom

s,

is

at

the inner angl<

(1) the nasal proc< ss of the superior

(3) the os

The

frontal

root' is formed
bone anterior-

The ROOF is dome-like.

The depr< ssion

the lachrymal fossa for the lachyrmal gland.

theSuperior oblique muscle

bone;

of

the lesser wing of the sphenoid posteriorly.

outer angle

by four

suture posteriorly.

orbital plate

(2)

the infraorbital groove

(">)

planum

of the

ethmoid;

(4)

body

Tin inner wall

maxillary

(2) the

is

formed

lachrymal

of the sphenoid.

has,(l) lachrymal crest;(2) groove for lachrymal sac; (3) ethmo-lachry-

mal suture;

(4)

ethmo-sphenoidal foramina.

ANATOMY

370

IN A

NUTSHELL

The outer wall is formed by two bones, the orbital process of the malar and
It presents (1) the opening of the malar
wing of the sphenoid bone.
greater
the
The four boundaries of the orbit make four
canal. (2) spheno-malar suture.
external, superior internal, inferior external,
and inferior internal. The superior external angle has(l) fronto-malar and
angles, viz., the stjperiob

PLATE CXC.

Showing the Writing Center

in

fronto-sphenoidal articulation, (2) the sphenoidal

the Brain.
fissure

which transmits the

third, fourth, three divisions of the ophthalmic division of the fifth,

and sixth

nerves, filaments of the sympathetic, processes of the dura mater, orbital

branches of the middle meningeal and recurrent lachrymal arteries.

PLATE CXCI

ANTERIOR

CONUS

GANGLION ON

POSTERIOR

-THORACIC

MEDULLARS

NERVE

SPINAL ARTERY

XII

ROOT

LUMBAR

COCCYGEAL
FILUM

TERMINALE SURROUNDED

BY

CANDA

Antkkiok Yikw of Cauda Equin

371

\.

EQUINA

ANATOMY

372

The superior

internal

IN A NUTSHELL.

angle has

(1)

the lachrymo-ethmo-frontal suture,

anterior ethmoidal foramen which transmits the anterior ethmoidal vessels,

and
foramen which transmits the posterior
ethmoidal vessels and sometimes a branch of the nasal nerve. The inferior external angle has the spheno-maxillary fissure which is formed by the greater
wing of thf sphenoid bone externally and the superior maxillary bone and palate
bone internally. This fissure connects the orbit with (1) the temporal fossa,
(2) zygomatic fossa, (3) spheno-maxillary fossa and transmits the infraorbital
artery, superior maxillary nerve and its orbital branches and the ascending
nasal nerve, (2) the posterior ethmoidal

PLATE

CXCII.
DENTICULATUM

LIGAMENTUM

POSTERIOR ROOT

LINEA

SPLENDNS
ANTERIOR

ROOT

Showing the Dura Mater, Arachnoid, and Piamater.

branches of Meckel's ganglion.
illo-palato-lachryma] suture.

The
At

inferior internal angle has the

the apex of the orbit

is

ethmo-max-

the optic foramen

between the two roots of tin h sser wing of the sphenoid. It transmits
and opthalmic artery, the nerve lying above and inner to the
arten-.
The ligament of Zinn is attached to the circumference of the optic
foramen, deficient at the upper and outer part, and gives a common origin to the
which

is

the optic nerve

The supraorbital notch or foramen is situated at the

four Recti OlUSCleS.
junction of the inner and middle third of the upper circumference of the orbit.
transmits the supraorbital vessels and nerve.
It
A line drawn from this notch
or foramen In the mental foramen passes through the infraorbital foramen.

There are EIGHT MUSCLES

in

the orbit,

viz..

the four Recti, the two Oblique,

ANATOMY

373

IX A NUTSHELL.

Levator palpebrae, and the Tensor tarsi (Horner's muscle).

1. Papillitis is an inflammation of the optic papilla.
2. Xeuroretinitis is inflammation of the optic nerve and retina.
3. Retrobulbar Neuritis is an inflammation behind the eye-ball.

PLATE

CXCIII.

POSTER 0- MEDIAN SlUXUS

H
^C\

A.

ATTHELEVEL OF THE6TH

CERVIC/-. NERVfi00rr

ANTERIOR FISSURE

B.AT THE MID- DORSAL REGION

CENTRAL CANAL

POSTERIOR ROOTS

CAT THE CENTRE

OF THE LUMBAR ENLARGEMENT

ANTERIOR ROOTS

0.

Transverse Sections
4.

tina

Amblyopia

is

and without an
5.

lesion

Amaurosis

is

<>k

AT THE UPPER PART OF THE CONUc

MEDULLARS

E.

AT THE LEVEL OF THE 5TH SACRAL NERVE

AT THE LEVEL OF THE COCCYGEAL NERVE ROOTS

the Cord at Different

ROCTi

Li.\ els.

dimness of vision from imperfect sensation of the

re-

organic lesion of the eye,

blindness, especially blindness occuring without apparent
of the optic nerve, retina, spine or brain.

of the eve. from disease

ANATOMY

374
6.

IN A NUTSHELL.

Retinal or oculae hyperesthesia

is

a condition in which the eye

is

abnormally sensitive to light.

h'Ia is a condition

7.

Ny<

8.

Hemianopsia

ai.<

is

where the patient can see better in dim light.

which there is blindness

half blindness, a condition in

of one-half of the visual held.

9.

Myopia

is

power of the eyes so

beyond a certain distance are fixed in front

short-sightedness, too great refracting

lhat the rays coining from an object

of the retina.

PLATE CXCIV.

MARGINAL ZONE OR LISSAUER S TRACT.

A Transverse Section of the Cord, Showing Tracts, Diseases, Etc.

10.

Hypermetropia

parellel rays
11.

behind the

or

hyperopia

is

far-sightedness,

the

focusing

of

retina.

Presbyopia is long-sightedness, an impairment of vision due to old

upon diminution of the power of accommodation from loss of

age dependenl

elasticity of the crystalline lens, causing the near-point of distinct vision to

removed

be

farther from the eye.

12.

Emmetropia

13.

Astigmatism

is

is

normal condition of the eye as respects refraction.

a condition caused by inequality of the curvature of

the different meridians of the cornea.

Itmaybe caused by(l)

imperfections of

the lens, (2) unequal contraction of the ciliary muscles, (3) retinal imperfections.

PLATE CXCV
PARUTiD

GUND

TEMPORAL
'DISTRIBUTION OF FACIAL NERVE

POSTERIOR AURICULAR

A.

SUBMAXILLARY GLAND

EXTERNAL

$1

*.

'

fig *J*Sfe<i

'

CAROTID

SUBCLAVIAN ARTERY

INNOMINATE

ARTERY

VEIN

INTERCOSTAL ARTERY

NERVE

PARVAGUM OR
PNEUMGGASTRIC

THE SYMPATHETIC GANGLIA

SPLENIC

WITH
COELIAC

Jjx.

"V^).',

RIGHT

V =^S*^SUP
\^^^T
-

VEJENTERiC ARTERY WITH

VSLiP MESEV
ESENTERIC PLEXUS

NFERIOR MESENTERIC ART

ITH INF MES
PLEXUS

COMMON CAROTID ARTER

SPERMATIC CCRD

ARTERY
SPLENIC
PLEXUS

AXIS

IT?/'

'

'

if-

PUBIS SYMPHYSIS

Vena Azygos Major, Abdominal Aorta and Sympathetic Nerve.

375

ANATOMY

370

There are seven muscles

Rectus superior,

the orbital region, viz., (1) Levator palpebrae

in

superioris, (2)

IN A NUTSHELL.

(3)

Rectus

Rectus internal,

inferior, (4)

tus external, (6) Superior oblique, (7) Inferior oblique.

(5)

Rec-

All of these are attach-

ed to the eye-ball except the Levator palpebrae superioris. The third nerve supseven muscles, ail except the Superior oblique which is sup-

plies five of these

by the fourth, and the External rectus which

plied

is

supplied by the sixth.

(Plate CCVI).

The eye-ball

spheroidal

is

shape, but consists of the segments of two spheres,

in

forming

a portion of the smaller sphere

set

anterior transparent part,

its

on the front of the posterior segment, which

The

eye-ball consists of three coats, sclerotic, choroid,

The sclerotic coat

(a)

and being

a part of the larger sphere.

is

and

retina.

an opaque, white, dense, fibrous, inelastic

is

mem-

brane, continuous with the cornea in front, the two forming the external coat
of the eye-ball.

The choroid

(b)

a delicate, highly vascular

is

membrane, forming one of

it and

the coats or tunics of the eye-ball, lining the sclerotic, and lying between
the retina, with
(c)

part of

which

The retina

it is

in

contact by

its

inner surface.

and chiefly nervous coat of the posterior

eyeball,between the choroid coat and vitreous humor. It may be divided

into ten layers.

The

is

Plate

the innermost

('(').

eye-ball has three refracting media, the

The aqueous humor

(a)

aqueous humor, the crystalline

humor.

lens, the vitreous

is

a limpid,

watery

fluid

which

fills

the space be-

tween the cornea and the crystalline lens of the eye.

The crystalline humor or lens

(b)

is

a lentiform pellucid body,

posed of transparent firm substance, inclosed in a

situated

in front of

the vitreous

The vitreous humor

(c)

humor and behind

a pellucid gelatine

is

four-filths of the hall of the eve.

eye-ball

is

composed

From without inward

media.

ROTIC and (b) cornea;

choroid,
of:

(b)

(2)

the

of

'_'.

:;.

\.

CVI.

(c) iris; (d)

limitans interna.

5.

Inner nuclear Layer,

6.

Outer molecular, or granular,

7.

layer.

)uter nuclear layer.

Membrana
Layer of

limitans externa.

roils

(a)

Nervous coat or retina consisting

Ganglionic layer, consisting of nerve-cells.

Inner molecular, or granular, layer.

9.

and three refracting

Vascular (tunica vasculosa oculi), consisting of

Fibrous layer, consisting of nerve-fibres.

8.

about

the tunics are (1) fibrous, consisting of (a) scele-

ciliary body, and

Membrana

fills

lens.

three investing tunics

(Plate (V,.
1.

of the eye.

iris

substance which

behind the crystalline

LESSON
The

com-

membraneous capsule and

and cones (Jacob's membrane).

PLATE CXCVI.
ANTERIOR

VIEW

0^

PONS

VAROLII

Trt.utMINUS NERVE

(DlV'r..)

ttfc
INTERNAL CA"CTIO
"

'.

GLOSSOPHARYNGEAL
VAGUS AND SPINAL ACCESSORi

"

INTERNAL JUGULAR

V|N

OBLONGATA

EDULLA

.7ERI0R CERVICAL GAN:LION

STERNO-CLEIDO MASTOID

NERVE

HYPOGLOSSAL

14*-

ifel

iUALENUS ANTICUS

MIDDLE LcHVICH GANGLION

PLEXUS

BRACHIAL

SUBCLaKIAN ARTERY

ism

FIRST RIB

INFERIOR CERVICAL G SGLION

'

INTERCOSTAL

ARTE

VEIN
NERVE

SYMPATHETIC GANGLIA

LIO-HYPOGASTRIC N

OUADRAIUS LUMBORUM

LIO-

Tv)

EXTERNAL

:-mm
SACRAL GANGI

IA

INGUINAL

CUTANEOUS

GENITO

my$r

CRURAL

OR CRURAL NERVE

OBTURATOR N

v r

GRE4T SCIATIC

rnrrv

Anterior View of Sympathetic Nerve and Spinal Cord

377

N.

ANATOMY

378
10.

Pigmentary

IN A NUTSHELL.

Layer.

The refracting media are (1) Aqueous humor, (2) Vitreous humor, and
(3) Crystalline lens.
The capsule of Tenon is a layer of fascia which surrounds the posterior
Where the optic nerve enters it is continuous with
five-sixths of the eve-hall.
Anterior

the sclerotic coat.

corneo-sclerotic junction.

it

It is

connected loosely to the sclerotic at the

pierced by the tendons of the four Recti and
is

two Oblique muscles of the eye. Between the anterior and posterior attachments there is a delicate attachment, between the capsule and the eye-ball, of
connective tissue; these constitute extensively lymphatic spaces in which the
eve-ball glidesjthis is a ball-and-socket (enarthrodial) joint. An expansion from
the sheath of the Superior oblique muscle blends with the tendon of the Levator
palpebrse.

An expansion from

the Inferior rectus

is

attached to the inferior

tarsal plate, therefore these two Recti muscles influence the movements of the
evelids.
The expansion of the sheath of the Internal rectus is attached to the

lachrymal bone and

is

called the internal check ligament.

the External retcus which

is

very strong,

is

The expansion from

attached to the malar bone and

is

The suspensory ligament of the eye

is atcalled the external check ligament.

tached to the malar and lachrymal bones, passing below the eye-ball ;it is narrow
The anterior pole is the central
at each extremity and broad in the center.

point of the anterior curvature of the eye-ball ;the posterior pole is the central
The sagittal axis is a line joining these two
point of the posterior curvature.

The transverse diameter of the eyeball is about one inch, the vertical nine-tenths, and the antero-posterior is intermediate.
The sclerotic coat is fibrous and opaque tunic, occupying the posterior fiveIt is continuous in front with the cornea. The outer
sixths of the eye-ball.

poles.

surface

is

It is smooth, except where

brown and marked by grooves

white, being covered with conjunctiva.

Its inner surface

the muscles are inserted.

for the ciliary vessels

of the choroid by

and nerves and

fine cellular tissue

deal lymphatic spaces.

The

is

is

loosely connected to the outer surface

(lamina fusca) thus forming the perichoroi-

optic nerve passes through the posterior part of

about one-eighth of an inch internal to the axis of the eye-ball.

The point of perforation is called the lamina cribrosa. The outer sheath of

the sclerotic coat

The sclerotic is
its entrance.
and thinnest about one-fourth an inch from the

the optic nerve blends with the sclerotic coat at

thickest at the posterior part of

cornea.

The canal

of

Schlemm, or sinus venosus

of the cornea with the sclerotic;

ii

is

scleroe, is close to

the junction

snail circumferential lymphatic space.

The structure of the sclerotic is white fibrous tissue intermingled with elastic
tissue and flattened connective tissue corpuscles which are contained in the cell
between the

fibers.

Some

of the corpuscles are

pigmented.

mode of ending is not known.

and anterior ciliary arteries of the ophthalmic.
The cornea is transparent and forms about one-sixth of the circumference
of the eye-ball anteriorly.
is a segment of a smaller sphere than that which
It
The nerves

The

are from the ciliary, but their

vessels are from the short

It
forms the posterior five-sixths.
a watch crystal fits into the face of

fits

into the

sclerotic

coat

somewhat

like

watch, thus projecting beyond the curva-

<

PLATECXCVII.
GANGLION OF

RIBES

CAROTID

70

OF

GANGLION

ROOT

OF

PLEXUS

PNEUMOGASTRIC

TO

TH. NERVE

^~- TO 4 TH. NERVE

CAVERNOUS PLEXUS
, LARGE SUPERFICIAL
TO PETROUS GANGLION OF

GLOSSO PHAR
:

VIDIAN
1ST.

CERVICAL

PETROSAL

TO-MECKEL S

GANGLION

NERVE

'LARGE DEEP PETROSAL

-<ND

TO-BRANCHES

<+

*%

CARDIAC

^,

OF

EXTERNAL CAROTID

ARTERY

BRANCHES FROM PNEUMOGASTRIC

RECURRENT LARYNGEAL NERVES

AND

GANGLION OF

HEPATIC

WRISBERG

PLEXUS

CYSTIC PLEXUS
GASTRO DUODENAL
PYLORIC PLEXUS
GASTRIC V PLEXUS

ST SACRAL

NERVE^T

^PELVIC-

5 TH.

SACRAL

OR

INFERIOR

HYPOGASTRIC PLEXUS

NERVE
GANGLION

OF

IMPAR

CUUCYGEAL NERVE

Side View of Sympathetic System.

379

PLEXUS

ANATOMY

380

IX A

NUTSHELL.

The posterior
is continuous with the sclerotic coat.
concave and projects a little farther backward than the
The posterior surface of the cornea forms the anterior
anterior convex surface.
boundary of the anterior chamber which contains aqueous humor. Its anterior

ture of the sclerotic.

surface o( the cornea

surface

is

It

is

covered with conjunctiva which, in this position, constitutes one of

It is of a uniform thickness and is more curved in youth

the epithelial layers.

than

in old age, when it becomes flattened.

The ligamentum pectinatum iridis or the

fibers
iris.

pillars of the iris, are

formed by

from the stroma of the cornea which pass backward and outward to the
They form an annular meshwork encircling a series of lymphatic spaces

PLATE

CXCVIII.
TO

,-

HIGHER

GANGLION

0.',

FROM RAMUS COMMUNICANS

SYMPATHETIC TRUNK

TO VERTEBRAE AND INTERCOSTAL

MEDULLATED FIBERS PASSING

a
THROUGH THE GANGLION TO
PREVERTEBRAL PLEXUS OR

AND LUMBAR VESSELS

DIRECTLY TO VISCERA

SOMATIC VASOMOTOR,

PILOMOTOR,

SECRETORY

GRAY VISCERAL FIBERS

RAMI EFFERENTES

SYMPATHETIC TRUNK

vertebrae
ligaments
spinal vessels

and
NTRAL

SPINAL

Dura

NERVE

ROOT

DORSAL SPINAL NERVE ROOT

ACCOMPANYING DORSAL ROOT TO DURA

Showing the Rami Communicantes.

(spaces of Fontana) which

communicate with the anterior chamber, and the

canal of Schlemn, and the scleral veins.

Structure.

The

of epithelial cells

cornea consists of four layers, viz:

continuous with those of the conjunctiva,

(1)
(a)

Several strata

The external

columnar epithelium, (b) Two

Three or tour layers of scaly epithelial with flattened nuclei. (2) A
(hick, central, fibrous structure called the substance propria.
It is fibrous,
set

consists of

cells,

or three layers of polyhedral

(c)

tough, unyielding, perfectly transparent and continuous with the sclerotic and
consists of aliout sixty flattened lamellae, the fibres passing one lamella to an-

other.

The corneal spaces

are between the hunelhe,

which are connected by an

ANATOMY

IN A NUTSHELL.

interstitial

cement substance and each space contains

which are

stellate in shape.

(3)

A homogenous

cells, the

elastic

layer of endothelial cells forming part of the lining

chamber

381
conical corpuscles

lamina.

membrane

(4)

single

of the anterior

of the eye-ball.

Besides these four strata we have the anterior and posterior elastic
lamina. The anterior clastic lamina (n embrane of Bowman) is the uppermost
layer of the corneal

The posterior
terior lining

elastic

stroma immediately beneath the conjunctival epithelium.

lamina (membrane of Descemet or Demours) is the pos-

membrane

of the cornea.

the ciliary.

Its function

The nerves

curvature of the cornea proper.

are

is

to preserve the correct

numerous and

are derived from

It is non-vascular.

LESSON

CVII.

The choroid consists of two layers, an outer and an inner. The inner layer
Ruyschiana is formed by the capillary endings of the vessels of the
They pass forward to within one-eighth of an inch of the cornea
outer coat.
or tunica

PLATE CXIX.
EXTERNAL ROOT FROM TEMPORAL

LOE

INTERNAL ROOT FROM GYRUS FORNICATUS.

The Olfactory ok First Cranial Nerve.

The choroid consists of blood vessels
Connected together by loose connective tissue and containing large branched
and pigmented cells.
Externally it is connected to the selenitic by loose coni:< ctive
It is a continuation of the pigmentary
issue forming lymphatic spaces.

joining those of the ciliary processes.

feells

The choroid is thickest behind where

The outer layer contains the larger branches

of the retina.

optic nerve.
Bhoii

it

is

pierced

by the

of the vessles.

The

ciliary arteries after piercing the sclerotic close to the optic nerve pass

forward and inward

r of the choroid.
The venae vortinumber, are formed by numerous smaller veins
and lie external to the arteri< s. They pierce th< sclerotic midway be1 ween the
cornea and the optic nerve.
The venae vorticosae form the two ophthalmic
veins which join to form the common ophthalmic v< in.
The common ophthalB<

-;r.

to

which are four or

<

nd

in

the inner lay<

five in

mic vein passes from the orbit through the internal inferior angle of the sphen-

ANATOMY

382

IN A NUTSHELL.

noidal fissure (anterior lacerated) into the cavernous sinus which divides into

superior and inferior petrosal sinuses, each of which empties into the lateral
sinus.

vein.

The

and

lateral sinus

inferior petrosal sinus

form the internal jugular

This vein receives the subclavian vein thus forming the innominate vein.

The two innominate veins form the superior vena cava which empties into the
righl auricle of the heart. Thus the blood passes from the eye-ball to the heart.

PLATE

CC.

PIGMENTARY LAYER

IAC0BS MEMBRANE

LAYER

OF

RODS AND CONES

p'lO

MEMBRANA

LIMITANS

OUTER NUCLEAR

EXTERNA

VIII

LAYEf

OR GRANULAR LAYER

OUTER MOLECULAR LAYER

INNER

OR

NUCLEAR LAYER

GRANULAR LAYER

CONE

INNER MOLECULAR LAYER

GANGLIONIC

LAYER

OF NERVE CELLS

LAYER OF NCf.VE FIBERS

MEMBRANA

L'V.ITANS

INTERNA

The Layers of the Retina.

The arterial blood passes from the heart to the eye-ball as follows:
From ili<' lefl ventricle through the arch of the aorta through which
passes in'" the

common

carotid

on the right side

it

must

first

it

go through the

innominate arteryfrom the common carotid into the internal carotid by

means of which it which passes into the skull through the carotid canal and'

middle lacerated foramen.

Then the

internal carotid gives off the

ophthalmic

ANATOMY

IN A

NUTSHELL

383

artery which passes through the optic foramen into the orbit with the optic

However,

nerve.

sometimes passes with the ophthalmic vein through

this artery

the anterior lacerated or sphenoidal fissure.

In the orbit

it

gives off the fol-

lowing branches, an orbital group and an ocular group.

The branches

orbital group are:

1. Lachrymal.
4.

Anterior ethmoidal.

7.

Nasal.

of the

2.

Supraorbital.

3.

Posterior ethmoidal.

5.

Internal palpebral.

6.

Frontal

PLATE CCL
foARGJNAL CORNEAL PLEXUS

CANAL OF SCHLEMM AND CONNECTIONS WITH ANTERIOR CILIARY VEIN

ANTERIOR CONJUNCTIVAL VEIN

CIRCULUS

BRANCH FROW CILIARY BODY TO

IRIDIS

MAJOR

CONIUNCTIVAL VEIN

ANTERIOR CILIARY VEIN

ANTERIOR

PROCESSES

VESSELS OF CILIARY

ARTERY

CILIARY

POSTERIOR CONJUNCTIVAL ARTERY

AND CILIARY
IRIS
BODY TO VENA VORTICO'SA

VEIN FROM

ANTERIOR CILIARY VEIN

EPISCLERAL VEIN

EPISCLERAL ARTERY.

VENA VORTICOSA

BRANCH

FROM

SHORT
POSTERIOR LONG CILIARY AflTERY.

POSTERIOR CILIARY ARTERY

TO OPTIC NERVE

SHORT

SHOT CILIARY ARTERIES.

POSTERIOR

POSTERIOR CILIARY ARTERY

VESSELS OF PIAL

SHEATH F OPTIC HERVE

VESSELS CF DURAL SHEATH.

VENA CENTRALIS RETINAE

wrteeia centralis retina.

Blood Supply to the Eye-Ball.

The ocular group

(Leber).

consists of:

1.

Short ciliary

3.

2.

Long

4.

I.

Muscular.

ciliary

off close to

is

one of the largest branches from the ophthalmic ami

the optic foramen although

passes through the optic foramen.

it

Occasionally

may come
it

anterior branches of the middle meningeal artery.

wall of the orbit
It

is

Arteria centralis
retinse.

The lachrymal
comes

Anterior Ciliary.

is

off

before the artery

derived from
It

one of the

passes along the outer

above the External rectus muscle with the Lachrymal nerve.

distributed to the lachrymal gland and to the eyelids and conjunctiva.

Those to the

lids are

two

in

number,

called the external palpehral running in the

AXATOMY

IN A NUTSHELL.

It gives off one or

upper and lower lids, uniting with the internal palpebral.
two malar branches, one of them pass through the malar foramen to anastomose with the transverse facial, the other passes through a foramen in the malar

bone to anastomose with the deep temporal in the temporal fossa. A branch
from the lachrymal passes through the sphenoidal fissure to the dura mater to
(Plate CCIII).
anastomose with the middle meningeal artery.
The supraorbital artery arises above the optic nerve and passes above the

PLATE

CCII.

CILIARY ARTERY.

LONG POSTERIOR CILIARY

ARTERY
COPTIC

SHORT POSTERIOR CILIARY ARTERIES

N.

V
V

Showing Vkn.k Vorticose.

muscles and

b< neath the root' of the orbil onto the forehead through the supraforamen with the supraorbital nerve.
While in this foramen it gives off
a branch to the diplce.
After leaving the foramen it divides into superficial and
deep branches.
It
supplies muscles, integument and the pericranium on the
h anastomoses with the frontal, anterior temporal, artery of the
forehead,
opposite side, and angular artery.
It supplies the parts at
the inner canthus.
The Superior rectus and Levator palpebral are supplied by it.

orbital

The posterior ethmoidal is smaller than the anterior ethmoidal. It enters

the posterior ethmoidal foramen, supplying the posterior ethmoidal cells, giving

ANATOMY

IX A NUTSHELL.

385

branch to the dura mater and a nasal branch which passes through the cribriform plate of the ethmoid anastomosing with branches of the spheno-palatine.
The anterior ethmoidal accompanies the nasal nerve through the anterior
ethmoidal foramen into the cranium, supplying the anterior ethmoidal cells and
It gives meningeal branches to the dura mater and passes through
frontal sinus.
the nasal slit to be distributed under surface of the nasal bone and the skin of
off a

the nose.

The

internal palpebral are

two

in

number, coming from the ophthalmic

These pass between the dorsal

opposite the pulley of the Superior oblique.

cartilages

The

and the Orbicularis palpebrarum.

frontal artery

one of the terminal branches.

is

It

passes

upward

at

the inner angle of the eye anastomosing with the supraorbital and the artery of
the opposite side, to be distributed to the integument, muscles, and pericranium.

The nasal branch

the tendo oculi.

is

another terminal branch.

It gives

branches to the lachrymal

It

leaves

sac.

the orbit above

Its transverse nasal

branch anastomoses with the angular and its dorsalis nasi supplies the outer
and anastomoses with the artery of the opposite side and

surface of the nose

lachrymal branch of the

The

facial.

and anterior. The short ciliary

They come from the ophthalmic or some of its

ciliary arteries are the short, long,

are eight or ten in

They

branches.

number.

pierce the sclerotic coat forming a circle around the optic

forward on the inner surface of the choroid, supplying the

The long ciliary are two in number
choroid coat and the ciliary processes.
which pierce the sclerotic coat running forward to form two arches, the circulus
nerve, passing

major which is around the circumference of the iris and the circulus minor
around the papillary margin. The anterior ciliary come from the muscular
branches and pass forward with the tendons of the Recti muscles. They form
a network beneath the conjunctiva and pierce the sclerotic coat a short distance from the cornea to join the circulus major at the iris.

The

arteria centralis retina pierces

fourth an inch behind the eye-ball.

ophthalmic.

It

It

to the

one of the smallest branches of the

enters the globe of the eve-ball through the porus opticus.

supplies the inner surface of the retina

veins.

the optic nerve obliquely about oneis

and

is

It

accompanied by the corresponding

In the fetus a branch passes from this artery through Stilling's canal

capsule of the lens.

It lies

beneath the sheath before

LESSON

it

pierces the nerve.

CVIII.

Muscular branches are given off from various branches of the ophthalmic
and are two in number, the superior and inferior. They may come from Uncommon trunk. The superior one supplies the Superior rectus. Levator palThe inferior one supplies the Inferior rectus,
pebrae, and Superior oblique.
This inferior one gives
External rectus. Internal rectus, and Inferior oblique.
off one of the anterior ciliary branches.
Muscular branches are also given off
from the lachrymal, supraorbital, and the ophthalmic itself.

ANATOMY

386

The

The

IN A NUTSHELL.

body consists of the

ciliary

ciliary processes are of the

and the

ciliary processes

same structure

are a series of folds (seventy or eighty)

margin of the choroid and are received

ciliary muscle.

as the rest of the choroid.

They

which are derived from the anterior

in the

corresponding folds of the sus-

The blood supply is the

The ciliary muscle consists of two sets of involuntary muscular
fibers, radiating and circular.
It has a circular band one-eighth of an inch wide
on the outer surface of the choroid in front. The radiating fibers are more
numerous and more external arising from the sclerotic close to the junction of
the sclerotic and the cornea, between the spaces of Fontana and the canal of
Schlemn and pass backward to be inserted in the choroid opposite the ciliary
processes.
The circular fibers are internal to the radiating at the base of the
pensory Ligament of the lens and the vitreous humor.
anterior ciliary.

surrounding the

ciliary processes

iris.

PLATE

CCII I.
NASAL.

SUPRAORBITAL

TEMPORAL
BRANCHES

ETHMOIDAL.

POST.

ETHMOIDAL.

yC^f

^^T^f

LACHRYMAL

ARTERIA

ANT.

CENTRALIS

RETINAE.

OPHTHALMIC.

INTERNAL

CAROTID.

Distribution of Ophthalmic Artery.

The

iris is

a thin, fibrous, and contractile circular

color to the eye.

It is

suspended

in

the aqueous

membrane which gives

humor between the cornea in

front and the lens behind.

The pupil is an aperature in its center. It is continuous at the circumference with the choroid and anterior to this it is connected to the cornea by the pillars of the iris or Ligamentum pectination. It is also

connected to the

ciliary muscle.

The uvea

or the posterior surface

is

marked

ANATOMY

with folds prolonged from the ciliary processes and

anterior surface

is

colored and

the free edge of the pupil.

which

H87

IX A NUTSHELL.

marked by wavy

This surface

is

lines

darkly pigmented.

The

which converge towards

covered by a layer of epithelium

is

membrane

of Descemet.
The frame work
struma which consists of connective tissue containing
blood vessels, nerves, pigment cells, and muscular fibers (involuntary). The
first, sphincter fillers which form a circular narrow band pass to the pupil and

of the

is

continuous with that of the

iris is

a delicate

This band

about one-thirtieth of an inch in thickwhich are radiating, commence at the outer margin
of the iris, converging towards its center to join the circular one near the pupil.
Some say these are elastic and not muscular. It receives the sympathetic
nerve.
The blood supply is from the Long and anterior ciliary and the vessels
of the ciliary processes.
Nerve supply from the ciliary branches of the lenticular ganglion and long ciliary branches of the nasal nerve which is a branch of the
ophthalmic division of the fifth. The nerves form a plexus around the marin.
The membrana pupillaris is a delicate transparent vascular membrane which
closes the pupil in the fetus.
It disappears about the seventh month.
The retina ends behind the ciliary muscle in an irregular margin, the ora
serrata.
The pars ciliaris (radiating fibers of Muller covered bv pigmented
layers) is a thin membrane passing from the ora serratus to the iris.
The
macula lutea is the most perfect point of vision. It is situated at the center of
receive the third nerve.

ness.

The second,

dilator,

inner surface behind.

its

poms

is

It

has a depression called the fovea centralis.

opticus of the optic nerve

is

The

pierced by the arteria centralis retinae and

one-tenth of an inch internal to the macula lutea.

is

Mutter's fibers are connective

which bind the layers of the retina together. The aqueous humor
and posterior aqueous chambers which are situated between
the posterior surface of the cornea and the anterior surface of the iris and between the posterior surface of the iris and the anterior surface of the crystalline

tissue fibers
fills

lens.

the anterior

It is a slightly

alkaline fluid.

The

lens

is

in contact anteriorly

with the

humor, fovea pupillaris.

It is surrounded by a capsule-zonule of Zinn which is derived from the hyaloid
membrane. The lens is about one-fourth of an inch antero-posteriorly and onehalf transversely.
It is a transparent, solid, biconvex body composed of concentric laminae and is hardest at the center. The vitreous humor occupies about
four-fifths of the eye-ball resting upon the retina behind and is hollowed out in
front the fossa pupillaris for the lens.
It is a soft, gelatinous substance and
surrounded by transparent hyaloid membrane. It fills the cavity of the retina.
The canal of Stilling runs through its center from the porus opticus to
This canal
the lens and is lined by a prolongation of the hyaloid membrane.
is filled with fluid.
In the fetus an artery runs from the arteria centralis retina'
iris:

posteriorly

it

rests in the depression of the vitreous

At the pars

to the capsule of the lens.

a layer behind the capsule

ligament of the
the lens.

lens.

It

and one

ciliaris this

in front:

contains elastic

membrane

the anterior one

fibers.

The canal

is

divides sending
the suspensory

of Petit

surrounds

(Plate CC).

The lachrymal gland (Plate CCV) resembles serous salivary glands.

It is

situated

internal to the external angular process in a depression in the orbital plate of

ANATOMY

388

IN A NUTSHELL.

the frontal bone resting on the eye-ball and the Superior rectus and External
rectus muscles.
in

ihf center.

It is

The

about the shape and

an almond.

size of

It

is

constricted

ducts, about seven, pass through the conjunctiva, opening

on the outer part of the upper lid. The lachrymal canals, two in number, begin
at the puncta lachrymalia in each lid, the superior one passing upward and then
inward to join the inferior one which passes downward and then inward. They

The lachrymal sac lies in a groove

into the lachrymal sac together.
formed by the lachrymal bone and nasal process of the superior maxillary. It
It is crossed by the Tensor tarsi and
is the dilated upper part of the nasal duct.
The duct is about one-half
is covered by an expansion from the tendo oculi.
an inch long and directed downward, slightly outward and backward. It is
formed by the lachrymal, superior maxillary, and inferior turbinated bones. It
extends from the lachrymal to the inferior meatus of the nose where it opens.
The opening has a valve formed by the mucous membrane.

empty

PLATE

CCIV.

MOALJJNE
AXJS

OPTICAL.

FOVEA CENTRALIS
OR CENTRAL PIT

OF THE
MACULA LUTEA.

Optical Axis and Visual Line.

LESSON CVIX.
The conjunctiva (joined together) which unites the eyelids and the eye-ball
mucous membrane. It lines each eyelid at the base of which it is reflected
mi the eye-ball. The lines of reflection are the fornices. The supeiior one is
the deeper and some of the fibers of the Levator palpebral are inserted into it.
The conjunctiva is loosely attached to the sclerotic cord, but at the outer maris

gin of the cornea

it

is

ferior epithelial layer.

firmly attached, passing over the cornea, forming its in-

The ducts

of the

lachrymal gland open into the con-

junctival sac above and the opening of the lachrymal canaliculi at the puncta

lachyrymalia
thick.

below.

The palpebral conjunctiva

Pari of the eye-ball or ocular conjunctiva

slightly vascular in the healthy condition.

conjunctiva
of the

at

the inner canthus of the eye.

membrana

The
It

is

sensitive,

vascular and

thin, transparent

is

plica semilunaris
is

and
is

is

only

a fold of

the rudimentary homologue

Nictitans (third eyelid) in birds.

(Plates

CCV-CCIX).

ANATOMY
The eyebrows

IN A NUTSHELL.

389

two arched eminences over each orbitc,onintegument and muscles and are covered by thick hairs.
connected with the Orbicularis palpebrarum, Corrugator super(supercilia) are

sisting of thickened

Each one
and

cilii,

is

Occipito-frontalis.

more movable than the lower one. When

Where the upper and lower lids
meet when open they form the outer and inner canthus. The lacus lachrymaiis
is a small triangular area in the inner canthus in which is a mass of fat (pink)
connective tissue. This mass is caruncula lachrymaiis and it is separated from
the eye-ball by a vertical fold of conjunctiva, the plica semilunaris which is a
Eyelids.

The upper one

is

closed they protect the eye-ball from injury.

rudimentary third

The eyelashes
free

eyelid.
(cilia)

margin of each

than those of the lower

out inward:
plate,

(5)

are short, thick hairs which

Those

lid.

lid.

of the

Each

upper

lid are

eyelid has the following structures from with-

Skin, (2) areolar tissue, (3)

(1)

palpebral ligament,

form a double row at the

longer and more numerous

Orbicular muscle,

Meibomian glands,

(6)

(7)

(4)

tarsal

conjunctiva.

The

upper lid has in addition the aponeurosis of the Levator palpebral which is attached to the upper surface of the tarsal plates.
The tarsal plates are in each lid and are formed by lamina of a dense conThe upper one is the larger; it is half oval in shape while the
nective tissue.
lower one is a narrow oblong slit.
The Meibomian glands are lodged in these plates. The palpebral ligaments
are at the outer and inner angle of the eye, forming attachments for the Orbicularis palpebrarum muscle. They form an imperfect diaphragm for the anterior
orifice of

the orbit.

Peripherally they are attached to the orbital margin

centrally to the edges of the tarsal plates.

The

third or

motor

oculi has its

the inner side of the crus cerebri.

median

line

on the

floor of the

substantia nigra and the

and

(See Plate CCXII.)

superficial origin in front of the pons on

deep origin is situated on each side of the

Its

aqueduct of Sylvius, after passing through the

tegmentum

of the crus.

All the muscles of the orbital

by the third nerve except the Superior oblique, which receives the fourth nerve and the External rectus, which receives the sixth.
This
nerve also supplies the sphincters of the iris and the ciliary muscle through its

region are supplied

connection with the ciliary ganglion. Remember that the External rectus of
one eye and the Internal rectus of the other eye have their nerve supply from
the same nucleus.
The nucleus of the third nerve receives the fibers from that
of the sixth nerve of the opposite side; this accounts for the fact that one can
move both eyes to the right or left at the same time. From this deep origin

muscle supplied by it has its own set of cells. Then from

behind forward their position is (1) those cells to the Internal rectus; (2) to the
Levator palpebral; (3) the Superior rectus; (4) the Inferior rectus; ami (">) the

of the third nerve each

Inferior oblique.
tion

and

In front of these are the nuclei of the fibers for

for sphincter pupillae.

It

is

accommoda-

covered with pia mater and arachnoid on

the dura mater anterior and external to the poshaving passed between the superior cerebellar and
the posterior cerebral arteries.
It then passes through the cavernous sinus

leaving the brain.

It pierces

terior clinoid process after

ANATOMY

390

IN A NUTSHELL.

In this position it communicates with the

above the other orbital nerves.
and
fifth
with the cavernous plexus. Before enterdivision
the
of
ophthalmic
ing the sphenoidal fissure it divides into two branches, a superior and an in(Plate
ferior one, with the nasal branch of the fifth nerve between them.
CXXIV). All the structures on the Lower border of the sphenoidal fissure are between tlif two heads of the External rectus muscle. The superior branch is the
smaller,
h passes forward over the optic nerve and supplies the Levator
The inferior branch supplies three
palpebrae and Superior rectus muscles.
muscles; the division which goes to the Internal rectus passes beneath the optic
nerve; the second division passes to the Inferior rectus, and the third or lower
division passes to the Inferior oblique between the External rectus and the Inferior rectus. This division to the Inferior oblique sendsa motor branch to the Inferior rectus.
The branches of the third nerve enter their muscles on the orbital
surface except the branch to the Inferior oblique which enters on the posterior
inn ler.
This third nerve may supply the anterior belly of the Occipito-frontalis,
(

PLATE

CCV.
DUCTS

OF

LACHRYMAL

GLAND.

LACHRYAMAL SAC

CARUNCLE

NASAL .DUCT

Nasal Duct, Conjunctiva, and Lachrymal Gland.

the

and the Orbicularis palpebrarum. These muscles

by the seventh, but they have escaped paralyses in lesions
the seventh nerve.
From the nucleus of the third nerve some

Corrugator

supercilii,

are generally supplied

of the nuclei of
fibers
ju.-t

which descend

before

tinned.

it

in

the posterior longitudinal bundle join the facial nerve

leaves the pons; these fibers supply the three muscles above

Paralyses of the third nerve

muscle or

it

may

be the whole nerve.

may be
When

men-

only in part as any fibers to one

the whole nerve

is

paralyzed the

Prominence of the eye-ball because most of the muscles are relaxed. (2) Extern vl strabismus, the eye-ball being drawn outward
because the External rectus which is supplied by the sixth is not paralyzed.
(3) Ptosis because the Levator palpebrae is paralyzed. (4) Loss of accommodation because the [nternal rectus, the ciliary muscle, and the sphincter pupillse
are paralyzed.
(5) Dilatation of the pupil because the sphincter fibers of
following result

the

iris

(1

are paralyzed.

ANATOMY

IN A NUTSHELL.

LESSON CX.

391

(Plate CCXIII).

The fourth cranial nerve or Pathetic or Trochlear, has its superficial

origin in the valve of Vieussens behind the corpora quadrigemina. The two
Its deep origin is in the
nerves decussate on the upper surface of the valve.
This nerve can be seen on the base of the brain
floor of the aqueduct of Sylvius.
on the outer side of the cms cerebri, just in front of the pons. It is the smallest
of all the cranial nerves but has the longest intercranial course.
Coming from
the upper end of the valve of Vieussens this nerve crosses the superior peduncles
of the cerebellum and the crusta of the mid-brain, just beneath the pons, then
it pierces the dura mater in the free border of the tentorium, immediately behind and external to the posterior clinoid process. From this point it passes
forward in the outer wall of the cavernous sinus between the third nerve and the
ophthalmic division of the fifth (See Plate CCXXXII) it then crosses the
;

PLATE

CCVI.

TARSAL CARTILAGE

The Muscles of the Orbital Region.

third nerve

and enters the orbit through the sphenoidal

ated); in this fissure

it

is

the highest of

all

fissure (anterior Lacer-

the nerves (See Plate

CCXXIV)

being situated at the upper and inner angle, internal to the frontal nerve.
In
the orbit it passes inward above the origin of the Levator palpebrae to enter the
orbital surface of the Superior oblique.
In the cavernous sinus it communicates with the ophthalmic division of the

fifth,

with the ciliary plexus, and semis

a recurrent branch backward between the layers of the tentorium as far as the
lateral sinus.
While in the anterior lacerated fissure it may send a branch to
the lachrymal nerve.

If

Superior oblique

and one cannot turn the

wai;i>.

is

lost

the fourth

Should one attempl

vision, diplopia.

to

nerve

do so the eye

is

is

paralyzed the function of the

eye-ball

now

\\\ \ki>

\\n out-

twisted inward producing double

ANATOMY

392

IN A NUTSHELL.

Abducent has its superficial origin from the lower part

of the pons in the groove between the pyramid and the pons or in the constricted
Its deep origin is in the floor of the fourth ventricle
part of the pyramid.

The

sixth nerve or

close to the
fifth.

median

This origin

teres.

is

and

line

a little lower

than that of the motor root of the

traced to a nucleus under the upper half of the funiculus

This nerve enters the cavernous sinus after the dura mater of the basilar

process of the sphenoid, running through a notch immediately below the pos

In the cavernous sinus

terior clinoid process.

From

carotid artery.

this sinus

it

external to the internal

lies

enters the orbit between the two heads of

it

the External rectus to supply this muscle, entering the muscle

on the orbital

surface.

PLATE

CCVII.

RECTUS.

SUP.

INf.

INTERNAL RECTUS.

EXTERNAL RECTUS.

SUP.

RECTUS.

INF.

OBLIQUE.

-OBLIQUE.

'y

Showing the Directions that Muscles of the Eye-Ball Move the Eye.
For

its

position in the sinus (See Plate

the floor of the sphenoidal fissure

rectus.

For

position

the

of

lie

CCXXXII.)

All the structures

between the two heads

on

of the External

nerves in the orbit (See Plate

CCXV).

The

on the Superior oblique, the frontal nerve on the Levator palThe superior division
pebrae, and the lachrymal nerve on the External rectus.
of the third nerve lies along the Superior rectus; the nasal nerve crosses the optic
nerve from without inward: the optic nerve is surrounded anteriorly by the
fourth nerve

lies

ciliary nerves; the lenticular ganglion lies

ternal rectus.

The

sixth nerve

is

between the optic nerve and the Ex-

on the outer surface of the orbit.

The

in-

below the lenticular ganglion and this nerve

is joined by filaments from the cavernous plexus, carotid plexus, and the ophthalmic nerve.
If the sixth nerve is paralyzed internal or convergent squint
ferior division of the third

nerve

is

follows as the External rectus loses

some extent

in

its

paralysis of this nerve as

radiating muscle of the

iris

The fifth nerve is the

nerve than any other of

function.

some

The pupil

of the

is

contracted to

sympathetic

fibers to the

pass along this nerve.

largest of the cranial nerves.

the cranial nerves.

It is

It is

more

compound

like a

spinal

nerve, having

ANATOMY
an anterior or motor, and

393

IN A NUTSHELL.

a posterior or sensory root with a ganglion

upon

it.

superficial origin is on the

Its motor fibers,
side of the pons, nearer the upper than the lower border.
which are three or four bundles, are separated from the sensory fibers, which
the trifacial or trigeminus,

It is called

are seventy to one hundred bundles,

origin

by

lis

The deep

a few transverse fibers.

the floor of the fourth ventricle.

is in

Its

sensory portion

is

in a

nucleus

and just beyond the margin of the upper half

The motor portion is a nucleus internal to the sensory
of the fourth ventricle.
and external to the funiculus teres on the upper half of the floor. (Plates CCXIYin the

pons just below the

floor

CCXV).

PLATE

CCVTII.

2ND

Showing Refraction of Light Through Crystalline Lens.

It is

the

sensory nerve

to the

head and

face,

and

motor NERVE

to the

muscles of mastication.
Its roots pass through an oval opening in the dura mater
The senBory root
near the apex of the petrous portion of the temporal bone.
is from the Gasserian ganglion, which is situated in Meckel's cave.
This cave
is

a depression

temporal bone.

and
it

is

near the apex of the anterior surface of the petrous portion of the
The anterior or motor root passes under the Gasserian ganglion

not joined to

it

but joins the inferior maxillary division of the

passes through the foramen ovale, thus making

this pari of the

fifth

nerve

after

a coin-

pound nerve; in fact it is the only pari of the fifth nerve which is a compound
This ganglion gives off
nerve for the other two divisions are purely sensory.
from its anterior edge three trunks. (1) Ophthalmic, (2) Superior maxillary, and
(3) Inferior

maxillary.

It

sends communicating branches to the carotid plexus,

tentitorium. cerebellum, and the dura mater of the middle fossa.

ANATOMY IN A NUTSHELL.

394
I.

The ophthalmic branch purely sensory,

is

the smallest and courses along

the outer wall of the cavernous sinus below the third and fourth nerves. It
divides into three branches which leave the cranium through the anterior lacer(For relation of these branches see Plate CCXXIV.)
ated or sphenoidal fissure.
The ophthalmic supfrontal,
nasal, and lachrymal.
the
are
branches
These

lachrymal gland, the orbital and nasal mucous

eyebrow, forehead, and nose.

plies the eye-ball, the

and skin

of the

membrane

The frontal branch is the largest and is just external to the fourth nerve
and the anterior lacerated or sphenoidal fissure and passes forward on the Levator palpebral dividing into two branches.

PLATE

CCTX.

SUPERIOR FORNIX

UPPER LID

LOWER

LID

INFERIOR FORNIX

Superior Fornix and Inferior Fornix of Conjunctiva.

LESSON

CXI.

The supraorbital which passes through the supraorbital foramen or

branch to the diplce and mucous membrane of the frontal
sinus.
The outer and inner branches supply twigs to the pericranium and
pierce the Frontalis muscle. They communicate with branches from the facial
nerve and are distributed to the skin of the scalp in the frontal and parietal
regions.
The outer branch is the larger and passes backward almost to the
(a)

notch.

It gives a

lambdoid suture.

The supratrochlear nerve is the smaller and passes inward above

and sends a branch to join the infratrochlear
branch of the nasal.
It Leaves the orbit between the supraorbital foramen and
the pulley and passes upward under cover of the Corrugator supercilii and
(b)

tin'

pulley of the Superior oblique

>ccipito-frontalis to

supply the skin of the lower part of the forehead near the

midline.

The lachrymal

is

the smallest branch.

the lachrymal gland where

ii

It passes to the

under surface of

joins the orbital of the superior maxillary, form-

ing a loop which sends branches into the gland.

It passes

through the sphenoid-

ANATOMY
al fissure

395

IN A NUTSHELL.

external and below the frontal nerve and passes along the upper bor-

der of the External rectus muscle.

It

then pierces the palpebral fascia and

and integument at the outer canthus

supplies the conjunctiva

of the eye

and

that over the external angular process.

The nasal branch

the third division of the ophthalmic division of the

is

It passes into the orbit

fifth.

between the two divisions

the floor of the sphenoidal fissure.

In the orbit

it

on

of the third nerve

passes from the outer to the

inner side over the optic nerve, below the Superior rectus, then

it

passes between

the Superior oblique and Internal rectus to leave the orbit through the anterior

ethmoidal foramen with the anterior ethmoidal vessels into the cranium.
the cranium

it

In

passes forward outside of the dura mater, which separates

from the Levator palpebral to pass through the nasal

where it divides into its three terminal branches.

slit

it

into the nasal fossa

PLATE CCX.

CILIARY PROCESSES.

AND

MUSCLE^

SUSPENSORY

LIGAMENT.

Crystalline Lens.

Internal or septal branch, which

(a)

front of nasal septum,

(b)

is

distributed to the upper

and

External branch to superior and middle turbinated

(c) Anterior
bones and to the mucous membrane of the outer wall of the nose,
branch runs in the groove on the inner surface of the nasal bone. It pierces the
wall of the nose between the nasal bone and the upper lateral cartilage and sup-

integument of the lower part of the dorsum of the nose as far as the tip.
The nasal nerve gives off the following collateral branches:
1. The long root to the ciliary ganglion which runs forward on the outer
of the optic nerve to the upper and back part of the ciliary, lenticular, or

plies the

side

ophthalmic ganglion.
2. Long ciliary branches, two or three

in

number, pass along the inner

side of the optic nerve, join the short ciliary branch from the ganglion, thru

pierce the sclerotic coat to be distributed to the ciliary muscle, the

iris,

and the

cornea.
3.

Infratrochlear nerve

is

given

off just

before the nasal nerve passes

between the Superior oblique and Internal rectus. It communicates with the
Supratrochlear and is distributed to the skin of the eyelid and side of the nose,
conjunctiva, lachrymal sac, and caruncula lachrynialis.
This lenticular, ciliary, or ophthalmic ganglion has three roots.

ANATOMY

396

IX A NUTSHELL.

A MOTOR ROOT from the third nerve, sympathetic root from the cavernous
Its branches are distributed to
plexus, and a sensory root from the nasal.
the iris, ciliary muscle, and cornea.
The superior maxillary division of the fifth is intermediate in size and
11.
It, like the
position between the ophthalmic and inferior maxillary division.
from
part
of the
the
anterior
It
comes
sensory.
purely
ophthalmic branch, is
sinus
in
the
lower
and
cavernous
the
passes
and
through
Gasseriarj ganglion
rotundum,
entering
foramen
the
through
leaves
the
cranium
outer part; it then

PLATE CCXI.

CANAL OF SCHLEMN

POSTERIOR CHAMBER.

CILIARY BODY

CANAL

OF PETIT

CILIARY PROCESSES

NTERNAL RECTUS MUSC1

EXTERNAL RECTUS

CHOROID COAI

NERVE SHEATH

A Horizontal Section of the Eye-Ball.

connected with Meckel's ganglion. As
and passes in the groove on
the floor of the orbit and comes out on the face through the infraorbital foramen.
This foramen is beneath the Levator labii superioris and the Levator anguliThe nerve in this position anastomoses with the seventh to form a plexus
oris.
the Bpheno-maxillary fossa where

it

passes forward

it is

it

is

called the infratrochlear nerve

ANATOMY

IX A NUTSHELL.

397

which gives off three branches, (1) palpebral, (2) nasal, and (3) labial.
While in the sphenomaxillary fossa it is in relation with the infraorbital artery
which accompanies it on its course to the face. The branches of distribution are:
(1) those given off in the cranium; (2) those given off in the spheno-maxillarv
fossa; (3) those given off in the infraorbital canal: and (4) those given off on the
face.

cranium are one or two meningeal branches which unite with

fifth and also with
the sympathetic nerve around the meningeal artery which accompanies it to

Those

in the

the recurrent branch of the inferior maxillary division of the

the dura mater.

PLATE

CCXII.

LEVATOR PALPEBRAE

RECTUS

SUPERIOR;

RECTUS INFERIOR
RECTUS INTERNUS.
INFERIOR OBLIQUE,

The Third Cranial or Motor Oculi Nerve.

In the spheno-maxillarv fossa are, 1. Orbital or temporo-nialar branch
which passes upward and forward to enter the spheno-maxillarv fissure where
it divides into temporal and malar branches.
The temporal branch passes upward in a groove in the outer wall of the
orbit where it receives a branch from the lachrymal before it traverses the
It turns round the anterior
Bpheno-malar foramen to enter the temporal fossa.
of
fascia,
running
border
the temporal
then
forward and outward to pierce its
zygoma
to
anastomose
with the seventh and
about
inch
fascia
an
above the
auiiculo-teniporal of the inferior maxillary division of the fifth, and supplies

the skin of the anterior part of the temporal region.

The malar branch (subcutaneous mala?) supplies the skin on the prominence of the cluck after passing along the external inferior angle of the orbit
through the foramen

in

the malar bone where

it

perforates

the Orbicularis

palpebrarum muscle.
2.

The spheno-palatine branches

are

two

in

number and descend

to

the

Bpheno-palatine or Meckel's ganglion but do not end there, for most of the fibers
pass into the palatine nerves.

ANATOMY

398

IN A NUTSHELL.

The third set are (1) the posterior superior dental, usually two in
They pass downward and outward through the ptery go-maxillary
fissure into the zygomatic fossa where they give branches to the mucous membrane of the gums and the posterior part of the mouth. They then enter the
3.

number.

posterior dental canals on the zygomatic surface of the superior maxillary bone

communicate with the middle dental nerve and branches to the lining membrane of the antrum of Highmore (superior maxillary sinus). It also gives off
to

three branches to the molar teeth which enter the foramina at the apices of the

fangs to supply the pulp.

The middle superior dental and the anterior superior dental are
the infraorbital sulcus.
The middle supplies the bicuspid teeth
and the mucous membrane of the antrum and the gums. After leaving the
infraorbital nerve it passes downward and forward in a canal in the superior
(b)

given

off in

maxillary.
ior superior

These branches which supply the teeth anastomose with the anter-

and posterior superior dental branches.

middle and anterior

and posterior

is

is

At the junction

of the

the ganglion of Bochdalek; at the junction of the middle

the ganglion of Valentin.

PLATE OCX III.

RECURRENT TO SYMPATHETIC-

The Trochlear or Fourth Cranial Nerve.

LESSON
(c)

The anterior superior branch

CXII.
is

given

off just

before the infraorbital

nerve enters the infraorbital foramen.

It descends to supply the incisor and
canine teeth.
It
gives branches to the gums and mucous membrane of the

antrum and the nasal branch which enters the nasal fossa through a small
foramen and supplies the mucous membrane of the forepart of the inferior
meatus and its floor. It communicates with the nasal branch from Meckel's
ganglion.

The branches on the face are palpebral, labial, and nasal.

The palpebral supplies the skin and mucous membrane
lid.

At the outer angle of the orbil

of the orbital.

it

joins with the seventh

of the lower eye-

and malar branch

ANATOMY

IN A NUTSHELL.

399

The nasal branch passes inward and upward under cover of the Levator
supply the skin on the posterior part of the lateral aspect of

labii superioris to

the nose.

It joins

with the nasal branch of the ophthalmic.

The labial branch descends beneath the Levator

distributed to the integument of the upper

mouth and

lid,

also to

labii superioris to

be

mucous membrane

of

to labial glands.

PLATE CCXIV.

TO TENTORIUM CEREBELLI.

--

--

HATES

FROM CARVERNOUS PLEXUS.

FROM
...

LESTICULARJiANGLION.

/V^

3RD. NERVE.

,GASSEPIAV JJTRIFAPAL

^ & r.auni mil /

MOTOR ROOT
GREAT SUPERFICIAL PETROSAL. FROM 7JH NERVE.
GREAT DEEP PETROSAL. FROM CAROTID PLEXUS.

C.

WITH AURICULOTEMPORAL.

AURICULOTEMPORAL
TOFACIAL
TO TEMPORO-MAXILLARY JOINT.
TO MEATUS-AUDITORIUS.

MALL SUPERFICIAL PETROSAL FROM

THE

FACIAL*

STMP. ON MIDDLE MENINGEAL.

C

C4

X T0

TO

^Vr INFERIOR

TENSOR PALATI

TENSOR TYMPANI.

TO INTERNAL PTERYGOID

FROM SYMPATHETIC ON FACIAL ARTERY.

JWT. BELLY OF DIGASTRIC.

Showing Branches of the Fifth Cranial Nerve.

is

III. The inferior maxillary division of the fifth, the mandibular branch,
compound nerve after it passes through the foramen ovale. It is the largesl

branch of the

fifth

nerve.

compound

Its

sensory portion comes from the Gasseriau gang-

leaves the foramen ovale,

it
and posterior branches. The main trunk before it divides
has the External pterygoid muscle and optic ganglioD external, and the Tensor
palati muscle internal, and in front of it is the posterior border of the Internal
The branches
pterygoid muscle, and behind is the middle meningeal artery.
from the trunk are (1) a recurrent which passes backward with the middle
meningeal artery through the foramen spinosum to supply the dura mater.
2. The nerve to the Internal pterygoid muscle.
This nerve sends a motor
branch to the optic ganglion. The anterior division of the main nerve is small
lion.

This

divides into anterior

nerve, immediately after

ANATOMY

400

ami

motor ami gives

chiefly

off a

IN A NUTSHELL.

masseteric branch which accompanies the

through the sigmoid notch of the inferior maxillary bone to be

It gives a twig to the tempcro-mandidistributed to the Masseter muscle.
ter artery

nilar articulation.
3.

Deep temporal branches, two

or

three

in

number, which

be-

lies

tween the bone and the upper border of the External pterygoid muscle to
end in the deep surface of the Temporal muscle. The anterior one is from the
The middle one to supply
Buccal to supply the front of the Temporal muscle.

PLATE CCXV.
LEVATOr, PALPEBRAL M.

SUPRATROCHLEAR

SUPERIOR RECTUS
FRONTAL N.
INTERNAL RECTUS M.

N,

OPTIC

SUPRAORBITAL N

N.

SHORT CILIARY NERVES.

ASAL N.

PULLEYOF SUPERIOR OBLIQUE M

LENTICULAR GANG LION

EXTERNAL RECTUS

TENDON OF SUP OBLIQUE

M.

INFERIOR RECTUS M.

TAHSAL CARTILAGE

LACHRYMAL

N.

OF UPPER EYELID

THIRD

LACHYMAL GLAND

N.

FOURTH NERVE.

.OOP BETWEEN ORBITAL

SIXTH

AND
LACHRYMAL NERVES

NERVE.

OPHTHALMIC

DIV.

OF 5TH N

SUPERIOR MAXILLARY N
INFERIOR OBLIQUE M

GASSERIAN GANGLION.

PALFEBRAL BRANCH

HENO-PALATINEN.
IAN

N.

AURICULOTEMPORAL

NASAL BRANCH
INFERIOR MAXILLARY N

LABIAL BRANCH

SMALL MENINGEAL

MIDDLE MENINGEAL A

ANT.

.SUPERIOR DENTAL

N.

INTERNAL MAXILLARY

A.

AN D A

NFERIOR DENTAL

MIDDLE
SUPERIOR DENTAL A
AND N

NFERIOR DENTAL N

BUCCAL
GINGIVAL

A.

A.

A.

INCISIVE BR._

MYLO-HYOID N

MENTAL

MENTAL

CHORDA-TYMPANI

Showing Distribution of the Fifth Nerve

N.

in

Reference to Other

Structures.
the deep part of the Teiu
goid.

The

>or;il

muscle after passing above the External ptery-

posterior one after uniting with the masseter nerve

posterior pari

<<\

the

Temporal muscle.

is

sent to the

PLATE CCXVI.

SUPRATROCHLEAR N

INFRATROCHLEAR

NASAL N

SUPRACLAVICULAR

SHOWING THE CUTANEOUS NERVE SUPPLY OF HEAD AND

Showing Cutaneous Nerve Supply of Head

101

\\i>

NECK

\i<

k.

ANATOMY

402
4.

The buccal

is

IN A NUTSHELL.

sensory and comes out between the two heads of the Ex-

ternal pterygoid to reach the Buccinator

temporal and external pterygoid nerves.

and

is

5.

mucous membrane

distributed to the

Branch

and is often joined to the anterior

It communicates with the seventh
of the skin of cheek.

to the External pterygoid muscle

long buccal nerve.

The

chiefly sensory.

has three main branches,

It

posterior branch of the

is

generally adherent to the

common trunk

is

larger

and

is

(a) auriculo- temporal, (b) lingual

which is purely sensory, but (c) the inferior dental nerve has a few motor fibers
in it which pass to the Mylo-hyoid muscle.
6. The auriculotemporal arises by two heads between which is the middle
It then passes under the External pterygoid muscle, over
memingeal artery.
From here upward
ligament
into the temporo-mandibular joint.
the capsular
parotid
gland
the
temporal
temporal
beneath
the
to
fossa where
artery
with the
and
the
superficial
temporal
cutaneous
posterior
to
artery.
lies
It
it becomes
branch
facial
nerve,
(b)
a
branch
branches:
a
to
the
otic
off
seven
(a)
to
gives
ganglion, (c) two anterior auricular branches distributed to tragus and upper
and outer part of pinna, (d) superior temporal to integument of the greater part
of the temporal region and they anastomose with the seventh, (e) auricular
branch to temporo-maxillarv articulation, (f) branches to external auditory
meatus, which branches are given off in the parotid gland. They pass between
These branches supply the
the cartilage and the bone to enter the meatus.
upper part of the meatus, tympanic membrane, and occasionally the lobule,
(g)

branches to the parotid gland.

7.

LiNGUAL(gustatory)formerly supposed to be the nerve of taste. so it was

it is a nerve of common sensation and the name gustatory
used for this nerve.
It lies at first internal to the External pterygoid

called gustatory, but

is

still

downward in front of the inferior dental nerve and is

by the chorda tympani nerve from the seventh. From
here L1 passes downward and forward between the Internal pterygoid and the
ramus, over the Superior constrictor of the pharynx on the Hyo-glossus muscle,
muscle and then

it

passes

joined at an acute angle

above the deep part of the submaxillary gland to the sides of the tongue. It
has (a) communicating branches to the anterior dental nerve and submaxillary
ganglion and the twelfth nerve, and (b) branches of distribution to the tongue.
8. TheiNFERiOR dental is the largest branch and passes downward underthe
External pterygoid muscle posterior to the lingual nerve. then to the dental foramen after passing between the ramus and internal lateral ligament. It passes
through the dental canal to emerge at the mental foramen. This nerve has four
main sets of branches, (a) Those to the Mylo-hyoid muscle, (b) branches to the
molar and bicuspid teeth, (c) branches to mucous membrane and canine teeth,
and (d) branches to the integument of chin and lower lip.
The Gasserian ganglion is sometimes called the semilunar ganglion.
It
lies in Meckel's cave near the apex of the petrous portion of the temporal bone.
Beneath this ganglion is the motor root of the fifth nerve and the large superficial petrosal nerve which is a branch of the seventh.
This latter nerve helps
to form the vidian nerve.
Filaments from the cavernous plexus of the sympathetic join this ganglion on its inner side.
Branches pass to the tentorium

ANATOMY
cerebelli

and the dura mater

of the

great branches of the fifth nerve,

and the

inferior maxillary arise

IN A NUTSHELL.

middle fossa from this ganglion. The three

the ophthalmic, the superior maxillary,

viz.,

from

this ganglion.

Besides the Gasserian ganglion the

The

403

fifth

nerve has four other ganglia.

Lenticular, ciliary, or ophthalmic ganglion, (Plate

CCXIV)

is about the
between the optic
nerve and the External rectus muscle. The ophthalmic artery is generally on
This ganglion has three roots, (a) the sensory root which
its inner side.

(1)

size of

a pin's head and

is

reddish gray in color.

It is situated

PLATE CCXVII.
SUPERIOR NASAL NERVES

SPHENOPALATINE

MECKEL

NASAL

N.

GANGLION

NERVE

NASAL BONE

OTIC GANGLION

SYMPATHETIC ROOT

AURICULO-TEMPORAL

N.

MIDDLE MENINGEAL

A.

INTERNAL PTERYGOID

TENSOR PALATI

NASO-PALATINE

EXT. PALATINE

NERVE

Meckel's Ganglion and the Otic Ganglion.

(

comes from the nasal branch

ganglion.

This

is

of the

the long root,

ophthalmic and joins the upper angle of the

(b) The motor root which conies from a

branch of the third nerve that passes

the short

mot and

to the

Inferior oblique muscle.

joins the inferior angle of the ganglion,

(c)

The

This

is

sw,n-\-

It
from the cavernous plexus of the sympathetic.
This ganglion gives off five or ten short
These
ciliary nerves from the anterior superior and the anterior inferior angles.
nerves pass with the ciliary arteries forward, one set above the optic nerve and

thetic root which

coin* s

usually blends with the long root.

ANATOMY

404
the other set below

IN A NUTSHELL.

After being joined by the long ciliary nerves of the nasal

it.

branch of the fifth, they pierce the back part of the sclerotic coat of the eye and
then pass forward in grooves on the inner surface of the sclerotic coat to supply
(Plate CCII).
the ciliary muscle, iris, and cornea.

LESSON

CXIII.

(2) Meckel's ganglion is also called spheno-palatine and is situated in the

It is reddish gray in color and somewhat triangular
spheno-maxillary fossa.
It has three roots, (a) a sensory root which comes from the suin shape.

Most

perior maxillary nerve through the spheno-palatine branches.

it.

motor root comes from

Its

(b)

ficial

petrosal,

which

is

unite to

(c)

the facial nerve through the great super-

Its sympathetic root comes from the great deep petrosal

a branch of the carotid plexus.

make

The

lion.

of the

nerves pass in front of Meckel's ganglion but a few of them enter

fibers of these

This motor root and this sensory root

the vidian nerve which enters the posterior surface of the gang-

great superficial petrosal nerve comes from the geniculate ganglion

seventh nerve in the aqueductus Fallopii. After passing through the

hiatus Fallopii, it runs forward in a groove on the anterior surface of the petrous
portion of the temporal bone under the dura mater and the Gasserian ganglion.

of the

In the middle lacerated foramen it unites with the large deep petrosal which
comes from the carotid plexus and runs through the carotid canal on the outer
It then enters the middle lacerated foramen
side of the internal carotid artery.

where with the large

superficial petrosal

it

forms the vidian.

This ganglion

gives off the following branches, (a) ascending which are two or three small

branches pass to the orbit through the spheno-maxillary

its p<

fissure

and supply

riosteum, (b) the anterior palatine, sometimes called large palatine, passes

through the posterior palatine canal and the posterior palatine foramen to the
It
hard palate where it runs forward in a groove nearly to the incisor teeth.
supplies tin- gums, mucous membrane, and glands, and communicates with the

The

naso-palatine nerves.

inferior

come from the

nasal branches

anterior

and supply the middle

inferior
The anterior
turbinated bones.
meatus and the middle and
palatine also give s off a palatine branch after leaving the canal which supplies
palatine and pass through foramina in the palate bone

tin- .-oil

palate

when

is

it

and

tonsil,

it

(c)

the middle or external

palatine

is

not

always present, but

passes through an accessory palatine canal to supply the uvula,

soft

palab

(d) the posterior or

small palatine passes through the

small posterior palatine canal to supply the Levator palati, Azygos uvulae, soft

and uvula. These last two branches with branches from the
This plexus is called
n< rve form a plexus around the tonsil.
circulus tonsillaris,
(e) The superior nasal which arefour or five branches pass
through the sph< no-palatine foramen where they supply the mucous membrane
on tin superior turbinated processes and the middle turbinated boms and also
the mucous membrane of tin posterior ethmoidal cells.
It communicates with
branch
anti
of the anterior
a
which
surface
rior dental by
the
passes to the inner
through
wall of the antrum of Highmor<
forward
naso-palatine
(f) The
passes
palat

tonsil,

glosso-pharyngeaJ

ANATOMY
the spheno-palatine foramen

and from here

405

and then across the roof

of the nose to the

septum.

downward and forward beneath the mucous membrane

palatine foramen.
The naso-palatine nerve on the left side

it

to the anterior

IN A NUTSHELL.

runs

passes through the anterior of the two foramina of Scarpa, while the one on the

Here they supply the mucous

right side passes through the posterior one.

membrane behind

the teeth and join the anterior palatine nerve,

(g)

The

pharyngeal branches, called pterygo-palatine, arise from the back of the ganglion and pass with the ptery go-palatine artery through the ptery go-palatine

mucous membrane of the upper part of the pharynx behind

(h) The posterior superior nasal are a few small branches
which pass in the sheath of the vidian nerve to supply the mucous membrane
at the back part of the roof, septum, and superior meatus in the nose, and also
to the mucous membrane covering the end of the Eustachian tube.
(3) The otic ganalion, sometimes called Arnold's, is reddish gray in color.
It is small and flat and situated under the foramen ovale on the inner surface
of the inferior maxillary nerve near the point where the motor and sensory
canal to supply the

the Eustachian tube,

branches
its

join.

This ganglion has behind

it

the middle

ni<

ningeal artery.

On

and the origin of

This ganglion has three roots which are (a) its

inner side the cartilaginous portion of the Eustachian tube

the Tensor palati muscle.

PLATE CCX VI 11.

x=

"

to sympathetic

The Abdtjcens or Sixth Cranial Nerve.

motor root which comes from the

internal pterygoid branch of the inferior

sensory root may come from the same

motor root, (c) its sympathetic root comes from the sympathetic fibers from the middle meningeal plexus.
Its motor root may
(N. B.)
come from the facial nerve, and its sensory from the glosso-pharyngeal nerve
through the small superficial petrosal nerve and the tympanic plexus.
Branches from this ganglion are (a) a filament passes backward on the
OUtei side of the Eustachian tube to the Tensor tympani muscle, (1>) a branch
maxillary division of the

fifth, (b)

its

origin as the

Both of these branches are derived prinfrom the interna] pterygoid nerve, (<) Small branches pass to the
chorda tympani and buccal nerves.
passes to the Tensor palati muscle.
cipally

(4)

The submaxillary ganglion

is

situated above the deep portion of the

submaxillary gland close to the posterior border of the Mylo-hyoid muscle.

This ganglion has three roots which are (a) its SYMPATHETIC ROOT is from the
plexus on the facial artery, (b) its
the facial and
off

(c) its

sensory root

the following branches,

(a)

motor root
is

five

from the

is

from the chorda tympani of

fifth

nerve.

This ganglion gives

or six small branches which supply

the

ANATOMY

406

mucous membrane

of the

IN A NUTSHELL.

mouth and Whorton's duct and

the submaxillary

gland, (b) branches pass from the lingual branch through the submaxillary

ganglion with the chorda tympani to the sublingual gland and tongue.

we
a

Thus
and

sec that each of these four ganglia has three roots, a motor, a sensory

sympathetic.

LESSON CXIV.

(Plate

CCXIX-CCXX.)

The superficial origin of the seventh nerve (Plate CLXXXVII) is in the

upper part of the groove between the olivary and restiform bodies of the medulla
The deep origin is in the pons under the floor of the fourth venoblongata.
The seventh cranial
tricle, anterior and external to that of the sixth nerve.
nerve and the eighth cranial nerve were formerly called the seventh and contwo parts, portio dura, which is now called the seventh, and the

sisted of

portio mollis, which is now called the eighth. The pars intermedia arises
from the medulla between the seventh and eighth cranial nerves and is connected
with them at its origin. The seventh nerve or facial nerve is the motor nerve
of the facial muscles of expression, of the muscles of the external ear, Platysma
myoides, Buccinator, posterior belly of the Digastric, Stylo-hyoid, Lingualis,
and Stapedius. This nerve passes with the eighth nerve into the internal audFrom the internal
itory meatus where they are joined by the pars intermedia.
auditory meatus it runs into the aqueductus Fallopii where it has an enlargement upon it called the geniculate ganglion, which is reddish in color. It now
bends backward on the inner wall over the fenestra ovalis and then runs vertically downward behind the tympanum to the stylo-mastoid foramen.
After it
passes out of the stylo-mastoid foramen it runs forward in the parotid gland and
crosses the external carotid artery.
At the ramus of the jaw it divides into the
temporo-facial and cervico-facial branches.
These two branches with their
sub-divisions form the pes anserinus.
The seventh nerve gives off the following branches of communication, (1)
in wditory canal, (a) small branches to the auditory nerve, (2) in aqueduct
of Fallopius, (a) large superficial petrosalfrom thegeniculate ganglion which
with the large deep petrosal forms the vidian nerve. This nerve passes to
Meckel's ganglion,
(b) Small superficial petrosal passes from the geniculate
ganglion to the otic ganglion, (c) external superficial petrosal from the geniculate ganglion to the sympathetic plexus around the middle meningeal artery,
(d) a branch to the auricular branch of the pneumogastric (Arnold's).
(3) At
tin. exit OF the stylo-mastoid foramen (a) a branch to the great auricular
of the cervical plexus, (b) to auriculo-temporal of the fifth, (c) a branch to the
pneumogastric, (d) a branch to the glosso-pharyngeal.
(4) Behind the ear,
a branch of communication
occipital.
the face,
to the small
(5) On
branches to the three divisions of the fifth nerve.
In the neck, branches
(6)
to

the superficial cervical.

