ANATOMY 
✓ 
DESCRIPTIVE AND APPLIED 
BY 
HENRY GRAY, F.R.S. 
FELLOW OF THE ROYAL COLLEGE OF SURGEONS; LECTURER ON ANATOMY AT ST. GEORGE'S 
HOSPITAL MEDICAL SCHOOL, LONDON 
A NEW AMERICAN 
FROM THE EIGHTEENTH ENGLISH EDITION 
THOROUGHLY REVISED AND RE-EDITED 
WITH THE BASLE ANATOMICAL NOMENCLATURE 
IN ENGLISH 
BY 
ROBERT HOWDEN, M.A., M.B., C.M. 
PROFESSOR OF ANATOMY IN THE UNIVERSITY OF DURHAM, ENGLAND 
PART V 
SPLANCHNOLOGY SURFACE ANATOMY SURFACE 
MARKING GLOSSARY INDEX 
LEA & FEBIGER 
PHILADELPHIA AND NEW YORK 
1913 Entered according to the Act of Congress, in the year 1913, by 
LEA & FEBIGER 
in the Office of the Librarian of Congress. All rights reserved. SPLANCHNOLOGY. 
TNDER this heading are included the respiratory, digestive, and urogenital 
v organs, and the ductless glands. 
THE RESPIRATORY APPARATUS (APPARATUS RESPIRATORIUS; 
RESPIRATORY SYSTEM). 
The respiratory apparatus consists of the larynx, trachea, bronchi, lungs, and 
pleura. 
THE LARYNX. 
The larynx or organ of voice is placed at the upper part of the air passage. 
It is situated between the trachea and the root of the tongue, at the upper and 
forepart of the neck, where it presents a considerable projection in the middle 
line. It forms the lower part of the anterior wall of the pharynx, and is covered 
behind by the mucous lining of that cavity; on either side of it lie the great vessels 
of the neck. Its vertical extent corresponds to the fourth, fifth, and sixth cervical 
vertebrae, but it is placed somewhat higher in the female and also during childhood. 
Symington found that in infants between six and twelve months of age the tip 
of the epiglottis was a little above the level of the fibrocartilage between the 
odontoid process and body of the axis, and that between infancy and adult life 
the larynx descends for a distance equal to two vertebral bodies and two inter- 
vertebral fibrocartilages. According to Sappey the average measurements of the 
adult larynx are as follows: 
In males. 
In females. 
Length 
44 mm. 
36 mm. 
Transverse diameter 
43 " 
41 " 
Antero-posterior diameter 
. ' .' 36 " 
26 " 
Circumference .... 
136 " 
112 " 
Until puberty the larynx of the male differs little in size from that of the female. In the 
female its increase after puberty is only slight; in the male it undergoes considerable increase; 
all the cartilages are enlarged and the thyroid cartilage becomes prominent in the middle line of 
the neck, while the length of the rima glottidis is nearly doubled. 
The larynx is broad above, where it presents the form of a triangular box flattened 
behind and at the sides, and bounded in front by a prominent vertical ridge. 
Below, it is narrow and cylindrical. It is composed of cartilages, which are con- 
nected together by ligaments and moved by numerous muscles. It is lined by 
mucous membrane continuous above with that of the pharynx and below with 
that of the trachea. 
The Cartilages of the Larynx (cartilagines laryngis) (Fig. 902) are nine in number, 
three single and three paired, as follows: 
Thyroid. 
Cricoid. 
Two Arytenoid. 
Two Corniculate. 
Two Cuneiform. 
Epiglottis. 1080 
SPLANCHNOLOGY 
rl he Thyroid Cartilage (carhlago thyreoidea) is the largest cartilage of the larynx. 
It consists of two laminae the anterior borders of which are fused with each other 
at an acute angle in the middle line of the neck, and form a subcutaneous projec- 
tion named the laryngeal prominence (pomum Adami). This prominence is most 
distinct at its upper part, and is larger in the male than in the female. Immediately 
above it the laminae are separated by a V-shaped notch, the superior thyroid notch. 
The laminae are irregularly quadri- 
lateral in shape, and their posterior 
angles are prolonged into processes 
termed the superior and inferior 
cornua. 
The outer surface of each lamina 
presents an oblique line which runs 
downward and forward from the 
superior thyroid tubercle situated 
near the root of the superior cornu, 
to the inferior thyroid tubercle on 
the lower border. This line gives 
attachment to the Sternothyreoid- 
eus, Thyreohyoideus, and Constric- 
tor pharyngis inferior. 
The inner surface is smooth; above 
and behind, it is slightly concave and 
covered by mucous membrane. In 
front, in the angle formed by the 
junction of the laminae, are attached 
the stem of the epiglottis, the ven- 
tricular and vocal ligaments, the 
Thyreoarytaenoidei, Thyreoepiglot- 
tici and Vocales muscles, and the 
thyroepiglottic ligament. 
The upper border is concave behind 
and convex in front; it gives attach- 
ment to the corresponding half of 
the hyothyroid membrane. 
The lower border is concave be- 
hind, and nearly straight in front, 
the two parts being separated by 
the inferior thyroid tubercle. A 
small part of it in and near the 
middle line is connected to the cri- 
coid cartilage by the middle crico- 
thyroid ligament. 
The posterior border, thick and 
rounded, receives the insertions of 
the Stylopharyngeus and Pharyngopalatinus. It ends above, in the superior cornu, 
and below, in the inferior cornu. The superior cornu is long and narrow, directed 
upward, backward, and medialward, and ends in a conical extremity, which gives 
attachment to the lateral hyothyroid ligament. The inferior cornu is short and 
thick; it is directed downward, with a slight inclination forward and medialward, 
and presents, on the medial side of its tip, a small oval articular facet for articula- 
tion with the side of the cricoid cartilage. 
During infancy the laminae of the thyroid cartilage are joined to each other 
by a narrow, lozenge-shaped strip, named the intrathyroid cartilage. This strip 
Fig. 902.-The cartilages of the larynx. Posterior view. THE LARYNX 
1081 
extends from the upper to the lower border of the cartilage in the middle line, 
and is distinguished from the laminae by being more transparent and more flexible. 
The Cricoid Cartilage {cartilago cricoidea) is smaller, but thicker and stronger 
than the thyroid, and forms the lower and posterior parts of the wall of the larynx. 
It consists of two parts: a posterior quadrate lamina, and a narrow anterior arch, 
one-fourth or one-fifth of the depth of the lamina. 
The lamina {lamina cartilaginis cricoideae; posterior portion) is deep and broad, 
and measures from above downward about 2 to 3 cm.; on its posterior surface, in 
the middle line, is a vertical ridge to the lower part of which are attached the 
longitudinal fibres of the oesophagus; and on either side of this a broad depression 
for the Cricoarytaenoideus posterior. 
The arch {arcus cartilaginis cricoideae; anterior portion) is narrow and convex, 
and measures vertically from 5 to 7 mm.; it affords attachment externally in front 
and at the sides to the Cricothyreiodei, and behind, to part of the Constrictor 
pharyngis inferior. 
On either side, at the junction of the lamina with the arch, is a small round 
articular surface, for articulation with the inferior cornu of the thyroid cartilage. 
The lower border of the cricoid cartilage is horizontal, and connected to the 
highest ring of the trachea by the cricotracheal ligament. 
The upper border runs obliquely upward and backward, owing to the great 
depth of the lamina. It gives attachment, in front, to the middle cricothyroid 
ligament; at the side, to the conus elasticus and the Cricoarytaenoidei laterales; 
behind, it presents, in the middle, a shallow notch, and on either side of this is a 
smooth, oval, convex surface, directed upward and lateralward, for articulation 
with the base of an arytenoid cartilage. 
The inner surface of the cricoid cartilage is smooth, and lined by mucous 
membrane. 
The Arytenoid Cartilages {cartilagines arytenoideae) are two in number, and sit- 
uated at the upper border of the lamina of the cricoid cartilage, at the back of 
the larynx. Each is pyramidal in form, and has three surfaces, a base, and an 
apex. 
The posterior surface is a triangular, smooth, concave, and gives attachment 
to the Arytaenoidei obliquus and transversus. 
The antero-lateral surface is somewhat convex and rough. On it, near the apex 
of the cartilage, is a rounded elevation (colliculus) from which a ridge (crista arcuata) 
curves at first backward and then downward and forward to the vocal process. 
The lower part of this crest intervenes between two depressions or foveae, an 
upper, triangular, and a lower oblong in shape; the latter gives attachment to the 
Vocalis muscle. 
The medial surface is narrow, smooth, and flattened, covered by mucous mem- 
brane, and forms the lateral boundary of the intercartilaginous part of the rima 
glottidis. 
The base of each cartilage is broad, and on it is a concave smooth surface, 
for articulation with the cricoid cartilage. Its lateral angle is short, rounded, 
and prominent; it projects backward and lateralward, and is termed the muscular 
process; it gives insertion to the Cricoarytaenoideus posterior behind, and to the 
Cricoarytaenoideus lateralis in front. Its anterior angle, also prominent, but more 
pointed, projects horizontally forward; it gives attachment to the vocal ligament, 
and is called the vocal process. 
The apex of each cartilage is pointed, curved backward and medialward, and 
surmounted by a small conical, cartilaginous nodule, the corniculate cartilage. 
The Corniculate Cartilages {cartilagines corniculatae; cartilages of Santorini) are 
two small conical nodules consisting of yellow elastic cartilage, which articulate 
with the summits of the arytenoid cartilages and serve to prolong them backward 1082 
SPLANCHNOLOGY 
and medial ward. They are situated in the posterior parts of the aryepiglottic 
folds of mucous membrane, and are sometimes fused with the arytenoid cartilages. 
The Cuneiform Cartilages {cartilagines cuneiformes; cartilages of Wrisberg) are two 
small, elongated pieces of yellow elastic cartilage, placed one on either side, in the 
aryepiglottic fold, where they give rise to small whitish elevations on the surface 
of the mucous membrane, just in front of the arytenoid cartilages. 
The Epiglottis (cartilago epiglottica) is a thin lamella of fibrocartilage of a yel- 
lowish color, shaped like a leaf, and projecting obliquely upward behind the root 
of the tongue, in front of the entrance to the larynx. The free extremity is broad 
and rounded; the attached part or stem is long, narrow, and connected by the 
thyroepiglottic ligament to the angle formed by the two laminae of the thyroid 
cartilage, a short distance below the superior thyroid notch. The lower part of 
its anterior surface is connected to the upper border of the body of the hyoid 
bone by an elastic ligamentous band, the hyoepiglottic ligament. 
The anterior or lingual surface is curved forward, and covered on its upper, free 
part by mucous membrane which is reflected on to the sides and root of the tongue, 
forming a median and two lateral glossoepiglottic folds; the lateral folds are partly 
attached to the wall of the pharynx. The depressions between the epiglottis and 
the root of the tongue, on either side of the median fold, are named the valleculse. 
The lower part of the anterior surface lies behind the hyoid bone, the hyothyroid 
membrane, and upper part of the thyroid cartilage, but is separated from these 
structures by a mass of fatty tissue. 
The posterior or laryngeal surface is smooth, concave from side to side, concavo- 
convex from above downward; its lower part projects backward as an elevation, 
the tubercle or cushion. When the mucous membrane is removed, the surface of 
the cartilage is seen to be indented by a number of small pits, in which mucous 
glands are lodged. To its sides the aryepiglottic folds are attached. 
Structure.-The corniculate and cuneiform cartilages, the epiglottis, and the apices of the 
arytenoids at first consist of hyaline cartilage, but later elastic fibres are deposited in the matrix, 
converting them into yellow fibrocartilage, which shows little tendency to calcification. The 
thyroid, cricoid, and the greater part of the arytenoids consist of hyaline cartilage, and become 
more or less ossified as age advances. Ossification commences about the twenty-fifth year in 
the thyroid cartilage, and somewhat later in the cricoid and arytenoids; by the sixty-fifth year 
these cartilages may be completely converted into bone. 
Ligaments.-The ligaments of the larynx (Figs. 903, 904) are extrinsic, i. e., those 
connecting the thyroid cartilage and epiglottis with the hyoid bone, and the cricoid 
cartilage with the trachea; and intrinsic, those which connect the several cartilages 
of the larynx to each other. 
Extrinsic Ligaments.-The ligaments connecting the thyroid cartilage with the 
hyoid bone are the hyothyroid membrane, and a middle and two lateral hyo- 
thyroid ligaments. 
The Hyothyroid Membrane fmembrana hyothy reoidea; thyrohyoid membrane) is 
a broad, fibro-elastic layer, attached below to the upper border of the thyroid 
cartilage and to the front of its superior cornu, and above to the upper margin of 
the posterior surface of the body and greater cornua of the hyoid bone, thus passing 
behind the posterior surface of the body of the hyoid, and being separated from it 
by a mucous bursa, which facilitates the upward movement of the larynx during 
deglutition. Its middle thicker part is termed the middle hyothyroid ligament 
(lig amentum hyothy reoideum medium; middle thyrohyoid ligament), its lateral thinner 
portions are pierced by the superior laryngeal vessels and the internal branch of 
the superior laryngeal nerve. Its anterior surface is in relation with the Thyreo- 
hyoideus, Sternohyoideus, and Omohyoideus, and with the body of the hyoid 
bone. THE LARYNX 
1083 
The Lateral Hyothyroid Ligament {ligamentum hyothyreoideum laterale; lateral 
thyrohyoid ligament) is a round elastic cord, which forms the posterior border 
of the hyothyroid membrane and passes between the tip of the superior cornu of 
the thyroid cartilage and the extremity of the greater cornu of the hyoid bone. 
A small cartilaginous nodule {cartilago triticea), sometimes bony, is frequently 
found in it. 
The Epiglottis is connected with the hyoid bone by an elastic band, the hyo- 
epiglottic ligament {ligamentum hyoepiglotticuni), which extends from the anterior 
surface of the epiglottis to the upper border of the body of the hyoid bone. The 
glossoepiglottic folds of mucous membrane (page 1082) may also be considered 
as extrinsic ligaments of the epiglottis. 
Fig. 903.-The ligaments of the larynx. Antero-lateral view. 
The Cricotracheal Ligament (ligamentum cricotracheale) connects the cricoid car- 
tilage with the first ring of the trachea. It resembles the fibrous membrane which 
connects the cartilaginous rings of the trachea to each other. 
Intrinsic Ligaments.-Beneath the mucous membrane of the larynx is a broad 
sheet of fibrous tissue containing many elastic fibres, and termed the elastic membrane 
of the larynx. It is subdivided on either side by the interval between the ven- 
tricular and vocal ligaments, the upper portion extends between the arytenoid 
cartilage and the epiglottis and is often poorly defined; the lower part is a well- 
marked membrane forming, with its fellow of the opposite side, the conus elasticus 
which connects the thyroid, cricoid, and arytenoid cartilages to one another. 
In addition the joints between the individual cartilages are provided with ligaments. 
The Conus Elasticus {cricothyroid membrane) is composed mainly of yellow elastic 
tissue. It consists of an anterior and two lateral portions. The anterior part or 
middle cricothyroid ligament {ligamentum cricothyreoideum medium; central parTof 1084 
SPLANCHNOLOGY 
cricothyroid membrane) is thick and strong, narrow above and broad below. It 
connects together the front parts of the contiguous margins of the thyroid and 
cricoid cartilages. It is overlapped on either side by the Cricothyreoideus, but 
between these is subcutaneous; it is crossed horizontally by a small anastomotic 
arterial arch, formed by the junction of the two cricothyroid arteries, branches 
of which pierce it. The lateral portions are thinner and lie close under the mucous 
membrane of the larynx; they extend from the superior border of the cricoid carti- 
lage to the inferior margin of the vocal ligaments, with which they are continuous. 
These ligaments may therefore be regarded as the free borders of the lateral por- 
tions of the conus elasticus, and extend from the vocal processes of the arytenoid 
cartilages to the angle of the thyroid cartilage about midway between its upper 
and lower borders. The lateral portions are lined medially by mucous membrane, 
and covered by the Cricoarytaenoideus lateralis and Thyreoarytaenoideus. 
Fig. 904.-Ligaments of the larynx. Posterior view. 
An articular capsule, strengthened posteriorly by a well-marked fibrous band, 
encloses the articulation of the inferior cornu of the thyroid with the cricoid car- 
tilage on either side. 
Each arytenoid cartilage is connected to the cricoid by a capsule and a posterior 
cricoarytenoid ligament. The capsule (capsula articularis cricoarytenoidea) is thin 
and loose, and is attached to the margins of the articular surfaces. The posterior 
cricoarytenoid ligament (ligamentw/n cricoarytenoidewn posterius) extends from the 
cricoid to the medial and back part of the base of the arytenoid. 
The thyroepiglottic ligament {ligamentum thyreoepiglotticum) is a long, slender, 
elastic cord which connects the stem of the epiglottis with the angle of the thyroid THE LARYNX 
1085 
cartilage, immediately beneath the superior thyroid notch, above the attachment 
of the ventricular ligaments. 
Movements.-The articulation between the inferior cornu of the thyroid cartilage and the 
cricoid cartilage on either side is a diarthrodial one, and permits of rotatory and gliding move- 
ments. The rotatory movement is one in which the cricoid cartilage rotates upon the inferior 
cornua of the thyroid cartilage around an axis passing transversely through both joints. 
The gliding movement consists in a limited shifting of the cricoid on the thyroid in different 
directions. 
The articulation between the arytenoid cartilages and the cricoid is also a diarthrodial one, 
and permits of two varieties of movement: one is a rotation of the arytenoid on a vertical axis, 
whereby the vocal process is moved lateralward or medialward, and the rima glottidis increased 
or diminished; the other is a gliding movement, and allows the arytenoid cartilages to approach 
or recede from each other; from the direction and slope of the articular surfaces lateral gliding 
is accompanied by a forward and downward movement. The two movements of gliding and 
rotation are associated, the medial gliding being connected with medialward rotation, and the 
lateral gliding with lateralward rotation. The posterior cricoarytenoid ligaments limit the 
forward movement of the arytenoid cartilages on the cricoid. 
Interior of the Larynx (Figs. 905, 907).-The cavity of the larynx (cavum 
laryngis) extends from the laryngeal entrance to the lower border of the cricoid 
cartilage where it is continuous with 
that of the trachea. It is divided 
into two parts by the projection of 
the vocal folds, between which is a 
narrow triangular fissure or chink, 
the rima glottidis. The portion of 
the cavity of the larynx above the 
vocal folds is called the vestibule; it 
is wide and triangular in shape, its 
base or anterior wall presenting, 
however, about its centre the back- 
ward projection of the tubercle of 
the epiglottis. It contains the ven- 
tricular folds, and between these 
and the vocal folds are the ventricles 
of the larynx. The portion below the 
vocal folds is at first of an elliptical 
form, but lower down it widens out, 
assumes a circular form, and is con- 
tinuous with the tube of the trachea. 
The entrance of the larynx (Fig. 
906) is a triangular opening, wide 
in front, narrow behind, and sloping 
obliquely downward and backward. 
It is bounded, in front, by the epi- 
glottis; behind, by the apices of the 
arytenoid cartilages, the corniculate 
cartilages, and the interarytenoid notch; and on either side, by a fold of mucous 
membrane, enclosing ligamentous and muscular fibres, stretched between the side 
of the epiglottis and the apex of the arytenoid cartilage; this is the aryepiglottic 
fold, on the posterior part of the margin of which the cuneiform cartilage forms a 
more or less distinct whitish prominence, the cuneiform tubercle. 
The Ventricular Folds (plicae ventriculares; superior or false vocal cords) are two 
thick folds of mucous membrane, each enclosing a narrow band of fibrous tissue, 
the ventricular ligament which is attached in front to the angle of the thyroid car- 
tilage immediately below the attachment of the epiglottis, and behind to the antero- 
Fig. 905.-Sagittal section of the larynx and upper part of the 
trachea. 1086 
SPLANCHNOLOGY 
lateral surface of the arytenoid cartilage, a short distance above the vocal process. 
The lower border of this ligament, enclosed in mucous membrane, forms a free 
crescentic margin, which constitutes the upper boundary of the ventricle of the 
larynx. 
Sulcus terminalis 
Fig. 906.-The entrance to the larynx, viewed from behind. 
The Vocal Folds plicae vacates; inferior or true vocal cords') are concerned in the 
production pf sound, and enclose two strong bands, named the vocal ligaments 
(figamenta vacates; inferior thyroarytenoid). Each ligament consists of a band of 
yellow elastic tissue, attached in front to the angle of the thyroid cartilage, and 
behind to the vocal process of the arytenoid. Its lower border is continuous with 
the thin lateral part of the conus elasticus. Its upper border forms the lower 
boundary of the ventricle of the larynx. Laterally, the Vocalis muscle lies parallel 
with it. It is covered medially by mucous membrane, which is extremely thin and 
closely adherent to its surface. 
The Ventricle of the Larynx (ventriculus laryngis [Morgagnii]-, laryngeal sinus) 
is a fusiform fossa, situated between the ventricular and vocal folds on either side, 
and extending nearly their entire length. The fossa is bounded, above, by the free 
crescentic edge of the ventricular fold; below, by the straight margin of the vocal 
fold; laterally, by the mucous membrane covering the corresponding 'J'hyreoary- 
taenoideus. The anterior part of the ventricle leads up by a narrow opening 
into a cecal pouch of mucous membrane of variable size called the appendix. 
The appendix of the laryngeal ventricle (appendix ventriculi laryngis; laryngeal 
saccule) is a membranous sac, placed between the ventricular fold and the inner 
surface of the thyroid cartilage, occasionally extending as far as its upper border 
or even higher; it is conical in form, and curved slightly backward. On the surface THE LARYNX 
1087 
of its mucous membrane are the openings of sixty or seventy mucous glands, which 
are lodged in the submucous areolar tissue. This sac is enclosed in a fibrous capsule, 
continuous below with the ventricular 
ligament. Its medial surface is covered 
by a few delicate muscular fasciculi, which 
arise from the apex of the arytenoid car- 
tilage and become lost in the aryepiglottic 
fold of mucous membrane; laterally it is 
separated from the thyroid cartilage by 
the Thyreoepiglotticus. These muscles 
compress the sac, and express the secre- 
tion it contains upon the vocal folds to 
lubricate their surfaces. 
The Rima Glottidis (Fig. 908) is the elon- 
gated fissure or chink between the vocal 
folds in front, and the bases and vocal 
processes of the arytenoid cartilages be- 
hind. It is therefore subdivided into a 
larger anterior intramembranous part 
(glottis vocalis), which measures about 
three-fifths of the length of the entire 
aperture, and a posterior intercartilaginous 
part (glottis respiratoria). Posteriorly it is 
limited by the mucous membrane passing 
between the arytenoid cartilages. The 
rima glottidis is the narrowest part of the 
cavity of the larynx, and its level corre- 
sponds with the bases of the arytenoid car- 
tilages. Its length, in the male, is about 23 
mm.; in the female from 17 to 18 mm. 
The width and shape of the rima glottidis vary with the movements of the vocal 
folds and arytenoid cartilages during respiration and phonation. In the condition 
of rest, i. e., when these structures are uninfluenced by muscular action, as in 
Fjg. 907.-Coronal section of larynx and upper part 
of trachea. 
Fig. 908.-Laryngoscopic view of interior of larynx. 
quiet respiration, the intramembranous part is triangular, with its apex in front 
and its base behind-the latter being represented by a line, about 8 mm. long, 
connecting the anterior ends of the vocal processes, while the medial surfaces of 1088 
SPLANCHNOLOGY 
the arytenoids are parallel to each other, and hence the intercartilaginous part 
is rectangular. During extreme adduction of the vocal folds, as in the emission 
of a high note, the intramembranous part is reduced to a linear slit by the ap- 
position of the vocal folds, while the intercartilaginous part is triangular, its apex 
corresponding to the anterior ends of the vocal processes of the arytenoids, which 
are approximated by the medial rotation of the cartilages. Conversely in extreme 
abduction of the vocal folds, as in forced inspiration, the arytenoids and their 
vocal processes are rotated lateralward, and the intercartilaginous part is trian- 
gular in shape but with its apex directed backward. In this condition the entire 
glottis is somewhat lozenge-shaped, the sides of the intramembranous part 
diverging from before backward, those of the intercartilaginous part diverging 
from behind forward-the widest part of the aperture corresponding with the 
attachments of the vocal folds to the vocal processes. 
Muscles.-The muscles of the larynx are extrinsic, passing between the larynx 
and parts around-these have been described in the section on Myology; and 
intrinsic, confined entirely to the larynx. 
The intrinsic muscles are: 
Cricothyreoideus. 
Cricoarytaenoideus posterior. 
Cricoarytaenoideus lateralis. 
Arvtaenoideus. 
Thyroarytaenoideus. 
The Cricothyreoideus (Cricothyroid) (rig. 909), triangular in form, arises from the 
front and lateral part of the cricoid cartilage; its fibres diverge, and are arranged 
in two groups. The lower fibres constitute a 
pars obliqua and slant backward and lateral- 
ward to the anterior border of the inferior 
cornu; the anterior fibres, forming a pars recta, 
run upward, backward, and lateralward to the 
posterior part of the lower border of the lamina 
of the thyroid cartilage. 
The medial borders of the two muscles are 
separated by a triangular interval, occupied 
by the middle cricothyroid ligament. 
The Cricoarytaenoideus posterior (posterior 
cricoarytenoid) (Fig. 910) arises from the broad 
depression on the corresponding half of the pos- 
terior surface of the lamina of the cricoid carti- 
lage; its fibres run upward and lateralward, 
and converge to be inserted into the back of 
the muscular process of the arytenoid carti- 
lage. The uppermost fibres are nearly hori- 
zontal, the middle oblique, and the lowest 
almost vertical. 
The Cricoarytaenoideus lateralis (lateral 
cricoarytenoid) (Fig. 911) is smaller than the 
preceding, and of an oblong form. It arises 
from the upper border of the arch of the 
cricoid cartilage, and, passing obliquely up- 
ward and backward, is inserted into the front of the muscular process of the 
arytenoid cartilage. 
The Arytaenoideus (Fig. 910) is a single muscle, filling up the posterior concave 
surfaces of the arytenoid cartilages. It arises from the posterior surface and lateral 
border of one arytenoid cartilage, and is inserted into the corresponding parts of 
the opposite cartilage. It consists of oblique and transverse parts. The Arytae- 
Fig. 909.-Side view of the larynx, showing 
muscular attachments. THE LARYNX 
1089 
noideus obliquus, the more superficial, forms two fasciculi, which pass from the base 
of one cartilage to the apex of the opposite one, and therefore cross each other 
Fig. 910.-Muscles of larynx. Posterior view. 
Fig. 911.-Muscles of larynx. Side view. Right lamina 
of thyroid cartilage removed. 
like the limbs of the letter X; a few fibres 
are continued around the lateral margin 
of the cartilage, and are prolonged into 
the aryepiglottic fold; they are sometimes 
described as a separate muscle, the Ary- 
epiglotticus. The Arytaenoideus trans- 
versus crosses transversely between the 
two cartilages. 
The Thyreoarytaenoideus (Thyroary- 
tenoid) (Figs. 911, 912) is a broad, thin, 
muscle which lies parallel with and lateral 
to the vocal fold, and supports the wall of 
the ventricle and its appendix. It arises 
in front from the lower half of the angle 
of the thyroid cartilage, and from the 
middle cricothyroid ligament. Its fibres 
pass backward and lateral ward, to be in- 
serted into the base and anterior surface 
of the arytenoid cartilage. The lower and 
deeper fibres of the muscle can be differ- 
entiated as a triangular band which is 
inserted into the vocal process of the arytenoid cartilage, and into the adjacent 
portion of its anterior surface; it is termed the Vocalis, and lies parallel with the 
vocal ligament, to which it is adherent. 
Fig. 912.-Muscles of the larynx, seen from above. 
(Enlarged.) 1090 
SPLANCHNOLOGY 
A considerable number of the fibres of the Thyreoarytaenoideus are prolonged 
into the aryepiglottic fold, where some of them become lost, while others are con- 
tinued to the margin of the epiglottis. They have received a distinctive name, 
Thyreoepiglotticus, and are sometimes described as a separate muscle. 
Actions.-In considering the actions of the muscles of the larynx, they may be conveniently 
divided into two groups, vix.: 1. Those which open and close the glottis. 2. Those which regu- 
late the degree of tension of the vocal folds. 
1. The muscles which open the glottis are the Cricoarytaenoidei posteriores; and those which 
close it are the Cricoarytaenoidei laterales and the Arytaenoideus. 2. The muscles which 
regulate the tension of the vocal folds are the Cricothyreoidei, which elongate and render them 
tense; and the Thyreoarytaenoidei, which relax and shorten them. 
The Cricoarytaenoidei posteriores separate the vocal folds, and, consequently, open the glottis, 
by rotating the arytenoid cartilages outward around a vertical axis passing through the crico- 
arytenoid joints; so that their vocal processes and the vocal folds attached to them become 
widely separated. 
The Cricoarytaenoidei laterales close the glottis by rotating the aryteno,id cartilages inward, 
so as to approximate their vocal processes. 
The Arytaenoideus approximates the arytenoid cartilages, and thus closes the opening of 
the glottis, especially at its back part. 
The Cricothyreodei produce tension and elongation of the vocal folds by drawing up the arch 
of the cricoid cartilage and tilting back the upper border of its lamina; the distance between the 
vocal processes and the angle of the thyroid is thus increased, and the folds are consequently 
elongated. 
The Thyreoarytaenoidei, consisting of two parts having different attachments and different 
directions, are rather complicated as regards their action. Their main use is to draw the aryte- 
noid cartilages forward toward the thyroid, and thus shorten and relax the vocal folds. But, 
owing to the connection of the deeper portion with the vocal fold, this part, if acting separately, 
is supposed to modify its elasticity and tension, while the lateral portion rotates the arytenoid 
cartilage inward, and thus narrows the rima glottidis by bringing the two vocal folds together. 
The manner in which the entrance of the larynx is closed during deglutition is referred to 
on page 1114. 
Mucous Membrane.-The mucous membrane of the larynx is continuous above with that 
lining the mouth and pharynx, and is prolonged through the trachea and bronchi into the lungs. 
It lines the posterior surface and the upper part of the anterior surface of the epiglottis, to which 
it is closely adherent, and forms the aryepiglottic folds which bound the entrance of the larynx. 
It lines the whole of the cavity of the larynx; forms, by its reduplication, the chief part of the 
ventricular .fold, and, from the ventricle, is continued into the ventricular appendix. It is then 
reflected over the vocal ligament, where it is thin, and very intimately adherent; covers the 
inner surface of the conus elasticus and cricoid cartilage; and is ultimately continuous with the 
lining membrane of the trachea. The anterior surface and the upper half of the posterior surface 
of the epiglottis, the upper part of the aryepiglottic folds and the vocal folds are covered by 
stratified squamous epithelium; all the rest of the laryngeal mucous membrane is covered by 
columnar ciliated cells, but patches of stratified squamous epithelium are found in the mucous 
membrane above the glottis. 
Glands.-The mucous membrane of the larynx is furnished with numerous mucous secreting 
glands, the orifices of which are found in nearly every part; they are very plentiful upon the 
epiglottis, being lodged in little pits in its substance; they are also found in large numbers along 
the margin of the aryepiglottic fold, in front of the arytenoid cartilages, where they are termed 
the arytenoid glands. They exist also in large numbers in the ventricular appendages. None 
are found on the free edges of the vocal folds. 
Vessels and Nerves.-The chief arteries of the larynx are the laryngeal branches derived 
from the superior and inferior thyroid. The veins accompany the arteries; those accompanying 
the superior laryngeal artery join the superior thyroid vein which opens into the internal jugular 
vein; while those accompanying the inferior laryngeal artery join the inferior thyroid vein 
which opens into the innominate vein. The lymphatic vessels consist of two sets, superior 
and inferior. The former accompany the superior laryngeal artery and pierce the hyothyroid 
membrane, to end in the glands situated near the bifurcation of the common carotid artery. Of 
the latter, some pass through the middle cricothyroid ligament and open into a gland lying in 
front of that ligament or in front of the upper part of the trachea, while others pass to the deep 
cervical glands and to the glands accompanying the inferior thyroid artery. The nerves are 
derived from the internal and external branches of the superior laryngeal nerve, from the 
recurrent nerve, and from the sympathetic. The internal laryngeal branch is almost entirely 
sensory, but some motor filaments are said to be carried by it to the Arytaenoideus. It enters 
the larynx by piercing the posterior part of the hyothyroid membrane above the superior THE TRACHEA AND BRONCHI 
1091 
laryngeal vessels, and divides into a branch which is distributed to both surfaces of the epi- 
glottis, a second to the aryepiglottic fold, and a third, the largest, which supplies the mucous 
membrane over the back of the larynx and communicates with the recurrent nerve. The external 
laryngeal branch supplies the Cricothyreoideus. The recurrent nerve passes upward beneath 
the lower border of the Constrictor pharyngis inferior immediately behind the cricothyroid joint. 
It supplies all the muscles of the larynx except the Cricothyreoideus, and perhaps a part of the 
Arytaenoideus. The sensory branches of the laryngeal nerves form subepithelial plexuses, from 
which fibres pass to end between the cells covering the mucous membrane. 
Over the posterior surface of the epiglottis, in the aryepiglottic folds, and less regularly in 
some other parts, taste-buds, similar to those in the tongue, are found. 
THE TRACHEA AND BRONCHI (Fig. 913). 
The trachea or windpipe is a cartilaginous and membranous tube, extending 
from the lower part of the larynx, on a level with the sixth cervical vertebra, to the 
Fig. 913.-Front view of cartilages of larynx, trachea, and bronchi. 
upper border of the fifth thoracic vertebra, where it divides into the two bronchi, 
one for each lung. The trachea is nearly but not quite cylindrical, being flattened 
posteriorly; it measures about 11 cm. in length; its diameter, from side to side, 1092 
SPLANCHNOLOGY 
is from 2 to 2.5 cm., being always greater in the male than in the female. In 
the child the trachea is smaller, more deeply placed, and more movable than 
in the adult. 
Relations.-The anterior surface of the trachea is convex, and covered, in the neck, from 
above downward, by the isthmus of the thyroid gland, the inferior thyroid veins, the arteria 
thyroidea ima (when that vessel exists), the Sternothyreoideus and Sternohyoideus muscles, 
the cervical fascia, and, more superficially, by the anastomosing branches between the anterior 
jugular veins; in the thorax, it is covered from before backward by the manubrium sterni, 
the remains of the thymus, the left innominate vein, the aortic arch, the innominate and left 
common carotid arteries, and the deep cardiac plexus. Posteriorly it is in contact with the 
oesophagus. Laterally, in the neck, it is in relation with the common carotid arteries, the right 
and left lobes of the thyroid gland, the inferior thyroid arteries, and the recurrent nerves; in the 
thorax, it lies in the superior mediastinal cavity, and is in relation on the right side with the 
pleura and right vagus, and near the root of the neck with the innominate artery; on its left side 
are the left recurrent nerve, the aortic arch, and the left common carotid and subclavian arteries. 
The right bronchus (bronchus dexter), wider, shorter, and more vertical in direc- 
tion than the left, is about 2.5 cm. long, and enters the right lung nearly opposite 
the fifth thoracic vertebra. The azygos vein arches over it from behind; and the 
right pulmonary artery lies at first below and then in front of it. About 2 cm. 
from its commencement it gives off a branch to the upper lobe of the right lung. 
This is termed the eparterial branch of the bronchus, because it arises above the right 
pulmonary artery. The bronchus now passes below the artery, and is known as the 
hyparterial branch; it divides into two branches for the middle and lower lobes. 
The left bronchus (bronchus sinister) is smaller in calibre but longer than the 
right, being nearly 5 cm. long. It enters the root of the left lung opposite the sixth 
thoracic vertebra. It passes beneath the aortic arch, crosses in front of the oeso- 
phagus, the thoracic duct, and the descending aorta, and has the left pulmonary 
artery lying at first above, and then in front of it. The left bronchus has no 
eparterial branch, and therefore it has been supposed by some that there is no 
upper lobe to the left lung, but that the 
so-called upper lobe corresponds to the 
middle lobe of the right lung. 
The further subdivisions of the bronchi 
will be considered with the anatomy of 
the lung. 
If a transverse section be made across 
the trachea a short distance above its 
point of bifurcation, and a bird's-eye view 
taken of its interior (Fig. 914), the septum 
placed at the bottom of the trachea and 
separating the two bronchi will be seen 
to occupy the left of the median line, and the right bronchus appears to be a more 
direct continuation of the trachea than the left, so that any solid body dropping 
into the trachea would naturally be directed toward the right bronchus. This 
tendency is aided by the larger diameter of the right tube as compared with 
its fellow. This fact serves to explain why a foreign body in the trachea more 
frequently falls into the right bronchus.1 
Structure (Fig. 915) -The trachea and extrapulmonary bronchi are composed of imperfect 
rings of hyaline cartilage, fibrous tissue, muscular fibres, mucous membrane, and glands. 
The cartilages of the trachea vary from sixteen to twenty in number: each forms an imperfect 
ring, which occupies the anterior two-thirds or so of the circumference of the trachea, being 
deficient behind, where the tube is completed by fibrous tissue and unstriped muscular fibres. 
The cartilages are placed horizontally above each other, separated by narrow intervals. They 
measure about 4 mm. in depth and 1 mm. in thickness. Their outer surfaces are flattened in 
a vertical direction, but the internal are convex, the cartilages being thicker in the middle than 
Fig . 914.-Transverse section of the trachea, just 
above its bifurcation, with a bird's-eye view of the 
interior. 
1 Reigel asserts that the entry of a foreign body into the left bronchus is by no means so infrequent as is generally 
supposed. See also Med.-Chi. Trans., Ixxi, 121. THE TRACHEA AND BRONCHI 
1093 
at the margins. Two or more of the cartilages often unite, partially or completely, and they 
are sometimes bifurcated at their extremities. They are highly elastic, but may become calcified 
in advanced life. In the right bronchus the cartilages vary in number from six to eight; in the 
left, from nine to twelve. They are shorter and narrower than those of the trachea, but have 
the same shape and arrangement. The peculiar tracheal cartilages are the first and the last 
(Fig. 913). 
The first cartilage is broader than the rest, and often divided at one end; it is connected by 
the cricotracheal ligament with the lower border of the cricoid cartilage, with which, or with 
the succeeding cartilage, it is sometimes blended. 
The last cartilage is thick and broad in the middle, in consequence of its lower border being 
prolonged into a triangular hook-shaped process, which curves downward and backward between 
the two bronchi. It ends on each side in 
an imperfect ring, which encloses the com- 
mencement of the bronchus. The cartilage 
above the last is somewhat broader than 
the others at its centre. 
The Fibrous Membrane.-The cartilages 
are enclosed in an elastic fibrous mem- 
brane, which consists of two layers; one, 
the thicker, passing over the outer surface 
of the ring, the other over the inner sur- 
face: at the upper and lower margins of 
the cartilages the two layers blend together 
to form a single membrane, which connects 
the rings one with another. They are thus 
invested by the membrane. In the space 
behind, between the ends of the rings, the 
membrane forms a single layer. 
The muscular tissue consists of two 
layers of non-striated muscle, longitudinal 
and transverse. The longitudinal fibers 
are external, and consist of a few scattered 
bundles. The transverse fibres {Trachealis 
muscle) are internal, and form a thin layer 
which extends transversely between the 
ends of the cartilages. 
Mucous Membrane.-The mucous mem- 
brane is continuous above with that of the 
larynx, and below with that of the bron- 
chi. It consists of areolar and lymphoid 
tissue, and presents a well-marked base- 
ment membrane, supporting a stratified 
epithelium, the surface layer of which is 
columnar and ciliated, while the deeper 
layers are composed of oval or rounded 
cells. Beneath the basement membrane 
there is a distinct layer of longitudinal 
elastic fibres with a small amount of intervening areolar tissue. The submucous layer is com- 
posed of a loose mesh-work of connective tissue, containing large bloodvessels, nerves, and 
mucous glands; the ducts of the latter pierce the overlying layers and open on the surface 
(Fig. 915). 
Vessels and Nerves.-The trachea is supplied with blood by the inferior thyroid arteries. 
The veins end in the thyroid venous plexus. The nerves are derived from the vagus and the 
recurrent nerves, and from the sympathetic; they are distributed to the Tracheahs muscles and 
between the epithelial cells. 
Applied Anatomy.--Foreign bodies often find their way into the air passages. These may 
consist of large soft substances, as pieces of meat, which may become lodged in the entrance of 
the larynx, or in the rima glottidis, and cause speedy suffocation unless rapidly got rid of, or unless 
an opening is made into the air passages below, so as to enable the patient to breathe. Smaller 
bodies, frequently of a hard nature, such as cherry or plum stones, small pieces of bone, buttons, 
etc., may find their way through the rima glottidis into the trachea or bronchus, or may become 
lodged in the ventricle of the larynx. The dangers then depend not so much upon the mechanical 
obstruction as upon the spasm of the glottis which they excite from reflex irritation. When 
lodged in the ventricle of the larynx, they may produce very few symptoms, beyond sudden 
loss of voice or alteration in the voice sounds immediately after the inhalation of the foreign 
body. When, however, they are situated in the trachea, they are constantly striking against 
Fig. 915.-Transverse section of trachea. 1094 
SPLANCHNOLOGY 
the vocal folds during expiratory efforts, and produce attacks of dyspnoea from spasm of the 
glottis. When lodged in the bronchus, they usually become fixed there, and, occluding the 
lumen of the tube, cause a loss of the respiratory murmur on the affected side, and may subse- 
quently lead to purulent bronchitis and gangrene of the lung. Foreign bodies in the air passages 
should always be removed as soon as possible. 
Beneath the mucous membrane of the upper part of the air passages there is a considerable 
amount of submucous tissue, which is liable to become much swollen from effusion in inflam- 
matory affections, constituting the condition known as oedema of the glottis. This effusion does 
not extend below the level of the vocal folds, on account of the fact that the mucous membrane 
is closely adherent to these structures without the intervention of any submucous tissue. So 
that, in cases of oedema of the glottis, in which it is necessary to open the air passages to prevent 
suffocation, the operation of laryngotomy is sufficient. Laryngeal or glottidean oedema may 
be secondary to some local inflammatory affection, such as acute septic laryngitis, syphilitic 
laryngeal perichondritis, or to malignant disease. Or the oedema may be passive (non-inflam- 
matory), consequent upon renal or cardiac mischief, angioneurotic oedema; or, in unusually 
susceptible persons, the administration of potassium iodide. 
Chronic laryngitis is an inflammation of the mucous glands of the larynx, which occurs in 
those who speak much in public, and is known as clergyman's sore throat. It is due to the dryness 
induced by the large amount of cold air drawn into the air passages during prolonged speaking, 
which excites increased activity of the mucous glands to keep the parts moist, and this eventually 
terminates in inflammation of these structures. 
Ulceration of the larynx may occur from syphilis, either as a superficial ulceration, or from 
the softening of a gumma; from tuberculous disease (laryngeal phthisis), or from malignant 
disease (epithelioma). 
The air passages may be opened in three different situations: by a vertical incision through 
the centre of the thyroid cartilage {thyrotomy); through the middle cricothyroid ligament (faryn- 
gotomy), or in some part of the trachea (tracheotomy'). 
Thyrotomy is usually performed for the purpose of removing growths from the vocal folds or 
for extracting foreign bodies from the ventricle of the larynx. A median incision is made from 
the upper border of the body of the hyoid bone to the lower border of the cricoid cartilage, and 
is carried through the subcutaneous tissues and deep fascia between the margins of the Sterno- 
hyoidei. An incision is then made in the middle cricothyroid ligament, and one blade of a stout, 
sharp-pointed pair of scissors is introduced beneath the lower border of the thyroid cartilage, 
and this structure is divided from below upward. Great care must be taken to cut exactly in 
the middle line to avoid wounding the vocal folds. If the two halves of the cartilage are now 
drawn apart, a very good view of the interior of the larynx will be obtained. 
Laryngotomy is anatomically a simple operation: it can readily be performed, and should 
be employed in those cases where the air passages require opening in an emergency for the relief 
of some sudden obstruction to respiration. The middle cricothyroid membrane is very super- 
ficial, being covered only in the middle fine by the skin, superficial fascia, and the deep fascia. 
On either side of the middle line it is also covered by the Sternohyoideus and Sternothyreoideus, 
which diverge from each other at theii' upper parts, leaving a slight interval between them. On 
these muscles rest the anterior jugular veins. The only vessel of any importance in connection 
with this operation is the cricothyroid artery, which crosses the middle cricothyroid ligament, 
and may be wounded, but rarely gives rise to any trouble. The operation is performed thus: the 
head being thrown back and steadied by an assistant, the finger is passed over the front of the 
neck, and the cricothyroid depression felt for. A vertical incision is then made through the skin 
in the middle line over this spot, and carried down through the fascia until the middle crico- 
thyroid ligament is exposed. A cross-cut is then made through the ligament close to the upper 
border of the cricoid cartilage, so as to avoid, if possible, the cricothyroid artery, and a laryn- 
gotomy tube inserted. It has been recommended, as a more rapid way of performing the opera- 
tion, to make a transverse instead of a longitudinal cut through the superficial structures, and 
thus to open at once the air passages. It will be seen, however, that in operating in this way 
the anterior jugular veins are in danger of being wounded. 
Tracheotomy may be performed either above or below the isthmus of the thyroid gland, or 
this structure may be divided and the trachea opened behind it. 
From the relations already described, it must be evident that the trachea can be more readily 
opened above than below the isthmus of the thyroid gland. 
Tracheotomy above the isthmus is performed thus: the patient should, if possible, be laid 
on his back on a table in a good light. A pillow is to be placed under the shoulders and the 
head thrown back and steadied by an assistant. The surgeon standing on the right side of his 
patient makes an incision from 4 to 5 cm. long in the median line of the neck from the top of 
the cricoid cartilage. The incision must be made exactly in the middle line so as to avoid the 
anterior jugular veins, and after the superficial structures have been divided, the interval between 
the Sternohyoidei must be found, the raphe divided, and the muscles drawn apart. The lower 
border of the cricoid cartilage must now be felt for, and the upper part of the trachea exposed THE PLEURAE 
1095 
from this point downward in the middle line. Bose has recommended that the layer of fascia 
in front of the' trachea should be divided transversely at the level of the lower border of the 
cricoid cartilage, and, having been seized with a pair of forceps, pressed downward with the 
handle of the scalpel. By this means the isthmus of the thyroid gland is depressed and is saved 
from all danger of being wounded, and the trachea cleanly exposed. The trachea is now trans- 
fixed with a sharp hook and drawn forward in order to steady it, and is then opened by inserting 
the knife into it and dividing the upper two or three rings by cutting upward. If the trachea is 
to be opened beneath the isthmus, the incision must be made from a little below the cricoid 
cartilage to the top of the sternum. 
A portion of the larynx or the whole of it may be removed for malignant disease. The results 
which have been obtained from the removal of the whole of it have not been very satisfactory, 
and the cases in which the operation is justifiable are very few. It may be removed by a median 
incision through the soft parts, freeing the cartilages from the muscles and other structures 
in front, separating the larynx from the trachea below, and dissecting off the deeper structure 
from below upward. 
THE PLEURA. 
Each lung is invested by an exceedingly delicate serous membrane, the pleura, 
which is arranged in the form of a closed invaginated sac. A portion of the serous 
membrane covers the surface of the lung and dips into the fissures between its 
lobes; it is called the pulmonary pleura. The rest of the membrane lines the inner 
surface of the chest wall, covers the Diaphragma, and is reflected over the structures 
occupying the middle of the thorax; this portion is termed the parietal pleura. The 
two layers are continuous with one another around and below the root of the lung; 
in health they are in actual contact with one another, but the potential space 
between them is known as the pleural cavity. When the lung collapses or when 
air or fluid collects between the two layers the cavity becomes apparent. The right 
and left pleural sacs are entirely separate from one another; between them are all 
the thoracic viscera except the lungs, and they only touch each other for a short 
distance in front; opposite the second and third pieces of the sternum the interval 
between the two sacs is termed the mediastinal cavity. 
Different portions of the parietal pleura have received special names which 
indicate their position: thus, that portion which lines the inner surfaces of the 
ribs and Intercostales is the costal pleura; that clothing the convex surface of the 
Diaphragma is the diaphragmatic pleura; that which rises into the neck, over the 
summit of the lung, is the cupula of the pleura (cervical pleura); and that which is 
applied to the other thoracic viscera is the mediastinal pleura. 
Reflections of the Pleura (Figs. 916, 917).-Commencing at the sternum, the 
pleura passes lateralward, lines the inner surfaces of the costal cartilages, ribs, 
and Intercostales, and at the back part of the thorax passes over the sympathetic 
trunk and its branches, and is reflected upon the sides of the bodies of the vertebrae, 
where it is separated by a narrow interval, the posterior mediastinal cavity, from 
the opposite pleura. From the vertebral column the pleura passes to the side of the 
pericardium, which it covers to a slight extent; it then covers the back part of the 
root of the lung, from the lower border of which a triangular sheet descends verti- 
cally toward the Diaphragma. This sheet is the posterior layer of a wide fold, 
known as the pulmonary ligament. From the back of the lung root, the pleura 
may be traced over the costal surface of the lung, the apex and base, and also over 
the sides of the fissures between the lobes, on to its mediastinal surface and the front 
part of its root. It is continued from the lower margin of the root as the anterior 
layer of the pulmonary ligament, and from this it is reflected on to the pericardium 
(pericardial pleura), and from it to the back of the sternum. Above the level of 
the root of the lung, however, the mediastinal pleura passes uninterruptedly from 
the vertebral column to the sternum over the structures in the superior media- 
stinal cavity. Below, it covers the upper surface of the Diaphragma and extends, 
in front, as low as the costal cartilage of the seventh rib; at the side of the chest, 1096 
SPLANCHNOLOGY 
to the lower border of the tenth rib on the left side and to the upper border of the 
same rib on the right side; and behind, it reaches as low as the twelfth rib, and some- 
times even to the transverse process of the first lumbar vertebra. Above, its cupula 
projects through the superior opening of the thorax into the neck, extending from 
2.5 to 5 cm. above the sternal end of the first rib; this portion of the sac is strength- 
ened by a dome-like expansion of fascia (Sibson's fascia), attached in front to the 
inner border of the first rib, and behind to the anterior border of the transverse 
process of the seventh cervical vertebra. This is covered and strengthened by a 
few spreading muscular fibres derived from the Scaleni. 
Fig. 916.-Front view of thorax, showing the relations of the pleurae and lungs to the chest wall. 
Pleura in blue; lungs in purple. 
In the front of the chest, where the parietal pleura is reflected backward to the 
pericardium, the two pleural sacs are in contact for a short distance. At the upper 
part of the chest, behind the manubrium, they are separated by an angular interval; 
the line of reflection being represented by a line drawn from the sternoclavicular 
articulation to the mid-point of the junction of the manubrium with the body 
of the sternum. From this point the two pleurae descend in close contact to the 
level of the fourth costal cartilages, and the line of reflection on the right side is 
continued downward in nearly a straight line to the xiphoid process, and then 
turns lateralward, while on the left side the line of reflection diverges lateralward 
and is continued downward, close to the left border of the sternum, as far as the 
sixth costal cartilage. The inferior limit of the pleura is on a considerably lower 
level than the corresponding limit of the lung, but does not extend to the attach- 
ment of the Diaphragma, so that below the line of reflection of the pleura from the 
chest wall on to the Diaphragma the latter is in direct contact with the rib cartilages THE PLEURA! 
1097 
and the Intercostales interni. Moreover, in ordinary inspiration the thin inferior 
margin of the lung does not extend as low as the line of the pleural reflection, with 
the result that the costal and diaphragmatic pleurae are here in contact, the inter- 
vening narrow slit being termed the phrenicocostal sinus. A similar condition 
exists behind the sternum and rib 
cartilages, where the anterior thin 
margin of the lung falls short of 
the line of pleural reflection, and 
where the slit-like cavity between 
the two layers of pleura forms 
what is called the costomediastinal 
sinus. 
The line along which the right 
pleura is reflected from the chest- 
wall to the Diaphragma starts in 
front, immediately below the 
seventh sternocostal joint, and 
runs downward and backward 
behind the seventh costal carti- 
lage so as to cross the tenth rib in 
the mid-axillary line, from which 
it is prolonged to the spinous pro- 
cess of the twelfth thoracic verte- 
bra. The reflection of the left 
pleura follows at first the ascending 
part of the sixth costal cartilage, 
and in the rest of its course is 
slightly lower than that of the right 
side. 
The free surface of the pleura is 
smooth, polished, and moistened 
by a serous fluid; its attached sur- 
face is intimately adherent to the 
lung, and to the pulmonary vessels 
as they emerge from the pericar- 
dium; it is also adherent to the upper surface of the Diaphragma: throughout the 
rest of its extent it is easily separable from the adjacent parts. 
The right pleural sac is shorter, wider, and reaches higher in the neck than the 
left. 
Pulmonary Ligament (ligamentum pulmonale; ligamentum latum pulmonis').- 
From the above description it will be seen that the root of the lung is covered in 
front, above, and behind by pleura, and that at its lower border the investing 
layers come into contact. Here they form a sort of mesenteric fold, the pulmonary 
ligament, which extends between the lower part of the mediastinal surface of the 
lung and the pericardium. Just above the Diaphragma the ligament ends in a free 
falciform border. It serves to retain the lower part of the lung in position. 
Structure of Pleura.-Like other serous membranes, the pleura is covered by a single layer 
of flattened, nucleated cells, united at their edges by cement substance. These cells are modified 
connective-tissue corpuscles, and rest on a basement membrane. Beneath the basement mem- 
brane there are net-works of yellow elastic and white fibres, imbedded in ground substance which 
also contains connective-tissue cells. Bloodvessels, lymphatics, and nerves are distributed in 
the substance of the pleura, and the lymphatics communicate with the pleural cavity by means 
of stomata or openings between the cells of the superficial layer. 
Vessels and Nerves.-The arteries of the pleura are derived from the intercostal, internal 
mammary, musculophrenic, thymic, pericardiac, and bronchial vessels. The veins correspond 
Fig. 917.-Lateral view of thorax, showing the relations of 
the pleurae and lungs to the chest wall. Pleura in blue; lungs in 
purple. 1098 
SPLANCHNOLOGY 
to the arteries. The lymphatics are described on page 800. The nerves are derived from the 
phrenic and sympathetic (Luschka). Kolliker states that nerves accompany the ramifications 
of the bronchial arteries in the pulmonary pleura. 
Applied Anatomy.-Acute inflammation of the pleura or pleurisy may be either dry or wet, 
and, if wet, either serous or purulent. Dry pleurisy is common in pneumonia, and is often an 
early manifestation of tuberculosis. It gives rise to much pain, and to friction sounds due to 
the scraping to and fro over one another of the inflamed and roughened parietal and pulmonary 
pleurae. Wet pleurisy occurs if the inflammation causes the effusion of serum into the pleural 
cavity. The two pleural layers are now separated by the fluid effusion, so the friction sounds 
are no longer produced. Room is found for the fluid by shrinkage of the supernatant lung due 
to the retraction of its elastic tissue, and later, when the quantity of serum exceeds about 1.5 
litre, by shifting over of the heart and unaffected lung toward the sound side. This shifting 
may be so extensive that the apex beat of the heart comes to lie under the right mammary papilla. 
Any pleural effusion that is large enough to embarrass respiration seriously, or has remained 
unabsorbed for two or three weeks, should be removed by tapping (paracentesis thoracis). The 
trocar is pushed through the chest wall into the fluid, in the sixth or seventh intercostal space 
in the mid-axillary line, or in the eighth or ninth space just outside the angle of the scapula. 
Aspiration is then performed, and as much fluid as possible drawn off; it must be stopped, how- 
ever, if the patient shows signs of collapse, or if fits of coughing occur and threaten to wound 
the expanding lung against the sharp end of the trocar. Non-inflammatory or passive effusion 
into the pleura, called hydrothorax, is often seen in the later stages of chronic renal or cardiac 
disease, and demands treatment on lines similar to the above. 
Purulent pleural effusion, or empyema, often occurs after such diseases as pneumonia or measles. 
This condition requires drainage of the cavity, which usually necessitates excision of a portion 
of the rib. An incision is made down to the seventh or eighth rib in the mid- or posterior axillary 
line and the periosteum is incised, and separated from the shaft of the rib, carrying with it the 
structures in the costal groove. With bone-cutting forceps about 4 or 5 cm. of the rib are sepa- 
rated and removed, and the underlying pleura is incised. The pus having been evacuated, a large 
drainage-tube is inserted into the cavity. The pleura should never be irrigated, as sudden death 
has followed this proceeding, and great care should be taken to prevent the tube from slipping 
into the cavity, an occurrence which is far from uncommon. 
Pneumothorax, or the presence of gas in the pleural cavity, is a common terminal event in 
tuberculosis of the lungs; less often it is due to trauma-rupture of the lung, for example, when 
the chest is crushed, or tearing of the lung tissue by the sharp projecting end of a broken rib. 
Air escapes from the lung into the pleural cavity; the elastic tissue of the lung at once contracts, 
and finally that organ shrinks away to a dark rounded mass the size of a fist, lying close against 
the vertebral column. The symptoms of pneumothorax are often very severe; cyanosis, intense 
dyspnoea, great pain on the affected side, and cardiac failure. Their severity is increased by 
the fact that the bloodvessels of the collapsed lung offer less resistance to the circulation of 
the blood than do those of the other lung. Not only, therefore, does the sound lung suddenly 
have to take over the work-the aeration of the blood-normally performed by both lungs, but 
it has to do so at the moment when the circulation of blood through it is partially short-circuited 
by the collapsed lung, If the patient survives for a few days, empyema often complicates the 
pneumothorax, setting up the condition called pyopneumothorax. 
In operations upon the kidney, it must be borne in mind that the pleura usually extends 
below the level of the medial portion of the last rib, and may therefore be opened in these opera- 
tions, especially when the last rib is removed in order to give more room. 
THE MEDIASTINAL CAVITY (INTERPLEURAL SPACE). 
The mediastinal cavity is the space between the right and left pleurae in and near 
the median sagittal plane of the chest. It extends from the sternum in front 
to the vertebral column behind, and contains all the thoracic viscera excepting 
the lungs. The cavity may be divided for purposes of description into two parts: 
an upper portion, above the upper level of the pericardium, which is named the 
superior mediastinal cavity; and a lower portion, below the upper level of the 
pericardium. This lower portion is again subdivided into three parts, viz., that 
in front of the pericardium, the anterior mediastinal cavity; that containing the 
pericardium and its contents, the middle mediastinal cavity; and that behind 
the pericardium, the posterior mediastinal cavity. 
The superior mediastinal cavity (Fig. 918) is that portion of the interpleural 
space which lies between the manubrium sterni in front, and the upper thoracic THE MEDIASTINAL CAVITY 
1099 
vertebrae behind. It is bounded below by a slightly oblique plane passing backward 
from the junction of the manubrium and body of the sternum to the lower part 
Fig. 918.-Transverse section through the upper margin of the second thoracic vertebra. (Braune.) 
Fig. 919.-A transverse section of the thorax, showing the contents of the middle and posterior mediastinal cavities. 1100 
SPLANCHNOLOGY 
of the body of the fourth thoracic vertebra, and laterally by the pleurae. It con- 
tains the origins of the Sternohyoidei and Sternothyreoidei and the lower ends of 
the Longi colli; the aortic arch; the innominate artery and the thoracic portions 
of the left common carotid and the left subclavian arteries; the innominate veins 
and the upper half of the superior vena cava; the left highest intercostal vein; the 
vagus, cardiac, phrenic, and left recurrent nerves; the trachea, oesophagus, and 
thoracic duct; the remains of the thymus, and some lymph glands. 
Fig. 920.-The middle and posterior mediastina. Left side. 
The anterior mediastinal cavity (Fig. 919) exists only on the left side where 
the left pleura diverges from the mid-sternal line. It is bounded in front by the 
sternum, laterally by the pleurae, and behind by the pericardium. It is narrow, 
above, but widens out a little below. Its anterior wall is formed by the left Trans- 
versus thoracis and the fifth, sixth, and seventh left costal cartilages. It contains THE LUNGS 
1101 
a quantity of loose areolar tissue, some lymphatic vessels which ascend from the 
convex surface of the liver, two or three anterior mediastinal lymph glands, and 
the small mediastinal branches of the internal mammary artery. 
The middle mediastinal cavity (Fig. 919) is the broadest part of the interpleural 
space. It contains the heart enclosed in the pericardium, the ascending aorta, 
the lower half of the superior vena cava with the azygos vein opening into it, 
the bifurcation of the trachea and the two bronchi, the pulmonary artery dividing 
into its two branches, the right and left pulmonary veins, the phrenic nerves, 
and some bronchial lymph glands. 
The posterior mediastinal cavity (Figs. 919, 920) is an irregular triangular 
space running parallel with the vertebral column; it is bounded in front by the 
pericardium above, and by the posterior surface of the Diaphragma below, behind 
by the vertebral column from the lower border of the fourth to the twelfth thoracic 
vertebra, and on either side by the mediastinal pleura. It contains the thoracic 
part of the descending aorta, the azygos and the two hemiazygos veins, the vagus 
and splanchnic nerves, the oesophagus, the thoracic duct, and some lymph glands. 
Applied Anatomy.-Primary tumors of the mediastinum are usually lymphoma or lympho- 
sarcoma arising from the thymus or from the bronchial or posterior mediastinal lymph glands 
sarcomata, dermoid cysts, and embryomata occur more rarely. These tumors give rise to pain, 
deformity of the chest, and symptoms of pressure on the various nerves, bloodvessels, air passages, 
lymphatics, and on the oesophagus, as these various structures pass through the thorax. They 
may produce physical signs very much like those of an aortic aneurism, so that diagnosis between 
the two is often difficult. The prognosis is bad, the condition usually proving fatal within a few 
months or a year of the onset of the symptoms. 
Inflammation of the mediastinum due to wounds, or to the spread of inflammation from adja- 
cent parts, e. g., the oesophagus, the pericardium, is sometimes acute, leading to abscess forma- 
tion. A more chronic form associated with adhesions and inflammation of the pericardium- 
the so-called chronic adhesive mediastinopericarditis-gives rise to obscure symptoms suggesting 
gradual heart-failure, and leads to death slowly but surely. • 
THE LUNGS (PULMONES). 
The lungs are the essential organs of respiration; they are two in number, placed 
one on either side within the thorax, and separated from each other by the heart 
and other contents of the mediastinal cavity (Fig. 921). The substance of the lung 
is of a light, porous, spongy texture; it floats in water, and crepitates when handled, 
owing to the presence of air in the alveoli; it is also highly elastic; hence the retracted 
state of these organs when they are removed from the closed cavity of the thorax. 
The surface is smooth, shining, and marked out into numerous polyhedral areas, 
indicating the lobules of the organ: each of these areas is crossed by numerous 
lighter lines. 
At birth the lungs are pinkish white in color; in adult life the color is a dark 
slaty gray, mottled in patches; and as age advances, this mottling assumes a black 
color. The coloring matter consists of granules of a carbonaceous substance 
deposited in the areolar tissue near the surface of the organ. It increases in quan- 
tity as age advances, and is more abundant in males than in females. As a rule, 
the posterior border of the lung is darker than the anterior. 
The right lung usually weighs about 625 gm., the left 567 gm., but much varia- 
tion is met with according to the amount of blood or serous fluid they may contain. 
The lungs are heavier in the male than in the female, their proportion to the body 
being, in the former, as 1 to 37, in the latter as 1 to 43. 
Each lung is conical in shape, and presents for examination an apex, a base, 
three borders, and two surfaces. 
The apex (apex pulmonis) is rounded, and extends into the root of the neck, 
reaching from 2.5 to 4 cm. above the level of the sternal end of the first rib. A 1102 
SPLANCHNOLOGY 
sulcus produced by the subclavian artery as it curves in front of the pleura runs 
upward and lateralward immediately below the apex. 
The base (basis pulmonis) is broad, concave, and rests upon the convex surface 
of the Diaphragma, which separates the right lung from the right lobe of the liver, 
and the left lung from the left lobe of the liver, the stomach, and the spleen. Since 
the Diaphragma extends higher on the right than on the left side, the concavity 
on the base of the right lung is deeper than that on the left. Laterally and behind, 
the base is bounded by a thin, sharp margin which projects for some distance 
into the phrenicocostal sinus of the pleura, between the lower ribs and the costal 
attachment of the Diaphragma. The base of the lung descends during inspiration 
and ascends during expiration. 
Fig. 921.-Front view of heart and lungs. 
Surfaces.--The costal surface (facies costalis; external or thoracic surface') is 
smooth, convex, of considerable extent, and corresponds to the form of the cavity 
of the chest, being deeper behind than in front. It is in contact with the costal 
pleura, and presents, in specimens which have been hardened in situ, slight grooves 
corresponding with the overlying ribs. 
The mediastinal surface (facies mediastinalis; inner surface) is in contact with 
the mediastinal pleura. It presents a deep concavity, the cardiac impression, 
which accommodates the pericardium; this is larger and deeper on the left than 
on the right lung, on account of the heart projecting farther to the left than to the 
right side of the median plane. Above and behind this concavity is a triangular 
depression named the hilus, where the structures which form the root of the lung 
enter and leave the viscus. These structures are invested by pleura, which, below THE LUNGS 
1103 
the hilus and behind the pericardial impression, forms the pulmonary ligament. 
On the right lung (Fig. 922), immediately above the hilus, is an arched furrow 
which accommodates the azygos vein; while running upward, and then arching 
lateralward some little distance below the apex, is a wide groove for the superior 
vena cava and right innominate vein; behind this, and nearer the apex, is a furrow 
for the innominate artery. Behind the hilus and the attachment of the pulmonary 
ligament is a vertical groove for the oesophagus; this groove becomes less distinct 
below, owing to the inclination of the lower part of the oesophagus to the left of 
the middle line. In front and to the right of the lower part of the oesophageal 
groove is a deep concavity for the extrapericardiac portion of the thoracic part 
of the inferior vena cava. On the left lung (Fig. 923), immediately above the hilus, 
is a well-marked curved furrow produced by the aortic arch, and running upward 
Fig. 922.-Mediastinal surface of right lung. 
from this toward the apex is a groove accommodating the left subclavian artery; 
a slight impression in front of the latter and close to the margin of the lung lodges 
the left innominate vein. Behind the hilus and pulmonary ligament is a vertical 
furrow produced by the descending aorta, and in front of this, near the base of 
the lung, the lower part of the oesophagus causes a shallow impression. 
Borders.-The inferior border (margo inferior) is thin and sharp where it sepa- 
rates the base from the costal surface and extends into the phrenicocostal sinus; 
medially where it divides the base from the mediastinal surface it is blunt and 
rounded. 
The posterior border {margo posterior) is broad and rounded, and is received into 
the deep concavity on either side of the vertebral column. It is much longer 
than the anterior border, and projects, below, into the phrenicocostal sinus. 1104 
SPLANCHNOLOGY 
The anterior border {margo anterior) is thin and sharp, and overlaps the front 
of the pericardium. The anterior border of the right lung is almost vertical, and 
projects into the costomediastinal sinus; that of the left presents, below, an angular 
notch, the cardiac notch, in which the pericardium is exposed. Opposite this 
notch the anterior margin of the left lung is situated some little distance lateral 
to the line of reflection of the corresponding part of the pleura. 
Fig. 923.-Mediastinal surface of left lung. 
Fissures and Lobes of the Lungs.-The left lung is divided into two lobes, 
an upper and a lower, by an interlobular fissure, which extends from the costal 
to the mediastinal surface of the lung both above and below the hilus. As seen 
on the surface, this fissure begins on the mediastinal surface of the lung at the 
upper and posterior part of the hilus, and runs backward and upward to the pos- 
terior border, which it crosses at a point about 6 cm. below the apex. It then 
extends downward and forward over the costal surface, and reaches the lower 
border a little behind its anterior extremity, and its further course can be followed 
upward and backward across the mediastinal surface as far as the lower part of 
the hilus. The superior lobe lies above and in front of this fissure, and includes the 
apex, the anterior border, and a considerable part of the costal surface and the 
greater part of the mediastinal surface of the lung. The inferior lobe, the larger 
of the two, is situated below and behind the fissure, and comprises almost the 
whole of the base, a large portion of the costal surface, and the greater part of 
the posterior border. 
The right lung is divided into three lobes, superior, middle, and inferior, by 
two interlobular fissures. One of these separates the inferior from the middle 
and superior lobes, and corresponds closely with the fissure in the left lung. Its THE LUNGS 
1105 
direction is, however, more vertical, and it cuts the lower border about 7.5 cm. 
behind its anterior extremity. The other fissure separates the superior from the 
middle lobe. It begins in the previous fissure near the posterior border of the lung, 
and, running horizontally forward, cuts the anterior border on a level with the 
sternal end of the fourth costal cartilage; on the mediastinal surface it may be 
traced backward to the hilus. The middle lobe, the smallest lobe of the right 
lung, is wedge-shaped, and includes the lower part of the anterior border and the 
anterior part of the base of the lung. 
The right lung, although shorter by 2.5 cm. than the left, in consequence of the 
Diaphragma rising higher on the right side to accommodate the liver, is broader, 
owing to the inclination of the heart to the left side; its total capacity is greater 
and it weighs more than the left lung. 
The Root of the Lung (radix pulmonis).-A little above the middle of the medias- 
tinal surface of each lung, and nearer its posterior than its anterior border, is its 
root, by which the lung is connected to the heart and the trachea. The root is 
formed by the bronchus, the pulmonary artery, the pulmonary veins, the bronchial 
arteries and veins, the pulmonary plexuses of nerves, lymphatic vessels, bronchial 
lymph glands, and areolar tissue, all of which are enclosed by a reflection of the 
pleura. The root of the right lung lies behind the superior vena cava and part 
of the right atrium, and below the azygos vein. That of the left lung passes 
beneath the aortic arch and in front of the descending aorta; the phrenic nerve, 
the pericardiacophrenic artery and vein, and the anterior pulmonary plexus, lie 
in front of each, and the vagus and posterior pulmonary plexus behind each; 
below each is the pulmonary ligament. 
The chief structures composing the root of each lung are arranged in a similar 
manner from before backward on both sides, viz., the upper of the two pulmonary 
veins in front; the pulmonary artery in the middle; and the bronchus, together 
with the bronchial vessels, behind. From above downward, on the two sides, 
their arrangement differs, thus: 
On the right side their position is-eparterial bronchus, pulmonary artery, 
hyparterial bronchus, pulmonary veins, but on the left side their position is- 
pulmonary artery, bronchus, pulmonary veins. The lower of the two pulmonary 
veins, is situated below the bronchus, at the apex or lowest part of the hilus 
(Figs. 922, 923). 
Divisions of the Bronchi.-Just as the lungs differ from each other in the number 
of their lobes, so the bronchi differ in their mode of subdivision. 
The right bronchus gives off, about 2.5 cm. from the bifurcation of the trachea, 
a branch for the superior lobe. This branch arises above the level of the pulmonary 
artery, and is therefore named the eparterial bronchus. All the other divisions 
of the main stem come off below the pulmonary artery, and consequently are 
termed hyparterial bronchi. The first of these is distributed to the middle lobe, 
and the main tube then passes downward and backward into the inferior lobe, 
giving off in its course a series of large ventral and small dorsal branches. The 
ventral and dorsal branches arise alternately, and are usually eight in number- 
four of each kind. The branch to the middle lobe is regarded as the first of the 
ventral series. 
The left bronchus passes below the level of the pulmonary artery before it divides, 
and hence all its branches are hyparterial; it may therefore be looked upon as 
equivalent to that portion of the right bronchus which lies on the distal side of its 
eparterial branch. The first branch of the left bronchus arises about 5 cm. from 
the bifurcation of the trachea, and is distributed to the superior lobe. The main 
stem then enters the inferior lobe, where it divides into ventral and dorsal branches 
similar to those in the right lung. The branch to the superior lobe of the left lung 
is regarded as the first of the ventral series. 1106 
SPLANCHNOLOGY 
Structure.--The lungs are composed of an external serous coat, a subserous areolar tissue, 
and the pulmonary substance or parenchyma. 
The serous coat is the pulmonary pleura (page 1097); it is thin, transparent, and invests the 
entire organ as far as the root. 
The subserous areolar tissue contains a large proportion of elastic fibres; it invests the entire 
surface of the lung, and extends inward between the lobules. 
The parenchyma is composed of lobules which, although closely connected together by an 
interlobular areolar tissue, are quite distinct from one another, and may be teased asunder 
without much difficulty in the fetus. The lobules vary in size; those on the surface are large, 
of pyramidal form, the base turned toward the surface; those in the interior smaller, and of 
various forms. Each lobule is composed of a lobular bronchiole and its terminal air cells, and 
of the ramifications of the pulmonary and bronchial vessels, lymphatics, and nerves; all of these 
structures being connected together by areolar tissue. 
The intrapulmonary bronchi divide and subdivide throughout the entire organ, the smallest 
subdivisions constituting the lobular bronchioles. The larger divisions consist of: (1) an outer 
coat of fibrous tissue in which are found at intervals irregular plates of hyaline cartilage, most 
developed at the points of division; (2) internal to the fibrous coat, a layer of circularly disposed 
smooth muscle fibres, the bronchial muscle; and (3) most internally, the mucous membrane, 
lined by columnar ciliated epithelium resting on a basement membrane. The corium of the 
mucous membrane contains numerous elastic fibres running longitudinally, and a certain amount 
of lymphoid tissue; it also contains the ducts of mucous glands, the acini of which lie in the 
fibrous coat. The lobular bronchioles differ from the larger tubes in containing no cartilage 
and in the fact that the ciliated epithelial cells are cubical in shape. The lobular bronchioles 
are about 0.2 mm. in diameter. 
Fig. 924.-Section of lung of cat, showing termination of bronchus. X 50. 
Each bronchiole terminates at a point called the vestibule by dividing into from three to six 
wider irregular passages called atria. These are lined by flattened non-ciliated epithelium; at 
the vestibule the bronchial muscle forms a definite circular band. From each atrium arise two 
or more infundibula, elongated, blind passages, lined by simple squamous epithelium, and beset 
on all sides by hemispherical alveoli or air cells (Fig. 924). 
The alveoli are lined by a delicate layer of simple squamous epithelium, the cells of which 
are united at their edges by cement substance. Between the squames are here and there smaller, 
polygonal, nucleated cells. Outside the epithelial lining is a little delicate connective tissue, 
containing numerous elastic fibres and a close net-work of blood capillaries, and forming a common 
wall to adjacent alveoli (Fig. 925). 
The fetal lung resembles a gland in that the alveoli have a small lumen and are lined by 
cubical epithelium (Fig. 926). After the first respiration the alveoli become distended, and the 
epithelium takes on the characters described above. THE LUNGS 
1107 
Vessels and Nerves.-The pulmonary artery conveys the venous blood to the lungs; it divides 
into branches which accompany the bronchial tubes and end in a dense capillary net-work in 
Fig. 925.-Section of lung tissue. 
the walls of the alveoli. In the lung the branches of the pulmonary artery are usually above 
and in front of a bronchial tube, the vein below. 
Fig. 926.-Section of lung of pig embryo, 13 cm. long, showing the glandular character of the developing alveoli. 
(J. M. Flint.) X 70. a. Interstitial connective tissue. 6. A bronchial tube. c. An Alveolus. I. lymphatic clefts, 
p. Pleura. 
The pulmonary capillaries form plexuses which lie immediately beneath the lining epithe- 
lium, in the walls and septa of the alveoli and of the infundibula. In the septa between the 1108 
SPLANCHNOLOGY 
alveoli the capillary net-work forms a single layer. The capillaries form a very minute net-work, 
the meshes of which are smaller than the vessels themselves; their walls are also exceedingly 
thin. The arteries of neighboring lobules are independent of each other, but the veins freely 
anastomose. 
The pulmonary veins commence in the pulmonary capillaries, the radicles coalescing into 
larger branches which run through the substance of the lung, independently of the pulmonary 
arteries and bronchi. After freely communicating with other branches they form large vessels, 
which ultimately come into relation with the arteries and bronchial tubes, and accompany 
them to the hilus of the organ. Finally they open into the left atrium of the heart, conveying 
oxygenated blood to be distributed to all parts of the body by the aorta. 
The bronchial arteries supply blood for the nutrition of the lung; they are derived from the 
thoracic aorta or from the upper aortic intercostal arteries, and, accompanying the bronchial 
tubes, are distributed to the bronchial glands and upon the walls of the larger bronchial tubes 
and pulmonary vessels. Those supplying the bronchial tubes form a capillary plexus in the 
muscular coat, from which branches are given off to form a second plexus in the mucous coat; 
this plexus communicates with branches of the pulmonary artery, and empties itself into the 
pulmonary veins. Others are distributed in the interlobular areolar tissue, and end partly in 
the deep, partly in the superficial, bronchial veins. Lastly, some ramify upon the surface of 
the lung, beneath the pleura, where they form a capillary network. 
The bronchial vein is formed at the root of the lung, receiving superficial and deep veins corre- 
sponding to branches of the bronchial artery. It does not, however, receive all the blood supplied 
by the artery, as some of it passes into the pulmonary veins. It ends on the right side in the 
azygos vein, and on the left side in the highest intercostal or in the accessory hemiazygos vein. 
The lymphatics are described on page 799. 
Nerves.-The lungs are supplied from the anterior and posterior pulmonary plexuses, formed 
chiefly by branches from the sympathetic and vagus. The filaments from these plexuses accom- 
pany the bronchial tubes, supplying efferent fibres to the bronchial muscle and afferent fibres 
to the bronchial mucous membrane and to the alveoli of the lung. Small ganglia are found 
upon these nerves. 
Applied Anatomy.-The lungs may be wounded or torn in three ways: (1) by compression 
of the chest, without any injury to the ribs; (2) by a fractured rib penetrating the lung; (3) by 
stabs, gunshot wounds, etc. 
The first form, where the lung is ruptured by external compression without any fracture of 
the ribs, is very rare, and usually occurs in young children, and affects the root of the lung, i. e., 
the most fixed part, and thus, implicating the great vessels, is frequently fatal. It would seem 
a 'priori a most unusual injury, and its exact mode of causation is difficult to interpret. 
In the second variety, when the wound in the lung is produced by the penetration of a broken 
rib, both the costal pleura and pulmonary pleura must necessarily be injured, and consequently 
the air taken into the wounded alveoli may find its way through these wounds into the cellular 
tissue of the parietes of the chest, producing surgical emphysema. This it may do without col- 
lecting in the pleural cavity; the two layers of the pleura are so intimately in contact that the 
air passes straight through from the wounded lung into the subcutaneous tissue. Emphysema 
constitutes therefore the most important sign of injury to the lung in cases of fracture of the 
ribs. Pneumothorax, or air in the pleural cavity, is much more likely to occur in injuries of 
the third variety-that is to say, from external wounds, from stabs, gunshot injuries, and such 
like-in which case air passes either from the wound of the lung or from the external wound 
into the cavity of the pleura during the respiratory movements. In these cases there is generally 
no emphysema of the subcutaneous tissue unless the external wound is small and valvular, so 
that the air is drawn into the wound during inspiration, and then forced into the cellular tissue 
around during expiration because it cannot escape from the external wound. Occasionally in 
wounds of the parietes of the chest no air finds its way into the cavity of the pleura, because 
the lung at the time of the accident protrudes through the wound and blocks the opening. This 
takes place where the wound is large, and constitutes one form of hernia of the lung. Another 
form of hernia of the lung occurs, though very rarely, after wounds of the chest wall, when 
the wound has healed and the cicatrix subsequently yields from the pressure of the viscus behind. 
It forms a globular, elastic, crepitating swelling, which enlarges during expiratory efforts, falls 
in during inspiration, and disappears on holding the breath. 
An incision into the lung is occasionally required in cases of abscess the result of pneumonia 
or the presence of a foreign body, and from an abscess in the liver which has made its way through 
the Diaphragma into the lung substance, and also in cases of hydatid disease. In these cases 
there is always risk of hemorrhage, and it has been recommended that the lung tissue should 
be penetrated by the actual cautery, rather than with the knife. Unless adhesions have formed 
between the two layers of the pleura, the pleural cavity must necessarily be opened, and there 
is the further risk of pneumothorax, and possibly of septic infection. It is therefore advisable 
to suture the lung to the opening in the thoracic wall, and wait for adhesions to form before 
perforating the lung. THE DIGESTIVE APPARATUS 
1109 
The routine methods of physical examination-inspection, palpation, percussion, and auscul- 
tation-are nowhere more important than they are in the diagnosis of diseases of the lungs. 
It is essential, too, that in every case the two sides of the chest should be compared with one 
another, and that the wide variations that may be met with under normal conditions in different 
persons and at different ages should be kept in mind when the chest is being examined. On 
inspection the thorax will be seen to be enlarged and barrel-shaped in emphysema, in which 
the volume of the lungs is increased by dilatation of their alveoli, or in an acute attack of asthma, 
or when a large pleural effusion or mediastinal tumor is present. The chest wall will be flattened 
or sunken, on the other hand, over an area of lung that has collapsed or become fibrosed, as 
often happens in chronic pulmonary tuberculosis. The respiratory movements of the chest wall 
will be lessened, or even absent, over a part of the whole of the affected side in such acute dis- 
orders as pleurisy, pneumonia, or pleural effusion, or in more chronic diseases where the under- 
lying lung is fibrosed, or is crushed to one side by a mediastinal tumor; and by the use of the 
x-rays a corresponding loss of movement or displacement of the Diaphragma on the affected 
side can often be observed. Under normal conditions the intercostal spaces are a little depressed; 
but they may be obliterated or even bulging on that side when a large effusion or new growth 
fills up one of the pleural cavities. 
On palpation the hand can be used to verify the eye's impressions as to the degree of move- 
ment on respiration of any part of the chest wall. The facility with which the vibrations produced 
by the voice are conducted from the larynx by the underlying lung to the hand (in the form of 
vocal fremitus') can also be tested. The vocal fremitus is commonly much increased over the 
consolidated area in pneumonia or in fibrosis of the lung, and much diminished over a pleural 
effusion when the lung is pushed up by the fluid toward the top of the pleural cavity. It is also 
diminished, but to a less extent, in emphysema, and in bronchitis when the bronchi are blocked 
by secretion. In bronchitis the bubbling of the secretion in the tubes can often be felt by a hand 
placed on the chest wall as the patient breathes; and in chronic pleurisy the friction of the two 
roughened pleural surfaces against one another can sometimes be felt in the same way. 
On percussion, the normal resonance of the pulmonary tissue is found to be increased in emphy- 
sema, and in pneumothorax (page 1098) this hyperresonance may be still further increased. 
The resonance is lessened in any condition causing collapse or solidification of the lung tissue, 
or when its place is taken by fluid (pleural effusion) or some solid growth (mediastinal tumor). 
Thus dulness on percussion at the bases of the lungs is common in the hypostatic congestion of 
the bases seen in heart failure; dulness at the right base is often due to compression of the lung 
by enlargement of the liver; some dulness at the apex of a lung is frequently met with in tuber- 
culosis of the part, before the disease has progressed very far. Complete dulness over one side 
of the chest, back and front alike, except at the apex, is common when a large pleural effusion 
has taken the lung's place. Von Koranyi, Grocco, and others have drawn attention to a tri- 
angular patch of dulness along the vertebral column (the paravertebral triangle of dulness) on 
the unaffected side in pleural effusion; this triangle of dulness is said to be absent in other con- 
ditions, causing loss of pulmonary resonance on percussion, and is due to shifting over of the 
contents of the posterior mediastinal cavity toward the sound side. The apex of this triangle is in 
the middle line at the upper level of the fluid effusion; its base, some 5 to 10 cm. in length, runs 
horizontally outward from the middle line at the level where the pulmonary resonance normally 
comes to an end. 
On auscultation of the lungs, both in health and disease, the variety of sounds to be heard 
is very great. It is impossible to give adequate consideration to them here, and for further 
information reference should be made to text-books dealing with the subject.1 
THE DIGESTIVE APPARATUS (APPARATUS DIGESTORIUS; ORGANS 
OF DIGESTION). 
The apparatus for the digestion of the food consists of the digestive tube and of 
certain accessory organs. 
The Digestive Tube (alimenatry canal) is a musculomembranous tube, about 
9 metres long, extending from the mouth to the anus, and lined throughout its 
entire extent by mucous membrane. It has received different names in the various 
parts of its course: at its commencement is the mouth, where provision is made 
for the mechanical division of the food (mastication), and for its admixture with 
a fluid secreted by the salivary glands (insalivation); beyond this are the organs 
of deglutition, the pharynx and the oesophagus, which convey the food into the 
stomach, in which it is stored for a time and in which also the first stages of the 
1 See especially Auscultation and Percussion, by Austin Flint, M.D., 6th ed., 1912. 1110 
SPLANCHNOLOGY 
digestive process take place; the stomach is followed by the small intestine, which 
is divided for purposes of description into three parts, the duodenum, the jejunum, 
and ileum. In the small intestine the process of digestion is completed and the 
resulting products are absorbed into the blood and lacteal vessels. Finally the 
small intestine ends in the large intestine, which is made up of cecum, colon, rectum, 
and anal canal, the last terminating on the surface of the body at the anus. 
The accessory organs are the teeth, for purposes of mastication; the three pairs 
of salivary glands-the parotid, submaxillary, and sublingual-the secretion from 
which mixes with the food in the mouth and converts it into a bolus and acts 
chemically on one of its constituents; the liver and pancreas, two large glands 
in the abdomen, the secretions of which, in addition to that of numerous minute 
glands in the walls of the alimentary canal, assist in the process of digestion. 
THE MOUTH (CAVUM ORIS; ORAL OR BUCCAL CAVITY). 
The cavity of the mouth is placed at the commencement of the digestive tube 
(Fig. 927); it is a nearly oval-shaped cavity which consists of two parts: an outer, 
smaller portion, the vestibule, and an inner, larger part, the mouth cavity proper. 
The Vestibule (vestibidum Oris') is a slit-like space, bounded externally by the 
lips and cheeks; internally by the gums and teeth. It communicates with the 
surface of the body by the rima or orifice of the mouth. Above and below, it is 
limited by the reflection of the mucous membrane from the lips and cheeks to 
the gum covering the upper and lower alveolar arch respectively. It receives the 
secretion from the parotid salivary glands, and communicates, when the jaws are 
closed, with the mouth cavity proper by an aperture on either side behind the 
wisdom teeth, and by narrow clefts between opposing teeth. 
The Mouth Cavity Proper (cavum oris proprium) (Fig. 943) is bounded laterally 
and in front by the alveolar arches with their contained teeth; behind, it communi- 
cates with the pharynx by a constricted aperture termed the isthmus faucium. 
It is roofed in by the hard and soft plates, while the greater part of the floor is 
formed by the tongue, the remainder by the reflection of the mucous membrane 
from the sides and under surface of the tongue to the gum lining the inner aspect 
of the mandible. It receives the secretion from the submaxillary and sublingual 
salivary glands. 
Structure.-The mucous membrane lining the mouth is continuous with the integument at 
the free margin of the lips, and with the mucous lining of the pharynx behind; it is of a rose- 
pink tinge during life, and very thick where it overlies the hard parts bounding the cavity. It 
is covered by stratified squamous epithelium. 
The Lips (labia oris), the two fleshy folds which surround the rima or orifice of 
the mouth, are formed externally of integument and internally of mucous mem- 
brane, between which are found the Orbicularis oris muscle, the labial vessels, 
some nerves, areolar tissue, and fat, and numerous small labial glands. The inner 
surface of each lip is connected in the middle line to the corresponding gum by a 
fold of mucous membrane, the frenulum-the upper being the larger. 
The Labial Glands (glandulae labiales) are situated between the mucous membrane 
and the Orbicularis oris, around the orifice of the mouth. They are circular in form, 
and about the size of small peas; their ducts open by minute orifices upon the 
mucous membrane. In structure they resemble the salivary glands. 
The Cheeks (buccae) form the sides of the face, and are continuous in front with 
the lips. They are composed externally of integument; internally of mucous 
membrane; and between the two of a muscular stratum, besides a large quantity 
of fat, areolar tissue, vessels, nerves, and buccal glands. 
Structure.-The mucous membrane lining the cheek is reflected above and below upon the 
gums, and is continuous behind with the lining membrane of the soft palate. Opposite the THE MOUTH 
1111 
second molar tooth of the maxilla is a papilla, on the summit of which is the aperture of the 
parotid duct. The principal muscle of the cheek is the Buccinator; but other muscles enter into 
its formation, viz., the Zygomaticus, Risorius, and Platysma. 
The buccal glands are placed between the mucous membrane and Buccinator muscle: they 
are similar in structure to the labial glands, but smaller. About five, of a larger size than the 
rest, are placed between the Masseter and Buccinator muscles around the distal extremity of 
the parotid duct; their ducts open in the mouth opposite the last molar tooth. They are called 
molar glands. 
Fig. 927.-Sagittal section of nose, mouth, pharynx, and larynx. 
The Gums (gingivae) are composed of dense fibrous tissue, closely connected to 
the periosteum of the alveolar processes, and surrounding the necks of the teeth. 
They are covered by smooth and vascular mucous membrane, which is remark- 
able for its limited sensibility. Around the necks of the teeth this membrane 1112 
SPLANCHNOLOGY 
presents numerous fine papillae, and is reflected into the alveoli, where it is con- 
tinuous with the periosteal membrane lining these cavities. 
Applied Anatomy.-The gums are occasionally the seat of considerable hypertrophy, forming 
a lobulated vascular fold growing up in front of and behind the teeth, so as almost to bury them. 
They may also become swollen and congested, bleeding freely, and often becoming ulcerated. 
The condition is known as spongy gums, and may occur in scurvy, in stomatitis and dyspepsia, in 
ill-fed tuberculous children, and from the administration of mercury; the gums are very tender, 
mastication is painful, and there is often considerable fetor. The margin of the gum presents 
an interrupted blue line in cases of lead poisoning. The collection of tartar, which consists of 
the secretion from the gums, mixed with fragments of food and salivary salts, may give rise to 
a condition known as pyorrhoea alveolaris, which is an inflammatory condition of the gums, 
followed by the gradual absorption of the alveolus and the falling out of the teeth. Fibrous 
tumors (epulis), myeloid growths, and epitheliomata are met with in the gums. 
The Palate (palatum) forms the roof of'the mouth; it consists of two portions, 
the hard palate in front, the soft palate behind. 
The Hard Palate (palatum durum) (Fig. 943) is bounded in front and at the sides 
by the alveolar arches and gums; behind, it is continuous with the soft palate. 
It is covered by a dense structure, formed by the periosteum and mucous mem- 
brane of the mouth, which are intimately adherent. Along the middle line is a 
linear raphe, which ends anteriorly in a small papilla corresponding with the 
incisive canal. On either side and in front of the raphe the mucous membrane 
is thick, pale in color, and corrugated; behind, it is thin, smooth, and of a deeper 
color; it is covered with. stratified squamous epithelium, and furnished with 
numerous palatal glands, which lie between the mucous membrane and the surface 
of the bone. 
The Soft Palate (palatum molle) (Fig. 943) is a movable fold, suspended from the 
posterior border of the hard palate, and forming an incomplete septum between 
the mouth and pharynx. It consists of a fold of mucous membrane enclosing 
muscular fibres, an aponeurosis, vessels, nerves, adenoid tissue, and mucous glands. 
When occupying its usual position, i. e., relaxed and pendent, its anterior surface 
is concave, continuous with the roof of the mouth, and marked by a median raphe. 
Its posterior surface is convex, and continuous with the mucous membrane covering 
the floor of the nasal cavities. Its upper border is attached to the posterior margin 
of the hard palate, and its sides are blended with the pharynx. Its lower border 
is free. Its lower portion, which hangs like a curtain between the mouth and 
pharynx is termed the palatine velum. 
Hanging from the middle of its lower border is a small, conical, pendulous 
process, the palatine uvula; and arching lateralward and downward from the base 
of the uvula on either side are two curved folds of mucous membrane, containing 
muscular fibres, called the arches or pillars of the fauces. 
The glossopalatine arch (arcus glossopalatinus; anterior pillar of fauces) on either 
side runs downward, lateralward, and forward to the side of the base of the tongue, 
and is formed by the projection of the Glossopalatinus with its covering mucous 
membrane. 
The pharyngopalatine arch (arcus pharyngopalatinus; posterior pillar of fauces) is 
larger and projects farther toward the middle line than the anterior; it runs down- 
ward, lateralward, and backward to the side of the pharynx, and is formed by the 
projection of the Pharyngopalatinus, covered by mucous membrane. On either side 
the two arches are separated below by a triangular interval, in which the palatine 
tonsil is lodged. 
The aperture by which the mouth communicates with the pharynx is called 
the isthmus faucium. It is bounded, above, by the soft palate; below, by the dorsum 
of the tongue; and on either side, by the glossopalatine arch. 
Palatine Aponeurosis.-Attached to the posterior border of the hard palate is 
a thin, firm fibrous lamella which supports the muscles and gives strength to the THE MOUTH 
1113 
soft palate. It is thicker above than below, where it becomes very thin and difficult 
to define. Laterally it is continuous with the pharyngeal aponeurosis. 
Muscles of the Palate.-The muscles of the palate (Fig. 928) are: 
Levator veli palatini. 
Tensor veli palatini. 
Musculus uvulae. 
Glossopalatinus. 
Pharyngopalatinus. 
Fig. 928.-Dissection of the muscles of the palate from behind. 
The Levator veli palatini {Levator i)alati) is a thick, rounded muscle situated 
lateral to the choanse. It arises from the under surface of the apex of the petrous 
part of the temporal bone and from the medial lamina of the cartilage of the audi- 
tory tube. After passing above the upper concave margin of the Constrictor 
pharyngis superior it spreads out in the palatine velum, its fibres extending 
obliquely downward and medialward to the middle line, where they blend with 
those of the opposite side. 
The Tensor veli palatini {Tensor palati) is a broad, thin, riband-like muscle 
placed lateral to the Levator veli palatini. It arises by a flat lamella from the 
scaphoid fossa at the base of the medial pterygoid plate, from the spina angularis 
of the sphenoid and from the lateral wall of the cartilage of the auditory tube. 
Descending vertically between the medial pterygoid plate and the Pterygoideus 
interims it ends in a tendon which winds around the pterygoid hamulus, being 
retained in this situation by some of the fibres of origin of the Pterygoideus interims. 1114 
SPLANCHNOLOGY 
Between the tendon and the hamulus is a small bursa. The tendon then passes 
medialward and is inserted into the palatine aponeurosis and into the surface 
behind the transverse ridge on the horizontal part of the palatine bone. 
The Musculus uvulae {Azygos uvulae) arises from the posterior nasal spine of 
the palatine bones and from the palatine aponeurosis; it descends to be inserted 
into the uvula. 
The Glossopalatinus {Palatoglossus) is a small fleshy fasciculus, narrower in 
the middle than at either end, forming, with the mucous membrane covering 
its surface, the glossopalatine arch. It arises from the anterior surface of the 
soft palate, where it is continuous with the muscle of the opposite side, and passing 
downward, forward, and lateralward in front of the palatine tonsil, is inserted 
into the side of the tongue, some of its fibres spreading over the dorsum, and 
others passing deeply into the substance of the organ to intermingle with the 
Transversus linguae. 
The Pharyngopalatinus {Palatopharyngeus) is a long, fleshy fasciculus narrower 
in the middle than at either end, forming, with the mucous membrane covering 
its surface, the pharyngopalatine arch. It is separated from the Glossopalatinus 
by an angular interval, in which the palatine tonsil is lodged. It arises from the 
soft palate, where it is divided into two fasciculi by the Levator veli palatini and 
Musculus uvulae. The posterior fasciculus lies in contact with the mucous mem- 
brane, and joins with that of the opposite muscle in the middle line; the anterior 
fasciculus, the thicker, lies in the soft palate between the Levator and Tensor, 
and joins in the middle line the corresponding part of the opposite muscle. Passing 
lateralward and downward behind the palatine tonsil, the Pharyngopalatinus 
joins the Stylopharyngeus, and is inserted with that muscle into the posterior 
border of the thyroid cartilage, some of its fibres being lost on the side of the 
pharynx and others passing across the middle line posteriorly, to decussate with 
the muscle of the opposite side. 
Dissection.-In a dissection of the soft palate from its posterior or pharyngeal surface to its 
anterior or oral surface, the muscles would be exposed in the following order: viz., the posterior 
fasciculus of the Pharyngopalatinus, covered by a continuation of the mucous membrane of 
the floor of the nasal cavities; the Musculus uvulae; the Levator veli palatini; the anterior 
fasciculus of the Pharyngopalatinus; the aponeurosis of the Tensor veli palatini, and the Glosso- 
palatinus covered by a continuation of the oral mucous membrane. 
Nerves.-The Tensor veli palatini is supplied by a branch from the otic ganglion; the remain- 
ing muscles of this group are in all probability supplied by the accessory nerve through the 
pharyngeal plexus.1 
Actions.-During the first stage of deglutition, the bolus of food is driven back into the fauces 
by the pressure of the tongue against the hard palate, the base of the tongue being, at the same 
time, retracted, and the larynx raised with the pharynx. During the second stage the entrance 
to the larynx is closed by the drawing forward of the arytenoid cartilages toward the cushion 
of the epiglottis-a movement produced by the contraction of the Thyreoarytaenoidei, the 
Arytaenoidei, and the Arytaenoepiglottidei. 
After leaving the tongue the bolus passes on to the posterior or laryngeal surface of the epi- 
glottis, and glides along this for a certain distance; then the Glossopalatini, the constrictors of 
the fauces, contract behind it; the palatine velum is slightly raised by the Levator veli palatini, 
and made tense by the Tensor veli palatini; and the Pharyngopalatini, by their contraction, 
pull the pharynx upward over the bolus, and come nearly together, the uvula filling up the 
slight interval between them. By these means the food is prevented from passing into the nasal 
part of the pharynx; at the same time, the Pharyngopalatini form an inclined plane, directed 
obliquely downward and backward along the under surface of which the bolus descends into, 
the lower part of the pharynx. The Salpingopharyngei raise the upper and lateral parts of the 
pharynx-i. e., those parts which are above the points where the Stylopharyngei are attached 
to the pharynx. 
Mucous Membrane.-The mucous membrane of the soft -palate is thin, and covered with strati- 
fied squamous epithelium on both surfaces, excepting near the pharyngeal ostium of the auditory 
tube, where it is columnar and ciliated. According to Klein, the mucous membrane on the 
1 "The Innervation of the Soft Palate," by Aldren Turner, Journal of Anatomy and Physiology, xxiii, 523. THE MOUTH 
1115 
nasal surface of the soft palate in the fetus is covered throughout by columnar ciliated epithelium, 
which subsequently becomes squamous; some anatomists state that it is covered with columnar 
ciliated epithelium, except at its free margin, throughout life. Beneath the mucous membrane 
on the oral surface of the soft plate is a considerable amount of adenoid tissue. The palatine 
glands form a continuous layer on its posterior surface and around the uvula. 
Vessels and Nerves.-The arteries supplying the palate are the descending palatine branch 
of the internal maxillary, the ascending palatine branch of the external maxillary, and the pala- 
tine branch of the ascending pharyngeal. The veins end chiefly in the pterygoid and tonsillar 
plexuses. The lymphatic vessels pass to the deep cervical glands. The sensory nerves are 
derived from the palatine and nasopalatine nerves and from the glossopharyngeal. 
Applied Anatomy.-The occurrence of a congenital cleft in the palate has been already referred 
to as a defect in development (page 299). After the operation for the closure of a cleft in the 
palate, the palatine muscles, especially the Tensor and Levator veli palatini, have a tendency 
to retard the healing process by active traction upon the line of suture. To obviate this, it is 
necessary to divide them. This is best done by making longitudinal incisions, on either side, 
parallel to the cleft and just medial to the pterygoid hamulus, in such a position as to avoid 
the descending palatine artery. Acquired perforations of the palate are almost invariably the 
result of the breaking down of syphilitic gummata. The ensuing ulceration may continue until 
practically the whole palate, both hard and soft, has been destroyed. Tumors of the palate, 
both innocent and malignant, are occasionally seen. 
Paralysis of the soft palate often occurs after diphtheria. It gives rise to a change in the 
voice, which becomes nasal, and to the regurgitation of fluids down the nose when their swal- 
lowing is attempted. On inspection, the palate is seen to hang flaccid and motionless when 
phonation or deglutition are attempted; it is also anesthetic. 
Fig. 929.-Side view of the teeth and jaws. 
The Teeth (dentes') (Figs. 929 to 931).-Man is provided with two sets of teeth, 
which make their appearance at different periods of life. Those of the first set 
appear in childhood, and are called the deciduous or milk teeth. Those of the second 
set, which also appear at an early period, may continue until old age, and are 
named permanent. 
The deciduous teeth are twenty in number: four incisors, two canines, and four 
molars, in each jaw. 
The permanent teeth are thirty-two in number: four incisors, two canines, four 
premolars, and six molars, in each jaw. 1116 
SPLANCHNOLOGY 
The dental formulae may be represented as follows: 
Deciduous Teeth. 
mol. 
can. 
in. ; 
in. 
can. 
mol. 
Upper jaw 
2 
1 
2 
2 
1 
2 1 
Lower jaw 
2 
1 
2 
2 
1 
2 J 
Permanent Teeth. 
mol. pr. mol. 
can. 
in. 
in. 
can. pr. mol. 
mol. 
Upper jaw 
. 3 2 
1 
2 
2 
1 
2 
31 
- > Total 32 
Lower jaw 
. 3 2 
1 
2 
2 
1 
2 
3 J 
General Characteristics. - Each tooth consists of three portions: the crown, 
projecting above the gum; the root, imbedded in the alveolus; and the neck, the 
constricted portion between the crown and root. 
Fig. 930.-Permanent teeth of upper dental arch, 
seen from below. 
Fig. 931.-Permanent teeth of right half of 
lower dental arch, seen from above. 
The roots of the teeth are firmly implanted in depressions within the alveoli; 
these depressions are lined with periosteum which invests the tooth as far as the 
neck. At the margins of the alveoli, the periosteum is continuous with the fibrous 
structure of the gums. 
In consequence of the curve of the dental arch, terms such as anterior and 
posterior, as applied to the teeth, are misleading and confusing. Special terms 
are therefore used to indicate the different surfaces of a tooth: the surface directed 
toward the lips or cheek is known as the labial or buccal surface; that directed 
toward the tongue is described as the lingual surface; those surfaces which touch THE MOUTH 
1117 
neighboring teeth are termed surfaces of contact. In the case of the incisor and 
canine teeth the surfaces of contact are medial and lateral; in the premolar and 
molar teeth they are anterior and posterior. 
The superior dental arch is larger than the inferior, so that in the normal condi- 
tion the teeth in the maxillae slightly overlap those of the mandible both in front 
and at the sides. Since the upper central incisors are wider than the lower, the 
other teeth in the upper arch are thrown somewhat distally, and the two sets do 
not quite correspond to each other when the mouth is closed: thus the upper 
canine tooth rests partly on the lower canine and partly on the first premolar, 
and the cusps of the upper molar teeth lie behind the corresponding cusps of the 
lower molar teeth. The two series, however, end at nearly the same point behind; 
this is mainly because the molars in the upper arch are the smaller. 
The Permanent Teeth {dentes permanentes) (Fig. 932).-The Incisors {dentes 
incisivi; incisive or cutting teeth) are so named from their presenting a sharp cutting 
edge, adapted for biting the food. They are eight in number, and form the four 
front teeth in each dental arch. 
Fig. 932.-Permanent teeth. Right side. (Burchard.) 
The crown is directed vertically, and is chisel-shaped, being bevelled at the expense 
of its lingual surface, so as to present a sharp horizontal cutting edge, which, 
before being subjected to attrition, presents three small prominent points separated 
by two slight notches. It is convex, smooth, and highly polished on its labial 
surface; concave on its lingual surface, where, in the teeth of the upper arch, it is 
frequently marked by an inverted V-shaped eminence, situated near the gum. 
This is known as the basal ridge or cingulum. The neck is constricted. The root 
is long, single, conical, transversely flattened, thicker in front than behind, and 
slightly grooved on either side in the longitudinal direction. 
The upper incisors are larger and stronger than the lower, and are directed 
obliquely downward and forward. The central ones are larger than the lateral, 
and their roots are more rounded. 
The lower incisors are smaller than the upper: the central ones are smaller than 
the lateral, and are the smallest of all the incisors. They are placed vertically 
and are somewhat bevelled in front, where they have been worn down by contact 
with the overlapping edge of the upper teeth. The cingulum is absent. 
The Canine Teeth {dentes canini) are four in number, two in the upper, and two 
in the lower arch, one being placed laterally to each lateral incisor. They are larger 
and stronger than the incisors, and their roots sink deeply into the bones, and 
cause well-marked prominences upon the surface. 1118 
SPLANCHNOLOGY 
The crown is large and conical, very convex on its labial surface, a little hollowed 
and uneven on its lingual surface, and tapering to a blunted point or cusp, which 
projects beyond the level of the other teeth. The root is single, but longer and 
thicker than that of the incisors, conical in form, compressed laterally, and marked 
by a slight groove on each side. 
The upper canine teeth (popularly called eye teeth) are larger and longer than 
the lower, and usually present a distinct basal ridge. 
The lower canine teeth (popularly called stomach teeth) are placed nearer the 
middle line than the upper, so that their summits correspond to the intervals 
between the upper canines and the lateral incisors. 
The Premolars or Bicuspid teeth {dentes praemolares) are eight in number, four 
in each arch. They are situated lateral to and behind the canine teeth, and are 
smaller and shorter than them. 
The crown is compressed antero-posteriorly, and surmounted by two pyramidal 
eminences or cusps, a labial and a lingual, separated by a groove; hence their name 
bicuspid. Of the two cusps the labial is the larger and more prominent. The 
neck is oval. The root is generally single, compressed, and presents in front and 
behind a deep groove, which indicates a tendency in the root to become double. 
The apex is generally bifid. 
The upper premolars are larger, and present a greater tendency to the division 
of their roots than the lower; this is especially the case in the first upper premolar. 
The Molar Teeth {dentes molares) are the largest of the permanent set, and their 
broad crowns are adapted for grinding and pounding the food. They are twelve 
in number; six in each arch, three being placed posterior to each of the second 
premolars. 
The crown of each is nearly cubical in form, convex on its buccal and lingual 
surfaces, flattened on its surfaces of contact; it is surmounted by four or five tuber- 
cles, or cusps, separated from each other by a crucial depression; hence the molars 
are sometimes termed multicuspids. The neck is distinct, large, and rounded. 
Upper Molars.-As a rule the first is the largest, and the third the smallest of 
the upper molars. The crown of the first has usually four tubercles; that of the 
second, three or four; that of the third, three. Each upper molar has three roots, 
and of these two are buccal and nearly parallel to one another; the third is lingual 
and diverges from the others as it runs upward. The roots of the third molar 
{dens serotinus or wisdom-tooth) are more or less fused together. 
Lower Molars.-The lower molars are larger than the upper. On the crown 
of the first there are usually five tubercles; on those of the second and third, four 
or five. Each lower molar has two roots, an 
anterior, nearly vertical, and a posterior, 
directed obliquely backward; both roots are 
grooved longitudinally, indicating a tendency 
to division. The two roots of the third molar 
{dens serotinus or wisdom tooth) are more or 
less united. 
