MANUAL AND ATLAS 
 OF DISSECTION 
 
 - 
 
 314 ILLUSTRATIONS 
 
MEDICAL >SCH<S>L 
 
 Gift of 
 
 Panama- Pacific 
 Intern '1 Exposition Go 
 
A MANUAL AND ATLAS 
 
 OF 
 
 DISSECTION 
 
 BY 
 
 SIMON MENNO YUTZY, M.D. 
 
 INSTRUCTOR IN OSTEOLOGY AND DEMONSTRATOR OF ANATOMY IN THK VNIYERSJTY OP MICHIGAN 
 
 tUitb 314 Illustrations 
 
 WITH AN INTRODUCTION 
 
 BY 
 
 J. PLAYFAIR MCMURRICH, A.M., PH.D. 
 
 PHILADELPHIA 
 
 P. BLAKISTON'S SON & CO. 
 
 IOI2 WALNUT STREET 
 
COPYRIGHT, 1906, BY P. BLAKISTON'S SON & Co. 
 
 PRESS OF 
 
 WM. F. FELL COMPANY 
 220-24 SANSOM STREE 
 
cm 35 
 
 
 PREFACE 
 
 The objects of this outline are to direct the student in his work in 
 dissection, and to give a method of isolating the various structures with 
 system and order. The work is divided into demonstrations. This means 
 that a certain region, or regions called a demonstration, is to be dissected 
 out and carefully studied by the student, and then the dissection inspected 
 by a quiz master, the student quizzed and made to demonstrate the struc- 
 tures before going on to the dissection of another region. 
 
 The figures in this outline are principally taken from Moms' and Hoi- 
 den's "Anatomy," and will serve to give valuable suggestions. 
 
 < 
 
INTRODUCTION 
 
 For students attempting to use in connection with their laboratory work 
 any of the popular text-books of Descriptive Anatomy, some sort of guide 
 is necessary. There is, always a danger that such a guide may become to 
 the student the sole source of his information, which may thereby become 
 superficial and imperfect. This difficulty may be avoided in two ways: 
 either by making the guide so comprehensive that it becomes a text-book 
 of Topographic Anatomy, or by reducing it to the status of a topograph- 
 ical index. 
 
 In the present volume the latter plan has been adopted. The student 
 obtains from it only a list of the structures w r hich he should find and study 
 during his dissection of any part of the body, together with some concise 
 directions as to how he should proceed with his dissection ; for a description 
 of the structures he must necessarily turn to his text-book. The dangers 
 of the quiz-compend are thus avoided; indeed, the guide may serve as an 
 excellent quiz-master in supplying the student with topics concerning 
 whose relations he may test his knowledge. The numerous illustrations 
 will but serve to increase the efficiency of the volume in both these respects. 
 
 The long experience of my colleague, Dr. Yutzy, as a successful teacher 
 of Anatomy is a guarantee for the carefulness and thoroughness with which 
 the book has been planned, and the satisfactory results which have fol- 
 lowed the use of similar guides in the Anatomical Laboratory of the Uni- 
 versity of Michigan awaken the hope that it may prove equally satisfactory 
 in a larger field. 
 
 J. PLAYFAIR McMuRRicn. 
 
 P. Blaiuton's Soa Co, 
 
CONTENTS 
 
 PART I HEAD, iNECK, THORAX, THORACIC VISCERA, 
 AND UPPER EXTREMITIES 
 
 PAGE 
 
 Demonstration I i 
 
 Surface Anatomy of Cranial Region. 
 
 Demonstration II 3 
 
 The Head. 
 Auricular Region. 
 
 Demonstration III 6 
 
 Face. 
 
 External Palpebral Region. 
 
 Nasal Region. 
 
 Superior, Inferior, and Inter-maxillary Region. 
 
 Demonstration IV 12 
 
 Skull. 
 
 Internal Orbital Region. 
 
 The Eye. 
 
 Demonstration V 20 
 
 The Neck. 
 
 Triangles of the Neck. 
 
 Demonstration VI 24 
 
 Anterior Triangles of the Neck. 
 Thyroid Gland. 
 Submaxillary Triangle. 
 
 Demonstration VII 33 
 
 Temporo- and Pterygo-maxillary Region. 
 
 Demonstration VIII 40 
 
 Deep Dissection of the Neck. 
 
 Demonstration IX .... 42 
 
 Anterior Vertebral Region. 
 
 Pharynx. 
 
 Palate. 
 
 Tonsils. 
 
 Mouth. 
 
 Teeth. 
 
 Tongue. 
 
 Larynx. 
 
 ix 
 
x CONTENTS 
 
 PAGE 
 
 Demonstration X 56 
 
 Supra-maxillary Region. 
 
 Nose. 
 
 Ear. 
 Demonstration XI 60 
 
 Back. 
 
 Suboccipital Triangle. 
 Demonstration XII , 68 
 
 Pectoral and Axillary Region. 
 Demonstration XIII 75 
 
 Thorax and Thoracic Viscera. 
 
 Heart. 
 
 Lungs. 
 Demonstration XIV . 85 
 
 Shoulder and Arm. 
 
 Brachial Plexus. 
 
 Demonstration XV 95 
 
 Forearm, Wrist, and Hand. 
 
 Anastomoses of Arteries of Upper Extremities. 
 
 Demonstration XVI 113 
 
 Articulations and Ligaments. 
 
 Cutaneous Nerves. 
 
 Sections of the Body and Extremities. 
 
 PART II ABDOMEN, ABDOMINAL VISCERA, PELVIS, PELVIC 
 VISCERA, AND LOWER EXTREMITIES 
 
 Demonstration I 133 
 
 Surface Anatomy of Abdomen. 
 Demonstration II 135 
 
 Abdominal Walls. 
 
 Demonstration III 141 
 
 Abdominal Cavity. 
 Contents of Abdomen. 
 Peritoneum. 
 Mesenteric Arteries. 
 
 Demonstration IV 151 
 
 Removal of Abdominal Viscera. 
 
 Small Intestines. 
 
 Large Intestines. 
 
 Stomach. 
 
 Duodenum and Pancreas. 
 
 Spleen. 
 
COX TEXTS xi 
 
 PACE 
 
 Demonstration V J 59 
 
 Liver. 
 
 Kidney and Suprarenal Body. 
 Demonstration VI ... 164 
 
 Structures on Posterior Wall of Abdomen. 
 
 Solar Plexus. 
 
 Lumbar Plexus. 
 Demonstration VII ... .... 171 
 
 Pelvic Region. 
 
 Demonstration VIII . J?3 
 
 Perineum. 
 Male Perineum. 
 Pelvic Fascia. 
 Female Perineum. 
 
 Demonstration IX 186 
 
 Pelvic Viscera. 
 
 Rectum. 
 
 Male Reproductive Organs. 
 
 Female Reproductive Organs. 
 
 Demonstration X ... 194 
 
 Cavity of Pelvis. 
 Sacral Plexus. 
 Sympathetic Nerves. 
 
 Demonstration XI ... 199 
 
 Gluteal Region. 
 Demonstration XII - 205 
 
 Anterior Femoral Region. 
 
 Internal Femoral Region. 
 Demonstration XIII - 215 
 
 Popliteal Space. 
 
 Posterior Femoral Region. 
 
 Demonstration XIV 219 
 
 Anterior Tibio-Fibular Region. 
 
 Demonstration XV 225 
 
 Posterior Tibio-Fibular Region. 
 
 Plantar Region. 
 
 Anastomoses of Arteries of Lower Extremities. 
 
 Demonstration XVI 239 
 
 Articulations and Ligaments. 
 Sections of the Body and Extremities. 
 
PART 
 
 HEAD, NECK, THORAX, THORACIC VISCERA, AND UPPER 
 
 EXTREMITIES 
 
GENERAL REMARKS TO THE STUDENT 
 
 It will add much to the comfort of all in the dissecting-room if each 
 student sees that his material, table; and floor about the table are kept 
 clean. 
 
 Do no cutting before you have familiarized yourself with the region 
 upon which you are working. Read the descriptive anatomy in your text- 
 books and examine the figures of the parts about to be dissected. Identify 
 the landmarks and the relations they bear in position to the deeper struc- 
 tures. 
 
 Then carefully work out each structure, studying each part fully as 
 it is exposed, noting its appearance and position in relation to other parts. 
 
 Clean muscles, noting their form, origin, insertion, action, and innerva- 
 tion. Remove the tissue from blood-vessels and nerves, and trace their 
 branches as far as possible. 
 
 When a region is fully dissected out review frequently and carefully 
 the dissection on the cadaver, observing each part in its proper position 
 and its relation to surrounding parts. Learn to observe intelligently what 
 you see. Observation, examination, and analysis are important qualities 
 to the successful study and practice of medicine, and the earlier the habit 
 of accuracy in these qualities is formed, the greater the success. 
 
 Each student should make a drawing of his dissection. 
 
 xvi 
 
MANUAL AND ATLAS OF DISSECTION. 
 
 DEMONSTRATION I. 
 
 CRANIAL REGION 
 
 Shave the head. 
 
 Surface anatomy : 
 
 Identify the following bony landmarks: Xasion, glabella, inion, 
 
 bregma, lambda, frontal eminence, parietal eminence, zygomatic arch, tem- 
 poral ridge, supra-orbital arch, supra-orbital notch or foramen. 
 
GENERAL REMARKS TO THE STUDENT 
 
 It will add much to the comfort of all in the dissecting-room if each 
 student sees that his material, table/ and floor about the table are kept 
 clean. 
 
 up< 
 bo( 
 the ERRATA. 
 
 tui 
 
 Page 48, under muscles of tongue, read " Extrinsic. (See Fig. 55)" 
 
 instead of Fig. 60. 
 it l 
 
 Page 48, under muscles of tongue, read "Intrinsic. (See Fig. 55)" 
 , instead of Fig. 60. 
 
 br Pa S e 6 9> twelfth line from bottom, read " Figs. 95, 99, 100 " instead 
 
 of Figs. 94, 98, 100. 
 
 the 
 an< 
 
 yoi , 
 
 to the successful study and practice of medicine, and the earlier the habit 
 of accuracy in these qualities is formed, the greater the success. 
 Each student should make a drawing of his dissection. 
 
 xvi 
 
MANUAL AND ATLAS OF DISSECTION. 
 
 DEMONSTRATION I. 
 
 CRANIAL REGION 
 
 Shave the head. 
 
 Surface anatomy : 
 
 Identify the following bony landmarks: Xasion, glabella, inion, 
 
 FIG. i. THE SKULL. (Morris.) 
 
 BREGMA 
 
 GLABELLA NASIO 
 
 bregma, lambda, frontal eminence, parietal eminence, zygomatic arch, tem- 
 poral ridge, supra-orbital arch, supra-orbital notch or foramen. 
 
2 THE HEAD 
 
 With coloured pencil or crayon outline the arteries of the head and face. 
 Also outline veins of head and neck. (See Fig. 5.) 
 
 FIG. 2. BRANCHES OF THE EXTERNAL CAROTID ARTERY. (Holden,} 
 
 r. External carotid. 2. Lingual. 3. Facial. 4. Inferior labial. 5. Inferior coronary. 
 6. Superior coronary. 7. Lateral nasal. 8. Angular. 9. Superior thyroid. 10 and 
 16. Occipital, ir. Posterior auricular. 12. Anterior auricular. 13. Internal maxil- 
 lary. 14. Transverse facial. 15. Middle temporal. 17. Anterior temporal. 18. 
 Posterior temporal. 19. Supra -orbital. 20. Frontal. 
 
 Also outline superficial nerves of head and neck. (See Figs. 3 and 4.) 
 Describe muscle, tendon, aponeurosis, superficial and deep fasciae. 
 
THE HEAD 
 
 DEMONSTRATION II. 
 
 Dissection. Make a vertical incision through the skin only, from the 
 root of the nose to the external occipital protuberance. Make a second inci- 
 sion horizontally along the forehead and around the side of the head, from 
 the anterior to the posterior extremity of the first incision. 
 
 Remove the skin with great care so as not to remove the blood-vessels 
 and nerves lying in the superficial fascia. 
 Study the skin of the scalp. 
 Study the fascia of the scalp. 
 
 Dissect out and study the following nerves and blood-vessels: 
 Nerves (see Figs. 3 and 4): 
 Frontal. 
 
 Supra -orbital. FlG - 
 
 Supratroch- 
 
 lear. 
 Auriculo-t e m - 
 
 poral. 
 Orbital or tem- 
 
 poro-malar. 
 Temporal 
 branch of 
 seventh. 
 Occipitalis ma- 
 jor. 
 
 Occipitalis mi- 
 nor. 
 
THE HEAD 
 
 FIG. 4. CRANIAL NERVES. (Potter.) 
 
 . 
 
 2. Infra.- tree/dear, 
 
 3. Supm-ort>ttai,3t>i' 
 
 4. Auricula-temporal. SO* 
 
 6 Tempor 
 7, Mater; 
 
 Arteries (see Fig. 2) : 
 Supra-orbital. 
 Frontal. 
 
 Superficial temporal. 
 Posterior auricular. 
 Occipital. 
 
 Veins (see Fig. 5 ) : 
 Supra-orbital. 
 Frontal. 
 Temporal. 
 Posterior auricular. 
 Occipital. 
 
 Study lymphatics of head and face. Some of the larger lymphatic 
 nodes can be dissected out. The smaller nodes and lymphatic vessels 
 cannot be seen in dissection, and the student must be satisfied with 
 studying the text and figures in books. 
 
 Expose and study occipito-frontalis muscle (M. epicranius}. (See 
 Fig- 7-) 
 
THE HEAD. 
 
 FIG. 5. -TiiE SUPERFICIAL LYMPHATICS AND VEINS OF THE SCALP, FACE, AND NECK. 
 
 (Morris.) 
 
 Frontal vein 
 
 Si/praorbital rein 
 Communication with. 
 
 ophthalmic rein 
 Tranxverte nasal rein 
 
 Angular vein 
 Lateral nasal veins 
 
 Transverse facial 
 
 rein 
 Superior labial or 
 
 coronary rein 
 
 A n terior pterygoid 
 
 or deep facial rein 
 
 Inferior coronary 
 
 rein 
 
 facial rein 
 
 Inferior labial veil 
 
 Submental rein 
 Lingual rein 
 
 Superior thyroid 
 vein 
 
 Middle thyroid 
 
 rein 
 
 Btemo-mastoid 
 
 Anterior jugular 
 
 rein 
 
 Communication 
 between anterior 
 jugular reins 
 Platysma, cut 
 
 Anterior temporal vein 
 Posterior temporal rein 
 
 Deep temporal rein 
 Parotid lymphatic gland* 
 Common temporal rein 
 Internal maxillary vein 
 Occipital vein 
 Temporo-maxillary vein 
 P?^ Posterior auricular vein 
 
 Occipital lymphatic glandt 
 Slerno-mastoid lymphatic 
 
 glands 
 
 Communication between 
 facial and external 
 jugular reins 
 Sitbmaxillary lymphatic 
 
 glandt 
 Internal jugular rein 
 
 Posterior external jugular 
 
 vein 
 External jugular vein 
 
 Superficial cervical chain 
 of glands 
 
 Trapezius 
 
 Transverse 
 cervical vein 
 
 S Stiprascapular 
 vein 
 
 Jugulo-cephalic 
 vein 
 
 AURICULAR REGION 
 
 Carefully remove the skin from about the auricle and expose the ex- 
 trinsic muscles of the auricle: 
 
 Attrahens aurem (M. auricularis anterior}. (See Fig. 7.) 
 Attollens aurem (M. auricularis superior}. 
 Retrahens. aurem (M. auricularis posterior}. 
 
 Draw the auricle in a direction from the point of origin of the muscle; 
 this will make the muscle-fibres prominent and the muscle can be ex-posed. 
 Expose the following nerves and blood-vessels: 
 Nerves (see Fig. 3) : 
 Posterior auricular. 
 
 Auricular branch of auricularis magnus. 
 Arteries (see Fig. 2) : 
 Posterior auricular. 
 
THE FACE 
 
 DEMONSTRATION III. 
 FACE 
 
 EXTERNAL PALPEBRAL AND ORBITAL REGIONS 
 
 General surface view. 
 
 Appendages of the eye. 
 Eyebrows. 
 Eyelids. 
 
 Outer and inner canthus. 
 Eyelashes. 
 Tarsal plates. 
 
 Study and trace the conjunctiva. 
 Observe caruncula lachrymalis. 
 
 FIG. 6. -LACHRYMAL APPARATUS. (Morris.) 
 
 SUPERIOR LACHRYMAL GLAND 
 INFERIOR LACHRYMAL GLAND 
 
 DUCT FROM SUPERIOR GLAND 
 
 UPPER EYELID PARTIALLY 
 DIVESTED OF SKIN 
 
 UPPER PUNCTUM 
 
 LACHRYMAL SAC, NEAR ITS FUNDUS 
 
 COMMON DUCT FORMED BY JUNC- 
 TION OF CANALICULI 
 
 UPPER AND LOWER CANALICULI 
 LOWER PUNCTUM 
 
 NASAL DUCT 
 
 Lachrymal apparatus: 
 
 Lachrymal gland. 
 
 Puncta lachrymalia. 
 
 Lachrymal canal. 
 
 Lachrymal sac. 
 
 Nasal duct. 
 
 Pass a probe into the puncta lachrymalia and out the lachrymal canal 
 into the lachrymal sac. Slit open the inferior lachrymal canal to the sac 
 and then pass a probe down the nasal duct. 
 
 Make an incision through the skin encircling the anterior border of 
 the orbit ; remove' the skin over the eyelids to their edges and expose : 
 Muscles : - 
 
 Orbicularis palpebrarum (M. orbicularis ocidi), (Fig. 7.) 
 
 Tensor tarsi. 
 
 Tendo oculi. 
 
 Corrugator supercilii. (Fig. 7.) 
 
 Levator palpebrae superioris. 
 Nerves (see Figs. 3 and 4) : 
 
 Supra-orbital. 
 
 Supratrochlear. 
 
 Infratrochlear. 
 
THE FACE 7 
 
 Arteries (see Fig. 2) : 
 Supra -orbital. 
 Frontal. 
 Nasal. 
 Palpebral. 
 Lachrymal. 
 
 Observe the Meibomian glands in the tarsal plates by holding the 
 eyelids between you and the light. (Fig.. 8.) 
 
 FIG. 7. (Holden.) 
 
 LEVATOR Bit 
 
 Expose the tendons of the muscles inserted into the sclerotic coat of 
 the eye by cutting through conjunctiva between the eyelids and eyeball. 
 To keep the insertion of the tendons in view place a splinter under each. 
 
 Moderately distend the cheek with tow and stitch the lips togetlier. Make 
 a longitudinal incision through the skin down the median line of the face to 
 the upper lip, then carry an incision along the margin of the lip and trans- 
 versely across the face to the angle of the jaw. Turn the skin outwards. 
 
THE FACE 
 
 FIG. 8. TENSOR TARSI ATTACHMENT OF THE ORBICULARIS PALPEBRARUM TO THE 
 
 PART OF THE BASE OF THE ORBIT. (Holden.) 
 
 i. Inner wall of the orbit. 2, 2. Internal part of the orbicularis palpebrarum. 3, 3. 
 Attachment of this muscle to the circumference of the base of the orbit. 4. Open- 
 ing for the nasal artery. 5. Tensor tarsi. 6, 6. Posterior view of the lids. 7, 7. 
 Orbital portion of the lachrymal gland. 8, 9, 10. Palpebral portion of this gland, 
 n, n. Mouths of its excretory ducts. 
 
 NASAL REGION 
 
 Expose the following structures: 
 Arteries (see Fig. 2) : 
 
 Lateralis nasi. 
 
 Angular. 
 
 Muscles (see Fig. 7) : 
 Pyramidalis nasi. 
 
 Levator labii superioris alaeque nasi. 
 Dilator naris posterior. 
 Dilator naris anterior. 
 Compressor nasi. 
 Compressor narium minor. 
 , Depressor alae nasi. 
 
 Nerves : 
 
 Nasal branch of ophthalmic. 
 Nasal branch of infra-orbital. 
 
 SUPERIOR, INFERIOR, AND INTER-MAXILLARY REGION 
 
 Make an incision along the margin of the lower lip and turn the skin 
 down to the lower border of the mandible. 
 
 Study the parotid fascia. Carefully expose the surface of the parotid 
 gland. Exercise great care in this region so as not to cut any branches 
 of the facial nerve. 
 
 Study the parotid gland. (Fig. 9.) 
 
THE FACE 9 
 
 Expose the facial nerve by first finding the infra-orbital branch. This 
 lies below the zygomatic arch and close to the parotid duct. Trace the 
 nerve forwards under the levator labii superioris muscle, and expose the 
 infra-orbital plexus. At the same time trace forwards the parotid duct to 
 where it pierces the buccinator muscles. Now trace the infra -orbital 
 branch back into the parotid gland, carefully looking for the other branches 
 of facial nerve. (See Fig. 3.) 
 
 FIG. 9. (H olden.) 
 
 Branches of the facial nerve on the face (Fig. 3) 
 Temporo-facial. 
 Temporal. 
 Malar. 
 
 Infra -orbital. 
 Cervico-facial. 
 Buccal. 
 
 Supra -maxillary. 
 Infra -maxillary. 
 
 Auricularis magnus nerve of cervical plexus. 
 Muscles (see Fig. 7): 
 
 Platysma myoides. 
 
 Superior maxillary region. 
 Levator labii superioris. 
 
io THE FACE 
 
 Levator anguli oris. 
 
 Zygomaticus major. 
 
 Zygomaticus minor. 
 Intermaxillary region. 
 
 Orbicularis oris. 
 
 Buccinator. 
 
 Risorius. 
 Inferior maxillary region. 
 
 Levator labii inferioris. 
 
 Depressor labii inferioris. 
 
 Depressor anguli oris. 
 
 FIG. io. -THE CRANIAL NERVES. FIFTH NERVE TRIGEMINUS. (Potter.) 
 
 .Potter del 
 
 Branches of fifth nerve on face (see Fig. 4) : 
 Infra -orbital. 
 
 Palpebral. 
 
 Nasal. 
 
 Labial. 
 
 Malar. 
 
 Auriculo-temporal. 
 
 Mental. 
 Study the whole of fifth or trifacial nerve at this time. (Fig. io.) 
 
THE FACE. IT 
 
 Study the whole of facial nerve at this time. 
 FIG. ii. THE CRANIAL NERVES. SEVENTH NERVE FACIAL OR PORTIO DURA. (Potter.} 
 
 ~lfcntal5a* 
 
 References 
 I. LargeSuperf. Petrosal.toform Vidian with N*?5 
 
 2 Small Superf. Petrosal,to utic Ganglion. 
 
 3 External Superf. Petrosal, to Plexus on MidMenmgeal Artery. 
 
 4 Tympanic Br. to Stapedius.etc 
 
 5 Br From Carotid Plexus.Making Vidian, with N*?l. 
 6. 7. Brs.to Auriculo -Temporal of 5^ 
 
 8. Br to Auricular of Vagus Potter.deL 
 
 M.The Ganglion of Meckel 
 
 O.A.F. Orifice of Aqua3doctus Fallopii 
 
 Arteries on the face (see Fig. 2) : 
 
 Facial and branches (.-1. maxillaris externa). 
 
 Transverse facial. 
 
 Middle temporal. 
 
 Orbital (A. zygomatico-orbitalis). 
 
 Infra-orbital. 
 
 Mental. 
 Veins on face (see Fig. 5) : 
 
 Frontal. 
 
 Supra-orbital. 
 
 Angular. 
 
 Facial and branches. 
 
 Temporal. 
 
 Internal maxillary. 
 
 Temporo-maxilla ry . 
 
 Posterior auricular. 
 Lymphatics (see Fig. 5) : 
 
 Study lymphatics of head, face, and neck 
 
12 THE SKULL 
 
 DEMONSTRATION IV. 
 SKULL 
 
 Study the external surfaces of the superior, posterior, lateral, and 
 anterior regions of the skull. 
 
 Remove the skull-cap by making a circular incision with the saw, com- 
 mencing in front about one inch above the margin of the orbit, and extending 
 behind a little above the external occipital protuberance. Saw through the 
 bone only, and with chisel and hammer break the skull-cap loose with care 
 so as not to break the investing membranes of the brain. 
 
 Observe the interior of skull-cap. Note groove for middle meningeal 
 artery. 
 
 Examine diploe by chiseling away part of the outer plate of skull-cap. 
 
 Study veins of diploe. 
 
 FIG. 12. THE VEINS OF THE DIPLOE. (Morris.) 
 (From a specimen in St. Bartholomew's Hospital Museum.) 
 
 THE LAMBDOID 
 SUTURE 
 
 The occipital or 
 parieto-occipilal 
 diploic vein 
 
 The external pari- 
 etal or posterior 
 temporal diploic 
 vein 
 
 THE MASTOID 
 FORAMEN 
 
 THE CORONAL SUTURE 
 
 The frontal di- 
 ploic vein 
 
 The fronto-sphe- 
 noidal diploic 
 vein 
 
 The Jronto-pari- 
 e/al or anterior 
 temporal diploic 
 vein 
 
 Observe middle meningeal artery. What is its origin and course? 
 
 Membranes of brain: 
 
 Study dura mater. 
 
 Make a puncture in median line of dura mater, insert a blow-pipe, and 
 distend with air the superior longitudinal sinus. Then make an incision 
 through the dura on one side of the superior longitudinal sinus and 
 turn the dura outwards. Observe the falx cerebri and tentorium cere- 
 belli. (Fig. 13.) 
 
 Study superior longitudinal, inferior longitudinal, and straight sinuses. 
 
 Study arachnoid and pia mater. 
 
 Observe the glandulae Pacchioni. 
 
ARTERIES AT THE BASE OF BRA IX 
 
 FIG. 13. THE VENOUS SINUSES. (Longitudinal section.) (Morris.) 
 
 FUlRItt SERVE 
 
 I 
 
 Fall cerebri 
 
 THIRD SERVE 
 
 SECOXD NERVE 
 
 Lateral tinui 
 
 Superior 
 petrotal sinus 
 
 Fali-cere belli 
 
 8MVXSTMAND 
 
 EIGHTH 
 
 irssrss 
 
 .v/.vTV/. TESTH. Ayr) 
 
 ELEVENTH SERVES 
 TWELFTH SERVE 
 
 SECOSD CERVICAL NERVE 
 
 Ligamentum denticulatum 
 
 Vertebral 
 artery 
 
 FIFTH 
 NER VE 
 
 fJKST 
 
 CERVICAL 
 
 SER VE Inferior pttrosa! sinta 
 
 Remove the brain. Lift the frontal lobes from the dura and turn the 
 brain back. Observe tlie cranial nerves. Cut the nerves so that part is left 
 on the base of cranium. Cut through the tentorium cerebelli along its attach- 
 ment to the superior border of the petrous portion of temporal bone. Push 
 the cerebellum to one side and observe the nerves as they leave the brain, cut 
 the nerces, and then thrust a knife into the vertebral canal and divide the 
 spi)ial cord. 
 
 Study the arteries at the base of the brain (Fig. 14): 
 Cerebral portion of internal carotid. 
 Anterior cerebral. 
 Middle cerebral. 
 Posterior communicating. 
 Anterior choroid. 
 Basilar and branches. 
 
 Circle of Willis (Fig. 14) (Circuliis arteriosus] is formed by: 
 Anterior cerebral. 
 Anterior communicating. 
 Posterior cerebral. 
 Posterior communicating. 
 
FIG. 14. THE ARTERIES OF THE BRAIN. (Morris.) 
 
 (The posterior part of the cerebrum on the left side has been cut away to show the cere- 
 bellum. From a preparation in the Museum of St. Bartholomew's Hospital.) 
 
 Anterior cerebral 
 artery 
 
 Middle cerebral 
 
 artery 
 Internal carotid 
 
 artery 
 Postero- j median 
 
 perforating 
 Posterior cerebral 
 
 artery 
 
 Superior cerebellar 
 artery 
 
 Anterior inferior 
 cerebellar artery 
 
 Vertebral artery 
 
 Posterior inferior 
 cerebellar artery 
 
 Observe where the cranial nerves leave the brain. 
 
 / FIG. 15. VIEW OF THE BASE OF THE BRAIN. (Morris.) 
 
 OLFACTORY 
 BULB 
 
 OPERCULUM 
 
 3rd or OCULO- 
 MOTOR 
 
 ethor ABDUCEXT 
 
 7th or FACIAL 
 
 8th or AUDITORY 
 
 9th, GLOSSO- 
 
 PHARYNG. 
 
 toth, PNEUMO- 
 
 GAST. 
 
 llth, SPINAL 
 ACCESS. 
 12th, HYPO- 
 GLOSSAL 
 
 Anterior com- 
 municating 
 artery 
 
 Antero-lalentl 
 perforating 
 
 A nterior choroid 
 
 Posterior 
 communicating 
 artery 
 
 Posterior choroid 
 
 Bnsilar artery 
 Cms cerebelli, cut 
 
 Anterior spinal 
 artery 
 
 XTERIOR 
 
 PERFORA TED 
 
 SPACK 
 PITUITARY 
 
 BODY 
 TUBER 
 
 CORPUS 
 
 ALBH'A V.s' 
 POST. PERF. 
 
 SPACE 
 CRUS CKRERRI 
 
 PI>XS VAROLII 
 
 AXTERIOR 
 PYRAMID 
 OLIVARY ROOT 
 
 IXFKRIOR 
 
 VERMIFORM 
 PMOCS8S 
 
BASE OF CRANIUM 15 
 
 Place the brain, if in good condition, in alcohol or formalin for 
 future use. 
 
 The central nervous system is so important and so extensive that a 
 separate dissection is advisable, therefore the directions for the dissection 
 of the brain and spinal cord are not given in this outline. 
 
 Xow note the exit of the cranial nerves through the dura and base of 
 cranium. 
 
 FIG. 16. THE VENOUS SINUSES. (Morris.) 
 (From a dissection by W. J. Walsham in St. Bartholomew's Hospital Museum.) 
 
 Meningral branch of 
 anterior etkmoidal artery 
 
 Meningeal branch of pos- 
 terior tthmfjidal artery 
 
 Middle meningeal 
 
 artery 
 
 OPHTHALMIA 
 
 I>rvISH>\ OF 
 
 FIFTH SERVF 
 
 THIRD SERVE 
 
 Oarernoux tin us 
 
 FOURTH XERVE 
 
 Al'l'ITORY A\r> 
 
 FACIAL NERVES 
 
 Sxjtfridr pftf 
 Inferior fxti' 
 Petro-tqnamous fin us 
 tPIXAL 
 
 .'} .\ERIF 
 Siyi' 
 
 latfrnl situu 
 Posterior meniniftal 
 branch of vertebral 
 artery 
 Left marginal riniu 
 
 Lrfl lateral tiniu 
 Snptrirjr I'jnqitu-iinal tiatu 
 
 Circular tinut 
 Carotid artery 
 SIXTH XER VE 
 Batilar artery 
 Basilar plexvt of reuw 
 A iiditory artery 
 Vertebral ai'tetf 
 
 "HAKrSGEAL 
 A\I> PXEl'MOGASTKIC 
 Anterior spinal artery [.V. 
 
 HYPOGLOSSAL 
 
 SERVE 
 
 SPIXAL ACCES- 
 .-<'>/: Y SFR VE 
 
 Right marginal tinnt 
 Occipital tinut 
 Right lateral tinut 
 
 Expose the sinuses of the dura mater (see Figs. 13 and 16): 
 The superior longitudinal, inferior longitudinal, and straight sinuses 
 have been seen. 
 
 The remaining are:- 
 Lateral. 
 Occipital. 
 Cavernous. 
 
 Circular. 
 
 Superior petrosal. 
 Inferior petrosal. 
 Transverse. 
 
 Study: Ophthalmic veins and emissary veins. 
 
 Name and locate the openings through the base of cranium in 
 
It) 
 
 THE ORBIT 
 
 Anterior cranial fossa. 
 Middle cranial fossa. 
 Posterior cranial fossa. 
 
 INTERNAL ORBITAL REGION 
 
 Remove the roof of the orbit by making one section with the saw on the 
 outer angle and one on the inner angle of the orbit, so that the two sections 
 converge at the optic foramen. Be careful not to injure the pulley at the inner 
 angle for superior oblique muscle. Do not cut entirely through the bone 
 with the saw, but with a hammer break the anterior part of orbit transversely 
 and turn this forwards and downwards. Remove the rest of the roof with 
 bone forceps back to the optic foramen. Now insert a blow-pipe into cra- 
 nial end of optic nerve and distend the eyeball with air. 
 
 Study the periosteum of the orbit. Notice it is a continuation of the 
 dura mater through the sphenoidal fissure. 
 
 Study the fascia of the orbit. 
 
 Next expose the following structures: 
 
 Lachrymal gland. (Figs. 6 and 8.) 
 
 FIG. 17. VIEW OF ORBIT FROM ABOVE. (Holden.) 
 
 IN FRA-TROCHLEAR 
 
 SUPRA-ORBITAL 
 
 SUPRA- 
 TROCHLE AR 
 
 NASAL 
 
 LAC HRYM AL 
 FRONTAL 
 
 Nerves : 
 
 Ophthalmic. 
 
 Frontal. 
 
 Lachrymal. 
 
 Nasal. 
 Ciliary ganglion. (This lies between the external rectus muscle 
 
 and optic nerve in posterior third of orbit.} (Fig. 18.) 
 Motor oculi. 
 Trochlear. 
 Abducens. 
 
 Orbital branch of superior maxillary. 
 Optic. 
 
THE ORBIT 
 FIG. iS. NERVES OF THE ORBIT, FROM THE OUTER SIDE. (Morris.) 
 
 I. FXTICULA R GA NGLION 
 SUPERIOR DIVISION OF THE THIRD NERVE 
 
 SUPRAORBITAL 
 
 SERVE 
 
 SHORT f'JLlARY. 
 SERVES 
 
 SPA NCH OF THIRD TO 
 INFERIOR OBLiqUE 
 
 NASAL BRANCH OF OPHTHALMIC 
 
 LONG ROO T OF LENTICU- 
 LAR GANGLION 
 
 OPTIC NERVE 
 
 THIRD NERVE 
 SIXTH NERVE 
 GASSERIAN GANGLION 
 
 OPHTHALMIC DIVISION 
 OF FIFTH NERVE 
 
 SHORT ROOT OF SYMPA THETIC ROOT OP LENTICULAR 
 
 LENTICULAR GANGLION GANGLION 
 
 Arteries (see Fig. 19): 
 
 Ophthalmic and branches. 
 Veins : 
 
 Ophthalmic and tributaries. 
 Muscles (see Fig. 20): 
 
 Levator palpebrae. 
 
 Rectus superior. 
 
 Rectus inferior. 
 
 Rectus externus. 
 
 Rectus internus. 
 Superior oblique. 
 Inferior oblique. 
 
 FIG. 19. THE LEFT OPHTHALMIC ARTERY AND VEIN. (Morris.) 
 
 Svpraorbital artery 
 
 LACHRYMAL GLAND 
 
 Superior rectus, cut 
 
 EYEBALL 
 
 External rectus 
 Lachrymal artery 
 
 Superior rectus, cut 
 Jnferitjr ophthalmic rein 
 Superior ophthalmic rein 
 
 OPTIC NERVE 
 Common ophthalmic vein 
 
 Commencement of tuperior 
 ophthalmic rein 
 
 Reflected tendon of superior 
 
 oblique 
 Ophthalmic artery 
 
 Anterior ethmoidal artery 
 
 Posterior ethmoidal artery 
 
 Ciliary arteriet 
 
 * 
 
 Levator palpebrae, cut 
 Ligament of Zinn 
 Ophthalmic artery 
 
 OPTIC COMMISSURE 
 
 Internal carotid artery 
 
i8 
 
 THE EYE 
 
 FIG. 20 (see also Fig. 18). VIEW OF LEFT ORBIT FROM ABOVE, SHOWING THE OCULAR 
 MUSCLES. (Morris.) 
 
 Internal rectus muscle 
 
 Superior oblique muscle 
 
 Trochlea 
 
 Levator palpebrae superioris 
 muscle, cut 
 
 External rectua muscle 
 
 Inferior oblique muscle 
 Superior rectus muscle 
 
 Levator palpebrae superioris 
 muscle, cut 
 
 THE EYE 
 
 Dissect the eye of an ox or sheep. Remove the muscles and fat about 
 the eyeball. 
 
 Study the aqueous humor, sclerotic coat, and cornea. Then cut 
 through the sclerotic coat just behind the cornea, nearly encircling the 
 eye, and turn forwards the anterior part. Note the iris and pupil. 
 
 Float out the crystalline lens and vitreous in water. Study the lens 
 and its capsule and vitreous. Then note and study choroid, ciliary pro- 
 cesses, retina, anterior and posterior chambers. 
 
 FIG. 21. SURFACE OF CHOROID AND IRIS EXPOSED BY REMOVAL OF SCLEROTIC AND COR- 
 NEA, SHOWING DISTRIBUTION OF BLOOD-VESSELS AND NERVES. (Twice natural size.) 
 (Morris.) 
 
 A CILIARY NERVE 
 
 SURFACE OF CHOROID IN 
 CILIARY REGION 
 
 A CILIARY XERVE 
 
 Long posterior ciliary 
 artery 
 
 FLAP OF SCLEROTIC, 
 REFLECTED 
 
THE EYE 
 
 FIG. 22. SEMI-DIAGRAMMATIC HORIZONTAL SECTION THROUGH EYEBALL AND OPTIC NERVE. 
 
 (Morris.') 
 
 Corneal epithelium 
 
 CORNEA 
 
 ; ^/ ^NX 
 
 CANAL OF SCHLEUU 
 Ciliary muscle 
 
 CANAL OF PETIT 
 
 cowimci -A 
 
 MOM : 
 
 BETIXA 
 
 Central retinal vessel* 
 
 OPTIC XERVE- 
 
 Sl'BXTAXCE 
 
 PIAL XERVE- 
 
 SCLEROTIC 
 
 (covered exter- 
 nally by Tenon't 
 capsule and 
 
 loose tissue) 
 
 DURAL XERVE-SHEATH 
 
20 
 
 THE NECK 
 
 DEMONSTRATION V. 
 THE NECK 
 
 Place the body upon its back with a block under the upper part of the 
 thorax; turn the face to one side. You will see that the side of the neck pre- 
 sents a quadrilateral figure, the boundaries of which are: Anterior, middle 
 line; posterior, anterior margin of trapezius muscle; superior, mandible; 
 inferior, clavicle and manubrium. 
 
 FIG. 23. ANTERIOR AND LATERAL CERVICAL MUSCLES. (Morris.} 
 
 Stylo-glossus 
 
 Hyo-glossus 
 
 Mylo-hyoid 
 
 Anterior belly 
 of digastric 
 
 Raphe of raylo- 
 hyoid 
 
 Thyro-hyoid 
 Inferior constrictor 
 
 Anterior belly of 
 omo-hyoid 
 
 Sterno-hyoid 
 Sterno-thyroid 
 
 Stylo-hyoid 
 
 Posterior belly of digastric 
 
 Splenius capitis 
 
 Sterno-mastoid 
 
 Levator anguli scapulae 
 
 Scalenus medius 
 Trapezius 
 
 Scalenus posticus 
 
 Posterior belly of 
 omo-hyoid 
 
 Surface anatomy: 
 
 Outline sterno-mastoid muscle. This muscle divides the neck into an 
 anterior or carotid and a posterior triangle. The omo-hyoid muscle divides 
 the anterior triangle into a superior and inferior carotid triangle; and 
 the posterior triangle into the subclavian and occipital. The submaxil- 
 lary or digastric triangle is between the mandible and stylo-hyoid and 
 digastric muscles. 
 
 Locate the hyoid bone, thyroid and cricoid cartilages, and trachea. 
 As the trachea passes down from the cricoid cartilage it recedes so that 
 there is a deep fossa fonticulus gutturis above the sternum. 
 
 Dissection: Make a vertical incision through the skin down the middle 
 of the neck from the symphysis of the mandible to the sternum, a second in- 
 cision along the clavicle to the acromion process. Reflect the skin outwards 
 to the anterior boundary of the trapezius muscle. 
 
THE NECK 
 
 21 
 
 This will expose the superficial fascia and platysma myoides muscle. 
 Study the superficial cervical fascia. 
 
 FIG. 24. THE SUPERFICIAL VEINS AND LYMPHATICS OF THE SCALP, FACE, AND NECK. 
 
 (Morris.) 
 
 Frontal i tin 
 
 SiipraorbUal vein 
 Communication with 
 
 ophthalmic vein 
 Transrtrse natal r 
 
 Angular rtin 
 Lateral natal reins 
 
 Transverse facial 
 
 vein 
 Superior labial or 
 
 coronary rein 
 
 Anterior p'terygoid 
 
 or deep facial rein 
 
 Inferior coronary 
 
 vein 
 
 Facial rein - 
 
 Inferior labial vein 
 
 Submental rein 
 
 Lingual vein 
 
 Superior thyroid 
 
 Middle thyroid 
 vein 
 
 Sterno-maatoid 
 
 A nterior jou lor 
 
 rein 
 
 Communication 
 between anterior 
 jugular veins 
 
 Platysma 
 
 Anterior temporal vein 
 Posterior temporal vein 
 
 Deep temporal vein 
 Parotid lymphatic gland* 
 Common temporal rein 
 Internal maxillary vein 
 -77- \~r Occipital vein 
 ^ff Temporo^mazillary rein 
 Posterior auricular vein 
 
 Occipital lymphatic gland* 
 Sterno-mastoid lymphatic 
 
 glands 
 
 Communication beltceen 
 facial and external 
 jugular rein* 
 Svbmarillary lymphatic 
 
 glands 
 
 Internal jugular rein 
 Posterior external jugular 
 
 vein 
 External jugular rein 
 
 Superficial cervical chain 
 of gland* 
 
 Trapeziua 
 
 Transrerte 
 cervical rein 
 
 Supratcapular 
 rein 
 
 Jugulo-cephalic 
 vein 
 
 Superficial branches of cervical plexus. (See Fig. 25.) 
 
 Transverse cervical. 
 
 Supra-sternal. 
 
 Supra -clavicular. 
 
 Supra-acromial. 
 
 Great auricular. 
 
 Small occipital. 
 Spinal accessory. 
 
 Study the platysma myoides. 
 
 Carefully remove the platysma myoides and expose :- 
 
 Superficial veins (Fig. 24) : 
 
 External jugular. 
 
 Anterior jugular. 
 
 Posterior jugular. 
 
22 
 
 THE NECK 
 
 Lymphatics of the neck. (Fig. 24.) 
 Superficial cervical. 
 External jugular. 
 Anterior cervical. 
 Submaxillary. 
 Submental. 
 
 FIG. 25. SUPERFICIAL BRANCHES OF THE CERVICAL PLEXUS. (Morns.} 
 
 POSTERIOR 
 
 A URICULAR 
 NER VE 
 
 FACIAL NERVE 
 
 INFRAMAXUIB ULAR 
 
 SUPERFICIAL CERVICAL 
 BRANCHES OF SUPER- 
 FICIAL CERVICAL 
 NERVE 
 
 SUPRASTERNAL 
 
 BRANCHES OF 
 }- GREA T 
 ) AURICULAR 
 
 GREAT OCCIPITAL 
 
 LESSER OCCIPITAL 
 
 GREA T A URICI'LA R 
 .V AS TO ID BR. OR 2nd 
 
 SMALL OCCIPITAL 
 SPINAL ACCESSORY 
 
 BR. TO LEV ATI IR 
 
 \si;ri.i sr.\i>rr..E 
 
 SUPRA- A CROMIAL 
 SUPRACLAVICCLAR 
 
 BRANCHES TO 
 
 TRAPEZIUS 
 
 SU PR AC LA VIC ULAR 
 
 Study deep cervical fascia. 
 Triangles of the neck : 
 
 Anterior triangles. 
 
 Digastric or submaxillary. 
 Carotid superior or carotid. 
 Carotid inferior or muscular. 
 Posterior triangles. 
 Occipital. 
 Subclavian. 
 
 Complete the dissection of the posterior triangle before doing any 
 further dissection on the anterior triangles. 
 
THE NECK 
 
 In posterior triangle expose and study: 
 Arteries : 
 
 Supra-scapular (A. transversa scapula). 
 
 Transverse cervical. 
 
 Expose third portion of subclavian artery by pushing aside 
 scalenus anticus and medius muscles. 
 
 FIG. 26. REGION OF THE THIRD PART OF THE SUBCLAVIAN ARTERY. 
 
 (Morris.) Also see Fig. 28. 
 (The shoulder represented depressed.) 
 
 (Bellamy.) 
 
 \ 
 
 Splenius 
 
 Lerator anguli scapulae 
 Scalenus posticus 
 
 f'ERFlCIAL DE- 
 .S' /: \DIXG BRA -V 'H 
 1 1 r THE CER I '1C A L 
 PLKXU8 
 
 ft RA fill A L PL EX f 'I 
 Transrtrtali* colli artery 
 
 (deep) 
 
 First serration of serratus 
 magnus 
 
 PHRESIC XER VE 
 
 Scalenus anticus 
 
 First serration of serratus magnus 
 v -~ Siibclarian vei 
 
 Suprascapular artery 
 Svbclarian artery 
 
 Stiprascapuiar rein 
 Costo-coracoid membrane and cephalic et 
 
 Xerves (see Figs. 25 and 28): 
 Cervical plexus. 
 