The seventh nerve has the following branches of distribution

(1) I.\ the aqueduct of Fallopius, (a) tympanic branch which
opposite the pyramid and passes through a small canal in the pyramid

arises

to the

ANATOMY

407

IX A NUTSHELL.

Stapedius, (b) chorda tympani arises a quarter of an inch above the stylo-mas-

and passes upward and forward and enters the tympanum through
This opening is between the
its posterior wall.
opening of the mastoid cells and the membrana tympanum. This nerve now
passes between the handle of the malleus and the vertical ramus of the incus to
toid foramen

the iter chordae posterius on

the anterior inferior angle of the

tympanum where

it

passes through the iter

chordae anterius (canal of Huguier) at the inner end of the Glasserian fissure.

PLATE CCXIX.

FROM GLOSSO-PHARYNGEAl
SUPERFICIAL

CERVICAL

Branches of Facial Nerve.

While

now

in

the

tympanum

this

nerve

is

covered with mucous membrane.

It
t\vi<: from the

passes between the Pterygoid muscles and after receiving a

otic ganglion joins the lingual

branch of the

fifth

nerve and passes with

it

to

The sublingual gland may receive a few fillers

from this nerve, but most of them pass to the Inferior lingual muscle. Sonic
physiologists claim that the chorda tympani nerve supplies the anterior two-

the submaxillary ganglion.

thirds of the tongue with taste, others claim thai

the ninth nerve passes with

chorda tympani branch to be distributed to the anterior two-thirds of the

tongue, in such a case the ninth nerve is the nerve of taste for the entire tongue.

this

ANATOMY

408

(2)

\i:\i;

IX A

NUTSHELL.

the stylo-mastoid foramex,

(a) posterior auricular arises

from

the seventh nerve just outside the stylo-mastoid foramen and passes between the
external auditory meatus and the mastoid process where it receives a branch
It communicates with the small occipital
of
the
auricular.
It now divides into an
great
and
branch
mastoid
the
nerve
auricular branch which supplies the Retrahens aurem and an occipital branch
which supplies the Occipitalis muscle, (b) the digastric branch may have its

of the auricular branch of the vaults.

origin by

common

trunk with the stylo-hyoid branch.

belly of the Digastric

and

It

supplies the posterior

after perforating that muscle joins the

glossopharyn-

geal nerve, (c) stylo-hyoid branch enters the Stylo-hyoid muscle near its center

ami communicates with the sympathetic plexus on the external carotid artery.
:;>
On the FACE,(a)it has the temporo-facial branch which passes through
the parotid gland over the external carotid artery and temporo-maxillary vein,
and as it passes over the condyle of the lower jaw it communicates with the
it finally divides into three sets
auriculo-temporal branch of the fifth nerve,
of branches, first, temporal branch which crosses the zygoma of the temporal
bone and supplies the Attrahens aurem and Attolens aurem muscles and joins
with the temporal branch of the temporo-malar of the fifth ami the auriculotemporal also of the fifth.
It supplies the Orbicularis palpebrarum, Corrugator
supercilii, and the Frontalis muscles, and joins the supraorbital and lachrymal
blanches of the ophthalmic division of the fifth; second, the malar branches pass
to the outer portion of the orbit where a few fibers pass to the Orbicularis palpebrarum arid join branches from the lachrymal nerve, and the others supply
the lower eye lid and join the malar branch of the superior maxillary; third, the
infraorbital passes to the parts between the mouth and the orbit and supplies
the superficial facial muscles and the Pyramidalis nasi ami joins with the infratrochlear and nasal branches of the ophthalmic at the inner angle of the orbit.
Other branches pass under the Zygomatici and the Levator labii superioris,
supplying both of these muscles as well as the Levator anguli oris. They form
an infraorbital plexus with the infraorbital branch of the superior maxillary and
buccal branches of the cervical facial nerves.
These branches supply the Levator labii superioris alanine nasi and the muscles of the nose,
(b) The cervical
facial branch passes forward through the parotid gland across the external
carotid artery and receives branches from the great auricular.
It divides opposite the angle of the lower jaw into three sets of branches, first, buccal which
crosses the Masseter muscle to supply the Buccinator and the Orbicularis oris.
These buccal branches join the infraorbital branches of the temporo-facial and
the buccal branches of the inferior maxillary; second, the supramaxillary (mandibular) branches pas> under the Platysma myoides and Depressor anguli oris
to supply the muscle of the chin and lower lip and join the mental branch of the
inferior dental of the fifth: third, the inframaxillary

under the Platysma myoides and supply

it.

(cervical) branches pass

One branch descends

to join the superficial cervical of the cervical plexus.

The eighth nerve

will

be given with the

anatomy

of the ear.

vertically

PLATE CCXX.

TERMINATIONS OF

SUPRATROCH LEAR
OF

OF

INFRA TROCHLEAR

INFRA-ORBITAL

Showing Facial Nerve

\\i

Superfic]
109

\i.

Cki;\ ecal

Plexuj

ANATOMY

410

IN A NUTSHELL.

LESSON CXV.
The ninth cranial nerve called the glosso-pharyngeal passes to the tongue
and the pharynx. It supplies the raucous membrane of the pharynx, tonsil,
and fauces with ordinary sensation, and the tongue it supplies with a nerve of
Its superficial origin is in the
This nerve is a compound nerve.
taste.
(Plate CLXXXVII).
Its
groove between the olivary and restiform bodies.
DEEP ORIGIN is from the lower part of the floor of the fourth ventricle from three
main points. (1) from a nucleus of gray matter beneath the inferior fovea, (2)
from the funiculus solitarius, (3) from the nucleus ambiguus. The nucleus
ambiguus gives motor branches to the glosso-pharyngeal and the tenth nerves
The sensory fibers of the
and to the bulbar part of the spinal accessory nerve.
Van Gehuchten says that
ninth nerve are in the jugular and petrosal ganglia.
the fasciculus solitarius

nerve passes from

its

is

The ninth

the only sensory nucleus of this nerve.

outward

superficial origin

to leave the skull through the

has a sheath of dura mater of

own

centra] part of the jugular foramen.

It

and

and spinal accesthe internal carotid artery and beneath

is

its

situated external to and in front of the pneumogastric

sory nerves.

It

descends

in front of

and muscles attached to it to the lower border of the Stylo?

pharyngeus muscle. The nerve now passes inward, lying upon the Stylopharyngeus and the Middle constrictor of the pharynx. It finally passes beneath the Hyo-glossus muscle to its destination. This nerve has two ganglia
upon it
The jugular ganglion or superior one is in the upper part of the groove
the styloid process

which the nerve is placed while passing through the jugular formen. It is
quite smal] and may be regarded as a segmentation of the lower ganglion.
The
petrous ganglion is the inferior one and is situated in the lower border of the
petrous portion of the temporal bone.
It is much larger than the superior one.
Fibers arise from it to connect this nerve with the tenth and the sympathetic.
It sends two filaments to the pneumogastric, one of which passes to the auricular branch of the pneumogastric, and the other to the ganglion of the root of

in

The branch which passes

the tenth.

to the sympathetic passes to the superior

and the branch which passes to the facial nerve arises from
the nerve below the petrous ganglion and joins the facial just after it leaves the

cervical ganglion,

stylo-mastoid

foramen.

(Plate

CCXXII).

branches of distribution are, (1) tympanic branch, called Jacobson's

nerve, comes from the petrous ganglion and passes in a small canal in the lower
surface of the petrous portion of the temporal bone.
The lower opening of this
It-

canal

now

is

on

a ridge

passes to the

gives off

(a

between the carotid canal and the jugular fossa. This nerve
tympanum and forms the typmanic plexus. This plexus

a greater pari of the small superficial petrosal, (b)

large superficial petrosal, (c) branches to the

tympanic cavity,

the carotid plexus,(e) to the Eustachian tube,

(f)

a branch to the
(d)

branches to

to fenestra ovalis, (g) to fen-

estra rotunda.
(2)

Pharyngeal branches which

are three or four in

the pharyngeal branches of the pneumogastric

number

unite with

and sympathetic nerves

to form

ANATOMY

IN A NUTSHELL.

411

This union takes place opposite the Middle constrictor

Branches from this plexus perforate the muscular coat of the
pharynx to supply the muscles and the mucous membrane.
(3) Muscular branch which is distributed to the Stylo-pharyngeus muscle, receives a communication from the seventh nerve.
(4) The tonsillar branches, which are small, arise undercover of the
Hyo-glossus muscle. They pass to the tonsil around which they form a plexus,
From this plexus twigs pass to the pillars of the fauces and
circulus tonsillaris.
to the soft palate where they communicate with the palatine nerve.

the pharyngeal plexus.

of the pharynx.

PLATE CCXXI.
OPTIC NERVE

INFUNDIBULUM

TUBER

CINEREUM

CORPORA VAMMILLARIA

0CUL0-M0T0R
STEP'.

III.'

TROCHLEAR NERVE

LOCUS PERFORATES'
POSTICUS
.

IV.

WINDING ROUND THE CRUS CEREBRI

TRIGEMINAL NERVE V

//

ABDUCENT NERVE
FACIAL NERVE

VI.)
VII.

M'ODLE PEDUNCLE
OP
THE

CEREBELLUM

RESTIFORM

BODY

OLIVARY

BODY

=:, -

ANTERIOR SUPERFICIAL
ARCUATE FIBERS

DECUSSATION OF

SUPERIOR

SEMICIRCULAR

CANAL

EXTERNAL SEMICIRCULAR

CANAL

POSTERIOR SEMICIRCULAR CANAL

Origin and Distribution of Auditory Nerve.

The lingual nerves

number, one supplies the circumvallate papillae and mucous membrane of the base of the tongue, and the other sel
supplies the mucous membrane and follicular glands and the posterior one-halt
of the tongue and communicates with the Lingua] nerve.
g
(5)

are

two

in

LESSON CXVI.
The tenth
nerve

the

tro-hepatic.

cranial

nerve,

pneumogastric, or vagus.

Pancoasl

rails

this

auriculo-laiyngo-pharyngo-03sophago-tracheo-pulmono-cardio-gasThis is a compound nerve and sends motor and sensory fibers

the organs of voice and respiration, and motor fiber* to the pharynx, the oesopha-

ANATOMY

412
mis. stomach,

and

ficial origin

is

IN A NUTSHELL.

It is the longest of all the cranial nerves.

Its superheart.
from the groove between the olivary and restiform bodies below
that <>f the glosso-pharyngeal nerve by eight or ten fasciculi (Plate CLXXXVII).
Its deep origin is in the floor of the fourth ventricle from the nucleus vagi
beneath the ala cinerea below ami continuous with the nucleus of origin of the

glosso-pharyngeal.

The

origin of the sensory fibers of the tenth nerve

Van Gehuchten

ganglion of the root and the ganglion of the trunk.

is

in the

says that

The nerve
compartment of the jugular foramen, passing behind the glosso-pharyngeal in the same sheath with the spinal
After leaving the jugular foramen it is connected with the accessory
accessory.
part of the spinal accessory and has an enlargement called the ganglion of the
The accessory part of the spinal accessory nerve sends most of its branches
trunk.
into the pharyngeal and superior laryngeal branches of the tenth, while some of
The tenth nerve now passes down the
its fibers join the ganglion of the trunk.
the only sensory nucleus of the tenth

now

is

in the fasciculus solitarius.

passes over the flocculus to the middle

neck

the carotid sheath to the root of the neck.

in

terna] jugular vein externally, the

tenth nerve between

them but on

common

This sheath contains the in-

carotid artery internally,

and the

The relations of this

a plane posterior.

SHEATH ARE AS FOLLOWS:

Ix Front. A few filaments descending from the loop of communication
between the descendens and communicans hypoglossi.
Behind. (1) The inferior thyroid artery, (2) The recurrent laryngeal
nerve. (3) The sympathetic nerve.
On the inner side. (1) Trachea, (2) Thyroid gland, (3) Lower part of

the larynx (more prominent in the female).

The ganglion
diameter and

is

of the root

is

a small gray

superior cervical ganglion of the sympathetic

It

gives off an auricular branch

glosso-pharyngeal nerves.

The ganglion

mass about

situated in the jugular foramen.

of the

internal jugular vein

it is

and the

is

five millimetres in

connected with the

spinal accessory nerves.

connected with the facial and the

gives off a recurrent meningeal branch.

below the base of the skull and in front of the
about seventeen millimetres long. It is connected

It also

trunk

and

by which

It

is

is

with the accessory part of the spinal accessory nerve, with the hypoglossal nerve,

ami with the superior cervical ganglion of the sympathetic, and with the loop
between the firsl and second cervical nerves. The branches it gives off are (1)
a pharyngeal, (2) a superior laryngeal, (3) a superior
(

(XX

cardiac

(Plates

CCXXII-

II.

The

right pneuinogastric nerve passes

downward between

the

first

part of

the subclavian artery and the subclavian vein beside the trachea, behind the

innominate vein, and behind the root of the right lung.

It helps to form
pulmonary plexus. It now passes downward in two cords which
run on the oesophagus and communicate with the pneumogastric nerve of the
opposite side making the oesophageal plexus.
The two divisions of the
pneumogastric nerve mute into one trunk behind the (esophagus and passing
through the oesophageal opening in the Diaphragm, is distributed to the posterior surface ot' the stomach and to the solar plexus and its divisions.

righl

the posterior

PLATE CCXXII.

>

M**^^

Showing Disthibution of Ninth, Tenth, and Eleventh Cranial Nehves.

413
(Mi'litied

from Gray's Flower.)

ANATOMY

414

IN A NUTSHELL.

pneumogastric nerve passes between the subclavian artery and the

At this point the left phrenic
It now passes in front of the arch of the aorta behind the root
nerve crosses it.
It now
of the left lung where it helps to form the posterior pulmonary plexus.
passes along the anterior surface of the oesophagus through the Diaphragm to

The

left

carotid artery, behind the left innominate vein.

be distributed to the anterior surface of the stomach and the

liver.

It occasion-

joins the solar plexus.

ally

The pneumogastric nerve has the following connections:

(1) Thk ganglion of the root is joined to the spinal accessory,
petrous ganglion of the glosso-pharyngeal,

trunk

lion of thk
to a loop

is

between the

(3) to

the sympathetic.

(2) to

the

The gang-

joined (1) to the hypoglossal, (2) to the sympathetic, (3)

and second cervical nerves.

first

meningeal branch (recurrent) which

from the ganglion of the root in the jugular foramen.
Ii is distributed to the dura mater in the posterior fossa at the base of the skull.
(2) The auricular branch (Arnold's) comes from the ganglion of the root in
A branch from the petrous ganglion of the glosso-pharynthe jugular foramen.
The nerve now passes through a foramen in the outer wall of the
geal joins it.
jugular fossa of the petrous portion of the temporal bone and communicates
It leaves the temporal bone by the stylo-mastoid forawith the facial nerve.
men as a rule but it may pass through the tympano-mastoid fissure. Behind
the pinna it divides into two branches one of which joins the posterior auricular of the facial, while the other supplies the posterior and inferior part of the
externa] auditory meatus and the back of the pinna.
(3) Pharyngeal
\< ihes are
wo or three and join the pharyngeal branch of the glosso-pharynp.i;
geal on the outer surface of the internal carotid artery and after passing with this
artery interna] to the external carotid artery, it turns downward and inward to
reach the posterior aspect of the pharynx.
At this point the two nerves are
joined by branches from the superior cervical ganglion of the sympathetic to
help form the pharyngeal plexus.
This nerve is the principal motor nerve of the
pharynx and comes from the upper part of the ganglion of the trunk of the
.Most of its fibers come from the accessory portion of the
pneumogastric.
spinal accessory nerve.
(4) The superior laryngeal nerve comes from the
ganglion ^^ the Punk and passes behind the internal carotid artery where it
divides into the external laryngeal nerve which branch joins the pharyngeal
plexus and the sympathetic, and it supplies the Crico-thyroid muscle and Inferior constrictor muscle and occasionally the thyroid gland; and the internal
The branches

is

of distribution are (1)

a small filament given off

membrane

laryngeal nerve which passes through the thyro-hyoid

buted

to the

recurrenl

laryngeal,

the right side arises

right

and

(5)
at

between the

It

inward behind the

common

of the larynx,

the root of the nick

subclavian artery.

slightly

to be distribranch from the

The inferior oe recurrent laryngeal nerve on

mucous membrane

in

and

it

joins a

front of the first portion of the

passes around the artery

common

carotid artery.

and runs upward and

It

now runs

carotid artery and the (esophagus, having with

of the inferior thyroid artery.

It

in a
it

groove

branches

passes under the lower border of the Inferior

constrictor of the pharynx into the larynx where

it

breaks up into branches for

PLATE CCXXIII.

SPINAL ACCESSORY

GANGLION

OF

PNEUMOGASTRlC

LINGUAL NERVE

PHARYNGEAL BR

SUPERIOR CERVICAL GANGLION

OF PNEUMOGASTRlC
<=HB

MAXILLARY

GANGLION

SECOND CERVICAL NERVE

HYPOGLOSSAL

STEfiNO-MASTOID

NERVE

THIRD

SUPERIOR

LARYNGEAL

CERVICAL NERVE

EXTERNAL LARYNGEAL NERVE

PHARYNGEAL PLEXUS
MIDDLE CONSTRICTOR

MIDDLE CERVICAL GANGLION

SPINAL ACCESSORY

^M. SUBCLAVIAN ARTERY

BRACHIAL

PLEXUS

|NFER'"R CERVICAL GANGLION

INFERIOR

CARDIAC

TRAPEZIUS

PNEUMOGASTRlC
LEFT

COMMON

CAROTID

PHRENIC

RECURRENT LARYNGEAL NERVE

PULMONARY PLEXUS

VENAAZYGOS TERTIUS

INTEKCOSTAI

VEI*

ARTERY
IERVE

NA AZYGOS

Showing Pneumogastric Nerve and Sympathetic Ganglia.

MINOB

ANATOMY

416

IN A

NUTSHELL.

the intrinsic muscles of the larynx except the Crico-thyroid muscle and
communicates with the superior laryngeal. Near the beginning of this nerve
Between the (esophagus and the trachea
it usually gives off a cardiac branch.
and near its termination it gives some
structures
it
gives branches to these
all

branch)

geal nerve conn

ternal

On

to the Inferior constrictor muscle.

The remainder

trachea.

left

side the recurrent laryn-

and winds round the arch exand passes up the left side of the

the obliterated ductus arteriosus

to

the

front of the arch of the aorta

s in

of its course

is

similar to that of the right side.

This

nerve passes through the superior opening of the thorax while the right one does
not.

The cardiac brahches

(6)

pneumogastric

of the

cardiac plexus except the inferior cervical cardiac on the

pass to the deep

all

left side.

It gives off

three cardiac branches, (a) the superior cervical arises from the pneumogastric

from the upper part

sympathetic,

on

of the

neck and join the corresponding branches from the

nerve of the left side passes down-

(b) the inferior cervical cardiac

of the arch of the aorta

war*

and

joins the superficial cardiac plexus.

the

the

1(

side

f1

superior cardiac of the sympathetic

left

On

the aorta.

between

this arch

The phrenic nerve

is

behind

it

as

it

is

in

and the pleura

front of it and

crosses the arch of

the right side this branch passes in front or beside the innomi-

nate artery on the side of the trachea to join the deep cardiac plexus, (c) Thoracic cardiac branches arise' near the recurrent laryngeal nerve and the one on
the right side' is on a higher level than the one em the left because the recurrent
laryng<

al n<

rve com<

off

fronl of the lower

to the

em a higher

end

level

on the right

of the trachea to

end

in

side.

They pass inward

the deep cardiac plexus.

are two or three in number which

upper border at the root of the lung. They join filaments from the
sympathetic and form the' anterior pulmonary plexus from which fine branches
pass along the branches into the lung.
(8) The posterior pulmonary
br inches are' larger than the anterior branches anel are joined by filaments from
7

The anterior pulmonary branches

arise at the

the' sympathetic and form the posterie>r

pulmonary plexus from which branche s pass into the- root of the lung. Occasionally branches from the first and second thoracic ganglia pass te> this plexus. (9)
Oesophageal branches are given off from the- pneumogastric both above and
below the pulmonary branches, but the' low* r one s are- larger and more numerous

the third and fourth thoracic ganglia of

than

upper ones.

the'

branch*

of the opp<

sit<

The gastric branches

and the

1 <

ft

one

is

These
side,

oesophageal

form

the

the'

corresponding

pass through the oesophageal op< ning in the

distributed to the

of the largest branch*

branches, with

oesophageal plexus (Gulae plexus).

accompany

(10)

Diaphragm

anterior surface of the stomach.

Some

the gastric artery along the lesser curvature

the' hepatic artery and join

The terminal branches of the right pneumogastric are
distributed on the posterior surface of the stomach and join the cceliac plexus,
ft
plexus.
r< mil
splenic plexus, and the

of the'

stomach, and from these small twigs pass on

the hepatic plexus.

1<

LESSON CXVII.
The eleventh cranial ner\e (Plate CLXXXVII) is called the' spinal acccsIt consists of two main parts. (1) an ACCESSORY or
SOry and is purely motor.
SPINAL PORTION.
THE SUPERFICIAL ORIGIN
MEDULLARY PORTION, and (2)
\

li

ANATOMY

IN A NUTSHELL.

417

is by four or five small filaments from the sides of the medulla just
below the superficial origin of the tenth nerve. Its deep origin is in the floor
of the fourth ventricle in a gray nucleus at the back of the medulla, dorso-

of this nerve

The

lateral to the hypoglossal nucleus.

spinal portion
vical nerve.

is

from the

The deep

Tin-:

lateral tract of the cord as

origin of

ami deep origin

superficial

are those of the accessory portion of the nerve.

the spinal

superfk

upward between

tin

\i.

may

be traced

ligamentum denticulatum ami the posterior

then directed outward to the jugular foramen where

middle compartment of this foramen

tric

but separated from

it

by

to the

This spinal portion of the

roots of the spinal nerves to enter the skull through the foramen
is

just given

origin of the

low down as the sixth cer-

portion

medio-lateral tract of the gray matter of the cord.

nerve passes

in a

common

n -changes fibers with the accessory portion.

It

sheath with the pneumogas-

While

a fold of arachnoid.

magnum.

passes through the

it

in

the cranium

it

in-

After passing out of the foramen

PLATE CCXXIV.

SUPERIOR DIVISION OF
'W/Ji

NASAL

,RD.

/
'

INFERIOR

DIVISION

OF

RD.

TH.

OPHTHALMIC VEIN
OPTIC

FORAMEN

Showing Structurks Passing Through the Sphenoidal Fissure.

in.-

gnum,

it

passes

downward behind

the Digastric and Stylo-hyoid muscles to

the upper part of the Sterno-cleido-mastoid.

and crosses the post( rior triangle

The accessory portion, while
Trapezius.
oid

It

supplies the Sterno-cleido-

of the neck to the d< ep surface of the

in

the jugular foramen,

to the ganglion of the root of the pn< umogastric,

and sonic

of

its

is

connected

fib< rs

become

parated from the spinal portion and pass to the ganglion of the trunk of the
pneumogastric from which they p;>ss to the pharyngeal and superior laryngeal

B<

It
supplies the muscles of the soft palate
branches of the pneumogastric.
through the pharyngeal branch. Some of the branches are continue. below
die ganglioD of the trunk of the pn< umogastric into the recurrent laryng< ;i! ami
cardiac nerves.
This is the nerve that is affect ed in spasmodic torticollis. (Plate
I

CCXXII).

LESSON ('Will.
is exclusively motor and supplies
and the Genio-hyoid muscle and all the ex'I'm
SUPERFICIAL
trinsic muscles of the tongue e\c< pt the PalatO-gloSSUS.
ORIGIN of this nerve arises by tell or fifteen filaments between the pyramidal and

The

twelfth cranial nerve or hypoglossal

the intrinsic muscles of the tongue

ANATOMY

118

olivary bodies of the medulla.

IN A NUTSHELL.

CLXXXVII).

(Plate

Its

deep origin is from

The nerve passes

the trigonum hypoglossi in the floor of the fourth ventricle.

two bundles through the anterior condyloid foramen after which they unite.
now passes downward hot ween the tenth and eleventh nerves and between the
internal carotid artery and the internal jugular vein to the lower border of the
It
now curves round the occipital artery crossing the exDigastric muscle.
ternal carotid and lingual arteries to pass between the Mylo-hyoid and HyoIt now enters the Genio-hyo-glossus muscle and is continued
glossus muscle.
Its branches of communication are (1) with
forward to the tip of the tongue.
the GANGLION OF the trunk of the pneumogastric, which connection takes
It also communicates with
place close to the exit of the nerve from the skull.
ilu pharyngeal plexus as it winds around the occipital artery.
(2) It communicates with Tin; SUPERIOR CERVICAL GANGLION of the sympathetic which
communication takes place opposite the atlas. (3) It communicates with
TIIK KIKST AND SECOND CERVICAL NERVES.
(4) WlTH THE LINGUAL BRANCH OF
Tin; fifth which communication takes place near the anterior border of the
in
It

Hyo-glossus muscle.
1

1>

CCXXII).

(Plate

branches of distribution are

two filaments given

off in

(1)

meningeal, which are represented by

the anterior condyloid foramen, pass backward into

te> be distributed to the dura mater.

These
probably derived from the first and second cervical nerves, the sym-

the posterior fossa of the skull

nerves

are'

It was formerly thought they were' derived from the

hypoglossi
is given off from the twelfth nerve as it
fifth, (2) Descendens
round
From this point. is passes down over the
the occipital artery.
passes
-heath of the' common carotid artery and joins the' conmmnicans hypoglossi
from the second and third cervical nerves just above the middle of the Omohyoid muscle. This loop between the descendens hypoglossi anel communicans

pathetic, or the tenth.

hpyoglossi

is

the Sterno-hyoid, Sterno-thyroid,

muscles.

the

the-

muscle's,

Genio-hyo-glossus,
ferior lingual

and the posterior

branches are given to

belly of the Orno-hyoid

(3)

The thyro-hyoid branch

passes from the twelfth

downward

posterior border of the Hyo-glossus muscle

Thyro-hyoid muscle.

following

this ansa

filament from this loop descends into the chest to join the cardiac

and phrenic nerves.

nerve near

From

called the' ansa hypoglossi.

(a)

(4)

Muscular branches

Stylo-glossus,

(b)

are

Hyo-glossus,

(c)

muscles of the tongue.

(e) to the intrinsic

to

supply
to

the

Genio-hyoid,

(d)

distributed

Possibly the In-

muscle receives the chorda tympani branch of the seventh.

Sympathetic System.

(XIX.

!XCV-( !X( !VI-( !XCV 1-( !XCV II.)

from the somatic nerve in four different
(1) it has a greal tendency to form plexuses; (2) it has a preponderQon-medullated fibres; (3) fibers are' interrupted in nerve cells and (4)

LESS<

>.\

The sympathetic nerve

ways:
ance of
its

Plate's

individual nerve fibers are smaller.

organic

life.

If

differs

we had nothing but

the'

The sympathetic nerve

sympathetic nerve'

it

is

the nerve of

would be

in the

form of the human body.

lis frame work consists of a chain of ganglia extending in fnmt of the- vertebral column, the upper ganglia being on the anterior

PLATE CCXXV

Showing the Ajbdomin

419

\i.

Aim:

\-.

ANATOMY

420

IN A NUTSHELL.

of the circle of Willis

communicating artery

and

is

called the ganglion of Ribes;

This frame work

the Lower one, the ganglion of impar is in front of the coccyx.
beads.
The
thread
upon
which
chain
tho beads are
of
a
to
mighl be compared
and
the
In
represent
the
ganglia.
nerve
beads
the
sympathetic
called
strung is
the cervical region there are only three, in the dorsal region eleven or twelve,
There ought to be
in the lumbar region four, and in the sacral region five.

thirty-one of these, one for each spinal nerve, but on account of the coalesecence
of several into one, there are only twenty-three.

There

is

only one nervous system but

the thirty-one spinal nerves

i

lie

it

has three divisions:

(1)

the cen-

consisting of the brain and spinal cord; (2) the twelve cranial nerves

tral

sympathetic system.

is

the peripheral system; and

(3)

the rest

is

and

called

The frame work of the sympathetic is connected to

by rami communicantes. Each gang-

the anterior branch of the spinal nerves

ramus to the anterior branch of the spinal nerve which is graj

and the anterior branches of the spinal nerves in the dorsal and lumbar regions
give off rami communicantes, which are white, to the ganglion of the syntpaGray rami communicantes are indigenous to every part of the spinal
th< tic.
Every
cord, while the white are indigenous to the dorsal and lumbar regions.
branch that leaves a ganglion is called a ramus efferent, and these rami efh rentes have special names, for instance, those going to anterior branches of the
first four cervical nerves are called rami communicantes and those that leave
The gray rami
se ganglia and go to the heart are called cardiac branches.
communicantes after theypass to the anterior branch of the spinal nerves folThose that are given off to bone, facia,
low these- nerves to their destination.
Ligament, or blood vessels are called gray rami communicantes, for instance,
the musculo-cutaneous nerve- of the brachial plexus gives off a branch that goes
into the nutrie nt foramen of the- humerus; this is an xample of the gray rami
communicantes. Tin- anterior crural nerve and the obturator nerve give off
branches to the femoral artery; these- branches are also examples of gray rami.
The nerve- to the popliteus muscle- sends a branch with an artery into the tibia.
The- parietal layer of the peritom inn
This is another example of gray rami.
gets its nerv< supply from the- gray rami.
Here we apply Hilton's law the
Lion giv< -s off a

it

<

which supplies th< integumenl supplies the muscle- beneath the integunient and the Lining beneath the muscle, and this nerve- that supplies the lining

nerv<

it
through th< branch's called gray rami.
The sympathetic nerve is
developed from the ganglia upon tin posterior nerve root of the spina! cord.
The
0n< -i of physiologists say ii is d< veloped from the suprarenal capsule-.

does

to its destination by following the- somatic nerves or

The sympathetic nervous system, like the central system, connerve << lis and nerve fibres which are- either motor, senseuy or com-

sympathetic nerve gets

blood

v< ssels.

sists of

pound.

Tin-

trophic cells

are-

in

the

veite-bral

ganglion of

the-

sympathetic

The motor cells of the sympathetic originate in the' ganglion of the

sympathetic and some observers say thai the sensory fibres of the- sympathetic
nerve.

originate here also, but others say

ganglia.

In tlii> Latt<

place within

the-

case (which

tin
is

sensory

probably

are-

in

the-

true-) reflex

cells of the- spinal

action can not take

sympathetic without involving the spinal nerves.

The- super-

ANATOMY
ior cervical ganglion

is

IN A NUTSHELL.

421

reddish-gray in color, about an inch and a half Long,

situated behind the internal jugular vein and the carotid artery and in front of

the Rectus capitis amicus major muscle.

ss

the second

sometimes a

little

ganglion are rami efferent*

1.

It is in front of

the transverse pre-

and third cervical vertebra-, sometimes a little higher and

lower, and the branches given off from this superior cervical
s.

LESSON CXX.
Four gray rami to the first four spinal nerves.
Branches to the twelfth cranial nerve and branch

to the trunk of the

2.
pneumogastric and nervus jugulaiis which divides, sending one branch to the
root of the pneumogastric and another to the petrosal ganglion of the ninth.

PLATE CCXXVI.

BICUSPIDS

MOLARS

The Permanent Teeth.

3.

Four or five pharyngeal branches which

unite with the ninth

and

tenth cranial nerves making the pharyngeal plexus, and other branches to the
superior and external laryngeal nerves.
4.

Superior cervical cardiac nerve which

behind or

in front of

the inferior thyroid artery,

is

in

behind the carotid sheath,

front of the Longus colli

where it joins the cardiac branches of the tenth and middle cervical cardiac
It
branches of the sympathetic and recurrent and external laryngeal nerves.
descends behind or in front of the right subclavian artery, along the innomi-

The
nate artery to the division of the trachea to enter the deep cardiac plexus.
left one is in front of the left commoD carotid and the arch of the aorta, joining
the superficial cardiac plexus.
5.

The nervi molles

subdivisions.

They

are branches to the external carotid artery

rive off subdivisions (a)

to the internal-carotid

and

its

artery.

ANATOMY

422

NUTSHELL.
which comes from

to the submaxillary ganglion

tn the thyroid gland, (c)

(b)

IN A

the sympathetic around the facial artery, (d) to the geniculate ganglion of the

seventh and the otic ganglion of the fifth.

(i.
Sends branches to ligaments and bonis.

Sends branches

7.
-i

ts,

side

those on

its

carotid plexus.

pituitary body,

membrane

to the internal carotid artery

inner side are called

(l>)

which divides into two

cavernous plexus, those on the other

The cavernous plexus sends

off

(a)

to the dura mater on the sphenoid bone,

of the sphenoidal sinus, (d) to the third nerve,

branches to the
(c)

to the

mucous

and the fourth nerve,

and the ophthalmic nerve, (e) to the carotid artery, (f) to the ciliary ganglion.
The carotid plexus gives off (a) small deep petrosal to tympanic plexus.
(h) greal deep petrosal to Vidian nerve, (c) to the Gasserian ganglion of the
tilth nerve and (e) to the sixth n#rve.

LESSON CXXI.
The
made by

middle cervical ganglion

is

is

it

shape and
two gray rami com-

It is triangular in

often absent.

two ganglia and

the coalescence of

sends

(a)

municantes to the fifth and sixth spinal nerves, (b) branches to the thyroid
gland along the inferior thyroid artery, (c) middle cardiac nerve which is behind or in front of the first part of the subclavian artery, joins the upper
cardiac nerve, recurrent laryngeal nerve and ends in the dee}) cardiac plexus.
On the left side this nerve enters the thorax between the left common carotid and the left subclavian artery. It sends an ascending branch to
join the superior cervical ganglion and one inferior to join the inferior cervical
ganglion.

It also

sends a branch in front of the subclavian artery to join this

ganglion called ansa Yieussens.

The
behind
i

inferior cervical ganglion

lorsal.

Its

It is

irregular.

In front

is

the vertebral artery,

very close to the

first

dorsal ganglia with which

it

first

sometimes unites.

branches are;

Two

(a)

dorsal to

make

going about
nerves
;)

dorsal;

gray rami to the seventh and eighth cervical ganglia.

Branches to the vertebral artery which join a branch from the

(b)

in

into the circle of Willis.

first

and

This plexus joins the roots of the spinal

the neck.

To
it

it

the vertebral plexus which surrounds the vertebral artery

comes from the first

and recurrent laryngeal nerve and

the inferior cervical cardiac which sometimes

joins the middle cardiac nerve

descends on the trachea to the

is

is

space between the transverse process of the last cervical and the

d<

ep cardiac plexus.

On the left side this nerve

common trunk.

occasionally joined to the middle cervical to form a

LESSON CXX II.

The thoracic ganglia are eleven in number; the first one is called stellatum.
i- situated on
[1
the neck of the first rib.
The second to the ninth are situated
on the heads of the ribs. The tenth and eleventh are on the vertebras. They
receive white rami communicantes from the spinal nerves and give off gray rami.
Each of these ganglia give off rami efferentes which divide into external and

ANATOMY
The

internal branches.

IN A NUTSHELL.

123

external branches stud (1) branches to the meninges

of the cord

(2) to the posterior division of the spinal nerves. (3) to the anterior
divisions of the spinal nerves.
These last two pass to the vessels of the skin.

glands of the skin, and the muscles of the hair.

The internal branches divide

and a lower set. The uppeb set, four or five, send branches
to the vertebrae and to ligaments and thoracic aorta and to the lungs.
The
lower set give off the great splanchnic nerves. The great splanchnic
nerves come from the fifth to tenth and end in the semilunar ganglion.
The
LESSER SPLANCHNIC nerve passes from the ninth and tenth and ends in the renal
The least splanchnic comes from the last dorsal ganglion
or solar plexus.
The secretory fibers to the lower limbs, \ A.SOto end in the renal plexus.
to
vessels
of
the
abdomen, pilo-motor to the circular fibers of the
constrictor
rectum, and inhibitory fibers to the longitudinal muscles of the rectum descend from the thoracic tothe lumbar region. Besides these there are afferenl
fibers (splanchnic sensory) which pass towards the posterior roots of the dorThe lumbar ganglia are four, being set in front of the vertebrae. The
sal nerve.
into an

upper

set

right cord of the sympathetic

is

behind the inferior

White rami pass

v<

na cava, the

left

behind

and gray rami pass from

them. The rami efferentes are first, external divisions and second, internal
The external divisions send gray rami to the lumbar nerves. The
divisions.
the peritoneum.

to these ganglia

internal divisions send (1) branches to the aorta. (2) hypogastric plexus

and ligaments, and additional vaso constrictor fibers to the

secretory fibers to the ve ssels of the lower limbs and onBTRICTOR fibers to the vessels of the- lower limbs, pilo-motor and motor fibers
for the circular and ixhibitory fibers for the longitudinal muscles of the' rectum,
and motor fibers to the uterus and vas deferens and round ligament, and
VASO-MOTOR to the penis anel motor fibers to the circular and INHIBITORY
to the vertebra?

renal vessels anel

fibers for the longitudinal muscles of the bladd<

r.

LESSON ('Will.
The

sacral portion of the sympathetic ends in the ganglion of [mpar.

has five ganglia which give off rami

efft re nte s, (1)

It

gray rami to the sacral nerves,

branches to anastomose with the branch* s of the opposite side. <:!) branches
on the middle sacral artery, (4) branches to plevic plexuses
branches from impar to tin coccyx and its ligament to the coccygeal gland.
(2)

to plexuses

There are no white rami

the dorsal

motor

in this

region"

splanchnics.

the bladder

and

are'

body com< from

for the longitudinal

the'

White' rami enter tin

the superior ganglion,

"White' rami of

this region.

c<

fibers

to

ar<

called

muse
rectum ami to the

the longitudinal

and inhibitory

of the

prostate gland and vaso-dilator to the penis.

sympathi tic from tin dorsal some term in.mi.'

the middle ganglion, ami some in the lower
many an unknown.

rvical

some

The distribution of
The sympathetic has three

ganglion.

They descend from

represented by their viscera] branches and

They contain motor

uterus and secretory to

in

portion of the sympathetic.

Vaso-constrictor and secretory for the lower limbs, pilo-

for posterior part of the

sacral
pe Ivic

region.

in

great prevertebral plexuses.

First, the cardiac,

ANATOMY

424

IX A NUTSHELL.

which is situated below and behind the arch of the aorta. For convenience it is
It is formed by all the cardiac
divided into two parts, the superficial and d< ep.
branches and the cardiac branches of the pneumogastric nerve. The three
cardiac branches conic from the three cervical ganglia, the superior from the
superior one. and the middle from the middle one. and the inferior one from the

These unite with the pneumogastric nerve and form

The superficial cardiac plexus is made by the left
superior cervical cardiac and the left inferior cervical cardiac from the pneumogastric, plus fibers from the deep plexus. The superficial cardiac plexus gives
off brandies to the right coronary plexus and the left pulmonary plexus.
The
deep cardiac plexus consists of left portion and right portion. The left por-

inferior cervical ganglion.

the cardiac plexuses.

PLATE CCXXVII.

DENTINF

PULP
CAVITY

mm
X

yr

* J

\ i

Verticle Section of a Canine Tooth.

off branches to the left coronary plexus and the left auricle.
The
right part gives off branches both to the right and left pulmonary plexuses
and tlir righl auricle.

tion gives

Thus we see that the cardiac plexus is made by sympathetic nerves plus
somatic uerve, and the somatic nerve is the tenth.

LESSON (XXIV.
Tin

><>lar

plexus has three uames, SOLAR, EPIGASTRIC,

situated around the coeliac axis.

ABDOMINAL BRAIN.

formed by the three splanchnic

nerves from each side and the semilunar ganglia and the right pneumogastric
uerve, and occasionally the left.
It gives off branches to the following arteries
ami these subdivisions take the nami s of the arteries which they surround.
It

i<

It

is

ANATOMY

IX A NUTSHELL.

This plexus, like the cardiac plexus,

somatic nerve, which

is

made up

of

sympathetic nerves plus

the tenth cranial.

is

Phrenic ob Diaphragmatic Plexus.

This plexus accompanies the phrenic artery and is larger on the right than
on the left side. At its point of junction with the phrenic nerve is the Ganglion

diaphragmaticum.

phragm near

This plexus

is

situated on the under surface of the Dia-

the supra renal capsule.

Its

branches are distributed

to (1)

In-

vena cava. (2) supra renal capsule, and (3) hepatic plexus. There is no
ganglion on the left side. It receives branches from the semilunar ganglia and
solar plexus, also from the phrenic nerve.
This plexus gives off branches to the
ferior

Diaphragm and the supra

renal capsules.

Supra Renal Plexi

s.

This plexus surrounds the supra renal artery and

At

size.

its

junction with the great splanchnic nerve

its
is

branches are of large

found a ganglion. It

receives branches from the solar plexus and semilunar ganglia, also from the

phrenic nerve and the diaphragmatic plexus.

It

distributes branches to the

medullary portion of the suprarenal capsules.

Renal Plexus.
cells.

This plexus surrounds the renal artery and contains groups of ganglion
Its brandies of distribution enter the hilum of the kidney.
This plexus

receives branches from the solar plexus

ami semilunar ganglia, also from the

and smallest splanchnic nerves. It sends branches of distributhe substance- of the kidn< y, the sp< rmatic plexus anel the inferior vena

aortic plexus

tion to

cava.

Spermatic Plexus.
This plexus accompanies the spermatic vessels to the testes.

branches from the renal,

aeirtic, anel

pelvic plexus.

It

It elistributes

rec< ives

branches to

the spermatic vessels, vas deferens, and the testes.

In the female this plexus follows the course of the round ligament to the

ovarian plexus and

i>

distributed to the ovaries and fundus of the uterus.

Cosliac Plexus.
This plexus
coeliac axis.

is

nerves, and the

The

right vagus.

stomach.

(2)

accompanies the gastric artery along the lesser curvareceives branches from the coeliac plexus and from the
sends branches of distribution to the stomach and to the

It

plexus.

branches from the

It

the largesl offset from the coeliac plexus.

is

coeliac

distributes

plexus, the

branch

left

It

receives

vagus nerve and the righl

phrenic

to the pyloric plexus,

duodenal plexus, which plexus divides into the

the pancreatico-duodenal plexus.
the right hepatic and the

The

gastric plexus,

It

The hepatic plexus

nerve.

(1)

lesser splanchnic

(3) splenic plexus.

vagus nerve.

pyloric

It sub-divides into the

gastric plexus

ture of the
left

and surrounds the

receives branches from the solar plexus, the

It

hepatic plexus.

a direct continuation of the solar plexus

splenic plexus

left

hepal

It

LC

righl

and branches

to the gastro-

gastro-epiploic plexus and

also sends branches to the cystic plexus.

plexus.

accompanies the splenic artery, and receives branches

ANATOMY

421)

from the
It

cceliac plexus, the right

IN A NUTSHELL.

vagus nerve, and the

distributes branches to the pancreatic

the substance of the spl<

and

left

left

semilunar ganglion.

gastro-epiploic plexus, also to

n.

Superior Mesenteric Plexus.

This plexus emerges from under cover of the pancreas and surrounds the
A few ganglia which are found around
trunk of the superior ni< seiiti ric artery.
The branches of this plexus are of
this artery are called ganglia mesenterica.

and are white and firm. It rec< ives branches from the solar plexus.
and the right vagus nerve. It gives off branches to the
pancreas, all the small intestines, to the ascending and half of the transverse
colon, and to the pancreatico-duodenal plexus.

a large size

the cceliac plexus,

PLATE CCXXVIII.
ANTERIOR PALATINE FORAMEN

ACCESSORY PALATINE FORAMINA

Tin:

Branches from

plexus form

this

primary and secondary loops

spreading ou1

the m<

in

s<

is

It

'Kin-

and
It

Plexus.
and in

fronl of the aorta,

between the

inferior mesenteric arteries.

receives branches from th< solar

the lumbar ganglia.

and reach the small intestines by

ritery.

situated on the sid(

origins of the superior

secondary plexus corresponding to the

.a

of 'he artery

\<

This plexus

Hard Palate.

pit

xus and semilunar ganglia, also from

gives off branches of distribution

plexus, the inferior mesenteric plexus,

tin-

to

the spermatic

hypogastric plexus, and the inferior

vena cava.

Inferior Mesenteric Plexus.

The

and divides into

lion

Mesenteric plexus surrounds the inferior mesenteric artery

inferior

called

the

number

inferior

of

secondary plexuses.

mesenteric ganglion.

Upon

this artery is a

gang-

This plexus receives branches

ANATOMY

427

IN A NUTSHELL.

from the aortic plexus. It distributes branches to half of the transverse colon
and the descending colon, to the sigmoid plexus, to the superior hemorrhoidal
plexus, and to the pelvic plexus.

LESSON CX XV.
This plexus
the

common

Hypogastric Plexus.
situated in front of the promontory

is

iliac arteries.

It

sacrum between
branches from
It bifurcates below into two lateral
This plexus is made up exclusively of

contains no ganglia.

the aortic plexus, the lumbar ganglia.

halves which form the pelvic plexuses.

of the

It receives

sympathetic nerves.

Pelvic Plexus.
This

is

the female

situated at the side of the rectum and bladder

it is

at the side of the rectum, bladder

the branches of the internal

iliac

plexus contains small ganglia.

It

in

and vagina.

the male, and in

It

accompanies

artery and supplies the pelvic viscera.

is

formed by the two

This

lateral continuations of

hypogastric plexus, branches of the sacral part of the gangliated cord, branches

and fourth sacral nerves. It sends branches of distribution

middle hsemorrhoidal plexus, the inferior hemorrhoidal plexus, the vesical

of the second, third

to the

and the uterine plexus.

The middle hsemorrhoidal plexus is situated on the sides of the rectum, and
is formed by branches from the pelvic plexus.
It communicantes above with
the superior hsemorrhoidal plexus and below with the inferior hsemorrhoidal

plexus, the prostatic plexus, the vaginal plexus,

It is distributed to the

plexus.

rectum.

The inferior hsemorrhoidal plexus arises from the back part of the pelvic
plexus and joins with branches from the superior and middle hsemorrhoidal
plexuses.

The
formed

It

is

distributed to the rectum.

from the fore part of the pelvic plexus, and is

by fibers from the third and fourth sacral nerves. Tin nerves
This plexus is divided into two
pass on each side of the bladder.
vesical plexus arises

chiefly

sent off

groups, (1) superior group, (2) inferior group.

distributes branches to the

It

bladder, the vesiculse seminales, the vas deferens, the spermatic plexus.

The
is

prostatic plexus

is

a continuation

situated around the prostate gland.

downward

Its

of the pelvic plexus

and

On

the

nerves are of large

size.

sides of the gland are several ganglionic masses from one-fourth to one-half an

inch

in

length (ganglia prostatica of Muller).

branches

internal pudic nerve.

It distributes

iculse seminales, small

cavernous nerves

joined by branches of the

It

is

to

the prostate gland, the ves-

to the erectile structure of the penis,

corpora caveronsa and corpus spongiosum,

barge cavernous nerve joins the

branch
pudic
supplies
the
dorsal
of the
corpora cavernosa and corpus
nerve and
spongiosum.
The vaginal plexus arises from the lower part of the pelvic plexus and is
composed hugely of sacral nerves. It is situated on the sides of the vagina.
It gives off branches to the erectile tissue of the vagina, the
of the vagina,

The

and

few twigs

mucous membrane

to the clitoris.

uterine plexus arises from the upper pari of the pelvic plexus and ac-

428

ANATOMY

IN A NUTSHELL.

companies the uterine artery between the layers of the

broad ligament
It
a few twigs from the ovarian plexus.
It distributes branches to the
cervix and body of the uterus.
Other filaments pass separately into the body
oJ the Qterus and fche Fallopian tubes.
There are ganglionic enlargements
found mi these filaments.
receives

PLATE CCXXIX.

C'JRRUGATOR

SUPERCILII

ORBICULARIS

PALPEBRARUM

TENDO OCULI
LEVATOR
LEVATOR

ALBII

SUPERIORIS

LABII SUPERIORIS

ANTERIOR NASAL

SPINE

LEVATOR ANGULI ORIS

INCISIVE FOSSA
COMPRESSOR NARIS

OEPRFSSOR

LEVATOR

ALAE NASI

MENTI

GROOVE

OEPRESSOR LABII INFERIORS

DEPRESSOR ANGULI

FOR

FACIAL

ARTERY

ORIS

Tin:

Bones of the Orbit.

LESSON CX XVI.
The gray rami coimn unit-antes

originate in cells of the vertebral ganglion,

here pass to their destination byway
of the spinal nerves, (1) to ad""
y:
J;,
'
'"' "' the Prevertebral plexus,
directly to the viscera and
(3)
/
"';f
vessels.
Ihe.r trophic cells are in
these ganglia where they originate.
These

^d

in,,,,
!

ANATOMY

429

IN A NUTSHELL.

nerves are indigenous in every part of the spinal cord. The branches that pass
from the Anterior Crural and Obturator are gray rami

to the femoral artery

communicantes, and through these branches the non-medullated axis-cylinder

processes of the sympathetic ganglion cells reach the vessels, fascia', bones,

and periosteum of the lower extremity.

gray ramus communicans passes to the tibia from the branch of the inEach spinal nerve
ternal popliteal nerve which passes to the Popliteus muscle.
is joined near its origin by a gray ramus communicans from the sympathetic
cartilages,

The superior cervical ganglion gives off four gray rami comgangliated cord.
municantes to the first four cervical nerves. These rami may come from the
sympathetic nerve below the ganglion. The middle cervical ganglion s< ntds two
gray rami to the fifth and sixth cervical nerves. The inferior cervical ganglion
sends two gray rami to the seventh and eighth nerves. The first dorsal ganglion
(stellatum) of the sympathetic or the last cervical sends a gray ramus to the first
One ganglion may send gray rami to two nerves, or two gray
dorsal nerve.
rami to one nerve. In the lumbar and sacral regions the gray rami are long and
pass

downward and outwards over

terior division of the nerve.

the bodies of the vertebrae to reach the an-

In the lumbar region they pass under the Psoas

magnus muscle.
The white rami communicantes originate in the motor roots of the cranial
and spinal nerves. Some of these white rami pass through the vertebral ganglia
lia.

without interruption, while others arborize with cells in the vertebral gangThe white rami communicantes are indigenous in the thoracic and upper

lumbar regions only, while the gray rami are indigenous in all parts of the cord.
The white rami may be called the visceral divisions of the spinal nerves. Although the white rami are for the most part derived from the ventral or anThe
terior roots, yet some of them come from the dorsal or posterior roots.
white rami from the hist two lumbar, and peihaps also from the third and fourth
lumbar nerves, pass forward by themselves or in company with the gray rami
The fifth lumbar and in si
to join the upper pait of the lumbar gangliated cord.
sacral do not have white rami while the third sacral and possibly tin s cond and
fourth have both white and gray rami.
The fifth sacral and coccygeal nerves
(

no

hav<

white rami.

In Plate

CXCVI1

we

s<

gray and white rami communicantes. A, B,

dullat< d rami, while E, F, G, H, L, M, N, r< pres<
e the

and

D represent

tlu

gray or non-medullated ran

to the

white or n

sympathetic ganglion of

B has

ganglion below.

segment.
of

its

<

Chas

own segment

own segmenl through which

a similar origin

a similar origin

'.

nt

A passes from the anterior or ventral root

i.

its

but ends

in

it

passes to the

the ganglion of

and passes through the sympathetic

to a prev< rtebral

plexus or directly to

visc< ra.

its

own

ganglion
has

sim-

and passes through the sympathetic ganglion of its own stum, nt to

F originates in the sympathetic ganglion and passes
end in a higher ganglion.
G originates in
along the posterior nerve rod to the dura mater of thi mn\.
the sympathetic ganglion and passes along the posterior division of the spinal
II originates in the sympathetic ganglion ami passes
nerve to its destination.
ilar

origin

along the anterior division of the spinal nerve

t<>

iis

destination.

It

passes to

PLATE CCXXX.

CEREBRAL CORTEX

prosencephalon

( [cerebrum)

OPTIC

THALAMUS

mesencephalon
(mid brain)

CORPORA QUADRIOEWINA

CEREBELLAR
CORTEX

NUCLEUS
DENTATUS

METENCEPHALON

NUCLEI

PONTIS

/pONSiCEREBELLUM

ULBAR
NUCLEI

NUCLEUS FASCICULUS CUNEATUS

V.

MYELENCEPHALON

( MEQULLA OBLONGATA

NUCLEUS FASCICULUS GRACILLIS

SPINAL CORD

Showing the Sensory Pathways to the Brain.

330
(Modified from Eckley's Jackson.)

ANATOMY

IN A NUTSHELL.

somatic, vasomotor, pilo motor, and secretory.

thetic ganglion

spinal vessels,

431
originates in the

and passes along the recurrent branch to the

and dura mater of the cord. L originates

pathetic ganglion and like

all

sympathetic

in the

ganglion and passes along the gray rami for a short distance then
pass to the vertebra?, intercostal and lumbar vessels.

it

leaves

originates in the

it

to

sym-

others that originate in this ganglion are called

rami efferentes. X originates in the sympathetic ganglion and pass

lion above it or the ganglion below it.

LESSON
"The gross anatomy

sympa-

vertebrae, ligaments,

to the

gang-

XXV II.

sympathetic gives no idea of its true

anatomical relations as revealed by physiological experiments and pathological
of the cervical

phenomena. The physiological connections as at present understood mar be

summed up as follows:
1. Pupillo-dilator fibers pass by white rami communicantes from the
first, second and third thoracic nerves and ascend in the sympathetic cord to
the superior cervical ganglion to form arborizations round its cells.
Thence
gray fibers pass to the Gasserian ganglion and reach the eye-ball by the ophthalmic division of the fifth and long ciliary nerves.
2. Motor fibers to the involuntary muscles of the orbit and eyelids from
the fourth and fifth thoracic nerves follow a similar course.
3. Yaso-motor-fibers to the head, secretory fibers to the submaxillary
gland, pilomotor fibres to the head and neck are derived from the upper thoracic nerves and reach their areas of distribution after a similar interruption in
the superior cervical ganglion.

The accelerator fibers

from the upper thomiddle and lower cervical ganglion

gray fibers in the cervical cardiac nerv< s completing the connection." (Gerrish).
A patient with laceration of the cervix goes through five stages: (1) irritation; (2) INDKiESTION; (3) .MALNUTRITION! (4) ANEMIA; (5) NEUROSIS.
These stages will appear if the patient has a neuropathic constitution or
4.

of the heart are derived

and end similarly

racic spinal nerves,

in the

"

diathesis.

"A

general

nutrition; (b)

it

summary

of the

abdominal brain

controls circulation: (c)

i1

is:

that (a)

it

g< n<

an absolute control

peripheral visceral automatic ganglia."

its

it

it

pre-

influences in a dominant, though not

sides over the organs of

ration; (e)

presides over

controls gland secretion; (d)

(Byron

Rob-

inson).

nvi.ii

Tim Paths.

The cortex

of each

LESSON CXXVIII.
(Pint, s CCX X \-( 'X X X I-( XXXIII).
'(

'(

hemisphere of

tin

communication with the

conducting impulses to and from

brain

opposite half of the body by means of fibers

it.

These

duction

fibers

maybe divided

into

two

in

according to the

sets,

centrifugal, or motor, which conduct

is

<

dir<

ction of con-

xcitations from the cortex to the

various muscles of the body: and centripetal, or sensory, which convey excita-

PLATE

('(

XXXI.

CEREBRAL CORTEX

prosencephalon
(cerebrum)

mesencephalon
(mid brain)

NUCLEI

PONTIS

MESENCEPHALON

((PONS

CEREBELLUM^

MYELENCEPHALON
MEDULLA OBLONGATA)

NUCLEUS FASCICU

NUCLEUS FASCICU

>

Showing the Motor Pathways From the

432
(Modified from Eckley'a Jackson.)

SPINAL

Biiain.

ANATOMY

IN A NUTSHELL.

433

from the skin, mucous membranes, bones, special sense organs, to the
where are produced in an unknown way what we call sensation. Each
half of the body is thus represented in or projected upon the cortex of the opposite
tions

cortex,

name

hemisphere; hence the

of

projection fibers given to those fibers of the

brain through which communication

many

are in

maintained.

is

(Plate

CLXXXI). Thev
may speak of

instances collected into distinct bundles; so that we

motor and sensory tracts or paths, meaning thereby

along which motor or sensory impulses, as the case

definite groups of fibers

may

Moreover

be, travel.

these groups of fibers often arise from or terminate hi fairly definite areas of the
cortex, which areas are usually called centers.
(Plate CLXXXI 1).
Thus,
that from which springs the fibers that conduct impulses to the muscles which
produce the movements of the hand may be called the motor center of the hand;
1

that which receives the

fibers

along

which visual

impressions travel

is

the

center of sight.

many ways

Of the

which impulses

may

and the
most important that
have been demonstrated. If these impulses travel through the cerebellum we
call the way they pass the indirect route, but if they miss the cerebellum we call
This applies to both motor and sensory
the way they travel the direct route.
in

travel between the brain

spinal cord, the following (1), (2), (3), (4), (5), (6), are the

impulses.

Sensory impulses, which are afferent, (centripetal) take the following routes:

They travel by the way of the tracts of Goll and Burdach

(1.)

(fasciculus gracilis et cuteatus) (Plate

by means

CCXXX)

of neurones of the first order.

to the nuclei gracilis et cuneatus

By way

of explanation

that a neurone system consists of a group of nerve fibers

From

nuclei gracilis et cunetus the impulses travel

order through the mesial

to the opposite side

From

mid-brain.

by the way
order

may

Thus we

may

fillet

and gives

and

by neurones of the second

The mesial fillet crosses

to the optic thalamus.

off collaterals to (a)

the bulbar nuclei,

is

(1))

to the

the optic thalamus the impulses travel to the cerebral cortex

of neurones of the third order,

however some

of those of the second

pass through the optic thalamus to the cerebral cortex uninterrupted.

see

two neurone systems may carry the impulses to the cortex or it

Muscle and joint sensations travel through these racts. This

take three.

route

we might say

their cells of origin.

direct because

it

does not travel through the cerebellum.

first order by the way of colgray matter of the anterior horn, the impulses travel through the
AlNTERO-lateral- ground bundle (fasciculi proprii) by neurones oi the second
order to the optic thalamus.
While in the posterior longitudinal bundle (fasciculus longitudinalis medialis) collaterals are given to the bulbar nuclei and

(2.)

After passing through neurones of the

laterals to the

mid-brain.
Cortex.

From

This route

the optic thalamus neurones of the third order pass to the

is

direct

and conveys cutaneous and painful sensations.

first order by the way of colmatter of the cord, they travel by the way of the
tracts of Gower's (antero-lateral ascending) by neurones of the second order
through the dorsal region of the pons and medulla to mid-brain and optic thalamus.
From the optic thalamus neurones of the third order complete the

(3.)

After passing through neurones of the

laterals to the cells of gray

'

ANATOMY

434

This route

course to the cortex.

is

IN A NUTSHELL.

and conveys cutaneous and painful

direct

sensations.

LESSON (XXIX.

(Plate

CCXXX).

Neu(4.) This route is indirect because it passes through the cerebellum.

rones of the first order carry impulses to nuclei gracilis et cuneatus by way of
From here neurones
vers ok Goll and Btjrdach just as in the direct route.
i

i;

second order through the restiform bodies (inferior peduncles of the cerebellum) of the same or opposite side to the vermis, giving off collaterals to the
Impulses now pass from
nuclei in the cerebellum, such as nucleus dentatus.
of the

PLATECCXXX1I.
OPTIC

INTERNAL

\
\

"^^^^^^T^nA

DIAPHRAGMA SELLAE
PITUITARY

."'

'"

7^Ju\
ll^^.X

ADUCENT

CLINOIO PROCESS
rn r
NERVE.

/ TROCHLEAR

^/W'M/^^M^P^

(R^^f^/ ft

:::

/^^^'\ ^-V5^
"
x
-

'

SOP.
INF.

\\^^^
\ \ \ FORAMEN
\ \\
\

/(^ar ^y f'*pT^/^. N

CAVERNOUS SINUS
DIVISION OF

LACHRYMAL BRANCH

TRIGEMINAL

NERVE

MAXILLARY DIVISION OF USEMINAL NERVE

AXILLARY DIVISION OF TRIGEMINAL NERVE

/
/
/

/
/
/

NERVE. -SUP. DIVISION

"---^S^3^y\^^0CUL0-M0T0R NERVE (INF. DIVISION;

SPHENOID

OPHTHALMIC

^T

NASAL BRANCH OF OPHTHALMIC NERVE

g^3x//

NERVE^^^^y^ftQ-X^^^^__
B0NEs
^J^^Tp-J^

INTERNAL CAROTID ARTERY/

'

'f^'fiS.":;:- A-.^^-^p' -^>'-^V^^-l0CUL0-M0T0R

^m^^y^My^m^

SPHENOIDAL SINUS

ARTERY

/ ANTERIOR

^gSS?

-J|f ^FIW

FOSSA.

OPHTHALMIC

NERVE

TROCHLEAR

NERVE

ARTERY

CAROTID

"'

^ ABDUCENT NERVE
MAXILLARY DIVISION OF TRIGEMINAL

NERVE

OVALE

INFERIOR MAXILLARY

DIVISION OF TRIGEMINAL

NERVE

MOTOR RO

'

The Cavernous Sinus (Modified from Cunningham.)

the vermis to the nucleus dentatus by
t

way

of neurones of the third order.

From

he nucleus dentatus impulses pass to the red nucleus of the opposite side through

the superior peduncles.

From
From

This

is

done by means

of neurones of the fourth order.

the red nucleus neurones of the fifth order pass to the optic thalamus.
the optic thalamus neurones of the sixth order pass to the cortex.

!">.!

These Impulses pass

in

spino-cerebellaris dorso-lateralis)

the direct cerebellar tract

(fasciculus

then through the inferior peduncles of the

cerebellum to the vermis of the same and opposite side by means of neurones of
the

second order.

Collaterals are given off to the nucleus dentatus.

the vermis neurones of the third order pass to the nucleus dentatus

here by

in

urones of the fourth order to the red nucleus.

From

From

and from

the red nucleus

order and from the optic thalamus

to the cortex by neurones of the sixth order.
Neurones of the first order transmit impulses to cells in the columns of Clark by the way of collaterals.
This
to the optic

route

is

hah) inns by

indirect because

n<

urones of the

it

passes through the cerebellum.

fifth

AX ATOMY

IN A

435

NUTSHELL.

up (Power's tract (fasciculus spinoby neurones of the second older to the mid-brain.
From here they reach the superior worm by the way of the superior peduncles
The remainder of the route is the same as that in route 4
of the cerebellum.
(6.)

In this route impulses pass

cerebellaris ventro-lateralis)

and
The

Neurones of the

5.

indirect route

order give collaterals to

first

neuroxk SYSTEMS

take six

only three.

the direct takes

the

may

This route

to

cells of

indirect because

is

the gray matter.

complete
it

its

course while

passes through

cerebellum.

LESSON CXXX.
The motor impulses, which

(Plate

CCXXXI).

are efferent (centrifugal) take the following

routes
(1.)

By the way of the pyramidal tract without

the cerebellum.
Impulses

This route

in this

passing through

direct.

is

route pass from the cortex through the corona radiata.

end of the medulla by neuend

the
of
medulla the fibers pass in
lower
order.
From the
rones of the
opposite
side in the decussathe
the following ways: (a) most of them cross to
pyramidal
tract
(fasciculus ceretion of the pyramid to descend in the crossed

and pyramidal

internal capsule,

tracts to the lower

first

bro-spinalis lateralis) to

end

in the

of the fibers descend in the direct

ventralis) to
d< set rid in

end

in

the gray matte

gray matter of the anterior horn.

the crosst d pyramidal tract of the

From

of the anterior horn.

some

(1>)

pyramidal tract (fasciculus cerebro-spinalis

of the anterior horn, (c) the remaining fibers

same

side to

nd

in the

gray matter

the cells in the gray matter of the anterior horn neu-

Thus we see that two

motor impulse from the cortex to the muscle
(2.) By the way of corpus striatum and mid-brain without passing
THROUGH THE CEREBELLUM. This route is direct.
These- impulses pass by neurones of the first order to the- corpus striatum.
Most of these' come from the frontal region.
They now pass by neurones of the
rones of the second order carry impulses to the muscle.

neurone systems

se'e-eind

order to

will carry a

the'

of the third order

by

(3.)

the'

From

the'

the'

mid-brain impulses pass by neurones

antero-lateral de scending tract to end in

Neurones

of the fourth order

now

the'

gray matter

carry the impulse' to

anterior roots of the spinal nerves.

PONTIS, CEREBELLUM, BULThis route passes through the cerebellum therefore it is an inImpulses pass by the neurones of the first order through the

By way of the pyramidal TRACT, NUCLEI

BAR nuclei.
direct

mid-brain.

of the' 'anterior horn.

the muscles over

route.

corona radiata, internal capsule, and pyramidal tract

pontis nuclei impulse's pass by

the'

middle' peduncle's to

to
the'

the pons.

From

the-

cortex of the opposite

here neurones of the third order carry the impulses to the' dentate' nucleus.
Neurones of the fourth order pass from the
Neurones of the fifth order pass from
dentate' nucleus to the bulbar nuclei.

side of the- cerebellum.

the bulbar nuclei to end

neurones of

the'

From

in

the gray matte

of the

sixth order pass to the muscle

s.

and

rior

horn and from here

PLATECCXWIII.

PROSENCEPHALON

CEREBRAL CORTEV

ERERKUM)

MESENCEPHALON

PONTIS

METENCEPHALON
/PQNS*CEKEBELLUM|

myelencephalon

NUCLEUS FASCICULUS CUNEA"r|

(medulla oblongata)

NUCLEUS FASCICULUS C-RACILLIS

SPINAL COHD

Showing Both Sknsoiiy and Motor Pathways.

Modified from Eckley- Jackson.)

436

ANATOMY

flex

IN A NUTSHELL.

437

Every sensory point of the body is connected to every motor point by a

pathway, and all nerve impulses conform to the reflex type.

impulse

reflex

may

pass over

sensory point and motor point.

efferent

re-

many different paths between any given

CCXXXII) show- both afferent and

(Plate

pathways.

The brain is a collection of gray ganglia connected by white commissures.

The middle commissure is gray, but it is not a commissure in the true
(Xote).
sense because

it

When we

has not fibers

name and

can

hi

it.

define the commissures of the brain

and give the

boundaries of all the ventricles and describe each structure which helps to
make these boundaries, then we understand something of the brain.

LESSOX CXXXI.
The Transverse Commisures are
1.

Anterior commissure. See page 347

See page 348

2.

Middle commissure.

3.

Posterior commissure. See page 348

4.

Optic commissure.

See page 366

The Longitudinal commissures

are:

See page 365

1.

Olfactory tracts.

2.

Tsenia Semicircularis. See page 356

3.

Crura cerebri.

4.

Processus-e-cerebello-ad-testes.

See page 363

See

page 354
5.
6.
7.

8.

Corpus callosus. See page 350

Pons varolii. See page 362
Fornix, also longitudinal. Page 348
Sup. or ant. medullary velum

5.

Peduncles of pineal glad.

6.

Fornix.

7.

Gyrus Fornieatus.

8.

Lamina cmerea.

9.

Infundibulum.

See page 348

See page 345

(valve of Yieussens.)

9.

Inf.

or post, medullary velum

10.

Fasciculus uniformis.

LESSON CXXXII.
Third Ventricle.

WTKRlnR BORDER.

ROOF.
1.

Corpus callosum.

2.

Fornix.

3.

Velum interpositum

See page 350

See page 348

superior).

(Tela choroidea

1.

Anterior commissure. See page 347

2.

Anterior

pillars of fornix.

3.

Foramen

of

Monro.

Page 349

Seepage

".11

See page 351

4.

Epithelium.

1.

Tegmental portion

floor.

P<

of the diverg-

ing crura cerebri.

2.

See page 363

Posterior perforated spare

3.

Corpora albican

4.

Tuber cinereum.

5.

Infundibulum.

6.

Lamina cinerea

in.

istkriok BORDER.

1.

Posterior commissure.

2.

Aquedud

Page 348

Page 341
Epithelium from pineal body

3.

See pa.ue 349

to

of

Sylvius.

velum interpositum

(tela choroi-

dea superior).
BIDES.

(anterior wall).

tptic

thalamus. See page

:,

ANATOMY

>,S

IX A

NUTSHELL.

PLATE CCXXXIV.
BREGMA.

TEMPORAL
RIDGES.

3
CO

NION.

BONE S
l-FRONTAL.

6-MALAR.

2-PARIETAL.

7-LACHRIMAL.

3-0CC1P1TAL.

8-SDR MAXILLARY.

4-TEMPORAL.

9-NASAL.

5-SPHENOID.

KHNF. MAXILLARY.

-SUTURES-

CORONAL- FROM PTERION TO PTERION. BETWEEN FRONTAL AND PARIETALS.

SAGITTAL- FROM BREGMA

TO LAMBDA

LAMBDOID- FROM ASTERION TO ASTERION

BETWEEN THE PARIETALS.

BETWEEN PARIETAS AND OCCIPITAL.

The Sutures of the Skull.

LESSON CX XX III.
L

L.

ROOF
Corpus callosum.

1.

'''" nK
Caudate nucleus.

2.

Taenia semicircularis.

\ti:i; \i.

Ventricle:

OUTER

::

4.
").

6.

See page 350

-

1.

See page 356

Lamina cornea.
Choroid plexus.
optic thalamus.
Fornix.

See

1.

p.-iu<'

2.

3.

Sec page 352

''<

18

SIDE.

Corpus callosum. See page 350

INNKK SIDE.
Corpus callosum. Seepage :r><>
Fornix.

See page 348

Septum lucidum.

See page 351

ANATOMY

439

IX A NUTSHELL.

LESSON CXXX1Y.
Fourth Ventricle.
The

ruof or posterior

boundary

Is

formed by the cerebellum and has the

following points for consideration:

1.

2.
3.

4.

See page 354

Superior peduncles of cerebellum.
Valve of Vieussens, anterior or superior medullary velum.
White matter of vermiform process of cerebellum.
Inferior medullary velum.

5.

Epithelial lining of choroid plexus.

6.

Tela choroidea inferior.

7.

Obex.

8.

Ligulse.

The

floor or anterior

boundary

is

formed by the pons and medulla and has

the following points for consideration:

5.

Eminentia teres.
Fovea superior.
Conductor sonorus.
Locus caeruleus.
Fovea inferior.

6.

Ala cinerea (trigonum vagi.)

7.

Trigonum hypoglossi.
Tuberculum acusticum.

1.

2.
3.
4.

8.

LESSON CXXXV.
The

first

cranial nerve

is

called olfactory.

One

the cribriform plate of the ethmoid.

The second

cranial nerve

One

optic foramen.

The third

called optic.

is

disease of this nerve

cranial nerve

is

called

motor

It

leaves the cranium through

disease of this nerve

is

is

called anosmia.

leaves the cranium through the

It

optic neuritis.

oculi.

It

leaves the cranium through

Paralysis of this nerve will canst

the anterior lacerated (sphenoidal) fissure.

ptosis.

The fourth

cranial nerve

is

called trochlear. It leaves the

the anterior lacerated (sphenoidal) fissure.

cranium through

Paralysis of this nerve will cause

diplopia.

The

fifth

cranial nerve

is

The ophthalmic

called trifacial.

the cranium through the sphenoidal fissure.

division Leaves

This division of the nerve

is

sub-

The superior maxillary division Leaves

The inferior maxillary division
the cranium through the foramen rotundum.
These last two divisions are
leaves the cranium through the foramen ovale.
The fifth nerve is involved in tic-douloureux,
subject to rheumatic influences.
neuralgia, and toothache.
The sixth cranial nerve is called abducens. It leaves the cranium through

ject to

malarial and septic poisons.

the anterior lacerated (sphenoidal)

convergent

fissure.

