The dissector's manual of practical and surgical anatomy

Preface

Instruction in Anatomy is conveyed to the student in two ways ; firstly , by a systematic arrangement which analyses the component structures of the body, and treats of them in physiological order, as Bones, J oints, Muscles, Vessels, Nerves, and Organs ; secondly , by demonstration, which displays the component structures in their relations to each other, and their complicity in the injuries and surgical operations to which the body may be subjected. To this latter branch of the subject the present book is devoted ; while the former is treated of in my other anatomical work, the Anatomist’s Vademecum.

The opportunity of revision afforded by the demand for a second edition of this book I have faithfully taken advantage of, by re-writing such parts as I thought could be improved, and by the addition of twenty-five new illustrations, engraved on wood by Bagg, the greater part from drawings made by myself.

It remains for me further only to hope that the book may prove an useful and favoured companion with those

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PREFACE.

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VI

for whom it was written, maintaining its character of manual by being always at hand when not in the hand of the student, and a not unworthy member of the shelf of reference of those students of an older growth, who having discharged the immediate labours of their education, still find a pleasure in refreshing the knowledge of early and retrospective days.

17. Henrietta Street, Cavendish Square,

January, 1853.

ERRATA.

The Reader is requested to correct immediately the following : — -

Page 49. line 2., for “communicans peronei, cutaneous and articular,” read “ anterior tibial and musculo-cutaneous.”

59., line 17., from bottom, after “ anterior tibial,” insert “ artery.”

97- line 9., for “ vein and artery,” read “vein and nerve.”

134. line 12., for “ abductor,” read “ adductor.”

269., between lines 3 and 4., insert — “The infra-orbital artery would appear from its size to be the proper continuation of the internal maxillary. It runs along the infra-orbital canal with the superior maxillary nerve, sending branches upwards into the orbit ; and downwards, through canals in the bone, to supply the mucous membrane of the antrum, and the teeth of the upper jaw, and emerging on the face at the infra-orbital foramen. A branch sent to the incisor teeth is the anterior dental ; and on the face the infra-orbital inosculates with the facial and transverse facial artery.”

311., between lines 22 and 23., insert — “The choroidean artery is a small branch given off by the internal carotid, near the origin of the posterior communicating : it passes beneath the edge of the middle lobe of the brain to enter the descending cornu of the lateral ventricle, and is distributed to the choroid plexus.”

330., between the last two lines insert the word “ ventricle.”

484., line 10. from bottom, for “ cesophagial,” read “oesophageal.”

Contents

INTRODUCTION ; General Anatomy

Chapter I. Lower Extremity

Surgical observations -

Anterior femoral region -

Internal femoral region -

Vessels of the thigh -

Operations on the femoral artery

Nerves of the thigh -

Femoral hernia -

Gluteal region -

Posterior femoral region -

Popliteal region -

Operation on the popliteal artery

Anatomy of the leg -

Anterior tibial region -

Operations on the anterior tibial artery

Dorsal region of the foot -

Operation on the dorsalis pedis artery

Fibular region -

Posterior tibial region -

Operations on the posterior tibial artery

Operations on the peroneal artery

Sole of the foot -

Actions of muscles of the lower extremity

Page

46 49 51

59 64 66 68 74

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CONTENTS.

Chapter II. Upper Extremity

Page

General anatomy - - - - - -76

Table of muscles - - - - - - 77

Anterior thoracic region - - - -• 81

Mammary gland - - - - - - 82

Operations on the axillary artery ; upper part - - 86

Anatomy of the axilla - - - - - 88

Operations on the axillary artery ; lower part - - 89

Brachial plexus of nerves - - - - - 93

Anatomy of the walls of the thorax - - - 95

Anatomy of the shoulder and scapula - - - 99

Anterior brachial region - - - - - 104

Veins of the bend of the elbow - - - - 105

Accidents from venesection - - - - 106

Operations on the brachial artery - • - - 112

Anatomy of the fore-arm - - - - -115

Operations on the radial artery - - - - 121

Operations on the ulnar artery - - - - 124

Palm of the hand - - - - - -132

CHAPTER HI.

THORAX.

Boundaries of the thorax - - - - -140

Pleurae ; mediastinum - - - - -141

Phrenic nerves - - - - - -143

Great vessels of the hearl^ - - - - - 1 62

Nerves of the thorax - - - - -166

Pneumogastric nerve - - - - -166

Sympathetic nerve - - - - - 168

Intercostal nerves - - - - -170

CEsophagus - - - - - -172

Thoracic aorta - - - - - -173

Azygos veins - - - - - -175

Thoracic duct - - - - - -176

CONTENTS.