 Superficial branches have been studied. 
 Deep branches: 
 External. 
 Muscular. 
 Communicating. 
 Internal. 
 Muscular. 
 Communicating. 
 
 Phrenic lies on anterior surface of scalenus anticus. 
 Spinal accessor}-. 
 Muscles: 
 
 Sterno-cleido-mastoid. Scalenus medius. 
 
 Omo-hyoid. Scalenus posticus. 
 
 Trapezius. Splenius. 
 
 Scalenus anticus. Levator anguli scapulae. 
 
24 THE NECK 
 
 DEMONSTRATION VI. 
 
 In anterior triangles of the neck. 
 
 Note that the carotid artery lies just beneath the anterior border of 
 the sterno-mastoid muscle. 
 
 Cut the clavicle at its inner third, disarticulate sternal end, turn it up with 
 the sterno-mastoid muscle, taking care not to remove any of the structures 
 beneath the muscle. 
 
 Study the cervical fascia. 
 
 Lying on or in the sheath of the carotid artery, internal jugular vein, 
 and vagus nerve you will find the descendens hypoglossi nerve. Trace it 
 up to the hypoglossal nerve and down to the communication with the com- 
 municantes hypoglossi, forming the anas. (Fig. 27.) 
 
 FIG. 27. CENTRAL LINE OF NECK. COURSE AND RELATIONS OF COMMON CAROTID 
 
 ' ARTERY. (Holden.} 
 
 Occipital a. 
 
 Hypoglossal 
 
 n. 
 
 Descendens 
 hypoglossi n . 
 
 2d cervical n. 
 
 Superior thy- _ 
 roid a. 
 
 3d cervical n. 
 
 Communicans 
 hypoglossi n. 
 Crico-thyroid 
 
 m. 
 
 Internal jugu- 
 lar v. 
 
 Common car- 
 otid a. 
 
 Digastricus. 
 
THE XECK 
 
 FIG. 28. THE COMMON CAROTID, THE EXTERNAL AND INTERNAL CAROTID AND THE SUB- 
 
 CLAVIAN ARTERIES OF THE RIGHT SIDE AND THEIR BRANCHES. (Morris.) 
 (From a dissection by Dr. Alder Smith in the Museum of St. Bartholomew's Hospital.) 
 
 Stylo-gloss ua 
 
 INFERIOR DESTAL SERVE 
 CHORDA TYMPASI 
 FACIAL SERVE 
 Internal maxillary artery 
 Stylo-hyoid, turned up 
 Digastricus, turned up 
 Temporal artery 
 
 Submental artery 
 facial artery 
 
 MYLO-HYOID SERVE 
 LOWER JAW. TURNED UP 
 
 Posterior auricular artery 
 Internal jugular rein 
 
 SECOS'n CERVICAL 
 
 SERVE 
 $PI\A I. A CCESSOR Y N 
 
 SERVE 
 
 Bectus capitis anticus major 
 
 Stylo-pharyngeus muscle 
 
 OF SYMPATHETIC 
 
 "it-PHAR. SERVE 
 
 Sterno-mastoid, reflected 
 
 Occipital artery 
 
 Internal carotid 
 
 Lerator anguli scapulae 
 
 THIRD CERVH: SERVE 
 
 L>E -ESl>f-:S.< HYPIJ- 
 
 SSI SERVE 
 
 External carotid 
 
 Inferior constrictor 
 
 l\\'. HYPOGLOSSI 
 FO UR TH f 'ER I '. SER f 'E 
 Atcending cerrfcal artery 
 ZPISA L A C>. "ESSOR Y 
 PHRESIC SER VE 
 Scalenus anticus 
 Levator anguli scapulae 
 
 FIFTH CERV. SERVE 
 Scalenus medius 
 r'F.RVIi-AL PLEXUS 
 
 \7>/;.V.S - BRASfff 
 PSEl'UOGASTRIC 
 
 SERVE ^^ 
 
 DRAfHlAL PLEXl ~ 
 
 Internal jugular rein 
 Superficial cerrical artery 
 
 Suprateapular artery 
 
 Serratus magnus 
 
 Coraco-brachialis 
 
 Suprateapular artery giren of from third 
 part of tubclarian 
 
 Posterior scapular artery 
 Sl'PRASCAPl'LAR SERVE 
 
 Humeral thoracic artery 
 Posterior belly of orno-hyoid, drawn do 
 
 SL'B.V AXIL LAKY GANGLION 
 G US TA TORY SER I ~E 
 SUBMAXIUART DUCT 
 SUBUAX1LURY 6UND 
 TONGUE 
 
 1IYPOGLOS. SERVE 
 Ranine artery 
 
 Genio-hyo-glossus 
 Sublingual artery 
 
 Lingual artery 
 Artery offraenvm 
 LOWER JAW 
 
 Genio-hyoid 
 
 Hyo-glosaus 
 Lingual artery 
 Hyoid branch 
 Mylo-hyoid muscle 
 Thyro-hyoid membrane 
 
 SUPERIOR LARYS- 
 GEAL SERVE 
 
 Superior iaryngtal artery 
 
 Thyro-hyoid 
 
 Superior thyroid artery 
 
 Omo-hyoid 
 
 EX TERSA L L A R YA'- 
 
 GEAL SERVE 
 THYROID GLAND 
 
 Sterno-hyoid 
 Common carotid 
 Sterno-thyroid 
 
 Vertebral artery 
 Inferior thyroid artery 
 Anterior jugular rein 
 Common carotid 
 CLAVICLE 
 
 Vertebral rein 
 
 BRACIHAL PLEXUS 
 (SEVESTH CERVIC.) 
 
 Subclarian artery 
 
 Fectoralis major, 
 reflected 
 
 \ Transverse cerrical artery 
 Subclavius, reflected 
 
 BRACHIAL PLEXUS (EIGHTH CERVICAL) 
 Pectoral branch of acromial thoracic artery 
 Subclarian rein 
 Pectoralis minor 
 
 Expose the carotid artery, internal jugular vein, and vagus nerve, and 
 note their relative position to each other and to surrounding structures. 
 
 Expose the sympathetic gangliated cord behind the carotid sheath. 
 (See Figs. 28 and 29.) 
 
 Trace the superior laryngeal nerve to the superior border of thyroid 
 cartilage; note its division into internal and external branches. 
 
 Xote the division of the common carotid into the external and internal 
 carotid. 
 
26 
 
 THE NECK 
 
 Now expose and study the branches of the external carotid . (See Fig. 28.) 
 Expose the subclavian artery and its branches. (See Figs. 26 and 28.) 
 What position does this artery have in relation to the subclavian vein, 
 vagus nerve, and scaleni muscles? 
 
 Expose the inferior or recurrent laryngeal nerve lying behind the com- 
 mon carotid artery and in the groove between the trachea and oesophagus. 
 
 FIG. 29. DISTRIBUTION OF THE PNEUMOGASTRIC NERVE, 
 
 (Krause.) (Morris.} 
 
 VIEWED FROM BEHIND. 
 
 Stylo-hyoid 
 
 Ligamentum pharyngeum 
 XI 
 
 Posterior belly of 
 digastric 
 
 Sterno-mastoid 
 
 Rectus capitis 
 anticus major 
 
 Stylo-pharyngeus 
 
 Stylo-glossus 
 
 Internal pterygoid 
 
 XIT'ERIOR 
 CERVICAL 
 GANGLION 
 
 Middle constrictor 
 
 Common carotid 
 artery 
 
 Inferior constrictor 
 
 GANGLION 
 
 THYROIDEUM 
 (VARIETY) 
 
 THYROID GLAND 
 
 Infa-io? thyroid 
 artery 
 
 Subc/arittii iirli'rii 
 
 RECURRENT 
 LARYNGEAL 
 NER VE 
 
 Thoracic aorta 
 
 Cru3 of diaphragm 
 
 Internal carotid 
 
 in /;// 
 
 ' 
 
 SYMPATHETIC 
 Occipital urti'ry 
 
 Posterior belly of 
 digastric 
 
 DESCENDEN8 
 HYPdGLOSSI 
 
 <'<iiiiiii<n< carotid 
 artery 
 
 - Sterno-raastoid 
 
 TWIG or 
 RECURRENT 
 
 LARYNGEAL TO 
 
 I'llARYSGEAL 
 
 PLEXUS 
 
 Thyroid <u'M 
 
 INFERIOR 
 CERVICAL 
 GANGLION 
 
 RECURRENT 
 LARYXGEAL 
 
 ['LEXL'S GULJE 
 
 RIGHT 
 PNEUMOGA8TRIG 
 
THE NECK 
 
 27 
 
 Search carefully for the thoracic duct on the left side as it enters the 
 subclavian vein near the junction with internal jugular. (Fig. 30.) 
 
 FIG. 30. THE SUPERIOR AND INFERIOR VEN.E CAVJB, THE INNOMINATE VEINS, AND THE 
 
 AZYGOS VEINS. (Morris.) 
 
 Right common carotid 
 
 artery 
 
 Right internal jugular 
 rein 
 
 RIGHT LYMPHATIC DUCT 
 
 Innominate artery 
 
 RIGHT PffBUMO- 
 
 GASTRIC XERl'E 
 
 Right innominate vein 
 
 Internal mammary vein 
 
 Trunk of the perifardiac 
 and thymic veins 
 Vena cata superior 
 
 Vena azygos major 
 
 Vena azygos minor, cross- 
 ing spine tfj enter vena 
 major 
 
 Hepatic reins 
 
 Vena cata inferior 
 
 Right phrenic artery 
 Cailiac axis 
 
 Right middle suprarenal 
 artery 
 
 Right spermatic artery 
 Right spermatic rein 
 
 Left common carotid 
 
 artery 
 
 LEFT PNMUMOGA& 
 TRIG SERVE 
 
 THORACIC DUCT 
 
 Left innominate vein 
 
 Left subclavian artery 
 
 Left superior intercostal 
 rein 
 
 RECURRENT 
 LARYSGEAL 
 XER YE 
 
 Vena azygos tertius 
 
 (ESOPHAGUS 
 
 Left upper azygos vein 
 
 CEsophageal branches 
 from aorta 
 
 Vena azygos minor 
 
 THORAC C DUCT 
 
 Left phrenic artery 
 
 Left middle suprarenal 
 artery 
 
 RECEPTACULUM CHYLI 
 
 Superior mesenteric 
 artery 
 
 Left ascending lumbar 
 rein 
 
 Left spermatic vessel* 
 
 Inferior mesenteric 
 artery 
 
 In the anterior triangle you have the following structures, some of 
 which have been exposed and studied. Clean and study each carefully 
 and note the position each bears to the surrounding structures: - 
 Xerves : 
 
 Descendens hypoglossi. 
 Hypoglossal. 
 
 Communicantes hypoglossi. 
 
28 THE NECK 
 
 Ansa hypoglossi. 
 Vagus or pneumogastric. 
 
 Pharyngeal. 
 
 Superior laryngeal. 
 
 Inferior laryngeal. 
 Phrenic. 
 Sympathetic. 
 
 Arteries : 
 
 Common carotid. 
 External carotid. 
 
 Superior thyroid. 
 
 Lingual. 
 
 Facial. 
 
 Ascending pharyngeal. 
 
 Occipital. 
 
 Posterior auricular. 
 Internal carotid. 
 
 Veins : 
 
 Internal jugular. 
 
 Tributaries to internal jugular. 
 
 Review veins of head and neck. 
 Thoracic duct, its termination. 
 Right lymphatic duct. 
 Review lymphatics of head and neck. 
 
 Subclavian artery. 
 
 Thyroid axis (A . truncus thyreo-cervicalis) and branches. 
 
 Vertebral. 
 
 Internal mammary. 
 
 Superior intercostal (A. truncus costocervicalis] . 
 
 Subclavian vein. 
 
 Tributaries to internal jugular. 
 
 Muscles (see Fig. 27 and 34): 
 Omo-hyoid. 
 Sterno-hyoid. 
 Sterno-thyroid. 
 Thyro-hyoid. 
 Scaleni. 
 
THE XECK 
 
 29 
 
 FJG. 31. DIAGRAM OF THE SUPERFICIAL LYMPHATIC VESSELS AND GLANDS OF THE HEAD 
 AND NECK. (After Drawing by Dr. Francis R. Sherwood.) (Morris.) 
 
 Ext. part of eyel 
 Outer part of cheek 
 Part of face 
 
 Occipital region 
 
 Face and Lips superficial 
 Nose and floor of mcut 
 
 Ant. part of tongue 
 
 Sublingual 
 
 Submaxillary 
 
 Part of parotid 
 
 Submaxillary glands 8 to 
 
 Deep cervical glands 
 
 Superficial cervical glands 
 
 Suboccipital gland* 
 
 Post. Auric, or 
 Sterno-mastoid glands 
 
 Efferent vessels to deep cervical 
 
 FIG. 32.- DIAGRAM OF THE DEEP LYMPHATIC VESSELS AND GLANDS OF THE HEAD AND 
 XECK. (After Drawing by Dr. Francis R. Sherwood.) (Morris.') 
 
 Spheno-maxfflary Fossa 
 
 Temporal Fossa 
 
 Orbit 
 Nose 
 
 Upper part of pharynx and pal 
 
 Internal maxillary glands 3 to 
 
 Efferent vessels from 
 submaxJIlary glands 
 
 Middle of pharynx 
 Lower part of Larynx 
 
 Upper and post, part of Tongue 
 
 Interior of Cranium 
 
 Inner and posterior part of Nose 
 
 Trachea ) u 
 Esophagus) 
 
 CEs 
 
 Lower part of Thyroid body 
 
 Efferent vessels 
 
 Upper part of pharynx 
 
 Deep muscles of neck 
 (prevertebral) 
 
 Posterior pharyngeal glandr 
 
 Deep cervical glands 
 
 Deep muscje* 
 
 nd L. Lymphatic ducts 
 
Thyroid body or gland. 
 
 Position and general description. 
 
 Lobes. 
 
 Isthmus. 
 
 M. levator glandulse thyroidae. 
 Accessory thyroids. 
 Arteries and veins. 
 
 FIG. 33. VIEW OF THYROID BODY. (Morris.) 
 
 SMALLER CORNU OF HYOID BONE 
 
 BODY OF HVOID BONE 
 
 Thyro-hyoid ligament 
 
 THYROID CARTILAGE 
 
 THYROID ISTHMUS 
 
 Thyro-hyoid membrane 
 
 Thyro-hyoid muscle 
 
 Inferior constrictor 
 
 Sterno-thyroid muscle 
 
 Median portion of crieo- 
 thyroid membrane 
 
 - Crico -thyroid muscle 
 
 LATERAL LOBE OF THYROID BODY 
 
 SECTION THROUGH CARTILAGES 
 
 FIG. 34- THYROID BODY, WITH MIDDLE LOBE AND LEVATOR MUSCLE. (Morris.) 
 
 Stylo-hyoid ligament 
 
 TRACHEA 
 
 EPIGLOTTIS 
 
 BODY OF HYOID BONE 
 Thyro-hyoid ligament 
 
 Thyro-hyoid membrane 
 
 Levator glandulae thyroidea 
 THYROID CARTILAGE 
 
 PYRAMIDAL PROCESS OF THYROID BODY 
 
 I LEFT LATERAL LOBE 
 
THE NECK 
 
 FIG. 35. THVMUS GLAND IN A CHILD AT BIRTH. (Morris.) 
 
 3' 
 
 HYOID BONE 
 
 Thyro-hyoid membrane 
 THYROID CARTILAGE 
 
 Sterno-thyroid muscle 
 Crico-thyroid 
 membrane 
 
 Crico-thyroid muscle 
 THYROID BUND 
 
 Right common carotid 
 
 artery 
 RIGHT pyEl'MO- 
 
 i:i<- yERVK 
 
 lernal jugular 
 MSN 
 
 Level of sternum 
 
 SECTION OF CLAYICLE 
 SECTION OF FIRST RIB 
 
 SECTION OF STERNUM 
 
 Thyro-hyoid muscle 
 
 Lateral portion crico- 
 thyroid membrane 
 
 Omo-hyoid muscle 
 Sterno-mastoid muscle 
 
 CRICOID CARTIUGE 
 FIRST RIN6 OF TRACHEA 
 
 TRACHEA 
 
 Left suspensory 
 
 ligament 
 LEFT RECTRREXT 
 
 XER VE 
 
 (Esophagus 
 
 Lift innominate rein 
 LEFT LOBE OF TIIYHUS 
 
 Left inltrnaj mammary 
 artery 
 
 Pericardium 
 
 SECTION OF RFTH RIB 
 CARTILAGE 
 
 ENSIFORM CARTIUGE 
 
 Submaxillary or Digastric Triangle (Fig. 36). 
 
 Expose the following superficial structures only:- 
 Submaxillary gland. 
 
 Do not remove this gland now. 
 Facial artery. 
 Hypoglossal nerve. 
 
THE NECK 
 
 Muscles : 
 
 Digastric. 
 
 Stylo-hyoid. 
 
 Mylo-hyoid. 
 
 FIG. 36. DIGASTRIC TRIANGLE AND CONTENTS. (Holden.) 
 
 Occipita 
 
 Hypoglossal 
 
 Descendens 
 glossi n. 
 
 Ling 
 
 hypo- 
 
 lala. 
 
 Internal jugu 
 Superior thyr- 
 
 oid a 
 
 Common carotid a. __ 
 
 ala. 
 
 hyoid n. 
 
 bmental ; 
 
TEMPORAL AND PTERYGOID MUSCLES 
 
 33 
 
 DEMONSTRATION VII. 
 
 TEMPORO- AND PTERYGO-MAXILLARY REGION. 
 
 Study the temporal fascia and remove it. 
 
 Study the masseter fascia and remove it. 
 
 Study the masseter muscle. (Fig. 7.) 
 
 Then cut the zygomatic arch on each side of the masseter muscle. The 
 posterior cut should be made immediately in front of the glenoid fossa; the 
 anterior cut should extend obliquely through the malar bone. Now turn the 
 bony arch thus cut with the masseter muscle down; observe the nerve 
 and artery which pass to the muscle through the sigmoid notch between 
 the neck of the jaw and posterior margin of the temporal muscle. When 
 the nerve and artery are found and studied, cut them and remove them 
 with the muscle. 
 
 Clean and study the temporal muscle. 
 
 Then cut the coronoid process of mandible and turn it up with the tem- 
 poral muscle attached. 
 
 Now note the external pterygoid muscle. 
 
 FIG. 37. (Holder.) 
 
 Clean and study the external pterygoid muscle with care so as not 
 to destroy the internal maxillary artery. (Figs. 38 and 39.) 
 
34 
 
 PTERYGOID REGION 
 
 FIG. 38. THE PTERYGOID MUSCLES. (Morris.) 
 
 External pterygoid 
 
 Internal pterygoid 
 
 flbro-cartilage 
 
 FIG. 39. SCHEME OF LEFT INTERNAL MAXILLARY ARTERY. (Walsham.) (Morris.) 
 
 Infraorbital artery and nerve 
 
 Orbital branch 
 
 Palpebral 
 ch 
 
 lpebr 
 bran 
 
 Nasal branch 
 
 Anterior . 
 dental branch I 
 
 Labial branch 
 
 Posterior dental 
 
 branch 
 
 Alveolar branch 
 
 Incisive branch 
 Menial branch 
 
 Submenlal branch 
 
 Spheno-palatine branch 
 
 Posterior or descending palatine branch 
 Inline branch 
 
 'emporal artery 
 
 Small meningeal 
 artery 
 
 Middle meningeal 
 
 artery 
 
 Temporal artery 
 Ti/in/iiinic branch 
 
 Deep auricular 
 branch 
 
 A I'HICULO-TEM- 
 I'OHAL XKRVK 
 
 Manseteric brunch 
 
 External carotid 
 artery 
 
 Internal lateral or 
 spheno-mandibu- 
 lar ligament 
 
 Mtinillbiiltir or 
 htfi'rinr dental 
 artery and nerve 
 
 Buccal branch with. Internal pterygoid branch 
 portion of buccal nerve 
 Mylo-hyoidean branch 
 
PTERYGOID REGIOX 
 
 35 
 
 Cut the condyle of the mandible, disarticulate, and remove it, unthjhe ex- 
 ternal pterygoid muscle. 
 
 Study the temporo-mandibular articulation. 
 
 FIG. 40. VERTICAL SECTION THROUGH THE COXDYLE OF JAW TO SHOW THE TWO]SYXOVIAL 
 
 SACS AXD THE IXTERARTICULAR FlBRO-CARTILAGE. (Morris.) 
 
 Stylo-mandibular ligament 
 
 Xext expose the deep pterygoid region by removing the upper part of 
 the ramus of the mandible. Cut the ramus with saw and bone-pliers im- 
 mediately above the inferior dental foramen. To find the inferior dental 
 foramen thrust a knife handle down between the ramus and soft parts until 
 its progress is arrested by the entrance of the inferior dental nerve and vessels 
 into the foramen. 
 
 Expose the inferior dental vessels and nerve as far as possible by cutting 
 
 \y part of the mandible with chisel and bone-pliers. 
 
 Cut the mandible at the mental foramen and turn the piece cut off up, care- 
 fully cutting the insertions of the internal pterygoid and mylo-hyoid muscles 
 and other structures beneath from the bone. 
 
 Study the internal pterygoid muscle. Xote its relation to the ex- 
 ternal pterygoid. Also note the structures lying between these two mus- 
 cles. . 
 
 Expose and study the following structures : - 
 
 Arteries : 
 
 Internal maxillary and branches. (See Figs. 39 and 41.) 
 
 Veins : 
 
 Internal maxillary and its tributaries. 
 
MAXILLARY REGION 
 
 Nerves (Figs. 42 and 43) : 
 
 Mandibular division of fifth. 
 Recurrent. 
 Internal pterygoid. 
 Anterior portion. 
 Temporal. 
 Masseteric. 
 External pterygoid. 
 Long buccal. 
 
 Posterior portion. 
 
 Lingual. 
 
 Inferior dental. 
 
 Auriculo-temporal. 
 Submaxillary ganglion . 
 Otic ganglion. 
 Chorda tympani. 
 
 FIG. 41. INTERNAL MAXILLARY ARTERY. (Holden.} 
 
 INCISOR 
 
 Submaxillary or digastric triangle. 
 
 The superficial structures have been worked out. 
 Deep structures: 
 Submaxillary gland. 
 Submaxillary ganglion. (See Fig. 43.) 
 Sublingual gland. (Fig. 44.) 
 Nerves in this triangle : 
 
 Lingual. 
 
 Inferior dental. 
 
 Hypoglossal. 
 
 Chorda tympani. 
 Arteries (see Figs. 45 and 28): 
 
 Lingual and branches. 
 
 Facial (a. maxillaris externa). 
 
 Inferior dental. (Fig. 41.) 
 
 Veins : 
 Lingual. 
 Facial. 
 
FIG. 42. DISTRIBUTION OF THE MAXDIBULAR DIVISION OF THE TRIGEMINAL NERVE. 
 
 (Henle.) (Morris.) 
 
 SUB- 
 
 MAXDIBCLAR 
 GAXGLIOy 
 
 MENTAL 
 
 BRANCH 
 
 ANTERIOR TEM- 
 PORAL NER VE 
 
 AL'RICULO-TEM- 
 PORAL SERVE 
 
 POSTERIOR TEM- 
 PORAL SERVE 
 
 NERVE TO MAS- 
 SETER 
 
 CHORDA TYM- 
 PANI 
 
 MYLO-HYOID 
 
 XERVE 
 LiyGUAL 
 XER VE 
 
 INFERIOR 
 DEXTAL SERVE 
 
 FIG. 43. SHOWING FIFTH XERVE. (Holden.) 
 
 
 SSKSCftY ROOT 
 MOTOR HOOT 
 
 AHHICULO TtMPOHM. H. 
 
 37 
 
SUBMA XILLA R Y REGION 
 
 FIG. 44. THE SALIVARY GLANDS. (Morris.) 
 
 PAROTID GLAND 
 
 Masseter muscle 
 
 SOOIA HAROTIDIS 
 
 DUCT OF PAROTID 
 
 Bristle inserted 
 into duct 
 
 Fraenum linguae 
 
 DUCT OF R1VINUS 
 
 SUBLINGUAL GLAND 
 
 DUCT OF SUBMAXILLARY 
 
 GLAND 
 Mylo-hyoid muscle 
 
 Sterno-mastoid 
 
 muscle 
 
 Posterior belly of 
 digastric muscle 
 
 SUBMAXILLARY GLAND, 
 DRAWN BACKWARDS 
 
 Loop of fascia 
 
 HYOID BONE' 
 
 Anterior belly of 
 digastric muscle 
 
 DEEP PORTION OF SUBMAXILLARY GLAND 
 
 FIG. 45. SCHEME OF THE RIGHT LINGUAL ARTERY. (Walsham.) (Morris.) 
 
 Descending palatine artery 
 Falato-pharyngeus 
 
 TONSIL 
 
 Ascending palatine branch 
 
 of facial 
 Tonsillar branch of dorsalis 
 
 linguce 
 
 Tonsillar branch of facial 
 
 Stylo-glossus 
 
 Dorsalis linguce artery 
 
 le constrictor 
 ?AL NERVE 
 
 Facial artery 
 
 Posterior belly of digastric 
 and stylo-hyoid 
 Supra-hyo'id branch 
 
 SUP. LARYNGEALN. 
 
 Infra-hyoid branch 
 Internal carotid artery 
 
 Middle constrictor 
 HYPOGLOSSAL NERVE 
 
 Falato-glossus 
 
 Ranine artery 
 
 r thyroid artery 
 
 External carotid artery 
 Common carotid artery 
 
 Muscles (Figs. 45 and 46) : 
 Mylo-hyoid. 
 Hyo-glossus. 
 Genio-hyoid. 
 Stylo-glossus. 
 
 Genio-hyo-glossus (m. genioglossus}. 
 Chondro-glossus . 
 
SUBM AXILLARY 
 
 39 
 
 FIG. 46. MUSCLES, VESSELS, AXD NERVES OF THE TONGUE. (Holden.) 
 
 Styloid 
 process. 
 
 Glosso- 
 pharyngeal n. 
 
 Hypoglossal n. 
 Occipital a 
 
 Submandibular 
 ganglion. 
 Duct of sub- 
 mandibular 
 gland. 
 Middle con- 
 strictor m. 
 
 Lingual a. 
 
 Descendens 
 hypoglossi n. 
 
 . Chorda tympani c . 
 . Gustatory n. 
 
 Sablin- 
 guala. 
 
40 DEEP NECK 
 
 DEMONSTRATION VIII. 
 DEEP DISSECTION OF THE NECK. (Figs. 28 and 47.) 
 
 Expose the ascending pharyngeal artery. 
 
 Trace to the base of the cranium the : 
 Internal carotid artery. 
 Internal jugular vein. 
 Vagus nerve. 
 Hypoglossal nerve. 
 Gangliated cord. 
 
 Note the cervical ganglia of the sympathetic. 
 
 Clean and study the stylo-pharyngeus muscle. Use care so as not to 
 cut the glosso-pharyngeal nerve, which winds around the posterior and 
 external surface of the stylo-pharyngeus muscle. 
 Trace and study the glosso-pharyngeal nerve. 
 Branches of seventh nerve at its exit through stylo-mastoid foramen. 
 
 Digastric. 
 
 Stylo-hyoid. 
 
 Posterior auricular. 
 
 Note the position of the internal carotid artery in relation to the follow- 
 ing structures: 
 Muscles : 
 
 Middle constrictor of the pharynx. 
 
 Superior constrictor of the pharynx. 
 
 Stylo-pharyngeus. 
 
 Stylo-glossus. 
 
 Ascending pharyngeal artery. 
 Glosso-pharyngeal nerve. 
 
DEEP NECK 
 
 FIG. 47. SCHEME OF RIGHT ASCENDING PHARYNGEAL ARTERY. (Walsham.) (Morris.} 
 
 The internal carotid artery is hooked aside. 
 
 Also see Figs. 30 and 50. 
 
 Meningtal branch pasting through 
 middle lacerated foramen 
 
 Tympanic branch 
 
 Men ingtal branch patting through 
 
 jugular foramen 
 
 Men ingeal branch pasting through 
 anterior candy loid foramen 
 
 Stylo-pharyngeus 
 
 GLOSSO-PfTA R YXGEA L 
 *E YE 
 
 Occipital artery 
 Rectua capitis anticus 
 
 major 
 Ascending pharyngeal 
 
 artery 
 
 Middle constrictor of 
 pharynx 
 
 SY.VPA THE TIC .\ERTE 
 Internal carotid artery 
 External carotid artery 
 
 Intracranial part of internal 
 carotid 
 
 Intraosseous part of internal 
 carotid 
 
 Leva tor palati 
 Palatine branch 
 
 Buccinator muscle 
 
 Superior constrictor 
 of pharynx 
 
 Pterygo-maxillary 
 ligament 
 
 Stylo-glossus 
 
 Ascending palatine branch 
 of facial artery 
 
 Tonrillar branch of facial artery 
 
 Hyo-glossus 
 Facial artery 
 
 Lingual artery 
 Superior thyroid artery 
 
 Common carotid artery 
 
42 ANTERIOR VERTEBRAL AND PHARYNX 
 
 DEMONSTRATION IX. 
 
 Remove the anterior part of the skull with pharynx attached by dividing 
 the trachea and oesophagus about one inch below the larynx. Draw the trachea 
 and (esophagus forward and separate them from their arterial and vertebral 
 attachments. With a saw cut inward along the posterior border of petrous por- 
 tion of temporal bone, passing behind the jugular foramen. Divide the basilar 
 part of occipital bone with a chisel. 
 
 Wrap the part thus severed in a wet cloth and lay it aside while the anterior 
 vertebral region is being dissected. 
 
 ANTERIOR VERTEBRAL REGION. 
 
 Expose and study the following structures: 
 Muscles (Fig. 48) : 
 
 Longus colli. 
 
 Rectus capitis anticus major. 
 
 Rectus capitis anticus minor. 
 
 Rectus capitis lateralis. 
 
 Scaleni. 
 
 Arteries (Fig. 49) : 
 
 Vertebral and branches. 
 Deep cervical. 
 
 Veins : 
 
 Vertebral and tributaries. 
 
 Nerves : 
 
 Trunks of cervical plexus. (Fig. 50.) 
 Trunks of brachial plexus. 
 
 Study articulations of head. 
 Atlas with occiput. 
 Atlas and axis. 
 Axis and occiput. 
 
 PHARYNX. (Figs. 51 and 52.) 
 
 Moderately distend the walls of the pharynx with tow. 
 
 Study a description of the pharynx. Then clean and study the in- 
 ferior, middle, and superior constrictor muscles. 
 
 Study the pharyngeal aponeurosis. 
 
 Now open the pharynx by a posterior median incision. (Fig. 53.) 
 
 Study the interior of the pharynx. Examine, posterior nares, open- 
 ing of Eustachian tube, opening into larynx, pharyngeal recess or fossa 
 of Rosenmuller, pharyngeal tonsil, pharyngeal bursa, base of tongue and 
 beginning of oesophagus. 
 
AXTERIOR VERTEBRAL REGIOX 
 
 FIG. 48. THE MUSCLES OF THE FRONT OF THE NECK. (Morris.) 
 
 Rectus capitis anticua 
 minor 
 
 Rectus capitis lateralis 
 
 Rectus capitis anticus 
 major 
 
 Origin of rectus capitis 
 anticus major 
 
 Scalenus medius 
 
 Scalenus antious 
 
 Scalenus posticus 
 
 Rectus capitis later- 
 alis 
 
 Rectus capitis anti- 
 cus minor 
 
 Intertransyersalis 
 anterior 
 
 Intertransversalis 
 posterior 
 
 Longus colli 
 
 Insertion of scalenus 
 anticus 
 
 Sealenus medius 
 
 Scalenus posticus 
 
44 
 
 DEEP NECK 
 
 FIG. 49. SCHEME OF THE LEFT VERTEBRAL ARTERY. (Walsham.) (Morris.} 
 The internal jugular and vertebral veins are hooked aside to expose the artery. 
 
 Right posterior cerebral artery 
 
 Left posterior cerebral artery 
 
 Basilar artery 
 
 BASILAR PROCESS, OCCIPITAL BONE 
 
 Inlracranial portion of vertebral artery 
 Rectus capitis lateralia muscle 
 
 FIRST CER VIC A L NER VE 
 
 Commencement of vertebral vein 
 
 SECOND CERVICAL NERVE 
 
 Vertebral plexus of reins 
 
 THIRD CERVICAL NERVE 
 
 Vertebral portion of vertebral artery 
 FOURTH CERVICAL NERVE 
 
 Vertebral plexus of veins 
 FIFTH CERVICAL NERVE 
 
 SIXTH CERVICAL NERVE 
 
 Inferior thyroid artery 
 
 Longus colli muscle 
 
 Cervical portion of vertebral artery 
 
 Internal jugular vein, hooked a little 
 aside 
 
 Vertebral re hi, cut 
 Subclavian artery 
 
 Right and left supe- 
 i i</r cerebellar 
 arteries 
 
 OCCIPITAL BONE 
 
 Rectus capitis pos- 
 ticus minor mus- 
 cle 
 
 Occipital portion of vertebral artery 
 
 Arleria princeps cervicis 
 
 Semispinalis colli muscle 
 
 Deep cervical artery 
 
 Scalenus anticus muscle, cut 
 Thyroid axis, hooked a little aside 
 Siibclavian vein 
 
DEEP NECK 
 
 45 
 
 FIG. 50. DIAGRAM OF THE CERVICAL PLEXUS. (Morris.) 
 
 STERNO-MASTOID 
 SMALL OCCIPITAL 
 
 on E.I T 
 
 A URICL'LAR 
 
 SCA LEX US 
 MEDIUM 
 
 SPINA L 
 ACCESSORY 
 
 TRANSVERSE 
 
 CERVICAL 
 
 S^A LE.VT'S 
 
 MED 1 1 \ 
 
 LEVA TOR 
 SCA PULJE 
 
 SYMPATHETIC 
 
 RECTUS CA PITTS ANTICUS 
 
 MAJOR 
 RECTUS CAPITIS ANTICUS 
 
 MINOR 
 RECTUS CAPITIS LATER ALIS 
 
 HYPOGLOSSAL NERVE 
 
 SUPERIOR CERVICAL 
 SYMPATHETIC GANGLION 
 
 LONG US COLLI 
 RECTUS CAPITIS ANTICUS 
 MAJOR 
 
 GENIO-HYOID 
 THYRO-HYOID 
 
 LONG US COLLI 
 RECTUS CAPITIS 
 ANTICUS MAJOR 
 DESCEND ENS 
 
 CERVICIS- 
 O3IO-HYOID 
 
 COMXUNICANS 
 
 CERVICIS 
 LONG US COLLI 
 
 STERNO-HYOID 
 RECTUS CAPITIS 
 ANTICUS MAJOR 
 SCA LENUS 
 A NTICUS 
 STKR NO- 
 THYROID 
 OMO-HYOID 
 
 SCA L EN US MED I US 
 LEVATOR SCAPULM 
 
 TRAI'EZIUS 
 
 SUPRA- SUPRA- 
 
 A CROMIA L CLA J 'ICULA R 
 
 SUPRASTERNAL 
 
46 THE PHARYNX 
 
 FIG. 51. SIDE VIEW OF THE MUSCLES OF THE PHARYNX. (Holden.) 
 
 Obicularis oris 
 
 Pterygo-mandibular 
 ligament. 
 
 - Glosso-pharyngeal n. 
 
 - Stylo-pliaryngeus. 
 
 Mylo-hyoideus. 
 
 Os hyoides. 
 
 Thyro-hyoid ligament. 
 
 Pomum Adami. 
 
 Cricoid cartilage. 
 
 Trachea. 
 
 Superior laryngeal 
 n. and a. 
 
 External laryngeal n. 
 - Crico-thyroideus. 
 
 Inferior laryngeal n. 
 (Esophagus. 
 
 FIG. 52. VIEW OF THE CONSTRICTOR MUSCLES FROM BEHIND. (Holden.) 
 
THE PHARYNX 
 
 47 
 
 p 1G ro VIEW OF MUSCLES OF SOFT PALATE, AS SEEN FROM WITHIN THE PHARYNX. 
 
 (Modified from Bourgery.) (Morris.) 
 
 Levator palati 
 
 Azygos uvulae 
 Hamular process 
 
 Palato- 
 pharyngeus 
 
 EUSTACHIAN TUBE 
 
 Levator palati 
 
 Palato-pharyngeus 
 
 Superior constrictor 
 
 Crico-arytenoideus 
 posticus 
 
 Thyroid cartilage 
 
 Cricoid cartilage 
 
 (ESOPHAGUS 
 
48 PALATE, MOUTH, TONGUE, ETC. 
 
 PALATE. 
 
 Study description of hard and soft palate. 
 Soft palate: 
 
 Anterior palatine arch or pillar. 
 
 Posterior palatine arch or pillar. 
 
 Tonsillar recess. 
 
 Isthmus of fauces. 
 
 Uvula. 
 Dissect out and study the following muscles (Fig. 53) : 
 
 Palato-pharyngeus. 
 
 Palato-glossus. 
 
 Levator palati (M. levator veli palatini}. 
 
 Tensor palati (M. tensor veli palatini}. 
 
 Azygos uvulae (M. wuulaz). 
 
 Salpingo-phary ngeus . 
 Tonsils, faucial. 
 
 Their location and description. 
 
 Describe the arteries, veins, and nerves of the pharynx, palate, and 
 tonsils. 
 
 MOUTH. 
 
 Study a description of mouth. 
 
 TEETH. 
 
 General description. 
 Temporary or milk teeth: 
 
 How many? 
 
 At what ages do their eruptions occur? 
 Permanent teeth. 
 
 How many? 
 
 At what ages do their eruptions occur? 
 What is the arterial and nerve supply of the teeth? 
 
 TONGUE. 
 
 General description. 
 Muscles of tongue: 
 
 Extrinsic. (See Fig. 60.) 
 
 Hyo-glossus. 
 
 Genio-hyo-glossus. 
 
 Stylo-glossus. 
 
 Palato-glossus. 
 
 Part of sup. constrictor. 
 Intrinsic. (See Fig. 60). 
 
 Lingualis superior. 
 
 Lingualis inferior. 
 
 Transverse fibres. 
 
 Vertical fibres. 
 What is the arterial and nerve supply of the tongue? 
 
THE TOXGUE 
 
 49 
 
 fFic. 54. DORSUM OF THE TONGUE. (Morris.) 
 
 EXTREMITY OF CORNU OF False vocal cord LOWER END OF PHARYNX 
 
 HYOIO BONE 
 
 SUPERIOR CORNU OF THYROID\ 
 CARTILAGE 
 
 LATERAL GLOSSO- 
 EPIGLOTTIDEAN FOLD 
 
 ANTERIOR WALL OF THE 
 PHARYNX 
 
 CORNICULUM LARYNGIS 
 CUNEIFORM CARTILAGE 
 SINUS PYRIFORMIS 
 
 True vocal cord 
 EPIGLOTTIS 
 
 MEDIAN GLOSSO- 
 EPIGLOTTIDEAN FOLD 
 
 POSTERIOR PILLAR OF FAUCES 
 
 CIRCUMVALLATE PAPILL/E 
 
 FUN6IFORM PAPILLC 
 
THE TONGUE 
 
 FIG. 55. UNDER SURFACE OF THE TONGUE WITH MUSCLES. (Morris.) 
 
 FR/ENUM LINGU/E 
 
 LingualiB inferior 
 
 Hyo-glosBus 
 
 Qenio-hyoid 
 
 Mylo-hyoid, reflected 
 
 Sterno-hyoid 
 
 Lingualis inferior 
 
 Genio-hyo-elossu 
 
 Stylo-glossus 
 
 Hyo-glosaua 
 BODY OF HYOID BONE 
 Oenio-hyoid 
 
 THYROID CARTILAGE 
 
THE LARYNX 
 
 LARYNX. 
 
 General description. 
 
 Note its position, and its relation to the pharynx. 
 
 FIG. 56. FRONT VIEW OF THE CARTILAGES OF THE LARYNX. (Modified from Bourgery 
 
 and Jacob.) (Morris.) 
 
 BODY OF HYOID BONE 
 Thyro-hyoid ligament 
 
 Cartilage triticea 
 Foramen for superior 
 
 laryngeal nerve 
 Median portion ol thyro- 
 
 hyoid membrane 
 
 SUPERIOR CORNU OF THYROID 
 
 CARTILAGE 
 
 MEDIAN NOTCH OF THYROID 
 CARTILAGE 
 
 Fomum Adami 
 
 OBLIQUE LINE OF THYROID 
 CARTILAGE 
 
 Crico-thyroid membrane 
 
 THIRD RING OF TRACHEA 
 
 Note the following: 
 
 Connection with the tongue. (Fig. 54.) 
 
 Median glosso-epiglottic fold. 
 
 Lateral glosso-epiglottic fold. 
 
 Epiglottic vallecula. 
 Superior aperture of larynx. (Fig. 54.) 
 
 Epiglottis. 
 
 Aryteno-epiglottic fold. 
 
 Cuneiform cartilage. 
 
 Carniculum laryngeus. 
 
 Inter-arytenoid fold. 
 
 Sinus pyriformis. 
 
 Lower end of pharynx. 
 Inside of larynx. 
 
 Cushion or tubercle of the epiglottis. 
 
 Vocal process of arytenoid cartilage. 
 
THE LARYNX 
 
 FIG. 57. SIDE VIEW OF THE CARTILAGES- OF THE LARYNX. (Modified from Bourgery and 
 
 Jacob.) (Morris.) 
 
 Thyro-hyoid membrane 
 
 SUPERIOR BORDER OF THYROID 
 
 Crieo-thyroid muscle 
 Crico-thyroid membrane 
 (median portion) 
 
 Crico-thyroid muscle 
 
 THIRD RING OF TRACHEA 
 
 Thyro-hyoid ligament 
 
 CARTILAGO TRITICEA 
 
 -SUPERIOR CORNU 
 
 Superior tubercle 
 Stylo-pharyngeus and 
 palato-pharyngeus 
 
 Thyro-hyoid muscle 
 
 Sterno-thyroid muscle and 
 inferior tubercle 
 
 Inferior constrictor 
 
 FIG. 58. POSTERIOR VIEW OF THE LARYNX, WITH THE MUSCLES REMOVED. (Holden.) 
 E., Epiglottis cushion (W.); L. ar.-ep., Aryteno-epiglottic fold or ligament; M.m., Mem- 
 brana mucosa; C. W., Cartilage of Wrisberg or cuneiform; C. S., Cartilage of Santorini 
 or cornicula laryngis; C. aryt., Arytenoid cartilage; C. c., Cricoid cartilage; P. m., 
 Muscular process or external angle; L.cr.-ar., Cricoarytenoid ligament; C. s., Superior 
 cornu; C. i., Inferior cornu of the thyroid cartilage; L. ce.-cr. p. i., Posterior inferior 
 cerato-cricoid ligament; C. tr., Tracheal cartilage; P. m. tr., Membranous portion of 
 the trachea. 
 
THE LARYXX 
 
 53 
 
 True vocal cords. 
 
 False vocal cords. 
 
 Ventricle of larynx. 
 
 Rima glottidis. 
 
 Study the cartilages of the larynx. (Fig. 58.) 
 
 Note the articulations of the thyroid, cricoid, and arytenoid cartilages. 
 Clean and study the muscles: 
 Crico-thvroid. 
 
 FIG. 59. POSTERIOR VIEW OF THE LARYNX, WITH ITS MUSCLES. (Holden.) 
 E., Epiglottis, with the cushion (W.); C.W., Cartilage of Wrisberg; C.S., Cartilage of San- 
 torini; Cart, eric., Cricoid cartilage; Cornu sup., Superior cornu of the thyroid carti- 
 lage; A/, ar. tr., Transverse portion of the arytenoideus ; Mtn.ar. obi., Oblique portion 
 of the arytenoideus; M. cr. aryt. post., Crico-arytenoideus muscle; Pars can., Car- 
 tilaginous rings of the trachea; Pars memb., Tracheal membrane. 
 
 Crico-arytenoides posticus. 
 
 Arytenoides. 
 
 Now cut the thyroid cartilage a little to one side of the anterior median line, 
 disarticulate the inferior cornu from cricoid cartilage and remove this part of 
 thyroid cartilage. Then expose the muscles: 
 Crico-arytenoides lateralis. 
 Thyro-arytenoides. 
 Aryteno-epiglottideus . 
 Thyro-epiglottideus . 
 
 Study closely the action of the laryngeal muscles. 
 