Paralysis of this nerve will cause

squint.

The seventh

cranial nerve

is

called facial.

It

starts to leave the

cranium

through the internal auditory meatus and after passing through the aqueduc-

PLATE CCXXXV.

GROOVE FOR SUPERIOR LONGITUDINAL SINUS

GROOVE FOR ANTERIOR MENINGEAL ARTERY

FORAMEN CAECUM

CRISTA GALLI

SLIT FOR NASAL NERVE

GROOVE FOR

NASAL NERVE

ANTERIOR ETHMOIDAL FORAMEN

ORIFICES

POSTERIOR

FOR

OLFACTORY NERVES

ETHMOIDAL

FORAMEN

ETHMOIDAL SPINE
OLFACTORY GROOVES

OPTIC FORAMEN
OPTIC GROOVE
OLIVARY PROCESS
ANTERIOR CLINOID

PROCESS
MIDDLE CLINOID PROCESS

POSTERIOR CLINOID PROCESS

GROOVE FOR SIXTH NERVE
MIDDLE LACERATED FORAMEN
ORIFICE OF CAROTID CANAL
DEPRESSION FOR GASSERIAN

_-

GANGLION

NTERNAL AUDITORY MEATUS

SLIT FOR DURA MATER
SUPERIOR PETROSAL GROOVE
FORAMEN LACERUM POSTERIUS
ANTERIOR CONDYLOID FORAMEN
AQUAEOUCTUS VESTIBULI
POSTERIOR
CONDYLOID FORAMEN

MASTOID

FORAMEN

- POSTERIOR MENINGEAL GROOVES

Showing Foramina at the Base^of the Skull.

440

ANATOMY
tus Fallopii

it

NUTSHELL.

IX A

passes through the stylomastoid foramen.

paralyzed after

it

also called

is

it

The eighth
is

called Bell's paralysis.

its

may

he

passage through

its

origin in the

brain.

Paralysis of this nerve

in

In

any

the brain

is

bulbar paralysis.
cranial nerve

is

called auditory.

meatus but stays

internal auditory

nerve

This nerve

leaves the stylo-mastoid foramen, or during

the petrous portion of the temporal hone, or at

of these cases

441

It starts to

leave through the

One

the internal ear.

in

disease of this

deafness.

The ninth

cranial nerve

called glosso-pharyngeal.

is

leaves the cranium

It

through the middle compartment of the jugular foramen.

Loss of taste

is

ageusia.

The tenth cranial nerve is called pneumogastric. It leaves the cranium

through the middle compartment of the jugular foramen. One thing that may
happen when this nerve does not preform its function is asthma.

The eleventh

cranial nerve

is

called spinal accessory.

through the middle compartment of the jugular

nerve causes spasmodic torticollis.

The

twelfth cranial nerve

is

called

hypoglossal.

through the anterior condyloid foramen.

leaves the cranium

It

foramen.
It

Paralysis of this

leaves the cranium

Paralysis of this nerve causes motor

aphasia.

The following

are the descriptions of those parts of the brain not previously

given.
(1)

Valve of Yieussens

is

a thin leaf of medullary substance between the

superior peduncles of the cerebellum. It

is

also called anterior or superior

medul-

lary velum.
(2)

Posterior or inferior medullary velum

is

the commissure of the

flocculus of the cerebellum.

(3)

Posterior perforated space

is

pora albicantia at the base of the brain.

space pass to the optic thalamus.

It

the depression just behind the cor-

The

arteries which pass through this

would be better to call it the posterior

perforated substance.
(4) Tuber cinereum is a tract of gray matter extending from the optic
commissure to the corpora albicantia. and it is one of the structures in the floor

of the third ventricle.

(5)

Lamina cinerea

is

connecting layer of gray matter between the cor-

pus callosuin and the optic commissure.

(6)

Infundibulum

is

a funnel shaped process of the brain passing from the

tuber cinereum to the pituitary body.

(7) Corpus striatum consists of the caudate nucleus, the lenticular nucleus.
and the internal capsule, and is situated opposite the Assure of Sylvius.
(8) Choroid plexuses are vascular plexuses in the ventricles of the brain.
(9) Tela choroidea [nferior is the membranous pari of the roof of the

fourth ventricle.
(10)

Peduncles of the pineal gland

are delicate white

bands passing

forward from each side of the pineal gland along the edge of the third ventricle
to join the anterior pillars of the fornix.


PLATE CCXXXVI.

ANTERIOR PALATINE FOSSA

TRANSMITS LEFT NASO- PALATINE

TRANSMITS

ANTERIOR

NERVE

PALATINE VESSEL

TRANSMITS RIGHT NASOPALATINE NERVE

ACCESSORY PALATINE FORAMINA

TENSOR

PALATI

POSTERIOR NASAL SPINE

AZYGOS UVULAE

HAMULAR PROCESS

PROCESS OF PALATE
PTERYGOPALATINE CANAL
BASILAR PROCESS
TENSOR TYMPANI
RECTU!

SPHENOID

PHARYNGEAL SPINE

FOR.

SITUATION OF SUPERIOR CONSTRICTOR

EUSTACHIAN TUBE AND CANAL FOR TENSOR

TYMPANI

LEVATOR PALATI
CANAL FOR JACOBSON S NERVE
AQUAEDUCTUS COCHLEAE -

FORAMEN

LACERUM

CANAL FOR

POSTERIUS

ARNOLDS

NERVE

ANTERIOR CONDYLOID

CONDYLE ARTICULATES WITh ATLAS

POSTERIOR

CONDYLOID

LIGAMENTUM

FORAMEN

"

ORAMEN

FORAMEN

NUCHAE

lm; Inferior Surfa<

of Base of Skull

442

ANATOMY
(11)

Obex

is a band
The calamus

soriptorius.

ventricle, at the
(12)

end

Ligula

of

nervous matter

of gray

scriptorius

which

is

443

IN A NUTSHELL.

at

the point of the calamus

the groove on the floor of the fourth

is

the Ventricle of Arantius.

the tongue shaped organ of white matter on the lower part

is

of the roof of the fourth ventricle.

(13)

Fovea superior

a depression

is

in

the floor of the fourth ventricle

on the outer side of the eminentia teres.

(14) Fovea inferior is a depression with

apex at the striae, which

and its base below.
of the median line on the upper
produced by an underlying bundle
its

cross the center of the floor of the fourth ventricle,

(15)

Eminentia teres

is

on each side

half of the floor of the fourth ventricle.

of

It is

white fibers (funiculus teres) formed by fibers of the facial nerve.

(16) Conductor sonorus is formed by a whitish band of fibers which are

connected below with the strke medullaris.

(17)

(18)

Ala cinerea (trigonum vagi) is a d< pr< ssion below the inferior fovea.
Trigonum hypoglossi is situated on the inner side of the inferior

fovea.
(19)

Tuberculum acusticum

is

situated en the outer side of the inferior

fovea.
(20)
lobe,

and
(21)

Fasciculus unciformis connects the parietal lobe with the temporal

is situated in the bottom of the fissu'-e of Sylvius.
Locus ceruleus is a bluish depression above the fovea superior.

LESSON CXXXVI.
The relations of the External Carotid Artery.

CXVI-

(Plates

CXVII-CXVIII.
In Front.
(4)

Skin. (2) Superficial fascia. (3)

(1)

Anterior border

vein,

(7)

Facial

of

vein,

Sterno-mastoid,
(8)

Digastric

(">)

Platysma and deep

Hypoglossal

muscle.

(9)

nerve,

Stylo-hyoid

Parotid gland with facial nerve and temporo-maxillary vein

Behind.
pharyngeus,

Superior

(1)

(4)

laryngeal

nerve,

Glosso-pharyngeal nerve,

(5)

(2)

in

fascia.

Lingual

(6)

muscle.
its

Stylo-glossus,

(10)

substance.
(3)

Stylo?

Parotid "land.

Internal carotid artery.

Pharynx,
[nternally.
Hyoid bone,

Externally.

(1)

nerve,

(4)

(2)

Parotid gland,

(5)

Ramus

(3)

Superior

laryngeal

of jaw.

(PlaKs CXVI-CXVII-CXVIII) which

border of the thyroid cartilage is divided for convenience

The INTERNAL CAROTID ARTERY

begins at the upp<
into four parts.

(1)

The

cervical portion passes vertically

the transverse processes of the three

upper

upward

cervical vertebra? to

in

front of

enter the car-

This portion has no

branches.
(2) The petrous portion passes in the carotid canal where it runs
forward and inward in front of the tympanum and from here ascends to the

otid canal

in

the petrous portion of the temporal bone.

cavernous sinus.

This portion

gives off

the

tympanic branch, which runs

tympanum.

in the wall of the carotid canal to enter the

through a small foramen

(3) The cavernous portion passes

in

the cavernous sinus to the posterior clinoid

process and from here along the body

of the

sphenoid bone and then passes

ANATOMY

444

IN A NUTSHELL.

the inner side of the anterior clinoid process where

upward on

ernous sinus.

This portion gives

off (a)

it

leaves the cav-

the artkri.e receptaculi branches

which pass to the pituitary body, Gasserian ganglion, and to the walls of the
cavernous sinus and inferior petrosal sinus, (b) anterior meningeal which
passes over the lesser wing of the sphenoid to the dura mater in the anterior
this artery has been described od page 383, (4) The
fossa, ici ophthalmic

the fissure of Sylvius and gives off (a)

cerebral portion <nt<

rs

BRAL which runs

the longitudinal fissure around tin

in

(Plate

posterior part.

CLXXIIL)

Tin: anterior

ANTERIOR CERE-

corpus callosum to

its

communicating artert

PLATE CCXXXVIL
ARTIC
PARIETAL

PACCHIONIAN
DEPRESSIONS.

-GROOVES
FOR MEN

1NGEAL
ARTERIES

FORAMEN*

ARTIC. WITH

CAICUM.

GRTR WING
SPHENOID.

3F

ORBITAL PLATE
ARTIC. WITH

ARTIC WITH
MALAR.

ESSER WING.

HRYMAL
FOSSA.

ARTIC WITH OS-PLANUM

ARTIC. WITH

LACHRYMAL.

ARTIC. WITH MAXILLARY

ARTIC. WITH

NASAL

NASAL.

'SPINE

ETHMOIDAL NOTCH
DEPRESSION FOR PULLY OF SUP OBLIQUE
UNDER SURFACE OF NASAL PROC.

[nternal Surface of Frontal Bone.

joins tin- artery with

its

fellow near their beginning.

This artery gives

off

the

antero-mediarj ganglionic, which passes through the anterior perforated space.

and lamina cinerea

gives
lobes;

<>\'\

to

the caudate nucleus of the corpus striatum.

the antero-internal frontal, which passes to the

ami the middle internal

frontal,

which passes

to the

two

It

also

inferior frontal

corpus callosum and

ascending frontal lobe and first frontal lobe; and it

the posterior internal frontal which passes to the quadrate lobe,

i" the inner surface of the

finally gives off

il.)

MIDDLE CEREBRAL, (Plates

and gives off

fissure of Sylvius

CLXXIII-CLXXV)
its

which runs outward in the

branches near the central lobe.
Its branches

ANATOMY

445

IN A NUTSHELL.

are anterolateral ganglionic which passes to the corpus striatum, internal capsule and optic thalamus; external and inferior frontal which pass to the third
frontal convolution; ascending frontal which passes to the ascending frontal
convolution; the ascending parietal which passes to the ascending parietal convolution; and parieto-sphenoidal which passes to the angular convolution and

posterior commu(c) The

the superior temporo-sphenoidal convolution,
nicating artery, (Plate CLXXIII) which runs backward and joins the posIt sends postero-mediaD ganglionic branches which
terior cerebral artery.
pass through the posterior perforated space, the optic thalamus and wall of the
(d) Anterior choroid artery which runs backward into
third ventricle,
the descending horn of the lateral ventricle.

The
at the
in

(Plate

CLXXIII.)

formed by seven arteries which make an enclosure

All the structures
the brain just beneath the third ventricle.

circle of Willis is

base of

the floor of the third ventricle are in the circle of Willis except the tegmental

portion of the cms, and everything in the circle of Willis

third ventricle except the optic commissure.

The

is

in the floor of

arteries that

make

the

this circl e

two anterior cerebral which

are branches of the internal carotid; the two posterior communicating and the
anterior communicating which is the shortest artery in the body and has upon

arc the

it

two posterior cerebral from the

basilar; the

ganglion of Ribes.

The
the
(a)

posterior cerebral which are branches of the basilar artery

wind around

cms cerebri to the under surface of the occipital lobe. Here it sends branches
TO THE UNCINATE LOBE, (b) TO THE CUNEATE LOBE, (c) TO THK TEMPORAL

lobe.

Xear

its

origin

it

receives the

communicating

posterior

artery.

The

postero-median ganglionic branches pass from the posterior cerebral through

A posterior
the posterior perforated space to the walls of the third ventricle.
choroid branch conns from the posterior cerebral and passes to the velum interpositum and choroid plexus. A postero-Iateral ganglionic branch comes
from the posterior cerebral ami passes to the optic thalamus.

LESSON CXXXVII
The Relations of the Entern

kl

Carotid Artery.

(1) Skin, (2) Superficial ami deep fascia, (3) Platysma, (4)
Sterno-mastoid, (5) Occipital artery, (0) Posterior auricular artery. (7) Hypoglossal nerve, (8) Parotid gland, (9) Stylo-glossus, (10) Stylo-pharyngetis.

Ix Front.

(11)

Behind.
ior

Pharyngeal branch of the pneumogastric.

Rectus capitis amicus major. (2) Sympathetic, ('>) Super-

Glosso-pharyngeal nerve, (12)

(1)

laryngeal nerve.

Externally.
Internally.

pharyngeal artery,

(1)

(1)
(4)

Internal

Pharynx,

jugular vein,
(2)

(2)

Pneumogastric nerve.
(3) Ascending

Superior laryngeal nerve.

Tonsil.

The Right subclavian artery arises from the innominate opposite the sternoand passes upward and outward to the Scalenus anticus
muscle on the right side. The left Subclavian artery arises from the end of
The artery
the arch of the aorta and ascends to the Scalenus anticus muscle.
clavicular articulation

W ATOMY

440

IX A XI TSHELL.

now runs outward behind the Scalenus anticus muscle then downward under
first rib where it takes the name of axilScalenus anticus muscle divides this artery into three portions.

the clavicle to the lower border of the

'Hit'

lary.

The portion
;Ik

internal to the muscle

second portion, and the portion

'I'm:

<

the

portion, the portion behind

first

xternal to

it is

it

is

the third portion.

Relations of First Portion ok the Right Subclavian Artery.

(1) Skin. (2) Superficial fascia. (.'!) Platysma and deep fascia,

Front.

1\

is

Clavicular origin of Sterno-mastoid, (5) Sterno-hyoid, (6) Sterno-thyroid,

(7)

Anterior jugular,

(8)

Internal

jugular,

(9)

Vertebral

veins,

(10)

Pneu-

PLATE CCXXXVIII.

METOPIC

%%

SUTURE.

SUPERCILIARY

Wk'

SUPRAORBITAL

NOTCH OR FORAMEN.

RIDGE.

CORRUGATOR

0BICULAR1S PALPEBRARUM.'
INT.

FRONTAL
EMINENCE

ANGULAR PROC
Extern

\i.

SUPERCILII.

NASAL SPINE.

Surface of Frontal Bone.

mogastric nerve, (11) Cardiac nerves, (12) hoop from the sympathetic.
Behind. (1) Recurrent laryngeal nerve, (2) Sympathetic, (3) Pleura
i

Apex

of lung.

Beneath. (1)
In

nerve,
(7i

Pleura,

(2)

Recurrent

laryngeal

nerve.

Relations of First Portion ok Left Subclavian Artery.

Tin:

Front.
(4)

Left

Vertebral

(1)

Pneumogastric

carotid artery.
vein,

(8)

(5)

nerve,

(2)

Cardiac

Thoracic duct,

Innominate

vein,

(9)

((i)

nerves,
Left

(3)

Phrenie

internal jugular.

Sterno-thyroid.

(10)

Sterno-

hyoid, (11) Sterno-mastoid.

Behind.

(1)

Oesophagus,

(2)

Thoracic duct.

(.'-!)

Inferior cervical gang-

ANATOMY
Longus

lion of sympathetic, (4)

Outer
Inner

Side.
Bide.

Pleura,

(1)

447

colli.

Left lung.

(2)

Trachea.

(1)

IN A NUTSHELL.

(2)

(Esophagus,

Thoracic duct.

(3)

LESSON CXXXVIII.
The Relations of Second Portion of Subclavian Artery are the same
on each

side.

In Front.
vical
'

fascia,

(1)

(4)

Skin, (2) Superficial fascia, (3) Platysma and deep cer-

Sterno-mastoid,

Phrenic

(5)

nerve,

(6)

Scalenus

auticus.

Subclavian vein.

7)

Behind.

Pleura,

(1)

Scalenus medius.

(2)

Aboa e. Brachial plexus.

Below. Pleura.
The Relations of Third Portion of Subclavian Artery are the same
on each side.
t

(1) Skin, (2) Superficial fascia, (3) Platysma and deep cerDescending branches of cervical plexus, (5) Nerve to subclavius muscle, (6) Subclavius muscle, (7) Suprascapular artery, (8) Supra-

In Front.

vical fascia, (4)

scapular vein,

The external jugular

(9)

vein,

(10) Transverse cervical

vein.

(11) Clavicle.

Scalenus medius,
Brachial plexus,
First

Behind.
Above.
Below.

(1)

(1)

Lower cord of brachial

Omo-hyoid muscle.

(2)

(2)

plexus.

rib.

LESSON CXXXIX.
The branches of the subclavian artery are (1) vertebral, which arises at
the upper and back part of the artery and passes upward through the foramina
in

the transverse processes of the upper six cervical vertebrae.

through the foramen

in the transverse process of the atlas,

articular process of this

occipital nerve.

magnum
It

11

now

of the occipital

bone

in

it

passes

mater and passes through the

medulla oblongata.

torn men

to the front of the

unites with the opposite vertebral at the low<

the basilar artery.

After

passes behind the

the sinus atlantis lying superficial to the sub-

pierces the dura

bone

it

The branches

border of the pons

of the vertebral artery are:

(A)

to

form

the cer-

vical branches which send muscular branches to the neck, lateral spinal
which pass through the intervertebral foramen and then divides into two
branches one of which runs along the nerve roots to the cord and its coverings,
the other divides into ascending and descending branches which form with
similar branches from

above and below loops on the posterior surfaces of the

(B) cranial branches which send posterior menin-

bodies of the vertebrae.

branches to the posterior fossa, anterior spina! descends in front of the

its fellow to form a single trunk at the foramen magnum. This main branch descends in the anterior median fissure of the cord.

geal

medulla and unites with

and posterior spina! see page 337. The posbranch of this crania] portion and winds
around the medulla across the restiform body to the under surface of the cereFor description

of anterior spinal

terior inferior cerebellar

bellum.

is

tin-

last

ANATOMY

lis

IN A

These two vertebral arteries unite

in the middle of the pons to

in a

groove

the

posterior cerebral

branch.

The

NUTSHELL

to
its

form the basilar artery, which runs

anterior border where it divides into

basilar

artery gives off

(A)

numerous

and adjacent parts, (B) THE INTERNA!

\i [>n<n;v
v.rtery which runs with the auditory uerve in the internal meatus
(C) the anterior inferior cerebellar artery which crosses the cms cerebelli to the anterior border of the under surface of the cerebellum, (D) the
51 perior cerebellar which winds abound the crus cerebri on each side near
the fourth uerve to reach the upper surface of the cerebellum.

TRANSVERSE BRANCHES

to

the

polls

>

PLATE CCXXXIX.
ANT. SUP.

ANGLE.
POST.SUF.

ANGLE

ANT.

INF.

ANGLE.

-GROOVES FOR

POST. INF

ODLE MENINGEAL,
ARTERY.

ANCLE.

FOR LATERAL
SINUS.

[nternal Surface of the Parietal Bone.

(2)

The

internal

mammary

arises

from the

first

portion of the subclavian

artery opposite the thyroid axis and descends on the posterior surfaces of the
cartilages to the sixth interspace where it divides into the musculo*
phrenic and the superior epigastric branches.
As it passes down it is about a

costal

fromthe sternal margin. The branches of the internal mammary

COMES \Kuvi phrenici which accompanies the phrenic nerve to the
Diaphragm, (b) the mediastinal branch which passes to the anterior med-

half an inch

are

(a

iastinum, (c) pericardiac which passes to the anterior surface of the pericardium,
(d)
(e)

sternal branches which pass to the posterior surface of the sternum,

interior [ntercostal branches which pass to the five or six upper in-

terspaces where each branch divides inio two divisions to pass along the mar-

\\

\TOMY IX A NUTSHELL.

449

(f) perforating branches which pass through the

upper interspaces to the skin and muscles on the chest, and those
that pass through the second, third, and fourth spaces go to the mammary

gins of the interspaces,

five or six

gland.

Of

its

terminal branches the musculo-phrenic runs behind the cartilages

Diaphragm at the eighth or ninth rib and ends at

of the false ribs to pierce the

the twelfth rib where

it

gives off anterior intercostals to the lower intercostal

spaces pericardiac branches, and diaphragmatic branches.

Its other terminal branch the superior epigastric descends in the interval
between the sternal and costal attachments of the Diaphragm to pierce the
sheath of the Rectus muscle running on its posterior surface to anastomose
with the deep epigastric in the substance of this muscle.

LESSON CXL.
The thyroid

(3)

axis arises near the the Scalenus Anticus

portion of subclavian artery

trans versalis

The

and gives

It crosses

laryngeal nerve.

from the

first

suprascapular, and

arteries.

colli

inferior thyroid artery ascends

the sympathetic and the sheath of the

gland.

off inferior thyroid,

behind the middle cervical ganglion of

common

the vertebral artery, Longus

It

carotid artery to the thyroid

colli

may, however, pass under

muscle, and the recurrent

this nerve.

Its

branches are,

tracheal, which pass to the trachea, (b) oesophageal, which pass to the
oesophagus, (c) muscular, which pass to the adjacent muscles, (d) inferior
laryngeal, which passes to the back of the larynx with the recurrent laryngeal nerve, (e) ascending cervical, which passes between the Scalenus anticus muscle and the Rectus capitis anticus major on the anterior tubercles of
(a)

the transverse processes.

The suprascapular artery crosses the Scalenus anticus muscle behind the
and passes over the transverse ligament of the scapula to the supraspinous and infraspinous fossa?. This artery goes to the clavicle, scapula, and
humerus, as well as to the sterno-clavicular articulation and acromio-clavicular articulation and the shoulder girdle.
The transversalis colli is on a higher level than the suprascapular artery and
crosses the Scaleni muscles and the brachial plexus to the Trapezius muscle.
Here it divides two branches, (a) superficial cervical which ascends under
clavicle

the anterior border of the Trapezius to anastomose with the superficial branch
of the arteria princeps cervicis, (b) tiiio

posterior SCAPULAR branch, which

runs under the Levator anguli scapulae to the superior angle of the scapula and

then descends under the Rhomboidei muscles to the inferior angle of the scapula.
This artery may arise from the third portion of the subclavian.

The superior

(4)

intercostal

comes from the upper and hack pari of the

of the first two ribs to supply

subclavian artery and descends on the neck

the

first

two

branch which
artery

in

intercostal spaces.
is

distributed

the second

aortic intercostal.

in

In
like

the

first

manner

intercostal space
to

intercostal space generally joins one

All

it

gives off

the aortic intercostals.

The

from the highest

intercostal arteries give off branches to

the posterior

ANATOMY

450

IX A NUTSHELL.

and a small one which passes to the spinal cord and its memThe profundus cervicis most always comes from the superior interIt ascends under
costal, but it may come from the subclavian artery itself.
the Complexus muscle as far the axis to anastomose with the deep branch of the

spinal muscles

brane.

princeps cervicis.

arteria

The relation of the thoracic aorta are given on page

286. and

its

branches arc (1) pericardiac, which are small arteries and are distributed To
the pericardium. (2) the bronchial arteries are nutrient arteries to the lungs.

The one on the

may come

right side

(A)

from the first aortic intercostal,

PLATE CCXL.
PARITTAL
FORAMEN.

TEMPORAL
R,DGES

jurtu

:^*~

SQUAMOUS

ART LT'5 Wl
SPHENOID.

PORTION,

TEMPORAL MUSCLE.

^-EMINENCE.

MASTOID
PORTION-

External Surface of the Parietal Bone.

(B) IT MAY COME BY A COMMON TRUNK WITH THE LEFT BRONCHIAL which collies
from the fronl of the thoracic aorta. There are generally two on the left side.
These arteries nourish the bronchial tubes, the cellular tissue of the lungs, the

bronchial glands, and the (esophagus, (3)

(Esophageal arteries are generally

four or five in number,and come from the front of the thoracic aorta and pass ob-

Above they anastomose with the inferior thyroid

ami below with branches from the phrenic and gastric arteries. (4)
The posterior mediastinal arteries are small arteries which supply the glands in
the posterior mediastinum.
liquely to the oesophagus.
arteries,

ANATOMY

IN A NUTSHELL.

451

LESSON CXLI.
number. Those of the first and
(5)
second spaces come from the subclavian, and the remaining nine come from the
The last one, which passes along the lower border of the Last
thoracic aorta.

The

rib,

intercostal arteries are eleven in

called the subcostal.

is

than the left ones because the

In each intercostal space the
artery lies upon the External intercostal muscle and has in front of it the pleura
and a thin fascia. From here it passes between the two layers of intercostal
muscles and passes to the lower border of the rib above to pass forward in the
groove on the lower border of this rib to anastomose with the anterior inter-

The

aorta

is

right intercostal arteries are longer

situated on the left side of the spine.

The first intercostal,

costals which are branches of the internal mammary.
which comes from the aorta, anastomoses with the superior intercostal, while
the last three intercostals which come from the aorta pass between the abdominal muscles to anastomose with the epigastric in front and with the phrenic
and lumbar arteries behind. In each intercostal space there is a vein, artery,
and nerve, and their position from above down is vein, artery, and nerve, except in the upper intercostal spaces where the nerve is first above the artery.
Fibrous arches keep the intercostal muscles from pressing upon the intercostal
arteries during respiration.

The lower

intercostal arteries pass into the ab-

dominal wall and into the sheath of the Rectus muscle where they anastomose
with the internal mammary and the deep epigastric artery. The branches of
the intercostal arteries are (a) the posterior or dorsal branch, which passes
backward to the inner side of the anterior costo-transverse ligament where it
is distributed to muscles and integument of the back after dividing into an ex(b) The spinal branch, which passes through
ternal and internal branch,
the intervertebral foramen to be distributed to the spinal cord and its coverings
and the bodies of the vertebrae, (c) The collateral intercostal branch
arises from the intercostal artery close to the angle of the rib and then passes
downward to the upper border of the rib below, along which it passes to anastomose with the anterior intercostals from the internal mammary.
The thoracic aorta commences on a level with the fourth dorsal vertebra
and descends on the left side of the spine to pass through the abdominal opening in the Diaphragm after which it is called abdominal aorta.
The abdominal aorta commences at the aortic opening in the Diaphragm
extends to the front of the body of the fourth lumbar vertebra where it divides
(Plate XCI
into tiih right and lkft common iliac arteries.
|

LESSON CXLI I.
The Relations of the Abdominal Aorta.
In

Front.

cceliac axis,

(4)

(1)

vein, (8) Transverse

Behind.

Lesser

omentum,

(2)

Stomach.

Solar plexus, (5) Splenic vein,

(1)

duodenum,
lumbar

Left

(9)

((>)

(3)

Branches

Pancreas,

(7)

the

of

Left

renal

Mesentery, (10) Aortic plexus.

(2) Vertebral column.

veins,

Right Side. (1) Right cms of Diaphragm, (2) Inferior vena cava,
Yena azygos major, (4) Thoracic duct, (5) Right semilunar ganglion.

(3)

ANATOMY

452

IN A NUTSHELL.

this

Left Side. (1) Left lumbar veins. (2) Left semilunar ganglion.
The branches of the abdominal aorta are (1) parietal branches and under
we have (A) phrenic branches which are two in number and as a rule

arise close together

on the under surface of the Diaphragm, but they present

PLATE CCXLI.
A-0CCIP1T0 FRONTALIS.

0- SUP. CURVED OR NUCHAL LINE.

P-

B-TRAPEZIUS.

LINEA SUPREMA.
Q-

C-STERNO- MASTOID

INF.

LINE.

R-FOR LIGAMENTUM

D-SPLENIUS
E-COMPLEXU!

NUCHAL.

^%%a

F-0BL'Q5.SUR

G - RECTU S
CAPITUS
POST.

CURVED

INION OR EXT.

OCCIPITAL
PROTUBERANCE.

Ml
T- CREST.

H-NECTUS
CAPIT

&

POST.MIN.
-

U-BASILAR

PROC

RECTU5-

V- PHAR-

CAP.LAT.

YNGEAL

J-FEC-CAB/I

SPINE.
K-RECCftP.AJfT.MJ.

-TUBERCLES
FOR CHECK

L-SURCONSTRICTO

M- POST. CONDYLOID

LIGAMENTS

FORAMEN.

X- JUGULAR PROC.

N- ANT. CONDYLOID FORAMEN.

Y-

CONDYLES. ART.WITH ATVS.

External Surface of Occipital Bone.

much variation in their origin since they may come by a common trunk or one
may come from the comae axis and the other from the renal artery. The one
on the righl side passes across the crura of the Diaphragm to the under surface
of that

muscle behind the inferior vena cava, while the one on the

behind the oesophagus to the under surface of the Diaphragm.

left side

passes

(B) Ltjmbab

arteries are five pairs and arise from the back of the aorta to pass outward
on the body of the vertebrae beneath the Psoas magnus muscle and the sympathe-

The first two pairs pass under the crura of the Diaphragm and the
one
also
right
passes under the inferior vena cava.
Near the transverse processes of the vertebrae they divide into an abdominal branch, which passes
tic

nerve.

outward beneath the Quadratus lumborum to end between the muscles of the
abdominal wall where they anastomose with the deep epigastric, the internal
mammary, the ilio-lumbar, and the circumflex iliac arteries. It is well to say

ANATOMY
that the

first

IN A NUTSHELL.

lumborum

pair cross the Quadratus

453

The other branch

muscle.

is

the dorsal branch which passes with the posterior primary branch of the intercostal nerve and gives off spinal branches which supply the spinal cord and its
coverings.

It

anastomoses with the intercostal artery.

(C)

Sacramedia

is

small branch given off at the bifurcation of the abdominal aorta and passes
over the fifth lumbar vertebra and the sacrum to the coccyx where it anastoa

moses with the lateral sacral

(Plate XC.)

arteries.

LESSON

CXLIII.
and under these we have (A) coeliac axis, which
is a short trunk about a half of an inch long, arises between the crura of the
Diaphragm just above the Pancreas. It passes horizontally forward and di(2)

The

visceral branches

Gastric or coronary artery

vides into three branches.

is

the smallest of these

and passes upward to the left side behind the lesser' sac of the
peritoneum to the cardiac end of the stomach. It also uives branches to the
oesophagus, then turns to the right and passes along the lesser curvature of the
stomach sending branches to both sides of the stomach. It anastomoses with
Hepatic artery passes forward and
the pyloric branch of the hepatic artery.
upward between the layers of the lesser omentum to the transverse fissure in
the liver where it divides into right and left hepatic branches to supply the

three branches

lobes of the liver.

axis because

it

In the fetus this

the largest of the branches of the cceliac

is

supplies the liver which

the adult this artery

is

is

In

such a large organ in the fetus.

smaller than the splenic artery.

The branches

of the

hepatic artery are Pyloric, which extends along the lesser curvature of the
i.\^stomach passing from right to left to anastomose with the gastric artery.
tro-duodenalis pass behind the first portion of the duodenum and divides
Gastro-epiploiea dextra, which runs along the
into the folio whig branches.
greater curvature of the stomach from right to left to anastomose with the
This artery
gastro-epiploiea sinistra which is a branch of the splenic artery.
Pancreaticogives branches to both the stomach and the great omentum.
duodenalis superior passes between the second part of the duodenum and the
(

pancreas.

After supplying both of these organs,

anastomoses with the pan-

it

branch of the superior mesentery and

The right hepatic passes to the
with the pancreatic branches of the splenic.
righl lobe of the liver ami uives off the cystic artery which supplies the gall
bladder.
The left HEPATIC passes to the left lobe of the Liver and uives off

creatico-duodenalis inferior which

branches to the Spigelian lobe

branches of the cceliac axis and

is

The

is

splenic artery

very tortuous

the upper border of the pancreas, crosses the

divides into

pancreatic^

i'\i;\

border of the pancreas while

branch, passes from the

left

e.

Tin;

in
left

is

its

the largest of the three

course.

kidney

to

passes along

It

the spleen.

It

These pancreatic branches supply the upper

single large
MAGNA, which is
PANCREATN

to the right

:i

near the posterior surface of the pan-

accompanying the pancreatic duct. Tun GASTRIC BRANCHES, called

vasa BREVIA, are live or >i\ in number and pass to the left extremity of the
stomach which it supplies. Gastroepiploic* sinistra is the Largesl o\' the
branches of the splenic artery and runs from left bo right along the greater cur-

creas

ANATOMY

454

IN A NUTSHELL.

It anastovature of the stomach between the layers of the great omentum.

moses with the gastro-epiploica dextra and supplies both the greater omentum

and the stomach.

(B) Superior mesentery arises about one-fourth of an inch

and passes between the pancreas and the third portion

crosses and passes downward to the right be + ^en
it
It supplies all of the small intestine, except the
the layers of the mesentery.
below the

cceliac axis

duodenum which

of the

portion of the

first

duodenum.

It also supplies the caecum,

the ascending

PLATE CCXLII.
FOUFALX CEREBRI

FOR FALX CEREBELLI.

TORCULAR
HEROPHILI.

POST CONDYLOID
FORAMEN.
LATERAL SINUS

ANT GONDYLOID FORAMEN

FOR PETROSAL SINUS.

JUGULAR FOSSA.
GROOVE FOR MEDULLA.
BASILAR PROC.

Internal Surface of Occipital Bonk.

the transverse colon.
Its branches are pancreatico-duodenalis inferior, which passes from Left to right in the concavity of the duodenum where
colon,

anastomoses with the pancreatico-duodenalis superior. It gives branches to

and to the transverse and descending portions of the
duodenum. Vasa entestini tenuis are twelve or fifteen in number which
from the left convex side of the superior mesenteric artery to supply the
c
jejunum and ileum. Aboul two inches from their origin each branch divides
and joins similar branches from the adjacent artery thus forming arches from
ii

the head of the pancreas

ANATOMY IN A NUTSHELL.

455

which numerous branches are given off to supply the mesentery and the small
Four or five sets of arches are given off. The ilio-colic artery
intestine.
It passes beis given off from the right side of the superior mesentery artery.
tween the layers of the mesentery to the right iliac fossa where it divides into
two -anehes, ascending and descending. The ascending one passes to the
ascending colon and anastomoses with the colica-dextra. The descending one
passes to the lower part of the ileum, csecum. appendix, and ileo-csecal valve.
The colica-dextra arises from the middle of the superior mesentery artery
and passes behind the peritoneum to the ascending
ion where it gives off an
ascending branch which anastomoses with the colica-media. and a descending
branch which anastomoses with the ileo-colic. Colica-media comes from the
upper part of the concavity of the superior mesenteric artery and passes for-

PLATE CCXLIIL
GRqOVE FOR OLFACTORY

LESSER WING.

REATER WING

TRACT. C

- ANT.CLINOIO

10-

II-

MID. CLINOIO

PROC
-

POSTCLINOID PROC

OLIVARY PROC.

SELLA TURCICA.

12

-SPHENOIDAL
FISSURE.

13-

FORAMEN
VESALII.

H- FORAMEN

CAVERNOUS GROOVE

8-LINGULA

GROOVE FOR

SIXTH WTRVE.

4 -OPTIC GROOVE
5--

FORAMEN
OPTICUM.

PROCESS

15-

\/\ SUPP0RT5
'X-'l

PTERYGOI

-SPINOUS PROC.

1/

16-

OVALE

FORAMEN

SPINOSUM.
FORAMEN ROruNDUM

Posterior View of the Sphenoid Bom:.

ward in the transverse meso-colon where it givi s a right branch which anastomoses with the colica-dextra, and a left branch which anastomoses with the
((')
(Plate CLVII.)
The inferior mesentery artery arises from
colica-sinistra.
It
the left side of the aorta aboul an inch and a half above the bifurcation.
supplies the descending colon, sigmoid flexure, and the greater part of the rectum. It lies a1 hist on the left side of the abdominal aorta, then crosses the
Psoas muscle, left common iliac artery, ami un ter, to the back of the rectum.
It gives off the following branches. COLU \->i\i>ti; \. which passes behind the
peritoneum upward in front of the left kidney to th< descending colon where it
divides into an ascending branch, which anastomoses with the colica-media,

branch which anastomoses with the sigmoid artery and the

Tin: sigmoid lrteri passes to the sigmoid
flexure and anastomosi s with the colica-sinisl ra and the superior haemorrhoidal.

and

a descending

superior hemorrhoidal artery.

ANATOMY

156

IN A NUTSHELL.

The SUPERIOB hemorrhoidal artery

is

really a continuation of the inferior

mesenteric artery and passes behind the rectum to divide into two branches in
One branch passes od cither side to within about six inches
the meso-rectum.

This artery anastothe anus where they subdivide to supply the rectum.
moses with the sigmoid, middle and inferior haemorrhoidal arteries. (D) The
suprarenal, sometimes called middle capsular, are two in number and come
from the abdominal aorta a little below the cceliac axis. They pass obliquely
upward and outward over thecrura of the Diaphragm to the suprarenal body.
They anastomose with the superior capsular of the phrenic and the inferior
(E) The renal arteries are two in number which come
capsular of the renal.
oi

PLATE CCXLIV.
SPHENOIDAL FISSURE, OPTIC FORAMEN

ARTIC.

WITH PERPEND'R PLATE- ARTIC. WITH MALAR.

TEMP'L FOSSA

{ ,\

ORB [TAL SURFACE

TEMPORAL.

EXT.

PTERYGOID RIOGE.

PTERYGOID.

FORAMEN ROTUNDUM
'

ZYGOMATIC FOSSA

Fn ERYG0 WL GROOVE FOR

\1
W\(<k
U
ATINE CANAL. ALA OF VOMER

VIDIAN CANAL.

+ SPHENODAL

'

TURBINAL BONES

VAGlNALPf?0C

SPINOUS PROC.

ROSTRUM.

* ARTIC. WITH VOMER.

FORAMEN

y IN"D

PTERYGOIO PLATES EXT.

HAMULAR PROCESSES

SPJNOSUM.

NOTCH

Anterior View of Sphenoid Bone.

tin abdominal aorta about a half an inch below the superior mesenteric.
The one on the righl side is a little lower than the one on the left side because
the kidney is a little lower.
Each passes outward to supply the kidney. The

from

As they enter the kidney

righl one passing behind the inferior vena cave.
each divides into four or five branches.
A plexus of nerves accompany this
[t supplies branches to the suprarenal body, ureter, and the surroundand muscles. Som< times th< re is a second renal artery. At the hilum
the kidney the position of the structures from before backward are vein,
and ii"
(F) The spermatic arteries are wo small arteries which

artery,

ing
of

fa1

from the abdominal aorta. They pass downward and outward behind the peritoneum but over the Psoas magnus muscle

arise jusl

and

b<

ur< ter

low the renal

and external

arteri< s

iliac

artery, the one on the right side also crosses the

abdominal ring. Here they pass with the

spermatic vein- and spermatic plexuses and vas deferens through the inguinal
inferior vena cava) to the internal

canal

t<>

puss out the

xternal abdominal ring into the scrotum where

it

sup-


ANATOMY

457

IN A NUTSHELL.

Each artery anastomoses with the artery of the vas deferens

and the cremasteric artery. In the female these arteries are called the ovarian.
They are shorter than the spermatic and do no1 pass out of the abdominal cavThey rim between the layers of the broad ligament of the uterus to the
ity.
ovary and the round ligament and Fallopian tubes. Branches are given off
which follow the round ligament through the inguinal canal to the integument
of the labium and groin.
plies the testicle.

PLATE CCXLV

,'fl\^

PALATI

INTERNAL PTERYGOID

^
TERYG0ID

TENSOR

FOSSA

SUPERIOR CONSTRICTOR

The Pterygoid Processes.

eleven of these on each

extending from the tubercles of the ribs posteriorly to the commencement

External intercostal*.
side,

LESSOX CXLIV.
Muscles of the Thorax.
Description. Then are
From

of the cartilages of the ribs anteriorly.

cle

the anterior intercostal membrane

fibers of the

the ant t rior

The middle im<

ternal intercostal muscles.

cate than either of the oth<

Intercostal fascia' are best

rn ui n anteriorly

b<

m situations

placed
In

b<

inn;

rcostal fascia,

\v<

<

n the

two

surface of tin

which

is

more

set> of muscl<

s.

twe< n the External intercostal muscles

tw< en the

nit rnal int< rcostals

Indeli-

The
and

and the spine pos-

tin-

<

commencemi

nt

of the cartilag*

Into the upper bord<

two lower spaces, but in

Insertion.
tilages in the

is

The

fib

muscular fiU rs arc d< fici< at.

From the lower border of each rib xtending from the tubercles

teriorly, for in th<

and

rs,

shown

like tin

firm layer of fascia covers the

outer surface of the External intercostal aswell asthe

Origin.

xtremity of the mus-

External intercostals pass downward and forward

the External oblique muscle of the abdomen.

to the

<

extends forward to the sternum.

Action.To

s.
r

below extending to the carupper two or three not quite so far.

of the rib

tin

raise the ribs so as to increase the capacity of the chest.

Xki;\ e Supply

Inn rcostal

n< rv< s.

ANATOMY

458

Blood Supply.

Intercostal

IX A NUTSHELL.

arteries.

Their
Description. These are eleven in number.
tillers pass obliquely downward and backward in the opposite direction to those
They extend from the sternum anteriorly to the
of the External intercostals.
Internal intercostal*.

angles of the ribs posteriorly.

Origin.

From

the inner surface of each rib

and the

costal cartilage.

Into the upper border of the rib below.

[NSERTION.

To depress the ribs and diminish the thoracic cavity. At the

from of the chest the Internal intercostal muscles help the External intercostal
Action.

muscles in raising the cartilages.

PLATE CCXLVI.

MASTOID PORTION

MASSETER.
CLASERIAN FISSURE

CLENOID FOSSA.

^'.W^J^ TRACHELOMAST.

EXT. AUDITORY

MEATUS

STYLOID PROCESS

DIGASTRIC.

STYLO- GLOSSUS

STYLO-HYOID

SPLEVHUS-CAPITIS.

PROCESS.

STYLO- PHARYNGEUS.

STERNOCLEIDOMASTOID-

RETRAHENS AURICULAM

The External Surface of Temporal Bone.

Nerve Si pply. Intercostal
Blood Supply. Intercostal

nerves.
arteries.

Description. These muscles vary

and number and are placed on the inner surface of the ribs where the

Infracostals, also called Subcostals.

in their size

Internal intercostals cease.

Origin.

From

Insertion.
Their direction

the inner surface of the rib.

Into the inner surfaci

is

like thai

of the

>

of the first,

second or third rib below.

They

Internal intercostals.

are

more often

presenl between the lower ribs than between the upper ribs.
Ai

Depress

[on.

N u;\

i.

Si

I'i'i.i

Blood Supply.

ribs.

Intercostal uerves.

Intercostal arteries.

Triangularis sterni.

Des< ription.- This muscle

is

upon the inner

and tendinous fibers.

situated

wall of the chesl anteriorly and consists of thin muscular


ANATOMY

IN A NUTSHELL.

459

muscle varies not only in different bodies but on the

The superior fibers pass vertically, its middle
opposite side of the same body.
outward,
and
its lower fibers horizontally.
fibers obliquely

The attachment

Origin.

of this

From

the posterior surface of the ensiform cartilage and the

end of the costal cartilages of the three or four

from the lower one-third of the posterior surface of

posterior surfaces of the sternal

lower

true ribs,

and

also

the sternum.

Insertion.

Into

the inner surface and lower border of the costal cartil-

ages of the second, third, fourth,

and

fifth ribs.

Muscle of forced expiration.

Nerve Supply. Intercostal nerves.
Blood Supply. Intercostal

Action.

arteries.

PLATE CCXLVII.
EMINENCE FOR SUP.
SEMI-CIRCULAR CANAL \
SUP. SURF. OF PETROUS

SQUAMOUS
PORTION.

PORTld

FOR SUP. PETROSAL SINUS

DEPRESSION FOR
CASSER1AN GANGLION.
CAROTID CANAL
'

OPENING FOR SMALLER PETROSAL

N.

HIATUS FALLOPII
INT AUDITORY MEATUS

OPENINGFOR PROC.OF DURA-MATCR

FOR LATER SINUS

POST.

SURFACE OF PFTROUS PORTION

AQUEDUCTUS VESTIBULI

The Petrous Portion of the Temporal Bone.

Levatores costarum.

Description.

These

muscles are situated between

the transverse processes of the seventh cervical vertebra and the eleven upper

There are twelve

dorsal vertebrae and the border of the first rib below them.
on each side of the spine.
Origin. From the ends of the transverse processes of the seventh cervical and the eleven upper dorsal vertebra
Their direction is obliquely downward and outward.
Insertion. Into the upper bonier of the firsl rib below between the
tubercle and angle. In the lower Levatores costarum muscles there is a second
insertion to the second rib below its origin, thus where this is true each rib receives fibers from the transverse processes of the two vertebras.
Action. Muscle of inspiration.
Nerve Supply. Intercostal nerves.
Blood Supply. Intercostal arteries.


ANATOMY

460

IN A NUTSHELL.

LESSON CXLV.
The mediastinum
viscera except

the mil

the -pace

the thorax which contains

The anterior mediastinum

sto, I stand.

the sternum anteriorly

in

all

the thoracic

This word comes from two other words

the lungs.

ami

Idle,

is

and the pericardium

is

posteriorly.

medius,

the space between

contains the Tri-

It

angularis sterni muscle, parts of other muscles, lymphatic nodes, and areolar

The middle mediastinum

tissue.

cavity.

pericardiac

It

is

and the superior vena cava,

artery,

pericardium.

It

is

nearly the

same

i.e.,

as the

the parts of these which are within the

also has the phrenic nerves, the root of each lung,

The

phatic nodes.

the space which

contains the heart, the ascending aorta, pulmonary

posterior

mediastinum

is

and lym-

the space between the spine pos-

PLATE CCXLVIII.

EUSTACHIAN TUBE
PROC. COCHLEARIFORMIS.

CAROTID

'

PROMONTORY.

STAPES

^\

CANAL/

AQUEDUCTUS

COCHLEARIFORMIS

l^^EUSTACHIAN TUBE

ROTUNDA
CANAL FOR FENESTRA
-[<- q
PYRAMID.
TYMPANI.

C\\

TYMPANUM.

CAROTID CANAL.

FALLOPII

ANTRUM

%&Y

ANTRUM. \

MARROW

STYL0I0 PROCESS.

AQUEDUCTUS FALLOPII.

CELLS.

The Temporal Bone Laid Open.

teriorly

and the pericardium anteriorly.

It

contains the descending aorta,

the (esophagus, pneumogastric nerves, and

The superior mediastinum is the space which has in
front the upper pari of the sternum and the spine behind.
It is situated above
the pericardium and contains all the forty structures which pass through the
superior opening in the thorax except the apices of the lungs and the pleura'.
the azygos
thi

v< ins the thoracic duct,

splanchnic aerves.

For structures which pass through the superior opening

Name and

classify these

in

the thorax see page232.

forty structures.

LESSON CXLVI.
Muscles of the Superficial Abdominal Region.
Obliquus externus also called

Descending oblique.

Description.

This

ANATOMY

IN A NUTSHELL.

461

the most superficial and the largesl muscle

in the superficial abdominal

on the side and front part of the abdomen. The side of
the muscle consists of muscular fibers and its anterior part of aponeurotic
The aponeurosis of this muscle is strong but thin, and its fibers pass
fibers.
At the linea alba, or median line of the abobliquely downward and inward.

muscle

is

It is situated

region.

domen,

it

joins the aponeurosis of its fellow.

border of the Pectoralis major above and below

connected

It

is

its

attachment

to the lower
extends from

the anterior superior spine of the ilium to the spine of the os pubes ami theiliopectineal line, thus forming Poupart's ligament.

Okigin.
lower

The

From

the external surface and the lower borders of the eight

The attachment

ribs.

of the

of these digitations,

first five

digitations run

which increase

downward and backward.

in size

from above downward.

PLATE CCXLIX.
CANAL FOR JACOBSON'S NERVE
AQUAIDUCTUS COCHLEAR
CANAL FOR ARNOLD'S NERVE
JUGULAR FOSSA
VAGINAL PROCESS.
STYLOID PROCESS.
STYLO-MASTOID FOR AM E
JUGULAR SURFACE.

OPENING OF CAROTED GANAL.

QUAPLAT'L ROUGH SURFACE

TENSOR TYMPANI MUSCLE

LEVATOR PALATI

CANAL FOR EUSTACHIAN TUBE

AND,.TENSOR TYMPANI MUS.

STYLO-PHARYNGEUS
EMINENTIA

OCCIPITAL GROOVE.^
DIGASTRIC
FOSSA.

ARTICULARIS

The Inferior Surface of Petrous Portion of Temporal Bonf.

magnus musfrom above down-

are received between the corresponding processes of the Serratus

cle,

while the last three digitations which diminish

in size

ward interdigitate with processes of the Latissimus dorsi muscle.

Insertion. Into the anterior half of th( out< r lip of the cr< si of he
and into the aponeurosis of the muscle extending from the prominence
I

ilium,
of the

ninth costal cartilage to the anterior superior spinous process of the ilium.
Action. To compress the viscera. To flex the thorax on the pelvis or

to flex the pelvis on the thorax.

in

These muscles of the abdominal wall

and parturition.
Nerve Supply. Lower intercostals,
BLOOD SUPPLY. Intercostal and lumbar

assisl

micturition, defecation,

muscle

lies

arteries.

Description. This
Ascending oblique.
bfeneath the External oblique and is smaller and thinner than that

Obliquus interims, also

called

muscle.

Origin.-

From

the outer half of

Poupart's ligament, from the anterior

ANATOMY

462

IN A NUTSHELL.

lip of the crest of the ilium, and from the posterior

lumbar fascia.
Insertion. Those fibers which arise from Poupart's ligament arch downward and inward over the spermatic cord in the male and the round ligament
in the female, and arc inserted with fibers of the Transversalis muscle into the
The
cresl of the os pubes and the pectineal line to the extent of half an inch.
(unjoined tendon is formed by the joining of the Internal oblique muscle and the
The part of the muscle which arises from the
Transversalis just spoken of.

two-thirds of the middle

layer of the

anterior one-third of the middle lip of the crest of the ilium, passes horizontally

and

the linea semilunaris

at

aponeurosis in front of the

divides sending the lower one-fourth

it

Rectus muscle

of its

to be inserted into the linea alba,

while the upper three-fourths sends a layer of fascia in front of the Rectus

muscle to be inserted into tbe linea alba and a posterior layer to pass behind
the sheath of the Rectus muscle to be inserted into the linea alba also into the
That part of the muscle which passes obliquely
seventh, eighth. and ninth ribs.

upward

is

inserted in the lower border of the cartilages of the three lower ribs

PLATE
SUP.

CCL.

BORDER

^v
MEDIAN
BORDER.

I'

I'

.'/

SI-,

GROOVE
^'^BfcFOR NASAL NERVE. \*.*$&s^~

./

A?
The Nasal Bone.
where

it

is

continuous with the Internal intercostal muscles. The outer layer

is called the ligament of Hesselback. while the inner

of the conjoined tendon

layer

is

called the ligament of Henle.

Same as External oblique.

Nerve Supply.Lower intercostals.

A.CTION.

Uio-inguinal.

Blood Supply.

Intercostal

ilio-hypogastric,

and lumbar

and sometimes the

arteries.

LESSON CXLVIL
Internal oblique takes
Oniiiix.

its

This muscle which is placed beneath the

from
the direction of its fibers.
name

Transversalis.- Description.

From outer one-third

fourths of the inner

of

Poupart's ligament, anterior threeand inner surface of the car-

lip of the crest of the ilium,

tilages of the lower six ribs, interdigitating with the

from the lumbar

Diaphragm.

It also

comes

fascia.

Insertion.This muscle ends in a broad aponeurosis the lower part of

which joins the Internal oblique forming the conjoined tendon. The remain-

ANATOMY
iiig

IX A NUTSHELL.

463

part of the aponeurosis passes horizontally Towards the linea alba, but at

the linea semilunaris

passes behind the Rectus muscle blending with the pos-

it

terior layer of the Internal oblique.

Same as the External oblique.

Nerve Supply. Intercostal, ilio-hypogastric, and sometimes

Action.

Blood Supply. Intercostal

the

ilio-

inguinal.

and lumbar

arteries.

Rectus abdominis. Description. This muscle extends from the symIt is much broader and thinner above than
physis pubes to the sternum.
below and is separated from its fellow by the linea alba. The linea' transversa
There are three such
are tendinous intersections which cross this muscle.
One is situated opposite the umbilicus and one at the extremity of the
lines.
ensiform cartilage, and a third one between these two.

Occasionally one or
two additional lines may be seen. These lines are homologues of ribs. The
sheath of the Rectus muscle contains the Pyramidalis muscle and the superior
epigastric artery, the deep epigastric artery, anel the terminal branches of the
lower intercostal and lumbar arteries anel nerves.

PLATE CCLI.
LACHRYMAL
GROOVE \/wSjk

HAMULUS

The Lachrymal Bone.

Origin.

By two

heads. (1) the external or Larger head being attached to

the crest of the os pubes. (2) the internal one

covering the symphysis and interlacing with

Insertion.

Into

the cartilages of the

is

its

connected with the ligaments

fellow of the opposite side.

fifth, sixth,

and seventh

ribs,

and

occasionally connected with the costo-ziphoid ligaments and side of the ensi-

form cartilage.
Action. To compress abdominal viscera, and to flex thorax.
Xervk Supply. Lower intercostals.
Blood Supply. Intercostal, lumbar, deep epigastric and superior epigas-

tric

arteries.

Pyramidalis.

Description.

This

muscle

is

situated

in

the

same sheath

with the Rectus abdominis muscle in front of the lower portion of that muscle.
It may be absent on one or both sides, or it may be double on one side.
Origin. From front of pubic bone and anterior pubic Ligament.

Into the linea alba half way

To tense linea alba.

Insertion.

Action.

Nerve Supply. -Twelfth

to the umbilicus.

thoracic and ilio-hypogastric.


ANATOMY

464

IN A NUTSHELL.

By arteries the sheath of the Rectus.

Description. This muscle, which consists of

Blood Supply.

in

thin musular
those
of
the
continuous
with
Internal
which
are
oblique
and some
fasciculi
Trans
versalis,
descends
through
of
the
the
external
those
with
abdominal
times
ring from the front of the spermatic cord.
Origin. From the middle of Poupart's ligament.
Insertion. Into the crest of the os pubis and sheath of the Rectus.

Cremaster.

Action. To retract testicle.

Nerve Supply. Genital branch of the genito-crural.
Blood Supply. Spermatic artery.

PLATE

CCLII.

NASAL PROC

FQRSUP.TURBINAL.

RIDGE FORMID.TURBINAL.

MIDDLE MEATUS

ANTRUM

RIDGE FOR
NF.TURBINAL.

POST. PALATINE

ART WITH VOMER

GROOVE.
INF

ANT. NASAL
SPINE.

MEATUS

-CREST
PALATINE PROC.

ANT PALATINE
GROOVE.

The Internal Surface of Superior Maxillary Bone.

The

and insertion

muscle is similar to that of the lower fibers

is found in the male, but a few muscular
be seen on the round ligament of the female which correspond to

origin

of the Internal oblique.

fibers

this

may

of this

This muscle

muscle.

LESSON CXLVIII.
(1)

(2)
(3)
(4)

Muscles of deep Abdominal Region.

Psoas parvus which has been described on page 134.
Psoas magnus which lias been described on page 134.
Uiacus which has been described on page 135.
Quadratus lumboruni. Description. This muscle

sheath formed

l>v

the anterior

and middle layers

of the

is

lumbar

situated in

fascia.

On

the

ANATOMY

IN A NUTSHELL.

465

anterior surface of this muscle beneath this fascia are the last dorsal, ilio-hypogastric,

and

ilio-inguinal nerves.

The middle layer

of the

lumbar

fascia sep-

muscle from the Erector spinae. This muscle as its name implies
broader below than above.
quadrilateral,
is
Origin. From the ilio-lumbar ligament and the crest of the ilium for
about two inches. Occasionally a second portion of this muscle is found situated in front of the muscle, and when so found it has its origin from the upper
arates this

borders of the transverse processes of three or four lower lumbar vertebrae and
is inserted into the lower margin of the last rib.

Insertion.

Into the apices of the transverse processes of the four upper

lumbar vertebrae and into the lower border

of the last rib

for

about half

its

length.

Action.

To

draw down the

and acts as a muscle of inspiration.

and occasionally the second lumbar.
lumbar arteries.

last rib

Nerve Supply. Last dorsal,

Blood Supply. Intercostal and

first

LESSON CXLIX
used to name any thin expansion of tissue, and has
Serous membrane, which is the simplest of all
These serous membranes derive their name from the fact that they
forms.
The serous membranes are closed sacs,
are moist with a fluid like blood-serum.
such as the pericardium, pleura, and peritoneum. However, the peritoneum
in the female is an open sac.
(2) Synovial membrane which lines the joints.
This membrane secrets synovia, which resembles the white of egg. Under
synovial membrane we have three classes, (a) articular, which occurs hi joints,

The word membrane

the following classes:

found where the tendons of muscles run over bones, (c)

is a bag which is lined with synovial membrane and
placed between the tendon of a muscle and a bone, or two muscles, or two
tendons.
(3) Mucous membrane. The mucous membrane lines open cavities.
(4) Cutaneous membrane, which is commonly called skin.
The peritoneum is a serous membrane with a smooth shining surface. This
membrane is transparent, uncolored, strong, and moist. The peritoneum is
reflected from the abdominal walls and from pelvic walls over the viscera
The part which lines the
to invest and at the same time hold them in position.
abdominal and pelvic wall is called parietal or external peritoneum, and
(b)

vaginal, which

is

(1)

bursal.

is

synovial bursa

is called the visceral

were possible to separate the entire peritoneum
in the form of a large closed sac with a constriction a little above its center, thus forming the greater and lesser sacs of the
peritoneum. The passage way between these two sacs is called the foramen
OF Winslow. The foramen of Winslowhas above it the caudate lobe of the
liver, in front of it the lesser omentum, below it the duodenum, and hepatic
The lesser sac of the peritoneum
vessels, behind it the inferior vena cava.
lies back of and below the stomach and liver, while the greater sac lies in front
and below these viscera.

that which invests the viscera, to agreater or lessextent,

internal peritoneum.
from the body, it would be
or

If it

ANATOMY

466

IN A NUTSHELL.

meaning is stretched around) in the male forms a

tonus an open sac by means of the two Fallopian
It
It has an outer or parietal layer and an inner or visceral layer.
tubes.
abdominal
cavity
its
forms
and
in
viscera
of
the
development
of
the
mos1
lines
The lesser sac is in the greater omentum but the greater
folds and ligaments.
A fold of peritoneum going from the abdomsac is not in the lesser omentum.

The peritoneum

(literal

Ln the female

closed sac.

it

inal wall to the small intestine

is

called the mesentery.

fold of

peritoneum

going from the lesser curvature of the stomach to the transverse fissure of the
liver

called the lesser

is

omentum and

curvature of the stomach

to the

The greater omentum has four

in

a fold of

peritoneum passing from the

omentum. All other folds

The following eleven
(1)

Spleen,

(2)

liver.

(3)

is

omentum.

called the greater

which cannot be demonstrated

The lesser omentum has two folds in it. A

layers in

the adult but can be in the fetus.

fold of

peritoneum going from the greater

transverse colon
it

liver to the spleen

called gastro-splenie

is

peritoneum are called ligaments.

of

structures

stomach,

are
(4)

entirely
first

covered

portion

with peritoneum:

the

of

duodenum,

small intestine, (6) csecum, (7) transverse colon, (8) sigmoid flexure, (9)

(5)
first

portion of the rectum, (10) ovaries, and (11) the uterus.

The
creas, (2)

following six structures are entirely stripped of peritoneum, (1) pan-

kidney. (3) suprarenal capsule, (4) third portion of the rectum. (5)
and (6) lower portion of the vagina.

anterior portion of the bladder,

it

umbilicus and de-

(Plate CLI.) starting at the

Tracing the greater sac,

scending,

covers the anterior abdominal wall, reflected over the symphysis

pubis, over the posterior portion of the bladder, overthe uterus

and the anterior

up the pos-

surface of the rectum, forming a pouch called the pouch of Douglas,

terior

abdominal wall

it

reaches almost to the pancreas and there

it

is

reflected

towards the small intestine forming the posterior layer of the mesentery; surrounding the small intestine il passes up to the abdominal wall again, forming
the anterior laverof the mesentery

and thereit

is

reflected over to the transverse

from there

colon, forming the posterior layer of the transverse meso-colon;

ii

forms the fourth and first layers of the greater omentum, passing up to the stomach
ami from there over the anterior border of the stomach and continuing up to
the transverse fissure of the liver forming the anterior layer of the lesser

From

this fissure

ii

continues over the anterior portion of the

omentum.

liver,

forming

the suspensory ligament of the Liver, from there being reflected on the anterior

abdominal wall down

The

lesser

sac

to the starting point.

(Plate

CLI)

is

traced

from

the

posterior

surface

of

the liver, descending and forming the posterior layer of the lesser omentum.
being reflected over the posterior surface of the stomach and from there form-

and third Layersof the greater omentum and from there ascendand forming tli<' anterior laverof the transverse meso-colon up to the pos-

ing the second

ing

terior surface of the liver.

The peritoneum can be shown

at the umbilicus!

The functions
Lubricates

its

as a closed sac best

by

a transverse section

(Plate CL.)
of the

peritoneum are as follows:

adjacent surfaces.

(2)

it

(1)

It

secrets

absorbs any excess of

its

serum which

own

secretion

rOMY IX A XUT>HELL.

may

well as foreign material which

4 17

be introduce!

is

Ligatory such as

where
which
hind
organs
(5)
to the walls of the abdomen and conducts nutrient nerves and vessels to the
The transverse meso-colon is an example of this. (6) It is omental.
organs.
which means it binds one organ to another. An example the gastro-splenic
the falciform ligament of the liver. (4)
it

makes

a fold

it is

pilieate.as the plica epigastrica

over the episgastric artery,

it is

mi

An omentum may or may not contain nutrient

Nerve Slpply. The parietal peritoneum receives its

omentum.

the sympathetic through the gray rami commnnicantes.

toneum

receives

its

nerves and vessels.

nerve supply from

The

visceral, peri-

nerve supply from the solar plexus.

PLATE

CCLIII.

POST.

A-0RB1CULAR1S-

DENTAL CANALS

T- INCISIVE TOSSA.

PALPEBRARUM

P-ARTIC.WITH LACHRYMAL

U-CANINE FOSSA.

B-TENDO-OCULI.

0- INFRAORBITAL GROOVE.
R -MALAR PROC.

V- CANINE FMINENCE.

W-OBRITAL SURFACE.

S -ALVEOLAR PROC.

X- FACIAL SUREACE.

C-LEV.LADU

SUP.

AL/tQUE-NASI. /:/*

Y ZYGOMATIC SURFACE

D-INF.OBUQUE.

^A

E-LEV.LABII-

Z-TUBEROSUY.

SUPERIORIS

F - LEV. ANG.

ORIS.

G- COMPRESSOR
MARIS.

H- DEPRESSOR
ALAl-fJASl.
I

MASSETER.

BUCCIN-

ATOR.

K- NASAL

PROC
L

-NASAL
NOTCH.

M-NASAL
SPINE.

N- NUTRIENT FORAMINA.

External Surface
Blood Supply. The

>f

Superk

Maxill \ky

parietal peritoneum receive-

the intercostals, phrenic, lumbar, circumflex

The

iliac,

its

B< >ne.

blood supply from

and deep epigastric

arteries.

peritoneum receives its blood supply from the gastric, hepatic

These latter arteries nourish organs.
renal, ami mesentery arteries.

visceral

splenic,

LESSON

CL.

The kidney (Plate CCLXVI) belongs to the urinary system, which has
but one function, that of elimination, while the alimentary system has two
functions, appropriation

situated between

and elimination.

the spinous processes

<<\

The kidney

is

bean-shaped ami

is

the eleventh dorsal and the third

ANATOMY IN A NUTSHELL.

468

right kidney is a little lower than the left one on account of the
above the kidney on the right side. The scar, or the point where
the vessels enter and leave the kidney is on the inner border, about its middle.
Its vessels bear this relation to one another, the renal vein, renal artery, and the
The kidney is entirely stripped of peritoneum.
ureter, from before backward.
It has above and in front of it the suprarenal capsule which has something to
do with the pigmentation of the body and is considered by some as belonging
The kidney has the following dimensions,
to the sympathetic nervous system.
four and three-fourths by two and one-half by one and three-fourths inches.
Its nerve supply is from the renal plexus
It weighs from four to six ounces.
which comes from the solar plexus. Its blood supply is the renal, suprarenal,
The right renal vein contains the purest blood in the
spermatic, and Lumbar.

lumbar.

The

liver being

body.

The outer

portion of the kidney

The kidney

medullary portion.
like a

bunch

of grapes;

it is

is

called cortex, while the interior

is

called

and someof the lower animals looks

individual lobes; the point where these

in the fetus

made up

of

lobes coalesce entirely disappears in the adult kidney, giving the appearance

one solid body. The physiolological kidney consists of the uriniferous tubules.
These are about one-half million in number and would be fifteen miles in length
This uriniferous tubule consists of (1) a capsule or head,
if placed end to end.
(2) neck, (3) spiral portion, (4) descending portion, (5) loop, (6) ascending
portion, (7) distal spiral portion, (8) convoluted portion, (9) irregular portion,
(Plate CCLXV.)
The
(10) arched portion, and (11) a descending portion.
capsule, or Malpighian body, takes from the blood the water and lesser salts,
The
while the rest of the tube takes the more important salts from the blood.
medullary portion of the kidney consists of Malpighian pyramids, eighteen or
twenty In number, with the apex towards the hilum of the kidney. The apex
consists of infundibula, and the infundibula make the calices, the calices form

of

Between these pyramids is

same as the cortex of the outer portion of the kidney, but has a
That part of the uriniferous
special name, called the column op Bertin.
tubules consisting of a straight portion and the two spiral portions form what
is called the medullary ray, or the pyramids of Ferrein, the base of the
pyramid is on the base of the Malpighian pyramid and the apex is towards the
The uriniferous tubules in the cortex form what is called the
periphery.
the pelvis and the pelvis opens into the ureter.
cortex, the

labi rinth.

The relations of the right kidney.

Above. Suprarenal capsule.
Ix Front.
(1) Suprarenal capsule, (2) Liver,

cending colon,

Bihim).
(4)

(5)

Jejuno-ileum.

(1)

The

Psoas magnus.

last

rib,

(2)

Diaphragm,

(3)

(3)

Duodenum,

(4)

As-

Quadratus lumborum,

(Plate VIII.)

The relations of the left kidney.

Above.

Suprarenal capsule.
Suprarenal capsule,

In Front.

(1)

creas, (5) Splenic flexure, (6)

(2)

Spleen,

Descending colon,

(7)

(3)

Stomach,

Jejuno-ileum.

(4)

Pan-

'

ANATOMY
Behind.

The

(1)

last

rib,

469

IN A NUTSHELL.

(2)

Diaphragm,

(3)

Quadratus Lumborum,

(Plate VIII.)
Psoas magnus.
The organs of the urinary system are, (1) the two kidneys, which form the
urine from the materials furnished by the blood; (2) the ureters, which con-

(4)

vey the urine away from the kidneys; (3) the bladder in which the urine is
it is discharged, and (4) the urethra, a tube through which the
urine passes from the bladder.
The kidney is a glandular structure whose function is the purification of
It is held in position by its vessels,
the blood by the excretion of the urine.
This fatty tissue forms the
the peritoneum and the abundant fatty tissue.

stored until

" adipose

capsule.

The hilum

'

of the kidney

is

the place on the median side of the kidney.

corresponding to the place of the scar on the bean. It is where the ureter goes
out and the vessels and nerves enter. The capsule of the kidney is a smooth

membrane

and forming its outer coat.

one which has become loose and displaced hi the abdomen. Surgical kidney is a term somewhat loosely applied to nephritic conditions, secondary conditions to mischief farther down in the urinary tract, but
fibrous

closely investing the kidney

Floating kidney

is

especially to suppurative pyelonephritis arising

The

pelvis or sinus of the kidney

The

of the kidney.

calices of the

is

from

cystitis.

the concavity or re-entrance at the hilum

kidney are cup-like or infundibuliform be-

ginnings of the ureter in the pelvis of the kidney surrounding the apices of the

Malpighian pyramids, each usually receiving more than one pyramid.

There

and uniting in the infundiThe infundibula of the kidney

are from seven to thirteen such calices, converging

which

bula,

in

turn combine to form the pelvis.

are, (a) the calices; (b) the

two or three main

divisions of the pelvis of the

kidney formed by the confluence of the calices.

The apices of the Malpighian pyramids, also called mamillae, are the
The Malpighian pyramids are pale-reddish conical
papillse of the kidney.
masses forming the medullary part of the kidney, whose apices project into the
The Malpighian
calices of the pelvis of the kidney, and are called papillae.
corpuscles or bodies are the glomeruli of the kidney surrounded by its capsule.
These form the terminations of the branches of the uriniferous tubules, occur
in the cortical substance of the kidney, and are about in ,,,, of an inch in diameter. They are formed of the expanded end of the tube invaginated by the
bunch of blood vessels constituting the glomerulus which thus are embraced
in a double epithelial sac, and the blood is separated from the lumen of the
1

tubule by the vascular wall and the epithelium of the inner layer of the capsule.
The Malpighian tuft is the glomerulus or vascular network or plexus in a

Malpighian body.

Marcello Malpighi (1628-94) was an Italian anatomisl and

physiologist.

The

cortical substance of the

kidney

is

the outer part of the kidney sub-

The columns of Bertin are named after

French anatomist (1712-81). They are the prolongations in-

stance which contains the glomeruli.

E. F. Bertin, a

ward

of the cortical

substance of the kidney between the pyramids.

AX ATOMY

470

The tubes

make

of Ferrein

IX A NUTSHELL.

the pyramids of Ferrein.

They

are in help

to

the cortical substance and are convoluted. The pyramids ofFerrein are formed
by bundles of straight and convoluted renal tubules which constitute the medul-

named on account of their radiation from the medulla.

The tubes of Bellini are the excretory tubes opening on the papilla.

lary rays, so

They

are straight tubes.

The tubes of Henle connect those

of Bellini

and Ferrein.

They are looped

tubes.

The capsule

of Muller

is

the dilated extremity of a tube of Ferrein

invest-

ing the Malpighian tuft probably by two layers, similar to the pleural invest-

ment

the

of

lung's.

PLATE CCLIV.

MASSETER

Internal Surface of the Malar Bone.

The nerve SUPPLY

to the

kidney

is

from the renal plexus which

is

formed

by filaments from the solar plexus and the lesser splanchnic nerve.

The blood supply

(vessels carrying to),

The

vascular.

is

(1>)

from the renal artery and renal vein,

efferent vessels (carrying from).

(a)

Afferent

The kidney

is

very

up between the pyramids of Malbases into cortico-medullary arches which lie be-

larger arterial branches run

pighi to subdivide

their

a1

tween the cortex and medulla, giving off arterioles in both directions, the cortical branches supplying afferent twigs to the glomeruli within the capsules of

Bowman.
The medullary branches running inwards
and looped tubules

straight
of the

Malpighian glomeruli form

tubule- and terminate

The

in

form plexuses around the

capillary plexus

The

efferent vessels

around the uriniferous

renal veins.

surface of the kidney receives small arteries which pass through the

fatty capsule from the suprarenal, spermatic,

ficial

to

of the Malpighian pyramids.

veins appear

in

the form of

little stellate

and lumbar

vessels

.The super-

groups (stars of Yerhayen) which

ANATOMY

IN A NUTSHELL.

471

communicate with the venous plexus in the adipose capsule and by means of
These vein> are very disthis with the visceral and parietal veins close by.

when the organ is congested.