The Deciduous Teeth {dentes decidui; tem- 
porary or milk teeth) (Fig. 933).-The decid- 
uous are smaller than, but, generally speak- 
ing, resemble in form, the teeth which bear 
the same names in the permanent set. The 
hinder of the two molars is the largest of all 
the deciduous teeth, and is succeeded by the 
second premolar. The first upper molar has only three cusps-two labial, one 
lingual; the second upper molar has four cusps. The first lower molar has four 
cusps; the second lower molar has five. The roots of the deciduous molars are 
Fig. 933.-Deciduous teeth. Left side. THE MOUTH 
1119 
smaller and more divergent than those of the permanent molars, but in other 
respects bear a strong resemblance to them. 
Structure of the Teeth.-On making a vertical section of a tooth (Fig. 934), a cavity will be 
found in the interior of the crown and the centre of each root; it opens by a minute orifice at 
the extremity of the latter. This is called the pulp cavity, and contains the dental pulp, a loose 
connective tissue richly supplied with vessels and nerves, which enter the cavity through the 
small aperture at the point of each root. Some of the cells of the pulp are arranged as a layer 
on the wall of the pulp cavity; they are named the odontoblasts of Waldeyer, and during the 
development of the tooth, are columnar in shape, but later on, after the dentin is fully formed, 
they become flattened and resemble osteoblasts. Each has two fine processes, the outer one 
passing into a dental canaliculus, the inner being continuous with the processes of the connective- 
tissue cells of the pulp matrix. 
Fig. 935.-Vertical section of a molar tooth. 
Fig. 934.-Vertical section of a tooth in situ. X 15. 
c is placed in the pulp cavity, opposite the neck of the 
tooth; the part above it is the crown, that below is the 
root. 1. Enamel with radial and concentric markings. 
2. Dentin with tubules and incremental lines. 3. Cement 
or crusta petrosa, with bone corpuscles. 4. Dental 
periosteum. 5. Mandible. 
Fig. 936.-Vertical section of a premolar tooth. 
(Magnified.) 
The solid portion of the tooth consists of (1) the ivory or dentin, which forms the bulk of the 
tooth; (2) the enamel, which covers the exposed part of the crown; and (3) a thin layer of bone, 
the cement or crusta petrosa, which is disposed on the surface of the root. 
The dentin (substantia eburnea; ivory) (Fig, 936) forms the principal mass of a tooth. It is 
a modification of osseous tissue, from which it differs, however, in structure. On microscopic 
examination it is seen to consist of a number of minute wavy and branching tubes, the dental 
canaliculi, imbedded in a dense homogeneous substance, the matrix. 1120 
SPLANCHNOLOGY 
I he dental canahcuh {dentinal tubules) (rig. 937) are placed parallel with one another, and 
open at their inner ends into the pulp cavity. In their course to the periphery they present two 
or three curves, and are twisted on themselves in a spiral direction. These canaliculi vary in 
direction: thus in a tooth of the mandible they are vertical in the upper portion of the crown, 
becoming oblique and then horizontal in the neck and upper part of the root, while toward the 
lower part of the root they are inclined downward. In their course they divide and subdivide 
dichotomously, and, especially in the root, give off minute branches, which join together in 
loops in the matrix, or end blindly. Near the periphery of the dentin, the finer ramifications 
of the canaliculi terminate imperceptibly by free ends. The dental canaliculi have definite walls, 
consisting of an elastic homogeneous membrane, the dentinal sheath of Neumann, which resists 
the action of acids; they contain slender cylindrical prolongations of the odontoblasts, first 
described by Tomes, and named Tomes' fibres or dentinal fibres. 
The matrix {intertubular dentin) is translucent, and contains the chief part of the earthy 
matter of the dentin. In it are a number of fine fibrils, which are continuous with the fibrils 
of the dental pulp. After the earthy matter has 
been removed by steeping a tooth in weak acid, 
the animal basis remaining may be torn into lamina; 
which run parallel with the pulp cavity, across the 
direction of the tubes. A section of dry dentin often 
displays a series of somewhat parallel lines-the 
incremental lines of Salter. These lines are com- 
posed of imperfectly calcified dentin arranged in 
layers. In consequence of the imperfection in the 
calcifying process, little irregular cavities are left, 
termed interglobular spaces (Fig. 937). Normally 
a series of these spaces is found toward the outer 
surface of the dentin, where they form a layer which 
is sometimes known as the granular layer. They 
have received their name from the fact that they 
are surrounded by minute nodules or globules of 
dentin. Other curved lines may be seen parallel to 
the surface. These are the lines of Schreger, and 
are due to the optical effect of simultaneous curva- 
ture of the dentinal fibres. 
Chemical Composition. - According to Berzelius 
and von Bibra, dentin consists of 28 parts of animal 
and 72 parts of earthy matter. The animal matter 
is converted by boiling into gelatin. The earthy 
matter consists of phosphate of lime, carbonate of 
lime, a trace of fluoride of calcium, phosphate of 
magnesium, and other- salts. 
The enamel {substantia adamantina) is the hardest 
and most compact part of the tooth, and forms a 
thin crust over the exposed part of the crown, as far 
as the commencement of the root. It is thickest on 
the grinding surface of the crown, until worn away 
by attrition, and becomes thinner toward the neck. 
It consists of minute hexagonal rods or columns 
termed enamel fibres or enamel prisms {prismata adamantina). They lie parallel with one 
another, resting by one extremity upon the dentin, which presents a number of minute depres- 
sions for their reception; and forming the free surface of the crown by the other extremity. 
The columns are directed vertically on the summit of the crown, horizontally at the sides; they 
are about 4^i in diameter, and pursue a more or less wavy course. Each column is a six-sided 
prism and presents numerous dark transverse shadings; these shadings are probably due to the 
manner- in which the columns are developed in successive stages, producing shallow constric- 
tions, as will be subsequently explained. Another series of lines, having a brown appearance, 
the parallel striae or colored lines of Retzius, is seen on section. According to Ebner, they are 
produced by air in the interprismatic spaces; others believe that they are the result of true 
pigmentation. 
Numerous minute interstices intervene between the enamel fibres near their dentinal ends, 
a provision calculated to allow of the permeation of fluids from the dental canaliculi into the 
substance of the enamel. 
Chemical Composition.-According to von Bibra, enamel consists of 96.5 per cent, of earthy 
matter, and 3.5 per cent, of animal matter. The earthy matter consists of phosphate of lime, 
with traces of fluoride of calcium, carbonate of lime, phosphate of magnesium, and other salts. 
According to Tomes, the enamel contains the merest trace of organic matter. 
Fig. 937.-Transverse section of a portion of the 
root of a canine tooth. X 300. THE MOUTH 
1121 
The crusta petrosa or cement {substantia ossea} is disposed as a thin layer on the roots of the 
teeth, from the termination of the enamel to the apex of each root, where it is usually very thick. 
In structure and chemical composition it resembles bone. It contains, sparingly, the lacunae 
and canaliculi which characterize true bone; the lacunae placed near the surface receive the 
canaliculi radiating from the side of the lacunae toward the periodontal membrane; and those 
more deeply placed join with the adjacent dental canaliculi. In the thicker portions of the 
crusta petrosa, the lamellae and Haversian canals peculiar to bone are also found. 
Fig. 938.-Sagittal section through the first lower deciduous molar of a human embryo 30 mm. long. (Rose.) 
X 100. L.E.L. Labiodental lamina, here separated from the dental lamina. Z.L. Placed over the shallow dental 
furrow, points to the dental lamina, which is spread out below to form the enamel germ of the future tooth. P.p. 
Bicuspidate papilla, capped by the enamel germ. Z.S. Condensed tissue forming dental sac. M.E. Mouth epithelium. 
As age advances, the cement increases in thickness, and gives rise to those bony growths or 
exostoses so common in the teeth of the aged; the pulp cavity also becomes partially filled up by 
a hard substance, intermediate in structure between dentin and bone {osteodentin, Owen; second- 
ary dentin, Tomes). It appears to be formed by a slow conversion of the dental pulp, which 
shrinks, or even disappears. 
Development of the Teeth (Figs. 938 to 941).-In describing the development of the teeth, 
the mode of formation of the deciduous teeth must first be considered, and then that of the 
permanent series. 
Fig. 939.-Similar section through the canine tooth of an embryo 40 mm. long. (Rose.) X 100. L.F. Labio- 
dental furrow. The other lettering as in Fig. 938. 
Development of the Deciduous Teeth.-The development of the deciduous teeth begins 
about the sixth week of fetal life as a thickening of the epithelium along the Hue of the future 
jaw, the thickening being due to a rapid multiplication of the more deeply situated epithelial 
cells. As the cells multiply they extend into the subjacent mesoderm, and thus form a ridge 
or strand of cells imbedded in mesoderm. About the seventh week a longitudinal splitting or 
cleavage of this strand of cells takes place, and it becomes divided into two strands; the separa- 
tion begins in front and extends laterally, the process occupying four or five weeks. Of the two 
strands thus formed, the labial forms the labiodental lamina; while the other, the lingual, 
is the ridge of cells in connection with which the teeth, both deciduous and permanent, are 
developed. Hence it is known as the dental lamina or common dental germ. It forms a flat 1122 
SPLANCHNOLOGY 
band of cells, which grows into the substance of the embryonic jaw, at first horizontally 
inward, and then, as the teeth develop, vertically, i. e., upward in the upper jaw, and 
downward in the lower jaw. While still maintaining a horizontal direction it has two edges 
Fig. 940.-Vertical section of the mandible of an early human fetus. X 25 
-an attached edge, continuous with the epithelium lining the mouth, and a free edge, projecting 
inward, and imbedded in the mesodermal tissue of the embryonic jaw. Along its line of 
attachment to the buccal epithelium is a shallow groove, the dental furrow. 
About the ninth week the dental lamina begins 
to develop enlargements along its free border. 
These are ten in number in each jaw, and each 
corresponds to a future deciduous tooth. They 
consist of masses of epithelial cells; and the cells 
of the deeper part-that is, the part farthest from 
the margin of the jaw-increase rapidly and spread 
out in all directions. Each mass thus comes to 
assume a club shape, connected with the general 
epithelial lining of the mouth by a narrow neck, 
embraced by mesoderm. They are now known as 
special dental germs. After a time the lower ex- 
panded portion inclines outward, so as to form an 
angle with the superficial constricted portion, which 
is sometimes known as the neck of the special 
dental germ. About the tenth week the meso- 
dermal tissue beneath these special dental germs 
becomes differentiated into papillae; these grow 
upward, and come in contact with the epithelial 
cells of the special dental germs, which become 
folded ovei- them like a hood or cap. There is, 
then, at this stage a papilla (or papillae) which 
has already begun to assume somewhat the shape 
of the crown of the future tooth, and from which 
the dentin and pulp of the tooth are formed, sur- 
mounted by a dome or cap of epithelial cells from 
which the enamel is derived. 
In the meantime, while these changes have been 
going on, the dental lamina has been extending 
backward behind the special dental germ corre- 
sponding to the second deciduous molar tooth, 
and at about the seventeenth week it presents an 
enlargement, the special dental germ, for the first 
permanent molar, soon followed by the formation 
of a papilla in the mesodermal tissue for the same tooth. This is followed, about the sixth 
month after birth, by a further extension backward of the dental lamina, with the formation 
Fig. 941.-Longitudinal section of the lower part 
of a growing tooth, showing the extension of the layer 
of adamantoblasts beyond the crown to mark off 
the limit of formation of the dentin of the root. 
(Rose.) ad. Adamantoblasts, continuous below with 
ep.sch., the epithelial sheath of Hertwig. d. Dentin. 
en. Enamel, od. Odontoblasts, p. Pulp. THE MOUTH 
1123 
of another enlargement and its corresponding papilla for the second molar. And finally the pro- 
cess is repeated for the third molar, its papilla appearing about the fifth year of life. 
After the formation of the special dental germs, the dental lamina undergoes atrophic changes 
and becomes cribriform, except on the lingual and lateral aspects of each of the special germs 
of the temporary teeth, where it undergoes a local thickening forming the special dental germ 
of each of the successional permanent teeth-i. e., the ten anterior ones in each jaw. Here the 
same process goes on as has been described in connection with those of the deciduous teeth: 
that is, they recede into the substance of the gum behind the germs of the deciduous teeth. As 
they recede they become club-shaped, form expansions at their distal extremities, and finally 
meet papillae, which have been formed in the mesoderm, just in the same manner as was the 
case in the deciduous teeth. The apex of each papilla indents the dental germ, which encloses 
it, and, forming a cap for it, becomes converted into the enamel, while the papilla forms the 
dentin and pulp of the permanent tooth. 
The special dental germs consist at first of rounded or polyhedral epithelial cells; after the 
formation of the papillae, these cells undergo a differentiation into three layers. Those which 
are in immediate contact with the papilla become elongated, and form a layer of well-marked 
columnar epithelium coating the papilla. They are the cells which form the enamel fibres, 
and are therefore termed enamel cells or adamantoblasts. The cells of the outer layer of the 
special dental germ, which are in contact with the inner surface of the dental sac, presently to 
be described, are much shorter, cubical in form, and are named the external enamel epithelium. 
All the intermediate round cells of the dental germ between these two layers undergo a peculiai' 
change. They become stellate in shape and develop processes, which unite to form a net-work 
into which fluid is secreted; this has the appearance of a jelly, and to it the name of enamel pulp 
is given. This transformed special dental germ is now known under the name of enamel organ 
(Fig. 940). 
While these changes are going on, a sac is formed around each enamel organ from the sur- 
rounding mesodermal tissue. This is known as the dental sac, and is a vascular membrane 
of connective tissue. It grows up from below, and thus encloses the whole tooth germ; as it 
grows it causes the neck of the enamel organ to atrophy and disappear; so that all communi- 
cation between the enamel organ and the superficial epithelium is cut off. At this stage there 
are vascular papillae surmounted by caps of epithelial cells, the whole being surrounded by 
by membranous sacs. 
Formation of the Enamel.-The enamel is formed exclusively from the enamel cells or adaman- 
toblasts of the special dental germ, either by direct calcification of the columnar cells, which 
become elongated into the hexagonal rods of the enamel; or, as is more generally believed, as 
a secretion from the adamantoblasts, within which calcareous matter is subsequently deposited. 
The process begins at the apex of each cusp, at the ends of the enamel cells in contact with 
the dental papilla. Here a fine globular deposit takes place, being apparently shed from the end 
of the adamantoblasts. It is known by the name of the enamel droplet, and resembles keratin 
in its resistance to the action of mineral acids. This droplet then becomes fibrous and calcifies 
and forms the first layer of the enamel; a second droplet now appears and calcifies, and so on; 
successive droplets of keratin-like material are shed from the adamantoblasts and form successive 
layers of enamel, the adamantoblasts gradually receding as each layer is produced, until at the 
termination of the process they have almost disappeared. The intermediate cells of the enamel 
pulp atrophy and disappear, so that the newly formed calcified material and the external enamel 
epithelium come into apposition. This latter layer, however, soon disappears on the emergence 
of the tooth beyond the gum. After its disappearance the crown of the tooth is still covered 
by a distinct membrane, which persists for some time. This is known as the cuticula dentis, or 
Nasmyth's membrane, and is believed to be the last-formed layer of enamel derived from the 
adamantoblasts, which has not become calcified. It forms a horny layer, which may be separ- 
ated from the subjacent calcified mass by the action of strong acids. It is marked by the hexagonal 
impressions of the enamel prisms, and, when stained by nitrate of silver, shows the characteristic 
appearance of epithelium. 
Formation of the Dentin.-While these changes are taking place in the epithelium to form 
the enamel, contemporaneous changes occurring in the differentiated mesoderm of the dental 
papillae result in the formation of the dentin. As before stated, the first germs of the dentin are 
the papillae, corresponding in number to the teeth, formed from the soft mesodermal tissue 
which bounds the depressions containing the special enamel germs. The papillae grow upward 
into the enamel germs and become covered by them, both being enclosed in a vascular connective 
tissue, the dental sac, in the manner above described. Each papilla then constitutes the forma- 
tive pulp from which the dentin and permanent pulp are developed; it consists of rounded cells 
and is very vascular, and soon begins to assume the shape of the future tooth. The next step 
is the appearance of the odontoblasts, which have a relation to the development of the teeth 
similar to that of the osteoblasts to the formation of bone. They are formed from the cells 
of the periphery of the papilla-that is to say, from the cells in immediate contact with the 
adamantoblasts of the special dental germ. These cells become elongated, one end of the 1124 
SPLANCHNOLOGY 
elongated cell resting against the epithelium of the special dental germs, the other being tapered 
and oftened branched. By the direct transformation of the peripheral ends of these cells, or 
by a secretion from them, a layer of uncalcified matrix (prodentin) is formed which caps the 
cusp or cusps, if there are more than one, of the papillae. This matrix becomes fibrillated, and 
in it islets of calcification make their appearance, and coalescing give rise to a continuous layer 
of calcified material which covers each cusp and constitutes the first layer of dentin. The odon- 
toblasts, having thus formed the first layer, retire toward the centre of the papilla, and, as they 
do so, produce successive layers of dentin from their peripheral extremities-that is to say, 
they form the dentinal matrix in which calcification subsequently takes place. As they thus 
recede from the periphery of the papilla, they leave behind them filamentous processes of cell 
protoplasm, provided with finer side processes; these are surrounded by calcified material, and 
thus form the dental canaliculi, and, by their side branches, the anastomosing canaliculi: the 
processes of protoplasm contained within them constitute the dentinal fibres (Tomes' fibres'). 
In this way the entire thickness of the dentin is developed, each canaliculus being completed 
throughout its whole length by a single odontoblast. The central part of the papilla does not 
undergo calcification, but persists as the pulp of the tooth. In this process of formation of dentin 
it has been shown that an uncalcified matrix is first developed, and that in this matrix islets of 
calcification appear which subsequently blend together to form a cap to each cusp: in like manner 
successive layers are produced, which ultimately become blended with each other. In certain 
places this blending is not complete, portions of the matrix remaining uncalcified between the 
successive layers; this gives rise to little spaces, which are the interglobular spaces alluded to 
above. 
Formation of the Cement.-The root of the tooth begins to be formed shortly before the crown 
emerges through the gum, but is not completed until some time afterward. It is produced by a 
downgrowth of the epithelium of the dental germ, which extends almost as far as the situation 
of the apex of the future root, and determines the form of this portion of the tooth. This fold 
of epithelium is known as the epithelial sheath, and on its papillary surface odontoblasts appear, 
which in turn form dentin, so that the dentin formation is identical in the crown and root of the 
tooth. After the dentin of the root has been developed, the vascular tissues of the dental sac 
begin to break through the epithelial sheath, and spread over the surface of the root as a layer 
of bone-forming material. In this osteoblasts make their appearance, and the process of ossi- 
fication goes on in identically the same manner as in the ordinary intramembranous ossification 
of bone. In this way the cement is formed, and consists of ordinary bone containing canaliculi 
and lacunae. 
Formation of the Alveoli.-About the fourteenth week of embryonic fife the dental lamina 
becomes enclosed in a trough or groove of mesodermal tissue, which at first is common to all the 
dental germs, but subsequently becomes divided by bony septa into loculi, each loculus con- 
taining the special dental germ of a deciduous tooth and its corresponding permanent tooth. 
After birth each cavity becomes subdivided, so as to form separate loculi (the future alveoli) 
for the deciduous tooth and its corresponding permanent tooth. Although at one time the whole 
of the growing tooth is contained in the cavity of the alveolus, the latter never completely encloses 
it, since there is always an aperture over the top of the crown filled by soft tissue, by which the 
dental sac is connected with the surface of the gum, and which in the permanent teeth is called 
the gubernaculum dentis. 
Development of the Permanent Teeth.-The permanent teeth as regards their development 
may be divided into two sets: (1) those which replace the deciduous teeth, and which, like them, 
are ten in number in each jaw: these are the successional permanent teeth; and (2) those which 
have no deciduous predecessors, but are superadded distal to the temporary dental series. These 
are three in number on either side in each jaw, and are termed superadded permanent teeth. 
They are the three molars of the permanent set, the molars of the deciduous set being replaced 
by the premolars of the permanent set. The development of the successional permanent teeth- 
the ten anterior ones in either jaw-has already been indicated. During their development the 
permanent teeth, enclosed in their sacs, come to be placed on the lingual side of the deciduous 
teeth and more distant from the margin of the future gum, and, as already stated, are separated 
from them by bony partitions. As the crown of the permanent tooth grows, absorption of these 
bony partitions and of the root of the deciduous tooth takes place, through the agency of osteo- 
clasts, which appear at this time, and finally nothing but the crown of the deciduous tooth remains. 
This is shed or removed, and the permanent tooth takes its place. 
The superadded permanent teeth are developed in the manner already described, by extensions 
backward of the posterior part of the dental lamina in each jaw. 
Eruption of the Teeth.-When the calcification of the different tissues of the tooth 
is sufficiently advanced to enable it to bear the pressure to which it will be afterward 
subjected, eruption takes place, the tooth making its way through the gum. The 
gum is absorbed by the pressure of the crown of the tooth against it, which is THE MOUTH 
1125 
itself pressed up by the increasing size of the root. At the same time the septa 
between the dental sacs ossifiy, and constitute the alveoli; these firmly embrace 
the necks of the teeth, and afford them a solid basis of support. 
The eruption of the deciduous teeth commences about the seventh month after 
birth, and is completed about the end of the second year, the teeth of the lower 
jaw preceding those of the upper. 
The following, according to C. S. Tomes, are the most usual times of eruption: 
Lower central incisors 6 to 9 months. 
Upper incisors 8 to 10 months. 
Lower lateral incisors and first molars 15 to 21 months. 
Canines 16 to 20 months. 
Second molars 20 to 24 months. 
There are, however, considerable variations in these times; thus, according 
to Holt: 
At the age of 1 year a child should have 6 teeth. 
" 1| years " " 12 " 
" " 2 " " " 16 " 
" " 2| " " " 20 " 
Calcification of the permanent teeth proceeds in the following order in the 
lower jaw (in the upper jaw it takes place a little later): the first molar, soon 
after birth; the central and lateral incisors, and the canine, about six months 
after birth; the premolars, at the second year, or a little later; the second molar, 
about the end of the second year; the third molar, about the twelfth year. 
The eruption of the permanent teeth takes place at the following periods, the 
teeth of the lower jaw preceding those of the upper by short intervals: 
First molars 6th year. 
Two central incisors 7th year. 
Two lateral incisors Sth year. 
First premolars 9th year. 
Second premolars . 10th year. 
Canines 11th to 12th year. 
Second molars 12th to 13th year. 
Third molars 17th to 25th year. 
Toward the sixth year, before the shedding of the deciduous teeth begins, there 
are twenty-four teeth in each jaw, viz., the ten deciduous teeth and the crowns 
of all the permanent teeth except the third molars. 
Applied Anatomy.-As a consequence of local irritation or of chronic digestive disturbances 
occurring during their eruption, both the deciduous and the permanent teeth may show defective 
development or irregular transverse furrowing and erosions; this is particularly the case with 
the incisors. Quite distinct from and much less common than this is a characteristic malforma- 
tion of the two upper central permanent incisors seen in patients with inherited syphilis, and 
first described by Hutchinson. Here there is a crescentic notch in the anterior surface and at 
the cutting edge of the tooth, which is peg-shaped, stunted, and often also set obliquely in the 
gum, pointing either inward or outward. Numerous forms of innocent tumor arising from the 
teeth, or from their constituent layers, have been described under the general name of odontoma. 
Infection of the pulp of a tooth by bacteria gaining access thereto in consequence of dental caries 
gives rise to the common and very painful alveolar abscess; starting in the apical space between 
the root of the tooth and its alveolar socket, the pus from such an abscess may make its way 
into the maxillary antrum, or burst through the hard palate or cheek. A more superficial abscess 
forming between the root of a tooth and the gum is known as a gum-boil. 
The Tongue (lingua).-The tongue is the principal organ of the sense of taste, 
and an important organ of speech; it also assists in the mastication and deglutition 1126 
SPLANCHNOLOGY 
of the food. It is situated in the floor of the mouth, within the curve of the 
body of the mandible. 
Its Root (radix linguae; base) (Fig. 906) is directed backward, and connected 
with the hyoid bone by the Hyoglossi and Genioglossi muscles and the hyoglossal 
membrane; with the epiglottis by three folds (glossoepiglottic) of mucous membrane; 
with the soft palate by the glossopalatine arches; and with the pharynx by the 
Constrictores pharyngis superiores and the mucous membrane. 
Its Apex (apex linguae; tip), thin and narrow, is directed forward against the 
lingual surfaces of the lower incisor teeth. 
Fig. 942.-The mouth cavity. The apex of the tongue is turned upward, and on the right side a superficial 
dissection of its under surface has been made. 
Its Inferior Surface (facies inferior linguae; under surface) (Fig. 942) is connected 
with the mandible by the Genioglossi; the mucous membrane is reflected from it 
to the lingual surface of the gum and on to the floor of the mouth, where, in the 
middle line, it is elevated into a distinct vertical fold, the frenulum linguae. On 
either side lateral to the frenulum is a slight fold of the mucous membrane, the 
plica fimbriata, the free edge of which occasionally exhibits a series of fringe-like 
processes. 
The apex of the tongue, part of the inferior surface, the sides, and dorsum are 
free. 
The Dorsum of the Tongue (dorsum linguae) (Fig. 943) is convex and marked by 
a median sulcus, which divides it into symmetrical halves; this sulcus ends behind, 
about 2.5 cm. from the root of the organ, in a depression, the foramen cecum, 
from which a shallow groove, the sulcus terminalis, runs lateralward and forward 
on either side to the margin of the tongue. The part of the dorsum of the tongue THE MOUTH 
1127 
in front of this groove, forming about two-thirds of its surface, looks upward, and 
is rough and covered with papillae; the posterior third looks backward, and is 
smoother, and contains numerous muciparous glands and lymph follicles (lingual 
tonsil}. The foramen cecum is the remains of the upper part of the thyroglossal 
duct or diverticulum from which the thyroid gland is developed; the pyramidal 
lobe of the thyroid gland indicates the position of the lower part of the duct. 
Fig. 943.-The mouth cavity. The cheeks have been slit transversely and the tongue pulled forward. 
The Papillae of the Tongue (Fig. 943) are projections of the corium. They are 
thickly distributed over the anterior two-thirds of its dorsum, giving to this surface 
its characteristic roughness. The varieties of papillae met with are the papillae 
vallatae, papillae fungiformes, papillae filiformes, and papillae simplices. 
The papillae vallatae (circumvallate papillae} (Fig. 944) are of large size, and vary 
from eight to twelve in number. They are situated on the dorsum of the tongue 
immediately in front of the foramen cecum and sulcus terminalis, forming a row 
on either side; the two rows run backward and medialward, and meet in the middle 
line, like the limbs of the letter V inverted. Each papilla consists of a projection 
of mucous membrane from 1 to 2 mm. wide, attached to the bottom of a circular 
depression of the mucous membrane; the margin of the depression is elevated to 
form a wall (vallum}, and between this and the papilla is a circular sulcus termed 1128 
SPLANCHNOLOGY 
the fossa. The papilla is shaped like a truncated cone, the smaller end being 
directed downward and attached to the tongue, the broader part or base projecting 
a little above the surface of the tongue and being studded with numerous small 
secondary papillse and covered by stratified squamous epithelium. 
Fig. 944.-Vertical section of vallate papilla from 
the calf. (Engelmann.) A. The papilla. B. The 
surrounding wall. n. Nerves, d. Duct of a lingual 
gland. 
Fig. 945.-A filiform papilla. Magnified 
Ihe papillae fungiformes (fungiform papulae) (rig. 946), more numerous than the 
preceding, are found chiefly at the sides and apex, but are scattered irregularly 
and sparingly over the dorsum. They are easily recognized, among the other 
papillae, by their large size, rounded eminences, and deep red color. They are 
narrow at their attachment to the tongue, but 
broad and rounded at their free extremities, and 
covered with secondary papillae. 
The papillae filif ormes (filiform or conical papillae) 
(Fig. 945) cover the anterior two-thirds of the 
dorsum. They are very minute, filiform in shape, 
and arranged in lines parallel with the two rows of 
the papillae vallatae, excepting at the apex of the 
organ, where their direction is transverse. Pro- 
jecting from their apices are numerous filamentous 
processes, or secondary papillae; these are of a 
whitish tint, owing to the thickness and density of 
the epithelium of which they are composed, and which has here undergone a 
peculiar modification, the cells having become cornified and elongated into dense, 
imbricated, brush-like processes. They contain also a number of elastic fibres, 
which render them firmer and more elastic than the papillae of mucous membrane 
generally. The larger and longer papillae of this group are sometimes termed 
papillae conicae. 
The papillae simplices are similar to those of the skin, and cover the whole of 
the mucous membrane of the tongue, as well as the larger papillae. They consist 
of closely set microscopic elevations of the corium, each containing a capillary 
loop, covered by a layer of epithelium. 
Muscles of the Tongue.-The tongue is divided into lateral halves by a median 
fibrous septum which extends throughout its entire length and is fixed below to the 
hyoid bone. In either half there are two sets of muscles, extrinsic and intrinsic; 
the former have their origins outside the tongue, the latter are contained entirely 
within it. 
Fig. 946.-Section of a fungiform 
papilla. Magnified. THE MOUTH 
1129 
The extrinsic muscles (Fig. 947) are: 
Genioglossus. 
Hyoglossus. 
Chondroglossus. 
Styloglossus. 
Glossopalatinus.1 
Fig. 947.-Extrinsic muscles of the tongue. Left side. 
The Genioglossus (Geniohyoglossus) is a flat triangular muscle close to and par- 
allel with the median plane, its apex corresponding with its point of origin from the 
mandible, its base with its insertion into the tongue and hyoid bone. It arises 
by a short tendon from the superior mental spine on the inner surface of the sym- 
physis menti, immediately above the Geniohyoideus, and from this point spreads 
out in a fan-like form. The inferior fibres extend downward, to be attached by a 
thin aponeurosis to the upper part of the body of the hyoid bone, a few passing 
between the Hyoglossus and Chondroglossus to blend with the Constrictores 
pharyngis; the middle fibres pass backward, and the superior ones upward and for- 
ward, to enter the whole length of the under surface of the tongue, from the root 
to the apex. The muscles of opposite sides are separated at their insertions by the 
median fibrous septum of the tongue; in front, they are more or less blended owing 
to the decussation of fasciculi in the median plane. 
The Hyoglossus, thin and quadrilateral, arises from the side of the body and 
from the whole length of the greater cornu of the hyoid bone, and passes almost 
vertically upward to enter the side of the tongue, between the Styloglossus and 
Longitudinalis inferior. The fibres arising from the body of the hyoid bone overlap 
those from the greater cornu. 
Relations.-The Hyoglossus is in relation by its superficial surface with the Digastricus, the 
Stylohyoideus, Styloglossus, and Mylohyoideus, the submaxillary ganglion, the lingual and 
1 The Glossopalatinus (Palatoglossus), although one of the muscles of the tongue, is more closely associated with the 
soft palate both in situation and function; it has consequently been described with the muscles of that structure 
(p. 1114). 1130 
SPLANCHNOLOGY 
hypoglossal nerves, the ranine vein, the sublingual gland, the deep portion of the submaxillary 
gland, and the submaxillary duct. By its deep surface it is in relation with the stylohyoid liga- 
ment, the Genioglossus, Longitudinalis inferior, and Constrictor pharyngis medius, the lingual 
vessels, and the glossopharyngeal nerve. 
The Chondroglossus is sometimes described as a part of the Hyoglossus, but is 
separated from it by fibres of the Genioglossus, which pass to the side of the 
pharynx. It is about 2 cm. long, and arises from the medial side and base of the 
lesser cornu and contiguous portion of the body of the hyoid bone, and passes 
directly upward to blend with the intrinsic muscular fibres of the tongue, between 
the Hyoglossus and Genioglossus. 
A small slip of muscular fibres is occasionally found, arising from the cartilage 
triticea in the lateral hyothyroid ligament and entering the tongue with the hinder- 
most fibres of the Hyoglossus. 
The Styloglossus, the shortest and smallest of the three styloid muscles, arises 
from the anterior and lateral surfaces of the styloid process, near its apex, and 
from the stylomandibular ligament. Passing downward and forward between the 
internal and external carotid arteries, it divides upon the side of the tongue 
into two portions: one, longitudinal, enters the side of the tongue near its 
dorsal surface, blending with the fibres of the Longitudinalis inferior in front of 
the Hyoglossus; the other, oblique, overlaps the Hyoglossus and decussates with 
its fibres. 
The intrinsic muscles (Fig. 948) are: 
Longitudinalis superior. 
Longitudinalis inferior. 
Transversus. 
Verticalis. 
The Longitudinalis linguae superior {Superior lingualis) is a thin stratum of oblique 
and longitudinal fibres immediately underlying the mucous membrane on the 
dorsum of the tongue. It arises from 
the submucous fibrous layer close to 
the epiglottis and from the median 
fibrous septum, and runs forward to 
the edges of the tongue. 
The Longitudinalis linguae inferior 
{Inferior lingualis') is a narrow band 
situated on the under surface of the 
tongue between the Genioglossus and 
Hyoglossus. It extends from the root 
to the apex of the tongue: behind, 
some of its fibres are connected with 
the body of the hyoid bone; in front 
it blends with the fibres of the Stylo- 
glossus. 
The Transversus linguae {Transverse 
lingualis) consists of fibres which arise 
from the median fibrous septum and 
pass lateralward to be inserted into 
the submucous fibrous tissue at the 
sides of the tongue. 
The Verticalis linguae {Vertical lin- 
gualis) is found only at the borders of 
the forepart of the tongue. Its fibres extend from the upper to the under surface 
of the organ. 
Applied Anatomy.-The median fibrous septum of the tongue is very complete, so that the 
anastomosis between the two lingual arteries is not very free. This is a point of considerable 
Fig. 948.-Coronal section of tongue, showing intrinsic 
muscles. (Altered from Krause.) a. Lingual artery, b. 
Longitudinalis inferior, c. Hyoglossus. d. Styloglossus, e. 
Insertion of Transversus. f. Longitudinalis superior, g. 
Papillae of tongue, h. Vertical fibres of Genioglossus inter- 
secting Transversus. i. Septum. THE MOUTH 
1131 
importance in connection with removal of one-half of the tongue for cancer, an operation fre- 
quently resorted to when the disease is strictly confined to one side of the organ. If the mucous 
membrane be divided exactly in the middle line, the tongue can be split into halves, without any 
appreciable hemorrhage, and the diseased half can then be removed. 
Nerves.-The muscles of the tongue described above are supplied by the hypoglossal nerve. 
Actions.-The movements of the tongue, although numerous and complicated, may be under- 
stood by carefully considering the direction of the fibres of its muscles. The Genioglossi, by means 
of their posterior fibres, draw the root of the tongue forward, and protrude the apex from the 
mouth. The anterior fibres draw the tongue back into the mouth. The two muscles acting in 
their entirety draw the tongue downward, so as to make its superior surface concave from side 
to side, forming a channel along which fluids may pass toward the pharynx, as in sucking. The 
Hyoglossi depress the tongue, and draw down its sides. The Styloglossi draw the tongue upward 
and backward. The Glossopalatini draw the root of the tongue upward. The intrinsic muscles 
are mainly concerned in altering the shape of the tongue, whereby it becomes shortened, nar- 
rowed, or curved in different directions; thus, the Longitudinalis superior and inferior tend to 
shorten the tongue, but the former, in addition, turn the tip and sides upward so as to render 
the dorsum concave, while the latter pull the tip downward and render the dorsum convex. 
The Transversus narrows and elongates the tongue, and the Verticalis flattens and broadens it. 
The complex arrangement of the muscular fibres of the tongue, and the various directions in 
which they run, give to this organ the power of assuming the forms necessary for the enuncia- 
tion of the different consonantal sounds; and Macalister states "there is reason to believe that 
the musculature of the tongue varies in different races owing to the hereditary practice and 
habitual use of certain motions required for enunciating the several vernacular languages." 
Structure of the Tongue.-The tongue is partly invested by mucous membrane and a sub- 
mucous fibrous layer. 
The mucous membrane {tunica mucosa linguae') differs in different parts. That covering the 
under surface of the organ is thin, smooth, and identical in structure with that lining the rest 
of the oral cavity. The mucous membrane of the dorsum of the tongue behind the foramen 
cecum and sulcus terminalis is thick and freely movable over the subjacent parts. It contains 
a large number of lymphoid follicles, which together constitute what is sometimes termed the 
lingual tonsil. Each follicle forms a rounded eminence, the centre of which is perforated by a 
minute orifice leading into a funnel-shaped cavity or recess; around this recess are grouped 
numerous oval or rounded nodules of lymphoid tissue, each enveloped by a capsule derived from 
the submucosa, while opening into the bottom of' the recesses are also seen the ducts of mucous 
glands. The mucous membrane on the anterior part of the dorsum of the tongue is thin, inti- 
mately adherent to the muscular tissue, and presents numerous minute surface eminences, the 
papillae of the tongue. It consists of a layer of connective tissue, the corium or mucosa, covered 
with epithelium. 
The epithelium is of the stratified squamous variety, similar to but much thinner than that 
of the skin: and each papilla has a separate investment from root to summit. The deepest cells 
may sometimes be detached as a separate layer, corresponding to the rete mucosum, but they 
never contain coloring matter. 
The corium consists of a dense felt-work of fibrous connective tissue, with numerous elastic 
fibres, firmly connected with the fibrous tissue forming the septa between the muscular bundles 
of the tongue. It contains the ramifications of the numerous vessels and nerves from which 
the papillae are supplied, large plexuses of lymphatic vessels, and the glands of the tongue. 
Structure of the Papillae.-The papillae apparently resemble in structure those of the cutis, 
consisting of cone-shaped projections of connective tissue, covered with a thick layer of stratified 
squamous epithelium, and containing one or more capillary loops among which nerves are dis- 
tributed in great abundance. If the epithelium be removed, it will be found that they are not 
simple elevations like the papillae of the skin, for the surface of each is studded with minute 
conical processes which form secondary papillae. In the papillae vallatae, the nerves are numer- 
ous and of large size; in the papillae fungiformes they are also numerous, and end in a plexiform 
net-work, from which brush-like branches proceed; in the papillae filiformes, their mode of 
termination is uncertain. 
Glands of the Tongue.-The tongue is provided with mucous and serous glands. 
The mucous glands are similar in structure to the labial and buccal glands. They are found 
especially at the back part behind the vallate papillae, but are also present at the apex and mar- 
ginal parts. In this connection the anterior lingual glands (Blandin or Nuhn) require special 
notice. They are situated on the under surface of the apex of the tongue (Fig. 942), one on either 
side of the frenulum, where they are covered by a fasciculus of muscular fibres derived from the 
Styloglossus and Longitudinalis inferior. They are from 12 to 25 mm. long, and about 8 mm. 
broad, and each opens by three or four ducts on the under surface of the apex. 
The serous glands occur only at the back of the tongue in the neighborhood of the taste-buds, 
their ducts opening for the most part into the fossae of the vallate papillae. These glands are 
racemose, the duct of each branching into several minute ducts, which end in alveoli, lined by 1132 
SPLANCHNOLOGY 
a single layer of more or less columnar epithelium. Their secretion is of a watery nature, and 
probably assists in the distribution of the substance to be tasted over the taste area. (Ebner.) 
The septum consists of a vertical layer of fibrous tissue, extending throughout the entire 
length of the median plane of the tongue, though not quite reaching the dorsum. It is thicker 
behind than in front, and occasionally contains a small fibrocartilage, about 6 mm. in length. 
It is well displayed by making a vertical section across the organ. 
The hyoglossal membrane is a strong fibrous lamina, which connects the under surface of 
the root of the tongue to the body of the hyoid bone. This membrane receives, in front, some 
of the fibres of the Genioglossi. 
Taste-buds, the end-organs of the gustatory sense, are scattered over the mucous membrane 
of the mouth and tongue at irregular intervals. They occur especially in the sides of the vallate 
papillae. In the rabbit there is a localized area at the side of the base of the tongue, the papilla 
foliata, in which they are especially abundant (Fig. 949). They are described under the organs 
of the senses (page 1007). 
Fig. 949.-Vertical section of papilla foliata of the rabbit, passing across the folia. (Ranvier.) a. Serous gland. 
g. Gustatory, calyculus. n. Nerve bundles, p. Central lamina of corium. p'. Lateral lamina, z. Section across a 
sinus-like vein, which traverses the whole length of the folium. 
Vessels and Nerves.-The main artery of the tongue is the lingual branch of the external 
carotid, but the external maxillary and ascending pharyngeal also give branches to it. The 
veins open into the internal jugular. 
The lymphatics of the tongue have been described on page 778. 
The sensory nerves of the tongue are: (1) the lingual branch of the mandibular, which is 
distributed to the papillae at the forepart and sides of the tongue, and forms the nerve of ordinary 
sensibility for its anterior two-thirds; (2) the chorda tympani branch of the facial, which runs 
in the sheath of the lingual, and is generally regarded as the nerve of taste for the anterior two- 
thirds; this nerve is a continuation of the sensory root of the facial (nervus intermedins'); (3) the 
lingual branch of the glossopharyngeal, which is distributed to the mucous membrane at the 
base and sides of the tongue, and to the papillae vallatae, and which supplies both gustatory 
filaments and fibres of general sensation to this region; (4) the superior laryngeal, which sends 
some fine branches to the root near the epiglottis. 
Applied Anatomy.-The diseases to which the tongue is liable are numerous, and any or all of 
the structures of which it is composed-muscles, connective tissue, mucous membrane, glands, 
vessels, nerves, and lymphatics-may be the seat of morbid changes. It is not often the seat 
of congenital defects, though a few cases of vertical cleft have been recorded, and it is occasionally, 
though much more rarely than is commonly supposed, the seat of "tongue-tie," from shortness 
of the frenulum. 
There is one condition which may be regarded as congenital, the so-called macroglossia, though 
sometimes it does not evidence itself until a year or two after birth. This is an enlargement 
of the tongue which is due primarily to a dilatation of the lymph channels and a greatly increased 
development of the lymphatic tissue throughout the organ. This is often aggravated by inflam- 
matory changes induced by injury or exposure, and the tongue may assume enormous dimensions 
and hang out of the mouth, giving the child an imbecile expression. The treatment consists in 
excising a V-shaped portion and bringing the cut surfaces together with deeply placed sutures. 
Acute inflammation of the tongue, which may be caused by injury and the introduction of 
some septic or irritating matter, is attended by great swelling from infiltration of its connective THE MOUTH 
1133 
tissue, which is in considerable quantity. This renders the patient incapable of swallowing or 
speaking, and may seriously impede respiration. It may run on to suppuration, and the forma- 
tion of an acute abscess. 
In all ages the mucous membrane of the tongue has received much sedulous consideration in 
disease, and it is certain that the amount and the distribution of the "fur" with which it may 
be covered often give valuable help in diagnosis. The fur consists of proliferating or desquamated 
epithelium, bound up with inspissated mucus, the debris of food, and bacteria of all sorts. The 
mucous membrane of the tongue may become chronically inflamed, and presents different appear- 
ances in the various stages of the disease, to which the terms leucoplakia and psoriasis linguae 
have been given. They are usually the result of syphilis. 
The tongue is frequently the seat of ulceration, which may arise from many causes, as from 
the irritation of jagged teeth, dyspepsia, tuberculosis, syphilis, and cancer. Of these the can- 
cerous ulcer is the most important and also the most common. The variety is the squamous 
epithelioma, which soon develops into an ulcer with an indurated edge. It causes great pain, 
which speedily extends to all parts supplied with sensation by the trigeminal nerve, especially 
to the region of the ear (auriculotemporal nerve). 
Cancer of the tongue may necessitate removal of a part or the whole of the organ, and many 
different methods have been adopted for its excision. It may be removed from the mouth by 
the scissors; this is usually known as Whitehead's method. The mouth is widely opened with 
a gag, the tongue transfixed with a stout silk ligature, by which to hold and make traction on it; 
the reflection of mucous membrane from the tongue to the jaw, and the insertion of the Genio- 
glossus, are first divided with a pair of curved, blunt-pointed scissors. The Glossopalatinus is 
also divided. The tongue can now be pulled well out of the mouth. The base of the tongue is cut 
through by a series of short snips, each bleeding vessel being dealt with as soon as divided, until 
the situation of the main artery is reached. The remaining undivided portion of tissue is to be 
seized with a pair of Wells' forceps, the tongue removed, and the vessel secured. In the event 
of the artery being accidentally injured, hemorrhage can be at once controlled by passing the 
forefinger over the tongue till it touches the epiglottis, and then turning it toward the side on 
which the artery is to be compressed, and pushing it forcibly against the jaw (Heath). In cases 
where the disease is confined to one side of the tongue, this operation may be modified by splitting 
the tongue down the centre and removing only the affected half. 
In cases where the submaxillary lymph glands are involved, Kocher's operation should be 
resorted to. Having performed a preliminary tracheotomy, Kocher removes the tongue from 
the neck by an incision from near the lobule of the auricula, down the anterior border of the 
Sternocleidomastoideus to the level of the greater cornu of the hyoid bone, then forward to the 
body of the hyoid bone, and upward to near the symphysis menti. The lingual artery is now 
secured, and by a careful dissection the submaxillary lymph glands and the tongue are removed. 
If the lymph glands in the submaxillary region are in any way affected, an extensive dissection 
of these will be required if there is any chance of eradicating the disease, and for this purpose 
it will be found necessary to remove the submaxillary salivary gland. 
The more recent operations aim at, first, clearing the neck thoroughly of affected glands, 
both in the submaxillary region and along the carotid sheath, and secondly, removal of the 
tongue from within the mouth, leaving if possible the mucous membrane of the floor of the 
mouth intact, so as to avoid soiling the large wound in the neck by discharges from the mouth. 
The Salivary Glands (Fig. 952).-Three large pairs of salivary glands communi- 
cate with the mouth, and pour their secretion into its cavity; they are the parotid, 
submaxillary, and sublingual. 
Parotid Gland (glandulae parotis).-The parotid gland (Figs. 950, 951), the largest 
of the three, varies in weight from 14 to 28 gm. It lies upon the side of the face, 
immediately below and in front of the external ear. The main portion of the gland 
is superficial, somewhat flattened and quadrilateral in form, and is placed between 
the ramus of the mandible in front and the mastoid process and Sternocleido- 
mastoideus behind, overlapping, however, both boundaries. Above, it is broad 
and reaches nearly to the zygomatic arch; below, it tapers somewhat to about 
the level of a line joining the tip of the mastoid process to the angle of the mandible. 
The remainder of the gland is irregularly wedge-shaped, and extends deeply 
inward toward the pharyngeal wall. 
The gland is enclosed within a capsule continuous with the deep cervical fascia; 
the layer covering the superficial surface is dense and closely adherent to the 
gland; a portion of the fascia, attached to the styloid process and the angle of the 
mandible, is thickened to form the stylomandibular ligament which intervenes 
between the parotid and submaxillary glands. 1134 
SPLANCHNOLOGY 
The anterior surface of the gland is moulded on the posterior border of the 
ramus of the mandible, clothed by the Pterygoideus interims and Masseter. The 
inner lip of the groove dips, for a short distance, between the two Pterygoid muscles, 
Fig. 950.-Right parotid gland. Posterior and deep aspects. 
while the outer lip extends for some distance over the superficial surface of the 
Masseter; a small portion of this lip immediately below the zygomatic arch is 
usually detached, and is named the accessory part (soda porotidis) of the gland. 
Fig. 951.-Right parotid gland. Deep and anterior aspects. 
The posterior surface is grooved longitudinally and abuts against the external 
acoustic meatus, the mastoid process, and the anterior border of the Sterno- 
cleidomastoideus. THE MOUTH 
1135 
The superficial surface, slightly lobulated, is covered by the integument, the 
superficial fascia containing the facial branches of the great auricular nerve and 
some small lymph glands, and the fascia which forms the capsule of the gland. 
The deep surface extends inward by means of two processes, one of which lies 
on the Digastricus, styloid process, and the styloid group of muscles, and projects 
under the mastoid process and Sternocleidomastoideus; the other is situated in 
front of the styloid process, and sometimes passes into the posterior part of the 
mandibular fossa behind the temporomandibular joint. The deep surface is in 
contact with the internal and external carotid arteries, the internal jugular vein, 
and the vagus and glossopharyngeal nerves. 
The gland is separated from the pharyngeal wall by some loose connective 
tissue. 
Structures within the Gland.-The external carotid artery lies at first on the deep 
surface, and then in the substance of the gland. The artery gives off its posterior 
auricular branch which emerges from the gland behind; it then divides into its 
terminal branches, the internal 'maxillary and superficial temporal; the former runs 
forward deep to the neck of the mandible; the latter runs upward across the zygo- 
matic arch and gives off its transverse facial branch which emerges from the front 
of the gland. Superficial to the arteries are the superficial temporal and internal 
maxillary veins, uniting to form the posterior facial vein; in the low'er part of the 
gland this vein splits into anterior and posterior divisions. The anterior division 
emerges from the gland and unites with the anterior facial to form the common 
facial vein; the posterior unites in the gland with the posterior auricular to form 
the external jugular vein. On a still more superficial plane is the facial nerve, the 
branches of which emerge from the borders of the gland. Branches of the great 
auricular nerve pierce the gland to join the facial, while the auriculotemporal nerve 
issues from the upper part of the gland. 
The parotid duct {ductus parotideus; Stens en's duct) is about 7 cm. long. It 
begins by numerous branches from the anterior part of the gland, crosses the Masse- 
ter, and at the anterior border of this muscle turns inward nearly at a right angle, 
passes through the corpus adiposum of the cheek and pierces the Buccinator; it 
then runs for a short distance obliquely forward between the Buccinator and mucous 
membrane of the mouth, and opens upon the oral surface of the cheek by a small 
orifice, opposite the second upper molar tooth. While crossing the Masseter, 
it receives the duct of the accessory portion; in this position it lies between the 
branches of the facial nerve; the accessory part of the gland and the transverse 
facial artery are above it. 
Structure.-The parotid duct is dense, its wall being of considerable thickness; its canal is. 
about the size of a crow-quill, but at its orifice on the oral surface of the cheek its lumen is 
greatly reduced in size. It consists of a thick external fibrous coat which contains contractile 
fibres, and of an internal or mucous coat lined with short columnar epithelium. 
Vessels and Nerves.-The arteries supplying the parotid gland are derived from the external 
carotid, and from the branches given off by that vessel in or near its substance. The veins 
empty themselves into the external jugular, through some of its tributaries. The lymphatic 
end in the superficial and deep cervical lymph glands, passing in their course through two of 
three glands, placed on the surface and in the substance of the parotid. The nerves are derived 
from the plexus of the sympathetic on the external carotid artery, the facial, the auriculotem- 
poral, and the great auricular nerves. It is probable that the branch from the auriculotemporal 
nerve is derived from the glossopharyngeal through the otic ganglion. At all events, in some of 
the lower animals this has been proved experimentally to be the case. 
Submaxillary Gland (glandula submaxillaris).-The submaxillary gland (Fig. 
952) is irregular in form and about the size of a walnut. A considerable part of 
it is situated in the submaxillary triangle, reaching forward to the anterior belly 
of the Digastricus and backward to the stylomandibular ligament, which inter- 
venes between it and the parotid gland. Above, it extends under cover of the 1136 
SPLANCHNOLOGY 
body of the mandible; below, it usually overlaps the intermediate tendon of 
the Digastricus and the insertion of the Stylohyoideus, while from its deep surface 
a tongue-like deep process extends forward above the Mylohyoideus muscle. 
Its superficial surface consists of an upper and a lower part. The upper part 
is directed outward, and lies partly against the submaxillary depression on the 
inner surface of the body of the mandible, and partly on the Pterygoideus interims. 
The lower part is directed downward and outward, and is covered by the skin, 
superficial fascia, Platysma, and deep cervical fascia; it is crossed by the anterior 
facial vein and by filaments of the facial nerve; in contact with it, near the mandible, 
are the submaxillary lymph glands. 
Fig. 952.-Dissection, showing salivary glands of right side. 
The deep surface is in relation with the Mylohyoideus, Hyoglossus, Styloglossus, 
Stylohyoideus, and posterior belly of the Digastricus; in contact with it are the 
mylohyoid nerve and the mylohyoid and submental vessels. 
The external maxillary artery is imbedded in a groove in the posterior border 
of the gland. 
The deep process of the gland extends forward between the Mylohyoideus 
below and externally, and the Hyoglossus and Styloglossus internally; above 
it, is the lingual nerve and submaxillary ganglion; below it, the hypoglossal nerve 
and its accompanying vein. 
The submaxillary duct {ductus submaxillaris; Wharton's duct) is about 5 cm. long, 
and its wall is much thinner than that of the parotid duct. It begins by numerous 
branches from the deep surface of the gland, and runs forward between the Mylo- 
hyoideus and the Hyoglossus and Genioglossus, then between the sublingual 
gland and the Genioglossus, and opens by a narrow orifice on the summit of a small 
papilla, at the side of the frenulum linguae. On the Hyoglossus it lies between the THE MOUTH 
1137 
lingual and hypoglossal nerves, but at the anterior border of the muscle it is crossed 
laterally by the lingual nerve; the terminal branches of the lingual nerve ascend 
on its medial side. 
Vessels and Nerves.-The arteries supplying the submaxillary gland are branches of the 
external maxillary and lingual. Its veins follow the course of the arteries. The nerves are 
derived from the submaxillary ganglion, through which it receives filaments from the chorda 
tympani of the facial nerve and the lingual branch of the mandibular, sometimes from the 
mylohyoid branch of the inferior alveolar, and from the sympathetic. 
Sublingual Gland (glandula sublingualis).-The sublingual gland (Fig. 952) is the 
smallest of the three glands. It is situated beneath the mucous membrane of 
the floor of the mouth, at the side of the frenulum linguae, in contact with the 
sublingual depression on the inner surface of the mandible, close to the symphysis. 
It is narrow, flattened, shaped somewhat like an almond, and weighs nearly 2 gm. 
It is in relation, above, with the mucous membrane; below, with the Mylohyoideus; 
in front, with its fellow of the opposite side; behind, with the deep part of the sub- 
maxillary gland; laterally, with the mandible; and medially, with the Genioglossus, 
from which it is separated by the lingual nerve and the submaxillary duct. Its 
excretory ducts are from eight to twenty in number. Of the smaller sublingual 
ducts (ducts of Rivinus), some join the submaxillary duct; others open separately 
into the mouth, on the elevaterd crest of mucous membrane (plica sublingualis), 
caused by the projection of the gland, on either side of the frenulum linguae. One 
or more join to form the larger sublingual duct (duct of Bartholin), which opens into 
the submaxillary duct. 
Vessels and Nerves.-The sublingual gland is supplied with blood from the sublingual and 
submental arteries. Its nerves are derived from the lingual, the chorda tympani, and the 
sympathetic. 
Structure of the Salivary Glands.-The salivary glands are compound racemose glands, 
consisting of numerous lobes, which are made up of smaller lobules, connected together by 
dense areolar tissue, vessels, and ducts. Each lobule consists of the ramifications of a single 
duct, the branches ending in dilated ends or alveoli on which the capillaries are distributed. 
The alveoli are enclosed by a basement-membrane, which is continuous with the membrana 
propria of the duct and consists of a net-work of branched and flattened nucleated cells. 
The alveoli of the salivary glands are of two kinds, which differ in the appearance of their 
secreting cells, in their size, and in the nature of their secretion. (1) The mucous variety secretes 
a viscid fluid, which contains mucin; (2) the serous variety secretes a thinner and more watery 
fluid. The sublingual gland consists of mucous, the parotid of serous alveoli. The submaxillary 
contains both mucous and serous alveoli, the latter, however, preponderating. 
The cells in the mucous alveoli are columnar in shape. In the fresh condition they contain 
large granules of mucinogen. In hardened preparations a delicate protoplasmic net-work is seen, 
and the cells are clear and transparent. The nucleus is usually situated near the basement- 
membrane, and is flattened. 
In some alveoli are seen peculiar crescentic bodies, lying between the cells and the mem- 
brana propria. They are termed the crescents of Gianuzzi, or the demilunes of Heidenhain 
(Fig. 953), and are composed of polyhedral granular cells, which Heidenhain regards as young 
epithelial cells destined to supply the place of those salivary cells which have undergone 
disintegration. This view, however, is not accepted by Klein. Fine canaliculi pass between 
the mucus-secreting cells to reach the demilunes and even penetrate the cells forming these 
structures. 
In the serous alveoli the cells almost completely fill the cavity, so that there is hardly any 
lumen perceptible; they contain secretory granules imbedded in a closely reticulated protoplasm 
(Fig. 954). The cells are more cubical than those of the mucous type; the nucleus of each is 
spherical and placed near the centre of the cell, and the granules are smaller. 
Both mucous and serous cells vary in appearance according to whether the gland is in a resting 
condition or has been recently active. In the former case the cells are large and contain many 
secretory granules; in the latter case they are shrunken and contain few granules, chiefly collected 
at the inner ends of the cells. The granules are best seen in fresh preparations. 
The ducts are lined at their origins by epithelium which differs little from the pavement form. 
As the ducts enlarge, the epithelial cells change to the columnar type, and the part of the cell 
next the basement-membrane is finely striated. 1138 
SPLANCHNOLOGY 
The lobules of the salivary glands are richly supplied with bloodvessels which form a dense 
net-work in the interalveolar spaces. Fine plexuses of nerves are also found in the interlobular 
tissue. The nerve fibrils pierce the basement-membrane of the alveoli, and end in branched 
varicose filaments between the secreting cells. In the hilus of the submaxillary gland there is 
a collection of nerve cells termed Langley's ganglion 
Fig. 953.-Section of submaxillary gland of kitten. Duct 
semidiagrammatic. X 200. 
Fig. 954.-Human submaxillary gland. (R. Heiden- 
hain.) To the right of the figure is a group of mucous 
alveoli, to the left a group of serous alveoli. 
Accessory Glands.-Besides the salivary glands proper, numerous other glands are found 
in the mouth. Many of these glands are found at the posterior part of the dorsum of the tongue 
behind the vallate papillae, and also along its margins as far forward as the apex. Others he 
around and in the palatine tonsil between its crypts, and large numbers are present in the soft 
palate, the lips, and cheeks. These glands are of the same structure as the larger salivary glands, 
and are of the mucous or mixed type. 
Applied Anatomy.-The parotid glands, and much less often the other salivary glands, are 
liable to an acute infectious inflammation, known in the case of the parotid as mumps. The 
affected glands swell up, becoming tense, tender, and painful; much pain is felt when swallowing 
or mastication is attempted, and salivation may or may not occur. The inflammation goes 
down after a few days; suppuration in the affected glands is very rare. 
THE PHARYNX. 
The pharynx is that part of the digestive tube which is placed behind the nasal 
cavities, mouth, and larynx. It is a musculomembranous tube, somewhat conical 
in form, with the base upward, and the apex downward, extending from the under 
surface of the skull to the level of the cricoid cartilage in front, and that of the 
sixth cervical vertebra behind. 
The cavity of the pharynx is about 12.5 cm. long, and broader in the transverse 
than in the antero-posterior diameter. Its greatest breadth is immediately below 
the base of the skull, where it projects on either side, behind the pharyngeal ostium 
of the auditory tube, as the pharyngeal recess (fossa of Rosenmuller); its narrowest 
point is at its termination in the oesophagus. It is limited, above, by the body 
of the sphenoid and basilar part of the occipital bone; below, it is continuous with 
the oesophagus; posteriorly, it is connected by loose areolar tissue with the cervical 
portion of the vertebral column, and the prevertebral fascia covering the Longus 
colli and Longus capitis muscles; anteriorly, it is incomplete, and is attached in THE PHARYNX 
1139 
succession to the medial pterygoid plate, pterygomandibular raphe, mandible, 
tongue, hyoid bone, and thyroid and cricoid cartilages; laterally, it is connected to 
the styloid processes and their muscles, and is in contact with the common and 
internal carotid arteries, the internal jugular veins, the glossopharyngeal, vagus, 
and hypoglossal nerves, and the sympathetics trunks, and above with small parts 
of the Pterygoidei interni. Seven cavities communicate with it, viz., the two 
nasal cavities, the two tympanic cavities, the mouth, the larynx, and the oesophagus. 
The cavity of the pharynx may be subdivided from above downward into three 
parts: nasal, oral, and laryngeal (Fig. 927). 
Fig. 955.-Front of nasal part of pharynx, as seen with the laryngoscope. 
The Nasal Part of the Pharynx (pars nasalis pharyngis; nasopharynx) lies behind 
the nose and above the level of the soft palate: it differs from the oral and laryn- 
geal parts of the pharynx in that its cavity always remains patent. In front (Fig. 
955) it communicates through the choanse with the nasal cavities. On its lateral 
wall is the pharyngeal ostium of the auditory tube, somewhat triangular in shape, 
and bounded behind by a firm prominence, the torus or cushion, caused by the 
medial end of the cartilage of the tube which elevates the mucous membrane. 
A vertical fold of mucous membrane, the salpingopharyngeal fold, stretches from 
the lower part of the torus; it contains the Salpingopharyngeus muscle. A second 
and smaller fold, the salpingopalatine fold, stretches from the upper part of the torus 
to the palate. Behind the ostium of the auditory tube is a deep recess, the pharyn- 
geal recess (fossa of Rosenmuller). On the posterior wall is a prominence, best 
marked in childhood, produced by a mass of lymphoid tissue, which is known as the 
pharyngeal tonsil. Above the pharyngeal tonsil, in the middle line, an irregular 
flask-shaped depression of the mucous membrane sometimes extends up as far 
as the basilar process of the occipital bone; it is known as the pharyngeal bursa. 
The oral part of the pharynx (pars oralis pharyngis) reaches from the soft palate 
to the level of the hyoid bone. It opens anteriorly, through the isthmus faucium, 
into the mouth, while in its lateral wall, between the two palatine arches, is the 
palatine tonsil. 
The Palatine Tonsils (tonsillae palatinae; tonsil) are two prominent masses situated 
one on either side between the glossopalatine and pharyngopalatine arches. Each 
tonsil consists fundamentally of an aggregation of lymphoid tissue underlying 
the mucous membrane between the palatine arches. The lymphoid mass, however, 
does not completely fill the interval between the two arches, so that a small depres- 
sion, the supratonsillar fossa, exists at the upper part of the interval. Further, 1140 
SPLANCHNOLOGY 
the tonsil extends for a variable distance under cover of the glossopalatine arch, 
and is here covered by a reduplication of mucous membrane; the upper part of this 
fold reaches across the supratonsillar fossa, between the two arches, as a thin 
fold sometimes termed the plica semilunaris; the remainder of the fold is called the 
plica triangularis. Between the plica triangularis and the surface of the tonsil is 
a space known as the tonsillar sinus; in many cases, however, this sinus is obliterated 
by its walls becoming adherent. From this description it will be apparent that a 
portion of the tonsil is below the level of the surrounding mucous membrane, i. e., is 
imbedded, while the remainder projects as the visible tonsil. In the child the 
tonsils are relatively (and frequently absolutely) larger than in the adult, and about 
one-third of the tonsil is imbedded. After puberty the imbedded portion diminishes 
considerably in size and the tonsil assumes a disk-like form, flattened from side 
to. side; the shape and size of the tonsil, however, vary considerably in different 
individuals. 
Fiq. 956.-Section through one of the crypts of the tonsil. (Stohr.) Magnified, e. Stratified epithelium of general 
surface, continued into crypt, f, f. Nodules of lymphoid tissue-opposite each nodule numbers of lymph cells are 
passing into or through the epithelium, s, s. Cells which have thus escaped to mix with the saliva as salivary corpuscles. 
The medial surface of the tonsil is free except anteriorly, where it is covered by 
the plica triangularis; it presents from twelve to fifteen orifices leading into small 
crypts or recesses from which numerous follicles branch out into the tonsillar 
substance. 
The lateral or deep surface is adherent to a fibrous capsule which is continued 
into the plica triangularis. It is separated from the inner surface of the Constrictor 
pharyngis superior usually by some loose connective tissue; this muscle intervenes 
between the tonsil and the external maxillary artery with its tonsillar and ascend- 
ing palatine branches. The internal carotid artery lies behind and lateral to the 
tonsil at a distance of 20 to 25 mm. from it. 
The tonsils form part of a circular band of adenoid tissue which guards the 
opening into the digestive and respiratory tubes. The anterior part of the ring 
is formed by the submucous adenoid collections (lingual tonsil) on the posterior 
part of the tongue; the lateral portions consist of the palatine tonsils and the ade- 
noid collections in the vicinity of the auditory tubes, while the ring is completed THE PHARYNX 
1141 
behind by the pharyngeal tonsil on the posterior wall of the pharynx. In the 
intervals between these main masses are smaller collections of adenoid tissue. 
Structure (Fig. 956).-The follicles of the tonsil are lined by a continuation of the mucous 
membrane of the pharynx, covered with stratified squamous epithelium; around each follicle 
is a layer of closed capsules consisting of lymphoid tissue imbedded in the submucous tissue. 
Lymph corpuscles are found in large numbers invading the stratified epithelium. It is probable 
that they pass into the mouth and form the so-called salivary corpuscles. Surrounding each 
follicle is a close plexus of lymphatics, from which the lymphatic vessels pass to the deep cervical 
glands in the neighborhood of the greater cornu of the hyoid bone, behind and below the angle 
of the mandible. 
Vessels and Nerves.-The arteries supplying the tonsil are the dorsalis linguae from the 
lingual, the ascending palatine and tonsillar from the external maxillary, the ascending pharyn- 
geal from the external carotid, the descending palatine branch of the internal maxillary, and a 
twig from the small meningeal. 
The veins end in the tonsillar plexus, on the lateral side of the tonsil. 
The nerves are derived from the sphenopalatine ganglion, and from the glossopharyngeal. 
Applied Anatomy.-The palatine tonsils can be easily inspected by instructing the patient 
to throw the head back and open his mouth widely; the tongue at the same time being depressed 
by a spatula or tongue-depressor. The normal tonsil should not project beyond the plane of 
the glossopalatine arch. They are prone to become enlarged, especially in tuberculous children; 
and when much increased in size they cause great trouble, owing to obstruction to respiration 
and deglutition. The tonsils may be the seat of acute inflammation, which may run on to sup- 
puration, requiring evacuation of the pus. The incision into the tonsil should always be made 
from in front backward and medialward. Another form of acute inflammation of the tonsil 
is follicular tonsillitis, due to the lodgement of microorganisms in the crypts of the tonsil. The 
removal of an enlarged tonsil is, as a rule, a very simple operation, and is not usually attended 
with much hemorrhage, unless the patient is suffering from hemophilia. The tonsil may be the 
seat of malignant growth, either an epithelioma or a lymphosarcoma. 
The Laryngeal Part of the Pharynx {pars laryngea pharyngis) reaches from the 
hyoid bone to the lower border of the cricoid cartilage, where it is continuous with 
the oesophagus. In front it presents the triangular entrance of the larynx, the base 
of which is directed forward and is formed by the epiglottis, while its lateral boun- 
daries are constituted by the aryepiglottic folds. On either side of the laryngeal 
orifice is a recess, termed the sinus piriformis, which is bounded medially by the 
aryepiglottic fold, laterally by the thyroid cartilage and hyothyroid membrane. 
MusqGJs of the Pharynx.-The muscles of the pharynx (Fig. 957) are: 
Constrictor inferior. 
Constrictor medius. 
Constrictor superior. 
Styloph aryngeus. 
Salpingopharyngeus. 
Pharyngopalatinus.1 
Dissection.-In order to examine the muscles of the pharynx, cut through the trachea and 
oesophagus just above the sternum, and draw them upward by dividing the loose areolar tissue 
connecting the pharynx with the front of the vertebral column. The parts being drawn well 
forward, apply the edge of the saw immediately behind the styloid processes, and saw the base 
of the skull through from below upward. The pharynx and mouth should then be stuffed with 
tow, in order to distend its cavity and render the muscles tense and easier of dissection. 
The Constrictor pharyngis inferior {Inferior constrictor), the thickest of the 
three constrictors, arises from the sides of the cricoid and thyroid cartilage. 
From the cricoid cartilage it arises in the interval between the Cricothyreoideus 
in front, and the articular facet for the inferior cornu of the thyroid cartilage 
behind. On the thyroid cartilage it arises from the oblique line on the side of the 
lamina, from the surface behind this nearly as far as the posterior border and from 
the inferior cornu. From these origins the fibres spread backward and medialward 
to be inserted with the muscle of the opposite side into the fibrous raphe in the 
posterior median line of the pharynx. The inferior fibres are horizontal and con- 
tinuous with the circular fibres of the oesophagus; the rest ascend, increasing in 
obliquity, and overlap the Constrictor medius. 
1 The Pharyngopalatinus is described with the muscles of the palate (p. 1114). 1142 
SPLANCHNOLOGY 
Relations.-The Constrictor inferior is covered by the thin membrane which surrounds the 
entire pharynx (buccopharyngeal fascia). Behind, it is in relation with the vertebral column and 
the prevertebral fascia and muscles; laterally, with the thyroid gland, the common carotid artery, 
and the Sternothyreoideus; by its internal surface, with the Constrictor medius, the Stylopharyn- 
geus, the Pharyngopalatinus, the pharyngeal aponeurosis and the mucous membrane of the 
pharynx. The internal branch of the superior laryn- 
geal nerve and the laryngeal branch of the superior 
thyroid artery run near the upper border, and the 
recurrent nerve and the laryngeal branch of the 
inferior thyroid artery pass beneath the lower border 
of this muscle, before they enter the larynx. 
The Constrictor pharyngis medius (Middle 
constrictor) is a fan-shaped muscle, smaller 
than the preceding. It arises from the whole 
length of the upper border of the greater 
cornu of the hyoid bone, from the lesser 
cornu, and from the stylohyoid ligament. 
The fibres diverge from their origin: the 
lower ones descend beneath the Constrictor 
inferior, the middle fibres pass transversely, 
and the upper fibres ascend and overlap the 
Constrictor superior. It is inserted into the 
posterior median fibrous raphe, blending 
in the middle line with the muscle of the 
opposite side. 
Relations.-This muscle is separated from the 
Constrictor superior by the glossopharyngeal nerve, 
the Stylopharyngeus and the stylohyoid ligament; 
and from the Constrictor1 inferior by the internal 
branch of the superior laryngeal nerve and laryngeal 
branch of the superior thyroid artery. Behind, it 
lies on the prevertebral fascia, the Longus colli, 
and the Longus capitis. Laterally it is in relation 
with the carotid vessels, the pharyngeal plexus, and 
some lymph glands. Near its origin it is covered by the Hyoglossus, from which it is separated 
by the lingual vessels. It lies upon the Constrictor superior, the Stylopharyngeus, the Pharyngo- 
palatinus, the pharyngeal aponeurosis, and the mucous membrane of the pharynx. 
The Constrictor pharyngis superior (Superior constrictor) is a quadrilateral muscle, 
thinner and paler than the other two. It arises from the lower third of the posterior 
margin of the medial pterygoid plate and its hamulus, from the pterygomandibular 
raphe, from the alveolar process of the mandible above the posterior end of the 
mylohyoid line, and by a few fibres from the side of the tongue. The fibres curve 
backward to be inserted into the median raphe, being also prolonged by means of 
an aponeurosis to the pharyngeal spine on the basilar part of the occipital bone. 
The superior fibres arch beneath the Levator veli palatini and the auditory tube. 
The interval between the upper border of the muscle and the base of the skull is 
closed by the pharyngeal aponeurosis, and is known as the sinus of Morgagni. 
Relations.-The Constrictor superior is in relation by its outer surface with the prevertebral 
fascia and muscles, the vertebral column, the internal carotid and ascending pharyngeal arteries, 
the internal jugular vein and pharyngeal venous plexus, and the glossopharyngeal, vagus, hypo- 
glossal, and lingual nerves, the sympathetic trunks, the Constrictor medius and Pterygoideus 
internus, the styloid process, the stylohyoid ligament, and the Stylopharyngeus. By its internal 
surface it is in relation with the Pharyngopalatinus, the capsule of the palatine tonsil, the pharyn- 
geal aponeurosis, and the mucous membrane of the pharynx. Its lower border is separated from 
the Constrictor medius by the Stylopharyngeus and the glossopharyngeal nerve. 
The Stylopharyngeus (Fig. 947) is a long, slender muscle, cylindrical above, 
flattened below. It arises from the medial side of the base of the styloid process, 
Fig. 957.-Muscles of the pharynx and cheek. THE PHARYNX 
1143 
passes downward along the side of the pharynx between the Constrictores superior 
and medius, and spreads out beneath the mucous membrane. Some of its fibres 
are lost in the Constrictor muscles, while others, joining with the Pharyngopalatinus, 
are inserted into the posterior border of the thyroid cartilage. The glossopharyn- 
geal nerve runs on the lateral side of this muscle, and crosses over it to reach the 
tongue. 
The Salpingopharyngeus (Fig. 928) arises from the inferior part of the auditory 
tube near its orifice; it passes downward and blends with the posterior fasciculus 
of the Pharyngopalatinus. 
Nerves.-The Constrictores and Salpingopharyilgeus are supplied by branches from the 
pharyngeal plexus, the Constrictor inferior by additional branches from the external laryngeal 
and recurrent nerves, and the Stylopharyngeus by the glossopharyngeal nerve. 
Actions.-When deglutition is about to be performed, the pharynx is drawn upward and 
dilated in different directions, to receive the food propelled into it from the mouth. The Stylo- 
pharyngei, which are much farther removed from one another at their origin than at their inser- 
tion, draw the sides of the pharynx upward and lateralward, and so increase its transverse 
diameter; its breadth in the antero-posterior direction is increased by the larynx and tongue 
being carried forward in their ascent. As soon as the bolus of food is received in the pharynx, 
the elevator muscles relax, the pharynx descends, and the Constrictores contract upon the 
bolus, and convey it downward into the oesophagus. 
Structure.-The pharynx is composed of three coats: mucous, fibrous, and muscular. 
The pharyngeal aponeurosis, or fibrous coat, is situated between the mucous and muscular 
layers. It is thick above where the muscular fibres are wanting, and is firmly connected to the 
basilar portion of the occipital and the petrous portions of the temporal bones. As it descends 
it diminishes in thickness, and is gradually lost. It is strengthened posteriorly by a strong fibrous 
band, which is attached above to the pharyngeal spine on the under surface of the basilar portion 
of the occipital bone, and passes downward, forming a median raphe, which gives attachment 
to the Constrictores pharyngis. 
The mucous coat is continuous with that fining the auditory tubes, the nasal cavities, the 
mouth, and the larynx. In the nasal part of the pharynx it is covered by columnar ciliated 
epithelium; in the oral and laryngeal portions the epithelium is stratified squamous. Beneath 
the mucous membrane are found racemose mucous glands; they are especially numerous at the 
upper pa t of the pharynx around the orifices of the auditory tubes. 
Applied Anatomy.-Hypertrophy of the lymphatic tissue in the nasal part of the pharynx 
commonly known as "adenoids," is a frequent cause of mouth-breathing and all its attendant 
disadvantages and dangers in children. It entails a proneness to inflammation of all parts of 
the air passages and the auditory tubes, and leads to deformed development of the palate and 
dental arch. In many cases adenoids tend to atrophy about the age of puberty, by which time 
their presence is likely to have caused permanent injury to the health and development of the 
patient. 
The pharynx is sometimes the seat of a pouch-like dilatation of its walls, in which the food 
collects when the patient swallows. A cure is effected by removing the diverticulum and accu- 
rately suturing the opening which has been made in the pharynx. The internal carotid artery is 
in close relation with the pharynx, so that its pulsations can be felt through the mouth. It has 
been occasionally wounded by sharp-pointed instruments, introduced into the mouth and thrust 
through the wall of the pharynx. In aneurism of this vessel in the neck, the tumor necessarily 
bulges into the pharynx, as this is the direction in which it meets with the least resistance, nothing 
lying between the vessel and the mucous membrane except the thin Constrictor muscles, whereas 
on the lateral side there are the dense cervical fascia, the muscles descending from the styloid 
process, and the margin of the Sternocleidomastoideus. 
The mucous membrane of the pharynx is very vascular, and is often the seat of inflammation, 
frequently of a septic character, since the numerous recesses are prone to lodge microorganisms. 
And, in addition, owing to its exposed situation, the mucous membrane is liable to be irritated 
by agents introduced during inspiration. The inflammation may be attended with serious 
consequences: it may extend up the auditory tube and involve the middle ear; it may spread 
to the entrance of the larynx, causing oedema and seriously interfering with respiration; or, 
invading the lymphatics, it may spread to the loose areolar tissue surrounding the pharyngeal 
wall, and may extend far and wide, sometimes into the posterior mediastinal cavity along the 
oesophagus. Abscess may form in the connective tissue behind the pharynx, between it and 
the vertebral column, constituting what is known as retropharyngeal abscess. This may be due 
to caries of the cervical vertebrae or may be caused by suppuration of the lymph glands, which 
are situated in this position opposite the axis, and which receive the lymphatics from the nasal 
cavities. In these cases the pus may be easily evacuated by incision with a guarded bistoury, 1144 
SPLANCHNOLOGY 
through the mouth, but, for aseptic reasons, it is desirable that the abscess should be opened 
from the neck. In some instances this is perfectly easy: the abscess can be felt bulging at the 
side of the neck, and merely requires an incision for its relief; but this is not always so, and then 
an incision should be made along the posterior border of the Sternocleidomastoideus and the 
deep fascia divided. A director is now to be inserted into the wound, the forefinger of the left 
hand being introduced into the mouth and pressure made upon the swelling. This acts as a 
guide, and the director is to be pushed onward until pus appears in the groove. A pair of sinus 
forceps is now inserted along the director and the opening into the cavity dilated. 
Abscess also occurs in children, underneath the mucous membrane, between it and the pharyn- 
geal aponeurosis. The condition usually arises from a peritonsillar inflammation, which spreads 
backward. In some cases an enormous swelling may form, which pushes forward the soft palate 
and gives rise to respiratory obstruction. In such the abscess should be opened through the 
mouth with the child in the inverted positions, so as to prevent the first gush of pus from entering 
the superior opening of the larynx. 
Foreign bodies not infrequently become lodged in the pharynx, and most usually at its termina- 
tion at about the level of the cricoid cartilage, just beyond the reach of the finger, as the distance 
from the arch of the teeth to the commencement of the oesophagus is about 15 cm. 
THE (ESOPHAGUS (Fig. 958). 
The oesophagus or gullet is a muscular canal, about 23 to 25 cm. long, extending 
from the pharynx to the stomach. It begins in the neck at the lower border of 
the cricoid cartilage, opposite the sixth cervical vertebra, descends along the front 
of the vertebral column, through the superior and posterior mediastinal cavities, 
passes through the Diaphragma, and, entering the abdomen, ends at the cardiac 
orifice of the stomach, opposite the eleventh thoracic vertebra. The general direc- 
tion of the oesophagus is vertical; but it presents two slight curves in its course. 
At its commencement it is placed in the middle line; but it inclines to the left side 
as far as the root of the neck, gradually passes to the middle line again at the level 
of the fifth thoracic vertebra, and finally deviates to the left as it passes forward 
to the oesophageal hiatus in the Diaphragma. The oesophagus also presents 
antero-posterior flexures corresponding to the curvatures of the cervical and 
thoracic portions of the vertebral column. It is the narrowest part of the diges- 
tive tube, and is most contracted at its commencement, and at the point where 
it passes through the Diaphragma. 
Relations.-The cervical portion of the oesophagus is in relation, in front, with the trachea; 
and at the lower part of the neck, where it projects to the left side, with the thyroid gland; behind, 
it rests upon the vertebral column and Longus colli muscles; on either side it is in relation with 
the common carotid artery (especially the left, as it inclines to that side), and parts of the lobes 
of the thyroid gland; the recurrent nerves ascend between it and the trachea; to its left side is 
the thoracic duct. 
The thoracic portion of the oesophagus is at first situated in the superior mediastinal cavity 
between the trachea and the vertebral column, a little to the left of the median line. It then 
passes behind and to the right of the aortic arch, and descends in the posterior mediastinal 
cavity, along the right side of the descending aorta, then runs in front and a little to the left 
of the aorta, and enters the abdomen through the Diaphragma at the level of the tenth thoracic 
vertebra. Just before it perforates the Diaphragma it presents a distinct dilatation. It is in 
relation, in front, with the trachea, the left bronchus, the pericardium, and the Diaphragma; 
behind, it rests upon the vertebral column, the Longus colli muscles, the right aortic intercostal 
arteries, the thoracic duct, and the hemiazygos veins; and below, near the Diaphragma, upon 
the front of the aorta. On its left side, in the superior mediastinal cavity, are the terminal part 
of the aortic arch, the left subclavian artery, the thoracic duct, and left pleura, while running 
upward in the angle between it and the trachea is the left recurrent nerve; below, it is in relation 
with the descending thoracic aorta. On its right side are the right pleura, and the azygos vein 
which it overlaps. Below the roots of the lungs the vagi descend in close contact with it, the 
right nerve passing down behind, and the left nerve in front of it; the two nerves uniting to 
form a plexus around the tube. 
In the lower part of the posterior mediastinal cavity the thoracic duct lies to the right side 
of the oesophagus; higher up, it is placed behind it, and, crossing about the level of the fourth 
thoracic vertebra, is continued, upward on its left side. THE (ESOPHAGUS 
1145 
The abdominal portion of the oesophagus lies in the oesophageal groove on the posterior' surface 
of the left lobe of the liver. It measures about 1.25 cm. in length, and only its front and left 
aspects are covered by peritoneum. It is somewhat conical with its base applied to the upper 
orifice of the stomach, and is known as the antrum cardiacum. 
Structure (Fig. 959).-The oesophagus has four coats: an external or fibrous, a muscular, 
a submucous or areolar, and an internal or mucous coat. 
The muscular coat (tunica muscularis) 
is composed of two planes of consider- 
able thickness: an external of longitu- 
dinal and an internal of circular fibres. 
The longitudinal fibres are arranged, 
at the commencement of the tube, in 
three fasciculi: one in front, which is 
attached to the vertical ridge on the 
posterior surface of the lamina of the 
cricoid cartilage; and one at either 
side, which is continuous with the 
muscular fibres of the pharynx: as 
they descend they blend together, and 
form a uniform layer, which covers the 
outer surface of the tube. 
Accessory slips of muscular fibres 
pass between the oesophagus and the 
Fig. 959.-Section of the human oesophagus. 
(From a drawing by V. Horsley.) Moderately 
magnified. The section is transverse and from 
near the middle of the gullet, a. Fbrous cover- 
ing. &. Divided fibres of longitudinal muscular 
coat. c. Transverse muscular fibres, d. Sub- 
mucous or areolar layer. _ e. Muscularis mucosae. 
f. Mucous membrane, with vessels and part of a 
lymphoid nodule, g. Stratified epithelial lining. 
A. Mucous gland, i. Gland duct. m'. Striated 
muscular fibres cut across. 
Fig. 958.-The oesophagus. 
left pleura, where the latter covers the thoracic aorta, or the root of the left bronchus, or the 
back of the pericardium. 
The circular fibres are continuous above with the Constrictor pharyngis inferior; their direction 
is transverse at the upper and lower parts of the tube, but oblique in the intermediate part. 
The muscular fibres in the upper part of the oesophagus are of a red color, and consist chiefly 
of the striped variety; but below, they consist of the most part of involuntary fibres. 
The areolar or submucous coat (tela submucosa) connects loosely the mucous and muscular 
coats. It contains bloodvessels, nerves, and mucous glands. 1146 
SPLANCHNOLOGY 
The mucous coat {tunica mucosa) is thick, of a reddish color above, and pale below. It is 
disposed in longitudinal folds, which disappear on distension of the tube. Its surface is studded 
with minute papilke, and it is covered throughout with a thick layer of stratified squamous 
epithelium. Beneath the mucous membrane, between it and the areolar coat, is a layer of longi- 
tudinally arranged non-striped muscular fibres. This is the muscularis mucosae. At the com- 
mencement of the oesophagus it is absent, or only represented by a few scattered bundles; lower 
down it forms a considerable stratum. 
The oesophageal glands {glandulae oesophageae) are small compound racemose glands of the 
mucous type: they are lodged in the submucous tissue, and each opens upon the surface by a 
long excretory duct. 
Vessels and Nerves.-The arteries supplying the oesophagus are derived from the inferior 
thyroid branch of the thyrocervical trunk, from the descending thoracic aorta, from the left 
gastric branch of the coeliac artery, and from the left inferior phrenic of the abdominal aorta. 
They have for the most part a longitudinal direction. 
The nerves are derived from the vagi and from the sympathetic trunks; they form a plexus, 
in which are groups of ganglion cells, between the two layers of the muscular coats, and also a 
second plexus in the submucous tissue. 
Applied Anatomy.-The oesophagus may be obstructed by foreign bodies, and also by changes 
in its coats producing stricture, or by pressure on it from without of new growths or aneurism, 
etc. The different forms of stricture are: (1) the fibrous, due to cicatrization following destruc- 
tion of tissue, the result of swallowing boiling or corrosive fluids--here dilatation of the stricture 
may be carried out; and (2) malignant, usually epitheliomatous in its nature. This may be 
situated either at the upper end of the tube, opposite the cricoid cartilage, or at its lower end 
at the cardiac orifice, but is most commonlly found in that part of the tube which is crossed by 
the left bronchus. In these cases, if the patient is losing weight from insufficient nourishment, 
the operation of gastrostomy may be performed in order to avoid death from starvation; death, 
however, most commonly occurs from u'ceration of the growth into the mediastinal cavity or 
air passages. In cases of stricture of the oesophagus it may be necessary to dilate the canal by 
a bougie, when it is of importance that the direction of the oesophagus and its relations to sur- 
rounding parts should be remembered. In cases of malignant disease of the oesophagus, where 
its tissues have become softened from infiltration of the growth, the greatest care is requisite 
in directing the bougie through the strictured part, as a false passage may easily be made, and 
the instrument may pass into the mediastinal cavity or into one or other pleural cavity, or even 
into the pericardium. 
In cases of obstruction of the oesophagus, and consequent symptoms of stricture, produced 
by an aneurism of some part of the aorta pressing upon this tube, the passage of a bougie will 
only hasten the fatal issue. 
In passing a bougie, the left forefinger should be introduced into the mouth, and the epiglottis 
felt for, care being taken not to throw the head too far backward. The bougie is then to be 
passed beyond the finger until it touches the posterior wall of the pharynx. The patient is now 
asked to swallow, and at the moment of swallowing the bougie is passed gently onward, all 
violence being carefully avoided. 
It occasionally happens that a foreign body becomes impacted in the oesophagus, and can 
neither be brought upward nor moved downward. When all ordinary means for its removal 
have failed, excision is the only resource. This, of course, can only be performed when it is not 
very low down. If the foreign body is allowed to remain, extensive inflammation and ulceration 
of the oesophagus may ensue. In one case the foreign body ultimately penetrated the inter- 
vertebral fibrocartilage, and destroyed life by inflammation of the membranes and substance 
of the medulla spinalis. 
THE ABDOMEN. 
The abdomen is the largest cavity in the body. It is of an oval shape, the extrem- 
ities of the oval being directed upward and downward. The upper extremity is 
formed by the Diaphragma which extends as a dome over the abdomen, so that the 
cavity extends high into the bony thorax, reaching on the right side, in the mammary 
line, to the upper border of the fifth rib; on the left side it falls below this level by 
about 2.5 cm. The lower extremity is formed by the structures which clothe the 
inner surface of the bony pelvis, principally the Levator ani and Coccygeus on 
either side. These muscles are sometimes termed the diaphragm of the pelvis. 
The cavity is wider above than below, and measures more in the vertical than in 
the transverse diameter. In order to facilitate description, it is artificially divided 
into two parts: an upper and larger part, the abdomen proper; and a lower and smaller THE ABDOMEN 
1147 
part, the pelvis. These two cavities are not separated from each other, but the 
limit between them is marked by the superior aperture of the lesser pelvis. 
The abdomen proper differs from the other great cavities of the body in being 
bounded for the most part by muscles and fasciae, so that it can vary in capacity 
and shape according to the condition of the viscera which it contains; but, in addi- 
tion to this, the abdomen varies in form and extent with age and sex. In the adult 
male, with moderate distension of the viscera, it is oval in shape, but at the same 
time flattened from before backward. In the adult female, with a fully developed 
pelvis, it is ovoid with the narrower pole upward, and in young children it is also 
ovoid but with the narrower pole downward. 
Boundaries.-It is bounded in front and at the sides by the abdominal muscles 
and the Iliacus muscles; behind by the vertebral column and the Psoas and 
Quadratus lumborum muscles; above by the Diaphragma; below by the plane of 
the superior aperture of the lesser pelvis. The muscles forming the boundaries 
of the cavity are lined upon their inner surfaces by a layer of fascia. 
The abdomen contains the greater part of the digestive tube; some of the 
accessory organs to digestion, viz., the liver and pancreas; the spleen, the kidneys, 
and the suprarenal glands. Most of these structures, as well as the wall of the 
cavity in which they are contained, are more or less covered by an extensive and 
complicated serous membrane, the peritoneum. 
The Apertures in the Walls of the Abdomen.-The apertures in the walls of the 
abdomen, for the transmission of structures to or from it, are, in front, the umbilical 
(in the fetus), for the transmission of the umbilical vessels, the allantois, and vitel- 
line duct; above, the vena caval opening, for the transmission of the inferior vena 
cava, the aortic hiatus, for the passage of the aorta, azygos vein, and thoracic duct, 
and the oesophageal hiatus, for the oesophagus and vagi. Below, there are two 
apertures on either side: one for the passage of the femoral vessels and lumbo- 
inguinal nerve, and the other for the transmission of the spermatic cord in the male, 
and the round ligament of the uterus in the female. 
Regions.-For convenience of description of the viscera, as well as of reference 
to the morbid conditions of the contained parts, the abdomen is artificially divided 
into nine regions by imaginary planes, two horizontal and two sagittal, passing 
through the cavity, the edges of the planes being indicated by lines drawn on the 
surface of the body. Of the horizontal planes the upper or transpyloric is indicated 
by a line encircling the body at the level of a point midway between the jugular 
notch and the symphysis pubis, the lower by a line carried around the trunk at the 
level of a point midway between the transpyloric and the symphysis pubis. The 
latter is practically the intertubercular plane of Cunningham, who pointed out1 
that its level corresponds with the prominent and easily defined tubercle on the 
iliac crest about 5 cm. behind the anterior superior iliac spine. By means of these 
imaginary planes the abdomen is divided into three zones, which are named from 
above downward the subcostal, umbilical, and hypogastric zones. Each of these is 
further subdivided into three regions by the two sagittal planes, which are indi- 
cated on the surface by lines drawn vertically through points half-way between 
the anterior superior iliac spines and the symphysis pubis.2 
The middle region of the upper zone is called the epigastric; and the two lateral 
regions, the right and left hypochondriac. The central region of the middle zone 
is the umbilical; and the two lateral regions, the right and left lumbar. The middle 
region of the lower zone is the hypogastric or pubic region; and the lateral regions 
are the right and left iliac or inguinal (Fig. 960). 
The pelvis is that portion of the abdominal cavity which lies below and behind 
a plane passing through the promontory of the sacrum, lineae terminales of the 
hip bones, and the pubic crests. It is bounded behind by the sacrum, coccyx, 
1 Journal of Anatomy and Physiology, vol. xxvii. 
2 Ibid., vols. xxxiii, xxxiv, xxxv. 1148 
SPLANCHNOLOGY 
Piriformes, and the sacrospinous and sacrotuberous ligaments; in front and 
laterally by the pubes and ischia and Obturatores interni; above it communicates 
Fig. 960.-Front view of the thoracic and abdominal viscera, a. Median plane, b b Lateral planes, c c. Trans- 
tubercular plane, d d. Subcostal plane, e e. Transpylonc plane. THE PERITONEUM 
1149 
with the abdomen proper; below it is closed by the Levatores ani and Coccygei and 
the urogenital diaphragm. The pelvis contains the urinary bladder, the sigmoid 
colon and rectum, a few coils of the small intestine, and some of the generative 
organs. 
When the anterior abdominal wall is removed, the viscera are partly exposed 
as follows: above and to the right side is the liver, situated chiefly under the shelter 
of the right ribs and their cartilages, but extending across the middle line and reach- 
ing for some distance below the level of the xiphoid process. To the left of the liver 
is the stomach, from the lower border of which an apron-like fold of peritoneum, 
the greater omentum, descends for a varying distance, and obscures, to a greater 
or lesser extent, the other viscera. Below it, however, some of the coils of the small 
intestine can generally be seen, while in the right and left iliac regions respectively 
the cecum and the iliac colon are partly exposed. The bladder occupies the ante- 
rior part of the pelvis, and, if distended, will project above the symphysis pubis; 
the rectum lies in the concavity of the sacrum, but is usually obscured by the coils 
of the small intestine. The sigmoid colon lies between the rectum and the bladder. 
When the stomach is followed from left to right it is seen to be continuous with 
the first part of the small intestine, or duodenum, the point of continuity being 
marked by a thickened ring which indicates the position of the pyloric valve. 
The duodenum passes toward the under surface of the liver, and then, curving 
downward, is lost to sight. If, however, the greater omentum be thrown upward 
over the chest, the inferior part of the duodenum will be observed passing across 
the vertebral column toward the left side, where it becomes continuous with the 
coils of the jejunum and ileum. These measure some 6 metres in length, and if 
followed downward the ileum will be seen to end in the right iliac fossa by opening 
into the cecum, the commencement of the large intestine. From the cecum the 
large intestine takes an arched course, passing at first upward on the right side, 
then across the middle line and downward on the left side, and forming respectively 
the ascending transverse, and descending parts of the colon. In the pelvis it 
assumes the form of a loop, the sigmoid colon, and ends in the rectum. 
The spleen lies behind the stomach in the left hypochondriac region, and may 
be in part exposed by pulling the stomach over toward the right side. 
The glistening appearance of the deep surface of the abdominal wall and of the 
surfaces of the exposed viscera is due to the fact that the former is lined, and the 
latter are more or less completely covered, by a serous membrane, the peritoneum. 
The Peritoneum (Tunica Serosa). 
The peritoneum is the largest serous membrane in the body, and consists, in the 
male, of a closed sac, a part of which is applied against the abdominal parietes, 
while the remainder is reflected over the contained viscera. In the female the 
peritoneum is not a closed sac, since the free ends of the uterine tubes open directly 
into the peritoneal cavity. The part which lines the parietes is named the parietal 
portion of the peritoneum; that which is reflected over the contained viscera con- 
stitutes the visceral portion of the peritoneum. The free surface of the membrane 
is smooth, covered by a layer of flattened endothelium, and lubricated by a small 
quantity of serous fluid. Hence the viscera can glide freely against the wall of the 
cavity or upon one another with the least possible amount of friction. The attached 
surface is rough, being connected to the viscera and inner surface of the parietes by 
means of areolar tissue, termed the subserous areolar tissue. The parietal portion 
is loosely connected with the fascial lining of the abdomen and pelvis, but is more 
closely adherent to the under surface of the Diaphragma, and also in the middle 
line of the abdomen. 
The space between the parietal and visceral layers of the peritoneum is named 
the peritoneal cavity; but under normal conditions this cavity is merely a potential 1150 
SPLANCHNOLOGY 
one, since the parietal and visceral layers are in contact. The peritoneal cavity 
gives off a large diverticulum, the omental bursa, which is situated behind the 
stomach and adjoining structures; the neck of communication between the cavity 
and the bursa is termed the epiploic foramen (foramen of Winslow). Formerly the 
main portion of the cavity was described as the greater, and the omental bursa 
as the lesser sac. 
The peritoneum differs from the other serous membranes of the body in pre- 
senting a. much more complex arrangement, and one that can only be clearly under- 
stood by following the changes which take place in the digestive tube during its 
development; the student therefore is advised to preface his study of the peri- 
toneum by reviewing the chapter dealing with this subject in the section on 
Embryology (page 162). 
To trace the membrane from one viscus to another, and from the viscera to the 
parietes, it is necessary to follow its continuity in the vertical and horizontal 
directions, and it will be found simpler to describe the main portion of the cavity 
and the omental bursa separately. 
Fig. 961.-Vertical disposition of the peritoneum. Main cavity, red; omental bursa, blue. 
Vertical Disposition of the Main Peritoneal Cavity {greater sac) (Fig. 961).-It 
is convenient to trace this from the back of the abdominal wall at the level of the 
umbilicus. On following the peritoneum upward from this level it is seen to be 
reflected around a fibrous cord, the ligamentum teres {obliterated umbilical vein), 
which reaches from the umbilicus to the under surface of the liver. This reflection 
forms a somewhat triangular fold, the falciform ligament of the liver, attaching the 
upper and anterior surfaces of the liver to the Diaphragma and abdominal wall. 
With the exception of the line of attachment of this ligament the peritoneum 
covers the whole of the under surface of the anterior part of the Diaphragma, 
and is continued from it on to the upper surface of the right lobe of the liver as THE PERITONEUM 
1151 
the superior layer of the coronary ligament, and on to the upper surface of the left 
lobe as the superior layer of the left triangular ligament of the liver. Covering the 
upper and anterior surfaces of the liver, it is continued around its sharp margin 
on to the under surface, where it presents the following relations: (a) It covers the 
under surface of the right lobe and is reflected from the back part of this on to the 
right suprarenal gland and upper extremity of the right kidney, forming in this 
situation the inferior layer of the coronary ligament; a special fold, the hepatorenal 
ligament, is frequently present between the inferior surface of the liver and the 
front of the kidney. From the kidney it is carried downward to the duodenum 
and right colic flexure and medialward in front of the inferior vena cava, where it 
is continuous with the posterior wall of the omental bursa. Between the two layers 
of the coronary ligament there is a large triangular surface of the liver devoid of 
peritoneal covering; this is named the bare area of the liver, and is attached to the 
Diaphragma by areolar tissue. Toward the right margin of the liver the two 
layers of the coronary ligament gradually approach each other, and ultimately 
fuse to form a small triangular fold connecting the right lobe of the liver to the 
Diaphragma, and named the right triangular ligament of the liver. The apex of 
the triangular bare area corresponds with the point of meeting of the two layers 
of the coronary ligament, its base with the fossa for the inferior vena cava. (6) 
It covers the lower surface of the quadrate lobe, the under and lateral surfaces 
of the gall-bladder, and the under surface and posterior border of the left lobe; it is 
then reflected from the upper surface of the left lobe to the Diaphragma as the 
inferior layer of the left triangular ligament, and from the porta of the liver and the 
fossa for the ductus venosus to the lesser curvature of the stomach and the first 
2.5 cm. of the duodenum as the anterior layer of the hepatogastric and hepatoduodenal 
ligaments, which together constitute the lesser omentum. If this layer of the lesser 
omentum be followed to the right it will be found to turn around the hepatic artery, 
bile duct, and portal vein, and become continuous with the anterior wall of the 
omental bursa, forming a free folded edge of peritoneum. Traced downward, it 
covers the antero-superior surface of the stomach and the commencement of the 
duodenum, and is carried down into a large free fold, known as the gastrocolic 
ligament or greater omentum. Reaching the free margin of this fold, it is reflected 
upward to cover the under and posterior surfaces of the transverse colon, and thence 
to the posterior abdominal wall as the inferior layer of the transverse mesocolon. 
It reaches the abdominal wall at the head and anterior border of the pancreas, 
is then carried down over the lower part of the head and over the inferior surface 
of the pancreas on the superior mesenteric vessels, and thence to the small intestine 
as the anterior layer of the mesentery. It encircles the intestine, and subsequently 
may be traced, as the posterior layer of the mesentery, upward and backward 
to the abdominal wall. From this it sweeps down over the aorta into the pelvis, 
where it invests the sigmoid colon, its reduplication forming the sigmoid mesocolon. 
Leaving first the sides and then the front of the rectum, it is reflected on to the semi- 
nal vesicles and fundus of the urinary bladder and, after covering the upper surface 
of that viscus, is carried along the medial and lateral umbilical ligaments (Fig. 
962) on to the back of the abdominal wall to the level from which a start was made. 
Between the rectum and the bladder it forms, in the male, a pouch, the recto- 
vesical excavation, the bottom of which is slightly below the level of the upper 
ends of the vesiculae seminales-i. e., about 7.5 cm. from the orifice of the anus. 
When the bladder is distended, the peritoneum is carried up with the expanded 
viscus so that a considerable part of the anterior surface of the latter lies directly 
against the abdominal wall without the intervention of peritoneal membrane. 
In the female the peritoneum is reflected from the rectum over the posterior vaginal 
fornix to the cervix and body of the uterus, forming the rectouterine excavation 
{pouch of Douglas). It is continued over the intestinal surface and fundus of the 1152 
SPLANCHNOLOGY 
uterus on to its vesical surface, which it covers as'far as the junction of the body 
and cervix uteri, and then to the bladder, forming here a second, but shallower, 
pouch, the vesicouterine excavation. It is also reflected from the sides of the uterus 
to the lateral walls of the pelvis as two expanded folds, the broad ligaments of the 
uterus, in the free margin of each of which is the uterine tube. 
Fig. 962.-Posterior view of the anterior abdominal wall in its lower half. The peritoneum is in place, and the various 
cords are shining through. (After Joessel.) 
Vertical Disposition of the Omental Bursa (lesser peritoneal sac) (Fig. 961).-A 
start may be made in this case on the posterior abdominal wall at the anterior 
border of the pancreas. From this region the peritoneum may be followed upward 
over the pancreas on to the inferior surface of the Diaphragma, and thence on to the 
caudate lobe and caudate process of the liver to the fossa from the ductus venosus 
and the porta of the liver. Traced to the right, it is continuous over the inferior 
vena cava with the posterior wall of the main cavity. From the liver it is carried 
downward to the lesser curvature of the stomach and the commencement of the 
duodenum as the posterior layer of the lesser omentum, and is continuous on the 
right, around the hepatic artery, bile duct, and portal vein, with the anterior layer 
of this omentum. The posterior layer of the lesser omentum is carried down as a 
covering for the postero-inferior surfaces of the stomach and commencement of the 
duodenum, and is continued downward as the deep layer of the gastrocolic ligament 
or greater omentum. From the free margin of this fold it is reflected upward on 
itself to the anterior and superior surfaces of the transverse colon, and thence as 
the superior layer of the transverse mesocolon to the anterior border of the pancreas, 
the level from which a start was made. It will be seen that the loop formed by THE PERITONEUM 
1153 
the wall of the omental bursa below the transverse colon follows, and is closely 
applied to, the deep surface of that formed by the peritoneum of the main cavity, 
and that the greater omentum or large fold of peritoneum which hangs in front 
of the small intestine therefore consists of four layers, two anterior and two posterior 
separated by the potential cavity of the omental bursa. 
Horizontal Disposition of the Peritoneum.-Below the transverse colon the 
arrangement is simple, as it includes only the main cavity; above the level of the 
transverse colon it is more complicated on account of the existence of the omental 
bursa. Below the transverse colon it may be considered in the two regions, viz., 
in the pelvis and in the abdomen proper. 
Fig. 963.-The peritoneum of the male pelvis. (Dixon and Birmingham.) 
(1) In the Pelvis.-The peritoneum here follows closely the surfaces of the 
pelvic viscera and the inequalities of the pelvic walls, and presents important 
differences in the two sexes, (a) In the male (Fig. 963) it encircles the sigmoid 
colon, from which it is reflected to the posterior wall of the pelvis as a fold, the 
sigmoid mesocolon. It then leaves the sides and, finally, the front of the rectum, 
and is continued on to the upper ends of the seminal vesicles and the bladder; 
on either side of the rectum if forms a fossa, the pararectal fossa, which varies in 
size with the distension of the rectum. In front of the rectum the peritoneum forms 
the rectovesical excavation, which is limited laterally by peritoneal folds extending 
from the sides of the bladder to the rectum and sacrum. These folds are known 
from their position as the rectovesical or sacrogenital folds. The peritoneum of 
the anterior pelvic wall covers the superior surface of the bladder, and on either 
side of this viscus forms a depression, termed the paravesical fossa, which is limited 
laterally by the fold of peritoneum covering the ductus deferens. The size of this 
fossa is dependent on the state of distension of the bladder; when the bladder is 
empty, a variable fold of peritoneum, the plica vesicalis transversa, divides the fossa 
into two portions. On the peritoneum between the paravesical and pararectal 
fossae the only elevations are those produced by the ureters and the hypogastric 
vessels. (6) In the female, pararectal and paravesical fossae similar to those in the 1154 
SPLANCHNOLOGY 
male are present: the lateral limit of the paravesical fossa is the peritoneum invest- 
ing the round ligament of the uterus. The rectovesical excavation is, however, 
divided by the uterus and vagina into a small anterior vesicouterine and a large, 
deep, posterior rectouterine excavation. The sacrogenital folds form the margins 
of the latter, and are continued on to the back of the uterus to form a transverse 
fold, the torus uterinus. The broad ligaments extend from the sides of the uterus 
to the lateral walls of the pelvis; they contain in their free margins the uterine 
tubes, and in their posterior layers the ovaries. Below, the broad ligaments are 
continuous with the peritoneum on the lateral walls of the pelvis. On the lateral 
pelvic wall behind the attachment of the broad ligament, in the angle between 
the elevations produced by the diverging hypogastric and external iliac vessels is 
a slight fossa, the ovarian fossa, in which the ovary normally lies. 
Fig. 964.-Horizontal disposition of the peritoneum in the lower part of the abdomen. 
(2) In the Lower Abdomen (Fig. 964).-Starting from the linea alba, below the 
level of the transverse colon, and tracing the continuity of the peritoneum in a 
horizontal direction to the right, the membrane covers the inner surface of the 
abdominal wall almost as far as the lateral border of the Quadratus lumborum; 
it encloses the cecum and vermiform process, and is reflected over the sides and front 
of the ascending colon; it may then be traced over the duodenum, Psoas major, 
and inferior vena cava toward the middle line, whence it passes along the mesen- 
teric vessels to invest the small intestine, and back again to the large vessels in 
front of the vertebral column, forming the mesentery, between the layers of which 
are contained the mesenteric bloodvessels, lacteals, and glands. It is then con- 
tinued over the left Psoas; it covers the sides and front of the descending colon, 
and, reaching the abdominal wall, is carried on it to the middle line. 
(3) In the Upper Abdomen (Fig. 965).--Above the transverse colon the omental 
bursa is superadded to the general sac, and the communication of the two cavities 
with one another through the epiploic foramen can be demonstrated. 
(a) Main Cavity.-Commencing on the posterior abdominal wall at the inferior 
vena cava, the peritoneum may be followed to the right over the front of the 
suprarenal gland and upper part of the right kidney on to the antero-lateral THE PERITONEUM 
1155 
abdominal wall. From the middle line of the anterior wall a backwardly directed 
fold encircles the obliterated umbilical vein and forms the falciform ligament 
of the liver. Continuing to the left, the peritoneum lines the antero-lateral 
abdominal wall and covers the lateral part of the front of the left kidney, and is 
reflected to the posterior border of the hilus of the spleen as the posterior layer 
of the phrenicolienal ligament. It can then be traced around the surface of the spleen 
to the front of the hilus, and thence to the cardiac end of the greater curvature 
of the stomach as the anterior layer of the gastrolienal ligament. It covers the 
antero-superior surfaces of the stomach and commencement of the duodenum, 
and extends up from the lesser curvature of the stomach to the liver as the anterior 
layer of the lesser omentum. 