54 
 
 THE LARYNX 
 FIG. 60. SIDE VIEW OF THE MUSCLES AND LIGAMENTS OF THE LARYNX. (Morris.} 
 
 Epiglottis 
 
 Cut edge of hyo-epiglottidean 
 ligament 
 
 SECTION THROUGH BODY OF HYOID 
 BONE 
 
 Periglottis 
 
 Cut edge of thyro-hyoid 
 membrane 
 
 Thyro-epiglottideus muscle 
 
 SECTION OF THYROID CARTILAGE 
 Thyro-arytenoideus muscle 
 
 Crico - arytenoideus lateralis 
 muscle (the pointer crosses 
 crico-thyroid membrane.) 
 
 CRICOID CARTILAGE 
 
 Aryteno-epiglottidean fold 
 Aryteno-epiglottideus muscle 
 
 Arytenoideus muscle 
 
 Crico-arytenoideus posticus 
 
 Recurrent laryngeal nerve 
 
 FIG. 61. NERVES OF THE LARYNX (POSTERIOR VIEW.) (Morris.} 
 
 FORAMEN C/ECUM 
 BASE OF TONGUE 
 
 GREATER CORNU OF 
 
 HYOID BONE 
 CARTILAGO TRITICEA 
 
 SUPERIOR CORNU OF 
 THYROID CARTILAGE 
 
 BRANCH TO LATERAL 
 CRICO ARYTENOID 
 AND THYRO-ARYTE- 
 JfOID MUSCLES 
 BRANCH JOINING THE 
 SUPERIOR LARYN- 
 GEAL NERVE 
 Crico-arytenoideus 
 posticus muscle 
 INFERIOR CORNU OF 
 THYROID CARTILAGE 
 
 EXTERNAL LARYN- 
 GEAL NERVE 
 
 IN TERN A LLAR YN- 
 GEAL NERVE 
 
 Cut edge of thyro- 
 hyoid membrane 
 
 Arytenoideus muscle 
 
 RECURRENT 
 
 I,M:YNGEAL 
 
 NER VE 
 
THE LARYXX 
 
 55 
 
 Study the thyro-hyoid membrane, crico-thyroid membrane, infenor 
 thyro-arytenoid ligament, superior thyro-arytenoid ligament, true vocal 
 cords, rima glottidis, ventricle, false vocal cords, laryngeal pouch or sac- 
 culus laryngis, and the mucous membrane. 
 
 Describe the nerve supply of the larynx (See Fig. 61): 
 Superior laryngeal. 
 Inferior or recurrent laryngeal. 
 Describe the arteries of the larynx (See Fig. 62) : 
 Branches of superior thyroid. 
 Branches of inferior thyroid. 
 Dorsalis lingual. 
 
 FIG. 62. SCHEME OF LEFT SUPERIOR THYROID ARTERY. (Walsham.) (Morris.) 
 
 Facial artery 
 
 Lingual artery 
 
 Supra-hyoid branch 
 Infra-hyoid branch 
 
 Superior laryngeal bratictt 
 
 Crico-thyroid branch 
 
 External carotid artery 
 Ascending pharyngeal artery 
 
 Internal carotid artery 
 
 Sterno-mastoid branch 
 
 Superior thyroid artery 
 
 Common carotid artery 
 
 Inferior thyroid artery 
 
SUPRAM AXILLARY NERVE AXD XOSE 
 
 DEMONSTRATION X. 
 
 SUPRA-MAXILLARY REGION. 
 
 With a saw cut through the squamous portion of the temporal bone to within 
 one-fourth of an inch of the foramen rotundum. With a hammer break out 
 the portion of bone in front of the incision. Then begin at the Gassenan gan- 
 glion and trace out the superior tnaxillary division of the fifth nerve across the 
 spheno -maxillary fossa to the infra-orbital canal. 
 
 Deep in the spheno-maxillary fossa and just below the superior maxil- 
 lary nerve find Meckel's ga'nglion. (Figs. 63 and 66.) 
 
 FIG. 63. THE MAXILLARY NERVE SEEN FROM WITHOUT. (Beaunis.) (Morris.) 
 
 AJXTERWR DENTAL MAXILLARY KERVE ORBITAL BRAN< II 
 
 I \ .MAXILLARY NERVE 
 
 MECKEL'S GANGLION 
 
 POSTERIOR DENTAL 
 
 LOOP FORMED BY MIDDLE AND ANTERIOR DENTAL NERVES 
 
 Trace and study the branches of superior maxillary nerve: 
 
 Recurrent meningeal. 
 
 Spheno-palatine . 
 
 Orbital or temporo-malar. 
 
 Posterior superior dental. 
 
 Middle superior dental. 
 
 Anterior superior dental. 
 
 Review the third division of the internal' maxillary artery. 
 
 NOSE. 
 
 Study general description of the nose. 
 
 Open the nasal cavity by a vertical incision to one side of median line 
 so as to escape the septum. (Figs. 64 and 65.) 
 Study the septum. 
 
 Study the turbinate bones and meatuses and the openings into each. 
 What is the nerve and arterial supply of the nose? 
 
THE XOSE 
 
 57 
 
 FIG. 64. SECTION SHOWING BONY AND CARTILAGINOUS SEPTUM. (Morris.) 
 The dotted lines indicate the course of the anterior palatine canal. 
 
 NASAL BONE 
 
 Frontal sinus 
 
 Sphenoidal sinus 
 
 UPPER LATERAL CARTILAGE 
 
 Groove between septal 
 and upper lateral 
 cartilage 
 
 LZ.'.i- LATERAL 
 
 N-P- -V 
 
 THICKENED BORDER OF CARTILAGE RESTING \ Pouch at r 
 
 UPOa AUTERiOR NASAL SPINE Incisive papilla \ extremity of Sten- 
 
 SEPTAL CARTILAGE 8on>8 canal 
 
 ORIFICE OF EUSTACHIAH 
 
 TUBE 
 SOFT PALATE 
 
 FIG. 65. SECTION OF THE XOSE. SHOWING THE TURBINAL BONES AND MEATUSES. WITH 
 THE OPENINGS IN DOTTED OUTLINE. (Morris.) 
 
 Frontal sinus 
 
 Orifice of middle ethmoidal cells 
 
 SUPERIOR TURBINAL BONE 
 
 Orifice of the posterior ethmoidal cells 
 Orifice of the sphenoidal sinus 
 Sphenoidal sinus 
 
 Orifice of frontal sintu 
 
 UPPER ORIRCE OF 
 NASAL DUCT 
 
 OWFICE OF EUSTACHIAN 
 
 / 17 \ 
 
 MIDDLE TURBINAL BONE / \ \ 
 
 INFERlOfi TURBINAL BONE ORIFICE OF THE ANTRUM ORIFICE OF INFUNOIBULUU 
 
 LOWER ORIFICE OF NASAL DUCT 
 
THE NOSE 
 
 FIG. 66. NERVES OF THE NASAL CAVITY. (Morris.) 
 
 NA SA L OLFA CTOR Y 
 FRONTAL SINUS NERVE NERVE 
 
 OF, FA CTOR Y NEK VK 
 TO SUPERIOR TUR- 
 BINA TE BONE 
 
 SPHENOIDAL SINUS 
 
 VIDIAN SERVE 
 
 MECKEL'S 
 GANGLION 
 
 DESCENDING 
 PA LA TINE 
 
 ORIFICE OF EUSTACHIAN 
 TUBE 
 
 NASAL BRANCHES 
 
 POSTERIOR 
 
 PALATINE 
 . ANTERIOR 
 
 PA LA TINE 
 MIDDLE PALATINE 
 
 FIG. 67. SECTION OF THE MIDDLE AND EXTERNAL EAR. (Morris.) 
 
 SEMI- 
 CIRCULAR 
 CANALS 
 Membrana 
 tympani 
 
 CAVITY OF 
 TYMPANUM 
 
 CARTILAGE 
 
 PINNA 
 
 CARTILAGINOUS MEATUS 
 
 OSSEOUS MEATUS 
 
 CARTILAGE OF EXTERNAL 
 MEATUS 
 
 PAROTID GLAND 
 
 STYLOID PROCESS 
 
 Internal carotid 
 artery 
 
 CARTILAGINOUS EUSTACHIAN 
 TUBE 
 
 OSSEOUS EUSTACHIAN TUBE 
 
THE EAR 
 
 59 
 
 EAR. 
 
 External ear. (Fig. 67.) 
 Pinna or auricle. 
 Integument. 
 Cartilage. 
 Ligaments. 
 Muscles. 
 
 External auditory meat us. 
 Cartilaginous portion. 
 Osseous portion. 
 Skin. 
 
 Middle ear or tympanum. 
 
 Tympanic Cavity. This is best opened for inspection by removing its 
 roof or tegmen tympani. Make an opening through the tegmen tympani 
 external to the elevation formed by the superior semicircular canal. Re- 
 move the whole roof of the tympanic cavity, and study its ossicles, walls, 
 mastoid antrum, attic, and Eustachian tube. 
 Internal ear or labyrinth. 
 Osseous labyrinth. 
 Vestibule. 
 
 Semicircular canals. 
 Cochlea. 
 
 FIG. 68. SECTION OF THE TYMPANUM, ETC. Enlarged. (Morris.) 
 
 HEAD OF MALLEUS 
 
 LONG CRUS OF INCUS 
 BASE OF STAPES 
 HEAD OF STAPES 
 
 ORBICULAR BONE, OR 
 
 LENTICULAR PROCESS 
 
 EUSTACHIAN TUBE 
 
 Fibrous layer of 
 membrana tympani 
 
 CAVITY OF TYMPANUM 
 
 
 Suspensory ligament 
 ATTIC OF THE TYMPANUM 
 External ligament 
 SHORT CRUS OF MALLEUS 
 
 HANDLE OF MALLEUS 
 EXTERNAL AUDITORY CANAL 
 
60 THE BACK 
 
 DEMONSTRATION XL 
 BACK. 
 
 Place the cadaver in a prone position. Note the vertebral spines. Sup- 
 port the chest with a block so as to make the muscles tense. 
 
 Dissection: Make an incision along the middle line of the back from 
 the occiput down. Turn the skin outward with care so as not to destroy 
 all of the posterior primary divisions of nerves. (Fig. 69.) 
 
 Posterior primary nerves: 
 Cervical. 
 
 Internal branches. 
 
 External branches. 
 First cervical. 
 Second cervical. 
 
 Internal branch or Great Occipital. 
 Third cervical. 
 
 Small occipital. 
 
 Fourth, fifth, sixth, seventh and eighth cervical. 
 Dorsal. 
 
 Internal branches. 
 
 External branches. 
 
 Lumbar branches. 
 
 Study superficial and deep fascia of the back. 
 Expose and study the following: 
 
 Muscles : 
 
 First layer. (Fig. 70.) 
 Trapezius. 
 Latissimus dorsi. 
 
 ' Second layer. (Fig. 71.) 
 
 Levator anguli scapulas. 
 Rhomboideus minor. 
 Rhomboideus major. 
 
 Third layer. (Fig. 72.) 
 
 Serratus posticus superior. 
 Serratus posticus inferior. 
 Splenius capitis colli. 
 
THE BACK 
 
 61 
 
 FIG. 69. DISTRIBUTION OF THE POSTERIOR PRIMARY DIVISIONS OF THE SPINAL NERVES. 
 
 (Henle.) (Morris.} 
 
 Scmi-spinalis 
 
 Multifldua spinae 
 
 LongissimuB 
 dorsi 
 
 Ilio-costalia 
 
 Trap ezi ns 
 
 Gluteus 
 maiimua 
 
62 THE BACK 
 
 FIG. 70. FIRST LAYER OF MUSCLES OF THE BACK. (Morris.} 
 
 Triceps '- 
 
 Teres minor 
 Infraapinatus 
 
 Teres major 
 
 Rhomboideus major 
 
 Pectoralis major 
 
 Obliquus externus 
 
 Glutens medius 
 
 Glutens maximus 
 
THE BACK 
 
 FIG. 71. THE LEVATOR ANGULI SCAPULAE AND RHOMBOIDEI. (Morris.') 
 
 Supraspinatu 
 
 Obliquus internus 
 
 Complexus 
 Splenius capitis 
 
 Levator anguli scapulae 
 
 Serratus posticua 
 superior 
 
 Rhomboideua minor 
 
 Splenius colli 
 Rhomboideus major 
 
THE BACK 
 
 FIG. 72. THE THIRD AND FOURTH LAYERS OF THE MUSCLES OF THE BACK. (Morris.) 
 
 Spleniu; 
 
 Sple 
 
 Serratus posticua 
 
 Vertebral aponeurcwis 
 
 Serratus postious 
 inferior 
 
 Obliquus interims 
 
 Origin of latissimus 
 dorsi 
 
 SEVENTH CERV CAL VERTEBRA 
 
 TWELFTH THORACIC VERTEBRA 
 
 FIFTH LUMBAR VERTEBRA 
 
THE BACK 
 
 FIG. 73. SCHEME OF INTERCOSTAL ARTERY. (Walsham.) (Morris.) 
 
 . Internal division of muscular branch 
 Semispinalis dorsi and multifidus spinae 
 
 Posterior spinal arteries 
 
 Rftroneural branch 
 
 Medullary branch 
 
 Preneural branch 
 
 > /'/.V.I /, ffjRD 
 
 Anterior spinal artery 
 
 Intercostal artery 
 
 Vena azygos minor 
 Vena azygns major _ 
 THORACIC DUCT 
 
 External division of mitscular branch 
 
 Ilio-costalis 
 
 Spinal branch 
 
 Donal branch 
 
 Anterior intercostal 
 
 Internal mammary artery 
 
 Anterior perforating branch if 
 " Inti-miil mammary artery 
 
 SYMPATHETIC 
 
 Lower branch of 
 aortic intercostal 
 
 Upper or main 
 branch of aortic 
 intercostal 
 
 Lower branch of 
 anterior intercostal 
 
 Mammary glandular 
 
 branch 
 
 l'/>per or main 
 branch of anterior 
 
 intercostal 
 
 FIG. 74. SCHEME OF ANASTOMOSES OF THE RIGHT SCAPULAR ARTERIES. (Walsham.) 
 
 (Morris. ) 
 
 Snhscapular branch of suprascapular artery 
 Supratpinons branch of siiprascapular artery 
 
 Posterior scapular artery 
 
 Suitraspinott* branch 
 
 of posterior scapular 
 
 artery 
 Snbscapular branch 
 
 of posterior scapular 
 
 artery 
 
 Branch of intercostal 
 artery 
 
 Branch of intercostal 
 
 artery 
 
 Continuation of posterior 
 scapular artery 
 
 Siiproicapular artery 
 
 Acromial branch 
 ofacromio- 
 thoracic 
 
 Acromial rete 
 
 Subscapular branch 
 
 of svprascapiilar 
 
 artery 
 Infraspinovs branch 
 
 of suprascapular 
 
 artery 
 Sttbscajmlfir branch 
 
 of axillary artery 
 
 Dorsal scapular branch of 
 subscapnlar artery 
 
 Continuation of sub- 
 scapular artery 
 
66 
 
 THE BACK 
 
 FIG. 75. THE FIFTH LAYER OF THE MUSCLES OF THE BACK. (Morris.) 
 
 Com pi 
 
 Traehelo-m 
 
 Transversalis colli 
 
 Cervicalis ascendens 
 
 Longissimus dorsi 
 
 Aceessorius ad ilio- 
 
 costalera 
 
 Spinalis dorsi 
 
 Ilio-eostalis 
 
 Obliquus internus 
 
 Erector spinae 
 
 SEVENTH CERVICAL VERTEBRA 
 
 TWELFTH THORACIC VERTEBRA 
 
 FIFTH LUMBAR VERTEBRA 
 
SUBOCCIPITAL TRIANGLE 
 
 67 
 
 Arteries (Figs. 73 and 74) : 
 Intercostals. 
 Posterior scapular. 
 
 Expose and study the erector spinae muscle. (Fig. 75.) 
 Study the vertebral aponeurosis. 
 
 The remaining muscles of the back, except the muscles of the sub- 
 occipital triangle, need not be dissected out. The names of the muscles 
 should, however, be remembered. 
 
 FIG. 76. DRAWING FROM NATURE, OF THE SUBOCCIPITAL TRIANGLE. (Holden.~) 
 and 7. Complexus. 2. Rectus cap. posticus minor. 3. Rectus cap. posticus major. 
 4. Obliquus inferior. 5. Sternomastoid. 6. Semispinalis colli. 8. Obliquus superior. 
 10. Splenius. n. Trachelo-mastoid. 12. Great occipital nerve. 13. Occipital artery 
 giving off its descending branch the princeps ceruicis. 14. Suboccipital nerve. 15. 
 Third cervical nerve (posterior branch). 
 
 SUBOCCIPITAL TRIANGLE. 
 
 Muscles : 
 
 Rectus capitis posticus major. 
 
 Rectus capitis posticus minor. 
 
 Obliquus capitis inferior. 
 
 Obliquus capitis superior. 
 Xerves : 
 
 First cervical (suboccipitalis). 
 
 Second cervical. 
 
 Great occipital. 
 Arteries : 
 
 Vertebral. (See Fig. 49.) 
 
 Occipital. 
 
 Princeps cervicis. 
 
 Deep cervical. 
 
68 
 
 PECTORAL REGION 
 
 DEMONSTRATION XII. 
 
 PECTORAL AND AXILLARY REGION. 
 
 Examine in the articulated skeleton the position of the following 
 
 Clavicle. Sternum. 
 
 Scapula and processes. 
 
 Shoulder joint. 
 
 Ribs. Costal cartilages. 
 Outline position of the heart. (Fig. 85.) 
 
 FIG. 77. THE PECTORALIS MAJOR AND DELTOID. (Morris.) 
 
 Biceps 
 
 Terse major 
 
 Serratus magnus 
 
 I Aponeurosis of external oblique 
 
 External intercostal 
 
 Place the cadaver upon its back, draw the arm out to a right angle with the 
 trunk, then make a vertical incision through the skin in the median line from 
 the upper to the lower part of the sternum; a second incision from the ensi- 
 form cartilage along the inner fold of the axilla to the deltoid muscle; a third 
 incision from the middle of the clavicle along the anterior part of the upper 
 third of the arm. Remove the skin from the pectoral region, turn it outward 
 from the upper arm, outward and backward from the axilla. 
 
 Note and study the superficial fascia, pectoral fascia, clavi-pectoral 
 fascia, costo-coracoid membrane, and axillary fascia. 
 
PECTORAL REGION AND AXILLA 69 
 
 Study superficial nerves. (See Fig. 81.) 
 Study mammary gland. 
 
 Study the lymphatics of the thorax, upper extremity, and axilla. 
 Expose and study the pectoralis major muscle. (Fig. 77.) 
 Detach this muscle from its origin and turn it outward. See the an- 
 terior thoracic nerves as they enter the muscle on the posterior surface. 
 Clean and study the pectoralis minor muscle. (See Fig. 78.) 
 Detach this muscle from its origin and turn it outward. 
 Clean and study the subclavius muscle. (See Fig. 79.) 
 Clean and study: 
 Nerves : 
 
 Anterior thoracic. 
 External. 
 Internal. 
 Dorsal. (Fig. 80.) 
 
 Anterior primary divisions. 
 Lateral. 
 Anterior. 
 
 Intercosto-humeral (Fig. 81) this lateral branch of the 
 second dorsal passes out from the second intercostal space 
 to the arm. 
 
 Expose the brachial plexus and notice the relation the cord and larger 
 branches bear to the blood-vessels. (Figs. 94, 98, 100.) 
 Arteries : 
 
 Perforating branches of internal mammary. (Fig. 82.) 
 Axillary and branches. (See Fig. 83.) 
 Veins : 
 
 Axillary and tributaries. 
 
 Expose and study the serratus magnus muscle (M. serratus anterior). 
 (Fig. 84.) 
 
 Review carefully the lymphatic nodes and afferent and efferent vessels 
 of the axilla. 
 
 When all the structures in the axilla are exposed study their relative 
 positions to each other and to surrounding parts. 
 
7 o 
 
 PECTORAL REGION 
 
 FIG. 78. THE PECTORALIS MINOR, OBLIQUUS INTERNUS, PYRAMIDALIS, AND RECTUS AB- 
 
 DOMINIS. (Morris.} 
 
 Subscapularis 
 
 Pectoralis minor 
 
 Pectoralis major 
 77 Teres major 
 
 Internal oblique 
 
 Pyramidalis 
 Conjoined tendon 
 
PECTORAL REGION 
 
 7 1 
 
 FIG. 79. THE SUBCLAVICS AND THE UPPER PORTION* OF THE SERRATUS MAGNUS. (Morris.) 
 
 Subclavius 
 
 Serratus magnos 
 
 \ 
 
 FIG. 80. DIAGRAM OF THE DISTRIBUTION OF A TYPICAL DORSAL NERVE. (Morris.) 
 
 INTERNAL BRANrif 
 
 Longiasirnus Dorsi 
 
 Semispinalis Dorsi 
 Multifldua Spinae 
 
 Superior Costo-transverse 
 
 Ligament 
 POSTERIOR ROOT 
 
 ANTERIOR ROOTJ 
 RECURRENT BRANCH 
 SYMPA THETIC GANGLION 
 
 EFFERENT BRA NC1I 
 
 BR ASCII TO AORTA 
 
 (Esophagus 
 
 Internal Mammary Artery 
 Triaugularis Sterni 
 
 AccesBOrius 
 
 EXTERNAL BRANCH 
 
 POSTERIOR PRIMARY 
 DIVISION 
 ANTERIOR PRIMARY 
 
 Dl VISION 
 Internal Intercostal Muscle 
 
 External Intercostal Muscle 
 
 LATERAL BRANCH 
 
 ANTERIOR BRANCH 
 
 Anterior Intercostal Membrane 
 
7 2 
 
 PECTORAL REGION 
 
 FIG. 81. CUTANEOUS NERVES OF THE THORAX AND ABDOMEN, VIEWED FROM THE SIDE. 
 
 (After Henle.) (Morris.) 
 
 Fectoralis major 
 
 SUPRA CLA VTCULAR 
 BRANCH OF 
 CERVICAL PLEXUS 
 
 Pectoralis minor rr 
 
 INTERCOSTO- 
 HUMERAL 
 
 11 !;I**#!TJ Latissimus dorsi 
 
 Sheath of rectus 
 
 ANTERIOR 
 
 CUTANEOUS OF 
 LAST THORACIC 
 
 ILIO- 
 HYPOGASTRIC 
 
 ILIO-INGUINAL 
 
 Serratus magnus 
 
 Ezternal oblique 
 
 LATERAL CUTANEOUS 
 OF LAST THORACIC 
 NERVE 
 
IXTERXAL MAMMARY ARTERY 
 
 73 
 
 FIG. 82. SCHEME OF THE RIGHT INTERNAL MAMMARY ARTERY. (Walsham.) (Morris.) 
 
 Common carotid artery 
 
 PHREXLC XER VE 
 
 Sabclarian artery 
 
 Subclavian i-ein, cut 
 
 Anterior intercostal branch 
 
 Anterior intercostal branch 
 
 Mutcvlo-phrenic artery 
 
 Deep circumflex iliac artery 
 
 Internal jugular vein 
 Subclarian rein, cut 
 Scalenua anticus muscle 
 
 STERNUM 
 
 Triangularis sterni muscle 
 Perforating branch 
 
 Superior epigattric artery 
 
 Deep epigattric artery 
 
FIG. 83. DIAGRAM OF AXILLA. (Holden.) 
 
 i. Axillary artery. 2. Brachial artery. 3. Thoracica humeraria artery. 4. Superior 
 thoracic artery. 5. Subscapular artery. 6. Dorsalis scapulae artery. 7. Posterior 
 circumflex artery. 8. Superior profunda artery. 9. Posterior thoracic nerve. 10. 
 Long subscapular nerve, n. Median nerve. 12. Cephalic vein. 13. Musculo-cuta- 
 neous nerve. 14. Teres major. 
 
 FIG. 84. SERRATUS MAGNUS. (Morris.} 
 
 Upper part of 
 
 eerratus magnus 
 
 Middle part 
 
 Lower part 
 
 74 
 
THORAX 
 
 75 
 
 DEMONSTRATION XIII. 
 
 THORAX AND THORACIC VISCERA. 
 
 Study the thorax in the articulated skeleton. Note: 
 
 Cavity of thorax. 
 
 Superior aperture. 
 
 Inferior aperture. 
 
 Costal arches. 
 
 Intercostal spaces. 
 
 Locate the position of heart and its valves. 
 
 Xow cut the costal cartilages where they join the ribs and remove them 
 with the sternum. Do this with care so as not to destroy the structures 
 beneath. 
 
 Xote and study internal mammary artery and branches. (See Fig. 82.) 
 
 FIG. 85. SHOWING THE POSITION OF THE HEART AND ITS VALVES IN RELATION TO THE 
 
 CHEST WALLS. (Morris.) 
 
 (Reduced from Hensman and Fisher's Anatomical Outlines.) 
 
 (The right auricle and ventricle, with the pulmonary semilunar and tricuspid valves, are 
 outlined in blue tints; whilst the left auricle and ventricle, with their corresponding 
 valves, are indicated in red.) 
 
7 6 
 
 THORAX 
 
 FIG. 86. ANTERIOR VIEW OF THE THORAX WITH CHEST WALL REMOVED, SHOWING THE 
 LUNGS. (Modified from Bourgery.) (Morris.} 
 
 CLAVICLE 
 
 Pectoralis major muscle 
 Peetoralis minor muscla 
 
 SUPERIOR LOBE 
 
 Serratus magnua 
 muacle 
 
 MIDDLE LOBE 
 
 Diaphragm 
 
 STERNUM 
 
 ENSIFORM CARTILAGE 
 
 Trace as far as possible and study the pericardium. 
 
 Trace as far as possible and study the pleura. 
 
 Mediastinal space. What is it? 
 
 Study the thymus gland. (See Fig. 35.) 
 
 Study the position and relation of the heart, large blood-vessels, lungs, 
 trachea, bronchi, and oesophagus. (Figs. 87, 88, 92.) 
 
 Trace the phrenic nerve down between the pericardium and pleura. 
 (Fig. 88.) 
 
 Trace the vagus nerve down to the pulmonary plexus. (Figs. 88 and 89.) 
 
 Remove the heart and lungs. Cut the arch of the aorta just beyond 
 the origin of the left subclavian artery. Cut the pericardium from the 
 diaphragm. Lay the heart and lungs aside and dissect out and study the 
 following : 
 
 Muscles : 
 
 Intercostal. 
 External. 
 Internal. 
 Diaphragm. 
 Dorsal, or intercostal nerves. (See Fig. 80.) 
 
 Infracostalis (Mm. subcostales] . 
 Triangularis sterni (M. transversus thoracis}. 
 Levatores costarum. 
 
THORACIC VISCERA 
 
 77 
 
 FIG. 87. ANTERIOR VIKW OF THE LUNGS; PERICARDIUM. (Modified from Bourgery.) 
 
 (Morris.) 
 
 Vena cava superior 
 
 BRONCHUS 
 
 Pulmonary artery 
 Pulmonary vein 
 
 Arch. of aorta 
 
 Pulmonary artery 
 BRONCHUS 
 Pulmonary vein 
 
 ENSIFORM CARTILAGE 
 
THORACIC VISCERA 
 
 FIG. 88. THE ARCH OF THE AORTA 
 OF THE AORTA. 
 
 RIGHT RECUR- 
 RENT LA RYN- 
 GEAL NERVE 
 
 Transverse cervical 
 
 artery 
 Right common carotid 
 
 artery 
 Suprascapular artery 
 
 Internal jugular vein 
 
 PNEUMOGASTRIC 
 NERVE 
 Stibclavian vein 
 
 Inferior thyroid vein 
 
 PHRENIC NER VE 
 
 Left innominate vein 
 
 Ascending aorta 
 
 Superior vena cava 
 RIGHT BRONCHUS 
 
 Branch to superior lobe 
 
 of lung 
 
 Upper branch of right 
 
 pulmonary ////// 
 
 Branch to middle lobe 
 
 of lung 
 Right pulmonary vein 
 
 RIGHT AURICLE 
 
 Right coronary artery 
 Lower branch of right 
 pulmonary ///'/// 
 THORACIC VERTEBRA 
 
 Intercostal vein 
 Intercostal artery 
 Vena azygos major 
 
 Intercostal vein 
 Intercostal artery 
 
 Intercostal vein 
 Intercostal artery 
 
 WITH THE PULMONARY ARTERY AND CHIEF BRANCHES 
 (Morris.). Also see Fig. 96. 
 
 THYROID BODY 
 LEFT RECURRENT 
 LARYNGEAL 
 NER VE 
 1'NEIMOGASTRIC 
 
 NER VE 
 Left internal jugular 
 
 vein 
 Left common carotid 
 
 artery 
 Left subclavian artery 
 
 Left subclavian vein 
 
 TRACHEA 
 
 Inferior thyroid vein 
 
 PHRENIC NKR VE 
 
 (huokeil aside) 
 RECURRENT 
 J.MiYNGEAL 
 NERVE 
 
 PNEUMOGASTRIC 
 NERVE 
 
 DUCTUS ARTERIOSU8 
 
 Lqft pulmonary artery 
 
 Pulmonary artery 
 
 Right pulmonary 
 artery 
 
 LEFT BRONCHUS 
 
 Left coronary artery 
 
 f'jtpi'i- left pulmonary 
 
 vein 
 RIGHT VENTRICLE 
 
 (Conus arteriosus) 
 Ltiii-rr left iniliiiimtiry 
 
 artery 
 Lover left /mlmonary 
 
 rein 
 
 (ESOPHAGUS 
 (hooked aside^ 
 
 THORACIC DUCT 
 Thoracic aorta 
 
VAGUS AXD SYMPATHETIC XERVES 
 
 79 
 
 FIG. 89. THE CERVICAL PORTION- OF THE SYMPATHETIC AND THE 
 PNEUMOGASTRIC NERVE. VIEWED FROM BEHIND. (Krause.) 
 Fig. 88. 
 
 DISTRIBUTION OF THE 
 (Morris.') Also see 
 
 Stylo-hyoid 
 
 Ligamentum pharyngeum 
 
 1X1 
 
 Posterior belly of 
 digastric 
 
 Sterno-mastoid 
 
 Rectus capitis 
 anticus major 
 
 Stylo-pharyngeie 
 
 Stylo-gloss us 
 
 Internal pterygoid 
 
 SUPERIOR 
 CERVICAL 
 GAXGLIUS 
 
 Middle constrictor 
 
 Common carotid 
 artery 
 
 Inferior constrictor 
 
 THYROIHEl'M 
 I RIETY) 
 
 THYROID GLAND 
 
 Inferior thyroid 
 
 artery 
 Subclarian arltry 
 
 RECURRENT 
 
 LARYXGEAI. 
 
 A'ERl'E 
 
 Thoracic aorta 
 
 Crus of diaphragm 
 
 Internal carotid 
 
 artery 
 RIGHT 
 SYMPA THETIC 
 
 Occipital artery 
 
 Posterior belly of 
 digastric 
 
 DESCENDERS 
 
 HYPOGLOSSI 
 
 Common carotid 
 artery 
 
 Sterno-mastoid 
 
 TWIG OF 
 RECl'RREXT 
 LARYSGEAL TO 
 PHARYSGEAL 
 PLEXUS 
 
 Thyroid axis 
 
 INFERIOR 
 CERVICAL 
 GAXGLIOS 
 
 RECCRREXT 
 LARYXGEAL 
 
 PLEXUS Gl'LJE 
 
 RIGHT 
 PSEUMOGASTRIC 
 
8o 
 
 THE HEART 
 
 FIG. 90. ANTERIOR VIEW OF THE RIGHT CHAMBERS OF THE HEART, WITH THE GREAT 
 
 VESSELS. (Morris.) 
 
 Left subclavian 
 
 Arch of Aorta 
 Vena cava superior 
 
 RIGHT AURICULAR 
 
 APPENDIX \^ 
 
 Orifice of vein j 
 
 of Galen \l 
 
 ANNULUS OVALIS 
 
 Right pulmonary artery 
 Duclus arteriosus 
 
 Left pulmonary artery 
 
 \onary artery 
 
 onary semilunar valves 
 
 AURICULAR APPENDIX 
 
 papillary muscle connected 
 vmh septum 
 
 (1) Columna carnea 
 / CHORD* TENDINE/E 
 
 Anterior papillary 
 muscle 
 
 Left coronary artery 
 
 Vena cava inferior 
 ANTERIOR SEGMENT OF TRICUSPID VALVE 
 
 RIGHT SEGMENT OF TRICUSPIO VALVE 
 
 SECTION OF VENTRICULAR WALL 
 
 Vena cava inferior 
 
 Posterior papil- (2) Columna carnea 
 lary muscle 
 
HEART AXD LUXGS 81 
 
 HEART. 
 
 Study the heart : 
 Position. 
 Size and weight. 
 Auriculo-ventricular groove. 
 Interventricular groove or coronary sulcus. 
 Coronary arteries. 
 
 Dissect the heart. Make an incision as shown in figure 90. 
 Also make a dissection of the heart of an ox or sheep. 
 Examine and study carefully the whole of the exterior and interior of 
 the heart. 
 
 What is its nerve- and blood-supply? 
 Study the foetal heart and foetal circulation. (Fig. 91.) 
 Expose and study pulmonary arteries and pulmonary veins. (See Figs. 
 87 and 88.) 
 
 Expose and study: 
 
 Aorta (See Figs. 90, 92): 
 Branches of arch: 
 Coronary. 
 Innominate. 
 Left common carotid. 
 Left subclavian. 
 Thyroidea ima. 
 
 Branches of descending aorta in thorax. 
 Pericardiac. Intercostal. 
 
 Bronchial. Diaphragmatic. 
 
 (Esophageal. 
 
 Superior intercostal artery. (See Fig. 93.) 
 Veins (See Fig. 88) : 
 
 Innominate right. Superior vena cava. 
 
 Innominate left. Azygos and tributaries. (Fig. 92.) 
 
 Internal mammary. Spinal veins. (Fig. 94.) 
 
 Superior intercostal. 
 
 Expose and study thoracic duct. (See Fig. 92.) 
 Clean and study the thoracic gangliated cord. 
 
 LUNGS. 
 
 Xote the position in the thorax, upper and lower boundaries. (See 
 Figs. 86 and 87.) 
 
 Describe the lungs. 
 
 What is the blood- and nerve-supply?' 
 
 Study the trachea and bronchi. (Fig. 87.) 
 
 Xote the relation of oesophagus to the trachea. Study oesophagus. 
 
 Study the articulations of the ribs with the vertebrae, and the cartilages 
 with the ribs and sternum. 
 
82 
 
 FCETAL CIRCULATION 
 
 FIG. 91. THE HEART, WITH THE ARCH OF THE AORTA, THE PULMONARY ARTERY, THE 
 DUCTUS ARTERIOSUS, AND THE VESSELS CONCERNED IN THE FCETAL CIRCULATION. 
 (Morris.} 
 (From a preparation of a fetus in the Museum of St. Bartholomew's Hospital.) 
 
 Right innominate vein 
 
 Vena cava superior 
 Right pulmonary artery 
 
 Vena cava inferior 
 
 Left branch of portal vein 
 DUCTUS VENOSUS 
 
 Umbilical vein 
 
 Portal vein 
 
 Right branch of 
 portal vein 
 
 Umbilical vein 
 Umbilical arteries 
 
 Jfypogastric artery 
 
 Left innominate 
 rein 
 
 Arch of aorta 
 
 DUCTUS ARTERIOSUS 
 
 Left pulmonary 
 artery 
 
 Descending aorta 
 
 Superior 
 
 mesenteric artery 
 
 Splenic vein 
 
 Superior 
 mesenteric vein 
 
 Inferior 
 
 mesenteric artery 
 
 _jj|j. Left common iliac 
 
 ~^'; ( > artery 
 
 Internal iliac arii'nj 
 
 External iliac artfrij 
 
 
AORTA, VEINS, AND THORACIC DUCT 
 
 FIG. 92. THE ARCH OF THE AORTA, THE THORACIC AORTA, AND THE ABDOMINAL AORTA, 
 WITH THE SUPERIOR AND INFERIOR VENA CAVA AND THE INNOMINATE AND AZYGOS 
 VEINS. (Morris.) 
 
 Right common carotid 
 
 artery 
 Right internal jugular 
 
 RIGHT LYMPHATIC DUCT 
 
 Innominate artery 
 
 RIGHT PJTXUMO- 
 
 GASTRIC SERVE 
 
 Right innominate rf.in 
 
 Internal mammary vein 
 
 Trunk of the pericardiac 
 and thyniic reins 
 Vena cata superior 
 
 Vena azygos major 
 
 Vena azygos minor, cross- 
 ing spine to enter rena 
 azygot major 
 
 Hepatic reim 
 
 Vena cava inferior 
 
 Right phrenic artery 
 Caeliac axis 
 
 Right middle suprarenal 
 artery 
 
 Right spermatic artery 
 Right spermatic vein 
 
 Left common carotid 
 artery 
 
 TRIC SER VE 
 THORACIC DUCT 
 Left innominate vein 
 Left subclai'ian artery 
 
 Left superior intercostal 
 
 rein 
 
 RECURRENT 
 LARYSGEAL 
 SERVE 
 
 Vena azygos tertius 
 
 ESOPHAGUS 
 
 Left upper azygos rein 
 
 (Etophageal branches 
 from aorta 
 
 Vena azygos minor 
 
 THORACIC DUCT 
 
 Left phrenic artery 
 
 Left middle suprarenal 
 artery 
 
 RECEPTACULUM CHYLI 
 
 Superior mesenteric 
 artery 
 
 Left ascending lumbar 
 
 rein 
 Left spermatic vessels 
 
 Inferior mesenteric 
 artery 
 
8 4 
 
 ARTERIES AND VEINS 
 
 FIG. 93. SCHEME OF THE RIGHT SUPERIOR INTERCOSTAL ARTERY. (Walsham.) 
 
 (Morris.} 
 
 Scalenus anticus muscle 
 
 Deep cervical branch 
 
 FIRST DORSAL NERVE 
 
 FIRST INTERCOSTAL 
 NERVE 
 
 Subclavian artery 
 
 SECOND INTERCOSTAL 
 NER VE 
 
 Anterior intercostal 
 
 artery 
 
 THIRD INTER- 
 COSTAL NERVE 
 
 Anterior intercostal 
 artery 
 
 Internal mammary 
 artery 
 
 Intercostal vessels of 
 third space 
 
 SYMPA THETIC 
 NER VE 
 
 INFERIOR CERVI- 
 CAL GANGLION 
 
 \ Superior intercostal 
 ) artery 
 
 Arteria qperrans 
 
 Branch from first aortic 
 intercostal 
 
 Arteria aberrant 
 
 First aortic intercostal 
 artery 
 
 Second aortic intercostal 
 artery 
 
 Intercostal vessels of fourth space 
 
 FIG. 94. THE SPINAL VEINS. (Morris.} 
 
 ACCESSORY PRO- 
 CESS OR TIP 
 OF THE TRUE 
 TRANSVERSE 
 PROCESS 
 
 COSTAL ELEMENT 
 
 Posterior transverse 
 
 branch 
 
 Vein from cord 
 Transverse branc 
 
 A nlerwr transfers 
 vein 
 
 Lumbar vein 
 
 Dorsal spinal plexus 
 
 I'll.ltfl-ilir IdllljillKlilKll 
 l r, in 
 
 Lateral transverse 
 
 branch 
 
 Anterior /onr/i/in/ii/ril 
 spinal vein seen in 
 fiction 
 
 Veins from body of 
 vtriebra 
 
 Anterior spinal plexus 
 
 
SHOULDER AND ARM 85 
 
 DEMONSTRATION XIV. 
 
 SHOULDER AND ARM. 
 
 Sever the spinal column above and below the brachial plexus; then saw 
 the piece thus severed through the middle, lengthwise. 
 
 FIG. 95. THE BRACHIAL ARTERY, LEFT SIDE. (Morris.) 
 (From a dissection in the Museum of the Royal College of Surgeons ) 
 
 Supratcajmlar artery and nerve 
 
 Subscapular vessels 
 
 CIRCUMFLEX 
 XER VE 
 
 SUBSCAPULAR ^ 
 
 SER VE 
 
 Axillary artery and 
 
 vein 
 
 MUSCULO-CUTA- 
 XEOUS and in- 
 ternally outer 
 head of MEDIAN 
 
 XR VE 
 
 ~ One of the brachial 
 veins 
 
 Coraeo-brachialis 
 
 Triceps 
 
 ULNAR NERVE 
 
 Triceps 
 
 Inferior profunda artery 
 
 IXTERXA L CUTA XEO US 
 NEBVB 
 
 Brachial artery 
 
 MEDIAN NEE VE 
 
 Ulnar artery 
 
 Biceps 
 
 Cephalic vein 
 Anastomotica magna artery 
 
 MUSCUL O-CUTA NEO US 
 NER VE 
 
 Supinator longua 
 Radial rein 
 
 Median vein 
 
 Radial artery 
 
86 
 
 SHOULDER AND ARM 
 
 FIG. 96. SUPERFICIAL VEINS AND LYMPHATICS OF THE LEFT FOREARM AND ARM. 
 
 (Walsham.) (Morris.) 
 
 Fectoralis major, hooked up 
 
 External jvgular vein 
 
 Pectoralis major 
 
 Lymphatics from side of chest 
 
 Pectoral glands 
 
 Basilic vein 
 
 Epitrochlear gland ,^_ _^___^ 
 ial ulnar '"/ ~^-. 
 
 Posterior superficia 
 
 vein 
 Median basilic vein 
 Inner set of superficial lym- 
 phatics of forearm 
 
 Deep median vein 
 
 INTERNAL CUTANEOUS 
 NERVE 
 
 Anterior superficial ulnar 
 vein 
 
 Median set of superficial lym- . 
 phatics of forearm 
 
 Supraclariciilar gland 
 Jugulo-cephalic vein 
 
 Deltoid muscle 
 
 LymphaHet lu-i-uinjianying 
 
 vephulir ri in 
 
 - Axillary glaiula 
 Cephalic vein 
 
 Lymphatic i-exxfls of inner 
 side of arm 
 
 Biceps, exposed 
 
 MUSCULO-CUTANEOUS 
 NER VE 
 
 lilitl artery 
 Bicipital fascia 
 Median cephalic vein 
 
 Superficial radial vein 
 Superficial median rein 
 
 Outer set of superficial lym- 
 phatic vessels of forearm 
 
SHOULDER AND ARM 87 
 
 Study on the skeleton the bones of the shoulder- and elbow-joints. 
 
 Outline arteries, superficial veins, and superficial nerves. (See Figs. 
 95, 96, and 97.) 
 
 Dissection. -Make an incision down the anterior part of the arm to 
 inches below the elbow; turn the skin outward and inward, exposing the 
 superficial fascia, veins, and nerves. 
 
 Study the superficial and deep fascia and lymphatics. Xote the epi- 
 trochlear gland. (Fig. 96.) 
 
 FIG. 97. DISTRIBUTION OF CUTANEOUS NERVES ON THE ANTERIOR AND POSTERIOR ASPECTS 
 OF THE SUPERIOR EXTREMITY. (Morris.) 
 
 IXTERXAL 
 CUTAXEOCS OP 
 
 Ml'?' 
 
 SPIRAL 
 
 IXTER.VA L 
 Cl'TAXEUl'S 
 
 PALMAR 
 
 'TTAXEOrS OF 
 MSDIAA' 
 
 PALMAR 
 
 fTTAXEOl'ii OF 
 L'LXAB 
 
 SUPRA- 
 ACBOMIAL 
 
 CIRCUMFLEX 
 
 IXTERCOSTO- 
 HUMERAL 
 
 TWIG OP 
 
 IXTERXAL 
 CUTAXEOCS 
 
 EXTERXAL 
 CUTAXEOl'S OP 
 
 MCSCCLO- 
 
 SPIRAL 
 
 MT'SCULO- 
 CUTASEOUS 
 
 PALMAR 
 < I'TAXEOUS 
 OF RADIAL 
 
 SUPRA- 
 ACROMIAL 
 
 EXTERXAL 
 
 CUTAXEOVS 
 
 OF 
 
 JtrsccLO- 
 SPIRAL 
 
 xrscrLO- 
 
 CCTAXSOCS 
 
 IXTERXAL 
 CUTANEOUS OP 
 
 MCSCULO- 
 
 SPIRAL 
 IXTERCOSTO- 
 
 BUJfERAL 
 
 XERVE OF 
 WRISBERG 
 
 IXTERNAL 
 CUTANEOUS 
 
 RADIAL 
 
 ULXAR 
 
 Clean and study the following: 
 Veins (see Fig. 96): 
 Cephalic. 
 
 Median cephalic. 
 Basilic. (See Fig. 95.) 
 Median basilic. 
 
88 
 
 SHOULDER AND ARM 
 
 Bicipital fascia. (See Fig. 98.) 
 
 Note the relative positions of the veins, arteries, and nerves in front 
 of the elbow. 
 
 Review the subclavian and axillary arteries. Then trace out the: 
 Brachial artery and its branches. (Fig. 99.) 
 Brachial veins and tributaries. 
 
 FIG. 98. THE BEND OF THE ELBOW, LEFT SIDE. (Morris.) 
 (From a dissection by Dr. Alder Smith in the Museum of St. Bartholomew's Hospital.) 
 