The renal lymphatics may be divided into two sets, capsular and parenchymatous. They terminate in a series of glands lying with the renal vessels in
the subperitoneal tissue, and their contents are ultimately conveyed into the
tinct

receptaculum

chyli.

LESSON
The

(Plate VIII.)

ureter

ney to the blader

in

a tube conveying the

is

mammals,

CLI.
urine from

the kid-

or into the cloaca in case no bladder exists.

The human ureter is a slender tube from fifteen to eighteen inches long running
from the pelvis of the kidney to the base of the bladder, at the posterior angle
It is behind the peritoneum and rests upon the Psoas muscle.
of the trigonum.
Its structure includes (1) a fibrous coat. (2) longitudinal and circular
muscular fibers, and (3) a lining of mucous membrane with vessels and nerves
from various sources. The ureter pierces the wall of the bladder very obliqueIt runs for nearly an inch behind the muscular and mucous coats of the
ly.
bladder.

Blood Supply.
\

(1)

The

(1)

Inferior mesenteric.

renal,

(2)

Spermatic.

(3)

Internal

iliac,

and

Inferior vesical.

Nerve Supply.

Spermatic plexus,

(2)

(3)

Pel-

vic plexus.

The bladder
It

(3)

the reservoir in which the urine

is

has four coats.

(1)

the mucous, which

the muscular, and

(-4)

is

The trigonum

the serous.

area at the base of the bladder, whose apex

and whose other two angles are

collected from the ureters.

is

nearest the cavity. (2) the areolar.

is

at the

is

a triangular

space or

beginning of the urethra.

at the point of entrance of the ureters into the

bladder.

When

the bladder

that a sagittal section

is

collapsed

shows the

its

line

mucous

walls

fall

between them

in

together

in

such

the shape of a

way
with

unequal and widely spread arms, the point of the V indicating the opening of
It> capacity is about
Its dimensions are three by five inches.
the urethra.
a pint.
In the child the bladder is almost an abdominal organ, while in the
adult

it

is

in

the pelvis.

The urachus
the umbilicus.

is

It

a fibrous

represents

cord extending from the fundus of the bladder to

in

the adult a part of the sac of the allantoic and

have been obliterated.

is constituted by
bo much of the allantoic sac and hypogastric arteries a- becomes impervious,
the section remaining pervious being the bladder and superior vesical arteries.
It sometimes remains pervious, as a malformation, when the child may urinate
associate allantoic vessels of the fetus,
It is

l)v

whose

cavities

that intra-abdominal section of the navel-string which

the navel.

ANATOMY IN

472

NUTSHELL.

A.

most vertebrates, developing as a sac

It is one
uf the organs of the embryo of all amniotic vertebrates, or those which develop
an amnion, but is wanting or is most rudimentary in amphibians and fishes,
In birds and reptiles it is large and perforins a respiratory function, and in
mammals contributes to form the umbilical cord and placenta. Its exterior

The

allantois

is

a fetal

appendage

of

or diverticulum from the posterior portion of the intestinal cavity.

primitively consists of mesoblast,

its

cavity receiving the secretion of the pri-

So much of the sac as remains pervious

within the body of the embryo becomes the urinary bladder, or in some degree
mordial kidneys (Wolffian bodies).

urinary passage.

The

umbilical arteries and veins course along the elongated stalk of the

which becomes the umbilical cord, and that part of these allantoic vessels
within the body which does not remain pervious become the urachus and round

sac,

Ligament of the

liver.

of the allantois, in most mammals, unites with

form
placenta.
In those vertebrates, as mammals, in which
the
the chorion to
umbilical
period of activity, the allantois chiefly
has
but
a
short
the
vesicle
the
functions
whereby
the
fetus
is nourished by the blood of the mother
sustains
and has its own blood arterialized. In parturition, so much of the allantois

The expanded extremity

as

outside of the body of the fetus

is

is

cast

off,

the separation taking place at

the navel.

The uvula

vesica?

is

bladder into the cystic

The

a slight projection of

orifice of

mucous membrane from the

the urethra.

middle and inferior vesical and

and vaginal also; its veins are radicles of the internal
iliac.
The Lymphatics accompany the veins and terminate in the internal iliac
The nerves are derived partly from the sympathetic system through
gland.
the hypogastric plexuses, partly from the cerebro-spinal system through the
third and fourth sacral nerves.
The former supply the mucosa, the latter of
in

arteries of the bladder are the superior,

the female the uterine

the muscularis.

The bladder is held in place by ligaments which are divided into true and
The true ligaments are five in number; the two anterior, two lateral,

false.

and the urachus (superior). Tin: false ligaments, also five in number, are
formed by folds of the peritoneum. The false are named the two posterior,
two Lateral and superior.

LESSON
The word urethra
which means

(Plates

to urinate.

CLII,

CCLXXII-CCLXXIX)

The male and female

is

derived from the Greek

urethrae differ.

It is

a modifica-

ora groove for the discharge of

the secretion of the genital <>r urinary organs or both; in most mammals, including man, a complete tube from the bladder to the exterior, conveying urine
and semen in the male sex. urine only in the female: in some birds a penial
groove for the conveyance of semen only. The urethra in the male is always
tion of a pari of a uro-genital sinus into a tube

a part of the penis, or penial urethra,

continuous usually with the urethral part

ANATOMY

IN A NUTSHELL.

of the urogenital sinus; that of the female

clitoris.

In

man

prostatic,

tions of

only exceptionally a part of the

is

the urethra extends from the bladder to the end of the penis,

usually a distance of eight or nine inches.

the

473

the membranous,

which are essentially

The male urethra has

the spongy

different.

the

three portions

and the

structures

rela-

Except during the passage of the

urine or semen the urethra

is a mere transverse cleft or slit with its upper and

At the orifice of the urethra, at the end of the penis.
the slit is vertical and in the prostatic portion somewhat arched. The prostatic portion is one and one-fourth inches long, the membranous three-fourths
of an inch long, and the spongy four and one-half inches long.
The first and
second portions are not subject to any physiological changes such as character-

under surfaces

in contact.

ize the third.

PLATE CCLV.

FRONTAL PROC.

TEMPOROMALAR
CANALS.

7YC0MATIC PROC.

LEVATOR
l.ABU SUP.

ZYG0MAT1CUS

ZYGOMATICS 'M1N-

MAJ.

External Surface of Malar Bone.

The urethra has three
of the urethra

iosum of the

is

coats,

mucous, muscular, and

The bulb

erectile.

the posterior enlarged rounded extremity of the corpus spong-

penis.

The crista urethra is the crest of the urethra; a longitudinal fold of mucous
membrane and subadjacent tissue on the median line of the floor of the prosabout three-fourths of an inch in length and one-fourth of an
it is greatest.
On the summit open the ejaculatory duct-.
It is also called colliculus seminalis, caput galliaginis, and veruinontanum.
The prostatic sinus is a longitudinal groove in the Hoor of the urethra on
each side of the crest, into which the prostatic ducts open.
tatic urethra,

inch in height where

The
its

pocularis sinus

is

a small cul-de-sac, from

quarter

greatest diameter, situated at the middle of the highest

of the urethra.

It

to hall'

an inch

in

part of the crest

corresponds with the uterus of the female.

Also called

prostatic vesicle, utricle, uterus masculinus.

The semilunar ducts open on

margins of the sinus pocularis.

Cowper's glands (Plate (VLXXIX) are

pair of accessory

urethral glands of lobulated or follicular structure which pour a

the

prostatic or

mucous

secre-

ANATOMY

474

IN A NUTSHELL.

In man they arc small. about the size of a pea, Lying betion into the urethra
neath the membranous portion of the urethra, close behind the bulb and emptyTheir size, shape, and position vary
ing into the bulbous portion of the tract.
in different animals, in some of which they are much more highly developed

than

man.

in

is (a) a recess in the urethra, near the urinary meatus,

where the caliber of the tube is enlarged. (1) A depressed space between the
posterior commissure of the vulva and the fourchette.

Tlie tossa navioularis

The lacuna magna

the Largesl

is

of

several orifices of

mucous

follicles,

situated on the roof of the fossa naviculars.

The glands of Littre are the crypts along the spongy portion of the urethra.
The prostate ("standing in front") is a glandular body situated around the
initial

tion,

portion of the urethra.

and

in

It

develops

puberty, atrophies after castra-

at

certain animals increases in size during the breeding season.

The female urethra

bladder and ends

is

meatus urinarius Lnternus

a tube beginning at the

meatus urinarius externus in the vulva. It is

about one ami one-half inches long, imbedded in the anterior all of the vagina.
perforating the triangular ligament, and surrounded by the fibers of the ComIts diameter is about one-fourth inch, but it is capable
pressor urethrse muscle.
of considerable dilatation, being surrounded by softer structures than those
around the male urethra. When dilated far beyond its usual calibre it does
at the

in the

not lose

its

tone.

LESSON
The

meaning

CLIII.

tumor formed by the dispart which has escaped from its natural cavity
branch.

It

by some aperture and projects externally.

It

literal

of hernia

placement and protrusion of a

We may

mean hernia

When we

in

some part

the inner wall of the

of the viscera

tin'

femoral
'4.

Ci;i

through

natural or accidental

abdomen, the external skin generally remaining

The following are some

Cerebral hernia, which is

2.

sometimes called rupture.

speak of hernia without any qualification, we

is the most common form, consisting

unbroken.
ing in

is

of the abdomen, and this

of the protrusion of

1.

is

have hernia of the brain and of the coverings of the cord, of the thorax.

or of the abdomen.

aperture

is

of the
a

forms of hernia:

protrusion of the brain through an open-

cranial walls.

RAL HERNIA or FEMORAL HERNIA

is

hernia descending beside the

vessels.

Direct inguin

\i.

hernia

is

hernia of the intestine or

omentum which

descends through the inguinal canal: but uo1 through the internal abdominal
ring having broken into the canal below this ring in Hesselbach's triangle.
4.
is

Tin: [NDIRECT or OBLIQUE [NGl [NAL HERNIA

is

a hernia

whose course

thai of the spermatic cord through the ingiunal canal.

5.

6.

LUMBAR HERNIA is a hernia in the loins or lumbar region.

Phrenic hernia i- a hernia projecting through the Diaphragm

one of the pleural

cavities.

into

ANATOMY
7.

Strangulated hernia

475

IN A NUTSHELL.

compressed

a hernia so tightly

is

some part

in

has been protruding as not to be reducible by

ordinary means, as by the application of pressure and tointerfere with the cirof the channel through

which

it

culation in the protruding part.

8.

Umbilical hernia

is

henna

of the intestine at the navel.

It is

called

exomphalos.

The following are the principal causes of hernia:

diminishes the abdominal cavity.

1.

Tight lacing, because

2.

Crying and fretting, bronchitis, asthma, cough.

3.

Deposit of fat in the

it

omentum because

it

volume and

increases the

weight of the parts within.

4.

Pregnancies because of the stretching of the abdominal walls.

5.

Straining in defecation.

6.
7.

Phimosis because of the straining to expell the urine.

Feats of strength as in lifting heavy weights.

8.

Men have

larger inguinal rings,

women have

a larger femoral arch, so

sex has something to do with the kind of hernia.

0.

10.

Presence of the spermatic

cor,

I.

Deficiency of some of the layers below.

11.

Persistence of the original process of the peritoneum.

12.

long mesentery.

The inguinal canal

is parallel to Poupait's ligament and just aboveit, exIt

tending from the internal abdominal ring to the external abdominal ring.
is about an inch and a half long.
This is a potential canal, but for a short time

months

in the later

of fetal life

it

a real canal.

is

The spermatic cord

in

the

Its
male and the round ligament in the female pass through this canal.
direction is downward, forward and inward.
The relations of the inguinal canal.
In Front.
(1) Skin. (2) Superficial fascia. (3) External oblique muscle
for all the way, (4) Internal oblique muscle for the outer third of the canal.

The union of the transversalis

The conjoined tendon.

Below.

Behind.

lar fascia, (4)

(1)

(2)

Subperitoneal tissue.

fascia with Poupart's ligament.

Transversalis fascia,

(3)

Triangu-

Peritoneum.

(5)

Above. Arched fibers of the Internal oblique and Transversalis muscles.

The COVERINGS OF THE [NDIRECT nii oblique inguinal hernia from
within outward ark:
1.

Peritoneum, which

2.

Extra-peritoneal

3.

Infundibuliform fascia, which

4.

Crematseric fascia, which

5.

Intercolumnar

6.

Two

7.

Skin.

is

fat.

fascia,

the proper hernial sac.

This

is

which

inappreciable.

from the internal abdominal

from the inguinal canal.
Ls

is

from the external abdominal

ring.

ring.

layers of superficial fasica.

The coverings of the direct

are:

almost

is

[ngi enal

hernia from within outward

ANATOMY

476
1.

IN A NUTSHELL.

Peritoneum.

2.

Extra-peritoneal

.'>.

Transversalis fascia.

4.

Conjoined tendon, which takes the place of cremasteric fascia in

fat.

the-

indirect hernia.
5.

Intercolumnar

fascia,

which takes the place

of infnndibnliform in the

indirect hernia.
6.

Two

7.

Skin.

layers of superficial fascia.

PLATE

CCLVI.

CORONOID
PROC.

A-MASSETER.

B-BUCCINATOR.
C-LEVATOR-MENTI.
D-DEPRESSOR-LABU-

INF.

E-DEPRESSOR-ANGULI-ORIS

F-PLATYSMA-MYOIDES.
G-

MENTAL

m/A

MENTAL FORAMEN.

'

PROC.

groove for facial artery.

External Surface of Inferior Maxillary Bone.

The

XV) is a potential opening in the aponwhich is made by the divergence of two

The size of this opening varies on account of the strength of
of its fasciculi.
It is about an inch long and half an inch wide.
its sides or pillars.
It is situated above and to the outer side of the crest of the os pubis. The spermatic
cord in the male and the round ligament in the female passes through this
opening to pass from the abdomen.
The relations of the external abdominal ring.
Above. A series of curved fibers called the intercolumnar.
external abdominal ring (Plate

eurosis of the External oblique muscle

Below. The crest of the os pubis.

On Either Side. Columns or pillars

of the ring.

ANATOMY
The

IN A NUTSHELL.

internal abdominal ring (Plate

XV)

477

situated about half

is

way between

the anterior superior spine of the ilium and the symphysis pubis.
half an inch
is

above Poupart's ligament and

also a potential opening.

This

is

much

It Is

about

in the transversalis fascia.

This

larger in the male than in the female.

The relations of the internal abdominal ring.

Above and Externally. Arched fibers of the Transversalis
Below and Internally. Deep epigastric vessels.

muscle.

The spermatic cord in the male and the round ligament in the female pass
through this opening.
Gimbernat's ligament is about a half an inch in length and larger in the
male than in the female. In the erect posture it is almost horizontal in direction with its base directed outward, it being triangular in form.
It is derived
from the External oblique muscle and is reflected downward and outward from
the spine of the os pubis to be inseretd into the pectineal line.
Its anterior
margin is continuous with Poupart's ligament.
The

triangular ligament of the

pectineal line where

it

it is

abdomen

is

attached by

its

apex to the

continuous with Gimbernat's ligament.

From

there

passes inward beneath the spermatic cord behind the inner pillar of the ex-

ternal

abdominal ring and

where

it

Poupart's ligament
of the

abdomen and

the conjoined tendon to the linea alba

is

crural

formed by the

fascia of the External oblique

muscle

passes from the anterior superior spine of the ilium to the

This ligament

spine of the os pubis.

called

in front of

joins its fellow.

lies

beneath the spermatic cord and

is

arch.

LESSON CLIV.
Femoral hernia passes below Poupart's ligament and passes down towards
the saphenous opening in the femoral or crural canal.

opening

it is

called complete,

The coverings of
1.

Peritoneum.

2.

if it

does not

it is

If

it

passes through this

called incomplete.

a femoral hernia from within

outward are:

5.

Subserous areolar tissue, called the fascia propria of Cooper.

Septum crurale, which is from the femoral ring.
Crural sheath, which is from the transversalis fascia.
Cribriform fascia, which is from the saphenous opening.

6.

Superficial fascia.

7.

Skin.

3.
4.

The femoral sheath

The outer one

is

Its superficial layer.

is

funnel-shaped and has three compartments

for the femoral artery.

THE MIDDLE ONE

and the internal one for the femoral canal.

The femoral canal is about three-fourths

The relations of the femoral canal.

Transversalis

fascia.

it.

(Plate XVI).
of an inch Long

the femoral ring above to the saphenous opening below.

In Front.

in

tor the femora] vein,

and extends from

ANATOMY

178

Behind.

Kvn

fascia.

Iliac

i;\ \i.ly.

Internally.

IN A NUTSHELL.

septum between

Gimbemat's

it

and the

vein.

ligament and the meeting of the

fascia

iliac

and the transversalis fascia.

The femoral ring is the upper opening of the femoral canal and is oval
It is larger in women.
shaped about half an inch in diameter.
The relations of the femoral ring.
I.\ Front.
Poupart's ligament and the deep crural arch which is a thick-

ening of the transversalis fascia.

Behind. The Pectineus muscle and the ilio-peetin'eal line.

[ntern u.i.y. Gimbernal 's ligament.
Extern u.i.v.- Femoral vein.
It
is closed by the septum crurale. which is composed of fatty connective
tissue and is perforated by lymphatics passing from the superficial to the deep
On the upper and outer angle
There is a small lymphatic gland here.
group.
of this ring is the deep epigastric artery.
On the upper and inner margin is
the obturator artery, when it arises from a common trunk with the deep epi-

gastric artery

which

does

it

about thirty per cent of the cases.

in

The coverings of the umbilical hernia are:

1.

Peritoneum.

2.

Extra-peritoneal fatty tissue.

3.

Transversalis fascia.

4.

Prolongation of scar tissue of the umbilicus stretched out.

0.

Superficial fascia.

(i.

Skin.

Congenital hernia (Plate

CCLXXXVIII)

place from birth or during any period of

occurrence existed

at

birth.

applied to hernia which takes

if

the conditions favorable to

life,

is

The vaginal portion

not close after the descenl of the testicle in the fetus,

is

a hernia

parietal

and

in this

case

when

its

may

of the tunica vaginalis

there

the intestine does not push forward a sac which comes from the

layer of the peritoneum, but instead

which

lies

it

a sac formed

in

by the

These
forms of hernia ate called congenital and are always oblique.
The following are the different kinds of congenital hernia:

tunica

1.

vaginalis

Hernia

in

is

still

the tunica

connected with the peritoneal cavity.

vginalis testis.

hernia the intestine surrounds the testis

In this form of congenital

and the sac

is

formed by the tunica

narrow canal which

vaginalis testis, because the intestine passes through the

is

present between the cavity of the peritoneum

tis,

the original communication between

2.

this

Hernia

form

in

them

is

and the tunica vaginalis

tes-

not obliterated.

the funIcular portion of the tunica vaginalis. In

henna the sac is formed by the original pouch of the

of congenital

peritoneum which descends with the testicle but is shut off from the tunica
vaginalis testis by a thin septum.
The canal above this septum being still
presenl and communicating with the peritoneal cavity.

Infantile hernia. This form of congenital hernia is rare and is produced by the descent of the hernia through the internal abdominal ring but
'.].

ANATOMY

IN A NUTSHELL.

479

behind this abnormal extension of the tunica vaginalis,

in this case there arc

three layers of peritoneum in front of the hernia, two of

them

tunica vaginalis and the third from the sac around the hernia.

may

hernia the tunica vaginalis testis

arc from the

In this

form of

pass up as high as the internal abdominal

ring.
4.

and

is

Encysted hernia. This is the rarest of all forms of congenital hernia

formed by the hernia pushing the closing septum of the internal abdom-

inal ring as a

diverticulum into the unclosed tunica vaginalis.

PLATE CCLVII.
MUSCLES
PTERYGOID

A-EXT.

GROOVES

LIG'MTS.LTr.

J-MANDIBULAR SPINE.

B-INT. PTERYGOID

K-

C-TEMPORAL.
D-BUCCINATOR

L-SPHENO-MAND'R

MANDIBULAR FORAMEN
LIG'MT.

M-STYLO-MAND'R LIG'WT

E-SUP. CONSTRICTOR. N-GROOVE FOR SUBMAY'Y GLAND.

F-MYLO-HYOID.

O-GR00VE FOR SUBLING'L GLAND

G-GENI0-HYO-GL0SSUS.P-MYLO-HYOID GROOVE

H-GENIO-HYOIDEUS.

3-MYLO-HYOID RIDGE.

R-CAPSULE.

Internal Surface of Inferior Maxillary Bone.

LESSON CLV.
Veins.

Every vessel that Leaves the heart

enters the heart

is

called a vein.

is

called an artery,

and every

vessel thai

Arteries, as a rule, carry pure blood, while

the veins carry impure blood bu1 there are exceptions to each of these cases.

The pulmonary
pure blood.

As

arteries carry
a general

impure blood while the pulmonary veins carry

thing veins have valves and arteries do not have

valves, but there arc exceptions to tins rule, for the

valve and the pulmonary veins do not have valves.

three coats,

around

it

and the middle coai

pulmonary artery has

like that of the artery lias

but not so well developed as

in

the arteries.

Veins, like arteries, have

sympathetic

fibers

ANATOMY

480

IN A NUTSHELL.

The veins of the dura mater of the brain are called sinuses, also cavities in
bones arc called sinuses. After the blood has left the heart by way of the
arteries and nourished the entire body, it comes back to the heart by means of
We have a pulmonary venous system and a systemic venous system.
veins.
The

have been described on page 117 and the veins

have been described on page 192. We will now give the

veins of the upper extremity

of the lower extremity

remaining veins of the body.

Tin: Veins ok
1.

The

the Exterioe of the Head and Face.

frontal vein passes

down

canthus of the eye, after which

fellow of the opposite side which
cate with the temporal veins.

2.

which

The

Plate

supraorbital vein

it

the middle of the frontal bone to the inner

called angular.

is

by

joins

with its
branch just before it

It lies parallel

a transverse

At their beginning the frontal veins communiAt the inner angle of the orbit they receive the

reaches the root of the nose.

the supraorbital veins.

it

CXV.

lies

on the forehead externally to the frontal vein

form the angular vein at the inner angle of the orbit.

3. The angular vein passes from the inner canthus of the eye where
formed by the two veins just mentioned and passes to the base of the nose.
it

joins to

radicles are (a)

it is

Its

and (d) nasal,

the facial, which passes

supraorbital, (b) frontal, (c) superior palpebral,

4. From the base of the nose this vein continues as

under the Zygomatici muscles and over the anterior border of the Masseter
muscle in a groove on the inferior maxillary bone. From here it passes into

the internal jugular after communicating with the external jugular.

angular, (b) inferior palpebral,

cles are (a)

anterior internal maxillary (deep facial),

(f)

buccal, (g) masseteric, (h) labial,

tonsillar,

(i)

(e)

(c)

dorsal

and

Its radi-

lateral nasal, (d)

coronary (superior and inferior),

submental,

(j)

ascending palatine, (k)

glandular (parotid and submaxillary), (m) part of the temporo-

(1)

maxillary.
5.

Temporal vein

is

formed. by the anterior temporal and posterior tem-

from the side and the vertex of the head and

above the zygoma, passesover the zygoma to be situated in front
of the ear between the condyle of the jaw and the external auditory meatus.
It now passes in tn the substance of the parotid gland where it receives the internal maxillary vein to form the temporo-maxillary vein.
The radicles of
this vein are (a) anterior temporal, (b) posterior temporal, (c) middle temporal,
poral which collects the blood

after uniting

(d)

parotid, (e) anterior auricular,

6.

The

internal maxillary vein

transverse facial.

(f)
is

formed by

radicles

which correspond to

branches of the internal maxillary artery.

These radicles form the
pterygoid plexus of veins, and this plexus of veins communicates with the facial

the

vein by the anterior internal maxillary vein or deep facial.

The temporo-maxillary

formed by the temporal and internal

At the angle of the jaw
it joins the posterior auricular to form the external jugular.
It may however,
divide into an anterior branch which joins the facial vein and a posterior branch
which joins the posterior auricular to form the external jugular.
7.

maxillary veins

in

vein

is

the substance of the parotid gland.

ANATOMY

IN A NUTSHELL.

4S1

S. The posterior auricular vein conies from a plexus on the side of the head
and hack of ear. It receives the stylo-mastoid vein and branches from the

external ear.

The

joins the temporo-maxillary to form the external jugular.

It

formed from

hack part of the vertex

It passes over the
suboccipital triangle under theComplexus muscle where it communicates with
It empties into the internal jugular as a rule, hut occasionthe vertebral vein.
9.

occipital vein

of the skull.

It

is

is

a plexus at the

placed deeply between muscles of neck.

ally into the external jugular.

The Veins of the Neck.

1.

The

CXV.)

(Plate

external jugular vein collects the blood from the

the cranium and the deep part of the face.

of the temporo-maxillary trunk

It is

and the posterior auricular veins

From

stance of the parotid gland at the angle of the jaw.

down beneath

exterior part of

formed by the junction of pari

muscle and ends near the clavicle

Sometimes

the subclavian vein.

in

It

about an inch and

a half

The upper

called a sinus.

is

above the

nation into the subclavian vein.

it

empties

The portion

of

pair of valves

is

lower pair

clavicle, while the

at its

is

temi-

Its radicles are (a) posterior external jugular,

(b) suprascapular, (c) transverse cervical, (d)

frequently the anterior

jugular.

posterior external jugular vein receives the blood from the integu-

ment and muscles

region.

occipital

passes

has two pairs of valves which do not prevent

the regurgitation of blood, as they are not complete valves.

the vein between the two valves

The

it

the Platysma myoides muscle over the Sterno-cleido-mastoid

into the internal jugular vein.

2.

the sub-

in

this point

in

the tipper and back part of the neck and also from the

It

lies

between the

Splenitis

and Trapezius muscles.

It

empties into the middle of the external jugular vein.

'A.

The

anterior jugular vein aiises near the hyoid bone and

the superficial veins of the submaxillary region.

superficial muscles

joins

its

and integument

ternal jugular vein.

4.

of anterior

fellow just above the sternum.

The

superficial

It

of the face.

lateral sinus.

passes

It

It

fourths of an
d>) lingual,

and middle regions

of neck.

It

down

It

the blood

collects
is

formed by the

the side of the neck

in

from the brain and the

inferior petrosal sinus

the

common

For contents of

this

and

carotid sheath

sheath see page

the subclavian vein near the inner margin of the Scalenus ami-

It joins

cus muscle.

formed by
from the

empties into the subclavian or ex-

Ii

on the outer side of the carotid artery.

282.

is

collects the blood

has no valves.

internal jugular vein

pint

It

is

provided with

inch above

its

a pair of

valves which are placed about three-

termination.

radicles are (a) pharyngeal,

tongue and Lingual vena comites
superior thyroid, under which we have larynIts

and under lingual we have dorsal

and ranine, (c) common facial, (d)

and ci'ico-t hyroid, (e) middle thyroid,

geal

of

(f)

occipital,

which

may

be

a radicle

of the external jugular.

.").

The

vertebral vein

deep muscles
of veins

at

commences

in

the occipital

the upper and back pari of the neck.

region

This

is

and drains the

more of plexus
:i

than one large vein and they run down through the foramina

in

the

ANATOMY

482

IN A

NUTSHELL

When they reach the sixth certransverse processes of the cervical vertebra?.
they form two main trunks, one of which passes through the

vical vertebra

foramen in the transverse process of the sixth cervical vertebra and the other
through thai of the seventh. They now unite into a common trunk which
empties into the back pari of the innominate vein. One pair of valves guard
The radicles of the vertebral vein are (a) muscular, (b) dorsi-spinal,
its mouth.
(c)

meningo-rachidian, (d) ascending cervical,

(e)

deep cervical,

(f)

first

inter-

costal.

The deep cervical, also called posterior vertebral, lies between the ComIt accompanies the profunda cervicis
plcxus and the Semispinalis muscles.
It empties into the lower end of the vertebral vein.
aitery.

PLATE

CCLVIII.

INFUNDIBULUM

ETHMOIDAL

MIDDLE
uncinate

CANALS

TURBINATED

process

Lateral View of the Ethmoid.

LESSON CLVI.
The

axillary vein

commences

at

the lower border of the axillary space and

At the
Below the

receives radicles corresponding to the branches of the axillary artery.

outer border of the

first

rib

it

continues as the subclavian vein.

Lower border of the tendons of the Teres major and Latissimus dorsi it is called
basilic
It has a pair of valves opposite the lower border of the Subscapularis
muscle.

At the termination of the cephalic vein and the subscapularis vein.

valves arc also found.

The subclavian vein

border of the

first

is

rib to the

vein at the outer

a continuation of the axillary

inner end of the clavicle where

it

joins the internal

jugular vein and makes the innominate vein.

into this veil]

and the anterior

The external jugular vein empties

The Scalenus antijugular may empty into it.

cus muscle and the phrenic nerve separate this vein from the subclavian artery.
It has valves about an inch from its termination.

The

right

innominate vein, which

is

is formed behind
and subclavian veins. It

about an inch long,

the inner end of the clavicle by the internal jugular

ANATOMY
passes
first

downward

IN A NUTSHELL.

innominate vein

to join the left

make

right costal cartilage to

483
at the inferior

the superior vena cava.

border of the

Its radicles are.

mammary, which are two for each artery

trunk before entering into the innominate vein,
(c) right inferior thyroid, which are three or four in number pass from the thyroid venous plexus into the left innominate vein, (d) right superior intercostal,
(a) right vertebral, (b) right

but uniting into a

receives the blood

The

internal

common

from the second and third intercostal spaces.

where the right subclavian vein

right lymphatic duct opens at the angle

joins the right internal jugular vein.

The

innominate vein, which

is about three inches long, is larger than

formed by the left internal jugular vein and the left subclavian
vein at the inner end of the clavicle.
It joins the right innominate vein to
form the superior vena cava. The innominate veins have no valves. The
radicles of the left innominate vein are, (a) left vertebral, (b) left internal
mammary, which are two for each artery but unite into a common trunk
before entering into the innominate vein, (c) left inferior thyroid, which are
three or four in number pass from the thyroid venous plexus into the left innominate vein, (d) the left superior intercostal receives the blood from the second
and third intercostal spaces.
The one on the right side passes down to enter the vena azygos major,
while the one on the left side passes across the arch of the aorta to enter the
left innominate vein, and receives the left bronchial vein.
The highest intercostal vein, which comes from the first intercostal space, empties into the corresponding vertebral or innominate vein.
The superior vena cava is formed by the two innominate veins behind the

left

the right.

It is

junction of the

first

right costal cartilage with the sternum.

inches long and passes clown into

of the third right costal cartilage.
(a) pericardiac, (b)

from the upper

mediastinal,

half. of the

It is

about three

the right auricle opposite the upper

(c)

This vein has no valves.

vena azygos major.

It

border

Its radicles are,

collects the blood

body.

When

the blood is given off from the thoracic aorta into the intercostal
comes back by the intercostal veins, which would have no place to
empty unless there was a special provision made for them. They cannot empty
into the heart, and the inferior vena cava has no length above the Diaphragm,
and the superior vena cava is too high for most of them, so they empty into
veins called azygos veins which connect the superior and inferior vena cava.
The azygos veins have no valves, but their tributaries do have valves. The
arteries,

it

(Plate CXCV).
The vena azygos major, also

azygos veins are:

1.

mences

at

bar veins,

the

first

(b) or

by

called right azygos vein.

This vein

com-

or second lumbar vertebra by a branch from (a) right luma

branch from the

the inferior vena cava.

righl renal vein, (c) or

by

After passing through the aortic opening

branch from
in

the Dia-

phragm, it passes to the fourth dorsal vertebra along the right side of the vertebral column and ends in the superior ven cava just before it enters the pericardium.

Its radicle.- are. (a)

the lower ten intercostal veins on the righl side,

4M
(in

ANATOMY
vena azygos minor from the

NUTSHELL.

IX A

oesophageal, pericardiac, and medias-

Left side, (c)

tinal veins, (d) the right bronchial vein, (e) the right superior intercostal vein.

The vena azygos minor, also called

2.

This vein

is

formed by

branch from

After passing through the

renal vein.

side of the vertebral

along the

left

passes to

the right

behind the

the vena azygos major.

cf the

(a)

left

side, (b)

1 1

lower or smaller azygos vein.

left

the lumbar veins, (b) or from the left

cms

left

column ami

thoracic aorta

of the
at

Diaphragm,

it

passes

the ninth dorsal vertebra

and thoracic duct

to

end

in

radicles are, (a) four or five lower intercostal veins

>

some (esophageal and mediastinal

veins.

upper azygos vein, also called vena azygos tertius. The radicles
of this vein are from the intercostal spaces between the left superior intercostal
These radicles join to
vein and the highest radicle of the vena azygos minor.

The

3.

form

left

main trunk, which empties into the vena azygos major or the vena azygos
Somtimes this vena azygos tertius is wanting, then the left superior

minor.

intercostal vein takes

place.

its

The bronchial veins from the

while those of the

left

empty

right side

open into the

side

left

vena azygos major;

into the

superior intercostal or vena azygos

tertius.

For veins of the abdomen see page 186.

LESSON CLVII.
The Portal System of Ykixs.

CXXXVIII.)

(Plates

The

portal system collects the blood from the digestive tract and from the
The veins of this system form the portal vein which enters the liver
and breaks up into branches like an artery into the substance of the liver.
spleen.

This system consists of:

The

which drains the blood from the rectum,

This vein empties into the splenic
vein after passing behind the transverse pari of the duodenum and the pancreas
and over the left kidney.
Its hemorrhoidal radicles inosculate with the luemor1.

inferior mesenteric vein,

sigmoid flexure, and the descending colon.

rhoidal branches of the internal

iliac.

The superior mesenteric vein collects the blood from the small intestine,
the caecum, the ascending colon, and transverse colon.
The radicles of this
2.

vein correspond with the branches of the superior mesenteric artery, just as

the radicles of the inferior mesenteric correspond to the branches of the inferior

the

mesenteric artery.

This vein passes

duodenum and behind

binder of the pancreas where

3.

The

splenic vein

in front of

the transverse portion of

the pancreas to join the splenic vein at the upper

forms the portal vein.

in the hilum of the spleen by five or six
form one main funk.
It now passes below the splenic
it

commences

branches which unite to

artery and behind the upper border of the pancreas

in front of

the abdominal

aorta to join the superior mesenteric vein.

I.

The

gastric vein,

also called coronary,

is

a large vein

the lesser curvature of the stomach to the cardiac end where

which passes along

it

receives radicles

ANATOMY

IX A

NUTSHELL.

from the oesophagus and then passes behind the

485

lesser sac of the

peritoneum

into the portal vein.

The

.").

portal vein

is

formed by the splenic vein and the superior mesenteric

It passes behind the first part of the

vein behind the neck of the pancreas.

duodenum and then

now divides into

in

the lesser

omentum

to the transverse fissure of the liver.

and left branches for the right and left lobes of the
branch to the Spigelian lobe. For the further subdiviliver and also gives
sion of the portal vein see page 190.
The portal vein most always receives the cystic vein, although it may
sometimes end in the right branch of the portal vein.
It

right
;i

PLATE CCLIX.
VERTICAL

PLATE

INFUNDIBULIIM

CRIBRIFORM

PLATE

Superior View of the Ethmoid.

The veins of the heart are:

The

1.

heart

great cardiac vein (coronary vein)

and passes

From

groove.

commences

at

the apex of the

to the base of the ventricles in the anterior interventricular

here

it

left in the auriculo-ventricular groove to

opens into the coronary sinus.
Its opening
Its radicles are. (a) those winch drain the right ventricle,
These radicles
ventricle, (c) those from the left auricle.

passes to the

the back pari of the heart where

has a pair of valves.

(b) those from the
have valves.

left

it

2. The posterior cardiac vein (the middle cardiac vein) commence- at the
apex of the heart and passes along the posterior interventricular groove to
1> radicles are. (a) those
empty into the coronary sinus, where it has a valve.
from the posterior surface of the left ventricle, (b) those from the posterior
1

surface of the right ventricle.

3.

the

The

left

of these.

left

cardiac veins collect

ventricle

and open

the blood from the posterior surface of

into the coronary sinus.

There are three or four

ANATOMY

186

anterior cardiac veins collect the blood from the anterior surface of

The

1.

IN A NUTSHELL.

the right ventricle

and empty

of

There

into the lower part of the righl auricle.

are three or four of these veins, and the largest one, which

is

called the vein

Galen passes along the right border of the heart.

empties into the coronary
5. The right coronary vein (small coronary)

>inus after passing between the righl auricle

icle- are, (a)

the right

and the

from the hack part of the right auricle,

right ventricle.
(h)

Its rad-

from the hack part

of

ventricle.

6. Venae Thesesii, also called venae cordis minimse, open by small orifices
on the inner surface of the right auricle. These orifices are called foramina

Thebesii.

The coronary

7.

hit

sinus

is

a dilatation situated in

auriculo-ventricular groove.

It

receives

all

the posterior part of the

the veins just mentioned ex-

and it also receives the oblique vein of Marshall, which

from the back part of the left auricle. This vein empties into the right auricle
of the heart between the inferior vena cava and the auriculo-ventricular opencept the vena Thebesii,
1

is

ing.

All these veins of the

is guarded by the valve of Thebesii (coronary).
which empty into the coronary sinus have valves except the oblique

It

heart,

vein of Marshall.

Tuk veins of Spinal Column and Cord.

The veins of the spinal column and cord are:

(Plates CI-CII.)

Dorsi-spinal veins, which collect the blood from the back on either side

These veins form a great plexus, which join the

by branches which perforate theligmenta subflavaand
by other branches which pass through the intervertebral foramina. These
veins end in the vertebrals in the neck, in the intercostal veins, and in lumbar
and sacral veins in their respective regions.
2. Meningo-raehidian veins, which are situated in the spinal canal, form
two greal columns, (a) the anterior longitudinal spinal veins which pass from
the foramen magnun to the base of the coccyx.
There are two of these anterior
of

the spinous processes.

veins

in

the spinal canal

longitudinal spinal columns, one on each side of the posterior surface of the

The radicles of these veins are venae basis vertebrarum.

These veins communicate with the dorsi-spinal veins, vertebral veins, intercostal veins, Lumbar ami sacral veins,
(b) The posterior longitudinal spinal

bodies of the vertebras.

veins are situated along the posterior border of the spinal canal.

municate

They com-

freely with the anterior ones, the dorsi-spinal veins, vertebral veins,

intercostal veins,

lumbar veins and sacral veins. The meningo-raehidian veins

and communicate freely with one another, thus form-

are not of uniform caliber

ing sort of a plexus.
3.

Venae basis vertebrarum pass from the posterior surface of the vertebrae

to join the transverse trunk

connecting the anterior spinal veins.

the blood from the substance of the hone

diplce
4.

found

in

They

collect

to the veins of the

the hones of the cranium.

The medulli

which forms

and are similar

spinal veins collect the blood from the substance of the cord
venous plexus around the entire surface of the cord between

ANATOMY
the arachnoid and pia mater.

IN A NUTSHELL.

In the

IS',

upper part of the neck these veins empty

into the inferior cerebellar veins or the inferior petrosal

None

they empty into the veins of the spinal canal.

sinus.

Below

of the spinal veins

this

have

valves.

LESSON

CLVIII.

Veins of Diplce.
lie between the two plates of the bones of the cranium and can
removing
the outer plate of the skull. They are, (1) the frontal,
be seen by
which empties into the supraorbital vein, (2) the anterior temporal which joins
the deep temporal vein, (3) posterior temporal which joins the lateral sinus,
(4) the occipital which joins the occipital vein or lateral sinus.
Emissary veins are small veins which pass through foramina in the bones of
the cranium to connect the sinuses with the external veins of the head.
The
principal ones are as follows:
(1) One which passes thorugh the parietal for-

These veins

amen to connect the veins of

(2) One which passes through

the scalp with the superior longitudinal sinus.

the mastoid foramen to connect the posterior

(3) One which passes

through the anterior condyloid foramen to connect the vertebral vein and deep
veins of neck with occipital sinus.
(4) One which passes through the posterior
condyloid foramen to connect the lateral sinus with the deep veins of the neck.
(5) One which passes through the foramen ovale.
(6) Two or three which
foramen.
pass through the middle lacerated
(7) One which passes through the
foramen of Vesalius. The fifth, sixth, and seventh all connect the cavernous
sinus with pterygoid and pharyngeal plexuses.
(8) One which passes through
the carotid canal to connect the cavernous sinus with the internal jugular vein.

auricular vein or occipital vein with the lateral sinus.

Cerebral Veins.
The

cerebral veins havethin

coatsandno muscular coat or valves. They are

set.
Under the superficial set we have

divided into a superficial set and a deep

(1)

superior cerebral veins, which are lodged

in

the fissures on the cerebral sur-

and pass forward and inward to the superior Longitudinal sinus, (2) The
median cerebral veins which collect the blood from the convolutions of the
mesial surface of the hemispheres.
These veins empty into the superior veins

face

or into the inferior longitudinal sinus.

(3)

Inferior

cerebral

veins

collect

the

blood on

the

lower pari of

the outer and on the under surface of the cerebral hemisphere.

Under these
veins we have, (a) middle cerebral which runs along the fissure of Sylvius on
the under surface of the temporal lobe and empties into the cavernous sinus.
(b)

the great anastomotic vein of the Trolard runs along the horizontal Limb

of the fissure of Sylvius

and empties into the anterior part of the cavernous

under surface of the brain empty into the super-

sinus, (c) the other veins on the

ior petrosal sinus

and

lateral

sinus.

ANATOMY

488

IN A NUTSHELL.

Under the deep set, we have (1.) Venae Galeni, which are two in number.
They pass
Thrv are formed by the vena corporis striata and vena choroidea.
sinus.
These two
enter
the straight
hack and onl of the transverse fissure to
veins generally unite into one vein, just before the entrance into the straight
sinus. (2.) The basilar vein is formed by the junction of the deep Sylvian vein,

and anterior cerebral

enter the vein of Galen

inferior striate vein,

the

cms

cerebri to

of the opposite side.

The

veins.

It

now

passes

backward over

just before its junction with the vein

Under these we have,

cerebellar veins.

(1)

superior

qnes, which pass forward and inward to end in the straight sinus and the veins
of Galen, but some of them pass outward to the lateral and the superior petrosal
sinus, (2) the inferior cerebellar veins end in the lateral sinus, superior petrosal

and occipital

sinus,

The

sinus.

veins of the medulla oblongata

and pons end

in

the inferior petrosal

sinus and lateral sinus.

PLATE CCLX.
ARTICULATES WITH ETHMOID.
WITH LACHRYMAL.

WITH LACHRYMAL

MAXILLARY PROC.
WITH

ARTIC. WITH PALATE

SUP.

MAXILLARY.

POSTERIOR
END.

Inferior Turbinated Bone.

LESSON CL1X.
The Sinuses of the Dura Mater.

(Plates

CLXXVIII-CLXXIX.)

The sinuses of the dura mater are as follows:

The superior longitudinal sinus commences at the foramen caecum and

the upper border of the falx cerebri to end in the torcular HerThe blood
receives the occipital sinus and the straight sinus.
ophili, where
which passes through the superior longitudinal sinus and the occipital sinus
1.

passes along

ii

turns to the righl

at

the torcular Herophili to pass into the right lateral sinus,

while the blood from the straight sinus passes into the
ever, this

may

be vice versa.

left lateral

sinus.

How-

caecum a small vein comThis sinus on cross

children.

At the foramen

municates with the veins of the nasal fossa' in

is triangular with
apex below next to the falx cerebri. The chorda'
Willisii arc fibrous glands which constrict this sinus and take the place of valves.

section

Most of the radicle- of

is

received

at

righl

this sinus pass into

it

in

such

angles to or againsl the current

a
in

manner

that the blood

the sinus.

It

receives

veins from the diploe and the dura mater, the superior cerebral veins, and veins

from the pericranium niter passing through the parietal foramina.

ANATOMY
The torcular Herophili

is

489

IN A NUTSHELL.

a dilatation at the point on the eight side of the

internal occipital protuberance

where the superior Longitudinal, occipital and

straight sinuses meet.

2.

The

inferior longitudinal sinus

falx cerebri.

It

sagittal surface of the hemispheres.

section

circular.

is

passes along the lower border of the

receives veins from the falx cerebri

It

ends

in

and

also

some from the

the straight sinus, ami on cross

This sinus, as well as the preceding one. increases

in size

from before backward.

3.

The

straight sinus

superior longitudinal sinus

with the tentorium

connects the inferior longitudinal sinus with the

and

cerebelli.

is

situated at the junction of the falx cerebri

The
empty

inferior longitudinal

venae Galeni,

sinus,

into it.
and superior cerebellar veins
4. and 5. The lateral sinuses are two in number and are situated where
The right one, after receiving the blood
the tentorium cerebelli joins the bone.
from the superior longitudinal and occipital sinus, passes to the light as far as
It then passes downward and inthe petrous portion of thetemporal bone.
ward to the jugular foramen, where it receives the inferior petrosal sinus to

make the

jugular vein.

It

also receives the superior petrosal sinus at the base

of the petrous portion of the

ilar

The

temporal hone.

left lateral

description but receives the blood from the straight sinus.

receives the blood from the superior longitudinal

and

sinus has a simIt

occasionally

occipital sinus,

and then

the right lateral sinus receives the blood from the straight sinus.
6.

and

7.

be double.

It

The
is

occipital sinus

which

is

the smallest of these sinuses,

may

situated where the falx cerebelli joins the hone, ami as said

it empties into the torcular Herophili.

These seven sinuses are situated on the upper and back part of the skull,
while the remaining sinuses of the dura mater are situated at the base of the

before,

skull.
8. and 9. The cavernous sinuses pass from the sphenoidal fissure to the
apex of the pelrous portion of the temporal hone. They are formed by the
ophthalmic vein and end by dividing into the superior and inferior petrosal

sinuses.

In

each cavernous sinus the following structures are found;

(a)

The

third cranial nerve, (b) the fourth cranial nerve, (c) the ophthalmic division
of the fifth cranial,

(e)

the sixth cranial,

position of these structures

in

(f)

the internal carotid artery.

this sinus see plate

communicates with this sinus through the ophthalmic

connects the two cavernous sinuses.
10.

The

of this circle

circular sinus surrounds the

is

vein.

hypophysis.

larger than the posterior one.

For

CCXXXII.

One

The facial vein

The circular >inm

The anterior segment

or the other of these seg-

ments may be absent.

The superior petrosal sinuses are two in number, one on
11. and 12.
They are
either side, and they connect the cavernous with the lateral sinus.
tin' superior border of the petrous portions of the temporal
Veins fromtympanic cavity, some cerebellar vein- and inferior cerebral

situated along

bone.

Veins, pass into

it

4'.

ANATOMY

M)

13.

and

14.

The

IN A NUTSHELL.

inferior petrosal sinuses pass

from the cavernous sinus

jugular foramen where they join the lateral sinus to

to the

make

the internal

arc situated where the posterior border of the petrous por-

They

jugular vein.

temporal bone joins the basilar process of the occipital.

The transverse siims (basilar sinus) connects the two inferior petrosal

tion of the
15.

sinuses.

passes over the basilar process of the occipital bone.

It

The Muscles of the [schio-rectal Region.

Description.

Corrugator cutis ani.

fice of

the anus and

Origin.

<

This

(Plate

CCLXXI.)

muscle radiates from the

ori-

a thin involuntary muscle.

is

From the true skin externally from the anus.

Into the submucous tissue internally.

Insertion.
A.CTION.

To

around the anus.

raise the skin in ridges

Nerve Supply

Sympathetic nerve.

Inferior

Blood Supply.

hemorrhoidal.
Description. This muscle surrounds the margin
It is about an
of the anus and is elliptical in shape and thin and flat in form.
inch broad opposite tin anus, and from its anterior to its posterior extremity
is about three inches.
it
It consists of two planes of muscular fibers.
Origin. From the tip of coccyx by a narrow tendon and from super-

External sphincter ani.

ficial fascia

in

front of bone.

Insertion.
Transversus

Into the central tendons of perineum where

Levator

perinaei,

ani.

and Accelerator

it

joins with the

urinae.

Action. -To close anus.

Nerve Supply.

From

ferior lnemorrhoidal

branch

Blood Supply.

the anterior division of the fourth sacral

of the internal

Inferior

Internal sphincter ani.

in-

hemorrhoidal from internal pudic.

muscle surrounds the lower

Description. This

part of the rectum for about an inch.

lar

and

pudic nerve.

It

is

composed

of involuntary

muscu-

fibers.

A'

HON.- -To

close the amis.

Nerve Supply. Hsemorrhoi

Blood Supply.

lal.

hemorrhoidal from internal pudic.

Description. This muscle which is thin and broad
Inferior

Levator ani.
uated on the side of the pelvis.
cavity.

It

helps to support the viscera

in

is

sit-

the pelvic

Sometimes the anterior portion of this muscle is separated from the

and then it is called the Levator pros-

posterior portion by connective tissue,

tatas.

From

Origin.

the

posterior surface of the

pubis on the outer side of the symphysis.

body and ramus

of the os

Also from the inner surface of the

spine of the ischium and from the fascia between these points.

Insertion.
of the coccyx,

The

and those

posterior fibers are inserted into the sids of the apex

fibers just in front

of these

mute with those

of

opposite side extending between the coccyx and the margin of the anus.

The middle

fibers,

the
(2)

which form the greater portion of the muscle, are inserted

ANATOMY

rectum blending with the

into the sides of the

(3)

The

IN A NUTSHELL.

491

fibers of the sphincter muscles.

anterior fibers, which are the longest, descend upon the side of the

prostate gland to join beneath

with fibers of the opposite side, and also blend-

it

ing with fibers of the External sphincter

and Transversus

perinaei a1 the central

tendon.

Action.

end

muscle of forced expiration.

and bladder during efforts

It is a

of the rectum, vagina,

It

also supports the Lower

of expulsion.

Nerve Supply. Branch from the anterior division of the fourth sacral
and a branch from fhe pudic nerve which sometimes comes from the perineal
or from the inferior hemorrhoidal division.
Blood Supply. Internal pudic.
Coccygeus. Description. This muscle is situated parallel to the Levator
ani but behind it.
Its upper border is separated from the lower border of the
Pyriformis muscle by the internal pudic vessels and nerves.

PLATE CCLXI.
ANTERIOR

ALA.

BORDER.

GROOVE FOR
SEPTAL CARTILAGE

POST. SUP.

P031.

BORDER.

Wk

VIEW.

Ha
GROOVE FOR NASO- PALATINE

NERVE
ALA.

The Vomer.
Origin.

From

the apex of the spine of the ischium and from the lesser

sacro-sciatic ligament.

Insertion.

Into

the margin of the coccyx and side of lower piece of

sacrum.

Action.

Raises and supports coccyx.

Branch from the fourth
Internal pudic.

Nerve Supply.
Blood Supply.

and

fifth sacral

nerves.

LESSON CLX.
Muscles of the Perineum in the
Transversus perinsei.

Description.

the back part of the perineal space,

is

This

(Plate

muscle,

narrow muscular

CCLXXI.)

which

of

small tendon.

of

of

passes

across

slip.

From the inner and forepart the tuberosity

Insertion. Into the central tendon
the perineum.
Nerve Supply. Perineal branch
the internal pudic.
Blood Supply. Internal pudic.
Origin.

Mali:.

of the ischium

by

ANATOMY

492
Accelerator

urinae.

-This muscle

tion.

of the anus.

Bulbo-cavernosus-Ejaculator seminis.)
Descripin the middle line of the perineum just in front

situated

is

in

the middle line by a

the central tendon of the perineum,

and from the median

consists of

It

IN A NUTSHELL.

two similar parts united

tendinous raphe.

From

Origin.
raphe
hull)

in

trout.

Insertion.Into the anterior surface of the triangular ligament into the

and adjacent parts of the corpus spongiosum, and into the tunica albu-

genia of corpora cavernosa.

Action.To empty the urethra and assist the erector penis.

Nerve Supply. Perineal branch of the internal pudic.
Blood Supply. Superficial perineal from internal pudic.

Erector penis.
part of the

cms

penis and

is

This muscle

the perineum.

Description.

[schio-cavernosus.)

This

muscle covers

situated on either side of the lateral boundary of

is

broad

in

the middle and narrow at the extrem-

ities.

Origin.

From

the inner surface of the tuberosity of the ischium, from

the surface of the cms, and from the adjacent portion of the ramus of the ischium.
Into the sides and into the under surface of the crus penis
[nsertion.

by an aponeurosis.
Action".
By compressing the crus penis, it retards the blood through the
this
manner keeps the organ erect.
veins and in
Nerve Supply. Perineal branch of internal pudic.
Blood Supply.Superficial perineal from internal pudic.

is

DESCRIPTION. This muscle

Compressor urethra'. (Constrictor urethra'.
ligament and surrounds the
between
the
two
layers
the
triangular
of
situated
)

membranous portion of the urethra.

Origin.From the junction of the rami
tending

to half an inch or

of the os pubis

and ischium, ex-

more.

[nsertion.
Each portion of this muscle divides into two fasciculi which
surround the urethra from the prostate gland behind to the bulbous portion of
They mute at the upper and lower surfaces of this tube
the urethra in front.
with the muscle of the opposite side.

Action. These muscles acting together assist expelling the

compressing the membranous portion of the urethra.
Nerve Supply.Perineal branch of the internal pudic.
Blood Supply. Superficial perineal from internal pudic.

fluids

and

LESSON CLXI.
Mcs< lesofthe Perineum ixthk Female.
Transversus

periiuei.

DESCRIPTION.

This

is

Plate

CCLXXI.)

small muscular slip in the

female which passes across the back part of the perineal space.

Okioiw

From

a small tendon.

the inner

and forepart

of the tuberosity of the

ischium by


ANATOMY

IN A NUTSHELL.

41)o

Insertion. Into the central tendon of the perineum.

Action. This muscle with its fellow fixes the central tendon.
Nerve Supply.- Perineal branch of internal pudic.
Blood Supply. Superficial perineal from internal pudic.

Sphincter

vagina. Description.The

the orifice of the vagina

is

Sphincter vagina which surrounds

the homologue of the Accelerator

Posteriorly from the central tendinous

blends with the External sphincter
where
Insertion. Into the corpora cavernosa of the
Origin.

mime

part

of

in

the male.

the perineum

aid.

it

and

clitoris,

passes over the

Action.

body of the clitoris to compress its dorsal

To diminish the orifice of the vagina.

a fasciculus

vein.

Nerve Supply. Perineal branch of the internal pudic.

Blood Supply. Superficial perineal from internal pudic.
Erector

clitoridis.

Description. This

Erector penis in the male, but

Origin.

From

is

muscle

the homologue of the

is

a smaller muscle.

the inner surface of the tuberosity of the ischium behind

the eras clitoridis, and also from the surface of the eras and the adjacent portion of the

ramus

Insertion.

of the ischium.

Into the sides and upper surface of the eras

clitoridis.

To

maintain the organ erect by pressing on the eras

and retarding the return of blood through the veins.

Action.

clitoridis

Perineal branch of the internal pudic.

Superficial peiineal from internal pudic.
urethra. (Constrictor urethra).

Nerve Supply.
Blood Supply.
Compressor
Origin.

From the margin of the descending ramus of the os pubis.

from the front part of the muscle cross the
The

Insertion.

fibers

pubic arch in front of the urethra to blend with

its

sub-

fellow of the opposite side,

while fibers from the posterior portion pass inward to blend with the walls of
the vagina behind the urethra.

Action.

To expell the mine and

assist in erection.

Nerve Supply. Perineal branch of the internal pudic.

Blood Supply. Superficial perineal from internal pudic.

LESSON CLXII.
The Perineum.
The word Perineum

is

\\>n\

in

(Plate

CCLXIX.)

three different senses.

il

includes the

entire outlet of the pelvis, which extends from the apex of the sub-pubic arch
in

(2)

front to the tip of the coccyx behind,

Il

schii.

is

the part of the pelvic outlet

This

is

in

and

between the tuberischii.

called the true perineum, while the pari behind this line

the anal, ischio-rectal. or false perineum.

sense of the

laterally

fnint of a line connecting the tuberi-

(3)

In

is

called

the surgical and obstetrical

word the term may include in the female all the deeper par between
and the anterior wall of the ledum. Tin- is

the posterior wall of the vagina

called the perineal body.

ANATOMY

494

The

IN A NUTSHELL.

ischio-rectal fossae are situated

on each side of the lower end of the

recutm, having on the outer side of each fossa, the tuberosity of the ischium,
The ischio-rectal fossa is in the form of a pyramid with its apex corresponding
Its base is between
to the junction of the Levator ani and Obturator muscles.

and the tuberischii. It is bounded on the inner side by the Sphincter

Levator ani. and Coccygeus muscles; and behind by the edge of the Gluteus

the anus
ani.

the site of abscesses

It is
ligament.
the great sacro -sciatic
(Plate CCLXX.)
with a mass of adipose connective tissue.

maximus and
and

is

filled

THE
1.

FAsei.K OF

The

THE PERINEUM ARE:

superficial layer of the superficial fascia,

the sub-cutaneous fascia of the thighs,

the lowest of

all

is

which

is

continuous with
This is

thick and loaded with fat.

the fascia of the perineum.

PLATECCLXII.
ORBITAL

ORBITAL

PROCESS

SPHENOIDAL

SURFACE

SURFACE

NASAL

POSTERIOR

SPINE

AZYGOS UVULAE

The Palate Bone, Posterior View.

2.

not

The deep layer

thick, but

anteriorly

it

of the superficial fascia

very strong.

It

is

called Colles' fascia.

It is

becomes continuous with the external

scrotum ami the fascial covering of the penis.

of the

is

attached posteriorly to the perineal ledge.

pubis ami

ischium.

Some anatomists

It

fascial investment of the

extends laterally to the rami

call

this

fascia

the

anterior

LEAFLET OF THE TRIANGULAR LIGAMENT.

deep perineal fascia is triangular in shape like
side by the ramus of the pubis and ischium
Colles'
and extending in from from the pubic arch and sub-pubic ligament to the perSome anatomists call this THE MIDDLE LEAFLET OF
ineal Ledge p0Steri6rly.
3.

Tin' anterior Layer of the

fascia,being bounded on either

TRIANGUL \l< LIG V.MENT.

The posterior layer of the deep perineal fascia is called by some anatomists THE POSTERIOR LEAFLET OF THE TRIANGULAR LIGAMENT and has the same

'IH1-;

4.

attachments as the middle

leaflet of

the triangular ligament.

ANATOMY

IX A XUTSHELL.

495

The "white line," or arcus tenmbtEus,

extends from the inner aspect

back of the os pubis, external to the symphysis,
and is formed by a thickening of the obturator fascia where the fascia of LevaThis line, of course, is Dot straigb.1
tor ani muscle meets the obturator fascia.
because it comforms to the curve of the pelvic wall.
Buck's fascia is a continuation of Colles' fascia which extends forward
upon the penis, which it invests completely, as far as the gland.-.
The triangular ligament of the urethra. One set of anatomists describe
the anterior layer of the deep perixeai. fasci as the triangular ligament,
while another set include the posterior layer of the deep perineal fasci \.
thus making two layers of the triangular ligament.
Still a third set of anatomists include Colles' fascia in the triangular ligament, thus making three
of the spine of the ischium to the

Where these three triangular leaflets meet

the perineal ledge, and as they pass forward towards
the symphysis pubis there are two spaces between these three leaflets.
The
one between the first two leaflets is called the superficial perineal interspace, and contains the following structures:
1. The crura of the corpora cavernosa.
2. The bulb of the corpus spongiosum.
leaflets in the triangular ligament.

posteriorly

is

is

called

3.

Scattered fibers of the Superficial transverse periinei muscle.

4.

Arteiies of the corpora

5.

Dorsal nerves of the penis.

6.

Superficial perineal vessels

cavernosum and dorsal

vessels of the penis.

and nerves.

The space between the second and third leaflets of the

called the deep perineal interspace and contains:
1. The membranous urethra.
2.

C'owper's glands.

3.

Internal pudic arteries.

4.

Pudic veins.

5.

The pudic lymphatics.

6.

Dorsal nerves of the penis.

triangular ligament

The deep Transverse peiinaei and Compressor urethra muscles.

The central tendon of the perineum is about half an inch in front of the
amis, in the middle of the perineal ledge, and is the place where the External
sphincter ani and Accelerator mime and Transverse perinaei muscles meet.
Alcock's canal is about two inches in length and is formed by a delamina7.

It is situated on the outer wall of the ischioextending from the lesser sacro-sciatic foramen to the lower border
of the triangular ligament.
The internal pudic vessels and nerve pass through

tion of the obturator fascia.

rectal fossa,

this canal.

The
into

(1

(Plate

CCLXX.)

pelvic fascia lines the cavity of the pelvis

rk< Tn-\ ESU

\\.

FASCIA, which

is

and

at

the white line

it

divides

called visceral layer of the pelvic fascia.

This layer descends from the white line over the Levator ani muscle, over the
prostate gland. rentum, vesiculae seminales and the bladder.

ligaments of the bladder.

(2)

The obturator

fascia,

It

which

forms the true

is

called

the

anatomy

mm;

in a

nutshell.

This layer passes from the white line on the

parietal layer of the pelvic fascia.

cover the Obturator interims muscle, and above Alcock's canal gives
fascia (ischio-rectal) over the lower surface of the Levator ani musanal
the
off
with the corresponding fascia of the opposite side forms the
fascia
This
cle.
pelvis tn

deep superior layer of the triangular ligament.

LESSON CLXIII.
(Plates CCLXXXIX-CCXC.)

Lymphatic System.

"niphatic system consists of lymphatic vessels, and lymphatic nodes.

vessels of the small intestine are called lacteals or chyliferous

The lymphatic

vessels because during the process of digestion they contain chyle

which they

The lymphatic vessels are

carry into the blood through the thoracic duct.
of
the
except
the
nails,
hair,
cuticle, and cartilage.
body
present in all the pari
It commences in
is in the form of the human body.
join
one
to
which
make
until they
another
larger
spaces
microscopic spacethe
left.
The
left one is
lymphatic
ducts,
the
and
two
righl
finally form the
collects
because
the
thorax.
It
it
passes
through
lymph
called the thoracic duct

The lymphatic system

from all the body except the right half of the head, the right half of the thorax.
and the upper surface of the liver, and the right arm. The lymph in these
This right lymphastructures just named pass into the right lymphatic duct.
tic

duct

The

lefi

about half an inch long and empties into the tight subclavian vein.
lymphatic or thoracic duct is about eighteen inches long and passes
is

upon the vertebral column behindthe archof the aorta,

This duct

subclavian vein.

may

be double for part of

ii

its

finallyends in the

way

left

or throughits en-

may empty

It has
constricinto the vena azygos major.
and a double valve at its termination.
Every cell in the body is surrounded by lymph and is therefore an aquatic
These cells receive their food from the lymph into which they also
animal.

ure course, and

tions through

throw

their

it

its

entire course

waste

products.

body are in two sets, superficial and deep.

The superficial lymphatics pass just under the skin with the superficial veins
and they pierce the deep fascia to join the deep lymphatic vessels. The deep
lymphatics although not so numerous as the superficial ones are larger and
accompany the deep blood vessels. The lymphatic, absorbent, or conglobate

The lymphatic

vessels in the

which the lymphatic vessels pass

and lymphatic duct-. These nodes vary
from very small ones which are microscopic, to large one- which are

nodes are small bodies of adenoid tissue

through on their way

in

size

aboui the

si/.e

bronchial

region

to the thoracic

of a small bean.

are

Their color

is

pinkish-gray, but those

in

the

darker color.

The lymphatics,

like veins, have three coats, but the smallest lymphatic

have one coat which is composed of epithelial cells. Those vessels
which have three coat.- have the following arrangement, (1) an inner coat of
epithelium and a -mull amount of yellow fibrous tissue: (2) \ MIDDLE COAT
composed of muscular tissue and yellow fibrous tissue: (3) AX OUTER COAT
which consists of white fibrous tissue and a little of the yellow fibrous tissue.

vessels

All

three of these coat- pu1

together are transparent.

Valves are present

in

ANATOMY

IX A NUTSHELL.

497

lymphatic vessels to prevent the backward how of the lymph.

by

membrane and

folds of the lining

their position

is

They are formed

marked by a circular con-

striction.

The thoracic duct has three coats, (1) an internal or endothelial, (2) a
middle of white connective tissue, (3) an external of areolar tissue. There
are numerous valves in the thoracic duct especially at its upper end, and there
is

a pair at its

termination to prevent blood from entering the duct.

The kelations of the thoracic duct are:

.Behind.

seven

The body

(1)

lower thoracic

of the second

vertebra1

right intercostal arteries.

(.1)

(3)

lumbar vertebra,

Anterior

common

Vena azygos minor,

((>)

(2)

Bodies of the

ligament,

Vena azygos

(4)

Lower

tertius, (7)

Upper thoracic vertebrae.

Ox Right Side. (1) Right cms

(3)

of the Diaphragm, (2) Vena azygos major,

Right pleura, (4) (Esophagus.
In Front. (1) Aorta and right cms of the Diaphragm, (2) Pericardium,
(Esophagus, (4) Arch of the aorta, (5) First portion of subclavian artery.

(3)

On Left
Vena azygos

Side.

(1)

Aorta,

Left pleura, (3)

(2)

Vena azygos minor.

(4)

tertius.

PLATE
ETHMOIDAL

CCLXIII.

PROCESS

ORBITAL

SURFACE
SURFACE

ORBITAL

MAXILLARY

SUPERIOR MEATUS

SURFACE

SPHENO-PALATINE

FORAMEN^

SPHENOIDAL PROCESS 'J<C<\

(MC
MEA
-* TUS
< v
;

'fyli

>

/o\V
TURBINATED

INF.

ft,

.'

c,

*|fc-MAXILURY
/^

.x j\\ INFERIOR

MEATUS
ARTICULATES WITH "

/=

PROCESS

_j

ffWm
HORIZONTAL

ARTICULATES

WITH

PLATE

VOMER

AND OPPOSITE

HONE

The Lateral View of the Palate Bone.

The receptaculum
lar,

chyll

is

the beginning of the thoracic duct.

sacculated and fusiform sac.

It

has no valves

in it.

and

its

It

isan irregu-

dimensions are

one and a half by three-quarters of an inch.

It is situated in fronl of tin" second hunbai' vertebra.
A lymphatic node consists of an outer pari called a capsule, which is made
of white fibrous tissue and a small amount of smooth muscular tissue.
From
the inner surface of

his

capsule trabecular pass towards the center of the node.

ANATOMY

498

These trabecule arc broad

at

IN A NUTSHELL.

the attachment of the capsule but small in the

of the node is called cortex and the inner

These trabeculse form numerous divisions in the
The space between the
node, and these divisions are partly filled with pulp
pulp and the division wall is called the lymph sinus and is crossed by a network of adenoid reticular tissue. This pulp is a mass of leucocytes. The

The outer portion

central portion.

portion

medulla.

called

is

notch where the arteries enter and the veins and efferent vessels Leave
These nodes make white blood corpuscles.
the node.
There are aboul seven hundred lymphatic nodes in the body andtheyare

hilum

is

situated beneath the deep fascia except the superficial inguinal nodes.

all

LESSON CLXIV.
lymphatic vessels of the upper extremity pass from the tips
Those on the
towards
the shoulder with the superficial veins.
of the fingers
the
elbow
with the
veins
towards
then
the
ulnar
run
with
of
the
arm
side
inner
Those
outer
side of
deep
vessels.
on
the
and
to
the
glands
axillary
basilic vein

The

the

superficial

arm run with

the radial veins to the elbow,

and

at this point

some

join the

group, while others run with the cephalic vein to the axillary nodes.
few i^ this last set pass between the Deltoid muscle and the Pectoralis major

basilic

to the

subclavian nodes.

The deep lymphatic vessels of the upper extremity pass with the deep blood
They accompany the following arteries in the forearm: (t) radial,
vessels.
They
ULNAK.
(2)
(3) ANTERIOR INTEROSSEOUS, (4) POSTERIOR INTEROSSEOUS.
communicate with the superficial lymphatic vessels at intervals. They accompany the brachial artery from the elbow and pass through the axillary and
subclavian nodes to the thoracic duct on the

left

side, while those

on the right

lymphatic duct.
The superficial lymphatic nodes of the upper extremity are not numerous.
In the cubital fossa there are two or three and above the internal condyle near
the basilic vein there is one or two.
The deep lymphatic nodes of the upper exremity are found along the radial

side

pass to the right

and ulnar

vessels.

A few

brachial artery, and one or

small ones are found along the inner side of the

There arc ten

two just above the inner condyle.

ortwelve around the axillary vessels which drain the front of the chest and the
skin of the back.
The subclavian nodes are two or three which are connected
They lie under the clavicle.
with the axillary nodes and deep cervical nodes.

The
ficial

superficial

fascia.

They

lymphatic vessels of the lower extremity

are divided into two groups, (1)

lie

in

the supei-

a large internal group

which follows the internal saphenous vein to the vertical set of the superficial
From these superficial inguinal nodes some efferent vessels

inguinal nodes.

and femoral sheath to a node in the femoral

communicates with the vessels of the trunk, and others pass
through the fascia lata to the deep inguinal nodes.
(2) An external group,
which is smaller and is situated on the outer side of the foot, sends one set of
pass through the cribriform fascia

canal by which

it

vessels across the tibia just

below the knee

to join the internal

group, while the

ANATOMY
other

set

499

IN A NUTSHELL.

passes with the external saphenous vein to join the popliteal nodes.

The deep lymphatic vessels

arteries: (1) anterior tibial,

of the lower extremity

accompany

the following

posteriok tibial, (3) perineal, to the

From the popliteal nodes they pass with the femoral vein
popliteal nodes.
to the deep inguinal nodes, and then under Poupart's ligamenl to the nodes

around the external

(2)

The lymphatic

iliac vessels.

pass to the "luteal nodes

vessels

in

the gluteal region

The lymphatic

the great sacro-sciatic foramen.

in

vessels of the ischiatic region

have

a similar course.

The superficial lymphatic nodes of the lower extremity are, (1 eighl or ten
superficial inguinal nodes which lie just under the skin. They consisl of
two sets, (a) the upper oblique along Poupart's ligament, which drains the
scrotum, penis, abdominal wall, perineal and gluteal regions, and urethral
mucous membrane, (b) The vertical set which surrounds the saphenous open)

and receive the superficial vessels of the lower extremity.

The deep lymphatic nodes of the lower extremity are, (1) one or two anterior tibial, which are placed beside the anterior tibial artery on the upper part
of the interosseous membrane, (2) four or five popliteal, which are placed
around the popliteal vessels, (3) the deep inguinal, which are placed under
These communicate with the
the deep fascia around the femoral vessels.
ing

nodes through the saphenous opening.

(4) The gltjte \i..
which follow their corresponding vessels into the great sacro-sciatic foramen
above the P) riformis muscle. (5) Ischiatic which follow their corresponding
vessels into the sacro-sciatic foramen below the Pyriformis muscle.

superficial inguinal

LESSON CLXV.
The

superficial lymphatic vessels of the pelvic

with the superficial blood vessels.

(1)

and abdominal walls pass

Those below the umbilicus

pass

with the superficial epigastric vessels to the oblique set of the superficial inguinal
nodes.

(2)

A DEEPER SET

passes with the deep epigastric vessels to the ex-

around the external iliac blood vessels.

Three of these nodes are found just behind the crural arch which communicates
(3) Those
with the lumbar nodes above and with the inguinal nodes below.
FROM THE SIDES OF THE LUMBAB PART OF THE ABDOMINAL WALL pass with the
ternal iliac nodes which form a chain

superficial iliac blood vessels to the oblique set of the superficial inguinal node-.

them pass with the ilio-lumbar and lumbar blood vessels to the
lumbar nodes. (4) Those of the gluteal region pass around the

lmt most of
lateral

outer side of the nates to end

in

the superficial inguinal nodes.

of the scrotum A\D perineum pass with the external pudic

the superficial inguinal nodes.
(6) Those of tin: penis end
inguinal

nodes.

(7)

in

THOSE
end

in

the superficial

Those which drain the mucous membrane of the

labia, NYMPH.E, and clitoris

ficial

(">)

vessels to

in

the female end

in

the oblique set of the super-

nodes.

The deep lymphatic vessels of the pelvic and abdominal walls pass with the
biood vessels and are, (1) those which accompany the gluteal vesTHOSE WHICH
BELS, (2) THOSE WHICH ACCOMPANY THE [SCHIATIC VESSELS,

chief

('))

ANATOMY

500

IX A

NUTSHELL

accompany the obturator vessels. All these pass with the internal iliac
(4) Those ok tin: penis pass with the internal
artery to join the Lumbar mules.
pudic vessels to join the internal iliac nodes.
The lymphatic vessels of the bladder pass through

its

mules mi the pos-

lymphatic vessels from the prostate gland ami seminal

terior
iliac nodes which surround the internal iliac blood
internal
the
pass
into
vesicles
nodes
receive
radicles corresponding to the branches of the
These
vessels.
surface ami

join the

and they communicate with the lumbar nodes.

rectum pass through nodes on its outer wall
and in the meso-rectum. They empty into the sacral nodes which occupy the
sides and t'roiii of the sacrum in the meso-rectal fold.
internal iliac artery

The lymphatic

vessels of the

PLATE CCLXIV
SUPERIOR TURBINATED

INFERIOR TURBINATED

The Meatuses.
Tin'

lymphatic vessels of the uterus are.