Fig. 965.-Horizontal disposition of the peritoneum in the upper part of the abdomen. 
(6) Omental Bursa (bursa omentalis; lesser peritoneal sac).-On the posterior 
abdominal wall the peritoneum of the general cavity is continuous with that of 
the omental bursa in front of the inferior vena cava. Starting from here, the 
bursa may be traced across the aorta and over the medial part of the front of 
the left kidney and Diaphragma to the hilus of the spleen as the anterior layer 
of the phrenicolienal ligament. From the spleen it is reflected to the stomach as 
the posterior layer of the gastrosplenic ligament. It covers the postero-inferior 
surfaces of the stomach and commencement of the duodenum, and extends 
upward to the liver as the posterior layer of the lesser omentum; the right margin 
of this layer is continuous around the hepatic artery, bile duct, and portal vein, 
with the wall of the general cavity. 
The epiploic foramen (foramen epiploicum; foramen of Winslow) is the passage of 
communication between the general cavity and the omental bursa. It is bounded 
in front by the free border of the lesser omentum, with the common bile duct, 
hepatic artery, and portal vein between its two layers; behind by the peritoneum 
covering the inferior vena cava; above by the peritoneum on the caudate process 
of the liver, and below by the peritoneum covering the commencement of the 
duodenum and the hepatic artery, the latter passing forward below the foramen 
before ascending between the two layers of the lesser omentum. 
The boundaries of the omental bursa will now be evident. It is bounded in front 1156 
SPLANCHNOLOGY 
from above downward, by the caudate lobe of the liver, the lesser omentum, the 
stomach, and the anterior two layers of the greater omentum. Behind, it is limited, 
from below upward, by the two posterior layers of the greater omentum, the trans- 
verse colon, and the ascending layer of the transverse mesocolon, the upper surface 
of the pancreas, the left suprarenal gland, and the upper end of the left kidney. 
To the right of the oesophageal opening of the stomach it is formed by that part 
of the Diaphragma which supports the caudate lobe of the liver. Laterally, the 
bursa extends from the epiploic foramen to the spleen, where it is limited by 
the phrenicolienal and gastrolienal ligaments. 
The omental bursa, therefore, consists of a series of pouches or recesses to which 
the following terms are applied: (1) the vestibule, a narrow channel continued 
from the epiploic foramen, over the head of the pancreas to the gastropancreatic 
fold; this fold extends from the omental tuberosity of the pancreas to the right 
side of the fundus of the stomach, and contains the left gastric artery and coronary 
vein; (2) the superior omental recess, between the caudate lobe of the liver and the 
Diaphragma; (3) the lienal recess, between the spleen and the stomach; (4) the 
inferior omental recess, which comprises the remainder of the bursa. 
In the fetus the bursa reaches as low as the free margin of the greater omentum, 
but in the adult its vertical extent is usually more limited owing to adhesions 
between the layers of the omentum. During a considerable part of fetal life the 
transverse colon is suspended from the posterior abdominal wall by a mesentery 
of its own, the two posterior layers of the greater omentum passing at this stage 
in front of the colon. This condition occasionally persists throughout life, but as 
a rule adhesion occurs between the mesentery of the transverse colon and the pos- 
terior layer of the greater omentum, with the result that the colon appears to receive 
its peritoneal covering by the splitting of the two posterior layers of the latter fold. 
In the adult the omental bursa intervenes between the stomach and the structures 
on which that viscus lies, and performs therefore the functions of a serous bursa 
for the stomach. 
Numerous peritoneal folds extend between the various organs or connect them 
to the parietes; they serve to hold the viscera in position, and, at the same time, 
enclose the vessels and nerves proceeding to them. They are grouped under the 
three headings of ligaments, omenta, and mesenteries. 
The ligaments will be described with their respective organs. 
There are two omenta, the lesser and the greater. 
The lesser omentum (omentum minus; small omentum; gastrohepatic omentum) is the 
duplicature which extends to the liver from the lesser curvature of the stomach and 
the commencement of the duodenum. It is extremely thin, and is continuous with the 
two layers of peritoneum which cover respectively the antero-superior and postero- 
inferior surfaces of the stomach and first part of the duodenum. When these 
two layers reach the lesser curvature of the stomach and the upper border of the 
duodenum, they join together and ascend as a double fold to the porta of the liver; 
to the left of the porta the fold is attached to the bottom of the fossa for the ductus 
venosus, along which it is carried to the Diaphragma, where the two layers separate 
to embrance the end of the oesophagus. At the right border of the omentum the 
two layers are continuous, and form a free margin which constitutes the anterior 
boundary of the epiploic foramen. The portion of the lesser omentum extending 
between the liver and stomach is termed the hepatogastric ligament, while that 
between the liver and duodenum is the hepatoduodenal ligament. Between the two 
layers of the lesser omentum, close to the right free margin, are the hepatic 
artery, the common bile duct, the portal vein, lymphatics, and the hepatic plexus of 
nerves-all these structures being enclosed in a fibrous capsule (Glisson's capsule). 
Between the layers of the lesser omentum, where they are attached to the 
stomach, run the right and left gastric vessels. THE PERITONEUM 
1157 
The greater omentum {omentum magus; great omentum; gastrocolic omentum) is the 
largest peritoneal fold. It consists of a double sheet of peritoneum, folded on itself 
so that it is made up of four layers. The two layers which descend from the stomach 
and commencement of the duodenum pass in front of the small intestines, sometimes 
as low down as the pelvis; they then turn upon themselves, and ascend again as 
far as the transverse colon, where they separate and enclose that part of the intes- 
tine. These individual layers may be easily demonstrated in the young subject, 
but in the adult they are more or less inseparably blended. The left border of the 
greater omentum is continuous with the gastrolienal ligament; its right border 
extends as far as the commencement of the duodenum. The greater omentum is 
usually thin, presents a cribriform appearance, and always contains some adipose 
tissue, which in fat people accumulates in considerable quantity. Between its 
two anterior layers, a short distance from the greater curvature of the stomach, 
is the anastomosis between the right and left gastroepiploic vessels. 
The mesenteries are: the mesentery proper, the transverse mesocolon, and the 
sigmoid mesocolon. In addition to these there are sometimes present an ascending 
and a descending mesocolon. 
The mesentery proper {mesenterium) is the broad, fan-shaped fold of peritoneum 
which connects the convolutions of the jejunum and ileum with the posterior wall 
of the abdomen. Its root-the part connected with the structures in front of the 
vertebral column-is narrow, about 15 cm. long, and is directed obliquely from the 
duodenojejunal flexure at the left side of the second lumbar vertebra to the right 
sacroiliac articulation (Fig. 966). Its intestinal border is about 6 metres long; and 
here the two layers separate to enclose the intestine, and form its peritoneal coat. 
It is narrow above, but widens rapidly to about 20 cm., and is thrown into numerous 
plaits or folds. It suspends the small intestine, and contains between its layers 
the intestinal branches of the superior mesenteric artery, with their accompanying 
veins and plexuses of nerves, the lacteal vessels, and mesenteric lymph glands. 
The transverse mesocolon {mesocolon transvergum) is a broad fold, which connects 
the transverse colon to the posterior wall of the abdomen. It is continuous with 
the two posterior layers of the greater omentum, which, after separating to surround 
the transverse colon, join behind it, and are continued backward to the vertebral 
column, where they diverge in front of the anterior border of the pancreas. This 
fold contains between its layers the vessels which supply the transverse colon. 
The sigmoid mesocolon {mesocolon sigmoideum) is the fold of peritoneum which 
retains the sigmoid colon in connection with the pelvic wall. Its line of attachment 
forms a V-shaped curve, the apex of the curve being placed about the point of 
division of the left common iliac artery. The curve begins on the medial side of 
the left Psoas major, and runs upward and backward to the apex, from which it 
bends sharply downward, and ends in the median plane at the level of the third 
sacral vertebra. The sigmoid and superior hemorrhoidal vessels run between the 
two layers of this fold. 
In most cases the peritoneum covers only the front and sides of the ascending 
and descending parts of the colon. Sometimes, however, these are surrounded 
by the serous membrane and attached to the posterior abdominal wall by an 
ascending and a descending mesocolon respectively. A fold of peritoneum, the 
phrenicocolic ligament, is continued from the left colic flexure to the Diaphragma 
opposite the tenth and eleventh ribs; it passes below and serves to support the 
spleen, and therefore has received the name of sustentaculum lienis. 
The appendices epiploicae are small pouches of the peritoneum filled with fat 
and situated along the colon and upper part of the rectum. They are chiefly 
appended to the transverse and sigmoid parts of the colon. 
Peritoneal Recesses or Fossae {retroperitoneal fossae).-In certain parts of the 
abdominal cavity there are recesses of peritoneum forming culs-de-sac or pouches, 1158 
SPLANCHNOLOGY 
which are of surgical interest in connection with the possibility of the occurrence 
of "retroperitoneal" herniee. The largest of these is the omental bursa (already 
described), but several others, of smaller size, require mention, and may be divided 
into three groups, viz.: duodenal, cecal, and intersigmoid. 
Fig. 966.-Diagram devised by Del6pine to show the lines along which the peritoneum leaves the wall of the abdomen 
to invest the viscera. 
1. Duodenal Fossae (Figs. 967, 968).-Three are fairly constant, viz.: (a) The 
inferior duodenal fossa, present in from 70 to 75 per cent, of cases, is situated 
opposite the third lumbar vertebra on the left side of the ascending portion of 
the duodenum. Its opening is directed upward, and is bounded by a thin sharp 
fold of peritoneum with a concave margin, called the duodenomesocolic fold. The 
tip of the index finger introduced into the fossa under the fold passes some 
little distance behind the ascending portion of the duodenum. (6) The superior 
duodenal fossa, present in from 40 to 50 per cent, of cases, often coexists with the 
inferior one, and its orifice looks downward. It lies on the left of the ascending 
portion of the duodenum, in front of the second lumbar vertebra, and behind a THE PERITONEUM 
1159 
sickle-shaped fold of peritoneum, the duodenojejunal fold, and has a depth of about 
2 cm. (c) The duodenojejunal fossa exists in from 15 to 20 per cent, of cases, 
but has never yet been found in conjunction with the other forms of duodenal 
fossse; it can be seen by pulling the jejunum downward and to the right, after the 
Fig. 967.-Superior and inferior duodenal fossse. (Poirier and Charpy.) 
transverse colon has been pulled upward. It is bounded above by the pancreas, 
to the right by the aorta, and to the left by the kidney; beneath is the left renal 
vein. It has a depth of from 2 to 3 cm., and its orifice, directed downward and to 
the right, is nearly circular and will admit the tip of the little finger. 
Fig. 968.-Duodenojejunal fossa. (Poirier and Charpy.) 
2. Cecal Fossae {pericecal folds or fossae).-There are three principal pouches 
or recesses in the neighborhood of the cecum (Figs. 969 to 971): {a) The superior 
ileocecal fossa is formed by a fold of peritoneum, arching over the branch of the 1160 
SPLANCHNOLOGY 
ileocolic artery which supplies the ileocolic junction. The fossa is a narrow chink 
situated between the mesentery of the small intestine, the ileum, and the small 
portion of the cecum behind. (6) The inferior ileocecal fossa is situated behind the 
angle of junction of the ileum and cecum. It is formed by the ileocecal fold of 
peritoneum (bloodless fold of Treves'), the upper border of which is fixed to the ileum, 
opposite its mesenteric attach- 
ment, while the lower border, 
passing over the ileocecal junc- 
tion, joins the mesenteriole of the 
vermiform process, and some- 
times the process itself. Between 
this fold and the mesenteriole 
of the vermiform process is the 
inferior ileocecal fossa. It is 
bounded above by the posterior 
surface of the ileum and the me- 
sentery; in front and below by the 
ileocecal fold, and behind by the 
upper part of the mesenteriole 
of the vermiform process, (c) 
The cecal fossa is situated im- 
mediately behind the cecum, 
which has to be raised to bring 
it into view. It varies much in 
size and extent. In some cases 
it is sufficiently large to abmit the index finger, and extends upward behind the 
ascending colon in the direction of the kidney; in others it is merely a shallow 
depression. It is bounded on the right by the cecal fold, which is attached by 
one edge to the abdominal wall from the lower border of the kidney to the iliac 
fossa and by the other to the postero-lateral aspect of the colon. In some 
instances additional fossae, the retrocecal fossae, are present. 
Fig. 969.-Superior ileocecal fossa. (Poirier and Charpy.) 
Fig. 970.-Inferior ileocecal fossa. The cecum and ascending colon have been drawn lateralward and downward, 
the ileum upward and backward, and the vermiform process downward. (Poirier and Charpy.) 
3. The intersigmoid fossa (recessus intersigmoideus) is constant in the fetus and 
during infancy, but disappears in a certain percentage of cases as age advances. 
Upon drawing the sigmoid colon upward, the left surface of the sigmoid mesocolon 
is exposed, and on it will be seen a funnel-shaped recess of the peritoneum, lying 
on the external iliac vessels, in the interspace between the Psoas and Iliacus muscles. 
This is the orifice leading to the intersigmoid fossa, which lies behind the sigmoid THE STOMACH 
1161 
mesocolon, and in front of the parietal peritoneum. The fossa varies in size; in 
some instances it is a mere dimple, whereas in others it will admit the whole of the 
index finger. 
Fig. 971.-The cecal fossa. The ileum and cecum are drawn backward and upward. (Souligoux.) 
Applied Anatomy.-Any of these fossae may be the site of a "retroperitoneal" hernia. The 
cecal fossae are of special interest, because hernia of the vermiform process frequently takes 
place into one of them, and it may there become strangulated. The presence of these pouches 
also explains the course which pus has been known to take in cases of perforation of the vermi- 
form process, where it travels upward behind the ascending colon as far as the Diaphragma.1 
The Stomach (Ventriculus; Gaster). 
The stomach is the most dilated part of the digestive tube, and is situated between 
the end of the oesophagus and the beginning of the small intestine. It lies in the 
epigastric, umbilical, and left hypochondriac regions of the abdomen, and occupies 
a recess bounded by the upper abdominal viscera, and completed in front and on 
the left side by the anterior abdominal wall and the Diaphragma. 
The shape and position of the stomach are so greatly modified by changes within 
itself and in the surrounding viscera that no one form can be described as typical. 
The chief modifications are determined by (1) the amount of the stomach contents, 
(2) the stage which the digestive process has reached, (3) the degree of develop- 
ment of the gastric musculature, and (4) the condition of the adjacent intestines. 
It is, however, possible by comparing a series of stomachs to determine certain 
markings more or less common to all (Figs. 972, 973). 
The stomach presents two openings, two borders or curvatures, and two surfaces. 
Openings.-The opening by which the oesophagus communicates with the 
stomach is known as the cardiac orifice, and is situated on the left of the middle 
line at the level of the tenth thoracic vertebra. The short abdominal portion of the 
oesophagus (antrum cardiacum) is conical in shape and curved sharply to the left, 
the base of the cone being continuous with the cardiac orifice of the stomach. 
The right margin of the oesophagus is continuous with the lesser curvature of the 
1 On the anatomy of these fossae, see the Arris and Gale Lectures by Moynihan, 1899. 1162 
SPLANCHNOLOGY 
stomach, w'hile the left margin joins the greater curvature at an acute angle, termed 
the incisura cardiaca. 
The pyloric orifice communicates with the duodenum, and its position is usually 
indicated on the surface of the stomach by a circular groove, the duodenopyloric 
constriction. This orifice lies to the right of the middle line at the level of the upper 
border of the first lumbar vertebra. 
Curvatures.-The lesser curvature (curvatura ventriculi minor), extending between 
the cardiac and pyloric orifices, forms the right or posterior border of the stomach. 
It descends as a continuation of the right margin of the oesophagus in front of the 
fibres of the right crus of the Diaphragma, and then, turning to the right, it crosses 
the first lumbar vertebra and ends at the pylorus. Nearer its pyloric than its 
cardiac end is a well-marked notch, the incisura angularis, which varies somewhat 
in position with the state of distension of the viscus; it serves to separate the 
stomach into a right and a left portion. The lesser curvature gives attachment 
to the two layers of the hepatogastric ligament, and between these two layers are 
the left gastric artery and the right gastric branch of the hepatic artery. 
Fig. 972.-Outline of stomach, showing its anatomical 
landmarks. 
Fig. 973.-Outline of stomach at an early stage of 
gastric digestion. 
The greater curvature (curvatura ventriculi major) is directed mainly forward, 
and is four or five times as long as the lesser curvature. Starting from the cardiac 
orifice at the incisura cardiaca, it forms an arch backward, upward, and to the left; 
the highest point of the convexity is on a level with the sixth left costal cartilage. 
From this level it may be followed downward and forward, with a slight convexity 
to the left as low as the cartilage of the ninth rib; it then turns to the right, to the 
end of the pylorus. Directly opposite the incisura angularis or the lesser curva- 
ture the greater curvature presents a dilatation, which is the left extremity of the 
pyloric part; this dilatation is limited on the right by a slight groove, the sulcus 
intermedius, which is about 2.5 cm, from the duodenopyloric constriction. The 
portion between the sulcus intermedius and the duodenopyloric constriction is 
termed the pyloric antrum. At its commencement the greater curvature is covered 
by peritoneum continuous with that covering the front of the organ. The left 
part of the curvature gives attachment to the gastrolienal ligament, while to its 
anterior portion are attached the two layers of the greater omentum, separated 
from each other by the gastroepiploic vessels. 
Surfaces.-When the stomach is in the contracted condition, its surfaces are 
directed upward and downward respectively, but when the viscus is distended they 
are directed forward, and backward. They may therefore be described as antero- 
superior and postero-inferior. 
Antero-superior Surface.-The left half of this surface is in contact with the 
Diaphragma, which separates it from the base of the left lung, the pericardium, THE STOMACH 
1163 
and the seventh, eighth, and ninth ribs, and intercostal spaces of the left side. The 
right half is in relation with the left and quadrate lobes of the liver and with the 
anterior abdominal wall. When the stomach is empty, the transverse colon may 
lie on the front part of this surface. The whole surface is covered by peritoneum. 
The Postero-inferior Surface is in relation with the Diaphragma, the spleen, 
the left suprarenal gland, the upper part of the front of the left kidney, the anterior 
surface of the pancreas, the left colic flexure, and the upper layer of the transverse 
mesocolon. These structures form a shallow bed, the stomach bed, on which the 
viscus rests. The transverse mesocolon separates the stomach from the duodeno- 
jejunal flexure and small intestine. The postero-inferior surface is covered by 
peritoneum, except over a small area close to the cardiac orifice; this area is limited 
by the lines of attachment of the gastrophrenic ligament, and lies in apposition 
with the Diaphragma, and frequently with the upper portion of the left supra- 
renal gland. 
Component Parts of the Stomach.-The stomach is capable of subdivision into distinctive 
parts, and the divisions may be made on either anatomical or clinical grounds. 
Anatomical Subdivisions.-A plane passing through the incisura angularis on the lesser curva- 
ture and the left limit of the opposed dilatation on the greater curvature divides the stomach 
into a left portion or body and a right or pyloric portion. The left portion of the body is known 
as the fundus, and is marked off from the remainder of the body by a plane passing horizon- 
tally through the cardiac orifice. The pyloric portion is divided by a plane through the sulcus 
intermedins at right angles to the long axis of this portion; the part to the right of this plane 
is the pyloric antrum (Fig. 972). 
Clinical Subdivisions.-If the stomach be examined during the process of digestion it will be 
found divided by a muscular constriction into a large dilated left portion, and a narrow con- 
tracted tubular right portion. The constriction is in the body of the stomach, and does not 
follow any of the anatomical landmarks; indeed, it shifts gradually toward the left as digestion 
progresses, i. e., more of the body is gradually absorbed into the tubular part. These two por- 
tions are known as the fundus and pyloric portions. It will be seen therefore that the clinical 
fundus includes the anatomical fundus and the proximal part of the body, while the clinical 
pyloric portion comprises the distal part of the body, and the anatomical pyloric part (Fig. 973). 
Position of the Stomach.-The position of the stomach varies with the posture, with the 
amount of the stomach contents and with the condition of the intestines on which it rests. In 
the erect posture the empty stomach is somewhat J-shaped; the part above the cardiac orifice 
is usually distended with gas; the pylorus descends to the level of the second lumbar vertebra 
and the most dependent part of the stomach is at the level of the umbilicus. Variation in the 
amount of its contents affects mainly the cardiac portion, the pyloric portion remaining in a more 
or less contracted condition during the process of digestion. As the stomach fills it tends to 
expand forward and downward in the direction of least resistance, but when this is interfered 
with by a distended condition of the colon or intestines the fundus presses upward on the fiver 
and Diaphragma and gives rise to the feelings of oppression and palpitation complained of in 
such cases. His1 and Cunningham2 have shown by hardening the viscera in situ that the con- 
tracted stomach has a sickle shape, the fundus looking directly backward. The surfaces are 
directed upward and downward, the upper surface having, however, a gradual downward slope 
to the right. The greater curvature is in front and at a slightly higher level than the lesser. 
The position of the full stomach depends, as already indicated, on the state of the intestines; 
when these are empty the fundus expands vertically and also forward, the pylorus is displaced 
toward the right and the whole organ assumes an oblique position, so that its surfaces are directed 
more forward and backward. The lowest part of the stomach is at the pyloric vestibule, which 
reaches to the region of the umbilicus. Where the intestines interfere with the downward 
expansion of the fundus the stomach retains the horizontal position which is characteristic of 
the contracted viscus. 
Examination of the stomach during life by x-rays has confirmed these findings and has 
demonstrated that, in the erect posture, the full stomach usually presents a hook-like appear- 
ance, the long axis of the clinical fundus being directed downward, medialward, and forward 
toward the umbilicus, while the pyloric portion curves upward to the duodenopyloric junction. 
Interior of the Stomach.-When examined after death, the stomach is usually fixed at some 
temporary stage of the digestive process. A common form is that shown in Fig. 974. If the 
viscus be laid open by a section through the plane of its two curvatures, it is seen to consist of 
two segments: (a) a large globular portion on the left and (b) a narrow tubular part on the 
1 Archiv fur Anatomie und Physiologie, anat. Abth., 1903. 
2 Transactions of the Royal Society of Edinburgh, vol. xlv, part i. 1164 
SPLANCHNOLOGY 
right. These correspond to the clinical subdivisions of fundus and pyloric portions already 
described, and are separated by a constriction which indents the body and greater curvature, 
but does not involve the lesser curvature. To the left of the cardiac orifice is the incisura 
cardiaca: the projection of this notch into the cavity of the stomach increases as the organ 
distends, and has been supposed to act as a valve preventing regurgitation into the oesophagus. 
In the pyloric portion are seen: (a) the elevation corresponding to the incisura angularis, and 
(b) the circular projection from the duodenopyloric constriction which forms the pyloric valve; 
the separation of the pyloric antrum from the rest of the pyloric part is scarcely indicated. 
The pyloric valve (valvula pylori) is formed by a reduplication of the mucous 
membrane of the stomach, covering a muscular ring composed of a thickened por- 
tion of the circular layer of the muscular coat. Some of the deeper longitudinal 
fibres turn in and interlace with the circular fibres of the valve. 
Fig. 974.-Interior of the stomach. 
Structure.-The wall of the stomach consists of four coats: serous, muscular, areolar, and 
mucous, together with vessels and nerves. 
The serous coat (tunica serosa) is derived from the peritoneum, and covers the entire surface 
of the organ, excepting along the greater and lesser curvatures at the points of attachment of 
the greater and lesser omenta; here the two layers of peritoneum leave a small triangular space, 
along which the nutrient vessels and nerves pass. On the posterior surface of the stomach, 
close to the cardiac orifice, there is also a small area uncovered by peritoneum, where the organ 
is in contact with the under surface of the Diaphragma. 
The muscular coat (tunica muscularis) (Figs. 975, 976) is situated immediately beneath the 
serous covering, with which it is closely connected. It consists of three sets of fibres: longi- 
tudinal, circular, and oblique. 
The longitudinal fibres (stratum longitudinale) are the most superficial, and are arranged in 
two sets. The first set consists of fibres continuous with the longitudinal fibres of the oesophagus; 
they radiate in a stellate manner from the cardiac orifice and are practically all lost before the 
pyloric portion is reached. The second set commences on the body of the stomach and passes 
to the right, its fibres becoming more thickly distributed as they approach the pylorus. Some 
of the more superficial fibres of this set pass on to the duodenum, but the deeper fibres dip inward 
and interlace with the circular fibres of the pyloric valve. 
The circular fibres (stratum circulare) form a uniform layer over the whole extent of the stomach 
beneath the longitudinal fibres. At the pylorus they are most abundant, and are aggregated into 
a circular ring, which projects into the lumen, and forms, with the fold of mucous membrane 
covering its surface, the pyloric valve. They are continuous with the circular fibres of the 
oesophagus, but are sharply marked off from the circular fibres of the duodenum. 
The oblique fibres (fibrae obliquae) internal to the circular layer, are limited chiefly to the 
cardiac end of the stomach, where they are disposed as a thick uniform layer, covering both 
surfaces, some passing obliquely from left to right, others from right to left, around the cardiac 
end. THE STOMACH 
1165 
The areolar or submucous coat (tela submucosa') consists of a loose, areolar tissue, connecting 
the mucous and muscular layers. 
The mucous membrane (tunica mucosa) is thick and its surface is smooth, soft, and velvety. 
In the fresh state it is of a pinkish tinge at the pyloric end, and of a red or reddish-brown color 
Fig. 975.-The longitudinal and circular muscular fibres of the stomach, viewed from above and in front. (Spalteholz.) 
over the rest of its surface. In infancy it is of a brighter hue, the vascular redness being more 
marked, It is thin at the cardiac extremity, but thicker toward the pylorus. During the con- 
tracted state of the organ it is thrown into numerous plaits or rugae, which, for the most part, 
have a longitudinal direction, and are most marked toward the pyloric end of the stomach, 
and along the greater curvature (Fig. 974). These folds are entirely obliterated when the organ 
becomes distended. 
Fig. 976.-The oblique muscular fibres of the stomach, viewed from above and in front. (Spalteholz.) 1166 
SPLANCHNOLOGY 
Structure of the Mucous Membrane.-When examined with a lens, the inner surface of the 
mucous membrane presents a peculiar honeycomb appearance from being covered with small 
shallow depressions or alveoli, of a polygonal or hexagonal form, which vary from 0.12 to 0.25 
mm. in diameter. These are the ducts of the gastric glands, and at the bottom of each may be 
seen one or more minute orifices, the openings of the gland tubes. The surface of the mucous 
membrane is covered by a single layer of columnar epithelium with occasional goblet cells. This 
epithelium commences very abruptly at the cardiac orifice, where there is a sudden transition 
from the stratified epithelium of the oesophagus. The epithelial lining of the gland ducts is of 
the same character and is continuous with the general epithelial lining of the stomach (Fig. 979). 
The Gastric Glands.-The gastric glands are of three kinds: (a) pyloric, (b) cardiac, and (c) 
fundus or oxyntic glands. They are tubular in character, and are formed of a delicate basement- 
membrane, consisting of flattened transparent endothelial cells lined by epithelium. The pyloric 
glands (Fig. 978) are found in the pyloric portion of the stomach. They consist of two or 
three short closed tubes opening into a common duct or mouth. These tubes are wavy, and 
are about one-half the length of the duct. The duct is lined by columnar cells, continuous 
with the epithelium lining the surface of the mucous membrane of the stomach, the tubes 
by shorter and more cubical cell which are finely granular. The cardiac glands (Fig. 977), 
few in number, occur close to the cardiac orifice. They are of two kinds: (1) simple tubular 
Fig. 977.-Section of mucous membrane of human stomach, near the cardiac orifice, (v. Ebner, after J. Schaffer.) 
X 45. c. Cardiac glands, d. Their ducts, cr. Gland similar to the intestinal glands, with goblet cells, mm. Mucous 
membrane, m. Muscularis mucosae, m'. Muscular tissue within the mucous membrane. 
glands resembling those of the pyloric end of the stomach, but with short ducts; (2) com- 
pound racemose glands resembling the duodenal glands. The fundus glands (Fig. 979) are 
found in the body and fundus of the stomach; they are simple tubes, two or more of which 
open into a single duct. The duct, however,' in these glands is shorter than in the pyloric 
variety, sometimes not amounting to more than one-sixth of the whole length of the gland; 
it is lined throughout by columnar epithelium. The gland tubes are straight and parallel to each 
other. At the point where they open into the duct, which is termed the neck, the epithelium 
alters, and consists of short columnar or polyhedral, granular cells, which almost fill the tube, 
so that the lumen becomes suddenly constricted and is continued down as a very fine channel. 
They are known as the chief or central cells of the glands. Between these cells and the basement- 
membrane, larger oval cells, which stain deeply with eosin, ar.e found; these cells are studded 
throughout the tube at intervals, giving it a beaded or varicose appearance. These are known 
as the parietal or oxyntic cells, and they are connected with the lumen by fine channels which run 
into their substance. Between the glands the mucous membrane consists of a connective-tissue 
frame-work, with lymphoid tissue. In places, this latter tissue, especially in early life, is collected 
into little masses, which to a certain extent resemble the solitary nodules of the intestine, and are 
termed the lenticular glands of the stomach. They are not, however, so distinctly circumscribed 
as the solitary nodules. Beneath the mucous membrane, and between it and the submucous 
coat, is a thin stratum of involuntary muscular fibre (muscularis mucosae), which in some parts THE STOMACH 
1167 
consists only of a single longitudinal layer; in others of two layers, an inner circular and an outer 
longitudinal. 
Vessels and Nerves.-The arteries supplying the stomach are: the left gastric, the right 
gastric and right gastroepiploic branches of the hepatic, and the left gastroepiploic and short 
gastric branches of the lienal. They supply the muscular coat, ramify in the submucous coat, and 
are finally distributed to the mucous membrane. The arrangement of the vessels in the mucous 
membrane is somewhat peculiar. The arteries break up at the base of the gastric tubules into 
a plexus of fine capillaries which run upward between the tubules, anastomosing with each other, 
and ending in a plexus of larger capillaries, which surround the mouths of the tubes, and also 
form hexagonal meshes around the ducts. From these the veins arise, and pursue a straight 
course downward, between the tubules, to the submucous tissue; they end either in the lienal 
and superior mesenteric veins, or directly in the portal vein. The lymphatics are numerous: 
they consist of a superficial and a deep set, and pass to the lymph glands found along the two 
curvatures of the organ (page 792). The nerves are the terminal branches of the right and left 
Fig. 978.-A pyloric gland, from a section of the 
dog's stomach. (Ebstein.) m. Mouth, n. Neck. tr. 
A deep portion of a tubule cut transversely. 
Fig. 979.-A fundus gland. A. Transverse section 
of gland. 
vagi, the former being distributed upon the back, and the latter upon the front part of the organ. 
A great number of branches from the coeliac plexus of the sympathetic are also distributed to 
it. Nerve plexuses are found in the submucous coat and between the layers of the muscular coat 
as in the intestine. From these plexuses fibrils are distributed to the muscular tissue and the 
mucous membrane. 
Applied Anatomy.-Operations on the stomach are frequently performed. By gastrotomy is 
meant an incision into the stomach for the removal of a foreign body, the opening being imme- 
diately afterward closed-in contradistinction to gastrostomy, the making of a more or less per- 
manent fistulous opening. Gastrotomy is probably best performed by an incision in the linea alba, 
especially if the foreign body be large, but may be performed by an incision over the foreign 
body itself, where this can be felt, or by one of the incisions for gastrostomy mentioned below. 
The peritoneal cavity is opened, and the point at which the stomach is to be incised decided 
upon. This portion is then brought out of the abdominal wound, and gauze is carefully packed 
around it. The stomach is now opened by a transverse incision and the foreign body extracted. 
The wound in the stomach is then closed by Lembert's sutures, i. e., by sutures passed through 1168 
SPLANCHNOLOGY 
the peritoneal and muscular-coats in such a way that the peritoneal surfaces on each side of the 
wound are brought into apposition. In gastrostomy, the incision is commenced opposite the eighth 
left intercostal space, 5 cm. from the median line, and carried downward for 7.5 cm. By this 
incision the fibres of the Rectus abdominis are exposed, and these are separated in the same 
line. The posterior layer of the sheath, the Transversus muscle and transversalis fascia, and 
the peritoneum are then divided, and the peritoneal cavity opened. The anterior wall of the 
stomach is now seized and drawn out of the wound, and a silk suture passed through its mus- 
cular and serous coats at the point selected for opening the viscus. This is held by an assistant 
so that a long conical diverticulum of the stomach protrudes from the external wound, and the 
parietal peritoneum and the posterior layer of the sheath of the Rectus are sutured to it. A 
second incision is made through the skin, over the margin of the costal cartilage, above and a 
little to the outer side of the first incision. A tract is made under the skin through the subcu- 
taneous tissue from the one opening to the other, and the diverticulum of the stomach is drawn 
along this tract by means of the suture inserted into it, so that its apex appears at the second 
opening. A small perforation is now made into the stomach through this protruding apex, and 
its margins are carefully and accurately sutured to the edge of the external wound. The remainder 
of this incision and the whole of the first incision are then closed in the ordinary way and the 
wound dressed. 
In cases of gastric ulcer perforation sometimes takes place, and this was formerly regarded 
as an almost fatal complication. In the present day, by opening the abdomen and closing the 
perforation, which is generally situated on the anterior surface of the stomach, a considerable 
number of cases are cured, provided the operation is done not longer than twelve or fifteen 
hours after the perforation has taken place. The opening is best closed by bringing the peritoneal 
surfaces on either side into apposition by means of Lembert's sutures. Free drainage of the 
peritoneal cavity should be established at the same time. 
Excision of the pylorus has occasionally been performed, but the results of this operation are 
by no means favorable, and, in cases of cancer of the pylorus, before operative proceedings are 
undertaken, the tumor has become so fixed and has so far implicated surrounding parts that 
removal of the pylorus is impossible and gastroenterostomy has to be substituted. The object 
of this operation is to make a fistulous communication between the stomach, on the cardiac side 
of the disease, and the small intestine, as high up as is possible. In cases of cancer of the stomach 
involving other parts than the pylorus, the question of removing the whole or greater part of 
the stomach has to be considered. This operation has been performed by Schlatter and others 
with success. 
Hypertrophy and spasm of the circumferential muscular coat of the pylorus coming on during 
the first few weeks or months of life, and somewhat erroneously described as congenital hyper- 
trophic stenosis of the pylorus, is a serious disorder of infancy. It is characterized by abdominal 
pains and obstinate vomiting coming on after food has been given. Gastric peristalsis can be 
observed by inspection of the child's epigastrium after it has been fed and before vomiting has 
occurred. Progressive wasting for want of nourishment and death from exhaustion tend to 
ensue. Treatment should be by washing out the stomach, and the administration at frequent 
intervals of small quantities of easily digested food, so as to minimize irritation of the gastric 
mucous membrane. Surgical interference entailing a severe operation, gives favorable results 
in a small proportion of cases. 
The stomach is seldom ruptured from external violence on account of its protected position. 
If it occurs, it is when the organ is distended with food. The stomach is sometimes injured in 
gunshot wounds. There is intense shock and severe pain, localized at first at the seat of the 
injury, but soon radiating over the whole abdomen. The treatment consists of opening the 
peritoneal cavity, clearing away all the extruded contents of the stomach, and repairing the 
rent. 
The Small Intestine (Intestinum Tenue). 
The small intestine is a convoluted tube, extending from the pylorus to the colic 
valve, where it ends in the large intestine. It is about 6 metres long,1 and gradually 
diminishes in size from its commencement to its termination. It is contained in 
the central and lower part of the abdominal cavity, and is surrounded above and 
at the sides by the large intestine; a portion of it extends below the superior 
aperture of the pelvis and lies in front of the rectum. It is in relation, in front, with 
the greater omentum and abdominal parietes, and is connected to the vertebral 
1 Treves states that, in one hundred cases, the average length of the small intestine in the adult male was 22 feet 
6 inches, and in the adult female 23 feet 4 inches: but that it varies very much, the extremes in the male being 31 feet 
10 inches, and 15 feet 6 inches. He states that in the adult the length of the bowel is independent of age, height, and 
weight. THE SMALL INTESTINE 
1169 
column by a fold of peritoneum, the mesentery. The small intestine is divisible 
into three portions: the duodenum, the jejunum, and the ileum. 
The Duodenum (Fig. 980) has received its name from being about equal in 
length to the breadth of twelve fingers (25 cm.). It is the shortest, the widest, 
and the most fixed part of the small intestine, and has no mesentery, being only 
partially covered by peritoneum. Its course presents a remarkable curve, some- 
what of the shape of an imperfect circle, so that its termination is not far removed 
from its starting-point. 
In the adult the course of the duodenum is as follows: commencing at the pylorus 
it passes backward, upward, and to the right, beneath the quadrate lobe of the 
liver to the neck of the gall-bladder, varying slightly in direction according to the 
degree of distension of the stomach: it then takes a sharp curve and descends 
along the right margin of the head of the pancreas, for a variable distance, generally 
to the level of the upper border of the body of the fourth lumbar vertebra. It 
now takes a second bend, and passes from right to left across the vertebral column, 
Fig. 980.-The duodenum and pancreas. 
having a slight inclination upward; and on the left side of the vertebral column 
it ascends for about 2.5 cm., and then ends opposite the second lumbar vertebra 
in the jejunum. As it unites with the jejunum it turns abruptly forward, forming 
the duodendojejunal flexure. From the above description it will be seen that the 
duodenum may be divided into four portions: superior, descending, horizontal, 
and ascending. 
Relations.-The superior portion (pars superior; first portion) is about 5 cm. long. 
Beginning at the pylorus, it ends at the neck of the gall-bladder. It is the most 
movable of the four portions. It is almost completely covered by peritoneum, but a 
small part of its posterior surface near the neck of the gall-bladder and the inferior 
vena cava is uncovered; the upper border of its first half has the hepatoduodenal 
ligament attached to it, while to the lower border of the same segment the greater 
omentum is connected. It is in such close relation with the gall-bladder that it 
is usually found to be stained by bile after death, especially on its anterior surface.. 
It is in relation above and in front with the quadrate lobe of the liver and the gall- 1170 
SPLANCHNOLOGY 
bladder; behind with the gastroduodenal artery, the common bile duct, and the 
portal vein; and below and behind with the head and neck of the pancreas. 
The descending portion {pars descendens; second portion) is from 7 to 10 cm. long, and 
extends from the neck of the gall-bladder, on a level with the first lumbar vertebra, 
along the right side of the vertebral column as low as the upper border of the body 
of the fourth lumbar vertebra. It is crossed in its middle third by the transverse 
colon, the posterior surface of which is uncovered by peritoneum and is connected 
to the duodenum by a small quantity of connective tissue. The supra- and infra- 
colic portions are covered in front by peritoneum, the infracolic part by the right 
leaf of the mesentery. Posteriorly the descending portion of the duodenum is not 
covered by peritoneum. The descending portion is in relation, in front, from above 
downward, with the duodenal impression on the right lobe of the liver, the trans- 
verse colon, and the small intestine; behind, it has a variable relation to the front 
of the right kidney in the neighborhood of the hilus, and is connected to it by 
loose areolar tissue; the renal vessels, the inferior vena cava, and the Psoas below, 
are alsoTehind it. At its medial side is the head of the pancreas, and the common 
Fig. 981.-Interior of the descending portion of the duodenum, showing bile papilla. 
bile duct; to its lateral side is the right colic flexure. The common bile duct and 
the pancreatic duct together perforate the medial side of this portion of the intestine 
obliquely (Figs. 981 and 1014), some 7 to 10 cm. below the pylorus; the accessory 
pancreatic duct sometimes pierces it about 2 cm. above and slightly in front of these. 
The horizontal portion {pars horizontalis; third or preaortic or transverse portion) is 
from 5 to 7.5 cm. long. It begins at the right side of the upper border of the fourth 
lumbar vertebra and passes from right to left, with a slight inclination upward, 
in front of the great vessels and crura of the Diaphragma, and ends in the ascending 
portion in front of the abdominal aorta. It is crossed by the superior mesenteric 
vessels and the mesentery. Its front surface is covered by peritoneum, except 
near the middle line, where it is crossed by the superior mesenteric vessels. Its 
posterior surface is uncovered by peritoneum, except toward its left extremity, 
where the posterior layer of the mesentery may sometimes be found covering it 
to a variable extent. This surface rests upon the right crus of the Diaphragma, 
the inferior vena cava, and the aorta. The upper surface is in relation with the 
head of the pancreas. THE SMALL INTESTINE 
1171 
The ascending portion (pars ascendens; fourth portion) of the duodenum is about 
2.5 cm long. It ascends on the left side of the aorta, as far as the level of the upper 
border of the second lumbar vertebra, where it turns abruptly forward to become 
the jejunum, forming the duodenojejunal flexure. It lies in front of the left Psoas 
major and left renal vessels, and is covered in front, and partly at the sides, by 
peritoneum continuous with the left portion of the mesentery. 
The superior part of the duodenum, as stated above, is somewhat movable, 
but the rest is practically fixed, and is bound down to neighboring viscera and the 
posterior abdominal wall by the peritoneum. In addition to this, the ascending 
part of the duodenum and the duodenojejunal flexure are fixed by a structure 
to which the name of Musculus suspensorius duodeni has been given. This structure 
commences in the connective tissue around the cceliac artery and left crus of the 
Diaphragma, and passes downward to be inserted into the superior border of the 
duodenojejunal curve and a part of the ascending duodenum, and from this it is 
continued into the mesentery. It possesses, according to Treitz, plain muscular 
fibres mixed with the fibrous tissue of which it is principally made up. It is of 
little importance as a muscle, but acts as a suspensory ligament. 
Vessels and Nerves.-The arteries supplying the duodenum are the right gastric and superior 
pancreaticoduodenal branches of the hepatic, and the interior pancreaticoduodenal branch of 
the superior mesenteric. The veins end in the Renal and superior mesenteric. The nerves are 
derived from the cceliac plexus. 
Jejunum and Ileum.-The remainder of the small intestine from the end of the 
duodenum is named jejunum and ileum; the former term being given to the upper 
two-fifths and the latter to the lower three-fifths. There is no morphological line 
of distinction between the two, and the division is arbitrary; but at the same time 
the character of the intestine gradually undergoes a change from the commence- 
ment of the jejunum to the end of the ileum, so that a portion of the bowel taken 
from these two situations would present characteristic and marked differences. 
These are briefly as follows: 
The Jejunum (intestinum jejunum) is wider, its diameter being about 4 cm., 
and is thicker, more vascular, and of a deeper color than the ileum, so that a given 
length weighs more. The circular folds (valvulae conniventes) of its mucous mem- 
brane are large and thickly set, and its villi are larger than in the ileum. The aggre- 
gated lymph nodules are almost absent in the upper part of the jejunum, and in 
the lower part are less frequently found than in the ileum, and are smaller and tend 
to assume a circular form. By grasping the jejunum between the finger and thumb 
the circular folds can be felt through the walls of the gut; these being absent in 
the lower part of the ileum, it is possible in this way to distinguish the upper 
from the lower part of the small intestine. 
The Ileum (intestinum ileum) is narrow, its diameter being 3.75 cm., and its 
coats thinner and less vascular than those of the jejunum. It possesses but few 
circular folds, and they are small and disappear entirely toward its lower end, 
but aggregated lymph nodules (Peyer's patches) are larger and more numerous. 
The jejunum for the most part occupies the umbilical and left iliac regions, while 
the ileum occupies chiefly the umbilical, hypogastric, right iliac, and pelvic regions. 
The terminal part of the ileum usually lies in the pelvis, from which it ascends over 
the right Psoas and right iliac vessels; it ends in the right iliac fossa by opening 
into the medial side of the commencement of the large intestine. The jejunum 
and ileum are attached to the posterior abdominal wall by an extensive fold of 
peritoneum, the mesentery, which allows the freest motion, so that each coil can 
accommodate itself to changes in form and position. The mesentery is fan-shaped; 
its posterior border or root, about 15 cm. long, is attached to the posterior abdominal 
wall from the left side of the body of the second lumbar vertebra to the right sacro- 
iliac articulation, crossing successively the horizontal part of the duodenum, the 1172 
SPLANCHNOLOGY 
aorta, the inferior vena cava, the ureter, and right Psoas muscle (Fig. 966). Its 
breadth between its vertebral and intestinal borders averages about 20 cm., and is 
greater in the middle than at its upper and lower ends. According to Lockwood it 
tends to increase in breadth as age advances. Between the two layers of which it is 
composed are contained bloodvessels, nerves, lacteals, and lymph glands, together 
with a variable amount of fat. 
Fig. 982.-Section of duodenum of cat. (After Schafer.) X 60. 
Meckel's Diverticulum {diverticulum ilei').-This consists of a pouch which projects from the 
lower part of the ileum in about 2 per cent, of subjects. Its average position is about 1 meter 
above the colic valve, and its average length about 5 cm. Its calibre is generally similar to that 
of the ileum, and its blind extremity may be free or may be connected with the abdominal wall 
or with some other portion of the intestine by a fibrous band. It represents the remains of 
the proximal part of the vitelline duct, the duct of communication between the yolk-sac and the 
primitive digestive tube in early fetal fife. 
Structure.-The wall of the small intestine (Fig. 982) is composed of four coats: serous, 
muscular, areolar, and mucous. 
The serous coat {tunica serosa) is derived from the peritoneum. The superior portion of the 
duodenum is almost completely surrounded by this membrane neai' its pyloric end, but is only THE SMALL INTESTINE 
1173 
covered in front at the other extremity; the descending portion is covered by it in front, except 
where it is carried off by the transverse colon; and the inferior portion lies behind the peritoneum 
which passes over it without being closely incorporated with the other coats of this part of the 
intestine, and is separated from it in and near the middle line by the superior mesenteric vessels. 
The rest of the small intestine is surrounded by the peritoneum, excepting along its attached 
or mesenteric border; here a space is left for the vessels and nerves to pass to the gut. 
The muscular coat (tunica muscularis) consists of two layers of fibres: an external, longi- 
tudinal, and an internal, circular layer. The longitudinal fibres are thinly scattered over the 
surface of the intestine, and are more distinct along its free border. The circular fibres form a 
thick, uniform layer, and are composed of plain muscle cells of considerable length. The mus- 
cular coat is thicker at the upper than at the lower part of the small intestine. 
The areolar or submucous coat (tela submucosa) connects together the mucous and muscular 
layers. It consists of loose, filamentous areolar tissue containing bloodvessels, lymphatics, and 
nerves. 
The mucous membrane (tunica mucosa) is thick and highly vascular at the upper part of 
the small intestine, but somewhat paler and thinner below. It consists of the following structures: 
next the areolar or submucous coat is a double layer of unstriped muscular fibres, outer longi- 
tudinal and inner circular, the muscularis mucosse; internal to this is a quantity of retiform 
tissue, enclosing in its meshes lymph corpuscles, and in this the bloodvessels and nerves ramify; 
lastly, a basement-membrane, supporting a single layer of epithelial cells, which throughout the 
intestine are columnar in character. The cells are granular in appearance, and each possesses 
a clear oval nucleus. At their superficial or unattached ends they present a distinct layer of 
highly refracting material, marked by vertical striae, the striated border. 
The mucous membrane presents for examination the following structures, contained within 
it or belonging to it: 
Circular folds. 
Villi. 
Intestinal glands. 
Duodenal glands. 
Solitary lymphatic nodules. 
Aggregated lymphatic nodules. 
The circular folds (plicae circular es [Kerkringi]; valvulae conniventes; valves of Kerkring) are large 
valvular flaps projecting into the lumen of the bowel. They are composed of reduplications of the 
mucous membrane, the two layers of the fold being bound together by submucous tissue; unlike the 
folds in the stomach, they are permanent, and are not obliterated when the intestine is distended. 
The majority extend transversely around the cylinder of the intestine for about one-half or two- 
thirds of its circumference, but some form complete circles, and others have a spiral direction; 
the latter usually extend a little more than once around the bowel, but occasionally two or three 
times. The larger folds are about 8 mm. in depth at their broadest part; but the greater number 
are of smaller size. The larger and smaller folds alternate with each other. They are not found 
at the commencement of the duodenum, but begin to appear about 2.5 or 5 cm. beyond the 
pylorus. In the lower part of the descending portion, below the point where the bile and pan- 
creatic ducts enter the intestine, they are very large and closely approximated. In the hori- 
zontal and ascending portions of the duodenum and upper half of the jejunum they are large 
and numerous, but from this point, down to the middle of the ileum, they diminish considerably 
in size. In the lower part of the ileum they almost entirely disappear; hence the comparative 
thinness of this portion of the intestine, as compared with the duodenum and jejunum. The 
circular folds retard the passage of the food along the intestines, and afford an increased surface 
for absorption. 
The intestinal villi (villi intestinales') are highly vascular processes, proj ecting from the mucous 
membrane of the small intestine throughout its whole extent, and giving to its surface a velvety 
appearance. They are largest and most numerous in the duodenum and jejunum, and become 
fewer and smaller in the ileum. 
Structure of the villi (Figs. 983, 984).-The essential parts of a villus are: the lacteal vessel, 
the bloodvessels, the epithelium, the basement-membrane, and the muscular tissue of the mucosa, 
all being supported and held together by retiform lymphoid tissue. 
The lacteals are in some cases double, and in some animals multiple, but usually there is a 
single vessel. Situated in the axis of the villus, each commences by dilated cecal extremities 
near to, but not quite at, the summit of the villus. The walls are composed of a single layer of 
endothelial cells. 
The muscular fibres are derived from the muscularis mucosae, and are arranged in longitudinal 
bundles around the lacteal vessel, extending from the base to the summit of the villus, and giving 
off, laterally, individual muscle cells, which are enclosed by the reticulum, and by it are attached 
to the basement-membrane and to the lacteal. 
The bloodvessels (Fig. 985) form a plexus under the basement membrane, and are enclosed 
in the reticular tissue. 
These structures are surrounded by the basement-membrane, which is made up of a stratum 
of endothelial cells, and upon this is placed a layer of columnar epithelium, the characteristics 1174 
SPLANCHNOLOGY 
of which have been described. The retiform tissue forms a net-work (Fig. 984) in the meshes 
of which a number of leucocytes are found. 
Fig. 984.-Transverse section of a villus, from the human intes- 
tine. (v. Ebner.) X 350. a. Basement membrane, here some- 
what shrunken away from the epithelium, b. Lacteal, c. 
Columnar epithelium, d. Its striated border, e. Goblet cells. 
f. Leucocytes in epithelium, f. Leucocytes below epithelium. 
g. Bloodvessels, h. Muscle cells cut across. 
Fig. 983.-Vertical section of a villus from the 
dog's small intestine. X 80. 
The intestinal glands (glandulae intestinales [Lieberkuhni]', crypts of Lieberkuhn) (Fig. 986) are 
found in considerable numbers over every part of the mucous membrane of the small intestine. 
Small artery Lymphatic plexus 
Fig. 985.-Villi of small intestine, showing bloodvessels and lymphatic vessels. (Cadiat.) 
They consist of minute tubular depressions of tjie mucous membrane, arranged perpendicularly to 
the surface, upon which they open by small circular apertures. They may be seen with the aid THE SMALL INTESTINE 
1175 
of a lens, their orifices appearing as minute dots scattered between the villi. Their walls are 
thin, consisting of a basement membrane lined by columnar epithelium, and covered on their 
exterior by capillary vessels. 
The duodenal glands (glandulae duodenales [Brunneri]) Brunner's glands') are limited to the 
duodenum (Fig. 982), and are found in the submucous areolar tissue. They are largest and most 
numerous near the pylorus, forming an almost complete layer in 
the superior portion and upper half of the descending portions of 
the duodenum. They then begin to diminish in number, and 
practically disappear at the junction of the duodenum and jeju- 
num. They are small compound acinotubular glands consisting 
of a number of alveoli lined by short columnar epithelium and 
opening by a single duct on the inner surface of the intestine. 
The solitary lymphatic nodules (noduli lymphatici solitarii; soli- 
tary glands) are found scattered throughout the mucous mem- 
brane of the small intestine, but are most numerous in the lower 
part of the ileum. Their free surfaces are covered with rudimen- 
tary villi, except at the summits, and each gland is surrounded by 
the openings of the intestinal glands. Each consists of a dense 
interlacing retiform tissue closely packed with lymph-corpuscles, 
and permeated with an abundant capillary network. The inter- 
spaces of the retiform tissue are continuous with larger lymph 
spaces which surround the gland, through which they communi- 
cate with the lacteal system. They are situated partly in the 
submucous tissue, partly in the mucous membrane, where they 
form slight projections of its epithelial layer (see Fig. 998). 
The aggregated lymphatic nodules (noduli lymphatici aggregati; 
Peyer's patches; Peyer's glands; agminated follicles; tonsillae intes- 
tinales) (Fig. 987) form circular or oval patches, from twenty to 
thirty in number, and varying in length from 2 to 10 cm. They are 
largest and most numerous in the ileum. In the lower part of the 
jejunum they are small, circular, and few in number. They are 
occasionally seen in the duodenum. They are placed lengthwise 
in the intestine, and are situated in the portion of the tube most 
distant from the attachment of the mesentery. Each patch is 
formed of a group of solitary lymphatic nodules covered with mucous membrane, but the 
patches do not, as a rule, possess villi on their free surfaces. They are best marked in the 
Fig. 986.-An intestinal gland 
from the human intestine. (Flem- 
ming.) 
Fig. 987.-Vertical section of a human aggregated lymphatic nodule, injected through its lymphatic canals, a. 
Villi with their chyle passages, b. Intestinal glands, c. Muscularis mucosae, d. Cupola or apex of solitary nodule. 
e. Mesial zone of nodule, f. Base of nodule, g. Points of exit of the lacteals from the villi, and entrance into the true 
mucous membrane, h. Retiform arrangement of the lymphatics in the mesial zone. i. Course of the latter at the 
base of the nodule, k. Confluence of the lymphatics opening into the vessels of the submucous tissue. I. Follicular 
tissue of the latter. 
young subject, become indistinct in middle age, and sometimes disappear altogether in 
advanced life. They are freely supplied with bloodvessels (Fig. 988), which form an abundant 1176 
SPLANCHNOLOGY 
plexus around each follicle and give off fine branches permeating the lymphoid tissue in the 
interior of the follicle. The lymphatic plexuses are especially abundant around these patches. 
Vessels and Nerves.-The jejunum and ileum are supplied by the superior mesenteric artery, 
the intestinal branches of which, having reached the attached border of the Towel, run between 
the serous and muscular coats, with frequent inosculations to the free border, where they also 
anastomose with other branches running around the opposite surface of the gut. From these 
Fig. 988.-Transverse section through the equatorial 
plane of three aggregated lymphatic nodules from the 
rabbit. 
Fig. 989.-The myenteric plexus from the rabbit. 
X 50. 
vessels numerous branches are given off, which pierce the muscular coat, supplying it and forming 
an intricate plexus in the submucous tissue. From this plexus minute vessels pass to the glands 
and villi of the mucous membrane. The veins have a similar course and arrangement to the 
arteries. The lymphatics of the small intestine (lacteals) are arranged in two sets, those of the 
mucous membrane and those of the muscular coat. The lymphatics of the villi commence in 
these structures in the manner described above. They form an intricate plexus in the mucous 
and submucous tissue, being joined by the lymphatics from the 
lymph spaces at the bases of the solitary nodules, and from this pass 
to larger vessels at the mesenteric border of the gut. The lymphatics 
of the muscular coat are situated to a great extent between the two 
layers of muscular fibres, where they form a close plexus; through- 
out their course they communicate freely with the lymphatics from 
the mucous membrane, and empty themselves in the same manner 
as these into the origins of the lacteal vessels at the attached border 
of the gut. 
The nerves of the small intestines are derived from the plexuses of 
sympathetic nerves around the superior mesenteric artery. From 
this source they run to the mesenteric plexus (Auerbach' s plexus') 
(Fig. 989) of nerves and ganglia situated between the circular and 
longitudinal muscular fibres from which the nervous branches are 
distributed to the muscular coats of the intestine. From this a 
secondary plexus, the pleuxs of the submucosa (Meissner's plexus) 
(Fig. 990) is derived, and is formed by branches which have per- 
forated the circular muscular fibres. This plexus lies in the submucous coat of the intestine; it 
also contains ganglia from which nerve fibres pass to the muscularis mucosae and to the mucous 
membrane. The nerve bundles of the submucous plexus are finer than those of the myenteric 
plexus. 
The Large Intestine (Intestinum Crassum). 
The large intestine extends from the end of the ileum to the anus. It is about 
1.5 metres long, being one-fifth of the whole extent of the intestinal canal. Its 
calibre is largest at its commencement at the cecum, and gradually diminishes 
Fig. 990.-The plexus of the 
submucosa from the rabbit. 
X 50. THE LARGE INTESTINE 
1177 
as far as the rectum, where there is a dilatation of considerable size just above 
the anal canal. It differs from the small intestine in its greater calibre, its more 
fixed position, its sacculated form, and in possessing certain appendages to its 
external coat, the appendices epiploicae. Further, its longitudinal muscular fibres 
do not form a continuous layer around the gut, but are arranged in three longitudinal 
bands or taeniae. The large intestine, in its course, describes an arch which sur- 
rounds the convolutions of the small intestine. It commences in the right iliac 
region, in a dilated part, the cecum. It ascends through the right lumbar and hypo- 
chondriac regions to the under surface of the liver; it here takes a bend, the right 
colic flexure, to the left and passes transversely across the abdomen on the confines 
of the epigastric and umbilical regions, to the left hypochondriac region; it then 
bends again, the left colic flexure, and descends through the left lumbar and iliac 
regions to the pelvis, where it forms a bend called the sigmoid flexure; from this it 
is: continued along the posterior wall of the pelvis to the anus. The large intestine 
is divided into the cecum, colon, rectum, and anal canal. 
Fig. 991.-The cecum and vermiform process,'with their arteries. 
The Cecum (intestinum caecum) (Fig. 991), the commencement of the large 
intestine, is the large blind pouch situated below the colic valve. Its blind end 
is directed downward, and its open end upward, communicating directly with the 
colon,, of which this blind pouch appears to be the beginning or head, and hence the 
old name of caput caecum coli was applied to it. Its size is variously estimated by 
different authors, but on an average it may be said to be 6.25 cm. in length and 7.5 in 
breadth. It is situated in the right iliac fossa, above the lateral half of the inguinal 
ligament: it rests on the Uiacus and Psoas major, and usually lies in contact with the 
anterior abdominal wall, but the greater omentum and, if the cecum be empty, 
some coils of small intestine may lie in front of it. As a rule, it is entirely enveloped 
by peritoneum, but in a certain number of cases.(5 per cent., Berry) the peritoneal 
covering is not complete, so that the upper part of the posterior surface is uncovered 
and connected to the iliac fascia by connective tissue. The cecum lies quite free 
in the abdominal cavity and enjoys a considerable amount of movement, so that 1178 
SPLANCHNOLOGY 
it may become herniated down the right inguinal canal, and has occasionally 
been found in an inguinal hernia on the left side. The cecum varies in shape, but, 
according to Treves, in man it may be classified under one of four types. In early 
fetal life it is short, conical, and broad at the base, with its apex turned upward 
and medialward toward the ileocolic junction. It then resembles the cecum of some 
monkeys, e. g., mangabey monkey. As the fetus grows the cecum increases in 
length more than in breadth, so that it forms a longer tube than in the primitive 
form and without the broad base, but with the same inclination of the apex toward 
the ileocolic junction. This form is seen in other monkeys, e. g., the spider monkey. 
As development goes on, the lower part of the tube ceases to grow and the upper 
part becomes greatly increased, so that at birth there is a narrow tube, the vermi- 
form process, hanging from a conical projection, the cecum. This is'the infantile 
form, and as it persists throughout life in about 2 per cent, of cases, it is regarded 
by Treves as the first of his four types of human ceca. The cecum is conical and 
the appendix rises from its apex. The three longitudinal bands start from the 
appendix and are equidistant from each other. In the second type, the conical 
cecum has become quadrate by the growing out of a saccule on either side of the 
anterior longitudinal band. These saccules are of equal size, and the appendix 
arises from between them, instead of from the apex of a cone. This type is found 
in about 3 per cent, of cases. The third type is the normal type of man. Here 
the two saccules, which in the second type were uniform, have grown at unequal 
rates: the right with greater rapidity than the left. In consequence of this an 
apparently new apex has been formed by the growing downward of the right sac- 
cule, and the original apex, with the appendix attached, is pushed over to the left 
toward the ileocolic junction. The three longitudinal bands still start from the 
base of the vermiform process, but they are now no longer equidistant from each 
other, because the right saccule has grown between the anterior and postero- 
lateral bands, pushing them over to the left. This type occurs in about 90 per 
cent, of cases. The fourth type is merely an exaggerated condition of the third; 
the right saccule is still larger, and at the same time the left saccule has become 
atrophied, so that the original apex of the cecum, with the vermiform process, is 
close to the ileocolic junction, and the anterior band courses medialward to the 
same situation, This type is present in about 4 per cent, of cases. 
The Vermiform Process or Appendix (processus vermiformis) (Fig. 991) is a long, 
narrow, worm-shaped tube, which starts from what was originally the apex of the 
cecum, and may pass in one of several directions: upward behind the cecum; to 
the left behind the ileum and mesentery; or downward into the lesser pelvis. It 
varies from 2 to 20 cm. in length, its average being about 8.3 cm. It is retained 
in position by a fold of peritoneum (mesenteriole), derived from the left leaf of 
the mesentery. This fold, in the majority of cases, is more or less triangular in 
shape, and as a rule extends along the entire length of the tube. Between its two 
layers and close to its free margin lies the appendicular artery (Fig. 991). The canal 
of the vermiform process is small, extends throughout the whole length of the tube, 
and communicates with the cecum by an orifice which is placed below and behind 
the ileocecal opening. It is sometimes guarded by a semilunar valve formed by a 
fold of mucous membrane, but this is by no means constant. 
Structure.-The coats of the vermiform process are the same as those of the intestine: serous, 
muscular, submucous, and mucous. The serous coat forms a complete investment for the tube, 
except along the narrow line of attachment of its mesenteriole in its proximal two-thirds. The 
longitudinal muscular fibres do not form three bands as in the greater part of the large intestine, 
but invest the whole organ, except at one or two points where both the longitudinal and circular 
fibres are deficient so that the peritoneal and submucous coats are contiguous over small areas. 
The circular muscle fibres form a much thicker layer than the longitudinal fibres, and are 
separated from them by a small amount of connective tissue. The submucous coat is well 
marked, and contains a large number of masses of lymphoid tissue which cause the mucous THE LARGE INTESTINE 
1179 
membrane to bulge into the lumen and so render the latter of small size and irregular shape. 
The mucous membrane is lined by columnar epithelium and resembles that of the rest of the 
large intestine, but the intestinal glands are fewer in number (Fig. 992). 
The Colic Valve (valvula coli; ileocecal valve} (Fig. 993).-The lower end of the ileum 
ends by opening into the medial and back part of the large intestine, at the point 
of junction of the cecum with the colon. The opening is guarded by a valve, 
consisting of two segments or lips, which project into the lumen of the large intes- 
tine. If the intestine has been inflated and dried, the lips are of a semilunar shape. 
The upper one, nearly horizontal in direction, is attached by its convex border 
Fig. 992.-Transverse section of human vermiform process. X 20. 
Fig. 993.-Interior of the cecum and lower end of ascending colon, showing colic valve. 
to the line of junction of the ileum with the colon; the lower lip, which is longer 
and more concave, is attached to the line of junction of the ileum with the cecum. 
At the ends of the aperture the two segments of the valve coalesce, and are continued 
as narrow membranous ridges around the canal for a short distance, forming the 
frenula of the valve. The left or anterior end of the aperture is rounded; the right 
or posterior is narrow and pointed. In the fresh condition, or in specimens which 1180 
SPLANCHNOLOGY 
have been hardened in situ, the lips project as thick cushion-like folds into the lumen 
of the large gut, while the opening between them may present the appearance of a 
slit or may be somewhat oval in shape. 
Each lip of the valve is formed by a reduplication of the mucous membrane 
and of the circular muscular fibres of the intestine, the longitudinal fibres and 
peritoneum being continued uninterruptedly from the small to the large intestine. 
The surfaces of the valve directed toward the ileum are covered with villi, and 
present the characteristic structure of the mucous membrane of the small intestine; 
while those turned toward the large intestine are destitute of villi, and marked 
with the orifices of the numerous tubular glands peculiar to the mucous membrane 
of the large intestine. These differences in structure continue as far as the free 
margins of the valve. It is generally maintained that this valve prevents reflux 
from the cecum into the ileum, but in all probability it acts as a sphincter around 
the end of the ileum and prevents the contents of the ileum from passing too 
quickly into the cecum. 
The Colon is divided into four parts: the ascending, transverse, descending, and 
sigmoid. 
The Ascending Colon (colon ascendens) is smaller in calibre than the cecum, with 
which it is continuous. It passes upward, from its commencement at the cecum, 
opposite the colic valve, to the under surface of the right lobe of the liver, on the 
right of the gall-bladder, where it is lodged in a shallow depression, the colic impres- 
sion; here it bends abruptly forward and to the left, forming the right colic (hepatic) 
flexure (Fig. 980). It is retained in contact with the posterior wall of the abdomen 
by the peritoneum, which covers its anterior surface and sides, its posterior surface 
being connected by loose areolar tissue with the Iliacus, Quadratus lumborum, 
aponeurotic origin of Transversus abdominis, and with the front of the lower and 
lateral part of the right kidney. Sometimes the peritoneum completely invests 
it, and forms a distinct but narrow mesocolon.1 It is in relation, in front, with the 
convolutions of the ileum and the abdominal parietes. 
The Transverse Colon (colon transversum) the longest and most movable part of 
the colon, passes with a downward convexity from the right hypochondriac region 
across the abdomen, opposite the confines of the epigastric and umbilical zones, 
into the left hypochondriac region, where it curves sharply on itself beneath the 
lower end of the spleen, forming the left colic (splenic) flexure. In its course it 
describes an arch, the concavity of which is directed backward and a little upward; 
toward its splenic end there is often an abrupt U-shaped curve which may descend 
lower than the main curve. It is almost completely invested by peritoneum, and 
is connected to the inferior border of the pancreas by a large and wide duplicature 
of that membrane, the transverse mesocolon. It is in relation, by its upper surface, 
with the liver and gall-bladder, the greater curvature of the stomach, and the 
lower end of the spleen; by its under surface, with the small intestines; by its ante- 
rior surface, with the anterior layers of the greater omentum and the abdominal 
parietes; its posterior surface is in relation from right to left with the descending 
portion of the duodenum, the head of the pancreas, and some of the convolutions 
of the jejunum and ileum. 
The left colic or splenic flexure (Fig. 980) is situated at the junction of the trans- 
verse and descending parts of the colon, and is in relation with the lower end of the 
spleen and the tail of the pancreas; the flexure is so acute that the end of the trans- 
verse colon usually lies in contact with the front of the descending colon. It lies 
1 Treves states that, after a careful examination of one hundred subjects, he found that in fifty-two there was neither 
an ascending nor a descending mesocolon. In twenty-two there was a descending mesocolon, but no trace of a corre- 
sponding fold on the other side. In fourteen subjects there was a mesocolon to both the ascending and the descending 
segments of the bowel; while in the remaining twelve there was an ascending mesocolon, but no corresponding fold 
on the left side. It follows, therefore, that in performing lumbar colotomy a mesocolon may be expected upon the left 
side in 36 per cent, of all cases, and on the right in 26 per cent.-The Anatomy of the Intestinal Canal and Peritoneum 
in Man, 1885, p. 55. THE LARGE INTESTINE 
1181 
at a higher level than, and on a plane posterior to, the right colic flexure, and is 
attached to the Diaphragma, opposite the tenth and eleventh ribs, by a peritoneal 
fold, named the phrenicocolic ligament, which assists in supporting the lower end 
of the spleen (see page 1157). 
The Descending Colon1 (colon descendens) passes downward through the left 
hypochondriac and lumbar regions along the lateral border of the left kidney. 
At the lower end of the kidney it turns medialward toward the lateral border of 
the Psoas, and then descends, in the angle between Psoas and Quadratus lumborum, 
to the crest of the ilium, where it ends in the iliac colon. The peritoneum covers 
its anterior surface and sides, while its posterior surface is connected by areolar 
tissue with the lower and lateral part of the left kidney, the aponeurotic origin of 
the Transversus abdominis, and the Quadratus lumborum (Fig. 980). It is smaller 
in calibre and more deeply placed than the ascending colon, and is more frequently 
covered with peritoneum on its posterior surface than the ascending colon (Treves). 
In front of it are some coils of small intestine. 
Fig. 994.-Iliac colon, sigmoid or pelvic colon, and rectum seen from the front, after removal of pubic bones 
and bladder. 
The Iliac Colon (Fig. 994) is situated in the left iliac fossa, and is about 12 to 
15 cm. long. It begins at the level of the iliac crest, where it is continuous with 
the descending colon, and ends in the sigmoid colon at the superior aperture of the 
lesser pelvis. It curves downward and medialward in front of the Uiacus and Psoas, 
and, as a rule, is covered by peritoneum on its sides and anterior surface only. 
The Sigmoid Colon (colon sigmoideum; pelvic colon; sigmoid flexure) (Fig. 994) 
forms a loop which averages about 40 cm. in length, and normally lies within the 
pelvis, but on account of its freedom of movement it is liable to be displaced into 
1 In the Basle nomenclature the descending colon is the portion between the left colic flexure and the superior aper- 
ture of the lesser pelvis; it is, however, convenient to still describe its lowest part as the iliac colon. 1182 
SPLANCHNOLOGY 
the abdominal cavity. It begins at the superior aperture of the lesser pelvis, 
where it is continuous with the iliac colon, and passes transversely across the front 
of the sacrum to the right side of the pelvis; it then curves on itself and turns 
toward the left to reach the middle line at the level of the third piece of the sacrum, 
whefe it bends downward and ends in the rectum. It is completely surrounded by 
peritoneum, which forms a mesentery (sigmoid mesocolon), which diminishes in 
length from the centre toward the ends of the loop, where it disappears, so that the 
loop is fixed at its junctions with the iliac colon and rectum, but enjoys a consider- 
able range of movement in its central portion. Behind, the sigmoid colon are the 
external iliac vessels, the left Piriformis, and left sacral plexus of nerves; in front, 
it is separated from the bladder in the male, and the uterus in the female, by some 
coils of the small intestine. 
Fig. 995.-The posterior aspect of the rectum exposed by removing the lower part of the sacrum and the coccyx. 
The Rectum (intestinum rectum) (Fig. 995) is continuous above with the sigmoid 
colon, while below it ends in the anal canal. From its origin at the level of the 
third sacral vertebra it passes downward, lying in the sacrococcygeal curve, and 
extends for about 2.5 cm. in front of, and a little below, the tip of the coccyx, 
as far as the apex of the prostate. It then bends sharply backward into the anal 
canal. It therefore presents two antero-posterior curves: an upper, with its con- THE LARGE INTESTINE 
1183 
vexity backward, and a lower, with its convexity forward. Two lateral curves are 
also described, one to the right opposite the junction of the third and fourth sacral 
vertebrae, and the other to the left, opposite the left sacrococcygeal articulation; 
they are, however, of little importance. The rectum is about 12 cm. long, and at 
its commencement its calibre is similar to that of the sigmoid colon, but near its 
termination it is dilated to form the rectal ampulla. The rectum has no sacculations 
comparable to those of the colon, but when the lower part of the rectum is con- 
tracted, its mucous membrane is thrown into a number of folds, which are longitudi- 
nal in direction and are effaced by the distension of the gut. Besides these there 
are certain permanent transverse folds, of a semilunar shape, known as Houston's 
valves (Fig. 996). They are usually three in number; sometimes a fourth is found, 
and occasionally only two are present. One is 
situated near the commencement of the rectum, 
on the right side; a second extends inward from 
the left side of the tube, opposite the middle of 
the sacrum; a third, the largest and most con- 
stant, projects backward from the forepart of 
the rectum, Apposite the fundus of the urinary 
bladder. When a fourth is present, it is situated 
nearly 2.5 cm. above the anus on the left and 
posterior wall of the tube. These folds are about 
12 mm. in width, and contain some of the 
circular fibres of the gut. In the empty state of 
the intestines they overlap each other, as Houston 
remarks, so effectually as to require considerable 
manoeuvering to conduct a bougie or the finger 
along the canal. Their use seems to be, "to 
support the weight of fecal matter, and prevent 
its urging toward the anus, where its presence 
always excites a sensation demanding its dis- 
charge.1 
The peritoneum is related to the upper two- 
thirds of the rectum, covering at first its front 
and sides, but lower down its front only; from 
the latter it is reflected onto the seminal vesicles 
in the male and the posterior vaginal wall in the 
female. 
The level at which the peritoneum leaves the anterior wall of the rectum to be 
reflected on to the viscus in front of it is of considerable importance from a surgical 
point of view, in connection with the removal of the lower part of the rectum. It 
is higher in the male than in the female. In the former the height of the recto- 
vesical excavation is about 7.5 cm., i. e., the height to which an ordinary index 
finger can reach from the anus. In the female the height of the rectouterine excava- 
tion is about 5.5 cm. from the anal orifice. The rectum is surrounded by a dense 
tube of fascia derived from the fascia endopelvina, but fused behind with the fascia 
covering the sacrum and coccyx. The facial tube is loosely attached to the rectal 
wall by areolar tissue in order to allow of distension of the viscus. 
Relations of the Rectum.-The upper part of the rectum is in relation, behind, with the superior 
hemorrhoidal vessels, the left Piriformis, and left sacral plexus of nerves, which separate it from 
the pelvic surfaces of the sacral vertebrae; in its lower part it Ues directly on the sacrum, coccyx, 
and Levatores ani, a dense fascia alone intervening; in front, it is separated above, in the male, 
from the fundus of the bladder; in the female, from the intestinal surface of the uterus and its 
Fig. 996.-Coronal section of rectum and 
anal canal. 
1 Paterson ("The Form of the Rectum," Journal of Anatomy and Physiology, vol. xliii) utilizes the third fold for 
the purpose of dividing the rectum into an upper and a lower portion; he considers the latter "to be just as much a 
duct as the narrower anal canal below, " and maintains that, under normal conditions, it does not contain feces except 
during the act of defecation. 1184 
SPLANCHNOLOGY 
appendages, by some convolutions of the small intestine, and frequently by the sigmoid colon; 
below, it is in relation in the male with the triangular portion of the fundus of the bladder, the 
vesiculae seminales, and ductus deferentes, and more anteriorly with the posterior surface of 
the prostate; in the female, with the posterior wall of the vagina. 
The Anal Canal {pars analis recti') (Fig. 997), or terminal portion of the large 
intestine, begins at the level of the apex of the prostate, is directed downward and 
backward, and ends at the anus. It 
forms an angle with the lower part of 
the rectum, and measures from 2.5 to 
4 cm. in length. It has no peritoneal 
covering, but is invested by the Sphinc- 
ter ani internus, supported by the 
Levatores ani, and surrounded at its 
termination by the Sphincter ani ex- 
ternus. In the empty condition it pre- 
sents the appearance of an antero- 
posterior longitudinal slit. Behind it 
is a mass of muscular* and fibrous 
tissue, the anococcygeal body (Syming- 
ton); in front of it, in the male, but 
separated by connective tissue from it, 
are the membranous portion and bulb 
of the urethra, and the fascia of the uro- 
genital diaphragm; and in the female 
it is separated from the low'er end of 
the vagina by a mass of muscular and 
fibrous tissue, named the perineal body. 
The lumen of the anal canal pre- 
sents, in its upper half, a number of 
vertical folds, produced by an infolding 
of the mucous membrane and some of 
the muscular tissue. They are known as the rectal columns [Morgagni] (Fig. 996), 
and are separated from one another by furrows (rectal sinuses), which end below 
in small valve-like folds, termed anal valves, which join together the lower ends 
of the rectal columns. 
Structure of the Colon.-The large intestine has four coats: serous, muscular, areolar, and 
mucous. 
The serous coat {tunica serosa) is derived from the peritoneum, and invests the different 
portions of the large intestine to a variable extent. The cecum is completely covered by the 
serous membrane, except in about 5 per cent, of cases where the upper part of the posterior 
surface is uncovered. The ascending, descending, and iliac parts of the colon are usually covered 
only in front and at the sides; a variable amount of the posterior surface is uncovered.1 The 
transverse colon is almost completely invested, the parts corresponding to the attachment of 
the greater omentum and transverse mesocolon being alone excepted. The sigmoid colon is 
entirely surrounded. The rectum is covered above on its anterior surface and sides; below, 
on its anterior aspect only; the anal canal is entirely devoid of any serous covering. In the 
course of the colon the peritoneal coat is thrown into a number of small pouches filled with fat, 
called appendices epiploicae. They are most numerous on the transverse colon. 
The muscular coat {tunica muscularis) consists of an external longitudinal, and an internal 
circular, layer of non-striped muscular fibres. 
The longitudinal fibres do not form a continuous layer over the whole surface of the large intes- 
tine. In the cecum and colon they are especially collected into three flat longitudinal bands 
{taeniae coli), each of about 12 mm. in width; one, the posterior, is placed along the attached 
border of the intestine; the anterior, the largest, corresponds along the arch of the colon to the 
attachment of the greater omentum, but is in front in the ascending, descending, and iliac parts 
of the colon, and in the sigmoid colon; the third, or lateral band, is found on the medial side of 
the ascending and descending parts of the colon, and on the under aspect of the transverse colon. 
Fig. 997.-Coronal section through the anal canal. 
(Symington.) B. Cavity of urinary bladder. V.D. Ductus 
deferens. S.V. Seminal vesicle. R. Second part of 
rectum. A.C. Anal canal. L.A. Levator ani. I.S. 
Sphincter ani internus. E.S. Sphincter ani externus. 
1 See footnote, p. 1180. THE LARGE INTESTINE 
1185 
These bands are shorter than the other coats of the intestine, and serve to produce the sacculi 
which are characteristic of the cecum and colon; accordingly, when they are dissected off, the 
tube can be lengthened, and its sacculated character becomes lost. In the sigmoid colon the longi- 
tudinal fibres become more scattered; and around the rectum they spread out and form a layer, 
which completely encircles this portion of the gut, but is thicker on the anterior and posterior 
surfaces, where it forms two bands, than on the lateral surfaces. In addition, two bands of plain 
muscular tissue arise from the second and third coccygeal vertebrae, and pass downward and 
forward to blend with the longitudinal muscular fibres on the posterior wall of the anal canal. 
These are known as the Rectococcygeal muscles. 
The circular fibres form a thin layer over the cecum and colon, being especially accumulated 
in the intervals between the sacculi; in the rectum they form a thick layer, and in the anal canal 
they become numerous, and constitute the Sphincter ani internus. 
The areolar coat (tela submucosa; submucous coat) connects the muscular and mucous layers 
closely together. 
The mucous membrane (tunica mucosa) in the cecum and colon, is pale, smooth, destitute of 
villi, and raised into numerous crescentic folds which correspond to the intervals between the 
sacculi. In the rectum it is thicker, of a darker color, more vascular, and connected loosely to 
the muscular coat, as in the oesophagus. 
Fig. 998.-Section of mucous membrane of human rectum. (Sobotta.) X 00. 
As in the small intestine, the mucous membrane (Fig. 998) consists of a muscular layer, the 
muscularis mucosae; a quantity of retiform tissue in which the vessels ramify; a basement-mem- 
brane and epithelium which is of the columnar variety, and resembles the epithelium found in 
the small intestine. The mucous membrane of the large intestine presents for examination glands 
and solitary lymphatic nodules. 
The glands of the great intestine are minute tubular prolongations of the mucous membrane 
arranged perpendicularly, side by side, over its entire surface; they are longer, more numerous, 
and placed in much closer apposition than those of the small intestine; and they open by minute 
rounded orifices upon the surface, giving it a cribriform appearance. Each gland is lined by 
short columnar epithelium and contains numerous goblet cells. 
The solitary lymphatic nodules (noduli lymphatic solitarii) (Fig. 998) of the large intestine 
are most abundant in the cecum and vermiform process, but are irregularly scattered also over 
the rest of the intestine. They are similar to those of the small intestine. 
Vessels and Nerves.-The arteries supplying the colon are derived from the colic and sigmoid 
branches of the mesenteric arteries. They give off large branches, which ramify between and 
supply the muscular coats, and after dividing into small vessels in the submucous tissue, pass 
to the mucous membrane. The rectum is supplied by the superior hemorrhoidal branch of the 
inferior mesenteric, and the anal canal by the middle hemorrhoidal from the hypogastric, and 
the inferior hemorrhoidal from the internal pudendal artery. The superior hemorrhoidal, the 
continuation of the superior mesenteric, divides into two branches, which run down either side 
of the rectum to within about 12.5 cm. of the anus; they here split up into about six branches, 
which pierce the muscular coat and descend between it and the mucous membrane in a longi- 1186 
SPLANCHNOLOGY 
tudinal direction, parallel with each othei' as far as the Sphincter ani internus, where they anas- 
tomose with the other hemorrhoidal arteries and form a series of loops around the anus. The 
veins of the rectum commence in a plexus of vessels which surrounds the anal canal. In the 
vessels forming this plexus are smaller saccular dilatations just within the margin of the anus; 
from the plexus about six vessels of considerable size are given off. These ascend between the 
muscular and mucous coats for about 12.5 cm., running parallel to each other; they then 
pierce the muscular coat, and, by their union, form a single trunk, the superior hemorrhoidal 
vein. This arrangement is termed the hemorrhoidal plexus; it communicates with the tribu- 
taries of the middle and inferior hemorrhoidal veins, at its commencement, and thus a communi- 
cation is established between the systemic and portal circulations. The lymphatics of the large 
intestine are described on page 792. The nerves are derived from the sympathetic plexuses 
around the branches of the superior and inferior mesenteric arteries. They are distributed in 
a similar way to those found in the small intestine. 
Applied Anatomy.-The small intestine is much exposed to injury, but, in consequence of 
elasticity and the ease with which one coil glides over another, it is not so frequently ruptured 
as would otherwise be the case. Any part of it may be ruptured, but probably the most common 
situation is the horizontal portion of the duodenum, on account of its being more fixed than 
other portions of the bowel, and because it is situated in front of the bodies of the vertebrae, 
so that if this portion of the intestine is struck by a sharp blow, as from the kick of a horse, it is 
unable to glide out of the way, but is compressed against the bone and so lacerated. Wounds 
of the intestine sometimes occur. If the wound is a small puncture, under, it is said, 6 mm. in 
length, no extravasation of the contents of the bowel takes place; the mucous membrane becomes 
everted and plugs the little opening. The small intestine, and most frequently the.ileum, may 
become strangulated by internal bands, or through apertures, normal or abnormal. The bands 
may be formed in several different ways: they may be old peritoneal adhesions from previous 
attacks of peritonitis: or an adherent omentum from the same cause; or the band may be formed 
by Meckel's diverticulum, which has contracted adhesions at its distal extremity; or it may be 
the result of the abnormal attachment of some normal structure, as the adhesion of two appen- 
dices epiploicae, or an adherent vermiform process or uterine tube. Intussusception, most com- 
monly an invagination of the small intestine into the large, may take place; it may attain great 
size, and it is not uncommon in these cases to find the colic valve projecting from the anus. 
Stricture, the impaction of foreign bodies, and twisting of the gut (volvulus) may also lead to 
intestinal obstruction. 
Resection of a portion of the intestine may be required in cases of gangrene; for the removal 
of new growth in the bowel; in dealing with artificial anus; and in cases of rupture. The opera- 
gion is termed enterectomy, and is performed as follows: the abdomen having been opened and 
the amount of bowel requiring removal having been determined upon, the intestine must be 
clamped on either side of this portion in order to prevent the escape of any of its contents during 
the operation. The portion of the bowel is then separated above and below by means of scissors. 
If the portion resected is small, it may be simply removed from the mesentery at its attachment, 
and the bleeding vessels tied; but if it be large it will be necessary to take away a triangular piece 
of the mesentery, and, having secured the vessels, suture the cut edges of this structure together. 
In doing this, care must be taken not to leave any intestine projecting beyond the line of the 
section of mesentery, as gangrene is very likely to occur in the projecting part if this is done. 
The surgeon then proceeds, to unite the cut ends of the bowel together by what is termed end-to- 
end anastomosis. There are many ways of doing this, which may be divided into two classes, 
one where the anastomosis is made by means of some mechanical appliance, such as Murphy's 
button, or one of the forms of decalcified bone bobbin; and the other, where the operation is 
performed by suturing the ends of the bowel in such a manner that the peritoneum covering the 
two divided ends is brought into contact, so that speedy union may ensue. 
The vermiform process is very liable to become inflamed, because it contains a relatively 
large amount of lymphoid tissue, which is prone to bacterial infection. In many cases the inflam- 
mation is set up by the impaction in it of a solid mass of feces or a foreign body, or by the inspis- 
sation of its mucous secretion in catarrhal conditions. The inflammation may result in ulceration 
and perforation, or if very acute in gangrene of the process. These conditions generally require 
immediate operative interference, and in chronic cases with recurring attacks of inflammation 
it is always advisable to remove this diverticulum of the bowel. In incising the abdominal wall 
for this operation, the muscles should be split in the direction of their fibres rather than cut 
across in order to prevent subsequent weakening of the abdominal parietes and the occurrence 
of a ventral hernia. After the process has been removed it is better to suture the planes of the 
abdominal wall separately. 
In external hernia the ileum is the portion of bowel most frequently herniated. When a part 
of the large intestine is involved it is usually the cecum, and this may occur even on the left side. 
In some few cases the vermiform process has been the part implicated in strangulated hernia. 
Chronic ulcer of the duodenum is sometimes met with, probably produced by the same causes 
as chronic ulcer of the stomach. It may perforate and set up a rapidly fatal peritonitis, or it THE LARGE INTESTINE 
1187 
may open into one of the large duodenal vessels and cause death from hemorrhage. An acute 
ulcer sometimes, but rarely, follows extensive burns of the skin. 
The calibre of the large intestine gradually diminishes from the cecum, which has the greatest 
diameter of any part of the bowel, to the point of junction of the sigmoid colon with the rectum. 
At or a little below this point stricture most commonly occurs, and diminishes in frequency as 
one proceeds upward to the cecum. When distended by some obstruction low down, the outline 
of the large intestine can be defined throughout nearly the whole of its course-all, in fact, except 
the right and left colic flexures, which are more deeply placed; the distension is most obvious in 
the flanks and on the front of the abdomen just above the umbilicus. The cecum, however, 
is the portion of the bowel which becomes most distended. It may assume enormous dimensions, 
and has been known to give way from the distension, causing fatal peritonitis. The right colic 
flexure and the right extremity of the transverse colon are in close relationship with the liver, 
and abscess of this viscus sometimes bursts into the gut in this situation. The gall-bladder may 
become adherent to the colon, and gallstones may find their way into the latter and may become 
impacted or may be discharged per anum. The mobility of the sigmoid colon renders it more 
liable to become the seat of a volvulus or twist than any other part of the intestine. It generally 
occurs in patients who have been the subjects of habitual constipation, and in whom, therefore, 
the mesocolon is elongated. The gut at this part, being loaded with feces, falls over the part 
below, and so gives rise to the twist. 
Hernia.-The two chief sites at which external hernia may take place are the inguinal region 
and the femoral canal. The description of the inguinal canal and its relations will be found on 
page 508, and that of the femoral canal on page 712. Some points in regard to the disposition 
of the peritoneum in these regions may, however, be recapitulated here. 
Between the upper margin of the front of the pelvis and the umbilicus, the peritoneum, when 
viewed from behind, will be seen to be raised into five folds, with intervening depressions, by 
more or less prominent bands which converge to the umbilicus (Fig. 962). The middle umbilical 
ligament, situated in the middle fine, is covered by a fold of peritoneum known as the middle 
umbilical fold. On either side of this a fold of peritoneum around the obliterated umbilical artery 
forms the lateral umbilical fold. To either side of these three cords is the inferior epigastric 
artery covered by the epigastric fold. Between these raised folds are depressions constituting 
the so-called fovea?. The most medial, between the middle and lateral umbilical folds, is known 
as the supravesical fovea. The intermediate one is situated medial to the plica epigastrica, and 
is termed the medial inguinal fovea. The third is lateral to the plica epigastrica, and is known 
as the lateral inguinal fovea. Occasionally the inferior epigastric artery corresponds in position 
to the obliterated hypogastric artery, and then there is but one fold on each side of the middle 
fine. In the usual position of the parts, the floor of the lateral inguinal fovea corresponds to the 
abdominal inguinal ring, and into this fovea an oblique inguinal hernia descends. Medial to 
the epigastric fold are the medial inguinal and the supravesical foveae, and through either of 
these a direct hernia may descend. The whole of the space between the inferior epigastric artery, 
the margin of the Rectus abdominis, and the inguinal ligament is known as Hesselbach's triangle. 
Below the level of the inguinal ligament is a small depression corresponding to the position of the 
femoral ring. It is known as the femoral fovea, and into it a femoral hernia descends. 
Inguinal Hernia.-Inguinal hernia is that form of protrusion which makes its way through 
the abdominal wall in the inguinal region. There are two principal varieties of it: lateral or 
oblique, and medial or direct. 
In oblique inguinal hernia the intestine escapes from the abdominal cavity at the abdominal 
inguinal ring, pushing before it a pouch of peritoneum which forms the hernial sac. As it enters 
the inguinal canal it receives an investment from the extraperitoneal tissue and is enclosed in 
the infundibuliform fascia. In passing along the inguinal canal it displaces upward the arched 
fibres of the Transversus and Obliquus internus, and receives a covering of Cremaster muscle 
and cremasteric fascia. It then passes along the front of the spermatic cord and escapes from 
the inguinal canal at the subcutaneous inguinal ring, becoming invested by intercrural fascia. 
Lastly it descends into the scrotum, receiving coverings from the superficial fascia and the 
integument. 
The seat of stricture in oblique inguinal hernia is at either the abdominal or the subcutaneous 
inguinal ring; most frequently in the latter situation. If it is situated at the subcutaneous ring, 
the division of a few fibres at one point of the circumference is all that is necessary for the replace- 
ment of the hernia. If at the abdominal ring,- it is necessary to divide the aponeurosis of the 
Obliquus externus so as to lay open the inguinal canal, in dividing the aponeurosis the incision 
should be directed parallel to the inguinal figament, and the constriction at the abdominal ring 
should then be divided directly upward. 
When the intestine passes along the inguinal canal and escapes from the subcutaneous ring 
into the scrotum, it is called complete oblique inguinal or scrotal hernia. If the intestine does not 
escape from the subcutaneous ring, but is retained in the inguinal canal, it is called incomplete 
inguinal hernia or bubonocele. In each of these cases the coverings which invest it will depend 
upon the extent to which it descends in the inguinal canal. 1188 
SPLANCHNOLOGY 
there are some other varieties of oblique inguinal hernia (Fig. 999) depending upon congenital 
defects in the saccus vaginalis, the pouch of peritoneum which precedes the descent of the testis. 
Normally this pouch is closed before birth, closure commencing at two points, viz., at the abdomi- 
nal inguinal ring and at the top of the epididymis, and gradually extending until the whole of 
the intervening portion is converted into a fibrous cord. From failure in the completion of this 
process, variations in the relation of the 
hernial protrusion to the testis and 
tunica vaginalis are produced; these 
constitute distinct varieties of inguinal 
hernia, viz., the hernia of the funicular 
process and the complete congenital 
variety. 
Where the saccus vaginalis remains 
patent throughout, the cavity of the 
tunica vaginalis communicates directly 
with that of the peritoneum. The in- 
testine descends along this pouch into 
the cavity of the tunica vaginalis which 
constitutes the sac of the hernia, and 
the gut lies in contact with the testis. 
Though this form of hernia is termed 
complete congenital, the term does not 
imply that the hernia existed at birth, 
but merely that a condition is present 
which may allow of the descent of the 
hernia at any moment. As a matter of 
fact, congenital hernias frequently do 
not appear until adult life. 
Where the processus vaginalis is 
occluded at the lower point only, i. e., 
just above the testis, the intestine 
descends into the pouch of peritoneum 
as far as the testis, but is prevented 
from entering the sac of the tunica vaginalis by the septum which has formed between it and the 
pouch. This is known as hernia into the funicular process or incomplete congenital hernia; it 
differs from the former in that instead of enveloping the testis it lies above it. 
In direct inguinal hernia the protrusion makes its way through some part of Hesselbach's 
triangle, either through (a) the lateral part, where only extraperitoneal tissue and transversalis 
fascia intervene between the peritoneum and the aponeurosis of the Obliquus externus; or through 
(&) the inguinal aponeurotic falx which stretches across the medial two-thirds of the triangle 
between the artery and the middle line. In the former the hernial protrusion escapes from 
the abdomen on the lateral side of the inguinal falx, pushes before it the peritoneum, extra- 
peritoneal tissue, and transversalis fascia, and enters the inguinal canal. It passes along nearly 
the whole length of the canal and finally emerges from the subcutaneous ring, receiving an invest- 
ment from the intercrural fascia. The coverings of this form of hernia are similar to those of 
the oblique form, except that a portion derived from the general layer of transversalis fascia 
replaces the infundibuliform fascia. 
In the second form, which is the more frequent, the hernia is either forced through the fibres 
of the inguinal falx, or the falx is gradually distended in front of it so as to form a complete 
investment for it. The intestine then enters the lower end of the inguinal canal, escapes at the 
subcutaneous ring, lying on the medial side of the cord, and receives additional coverings from 
the intercrural fascia, the superficial fascia and the integument. The coverings of this form 
therefore differ from those of the oblique form in that the inguinal falx is substituted for the 
Cremaster, and the infundibuliform fascia is replaced by a portion of the general layer of the 
transversalis fascia. 
The seat of stricture in both varieties of direct hernia is usually found either at the neck of the 
sac or at the subcutaneous ring. In that form which perforates the inguinal falx it not infrequently 
occurs at the edges of the fissure through which the gut passes. In all cases of inguinal hernia, 
whether direct or oblique, it is proper to divide the stricture directly upward; by cutting in this 
direction the incision is made parallel to the inferior epigastric artery-lateral to it in the oblique 
variety, medial to it in the direct form of hernia; all chance of wounding the vessel is thus avoided. 
Direct inguinal hernia is of much less frequent occurrence than oblique, and is found more often 
in men than in women. The main differences in position between it and the oblique form are: 
(a) it is placed over the pubis and not in the course of the inguinal canal; (6) the inferior epi- 
gastric artery runs on the lateral or iliac side of the neck of the sac; and (c) the spermatic cord 
lies along its lateral and posterior sides, not directly behind it as in oblique inguinal hernia. 
Incomplete congenital 
Fig. 999.-Varieties of oblique inguinal hernia. THE LARGE INTESTINE 
1189 
Femoral Hernia.-In femoral hernia the protrusion of the intestine takes place through the 
femoral ring. As already described (page 712), this ring is closed by the femoral septum, a 
partition of modified extraperitoneal tissue; it is therefore a weak spot in the abdominal wall, 
and especially in the female, where the ring is larger and where profound changes are produced 
in the tissues of the abdomen by pregnancy. Femoral hernia is therefore more common in 
women than in men. 
When a portion of intestine is forced through the femoral ring, it carries before it a pouch of 
peritoneum, which forms the hernial sac. It receives an investment from the extraperitoneal 
tissue or femoral septum, and descends along the femoral canal, or inner compartment of the 
sheath of the femoral vessels, as far as the fossa ovahs; at this point it changes its course, being 
prevented from extending farther down the sheath on account of the narrowing of the latter, 
and its close contact with the vessels, and also the close attachment of the superficial fascia 
and femoral sheath to the lower part of the circumference of the fossa ovalis. The tumor is 
consequently directed forward, pushing before it the fascia cribrosa, and then curves upward 
over the inguinal ligament and the lower part of the aponeurosis of the Obliquus externus, being 
covered by the superficial fascia and integument. While the hernia is contained in the femoral 
canal it is usually of small size, owing to the resisting nature of the surrounding parts, but when 
it escapes from the fossa ovalis into the loose areolar tissue of the groin it becomes considerably 
enlarged. The direction taken by a femoral hernia is at first downward, then forward and up- 
ward; in the application of taxis for the reduction of a femoral hernia therefore, pressure should 
be directed in the reverse order. 
The coverings of a femoral hernia from within outward are: peritoneum, femoral septum, 
femoral sheath, fascia cribrosa, superficial fascia, and integument. Sir Astley Cooper has described 
an investment for femoral hernia under the name of fascia ■propria, lying immediately external 
to the peritoneal sac but frequently separated from it by some adipose tissue. Surgically it is 
important to remember the frequent existence of this layer on account of the ease with which an 
inexperienced operator may mistake the fascia for the peritoneal sac and the contained fat for 
omentum, as there is often a great excess of subperitoneal fatty tissue enclosed in the "fascia 
propria." In many cases it resembles a fatty tumor, but on further dissection the true hernial 
sac will be found in the centre of the mass of fat. The fascia propria is merely modified extra- 
peritoneal tissue which has been thickened to form a membranous sheet by the pressure of the 
hernia. 
When the intestine descends along the femoral canal only as far as the fossa ovalis the con- 
dition is known as incomplete femoral hernia. The small size of the protrusion in this form of 
hernia, on account of the firm and resisting nature of the canal in which it is contained, renders 
it an exceedingly dangerous variety of the disease, from the extreme difficulty of detecting the 
existence of the swelling, especially in corpulent subjects. The coverings of an incomplete 
femoral hernia would be from without inward: integument, superficial fascia, superior cornu of 
falciform margin of the fossa ovalis, femoral sheath, femoral septum, and peritoneum. 
The seat of stricture of a femoral hernia varies: it may be in the peritoneum at the neck of 
the hernial sac; in the greater number of cases it is at the point of junction of the falciform margin 
of the fossa ovalis with the free edge of the lacunar ligament; or it may be at the margin of the 
fossa ovalis. The stricture should in every case be divided in a direction upward and medialward 
for a distance of about 4 to 6 mm. All vessels or other structures of importance in relation to 
the neck of the sac will thus be avoided. 
The pubic tubercle forms an important landmark in serving to differentiate the inguinal from 
the femoral variety of hernia. The inguinal protrusion is above and medial to the tubercle, while 
the femoral is below and lateral to it. 
There are several details of practical interest in connection with the mesentery which merit 
notice. (1) The depth of the mesentery-that is to say, the distance from its parietal to its 
intestinal attachment-is normally less than 20 cm., generally nearer 15 cm.; but under certain 
abnormal conditions it may become elongated, and this would appear to favor the occurrence of 
hernia of the intestine. (2) Not only may the depth of the mesentery be increased, but its point 
of attachment to the posterior abdominal wall may yield, and descend over the lumbar vertebrae. 
This condition, which is known under the name of enteroptosis, usually occurs in women who 
have borne many children, and is attended with general relaxation of the abdominal parietes. 
It produces a characteristic appearance, the abdomen being prominent and pendulous below, 
while above, it is flattened and constricted. (3) Holes are sometimes present in the mesentery, 
and these may be congenital, or may be the result of injury. They are of practical importance, 
since a knuckle of intestine may become herniated into one of them, causing acute strangulation. 
(4) The lymph glands contained between the two layers of the mesentery are frequently the 
seat of tuberculous deposit, especially in children. 
The colon frequently requires opening in cases of intestinal obstruction, and by some surgeons 
this operation is performed in cases of cancer of the rectum as soon as the disease is recognized, 
in the hope that the symptoms may be relieved by removing the irritation produced by the 
passage of fecal matter over the diseased surface. The operation of colostomy may be performed 1190 
SPLANCHNOLOGY 
either in the iliac or lumbar region; but iliac colostomy has in the present day entirely super- 
seded the lumbar operation. The main reason for preferring this operation is that a spur-shaped 
process of the mesocolon can be formed, which prevents any fecal matter finding its way past 
the artificial anus, and the greater ease in maintaining cleanliness. The sigmoid colon being 
entirely surrounded by peritoneum, a coil can be drawn out of the wound and opened, leaving the 
attachment of the mesocolon to form a spur, much as it does in an artificial anus caused by 
sloughing of the intestine after a strangulated hernia, and this prevents any fecal matter finding 
its way from the gut above the opening into that below. The operation is performed by making 
an incision 5 to 7 cm. long from a point 2.5 cm. medial to the anterior superior iliac spine, parallel 
to the inguinal ligament. The various muscular layers are cut through, and the peritoneum 
opened; the sigmoid colon is now sought for, pulled out of the wound, and fixed by passing a 
needle threaded with carbolized silk first through the mesocolon close to the gut, and then through 
the abdominal wall. The wound is dressed, and about the second day the protruding coil of 
intestine is opened. 
The surgical anatomy of the rectum is of considerable importance. There may be congenital 
malformations due to arrest of, or imperfection in, development. Thus, there may be no proc- 
todoeal invagination (see page 174), and consequently a complete absence of the anus; or the 
hind-gut may be imperfectly developed, and there may be an absence of the rectum, though the 
anus is developed; or the ectodermal invagination may not communicate with the termination 
of the hind-gut from want of solution of continuity in the septum which in early fetal life exists 
between the two. The mucous membrane is thick and but loosely connected to the muscular 
coat beneath, and thus favors prolapse, especially in children. The vessels of the rectum are 
arranged, as mentioned above, longitudinally, and are contained in the loose cellular tissue 
between the mucous and muscular coats, and receive no support from surrounding tissues, and 
this favors varicosity. Moreover, the veins, after running upward in a longitudinal direction for 
about 12.5 cm. in the submucous tissue, pierce the muscular coats, and are liable to become 
constricted at this spot by the contraction of the muscular wall of the gut. In addition to this 
there are no valves in the superior hemorrhoidal veins, and the vessels of the rectum are placed 
in a dependent position, and are liable to be pressed upon and obstructed by hardened feces. 
The anatomical arrangement, therefore, of the hemorrhoidal vessels explains the great tendency 
to the occurrence of piles. The presence of the Sphincter ani externus is of surgical importance, 
since it is the constant contraction of this muscle which prevents an ischiorectal abscess from 
healing, and causes it to become a fistula. Also the reflex contraction of this muscle is the cause 
of the severe pain complained of in fissure of the anus. The relations of the peritoneum to the 
bowel are of importance in connection with the operation of removal of the rectum for malignant 
disease. This membrane gradually leaves the rectum as it descends into the pelvis; first leaving 
its posterior surface, then the sides, and then the anterior surface, to become reflected, in the 
male on to the posterior wall of the bladder, forming the rectovesical excavation, and in the 
female on to the posterior wall of the vagina, forming rectouterine excavation. The recto- 
vesical excavation extends to within 7.5 cm. from the anus. Within recent years much more 
extensive operations have been done for the removal of cancer of the rectum, and in these the 
peritoneal cavity has necessarily been opened. If, in these cases, the opening is plugged with 
antiseptic gauze until the operation is completed and then the edges of the wound in the peri- 
toneum are accurately brought together with sutures, no evil result appears to follow. For cases 
of cancer of the rectum which are too low to be reached by abdominal section, and too high to 
be removed by the perineum, Kraske has devised an operation which goes by his name. The 
patient is placed on his right side and an incision is made from the last piece of the sacrum to 
the anus. The soft parts are now separated from the back of the sides of the sacrum and coccyx, 
and the sacrotuberous and sacrospinous ligaments are separated. The coccyx is removed, and 
if necessary a small piece of the sacrum, and the edges of the wound being now forcibly drawn 
outward, a considerable length of the rectum is brought into view, and the diseased portion can 
be removed, leaving the anal portion of the gut, if healthy. The two divided ends of the gut 
can sometimes be approximated and sutured together, the posterior part being left open for 
drainage. 
The loose connective tissue around the rectum is occasionally the site of an abscess, the active 
focus of which, however, may be located elsewhere. This form of abscess may be described as 
the superior pelvic rectal; it is placed above the pelvic diaphragm but beneath the peritoneum. 
The acute variety is generally due to ulceration or perforation of the bowel (possibly produced 
by a foreign body) above the level of attachment of the Levator ani. The abscess may also occur 
above a stricture (simple or malignant) of the rectum; occasionally it arises from suppuration 
around the prostate, and more rarely follows abscess of the vesiculae seminales. Chronic abscesses 
also appear in the same region either from caries of the anterior surface of the sacrum or from 
caseation of the presacral lymph glands, while in other cases an abscess finds its way down into 
the pelvis from disease of the anterior surfaces of the bodies of the lumbar vertebrae. THE LIVER 
1191 
The Liver (Hepar). 
The liver is the largest gland in the body, and is situated in the upper and right 
parts of the abdominal cavity, occupying almost the whole of the right hypochon- 
drium, the greater part of the epigastrium, and not uncommonly extending into 
the left hypochondrium as far as the mammary line. In the male it weighs from 
1.4 to 1.6 kilogm., in the female from 1.2 to 1.4 kilogm. It is relatively much larger, 
in the fetus than in the adult, constituting, in the former, about one-eighteenth, 
and in the latter about one thirty-sixth of the entire body weight. Its greatest 
transverse measurement is from 20 to 22.5 cm. Vertically, near its lateral or right 
surface, it measures about 15 to 17.5 cm., while its greatest antero-posterior diame- 
ter is on a level with the upper end of the right kidney, and is from 10 to 12.5 cm. 
Opposite the vertebral column its measurement from before backward is reduced 
to about 7.5 cm. Its consistence is that of a soft solid; it is, however, friable and 
easily lacerated; its color is a dark reddish brown, and its specific gravity is 1.05. 
To obtain a correct idea of its shape it must be hardened in situ, and it will 
then be seen to present the appearance of a wedge, the base of which is directed 
to the right and the thin edge toward the left. Symington describes its shape 
as that "of a right-angled triangular prism with the right angle rounded off." 
Surfaces.-The liver possesses five surfaces, viz., superior, inferior, anterior, pos- 
terior, and right lateral. A sharp, well-defined margin divides the inferior from 
the superior, anterior, and right lateral surfaces, but the other surfaces are separated 
from one another by rounded borders. The superior and anterior surfaces are 
attached to the Diaphragma and anterior abdominal wall by a triangular or falci- 
form fold of peritoneum, the falciform ligament, in the free margin of which is a 
rounded cord, the ligamentum teres {obliterated umbilical vein). The line of attach- 
ment of the falciform ligament divides the liver into two parts, termed the right 
and left lobes, the right being much the larger. The inferior and posterior surfaces 
are divided into five lobes by five fossae, which are arranged in the form of the letter 
H. The left limb of the H marks on these surfaces the division of the liver into 
right and left lobes; it is known as the left sagittal fossa, and consists of two parts, 
viz., the fossa for the umbilical vein in front and the fossa for the ductus venosus 
behind. The right limb of the H is formed in front by the fossa for the gall-bladder, 
and behind by the fossa for the inferior vena cava; these two fossae are separated 
from one another by a band of liver substance, termed the caudate process. The 
bar connecting the two limbs of the H is the porta (transverse fissure')-, in front of it 
is the quadrate lobe, behind it the caudate lobe. 