 MEDIAN NERVE 
 Posterior branch of 
 anastomotica magna 
 BRANCHES OF 
 INTERNAL CUTA- 
 NEOUS NERVE 
 
 Posterior ulnar vein 
 
 Brachialis antieus 
 
 Anterior branch of 
 anastomolica magna ' 
 Anterior ulnar veil. 
 
 Median basilic vein 
 
 MUSCULAR BRANCH 
 OF MEDIAN NERVE 
 
 Tendon of biceps 
 Bicipital fascia 
 
 Brachialis antieus 
 
 Deep median vein 
 
 Ulnar artery 
 
 Pronator teres 
 
 Radial artery 
 
 Biceps 
 Internal vena 
 
 C/l/tll'X I if 
 
 liriK'liiul nr/ery 
 Basilic n'in 
 
 Brachialis 
 antieus 
 
 Brachial artery 
 EXTERNAL 
 
 ffTANEOrS 
 NERVE 
 
 Mvseiilo-ffiiral 
 n. and afi-i'mliinj 
 branch of nidinl 
 recurrent urt'Tit 
 I'udial vein 
 Median cephalic 
 
 rein 
 
 Asi-finling br. of 
 radial recurrent 
 RADIAL 
 
 JRiiilial recurrent 
 
 artery 
 
 Supinator 
 longus 
 DetceiuUng br. 
 
 of radial 
 recurrent 
 Median vein 
 
 RADIAL 
 NERVE 
 
SHOULDER AND ARM 
 
 FIG. 99. THE LOWER PART OF THE AXILLARY, THE BRACHIAL, AND THE RADIAL AND 
 
 ULNAR ARTERIES, RIGHT SIDE. (Morris.) 
 (From a dissection in the Museum of the Royal College of Surgeons of England.) 
 
 BRACHIAL PLEXUS 
 
 HEAD OF HUMERUS 
 Pectoralis minor, turned back 
 
 ML'SCUL 0-CUTA SEO US NER VE 
 
 BRANCH OF Mrt'TLO-CUTA- 
 
 NEOUS TO MEIUAS SERVE 
 
 Coraco-brachialis 
 
 Brachial artery 
 
 Superior prof undo artery 
 Biceps 
 
 MUSCULO-CUTANEOUS NERVE 
 
 BRA ycit OF MUSCULO-CUTA- 
 NEOUS NERVE TO BRACHI- 
 ALIS ANTICUS 
 
 Brachialia anticus 
 MEDIA S SERVE 
 
 Inner brachial vena comes 
 MUSCULO-SPIRAL NERVE 
 
 Radial recurrent artery 
 Supinator longus 
 
 Superficial median rein, cut short 
 
 Pronator radii teres, superficial 
 bead, cut 
 
 RADIAL NERVE . 
 
 Rudial artery 
 
 ixor sublitnia 
 rum 
 
 MEDI AS SERVE 
 
 Cut edge of flexor sublimis 
 digitorum 
 
 Flexor longus pollicis 
 
 Subscapularls 
 Acromio-lftoracic artery 
 Axillary artery 
 MEDI AS NERVE 
 Subscapular artery 
 
 Teres major 
 
 Latissimus dorsi 
 
 Long head of triceps 
 MUSCULO-SPIRAL SERVE 
 
 ) MUSCULAR BRANCH OF 
 } MUSCULO-SPIRAL 
 ] SERVE 
 
 Inferior prof undo artery 
 
 Inner bead of triceps 
 ULNAR NERVE 
 
 Anastomolica magna artery 
 Internal intermuscular septum 
 
 MUSCULAR BRANCHES OF 
 MEDI AS SERVE 
 
 Pronator teres and superficial 
 flexor muscles, turned back 
 
 Anterior ulnar recurrent artery 
 
 Deep bead of pronator radii 
 teres 
 
 Posterior ulnar recurrent artery 
 
 Superficial flexor muscles, 
 turned back 
 
 Anterior interosseous artery and nerve 
 Flexor profundus digitorum 
 ULNAR NERVE 
 
 Ulnar artery 
 
 Interosseous membrane with cut edge 
 of pronator quadratus 
 
go SHOULDER AND ARM 
 
 Clean and study the formation of the: 
 
 BRACHIAL PLEXUS. 
 
 Branches of the brachial plexus: 
 Nerve to rhomboid. 
 Suprascapular. 
 Posterior thoracic. 
 Anterior thoracic. 
 
 Wrisberg (n. cutaneus brachii medialis minor}. 
 Internal cutaneous (n. cutaneus brachii medialis}. 
 Subscapularis. 
 Musculo-cutaneus . 
 Ulnar. 
 Median. 
 
 Circumflex (n. axillaris}. 
 Musoulo-spiral (radialis} . 
 
 FIG. ioo. DIAGRAM OF THE BRACHIAL PLEXUS. (Morris.) 
 The posterior cord of the plexus is darkly shaded. 
 
 FIFTH 
 CERVICAL 
 
 SIXTH 
 CERVICAL 
 
 SEVENTH 
 
 CERVICAL 
 TO SCALENI & 
 LONG US COL LI 
 EIGHTH 
 CERVICAL 
 POSTERIOR 
 THORACIC 
 
 FIRST 
 THORACIC 
 FIRST 
 
 INTERCOSTAL 
 SECOND 
 THORA CIC 
 SECOND 
 INTERCOSTAL 
 
 THIRD 
 THORACIC 
 THIRD 
 INTERCOSTAL 
 
 FROM FOURTH CERVICAL 
 
 RHOMBOID NERVE 
 TO PHRENIC 
 
 NERVE TO SUBCLAVIUS 
 
 SUPRASCAPULAR 
 
 EXTERNAL ANTERIOR THORACIC 
 
 OUTER CORD OF PLEXUS 
 CIRCUMFLEX 
 MUSCULO-CUTANEO US 
 
 MUSCULO-SPIRA L 
 INNER CORD OF PLEXUS 
 
 LONG 
 SUBSCAPULAR 
 
 MEDIAN 
 
 ULNAR 
 INTERNAL 
 CUTANEOUS 
 
 NERVE OF 
 WRISBERG 
 
 INTERCOSTO-HUMERAL LATERAL CUTANEOUS 
 
 Dissect out and study the following: 
 Muscle : 
 
 Deltoid. 
 
 Separate the deltoid from its origin and turn it down. 
 Note the posterior circumflex artery and circumflex 
 nerve. (Fig. 102.) 
 
SHOULDER AXD ARM 
 
 9 1 
 
 FIG. 10 1. DISSECTION OF THE LEFT ARM FROM THE FRONT, SHOWING PORTIONS OF THE 
 ULNAR. MEDIAN, MUSCULO-CUTANEOUS, AND MVSCULO-SPIRAL NERVES. (Morris.) 
 Also see Fig. in. 
 
 Subscapularis 
 
 Teres major 
 
 Long head of triceps 
 Latissimus dorsi 
 
 MUSCULO-CUTASEOUS SERVE 
 MEDIAS SERVE 
 
 ULSAR SERVE 
 
 Internal bead of triceps 
 
 Pronator radii teres 
 Flexor carpi radialis 
 
 Pronator radii teres 
 deep head; 
 
 Flexor sublimis digitorum 
 
 Deltoid 
 
 Coraco-brachialis 
 Biceps 
 
 Pectoralis major 
 
 Brachialis anticus 
 
 Biceps 
 
 MUSCULO-SPIRAL 
 SERVE 
 
 RADIAL NERVE 
 POSTERIOR ISTER- 
 
 OSSEOl'S SERVE 
 Extensor carpi radialis 
 
 longior 
 
 ANTERIOR ISTER- 
 OSSEOUS SERVE 
 
 RADIUS 
 
SHOULDER AND ARM 
 
 FIG. 102. THE RIGHT POSTERIOR CIRCUMFLEX ARTERY. (Morris.) 
 (From a dissection by Mr. Homer in the Museum of St. Bartholomew's Hospital.) 
 
 Suprascapular artery 
 
 SPINE OF SCAPULA 
 
 Infra-spinatus, cut 
 ACROMIAL PROCESS I Tere8 minor 
 
 Superior profunda artery 
 
 Posterior circumflex artery 
 Deltoid, reflected 
 
 Infra-spinatus, cut 
 
 Teres major 
 Dorsal scapular artery 
 
 Branch of dorsal scapular artery 
 
 NER VE TO TERES MINOR 
 
 MU8CULO-8PIRAL NERVE 
 Outer head of triceps 
 
 ^ EXTERNAL CUTANEOUS 
 fcv BRANCH OF 
 
 MUSCULO- 
 SPIRAL NERVE 
 
 Long head of triceps 
 
 CUTANEOUS BRANCH OF CIRCUMFLEX NERVE, CUT 
 
 Muscles, continued: 
 
 Supra-spinatus. (See Fig. 103.) 
 
 Teres minor. 
 
 Teres major. 
 
 Subscapularis. (See Fig. 104.) 
 
 Coraco-brachialis . 
 
 Biceps (m. biceps brachii}. (See Fig. 105.) 
 
 Brachialis anticus (m. brachialis). 
 
 Triceps (m. triceps brachii}. (See Fig. 103.) 
 
 Latissimus dorsi. 
 
 Subanconeus (m. anconceus}. 
 
 When the dissection of the shoulder and arm is completed place the parts 
 in their proper position and study the relation each part bears to its surround- 
 ings. 
 
SHOULDER AXD ARM 93 
 
 FIG. 103. BACK VIEW OF THE SCAPULAR MUSCLES AND TRICEPS. (Morris.} 
 
 Supra-spinatus 
 
 Infra-spinatus 
 Teres minor 
 
 Teres major 
 
 Long head oi triceps 
 
 Outer head of triceps 
 
 Inner head of tricep 
 
 FIG. 104. FRONT VIEW OF THE SCAPULAR MUSCLES. (Morris.) 
 
 CLAVICLE 
 CORACOID PROCESS 
 
 Supra-spinatus 
 
 Subscapulans 
 
 Teres major 
 -Latissimus dorsi 
 
 Coraco-brachialis and short 
 head of biceps 
 
 Fectoralis major 
 
94 
 
 SHOULDER AND ARM 
 
 FIG. 105. SUPERFICIAL VIEW OF THE FRONT OF THE UPPER ARM. (Morris.} 
 
 Peetoralis minor 
 
 Coraco-brachialis 
 
 Lone head of triceps 
 
 Inner head of triceps 
 
 Brachialia anticus 
 
 Semilunar fascia 
 
 Tendons of insertion of pec- 
 toralis major and deltoid 
 
 Outer head of triceps 
 
 Brachialis anticus 
 
 Extensor carpi radialis 
 longior 
 
 Brachio-radialia 
 
FOREARM AXD HAND 
 
 95 
 
 DEMONSTRATION XV. 
 
 FOREARM, WRIST, AND HAND. 
 
 Study the bony parts of the elbow, wrist, and fingers on the articulated 
 skeleton. 
 
 Outline the superficial nerves and veins. 
 Study lymphatics. (See Figs. 96 and 97.) 
 
 FIG. 106. THE SUPERFICIAL MUSCLES OF THE PALM OF THE HAND. (Morris.') 
 
 Flexor carpi radialis 
 
 or ossis metacarpi pollicis 
 
 Opponens pollicia 
 
 Abductor pollicis 
 
 Flexor brevis pollicis 
 
 Adductor pollicia 
 
 First lum- 
 
 briealis 
 
 First dorsal 
 interoe- 
 
 seous 
 
 lentum vaginale 
 Flexor sublimis digitorum 
 
 Flexor profundus digitoruc 
 
 Flexor profundus 
 
 digitorum 
 
96 FOREARM AND HAND 
 
 Dissection. Make a vertical incision along the anterior middle line 
 through the skin from the elbow to the wrist, then make a transverse in- 
 cision from the lower extremity of the first incision. Turn off the skin, 
 exposing the superficial fascia, superficial veins, and nerves. 
 
 FIG. 107. TENDONS UPON THE DORSUM OF THE HAND. (Morris.} 
 
 Extensor ossis metacarpi 
 pollicis 
 
 Extensor brevis pollicis 
 
 Posterior annular ligament 
 
 Attachment of extensor 
 communis digitorum 
 to second phalanx 
 
 Attachment of extensor 
 communis digitorum 
 to third phalanx 
 
 Extensor carpi ulnaria 
 
 Extensor communis digitorum 
 
 Extensor minimi digiti 
 
 Extensor indicia 
 
 Dissect the skin down over the hand and fingers, taking care not to 
 destroy the annular ligaments nor the nerves and arteries. 
 
THE FOREARM 
 
 97 
 
 Observe and study: 
 
 Fascia of forearm. 
 Fascia of hand. 
 Annular ligament (liganientum carpi transversum dorsale). (See 
 
 Figs. 106 and 107.) 
 Palmaris brevis muscle. (Fig. 106.) 
 Synovial membranes beneath the anterior annular ligament. 
 
 FOREARM. 
 
 To separate the muscles of the forearm begin with their tendons at 
 the wrist and separate up toward the origin of the muscle. In separating 
 the muscles do not destrov the arteries and nerves. 
 
 FIG. 108. SUPERFICIAL MUSCLES ox THE ANTERIOR SURFACE OF THE LEFT FOREARM. 
 
 (Holden.) 
 
 Inferior part of the biceps. 
 
 Aponeurosis of the biceps. 
 
 Tendon by which it is at- 7 
 tached to the biripital 
 tuberosity of the radius. 8 
 
 4. Brachialis anticus. 
 
 Internal head of the tri- ., 
 
 ceps. 
 
 Pronator radii teres. 
 Flexor carpi radialis. 
 Palmaris longus. 
 Inferior extremity of this 
 
 muscle expanding into the 
 
 palmar fascia. 
 Flexor carpi ulnaris. 
 The attachment to the pisi- 
 form bone. 
 Supinator Ipngus or bra 
 
 chio-radialis. 
 Inferior attachment of this 
 
 muscle. 
 14. Extensor carpi radialis 
 
 longior. , 
 Extensor carpi radialis 
 
 brevior. 
 Extensor ossis metacarpi 
 
 poll! tis. 
 
 17. Tendon of the same in- 
 
 serted into the metacar- 
 pal bone. 
 
 18. Tendon of the extensor 
 
 secundi intemodii pollicis. 
 
 19, 19. FJexor sublimis digit o- 
 
 ggB. 
 
 20, 20. Tendons of insertion 
 
 dividing to allow the ten- 
 dons of the flexor profun- 
 dus digitorum to pass to 
 their insertion. 
 
 21, 21. Insertion of the flexor 
 
 sublimis digitorum to the 
 lower part of the middle 
 phalanges. 
 
 22, 22. Attachment of the 
 
 flexor profundus digito- 
 rum to the distal pha- 
 langes. 
 
 23, 23. Lumbricales. 
 
 24. Abductor pollicis. 
 
 25. Its attachment to the proxi- 
 
 mal phalanx of the thumb. 
 
 26, 26. Flexor longus pollicis. 
 
 27. Flexor brevis digitorum. 
 
 28. Abductor minimi digiti. 
 
THE FOREARM 
 
 Muscles in front of forearm: 
 
 Superficial group. (See Fig. 108.) 
 Palmaris longus. 
 Flexor carpi radialis. 
 Flexor carpi ulnaris. 
 Flexor sublimis digitorum. 
 Pronator radii teres (m. pronator teres}. 
 
 FIG. 109. FLEXOR MUSCLES OF THE FINGERS. (Holden.) 
 
 -;, 
 
 1. Flexor sublimis digito- 
 
 rum. 
 
 2. Its origin from the inter- 
 
 nal condyle. 
 
 3. Its origin from the 
 
 coronoid process. 
 
 4. 4. Its origin from the 
 
 radius . 
 
 5. 5. Its two superficial ten- 
 
 dons to the middle and 
 ring fingers. 
 
 6. 6. Its two deep tendons 
 
 to the index and little 
 fingers. 
 
 7. Flexor longus pollicis. 
 
 8. Tendon of this muscle. 
 
 9. Bifurcation of the tendons 
 
 of the flexor longus 
 digitorum. 
 
 10, 10. Groove made by 
 these tendons. 
 
 n, ii. Tendons of the 
 flexor profundus digi- 
 torum occupying these 
 grooves and filling 
 them up. 
 
 12. Brachialis anticus ten- 
 
 don. 
 
 13. Internal condyle of the 
 
 humerus. 
 
 14. Biceps tendon. 
 
 15. Supinator longus or 
 
 brachio-radialis. 
 
 16. Its attachment to the 
 
 styloid process of the 
 radius. 
 
 17. Extensor carpi radialis 
 
 longior. 
 
 18. Tendon of insertion of 
 
 the pronator radii teres. 
 
 19. Tendon of insertion of 
 
 the flexor carpi radialis. 
 
 20. Triceps. 
 
 21. Flexor carpi ulnaris. 
 
 22. Its attachment to the 
 
 pisiform bone. 
 
 23. Abductor minimi digiti. 
 
 24. Flexor brevis minimi 
 
 digiti. 
 
 25. Abductor pollicis. 
 
 Deep group. (See Fig. 109.) 
 Flexor profundus digitorum. 
 Flexor longus pollicis. 
 Pronator quadratus. 
 
THE FOREARM 
 
 99 
 
 Muscles of the back of forearm. (See Fig. no.) 
 Superficial group. 
 Brachio-radialis . 
 Extensor carpi radialis longior. 
 Extensor carpi radialis brevior. 
 Extensor communis digitorum. 
 Extensor minimi digiti. 
 Extensor carpi ulnaris. 
 Anconeus. 
 
 FIG. no. SUPERFICIAL EXTENSORS OF THE FOREARM. (Holden.) 
 
 - f 
 
 1 . Tendon of the triceps. 
 
 2. Origin of the supinator 
 longus or brachio-radi- 
 alis. 
 
 3. Extensor carpi radialis 
 longior. 
 
 4. Insertion of this muscle. 
 
 5. Extensor radialis bre- 
 vior. 
 
 6. Insertion of this muscle. 
 
 7. Extensor ossis meta- 
 carpi pollicis. 
 
 8. 8. Extensor brevis or 
 primi intemodii pollicis. 
 
 9. 9. Extensor longus or 
 secundi internodii pol- 
 licis. 
 
 10, 10. Posterior annular 
 ligament. 
 
 11, Extensor communis di- 
 gitorura. 
 
 12, 12. Attachments of the 
 
 tendons of this muscle 
 to the middle and distal 
 phalanges of the four 
 fingers. 
 
 13. Tendons, of the exten- 
 sor indicis uniting with 
 the tendon of the com- 
 munis digitorum indicis. 
 
 14. Tendon of the exten- 
 sor minimi digiti min- 
 gling posteriorly with 
 the tendon of the com- 
 munis to the little finger. 
 
 15. Extensor carpi ul- 
 naris. 
 
 16. Its insertion into the 
 metacarpal bone. 
 
 17. Anconeus. 
 
 18. Flexor carpi ulnaris 
 attached to the posterior 
 border of the ulna by 
 the aponeurosis. 
 
 Deep group. 
 
 Supinator radii brevis (m. supinator). 
 
 Extensor ossis metacarpi pollicis (m. abductor pollicis longus}. 
 
 Extensor brevis pollicis. 
 
ioo THE FOREARM 
 
 Extensor longus pollicis. 
 
 Extensor indicis. 
 
 Trace out and study the arteries and nerves of the forearm. 
 Nerves. (See Figs, in and 112): 
 Internal cutaneous. 
 Median. 
 
 Anterior interosseous. 
 Ulnar. 
 Musculo-spiral (radialis] . 
 
 Radial. 
 
 Posterior interosseous. 
 
 FIG. in. TERMINAL PORTION OF THE MEDIAN AND ULNAR NERVES. (Holden.) 
 Forearm, palmar, and digital portions of these nerves. 13. Branch to the pronator 
 radii teres muscle. 14. Anterior muscular branches divided and removed. 15. 
 Branch to the flexor profundus digitorum. 16. Branch to the flexor longus pol- 
 licis. 17. Branch to the interosseous membrane. 18. Palmar (cutaneous) branch 
 divided below its origin. 19. To the thenar eminence. 20. External lateral branch 
 of the thumb. 21. Internal lateral branch of the same. 22. External digital branch 
 to the index ringer. 23. Common trunk to the index and middle fingers. 24. Digi- 
 tal branches from the median to the middle finger and the thumb side of the ring 
 finger. 25. Ulnar nerve. 26. Branch of the same nerve to the flexor profundus 
 digitorum. 27. Cutaneous and anastomosing filament from the ulnar. 28. Dorsal 
 branch of this nerve. 29. Superficial palmar branch. 30. Common trunk for the 
 ring and little fingers. 31. Digital branch to the internal side of the little finger. 32. 
 Deep palmar branch. 33. Branches from the preceding to the hypothenar eminence. 
 34. Branches to the fourth interosseous and fourth lumbricales. 35. Branches to the 
 same in the third. 36. Branches to the adductor pollicis and the muscles of the first 
 and second interosseous spaces. 37, 38, 39, 40. Branches of radial. 
 
 16 ' 
 
 12 
 
THE FOREARM 
 
 Arteries (Figs, in, 113, and 114): 
 Radial and branches. 
 Ulnar and branches. 
 Anastomosis about elbow-joint. 
 
 FIG. 112. TERMINAL BRANCHES OF THE RADIAL XERVE. (Holden.) 
 
 101 
 
 1 . Trunk of the radial nerve. 
 
 2. Its branch to brachio- 
 
 radialis. 
 
 3. Its branch to extensor car- 
 
 pi radialis longior. 
 
 4. Its branch to extensor car- 
 
 pi radialis brevior. 
 
 5. Bifurcation of the trunk. 
 
 6. Posterior or muscular 
 
 branch. 
 
 7. The same branch travers- 
 
 ing the supinator brevis 
 and supplying it. 
 
 8. Terminal filaments of this 
 
 division. 
 
 9, 9. Anterior or cutaneous 
 
 branch of this nerve. 
 
 10. Termination of this 
 
 branch. 
 
 11. Musculo-cutaneous n. 
 
 12. Its terminal divisions. 
 
 13. Anastomosing branch with 
 
 the cutaneous division of 
 the radial 
 
IO2 
 
 THE FOREARM 
 
 THE ARTERIES OF THE FOREARM WITH THE SUPERFICIAL PALMAR ARCH. 
 
 (Morris.} 
 
 Biceps 
 
 Brachialis anticus 
 
 Tendon of biceps 
 
 Semilunar fascia of biceps 
 
 Radial recurrent artery 
 
 Supinator longus 
 
 RADIAL NERVE 
 
 Radial artery 
 
 Flexor longus pollicis 
 
 Pronator quadratus 
 
 Radial artery winding to back of 
 wrist under extensors of thumb 
 
 Superficiales vol(f 
 Superficial palmar arch 
 
 Brachial artery 
 Basilic rein 
 
 ULNAR NERVE 
 
 MEDIAN NERVE 
 
 Anastomolica magna 
 Brachial artery 
 
 INTERNAL CONDYLE 
 
 Ulnar artery 
 Pronator radii teres 
 Plexor carpi ulnaris 
 
 Flexor sublimis digitorum 
 Flexor carpi radialis 
 Palmaris longus 
 
 MEDIAN NERVE 
 Flexor sublimis digitorum 
 
 Ulnar artery 
 PISIFORM BONE 
 
 Anterior annular ligament 
 Palmaris brevis 
 
THE FOREARM 
 
 103 
 
 FIG. 1 14. THE ARTERIES OF THE RIGHT FOREARM AND THE DEEP PALMAR ARCH. (Morris.) 
 
 Inferior profunda artery 
 Anculomotica magnet artery 
 
 Biachial artery 
 Radial recurrent artery . 
 
 Supinator longus 
 Radial artery. 
 
 Plexor longus pollicis muscle 
 
 -Brachialis anticus muscle 
 
 Anterior ulnar recurrent 
 
 l 
 1 Posterior ulnar recurrent 
 
 -Ulnar artery 
 
 Anterior interosseous artery 
 Flexor carpi ulnaris 
 
 Flexor profundus digitorum muscle 
 Anterior interotseou* artery 
 
 Anterior annular ligament, cut 
 
 Anterior branch of ulnar artery, cut 
 . Deep palmar arch 
 
 Palmar interosseous arteries 
 Palmar digital artery, cut thorl 
 
 Collateral branch of palmar digital artery 
 
104 
 
 THE FOREARM 
 
 FIG. 115. THE BACK OF THE LEFT FOREARM, WITH THE POSTERIOR INTEROSSEOUS ARTERY 
 
 AND BRANCHES OF THE RADIAL AT THE BACK OF THE WRIST. (Morris.) 
 
 (From a dissection in the Hunterian Museum.) 
 
 Articular branch of superior 
 profumla 
 
 Brachialis antieua 
 Supinator lougus, cut 
 
 Common extensor tendon 
 
 Extensor carpi radialis longior 
 and brevior 
 
 Supinator brevis 
 Posterior interosseous artery 
 
 Extensor ossis metacarpi pollicis 
 Supinator longus, cut 
 
 Extensor primi internodii pollicis 
 
 Posterior annular ligament 
 
 Extensor carpi radialis longior 
 
 Radial artery 
 
 Dorsalis pollicis artery 
 
 Extensor secundi internodii* 
 
 pollicis 
 
 First dorsal interosseous muscle 
 
 Dorsalis indicts artery 
 
 Princeps pollicis artery 
 
 Dorsal digital artery 
 
 Triceps 
 
 Rete over olecranon 
 Interosseous recurrent artery 
 
 Anconeus, cut 
 
 xtensor carpi uluaris 
 .exor carpi ulnaris 
 
 rigin of extensor secundi and 
 indicator 
 
 is/erior branch of anterior interosseous 
 
 artery 
 terosseous membrane 
 
 terior ulnar carpal artery 
 ctensor carpi radialis brevior 
 
 sterior radial carpal artery 
 
 ird dorsal interosseous artery 
 cond dorsal interosseous artery 
 Metacarpal or first dorsal interosseous 
 artery 
 
THE HAXD 
 
 105 
 
 HAND. 
 
 Muscles : 
 Palm: 
 
 Palmaris brevis. 
 
 Lumbricales. 
 
 Interossei tlwse are best exposed later. (Figs. 119 and 1 20.) 
 
 Thenar eminence. (Fig. 118.) 
 
 Abductor pollicis. 
 
 Opponens pollicis. 
 
 Flexor brevis pollicis. 
 
 Adductor pollicis. 
 
 FIG. 1 1 6. SUPERFICIAL NERVES OF THE PALM. (Ellis.) (Morris.) 
 
 MEDIAX SERVE 
 
 BRANCH TO MUSCLES 
 OF THUMB 
 
 COLLATERAL 
 
 BRA. \ffn.s 
 MEDIA* 
 
 ULSAR SERVE 
 
 COMMUSICA TIOS 
 BETWEEN MEDIAN 
 ASD ULSAR 
 
 COLLATERAL 
 BRANCHES OF 
 UJJTAJt 
 
 Hypothenar eminence. (Fig. 118.) 
 Abductor minimi digiti. 
 Flexor brevis minimi digiti. 
 Opponens minimi digiti. 
 Trace out the arteries and nerves of hand. 
 
io6 THE HAND 
 
 Arteries. (See Figs. 114, 115 and 124):- 
 Superficial palmar arch. 
 Deep palmar arch. 
 Dorsal interosseous. 
 Dorsalis indicis. 
 Princeps pollicis. 
 Dorsal digital. 
 
 FIG. 117. A DISSECTION OF THE CUTANEOUS NERVES ON THE DORSAL ASPECT OF THE 
 
 HAND AND FINGERS. (H. St. J. B.) (Morris.) 
 The branches of the median nerve are shown in black. 
 
 DORSAL BRANCH 
 Of ULNAR 
 
 BRAXCH OF 
 
 MEDIA \ 
 NER VE 
 
 BRANCH OF MVSCVLO-SPIRAL 
 
 RADIAL XER VE 
 
 See Figs, in, 112 and 116. 
 Nerves : 
 
 Median. 
 
 Ulnar. 
 
 Radial. 
 
THE HAND 
 
 107 
 
 . THE SUPERFICIAL MUSCLES OF THE PALM OF THE HAND. (Morris.) 
 
 Flexor carpi radialis 
 
 Extensor ossis metacarpi pollicis 
 
 Opponens pollicis 
 
 Abductor pollicis 
 
 Flexor brevis pollicis 
 
 Adductor pollicis 
 
 First lum- 
 
 bricalis 
 
 First dorsal 
 
 interoe- 
 
 seous 
 
 Ligamentum vaginale 
 
 Flexor sublimis digitorum 
 
 Flexor profundus digitorum 
 
 Flexor profundus 
 digitorum 
 
io8 
 
 THE HAND 
 
 FIG 119. THE PALMAR INTEROSSEI. (Morris.} 
 
 FIG. 120. THE DORSAL INTEROSSEI. (Morris.} 
 
 After completing the dissection of the forearm, wrist, and hand place the 
 parts in their proper position and study the relation each part bears to its sur- 
 roundings. 
 
ANASTOMOSES OF ARTERIES OF UPPER EXTREMITY 
 
 109 
 
 Examine the anastomoses of the arteries of the upper extremity shown 
 in the following figures. 
 
 FIG. 121. THE ANASTOMOSES ABOUT THE SCAPULA. (Morris.) 
 
 Snliscnpitlar branch <>J suprascnpitlar artery 
 Sttpraspinous branch of suprascapular artery 
 
 Posterior scapular artenj 
 
 Supraitfiinaus branch 
 of posterior scapular 
 artery 
 
 Subscapular branch 
 of posterior sc/apular 
 artery 
 
 Branch of intercostal 
 artery 
 
 Branch of intercostal 
 
 artery 
 
 Continuation of posterior 
 scapular artery 
 
 Suprascapular artery 
 
 Acromial branch 
 ofacrontio- 
 thoracic 
 
 Acromial rete 
 
 bscapular branch 
 
 of suprasca imlur 
 
 artery 
 Infraspinous branch 
 
 of suprascupular 
 
 artery 
 Sttbxcafmlar branch 
 
 of axillary artery 
 
 Dorsal scapular branch of 
 subscapnlar artery 
 
 Infrascajnilar branch nf 
 dorsal scapular artery 
 
 Continuation of tub- 
 scapular artery 
 
no ANASTOMOSES OF ARTERIES OF UPPER EXTREMITY 
 
 FIG. 122. DIAGRAM OF THE ANASTOMOSES OF THE BRACHIAL ARTERY 
 (MacCormac and Anderson.) (Morris.) 
 
 Anterior circumflex 
 Posterior circumflex 
 
 Superior radial collateral (exces- 
 sively large) 
 
 Superior profunda 
 
 External posterior articular branch 
 of superior nrojunda 
 
 External anterior articular branch 
 of superior profunda 
 
 Posterior inlerosseous recurrent 
 
 Radial recurrent 
 Posterior interosseous recurrent 
 
 A cromio-thoracic 
 Long thoracic 
 
 Subscapular 
 Dorsalis scapulae 
 
 Posterior scapular 
 
 Anaslomotica magna 
 
 Transverse branch of anastomotica magna 
 
 Anastomosis of anterior ulnar recurrent with 
 anaslomotic 
 
 Anastomosis of posterior ulnar recurrent with 
 
 anaslomotic 
 
 ( Anterior ulnar recurrent 
 
 Posterior ulnar recurrent 
 
 Posterior interosseous from common interosseous of ulnar 
 
ANASTOMOSES OF ARTERIES OF UPPER EXTREMITY 
 
 FIG. 123. DIAGRAM OF THE RELATION OF THE ARTERIES OF THE LEFT FOREARM TO THE 
 BONES. (Walsham.) (Morris.) 
 
 Inferior profunda artery 
 Brachial artery 
 
 Anastomolica magna artery 
 
 Anterior ulnar recurrent 
 Posterior ulnar recurrent 
 
 Ulnar artery 
 Common interosseous artery 
 
 Anterior interosseous artery 
 
 Anterior ulnar carpal 
 
 Superficial branch of ulnar artery 
 (superficial palmar arch) 
 
 First palmar digital artery 
 
 Superior profunda artery 
 
 EXTERNAL CONOVLE 
 
 Articular branch of superior 
 profunda artery 
 
 Radial recurrent artery 
 Interosseous recurrent artery 
 
 Radial artery 
 - Oblique ligament 
 
 Interosseous membrane 
 Posterior interosseous artery 
 
 Anterior radial carpal 
 Radial artery at wrist 
 
 Superficial volar branch of 
 radial artery 
 
 lmar arch 
 
ANASTOMOSES OF ARTERIES OF UPPER EXTREMITY 
 
 FIG. 124. ANASTOMOSES AND DISTRIBUTION OF THE ARTERIES OF THE HAND. (Walsham.) 
 
 (Morris.) 
 
 Anterior interosseous 
 
 Radial artery 
 
 Anterior radial carpal 
 
 Superficial volar 
 Posterior radial carpal 
 Radial artery at wrist 
 
 Dorsalis pollicis 
 
 Metacarpnl or 
 
 first dorsal 
 
 interosseous 
 
 Princeps pollicis 
 
 Dorsalis indicis 
 
 Radialis itnlicis 
 
 First dorsal branch of collateral 
 digital 
 
 Second dorsal branch of collateral 
 digital 
 
 Anastomosis of collateral digital 
 arteries about matrix of nail 
 and pulp of finger 
 
 Ulnar artery 
 
 /L_ Anterior ulnar 
 carpal 
 
 Posterior ti/nar 
 carpal 
 
 Deep ulnar 
 Superficial arch 
 
 Carpal recurrent 
 
 Posterior comnttnn- 
 cnting or perforat- 
 ing 
 
 Palmar interosseous 
 
 Second, third, and 
 fourth pulmar 
 digital 
 
 Second and third 
 dorsal intei'osxeoits 
 
 First palmar digital 
 
 Anterior comnwni- 
 rntiity or perforat- 
 ing 
 
ARTICULATIONS 
 
 DEMONSTRATION XVI. 
 
 ARTICULATIONS AND LIGAMENTS. 
 
 Classes of articulations. 
 
 Various movements of joints. 
 
 Expose the ligaments in the following articulations: 
 
 Articulations of vertebral column. 
 
 1. Connecting the bodies of the vertebras. 
 
 2. Connecting the laminas. 
 
 3. Connecting the articular processes. 
 
 4. Connecting the spinous processes. 
 
 5. Connecting transverse processes. 
 
 FIG. 125. POSTERIOR VIEW OF THE STERNO-COSTO-CLAVICULAR JOINT. (Morris.} 
 
 Posterior 
 portion of 
 
 Interclavicular capsule 
 ligament 
 
 Rhomboid 
 ligament 
 
 Sterno-costo-clavicular. 
 
 Scapulo-clavicular. 
 
 Shoulder- joint. 
 
 Elbow-joint. 
 
 Radius with ulna. 
 
 Radio-carpal. 
 
 Carpal. 
 
 Carpo-metacarpal. 
 
 Interphalangeal. 
 
ARTICULATIONS 
 
 FIG. 126. ANTERIOR VIEW OF STERNO-COSTO-CLAVICULAR JOINT. (Morris.) 
 
 FIG. 127 .SECTION THROUGH STERNO-CLAVICULAR JOINT. (Morris.) 
 
 The Jaterarticular 
 flbro-cartilage 
 
 The joint between 
 the sternum and 
 second costal car- 
 tilage 
 
ARTICULATIOXS 
 
 FIG. 128. ANTERIOR VIEW OF SHOULDER, SHOWING ALSO CORACO-CLAVICULAR AND CORACO- 
 
 ACROMIAL LIGAMENTS. (Morris.) 
 
 Conoid ligament 
 
 Transverse scapular ligament 
 
 Trapezoid ligament 
 
 Coraeo-acromial ligament 
 
 ^ Short head of biceps 
 
 Subscapular tendon 
 
 Capsule of shoulder 
 
 Long tendon of 
 biceps 
 
 FIG. 129. POSTERIOR VIEW OF THE SHOULDER-JOINT, SHOWING ALSO THE ACROMIO-CLAVI- 
 
 CULAR JOINT AND THE SPECIAL LlGAMENTS OF THE SCAPULA. (Morris.) 
 
 Conoid ligament 
 
 Acromio-clavicular 
 ligament 
 
 Tendon of infra- 
 spinatus and teres 
 minor 
 
 Transverse ligament 
 
ARTICULATIONS 
 
 FIG. 130. VERTICAL SECTION THROUGH THE SHOULDER-JOINT TO SHOW THE GLENO- 
 
 HUMERAL LIGAMENT. (Morris.} 
 (The joint is opened from behind.) 
 
 Supra-spinatuB 
 muscle 
 
 Subacromial bursa 
 Tendon of biceps 
 
 with gleno-hume- 
 
 ral ligament 
 Tendon of subsca- _ 
 oularis 
 
 Capsular ligament 
 
 Suprascapular 
 ligament 
 
 Olenoid ligament or nbro-cartilage 
 
 FIG. 131. INTERNAL VIEW OF THE ELBOW-JOINT. (Morris.) 
 
 Oblique 
 ligament 
 
 Upper edge 
 of inter- 
 osseous 
 membrane 
 
ARTICULATIONS 
 
 117 
 
 FIG. 132. EXTERNAL VIEW OF THE ELBOW-JOINT. (Morris.} 
 
 k 
 
 Orbicular ligament 
 
 External lateral 
 ligament 
 
 Posterior ".igament 
 
 FIG. 133. ANTERIOR VIEW OF WRIST. ( 
 
 Anterior radio-ulnar 
 ligament 
 
 Internal lateral liga- 
 ment of wriat 
 Plexor carpi ulnaris 
 
 External lateral ligament 
 
 of wrist 
 Anterior radio-carpal 
 
 ligament 
 
 Tendon of flexor carpi 
 radialis 
 
 Capsular ligament of first 
 carpo-metacarpal joint 
 
u8 
 
 ARTICULATIONS 
 
 FIG. 134. POSTERIOR VIEW OF WRIST. (Morris.) 
 
 Posterior radio-carpal 
 
 ligament 
 
 Capsule of carpo-meta- 
 carpal joint of thumb 
 
 Posterior radio- 
 
 ulnar ligament 
 
 Internal lateral 
 ligament of wrist 
 
 FIG. 135. ANTERIOR AND POSTERIOR VIEW OF LIGAMENTS OF THE FINGERS. (Morris.) 
 
 Transverse ligament 
 between the heads 
 of the metacarpal 
 bones 
 
 Glenoid ligament 
 Lateral ligament 
 
 Areolar tissue 
 capsule 
 
 Lateral ligament 
 
 Glenoid ligament 
 Lateral ligament 
 
 Flexor tendon 
 
 Flexor tendon 
 
 Areolar tissue 
 
 capsule 
 Lateral ligament 
 
 Extensor tendon 
 
 Slips of the extensor . 
 tendon 
 
ARTICULATIONS 
 
 119 
 
 FIG. 136. SYNOVIAL MEMBRANES OF WRIST, HAND, AND FINGERS. (Morris.) 
 
 Synovial sac of the inferior radio- 
 uluar joint 
 
 Synovial sac of the carpus 
 
 Synovial sac, occasionally separate, 
 for the fourth and fifth metacar- 
 pal bones 
 
 Lateral ligaments of the metacarpo- 
 phalaugeal, and iuter-phalangeal 
 joints 
 
 Study the nerve- and blood-supply of each joint. 
 
I2O 
 
 CUTANEOUS NERVES 
 
 Showing the cutaneous nerve supply of the body. 
 
 FIG. 137. DIAGRAM OF THE CUTANEOUS NERVE AREAS OF THE HEAD AND NECK. (Morris.) 
 
 SMALLEST 
 OCCIPITAL 
 
 X INFRA ( 
 ORITAL\t 
 
 DESCENDING CER VfCA L 
 
 SMALL \. 
 OCCIPITAL 
 
 TEMPORAL 
 
 SUPRA 
 T ROC H LEAR 
 
 LACHRYMAL 
 
 INFRA 
 ROC H LEAR 
 
 NASAL 
 
CUTANEOUS XERVES 
 
 FIG. 138. DIAGRAM SHOWING THE AREAS OF DISTRIBUTION OF CUTANEOUS NERVES. 
 
 (Morris,) 
 
 HEAD: 
 
 Red First division of fifth, \\hite Second division of fifth. Blue Third division of fifth. Dark area Posterior 
 primary divisions of cervical nerves. Oblique and transverse shading Branches of cervical plexus. 
 
 BOD* AND LIMBS: 
 
 Red Anterior divisions of anterior primary branches. Blue Posterior di visions of anterior primary branches. Two 
 colors in one area indicate that the area is supplied by two sets of nerves, and it should be understood _that 
 wherever two nerve areas approach each other they overlap. The dotted blue area of small sciatic indi- 
 cates that the nerve comes from the posterior as well as from the anterior parts of anterior primary divisions 
 of sacral nerves, but it supplies a flexor area. The area of the perforating cutaneous nerve is left uncoloured 
 because its true nature is uncertain. Dark shading Posterior primary divisions. The numbers and initial 
 letters refer to the nerve-roots from which the nerves are derived. 
 
 Front 
 
 Back 
 
 Itt DIVISION OF 5th - 
 
 3d DIVISION OF oth - 
 
 td DIVISION OF oth 
 
 GREA T A URICULAR 
 
 t,3C, SUPERFICIAL CERVICAL 
 
 SUPERFICIAL 
 DESCEXDIXG CERV. 
 
 CIRCUMFLEX 
 LATERAL fTTAXEOUS 
 JKKSKB8 
 
 AXTERluR CUTAXE- 
 - XERVE* 
 
 IXTEKXAL CCTAXg- 
 t.V/> fXTERCOSTO-BC- 
 
 MERAL, I. S D 
 
 CPPER EXTERNAL CCTAXB- _. 
 OL'S OF MCSCI'LO-SPIRAL 
 
 IXTERXALCUTAXEOUS - 
 
 MUSCULO-CUTAXEOUS 
 
 EXTERXA L 
 CUTANEOUS 
 
 GEXITO-CRURAL 
 RADIAL, 6 C 
 
 IXGI'IXAL. I L 
 If ED I AX, g, 7, S C, I D - 
 
 ULXAR, 1 D ~. 
 
 IXTERXA L CUT A XEO US 
 MIDDLE CUTANEOUS 
 
 EXTERNAL POPLITEAL ~ 
 IXTERXAL SAPHEXOUS - 
 
 SUPRAORBITAL 
 
 GREAT OCCIPITAL 
 SMALL OCCIPITAL 
 SMALLEST OCCIPITAL 
 GREA T A URICULAR 
 
 POSTERIOR PRIMARY Diri- 
 SIOA'S OF CERVICAL SERVES 
 
 SUPERFICIAL DE- 
 1>ISG CERVI- 
 CAL,:, UC 
 
 CIRCUMFLEX, 5, 6 C 
 
 LATERAL BRAXCHES OF 
 DORSAL XERTES 
 
 UPPER ESTERXAL CCTAXX- 
 OCS OF MrSCVLO-SPIRAL 
 
 IXTERCOSTO-Hl'MERAL AXD 
 LESSER 1XT. CrTAXEOCS 
 
 IXTERXAL Cl'TAXBOCS OF 
 MrSCCLO-SPIRAL 
 
 LOWER E.TTERXAL OF 
 
 'LO-CUTAXEOUS 
 
 EXTERNAL SAPHEXOUS 
 
 AXTERIOR TIBIA L ~~ 
 
 IXTERXAL PLA.\TAR 
 
 IXTERXAL CCTAXEOCS 
 POSTERIOR PRIMARY 
 LL'MBAR 
 
 LATERAL CCTAXKOCS OF 
 
 ILIO-HTPOGA S TRir 
 
 . s.tc 
 
 POSTERIOR PRIM. SACRAL 
 PERFORA TIXO 
 CCTAXEOCS OF td 
 AKD 3d SACRAL 
 
 l'L\AS,8C 
 
 - A DIAL, 6,7 C 
 
 AREA SUPPLIED BT 
 
 RADIAL Axr> I-LXAX 
 XERTSS 
 
 ir. - JfEDfAX, 6, 7, 8 C, 
 ID 
 
 EXTERXAL CUTAXEOUS 
 
 SMALL SCIATIC 
 
 IXTERXA L CUT A XFO US A XD 
 OBTURATOR 
 
 EXTERXAL POPLITEA L,5 L,1,SS 
 IXTERXAL SAPHEXOUS, 3, U L 
 
 EXTERXAL SAPHEXOUS, 1, 1 S 
 
 CALCAXEO-PLAXTAR (Post- 
 tihial), 1,SS 
 
 EXTERXAL PL A XT A R, 1, t S 
 IXTERXAL PLAXTAR, ' 5 L,1S 
 
122 
 
 TRANSVERSE SECTIONS 
 
 An examination of the following figures will help to understand and 
 remember the relative positions of the structures exposed by the sections. 
 
 FIG. 139. SECTION OF NECK THROUGH THE SIXTH CERVICAL VERTEBRA. (One-half.) 
 