(1)

SUPERFICIAL ONES which are

situated under the peiitoneum and (2) deep ones situated in the substance
of the uterus.
Those from the vagina and from the cervix pass into the sacral

nodes and internal

iliac

nodes, while those from the body and fundus pass into

the -broad ligamenl to join those from the ovaries, broad ligaments, and Fallopian tubes to pa-- with the ovarian vessels to the

bar nodes are situated around the

common

lumbar nodes.

iliac vessels,

vena cava on the front of the lumbal- vertebrae.

They

These lum-

the aorta, and inferior

receive vessels from the

lower extremities, pelvis, testes, ami some of the abdominal viscera.

They
unite with the lacteal- to help form the thoracic duct.
The lateral lumbar
nodes are situated between the transverse processes of the vertebra? behind the

ANATOMY

IN A NUTSHELL.

501

Psoas magnus muscle and help to drain the spinal canal, posterior and lateral

abdominal

walls.

superficial which arc from

deep ones which are from the
epididymis and body of the testis. They empty into the lumbar nodes.
The lymphatic vessels of the kidney are, (1) superficial and ('_') deep.
These two vessels mute at the hilum to join the vessels from the ureter and
They end in the lumbar nodes.
suprarenal capsule.
The lymphatic vessels of the stomach are two set>. (1) SUPERFICIAL ONES
The vesin the subserous coat and (2) deep ones in the submucous coal.
sels which drain both surfaces of the stomach pass alongthe lesser curvature to
end in nodes at the pyloric end of the stomach. Those which drain the fundus
pass to the splenic nodes and those which pass along the greater curvature of
the stomach join lacteals at the root of the mesentery.
The lymphatic nodes of the stomach lie within the lesser omentum and
around the cardiac and pyloric orifices along the curvatures of the stomach.
The lymphatic vessels of the spleen are. (1) superficial which lie under
They end in the thoracic
its peritoneum, and (2) deep which lie in its substance.

The lymphatic

vessels of the testicle are. (1)

the surface of the tunica vaginalis, and

(2)

duet after receiving the pancreatic lymphatic vessels.

The nodes of the spleen are situated in its hilum.

The lymphatic vessels of the small intestine are called

lacteals

and

are, (1)

superficial which are placed between the layers of the muscular coat, or
between the nmscnlar and peritoneal coats. They run longitudinally. (2)
Deep which are situated in the submucous tissue and run transversely with
These empty into the thoracic duct.
the mesenteric vessels.
The lymphatic nodes of the small intestine, called mesentery node-, lie

between the layers of the mesentery, and they are about one hundred and
They vary in size from that of a pea to that of a small almond,
fifty in number.
and the largest ones are situated near the duodenum and the ilio-csecal valve.
In these positions they are also more numerous.

The lymphatic

two sets. (1) THOSE of

and transverse colon which pass to the mesenteric
the descending colon, sigmoid flexure, and rectum

vessels of the large intestine are in

the csecum, ascending colon,

nodes, and (2)

those

of

which pass to the lumbar nodes.

The lymphatic nodes of the large intestine are not so numerous as those of
the small intestine

and are very few along the transverse colon.

uated upon the intestine

itself

They

are

-it-

or along the vascular arches of the arteries.

LESSON CLXVI.
The lymphatic
which
liver.

vessels of the liver are

in

two

sets. (1)

THE SUPERFICIAL SET

the subperitoneal areolar tissue, and on the convex surface of the

Those vessels on the convex surface of the liver are divided into the

lie

in

following groups, (a) those branches which rnn forward ami then

upward

broad ligamenl pass through the Diaphragm to the anterior mediastinal

These anterior mediastinal nodes are situated on the Diaphragm in front

in

the

node-..

of the

ANATOMY

502

IN A NUTSHELL.

pericardium and around the greai vessels at the base of the heart. The vessels
from the liver jus; mentioned which pass through those mediastinal nodes pass
(b) Those vessels winch run around the anterior
into the right lymphatic duct,

margin to the under surface of the liver pass

Those branches which pass outward to the
through the Diaphragm

to the anterior

to

nude-

in

right lateral

the lesser

omentum.

ligament pass either

mediastinal nodes or across the

cms

of

Diaphragm to the anterior mediastinal nodes or across the cms of the

Diaphragm into the thoracic duct, (d) Those branches which run outward
from the left lobe to the left lateral ligament and then through the Diaphragm
Those superficial lymphatic vessels which
to the anterior mediastinal nodes.
the

are on the under surface of the liver form the following groups, (a) those branches
arise to the right of the "'all bladder pass to the lumbar nodes, (b) those
branches surrounding the gall bladder pass to the nodes in the lesser omentum,
and (c) those branches arising to the left of the gall bladder pass either to the
oesophageal nodes or to nodes along the lesser curvature of the stomach.

which

Tin: DEEP lymphatic VESSELS of

the livee

pass with the branches of

the portal vein, hepatic artery, and hepatic duct into the substance of the liver.
They puss from the liver at the transverse fissure to enter nodes which are

Or

placed along the lesser curvature of the stomach and behind the pancreas.

may

they

The

join a lacteal before entering the thoracic duct.

superficial lymphatic vessels of the thoracic wall pass across the Trape-

and Latissimus dorsi muscle.- behind and the Pectoralis major muscle in
Most of those from the mammary gland
front to end in the axillary nodes.
pass to small nodes which are situated along the lower border of the Pectoralis
major muscle in the axilla, however, a few from the inner side of mammary gland

zius

pass through the intercostal spaces to the anterior mediastinal node-.

The deep lymphatic vessels of the thoracic

Avail are. (1)

SELS which drain the Intercostal muscles and pleura.

These

intercostal
join vessels

es-

from

the buck of the thorax and spinal canal which entering the intercostal nodes

descend on the spine to the thoracic duct. The intercostal nodes which are
small, lie on each side of the spine near the costo-vertebral articulation, and
lying between the Intercostal muscles.
(2) The internal
where they
the
umbilicus
which
abdominal
above
mammary
muscles
begin on the
through
upward
Diaphrgam
pass
the
They
communicate with the epigastric.

some

of

those

where they are joined by the intercostal lymphatic vessels to empty into the
right lymphatic duct on the right side, while those on the left side empty into
thoracic duct.

(3)

The lymphatic essels

mammary
\

anterior mediastinal and internal

tercostal

The

of the

Diaphragm empty

into the

nodes anteriorly, and into the in-

and posterior mediastinal nodes posteriorly.

internal

mammary nodes
mammary

-pan- near the internal

lie

at the anterior

end of each intercostal

vessels.

The posterior mediastinal nodes lie along the aorta and oesophagus, and
communicate with the intercostal nodes, lumbar nodes, and deep cervical
nodes.

The

superficial lymphatic vessels of the lung

form

minute plexus which

covers the outer surface Of the lung under the pleura, while the deep lymphatic

ANATOMY

503

IX A NUTSHELL.

The lymphatics

vessels run with the blood vessels along the bronchi.

of the

Lung empty into the bronchial nodes, which lie around the bifurcation of the
Several efferenl vessels pass from these nodes
trachea and the root of the lung.
to the tracheal nodes and oesophageal nodes at the root of the neck, and those

on the right side empty into the right lymphatic duct, while those on the
side

empty into the thoracic duct.

The superficial cardiac lymphatic

vessels

lie

left

on the surface of the heart

the subserous or areolar tissue, while the deep cardiac lymphatic vessels

lie

in

in

These vessels accompany the coronary vessels. Those of

the right side uniting at the root of the aorta from which place they pass upward
over the arch of the aorta along the trachea to the right lymphatic duct. Those
of the left side unite at the base of the heart and pass along the pulmonary artery
to nodes at the root of the arota. and after ascending along the trachea pass into
the deeper tissues.

the thoracic duct.

The thymic vessels pass into the internal jugular veins from the under surthymus gland.
The lymphatics of the oesophagus, after communicating with the posterior

face of the

mediastinal nodes, end in tin thoracic duct.

1

LESSON CLXVII.
The

superficial lymphatic vessels of the scalp are as follows:

terior or OCCIPITAL vessels which follow the course

(1)

Pos-

of the superficial veins

PLATE CCLXV.

Tiii';

downward over

Urixiferous Turtles.

the occipital bone to the occipital nodes.

and are situated

These node- are also

below the superior line curved of the

occipital bone.
Their radicles are from the back of the bead, and the vessels
In
from these nodes empty into the superficial Lymphatic nodes of the neck.
called suboccipital

just

secondary syphilis these nodes arc enlarged.

tero-lateral) vessels pass

downward behind

(2)

POSTERIOR AURICULAR (pos-

the ear toend

in

the postero-auricu-

These nodes are situated over the inThe vessels which Leave these
sertion of the Stemo -cleido-mastoid muscle.
(")
Temporal lymphatic vessels,
nodes empty into the superficial cervical.
also called antero-lateral, pass with the superficial temporal veinand end in the

lar nodes, also called

Sterno -mastoid.

parotid lymphatic nodes.

These nodes are situated

over the parotid

gland

ANATOMY

504

and

sonic of

them are

drain part ofthe

IX A

NUTSHELL.

the substance of the parotid gland.

in

temple,

externa] pails

of the eye

lid.

Their radicles

and

the posterior

The vessels which leave these nodes empty into (a) sub(4) An
maxillary nodes, (b) some of them in the superficial cervical nodes.
anterior or frontal set pass over the frontal hone and empty into the
The buccal Lymphatic nodes are situated
buccal ami submaxillary nodes.
pari of die cheek.

mi the surface of the Buccinator muscle.

The

end in the submaxillary lymThese nodes are situated beneath the body of the lower jaw in

superficial lymphatic vessels of the face

phatic nodes.

There are eight to twelve

the submaxillary triangle of the neck.

of these nodes.

FROM THE UPPER AND LOWER LIPS \\D SIDE OF NOSE, (2)
FROM THE FLOOR OF THE MOUTH, (3) FROM FRONT PART OF TONGUE, (4) FROM
SUBLINGC \l. Wl> SI BM VXILI.ARY SALIVARY GLANDS, and (")) FROM THE ANTERIOR
PART OF THE CAROTID LYMPHATIC NODES. The vessels that leave these nodes
empty into the deep cervical lymphatic nodes and also into the superficial lymTheir radicles are,

phatic

(1)

nodes.

The suprahyoid lymphatic nodes are two or three in number and are situated in the median line between the anterior bellies of the Digastric muscles.
The superficial lymphatic vessels of the neck join the superfical lymphatic
They empty into
vess< Ls of the seal]) and face and upper part of the thorax.
These nodes are situated between
and the deep fascia along the course of the exSmall lymphatic nodes are found anterior to these between

the superficial cervical lymphatic nodes.

the Platysma myoides muscle

ternal jugular vein.

the hyoid bone and the sternum, also posteriorly over the Trapezius muscle.

The

nodes are, (1) thosk from the occipital

THOSE FROM THE POSTERIOR AURICULAR NODES, (3) SOME FROM THE
PAROTID \\D SUBMAXILLARY NODES, ,(4) FROM THE INTEGUMENT OF THE NECK
AND external ear. The vessels passing from these nodes end in the deep
radicle- of these superficial cervical

NODES,

cervical

(2)

lymphatic nodes.

LESSOX CLXVIII.
The deep lymphatic
an- a- follows: (1)

geal arteries through

nodes. (2)

head and neck follow the course of the

vessels of the

They
meningeal i.vMPHATic vessels which pass with the menin-

deep arteries and end

CEREBRAL

in

the deep cervical chain of lymphatic nodes.

foramina

at the

base of the skull to end

in

dee]) cervical

LYMPHATICS, which pass with the internal carotid artery,

and internal jugular vein through foramina at the base of the

deep lymphatic nodes. (3) lymphatic VESSELS of the ORBIT
follow the inferior orbital vein into the spheno -maxillary fossa ami fromhere
they follow the internal maxillary vein and empty into the internal maxillary
nodes and deep carotid nodes, (4) THE LYMPHATIC VESSELS FROM THE TEMPORAL
pass through the internal maxillary nodes to join
FOSSA wi> ZYGOMATK
SS
the deep cervical nodes, (5) lymphatn
essels from the inferior of the nose
end in the lymphatics of the pharynx and into the deep cervical nodes. They
communicate with the subdural lymph space and the subarachnoid lymph
bral artery,

skull to join the

ANATOMY

IX A NUTSHELL.

505

space by means of the lymph spaces which surround the olfactory nerves.

Lymphatic vessels of the mouth and tongue.

mouth pass into the submaxillary lymphatic nodes

Those from the floor of

through the
Mylo-hyoid muscle. Those from the lips pass into both the submaxillary and
Those deeply situated hi the check and in roof
into the deep cervical nodes.
Those on the tongue
of mouth join the internal maxillary lymphatic nodes.
pass with the ranine vein and empty into the deep cervical nodes, after passing
through small lingual nodes in the Hyo-glossus muscle. Lymphatic vessels of
the front part of the tongue pass into the submaxillary nodes after passing
through the Mylo-hyoid muscle. (7) The lymphatic vessels >f the pharynx
empty into the deep cervical nodes, but those from the upper pari of the pharynx
Lymphatic vessels of the tonsil
first pass through the post-pharyngeal node.
empty into the submaxillary nodes. (8) The lymphatics of the larynx
empty into the deep cervical nodes. (9) The lymphatics vessels of the
upper part OF the CESOPHAGUS axd trachea open into the deep cervical nodes.
(10) The lymphatics of the thyroid gland open into the dee] cervical nodes.
The deep lymphatic nodes of the head are, (1) the lingual, which are situated on the outer surface of the Hyo-glossus and Genio -hyo-glossus muscles.
There are two to four in number and collect the lymph from the upper surface
and posterior part of the substance of the tongue. The vessels from these nodes
empty into the superior nodes of the deep cervical nodes. (2) The [nternal
maxillary or deep facial nodes are situated behind the Buccinator muscle and
Their radicles arefrom (a) the orbit, (b) the nose,
are three to six in number.
(c) the temporal and spheno-maxillary fossaB, (d) the upper jaw. (e) the palate,
(f) the pharynx.
The vessels from these nodes empty into the superior nodes
of the deep cervical nodes.
(3) The post-pharyngeal node is situated near the
Its radicles are
base of the skull on the Rectus capitis anitcus major muscle.
from (a) the pharynx, do nose, (c) the deep prevertebral muscles.
The deep lymphatic nodes of the neck are, (1) an upper ski which passes
(6)

the

after passing

along the internal jugular vein as far as the thyroid cartilage.

This

set

of

nodes receives radicles from the (a) inferior of the cranium. (In from the deep
muscle- of the upper part of the neck, (c) from the internal maxillary glands,

from the posterior half of the tongue, (e) from the middle portion of the
(f) the upper part of the larynx, (g) the upper part of the thyroid
Vessels from
gland, (h) and some of the vessels from the submaxillary nodes.
these nodes pass downward to the lower deep cervical nodes.
(2) A lower
the thyroid cartilage to near itset which follows the internal jugular vein fr
termination.
These receive radicles from (a) the lower pari of the neck, (b)
the upper set of lymphatic node-, (c)the Lower part of the larynx, (d) lower
pari of thyroid gland, (e) the upper part of the oesophagus and trachea, (f)
from the superficial cervical nodes. The vessels which leave these node- end
(d)

pharynx,

the jugular lymphatic trunk which mute- with the subclavian lymphatic
trunk to form the right lymphatic trunk on the right side and the thoracic duct
in

on the

left side.

ANATOMY

506

IN A

NUTSHELL

LESSON CLXIX.
Frontal Bone.
The

(Plates

frontal bone consists of

noN which forms

GCXXXVII-CCXXXVIII.)

two main parts, a vertical or frontal por-

the forehead, and a horizontal or orbito-nasal portion

which forms the roofs of the orbits and nasal

The

fossae.

external surface of the vertical portion lias the following points for

consideration
1.

of

Tin. metopic

suture

(presenl

in

the young)

(Plate CCXXXVIII.)
The frontal eminence is just below

is

situated

in

the middle

the fn.nial bone.

2.

the center of the bOne externally

from the mid-lino.

PLATE CCLXVL

RENAL

?-

CAV1TY

J^BERT.INT^J^g

ARTERY

NFUNDIBUIU^

Sagittal Section of the Kidney.

The arched superciliary ridge

is
below the frontal eminence and
by a groove. This ridge, which is produced by the frontal
sinus, is more disl bid internally.
4. The glabella or nasal eminence is between the superciliary ridges and
continuous with them.

3.

separated from

5.

Tin

si

it

praorbital ^rch

is

the upper margin of the orbit and separates

the vertical and horizontal portions of the frontal bone.

6.

The

si

middle thirds

praorbital
<>f

this

mi >t<

arch.

It

ii

or foramen

is

at the

junction of the inner and

transmits the supraorbital vessels and nerve

ANATOMY
and

507

from the diplce passes into tin' supraorbital vein.

is the end of the supraorbital arch
articulates with the malar bone.

at this point a small vein

The external angular process

7.

and

IN A NUTSHELL.

is

well marked.

8.

It

The internal angular process

arch and

marked

not so well

is

is

the other end of the supraorbital

as the external angular process.

It

articulates

hone
temporal
ridges run upward and backward from the
The
9.
angular process. The lower ridge gives attachment to the Temporal
with the lachrymal

external

muscle,

and the upper one gives attachment to the temporal fascia.

10. The anterior part of the temporal fossa is below these ridges and
gives origin to part of the Temporal muscle.
11. The nasal notch is between the internal angular processes and articulates with the two nasal bones mesially and with the nasal process and the
superior maxillary bone ext< rnally.
P
12. The nas\l process passes from this notch under the nasal bones and
|

the nasal processes of the superior maxillary bones.

13. The nasal spine arises from the under surface of the nasal process
and joins the nasal bones in front and the perpendicular plate of the ethmoid
behind to form part of the septum.
The internal surface of the vertical portion has the following points for

consideration

vertical groove which passes along the middle line for the superior
longitudinal sinus, and the edges of this groove give attachment to the falx
1.

cerebri.
2.

The frontal crest

is

formed by the edges

of this

groove muting an-

teriorly.
3.

The foramen cecum

frontal crest

by

its

is

formed by a notch

articulation with the ethmoid.

cess of the falx cerebri,

and when open

a vein

in

the lower end of the

This foramen lodges

pro-

from the nose passes through

it

to the superior longitudinal sinus.

4. Eminences and depressions are found on this surface of the frontal
bone external to the median line for the cerebral convolutions.
5. Furrows which are for branches of the anterior meningeal arteries.
6. Depressions for the Pacchionian bodies are near the vertical groove.
The frontal sinuses are two spaces at the anterior inferior part of the bone
between its layers. They are lined with mucous membrane and open into the

middle meatus of the nose by the ini'undibula.

The

inferior surface of the horizontal portion has the following point- for

consideration:
1.

The ETHMOID NOTCH

of each orbit.

This notch

is

separates two thin plates which forms the vaull

filled

edges of this notch present half

the ethmoidal
2.

by the cribriform plate of the ethmoid, and

which with half cells of the ethmoid make

cells

cells.

The lachrymal

fossa, which

is

for the

lachrymal gland,

is

near the

external angular process.

3.

muscle

A depression
is at

or tubercle for the fibrous pulley

the nasal margin of this surface.

"\

the Superior oblique

ANATOMY

508
A.NTERIOB

4.

NUTSHELL.

IX A

ETHMOIDAL FORAMEN

is

the anterior ethmoidal vessels

for

and nasal branch of the ophthalmic nerve.

POSTERIOB ETHMOIDAL FORAMEN is for the posterior ethmoidal vessels.
The superior surface of the horizontal portion is convex and has depressions

and eminences for the frontal convolutions, also grooves for branches of the
anterior and middle meningeal arteries.
This hone has two centers of ossification, one for each half.
Ossification.
It
articulates with the following hones:
Ajrticulation.
(1) the two
parietal, (2) the sphenoid. (3) the ethmoid. (4) two nasal. (5) two superior
maxillary, (6) two Lachrymal, (7) two malar, thus making twelve bones.
Attachment of Muscles. It has three pairs of muscles attached to it.
Corrugator supercilii, (2) Orbicularis palpebrarum, (3) Temporal.
Blood Supply.- The middle and small meningeal arteries on the cerebral
The ethmoidal
surface and the frontal and supraorbital on the outer surface.
arteries and other branches of the ophthalmic artery pass to the horizontal
*

plate

Corrugator supercilii.

Description. This

neath the Occipito- frontalis and Orbicularis

the superciliary ridge,

muscle, which is situated bepalpebrarum at the inner end of

small and pyramidal.

is

From inner end of the superciliary ridge of temporal bone.

[nsertion. Into the deep surface of the skin opposite the middle of

Origin.

the

supraorbital arch.

To draw the eye brow downward and inward, which produces

A.CTION.

the vertical wrinkles

Nerve Supply.
third

the forehead.

in

Temporal

nerve which join

Blood Supply.

this

branch of the

Supra-orbital

the circumference of the orbil

a palpebral portion.

Origin of Orbicular Portion.

frontal

bone,

(2)

fibers of the

(1)

From

internal angular process of the

process of superior maxillary bone.

nasal

by

and frontal from ophthalmic artery.

This muscle, which surrounds
and eye lids, consists of an orbicular portion and

palpebrarum. -Description.

Orbicularis

facial nerve, or

nerve.

(3)

borders and

anterior surface of the tendo oculi.

Into the skin of the eye lids, forehead, temple,

[NSERTION.
ii-

upper

blending

fibers

and cheek.

with the Occipito-frontalis and the Corrugator super-

cilii.

Origin

Palpebral Portion.

<>v

This portion

INSERTION.
tarsal ligament,

Ai TION.

\u:\

i.

From

the bifurcation of the tendo oculi.

thinner and paler than the other portion.

is

Into

To

raphe on the outer side of the eye

lids,

the external

close the eye lids.

Supply.

nerve which join

; i

and malar bone.

this

Blood Supply.

Temporal branch

of facial

nerve or by fibers of the third

nerve.

Supra-orbital,

from the temporal.

Temporal.
Description. -This
the
temporal
in
fossa.

frontal

is

from ophthalmic, and branches

a large

and radiating muscle situated

ANATOMY

Origin.
of the

(1)

temporal

Insertion.

From temporal

IX A NUTSHELL.

ridge,

(2)

509

temporal

fascia,

(3)

greater part

fossa.

Into

the inner surface, apex and anterior border of the cor-

onoid process of the inferior maxillary bone.

Action.

To bring the incisor teeth together.

It

is

called the biting muscle.

PLATE CCLXVII.

W&:
v

xx

Ull

\N

A\V

x)

WJ-): ?''':

11 '

''I

*"/;'/'/'/.,'

'r'i

I,.',:.

''/.////.'/,
J

,.'
l

ir''//'/'

;.,'|M

GLANSCLITORIOIS

FRENULUM

CLITORIDlS

ORIFICIUM

\v

URETHR/e EXTERNUM

MAdU&Xx

LABIUM
,

'.'.'

'

'

LABIUM

POST.

:.\\H...\\-

:"

>''

. > ,_.,..-

'

Nerve Supply.
fifth

COMMISSURE

<

ANUS

'

The Female External Organs

the

Av

\V^^
MINUS V_V

x"

Temporal

of Generation.

branches of the inferior maxillary division of

nerve.

Blood Supply. .Muscular branches from

the second portion of the internal

maxillary artery.

LESSON CL XX.
The Parietal Bone.
The

parietal bone has

consideration.

two

(Plates

CCXXXIX-CCXL.)

surfaces, fouh borders, and four angles for

ANATOMY

510

NUTSHELL.

IN A

The external surface of the parietal bone has the following points:
1.
Parietal emineni e near the center of the bone where ossification commences.

TWO

SEMICIRCULAR TEMPORAL RIDGES which are about two-fifths of an

ami arc continuous with the ridges on the frontal bone, and like
those on the frontal bone give attachment to the Temporal muscle and to the
temporal fascia.
:!.
The surface below these ridges gives attachment to part of the
2.

inch apart

Temporal muscle.
4. The parietal foramen

is

near the superior border and transmits

vein to the superior longitudinal sinus.

artery passes through this foramen.

The

Occasionally a branch of the occipital

This foramen

internal surface of the parietal hone

is

is

inconstant.

concave and has the following

1

points:
1.

Eminences and depressions

2.

Furrows
A

3.

There

oi;oo\

which with

i..

its

fellow. Lodges the superior longitudinal sinus.

groove for the lateral sinus at the posterior inferior angle.

superior border is dentated and with its fellow forms a sagittal

also

i-

for the cerebral convolutions.

middle meningeal artery.

for the

The

suture, which

This border

a synarthrosis joint.

is

is

the longest and thickest

of the four borders.

The anterior border

joins the frontal

bone and helps to form the coronal

suture.
Tin-; POSTERIOR BORDER joins the occipital bone and helps to form the
Lambdoid suture.
Tin: [NFERIOR BORDER is divided into the following parts, (a) the anterior.
which is overlaped by the tip of the greater wing of the sphenoid, (b) the middle
part which i> overlaped by the squamous portion of the temporal bone, and
(c) the posterior pari which articulates with the mastoid process of the temporal

bone.

Tin. INTERIOR SUPERIOR

meel the frontal hone.

is

ANGLE

This

is

is

the point where the two parietal bones

the location of the anterior fontanelle which

called the -oft spol in the baby's head.

Tin-:

ami the

posterior superior axoi.k is the point where the two parietal bones
hone meet-. This is the location of the posterior fontanelle.

occipital

Tin. posterior [NFERIOR vngle joins the mastoid process of the temporal
hone.
'I'm.

INTERIOR [NFERIOR ANGLE joins the frontal hone and greater wing of

the sphenoid hone.

OSSIFICATION.

Artn

occipital bone.

making

This

lation.
(3)

It

bone

ossifies

from one center.

articulates with. (1) the opposite parietal bone. (2) the

the frontal. (4) the temporal,

and

(5)

the sphenoid, thus

five bone-.

Attachment of Mi
the Temporal.

s<

les.

This bone has but one muscle attached to

See page 508

Blood Supply.

Middle meningeal, occipital, supraorbital arteries.

it,

ANATOMY

IN A NUTSHELL.

511

LESSON CLXXI.
The Occipital Bone.
The

occipital

bone

is

CCXLI-CCXLIL)

(Plates

situated at the posterior and inferior region of the

This bone is curved upon itself.

in form.
convex and has the following points for consideration
1. The external occipital protuberance is situated midway between
the superior point of the hone and the foramen magnum.
It gives attachment
to the ligamentum nuchse.
2. The external occipital crest is a vertical ridge extending from the
external occipital protuberance to the foramen magnum.
Tins also gives attachment to the ligamentum nucha?.
3. The superior curved line extend- outward on each side from the
This line gives attachment to the Trapezius
external occipital protuberance.
muscle internally and the Occipito-frontalis and Sterno-mastoid muscles ex-

cranium and

The

is

trapezoidal

external surface

is

ternally.

line

4. The highest curved lixe (linea suprema) is above the superior curved
and gives attachment to epicranial aponeurosis.
5. The inferior curved lixe, which passes outward from the middle of

the external occipital crest together with a depression below

ment

it.

gives attach-

Rectus capitis posticus major and Rectus capitis posticus minor.

6. The depression between the superior and inferior curved lines gives
attachment to the Complexus muscle internally. Splenitis capitis and Superior
to the

oblique externally.

The foramen magnum

7.

Its greatest

tures:

(a)

diameter

is

is

the medulla and

its

opening near the inferior angle.

a large oval

antero-posteriorly.

membranes,

It

transmits the following struc-

(b) the spinal accessory nerve, (c)

the occipi to-axial ligaments, (d) vertebral arteries,

(e)

anterior and posterior

spinal arteries.

The condyles

8.

foramen magnum.
ward and outward

are convex

and reniform

in

They

shape.

of

the

look back-

to articulate with the atlas.

The tubercles

9.

are situated on each side of the anterior pail

They

are situated on the inner border of each condyle and

give attachment to the check ligaments.

10.

The jugulab processes

(transverse) are situated externally

to

the

condyles, and help to form the posterior lacerated foramen.

1

12.

The jugular foramen

A quadrilateral

cess for its

13.

is

on the anterior border of

lie

jugular process.

on the externa] surface of the jugular proarticulation with the petrous portion of the temporal bone.
deep <;k<><>\ e is on the upper surface of the jugular process for the

facet

is

lateral sinus.
14.

Ax eminence

(paramastoid

in

animals),

which may extend

to

the

transverse process of the atlas, gives attachmenl to the Rectus capitis lateralis

muscle and the lateral occipito-atlantal ligament.

1").

Anterior condyloid foramen

is

on the outer side of each condyle.

It

ANATOMY

IN A NTTSHELL.

transmits the hypoglossal nerve and some meningeal branches.

may

This foramen

double.

lie

Posterior condyloid foramen, which is behind the condyle, transIt is at the bottom of the posterior condyloid
mit.- a vein in the lateral sinus.
is
often
absenl
fossa and
The basilar process of the occipital hone is situated anterior to the foramen
magnum and is quadrilateral in shape. The pharyngeal spine (sagittal ridge)
to the tendinous raphe and the
is on its under surface and uives attachment
There
is
depression
on each side of this spine
muscle.
a
constrictor
Superior
Hi.

PLATE CCLXVIII.
SUB-PUOIC LIGAMENT WITH APERTURE FOR DORSAL VEIN OF THE PENIS

DORSAL NERVE
APERTURES FOR DORSAL ARTERY AND NERVE OF PENIS
ANTERIOR LAYER OF TRIANGULAR

LIGAMENT

APERTURE FOR AhTERY OF CORPUS CAVERNOSUM

CRUS
TRIANGULAR

SUPERFICIAL

DORSAL ARTERY OF PENIS

PENIS

'ERY OF

LIGAMENT

CAVERNOSUM

CORPUS

DEEP TRIANGULAR LIGAMENT

ISCHIO-CAVERNOSUS. OR ERECTOR PENIS.

APERTURE FOR ARTERY TO

ARTERY TO BULB

BULB

URETHRAL APERTURE
APERTURE FOR COWPER S
DUCT

PUDIC VEINS

DORSAL NERVE.

POSITION OF BULB

POSITION OF

APERTURES

INTERNAL PUDIC ARTERY

PERINAEAL VESSELS AND NERVE

COLLES

FASCIA OF

TURNED

COWPER

GLAND

SUPERFICIAL

FOR

BACKWARDS

POSTERIOR BORDER

OF PERINEAL LEDGE

JUNCTION OF TRIANGULAR LIGAMENTS WITH FASCIA OF COLLES.

Colles' Fascia
for the

\.nd

the Triangular Ligaments of Perineum.

attachmenl of the Rectus capitis anticus major ami Rectus capitis anti-

CUS minor.

The

Internal or cerebral surface of the occipital

hone

is

deeply concave ami

has the following points for consideration:

1.

;iic

I'm

for tie'
2.

FOSSAE ate foimed by a crucial ridge.

i;

The

inferior of these fossa'

cerebellum and the superior ones are for the cerebrum.

Till.

INTERNAL OCCIPITAL PROTUBERANCE lies

It
is the point
where the six

divisions of the ridges.

at

the junction of the

cranial sinuses meet

to

form the torcular Herophili.

Crucial ridge has a vertical portion which is for the falx cerebri (above)
and the falx cerebelli (below); and a transverse portion for the tentorium cere''.

l.elli.

4.

sinuses.

(d;<)<)\

ES

ai'c

presenl between the attachment of the dura mater for the

ANATOMY

IN A NUTSHELL.

513

The internal openings for the anterior condyloid foramina and poscondyloid foramina are seen on each side of the foramen magnum.
The basilar process of the occipital hone on its inner surface has a median
5.

terior

groove for the medulla and the pons,

narrow groove which joins another
temporal bone to receive the inferior
The superior ancle is a point
parietal bones.

This

is

and on each
groove

side of this groove there is a

from the petrous portion of the

petrosal sinus.

where the

occipital

hone meet- the two

the position of the posterior fontanelle.

Each lateral angle

is

the point where the occipital hone meets the

posterior inferior angle of the parietal

bone and the mastoid pail of the tem-

poral bone.

The inferior angle (basilar process) joins the body of the sphenoid
The superior border passes from one lateral angle to the superior

hone.

angle

form the lambdoid suture.

The inferior border passes from the lateral angle to the inferior angle.
The upper part of this border joins the mastoid bone and the lower part joins
the petrous portion of the temporal bone.

and helps

to

LESSON CLXXII.

Ossification. It has from four to eleven centers of ossification.

Articulation. It articulates with the two parietal, two temporal, sphenoid, and atlas, thus making six bones.
Attachment of Muscles. It has twelve pairs of muscles attached to it,
(1) those to the superior curved line are Occipitofrontal is of the frontal
region, Trapezius of the first layer of the back, and Stemo-cleido-mastoid of the

superficial cervical region.

2.

To the space between the curved lines

are the

Complexus

of the

fourth layer of the back, Splenius capitis of the third layer of the hack, and

Superior oblique of the

fifth

layer of the back.

Those attached to the lnferiok curved line and the space retwekn it and the foramen macnum are the Rectus capitis posticus major,
3.

and Rectus capitis posticus minor of the fifth layer of the back.
4. That attached to the transverse process is the Rectus

capitis

lateralis of the anterior vertebral region.

5.

Those attached to the basilar process

are the Rectus capitis anticus

major, and Rectus capitis anticus minor of the anterior vertebral region, and

the Superior constrictor of the pharynx of the pharyngeal region.

Blood Supply.Occipital, posterior auricular, middle meningeal, vertebral,

and ascending pharyngeal

Occipito-frontalis.

portion called frontal,

tion

which

is

Origin.

arteries.

Description.This muscle consists of an anterior

and a posterior portion called occipital, ami a third por-

between these two which

The

occipital

half of the superior curved line of th

the temporal

hone.

The

is

called the tendinous aponeurosis.

portion arises from the outer two-thirds or one-

frontal

'cipital

portion

hone ami the mastoid process

arises

from

the

'yramidalis

of

nasi.

5]

AXATOMY

Corrugator
Ixsi

i;

fibers of this

be attached to the nasal hone and the frontal bone.

Into the tendinous aponeurosis of the vertex of the skull.

[ON.

NUTSHELL.

and Orbicularis palpebrarum muscles. A few

supercilii,

muscle may

IX A

ACTION.The

frontal portion draws the scalp forward and raises the eye
brows and skin over the root of the nose. The occipital portion draws the scalp
backward. The Occipito-frontalis muscle is chiefly a muscle of facial ex-!OH.

i;\

Supply. The

i;

branch

terior auricular

frontal portion receives the facial nerve or

which join

of the third nerve

and anterior temporal

and posterior auricular

portion

frontal

The

arteries.

branches

occipital portion receives the pos-

and sometimes the

of the facial

Blood Supply. -The

The

this nerve.

occipitalis minor.

the supraorbital,

receives

portion

occipital

frontal,

receives the occipital

arteries.

this muscle see page 4.").

For description of this muscle see page 40.
For description of this muscle see page 27.").
Complexus.
For description of this muscle see page 272.
Splenius capitis.

Trapezius muscle.

For description of

Sterno-cleido-mastoid.

For description of

Superior oblique.

Rectus capitis posticus minor.

Rectus capitis
vertebral

terior

lateralis.

muscle see page 278.

this

muscle see page 278.

muscle see page 278.

muscle belongs to the an-

Description. This

this

region.

Origin. From
Insertion.

this

For description of
For description of

Rectus capitis posticus major.

the upper surface of the transverse process of the atlas.

Into

the under surface of the jugular process of the occipital

bone.

A<tio\.
\i.i;\

To

draw the head

Si pply.

laterally.

First cervical

Blood Supply.

nerve and a loop between

Rectus capitis anticus major.

DESCRIPTION. This

anterior vertebral region, and looks as though

of the Scalenus anticus.

hind
of

it

are the Longus colli

is

the

sympal

hei

third, fourth, fifth,

verges towards

ii>

INSERTION.

ic

it

muscle belongs to the

were a continuation upward

narrow below hut broad and thin above.

and Rectus capitis anticus minor muscles.

BeIn front

nerve.

the anterior tubercles of the transverse processes of the

and sixth cervical

As

vertebrae.

it

passes

upward

it

con-

fellow.

Into the basilar process of the occipital bone.

To

ACTION.
tion

and the second.

It is

it

Origin. From

it

Prevertebral branches of ascending pharyngeal artery.

flex and rotate the head, and to restore it to its natural posidrawn backward.
pply.
Firsl cervical and a loop between it and the second cer-

after being

Nerve

Si

vical nerve.

Blood Supply. Prevertebral branches of ascending pharyngeal.

Rectus capitis anticus minor.
DESCRIPTION. This muscle, which is short,
immediately behind the Rectus capitis anticus major and in front of the

lies

occipito-atlantal articulation.

Its

course

is

obliquely

upward and inward.

ANATOMY

IN A NUTSHELL.

.")
1

Origin. From the anterior surface of the lateral mass of the at la-, and
from the root of Its transverse process.
Insertion. Into the basilar process immediately behind the Rectus cap*-

it is

anticus major.

Action.

Same as the Rectus capitis anticus major.

Nerve Supply. Same as Rectus capitis amicus major.

Blood Supply. Prevertebral branches of the ascending

the upper part of

pharyngeal.

Superior constrictor.

Description. This muscle, which is situated at

the pharynx. i> of a quadrilateral shape ami thinner ami paler

PLATE CCLXIX.
ABDOMINAL MUSCLES
CRANSVERSALIS FASCIA

ILIAC

CREST

ILIAC FASCIA

PERITONEUM

PELVIU

EXTRA- PERITONEAL TISSUE

BORDER OF ACETABULUM
RECTOVESICAL FASCIA

~.

&

"

:\A

'J'

HI

SPHINCTERAL

- '.

APEX

'ikr^T>

OF

ISCHIORECTAL FOSSA

m0

hf^

ISCHIORECTAL FASCIA

'I

i,

="",y,

GLUTEUS
OBTURATOR

MAXIMUS

FASCIA

OBTURATOR

INTERN

ALCOCK'S CANAL WITH PUDIC VESSELS

The White Link and [schio-Rectal

than the other Constrictor muscles.
tor palati
JBouscle

Its

superior fibers pa-- beneath the Leva-

muscle ami the Eustachian tube.

ami the

basilar process this muscle

the pharyngeal aponeurosis.

Origin.

(1)

From
(4i

This interval

is
is

Between the upper border of this

deficient in fibers ami closed by

known

as the sinus of Morgagni.

the lower one-third of the posterior margin of the

internal pterygoid plate, (2)

the palate bone.

Fossa.

its

hamular

process,

''<>

the reflected tendon of the

the pterygo-maxillary ligament,

(6)

extremity of the mylo-hyoid ridge,

the contiguous portion of

Tensor palati muscle,

the aveolar process above the posterior

i?i a

few

fiber-

from the side of the tongue.

ANATOMY

.510

Insertion.

Into the median

IN A NUTSHELL.

raphe of the pharynx and to the pharyngeal

spine of the basilar process of the occipital bone by fibrous aponeurosis.

Action.

To

constrict the pharynx.

Nerve Supply.
Blood Supply.
the pharynx which

Branches from the pharyngeal plexus.

receives blood supply from the
It

is

its

(1)

blood supply

to

superior thyroid, (2) ascending pharyngeal from the

external carotid, and (3) the pterygo-palatine and (4) descending palatine from

the internal maxillary.

LESSON CLXXIII.
Temporal Bone.

(Plates

CCLXVI-CCLXVII-CCLXVIII-CCLXIX.)

The temporal bone lies at the inferior lateral portion of the skull and consquamous, mastoid, and petrous portion. It contains the organs of

sists of a

hearing.

The squamous portion

(scale-like)

forms the anterior superior part of the

hone.

The

convex and has grooves

has attached to it the
Temporal muscle, and forms part of the temporal fossa. A part of the temporal ridge is situated between this portion of the bone and the mastoid portion.
The zygomatic process arises by three roots and extends forward to articulate with the malar bone.
Its anterior root, which runs inward and ends in
on

its

external surface of the

squamous portion

posterior part for the deep temporal arteries.

the eminentia articularis,

is

short

and broad.

Its

is

It

middle root, also called post*

glenoid process, passes between the auditory process and the mandibular portion of the glenoid fossa.

The

posterior root passes

upward and backward

from the upper border of the zygoma and forms part of the temporal ridge (here
called supramastoid crest.)

To THE

BORDER of the ZYGOMA is attached the temporal fascia.

and concave inner surface is attached the Masseter
The external lateral ligamenl of the lower jaw is attached to a tubercle
muscle.
at the anterior root of the zygoma.
Between the anterior and middle roots of
the zygoma is the glenoid fossa, the anterior or mandibular portion of which
is for the articulation of the condyle of the lower jaw and is covered with car-

and

to

(JPPEB

the lower border

tilage, while its posterior part

lodges the parotid "land.

This posterior portion

formed chiefly by the tympanic plate which forms the antero-inferior wall of
the externa] auditory meatus and ends externally in the auditory process.
Tin-:

i-

Glaserian

fissure divides the glenoid fossa and transmits the tympanic

branch of the internal maxillary artery and lodges the processus gracilis malleus.
The opening of the canal of Eugieb is situated in the angle between the

squamous portion and petrous portion of the temporal bone. It transmits

the chorda tympana nerve.
The internal surface of the squamous portion is concave and has eminences
and depressions for the cerebral convolutions, also grooves for the middle
meningeal artery.

ANATOMY

The superior bordeb

IX A NUTSHELL.

squamous portion

of the

oil

is

thin

and overlaps the

parietal bone.

The antebo-infebiob border

thick and articulates with the greater wing

is

of the sphenoid bone.

The mastoid portion

of the temporal bone projects like a nipple from the

bone posteriorly.
The outer surface of the mastoid process has attached to it the OccipitoThe mastoid foramen may be on
frontalis muscle near the Retrahens aurem.
It transmits a vein to
this part of the bone but is often on the occipital bone.
There are
the lateral sinus and a meningeal branch of the occipital artery.
numerous small foramina on this surface.
The inner surface of the mastoid process has a deep curved fossa for the
This process gives attachment to the following muscles.
lateral sinus.
(1)
inferior portion of the

Sterno-cleido-mastoid.

Retrahens aurem,

(5)

The

digastric fossa

groove, which

Trachelo-mastoid,

(2) Splenitis capitis. (3)

(6)
is

on the inner side of the mastoid process.

The

occipital

for the occipital artery, lies parallel to the digastric fossa in-

is

it.
The mastoid cells are situated in the mastoid
tympanum. They are lined with mucous membrane.

ternally to
into the

(4) Digastric,

Occipito -frontalis.

and open
The upper ones

process

are large, while the lower ones are small.

The superior border

of the mastoid portion articulates with the pos-

terior angle of the parietal.

The posterior border

articulates with the occipital

bone between

it-

jugular process and lateral angle.

The petrous portion

of the

temporal bone

situated between the sphenoid bone

the bone

is

very dense and hard.

passes forward

and inward.

It

It

and the

of a

is

pyramidal form and

occipital bone.

i-

This portion of

and
and three

contains the internal and middle ear

has a base, an apex, three

surface.-,

borders.

The base

squamous and mastoid portions, the lower

between the divergence of the squamous and masThe base presents the
toid portions, but the upper half is concealed by them.
is

situated against the

half of this base can be seen

following points:

The meatus auditobius extebnus, which

ear.

This opening

lies

in

root and middle root of the zygoma.

smooth and belongs

of

it

to the

is

the external opening of the

front of the mastoid process

between the posterior

of this opening is

The upper margin

squamous portion

of the temporal bone. but the rest

belongs to the petrous portion of the temporal bone and forms the second

point for consideration at the base of the petrous portion, namely, the m diTORY process which is for the attachment of the cartilage of the ear.
The apex, which lies internally at the base of the skull, is received betw<

the greater wing of the sphenoid and the basilar process of the occipital bone.
thus forming the outer boundary of foramen lacerum medium, and contain- the
internal carotid canal.

The

anterior surface of the petrous portion of the temporal bone form- the

back part of the middle fossa

of

the skull

and

i>

united with the squamous

ANATOMY

.18

IN A NUTSHELL.

portion by the temporal or petro-squamous suture.

CCXLVII.)
Opening of the carotid can

sideration.
1.

has six points for con-

It

(Plate

\i.,

and plexus, is situated near the apex.

I:iss< '
2. A depression for the
(

i:t

which

is

for tin

ganglion of the

interna] carotid artery

fifth

nerve above the

carotid canal.
o.
i-

Hiatus Fallopi]

for the rcai petrosal

4.

Foramen

is

;i

groove which runs outward ami backward.

This

nerve and branches of the middle meningeal artery.

for the small petrosal nerve.

PLATE CCLXX.

4
IANGULAR

4.IGAMEN.

PERIGNEAL VESS.

TUBEROSITY OF ISCHIUM
NFERIOR /HEMORRHOIDAL

VESS

GREAT SACRO-SCIATIC LIGAMENT.

INFERIOR PUDENTAL NERVE

SUPERFICIAL PERINEAL NERVE

INFERIOR HAEMORRHOIDAL NERVE

SUPERFICIAL TRANSVERS'JS PERINAEI

CUTANEOUS BRANCH OF FOURTH SACRAL

Showing the Muscles of the Perineum.

.>.

Eminence over

the superior semicircular canal which

is

near the center

of this surface.

A depression external to the eminence over the tympanum.

The posterior surface of the petrous portion of the temporal hone forms the
anterior pari of the posterior fossa of the base of ihe skull and has the following
points for consideration:
(Plate CCXLVII.)
1. Meatus
^UDITORIUS [NTERNUS, which is a short canal at the end of
<>.

which

is

the lamina cribrosa.

This lamina

is

perforated by branches of the

seventh and eighth nerves, which puss into this opening.

2.

Opening of the

\<>i

eductus vestibuli which

is

behind the meatus

ANATOMY
auditorius interims.
of the
3.

It

IN A NUTSHELL.

519

transmits a small artery and vein and Lodges

process

dura mater.

An angulah

depression, which transmits

tissue ami lodges a process of the dura mater,

is

vein

the cancellous

to

between and above these other

openings.

LESSON CLXXIV.
The

inferior surface of the petrous portion of the temporal

of the hase of the skull

and from

its

apex to

its

base

it

hone forms

pai

has the following points

(Plate CCXLIX.)
A rough quadrilateral surface

for consideration:

for the origin of the Levator palati

and Tensor tympani muscles.
2. Opening <>f the carotid canal which ascends vertically into the hone
and then turning runs horizontally forward and inward. It transmits the
interna] carotid artery and carotid plexus.
3. Aqueductus cochleae, which transmits an artery and vein to and from
1.

the cochlea.
4.

Jugular fossa

is a

depression for the sinus of the internal jugular vein,

and with the occipital hone forms the foramen lacerum posterius, which transmits the internal jugular vein and the ninth, tenth, and eleventh cranial nerves.
5. Foramen foe Jacobson's nerve (tympanic branch of the glossopharyngeal) is in the ridge between the jugular fossa and the carotid canal.
6. Foramen for Arnold's nerve (auricular branch of the pneumogastric)
is

in

the outer wall of the jugular fossa.

7.

The jugular surface

is

smooth quadrilateral

facet

which articulates

with the jugular process of the occipital bone.

8. Vaginal process ensheaths the rool of the styloid process and gives
attachment to the Tensor palati muscle.
!).
Styloid prockss, which is about an inch long and runs downward, forward, and inward, and gives attachment to the stylo-hyoid, stylo-maxillary
ligaments, and to the Stylo-pharyngeus, Stylo-hyoid, and Stylo-glossus muscles.
10. STYLO-MASTOID FORAMEN is between the styloid process and the mastoid process.
It is the end of the aqueductus Fallopii and transmits the facial

nerve, and the stylo-mastoid artery enters

11.

THE AURICULAE

processes,

is

FISSURE, which

is

it.

between the auditory and mastoid

for the exit of Arnold's nerve.

SUPERIOR BORDER of the pet nuts portion of the temporal hone i> the
It gives attachment
longest and is grooved for the superior longitudinal sinus.
to the tentorium cerebelli and has a notch :it its inner end lor the fifth nerve.
It separates the middle fossa of the base of the skull from the posterior fossa.
The posterior border of the petrous portion of the temporal bone has on
its inner half a groove, which with n similar groove on the occipital bone
Till-:

l<

ihe inferior petrosal sinus.

On

the outer half of this border

is

;i

notch which

forms part of the jugular foramen.

Tut':

anterior border

of the petrous portion of the temporal

bone

is

the

ANATOMY

520

IN A

NUTSHELL

and has an inner portion which articulates with the sphenoid hone, and

shortest

an outer portion which joins with the squamous portion.

The processus cochleariformis is a thin plate of hone which separates two

The upper

canals at the petro-squamous angle.

of

these canals

for the

is

They

Tensor tynipani muscle, and the lower one for the Eustachian tube.
lead into the middle ear.
Ossification. This hone ossifies from ten centers.

ARTICULATION.
tal.

sphenoid.

(3)

Attachment
the

T<>

1.

SQI

It

<>k

articulates with five hones; (1) the occipital. (2) parie-

inferior maxillary. (5) malar.

(4)

Muscles.It has

VMOUS PORTION

tempero-maxillary region.
To the zygoma, the Masseter muscle of the temporo-maxillary region.

3.

To

mastoid portion,

Tin-:

the Occipito-frontalis of the cranial region,

(a)

Sterno-cleido-mastoid of the superficial cervical region,

(b)

it:

temporal hone, the Temporal muscle

2.

of the

of the third layer of the hack, (d)

hack.

ie)

Digastric of the supra-hyoid region,

region.

(b)

Stylo-hyoid of the supra-hyoid region,

Tothe styloid

4.

process, (a) Stylo-pharyngeus of the pharyngeal region.

tynipani of the tympanic region,

I'.i.

>

Supply.

The

(c) Stylo-glosstts of

(c)

It

Stapedius of the tympanic region.

The tympanic artery from the

passes through the Glaserian fissure.

the middle meningeal.

It

the lingual region.

the soft palate, (b) Tensor

stylo-mastoid artery from the posterior auricular.

enters the stylo-mastoid foramen.

maxillary

Splenius capitis

Retrahens aurem of the auricu-

(f)

To the petrous portion, (a) Levator palati of

.">.

(c)

Traehelo-mastoid of the fourth layer of the

lar

It

muscles attached to

fifteen

of the

passes by the hiatus Fallopii.

interna] carotid artery, while in the carotid canal.

which enter- the internal auditory meatus and

is

internal

Petrosal artery from

Tympanic from the

Auditory from the

basilar,

and

distributed to the cochlea

vestibule.

LESSON CLXXV.
Origin and Insertion

<f

the Muscles Attached to Temporal Boxe.

Temporal muscle which has been described on page 508.

Masseter muscle. -Description. There is a strong layer of fascia
which is derived from the deep cervical fascia which covers this muscle and is
1.

2.

connected with

it.

and posteriorly

it

This fascia

i-

attached to the lower border of the zygoma,

covers the parotid gland, making the parotid fascia.

Masseter muscle consists of two portions, a superficial and a deep portion.

deep portion

two portions
it-

is

smaller and more muscular than the superficial portion.

are

united

posterior margin, while

The

facial vein crosses it-

Origin.

The

their

;it

it-

lower anterior angle.

process
is from the malar
and the anterior two-thirds of the lower border
The origin of the deep portion is from the posterior

origin of the superficial portion

zygomatic arch.

These

gland overlaps

anterior margin overlaps the Buccinator muscle.

of the superior maxillary hone,

of the

insertion.

The parotid

The
The

ANATOMY

IN A NUTSHELL.

521

one-third of the lower border of the zygomatic arch and

Insertion.

The insertion

all

of the superficial portion

is

of its inner surface.

into the angle

and

The insertion of the deep

Lower half of the outer surface of ramus of the jaw.
portion is in the upper half of the ramus and outer surface of the coronoid process of the lower jaw.

Action.

It

is

a muscle of mastication.

It

raises

the back part of the

lower jaw.

Nerve Supply. Masseteric branch

fifth

of inferior maxillary division

of the

nerve.

Blood Supply. Facial artery, transverse

branch of the inferior maxillary artery.

facial artery,

and the masseteric

PLATECCLXXI.

CAVITY OF
CERVIX WITH
AReOR VITA

EXTERNAL CS

The Uterus, Horizontal

Section.

3.

Occipito-frontalis muscle, which has been described on page

4.

Sterno-cleido-mastoid, which has been described on page 40.

">13.

which has been described on page 272.

lias been described on page '-'7 1.
This muscle, which pierces the Stylo-hyoid
7. Digastric Description.
muscle near its insertion on the hyoid hone, consists of two fleshy bellies and
rounded tendon between them.
From this tendon of the Digastric a broad
5.

Splenitis capitis,

6.

Traehelo-masfoid, which

;i

aponeurosis
hyoid bone.

is

given

off

which

is

This aponeurosis

attached
is

to the

body and greater cornu

called the supra-hyoid aponeurosis.

of the


ANATOMY

522

IN A NUTSHELL.

Origin. The origin of the posterior belly is from the digastric groove of
The origin of the anterior holly is
process of the temporal bone.
mastoid
the
from the fossa on the inner surface of the inferior maxillary bone near the

symphysis.
Insertion.-

Into

its

central tendon, which

held to the body of the hyoid

is

bone by the supra-hyoid aponeurosis.

Action. To raise the hyoid bone and tongue,
and assist in opening the mouth.

Nerve Supply. The

depress the lower jaw

to

posterior belly receives the facial nerve, while the

anterior belly receives the mylo-hyoid branch of the inferior dental nerve.

Blood Supply.

Facial

artery, occipital artery,

and posterior auricular

artery.
8.

Retrahens aurem,

From

Origin.1

nsertk

in.-

the mastoid process of the temporal hone.

Into concha of ear.

and Lower part

of cranial surface.

To km rad the pinna.

Action.

Nerve Supply. Posterior auricular branch of die

Blood Supply. Branches from posterior auricular.
9.

Description.

Stylo-pharyngeus.

This

facial

which

muscle,

the styloid process of the temporal hone to die pharynx,

cle,

is

nerve.

extends

from

long slender mus-

rounded above and broad and thin below. The stylo-pharyngeus nerve in
lies on die outer side of this muscle.
Origin.- From the inner side and base of styloid process.
Insertion.- Into the Consl ictor muscles, Palato-pharyngeus muscle, and

passing to the tongue

the posterior border of die thyroid cartilage.

Action.

Nerve

To elevate and widen die pharynx.

Glosso-pharyngeal.

Si pply.

Blood Supply,

ts

same

as

die blood supply to

die pharynx,

which

is

found mi page 315.

K).

sertion

Description.

Stylo-hyoid.

by the tendon

This

muscle

of die Digastric muscle.

It

is
is

perforated

near

situated

front of

in

above die posterior belly of die Digastric.

Origin.- From the styloid process of the temporal hone near

its

its

in-

and

base.

.
body of die hyoid b
Ii
Action.
elevates and retracts the hyoid hone.
Nerve Supply.- facial.
Blood Si pply. Same a- Digastric muscle.

Insertion,

11.

tnto the

Stylo-glossus.

Im

-i

ription.- This

is

the shortesl

and smallest

of the

Styloid muscles.

Origin,
near

its

from

the anterior

and external surface

apex, and from the stylo-hyoid ligament by

Insertion,

into the sides of the tongue,

of the styloid

a thin

process

aponeurosis.

and entering the dorsum of the

tongue blends with the Lingualis muscle in front of the Hyo-glossus muscle,
and its oblique portion passes over the Hyo-glossus muscle and decussates with
its

fibers.

ANATOMY

To

Action.

elevate and retract

Nerve Supply.
Blood Supply.
12.

NUTSHELL.

IX A

Hypoglossal.
Facial, lingual

523

tongue.

the

and ascending pharyngeal.

Levator palati. Description.

This muscle,

which

is

long, thick,

and

rounded, is situated on the outer side of the posterior nares.

Origin. From the under surface of the apex of the petrous portioD of the
temporal bone, and from the inner surface of the cartilaginous portion of the
Eustachian tube.

[nsertiOn.

Into

the posterior surface of the

ii

blends

pharyngeal

plexus

palate where

sofl

with the muscle of the opposite side.

Action.

It

elevates the soft palate.

Nerve Supply.

The

spinal

through

accessory

the

possibly from the facial through the petrosal branch of the vidian nerve.

Blood Supply.

Ascending

ascending pharyngeal, descending-

palatine,

palatine, lingual.
13.

Description.

Tensor tympani.

osseous portion of the Eustachian tube

This

in

muscle

bony

is

situated

above the

is

separated from

under surface

of the petrous

canal.

It

the Eustachian tube by the processus cochleariformis.

Origin.

From

the canal

it

situated

is

in.

portion of the temporal bone, and the cartilaginous portion of the Eustachian
tube.

Ixskrtion.
Into the handle of the malleus near its root.
Action. To tense the tympanic membrane.
Nerve Supply. From the otic ganglion of the fifth nerve.
Blood Supply. Tympanic branch of ascending pharyngeal.
14. Stapedius.
Description. This is the smallest muscle in the body.
From the sides of the cavity in the tympanum. Its tendon
Origin.

pusses through the foramen in the apex of the pyramid.

Insertion.
Into the neck of the stapes.
Action. To draw the head of the stapes backward and thus rotating it>
base inward towards the vestibule, and probably compressing the contents of

the vestibule.

Nerve Supply.
Blood Supply.
If).

its

Tympanic
Tympanic

branch from the seventh.

branch of internal maxillary.

Tensor palati.- Description.- This

base upward, and

lies at

is

broad triangular muscle with

the outer side of the Levator palati.

Origin. From scaphoid

fossa

:it

the base of the internal pterygoid plate,

spine of sphenoid bone, vaginal process of temporal bone, cartilaginous portion

of the Eustachian tube,

Insertion.-

and hamular process.

Into the anterior surface of the sofl

palate,

and the trans-

verse ridge on the horizontal portion of the palate bone.

Action.11

tenses

the soft

palate,

and opens Eustachian tube during

deglutition.

Nerve Supply.
Blood Supply.
palatine, lingual.

Otic ganglion of the

fifth

nerve.

Ascending palatine, ascending

pharyngeal,

descending

ANATOMY

524

IN A NUTSHELL.

LESSON CLXXVI.
Ethmoid Bone.
The ethmoid bone which
and two
It

is

CCLVIII-CCLIX.

plate
consists of a horizontal plate a perpendicular

between the orbits.

masses is situated at the base of the cranium
the following
has
Its body
spongy bone and cubical in form.

lateral

lighl

FOR

POI NTS

(Plates

<

onsideration:

PLATE CCLXXII.

ca T

0Rls

Generation.
A Sagittal Section of the Female Organs of
1.

skull as
it^

Cribriform plate (horizontal) forms pan

it

is

situated

orbital plates.

in

of the anterior fossa of the

the ethmoidal notch of the frontal bone

and between

ANATOMY
2.

Crista galli
It is

teriorly.
is

is

situated

and

thick

IN A NUTSHELL.

in

525

the median line of the cribriform plate an-

triangular.

The long border

of this triangle,

The

the posterior one. gives attachment to the falx cerebri.

which

anterior border

by its articulation with the frontal bone completes the foramen

Between the two laminae of this triangle, there may be a shuts.

of this triangle,

caecum.
3.

Grooves

are on this plate on each side of the crista galli for the olfactory

bulbs.
4.

Foramina

perforate this horizontal plate for the passage of the olfactory

These foramina are in three rows, (a) an inner row, which leads to the
nasal septum, (b) a middle row which leads to the roof of the nose, and (c) an
outer row which leads to the superior turbinated bone.
5. Nasal slit is on the side of the crista galli anteriorly and is for the
passage of the nasal nerve, which is a branch of the fifth nerve.
6. Triangular notch is at the back of the cribriform plate for the ethmoid
nerves.

spine of the sphenoid.

7.

The perpendicular plate

descends from the under surface of the

cribriform plate and assists to form the nasal septum.

for filaments of the olfactory nerves.

The

are grooved

Its sides

nasal spine of the frontal and crests

bones articulate with its anterior border. The ethmoidal crest of

sphenoid articulates with the upper half of its posterior border, while the vomer
The triangular cartilage is atarticulates with the lower half of this border.
of the nasal

tached to

its inferior

border.

The lateral masses of the ethmoid bone

consist

of

number of

cellular cavities, and each lateral half presents the following points
for consideration:
1. The ethmoidal cells have thin walls and are situated between two
plates
2.

which form

Os planum

its

sides.

or orbital plate forms the outer surface of these cells and

It articulates with the orbital plateof

forms the inner wall of the orbit.
the frontal bone above, and forms the anteriorand posterior ethmoidal foramina
by their notched borders coming together with the superior maxillary bone
below, with the Lachrymal bone in front, and with the sphenoid and orbital

also

process of the palate bone behind.

3.

The middle turbinated

process, which

is

concave outward andforms

bone which descends

is the end
and forms part of the outer wall of the nasal fossa.
4. The superior turbinated process curves downward and outward.
PROCESS passes downward to articulate with the in5. The UNCIFORM
bone
ferior turbinated
and forms part of the inner wall of the antrum of High-

part of the middle meatus,

from the cribriform

of a thin plate of

plate,

more.

One

ossifies from three centers.

It
OSSIFICATION.
and one for each lateral mass.

Articulation.

It

center for the body

articulates with thirteen bones, namely, the sphenoid

and frontal of the cranium, and all the bones of the face excepl the two malar
articulates with are: the
and the inferior maxillary. The bones of the face
two
two
palate, two inferior turlachrymal,
two nasal, two superior maxillary,
it

ANATOMY

526

IX A

NUTSHELL.

The ethmoid bone with its articulations form the

The two sphenoidal turbinated bones articulate with the ethmoid
they are processes of the sphenoid we do not name them in the
of the ethmoid, since the sphenoid itself has been named.

binated, and the vomer.

nasal fossa.
also.

bu1 as

articulations

\<

hment of Muscles.

There are no

Aaiterior ethmoidal

Blood Supply.

ami nasal or spheno-palatine branch

muscles attached

artery,

to this

hone.

posterior ethmoidal artery,

of internal maxillary artery.

LESSON CLXXVII.
Sphenoid Bone.

(Plates

CCXLIII-CCXLIV).

bone forms most of the middle fossa at the base of the skull.
the hones of the cranium, the vomer, two palate and two malar
Occasionally its external pterygoid plate articulates with the

'The sphenoid
It

touches
the

all

face.

superior maxillary hone.

It

presents the following points for consideration:

1. A body, which is a hollow cuboid structure with six surfaces.

The superior surface has in front THE kthmoidal SPINE which articulates
It then has a smooth surface with
with the cribriform plate of the ethmoid.
mid-line
and on each side of this eminence
a slight longitudinal eminence in the
point
is the optic groove, which
next
The
is a groove for the olfactory tract.
thk optic FORAMEN which
on
each
side
in
lodges the optic commissure and ends
Thk olivary
ophthalmic
artery.
is for the passage of the optic nerve and the
sklla
Thk
groove.
Turcica
optic
(pitprocess is immediately behind the
of
is
body
the
brain,
just
(hypophysis)
uitary fossa), which is for the pituitary
bound
the
sella
processes
Thk
middle
clinoid
behind the olivary process.
Thk dorsum skll.k (dorsum ephippii) bounds the sella
Turcica in front.

grooved on each side for the sixth nerve. Thk posterior clinoid processes are a1 each upper angle of the dorsum sella?. Grooves
are situated laterally on the body for the cavernous sinus and the internal
Turcica behind, and

carotid artery.

is

They

ate curved like the Italic letter

ridge along the outer margin

of this

groove

posteriori}-.

f.
Thk lingula is a
Thk clivus is a shallow

depression which lodges the pons and slopes backward from the
to be continuous with the basilar groove of the occipital bone.

The

dorsum

shape and there is a layer of cartilage between

ce is quadrilateral
bone
about
the twentieth year.
until
the occipital
The anterior surface has in the median line thk ETHMOIDAL CREST.
cresl
i

This

posterior surface joins the basilar process of the occipital bone.

in

articulates with

sella'

it

and
This

Sphenoidal
Thk SPHENOIDAL

the perpendicular plate of the ethmoid.

ELLS or sinuses are on each side of this ethmoidal crest.

RBINATED BONE partly closes these cells or sinuses in front and below, but
they communicate with the nose and sometimes with the posterior ethmoidal
cell.-.
This surface articulates with the orbital process of the frontal bone
above, and with the orbital process of the palate bone below, and with the os
plannum of the ethmoid LATERALLY.
The inferior surface has in its mid-line Tin: ROSTRUM, which articulates
Ti

with the upper edge of the vomer.

and articulate with the

alae of

Thk vaginal processes

the vomer.

are on each side,

This inferior surface helps to form

\TiiMV IN A NUTSHELL.

527

Grooves, which articulate with the sphenoidal processes of

the nasal fossa.
the palate bone, form the pterygo-palatine canals which are for the transmission of the pterygo-palatine vessels and nerves.
2.

The greater wings

from the sides of the body and

Each greal wing has the following

of the sphenoid arise

curve upward, outward, and backward.

points for consideration:
of

division

(a)

the fifth nerve,

foramen rotundum
foramen ovale

for the superior maxillary

or

(b)

the

inferior

maxillary

division of the fifth nerve, the small petrosal nerve, small meningeal artery,

foramen Vesalii transmits a small vein, tins foramen is often absent, (d)
foramen spinosum transmits the noddle meningeal artery, veins, and sympa(c)

thetic filaments

from the cavernous plexus.

This foramen

is

often double.

PLATE CCLXXIII.
ANASTOMOSIS OF

UTERINE

AND

OVARIAN ARTERIES.
HELICINE

UTERO-OVARIAN

BRANCHES

LIGAMENT

EXTRFMITY

FIMBRIATED

OF

MBRIA

TUBE

OVARICA

OVARIAN ARTERY.

ILIAC

VAGINAL

INTERNAL

BRANCHES

OS EXTERNUM

The Uterus With Vagina Laid Open.

The external surface

of the greater

wing

is

convex and

transverse pterygoid ridge into an upper portion, and

upper portion

is

The

and forms pari of the temporal fossa, and the lower

This lower surface ends posteriorly
the zygomatic fossa.

the spinous process, or spine, of the sphenoid.

ment

divided by the

larger

portion forms part of

in

is

lower portion.

This process gives attach-

to the Tensor palati and internal lateral ligament of the lower jaw.

The

anterior or orbital surface of the greater wing of the sphenoid forms

pari of the outer wall of the orbit,

and

is

quadrilateral

in

shape.

The upper

border of this surface articulates with the frontal bone, the outer border with
the malar hone, and the lower border, which is rounded, helps to form the
pterygo-maxillary fissure, while the inner, which is sharp, forms the lower
border of the sphenoidal fissure (anterior lacerated).

This surface has

notch

ANATOMY

528

IN A NUTSHELL.

upper pari for a branch of the lachrymal artery, and a spine at its center
which gives origin to one head of the External rectus muscle.
'I'lic circumference of the greater wing of the sphenoid articulates with
Tart of its inner portion forms the lower
the temporal and frontal hones.
sphenoidal
fissure and helps to form the foramen lacerum
boundary of the
at its

medium.
3. The lesser wings ni the sphenoid hone (processes of Incrassias) project
outward from the upper and lateral part of the body to end in a sharp point.
Each wing has two roots; the upper is thin and flat, and the lower is thicker and
has near the body a small tubercle to which is attached the ligament of Zinn.
Tin; OPTIC FORAMEN which transmits the optic nerve and the ophthalmic artery
The anterior border of each wing articulates with the
is between these roots.
hone,
the
while
posterior
border lies in the fissure of Sylvius, and ends
frontal
Its upper surface is smooth and
in THE INTERIOR CLINOID process internally.
The lower
flat and is situated in the anterior fossa at the base of the skull.
surface forms the upper border of the sphenoidal fissure and the hack of the
Tin-: sphenoidal fissure (anterior lacerated) is hounded
roof of the orbit.
above by the lesser wing of the sphenoid, internally by the body of the sphenoid, and below by the inner margin of the orbital surface of the greater wing
The following strictures pass through the sphenoidal
of the sphenoid.
fissure:

the third nerve, fourth nerve, three divisions of the ophthalmic division

of the fifth

the sixth nerve, filaments from the cavernous plexus of the

sympa-

hranches of the middle meningeal artery, the ophthalmic vein,

and recurrent branch of the lachrymal artery.
4. The pterygoid processes of the sphenoid bone descend on either side from
thetic, orbital

Each process consists of two

and internal pterygoid plate, and a pterygoid
Tin: external pterygoid plate forms part of the inner wall of the
fossa.
zygomatic fossa and gives attachment to the External pterygoid muscle, and
to the Internal pterygoid muscle.
Tin:
its inner surface gives attachment
internal pterygoid plate is longer and narrower than the external one and
has on its extremity the hamular process around which the tendon of the
Tensor palati muscle turns. The scaphoid fossa is at the base of the internal pterygoid plate and gives origin to the Tensor palati muscle.
The
vidian canal is at the loot of the pterygoid process for the vidian nerve and
A triangi lap notch is at the rool of the hamular process to articuvessels.
the junction of the body witli the greater wing.

plates, external pterygoid plate

late with the pterygoid process of the palate hone.

5.

The sphenoidal turbinated hones (spongy) articulate in front with the

They are irregular bones, wide an-

ethmoid ami with the palate externally.

teriorly, and tapering posteriorly.

Ossifn vtion. This bone ossifies from fourteen centers.

It articulates with twelve hones which are. the two malar,
Articulation.
the two palate, and the vomer of the lace, and with all the hones of the cranium
which are. frontal, ethmoid, two parietal, two temporal, and the occipital.
Attachment of Mi scles. It has twelve pairs of muscles attached to it.

TheTemporal

of thetemporo-maxillary region, the External pterygoid

and the

ANATOMY

IX A NUTSHELL.

529

Internal pterygoid of the pterygo-maxillary region, the Superior constrictor of

the pharynx, the Tensor palati of the soft palate the Levator palpebral of the
orbital region, the Superior oblique of the orbital region, the Superior rectus.
Inferior rectus. External rectus,

and Internal rectus

of the orbital region,

and

the Laxator tympani.

Blood Supply.

Middle and small meningeal, anterior deep temporal,

pterygopalatine and spheno-palatine, and twigs from the interna]

vidian,
carotid.

LESSON CLXXVIII.
Temporal muscle which has been described on page 508.
External pterygoid.
Description. This muscle, which passes almost
horizontally between the zygomatic fossa and the condyle of the jaw. is a thick,
1.

2.

short muscle, conical in form.

Origin.

by two heads between which pass the buccal nerve and

The upper head comes from the pterygoid arch
surface of the greater wing of the sphenoid, while the lower

It arises

the internal maxillary artery.

and the inferior

head comes from the outer surface of the external pterygoid plate, and from
the tuberosities of the palate and superior maxillary bone.
Insertion. Into a depression in front of the condyle of the lower jaw.
and the inter-articular fibro-cartilage.
Action. To draw the condyle and interarticular fibro-cartilage forward
and inward.
Nerve Supply. Pterygoid branch of the inferior maxillary division of

the

Supply. External

fifth.

Blood

pterygoid branches of the internal maxillary

artery.

Internal pterygoid.

3.

Description.

This

muscle

is

thick

and quad-

rilateral.

Origin.

From the inner surface of the external

pterygoid plate and from

the tuberosity of the palate bone, and the adjacent pari of the superior maxillary.

Insertion.

Into

the internal surface of the ramus of the jaw as high as

the mandibular foramen

Action.To

and mylo-hyoid groove.

mouth and to draw the lower jaw forward and

close the

inward.

Nerve Supply.

Inferior

Blood Supply.

maxillary division of the

Branches from the second division

fifth

nerve.

of the internal maxil-

lary artery.
4.

Superior constrictor muscle which has been described on

5.

Tensor

6.

Levator

angular

Meshy

in

in
its

palati

pa^

muscle which ha- been described on page

Description. This muscle is tri(superioris).

narrow ami tendinous at ii- origin, bu1 broad and
center and ends in a wide aponeurosis which passes between the
palpebrae

shape and

is

fibers of the Orbicularis to

it

>

insertion.

From the under surface of the

Origin.
above and in front of the optic foramen.

lesser

wing of the sphenoid bone

ANATOMY

530

Into

[nsertion.
lid,

IX A

NUTSHELL

the aponeurosis of the upper

t:\rsal

cartilage, skin of

and conjunctiva.
Action. Lifts the upper lid and antagonizes the Orbicularis palpebrarum.
Nerve Supply. A branch of the third nerve which pierces the su-

perior rectus muscle.