The superior surface (facies superior) (Fig. 1000) comprises a part of both lobes, 
and, as a whole, is convex, and fits under the vault of the Diaphragma; its central 
part, however, presents a shallow depression, which corresponds with the position 
of the pericardium on the upper surface of the Diaphragma. It is separated from 
the anterior, posterior, and right lateral surfaces by rounded borders. Its left 
extremity is separated from the under surface by a prominent sharp margin. 
Except along the lines of attachment of the falciform ligament it is completely 
covered by peritoneum. 
The anterior surface is large, triangular in shape, and also comprises a part of 
both lobes. It is directed forward, and the greater part of it is in contact with 
the Diaphragma, which separates it on the right from the sixth to the tenth ribs 
and their cartilages, and on the left from the seventh and eighth costal cartilages. 
Its middle part lies behind the xiphoid process, and, in the angle between the diverg- 
ing rib cartilage of opposite sides, is in contact with the abdominal wall. It is 
separated from the inferior surface by a sharp margin, and from the superior and 
right lateral surfaces by rounded borders, It is completely covered by peritoneum 
except along the line of attachment of the falciform ligament. 1192 
SPLANCHNOLOGY 
The right lateral surface is covered by peritoneum, and is convex from before 
backward and slightly so from above downward. It is directed toward the right 
side, forming the base of the wedge, and lies against the lateral portion of the Dia- 
phragma, which separates it from the lower part of the pleura and lung, outside 
which are the right costal arches from the seventh to the eleventh inclusive. 
Fig. 1000.-The superior, anterior, and right lateral surfaces of the liver. (From model by His.) 
The inferior surface (facies inferior; visceral surface) (Figs. 1001 1002) is uneven, 
concave, directed downward, backward, and to the left, and is in relation with 
the stomach and duodenum, the right colic flexure, and the right kidney and supra- 
renal gland. The surface is almost completely invested by peritoneum; the only 
parts devoid of this covering are where the gall-bladder is attached to the liver, 
and at the porta hepatis where the two layers of the lesser omentum are separated 
from each other by the bloodvessels and ducts of the liver. The inferior surface 
of the left lobe presents behind and to the left the gastric impression, moulded 
over the antero-superior surface of the stomach, and to the right of this a rounded 
eminence, the tuber omentale, which fits into the concavity of the lesser curvature 
of the stomach and lies in front of the anterior layer of the lesser omentum. The 
under surface of the right lobe is divided into two unequal portions by the fossa 
for the gall-bladder; the portion to the left, the smaller of the two, is the quadrate 
lobe, and is in relation with the pyloric end of the stomach, the superior portion 
of the duodenum, and the transverse colon. The portion of the under surface of 
the right lobe to the right of the fossa for the gall-bladder presents two impressions, 
one situated behind the other, and separated by a ridge. The anterior of these 
two impressions, the colic impression, is shallow and is produced by the right colic 
flexure; the posterior, the renal impression, is deeper and is occupied by the upper 
part of the right kidney and lower part of the right suprarenal gland. Medial 
to the renal impression is a third and slightly marked impression, lying between it 
and the neck of the gall-bladder. This is caused by the descending portion of the 
duodenum, and is known as the duodenal impression. Just in front of the inferior 
vena cava is a narrow strip of liver tissue, the caudate process, which connects 
the right inferior angle of the caudate lobe to the under surface of the right lobe. 
It forms the upper boundary of the epiploic foramen of the peritoneum. THE LIVER 
1193 
The posterior surface (facies posterior') (Fig. 1002) is rounded and broad behind 
the right lobe, but narrow on the left. Over a large part of its extent it is not 
covered by peritoneum; this uncovered portion is about 7.5 cm. broad at its widest 
Fig. 1001.-Inferior surface of the liver. (From model by His.) 
part, and is in direct contact with the Diaphragma. It is marked off from the upper 
surface by the line of reflection of the upper layer of the coronary ligament, and 
from the under surface by the line of reflection of the lower layer of the coronary 
Fig. 1002.-Posterior and inferior surfaces of the liver. (From model by His.) 
ligament. The central part of the posterior surface presents a deep concavity 
which is moulded on the vertebral column and crura of the Diaphragma. To the 
right of this the inferior vena cava is lodged in its fossa between the uncovered 1194 
SPLANCHNOLOGY 
area and the caudate lobe. Close to the right of this fossa and immediately above 
the renal impression is a small triangular depressed area, the suprarenal impression, 
the greater part of which is devoid of peritoneum; it lodges the right suprarenal 
gland. To the left of the inferior vena cava is the caudate lobe, which lies between 
the fossa for the vena cava and the fossa for the ductus venosus. Its lower end 
projects and forms part of the posterior boundary of the porta; on the right, it 
is connected with the under surface of the right lobe of the liver by the caudate 
process, and on the left it presents an elevation, the papillary process. Its posterior 
surface rests upon the Diaphragma, being separated from it merely by the upper 
part of the omental bursa. To the left of the fossa for the ductus venosus is a 
groove in which lies the antrum cardiacum of the oesophagus. 
The anterior border (viargo anterior) is thin and sharp, and marked opposite 
the attachment of the falciform ligament by a deep notch, the umbilical notch, 
and opposite the cartilage of the ninth rib by a second notch for the fundus of the 
gall-bladder. In adult males this border generally corresponds with the lower 
margin of the thorax in the right mammary line; but in women and children it 
usually projects below the ribs. 
The left extremity of the liver is thin and flattened from above downward. 
Fossae.--The left sagittal fossa (fossa sagittalis sinistra; longitudinal fissure) 
is a deep groove, which extends from the notch on the anterior margin of the liver 
to the upper border of the posterior surface of the organ; it separates the right and 
left lobes. The porta joins it, at right angles, and divides it into two parts. The 
anterior part, or fossa for the umbilical vein, lodges the umbilical vein in the fetus, 
and its remains (the ligamentum teres) in the adult; it lies between the quadrate 
lobe and the left lobe of the liver, and is often partially bridged over by a pro- 
longation of the hepatic substance, the pons hepatis. The posterior part, or fossa 
for the ductus venosus, lies between the left lobe and the caudate lobe; it lodges in 
the fetus, the ductus venosus, and in the adult a slender fibrous cord, the ligamentum 
venosum, the obliterated remains of that vessel. 
The porta or transverse fissure (porta hepatis) is a short but deep fissure, about 
5 cm. long, extending transversely across the under surface of the left portion of the 
right lobe, nearer its posterior surface than its anterior border. It joins nearly 
at right angles with the left sagittal fossa, and separates the quadrate lobe in 
front from the caudate lobe and process behind. It transmits the portal vein, 
the hepatic artery and nerves, and the hepatic duct and lymphatics. The hepatic 
duct lies in front and to the right, the hepatic artery to the left, and the portal 
vein behind and between the duct and artery. 
The fossa for the gall-bladder (fossa vesicae felleae) is a shallow, oblong fossa, 
placed on the under surface of the right lobe, parallel with the left sagittal fossa. 
It extends from the anterior free margin of the liver, which is notched by it, to the 
right extremity of the porta. 
The fossa for the inferior vena cava (fossa venae cavae) is a short deep depression, 
occasionally a complete canal in consequence of the substance of the liver surround- 
ing the vena cava. It extends obliquely upward on the posterior surface between 
the caudate lobe and the bare area of the liver, and is separated from the porta 
by the caudate process. On slitting open the inferior vena cava the orifices of 
the hepatic veins will be seen opening into this vessel at its upper part, after 
perforating the floor of this fossa. 
Lobes.-The right lobe (lobus hepatis dexter) is much larger than the left; the 
proportion between them being as six to one. It occupies the right hypochon- 
drium, and is separated from the left lobe on its upper and anterior surfaces by 
the falciform ligament; on its under and posterior surfaces by the left sagittal 
fossa; and in front by the umbilical notch. It is of a somewhat quadrilateral form, 
its under and posterior surfaces being marked by three fossse: the porta and the THE LIVER 
1195 
fossae for the gall-bladder and inferior vena cava, which separate its left part 
into two smaller lobes; the quadrate and caudate lobes. The impressions on the 
right lobe have already been described. 
The quadrate lobe (lobus quadratics) is situated on the under surface of the right 
lobe, bounded in front by the anterior margin of the liver; behind by the porta; 
on the right, by the fossa for the gall-bladder; and on the left, by the fossa for the 
umbilical vein. It is oblong in shape, its antero-posterior diameter being greater 
than its transverse. 
The caudate lobe (tabus caudatus; Spigelian lobe) is situated upon the posterior 
surface of the right lobe' of the liver, opposite the tenth and eleventh thoracic 
vertebrae. It is bounded, below, by the porta; on the right, by the fossa for the 
inferior vena cava; and, on the left, by the fossa for the ductus venosus. It looks 
backward, being nearly vertical in position; it is longer from above downward 
than from side to side, and is somewhat concave in the transverse direction. The 
caudate process is a small elevation of the hepatic substance extending obliquely 
lateralward, from the lower extremity of the caudate lobe to the under surface of 
the right lobe. It is situated behind the porta, and separates the fossa for the gall- 
bladder from the commencement of the fossa for the inferior vena cava. 
The left lobe (lobus hepatis sinister) is smaller and more flattened than the right. 
It is situated in the epigastric and left hypochondriac regions. Its upper surface 
is slightly convex and is moulded on to the Diaphragma; its under surface presents 
the cardiac impression and omental tuberosity, already referred to page 1192. 
Ligaments.-The liver is connected to the under surface of the Diaphragma 
and to the anterior wall of the abdomen by five ligaments; four of these-the 
falciform, the coronary, and the two lateral-are peritoneal folds; the fifth, the 
round ligament, is a fibrous cord, the obliterated umbilical vein. The liver is also 
attached to the lesser curvature of the stomach by the hepatogastric and to the 
duodenum by the hepatoduodenal ligament (see page 1156). 
The falciform ligament (ligamentum falciforme hepatis) is a broad and thin antero- 
posterior peritoneal fold, falciform in shape, its base being directed downward 
and backward, its apex upward and backward. It is situated in an antero-posterior 
plane, but lies obliquely so that one surface faces forward and is in contact with 
the peritoneum behind the right Rectus and the Diaphragma, while the other is 
directed backward and is in contact with the left lobe of the liver. It is attached 
by its left margin to the under surface of the Diaphragma, and the posterior surface 
of the sheath of the right Rectus as low down as the umbilicus; by its right margin 
it extends from the notch on the anterior margin of the liver, as far back as the 
posterior surface. It is composed of two layers of peritoneum closely united 
together. Its base or free edge contains between its layers the round ligament 
and the parumbilical veins. 
The coronary ligament (ligamentum coronarium hepatis) consists of an upper 
and a lower layer. The upper layer is formed by the reflection of the peritoneum 
from the upper margin of the bare area of the liver to the under surface of the Dia- 
phragma, and is continuous with the right layer of the falciform ligament. The 
lower layer is reflected from the lower margin of the bare area on to the right kidney 
and suprarenal gland, and is termed the hepatorenal ligament. 
The triangular ligaments (lateral ligaments) are two in number, right and left. 
The right triangular ligament (ligamentum triangulare dextrum) is situated at the 
right extremity of the bare area, and is a small fold which passes to the Diaphragma, 
being formed by the apposition of the upper and lower layers of the coronary 
ligament. The left triangular ligament (ligamentum triangulare sinistrum) is a fold 
of some considerable size, which connects the posterior part of the upper surface 
of the left lobe to the Diaphragma; its anterior layer is continuous with the left 
layer of the falciform ligament. 1196 
SPLANCHNOLOGY 
The round ligament (ligamentum teres hepatis) is a fibrous cord resulting from the 
obliteration of the umbilical vein. It ascends from the umbilicus, in the free margin 
of the falciform ligament, to the umbilical notch of the liver, from which it may be 
traced in its proper fossa on the inferior surface of the liver to the porta, where 
it becomes continuous with the ligamentum venosum. 
Fig. 1003.-Longitudinal section of a hepatic vein. 
(After Kiernan.) 
Fig. 1004.-Longitudinal section of a small portal vein 
and canal. (After Kiernan.) 
Vessels and Nerves.-The vessels connected with the liver are: the hepatic artery, the portal 
vein, and the hepatic veins. 
The hepatic artery and portal vein, accompanied by numerous nerves, ascend to the porta, 
between the layers of the lesser omentum. The bile duct and the lymphatic vessels descend 
from the porta between the layers of the same omentum. The relative positions of the three 
structures are as follows: the bile duct lies to the right, the hepatic artery to the left, and the 
Fig. 1005.-Section of injected liver (dog). 
portal vein behind and between the other two. They are enveloped in a loose areolar tissue, the 
fibrous capsule of Glisson, which accompanies the vessels in their course through the portal 
canals in the interior of the organ (Fig. 1004). 
The hepatic veins (Fig. 1003) convey the blood from the liver, and are described on page 764. 
They have very little cellular investment, and what there is binds their parietes closely to the THE LIVER 
1197 
walls of the canals through which they run; so that, on section of the organ, they remain widely 
open and are solitary, and may be easily distinguished from the branches of the portal vein, 
which are more or less collapsed, and always accompanied by an artery and duct. 
The lymphatic vessels of the liver are described on page 792. 
The nerves of the liver, derived from the left vagus and sympathetic, enter at the porta and 
accompany the vessels and ducts to the interlobular spaces. Here, according to Korolkow, the 
medullated fibres are distributed almost exclusively to the coats of the bloodvessels; while the 
non-medullated enter the lobules and ramify between the cells. 
Structure of the Liver.-The substance of the liver is composed of lobules, held together by 
an extremely fine areolar tissue, in which ramify the portal vein, hepatic ducts, hepatic artery, 
hepatic veins, lymphatics, and nerves; the whole being invested by a serous and a fibrous coat. 
The serous coat (tunica serosa') is derived from the peritoneum, and invests the greater part 
of the surface of the organ. It is intimately adherent to the fibrous coat. 
The fibrous coat (capsula fibrosa [ Glissoni]; areolar coat) lies beneath the serous investment, 
and covers the entire surface of the organ. It is difficult of demonstration, excepting where 
the serous coat is deficient. At the porta it is continuous with the fibrous capsule of Glisson, 
and on the surface of the organ with the areolar tissue separating the lobules. 
The lobules (lobuli hepatis) form the chief mass of the hepatic substance; they may be seen 
either on the surface of the organ, or by making a section through the gland, as small granular 
bodies, about the size of a millet-seed, measuring from 1 to 2.5 mm. in diameter. In the human 
subject their outlines are very irregular; but in some of the lower animals (for example, the pig) 
they are well-defined, and, when divided transversely, have polygonal outlines. The bases of 
the lobules are clustered around the smallest radicles (sublobular) of the hepatic veins, to which 
each is connected (Fig. 1003) by means of a small branch which issues from the centre of the 
lobule (intralobular). The remaining part of the surface of each lobule is imperfectly isolated 
from the surrounding lobules by a thin stratum of areolar tissue, in which is contained a plexus 
of vessels, the interlobular plexus, and ducts. In some animals, as the pig. the lobules are com- 
pletely isolated from one another' by the interlobular areolar tissue (Fig. 1006). 
If one of the sublobular veins be laid open, the bases of the lobules may be seen through the 
thin wall of the vein on which they rest, arranged in a form resembling a tesselated pavement, 
the centre of each polygonal space presenting a minute aperture, the mouth of an intralobular 
vein (Fig. 1003). 
Microscopic Appearance (Fig. 1006).-Each lobule consists of a mass of cells, hepatic cells, 
arranged in irregular radiating columns between which are the blood channels (sinusoids). These 
convey the blood from the circum- 
ference to the centre of the lobule, 
and end in the intralobular vein, 
which runs through its centre, to 
open at its base into one of the sub- 
lobular veins. Between the cells are 
also the minute bile capillaries. 
Therefore, in the lobule there are all 
the essentials of a secreting gland; 
that is to say: (1) cells, by which 
the secretion is formed; (2) blood- 
vessels, in close relation with the 
cells, containing the blood from 
which the secretion is derived; (3) 
ducts, by which the secretion, when 
formed, is carried away. 
1. The hepatic cells are polyhedral 
in form. They vary in size from 12 
to 25y in diameter. They contain 
one or sometimes two distinct nuclei. 
The nucleus exhibits an intranuclear 
net-work and one or two refractile 
nucleoli. The cells usually contain 
granules; some of which are proto- 
plasmic, while others consist of glycogen, fat, or an iron compound. In the lower vertebrates, 
e. g., frog, the cells are arranged in tubes with the bile duct forming the lumen and bloodvessels 
externally. According to Delepine, evidences of this arrangement can be found in the human 
liver. 
2. The Bloodvessels.-The blood in the capillary plexus around the liver cells is brought to 
the liver principally by the portal vein, but also to a certain extent by the hepatic artery. 
The hepatic artery, entering the liver at the porta with the portal vein and hepatic duct, 
ramifies with these vessels through the portal canals. It gives off vaginal branches, which ramify 
Fig. 1006.-A single lobule of the liver of a pig. X 60. 1198 
SPLANCHNOLOGY 
in the fibrous capsule of Glisson, and appear to be destined chiefly for the nutrition of the coats 
of the vessels and ducts. It also gives off capsular branches, which reach the surface of the 
organ, ending in its fibrous coat in stellate plexuses. Finally, it gives off interlobular branches, 
which form a plexus outside each lobule, to supply the walls of the interlobular veins and the 
accompanying bile ducts. From this plexus lobular branches enter the lobule and end in the 
net-work of sinusoids between the cells. 
The portal vein also enters at the porta, and runs through the portal canals (Fig. 1007), 
enclosed in Glisson's capsule, dividing in its course into branches, which finally break up into a 
plexus, the interlobular plexus, in the interlobular spaces. These branches receive the vaginal 
and capsular veins, correspond- 
ing to the vaginal and capsular 
branches of the hepatic artery. 
Thus it will be seen that all the 
blood carried to the liver by the 
portal vein and hepatic artery 
finds its way into the interlob- 
ular plexus. From this plexus 
the blood is carried into the lobule 
by fine branches which converge 
from the circumference to the 
Fig. 1007.-Section across portal canal of pig. X 250 
Fig. 1008.-Bile capillaries of rabbit, 
shown by Golgi's method. X 450. 
centre of the lobule, and are connected by transverse branches (Fig. 1005). The walls of these 
small vessels are incomplete so that the blood is brought into direct relationship with the liver 
cells. The lining endothelium consists of irregularly branched, disconnected cells (stellate cells of 
Kupffer). Moreover, according to Herring and Simpson, minute channels penetrate the liver cells 
themselves, conveying the constituents of the blood into their substance. It will be seen that the 
blood capillaries of the liver lobule differ structurally from capillaries elsewhere. Developmentally 
they are formed by the growth of the columns of liver cells into large blood spaces or sinuses, 
and hence they have received the name of "sinusoids." Arrived at the centre of the lobule, 
the sinusoids empty themselves into one vein, of considerable size, which runs down the 
centre of the lobule from apex to base, and is called the intralobular vein. At the base of 
the lobule this vein opens directly into the sublobular vein, with which the lobule is con- 
nected. The sublobular veins unite to form larger and larger trunks, and end at last in the 
hepatic veins, these converge to form three large trunks which open into the inferior vena cava 
while that vessel is situated in its fossa on the posterior surface of the liver. 
3. The bile ducts commence by little passages in the liver cells which communicate with 
canahculi termed intercellular biliary passages (bile capillaries'). These passages are merely 
little channels or spaces left between the contiguous surfaces of two cells, or in the angle where 
three or more liver cells meet (Fig. 1008), and they are always separated from the blood capil- 
laries by at least half the width of a liver cell. The channels thus formed radiate to the circum- 
ference of the lobule, and open into the interlobular bile ducts which run in Glisson's capsule, 
accompanying the portal vein and hepatic artery (Fig. 1007). These join with other ducts to 
form two main trunks, which leave the livei' at the transverse fissure, and by their union form 
the hepatic duct. 
Structure of the Ducts.-The walls of the biliary ducts consist of a connective-tissue coat, in 
which are muscle cells, arranged both circularly and longitudinally, and an epithelial layer, 
consisting of short columnar cells resting on a distinct basement-membrane. 
Excretory Apparatus of the Liver.-The excretory apparatus of the liver con- 
sists of (1) the hepatic duct, formed by the junction of the two main ducts, which THE LIVER 
1199 
pass out of the liver at the porta; (2) the gall-bladder, which serves as a reservoir 
for the bile; (3) the cystic duct, or the duct of the gall-bladder; and (4) the common 
bile duct, formed by the junction of the hepatic and cystic ducts. 
The Hepatic Duct {ductus hepaticus').-Two main trunks of nearly equal size 
issue from the liver at the porta, one from the right, the other from the left lobe; 
these unite to form the hepatic duct, which passes downward and to the right for 
about 4 cm., between the layers of the lesser omentum, where it is joined at an 
acute angle by the cystic duct, and so forms the common bile duct. The hepatic 
duct is accompanied by the hepatic artery and portal vein. 
The Gall-bladder {vesica /ellea) (Fig. 1009).-The gall-bladder is a conical or 
pear-shaped musculomembranous sac, lodged in a fossa on the under surface 
of the right lobe of the liver, and extending 
from near the right extremity of the porta to 
the anterior border of the organ. It is from 
7 to 10 cm. in length, 2.5 cm. in breadth at its 
widest part, and holds from 30 to 35 c.c. It is 
divided into a fundus, body, and neck. The 
fundus, or broad extremity, is directed down- 
ward, forward, and to the right, and projects 
beyond the anterior border of the liver; the 
body and neck are directed upward and back- 
ward to the left. The upper surface of the gall- 
bladder is attached to the liver by connective 
tissue and vessels. The under surface is 
covered by peritoneum, which is reflected on to 
it from the surface of the liver. Occasionally 
the whole of the organ is invested by the 
serous membrane, and is then connected to 
the liver by a kind of mesentery. 
Relations.-The body is in relation, by its upper 
surface, with the liver; by its under surface, with the 
commencement of the transverse colon; and farther 
back usually with the upper end of the descending 
portion of the duodenum, but sometimes with the 
superior portion of the duodenum or pyloric end of 
the stomach. The fundus is completely invested by 
peritoneum; it is in relation, in front, with the abdom- 
inal parietes, immediately below the ninth costal car- 
tilage; behind with the transverse colon. The neck is 
narrow, and curves upon itself like the letter S; at its 
point of connection with the cystic duct it presents a 
well-marked constriction. 
Structure (Fig. 1010).-The gall-bladder consists of 
three coats: serous, fibromuscular, and mucous. 
The external or serous coat (tunica serosa vesicae felleae) is derived from the peritoneum; it 
completely invests the fundus, but covers the body and neck only on their under surfaces. 
The fibromuscular coat (tunica muscularis vesicae felleae'), a thin but strong layer forming the 
frame-work of the sac, consists of dense fibrous tissue, which interlaces in all directions, and is 
mixed with plain muscular fibres, disposed chiefly in a longitudinal direction, a few running 
transversely. 
The internal or mucous coat (tunica mucosa vesicae felleae') is loosely connected with the fibrous 
layer. It is generally of a yellowish-brown color, and is elevated into minute rugae. Opposite 
the neck of the gall-bladder the mucous membrane projects inward in the form of oblique ridges 
or folds, forming a sort of spiral valve. 
The mucous membrane is continuous through the hepatic duct with the mucous membrane 
lining the ducts of the liver, and through the common bile duct with the mucous membrane of 
the duodenum. It is covered with columnar epithelium, and secretes mucin; in some animals 
it secretes a nucleoprotein instead of mucin. 
Fig. 1009.-The gall-bladder and bile ducts 
laid open. (Spalteholz.) 1200 
SPLANCHNOLOGY 
The Cystic Duct (ductus cysticus).-The cystic duct about 4 cm. long, runs back- 
ward, downward, and to the left from the neck of the gall-bladder, and joins the 
hepatic duct to form the common bile duct. The mucous membrane lining its 
interior is thrown into a series of crescentic folds, from five to twelve in number, 
similar to those found in the neck of the gall-bladder. They project into the duct 
in regular succession, and are directed obliquely around the tube, presenting 
much the appearance of a continuous spiral valve. When the duct is distended, 
the spaces between the folds are dilated, so as to give to its exterior a twisted 
appearance. 
The Common Bile Duct (ductus choledochus).-The common bile duct is formed 
by the junction of the cystic and hepatic ducts; it is about 7.5 cm. long, and of the 
diameter of a goose-quill. 
It descends along the right border of the lesser omentum behind the superior 
portion of the duodenum, in front of the portal vein, and to the right of the hepatic 
artery; it then runs in a groove near the right border of the posterior surface of the 
head of the pancreas; here it is situated in front of the inferior vena cava, and is 
occasionally completely imbedded in the pancreatic substance. At its termination 
it lies for a short distance along the right side of the terminal part of the pancreatic 
duct and passes with it obliquely between the mucous and muscular coats. The 
two ducts unite and open by a common orifice upon the summit of the duodenal 
papilla, situated at the medial side of the descending portion of the duodenum, a 
little below its middle and about 7 to 10 cm. from the pylorus (Fig. 1015). The 
short tube formed by the union of the two ducts is dilated into an ampulla, the 
ampulla of Vater. 
Structure.-The coats of the large biliary ducts are an external or fibrous, and an internal or 
mucous. The fibrous coat is composed of strong fibroareolar tissue, with a certain amount of 
muscular tissue, arranged, for the most part, in a circular manner around the duct. The mucous 
coat is continuous with the lining membrane of the hepatic ducts and gall-bladder, and also with 
that of the duodenum; and, like the mucous membrane of these structures, its epithelium is of 
the columnar variety. It is provided with numerous mucous glands, which are lobulated and 
open by minute orifices scattered irregularly in the larger ducts. 
Applied Anatomy.-On account of its large size, its fixed position, and its friability, the liver 
is more frequently ruptured than any of the other abdominal viscera. The rupture may vary 
from a slight scratch to an extensive and complete laceration of its substance, dividing it into 
two parts. Sometimes an internal rupture, without laceration of the peritoneal covering, takes 
place, and such injuries are most susceptible of repair; but small tears of the surface may also 
heal; when, however, the laceration is extensive, death usually takes place from hemorrhage, 
on account of the fact that the hepatic veins are contained in rigid canals in the liver substance 
and are unable to contract, and are moreover unprovided with valves. The liver may also be 
torn by the end of a broken rib perforating the Diaphragma. It may be injured by stabs or 
Fig. 1010.-Transverse section of gall-bladder. THE PANCREAS 
1201 
other punctured wounds, and when these are inflicted through the chest wall the pleural and 
peritoneal cavities may both be opened up, and both lung and liver wounded. In cases of wound 
of the liver from the front, hernia of a part of this viscus may take place, but generally can be 
easily replaced. In cases of laceration of the liver, when there is evidence that bleeding is going 
on, the abdomen must be opened, the laceration sought for, and the bleeding arrested. This 
may be done temporarily by introducing the forefinger into the epiploic foramen and placing the 
thumb on the lesser omentum, and compressing the hepatic artery and portal vein between the 
two. The margins of the laceration, if small, can be brought together and sutured by means 
of a blunt curved needle passed from one side of the wound to the other. All sutures must be 
passed before any are tied, and this must be done with the greatest gentleness, as the liver sub- 
stance is very friable. When the laceration is extensive it must be packed with gauze, the end 
of which is allowed to hang out of the external wound. 
Abscess of the liver is of not infrequent occurrence. The so-called tropical abscess is due to 
absorption from the intestine of the amoeba of dysentery, which reaches the liver through the 
portal system and causes the formation of a large chronic abscess; this may open in many different 
ways on account of the relations of the liver to other organs. Thus it has been known to burst 
into the lungs when the pus is coughed up, or into the stomach when the pus is vomited; it may 
burst into the colon, or duodenum; or, by perforating the Diaphragma, it may empty itself into 
the pleural cavity. It often makes its way forward, and points on the anterior abdominal wall, 
and finally it may burst into the peritoneal or pericardial cavities. Abscesses of the liver fre- 
quently require opening, and this must be done by an incision in the abdominal wall, in the 
thoracic wall, or in the lumbar region, according to the direction in which the abscess is tracking. 
The incision through the abdominal wall is to be preferred when possible. The abdominal wall 
is incised over the swelling, and, unless the peritoneum is adherent, gauze is packed all around 
the exposed liver surface, the abscess opened, and a large drainage-tube inserted. 
Hydatid cysts are more often found in the liver than in any of the other viscera. The reason 
of this is not far to seek. The embryo of the egg of the taenia echinococcus, being liberated in 
the stomach by the disintegration of its shell, bores its way through the gastric walls and usually 
enters a bloodvessel, and is carried by the blood stream to the hepatic capillaries, where its onward 
course is arrested, and where it undergoes development into the fully formed hydatid. 
Ptosis of the liver, or hepatoptosis, from abnormal laxity of its ligaments and failure of the 
support it usually receives from the subjacent viscera, is an occasional cause of various nervous 
and gastro-intestinal disturbances. It has been very fully described by Glenard and his pupils. 
In women who have used very tight corsets and in men who have worn tightly buckled belts, 
the lower margin of the right lobe may become elongated by the pressure, producing an abnormal 
lobe known as the linguiform or Riedel's lobe. This may cause indefinite abdominal symptoms 
suggesting dyspepsia or disease of the gall-bladder; and if discovered accidentally, a Riedel's 
lobe may be mistaken for a tumor of the right kidney, of the right suprarenal gland, of the 
transverse colon or pancreas, or even of the vermiform process. 
The gall-bladder may become distended in cases of obstruction of its duct or the common 
bile duct, or from a collection of gall-stones in its interior, thus forming a large tumor. The 
swelling is pear-shaped, and projects downward and forward to the umbilicus. It moves with 
respiration, since it is attached to the fiver. To relieve this condition, the gall-bladdei' must be 
opened {cholecystotomy} and the gall-stones removed. The operation is performed by an incision, 
5 to 7 cm. long, through the lateral part of the right Rectus, commencing at the costal margin. 
The peritoneal cavity is opened, and, the tumor having been found, gauze is packed around it 
to protect the peritoneal cavity, and it is aspirated. When the contained fluid has been evacu- 
ated the flaccid bladder is drawn out of the abdominal wound and its wall incised; any gall- 
stones in the-bladder are now removed. If the case is one of obstruction of the duct, an attempt 
must be made to dislodge the stone by manipulation through the wall of the duct; or it may be 
crushed from without by the fingers or carefully padded forceps. If this does not succeed, the 
safest plan is to incise the duct, extract the stone, and close the incision by fine sutures in two 
layers. After all obstruction has been removed, the edges of the incision in the gall-bladder may 
be sutured to the posterior sheath of the Rectus and a fistulous communication established 
between the gall-bladder and the exterior, a drainage-tube being inserted into the cavity; this 
fistulous opening usually closes in the course of a few weeks. The gall-bladder may be com- 
pletely removed if it be quite certain that no cause for biliary obstruction remain: this is also 
done for primary malignant growth of the viscus. 
The Pancreas (Figs. 1011, 1012). 
Dissection.-The pancreas may be exposed for dissection in three different ways: (1) By 
raising the liver, drawing down the stomach, and tearing through the gastrohepatic omentum, 
and the ascending layer of the transverse mesocolon. (2)' By raising the stomach, the arch of 
the colon, and greater omentum, and then dividing the inferior layer of the transverse mesocolon 1202 
SPLANCHNOLOGY 
and raising its ascending layer. (3) By dividing the two layers of peritoneum, which descend 
from the greater curvature of the stomach to form the greater omentum; turning the stomach 
upward, and then cutting through the ascending layer of the transverse mesocolon (see Fig. 961). 
Fig. 1011.-Transverse section through the middle of the first lumbar vertebra, showing the relations of the pancreas. 
(Braune. 
Fig. 1012.-The duodenum and pancreas. 
The pancreas is a compound racemose gland, analogous in its structures to the 
salivary glands, though softer and less compactly arranged than those organs. THE PANCREAS 
1203 
It is long and irregularly prismatic in shape; its right extremity, being broad, is 
called the head, and is connected to the main portion of the organ, or body, by a 
slight constriction, the neck; while its left extremity gradually tapers to form the 
tail. It is situated transversely across the posterior wall of the abdomen, at the 
back of the epigastric and left hypochondriac regions. Its length varies from 12.5 
to 15 cm., and its weight from 60 to 100 gm. 
Relations.-The Head (caput pancreatis} is flattened from before backward, and 
is lodged within the curve of the duodenum. Its upper border is overlapped by the 
superior part of the duodenum and its lower overlaps the horizontal part; its right 
and left borders overlap in front, and insinuate themselves behind, the descending 
and ascending parts of the duodenum respectively. The angle of junction of the 
lower and left lateral borders forms a prolongation, termed the uncinate process. In 
the groove between the duodenum and the right lateral and lower borders in front 
are the anastomosing superior and inferior pancreaticoduodenal arteries; the com- 
mon bile duct descends behind, close to the right border, to its termination in the 
descending part of the duodenum. 
Fig. 1013.-The pancreas and duodenum from behind. (From model by His.) 
Anterior Surface.-The greater part of the right half of this surface is in contact 
with the transverse colon, only areolar tissue intervening. From its upper part 
the neck springs, its right limit being marked by a groove for the gastroduodenal 
artery. The lower part of the right half, below the transverse colon, is covered 
by peritoneum continuous with the inferior layer of the transverse mesocolon, 
and is in contact with the coils of the small intestine. The superior mesenteric 
artery passes down in front of the left half across the uncinate process; the superior 
mesenteric vein runs upward on the right side of the artery and, behind the neck, 
joins with the lienal vein to form the portal vein. 
Posterior Surface.-The posterior surface is in relation with the inferior vena 
cava, the common bile duct, the renal veins, the right crus of the Diaphragma, 
and the aorta. 
The Neck springs from the right upper portion of the front of the head. It is 
about 2.5 cm. long, and is directed at first upward and forward, and then upward 1204 
SPLANCHNOLOGY 
and to the left to join the body; it is somewhat flattened from above downward 
and backward. Its antero-superior surface supports the pylorus; its postero- 
inferior surface is in relation with the commencement of the portal vein; on the 
right it is grooved by the gastroduodenal artery. 
The Body {corpus pancreatis) is somewhat prismatic in shape, and has three 
surfaces: anterior, posterior, and inferior. 
The anterior surface {facies anterior) is somewhat concave; and is directed for- 
ward and upward: it is covered by the postero-inferior surface of the stomach 
which rests upon it, the two organs being separated by the omental bursa. Where 
it joins the neck there is a well-marked prominence, the tuber omentale, which 
abuts against the posterior surface of the lesser omentum. 
The posterior surface {facies posterior) is devoid of peritoneum, and is in contact 
with the aorta, the lienal vein, the left kidney and its vessels, the left suprarenal 
gland, the origin of the superior mesenteric artery, and the crura of the Diaphragma. 
The inferior surface {facies inferior) is narrow on the right but broader on the left, 
and is covered by peritoneum; it lies upon the duodenojejunal flexure and on some 
coils of the jejunum; its left extremity rests on the left colic flexure. 
The superior border {margo superior) is blunt and flat to the right; narrow and 
sharp to the left, near the tail. It commences on the right in the omental tuber- 
osity, and is in relation with the coeliac artery, from which the hepatic artery 
courses to the right just above the gland, while the lienal artery runs toward the 
left in a groove along this border. 
The anterior border {margo anterior) separates the anterior from the inferior 
surface, and along this border the two layers of the transverse mesocolon diverge 
from one another; one passing upward over the anterior surface, the other 
backward over the inferior surface. 
The inferior border {margo inferior) separates the posterior from the inferior 
surface; the superior mesenteric vessels emerge under its right extremity. 
The Tail {cauda pancreatis) is narrow; it extends to the left as far as the lower 
part of the gastric surface of the spleen, lying in the phrenicolienal ligament, 
and it is in contact with the left colic flexure. 
Birmingham described the body of the pancreas as projecting forward as a promi- 
nent ridge into the abdominal cavity and forming part of a shelf on which the 
stomach lies. "The portion of the pancreas to the left of the middle line has a 
very considerable antero-posterior thickness; as a result the anterior surface is of 
considerable extent; it looks strongly upward, and forms a large and important 
part of the shelf. As the pancreas extends to the left toward the spleen it crosses 
the upper part of the kidney, and is so moulded on to it that the top of the kidney 
forms an extension inward and backward of the upper surface of the pancreas 
and extends the bed in this direction. On the other hand, the extremity of the 
pancreas comes in contact with the spleen in such a way that the plane of its 
upper surface runs with little interruption upward and backward into the concave 
gastric surface of the spleen, which completes the bed behind and to the left, and, 
running upward, forms a partial cap for the wide end of the stomach.1 
The Pancreatic Duct {ductus pancreaticus [Wirsungi]; duct of Wirsung) extends 
transversely from left to right through the substance of the pancreas (Fig. 1014). It 
commences by the junction of the small ducts of the lobules situated in the tail of the 
pancreas, and, running from left to right through the body, it receives the ducts of the 
various lobules composing the gland. Considerably augmented in size, it reaches the 
neck, and turning downward, backward, and to the right, it comes into relation with 
the common bile duct, which lies to its right side; leaving the head of the gland, 
it passes very obliquely through the mucous and muscular coats of the duodenum, 
1 Journal of Anatomy and Physiology, pt. 1, xxxi, 102. THE PANCREAS 
1205 
and ends by an orifice common to it and the common bile duct upon the summit 
of the duodenal papilla, situated at the medial side of the descending portion 
of the duodenum, 7.5 to 10 cm. below the pylorus. The pancreatic duct, near the 
duodenum, is about the size of an ordinary quill. Sometimes the pancreatic duct 
and the common bile duct open separately into the duodenum. Frequently there 
is an additional duct, which is given off from the pancreatic duct in the neck of 
the pancreas and opens into the duodenum about 2.5 cm. above the duodenal 
papilla. It receives the ducts from the lower part of the head, and is known as 
the accessory pancreatic duct {duct of Santorini). 
Fig. 1014.-The pancreatic duct. 
Structure (Fig. 1015).-In structure, the pancreas resembles the salivary glands. It differs 
from them, however, in certain particulars, and is looser and softer in its texture. It is not 
enclosed in a distinct capsule, but is surrounded by areolar tissue, which dips into its interior, 
and connects together the various lobules of which it is composed. Each lobule, like the lobules 
of the salivary glands, consists of one of the ultimate ramifications of the main duct, ending in a 
number of cecal pouches or alveoli, which are tubular and somewhat convoluted. The minute 
ducts connected with the alveoli are narrow and lined with flattened cells. The alveoli are 
almost completely filled with secreting cells, so that scarcely any lumen is visible. In some 
animals spindle-shaped cells occupy the centre of the alveolus and are known as the centro- 
acinar cells of Langerhans. These are prolongations of the terminal ducts. The true secreting 
cells which line the wall of the alveolus are very characteristic. They are columnar in shape 
and present two zones: an outer one, clear and finely striated next the basement-membrane, and 
an inner granular one next the lumen. In hardened specimens the outer zone stains deeply with 
various dyes, whereas the inner zone stains slightly. During activity the granular zone gradually 
diminishes in size, and when exhausted is only seen as a small area next to the lumen. During 
the resting stages it gradually increases until it forms nearly three-fourths of the cell. In some 
of the secreting cells of the pancreas is a spherical mass, staining more easily than the rest of 
the cell; this is termed the paranucleus, and is believed to be an extension from the nucleus. 
The connective tissue between the alveoli presents in certain parts collections of cells, which are 
termed interalveolar cell islets {islands of Langerhans'). The cells of these stain lightly with 
hematoxylin or carmine, and are more or less polyhedral in shape, forming a net-work in which 
ramify many capillaries. There are two main types of cell in the islets, distinguished as A-cells 
and B-cells according to the special staining reactions of the granules they contain. The cell 1206 
SPLANCHNOLOGY 
islets have been supposed to produce the internal secretion of the pancreas which is necessary 
for carbohydrate metabolism, but numerous researches have so far failed to elucidate their 
real function. 
The walls of the pancreatic duct are thin, consisting of two coats, an external fibrous and an 
internal mucous; the latter is smooth, and furnished near its termination with a few scattered 
follicles. 
Vessels and Nerves.- The arteries of the pancreas are derived from the lienal, and the 
pancreaticoduodenal branches of the hepatic and superior mesenteric. Its veins open into the 
lienal and superior mesenteric veins. Its 
lymphatics are described on page 793. Its 
nerves are filaments from the lienal plexus. 
Applied Anatomy.-Inflammation of the 
pancreas has of late years received con- 
siderable attention. It appears to be due 
to infection of the pancreatic ducts by 
microorganisms from the duodenum in 
cases of gastroduodenal catarrh, or from 
the biliary passages in which a gall-stone 
is lodged. Acute cases usually terminate 
fatally and are frequently of the hemor- 
rhagic type; chronic inflammation of the 
pancreas produces few symptoms of disease 
unless it is extensive, when attacks of 
abdominal pain, loss of appetite, progressive 
weakness and wasting, and the passage of 
whitish fatty motions, are likely to follow. 
Extensive fibrosis of the pancreas also one 
of the commonest lesions found post mortem 
in cases of diabetes mellitus. Cysts of the 
pancreas are sometimes met with. They 
may be the result of traumatism, when they 
generally contain blood, or they may be due to retention from obstruction of a duct, or from 
pressure on the main duct by a gall-stone. They may attain a large size, and cause symptoms 
by pressing on the stomach, Diaphragma, or common bile duct. They generally push their 
way forward between the stomach and transverse colon, and may then be felt as a definite tumor 
in the middle line of the upper part of the abdomen. The tumor is fixed and does not move 
with respiration. The treatment consists in opening the abdomen in the middle line, incising 
the cyst, evacuating its contents, and fixing its walls to the deeper layers of the abdominal wall. 
Drainage in the left loin, just below the last rib, can sometimes be established. When they 
are situated in the tail of the pancreas they have been removed. The pancreas is often the seat 
of cancer; this usually affects the head, and therefore speedily involves the common bile duct, 
leading to persistent jaundice; or it may press upon the portal vein, causing ascites, or involve 
the stomach, causing pyloric obstruction. It has been said that the pancreas is the only abdominal 
viscus which has never been found in a hernial protrusion; but even this organ has been found 
in company with other viscera, in rare cases of diaphragmatic hernia. 
THE UROGENITAL APPARATUS (APPARATUS UROGENITALIS; 
UROGENITAL ORGANS). 
The urogenital apparatus consists of (a) the urinary organs for the secretion 
and discharge of the urine, and (6) the genital organs, which are concerned with 
the process of reproduction. 
THE URINARY ORGANS. 
The urinary organs comprise the kidneys, which secrete the urine, the ureters, 
or ducts, which convey urine to the urinary bladder, where it is for a time retained; 
and the urethra, through which it is discharged from the body. 
The Kidneys (Renes). 
The kidneys are situated in the posterior part of the abdomen, one on either side 
of the vertebral column, behind the peritoneum, and surrounded by a mass of fat 
Fig. 1015.-Section of pancreas of dog. X 250. THE KIDNEYS 
1207 
and loose areolar tissue. Their upper extremities are on a level with the upper 
border of the twelfth thoracic vertebra, their lower extremities on a level with the 
third lumbar. The right kidney is usually slightly lower than the left, probably 
on account of the vicinity of the liver. The long axis of each kidney is directed 
downward and lateralward; the transverse axis backward and lateralward. 
Each kidney is about 11.25 cm. in length, 5 to 7.5 cm. in breadth, and rather 
more than 2.5 cm. in thickness. The left is somewhat longer, and narrower, than 
the right. The weight of the kidney in the adult male varies from 125 to 170 gm., 
in the adult female from 115 to 155 gm. The combined weight of the two 
kidneys in proportion to that of the body is about 1 to 240. 
The kidney has a characteristic form, and presents for examination two surfaces, 
two borders, and an upper and lower extremity. 
Fig. 1016.-The anterior surfaces of the kidneys, showing the areas of contact of neighboring viscera. 
Relations.-The anterior surface (facies anterior) (Figs. 1012 and 1016) of 
each kidney is convex, and looks forward and lateralward. Its relations to 
adjacent viscera differ so completely on the two sides that separate descriptions 
are necessary. 
Anterior Surface of Right Kidney.-A narrow portion at the upper extremity is in 
relation with the right suprarenal gland. A large area just below this and involv- 
ing about three-fourths of the surface, lies in the renal impression on the inferior 
surface of the liver, and a narrow but somewhat variable area near the medial 
border is in contact with the descending part of the duodenum. The lower part of 
the anterior surface is in contact laterally with the right colic flexure, and medially, 
as a rule, with the small intestine. The areas in relation with the liver and small 
intestine are covered by peritoneum; the suprarenal, duodenal, and colic areas 
are devoid of peritoneum. 
Anterior Surface of Left Kidney.--A small area along the upper part of the medial 
border is in relation with the left suprarenal gland, and close to the lateral 
border is a long strip in contact with the renal impression on the spleen. A 
somewhat quadrilateral field, about the middle of the anterior surface, marks the 
site of contact with the body of the pancreas, on the deep surface of which are the 
lienal vessels. Above this is a, small triangular portion, between the suprarenal 
and splenic areas, in contact with the postero-inferior surface of the stomach. 
Below the pancreatic area the lateral part is in relation with the left colic flexure, 1208 
SPLANCHNOLOGY 
the medial with the small intestine. The areas in contact with the stomach and * 
spleen are covered by the peritoneum of the omental bursa, while that in relation 
Fig. 1017.-The posterior surfaces of the kidneys, showing areas of relation to the parietes. 
to the small intestine is covered by the peritoneum of the general cavity; behind 
the latter are some branches of the left colic vessels. The suprarenal, pancreatic, 
and colic areas are devoid of peritoneum. 
Fig. 1018.-The relations of the kidneys from behind. 
The Posterior Surface (facies posterior) (Figs. 1017, 1018).-The posterior surface 
of each kidney is directed backward and medialward. It is imbedded in areolar THE KIDNEYS 
1209 
and fatty tissue and entirely devoid of peritoneal covering. It lies upon the Dia- 
phragma, the medial and lateral lumbocostal arches, the Psoas major, the Quadratus 
lumborum, and the tendon of the Transversus abdominis, the subcostal, and one 
or two of the upper lumbar arteries, and the last thoracic, iliohypogastric, and 
ilioinguinal nerves. The right kidney rests upon the twelfth rib, the left usually 
on the eleventh and twelfth. The Diaphragma separates the kidney from the 
pleura, which dips down to form the phrenicocostal sinus, but frequently the 
muscular fibres of the Diaphragma are defective or absent over a triangular area 
immediately above the lateral lumbocostal arch, and when this is the case the 
perinephric areolar tissue is in contact with the diaphragmatic pleura. 
Borders.-The lateral border (margo lateralis; external border) is convex, and is 
directed toward the postero-lateral wall of the abdomen. On the left side it is in 
contact at its upper part, with the spleen. 
The medial border (margo medialis; internal border) is concave in the centre and 
convex toward either extremity; it is directed forward and a little downward. 
Its central part presents a deep longitudinal fissure, bounded by prominent over- 
hanging anterior and posterior lips. This fissure is named the hilus, and transmits 
the vessels, nerves, and ureter. Above the hilus the medial border is in relation 
with the suprarenal gland; below the hilus, with the ureter. 
Extremities.-The superior extremity (extremitas superior) is thick and rounded, 
and is nearer the median line than the lower; it is surmounted by the suprarenal 
gland, which covers also a small portion of the anterior surface. 
The inferior extremity (extremitas inferior) is smaller and thinner than the supe- 
rior and farther from the median line. It extends to within 5 cm. of the iliac crest. 
The relative position of the 
main structures in the hilus is as 
follows: the vein is in front, the 
artery in the middle, and the 
ureter behind and directed down- 
ward. Frequently, however, 
branches of both artery and 
vein are placed behind the ureter. 
Fixation of the Kidney (Figs. 
1019, 1020).-The kidney and its 
vessels are imbedded in a mass 
of fatty tissue, termed the adipose 
capsule, which is thickest at the 
margins of the kidney and is pro- 
longed through the hilus into the 
renal sinus. The kidney and the 
adipose capsule are enclosed in a 
sheath of fibrous tissue continuous 
with the subperitoneal fascia, and 
named the renal fascia. At the 
lateral border of the kidney the 
renal fascia splits into an anterior 
and a posterior layer. The ante- 
rior layer is carried medialward 
in front of the kidney and its 
vessels, and is continuous over 
the aorta with the corresponding layer of the opposite side. The posterior layer 
extends medialward behind the kidney and blends with the fascia on the Quad- 
ratus lumborum and Psoas major, and through this fascia is attached to the verte- 
bral column. Above the suprarenal gland the two layers of the renal fascia fuse, 
Fig. 1019.-Sagittal section through posterior abdominal wall, 
showing the relations of the capsule of the kidney. (After Gerota). 1210 
SPLANCHNOLOGY 
and unite with the fascia of the Diaphragma; below they remain separate, and are 
gradually lost in the subperitoneal fascia of the iliac fossa. The renal fascia is 
connected to the fibrous tunic of the kidney by numerous trabeculee, which traverse 
the adipose capsule, and are strongest near the lower end of the organ. Behind 
the fascia renalis is a considerable quantity of fat, which constitutes the paranephric 
body. The kidney is held in position partly through the attachment of the renal 
fascia and partly by the apposition of the neighboring viscera. 
Fig. 1020.-Transverse section, showing the relations of the capsule of the kidney. (After Gerota.) 
General Structure of the Kidney.-The kidney is invested by a fibrous tunic, which forms 
a firm, smooth covering to the organ. The tunic can be easily stripped off, but in doing so 
numerous fine processes of connective tissue and small bloodvessels are torn through. Beneath 
this coat a thin wide-meshed net-work of unstriped muscular fibre forms an incomplete covering 
to the organ. When the capsule is stripped off, the surface of the kidney is found to be smooth 
and even and of a deep red color. In infants fissures extending for some depth may be seen on 
the surface of the organ, a remnant of the lobular construction of the gland. The kidney is 
dense in texture, but is easily lacerable by mechanical force. If a vertical section of the kidney 
be made from its convex to its concave border, and the loose tissue and fat removed from around 
the vessels and the excretory duct, it will be seen that the kidney consists of a central cavity sur- 
rounded at all parts but one by the proper kidney substance (Fig. 1021). This central cavity 
is called the renal sinus, and is lined by a prolongation of the fibrous tunic, which is continued 
around the lips of the hilus. Through the hilus the bloodvessels of the kidney and its excretory 
duct pass, and therefore these structures, upon entering or leaving the kidney, are contained within 
the sinus. The excretory duct or ureter begins by several short truncated branches termed 
calcies, which unite to form two or three short tubes; these in turn expand into a wide funnel- 
shaped sac named the renal pelvis, from the neck of which the ureter issues. The calices and 
pelvis lie within the sinus; the bloodvessels of the kidney, after passing through the hilus, are 
also contained in the sinus, lying between its lining membrane and the excretory apparatus. 
The kidney is composed of an internal medullary and an external cortical substance. 
The medullary substance (substantia medullaris) consists of a series of red-colored striated 
conical masses, termed the renal pyramids, the bases of which are directed toward the circum- 
ference of the kidney, while their apices converge toward the renal sinus, where they form promi- 
nent papillae projecting into the interior of the calices; each calyx receives from one to three 
papillae. THE KIDNEYS 
1211 
The cortical substance (substantia corticalis) is reddish brown in color and soft and granular 
in consistence. It Ues immediately beneath the fibrous tunic, arches over the bases of the 
pyramids, and dips in between adjacent pyramids 
toward the renal sinus. The parts dipping in between 
the pyramids are named the renal columns (Bertini), 
while the portions which connect the renal columns to 
each other and intervene between the bases of the 
pyramids and the fibrous tunic are called the cortical 
arches (indicated between A and A' in Fig. 1021). 
If the cortex be examined with a lens, it will be seen 
to consist of a series of lighter-colored, conical areas, 
termed the radiate part, and a darker-colored inter- 
vening substance, which from the complexity of its 
structure is named the convoluted part. The rays 
gradually taper toward the circumference of the kidney, 
and consist of a series of outward prolongations from 
the base of each renal pyramid. 
The cortical and medullary substances, so dissimilar 
in appearance, are very similar in structure, being made 
up of renal tubules and bloodvessels, united and bound 
together by a connecting stroma. 
Minute Anatomy.-The renal tubules (Fig. 1022), 
of which the kidney is for the most part made up, 
commence in the cortical substance, and after pursuing 
a very circuitous course through the cortical and medul- 
lary substances, finally end at the apices of the renal 
pyramids by open mouths, so that the fluid which 
they contain is emptied, through the calices, into the 
pelvis of the kidney. If the surface of one of the 
papillae be examined with a lens, it will be seen to be 
studded over with minute openings, the orifices of the 
Fig. 1021.-Vertical section of kidnejr. 
Fig. 1022.-Scheme of renal tubule and its vascular supply. 1212 
SPLANCHNOLOGY 
renal tubules, from sixteen to twenty in number, and if pressure be made on a fresh kidney, 
urine will be seen to exude from these orifices. The tubules commence in the convoluted part 
and renal columns as the Malpighian bodies, which are small rounded masses of a deep red 
color, varying in size, but of an average of about 0.2 mm. in diameter. Each of these little 
bodies is composed of two parts: a central glomerulus of vessels, called a Malpighian tuft, 
and a membranous envelope, the Malpighian capsule (capsule of Bowman), which is the small 
pouch-like commencement of a renal tubule. 
The Malpighian tuft (vascula glomerulus) is a lobulated net-work of convoluted capillary 
bloodvessels, held together by scanty connective tissue. This capillary net-work is derived from 
a small arterial twig, the afferent vessel, which enters the capsule, generally at a point opposite 
to that at which the latter is connected with the tubule; and the resulting vein, the efferent 
vessel, emerges from the capsule at the same point. The afferent vessel is usually the larger of 
the two (Fig. 1023). The Malpighian or Bowman's capsule, which surrounds the glomerulus, 
is formed of a hyaline membrane, supported by a small amount of connective tissue, which is 
continuous with the connective tissue of the tube. It is lined on its inner surface by a layer of 
squamous epithelial cells, which are reflected from the lining membrane on to the glomerulus, 
at the point of entrance or exit of the afferent and efferent vessels. The whole surface of the 
glomerulus is covered with a continuous layer of the same cells, on a delicate supporting mem- 
brane (Fig. 1024). Thus between the glomerulus and the capsule a space is left, forming a cavity 
lined by a continuous layer of squamous cells; this cavity varies in size according to the state 
of secretion and the amount of fluid present in it. In the fetus and young subject the lining 
epithelial cells are polyhedral or even columnar. 
Fig. 1023.-Distribution of bloodvessels in cortex of kidney. 
Fig. 1024.-Malpighian body. 
The renal tubules, commencing in the Malpighian bodies, present, during their course, many 
changes in shape and direction, and are contained partly in the medullary and partly in the 
cortical substance. At their junction with the Malpighian capsule they exhibit a somewhat 
constricted portion, which is termed the neck. Beyond this the tubule becomes convoluted, 
and pursues a considerable course in the cortical substance constituting the proximal convoluted 
tube. After a time the convolutions disappear, and the tube approaches the medullary sub- 
stance in a more or less spiral manner; this section of the tubule has been called the spiral tube. 
Throughout this portion of their course the renal tubules are contained entirely in the cortical 
substance, and present a fairly uniform calibre. They now enter the medullary substance, 
suddenly become much smaller, quite straight in direction, and dip down for a variable depth 
into the pyramids, constituting the descending limb of Henle's loop. Bending on themselves, 
they form what is termed the loop of Henle, and reascending, they become suddenly enlarged, 
forming the ascending limb of Henle's loop, and reenter the cortical substance. This portion 
of the tubule ascends for a short distance, when it again becomes dilated, irregular, and angular. 
This section is termed the zigzag tubule; it ends in a convoluted tube, which resembles the 
proximal convoluted tubule, and is called the distal convoluted tubule. This again terminates 
in a narrow junctional tube, which enters the straight or collecting tube. 
The straight or collecting tubes commence in the radiate part of the cortex, where they receive 
the curved ends of the distal convoluted tubules. They unite at short intervals with one another, 
the resulting tubes presenting a considerable increase in calibre, so that a series of comparatively 
large tubes passes from the bases of the rays into the renal pyramids. In the medulla the tubes 
of each pyramid converge to join a central tube (duct of Bellini') which finally opens on the summit 
of one of the papillae; the contents of the tube are therefore discharged into one of the calices. 
Structure of the Renal Tubules.-The renal tubules consist of a basement membrane lined with 
epithelium. The epithelium varies considerably in different sections of the tubule. In the neck THE KIDNEYS 
1213 
the epithelium is continuous with that lining the Malpighian capsule, and like it consists of 
flattened cells each containing an oval nucleus (Fig. 1026). The two convoluted tubules, the 
spiral and zigzag tubules and the ascending limb of Henle's loop, are lined by a type of epithelium 
which is histologically the same in all. The cells are somewhat columnar in shape and dovetail 
into one another of their lateral aspect. Each has a striated border next the lumen of the tube, 
its inner part is granular and its outer portion vertically striated. The nucleus is spherical and 
situated about the centre of the cell. In the descend- 
ing limb of Henle's loop the epithelium resembles that 
found in the Malpighian capsule and the commence- 
ment of the tube, consisting of flat, clear epithelial 
plates, each with an oval nucleus (Fig. 1025). The 
nuclei alternate on opposite surfaces of the tubule so 
that the lumen remains fairly constant. 
In the straight tube the epithelium is clear and 
cubical: in its papillary portion the cells are distinctly 
columnar and transparent (Fig. 1026). 
The Renal Bloodvessels.-The kidney is plentifully 
supplied with blood (Fig. 1027) by the renal artery, a 
large offset of the abdominal aorta. Before it enters 
the kidney, each artery divides into four or five 
branches which at the hilus lie mainly between the 
renal vein and ureter, the vein being in front, the 
ureter behind; one branch usually lies behind the 
ureter. Each vessel gives off some small branches to 
the suprarenal glands, to the ureter, and to the sur- 
rounding cellular tissue and muscles. Frequently a 
second renal artery, termed the inferior renal, is given 
off from the abdominal aorta at a lower level, and supplies the lower portion of the kidney, 
while occasionally an additional artery enters the upper part of the kidney. The branches 
of the renal artery, while in the sinus, give off a few twigs for the nutrition of the surround- 
ing tissues, and end in the arteriae propriae renales, which enter the kidney proper in the 
renal columns. Two of these pass to each renal pyramid, and rim along its sides for its 
entire length, giving off in their course the afferent vessels of the Malpighian bodies in the renal 
Fig. 1025. - Longitudinal section of de- 
scending limb of Henle's loop. a. Membrana 
propria, b. Epithelium. 
Fig. 1026.-Section of cortex of human kidney. 
columns. Having arrived at the bases of the pyramids, they form arterial arches or arcades 
which lie in the boundary zone between the bases of the pyramids and the cortical arches, and 
break up into two distinct sets of branches devoted to the supply of the remaining portions 
of the kidney. 
The first set, the interlobular arteries (Fig. 1022), are given off at right angles from the side 
of the arterial arcade looking toward the cortical substance, and pass directly outward between 1214 
SPLANCHNOLOGY 
the medullary rays to reach the' fibrous tunic, where they end in the capillary net-work of this 
part. These vessels do not anastomose with each other, but form what are called end-arteries. 
In their outward course they give off lateral branches; these are the afferent vessels for the Mal- 
pighian bodies (see page 1212); they enter the capsule, and end in the Malpighian tufts. From 
each tuft the corresponding efferent vessel arises, and, having made its egress from the capsule 
near to the point where the afferent vessel enters, breaks up into a number of branches, which 
form a dense plexus around the adjacent urinary tubes. 
The second set of branches from the arterial arcades supply the renal pyramids, which they 
enter at their bases; and, passing straight through their substance to their apices, terminate 
in the venous plexuses found in that situation. They are called the arteriae rectae. The efferent 
vessels from the glomeruli nearest the medulla break up into leashes of straight vessels (false 
arteriae rectae) which pass down into the medulla and join the plexus of vessels there (Fig. 1022). 
The renal veins arise from three sources, viz., the veins beneath the fibrous tunic, the plexuses 
around the convoluted tubules in the cortex, and the plexuses situated at the apices of 
the renal pyramids. The veins beneath the fibrous tunic (venae stellatae) are stellate in 
arrangement, and are derived from the capillary net-work, into which the terminal branches of 
the interlobular arteries break up. These join to form the interlobular veins, which pass inward 
between the rays, receive branches from the plexuses around the convoluted tubules, and, having 
arrived at the bases of the renal pyramids, join with the venae rectae, next to be described. 
Fig. 1027.-Transverse section of pyramidal substance of kidney of pig, the bloodvessels of which are injected. 
a. Large collecting tube, cut across, lined with cylindrical epithelium, b. Branch of collecting tube, cut across, lined 
with cubical epithelium, c, d. Henle's loops cut across, e. Bloodvessels cut across. D. Connective tissue ground 
substance. 
The venae rectae are branches from the plexuses at the apices of the medullary pyramids, 
formed by the terminations of the arteriae rectae. They run outward in a straight course between 
the tubes of the medullary substance, and joining, as above stated, the interlobular veins, form 
venous arcades; these in turn unite and form veins which pass along the sides of the pyramids 
(Fig. 1022). 
These vessels, venae propriae renales, accompany the arteries of the same name, running 
along the entire length of the sides of the pyramids, and quit the kidney substance to enter the 
sinus. In this cavity they join the corresponding veins from the other pyramids to form the 
renal vein, which emerges from the kidney at the hilus and opens into the inferior vena cava; 
the left vein is longer than the right, and crosses in front of the abdominal aorta. 
The lymphatics of the kidney are described on page 793. 
Nerves of the Kidney.-The nerves of the kidney, although small, are about fifteen in number. 
They have small ganglia developed upon them, and are derived from the renal plexus-, which is 
formed by branches from the coeliac plexus, the lower and outer part of the coeliac ganglion and 
aortic plexus, and from the lesser and lowest splanchnic nerves. They communicate with the 
spermatic plexus, a circumstance which may explain the occurrence of pain in the testis in affec- 
tions of the kidney. They accompany the renal artery and its branches, and are distributed to 
the bloodvessels and to the cells of the urinary tubules. 
Connective Tissue (intertubular stroma). - Although the tubules and vessels are closely 
packed, a small amount of connective tissue, continuous with the fibrous tunic, binds them 
firmly together and supports the bloodvessels, lymphatics, and nerves. 
Applied Anatomy.-Malformations of the kidney are not uncommon. There may be an 
entire absence of one kidney, but, according to Morris, the number of these cases is "excessively 
small": or there may be congenital atrophy of one kidney, when the kidney is very small, but 
usually healthy in structure. These cases are of great importance, and must be duly taken into THE KIDNEYS 
1215 
account when nephrectomy is contemplated. A more common malformation is where the two 
kidneys are fused together. They may be joined together only at their lower ends by means 
of a thick mass of renal tissue, so as to form a horseshoe-shaped body, or they may be completely 
united, forming a disk-like kidney, from which two ureters descend into the bladder. These fused 
kidneys are generally situated in the middle line of the abdomen, but may be misplaced as well. 
In some mammals, e. g., ox and bear, the kidney consists of a number of distinct lobules; this 
lobulated condition is characteristic of the kidney of the human fetus, and traces of it may persist 
in the adult. Sometimes the pelvis is duplicated, while a double ureter is not very uncommon. 
In some rare instances a third kidney may be present. 
One or both kidneys may be misplaced as a congenital condition, and remain fixed in this 
abnormal position. They are then very often misshapen. They may be situated higher, though 
this is very uncommon, or lower than normal or removed farther from the vertebral column 
than usual; or they may be displaced into the iliac fossa, over the sacroiliac joint, on to the 
promontory of the sacrum, or into the pelvis between the rectum and bladder or by the side of 
the uterus. In these latter cases they may give rise to very serious trouble. The kidney may also 
be misplaced as a congenital condition, but may not be fixed; it is then known as a floating kidney. 
It is believed to be due to the fact that the kidney is completely enveloped by peritoneum which 
then passes backward to the vertebral column as a double layer, forming a mesonephron which 
permits of movement taking place. The kidney may also be misplaced as an acquired condition; 
in these cases the kidney is mobile in the tissues by which it is surrounded, moving with the 
capsule in the perinephric tissues. This condition is known as movable kidney, and is more common 
in the female than in the male. It occurs in badly nourished people, or in those who have become 
emaciated from any cause. It must not be confounded with the floating kidney, which is a 
congenital condition due to the development of a mesonephron. The two conditions cannot, 
however, be distinguished until the abdomen is opened or the kidney explored from the loin. 
Injuries of the kidney are generally due to some severe crushing force, as from being run over 
by a heavy wagon or cart, or from the abdomen being compressed between the buffers of two 
railway carriages. When a laceration occurs on the posterior surface of the organ, infiltration 
of blood and urine takes place into the retroperitoneal connective tissue; this is often followed 
by suppuration, and death may ensue from septic poisoning. When the laceration is in front, 
the peritoneum may be torn and extravasation of blood and urine take place into the peritoneal 
cavity. Death may occur from hemorrhage or peritonitis. Occasionally, when rupture involves 
the pelvis of the kidney or the commencement of the ureter, this duct may become blocked, and 
hydronephrosis follow. Sometimes the kidney may be bruised by blows in the loin, or by being 
compressed between the lower ribs and the ilium when the body is violently bent forward. This 
is followed by a little transient hematuria, which, however, speedily passes off. 
The loose cellular tissue around the kidney may be the seat of suppuration, constituting 
perinephric abscess. This may be due to injury, to disease of the kidney itself, or to extension 
of inflammation from neighboring parts. The abscess tends to point externally in the groin or 
loin. 
Tumors of the kidney, of which perhaps sarcoma is the most common, may be recognized 
by their position; by the resonant colon lying in front of them; and by their rounded outline 
not presenting a notched anterior margin like the spleen, with which they are most likely to be 
confounded. 
The hypernephroma, a benign or malignant tumor arising from the suprarenal gland, or from 
suprarenal "rests" or inclusions in the cortex or medulla of the kidney, is not infrequent. When 
occurring in children it is often associated with precocious growth of the body generally and of 
the hair and sexual organs in particular. Arising, as it often does, in the kidney, a hypernephroma 
may be indistinguishable from a true renal tumor so far as the physical signs and symptoms go; 
it is really, however, a tumor of the suprarenal gland substance. 
The examination of the kidney should be bimanual; that is to say, one hand should be placed 
in the flank and firm pressure made forward; while the other hand is buried in the abdominal 
wall, over the situation of the organ. Manipulation of the kidney frequently produces a peculiar 
sickening sensation, sometimes with faintness. 
The kidney may require exposure for exploration or the evacuation of pus (nephrotomy)', it 
may be incised for the removal of stone (nephrolithotomy')', it may be sutured when movable or 
floating (nephrorrhaphy); or it may be removed (nephrectomy). It may be exposed either by a 
lumbar or an abdominal incision; except in cases of very large tumors, a lumbar incision is best, 
as it has the advantages of not opening the peritoneum, and of affording admirable drainage. 
An oblique incision should be made, starting at the lateral border of the Sacrospinalis, 1.25 cm. 
below the last rib and directed downward and forward toward a point 2.5 cm. in front of the 
anterior superior spine of the ilium. The structures divided are the skin, the superficial fascia 
with the cutaneous nerves, the deep fascia, the posterior border of the Obliquus externus ab- 
dominis, and the outer border of the Latissimus dorsi; the Obliquus internus and the posterior 
aponeurosis of the Transversus abdominis; the lateral border of the Quadratus lumborum; the 
deep layer of the lumbodorsal fascia and the transversalis fascia. The fatty tissue around the 1216 
SPLANCHNOLOGY 
kidney is now exposed to view, and must be separated by the fingers, or a director, in order to 
reach the kidney. The operations of nephrolithotomy, for the removal of calculi from the kidney, 
and nephrotomy, or incision of the kidney for abscess, etc., are generally performed by the lumbar 
incision. This route is also generally chosen for nephrectomy, especially if the organ is thought 
to contain pus. The abdominal operation is best performed by an incision through the lateral 
part of the Rectus abdominis on the side of the kidney to be removed; the kidney is then reached 
from the lateral side of the colon, ascending or descending, as the case may be, and thus the 
vessels of the colon are not interfered with. The incision commencing just below the costal arch 
is made of varying length, according to the size of the kidney. The abdominal cavity having 
been opened, the intestines are drawn medialward and the peritoneum covering the kidney to 
the lateral side of the colon is incised, so that the fingers can be introduced behind the peritoneum. 
The kidney must now be enucleated, and the vessels firmly ligatured and divided, the ureter 
being tied separately. The particular advantage of the abdominal operation is that the con- 
dition of the other kidney can be ascertained by manual examination, before the removal of the 
diseased kidney is finally decided upon; and further, involvement of neighboring structure by 
a new-growth, rendering removal impossible, can only be discovered by the abdominal route. 
Nephrorrhaphy is the name given to the operation for fixing a movable kidney. The kidney 
is reached by the lumbar incision, and its posterior surface denuded of its adipose capsule. Three 
stitches of medium thickness are passed through the transversalis fascia and muscles and through 
the cortical substance of the kidney, securing a good hold of it. When these sutures are tied, 
the kidney is tightly anchored in position; cases which are seen sometime afterward seem, however, 
to show that it does not always remain fixed. 
The Ureters. 
The ureters are the two tubes which convey the urine from the kidneys to the 
urinary bladder. Each commences within the sinus of the corresponding kidney 
as a number of short cup-shaped tubes, termed calices, which encircle the renal 
papillae. Since a single calyx may enclose more than one papilla the calices are 
generally fewer in number than the pyramids-the former varying from seven to 
thirteen, the latter from eight to eighteen. The calices join to form two or three 
short tubes, and these unite to form a funnel-shaped dilatation, wide above and 
narrow below, named the renal pelvis, which is situated partly inside and partly 
outside the renal sinus. It is usually placed on a level with the spinous process of 
the first lumbar vertebra. 
The Ureter Proper measures from 25 to 30 cm. in length, and is a thick-walled 
narrow cylindrical tube which is directly continuous near the lower end of the 
kidney with the tapering extremity of the renal pelvis. It runs downward and 
medialward in front of the Psoas major and, entering the pelvic cavity, finally 
opens into the fundus of the bladder. 
The abdominal part (pars abdominalis) lies behind the peritoneum on the medial 
part of the Psoas major, and is crossed obliquely by the internal spermatic vessels. 
It enters the pelvic cavity by crossing either the termination of the common, or 
the commencement of the external, iliac vessels. 
At its origin the right ureter is usually covered by the descending part of the 
duodenum, and in its course downward lies to the right of the inferior vena cava, 
and is crossed by the right colic and ileocolic vessels, while near the superior aperture 
of the pelvis it passes behind the lower part of the mesentery and the terminal 
part of the ileum. The left ureter is crossed by the left colic vessels, and near the 
superior aperture of the pelvis passes behind the sigmoid colon and its mesentery. 
The pelvic part (pars pehinaf runs at first downward on the lateral wall of the 
pelvic cavity, along the anterior border of the greater sciatic notch and under 
cover of the peritoneum. It lies in front of the hypogastric artery medial to the 
obturator nerve and the umbilical, obturator, inferior vesical, and middle hemor- 
rhoidal arteries. Opposite the lower part of the greater sciatic foramen it inclines 
medialward, and reaches the lateral angle of the bladder, where it is situated in 
front of the upper end of the seminal vesicle and at a distance of about 5 cm. 
from the opposite ureter; here the ductus deferens crosses to its medial side, and THE URETERS 
1217 
the vesical veins surround it. Finally, the ureters run obliquely for about 2 cm. 
through the wall of the bladder and open by slit-like apertures into the cavity 
of the viscus at the lateral angles of the trigone. When the bladder is distended 
the openings of the ureters are about 5 cm. apart, but when it is empty and con- 
tracted the distance between them is diminished by one-half. Owing to their 
oblique course through the coats of the bladder, the upper and lower walls of the 
terminal portions of the ureters become closely applied to each other when the viscus 
is distended, and, acting as valves, prevent regurgitation of urine from the bladder. 
In the female, the ureter forms, as it lies in relation to the wall of the pelvis, 
the posterior boundary of a shallow depression named the ovarian fossa, in which 
the ovary is situated. It then runs medialward and forward on the lateral aspect 
of the cervix uteri and upper part of the vagina to reach the fundus of the bladder. 
In this part of its course it is accompanied for about 2.5 cm. by the uterine artery, 
which then crosses in front of the ureter and ascends between the two layers of the 
broad ligament. The ureter is distant about 2 cm. from the side of the cervix of 
the uterus. The ureter is sometimes duplicated on one or both sides, and the 
two tubes may remain distinct as far as the fundus of the bladder. On rare 
occasions they open separately into the bladder cavity. 
Structure (Fig. 1028).-The ureter is composed of three coats: fibrous, muscular, and mucous 
coats. 
The fibrous coat (tunica adventitia') is continuous at one end with the fibrous tunic of the kidney 
on the floor of the sinus; while at the other it is lost in the fibrous structure of the bladder. 
In the renal pelvis the muscular coat 
(tunica muscularis) consists of two 
layers, longitudinal and circular: the 
longitudinal fibres become lost upon the 
sides of the papillae at the extremities 
of the calices; the circular fibres may 
be traced surrounding the medullary 
substance in the same situation. In 
the ureter proper the muscular fibres 
are very distinct, and are arranged in 
three layers: an external longitudinal, 
a middle circular, and an internal, less 
distinct than the other two, but having 
a general longitudinal direction. Ac- 
cording to Kblliker this internal layer is 
found only in the neighborhood of the 
bladder. 
The mucous coat (tunica mucosa') is 
smooth, and presents a few longitudinal 
folds which become effaced by disten- 
sion. It is continuous with the mucous 
membrane of the bladder below, while 
it is prolonged over the papillae of the 
kidney above. Its epithelium is of a 
transitional character, and resembles 
that found in the bladder (see Fig. 
1034). It consists of several layers of 
cells, of which the innermost-that is to 
say, the cells in contact with the urine- 
are somewhat flattened, with concavities on their deep surfaces into which the rounded ends 
of the cells of the second layer fit. These, the intermediate cells, more or less resemble columnar 
epithelium, and are pear-shaped, with rounded internal extremities which fit into the concavities 
of the cells of the first layer, and narrow external extremities which are wedged in between the 
cells of the third layer. The external or third layer consists of conical or oval cells varying in 
number in different parts, and presenting processes which extend down into the basement- 
membrane. Beneath the epithelium, and separating it from the muscular coats, is a dense layer 
of fibrous tissue containing many elastic fibres. 
Vessels and Nerves.-The arteries supplying the ureter are branches from the renal, internal 
spermatic, hypogastric, and inferior vesical. 
The nerves are derived from the inferior mesenteric, spermatic, and pelvic plexuses. 
Fig. 1028.-Transverse section of ureter. 1218 
SPLANCHNOLOGY 
Applied Anatomy.-Rupture of the ureter is not a common accident, but occasionally occurs. 
If it be torn completely across, the urine collects in the retroperitoneal tissues; if it be not com- 
pletely divided, the lumen of the tube may become strictured and hydronephrosis or pyonephrosis 
result. The ureter may be accidentally wounded in some pelvic operations, such as removal of 
the uterus; if this should happen the divided ends must be sutured together, or failing to accom- 
plish this an attempt may be made to implant the upper end into the bladder or rectum. If this 
cannot be carried out the only alternative is to remove the kidney immediately. 
Stones not uncommonly become impacted in the ureter. These may occur at any part, but 
most commonly either at the point where the tube is crossing the pelvic brim or at the termina- 
tion, where it is passing obliquely through the muscular wall of the bladder. In the former case, 
an incision with its centre opposite, and 2.5 cm. internal to, the anterior superior iliac spine, 
dividing all the structures down to the peritoneum, enables the operator to reach the ureter by 
pushing the unopened peritoneum inward; the stone can then be felt in the ureter, the wall of 
which is incised, and the stone extracted, free drainage being provided for the escaping urine. 
When the stone is impacted at the vesical end of the tube a preliminary incision into the bladder 
is required, and by scratching through the mucous membrane overlying it the calculus can be 
removed. 
The Urinary Bladder (Vesica Urinaria; Bladder) (Fig. 1029). 
The urinary bladder is a musculomembranous sac which acts as a reservoir 
for the urine; and as its size, position, and relations vary according to the amount 
of fluid it contains, it is necessary to study it as it appears (a) when empty, and (6) 
Fig. 1029.-Median sagittal section of male pelvis. 
when distended. In both conditions the position of the bladder varies with the 
condition of the rectum, being pushed upward and forward when the rectum is 
distended. 
The Empty Bladder.-When hardened in situ, the empty bladder has the 
form of a flattened tetrahedron, with its vertex tilted forward. It presents a fundus, THE URINARY BLADDER 
1219 
a vertex, a superior and an inferior surface. The fundus (Fig. 1041) is triangular 
in shape, and is directed downward and backward toward the rectum, from which 
it is separated by the rectovesical fascia, the vesiculae seminales, and the terminal 
portions of the ductus deferentes. The vertex is directed forward toward the upper 
part of the symphysis pubis, and from it the middle umbilical ligament is continued 
upward on the back of the anterior abdominal wall to the umbilicus. The peri- 
toneum is carried by it from the vertex of the bladder on to the abdominal wall 
to form the middle umbilical fold. The superior surface is triangular, bounded 
on either side by a lateral border which separates it from the inferior surface, and 
behind by a posterior border, represented by a line joining the two ureters, which 
intervenes between it and the fundus. The lateral borders extend from the ureters 
to the vertex, and from them the peritoneum is carried to the walls of the pelvis. 
On either side of the bladder the peritoneum shows a depression, named the para- 
vesical fossa (Fig. 963). The superior surface is directed upward, is covered by peri- 
toneum, and is in relation with the sigmoid colon and some of the coils of the small 
intestine. When the bladder is empty and firmly contracted, this surface is convex 
and the lateral and posterior borders are rounded; whereas if the bladder be relaxed 
it is concave, and the interior of the viscus, as seen in a median sagittal section, 
presents the appearance of a V-shaped slit with a shorter posterior and a longer 
anterior limb-the apex of the V corresponding with the internal orifice of the 
urethra. The inferior surface is directed downward and is uncovered by peritoneum. 
It may be divided into a posterior or prostatic area and two infero-lateral surfaces. 
The prostatic area is somewhat triangular: it rests upon and is in direct continuity 
with the base of the prostate; and from it the urethra emerges. The infero-lateral 
portions of the inferior surface are directed downward and lateralward: in front, 
they are separated from the symphysis pubis by a mass of fatty tissue which is 
named the retropubic pad; behind, they are in contact with the fascia which covers 
the Levatores ani and Obturatores interni. 
When the bladder is empty it is placed entirely within the pelvis, below the level 
of the obliterated hypogastric arteries, and below the level of those portions of the 
ductus deferentes which are in contact with the lateral wall of the pelvis; after 
they cross the ureters the ductus deferentes come into contact with the fundus 
of the bladder. As the viscus fills, its fundus, being more or less fixed, is only 
slightly depressed; while its superior surface gradually rises into the abdominal 
cavity, carrying with it its peritoneal covering, and at the same time rounding 
off the posterior and lateral borders. 
The Distended Bladder.-When the bladder is moderately full it contains 
about 0.5 litre and assumes an oval form; the long diameter of the oval measures 
about 12 cm. and is directed upward and forward. In this condition it presents 
a postero-superior, an antero-inferior, and two lateral surfaces, a fundus and a 
summit. The postero-superior surface is directed upward and backward, and is cov- 
ered by peritoneum: behind, it is separated from the rectum by the rectovesical 
excavation, while its anterior part is in contact with the coils of the small intestine. 
The antero-inferior surface is devoid of peritoneum, and rests, below, against the 
pubic bones, above which it is in contact with the back of the anterior abdominal 
wall. The lower parts of the lateral surfaces are destitute of peritoneum, and are 
in contact with the lateral walls of the pelvis. The line of peritoneal reflection 
from the lateral surface is raised to the level of the obliterated hypogastric artery. 
The fundus undergoes little alteration in position, being only slightly lowered. 
It exhibits, however, a narrow triangular area, which is separated from the rectum 
merely by the rectovesical fascia. This area is bounded below by the prostate, 
above by the rectovesical fold of peritoneum, and laterally by the ductus deferentes. 
The ductus deferentes frequently come in contact with each other above the pros- 
tate, and under such circumstances the lower part of the triangular area is obliter- 1220 
SPLANCHNOLOGY 
ated. The line of reflection of the peritoneum from the rectum to the bladder 
appears to undergo little or no change when the latter is distended; it is situated 
about 10 cm. from the anus. The summit is directed upward and forward above 
the point of attachment of the middle umbilical ligament, and hence the peritoneum 
which follows the ligament, forms a pouch of varying depth between the summit 
of the bladder, and the anterior abdominal wall. 
Fig. 1030.-Sagittal section through the pelvis of a newly born male child. 
The Bladder in the Child (Figs. 1030, 1031).-In the newborn child the internal 
urethral orifice is at the level of the upper border of the symphysis pubis; the 
bladder therefore lies relatively at a much higher level in the infant than in the 
Fig. 1031.-Sagittal section through the pelvis of a newly born female child. 
adult. Its anterior surface " is in contact with about the lower two-thirds of that 
part of the abdominal wall which lies between the symphysis pubis and the umbili- 
cus" (Symington1). Its fundus is clothed with peritoneum as far as the level 
1 The Anatomy of the Child. THE URINARY BLADDER 
1221 
of the internal orifice of the urethra. Although the bladder of the infant is usually 
described as an abdominal organ, Symington has pointed out that only about 
one-half of it lies above the plane of the superior aperture of the pelvis. Disse 
maintains that the internal urethral orifice sinks rapidly during the first three 
years, and then more slowly until the ninth year, after which it remains stationary 
until puberty, when it again slowly descends and reaches its adult position. 
The Female Bladder (Fig. 1032).-In the female, the bladder is in relation 
behind with the uterus and the upper part of the vagina. It is separated from the 
anterior surface of the body of the uterus by the vesicouterine excavation, but 
below the level of this excavation it is connected to the front of the cervix uteri 
and the upper part of the anterior wall of the vagina by areolar tissue. When 
the bladder is empty the uterus rests upon its superior surface. The female bladder 
is said by some to be more capacious than that of the male, but probably the 
opposite is the case. 
Fig. 1032.-Median sagittal section of female pelvis. 
Ligaments.-The bladder is connected to the pelvic wall by the fascia endo- 
pelvina. In front this fascial attachment is strengthened by a few muscular fibres, 
the Pubovesicales, which extend from the back of the pubic bones to the front 
of the bladder; behind, other muscular fibres run from the fundus of the bladder 
to the sides of the rectum, in the sacrogenital folds, and constitute the Rectovesicales. 
The vertex of the bladder is joined to the umbilicus by the remains of the urachus 
which forms the middle umbilical ligament, a fibromuscular cord, broad at its 
attachment to the bladder but narrowing as it ascends. 
From the superior surface of the bladder the peritoneum is carried off in a series 
of folds which are sometimes termed the false ligaments of the bladder. Anteriorly 
there are three folds: the middle umbilical fold on the middle umbilical ligament, 1222 
SPLANCHNOLOGY 
and two lateral umbilical folds on the obliterated hypogastric arteries. The reflec- 
tions of the peritoneum on to the side walls of the pelvis form the lateral false 
ligaments, while the sacrogenital folds constitute posterior false ligaments. 
Interior of the Bladder (Fig. 1033).-The mucous membrane lining the bladder 
is, over the greater part of the viscus, loosely attached to the muscular coat, and 
appears wrinkled or folded when the bladder is contracted: in the distended condi- 
tion of the bladder the folds are effaced. Over a small triangular area, termed the 
trigonum vesicae, immediately above and behind the internal orifice of the urethra, 
the mucous membrane is firmly bound to the muscular coat, and is always smooth. 
The anterior angle of the trigonum vesicae is formed by the internal orifice of the 
urethra: its postero-lateral angles by the orifices of the ureters. Stretching behind 
the latter openings is a slightly curved ridge, the torus uretericus, forming the base 
of the trigone and produced by an underlying bundle of non-striped muscular 
Fig. 1033.-The interior of bladder. 
fibres. The lateral parts of this ridge extend beyond the openings of the ureters, 
and are named the plicae uretericae; they are produced by the terminal portions of 
the ureters as they traverse obliquely the bladder wall. When the bladder is 
illuminated the torus uretericus appears as a pale band and forms an important 
guide during the operation of introducing a catheter into the ureter. 
The orifices of the ureters are placed at the postero-lateral angles of the trigonum 
vesicae, and are usually slit-like in form. In the contracted bladder they are about 
2.5 cm. apart and about the same distance from the internal urethral orifice; in 
the distended viscus these measurements may be increased to about 5 cm. 
The internal urethral orifice is placed at the apex of the trigonum vesicae, in the 
most dependent part of the bladder, and is usually somewhat crescentic in form; 
the mucous membrane immediately behind it presents a slight elevation, the 
uvula vesicae, caused by the middle lobe of the prostate. THE URINARY BLADDER 
1223 
Structure (Fig. 1034).-The bladder is composed of the four coats: serous, muscular, sub- 
mucous, and mucous coats. 
The serous coat (tunica serosa) is a partial one, and is derived from the peritoneum. It invests 
the superior surface and the upper parts of the lateral surfaces, and is reflected from these on 
to the abdominal and pelvic walls. 
The muscular coat (tunica muscularis) consists of three layers of unstriped muscular fibres: 
an external layer, composed of fibres having for the most part a longitudinal arrangement; a 
middle layer, in which the fibres are arranged, more 
or less, in a circular manner; and an internal layer, 
in which the fibres have a general longitudinal ar- 
rangement. 
The fibres of the external layer arise from the pos- 
terior surface of the body of the pubis in both sexes 
(musculi pubovesicales), and in the male from the 
adjacent part of the prostate and its capsule. 
They pass, in a more or less longitudinal manner, up 
the inferior surface of the bladder, over its vertex, 
and then descend along its fundus to become at- 
tached to the prostate in the male, and to the front 
of the vagina in the female. At the sides of the 
bladder the fibres are arranged obliquely and inter- 
sect one another. This layer has been named the 
Detrusor urinae muscle. 
The fibres of the middle circular layer are very 
thinly and irregularly scattered on the body of the 
organ, and, although to some extent placed trans- 
versely to the long axis of the bladder, are for the 
most part arranged obliquely. Toward the lower 
part of the bladder, around the internal urethral 
orifice, they are disposed in a thick circular layer, 
forming the Sphincter vesicae, which is continuous 
with the muscular fibres of the prostate. 
The internal longitudinal layer is thin, and its 
fasciculi have a reticular arrangement, but with a 
tendency to assume for the most part a longitudinal direction. Two bands of oblique fibres, 
originating behind the orifices of the ureters, converge to the back part of the prostate, and 
are inserted by means of a fibrous process, into the middle lobe of that organ. They are the 
muscles of the ureters, described by Sir C. Bell, who supposed that during the contraction of 
the bladder they serve to retain the oblique direction of the ureters, and so prevent the reflux of 
the urine into them. 
The submucous coat (tela submucosa) consists of a layer of areolar tissue, connecting together 
the muscular and mucous coats, and intimately united to the latter. 
The mucous coat (tunica mucosa) is thin,- smooth, and of a pale rose color. It is continuous 
above through the ureters with the lining membrane of the renal tubules, and below with that 
of the urethra. The loose texture of the submucous layer allows the mucous coat to be thrown 
into folds or rugae when the bladder is empty. Over the trigonum vesicae the mucous mem- 
brane is closely attached to the muscular coat, and is not thrown into folds, but is smooth and 
flat. The epithelium covering it is of the transitional variety, consisting of a superficial layer 
of polyhedral flattened cells, each with one, two, or three nuclei; beneath these is a stratum 
of large club-shaped cells, with their narrow extremities directed downward and wedged in 
between smaller spindle-shaped cells, containing oval nuclei (Fig. 1034). The epithelium varies 
according as the bladder is distended or contracted. In the former condition the superficial cells 
are flattened and those of the other layers are shortened; in the latter they present the appear- 
ance described above. There are no true glands in the mucous membrane of the bladder, though 
certain mucous follicles which exist, especially near the neck of the bladder, have been regarded 
as such. 
Vessels and Nerves.-The arteries supplying the bladder are the superior, middle, and inferior 
vesical, derived from the anterior trunk of the hypogastric. The obturator and inferior gluteal 
arteries also supply small visceral branches to the bladder, and in the female additional branches 
are derived from the uterine and vaginal arteries. 
The veins form a complicated plexus on the inferior surface, and fundus near the prostate, and 
end in the hypogastric veins. 
The lymphatics are described on page 793. 
The nerves of the bladder are (1) fine medullated fibres from the third and fourth sacral nerves, 
and (2) non-medullated fibres from the hypogastric plexus. They are connected with ganglia 
in the outer and submucous coats and are finally distributed, all as non-medullated fibres, to the 
muscular layer and epithelial lining of the viscus. 
Fig. 1034.-Vertical section of bladder wall. 1224 
SPLANCHNOLOGY 
Applied Anatomy.-A defect of development, in which the bladder is implicated, is known 
under the name of extroversion of the bladder. In this condition the lower part of the abdominal 
wall and the anterior wall of the bladder are wanting, so that the fundus of the bladder' presents 
on the abdominal surface, and is pushed forward by the pressure of the viscera within the abdomen, 
forming a red vascular tumor on which the openings of the ureters are visible. The penis, except 
the glans, is rudimentary and is cleft on its dorsal surface, exposing the floor of the urethra, a 
condition known as epispadias. The pelvic bones are also arrested in development (see page 344). 
The bladder may be ruptured by violence applied to the abdominal wall, when the viscus is 
distended, without any injury to the bony pelvis, or it may be torn in cases of fracture of the 
pelvis. The rupture may be either intraperitoneal or extraperitoneal: that is, may implicate 
the superior surface of the bladder in the former case, or one of the other surfaces in the latter. 
Until recently intraperitoneal rupture was uniformly fatal, but now abdominal section and 
suturing the rent with Lembert's suture is resorted to, with a very considerable amount of success. 
The sutures are inserted only through the peritoneal and muscular coats in such a way as to 
bring the serous surfaces at the margins of the wound into apposition, and one is inserted just 
beyond each end of the wound. The bladder should be tested as to whether it is water-tight 
before closing the external incision. 
The muscular coat of the bladder undergoes hypertrophy in cases in which there is any obstruc- 
tion to the flow of urine. Under these circumstances the bundles of which the muscular coat 
consists become much increased in size, and, interlacing in all directions, give rise to what is 
known as the fasciculated bladder. Between these muscular bundles the mucous membrane 
may bulge out, forming sacculi, constituting the sacculated bladder, and in these little pouches 
phosphatic concretions may collect, forming encysted calculi. The mucous membrane is very 
loosely attached, except over the trigone, to allow of the distension of the viscus. 
Various forms of tumor have been found springing from the wall of the bladder. The com- 
monest innocent tumor is the villous papilloma. Of the malignant tumors, epithelioma is the 
most common, but sarcoma is occasionally found in the bladder of children. 
In doubtful cases the cystoscope proves a valuable aid in diagnosis. This instrument consists 
of a tube in which is fixed a small electric light, the wires of which run through the shaft of the 
instrument. Upon introducing this down the urethra, the bladder can be examined with the eye 
and a villous growth or other tumor, a calculus, or an ulcer can be detected; or the orifices of 
the ureters can be examined, and renal hematuria diagnosticated, and it can be definitely settled 
from which kidney the blood comes. Again, the presence of minute tuberculous ulceration near 
the mouth of the ureter on the affected side may establish the diagnosis, not only of tuberculous 
kidney, but also of the side in which the disease is located. The cystoscope can be used to 
catheterize the ureter, for the purpose of obtaining a specimen of urine from either kidney, or to 
ascertain the condition of both kidneys where it is proposed to remove one. Ureteric bougies 
opaque to x-rays can be passed up and photographed. 
Puncture of the bladder may be performed either above the symphysis pubis or through 
the rectum, in both cases without wounding the peritoneum. The former plan is generally to 
be preferred, since in puncture by the rectum a permanent fistula may be left from abscess forming 
between the rectum and the bladder; or pelvis cellulitis may be set up; moreover, it is exceedingly 
inconvenient to keep a cannula in the rectum. In some cases, in performing this operation the 
rectovesical excavation of the peritoneum has been wounded, inducing fatal peritonitis. Puncture 
through the rectum, therefore, has been almost completely abandoned in favor of the suprapubic 
route. 
Access to the bladder, for the purpose of removing calculi or an enlarged prostate, is almost 
always effected by the suprapubic route, the old perineal operation being now rarely resorted 
to. In the female, owing to the shortness of the urethra, and its ready dilatability, calculi and 
foreign bodies and new growths, when of small size, may be removed by the urethral route. 
Suprapubic cystotomy is performed by first injecting ten or twelve ounces of some weak anti- 
septic fluid into the bladder. Then, with or without distending the rectum, a vertical median 
incision, from 7 to 10 cm. in length, is made in the hypogastric region immediately above the 
symphysis, and extended between the Pyramidales and Recti until the transversalis fascia is 
reached. This is divided and some fatty tissue exposed (space of Retzius). Upon separating 
this, the inferior surface of the bladder will be exposed and will be recognized by its muscular 
fibres. A needle should be passed through its coat on either side of the spot selected for the 
opening, and two long pieces of silk inserted. The bladder is incised between these stays, which 
are held by an assistant and form a useful guide to the opening in the bladder when the fluid 
has escaped. 
It is important that the bladder should be emptied by catheter as a routine measure in women, 
prior to operations on the lower part of the abdomen or pelvis. Neglect of this precaution has, 
not uncommonly, led to that viscus being opened by accident. Women especially are apt to 
acquire an atonic distension of the bladder, and the fact that some quantity of urine has been 
passed immediately before operation is no guarantee that the viscus is not distended. If the 
accident should occur, the bladder wall must be carefully sutured before the peritoneum is 
opened. THE MALE URETHRA 
1225 
The Male Urethra (Urethra Virilis) (Fig. 1035). 
The male urethra extends from the internal urethral orifice in the urinary bladder 
to the external urethral orifice at the end of the penis. It presents a double curve 
in the ordinary relaxed state of the penis (Fig. 1030). Its length varies from 17.5 
to 20 cm.; and it is divided into three portions, the prostatic, membranous, and 
cavernous, the structure and rela- 
tions of which are essentially 
different. Except during the 
passage of the urine or semen, 
the greater part of the urethral 
canal is a mere transverse cleft 
or slit, with its upper and under 
surfaces in contact; at the external 
orifice the slit is vertical, in the 
membranous portion irregular or 
stellate, and in the prostatic por- 
tion somewhat arched. 
The prostatic portion (pars pros- 
tatica}, the widest and most dila- 
table part of the canal, is about 
3 cm. long, It runs almost ver- 
tically through the prostate from 
its base to its apex, lying nearer 
its anterior than its posterior 
surface; the form of the canal 
is spindle-shaped, being wider in 
the middle than at either extrem- 
ity, and narrowest below, where 
it joins the membranous portion. 
A transverse section of the canal 
as it lies in the prostate is horse- 
shoe-shaped, with the convexity 
directed forward. 
Upon the posterior wall or 
floor is a narrow longitudinal 
ridge, the urethral crest (veru- 
montanum), formed by an eleva- 
tion of the mucous membrane 
and its subjacent tissue. It is 
from 15 to 17 mm. in length, 
and about 3 mm. in height, and 
contains, according to Kobelt, muscular and erectile tissue. When distended, 
it may serve to prevent the passage of the semen backward into the bladder. 
On either side of the crest is a slightly depressed fossa, the prostatic sinus, the floor 
of which is perforated by numerous apertures, the orifices of the prostatic ducts 
from the lateral lobes of the prostate; the ducts of the middle lobe open behind 
the crest. At the forepart of the urethral crest, below its summit, is a median 
elevation, the colliculus seminalis, upon or within the margins of which are the 
orifices of the prostatic utricle and the slit-like openings of the ejaculatory ducts. 
The prostatic utricle (sinus pocularis) forms a cul-de-sac about 6 mm. long, which 
runs upward and backward in the substance of the prostate behind the middle 
lobe. Its w'alls are composed of fibrous tissue, muscular fibres, and mucous 
Fig. 1035.-The male urethra laid open on its anterior (upper) 
surface. 1226 
SPLANCHNOLOGY 
membrane, and numerous small glands open on its inner surface. It was called 
by Weber the uterus masculinus, from its being developed from the united 
lower ends of the atrophied Mullerian ducts, and therefore homologous with the 
uterus and vagina in the female. 
The membranous portion (pars membranacea') is the shortest, least dilatable, 
and, with the exception of the external orifice, the narrowest part of the canal. 
It extends downward and forward, with a slight anterior concavity, between the 
apex of the prostate and the bulb of the urethra, perforating the urogenital dia- 
phragm about 2.5 cm. below and behind the pubic symphysis. The hinder part 
of the urethral bulb lies in apposition with the inferior fascia of the urogenital 
diaphragm, but its upper portion diverges somewhat from this fascia: the anterior 
wall of the membranous urethra is thus prolonged for a short distance in front 
of the urogenital diaphragm; it measures about 2 cm. in length, while the posterior 
wall which is between the two fasciae of the diaphragm is only 1.25 cm. long. 
The membranous portion of the urethra is completely surrounded by the fibres 
of the Sphincter urethrae membranaceae. In front of it the deep dorsal vein of 
the penis enters the pelvis between the transverse ligament of the pelvis and the 
arcuate pubic ligament; on either side near its termination are the bulbourethral 
glands. 
The cavernous portion (pars cavernosa; penile or spongy portion) is the longest 
part of the urethra, and is contained in the corpus cavernosum urethrae. It is 
about 15 cm. long, and extends from the termination of the membranous portion 
to the external urethral orifice. Commencing below the inferior fascia of the 
urogenital diaphragm it passes forward and upward to the front of the symphysis 
pubis; and then, in the flaccid condition of the penis, it bends downward and 
forward. It is narrow, and of uniform size in the body of the penis, measur- 
ing about 6 mm. in diameter; it is dilated behind, within the bulb, and again 
anteriorly within the glans penis, where it forms the fossa navicularis urethrae. 
The external urethral orifice (orificium urethrae externum; meatus urinarius') is 
the most contracted part of the urethra; it is a vertical slit, about 6 mm. long, 
bounded on either side by two small labia. 
The lining membrane of the urethra, especially on the floor of the cavernous 
portion, presents the orifices of numerous mucous glands and follicles situated 
in the submucous tissue, and named the urethral glands (Littre). Besides these 
there are a number of small pit-like recesses, or lacunse, of varying sizes. Their 
orifices are directed forward, so that they may easily intercept the point of a 
catheter in its passage along the canal. One of these lacunae, larger than the rest, 
is situated on the upper surface of the fossa navicularis; it is called the lacuna 
magna. The bulbo-urethral glands open into the cavernous portion about 2.5 cm. 
in front of the inferior fascia of the urogenital diaphragm. 
Structure.-The urethra is composed of mucous membrane, supported by a submucous tissue 
which connects it with the various structures through which it passes. 
The mucous coat forms part of the genito-urinary mucous membrane. It is' continuous with 
the mucous membrane of the bladder, ureters, and kidneys; externally, with the integument 
covering the glans penis; and is prolonged into the ducts of the glands which open into the urethra, 
viz., the bulbo-urethral glands And the prostate; and into the ductus def erentes and vesiculae 
seminales, through the ejaculatory ducts. In the cavernous and membranous portions the mucous 
membrane is arranged in longitudinal folds when the tube is empty. Small papillae are found 
upon it, near the external urethral orifice; its epithelial lining is of the columnar variety except 
near the external orifice, where it is squamous and stratified. 
The submucous tissue consists of a vascular erectile layer; outside this is a layer of unstriped 
muscular fibres, arranged in a circular direction, which separates the mucous membrane and 
submucous tissue from the tissue of the corpus cavernosum urethrae. 
Applied Anatomy.-The urethra may be ruptured by the patient falling astride of any hard 
substance and striking his perineum, so that the urethra is crushed against the pubic arch. 
Bleeding will at once take place from the urethra, and this, together with the bruising in the THE MALE URETHRA 
1227 
perineum and the history of the accident, will point to the nature of the injury. Rupture of 
the urethra is due in other cases to the perforation of a periurethral abscess. Extravasation of 
urine most frequently takes place into the perineum in front of the inferior fascia of the urogenital 
diaphragm, i. e., under the fascia of Colles. Both these layers of fascia are attached firmly to 
the ischiopubic rami. It is clear, therefore, that when extravasation of fluid takes place between 
them, it cannot pass backward, because the two layers are continuous with each other around 
the Transversus perinaei muscles; it cannot extend laterally, on account of the connection of 
both these layers to the rami of the pubis and ischium; it cannot find its way into the pelvis, 
because the opening into this cavity is closed by the urogenital diaphragm, and, therefore, so 
long as these two layers remain intact, the only direction in which the fluid can make its way 
is forward into the areolar tissue of the scrotum and penis, and thence on to the anterior wall of 
the abdomen. 
Gonorrhoea is an acute and very prevalent inflammatory infection of the mucous membrane 
of the urethra. The causative organisms (gonococci) pass through the mucous membrane into 
the submucous tissue, and most serious complications and results may follow. In most cases 
the disease remains limited to the part of the urethra in front of the urogenital diaphragm, but 
in some (about 10 per cent.) the "posterior urethra" becomes involved in the process, leading to 
an inflammation of the openings of the prostatic follicles. Such a condition is apt to continue 
as a very chronic form of prostatitis, and in many cases the infection will spread along the ductus 
deferens, giving rise to epididymitis. 
The anatomy of the urethra is of considerable importance in connection with the passage of 
instruments into the bladder. Otis was the first to point out that the urethra is capable of great 
dilatability, so that, excepting through the external urethral orifice, an instrument corresponding 
to 18 English gauge (29 French) can usually be passed without damage. The external orifice 
of the urethra is not so dilatable, and therefore may require slitting. A recognition of this dila- 
tability caused Bigelow to very considerably modify the operation for crushing a stone in the 
bladder. In passing catheters, especially fine ones, the point of the instrument should be kept 
as far as possible along the upper wall of the canal, as otherwise it is very liable to enter one of 
the lacunae. 
Stricture of the urethra is a disease of very common occurrence, and is generally situated in 
the cavernous part of the urethra, just in front of the membranous portion, but in a very con- 
siderable numbei' of cases in the antescrotal part of the canal. The stricture usually results from 
the contraction of inflammatory products in the submucous tissue, the result, in the vast majority 
of all cases, of a prolonged gleet following gonorrhoea. Urethral stricture, however, follows 
rupture of that tube resulting from falls on the perineum, and in this variety is very dense, 
and is a most unsatisfactory condition with regard to treatment. Congenital stricture is also 
occasionally met with, and in such cases multiple strictures may be present throughout the 
whole length of the cavernous portion. 
Congenital defects of the urethra occur occasionally. The one most frequently met with is 
where there is a cleft on the floor of the urethra owing to an arrest of union in the middle fine. 
This is known as hypospadias, and the cleft may vary in extent. The simplest and by far the 
most common form is where the deficiency is confined to the glans penis. The urethra ends at 
the point where the extremity of the prepuce joins the body of the penis, in a small valve-like 
opening. The prepuce is also cleft on its under surface and forms a sort of hood over the glans. 
There is a depression on the glans in the position of the normal meatus. This condition produces 
no disability and requires no treatment. In more severe cases the cavernous portion of the 
urethra is cleft throughout its entire length, and the opening of the urethra is at the point of 
junction of the penis and scrotum. The under surface of the penis in the middle line presents a 
furrow lined by a moist mucous membrane, on either side of which is often more or less dense 
fibrous tissue stretching from the glans to the opening of the urethra, which prevents complete 
erection taking place. Great discomfort is induced during micturition, and sexual connection is 
impossible. The condition may be remedied by a series of plastic operations. The worst form 
of this condition is where the urethra is deficient as far back as the perineum, and the scrotum 
is cleft. The penis is small and bound down between the two halves of the scrotum, so as to 
resemble an hypertrophied clitoris. The testes are often retained. The condition of parts, 
therefore, very much resembles the external organs of generation of the female, and many chil- 
dren the victims of this malformation have been brought up as girls. The halves of the scrotum, 
deficient of testes, resemble the labia, the cleft between them looks like the orifice of the vagina, 
and the diminutive penis is taken for an enlarged clitoris. There is no remedy for this condition. 
A much more uncommon form of malformation is where there is an apparent deficiency of the 
upper wall of the urethra; this is named epispadias. The deficiency may vary in extent; when 
it is complete the condition is associated with extroversion of the bladder. In less extensive cases, 
where there is no extroversion, there is an infundibuliform opening into the bladder. The 
penis is usually dwarfed and turned upward, so that the glans lies over the opening. 1228 
SPLANCHNOLOGY 
The Female Urethra (Urethra Muliebris) (Fig. 1032). 
The female urethra is a narrow membranous canal, about 4 cm. long, extending 
from the internal to the external urethral orifice. It is placed behind the sym- 
physis pubis, imbedded in the anterior wall of the vagina, and its direction is ob- 
liquely downward and forward; it is slightly curved with the concavity directed 
forward. Its diameter when undilated is about 6 mm. It perforates the fasciae 
of the urogenital diaphragm, and its external orifice is situated directly in front 
of the vaginal opening and about 2.5 cm. behind the glans clitoridis. The lining 
membrane is thrown into longitudinal folds, one of which, placed along the floor 
of the canal, is termed the urethral crest. Many small urethral glands open into 
the urethra. 
Structure.--The urethra consists of three coats: muscular, erectile, and mucous. 
The muscular coat is continuous with that of the bladder; it extends the whole length of the 
tube, and consists of circular fibres. In addition to this, between the superior and inferior fasciae 
of the urogenital diaphragm, the female urethra is surrounded by the Sphincter urethrae mem- 
branaceae, as in the male. 
A thin layer of spongy erectile tissue, containing a plexus of large veins, intermixed with 
bundles of unstriped muscular fibres, lies immediately beneath the mucous coat. 
The mucous coat is pale; it is continuous externally with that of the vulva, and internally with 
that of the bladder. It is lined by stratified squamous epithelium, which becomes transitional 
near the bladder. Its external orifice is surrounded by a few mucous follicles. 
THE MALE GENITAL ORGANS (ORGANA GENITALIA VIRILIA). 
The male genitals include the testes, the ductus deferentes, the vesiculae semi- 
nales, the ejaculatory ducts, and the penis, together with the following accessory 
structures, viz., the prostate and the bulbourethral glands. 
The Testes and Their Coverings (Fig. 1036). 
The testes are two glandular organs, which secrete the semen; they are suspended 
in the scrotum by the spermatic cords. At an early period of fetal life the testes 
are contained in the abdominal cavity, behind the peritoneum. Before birth they 
descend to the inguinal canal, along which they pass with the spermatic cord, 
and, emerging at the subcutaneous inguinal ring, they descend into the scrotum, 
becoming invested in their course by coverings derived from the serous, muscular, 
and fibrous layers of the abdominal parietes, as well as by the scrotum. 