 (Braune.) (Morris.} 
 
 RECURRENT LARYNGEAL NERVE 
 
 PHARYNX i LARYNX 
 
 Longus colli muscle 
 Superior thyroid artery 
 DESCENDENS NON1 
 
 VAGUS 
 PHRENIC NER VE 
 
 Soalenus anticus 
 Sterno-oleido-mastoid 
 
 BRACHIAL PLEXUS 
 
 Scalentia medius 
 External jugular rein 
 
 SPINAL ACCESSORY 
 NERVE 
 
 SpleniuB 
 
 PART OF ARTICULAR SURFACE OF SEVENTH CERVICAL VERTEBRA 
 
 Semi-spinalis and multifidua 
 
 SIXTH CERVICAL VERTEBRA 
 
 Thyro-aryteuoid muscle 
 
 CRICOID CARTILAGE (and omo-hyoid muscles 
 
 Sterno-hyoid (just posterior are seen the thyro- 
 Crico-arytenoideus lateralis 
 
 Muscular process of the thyroid cartilage 
 
 THYROID GLAND 
 
 Common carotid artery 
 Internal jugular vein 
 
 BRACHIAL PLEXUS 
 
 Scalenus medius 
 External jugular vein 
 Scalenus posticus 
 
 SPINAL ACCESSORY 
 NER VE 
 
 Levator anguli scapulae 
 
 Cervicalis ascendens 
 Transversalis cervicis and traehelp- 
 Profunda cervicis vessels 
 Trapezius 
 
 Biveuter cervicis and complexus 
 
 FIG. 140. DIAGRAM SHOWING RELATION OF KIDNEY TO CAPSULE. (Morris.) 
 
 TRANSVERSE COLON 
 
 DESCENDING COLON 
 
 PERITONEUM 
 
 FATTY CAPSULE 
 
 KIDNEY 
 PERITONEAL CAVITY 
 
 Diaphragmatic 
 fascia 
 
 Parietal muscle 
 
 CUT EDGE OF 
 PERITONEUM 
 
 Muscular fibre in 
 subperitoneal 
 tissue 
 
 PANCREAS 
 
 Sup. mesenteric vein 
 DUODENUM 
 
 LYMPHATIC GLAND 
 
 LUMBAR VERTEBRA 
 
 SUBPERITONEAL TISSUE FATTY CAPSULE Renal vessels embedded in mbperitoneai tissue 
 
TRANSVERSE AND SAGITTAL SECTIONS 
 
 123 
 
 FIG. 141. TRANSVERSE SECTION OF THE ABDOMEN THROUGH THE KIDNEYS AND PANCREAS. 
 AT THE LEVEL OF THE FIRST LUMBAR VERTEBRA. (Braune.) (Morris.) 
 
 Inferior caro 
 
 Bound ligament 
 RectuB 
 
 EIGHTH RIB 
 
 STOMACH 
 
 8I6MOID FLEXURE 
 
 DESCENDING COLON 
 External oblique 
 
 PANCREAS 
 
 SPLEEN 
 
 TRANSVERSE COLON 
 / SEVENTH RIB 
 
 ASCENDING COLON 
 
 DUODENUM 
 
 EIGHTH RIB 
 
 Obliquus eiternns 
 NINTH RIB 
 PLEURA 
 TENTH RIB 
 
 Splenic rtin 
 
 Descending aorta 
 BODY OF FIRST LUMBAR VERTEBRA TWELFTH RIE 
 
 LIVER 
 Diaphragm 
 
 ELEVENTH RIB 
 
 FIG. 142. SAGITTAL SECTION OF MALE PELVIS IN THE MESIAL LINE. (One-third.) (Braune.) 
 
 (Morris.) 
 
 BLADDER 
 
 F.ES 
 
 BULB 
 
 - POUCH OF DOUGLAS 
 
 - RECTUM 
 
 - FOLD OF HOUSTON 
 
 - VESICULA SEMINAUS 
 
 !J~ DUCTUS EJACULATORIUS 
 L. PROSTATE 
 
 External sphincter 
 
 | Internal sphincter 
 
 External sphincter 
 
i2 4 SAGITTAL AND TRANSVERSE SECTIONS 
 
 FIG. 143. SECTION OF THE FEMALE PELVIS. (After Henle.) (Morris.} 
 
 VESICAL WALL 
 
 CAVITY OF BLADDER 
 
 Prevesical fat 
 
 Deep transver- 
 sus perinaei 
 
 RECTUM 
 
 COCCYX 
 
 Recto-coccy- 
 geal muscle 
 POSTERIOR LIP OF 08 
 
 UTERI 
 ANTERIOR LIP 
 
 VAGINA 
 
 External 
 sphincter ani 
 
 Internal 
 sphincter ani 
 
 LABIUM MAJUS 
 Unstriped muscular fibre 
 
 URETHRA 
 LABIUM MINUS 
 
 ANUS 
 
 Internal sphincter ani 
 Fart of external sphincter ani 
 
 Unstriped muscular fibre Vessels 
 
 VAGINAL ORIFICE 
 
 FIG. 144. SECTION SHOWING THE ISCHIO-RECTAL FOSSA IN ITS RELATIONS TO THE PELVIC 
 
 VISCERA. (Morris.) 
 
 OS PUBIS 
 Muscles 
 
 Levator ani with recto-vesical 
 and ischio-rectal fasciae 
 
 Obturator internus 
 
 Internal pudie vessels and 
 
 NER VES in obturator fascia 
 
 TUBER ISCHII 
 
 Ischio-rectal fossa with its 
 anterior and posterior ex- 
 tensions 
 
 Gluteus maximus 
 
 SYMPHYSIS PUBIS 
 
 Pubo-prostatic ligaments 
 Proslatic plexus 
 PROSTATE 
 
 Capsule of prostate formed 
 
 by recto-vesical fascia 
 Fat 
 
 RECTUM INVESTED BY RECTO- 
 VESICAL FASCIA 
 
SECTION OF SHOULDER-JOINT 
 
 125 
 
 FIG. 145. TRANSVERSE SECTION THROUGH THE RIGHT SHOULDER-JOINT, SHOWING THE 
 STRUCTURES IN CONTACT WITH IT. (Braune.) (Morris.) 
 
 CLAVICLE 
 
 ACROMION 
 Supra-spinatus 
 
 Trapezius 
 Infra-spinatus 
 
 Teres minor 4 
 
 Teres major 
 Latiasimus dorsi 
 
 Pectoral is major 
 
 Axillary vessels and NER VES Tendon of subscapularis blended with 
 
 the scapular ligament 
 Coraco-brachialis and short head of biceps 
 
 FIG. 146. DIAGRAMMATIC SECTION OF SHOULDER THROUGH BICIPITAL GROOVE. 
 
 (Anderson.) (Morris.) 
 
 Deltoid 
 
 SUBACROMIAL BURSA 
 
 CAPSULE OF SHOULDER-JOINT 
 Long tendon of biceps 
 
 Synovial membrane lining 
 capsule and synovial 
 membrane 
 
 Extra-articular portion of 
 bicepa tendon 
 
 Glenoid ligament 
 
 GLENOID CAVITY 
 
 Glenoid ligament 
 
 Inner fold of capsule and 
 synovial membrane 
 
126 
 
 ARM AND ELBOW 
 
 FIG. 147. SECTION THROUGH THE MIDDLE OF THE RIGHT UPPER ARM. (Heath.) 
 
 (Morris.) 
 
 Cephalic vein 
 
 MUSCULO-CUTANEO US 
 NER VE 
 Brachialis anticus 
 
 MUSCULO-SPIRAL NERVE 
 Superior profunda vessels 
 
 Triceps, with fibrous intersection 
 
 Biceps 
 
 Brachial vessels 
 
 - MEDIA N NER VE 
 ULNAR NERVE 
 Basilic vein, u-ith internal 
 cutaneous nerves 
 
 Inferior profunda vessels 
 FIG. 148. VERTICAL SECTION OF THE ELBOW. . (One-half.) (Braune.) (Morris.) 
 
 Tendon of biceps 
 
 Brachio-radialis 
 RADIAL NERVE 
 
 Brachialis anticus 
 Extensor carpi radialis longior 
 
 Anconeus 
 
 Pronator teres 
 MEDIAN NERVE 
 
 - Flexor carpi radialis 
 
 Internal lateral ligament 
 ULNAR NERVE 
 
 OlECRANON 
 Tendon of triceps 
 
 FIG. 149. LONGITUDINAL SECTION OF THE ELBOW-JOINT. (One-half.) (Braune.) 
 
 (Morris.) 
 
 Triceps 
 
 Extensor carpi nlnaris 
 
 Biceps 
 
 Brachialis anticus 
 
 MUSCUL 0-SPIRA L NER VE 
 Brachio-radialis 
 
 Supinator brevis 
 
 Extensor carpi radialis longior 
 
FOREARM AND }VRIST 
 
 127 
 
 FIG. 150. SECTION -THROUGH THE MIDDLE OF THE RIGHT FOREARM. (Heath.) (Morris.) 
 
 Brachio-radlalis 
 
 Supinator brevis 
 
 Extensor carpi radialis 
 longior and brevier 
 
 Extensor ossis metacarpi 
 pollicis 
 
 Extensor communis digitorum 
 
 Extensor carpi ulnaris 
 Posterior interosseous vessels and NERVE 
 
 Flexor sublimis digitorum 
 
 Flexor carpi ulnaris 
 
 Ulnar vessels and NERVE 
 Flexor profundus digitorum 
 MEDIAN NERVE 
 
 Extensor secundi iuternodii pollicis 
 
 FIG. 151. SECTION THROUGH REGION OF WRIST, A LITTLE ABOVE THE JOINT. RIGHT 
 SIDE, UPPER HALF OF THE SECTION. (Tillaux.) {Morris.) 
 
 Flexor carpi radialis 
 Radial artery 
 
 Brachio-radialis 
 
 Flexor longus pollicis 
 / Flexor sublimis 
 
 Flexor profundus 
 
 Pronator quadratus 
 
 RADIAL NERVE 
 
 Extensor ossis meta- 
 carpi pollicis 
 Extensor primi 
 internodii pollicis 
 
 Extensor carpi radialis 
 
 longior 
 Extensor carpi radialis 
 
 brevior 
 
 Extensor secundi internodii 
 pollicis 
 
 Ulnar artery, mnrr 
 internal ly the NERVE 
 
 Anterior interosseout 
 artery 
 
 Flexor carpi ulnaris 
 
 RADIUS 
 
 Extensor carpi ulnaris 
 Extensor minimi digiti 
 
 Extensors corn- 
 munis and indicis 
 
128 
 
 SECTION OF THE WRIST 
 
 FIG. 152. TRANSVERSE SECTION OF THE WRIST, THROUGH THE MIDDLE OF THE PISIFORM 
 
 BONE. (Morris,} 
 
 Sheath of flexores sublimis and profundus digitorum and flexor longus pollicis, 
 enclosed by the annular ligament 
 
 Cut tendon of palmaris longu 
 
 SEMILUNAR BONE 
 
 ULNAR NERVE 
 
 Ulnar vessels 
 
 Sheath for flexor carpi radialis 
 Radial origin of annular ligament 
 
 Sheath for extensor ossis metacarpi 
 and primi internodii pollicis 
 
 Radial vessels 
 
 Sheath for extensor ossis metacarpi 
 and primi internodii pollicis 
 
 OS MAGNUM 
 
 Sheath of extensor secundi 
 internodii pollicis 
 
 Sheath of extensores carpi radialis, longior and brevior 
 
 Sheath of extensor communis and indicator 
 
 - CUNEIFORM 
 
 Sheath of extensor carpi 
 ulnaris 
 
 Sheath of extensor minimi digiti 
 
 CUNEIFORM 
 UNCIFORM 
 
 FIG. 153. SECTION OF CARPUS, THROUGH THE UNCIFORM BONE. 
 
 after Henle.) (Morris.) 
 
 (Two-thirds.) (Bellamy 
 
 MEDIAN NERVE 
 Plexor longus pollicis Flexores sublimis and profundus 
 
 Flexor carpi radialis 
 
 Thenar muscles 
 BASE OF FIRST METACARPAL BONE 
 
 Ulnar vessels and NER VE 
 
 Palmaris brevis 
 
 Hypothenar muscles 
 
 Extensor ossis 
 metacarpi pollici 
 TRAPEZIUM 
 
 Extensor primi internodii 
 
 pollicis 
 
 Radial vessel, 
 
 Extensor carpi radialis longior- 
 
 TRAPEZOID 
 External carpi radialis brevior 
 
 Extensor carpi ulna via 
 Extensor minimi digiti 
 UNCIFORM 
 
 OS MAGNUM Extensor communis digitorum 
 Extensor indicis 
 
SECTION OF HAND 
 
 129 
 
 FIG. 154. HORIZONTAL SECTION OP THE HAND THROUGH THE CARPO-METACARPAL JOINTS. 
 
 (Bellamy after Henle.) {Morris.) 
 
 Volar aponeurosis 
 Flexor tendon in the sheath Inter-osseous 
 
 Lumbricales 
 Flexor tendon in the sheath 
 
 Deep volar aponeurosis 
 
 Lumbricales 
 Anterior carpal ligament 
 
 Flexor tendon in the sheath 
 Deep volar aponeurosis I 
 Iiumbric 
 
 Lumbricales 
 
 Anterior carpal ligament 
 f Flexor tendon in the sheath 
 Hypothenar muscles 
 
 FIG. 155. DIAGRAM OF A VERTICAL SECTION THROUGH THE MIDDLE OF THE HAND. 
 
 (Morris.) 
 
 Posterior annular ligament 
 
 Deep transverse ligament 
 Attachment of common extensor 
 to first phalanx 
 
 Superficial transverse ligament 
 
 Vincula accessoria 
 
 Attachment of common extensor 
 to second phalanx 
 
 Attachment of common extensor 
 to third phalanx 
 
 Great palmar bursa 
 
 Anterior annular ligament 
 
 Dorsal inter-osseous 
 Lumbricalis 
 Palmar fascia 
 
 Flexor profundus digitorum 
 Flexor sublimis digitorum 
 
 Theca 
 
 Ligameutum vaginale 
 Vincula accessoria 
 
PART II. 
 
 ABDOMEN, ABDOMINAL VISCERA, PELVIS, PELVIC VISCERA, 
 AND LOWER EXTREMITIES. 
 
DEMONSTRATION I. 
 THE ABDOMEN. 
 
 Surface Anatomy. Umbilicus, linea alba, recti muscles, and linea semi- 
 lunaris, should be located. The external abdominal ring can be felt above 
 and external to the spine of the pubis. Passing from the spine of os pubis 
 to the anterior superior spine of the ilium is Poupart's ligament. 
 
 The external abdominal ring in the male can be felt by passing your 
 finger along the spermatic cord beginning at the testes. 
 
 In order that the viscera in the abdomen may be more easily located 
 the abdomen is divided into regions by drawing one line horizontally across 
 the abdomen on a level with the cartilages of the ninth ribs ; another on 
 a level with the anterior superior spines of the ilia. Then draw a vertical 
 line on each side from the cartilages of the eighth ribs to the middle of 
 Poupart's ligament. This divides the abdomen into epigastric, umbilical, 
 hypogastric, right and left hypochondrium, right and left lumbar, right 
 and left inguinal regions. 
 
 FIG. 156. (Holden.) 
 
134 THE ABDOMEN 
 
 Another division can be made, shown in figure 157, from Morris: 
 
 FIG. 157. DIAGRAM OF THE ABDOMINAL REGIONS. (Morris.} 
 
 Joint between meeo-Bter- 
 num and ensiform cartilage 
 
 Tip of ensiform cartilage 
 Costal border 
 
 UPPER HORIZONTAL PLANE 
 
 LOWER HORIZONTAL PLANE A, Al 
 LEVEL OF TUBERCLES OF ILIAC 
 CREST 
 
 LOWER HORIZONTAL PLANE B, AT 
 LEVEL OF ANTERIOR ILIAC SPINES 
 
 VERTICAL PLANE A, FROM MIDDLE OF 
 POUPART'S LIGAMENT 
 
 VERTICAL PLANE B, AT OUTER BOR- 
 DER OF RECTUS (SEMILUNAR LINE) 
 
 SUMMIT OF SYMPHYSIS PUBIS 
 
 What viscera are in each region ? 
 
THE ABDOMINAL WALLS 
 
 135 
 
 DEMONSTRATION II. 
 
 ABDOMINAL WALLS. 
 
 Make a circular incision through the skin around the umbilicus one and 
 one-half inches in diameter; turn the skin toward the umbilicus. This serves 
 to hold a string. Now make a puncture through the umbilicus, insert a blow- 
 pipe, distend the abdomen with air, remove blow-pipe, and draw the string 
 tight. 
 
 Dissection. Make an incision through the skin from the ensiform 
 cartilage to the os pubis, another midway between the umbilicus and os 
 pubis, transversely outward to the anterior superior iliac spine and along 
 the crest of the ilium to its posterior third. Another from the umbilicus 
 upward and outward to the sixth rib. Dissect off the skin, exposing the 
 superficial fascia. 
 
 Study the superficial fascia and note in it the following: 
 
 Superficial arteries (Fig. 158): 
 Superficial epigastric. 
 Superficial circumflex iliac. 
 Superficial external pudic. 
 
 FIG. 158. SUPERFICIAL VESSELS AND GLANDS OF THE GROIN. (Holden.) 
 Saphenous opening of the fascia lata. 2. Saphena vein. 3. Superficial epigastric a. 
 4. Superficial circumflexa ilii a. 5. Superficial external pudic a. 6. External ab- 
 dominal ring. 7. Fascia lata of the thigh. 
 
136 
 
 THE ABDOMINAL WALLS 
 
 Superficial nerves (see Fig. 81): 
 
 Lower dorsal. 
 
 Ilio-hypogastric . 
 
 Ilio-inguinal. 
 Superficial lymphatics. 
 
 FIG. 159. LYMPHATIC VESSELS AND GLANDS OF THE GROIN. (Holden.} 
 
THE ABDOMINAL WALLS 
 
 137 
 
 Dissect the skin 'down only one inch below Poupart's ligament. Do not 
 go onto the thigh. 
 
 Expose the external abdominal muscle. 
 
 Carefully locate and study Poupart's ligament. 
 
 Locate and study the external abdominal ring, noting its position and 
 its boundary. Note spermatic cord or round ligament. Feel the opening 
 by pushing your finger up along the spermatic cord into the ring. 
 
 FIG. 160. POUPART'S LIGAMENT, THE APONEUROSIS OF THE EXTERNAL OBLIQUE AND 
 THE EXTERNAL ABDOMINAL RING. (Holden.) 
 
 i. External abdominal ring. 2. Its inferior or external pillar, curvilinear, attached to the 
 spine of the pubis. 3, 3. Its superior or internal straight pillar, prolonged to the 
 median line attached to the symphysis pubis, and interlacing with the one of the oppo- 
 site side. 4, 4. Ligament of Colles, situated behind the preceding pillar and interlacing 
 with it, attached to the crest of the pubis of the opposite side, thus forming an internal 
 pillar. 5,5. Attachment of Colles' ligament. 6. Arched fibers connecting the internal 
 and external pillars, forming the external boundary of the ring. 7. Linea alba. 8. 
 Symphysis pubis. Q. Spermatic cord. 10. Poupart's ligament, n, n. Cribriform 
 fascia. 12. Internal saphenous vein. 
 
 331 6 
 
 */.. i 
 
 12 j A 
 
 Study the external abdominal muscle and then detach it by cutting 
 it halfway between its origin and the linea semilunaris; turn it outward, 
 and inward to the linea semilunaris. Do not destroy Poupart's ligament, 
 but make an incision about one-half inch above the lower border of the 
 aponeurosis of the external oblique and parallel with its lower border, 
 thus making Poupart's ligament. 
 
 Study the internal oblique muscle and then detach this muscle the 
 same as the external oblique. 
 
 Observe the fibres of the cremaster muscle, the conjoined tendon and 
 triangular fascia. (See Figs. 161 and 162.) 
 
138 
 
 THE ABDOMINAL WALLS 
 
 FIG. i6i. DISSECTION OF INGUINAL CANAL. (Wood.) (Morris.) 
 
 ,A\ 
 
 Ext. oblique 
 (turned down) 
 
 Hectus abdominis 
 (with sheath opened) 
 
 Int. oblique 
 Transversalis 
 
 Conjoined tendon 
 Triangular fascia 
 Cremaster 
 
 FIG. 162. DIAGRAM OF THE LOWER FIBRES OF THE INTERNAL OBLIQUE AND TRANSVERSALIS, 
 
 WITH THE CREMASTER MUSCLE. (Holden.) 
 
 i. Conjoined tendon of internal oblique and transversalis. 2. Cremaster muscle passing 
 
 down in loops over the cord. 
 
THE ABDOMINAL WALLS 139 
 
 Locate the internal abdominal ring; study its boundary. (See Fig. 16 1 .) 
 
 What is the inguinal canal? 
 
 Study the transversalis muscle and detach it same as the oblique 
 muscles. (See Fig. 161.) 
 
 Observe the transversalis fascia and note that the internal abdominal 
 ring is bounded by this fascia. Note the spermatic cord in the male and 
 the round ligament in the female as they pass along the inguinal canal. 
 
 Expose the rectus abdominis muscle by cutting through its sheath 
 lengthwise. Note the linea transversae. (See Fig. 163.) 
 
 What forms the sheath of rectus abdominis muscle? 
 
 Observe and study the pyramidalis muscle. 
 
 Study rectus abdominis muscle and then cut it across at the um- 
 bilicus and turn it upward and downward. Observe in the muscle above 
 the umbilicus the superior epigastric artery, and in the sheath behind 
 the muscle below the umbilicus the deep epigastric artery. Note the 
 relation of the deep epigastric to the internal abdominal ring. (See Fig. 
 
 165.) 
 
 Also observe the plica semilunaris, or fold of Douglas. 
 
 FIG. 163 DEEP MUSCLES OF THE ABDOMINAL WALL. (Holden.) 
 
 Rectus abdominis. .2, 2. Internal oblique. 3,3. Anterior leaflet of the aponeurosis of 
 the internal obliq.ue. 4,4. Cut external oblique. 5,5. Spermatic cord. 6,6. Inferior 
 part of the external oblique aponeurosis turned back on the thigh. 7. Rectus abdom- 
 inis; the upper part has been excised to show the aponeurosis of the transversalis. 8, 8. 
 Fleshy portion of this muscle. 9. Its aponeurosis. 10 Umbilicus, n. Linea alba 
 above umbilicus. 12. Infraumbilical linea alba separating below the two pyramidales. 
 13, 13. Serratus magnus. 14. Cut right latissimus dorsi. 15. Cut left latissimus 
 dorsi. 16. Cut serratus magnus. 17, 17. External intercostals, 18, 18. Femoral 
 aponeurosis. 19. Cut internal oblique. 
 
 
140 
 
 THE ABDOMIXAL WALLS 
 
 Deep arteries of abdomen: 
 
 Deep epigastric (A. epigastrica inferior}. 
 Deep circumflex iliac. 
 Superior epigastric. 
 Intercostalis, lower. 
 Lumbar, terminal branches. 
 
 FIG. 164. SIDE VIEW OF PELVIS AND UPPER THIRD OF THIGH, WITH THE EXTERNAL ILIAC, 
 INTERNAL ILIAC, AND FEMORAL ARTERIES AND THEIR BRANCHES, LEFT SIDE. (Morris.} 
 (From a dissection by W. J. Walsham in the Museum of St. Bartholomew's Hospital.) 
 The bladder is hooked over to expose back of pelvis. 
 
 Common iliac artery 
 SYMPA THETIC SER VE 
 Middle sacral artery 
 
 
 Common iliac vein 
 URETER 
 
 Internal iliac artery 
 External iliac vein 
 
 External iliac artery 
 
 Potterior branch of internal iliac dividing into 
 gluteal and ilio-lumbar arteries 
 
 Lateral sacral artery 
 
 SAGRAL PLEXUS 
 OBTURA TOR NER VE - 
 
 Obturator artery 
 Obliterated hypogastric 
 
 Superior vesical artery 
 Edge of levator ani 
 
 Pudic artery 
 
 BLADDER 
 
 Middle vesical artery 
 
 Deep epigastric artery 
 Pubic branch of epi- 
 gastric artery 
 Common femoral artery 
 
 Long snphenoiis vein 
 Peetineus muacle 
 
 Obturator artery 
 
 Adductor maguus 
 
 Internal circumflex artery 
 
 Adductor brevis 
 
 OBTURATOR NERVE (ant. branch) 
 
 Profunda artery 
 
 Adductor longus, hooked aside 
 
 Superficial femoral artery and vein 
 
 Graeilis muscle 
 Lower part of sartoriua 
 
 Psoaa muscie 
 Iliu-lumbar artery 
 
 EXTERSA 7, f'UTA- 
 SEOL'K SERVE 
 
 Iliacus muacle 
 
 ESI TO-CRURAL ,. 
 SERVE 
 
 ASTER I OR CRU- 
 RAL SERVE 
 
 Deep circnnifli-jc iliac 
 artery 
 
 Superficial circumflex 
 
 ilia,- 
 A \TKRIOR CRURAL N. 
 
 Hint: <:/. artery and 
 
 x,,,, -I:.,- ,,l,lt,,,l ,,;; 
 
 Tenaor faciae femoria 
 
 (hooked aside) 
 Gluteus medius and 
 
 minimus 
 Sariorius muscle 
 MlhDLI-: / CTA- ' 
 SEOUS SERVE 
 
 SERVE TO RECTUS 
 
 KERVE Til 1M.V/T5 
 BXTBSNU8 
 
 Efli'fnnl cin-ii in flex ar. 
 
 XERVE TO CRl'REl'S 
 
 Rectus, hooked aside 
 I'm ,;,, la rein 
 
 L<>.\<; SAI'llESOUS 
 SERVE AM> 
 SERVE Tit VAS- 
 TUS 
 
 Vastus internus 
 muscle 
 
THE ABDOMIXAL CAVITY 
 
 141 
 
 Study carefully the anatomy concerned in inguinal hernia. (See Figs. 
 161 and 165.) 
 
 FIG. 165. POSTERIOR PART OF LOWER WALL OF ABDOMEN WITH THE DIFFERENT STRUC- 
 TURES ON IT. (Blandin.) (Morris.} 
 
 Deep epigastric vessels 
 Internal abdominal ring 
 
 INNER BORDER OF INGUINAL CANAL 
 \ 
 
 External iliac vein 
 ILIUM 
 
 VAS DEFERENS 
 CRURAL CANAL 
 
 Pelvic fascia 
 
 Obturator fascia 
 
 Leu 
 Hecto-vesi 
 
 Fascia iliaca 
 
 Obliterated hypogastrie artery 
 
 RECTUM 
 ISCHIO-RECTAL FOSSA 
 
 BLADDER 
 
 INTERNAL PUDIC VESSELS AND 
 SERVE 
 
 DEMONSTRATION III. 
 
 ABDOMINAL CAVITY. 
 
 General description; boundaries. 
 
 Open the abdomen by making an incision through the transversalis 
 fascia and peritoneum, lying below it, a little to the left of the median line 
 and extending from the ensiform cartilage to a level of the umbilicus. 
 From this point make an incision on each side extending obliquely outward 
 to the anterior superior spine of the ilium. 
 
 Examine the inner surface below the umbilicus and note : 
 
 Urachus. 
 
 Hypogastrie artery obliterated. 
 
 Fossae. 
 
 (See Fig. 165.) 
 
 CONTENTS OF ABDOMEN. 
 
 Study the position of each viscus, noting the relations to each other 
 and to external landmarks: 
 
 Stomach: Shape, position in abdomen, and relation to surrounding 
 parts. 
 
142 
 
 THE ABDOMINAL VISCERA 
 
 Liver: Position in relation to ribs, stomach, colon, and kidney. 
 
 Large Intestines: Relation to small intestines, liver, spleen, kidney, 
 and stomach. 
 
 Small Intestines: Duodenum, jejunum, ileum, junction with large in- 
 testines. 
 
 Vermiform Appendix: Relation to caecum. 
 
 Kidney: Position as to crest of ilium, ribs, and vertebras. 
 
 Spleen: Relation to ribs, colon, stomach, and pancreas. 
 
 Pancreas: Relation to stomach, duodenum, and superior mesentery 
 artery. 
 
 FIG. 166. THE VISCERA AS SEEN ON FULLY OPENING THE ABDOMEN WITHOUT DISARRANGE- 
 MENT OF THE INTERNAL PARTS. (After Sarazin.) (Morris.) 
 
 DIAPHRAGM 
 
 STOMACH 
 SPLEEN 
 
 GREAT OMENTUM 
 SMALL INTESTINE 
 
THE ABDOMINAL VISCERA 
 
 J 43 
 
 FIG. 167. VIEW OF THE DEEPER ABDOMINAL VISCERA. (Rudinger.) (Morris.) 
 
 Superior vena cava 
 
 THORACIC DUCT 
 
 Inferior vena caret 
 
 ASCENDING COLON 
 
 Aorta 
 
 LEFT BRONCHUS 
 
 aSOPHAGUS 
 
 SPLKN 
 
 KIDNEY 
 DUODENUM 
 DESCENDING COLON 
 
 SIGMOiD FLEXURE 
 3LADDER 
 
i 44 THE PERITONEUM 
 
 FIG. 168. THE VISCERA OF THE FCETUS. (Rudinger ) (Morris.} 
 
 THYROID 
 
 LUNG 
 
 LIVER 
 Suspensory ligament 
 
 SMALL INTESTINE 
 
 BLADDER 
 
 TRACHEA 
 
 THYMUS 
 
 LUNG 
 
 RIGHT AURICLE 
 
 RIGHT VENTRICLE 
 
 STOMACH 
 
 PART OF TRANSVERSE 
 COLON 
 
 Hypttyastric artery 
 
 PERITONEUM. 
 
 General character. The following is taken from Holden's " Anatomy " : 
 "A certain range of motion being necessary to the abdominal viscera, 
 they are provided with a serous membrane, called peritoneum. This mem- 
 brane, like other serous membranes, is a closed sac, one part of which lines 
 the containing cavity, the other is reflected over the containing viscera. 
 These are respectively termed the parietal and the visceral layers. In the 
 female, however, it is not, strictly speaking, a closed sac, since it communi- 
 cates with the cavity of the uterus through the Fallopian tubes. The in- 
 ternal surface of the peritoneum is smooth and polished, and lined by 
 squamous endothelium; the external surface the subperitoneal tissue- 
 is composed of areolar tissue, which connects the internal layer to the in- 
 vested viscera or abdominal parietes. There is nothing between the par- 
 ietal and visceral layers in other words, inside the sac but just sufficient 
 moisture to lubricate its smooth and polished surface. The viscera are 
 all, more or. less, outside the sac ; some lie altogether behind it, as the 
 
THE PERITONEUM 
 
 145 
 
 pancreas, kidneys, suprarenal capsule; others, as the lower parts of the 
 duodenum, caecum, ascending and descending colon, are only partially 
 covered by it; while others, as the stomach, liver, jejunum, ileum, and 
 some parts of the large intestines, are completely invested by it; these 
 latter push the visceral layer before them, and so give rise to membranous 
 folds; the larger the fold, the freer is the mobility of the viscus which 
 occasions it." 
 
 To properly understand the peritoneum a knowledge of its formation 
 is necessary. The student should therefore study some good description 
 of the development of the peritoneum. 
 
 Trace the peritoneum vertically. 
 
 FIG. 169. DIAGRAM TO SHOW THE PERITONEUM AS SEEN IN A VERTICAL SECTION. (Allen 
 
 Thomson.) (Morris.) 
 
 LIVER 
 
 GASTRO-HEPATIC OMENTUM 
 STOMACH 
 
 TRANSVERSE COLON 
 MESENTERY 
 
 SMALL INTESTINE 
 
 FORAMEN OF WINSLOW 
 PANCREAS 
 
 DUODENUM 
 
 TRANSVERSE MESO-COLON 
 
 A orta 
 
 RECTUM 
 
 BLADDER 
 
146 
 
 THE PERITONEUM 
 
 Trace the peritoneum in transverse sections at different levels, using 
 the figures below as guides. 
 
 FIG. 170. TRANSVERSE SECTION OF THE PERITONEAL SAC AT ABOUT THE LEVEL OF THE 
 
 UMBILICUS. (Morris.) 
 
 FIG. 171. TRANSVERSE SECTION OF THE ABDOMEN AT THE LEVEL OF THE FORAMEN OP 
 
 WINS LOW. (Morris.) 
 
 GASTRO-HEPATIC OMENTUM 
 
 bASTRO-SPLENIC 
 OMENTUM 
 
 Greater sac. 
 Lesser sac. 
 
 Trace each. 
 
 What viscera, and what parts of what viscera are covered by the greater 
 sac ; what by the lesser sac ? 
 
 Where and what is the foramen of Winslow? 
 Great omentum (Fig. 175). 
 
 Position. 
 
 Description. 
 Lesser omentum or gastro-hepatic. 
 
 Position. 
 
 Description. 
 Gastro-splenic omentum. 
 
 Position. 
 
THE PERITONEUM 147 
 
 Gastro-phrenic ligament. 
 Position. 
 
 Phreno-colic ligament. 
 Position. 
 
 Peritoneal ligaments connected with the liver, bladder, and uterus are 
 described with those organs. 
 
 There are several pouches formed in the development of the peritoneum 
 which may become the seat of intra -abdominal herniae. Locate these. 
 
 They are named from their positions: 
 
 Fossa duodeno-jejunalis. (See Fig. 172.) 
 
 FIG. 172. THE FOSSA DUODEXO-JEJUXALIS. (Treves.) (Morris.) 
 
 THE FOSSA 
 
 THE DUODENAL 
 FOLD 
 
 Inferior mesenteric 
 rein 
 
 Fossa subcaecalis or ileo-caecal. 
 Fossa intersigmoidea. 
 
148 
 
 THE MESENTERY ARTERIES 
 
 Expose by cutting through the anterior layer of mesentery the follow, 
 ing blood-vessels: 
 
 Superior mesentery artery and branches. 
 
 FIG. 173. THE SUPERIOR MESENTERIC ARTERY AND VEIN. (Morris.) 
 (The colon is turned up, and the small intestines are drawn over to the left side.) 
 
 Ileo-colic artery 
 
 C/ECUM 
 
 VERMIFORM 
 APPENDIX 
 
 Left colic artery 
 
 Superior meseji- 
 teric artery and 
 vein 
 
 Vasa intfstini 
 tewiii 
 
 SMALL INTESTINES 
 
 Superior mesenteric vein and tributaries. 
 
 Note the mesenteric glands. (See Fig. 177.) 
 
 Inferior mesenteric artery and branches. 
 
 Inferior mesenteric vein and tributaries. (See Fig. 174.) 
 
 Portal vein and tributaries. (See Figs. 173, 174, and 175.) 
 
THE MESENTERY ARTERY 
 
 149 
 
 FIG. 174. THE INFERIOR MESENTERIC ARTERY AND VEIN. (Morris.') 
 
 Middle colic artery 
 
 Inferior pancreatico- 
 diKjdenal artery 
 
 Xii}ii:rior meseiitcric 
 artery 
 
 Riyht colic artery 
 
 Abdominal aorta 
 Vena cava inferior 
 
 Riijht common iliaf 
 
 artery 
 
 Middle sacral artery 
 and vein 
 
 Lffl colic artery 
 
 Inferior mesenteric 
 vein 
 
 Inferior mesenteric 
 
 artery 
 
 Left colic- artery 
 Inferior mesenleric 
 
 artery 
 
 Left common iliac 
 rein 
 
 Sir/moid artery 
 
 Superior hiemor- 
 rhoidai artery 
 
'50 
 
 VEINS OF STOMACH 
 
 FIG. 175. THE VEINS OF THE STOMACH AND THE PORTAL VEIN. (Morris.) 
 (From a dissection by W. J. Walsham.) 
 
 Cystic vein 
 
 Right branch of 
 portal vein 
 
 Portal vein 
 
 Hepatic arterii 
 
 Continuation of 
 
 hepatic artery 
 
 Gastro-diiodenal 
 
 branch of hepatic 
 
 artery 
 
 Pyloric vein 
 
 Right gaftro- 
 epiploic vein 
 
 Omental veins 
 
 Left branch oj 
 portal rein 
 
 Veins corre- 
 spond ing lo 
 ruxii brecia 
 arteries 
 
 Gastric artery 
 
 Hepatic artery 
 Splenic artery 
 
 Gastric or 
 coronary vein 
 
 Left ffastro- 
 rpip/oic vein 
 
ABDOMINAL VISCERA 
 
 DEMONSTRATION IV. 
 REMOVAL OF ABDOMINAL VISCERA. 
 
 SMALL INTESTINES:- 
 
 Place two ligatures around the jejunum at its beginning and cut be- 
 tween the ligatures. Similarly divide the ileum six inches above its ter- 
 mination. Divide the mesentery close to the intestines. Cut off about 
 ten inches of the upper part of the jejunum and the same length of the 
 lower part of the ileum, wash them, distend with air, and dry them. After 
 they are dry cut them open and study them. 
 
 . What is the length of jejunum; length of ileum? 
 
 What is Meckel's diverticulum? 
 
 Mesentery attachments and extent. 
 
 Structure of intestinal wall. 
 
 Four coats describe each. 
 
 In mucous coat valvulae conniventes, villi, solitary glands, and Fever's 
 patches. 
 
 FIG. 176. PORTIOX OF THE SMALL INTESTINE, LAID OPEN TO SHOW THE VALVUL.* CONNI- 
 VE XTES. (Brinton.) (Morris.) 
 
 What is. the blood-supply? (See Fig. 173.) 
 What is the nerve-supply? 
 Lymphatics of small intestines. 
 
ABDOMINAL VISCERA 
 FIG 177. VESSELS OF THE SMALL INTESTINE. (Morris.) 
 
 Veins 
 
 LARGE INTESTINES. 
 
 Note the position of the different parts of the large intestines. 
 
 Divide the ascending colon six inches above the entrance of the ileum. 
 Remove, wash, distend with air and dry the caecum. Then cut open and 
 study caecum, walls, ilio-caecal valve, opening of appendix, and appendix. 
 
 FIG. 178. SECTION THROUGH THE JUNCTION OF THE LARGE AND SMALL INTESTINE TO 
 
 SHOW THE ILEO-C.ECAL VALVE AND APPENDIX VERMIFORMIS. (Holden.} 
 
 i. Ileum. 2. Caecum or caput coli. 3. Appendix Vermiformis. 
 
 
 Types of caecum (Fig. 179). 
 
 Remove the rest of the large intestines down to the rectum. Note 
 hepatic, splenic, and sigmoid flexures. 
 
 Clean, distend with air, and dry part of the ascending colon and sig- 
 moid flexure, then cut open and study their walls, blood-supply, and nerve- 
 supply. 
 
ABDOMIXAL VISCERA 
 
 FIG. 179. THE FOUR TYPES OF CAECUM. (Treves.) (Morris.) 
 ABC D 
 
 FIG. 180. SECTION- OF THE ASCENDING COLON. (Allen Thomson.) (Morris.} 
 
 Cr?sceTltie ridge of mucous 
 
 membrane which divides the sacculi Longitudinal muscle 
 
 Serous coat 
 
 Anterior band 
 Mucous membrane 
 
 Crescentic ridge of 
 mucous membrane 
 
 Circular muscle 
 
 Appendix epiploica 
 
 Posterior band 
 Mucous membrane 
 
 Crescentic ridge of 
 mucous membrane 
 
 Serous coat 
 
 Inner band 
 
 Circular muscle 
 
i 5 4 ABDOMINAL VISCERA 
 
 For blood-supply see Figs. 173 and 174. 
 
 A close network of tissue surrounds the branches of the abdominal 
 aorta. This tissue consists almost entirely of nerve -plexuses of the sym- 
 pathetic system. The solar plexus is the largest and surrounds the cceliac 
 axis. 
 
 Study the solar plexus and the offsets of the solar plexus. 
 
 Expose and study the cceliac axis and its branches. Xote especially 
 the branches going to the stomach. To expose these pull down the stomach 
 and cut through the peritoneum above the stomach. 
 
 FIG. 181. THE CCELIAC ARTERY AND ITS BRANCHES. (Morris.} 
 
 Abdominal aorta LEFT CRUS OF DIAPHRAGM 
 
 (ESOPHAGEAL BRANCH 
 
 RIGHT CRUS OF DIAPHRAGM 
 
 Cfgliac axis 
 
 Gastric Vasa 
 
 artery l/revia 
 
 Cystic artery 
 
 Right phrenic artery 
 
 HEPATIC DUCT 
 
 CYSTIC DUCT 
 
 Splenic artery 
 
 COMMON BILE DUCT 
 
 Pyloric artery 
 
 Gastro-dnodenal artery 
 
 Superior pancreatico- 
 ditodeital artery 
 HEAD OF PANCREAS 
 
 Inferior pancrealico- 
 
 duodenal artery 
 
 ight gastro-epiploic 
 
 ' artery 
 
 Left gas/ro-ejiiploic artery 
 
 Pull the stomach down and cut the oesophagus just below the dia- 
 phragm, and ligate and divide the duodenum at its beginning. Cut the 
 blood-vessels going to the stomach and remove the stomach; clean, dis- 
 tend with air, and dry it. 
 Study the stomach: 
 
 General description. 
 
 Cardiac orifice; cardiac end, or fundus. 
 
 Borders and surfaces. 
 
 Relation to surrounding parts. 
 
 Relation to peritoneum. 
 
 Alterations in position. 
 
 Structures of its wall four coats. 
 
ABDOMIXAL VISCERA 
 FIG. 182. ANTERIOR SURFACE OF THE STOMACH. (Morris.) 
 
 PYLORUS CARDIAC ORIFICE 
 
 ANTRUM PYLORI 
 
 FIG. 183. MUSCULAR COAT OF THE STOMACH. (Luschka.) (Morris.) 
 
 LONGITUDINAL LAYER 
 
 CIRCULAR LAYER 
 
 Blood-supply of stomach. (See Fig. 181.) 
 
 Nerve-supply vagus and sympathetic. 
 
 Lymphatics. 
 
 Innate the duodenum in place; note its form, parts, and its relation 
 to pancreas, common bile-duct, pancreatic duct, kidney, superior mesen- 
 teric artery and vein (Figs. 184, 185, 186). 
 
 Observe the fossa duodeno-jejunalis. (See Fig. 172.) 
 
 Also study the pancreas in place and its relation to surrounding struc- 
 tures. See same figures as for duodenum. 
 
ABDOMINAL VISCERA 
 
 FIG. 184. THE DUODENUM FROM ix FRONT. (Morris.) 
 
 SUPERIOR LAYER OF TRANSVERSE MESO-COLON 
 
 SECOND PART OF 
 DUODENUM 
 
 FOURTH PART OF DUODENUM 
 
 INFERIOR LAYER OF TRANSVERSE MESO-COLON 
 
 THIRD PART OF DUODENUM 
 
 SUPERIOR MESENTERIC VESSELS 
 
 FIG. 185. THE DUODENUM FROM BEHIND. (Morris.) (Also see Fig. 182.) 
 
 Portal rein 
 
 FOURTH PART OF DUODENUM 
 
 HEAD OF PANCREAS 
 
 Next raise the liver and expose the common bile-duct, the hepatic 
 artery, and the portal vein by cutting through the lesser omentum. Notice 
 their relative positions. 
 
 Trace the common bile-duct down to its entrance into duodenum and 
 junction with the pancreatic duct. Also trace the common bile-duct up 
 toward the liver to where it is formed by the hepatic ducts; trace the 
 hepatic ducts and cystic duct. Also trace the hepatic artery and portal 
 vein up to the liver. (See Figs. 186, 187, 188, and 189.) 
 
ABDOMIXAL VISCERA 
 
 157 
 
 FIG. 186. DIAGRAM OF THE BRANCHES OF THE CCELIAC Axis. (Holden.) 
 
 (Pancreas in dotted outline behind the stomach.) 
 
 i. Coronaria ventriculi. 2. Splenic a. 3. Hepatic a. 4. Pyloric a. 5. Gastro-duode- 
 nalis. 6. Gastro-epiploica sinistra. 7. Vasa brevia. 8. Superior mesenteric a. 
 
 \--Spleen 
 
 Commencement of the intes- 
 tinum jejunum. 
 
 FIG. 187. DIAGRAM OF THE VENA PORT^E (Holden.) 
 (The arrow is introduced behind the free border of the lesser omentum.) 
 
 rv-T.. SPLENIC. V 
 
 &hs? 
 
158 ABDOMINAL VISCERA 
 
 FIG. 188. RELATION OF STRUCTURES AT AND BELOW THE TRANSVERSE FISSURE. (Thane.) 
 
 (Morris.) 
 
 GALL BLADDER 
 
 BILE DUCT 
 
 Portal rein 
 
 Expose the pancreatic duct or canal of Wirsung, and trace it^to^its 
 junction with the common bile-duct or entrance into duodenum. 
 Also trace duct of Santorini. 
 
 FIG. 189. THE PANCREAS AND ITS DUCT. (Morris.} 
 
 DUCT OF PANCREAS DUCT OF SANTORINI COMMON BILE DUCT 
 
 DUCT OF WIRSUNG 
 
 Now remove the duodenum and pancreas. 
 
 Study the duodenum, its structure, blood- and nerve-supply. 
 Study the pancreas, head, neck, body, and tail, ducts, blood- and 
 nerve-supply, and lymphatics. 
 