Chapter IV. Region Of The Back

Page

Table of muscles -

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Cutaneous nerves of the back

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Nerves and vessels of the back

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Table of origins and insertions of muscles

Chapter V. Head And Neck

Muscles of the head and face

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Vessels and nerves of the cranium

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Parotid gland -

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Vessels and nerves of the face

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Facial nerve -

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Facial artery -

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Anatomy of the orbit -

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Muscles of the neck -

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Thyroid gland -

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Tracheotomy and laryngotomy

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Submax illary gland -

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Sublingual gland -

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Vessels and nerves of the neck

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External jugular vein ; operation

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Posterior triangular space ...

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Cervical nerves -

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Brachial plexus of nerves -

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Subclavian artery and branches

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Operation on the subclavian artery -

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Common carotid artery -

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Operations on the common carotid artery

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Operation on the arteria innominata

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Thoracic duct -

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External carotid artery and branches

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Fifth pair of nerves -

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Internal carotid artery ...

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Facial nerve ; deep portion -

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Eighth pair of nerves -

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Hypoglossal nerve -

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Sympathetic nerve -

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CONTENTS.

Praevertebral region Pharynx Soft palate (Esophagus

Chapter VI. Brain And Spinal Cord

Membranes of the brain -

Vessels of the brain -

Cerebrum - Cerebellum -

Base of the brain - Medulla oblongata -

Fibres of the brain - - - -

Cranial nerves -

Sinuses of the cranium -

Spinal cord -

Chapter VII. Organs Of Sense

Nose and nasal fossae Appendages of the eye Lachrymal apparatus Eye-ball -

Ear -

Mouth and tongue - - -

Larynx -

Skin -

Appendages of the skin

Chapter VIII. Abdomen

Superficial anatomy Muscles of the abdomen Vessels and nerves of the parietes Spermatic cord - Anatomy of hernia Cavity of the abdomen

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CONTENTS.

XI

Regions and position of viscera

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Stomach -

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Intestines -

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Vessels and nerves of the alimentary canal

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Liver -

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Gall bladder

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Pancreas -

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Spleen -

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Supra-renal capsules

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Kidneys -

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Deep vessels and nerves of the abdomen

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Abdominal aorta

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Common and external iliac arteries

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Inferior vena cava

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Sympathetic nerve and plexuses

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Lymphatic vessels and glands

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Receptaculum chyli -

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Deep muscles of the abdomen

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Diaphragm

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Lumbar nerves and plexus -

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Chapter IX. Pelvis And Organs Of Generation

Viscera of the pelvis -

Pelvic fascia

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Muscles of the cavity of the pelvis

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Rectum - > -

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Urinary bladder

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Vesiculse seminales

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Vessels of the pelvis

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Nerves of the pelvis

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Male organs of generation

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Urethra -

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Testes

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Female pelvis

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Female organs of generation -

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External organs

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CONTENTS.

Chapter X. Anatomy Of The Perineum

Page

General considerations - - - - - 539

Internal pudic artery - - - - - 547

Operation of lithotomy - - - - - 552

Female perineum - - - - - -554

Chapter XI. Anatomy Of The Fcetus

Exterior anatomy of the foetus - 556

Foetal circulation - - - - - -557

Foetal thymus gland - - - - -560

Foetal heart - - - - - - 563

Viscera of the abdomen - - - - - 564

Viscera of the pelvis - - - - -565

Foetal testes, their descent - - - - - 566

Chapter XII. Ligaments

General anatomy - - - - - -568

Ligaments of the trunk - - - - 572

Ligaments of the upper extremity - - - - 586

Ligaments of the lower extremity - - - 598

DISSECTOR’S MANUAL.

Introduction

The human body is composed of certain principal structures, which occupy the same relative position to each other, wheresoever they be examined. To obtain a good knowledge of these, is the first duty of the dissector ; the more particularly, that a just conception of their nature and position will greatly facilitate the future progress of his studies. These parts may be thus arranged, in the order of their superposition : —

Integument.

Superficial fascia.

Deep fascia.

Muscles.

fi Arteries.

Vessels, -! Veins.

Lymphatics.

Nerves.

Bones and ligaments,

and cellular tissue, the common connecting medium of the body, by which they are all held together.

The business of dissection, therefore, consists in dividing and turning aside the integument, the superficial fascia, and the deep fascia ; in freeing the muscles from their enveloping cellular tissue ; in separating them, so as as to display the vessels and nerves which lie between them ; and in following the latter to their ultimate ramifications.