Blood
7.

Supply'.

Muscular

branches from the ophthalmic artery.

This muscle belongs to the orbital

-Description.

Superior oblique.

region and receives the fourth nerve.

Its tendon
Orsgin. From above the inner margin of optic foramen.
process
bone,
the
internal
angular
the
near
pulley
of
frontal
passes through a
rectus
muscle.
Superior
then beneath the

Into the sclerotic coat between the Superior rectus and ExInsertion.
muscle
at right angles to these muscles.
ternal rectus

PLATE CCLXXIV.
SUPERFICIAL DORSAL VEIN

DEEP DORSAL

DORSAL

VEIN

ARTERY

CORPUS
DARTOS

AREOLAR

TISSUE

ANTERIOR BRANCH BULBO-CAVERNOUS ARTERY

CORPUS SPONGIOSIS

A Transverse
Action.

it

Section oe the Penis.

rotates the eye-ball on

its

antero-posterior axis, drawing the

downward and outward.

Nerve Supply*. Fourth cranial nerve.
Blood Supply. Muscular branches from

cornea

8.

Superior rectus.

Description. This

the ophthalmic artery.

is

the thinnest

and narrowest

the Recti muscles.

ORIGIN.

From

the upper margin of the optic foramen, and fibrous sheath

of the optic nerve.

Insertion.-

Into

the sclerotic coat

three or lour lines from the sclero-

corneal junction.

Action.

Elevates and abducts and rotates the cornea inward.

Nerve Supply.
Blood Si pply.

Third

cranial nerve.

Muscular

U.

branches of the ophthalmic artery.

Inferior rectus.

Origin.

From

the ligamenl of Zinn with the Internal rectus.

ANATOMY
Insertion.

Into

NUTSHELL.

EN A

531

the sclerotic coat three of tour lines from the

sclero-

corneal junction.

Action. Abducts the cornea.

Nerve Supply. Thin nerve.
Blood*Supply. Muscular branches of the ophthalmic artery.
10. External rectus.
Description. This is the largesl of the

Recti

muscles.

Origin.

From two heads.

The outer head from

The lower head from the ligament

foramen.

optic

the outer margin of the

of Zinn

and the lower

margin of the sphenoidal fissure.

Insertion. Into the sclerotic coat.
Action. It abducts the cornea.
Nerve Supply. The sixth nerve.

Blood Supply.

Muscular branches

from the ophthalmic artery.

All the structures on the floor of the sphenoidal fissure are between the

two heads

of the External rectus muscle,

namely, ophthalmic vein, sixth. two

and the nasal branch of the fifth nerves.

Description. This is the broadest
Internal rectus.

divisions of the third,

11.

of

the

meet

muscles.

From the ligament of Zinn.

Into the sclerotic coat.
Action.
adducts the cornea.
Nerve Supply. From the inferior division of the third cranial
Blood Supply. Muscular branches of the ophthalmic artery.
Origin.

Insertion.

It

nerve.

Laxator tympani, so-called by Sommeriny, is now called the anterior

It is attached tuthe neck of the malleus and to the
anterior wall of the tympanum, with some of its fibers passing through Glas12.

ligament of the malleus.

erian fissure to the spine of the sphenoid bone.

LESSON CLXXIX.
Nasal Bone.
The

nasal bone, which with

its

(Plate CCL).

fellow forms the bridge of the nose,

bone with two surfaces and four borders.

It

is

is

situated at the upper part of

the face.

The outer
wark.
a

It

vein.

has

surface

many

is

may

This foramen

The inner

convex transversely, but concave from above downits center a foramen for

small furrows for arteries, and at

be double.

the reverse of the ohter surface, which makes it

convex
from above downward. There i- a longiconcave transversely and
on
for
a
branch of the nasal nerve.
tudinal groove
this surface

The
It

is

surface

is

jus!

superior border articulates with the nasal notch of the frontal bone.

serrated,

thick,

ami narrow.

The

inferior border

The

external

the superior border, ami

is thinner and broader than
notch at its middle for
to
lateral
a
the
attachment
There
is
cartilage.
gives
the branch of the nasal nerve.

maxillary bone.

border articulate-

with

the

nasal

process of

the superior

ANATOMY
The

IN A NUTSHELL.

internal border articulates with

its fellow,

and with the nasal spine

the frontal bone above and the perpendicular plate of the ethmoid

Ossification.

of

An

\<

from one center.

The frontal and ethmoid

and the superior maxillary of the fare.
of Muscles.
A few fibers of the Occipito-frontalis of the

Articulation.
the cranium, and
iiMi.vr

may

cranial region

ossifies

It

of

below.

It

its

articulates with four bones.

fellow

he attached to this

hone

branch of the ophthalmic artery, frontal, the

angular and the anterior tehmoidal arteries.
For ORIGIN and ensertion of the Occipito-frontalis muscle see page
Lachrymal Bonk. (Plate CCLI.)
The lachrymal bone lies on the anterior part of the inner wall of the orbit.

Blood Supply.

Nasal

a finger nail, and has the following points for consideration:

The external surface has upon it a vertical ridge called the lachrymal
This
cresl which passes in its mid-line and ends below in the hamular process.
process is sometimes separated from the bone and then is called the lesser
It helps to form the lachrymal groove above by articulalachrymal bone.
The portion
ble with the lachrymal tubercle of tin' superior maxillary bone.
It

resembles

behind the lachrymal crest helps to form the inner wall of the
lachrymal crest forms part of the lachrymal

of this surface

orbit, while the part in front of the

groove.

The
its

internal surface, or nasal surface, forms part of the middle

anterior portion,

while

its

by

posterior portion

its

meatus by

articulation with the

ethmoid bone completes the anterior ethmoidal canals. This surface has a
furrow upon it corresponding to the position of the crest of the external surface.

The anterior border articulates with tin nasal process of the superior
maxillary bone and is the longest.
The posterior border articulates with the os planum of the ethmoid.
The superior border, which is the shortest and thickest, articulates with
1

the internal angular process of the frontal bone.

The inferior border articulates with the lachrymal process of the inferior
turbinated bone, and posteriorly with the orbital plate of the superior maxillary

bone

These two portions of

Ossification.

It

this

border are separated by thecrest.

from one center.

ossifies

Articulation.
It
The frontal and ethmoid
articulates with four bones.
and the superior maxillary and inferior turbinated of the face.
Attachment of Muscles. It has one muscle attached to it. namely, the
the palpebral region.
f
Tensor tarsi
Blood Supplj
Inferior orbital, nasal branch of ophthalmic, and anterior

of the cranium,

ethmoii

lal

artei ies.

Tensor

tarsi.

Descr iption.This muscle

is

the deep part of the Orbi-

cularis palpebral urn.

Origin.

It

arises

from the

crest of the

lachrymal bone and passes across

the lachrymal sac and divides into two portions.

Insertion.

Into the upper and lower tarsal cartilages.

ANATOMY
Action.
eye,

and

to

IN A NUTSHELL.

To compress the puncta lachrymals againsl the globe of the

compress the lachrymal sac into a position mosl favorable for re-

ceiving the tears.

Nerve Supply.
Blood Supply.

Facial, and perhaps

Branches from the

the third nerve.

facial artery.

PLATE CCLXXV.
ORIFICES OF

URETERS
PLICA URETERICA

TRIGONE

WTERNAL URINARY MEATUS

PROSTATE GLAND
IFICES Or PROSTATIC DUCTS

SINUS POCULARIS
COWPEIVS GLAND

MEMBRANOUS URETHRA

CRUS PENIS
ORIFICE OF DUCT OF
COWPER'S GLAND
PECTINIFORM SEPTUM

RPUS SPONGIOSUM
PORA CAVERNOSA
rOSSA NAVICULARS

GCANS
NAL URINAY MLATUS

A Horizontal Section op the Penis.

LESSON CLXXX.
Malab Bone.
The malar bone,

or check bone,

(Plates
is

CCLIV-CCLT

situated

at

forms part of the outer wall and the

the temporal and zygomatic fossae.
the face.

It

the outerand upper part- of

floor of the orbit,

and

part of

ANATOMY

;,.U

IN A NUTSHELL.

external surface of the malar hone is convex and gives attachment

Zygomaticus major and the Zygomaticus minor. It has a malar foramen tor malar branch of temporo-malar nerve and vessels.
lt> inner surface is concave and has a triangular rough surface for its articIt has a smooth concave surface exulation with the superior maxillary.
ternally which forms part of the temporal fossa above and part of the zygo-

The

to the

This surface gives origin to the Masseter muscle.

matic fossa below.

The

orbital border, or antero-superior,

forms part of the circumference of

the oribt.

The maxillary border, or

The Levator

maxillary hone.

antero-inferior,
labii

articultaes

with the superior

superioris propius muscle

is

attached to

this border.

border, or post em-superior,

The temporal
poral fascia

ridge above

is

attached to this border which

and with the upper border

The zygomatic

of the

is

is

curved border.

The tem-

continuous with the temporal

zygomatic arch below.

is continuous with the lower

border, or postero-inferior,

border of the zygomatic arch and gives origin to the Masseter muscle.
The maxillary process articulates with the superior maxillary bone.

It is

rough ami triangular.

The zygomatic process

articulates with the zygomatic process of the

tem-

poral hone.
frontal process articulates with the external angular process of the

The

hone.

frontal

The

backward forming part of the floor and outer

forms part of the temporal fossa and bounds the
anteriorly.
It presents the inner opening of the tem-

orbital process passes

wall of the orbit.

also

It

spheno-maxillary fissure

poro-malar canals.

Ossification. From two or three centers.

Articulation. It articulates with four bones. The frontal, sphenoid,
and temporal of the cranium, ami the superior maxillary of the face.
An \< iimi.vi of Muscles. It has five muscles attached to it. Levator
labii superioris propius of the superior maxillary region, Zygomatic major and

Zygomatic minor

of the superior maxillary region, the Masseter of the

temporo-

maxillary region, Temporal of the temporo-maxillary region.

Blood Supply.

Interim' orbital, lachrymal branches of the ophthalmic,

transverse facial, and deep temporal arteries.

Levator

labii superioris

Origin.al.-o

From

proprius.

the superior maxillary bone above the infraorbital foramen,

from the lower border of the maxillary process of the malar bone.
Into the facial part of the Orbicularis oris.
Insertion.
\>

[ON.

\'l.l;\

l.

To elevate ami protrude the

Si PPL1

Blood Supply.
The infraorbital

lip.

facial nerve.

Branchesfrom the facial artery.

is formed by the fifth and seventh nerves
and the anastomosis of the infraorbital and facial arteries, are beneath this
muscle.

plexus, which

ANATOMY

IN A NUTSHELL.

535

Zygomaticus major.
Origin. From the malar bone on its posterior asped
Into the angle of the mouth.
Insertion.
Action. It raises the lip outward.

of external border.

Nerve Supply. Facial.

Blood Supply. Branches from the facial artery.
Zygomaticus minor. Stenson's dud the facial artery and

vein pass under

this muscle.

Origin.

From

the anterior aspect of the external surface

malar

of the

bone.

Insertion.

Into the angle of the mouth, where

blends with the Levator

it

labii superioris.

Action.

To

outward.

raise the lip

Nerve Supply. Facial.

Blood Supply. Branches from

the facial artery.

Masseter muscle which has been given on page 520.

Temporal muscle which has been given on page 508.

LESSON CLXXXI.
Superior Maxillary Bone.

The

superior maxillary bones are two

(Plates CCLII-CCLIII).
in

number and form

the upper jaw.

only one bone of the face larger than the superior maxillary and that
This bone forms parts of the roof of the mouth, of
is the inferior maxillary.
the floor and outer wall of the nose, of the Moor of the orbit; and parts of the

There

is

zygomatic and spheno-maxillary fossae, spheno- and pterygo-maxillary fissures.

The body of the superior maxillary bom is a hollow cube. This hollow
is called the antrum of Highmore.
1

The external

On

ward.

surface, or facial surface of the body, looks forward

this surface

incisive fossa is just

alse nasi

muscle.

we have

above the

and outThe

the following points for consideration:

incisor teeth

and gives

origin for the Depressor

Just below this fossa a portion of the Orbicularis oris

External

tached to the aveolar border.

to this fossa

is

the origin of the

is

at-

Com-

The canine fossa, which skives origin to the Levator anguli

separated from the incisive fossa by the canine eminence. Tins emi-

pressor alse nasi.

oris,

is

nence

is

produced by the canine tooth. The infraorbital foraand nerve, is above the canine fossa.
of the orbit gives attachment to the Levatorlabii superioris propus

vertical ridge

men, which
The margin

is

for the infraorbital vessels

muscle.

The
matic

Near

posterior, or

fossa.
its

()n

is convex and forms pari of the zygowe have the following points for consideration:

zygomatic surface

this surface

center are the openings of the posterior dental canals for the posterior

dental vessels ami nerve.

The

tuberosity, which

is

at

surface, gives origin to the Internal pterygoid muscle.

ulates with the tuberosity of the palate bone

pterygoid plate of the sphenoid.

A groove

the lower

This

pan

of this

tuberosity artic-

and some time- with the external

above this tuberosity i- con-

just

ANATOMY

536

IX A XUTSHELL.

verted into the posterior dental canal by

The superior

its

articulation with the palate bone.

surface, or orbital surface, forms part of the floor of the orbit.

Its inner border articulates with the orbital process of the palate bone behind,
and with the os planum of the ethmoid in the middle, and with the lachrymal
Its outer border helps in form the spheno-maxillary fissure
bone in front.
and sometimes articulates with the orbital plate of the sphenoid bone. Its
anterior border helps to form the circumference of the orbit and is continuous

PLATE CCLXXVI.

SPERMATIC ARTERY

ARTERY
VAS

OF

DEFERENS.

PAMPINIFORM PLEXUS

HEAD Of

GLOBUS

HYATID

EPIOIDYMUS

MAJOR

MORGAGNI

TAIL OF

EPIDIOYMUS

MINOR

GLOBUS
PORTION

PARIETAL

OF

TUNICA

VAGINALIS.'

Testicle

\\i>

Spermatic Cord.

with the nasal process internally and the malar process externally.
fraorbital groove,
in

which

the mid-line to end

opens into

in

is

for the infraorbital vessels

the infraorbital canal

small canal which runs

in

The

in-

and nerve, runs forward

and foramen.

This canal also

the anterior wall of the

antrum

for

the passage of the anterior dental vessels ami nerve.

There may also be a second dental canal for the middle dental nerve which passes to the bicuspid teeth.

The

Inferior oblique muscle of the orbital region arises

external

to

the

lachrymal groove.

from

depression just

ANATOMY
The

internal surface

is

IX A

NUTSHELL.

537

divided into two partsby the palate process.

The

part above the palate process forms part of the outer wall of the nasal fossa

opening of the antrum of Highmore. The part below the

mouth and is concave. Above the
opening of the antrum of Highmore are half cells which are completed by articulation with the ethmoid and lachrymal hones, while below the opening of the
antrum of Highmore is a smooth surface which forms part of the inferior meatus.

and has the large

palate process forms part of the roof of the

Behind

opening

rough surface which articulates with the perpendicular

is crossed obliquely by a groove which is
converted into the posterior palatine canal by its articulations with the palate
bone.
The lachrymal groove is in front of the antrum of Highmore and lodges
is converted into a canal by its articulation with the
It
the lachrymal duct.
lachrymal and inferior turbinated hones.
The inferior turbinated crest, which
this

is

plate of the ethmoid.

articulates

This surface

with the inferior turbinated hone,

groove.

The middle meatus

below

is

it

is

anterior to

the lachrymal

the concavity above this crest, while the part

is

the inferior meatus.

The antrum of Highmore (maxillary sinus) (Plate CCLXIV) is a pyramidal

cavity in the body of the superior maxillary bone.
The apex of this cavity is
formed by the malar process and its walls are the orbital, facial, and zygomatic
surfaces of the body of the sphenoid bone.
The outer wall of the nose forms
its base in which there is the opening.
This opening is partly closed by the
ethmoid bone above, by the inferior turbinated below, by the palate bone
behind.
The posterior dental canals, which are for the posterior dental vessels
and nerve, are on the posterior wall of this antrum. Processeson the floor of
the antrum are produced by first and second molar teeth.
The malar process, which is triangular and rough, is situated between the
facial surface and the zygomatic surface and articulates with the malar bone.

This process gives partial origin to the Masseter muscle.

The

nasal process, which passes upward, inward and backward by the side

of the nose

is

The Levator labii

Tendo oculiare attached

triangular and thick.

Orbicularis palpebrarum, and

superioris alaeque nasi.

to its external surface.

The upper part

ethmoid hone completing the anterior
ethmoidal cells, while below this is the superior turbinated cresl which articThe middle meatus is immediately
ulates with the middle turbinated bone.
below, and below the middle meatus is the inferior turbinated crest.
Its interna] surface

of

this

makes part

surface articulates

of the outer wall of the nose.

with

the

The upper border of the nasal process articulates with the frontal
The anterior border of this process articulates with the nasal bone.
The posterior border of this process has the lachrymal groove for the

bone.

nasal

and the inner margin of this groove articulates ith the lachrymal bone.
while the outer margin of this groove forms pari of the circumference of the

duct,

joins with the orbital surface is the lachrymal tubercle.

Where
The lachrymal groove is made into a canal by the lachrymal bone and

Orbit.

it

the

lachrymal process of the inferior turbinated bone. This canal which opens
into the inferior meatus, runs downward, outward, and backward.
(Plate

CCLII.)

ANATOMY

538
Areolar process
est

behind and

lias eighl

IN A NUTSHELL.

cavities in

it

for the teeth.

This process

is

broad-

the most spongy part of the superior maxillary bone.

is

Its

molar tooth gives origin to the Buccinator muscle.

The palate process, which passes inward from the inner surface of the
body, forms part of the floor of the nasal cavity and the roof of the mouth.

outer surface behind the

On

first

lnferior surface

its.

is

longitudinal groove or canal for the posterior

palatine vessels and the anterior and external palatine nerves.

It

articulates

with the vomer, the palate, and with its fellow process of the opposite side.
At the point where the two palate processes meet anteriorly is the anteriok

palatine canal or fossa. There are four openings in the bottom of this
the two lateral openings are called foramina of Stenson, and transmit
The anterior and posanterior branches of the descending palatine arteries.
terior foramina are called the foramina of Scarpa, and transmit the naso-palatine nerves.
The left nerve passing through the anterior one and the right
Sometimes a suture passes from this fossa on
nerve through the posterior one.
each side to the interval between the canine and incisor teeth, thus making a
bone called the intermaxillary or incisive hone. See plate CCXXVIII.
The SUPERIOR SURFACE is concave transversely and forms part of the floor of
fossa,

and has the upper openings of the canal

the nose,

The anterior part

Stenson.

of

Scarpa and the canal of

of the inner border of this surface

nasal crest, which articulates with

The anterior extremity
the vomer.

its

of

is

called

the

making a groove to receive

the nasal crest is the anteriok nasal
fellow thus

SPINE.

This bone ossifies from seven centers.

Articulation. it articulates with nine bones. The frontal and ethmoid
of the cranium, and the nasal, malar, lachrymal, inferior turbinated, palate,
and vomer of the face, and with its fellow of the opposite side. Sometimes
articulates with the external pterygoid plate of the sphenoid and also with

OSSIFICATION.

it

the orbital

plate of

the sphenoid.

Attachment of Muscles.

It

has twelve muscles attached to

Orbicularis palpebrarum of the palpebral region, the

it.

The

Inferior oblique of the

orbital region, Levator labii superioris aleque nasi of the nasal region,

anguli oris of the superior maxillary region, the Compressor nasi.

Levator

Depressor

Dilator nares posterior of the nasal region, Masseter of the temporo-

alse nasi,

maxillary

region,

Buccinator of the inter-maxillary region.

Internal ptery-

goid of the pterygo-maxillary region, Orbicularis oris of the intermaxillary

region, Levator labii superioris propius of the superior maxillary region.
lb. odd

frontal,

Supply.

and

nasal,

Infraorbital,
facial

alveolar,

descending palatine, ethmoidal,

arteries.

LESSON CLXXXII.
I

(2)

Orbicularis

palpebrarum muscle has been

described

on page 508.

Inferior oblique.

Origin.

It

arises fr

the orbital plate of the superior maxillary bone.

ANATOMY
Insertion.

Into

IN A NUTSHELL.

")o'.l

the sclerotic coat below the insertion of the External

rectus.

Action.

It

turns the eye-ball on

its

antero-posterior axis outward and

upward.

Nerve Supply. Third cranial.

Blood Supply. Muscular branches
(3)

Levator

Origin.

labii

of the

ophthalmic artery.

snperioris ala^que nasi.

From the nasal process of the superior maxillary

Into the cartilage the ala of the nose and

Insertion.

of

hone.
into the facial

part of the Orbicularis oris.

Action.

Elevates

the upper

Nerve Supply. Facial.

Blood Supply. Angular

lip

and

dilates the nostrils.

artery from the facial.

PLATE CCLXXVII.
ATTACHMENT OF TRABECULAE

TUNICA ALBUGINEA RECEIVING

CONI

&m$l&
rvv^-

VASCULOSI

COLLECTING TUBE
t

jsgp

VAS

DEFERENS

VAS ABERRANS

'MINOR'

RETE TESTIS

IN

MEDIASTINUM

The
(4)

Levator anguli

TESTIS

Testicle.

oris.

From the canine fossa of the superior maxillary

Insertion. Into the
part of the Orbicularis
Action. To
the angle of the mouth.
Nerve Supply. Facial.
Blood Supply. Facial artery.
Origin.

bone.

oris.

facial

lift

(5)

Compressor nasi.

From the superior maxillary bone

Insertion. Into the fibro-cartilage of the
Origin.

and the Pyramidalis

of the opposite side

Action.

It dilates

(6)

Depressor

incisive fossa.

nose, joining here

nasi.

the nostril.

Facial.
Lateralis nasi

Nerve Supply.
Blood Supply.

of the facial artery.

alse nasi.

From the incisive

Insertion. Into the septum

Origin.

above the

fossa of the superior maxillary bone.

and alar cartilage

of the nose.

its

fellow

ANATOMY

540

To contract the

Action.

IN A NUTSHELL.

nostrils.

Nerve Supply. Facial.

Blood Supply. Branches

of the facial.

Dilator nares posterior.

Origin.It

arises

from the margin

of the nasal

notch and

sesamoid car-

tilages.

Into the skin at the

To dilate the nostril.

Insertion.

Action.

Facial.
Branches

margin of the

nostril.

\ki;\ e Supply.

Blood Supply.

from the

facial artery.

(8)

Massetef muscle which has been described on page 520.

(0)

Buccinator.

nator muscle meet

The upper and lower fibers of the Buccimonth where they decussate to he conthe Orbicularis oris, however, the highest and the

Description.

at

the angle of the

tinuous with the fibers of

This muscle, which

lowest of these fibers do not decussate.

is

united with the

Superior constrictor of the pharynx by the pterygo-maxillary ligament, forma

a muscular wall for the mouth, while the Superior constrictor forms a muscular wall for the pharynx.

Origin.

From the posterior areolar processes of both the maxillary bonea

and the pterygo-maxillary ligament.

Insertion. Into the Orbicularis
scribed

in

oris

in

manner which has been

del

the description of the muscle.

Action.- To compress the cheeks.

Supply. Facial, and buccal branch of the

Xia;\ e

inferior

maxillary

division of the fifth nerve.

Blood Supply.

Facial

artery.

(10)

Internal pterygoid which has been described on page 529.

(11)

Orbicularis oris.

Description.

The

fibers

of this

muscle are de-

rived from the other facial muscles which are inserted into the lips,

The

and

it

has

which belong to the lips pass in

an oblique direction from the under surface of the skin through the thickness
Besides these two sets of fibers just menof the lip to the mucous membrane.
fibers

which belong

to

the

lip itself.

fibers

wheh connect it with the superior maxillary

septum of the nose.
Origin.
By accessory fibers of nasal septum and the facial muscles surrounding the mouth.
Into the Buccinator and other muscles surrounding the
Insertion.
mouth. This muscle is not a sphincter muscle.
ACTION.-To pucker and close the mouth.
Nerve Supply. Buccal and supramaxillary divisions of the cervicotioned,

bone

it

:tnd

has

a third set of fibers

the

facial division of the

seventh nerve.

Blood Supply. Superior and

(12) Levator

inferior coronary,

labil superioris proprius.

and

inferior labial.

DESCRIPTION. This muscle covers

the origin of the Compressor nasi and Levator anguli oris muscles, and the infraorbital vessels
(

)i;i<;i\.

and nerve

from

as they pass

from the infraorbital foramen.

the superior maxillary bone above the infraorbital foramen.

ANATOMY IN A NUTSHELL.

Into the upper

To elevate the
Supply. Infraorbital
Supply. Facial.

Insertion.

Action.

Nerve
Blood

lip

541

blending with the Orbicularis

oris.

lip.

branch of the

facial.

LESSON CLXXXIII.
Inferior Maxillary Honk. (Plates CCLVI-CCLVII).
bone consists of a body shaped something like a
hi nvs shoe with the ends spread, and two vertical rami which meet the body at
The body has the following points for consideration:
nearly a right angle.
The external surface of the body is convex from side to side. bu1 concave
from above downward. The symphysis is a vertical ridge in the middle line
marking the junction of the two lateral portions of the bone. The mental proThe incisive
cess is a prominent triangular eminence which forms the chin.
fossa is situated on each side of the symphysis just below the incisor teeth, ami
The Orbicularis oris has an origin
jives origin to the Levator menti muscle.
The mental foramen is jusl below the interval
just externally from this fossa.
between the bicuspid teeth and is for the passage of the mental vessels and
nerve.
The external oblique line passes outward from the base of the mental
process for a short distance, then passes upward and finally become- continu-

The

inferior maxillary

ous with the anterior border of the ramus.

This line gives origin to the De-

and the Depressor anguli

attached the Platysma myoides.
There

pressor labii inferioris

it

is

inferior

oris muscles, while just

is

below
groove near the anterior

border of the Masseter muscle for the facial artery.

internal surface of the body is concave from side

The

to side

from above downward, just the reverse of the external surface.

and convex
It

has the

following points for consideration:

depression in the mid-line corresponding to the symphysis.

The genial

two pairs and are situated just below the center

of this depression on either side.
The upper pair give attachment to the
Eenio-hyo-glossi, and the lower pair give attachment to the Genio-hyoidei.
The sublingual fossa, which is for the sublingual gland, is external to these
tubercles on either side.
Beneath this sublingual fossa at the lower margin of
the bone is the digastric fossa, which gives attachment to the Digastric muscle.
The mylo-hyoid ridge passes obliquely upward and outward and gives attachtubercles or mental spin-'- are

in

ment to the Mylo-hyoid muscle. The posterior extremity of this ridge gives
attachment to the Superior constrictor muscle and the pterygo-maxillary ligament.
The submaxillary fossa, which b for the submaxillary gland, is below
the mylo-hyoid ridge.
These oblique line- mi the external surface and the internal surface divide the

The superior border

body

into an

upper and

lower portion.

of the body, or aveolar border.

i>

thick behind

on each side eighl cavities for the teeth,

muscle on

The
teriorly

its

h gives attachment
external surface behind the first molar tooth.

inferior border

which

is

just

is

to the

longer than the superior border and

the reverse of the superior border.

is

and has

Buccinator
thicker an-

A groove

for the

ANATOMY

542
facial artery

groove

i-

is

od this border

at the

IN A NUTSHELL.

function of the body with the ramus.

This

also partly od the external surface.

The rami of the inferior maxillary bone are the perpendicular portions.
They arc quadrilateral in shape and each one has two surfaces, four borders!

PLATE CCLXXVIII.

GREAT

OMENTUM

LEFT COMMON ILIAC VEIN

A Sagittal Section of the Male Organs op Generation.

The external surface of the ramus gives attachment to the

The internal surface of the ramus lias near its center the
Masseter muscle.
The mylo-hyoid
inferior dental foramen, which open- behind the spine.
groove runs obliquely downward from the dental foramen and Indues the myloand two processes.

ANATOMY

IN A NUTSHELL.

!'

The Internal pterygoid muscle is attached to a rough

The lingula is a sharp spine at the anterior margin
the mental foramen and gives attachment to the internal lateral ligamenl of

hyoid vessels and nerve.

surface behind this groove.

of

the

jaw.

The anterior border of the ramus

oblique

is

a continuation of the external

line.

The superior border of the ramus

the deep sigmoid notch in the center,

The deep sigmoid notch

teriorly.

has the coronoid process anteriorly,

and the condyle of the lower jaw poscrossed by the masseteric vessels and

is

nerve.

The posterior border, which

is

thick and rounded,

is

saddled by the

parotid gland.

The inferior border

The angle

of the

jaw

continuous with the body.

is
is

the junction of the posterior border and the in-

On the lower part of the posterior border between the Masseter

muscle externally and the Internal pterygoid muscle internally is the attach-

ferior border.

ment of the stylo-maxillary ligament.

The inferior dental canal, which is for the inferior dental vessels and nerve,
passesfrom thedental foramen in the ramusof the bone downward and forward.
It now turns forward to pas- underthe alveoli in the body of thebone as far as
the incisor teeth.
lies

It

gives off a branch to the mental foramen.

near the internal surface of the bone for

external surface 'for

The coronoid

its

its first

This canal

two-thirds, and near the

anterior one-third.

process, which

is at the anterior margin of the upper border

and triangular. It gives attachment to the Temporal muscle on both its external and interna] surface-.
The condyloid process is situated at the posterior margin of the superior
Its condyle, winch has its long axis transversely and
border of the ramus.
its outer end higher and more anterior than the inner, articulates with the
The neck of the condyloid process receives
glenoid fossa of the temporal bone.
the insertion of the External pterygoid muscle internally.
There is a tubercle
on its external margin for the capsular and external lateral ligamenl of the

of the

ramus,

is

thin. flat,

lower jaw.

Ossification.

This

bone

ossifies

from twelve centers;

six for

each lateral

half.

Articulation.

It

articulates with the glenoid fossa' of the two temporal

bone-.

this

Attachment of Muscles. Thee are fifteen pairs of muscles attached to

hone.
To the kames. the Masseter of the teniporo-niaxillarv region, the

Internal

and

pterygoid and

Temporal

of

the

External pterygoid of the pterygo-maxillary region,

temporo-maxillary region; to internal surfaci

'nil-: body, the Genio-hyo-glossus and Genio-hyoideus of the lingual region,

Mylo-hyoid of the supra-hyoid region, Digastric of the supra-hyoid region, and
Superior constrictor of the pharynx ro the extern ^l surfaci of the body,
Depressor lahii Lnferioris and Depressor anguli oris of the inferior maxillary

ok

region, Levator menti of the inferior maxillarv region.

Orbicularis oris of the

ANATOMY

.",44

IX A

XUTSHELL.

intermaxillary region, Platysma myoides of the superficial cervical region, and

Buccinator of the intermaxillary region.

Blood Supply. Branches from the internal maxillary.

LESSON CLXXXIV.
Masseter muscle which has been described on page o'20.
Internal pterygoid which has been described on page 529.

1.

2.

External pterygoid which has been described on pane 529.

Temporal muscle which has been described on page 508.
Description. This muscle is fan-shaped and
Genio-hyo-glossus.
The apex of this
placed vertically on either side of the middle line of the jaw.
muscle is at its point of attachment to the lower jaw and its base is its insertion
This muscle is more or less blended with
into the tongue and the hyoid hone.
its fellow in front but separated from it behind.
.!.

4.

.").

Origin.

From

the superior genial tubercle on the inner side of the

sym-

physis of the jaw.

Into the upper part of the body of the hyoid bone and median
NSERTK in.
1

line of the tongue, the side of the

pharynx, and the entire length of the under

surface of the tongue.

Action.To

retract

and protrude the tongue.

Hypoglossal.
Blood Si pply. Lingual.
Genio-hyoideus. Description. This

Xki;\ e Supply.

(>.

it

pa>ses towards

insertion

its

and

lies

muscle increases

close to its fellow.

It

in
is

breadth as
situated be-

neath the inner border of the Mylo-hyoid.

Origin. From the inferior genial tubercle of the lower jaw.

Insertion. Into the anterior surface of the body of the hyoid bone.
To lift and draw forward the hyoid bone.
A' tion.

Hypoglossal.
Lingual.

Nerve Supply.
Blood Supply.
Mylo-hyoid.

7.

Origin.

From

Insertion.
running

the mylo-hyoid ridge of the lower jaw.

Into the

body

of the

hyoid bone and a median fibrous raphe

mid-line of the hyoid bone to the chin.

in

Lift- the hyoid and draws it forward.

Si pply.- -Mylo-hyoid branch of the inferior dental
N i:\
Blood Supply. Submental and mylo-hyoid arteries.

ii"\.

8.

i.

of the fifth.

Digastric muscle which has been described on page 521.

Superior constrictor which has been described on page 515.

in. Depressor labii int'erioris, also called Quadratus menti.

9.

Origin.
From the external oblique line of the inferior maxillary bone
below and internal to the mental foramen.

Insertion.
Action.

Nerve

Into

the lower

lip (facial pari

To draw the lower

Si pply.

lip

of the Orbicularis oris).

down.

Supramaxillary branch of

facial

nerve.

ANATOMY
Blood Supply.

Branches

IX A NUTSHELL.

from the

545

facial artery.

Depressor anguli oris (also called Triangularis nienti).

From the external oblique line of the inferior maxillary bone
Origin.
between the attachments of the Depressor iabii inferioris and Platysma myoides.
11.

Insertion. Into the angle of the mouth.

Action. To draw down the angle of the mouth.
Xerve Supply. Supramaxillarv division of the facial.
Blood Supply. Branches of the facial artery.

PLATE CCLXXIX.
AMPULLA OF DUCT

ACINI OF

(HAND

MAMMILLA

ADIPOSE

LOCULUS
AREOLA

GLAND

LOCULUS

The Mammary
12.

Levator

Origin.

labii inferioris, also called

From

Insertion.

}land.

Levator menti.

the incisive fossa of the inferior maxillary bone.

Into

the facial pari of the Orbicularis oris and internment

of chin.

Action.-

To

raise the lower lip.

Nerve Supply.
Blood Supply.
13.

Supramaxillarv
Branches

of

the

branch of the seventh.

facial

artery.

Orbicularis oris which has been described on page 540.

14. Platysma inyoides.

Description. The Platysma myoides, which i^
broad thin layer of muscle, lies in the superficial fascia.
Ork;ix. From the dee]) fascia which covers the Deltoid and Pectoralis

ANATOMY

546

major muscles, as
Insertion.

IN A NUTSHELL.

may be attached to it.

from the angle of the mouth to
maxillary bone below the mental

passes over the clavicle a few fibers

it

Into the fascia extending

the angle of the jaw, also into the inferior

foramen.
Helps

A.CTION.

to

depress the lower jaw.

Nerve Supply. The inframaxillary division of the seventh.

Blood Supply. Branches of the external carotid artery.
15. Buccinator which has been described on page 540.

LESSON CLXXXV.
[nferioe Turbinated Bone. (Plates CCLX-CCLXIV.)
The inferior turbinated bone, which is situated in the nasal fossa along its
It has two surfaces, two borders, two exouter wall, is curved upon itself.
tremities,

The
to

form the

The
The
The
of

and three processes.

external surface of the inferior turbinated bone

is

concave, ami helps

meatus.

inferior

bone is convex.
narrow and pointed.

internal surface of the inferior turbinated

extremities of this bone are

inferior border (free border) passes to within half an inch of the floor

the nose.

The superior border

articulates with the inferior turbinated crest of the

superior maxillary bone anteriorly, and with the inferior turbinated crest of

the palate bone posteriorly.

The lachrymal

process

is

on the superior border

anterior one-fourth with the posterior three-fourths.

at the junction of the

It

articulates with the

lachrymal bone and also with the nasal process of the

superior maxillary bone, thus helping to form the nasal duct.
The ethmoidal process is on the superior border about half way between
inferior angle of the

the lachrymal process and the posterior extremity of the bone.

It articulates

with the unciform process of the ethmoid.

The maxillary

process,

which

is

immediately below the ethmoidal process

but on the external surface of the bone, articulates with the lower edge of the

aperature of the antrum of Eighmore, and also helps to close this opening.

Ossification.-

Articulation.

It

It

ossifies

from one center.

articulates

with

four

bones.

The ethmoid

cranium, superior maxillary, lachrymal, and palate of the face.

Attachment of Muscles. It has no muscles attached to
Bl<

>i>

Si pply.

of

the

it.

Vomer Bone. (Plate CCLXI).

The vomer (ploughshare) forms the postero-inferior part of the nasal
septum and is a single bone. It has the following points for consideration:
The oaso-palatine grooves or canals are situated on each side of this hone
They are for
runnin g downward and forward to the intermaxillary suture.
the naso-palatine nerves.

The
is

posterior border of the

thin, while

its

upper portion

vomer
is

is

concave and

divided.

free.

Its

lower portion

ANATOMY
The

IX A NUTSHELL.

547

which is the longest, articulates with the nasal cresl

and palate bone.
The anterior border is short and articulates with the incisor crests of the
inferior border,

of the superior maxillary

superior maxillary bone.

The antero-superior border

cartilage below

and the

receives

the Lower margin of the triangular

ethmoid above.

vertical plate of the

The postero-superior border

is

the thickest and has a median groove which

receives the rostrum of the sphenoid bone.

side
is

by the

ala,

which

fits in

This border

is

bounded on

the vaginal process of the sphenoid.

either

This joint

a schindylesis.

OSSIFICATION.

This bone
from one center.
articulates with bones. The sphenoid and ethmoid
ossifies

Articulation.
of the cranium, the

six

It

two superior maxillary, the two palate

of the face.

It

also

articulates with the cartilage of the septum.

Attachment of Muscles. It has no muscles attached to it.

Blood Supply. Anterior and posterior ethmoidal, and nasopalatine

through Stenson's canal.

LESSON CLXXXVI.
Palate Bone.
The palate bones

(Plates
are

two

CCLXII-CCLXIII-CCXXVIII-CCXXIX).
in number and situated between the superior

maxillary bones and the pterygoid processes of the sphenoid bone at the back
of the nasal fossae.

Each bone helps

illary fissure,

spheno-maxillary

form the

and outer wall of

form the spheno-maxand the pterygoid fossa, and the zygo-

to

They

the nose, and the floor of the orbit.

fossa,

roof, floor,

also help to

Each one has the following points for consideration:

The horizontal plate, which is thick, has two surfaces and four borders.
The superior surface is concave transversely and forms the back part of

matic

fossae.

the floor of the nose.

The inferior surface is also concave and forms the back pail of the hard
and has upon it a transverse ridge for the attachment of the Tensor
tympani aponeurosis. A groove is situated at the outer end of this transverse

palate,

ridge which with the tuberosity of the superior maxillary bone forms the pos
terior palatine canal.

Posterior to this groove are foramina of the accessory

posterior palatine canals.

The

anterior border

is

serrated ami articulates with the palate process of

the superior maxillary bone.

The

internal border

fellow, thus forming a

and articulate- with the internal border of itgroove on the upper surface for the reception of the
is

thick

vomer. On the posterior extremity of this border

which is for the origin of the Azygos uvula- muscle.

The
The
palate.

external border joins the verl

posterior border

is

free

Leal

is

posterior nasal -pine

plate of the palate bone

at

and concave, and gives attachment

righl angle.
to the soft

ANATOMY

548

The

vertical plate

IN A NUTSHELL.

broad and thick and

is

is

directed

upward and

slightly

This plate has two surfaces and four borders.

inward.
The external surface articulates with the superior maxillary bone for most
of

extent.

its

This pari of the hone

is

The

rough.

front part of this surface

The upper and

form the spheno-maxillary fossa and is also
smooth. On the posterior part of this surface is a deep groove which with the
superior maxillary hone forms the posterior palatine canal for the descending
is

smooth and covers the

back part

orifice of the

antrum

Highmore.

of

of this surface helps to

palatine vessels and the descending palatine nerve.

The

internal surface forms part of the inferior

meatus which

is

below the

The superior turbinated crest articulates with the

middle turbinated hone, and above this crest is the superior meatus, while
between this crest and the inferior turbinated crest is the middle meatus.
The inferior border joins the horizontal plate at right angles.

inferior turbinated crest.*

PLATE CCLXXX.

The Outee Surface of the Pinna.

The superior border has

notch separating the sphenoidal process from

is converted into the spheno-palatine foramen

by the sphenoidal turbinated bone. The spheno-palatine vessels and the
It was
superior nasal and naso-palatine oerves pass through this foramen.
stated above that this notch was converted into a foramen by the sphenoidal
turbinated bone, but it may be convened into a foramen by the two processes
i

he orbital process, and this notch

meet

ing.

The anterior border has the maxillary process

of tlw inferior turbinated crest.

posteriorly and inferiorly.

I

at

the anterior extremity

This process closes the antrum of Highmore

This border articulates with the superior maxillary

MlllC.

The

posterior border has a deep groove

process of the sphenoid bone.

origin from a
of

the

The

The

and articulates with the pterygoid

Internal pterygoid muscle has part of

median groove on the lower pari

pterygoid

of this

its

border which forms part

process.

orbital process

is

triangular

in

shape and

is

directed

upward and out-

ANATOMY

IX A NUTSHELL.

549

has three articular surfaces and two free surfaces.

The articular
the anteriob or maxillary, which articulates with the superior
maxillary bone. internal or ethmoidal surface, which articulates with the
ethmoid hone. and posterior or sphenoidal surface, winch articulate.- with
The free surfaces are the orbital, which
the sphenoidal turbinated bone.
forms part of the Moor of the orbit. ami Tin: external or zygomatic surface,
ward.

It

surface- are

which forms part of the zygomatic fossa. This process has a rounded border
which forms part of the spheno-maxillary fissure.
The sphenoidal process is -mailer than the orbital process and articulates
.superiorly with the body of the sphenoid, and externally with the pterygoid
It has three surfaces and two borders.
Tin: internal
process of the sphenoid.
surface, which is concave, forms part of the outer wall of the nasal
fossathe superior surface, which articulates with sphenoidal turbinated bone,

surface

is

converted into the pterygo-palatine canal,

Tin:

articulates with the inner surface of the pterygoid

sphenoid bone, and also

help.- to

form the spheno-maxillary

fossa.

border forms the back part of the spheno-palatine foramen.

terior border articulates with the inner surface of the pterygoid
IOR

Ossification.

This bone
articulates
It

with six bones.

superior maxillary, inferior turbinated, vomer, and

Attachment of Muscles.

Its

ANTER-

Its

pos-

process.

from one center.

ossifies

Articulation.

external

process of the

The sphenoid, ethmoid,

its

fellow.

This

bone has four muscles attached to it.

The Tensor palati of the soft palate. Azygos uvulae of the soft palate. Internal
pterygoid of the pterygo-maxillary region, and Superior constrictor of the
pharynx.
Blood Supply. Descending palatine, spheno-palatine, and pterygo-

palatine.

which has been described on page 522.

1.

Tensor

2.

Internal pterygoid muscle, which has been described on page 529.

palati,

There

Description.
3. Azygos uvulae.
from the name we might think there
of the

median

Origin.
eurosis of

is

is

a pair of these

but one.

There

is

muscles although
one on each side

line of the soft palate.

From

the soft

the nasal spine of the palate bone and the adjacent apopalate.

Into the uvula.

nsertk i\.
Action. To shorten the uvula.
Nerve Supply. Internal branch
I

of spinal accessory,

through the pharyn-

geal plexus.

Bloob Supply.
4.

Palatine

arteries

from internal maxillary.

Superior constrictor, which has been described on page 515

LESSON CLXXXVII.
Hyoid Bone. (Plate XIX).
which
is situated a1 the base of the tongue consists
The hyoid bone,
body, two greater cornua, two lesser cornua, making it horse-shoe in shape.
The anterior surface of tin- body is convex and
It is called the lingual bone.

550

AX ATOMY IX A XUTSHELL.

There is a small tubercle on the upper end of

has a ventral ridge in its center.
This surface has attached to it the following muscles: Geniothis ridge.
hyoid. Genio-hyo-glossus, Hyo-glossus, Mylo-hyoid, Stylo-hyoid, the aponeu-

the Digastric muscle.

rosis of

The posterior surface of the hotly is concave.

The lateral surfaces articulate with the greater cornua.
The superior surface gives attachment to the Genio-hyo-glossus, and
(

Jhondro-glossus.

The inferior border gives attachment to the Sterno-hyoid, Omo-hyoid, and

Thyro-hyoid muscles. All muscles attached to this hone are in pairs.
The greater cornu projects backward and outward from the lateral surThe thyro-hyoid ligament is attached to the end of the
face of the body.
The Hyo-glossus muscle is attached to its outer surface, the
greater cornu.
Middle consl rictor to
The lesser cornu

is

he ankylosed hut

Ossification.

its

lower border.

situated at the angle where the greater cornu joins the

The stylo-hyoid ligament

hotly.

may

upper border, and the Thyro-hyoid to

its

is

is

attached to

its

apex.

This articulation

generally free.

From

five centers.

Articulation. It articulates with no bone.

A it \i hment of Muscles. This bone has twelve pairs of muscles attached
to it, as well as the thyro-hyoid membrane and the stylo-hyoid, thyro-hyoid,
and hyo-epiglottic ligaments.
Blood Supply. Superior thyroid and lingual of the external carotid

artery.
1.

Sterno-hyoid muscle, which has been described on page 40.

2.

Thyro-hyoid.

Origix.

From

Action.

the oblique line on the thyroid cartilage.

Into the

Insertion.-

To

body and the greater cornu

of the

hyoid bone.

depress the larynx and the hyoid hone.

Nerve Supply. Hypoglossal

nerve.

Blood Supply. Superior thyroid artery.

Omo-hyoid muscle, which has been described on page

as

''.

59.

4.

Digastric muscle, which has been described on page 521.

5.

Stylo-hyoid, which has been described 522.

6.

Mylo-hyoid, which has been described on page 544.

7.

Genio-hyoid, which has been described on page 544.

8.

Genio-hyo-glossus, which has been described on page 544.

o.

Chondro-glossus.-

pari

of

Description.This muscle

From the body and

Origin.

Insertion.

lesser

ami the Genio-hyo-glossus.

Action. To draw down tin- side
I'.i.t

Hi.

Supplj

>n Si

sometimes described

cornu of the hyoid bone.

Ento the intrinsic muscles of the tongue between the

glossus

\i.i;\ e

is

Hyo-glossus.

the

ppl"5

.-

Byo-glossus.

-Hypoglossal.

Lingua] artery.

of the tongue.

Hyo-

ANATOMY
Origin.

IN"

A NUTSHELL.

551

From the whole length of the greater cornu

and from the body

of the hyoid bone.

Into the side of the tongue.

[nsertion.
Action. To draw down the side of the tongue.

Nerve Supply.
Blood Supply.
]

Hypoglossal.
Lingual artery.

Middle constrictor.

Origin.

From

the greater cornu of the hyoid

Ik die

and the stylo-hyoid

ligament.

Into the middle line of the pharynx by the fibrous raphe.

Insertion.
Action. To constrict the pharynx antero-posteriorly.
Nerve Supply. Pharyngeal plexus.

PLATE CCLXXXI.
DUCTUS ENDOLYMPHATIC!.)";

TYMPANIC CAVITY

SACCULE

EUSTACHIAN TUBE'! 1/1

MEMRRANA TYMPANI
EXT AUDITORY MEATUS

Diagrammatic View of the Organs of Eearing.

(Modified prom Cunningham.)

Blood Supply.
on page 315.
^'2.

tongue

Same as the blood supply

Inferior Ungualis,
in

its

to the

pharynx, which

is

given

This

whole length,

muscle runs along the under edge of the

h makes the dorsum convex and shortens the

tongue.

LESSON CLXXXVIII.
There auk three Pairs of Meati
The superior meatus, which

is

ses i\

the Nose.

the smallest

of

(Plate

the three,

CCLXIV).
is

situated be-

ANATOMY

552

IN A NUTSHELL.

tweeD the superior turbinated bone and middle turbinated bone at the upper
and back pari of tin- nasal fossa. This meatus occupies the posterior one-third
The spheno-palatine foramen opens into
of the outer wall of the nasal fossa.
it
it

back part of

at the

its

miter wall, while the posterior ethmoidal

the anterior part of the outer wall.

at

cells

The spheno-ethmoidal

open into

recess

is

be-

hind the superior turbinated bone at the superior and posterior part of the
nasal fossa and opens into the sphenoidal sinus.
The middle meatus occupies the posterior two-thirds of the outer wall of
the nasal fossa and

turbinated

inferior

is

situated between the middle turbinated bone and the

This meatus communicates anteriorly with the

means of the infundibulum and through these cells
The opening of the antrum of Highmore is near the

bone.

anterior ethmoidal cells by

with the frontal sinus.

center of this meatus.

The

inferior meatus,

which

is

the largest of

the meatuses,

is

situated

be-

It will
tween the inferior turbinated bone and the floor of the nasal fossa.
be noticed that the superior meatus occupied the posterior one-third of the

outer wall and the midlle

meatus occupied the posterior two-thirds

of the

outer wall, while the inferior meatus occupiesthe entire length of the outerwall
of the nasal fossa.

The canal

for the nasal duct

opens

at the anterior

extremity

of this meatus.

The nasal fossae extend from the base of the cranium to the roof of the
mouth, and are situated on each side of the middle line of the face. They are
two large cavities which are separated from each other by a thin septum. The
anterior nares open on the front of the face from the nasal fossa' while the posterior nares open into the pharynx.
The frontal sinus communicates with
the nasal fossa above, the sphenoidal sinus communicates with the nasal fossa
posteriorly, and the antrum of Highmore and the ethmoidal sinus communiThe orbit is joined to the nasal fossa by the lachrycate with it externally.
The mouth communicates with the nasal fossa by the anterior
The cranium communicates with the nasal fossa by the olfactory foramina, and the spheno-maxillary fossa communicates with the nasal
Sometimes the nasal fossae communifossa by the spheno-palatine foramen.
mal groove.

palatine canal.

cate with each other by an opening

in

the nasal fossae.

They include

all

There are fourteen bones

bones
of
the
the face except the two malar
in

the septum.

and the inferior maxillary, and in place of these three it has the frontal, ethmoid and sphenoid of the crainum. The ethmoid bone with all its articulation- make the nasal fossa-.
The frontal, ethmoid, and sphenoid are common to the nasal fossa, cranium and the orbits.
There are numerous foramina at the base of the skull extending from the
foramen csecum to the foramen magnum. There are also three large fossae at
the base of the skull, namely, the anterior fossa, middle fossa, ami the posterior
fossa.

(Plate

CCXXXV.)

WTI.imu; FOSSA HAS THE FOLLOWING FORAMINA:

1. Foramen caecum through which a vein passes to the superior longitudinal sinus, sometimes one from the frontal sinus.
This is a single foramen,
Till.

while the others

in

this fossa arc in

pair-.

ANATOMY
2.

The ethmoidal

fissure

IN A

553

NUTSHELL.

through which passes the nasal nerve and the

anterior ethmoidal vessels.

3.

Olfactory foramina for the olfactory nerves and nasal branches of the

ethmoidal
4.

arteries.

Anterior ethmoidal foramen for anterior ethmoidal vessels and nasal

nerve.
5.

Posterior ethmoidal foramen for posterior ethmoidal vessels and a branch

of the nasal nerve.

6.

amen

Optic foramen for the opticnerve and the ophthalmic artery.

Thisfor-

sometimes given as belonging to the middle fossa since it is <>n the

Thus we can see that
boundary line between the anterior and middle fossa.
anterior
fossa
five pairs and a single one.
there are eleven sets of foramina in the
is

LESSON CLXXX1X.
The middle fossa is on a lower level than the interior fossa
HAS THE FOLLOWING FORAMINA ALL OF WHICH ARE IN PAIRS:
1.

Sphenoidal fissure (anterior lacerated foramen)

third nerve, the fourth nerve,

and three

wn

winch transmits the

divisions of the ophthalmic division

and the sixth nerve, also filaments from the cavernous plexus.
ophthalmic vein, recurrent branch from the lachrymal artery, orbital branch
of the middle meningeal artery, and a process of the dura mater.
2. Foramen rotundum through which passes the superior maxillary diviof the fifth nerve,

sion of the fifth nerve.

3.
4.

the

Foramen Vesalii which is for a small vein.

Foramen ovale through which passes the

fifth

inferior maxillary division of

nerve, small petrosal nerve, and the small meningeal artery.

5. Foramen spinosum through which passes the middle meningeal artery,

meningeal veins, and filaments from the cavernous plexus.
6. Foramen laeerum medium through which passes the vidian nerve, a

branch from the ascending pharyngeal artery, carotid artery, and carotid plexus.
7. Hiatus Fallopii through which passes the petrosal branch of the vidian
nerve and the petrosal branch of the middle meningeal artery.
8.

we

small foramen through which passes the lesser petrosal nerve.

see there are sixteen sets of foramina

in

Thus

the middle fossa.

is ox a deeper level than either of the other

AND
CEREBELLUM AND THE MIDDLE FOSSA CONTAINS
CONTAINS
THE
FOSSAE
THECEREBRUM AND THE INTERIOR FOSSA CONLOBES
OF
TEMPORO-SPHENOIDAL
CEREBRUM. THIS FOSSA HAS THE FOLLOWTHE
FRONTAL
LOBES
OF
TAINS THE
foramina:
ING
1. The meatus auditorius interims for the facial and auditory nerves and

The posterior FOSSA

the

auditory artery.
2.

The aqueductus

vestibuli

is

for a small artery

and vein and

pri

the dura mater.

The jugular foramen (foramen laeerum posterius) in which there are

compartments,
through the anterior one of which passes the inferior
three
3.

ANATOMY

554

IN A NUTSHELL.

petrosal sinus, through the middle one passes the glosso-pharyngeal,

gastric,

sinus,

pneumo-

and spinal accessory nerves, through the posterior one the lateral
and meningeal branches of the occipital, and ascending pharyngeal

arteries.
4.

Mastoid foramen (often absent)

for a small vein

is

and sometimes the

mastoid artery.
.">.

The

anterior condyloid foramen which

for the hypoglossal nerve,

is

and

meningeal branches of the ascending pharyngeal artery.

(i.
The posterior condyloid foramen (often absent) for posterior condyloid
vein.

magnum which transmits the medulla oblongata and its

7. Foramen
membranes, spinal accessory nerves, vertebral arteries, anterior and posterior
This foramen is a single one
spinal arteries, and the occipito-axial ligaments.

PLATE CCLXXXII.

A\

ma

fa

\\\

ATTOLLENS AURICULAI

HELIX
ANTI-

HELIX

ml

fk

\\

';'//
'

///'

f&

ATTRAHENS AURICULAM

OBLIOUUS AURICULAM

EXTERNAL

AUDITORY

MEATUS

^ARTIUGINEUS

Posterior View of the Ear With Auricular Muscles.

and the others are
posterior fossa.
fossa,

base

pairs.

in

The eleven

and the thirteen

of

the

in

Thus we

see there are thirteen foramina in the

in the anterior fossa,

and sixteen

make the

the posterior fossa

in the

middle

forty foramina at the

-hull.

lesson cxc.
The temporal

fossa (Plate

CCXXXIV)

is

hounded anteriorly by the

ex-

ternal angular process of the frontal bone, superiorly

by the temporal ridges,

posteriorly by the temporal ridges, inferiorly by the zygomatic arch.
This
fossa is separated from the zygomatic fossa by tin pterygoid ridge which is
on the outer surface of the greater wing of the sphenoid hone. The temporal
fossa is formed by five hone-, ill pari of the frontal hone, (2) greater wing of
the sphenoid hone. (3) pari of the parietal hone. (4) squamous portion of the
1

temporal, (5) malar bone.

verse facial -uture.

("_M

It

has the following sutures:

spheno-malar suture,

(3)

(1)

a part of the trans-

coronal suture,

(4)

spheno-pari-

ANATOMY
etal suture,

(5)

IN A NUTSHELL.

squamo-parietal suture,

The stephanion

is

(6)

>>>

squamo-sphenoidal suture.

the point where the coronal suture meets the temporal

ridge.

The

pterion

is

the point where the parietal, frontal,

squamous portion

of

the temporal, and the greater wing of the sphenoid meet.

The temporal fossa is deep and concave anteriorly, but convex posteriorly.
marked by grooves which lodge branches of the deep temporal arteries.
The Temporal muscle fills this fossa.
The zygomatic fossa is bounded anteriorlyby the tuberosity of thesuperior
It

is

maxillary bone, posteriorly by the eminentia articularis and the posterior border of the external pterygoid process, superiorly by the pterygoid ridge which

on the outer surface of the greater wing of the sphenoid hone and separates
from the temporal fossa, interiorly by the alveolar border of the superior maxillary bone, externally by the zygomatic arch and the ramus of the lower
is

this fossa

jaw, internally

by the external pterygoid

the inferior maxillary nerve ami

its

plate.

The

internal maxillary artery,

branches, the External pterygoid muscle.

pan of the Temporal muscle are

The spheno-maxillary fissure ami the pterygo-maxillary
the superior and internal part of this fossa.

the Internal pterygoid muscle, and the lower

situated in this fossa.
fissure are at

which opens into the outer and back part

of the orbit, is horizontal in direction and is formed by the lower border of the
orbital surface of the greater wing of the sphenoid superiorly, by the external
border of the orbital surface of the superior maxillary bone and a small pari of
the palate bone inferiorly; by a small part of the malar bone externally; and it

The spheno-maxillary

fissure,

joins the pterygo-maxillary fissure at right

angles internally.

By means

of

this fissure the orbit communicates with the temporal fossa, zygomatic fossa,
and the spheno-maxillary fossa. The superior maxillary nerve and it > orbital
branch, the inferior orbital vessels, and the ascending branches from Meckel's
ganglion (spheno-palatine) are transmitted by this fissure.
The pterygo-maxillary fissure passes at light angles from the inner extremity of the spheno-maxillary fissure and is therefore vertical in direction.
It is formed by the separation of the superior maxillary bone from the
It
pterygoid process of the sphenoid bone and is shaped like the letter \
transmits the branches of the internal maxillary artery and connects the spheno.

maxillary fossa with the zygomatic fossa.

The spheno-maxillary

fossa

is

situated beneath the apex of the orbit where

It is bounded
the spheno-maxillary fissure joins the pterygo-maxillary fissure.
by the under surface of the body of the sphenoid bone and orbital process of

the palate bone superiorly, by the superior maxillary bone anteriorly, by the
anterior surface of the base of the pterygoid process and lower part of the anterior surface of the greater

wing of the sphenoid bone posteriorly, by the vertical

The sphenoidal fissure, the spheno-maxillary

plate of the palate internally.

and pterygo-maxillary fissure open into it. The orbital fossa, nasal
fossa, and the zygomatic fossa, and the cavity of the cranium communicate with
this fossa.
The foramen rotundum superiorly, the vidian foramen belo^ and
internal to the foramen rotundum, and the pterygopalatine foramen open on
fissure,

ANATOMY

556
its

IN A NUTSHELL.

The spheno-palatine foramen and the foramen

posterior wall.

terior palatine canal

open on

its

inner wall.

of the pos-

.Meckel's ganglion, the superior

maxillary nerve, and the termination of the internal maxillary artery are in
this fossa.

LESSON CXCI.
Female Organs of Generation.

CCLXXI-CCLXXII-CCLXXIII).

(Plates

The internal female organs of generation are,

(3)

(1

the vagina, (2) the uterus

Fallopian tubes, (4) the ovaries, while the external female organs of

lie

known by the term vulva or pudendum.

The vagina is the sexual canal of the female which extends upward and
Its upper extremity embraces
slightly backward from the vulva to the uterus.
generation are

the cervix uteri, the posterior wall reaching the cervix higher up than does the

The anterior wall is two ami three-fourths inches long, while

These walls are in
is three and three-fourths inches long.
There is a longitudinal ridge (carina) of the mucous membrane on

anterior wall.

the posterior wall

contact.

the lower half of the anterior wall, while on the posterior wall there are two
ridges

cohnnme rugarum. From all three

all the higher mammalia the vagina

called

rugae pass.

In

dud

Mnllerian

the vagina

is

or oviduct united with

its

of
is

these ridges

fellow, while in the lower

In

left.

some oviparvus animals,

nation of the oviduct beyond the uterine part receives the

The hymen
its

at

-iic.

mammalia

double, wholely or in part there being two more or less complete

vagina, the right and the

vagina

transverse

the terminal section of a

a erescentric or circular

is

mucous

as birds, the termi-

name

of vagina.

fold which constricts the

its entrance.
When the hymen is ruptured warty eminences mark
These are called carunculae myrtiformes. The hymen has the fol-

lowing forms:

Hymen bifenestratus

(biforijB)is one in which there are two openings

and a broad septum between them.
HYMEN CRIBRIFORMIS is one in which the opening is filled by membrane

1.

side by side
2.

many small openings.

HYMEN DENTICULAR is one in which the opening has serrate edges.
Hymen imperforate is one which completely closes the vaginal orifice.

pierced by
3.

4.

In

condition

this

period,

Hy.mkn

5.

surgical operation, after

si

i.

i'ii

i;i.i>

carved ou1 of thickened

6.

Hymi nsepti

7.

commencement ofthe menstrual

necessary.

is

"i

sis

m EN SUBSEPT1

is

one having an irregularly curved edge as

3 is

in

which the opening is divided by a narrow septum.

in which the opening is partly filled by a septum

one

growing ou1 of one wall bnt not reaching the other.

Although the hymen is most always ruptured by sexual congress
remain unbroken until parturition.

The vagina
where

it

is

is

if

tissue.

smallest below

and

largest

where

it

it

surrounds the os

may
uteri,

very dilatable.

The vagina has

bladder, BEHIND

it

in

FRONT ok

it

the urethra

and the posterior wall of the

and the pouch of Douglas.

the anterior wall of the rectum

AXATOMV

IX A NUTSHELL.

.-).)<

ox each side of it are the Levator aid muscles and the

The vagina has three coats:
1.

Outer or

The
cle

fibro-elastic.

Middle or muscular.

2.

recto-vesical fascia.

Mucous or

3.

internal.

circular fibers near the entrance constitute the Sphincter vagina

mus-

which has been described on page 493.

The mucous
epithelium,

it

lining of the vagina

has no "lands but

which moisten-

fore the fluid

it

is

is

covered with squamous laminated

is

furnished with crypts and

follicles,

there-

the nature of a transudation rather than

that of a secretion.

Nerve Supply.

Hypogastric

plexus,

the fourth sacral, and

the

pudic

ei ve.

PLATE CCLXXXIII.
TERMINATION OF SEMICIRCULAR

CANALS

CONNECTION OF MODIOLUS WITH CUPOLA

APEX OF

MODIOLUS

COCHLEA

WINDING OF

FIRST

COCHLEA

SECOND WINDING OF

SCALA TYMPANI INFERIOR

THIRD

HALF

WINDING

COCHLEA

OF

BASE OF COCHLEA

The Boxy Cochlea.

Blood Supply.

branch of the internal

inferior vesical artery in the male.

It

iliac

artery, on

either

side.

This artery corresponds to the

passing to the vagina and base of the bladder.

also receives branches of the uterine

artery.

Lymphatics

of the vagina

end

in

the pelvic inguinal nodes.

LESSON CXCII.
The uterus

is

that pari of the female sexual passage to which a ripe

conveyed from the ovary ami in which it

fetus is matured and expelled in parturition.

is

is

is

detained

in

ovum

gestation until the

The non-pregnan1 human uterus

pear-shaped organ about three inches long: with

broad flattened part

above called the body and a narrow, more cylindrical pari below called the
Within is a cavity which passes out in the Fallopian tube on each
vix.
above ami below opens into the vagina. The cavity narrows as it passes
the cervix

terminate

the internal os and continues

at

at

into

downward to the cervical canal to

The uterus i> supported by the

the external os uteri or OS tinea'.

broad ligament which

each side.

cer-

side

It

is

transverse fold of peritoneum ami embraces

it

on

has accessory ligaments, such as the round ligament, vesico-

uterine ligament, and lecto-uterine ligament.

It

consists of

:i

serous or peri-

ANATOMY

IN A NUTSHELL.

smooth muscular fibers forming most of its thickand an epithelial lining.

The dimensions of the uterus are as follows: about three inches in length.
The walls of the
aboul two inches in breadth, and about an inch in thickness.
uterus are about three-eighths of an inch in thickness.
In women who have
toneal coat, a middle coat of

ness,

borne children these dimensions are increased.

It
weighs from seven to twelve drachm.-.

The
ant

direction of the uterus

is

towards the umbilicus, slightly to the right

forms an angle with the vagina close to ninety degrees, and as a rule the

is a little further forward than the right.

The position of the
changed when the bladder is full or when the rectum is full. In diseased conditions it may be axtkflexed (an abnormal forward curvature); a
form of displacement in which the upper part of the organ is bent forward, or
we may have ax ANTEVERSION (a forward tipping or tilting of the organ); a
displacement in which the organ is tipped forward but not bent at an angle as
It may be retroplexed (bent backward), or there may be a
anteflexion).
retroversion (the tipping of the entired organ backward).
The fundus of the uterus is broad and convex and is covered with peritoneum.

left

superior angle

uterus

is

The body
is

is

flat anteriorly,

joined to the bladder by

the body
covers

convex posteriorly, and concave

The

cervix

is

laterally.

It

posterior surface of

while in front the peritoneum

entirely covered with peritoneum,

upper three-fourths.

is

its

The

lower anterior fourth.

its

the lower constricted portion and

is

embraced by the upper

extremity of the vagina.

The

cavity of the body

is

triangular and flattened from before backward.

This cavity has too lateral cornua above, and a constricted opening (internal

lower angle.

its

The

cavity of the cervix

is

spindle-shaped ami has on

terior walls longitudinal folds called

The

external os

is

a transverse orifice at

cervix and opens into the vagina.

'I'm.
1.

arbor

It

anterior and pos-

the lower end of the cavity of the

lip and
NUMBER.

has an anterior

LIGAMENTS OF THE UTERUS ARE EIGHT

The anterior ligament (vesico-uterine)

from the front of the uterus on

its

vitse.

IX
is

a posterior lip.

a reflexion of

the peritoneum

to the bladder.

The posterior ligament (recto-uterine) passes from the posterior wall of

and over the upper one-fourth of the vagina and then to the rectum
and sacrum, thus forming the pouch of Douglas which is behind the upper
2.

the uterus

portion of the vagina.

and

The two

broad ligaments are folds of peritoneum which

and thus form
septum across the pelvic cavity. The broad ligaments contain the Fallopian
tubes, the round ligaments, the ovaries, the parovaria (organs of Rosenmuller).
blood vessels and nerves, as well as connective tissue and unstriped muscle
''>

1.

lateral or

pass From the sides of the uterus to the lateral wall.- of the pelvis,

:i

fibers.

and

6.

The two sacro-uterine ligaments

are folds of peritoneum which

ANATOMY

IN A NUTSHELL.

*>">*

pass from the sides of the uterus to the sides of therectum

then to the

first,

sacrum.
7 and 8. The two round ligaments arc about five inches Long and extend
from the lateral aspect of the fundus of the uterus through the inguinal canals
They are composed of muscular tissue, areolar tissue,
to the labia majora.
and fibrous tissue, as well as vessels and nerves.
The canal of Xuck is a tubule of peritoneum in the young female descending
from the uterus into the inguinal canal. It is usually obliterated in the adult.
Blood Supply. (1) The uterine, which is a branch of the anterior division
of the internal iliac artery. (2) funicular from the superior vesical, (3) the
ovarian from the abdominal aorta.
Nerve Supply. From the inferior hypogastric and ovarian plexus of
the sympathetic, and the third and fourth sacral nerves.
The lymphatics of the cervix end in the pelvic nodes, while those from
the body end in the lumbar node.-.
The coats of the uterus are three, (1) a serous, (2) a muscular, and (3) a
mucous.
The serous coat is the peritoneum which invests the uterus, except at

its

lower anterior one-fourth.

The muscular

coat, which

of the uterus.

composed

of

smooth muscular

fiber inter-

tissue,

while the longitudinal are most

The mucous coat

to

is

blood vessels and nerves, forms the chief bulk

The circular muscular fibers are most numerous in the cervix,

mingled with the areolar

numerous

in

the body of the uterus.

very thick (one-eighth of an inch) is closely adherent

the internal muscular layer.
It is pale and smooth, and has the openings
is

numerous glands upon its surface and is covered with ciliated columnar
The ovula of Naboth are glandules or follicles within the os uteri
and cervical canal which are often distended with mucus, which mucus Naboth
mistook for human ova. hence their name.
A laceration of the cervix in a diathesis or neuropathic constitution
is followed (1) by irritation. (2) indigestion, (3) malnutrition. (4) anemia. (5)

of

epithelium.

neurosis.

LESSON CXCIII.
The Fallopian tubes

(oviducts) which serve to convey the

Each one

ovum from

the

ovary to the uterine cavity, are two in number.

aboul four inches
long and one eighth of an inch in diameter and they are situated in the free or
upper margin of the broad ligament, extending from the superior angles of the
is

One end of the

uterus to the superior or outer extremity of the ovary.

Fallopian

and the other end opens

tube opens into the uterus at its
into the peritoneal cavity.
lined
with ciliated columnar epitheEach tube is
lium and its mucous lining is continuous with the uterine mucous membrane at
superior external point

one extremity and with the peritoneum at the other extremity.

salpinx is the mesentery of the fallopian tube and it is that part
ligament between the tube and the ovary.
Each tube increasewithin outward and consists of the following parts:

The mesoof the

in

size

broad
from

ANATOMY

560
1.

IN A NUTSHELL.

The isthmus is the inner constricted third of the tube which is hard,
and nearly horizontal. It is about an inch and a half long and

cylindrical,

one-eighth of an inch

in

diameter.

The ampulla (receptaculum seminis) is the outer dilated portion curving

over the ovary and extends from the isthmus to the fimbriated extremity. Its
diameter is about twice that of the isthmus and its walls are thinner and softer.
The isthmus and the ampulla make the body of the tube.
3. The Iniundibulum is the expanded outer end. the opening of which is
2.

the ostium abdominale.

4.

The

fimbriae are fringe-like processes

The frimbria ovarica

concentric circles.

is

which are arranged in two or three

larger than its fellows and is at-

tached to the superior extremity of the ovary.

5.

Morgagni is the cyst like remnant

the oviduct by a long stalk of peritoneum.

The hydatid

attached to

of the Mullerian duct

of

PLATE CCLXXXIV.
CANALb

TERMINATION OF SEMICIRCULAR

CONNECTION OF MODIOLUS WITH CUPOLA

CUPOLA.

^
MODIOLUS

APEX OF
CALA VESTIBULI

c/^^J^S5^---^

WINDING OF

FIRST

SECOND WINDING

OF

COCHLEA

COCHLEA

,B0NY SPIRAL
LAMINA

THIRD
SUP

HALF

WINDING

OF

COCHLEA
"

CENTRAI CANAL OF MODIOLUS

SCALA TYMPANI

INFERIOR

BASE OF MOOIOLUS

The Boxy Cochlea Cut Through.

\eu\

and ovarian

Supply.The nerves

are derived from a plexus around the uterine

arteries.

Blood Supply.

The

external tubular from the ovarian ami the internal

tubular from the uterine.

[/j

\irn V.TICS, after joining with those of the uterus,

empty

into the

lumbar

lioile-.

The

ovaries,

which are the essential female organs

of generation, are

two

grayish pink bodies situated in the broad ligament behind ami below the Fallo-

The position of the ovary is indicated on the body by the midpian tube.
point of a line drawn from the anterior superior spinous process of the ilium to
symphysis pubis.
The dimensions
third of an inch.

of the

They

ovary arc one and

LIG Ml. NTS ok 'nil-: OVARY ARE:

The utero-ovarian, which is over an

by three-fourths, by oneand in old age atrophiy.

a half,

are not so dense as the ^esticle

inch in length, connects the inferior

extremity of the ovary with the superior angle of the uterus. This ligament
1.

ANATOMY
has

IN A NUTSHELL.

it fibrous tissue, plain muscular tissue which

muscular layer of the uterus.

iii

ficial

561
derived from the super-

Ls

2. The tubo-ovarian (fimbria ovarica) joins the superior extremity of the

ovary with the fimbriated extremity of the Fallopian tube.
3. The suspensory (lumbo-ovarian) is the upper part of the external border
of the broad ligament.
In the normal position of the ovary, if their axes were continued, they

would meet

in front of the uterus,

but the position of the ovary varies because

the ligaments are attached to movable points.

turns to the right the ovary of that side

side

is

vertical

For instance, if the uterus

and the ovary of the opposite

nearlv horizontal.

is

LESSON CXCIV.
The ovary

consists of a vascular

stroma which contains the Graafian

foll-

icles.