 SPLEEN: 
 
 Note its position, shape, surfaces, borders, and supplementary spleens, 
 or lienculi. 
 
 Trace splenic artery from cceliac axis to spleen. 
 
 Remove the spleen. Study its structure, size, and weight. 
 
 What is its nerve-supply? 
 
 Lymphatics of spleen. 
 
ABDOMIXAL VISCERA 
 
 159 
 
 DEMONSTRATION V. 
 LIVER : 
 
 What is its position in relation to the ribs, stomach, kidney, and colon? 
 
 Peritoneum and ligaments. 
 
 Remove the liver. Study its borders, surfaces, lobes, fissures and 
 structures. Describe the gall-bladder or cyst. 
 
 FIG. 190. SUPERIOR SURFACE OF THE LIVER. (Morris.) 
 
 Site of the Spigelian lobe 
 
 GALL BLADDER 
 
 Falciform or suspensory ligament 
 
 FIG.. 191. THE INFERIOR SURFACE OF THE LIVER. (Morris.) 
 
 Vena cara 
 
 BILE DUCT 
 Portal vein 
 Hepatic artery 
 SPIGELIAN LOBE 
 
 UMBILICAL FISSURE 
 
i6o 
 
 ABDOMINAL VISCERA 
 
 Trace the hepatic ducts, portal vein, hepatic artery into the liver. Note 
 hepatic veins. How many sets of capillaries does the liver have? 
 
 FIG. 192. POSTERIOR SURFACE OF THE LIVER. (Morris.} 
 
 Vena cava 
 
 LEFT LOBE 
 
 TUBER OMENTALE 
 
 ATTACHMENT OF CASTRO-HEPATIC OMENTUM 
 
 ! 
 
 SPIGELIAN LOBE 
 
 IMPRESSION FOR RIGHT 
 SUPRARENAL 
 
 Review the hepatic artery; the portal vein and its tributaries. 
 
 KIDNEY AND SUPRARENAL BODY. 
 
 Expose the kidneys and suprarenal bodies by removing the tissue in 
 front of them. 
 
 Study their position and relations to surrounding parts. 
 Study the investment or capsule of kidney. 
 
 FIG. 193. DIAGRAM SHOWING RELATION OF KIDNEY TO CAPSULE. (W. A.) (Morris.) 
 
 TRANSVERSE COLON 
 
 DESCENDING COLON 
 
 PERITONEUM 
 
 FATTY CAPSULE 
 
 KIDNEY 
 
 PERITONEAL CAVITY 
 Diaphragmatic 
 
 Parietal muscle 
 
 CUT EDGE OF 
 PERITONEUM 
 
 Muscular fibre in 
 subperitoueal 
 tissue 
 
 PANCREAS 
 
 Sup. mesenteric vein 
 DUODENUM 
 
 LYMPHATIC GLAND 
 
 LUMBAR VERTEBRA 
 
 SUBPERITONEAL TISSUE FATTY CAPSULE Renal vesselt embedded In subperitoneal tism, 
 
ABDOMIXAL VISCERA 
 
 161 
 
 Xote the relative position of the renal artery, renal vein, and ureter. 
 
 Remove one kidney with its ureter, cutting the ureter at the brim of 
 pelvis. Do not remove the other kidney at this dissection. 
 
 General description of the kidney, shape, size, hilum, and sinus. 
 
 Cut the kidney lengthwise, as seen in the figure below. Study the 
 parts exposed by the cut. 
 
 FIG. 194. LONGITUDINAL SECTION OF THE KIDNEY (Tyson, after Henle). (Holden.) 
 Cortex, i". Labyrinth, i'. Medullary Rays. 2. Medulla. 2". Boundary layer of 
 medulla. 2'. Papillary portion of medulla. 3. Transverse section of tubules in boun- 
 dary layer. 4. Fat of renal sinus. *. Transversely coursing medullary rays. 5. 
 Artery. C. Renal calyx. U. Ureter. A. Branch of renal artery. 
 
 What is the blood- and nerve-supply of the kidney. 
 Describe the suprarenal bodies. 
 
162 
 
 ABDOMINAL VISCERA 
 
 The figures below show the relations of some of the abdominal and 
 thoracic viscera. 
 
 p IG I9 ^ RELATION OF THE ABDOMINAL VISCERA TO THE PARIETES. (Treves.) (Morris.) 
 
ABDOMINAL VISCERA 
 
 163 
 
 FIG 196. ABDOMINAL VISCERA, FROM BEHIND. (Riidinger.) (Morris.} 
 
 LARYNX 
 
 DESCENDING COLON - 
 
 Inferior mesenteric 
 vein 
 
 Superior mesenteric 
 
 rein 
 ASCENDING COLON 
 
1 64 STRUCTURES ON POSTERIOR WALL OF ABDOMEN 
 
 DEMONSTRATION VI. 
 
 STRUCTURES ON THE POSTERIOR WALL OF ABDOMEN. 
 
 Sympathetic nerves. 
 
 You will find a close network of tissue in front of the abdominal aorta 
 and around its branches. This tissue is nearly entirely sympathetic nerve 
 tissue. It is arranged in plexuses, each plexus taking the name of the 
 artery around which it is placed. The plexus around the cceliac axis is 
 the largest and is called the solar plexus. 
 
 The other plexuses are offsets of the solar plexus. 
 
 SOLAR PLEXUS :- 
 
 Position. 
 
 Semilunar ganglion. 
 
 Expose the ganglia. Note their position, shape and the connection 
 of the great splanchnic and small splanchnic nerves. 
 Study the splanchnic nerves. 
 Offsets of the solar plexus. 
 
 These take the names of the arteries with which they pass out to the 
 viscera. 
 
 Expose the gangliated cord in the abdomen. (See Fig. 197.) 
 Arteries : 
 
 Abdominal arteries. 
 
 Expose the abdominal aorta, notice the position of its branches, study 
 those with which you are not already familiar. 
 Branches : 
 
 Phrenic. Renal. 
 
 Cceliac. Suprarenal. 
 
 Sup. mesenteric. Spermatic. 
 
 Inf. mesenteric. Ovarian. 
 
 Lumbar. Middle sacral. 
 
 Veins : 
 
 Inferior vena cava and tributaries. Note the relation of the veins to 
 the arteries. What difference between right and left spermatic vein? 
 (See Fig. 198.) 
 
 Note the beginning of the azygos veins by the ascending lumbar (Fig. 
 199). 
 
 Expose the receptaculum chyli, the beginning of the thoracic duct. 
 It lies behind the aorta, and between the aorta and right crus of the 
 diaphragm in front of the second lumbar vertebra (Fig. 199). 
 
 Study the iliac fascia. Do not remove it at this time in the dissection. 
 Observe and study the muscles: 
 Psoas. 
 
 Psoasparvus. 
 Iliacus. 
 Quadratus lumborum. 
 
STRUCTURES ON POSTERIOR WALL OF ABDOMEX 
 
 165 
 
 FIG. 197. LUMBAR PORTION OF THE GANGLIATED CORD, WITH THE SOLAR AND HYPO- 
 GASTRIC PLEXUSES. (Henle.) (Morris.} 
 
 GANGLION DIAPHRA GMA TICUM 
 
 ^UPRARENAL 
 CAPSULE 
 
 GREAT SPLANCH- 
 NIC NER VE 
 RIGHT SEMI LU- 
 NAR GANGLION 
 
 RENAL GANGLION 
 
 SMALL SPLANCHNIC 
 NER VE 
 
 Renal artery 
 
 GANGLIATED CORD 
 
 RAMUS COMMUNICANS 
 
 Hepatic artery 
 
 BRANCH TO A OR TIC 
 PLEXUS 
 
 LEFT SEMILV- 
 NAR GANGLION 
 
 GREAT SPLANCH- 
 NIC NERVE 
 
 SMALL SPLANCH- 
 NIC NER VE 
 
 Superior mesenteric 
 arter;/ 
 
 RENAL GANG LION 
 Renal artery 
 
 SUPERIOR MESEKTERIC 
 GANGLION- 
 
 BRANCH TO AORTIC 
 PLEXUS 
 
 GANGLIATED CORD OP 
 SYMPA THE TIC 
 
 Inferior mesenteric artery 
 
 INFERIOR MESEN- 
 TERIC GANGLION 
 
 Disc between last lumbar 
 and first aacral vertebra 
 
 Common iliac vein 
 Common iliac artery 
 
i66 
 
 STRUCTURES ON POSTERIOR WALL OF ABDOMEN 
 
 FIG. 198. THE ABDOMINAL AORTA AND ITS BRANCHES, WITH THE INFERIOR VENA CAVA 
 
 AND ITS TRIBUTARIES. (Morris.) 
 
 Cystic artery 
 
 HEPATIC DUCT 
 
 CYSTIC DUCT 
 
 COMMON DUCT 
 
 Portal vein 
 
 Gastro-dnodenal br. 
 
 Superior jiyloric l: 
 
 Hepatic artery 
 
 Right suprarenal vein 
 Inferior suprarenal 
 artery 
 Renal artery 
 
 Renal vein 
 
 Inferior vena cava 
 KIDNEY 
 
 Right spermatic rein 
 
 Right spermatic artery 
 
 Quadratus lumborum 
 muscle 
 
 Right lumbar artery and 
 left lumbar vein 
 Ureteric branch of 
 spermatic artery 
 
 Middle sacral vessels 
 
 LEFT LOBE OF LIVER 
 
 (ESOPHAGUS 
 
 Left phrenic artery 
 
 Right phrenic artery 
 
 Superior suprarenal 
 Gastric artery 
 Inferior suprarenal 
 Splenic artery 
 
 Left phrenic vein 
 Left suprarenal vein 
 Superior mesenteric 
 
 artery 
 KIDNEY 
 
 Ureter ic branch of renal 
 Left spermatic vein 
 
 URETER 
 
 Left spermatic artery 
 
 Inferior mesenteric artery 
 
 Ureteric branch of 
 spermatic 
 
 Ureteric branch of 
 
 common iliac 
 Common iliac artery 
 
 External iliac artery 
 Internal iliac artery 
 
STRUCTURES OX POSTERIOR WALL OF ABDOMEN 
 
 167 
 
 FIG. 199. THE SUPERIOR AND INFERIOR VEN^ CAV^, THE INNOMINATE VEINS, AND 
 
 THE AZYGOS VEINS. 
 
 Right common carotid 
 
 artery 
 
 Right internal jugular 
 vein 
 
 RIGHT LYMPHATIC DUCT 
 
 Innominate artery 
 
 RIGHT PXEUMO- 
 
 GASTRIC SER VE 
 
 Right innominate vein 
 
 Internal mammary vein 
 
 Trunk of the pericardiac 
 ami thymic reins 
 Vena cava superior 
 
 Vena azygos major 
 
 Vena azygos minor, cross- 
 ing spine In enter vena 
 azygos major 
 
 Hepatic veins 
 
 Vena cava inferior 
 
 Right phrenic artery 
 Cieliac axis 
 
 Right middle suprarenal 
 artery 
 
 Right spermatic artery 
 Right spermatic vein 
 
 Left common carotid 
 
 artery 
 
 LEFT PXEUMOGAS- 
 TRIC SER VE 
 
 THORACIC DUCT 
 
 Left innominate vein 
 
 Left subclavian artery 
 
 Left superior intercostal 
 rein 
 
 RECURRENT 
 LARYSGEAL 
 NERVE 
 
 Vena azygos lertiut 
 
 (ESOPHAGUS 
 
 Ijeft upper azygos vein 
 
 fExophageal branches 
 from aorta 
 
 Vena mygos minor 
 
 THORACIC DUCT 
 
 Left phrenic artery 
 
 Left middle suprarenal 
 artery 
 
 RECEPTACULUM CHYLI 
 
 Superior mesenterie 
 artery 
 
 Left ascending lumbar 
 
 vein 
 Left spermatic vessels 
 
 Inferior mesenterie 
 artery 
 
168 STRUCTURES ON POSTERIOR WALL OF ABDOMEN 
 
 FIG. 200. PSOAS, ILIACUS, AND QUADRATUS LUMBORUM. (Morris.} 
 
 Quadratus lutnborum 
 
 Paoas parvus 
 
 Fsoaa maguus 
 
 Iliaous 
 
 transversalis 
 anterior 
 
 ratus lumborum 
 
LUMBAR PLEXUS 
 
 169 
 
 LUMBAR PLEXUS: 
 
 A plan of the formation of the lumbar plexus is given in the figure 
 below. 
 
 FIG. 201. DIAGRAM OF THE LUMBAR AND SACRAL PLEXUSES. (Modified from Paterson.) 
 
 (Morris.} 
 
 FROM LAST THORACIC 
 
 GEX1TO-CRURAL 
 
 ILIV-HYPOGASTRIC 
 
 ILIO-ING UIXA L 
 
 EXTERN A L 
 CUTANEOUS 
 
 OBTURATOR 
 
 ACCESSORY 
 OBTURATOR 
 
 BRANCH TO ILIACUS 
 ANTERIOR CRURAL 
 
 SUPERIOR GLUTEAL 
 INFERIOR GLUTEAL 
 
 GREAT SCIATIC 
 
 NERVE TO 
 
 QUADRATIC 
 
 FEMUR1H 
 
 EXTERNAL 
 
 POPLITEAL 
 
 SECTION 
 
 INTERNAL 
 
 POPLITEAL 
 
 SECTIO.\ 
 
 FIRST LUMBAR 
 
 SECOND LUMBAR 
 
 THIRD LUMBAR 
 
 FO UR TH L UMBA R 
 
 FIFTH LUMBAR 
 
 FIRST SACRAL 
 
 SECOND SACRAL 
 
 THIRD SACRAL 
 
 VISCERAL 
 FOURTH SA CRAL 
 
 PERFORA TIXG 
 
 CUTANEOUS 
 PERIN^EAL 
 FIFTH SACRAL 
 
 JfKRVK TO COCCTGEUS 
 
 NER VE TO LE VA TOR 
 ANI 
 
 FIRST COCCYGEAL 
 
 TO HAMSTRINGS /' SMALL SCIATIC 
 NERVE TO OBTURATOR INTERNUS 
 
 VISCERAL 
 
 PUDIC 
 
 Expose the lumbar plexus: 
 
 Genito-crural (X. genito-femoralis) lies on the anterior surface of the 
 psoas muscle. Trace it back through the psoas muscle to its origin and 
 down to its division. 
 
 Ilio-hypogastric and inguinal pass in front of the quadratus lurn- 
 bommjmuscle ; pick them up here and trace them back through the psoas 
 muscle to their origin. 
 
 External cutaneous (X. cutaneus fenwris lateralis] passes in front 
 
i yo 
 
 LUMBAR PLEXUS 
 
 of the iliac muscle and behind iliac fascia. Trace it back through the 
 psoas muscle to its origin and out to where it passes below Poupart's liga- 
 ment just below the anterior superior spine of the ilium. 
 
 Anterior crural (N. femoralis) emerges from the outer border of the 
 psoas above Poupart's ligament. Trace it through the psoas to its origin 
 and down to where it passes below Poupart's ligament. 
 
 Obturator emerges from the inner border of the psoas at the pos- 
 terior part of the brim of the pelvis. Trace it back to its origin and out 
 to the obturator foramen. 
 
 Accessory obturator, when present, lies close to the obturator nerve. 
 Trace it to its origin and down to where it passes anterior to the brim of 
 the pelvis. 
 
 Lumbo-sacral cord lies in front of the ala of sacrum. Trace it to its 
 origin and to its junction with sacral plexus. 
 
 Also expose the last dorsal nerve. 
 
 FIG. 202. BRANCHES OF THE LUMBAR AND SACRAL PLEXUS VIEWED FROM BEFORE. (After 
 
 Hirschfeld and Leveille'.) (Morris.} 
 
 GANGLIATED CORD OF SYMPATHETIC 
 LAST THORACIC NERVE 
 
 FIRST LUMBAR 
 
 ILIO- 
 
 HYPOGASTRIC 
 INGUINAL 
 
 SECOND 
 LUMBAR 
 
 FOURTH 
 
 LUMBAR 
 
 INGUINAL 
 
 EXTERNAL 
 
 CUTANEOUS 
 
 GEXITO-CRURAL 
 
 LUMBO-SACRAL 
 
 CORD 
 
 ANTERIOR CRURAL - 
 OBTURATOR 
 
 GE VITAL BRAffCB 
 OF GEfilTO'-CRURAL 
 
 CRURAL BRAXCH OF 
 GE\[TO-CRURAL 
 
 INGUINAL 
 
 DISTRIBU- 
 TION OF 
 EXTERNAL ' 
 CUTANEOUS 
 
 CRURAL 
 
 BRANCH 
 
 OF GENITO- 
 
 CRURAL 
 
 AORTIC PLEXUS 
 
 LAST THORACIC NERVE 
 
 ILIO-HYPO- 
 GASTRIC 
 
 INGUINAL 
 
 THIRD 
 LUMBAR 
 NER VE 
 
 GENITO- 
 CRURAL 
 
 EXTERNA L 
 CUTANEOUS 
 
 GENITAL 
 BRANCH 
 OF 
 
 GENI TO- 
 CRURAL 
 
 CRT HAL 
 BRANCH OF 
 QBNITO- 
 C RURAL 
 
 OBTU- 
 RATOR 
 
 SACRAL 
 PLEXUS 
 
PELVIC VISCERA 
 
 171 
 
 DEMONSTRATION VII. 
 
 PELVIC REGION. 
 
 What is the difference between the male and female pelvis? 
 
 Study the positions and relations of the pelvic organs to each other 
 and to the surrounding landmarks. Remove none of the viscera. 
 
 Note in the male pelvis: 
 
 Bladder: Position, form, relation, ligaments, and the part covered by 
 peritoneum. 
 
 Rectum. Position arid the part covered by peritoneum. 
 
 In female pelvis. 
 
 Note the bladder and rectum. 
 
 Also uterus. Position, ligaments, and part covered by peritoneum. 
 
 Fallopian Tubes. Position, relation to broad ligaments. 
 
 Ovaries. Position, relation to broad ligaments, and Fallopian tubes. 
 
 Round Ligaments. Position, relation to broad ligaments, and attach- 
 .ments. 
 
 Trace the peritoneum in its course in the pelvis and over the pelvic 
 viscera. 
 
 FIG. 203. DIAGRAM OF THE RELATIVE POSITION OF THE PELVIC VISCERA. (Holden.) 
 
 Symphysis pubis. 
 
 Corpus cavernosum 
 penis. 
 
 Glans penis. 
 
 Corpus spongiosum 
 urethra. 
 
 Bulb of corp. spon- 
 giosum. 
 Cowper's gland with 
 
 duct. 
 
 Membranous part of 
 urethra surrounded 
 by compressor 
 muscle. 
 
 Prostate gland. 
 
 Peritoneum in 
 dotted outline. 
 
 Ureter. 
 
 Vas deferens. 
 
 Vesicula senn- 
 nalis. 
 
 Expose the following arteries and veins: 
 Arteries. (See Fig. 164): 
 Common iliac. 
 External iliac. 
 
 Internal iliac (A. hypogastrica). 
 Hypogastric. 
 
 Superior, middle and inferior vesical. 
 Middle hemorrhoidals. 
 
 Uterine. 
 Ovarian. 
 Vaginal. 
 
172 
 
 PELVIC VISCERA 
 
 FIG. 204. DIAGRAMMATIC VERTICAL SECTION THROUGH THE FEMALE PELVIC VISCERA 
 
 (H olden.} 
 
 Urethra sur- 
 rounded by its 
 compressor 
 muscle. 
 
 Vagina. 
 
 Rectum. 
 
 Veins accompanying the arteries. 
 
 FIG. 205. SCHEME OP THE OVARIAN AND UTERINE AND VAGINAL ARTERIES. (Morris.) 
 
 Branch Branches Branch nMRRiiTcn 
 
 Uterine to round to to EXTREMITY Of 
 
 branch ligament isthmus ampulla FALLOPIAN TUBE 
 
 \ l \ 
 
 Cervical branch 
 
 Coronal artery 
 
 Uterine artery 
 Internal iliac artery 
 
 Vaginal arteries 
 
 Azygos artery of rayina 
 
 Review the lymphatics of the pelvis and abdomen. 
 Sympathetic nerves. 
 
 Hypogastric plexus. 
 
 Pelvic plexus. 
 
THE PERI X ELM 
 
 DEMONSTRATION VIII. 
 PERINEUM. 
 
 Read a general description of the perineum. 
 
 Examine the osseous and ligamentous boundaries of the lower aper- 
 ture of the pelvis. 
 
 Draw a line from one tuberosity of the ischium to the other. This 
 divides the aperture into an anterior or urethral region, and a posterior, 
 ischio-rectal, or anal region. 
 
 FIG. 206. DIAGRAM OF THE FRAMEWORK OF THE PERINEUM. (Holden.) 
 
 Place the subject on his back in the perineal frame; draw the frame, 
 with the cadaver, to the end of the table. 
 
 FIG. 207. PERINEAL FRAME. 
 
 MALE PERINEUM. 
 
 Pass a urethral sound along the urethra into the bladder, 
 prostate gland by inserting the finger into the rectum. 
 
 Feel the 
 
174 
 
 THE PERINEUM 
 
 Moderately distend the rectum with tow, and sew the edges of the 
 anus together; raise the scrotum by means of hooks. 
 
 Dissection of the anal region. 
 
 Make an incision through the skin along the line drawn from one 
 tuberosity of the ischium to the other, crossing in front of the anus; a 
 second incision parallel to the first across the tip of the coccyx; a third 
 from the middle of the first incision back, encircling the anus, to the tip 
 of the coccyx. 
 
 Notice the wrinkles of the skin around the anus caused by the corru- 
 gator cutis ani muscle. 
 
 FIG. 208.- 
 
 -MuscLES, WITH SUPERFICIAL VESSELS AND NERVES, OF THE PERINEUM. 
 
 (H olden.) 
 
 Inferior 
 pudenda] 
 
 Dissect the skin carefully away from the anus so as not to destroy the 
 external sphincter ani and turn it outward onto the thigh. Notice the 
 superficial fascia. This fascia is common to both anal and urethral re- 
 gions of the perineum and is continuous with similar structures in adjacent 
 regions. 
 
 Clean and study the external sphincter muscle. (See Fig. 208.) 
 
 On each side of the anus you see the base of the ischio-rectal fossa 
 filled with fat. 
 
 The inferior hemorrhoidal arteries and nerves pass through this fat to 
 
THE PERI X RUM 175 
 
 the rectum. Remove the fat with care so as to preserve as many as pos- 
 sible of these hemorrhoidal arteries and nerves. 
 
 At the posterior boundary of this fossa is the gluteus maximus muscle ; 
 at the anterior boundary is the superficial transversus perinei muscle, at 
 the inner side the levator ani muscle, outer side the internal obturator 
 muscle. Expose these muscles, but do not destroy any part of them. 
 
 Trace on the bony pelvis the internal pudic artery and pudic nerve. 
 
 Now study the inferior hemorrhoidal arteries and hemorrhoidal, super- 
 ficial perineal, and fourth sacral nerves, and hemorrhoidal veins,- plexus 
 of veins. Also note the long pudendal nerve (Fig. 210). 
 
 FIG. 209. THE ARTERIES OF THE PERINEUM. (Morris.) 
 
 On the right side of the perinaeum (left side of this figure) Colles's fascia has been turned 
 back to show the superficial vessels. On the left side the superficial vessels have been cut 
 away with the anterior layer of the triangular ligament to show the deep vessels. 
 
 Superficial perinceal vessels 
 
 Colles's fascia, turned back 
 
 Dorsal artery of penis 
 Artery of crus 
 
 Artery of bulb 
 
 COWPER'S GLAND 
 
 Pudic artery 
 
 Transrerse perina-n 
 
 Cut edge of triangular 
 
 ligament 
 .-> I TKi: I-'K'f,\ L 
 
 XKRVI-: (-[VtyiT OFF 
 TIL 1 SS \ 'ERSE BRA NCH 
 Pudic vessels 
 
 Inferior hremorrhoidal vessels 
 anil nerves 
 
 Dissection of the urethral region. 
 
 Dissection. Make an incision from the scrotum along the raphe to 
 the anal region. Reflect the skin outward onto the thigh. Just beneath 
 the skin is the superficial fascia common to both urethral and anal regions 
 and is continuous with similar structures in adjacent regions. 
 
 Beneath this superficial fascia, in the urethral region only, is a layer 
 of fascia known as the superficial perineal fascia, Colles's fascia, or deep 
 layer of the superficial perineal fascia. To avoid confusion we will call it 
 Colles's fascia. 
 
176 
 
 THE PERINEUM 
 
 Colles's fascia may be demonstrated by blowing air beneath it with a 
 blow-pipe. It is attached on each side to the rami of the os pubis and 
 ischium; anteriorly it is continuous with the tunic dartos of the scrotum, 
 posteriorly at the base of the urethral triangle it passes around the trans- 
 versus perinei muscles and becomes continuous with the deep perineal 
 fascia or triangular ligament. 
 
 Remove Colles's fascia and expose the structures below: 
 
 Nerves (see Figs. 209, 210): 
 Superficial perineal. 
 Inferior pudendal. 
 
 FIG. 210. THE MALE PERINEUM. (Modified from Hirschfeld and Leveille.) (Morris.} 
 
 BULBO-CAVERNOSUS 
 
 Superficial triangular ligament 
 
 ISCHIO-CAVERNOSUS 
 
 Muscles of thigh 
 
 INFERIOR PUDENDAL NERVE 
 SUPERFICIAL PERINEAL NERVE 
 
 INFERIOR HJEMORRHOIDAL NERVE 
 CUTANEOUS BRANCH OF FOURTH SACRAL 
 
 Arteries (see Fig. 209): 
 
 Superficial perineal. 
 
 Transverse perineal. 
 Muscles (see Fig. 208) : 
 
 Bulbo-cavernosus. 
 
 Ischio-cavernosus . 
 
 Trans versus perinaei. 
 What is the tendinous point? 
 
 Gluteus masimus 
 
 TUBEROSITY OF ISCHIUM 
 Great sacro-sciatic ligament 
 Levutor ani 
 Superficial transversus perinaei 
 
 Sphincter ani 
 
THE PERIXEUM 
 
 Xotice the arrangement of the fibres of bulbo-cavernosus muscle in the 
 figure beloii': 
 
 FIG. 211. DIAGRAM TO SHOW THE ACCELERATOR URIN.-E IN PROFILE. (Holden.~) 
 
 Corpus cavemosum. 
 Corpus spongiosum. 
 
 Upper fibres. 
 Middle fibres. 
 
 Lower fibres. . 
 Tendinous centre of 
 perineum. 
 
 Cut through the median line of the bulbo-cavernosus muscle and turn 
 the fibres outward to expose the bulb of the urethra. 
 
 Remove part of the ischio-cavernosus muscle and observe the cms of 
 the penis. 
 
 The triangular ligament or deep perineal fascia can be seen in the 
 space between the transversus perinaei, ischio-cavernosus, and bulbo-cav- 
 ernosus muscles. (See Figs. 209 and 210.) 
 
 Between the fascia of Colles and the triangular ligament are the fol- 
 lowing structures: 
 Muscles : 
 
 Bulbo-cavernosus. 
 I schio-cavernosus . 
 Transversus perinasi. 
 X erves : 
 
 Superficial perinaei. 
 Long pudendal. 
 Arteries : 
 
 Superficial perinaei. 
 Transversus perinaei. 
 
 The triangular ligament or deep perineal fascia stretches across the 
 pubic arch from the symphysis, where it is connected with the sub- 
 pubic ligament, back to the transverse perineal muscle, where it joins 
 with Colles 's fascia. It consists of two layers, superficial, or inferior, 
 layer, and the deep, or superior, layer. Remember, in describing the fascia, 
 the body is in the upright position. 
 
 The superficial layer of the triangular ligament is attached ori the 
 sides to the rami of the os pubis and ischium, anteriorly to the subpubic 
 ligament, as stated above, posteriorly it is connected with the central 
 13 
 
r 7 8 
 
 THE PERINEUM 
 
 tendinous point, and is continuous with Colles's fascia, the anal and ischio- 
 rectal fascia. 
 
 The deep layer of the triangular ligament is a continuation of the 
 obturator fascia across the pubic arch. The obturator fascia is attached 
 to the rami of the pubis and ischium and then passes across the pubic 
 arch as the deep triangular ligament, joining the superficial layer of the 
 triangular ligament posteriorly. 
 
 FIG. 212. DIAGRAM SHOWING LINES OF ATTACHMENT OF THE FASCI/E AND MUSCLES OF 
 
 THE PELVIS. (W. A.) (Morris.} 
 
 GREATER SACRO-SCIATIC 
 NOTCH 
 
 ISCHIAL SPINE WITH ATTACH- 
 MENTS OF COCCY6EUS AND 
 LEVATOR ANI 
 
 LESSER SCIATIC NOTCH 
 
 Course of ' white line ' 
 
 Obturator fascia 
 
 Deep triangular ligament 
 
 Posterior border of 
 perinaeal ledge 
 
 Transversua perinaei 
 
 Obturator fascia 
 
 Levator ani 
 
 SYMPHYSIS 
 
 Subpubic ligament 
 
 Superficial triangular 
 
 ligament 
 Fascia of Colles 
 
 ISCHIO-CAVERNOSUS AND CR'JS 
 
 Between the superficial layer and deep layer of the triangular ligament 
 is a space known as the deep perineal interspace. 
 
 Remove the superficial layer of the triangular ligament, thus opening 
 up the deep perineal interspace and exposing the structures between the 
 two layers of the triangular ligament. 
 
 These structures are (see Figs. 209, 213): 
 
 Membranous urethra, Cowper's glands, internal pudic artery and vein, 
 artery to bulb and cms, dorsal nerve to penis, deep transverse or com- 
 pressor urethras (M. constrictor urethra), transverse perineal, and pro- 
 fundus of Henle muscles. Study each of the above structures. 
 
 Review the internal pudic artery and branches, and pudic nerve and 
 branches. What is Alcock's canal? 
 
THE PERINEUM 
 
 FIG. 213. DIAGRAM TO SHOW THE TRIANGULAR LIGAMENT OF THE URETHRA OR DEEP 
 
 PERINEAL FASCIA. (Maiden.) 
 
 Crus penis. 
 
 Crus penis 
 with its artery 
 cut through. 
 
 Tuber ischii 
 
i8o 
 
 THE PERINEUM 
 
 FIG. 214. DIAGRAM OF THE RELATIONS OF THE, COMPRESSOR URETHRA AS SEEN FROM 
 
 ABOVE. (Holden.) 
 
 Catheter. 
 
 Dorsal nerve of the 
 
 penis. 
 Dorsal artery of the 
 
 penis. 
 Dorsal vein of the ~ 
 
 penis. 
 
 Anterior layer of tri- 
 angular ligament. 
 Ramus os pubis 
 cut through. 
 
 Posterior layer of tri- 
 angular ligament : 
 part of the pelvic 
 fascia. 
 
THE PERINEUM 
 
 181 
 
 FIG. 215. SIDE VIEW OF THE PELVIC VISCERA. (Holden.} 
 
 (Taken from a Photograph.) 
 
 External sphincter. 2. Internal sphincter. 3. Levator ani cut through. 4. Accele- 
 rator urinae. 5. Membranous part of the urethra, surrounded by compressor muscle. 
 (). Prostate gland. 7. Vesicula seminalis. 8. Ureter. 9. Vas deferens. 10. Crus 
 penis divided, n. Triangular ligament. 12. Superficial perineal fascia. 13. Rec- 
 tum. 
 
 FIG. 216. DEEP DISSECTION OF MALE PERINEUM. (Roser.) (Morris.) 
 The bulb is slightly raised and the rectum drawn backwards, in order to make clear 
 the membranous urethra and prostate, which are shown incised as in the lateral opera- 
 tion of lithotomy. 
 
 Erector penis ^ 
 
 Wilson's muscle. 
 
 URETHRA DIVIDED AS IN 
 
 THE LATERAL INCISION , 
 
 Artery to bulb (abnormal) * 
 
 PROSTATE GLAND, WITH ITS 
 
 PLEXUS OF VESSELS 
 Superficial perinceal / 
 
 a rtrrii 
 
 Levantor ani, its 
 anterior fibres raised 
 to show the prostate 
 
 Gluteua maximu... 
 
 ntinuation of internal 
 
 piidic artery 
 , Anterior layer of 
 
 triangular ligament 
 -Artery to bulb 
 
 I-SJS COWPER'S GLAND 
 
 INCISION IN THE PROSTATE 
 _.GLAND AS IN THE LATERAL 
 
 OPERATION 
 
 Transversus perinaei 
 muscle 
 
 3* Trunk of internal pudie 
 !3f RECTUM 
 
 External sphincter 
 
i8a 
 
 THE PERINEUM 
 
 Locate and study the following muscles: 
 Levator ani. (See Figs. 217, 218, 219.) 
 
 Pubo-coccygeus. 
 
 Ilio-coccygeus. 
 Coccygeus. 
 Obturator internus. 
 
 FIG. 217. MUSCLES OF THE FLOOR OF THE PELVIS. (Morris.) 
 
 SACRUM ^ 
 
 Pyriformis 
 
 Levator ani (divided 
 below the ' white line '} 
 
 Space for obturator 
 interims 
 
 SYMPHYSIS 
 
 rn.txiif/e for gluieal 
 vessels and nerve 
 
 Pyriformis 
 
 Pasxitye fur xrialic 
 a inl 11 ml it' vessels 
 and nerve 
 
 ISCHIAL SPINE 
 
 Coceygeus 
 Cellular interval 
 Levator ani 
 
 Capsule of prostate, 
 and pubo-prostatic 
 ligaments 
 
 FIG. 2 1 8. DIAGRAM OF THE PELVIC FASCIA. (Morris.) 
 
 Transversalis fascia 
 
 Obturator fascia 
 
 White line ' 
 
 Hecto-vesieal fascia 
 
 Obturator fascia 
 
 Isehio-rectal fascia 
 
 Alcock'a canal with 
 pudic vessels 
 
 Abdominal muscle* 
 ILIAC CREST 
 
 Psoas 
 
 BORDER Of ACETABULUM 
 
 Apex of ischio-rectal 
 fossa 
 
 Levator ani 
 
 ISCHIAL TUBEROSITY 
 Sphincter ani 
 
PELVIC FASCIA 
 
 183 
 
 FIG. 219. MUSCLES OF THE FLOOR OF THE PELVIS. (W. A.) (Morris.) 
 (A portion of the ischial and pubic bones sawn away.) 
 
 Aperture for 
 
 ior gluteal 
 vessels and litres 
 
 Aperture for 
 sciatic anil pudic 
 vessels and nerve 
 
 Coecygeal fibres of 
 levator ani 
 
 Fibres of leva- 
 tor ani 
 
 Sphincter ani 
 RECTUM 
 
 ' White line ' of 
 obturator fascia 
 
 Pubic attachment 
 of levator ani 
 
 PROSTATE 
 
 Tendinous centre 
 of periuasum 
 
 PELVIC FASCIA. 
 
 To expose the pelvic fascia remove the peritoneum. Note the loose 
 connective tissue between the peritoneum and fascia about the bladder. 
 
 Study a description of the pelvic fascia. Notice, first, to what parts 
 of the pelvis the fascia is attached, and then, second, the manner in which 
 it is reflected on the pelvic viscera. 
 
 Trace the fascia, beginning with the iliac fascia, with which the pelvic 
 fascia is continuous, into the pelvis, notice its division into recto-vesical, 
 obturator, and anal, or ischio-rectal, fasciae. 
 
1 84 
 
 PELVIC FASCIA 
 
 FIG. 220. TRANSVERSE SECTION OF THE PELVIS, TO SHOW THE REFLECTIONS OF THE 
 PELVIC FASCIA. (After Gray.) (H olden.} 
 
 Pelvic fascia 
 dividing. 
 
 Obturator 
 fascia cover- 
 ing obturator 
 internus. 
 
 Recto-vesical 
 layer cover- 
 ing levator 
 am. 
 
 Anal fascia. 
 
 FIG. 221. VERTICAL FRONTAL SECTION OF THE PELVIS, SHOWING FASCI/E. (Morris.} 
 
 (Modified from Braune.) 
 
 PROSTATE 
 VERUMONTANUM 
 
 Levator ani 
 
 MEMBRANOUS URETHRA 
 
 Pudie vessels 
 
 PUBIC ARCH 
 
 Fascia of ischio- 
 
 cavernosus 
 
 CRUS PENIS 
 
 BULB 
 
 BULBO-CAVERNOSUS 
 
 WITH ITS FASCIA 
 
 Integument of 
 
 perinaeum 
 
 White line 
 
 Subperitoneal fat 
 
 Obturator internus 
 
 Ischio-reetal fascia 
 
 OS INNOMINATUM 
 
 Keeto-vesical fascia, 
 parietal and visce- 
 ral layers 
 
 Obturator fascia 
 
 Obturator mem- 
 brane 
 
 ISCHIO-RECTAL FOSSA 
 
 Deep triangular lig, 
 Deep transversus 
 
 perinaei 
 
 Superficial triangu- 
 lar ligament 
 
 Muscles of thigh 
 Isehio-cavernosus 
 
 Muscles of thigh 
 
FEMALE PERINEUM 
 
 185 
 
 FEMALE PERINEUM. 
 
 Follow the same general order and directions as those given for the 
 dissection of the male perineum, noting the differences in the organs and 
 the provisions made for their accommodations. 
 Study the external organs of generation: 
 Mons veneris. 
 Vulva. 
 
 Labia majora. 
 Labia minora. 
 Clitoris. . 
 Vestibule. 
 Fourchette. 
 Glands of Bartholin. 
 Vagina. 
 Hymen. 
 Bulbi vestibuli. 
 Study urethra, position, size, and plexus of veins. 
 
 FIG. 222. THE EXTERNAL GENITALS OF THE FEMALE. (Morris.} 
 
 MONS VENERIS 
 
 GLANS CLITORIOIS % 
 
 MEATUS URINARIUS IN 
 VESTIBULAR SPACE 
 
 CORPUS CL1TORIDIS 
 
 LABIUM KAJUS 
 LABIUM !;,INUS 
 
 Examine the osseous and ligamentous boundaries of the lower aperture 
 of the pelvis. What difference exists between the male and female pelvis? 
 
i86 
 
 PELVIC VISCERA 
 
 Distend the rectum moderately with tow and sew the edge's of the 
 anus together; also sew the edges of the labia majora together. 
 
 Dissection: Proceed on the same plan as in the dissection of the 
 male perineum, following the same directions, looking up the same fig- 
 ures, noting the differences, where they exist. 
 
 FIG. 223. DIAGRAMMATIC REPRESENTATION OF THE PERINEAL STRUCTURES IN THE FE- 
 MALE. (Morris.) 
 
 ISCHIO-PUBIG ARCH 
 
 CRUS CLITORIDIS WITH 
 ISCHIO-CAVERNOSUS 
 
 BULBO-CAVERNOSU3 
 COVERING BULBU3 
 VESTIBULI 
 
 Superficial trian- 
 gular ligament 
 
 GLANS CLITORIDIS 
 WITH PREPUCE 
 
 PARS INTERMEDIALIS 
 Mucous membrane 
 of vestibule 
 
 MEATUS URINARIUS 
 
 BULBUS VESTIBULI 
 
 GLAND OF BARTHOLIN 
 
 Sphincter ani 
 
 DEMONSTRATION IX. 
 
 PELVIC VISCERA. 
 
 Remove the pelvic viscera. 
 
 Draw down the penis and separate it from the pudic arch. Divide the 
 transversus perinaei and levator ani close to their insertions, detach the 
 sphincter ani from its attachment to the coccyx. Remove the organs 
 of generation, rectum, and bladder with the remaining kidney and ureter 
 attached. 
 
 In the female separate the clitoris from the pubic arch; then proceed 
 the same as in removing the male organs. 
 
 Dissect the rectum from the rest of the organs. 
 
 Rectum: 
 
 Clean and study the rectum, position and relation to surrounding 
 parts, peritoneum, recto-vesical or recto-vaginal pouch, anus, internal 
 sphincter muscle, mucous membrane, and rectal or Houston's valves. 
 
PELVIC VISCERA 
 Describe the blood- and nerve-supply. 
 
 187 
 
 Male Reproductive Organs. 
 Prostate gland: - 
 
 Expose the prostate gland and vesiculae seminales by following down 
 the vas deferens, dissecting away the tissue about the neck of the bladder 
 * and the posterior inferior surface of the bladder. 
 
 FIG. 224. POSTERIOR VIEW OF THE BLADDER. (Holden.) 
 i. Ureter. 2. Vas deferens. 3. Vesicula seminalis. 4. Trigone. 5. Prostate. 
 
 FIG. 225. DIAGRAM OF THE RELATIVE POSITION OF THE PELVIC VISCERA. (Holden.) 
 
 Symphysis pubis. 
 
 Corpus cavernosum 
 penis. 
 
 Glans penis. 
 
 Corpus spongiosum 
 urethrse. 
 
 Bulb of corp. spon- 
 giosum. 
 Cowper's gland with 
 
 duct. 
 
 Membranous part of 
 urethra surrounded 
 by compressor 
 muscle. 
 
 Prostate gland. 
 
 Peritoneum in 
 dotted outline. 
 
 Ureter. 
 
 Vas deferens. 
 
 Vesicula semi- 
 nalis. 
 
 Describe the prostate gland, vesiculae seminales, vas deferens, and 
 ejaculatory duct, position, function, blood- and nerve-supply of each. 
 
8 PELVIC VISCERA 
 
 FIG. 226. VASA DEFERENTIA AND VESICUL^E SEMINALES. (After Sappey.) (Morris.) 
 
 EJACULATORY DUCT - 
 SINUS POCULARIS 
 
 VERUMONTANUM 
 ORIFICE OF EJACULATORY DUCT 
 
 AMPULLA OF VAS DEFERENS 
 
 UNION OF VESICULA WITH VAS 
 
 EJACULATORY DUCT ENTERING 
 PROSTATIC FISSURE 
 
 PROSTATE 
 
 MEMBRANOUS URETHRA 
 
 VAS DEFERENS 
 
 ORIFICE OF SINUS POCULARIS 
 LOWER END OF VERUMONTANUM 
 
 VESICULA SEMINALIS 
 
 FIG. 227. VAS DEFERENS AND VESICULA SEMINALIS DISSECTED. " (After Sappey ) 
 
 (Morris.) 
 
 DIVERTICULA 
 
 DIVERTICULA 
 
 SACCULUS 
 
 SACCULI OF AMPULLA OF VAS 
 
 JUNCTION OF VAS AND VESICULA 
 EJACULATORY DUCT 
 
PELVIC VISCERA 
 
 189 
 
 Testes and their coverings. 
 
 General description of the testes. Position in foetal life and their 
 descent. 
 
 Describe the coverings of the testes. 
 
 FIG. 228. HORIZONTAL SECTION OF THE SCROTUM AND TESTICLE. (Diagrammatic.) 
 
 (Morris.) 
 
 Skin 
 
 Dartos 
 
 External spermatic fascia 
 
 Cre mast eric fascia 
 
 Parietal layer of tunica vaginalis 
 
 Septum scroll 
 
 MEDIASTINUM TESTIS 
 
 Internal spermatic fascia and 
 Bubperitoneal fascia 
 
 Cavity of tunica vaginalis 
 Visceral layer of tnnica vaginahg 
 Tunica albuginea 
 Digital fcssa 
 
 Open the scrotum and examine the testes, epididymis, and the begin- 
 ning of the vas deferens. Describe each; also describe the spermatic 
 cord. 
 
 FIG. 229. DIAGRAM OF THE TESTICULAR TUBULES. (Morris.) 
 
 TUNICA ALBUGINEA RECEIVING ATTACH- 
 MENT OF TRABECUL/t 
 
 VAS RECTUM 
 
 COLLECTING TUBE 
 CONI VASCULOSI 
 
 VASA EFFERENTIA 
 
 RETE TESTIS IN MEDIASTINUM TES1IS 
 TUBE OF EPIDIDYMIS 
 
 VAS ABERRANS 
 VAS DEFERENS 
 
 Penis: 
 
 Root, body, and glans penis. Study each part. What is the blood - 
 and nerve-supply? 
 
 Bladder: 
 
 Insert a blow-pipe through the urethra and distend with air, and dry 
 the bladder. 
 
IQO 
 
 PELVIC VISCERA 
 
 Study its external surface, walls, and structures, ligaments, form 
 when distended and when empty. 
 
 Open the bladder by making an incision through the anterior wall 
 along the median line ; extend the incision along the superior wall of the 
 penis, thus laying open the bladder and urethra. 
 
 FIG. 230. THE MALE URETHRA, CLEFT DORSALLY TO SHOW VENTRAL Mucous WALL. 
 
 (M orris.) 
 