In the same manner the performance of an operation with the aid of the knife, as, for example, the tying of an artery, requires the division of the integument, super-

B ficial fascia, and deep fascia, the separation of the muscles, and the finding and securing of the vessel. So again, in amputation, the same structures are to he divided, and in precisely the same order. Thus the student will perceive that one principal object of dissection is the practice of his knife in the division and separation of these parts, so as to enable him to accomplish his end with ease and dexterity. All the operations of dissection should be conducted with the same delicacy that is observed in the treatment of the living subject. The result of such practice must be obvious — the attainment of that confidence and precision in surgical manipulations, which is so necessary to the successful surgeon.

Now, let us inquire into the nature of the structures composing the preceding table.

The integument (integere, to cover in,) is the investing covering of the entire body ; in common parlance, the skin : it consists of the epiderma and derma.

The Epiderma (cuticle, scarfskin) is the thin, horny layer which forms the surface of the integument. It is produced by the derma, upon which it is exactly moulded; is dense and hard on the outer surface, but softer within ; hence it has been described as consisting of two layers, of which the inner and deeper layer is called rete mucosum {rete, because the depressions caused by the papillae of the derma give it the appearance of a net ; mucosum , from its softness). In intimate structure the epiderma is composed of nucleated cells, which are thick in the part called rete mucosum, but flattened into thin scales in the outer layer. These cells are the seat of the pigment of the skin ; which has a deeper hue in the thick and newly-formed cells than in the scales of the horny layer where it is pale and almost lost, from drying. The epiderma is very thick in the palms of the hands and soles of the feet, and, in a state of increased density, constitutes the nails.

The Derma or cutis, or true skin, also presents a superficial and a deep layer. The former constituting the surface of the derma, and, formed into numberless minute papillae, is termed the papillary layer. The latter, being the chief bulk of the derma, is the corium. The papillary layer contains the capillaries and ultimate nervous plexuses of the skin ; the corium is composed of

SUPERFICIAL AND DEEP FASCIA.

fibres and strands of fibrous tissue, which form meshes of extreme fineness in the superficial portion of the layer, and coarser meshes in its deeper part. The meshes of the corium are occupied by fat, and give passage to the vessels and nerves of the papillary layer.

The superficial fascia (fascia, a bandage), placed immediately beneath the tegument over every part of the body, is the medium of connection between that layer and the deeper parts. It consists of fibro-cellular tissue, in which is deposited an abundance of adipose tissue. The fat, being a bad conductor of caloric, serves to retain the warmth of the body ; while it forms at the same time a yielding medium, through which the minute vessels and nerves pass to the papillary layer of the skin, without incurring the risk of obstruction from injury or pressure. By dissection, the superficial fascia may be separated into two layers , between which are found the superficial or cutaneous vessels and nerves ; as the superficial epigastric artery, the saphenous veins, the radial and ulnar veins, the superficial lymphatic vessels, or the cutaneous nerves, and in one instance a muscle, platysma myoides.

The deep fascia is a dense and resisting layer, found chiefly in the extremities and in the neck, where large vessels are carrying onwards the circulating fluids in opposition to the laws of gravity, and where muscles are often acting with prodigious force. In other situations, as over the trunk of the body or upon the head, this layer cannot be said to exist. The deep fascia in the limbs (aponeurotic fascia) is a white fibrous membrane, formed by a close interlacement of glistening fibres, which cross each other in various directions. To the eye it presents a brilliant, nacreous lustre. It is strong and unyielding, enclosing the entire limb, and is prolonged into its substance so as to form distinct sheaths to all the muscles. Upon the inner side of the limb it is thin ; on the outer and less protected side it is dense and thick. It is connected to the prominent points about the limb, as to the pelvis, knee, and ankle, in the lower extremity, and to the clavicle, scapula, elbow, and wrist, in the upper extremity. Its tension is regulated in some situations by muscular action, as by the tensor vaginae femoris and gluteus maximus in the thigh, and by the biceps and palmaris longus in the arm. The deep fascia of the neck dissector’s manual.

(cellulo-fibrous fascia) is thinner and has none of the resplendency of that of the limbs, although composed, like the latter, of white fibrous tissue.