The stroma

is

composed

of connective tissue

which has

hi it cells,

white

fibrous tissue, yellow elastic tissue, plain muscular fibers, blood vessels

and

From

the hilum a core, called medullary substance, passes into the

It is composed of stroma and has passing from it numerous
center of the ovary.

nerves.

trabecular to the cortex of the ovary, thus leaving spaces in which are situated

The tunica albuginea is a condensed layer of the stroma

follicles.
which covers the ovary. The epithelial covering which surrounds the tunica
albuginea is the remains of the germinal epithelium.
The Graafian follicles are the ova sacs which contain the ova. The majority of these Graafian follicles are microscopic, but when matured they liecome much larger. The smallest ones vary from g i to i of an inch in
diameter and the largest ones from i to * of an inch in diameter.
The tunica fibrosa encloses the blood trunks and lymphatic spaces of the
Graafian

follicle.

This

is

the outer layer of the

The tunica propria

and

capillar}' plexuses.

is

This

is

The membrana granulosa

the

Graafian

The

Ovum

is

follicle.

a vascular layer

composed

the inner layer of the

is

the

cell

of connective tissue cells

follicle.

layer which lines the inner surface of

follicle.

discus proligenis

is

that part of the

membrana granulosa

in

which the

imbeded.

The membrana

propria

(vitalline

membrane)

is

between the membrana

granulosa and the tunica propria.

The corpus luteum is the yellow spot in the substance of the ovary and is
caused by the rupture of the Graafian follicle, but it disappears when impregnation has not occurred.
When impregnation has occurred it may undergo
remarkable development
The true corpus luteum (corpus luteum of pregnancy)

The

is

usually regarded

corpus luteum (corpus

greatesl development in less than a week

as absolute proof of previous impregnation.

false

luteum of menstruation) attains its

and begins to shrink in less than three weeks and completely disappears

in

ANATOMY

562

IN A NUTSHELL.

The true corpus luteum continues to grow for two or three months
few weeks.
and may be as large as one-third of the entire ovar}\ It continues till toward
the end of gestation and then shrinks to a small white scar which may not enWhile this is the general rule it
birely disappear until a month after labor.
does not always hold good for bodies which are identical with the true cori'oi;\ i.itka have been found in the virgin ovaries.
The ovary in its descent may pass into the inguinal canal and out the exThis
ternal abdominal ring and become an external organ like the testicle.
is

a very rare occurrance.

At the

third

month

of intra-uterine life the ovaries

lumbar region in front of the Psoas magnus near the kidney

are situated
month
the
ninth
they have descended to the brim of the pelvis. This
and by
is caused by the lumbar region growing away from the ovary.
Nerve Supply. The nerves are from the ovarian plexus of the sympathetic and branches of the third and fourth sacral nerves.
Blood Supply. Ovarian from the abdominal aorta which corresponds to
The blood from the left ovary passes through its
the spermatic in the male.
veins into the left renal vein, while the blood from the right ovary passes into
the inferior vena cava.
Lymphatics from the ovary pass into the lumbar nodes.
in

the

LESSON CXCV.
The external female organs of generation are known by the term vulva or
pudendum and includes (1) the mons veneris, (2) the labia majora, (3) labia
minora,

(4) clitoris, (5)

the orifice of the vagina.

The mons veneris (mount

Venus)

of

is

a round prominence at the symphysis

cushioned with fat and covered with hair.

The labia majora are hairy folds of the skin on either side of the slit of the
vulva extending from the mons veneris to the perineum. Where they meei

pubes

in

the female, which

is

anteriorly they form the anterior commissure,

and where they meet below they

form the posterior commissure (fourchette) which is about an inch in front of
the anus at the anterior boundary of the perineum.
The fossa navicularis is

between the posterior commissure and the hymen. The nerve supply of the
labia majora is the superficial perineal from the pudic and the inferior pudendal
from the small sciatic.
The labia minora (nymphae) are folds of mucous membrane within the labia
They extend from the prepuce of the clitoris to the inner surface
majora.

They

of the labia majora.

air largesl

and the
The

are not well developed until the age of puberty

during pregnancy.

The

vestibule

is

the space between these

lips

orifice of the vagina.

clitoris, which i> situated at the anterior angle of the vulva

elongated erectile body of the female of most mammals. These

include the

human

species

the penis of the male

although it
usually concealed
thra,

and

is

in

in
in

and numerous

that

it

is

birds, as the ostrich.

as lemurs.

In the

small

It differs

smaller and as a rule not perforated

some animals,

is

mammals

human

by a

female

from
ureit is

the normal state of the parts, but in the spider-monkey

'

ANATOMY
it is

quite large and

sists of

it is

distinguish

difficult to

the corpora cavernosa and the glans

The

stalk hydatid of Morgagni,

563

IN A NUTSHELL.

from the penis.

it

when present

in the female,

the broad ligament at the outer extremity of the ovary.

remnant

lated sac, being a

of the pronephros.

clitoridis is a fold,

Ii

is

is

situated in

small peduncu-

homologue

lis

the stalk hydatid of Morgagni, for which see, Plate

The preputium

It con-

clitoridis.

in

the male

is

CCLXXVI.

formed by the Labia minora, covering the

clitoris.

The duct

of Gartner (a relic of the Wolffian duct)

a straight canal ex-

is

tending from the parovarium through the broad ligament to the vagina.
Bulbus vestibuli is a mass of erectile tissue situated on each side of the vestibule beneath the

mucous membrane.

It is

homologous

to the

bulb of the cor-

pus spongiosum in the male, while the pars intermedialis which is a continuation of the bulbus vestibuli anteriorly is homologous to the corpus spongiosum
itself.

PLATE CCLXXXV.
COMMON TERMINATION
POSTERIOR

AUDITORY NERVE

VESTIBULAR

COCHLEAR

OF SUPERIOR

ANO

SEMICIRCULAR CANALS

NERVE

NERVE

EXTERNAL

CUPOLA
SACCULARIS

R10"R

AMPULLA

BORDER OF SPIRAL PLATE

SEMICIRCULAR CANAL

SUPERIOR

The Interior of the Labyrinth with Distribution of Auihtoky Nehye.

The paroophoron (parovarium) (organ
broad

Etosenmuller)

of

ligament of the urinary portion of the Wolffian body.

Ii

is
is

a
a

relic

in

the

tubular body

It
is present
to the organ ofGiraldes (Paradidymis) in the male.
always
recognized.
cannot
be
and
childhood
only in
The long tube of the parovarium is homologous to the tubeof the epididymis.

homologous

The

short tubules of the parovarium are

the coni vasculosi

in

homologous

to therete testis

and

the male.

Bartholin's glands are the vulvo-vaginal glands which are situated on each

They are small racemose

opens
each
with a due! near the
and
inch
an
Long
about
of
one-third
glands
Sec
Bartholin's
of
glands.
homologues
are
glands
the
nymphse. Cowper's
see
1.
page
17
urethra
female
the
description
of
For
page 473,
side of the vagina posteriorly to the bulbi vestibuli.

The Mammahv Gland.

The mammary glands

are

named

is

Plate

CCLXXIX).

zoology, from their position, axillary,

ANATOMY

564

IN A NUTSHELL.

Sometimes they are quite high

The mamma of the cow is
formed from the coalescence of as many
glands are paired as arule and common to
both sexes, but remain rudimentary and functionless in the male as a general
The male mammas have been known to secrete milk.
thing.
The mammary gland of the human female is situated between the third
and sixth rib on each side between the sternum and the axilla. The nipple
is situated between the fourth and fifth rib about four and one-half inches from
The base of
the middle line of the sternum but. of course, this position varies
each nipple is surrounded by a zone of colored skin called the areola, and this
areola has numerous small whittish tubercles which contain the openings of
The nipple is highly vascular and its skin is sensitive
the sebaceous glands.
and contains retiform tissue and unstriped muscular fibers. There are about
twenty orifices in the summit of the nipple which are the ends of the milk ducts.
This gland is racemose and consists of from fifteen to twenty lobes, which are
Each of these lobes is made up of lobules, and
independent of one another.
these are formed by the aggregation of alveoli in which the milk is secreted.
pectoral, ventral or abdominal, and
on the sides of the animal but are
situated in the median line, being
mammae as there arc teats. These

inguinal.

never dorsal.

Blood Supply.

The

anterior intercostals, the external

mammary

and acromio-thoracic arteries.

Nerve Supply. Anterior and lateral cutaneous branches

(long

thoracic),

costal

of the inter-

nerves.

Lymphatics of the mammary gland pass into the axillary nodes.

The Wolffian body is the mesonephros or primitive kidney, the excretory
organ of the embryo.

It

consists of a long tube in the lower part of the body-

cavity, running parallel with the spinal axis

and joined at

right angles

by

row of twisting tubes given off from the Malpighian body, and forming a structure resembling a comet.

The Wolffian body develops

epididymis, vas deferens, and ejaculatory duct

in

into the

head

of the

the male.

LESSON CXCVI
The Male Organs of Generation. (Plates CCLXXIV-CCLXXV-CCLXXVICCLXXVII-CCLXXVIII).
The
inches

prostate gland

in itsl

to apex.

Its

of this

\i'i.\

shaped

weight
gland

is

is

a1

like a

chestnut and
is

[ts

is

is

encircle the urethra.

base

is

drachms).

The

at the neck of the

joined to the rectum by areolar tissue.

It

derived from the recto-vesical fascia and the

It consists of a median lobe and two

posed of glandular matter, and muscular fibers which

posterior layer of the trangular ligament.

It

about one and one-half

testicle, (six

is

lateral lobes.

is

one and one-fourth inches from base

aboul the same as the

posterior surface

Its

it

the triagular ligament,

dense firm capsule which

bladder.
-

is

ransverse diameter while

ANATOMY

IN A NUTSHELL.

565

The penis is composed of a mass of erectile tissue enclosed in three rod-like

segments which are firmly united together by a sheath composed of integument, dartos, and fascia. These segments arc the two corpora cavernosa, and
the corpus spongiosum. The root of the penis is attached to the symphysis
and pudic arch. The body, which is triangular on cross section, forms the
The glans forms the expanded
more developed on the dorsal than on the
ventral aspect, and the urethral opening is at its distal extremity.
The glans
is separated from the body by a constriction called the neck.
The corpora cavernosa, which lie side by side, form the upper and lateral
(Plate CCLXXIV).
The crura are formed by the posterior
parts of the penis.
one-fourth of the corpora cavernosa, Plate CCLXXV, and are attached to the
The groove
tuberosities of the ischia and the descending rami of the ischia.
above the corpora cavernosa are for the dorsal vessels and dorsal nerves, while
The suspensory ligament
the groove below that is for the corpus spongiosum.
greater part of the free portion of the organ.

extremity of the organ and

distal

is

Is a fibrous membrane which connects the root of the organ to the

symphysis pubes. The fibrous septum between the two corpora cavernosa,
only present between its posterior two-thirds, is called septum pectiniform.
The corpus spongiosum lies in the groove between the corpora cavernosa
It conThis has no erectile tissue in it like the corpora cavernosa.
inferiorly.
The clans is somewhat heart-shaped and
sists of glans, a body, and a bulb.
at its base is a ridgecalled corona glandis, behind which is the neck of the penis.
The external urinary meatus is a vertical fissure about one-third of an inch
The body
It is the outlet of the urethra.
in length at the apex of the glans.
of the corpus spongiosum has passing through its whole length the urethra.
For description of the urethra see page 472, and for Plate page 533. The
bulb of the corpus spongiosum is surrounded by the Accelerator mime mus-

of the penis

cle.

It passes posteriorly to within

an inch of the anus.

The prepuce

continuation of the integument of the penis which more or

is

completely

less

The fr.enum pr.eputium is a fold of mucous membrane

Phimosis (muzwhich connects the prepuce with the glans along the raphe.
zling or closure) is the tightness of the foreskin such that it cannot be drawn
Paraphimosis is a retraction of a narrow or inback from over the glans.
Epispadias is a congenital defed
flamed foreskin which cannol be replaced.
In female epispadias
in which the urethra opens on the dorsum of the penis.
Bypospadias ithere is a fissure of the upper wall of the female urethra.
conceals the glans.

:i

congenital opening of the urethra on the under side of the penis.

hypospadias there

Is

an opening

In

the female

of the urethra in the vagina.

The dartos is the reddish, cellular, contractile tissue beneath the skin of
The female
the penis and continuous with the dartos tissue of the scrotum.
dartos

is

layer of unstriped muscular fibers immediately under the skin o\

the labia majora.

The dartos

enter- into the formation of the prepuce, and

a sphincter around the preputial ori-

some

authorities claim, forms a kind of

fice.

The

nerves,

penis

is

is

areolar tissue of the penis, which contains the superficial vessels and
just beneath the dartos.

beneath the areolar

tissue.

(Plate
It

is

CCLXXIV).
joined to

The deep

fascia of the

the skin and the corpus

ANATOMY

566
spongiosum.

IN A NUTSHELL.

This fascia and the dartos aided by the Bulbo cavernosi and the

[schio-cavernosi muscles compress the veins of the penis in the action of erection.

Blood Supply.The arteries to the penis are branches of the internal

(a) The artery of the bulb, which goes to the bulb of the corpus sponpudic.
(hi

giosum,

the arteries of the corpora cavernosa,

The envelops of the

penis.

(c)

the dorsal artery of the

penis are supplied by the external pudic, the

and the dorsal artery. The veins of the penis are in two
veins, which pass between the dartos and fascial sheath
sets,
saphenous
and femoral veins, (b) the deep veins, which drain
in
long
the
end
the corpora cavernosa, corpus spongiosum, end in the deep dorsal vein and in

superficial perineal,
(a)

superficial

the internal pudic vein.

Lymphatics of the penis are divided into two sets, (a) superficial ones
which pass to the inguinal nodes, and (b) deep ones which empty into the pelvic
and Lumbar nodes as well as in the inguinal nodes.

Nerve Supply.
ficial

The

genital branch of the genito-crural

and the super-

perineal branches of the pudic supply the covering of the penis, while the

dorsal nerve of the penis,

and

superficial perineal,

and hypogastric plexus sup-

ply the erectile bodies.

PLATE CCLXXXVI.
SEMICIRCULAR CANAL

5CALA TYMPANI

INFERIOR

Interior of Bony Labyrinth.

The spermatic cord

abdominal ring

to

inguinal canal.

It

about four inches long and extends from the internal

It passes through the
the globus minor of the epididymis.
is composed of the following structures held together by
is

areolar tissue and invested

1.

The vas

from the

testis

by layers broughl down by the descent

deferens, which
to

is

the ejaculatory

of the testicle.

the excretory duct of the testicle passing

dud.

It

is

recognizable by

its

cord-like

resistance to pressure.
_'.

artery.

The artery
It

arises

of the vas deferens,

from

this artery

which

is

branch of the superior vesical

near the place where the vas deferens crosses

it
divides into an ascending branch
which follows the vas deferens through the inguinal canal, and a descendingbranch which passes n> the dilated poll ion of the vas deferens and the vesicula

the obliterated hypogastric artery, and

seminalis.
:!.

The cremasteric

artery,

which

is

branch of the

dee]) epigastric, passes

ANATOMY

IN A NUTSHELL.

567

through the inguinal canal with the vas deferens andsupplies the Cremasteric
muscle.
4. The spermatic artery, which is a branch of the abdominal aorta, passes
over the Psoas muscle to the internal abdominal ring, then through the inguinal
canal into the scrotum to the testicle.
It
gives off the following branches,

branchesto theureter,

(a) ureteral

muscle,

(c)

epididymal

(b) cremasteric

to the epididymis, (d)

branches

to the

Cremasteric

testicular branches to the

bpdy

of the testis.

The spermatic

veins, or pampiniform plexus, surrounds the artery.

Spermatic plexus of nerves (sympathetic) accompanying the artery.
The vas aberrans is a blind tube connected with the epididymis or vas

5.
(i.

7.

Its homologue is the duct of Gartner in the female.

The lymphatics which pass with the veins.
The Internal cremasteric muscle, which is composed of smooth muscu-

deferens.
8.
9.

lar fibers.

The

10.

obliterated processes vaginalis of the peritoneum, which

a relic

is

between the tunica vaginalis and the peritoneum.

branch of the ilio-inguinal nerve.
branch of the ffenito-crural nerve.

of the tube
11.

12.

A
A

LESSON CXCVII.
The infundibuliform
cremasteric fascia which
fascia

which

is

is

fascia

from

which
tin

is

from the transversalis

from the external spermatic

skin of the scrotum,

all

fascia,

the

Internal oblique muscle, the intercolumnar

and the

fascia, the superficial fascia

these are coverings of the spermatic cord from within

outward.

The

two lobulated membranous pouches between

vesicula? seminales are

the base of the bladder and the rectum, and they serve as reservoirs for the

semen, as well as secrete the

fluid

which

is

added

to the

They have

semen.

three coats, an external or fibrous coat, a middle or muscular coat, and an

1

ternal or

The

mucous

ejacnlatory duct

is

about an inch long and

the vas deferens and the vesicula seminalis.

of

verti

montanum

is

formed by the union of

diameter

is aboul one-eighth
opens
about one-fill ieth of an inch.
on either side of the opening of the sinus pocularis.

an inch above, but where

on the

in-

coat.

it

opens

it

Its

is

The testicles are two in number and aresuspended by the spermatic cords.
They weigh less than an ounce and are about an inch and a half long, and inch
and a quarter deep, and about an inch in thickness. They secrete the seminal
fluid.
They have the following coverings from within outward.
portion of
serous covering formed by
1. The tunica vaginalis, which is
;i

;i

the peritoneum which descended with the testicle and afterwards forms

closed

pouch investing it. This tunica consists of two layers, a visceral ami
parietal
strong
layer.
Beneath the tunica vaginalis is the tunica albuginea which i^
fibrous coat (Plate CCLXXVII) and beneath this coat, the tunica vasculosa
(pia mater testis) which is composed chiefly of blood vessels held together by
:i

; i

ANATOMY

568

IX A

NUTSHELL.

This coat lines the tunica albuginea and the various septa

areolar tissue.

within the testicle.

The infundibuliform fascia (internal spermatic) is the fascia propria

downward of the transversalis fascia.
The cremasteric fascia (middle spermatic fascia) is composed of mus-

2.

and

is

a continuation

:;.

cular fibers (the ('remaster muscle) which are derived from the lower border
of the Internal oblique muscle.

The intercolunmar

4.

fascia (external spermatic)

which

is

closely adherent

to the dartos.

The scrotum consists of two layers, (a) the integument which is more
and covered in the adult with scattered hair. A raphe is
present in the median line from which pass transverse wrinkles,
(b) The dartos
5.

or less pigmented

which

beneath the skin of the scrotum.

a reddish, cellular, contractile tissue

is

The epididymis (upon the testis) lies at the posterior and superior part
of the testicle and consists of the globus minor which contains the efferent
duct, and the globus major composed of vasa efferentia and coni vasculosa.
If the epididymis were unraveled it would be a tube twenty feet long.
The lobules of the testicle are contained in the spaces formed by the tra1.

becular which divide the testicle into divisions.

These lobules consist of the

which consist of a basement membrane lined with a layer of
cuboidal cells in which are developed the spermatoza.
The tubuli at the apices
of the lobules become straight and join the vasa reta which join the rete testes
in the mediastinum, the rete testes
end in the vasa efferentia which pertubuli seminiferi

and form the coni vasculosa.

Gubernaculum testis is a fetal cord attached to the lower end of the epididymis and to the bottom of the scrotum. It governs the descent of the testicle.
Its homologue is the round ligament of the female.
The paradidymis (organ of Giraldes) is on the spermatic cord above the

forate the tunica albuginea

epididymis.

body,

is

It

represents the remains of the posterior part of the Wolffian

closed tube.

The duct of Kathke

natal

is

Its

and remains patulous.

life

homologue

a part of

is

the paroophoron in the female.

the duct of Muller which persists hi post-

The oviduct

is

the homologue of the

dud

of

Rathke.

The
which

hydatid of Morgagni is the upper part of the duct of Muller,

and is attached to the upper aspect of the testicle. The fimbria

sessile

persists

of the oviduct

is

the

homologue

of the sessile

hydatid of Morgagni.

LESSON CXCVIII.
The Organs

oi Hearing.
(Plates CCLXXX-CCLXXX VII, inclusive).
These organs consist of three portions.
1.
The external ear, which consists of (a) pinna or auricle which is not of
much importance physiologically, and (b) the meatus auditorius externus,
which is
canal leading inward to the tympanic membrane.
;i

The middle

ear, which is composed of (a) the tympanum (an air chamber)

containing the malleus, incus, and stapes (the auditory ossicles ) and com2.

ANATOMY

IN A NUTSHELL.

569

municates with the naso-pharynx by means of the Eustachian tube, (b) the
mastoid antrum, (c) the mastoid cells,
(b) and (c) are accessory air chambers

tympanum.
The internal ear or labyrinth, contains the membranous labyrinth
which is a cast of the bony structures. The membranous labyrinth contains
the endolymph, and within it are the specialized neuro-epithelial cells and the
terminations of the auditory nerve. The perilymph is on the outside of the
membranous labyrinth.
to

the
3.

The External Ear.

The pinna

is

the projecting part of the ear lying outside of the head, and

is

attached to the malar and temporal bones by ligaments. It consists of a layer

It has the following parts.
of yellow fibro-cartilage covered with integument.

PLATE CCLXXXVII.
FOR

FOSSA

ARTICULAR SURFACE

INCUS

FOR

LEFT MALLEUS

MALLEUS

HEAD OF MALLtUS

SHORT

SHORT PROCESS

PROCESS

SLENDER PROCESS
HANDLE OR MANUBRIUM

ANTERIOR CRU3

BASE-

POSTERIOR CRUS

BASE

OF

STAPES

Malleus, [ncus and Stapes.

1.

The

helix

is

the outer curved edge of the pinna which passes upward

from the rim of the pinna and ends behind

2.

The

lobule

is

in

the lobule.

the lowest portion of the auricle and consists of fatty and

areolar tissue.
3.

The

fossa of the helix (scaphoid ibssa)

is

depression internal to the

helix.

The antihelix is a range which begins above the Lobule .-u the antitragus and passing upward bifurcates to enclose a triangular depression called
4.

the fossa of the antihelix.

ANATOMY

570

5.

The concha

IN A NUTSHELL.

the deep hollow

is

in

the center of the pinna which leads

into the auditory canal.

6.

The tragus

ward over the

with hair along

7.
it

is

conical eminence in front of the concha projecting back-

is

orifice of the external

its

auditory meatus.

It

is

usually covered

inferior border.

The antitragus

a small projection posterior to the tragus

is

separated by a deep fissure called the incisura intertragica.

The muscles of the external ear are divided into two sets,

from which

the extkixsk

The extrinsic aie. the Attrahens aurem, Retrahens aurem,

ami the entrinsh
and Attollens aurem. These muscles have been described on page 522 and in
the table of muscles in the back of the book.
The [ntrinsic muscles are:
1. Tragicus, which lies vertically on the outer surface of the tragus.
It ariseAntitragicus lies on the posterior wall of the auditory canal.
L'.
into
passes
upward
be
inserted
and
to
from the outer part of the antitragus
.

the posterior extremity of the helix.

3.

Helicis

mencemenl
4.
">.

minor

often absent, but

is

of the helix

Helicis

major

is

when present

is

attached to the com-

and extends into the concha.

situated on the anterior margin of the helix.

Transversus aurem

is

situated on the posterior surface of the auricle

and the convexity of the concha.

on the posterior surface of the auricle passing upward

in the depression between the helix

6.

Obllquus aurem

is

from the convexity of the concha.

Nerve Supply. From the auriculo-temporai, auricularis magnus, occipiThe intrinsic muscles receive
lalis minor, and Arnold's nerve from the tenth.

the seventh

Action

nerve.
of the Intrinsic muscles

is

to retard the

passage of sound to the

meatus. These muscles are rudimentary and unimportant.

Blood Supply. The pinna receives the posterior auricular, the occipital.
and superficial temporal arteries.
Lymphatics of the pinna empty into the preauricular nodes, and into the

nodes upon the insertion of the Sterno-cleido-mastoid muscle.

Tin' external auditory canal is a little over an inch long, extending from
This canal is curved with its convexity
the concha to the membrana tympani.
upward. This canal is lined with integument which contains sebaceous and
ceruminous glands and also numerous hair

The outer one-third

of this canal

is

follicles.

cartilaginous,

and the inner portion

osseous.

The Annulus tympanicus isthe osseous portions of this canal at birth, at

which time it is an incomplete bony ring.
Blood Supply.- From branches of the internal maxillary, posterior auricular, and superficial temporal.
Nerve Supply. Auriculo-temporai, auricularis magnus. and Arnold's
nerve.

Tin

LYMPHATICS

of the external auditory

the posterior auricular nodes.

meatus end

in the

parotid and

ANATOMY

IN A NUTSHELL.

571

The membrana tympani, which is attached to a grooved ridge of bone at

of the external auditory meatus, is an oval, clastic semi-transbottom
the
membrane
of an inch in thickness, aboul
about ,]
parent
of an inch
antero-posterior
diameter
and slightly less in its vertical diameter. This
in its
7

membrane

is

,-'.,

situated obliquely,

downward, and forward,

so

outer surface being directed outward,

its

as to form almost

wall of the external auditory meatus.

horizontal.

The membrana tympani

or cutaneous layer, a middle or fibrous

a continuation of the posterior

In infancy this

membrane

is

al

>t

composed of three Layers; an outer

layer, and an inner or mucous layer.
It
is

has the following points for consideration:

1.

2.

The umbo (naval) is the dark depressed center of the membrane.

The cone of light is a triangular area, the apex of which i> attached

the tip of the handle of the malleus, and at

ference of the

membrane.

This

is

its

to

base extends toward the circum-

of value hi diagnosis of diseases of the

tym-

panum and membrana tympani.

3.

The

tubercle which

at the upper border

is

formed by theshorl pro-

is

cess of the malleus.

4.

The

stripe

which runs down from the tubercle

to the

umbo and

is

formei

by the handle of the malleus.

membrane (membrana fiaccida) is situated at the upper

membrane below the notch of Rivini.
This notch is formed where
bony
ring
membrane
is
attached is incomplete.
the
to which the tympanic
Rivinian
foramen
minute
opening
which
exists in Sharpnell's mem6.
is a
5.

Sharpnell's

part of the

brane.

Membrana tensa is all the tympanic membrane except the membrana

fiaccida.
This membrane is concave externally.
Blood Supply. From tympanic branches of the internal maxillary and
7.

carotid arteries.

Nerve Supply.

The external surface receives the auriculo-temporal from

the fifth nerve and Arnolds' nerve from the tenth.

The

internal surface receives

branches from the tympanic plexus.

LESSON CXCIX.
The Middle
The tympanum (drum)

is

Ear.

an irregular cavity situated within the petrous

portion of the temporal bone, and lined with mucous membrane.

It

lies

be-

lis antero-posterior
tween the external auditory meatus and the internal ear.
length is about half of an inch, vertically a lil tie more ban half an inch, and its
It consists of two main parts, (a) attic or
width is about one sixth of an inch.
recessus epitympaniticus which is situated in the highesl portion of the tympanic cavity and contains the head of themalleus and the greaterparl of the
do Atrium (tympanic. cavincus.
This attic leads into the mastoid antrum,
ity proper) is situated opposite the tympanic membrane.
The roof of the tympanum is a thin plate of bone (tegmen tympani) which
separates the tympanum from the middle fossa :it the base of the skull.
I

PLATE CCLXXXVII]

ENCYSrtO

HERNIA

INFANTILE

HERNIA.

'NTC

THE

TUNICA

VAGINALIS

HERNIA

HERNIA

INTO

THE

FUNICULAR

Forms of Congenital Hernia (After Deaver.)

572

PROCESS

ANATOMY

IN A NUTSHELL.

573

tympanum is formed by the thin plate of bone which sepatympanum from the jugular fossa.
The anterior Avail of the tympanum is deficient above where the Eustachian
tube opens into it. This wall separates the tympanum from the carotid canal
The

floor of the

rates the

and has opening of canal for Tensor tympani muscle above, and below the openThese canals are separated from one another by
ing of the Eustachian tube.
the processus cochleariformis.

The

posterior wall of the

toid cells

tympanum

separates the

tympanum from

and communicates wtih the mastoid antrum by one

large

the masand several

small openings.

The outer wall of the tympanum is formed by the membrana tympani and
by the squamous portion of the temporal bone above. It has the following
points for consideration:

the

The iter chordae postertus, which is close to the posterior edge of

1.
drum head. The chorda tympani nerve which is a branch of the seventh

cranial nerve enters the

The

tympanum through

this opening.

which is just above the drum head,

is the opening by which the chorda tympani nerves leaves the tympanum.
The Glaseriax fissure, which opens above and in front of the head,
3.
lodges the long process of the malleus, the Laxator tympani muscle. and the
2.

anterius,

iter chordae

tympanic branch of the internal maxillary artery.

The inner wall

of the

tympanum

is

the outer wall of the labyrinth and

presents several points for consideration.

1.

The fenestra ovalis

brane which
2.

is

leads to the vestibule

and

is

closed

by

mem-

attached to the base of the stapes.

The fenestra rotunda

the scala tympani of the cochlea.

is

below the fenestra ovalis and leads into

closed by the membrana tympani secund-

It is

daria
3.
It is

and

The promontary

is

an elevation formed by the first turn of the cochlea.

is located between the two fenestras

covered by the tympanic plexus and

in front of
-i.

them.

The pyramid

is

behind the fenestra ovalis and from

its

summit passes

the tendon of the Stapedius muscle, and a branch of the seventh nerve pierces
the pyramid to supply the Stapedius.

The ridge of the aqueductus Eallopii. which is above the fenestra

and covers the seventh nerve in its passage through the tympanum.
Blood Supply. Tympanic branch of the internal maxillary artery, tym-

5.

ovalis

panic branch of internal carotid artery, stylo-mastoid branch of the posterior

auricular artery, petrosal

branch

of

the middle meningeal artery, a branch

ascending pharyngeal artery which enters through the Eustachian tube, tymThe veins of the middle ear follow the correspanic branch of vidian artery.
of

ponding arteries and empty into the temporo-maxillary vein, the superior petrosal sinus, the lateral sinus, the internal jugular vein and pharyngeal veins.
The lymphatics of the middle ear end in the posterior auricular and carotid

nodes.

Nerve Supply.

Tympanic

plexus which supplies the mucous

membrane

ANATOMY

.J74

IN A

NUTSHELL

Jacob-son's
(1)
of the tympanum and is formed by the following nerves:
nerve, (2) great superficial petrosal nerve, (3) small superficial petrosal nerve,
small deep petrosal.
I

tympanum

is filled with air and contains the malleus,

form a chain of bones which transmits the impulses of
sound waves between the tympanic membrane and the parilymphand endolymph of the internal ear.
The malleus (hammer) consists of the following parts, (1) a head, (2) a neck,
shorl process, (4) long process (process gracilis) (5) handle (manubrim).
(3)
The handle is connected with the middle layer of the drum head and is situated
The short process (process brevis)
between this middle and mucous layer.
The long process is received into
is attached to the Tensor tympani muscle.
The head, which is situated in the attic, is connected
the Glaseriarj fissure.
with the roof of the attic by the superior ligament of the malleus and it articulates with the body of the incus.
The Incus (anvil) has the following parts, (1) a body (head), (2) a long
The body articulates with the head of the malleus.
process, (3) a short process.
This joint is covered by a capsular ligament and lined by synovial membrane.
Tie shorl process articulates with the fossa incudis in the attic to which it is
connected by fibrous tissue. The long process articulates with the head of the
-tapes.
The end of this process is called os orbiculare. This os orbiculare is
In adult life it forms part of the incus.
the smallest bone in the body.
The stapes (stirrup) has the following parts, (1) a head, (2) a neck, (3) a
The head articulates with the os
base (foot piece), (4) two crura (branches).

The middle ear

or

incus and stapes. These

:i

'I

orbiculare of the incus.

The

base

fits

ceives the tendon

The Ligaments

on the

This

is

a ball-and-socket joint.

membrane

closing the fenestra ovalis.

The neck

re-

of the Stapedius.
of the malleus, incus,

and stapes are

five besides the capsular

ligaments of their articulations.

1.

The superior ligament of the MALLEUsisa

fibrous

band passing from

the head of the malleus to the outer part of the roof of the attic.
_'.

Tin:

wall of the

malleus.

It

Tiii':

:;.

interior ligament of the malleus

tympanum and
is

is

attached to the anterior

head and neck of the

to the anterior part of the

sometimes described

as the

Laxator tympani muscle.

is attached to the neck

external ligament of the malleus

of

margin of notch of Rivini by its base.

1.
The [NTERNAL ligament of the malleus extends from the tip of the
processus cochleariformis to the insertion of the Tensor tympani tendon.
the malleus by

5.

its

apex and

to the

The ligament of the incus

is

attached to the short process of the

incus and to the posterior wall of the attic near the orifice of the mastoid ant urn.

Besides these five ligaments just

named we have capsular ligaments around

the joints between the malleus and incus, and between the incus and stapes.

The muscles of the tympanum have been described on page 523.

The mastoid antrum is situated posterior to the tympanum and
It opens in the attic of the tympanum and
with mucous membrane.
mastoid

cells.

is

lined

into the

PLATE CCLXXXIX.

The Lymph
575

ltic

Max.

ANATOMY

576

IX A

NUTSHELL.

The mastoid cells are no1 present at birth but at the age of puberty there
and they occupy the greater portion of the mastoid process. They

are a few

are secondary organs of hearing.

The Eustachian tube is a passage from the uaso-pharynx to the tympanum.

It is between
It passes inward, downward, and forward from the tympanum.
of an
one-fifth
long
one-twelfth
and from
to
an inch and a half and two inches
than
the
caris
is
smaller
which
It
inch in diameter.
made up of a bony part
cartilaginous
temporal
and
of
a
and
in
the
bone,
situated
tilaginous portion
Its purportion which is somewhat trumpet-shaped ending hi the pharynx.
pose

is

to equalize the air pressure within the

ternal car.
i

tympanum

with that of the ex-

At the point where the bony portion joins the cartilaginous portion

the isthmus tuba-.

The opening

of the Eustachian tube into the

tympanum

PLATE CCXC.

A Lymphatic Node (After

Gerrish.)

on the anterior wall, while its pharyngeal opening is on the lateral wall of
This tube is closed except dur
the naso-pharynx behind the posterior nares.

is

ing swallowing,

Levator

palati.

when it is opened by the following muscles: Tensor palati

Salpingo-pharyngeus, and pari of the Palato-pharyngeus.

lessox
The Internal

Lai;.

re.
(Labyrinth).

This car consists of a bony labyrinth within which

is

the

membranous

labyrinth.
Tin' bony labyrinth is made up of the vestibule, the cochlea, and the
SEMK li;< LAB CAN ^LS.
The membranous labyrinth is smaller than the bony labyrinth of which
i

it

and the space between the two is lined with endothelium which conThe parts which make the membranous labyrinth are, the
tain- parilymph.
rjTRK i.i which is a membranous sac in the vestibule, saccule which is also a
membranous sac in the vestibule, membranous semicirculab canals which
are in 'he osseous canals, and the membranous cochlea which is aspiral tube
is

casl

inclosed in the osseous cochlea.

ANATOMY

IN A NUTSHELL.

The eighth nerve (auditory) which

is

577

the portio mollis of the seventh nerve.

This nerve has no neurilemma.

The organ

of Corti

is

the terminal auditory apparatus

in

the

membranous

cochlea.

internal auditory meatus is the opening into the internal oar from the
for the seventh ami eighth nerve and stylo-mastoid artery.
cavity
cranial
is an oval cavity at the entrance to the cochlea within the
vestibule
The
it is about one-fifth of an inch, laterally about onecar.
Vertically
internal

The

tenth of an inch.

It

contains a fluid called perilymph and the utricle and

It is situated between the cochlea and
labyrinth.

and membranous

saccule,

the semicircular canals internal to the

tympanum.

It

has the following points

for consideration:

The fenestra ovalis is on its outer or lateral wall and communicantes

It is closed by the base of the stapes and its annular
with the tympanum.
1.

ligament which

is

from the

periosteal lining of the vestibule.

2. The fovea hemispherica is a small circular depression at the inner

portion of the inner or median wall at the bottom of which are numerous mall

openings for the vestibular branch of the auditory nerve.

-

3.

The crista vestibuli

is

posterior to the fovea hemispherica.

It

is

vertical crest.

The fovea cochlearis

is

a small depression

which

is

perforated for the

passage of the filaments of the auditory nerve.

The aqueductus vestibuli is on the posterior portion of the inner wall.

It transmits a small vein and lodges the ductus endolymphaticus which connects the membranous labyrinth with the general cerebral lymph spaces.
6. The fovea he.mielliptica is an oval fossa on the roof.
5.

In the posterior portion of the vestibule are the five openings of the semicircular canals, while at the anterior portion of the vestibule

is

an opening

leading into the scala vestibuli of the cochlea.

The

semicircular canals are three C-shaped bony tubes aboul one-twentieth

of an inch in diameter which are situated above

1.

The superior SEMICIRCULAR canal

is

and behind the

vestibule.

nearly an inch long and

lies in a

saggital plane of the body.

2.

and

The external semicircular canal

lies

is

abut one-fifth of an inch long

horizontally.

The posterior semicircular canal is nearly an inch long and lie- in a

From this we can see that the three semicircular canal- are at
coronal plane.
3.

one another and each forms more than a semicircle. The ampulla
is about one-tenth of an inch in diameter.
The cochlea is a bony tube about one and a half inch long situated anteriorly
It resembles a snail shell and coils around a central axis two
to the vestibule.
right angles to

and three-fourths times. It has the following points for consideration

around which is wound a spiral tube.
1. The modiolus (central axis)
branches of the auditory nerve and
for
This axis has numerous canals in it
:

artery, the largest one of these canals

2.

The base of the cochlea

is

is

canalis centralis modioli.

two-fifths of an inch

in

diameter and

i-

ANATOMY

578

IN A NUTSHELL.

perforated by numerous foramina for branches of the auditory nerve.

directed toward the meatus auditorius interims.

It

is

The spiral canal

(canalis spiralis modioli) is the space between the

It diminishes in diameter as it
of the cochlea.
outer
wall
the
and
modiolus
approaches the apex of the cochlea and ends in a closed extremity (cupola)
after making two and three-fourths turns.
4. The lamina spiralis is a thin osseous plate projecting into the spiral
3.

reaching half way across the spiral canal. It winds

around the modiolus and ends near the apex in a hook-like process (the hamulus).
Helicotrema is the deficiency in the last half turn of the cochlea. The
membrana basilaris and the membrana Reissner are two membranes which
extend from the free border of the lamina spiralis and are connected with the
Between them is the scala media (cochlear duct).
outer wall of the cochlea.
canal from the modiolus

scala media divides the spiral canal into three parts, the scala tympani
below and the scala vestibuli above, and between these two the scala media.
The scala tympani opens into the tympanum at the fenestra rotunda, however,
The scala vestibuli opens
this opening is closed by the membrana secundaria.
Where these two scalse communicate with each other at
into the vestibule.

The

the

summit of the cochlea is called the helicotrema.

The membranous labyrinth is situated within the bony labyrinth from

which

ii

The
h

sac.

is

separated by the perilymph.

utricle lies partly in the

is

filled

fovea hemielliptica and

is

a flattened, oblong

with endolymph and communicates with the saccule through

The membranous semicircular canals

a small tube in the aqueductus vestibuli.
open into the utricle by five orifices.
1. Macula acustica utricularis is a thickened portion of the walls of the
utricle which contain calcareous masses (otoliths) in which are distributed
filaments of the vestibular branch of the auditory nerve.

DUCTUS ENDOLYMPHATICUS which has been previously described.

The saccule, which is smaller than the utricle, receives branches of the
auditory nerve through the openings in the fovea hemispheriea, and these
2.

branches end

the thicked part of the wall which

in

is

covered with otoliths.

The membranous semicircular canals are the same shape

as the osseous

semicircular canals and are about one-fourth the diameter of the osseous canals.

Their enlarged extremities are called ampulla.

The membranous cochlea (cochlear duct)

enclosed

in

(scala

media)

is

a spiral tube

the spiral canal of the osseous cochlea between the scala vestibuli

and the

scala

ol Cortl

which

tympani.
It is filled with endolymph and contains the organ
is a complex arrangement of modified epithelial cells including
the rods of Corti and the auditory cells.

Blood Supply. From

the auditory artery which enters the internal

and divides into branches for the cochlea and vestibule. The
veins empty into the internal jugular and into the superior petrosal sinus.
Nerve Supply.- The auditory ne ve which is the nerve of special sense of

auditory meati

hearing.

ANATOMY

IN A NUTSHELL.

Lymphatics of the internal ear end

in the

579

tympanic and intracranial

lymphatic vessels.

The

superficial mesial origin of the auditory nerve

is

tween the olivary and restiform bodies at the lower border

The deep mesial

origin

in

is

from the groove beof the pons.

the dorsal auditory nucleus, which

is

on the

outer side of the inferior fovea on the floor of the fourth ventricle

The superficial lateral origin of the auditory nerve is from the auditory
and after winding around the upper end of the restiform body joins the

striae,

mesial root in the groove between the olivary and restiform bodies.

The deep
striae,

last

(3)

from (1) a ganglion of the lateral root, which is

winds around the restiform body, (2) the auditory

lateral origin is

situated in this root as

it

the trapezium of the pons,

nucleus

lies in

the ventral auditory nucleus.

(4)

front of the restiform

body between the two

This

roots.

The main trunk of the auditory nerve now passes into the internal auditory
meatus with the facial nerve and the auditory artery. At the bottom of this
meatus it comes to the lamina cribrosa, where it divides into the cochlear branch
and the vestibular branch. (Plate CCXXI).
The cochlear branch sends branches to the saccule, to the ampulla of the
posterior semicircular canal, and to the hair cells of the organ of Corti in the

membranous cochlea.
The vestibular branch has upon it the ganglion of Scarpa,while
auditory meatus

it

in

the internal

sends branches to the utricle, to the ampulla of the external

semicircular canal, to the ampulla of the posterior semicircular canal.

The principal salivary glands are the parotid, submaxillary, and

sublingual.
The parotid gland takes its name from its position which is near the ear.
It is about the size of the pinna (auricle) of the external ear, and weighs almost
an ounce. It extends from the mastoid process and the angle of the jaw BELOW to the zygoma above, being immediately in front of the external meatus.
This gland is saddled over the ramus of the lower jaw, and lias upon its outer
surface a few lymphatic nodes, while its inner surface has two processes upon
it.
One of which extends behind the styloid process of the temporal bone and
beneath the mastoid process of the same bone, while the other is in front of the
styloid process.

The following

structures pass through the parotid gland:

the external carotid artery which gives

off

the temporal branch above,

(1)

the

posterior auricular behind, and the internal maxillary internally, also the trans-

verse facial artery which

part of the "land, (2) the

maxillary veins,

(3)

is

Iranch of the temporal passes through the upper

trunk formed by the temporal and internal

common

branch connecting

rein, (4) the facial nerve

and

its

trunk with the internal jugular

this

branches.

(.">)

branches of the greal auricular

nerve.

The upper anterior portion

portion

is

of

the gland

is

called socia

parotidis.

This

often detached from the rest of the gland.

It
is called
about two and one-half inches long.
After crossing the Masseter muscle and passing
into tin substance of the Buccinator muscle this duct opens upon the inner sur-

The duct

of this gland

Stenson's or Steno's duct.

1

is

ANATOMY

580
face of the cheek

This duct

jaw.

IN A NUTSHELL.

by a small opening opposite the second malar tooth

is

about the

size of a crow-quill.

It

of the

upper

has an external or fibrous

which contains contractile fibers, and an internal or mucous coat, which

columnar epithelium.
Blood Supply. From branches of the external carotid artery.
Nerve Supply. (1) sympathetic from the carotid artery, (2) the fifth
nerve (auriculo-temporal), (3) the seventh nerve, (4) the great auricular (cercoat,

is

lined with short

vical

plexus).

The submaxillary gland which weighs about two drachms

is

situated in

the anterior part of the submaxillary triangle of the neck below the mylo-

hyoid ridge of the inferior maxillary bone. The stylo-maxillary ligament separates this gland from the parotid gland, and the Mylo-hyoid muscle separates
it

from the sublingual gland.

TIh' duct of this gland (Whadon's)

is

about two inches long ami opens at

the side of the frsenum linguae.

Blood Supply. From the facial and lingual arteries.

Nerve Supply. (1) sympathetic, (2) the fifth nerve

(submaxillary), (3)

the seventh nerve (chorda tympani).

The sublingual gland weighs about a drachm and

is

situated at the side of

the frsenum lingua? in a fossa above the mylo-hyoid ridge of the lower jaw close
to the symphysis.

The duct

of this gland

is

called the Bartholin or Rivinus.

This duct opens into the duct of the submaxillary gland near
nation.

Blood Supply.
Nerve Supply.

From the sublingual and

Sympathetic, the
(1)

(2)

submental
fifth

arteries.

(gustatory).

its

termi

ANATOMY

"

IN A NUTSHELL.

ATABLE OF MUSCLES
WITH
Nerve Supply and Page of Description.

Cranial Region.

Occipito-frontalis.

Facial,

or

branches of third

cranial

occipital part sometimes receives the occipitalis minor nerve

Attollens aurem.

nerve,

the

Page 513

Auricular Region.

From the Occipito-frontalis aponeurosis.

Insertion. Into the pinna of ear above. (Plate XIV.)
Action. It raises the pinna.
Nerve Supply. Facial.
Blood Supply. Temporal
Attrahens aurem.
Origin. From the cranial aponeurosis.
Insertion. Into the helix of the ear anteriorly.
Action. It draws the pinna forward.
Origin.

arteries.

Nerve Supply. Facial.

Blood Supply. Branches from the temporal.
Retrahens aurem. Posterior auricular of facial nerve

Page 522

Palpebral Region.

Orbicularis palpebrarum.

Temporal branch of

facial or fibers of third

Page 508

cranial nerve

Corrugator

supercilii.

Temporal

branch of

facial

or fibers of third

cranial nerve

Facial and perhaps third cranial nerve

Orbital Region.
Levator palpebr^e. Third cranial nerve
Rectus superior. Third cranial nerve
Rectus inferior. Third cranial nerve
Rectus internus. Third cranial nerve
Rectus externus. Sixth cranial nerve
Obliquus superior. Fourth cranial nerve
Obliques inferior. Third cranial nerve
Muscles of Tympanum.
Stapedius. Tympanic branch from seventh cranial nerve
Tensor

tarsi.

Tensoi; tymi'wi.

From

the otic ganglion

Laxator tympani
Ptramidalis

nasi.

Page 508
Page 532
Page
Page
Page
Page
Page

530

Page

">">

529

530
53 1
">:'> 1

Page 538
Page 523
Page 523

Page 531

Nasal

Region.


ANATOMY
Origin.

From

[nsertion.

IN A NUTSHELL.

the Occipito-frontalis.

Into

the fibro-cartilage of the ala of the nose with the

Com-

nasi.

'i-

Depresses the eye brows and makes the transverse wrinkles on

Action.

the bridge of the nose.

N u;\

i.

Supply.

Facial.

Supply.Facial.
Levator labij buperioris al^bque
><>i>

'.ij

Dilatob naris posterior.

DlLATOB NARIS ANTERIOR.

Origin.From
Insertion.

nasi.

Facial

Facial

Page 539
Page 540

the alar cartilage.

Into the skin near the margin of the nose.

Action.To dilate the nostril.

\'i.k\
Supply.Facial.
Blood Supply. Facial.
Compressor nasi. Facial
Compressor narium .minor.
Origin.From the fibro-cartilage
i:

Insertion.

Action.

To

Page 539

the nose.

of

Into the skin at the end of nose.

dilate the nostril.

Nerve Supply.

Facial.
Facial.
nasi. Facial

Blood Supply.
Depressor al.k

Page 539

Superior Maxillary Region.

Levator labii superioris. Facial

Levator anguli oris. Facial
Zygom \th is major. Facial
Zygomaticus minor. Facial

Page
Page
Page
Page

534
539
535
535

Inferior Maxillary Region.

I.i.\

vim;

LABI)

tNFERiORis.

Facial

Page 545
Page 544
Page 545

Depressor labii inferioris.. Facial

Depressor anguli oris. Facial

Intermaxillary Region.
l'.i

(i

[NATOR.

crania]

fifth

Risorius.
<

>i;h,i \.

Facial

Page 540

From

the masseter fasica.

the angle of the

Into

Action.To draw
i.i;\

i.

of inferior maxillary division of

Insertion.

and buccal branch

aerve

Si pply.

the angle of the

mouth.

mouth backward.

Facial.

Blood Supply. Facial.

Orbicularis oris.- Facial

through

its

buccal

visions

and supramaxillary diPage 540

Temporo-Maxillary Region.

TEMPORAL.Masseter.

Inferior maxillary division of the fifth nerve

Inferior maxillary division of the fifth nerve

Page 508
Page 520

ANATOMY

IN A NUTSHELL.

583

Pterygo-Maxillary Region.

Pterygoideus externus. Pterygoid branch

of

the

Inferior

maxillary

of

the

Inferior

maxillary

division of the fifth nerve

Page 529

Pterygoideus internus.

Pterygoid

branch

division of the fifth nerve

Page 529

Superficial

Platysma myoides.

Cervical

Facial
Spinal

Sterno-cleido-mastoid.

Region.

Page 5
accessory, second

and third

(?)

Page

cal nerves

15

cervil"

Infra-Hyoid Region.
(Depressors of the Os hyoides and the Larynx).
Sterno-hyoid. Branches from the loop of communication between the
Page 40
cervical plexus and twelfth cranial nerve
Sterno-thyroid. Branches from the loop of communication between
Page 41
the cervical plexus and twelfth cranial nerve
Page 550
Thyro-hyoid. Hypoglossal nerve
Page 59
Omo-hyoid. Tenth, twelfth, and cervical plexus
Supra-Hyoid Region.

(Elevators of the Os hyoides and the larynx.)

Digastric.

Posterior

belly gets the facial,

and the anterior

mylo-hyoid branch of inferior dental nerve

Stylo-hyoid. Facial
Mylo-hyoid. Mylo-hyoid branch of inferior dental of
Geniohyoid. Hypoglossal nerve
Lingual Region.
(Muscles of the Tongue.)

belly

gets

Page 521
Page 522
fifth

nerve Page

Page

Page 5
Genio-hyo-glossus. Hypoglossal nerve
Page 551
Hyo-glossus. Hypoglossal nerve
Page 522
Stylo-GLOSSUS. Hypoglossal nerve
Page 550
Chondro-glossus. Hypoglossal nerve
Page 551
Inferior lingualis. Hypoglossal nerve
Superior lingualis lies near the upper surface of the tongue passing
from base to apex. Its action is to shorten the tongue and make ii concave

longitudinally.

Nerve Supply.

Hypoglossal.

Blood Supply. Same as tongue.

Transverse lingualis runs from the median raphe of the tongue to the
dorsum and margin. Its action is to increase the length of the tongue, at the
same time make it narrow.
lypoglossal.
X kkye Sui'i'M
Blood Supply.- Same as tongue.
Vertical lingualis consists of fasciculi which pass from the dorsum ol
Its action is to make the tongue Ik'it and
the tongue to its under surface.
.

broad.

Nerve Supply. Hypoglossal.

Blood Supply. Same as tongue.

anatomy

584

Palatoglossus.
Origin.

From

in a nutshell.

the median line of the soft palate and from

its

fellow of

the opposite side.

Insertion.

Action.

Into the side

It

and dorsum of the tongue.

and elevates the tongue,

constricts the fauces

also pulls

down

the velum.

Internal branch of spinal accessory through the pharynBlood Supply.

Muscles of the Pharynx.
Constrictor inferior.
Origin. From the cricoid and thyroid cartilages.

Nerve Supply.
geal plexus.

Insertion. Into the

Action.

It

fibrous raphe of the pharynx.

compresses the pharynx and

lifts it

upward and backward.

Pharyngeal plexus and inferior laryngeal.

Same as pharynx which given on page 315.
Page 551
Constrictor medius. Pharyngeal plexus
Constrictor superior. Branches from the pharyngeal plexus. .Page 515
Page 522
Stylo-pharyngeus. Glosso-pharyngeal
Palato-pharyngeus.
Origin. From the soft palate by two heads near the median
Insertion. Into the side of the pharynx and posterior border of thyroid
Nerve Supply.
Blood Supply.

is

line.

cartilage.

It

Action.

the Stylo-pharyngeus muscle.

joins

Constricts

the fauces and elevates the larynx and tongue, and

closes the posterior nares.

Nerve

Internal

Supply.-

branch of spinal accessory through the pharyn-

plexus.

geal

Same as pharynx. Page 315.

Muscles of the Soft Palate.
Levator palati. Spinal accessory through pharyngeal plexus, possibly
through petrosal branch of the vidian nerve
Page 523.
Tensor palati. From the
ganglion
Page 523
Azygos uvuljE. Spinal accessory through pharyngeal plexus. .Page 549

Blood Supply.

facial

otic

Palato-glossus, which has been described with the muscles

in

of the

tongue

Palato-pharyngeus, which has been described with the muscles

of the

the lingual region.

pharynx.
Muscles of the Anterior Vertebral Region.

Rectus capitis anticus major.

First

and loop between it and

Page 514
Rectus capitis antic is minor. First cervical and loop between it and
second cervical nerve
Page 514
Rectus CAPITIS lateralis. First cervical and a loop between it and
second cervical nerve
Page 514
Longus colli. Description. This muscle consists of three portions,
second cervical nerve

cervical

ANATOMY
(a)

IX A NUTSHELL.

585

a longitudinal portion, (b) a superior oblique portion, (c) inferior oblique

portion.
is from the bodies of the first, second,
and seventh cervical vertebra?.
portion into the body of the second, third, and fourth

Origin of the longitudinal portion

and third

dorsal,

and

of the sixth

Insertion of this
cervical vertebra?.

is from the anterior tubercle

and fifth cervical vertebra?.

Origin of superior oblique portion

verse processes of the third, fourth,

of the trans-

Insertion of this portion into the anterior tubercle of atlas.

Origin of inferior oblique portion

third thoracic

Insertion of this portion

processes of the fifth

Action.

is

from the bodies of the

first,

second, and

vertebra?.

To

flex

is

and sixth

into the anterior tubercle of the transverse

cervical vertebra?.

the cervical portion of the spinal column, and rotates

it.

Anterior branches of the lower cervical before

go
into the brachial plexus
Blood Supply.
Muscles of the Lateral Vertebral Region.
Scalenus anttcus.
Origin. From the anterior tubercles of the transverse processes of the
and sixth cervical vertebrae.
third, fourth,
Insertion. Into the tubercle on the inner and upper surface of the
in front of the subclavian artery.
Action.
the neck and elevates the
Xerve Supply. Anterior primary branches of the fourth,
and
sixth cervical nerves.
Blood Supply.
Scalenus medius. Description.
the largest of the Scaleni muscles
Nerve Supply.

the}'

fifth,

first

rib

It flexes

first rib.

fifth,

Is

and passing through

its

substance

is

the posterior thoracic or long thoracic

nerve.

From the posterior tubercles of the transverse processes the

behind the groove
Insertion. Into the upper surface of the
the subclavian artery.
Action.
the cervical portion of the spinal column and elevates
the
Xerve Supply. From the posterior primary branches of the cervical
nerves.
Blood Supply.
the smallest and deepest
Scalenus posticus. Description.
Origin.

of

lower six cervical vertebrae.

first rib

for

It flexes

first

rib.

Tlii<

of the Scaleni muscles

Origin.

From

is

and sometimes blends with the Scalenus medius.

the posterior tubercle of the transverse processes of the

lower two or three cervical vertebra'.

Insertion.

Into

the outer surface of the second rib behind the origin

of the Serratus magnus.

Action.

It flexes

the cervical vertebrae laterally and raises the Brs1

rib.

ANATOMY

586

Nerve Supply.
Blood Supply.

From

IN A NUTSHELL.

the lower three cervical nerves.

Muscles of the Larynx.

laryngeal from the superior laryngeal Page 251
Crico-arytenoideus posticus. Recurrent laryngeal branch from pneuPage 251
ni( igast ric nerve

Crico-thyroid.

Externa]

Crico-arytenoideus lateralis.

Recurrent

laryngeal branch from pneu-

Page 251
and
Page 252

mogastric uerve

Arytenoideus.-Recurrent

laryngeal

branch from pneumogastric

superior laryngeal nerve

Thyro-artenoideus.

Recurrent

laryngeal

nerve

Thyro-epiglottideus.

Recurrent

branch from pneumogastric

Page 252

laryngeal branch from pneumogastric

Page 252

nerve

Recurrent laryngeal nerve Page 252

Recurrent laryngeal nerve Page 252

Aryteno-epiglottideus superior.
ArytEno-epiglottideus inferior.

Muscles of the Back.

First layer.

Trapezius.Spinal
LATISSIMUS DORSI.
Second

accessory, third and fourth cervical nerves. .Page

Middle or long subscapular

Page

45
52

layer.

Levatob ANGULI suapul.e. Third and fourth, sometimes the fifth Page r>o
Page 55
Rhomboideus .major. Fifth cervical nerve
Page 55
Rhomboideus minor. Fifth cervical nerve

Third layer.

All the muscles of the third layer Page 271

of the back receive the external Page 272

Serratus posticus superior.

Serratus posticus inferior

divisions of the posterior branches

of spinal nerves their respective regions.

Splenius capitis.
Splenius colli.

in

Page 272
.Page 272

Fourth layer.
\l.
\M> LUMBAR REGIONS.

SACB

Exectok
I

SPiNiE.-

External division of posterior branches of spinal nerves

Page 272

tarsal region.

Kxternal division of posterior branches of spinal nerves

Ilio-Costalis.

Page 273
Musci

i.i

\<

ejssorius ad ilio-costalem. External division of posterior

Page 274
Longissimus dorsi. -External division of posterior branches of spinal
nerves
Page 274
branches of spinal nerves

Spinalis dorsi.

[nternal

division of posterior branches of spinal nerves

Page 274
<

tervical region.

Cervn ojs
nerve-

\><

endens.

External division of posterior branches of spinal

Page 274

'

ANATOMY
Transveksalis colli.

IN A NUTSHELL.

External division

587

of posterior branches of spinal

nerves

Pag

Trachelo-mastoid. Internal divisions of posterior branches, also suboccipital and great oeeipitial nerves
Pag 27
Complexus. Internal divisions of posterior branches, also suboccipital
and great occipital nerves
271
g<
;

BrvENTEK

cervicis.

External

division of

nerves

Spinalis colli.

Internal

posterior branches of spinal

Pag<

27f

division of posterior branches of spinal nei

Page 275
Fifth layer.

Semispinalis dorsi.

Internal

divisions

of

the

posterior

branches

spinal nerves

Pagi

Semispinalis colli.

Internal division- of the posterior branches of spinal

nerves

Page

Multifidtjs spin.e.

Internal

divisions

of

posterior

J7

<

branches of spinal

Page 276

nerves

Rotatores

of

276

-pix.e.

Internal

divisions of the posterior branches of spinal

Page 276

nerves

Supraspinales. Internal

divisions of posterior branches of spinal ne

Page 276

Interspinales. Internal

divisions of posterior branches of spinal nerves

Page 278

Extensor coccyges.

Internal

division- of posterior branches of spinal

Page 278

nerves

Intertransversales.

Internal division.- of posterior

branches of spinal

Page 278
Page -7 s

nerves

Rectus capitis posticus major. Suboccipital nerve

Rectus capitis posticus minor. Suboccipital nerve
Obliquus capitis superior. Suboccipital nerve
Obliqtjus

capitis

Suboccipital

inferior.

and

greal

Page -7 s
Page -7 s
occipital

nerves

Page 280

'

Thoracic Region.

fntercostal
Intercostales interni. Entercostal
Infra* ostales. Intercostal nerves
Inter* ostales externi.

Triangularis sterni.Levatores costarum.

Intercostal

Intercostal

nerves

Page

nerves

Page 158

l>,

Page 458
l> s

nerves

Page

nerves

Page 159

Diaphragmatic Region.
plexus, intercostal, and phrenic nerves .. Page 233

Diaphragm.Phrenic

Superficial

Obliquus externus.
Obliquus internus.
iUo-inguinal nerve

Lower

Lower

Abdominal Region.
intercostal

Page 160

nerves

intercostals,

ilio-hypogastric,

etiraes
''''-'

"''

ANATOMY

588

Lower

IN A NUTSHELL.

sometimes ilioPage 462

Lower intercostal nerves
Page 463
Re( ii S abdominis.
Pyramidalis. Twelfth thoracic and ili< (-hypogastric nerves. ..Page 463
Page 464
Cremaster. Genital branch of genito-crural nerve
Deep Abdominal Region.
Psoas parvus. Anterior branch of first lumbar nerve
Page 134
Psoas magnus.- Anterior branches of second and third lumbar Page 134
Anterior branches of second and third lumbar through the
Iliactjs.
Page 135
anterior crural nerve
Page 464
Qu \in; \ti rs lumborum. Lower intercostal nerves
Ischio-Rectal Region and Perineum.
Page 490
Corrug viok cutis ani. Sympathetic nerves
External sphincter ani. Anterior division of fourth sacral and inPage 490
ferior haemorrhoidal branch of internal pudic nerve
xtkkxal sphincter ani. Hemorrhoidal
Page 490
Levator ani. Branches from anterior division of fourth sacral and
Page 490
branches from pudic nerve
Page 491
Coccygeus. Branches from fourth and fifth sacral nerves

Transversalis.

intercostuls,

ilio-hypogastric,

inguinal nerve

In

the male.

Transversus perin^ei. Perineal branch of internal pudic nervePage

Accelerator rnix.E. Superficial perineal from internal pudic. Page
Kkkctoh pexik. Perinea] branch of internal pudic nerve
Page
Compressor urethr.e. Perineal branch of internal pudic nerve Page

491

492
492
492

In the female.

lnsversus p Hi !ix. Ei. Perineal branch of internal pudic nerve Page

Sphincter vagix.e. Perineal branch of internal pudic nerve.. Page
Erector clitoridis. Perineal branch of internal pudic nerve Page
Compressor urethra. Perineal branch of internal pudic nerve Page
Ti;

492
493
493

493

Anterior Thoracic Region.

Pectoralis

major.

Pectoralis minor.
Subclavitjs.

External

Internal

and

internal

anterior

anterior thoracic nerve

Fifth and sixth cervical nerves

thoracic

nerves

Page
Page
Page

41

50
42

Lateral Thoracic Region.

Serratus MAGNUS.

Posterior

thoracic

from the

fifth

.seventh cervical nerves

and sixth and

Page 54

Acromial Region.

Deltoid.

Circumflex nerve

Page

43

Page

56

Anterior Scapular Region.

Subscapulars.

Upper and lower subscapular nerves

Posterior Scapular Region.

Supraspinatus.
Infraspinatus.

Teres minor.-

and sixth cervical through suprascapular. Page

56

Fifth and sixth cervical through suprascapular. Page

55

Page

56

Fifth

Fifth cervical

through circumflex

ANATOMY
Teres major.

Fifth

IN A

and sixth

NUTSHELL.

589

cervical through the lower subscapular

Page

56

Page
Page

58

.Page

79

I'air<-

50

Page

79

Anterior Humeral Region.

Coraco-brachtalis. Musculo-cutaneous nerve

Biceps. Musculo-cutaneous nerve
Brachialis axticus. Musculo-cutaneous and musculo-spiral

Posterior

Triceps.

58

Humeral Region.

Seventh and eighth cervical through

Musculo-spiral nerve

musculo-spiral.

Subaxcoxeus.

Anterior Radio-Ulnar Region.

Proxator radii teres. Median nerve

Flexor carpi radialis. Median nerve

Page
Page
Palmaris loxgus. Median-nerve
Page
Flexor carpi ulnaris. Ulnar nerve
Page
Flexor sublimis digitorum. Median nerve
Page
Flexor profundus digitorum. Ulnar and anterior interosseous. Page
Flexor loxgus pollicis. Anterior interosseous
Page
Proxator quadratus. Anterior interosseous
Page

79
81
81

81

82

82
84
84

Radial Region.

Supinator loxgus.

Musculo-spiral nerve
Musculo-spiral nerve
Posterior interosseous.

Extensor carpi radialis loxgior.

Extexsor carpi radialis brevior.

Page
Page

84

.Page

s ">

85

Posterior Radio-Ulnar Region.

Extexsor communis digitorum. Posterior interosseous

Page 85
Extexsor miximi digiti. Posterior interosseous
Page 87
Extexsor carpi ulnaris.
Origix. (1) From the outer condyle of thehumerus bythe common tendon,

adjacent intermuscular septa, and deep fascia.

(2)

from the middle third

of the

posterior surface of the ulna, (3) from the posterior border of the ulna with the

Flexor carpi ulnaris and Flexor profundus digitorum.

Insertion. Into the ulnar side of the base of the

Action. To extend the carpus.

fifth

metacarpal hone.

Nerve Supply. Posterior interosseous.

Blood Supply. Ulnar artery.

s7

Page
Anconeus. Musculo-spiral nerve
Supixator brevis. Posterior interosseous nerve
Pag<
Extensor ossis metacarpi pollicis. Posterior interosseous nerve P

ss
ss

ss

Extensor brevis pollicis. Posterior interosseous aerve

Page
Extensor longus pollicis. Posterior interosseous nerve .... Page
Page
Extensor indicis. Posterior interosseous nerve

91
91

Radial Region of the Hand.

Abductor pollicis. Median nerve

Flexor ossis metacarpi pollicis.- Median nerve
Flexor brevis pollicis. Median and ulnar nerves
Adductor obliquus pollicis. Ulnar nerve

Page

Page
Page
Page

12

12

L2

ANATOMY

590

Adductor transversus

IN A NUTSHELL.

Ulnar nerve
Ulnar Region.
Palmaris brevis. Ulnar nerve
Abductor minimi digiti. Ulnar nerve
Flexor brevis minimi digiti. Ulnar nerve
Flexor ossis metacarpi minimi digiti. Ulnar nerve
Palmer Region.

Lumbricales.

Two

pollicis.

Page 112
Page
Page
Page
Page

median;

outer ones get the

two inner

ulnar nerve

Iliac

113
113

get the

Region.

Anterior branches of second and third

Anterior branch of the
lumbar

Iliacus.

113

Page 113
Page 114
Page 114

The three palmar interossei. Ulnar nerve

The four dorsal interossei. Ulnar nerve
Psoas magnus.
Psoas parvus.

113

lumbar. .Page 134

Page 134
branches of second, and third lumbar through the
first

Anterior

anterior crural nerve

Page 135
Anterior Femoral Region.

Tensor vaginae femoris.

(lie

Fourth and

fifth

lumbar and

first

sacral through

superior gluteal nerve

Page 135

Anterior crural
Page 135
Rectus. Anterior crural
Page 136
Vastus externus. Anterior crural
Page 137
Vastus internus. Anterior crural
Page 137
Crureus. Anterior crural
Page 138
Subcrureus. Anterior crural
Page 138
Internal Femoral Region.
rRACiLis. Third and fourth lumbar through the obturator nerve. Page 138
PectinetjS. Anterior
obturator accessory and occasionally branch
Sartorius.

crural,

from the obturator nerve

Adductor longus.

Page
Page
Page
Page

Obturator nerve

Adductor brevis. Obturator nerve

Adductor magnus. Obturator and great

sciatic nerves

138
140
140
140

Gluteal Region.

Gluteus maximus. Inferior gluteal and small

Gluteus medius. Superior gluteal
Gluteus minimis. Superior gluteal

sciatic nerve.

.Page 141

Page
Page
Page
nerves Page

141

143

and second sacral nerves

143
Gemellus superior. Fifth lumbar, first and second sacral
144
Obturatob [nternus. Fifth lumbar, first and second sacral nerves
Page 143
Gemellus inferior.Fourth and fifth lumbar, and first sacral. .Page 144
Obturator externus.
>bturator nerve
Page 144
Quadratis fi.mokis. Last lumbar and first sacral nerves
Page 144
Posterior Femoral Region.
Great sciatic nerve
Biceps.
Page 14C>
SEMITENDINOSUS.- iieat sciatic nerve
Page 146
Ia riformis.- First

ANATOMY

IN A NUTSHELL.

591

Great
nerve
Anterior Tibio-Fibular Region.
Tibialis anticus. Anterior
nerve
Extensor longus digitorum. Anterior
nerve
Extensor propius halluces. Anterior
nerve
Peroneus tertius. Anterior
nerve
Semimembranosus.

sciatic

Page 147

tibial

Page 152
Pago 152

tibial

tibial

Pane 152
Page loo

tibial

Posterior Tibio-Fibular Region.

Gastrocnemius. Internal
Plantaris.

popliteal

from great

Internal popliteal from great

sciatic nerve.

sciatic

nerve

Page 153
Page 154
Page 53
Page 154

Soleus. Internal popliteal and posterior tibial.

Popliteus. Internal popliteal nerve
Flexor longus hallucis. Fifth lumbar, first and second sacral through
posterior tibial nerve
Page 1 54
Flexor longus digitorum. Posterior tibial nerve
Page 156
Tibialis posticus. Posterior tibial nerve
Page "fi
1

Peroneus
nerves

Peroneus

Fibular Region.
longus. Alusculo-cutaneous, a
brevis. Alusculo-cutaneous, a

branch of external popliteal

Page 15ii
branch of external popliteal

narves

Page 157
Dorsal Region of the Foot.

Extensor brevis digitorum.

Anterior

tibial

nerve

Page 157

Plantar Region of the Foot.

Abductor hallucis. Internal plantar nerve

Flexor brevis digitorum. Internal plantar nerve
Abductor minimi digiti. External plantar nerve
Flexor accessories. External plantar nerve
Lumbricales.

The

Page 158
Page 158

Page 158
Page

161

two inner ones get the internal plantar nerve, the

two outer ones get the external plantar nerve

Page 162
Flexor brevis hallucis. Internal plantar nerve
Page 162
Adductor obliquus hallucis. External plantar nerve
Page 158
Flexor brevis minimi digiti.
Origin. From the base of the fifth metatarsal bone and from the sheath
of the tendon of the Peroneus longus.
Insertion. Into the base of the first phalanx of little toe and fifth meta-

tarsal.

Action.

To

flex

the

little

toe.

Nerve Supply. External plant;

Blood Supply. External plantar.
Adductoe transversus hallucis
.

(pedis).

External

plantar

nerve

Page

The four dorsal

lnterossei.

External plantar nerve.

enterossei.

firsl

mo
and

nerve

Page 160

External plantar nerve

Page L60

second also receive extra filaments from the anterior

The three plantar

The

tibial

INDEX.

593

INDEX
Ankle

and nerve supply, 204

203

joint blood

ligaments of
Annec'ent gyrus, 345
joint

Abdoinen,

307
contents of, 307-309
regions of, 307
superficial muscles of, 460
deep muscles of 464
veins of, 186
lymphatics of, 499

Abdominal ring

Annulu* ovalis, 240

Anosmia, 365
Anterior annular ligament, 221-110
Condyloid foramen. 554
cerebral artery,

ring internal, 477

brain function

of.

cardiac \ cm. 486

17
commissure,

431

''

aorta. 4.51-172

crual nerve. _'ln

aorta relations of, 451

aorta branches of. 452
anterior trunk, 172
Abducens nerve, 439-392
Abductor hallucis muscle, 158

carpal artery, 96-92

circumflex artery, 65
el

lateral ascending tract. 433

Anterior ligament. 61
meningeal artery, 444

mediastinum 460
nerve roots. 333
Spinal arteries. 337
tibial nerve. 218
tibial vein
192
tibial artery, 1N4-1S0

Acromio-clavicular articulation, 38
clavicular articulation ligaments, 38
clai icular articulation blood and nerve supply, 38
Adductor transversus hallucis muscle, 160
obliquus hallucis muscle, 158
magnus muscle, 140
brevis muscle, 140
longus muscle. 140
transversa pollicis muscle, 112
Adductor obliquus pollicis muscle, 112

ulna

Antrum

recurrent
of

182

of,

artery, 95

569

ihelix of ear,

Aortic opening of diaphragm, 234

plexus,

126

Aponeurosis description

17

of,

Aqueduct of Syh ius, 3

Aqueduct u~ \ est ibuli,
Aqueous humor, 376
Arachnoid of brain. 341
Arachnoid of cord, 332

of,

26

definition of, 17

\nii- tendinous,

17

Anastomotica magna artery

artery (arm), 69

leu.