 URETER -\ 
 
 Plica uretica 
 
 SECTION OF BLADDER 
 
 INTERNAL URINARY MEATUS 
 
 PROSTATIC SINUS WITH OPENING OF 
 PROSTATIC GLANDS 
 
 SINUS POCULARIS 
 
 FOLLICULAR GLANDS OF DORSAL WALL 
 
 SEPTUM PECTINIFORME 
 
 THIN LAYER OF CORPUS SPONGIOSUM 
 ORIFICE OF COWPER'S GLAND 
 
 Albuginea of corpora cavernosa 
 
 SECTION OF PROSTATE 
 VERUMONTANUM 
 EJACULATORY DUCT 
 PROSTATIC GLANDS 
 
 MEMBRANOUS URETHRA 
 
 SECTION OF CORPUS CAVERNOSUH 
 
 BULBOUS PORTION OF URETHRA 
 
 Mucous membrane 
 
 FOSSA NAVICULARIS 
 
 EXTERNAL URINARY MEAVJS; 
 
 PREPUCE 
 GLANS PENIS 
 
 Examine and study the inner surface of the bladder. 
 What difference between male and female bladder? 
 
PELVIC VISCERA 
 
 191 
 
 FIG. 231. THE POSTERIOR WALL OF THE BLADDER. (After Henle.) (Morris.} 
 
 VAS DEFERENS 
 
 MRETER PIERCING VESICAL 
 WALL 
 
 PLICA URETERICA 
 VESICAL APERTURE OF 
 URETER 
 
 MUSCULARIS 
 
 MUCOSA 
 JVULA OF LIEUTAUD 
 
 PROSTATE 
 VERUMONTANUM 
 OPENING OF EJACULATORY DUCT 
 
 SINUS POCULARIS - 
 PROSTATIC SINUS 
 
 Examine and study the urethra. (See Fig. 230.) 
 What difference between male and female urethra? 
 
 Female reproductive organs. 
 
 Review the external organs. 
 Vagina: 
 
 Open the vagina by a posterior incision through its wall. Note its 
 mucous membrane and the intra-vaginal cervix. Describe the vagina. 
 
 FIG. 232. THE FEMALE ORGANS OF GENERATION. (Modified from Sappey.) (Morris.} 
 (Vagina divided and laid open behind.) 
 
 POSTERIOR SURFACE OF BODY OF UTERUS 
 
 Utero-ovarian ligament 
 OVARY 
 
 FALLOPIAN TUBE 
 
 Broad ligament 
 
 FIMBRIATED EXTREMITY 
 
 OF TUBE 
 FIMBRIA OVARICA 
 
 Lower 
 part of broad ligament 
 
 OS UTERI 
 
 OS EXTERNUM 
 
 VAGINAL WALL, DIVIDED AND REFLECTED 
 
 VAGINA, ANTERIOR WALL 
 
iQ 2 PELVIC VISCERA 
 
 Uterus: 
 
 Examine the uterus with its broad ligaments, Fallopian tubes, round 
 ligaments and ovaries attached. 
 
 Open the uterus by a posterior median incision. 
 Study uterus and ligaments; and ovaries. 
 
 F IG - 233. FRONTAL SECTION OF THE VIRGIN UTERUS. (After Sappey.) (Morris.} 
 
 UTERINE WALL 
 CAVITY OF BODY 
 
 UTERINE WALL 
 CAVITY OF CERVIX WITH ARBOR VIT/E 
 
 OS EXTERNUM 
 VAGINAL WALL 
 
 FIG. 234. THE BROAD LIGAMENT AND ITS CONTENTS, SEEN FROM THE FRONT. (Morris.) 
 
 (After Sappey.) 
 Also see Fig. 232. 
 
 PAROVARIUM 
 
 AMPULLA OF FALLOPIAN TUBE 
 
 FALLOPIAN TUBE 
 
 EXTERNAL ANGLE OF UTERUS 
 
 FIMBRIATEO EXTREMITY OF TUBE 
 
 FIMBRIA OVARICA 
 
 Round ligament 
 Ligament of ovary 
 
 Anterior peritoneal lamina 
 
 What is the blood- and nerve-supply of the uterus, vagina, ovaries, 
 and broad ligaments? (Figs. 205, 235.) 
 
 Study the lymphatics of the pelvic and abdominal viscera. 
 
'93 
 
 FIG. 235. DIAGRAM OF THE ARTERIES AND LYMPHATICS OF THE FEMALE GENERATIVE 
 
 ORGANS. (Mcrris.) 
 
 Lymphatics of broad ligament 
 (to lumbar glands) 
 
 OVARY 
 
 FALLOPIAN TUBE 
 
 Funicular lymphatics 
 (to inguinal glands) 
 
 Uterine and vaginal lymphatics 
 (topeli-ic glands) 
 
 Vnlvar li/mptiafics 
 (to inguinal glands) 
 
 Ovarian 
 artery 
 
 Funicular 
 artery 
 
 Vaginal arteriet 
 
 Transverse perinceal artery 
 
194 
 
 PELVIC CAVITY 
 
 DEMONSTRATION X. 
 
 CAVITY OF THE PELVIS. 
 
 Examine the pelvis on an articulated skeleton. True pelvis; false 
 pelvis. Note the important ligaments of the pelvis. 
 
 FIG. 236. VERTICAL AXTERO-POSTERIOR SECTION OF THE PELVIS. (Morris.} 
 
 Superior sacro-iliac 
 ligament 
 
 Anterior sacro-iliac 
 ligament 
 
 Inferior sacro-iliac 
 ligament 
 
 Small sacro-sciatio 
 ligament 
 
 Great sacro-sciatic 
 ligament 
 
 Review the pelvic fascia. 
 
 Divide the body transversely in the lumbar region just above the crest of 
 the ilium, and then through the middle line of the sacrum and symphysis of 
 pub-is. 
 
 Now expose the internal iliac artery and its branches, and internal 
 iliac vein and its tributaries. 
 
PELVIC CAVITY 195 
 
 F IG 237 . SIDE VIEW OF PELVIS AND UPPER. THIRD OF THIGH, WITH THE EXTERNAL 
 
 ILIAC, INTERNAL ILIAC, AND FEMORAL ARTERIES AND THEIR BRANCHES, LEFT SIDE. 
 
 (From a dissection by W. J. Walsham in the Museum of St. Bartholomew's Hospital.) 
 
 The bladder is hooked over to expose back of pelvis. 
 
 Common iliac artery 
 S YMPA THETIC SER \ ~E 
 Middle sacral artery 
 
 Common iliac vein 
 URETER 
 
 Internal iliac artery 
 External iliac vein 
 
 External iliac artery 
 
 Potterivr Iranch of internal iliac dividing into 
 gluteal and ilio-lumbar arteries 
 
 Lateral sacral artery 
 
 SACRAL PLEXUS 
 OBTURATOR SERVE- 
 
 Obturator ar t 
 Obliterated hypogastric 
 Superior vesical artery 
 Edge of levator aiii 
 
 Pudic artery 
 
 BLADDER 
 Middle vesical artery 
 
 Deep epigastric artery 
 Pubic branch of epi- 
 
 artery 
 Common femoral artery 
 
 Long sripfienotts rein 
 Pectineus muscle 
 
 Obturator artery 
 
 Adductor magnus 
 
 Internal circumflex artery 
 
 Adductor brevis 
 
 OBTURA TOR SERVE (ant. branch) 
 
 Profunda artery 
 
 Adductor longus, hooked aside 
 
 Superficial femoral artery and rein 
 
 Gracilis muscle 
 Lower part of sartorius 
 
 Psoas muscle 
 Ilio-lumbar artery 
 
 EXTERSAL CUTA- 
 SEOUS SERVE 
 
 Iliacus muscle 
 
 GESITO-CRURAL 
 SER VE 
 
 ASTERIOR CRU- 
 RAL SERVE 
 
 Deep circumflex iliac 
 
 artery 
 Superficial circumflex 
 
 iliac artery 
 
 ANTERIOR CRURAL tf. 
 Gluteal artery and 
 
 " 
 
 uteali 
 
 Tensor facias iemoris 
 
 (hooked aside) 
 Glutens medius and 
 
 minimus 
 Sartorius muscle 
 MIDDLE CUTA- 
 SEOl'SSERVE 
 
 SERVE TO RECTUS 
 
 KERYE TO VASTUS 
 EXTERXUS 
 
 External circumflex ar. 
 
 NERVE TO CRUREl'S 
 Rectus, hooked aside 
 Profunda rein 
 
 LOSfi SAPHESOUS 
 SERVE AND 
 SERVE TO VAS- 
 TUS ISTERSUX 
 
 Vastus internus 
 muscle 
 
 Fio. 238. PLAN OF THE BRANCHES OF THE INTERNAL ILIAC ARTERY. (Holden.} 
 
 SAC. MED 
 
PELVIC CAVITY 
 
 Sacral plexus. 
 
 Plan of formation of pelvic plexus. 
 
 FIG. 239. DIAGRAM OF THE LUMBAR AND SACRAL PLEXUSES. (Modified from Paterson.) 
 
 (Mom?.) 
 
 FROM LAST THORACIC 
 
 GEN1TO-CRURAL 
 
 ILIO-HYPOGASTRIC 
 
 INGUINAL 
 
 EXTERNAL 
 CUTANEOUS 
 
 OBTURATOR 
 
 ACCESSORY 
 OBTURA TOR 
 
 BRANCH TO ILIAC US 
 ANTERIOR CRURAL 
 
 SUPERIOR GLUTEAL 
 
 INFERIOR GLUTEAL 
 
 GREAT SCIATIC 
 
 NERVE TO 
 
 Q.UADRATUS 
 
 FEMORIS 
 
 EXTERNAL 
 
 POPLITEAL 
 
 SECTION 
 
 INTERNA L 
 
 POPLITEAL 
 
 SECTION 
 
 TO HAMSTRINGS 
 
 FIRST LUMBAR 
 
 SECOND LUMBAR 
 
 THIRD LUMBAR 
 
 -- FOURTH L UMBA R 
 
 FIFTH LUMBAR 
 
 FIRST SACRAL 
 
 SECOND SACRAL 
 
 THIRD SACRAL 
 
 VISCERA L 
 FOURTH SACRAL 
 
 PERFORATING 
 CUTANEOUS 
 
 FIFTH SACRAL 
 
 KERVE TO COCCYGEUS 
 
 NER VETO LEI 'A TOR 
 
 ANI 
 
 FIRST COCCYGEAL 
 
 SMA LL SCIA TIC PUDIC 
 NER VE TO OBTURA TOR INTERNUS 
 
 VISCERAL 
 
PELVIC CAVITY 
 
 197 
 
 Expose the sacral plexus by removing from its anterior surface pelvic 
 fascia. The sciatic and internal pudic arteries also lie anterior to the 
 sacral plexus, pelvic fascia lying between the arteries and the plexus of 
 nerves. 
 
 Trace the branches of the sacral plexus to where they pass out of 
 the pelvis. 
 
 FIG. 240. BRANCHES OF THE LUMBAR AND SACRAL PLEXUS VIEWED FROM BEFORE. 
 (After Hirschfeld and Leveill.) (Morris.) 
 
 GANGLIATED CORD OF SYMPATHETIC 
 LAST THORACIC SERVE 
 
 FIRST L UMBAR 
 
 ILIO- 
 
 HYPOGASTRIC 
 ING I" IX A L 
 
 SECOND 
 LUMBAR 
 
 FOURTH 
 
 LUMBAR 
 
 DfQUINAL 
 
 EXTERNAL 
 
 CUTANEOUS 
 
 GKX1TO-CRURAI. 
 LU.VBO-SACRAL 
 
 CORD 
 
 ANTERIOR CRURAL 
 OBTURATOR 
 
 GEXITAL BRAXCB 
 OF GEXITO-CRURAL 
 
 CRURAL BRA\rrr OF 
 
 GKXITO- CRURAL 
 
 INGUINAL 
 
 IHXTRIBU- \ 
 
 TI<>\ /il' 
 EXTEHXA L 1 
 
 CRURAL 
 BRANCH 
 
 OF G EX I TO- 
 CRURAL 
 
 AORTIC PLEXUS 
 
 LAST THORACIC NERVE 
 
 ILIO-HYPO- 
 GASTRIC 
 
 INGUINAL 
 
 THIRD 
 LUMBAR 
 
 XERVE 
 
 GENITO- 
 CRURAL 
 
 EXTERNAL 
 CUTANEOUS 
 
 GENITAL 
 BRANCH 
 OF 
 
 GENITO- 
 CRURAL 
 
 CRURAL 
 BRANCH OP 
 GBK1TO- 
 CRURAL 
 
 OBTU- 
 RATOR 
 
 SACRAL 
 PLEXUS 
 
 Also expose the: 
 
 Fifth sacral nerve. 
 Coccygeal nerve. 
 Sacro-coccygeal plexus. 
 
198 
 
 PELVIC CAVITY 
 
 FIG. 241. A DISSECTION OF THE LUMBAR AND SACRAL PLEXUSES, FROM BEHIND. 
 
 (Morris.} 
 
 (The anterior crural nerve is placed between the external cutaneous and obturator nerves. ) 
 
 Also see Fig. 240. 
 
 TWELFTH RIB 
 
 LAST THORA CIC NER VE 
 
 ILIO- 
 HYPOGASTRIC 
 
 INGUINAL 
 
 ILIAC BRANCH 
 
 OF ILIO- 
 HYPOGASTRIC 
 
 Glutens medius 
 
 Gluteal artery 
 SUPERIOR 
 GLUTEAL NERVE 
 
 GREA T-SCIA TIC NER VE 
 
 INFERIOR GLUTEAL 
 NERVE 
 
 SMA LL SCIA TIC NER VE 
 
 Dura mater of cord 
 
 - POSTERIOR PRIMARY 
 DIVISION 
 
 -- GENITO-CRURAL 
 
 - CAUDA EQUINA 
 
 Filura terminate 
 
 EXTERNAL 
 CUTANEOUS 
 
 OBTURATOR 
 
 LUMBO-SACRAL CORD 
 
 *f ' FIRST SACRAL 
 NERVE 
 
 FIFTH SACRAL 
 NERVE 
 
 VISCERAL BHAXCHES 
 Sciatic artery 
 Small sacro-seiatic 
 
 ligament 
 PUDIC NER VE 
 
 NERVE TO 
 
 OI1TURA TOR 
 INTERNUS 
 
 PERFORA TING 
 CUTANEOUS OF 
 SECOND AND 
 THIRD SACRAL 
 NERVES 
 
 Sympathetic nerves: 
 
 Trace down into the pelvis the gangliated cord. 
 Pelvic plexus: 
 
 Offsets of the pelvic plexus. 
 Hemorrhoidal. 
 Vesical. 
 
 Prostatic in male. 
 Vaginal in female. 
 Uterine in female. 
 Muscles: 
 
 Examine the pyriformis, coccygeus, obturator internus, and origin 
 of levator ani. (See Figs. 217, 218.) 
 
 Locate the white line. (See Fig. 219.) 
 
GLUTEAL REGION 
 
 199 
 
 DEMONSTRATION XL 
 
 GLUTEAL REGION. 
 
 Dissection: Make an incision through the skin from the tip of the 
 coccyx, carrying it obliquely downward and outward to the anterior side 
 of the thigh four inches below the great trochanter. Turn the. skin off, 
 exposing the gluteus maximus muscle. Notice the cutaneous nerves. 
 
 FIG. 242. DISTRIBUTION OF CUTANEOUS NERVES ON THE POSTERIOR AND ANTERIOR 
 ASPECTS OF THE INFERIOR EXTREMITY. (Morris.} 
 
 LAST 
 
 THORACIC 
 ILIO-HYI'O- 
 GASTRIC 
 
 SHORT 
 SAPHENOU8 
 
 POSTERIOR 
 HI! I Xf/fKS 
 OF Ll'AfBAR 
 XER VE3 
 
 POSTERIOR 
 BRANCHES 
 III-- SACRAL 
 XER y3 
 
 PERFORA Tiyn 
 
 ctTTAirxous or 
 
 INGUINAL 
 
 THIRD SACRAL 
 
 TWIG 
 FRolf IN- 
 TERNAL 
 CUTA- 
 NEOUS 
 
 BRANCHES OF 
 SMALL 
 SCI A TIC 
 
 INTERNAL 
 
 CUTA- 
 OBTCRATOR NEOUS 
 
 POSTERIOR 
 BRAXCB OP 
 IXTERXAL 
 CITAXEOL'S 
 
 COMMTXf- 
 CAMS 
 
 TIBIALIS 
 
 PA TELLAR 
 BRANCH 
 OF LONG 
 S A PHE- 
 NOL'S 
 
 LONG 
 S A PHE- 
 NOL'S 
 
 TWIGS FROM 
 LONG 
 
 a A PHENOL'S 
 
 INTERNAL 
 CALCANEAN 
 
 ANTERIOR 
 TIBIAL 
 
 EXTERNAL 
 CUTA- 
 NEOUS 
 
 GENITO- 
 CRURAL 
 
 MIDDLE 
 CUTA- 
 NEOUS 
 
 CUTA- 
 NEOUS 
 BRANCH OF 
 EXTERNAL 
 fOPLITEAL 
 
 MUSCULO- 
 CUTA- 
 NEOUS 
 
 SHORT 
 
 SAPHE- 
 
 KOUS 
 
 Gluteus maximus muscle. (See Fig. 243.) 
 
 Clean and study the muscle. Then separate its border and cut it 
 transversely at its origin, and as you turn it down notice the structures 
 beneath and the inferior gluteal nerve passing into the muscle. Cut this 
 nerve and turn the muscle dowTi to its insertion. 
 
 Gluteus medius muscle is now exposed. (See Fig. 246.) 
 
 Study this muscle. Cut it vat its origin and turn it down to its inser- 
 tion with care so as not to destroy the structures beneath. 
 
2OO 
 
 GLUTEAL REGION 
 
 FIG. 243. THE GREAT SCIATIC NERVE, WITH ITS COLLATERAL AND TERMINAL 
 
 BRANCHES. (Holden.} 
 
 . Superior gluteal nerve. 
 . Inferior gluteal or lesser 
 
 sciatic. 
 , 3, 3. Its branch to the 
 
 gluteus maximus. 
 . Branch to the pyriformis. 
 . Genital branch of the 
 
 lesser sciatic. 
 . Femoro-popliteal of the 
 
 same nerve. 
 , 7. Trunk of the great 
 
 sciatic. 
 
 , g. Hranch to the long and 
 short heads of the biceps. 
 
 13. Branch to the semi- 
 tendinosus. 
 
 11. Branches to the 
 semi-membranosus. 
 
 12. Branch to the ad- 
 ductor magnus. 
 External popliteal or 
 peroneal. 
 
 Internal popliteal. 
 
 Filament to the plan- 
 
 taris muscle. 
 
 16. Branches to the 
 
 j;astrocnemius. 
 
 Origin of the external 
 
 saphenous nerve. 
 
 FIG. 244. THE ARTERIES OF THE GLUTEAL REGION. (Holden.} 
 
 i. Gluteal artery and nerve. 2. Pudic artery and nerve, and nerve to obturator internus. 
 3. Great sacro-sciatic nerve. 4. Sciatic artery. 5. Internal circumflex artery. 6. 
 The first perforating artery. 
 
GLUTEAL REGION 201 
 
 Gluteus minimus muscle is now exposed. (See Fig. 246.) 
 
 Study this muscle in place; do not remove it. 
 
 Pyriformis muscle is also exposed. Clean and study the muscle. 
 Note its relation to the structures coming out through the obturator fora- 
 men. Do not remove the pyriformis muscle. (See Fig. 246.) 
 
 FIG.- 245. MUSCLE BENEATH THE GLUTEUS MAXIMUS. (Holden.) 
 
 i. Origin of gluteus maximus divided. 2. Its insertion into the oblique line. 3, 3. Its 
 insertion into the fascia lata. 4. Gluteus medius. 5. Its insertion. 6. Fascia lata, 
 showing continuity with insertion of the gluteus maximus. 7. Pyriformis. 8. Ob- 
 turator internus. 9. Gemellus superior or cephalad. 10. Gemellus inferior. n. 
 Quadratus femoris. 12. Semi-membranosus. 13. Biceps. 14. Adductor magnus. 
 15. Gracilis. 16. Vastus externus. 
 
 LflfflLifdel. 
 
 Nerves exposed in this region (see Figs. 247 and 248)- 
 Inferior gluteal. 
 Small sciatic. 
 
 Great sciatic (N. ischiadicus] . 
 Pudic. 
 Superior gluteal (Fig. 243). 
 
 Arteries (see Fig. 246): 
 
 Gluteal (a. glutea superior). 
 Sciatic (a. glutecs inferior}. 
 Internal pudic. 
 
2O2 
 
 GLUTEAL REGION 
 
 FIG. 246. THE GLUTEAL REGION, WITH THE GLUTEAL, SCIATIC, AND PUDIC ARTERIES. 
 
 (Morris.) 
 
 (From a dissection by W. J. Walsham in St. Bartholomew's Hospital Museum.) 
 
 The inferior gluteal branch of the sciatic artery has been drawn inwards over the tuber 
 
 ischii with the reflected origin of the gluteus maximus muscle. 
 
 OHuteus rnedius, turned up 
 
 INFERIOR GLUTEAL NERVE 
 
 Gluteus mazimus, cut 
 Internal circumflex artery 
 Obturator externus 
 
 Insertion of gluteus medius 
 
 External circu 
 
 Gluteus minimus 
 
 Muscular branches of sciatic artery 
 Deep branch of gluteal artery 
 
 SUPERIOR GLUTEAL NERVE 
 
 ted by peroneal 
 atic nerve 
 
 of gluteus maximus 
 
 Insertion of 
 
 gluteus maximus ' 
 
 First per/orating artery 
 
 Qua'dratus femori 
 
 Branch of internal circumflex artery 
 Obturator interims with the two gemelli 
 
 Pudic artery and nerve 
 Sciatic artery 
 
 Semi-tendinosus 
 Semi-membrauosus 
 
 LESSER SCI A TIC NERVE 
 A rteria comes nervi ischiatici. 
 
 POPLITEA L FOR TION OF ORE A T SCIA TIC NER VE 
 LONG Pf'DENDAL NERVE 
 
 PERONEAL PORTION OF GREA T SCIA TIC NERVE 
 
GLUTEAL REGIOX 
 
 203 
 
 FIG. 247. A DISSECTION OF THE NERVES IN THE GLUTEAL REGION. (Morris.} 
 
 (The g^teus maximus and gluteus medius have been divided near their insertions, and 
 
 thrown upwards.) 
 
 Sciatic artery 
 
 INTERIOR GLl'TEAL XER\'E 
 Glutcal artery 
 
 Gluteus 
 medius 
 
 Gluteus niaximua 
 
 BRANCH TO GLl'- 
 ft> MAXIMl'S 
 
 Pl'DIC SERVE 
 
 Great sacro-sciatic 
 ligament 
 
 [diet 
 
 Come* nerri teckia- 
 Gemellus 
 inferior 
 
 Tensor 
 
 fasciae 
 
 femoris 
 
 XKIIVE TO 
 
 TKXSftK 
 
 FASCIA 
 
 FEMORIS 
 
 Tendon of obturator externus 
 
 Vastus extrnua 
 
 Gluteus mazimuB 
 
 Muscles. Expose and study (see Fig. 246): 
 Pyriformis. 
 Gemellus superior. 
 Gemellus- inferior. 
 Obturator internus. 
 Obturator externus. 
 Study obturator membrane. 
 Quadratus femoris. 
 
204 
 
 GLUTEAL REGION 
 
 FIG. 248. DEEP DISSECTION OF THE GLUTEAL REGION. (From a preparation in the 
 
 Hunterian Museum.) (Morris.} 
 Also see Fig. 245. 
 
 Gluteua medius 
 
 Gluteus minimus 
 
 Pyriformis, divided 
 
 into two by the 
 
 great sciatic nerve 
 
 GREAT TROCHANTER 
 
 Obturator ezternus 
 
 Quadratus femori 
 
 Fascial insertion of 
 gluteus mazimus 
 
 Horizontal fibres of 
 adductor inaguus 
 
 Fleshy insertion of 
 gluteus mazimus 
 
 GREAT SACRO-SCIATIC 
 FORAMEN 
 
 GLUTEAL NERVE 
 SUPPLYING POR- 
 TIONX OF QLU- 
 TE[\S MEDIfs 
 Gluteus mazimus 
 
 Obturator internus. 
 Below is the infe- 
 rior geinellus. The 
 superior gemellus 
 is absent 
 
 BRANCHES OF IN- 
 FER ion JTI>EX- 
 DAL NERVE 
 
 GREA T SCIA TIC NER VE. 
 Under it, oblique fibres of 
 adductor magnus are seen 
 
 SMALL SCIA TIC NER VE 
 
ANTERIOR FEMORAL REGION 
 
 205 
 
 DEMONSTRATION XII. 
 
 ANTERIOR FEMORAL REGION. 
 
 Cutaneous nerves (Fig. 242). 
 
 Outline superficial veins of leg and thigh (Fig. 250). 
 Superficial lymphatics of leg and thigh (Fig. 250). 
 Outline femoral artery. (See Fig. 257.) 
 
 FIG. 249. NERVES ON THE ANTERIOR OR VENTRAL PART OF THE THIGH. (Holden.) 
 
 The crural. 
 
 Branch to the iliacus. 
 
 Filament to the psoas 
 magnus. 
 
 Three branches of the 
 crural to the skin, 
 divided to show the 
 deeper branches. 
 
 6. Muscular filaments 
 of the superficial por- 
 tion. 
 
 Internal cutaneous, 
 which pierces the fas- 
 cia lata. 
 
 Anastomosing branch 
 of the internal cuta- 
 neous. 
 
 Branch to the rectus 
 femoris. 
 
 Branch to the vastus 
 externus. 
 
 1 1 . Branch to the vas- 
 tus intemus. 
 
 -22 
 
 
 12, 
 
 12. Internal, or long, 
 
 ] t 
 
 
 saphena nerve. 
 
 .19 
 18 
 
 IS- 
 
 Patellar branch of this 
 
 IS 
 
 
 nerve. 
 
 |17 
 
 M- 
 
 Its vertical branch. 
 
 13 
 
 'S- 
 
 Obturator nerve. 
 
 1 
 
 16. 
 
 Its branch to adductor 
 
 : 
 
 
 longus. 
 
 . 
 
 '7- 
 
 Its branch to the ad- 
 
 
 
 ductor brevis. 
 
 
 18. 
 
 Its branch to the gra- 
 
 1 
 
 
 cilis. 
 
 
 9- 
 
 Its branch to the ad- 
 
 
 
 ductor magnus. 
 Lumbo-sacral trunk. 
 
 
 21. 
 
 Union of this trunk 
 
 
 
 and the first sacral 
 
 
 
 nerve. 
 
 
 22, 
 
 22. Lumbar and sacral 
 
 
 
 portion of the sympa- 
 
 
 
 thetic. 
 
 
 23- 
 
 External cutaneous 
 
 
 
 nerve . 
 
 Dissection. Make an incision through the skin along the anterior 
 part of the thigh from the middle of Poupart's ligament to just below 
 the patella ; turn the skin outward and inward. Note the structures 
 beneath : 
 
 Superficial fascia. 
 Superficial nerves. Tracer- 
 Anterior crural. 
 
 Middle cutaneous. (See Fig. 242.) 
 Internal cutaneous. (See Fig. 242.) 
 
206 
 
 ANTERIOR FEMORAL REGION 
 
 FIG. 250. THE SUPERFICIAL VEINS AND LYMPHATICS OF THE LEFT LOWER LIMB. (Wai- 
 sham.) (Morris.) 
 
 Supe rficial ly mphat ics from 
 lateral wall of abdomen 
 
 Superficial lymphatics from 
 lower and anterior walls 
 of abdomen 
 
 Superficial epigastric vein 
 
 Lymphatics from penis and 
 
 scrotum 
 Common femoral vein 
 
 Superficial femoral lymphatic 
 
 glands 
 Superficial external pudic vein 
 
 Internal femoral cutaneous vein 
 
 Long saphenous vein 
 
 INTERNAL MALLEOLUS 
 Dorsal venous arch 
 
 Superficial inguinal 
 
 lympltatic (/lands 
 
 Superficial circumflex 
 
 iliac vein 
 
 External femoral 
 cutaneous vein 
 
.\\JERIOR FEMORAL REGIOX 
 
 207 
 
 External cutaneous. (See Fig. 242.) 
 
 Ilio-inguinal. 
 
 Genito-crural. (See Fig. 242.) 
 Superficial veins (see Fig. 2 50) : 
 
 Long saphenous and tributaries. (See Fig. 250.) 
 
 Trace the long saphenous vein up to where it passes through the saphen- 
 ous opening in* the fascia lata (Fig. 251). 
 
 Superficial arteries. The origin from the femoral: 
 
 Superficial epigastric. 
 
 Superficial circumflex iliac. 
 
 Superficial external pudic. 
 
 FIG. 251. SUPERFICIAL VESSELS AND GLANDS OF THE GROIN. SAPHENOUS OPENING WITH 
 
 THE CRIBRIFORM FASCIA. (Holden.) 
 i. Saphenous opening of the fascia lata. 2. Saphena vein. 3. Superficial epigastric a. 
 
 4. Superficial circumflexa illii a. 5. Superficial pudic a. 6. External abdominal ring. 
 
 7. Fascia lata of the thigh. 
 
 Examine and study the fascia lata. 
 
 Expose saphenous opening: 
 
 Position, how formed, relation of cribriform fascia. (See Figs. 250 
 and 251, also 252.) 
 
 Locate Gimbernat's ligament (Figs. 252, 253). 
 
 Locate the femoral artery and vein under Poupart's ligament. The 
 sheath of these vessels, called femoral, or crural, sheath, is formed in front 
 by a continuation of the transversalis fascia, behind by a continuation 
 of the iliac fascia. These fascia meet close to the femoral artery on the 
 
208 
 
 ANTERIOR FEMORAL REGION 
 
 iliac side, but a small space exists between femoral vein and where they 
 meet on the pubic side; this is the femoral or crural canal. 
 
 Locate and describe the femoral or crural canal, femoral or crural 
 ring, septum crurale. 
 
 What are the coverings of femoral hernias? 
 
 FIG. 252. DIAGRAM OF THE FEMORAL RING AND THE SAPHENOUS OPENING. (Holden.) 
 
 (The arrow is introduced into the femoral ring.) 
 i. Crural arch. 2. Saphenous opening of the fascia lata. 3. Saphena vein. 4. Femoral 
 
 vein. 5. Gimbernat's ligament. 6. External abdominal ring. 7. Position of the 
 
 internal ring in dotted outline. 
 
 FIG. 253. POSITION OF PARTS UNDER THE CRURAL ARCH (VERTICAL SECTION). (Holden.} 
 
 External cutaneous n. 
 
 Iliacus. 
 
 Anterior crural n. 
 Psoas. 
 
 Crural arch. 
 External ring. 
 
 \ Femoral ring. 
 
 T Femoral vein and artery. 
 
 When the obturator artery comes from the external iliac artery what 
 position may it occupy in relation to the femoral ring? (Figs. 254, 255.) 
 Study the anatomy concerned in femoral hernia. 
 Remove the fascia lata and expose the following structures: 
 Nerves (see Fig. 249): 
 
AXTERIOR FEMORAL REGION 
 
 209 
 
 Anterior crural and branches. Trace the long or internal saphenous 
 down to the knee. 
 Scarpa's triangle. 
 Muscles (see Fig. 256): 
 Sartorius. 
 Tensor vaginae femoris. 
 
 Ilio-tibial band of fascia lata. 
 
 FIG. 254. IRREGULARITIES OF THE OBTURATOR ARTERY. (After Gray.) (Morris.) 
 
 Deep circumflex iliac artery 
 
 External iliac artery 
 External iliac vein 
 
 Obturator foramen. 
 
 / 
 
 Internal ring, with spermatic 
 vessels cut short in it 
 
 Deep epigastric artery 
 
 Lymphatic gland in femoral 
 ring 
 
 The obturator artery, given off 
 from the external iliac tcith ttie 
 deep epigastric, descends to gain 
 the obturator foramen, but at a 
 safe distance from the femoral 
 ring 
 
 FIG. 255. IRREGULARITIES OF THE OBTURATOR ARTERY. (After Gray.) (Morris.) 
 
 n~ 
 
 The obturator artery, coming off 
 from the deep epigastric, takes 
 a course -so near to the femoral 
 ring that if would very likely 
 be divided Iry the bistoury intro- 
 duced from irithout to divide 
 the base of Gimbernafs liga- 
 ment, the cause of the constric- 
 tion 
 
 Quadriceps extensor. 
 Rectus femoris. 
 
 Vastus externus (M. vastus lateralis). 
 Vastus internus (M. vastus medialis). 
 Crureus (M. vastus intermedialis) . 
 Ligamentum patellae. 
 
 Expose and study these muscles, but do not remove any of them. 
 15 
 
2IO 
 
 FIG. 256. MUSCLES OF THE FRONT OF THE THIGH. (Morris.) 
 
 Psoas 
 
 Iliacus 
 
 Pectineus 
 
 Adductor brevis 
 
 Adductor longus 
 
 Gravilis 
 
 Adductor magnus 
 
 Vastus internus 
 
 Tendon of sartorius 
 
 Gluteua medius 
 
 Gluteus minimus 
 Tensor vaginae femoris 
 
 Sartorius 
 
 Rectus femoris 
 
 Ilio-tibial band of fascia lata 
 
 Vastus ezternus 
 
 Ligamentum patellae 
 
AXTERIOR FEMORAL REGION 
 
 211 
 
 Arteries : 
 
 Common femoral and branches. 
 Superficial femoral and branches. 
 Deep femoral n-ill be followed later. 
 
 FIG. 257. SIDE VIEW OF PELVIS AND UPPER THIRD OF THIGH, WITH THE EXTERNAL 
 
 ILIAC, INTERNAL ILIAC. AND FEMORAL ARTERIES AND THEIR BRANCHES. LEFT SIDE. 
 
 (From a dissection by W. J. Walsham in the Museum of St. Bartholomew's Hospital.) 
 
 The bladder is hooked over to expose back of pelvis. 
 
 Common iliac artery 
 S YMPA THETIC SER I 'E 
 Middle sacral artery 
 
 Common iliac vein 
 URETER 
 
 Internal iliac 
 Exlet 
 
 External Hi 
 
 Potttrior krone* of internal iliac dicid 
 gluieol and ilio-lml>ar arttria 
 
 Lateral sacral artery 
 
 SACRAL PLEXUS 
 OBTURA TOR SER VE - 
 
 Obtu 
 OUUermted hypogoMtrie 
 
 Superior tttieal artery 
 Edge of levator ani 
 
 Pudic artery 
 
 una 
 
 Jf iil-.He retical artery 
 
 Deep epigastric artery 
 Pubic krone* of cpi- 
 
 gastric artery 
 Common femoral artery 
 
 Long snphenmis rtin 
 Pectineus muscle 
 
 Obturator artery 
 
 Adductor magnus 
 
 Internal circumflex artery 
 
 Adductor brevia 
 
 OBTURATOR SERVE (ant. branch) 
 
 Profunda artery 
 
 Adductor longua, hooked aaids 
 
 Superficial femoral artery and rein 
 
 Gracilia muscle 
 Lower part of sartorius 
 
 Psoas musc-e 
 Ilio-tumbar artery 
 
 EXTERNAL 
 SEOl'S SERVE 
 
 Iliacus muscle 
 
 GEXITO-CRURA.L 
 SER VE 
 
 ASTERIOR CRU- 
 RAL SERVE 
 
 Deep circumflex iliac 
 artery 
 
 Superficial circumflex 
 
 iliac artery 
 
 ANTERIOR CSrSAL -V. 
 Glntfal artery and 
 mffrior gluttal nerre 
 Tensor faciae femoris 
 
 hooked aside) 
 Gluteus medius and 
 
 minimus 
 
 ! Sartorius muscle 
 lilliDLE I UTA- 
 SEOl'S SERVE 
 
 SERVE TO RECTUS 
 
 XERTE TO VASTL'S 
 EKTEBSVS 
 
 External circttmflei ar. 
 
 .VERVE TO CarREl'S 
 
 Rectus, hooked aside 
 
 Proruada rein 
 LOSG SAPHESOUS 
 SERVE ASD 
 SERVE TO VAS- 
 TLY ISTERSUS 
 
 Vastus interuus 
 muscle 
 
ANTERIOR FEMORAL REGION 
 
 FIG. 258. SIDE VIEW OF THE RIGHT POPLITEAL ARTERY. (Morris.) 
 (From a dissection in the Hunterian Museum.) 
 
 Femoral artery and vein 
 
 BRANCHES OF THE 
 INTERNAL CUTA- 
 NEOUS NERVE 
 
 Apoueurotio covering 
 of Hunter's canal 
 
 Anastomotica magna 
 artery 
 
 LONG SAPHENOUS 
 NER VE 
 
 Vertical fibers of the 
 adductor magnus 
 
 Popliteal artery 
 
 Vastus internus 
 Cut edge of fascia lata 
 
 BRANCH OF SAPHE- 
 NOUS NERVE TO 
 P A TELL A R PLEX- 
 US 
 
 SMALL SCIATIC 
 NER VE 
 
 Adductor rnagnua 
 
 Internal saphenous vein 
 
 Part of seml- 
 tendiuoBua 
 
 Observe Hunter's canal. 
 Veins : 
 
 Femoral and tributaries. 
 Study the deep and superficial lymphatics. 
 
IXTERXAL FEMORAL REGION 
 
 213 
 
 INTERNAL FEMORAL REGION. 
 
 Dissection. Remove the skin from the internal femoral region; 
 turn it inward, exposing the superficial fascia and nerves. 
 Expose the following: 
 Muscles (see Figs. 256, 257): 
 
 Gracilis. 
 
 Pectineus. 
 
 Adductor longus. 
 
 Adductor magnus. 
 
 Adductor brevis. 
 
 Iliacus. 
 
 Psoas. 
 
 FIG. 259. ANTERIOR CRURAL AND OBTURATOR NERVES. (Ellis.) (Morris.) 
 
 Also see Fig. 256. 
 
 Femoral vein 
 
 femoral artery 
 
 Pectineus 
 OBTURATOR (ANTERIOR DIV.) 
 
 OBTURATOR (POSTERIOR 
 DIVISION) 
 
 Adductor longus 
 
 Adductor brevis 
 
 OBTURA TOR 
 
 (ANTERIOR 
 
 DIVISION) 
 
 Gracilis 
 
 Adductor 
 
 GEXICULA TE 
 BRANCH OF 
 OBTURATOR 
 
 Semi-membranosus 
 
 Anastomotica artery 
 
 PA TELLAR BRANCH OF 
 LONG SAPHENOUS 
 
 Sartorius 
 Iliacus 
 
 ANTERIOR CRURAL 
 
 Fsoaa 
 
 Tensor vaginae femoris 
 
 Profunda artery 
 
 Pectineus 
 Kectus femoria 
 
 LONG SAPHENOUS 
 
 NERVE TO VASTUS 
 INTERNUS 
 
 - Adductor longus 
 Femoral artery 
 
2I 4 
 
 INTERNAL FEMORAL REGION 
 
 Arteries: Trace the following: 
 Femoral : 
 
 Profunda femoris. 
 
 Branches. 
 Muscular. 
 
 Anastomotica magna. 
 Obturator. 
 
 FIG. 260. PLAN OF THE INOSCULATIONS of THE CIRCUMFLEX ARTERIES. (Holden.) 
 i. Crural Arch. 2. Internal iliac. 3. Superficial femoral. 4. Profunda. 5. Internal cir- 
 cumflex. 6. External circumflex. 7. First perforating. 8. Second ditto. 9. Third 
 ditto. 10. Gluteal. u. Obturator. 12. Sciatic. 13. Anastomotica magna. 
 
 Nerves : 
 
 Obturator. 
 Accessory obturator. 
 Anterior crural and branches. 
 
 (See Fig. 259.) 
 
POPLITEAL SPACE 
 
 215 
 
 DEMONSTRATION XIII. 
 
 POSTERIOR FEMORAL REGION AND POPLITEAL SPACE. 
 
 Popliteal space. 
 
 The superficial structures of the popliteal space should be dissected 
 first so as to .see the relative position of the parts. 
 
 Dissection. Make two transverse incisions, one three inches above 
 and one three inches below the knee-joint, a third incision connecting 
 these two in the median line. Turn the skin outward and inward. 
 
 Xote the superficial fascia, cutaneous branches of small sciatic nerve, 
 internal cutaneous and communicans fibularis and communicans tibialis 
 nerves. 
 
 Remove the fascia and clean the tendons of the outer hamstring and 
 inner hamstring, external and internal popliteal nerves, popliteal vein, 
 short saphenous vein, and popliteal artery. 
 
 FIG. 261. LEFT POPLITEAL SPACE. (Holden.) 
 
 Outer head of Gastroc- 
 
 nemius. 
 
 - Semi tendinosus. 
 
 Semimembranosus 
 
 Gracilis. 
 
 Sartorius. 
 
 Inner head of gastroc- 
 nemius. 
 
 Posterior femoral region. 
 
 Dissection. Make a median incision along the posterior part of 
 the thigh and turn the skin outward and inward. Note the: 
 Superficial nerves (Fig. 242). 
 Small sciatic. 
 External cutaneous. 
 Obturator. 
 
2l6 
 
 POSTERIOR FEMORAL REGION 
 
 FIG. 262. SUPERFICIAL MUSCLES OF THE BACK OF THE THIGH AND LEG. (Morris.'} 
 
 Gluteus tnediuB 
 
 Aponeurosis of gluteus niaximus 
 
 Biceps 
 
 Vastus externus 
 
 Oastrocnemius 
 
 Peroneus longua 
 
 I: iflllf 
 
 Gluteus maximus 
 
 Semi-membranosue 
 
 Semi-tendinoBua 
 
 Graeilis 
 
 Tendon of semi-membranosus 
 
 Flexor longus digitorum 
 
 Tendo AchilliB 
 
POSTERIOR FEMORAL REGION 
 
 21 7 
 
 Muscles (Fig. 262): 
 Biceps, 
 
 Semitendinosus. 
 Semimembranosus. 
 
 Arteries : 
 
 Branches of the profunda. 
 Sciatic. 
 Xerves : Deep branches. 
 
 Great sciatic (n. ischiadiciis] . 
 Small sciatic (n. cutanens posterior}. 
 Obturator. 
 
 Deep parts of the popliteal space. 
 Xerves (see Fig. 263): 
 External popliteal. 
 Internal popliteal. 
 Obturator, articular branch. 
 Arteries : 
 
 Popliteal and branches. 
 Anastomosis about the knee-joint. 
 Veins : 
 
 Popliteal and tributaries. 
 
 FIG. 263. DEEP VIEW OF THE POPLITEAL SPACE. (Hirschfeld and Leveill6.) (Morris.) 
 
 Adductor magnus 
 
 Popliteal vein 
 Popliteal artery 
 
 INTERNAL POPLITEAL NERVE 
 
 Vaatus internus 
 
 Superior internal articular artery 
 
 Tendon of semi-membranosus 
 Inner bead of gastroenemius 
 
 Inferior internal articular ar/eri/ 
 Poplitfnl rein 
 Popliteua 
 
 Tendon of plantaria 
 
 Vaetus eiternus 
 
 GREA T SCI A TIC NERVE 
 
 w- Short head of biceps 
 EXTERNAL POPLITEAL NERVE 
 
 Long head of biceps, cut 
 Outer head of gastroenemius 
 
 COMMUNICAJS8 PERONEI NERVE 
 
 - Soleus 
 
 Gastroenemius 
 
 External sapfienous rein and nerve 
 
2l8 
 
 ARTERIES ABOUT THE KNEE 
 
 FIG. 264. THE ANASTOMOSIS ABOUT THE LEFT KNEE-JOINT. (Walsham.) (Motris.) 
 
 (Semi-diagrammatic.) 
 
 Deep branch of anastomolica magna 
 
 Superficial branch of anastomotica 
 magna 
 
 Adductor magnuB 
 
 Superficial internal articular artery 
 piercing tendon of adductor 
 magnus 
 
 Internal lateral ligament 
 
 Inferior internal articular artery 
 passing under internal lateral 
 ligament 
 
 Posterior tibial artery 
 
 Descending branch of external 
 circumflex artery 
 
 Superior external articular artery 
 passing through external inter- 
 muscular septum 
 
 EXTERNAL CONDYLE 
 
 Long external lateral ligament 
 
 Inferior external articular artery 
 passing under external lateral 
 ligament 
 
 Anterior tibial recurrent artery 
 
 Anterior tibial artery 
 
ANTERIOR TIBIO-FIBULAR REGIOX 219 
 
 DEMONSTRATION XIV. 
 
 ANTERIOR TIBIO-FIBULAR REGION. 
 
 Examine the osseous parts of the leg, and knee- and ankle-joints on 
 the articulated skeleton. 
 
 Dissection. Make an incision down the anterior median line of 
 the leg and dorsum of the foot to the toes, a transverse incision just back 
 of the metatarso-phalangeal articulation. Turn the skiji outward and 
 inward. Make a longitudinal incision along the dorsum of each toe and 
 turn the skin off. 
 
 In removing the skin from the anterior part of the leg care must be 
 used not to destroy the musculo-cutaneous, internal or long saphenous, 
 and external saphenous nerves. (See Fig. 242.) 
 Xote and study the fascia of the leg. 
 Clean and study the annular ligament (Fig. 266). 
 Nerves: Trace out the: 
 
 Long, or internal saphenous. 
 External saphenous. (See Fig. 265.) 
 External popliteal. 
 