The muscles (musculus, from movere, to move) are the moving organs of the body : they are made up of fibres disposed parallel to each other in a framework of cellular tissue. Towards the extremities of the muscles the fibres cease, and the cellular framework is condensed into a rounded cord, called tendon (tendo, a sinew), by which it is attached to the bones. The more fixed extremity of a muscle is called the “ origin its more moveable end the “ insertion The muscles which enclose cavities, as the abdominal, are broad and extensive ; and their tendon is flattened out into a thin expansion, which is called “aponeurosis” («7 ro, longe ; revpor, nervus ; a nerve widely spread out). This derivation demands some explanation. The ancients named all the white fibres of the body vevpa , or nerves.

The vessels are of three kinds, arteries, veins, and lymphatics. Arteries are cylindrical tubes, composed of three layers, an external, formed of condensed cellular tissue, the cellulo-fibrous coat ; a middle , of fibres analogous to those of organic muscle, the contractile coat ; and a lining membrane, the internal or serous coat. After death they are usually found empty, but preserve their cylindrical form by reason of the thickness of their coats ; hence their name ( ar\p tijoelv, to contain air), from a supposition of the ancients that they were intended to confine the vital spirits. Their office is to convey the vital fluid to every part of the system ; and their ultimate terminations are denominated, from their extreme minuteness, capillaries (capillus, hair).

The veins are found in company with the arteries ; with the exception of the superficial veins. They return the blood from the capillary vessels of the arteries to the right side of the heart, to be then circulated through the lungs. They are larger than the arteries, and after death are found filled with dark-coloured blood. The coats are the same as those of the arteries, but much thinner ; and the internal coat is reflected inwards at various points, so as to form valves. The position of these valves is evidently marked on the exterior of the tube, by the swellings on that part of the vessel which immediately precedes them.

VESSELS. — NERVES. — BONES.

The lymphatics (lympha, water) are small, delicate vessels which accompany the veins, and present many points of resemblance with them. They return a limpid fluid to the venous circulation, and are provided with a number of valves placed at short distances, which, with the corresponding swellings, give them a knotted appearance. Their coats are the same as those of veins and arteries. Near the flexures of the joints they enter small red bodies, called glands, from which they emerge fewer in number, and larger in size. They are too minute to be seen in an ordinary dissection, unless the subject be anasarcous.

The nerves ( vsvpa , nerves) are white flattened cords, composed of fibres, which are connected by one extremity with the cerebro-spinal axis ; and, by the other, are distributed to all the textures of the body, communicating to them sensibility and power of motion. The smallest nerve is made up of a number of tubular fibres, enclosed in a peculiar transparent sheath, called 7ieurilemma ; which, when freshly exposed, presents a continuous zigzag line along its cylinder. The nerves are usually found accompanying the arteries, and, in the extremities, are placed nearer the integument than those vessels, as if to be ready to apprise the neighbouring muscles of the first approach of injury, that they may withdraw the more immediately important organs, the arteries, from its consequences.

The bones are the organs of support to the animal frame. They give firmness and strength to the entire fabric, afford points of connection to the numerous muscles, and bestow general form upon the body. In the limbs they are hollow cylinders, calculated by their form and structure to support weight, and resist violence. In the trunk and head, they are flattened and arched, to protect cavities and provide extensive surfaces of attachment. In many situations they present projections of considerable length that serve as levers ; and smooth surfaces that possess all the mechanical advantages of the pulley. While strength and solidity are the principal objects sought for in the shaft of the bone, the extremities are expanded into broad surfaces, that they may transmit the weight of the body with perfect security to the bones below.

In the formation of a joint a new organ is introduced, the ligament (ligare, to bind). It consists of short strata of fibres passing from bone to bone, in order to connect them together. The different varieties of joint demand a different arrangement of these ligaments. Thus the hinge joint, as the elbow, wrist, knee, ankle, moving in one direction only, has necessarily a squareness of form, and is provided with a ligament to each of its four sides. These are named from their position, anterior, posterior, and lateral. A great proportion of the joints of the body are constructed upon this simple principle. When more extensive movements are demanded, the ball and socket joint is provided, and to accommodate its circular form, the four ligaments are, as it were, united into one, which completely surrounds the ends of the two bones. Hence the capsular ligaments of the hip, the shoulder, and the thumb. And when repose and solidity are the great objects, as in the vertebral column, the pelvis, the carpus, and tarsus, small slips of ligaments are seen passing from bone to bone in every direction in which these straight bands can be arranged, without inconvenience to the general plan.

These then are the structures of which, with the exception of the viscera, the whole animal frame is composed ; and it is incumbent upon the student of anatomy to possess a clear and distinct idea of all these parts, their uses, and natural dependencies, before he can hope to display and examine them in the body with advantage.