The coverings of the testes are, the 
Skin 
Dartos tunic 
■ Scrotum. 
Cremaster. 
Infundibuliform fascia. 
Tunica vaginalis. 
Intercrural fascia. 
The Scrotum is a cutaneous pouch which contains the testes and parts of the 
spermatic cords. It is divided on its surface into two lateral portions by a ridge 
or raphe, which is continued forward to the under surface of the penis, and backward, 
along the middle line of the perineum to the anus. Of these two lateral portions 
the left hangs lower than the right, to correspond with the greater length of the 
left spermatic cord. Its external aspect varies under different circumstances: 
thus, under the influence of warmth, and in old and debilitated persons, it becomes 
elongated and flaccid; but, under the influence of cold, and in the young and 
robust, it is short, corrugated, and closely applied to the testes. 
The scrotum consists of two layers, the integument and the dartos tunic. 
The Integument is very thin, of a brownish color, and generally thrown Into 
folds or rugse. It is provided with sebaceous follicles, the secretion of which has a THE TESTES AND THEIR COVERINGS 
1229 
peculiar odor, and is beset with thinly scattered, crisp hairs, the roots of which 
are seen through the skin. 
The Dartos Tunic (tunica dartos) is a thin layer of non-striped muscular fibres, 
continuous, around the base of the scrotum, with the two layers of the superficial 
fascia of the groin and the perineum; it sends inward a septum, which divides 
the scrotal pouch into two cavities for the testes, and extends between the raphe 
and the under surface of the penis, as far as its root. 
The dartos tunic is closely united to the skin externally, but connected with 
the subjacent parts by delicate areolar tissue, upon which it glides with the 
greatest facility. 
Fig. 1036.-Transverse section through the left side of the scrotum and the left testis. The sac of the tunica 
vaginalis is represented in a distended condition. (Diagrammatic.) (Delepine.) 
The Intercrural Fascia (intercolumnar or external spermatic fascia) is a thin 
membrane, prolonged downward around the surface of the cord and testis (see 
page 501). It is separated from the dartos tunic by loose areolar tissue. 
The Cremaster consists of scattered bundles of muscular fibres connected 
together into a continuous covering by intermediate areolar tissue (see page 504). 
The Infundibuliform Fascia (tunica vaginalis communis [testis et funiculi sper- 
matid]) is a thin layer, which loosely invests the cord; it is a continuation 
downward of the transversalis fascia (see page 508). 
The Tunica Vaginalis is described with the testes. 
Vessels and Nerves.-The arteries supplying the coverings of the testes are: the superficial 
and deep external pudendal branches of the femoral, the superficial perineal branch of the 
internal pudendal, and the cremasteric branch from the inferior epigastric. The veins follow 
the course of the corresponding arteries. The lymphatics end in the inguinal lymph glands. 
The nerves are the ilioinguinal and lumboinguinal branches of the lumbar plexus, the two 
superficial perineal branches of the internal pudendal nerve, and the pudendal branch of the 
posterior femoral cutaneous nerve. 
The Inguinal Canal (canalis inguinalis) is described on page 508. 
The Spermatic Cord (funiculus spermaticus) extends from the abdominal 
inguinal ring, where the structures of which it is composed converge, to the back 
part of the testis. In the abdominal wall the cord passes obliquely along the 
inguinal canal, lying at first beneath the Obliquus internus, and upon the fascia 1230 
SPLANCHNOLOGY 
transversalis; but nearer the pubis, it rests upon the inguinal and lacunar liga- 
ments, having the aponeurosis of the Obliquus externus in front of it, and the 
inguinal falx behind it. It then escapes at the subcutaneous ring, and descends 
nearly vertically into the scrotum. The left cord is rather longer than the right, 
consequently the left testis hangs somewhat lower than its fellow. 
Structure of the Spermatic Cord.-The spermatic cord is composed of arteries, veins, lymphatics, 
nerves, and the excretory duct of the testis. These structures are connected together by areolar 
tissue, and invested by the layers brought down by the testis in its descent. 
The arteries of the cord are: the internal and external spermatics; and the artery to the ductus 
deferens. 
The internal spermatic artery, a branch of the abdominal aorta, escapes from the abdomen 
at the abdominal inguinal ring, and accompanies the other constituents of the spermatic cord 
along the inguinal canal and through the subcutaneous inguinal ring into the scrotum. It then 
descends to the testis, and, becoming tortuous, divides into several branches, two or three of 
which accompany the ductus deferens and supply the epididymis, anastomosing with the artery 
of the ductus deferens: the others supply the substance of the testis. 
The external spermatic artery is a branch of the inferior epigastric artery. It accompanies the 
spermatic cord and supplies the coverings of the cord, anastomosing with the internal spermatic 
artery. 
The artery of the ductus deferens, a branch of the superior vesical, is a long, slender vessel, which 
accompanies the ductus deferens, ramifying upon its coats, and anastomosing with the internal 
spermatic artery near the testis. 
The spermatic veins emerge from the back of the testis, and receive tributaries from the epi- 
didymis: they unite and form a convoluted plexus, the plexus pampiniformis, which forms the 
chief mass of the cord; the vessels composing this plexus are very numerous, and ascend along 
the cord in front of the ductus deferens; below the subcutaneous inguinal ring they unite to form 
three or four veins, which pass along the inguinal canal, and, entering the abdomen through the 
abdominal inguinal ring, coalesce to form two veins. These again unite to form a single vein, 
which opens on the right side into the inferior vena cava, at an acute angle, and on the left side 
into the left renal vein, at a right angle. 
The lymphatic vessels are described on page 794. 
The nerves are the spermatic plexus from the sympathetic, joined by filaments from the pelvic 
plexus which accompany the artery of the ductus deferens. 
Applied Anatomy.-The scrotum forms an admirable covering for the protection of the testes. 
These bodies, lying suspended and loose in the cavity of the scrotum and surrounded by serous 
membrane, are capable of great mobility, and can therefore easily slip about within the scrotum 
and thus avoid injuries from blows or squeezes. The skin of the scrotum is very elastic and 
capable of great distension, and on account of the looseness and amount of subcutaneous tissue, 
the scrotum becomes greatly enlarged in cases of oedema, to which this part is especially liable 
as a result of its dependent position. The scrotum is occasionally the seat of epithelioma; this is 
no doubt due to the rugae on its surface, which favor the lodgement of dirt, and this, producing 
irritation, is the exciting cause of the disease. The disease is very much less common than it 
used to be; this is probably due to the better hygienic conditions of the working classes. The 
scrotum is also the part most frequently affected by elephantiasis. 
On account of the looseness of the subcutaneous tissue, large extravasations of blood may take 
place from very slight injuries. It is therefore generally recommended never to apply leeches to 
the scrotum, since they may lead to ecchymosis, but rather to puncture one or more of the super- 
ficial veins of the scrotum in cases where local blood-letting from this part is judged to be desirable. 
The muscular fibre in the dartos tunic causes contraction and considerable diminution in the size 
of a wound of the scrotum, as after the operation of castration, and are of assistance in keeping 
the edges together, and covering the exposed parts. 
The Testes are suspended in the scrotum by the spermatic cords, the left testis 
hanging somewhat lower than its fellow. The average dimensions of the testis 
are from 4 to 5 cm. in length, 2.5 cm. in breadth, and 3 cm. in the antero-posterior 
diameter; its weight varies from 10.5 to 14 gm. Each testis is of an oval form 
(Fig. 1037), compressed laterally, and having an oblique position in the scrotum; 
the upper extremity is directed forward and a little lateralward; the lower, 
backward and a little medialward; the anterior convex border looks forward and 
downward, the posterior or straight border, to which the cord is attached, 
backward and upward. 
The anterior border and lateral surfaces, as well as both extremities of the organ, THE TESTES AND THEIR COVERINGS 
1231 
are convex, free, smooth, and invested by the visceral layer of the tunica vaginalis. 
The posterior border, to which the cord is attached, receives only a partial invest- 
ment from that membrane. Lying upon the lateral edge of this posterior border 
is a long, narrow, flattened body, named the epididymis. 
The epididymis consists of a central portion or body; an upper enlarged extremity, 
the head (globus major)-, and a lower pointed extremity, the tail (globus minor), 
which is continuous with the ductus deferens, the duct of the testis. The head 
is intimately connected with the upper end of the testis by means of the efferent 
ductules of the gland; the tail is connected with the lower end by cellular tissue, 
and a reflection of the tunica vaginalis. The lateral surface, head and tail of the 
epididymis are free and covered by the serous membrane; the body is also com- 
pletely invested by it, excepting along its posterior border; while between the 
body and the testis is a pouch, named the sinus of the epididymis (digital fossa). 
The epididymis is connected to the back of the testis by a fold of the serous 
membrane. 
Fig. 1037.-The right testis, exposed by laying open the tunica vaginalis. 
Appendages of the Testis and Epididymis.-On the upper extremity of the testis, 
just beneath the head of the epididymis, is a minute oval, sessile body, the appendix 
of the testis (hydatid of Morgagni'); it is the remnant of the upper end of the Mullerian 
duct. On the head of the epididymis is a second small stalked appendage (some- 
times duplicated); it is named the appendix of the epididymis (pedunculated hydatid), 
and is usually regarded as a detached efferent duct. 
The testis is invested by three tunics: the tunica vaginalis, tunica albuginea, 
and tunica vasculosa. 
The Tunica Vaginalis (tunica vaginalis propria testis) is the serous covering of 
the testis. It is a pouch of serous membrane, derived from the saccus vaginalis 
of the peritoneum, which in the fetus preceded the descent of the testis from the 
abdomen into the scrotum. After its descent, that portion of the pouch which 
extends from the abdominal inguinal ring to near the upper part of the gland 
becomes obliterated; the lower portion remains as a shut sac, which invests the 
surface of the testis, and is reflected on to the internal surface of the scrotum; 
hence it may be described as consisting of a visceral and parietal lamina. 
The visceral lamina (lamina visceralis) covers the greater part of the testis and 
epididymis, connecting the latter to the testis by means of a distinct fold. From 1232 
SPLANCHNOLOGY 
the posterior border of the gland it is reflected on to the internal surface of the 
scrotum. 
The parietal lamina (lamina parietalis) is far more extensive than the visceral, 
extending upward for some distance in front and on the medial side of the cord, 
and reaching below the testis. The inner surface of the tunica vaginalis is 
smooth, and covered by a layer of endothelial cells. The interval between the 
visceral and parietal laminae constitutes the cavity of the tunica vaginalis. 
The obliterated portion of the saccus vaginalis may generally be seen as a fibro- 
cellular thread lying in the loose areolar tissue around the spermatic cord; some- 
times this may be traced as a distinct band from the upper end of the inguinal 
canal, where it is connected with the peritoneum, down to the tunica vaginalis; 
sometimes it gradually becomes lost on the spermatic cord. Occasionally no trace 
of it can be detected. In some cases it happens that the pouch of peritoneum does 
not become obliterated, but the sac of the peritoneum communicates with the 
tunica vaginalis. This may give rise to one of the varieties of oblique inguinal 
hernia (page 1187). In other cases the pouch may contract, but not become 
entirely obliterated; it then forms a minute canal leading from the peritoneum to 
the tunica vaginalis. 
The Tunica Albuginea is the fibrous covering of the testis. It is a dense membrane, 
of a bluish-white color, composed of bundles of white fibrous tissue which interlace 
in every direction. It is covered by the tunica vaginalis, except at the points of 
attachment of the epididymis to the testis, and along its posterior border, where 
the spermatic vessels enter the gland. It is applied to the tunica vasculosa over 
the glandular substance of the testis, and, at its posterior border, is reflected 
into the interior of the gland, forming an incomplete vertical septum, called the 
mediastinum testis (corpus Highmori). 
The mediastinum testis extends from the upper to near the lower extremity 
of the gland, and is wider above than below. From its front and sides numerous 
imperfect septa (trabecula?) are given off, which radiate toward the surface of the 
organ, and are attached to the tunica albuginea. They divide the interior of the 
organ into a number of incomplete spaces which are somewhat cone-shaped, being 
broad at their bases at the surface of the gland, and becoming narrower as they 
converge to the mediastinum. The mediastinum supports the vessels and duct 
of the testis in their passage to and from the substance of the gland. 
The Tunica Vasculosa is the vascular layer of the testis, consisting of a plexus 
of bloodvessels, held together by delicate areolar tissue. It clothes the inner sur- 
face of the tunica albuginea and the different septa in the interior of the gland, 
and therefore forms an internal investment to all the spaces of which the gland is 
composed. 
Structure.-The glandular structure of the testis consists of numerous lobules. Their number, 
in a single testis, is estimated by Berres at 250, and by Krause at 400. They differ in size 
according to their position, those in the middle of the gland being larger and longer. The 
lobules (Fig. 1038) are conical in shape, the base being directed toward the circumference of the 
organ, the apex toward the mediastinum. Each lobule is contained in one of the intervals between 
the fibrous septa which extend between the mediastinum testis and the tunica albuginea, and 
consists of from one to three, or more, minute convoluted tubes, the tubuli seminiferi. The 
tubules may be separately unravelled, by careful dissection under water, and may be seen to 
commence either by free cecal ends or by anastomotic loops. They are supported by loose con- 
nective tissue which contains here and there groups of " interstitial cells" containing yellow 
pigment granules. The total number of tubules is estimated by Lauth at 840, and the average 
length of each is 70 to 80 cm. Their diameter varies from 0.12 to 0.3 mm. The tubules are pale 
in color in early life, but in old age they acquire a deep yellow tinge from containing much fatty 
matter. Each tubule consists of a basement layer formed of laminated connective tissue con- 
taining numerous elastic fibres with flattened cells between the layers and covered externally by 
a layer of flattened epithelioid cells. Within the basement-membrane are epithelial cells arranged 
in several irregular layers, which are not always clearly separated, but which may be arranged 
in three different groups (Fig. 1039). Among these cells may be seen the spermatozoa in different THE TESTES AND THEIR COVERINGS 
1233 
stages of development. (1) Lining the basement membrane and forming the outer zone is a 
layer of cubical cells, with small nuclei; some of these enlarge to become spermatogonia. The 
nucleus of some of the spermatogonia may be seen to be in process of indirect division (karyo- 
kineses, page 34), and in consequence of this daughter cells are formed, which constitute the second 
zone. (2) Within this first layer is to be seen a number of larger polyhedral cells, with clear 
nuclei, arranged in two or three layers; these are the intermediate cells or spermatocytes. Most 
of these cells are in a condition of karyokinetic division, 
and the cells which result from this division form those 
of the next layer, the spermatoblasts or spermatids. 
(3) The third layer of cells consists of the spermato- 
blasts or spermatids, and each of these, without further 
subdivision, becomes a spermatozoon. The spermatids 
are small polyhedral cells, the nucleus of each of which 
contains half the usual number of chromosomes. In 
addition to these three layers of cells others are seen, 
which are termed the supporting cells {cells of Sertoli'). 
They are elongated and columnar, and project inward 
from the basement membrane toward the lumen of the 
tube. As development of the spermatozoa proceeds 
the latter, group themselves around the inner extremi- 
ties of the supporting cells. The nuclear portion of 
the spermatid, which is partly imbedded in the sup- 
porting cell, is differentiated to form the head of the 
spermatozoon, while part of the cell protoplasm forms 
the middle piece and the tail is produced by an out- 
growth from the double centriole of the cell. Ultimately 
the heads are liberated and the spermatozoa are set 
free. The structure of the spermatozoa is described on 
pages 80, 81. 
In the apices of the lobules, the tubules become less 
convoluted, assume a nearly straight course, and unite 
together to form from twenty to thirty larger ducts, 
of about 0.5 mm. in diameter, and these, from their 
straight course, are called tubuli recti (Fig. 1038). 
The tubuli recti enter the fibrous tissue of the mediastinum, and pass upward and backward, 
forming, in their ascent, a close net-work of anastomosing tubes which are merely channels in 
the fibrous stroma, lined by flattened epithelium, and having no proper walls; this constitutes the 
rete testis. At the upper end of the mediastinum, the vessels of the rete testis terminate in from 
twelve to fifteen or twenty ducts, the ductuli efferentes; they perforate the tunica albuginea, 
and carry the seminal fluid from the testis to the epididymis. Their course is at first straight; 
they then become enlarged, and exceedingly convoluted, and form a series of conical masses, 
Fig. 1038.-Vertical section of the testis, to 
show the arrangement of the ducts. 
Fig. 1039.-Transverse section of a tubule of the testis of a rat. X 250. 
the coni vasculosi, which together constitute the head of the epididymis. Each cone consists 
of a single convoluted duct, from 15 to 20 cm. in length, the diameter of which gradually decreases 
from the testis to the epididymis. Opposite the bases of the cones the efferent vessels open at 
narrow intervals into a single duct, which constitutes, by its complex convolutions, the body 
and tail of the epididymis. When the convolutions of this tube are unravelled, it measures 
upward of 6 metres in length; it increases in diameter and thickness as it approaches the ductus 1234 
SPLANCHNOLOGY 
deferens. The convolutions are held together by fine areolar tissue, and by bands of fibrous 
tissue. 
The tubuli recti have very thin walls; like the channels of the rete testis they are lined by a 
single layer of flattened epithelium. The ductuli efferentes and the tube of the epididymis have 
walls of considerable thickness, on account of the presence in them of muscular tissue, which is 
principally arranged in a circular manner. These tubes are lined by columnar ciliated epithe- 
lium (Fig. 1040). 
Applied Anatomy.-The testis, developed in the lumbar region, may be arrested or delayed 
in its transit to the scrotum. It may be retained in the abdomen; or it may be arrested at the 
abdominal inguinal ring, or in the inguinal canal; or it may just pass out of the subcutaneous 
inguinal ring without finding its way to the bottom of the scrotum. When retained in the abdo- 
men it gives rise to no symptoms, other than the absence of the testis from the scrotum; but 
when it is retained in the inguinal canal it is subjected to pressure and may become inflamed 
and painful. The retained testis is probably functionally useless; so that a man in whom both 
testes are retained {anorchism) is sterile, though he may not be impotent. The absence of one 
testis is termed monorchism. When a testis is retained in the inguinal canal it is often compli- 
cated with a congenital hernia, the funicular process of the peritoneum not being obliterated. 
In addition to the cases above described, where there is some arrest in the descent of the testis, 
this organ may descend through the inguinal canal, but may miss the scrotum and assume some 
abnormal position. The most common form is where the testis, emerging at the subcutaneous 
inguinal ring, slips down between the scrotum and thigh and comes to rest in the perineum. 
This is known as perineal ectopia testis. With all varieties of abnormality in the position of the 
testis, it is very common to find concurrently a congenital hernia, or, if a hernia be not actually 
present, the funicular process is usually patent, and almost invariably so if the testis is in the 
inguinal canal. 
Fig. 1040.-Section of epididymis of guinea-pig. X 255. 
The testis, finally reaching the scrotum, may occupy an abnormal position in it. It may be 
inverted, so that its posterior or attached border is directed forward and the tunica vaginalis is 
situated behind. Should a hydrocele occur, and tapping be resorted to, the trocar may be thrust 
into the testis, if the operation is performed in the ordinary way, and care is not taken beforehand 
to ascertain the position of the gland. 
A number of instances of torsion of the spermatic cord, resulting in acute strangulation of the 
testis, have been recorded. In some it has been attributed to a strain or twist, and in several 
patients the condition has been associated with a late descent of the organ. Symptoms of this 
condition closely simulate those of a strangulated hernia. In consequence of the torsion the 
circulation is partly arrested and the organ swells and becomes acutely painful, and the condition 
may be accompanied with shock and vomiting. Gangrene of the testis, however, rarely follows, 
and the condition, if left without operation, ends in atrophy of the organ. Torsion of the body 
of the testis also sometimes occurs within the tunica vaginalis in those cases in which a persistent 
mesorchium is present. 
Fluid collections of a serous character are very frequently found in the scrotum. To these the 
term hydrocele is applied. The most common form is the ordinary vaginal hydrocele, in which 
the fluid is contained in the sac of the tunica vaginalis, which is separated, in its normal condition, 
from the peritoneal cavity by the whole extent of the inguinal canal. In another form, the 
congenital hydrocele, the fluid is in the sac of the tunica vaginalis, but this cavity communicates 
with the general peritoneal cavity, its tubular process remaining pervious. A third variety. THE DUCTUS DEFERENS 
1235 
known as an infantile hydrocele, occurs in those cases where the tubular process becomes obliter- 
ated only at its upper part, at or near the abdominal inguinal ring. It resembles the vaginal 
hydrocele, except as regards its shape, the collection of fluid extending up the cord into the inguinal 
canal. Fourthly, the funicular process may become obliterated both at the abdominal inguinal 
ring and above the epididymis, leaving a central unobliterated portion, which may become 
distended with fluid, giving rise to a condition known as the encysted hydrocele of the cord. 
Encysted hydrocele of the epididymis or spermatocele is the name given to a cyst found in con- 
nection with the head of the epididymis. Among its contents are found, in many instances, a 
varying number of spermatozoa, and it is probably a retention cyst of one of the tubules. 
The testis frequently requires removal for malignant disease; in tuberculous disease; in cases 
of large hernia testis, and in some instances of incompletely descended or misplaced testes. The 
operation of castration was formerly performed for enlargement of the prostate, but has now 
been entirely abandoned in favor of the direct operation of the enlarged prostate. Castration 
is in most cases best carried out by the "high" operation, an incision being made through the 
skin and fascia in the region of the subcutaneous inguinal ring. The testis, with its deeper cover- 
ings, is then pushed up into the wound and separated from the scrotal tissues. The cord is then 
isolated, and an aneurism needle, armed with a ligature, passed through it, as high as it is thought 
necessary, and the cord tied and divided. In cases of malignant and tuberculous disease, it is 
desirable to open the inguinal canal and tie the cord as near the abdominal ring as possible. 
When removing the testis in this manner the tunica vaginalis is not opened and its folds of reflec- 
to the scrotal tissues do not need division. The whole of the tunica vaginalis is thus removed 
with the cord and its coverings. 
Acute inflammation of the testis, or orchitis, is common in gonorrhoea; a chronic fibrosing 
form of orchitis is frequent in syphilis, and leads to shrinkage and hardening of the testis. In 
tabes dorsalis the testis often becomes quite insensitive to pressure, which, in the healthy adult, 
readily produces a severe and peculiar sickening sensation. 
The Ductus Deferens (Vas Deferens; Seminal Duct). 
The ductus deferens, the excretory duct of the testis, is the continuation of the 
canal of the epididymis. Commencing at the lower part of the tail of the epididymis 
it is at first very tortuous, but gradually becoming less twisted it ascends along 
the posterior border of the testis and medial side of the epididymis, and, as a con- 
stituent of the spermatic cord, traverses the inguinal canal to the abdominal 
inguinal ring. Here it separates from the other structures of the cord, curves 
around the lateral side of the inferior epigastric artery, and ascends for about 
2.5 cm. in front of the external iliac artery. It is next directed backward and slightly 
downward, and, crossing the external iliac vessels obliquely, enters the pelvic 
cavity, where it lies between the peritoneal membrane and the lateral wall of the 
pelvis, and descends on the medial side of the obliterated umbilical artery and the 
obturator nerve and vessels. It then crosses in front of the ureter, and, reaching 
the medial side of this tube, bends to form an acute angle, and runs medialward 
and slightly forward between the fundus of the bladder and the upper end of 
the seminal vesicle. Reaching the medial side of the seminal vesicle, it is directed 
downward and medialward in contact with it, gradually approaching the opposite 
ductus. Here it lies between the fundus of the bladder and the rectum, where it 
is enclosed, together with the seminal vesicle, in a sheath derived from the recto- 
vesical portion of the fascia endopelvina. Lastly, it is directed downward to the 
base of the prostate, where it becomes greatly narrowed, and is joined at an acute 
angle by the duct of the seminal vesicle to form the ejaculatory duct, which tra- 
verses the prostate behind its middle lobe and opens into the prostatic portion 
of the urethra, close to the orifice of the prostatic utricle. The ductus deferens 
presents a hard and cord-like sensation to the fingers, and is of cylindrical form; its 
walls are dense, and its canal is extremely small. At the fundus of the bladder 
it becomes enlarged and tortuous, and this portion is termed the ampulla. A small 
triangular area of the fundus of the bladder, between the ductus def erentes laterally 
and the bottom of the rectovesical excavation of peritoneum above, is in contact 
with the rectum. 1236 
SPLANCHNOLOGY 
Ductuli Aberrantes.-A long narrow tube, the ductulus aberrans inferior (vas aberrans of 
Haller}, is occasionally found connected with the lower part of the canal of the epididymis, or 
with the commencement of the ductus deferens. Its length varies from 3.5 to 35 cm., and it 
may become dilated toward its extremity; more commonly it retains the same diameter through- 
out. Its structure is similar to that of the ductus deferens. Occasionally it is found unconnected 
with the epididymis. A second tube, the ductulus aberrans superior, occurs in the head of the 
epididymis; it is connected with the rete testis. 
Paradidymis {organ of Giraldos').-This term is applied to a small collection of convoluted 
tubules, situated in front of the lower part of the cord above the head of the epididymis. These 
tubes are lined with columnar ciliated epithelium, and probably represent the remains of a part 
of the Wolffian body. 
Structure.-The ductus deferens consists of three coats: (1) an external or areolar coat; (2) a 
muscular coat which in the greater part of the tube consists of two layers of unstriped muscular 
fibre: an outer, longitudinal in direction, and an inner, circular; but in addition to these, at the 
commencement of the ductus, there is a third layer, consisting of longitudinal fibres, placed 
internal to the circular stratum, between it and the mucous membrane; (3) an internal or mucous 
coat, which is pale, and arranged in longitudinal folds. The mucous coat is lined by columnar 
epithelium which is non-ciliated throughout the greater part of the tube; a variable portion of 
the testicular end of the tube is lined by two strata of columnar cells and the cells of the 
superficial layer are ciliated. 
The Vesiculae Seminales (Seminal Vesicales) (Fig. 1041). 
The vesiculae seminales are two lobulated membranous pouches, placed between 
the fundus of the bladder and the rectum, serving as reservoirs for the semen, 
and secreting a fluid to be added to the secretion of the testes. Each sac is somewhat 
Fig. 1041.-Fundus of the bladder with the vesiculae seminales. 
pyramidal in form, the broad end being directed backward, upward and lateralward. 
It is usually about 7.5 cm. long, but varies in size, not only in different individuals, 
but also in the same individual on the two sides. The anterior surface is in contact 
with the fundus of the bladder, extending from near the termination of the ureter 
to-the base of the prostate. The posterior surface rests upon the rectum, from which 
it is separated by the rectovesical fascia. The upper extremities of the two vesicles 
diverge from each other, and are in relation with the ductus deferentes and the 
terminations of the ureters, and are partly covered by peritoneum. The lower THE PENIS 
1237 
extremities are pointed, and converge toward the base of the prostate, where each 
joins with the corresponding ductus deferens to form the ejaculatory duct. Along 
the medial margin of each vesicle runs the ampulla of the ductus deferens. 
Each vesicle consists of a single tube, coiled upon itself, and giving off several 
irregular cecal diverticula; the separate coils, as well as the diverticula, are connected 
together by fibrous tissue. When uncoiled, the tube is about the diameter of a 
quill, and varies in length from 10 to 15 cm.; it ends posteriorly in a cul-de-sac; 
its anterior extremity becomes constricted into a narrow straight duct, which 
joins with the corresponding ductus deferens to form the ejaculatory duct. 
Structure.-The vesiculae seminales are composed of three coats: an external or areolar coat; 
a middle or muscular coat thinner than in the ductus deferens and arranged in two layers, an 
outer longitudinal and inner circular; an internal or mucous coat, which is pale, of a whitish 
brown color, and presents a delicate reticular structure. The epithelium is columnar, and in 
the diverticula goblet cells are present, the secretion of which increases the bulk of the seminal 
fluid. 
Vessels and Nerves.-The arteries supplying the vesiculae seminales are derived from the 
middle and inferior vesical and middle hemorrhoidal. The veins and lymphatics accompany 
the arteries. The nerves are derived from the pelvic plexuses. 
Applied Anatomy.--The vesiculae seminales are often the seat of an extension of the disease 
in cases of tuberculosis of the testis, and should always be examined from the rectum, before 
deciding to perform castration in this affection. They also become affected in chronic posterior 
urethritis of gonorrhoeal origin. 
The Ejaculatory Ducts (Ductus Ejaculatorii) (Fig. 1042). 
The ejaculatory ducts are two in number, one on either side of the middle line. 
Each is formed by the union of the duct from the vesicula seminalis with the ductus 
deferens, and is about 2 cm. long. 
They commence at the base of 
the prostate, and run forward 
and downward between its mid- 
dle and lateral lobes, and along 
the sides of the prostatic utricle, 
to end by separate slit-like ori- 
fices close to or just within the 
margins of the utricle. The ducts 
diminish in size, and also converge, 
toward their terminations. 
Structure.-The coats of the ejacula- 
tory ducts are extremely thin. They 
are: an outer fibrous layer, which is 
almost entirely lost after the entrance 
of the ducts into the prostate; a layer 
of muscular fibres consisting of a thin 
outer circular, and an inner longitu- 
dinal, layer; and mucous membrane. 
The Penis. 
The penis is a pendulous organ suspended from the front and sides of the pubic 
arch and containing the greater part of the urethra. In the flaccid condition it is 
cylindrical in shape, but when erect assumes the form of a triangular prism with 
rounded angles, one side of the prism forming the dorsum. It is composed of 
three cylindrical masses of cavernous tissue bound together by fibrous tissue and 
covered with skin. Two of the masses are lateral, and are known as the corpora 
cavernosa penis; the third is median, and is termed the corpus cavernosum urethrae 
(Figs. 1043, 1044). 
Fig. 1042.-Vesiculae seminales and ampulla; of ductus defer- 
entes, seen from the front. The anterior walls of the left ampulla, 
left seminal vesicle, and prostatic urethra have been cut away. 1238 
SPLANCHNOLOGY 
The Corpora Cavernosa Penis form the greater part of the substance of the 
penis. For their anterior three-fourths they lie in intimate apposition with one 
another, but behind they diverge in the form of two tapering processes, known 
as the crura, which are firmly connected to the rami of the pubic arch. Traced 
from behind forward, each crus begins by a blunt-pointed process in front of the 
tuberosity of the ischium. Just before it meets its fellow it presents a slight enlarge- 
ment, named by Kobelt the bulb of the corpus cavernosum penis. Beyond this point 
the crus undergoes a constriction and merges into the corpus cavernosum proper, 
which retains a uniform diameter to its 
anterior end. Each corpus cavernosum 
penis ends abruptly in a rounded ex- 
tremity some distance from the point of 
the penis. 
The corpora cavernosa penis are sur- 
rounded by a strong fibrous envelope 
consisting of superficial and deep fibres. 
The superficial fibres are longitudinal in 
direction, and form a single tube which 
encloses both corpora; the deep fibres are 
arranged circularly around each corpus, 
and form by their junction in the median 
plane the septum of the penis. This is 
thick and complete behind, but is imper- 
fect in front, where it consists of a series 
of vertical bands arranged like the teeth 
of a comb; it is therefore named the sep- 
tum pectiniforme. 
The Corpus Cavernosum Urethrae 
(corpus spongiosum) contains the urethra. 
Fig. 1043.-The constituent cavernous cylinders of 
the penis. The glans and anterior part of the corpus 
cavernosum urethrae are detached from the corpora 
cavernosa penis and turned to one side. 
Fig. 1044.-Transverse section of the penis. 
Behind, it is expanded to form the urethral bulb, and lies in apposition with the 
inferior fascia of the urogenital diaphragm, from which it receives a fibrous invest- 
ment. The urethra enters the bulb nearer to the upper than to the lower surface. 
On the latter there is a median sulcus, from which a thin fibrous septum projects 
into the substance of the bulb and divides it imperfectly into two lateral lobes or 
hemispheres. 
The portion of the corpus cavernosum urethrae in front of the bulb lies in a 
groove on the under surface of the conjoined corpora cavernosa penis. It is cylin- 
drical in form and tapers slightly from behind forward. Its anterior end is expanded 
in the form of an obtuse cone, flattened from above downward. This expansion, 
termed the glans penis, is moulded on the rounded ends of the corpora cavernosa THE PENIS 
1239 
penis, extending farther on their upper than on their lower surfaces. At the summit 
of the glans is the slit-like vertical external urethral orifice. The circumference 
of the base of the glans forms a rounded projecting border, the corona glandis, 
overhanging a deep retroglandular sulcus, behind which is the neck of the penis. 
For descriptive purposes it is convenient to divide the penis into three regions: 
the root, the body, and the extremity. 
The root (radix penis) of the penis is triradiate in form, consisting of the 
diverging crura, one on either side, and the median urethral bulb. Each crus 
is covered by the Ischiocavernosus, while the bulb is surrounded by the Bulbo- 
cavernosus. The root of the penis lies in the perineum between the inferior fascia 
of the urogenital diaphragm and the fascia of Colles. In addition to being attached 
to the fasciae and the pubic rami, it is bound to the front of the symphysis pubis 
by the fundiform and suspensory ligaments. The fundiform ligament springs from 
the front of the sheath of the Rectus abdominis and the linea alba; it splits into two 
fasciculi which encircle the root of the penis. The upper fibres of the suspensory 
ligament pass downward from the lower end of the linea alba, and the lower fibres 
from the symphysis pubis; together they form a strong fibrous band, which extends 
to the upper surface of the root, where it blends with the fascial sheath of the organ. 
The body (corpus penis) extends from the root to the ends of the corpora caver- 
nosa penis, and in it these corpora cavernosa are intimately bound to one another. 
A shallow groove which marks their junction on the upper surface lodges the 
deep dorsal vein of the penis, while a deeper and wider groove between them 
on the under surface contains the corpus cavernosum urethrae. The body is 
ensheathed by fascia, which is continuous above with the fascia of Scarpa, and 
below with the dartos tunic of the scrotum and the fascia of Colles. 
The extremity is formed by the glans penis, the expanded anterior end of the 
corpus cavernosum urethrae. It is separated from the body by the constricted 
neck, which is overhung by the corona glandis. 
The integument covering the penis is remarkable for its thinness, its dark color, 
its looseness of connection with the deeper parts of the organ, and its absence of 
adipose tissue. At the root of the penis it is continuous with that over the pubes, 
scrotum, and perineum. At the neck it leaves the surface and becomes folded 
upon itself to form the prepuce or foreskin. The internal layer of the prepuce is 
directly continuous, along the line of the neck, with the integument over the glans. 
Immediately behind the external urethral orifice it forms a small secondary redu- 
plication, attached along the bottom of a depressed median raphe, which extends 
from the meatus to the neck; this fold is termed the frenulum of the prepuce. The 
integument covering the glans is continuous with the urethral mucous membrane 
at the orifice; it is devoid of hairs, but projecting from its free surface are a number 
of small, highly sensitive papillae. On the corona and neck numerous small glands, 
the preputial glands, have been described.1 They secrete a sebaceous material 
of very peculiar odor, which probably contains casein, and readily undergoes 
decomposition. 
The prepuce covers a variable amount of the glans, and is separated from it 
by a potential sac-the preputial sac-which presents two shallow fossee, one on 
either side of the frenulum. 
Structure of the Penis.-From the internal surface of the fibrous envelope of the corpora 
cavernosa penis, as well as from the sides of the septum, numerous bands or cords are given off, 
which cross the interior of these corpora cavernosa in all directions, subdividing them into a 
number of separate compartments, and giving the entire structure a spongy appearance (Fig. 
1044). These bands and cords are called trabeculae, and consist of white fibrous tissue, elastic 
fibres, and plain muscular fibres. In them are contained numerous arteries and nerves. The 
component fibres which form the trabeculae are larger and stronger around the circumference than 
1 Stieda (Comptes-rendus du XII Congres International de Medicine, Moscow, 1897) asserts that glands are never 
found on the corona glandis, and that what have hitherto been mistaken for glands are really large papillae. 1240 
SPLANCHNOLOGY 
at the centres of the corpora cavernosa; they are also thicker behind than in front. The inter- 
spaces (cavernous spaces), on the contrary, are larger at the centre than at the circumference, 
their long diameters being directed transversely. They are filled with blood, and are lined by a 
layer of flattened cells similar to the endothelial lining of veins. 
The fibrous envelope of the corpus cavernosum urethrae is thinner, whiter in color, and more 
elastic than that of the corpora cavernosa penis. The trabeculae are more delicate, nearly uniform 
in size, and the meshes between them smaller than in the corpora cavernosa penis: their long 
diameters, for the most part, corresponding with that of the penis. The external envelope or 
outer coat of the corpus cavernosum urethrae is formed partly of unstriped muscular fibres, and 
a layer of the same tissue immediately surrounds the canal of the urethra. 
Vessels and Nerves.-The arteries bringing the blood to the cavernous spaces are the deep 
arteries of the penis and branches from the dorsal arteries of the penis, which perforate the fibrous 
capsule, along the upper surface, especially near the forepart of the organ. On entering the 
cavernous structure the arteries divide into branches, which are supported and enclosed by the 
trabeculae. Some of these arteries end in a capillary net-work, the branches of which open directly 
into the cavernous spaces; others as- 
sume a tendril-like appearance, and 
form convoluted and somewhat dilated 
vessels, which were named by Muller 
helicine arteries. They open into the 
spaces, and from them are also given off 
small capillary branches to supply the 
trabecular structure. They are bound 
down in the spaces by fine fibrous pro- 
cesses, and are most abundant in the 
back part of the corpora cavernosa 
(Fig. 1045). 
The blood from the cavernous spaces 
is returned by a series of vessels, some 
of which emerge in considerable num- 
bers from the base of the glans penis 
and converge on the dorsum of the 
organ to form the deep dorsal vein; 
others pass out on the upper surface of 
the corpora cavernosa and join the same 
vein; some emerge from the under sur- 
face of the corpora cavernosa penis and 
receiving branches from the corpus cav- 
ernosum urethrae, wind around the sides 
of the penis to end in the deep dorsal 
vein; but the greater number pass out 
at the root of the penis and join the 
prostatic plexus. 
The lymphatic vessels of the penis are described on page 794. 
The nerves are derived from the pudendal nerve and the pelvic plexuses. On the glans and 
bulb some filaments of the cutaneous nerves have Pacinian bodies connected with them, and, 
according to Krause, many of them end in peculiar end-bulbs (see page 1069). 
Applied Anatomy.-The penis occasionally requires removal for malignant disease. Usually, 
removal of the antescrotal portion is all that is necessary, but sometimes it is requisite to remove 
the whole organ from its attachment to the rami of the pubes and ischia. The former operation 
is performed by cutting through the corpora cavernosa penis from the dorsum, and then separ- 
ating the corpus cavernosum urethrae from them, dividing it at a level nearer the glans penis. 
The mucous membrane of the urethra is then slit up, and the edges of the flap attached to the 
external skin, in order to prevent contraction of the orifice, which might otherwise take place. 
The vessels which require ligature are the deep and the dorsal arteries of the penis, and the artery 
of the septum. When the entire organ requires removal, the patient is placed in the lithotomy 
position, and an incision is made through the skin and subcutaneous tissue around the root of 
the penis, and carried down through the median line of the scrotum as far as the perineum. The 
two halves of the scrotum are then separated from each other, and a catheter having been intro- 
duced into the bladder as a guide, the corpus cavernosum urethrae below the urogenital diaphragm 
is separated from the corpora cavernosa penis and divided, the catheter having been withdrawn. 
The suspensory ligament is now severed and the crura separated from the bone with a perios- 
teum scraper, and the whole penis removed. The membranous portion of the urethra, which 
has not been removed, is now to be attached to the skin at the posterior extremity of the incision 
in the perineum. The remainder of the wound is closed, free drainage being provided for. 
Fig. 1045.-Section of corpus cavernosum penis in a non-dis- 
tended condition. (Cadiat.) a. Trabeculee of connective tissue, 
with many elastic fibres and bundles of plain muscular tissue, 
some of which are cut across (c). b. Blood sinuses. THE PROSTATE 
1241 
The Prostate (Prostata; Prostate Gland). 
The prostate is a firm, partly glandular and partly muscular body, which is 
placed immediately below the internal urethral orifice and around the commence- 
ment of the urethra. It is situated in the pelvic cavity, below the lower part 
of the symphysis pubis, above the superior fascia of the urogenital diaphragm, 
and in front of the rectum, through which it may be distinctly felt, especially 
when enlarged. It is about the size of a chestnut and somewhat conical in shape, 
and presents for examination a base, an apex, an anterior, a posterior, and two 
lateral surfaces. 
The base (basis prostatae) is directed upward, and is applied to the inferior 
surface of the bladder, The greater part of this surface is directly continuous 
with the bladder wall; the urethra penetrates it nearer its anterior than its 
posterior border. 
The apex (apex prostatae) is directed downward, and is in contact with the 
superior fascia of the urogenital diaphragm. 
Surfaces.-The posterior surface (facies posterior) is flattened from side to side 
and slightly convex from above downward; it is separated from the rectum by its 
sheath and some loose connective tissue, and is distant about 4 cm. from the anus. 
Near its upper border there is a depression through which the two ejaculatory 
ducts enter the prostate. This depression serves to divide the posterior surface 
into a lower larger and an upper smaller part. The upper smaller part constitutes 
the middle lobe of the prostate and intervenes between the ejaculatory ducts and 
the urethra; it varies greatly in size, and in some cases is destitute of glandular tissue. 
The lower larger portion sometimes presents a shallow median furrow, which 
imperfectly separates it into a right and a left lateral lobe: these form the main 
mass of the gland and are directly continuous with each other behind the urethra. 
In front of the urethra they are connected by a band which is named the isthmus: 
this consists of the same tissues as the capsule and is devoid of glandular substance. 
The anterior surface (facies anterior) measures about 2.5 cm. from above downward 
but is narrow and convex from side to side. It is placed about 2 cm. behind the 
pubic symphysis, from which it is separated by a plexus of veins and a quantity 
of loose fat. It is connected to the pubic bone on either side by the puboprostatic 
ligaments. The urethra emerges from this surface a little above and in front of the 
apex of the gland. 
The lateral surfaces are prominent, and are covered by the anterior portions of 
the Levatores ani, which are, however, separated from the gland by a plexus 
of veins. 
The prostate measures about 4 cm. transversely at the base, 2 cm. in its antero- 
posterior diameter, and 3 cm. in its vertical diameter. Its weight is about 8 gm. 
It is held in its position by the puboprostatic ligaments; by the superior fascia of 
the urogenital diaphragm, which invests the prostate and the commencement 
of the membranous portion of the urethra; and by the anterior portions of the 
Levatores ani, which pass backward from the pubis and embrace the sides of 
the prostate. These portions of the Levatores ani, from the support they afford 
to the prostate, are named the Levatores prostatae. 
The prostate is perforated by the urethra and the ejaculatory ducts. The 
urethra usually lies along the junction of its anterior with its middle third. The 
ejaculatory ducts pass obliquely downward and forward through the posterior 
part of the prostate, and open into the prostatic portion of the urethra. 
Structure (Fig. 1046).-The prostate is immediately enveloped by a thin but firm fibrous 
capsule, distinct from that derived from the fascia endopelvina, and separated from it by a plexus 
of veins. This capsule is firmly adherent to the prostate and is structurally continuous with 
the stroma of the gland, being composed of the same tissues, viz.: non-striped muscle and fibrous 1242 
SPLANCHNOLOGY 
tissue. The substance of the prostate is of a pale reddish-gray color, of great density, and not 
easily torn. It consists of glandular substance and muscular tissue. 
The muscular tissue according to Kblliker, constitutes the proper stroma of the prostate; 
the connective tissue being very scanty, and simply forming between the muscular fibres, thin 
trabeculae, in which the vessels and nerves of the gland ramify. The muscular tissue is arranged 
as follows: immediately beneath the fibrous capsule is a dense layer, which forms an investing 
sheath for the gland; secondly, around the urethra, as it lies in the prostate, is another dense 
layer of circular fibres, continuous above with the internal layer of the muscular coat of the 
bladder, and blending below with the fibres surrounding the membranous portion of the urethra. 
Between these two layers strong bands of muscular tissue, which decussate freely, form meshes 
in which the glandular structure of the organ is imbedded. In that part of the gland which is 
situated in front of the urethra the muscular tissue is especially dense, and there is here little or 
no gland tissue; while in that part which is behind the urethra the muscular tissue presents a 
wide-meshed structure, which is densest at the base of the gland-that is, near the bladder- 
becoming looser and more sponge-like toward the apex of the organ. 
Fig. 1046.-Transverse section of normal prostate through the middle of the urethral crest, from a subject aged 
nineteen years. (Taylor.) a. Longitudinal section of ducts leading from the lobules of the prostatic glands, b. Urethral 
crest, c. Prostatic utricle, d. Urethra, e. Ejaculatory ducts, f. Arteries, veins, and venous sinuses in sheath of 
prostate, g. Nerve trunks in sheath, h. Point of origin of fibromuscular bands encircling urethra, i. Zone of striated 
voluntary muscle on superior surface. 
The glandular substance is composed of numerous follicular pouches the lining of which fre- 
quently shows papillary elevations. The follicles open into elongated canals, which join to form 
from twelve to twenty small excretory ducts. They are connected together by areolar tissue, 
supported by prolongations from the fibrous capsule and muscular stroma, and enclosed in a 
delicate capillary plexus. The epithelium which lines the canals and the terminal vesicles is of 
the columnar variety. The prostatic ducts open into the floor of the prostatic portion of the 
urethra, and are lined by two layers of epithelium, the inner layer consisting of columnar and 
the outer of small cubical cells. Small colloid masses, known as amyloid bodies are often found 
in the gland tubes. 
Vessels and Nerves.-The arteries supplying the prostate are derived from the internal 
pudendal, inferior vesical, and middle hemorrhoidal. Its veins form a plexus around the sides 
and base of the gland; they receive in front the dorsal vein of the penis, and end in the hypogastric 
veins. The nerves are derived from the pelvic plexus. 
Applied Anatomy.-By means of the finger introduced into the rectum, the surgeon detects 
enlargement or other disease of the prostate; he can feel the apex of the gland, which is the guide 
to Cock's operation for stricture; he is enabled also by the same means to direct the point of a 
catheter, when its introduction is attended with difficulty either from injury or disease of the 
membranous or prostatic portions of the urethra. When the finger is introduced into the bowel 
the surgeon may, in some cases, especially in boys, learn the position, as well as the size, of a THE OVARIES 
1243 
calculus in the bladder; and in the operation for its removal, if, as is not infrequently the case, 
it should be lodged behind an enlarged prostate, it may be displaced from its position by pressing 
upward the fundus of the bladder from the rectum. The prostate is occasionally the seat of sup- 
puration, due to either gonorrhea or tuberculous disease. The gland is enveloped in a dense, 
unyielding capsule, which determines the course of the abscess, and also explains the great pain 
which is present in the acute form of the disease. The abscess most frequently bursts into the 
urethra, the direction in which there is least resistance, but may burst into the rectum, or more 
rarely in the perineum. In advanced life the prostate sometimes becomes considerably enlarged 
and projects into the bladder so as to impede the passage of the urine. According to Messer's 
researches, conducted at Greenwich Hospital, it would seem that such obstruction exists in 20 
per cent, of all men over sixty years of age. In some cases the condition affects principally the 
lateral lobes, which may undergo considerable enlargement without causing much inconvenience. 
In other cases it would seem that the middle lobe enlarges most, and even a small enlargement 
of this lobe may act injuriously, by forming a sort of valve over the internal urethral orifice, 
preventing the passage of the urine; and the more the patient strains, the more completely will 
it block the opening into the urethra. In consequence of the enlargement of the prostate, a 
pouch is formed at the base of the bladder behind the projection, in which urine collects, and 
from which it cannot be entirely expelled. For this condition prostatectomy is sometimes done. 
The bladder is opened by an incision above the symphysis pubis, the mucous membrane of the 
post-prostatic pouch is scratched through, and the finger is then introduced into the space between 
the true capsule of the prostate and outer capsule formed by the fascia endopelvina. Separation 
in this plane is then carried out below and laterally until the apex of the gland is reached. The 
whole of the work is done with the finger, which is gradually swept around the sides until the 
anterior surface is reached and freed. The gland is then, by traction, displaced into the bladder 
and removed, usually carrying with it the greater portion of the mucous membrane of the pros- 
tatic urethra. Hemorrhage, which may be considerable at times, is checked by hot irrigations, 
and the bladder is temporarily drained. Very satisfactory results have followed this operation. 
The prostate can be reached from the perineum, and in some cases the enlarged gland has 
been removed by this route, but the perineal approach is not usually employed except in the 
case of abscess of or about the gland. 
The Bulbourethral Glands (Glandulae Bulbourethrales; Cowper's Glands). 
The bulbourethral glands are two small, rounded, and somewhat lobulated bodies, 
of a yellow color, about the size of peas, placed behind and lateral to the membran- 
ous portion of the urethra, between the two layers of the fascia of the urogenital 
diaphragm. They lie close above the bulb, and are enclosed by the transverse fibres 
of the Sphincter urethrae membranaceae. Their existence is said to be constant: 
they gradually diminish in size as age advances. 
The excretory duct of each gland, nearly 2.5 cm. long, passes obliquely forward 
beneath the mucous membrane, and opens by a minute orifice on the floor of the 
cavernous portion of the urethra about 2.5 cm. in front of the urogenital diaphragm. 
Structure.-Each gland is made up of several lobules, held together by a fibrous investment. 
Each lobule consists of a number of acini, lined by columnar epithelial cells, opening into one 
duct, which joins with the ducts of other lobules outside the gland to form the single excretory 
duct. 
THE FEMALE GENITAL ORGANS (ORGANA GENITALIA MULIEBRIA). 
The female genital organs consist of an internal and an external group. The 
internal organs are situated within the pelvis, and consist of the ovaries, the uterine 
tubes, the uterus, and the vagina. The external organs are placed below the urogenital 
diaphragm and below and in front of the pubic arch. They comprise the mons 
pubis, the labia majora et minora pudendi, the clitoris, the bulbus vestibuli, and the 
greater vestibular glands. 
The Ovaries (Ovaria). 
The ovaries are homologous with the testes in the male. They are two nodular 
bodies, situated one on either side of the uterus in relation to the lateral wall of 
the pelvis, and attached to the back of the broad ligament of the uterus, behind 1244 
SPLANCHNOLOGY 
and below the uterine tubes (Fig. 1047). The ovaries are of a grayish-pink color, 
and present either a smooth or a puckered uneven surface. They are each about 
4 cm. in length, 2 cm. in width, and about 8 mm. in thickness, and weigh from 2 
to 3.5 gm. Each ovary presents a lateral and a medial surface, an upper or tubal 
and a lower or uterine extremity, and an anterior or mesovarion and a posterior 
free border. It lies in a shallow depression, named the ovarian fossa, on the lateral 
wall of the pelvis; this fossa is bounded above by the external iliac vessels, in front 
by the obliterated umbilical artery, and behind by the ureter. The exact position 
of the ovary has been the subject of considerable difference of opinion, and the 
description here given applies to the ovary of the nulliparous woman. The ovary 
becomes displaced during the first pregnancy, and probably never again returns 
to its original position. In the erect posture the long axis of the ovary is vertical. 
The tubal extremity is near the external iliac vein; to it is attached the ovarian 
fimbria of the uterine tube and a fold of peritoneum, the suspensory ligament of 
the ovary, which is directed upward over the iliac vessels and contains the ovarian 
Fig. 1047.-Uterus and right broad ligament, seen from behind. The broad ligament has been spread out and the 
ovary drawn downward. 
vessels. The uterine end is directed downward toward the pelvic floor, it is usually 
narrower than the tubal, and is attached to the lateral angle of the uterus, immedi- 
ately behind the uterine tube, by a rounded cord termed the ligament of the ovary, 
which lies within the broad ligament and contains some non-striped muscular 
fibres. The lateral surface is in contact with the parietal peritoneum, which lines 
the ovarian fossa; the medial surface is to a large extent covered by the fimbriated 
extremity of the uterine tube. The mesovarian border is straight and is directed 
toward the obliterated umbilical artery, and is attached to the back of the broad 
ligament by a short fold named the mesovarium. Between the two layers of this 
fold the bloodvessels and nerves pass to reach the hilus of the ovary. The free 
border is convex, and is directed toward the ureter. The uterine tube arches over 
the ovary, running upward in relation to its mesovarian border, then curving over 
its tubal pole, and finally passing downward on its free border and medial surface. 
Epobphoron (parovarium; organ of Rosenmuller) (Figs. 1047, 1048). - The 
epobphoron lies in the mesosalpinx between the ovary and the uterine tube, and 
consists of a few short tubules (ductuli transversi) which converge toward the ovary THE OVARIES 
1245 
while their opposite ends open into a rudimentary duct, the ductus longitudinalis 
epoophori {duct of Gartner'). 
Paroophoron.-The paroophoron consists of a few scattered rudimentary 
tubules, best seen in the child, situated in the broad ligament between the epo- 
ophoron and the uterus. 
Fig. 1048.-Adult ovary, epodphoron, and uterine tube. (From Farre, after Kobelt.) a, a. Epodphoron formed 
from the upper part of the Wolffian body. b. Remains of the uppermost tubes sometimes forming hydatids, c. Middle 
set of .tubes, d. Some lower atrophied tubes, e. Atrophied remains of the Wolffian duct. f. The terminal bulb or 
hydatid, h. The uterine tube. i. Hydatid attached to the extremity. I. The ovary. 
The ductuli transversi of the epodphoron and the tubules of the paroophoron 
are remnants of the tubules of the Wolffian body or mesonephros; the ductus 
longitudinalis epoophori is a persistent portion of the Wolffian duct. 
In the fetus, the ovaries are situated, like the testes, in the lumbar region, near 
the kidneys, but they gradually descend into the pelvis (page 187). 
Structure (Fig. 1049).-The surface of the ovary is covered by a layer of columnar cells which 
constitutes the germinal epithelium of Waldeyer. This epithelium gives to the ovary a dull 
gray color as compared with the shining 
smoothness of the peritoneum; and the 
transition between the squamous epithelium 
of the peritoneum and the columnar cells 
which cover the ovary is usually marked 
by a line around the anterior border of the 
ovary. The ovary consists of a number of 
vesicular ovarian follicles imbedded in the 
meshes of a stroma or frame-work. 
The stroma is a peculiar soft tissue, abun- 
dantly supplied with bloodvessels, consist- 
ing for the most part of spindle-shaped cells 
with a small amount of ordinary connective 
tissue. These cells have been regarded by 
some anatomists as unstriped muscle cells, 
which, indeed, they most resemble; by 
others as connective-tissue cells. On the 
surface of the organ this tissue is much 
condensed, and forms a layer (tunica albu- 
ginea) composed of short connective-tissue 
fibres, with fusiform cells between them. 
The stroma of the ovary may contain inter- 
stitial cells resembling those of the testis. 
Vesicular Ovarian Follicles (Graafian follicles).-Upon making a section of an ovary, numerous 
round transparent vesicles of various sizes are to be seen; they are the follicles, or ovisacs con- 
taining the ova. Immediately beneath the superficial covering is a layer of stroma, in which are 
a large number of minute vesicles, of uniform size, about 0.25 mm. in diameter. These are the 
follicles in their earliest condition, and the layer where they are found has been termed the 
cortical layer. They are especially numerous in the ovary of the young child. After puberty, 
and during the whole of the child-bearing period, large and mature, or almost mature follicles 
are also found in the cortical layer in small numbers, and also "corpora lutea," the remains of 
Fig. 1049.-Section of the ovary. (After Schron.) 1. 
Outer covering. 1'. Attached border. 2. Central stroma. 
3. Peripheral stroma. 4. Bloodvessels. 5. Vesicular follicles 
in their earliest stage. 6, 7, 8. More advanced.follicles. 9. 
An almost mature follicle. 9'. Follicle from which the ovum 
has escaped. 10. Corpus luteum. 1246 
SPLANCHNOLOGY 
follicles which have burst and are undergoing atrophy and absorption. Beneath this superficial 
stratum, other large and more or less mature follicles are found imbedded in the ovarian stroma. 
These increase in size as they recede from the surface toward a highly vascular stroma in the 
centre of the organ, termed the medullary substance (zona vasculosa of Waldeyerf This stroma 
forms the tissue of the hilus by which the ovary is attached, and through which the bloodvessels 
enter: it does not contain any follicles. 
The larger follicles (Fig. 1050) consist of an external fibro vascular coat, connected with the 
surrounding stroma of the ovary by a net-work of bloodvessels; and an internal coat, which con- 
sists of several layers of nucleated 
cells, called the membrana granulosa. 
At one part of the mature follicle the 
cells of the membrana granulosa are 
collected into a mass which projects 
into the cavity of the follicle. This 
is termed the discus proligerus, and 
in it the ovum is imbedded.1 The 
follicle contains a transparent albumi- 
nous fluid. 
The development and maturation 
of the follicles and ova continue un- 
interruptedly from puberty to the end 
of the fruitful period of woman's life, 
while their formation commences be- 
fore birth. Before puberty the ovaries 
are small and the follicles contained 
in them are disposed in a compara- 
tively thick layer in the cortical sub- 
stance; here they present the appear- 
ance of a large number of minute 
closed vesicles, constituting the early 
condition of the follicles; many, 
however, never attain full develop- 
ment, but shrink and disappear. At puberty the ovaries enlarge and become more vascular, 
the follicles are developed in greater abundance, and their ova are capable of fecundation. 
Discharge of the Ovum.-The follicles, after attaining a certain stage of development, gradu- 
ally approach the surface of the ovary and burst; the ovum and fluid contents of the follicle 
are liberated on the exterior of the ovary, and carried into the uterine tube by currents set up 
by the movements of the cilia covering the mucous membrane of the fimbriae. 
Corpus Luteum.-After the discharge of the ovum the lining of the follicle is thrown into 
folds, and vascular processes grow inward from the surrounding tissue. In this way the space 
is filled up and the corpus luteum formed. It consists at first of a radial arrangement of yellow 
cells with bloodvessels and lymphatic spaces, and later it merges with the surrounding stroma. 
Vessels and Nerves.-The arteries of the ovaries and uterine tubes are the ovarian from 
the aorta. Each anastomoses freely in the mesosalpinx, with the uterine artery, gives some 
branches to the uterine tube, and others which traverse the mesovarium and enter the hilus of 
the ovary. The veins emerge from the hilus in the form of a plexus, the pampiniform plexus; 
the ovarian vein is formed from this plexus, and leaves the pelvis in company with the artery. 
The nerves are derived from the hypogastric or pelvic plexus, and from the ovarian plexus, the 
uterine tube receiving a branch from one of the uterine nerves. 
Applied Anatomy.-The inflammations which affect the ovary are merely an extension of 
those from the tube. Ovarian new formations are of common occurrence, and are either solid 
or cystic; the former being the less common. The ovarian cysts in the majority of cases are 
cystadenomata which may assume enormous dimensions; in rarer instances they form from 
the tubules at the hilus of the ovary or those of the organ of Rosenmuller; in other instances a 
clear watery cyst forms between the layers of the broad ligament. An ovarian cyst, once diag- 
nosticated, should always be removed, as it is liable to become affected by suppuration, torsion 
of its pedicle, or other serious complications. The operation for its removal, badly termed 
ovariotomy, consists in opening the abdomen, and reducing the size of the cyst when large by 
tapping it before its withdrawal from the abdomen; the pedicle is then clamped with a large 
forceps, and the cyst is cut free. This pedicle must then be transfixed and securely ligatured 
by an interlocking ligature, which will not slip off. The pedicle consists of an elongated part of 
the broad ligament, including the uterine tube and ovarian artery, and a great number of large 
veins. Ovariotomy for a simple uncomplicated cyst presents no special difficulties, but, in cases 
where there are old adhesions implicating the small intestines, it may present very great difficulties. 
Fig. 1050.-Section of vesicular ovarian follicle of cat. X 50. 
1 For a description of the ovum, see page 77. THE UTERINE TUBE 
1247 
The Uterine Tube (Tuba Uterina [Fallopii]; Fallopian Tube; Oviduct). 
(Figs. 1047, 1051). 
The uterine tubes convey the ova from the ovaries to the cavity of the uterus. 
They are two in number, one on either side, situated in the upper margin of the 
broad ligament, and extending from the superior angle of the uterus to the side of 
the pelvis. Each tube is about 10 cm. long, and is described as consisting of three 
portions: (1) the isthmus, or medial constricted third; (2) the ampulla, or inter- 
mediate dilated portion, which curves over the ovary; and (3) the infundibulum, 
with its abdominal ostium, surrounded by fimbriae, one of which, the ovarian fimbria, 
Fig. 1051.-Female pelvis and its contents, seen from above and in front. 
is attached to the ovary. The uterine tube is directed lateralward as far as the 
uterine pole of the ovary, and then ascends along the mesovarian border of the 
ovary to the tubal pole, over which it arches; finally it turns downward and ends 
in relation to the free border and medial surface of the ovary. The uterine opening 
is minute, and will only admit a fine bristle; the abdominal opening is somewhat 
larger. In connection with the fimbriae of the uterine tube, or with the broad liga- 
ment close to them, there are frequently one or more small pedunculated vesicles. 
These are termed the appendices vesiculosae (hydatids of Morgagni). 
Structure.-The uterine tube consists of three coats: serous, muscular, and mucous. The 
external or serous coat is peritoneal. The middle or muscular coat consists of an external longi- 
tudinal and an internal circular layer of non-striped muscular fibres continuous with those of 
the uterus. The internal or mucous coat is continuous with the mucous lining of the uterus, and, 
at the abdominal ostium of the tube, with the peritoneum. It is thrown into longitudinal folds, 
which in the ampulla are much more extensive than in the isthmus. The lining epithelium is 
columnar and ciliated. This form of epithelium is also found on the inner surface of the fimbriae, 
while on the outer or serous surfaces of these processes the epithelium gradually merges into 
the endothelium of the peritoneum. 
Applied Anatomy.-The majority of the diseases of the uterine tube are due to infection 
which have spread by way of the vagina and uterus, and the disease often does not stop at the 
uterine tube, but passes on to the peritoneum, giving rise to acute general peritonitis, or a local- 
ized condition termed perimetritis that may be acute or chronic. Perimetritis is often followed 
by various painful conditions, which are due to the peritoneal adhesions resulting from the 1248 
SPLANCHNOLOGY 
inflammation of the serous membrane, and which persist throughout life. Tubal inflammation. 
(salpingitis') is usually the result of an infection either by the gonococcus or by septic organisms 
implanted at the time of labor or abortion. In many cases the fimbriated ends of the tubes 
become closed by adhesions, pus collects in the tubes, and a pyosalpinx results. 
Fertilization of the ovum is believed (page 82) to occur in the tube, and the fertilized ovum 
is then normally passed on into the uterus; the ovum, however, may adhere to an undergo develop- 
ment in the uterine tube, giving rise to the commonest variety of ectopic gestation. In such cases 
the amnion and chorion are formed, but a true decidua is never present; and the gestation usually 
ends by extrusion of the ovum through the abdominal ostium, although it is not uncommon for 
the tube to rupture into the peritoneal cavity, this being accompanied by severe hemorrhage, 
and needing surgical interference. 
The Uterus (Womb) (Figs. 1047, 1051, 1052). 
The uterus is a hollow, thick-walled, muscular organ situated deeply in the 
pelvic cavity between the bladder and rectum. Into its upper part the uterine 
tubes open, one on either side, while below, its cavity communicates with that of 
Fig. 1052.-Median sagittal section of female pelvis. 
the vagina. When the ova are discharged from the ovaries they are carried to the 
uterine cavity through the uterine tubes. If an ovum be fertilized it imbeds itself 
in the uterine wall and is normally retained in the uterus until prenatal develop- 
ment is completed, the uterus undergoing changes in size and structure to accom- 
modate itself to the needs of the growing embryo (see page 98). After parturition 
the uterus returns almost to its former condition, but certain traces of its enlarge- 
ment remains. It is necessary, therefore, to describe as the type-form the adult 
virgin uterus, and then to consider the modifications which are effected as a result 
of pregnancy. THE UTERUS 
1249 
In the virgin state the uterus is flattened antero-posteriorly and is pyriform 
in shape, with the apex directed downward and backward. It lies between the 
bladder in front and the pelvic or sigmoid colon and rectum behind, and is com- 
pletely within the pelvis, so that its base is below the level of the superior pelvic 
aperture. Its upper part is suspended by the broad and the round ligaments, 
while its lower portion is imbedded in the fibrous tissue of the pelvis. 
The long axis of the uterus usually lies approximately in the axis of the superior 
pelvic aperture, but as the organ is freely movable its position varies with the 
state of distension of the bladder and rectum. Except when much displaced by a 
fully distended bladder, it forms a forward angle with the vagina, since the axis 
of the vagina corresponds to the axes of the cavity and inferior aperture of the 
pelvis. 
The uterus measures about 7.5 cm. in length, 5 cm. in breadth, at its upper 
part, and nearly 2.5 cm. in thickness; it weighs from 30 to 40 gm. It is divisible 
into two portions. On the surface, about midway between the apex and base, 
is a slight constriction, known as the isthmus, and corresponding to this in the 
interior is a narrowing of the uterine cavity, the internal orifice of the uterus. The 
portion above the isthmus is termed the body, and that below, the cervix. The 
part of the body which lies above a plane passing through the points of entrance 
of the uterine tubes is known as the fundus. 
Body {corpus uteri). - The body gradually narrows from the fundus to the 
isthmus. 
The vesical or anterior surface {facies vesicalis) is flattened and covered by 
peritoneum, which is reflected on to the bladder to form the vesicouterine 
excavation. The surface lies in apposition with the bladder. 
The intestinal or posterior surface {facies intestinalis) is convex transversely and 
is covered by peritoneum, which is continued down on to the cervix and vagina. 
It is in relation with the sigmoid colon, from which it is usually separated by some 
coils of small intestine. 
The fundus {fundus uteri) is convex in all directions, and covered by peritoneum 
continuous with that on the vesical and intestinal surfaces. On it rest some coils 
of small intestine, and occasionally the distended sigmoid colon. 
The lateral margins {margo lateralis) are slightly convex. At the upper end of 
each the uterine tube pierces the uterine wall. Below and in front of this point 
the round ligament of the uterus is fixed, while behind it is the attachment of the 
ligament of the ovary. These three structures lie within a fold of peritoneum 
which is reflected from the margin of the uterus to the wall of the pelvis, and is 
named the broad ligament. 
Cervix {cervix uteri; neck).-The cervix is the lower constricted segment of 
the uterus. It is somewhat conical in shape, with its truncated apex directed 
downward and backward, but is slightly wider in the middle than either above or 
below. Owing to its relationships, it is less freely movable than the body, so that 
the latter may bend on it. The long axis of the cervix is therefore seldom in the 
same straight line as the long axis of the body. The long axis of the uterus as a 
whole presents the form of a curved line with its concavity forward, or in extreme 
cases may present an angular bend at the region of the isthmus. 
The cervix projects through the anterior wall of the vagina, which divides it 
into an upper, supravaginal portion, and a lower, vaginal portion. 
The supravaginal portion {portio supravaginalis [cervicis]) is separated in front 
from the bladder by fibrous tissue (parametrium), which extends also on to its sides 
and lateralward between the layers of the broad ligaments. The uterine arteries 
reach the margins of the cervix in this fibrous tissue, while on either side the ureter 
runs downward and forward in it at a distance of about 2 cm. from the cervix. 
Posteriorly, the supravaginal cervix is covered by peritoneum, which is prolonged 1250 
SPLANCHNOLOGY 
below on to the posterior vaginal wall, when it is reflected on to the rectum, 
forming the rectouterine excavation. It is in relation with the rectum, from 
which it may be separated by coils of small intestine. 
The vaginal portion (portio vaginalis [ceroids]) of the cervix projects free into the 
anterior wall of the vagina between the anterior and posterior fornices. On its 
rounded extremity is a small, depressed, somewhat circular aperture, the external 
orifice of the uterus, through which the cavity of the cervix communicates with 
that of the vagina. The external orifice is bounded by two lips, an anterior and a 
posterior, of which the anterior is the shorter and thicker, although, on account 
of the slope of the cervix, it projects lower than the posterior. Normally, both lips 
are in contact with the posterior vaginal wall. 
Interior of the Uterus (Fig. 1053).--The cavity of the uterus is small in 
comparison with the size of the organ. 
The Cavity of the Body (cavum uteri) is a mere slit, flattened antero-posteriorly. 
It is triangular in shape, the base being formed by the internal surface of the 
fundus between the orifices of the uterine 
tubes, the apex by the internal orifice of the 
uterus through which the cavity of the body 
communicates with the canal of the cervix. 
The Canal of the Cervix (canalis cervicis 
uteri) is somewhat fusiform, flattened from 
before backward, and broader at the middle 
than at either extremity. It communicates 
above through the internal orifice with the 
cavity of the body, and below through the 
external orifice with the vaginal cavity. The 
wall of the canal presents an anterior and a 
posterior longitudinal ridge, from each of 
which proceed a number of small oblique 
columns, the palmate folds, giving the appear- 
ance of branches from the stem of a tree; 
to this arrangement the name arbor vitae 
uterina is applied. The folds on the two 
walls are not exactly opposed, but fit between one another so as to close the 
cervical canal. 
The total length of the uterine cavity from the external orifice to the fundus 
is about 6.25 cm. 
Ligaments.--The ligaments of the uterus are eight in number: one anterior; 
one posterior; two lateral or broad; two uterosacral; and two round ligaments. 
The anterior ligament consists of the vesicouterine fold of peritoneum, which 
is reflected on to the bladder from the front of the uterus, at the junction of the 
cervix and body. 
The posterior ligament consists of the rectovaginal fold of peritoneum, which is 
reflected from the back of the posterior fornix of the vagina on to the front of the 
rectum. It forms the bottom of a deep pouch called the rectouterine excavation, 
which is bounded in front by the posterior wall of the uterus, the supravaginal 
cervix, and the posterior fornix of the vagina; behind, by the rectum; and laterally 
by two crescentic folds of peritoneum which pass backward from the cervix uteri 
on either side of the rectum to the posterior wall of the pelvis. These folds are 
named the sacrogenital or rectouterine folds. They contain a considerable amount 
of fibrous tissue and non-striped muscular fibres which are attached to the front 
of the sacrum and constitute the uterosacral ligaments. 
The two lateral or broad ligaments (tig amentum latum uteri) pass from the sides of 
the uterus to the lateral walls of the pelvis. Together with the uterus they form 
Fig. 1053.-Posterior half of uterus and upper 
part of vagina. THE UTERUS 
1251 
a septum across the female pelvis, dividing that cavity into two portions. In the 
anterior part is contained the bladder; in the posterior part the rectum, and in 
certain conditions some coils of the small intestine and a part of the sigmoid colon. 
Between the two layers of each broad ligament are contained: (1) the uterine 
tube superiorly; (2) the round ligament of the uterus; (3) the ovary and its ligament; 
(4) the epodphoron and paroophoron; (5) connective tissue; (6) unstriped muscular 
fibre; and (7) bloodvessels and nerves. The portion of the broad ligament which 
stretches from the uterine tube to the level of the ovary is known by the name 
of the mesosalpinx. Between the fimbriated extremity of the tube and the lower 
attachment of the broad ligament is a concave rounded margin, called the infun- 
dibulopelvic ligament. 
The round ligaments (Jigamentum teres uteri) are two flattened bands between 
10 and 12 cm. in length, situated between the layers of the broad ligament in front 
of and below the uterine tubes. Commencing on either side at the lateral angle 
of the uterus, this ligament is directed forward, upward, and lateralward over the 
external iliac vessels. It then passes through the abdominal inguinal ring and along 
the inguinal canal to the labium majus, in which it becomes lost. The round 
ligaments consists principally of muscular tissue, prolonged from the uterus; also 
of some fibrous and areolar tissue, besides bloodvessels, lymphatics; and nerves, 
enclosed in a duplicature of peritoneum, which, in the fetus, is prolonged in the 
form of a tubular process for a short distance into the inguinal canal. This process 
is called the canal of Nuck. It is generally obliterated in the adult, but sometimes 
remains pervious even in advanced life. It is analogous to the saccus vaginalis, 
which precedes the descent of the testis. 
In addition to the ligaments just described, there is a band named the ligamentum trans- 
versalis colli (Mackenrodt) on either side of the cervix uteri. It is attached to the side of the 
cervix uteri and to the vault and lateral fornix of the vagina, and is continuous externally with 
the fibrous tissue which surrounds the pelvic bloodvessels. 
The form, size, and situation of the uterus vary at different periods of life and under different 
circumstances. 
Fig. 1054.-Sagittal section through the pelvis of a newly born female child. 
In the fetus the uterus is contained in the abdominal cavity, projecting beyond the superior 
aperture of the pelvis (Fig. 1054). The cervix is considerably larger than the body. 
At puberty the uterus is pyriform in shape, and weighs from 14 to 17 gm. It has descended 
into the pelvis, the fundus being just below the level of the superior aperture of this cavity. The 
palmate folds are distinct, and extend to the upper part of the cavity of the organ. 1252 
SPLANCHNOLOGY 
The position of the uterus in the adult is liable to considerable variation, depending chiefly 
on the condition of the bladder and rectum. When the bladder is empty the entire uterus is 
directed forward, and is at the same time bent on itself at the junction of the body and cervix, 
so that the body lies upon the bladder. As the latter fills, the uterus gradually becomes more 
and more erect, until with a fully distended bladder the fundus may be directed backward toward 
the sacrum. 
During menstruation the organ is enlarged, more vascular, and its surfaces rounder; the external 
orifice is rounded, its labia swollen, and the lining membrane of the body thickened, softer, and 
of a darker color. According to Sir J. Williams, at each recurrence of menstruation, a mole- 
cular disintegration of the mucous membrane takes place, which leads to its complete 
removal, only the bases of the glands imbedded in the muscle being left. At the cessation of 
menstruation, a fresh mucous membrane is formed by a proliferation of the remaining 
structures. 
During pregnancy the uterus becomes enormously enlarged, and in the eighth month reaches 
the epigastric region. The increase in size is partly due to growth of preexisting muscle, and 
partly to development of new fibres. 
After parturition the uterus nearly regains its usual size, weighing about 42 gm.; but its cavity 
is larger than in the virgin state, its vessels are tortuous, and its muscular layers are more defined; 
the external orifice is more marked, and its edges present one or more fissures. 
In old age the uterus becomes atrophied, and paler and denser in texture; a more distinct 
constriction separates the body and cervix. The internal orifice is frequently, and the external 
orifice occasionally, obliterated, while the lips almost entirely disappear. 
Structure.-The uterus is composed of three coats: an external or serous, a middle or 
muscular, and an internal or mucous. 
The serous coat (tunica serosa) is derived from the peritoneum; it invests the fundus and 
the whole of the intestinal surface of the uterus; but covers the vesical surface only as far as 
the junction of the body and cervix. In the lower fourth of the intestinal surface the peritoneum, 
though covering the uterus, is not closely connected with it, being separated from it by a layer 
of loose cellular tissue and some large veins. 
The muscular coat (tunica muscularis) forms the chief bulk of the substance of the uterus. 
In the virgin it is dense, firm, of a grayish color, and cuts almost like cartilage. It is thick opposite 
the middle of the body and fundus, and thin at the orifices of the uterine tubes. It consists of 
bundles of unstriped muscular fibres, disposed in layers, intermixed with areolar tissue, blood- 
vessels, lymphatic vessels, and nerves. The layers are three in number: external, middle, and 
internal. The external and middle layers constitute the muscular coat proper, while the inner 
layer is a greatly hypertrophied muscularis mucosae. During pregnancy the muscular tissue 
becomes more prominently developed, the fibres being greatly enlarged. 
The external layer, placed beneath the peritoneum, is disposed as a thin plane on the vesical 
and intestinal surfaces. It consists of fibres which pass transversely across the fundus, and, 
converging at each lateral angle of the uterus, are continued on to the uterine tube, the round 
ligament, and the ligament of the ovary: some passing at each side into the broad ligament, 
and others running backward from the cervix into the sacrouterine ligaments. The middle 
layer of fibres presents no regularity in its arrangement, being disposed longitudinally, obliquely, 
and transversely. It contains most bloodvessels. The internal or deep layer consists of circular 
fibres arranged in the form-of two hollow cones, the apices of which surround the orifices of the 
uterine tubes, their bases intermingling with one another on the middle of the body of the uterus. 
At the internal orifice these circular fibres form a distinct sphincter. 
The mucous membrane (tunica mucosa) (Fig. 1055) is smooth, and closely adherent to the 
subjacent tissue. It is continuous through the fimbriated extremity of the uterine tubes, with 
the peritoneum; and, through the external uterine orifice, with the lining of the vagina. 
In the body of the uterus the mucous membrane is smooth, soft, of a pale red color, lined by 
columnar ciliated epithelium, and presents, when viewed with a lens, the orifices of numerous' 
tubular follicles, arranged perpendicularly to the surface. The structure of the corium differs 
from that of ordinary mucous membranes, and consists of an embryonic nucleated and highly 
cellular form of connective tissue in which run numerous large lymphatics. In it are the tube- 
like uterine glands, lined by ciliated columnar epithelium. They are of small size in the unim- 
pregnated uterus, but shortly after impregnation become enlarged and elongated, presenting 
a contorted or waved appearance (see page 98). 
In the cervix the mucous membrane is sharply differentiated from that of the uterine cavity. 
It is thrown into numerous oblique ridges, which diverge from an anterior and posterior longi- 
tudinal raphe. In the upper two-thirds of the canal, the mucous membrane is provided with 
numerous deep glandular follicles, which secrete a clear viscid alkaline mucus; and, in addition, 
extending through the whole length of the canal is a variable number of little cysts, presumably 
follicles which have become occluded and distended with retained secretion. They are called 
the ovula Nabothi. The mucous membrane covering the lower half of the cervical canal presents 
numerous papillae. The epithelium of the upper two-thirds is cylindrical and ciliated, but below THE UTERUS 
1253 
this it loses its cilia, and gradually changes to stratified squamous epithelium close to the external 
orifice. On the vaginal surface of the cervix the epithelium is similar to that lining the vagina, 
viz., stratified squamous. 
Fig. 1055.-Vertical section of mucous membrane of human uterus. (Sobotta.) 
Vessels and Nerves.-The arteries of the uterus are the uterine, from the hypogastric; and 
the ovarian, from the abdominal aorta (Fig. 1056). They are remarkable for their tortuous 
Fig. 1056.-The arteries of the internal organs of generation of the female, seen from behind. (After Hyrtl.) 
course in the substance of the organ, and for their frequent anastomoses. The termination of 
the ovarian artery meets that of the uterine artery, and forms an anastomotic trunk from which 
branches are given off to supply the uterus, their disposition being circular. The veins are of 1254 
SPLANCHNOLOGY 
large size, and correspond with the arteries. They end in the uterine plexuses. In the impreg- 
nated uterus the arteries carry the blood to, and the veins convey it away from, the intervillous 
space of the placenta (see page 100). The lymphatics are described on page 795. The nerves 
are derived from the hypogastric and ovarian plexuses, and from the third and fourth sacral 
nerves. 
Applied Anatomy.-A certain amount of anteversion and retroversion of the uterus can take 
place without the condition being regarded as pathological, but when the degree of flexion becomes 
considerable it must be regarded as a morbid condition. This is especially true of retroversion and 
retroflexion. The former is a falling back of the whole uterus, so that the cervix points upward 
toward the pubes, and the latter is a bending backward of the body, the cervix remaining in its 
normal position. The two conditions are usually combined. Prolapse of the uterus is another 
common infirmity. The organ sinks to an abnormally low level in the pelvis, and sometimes 
protrudes beyond the vulva. This is due to the supporting mechanism of the uterus being 
insufficient to sustain the strain thrown upon it. 
The uterus may require removal in cases of malignant disease or for fibroid tumors. Carcinoma 
is the most common form of malignant disease of the uterus, though cases of sarcoma do occur. 
It may show itself either as a columnar carcinoma or as a squamous carcinoma; the former com- 
mencing either in the cervix or body of the uterus, the latter always commencing in the epithelial 
cells of the mucous covering of the vaginal surface of the cervix. Cancer of the body or of the 
cervix may be treated in the early stage, before fixation has taken place, by removal of the uterus, 
either through the vagina or by means of abdominal section, but if the body be much enlarged 
the former operation is impossible. Vaginal hysterectomy is performed by placing the patient 
in the lithotomy position and introducing a large duck-bill speculum. The cervix is then seized 
with a volsellum and pulled down as far as possible, and the mucous membrane of the vagina 
incised around the cervix and as near to it as the disease will allow, especially in front, where the 
ureters are in danger of being wounded. The rectouterine excavation is then opened sufficiently 
to allow of the introduction of the two forefingers, by means of which the opening is dilated 
laterally as far as the sacro-uterine ligaments. A somewhat similar proceeding is adopted in 
front, but here the bladder has to be separated from the wall of the uterus for about 2.5 cm. 
before the vesicouterine fold of peritoneum can be reached. This is done by carefully burrowing 
upward with a director and stripping the tissues off the uterine wall. When the vesicouterine 
pouch has been opened and the aperture dilated laterally, the uterus remains attached only by 
the broad ligaments, in which are contained the vessels that supply the uterus. Before division 
of the ligaments, these vessels have to be dealt with. The forefinger of the left hand is introduced 
into the rectouterine excavation, and an aneurism needle, armed with a long silk ligature, is 
inserted into the vesicouterine pouch, and is pushed through the broad ligament about 2.5 cm. 
above its lower level and at some distance from the uterus. One end of the ligature is now 
pulled through the anterior opening, and in this way we have the lowest 2.5 cm. of the broad 
ligament, in which is contained the uterine artery (Fig. 1056), enclosed in a ligature. This is tied 
tightly, and the operation is repeated on the other side. The broad ligament is then divided on 
either side, between the ligature and the uterus, to the extent to which it has been constricted. 
By traction on the volsellum which grasps the cervix, the uterus can be pulled considerably 
further down in the vagina, and a second 2.5 cm. of the broad ligament is treated in a similar 
way. This second ligature will embrace the pampiniform plexus of veins, and, when the broad 
ligament has been divided on either side, it will be found that a third ligature can be made to 
pass over the uterine tube and top of the broad ligament, after the uterus has been dragged down 
as far as possible. After the third ligature has been tied and the structures between it and the 
uterus divided, this organ will be freed from all its connections and can be removed from the 
vagina. The third ligature will contain the ovarian artery, between the ovary and the uterus, 
as it lies below the uterine tube. The vagina is then sponged out and lightly dressed with gauze; 
no sutures being used. 
In the treatment of uterine fibroids which require operative interference, removal of the 
whole of the uterus, together with the tumors, through an abdominal incision gives the most 
satisfactory results; for, if the tumor is large, its size acts as a barrier to its safe delivery through 
the pelvis and genital passages. After the abdomen has been opened the uterine vessels are 
secured and the broad ligaments divided in a manner similar to that employed in vaginal hysterec- 
tomy, except that the proceeding is commenced from above. When the first two ligatures have 
been tied, and the broad ligament divided, it will be found that the uterus can be raised out of 
the pelvis. A transverse incision is now made through the peritoneum, where it is reflected 
from the front of the uterus on to the back of the bladder, and the serous membrane peeled 
from the surface of the uterus until the vagina is reached. The anterior wall of this canal is 
then cut across. The uterus is now turned forward and the peritoneum at the bottom of the 
rectouterine excavation incised transversely, and the posterior wall of the vagina cut across, 
until it meets the incision on the anterior wall. The uterus is now almost free, and is held only 
by the lower part of the broad ligament on either side, containing the uterine artery. A third 
ligature is made to encircle this as close to the uterus as possible, the position of the ureter THE VAGINA 
1255 
being always kept in mind, and, after having been tied, the structures are divided between the 
ligature and the uterus. The organ can now be removed. The vagina is plugged with gauze, 
and the external wound closed in the usual way. The vagina acts as a drain, and therefore the 
opening into it is not sutured. 
Inflammation of the cellular tissue surrounding the cervix occasionally takes place. Laceration 
of the cervix by instruments or by the fetal head frequently occurs, opening up the cellular 
planes and so exposing them to any infection that may be present. An inflammatory mass 
forms in the cellular tissue between the layers of the broad ligament or of the uterosacral liga- 
ments, and the condition is termed pelvic cellulitis or parametritis. This condition is usually con- 
fined to one side of the pelvis, forming a large inflammatory mass which pushes the uterus over 
to the opposite side. It does not always remain localized, however, but may spread widely, 
surrounding the rectum or the neck of the bladder, or mounting into the iliac fossa, or even to 
the perinephric cellular tissue. The condition may resolve or an abscess may form. In the 
former condition the cicatrization of the inflammatory products often produces displacements 
of the uterus toward the affected side of the pelvis, or stricture of the rectum when that viscus 
has been surrounded by the process. When suppuration ensues, the pus may burst into the 
bladder, vagina, or rectum, or it may present above the inguinal ligament, or it may mount 
to the anterior abdominal wall in front of the bladder or to the posterior abdominal wall between 
the iliac crest and last rib. The abscess may, moreover, make its way into the buttock by passing 
out of the pelvis through the greater sciatic foramen, or it may pass down between the fibres of 
the Levator ani and appear as a secondary ischiorectal abscess. 
The Vagina (Fig. 1052). 
The vagina extends from the vestibule to the uterus, and is situated behind the 
bladder and in front of the rectum; it is directed upward and backward, its axis 
forming with that of the uterus an angle of over 90°, opening forward. Its walls 
are ordinarily in contact, and the usual shape of its lower part on transverse section 
is that of an H, the transverse limb being slightly curved forward or backward, 
while the lateral limbs are somewhat convex toward the median line; its middle 
part has the appearance pf a transverse slit. Its length is 6 to 7.5 cm. along its 
anterior wall, and 9 cm. along its posterior wall. It is constricted at its commence- 
ment, dilated in the middle, and narrowed near its uterine extremity; it surrounds 
the vaginal portion of the cervix uteri, a short distance from the external orifice 
of the uterus, its attachment extending higher up on the posterior than on the 
anterior wall of the uterus. To the recess behind the cervix the term posterior 
fornix is applied, while the smaller recesses in front and at the sides are called the 
anterior and lateral fornices. 
Relations.-The anterior surface of the vagina is in relation with the fundus of the bladder, 
and with the urethra. Its posterior surface is separated from the rectum by the rectouterine 
excavation in its upper fourth, and by the rectovesical fascia in its middle two-fourths; the lower 
fourth is separated from the anal canal by the perineal body. Its sides are enclosed between 
the Levatores ani muscles. As the terminal portions of the ureters pass forward and medial- 
ward to reach the fundus of the bladder, they run close to the lateral fornices of the vagina, and 
as they enter the bladder are slightly in front of the anterior fornix. 
Structure.-The vagina consists of an internal mucous lining and a muscular coat separated 
by a layer of erectile tissue. 
The mucous membrane {tunica mucosa) is continuous above with that lining the uterus. Its 
inner surface presents two longitudinal ridges, one on its anterior and one on its posterior wall. 
These ridges are called the columns of the vagina and from them numerous transverse ridges 
or rugae extend outward on either side. These rugae are divided by furrows of variable depth, 
giving to the mucous membrane the appearance of being studded over with conical projections 
or papillae; they are most numerous near the orifice of the vagina, especially before parturition. 
The epithelium covering the mucpus membrane is of the stratified squamous variety. The sub- 
mucous tissue is very loose, and contains numerous large veins which by their anastomoses form 
a plexus, together with smooth muscular fibres derived from the muscular coat; it is regarded 
by Gussenbauer as an erectile tissue. It contains a number of mucous crypts, but no true glands. 
The muscular coat {tunica muscularis) consists of two layers: an external longitudinal, which 
is by far the stronger, and an internal circular layer. The longitudinal fibres are continuous 
with the superficial muscular fibres of the uterus. The strongest fasciculi are those attached 
to the rectovesical fascia on either side. The two layers are not distinctly separable from each 
other, but are connected by oblique decussating fasciculi, which pass from the one layer to the 1256 
SPLANCHNOLOGY 
other. In addition to this, the vagina at its lower end is surrounded by a band of striped muscular 
fibres, the Bulbocavemosus (see page 520). 
External to the muscular coat is a layer of connective tissue, containing a large plexus of 
bloodvessels. 
The erectile tissue consists of a layer of loose connective tissue, situated between the mucous 
membrane and the muscular coat; imbedded in it is a plexus of large veins, and numerous bundles 
of unstriped muscular fibres, derived from the circular muscular layer. The arrangement of the 
veins is similar to that found in other erectile tissues. 
The External Genital Organs (Partes Genitales Externae Muliebres) 
(Fig. 1057). 
The external genital organs of the female are: the mons pubis, the labia majora 
et minora pedundi, the clitoris, the vestibule of the vagina, the bulb of the vestibule, 
and the greater vestibular glands. The term pudendum or vulva, as generally applied, 
includes all these parts. 
Fig. 1057.-External genital organs of female. The labia minora have been drawn apart. 
The Mons Pubis (commissura labiorum anterior; mons Veneris), the rounded 
eminence in front of the pubic symphysis, is formed by a collection of fatty tissue 
beneath the integument. It becomes covered with hair at the time of puberty. 
The Labia Majora (labia major a pudendi) are two prominent longitudinal cuta- 
neous folds which extend downward and backward from the mons pubis and form 
the lateral boundaries of a fissure or cleft, the pudendal cleft or rima, into which 
the vagina and urethra open. Each labium has two surfaces, an outer, pigmented 
and covered with strong, crisp hairs; and an inner, smooth and beset with large 
sebaceous follicles. Between the two there is a considerable quantity of areolar 
tissue, fat, and a tissue resembling the dartos tunic of the scrotum, besides vessels, THE EXTERNAL GENITAL ORGANS 
1257 
nerves, and glands. The labia are thicker in front, where they form by their 
meeting the anterior labial commissure. Posteriorly they are not really joined, but 
appear to become lost in the neighboring integument, ending close to, and nearly 
parallel with, each other. Together with the connecting skin between them, 
they form the posterior labial commissure or posterior boundary of the pudendum. 
The interval between the posterior commissure and the anus, from 2.5 to 3 cm. 
in length, constitutes the perineum. The labia majora correspond to the scrotum 
in the male. 
The Labia Minora (labia minora pudendi; nymphos) are two small cutaneous 
folds, situated between the labia majora, and extending from the clitoris obliquely 
downward, lateralward, and backward for about 4 cm. on either side of the orifice 
of the vagina, between which and the labia majora they end; in the virgin the pos- 
terior ends of the labia minora are usually joined across the middle line by a fold 
of skin, named the frenulum of the labia or fourchette. Anteriorly, each labium 
minus divides into two portions: the upper division passes above the clitoris to 
meet its fellow of the opposite side, forming a fold which overhangs the glans 
clitoridis, and is named the preputium clitoridis; the lower division passes beneath 
the clitoris and becomes united to its under surface, forming, with its fellow of the 
opposite side, the frenulum of the clitoris. On the opposed surfaces of the labia 
minora are numerous sebaceous follicles. 
The Clitoris is an erectile structure, homologous with the penis. It is situated 
beneath the anterior labial commissure, partially hidden between the anterior 
ends of the labia minora. It consists of two corpora cavernosa, composed of 
erectile tissue enclosed in a dense layer of fibrous membrane, united together along 
their medial surfaces by an incomplete fibrous pectiniform septum; each corpus 
is connected to the rami of the pubis and ischium by a crus; the free extremity 
(glans clitoridis') is a small rounded tubercle, consisting of spongy erectile tissue, 
and highly sensitive. The clitoris is provided like the penis, with a suspensory 
ligament, and with two small muscles, the Ischiocavernosi, which are inserted 
into the crura of the clitoris. 
The Vestibule (vestibulum vaginae).-The cleft between the labia minora and 
behind the glans clitoridis is named the vestibule of the vagina: in it are seen the 
urethral and vaginal orifices and the openings of the ducts of the greater vestibular 
glands. 
The external urethral orifice (orificium urethrae externum; urinary meatus) is 
placed about 2.5 cm. behind the glans clitoridis and immediately in front of that 
of the vagina; it usually assumes the form of a short, sagittal cleft with slightly 
raised margins. 
The vaginal orifice is a median slit below and behind the opening of the urethra; 
its size varies inversely with that of the hymen. 
The hymen is a thin fold of mucous membrane situated at the orifice of the vagina; 
the inner surfaces of the fold are normally in contact with each other, and the 
vaginal orifice appears as a cleft between them. The hymen varies much in shape. 
When stretched, its commonest form is that of a ring, generally broadest posteriorly; 
sometimes it is represented by a semilunar fold, with its concave margin turned 
toward the pubes. Occasionally it is cribriform, or its free margin forms a mem- 
branous fringe. It may be entirely absent, or may form a complete septum across 
the lower end of the vagina; the latter condition is known as an imperforate hymen. 
It may persist after copulation, so that it cannot be considered as a test of 
virginity. When the hymen has been ruptured, small rounded elevations known 
as the carunculae hymeneales are found as its remains. Between the hymen and 
the frenulum of the labia is a shallow depression, named the navicular fossa. 
The Bulb of the Vestibule (bidbus vestibuli; vaginal bidb) is the homologue of 
the bulb and adjoining part of the corpus cavernosum urethrae of the male, and 1258 
SPLANCHNOLOGY 
consists of two elongated masses of erectile tissue, placed one on either side of the 
vaginal orifice and united to each other in front by a narrow median band termed 
the pars intermedia. Each lateral mass measures a little over 2.5 cm. in length. 
Their posterior ends are expanded and are in contact with the greater vestibular 
glands; their anterior ends are tapered and joined to one another by the pars 
intermedia; their deep surfaces are in contact with the inferior fascia of the uro- 
genital diaphragm; superficially they are covered by the Bulbocavernosus. 
The Greater Vestibular Glands {glandula vestibzdaris major [Bartholini]; Bar- 
tholin's glands') are the homologues of the bulbo-urethral glands in the male. They 
consist of two small, roundish bodies of a reddish-yellow color, situated one on either 
side of the vaginal orifice in contact with the posterior end of each lateral mass of 
the bulb of the vestibule. Each gland opens by means of a duct, about 2 cm. long, 
immediately lateral to the hymen, in the groove between it and the labium minus. 
The Mammae (Mammary Gland; Breasts). 
The mammae secretes the milk, and are accessory glands of the generative system* 
They exist in the male as well as in the female; but in the former only in the rudi- 
mentary state, unless their growth is excited by peculiar circumstances. In the 
female they are two large hemispherical eminences lying within the superficial 
fascia and situated on the front and sides of the chest ; each extends from the second 
rib above to the sixth rib below, and from the side of the sternum to near the mid- 
axillary line. Their weight and dimensions differ at different periods of life, and 
in different individuals. Before puberty they are of small size, but enlarge as the 
generative organs become more completely developed. They increase during preg- 
nancy and especially after delivery, and become atrophied in old age. The left 
mamma is generally a little larger than the right. The deep surface of each is 
nearly circular, flattened, or slightly concave, and has its long diameter directed 
upward and lateralward toward the axilla; it is separated from the fascia covering 
the Pectoralis major, Serratus anterior, and Obliquus externus abdominis by loose 
connective tissue. The subcutaneous surface of the mamma is convex, and presents, 
just below the centre, a small conical prominence, the papilla. 
The Mammary Papilla or Nipple {'papilla mammae) is a cylindrical or conical 
eminence situated about the level of the fourth intercostal space. It is capable 
of undergoing a sort of erection from mechanical excitement, a change mainly 
due to the contraction of its muscular fibres. It is of a pink or brownish hue, its 
surface wrinkled and provided with secondary papillae; and it is perforated by from 
fifteen to twenty orifices, the apertures of the lactiferous ducts. The base of the 
mammary papilla is surrounded by an areola. In the virgin the areola is of a delicate 
rosy hue; about the second month after impregnation it enlarges and acquires a 
darker tinge, and as pregnancy advances it may assume a dark brown or even black 
color. This color diminishes as soon as lactation is over, but is never entirely 
lost throughout life. These changes in the color of the areola are of importance 
in forming a conclusion in a case of suspected first pregnancy. Near the base of 
the papilla, and upon the surface of the areola, are numerous large sebaceous glands, 
the areolar glands, which become much enlarged during lactation, and present 
the appearance of small tubercles beneath the skin. These glands secrete a pecu- 
liar fatty substance, which serves as a protection to the integument of the papilla 
during the act of sucking. The mammary papilla consists of numerous vessels, 
intermixed with plain muscular fibres, which are principally arranged in a circular 
manner around the base:rsome few fibres-radiating from base to apex. 
Structure (Figs. 1058, 1059).-The mamma consists of gland tissue; of fibrous tissue, con- 
necting its lobes; and of fatty tissue in the intervals between the lobes. The gland tissue, when 
freed from fibrous tissue and fat, is of a pale reddish color, firm in texture, flattened from before THE MAMMAE 
1259 
backward and thicker in the centre than at the circumference. The subcutaneous surface of 
the mamma presents numerous irregular processes which project toward the skin and are joined 
to it by bands of connective tissue. It consists of numerous lobes, and these are composed of 
lobules, connected together by areolar tissue, bloodvessels, and ducts. The smallest lobules 
consist of a cluster of rounded alveoli, which open into the smallest branches of the lactiferous 
ducts; these ducts unite to form larger ducts, and these end in a single canal, corresponding with 
Fig. 1058.-Dissection of the lower half of the mamma during the period of lactation. (Luschka.) 
one of the chief subdivisions of the gland. The number of excretory ducts varies from fifteen 
to twenty; they are termed the tubuli lactiferi. They converge toward the areola, beneath 
which they form dilatations or ampullae, which serve as reservoirs for the milk, and, at the base 
of the papillae, become contracted, and pursue a straight course to its summit, perforating it 
by separate orifices considerably narrower than the ducts' themselves. The ducts are composed 
of areolar tissue containing longitudinal and transverse elastic fibres; muscular fibres are entirely 
absent; they are lined by columnar epithe- 
lium resting on a basement-membrane. 
The epithelium of the mamma differs ac- 
cording to the state of activity of the 
organ. In the gland of a woman who is 
not pregnant or suckling, the alveoli are 
very small and solid, being filled with a 
mass of granular polyhedral cells. During 
pregnancy the alveoli enlarge, and the cells 
undergo rapid multiplication. At the com- 
mencement of lactation, the cells in the 
centre of the alveolus undergo fatty degen- 
eration, and are eliminated in the first milk, 
as colostrum corpuscles. The peripheral 
cells of the alveolus remain, and form a 
single layer of granular, short columnar 
cells, with spherical nuclei, lining the base- 
ment membrane. The cells, during the 
state of activity of the gland, are capable of forming, in their interior, oil globules, which are 
then ejected into the lumen of the alveolus, and constitute the milk globules. When the acini 
are distended by the accumulation of the secretion the lining epithelium becomes flattened. 
The fibrous tissue invests the entire surface of the mamma, and sends down septa between 
its lobes, connecting them together. 
The fatty tissue covers the surface of the gland, and occupies the interval between its lobes. 
It usually exists in considerable abundance, and determines the form and size of the gland. There 
is no fat immediately beneath the areola and papilla. 
Fig. 1059.-Section of portion of mamma. 1260 
SPLANCHNOLOGY 
Vessels and Nerves.-The arteries supplying the mammae are derived from the thoracic 
branches of the axillary, the intercostals, and the internal mammary. The veins describe an 
anastomotic circle around the base of the papilla, called by Haller the circulus venosus. From 
this, large branches transmit the blood to the circumference of the gland, and end in the axillary 
and internal mammary veins. The lymphatics are described on page 797. The nerves are 
derived from the anterior and lateral cutaneous branches of the fourth, fifth, and sixth thoracic 
nerves. 
Applied Anatomy.--The ducts descending from the mammary papilla radiate through the 
gland, and when an incision is made into the breast the scalpel should be directed radially, from 
the centre to the periphery, so that it may not pass across the ducts. A milk duct may become 
obstructed and distended, forming a tumor known as a galadocele. Abscess frequently occurs 
about the mamma, and most often in women who are lactating, especially those who have cracks 
or fissures about the papilla. The abscess may lie between the septa, in the gland tissue itself; 
or it may lie beneath the skin by the side of the papilla and superficial to the mamma or it may 
form beneath it, between the mamma and the deep fascia. Free incision, radiating from the 
papilla, is required in such cases. 
Cystic formation of many different kinds is commonly seen in the mamma; in some cases it is 
due to dilatation of the larger ducts or of the lymph spaces throughout the gland; in others the 
cysts occur in new growths of the mamma, or as the result of obstruction of the smaller ducts by 
chronic inflammatory processes. 
Malignant growths are seen more often in the mamma than in any other organ; they are of 
great variety, but the commonest is the spheroidal-celled cancer, the cells of which are inter- 
mingled with a varying amount of fibrous tissue. A hard contracting tumor mass results, which 
drags on the fibrous septa between the lobes so that fixation or retraction of the papilla ensues, 
and sooner or later the malignant infiltration invades the surrounding gland tissues, *the skin, 
the deep fascia and Pectorales, and even the chest wall and pleura. The lymph glands beneath 
the Pectorales and those situated toward the apex of the axilla become early involved with 
secondary malignant deposit, and later the supraclavicular glands enlarge. In other cases the 
mediastinal glands may be involved, when the disease is situated on the medial side of the 
papilla. 
The operation for removal of a mamma affected with malignant disease should be an extensive 
procedure, with the object of extirpating all fascial planes and lymphatic structures that may be 
infected. The incision commences below, over the upper part of the sheath of the Rectus, encloses 
the mamma by an ellipse, and is then continued on toward the apex of the axilla. The skin is 
reflected on both sides of the incision; anteriorly, until the sternum is reached, and posteriorly 
to the posterior boundary of the axilla. The origin of the sternal portion of the Pectoralis major 
is then divided and turned outward. The Pectoralis minor is next seen, and its origin is then 
divided in a similar manner. The whole of the muscular and fascial planes of the front of the 
chest are thus separated en masse, carrying with them the mamma and the skin covering it. The 
insertions of the two Pectorales have next to be divided, and finally the axillary lymph glands 
and fat are removed from the axillary vessels in one piece with the mass of tissue already detached. 
This is done by first freely exposing the whole length of the axillary vein and then, with a blunt 
instrument, peeling the structures off the vein from above downward, from the point where they 
are crossed by the Subclavius muscle to the lower border of the axilla. In this part of the opera- 
tion many branches of both vein and artery require ligature. The only thing which then remains 
to be divided is the deep fascia along the posterior axillary wall. The wound is then closed, 
drainage is provided, and firm pressure is applied with the dressings. It will be noted that the 
.clavicular portion of the Pectoralis major is left intact, as it is of considerable service for 
the subsequent movements of the arm, the utility of which is but slightly impaired. 
THE DUCTLESS GLANDS. 
There are certain organs which are very similar to secreting glands, but differ 
from them in one essential particular, viz., they do not possess any ducts by which 
their secretion is discharged. These organs are known as ductless glands. They 
are capable of internal secretion-that is to say, of forming, from materials brought 
to them in the blood, substances which have a certain influence upon the nutritive 
and other changes going on in the body. This secretion is carried into the blood 
stream, either directly by the veins or indirectly through the medium of the 
lymphatics. 
These glands include the thyroid and the parathyroids, the thymus, the spleen, 
the suprarenal glands, and the glomus caroticum and glomus coccygeum, which will THE THYROID GLAND 
1261 
be described in this section. They also include the lymph glands, which have 
already been described in the section on Angiology; and the pineal gland and 
hypophysis cerebri described in the section on Neurology. 
THE THYROID GLAND (GLANDULA THYREIODEA; THYROID BODY) 
(Fig. 1060). 
The thyroid gland is a highly vascular organ, situated at the front and sides of 
the neck; it consists of right and left lobes connected across the middle line by a 
narrow portion, the isthmus. Its weight is somewhat variable, but is usually about 
30 grams. It is slightly heavier in the female, in whom it becomes enlarged during 
menstruation and pregnancy. 
Fig. 1060.-The thyroid gland and its relations. 
The lobes (lobuli gl. thyreoideae) are conical in shape, the apex of each being 
directed upward and lateralward as far as the junction of the middle with the lower 
third of the thyroid cartilage; the base looks downward, and is on a level with the 
fifth or sixth tracheal ring. Each lobe is about 5 cm. long; its greatest width is 
about 3 cm., and its thickness about 2 cm. The lateral or superficial surface is con- 
vex, and covered by the skin, the superficial and deep fasciae, the Sternocleido- 
mastoideus, the superior belly of the Omohyoideus, the Sternohyoideus and Sterno- 
thyreoideus, and beneath the last muscle by the pretracheal layer of the deep 
fascia, which forms a capsule for the gland. The deep or medial surface is moulded 
over the underlying structures, viz., the thyroid and cricoid cartilages, the trachea, 
the Constrictor pharyngis inferior and posterior part of the Cricothyreoideus, 
the oesophagus (particularly on the left side of the neck), the superior and inferior 
thyroid arteries, and the recurrent nerves. The anterior border is thin, and inclines 
obliquely from above downward toward the middle line of the neck, while the 1262 
SPLANCHNOLOGY 
posterior border is thick and overlaps the common carotid artery, and, as a rule, 
the parathyroids. 
The isthmus (isthmus gl. thyreoidea) connects together the lower thirds of the 
lobes; it measures about 1.25 cm. in breadth, and the same in depth, and usually 
covers the second and third rings of the trachea. Its situation and size present, 
however, many variations. In the middle line of the neck it is covered by the skin 
and fascia, and close to the middle line, on either side, by the Sternothyreoideus. 
Across its upper border runs an anastomotic branch uniting the two superior 
thyroid arteries; at its lower border are the inferior thyroid veins. Sometimes the 
isthmus is altogether wanting. 
A third lobe, of conical shape, called the pyramidal lobe, frequently arises from 
the upper part of the isthmus, or from the adjacent portion of either lobe, but 
most commonly the left, and ascends as far as the hyoid bone. It is occasionally 
quite detached, or may be divided into two or more parts. 
A fibrous or muscular band is sometimes found attached, above, to the body 
of the hyoid bone, and below to the isthmus of the gland, or its pyramidal lobe. 
When muscular, it is termed the Levator glandulae thyreoideae. 
Small detached portions of thyroid tissue are sometimes found in the vicinity 
of the lateral lobes or above the isthmus; they are called accessory thyroid glands 
(glandulae thyreoideae accessoriae). 
Fig. 1061.-Section of thyroid gland of sheep. X 160. 
Structure.-The thyroid gland is invested by a thin capsule of connective tissue, which pro- 
jects into its substance and imperfectly divides it into masses of irregular form and size. When 
the organ is cut into, it is of a brownish-red color, and is seen to be made up of a number of 
closed vesicles, containing a yellow glairy fluid, and separated from each other by intermediate 
connective tissue (Fig. 1061). 
The vesicles of the thyroid of the adult animal are generally closed spherical sacs; but in some 
young animals, e. g., young dogs, the vesicles are more or less tubular and branched. This 
appearance is supposed to be due to the mode of growth of the gland, and merely indicates that 
an increase in the number of vesicles is taking place. Each vesicle is lined by a single layer of 
cubical epithelium. There does not appear to be a basement-membrane, so that the epithelial 
cells are in direct contact with the connective-tissue reticulum which supports the acini. The 
vesicles are of various sizes and shapes, and contain as a normal product, a viscid, homogeneous, 
semifluid, slightly yellowish, colloid material; red corpuscles are found in it in various stages 
of disintegration and decolorization, the yellow tinge being probably due to the hemoglobin, 
which is thus set free from the colored corpuscles. The colloid material contains an iodine com- 
pound, iodothyrin, and is readily stained by eosin. It passes out between the cubical cells and 
is absorbed into the blood or lymph. 