 Musculo-cutaneous (X. peron&us superficialis). (See Fig. 267.) 
 Anterior tibial (X. peronozus projundus}. (See Fig. 267.) 
 Expose and study: 
 Muscles (see Fig. 263) : 
 Tibialis anticus. 
 
 Extensor proprius hallucis (M. extensor hallucis longus}. 
 Extensor longus digitorum. 
 Peroneus tertius. 
 Extensor brevis digitorum. 
 Dorsal interossei. 
 
 Arteries: Expose and note relations: 
 Anterior tibial (Figs. 267, 268). 
 Posterior tibial recurrent. 
 Superior fibular. 
 Anterior tibial- recurrent. 
 Muscular. 
 Internal malleolar. 
 External malleolar. 
 
 Dorsalis pedis, continuation of anterior tibial. 
 Tarsal. 
 
 Metatarsal (A. arcuata) and branches. 
 Dorsalis hallucis. 
 
 Communicating or plantar digital. 
 Muscles on fibular side: 
 Peroneus longus. 
 Peroneus brevis. (See Fig. 266.) 
 
22O 
 
 ANTERIOR TIBIO-FIBULAR REGION 
 
 FIG. 265. PERONEAL, EXTERNAL, OR LATERAL POPLITEAL NERVE. (Holden.) 
 External popliteal or peroneal. 2. Cutaneous branch. 3. Communicans peronei. 4. 
 External saphena. 5. Trunk formed by the union of the external saphena with the 
 accessory of the cutaneous. 6. Calcanean branch. 7. Terminal branch going to 
 5th toe. 8. Terminal branch to 4th and 5th toes. 9, 9. Musculo-cutaneous. 10, 10. 
 Its terminal branches. 1 1 . Anastomosis of the musculo-cutaneous with the ex- 
 ternal saphena. 12. Anastomosis of the internal and external or lateral branches 
 of the musculo-cutaneous. 13. Anterior tibial. 14. Terminal branch of anterior 
 tibial, supplying deeper structure great and index toes and anastomosing with the 
 musculo-cutaneous. 
 
ANTERIOR TIBIO-FIBULAR REGION 
 
 FIG. 266. THE MUSCLES OF THE FRONT OF THE LEG. (Morris.) 
 
 Ligamentum patellae 
 
 Gaatrocnemius 
 
 Soleus 
 
 ifiTtensor proprius hallucis 
 
 Dorsal iuterossei 
 
 ;te|v-^; I 
 
 1 / 
 
 Feroneus longua 
 
 Tibialia anticos 
 
 Peroneua tertiua 
 
 Extensor longus digitorum 
 
 Peroneus tertius 
 
 Extensor brevis digitorum 
 
222 
 
 AXTERIOR TIBIO-FIBULAR REGION 
 
 FIG. 267. BRANCHES OF THE EXTERNAL POPLITEAL NERVE. (Morris.) 
 Also see Figs. 248 and 265. 
 
 EXTERNAL POPLITEAL 
 
 NERVE 
 RECURRENT ARTICULAR 
 
 MUSCULO-CUTANEOUS 
 
 BRANCH TO PERONEUS 
 LONG US 
 
 BRANCH TO EXTENSOR 
 L ONG US DIGITOR UM 
 
 BRANCH TO PERONEUS 
 BREVIS 
 
 MUSCULO-CUTANEO US 
 
 MUSCULO-CUTANEO US 
 (OUTER DIVISION) 
 
 SHORT SAPHENOUS 
 
 COLLA TERAL 
 BRANCHES OF EX- 
 TERNAL SAPHENOUS 
 AND MUSCULO- 
 CUTANEOUS TO TOES 
 
 ANTERIOR TIBIAL 
 NER VE 
 
 Anterior libial arte.ru 
 
 Tibialis anticus 
 
 ANTERIOR TIBIAL 
 NERVE 
 
 MUSCULO-CUTANEOUS 
 (INNER DIVISION) 
 
 ANTERIOR TIBIAL 
 ( O UTER DJ I 'ISION) 
 
 ITS DISTRIBUTION TO 
 EXTENSOR BREVIS 
 DIG I TO RUM 
 
 ANTERIOR TIBIAL 
 (INNER DIVISION) 
 
 \ COLLATERAL 
 
 BRANCHES OF 
 ' MUSCULO-CUTANEOUS 
 ) TO TOES 
 
AXTERIOR TIBIO-FIBULAR REGION 
 
 223 
 
 FIG. 268. THE ANTERIOR TIBIAL ARTERY, DORSAL ARTERY OF THE FOOT, AND ANTERIOR 
 PERONEAL ARTERY, AND THEIR BRANCHES, LEFT SIDE. (Morris.} 
 
 Superior internal articular artery 
 
 Inferior internal articular artery 
 
 Anterior tibial recurrent artery 
 
 Anterior tibial artery 
 
 Tibialis anticus mus 
 
 AXTERIOR TIBIAL XERVE 
 
 Extensor longus hallucis 
 
 Internal malleolar artery 
 
 Anterior annular ligament 
 Dorsalis pedis artery 
 
 Innermost tendon of extensor 
 brevis digitorum 
 
 Communicating branch 
 Dorsalis hallucis artery 
 
 Superior external articular artery 
 
 Inferior external articular artery 
 
 Extensor longus digitorum 
 
 Extensor longus digitorum, 
 turned back 
 
 Peroneus tertius 
 
 Anterior peroneal artery 
 External malleolar artery 
 
 Peroneus brevis muscle 
 
 Extensor brevis digitorum, cut 
 External tarsal branch 
 Metatarsal branch. 
 Dorsal interoueout artery 
 
224 
 
 ANTERIOR TIBIO-FIBULAR REGION 
 
 FIG. 269. SCHEME OF THE DISTRIBUTION AND ANASTOMOSIS OF THE ARTERIES OF THE 
 
 RIGHT FOOT. (Walsham.) (Morris.} 
 (The plantar arteries are shown in dotted outline; the dorsal in solid red.) 
 
 Peroneal artery 
 
 Anterior peroneal branch 
 External malleolar branch 
 
 Posterior peroneal artery 
 
 External tarsal branch 
 
 External plantar artery 
 forming plantar arch 
 Posterior perforating branches 
 
 First digital artery to ou 
 side of little toe 
 
 Second, third, and fourth 
 dorsal inlerosseous arteries 
 given off" from melatarsal 
 artery 
 
 Second, third, and fourth 
 digital arteries 
 
 Anterior perforating branches 
 
 Branch of third dorsal 
 inlerosseous artery to 
 outer side of little toe 
 
 Anterior libial artery 
 
 Internal malleolar 
 branch 
 
 Malleolar brani-h of 
 posterior tibial artery 
 
 Communicating branch 
 between posterior tibial 
 and peroneal arteries 
 
 Internal plantar artery 
 
 Internal tarsal. branch 
 
 Melalarsal branch 
 
 Communicating artery 
 
 Dorsalis fialluci.i or 
 first dorsal inter- 
 osseous 
 
 Princeps hallucis or 
 fifth plantar digital 
 artery 
 
 Dorsal digital branch 
 of dorsalis halliicis 
 to inner side of 
 great toe 
 
POSTERIOR TIBIO-FIBULAR REGIOX 
 
 225 
 
 DEMONSTRATION XV. 
 
 POSTERIOR TIBIO-FIBULAR REGION. 
 
 Dissection. Remove the skin from the posterior tibial region with 
 care so as not to destroy the communicans fibularis and tibialis forming 
 the external saphenous nerve. (See Fig. 242.) Note external saphenous 
 vein. 
 
 When the above superficial nerves and vein in the superficial fascia 
 have been traced and studied, clean and study the gastrocnemius 
 muscle; then cut its two heads near their origins and turn it down; do 
 not remove it. 
 
 Observe the plantaris muscle. 
 
 FIG. 270. MUSCLES OF THE CALF. (Holden.) 
 
 1. Tendo Achillis. 
 
 2. Soleus. 
 ^j. Plantaris. 
 
 4. Its tendons. 
 
 ?. Popliteus. 
 . Annular fibres of the soleus. 
 
 7. Origin of the inner head of 
 the gastrocnemius. 
 
 $- Same of the outer head. 
 .ft Tendon of the biceps. 
 10, Tendon of the semi-membra- 
 
 nosus. 
 n. Adductor magnus. 
 
 12. Its tendon. 
 
 13. Lower opening of Hunter's 
 
 canal. 
 
 14. External intermuscular sep- 
 
 tum. 
 
 15. Vastus externus. 
 
 16. Tendon of the flexor longus 
 
 digitorum. 
 
 17. Tendon of the peroneus lon- 
 
 gus. 
 
 18. Tendon of the peroneus 
 
 brevis. 
 
 19. Flexor longus hallucis. 
 
 Et9 
 
 Study the soleus muscle. Then cut it at its origin and the tendon 
 of the plantaris and turn them down. 
 
 In cutting the origin of the soleus do not destroy any of the struc- 
 tures below. 
 
 16 
 
226 
 
 POSTERIOR TIBIO-FIBULAR REGION 
 
 p I( - T 2 ^j SUPERFICIAL* MUSCLES OF THE BACK OF THE THIGH AND LEG. (Morris.) 
 
 Qluteus mediUB 
 
 Aponeuroais of gluteus mazimua 
 
 Biceps 
 
 Vaatus externus 
 
 Gaatrocneinma 
 
 8oleu 
 
 Peroneua longua 
 
 GluteuB mazimus 
 
 Seini-tnembrauoaus 
 
 Semi-tendinosu* 
 
 Gracilia 
 
 Tendon of aemi-membranoaus 
 
 Sartorius 
 
 Flexor longus digitorum 
 
 Tendo Achillis 
 
POSTERIOR TIBIO-FIBULAR REGION 
 
 227 
 
 Xote the tendo Achillis (tendo calcaneus), its formation and inser- 
 tion. Turn the tendo Achillis down to its insertion, with the gastroc- 
 nemius, soleus, and tendon of plantaris attached, but do not remove them. 
 
 Note the deep tibial fascia and internal annular ligament. 
 
 Trace down the posterior tibial artery and nerve, observing their rela- 
 tion to each other and to the surrounding muscles. 
 
 FIG. 272. RELATIONS OF THE POPLITEAL ARTERY TO BOXES AND MUSCLES, LEFT SIDE. 
 
 (Morris.) 
 
 Superior external articular artery 
 
 POPLITEAL SERVE - 
 External lateral ligament 
 Inferior external articular artery 
 
 Popliteus 
 
 Muscular branch to soleus 
 
 Soleus 
 
 Anterior tibial artery 
 
 Peroneus longus 
 Peroneal artery . 
 
 BRANCH OF POSTERIOR TIBIAL 
 SERVE TO FLEXOR LOSGUS 
 HALLUCIS 
 
 Flexor longus hallucis 
 
 J 
 
 Superior internal articular artery 
 
 Popliteal arteru 
 
 Posterior ligament of knee 
 
 Azygos articular artery 
 SEMI-MEMBRANOSUS 
 
 Inferior Internal articular artery 
 
 Muscular branch 
 
 Tibialis posticus 
 POSTERIOR TIBIAL SERVE 
 
 MUSCULAR BRANCH OF POS- 
 TERIOR TIBIAL SERVE TO 
 FLEXOR LOSGUS DIG I TOR UM 
 
 Flexor longus digitorum 
 
 Potlerior tibial artery 
 
 Cutaneous branch ofperoneal artery 
 
 Peroneus bre via . 
 QmtiniMtion ofperoneal artery 
 
 Tibialis posticus 
 
 Communicating branch 
 Internal annular ligament 
 
 Internal calcaneal artery 
 
228 
 
 POSTERIOR TIBIO-EIBULAR REG/OX 
 
 Study the arteries, muscles, and nerves :- 
 Arteries : 
 
 Posterior tibial 
 
 Peroneal 
 
 Muscular. 
 
 Medullary. 
 
 Cutaneous 
 
 Communicating. 
 
 Malleolar 
 
 Calcanean 
 
 FIG. 273. THE POPLITEAL, THE POSTERIOR TIBIAL, AND THE PERONEAL ARTERY, RIGHT 
 
 SIDE. (Morris.) 
 
 3emi- tendinosuB 
 
 Semi-meinbranosuB 
 
 Sartorius 
 
 Inferior internal articular artery 
 
 GraciliB 
 
 Inner head of gastrocnemius, 
 hooked aside 
 
 Inferior sural artery 
 
 Tibialia posticus 
 
 Soleus, turned back 
 
 Posterior tibial artery 
 
 Flexor longus digitorum 
 
 Tlbialis posticus 
 Flexor longus digitorum 
 
 Communicating artery 
 
 Sn/ierior external articular artery 
 
 Biceps 
 
 Superior sural artery 
 
 Popliteal artery 
 
 Plautaris muscle 
 
 Fopliteus muscle 
 
 Inferior external articular artery 
 
 Spot at which anterior libial artery 
 passes to front of leg 
 
 Oastrocnemius and soleus 
 
 Knf^fj Flexor longus hallucis 
 
 |U 
 
 B ' : '! 'I 
 
 FIBULA 
 
 Anterior peroneal artery passing to the 
 front between the bones 
 
 Peroneus longus 
 Communicating artery 
 
POSTERIOR TIBIO-FIBULAR REGIOX 229 
 
 FIG. 274. ANASTOMOSES OF TIBIAL ARTERIES. (Morris.) (Also see Fig. 272 ) 
 
 Anterior tibial recurrent V 
 
 Posterior tibia/, giving off muscular and 
 medullary branches 
 
 TIBIA 
 
 Popliteal 
 
 Anterior tibial, giving off posterior tibia', 
 recurrent and superior fibulnr before ( 
 piercing interosseous membrane and 
 anterior tibial afterwards 
 
 FIBULA 
 
 Peroneal 
 
 Anastomosis of internal malleolar of anterior . 
 tibial u'itfi posterior internal malleular 
 
 Internal calcanean 
 Internal and external plantar 
 
 A nterior peroneal 
 
 Posterior peroneal 
 
 External malleolar oj anterior tibial joining 
 posterior peroneal 
 
 ASTRAGALUS 
 External calcanean 
 
 CALCANEUM 
 
 Nerves : 
 
 Posterior tibial (n. tibialis] and branches. (See Fig. 272.) 
 Muscles : 
 
 Popliteus. 
 
 Flexor longus hallucis. 
 
 Flexor longus digitorum. 
 
 Tibialis posticus. 
 
230 
 
 POSTERIOR TIBIO-FIBULAR REGION 
 
 FIG. 275. THE DEEP MUSCLES OF THE BACK OF THE LEG. (Morris.') 
 
 Outer head of gastrocnemius 
 
 Inner head of gastrocuemius 
 
 Biceps 
 
 Tendon of semi-membranosua 
 
 Popliteus 
 
 Peroneua longua 
 
 Flexor longus hallucis 
 
 Tibialis postieus 
 
 Flexor longus digitorum 
 
 Peroneua brevis . 
 
 Tibialia posticus 
 
 Teudo Aohillis 
 
THE FOOT 
 
 231 
 
 PLANTAR REGION OF THE FOOT. 
 
 Remove the skin from the plantar surface of the foot and toes. 
 Note the plantar fascia, position and density, describe it. Cut it 
 near the heel and turn it forward, exposing the first layer of muscles of 
 the sole of the foot and branches of arteries and nerves. 
 Muscles, First layer. 
 
 Flexor brevis digitorum pedis. 
 
 Abductor hallucis. 
 
 Abductor minimi digiti pedis. 
 
 FIG. 276. THE PLANTAR ARTERIES, LEFT FOOT. (Morris.') 
 (From a dissection in the Museum of St. Bartholomew's Hospital.) 
 
 External calcanean artery 
 Cutaneous branch of external plantar 
 
 Abductor minimi digiti 
 
 Anastomotic branch 
 External plantar artery 
 
 First digital to outer side of 
 little toe 
 Lumbrical muscle 
 
 Second digital 
 Third digital 
 Fourth digital 
 
 Anastomosis about inler- 
 
 phalangeal joint 
 Dorsal branch of collateral 
 digital 
 
 Anastomosis of collateral digital 
 arteries around matrix of nail 
 and pulp of toe 
 
 Internal calcanean artery 
 
 Cutaneous branch of internal 
 plantar 
 
 Plantar fascia, cut 
 
 Abductor hallucis 
 
 Internal plantar artery 
 
 Flexor brevis digitorum 
 
 Branch of internal plantar to 
 digital arteries (superficial 
 digital) 
 
 Flexor brevis hallucis 
 
 Princeps hallucis, or fifth plantar 
 digital artery 
 
 Collateral digital branch ofprincept 
 
 hallucis to second toe 
 Collateral digital branch ofprincep* 
 
 hallucis to inner side of great toe 
 Collateral digital branch ofprincept 
 hallucis to outer side of great toe 
 
232 
 
 THE FOOT 
 
 Nerves : 
 
 Internal plantar (n. plantaris medialis) and branches. 
 External plantar (n. plantaris lateral-is} and branches. 
 
 FIG. 277. SUPERFICIAL NERVES IN THE SOLE OF THE FOOT. (Ellis.) (Morris.) 
 
 Abductor hallucis 
 
 Flexor brevis digitorum 
 
 INTERNAL PLANTAR 
 
 NERVE 
 Internal plantar artery 
 
 BRANCH OF INTER- 
 NAL PLANTAR 
 NERVE TO INNER 
 SIDE OF HALLUX 
 
 Abductor minimi diiti 
 
 External plantar artery 
 
 EXTERNAL PLANTAR 
 NERVE 
 
 DIGITAL COLLATERAL 
 BRANCHES OF EX- 
 TERNAL PLANTAR 
 
 DIGITAL COLLATKRA1, 
 BRANCHES OF IN'l AA'- 
 NAL PLANTAR 
 
 Arteries : 
 
 Internal plantar (a. plantaris medialis} and branches. 
 
 External plantar (a. plantaris lateralis] and branches. 
 Use great care and do not cut the digital branches of nerves and arteries. 
 Remove the first layer of muscles and expose: 
 Arteries : 
 Deeper parts of the external and internal plantar and branches. 
 
THE FOOT 
 
 233 
 
 FIG. 278. RIGHT PLANTAR ARTERIES (DEEP). (Morris.) 
 (From a dissection in the Hunterian Museum.) 
 
 Internal calcanean branch 
 of posterior tibial 
 
 Posterior tibial artery 
 
 Abductor hallucis, out 
 
 Internal plantar artery 
 
 Inner head of flexor 
 accessor! UB 
 
 Flexor longua hallucia 
 
 External plantar artery 
 
 Adductor hallucis 
 
 Flexor brevis hallucis 
 
 Princeps hallucis artery 
 
 Flexor tendons, 
 
 cut short 
 
 Collateral digital branch of 
 
 princeps hallucis to inner 
 tide of great toe 
 
 Cutaneous and anastomolic 
 branches of external 
 plantar 
 
 Outer head of flexor 
 accessor! ua 
 
 Abnormal muscular slip 
 Muscular branch 
 Cutaneous branch 
 
 Collateral digital artery to 
 outer side of little toe 
 
 Second digital artery 
 Third digital artery 
 Fourth digital artery 
 
 FIG. 279. (Holden.) 
 i. Internal plantar artery. 2. External plantar artery. 
 
234 
 
 THE FOOT 
 
 Nerves : 
 
 Deeper parts of internal and external plantar and branches. 
 
 FIG. 280. MUSCLES, VESSELS, AND NERVES OF THE SOLE OF THE RIGHT FOOT, AFTER 
 REFLECTION OF THE FLEXOR BREVIS DIGITORUM. (Holden.) 
 
 i. Abductor minimi digiti. 2. Flexor Accessorius. 3. Abductor hallucis. 4. External 
 plantar artery and nerve. 5. Tendon of flexor longus hallucis. 6, 7. Internal plan- 
 tar artery and nerve. 8. Flexor brevis minimi digiti. 9. Lumbricales. 10. Inter- 
 nal plantar nerve, n. Tendons of the flexor brevis digitorum bifurcating for the 
 passage of the tendons of the flexor longus digitorum. 
 
THE FOOT 
 
 2 35 
 
 Muscles below the first layer of muscles : 
 Flexor accessories. 
 Lumbricales. 
 
 Tendon of flexor longus digitorum. 
 Tendon of flexor longus hallucis. 
 Flexor brevis hallucis. 
 Flexor brevis minimi digiti. 
 Adductor hallucis. 
 Transversus pedis. 
 Plantar interossei. 
 
 FIG. 281. SECOND LAYER OF THE MUSCLES OF THE SOLE. (Morris.*) 
 
 Jrigin of abductor minimi digiti 
 
 Part of abductor minimi digiti 
 
 Flexor brevis minimi digit 
 
 Abductor minimi digiti 
 Lumbrical's 
 
 Tendon of flexor brevis 
 
 digitorum 
 
 Tendon of flexor brevis digitorum 
 
 Flexor brevi: digitorum 
 
 Abductor hallueis 
 
 Accessorius 
 
 Flexor longus digitorum 
 
 Plexor longus hallucis 
 Flexor brevis hallucis 
 
 Adductor hallucis 
 Abductor hallucis 
 
2 3 6 
 
 THE FOOT 
 
 FIG. 282. VIEW OF THE THIRD LAYER OF MUSCLES OF THE FOOT. (Holden.) 
 a. Abductor hallucis. b. Flexor brevis digitorum. c. Abductor minimi digiti. d. Ten- 
 don of peroneus longus. e, n. Flexor_longus hallucis. /. Tendon of flexor longus 
 
 digitorum. . Flexor accessorius. 
 lucis. k. Flexor brevis hallucis. /. 
 posticus. 
 
 Flexor brevis minimi digiti. i. Adductor hal- 
 Interossei. m. Transversalis pedis. o. Tibialis 
 
 a 
 
THE FOOT 
 
 2 37 
 
 Examine the relations of the structures behind the inner malleolus 
 and above the ankle-joint. 
 
 FIG. 285. RELATIONS OF PARTS BEHIND THE INNER MALLEOLUS. (Heath.) (Morris.} 
 
 /Tendo Aehillis 
 
 Tibialis postieus 
 
 Tibialis 
 
 Tibialis anticus 
 
 postieus 
 
 Flexor longus digitortun 
 
 Interior tibia! artery 
 POSTERIOR TIBJUL A'E VE 
 
 Flexor longus digitomm 
 
 FIG. 284. TRANSVERSE SECTION THROUGH THE LOWER THIRD OF THE LEFT LEG, 
 
 IMMEDIATELY ABOVE THE ANKLE-JOINT. (Braune.) ( 
 
 Extensor longus digitorum 
 
 Peroneus longus 
 
 Peroneus brevis 
 
 Flexor longus hallucis 
 
 EXTERNAL Cl'TAXEOL'S XESl'E 
 
 Tibialia anticus 
 
 Extensor proprius hallucis 
 
 Tibialis postieus 
 Flexor longua difitoram 
 
 When the dissection of the lower extremity is completed place the parts 
 in their proper position and study the relative position each part has to 
 its surroundings. 
 
238 ANASTOMOSES OF ARTERIES OF LOWER EXTREMITY 
 Examine the anastomoses of the arteries of the lower extremity. 
 
 FIG. 285. To SHOW THE ANASTOMOSES OF THE ARTERIES OF THE LOWER EXTREMITY. 
 (After Smith and Walsham.) (Morris.) 
 
 Deep epigastric artery 
 Ilio-luHtbar artery 
 
 Deep circumflex iliac artery 
 Gluteal artery . 
 
 Common femoral artery 
 
 Profunda artery 
 
 External cimimflex artery 
 
 Crucial anastomosis 
 
 Abdominal aorta 
 Common iliac artery 
 Middle sacral artery 
 Internal iliac artery 
 External iliac artery 
 Obturator artery 
 Sciatic artery 
 Pudic artery 
 
 Internal circumflex artery 
 ' Superficial femoral artery 
 
 ' Perforating branches ofprofunda 
 
 Popliteal artery 
 
 Superior external articular 
 
 Inferior external articular 
 External lateral ligament 
 Tibial recurrent 
 
 Anterior libial artery 
 
 Peroneal artery . 
 
 External malleolar branch 
 Anterior peroneal artery 
 Posterior peroneal artery 
 
 External plantar artery 
 
 Anas/omotica magna 
 
 Terminal branch ofprofunda anastomosing 
 with popliteal 
 
 Superior internal articular 
 
 Internal lateral ligament 
 Inferior internal articular 
 Posterior tibial artery 
 
 . Internal malleolar branch 
 
 Tarsal branch 
 . Dorsalis pedis artery 
 . Metalarsal branch 
 
ARTICULATIONS 
 
 2 39 
 
 DEMONSTRATION XVI. 
 
 ARTICULATIONS AND LIGAMENTS. 
 
 Classes of articulations. 
 Various movements of joints. 
 Articulation of the pelvis. 
 
 Pelvis with the spine. 
 
 Sacro-iliac. 
 
 Sacro-coccygeal. 
 
 Symphysis of pelvis. 
 
 FIG. 286. ANTERIOR VIEW OF THE LIGAMENTS BETWEEN THE SPINE AND PELVIS. 
 
 (Morris.) 
 
 Foramen for last 
 
 lumbar nerve 
 Intervertebral body 
 between last lum- 
 bar and first sacral 
 vertebrae 
 
 Foramen for anterior primary branch of fourth 
 lumbar nerve 
 
 The ilio-lumbar 
 ligament 
 
 The sacro-lumbar 
 ligament 
 
 Superior sacro-iliac 
 ligament 
 
 Anterior sacro-iliac 
 ligament 
 
 Great sacro-sciatie 
 ligament 
 
 Leaser sacro-sciatic 
 ligament 
 
240 
 
 ARTICULATIONS 
 
 FIG. 287. VERTICAL ANTERO-POSTERIOR SECTION OF THE PELVIS. (Morris.) 
 
 Superior aacro-iliac 
 ligament 
 
 Anterior sacro-iliac 
 
 ligament 
 
 Inferior aacro-iliac 
 ligament 
 
 Small sacro-sciatic 
 ligament 
 
 Great sacro-seiatic 
 ligament 
 
 FIG. 288. SACRO-SCIATIC LIGAMENTS. (Posterior view.) (Morris.) 
 
 Posterior or great sacro- 
 sciatio ligament 
 
 Anterior or small sacro- 
 sciatic ligament 
 
 brm process of the 
 ;reat ligament 
 
 nuscle, continuous with 
 o-sciatic ligament 
 
ARTICULATIONS 
 
 241 
 
 FIG. 289. ANTERIOR VIEW OF THE SYMPHYSIS PUBIS (MALE), SHOWING THE DECUSSA- 
 TIOX OF THE FIBRES OF THE ANTERIOR LIGAMENT. (Morris.) 
 
 Superior pubic ligament 
 
 Inferior pubic ligament 
 
 Hip-joint. Ligaments are: 
 
 Capsular. Teres. 
 
 Ilio-femoral. Cotyloid. 
 
 Transverse. 
 
 FIG. 290. ANTERIOR VIEW OF THE CAPSULE OF THE HIP-JOINT. (Morris.') 
 
 Tendon of rectus pulled up 
 
 Tendino-trochanteric band passing 
 between reetus and vastus externuj 
 
 Placed on the weak spot of capsule, 
 which is sometimes perforated to 
 allow the bursa under psoaa to com- 
 municate with joint 
 
 nio-femoral band 
 
 Pectineo-femoral band 
 
242 
 
 ARTICULATIONS 
 
 FIG. 291. HIP-JOINT AFTER DIVIDING THE CAPSULAR LIGAMENT AND DISARTICULATING 
 
 THE FEMUR. (Morris.} 
 
 Ligamentuin teres 
 
 Capsular ligament 
 
 aular ligament, cut 
 
 id ligament 
 
 r ligament 
 
 FIG. 292. PORTIONS OF ISCHIUM AND PUBES, SHOWING THE COTYLOID NOTCH AND THE 
 LIGAMENTUM TERES ATTACHED OUTSIDE THE ACETABULUM. (Morris.) 
 
 Transverse ligament 
 
 Cotyloid ligament 
 
 Transverse ligament 
 
 Ligamentum teres attached 
 to ischium outside the 
 acetabulum 
 
ARTICULATIONS 
 
 243 
 
 FIG. 293. SECTION* THROUGH THE HIP-JOINT, SHOWING THE COTYLOID LIGAMENT, LIGA- 
 MENTUM TERES. AND RETINACULA. (^Morris.) 
 
 Ligamentum terea. 
 The upper line is 
 placed on the fem- 
 oral, the lower on 
 the ischial attach- 
 ment 
 
 Cotyloid cartilage 
 
 Capsular ligament 
 Keflected fibres of 
 capsule (retin- 
 aculai 
 
 Keflected fibres of 
 capsule 
 
244 
 
 ARTICULATIONS 
 
 Knee-joint. 
 
 External ligaments. 
 
 Anterior, or ligament um patellae. 
 
 Posterior. 
 
 Internal lateral. 
 
 Two external lateral. 
 
 Capsular. 
 Interior ligaments. 
 
 Anterior or external crucial. 
 
 Posterior or internal crucial. 
 
 Two semilunar fibre-cartilages. 
 
 Transverse. 
 
 Coronary. 
 
 Ligamentum mucosum. Processes of synovial 
 
 Ligament alaria. membrane. 
 
 FIG. 294. POSTERIOR VIEW OF THE KNEE-JOINT. (Morris.') 
 
 Outer head of gaatrocnemius 
 
 External lateral ligament: 
 anterior portion 
 
 Posterior part of external 
 lateral ligament 
 Tendon of popliteus 
 
 Tendon of biceps Q* 
 
 Posterior superior tibio- 
 fibular ligament 
 
 Tendon of adductor magnua 
 
 Inner head of 
 gastrocuemiiu 
 
 Tendon of emi-membra- 
 nosus with its slip to 
 thicken the posterior liea- 
 ment 
 
 Internal lateral ligament 
 
ARTICULATIONS 
 
 245 
 
 FIG. 295. ANTERIOR VIEW OF THE INTERNAL LIGAMENTS OF THE KNEE-JOINT. (Morris.) 
 
 Aperture leading into the 
 bursa beneath the quadri- 
 ceps extensor 
 
 Attachment of capsular, or 
 anterior ligament to femur 
 
 Fatty tissue within cut edge 
 of ligamentum mucosum 
 
 Anterior crucial ligament 
 
 External semilunar 
 
 flbro-cartilage 
 
 Coronary ligament 
 
 Posterior crucial ligament 
 
 Internal semilunar 
 fibro-cartilage 
 
 Transverse ligament 
 Coronary ligament 
 
246 
 
 ARTICULATIONS 
 
 FIG. 296. STRUCTURES LYING ON THE HEAD OF THE TIBIA. (Right knee.) (Morris.} 
 
 Ligamentum patellae - 
 
 Transverse ligament 
 
 Anterior crucial 
 
 Internal semilunar flbro- 
 cartilage 
 
 Posterior crucial 
 ligament 
 
 Expansion from quadriceps 
 extensor tendon. 
 
 External semilunar flbro- 
 cartilage 
 
 Tendon of biceps 
 External lateral ligament 
 
 FIG. 297. ANTERIOR VIEW OF THE KNEE-JOINT,' SHOWING THE SYNOVIAL LIGAMENTS. 
 
 (Morris.} 
 (Anterior portion of capsule with the extensor tendon thrown downwards.) 
 
 Posterior crucial 
 
 Ligamentum mucosum 
 
 Alar ligament 
 
 Synovial pouch under tendon 
 of quadriceps extensor 
 
 Alar ligament 
 
ARTICULATIONS 
 
 247 
 
 FIG 208 VERTICAL SECTION OF THE KNEE-JOINT IN THE ANTERO-POSTERIOR DIRECTION. 
 
 (Morris.} 
 (The bones are somewhat drawn apart.) 
 
 Fatty tissue 
 Opening in synovial 
 membrane behind 
 crucial ligament 
 leading into inner 
 half of joint 
 Synovial membrane re- 
 flected off crucial liga- 
 ments 
 Cut end of anterior cru - 
 
 cial ligament 
 Posterior crucial liga - 
 
 ment 
 Ligament of Winslow 
 
 Muscular fibres of quadriceps 
 extensor 
 
 Extension of synovial sac of knee 
 upon femur 
 
 Tendon of quadriceps extensor, 
 forming fibrous capsule of joint 
 
 PATELLA 
 Pre-patellar bursa 
 
 CONDYLEOF FEMUR (INNER) 
 Ligamentum mucosum 
 
 Patty tissue bet-ween 
 ligamentum patellae 
 and synovial sac 
 
 Bursa beneath ligamentum 
 patellae 
 
 ISA 
 
248 
 
 ARTICULATIONS 
 
 FIG. 299. CRUCIAL LIGAMENTS IN FLEXION. (Morris.} 
 
 Posterior crucial 
 
 Anterior crucial 
 
 Internal semilunar 
 
 cartilage 
 Transverse ligament 
 
 Slip from external cartilage to femur 
 External aemilunar cartilage 
 
 Coronary ligament 
 
 Antero-superior tibio-flbular ligament 
 
 Tibio-fibular union. Ligaments are: 
 Superior tibio-fibular joint. 
 
 Capsular. 
 
 Anterior tibio-fibular. 
 
 Posterior tibio-fibular. 
 Middle tibio-fibular union. 
 
 Interosseous membrane. 
 Inferior tibio-fibular. 
 
 Anterior inferior tibio-fibular. 
 
 Posterior inferior tibio-fibular. 
 
 Transverse. 
 
 Inferior interosseous. 
 
 Ankle-joint. Ligaments are: 
 Anterior. 
 Posterior. 
 Internal lateral. 
 External lateral. 
 
 COMPLIMENTS 
 OF 
 
 iston's SOB Co., 
 
 
ARTICULATIONS 
 
 249 
 
 FIG. 300. RIGHT ANKLE-JOINT, SHOWING THE LIGAMENTS. (Morris.} 
 (From dissection by Mr. W. Pearson, of the Royal College of Surgeons' Museum.) 
 
 Superficial fibres of anterior / 
 inferior tibio-nbular liga- j 
 ment 
 
 Deep fibres of anterior inferior 
 tibio-nbular ligament 
 
 ^ of ex- 
 Anterior fasciculus I ter 
 Posterior fasciculus flat 
 Middle fasciculus j 
 
 ment 
 
 if ex- , 
 ernal { 
 ateral \ 
 
 "-. I 
 
 Internal lateral ligament 
 
 FIG. 301. INNER VIEW OF THE ANKLE AND THE TARSUS, SHOWING THE GROOVE FOR THE 
 TENDON OF THE TIBIALIS POSTICUS. (Morris.) 
 
 Internal lateral 
 ligament 
 
 Inferior cal- 
 
 caneo-seaphoid 
 
 ligament 
 
 long plantar ligament 
 
250 ARTICULATIONS 
 
 FIG. 302. LIGAMENTS SEEN FROM THE BACK OF THE ANKLE-JOINT. (Morris.) 
 
 Posterior ligament of ankle- 
 joint 
 
 Posterior part of the internal 
 lateral ligament 
 
 The lower part of the inter- 
 osseous membrane 
 
 Transverse lieament of inferior 
 tibio-abular joint 
 
 Posterior fasciculus of external 
 lateral ligament 
 
 Middle fasciculus of external 
 lateral ligament 
 
 FIG. 303. EXTERNAL VIEW OF THE LIGAMENTS OF THE FOOT AND ANKLE. (Morris.) 
 
 Antero-inferior tibio-flbular 
 ligament 
 
 Outer extremity of the 
 iuterosseous ligament 
 
 External calcaneo- 
 scaphoid ligament 
 
 Postero-inferior tibio- 
 flbular ligament 
 
 Fasciculus of posterior 
 ligament of ankle 
 
 Posterior fasciculus ol 
 external lateral ligament 
 
 Internal calcaneo-cuboid Dorsal External Middle fasciculus of external lateral 
 calcaneo- calcaneo- ligament of the ankle 
 
 cuboid astragaloid 
 ligament 
 
ARTICULATIONS 251 
 
 Tarsal joints are: 
 
 Calcaneo-astragaloid. 
 
 Anterior portion of tarsus. 
 
 Medio-tarsal. 
 
 Expose and study the ligaments of the above joints. 
 Clean and study the ligaments of the following joints : 
 Tarso-metatarsal. 
 Intermetatarsal. 
 Metatarso-phalangeal. 
 Interphalangeal. 
 Study the blood- and nerve-supply of each joint. 
 
 FIG. 304. VIEW OF THE FOOT FROM ABOVE, WITH THE ASTRAGALUS REMOVED TO SHOW 
 THE INFERIOR AND EXTERNAL CALCANEO-SCAPHOID LIGAMENTS. (Morris.) 
 
 Dorsal cu bo-scaphoid 
 
 ligament 
 
 Dorsal oalcaneo-cuboid 
 
 ligament 
 
 Internal calcaneo-cuboid 
 
 ligament 
 
 External calcaneo-scaphoid 
 
 ligament 
 
 Cut edge of interosseous 
 ligament 
 
 Inferior calcaneo-seaphoid 
 ligament 
 
 Tendon of tibialia poaticus 
 
2 5 2 
 
 ARTICULATIONS 
 
 FIG. 305. LIGAMENTS OF THE SOLE OF THE LEFT FOOT. (Morris.) 
 
 Long plantar or long inferior 
 caleaneo-cuboid ligament 
 
 Tendon of peroneus longus 
 
 GROOVE FOR FLEXOR LONGUS 
 HALLUCIS 
 
 Inferior calcaneo-seaphoid 
 
 ligament 
 
 Short plantar or short inferior 
 calcaneo-cuboid ligament 
 
 TUBERCLE OF SCAPHOID 
 
 INTERNAL CUNEIFORM 
 
 Insertion of peroneus 
 
 longus 
 
 FIG. 306. SECTION TO SHOW THE SYNOVIAL CAVITIES OF THE FOOT. (Morris.) 
 
 1. Posterior calcaneo-astragaloid. 2. Calcaneo-cuboid. 
 
 4. Tarsal. 5. Cubo-metatarsal. 
 
 3. Anterior calcaneo-astrapalo-scaphoid. 
 6. J'irst metatarso-cuueiforiu. 
 
SECTIOX OF HIP-JOINT 
 
 253 
 
 The examinations of the following figures will help to understand and 
 remember the relative positions of the structures exposed by the sections. 
 
 FIG. 307. TRANSVERSE SECTION OF THE HIP-JOINT AND ITS RELATIONS. (One-third.) 
 
 (Braune.) (Morris.) 
 
 ANTERIOR CRURAL 
 
 jy >r/>-- 
 
 OF ILIA- 
 UfTERNUa 
 
 External iliac artery 
 
 Obturator internus 
 
 Adductor magnus * 
 
 i 
 
 tor externua * 
 
 Obtura 
 
 Adductor longus 
 Adductor brevls 
 
 ^ Gluteus minimus 
 
 Glutens mediua 
 
 Pectineus 
 Ilio-psoas 
 
 FIG. 308. SECTION THROUGH THE HIP AND GLUTEAL REGION. (One-third.) (Morris.) 
 
 Sartoriua 
 
 Reflected tendon 
 
 rectus 
 Psoea and iliacus 
 
 and buraa v 
 AXTERInr. 
 CR L'RAL SER VE^~ 
 Common femoral -^. 
 
 artery 
 Cvmmon femoral vein ^^ 
 
 Pnfunda resself 
 
 Gracilis 'gSJSff- ' 
 Semi-membranoaoa -jffi-jffi- 
 
 Adductor brevis - 
 
 ' - ' - ; 
 
 Semi-tendinosus --. 
 Obturator externus 
 
 Adductor longus 
 Adductor magnus 
 
 Gluteus maiimus 
 Gluteus mediua 
 
 - Gluteus minimus 
 
 Pyriformis 
 GREA T $CIA TIC 
 
 XER VE and sciatic. 
 
 vessels 
 
 Obturator internus 
 Gemelli , 
 
 Biceps 
 Quadratus femoris 
 
254 
 
 SECTION OF THIGH 
 
 FIG. 309. SECTION OF THE RIGHT THIGH AT THE APEX OF SCARPA'S TRIANGLE. 
 
 (Morris.} 
 
 (Heath.) 
 
 Femoral vessels 
 
 Sartorius 
 EXTERNAL CUTANEOUS NERVE 
 
 KectuB femoris 
 ANTERIOR CRURAL 
 
 NER VE 
 External circumflex 
 
 vessels 
 Tensor fasciae femoris 
 
 Vastua internus and 
 crureus 
 
 Vastus externus 
 
 Pro/undo, ressels 
 
 Adductor longus 
 
 SUPERFICIAL PART OF OBTURATOR 
 NERVE 
 
 Biceps femoris 
 
 Gracilis 
 Pectineus 
 Adductor brevjs 
 Itl-.EP PART OF OB- 
 TURATOR NERVE 
 Adductor magnus 
 
 Semi-membrauoauB 
 
 Semi-tendinosua 
 
 SMALL SCI A TIC NER VE 
 GREA T SCIA TIC NER VE 
 
 FIG. 310. SECTION OF THIGH THROUGH UPPER PART OF HUNTER'S CANAL. (W. A.) 
 
 (Morris, ) 
 
 Lymph spaces 
 
 LONG SAPHE- 
 NOUS NERVE 
 
 Femoral artery, with 
 tmall vena comitet 
 ( femoral vein deeper) 
 
 Sheath of vessels 
 
 Long saphenous vein 
 
 Lymph spaces 
 Superficial fascia 
 
 Deep fascia contin- 
 ued over back of 
 thigh as superfi- 
 cial layer of deep 
 fascia 
 
 Middle layer of 
 deep fascia 
 
 Deep layer of deep 
 fascia (muscular 
 aponeurosis) 
 
 GREA T SCIA TIC NER VE Vein 
 
SECTION KNEE-JOINT AND LEG 
 
 255 
 
 FIG. 311. HORIZONTAL SECTION OF THE KNEE-JOINT. (One-half.) (Morris.) 
 
 PATELLA 
 
 Synovial membrane 
 
 Crucial ligaments 
 
 Bicepp 
 
 Outer head of gaatroenemius 
 J'rj/ilHeal artery 
 
 EXTERNAL POPLITEAL SERVE 
 
 Poplilfiil rein 
 IXTERXAL POPLITEAL NERVE 
 
 External savhena rein 
 
 Inner head of gastrocremius 
 
 ' Sartorius 
 
 . Graeilis 
 
 Semi -mem branosus 
 Semi-tendinosua 
 
 FIG. 312. SECTION OF .THE RIGHT LEG IN THE UPPER THIRD. (Heath.) (Morris.) 
 
 Tibialis anti 
 
 Extensor longus digitoru 
 Anterior libial vessels and SER\'E 
 Peroneua longua 
 
 Flexor longus halluci 
 Soleus with fibrous intersectio: 
 
 Gastroenemiu: 
 
 Tibialis posticus 
 Flexor longua digitorum 
 
 Internal saphenous rein 
 
 COMMCSICAXS PEROXEI XER VE ' I 
 
 Peroneal vessel*] Posterior libiul rtssels and SERVE 
 External saphenous vein and SER \ 'E 
 
256 
 
 SECTION OF FOOT 
 
 FIG. 313. VERTICAL SECTION THROUGH THE CUNEIFORM AND CUBOID BONES. (One-half.) 
 
 (Morris.} 
 
 Dorsalis pedis vessels and NER VE 
 Extensor proprius hallucis 
 
 INTERNAL CUNEIFORM MIDDLE CUNEIFORM 
 
 Tibialia antieu 
 
 EXTERNAL CUNEIFORM 
 
 Extensor brevis digitorum 
 Dorsal apoueurosis 
 CUBOID 
 
 Peroneus tertius 
 
 Abductor hallucis 
 Internal plantar vessels and NER VE 
 
 Abductor hallucis 
 Flexor longus hallucis 
 
 Plantar fascia 
 Flexor longus digitorum 
 
 Flexor brevis digitorum 
 
 Abductor minimi digit! 
 
 External plantar vessels and NERVE 
 Tendon of peroneus lougus 
 
 FIG. 314. LONGITUDINAL SECTION OF FOOT. (One-third.) (Braune.) (Morris.) 
 
 Tendo Achillis 
 Posterior tibial vessels 
 ASTRAGALUS and NERVE 
 
 SCAPHOID 
 INTERNAL CUNEIFORM 
 
 Extensor proprius 
 
 Flexor longus hallueis 
 Flexor brevis hallucis 
 
 Lumbricalis 
 
 CALCANEUM 
 
 Abductor minimi diglti 
 External plantar vessels and NERVE 
 
 Accessoriua 
 
 Flexor brevis digitorum Flexor communis digitorum 
 INTERNAL PLANTAR NERVE 
 
1 
 
 I ( 
 
 UNIVERSITY OF CALIFORNIA 
 
 MEDICAL CENTER LIBRARY 
 
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 NQV 8 - 1946 
 NOV 1 8 J946 
 DEC 2 1340 
 
 DEC 2 I94fi 
 
 2m-9,'39(1176s) 
 
Y95 
 1906 
 
 Yubzy 
 
 , S.M. 
 manual and 
 dissection. 
 
 Library ol the 
 University ol California Medical School and Hospitals