178

es of,

19

117

questions on,

lymphatics
muscles

of,

120
198

gyrus, 345

artery, 292

of,

195

Arch aorta, 285

Arm cutaneous nen
veins of,

Anconeus muscle, 87
Angular vein, 180
Angle of jaw. 543
Angular processes, 507

Angiology definition
Ankle joint. 21)1-202

182

Highmore, 537

Amaurosis, 373
Amblyopia, 373
Amphiarthrosis, divisions

magna

arterj

branches
thoracic artery. 64

tibial artery

Antitragicus muscle, 570

Aorta, 284

172

divisions of,

tibial recurrent

Ant

17

Adult circulation, 39
Ala cinerea of brain, 443
Alar thoracic artery, 64
Alcock's canal, 495-214
Alimentary canal, 309

Anatomy

148

jugular vein, IM
Antero-lateral ground bundle tract, 433

fibers to heart, 431

Accessoriu^ muscle, 274
Acetabulum, 131
Acromial thoracic artery, 63

Allantois,

385

ethmoidal foramen. 553

interosseous artery, 95

muscle, 111
minimi digiti muscle, 113
Accelerator urinse muscle, 492

of,

hmoidal arterj

intercostal arteries,

pollicifi

Adenology definition

114

communicating artery, 444

commissure of brain, 437-347

external, 476

17

cent ralis

princeps

receptaculi

ret ina

cen

ici

artery,

ill

A Rvstem description of,

INDEX.

594
Arteries,

abdominal aorta, 452-172

acromial thoracic, 63
alar thoracic,

li

Arjery, frontal, 385

gastro-epiploica dextra, 453
epiploica sinistra, 453

anastomotica magna, (leg), 178

anastomotica magna (arm), 69

gastro-duodenalis, 453

anterior circumflex, 65.

gluteal, 172

gastric,

453-327

carpal, 92-96

hand

cerebral, 444

hepatic, 453

communicating, 444
ethmoidal, 385

hyoid, 288
hypogastric, 33

interosseous, 95

ileo-colic,

448
meningeal, 444

ilio-lumbar, 172

spinal, 337

mesentery, 455
thyroid, 449
laryngeal, 449
vesical, 172
dental, 297
labial, 292
innominate, 286

intercostal,

182-180

tibial,

recurrent, 95

aorta, 284
articular of knee, 182

ascending cervical 449

pharyngeal, 294
palatine, 291
angular, 292
auricular, 293-294
axillary, 62
basilar,

448

bladder

of,

lingual,

445

lumbar, 452
lateral

interosseous, 95

media, 455
sinistra, 455
coronary, 244-292
cremasteric, 560-176
crico-thyroid, 290
cutaneous of leg, 182
cystic, 453
deep palmar arch, 93
ulnar, 90
iliac,

metacarpal, 92
middle cerebral, 444
meningeal, 296
hemorrhoidal, 172
vesical, 173
musculo-phrenic, 449
nasal, 385

lingua', 291

external carotid,
iliac,

malleolar, 18

186

1st

291

170

occipital,

of,

19

172

293

oesophageal, 450-

palmar recurrent, 95
interossei, 94
pancreatica? parvse and magna, 453
pericardiac, 450-448

93

IM
hallucis, IM

pedis,

mammary,

obturator,

ophthalmic, 383-444-308
ovarian, 457

186

dorsalis pollicis, 92

femoral,

metatarsal, 184

nutrient rule

176-178
epigastric, 175-178
descending palatine, 298
circumflex

facial,

meningeal, 293
mesenteric, 326

455

colica dextra,

sacral, 172

mediastinal, 448

453

coeliac axis,

tarsal,

290

long thoracic, 64

385
30

plantar,

182

184
lachrymal, 383

of,

Artery external

maxillary, 295

pudic, 173

circle of Willis.

indicia,

172

iliac,

tarsal.

286
cerebellar, 448

digital,

carotid, 443

palpebral, 385

carotids.

common

internal auditory, 448

mammary, 448

brachial, 66

ciliary,

66

450

intercostal,

malleolar,

472

bronchial, 450
calcanean. 186

coats

455

inferior profunda,

thoracic, 64

ulna;

106

of,

i:i-288

175

peroneal,

186

phrenic, 44N-452
plantar digital, 184

pterygoid, 297
posterior carpal, 92-96
cerebral, 445

circumflex, 65

communicating, 445

INDEX.
384

Artery, ethmoidal,

595

Artery, ulnar, 95
umbilical. 472

interosseous, 95

mediastinal, 450

uterine. 174

perforating, 186

vasa aberrantia. 69
brevia. 453

scapular, 449
spinal.
tibial.

337
180-185

intestini tenuis, 451

vas deferens

182
ulnar recurrent, 95
popliteal. 176
princeps pollicis. 93
tibial recurrent.

profunda, 176
pterygo-palatine, 298

176

pudic.

566

of,

vertebral. 447
wrist of, 92
articular of knee. 182
Articular process of vertebra
Articulation, acromio-clavicular. 38

ethmoid bone of, 525

elbow joint, til

pulmonary. 284

femur. 150

pyloric. 4.53

frontal

radial. 91

submaxillary. 291
subscapular, 65
submental. 292

194
humerus; of, 61
ilium of. 128
inferior radioulnar, 79
maxillary bone of, 543
turbinated bone of, 546
knee, 198
lachrymal bone of. 532
metatarsal bone of, 164
metatarsophalangeal. 164
metacarpophalangeal. 110
middle radioulnar, 78
nasal bone of. 532
occipital bone of, 513
palate bone of, 549
parietal bone of. 510
pudic bones of, 128
sacrum. 133

superficial cervical, 449

sacro-vertebral

92

radial recurrent

radialis indicia,

94

ranine. 291
renal.

456

rule of, 32
sciatic.

174

sigmoid, 455
spheno-rnaxillary. 297
palatine. 298
splenic. 453-327

spermatic. 456-567
sternal,

448

subclavian, 445
sublingual, 291

suprascapular. 449
suprarenal. 456

iliac,

of,

508

superficial external pudic. 17S

circumflex

iliac.

178

epigastric. 178

176

palmar arch, 96
superficialis volas, 92

288
superior intercostal. 449
epigastric, 449
mesentery. 454
hemorrhoidal. 456

superfieial descending.

280

133

coccygeal.

supraorbital, 384

femoral,

bone

hip-joint.

134

sphenoidal hone of, 528

sternoclavicular. 38
superior radio-ulnar. 78
temporal bone of, 520
Aryteno-epiglottideus muscle. 252
Arytenoideus muscle. 252

Ascending cervical artery. 449

gyrus, 245
palatine artery. 291

pharyngeal artery, 294

fibers of cord. 433
Astigmatisn

vesical,

A~t ragalus bone, 162

fibular.

muscles attached, 162

Atla- hone. 260
muscles attached, 260

172
182
profunda. 66
perforating.

94

thoracic. 62

laryngeal. 288

thyroid, 288
sural. 182

temporal, 294
thoracic- aorta, 451

thyroid a\i~. 449

transver>alis, colli, 449
tonsillar,

291

449
tympanic, 295
tracheal.

ligaments of, 262

Atlantoaxial ligament
Auerbach's plexus
Auditory ner> -. 8), 441
meatus, 517
nerve superficial origin, 579
deep origin
cochlear branch. 579
vestibular branch. 579
canal external. 570

Auriculotemporal

nerve,

102

INDEX.

596

Bones, labyrinth of ear, 576

lachrymal, 532

Auricles of heart, 240-242

Auricular appendix, 240

Auricular artery, 293-295
Axilla, the 119

boundaries
\

of,

long,

19

malar, 333
malleus, 574

19

manubrium, 236

\illary artery. (12-98

Axis bone muscles attached, 264

ligaments of, 265

metacarpal, 106
metatarsus, 164
middle cuneiform, 164
middle cuneiform, 164

Azygos veins, 483-484

uvukr muscle, 549

non-articular cavities of, 22

118-482

vein,

\\i- bone, 26

nasal,

531

navicular. 163
occipital,

511

368
162
palate, 547
parietal, 509
orbit of,

Hack -km

280

o/,

muscles

'270

of,

Basilar artery,
vein,

os calcis,

18

488

process,

pelvis,

Bartholin's glands, 563

prominences

duct, 315

Bicepa muscle, 146-58

Bicuspid valve, 242
Big four. 319
Hi venter cervicis muscle, 274
Bladder, 471

471
urachus
arteries of, 472
ligaments of, 472
lymphatics, 500
Blood penis vessels of, 566
of,

vessels description of,

Bone

28

cavities of, 22

35

Lcle,

I".

cranium

525-20

268
sacrum, 132
scapuhe, 45
sesamoid, 20-168
short, 20
sphenoid, 526
stapes, 574
sternum, 236
rib,

69

vomer, 546

Wormian,

definition of, 23

Brain,

of, 574
eminences of, _'_'
Bones, externa] cuneiform, 164
ethmoid,

eai

">-'

339

ala cinerea, 443

anterior commissures of, 437-347

choroid plexuses of, 441

conductor sonorous of, 443
of. 340
corpus callosum of, 350-437
striatum of, 441
coverings of, 341
crura cerebri of, 363-437

cortex

20
femur,
flat,

Bbula.

forearm

127
128
radius, 69

pubic.

vertebra, 258

cuboid, 162

tare.

19

pubis,

ulna,

of,

of,

22

temporal, 516
tibia. 166
turbinated, 528

260
axis, 264
atlas,

:cj \.

of,

superior maxillary, 535

162

as1 ragalus,

els

131

phalanges, 164
processes definition

."Hi"

17

I7(i

69
506
gladiolus, 236
of,

frontal,

divisions of, 341

definition of,

i:>7

hand of, 106

humerus, ti()

eminentia

In oid,

342-343
348-437
fourth ventricle, 439
fovea superior, 443
inferior. 443
ganglia of. 343
gyri of, 345
inferior medullary velum, 441
infundibulum, 441

ilium.
incus,

fissures of.

25
">7

fornix.

internal eimifonn

163

inferior maxillary.

.">

turbinated,

546

innominate, 128
irregular,

443

fasciculus unciformis, 443

5 19
I

teres,

2(1

ischium, 127-129

INDEX.
Brain lateral ventricle, 438
lamina cinerea, 441
ligula. 443
lobes of. 344-342
longitudinal commissures. 340-437
locus cseruleus. 443
middle commissure. 348-437
obex, 443
Brain, olfactory tract. 365-437
optic commissure. 437-366
peduncles of. 354
pineal gland 441
pons varolii, 362-437
posterior commissure. 437-348
perforated space. 441
ta?nia semicircularii, 356-437
tela choroidia inferior. 441
third ventricle. 437
transverse commissures. 339-437
trigonum hypoglossi. 443
tuber cinereum. 441
tuberculum acusticum. 443
ventricles. 340-358
valve of Yieussens 441
Brachial plexus. 96
communicating branches, 98
artery. 66
relations of, 66
Brachialis amicus muscle. 79
Bronchus, 254
Bronchial veins. 4^4
arteries. 450
Brunner's glands, 321
Bryant's triangle. 196
Buccal nerve. 40_>
Buccinator muscle. 540
Buck's fascia. 495
Bulbus vestibuli. 563

Cseeum. 320
Calcarine fissure. 344

597

Capsule of Muller, 47"

of Tenon
Cauda equina, 331

Cavernou- sinus

189

-.

plexu-. 422
Cell-

of Sehultz

Center definition for. 364

Centers in medulla. 359
Center for smell,
Central canal of cord, 333
Central lobe of brain, 344
-ystem. 339
tendon perineum. 495
Centrifugal nerves, 431
Centripetal nerves, 431
Cerebrum location of. 356

Cerebellum fi tires

Cerebrum lobeexterior

354

of.

344
342

of.

of.

Cerebellar vein-.

Cerebral veil
hernia. 474

Cerebellar artery. 448

Cerebellum description of, 357-360
nuclei of, 361
peduncles of, 360-362
Cervicalis ascendens muscle. 27 5
Cervical nerves. 298
plexus. 304
branches of 305
communicating branche-. 98
Cervical nerves second, 301
third. 303
pleura. 256
vertebrae. 264

Cervix, laceration

431

of.

Chiasma, 366-357
Chondro-glossus muscle, 550
Chopart's amputation, 194
Choroid plexuses of brain, 441
Choroid coat of eye, 381-376
Chord* tendinea 241-243
Ciliary ganglion. 395-403
Ciliary body, 386
1

Calcaneo-cuboid ligamei.Calloso-marginal fissure. 343

-

arteries.

Call"--al gyrus, 34.5

Canal of Nuck. 559

Cardiac nerves. 416
plexus, 424
veins. 244

Circle of Willis.

44.'.

Circular sinus

Cardio-inhibitory center, 359

Carotid arteries. 286

Circumvallate papillse, 311

Circumflex nerve, 99
Circumpatellar anaston
Clavicle articular blood supi
articulatioi

relations of, 2>-7

artery external, 443

liean

443

internal,

triangle, superior,
inferior.

280

134

282

Capillarir-s. description of,

muscles attached,
_-.-u- muscle,
191

30

Capsular ligament. 48

I"

Cliton-

Carotid plexu-. 422

of knee.

muscles attached,

Carotid sheath, 282

*>

1]

INDEX.

598
Cceliac axis,

plexus,

Cremasteric artery, 566-176

fascia, 567-568
Cribriform plate, 524

153
l-'">

494

Colles's fascia,

Colica-dextra artery, 455

Colica sinistra artery, 455

320
descending, 320
Colon, transverse, 320
Columns of Bertin, 468
Of Clarke, 333
lolon ascending,

Columns

Common

vestibuli of ear, 577

Crista urethra, 473

carneae, 24 1-2 13

carotid arteries, 288

us artery, 95

intero

Commissures

of brain,

339

nerve, 306
Compressor urethra' muscle, 492-493

Communicans hypoglossi
nasi muscle, 539

Complete fissure, 342

Complexus muscle, 274

Concha of car, 570

Conducting paths of brain, 431
Conductor sonorous, 443
Condyles, 22-61
londyloid foramen, 51
Congenital hernia, 478
Imi nia kind- of, 478
(

Conus

arteriosus, 241

medullaris,

Crural hernia, 474

Crucial anastomosis, 174
ligaments, knee, 200
atlas, 264
Crura cerebri, 363-437
Crureus muscle, 138
Crus cerebri, 363
Crusta petrosa, 31

Crystalline

humor

of eye,

muscles attached, 162

arteries of leg, 182
nerves. 214
membrane description of, 465
Cuneate gyrus, 345
Cystic artery, 453

Cutaneous

vein,

485
246

goitre,

331

Coraco brachialis muscle, 58

Conjunctiva, 388
Cord membranes of, 332
tracts ,,f, 433
!oi tex centers of, 433
Coi pus Arantii, 242
callosus, 350-437
call. .Mini, 319-350
dent at um, 361
I

Dartos of penis, 565

Deep lymphatic vessels, 498
cervical vein, 482
Dental canal inferior, 543
Depressor alee nasi muscle, 539
Deciduous teeth, 309
Deep circumflex iliac artery, 176

Cor] hi- striatum, 441

epigastric artery, 175

Corpora cavernosa penis, 565

Corpus lutetim of ovary, 561
Coi pora triata, 347
!oi nea of eye, 378
-t met tire of, USD
Hi.. nary sinus. 486-240-244
arteries, 211-292
valve, 240
Corrugator cutis ani muscle, 490
"**
supercili) muscle, 508
Cortical substance of kidney, 469
Cortes of brain coi meet ion of, 431
Of I. lam. 340
<',,-.,, clavicular
ligament, 38
Costal pleura, 256
Cotyloid ligament, 196
Cowper'e (.'land, 137 195

fascia of

arm, 115
ulnar artery branch, 96

palmar arch, 93

Definition of center, 364

Deltoid muscle. 43

Cranial ner\

nen

es

376

Cuboid bone, 162

articulation of, 162

lonarium, 353

muscle, 251
thyroid artery, 290
thyroid muscle, 251
Crista galli, 525

!omes nervi phrenici, 307

218

fascia,

Crico-aryt enoideus lateralis muscle, 251

media artery, 455

139

second, 366
nerves description
e

of, 364-27
nerve- rule of origin, 364
nerves table of, 27
Cremastei muscle
Hit

Degeneration of cord, 334

Dental nerves, 398
Dentate gyrus, 346
fissure, 342
Dentine of teeth, 311
Depressor labii inferioris muscle, 544
anguli oris muscle, 545
Dermatology definition of, 17
Descending fibers of cord, 335
palatine artery, 298
Diabetic center, 359
Diaphragm muscle, 233
crus of, 234
openings in, 234
Diaphragmatic pleura, 256
plexus,
Diarthrosis divisions

Diastole of heart. 245

of,

26

[NDEX.
Digastric muscle, 521

Ethmoid bone, muscles attached,

triangle, 282

cribriform plate

Digital arteries, 186

Direct cerebellar tracts, 434

inguinal hernia, 474

475
coverings of
Dorsi-spinal veins, 486
Discus proligerus of ovum, 561
Diseases of spinal cord, 334
Dorsalis linguae artery. 291
Dorsal interossei muscle, 160-114
Dorsalis pedis artery, 184
hallucis artery. 184
Dorsales indicis artery, 93
pollicis artery, 92
Duct of Gartner, 563
Ductus arteriosus, the 33
Duodenum, 320
Dura Mater of cord, 332
blood supply, 341
nerve supply, 341
sinuses of, 488
of,

Ethmoidal
Ethmoid notch, ">o7
Eustachian tube, .".7 <
>

Dilator nares posterior muscle, 540

Diplce veins of, 486

veins

">-''

525

of,

valve.

1(1

Exophthalmic goitre, 16
Extensor carpi-radialis longior muscle 35
-'

Extensor brevis pollicis muscle, 88

digitorum muscle, 157
carpi-radialis brevior muscle, 85

communis digitorum muscle, 85

coccygis muscle, 278

muscle, 91
longus pollicis muscle, 91
digitorium muscle, L52
indicis

muscle, 87
metacarpi pollicis muscle, y ^
proprius hallucis muscle, 152
Externa] abdominal ring, 476
annular ligament. 222
auditory canal, 570
blood supply of, 570
nerve supply of, .">7<t
iiiiiiimi digil

<i~-i~

480

carotid artery,

13

til
cuneiform bone,
muscles attached. 104
cutaneous nen e, 210
ear, 568-569
blood and nerve supply
genitals, female, 562
I

Ear,

568
bones

574
576
intrinsic muscles
nerve of, 577
pinna, 569
of,

internal,

tympanum

of,

of,

570

186
intermuscular septum

jugular vein, 481

lateral ligament

mammary

Erector clitoridia muscle, 493

Erector penis muscle, 492
spinse muscle, 272

Esophagus,

plantar artery. 186

nerve. 216

pterygoid muscle,

31

sphincter ani muscle,

Eye-ball, 3<;s
coal

of,

376

refracting media. 376

blood supply of, 382

Eye-brows, 389
Eye diseases of, 373

Eye
I

ye
\.

389
389
muscles of,
lashes,
lid-.

525
525
525

nsorj

">-'''

ligament

crista galli of,

nasal

slit,

processes

of,

of,

525

190

,184
thoracic nerve, us
Extrinsic ligaments "t larynx, 250
tarsal arterj

of,

foramina

">-'!

rectu> muscle, 531

317
Ethmoid bone, 524
coats

artery, 64

orbital gyrus, 345

of teeth, 311

Encephalon, 341
Encysted hernia, 479
Endocardium, 244
Ensiform appendix, 237
Epigastric region, 309
Epiblast, 331
Epididymis, 568
Epiphysis, 353
Epeneephalon, 341
Epiglottis, 250

til'

malleolar artery, 184

61

Eleventh nerve, 416

Eminentia teres, 443
Emissary veins, 487
Emmet ropia, 375

Enamel

219

intercostal muscles, 457

of,

(leg>,

arm), 115

571

joint, 61

ligaments

570

iliac vein,

vestibule, 5777
Ejaculatory duct, 567

Elbow

artery.

iliac

of,

17">

Face

1\

mpii.it ice "i

nerves

ol

.-:

INDEX.

600

Foramen

of Winslow. 465
Win-low relations of. 465
Fire-arm description of, 69

Facial artery, 391

nerve, 407-439
superficial

of

origin,

106

radial region, 69

480

vein,

posterior radio-ulnar region, 69

Falciform process, 220

Fallopian tubes, 559

bones of, 69
Formatio reticularis, 363
Fornix, 348-437
description of, 356
pillars of, 349
Fossa of helix, 569

ampulla, 560
560
isthmus, 560

fimbria.

133

proprli,

u]j

Fasciculus unciformus, 437-443

Fascia arm form-- of, 115

navicularis of urethra. 17
ovalis,

Buck's, 195
cribriform, 218
thigh deep

of,

description

band

Fourth ventricle boundaries

nerve.

219

Fovea

of pelvic,

Frsenum

s
1

organs of generation, 556

477

sheath,

177

of,

507

lobe of brain, 344

345

nerve, 394

178

360
Rolando, 360
Fungiform papilla?, 311

176

gracilis,

anal. 477
hernia,

313

Frontal sinuses. 507

vein, 487-480
Funiculus cuneatus, 360

Femoral artery, 176

of,

bone sinuses
.">ti2

gyri,

132
uretbra, 474

pelvic,

relations of

lingua?,

4-t3

Frontal artery, 385

bone, 506
bone nutrient artery of, 508
bone muscle attached, 508

auces, 316
iinale organs of generation external.

brancbe-

358

cochlearis, 577

hemispherica, 577
and superior of brain.
Fractures of spinal column, 334

195

superficial of thigh, 2

439

inferior

495

recto-vesical,

of,

391

ventricle,

17

of,

116
lata. 219-220
of leg, 220
obturator, 495
plantar. 223
perineum, V.t.~>
>f
of,

240

178

ring,

brevia hallucis muscle, 162

brevia digitorum muscle, 158

Gall bladder, 325

minimi

Ganglion of trunk, 412

of root. 412
Gasserian ganglion, 402
Gastric artery, 327-453
glands, 318
nerves, 416
plexus, 425
vein, 484
Gastro-duodenalis artery, 453
epiploica sinistra artery, 453
epiploica dextra artery, 453
cnemius muscle, 153
Gemellus superior muscle, 144
inferior muscle, 144
Genesiology definition of, 17
Geniculate bodies, 352
Genio-hyo-glossus muscle, 544
hyoideus muscle, 544
Genito-crual nerve, 278
Gimbernat's ligament, 177
Glabella of frontal bone, 506
Gladioli- 236
GlancL of Lit re. 474
Glaserian fissure, 573
Glosso-pharyngea] nerve (9th), 441-41o

digiti muscle, 1 13
bre\i> pollicis muscle, 11-

carpi ulnaris muscle, 81

carpi radialis muscle, 81

sublimit digitorum muscle, 82

of hip joint

196
longus digitorum muscle,
longus hallucis muscle, 15
,

15*6
l

longus pollicis muscle, 84

profundus digitorum muscle

Floating kidney 169
Foramina of Stenson, 538
of Scarp
base "f skull, 552
of orbit. 369
of Thebesii, 240

Foramen

tecum, ~<r,j
caecum of tongue, :i
lacerum medium, 553
magnum, 511-332
Monro, .:)!
ovale, 527
<

rotundum,

r,J7

Bpinosum, 553-527
Vesalii, 527 553

82

[NDEX.
Gluteal aponeurosis, 220
Gluteus maximus muscle, 141
medius muscle, 141

601

Hernia, infantile, 478

strangulated, 475
umbilical, 475

minimus muscle, 143

tunica vaginalis

17s

testis,

Goitre. 246

Hemianopsia, 374

Goll and Burdach tracts, 433

Gower's tract, 433

Hemorrhage

Graafian

Horizontal fissure of cerebellum, 35

Horner's m isrle ''7 '.
Hepatic arterj
15
duct. 326
flexure. 320

561

follicles,

Gracilis muscle, 138

Gray rami communieantes,

363

of pons,

Hilton'- law, 25

128-421

nuclei of cerebellum, 362

Great auricular nerve, 305

cardiac vein, 185

plexus,

omentum, 318

veins, 190

215

sciatic nerve,

veins division

superficial petrosal nerve,

404

Greater sac of peritoneum, 466

Greater trochanter of femur, 149
Gubernaculum testis, 568
Gyri, 342-345

Hip-joint, description of, 194

articular nerves, 212

capsular ligament, 19
crucial anastomosis, 174

extensors,

Gyrus fornicatus

of brain, 4.37

description

of,

106

bones of, 106

muscles of. 111
questions on.

Humerus, description
1

systole of. 2 15

sounds

2 45

of.

246

of,

valves location of. 246

Heart ventricles of, 246
veins of, 485
weight of, 239
Head lymphatics of. 504
lymph nodes of. 505
Helix of ear, 569
Helicis major muscle, 570
minor muscles, 570
Hernia congenital, 478

causes
crural.

47

(7

of.

condyles

and

description

of.

of.

til

surfaces

of.

til

Hunter'- canal. L76

Hydatid of Morgagni, 560-563
Hymen. 556
Hyoid artery, 288
bone, 549
cornua of, 55m
, muscles of. 5511
b
Hyo-glossus muscle, 550
Hyperosmia, 365
Hypermetropia, 374
Hypochondriac, right, left. 307-309
Hypogastric, 307-309

'

arteries,

plexus,
1

127

'ircumpatellar anasti imosis,

179

82

lie!

.. .Ill 111 111

KM

loll.

nerve branches of distribution,

relations of,

126

fossa,

126

veins, 188

Uiacua muscles,
II

!l

4li'

.11

tel J

35
I'.'i

limn.

funicular, 478

bone descripl ion

femoral,

artioulati

477

Hypoglossal nerve, 417-141

notch,

474

lesser, tin

till

nutrient of, 69

lumbar, 474
phrenic, 474
encysted,

border-

Iliac ai terj

direct inguinal, 17

km;

60

of.

of greater

tleo-cecal valve,

474

indirect,

uberositj

175

of,

cerebral.

of.

Hey's amputation, 194

Hiluin of kidney. 469

121)

Hancock's amputation, 194

Hard palate, 315
Heart description of. 238-46
auricles of. 242
blood supply, 238-244
nerve, 23S-245
fibers of, 243
lymphatics of, 503
location of. 239
moderator Kami of, 242
openings in. 240
dyastole

l'.n;

blood supply, 196

nerve supply, 196
ligaments of, 194
synovial membrane

H
Hand

190

of,

Hippocampal gyrus, 345

346

operti,

12.".

f.

of.
-'7

25

\\S

lis

INDEX.

602

Internal ear blood supply, 578

auditory meatus, 577-553
carotid artery, 443

Ilium, muscles attached, L28

Qio-costalis muscle, 273
Ilio-fenidial ligament, 194

cavernous portion

Ilio-hypogastric aerve, 208

inguinal nerve, 208
tibial

petrous portion

band, 220

Impar ganglion,

of,

443

cervical portion of, 443

relations of,

123

of,

443

445

Incisura cerebelli, 354

capsule, 352

bone, 574
Inguinal hernia indirect, 174

cremasteric muscle, 567

cuneiform bone, 163
cuneiform muscle.- attached. 104
cutaneous nerve, 106

Incus

hernia indirect coverings

of,

475

Indirect route for fibers. 433

Infantile hernia. 478

Inferior cerebral veins. 4N7

ear,

cervical ganglion, 422

dental artery. 207

dental canal. 543

dental nerve, M)2

gluteal nerve, 214

laryngeal artery, 440

malleolar artery, 182

muscle, 557
longitudinal sinus, 489
lingualis

Internal

maxillary bone, 541

borders of, 541
surface- of, 541

rami

of,

542

dental canal

543

of,

570

ear nerve supply, 578

iliac artery, 172
iliac vein, 188
intercostal muscles, 458
intermuscular septum, 115-60
jugular vein, 481
lateral ligament, 62

muscles attached, 543

maxillary nerve, 399
medullary velum of brain, 441

mesentery artery. 455

mesenteric vein, 484
mesenteric plexus, 420
thyroid artery, 440
turbinated bone, 546
articulations of, 546
ossification of, 540
muscles attached, 546
oblique muscle, 538
petrosal sinuses, 490
profunda artery, 66

mammary

artery, 448

maxillary vein, 480

maxillary, 295
mammary nodes, 502
palpebral artery, 385
plantar nerve, 216
pterygoid muscle, 529
pudic artery, 173
rectus muscle. 531
sphincter ani muscle, 490
tar-al artery, 184
thoracic nerve, 99
tibial artery, 186
Intestines, 320
nerve supply, 322
blood supply of, 323-321
glands of, 321-322

lymphatics

radio-ulnar articulation, 79

of, 501
ligament, 268
Interspinales muscles, 278
Intertrans\ ersales muscle, 278

rectus muscle. 530

vena cava. 188

Ischio capsular ligament. 194

Interspinous

Iris,

rectal fossa,

172
muscle. 55

vessical artery,

Infraspinatus
Infracostal

muscle,

rectal region

of brain, 441-437
Infundibuliform fascia, 568-567
Infundibulum of heart, 241
Inguinal canal. 17."i

of.

490

muscles attached, 128

acetabulum, 131
Island of Reil, 344
Interchordse posterius, 573

175

of,

Innominate articulations.
Innominate artery. 286

2S

Jacobson's nerve, 410

Jaw, angle of, 543
.Jejunum. 32

bone. 128
vein-. 482-483

.loints, division of,

Intercostal arteries, 451

branches of, 151

-pace content- of, 451
Intercolumnar fascia. 50N-507
arteries,

Intermuscular septum of

leg,

Internal abdominal ring, 477

annular ligament
auditory artery,

494
muscles

Ischium, 127

158

Infundibulum

canal relation

386

222
148

218

25

elbuw, 61
ligaments, description
shoulder, 48

knee. 179
wrist, 78

Jugular foramen, 511, 553

ganglion, 410

of,

24

INDEX.

Leg, lymph nodes of, 499

Lenticular ganglion. U

Kakosmia, 365
Ki<lney. blood supply

columns

of, 4i i8-

'

of Bertin. 4(is

cortical substance of,

description

of,

dimensions

of,

469

4ti7

468
function of, 469
hiluni of, 469
lymphatics of, 501
medullary portion, 468
Malpighian pyramids of, 469
nerve supply of, 4tjs-47i>
pyramids of Ferrin. 468
pelvis of, 469
relations of its vessel-. 4ds
relation of, 468
<car of. 468
tubes Bellini, 470
tubes Ferrein. 470
tube- Henle. 470
uriniferous tubules of. 46S
Knee-joint, description of, 19s

Lesser internal cutaneous nerve. 106

k of

peritoneum.

Leva
mi muscles, 459
Levator anguli scapohe must
anguli ori- mus
ani muscle. 49(1
labii mferioris

muscle, 545

labii superioris proprius muscle,

palpebral mu-cl.
palati muscle,
labii superioris ala?que na-i

muse

Lieberkuhn gaud-. 32]

Ligamentous muscles of kne.
Ligament a denticulata. 333
vaginalis,

llti

Ligamentum teres, 196

mucosum, 202
patella. 198

pectinatum iridis. 380

alaria. 202
Ligaments, atlanto-axia
anterior.

blood supply. 179-19S

incorporated tendons of. 198
joint, nerve. 198

triangular. 477

flexors. 198
extensors. 198

Pourpart'-. 477
Winslowii, 198

ligaments of 198

of Zinn. 322
astragali and scaphoid, 2n4
of ankle-joint. 203

anterior annular.

Gimbernat'-.

116-221

477

acromio-claviculai

Labial nerve. 399

Labial artery. 292

broad vein

Labia majora. 562

minora. 562

crucial of at la-. 2(14

capsular.

194
coraco-humeral, 4s

Lacerations of cervix. 431-559

Lachrymal

190

of.

of bladder. 472

383

artery.

of clavicle. 38

bone. 532

-clavicular.

38
26

bone muscles attached. 532

--a. 507

external lateral. 62

gland

glenoid.

description

f(

nerve.

87

394

194

206

interosseous,

Lacuna magna
Lamina cinerea
cribrosa,

48

of hip-joint

Lacteals, 501

of.

47:-!

ischio-capsular,

of brain, 345-437-441

378

spiralis of ear.

194

194

internal lateral. 62
of liver. 324

577

of vertebra-. 258

odontoid, 264

Large deep petrosal nerve.

4(14

intestine-. 32(1-322

occipito-atlantal, 260-261

and cuboid, 206

and scaphoid, 204
os calcis and astragalus,

Larynx. 249

calcis

"- calcis

ligaments of, 250

muscle- of, 250
sinus of, 250
Lateral sinus, 189

358
ventricle boundary

ilio-femoral,

posterior annular.

16

posterioi
of radio-ulnar articulation,

ventricle.

of
of,

43s

Latissimu- dorai muscle, 52

Left cardiac vein, 485
Left innominate vein. 483
Leg. vena comites, 192
lymphatics of. 498

79

scapulav,

scaphoid, cuboid, Uuneiform,

transverse,

is

of wri-t-ji'
I.igula of brai

Lines aspera of femui

1
.

'

-'07

540-534

INDEX.

604

nerve. 402-411
Lisfranc's amputation, 194

of spleen. 501

319

Little four,

of pharynx, 505
rectum, 500
renal, 471
of scalp, 503

Lymphatics

Linea splendens, 333

Lingual artery, 290

stomach. 501
supra-hyoid, 504

Liver, description of, 324

of

blood supply of, 324

nerve supply of, 32
deep vessels, 329
lymphatics <>f. 501
ligament - of, 32

Lymphatic system, 490

of testicle, 501

thoracic wall.

502
313
500
vessels of body, 496
of

of tongue.

lobes of, 324

of

relations of, 324

328
190
Lobes of cerebellum, 344-361
f liver. 324
Lobule of ear, 569
superficial vessels

uterus,

superficial

and deep, 498

gels of,

Locus coeruleus

of brain,

443

Locomotor ataxia. 334

J. iing

thoracic artery, 6

subscapular nerve, 99
Longitudinal commissures of brain, 340-437
Longissmus dorsi muscle. _'7
extremity veins. 192

Lumbar

152

arteries,

hernia. 474

nodes, 500
plexus, 208
plexus, blood supply of, 212
region right and left. 307

ganglia of sympathetic, 428

veins. 188
Lumbricales muscles of hand, 113
muscles of foot, 162
Lungs.
nerves of, 416
roots of, 257
blood supply of, 255
nerve supply of, 256
lymphatics of, 502
!!."">

Lymph,

description

LymphaticOf

117

abdomen, 499

of

arm.

of,

of bladder. 500

of

face.

of,

.",ii

of head.

.",11

196

Of heart. 503

of intestines,
Of kidney.
of leg,

501-320-322

.",111

199

of liver,

199

of lung,

502
of mouth. 505
of neck. 504
PI7

superficial

oesophagus
..rbit.

",ii I

pan
pelvis,

199

578

gland. 564
blood supply, 564
nerve supply. 567

Manubrium. 23G
Malar bone. ."33
bone zygomatic process of, 534
bone muscles attached, 534
Male organs of generation. 564
Malpighian tuft, 469
pyramids, 469
of kidney, 468
Malleus bone, 574
Marginal gyrus, 346
Masseter muscle. 52m
Mastoid foramen. 554
antrum, 574
cells.

57t',

process, 517

Meatus auditorius internus, 553

Meat uses

'

>i

in se,

Meckel's ganglion.

551
4(14

Mediastinum description

of,

460

Mediastinal artery, 44s

pleura. 256

Median nerve, 99-101

fibers of, 360

nucleus of, 360
oblongata surfaces
Medulla veins of, 488

of,

360

Meibomian glands, 389

501

of lower extremities,

tunic.

utricularis,

Mammary

muscles supplied by, 101

Medullary portion of kidney, 468
Medulli spinal veins, 486
Medullary velum, 437
Medulla oblongata description of, 359
oblongata, 357

198

description
duct. 196

M
Macula acustica

and deep, 498

Meissner's plexus. 322

Membrane cochlea, 578

Membrana granulosa of ovary, 561
propria of ovum, 561
Membranous labyrinth of ear,
Membrana sacciformis. 119
Membrana semi-circular canal, 578

tympani blood supply, 571

tympani nerve supply, 571
tympani, 571

INDEX.
Membrana

571

tensa,

Membrane,

serous description of,

405
465

cutaneous description

of,

defiinition of,

mucous description

no;,

Muscle, adductor obliquus hallucis. 15s

obliquus pollicis, 112
111

pollicis,

465

ransA

ei

sue hallucis, 160

465
465
Meningo-rachidian veins, 486
Meningeal artery. 293

transversus pollicis,
anconeus, 87
:int itragicus, 570
aryetnoideus, -'.'._'

Mesoblast, 331
Mesentery, The 466
Mesenteric artery, 321
superior and inferior, 326

arj teno-epiglottideus,
of at hi-. 260

of.

synovial description

of,

plexus, 426
Metacarpal bones, 109

Mitral

artery,

bicep-. 5s-

brachialis anticus, 79

buccinator, 540
cervicalis ascendens,

-'7

chondro-glossus, 550
of coccyx, 134

coccygeus, 491
coniplexu-. 274
ipressor

nasi,

urethras,

539

192

urethra. 403

coraco-brachudi-. 58
corrugator cut i- ani, 190
supercilii,

cremastei

46

crico-arytenoideus, 251
thyroid, 251
crureus, 138
deltoid,

13

depressor alse nasi, 539

anguli oris, 5 15
labii inferior].-, 54

dilator uares posterior, 5 10

242

valve.

dorsal

Mons veneris, 562

Motor fibers sympathetic, 431

ear,

impulses indirect route. 435

direct route. 435
tracts of. 435
nerve,

oculi

nerve,

:;s9-368

315
lymphatics of. 505
Middle constrictor muscle, 551
Muscular accessorius, 274
Musculo cutaneous muscles supplied by, 102
spiral muscles supplied by, 103
Multifidus spinse muscle, 276
Musculi pectinati, 2 10
Muscles of abdomen, 160
abductor hallucis, 58
1

digiti,

158

digiti,

accelerator urine,
brevis,

longus.

maerous,

140
140

160-1 14

570

erector clitoridis, 493

penis,

192

spinse,

of

272

esophagus,

:;i

of. 526
extensor brevis digitorum, 157

of.

minimi
minimi

interossei,

ethmoid hone

439
paralyses of, 390

oculi

521

digastric,

Moderator band of heart. 242

addud or

Hi

biventer cervicis, 27

173

234

Mouth, ducts

24

of

asygos uvulae, 549

articulations of, 109

vesical

J~>-

of hack. 27(1

Metacarpal bones, nutrient artery of, 109

arteries, 92
Metatarsal arteries, 184
Metatarsus bones. 164
nutrient artery, 164
muscles attached, 164
Metatarso-phalangeal articulation, 206
Metencephalon, 341
Middle cerebral artery, 444
cervical ganglion. 422
commissure, 348
of brain, 348-437
cuneiform bone, 164
attachment of muscle^. 164
ear, 568-571
blood supply, 573
nerve supply, 573
hemorrhoidal artery, 172
mediastinum. 460
meningeal artery, 296
radio-ulnar articulation, 78
Midriff,

attachments
of axis, Jo

112

192
hi

pollicis,

carpi radialis ho-,

communis

digitoi

um

'.'l

longus digitorum,
longus pollicis, 91

minimi

digiti

pollicis,

52

s7

longus hallucis,

h">i

profundus digitorum
sublimis din
forced inspiratioi
expiral ion
frontal

85

278

coccygis,

iadicis,

85

ioi

carpi radialis longioi

bone
iifin in

ol
-

B5

INDEX.

606

Muscle, orbicularis palpebrarum, 508

.if orbit, 372-370-529
palate bone. 547

Muscle, gemellus inferior, ill

superior.

.544

genio-hyoideus,
byo-glossus, S

medius,

parietal

gluteus maximus,

palmar

helicis

of

273
158

female.

192

153

tertius.
of

inferior lingualis, 551

pharynx, 314
154

plantari.-.

543

of inferior maxillary bone,

plantar

inten

160

i.-ci.

platysma myoides, 545

oblique. 538

popliteus, 154
principles of, 24

530

rectus,

minor, 50
perineum, male, 491

peroneus brevis, 157

longus. 156

135

Lnfracostals,

13

pectoralis major. 41

band, L06
major. 570
minor. 570
of hyoid hone. 550
hyo-glossus, 550
,,f

ilio-costalis,

14

longus, 81
pectineus. 13s

143

gracili

iliacus,

51(1

palmaris brevis,

niininms,

bone

interossei,

infraspinatus, 55
internal cremasteric, 567

internal sphincter ani, 490

pronator radii teres, 79

quadrat us, 84
psoas magnus. 134
parvus, 134
of pubis. 129
pyramidalis, 463

intertransversales, 278

pyriformis.

intercostal-.

158

pterygoid, 529
531

rectus,

278

inter spinales,

lumhorum.

lachrymal hone. 532

minor, 514

latissimus dorsi, 52

posticus major, 278

levatores cost arum, 459

4(H)

ani.

aneuli oris, 539

54
545

inferioris,

lahii superioris alseque nasi.

proprius, 540-534

523

palate,

palpebra 529
longissimus dorsi, 27
lumbricales band,
foot.

posticus inferior, 272

135
of scapulae, 50

551
multifidus spina-. 27(i
i

Dumber

oid, 5

semimembranosus,
semitendinosus,

hone,
of.

semispinalis

.",:',_'

externus,

160

internus,

hil

s|

276

dorsi,

colli.

493

i74

stapedius, 523
51

''

digiti,

12

orbicularis oris,

ihincter vagina,

spinalis

..

omo-hyoid, 59
opponens minimi
1

hi

occipito-frontalis,

pollicis,

dorsi,

splenius capitis and

sphenoid hone, 528

obi urator externus,

occipital hone-

17

colli,

obliquus aurem, 570

oapitus superior, 278
inferior, 280

14(>

276
stylo-pharyngeus, 522
of -oft palate, 316
soleus, 153

_':;

internus,

271

superior,
sartorius,

of nasal

539

162

malar hone. 534

520
massetei
middle const ictoi
mylo-hj

minor, 278
514
abdominus, 463
femoris, 136
of rectum, 324
ret rahens aurem, 522
rhomboideus minor, 55
rot at ores spinas, 276
of sacrum. 133
serratus magnus, 54
lateralis,

anptili scapulas,
lahii

4f>4

rectus capitus amicus major, 514

of larynx, 250

levator

143

quadrat us femoris, 144

region, 490

ischio-rectal

sterno-cleido-ma&toid, 4
hyoid. 40
1

13

thyroid, 41
stylo-glossus,

540

hyoid,

522

522

272

INDIA.

Muscle, subcrureus, 138

subclavius. 4_'
subanconeus. 79

NasaJ arterj
bone, 531
muscles attached

supinator brevis, 88
longus, 84

56

subscapularis,

cresl

superior constrictor. .515

<>f superior maxillary bone, 538

-pin-. 5:;s-:,ii7

ner\

530

notch.

supraspinales, 276
supraspin&tus, 55
of temporal bone. 520
temporal. 520-508
tensor vaginae femoris, 135
teres major. 56

meatuses of, 551

Navicular bone, 163

attachment
Neck. Lymphatics
lymph node-

minor, 56

tympani, 523

Nerve abducent

523
of thorax, 457
thyro-arytenoideus, 252

5111

of,

505

210

KM

interosseus,

218

tibial,

atlas of, 264

550

264
auditory. 579
axis

152

156

of,

Vuerbach's plexus, 322

of tongue. 311

auriculo-temporal, 402
buccal. 402

trachelo-mastoid. 274

570
50

tragicu.-.

centers definition

triceps.

cervical,

triangularis sterni. 458

transversalis

colli,

transversalis,

462

45
vastus externus. 137
137

dental, 398

zygomaticus major. 535

minor. 535
extensor ossis metacarpi

desci ipl ion of, 26

roots
pollicis,

88

proprius ballucis, L52

external intercosttl 457

external cutaneous, 21
boracic, 98

plantar. 216

531
sphincter ani, 490

to lac-

pterygoid, 529

facial. 4(17

of eye. 529

398

genii o-crural,

carpi radialis,

-'1

161

it

215

to hip-joinl

13

mi

212

ilio-hypogastric

nallucis, 162

ilio-ihguinal,

278

inferior dental.

12

longus digitorum,

and joint sensation,

Musculo phrenic artery,

Mucous membrane,

in

superficial petrosal

(ligitorum. 158

auricular

sciatic,

.Si

81

brevi- minimi digiti.

pollicis,

glosso-pharyngeal,

accessorius,

ulnaris,

27

ol

dorsal, 35

rectus,

flexor

304

coccygeal plexus, 218

communicans hypoglossi, 306
cranial. 364
origin of, 364
cutaneous, 214

aurem. 570

l".i

27

circumflex, 99

trapezius.

of fern ui-.

ot.

3'

plexus,

-74

transversus perinaei, 491-492

internus,

163

392

anterior crural,

epiglottideus, 252
tibialis anticus.

of muscles,
of,

Nelaton's line. 196

Nervi-molle-. l.'l

palati.

thyro-hyoid,

507

52.-,

-lit.

tensor tarsi. 532

posticus,

552

fossae,

oblique, 530
rectus.

60*

156
133
1

maxillai

399

internal cutaneous, K 6

19

description

Myelon, 341
Mylo-hj oid muscle, 544
Myology, definition of. 17
Myopia. 374

102

gluteal, 21

of.

165

tioracic,

plantai
to

kidney,

'.

216
I7n

labial

of Lancisi

lame, deep pel rosal.

\0

608

INDEX.

Nerve,

lesser internal

cutaneous, 106

scapular. 99

Neuroretinitis, 373
Neurology, definition
Neuron system, 433

L'08

Nodes

lingual, 402-411

Song

sii'

lumbar

plexus, 208

definition of, 27
oculi,

389-368
103

musculo-spinal,
nasal, 390
obturator.

L'12

obturator accessory, 212

ophthalmic, 394
optic, 366
patellar plexus, 210
palpebral, 398
perforating cutaneous, 214
peritoneum to, 467
peroneal, 181-217
pharyngeal, 410

Obex

of brain, 443
Obliquus aurem muscle, 570

capitus superior muscle, 278

inferior muscle, 280

externus muscle, 460

internus muscle, 461
Obliterated processes vaginalis, 567
Obturator accessory nerve, 212

plexus, 315

artery,

phrenic, 306

105

thoracic, 98
tibial,

216
180

Occipital artery, 293

principles of, 26

pudendal, 214
pudic, 214
pneumogastric,

Occipito-atlantal ligaments, 260-26]

Occipital bone, 511

muscle
1

105
recurrent laryngeal, 414

sinus,

plexus, 212

vein,

214

subsartorial plexus, 212

subscapular, 99
suboccipital. 298-300
"IN

superior gluteal, 213

maxillary. 396

sympathetic, 418
temporal deep, 400
tongue of, 31
tonsillar. Ill

cen

ical,

-*

; <

* v

Nerve, trochlear, 368 391

trifacial,

:'.!_'

tubular prolongations
twelfth cranial. 117

mpanic,

HO

to ureter.

471

489
282

of,

487-481

(Esophageal artery, 449-450

(Esophagus lymphatics of, 503
nerves of, 416
Olecranon process, 75
Olfactory bulb, 347-365
foramina, 553
nerve, 439
tracts, 365-437
Olfactory tracts arachnoid of, 366
dura mater of, 366
pia mater of, 366
roots of, 365
Olivary nucleus of pons, 363
Omo-hyoid muscle, 59
Ophthalmic artery, 368-444-383
branches of, 383
ganglion, 394-403

spinal accessory, 416

r:in-\ erse

332

nerve, 394
Optic commissure. 357-366-437
foramen 368-553-52S
nerve, 366-439
lesions of, 367
radiations, 367
thalamus, 347
thalami, 352
,

visceral blanch.'- of sacral plexus,

Wrisberg, km;
Nrr\ on- system, 3
Neuroglia, 331

Neuron, 341

\0

513

Occipito-frontalis muscle, 513

Odontoid ligaments, 264

splanchnics, 423

of,

triangle,

sacro-vertebra! articulation, 280

sensory definition of, 27
small occipital, 305-301

suprascapular.

513

basilar process of, 512

lobe, 344

Sacro-iliac articulation,

sciatic,

of,

ossification

radial,

sacral

172

externus muscle, 144

foramen, 131
fascia, 495
internus muscle, 143
nerve, 212

post-auricular, 408

posterior interosseous,

popliteal,

mammary, 562

Ninth nerve, 410

Neucleus ambiguus, 410
emboliformis, 361
fastigii, 362
globosiis, 362

Meissner's plexus, 322

motor
motor

17

lymphatic,

99-101

nie.lian,

internal

of,

213

[NDEX.
Optic

tracts,

367

coverings

346

gyri.

of,

Opponens minimi

368

lobe.

muscle, 113

digiti

:;

bone muscle

muscle. 112
Orbicularis oris muscle. 540
palpebrarum muscle, 508
Orbit, description of, 368
angles of, 370
pollicis

ossification,

to-occipital

Patellar plexus, 210

ah- major muscle,

minor muscle, II

Pectineus muscle,
:^
Peduncles of cerebellum, 362
I

brain.

.;:.

258
Pelvis.

131

dimensions

of.

i:;i

Pelvic fascia, 195

Pelvis female. L32

Perforating cutaneous nerve, 211

Peni-.
bl

supply, 566

dartos

565

a, 565
corpus spongiosum, 565
Penis nerve supplj 566
.

Perineum
central tendon of, 195
fascia of,

19

muscles of female,
of male.

met ure-

-i

4<I2

l!l|

195

iii.

triangular ligament

Paricardium,
of.

510

fissun

Paroophoroi
Parosmia, 365

veins. 190

description

Mo

of,

Parietal bone, nutrienl artery of, 500

bones of, 368

boundaries of, 370
foramina of, 369
floor of, 369
lymphatics of, 504
muscles of, 372-376
Organ of corti, 577
generation male, 564
hearing, 568
Os calis bone, 162
Os calcis. attachment of muscles, 162
Osmatic animals, 365
Osteology, definition of, 17
Otic ganglion, 405
Ovaries, 560
Ovary, blood supply of, 561
nerve supply of, 561
corpus luteum of, 561
coats of, 561
Graafian follicles of, .561
ligaments of, 560
location of, 562
normal position of, 561
stroma of. .~>t;i
Ovarian arteries. 457

Ovum,

609

561

Pericardiac arterj

Peroneal

of,

495

238
18-450

artery,

186

Peroneu- brevis muscle, 157

longus muscle, 156
Peroneal nei e, 217-181

Palate bone, 538-547

borders of, 548

Peroneus ten

surfaces of, 548

in- muscle, L53

isteum fund ion of, 19
Peripheral system
Peril

muscles attached, 549

Peritoneum

nutrient artery, 549

articulation of, 549

Palmaris brevis muscle, 113

Palmar fascia, 116

Palmar

muscles,

arteries,

Palpebral

398

nerve,

Pampiniform plexus,
Pancreas 326

95

190

porl ion

laj ei

tempi

'

165

ered bj
ol

165

no
n al

bone, 517

Peyer's patches, 320

Phalanges bones attachmenl

.

nut rient

153

arterj

164

Pharynx, 313
boundari

373
Paradidymis, 568

Papillitis.

246

Pa>ietal bone, articulation of, 510

description

isceral

ei

<-<>\

artery, 453

goitre,

net urea

Pel on- ganglion,

Papillae of tongue, 31

Parenchymatous

166
166

parietal laj
-t

blood supply of, 326

nerve supply of, 326
lymphatic- of, 326
Pancreatica' parvae arterj

of, 4i>7

ligaments formed by, 466

nerve supplj of, Pi?

81

Palmar recurrent

magna

....

14

supply

interossci arteries, HI

Palmaris longus muscles,

bl

description of, 165

fund ions of, 166

of, olid

f,
313
openings in
'hi ynx, blood supply,
in
e supp
i

-,

lymphat

ii

muscles

of. 31

.'(15

of

muaclaa

164

INDEX.

610
Pharyngeal nerve, 410
nerve of vagus,
plexus,

';!

Posterior interosseous nerve, 105

II

ethmoidal artery, 384

ethmoidal foramen, 553
interosseous artery, 95

tonsil, 313
Phrenic artery of aorta, 452

Pharygneal
artery,

Posterior external jugular vein, 481

ligament, 62

L8

mediastinum, 460

174

hernia,

306

nerve,

mediastinal arteries, 450

nodes, 502
nerve root, 333
perforating arteries, 186
perforated space of brain, 441
10
scapula artery,

125

plexus,

vein-. 190
l'ia

mater

of brain, 34

333
380
Pineal gland, 353
Pinna "f ear, 569
Pirogoff's amputation, 194
of cord,

Pillar- of

iri-.

Placenta, 3

spinal arteries.
tibial artery,

relation of,

Plantar digital artery, 184

Plantar fascia, 223

l'lai

vein.

154

interossei muscle, Hiit

Pouch

ysma mj

Poupart

Plexus
cei

oides muscle, 5 15

bi achial, 3
\

coccygeal, 35
definition of,

'!

-anal. 35
Pleura. 256
nerve supply

blood supply

256
256

of,
of,

Pneumogastric accessorj
connect tons

part.

412

111

of,

di-t ribul ion of,

left

Ill

nerve. 111-41

cardiac branches,

16

pulmonary branches,
right,

L6

412

Pocularis sinus,

17:'.

Pons, 362
construction

of, 363
363
nei \ e- of, 363
varolii, 357-362-437

of,

Pudendal nerve, 214

Pulmonary artery, 284

180

L92-180
Portal system, 326- is
vein, 324 is:, mo
Po tei
annulai Ligament

nerves,

'i

cai pal

nei

16

408

e,

l'upillo-dilator fibers, 431

artery,

ein,

l*>

communicat ing

Pyramids

circumflex arterj

65

arterj

commissure, 348
ci

indj

I'

id

153

glands, 318

is.'i

cerebral artery,

commissure

2 16

Pyloric, 318

181

110

Pulsating goitre.
Pulvinar, 352

art<

cardiac

fissure,

muscles of, 129

attached. 128
lie! \ e. 214

vein,

vein,

563
Presbyopia, 375
Prevertebral plexus of symphatic, 123
Princeps pollicis artery, 93
Processus-e-cerebello-ad-te-te-. 354-437
cochleariformis, 520
Profunda artery, 176-180
femora] artery branches of. 178
artery perforating branches of. 180
Pronator quadratus muscle. 84
radii teres muscle, 79
Prosencephalon, 341
Prostate gland. 5IJ4-474
Prostat ie sinus, 473
Pseudocele, 358
Psoas magnus muscle, 134
parvus muscle. 134
Pterygoid artery, 297
processes, 528

bone. 128-127

Popliteus muscle, 154

am iculai

477

clitoridis,

Pubic artery, 176

Popliteal artery, 17(1-180

i'

558

ligament

palatine artery, 298

veins of, 188

space,

's

Pterygo-maxillary

cru;- cerebri,

branches

of Douglas,

Preputium

35

Leal,

MIL'

recurrent artery, 782

ulna reeurre.
artel \
95

161

muscle,

Plantaris

186

thoracic nerve, 98
tibial nerve, 216

Plate,

Y-'<7

180-185

of brain, -;is

foramen, 55

137

of
errein, 468
Pyramidalis muscle, 463
Pyramidal tracts. 334
Idier- of, 435
Pyriformis muscle,
13
I

555

INDEX,

Right innominate coronary vein.

Rivinian foramen, .">7

Quadratus femoris muscle. 144

Quadrate gyrus, 346
Quadratus lumborum muscle,

duel

Rhinencephaion, 34J
Rhomboideus minor mulungs, 257
res spins
Roux's amputation, 194
Ruga of stomach
Rule oi

164

Quadrilateral space, 77
Question review. 120

lower extremities. 224

Radial nerve,

611

10.5

artery relations

of, 95
branches of, 92
muscular branches of, 92-95

Saccule if
Sacral groove, 132
sympathetii

recurrent artery, 92
region forearm. <>9

plexus, 213

Radialis indicis artery. 94

Radius description

of,

plexus vi-ceral branch.

72

Sacro-vertebral articulation,
.Sacrum. 132

of, 72
muscles attached. 75
perimeter of, 73
Radio-ulnar articulation. 79
blood supply of, 79
nerve supply of, 79
Ramus of ischium. 130
Ranine artery, 291
Receptaculum chyli, 497
Recto-vesical fascia, 495

borders

base

133

ate,

muscles attached, 133

ossification of, 133
Salivary center,
glands,
parotid, 579
submaxillary.

anticu- major muscle, 514

minor muscle, 514

muscle.

132

of,

articulation. 133

Rectus capitis posticus major muscle, 278

minor muscle. 27s

lateralis

,~>su

580
Saphenous opening, 220
sublingual,

veins. 192

Sartorius muscles,

135

Scapula description

514

abdominis muscle, 163

articulation

of.

Is
ligament- o
muscles of, 50
Scalp lympha
Scarpa'- foramina, 538
Scarpa'- triangle, 176

femoris muscle, 136

Rectum, 320
of, 324
muscles of, 324
lymphatic- of, 500
Recurrent laryngeal nerve. 414
Keflex impulses. 437
Refracting media of eye, 378
Renal arteries, 456
lymphatic-. 17!
plexus, 425

description

membrane

Schneiderian
Sciatic

artery,

Sclerotic coat

17

of

Scrotum. 568
Second ner\
Segment- of cord

258
258
Restiform body, 360
liber- of, 364
Respiratory center, 359

Semicircular canal of

Reticula of spinal cord, 333

Semi-pinali-

air,

Semilunar

e air,

layers

endinosis muscle,

Sen- iry,

378

colli

Retinal hyperesthesia, 374

Septum lucidun

Retrobulbar neuritis, 37.'')

Retrahens aurem muscle 322

-.

Review

iiuesiionb, lowei

muscll

muscle, 276
council

impulses, routi

"i

extremity, 22

upper exl remity, 120

Rib, firsl and second, 270
descripti m of, 268
Right Innominate vein, 182

p..-l

icu- SU|

i.s

muscle* af
Se\ enl

200

241

Semimembranosus muscle,

dor-i
of,

fibro-cartilages,

valves,

Retina, 376
description

376

description of

veins, 190

Residua]

15

Is

of.

16

17

INDEX.

612

Spinal canal, 133

membrane, 571

Sharpnell's

column fractures
veins of, 486

18
Shoulder join!
ligaments
1)1
supply of, 18
net \ e supply nf, 48
Small meningeal arterj 297
occipital nerve, 301-305
.

diseases of, 334

ascending fibers of, 335

descending fibers, 335
blood supply, 336
enlargements of, 330
fissures of, 335
gray matter of, 336
membranes of, 332
Begments of, 337
veins of, 486
white matter of, 330
Spinal nerve first, 298
Spinalis dorsi muscle, 274
Spinous process of vertebra;, 258
Spiral canal of car. 578
Splanchnology definition of, 17
Splanchnic nerve greater, 423

nen

sciatic

21

e,

36

of,

diseases of, 365

Sinus, definition of, 17
189
nous,
189

circular,

Sinuses of dura mater, 488

489

inferior longitudinal,

petrosal 490
189

!.

Sinus of larj ax, 250

of Morgagni, 31 5

489

occipital,

rhomboidalis, 33
-upei

ii

petrosal,

Spleen, 248

udinal, 4SX

relations of, 248

189

blood supply of, 248

nerve supply of, 248
dimensions of, 24S
lymphatics of, 501
Splenic artery, 327-453

torcular Herophili, 489

490
valsalva of, 242
Sigmoid artery, 455
gyrus, 346
flexure, 320
Sixth nerve, 392
Skej '- amputation, 19
Skin of back, 280
Skull, base foramina of, 552
Sofl palate, 315
transverse,

plexus, 125
Splenic vein, 484

Splenius capiti: muscle, 272

colli muscle, 272

muscles
Solar plexus,

function

Stapes bone, 574

Stapedius muscle. 523

Steno s duct 315

Stenson foramina, 538
Stephanion, 555
Sterno-pericardial, 238

3] 6

of,

I-

123

lesser,

lmiirit

ii

489

straight,

of.

334

Spinal cord, 330

Smell, center

of,

131

Solitary gland, 321

Soleus muscle, L53

clavicular articulation, 38

Sounds

cleido-mastoid muscle, 40
hyoid muscle. 4

246
matic artery. 576-456
cord, 566
of hear;.

plexus,

thyroid muscie,
sternal

125

muscles attached, 237

Stomach, 318
blood supply of, 318
nerve supply of, 318
muscles of, 318
relations of, 319
glands of, 318
lymphatics of, 501
Stroma of ovary, 561

Straight

<

pterygoid processes
tin lunate,

nei ve,

sinus,

189

Strangulated hernia, 175

Structures of heart, 243
Styloglossus muscle, 51':'

528

bom

wings of, 527

Sphincter vagina muscle,
Spina bifida
Spina] accessor}

of,

11

448

Sternum, 236

veins, 576-190
Spheno-maxillary artery, 297
fossa, 555
B
lire
555
Spheno palat tne artery, 298
branches of, 297
Sphenoidal fissure, 553 528
Sphenoid bone, 526
nutrient ai terj of, 529
if, 527
foi amina
ii s of, 528
lessei wings of, 528
muscles ai tached, 528
orbital surface of, 527
t i

arteries,

193

H 6-441

muscle, 522
pharyngeus muscle, 522
Styloid process, 519
Subanconeus muscle, 79
Subarachnoid spaces, 335
Subastragaloid amputation, 194

hyoid

[NDEX.
Subscapular nerve-. 99
Subclavian artery, 4-1.5
relations of 44t>vein,

613
mesentery artery, 454
nteric

484

vein,

plexus
oblique muscle.

17

482

282
Subcrureus muscle, 138
Subdural space. 332
Subflava ligament, 266
Submaxillary ganglion, 405
Submaxillary triangle, 282
Submental artery. 292
Suboccipital nerve, 300-298
triangle. 282
Subclaviu> muscle, 12
Subscapular^ muscle, 56
Subscapular artery. 65
Subsartorial plexus, 212
Substantia gelatinosa rolandi, 330
Sulci. 342-343
Suprahyoid lymphatics. 504
Suprarenal artery. 456
capsules. 248
blood supply of, 248
nerve supply of. 249
vein. 190
Suspensory ligament of ovary, 561
Superficiali< volae artery. 92
Suprascapular artery, 449
nerve, 98
Supraorbital artery, 384
nerve. 394
notch. 372-506
vein, 487-480
Suprarenal plexus.
Supratrochlear nerve 394

perforating arte

triangle,

Superficial circumflex iliac artery

petrosal

sinus,

189

profunda artery, 66
radio ulnar articulation, 7^
rectus

in

thoracic artery, 62

thyroid artery, 288

vena
artery

vesica]

Supinator brevis

17_'

sv

muscle,

longus muSupraspinous ligament

Supraspinatus muscle, 55
Supraspinales muscle, Sura'

182

arteries,

Suspensory Ligament
Sylvian fis-ure. 343

Syme

amputate

378

'94

".

neM

-'ympathetic

e\e

ol

ll

acceleratore to lieart. 431

region, 420

cervical

dorsal, 420

lumbar, 420
120

sacral,

development
gross

of,

anatomy

12

431

of,

lumbar, 423
lumbar, 423
sacral, 423

motor
178

Superficial cervical artery. 449

143

libers to eye.

thoracic ganglia,

Synarthrosis divisions

Syndesmology

!-'_'

25

of,

definition of, 17

membrane

descending artery. 288

Synovia]

external pudic artery, 178

Systole of heart. 245

description

of,

405

epigastric artery. 178

femoral artery 176

lymphatic vessels. 498
palmar arch. 96
temporal artery. 29
Superior maxillary nerve, 396
1

of,

421

constrictor muscle, 515

external angle of orbit, 370
epigastric artery, 449
fibular

182

artery,

pr<

of

lachrymal

-'

arcuatus. 194
valgus, I'M
varus, 194
equinus, 194

310

488
nerves

maxillary bone, 535

antrum

reeth, descirption of, 309

laryngeal artery, 288

areolar

l!

Tarsus, metatarsus joints, 206

joints, ligament - of, 20

hemorrhoidal artery, 456

intercostal artery, 449

sinus,

of.

194

plantus, 194
Tarsal plate- of li

gluteal nerve, 213

longitudinal

Bemicircularis, 356-352

Talepes description
calcaueous,

cervical ganglion. 421

branches

Taenia semicircularis of brain, 350-437

Tegmenl um

Highmore, 537
groove,

537

surfaces of, 537

palate proce-> of, 53S

muscles attached, 538

mediastinum, 460

of,

:>b>

of

pon

najor muscli
Tela choroide
inferior of brain,

ro-maxillarj vein,

sphenoidal
lobe, 344

fissure,

s"

INDEX.

614

Tibia, attachment of muscles, 168

Temporal artery deep, 297

articulation of, 520

auditory meatus
surface,

inferior

muscles of, 520

mastoid process

517

of,

Tidal air of lungs, 258

519

Tongue nerves
of,

511

nutrient artery of, 520

processus cochleariformis, 520

process of. 519
petrous portion, 517

zygomatic process, 516

Temporal

554
muscle, 520-508
nerves ileep, 400
ridges, 507
veins. 4S7-4S0
Tendino-trochanteric band,
Tendon, definition of. 17

196

532

tympani muscle, 523

vagina- fenioris muscle, 135
Testicle-.

of,

lymph

567

lobules of, 568

lymphatics of. 501

Thalamencephalon. 341
The mesentery, 466

Thigh superficial fascia, 218

Third nerve, 390
ventricle, 358
boundaries of, 437
Thoracic aorta. 451
branches of. 450
duct, 496
coats of, 497
relation of, 497
ganglia sympathetic, 422
wall lymphatic of, 512
Throat, 316
Thorax, description of, 232
muscles of, 457
openings of, 232
Thorax structures passing through superior opening, 232
Thymic vessels. 503
Thymus gland, 248
blood supply, 248
nerve supply, 248
Thyroid gland, 246
diseases of, 246
blood supply of. _'17
nerve supply of, 247
Thyroid axis. 449
Thyro-arytenoid ligament, 250
arytenoideus muscle, 252
epiglottideus muscle, 252
hyoid muscle, 550
Tibia, bone, 166
nutrient artery, 168

311

of.

of.

papilla?,

311

311

vessels of, 313

blood supply

of,

Tonsils description
artery,

nerve,

Tenth nerve. 41
Tentorium cerebelli, 360
Tensor palati muscle, 523
tarsi muscle,

Tongue, 311
muscles

Tonsillar

gyri,

fossa,

567
covering;

anticus muscle, 152

posticus muscle, 156
Tibio-fibular joint superior. 202

Tibialis

bone, 51b

of,

313
315

291

411

Torcular Herophili, 489

Trachea. 254
blood supply of. 254
nerve supply of, 254
Tracheal artery, 449
Tracts of cord. 433
Tragicus muscle, 570

Tragus of ear 570

Trachelo-mastoid muscle, 274
Tranquil inspiration, 236
Trapezius muscle. 45
Transversalis colli artery. 449
Transversalis colli muscle. 274
muscle, 462

Transversus aurem muscle. 570

perimei muscle, 491-492
Transverse aorta, 284
commissure of brain, 437-339
cervical nerve, 306
fissure of brain, 343
ligament, 196
of atlas. 262
process of vertebra?. 258
-inus, 490
Triangles of neck, 280
Triangularis sterni muscle, 458
Triangular ligament. 494-477
Triceps muscle, 50
Tricuspid valve of heart. 241
Trigonum hypoglossi of brain. 443
Trifacial nerve, 392-439
Trochlear nerve. 391-439-368
Trophic centers, 334
Tuber annulare, 347
cinereum of brain, 441
Tubercle of Lower, 240
Tubercula quadrigemina, 347
Tuberosity of rib, 268
Tubes of Ferrein, 470
Turbinated bones sphenoidal, 528
Turbinated processes of ethmoid bone, 525
Tubo-ovarian, 561
Tubuli seminiferi. 568
Tuberculum acusticum of brain, 443
Tunica fibrosa of ovary. 561
propria of ovary, 561
vaginalis, 567
Twelfth cranial nerve, 417
Tympanic artery. 295
membrane, 571

INDEX.
Tympanic

lil/i

nerve, 410

walls

of,

573

interim-

muscle,

137

Velum interpositum,
Vena azygos ma joi 183

:;.">l

u
Ulnar artery, 95
branches of, 95
relations of, 96
nerve muscles supplied by, 102
Ulna, description of, 75
anterior posterior borders of, 76
muscles of, 77
nutrient artery of, 77
olecranon process of, 75

Umbilical arteries, 472

hernia, 475
coverings of, 478
regions, 309
veins, 472
Umbo of tympani, 571
Uncinate gyrus, 346
Urachus, 471
Ureter description of, 471
blood supply of, 471
nerve supply of. 471
Urethra, coats of, 473
description of, 472
divisions of, 473

female, 474

minor,

1M

tertius,

184

Venae basis \ ertebrarun

Vena cava inferior, 188
superior, 483
Venae comil es leg, 192

i^

Galeni,

Thebesii, 245 l6

Ventricle of brain, 3 10
descripti

f,
357
358
Ventricularis terminales
Vermiform appendix, ;'._'_'
Vermis of cerebellum, 355

number

of,

Vertebra?, description
cervical,

258

coccygeal, 258
dorsal, 258
lumbar, 258
sacral, 258

peculiarities of, 259

Vertebral artery. 447
supply
column hi
nerve supply of, 339
ligament- of, 266
1

vein. 481

Urinary system organs of, 469

Uriniferous tubules, 468

Vesiculse seminales

Uterine artery, 174

Uterus, 557
dimensions of, 558
fundus of, 558
ligaments of, 558-559
os, 558
blood supply of, 559
coats of, 559
nerve supply of, 559
lymphatics of, 500
Utricle of ear, 577
Uvula vesica, 472

Vestibule

Vessels

if

of

567

190

liver,

577

ear,

Vestigial fold of Marshall,

238

Veins of abdomen, 186

angular, 480
anterior cardiac, 486
jugular,

181

192

tibial,

118-482

axillary.

188

basilar,

of

broad Ligament

bronchial.

Is

cardiac, 2

190

488

cerebellar,

187

cerebral,

Vagina, 556
blood supply of 557
Vaginal coats of, 557
Vagus nerve, 411
Vallecula, 361
Valvular conniventes, 321
Valves of heart, 241
location, 246
of Vieussens of brain, 441
Vasa aberrant ia, 69
l.n\ ia, 453
efferentia, 568
intestini tenuis, 454
motor center, 359
fibers to head, 431
Vas aberrans, 567
deferans, 566
Vastus extemus muscle, 137

of,

_'.">s

Venae corporis striati, 188

choroidea, 188
coat- of, 30
coronary sinus, 186
185

cystic,

Veins deep.

IIS

cervical,

description

182
of,

30

desci n" i""

187

diploe,

of

dorsi

186

spinal,

dura mater, 180

emissarj
187
in ii ioi head and
of

external

iliac,
.

facial,

Is

160

femoral,
frontal

187

180

186

INDEX.

616
Veins, gastric, 484
great cardiac,

Veins, vense basis vertebrarum, 48'

Galeni, 488

485

Thebesii, 486

of heart, 485

vertebral, 481

hepatic, 190
iliac,

188

inferior

Villi,

mesenteric.

In

innominate, 482-483
internal jugular, 481
iliac, 188
mn.Tri1lB.ry, 480
left cardiac, 485
lower extremity, 192
lumbar, 188
of medulla, 488
medulli spinal, 486

meningo rachidian,
occipital,

320

Visceral branches sacral plexus, 21;

Viscus description of, 309

cerebral, 487

Vital capacity of lungs, 258

Vitreous humor, 376
Vicq'cl azyr fibers of, 349
Vocal cords, 250
Vomer bone, 54(5
muscle attached, 547

nutrient artery, 547

lsc>

Wharton's duct, 315

White line of perineum, 495
rami communicant es, 429-423
Wirsung's duct, 326
Wolffian body, 564

487-481

ovarian, 190
phrenic, 190

488
180-192
portal, 324-190-485

of pun.-,

popliteal,

Worm

posterior auricular, 481

cardiac, 485

92
ligaments of, 78
nerve supply of, 78
synovial membrane of, 119
arteries of,

192
external jugular, 481
pulmonary, 30
renal, 190
right coronary, 486
saphenous, 192
subclavian, 482
spermatic, 190-567
tibial,

of spinal

of cerebellum, 361

Wrist-joint, 78
joint

Xiphoid appendix, 237

cord, 486

column, 486
484

-picnic,

Y-ligament, 194

superior mesenteric, 484

superficial, 117

Yellow

(macula lutea),
Yellow spot of ovary, 561

temporo-maxillary, 480
temporal, 480-487
umbilical, 472-34
Veins, valves of, 32

(corpus luteum),

inferior, 34

azygos major, 483

minor, 484

vena cava superior, 483

vena'

corporis

choroidea, 488

250

spot of retina, 387

suprarenal, 190
systemic, 30

vena cava

cartilage,

eastic tissue, 26-561

supraorbital, 487-480

striati.

INN

Zygomatic fossa, 555

Zygmaticus major muscle, 535
minor muscle, 535
Zygomatic process temporal bone, 516
proce.-s, 534

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