Vessels and Nerves.-The arteries supplying the thyroid gland are the superior and inferior 
thyroids and sometimes an additional branch (thyroidea ima) from the innominate artery or the 
arch of the aorta, which ascends upon the front of the trachea. The arteries are remarkable 
for their large size and frequent anastomoses. The veins form a plexus on the surface of the THE PARATHYROID GLANDS 
1263 
gland and on the front of the trachea; from this plexus the superior, middle, and inferior thyroid 
veins arise; the superior and middle end in the internal jugular, the inferior in the innominate 
vein. The capillary bloodvessels form a dense plexus in the connective tissue around the vesicles, 
between the epithelium of the vesicles and the endothelium of the lymphatics, which surround 
a greater or smaller part of the circumference of the vesicle. The lymphatic vessels run in the 
interlobular connective tissue, not uncommonly surrounding the arteries which they accompany, 
and communicate with a net-work in the capsule of the gland; they may contain colloid material. 
They end in the thoracic and right lymphatic trunks. The nerves are derived from the middle 
and inferior cervical ganglia of the sympathetic. 
Applied Anatomy.--An enlargement of the thyroid gland is called a goitre. The swelling may 
take the form of a diffuse hypertrophy of the whole gland, giving rise to the parenchymatous goitre, 
this being mainly due to the hypertrophy of the thyroid follicles themselves; in other cases a 
fibroid form of goitre is produced owing to the increase in the interstitial connective tissue; in 
others, again, the vascular changes may preponderate, and many large pulsating vessels may 
be present. Much more commonly, however, the enlargement is due to adenomatous new growth 
in the substance of the thyroid; these tumors are always innocent, and tend to destroy life only 
by pressure on the air passages. A single tumor is the rule, but in some instances a very large 
number may be present. They tend to show marked mucoid degeneration, and so'become con- 
verted into cyst-adenomata, and finally into what appear to be simple cysts. These tumors 
may attain an enormous size and may involve practically the whole gland. Malignant tumor- 
growth more rarely attacks the organ. 
When, in spite of treatment, a goitre continues to grow, and especially when there are com- 
mencing symptoms of tracheal pressure, operative interference becomes necessary. This is not 
difficult, if an encapsuled tumor is to be dealt with, provided the anatomical layers covering 
it are remembered. In such a case it is necessary to make an incision suited to the size and 
situation of the tumor, and having divided the deep cervical fascia, to retract the Sternocleido- 
mastoideus or divide it if necessary. The Sternohyoideus and Sternothyreoideus next require 
division, or in some cases their fibres may be separated and drawn asunder, and beneath is found 
the ensheathing capsule derived from the pretracheal fascia; this requires division, and exposes 
the true capsule of the thyroid gland. In the case of an adenoma or cyst, this true capsule then 
needs incision before the tumor can be effectually shelled out, and this is usually accomplished 
with very little hemorrhage, and without any of the main vessels of the gland requiring ligature. 
Partial extirpation of the thyroid, viz., the removal of one lateral lobe with division of the 
isthmus, may be required in cases of parenchymatous goitre, and in the diffuse form of adenoma- 
tous disease. It is a more radical proceeding, and carries with it a much greater risk from hemor- 
rhage; there is also a danger of wounding the recurrent nerve. The whole gland must never be 
removed, as such a procedure is followed by the development of myxedema. In hemithyroid- 
ectomy a free incision is indicated-dividing muscles, if necessary-to expose the true gland, cap- 
sule, but at the same time avoiding injury to the large vessels which lie beneath it. The superior 
and inferior pedicles containing the respective thyroid arteries are then isolated and clamped 
on either side and divided between the clamps. The half gland is then turned over toward the 
'middle line, and the isthmus ligatured and divided. Some venous bleeding is apt to occur from 
connections with the tracheal veins, and must be stopped. The pedicles are then securely liga- 
tured and the wound closed. . In dealing with the inferior thyroid artery, the position of the 
recurrent nerve must be borne in mind, so as not to ligature or divide it. Temporary aphonia 
not uncommonly follows from bruising of the nerve, and if nothing more serious has occurred 
soon passes off. 
THE PARATHYROID GLANDS. 
The parathyroid glands are small brownish-red bodies, situated as a rule between 
the posterior borders of the lateral lobes of the thyroid gland and its capsule. 
They differ from it in structure, being composed of masses of cells arranged in a 
more or less columnar fashion with numerous intervening capillaries. They meas- 
ure on an average about 6 mm. in length, and from 3 to 4 mm. in breadth, and 
usually present the appearance of flattened oval disks. They are divided, accord- 
ing to their situation, into superior and inferior. The superior, usually two in number, 
are the more constant in position, and are situated, one on either side, at the level 
of the lower border of the cricoid cartilage, behind the junction of the pharynx 
and oesophagus. The inferior, also usually two in number, may be applied to the 
lower edge of the lateral lobes, or placed at some little distance below the thyroid 
gland, or found in relation to one of the inferior thyroid veins.1 
1 Consult an article "Concerning the Parathyroid Glands," by D. A. Welsh, Journal of Anatomy and Physiology, 
vol. xxxii. 1264 
SPLANCHNOLOGY 
In man, they number four as a rule; fewer than four were found in less than 1 
per cent, of over a thousand persons (Pepere1), but more than four in over 33 per 
cent, of 122 bodies examined by Civalleri. In addition, numerous minute islands 
of parathyroid tissue may be found scattered in the connective tissue and fat of 
the neck around the parathyroid glands proper, and quite distinct from them. 
Structure.-Microscopically the parathyroids consist of intercommunicating columns of 
cells supported by connective tissue containing a rich supply of blood capillaries. Most of the 
cells are clear, but some, larger in size, contain oxyphil granules. Vesicles containing colloid 
have been described as occurring in the parathyroid, but the observation has not been confirmed. 
Applied Anatomy.-No doubt the parathyroid glands produce an internal secretion essential 
to the well-being of the human economy; but it is still a matter of dispute what symptoms of 
disease are produced by their removal and suppression of their secretion. Pepere believes that 
they show signs of exceptional activity during pregnancy, and that parathyroid insufficiency 
is a main factor in the production of tetany in infants and adults, of eclampsia, and of certain 
sorts of fits. 
THE THYMUS (THYMUS GLANDS) (Fig. 1062). 
The thymus is a temporary organ, attaining its largest size at the time of 
puberty (Hammar), when it ceases to grow, gradually dwindles, and almost 
disappears. If examined when its growth is most active, it will be found to con- 
sist of two lateral lobes placed in close contact along the middle line, situated 
partly in the thorax, partly in the neck, and extending from the fourth costal 
cartilage upward, as high as the lower border of the thyroid gland. It is covered 
by the sternum, and by the origins of the Sternohyoidei and Sternothyreoidei. 
Fig. 1062.-The thymus of a full-time fetus, exposed in situ. 
Below, it rests upon the pericardium, being separated from the aortic arch and 
great vessels by a layer of fascia. In the neck it lies on the front and sides of the 
trachea, behind the Sternohyoidei and Sternothyreoidei. The two lobes generally 
differ in size; they are occasionally united, so as to form a single mass; and some- 
times separated by an intermediate lobe. The thymus is of a pinkish-gray color, 
soft, and lobulated on its surfaces. It is about 5 cm. in length, 4 cm. in breadth 
below, and about 6 mm. in thickness. At birth it weighs about 15 grams. 
Structure.-Each lateral lobe is composed of numerous lobules held together by delicate 
areolar tissue; the entire gland being enclosed in an investing capsule of a similar but denser 
structure. The primary lobules vary in size from that of a pin's head to that of a small pea, and 
are made up of a number of small nodules or follicles, which are irregular in shape and are more 
or less fused together, especially toward the interior of the gland. Each follicle is from 1 to 2 mm. 
1 Consult Le Ghiandole paratiroidee, by A. Pepere, Turin, 1906. THE THYMUS 
1265 
in diameter and consists of a medullary and a cortical portion, and these differ in many essential 
particulars from each other. The cortical portion is mainly composed of lymphoid cells, supported 
by a network of finely branched cells, which is continuous with a similar network in the medullary 
portion. This network forms an adventitia to the bloodvessels. In the medullary portion the 
reticulum is coarser than in the cortex, the lymphoid cells are relatively fewer in number, and 
there are found peculiar nest-like bodies, the concentric corpuscles of Hassall. These concentric 
corpuscles are composed of a central mass, consisting of one or more granular cells, and of a 
capsule which is formed of epithelioid cells (Fig. 1063). They are the remains of the epithelial 
tubes which grow out from the third branchial pouches of the embryo to form the thymus. 
Fig. 1063.-Minute structure of thymus. Follicle of injected thymus from calf, four days old, slightly diagram- 
matic, magnified about 50 diameters. The large vessels are disposed in two rings, one of which surrounds the follicle, 
the other lies just within the margin of the medulla. (Watney.) A and B. From thymus of camel, examined without 
addition of any reagent. Magnified about 400 diameters. A. Large colorless cell, containing small oval masses of 
hemoglobin. Similar cells are found in the lymph glands, spleen, and medulla of bone. B. Colored blood corpuscles. 
Each follicle is surrounded by a vascular plexus, from which vessels pass into the interior, 
and radiate from the periphery toward the centre, forming a second zone just within the margin 
of the medullary portion. In the centre of the medullary portion there are very few vessels, and 
they are of minute size. 
Watney has made the important observation that hemoglobin is found in the thymus, either 
in cysts or in cells situated near to, or forming part of, the concentric corpuscles. This hemo- 
globin occurs as granules or as circular masses exactly resembling colored blood corpuscles. He 
has also discovered, in the lymph issuing from the thymus, similar cells to those found in the 
gland, and, like them, containing hemoglobin in the form of either granules or masses. From 
these facts he arrives at the conclusion that the gland is one source of the colored blood corpuscles. 
More recently Schaffer has observed actual nucleated red-blood corpuscles in the thymus. 
Vessels and Nerves.-The arteries supplying the thymus are derived from the internal 
mammary, and from the superior and inferior thyroids. The veins end in the left innominate 
vein, and in the thyroid veins. The lymphatics are described on page 779. The nerves are 
exceedingly minute; they are derived from the vagi and sympathetic. Branches from the descen- 
dens hypoglossi and phrenic reach the investing capsule, but do not penetrate into the substance 
of the gland. 1266 
SPLANCHNOLOGY 
Applied Anatomy.-Sudden death-thymus death-with heart-failure, and with or without 
acute respiratory embarrassment, has been recorded in a number of infants and children in 
whom the thymus was considerably enlarged and the lymphatic tissues throughout the body 
showed general hypertrophy, but who showed no othei' evidence of disease. Such deaths have 
often occurred during the administration of anesthetics, particularly chloroform. How far the 
enlarged thymus was responsible for the death of these patients, and, if it was responsible, how 
far its action was mechanical, are points that have been much disputed. Short of producing 
this sudden death, it appears that thymic enlargement may cause attacks of respiratory stridor, 
or noisy and difficult breathing, and spasmodic attacks of asthma-thymic asthma-which may 
be frequently repeated and may even result in death. Primary tumors of the thymus are rare 
forms of mediastinal new growth, and are usually dermoids or lymphosarcomas. 
THE SPLEEN (LIEN). 
The spleen is situated principally in the left hypochondriac region, but its supe- 
rior extremity extends into the epigastric region; it lies between the fundus of the 
stomach and the Diaphragma. It is the largest of the ductless glands, and is of 
an oblong, flattened form, soft, of very friable consistence, highly vascular, and 
of a dark purplish color. 
Relations.-The diaphragmatic surface (facies diaphragmatica; external or phrenic surface) is 
convex, smooth, and is directed upward, backward, and to the left, except at its upper end, 
where it is directed slightly medialward. It is in relation with the under surface of the Dia- 
phragma, which separates it from the ninth, tenth, and eleventh ribs of the left side, and the 
intervening lower border of the left lung and pleura. 
The visceral surface (Fig. 1064) is divided by a ridge into an anterior or gastric and a posterior 
or renal portion. 
Fig. 1064.-The visceral surface of the spleen. 
The gastric surface {facies gastrica'), which is directed forward, upward, and medialward, is 
broad and concave, and is in contact with the posterior wall of the stomach; and below this 
with the tail of the pancreas. It presents near its medial border a long fissure, termed the hilus. 
This is pierced by several irregular apertures, for the entrance and exit of vessels and nerves. 
The renal surface {facies renalis') is directed medialward and downward. It is somewhat 
flattened, is considerably narrower than the gastric surface, and is in relation with the upper 
part of the anterior surface of the left kidney and occasionally with the left suprarenal gland. THE SPLEEN 
1267 
The superior extremity (extremitas superior) is directed toward the vertebral column, where 
it lies on a level with the eleventh thoracic vertebra. The lower extremity or colic surface 
(extremitas inferior) is flat, triangular in shape, and rests upon the left flexure of the colon and 
the phrenicocolic ligament, and is generally in contact with the tail of the pancreas. The anterior 
border (margo anterior) is free, sharp, and thin, and is often notched, especially below; it separ- 
ates the diaphragmatic from the gastric surface. The posterior border (margo posterior), more 
rounded and blunter than the anterior, separates the renal from the diaphragmatic surface; 
it corresponds to the lower border of the eleventh rib and lies between the Diaphragma and left 
kidney. The intermediate margin is the ridge which separates the renal and gastric surfaces. 
The inferior border (internal border) separates the diaphragmatic from the colic surface. 
The spleen is almost entirely surrounded by peritoneum, which is firmly adherent to its cap- 
sule. It is held in position by two folds of this membrane. One, the phrenicolienal ligament, 
is derived from the peritoneum, where the wall of the general peritoneal cavity comes into contact 
with the omental bursa between the left kidney and the spleen; the lierial vessels pass between its 
two layers (Fig. 965). The other fold, the gastrolienal ligament, is also formed of two layers, 
derived from the general peritoneal cavity and the omental bursa respectively, where they meet 
between the spleen and stomach (Fig. 965); the short gastric and left gastroepiploic branches 
of the lienal artery run between its two layers. The lower end of the spleen is supported by the 
phrenicocolic ligament (see page 1157). 
The size and weight of the spleen are liable to very extreme variations at different periods 
of life, in different individuals, and in the same individual under different conditions. In the 
adult, it is usually about 12 cm. in length, 7 cm. in breadth, and 3 or 4 cm. in thickness, and 
weighs about 200 grams. At birth, its weight, in proportion to the entire body, is almost equal 
to what is observed in the adult, being as 1 to 350; while in the adult it varies from 1 to 320 and 
400. In old age, the organ not only diminishes in weight, but decreases considerably in propor- 
tion to the entire body, being as 1 to 700. The size of the spleen is increased during and after 
digestion, and varies according to the state of nutrition of the body, being large in highly fed, 
and small in starved animals. Tn malarial fever it becomes much enlarged, weighing occasionally 
as much as 9 kilos. 
Frequently in the neighborhood of the spleen, and especially in the gastrolienal ligament and 
greater omentum, small nodules of splenic tissue may be found, either isolated or connected 
to the spleen by thin bands of splenic tissue. They are known as accessory spleens (lien acces- 
sorius; supernumerary spleen). They vary in size from that of a pea to that of a plum. 
Structure.-The spleen is invested by two coats: an external serous and an internal fibro- 
elastic coat. 
The external or serous coat (tunica serosa) is derived from the peritoneum; it is thin, smooth, 
and in the human subject intimately adherent to the fibroelastic coat. It invests the entire 
organ, except at the hilus and along the lines of reflection of the phrenicolienal and gastrolienal 
ligaments. 
The fibroelastic coat (tunica albuginea) invests the organ, and at the hilus is reflected inward 
upon the vessels in the form of sheaths. From these sheaths, as well as from the inner surface 
of the fibroelastic coat, numerous small fibrous bands, trabeculae (Fig. 1065), are given off in all 
directions; these uniting, constitute the frame-work of the spleen. The spleen therefore consists 
of a number of small spaces or areolae, formed by the trabeculae; in these areolae is contained 
the splenic pulp. 
The fibroelastic coat, the sheaths of the vessels, and the trabeculae, are composed of white and 
yellow elastic fibrous tissues, the latter predominating. It is owing to the presence of the elastic 
tissue that the spleen possesses a considerable amount of elasticity, which allows of the very 
great variations in size that it presents under certain circumstances. In addition to these 
constituents of this tunic, there is found in man a small amount of non-striped muscular fibre; 
and in some mammalia, e. g., dog, pig, and cat, a large amount, so that the trabeculse appear 
to consist chiefly of muscular tissue. 
The splenic pulp (pulpa lienis) is a soft mass of a dark reddish-brown color, resembling grumous 
blood; it consists of a fine reticulum of fibres, continuous with those of the trabeculse, to which 
are applied flat, branching cells. The meshes of the reticulum are filled with blood, in which, 
however, the white corpuscles are found to be in larger proportion than they are in ordinary 
blood. Large rounded cells, termed splenic cells, are also seen; these are capable of amoeboid 
movement, and often contain pigment and red-blood corpuscles in their interior. The cells of 
the reticulum each possess a round or oval nucleus, and like the splenic cells, they may contain 
pigment granules in their cytoplasm; they do not stain deeply with carmine, and in this respect 
differ from the cells of the Malpighian bodies. In the young spleen, giant cells may also be found, 
each containing numerous nuclei or one compound nucleus. Nucleated red-blood corpuscles 
have also been found in the spleen of young animals. 
Bloodvessels of the Spleen.-The lienal artery is remarkable for its large size in proportion 
to the size of the organ, and also for its tortuous course. It divides into six or more branches, 
which enter the hilus of the spleen and ramify throughout its substance (Fig. 1066), receiving 1268 
SPLANCHNOLOGY 
sheaths from an involution of the external fibrous tissue. Similar sheaths also invest the nerves 
and veins. 
Each branch runs in the transverse axis of the organ, from within outward, diminishing in 
size during its transit, and giving off in its passage smaller branches, some of which pass to the 
anterior, others to the posterior part. These ultimately leave the trabecular sheaths, and ter- 
minate in the proper substance of the spleen in small tufts or pencils of minute arterioles, which 
open into the interstices of the reticulum formed by the branched sustentacular cells. Each of 
the larger branches of the artery supplies chiefly that region of the organ in which the branch 
ramifies, having no anastomosis with the majority of the other branches. 
Fig. 1065.-Transverse section of the spleen, showing the trabecular tissue and the splenic vein and its tributaries. 
The arterioles supported by the minute trabeculae, traverse the pulp in all directions in bundles 
(pencilli) of straight vessels. Their trabecular sheaths gradually undergo a transformation, 
become much thickened, and converted into adenoid tissue; the bundles of connective tissue 
becoming looser and their fibrils more delicate, and containing in their interstices an abundance 
of lymph corpuscles (W. Muller). 
Fig. 1066.-Transverse section of the human spleen, showing the distribution of the splenic artery and its branches. 
The altered coat of the arterioles, consisting of adenoid tissue, presents here and there thick- 
enings of a spheroidal shape, the lymphatic nodules (Malpighian bodies of the spleen). These 
bodies vary in size from about 0.25 mm. to 1 mm. in diameter. They are merely local expansions 
or hyperplasise of the adenoid tissue, of which the external coat of the smaller arteries of the spleen THE SPLEEN 
1269 
is formed. They are most frequently found surrounding the arteriole, which thus seems to 
tunnel them, but occasionally they grow from one side of the vessel only, and present the appear- 
ance of a sessile bud growing from the arterial wall. In transverse sections, the artery, in the 
majority of cases, is found in an excentric position. These bodies are visible to the naked eye 
qp the surface of a fresh section of the organ, appearing as minute dots of a semiopaque whitish 
Fig. 1067.-Transverse section of a portion of the spleen. 
color in the dark substance of the pulp. In minute structure they resemble the adenoid tissue 
of lymph glands, consisting of a delicate reticulum, in the meshes of which lie ordinary lymphoid 
cells (Fig. 1067). The reticulum is made up of extremely fine fibrils, and is comparatively open 
in the centre of the corpuscle, becoming closer at its periphery. The cells which it encloses 
are possessed of amoeboid movement. When treated with carmine they become deeply stained, 
and can be easily distinguished from those of the pulp. 
Fig. 1068.-Section of the spleen, showing the termination of the small bloodvessels. 
The arterioles end by opening freely into the splenic pulp; their walls become much attenuated, 
they lose their tubular character, and the endothelial cells become altered, presenting a branched 
appearance, and acquiring processes which are directly connected with the processes of the 
reticular cells of the pulp (Fig. 1068). In this manner the vessels end, and the blood flowing 
through them finds its way into the interstices of the reticulated tissue of the splenic pulp. Thus 1270 
SPLANCHNOLOGY 
the blood passing through the spleen is brought into intimate relation with the elements of the 
pulp, and no doubt undergoes important changes. 
After these changes have taken place the blood is collected from the interstices of the tissue 
by the rootlets of the veins, which begin much in the same way as the arteries end. The con- 
nective-tissue corpuscles of the pulp arrange themselves in rows, in such a way as to form an 
elongated space or sinus. They become elongated and spindle-shaped, and overlap each other 
at their extremities, and thus form a sort of endothelial lining of the path or sinus, which is the 
radicle of a vein. On the outer surfaces of these cells are seen delicate transverse lines or markings, 
which are due to minute elastic fibrillse arranged in a circular manner around the sinus. Thus 
the channel obtains an external investment, and gradually becomes converted into a small 
vein, which after a short course acquires a coat of ordinary connective tissue, lined by a layer of 
flattened epithelial cells which are continuous with the supporting cells of the pulp. The smaller 
veins unite to form larger ones; these do not accompany the arteries, but soon enter the tra- 
becular sheaths of the capsule, and by their junction form six or more branches, which emerge 
from the hilus, and, uniting, constitute the lienal vein, the largest radicle of the portal vein. 
The veins are remarkable for their numerous anastomoses, while the arteries hardly anastomose 
at all. 
The lymphatics are described on page 793. 
The nerves are derived from the coeliac plexus and are chiefly non-medullated. They are 
distributed to the bloodvessels and to the smooth muscle of the capsule and trabeculae. 
Applied Anatomy.-Injury of the spleen is less common than that of the liver, on account of 
its protected situation and connections. It may be ruptured by direct or indirect violence; torn 
by a broken rib; or injured by a punctured or gunshot wound. When the organ is enlarged, the 
chance of rupture is increased. The great risk is hemorrhage, owing to the vascularity of the 
organ, and the absence of a proper system of capillaries. The injury is not, however, necessarily 
fatal, and this would appear to be due, in a great measure, to the contractile power of the cap- 
sule, which narrows the wound and prevents the escape of blood. In cases where the diagnosis 
is clear, and the symptoms indicate danger to life, laparotomy must be performed, and if the 
hemorrhage cannot be stayed by ordinary surgical methods, the spleen must be removed. 
The spleen may become enormously enlarged in certain diseased conditions, such as ague, 
leukemia, syphilis, valvular disease of the heart, or without any obtainable history of previous 
disease. It may also become enlarged in lymphadenoma, as a part of a general blood-disease. 
In these cases the tumor may fill a considerable part of the abdomen and extend into the pelvis, 
and may be mistaken for ovarian or uterine new growth. 
The spleen is sometimes the seat of cystic tumors, especially hydatids, and of abscess. These 
cases require treatment by incision and drainage; and in abscess great care must be taken, if 
there are no adhesions between the spleen and abdominal wall, to prevent the escape of any of 
the pus into the peritoneal cavity. If possible the operation should be performed in two stages. 
Sarcoma and carcinoma are occasionally found in the spleen, but very rarely as primary diseases. 
Extirpation of the spleen has been performed for wounds or injuries, in floating spleen, in 
simple hypertrophy, in leukemic enlargement (but the operation is now considered unjustifiable 
in this condition), and in the case of enlargement due to certain obscure parasitic infections met 
with in hot climates. The incision is best made in the left semilunar line; the spleen is isolated 
from its surroundings and delivered from the abdomen; the pedicle is then transfixed and ligatured 
in two portions. 
THE SUPRARENAL GLANDS (GLANDULAE SUPRARENALIS; ADRENAL 
CAPSULE) (Figs. 1069, 1070). 
The suprarenal glands are two small flattened bodies of a yellowish color, situated 
at the back part of the abdomen, behind the peritoneum, and immediately above 
and in front of the upper end of each kidney; hence their name. The right one is 
somewhat triangular in shape, bearing a resemblance to a cocked hat; the left is 
more semilunar, usually larger, and placed at a higher level than the right. They 
vary in size in different individuals, being sometimes so small as to be scarcely 
detected: their usual size is from 3 to 5 cm. in length, rather less in width, and from 
4 to 6 mm. in thickness. Their average weight is from 1.5 to 2.5 gm. each. 
Relations.-The relations of the suprarenal glands differ on the two sides of the body. 
The right suprarenal is situated behind the inferior vena cava and right lobe of the liver, and 
in front of the Diaphragma and upper end of the right kidney. It is roughly triangular in shape; 
its base, directed downward, is in contact with the medial and anterior aspects of the upper end THE SUPRARENAL GLANDS 
1271 
of the right kidney. It presents two surfaces for examination, an anterior and a posterior. The 
anterior surface looks forward and lateralward, and has two areas: a medial, narrow, and non- 
peritoneal, which lies behind the inferior vena cava; and a lateral, somewhat triangular, in 
contact with the liver. The upper part of the latter surface is devoid of peritoneum, and is in 
relation with the bare area of the liver near its lower and medial angle, while its inferior portion 
is covered by peritoneum, reflected on to it from the inferior layer of the coronary ligament; 
occasionally the duodenum overlaps the inferior portion. A little below the apex, and near 
the anterior border of the gland, is a short furrow termed the hilus, from which the suprarenal 
vein emerges to join the inferior vena cava. The posterior surface is divided into upper and 
lower parts by a curved ridge: the upper, slightly convex, rests upon the Diaphragma; the 
lower, concave, is in contact with the upper end and the adjacent part of the anterior surface 
of the kidney. 
Fig. 1069.-Suprarenal glands viewed from the front. 
The left suprarenal, slightly larger than the right, is crescentic in shape, its concavity being 
adapted to the medial border of the upper part of the left kidney. It presents a medial border, 
which is convex, and a lateral, which is concave; its upper end is narrow, and its lower rounded. 
Its anterior surface has two areas: an up^er one, covered by the peritoneum of the omental 
bursa, which separates it from the cardiac end of the stomach, and sometimes from the superior 
extremity of the spleen; and a lower one, which is in contact with the pancreas and lienal 
artery, and is therefore not covered by the peritoneum. On the anterior surface, near its lower 
end, is a furrow or hilus, directed downward and forward, from which the suprarenal vein 
emerges. Its posterior surface presents a vertical ridge, which divides it into two areas; the 
lateral area rests on the kidney, the medial and smaller on the left crus of the Diaphragma. 
Fig. 1070.-Suprarenal glands viewed from behind. 
The surface of the suprarenal gland is surrounded by areolar tissue containing much fat, and 
closely invested by a thin fibrous capsule, which is difficult to remove on account of the numerous 
fibrous processes and vessels entering the organ through the furrows on its anterior surface and 
base. 
Small accessory suprarenals (glandulae suprarenales accessoriae) are often to be found in the 
connective tissue around the suprarenals. The smaller of these, on section, show a uniform 
surface, but in some of the larger a distinct medulla can be made out. 
Structure.-On section, the suprarenal gland is seen to consist of two portions (Fig. 1071): 
an external or cortical and an internal or medullary. The former constitutes the chief part of 
the organ, and is of a deep yellow color; the medullary substance is soft, pulpy, and of a dark red 
or brown color. 1272 
SPLANCHNOLOGY 
The cortical portion (substantia corticalis') consists of a fine connective-tissue net-work, in 
which is imbedded the glandular epithelium. The epithelial cells are polyhedral in shape and 
possess rounded nuclei; many of the cells contain coarse granules, others lipoid globules. Owing 
to differences in the arrangement of the cells, three distinct zones can be made out: (1) the zona 
glomerulosa, situated beneath the capsule, consists of cells arranged in rounded groups, with 
here and there indications of an alveolar structure; the cells of this zone are very granular, and 
stain deeply. (2) The zona fasciculata, continuous with the zona glomerulosa, is composed of 
columns of cells arranged in a radial manner; these cells contain finer granules and in many 
instances globules of lipoid material. (3) The zona reticularis, in contact with the medulla, 
consists of cylindrical masses of cells irregularly arranged; these cells often contain pigment 
granules which give this zone a darker appearance than the rest of the cortex. 
The medullary portion (substantia medullaris) is extremely vascular, and is composed of a 
loose mesh-work of connective tissue surrounding a large plexus of sinusoidal venous spaces and 
containing non-striped muscular fibres. In addition to the veins, multinucleated masses of 
protoplasm are scattered throughout the medulla as well as many irregular-shaped cells con- 
taining pigment. The cell protoplasm has an especial affinity for chromic salts, which stain it 
a brown color. Such cells are therefore termed chromaffin cells (see page 133). This portion 
of the gland is richly supplied with non-medullated nerve fibres, and here and there sympathetic 
ganglia are found. 
Fig. 1071.-Section of a part of a suprarenal gland. (Magnified.) 
Vessels and Nerves.-The arteries supplying the suprarenal glands are numerous and of 
comparatively large size; they are derived from the aorta, the inferior phrenic, and the renal. 
They subdivide into minute branches previous to entering the cortical part of the gland, where 
they break up into capillaries which end in the venous plexus of the medullary portion. 
The suprarenal vein returns the blood from the medullary venous plexus and receives several 
branches from the cortical substance; it emerges from the hilus of the gland and on the right 
side opens into the inferior vena cava, on the left into the renal vein. 
The lymphatics end in the lumbar glands. 
The nerves are exceedingly numerous, and are derived from the coeliac and renal plexuses, 
and, according to Bergmann, from the phrenic and vagus nerves. They enter the lower and 
medial part of the capsule, traverse the cortex, and end around the cells of the medulla. They 
have numerous small ganglia developed upon them in the medullary portion of the gland. 
In connection with the development of the medulla from the sympathochromaffin tissue, it is 
to be noted that this portion of the gland secretes a substance, adrenalin, which has a powerful 
influence on those muscular tissues which are supplied by sympathetic fibres. 
Applied Anatomy.-The suprarenal cortex is derived from the coelomic epithelium of the 
Wolffian ridge, and is connected with the sexual glands; it is related to growth and development 
in some way, and is often found to be hypertrophied in patients with chronic kidney disease 
and high blood-pressure. The medulla, on the other hand, is neuro-ectodermal in origin, and THE COCCYGEAL SKEIN 
1273 
closely connected with the sympathetic nervous system. When the suprarenal medulla is 
destroyed by tuberculosis, to which the glands are prone, or by the pressure of a new growth, 
the secretion of adrenalin becomes inadequate, and Addison's disease develops. Patients with 
Addison's disease become pigmented in various parts of the body, possibly from irritation of 
the sympathetic, and complain of great weakness, lack of energy, nausea, and severe attacks of 
vomiting. Their blood-pressure is low, the whole nervous system is depressed, and death follows 
after a period of months or years, usually from asthenia. Tumors derived from the suprarenal 
itself, or from misplaced suprarenal "rests" occurring in such organs as the kidney or liver, may 
be either benign or malignant, and are classed together under the name "hypernephroma." 
In children the malignant hypernephroma is often associated with obesity and precocity. The 
benign hypernephroma, or suprarenal adenoma, appears to produce no symptoms except those 
due to its slow enlargement. 
THE CAROTID SKEINS (GLOMERA CAROTICA; CAROTID GLANDS; 
CAROTID BODIES.) 
The carotid skeins, two in number, are situated one on either side of the neck, 
behind the common carotid artery at its point of bifurcation into the external 
and internal carotid trunks. They are reddish brown in color and oval in shape, 
the long diameter measuring about 5 mm. 
Fig. 1072.-Section of part of human glomus caroticum. (Schaper.) Highly magnified. Numerous bloodvessels are 
seen in section among the gland cells. 
Each is invested by a fibrous capsule and consists largely of spherical or irregular 
masses of cells (Fig. 1072), the masses being more or less isolated from one another 
by septa which extend inward from the deep surface of the capsule. The cells 
are polyhedral in shape, and each contains a large nucleus imbedded in finely 
granular protoplasm, which is stained yellow by chromic salts. Numerous nerve 
fibres, derived from the sympathetic plexus on the carotid artery, are distributed 
throughout the organ, and a net-work of large sinusoidal capillaries ramifies among 
the cells. 
THE COCCYGEAL SKEIN (GLOMUS COCCYGEUM; COCCYGEAL GLAND 
OR BODY: LUSCHKA'S GLAND). 
The coccygeal skein is placed in front of, or immediately below, the tip of the 
coccyx. It is about 2.5 mm. in diameter and is irregularly oval in shape; several 
smaller nodules are found around or near the main mass. 
It consists of irregular masses of round or polyhedral cells (Fig. 1073), the cells 
of each mass being grouped around a dilated sinusoidal capillary vessel. Each cell 1274 
SPLANCHNOLOGY 
contains a large round or oval nucleus, the protoplasm surrounding which is clear, 
and is not stained by chromic salts.1 
Fig. 1073.-Section of an irregular nodule of the glomus coccygeum. (Sertoli.) X 85. The section shows the 
fibrous covering of the nodule, the bloodvessels Within it, and the epithelial cells of which it is constituted. 
Besides the ductless glands mentioned, reference may be made to a pair of small 
bodies, the aortic bodies of Zuckerkandl. These are found in the embryo, and persist 
until shortly after birth; they lie one on either side of the abdominal aorta between 
the superior mesenteric and common iliac arteries (see page 133). They consist 
essentially of masses of polygonal or cuboidal chromaffin cells imbedded in a 
wide-meshed capillary plexus. 
1 Consult the following article: "Uber die menschliche Steissdriise," von J. W. Thomson Walker, Archiv fiir mikro- 
skopisehe Anatomie und Entwickelungsgeschichte, Band 64, 1904. SURFACE ANATOMY AND SURFACE 
MARKINGS. 
SURFACE ANATOMY OF THE HEAD AND NECK. 
Bones (Fig. 1074).-Various bony surfaces and prominences on the skull can be 
easily identified by palpation. The external occipital protuberance is situated 
behind, in the middle line, at the junction of the skin of the neck with that of the 
head. The superior nuchal line runs lateralward from it on either side, while extend- 
ing downward from it is the median nuchal crest, situated deeply at the bottom 
of the nuchal furrow. Above the superior nuchal lines the vault of the cranium 
Fig. 1074.-Side view of head, showing surface relations of bones. 
is thinly covered with soft structures, so that the form of this part of the head is 
almost that of the upper portion of the occipital, the parietal, and the frontal 
bones. The superior nuchal line can be followed lateralward to the mastoid por- 
tion of the temporal bone, from which the mastoid process projects downward 
and forward behind the ear. The anterior and posterior borders, the apex, and 
the external surface of this process are all available for superficial examination the 
anterior border lies immediately behind the concha, and the apex is on a level 1276 
SURFACE ANATOMY AND SURFACE MARKINGS 
with the lobule of the auricula. About 1 cm. below and in front of the apex of 
the mastoid process, the transverse process of the atlas can be distinguished. In 
front of the ear the zygomatic arch can be felt throughout its entire length; its 
posterior end is narrow and is situated a little above the level of the tragus; its 
anterior end is broad and is continued into the zygomatic bone. The lower border 
of the arch is more distinct than the upper, which is obscured by the attachment 
of the temporal fascia. In front, and behind, the upper border of the arch can be 
followed into the superior temporal line. In front, this line begins at the zygomatic 
process of the frontal bone as a curved ridge which runs at first forward and 
upward on the frontal bone, and then curving backward separates the forehead 
from the temporal fossa. It can then be traced across the parietal bone, where, 
though less marked, it can generally be recognized. Finally, it curves downward, 
and forward, and passing above the external acoustic meatus, ends in the posterior 
root of the zygomatic arch. Near the line of the greatest transverse diameter of 
the head are the parietal eminences, one on either side of the middle line; further 
forward, on the forehead, are the frontal eminences, which vary in prominence in 
different individuals and are frequently unsymmetrical. Below the frontal emi- 
nences the superciliary arches, which indicate the position of the frontal sinuses, 
can be recognized; as a rule they are small in the female and absent in children. 
In some cases the prominence of the superciliary arches is related to the size of 
the frontal sinuses, but frequently there is no such relationship. Situated between, 
and connecting the superciliary ridges, is a smooth, somewhat triangular area, the 
glabella, below which the nasion (frontonasal suture) can be felt as a slight depres- 
sion at the root of the nose. 
Below the nasion the nasal bones, scantily covered by soft tissues, can be traced 
to their junction with the nasal cartilages, and on either side of the nasal bone 
the complete outline of the orbital margin can be made out. At the junction of 
the medial and intermediate thirds of the supraorbital margin the supraorbital 
notch, when present, can be felt; close to the medial end of the infraorbital margin 
is a little tubercle which serves as a guide to the position of the lacrimal sac. Below 
and lateral to the orbit, on either side, is the zygomatic bone forming the prominence 
of the cheek; its posterior margin is easily palpable, and on it just above the level 
of the lateral palpebral commissure is the zygomatic tubercle. A slight depression, 
about 1 cm. above this tubercle, indicates the position of the zygomaticofrontal 
suture. Directly below the orbit a considerable part of the anterior surface of the 
maxilla and the whole of its alveolar process can be palpated. The outline of the 
mandible can be recognized throughout practically its entire extent; in front of 
the tragus and below the zygomatic arch is the condyle, and 'from this the posterior 
border of the ramus can be followed to the angle; from the angle to the symphysis 
the lower rounded border of the mandible can be easily traced; the lower part of 
the anterior border of the ramus and the alveolar process can be made out without 
difficulty. In the receding angle below the chin is the hyoid bone, and the finger 
can be carried along the bone to the tip of the greater cornu, which is on a level 
with the angle of the mandible: the greater cornu is most readily appreciated 
by making pressure on one side, when the cornu of the opposite side will be rendered 
prominent and can be felt distinctly beneath the skin. 
Joints and Muscles.-The temporomandibular articulation is quite superficial, and 
is situated below the posterior end of the zygomatic arch, in front of the external 
acoustic meatus. Its position can be ascertained by defining the condyle of the 
mandible; when the mouth opens, the condyle advances out of the mandibular 
fossa on to the articular tubercle, and a depression is felt in the situation of the 
joint. 
The outlines of the muscles of the head and face cannot be traced on the surface 
except in the case of the Masseter and Temporalis. The muscles of the scalp SURFACE ANATOMY OF THE HEAD AND NECK 
1277 
are so thin that the outline of the bone is perceptible beneath them. Those of 
the face are small, covered by soft skin, and often by a considerable layer of fat, 
and their outlines are therefore concealed; they serve, however, to round off and 
smooth prominent borders, and to fill up what would otherwise be unsightly 
angular depressions. Thus the Orbicularis oculi rounds off the prominent margin 
of the orbit, and the Procerus fills in the sharp depression below the glabella. In 
like manner the labial muscles converging to the lips, and assisted by the super- 
imposed fat, fill up the sunken hollow of the lower part of the face. When in 
action the facial muscles produce the various expressions, and in addition through 
the skin into numerous folds and wrinkles. The Masseter imparts fulness to the 
hinder part of the cheek; if firmly contracted, as when the teeth are clenched, its 
quadrilateral outline is plainly visible; the anterior border forms a prominent 
vertical ridge, behind which is a considerable fulness especially marked at the 
Fig. 1075.-Anterolateral view of head and neck. 
lower part of the muscle. The Temporalis is fan-shaped and fills the temporal 
fossa, substituting for the concavity a somewhat convex swelling, the anterior 
part of which, on account of the absence of hair on the overlying skin, is more 
marked than the posterior, and stands out in strong relief when the muscle is in 
action. 
In the neck, the Platysma when contracted throws the skin into oblique ridges 
parallel with the fasciculi of the muscle. The Sternocleidomastoideus has the most 
important influence on the surface form of the neck (Figs. 1075, 1076). When the 
muscle is at rest its anterior border forms an oblique rounded edge ending below in 
the sharp outline of the sternal head; the posterior border is only distinct for about 
2 or 3 cm. above the middle of the clavicle. During contraction, the sternal head 
stands out as a sharply defined ridge, while the clavicular head is flatter and less 
prominent; between the two heads is a slight depression: the fleshy middle portion 1278 
SURFACE ANATOMY AND SURFACE MARKINGS 
of the muscle appears as an oblique elevation with a thick, rounded, anterior border, 
best marked in its lower part. The sternal heads of the two muscles are separated 
by a V-shaped depression, in which are the Sternohyoideus and Sternothyreoideus. 
Above the hyoid bone, near the middle line, the anterior belly of the Digastricus 
produces a slight convexity. 
The anterior border of the Trapezius presents as a faint ridge running from the 
superior nuchal line, downward and forward to the junction of the intermediate 
and lateral thirds of the clavicle. Between the Sternocleidomastoideus and the 
Trapezius is the posterior triangle of the neck, the lower part of which appears as 
a shallow concavity-the supraclavicular fossa. In this fossa, the inferior belly of 
the Omohyoideus, when in action, presents as a rounded cord-like elevation a little 
above, and almost parallel to, the clavicle. 
Arteries.-The positions of several of the larger arteries can be ascertained 
from their pulsations. 
The subclavian artery can be felt by making pressure downward, backward, and 
medialward behind the clavicular head of the Sternocleidomastoideus; its transverse 
cervical branch may be detected parallel to, and about a finger's breadth above, 
the clavicle. The common and external carotid arteries can be recognized immediately 
beneath the anterior edge of the Sternocleidomastoideus. The external maxillary 
artery can be traced over the border of the mandible just in front of the anterior 
border of the Masseter, then about 1 cm. lateral to the angle of the mouth, and 
finally as it runs up the side of the nose. The pulsation of the occipital artery 
can be distinguished about 3 or 4 cm. lateral to the external occipital protuberance; 
that of the posterior auricular in the groove between the mastoid process and the 
auricula. The course of the superficial temporal artery can be readily followed 
across the posterior end of the zygomatic arch to a point about 3 to 5 cm. above 
this, where it divides into its frontal and parietal branches; the pulsation of the 
frontal branch is frequently visible on the side of the forehead. The supraorbital 
artery can usually be detected immediately above the supraorbital notch or foramen. 
Fig. 1076.-Front view of neck. SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1279 
SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK. 
The Cranium.-Scalp-The soft parts covering the upper surface of the skull 
form the scalp and comprise the following layers (Fig. 1077): (1) skin, (2) subcuta- 
neous tissue, (3) Occipitalis frontalis and galea aponeurotica, (4) subaponeurotic tissue, 
(5) pericranium. The subcutaneous tissue consists of a close mesh-work of fibres, 
the meshes of which contain fatty tissue; the fibres bind the skin and galea aponeu- 
rotica firmly together, so that when the Occipitalis or the Frontalis is in action 
the skin moves with the aponeurosis. The subaponeurotic tissue, which intervenes 
between the galea aponeurotica and the pericranium, is much looser in texture, 
and permits the movement of the aponeurosis over the underlying bones. 
Fig. 1077.-Diagrammatic section of scalp. 
Bony Landmarks (Fig. 1074).-In addition to the bony points already described 
which can be determined by palpation, the following are utilized for surface 
markings: 
Auricular Point.-The centre of the orifice of the external acoustic meatus. 
Preauricular Point.-A point on the posterior root of the zygomatic arch imme- 
diately in front of the external acoustic meatus. 
Asterion.-The point of meeting of the lambdoidal, mastobccipital, and masto- 
parietal sutures; it lies 4 cm. behind and 12 mm. above the level of the auricular 
point. 
Pterion.-The point where the great wing of the sphenoid joins the sphenoidal 
angle of the parietal; it is situated 35 mm. behind, and 12 mm. above, the level 
of the frontozygomatic suture. 
Inion.-The external occipital protuberance. 
Lambda.-The point of meeting of the lambdoidal and sagittal sutures; it is 
in the middle line about 6.5 cm. above the inion. 
Bregma.-The meeting-point of the coronal and sagittal sutures; it lies at the 
point of intersection of the middle line of the scalp with a line drawn vertically 
upward through the preauricular point. 
A line passing through the inferior margin of the orbit and the auricular point 
is known as Reid's base line. The lambdoidal suture can be indicated on either 1280 
SURFACE ANATOMY AND SURFACE MARKINGS 
side by the upper two-thirds of a line from the lambda to the tip of the mastoid 
process. The sagittal suture is in the line joining the lambda to the bregma. The 
position of the coronal suture on either side is sufficiently represented by a line 
joining the bregma to the centre of the zygomatic arch. 
The floor of the middle fossa of the skull is at the level of the posterior three- 
fourths of the upper border of the zygomatic arch; the articular eminence of the 
temporal bone is opposite the foramen spinosum and the semilunar ganglion. 
Fig. 1078.-Drawing of a cast by Cunningham to illustrate the relations of the brain to the skull. 
Brain (Figs. 1078, 1079).-The general outline of the cerebral hemisphere, on 
either side, may be mapped out on the surface in the following manner. Starting 
from the nasion, a line drawn along the middle of the scalp to the inion represents 
the superior border. The line of the lower margin behind is that of the transverse 
sinus (see page 1282), or more roughly a line convex upward from the inion to the 
posterior root of the zygomatic process of the temporal bone; thence along the 
posterior two-thirds of the upper border of the zygomatic arch where the line turns 
up to the pterion; the front part of the lower margin extends from the pterion to 
the glabella about 1 cm. above the supraorbital margin. The cerebellum is so deeply 
situated that there is no reliable surface marking for it; a point 4 cm. behind and 
1.5 cm. below the level of the auricular point is situated directly over it. 
The relations of the principal fissures and gyri of the cerebral hemispheres to 
the surface of the scalp are of considerable practical importance, and several 
methods of indicating them have been devised. Necessarily these methods can SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1281 
only be regarded as approximately correct, yet they are all sufficiently accurate 
for surgical purposes. The longitudinal fissure corresponds to the medial line of 
the scalp between the nasion and inion. In order to mark out the lateral cerebral 
{Sylvian) fissure a point, termed the Sylvian point, which practically corresponds 
to the pterion, is defined 35 mm. behind and 12 mm. above the level of the fronto- 
zygomatic suture; this point marks the spot where the lateral fissure divides. 
Another method of defining the Sylvian point is to divide the distance between 
the nasion and inion into four equal parts; from the junction of the third and 
fourth parts (reckoning from the front) draw a line to the frontozygomatic suture; 
from the junction of the first and second parts a line to the auricular point. These 
two lines intersect at the Sylvian point and the portion of the first line behind 
this point overlies the posterior ramus of the lateral cerebral fissure. The position 
Fig. 1079.-Relations of the brain and middle meningeal artery to the surface of the skull. 1. Nasion. 2. Inion. 
3. Lambda. 4. Lateral cerebral fissure. 5. Central sulcus. A A. Reid's base line. B. Point for trephining the anterior 
branch of the middle meningeal artery. C. Suprameatal triangle. D. Sigmoid bend of the transverse sinus. E. 
Point for trephining over the straight portion of the transverse sinus, exposing dura mater of both cerebrum and 
cerebellum. Outline of cerebral hemisphere indicated in blue; course of middle meningeal artery in red. 
of the posterior ramus can otherwise be obtained by joining the Sylvian point to a 
point 2 cm. below the summit of the parietal eminence. The anterior ascending 
ramus can be marked out by drawing a line upward at right angles to the line 
of the posterior ramus for 2 cm. and the anterior horizontal ramus by a line of the 
same length drawn horizontally forward-both from the Sylvian point. To define 
the central sulcus {fissure of Rolando) two points are taken; one is situated 1.25 
cm. behind the centre of the line joining the nasion and inion; the second is at 
the intersection of the line of the posterior ramus of the lateral cerebral fissure 
with a line through the preauricular point at right angles to Reid's base line. The 
upper 9 cm. of the line joining these two points overlies the central sulcus and forms 
an angle, opening forward, of about 70° with the middle line of the scalp. An 
alternative method is to draw two perpendicular lines from Reid's base line to the 
top of the head; one from the preauricular point and the other from the posterior 1282 
SURFACE ANATOMY AND SURFACE MARKINGS 
border of the mastoid process at its root. A line from the upper end of the posterior 
line to the point where the anterior intersects the line of the posterior ramus of the 
lateral fissure indicates the position of the central sulcus. The precentral and 
postcentral sulci are practically parallel to the central sulcus; they are situated 
respectively about 15 mm. in front of, and behind, it. The superior frontal sulcus 
can be mapped out by a line drawn from the junction of the upper and middle 
thirds of the precentral sulcus, in a direction parallel with the longitudinal sulcus, 
to a point midway between the middle line of the forehead and the temporal line, 
4 cm. above the supraorbital notch. The inferior frontal sulcus begins at the junc- 
tion of the middle and lower thirds of the precentral sulcus, and follows the course 
of the superior temporal line. 
The horizontal limb of the intraparietal sulcus begins from the junction of the 
lower with the middle third of the postcentral sulcus and curves backward parallel 
to the longitudinal fissure, midway between it and the parietal eminence; it then 
curves downward to end midway between the lambda and the parietal eminence. 
The external part of the parietooccipital fissure runs lateralward at right angles 
to the longitudinal fissure for about 2.5 cm. from a point 5 mm. in front of the 
lambda. If the line of the posterior ramus of the lateral cerebral fissure be 
continued back to the longitudinal fissure, the last 2.5 cm. of it will indicate the 
position of the parietooccipital fissure. 
The lateral ventricle may be circumscribed by a quadrilateral figure. The upper 
limit is a horizontal line 5 cm. above the zygomatic arch; this defines the roof of 
the ventricle. The lower limit is a horizontal line 1 cm. above the zygomatic arch; 
it indicates the level of the end of the inferior horn. Two vertical lines, one through 
the junction of the anterior and middle thirds of the zygomatic arch, and the other 
5 cm. behind the tip of the mastoid process, indicate the extent of the anterior 
horn in front and the posterior horn behind. 
Vessels.-The line of the anterior division of the middle meningeal artery is 
equidistant from the frontozygomatic suture and the zygomatic arch; it is obtained 
by joining up the following points: (1) 2.5 cm., (2) 4 cm., and (3) 5 cm. from 
these two landmarks. The posterior division can be reached 2.5 cm. above the 
auricular point. 
The position of the transverse sinus is obtained by taking two lines: the first 
from the inion to a point 2.5 cm. behind the auricular point; the second from the 
anterior end of the first to the tip of the mastoid process. The second line corre- 
sponds roughly to the line of reflection of the skin of the auricula behind, and its 
upper two-thirds represents the sigmoid part of the sinus. The first part of the 
sinus has a slight upward convexity, and its highest point is about 4 cm. behind 
and 1 cm. above the level of the auricular point. The width of the sinus is 
about 1 cm. 
The Face.--Air Sinuses (Fig. 1080).-The frontal and maxillary sinuses vary 
so greatly in form and size that their surface markings must be regarded as only 
roughly approximate. To mark out the position of the frontal sinus three points 
are taken: (1) the nasion, (2) a point in the middle line 3 cm. above the nasion, 
(3) a point at the junction of the lateral and intermediate thirds of the supraorbital 
margin. By joining these a triangular field is described which overlies the greater 
part of the sinus. The outline of the maxillary sinus is irregularly quadrilateral 
and is obtained by joining up the following points: (1) the lacrimal tubercle, (2) 
a point on the zygomatic bone at the level of the inferior and lateral margins of the 
orbit, (3) and (4) points on the alveolar process above the last molar and the second 
premolar teeth respectively. 
External Maxillary Artery.-The course of this artery on the face may be indicated 
by a line starting from the lower border of the mandible at the anterior margin 
of the Masseter, and running at first forward and upward to a point 1 cm. lateral SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1283 
to the angle of the mouth, thence to the ala of the nose and upward to the medial 
commissure of the eye (Fig. 1081). 
Trigeminal Nerve.-Terminal branches of this nerve, viz., the supraorbital branch 
of the ophthalmic, the infraorbital of the maxillary, and the mental of the mandibular 
emerge from corresponding foramina on the face (Fig. 1081). The supraorbital 
foramen is situated at the junction of the medial and intermediate thirds of the 
supraorbital margin. A line drawn from this foramen to the lower border of the 
mandible, through the interval between the two lower premolar teeth, passes over 
the infraorbital and mental foramina; the former lies about 1 cm. below the margin 
of the orbit, while the latter varies in position according to the age of the individual; 
in the adult it is midway between the upper and lower borders of the mandible, 
in the child it is nearer the lower border, while in the edentulous jaw of old age 
it is close to the upper margin. 
Fig. 1080.-Outline of bones of face, showing position of 
air sinuses. 
Fig. 1081.-Outline of side of face, showing chief 
surface markings. 
The position of the sphenopalatine ganglion is indicated from the side by a 
point on the upper border of the zygomatic arch, 6 mm. from the margin of the 
zygomatic bone. 
Parotid Gland (Fig. 1081).--The upper border of the parotid gland corresponds to 
the posterior two-thirds of the lower border of the zygomatic arch; the posterior 
border to the front of the external acoustic meatus, the mastoid process, and the 
anterior border of Sternocleidomastoideus. The inferior border is indicated by a 
line from the tip of the mastoid process to the junction of the body and greater 
cornu of the hyoid bone. In front, the anterior border extends for a variable dis- 
tance on the superficial surface of the Masseter. The surface marking for the parotid 
duct is a line drawn across the face about a finger's breadth below the zygomatic 
arch, i. e., from the lower margin of the concha to midway between the red margin 1284 
SURFACE ANATOMY AND SURFACE MARKINGS 
of the lip and the ala of the nose; the duct ends opposite the second upper molar 
tooth and measures about 5 cm. in length. 
The Nose.-The outlines of the nasal bones and the cartilages forming the exter- 
nal nose can be easily felt. The mobile portion of the nasal septum, formed by 
the medial crura of the greater alar cartilages and the skin, is easily distinguished 
between the nares. When the head is tilted back and a speculum introduced 
through the naris, the floor of the nasal cavity, the lower part of the nasal septum, 
and the anterior ends of the middle and inferior nasal conchse can be examined. 
The opening of the nasolacrimal duct, which, lies under cover of the front of the 
inferior nasal concha, is situated about 2.5 cm. behind the naris and 2 cm. above 
the level of the floor of the nasal cavity. 
Fig. 1082.-The mouth cavity. The cheeks have been slit transversely and the tongue pulled forward. 
The Mouth.-The orifice of the mouth is bounded by the lips, which are covered 
externally by the whitish skin and internally by the red mucous membrane. The 
size of the orifice varies considerably in different individuals, but seems to bear a 
close relationship to the size and prominence of the teeth; its angles usually corre- 
spond to the lateral borders of the canine teeth. Running down the centre of the 
outer surface of the upper lip is a shallow groove-the philtrum. If the lips be 
everted there can be seen, in the middle line of each, a small fold of mucous mem- 
brane-the frenulum-passing from the lip to the gum. By pulling the angle of the SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1285 
mouth outward the mucous membrane of the cheek can be inspected, and on this, 
opposite the second molar tooth of the maxilla, is the little papilla which marks 
the orifice of the parotid duct. 
In the floor of the mouth is the tongue (Fig. 1082). Its upper surface is convex 
and is marked along the middle line by a shallow sulcus; the anterior two-thirds 
are rough and studded with papillae; the posterior third is smooth and tuberculated. 
The division between the anterior two-thirds and the posterior third is marked 
by a V-shaped furrow, the sulcus terminalis, which is situated immediately behind 
the line of the vallate papillae. 
Fig. 1083.-The mouth cavity. The apex of the tongue is turned upward, and on the right side a superficial 
dissection of its under surface has been made. 
On the under surface of the tongue (Fig. 1083) the mucous membrane is smooth 
and devoid of papillae. In the middle line, the mucous membrane extends to the 
floor of the mouth as a distinct fold-the frenulum-the free edge of which runs 
forward to the symphysis menti. Sometimes the ranine vein can be seen immedi- 
ately beneath the mucous membrane, a little lateral to the frenulum. Close to the 
attachment of the frenulum to the floor of the mouth, the slit-like orifice of the 
submaxillary duct is visible on either side. Running backward and lateralward 
from the orifice of the submaxillary duct is the plica sublingualis, produced by 
the projection of the sublingual gland which lies immediately beneath the mucous 
membrane. ' The plica serves also to indicate the line of the submaxillary duct 
and of the lingual nerve. At the back of the mouth is the isthmus faucium, bounded 
above by the palatine velum, from the free margin of which the uvula projects 
downward in the middle line. On either side of the isthmus are the two palatine 
arches, the anterior formed by the Glossopalatinus and the posterior by the Pharyn- 1286 
SURFACE ANATOMY AND SURFACE MARKINGS 
gopalatinus. Between the two arches of either side is the palatine tonsil, above 
which is the small supratonsillar recess; the position of the tonsil corresponds to 
the angle of the mandible. When the mouth is opened widely, a tense band- 
the pterygomandibular raphe-can be seen and felt lateral to the glossopalatine 
arch. Its lower end is attached to the mandible behind the last molar tooth, 
and immediately below and in front of this the lingual nerve can be felt; the upper 
Fig. ..1084.-Front of nasal part of pharynx, as seen with the laryngoscope. 
end of the ligament can be traced to the pterygoid hamulus. About 1 cm. in front 
of the hamulus and 1 cm. medial to the last molar tooth of the maxilla is the greater 
palatine foramen through which the descending palatine vessels and the anterior 
palatine nerve emerge. Behind the last molar tooth of the maxilla the coronoid 
process of the mandible is palpable. 
Fig. 1085.-Laryngoscopic view of interior of larynx 
By tilting the head well back a portion of the posterior pharyngeal wall, corre- 
sponding to the site of the second and third cervical vertebrae, can be seen through 
the isthmus faucium. On introducing the finger the anterior surfaces of the upper 
cervical vertebrae can be. felt through the thin muscular wall of the pharynx; 
if the finger be hooked round the palatine velum, the choanae can be distinguished in 
front, and the pharyngeal ostium of the auditory tube on either side. The level 
of the choanae is that of the atlas, while the palatine velum is opposite the body 
of the axis. SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1287 
With the laryngoscope many other structures can be seen. In the nasal part 
of the pharynx (Fig. 1084), the choanse, the nasal septum, the nasal conchae, and 
the pharyngeal ostia of the auditory tubes can all be examined. Further down, the 
base of the tongue, the anterior surface of the epiglottis with the glossoepiglottic 
and pharyngoepiglottic folds bounding the valleculae, and the pyriform sinuses, are 
readily distinguished. Beyond these is the entrance to the larynx, bounded on 
either side by the aryepiglottic folds, in each of which are two rounded eminences 
corresponding to the corniculate and cuneiform cartilages. 
Within the larynx (Fig. 1085) on either side are the ventricular and vocal folds 
(false and true vocal cords) with the ventricle between them. Still deeper are 
seen the cricoid cartilage and the anterior parts of some of the cartilaginous rings 
of the trachea, and sometimes, during deep inspiration, the bifurcation of the 
trachea. 
The Eye.-The palpebral fissure is elliptical in shape, and varies in form in dif- 
ferent individuals and in different races of mankind; normally it is oblique, in a 
direction upward and lateralward, so that the lateral commissure is on a slightly 
higher level than the medial. When the eyes are directed forward as in ordinary 
vision the upper part of the cornea is covered by the upper eyelid and its lower 
margin corresponds to the level of the free margin of the lower eyelid, so that 
usually the lower three-fourths are exposed. 
At the medial commissure (Fig. 1086) are the caruncula lacrimalis and the plica 
semilunaris. When the lids are everted, the tarsal glands appear as a series of 
nearly straight parallel rows of 
light yellow granules. On the 
margins of the lids about 5 mm. 
from the medial commissure are 
two small openings-the lacrimal 
puncta; in the natural condition 
they are in contact with the con- 
junctiva of the bulb of the eye, 
so that it is necessary to evert 
the eyelids to expose them. The 
position of the lacrimal sac is indi- 
cated by a little tubercle which 
can be plainly felt on the lower 
margin of the orbit; the sac lies 
immediately above and medial to 
the tubercle. If the eyelids be 
drawn lateralward so as to tighten 
the skin at the medial commissure 
a prominent core can be felt be- 
neath the tightened skin; this is the medial palpebral ligament, which lies over 
the junction of the upper with the lower two-thirds of the sac, thus forming a 
useful guide to its situation. The direction of the nasolacrimal duct is indicated 
by a line from the lacrimal sac to the first molar tooth of the maxilla; the length 
of the duct is about 12 or 13 mm. 
On looking into the eye, the iris with its opening, the pupil, and the front of the 
lens can be examined, but for investigation of the retina an ophthalmoscope is neces- 
sary. With this the lens, the vessels of the retina the optic disk, and the macula 
lutea can all be inspected (Fig. 1087). 
On the lateral surface of the nasal part of the frontal bone the pulley of the 
Obliquus superior can be easily reached by pushing the finger backward along the 
roof of the orbit; the tendon of the muscle can be traced for a short distance back- 
ward and lateralward from the pulley. 
Fig. 1086.-Front of left eye with eyelids separated to show 
medial canthus. 1288 
SURFACE ANATOMY AND SURFACE MARKINGS 
Fig. 1087.-The interior of the posterior half of the left eyeball. 
The Ear.-The various prominences and fossae of the auricula (see page 1044) 
are visible (Fig. 1088). The opening of the external acoustic meatus is exposed by 
drawing the tragus forward; at the orifice are a few 
short crisp hairs which serve to prevent the entrance 
of dust or of small insects; beyond this the secretion 
of the ceruminous glands serves to catch any small 
particles which may find their way into the meatus. 
The interior of the meatus can be examined through 
a speculum. At the line of junction of its bony 
and cartilaginous portions an obtuse angle is formed 
which projects into the antero-inferior wall and 
produces a narrowing of the lumen in this situation. 
The cartilaginous part, however, is connected to the 
bony part by fibrous tissue which renders the outer 
part of the meatus very movable, and therefore by 
drawing the auricula upward, backward, and slightly 
outward, the canal is rendered almost straight. In 
children the meatus is very short, and this should 
be remembered in introducing the speculum. 
Through the speculum the greater part of the tym- 
panic membrane (Fig. 1089) is visible. It is a pearly- 
gray membrane slightly glistening in the adult, placed 
obliquely so as to form with the floor of the meatus an angle of about 55°. At 
birth it is more horizontal and situated in almost the same plane as the base of the 
skull. The membrane is concave outward, and the point of deepest concavity- 
the umbo-is slightly below the centre. Running upward and slightly forward 
from the umbo is a reddish-yellow streak produced by the manubrium of the 
malleus. This streak ends above just below the roof of the meatus at a small 
white rounded prominence which is caused by the lateral process of the malleus 
projecting against the membrane. The anterior and posterior malleolar folds 
extend from the prominence to the circumference of the membrane and enclose 
the pars flaccida. Behind the streak caused by the manubrium of the malleus a 
second streak, shorter and very faint, can be distinguished; this is the long crus 
Fig. 1088.-The auricula or pinna. 
Lateral surface. SURFACE MARKINGS OF SPECIAL REGIONS OF HEAD AND NECK 
1289 
of the incus. A narrow triangular patch extending downward and forward from the 
umbo reflects the light more brightly than any other part, and is usually described 
as the cone of light. 
Fig. 1089.-The right tympanic membrane as seen through a speculum. 
Fig. 1090.-Left temporal bone showing surface markings for the tympanic antrum (red), transverse sinus (blue), 
and facial nerve (yellow). 
Tympanic Antrum.-The site of the tympanic antrum is indicated by the supra- 
meatal triangle (Fig. 1090). This triangle is bounded above by the posterior root 
of the zygomatic arch; behind by a vertical line from the posterior border of the 
external acoustic meatus; in front and below by the upper margin of the meatus. 
The Neck (Fig. 1091).-Larynx and Trachea.-In the receding angle below' the 
chin, the hyoid bone (page 1276), situated opposite the fourth cervical vertebra, can 
easily be made out. A finger's breadth below7 it is the laryngeal prominence of the 1290 
SURFACE ANATOMY AND SURFACE MARKINGS 
thyroid cartilage; the space intervening between the hyoid bone and the thyroid 
cartilage is occupied by the hyothyroid membrane. The outlines of the thyroid 
cartilage are readily palpated; below its lower border is a depression corresponding 
to the middle cricothyroid ligament. The level of the vocal folds corresponds to 
the middle of the anterior margin of the thyroid cartilage. The anterior part of 
the cricoid cartilage forms an important landmark on the front of the neck; it 
lies opposite the sixth cervical vertebra, and indicates the junctions of pharynx 
with oesophagus, the larynx with trachea. Below the cricoid cartilage the trachea 
can be felt, though it is only in thin subjects that the separate rings can be distin- 
guished; as a rule there are seven or eight rings above the jugular notch of the 
sternum, and of these the second, third, and fourth are covered by the isthmus 
of the thyroid gland. 
Fig. 1091.-Side of neck, showing chief surface markings. 
Muscles.-The posterior belly of Digastricus is marked out by a line from the tip 
of the mastoid process to the junction of the greater cornu and body of the hyoid 
bone; a line from this latter point to a point just lateral to the symphysis menti 
indicates the position of the anterior belly. The line of Omohyoideus begins at 
the lower border of the hyoid bone, curves downward and lateralward to cross 
Sternocleidomastoideus at the junction of its middle and lower thirds, i. e., opposite 
the cricoid cartilage, and then runs more horizontally to the acromial end of the 
clavicle. 
Arteries.-The position of the common carotid artery in the neck is indicated 
by a line drawn from the upper part of the sternal end of the clavicle to a point 
midway between the tip of the mastoid process and the angle of the mandible. 
From the clavicle to the upper border of the thyroid cartilage this line overlies 
the common carotid artery, beyond this it is over the external carotid. The 
external carotid artery may otherwise be marked out by the upper part of a line 
from the side of the cricoid cartilage to the front of the external acoustic meatus, 
arching the line slightly forward. 
The points of origin of the main branches of the external carotid in the neck 
are all related to the tip of the greater cornu of the hyoid bone as follows: (1) the 
superior thyroid, immediately below it; (2) the lingual, on a level with it; (3) the 
facial, and (4) the occipital a little above and behind it. SURFACE ANATOMY OF THE BACK 
1291 
The subclavian artery is indicated on the surface by a curved line, convex upward, 
from the sternoclavicular articulation to the middle of the clavicle. The highest 
point of the convexity is from 1 to 3 cm. above the clavicle. 
Veins.--The surface marking for the internal jugular vein is slightly lateral 
and parallel to that for the common carotid artery. The position of the external 
jugular vein is marked out by a line from the angle of the mandible to the middle 
of the clavicle. A point on this line about 4 cm. above the clavicle indicates the 
spot where the vein pierces the deep fascia. The line of the anterior jugular vein 
begins close to the symphysis menti, runs downward parallel with and a little 
to one side of the middle line and, at a variable distance above the jugular notch, 
turns later al ward to the external jugular. 
Nerves.-The facial nerve at its exit from the stylomastoid foramen is situated 
about 2.5 cm. from the surface, opposite the middle of the anterior border of the 
mastoid process; a horizontal line from this point to the ramus of the mandible 
overlies the stem of the nerve. To mark the site of the accessory nerve a line is 
drawn from the angle of the mandible to a point on the anterior border of Sterno- 
cleidomastoideus about 3 to 4 cm. below the apex of the mastoid process, or to the 
midpoint of the posterior border of the muscle; the line is continued across the 
posterior triangle to Trapezius. 
The cutaneous branches of the cervical plexus as they emerge from the posterior 
border of Sternocleidomastoideus may be indicated as follows: the lesser occipital 
begins immediately above the midpoint of the border and runs along the border to 
the scalp; the great auricular and cervical cutaneous both start from the middle 
of the border, the former running upward toward the lobule of the auricula, the 
latter crossing Sternocleidomastoideus at right angles to its long axis; the supra- 
clavicular nerves emerge from immediately below the middle of the posterior border 
and run down over the clavicle. The phrenic nerve begins at the level of the middle 
of the thyroid cartilage and runs behind the clavicle about midway between the 
anterior and posterior borders of Sternocleidomastoideus. 
The upper border of the brachial plexus is indicated by a line from the side of 
the cricoid cartilage to the middle of the clavicle. 
Submaxillary Gland.-On either side of the neck the superficial portion of the 
submaxillary gland, as it lies partly under cover of the mandible, can be palpated. 
SURFACE ANATOMY OF THE BACK. 
Bones.-The only subcutaneous parts of the vertebral column are the apices 
of the spinous processes. These are distinguishable at the bottom of a furrow 
which runs down the middle line of the back from the external occipital protuber- 
ance to the middle of the sacrum. In the cervical region the furrow is broad and 
ends below in a conspicuous projection caused by the spinous processes of the 
seventh cervical and first thoracic vertebrae. Above this, the spinous process of the 
sixth cervical vertebra sometimes forms a projection; the other cervical spinous 
processes are sunken, but that of the axis can be felt. In the thoracic region the 
furrow is shallow and during stooping disappears, and then the spinous processes 
become more or less visible; the markings produced by them are small and close 
together. In the lumbar region the furrow is deep and the situations of the spinous 
processes are frequently indicated by little pits or depressions, especially when the 
muscles in the loins are well-developed. In the sacral region the furrow is shallower, 
presenting a flattened area which ends below at the most prominent part of the 
dorsal surface of the sacrum, i. e., the spinous process of the third sacral vertebra. 
At the bottom of the sacral furrow the irregular dorsal surface of the bone may be 
felt, and below this, in the deep groove running to the anus, the coccyx. 
The only other portions of the vertebral column which can be felt from the 
surface are the transverse processes of the first, sixth, and seventh cervical vertebrae. 1292 
SURFACE ANATOMY AND SURFACE MARKINGS 
Muscles.-The muscles proper of the back are so obscured by those of the upper 
extremity (Fig. 1092) that they have very little influence on surface form. The 
Splenii by their divergence serve to broaden out the upper part of the back of the 
neck and produce a fulness in this situation. In the loin the Sacrospinales, bound 
Fig. 1092.-Surface anatomy of the back. 
down by the lumbodorsal fascia, form rounded vertical eminences which determine 
the depth of the spinal furrow and taper below to a point on the dorsal surface of 
the sacrum. The continuations of the Sacrospinales in the lower thoracic region 
form flattened planes which are gradually lost on passing upward. SURFACE MARKINGS OF THE BACK 
1293 
SURFACE MARKINGS OF THE BACK. 
Bony Landmarks.-In order to identify any particular spinous process it is 
customary to count from the prominence caused by the seventh cervical and first 
Fig. 1093.-Diagram showing the relation of the medulla spinalis to the dorsal surface of the trunk. The bones 
are outlined in red. 
Level of 
body of 
No. of 
nerve. 
Level of tip 
of spine of 
Level of 
body of 
No. of 
nerve. 
Level of tip 
of spine of 
C. 1 
C. 1 
T. 8 
T. 9 
7 T. 
2 
J2 
9 
10 
8 
13 
1 C. 
10 . 
11 
9 
3 
4 
2 
12 
10 
4 
5 
3 
11 
L. 1 
11 
5 
6 
4 
21 
6 
7 
5 
12 
13 
8 
6 
UJ 
12 
7 
T. 1 
7 
1 51 
T. 1 
2 
1 T. 
s. If 
2 
3 
L. 1 
j 21 
3 
4 
2 
3 
4 
5 
3 
4r 
1 L. 
5 
6 
4 
5 
6 
7 
5 
C. 1 
7 
8 
6 
L. 2 
- , 
- 1294 
SURFACE ANATOMY AND SURFACE MARKINGS 
thoracic; of these the latter is the more prominent. The root of the spine of the 
scapula is on a level with the tip of the spinous process of the third thoracic vertebra, 
and the inferior angle with that of the seventh. The highest point of the iliac 
crest is on a level with the spinous 
process of the fourth lumbar, and the 
posterior superior iliac spine with that 
of the second sacral. 
The transverse process of the atlas 
is about 1 cm. below and in front of 
the apex of the mastoid process. The 
transverse process of the sixth cervical 
vertebra is opposite the cricoid carti- 
lage; below it is the transverse pro- 
cess of the seventh and occasionally 
a cervical rib. 
Fig. 1094.-Sagittal section of vertebral canal to 
show the lower end of the medulla spinalis and the 
filum terminale. (Testut.) Li, Lv. First and fifth 
lumbar vertebrae. SU. Second sacral vertebra. 1. 
Dura mater. 2. Lower part of subarachnoid cavity. 
3. Lower extremity of medulla spinalis. 4. Filum ter- 
minale internum, and 5, Filum terminale externum. 
6. Attachment of filum terminate to first segment of 
coccyx. 
Fig. 1095.-Scheme showing the relations of the 
regions of attachment of the spinal nerves to the verte- 
bral spinous rocesses. (After Reid.) 
Medulla Spinalis.-The position of the lower end of the medulla spinalis varies 
slightly with the movements of the vertebral column, but, in the adult, in the 
upright posture it is usually at the level of the spinous process of the second lumbar 
vertebra (Fig. 1093); at birth it lies at the level of the fourth lumbar. 
The subdural and subarachnoid cavities end below opposite the spinous process 
of the third sacral vertebra (Fig. 1094). SURFACE ANATOMY OF THE THORAX 
1295 
Spinal Nerves (Fig. 1095).-The table on page 1293, after Macalister, shows the 
relations which the places of attachment of the nerves to the medulla spinalis 
present to the bodies and spinous processes of the vertebrae. 
SURFACE ANATOMY OF THE THORAX. 
Bones.-The skeleton of the thorax is to a very considerable extent covered by 
muscles, so that in the strongly developed muscular subject it is for the most part 
concealed. In the emaciated subject, however, the ribs, especially in the lowrer and 
lateral regions, stand out as prominent ridges with the sunken intercostal spaces 
between them. 
In the middle line, in front, the superficial surface of the sternum can be felt 
throughout its entire length at the bottom of a furrow, the sternal furrow, situated 
between the Pectorales majores. These muscles overlap the anterior surface 
somewhat, so that the whole width of the sternum is not subcutaneous, and this 
overlapping is greatest opposite the middle of the bone; the furrow, therefore, is 
wide at its upper and lower parts but narrow in the middle. At the upper border 
of the manubrium sterni is the jugular notch: the lateral parts of this notch are 
obscured by the tendinous origins of the Sternocleidomastoidei, which appear as 
oblique cords narrowing and deepening the notch. Lower down on the subcu- 
taneous surface is a well-defined transverse ridge, the sternal angle; it denotes the 
junction of the manubrium and body. From the middle of the sternum the sternal 
furrow spreads out and ends at the junction of the body with the xiphoid process. 
Immediately below this is the infrasternal notch; between the sternal ends of the 
seventh costal cartilages, and below the notch, is a triangular depression, the 
epigastric fossa, in which the xiphoid process can be felt. 
On either side of the sternum the costal cartilages and ribs on the front of the 
thorax are partly obscured by the Pectoralis major, through which, however, they 
can be felt as ridges with yielding intervals between them corresponding to the 
intercostal spaces. Of these spaces, that between the second and third ribs is the 
widest, the next two are somewhat narrower, and the remainder, with the exception 
of the last two, are comparatively narrow. 
Below the lower border of the Pectoralis major on the front of the chest, the 
broad flat outlines of the ribs as they descend, and the more rounded outlines of the 
costal cartilages, are often visible. The lower boundary of the front of the thorax, 
which is most plainly seen by bending the body backward, is formed by the xiphoid 
process, the cartilages of the seventh, eighth, ninth, and tenth ribs, and the ends of 
the cartilages of the eleventh and twelfth ribs. 
On either side of the thorax, from the axilla downward, the flattened external 
surfaces of the ribs may be defined. Although covered by muscles, all the ribs, 
with the exception of the first, can generally be followed without difficulty over the 
front and sides of the thorax. The first rib being almost completely covered by 
the clavicle can only be distinguished in a small portion of its extent. 
At the back, the angles of the ribs lie on a slightly marked oblique line on either 
side of, and some distance from, the spinous processes of the vertebrae. The line 
diverges somewhat as it descends, and lateral to it is a broad convex surface caused 
by the projection of the ribs beyond their angles. Over this surface, except where 
covered by the scapula, the individual ribs can be distinguished. 
Muscles.--The surface muscles covering the thorax belong to the musculature 
of the upper extremity (Figs. 1096, 1100), and will be described in that section 
(page 1319). There is, however, an area of practical importance bounded by these 
muscles. It is limited above by the lower border of Trapezius, below by the upper 
border of Latissimus dorsi, and laterally by the vertebral border of the scapula; the 1296 
SURFACE ANATOMY AND SURFACE MARKINGS 
floor is partly formed by Rhomboideus major. If the scapula be drawn forward by 
folding the arms across the chest, and the trunk bent forward, parts of the sixth 
and seventh ribs and the interspace between them become subcutaneous and avail- 
able for ausculation. The space is therefore known as the triangle of ausculation. 
Fig. 1096.-The left side of the thorax. 
Mamma.-The size of the mamma is subject to great variations. In the adult 
nulliparous female, it extends vertically from the second to the sixth rib, and 
transversely from the side of the sternum to the midaxillary line. In the male and 
in the nulliparous female the mammary papilla is situated in the fourth interspace 
about 9 or 10 cm. from the middle line, or 2 cm. from the costochondral junction. 
SURFACE MARKINGS OF THE THORAX. 
Bony Landmarks.-The second costal cartilage corresponding to the sternal 
angle is so readily found that it is used as a starting-point from which to count the 
ribs. The lower border of the Pectoralis major at its attachment corresponds to 
the fifth rib; the uppermost visible digitation of Serratus anterior indicates the 
sixth rib. 
The jugular notch is in the same horizontal plane as the lower border of the body 
of the second thoracic vertebra; the sternal angle is at the level of the fifth thoracic 
vertebra, while the junction between the body and xiphoid process of the sternum 
corresponds to the fibrocartilage between the ninth and tenth thoracic vertebrae. 
The influence of the obliquity of the ribs on horizontal levels in the thorax is 
well shown by the following line. " If a horizontal line be drawn around the body 
at the level of the inferior angle of the scapula, while the arms are at the sides, the SURFACE MARKINGS OF THE THORAX 
1297 
line would cut the sternum in front between the fourth and fifth ribs, the fifth rib 
in the nipple line, and the ninth rib at the vertebral column." (Treves). 
Diaphragma.-The shape and variations of the Diaphragma as seen by skia- 
graphy have already been described (page 497). 
Surface Lines.-For clinical purposes, and for convenience of description, the 
surface of the thorax has been mapped out by arbitrary lines (Fig. 1101). On the 
front of the thorax the most important vertical lines are the midsternal, the middle 
line of the sternum; and the mammary, which runs vertically downward from a 
point midway between the centre of the jugular notch and the tip of the acromion. 
This latter line, if prolonged, is practically continuous with the lateral line on the 
front of the abdomen. Other vertical lines on the front of the thorax are the lateral 
sternal along the sternal margin, and the parasternal midway between the lateral 
sternal and the mammary. 
On either side of the thorax the anterior and posterior axillary lines are drawn 
vertically from the corresponding axillary folds; the midaxillary line runs down- 
ward from the apex of the axilla. 
On the posterior surface of the thorax the scapular line is drawn vertically 
through the inferior angle of the scapula. 
Fig. 1097.-Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red 
outline). P. Pulmonary valve. A. Aortic valve. B. Bicuspid valve. T. Tricuspid valve. 
Pleurae (Figs. 1097, 1098).-The lines of reflection of the pleurae can be indicated 
on the surface. On the right side the line begins at the sternoclavicular articulation 
and runs downward and medial ward to the midpoint of the junction between the 
manubrium and body of the sternum. It then follows the midsternal line to the 
lower end of the body of the sternum or on to the xiphoid process, where it turns 
lateral ward and downward across the seventh sternocostal articulation. It crosses 
the eighth costochondral junction in the mammary line, the tenth rib in the mid- 
axillary line, and is prolonged thence to the spinous process of the twelfth thoracic 
vertebra. 1298 
SURFACE ANATOMY AND SURFACE MARKINGS 
On the left side, beginning at the sternoclavicular articulation, it reaches the 
midpoint of the junction between the manubrium and body of the sternum, and 
extends down the midsternal line in contact with that of the opposite side to the 
level of the fourth costal cartilage. It then diverges lateralward and is continued 
downward slightly lateral to the sternal border, as far as the sixth costal cartilage. 
Running downward and lateralward from this point it crosses the seventh costal 
cartilage, and from this onward it is similar to the line on the right side, but at a 
slightly lower level. 
Lungs (Figs. 1097, 1098).-The apex of the lung is situated in the neck above the 
medial third of the clavicle. The height to which it rises above the clavicle varies 
very considerably, but is generally about 2.5 cm. It may, however, extend as 
high as 4 or 5 cm., or, on the other hand, may scarcely project above the level 
of this bone. 
Fig. 1098.-Side of thorax, showing surface markings for bones, lungs (purple), pleura (blue), and spleen (green) . 
In order to mark out the anterior borders of the lungs a line is drawn from each 
apex point-2.5 cm. above the clavicle and rather nearer the anterior than the 
posterior border of Sternocleidomastoideus-downward and medialward across the 
sternoclavicular articulation and manubrium sterni until it meets, or almost meets, 
its fellow of the other side at the midpoint of the junction between the manubrium 
and body of the sternum. From this point the two lines run downward, prac- 
tically along the midsternal line, as far as the level of the fourth costal cartilages. 
The continuation of the anterior border of the right lung is marked by a prolonga- 
tion of its line vertically downward to the level of the sixth costal cartilage, and 
then it turns lateralward and downward. The line on the left side curves lateralward 
and downward across the fourth sternocostal articulation to reach the parasternal 
line at the fifth costal cartilage, and then turns medialward and downward to the 
sixth sternocostal articulation. SURFACE MARKINGS OF THE THORAX 
1299 
In the position of expiration the lower border of the lung may be marked by a 
slightly curved line with its convexity downward, from the sixth sternocostal 
junction to the tenth thoracic spinous process. This line crosses the mammary 
line at the sixth, and the midaxillary line at the eighth rib. 
The posterior borders of the lungs are indicated by lines drawn from the level 
of the spinous process of the seventh cervical vertebra, down either side of the 
vertebral column, across the costovertebral joints, as low as the spinous process 
of the tenth thoracic vertebra. 
The position of the oblique fissure in either lung can be shown by a line drawn 
from the spinous process of the second thoracic vertebra around the side of the 
thorax to the sixth rib in the mammary line; this line corresponds roughly to the 
line of the vertebral border of the scapula when the hand is placed on the top of 
the head. The horizontal fissure in the right lung is indicated by a line drawn from 
the midpoint of the preceding, or from the point where it cuts the midaxillary line, 
to the midsternal line at the level of the fourth costal cartilage. 
Trachea.-This may be marked out on the back by a line from the spinous 
process of the sixth cervical to that of the fourth thoracic vertebra where it bifur- 
cates; from its bifurcation the two bronchi are directed downward and lateralward. 
In front, the point of bifurcation corresponds to the sternal angle. 
(Esophagus.-The extent of the oesophagus may be indicated on the back by a 
line from the sixth cervical to the level of the ninth thoracic spinous process, 
2.5 cm. to the left of the middle line. 
Heart.-The outline of the heart in relation to the front of the thorax (Figs 
1097, 1099) can be represented by a quadrangular figure. The apex of the heart 
is first determined, either by its pulsation or as a point in the fifth interspace, 
9 cm. to the left of the midsternal line. The other three points are: (a) the seventh 
right sternocostal articulation; (6) a point on the upper border of the third right 
costal cartilage 1 cm. from the right lateral sternal line; (c) a point on the lower 
border of the second left costal cartilage 2.5 cm. from the left lateral sternal line. 
A line joining the apex to point (a) and traversing the junction of the body of the 
sternum with the xiphoid process represents the lowest limit of the heart-its 
acute margin. The right and left borders are represented respectively by lines 
joining (a) to (b) and the-apex to (c); both lines are convex lateralward, but the 
convexity is more marked on the right where its summit is 4 cm. distant from the 
midsternal line opposite the fourth costal cartilage. 
A portion of the area of the heart thus mapped out is uncovered by lung, and 
therefore gives a dull note on percussion; the remainder being overlapped by lung 
gives a more or less resonant note. The former is known as the area of superficial 
cardiac dulness, the latter as the area of deep cardiac dulness. The area of super- 
ficial cardiac dulness is somewhat triangular; from the apex of the heart two lines 
are drawn to the midsternal line, one to the level of the fourth costal cartilage, 
the other to the junction between the body and xiphoid process; the portion of the 
midsternal line between these points is the base of the triangle. Latham lays 
down the following rule as a sufficient practical guide for the definition of the area 
of superficial dulness. "Make a circle of two inches in diameter around a point 
midway between the nipple and the end of the sternum." 
The coronary sulcus can be indicated by a line from the third left, to the sixth 
right, sternocostal joint. The anterior longitudinal sulcus is a finger's breadth to 
the right of the left margin of the heart. 
The position of the various orifices is as follows: The pulmonary orifice is sit- 
uated in the upper angle of the third left sternocostal articulation; the aortic 
orifice is a little below and medial to this, close to the articulation. The left atrio- 
ventricular opening is opposite the fourth costal cartilage, and rather to the left 
of the midsternal line; the right atrioventricular opening is a little lower, opposite 1300 
SURFACE ANATOMY AND SURFACE MARKINGS 
the fourth interspace of the right side. The lines indicating the atrioventricular 
openings are slightly below and parallel to the line of the coronary sulcus. 
Arteries.-The line of the ascending aorta begins slightly to the left of the mid- 
sternal line opposite the third costal cartilage and extends upward and to the 
right to the upper border of the second right costal cartilage. The beginning of 
the aortic arch is indicated by a line from this latter point to the midsternal line 
about 2.5 cm. below the jugular notch. The point on the midsternal line is oppo- 
site the summit of the arch, and a line from it to the right sternoclavicular articu- 
lation represents the site of the innominate artery, while another line from a point 
slightly to the left of it and passing through the left sternoclavicular articulation 
indicates the position of the left common carotid artery in the thorax. 
Fig. 1099.-Diagram showing relations of opened heart to front of thoracic wall. Ant. Anterior segment of tri- 
cuspid valve. A.O. Aorta. A.P. Anterior papillary muscle. In. Innominate artery. L.C.C. Left common carotid 
artery. L.S. Left subclavian artery. L.V. Left ventricle. P.A. Pulmonary artery. R.A. Right atrium. R.V. 
Right ventricle. V.S. Ventricular septum. 
The internal mammary artery descends behind the first six costal cartilages 
about 1 cm. from the lateral sternal line. 
Veins.-The line of the right innominate vein crosses the right sternoclavicular 
joint and the upper border of the first right costal cartilage about 1 cm. from the 
lateral sternal line; that of the left innominate vein extends from the left sterno- 
clavicular articulation to meet the right at the upper border of the first right 
costal cartilage. The junction of the two lines indicates the origin of the superior 
vena cava, the line of which is continued vertically down to the level of the third 
right costal cartilage. The end of the inferior vena cava is situated opposite the 
upper margin of the sixth right costal cartilage about 2 cm. from the mid- 
sternal line. SURFACE ANATOMY OF THE ABDOMEN 
1301 
SURFACE ANATOMY OF THE ABDOMEN. 
Skin.-The skin of the front of the abdomen is thin. In the male it is often 
thickly hair-clad, especially toward the lower part of the middle line; in the female 
the hairs are confined to the pubes. Just below the line of the iliac crest, especially 
marked in fat subjects, is a shallow groove termed the iliac furrow, while in the 
site of the inguinal ligament a sharper fold known as the fold of the groin is easily 
distinguishable. 
After distension of the abdomen from pregnancy or other causes the skin com- 
monly presents transverse white lines which are quite smooth, being destitute 
of papillae; these are known as striae gravidarum or striae albicantes. The linea 
nigra of pregnancy is often seen as a pigmented brown streak in the middle line 
between the umbilicus and symphysis pubis. 
In the middle line of the front of the abdomen is a shallow furrow which extends 
from the junction between the body of the sternum with the xiphoid process to a 
short distance below the umbilicus; it corresponds to the linea alba. The umbilicus 
is situated in the middle line, but it varies in position as regards its height; in an 
adult subject it is always placed above the middle point of the body, and in a nor- 
mal well-nourished subject is from 2 to 2.5 cm. above the level of the tubercles 
of the iliac crests. 
Bones.-The bones in relation with the surface of the abdomen are (1) the lower 
part of the vertebral column and the lower ribs and (2) the pelvis; the former 
have already been described (page 1291), the latter will be considered with the 
lower limb. 
Muscles (Fig. 1100).--The only muscles of the abdomen which have any consider- 
able influence on surface form are the Obliquus externus and the Rectus. The 
upper digitations of origin of Obliquus externus are well-marked in a muscular sub- 
ject, interdigitating with those of Serratus anterior; the lower digitations are cov- 
ered by the border of Latissimus dorsi and are not visible. The attachment of the 
Obliqui externus and internus to the crest of the ilium forms a thick oblique roll 
which determines the iliac furrow. Sometimes on the front of the lateral region of 
the abdomen an undulating line marks the passing of the muscular fibres of the 
Obliquus externus into its aponeurosis. The lateral margin of the Obliquus externus 
is separated from that of the Latissimus dorsi by a small triangular interval-the 
lumbar triangle-the base of which is formed by the iliac crest, and its floor by 
Obliquus internus. 
The lateral margin of Rectus abdominis is indicated by the linea semilunaris, 
which may be exactly defined by putting the muscle into action. The surface of 
the Rectus presents three transverse furrows, the tendinous inscriptions: the upper 
two of these, viz., one opposite, or a little below, the tip of the xiphoid process, 
and the other midway between this point and the umbilicus, are usually well- 
marked; the third, opposite the umbilicus, is not so distinct. Between the two 
Recti the linea alba can be palpated from the xiphoid process to a point just below 
the umbilicus; it is represented by a distinct dip between the muscles: beyond 
this the muscles are in apposition. 
Vessels.-In thin subjects the pulsation of the abdominal aorta can be readily 
felt by making deep pressure in the middle line above the umbilicus. 
Viscera.-Under normal conditions the various portions of the digestive tube 
cannot be identified by simple palpation. Peristalsis of the coils of small intestine 
can be observed in some persons with extremely thin abdominal walls when some 
degree of constipation exists. In cases of constipation it is sometimes possible to 
trace portions of the great intestine by feeling the fecal masses within the gut. 
In thin persons with relaxed abdominal walls the iliac colon can be felt in the left 1302 
SURFACE ANATOMY AND SURFACE MARKINGS 
iliac region-rolling under the fingers when empty and forming a distinct tumor 
when distended. 
The greater part of the liver lies under cover of the lower ribs and their cartilages, 
but in the epigastric fossa it comes in contact with the abdominal wall. The 
Fig. 1100.-Surface anatomy of the front of the thorax and abdomen. 
position of the liver varies according to the posture of the body. In the erect 
posture in the adult male the edge of the liver projects about 1 cm. below the 
lower margin of the right costal cartilages, and its inferior margin can often be felt 
in this situation if the abdominal wall is thin. In the supine position the liver SURFACE MARKINGS OF THE ABDOMEN 
1303 
recedes above the margin of the ribs and cannot then be detected by the finger; 
in the prone position it falls forward and is then generally palpable in a patient 
with loose and lax abdominal walls. Its position varies with the respiratory 
movements; during a deep inspiration it descends below the ribs; in expiration 
it is raised. Pressure from without, as in tight lacing, by compressing the lower 
part of the chest, displaces the liver considerably, its anterior edge frequently 
extending as low as the crest of the ilium. Again its position varies greatly with 
the state of the stomach and intestines; when these are empty the liver descends, 
when they are distended it is pushed upward. 
The pancreas can sometimes be felt, in emaciated subjects, when the stomach 
and colon are empty, by making deep pressure in the middle line about 7 or 8 cm. 
above the umbilicus. 
The kidneys being situated at the back of the abdominal cavity and deeply 
placed cannot be palpated unless enlarged or misplaced. 
SURFACE MARKINGS OF THE ABDOMEN. 
Bony Landmarks.-Above, the chief bony markings are the xiphoid process, 
the lower six costal cartilages, and the anterior ends of the lower six ribs. The 
junction between the body of the sternum and the xiphoid process is on the level 
of the tenth thoracic vertebra. Below, the main landmarks are the symphysis 
pubis and the pubic crest and tubercle, the anterior superior iliac spine, and the 
iliac crest. 
Muscles (Fig. 1106).-The Rectus lies between the linea alba and the linea semi- 
lunaris; the former is indicated by the middle line, the latter by a curved line, 
convex lateralward, from the tip of the cartilage of the ninth rib to the pubic 
tubercle; at the level of the umbilicus the linea semilunaris is about 7 cm. from the 
middle line. The line indicating the junction of the muscular fibres of Obliquus 
externus with its aponeurosis extends from the tip of the ninth costal cartilage 
to a point just medial to the anterior superior iliac spine. 
The umbilicus is at the level of the fibrocartilage between the third and fourth 
lumbar vertebrae. 
The subcutaneous inguinal ring is situated 1 cm. above and lateral to the pubic 
tubercle; the abdominal inguinal ring lies 1 to 2 cm. above the middle of the inguinal 
ligament. The position of the inguinal canal is indicated by a line joining these 
two points. 
Surface Lines.-For convenience of description of the viscera and of reference 
to morbid conditions of the contained parts, the abdomen is divided into nine 
regions, by imaginary planes, two horizontal and two sagittal, the edges of the planes 
being indicated by lines drawn on the surface of the body (Fig. 1101). In the older 
method the upper, or subcostal, horizontal line encircles the body at the level of the 
lowest points of the tenth costal cartilages; the lower, or intertubercular, is a line 
carried through the highest points of the iliac crests seen from the front, i. e., 
through the tubercles on the iliac crests about 5 cm. behind the anterior superior 
spines. An alternative method is that of Addison, who adopts the following lines: 
(1) An upper transverse, the transpyloric, halfway between the jugular notch 
and the upper border of the symphysis pubis; this indicates the margin of the 
transpyloric plane, which in most cases cuts through the pylorus, the tips of the 
ninth costal cartilages and the lower border of the first lumbar vertebra; (2) a 
lower transverse line midway between the upper transverse and the upper border 
of the symphysis pubis; this is termed the transtubercular, since it practically corre- 
sponds to that passing through the iliac tubercles; behind, its plane cuts the body 
of the fifth lumbar vertebra. 1304 
SURFACE ANATOMY AND SURFACE MARKINGS 
By means of these horizontal planes the abdomen is divided into three zones 
named from above, the subcostal, umbilical, and hypogastric zones. Each of these 
is further subdivided into three regions by the two sagittal planes, which are indi- 
cated on the surface by a right and a left lateral line drawn vertically through 
points halfway between the anterior superior iliac spines and the middle line. The 
middle region of the upper zone is called the epigastric, and the two lateral regions 
Fig. 1101.-Surface lines of the front of the thorax and abdomen. 
the right and left hypochondriac. The central region of the middle zone is the 
umbilical, and the two lateral regions the right and left lumbar. The middle region 
of the lower zone is the hypogastric or pubic, and the lateral are the right and left 
iliac or inguinal. The middle regions, viz., epigastric, umbilical, and pubic, can each 
be divided into right and left portions by the middle line. In the following descrip- 
tion of the viscera the regions marked out by Addison's lines are those referred to. SURFACE MARKINGS OF THE ABDOMEN 
1305 
Stomach (Fig. 1103).-The shape of the stomach is constantly undergoing altera- 
tion; it is affected by the particular phase of the process of gastric digestion, by 
Fig. 1102.-Radiographs of a moderately distended stomach, showing the influence of posture. (Modified from 
Hertz.) A. With the patient in the erect posture. B. With the patient lying down. 
the state of the surrounding viscera, and by the amount and character of its con- 
tents. Its position also varies with that of the body (Fig. 1102), so that it is 
Fig. 1103.-Front of abdomen, showing surface markings for liver, stomach, and great intestine. 
impossible to indicate it on the surface with any degree of accuracy. The measure- 
ments given refer to a moderately filled stomach with the body in the supine 
position. 1306 
SURFACE ANATOMY AND SURFACE MARKINGS 
The cardiac orifice is opposite the seventh left costal cartilage about 2.5 cm. 
from the side of the sternum; it corresponds to the level of the tenth thoracic verte- 
bra. The pyloric orifice is on the transpyloric line about 1 cm. to the right of the 
middle line, or alternately 5 cm. below the seventh right sternocostal articulation; 
it is at the level of the first lumbar vertebra. A curved line, convex downward and 
to the left, joining these points indicates the lesser curvature. In the left lateral 
line the fundus of the stomach reaches as high as the fifth interspace or the sixth 
costal cartilage, a little below the apex of the heart. To indicate the greater cur- 
vature a curved line is drawn from the cardiac orifice to the summit of the fundus, 
thence downward and to the left, finally turning medialward to the pyloric orifice, 
but passing, on its way, through the intersection of the left lateral with the trans- 
pyloric line. The portion of the stomach which is in contact with the abdominal 
wall can be represented roughly by a triangular area the base of which is formed by 
a line drawn from the tip of the tenth left costal cartilage to the tip of the ninth 
right cartilage, and the sides by two lines drawn from the end of the eighth left 
costal cartilage to the ends of the base line. 
Fig. 1104.-Front of abdomen, showing surface markings for duodenum, pancreas, and kidneys. A A'. Plane 
through joint between body and xiphoid process of sternum. B B'. Plane midway between A A' and transpyloric 
plane. C C. Plane midway between transpyloric and transtubercular planes. 
A space of some clinical importance-the space of Traube-overlies the stomach 
and may be thus indicated. It is semilunar in outline and lies within the following 
boundaries: the lower edge of the left lung, the anterior border of the spleen, the 
left costal margin and the inferior margin of the left lobe of the liver. 
Duodenum (Fig. 1104).-The superior part is horizontal and extends from the 
pylorus to the right lateral line; the descending part is situated medial to the 
right lateral line, from the transpyloric line to a point midway between the trans- 
pyloric and transtubercular lines. The horizontal part runs with a slight upward 
slope from the end of the descending part to the left of the middle line; the ascending 
part is vertical, and reaches the transpyloric line, where it ends in the duodeno- 
jejunal flexure, about 2.5 cm. to the left of the middle line. 
Small Intestine.-The coils of small intestine occupy the front of the abdomen. 
For the most part the coils of the jejunum are situated on the left side, i. e., in the 
left lumbar and iliac regions, and in the left half of the umbilical region. The coils 
of the ileum lie toward the right in the right lumbar and iliac regions, in the right SURFACE MARKINGS OF THE ABDOMEN 
1307 
half of the umbilical region, and in the hypogastric region; a portion of the ileum 
is within the pelvis. The end of the ileum, i. e., the ileocolic junction, is slightly 
below and medial to the intersection of the right lateral and transtubercular lines. 
Cecum and Vermiform Process.-The cecum is in the right iliac and hypo- 
gastric regions; its position varies with its degree of distension, but the midpoint 
of a line drawn from the right anterior superior iliac spine to the upper margin of 
the symphysis pubis will mark approximately the middle of its louver border. 
The position of the base of the vermiform process is indicated by a point on the 
lateral line on a level with the anterior superior iliac spine. 
Ascending Colon.-The ascending colon passes upward through the right 
lumbar region, lateral to the right lateral line. The right colic flexure is situated in 
the upper and right angle of intersection of the subcostal and right lateral lines. 
Transverse Colon.-The transverse colon crosses the abdomen on the confines 
of the umbilical and epigastric regions, its lower border being on a level slightly 
above the umbilicus, its upper border just below the greater curvature of the 
stomach. 
Descending Colon.-The left colic flexure is situated in the upper left angle of 
the intersection between the left lateral and transpyloric lines. The descending 
colon courses down through the left lumbar region, lateral to the left lateral line, 
as far as the iliac crest (see footnote p. 1181). 
Iliac Colon.-The line of the iliac colon is from the end of the descending colon 
to the left lateral line at the level of the anterior superior iliac spine. 
Liver (Fig. 1103).-The upper limit of the right lobe of the liver, in the middle 
line, is at the level of the junction between the body of the sternum and the xiphoid 
process; on the right side the line must be carried upward as far as the fifth costal 
cartilage in the mammary line, and then downward to reach the seventh rib at 
the side of the thorax. The upper limit of the left lobe can be defined by continuing 
this line downward and to the left to the sixth costal cartilage, 5 cm. from the 
middle line. The lower limit can be indicated by a line drawn 1 cm. below the 
lower margin of the thorax on the right side as far as the ninth costal cartilage, 
thence obliquely upward to the eighth left costal cartilage, crossing the middle 
line just above the transpyloric plane and finally, with a slight left convexity, to 
the end of the line indicating the upper limit. 
According to Birmingham the limits of the normal liver may be marked out 
on the surface of the body in the following manner. Take three points: (a) 1.25 
cm. below the right nipple; (5) 1.25 cm. below the tip of the tenth rib; (c) 2.5 cm. 
below the left nipple. Join (a) and (c) by a line slightly convex upward; (a) and 
(b) by a line slightly convex lateralward; and (&) and (c) by a line slightly convex 
downward. 
The fundus of the gall-bladder approaches the surface behind the anterior 
end of the ninth right costal cartilage close to the lateral margin of the Rectus 
abdominis. 
Pancreas (Fig. 1104).--The pancreas lies in front of the second lumbar vertebra. 
Its head occupies the curve of the duodenum and is therefore indicated by the same 
lines as that viscus; its neck corresponds to the pylorus. Its body extends along 
the transpyloric line, the bulk of it lying above this line to the tail which is in the 
left hypochondriac region slightly to the left of the lateral line and above the 
transpyloric. 
Spleen (Figs. 1098, 1105).-To map out the spleen the tenth rib is taken as 
representing its long axis; vertically it is situated between the upper border of the 
ninth and the lower border of the eleventh ribs. The highest point is 4 cm. from 
the middle line of the back at the level of the tip of the ninth thoracic spinous 
process; the lowest point is in the midaxillary line at the level of the first lumbar 
spinous process. 1308 
SURFACE ANATOMY AND SURFACE MARKINGS 
Kidneys (Figs. 1104, 1105).-The right kidney usually lies about 1 cm. lower 
than the left, but for practical purposes similar surface markings are taken for each. 
On the front of the abdomen the upper pole lies midway between the plane of 
the lower end of the body of the sternum and the transpyloric plane, 5 cm. from 
the middle line. The lower pole 
is situated midway between the 
transpyloric and intertubercular 
planes, 7 cm. from the middle line. 
The hilus is on the transpyloric 
plane, 5 cm. from the middle line. 
Round these three points a kidney- 
shaped figure 4 cm. to 5 cm. broad 
is drawn, two thirds of which lie 
medial to the lateral line. To indi- 
cate the position of the kidney 
from the back, the parallellogram 
of Morris is used; two vertical lines 
are drawn, the first 2.5 cm., the 
second 9.5 cm. from the middle 
line; the parallelogram is completed 
by two horizontal lines drawn re- 
spectively at the levels of the tips 
of the spinous process of the 
eleventh thoracic and the lower 
border of the spinous process of the 
third lumbar vertebra. The hilus is 5 cm. from the middle line at the level of the 
spinous process of the first lumbar vertebra. 
Fig. 1105.-Back of lumbar region, showing surface markings 
for kidneys, ureters, and spleen. The lower portions of the lung 
and pleura are shown on the right side. 
Fig. 1106.-Front of abdomen, showing surface markings for arteries and inguinal canal. 
Ureters.-On the front of the abdomen, the line of the ureter runs from the 
hilus of the kidney to the pubic tubercle; on the back, from the hilus vertically 
downward, passing practically through the posterior superior iliac spine (Fig. 1105). SURFACE MARKINGS OF THE PERINEUM 
1309 
Vessels (Fig. 1106).-The inferior epigastric artery can be marked out by a line 
from a point midway between the anterior superior iliac spine and the pubic sym- 
physis to the umbilicus. This line also indicates the lateral boundary of Hessel- 
bach's triangle-an area of importance in connection with inguinal hernia; the other 
boundaries are the lateral edge of Rectus abdominis, and the medial half of the 
inguinal ligament. The line of the abdominal aorta begins in the middle line about 
4 cm. above the transpyloric line and extends to a point 2 cm. below and to the 
left of the umbilicus-or more accurately to a point 2 cm. to the left of the middle 
line on a line which passes through the highest points of the iliac crests (A A', 
Fig. 1106). The point of termination of the abdominal aorta corresponds to the 
level of the fourth lumbar vertebra; a line drawn from it to a point midway 
between the anterior superior iliac spine and the symphysis pubis indicates the 
common and external iliac arteries. The common iliac is represented by the upper 
third of this line, the external iliac by the remaining two-thirds. 
Of the larger branches of the abdominal aorta, the cceliac artery is 4 cm., the 
superior mesenteric 2 cm. above the transpyloric line; the renal arteries are 2 cm. 
below the same line. The inferior mesenteric artery is 4 cm. above the bifurcation 
of the abdominal aorta. 
Nerves.-The thoracic nerves on the anterior abdominal wall are represented by 
lines continuing those of the bony ribs. The termination of the seventh nerve is 
at the level of the xiphoid process, the tenth reaches the vicinity of the umbilicus, 
the twelfth ends about midway between the umbilicus and the upper border of 
the symphysis pubis. The first lumbar is parallel to the thoracic nerves; its ilio- 
hypogastric branch becomes cutaneous above the subcutaneous inguinal ring; its 
ilioinguinal branch at the ring. 
SURFACE ANATOMY OF THE PERINEUM. 
Skin.-In the middle line of the posterior part of the perineum and about 4 cm. 
in front of the tip of the coccyx is the anal orifice. The junction of the mucous 
membrane of the anal canal with the skin of the perineum is marked by a white 
line which indicates also the line of contact of the external and internal Sphincters. 
In the anterior part of the perineum the external genital organs are situated. 
The skin covering the scrotum is rough and corrugated, but over the penis it is 
smooth; extending forward from the anus on to the scrotum and penis is a median 
ridge which indicates the scrotal raphe. In the female are seen the skin reduplica- 
tions forming the labia majora and minora laterally, the frenulum of the labia 
behind, and the prepuce of the clitoris in front; still more anteriorly is the mons 
pubis. 
Bones.-In the antero-lateral boundaries of the perineum, the whole outline 
of the pubic arch can be readily traced ending in the ischial tuberosities. Behind 
in the middle line is the tip of the coccyx. 
Muscles and Ligaments.-The margin of the Glutaeus maximus forms the postero- 
lateral boundary, and in thin subjects, by pressing deeply, the sacrotuberous 
ligament can be felt through the muscle. The only other muscles influencing 
surface form are the Ischiocavernosus covering the crus penis, which lies on the side 
of the pubic arch, and the Sphincter ani externus, which, in action, closes the anal 
orifice and causes a puckering of the skin around it. 
SURFACE MARKINGS OF THE PERINEUM. 
A line drawn transversely across in front of the ischial tuberosities divides the 
perineum into a posterior or rectal, and an anterior or urogenital, triangle. This 
line passes through the central point of the perineum, which is situated about 1310 
SURFACE ANATOMY AND SURFACE MARKINGS 
2.5 cm. in front of the centre of the anal aperture or, in the male, midway between 
the anus and the reflection of the skin on to the scrotum. 
Rectum and Anal Canal.-A finger inserted through the anal orifice is grasped 
by the Sphincter ani externus, passes into the region of the Sphincter ani internus, 
and higher up encounters the resistance of the Puborectalis; beyond this it may 
reach the lowest of the transverse rectal folds. In front, the urethral bulb and 
membranous part of the urethra are first identified, and then about 4 cm. above 
the anal orifice the prostate is felt; beyond this the vesiculae seminales, if enlarged, 
and the fundus of the bladder, when distended, can be recognized. On either side 
is the ischiorectal fossa. Behind are the anococcygeal body, the pelvic surfaces 
of the coccyx and lower end of the sacrum, and the sacrospinous ligaments (Fig- 
1107). 
Fig. 1107.-Median sagittal section of male pelvis. 
In the female the posterior wall and fornix of the vagina, and the cervix and 
body of the uterus can be felt in front, while somewhat laterally the ovaries can 
just be reached. 
Male Urogenital Organs.-The corpora cavernosa penis can be followed backward 
to the crura which are attached to the sides of the pubic arch. The glans penis, 
covered by the prepuce, and the external urethral orifice can be examined, and the 
course of the urethra traced along the under surface of the penis to the bulb which 
is situated immediately in front of the central point of the perineum. Through 
the wall of the scrotum on either side the testis can be palpated; it lies toward 
the back of the scrotum, and along its posterior border the epididymis can be felt; 
passing upward along the medial side of the epididymis is the spermatic cord, 
which can be traced upward to the subcutaneous inguinal ring. 
By means of a sound the general topography of the urethra and bladder can SURFACE MARKINGS OF THE PERINEUM 
1311 
be investigated; with the urethroscope the interior of the urethra can be illuminated 
and viewed directly; with the cystoscope the interior of the bladder is in a similar 
manner illuminated for visual examination. In the bladder the main points to 
which attention is directed are the trigone, the torus uretericus, the plicae uretericae, 
and the openings of the ureters and urethra (see Fig. 1033). 
Fig. 1108.-External genital organs of female. The labia minora have been drawn apart. 
Female Urogenital Organs.-In the pudendal cleft (Fig. 1108) between the labia 
minora are the openings of the vagina and urethra. In the virgin the vaginal open- 
ing is partly closed by the hymen-after coitus the remains of the hymen are rep- 
resented by the carunculae hymeneales. Between the hymen and the frenulum of 
the labia is the fossa navicularis, while in the groove between the hymen and the 
labium minus, on either side, the small opening of the greater vestibular (Bartholin's) 
gland can be seen. These glands when enlarged can be felt on either side of the 
posterior part of the vaginal orifice. By inserting a finger into the vagina the fol- 
lowing structures can be examined through its wall (Fig. 1109). Behind, from 
below upward, are the anal canal, the rectum, and the rectouterine excavation. 
Projecting into the roof of the vagina is the vaginal portion of the cervix uteri 
with the external uterine orifice; in front of and behind the cervix the anterior 
and posterior vaginal fornices respectively can be examined. With the finger in the 
vagina and the other hand on the abdominal wall the whole of the cervix and 
body of the uterus, the uterine tubes, and the ovaries can be palpated. If a speculum 
be introduced into the vagina, the walls of the passage, the vaginal portion of the 
cervix, and the external uterine orifice can all be exposed for visual examination. 
The external urethral orifice lies in front of the vaginal opening; the angular 
gap in which it is situated between the two converging labia minora is termed the 1312 
SURFACE ANATOMY AND SURFACE MARKINGS 
vestibule. The urethral canal in the female is very dilatable and can be explored 
with the finger. About 2.5 cm. in front of the external orifice of the urethra are 
the glans and prepuce of the clitoris, and still farther forward is the mons pubis. 
Fig. 1109.-Median sagittal section of female pelvis. 
SURFACE ANATOMY OF THE UPPER EXTREMITY. 
Skin.-The skin covering the shoulder and arm is smooth and very movable 
on the underlying structures. In the axilla there are numerous hairs and many 
sudoriferous and sebaceous glands. Over the medial side and front of the forearm 
the skin is thin and smooth, and contains few hairs but many sudoriferous glands; 
over the lateral side and back of the arm and forearm it is thicker, denser, and 
contains more hairs but fewer sudoriferous glands. In the region of the olecranon 
it is thick and rough, and is very loosely connected to the underlying tissue so 
that it falls into transverse wrinkles when the forearm is extended. At the front 
of the wrist there are three transverse furrows in the skin; they correspond respec- 
tively from above downward to the positions of the styloid process of the ulna, 
the wrist-joint, and the midcarpal joint. 
The skin of the palm of the hand differs considerably from that of the forearm. 
At the wrist it suddenly becomes hard and dense and covered with a thick layer of 
epidermis; on the thenar eminence these characteristics are less marked than else- 
where. In spite of its hardness and density the skin of the palm is exceedingly 
sensitive and very vascular, but it is destitute of hairs and sebaceous glands. It 
is tied down by fibrous bands along the lines of flexion of the digits, exhibiting 
certain furrows of a permanent character. One of these, starting in front of the SURFACE ANATOMY OF THE UPPER EXTREMITY 
1313 
wrist at the tuberosity of the navicular bone, curves around the thenar eminence 
and ends on the radial border of the hand a little above the metacarpophalangeal 
joint of the index finger. A second line begins at the end of the first and extends 
obliquely across the palm to reach the ulnar border about the middle of the fifth 
metacarpal bone. A third line begins at the ulnar border about 2.5 cm. distal to 
the end of the second and extends across the heads of the fifth, fourth, and third 
metacarpal bones. The proximal segments of the fingers are joined to one another 
on the volar aspect by folds of skin constituting the "web" of the fingers; these 
folds extend across about the level of the centres of the proximal phalanges and their 
free margins are continuous with the transverse furrows at the roots of the fingers. 
Since the web is confined to the volar aspect the fingers appear shorter when viewed 
from in front than from behind. 
Over the fingers and thumb the skin again becomes thinner, especially at the 
flexures of the joints (where it is crossed by transverse furrows) and over the ter- 
minal phalanges; it is disposed on numerous ridges in consequence of the arrange- 
ment of the papillae in it. These ridges form, in different individuals, distinctive 
and permanent patterns which can be used for purposes of identification. The 
superficial fascia in the palm of the hand is made up of dense fibro-fatty tissue which 
binds the skin so firmly to the palmar aponeurosis that very little movement is 
permitted between the two. 
On the back of the hand and fingers the subcutaneous tissue is lax, so that the 
skin is freely movable on the underlying parts. Over the interphalangeal joints 
the skin is very loose and is thrown into transverse wrinkles when the fingers 
are extended. 
Bones.-The clavicle can be felt throughout its entire length. The enlarged 
sternal extremity projects above the upper margin of the sternum at the side of 
the jugular notch, and from this the body of the bone can be traced lateralward 
immediately under the skin. The medial part is convex forward, but the surface 
is partially obscured by the attachments of Sternocleidomastoideus and Pectoralis 
major; the lateral third is concave forward and ends at the acromion of the scapula 
in a slight enlargement. The clavicle is almost horizontal when the arm is lying 
by the side, although in muscular subjects it may incline a little upward at its 
acromial end, which is on a plane posterior to the sternal end. 
The only parts of the scapula that are truly subcutaneous are the spine and 
acromion, but the coracoid process, the vertebral border, the inferior angle, and to 
a lesser extent the axillary border can also be readily defined. The acromion and 
spine are easily recognizable throughout their entire extent, forming with the 
clavicle the arch of the shoulder. The acromion forms the point of the shoulder; 
it joins the clavicle at an acute angle-the acromial angle-slightly medial to, and 
behind the tip of the acromion. The spine can be felt as a distinct ridge, marked 
on the surface as an oblique depression which becomes less distinct and ends in a 
slight dimple a little lateral to the spinous processes of the vertebrse. Below this 
point the vertebral border can be traced downward and lateralward to the inferior 
angle, which can be identified although covered by Latissimus dorsi. From the 
inferior angle the axillary border can usually be traced upward through its thick 
muscular covering, forming with its enveloping muscles the posterior fold of the 
axilla. The coracoid process is situated about 2 cm. below the junction of the 
intermediate and lateral thirds of the clavicle; it is covered by the anterior border 
of Deltoideus, and thus lies a little lateral to the infraclavicular fossa or depression 
which marks the interval between the Pectoralis major and Deltoideus. 
The humerus is almost entirely surrounded by muscles, and the only parts 
which are strictly subcutaneous are small portions of the medial and lateral epi- 
condyles ; in addition to these, however, the tubercles and a part of the head of the 
bone can be felt under the skin and muscles by which they are covered. Of these, 1314 
SURFACE ANATOMY AND SURFACE MARKINGS 
the greater tubercle forms the most prominent bony point of the shoulder, extending 
beyond the acromion; it is best recognized when the arm is lying passive by the 
side, for if the arm be raised it recedes under the arch of the shoulder. The lesser 
tubercle, directed forward, is medial to the greater and separated from it by the 
intertubercular groove, which can be made out by deep pressure. When the arm 
is abducted the lower part of the head of the humerus can be examined by pressing 
deeply in the axilla. On either side of the elbow-joint and just above it are the 
medial and lateral epicondyles. Of these, the former is the more prominent, but the 
medial supracondylar ridge passing upward from it is much less marked than the 
lateral, and as a rule is not palpable; occasionally, however, the hook-shaped supra- 
condylar process (page 312) is found on this border. The position of the lateral 
epicondyle is best seen during semiflexion of the forearm, and is indicated by 
a depression; from it the strongly marked lateral supracondylar ridge runs 
upward. 
The most prominent part of the ulna, the olecranon, can always be identified at 
the back of the elbow-joint. When the forearm is flexed the upper quadrilateral 
surface is palpable, but during extension it recedes into the olecranon fossa. During 
extension the upper border of the olecranon is slightly above the level of the medial 
epicondyle and nearer to this than to the lateral; when the forearm is fully flexed 
the olecranon and the epicondyles form the angles of an equilateral triangle. On 
the back of the olecranon is a smooth triangular subcutaneous surface, and running 
down the back of the forearm from the apex of this triangle the prominent dorsal 
border of the ulna can be felt in its whole length: it has a sinuous outline, and is 
situated in the middle of the back of the limb above; but below, where it is rounded 
off, it can be traced to the small subcutaneous surface of the styloid process on the 
medial side of the wrist. The styloid process forms a prominent tubercle continuous 
above with the dorsal border and ending below in a blunt apex at the level of the 
wrist-joint; it is most evident when the hand is in a position midway between 
supination and pronation. When the forearm is pronated another prominence, 
the head of the ulna, appears behind and above the styloid process. 
Below the lateral epicondyle of the humerus a portion of the head of the radius 
is palpable; its position is indicated on the surface by a little dimple, which is best 
seen when the arm is extended. If the finger be placed in this dimple and the 
semiflexed forearm be alternately pronated and supinated the head of the radius 
will be felt distinctly, rotating in the radial notch. The upper half of the body of 
the bone is obscured by muscles; the lower half, though not subcutaneous, can be 
readily examined, and if traced downward is found to end in a lozenge-shaped con- 
vex surface on the lateral side of the base of the styloid process; this is the only 
subcutaneous part of the bone, and from its lower end the apex of the styloid process 
bends medialward toward the wrist. About the middle of the dorsal surface of 
the lower end of the radius is the dorsal radial tubercle, best perceived when the 
wrist is slightly flexed; it forms the lateral boundary of the oblique groove for the 
tendon of Extensor pollicis longus. 
On the front of the wrist are two subcutaneous eminences, one, on the radial 
side, the larger and flatter, produced by the tuberosity of the navicular and the ridge 
on the greater multangular; the other, on the ulnar side, by the pisiform. The tuber- 
osity of the navicular is distal and medial to the styloid process of the radius, and 
is most clearly visible when the wrist-joint is extended; the ridge on the greater 
multangular is about 1 cm. distal to it. The pisiform is about 1 cm. distal to the 
lower end of the ulna and just distal to the level of the styloid process of the radius; 
it is crossed by the uppermost crease which separates the front of the forearm from 
the palm of the hand. The rest of the volar surface of the bony carpus is covered 
by tendons and the transverse carpal ligament, and is entirely concealed, with 
the exception of the hamulus of the hamate bone, which, however, is difficult to SURFACE ANATOMY OF THE UPPER EXTREMITY 
1315 
define. On the dorsal surface of the carpus only the triangular bone can be clearly 
made out. 
Distal to the carpus the dorsal surfaces of the metacarpal bones, covered by the 
Extensor tendons, except the fifth, are visible only in very thin hands; the dorsal 
surface of the fifth is, however, subcutaneous throughout almost its whole length. 
Slightly lateral to the middle line of the hand is a prominence, frequently well- 
marked, but occasionally indistinct, formed by the styloid process of the third 
metacarpal bone; it is situated about 4 cm. distal to the dorsal radial tubercle. 
The heads of the metacarpal bones can be plainly seen and felt, rounded in contour 
and standing out in bold relief under the skin when the fist is clenched; the head 
of the third is the most prominent. In the palm of the hand the metacarpal bones 
are covered by muscles, tendons, and aponeuroses, so that only their heads can be 
distinguished. The base of the metacarpal bone of the thumb, however, is promi- 
nent dorsally, distal to the styloid process of the radius; the body of the bone is 
easily palpable, ending at the head in a flattened prominence, in front of which 
are the sesamoid bones. 
The enlarged ends of the phalanges can be easily felt. When the digits are 
bent the proximal phalanges form prominences, which in the joints between the 
first and second phalanges are slightly hollow, but flattened and square-shaped in 
those between the second and third. 
Articulations.-The sternoclavicular joint is subcutaneous, and its position is 
indicated by the enlarged sternal extremity of the clavicle, lateral to the long 
cord-like sternal head of Sternocleidomastoideus. If this muscle be relaxed a 
depression between the end of the clavicle and the sternum can be felt, defining 
the exact position of the joint. 
The position of the acromioclavicular joint can generally be ascertained by 
determining the slightly enlarged acromial end of the clavicle which projects above 
the level of the acromion; sometimes this enlargement is so considerable as to 
form a rounded eminence. 
The shoulder-joint is deeply seated and cannot be palpated. If the forearm 
be slightly flexed a curved crease or fold with its convexity downward is seen in 
front of the elbow, extending from one epicondyle to the other; the elbow-joint 
is slightly distal to the centre of the fold. The position of the radiohumeral joint 
can be ascertained by feeling for a slight groove or depression between the head 
of the radius and the capitulum of the humerus, at the back of the elbow-joint. 
The position of the proximal radioulnar joint is marked on the surface at the 
back of the elbow by the dimple which indicates the position of the head of the 
radius. ' The site of the distal radioulnar joint can be defined by feeling for the 
slight groove at the back of the wrist between the prominent head of the ulna 
and the lower end of the radius, when the forearm is in a state of almost complete 
pronation. 
Of the three transverse skin furrows on the front of the wrist, the middle corre- 
sponds fairly accurately with the wrist-joint, while the most distal indicates the 
position of the midcarpal articulation. 
The metacarpophalangeal and interphalangeal joints are readily available for 
surface examination; the former are situated just distal to the prominences of the 
knuckles, the latter are sufficiently indicated by the furrows on the volar, and the 
wrinkles on the dorsal surfaces. 
Muscles (Figs. 1075,1110,1111).-The anterior border of the Trapezius presents as 
a slight ridge running downward and forward from the superior nuchal line of the 
occipital bone to the junction of the intermediate and lateral thirds of the clavicle. 
The inferior border of the muscle forms an undulating ridge passing downward 
and medialward from the root of the spine of the scapula to the spinous process 
of the twelfth thoracic vertebra. 1316 
SURFACE ANATOMY AND SURFACE MARKINGS 
The lateral border of the Latissimus dorsi (Fig. 1096) may be traced, when the 
muscle is in action, as a rounded edge starting from the iliac crest and slanting 
obliquely forward and upward to the axilla, where it takes part with the Teres 
major in forming the posterior axillary fold. 
Fig. 1110.-Front of right upper extremity. 
The Pectoralis major (Fig. 1100) conceals a considerable part of the thoracic wall 
in front. Its sternal origin presents a border which bounds, and determines the 
width of the sternal furrow. The upper margin is generally well-marked medially 
and forms the medial boundary of a triangular depression, the infraclavicular fossa, 
which separates the Pectoralis major from the Deltoideus; it gradually becomes 
less marked as it approaches the tendon of insertion and is closely blended with 
the Deltoideus. The lower border of Pectoralis major forms the rounded anterior 
axillary fold. Occasionally a gap is visible between the clavicular and sternal parts- 
of the muscle. 
Fig. 1111.-Back of right upper extremity. 
When the arm is raised the lowest slip of origin of Pectoralis minor produces a. 
fulness just below the anterior axillary fold and serves to break the sharp outline 
of the lower border of Pectoralis major. 
The origin of the Serratus anterior (Figs. 1096, 1100) causes a very characteristic 
surface marking. When the arm is abducted the lower five or six serrations form 
a zigzag line with a general convexity forward; when the arm is by the side the 
highest visible serration is that attached to the fifth rib. 
The Deltoideus with the prominence of the upper end of the humerus produces, 
the rounded contour of the shoulder; it is rounded and fuller in front than behind,. SURFACE ANATOMY OF THE UPPER EXTREMITY 
1317 
where it presents a somewhat flattened form. Above, its anterior border presents 
a slightly curved eminence which forms the lateral boundary of the infraclavicular 
fossa; below, it is closely united with the Pectoralis major. Its posterior border 
is thin, flattened, and scarcely marked above, but is thicker and more prominent 
below. The insertion of Deltoideus is marked by a depression on the lateral side 
of the middle of the arm. 
Of the scapular muscles the only one which influences surface form is the Teres 
major; it assists the Latissimus dorsi in forming the thick, rounded, posterior 
axillary fold. 
When the arm is raised the Coracobrachialis reveals itself as a narrow elevation 
emerging from under cover of the anterior axillary fold and running medial to the 
body of the humerus. 
On the front and medial aspects of the arm is the prominence of the Biceps 
brachii, bounded on either side by an intermuscular depression. It determines the 
contour of the front of the arm and extends from the anterior axillary fold to the 
bend of the elbow; its upper tendons are concealed by the Pectoralis major and 
Deltoideus, and its lower tendon sinks into the anticubital fossa. When the muscle 
is fully contracted it presents a globular form, and the lacertus fibrosus attached 
to its tendon of insertion becomes prominent as a sharp ridge running downward 
and medialward. 
On either side of the Biceps brachii at the lower part of the arm the Brachialis 
is discernible. Laterally it forms a narrow eminence extending some distance up 
the arm; medially it exhibits only a little fulness above the elbow. 
On the back of the arm the long head of the Triceps brachii may be seen as a 
longitudinal eminence, emerging from under cover of Deltoideus and gradually 
passing into the flattened plane of the tendon of the muscle at the lower part of 
the back of the arm. When the muscle is in action the medial and lateral heads 
become prominent. 
On the front of the elbow are two muscular elevations, one on either side, sep- 
arate above but converging below so as to form the medial and lateral boundaries 
of the anticubital fossa. The medial elevation consists of the Pronator teres and 
the Flexors, and forms a fusiform mass, pointed above at the medial epicondyle 
and gradually tapering off below. The Pronator teres is the most lateral of the 
group, while the Flexor carpi radialis, lying to its medial side, is the most prominent 
and may be traced downward to its tendon, which is situated nearer to the radial 
than to the ulnar border of the front of the wrist and medial to the radial artery. 
The Palmaris longus presents no surface marking above, but below, its tendon 
stands out when the muscle is in action as a sharp, tense cord in front of the middle 
of the wrist. The Flexor digitorum sublimis does not directly influence surface 
form; the position of its four tendons on the front of the lower part of the forearm 
is indicated by an elongated depression between the tendons of Palmaris longus 
and Flexor carpi ulnaris. The Flexor carpi ulnaris determines the contour of the 
medial border of the forearm, and is separated from the Extensor group of muscles 
by the ulnar furrow produced by the subcutaneous dorsal border of the ulna; its 
tendon is evident along the ulnar border of the lower part of the forearm, and is 
most marked when the hand is flexed and adducted. 
The elevation forming the lateral side of the anticubital fossa consists of the 
Brachioradialis, the Extensors and the Supinator; it occupies the lateral and a 
considerable part of the dorsal surface of the forearm in the region of the elbow, 
and forms a fusiform mass which is altogether on a higher level than that produced 
by the medial elevation. Its apex is between the Triceps brachii and Brachialis 
some distance above the elbow-joint; it acquires its greatest breadth opposite the 
lateral epicondyle, and below this shades off into a flattened surface. About the 
middle of the forearm it divides into two diverging longitudinal eminences. The 1318 
SURFACE ANATOMY AND SURFACE MARKINGS 
lateral eminence consists of the Brachioradialis and the Extensores carpi radiales 
longus and brevis, and descends from the lateral supracondylar ridge in the direction 
of the styloid process of the radius. The medial eminence comprises the Extensor 
digitorum communis, Extensor digiti quinti proprius, and the Extensor carpi ulnaris; 
it begins at the lateral epicondyle of the humerus as a tapering mass which is sep- 
arated above from the Anconaeus by a well-marked furrow, and below from the 
Pronator teres and Flexor group by the ulnar furrow. The medial border of the 
Brachioradialis starts as a rounded elevation above the lateral epicondyle; lower 
down the muscle forms a prominent mass on the radial side of the upper part of 
the forearm; below it tapers to its tendon, which may be traced to the styloid 
process of the radius. The Anconaeus presents as a triangular slightly elevated 
area, immediately lateral to the subcutaneous surface of the olecranon and differ- 
entiated from the Extensor group by an oblique depression; the upper angle of 
the triangle is at the dimple over the lateral epicondyle. 
At the lower part of the back of the forearm in the interval between the two 
diverging eminences is an oblique elongated swelling; full above but flattened 
and partially subdivided below; it is caused by the Abductor pollicis longus 
and the Extensor pollicis brevis. It crosses the dorsal and lateral surfaces of 
the radius to the radial side of the wrist-joint, whence it is continued on to 
the dorsal surface of the thumb as a ridge best marked when the thumb is 
extended. 
The tendons of most of the Extensor muscles can be seen and felt on the back 
of the wrist. Laterally is the oblique ridge produced by the Extensor pollicis 
longus. The Extensor carpi radialis longus is scarcely palpable, but the Extensor 
carpi radialis brevis can be identified as a vertical ridge emerging from under the 
ulnar border of the tendon of the Extensor pollicis longus when the wrist is extended. 
Medial to this the Extensor tendons of the fingers can be felt, the Extensor digiti 
quinti proprius being separated from the tendons of the Extensor digitorum 
communis by a slight furrow. 
The muscles of the hand are principally concerned, as regards surface form, in 
producing the thenar and hypothenar eminences, and cannot be individually dis- 
tinguished; the thenar eminence, on the radial side, is larger and rounder than the 
hypothenar, which is a long narrow elevation along the ulnar side of the palm. 
When the Palmaris brevis is in action it produces a wrinkling of the skin over the 
hypothenar eminence and a dimple on the ulnar border. On the back of the hand 
the Interossei dorsales give rise to elongated swellings between the metacarpal 
bones; the first forms a prominent fusiform bulging when the thumb is adducted, 
the others are not so marked. 
Arteries.-Above the middle of the clavicle the pulsation of the subclavian artery 
can be detected by pressing downward, backward, and medialward against the 
first rib. The pulsation of the axillary artery as it crosses the second rib can be 
felt below the middle of the clavicle just medial to the coracoid process; along the 
lateral wall of the axilla the course of the artery can be easily followed close to the 
medial border of Coracobrachialis. The brachial artery can be recognized in practi- 
cally the whole of its extent, along the medial margin of the Biceps; in the upper 
two-thirds of the arm it lies medial to the humerus, but in the lower third is more 
directly on the front of the bone. Over the lower end of the radius, between the 
styloid process and Flexor carpi radialis, a portion of the radial artery is superficial 
and is used clinically for observations on the pulse. 
Veins.-The superficial veins of the upper extremity are easily rendered visible 
by compressing the proximal trunks; their arrangement is described on pages 747 
to 749. 
Nerves.-The uppermost trunks of the brachial plexus are palpable for a short 
distance above the clavicle as they emerge from under the lateral border of Sterno- SURFACE MARKINGS OF THE UPPER EXTREMITY 
1319 
cleidomastoideus; the larger nerves derived from the plexus can be rolled under the 
finger against the lateral axillary wall but cannot be identified. The ulnar nerve 
can be detected in the groove behind the medial epicondyle of the humerus. 
SURFACE MARKINGS OF THE UPPER EXTREMITY. 
Bony Landmarks.-The bony landmarks as described above are so readily avail- 
able for surface recognition that no special measurements are required to indicate 
them. It may be noted, however, that the medial angle of the scapula is applied 
to the second rib, while the inferior angle lies against the seventh. The intertuber- 
cular groove of the humerus is vertically below the acromioclavicular joint when 
the arm hangs by the side with the palm of the hand forward. 
Articulations.-The acromioclavicular joint is situated in a plane passing sagit- 
tally through the middle line of the front of the arm. The line of the elbow-joint 
is not straight; the radiohumeral portion is practically at right angles to the long 
axis of the humerus and is situated about 2 cm. distal to the lateral epicondyle; 
the ulnohumeral portion is oblique, and its medial end is about 2.5 cm. distal to the 
medial epicondyle. The position of the wrist-joint can be indicated by drawing a 
curved line, with its convexity upward, between the styloid processes of the radius 
and ulna; the summit of the convexity is about 1 cm. above the centre of a straight 
line joining the two processes. 
Muscles.-The only muscles of the upper extremity which occasionally require 
definition by surface lines are the Trapezius, the Latissimus dorsi, and the Pectorales 
major and minor. The antero-superior border of Trapezius is indicated by a line 
from the superior nuchal line about 3 cm. lateral to the external occipital protuber- 
ance to the junction of the intermediate and lateral thirds of the clavicle; the line 
of the lower border extends from the spinous process of the twelfth thoracic vertebra 
to the vertebral border of the scapula at the root of the spine. The upper border 
of Latissimus dorsi is almost horizontal, running from the spinous process of the 
seventh thoracic vertebra to the inferior angle of the scapula and thence somewhat 
obliquely to the intertubercular sulcus of the humerus; the lower border corresponds 
roughly to a line drawn from the iliac crest about 2 cm. from the lateral margin of 
the Sacrospinalis to the intertubercular sulcus. The upper margin of Pectoralis 
major extends from the middle of the clavicle to the surgical neck of the humerus; 
its lower border is practically in the line of the fifth rib and reaches from the fifth 
costochondral junction to the middle of the anterior border of Deltoideus. The 
two lines indicating the borders of Pectoralis minor begin at the coracoid process 
of the scapula and extend to the third and fifth ribs respectively, just lateral to the 
corresponding costal cartilages. On the front of the elbow-joint a triangular space 
-the anticubital fossa-is mapped out for convenience of reference. The base of 
the triangle is a line joining the medial and lateral epicondyles, while the sides are 
formed respectively by the salient margins of the Brachioradialis and Pronator 
teres. 
Mucous Sheaths.-On the volar surfaces of the wrist and hand the mucous 
sheaths of the Flexor tendons (Fig. 1112) can be indicated as follows. The sheath 
for Flexor pollicis longus extends from about 3 cm. above the upper edge of the 
transverse carpal ligament to the terminal phalanx of the thumb. The common 
sheath for the Flexores digitorum reaches about 3.5 to 4 cm. above the upper edge 
of the transverse carpal ligament and extends on the palm of the hand to about 
the level of the centres of the metacarpal bones. The sheath for the tendons to the 
little finger is continued from the common sheath to the base of the terminal phalanx 
of this finger; the sheaths for the tendons of the other fingers are separated from 
the common sheath by an interval; they begin opposite the necks of the meta- 1320 
SURFACE ANATOMY AND SURFACE MARKINGS 
carpal bones and extend to the terminal phalanges. The mucous sheaths of the 
Extensor tendons are shown in Fig. 1113 (see also page 550). 
Fig. 1112.-The mucous sheaths of the tendons on the front of the wrist and digits. 
Arteries (Fig. 1114).-The course of the axillary artery can be marked out by 
abducting the arm to a right angle and drawing a line from the middle of the 
clavicle to the point where the tendon of the Pectoralis major crosses the promi- 
nence of the Coracobrachialis. Of the branches of the axillary artery, the origin 
of the thoracoacromial corresponds to the point where the artery crosses the 
upper border of Pectoralis minor; the lateral thoracic takes practically the line of 
the*lower border of Pectoralis minor; the subscapular is sufficiently indicated by SURFACE MARKINGS OF THE UPPER EXTREMITY 
1321 
the axillary border of the scapula; the scapular circumflex is given off the sub- 
scapular opposite the midpoint of a line joining the tip of the acromion to the 
lower edge of the deltoid' tuberosity, while the humeral circumflex arteries arise 
from the axillary about 2 cm. above this. The position of the brachial artery is 
Fig. 1113.-The mucous sheaths of the tendons on the back of the wrist. 
marked by a line drawn from the junction of the anterior and middle thirds of the 
distance between the anterior and posterior axillary folds to a point midway 
between the epicondyles of the humerus and continued distally for 2.5 cm., at 
which point the artery bifurcates. With regard to the branches of the brachial 1322 
SURFACE ANATOMY AND SURFACE MARKINGS 
artery-the profunda crosses the back of the humerus at the level of the insertion 
of Deltoideus; the nutrient is given off opposite the middle of the body of the 
humerus; a line from this point to the back of the medial condyle represents 
the superior ulnar collateral; the inferior ulnar collateral is given off about 5 cm. 
above the fold of the elbow-joint and runs directly medialward. 
Fig. 1114.-Front of right upper extremity, showing surface markings for bones, arteries, and nerves. 
The position of the radial artery in the forearm is represented by a line from the 
lateral margin of the Biceps tendon in the centre of the anticubital fossa to the 
medial side of the front of the styloid process of the radius when the limb is 
in the position of supination. The situation of the distal portion of the artery 
is indicated by continuing this line around the radial side of the wrist to the 
proximal end of the first intermetacarpal space. 
Fig. 1115.-Back of right upper extremity, showing surface markings for bones and nerves. 
On account of the curved direction of the ulnar artery, two lines are required to 
indicate its course; one is drawn from the front of the medial epicondyle to the 
radial side of the pisiform bone; the lower two-thirds of this line represents two- 
thirds of the artery; the upper third is represented by a second line from the centre 
of the hollow in front of the elbow-joint to the junction of the upper and middle 
thirds of the first line. 
The superficial volar arch (Fig. 1116) can be indicated by a line starting from 
the radial side of the pisiform bone and curving distalward and lateralward as 
far as the base of the thumb, with its convexity toward the fingers. The summit 
of the arch is usually on a level with the ulnar border of the outstretched thumb. 
The deep volar arch is practically transverse, and is situated about 1 cm. nearer to 
the carpus. SURFACE ANATOMY OF THE LOWER EXTREMITY 
1323 
Nerves (Figs. 1114, 1115).-In the arm the line of the median nerve is practically 
the same as that for the brachial artery; at the bend of the elbow the nerve is 
medial to the artery. The course of 
the nerve in the forearm is marked 
by a line starting from a point just 
medial to the centre of one joining 
the epicondyles, and extending to the 
lateral margin of the tendon of Pal- 
maris longus at the wrist. 
The ulnar nerve follows the line of 
the brachial artery in the upper half 
of the arm, but at the middle of the 
arm it diverges and descends to the 
back of the medial epicondyle. In the 
forearm it is represented b^f a line 
from the front of the medial epi- 
condyle to the radial side of the pisi- 
form bone. 
The course of the radial nerve can 
be indicated by a line from just 
below the posterior axillary fold, to 
the lateral side of the humerus at 
the junction of its middle and lower 
thirds; thence it passes vertically 
downward on the front of the arm 
to the level of the lateral epicondyle. 
The course of the superficial radial 
nerve is represented by a continua- 
tion of this line downward to the 
junction of the middle and lower 
thirds of the radial artery; it then 
crosses the radius and runs distal- 
ward to the dorsum of the base of 
the first metacarpal bone. 
The axillary nerve crosses the humerus about 2 cm. above the centre of a line 
joining the tip of the acromion to the lower edge of the deltoid tuberosity. 
SURFACE ANATOMY OF THE LOWER EXTREMITY. 
Skin.-The skin of the thigh, especially in the hollow of the groin and on the 
medial side, is thin, smooth and elastic, and contains few hairs except on the neigh- 
borhood of the pubis. Laterally it is thicker and the hairs are more numerous. 
The junction of the skin of the thigh with that on the front of the abdomen is 
marked by a well-defined furrow which indicates the site of the inguinal ligament; 
the furrow presents a general convexity downward, but its medial half, which is 
the better marked, is nearly straight. The skin over the buttock is fairly thick 
and is characterized by its low sensibility and slight vascularity; as a rule it is 
destitute of conspicuous hairs except toward the post-anal furrow, where in some 
males they are abundantly developed. An almost transverse fold-the gluteal 
fold-crosses the lower part of the buttock; it practically bisects the lower margin 
of the Glutaeus maximus and is most evident during extension of the hip-joint. 
The skin over the front of the knee is covered by thickened epidermis; it is loose 
and thrown into transverse wrinkles when the leg is extended. The skin of the leg 
Fig. 1116.-Palm of left hand, showing position of skin 
creases and bones, and surface markings for the volar 
arches. 1324 
SURFACE ANATOMY AND SURFACE MARKINGS 
is thin, especially on the medial side, and is covered with numerous large hairs. 
On the dorsum of the foot the skin is thin, loosely connected to subjacent parts, 
and contains few hairs, on the plantar surface, and especially over the heel, the 
epidermis is of great thickness, and here, as in the palm of the hand, there are 
neither hairs nor sebaceous glands. 
Bones.-The hip bones are largely covered with muscles, so that only at a few 
points do they approach the surface. In front the anterior superior iliac spine is 
easily recognized, and in thin subjects stands out as a prominence at the lateral 
end of the fold of the groin; in fat subjects its position is indicated by an oblique 
depression, at the bottom of which the bony process can be felt. Proceeding 
upward and backward from this process the sinuously curved iliac crest can be 
traced to the posterior superior iliac spine, the site of which is indicated by a slight 
depression; on the outer lip of the crest, about 5 cm. behind the anterior superior 
spine, is the prominent iliac tubercle. In thin subjects the pubic tubercle is very 
apparent, but in the obese it is obscured by the pubic fat; it can, however, be 
detected by following up the tendon of origin of Adductor longus. Another part 
of the bony pelvis which is accessible to touch is the ischial tuberosity, situated 
beneath the Glutaeus maximus, and, when the hip is flexed, easily felt, as it is then 
uncovered by muscle. 
The femur is enveloped by muscles, so that in fairly muscular subjects the only 
accessible parts are the lateral surface of the greater trochanter and the lower 
expanded end of the bone. The site of the greater trochanter is generally indicated 
by a depression, owing to the thickness of the Glutaei medius and minimus which 
project above it; when, however, the thigh is flexed, and especially if it be crossed 
over the opposite one, the trochanter produces a blunt eminence on the surface. 
The lateral condyle is more easily felt than the medial; both epicondyles can be 
readily identified, and at the upper part of the medial condyle the sharp adductor 
tubercle can be recognized without difficulty. When the knee is flexed a portion 
of the patellar surface is uncovered and is palpable. 
The anterior surface of the patella is subcutaneous. When the knee is extended 
the medial border of the bone is a little more prominent than the lateral, and if 
the Quadriceps femoris be relaxed the bone can be moved from side to side. When 
the joint is flexed the patella recedes into the hollow between the condyles of the 
femur and the upper end of the tibia, and becomes firmly applied to the femur. 
A considerable portion of the tibia is subcutaneous. At the upper end the con- 
dyles can be felt just below the knee; the medial condyle is broad and smooth, 
and merges into the subcutaneous surface of the body below; the lateral is narrower 
and more prominent, and on it, about midway between the apex of the patella 
and the head of the fibula, is the tubercle for the attachment of the iliotibial band. 
In front of the upper end of the bone, between the condyles, is an oval eminence, 
the tuberosity, which is continuous below with the anterior crest of the bone. This 
crest can be identified in the upper two-thirds of its extent as a flexuous ridge, 
but in the lower third it disappears and the bone is concealed by the tendons of 
the muscles on the front of the leg. Medial to the anterior crest is the broad 
surface, slightly encroached on by muscles in front and behind. The medial 
malleolus forms a broad prominence, situated at a higher level and somewhat 
farther forward than the lateral malleolus; it overhangs the medial border of the 
arch of the foot; its anterior border is nearly straight, its posterior presents a sharp 
edge which forms the medial margin of the groove for the tendon of Tibialis 
posterior. 
The only subcutaneous parts of the fibula are the head, the lower part of the 
body, and the lateral malleolus. The head lies behind and lateral to the lateral 
condyle of the tibia, and presents as a small prominent pyramidal eminence slightly 
above the level of the tibial tuberosity; its position can be readily located by SURFACE ANATOMY OF THE LOWER EXTREMITY 
1325 
following downward the tendon of Biceps femoris. The lateral malleolus is a 
narrow elongated prominence, from which the lower third or half of the lateral 
surface of the body of the bone can be traced upward. 
On the dorsum of the tarsus the individual bones cannot be distinguished, with 
the exception of the head of the talus, which forms a rounded projection in front 
of the ankle-joint when the foot is forcibly extended. The whole dorsal surface of 
the foot has a smooth convex outline, the summit of which is the ridge formed by 
the head of the talus, the navicular, the second cuneiform, and the second meta- 
tarsal bone; from this it inclines gradually lateralward, and rapidly medialward. 
On the medial side of the foot the medial process of the tuberosity of the calcaneus 
and the ridge separating the posterior from the medial surface of the bone are 
distinguishable; in front of this, and below the medial malleolus, is the susten- 
taculum tali. The tuberosity of the navicular is palpable about 2.5 to 3 cm. in 
front of the medial malleolus. 
Farther forward, the ridge formed by the base of the first metatarsal bone can 
be obscurely felt, and from this the body of the bone can be traced to the expanded 
head; beneath the base of the first phalanx is the medial sesamoid bone. On the 
lateral side of the foot, the most 
posterior bony point is the lateral 
process of the tuberosity of the 
calcaneus, with the ridge separating 
the posterior from the lateral sur- 
face of the bone. In front of this 
the greater part of the lateral sur- 
face of the calcaneus is subcuta- 
neous; on it, below and in front of 
the lateral malleolus, the trochlear 
process, when present, can be felt. 
Farther forward the base of the 
fifth metatarsal bone is prominent, 
and from it the body and expanded 
head can be traced. 
As in the case of the meta- 
carpals, the dorsal surfaces of the 
metatarsal bones are easily defined, 
although their heads do not form 
prominences; the plantar surfaces 
are obscured by muscles. The 
phalanges in their whole extent are 
readily palpable. 
Articulations. - The hip-joint is 
deeply seated and cannot be pal- 
pated. 
The interval between the tibia 
and femur can always be easily 
felt; if the knee-joint be extended 
this interval is on a higher level 
than the apex of the patella, but 
if the joint be slightly flexed it is 
directly behind the apex. When 
the knee is semiflexed, the medial 
borders of the patella and of the medial condyle of the femur, and the upper 
border of the medial condyle of the tibia, bound a triangular depressed area which 
indicates the position of the joint. 
Fig. 1117-Front and medial aspect of right thigh. 1326 
SURFACE ANATOMY AND SURFACE MARKINGS 
The ankle-joint can be felt 
on either side of the Ex- 
tensor tendons, and during 
extension of the joint the 
superior articular surface of 
the talus presents below the 
anterior border of the lower 
end of the tibia. 
Muscles.-Of the muscles 
of the thigh, those of the 
anterior femoral region (Fig. 
1117) contribute largely to 
surface form. The Tensor 
fasciae latae produces a broad 
elevation immediately below 
the anterior part of the iliac 
crest and behind the ante- 
rior superior iliac spine; from 
its lower border a groove 
caused by the iliotibial band 
extends downward to the 
lateral side of the knee-joint. 
The upper portion of Sarto- 
rius constitutes the lateral 
boundary of the femoral tri- 
angle, and, when the muscle 
is in action, forms a promi- 
nent oblique ridge which is 
continued below into a flat- 
tened plane and then grad- 
ually merges into a general 
fulness on the medial side 
of the knee-joint. When 
the Sartorius is not in action, 
a depression exists between 
the Quadriceps femoris and 
the Adductors, and extends 
obliquely downward and 
medialward from the apex 
of the femoral triangle to 
the side of the knee. In 
the angle formed by the 
divergence of Sartorius and 
Tensor fasciae latae, just 
below the anterior superior 
iliac spine, the Rectus femoris 
appears, and in a muscular 
subject its borders can be 
clearly defined when the 
muscle is in action. The 
Vastus lateralis forms a long 
flattened plane traversed by 
the groove of the iliotibial 
band. The Vastus medialis 
gives rise to a considerable 
Fig. 1118.-Back of left lower extremity. SURFACE ANATOMY OF THE LOWER EXTREMITY 
1327 
prominence on the medial side of the lower half of the thigh; this prominence in- 
creases toward the knee and ends somewhat abruptly with a full curved outline. 
The Vastus intermedius is completely hidden. The Adductores cannot be differ- 
entiated from one another, with the exception of the upper tendon of Adductor 
longus and the lower tendon of Adductor magnus. When the Adductor longus is in 
action its upper tendon stands out as a prominent ridge running obliquely down- 
ward and lateralward from the neighborhood of the pubic tubercle, and forming 
the medial border of the femoral triangle. The lower tendon of Adductor magnus 
can be distinctly felt as a short ridge extending downward between the Sartorius 
and Vastus medialis to the adductor tubercle. The adductores fill in the tri- 
angular space at the upper part of 
the thigh, between the femur and 
the pelvis, and to them is due the 
contour of the medial border of 
the thigh, the Gracilis contributing 
largely to the smoothness of the 
outline. 
The Glutaeus maximus (Fig. 1118) 
forms the full rounded outline of the 
buttock; it is more prominent be- 
hind, compressed in front, and ends 
at its tendinous insertion in a de- 
pression immediately behind the 
greater trochanter; its lower border 
crosses the gluteal fold obliquely 
downward and lateralward. The 
upper part of Glutaeus medius is 
visible, but its lower part with Glu- 
taeus minimus and the external 
rotators are completely hidden. 
From beneath the lower margin of 
Glutaeus maximus the hamstrings 
appear; at first they are narrow 
and not well-defined, but as they 
descend they become more promi- 
nent and eventually divide into two 
well-marked ridges formed by their 
tendons; these constitute the upper 
boundaries of the popliteal fossa. 
The tendon of Biceps femoris is a 
thick cord running to the head of 
the fibula; the tendons of the Semi- 
membranosus and Semitendinosus as 
they run medialward to the tibia are separated by a slight furrow; the Semitendi- 
nosus is the more medial, and can be felt in certain positions of the limb as a sharp 
cord, while the Semimembranosus is thick and rounded. The Gracilis is situated a 
little in front of them. 
The Tibialis anterior (Fig. 1119) presents a fusiform enlargement at the lateral 
side of the tibia and projects beyond the anterior crest of the bone; its tendon can 
be traced on the front of the tibia and ankle-joint and thence along the medial side 
of the foot to the base of the first metatarsal bone. The fleshy fibres of Peronaeus 
longus are strongly marked at the upper part of the lateral side of the leg; it is 
separated by furrows from Extensor digitorum longus in front and Soleus behind. 
Below, the fleshy fibres end abruptly in a tendon which overlaps the more flattened 
Fig. 1119.-Lateral aspect of right leg. 1328 
SURFACE ANATOMY AND SURFACE MARKINGS 
elevation of Peronaeus brevis; below the lateral malleolus the tendon of Peronaeus 
brevis is the more marked. 
On the dorsum of the foot (Fig. 1120) the tendons emerging from beneath the 
transverse and cruciate crural ligaments spread out and can be distinguished as 
follows: the most medial and largest is Tibialis anterior, the next is Extensor 
hallucis proprius, then Extensor digitorum longus dividing into four tendons, to 
the second, third, fourth, and fifth toes, and lastly Peronaeus tertius. The Extensor 
digitorum brevis produces a rounded outline on the dorsum of the foot and a fulness in 
front of the lateral malleolus. The Interossei dorsales bulge between the metatarsal 
bones. 
Fig. 1120.-The mucous sheaths of the tendons around the ankle. Lateral aspect. 
At the back of the knee is the popliteal fossa, bounded above by the tendons of 
the hamstrings and below by the Gastrocnemius. Below this fossa is the prominent 
fleshy mass of the calf of the leg produced by Gastrocnemius and Soleus (Fig. 1118). 
When these muscles are in action the borders of Gastrocnemius form two well- 
defined curved lines which converge to the tendocalcaneus; the medial border is the 
more prominent. At the same time the edges of Soleus can be seen forming, on 
either side of Gastrocnemius, curved eminences, of which the lateral is the longer. 
The fleshy mass of the calf ends somewhat abruptly in the tendocalcaneus, which 
tapers in the upper three-fourths of its extent but widens out slightly below. 
Behind the medial border of the lower part of the tibia (Fig. 1121) a well-defined 
ridge is produced by the tendon of Tibialis posterior during contraction of the 
muscle. 
On the sole of the foot the Abductor digiti quinti forms a narrow rounded eleva- 
tion on the lateral side, and the Abductor hallucis a lesser elevation on the medial 
side. The Flexor digitorum brevis, bound down by the plantar aponeurosis, is not 
very apparent; it produces a flattened form, and the thickened skin underlying 
it is thrown into numerous wrinkles. 
Arteries.-The femoral artery as it crosses the brim of the pelvis is readily felt; 
in its course down the thigh its pulsation becomes gradually more difficult of recog- 
nition. When the knee is flexed the pulsation of the popliteal artery can easily be 
detected in the popliteal fossa. SURFACE MARKINGS OF THE LOWER EXTREMITY 
1329 
On the lower part of the front of the tibia the anterior tibial artery becomes 
superficial and can be traced over the ankle into the dorsalis pedis; the latter can 
be followed to the proximal end of the first intermetatarsal space. The pulsation 
of the posterior tibial artery becomes evident near the lower end of the back of the 
tibia, and is easily detected behind the medial malleolus. 
Fig. 1121.-The mucous sheaths of the tendons around the ankle. Medial aspect. 
Veins.-By compressing the proximal trunks, the venous arch on the dorsum 
of the foot, together with the great and small saphenous veins leading from it (see 
page 756), are rendered visible. 
Nerves.-The only nerve of the lower extremity which can be located by palpa- 
tion is the common peroneal as it winds around the lateral side of the neck of the 
fibula. 
SURFACE MARKINGS OF THE LOWER EXTREMITY. 
Bony Landmarks.-The anterior superior iliac spine is at the level of the sacral 
promontory-the posterior at the level of the spinous process of the second sacral 
vertebra. A horizontal line through the highest points of the iliac crests passes 
also through the spinous process of the fourth lumbar vertebra, while, as already 
pointed out (page 1303), the transtubercular plane through the tubercles on the 
iliac crests cuts the body of the fifth lumbar vertebra. The upper margin of the 
greater sciatic notch is opposite the spinous process of the third sacral vertebra, 
and slightly below this level is the posterior inferior iliac spine. The surface mark- 
ings of the posterior inferior iliac spine and the ischial spine are both situated in a 
line which joins the posterior superior iliac spine to the outer part of the ischial 
tuberosity; the posterior inferior spine is 5 cm. and the ischial spine 10 cm. below 
the posterior superior spine; the ischial spine is opposite the first piece of the 
coccyx. 
With the body in the erect posture the line joining the pubic tubercle to the top 
of the greater trochanter is practically horizontal; the middle of this line overlies 
the acetabulum and the head of the femur. 
A line used for clinical purposes is that of Nelaton (Fig. 1122), which is drawn 
from the anterior superior iliac spine to the most prominent part of the ischial 
tuberosity; it crosses the centre of the acetabulum and the upper border of the 1330 
SURFACE ANATOMY AND SURFACE MARKINGS 
greater trochanter. Another surface marking of clinical importance is Bryant's 
triangle, which is mapped out thus: a line from the anterior superior iliac spine 
to the top of the greater trochanter forms the base of the triangle; its sides are 
formed respectively by a horizontal line from the anterior superior iliac spine and 
a vertical line from the top of the greater trochanter. 
Fig. 1122.-Nelaton's line and Bryant's triangle. 
Articulations.-The posterior superior iliac spine overlies the centre of the sacro- 
iliac articulations. 
The hip-joint may be indicated, as described above, by the centre of a horizontal 
line from the pubic tubercle to the top of the greater trochanter; or more generally, 
it is below and slightly lateral to the middle of the inguinal ligament. The knee-joint 
is superficial and requires no surface marking. The level of the ankle-joint is that 
of a transverse line about 1 cm. above the level of the tip of the medial malleolus. 
If the foot be forcibly extended, the head of the talus appears as a rounded promi- 
nence on the medial side of the dorsum; just in front of this prominence and behind 
the tuberosity of the navicular is the talonavicular joint. The calcaneocuboid joint 
is situated midway between the lateral malleolus and the prominent base of the 
fifth metatarsal bone; the line indicating it is parallel to that of the talonavicular 
joint. The line of the fifth tarsometatarsal joint is very oblique; it starts from the 
projection of the base of the fifth metatarsal bone, and if continued would pass 
through the head of the first metatarsal. The lines of the fourth and third tarso- 
metatarsal joints are less oblique. The first tarsometatarsal joint corresponds to a 
groove which can be felt by making firm pressure on the medial border of the foot 
2.5 cm. in front of the tuberosity of the navicular bone; the position of the second 
tarsometatarsal joint is 1.25 cm. behind this. The metatarsophalangeal joints are 
about 2.5 cm. behind the webs of the corresponding toes. 
Muscles.-None of the muscles require any special surface lines to indicate 
them, but there are three intermuscular spaces which occasionally require defini- 
tion, viz., the femoral triangle, the adductor canal, and the popliteal fossa. SURFACE MARKINGS OF THE LOWER EXTREMITY 
1331 
The femoral triangle is bounded above by the inguinal ligament, laterally by the 
medial border of Sartorius, and medially by the medial border of Adductor longus. 
In the triangle is the fossa ovalis, through which the great saphenous vein dips to 
join the femoral; the centre of this fossa is about 4 cm. below and lateral to the 
pubic tubercle, its vertical diameter measures about 4 cm. and its transverse about 
1.5 cm. The femoral ring is about 1.25 cm. lateral to the pubic tubercle. 
The adductor canal occupies the medial part of the middle third of the thigh; it 
begins at the apex of the femoral triangle and lies deep to the vertical part of 
Sartorius. The popliteal fossa is bounded: above and medially by the tendons 
of Semimembranosus and Semitendinosus; above and laterally by the tendon of 
Biceps femoris; below and medially by the medial head of Gastrocnemius; below 
and laterally by the lateral head of Gastrocnemius and the Plantaris. 
Mucous Sheaths.-The positions of the mucous sheaths around the tendons 
about the ankle-joints are sufficiently indicated in Figs. 1120, 1121 (see also page 
586). 
Fig. 1123.-Left gluteal region, showing surface markings for arteries and sciatic nerve. 
Arteries.-The points of emergence of the three main arteries on the buttock, 
viz., the superior and inferior gluteals and the internal pudendal, maybe indicated 
in the following manner (Fig. 1123). With the femur slightly flexed and rotated 
inward, a line is drawn from the posterior superior iliac spine to the posterior supe- 
rior angle of the greater trochanter; the point of emergence of the superior gluteal 
artery from the upper part of the greater sciatic foramen corresponds to the junction 
of the upper and middle thirds of this line. A second line is drawn from the poste- 
rior superior iliac spine to the outer part of the ischial tuberosity; the junction 
of its lower with its middle third marks the point or emergence of the inferior 
gluteal and internal pudendal arteries from the lower part of the greater sciatic 
foramen. The course of the femoral artery (Fig. 1124) is represented by the upper 
two-thirds of a line from a point midway between the anterior superior iliac spine 
and the symphysis pubis to the adductor tubercle, with the thigh abducted and 
rotated outward; the profunda femoris arises from it about 1 to 5 cm. below the 
inguinal ligament. The course of the upper part of the popliteal artery (Fig. 1126) 
is indicated by a line from the lateral margin of Semimembranosus at the junction 
of the middle and lower thirds of the thigh, obliquely downward to the middle of 1332 
SURFACE ANATOMY AND SURFACE MARKINGS 
the popliteal fossa; from this point it runs vertically downward for about 2.5 cm. 
or to the level of a line through the lower part of the tibial tuberosity. The line 
indicating the anterior tibial artery (Fig. 1125) is drawn from the medial side of 
the head of the fibula to a point midway between the malleoli; the artery begins 
about 3 cm. below the head of the fibula. The dorsalis pedis artery is represented 
on the dorsum of the foot by a line from the centre of the interval between the 
malleoli to the proximal end of the first intermetatarsal space. 
Fig. 1124.- Front of right thigh, showing surface 
markings for bones, femoral artery and femoral nerve. 
Fig. 1125.-Lateral aspect of right leg, showing 
surface markings for bones, anterior tibial and 
' dorsalis pedis arteries, and deep peroneal nerve. 
The course of the posterior tibial artery (Fig. 1126) can be shown by a line from 
the end of the popliteal artery, i. e., 2.5 cm. below the centre of the popliteal fossa, 
to midway between the tip of the medial malleolus and the centre of the convexity 
of the heel; its main branch, the peroneal artery, begins about 7 or 8 cm. below the 
level of the knee-joint and follows the line of the fibula to the back of the lateral 
malleolus. The medial and lateral plantar arteries begin from the end of the poste- 
rior tibial; the medial extends to the middle of the plantar surface of the ball of the 
great toe, the lateral to within a finger's breadth of the tuberosity of the fifth 
metatarsal bone; from this latter point the plantar arch crosses the foot trans- 
versely to the proximal end of the first intermetatarsal space. 
Veins.-The line of the great saphenous vein is from the front of the medial 
malleolus to the centre of the fossa ovalis; the small saphenous vein runs from the 
back of the lateral malleolus to the centre of the popliteal fossa. SURFACE MARKINGS OF THE LOWER EXTREMITY 
1333 
Fig. 1126.-Back of left lower extremity, showing surface markings for bones, vessels, and nerves. 1334 
SURFACE ANATOMY AND SURFACE MARKINGS 
Nerves.-The course of the sciatic nerve (Fig. 1126) can be indicated by a line 
from a point midway between the outer border of the ischial tuberosity and the 
posterior superior angle of the greater trochanter to the upper angle of the popliteal 
fossa. The continuation of this line vertically through the centre of the popliteal 
fossa represents the position of the tibial nerve, while the common peroneal nerve 
follows the line of the tendon of Biceps femoris. The lines for the deep peroneal 
nerve and the continuation of the tibial nerve corresponds respectively to those for 
the anterior and posterior tibial arteries. A GLOSSARY OF THE INTERNATIONAL OR BASLE 
ANATOMICAL NOMENCLATURE. 
OSTEOLOGY. 
TERMINOLOGY ADOPTED IN TEXT 
Vertebral Column 
Vertebrae 
Vertebral arch 
Vertebral foramen 
Pedicle 
Vertebral notch 
Costal demifacet 
Facet for tubercle of rib 
Atlas 
Facet for odontoid process 
Odontoid process 
Sacrum 
Lateral part 
Sacral tuberosity- 
Middle sacral crest 
Lateral sacral crests 
Sacral articular crests 
Vertebral canal 
Sternum 
Jugular notch 
Body 
Sternal angle 
Xiphoid process 
Anterior surface of sternum 
Ribs 
Costal groove 
Cranial Bones 
Occipital bone 
Squama 
Highest nuchal line 
Superior nuchal line 
Inferior nuchal line 
Sagittal sulcus 
Lateral part 
Hypoglossal canal 
Condyloid canal 
Basilar part 
Superior border 
Upper half of inferior border 
BASLE TERMINOLOGY 
Columna Vertebralis 
Vertebrse 
Arcus vertebrae 
Foramen vertebrale 
Radix arcus vertebrae 
Incisura vertebralis 
Fovea costalis 
Fovea costalis transversalis 
Atlas 
Fovea dentis 
Epistropheus 
Dens 
Os Sacrum 
Pars lateralis 
Tuberositas sacralis 
Crista sacralis media 
Cristae sacrales laterales 
Cristae sacrales articulares 
Canalis sacralis 
Sternum 
Incisura jugularis 
Corpus 
Angulus sterni 
Processus xiphoideus 
Planum sternale 
Costae 
Sulcus costae 
Ossa Cranii 
Os occipitale 
Squama occipitalis 
Linea nuchae suprema 
Linea nuchae superior 
Linea nuchae inferior 
Sulcus sagittalis 
Pars lateralis 
Canalis hypoglossi 
Canalis condyloideus 
Pars basilaris 
Margo lambdoideus 
Margo mastoideus 
OLD TERMINOLOGY 
Spinal Column 
Vertebrae 
Neural arch 
Spinal foramen 
Pedicle 
Intervertebral notch 
Demifacet for head of rib 
Facet for tubercle of rib 
Atlas 
Facet for odontoid process 
Axis 
Odontoid process 
Sacrum 
Lateral mass 
Rough surface for posterior 
sacroiliac ligament 
Spinous processes of sacral 
vertebrae 
Transverse processes of sacral 
vertebrae 
Articular processes of sacral 
vertebrae 
Sacral canal 
Sternum (Breast bone) 
Suprasternal notch 
Gladiolus 
Angulus Ludovici 
Ensiform or xiphoid process 
Anterior surface of sternum 
Ribs 
Subcostal groove 
Cranial Bones 
Occipital bone 
Tabular portion 
Highest curved line 
Superior curved line 
Inferior curved line 
Groove for superior longitu- 
dinal sinus 
Condylic portion 
Anterior condyloid foramen 
Posterior condyloid foramen 
Basilar process 
Superior border 
Upper half of inferior border 1336 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Parietal bone 1 
External surface 
Parietal eminence 
Temporal lines 
Internal surface 
Sagittal sulcus 
Sagittal border 
Squamous border 
Frontal border 
Occipital border 
Frontal angle 
Sphenoidal angle 
Occipital angle 
Mastoid angle 
Groove for transverse sinus 
Frontal bone ' 
Squama 
External surface 
Orbital part 
Frontal eminence 
Zygomatic process 
Nasal part 
Frontal spine 
Internal surface 
Sagittal sulcus 
Temporal bone ' 
Squama 
Articular tubercle 
Mandibular fossa 
Petrotympanic fissure 
Mastoid notch 
Sigmoid sulcus 
Eminentia arcuata 
Hiatus of facial canal 
Trigeminal impression 
Internal acoustic meatus 
Canal for facial nerve 
Tympanic canaliculus 
Mastoid canaliculus 
Vaginal process 
Tympanomastoid fissure 
Angles of petrous part 
Septum canalis musculotubarii 
Semicanalis m. tensoris tympani 
Semicanalis tubae auditivae 
Tympanic part 
External acoustic meatus 
Sphenoidal bone ' 
Chiasmatic groove 
Tuberculum sellae 
Fossa hypophyseos 
Sphenoidal crest 
Great wings 
Spina angularis 
Small wings 
Infratemporal crest 
Pterygoid canal 
Lateral pterygoid plate 
Medial pterygoid plate 
Sphenoidal conchse 
Pterygoid hamulus 
Pharyngeal canal 
Ethmoidal bone 
Cribriform plate 
Perpendicular plate 
Ethmoidal labyrinth 
Lamina papyracea 
Uncinate process 
Middle nasal concha 
Superior nasal concha 
BASLE TERMINOLOGY 
Os parietale 
Facies parietalis 
Tuber parietale 
Lineae temporales 
Facies cerebralis 
Sulcus sagittalis 
Margo sagittalis 
Margo squamosus 
Margo frontalis 
Margo occipitalis 
Angulus frontalis 
Angulus sphenoidalis 
Angulus occipitalis 
Angulus mastoideus 
Sulcus transversus 
Os frontale 
Squama frontalis 
Facies frontalis 
Pars orbitalis 
Tuber frontale 
Processus zygomaticus 
Pars nasalis 
Spina frontalis 
Facies cerebralis 
Sulcus sagittalis 
Os temporale 
Squama temporalis 
Tuberculum articulare 
Fossa mandibularis 
Fissura petrotympanica 
Incisura mastoidea 
Sulcus sigmoideus 
Eminentia arcuata 
Hiatus canalis facialis 
Impressio trigemini 
Meatus acusticus internus 
Canalis facialis [Fallopii] 
Canaliculus tympanicus 
Canaliculus mastoideus 
Vagina processus styloidei 
Fissura tympanomastoidea 
Anguli pyramidis 
Septum canalis musculotubarii 
Semicanalis m. tensoris tympani 
Semicanalis tubae auditivae 
Pars tympanica 
Meatus acusticus externus 
Os sphenoidale 
Sulcus chiasmatis 
Tuberculum sellae 
Fossa hypophyseos 
Crista sphenoidalis 
Alae magna 
Spina angularis 
Alae parva 
Crista infratemporalis 
Canalis pterygoideus [Vidii] 
Lamina lateralis processus 
pterygoidei 
Lamina medialis processus 
pterygoidei 
Conchae sphenoidales 
Hamulus pterygoideus 
Canalis pharyngeus 
Os ethmoidale 
Lamina cribrosa 
Lamina perpendicularis 
Labyrinthus ethmoidalis 
Lamina papyracea 
Processus uncinatus 
Concha nasalis media 
Concha nasalis superior. 
OLD TERMINOLOGY 
Parietal bone 
External surface 
Parietal eminence 
Temporal ridges 
Internal surface 
Groove for superior longitu- 
dinal sinus 
Superior border 
Inferior border 
Anterior border 
Posterior border 
Antero-superior angle 
Antero-inferior angle 
Postero-superior angle 
Postero-inferior angle 
Groove for lateral sinus 
Frontale bone 
Frontal or vertical portion 
External surface 
Horizontal part 
Frontal eminence 
External angular process 
Internal angular process 
Nasal spine 
Internal surface 
Groove for superior longitudinal 
sinus 
Temporal bone 
Squamous portion 
Eminentia articularis 
Glenoid cavity 
Glaserian fissure 
Digastric fossa 
Fossa sigmoidea 
Eminence for superior semi- 
circular canal 
Hiatus Fallopii 
Impression for Gasserian 
ganglion 
Internal auditory meatus 
Aqueduct of Fallopius 
Canal for tympanic branch of 
glossopharyngeal nerve 
Canal for auricular branch of 
vagus 
Vaginal process of temporal 
bone 
Auricular fissure 
Borders of petrous part 
Processus cochleariformis 
Canal for Tensor tympani 
Bony part of Eustachian tube 
Tympanic plate 
External auditory meatus 
Sphenoid bone 
Optic groove 
Olivary eminence 
Pituitary fossa 
Ethmoidal crest 
Great wings 
Spinous process 
Small wings 
Pterygoid ridge 
Vidian canal 
External pterygoid plate 
Internal pterygoid plate 
Sphenoidal turbinated processes 
Hamular process 
Pterygopalatine canal 
Ethmoid bone 
Horizontal lamina 
Vertical plate 
Lateral mass 
Os planum 
Unciform process 
Middle turbinated process 
Superior turbinated process OR BASLE ANATOMICAL NOMENCLATURE 
1337 
TERMINOLOGY ADOPTED IN TEXT 
Facial Bones 
Nasal bones 
Groove for branch of nasociliary 
nerve 
Maxilla 
Anterior surface 
Infratemporal surface 
Alveolar canals 
Conchal crest 
Maxillary sinus 
Zygomatic process 
Frontal process 
Ethmoidal crest 
Palatine process 
Incisive foramen 
Incisive canal 
Os incisivum or premaxilla 
Lacrimal bone 
Posterior lacrimal crest. 
Lacrimal hamulus 
Zygomatic bone 
Malar surface 
Temporal surface 
Zygomaticofacial foramen 
Zygomaticotemporal foramen 
Frontosphenoidal process 
Zygomaticoorbital foramen 
Palatine bone 
Horizontal part 
Vertical part 
Conchal crest 
Ethmoidal crest 
Pterygopalatine canal 
Pyramidal process 
Lesser palatine foramina 
Inferior nasal concha 
Mandible 
Oblique line 
Mental spine 
Mylohyoid line 
Ramus 
Mandibular foramen 
Mandibular canal 
Mandibular notch 
Hyoid bone 
Body 
Greater cornua 
Lesser cornua 
Skull 
Sutural bones 
Greater palatine foramen 
Foramen lacerum 
Infratemporal fossa 
Inferior orbital fissure 
Pterygopalatine fossa 
Superior orbital fissure 
Nasal cavity 
Anterior nasal aperture 
Choanae 
Bones of Upper Extremity 
Shoulder girdle 
Clavicle 
Coracoid tuberosity 
Costal tuberosity 
Sternal extremity 
Acromial extremity 
Ossa Faciei 
Ossa nasalia 
Sulcus ethmoidalis 
Maxilla 
Facies anterior 
Facies infratemporalis 
Canales alveolares 
Crista conchalis 
Sinus maxillaris 
Processus zygomaticus 
Processus frontalis 
Crista ethmoidalis 
Processus palatinus 
Foramen incisivum 
Canalis incisivum 
Os incisivum 
Os lacrimale 
Crista lacrimalis posterior 
Hamulus lacrimalis 
Os zygomaticum 
Facies malaris 
Facies temporalis 
Foramen zygomaticofaciale ] 
Foramen zygomaticotem- > 
porale ) 
Processus frontosphenoidalis 
Foramen zygomaticoorbitale 
Os palatinum 
Pars horizontalis 
Pars perpendicularis 
Crista conchalis 
Crista ethmoidalis 
Canalis pterygopalatinus 
Processus pyramidalis 
Foramina palatina minora 
Concha nasalis inferior 
Mandibula 
Linea obliqua 
Spina mentalis 
Linea mylohyoidea 
Ramus mandibulae 
Foramen mandibulare 
Canalis mandibulae 
• Incisura mandibulae 
Os hyoideum 
Corpus ossei hyoidei 
Cornua majora 
Cornua minora 
Cranium 
Ossa saturarum 
Foramen palatinum majus 
Foramen lacerum 
Fossa infratemporalis 
Fissura orbitalis inferior 
Fossa pterygopalatina 
Fissura orbitalis superior 
Cavum nasi 
Apertura piriformis 
Choanae 
Ossa Extremitatis Superioris 
Cingulum extremitatis superioris 
Clavicula 
Tuberositas coracoidea 
Tuberositas costalis 
Extremitas sternalis 
Extremitas acromialis 
Facial Bones 
Nasal bones 
Groove for nasal nerve 
Superior maxillary bone; Upper jaw 
Facial or external surface 
Zygomatic surface 
Posterior dental canals 
Inferior turbinated crest 
Antrum of Highmore 
Malar process 
Nasal process 
Superior turbinated crest 
Palatal process 
Anterior palatine foramen 
Foramen of Stensen 
Premaxilla 
Lacrimal bone 
Lacrimal crest 
Hamular process 
Malar bone 
External surface 
Internal surface 
Malar foramina 
Frontal process 
Temporomalar canal 
Palate bone 
Horizontal plate 
Perpendicular plate 
Inferior turbinated crest 
Superior turbinated crest 
Posterior palatine canal 
Tuberosity 
Accessory palatine foramina 
Turbinated bone 
Inferior maxillary bone; Lower jaw 
External oblique line 
Genial tubercle 
Internal oblique line 
Perpendicular portions 
Inferior dental foramen 
Inferior dental canal 
Sigmoid notch 
Lingual bone 
Basihyal 
Thyrohyals 
Ceratohyals 
Skull 
Wormian bones 
Posterior palatine foramen 
Foramen lacerum medium 
Zygomatic fossa 
Sphenomaxillary fissure 
Sphenomaxillary fossa 
Sphenoidal fissure 
Nasal fossa 
Anterior aperture of nose 
Posterior nares 
Bones of Upper Extremity 
Shoulder girdle 
Clavicle; Collar bone 
Conoid tubercle 
Rhomboid impression 
Internal extremity 
Outer extremity 1338 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Scapula 
Supraspinatous fossa 
Infraspinatous fossa 
Scapular notch 
Medial angle 
Lateral angle 
Humerus 
Greater tubercle 
Lesser tubercle 
Intertubercular groove 
Crest of greater tubercle 
Crest of lesser tubercle 
Body 
Lateral border 
Radial sulcus 
Medial border 
Antero-lateral surface 
Antero-medial surface 
Capitulum 
Lateral epicondyle 
Medial epicondyle 
Ulna 
Olecranon 
Tuberosity 
Semilunar notch 
Radial notch 
Body 
Volar border 
Dorsal border 
Interosseous crest 
Volar surface 
Dorsal surface 
Medial surface 
Radius 
Radial tuberosity 
Body 
Volar border 
Dorsal border 
Interosseous crest 
Volar surface 
Dorsal surface 
Lateral surface 
Ulnar notch 
Carpus 
Navicular bone 
Lunate bone 
Triangular bone 
Greater multangular bone 
Lesser multangular bone 
Capitate bone 
Hamate bone 
Hamulus 
Bones of Lower Extremity 
Pelvic girdle 
Hip-bone 
Posterior gluteal line 
Anterior gluteal line 
Inferior gluteal line 
Arcuate line 
Iliac tuberosity 
Ischial spine 
Greater sciatic notch 
Lesser sciatic notch 
Superior ramus 
Inferior ramus 
Pubic tubercle 
Superior ramus 
Inferior ramus 
Acetabulum 
Obturator foramen 
Pectineal line 
Glenoidal labrum 
Acetabular notch 
BASLE TERMINOLOGY 
Scapula 
Fossa supraspinata 
Fossa infraspinata 
Incisura scapulae 
Angulus medialis 
Angulus lateralis 
Humerus 
Tuberculum majus 
Tuberculum minus 
Sulcus intertubercularis 
Crista tuberculi majoris 
Crista tuberculi minoris 
Corpus 
Margo lateralis 
Sulcus nervi radialis 
Margo medialis 
Facies anterior lateralis 
Facies anterior medialis 
Capitulum 
Epicondylus lateralis 
Epicondylus medialis 
Ulna 
Olecranon 
Tuberositas ulnae 
Incisura semilunaris 
Incisura radialis 
Corpus 
Margo volaris 
Margo dorsalis 
Crista interossea 
Facies volaris 
Facies dorsalis 
Facies medialis 
Radius 
Tuberositas radii 
Corpus 
Margo volaris 
Margo dorsalis 
Crista interossea 
Facies volaris 
Facies dorsalis 
Facies lateralis 
Incisura ulnaris 
Ossa Carpi 
Os naviculare manus 
Os lunatum 
Os triquetrum 
Os multangulum majus 
Os multangulum minor 
Os capitatum 
Os hamatum 
Hamulus oss. hamati 
Ossa Extremitatis Inferioris 
Cingulum extremitatis inferioris 
Os coxae 
Linea glutaea posterior 
Linea glutaea anterior 
Linea glutaea inferior 
Linea arcuata 
Tuberositas iliaca 
Spina ischiadica 
Incisura ischiadica major 
Incisura ischiadica minor 
Ramus superior ossis ischii 
Ramus inferior ossis ischii 
Tuberculum pubicum 
Ramus superior ossis pubis 
Ramus inferior ossis pubis 
Acetabulum 
Foramen obturatum 
Pecten ossis pubis 
Labrum glenoidale 
Incisura acetabuli 
OLD TERMINOLOGY 
Scapula; Shoulder blade 
Supraspinous fossa 
Infraspinous fossa 
Suprascapular notch 
Superior angle 
External angle 
Humerus; Arm bone 
Greater tuberosity- 
Lesser tuberosity- 
Bicipital groove 
External lip of bicipital groove 
Internal lip of bicipital groove 
Shaft 
External border 
Musculospiral groove 
Internal border 
External surface 
Internal surface 
Capitellum 
External condyle 
Internal condyle 
Ulna; Elbow bone 
Olecranon process 
Tubercle 
Greater sigmoid cavity 
Lesser sigmoid cavity 
Shaft 
Anterior border 
Posterior border 
External or interosseous border 
Anterior surface 
Posterior surface 
Internal surface 
Radius 
Bicipital tuberosity 
Shaft 
Anterior border 
Posterior border 
Medial border 
Anterior surface 
Posterior surface 
External surface 
Sigmoid cavity 
Carpus 
Scaphoid 
Semilunar 
Cuneiform 
Trapezium 
Trapezoid 
Os magnum 
Unciform 
Unciform process 
Bones of Lower Extremity 
Pelvic girdle 
Os innominatum 
Superior curved line 
Middle curved line 
Inferior curved line 
Iliac part of iliopectineal line 
Rough surface for posterior 
sacroiliac ligament 
Spine of ischium 
Greater sacrosciatic notch 
Lesser sacrosciatic notch 
Descending ramus 
Ascending ramus 
Spine of pubis 
Ascending ramus 
Descending ramus 
Cotyloid cavity 
Thyroid foramen 
Pubic part of iliopectineal line 
Cotyloid ligament 
Cotyloid notch OR BASLE ANATOMICAL NOMENCLATURE 
1339 
TERMINOLOGY ADOPTED IN TEXT 
Pelvis 
Linea terminalis 
Greater pelvis 
Lesser pelvis 
Superior aperture of pelvis 
Inferior aperture of pelvis 
Femur 
Greater trochanter 
Trochanteric fossa 
Lesser trochanter 
Intertrochanteric line 
Intertrochanteric crest 
Body 
Gluteal tuberosity 
Lateral condyle 
Medial condyle 
Intercondyloid fossa 
Medial epicondyle 
Lateral epicondyle 
Patellar surface 
Tibia 
Medial condyle 
Lateral condyle 
Intercondyloid eminence 
Tuberosity 
Body 
Anterior crest 
Medial border 
Interosseous crest 
Medial surface 
Lateral surface 
Popliteal line 
Malleolar sulcus 
Fibula 
Apex of head 
Body 
Interosseous crest 
Lateral malleolus 
Tarsus 
Calcaneus 
Tuberosity 
Medial process 
Lateral process 
Trochlear process 
Talus 
Navicular bone 
First cuneiform bone 
Second cuneiform bone 
Third cuneiform bone 
BASLE TERMINOLOGY 
Pelvis 
Linea terminalis 
Pelvis major 
Pelvis minor 
Apertura pelvis minoris superior 
Apertura pelvis minoris inferior 
Femur 
Trochanter major 
Fossa trochanterica 
Trochanter minor 
Linea intertrochanterica 
Crista intertrochanterica 
Corpus 
Tuberositas glutaea 
Condylus lateralis 
Condylus medialis 
Fossa intercondylea 
Epicondylus medialis 
Epicondylus lateralis 
Facies patellaris 
Tibia 
Condylus medialis 
Condylus lateralis 
Eminentia intercondyloidea 
Tuberositas tibiae 
Corpus 
Crista anterior 
Crista medialis 
Crista interossea 
Facies medialis 
Facies lateralis 
Linea poplitea 
Sulcus malleolaris 
Fibula 
Apex capituli fibulae 
Corpus 
Crista interossea 
Malleolus lateralis 
Ossa Tarsi 
Calcaneus 
Tuber calcanei 
Processus medialis 
Processus lateralis 
Processus trochlearis 
Talus 
Os naviculare pedis 
Os cuneiforme primum 
Os cuneiforme secundum 
Os cuneiforme tertium 
OLD TERMINOLOGY 
Pelvis 
Circumference of inlet of true 
pelvis 
False pelvis 
True pelvis 
■ Pelvic inlet 
Pelvic outlet 
Femur; Thigh bone 
Great trochanter 
Digital fossa 
Small trochanter 
Anterior intertrochanteric or 
spiral line 
Posterior intertrochanteric line 
Shaft 
Gluteal ridge 
External condyle 
Internal condyle 
Intercondyloid notch 
Inner tuberosity 
Outer tuberosity 
Trochlea 
Tibia; Shin bone 
Inner tuberosity 
Outer tuberosity 
Spine of tibia 
Tubercle 
Shaft 
Anterior border 
Internal border 
External border 
Internal surface 
External surface 
Oblique line of tibia 
Groove for tendons of Tibialis 
posterior and Flexor digi- 
torum longus 
Fibula; Calf bone 
Styloid process 
Shaft 
Antero-internal border 
External malleolus or distal ex- 
tremity 
Tarsus 
Os calcis 
Tuberosity 
Inner tubercle 
Outer tubercle 
Peroneal tubercle 
Astragalus or ankle bone 
Scaphoid bone 
Internal cuneiform 
Middle cuneiform 
External cuneiform 
SYNDESMOLOGY. 
Synarthrosis 
Amphiarthrosis 
Diarthrosis 
Ginglymus 
Trochoid or Pivot joint 
Condyloid articulation 
Articulation by reciprocal 
reception 
Enarthrosis 
Arthrodia 
Synarthrosis 
Amphiarthrosis 
Diarthrosis 
Ginglymus 
Articulatio trochoidea 
Articulatio ellipsoidea 
Articulatio sellaris 
Enarthrosis 
Arthrodia 
Immovable articulations 
Slightly movable articulations 
Freely movable articulations 
Hinge-joint 
Rotary joint 
Condyloid articulation 
Saddle-joint 
Ball-and-socket joints 
Gliding joints 1340 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Articulations of the vertebral 
column and cranium 
Anterior longitudinal ligament 
Posterior longitudinal ligament 
Intervertebral fibrocartilages 
Ligamenta flava 
Supraspinal ligament 
Interspinal ligaments 
Cruciate ligament of the atlas 
Anterior atlantobccipital mem- 
brane 
Posterior atlantobccipital mem- 
brane 
Membrana tectoria 
Alar ligaments 
Articulation of the mandible 
Temporomandibular ligament 
Sphenomandibular ligament 
Articular disk 
Stylomandibular ligament 
Articulations of the heads of 
the ribs 
Radiate ligament 
Interarticular ligament 
Costotransverse articulations 
Anterior costotransverse liga- 
ment 
Ligament of the neck of the rib 
Ligament of the tubercle of the 
rib 
Sternocostal articulations 
Radiate sternocostal ligaments 
Interarticular sternocostal liga- 
ment 
Costoxiphoid ligaments 
Interchondral articulations 
Articulations of the pelvis 
Sacrotuberous ligament 
Sacrospinous ligament 
Sacrococcygeal symphysis 
Lateral sacrococcygeal ligament 
Pubic symphysis 
Greater sciatic foramen 
Lesser sciatic foramen 
Pubic arcuate ligament 
Interpubic fibrocartilaginous 
lamina 
Sternoclavicular articulation 
Costoclavicular ligament 
Articular disk 
Acromioclavicular articulation 
Ligaments of the scapula 
Superior transverse ligament 
Inferior transverse ligament 
Humeral articulation 
Glenoidal labrum 
Elbow-joint 
Ulnar collateral ligament 
Radial collateral ligament 
BASLE TERMINOLOGY 
Ligamenta columnae vertebralis 
et cranii 
Lig. longitudinals anterius 
Lig. longitudinals posterius 
Fibrocartilaginss interverte- 
brales 
Ligg. flava 
Lig. supraspinale 
Ligg. interspinalia 
Lig. cruciatum atlantis 
Membrana atlantooccipitalis 
anterior 
Membrana atlantooccipitalis 
posterior 
Membrana tectoria 
Ligg. alaria 
Articulatio mandibularis 
Lig. temporomandibulare 
Lig. sphenomandibulare 
Discus articularis 
Lig. stylomandibulare 
Articulationes capitulorum 
Lig. capituli costae radiatum 
Lig. capituli costae interarticu- 
lare 
Articulationes costotransversariae 
Lig. costotransversarium an- 
terius 
Lig. colli costae 
Lig. tuberculi costae 
Articulationes sternocostales 
Ligg. sternocostalia radiata 
Lig. sternocostale interarticu- 
lare 
Ligg. costoxiphoidea 
Articulationes interchondrales 
Ligg. cinguli extremitatis inferi- 
oris 
Lig. sacrotuberosum 
Lig. sacrospinosum 
Symphysis sacrococcygea 
Lig. sacrococcygeum laterale 
Symphysis ossium pubis 
Foramen ischiadicum majus 
Foramen ischiadicum minus 
Lig. arcuatum pubis 
Lamina fibrocartilaginea inter- 
pubica 
Articulatio sternoclaviculare 
Lig. costoclaviculare 
Discus articularis 
Articulatio acromioclavicularis 
Ligg. cinguli extremitatis 
superioris 
Lig. transversum scapulae 
superius 
Lig. transvers um scapulae 
inferius 
Articulatio humeri 
Labrum glenoidale 
Articulatio cubiti 
Lig. collaterals ulnare 
Lig. collaterals radiale 
OLD TERMINOLOGY 
Articulations of the spine and 
cranium 
Anterior common ligament 
Posterior common ligament 
Intervertebral disks 
Ligamenta subflava 
Supraspinous ligament 
Interspinous ligaments 
Cruciform ligament 
Anterior atlantobccipital liga- 
ment 
Posterior atlantobccipital liga- 
ment 
Occipitoaxial ligament 
Odontoid or check ligaments 
Temporomandibular articulation 
External lateral ligament 
Internal lateral ligament 
Articular meniscus 
Stylbmaxillary ligament 
Costocentral articulations 
Anterior costovertebral or 
stellate ligament 
Intraarticular ligament 
Costotransverse articulations 
- Anterior superior ligament 
Middle costotransverse ligament 
Posterior costotransverse liga- 
ment 
Chondrosternal articulations 
Chondrosternal or sternocostal 
ligaments 
Intraarticular chondrosternal 
ligament 
Chondroxiphoid ligaments 
Articulations of the cartilages of 
the ribs with each other 
Articulations of the pelvis 
Great or posterior sacrosciatic 
ligament 
Small or anterior sacrosciatic 
ligament 
Articulation of the sacrum and 
coccyx 
Intertransverse ligament 
Articulation of the pubic bones 
Great sacrosciatic foramen 
Small sacrosciatic foramen 
Subpubic ligament 
Interpubic disk 
Sternoclavicular articulation 
Rhomboid ligament 
Interarticular fibrocartilage 
Scapuloclavicular articulation 
Ligaments of the scapula 
Suprascapular ligament 
Spinoglenoid ligament 
Shoulder-joint 
Glenoid ligament 
Elbow-joint 
Internal lateral ligament 
External lateral ligament OR BASLE ANATOMICAL NOMENCLATURE 
1341 
TERMINOLOGY ADOPTED IN TEXT 
Proximal radioulnar articulation 
Annular ligament 
Oblique cord 
Distal radioulnar articulation 
Articular disk 
Radiocarpal articulation 
Volar radiocarpal ligament 
Dorsal radiocarpal ligament 
Ulnar collateral ligament 
Radial collateral ligament 
Intercarpal articulations 
Volar ligaments 
Intermetacarpal articulations 
Transverse metacarpal ligament 
Metacarpophalangeal articula- 
tions 
Volar ligaments 
Collateral ligaments 
Articulation of the digits 
Coxal articulation 
Articular capsule 
Iliofemoral ligament 
Pubocapsular ligament 
Ischiocapsular ligament 
Glenoidal labrum 
Transverse acetabular ligament 
Knee-joint 
Articular capsule 
Patellar retinacula 
Oblique popliteal ligament 
Tibial collateral ligament 
Fibular collateral ligament 
Cruciate ligaments 
Anterior cruciate ligament 
Posterior cruciate ligament 
Menisci 
Medial meniscus 
Lateral meniscus 
Alar folds 
Patellar fold 
Tibiofibular articulation 
Articular capsule 
Ligaments of head of fibula 
Interosseous membrane 
Tibiofibular syndesmosis 
Anterior ligament 
Posterior ligament 
Talocrural articulation 
Articular capsule 
Deltoid ligament 
Anterior talofibular ligament 
Posterior talofibular ligament 
Calcaneofibular ligament 
Intertarsal articulations 
BASLE TERMINOLOGY 
Articulatio radioulnaris proxi- 
malis 
Lig. annulare radii 
Chorda obliqua 
Articulatio radioulnaris distalis 
Discus articularis 
Articulatio radiocarpea 
Lig. radiocarpeum volare 
Lig. radiocarpeum dorsale 
Lig. collaterale carpi ulnare 
Lig. collaterale carpi radiale 
Articulationes intercarpeae 
Ligg. intercarpea volaria 
Articulationes intermetacarpeae 
Lig. capitulorum (oss. metacar- 
palium) transversa 
Articulationes metacarpopha- 
langeae 
Ligg. metacarpophalangeae 
volaria 
Ligg. collateralia 
Articulationes digitorum manus 
Articulatio coxae 
Capsula articularis 
Lig. iliofemorale 
Lig. pubocapsulare 
Lig. ischiocapsulare 
Labrum glenoidale 
Lig. transversum acetabuli 
Articulatio genu 
Capsula articularis 
Retinacula patellae 
Lig. popliteum obliquum 
Lig. collaterale tibiale 
Lig. collaterale fibulare 
Ligg. cruciata genu 
Lig. cruciatum anterius 
Lig. cruciatum posterius 
Menisci 
Meniscus medialis 
Meniscus lateralis 
Plicae alares 
Plica synovalis patellaris 
Articulatio tibiofibularis 
Capsula articularis 
Ligg. capituli fibulae 
Membrana interossea cruris 
Syndesmosis tibiofibulare 
Lig. malleoli lateralis anterius 
Lig. malleoli lateralis posterius 
Articulatio talocruralis 
Capsula articularis 
Lig. deltoideum 
Lig. talofibulare anterius 
Lig. talofibulare posterius 
Lig. calcaneofibulare 
Articulationes intertarseae 
OLD TERMINOLOGY 
Superior radioulnar joint 
Orbicular ligament 
Oblique ligament 
Inferior radioulnar joint 
Triangular articular disk 
Wrist-joint 
Anterior ligament of the radio- 
carpal joint 
Posterior ligament of the radio- 
carpal joint 
Internal lateral ligament 
External lateral ligament 
Carpal joints 
Palmar ligaments 
Articulations of metacarpal bones 
with each other 
Transverse metacarpal ligament 
Metacarpophalangeal joints 
Glenoid ligament of Cruveilhier; 
palmar or vaginal ligaments 
Lateral ligaments 
Articulation of the phlanges 
Hip-joint 
Capsular ligament 
Y-ligament; ligament of Bigelow 
Pubofemoral band 
Ligament of Bertin 
Cotyloid ligament 
Transverse ligament 
Knee-joint 
Capsular ligament 
Lateral patellar ligaments 
Posterior ligament 
Internal lateral ligament 
External lateral or long external 
lateral ligament 
Crucial ligaments 
External crucial ligament 
Internal crucial ligament 
Semilunar fibrocartilages 
Internal semilunar cartilage 
External semilunar cartilage 
Ligamenta alaria 
Ligamentum mucosum 
Superior tibiofibular articulation 
Capsular ligament 
Anterior and posterior superior 
tibiofibular ligaments 
Middle tibiofibular ligament 
Inferior tibiofibular articulation 
Anterior inferior ligament 
Posterior inferior ligament 
Ankle-joint; tibiotarsal articulation 
Capsular ligament 
Internal lateral ligament 
Anterior fasciculus I of external 
Posterior fasciculus >lateral 
Middle fasciculus J ligament 
Articulations of the tarsus 1342 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Talocalcaneal articulation 
Articular capsule 
Anterior talocalcaneal ligament 
Posterior talocalcaneal ligament 
Lateral talocalcaneal ligament 
Medial talocalcaneal ligament 
Talocalcaneonavicular articula- 
tion 
Articular capsule 
Dorsal talonavicular ligament 
Calcaneocuboid articulation 
Articular capsule 
Dorsal calcaneocuboid liga- 
ment 
Bifurcated ligament 
Calcaneonavicular part of 
Calcaneocuboid part of 
Long plantar ligament 
Plantar calcaneocuboid ligament 
Plantar calcaneonavicular liga- 
ment 
Cuneonavicular articulation 
Articulation of the digits 
BASLE TERMINOLOGY 
Articulatio talocalcanea 
Capsula articularis 
Lig. talocalcaneum anterius 
Lig. talocalcaneum posterius 
Lig. talocalcaneum laterale 
Lig. talocalcaneum mediate 
Articulatio talocalcaneonavicu- 
laris 
Capsula articularis 
Lig. talonaviculare dorsale 
Articulatio calcaneocuboidea 
Capsula articularis 
Lig. calcaneocuboideum dorsale 
Lig. bifurcatum 
Pars calcaneonavicularis 
Pars calcaneocuboid 
Lig. plantare longum 
Lig. calcaneocaboideum 
plantare 
Lig. calcaneonaviculare plantare 
Articulatio cuneonavicularis 
Articulationes digitorum pedis 
OLD TERMINOLOGY 
Articulation of calcalcaneus and 
astragalus; calcaneo-astraga- 
loid articulation 
Capsular ligament 
Anterior c^lcaneo-astragaloid 
ligament 
Posterior calcaneoastragaloid 
ligament 
External calcaneoastragaloid 
ligament 
Internal calcaneoastragaloid 
ligament 
Talocalcaneonavicular articula- 
tion 
Capsular ligament 
Superior astragalonavicular liga- 
ment 
Articulation of calcaneus ' with 
cuboid 
Capsular ligament 
Superior calcaneocuboid liga- 
ment 
Superior calcaneonavicular liga- 
ment 
Internal calcaneocuboid liga- 
ment 
Long calcaneocuboid or super- 
ficial long plantar ligament 
Short plantar ligament 
: Inferior calcaneonavicular liga- 
ment 
Articulation of navicular with 
cuneiform bone 
Articulations of the phalanges 
MYOLOGY. 
Epicranius 
Galea aponeurotica 
Orbicularis oculi 
Lacrimal part 
Corrugator 
Procerus 
Nasalis 
Depressor septi 
Quadratus labii superioris 
Zygomatic head 
Infraorbital head 
Angular head 
Caninus 
Zygomaticus 
Mentalis 
Quadratus labii inferioris 
Triangularis 
Pterygomandibular raphe 
Parotideomasseteric fascia 
Temporalis 
Pterygoideus externus 
Pterygoideus internus 
Fascia colli 
Sternocleidomastoideus 
Digastricus 
Stylohyoideus 
Mylohyoideus 
Geniohyoideus 
Sternohyoideus 
Omohyoideus 
Sternothyreoideus 
Thyreohyoideus 
Longus capitis 
Rectus capitis anterior 
Epicranius 
Galea aponeurotica 
Orbicularis oculi 
Pars lacrimalis 
Corrugator 
Procerus 
Nasalis 
Depressor septi 
Quadratus labii superioris 
Caput zygomaticum 
Caput infraorbitale 
Caput angulare 
Caninus 
Zygomaticus 
Mentalis 
Quadratus labii inferioris 
Triangularis 
Fascia parotideomasseterica 
Temporalis 
Pterygoideus externus 
Pterygoideus internus 
Fascia colli 
Sternocleidomastoideus 
Digastricus 
Stylohyoideus 
Mylohyoideus 
Geniohyoideus 
Sternohyoideus 
Omohyoideus 
Sternothyreoideus 
Thyreohyoideus 
Longus capitis 
Rectus capitis anterior 
Occipitofrontalis 
Epicranial aponeurosis 
Orbicularis palpebrarum 
Tensor tarsi 
Corrugator supercilii 
Pyramidalis nasi 
Compressor naris 
Depressor alae nasi 
Zygomaticus minor 
Levator labii superioris 
Levator labii superioris 
alaeque nasi 
Levator anguli oris 
Zygomaticus major 
Levator menti 
Depressor labii inferioris; Quad- 
ratus menti 
Depressor anguli oris 
Pterygomandibular ligament 
Masseteric fascia 
Temporal 
External pterygoid 
Internal pterygoid 
Deep cervical fascia 
Sternomastoid 
Digastric 
Stylohyoid 
Mylohyoid 
Geniohyoid 
Sternohyoid 
Omohyoid 
Sternothyroid 
Thyrohyoid 
Rectus capitis anticus major 
Rectus capitis anticus minor OR BASLE ANATOMICAL NOMENCLATURE 
1343 
TERMINOLOGY ADOPTED IN TEXT 
Scalenus anterior 
Scalenus posterior 
Lumbodorsal fascia 
Splenius cervicis 
Sacrospinalis 
Iliocostalis 
" lumborum 
" dorsi 
' ' cervicis 
Longissimus 
dorsi 
cervicis 
capitis 
Spinalis dorsi 
" cervicis 
" capitis 
Semispinalis dorsi 
cervicis 
capitis 
Multifidus 
Rotatores 
Intertransversarii 
Rectus capitis posterior major 
Rectus capitis posterior minor 
Obliquus capitis inferior 
Obliquus capitis superior 
Intercostales 
Intercostales externi 
Intercostales interni 
Subcostales 
-Transversus thoracis 
Serratus posterior superior 
Serratus posterior inferior 
Diaphragma 
Medial crus 
Intermediate crus > 
Lateral crus ) 
Medial lumbocostal arch 
Lateral lumbocostal arch 
Obliquus externus abdominis 
Subcutaneous inguinal ring 
Superior crus 
Inferior crus 
Intercrural fibres 
Inguinal ligament 
Lacunar ligament 
Reflected inguinal ligament 
Obliquus internus abdominis 
Transversus abdominis 
Inguinal aponeurotic falx 
Tendinous inscriptions 
Linea semicircularis 
Abdominal inguinal ring 
Inguinal canal 
Superior fascia of pelvic dia- 
phragm 
Inferior fascia of pelvic dia- 
phragm 
Tendinous arch of pelvic fascia 
Sphincter ani externus 
Sphincter ani internus 
Transversus perinae superficialis 
Bulbocavernosus 
Ischiocavernosus 
Urogenital diaphragm 
Superior fascia of .urogenital 
diaphragm 
Inferior fascia of urogenital 
diaphragm 
Transversus perinaei pro- 
fundus 
Sphincter urethrae mem- I 
branaceae J 
Levator scapulae 
Pectoral fascia 
BASLE TERMINOLOGY 
Scalenus anterior 
Scalenus posterior 
Fascia lumbodorsalis 
Splenius cervicis 
Sacrospinalis 
Iliocostalis 
" lumborum 
" dorsi 
cervicis 
Longissimus 
dorsi 
cervicis 
capitis 
Spinalis dorsi 
" cervicis 
" capitis 
Semispinalis dorsi 
cervicis 
capitis 
Multifidus 
Rotatores 
Intertransversarii 
Rectus capitis posterior major 
Rectus capitis posterior minor 
Obliquus capitis inferior 
Obliquus capitis superior 
Intercostales 
Intercostales externi 
Intercostales interni 
Subcostales 
Transversus thoracis 
Serratus posterior superior 
Serratus posterior inferior 
Diaphragma 
Crus mediale I 
Crus intermedium > 
Crus laterale ) 
Arcus lumbocostalis medialis 
[Halleri] 
Arcus lumbocostalis lateralis 
[Halleri] 
Obliquus externus abdominis 
Annulus inguinalis subcutaneus 
Crus superior 
Crus inferior 
Fibrae intercrurales 
Ligamentum inguinale [Pou- 
parti] 
Ligamentum lacunare [Gimber- 
nati] 
Ligamentum inguinale reflexum 
[Collesi] 
Obliquus internus abdominis 
Transversus abdominis 
Falx aponeurotica inguinalis 
Inscriptiones tendineae 
Linea semicircularis [Douglasi] 
Annulus inguinalis abdominalis 
Canalis inguinalis 
Fascia diaphragm atis pelvis 
superior 
Fascia diaphragmatis pelvis 
inferior 
Arcus tendineus fasciae pelvis 
Sphincter ani externus 
Sphincter ani internus 
Transversus perinaei superficialis 
Bulbocavernosus 
Ischiocavernosus 
Diaphragma urogenitale 
Fascia diaphragmatis urogeni- 
talis superior 
Fascia diaphragmatis urogeni- 
talis inferior 
Transversus perinaei pro- -> 
fundus 
Sphincter urethrae mem- I 
branaceae J 
Levator scapulae 
Fascia pectoralis 
OLD TERMINOLOGY 
Scalenus anticus 
Scalenus posticus 
Lumbar aponeurosis and ver- 
tebral fascia 
Splenius colli 
Erector spinse 
Iliocostalis 
Sacrolumbalis 
Musculus accessorius 
Cervicalis ascendens 
Longissimus dorsi 
" dorsi 
Transversalis cervicis 
Trachelomastoideus 
Spinalis dorsi 
" colli 
Biventer cervicis 
Semispinalis dorsi 
colli 
Complexus 
Multifidus spinae 
Rotatores spinae 
Intertransversales 
Rectus capitis posticus major 
Rectus capitis posticus minor 
Obliquus inferior 
Obliquus superior 
Intercostal 
External intercostal 
Internal intercostal 
Infracostales 
Triangularis sterni 
Serratus posticus superior 
Serratus posticus inferior 
Diaphragm 
J Crura and origins from 
1 arcuate ligaments 
Internal arcuate ligament 
External arcuate ligament 
External or descending oblique 
External abdominal ring 
Internal pillar 
External pillar 
Intercolumnar fibres 
Poupart's ligament 
Gimbernat's ligament 
Triangular fascia 
Internal or ascending oblique 
Transversalis abdominis 
Conjoined tendon of Internal 
oblique and Transversalis 
Lineae transversae 
Fold of Douglas 
Internal or deep abdominal ring 
Spermatic canal 
Visceral layer of pelvic fascia 
Anal fascia 
White line of pelvic fascia 
External sphincter ani 
Internal sphincter ani 
Transversus perinaei 
Ejaculator urinae or Sphincter 
vaginae 
Erector penis vel clitoridis 
Constrictor urethrae 
Deep layer of triangular liga- 
ment 
Superficial layer of triangular 
ligament 
Constrictor urethrae 
Levator anguli scapulae 
Deep fascia of anterior thoracic 
region 1344 
A GLOSSARY OF THE INTERNATIONAL 
terminology adopted in text 
Coracoclavicular fascia 
-Serratus anterior 
Deltoideus 
Brachial fascia 
- Biceps brachii 
Lacertus fibrosus 
Brachialis 
Triceps brachii 
__ Medial head 
Long head 
Lateral head 
Antibrachial fascia 
~ Pronator teres 
Humeral head 
Ulnar head 
Brachioradialis 
Extensor carpi radialis longus 
-Extensor carpi radialis brevis 
Extensor digiti quinti proprius 
- Supinator 
Abductor pollicis longus 
- Extensor pollicis brevis 
Extensor pollicis longus 
Extensor indicis proprius 
Transverse carpal ligament 
Dorsal carpal ligament 
Mucous sheaths 
- Palmar aponeurosis 
Superficial transverse 
ligament 
Abductor pollicis brevis 
Abductor digiti quinti 
Flexor digiti quinti brevis 
Opponens digiti quinti 
Interossei dorsales 
Interossei volares 
Psoas major 
Psoas minor 
Fascia cribrosa 
Fossa ovalis 
Iliotibial band 
Tensor fasciae latae 
Quadriceps femoris 
Rectus femoris 
Vastus lateralis 
Vastus medialis 
Vastus intermedius 
- Articularis genu 
"Biceps femoris 
Tibialis anterior 
Extensor hallucis longus 
Tendo calcaneus 
Tibialis posterior 
' Transverse crural ligament 
Cruciate crural ligament 
Laciniate ligament 
Superior peronaeal retinaculum 
-Plantar aponeurosis 
Quadratus plantae 
Adductor hallucis 
"'Abductor digiti quinti 
Flexor digiti quinti brevis 
Interossei dorsales 
Interossei plantares 
BASLE TERMINOLOGY 
Fascia coracoclavicularis 
Serratus anterior 
Deltoideus 
Fascia brachii 
Biceps brachii 
Lactertus fibrosus 
Brachialis 
Triceps brachii 
Caput mediale 
Caput longum 
Caput laterale 
Fascia antibrachii 
Pronator teres 
Caput humerale 
Caput ulnare 
Brachioradialis 
Extensor carpi radialis longus 
Extensor carpi radialis brevis 
Extensor digiti quinti proprius 
Supinator 
Abductor pollicis longus 
Extensor pollicis brevis 
Extensor pollicis longus 
Extensor indicis proprius 
Lig. carpi transversum 
Lig. carpi dorsale 
Vaginae mucosae 
Aponeurosis palmaris 
Fasciculi transversi 
Abductor pollicis brevis 
Abductor digiti quinti 
Flexor digiti quinti brevis 
Opponens digiti quinti 
Interossei dorsales 
Interossei volares 
Psoas major 
Psoas minor 
Fascia cribrosa 
Fossa ovalis 
Tractus iliotibialis 
Tensor fasciae latae 
Quadriceps femoris 
Rectus femoris 
Vastus lateralis 
Vastus medialis 
Vastus intermedius 
Articularis genu 
Biceps femoris 
Tibialis anterior 
Extensor hallucis longus 
Tendo calcaneus [Achillis] 
Tibialis posterior 
Lig. transversum cruris 
Lig. cruciatum cruris 
Lig. laciniatum 
Retinaculum mm. peronaeorum 
superius 
Aponeurosis plantaris 
Quadratus plantae 
Adductor hallucis 
Abductor digiti quinti 
Flexor digiti quinti brevis 
Interossei dorsales 
Interossei plantares 
OLD TERMINOLOGY 
Costocoracoid membrane 
Serratus magnus 
Deltoid 
Deep fascia of arm 
Biceps; Biceps flexor cubiti 
Bicipital fascia 
Brachialis anticus 
Triceps; Triceps extensor cubiti 
Inner head 
Long head 
Outer head 
Deep fascia of forearm 
Pronator radii teres 
Humeral head 
Coronoid head 
Supinator longus 
Extensor carpi radialis longior 
Extensor carpi radialis brevior 
Extensor minimi digiti 
Supinator brevis 
Extensor ossis metacarpi pollicis 
Extensor primi internodii 
pollicis 
Extensor secundi internodii 
pollicis 
Extensor indicis 
Anterior annular ligament 
Posterior annular ligament 
Synovial sheaths 
Palmar fascia 
Superficial transverse 
ligament 
Abductor pollicis 
Abductor minimi digiti 
Flexor brevis minimi digiti 
Opponens minimi digiti 
Dorsal interossei 
Palmar interossei 
Psoas magnus 
Psoas parvus 
Cribriform fascia 
Saphenous opening 
Iliotibial band 
Tensor fasciae femoris 
Quadriceps extensor 
Rectus femoris 
Vastus externus 
Vastus internus 
Crureus 
Subcrureus 
Biceps 
Tibialis anticus 
Extensor proprius hallucis 
Tendo Achillis 
Tibialis posticus 
Upper part of anterior annular 
ligament 
Lower part of anterior annular 
ligament 
Internal annular ligament 
External annular ligament 
Plantar fascia 
Flexor accessorius 
Adductor obliquus hallucis 
Abductor minimi digiti 
Flexor brevis minimi digiti 
Dorsal interossei 
Plantar interossei 
ANGIOLOGY. 
Heart 
Coronary sulcus 
Anterior longitudinal sulcus 
Posterior longitudinal sulcus 
Atrium 
Sinus venarum 
Cor 
Sulcus coronarius 
Sulcus longitudinalis anterior 
Sulcus longitudinalis posterior 
Atrium 
Sinus venarum 
Heart 
Auriculoventricular groove 
Anterior interventricular groove 
Posterior interventricular 
groove 
Auricle 
Sinus venosus OR BASLE ANATOMICAL NOMENCLATURE 
1345 
TERMINOLOGY ADOPTED IN TEXT 
Heart (continued) 
Auricula 
Valve of inferior vena cava 
Valve of coronary sinus 
Limbus fossae ovalis 
Intervenous tubercle 
Tricuspid valve 
Anterior cusp 
Posterior cusp 
Medial cusp 
Trabeculae carneae 
Nodules of semilunar valves 
Bicuspid valve 
Aortic sinuses 
Ventricular septum 
Arteries • 
Pulmonary artery 
Ascending aorta 
Right coronary artery 
Left coronary artery 
Arch of aorta 
Innominate artery 
Common carotid artery 
External carotid artery 
Superior thyroid artery 
Hyoid branch 
Sternocleidomastoid branch 
Lingual artery 
Hyoid branch 
A. dorsalis linguae 
A, profunda linguae 
External maxillary artery 
Inferior labial artery 
Superior labial artery 
Sternocleidomastoid artery 
Descending branch of occipital 
artery 
Anterior tympanic artery 
Accessory meningeal branch 
Inferior alveolar artery 
Buccinator artery 
Posterior superior alveolar 
artery 
Caroticotympanic branch 
Artery of pterygoid canal 
Sphenopalatine artery 
Medial palpebral arteries 
Anterior choroidal artery 
Dorsal nasal artery 
Arterial circle of Willis 
Meningeal branch of vertebrae 
Posterior spinal artery 
Anterior spinal artery 
Internal auditory artery 
Thyrocervical trunk 
Transverse scapular artery 
Transverse cervical artery 
Ascending branch 
Descending branch 
Pericardiacophrenic artery 
Costocervical trunk i 
Highest intercostal artery J 
Highest thoracic artery 
Thoracoacromial artery 
Deltoid branch 
Lateral thoracic artery 
Scapular circumflex artery 
Posterior humeral circumflex 
artery 
Anterior humeral circumflex 
artery 
A. profunda brachii 
Radial collateral artery 
Superior ulnar collateral artery 
Inferior ulnar collateral artery 
BASLE TERMINOLOGY 
Cor {continued) 
Auricula 
Valvula venae cavae inferioris 
[Eustachii] 
Valvula sinus coronarii 
[Thebesii] 
Limbus fossae ovalis 
Tuberculum intervenosum 
Valvula tricuspidalis 
Cuspus anterior 
Cuspus posterior 
Cuspus medialis 
Trabeculae carneae 
Noduli valvularum semi- 
lunarium [Arantii] 
Valvula bicuspidalis [mitralis] 
Sinus aortae [Valsalvae] 
Septum ventriculorum 
Arteriae 
A. pulmonalis 
Aorta ascendens 
A. coronaria (cordis) dextra 
A. coronaria (cordis) sinistra 
Arcus aortae 
A. anonyma 
A. carotis communis 
A. carotis externa 
A. thyreoidea superior 
Ramus hyoideus 
Ramus sternocleidomastoideus 
A. lingualis 
Ramus hyoideus 
A. dorsalis linguae 
A. profunda linguae 
A. maxillaris externa 
A. labialis inferior 
A. labialis superior 
A. sternomastoidea 
Ramus descendens a. occipitalis 
A. tympanica anterior 
Ramus meningeus accessorius 
A. alveolaris inferior 
A. buccinatoria 
A. alveolaris superior posterior 
Ramus caroticotympanicus 
A. canalis pterygoidei [Vidii] 
A. sphenopalatina 
Aa. palpebrales mediales 
A. chorioidea 
A. dorsalis nasi 
Circuius arteriosus [Willisi] 
Ramus meningeus 
A. spinalis posterior 
A. spinalis anterior 
A. auditiva interna 
Truncus thyreocervicalis 
A. transversa scapulae 
A. transversa colli 
Ramus ascendens 
Ramus descendens 
A. pericardiacophrenica 
Truncus costocervicalis 1 
A. intercostalis supremaj 
A. thoracalis suprema 
A. thoracoacromialis 
Ramus deltoideus 
A. thoracalis lateralis 
A. circumflexa scapulae 
A. circumflexa humeri posterior 
A. circumflexa humeri anterior 
A. profunda brachii 
A. collateralis radialis 
A. collateralis ulnaris superior 
A. collateralis ulnaris inferior 
OLD TERMINOLOGY 
Heart (continued) 
Auricular appendix 
Eustachian valve 
Thebesian valve 
Annulus ovalis 
Tubercle of Lower 
Tricuspid valve 
Infundibular cusp 
Marginal cusp 
Septal cusp 
Columnae carneae 
Corpora Arantii 
Mitral valve 
Sinuses of Valsalva 
Interventricular septum 
Arteries 
Pulmonary artery 
Ascending aorta 
Right coronary artery 
Left coronary artery 
Transverse aorta 
Brachiocephalic artery 
Common carotid artery 
External carotid artery 
Superior thyroid artery 
Infrahyoid branch 
Sternomastoid branch 
Lingual artery 
Suprahyoid branch 
Rami dorsalis linguae 
Ranine artery; deep lingual 
artery 
Facial artery 
Inferior coronary artery 
Superior coronary artery 
Sternomastoid artery 
Arteria princeps cervicis 
Tympanic artery 
Small meningeal artery 
Inferior dental artery 
Buccal artery 
Alveolar or posterior dental 
artery 
Tympanic branch of internal 
carotid artery 
Vidian artery 
Nasopalatine artery 
Internal palpebral arteries 
Choroid artery 
Nasal artery 
Circle of Willis 
Posterior meningeal branch 
Dorsal spinal artery 
Ventral spinal artery 
Auditory artery 
Thyroid axis 
Suprascapular artery 
Transversalis colli artery 
Superficial cervical artery 
Posterior scapular artery 
A. comes nervi phrenici 
Superior intercostal artery 
Superior thoracic artery 
Acromiothoracic artery; thoracic 
axis 
Humeral branch 
Long thoracic artery 
Dorsalis scapulae artery 
Posterior circumflex artery 
Anterior circumflex artery 
Superior profunda artery 
Ant. branch of sup. profunda 
artery 
Inferior profunda artery 
Anastomotica magna artery 1346 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Arteries (continued) 
Volar carpal branch 
Superficial volar branch 
Dorsal carpal branch 
Dorsal metacarpal arteries 
A. volaris indicis radialis 
Deep volar arch 
Volar metacarpal arteries 
Volar interosseous artery 
Dorsal interosseous artery 
Volar carpal branch of ulnar 
Dorsal carpal branch of ulnar 
Deep volar branch of ulnar 
Superficial volar arch 
Common volar digital arteries 
Proper volar digital arteries 
Coeliac artery 
Left gastric artery 
Right gastric artery 
Lienal artery 
Short gastric arteries 
Intestinal arteries 
Middle suprarenal artery 
Internal spermatic arteries 
Hypogastric artery 
Internal pudendal artery 
Perineal artery 
Posterior scrotal arteries 
Deep artery of penis 
Inferior gluteal artery 
Superior gluteal artery 
Inferior epigastric artery 
External spermatic artery 
Femoral canal 
Femoral ring 
Femoral septum 
Femoral triangle 
Adductor canal 
Superficial external pudendal 
artery 
Deep external pudendal artery 
Profunda femoris artery 
Lateral femoral circumflex artery 
Medial femoral circumflex artery 
Highest genicular artery 
Sural arteries 
Superior genicular arteries 
Middle genicular artery- 
Inferior genicular arteries 
Anterior medial malleolar artery 
Anterior lateral malleolar artery 
Lateral tarsal artery 
Arcuate artery 
Dorsal metatarsal arteries 
Deep plantar artery 
Peroneal artery 
Perforating branch 
Lateral calcaneal 
Posterior medial malleolar artery 
Medial calcaneal 
Medial plantar artery 
Lateral plantar artery 
Plantar metatarsal arteries 
Plantar digital arteries 
Veins 
Great cardiac vein 
Small cardiac vein 
Oblique vein of left atrium 
Ligament of left vena cava 
Smallest cardiac veins 
Anterior facial vein 
Posterior facial vein 
Deep cervical vein 
Middle cerebral vein 
Internal cerebral veins 
Great cerebral vein 
Terminal vein 
Superior sagittal sinus 
BASLE TERMINOLOGY 
Arteriae {continued) 
Ramus carpeus volaris 
Ramus volaris superficialis 
Ramus carpens dorsalis 
Aa. metacarpeae dorsales 
A. volaris indicis radialis 
Arcus volaris profundus 
Aa. metacarpeae volares 
A. interossea volaris 
A. interossea dorsalis 
Ramus carpeus volaris 
Ramus carpeus dorsalis 
Ramus volaris profundus 
Arcus volaris superficialis 
Aa. digitales volares communes 
Aa. digitales volares propriae 
A. coeliaca 
A. gastrica sinistra 
A. gastrica dextra 
A. lienalis 
Aa. gastricae breves 
Aa. intestinales 
A. suprarenalis media 
A. spermaticae internae 
A. hypogastrica 
A. pudenda interna 
A. perinei 
Aa. scrotales posteriores 
A. profunda penis 
A. glutaea inferior 
A. glutaea superior 
A. epigastrica inferior 
A. spermatica externa 
Canalis femoralis 
Annulus femoralis 
Septum femorale [Cloqueti] 
Trigonum femorale [fossa 
Scarpae major] 
Canalis adductorius [Hunteri] 
A. pudenda externa super- 
ficialis 
A. pudenda externa profunda 
A. profunda femoris 
A. circumflexa femoris lateralis 
A. circumflexa femoris medialis 
A. genu suprema 
Aa. surales 
Aa. genu superiores 
A. genu media 
Aa. genu inferiores 
A. malleolaris anterior medialis 
A. malleolaris anterior lateralis 
A. tarsea lateralis 
A. arcuata 
Aa. metatarseae dorsales 
Ramus plantaris profundus 
A. peronaea 
Ramus perforans 
Ramus calcaneus lateralis 
A. malleolaris posterior medialis 
Rami calcanei mediales 
A. plantaris medialis 
A. plantaris lateralis 
Aa. metatarseae plantares 
Aa. digitales plantares 
Venae 
V. cordis magna 
V. cordis parva 
V. obliqua atrii sinistri [Mar 
sb alii] 
Lig. venae cavae sinistrae 
Vv. cordis minimae 
V. facialis anterior 
V. facialis posterior 
V. cervicalis profunda 
V. cerebri media 
Vv. cerebri internae 
V. cerebri magna [Galeni] 
V. terminalis 
Sinus sagittalis superior 
Arteries (continued) 
Anterior radial carpal artery 
Superficialis volae artery 
Posterior radial carpal artery 
Dorsal interosseous arteries 
Radialis indicis artery 
Deep palmar arch 
Palmar interosseous arteries 
Anterior interosseous artery 
Posterior interosseous artery 
Anterior ulnar carpal artery 
Posterior ulnar carpal artery 
Profunda branch 
Superficial palmar arch 
Palmar digital arteries 
Collateral digital arteries 
Cceliac axis 
Gastric or coronary artery 
Pyloric artery 
Splenic artery 
Vasa brevia 
Vasa intestini tenuis 
Middle capsular artery 
Spermatic arteries 
Internal iliac artery 
Internal pudic artery 
Superficial perineal artery 
Superficial perineal arteries 
Artery to corpus cavernosum 
Sciatic artery 
Gluteal artery 
Deep epigastric artery 
Cremasteric artery 
Crural canal 
Crural ring 
Septum crurale 
Scarpa's triangle 
Hunter's canal 
Superficial external pudic artery 
Deep external pudic artery 
Deep femoral artery 
External circumflex artery 
Internal circumflex artery 
Anastomotica magna artery 
Inferior muscular arteries 
Superior articular arteries 
Azygos articular artery 
Inferior articular arteries 
Internal malleolar artery 
External malleolar artery 
Tarsal artery 
Metatarsal artery 
Dorsal interosseous arteries 
Communicating artery 
Peroneal artery 
Anterior peroneal artery 
External calcaneal 
Internal malleolar artery 
Internal calcaneal 
Internal plantar artery 
External plantar artery 
Digital branches 
Collateral digital branches 
Veins 
Left coronary vein 
Right coronary vein 
- Oblique vein of Marshall 
Vestigial fold of Marshall 
Veins of Thebesius 
Facial vein 
Temporomaxillary vein 
Posterior vertebral or posterior 
deep cervical vein 
Superficial Sylvian vein 
Veins of Galen 
Great vein of Galen 
Vein of corpus striatum 
Superior longitudinal sinus OR BASLE ANATOMICAL NOMENCLATURE 
1347 
TERMINOLOGY ADOPTED IN TEXT 
Veins (continued) 
Inferior sagittal sinus 
Transverse sinus 
Confluence of the sinuses 
Basilar plexus 
Innotninate veins 
Highest intercostal vein 
Azygos vein 
Hemiazygos vein 
Accessory hemiazygos vein 
External vertebral venous plexus 
Internal vertebral venous plexus 
Great saphenous vein 
Small saphenous vein 
Inferior epigastric vein 
Hypogastric vein 
Superior gluteal veins 
Inferior gluteal veins 
Pudendal plexus 
Lienal vein 
Coronary vein 
Lymphatic vessels 
Cisterna chyli 
Posterior auricular glands 
Anterior auricular glands 
Deep facial glands 
Hypogastric glands 
Inferior gastric glands 
Pancreaticolienal glands 
Sternal glands 
BASLE TERMINOLOGY 
Venae (continued) 
Sinus sagittalis inferior 
Sinus transversus 
Confluens sinuum 
Plexus basilaris 
Vv. anonymae 
V. intercostalis suprema 
V. azygos 
V. hemiazygos 
V. hemiazygos aecesoria 
Plexus venosi vertebralis 
externi 
Plexus venosi vertebralis interni 
V. saphena magna 
V. saphena parva 
V. epigastrica inferior 
V. hypogastrica 
Vv. glutaeae superiores 
Vv. glutaeae inferiores 
Plexus pudendalis 
V. lienalis 
• V. coronaria ventriculi 
Vasa lymphatici 
Cisterna chyli 
Lymphoglandulae auriculares 
posteriores 
Lymphoglandulae auriculares 
anteriores 
Lymphoglandulae faciales pro- 
funda 
Lymphoglandulae hypogastricae 
Lymphoglandulae gastricae 
inferiores 
Lymphoglandulae pancreatico- 
lienales 
Lymphoglandulae sternales 
OLD TERMINOLOGY 
Veins (continued) 
Inferior longitudinal sinus 
Lateral sinus 
Torcular Herophili 
Transverse or basilar sinus 
Brachiocephalic veins 
Superior intercostal vein 
Vena azygos major 
Vena azygos minor inferior 
Vena azygos minor superior 
Extraspinal veins 
Intraspinal veins 
Internal or long saphenous vein 
External or short saphenous vein 
Deep epigastric vein 
Internal iliac vein 
Gluteal veins 
Sciatic veins 
Vesicoprostatic plexus 
Splenic vein 
Gastric vein 
Lymphatic vessels 
Receptaculum chyli 
Mastoid glands 
Superficial parotid or preauricu- 
lar glands 
Internal maxillary glands 
Internal iliac glands 
Right gastroepiploic gland 
Splenic glands 
Internal mammary glands 
NEUROLOGY. 
Medulla spinalis 
Funiculi of medulla spinalis 
Columns of gray substance 
Anterior column 
Lateral column 
Posterior column 
Dorsal nucleus 
Anterior cerebrospinal fasciculus 
Anterior proper fasciculus 
Lateral cerebrospinal fasciculus 
Cerebellospinal fasciculus 
Superficial antero-lateral fascic- 
ulus 
Lateral proper fasciculus 
Fasciculus gracilis 
Fasciculus cuneatus 
Rhombencephalon 
Medulla oblongata 
Anterior median fissure 
Posterior median fissure 
Olive 
Tubercle of Rolando 
Spinal tract of trigeminal nerve 
Lemniscus 
Decussation of lemniscus 
Cerebellospinal fasciculus 
Medial longitudinal fasciculus 
Horizontal sulcus [of cerebel- 
lum] 
Quadrangular lobule 
Folium vermis 
Medulla spinalis 
Funiculi medullae spinalis 
Columnae griseae 
Columna anterior 
Columna lateralis 
Columna posterior 
Nucleus dorsalis [Stillingi, 
Clarkii] 
Fasciculus cerebrospinalis anterior 
Fasciculus anterior proprius 
[Flechsigi] 
Fasciculus cerebrospinalis lateralis 
Fasciculus cerebellospinalis 
Fasciculus anterolateralis super- 
ficialis [Gowersi] 
Fasciculus lateralis proprius 
[Flechsigi] 
Fasciculus gracilis [Golli] 
Fasciculus cuneatus [Burdachi] 
Rhombencephalon 
Medulla oblongata 
Fissura mediana anterior 
Fissura mediana posterior 
Oliva 
Tuber cinereum 
Tractus spinalis n. trigemini 
Lemniscus 
Decussatio lemniscorum 
Fasciculus cerebellospinalis 
Fasciculus longitudinalis medi- 
alis 
Sulcus horizontalis [cerebelli] 
Lobulus quadrangularis 
Folium vermis 
Spinal cord 
Columns of spinal cord 
Horns Of gray matter 
Anterior cornu 
Lateral cornu 
Posterior cornu 
Clarke's column 
Direct pyramidal tract 
Anterior basis bundle 
Crossed pyramidal tract 
Direct cerebellar tract 
Gowers' tract. 
Lateral basis bundle 
Column of Goll 
Column of Burdach 
Hind-brain 
Spinal bulb 
Ventral or ventromedian fissure 
Dorsal or dorsomedian fissure 
Olivary body 
Tubercle of Rolando 
Spinal root of fifth cranial nerve 
Fillet 
Sensory decussation 
Direct cerebellar tract 
Posterior longitudinal bundle 
Great horizontal fissure 
Ant. and post, crescentic lobes 
Folium cacuminis; cacuminal 
lobe 1348 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Rhombencephalon {continued) 
Superior semilunar lobule 
Nodule 
Uvula 
Tonsillae 
Tuber vermis 
Inferior semilunar lobule 
Brachia conjunctiva 
Brachia pontis 
Restiform bodies 
Anterior medullary velum 
Posterior medullary velum 
Taenia of fourth ventricle 
Rhomboid fossa 
Medial eminence 
Colliculus facialis 
Area acustica 
Medullary striae 
Ala cinerea 
Mesencephalon 
Cerebral peduncle 
Base of peduncle 
Substantia nigra 
Inferior colliculus 
Superior colliculus 
Cerebral aqueduct 
Prosencephalon 
Thalami 
Intermediate mass 
Medial geniculate body 
Lateral geniculate body 
Pineal body 
Corpus subthalamicum 
Corpora mamillaria 
Hypophysis 
Optic chiasma 
Cerebral hemisphere 
Longitudinal fissure 
Lateral cerebral fissure 
Central sulcus 
Cingulate sulcus 
Anterior central gyrus 
Superior frontal gyrus 
Middle frontal gyrus 
Inferior frontal gyrus 
Intraparietal sulcus 
Posterior central gyrus 
Inferior parietal lobule 
Fusiform gyrus 
Transverse temporal gyri 
Insula 
Cingulate gyrus 
Callosal sulcus 
Hippocampal fissure 
Subcallosal gyrus 
Supracallosal gyrus 
Fascia dentata hippocampi 
Body of corpus callosum 
Calcar avis 
Anterior cornu of lateral 
ventricle 
Posterior cornu of lateral 
ventricle 
Inferioi cornu of lateral ven- 
tricle 
Hippocampus 
Caudate nucleus 
Lentiform nucleus 
Frontal part of internal capsule 
Occipital part of internal cap- 
sule 
Stria terminalis 
BASLE TERMINOLOGY 
Rhombencephalon (continued') 
Lobulus semilunaris superior 
Nodulus vermis 
Uvula vermis 
Tonsilla cerebelli 
Tuber vermis 
Lobulus semilunaris inferior 
Brachia conjunctiva [cerebelli] 
Brachia pontis 
Corpus restiformes 
Velum medullare anterius 
Velum medullare posterius 
Taenia ventriculi quarti 
Fossa rhomboidea 
Eminentia medialis 
Colliculus facialis 
Area acustica 
Striae medullares 
Ala cinerea 
Mesencephalon 
Pedunculus cerebri 
Basis pedunculi 
Substantia nigra 
Colliculus inferior 
Colliculus superior 
Aquaeductus cerebri 
Prosencephalon 
Thalami 
Massa intermedia 
Corpus geniculatum mediale 
Corpus geniculatum laterale 
Corpus pineale 
Corpus subthalamicum 
Corpora mamillaria 
Hypophysis 
Chiasma opticum 
H emisphaerium 
Fissura cerebri longitudinalis 
Fissura cerebri lateralis [Sylvii] 
Sulcus centralis [Rolandi] 
Sulcus cinguli 
Gyrus centralis anterior 
Gyrus frontalis superior 
Gyrus frontalis medius 
Gyrus frontalis inferior 
Sulcus interparietalis 
Gyrus centralis posterior 
Lobulus parietalis inferior 
Gyrus fusiformis 
Gyri temporales transversi 
Insula 
Gyrus cinguli 
Sulcus corporis callosi 
Fissura hippocampi 
Gyrus subcallosus 
Indusium griserum 
Fascia dentata hippocampi 
Truncus corporis callosi 
Calcar avis 
Cornu anterius 
Cornu posterius 
Cornu inferior 
Hippocampus 
Nucleus caudatus 
Nucleus lentiformis 
Pars frontalis capsulae internae 
Pars occipitalis capsulae internae 
Stria terminalis 
OLD TERMINOLOGY 
Hind-brain {continued) 
Postero-superior lobule 
Nodular lobe 
Uvular lobe 
Amygdaline nucleus 
Tuber valvulas 
Slender and postero-inferior 
lobules 
Superior cerebellar peduncles 
Middle cerebellar peduncles 
Inferior cerebellar peduncles 
Valve of Vieussens; superior 
medullary velum 
Inferior medullary velum 
Ligula 
Floor of fourth ventricle 
Fasciculus teres 
Eminentia teres 
Trigonum acusticum 
Striae acusticae 
Trigonum vagi 
Mid-brain 
Crus cerebri 
Crusta or pes 
Intercalatum 
Inferior quadrigeminal body 
Superior quadrigeminal body 
Aqueduct of Sylvius 
Fore-brain 
Optic thalamus 
Middle commissure 
Internal geniculate body; post- 
geniculatum 
External geniculate body; pre- 
geniculatum 
Epiphysis 
Nucleus of Luys 
Corpus albicantia 
Pituitary body 
Optic commissure 
Cerebral hemisphere 
Great longitudinal fissure 
Fissure of Sylvius 
Fissure of Rolando 
Callosomarginal fissure 
Ascending frontal convolution; 
precentral gyre 
Suprafrontal gyre 
Medifrontal gyre 
Subfrontal gyre 
Intraparietal fissure 
Ascending parietal convolution; 
postcentral gyre 
Subparietal district or lobule 
Occipitotemporal convolution 
Gyri of Heschl 
Island of Reil 
Callosal convolution 
Callosal sulcus 
Dentate fissure 
Peduncle of corpus callosum 
Gyrus epicallosus 
Gyrus dentatus 
Body of corpus callosum 
Hippocampus minor 
Anterior horn; precornu 
Postcornu 
Descending horn; medicornu 
Hippocampus major 
Caudatum 
Lenticular nucleus 
Anterior limb of internal capsule 
Posterior limb of internal cap- 
sule 
Taenia semicircularis OR BASLE ANATOMICAL NOMENCLATURE 
1349 
TERMINOLOGY ADOPTED IN TEXT 
Prosencephalon (continued') 
Cerebral hemisphere 
Optic radiation 
Column of fornix 
Thalamomamillary fasciculus 
Crura of fornix 
Septum pellucidum 
Cavity of septum pellucidum 
Tela chorioidea of third ven- 
tricle 
Tela chorioidea of fourth ven- 
tricle 
Choroid plexus of lateral 
ventricle 
Meninges 1 
Cerebral dura mater 
Spinal dura mater 
Subarachnoid cavity 
Cisterna cerebellomedullaris 
Cisterna interpeduncularis 
Arachnoid granulations 
Cerebral pia mater 
Spinal pia mater 
Cerebral nerves j 
Olfactory nerves 
Optic nerve 
Oculomotor nerve 
Trochlear nerve 
Trigeminal nerve 
Semilunar ganglion 
Nasociliary nerve 
Ciliary ganglion 
Maxillary nerve ' 
Middle meningeal nerve 
Zygomatic nerve 
Zygomaticotemporal branch 
Zygomaticofacial branch 
Posterior superior alveolar 
branches 
Middle superior alveolar 
branch 
Anterior superior alveolar 
branch 
Inferior palpebral branches 
Superior labial branches 
Sphenopalatine ganglion 
Greater superficial petrosal 
nerve 
Deep petrosal nerve 
Nerve of pterygoid canal 
Orbital branches 
Palatine nerves 
Mandibular nerve 
Nervus spinosus 
Buccinator nerve 
Inferior alveolar nerve 
Abducent nerve 
Facial nerve 
Sensory part of facial nerve 
Genicular ganglion 
Nerve to Stapedius 
Zygomatic branches 
Buccal branches 
Acoustic nerve 
Vestibular root 
Cochlear root 
Glossopharyngeal nerve 
Superior ganglion 
Petrous ganglion 
Tympanic nerve 
Vagus nerve 
Jugular ganglion 
Ganglion nodosum 
Meningeal branch 
Auricular branch 
BASLE TERMINOLOGY 
Prosencephalon (continued) 
Hemisphaerium 
Radiatio occipitothalamica 
Columna fornicis 
Fasciculus thalamomamillaris 
Crus fornicis 
Septum pellucidum 
Cavum septi pellucidi 
Tela chorioidea ventriculi tertii 
Tela chorioidea ventriculi quarti 
Plexus chorioideus ventriculus 
lateralis 
Meninges 
Dura mater encephali 
Dura mater spinalis 
Cavum subarachnoideale 
Cisterna cerebellomedullaris 
Cisterna interpeduncularis 
Granulationes arachnoidales 
Pia mater encephali 
Pia mater spinalis 
Nervi cerebrales 
Nn. olfactorii 
N. opticus 
N. oculomotorius 
N. trochlearis 
N. trigeminus 
Ganglion semilunare [Gasseri] 
N. nasociliaris 
Ganglion ciliare 
N. maxillaris 
N. meningeus medius 
N. zygomaticus 
Ramus zygomaticotemporalis 
Ramus zygomaticofacialis 
: Rami alveolares superiores 
posteriores 
Ramus alveolaris superior 
medius 
Ramus alveolaris superior 
anteriores 
Rami palpebrales inferiores 
Rami labiales superiores 
Ganglion sphenopalatinum 
1 N. petrosus superficialis major 
N. petrous profundus 
N. canalis pterygoidei [Vidii] 
Rami orbitales 
Nn. palatini 
N. mandibularis 
N. spinosus 
N. buccinatorius 
N. alveolaris inferior 
N. abducens 
N. facialis 
N. intermedius 
Ganglion geniculi 
N. stapedius 
Rami zygomatici 
Rami buccales 
N. acusticus 
Radix vestibularis 
Radix cochlearis 
N. glossopharyngeus 
Ganglion superius 
Ganglion petrosum 
N. tympanicus 
N. vagus 
Ganglion jugulare 
Ganglion nodosum 
Ramus meningeus 
Ramus auricularis 
OLD TERMINOLOGY 
Fore-brain (continued) 
Cerebral hemisphere 
Optic radiation 
Anterior pillar of fornix 
Bundle of Vicq d'Azyr 
Posterior pillar of fornix 
Septum lucidum 
Pseudocole; fifth ventricle 
Velum interpositum 
Tela chorioidea inferior 
Paraplexus 
Meninges 
Dura of brain 
Spinal dura 
Subarachnoid space 
Cisterna magna 
Cisterna basalis 
Pacchionian bodies 
Pia of brain 
Pia of cord 
Cranial nerves 
First nerve 
Second nerve 
Third nerve 
Fourth nerve 
Fifth nerve 
Gasserian ganglion 
Nasal nerve 
Ophthalmic or lenticular 
ganglion 
Superior maxillary nerve 
Meningeal or dural branch 
Temporomalar nerve 
Temporal branch; orbital 
nerve 
Malar branch 
Posterior superior dental 
branches 
Middle superior dental branch 
Anterior superior dental 
branch 
Palpebral branches 
Labial branches 
Ganglion of Meckel 
Large superficial petrosal 
nerve 
Large deep petrosal nerve 
Vidian nerve 
Ascending branches 
Descending branches 
Inferior maxillary nerve 
Recurrent or meningeal branch 
Long buccal nerve 
Inferior dental nerve 
Sixth nerve 
Seventh nerve 
Pars intermedia of Wrisberg 
Geniculate ganglion 
Tympanic branch 
Malar branches 
Infraorbital branches 
Eighth nerve; auditory nerve 
Vestibular nerve 
Cochlear nerve 
Ninth nerve 
Jugular ganglion 
Inferior ganglion 
Nerve of Jacobson 
Tenth nerve; pneumogastric 
nerve 
Ganglion of root 
Ganglion of trunk; inferior 
ganglion 
Dural branch 
Nerve of Arnold 1350 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Cerebral nerves (.continued) 
Vagus nerve 
Recurrent nerve 
Superior cardiac branches 
Inferior cardiac branches 
Anterior bronchial branches 
Posterior bronchial branches 
(Esophageal plexus 
Accessory nerve 
Cerebral part 
Spinal part 
Hypoglossal nerve 
Spinal nerves 
Posterior divisions 
Medial branch 
Lateral branch 
Greater occipital nerve 
Anterior divisions 
Smaller occipital nerve 
Anterior branch 
Posterior branch 
Cutaneous cervical nerve 
Supraclavicular nerves 
Anterior supraclavicular nerves 
Middle supraclavicular nerves 
Posterior supraclavicular nerves 
Brachial plexus 
Lateral cord 
Medial cord 
Posterior cord 
Dorsal scapular nerve 
Long thoracic nerve 
Lateral and medial anterior 
thoracic nerves 
Thoracodorsal nerve 
Axillary nerve 
Lateral brachial cutaneous nerve 
Lateral antibrachial cutaneous 
nerve 
Volar branch 
Dorsal branch 
Medial antibrachial cutaneous 
nerve 
Volar branch 
Ulnar branch 
Medial brachial cutaneous nerve 
Volar interosseous nerve 
Proper volar digital nerves 
Radial nerve 
Posterior brachial cutaneous 
nerve 
Dorsal antibrachial cutaneous 
nerve 
Superficial branch of radial 
nerve 
Deep branch of radial nerve / 
Dorsal interosseous nerve f 
Lumbosacral trunk 
Iliohypogastric nerve 
Lateral cutaneous branch 
Anterior cutaneous branch 
Genitofemoral nerve 
External spermatic nerve 
Lumboinguinal nerve 
Lateral femoral cutaneous nerve 
Femoral nerve 
Intermediate cutaneous nerve 
Saphenous nerve 
Infrapatellar branch 
BASLE TERMINOLOGY 
Nervi cerebrales (continued') 
N. vagus 
N. recurrens 
Rami cardiaci superiores 
Rami cardiaci inferiores 
Rami bronchiales anteriores 
Rami bronchiales posteriores 
(Plexus oesophageus anterior i 
(Plexus oesophageus posterior j 
N. accessorius 
Ramus internus 
Ramus externus 
N. hypoglossi 
Nervi spinales 
Rami posteriores 
Ramus medialis 
Ramus lateralis 
N. occipitalis major 
Rami anteriores 
N. occipitalis minor 
Ramus anterior 
Ramus posterior 
N. cutaneus colli 
Nn. supraclaviculares 
Nn. supraclaviculares anteriores 
Nn. supraclaviculares medii 
Nn. supraclaviculares pos- 
teriores 
Plexus brachialis 
Fasciculus lateralis 
Fasciculus medialis 
Fasciculus posterior 
N. dorsalis scapulae 
N. thoracalis longus 
Nn. thoracales anteriores 
N. thoracodorsalis 
N. axillaris 
N. cutaneus brachii lateralis 
N. cutaneus antibrachii lateralis 
Ramus volaris 
Ramus dorsalis 
N. cutaneus antibrachii medialis 
Ramus volaris 
Ramus ulnaris 
N. cutaneus brachii medialis 
N. interosseus volaris 
Nn. digitales volares proprii 
N. radialis 
N. cutaneus brachii posterior 
N. cutaneus antibrachii dorsalis 
Ramus superficialis 
Ramus profundus i 
N. interosseus dorsalis j 
Truncus lumbosacralis 
N. iliohypogastricus 
Ramus cutaneus lateralis 
Ramus cutaneus anterior 
N. genitofemoralis 
N. spermaticus externus 
N. lumboinguinalis 
N. cutaneus femoralis lateralis 
N. femoralis 
Ramus cutaneus anterior 
N. saphenus 
Ramus infrapatellaris 
OLD TERMINOLOGY 
Cranial nerves (continued) 
Tenth nerve; pneumogastric 
nerve 
Inferior or recurrent laryngeal 
nerve 
Cervical cardiac branches 
Thoracic cardiac branches 
Anterior or ventral pulmonary 
branches 
Posterior or dorsal pulmonary 
branches 
Plexus guise 
Eleventh nerve; spinal accessory 
nerve 
Accessory portion 
Spinal portion 
Twelfth nerve 
Spinal nerves 
Posterior divisions 
Internal branch 
External branch 
Great occipital nerve 
Anterior divisions 
Small occipital nerve 
Facial branch 
Mastoid branch 
Superficial or transverse cervical 
nerve 
Descending branches 
Suprasternal nerves 
Supraclavicular nerves 
Supra-acromial nerves 
Brachial plexus 
Outer cord 
Inner cord 
Posterior cord 
Nerve to Rhomboidei; posterior 
scapular nerve 
External respiratory nerve of 
Bell 
Internal and external anterior 
thoracic nerves 
Long subscapular nerve 
Circumflex nerve 
Cutaneous branch of circumflex 
nerve 
Cutaneous branch of musculo- 
cutaneous nerve 
Anterior branch 
Posterior branch 
Internal cutaneous nerve 
Anterior branch 
Posterior branch 
Lesser internal cutaneous nerve 
Anterior interosseous nerve 
Collateral branches of digital 
nerves 
Musculospiral nerve 
Internal cutaneous branch of 
musculospiral nerve 
External cutaneous branches of 
musculospiral nerve 
Radial nerve 
Posterior interosseous nerve 
Lumbosacral cord 
Iliohypogastric nerve 
Iliac branch 
Hypogastric branch 
Genitocrural nerve 
Genital branch 
Femoral or crural branch 
External cutaneous nerve 
Anterior crural nerve 
Middle cutaneous nerve 
Long or internal saphenous nerve 
Patellar branch OR BASLE ANATOMICAL NOMENCLATURE 
1351 
TERMINOLOGY ADOPTED IN TEXT 
Spinal nerves (continued) 
Posterior femoral cutaneous 
nerve 
Sciatic nerve 
Tibial nerve 
Medial sural cutaneous nerve 
Sural nerve 
Medial plantar nerve 
Lateral plantar nerve 
Common peroneal nerve 
Lateral sural cutaneous nerve 
Peroneal anastomotic branch 
Deep peroneal nerve 
Superficial peroneal nerve 
Medial dorsal cutaneous nerve 
Intermediate dorsal cutaneous 
nerve 
Pudendal nerve 
Posterior scrotal nerves 
Sympathetic system I 
Sympathetic trunks 
Internal carotid plexus 
Ansa subclavia [Vieussenii] 
Middle cardiac nerve 
Greater splanchnic nerve 
Lowest splanchnic nerve 
Cardiac plexus 
Posterior coronary plexus 
Anterior coronary plexus 
Coeliac plexus 
Cceliac ganglia 
Superior gastric plexus 
Abdominal aortic plexus 
Lesser cavernous nerves 
Greater cavernous nerve 
BASLE TERMINOLOGY 
Nervi spinales (continued) 
> N. cutaneus femoralis posterior 
N. ischiadicus 
N. tibialis 
N. cutaneus surae medialis 
N. suralis 
N. plantaris medialis 
N. plantaris lateralis 
N. peronaeus communis 
i N. cutaneus surae lateralis 
Ramus anastomoticus per- 
onaeus 
N. peronaeus profundus 
N. peronaeus superficialis 
N. cutaneus dorsalis medialis 
N. cutaneus dorsalis inter- 
medius 
N. pudendus 
Nn. scrotales posteriores 
Systema nervorum sympathi- 
cum 
Truncus sympathicus 
Plexus caroticus interims 
Ansa subclavia [Vieussenii] 
N. cardiacus medius 
N. splanchnicus major 
N. splanchnicus imus 
Plexus cardiacus 
Plexus coronarius posterior 
Plexus coronarius anterior 
Plexus coeliacus 
Ganglia coeliaca 
Plexus gastricus superior 
Plexus aorticus abdominis 
Nn. cavernosi penis minores 
N. cavernosus penis major 
OLD TERMINOLOGY 
Spinal nerves (continued) 
Small sciatic nerve 
Great sciatic nerve 
Internal popliteal nerve 
Nervus communicans tibialis 
Short saphenous nerve 
Internal plantar nerve 
External plantar nerve 
External popliteal nerve 
Lateral cutaneous branch 
Nervus communicans fibularis 
Anterior tibial nerve 
Musculocutaneous nerve 
Internal dorsal cutaneous 
branch 
External dorsal cutaneous 
branch 
Internal pudic nerve 
Superficial peroneal nerves 
Sympathetic system 
Gangliated cord 
Carotid plexus 
Ansa Vieussenii 
Great cardiac nerve 
Great splanchnic nerve 
Least splanchnic nerve 
Superficial and deep cardiac 
plexuses 
Left coronary plexus 
Right coronary plexus 
Solar plexus 
Semilunar ganglia 
Gastric or coronary plexus 
Aortic plexus 
Small cavernous nerves 
Large cavernous plexus 
PERIPHERAL ORGANS OF THE SPECIAL SENSES. 
Organ of Taste 
Gustatory calyculi 
Organ of smell 
External nose 
Lateral cartilage 
Greater alar cartilage 
Lesser alar cartilages 
Nasal cavity 
Choanae 
Accessory sinuses of nose 
Maxillary sinus 
Organ of sight 
Bulb of eye 
Sinus venosus sclerae 
Corneal epithelium 
Anterior elastic lamina 
Posterior elastic lamina 
Spaces of the angle of the iris 
Endothelium of the anterior 
chamber 
Zonula ciliaris 
Spatia zonularis 
Rectus medialis 
Rectus lateralis 
Ligament or tendon of Zinn 
Fascia bulbi 
Lateral palpebral commissure 
Medial palpebral commissure 
Organon gustus ' 
Calyculi gustatorii 
Organon olfactus 
Nasus externus 
Cartilago nasi lateralis 
Cartilago alaris major 
Cartilagines alares minores 
Cavum nasi 
Choanae 
Sinus paranasales 
Sinus maxillaris 
Organon visus 
Bulbus oculi 
Sinus venosus sclerae 
Epithelium corneae 
Lamina elastica anterior 
Lamina elastica posterior 
Spatia anguli iridis 
Endothelium camerae ante- 
rioris 
Zonula ciliaris [Zinni] 
Spatia zonularis 
M. rectus medialis 
M. rectus lateralis 
Annulus tendinous communis 
[Zinni] 
Fascia bulbi [Tenoni] 
Commissura palpebrarum later- 
alis 
Commissura palpebrarum 
medialis 
Organs of taste 
Taste-buds 
The nose 
Outer nose 
Upper lateral cartilage 
Lower lateral cartilage • 
Sesamoid cartilages 
Nasal fossa 
Posterior nares 
Accessory sinuses of nose 
Antrum of Highmore 
The eye 
Eyeball 
Canal of Schlemm 
Anterior layer 
Anterior limiting layer; Bow- 
man's membrane 
Membrane of Descemet; mem- 
brane of Demours 
Spaces of Fontana 
Posterior layer; corneal endo- 
thelium 
Zonule of Zinn 
Canal of Petit 
Rectus internus 
Rectus externus 
Ligament or tendon of Zinn 
Capsule of Tenon 
External canthus 
Internal canthus 1352 
A GLOSSARY OF THE INTERNATIONAL 
TERMINOLOGY ADOPTED IN TEXT 
Organ of sight {continued) 
Superior tarsus 
Inferior tarsus 
Orbital septum 
Medial palpebral ligament 
Lateral palpebral raphe 
Tarsal glands 
Lacrimal ducts 
Nasolacrimal duct 
Organ of hearing 
Auricula 
Fossa triangularis 
Scapha 
Auricularis anterior 
Auricularis superior 
Auricularis posterior 
External acoustic meatus 
Tegmental wall 
Jugular wall 
Membranous wall 
Petrotympanic fissure 
Labyrinthic wall 
Fenestra vestibuli 
Fenestra cochleae' 
Prominence of facial canal 
Mastoid wall 
Tympanic antrum 
Pyramidal eminence 
Carotid wall 
Auditory tube 
Anterior process [of malleus] 
Lateral process [of malleus] 
Short crus [of incus] 
Long crus [of incus] 
Lenticular process [of incus] 
Recessus sphaericus 
Recessus ellipticus 
Lateral semicircular canal 
Ductus reuniens 
Semicircular ducts 
Ductus cochlearis 
Vestibular membrane 
Spiral organ of Corti 
Vestibular ganglion 
Spiral ganglion of cochlea 
Common integument 
BASLE TERMINOLOGY 
Organon visus {continued) 
Tarsus superior 
Tarsus inferior 
Septum orbitale 
Lig. palpebrale mediate 
Raphe palpebralis lateralis 
Glandulae tarsales [Meibomi] 
Ductus lacrimales 
Ductus nasolacrimalis 
Organon auditus 
Auricula 
Fossa triangularis 
Scapha 
M. auricularis anterior 
M. auricularis superior 
M. auricularis posterior 
Meatus acusticus externus 
Paries tegmentalis 
Paries jugularis 
Paries membranacea 
Fissura petrotympanicus 
Paries labyrinthica 
Fenestra vestibuli 
Fenestra cochleae 
Prominentia canalis facialis 
Paries mastoidea 
Antrum tympanicum 
Eminentia pyramidalis 
Paries carotica 
Tuba auditiva 
Processus anterior [Folii] 
Processus lateralis 
Crus breve 
Crus longum 
Processus lenticularis 
Recessus sphaericus 
Recessus ellipticus 
Canalis semicircularis lateralis 
Ductus reuniens 
Ductus semicirculares 
Ductus cochlearis 
Membrana vestibularis [Reiss- 
neri] 
Organon spirale [Cortii] 
Ganglion vestibulare 
Ganglion spirale cochleae 
Integumentum commune 
OLD TERMINOLOGY 
The eye {continued) 
Superior tarsal plate 
Inferior tarsal plate 
Palpebral ligaments 
Internal tarsal ligament 
External tarsal ligament 
Meibomian glands 
Lacrimal canals 
Nasal duct 
The ear 
Pinna 
Fossa of antihelix 
Fossa of helix 
Attrahens aurem 
Attollens aurem 
Retrahens aurem 
External auditory meatus 
Roof of tympanic cavity 
Floor of tympanic cavity 
Outer wall 
Glaserian fissure 
Inner wall 
Fenestra ovalis 
Fenestra rotunda 
Prominence of aqueduct of 
Fallopius 
Posterior wall 
Mastoid antrum 
Pyramid 
Anterior wall 
Eustachian tube 
Processus gracilis 
Processus brevis 
Short process 
Long process 
Os orbiculare 
Recessus hemisphericus 
Recessus hemiellipticus 
External semicircular canal 
Canalis reunions 
Membranous semicircular canals 
Membranous cochlea or scala 
media 
Reissner's membrane 
Organ of Corti 
Ganglion of Scarpa 
Ganglion of Corti 
Skin 
SPLANCHNOLOGY. 
Respiratory apparatus 
Laryngeal prominence 
Corniculate cartilages 
Cuneiform cartilages 
Tubercle of epiglottis 
Hyothyroid membrane 
Lateral hyothyroid ligament 
Conus elasticus 
Middle cricothyroid ligament 
Ventricular folds 
Ventricular ligament 
Vocal folds 
Vocal ligament 
Ventricle of the larynx 
Appendix of laryngeal ventricle 
Rima glottidis 
Intermembranous part 
Intercartilaginous part 
Vocalis muscle 
Apparatus respiratorius 
Prominentia laryngea 
Cartilagines corniculatae [San- 
torini] 
Cartilagines cuneiformes 
Tuberculum epiglotticum 
Membrana hyothyreoidea 
Lig. hyothyreoideum laterale 
Conus elasticus 
Lig. cricothyreoideum medium 
Plicae ventriculares 
Lig. ventriculare 
Plicae vocales 
Lig. vocale 
Ventriculus laryngis [Mor- 
gagnii] 
Appendix ventriculi laryngis 
Rima glottidis 
Pars intermembranacea 
Pars intercartilaginea 
M. vocalis 
Respiratory system 
Pomum Adami 
Cartilages of Santorini 
Cartilages of Wrisberg 
Cushion of epiglottis 
Thyrohyoid membrane 
Lateral thyrohyoid ligament 
Cricothyroid membrane 
Central part of cricothyroid 
membrane 
Superior or false vocal cords 
Superior thyroarytenoid liga- 
ment 
Inferior or true vocal cords 
Inferior thyroarytenoid liga- 
ment 
Laryngeal sinus 
Laryngeal saccule 
Rima glottidis 
Glottis vocalis 
Glottis respiratoria 
Inner portion of Thyroarytenoid OR BASLE ANATOMICAL NOMENCLATURE 
1353 
TERMINOLOGY ADOPTED IN TEXT 
Respiratory apparatus {continued} 
Cricothyreoideus 
Cricoarytenoideus posterior 
Cricoarytenoideus lateralis 
Thyreoarytaenoideus 
Cupula of pleura 
Pulmonary ligament 
Costal surface 
Mediastinal surface 
Digestive apparatus 
Mouth 
Glossopalatine arch 
Pharyngopalatine arch 
Levator veli palatini 
Tensor veli palatini 
Musculus uvulae 
Glossopalatinus 
Pharyngopalatinus 
Incisor teeth 
Premolar teeth 
Dens serotinus 
Deciduous teeth 
Dentin 
Crusta petrosa 
Root of tongue 
Papillae vallatae 
Apex of tongue 
Inferior surface of tongue 
Genioglossus 
Longitudinalis linguae superior 
Longitudinalis linguae inferior 
Transversus linguae 
Verticalis linguae 
Anterior lingual gland 
Accessory parotid gland 
Parotid duct 
Submaxillary duct 
Smaller sublingual duct 
Larger sublingual ducts 
Nasal part of pharynx 
Pharyngeal recess 
Palatine tonsil 
Pterygomandibular raphe 
Constrictor pharyngis inferior 
Constrictor pharyngis medius 
Constrictor pharyngis superior 
Peritoneum 
Omental bursa 
Rectouterine excavation 
Epiploic foramen 
Lesser omentum 
Greater omentum 
Vesicouterine excavation 
* Gastrolienal ligament 
Phrenicolienal ligament 
Phrenicocolic ligament 
Mesenteriole of vermiform 
process 
Digestive tube 
Stomach 
Circular folds 
Intestinal glands 
Duodenal glands 
Solitary lymphatic nodules 
Aggregated lymphatic nodules 
Vermiform process 
BASLE TERMINOLOGY 
Apparatus respiratorius (continued') 
M. cricothyreoideus 
M. cricoarytenoideus posterior 
M. cricoarytenoideus lateralis 
M. thyreoarytaenoideus 
Cupula pleurae 
Lig. pulmonale 
Facies costalis 
Facies mediastinalis 
Apparatus digestorius 
Cavum oris 
Arcus glossopalatinus 
Arcus pharyngopalatinus 
M. levator veli palatini 
M. tensor veli palatini 
M. uvulae 
M. glossopalatinus 
M. pharyngopalatinus 
Dentes incisivi 
Dentes praemolares 
Dens serotinus 
Dentes decidui 
Substantia eburnea 
Substantia ossea 
Radix linguae 
Papillae vallatae 
Apex linguae 
Facies inferior linguae 
M. genioglossus 
M. longitudinalis linguae superior 
M. longitudinalis linguae inferior 
M. transversus linguae 
M. verticalis linguae 
Gl. lingualis anterior [Blandini, 
Nuhni] 
Glandula parotis accessoria 
Ductus parotideus [Stenonis] 
Ductus submaxillaris 
Ductus sublingualis major 
Ductus sublinguales minores 
Pars nasalis pharyngis 
Recessus pharyngeus [Rosen- 
muelleri] 
Tonsilla palatina 
Raphe pterygomandibularis 
M. constrictor pharyngis 
inferior 
M. constrictor pharyngis 
medius 
M. constrictor pharyngis 
superior 
Peritonaeum 
Bursa omentalis 
Excavatio rectouterina [cavum 
Douglasi] 
Foramen epiploicum [Winslowi] 
Omentum minus 
Omentum majus 
Excavatio vesicouterina 
Lig. gastrolienale 
Lig. phrenicolienale 
Lig. phrenicocolicum 
Mesenteriolum processus vermi- 
formis 
Tubus digestorius 
Ventriculus 
Plicae circulares 
Glandulae intestinales [Lieber- 
kuhn] 
Glandulae duodenales 
(Brunneri) 
Noduli lymphatici solitarii 
Noduli lymphatici aggregati 
[Peyeri] 
Processus vermiformis 
OLD TERMINOLOGY 
Respiratory system (continued) 
Cricothyroid 
Posterior cricoarytenoid 
Lateral cricoarytenoid 
Thyroarytenoid 
Cervical pleura 
Ligamentum latum pulmonis 
External or thoracic surface. 
Inner surface 
Organs of digestion 
Oral or buccal cavity 
Anterior pillar of fauces 
Posterior pillar of fauces 
Levator palati 
Tensor palati 
Azygos uvulae 
Palatoglossus 
Palatopharyngeus 
Incisive or cutting teeth 
Biscupid teeth 
Wisdom tooth 
Temporary or milk-teeth 
Ivory of teeth 
Cement of teeth 
Base of tongue 
Circumvallate papillse 
Tip of tongue 
Under surface of tongue 
Geniohyoglossus 
Superior lingualis 
Inferior lingualis 
Transverse lingualis 
Vertical lingualis 
Gland of Nuhn 
Socia parotidis 
Stensen's duct 
Wharton's duct 
Bartholin's duct 
Ducts of Rivinus 
Nasopharynx 
Fossa of Rosenmuller 
Tonsil 
Pterygomandibular ligament 
Inferior constrictor 
Middle constrictor 
Superior constrictor 
Peritoneum 
Lesser peritoneal sac 
Pouch of Douglas 
Foramen of Winslow 
Small omentum; gastrohepatic 
omentum 
Great omentum; gastrocolic 
omentum 
Uterovesical pouch 
Gastrosplenic omentum 
Ljenorenal ligament 
Phreno- or costocolic ligament 
Mesoappendix 
Alimentary canal 
Stomach; Gaster 
Valvulae conniventes; valves of 
Kerkring 
Crypts of Lieberkuhn) 
Brunner's glands 
Solitary glands 
Peyer's patches or glands 
Vermiform appendix 1354 
THE INTERNATIONAL OR BASLE ANATOMICAL NOMENCLATURE 
TERMINOLOGY ADOPTED IN TEXT 
Digestive apparatus {continued) 
Digestive tube 
Colic valve 
Right colic flexure 
Left colic flexure 
Descending colon > 
Iliac colon J 
Sigmoid colon 
Transverse rectal folds 
Anal canal 
Rectal columns 
Liver 
Inferior surface 
Left sagittal fossa 
Porta hepatis 
Caudate lobe 
Caudate process 
Fibrous coat 
Pancreatic duct 
Accessory pancreatic duct 
Urogenital apparatus 
Kidneys 
Urinary bladder 
Urethral crest 
Prostatic utricle 
Urethral glands 
Head of epididymis 
Tail of epididymis 
Sinus of epididymis 
Appendix of testis 
Appendix of epididymis 
Ductus deferens 
Corpus cavernosum urethrae 
Prostate 
Bulbourethral gland 
Epobphoron 
Vesicular ovarian follicles 
Uterine tube 
Internal uterine orifice 
External uterine orifice 
Pudendum 
Mons pubis 
Labia minora 
External urethral orifice 
Bulb of the vestibule 
Greater vestibular gland 
Mammse 
Ductless glands 
Thyroid gland 
Thymus 
Spleen 
Suprarenal glands 
Carotid skeins 
Coccygeal skein 
BASLE TERMINOLOGY 
Apparatus digestorius (continued) 
Tubus digestorius 
Valvula coli 
Flexura colica dextra 
Flexura colica sinistra 
Colon descendens 
Colon sigmoideum 
Plicae transversales recti 
Pars analis recti 
Columnae rectales [Morgagni] 
Hepar 
Facies inferior 
Fossa sagittalis sinistra 
Porta hepatis 
Lobus caudatus 
Processus caudatus 
Capsula fibrosa [Glissoni] 
Ductus pancreaticus [Wirsungi] 
Ductus pancreaticus accessorius 
[Santorini] 
Apparatus urogenitalis 
Renes 
Vesica urinaria 
Crista urethralis 
Utriculus prostaticus 
Glandulae urethrales 
Caput epididymis 
Cauda epididymis 
Sinus epididymis 
Appendix testis [Morgagni] 
Appendix epididymis 
Ductus deferens 
Corpus cavernosum urethrae 
Prostata 
Glandula bulbourethralis [Cow- 
peri] 
Epoophoron 
Folliculi oophori vesiculosi 
[Graafi] 
Tuba uterina [Fallopii] 
Orificium internum uteri 
Orificium externum uteri 
Pudendum muliebre 
Mons pubis 
Labia minora pudendi 
Orificium urethrae externum 
Bulbus vestibuli 
Glandula vestibularis major 
[Bartholini] 
Mammae 
Glandula thyreoidea 
Thymus 
Lien 
Glandulae suprarenalis 
Glomera carotica 
Glomus coccygeum 
OLD TERMINOLOGY 
Organs of digestion {continued) 
Alimentary canal 
Iliocecal valve 
Hepatic flexure 
Splenic flexure 
[Descending colon 
[Iliac colon 
Pelvic colon 
Houston's valves 
Anal canal 
Columns of Morgagni 
Liver 
Visceral surface 
Longitudinal fissure 
Transverse fissure of liver 
Spigelian lobe 
Caudate lobe 
Areolar coat 
Duct of Wirsung 
Duct of Santorini 
Urogenital organs 
Kidneys 
Bladder 
V erumontanum 
Sinus pocularis 
Glands of Littre 
Globulus major 
Globus minor 
Digital fossa 
Hydatid of Morgagni 
Pedunculated hydatid 
Vas deferens; seminal duct 
Corpus spongiosum 
Prostate gland 
Cowper's gland 
Parovarium; organ of Rosen- 
muller 
Graafian follicles 
Fallopian tube; oviduct 
Internal os 
External os 
Vulva 
Mons Veneris 
Nymphae 
Urinary meatus 
Vaginal bulb 
Bartholin's gland; commissura 
labiorum anterior 
Mammary glands; breasts 
Ductless glands 
Thyroid body 
Thymus gland 
Spleen 
Adrenal capsule 
Carotid body or glands 
Coccygeal gland or body; 
Luschka's gland INDEX. 
A 
Abdomen, 1140 
apertures in walls of, 1147 
boundaries of, 1147 
fascia of, 498 
triangular, 502 
lymph glands of, 785 
muscles of, 498 
dissection of, 498, 503, 504. 
505 
regions of, 1147 
surface anatomy of, 1301 
markings of, 1303 
Abdominal aorta, 686 
applied anatomy of, 687 
branches of, 689, 690 
surface markings of, 1309 
aortic plexus, 1004 
muscles, 498 
ring, deep, 508 
external, 500 
inguinal, 508 
internal, 508 
wall, lymphatic vessels of, 787 
Abducent nerve, 927 
applied anatomy of, 929 
Abductor digiti quinti muscle 
(foot), 588 
(hand), 554 
hallucis muscle, 587 
indicis muscle, 556 
minimi digiti muscle, 554 
pollicis brevis muscle, 552 
longus muscle, 545 
muscle, 552 
Aberrant ducts of testis, 1236 
Accelerator urinae muscle, 518 
Accessory hemiazygos vein, 753 
nerve, 944 
applied anatomy of, 945 
cerebral part of, 944 
spinal part of, 945 
obturator nerve, 980 
olivary nuclei, 830 
organs of digestive tube, 1109 
of eye, 1034 
pancreatic duct, 1205 
part of parotid gland, 1133 
processes, 205 
pudendal artery, 704 
sinuses of nose, 1014 
applied anatomy of, 1015 
spleens, 1267 
thyroid glands, 1263 
Acetabular fossa, 339 
notch, 339 
Acetabulum, 340 
Achromatic spindle, 36 
Acoustic meatus, external, 244, 
283, 1046 
development of, 141 
internal, 241, 291 
nerve, 934, 1046 
applied anatomy of, 936 
development of, 141 
nuclei of, 836, 935 
Acromioclavicular joint, 411 
applied anatomy of, 413 
movements of, 413 
Acromioclavicular joint, surface 
anatomy of, 1315, 1319 
Acromion, 306 
Acromiothoracic artery, 670 
Adamantoblasts, 1123 
Adductor brevis muscle, 568 
canal, 713 
hallucis muscle, 589 
longus muscle, 567 
magnus muscle, 568 
obliquus hallucis muscle, 589 
pollicis muscle, 554 
pollicis obliquus muscle, 554 
transversus muscle, 554 
transversus pollicis muscle, 554 
tubercle, 348 
Adenoid tissue, 45 
Adipose capsule of kidney, 1209 
tissue, 42 
Adminiculum lineae albae, 507 
Adrenal capsule, 1270 
Adrenalin, 1272 
Afferent nerves, 803 
vessels of kidney, 1214 
After-birth, 101 
Agger nasi, 260 
Aggregated lymphatic nodules, 
1175 
Agminated follicles, 1175 
Air cells, ethmoidal, 253, 1014 
mastoid, 240 
Air sinuses of nose, 1014 
of skull, 196 
Ala cinerea, 848 
lobuli centralis, 838 
nasi, 1008 
oss. ilii, 333 
Alae of ethmoid, 252 
of sacrum, 208 
of vomer, 269 
Alar cartilages of nose, 1009 
lamina, 119 
Alcock, canal of, 511 
Alimentary canal, 1109 
Allantoic vessels, 93 
Allantois, 93 
Alveolar arch, 260 
arteries, 640, 641 
border of mandible, 272 
canals, 257 
index, 296 
nerves, 918, 923 
point, 260, 296 
process of maxilla, 260 
Alveoli, formation of, 1124 
Alveus, 881, 887 
Amacrine cells of retina, 1028 
Amnion, 96 
false, 96 
Amniotic cavity, 96 
ectoderm, 95 
fold, 96 
Amphiarthroses, 381 
Ampulla of ductus deferens, 1235 
rectal, 1183 
of uterine tube, 1247 
of Vater, 1200 
Ampullae of semicircular canals, 
1058 
of tubuli lactiferi, 1259 
Amygdala, 883 
Amygdaline nucleus, 839 
Anal canal or anal part of rectum, 
1184 
development of, 172 
lymphatic vessels of, 792 
membrane of, 174 
valves of, 1184 
fascia, 511 
Anaphase of karyokinesis, 36 
Anastomoses of arteries, 619 
around elbow-joint, 675 
knee-joint, 721 
crucial, 717 
Anastomotic branch of inferior 
gluteal artery, 706 
Anastomotica magna of brachial 
artery, 675 
of femoral artery, 718 
Anatomical neck of humerus, 309 
Anconaeus muscle, 544 
Angiology, 595 
Angle of Louis, 218 note 
iridial or filtration, 1019 
of mandible, 273 
of pubis, 338 
of rib, 222 
sacrovertebral, 206 
of sternum, 218 
subscapular, 305 
Angular artery, 635 
gyrus, 871 
movement, 383 
vein, 733 
Angulus Ludovici, 218 
Animal cell, 33 
Ankle bone, 366 
Ankle-joint, 449 
applied anatomy of, 452 
movements of, 451 
relations of tendons and vessels 
to, 451 
surface anatomy of, 1326 
markings of, 1330 
Annular ligament, 547, 550 
of ankle, 584, 585 
of radius, 422 
of wrist, anterior, 547 
posterior, 550 
Annulus fibrosus [of intervertebral 
fibrocartilage], 335, 386 
inguinalis abdominis, 508 
subcutaneus, 500 
ovalis, 608 
tendineus communis, 1035 
Anococcygeal body, 1184 
nerves, 992 
raphe, 516 
Ansa hypoglossi, 957 
lentiformis, 882, 884 
subclavia [Vieusseni], 998 
Anterior annular ligament, 547, 
584 
basis bundle, 815 
calcaneoastragaloid ligament, 
452 
circumflex artery, 672 
common ligament, 384 
condyloid foramen, 229 
cornu of medulla spinalis, 809 1356 
INDEX 
Anterior costovertebral ligament, 
396 
crural nerve, 980 
inferior ligament, 448 
intercostal arteries, 664 
interosseous artery, 680 
nerve, 965 
ligament, 426 
peroneal artery, 726 
pillar of fauces, 1112 
pillars of fornix, 886 
pulmonary nerves, 943 
radial carpal artery, 678 
radioulnar ligament, 424 
superior dental nerve, 919 
ligament, 398, 448 
talotibial ligament, 450 
temporal artery. 638 
tibial nerve, 990 
ulnar carpal artery, 682 
Anteror-lateal ganglionic arteries' 
653 
muscles of abdomen, 498 
Antero-medial ganglionic arteries, 
652 
Antibrachial fascia, 536 
cutaneous nerve, dorsal, 969 
lateral, 963 
medial, 964 
Anticlinal vertebra, 202 note 
Anticubital fossa, 672 
Antihelix, 1044 
Antitragicus muscle, 1046 
Antitragus, 1044, 1145 
Antrum cardiacum, 1145, 1161 
of Highmore, 259, 1015 
pyloric, 1162, 1163 
tympanic, 240, 1052 
entrance to, 1052 
Anus, 1110 
lymphatic vessels of, 792 
Aorta, 621 
abdominal, 686 
applied anatomy of, 687 
branches of, 688 
abdominalis, 686 
arch of, 623 
applied anatomy of, 624 
branches of, 625 
peculiarities of, 624 
of branches of, 625 
ascendens, 621 
ascending, 621 
bulb of, 622 
coarctation of, 624 
descending, 683 
thoracalis, 683 
rami mediastinales, 685 
pericardiaci, 685 
thoracic, 683 
applied anatomy of, 683 
branches of, 685 
transverse, 623 
Aortae, anterior ventral, 152 
dorsal, 154 
primitive. 144 
Aortic arches, 152 
bodies, 133, 1274 
hiatus, 495 
isthmus, 154, 623 
lymph glands, 787 
opening of heart, 612 
plexus, 1004 
semilunar valves, 612 
septum, 150 
sinuses, 612 
spindle, 624 
vestibule, 612 
Aorticorenal ganglion, 1003 
Apertura pelvis [minoris] inferior, 
341 
superior, 340 
tympanica canaliculi chordae, 
1049 
Aperture, anterior nasal, 294 
Apertures in walls of abdomen, 
1147 
Apex cordis, 605 
of fibula, 359 
of heart, 605 
linguae, 1126 
of nose, 1008 
oss. sacri, 208 
prostatae, 1241 
pulmonis, 1101 
Aponeurosis, 463 
epicranial, 466 
lumbar, 486 
of obliquus externus, 499 
palatine, 1112 
palmar, 550 
palmaris, 550 
pharyngeal, 1143 
plantar, 586 
plantaris, 586 
suprahyoid, 481 
Apparatus digestorius, 1109 
lacrimalis, 1041 
respiratorius, 1079 
urogenitalis, 1206 
Appendages of testis, 1231 
Appendices epiploicae, 1157 
vesiculosae, 1247 
Appendicular artery, 693 
skeleton, 195 
Appendix, auricular, left, 610 
right, 606 
ensiform, 220 
of epididymis, 1231 
of testis, 1231 
of ventricle of larynx, 1086 
ventriculi laryngis, 1086 
vermiform, 1178 
xiphoid, 220 
Applied anatomy of abdominal 
aorta, 687 
of abducent nerve, 929 
of accessory nerve, 945 
of acoustic nerve, 936 
of acromioclavicular joint, 
413 
of adductor longus muscle, 
569 
of ankle-joint, 452 
of anterior facial vein, 733 
tibial artery, 722 
of arch of aorta, 624 
of arteries, 619 
of ascending pharyngeal ar- 
tery, 638 
of atrioventricular bundle, 
614 
of auditory tube, 1056 
of axilla, 667 
of axillary artery, 670 
fascia, 526 
glands. 781 
vein, 750 
of azygos veins, 754 
of biceps brachii muscle, 535 
of bone, 59 
of bones of foot, 375 
of forearm, 321 
of hand, 332 
of leg, 361 
of pelvis, 344 
of skull, 297 
of brachial artery, 673 
plexus, 970 
of brain, 899 
of branches of hypogastric or 
internal iliac artery, 708 
of bulb of eye, 1031 
of carpal bones, 332 
of cavernous sinus, 745 
of cerebellum, 844 
of cervical fascia, 478 
glands, 779 
plexus, 958 
ribs, 226 
Applied anatomy of clavicle, 303 
of common carotid artery, 
627 
iliac artery, 700 
peroneal nerve, 993 
of conjunctiva, 1043 
of coronary arteries, 623 
of deltoid muscle, 531 
of descending aorta, 683 
palatine artery, 642 
of dorsalis pedis artery, 724 
of elbow-joint, 421 
of emissary veins, 747 
of extensor tendons of fin- 
gers, 546 
of external acoustic meatus, 
1048 
carotid artery, 630 
ear, 1048 
iliac artery, 708 
jugular vein, 736 
maxillary artery, 635 
of eyelids, 1042 
of facial artery, 635 
nerve, 933 
vein, anterior, 733 
of fascia of axilla, 526 
of psoas and iliacus, 562 
of femoral artery, 715 
of femur, 352 
of fibula, 361 
of fingers, 551 
flexor sheaths of, 552 
of gall-bladder, 1116 
of gluteal arteries, 708 
of gums, 1112 
of hamstring tendons, 575 
of heart, 614 
of hemorrhoidal venous 
plexus, 761 
of hip-joint, 437 
of humerus, 313 
of hyoid bone, 277 
of hypogastric artery, 701 
of hypoglossal nerve, 947 
of iliac fascia, 562 
of inferior epigastric artery, 
710 
vena cava, 762 
of inguinal and subinguinal 
glands, 784 
of innominate artery, 626 
of intercostal arteries, 686 
nerves, 974 
of internal capsule, 895 
carotid artery, 647 
ear, 1068 
iliac artery, 701 
jugular vein, 737 
mammary artery, 666 
of intervertebral fibrocartil- 
ages, 386 
of intestines, 1186 
of ischiorectal fossa, 516 
of kidneys, 1214 
of knee-joint, 446 
of labyrinth of ear, 1068 
of lacrimal apparatus, 1043 
of laryngeal nerves, 943 
of larynx, 1093 
of lineal artery, 691 
of lingual artery, 632 
of liver, 1200 । 
of lumbar plexus, 992 
of lungs, 1108 
of lymphatic system, 770 
of mammae, 1260 
of mediastinal cavity, 1101 
of medulla oblongata, 833 
spinalis, 820 
of meninges, 907 
of mesenteric arteries, 696 
lymph glands, 789 
of metacarpal bones, 332 
of metatarsal bones, 375 INDEX 
1357 
Applied anatomy of metatarso- | 
phalangeal joint of great , 
toe, 459 
of middle meningeal artery, ' 
640 
of motor and sensory tracts, ' 
899 
of muscles, 462 
of lower extremity, 592 
ocular, 1038 
of palate, 1115 
of upper extremity, 556 
of vertebral column, 492 
of nasal cavities, 1015 
of nose, 1015 
of oculomotor nerve, 913 
of oesophagus, 1146 
of olfactory nerves, 909 
of optic nerve, 911 
of ovaries, 1246 
of palate, 299, 1115 
of palatine tonsils, 1141 
of palmar aponeurosis, 551 
arches, 682 
of pancreas, 1206 
of parametrium, 1255 
of parathyroid glands, 1264 
of patella, 355 
of pelvis, 344 
of penis. 1240 
of pericardium, 603 
of peritoneal fossae, 1161 
of pharynx, 1143 
of pigment, 46 
of plantar arch, 728 
calcaneonavicular liga- 
ment, 456 
of pleura, 1098 
of pons, 836 
of popliteal artery, 719 
lymph glands, 784 
of portal system of veins, 767 
of posterior tibial artery, 725 
of pronator teres muscle, 537 
of prostate, 1242 
of prostatic venous plexus, 
761 
of proximal radioulnar artic- 
ulation, 423 
of psoas major muscle, 562 
of pulmonary artery, 621 
of quadriceps femoris muscle, 
567 
of radial artery, 676 
nerve, 970 
of radius, 321 
of recti muscles of eye, 1038 
of rectus femoris muscle, 567 
of ribs, 225 
of sacral plexus, 993 
of salivary glands, 1138 
of saphenous veins, 747 
of scalp, 466 
of scapula, 309 
of sciatic or inferior gluteal 
artery, 708 
nerve, 993 
of scrotum, 1230 
of serratus anterior muscle, 
530 
of sheath of psoas muscle, 
562 
of shoulder-joint, 417 
of skull, 297 
of spermatic veins, 762 
of spinal arteries, 661 
of spleen, 1270 
of splenic or lienal artery, 
691 
of sternoclavicular joint, 411 
of sternocleidomastoideus 
muscle, 479 
of sternum, 225 
of stomach, 1167 
of subclavian artery, 657 
Applied anatomy of superior thy- 
roid artery, 631 
vena cava, 754 
of suprarenal glands, 1272 
of sympathetic nervous sys- 
tem, 1005 
of tarsal bones, 375 
joints, 457 
of teeth, 1125 
of temporal artery, 638 
of temporomandibular joint, 
396 
of tendons of leg and foot, 
583 
of testis, 1234 
of thoracic aorta, 683 
duct, 773 
nerves, 974 
of thorax, 226 
of thymus, 1266 
of thyroid gland, 1263 
of tibia, 361 
of tongue, 1130, 1132 
of trachea, 1093 
of tracheobronchial glands, 
798 
of triceps brachii muscle, 536 
of trigeminal nerve, 925 
of trochlear nerve, 914 
of tympanic cavity, 1056 
of ulna, 321 
of ulnar artery, 680 
of ureter, 1218 
of urethra, 1226 
of urinary bladder, 1224 
of uterus, 1254 
of vagus nerve, 943 
of veins in front of elbow, 749 
of vena cava, inferior, 762 
superior, 754 
mediana cubiti, 749 
of vertebral column, 214 
joints, 393 
of vesiculae seminales, 1237 
of volar arches, 682 
of wrist-joint, 426 
Aquaeductus cerebri, 854 
cochleae, 243, 1060 
Fallopii, 242, 1058 
vestibuli, 242, 280 
Aqueduct, cerebral, 854 
of cochlea, 243, 1060 
of Sylvius, 821, 854 
Aqueous humor, 1030 
Arachnoid, 903 
granulations, 905 
structure of, 906 
villi, 905 
Arachnoidea encephali, 903 
spinalis, 903 
Arantii, corpus, 610, 612 
i Arbor vitae [of cerebellum], 839 
uterina, 1250 
Arch, alveolar, 260 
of aorta, 623 
applied anatomy of, 624 
branches of, 625 
peculiarities of, 625 
of atlas, anterior, 199 
axillary, 524 
carotid, 153 
crural, deep, 509 
glossopalatine, 1112 
lumbocostal, 495 
palmar, deep, 679 
superficial, 682 
pharyngopalatine, 1112 
plantar, 727 
pubic, 341 
of a vertebra, 197 
volar, deep, 679 
superficial, 682 
zygomatic, 282 
। Arches, aortic, 144, 153 
branchial or visceral, 108 
Arches of fauces, 1112 
of foot, 459 
of soft palate, 1112 
superciliary, 234, 278, 282 
Arcuate artery, 724 
fibres, 831, 832 
ligaments, 495 
line of ilium, 335 
nucleus, 831 
Arcus aortae, 623 
cartilaginis cricoideae, 1081 
glossopalatinus, 1112 
lumbocostalis lateralis [Halleri], 
495 
medialis [Halleri], 495 
parietooccipitalis, 871 
pharyngopalatinus, 1112 
volaris profundus, 679 
superficialis, 682 
Area acustica, 848, 935 
cribrosa media, 241 
superior, 242 
facialis, 242 
olfactory, 111 
oval, of Flechsig, 818 
parolfactoria, 875 
pericardial, 87 
postrema, 848 
proamniotic, 87 
I Areas of cerebral cortex, 894 
of Cohnheim, 66 
vascular, 141 
| Areola of mamma, 1258 
Areolse of bone, 57, 58 
Areolar glands, 1258 
tissue, 40 
j Arm bone, 309 
fascia of, 534 
muscles of, 533 
i dissection of, 533 
Arnold's nerve, 941 
Arrectores pilorum muscle, 1077 
j Arteria alveolaris inferior, 640 
superior posterior, 641 
angularis, 635 
anonyma, 625 
arcuata, 724 
auditiva interna, 661 
auricularis posterior, 636 
ramus auricularis, 636 
occipitalis, 637 
profundus, 640 
axillaris, 668 
basilaris, 661 
rami ad pontem, 661 
brachialis, 672 
rami musculares, 675 
buccinatoria, 641 
bulbi urethrae, 705 
canalis pterygoidei, 642, 648 
carotis communis, 627 
externa, 630 
interna, 645 
ramus caroticotympanicus, 
648 
centralis retinae, 650, 1029 
cerebelli inferior anterior, 661 
posterior, 661 
superior, 661 
cerebri anterior, 651 
media, 652 
posterior, 662 
cervicalis ascendens, 663 
profunda, 666 
chorioidea, 653 
circumflexa femoris lateralis, 
716 
medialis, 717 
humeri anterior, 672 
posterior, 671 
ilium profunda, 710 
superftcialis, 716 
scapulae, 671 
coeliaca, 688 
colica dextra, 694 1358 
INDEX 
Arteria colica media, Q94: 
sinistra, 695 
collateralis ulnaris inferior, 675 
superior, 674 
comes nervi phrenici, 664 
comitans nervi ischiadici, 706 
communicans anterior, 652 
posterior, 653 
coronaria [cordis] dextra, 622 
sinistra, 623 
cystica, 691 
dorsalis hallucis, 724 
nasi, 650 
pedis, 724 
ramus plantaris profundus, 
725 
epigastrica inferior, 709 
superficialis, 715 
superior, 666 
femoralis, 710 
rami musculares, 716 
frontalis, 650 
gastrica dextra, 689 
sinistra, 688 
gastroduodenalis, 690 
gastroepiploica dextra, 690 
sinistra, 691 
genu media, 720 
suprema, 718 
glutaea inferior, 706 
ramus iliacus, 707 
lumbalis, 707 
superior, 707 
haemorrhoidalis inferior, 704 
media, 701 
superior, 696 
hepatica, 689 
hypogastrica, 700 
ileocolica, 693 
iliaca externa, 708 
iliolumbalis, 706 
infraorbitalis, 641 
interossea communis, 680 
dorsalis, 681 
volaris, 680 
labialis inferior. 634 
superior, 634 
lacrimalis, 649 
laryngea inferior, 662 
superior, 631 
lienalis, 691 
rami pancreatici, 691 
lingualis, 631 
rami dorsales linguae, 632 
ramus hyoideus, 632 
malleolaris anterior lateralis, 
723 
medialis, 723 
posterior medialis, 727 
mammaria interna, 664 
rami inter costales, 664 
perforantes, 666 
sternales, 664 
masseterica, 641 
maxillaris externa, 633 
rami glandulares, 634 
ramus tonsillaris, 634 
interna, 638 
rami pterygoidei, 641 
ramus meningeus acces- 
sorius, 640 
mediana, 680 
meningea anterior, 648 
media, 640 
mesenterica inferior, 694 
superior, 691 
musculophrenica, 666 
nutricia fibulae, 726 
humeri, 672 
tibiae, 726 
obturatoria, 702 
occipitalis, 635 
rami musculares, 636 
ramus auricularis, 636 
descendens, 636 
Arteria occipitalis, ramus menin- 
geus, 636 
ophthalmica, 648 
palatina ascendens, 634 
descendens, 642 
pancreatica magna, 691 
pancreaticoduodenalis inferior, 
690 
superior, 690 
perforans prima, 717 
secunda, 717 
tertia, 717 
pericardiophrenica, 664 
perinei, 705 
peronaea, 726 
ramus calcaneus lateralis, 726 
communicans, 726 
perforans, 726 
pharyngea ascendens, 637 
rami pharyngei, 637 
plantaris lateralis, 727 
medialis, 727 
poplitea, 718 
princeps cervicis, 636 
hallucis, 728 
pollicis, 678 
profunda brachii, 674 
femoris, 716 
penis, 705 
pudenda externa profunda, 716 
superficialis, 716 
interna, 703 
pulmonalis, 620 
ramus dexter, 620 
sinister, 621 
radialis, 676 
rami musculares, 678 
perforantes, 679 
ramus carpeus dorsalis, 678 
volaris, 678 
volaris superficialis, 678 
recurrens radialis, 678 
tibialis anterior, 723 
posterior, 724 
recurrentes ulnaris anterior, 680 
posterior, 680 
sacralis lateralis, 707 
media, 698 
sphenopalatina, 642 
spinalis anterior, 660 
posterior, 660 
sternocleidomastoidea, 636 
stylomastoidea, 636 
subdavia, 655 
sublingualis, 632 
submentalis, 634 
subscapularis, 671 
supraorbitalis, 649 
tar sea lateralis, 724 
temporalis media, 638 
superficialis, 637 
rami auriculares anteriores, 
638 
ramus frontalis, 638 
parietalis, 638 
thoracalis lateralis, 671 
suprema, 670 
thoracoacromialis, 670 
thyreoidea ima, 626 
inferior, 662 
rami oesophagei, 663 
tracheales, 662 
superior, 631 
ramus cricothyreoideus, 
631 
hyoideus, 631 
sternocleidomastoideus. 
631 
tibialis anterior, 722 
rami musculares, 723 
posterior, 725 
rami calcanei medialis, 727 
ramus communicans, 727 
transversa colli, 663 
ramus ascendens, 664 
Arteria transversa colli, ramus 
descendens, 664 
faciei, 638 
scapulae, 663 
tympanica anterior, 639 
inferior, 637 
ulnaris, 679 
rami musculares, 682 
ramus carpeus dorsalis, 682 
volaris, 682 
volaris prefundus, 682 
urethralis, 705 
uterina, 701 
vaginalis, 702 
vertebralis, 659 
rami spinales, 660 
ramus meningeus, 660 
vesicalis inferior, 701 
medialis, 701 
superior, 701 
volaris indicis radialis, 679 
Arteriae bronchioles, 685 
ciliar es, 650 
digitales volares communes, 682 
propriae, 682 
gastricae breves, 691 
genu inferiores, 721 
superiores, 720 
iliacae communes, 698 
inter costales, 685 
intestinales, 692 
lumbales, 698 
metacarpeae volares, 679 
metatarseae plantares, 728 
oesophageae, 685 
ovaricae, 697 
palpebrales mediates, 650 
phrenicae inferiores, 697 
propriae renales, 1213 
rectae, 1214 
renales, 696 
sigmoideae, 695 
spermaticae internae, 697 
suprarenales media, 696 
surales, 720 
tarseae mediates, 724 
tunica adventitia, 597 
intima, 596 
media, 596 
Arterial mesocardium, 603 
Artery or Arteries, abdominal 
aorta, 686 
accessory pudendal, 704 
meningeal, 640 
acromiothoracic, 670 
alveolar, 640, 641 
anastomoses of, 619 
anastomotic branch of inferior 
gluteal, 706 
anastomotica magna, of bra- 
chial, 675 
of femoral, 718 
angular, 635 
anterior cerebral, 651 
choroidal, 653 
ciliary, 650 
communicating, 651 
humeral circumflex, 672 
inferior cerebellar, 661 
meningeal, 648 
spinal, 660 
tibial, 722 
tympanic, 639 
antero-lateral ganglionic, 653 
antero-medial ganglionic, 652 
aorta, 622 
abdominal, 686 
arch of, 623 
ascending, 622 
descending. 683 
thoracic, 683 
appendicular, 693 
applied anatomy of, 619 
arcuate, 724 
articular, 720, 721 INDEX 
1359 
Artery or Arteries, ascending cer- 
vical, 663 
palatine, 634 
pharyngeal, 637 
auditory, 661 
internal, 661 
auricular, anterior, 638 
deep, 640 
of occipital, 637 
posterior, 636 
axillary, 668 
azygos, of knee, 720 
of vagina, 702 
basilar, 661 
brachial, 672 
brachiocephalic, 625 
of brain, 653 
bronchial, 685, 1108 
buccal, 641 
buccinator, 641 
bulbar, 661 
calcaneal, 726, 727 
calcanean, 726, 727 
capsular, middle, 696 
caroticotympanic, 648 
carotid, common, 627 
external, 630 
internal, 645 
carpal, dorsal, 678 
radial, 678 
ulnar, 682 
volar, 678, 682 
cavernous, 648 
cecal, of ileocolic, 693 
central, of retina, 650, 1029 
cerebellar, 661 
cerebral, anterior, 651 
middle, 652 
posterior, 662 
of cerebral hemorrhage, 653 
cervical, ascending, 663 
deep, 666 
superficial, 664 
transverse, 663 
choroid, 653 
choroidal, 653, 662 
ciliary, 650 
circle of Willis, 653 
circumflex, femoral, 716, 717 
humeral, 671, 672 
coccygeal of inferior gluteal, 
706 
cochlear, 1068 
cceliac, 688 
colic, 694, 695 
comitans nervi ischiadici, 706 
phrenici, 664 
common carotid, 627 
iliac, 698 
interosseous, 680 
communicating, anterior, 651 
of dorsalis pedis, 725 
posterior, 653 
coronary, of heart, 622 
of lips, 634 
of stomach, 688 
of corpus cavernosum, penis, 
705 
costocervical trunk, 666 
cremasteric, 709 
cricothyroid, 631 
cystic, 691 
deep auricular, 640 
epigastric, 709 
external pudendal, 716 
iliac circumflex, 710 
palmar arch, 679 
of penis, 703 
plantar, 725 
temporal, 641 
volar branch of ulnar, 682 
dental, inferior, 640 
posterior, 641 
descending aorta, 683 
development of, 141, 151 
Artery or Arteries, descending 
branch of occipital, 636 ■ 
palatine, 642 
digital, foot, 728 
hand, 682 
volar, 682 
distribution of, 619 
dorsal carpal of radial, 678 
of ulnar, 682 
interosseous, 681 
metacarpal, 678 
nasal, 650 
of penis, 706 
dorsales linguae, 632 
dorsalis hallucis, 724 
pedis, 724 
scapulae, 671 
of ductus deferens, 701 
epigastric, deep or inferior, 709 
superficial, 715 
superior, 666 
ethmoidal, 650 
external carotid, 630 
iliac, 708 
maxillary, 633 
plantar, 727 
pudendal, 716 
facial, 633 
transverse, 638 
femoral, 710 
circumflex, 716, 717 
fibular, 723 
frontal, 650 
ganglionic, 652, 653, 662 
gastric, 688, 689, 691 
gastroduodenal, 690 
gastroepiploic, 690, 691 
genicular, 718, 720, 721 
gluteal, 706, 707 
of head and neck, 626 
helicine, 1240 
hemorrhoidal, inferior, 704 
middle, 701 
superior, 696 
hepatic, 688 
highest genicular, 718 
intercostal, 666 
thoracic, 670 
humeral circumflex, 671, 672 
hypogastric, 700 
obliterated, 700 
ileal, of ileocolic, 693 
ileocolic, 693 
iliac circumflex, deep, 710 
superficial, 716 
common, 698 
external, 708 
internal, 700 
iliolumbar, 706 
inferior alveolar, 640 
articular of knee, 721 
cerebellar, 661 
epigastric, 709 
gluteal, 706 
hemorrhoidal, 704 
labial, 634 
laryngeal, 662 
mesenteric, 694 
pancreaticoduodenal, 692 
phrenic, 697 
profunda, 674 
thyroid, 662 
tympanic, 637 
ulnar collateral, 675 
infrahyoid, 631 
infraorbital, 641 
infrascapular, 671 
innominate, 625 
intercostal, 685, 686 
branches of internal mam- 
mary, 664 
highest, 666 
superior, 666 
interlobular, of kidney, 1213 
internal auditory, 661, 1068 
Artery or Arteries, internal caro- 
tid, 645 
iliac, 700 
mammary, 664 
maxillary, 638 
plantar, 727 
pudendal or pudic, 703 
spermatic, 697 
interosseous, common, 680 
anterior, 680 
dorsal, 681 
palmar, 679 
posterior, 681 
volar, 680 
intestinal, 692 
labial, 634 
of labyrinth, 1068 
lacrimal, 649 
laryngeal, inferior, 662 
superior, 631 
lateral calcaneal, 726 
femoral circumflex, 716 
nasal, 635 
palpebral, 649 
sacral, 707 
tarsal, 724 
left colic, 695 
gastric, 688 
gastroepiploic, 691 
lienal, 691 
lingual, 631 
deep, 632 
long ciliary, 650 
thoracic, 671 
of lower extremity, 710 
lumbar, 698 
malleolar, 723 
internal, 727 
mammary, internal, 664 
masseteric, 641 
maxillary, external, 633 
internal, 638 
medial palpebral, 650 
mediana, 680 
mediastinal, from aorta, 685 
from internal mammary,[664 
medidural, 640 
medullary, 661 
meningeal, accessory, 640 
anterior, 648 
of ascending pharyngeal, 637 
middle, 640 
of occipital, 636 
small, 640 
of vertebral, 660 
mesenteric, inferior, 694 
superior, 691 
metatarsal, 724 
middle cerebral, 652 
genicular, 720 
hemorrhoidal, 701 
meningeal, 640 
sacral, 698 
mode of division of, 619 
of origin of branches, 619 
musculophrenic, 664 
mylohyoid, 641 
nasal, 650 
dorsal, 650 
lateral, 635 
nasopalatine, 642 
nerves of, 598 
obturator, 702 
occipital, 635 
oesophageal of aorta, 685 
of inferior thyroid, 663 
ophthalmic, 648 
ovarian, 697 
palatine, ascending, 634 
of ascending pharyngeal, 637 
descending, 642 
palmar arch, deep, 679 
superficial, 682 
palpebral, 649, 650 
internal, 650 1360 
INDEX 
Artery or Arteries, pancreatic, of 
lienal, 691 
pancreaticoduodenal, 690 
parvidural, 640 
perforating, of foot, 728 
of hand, 679 
of internal mammary, 666 
of thigh, 717 
pericardiac, 664, 685 
pericardiacophrenic, 664 
perineal, 705 
superficial, 705 
peroneal, 726 
anterior, 726 
pharyngeal, ascending, 637 
of internal maxillary, 642 
phrenic, inferior, 697 
superior, 686 
plantar, 727 
deep, 725 
lateral (external), 727 
medial (internal), 727 
metatarsal, 728 
pontine, 661 
popliteal, 718 
posterior auricular, 636 
cerebral, 662 
communicating, 653 
humeral circumflex, 671 
inferior cerebellar, 661 
meningeal, from vertebral, 
660 
scapular, 664 
scrotal, 705 
superior alveolar, 641 
tibial, 725 
postero-medial ganglionic, 653, 
662 
princeps cervicis, 636 
pollicis, 678 
profunda, 674 
brachii, 674 
cervicalis, 666 
femoris, 716 
linguae, 632 
superior, 674 
of pterygoid canal, 642, 648 
pudendal, external, 716 
internal, 703 
in female, 706 
in male, 703 
pudic, external, 716 
internal, 703 
pulmonary, 620 
pyloric, 689 
radial, 676 
recurrent, 678 
radialis indicis, 679 
ranine, 632 
recurrent, of hand, 679 
interosseous, 682 
radial, 678 
tibial, 722, 723 
ulnar, 680 
renal, 696 
right colic, 694 
gastric, 689 
gastroepiploic, 691 
sacral, lateral, 707 
middle, 698 
scapular circumflex, 671 
posterior, 664 
transverse, 663 
sciatic, 706 
scrotal, posterior, 705 
sheaths of, 597 
short ciliary, 650 
gastric, 691 
sigmoid, 695 
spermatic, 697 
external, 709 
internal, 697 
sphenopalatine, 642 
spinal, 660 
splenic, 691 
j Artery or Arteries, sternal, 660 
■sternocleidomastoid, 631, 636 
sternomastoid, 631, 636 
striate, 653 
structure of, 596 
stylomastoid, 636 
subclavian, 655 
subcostal, 686 
sublingual, 632 
submaxillary, 634 
submental, 634 
subscapular, 671 
superficial cervical, 664 
epigastric, 715 
external pudendal, 716 
iliac circumflex, 716 
palmar arch, 682 
temporal, 637 
volar, 678 
arch, 682 
superior articular, of knee, 
720 
cerebellar, 661 
epigastric, 666 
gluteal, 707 
hemorrhoidal, 696 
intercostal, 666 
labial, 634 
laryngeal, 631 
mesenteric, 691 
phrenic, 686 
profunda, 674 
thoracic, 670 
thyroid, 631 
tympanic, 640 
ulnar collateral, 674 
vesical, 701 
superhyoid, 632 
supraorbital, 649 
suprarenal, 696, 697, 698 
suprascapular, 663 
sural, 720 
systemic distribution of, 619 
tarsal, 724 
temporal, 638 
deep, 641 
middle, 638 
superficial, 637 
thoracic, 670, 671 
aorta, 683 
axis, 670 
highest, 670 
lateral, 671 
superior, 670 
thoracoacromial, 670 
thyreoidea ima, 626 
thyrocervical trunk, 662 
thyroid axis, 662 
inferior, 662 
superior, 631 
tibial, anterior, 722 
posterior, 725 
recurrent, 723 
tonsillar, 634 ' 
transversa colli, 663 
transverse cervical, 663 
facial, 638 
perineal, 705 
scapular, 663 
transversalis colli, 663 
of trunk, 683 
tympanic, 637, 639, 640 
ulnar, 679 
recurrent, 680 
umbilical, in fetus, 616 
of upper extremity, 655 
urethral, 705 
of urethral bulb, 705 
uterine, 701 
vaginal, 702 
vasa aberrantia, 673 
brevia, 691 
intestini tenuis, 692 
vertebral, 659 
vesical, 701 
Artery or Arteries, vestibular, 
1068 
Vidian, 642, 648 
volar arch, deep, 679 
superficial, 682 
carpal, 678 
digital, common, 682 
interosseous, 680 
metacarpal, 679 
proper, 682 
volaris indicis radialis, 679 
Arterioles, 595 
Arthrodia, 382 
Articular arteries, 720, 721 
capsules, 379 
cartilage, 48 
disk of acromioclavicular joint, 
412 
of distal radioulnar joint, 377 
of sternoclavicular joint, 410 
of temporomandibular joint, 
395 
end bulbs, 1069 
lamella of bone, 379 
meniscus, 395 
processes of vertebrae, 197 
tubercle of temporal bone, 237, 
280 
Articulatio acromioclavicularis, 
411 
atlantoepistrophica, 388 
calcaneocuboidea, 454 
coxae, 432 
cubiti, 418 
cuneonavicular is, 456 
ellipsoidea, 382 
genu, 438 
humeri, 414 
mandibularis, 393 
radiocarpea, 425 
radioulnaris, 422 
distalis, 423 
proximalis, 422 
sacroiliaca, 404 
sellaris, 382 
sternoclavicularis, 409 
talocalcanea, 452 
talocalcaneonavicularis, 454 
lalocruralis, 449 
tibiofibularis, 448 
trochoidea, 382 
Articulation or Articulations, 379 
acromioclavicular, 411 
amphiarthroses, 381 
of ankle, 449 
atlantooccipital, 392 
of atlas with axis or epistro- 
pheus, 388 
with occipital bone, 392 
calcaneocuboid, 454 
calcaneonavicular, 455 
of calcaneus and astragalus, 
452 
with the cuboid, 454 
carpometacarpal, 429 
of carpus, 427 
of cartilages of ribs with each 
other, 401 
classification of, 380 
condyloid, 382 
costocentral, 396 
costochondral, 401 
costosternal, 399 
costotransverse, 397 
costovertebral, 396 
coxal, 432 
cuboideonavicular, 455 
cuneocuboid, 457 
cuneonavicular, 456 
diarthroses, 381 
of digits, 431, 549 
of elbow, 418 
gomphosis, 381 
of hip, 432 
humeral, 414 INDEX 
1361 
Articulation or Articulations, im- 
movable, 380 
inferior, 423 
intercarpal, 427 
interchondral, 401 
intercuneiform, 457 
intermetacarpal, 430 
intermetatarsal, 458 
intertarsal, 452 
of knee, 438 
of lower extremity, 432 
of mandible, 393 
metacarpophalangeal, 430 
metatarsophalangeal, 459 
movable, 381 
freely, 381 
slightly, 381 
movements of, 383 
of navicular with cuneiform 
bones, 456 
of pelvis, 404 
with vertebral column, 403 
of phalanges of foot, 459 
of hand, 431 
of pubic bones, 406 
symphysis, 406 
radiocarpal, 425 
radioulnar, distal, 423 
proximal, 422 
by reciprocal reception, 382 
sacrococcygeal symphysis, 406 
sacroiliac, 404 
of sacrum and coccyx, 406 
scapuloclavicular, 411 
schindylesis, 381 
shoulder, 414 
sternoclavicular, 409 
sternocostal, 399 
of sternum, 401 
sutura, 380, 381 
symphysis, 381 
pubis, 406 
synarthroses, 380 
synchondrosis, 381 
syndesmosis, 381 
talocalcaneal, 453 
talocalcaneonavicular, 454 
talocrural, 449 
tarsometatarsal, 457 
of tarsus, 452 
temporomandibular, 393 
tibiofibular, 448 
syndesmosis, 448 
tibiotarsal, 449 
of trunk, 384 
of upper extremity, 409 
of vertebra! arches, 386 
bodies, 384 
column, 384 
with cranium, 392 
with pelvis, 403 
of wrist, 425 
Articulationes capitulorum, 396 
carpometacarpeae, 429 
pollicis, 429 
costotransversariae, 397 
costovertebrales, 396 
digitorum manus, 431 
pedis, 459 
intercarpeae, 427 
inter chondrales, 401 
intermetacarpeae, 430 
intermetatarseae, 458 
intertarseae, 452 
metatar sophalangeae, 459 
ossiculorum auditus, 1054 
sterno co stales, 399 
tarsometatarseae, 457 
Aryepiglottic fold, 1085 
Aryepiglotticus muscle, 1089 
Arytaenoideus muscle, 1088 
Arytenoid cartilages, 1081 
glands, 1090 
swellings, 177 
Ascending aorta, 621 
Ascending cervical artery, 664 
colon, 1180 
frontal convolution, 869 
lumbar vein, 753 
oblique muscle, 503 
palatine artery, 634 
parietal convolution, 871 
pharyngeal artery, 637 
applied anatomy of, 638 
ramus of ischium, 337 
of os pubis, 337 
Association fibres of cerebral 
hemispheres, 890 
neurons, 811 
Asterion, 282, 296 
Astragalus, 366 
ossification of, 374 
Atavistic epiphyses, 59 
Atlantooccipital articulation, 392 
Atlas, 199 
development of anterior arch 
of, 104 
ossification of, 210 
Atresia, congenital, of pupil, 136 
Atria of bronchi, 1106 
Atrial canal, 145 
Atrioventricular bundle of His, 
614 
groove of heart, 604 
opening, left, 611 
right, 609 
Atrium dextrum, 606 
of heart, left, 610 
primitive, 145 
right, 606 
of nasal fossa, 1011 
sinistrum, 610 
Attic or epitympanic recess, 240, 
1049 
Attolens aurem muscle, 1045 
Attraction sphere, 34 
Attrahens aurem muscle, 1045 
Auditory artery, 661 
internal, 661 
canal, external, 1046 
meatus, external, 1046 
nerve, 934 
ossicles, 1053 
development of, 140 
pit, 138 
plate, 138 
teeth of Huschke, 1065 
tube, 1052 
cartilaginous portion of, 1052 
isthmus of, 1053 
osseous portion of, 1052 
pharyngeal ostium of, 1189 
tonsil of, 1053 
torus tubarius or cushion of, 
1052, 1140 
veins, 1068 
vesicle, 138 
Auerbach's plexus, 1176 
Auricle, left, 610 
right, 606 
Auricula dextra, 606 
of ear, 1044 
cartilage of, 1044 
development of, 141 
ligaments of, 1044 
muscles of, 1045 
vessels and nerves of, 1046 
of heart, left, 610 
right, 606 
sinistra, 610 
Auricular appendix, left, 610 
right, 606 
artery, anterior, 638 
deep, 640 
of occipital, 636 
posterior, 636 
lymph glands, 774 
nerves, anterior, 923 
great, 956 
posterior, 933 
Auricular nerves of vagus, 941 
point, 296 
surface of ilium, 335 
of sacrum, 208 
tubercle of Darwin, 1044 
vein, posterior, 734 
Auricularis muscles, 1045 
Auriculotemporal nerve, 923 
Auriculoventricular groove, 604 
Auris interna, 1057 
Auscultation, triangle of, 524 
Axes of pelvis, 342 
Axial filament of spermatozoon, 
81 
skeleton, 195 
Axilla, 667 
applied anatomy of, 667 
dissection of, 525 
fascia of, 526 
Axillary arch, 524 
artery, 668 
applied anatomy of, 669 
branches of, 670 
surface markings of, 1318 
lymph glands, 780 
nerve, 961 
sheath, 668 
vein, 750 
applied anatomy of, 750 
Axis, coeliac, 688 
of lens, 1031 
optic, 1017 
thoracic, 670 
thyroid, 662 
vertebra, 200 
ossification of, 210 
Axis-cylinder process, 71 
Axon of nerve cells, 71 
Azygos arteries of vagina, 702 
artery, articular, 720 
uvulae muscle, 1114 
vein, 753 
applied anatomy of, 754 
B 
Back, muscles of, deep, 485 
dissection of, 485 
Baillarger, band of, 883, 891 
Ball-and-socket joint, 382 
Band of Baillarger, 883, 891 
of Bechterew, 893 
of Gennari, 893 
of Giacomini, 875 
iliotibial, 563 
moderator, 610 
Bare area of liver, 1151 
Bartholin, duct of, 1137 
glands of, 190, 1258 
Basal column, posterior, 813 
knobs of Englemann, 38 
lamina, 119 
optic nucleus of Meynert, 861 
plate of placenta, 100 
ridge, or cingulum of tooth, 
1117 
vein, 740 
Base of cerebral peduncle, 849 
of heart, 605 
of sacrum, 208 
of skull, inferior surface, 278 
upper surface of, 288 
Basement membranes, 45 
Basichromatin, 34 
Basihyal of hyoid bone, 275 
Basilar artery, 661 
crest, 1064 
membrane, 1065 
part of occipital bone, 230 
plexus, 746 
sinus, 746 
Basilic vein, 748 
median, 747 
Basion, 281, 296 1362 
INDEX 
Basis bundle, anterior, 815 
lateral, 817 
cordis, 605 
oss. sacri, 208 
pedunculi, 849 
prostatae, 1241 
pulmonis, 1102 
Basivertebral veins, 755 
Basket cells of cerebellum, 642 
Bechterew, band of, 893 
nucleus of, 836, 935 
Bed of stomach. 1163 
Bell, nerve of, 957, 960 
Bellini, duct of, 1212 
Bertin, ligament of, 433 
Betz, giant cells of, 891 
Biceps brachii muscle, 534 
femoris muscle, 574 
flexor cubiti muscle, 534 
muscle, 534 
Bicipital fascia, 535 
groove, 311 
ridges, 311 
Bicuspid teeth, 1118 
valve, 612 
Bigelow, Y-shaped ligament of, 
433 
Bile capillaries, 1198 
ducts, 1198, 1200 
structure of, 1200 
Bipolar cells of retina, 1028 
Bird's nest of cerebellum, 839 
Biventer cervicis muscle, 489 
Biventral lobes of cerebellum, 839 
Bladder, 1218 
gall, 1199 
urinary, 1218 
applied anatomy of, 1224 
in child, 1220 
development of, 188 
distended, 1219 
empty, 1218 
female, 1221 
interior of, 1222 
ligaments of, 1221 
lymphatic vessels of, 793 
structure of, 1223 
trigone of, 1222 
vessels and nerves of, 1223 
Blandin, glands of, 1131 
Blastodermic vesicle, 85 
Blastopore, 86 
Blood, composition of, 61 
corpuscles, 61 
development of, 141 
origin of, 192 
course of, in an adult, 595 
in fetus, 616 
liquor sanguinis, 61 
plasma, 61 
platelets, 64 
Blood islands, 142 
Bochdalek, cornucopia of, 846 
Body or Bodies, anococcygeal, 
1184 
aortic, of Zuckerkandl, 1274 
carotid, 1273 
cavities, development of, 178 
ciliary, 1023 
coccygeal, 1273 
geniculate, 858 
Malpighian, of kidney, 1212 
of spleen, 1268 
olivary, 824 
of penis, 1239 
perineal, 1184 
pituitary, 861 
polar, 79 
restiform, 841 
of stomach, 1163 
thyroid, 1261 
trapezoid, 835 
of uterus, 1249 
of a vertebra, 197 
Body-stalk, 92, 96 
Bone or Bones, 50 
ankle, 366 
applied anatomy of, 59 
arm, 309 
articular lamella of, 379 
astragalus, 366 
atlas, 199 
axis, 200 
breast, 216 
calcaneus, 362 
calf, 359 
canaliculi of, 54 
cancellous tissue of, 50 
capitate, 327 
carpal, 323 
cells, 55 
chemical composition of, 55 
classes of, viz , long, flat, mixed 
or irregular, short, 195 
clavicle, 307 
coccyx, 209 
collar, 301 
compact tissue of, 50 
cranial, 227 
cuboid, 367 
cuneiform, of carpus, 324 
of tarsus, 369 
diploe of, 196 
of ear, 1053 
of elbow, 314 
eminences and depressions of, 
196 
epistropheus, 200 
ethmoid, 251 
ethmoidal, 251 
facial, 255 
femur, 345 
fibula, 359 
flat, 196 
of foot, 362 
frontal, 233 
hamate, 328 
of hand, 323 
Haversian canals of, 53 
systems of, 53 
hip, 333 
humerus, 309 
hyoid, 275 
ilium, 333 
incus, 1054 
inferior nasal conchae, 268 
innominate, 333 
interparietal., 231 
ischium, 336 
lacrimal, 263 
lesser, 263 
lacunae of, 54 
lamellae of, 54 
lingual, 275 
long, 195 
of lower extremity, 333 
jaw, 271 
lunate, 323 
lymphatics of, 53 
malar, 263 
malleus, 1053 
mandible, 271 
marrow of, 51 
maxillae, 256 
medullary artery of, 52 
membrane of, 51 
metacarpal, 329 
metatarsal, 371 
minute anatomy of, 53 
multangular, greater, 326 
lesser, 327 
nasal, 255 
navicular, of carpus, 323 
of tarsus, 368 
nerves of, 52 
number of, in body, 195 
nutrient artery of, 52 
occipital, 227 
os calcis, 362 
coxae, 333 
Bone or Bones, os magnum, 327 
ossification of, 56 
palate, 265 
palatine, 265 
parietal, 231 
patella, 354 
pelvic, 340 
perforating fibres of, 54 
periosteum of, 51 
phalanges of foot, 373 
of hand, 337 
pisiform, 326 
pubis, 337 
radius, 319 
ribs, 220 
sacrum, 206 
scaphoid, 323, 368 
scapula, 304 
semilunar, 323 
sesamoid, 376 
shin, 355 
short, 196 
sphenoid, 245 
sphenoidal, 245 
conchae, 250 
stapes, 1054 
sternum, 216 
structure and physical prop- 
erties of, 50 
surfaces of, 196 
sutural, 255 
talus, 366 
tarsal, 362 
temporal, 237 
thigh, 345 
tibia, 355 
trapezium, 326 
trapezoid, 327 
triangular, 324 
turbinated, 268 
ulna, 314 
unciform, 328 
of upper extremity, 301 
jaw, 256 
vertebra prominens, 201 
vertebrae, cervical, 198 
lumbar, 204 
thoracic, 201 
sacral and coccygeal, 205 
vessels of, 52 
vomer, 269 
Wormian, 255 
zygomatic, 263 
Bowman, capsule of, 1212 
glands of, 1012 
membrane of, 1020 
muscle of, 1023 
Brachia conjunctiva of cere- 
bellum, 841 
of corpora quadrigemina, 853 
pontis, 841 
Brachial artery, 672 
applied anatomy of, 673 
branches of, 674 
peculiarities of, 672 
surface marking of, 1321 
cutaneous nerve, lateral, 962 
medial, 964 
posterior, 969 
fascia, 534 
plexus, 958 
applied anatomy of, 970 
veins, 750 
Brachialis anticus muscle, 535 
muscle, 535 
Brachiocephalic artery, 625 
veins, 751 
Brachioradialis muscle, 542 
Brain, arteries of, 653 
commissures of, 856 
development of, 120 
dissection of, 821 
divisions of, 821 
dura of, 900 
meninges of, 900 INDEX 
1363 
Brain, pia of, 906 
surface markings of, 1280 
veins of, 739 
weight of, 894 
Branchial arches, 108 
grooves, 108 
Breadth index of skull, 296 
Breast bone, 216 
Breasts or mammae, 1258 
development of, 116 
Bregma, 238, 277, 296 
Bregmatic fontanelle, 294 
Bridge of nose, 1008 
Brim of pelvis, 340 
Broad ligaments of uterus, 1154, 
1250 
Broca, cap of, 870 
gyrus of, 870 
limbic lobe of, 873 
parolfactory area of, 874 
Bronchi, 1091 
Bronchial arteries, 685, 1108 
nerves, 943 
veins, 754, 1108 
Bronchomediastinal trunks, 798 
Bronchus dextra, 1092 
divisions of, 1105 
eparterial, 1105 
hyparterial, 1105 
intrapulmonary, 1106 
left, 1092 
right, 1092 
sinister, 1092 
Brunner's glands, 1175 
Bryant's triangle, 1330 
Buccal artery, 641 
branches of facial nerve, 933 
cavity, 1110 
glands, 1111 
nerve, long, 922 
Buccinator artery, 641 
muscle, 470 
nerve, 922 
Bucconasal membrane, 112 
Buccopharyngeal fascia, 477 
membrane, 86 
Bulb of aorta, 622 
of corpuscavernosum penis, 1238 
of eye, 1017 
olfactory, 874, 893 
of posterior cornu, 879 
spinal, 822 
vaginal, 1257 
of vestibule, 1257 
Bulbar arteries, 661 
Bulbocavernosus muscle, 518, 520 
Bulbourethral glands of Cowper, 
190, 1243 
Bulbs of internal jugular vein, 736 
Bulbus cordis, 145 
oculi, 1017 
olfactorius, 874 
vestibuli, 1257 
Bulla ethmoidalis, 294, 1011 
Bundle of His, 69 
oval, 119 
of Vicq d'Azyr, 857, 860, 886 
Burdach, tract of, 808, 817 
Burns' space, 477 
Bursa, omental, 1152, 1155 
development of, 170 
omentalis, 1155 
pharyngeal, 1139 
prepatellar, 566 
Burs® beneath glutaeus maxi- 
mus, 570 
mucosae, 380 
near knee-joint, 443 
shoulder-joint, 415 
C 
Cacuminal lobe, 838 
Calamus scriptorius, 847, 726 
Calcaneal arteries, 726, 727 
Calcanean arteries, lateral, 726 
mfedial, 727 
nerve, medial, 988 
sulcus, 365 
tuberosity, 365 
Calcaneoastragaloid articulation, 
452 
ligaments, 452, 453 
Calcaneocuboid ligaments, 454 
Calcaneonavicular ligaments, 455 
Calcaneotibial ligament, 450 
Calcaneus, 362 
ossification of, 374 
Calcar avis, 879 
femorale, 351 
Calcarine fissure, 869 
Calf bone, 359 
Calices of kidney, 1210, 1216 
Callosal convolution, 873 
fissure, 873, 876 
Callosomarginal fissure, 869 
Camper, fascia of, 498 
Canaliculi of bone, 53 
dental, 1119 
Canaliculus, inferior tympanic, 
243, 280 
mastoid, 243, 280 
Canalis centralis cochleae, 242 
craniopharyngeus, 251 
reunions [o/ Hensen}, 1062, 1064 
Canal or Canals, adductor, 713 
Alcock's, 511 
alimentary, 1109 
alveolar, 257 
atrial, 145 
auditory, external, 1046 
carotid, 242, 280 
central, of medulla spinalis, 810 
of cervix of uterus, 1250 
condyloid, 230 
craniopharyngeal, 166, 251 
ethmoidal, 235, 253 
femoral, 712 
Haversian, of bone, 53 
of Huguier, 238, 932, 1050 
Hunter's, 713 
hyaloid, 1030 
hypoglossal, 229 
incisive, 261, 278 
infraorbital, 258 
inguinal, 508 
lacrimal, 1041 
mandibular, 273 
neural, 88 
neurenteric, 88 
of Nuck, 187, 1251 
of Petit, 1030 
pharyngeal, 278 
pterygoid, 280 
pterygopalatine, 258, 267 
sacral, 208 
of Schlemm, 1018 
semicircular, 1058 
membranous, 1062 
spermatic, 508 
spiral, of modiolus, 1060 
vertebral, 208 
Canales semicirculares ossei, 1058 
Canaliculus innominatus of Ar- 
nold, 248, note 
Canalis adductorius, 713 
centralis [medulla spinalis}, 810 
cenicis uteri, 1250 
inguinalis, 508, 1229 
sacralis, 208 
semicircularis lateralis, 1059 
posterior, 1059 
superior, 1059 
Cancellous tissue of bone, 50 
Canine eminence, 257 
fossa, 257 
teeth, 1117 
Caninus muscle, 470 
Canthi of eyelids, 1038 
Cap of Broca, 870 
Capillaries, 598 
bile, 1198 
structure of, 598 
Capitate bone, 327 
Capitulum fibulae, 359 
humeri, 312 
mallei, 1053 
stapedis, 1054 
Capsula articularis. See Indi- 
vidual joints. 
cricoarytaenoidea, 1084 
externa, 884 
extrema, 883 
interna, 883 
lentis, 1030 
vasculosa lentis, 136 
Capsular artery, middle, 696 
Capsule, adipose, of kidney, 1209 
adrenal, 1270 
of Bowman, 1212 
of brain, 883, 884 
of Glisson, 1156, 1196 
of lens, 1030 
of T6non, 1037 
Caput caecum coli, 1177 
femoris, 345 
humeri, 309 
pancreatis, 1203 
tali, 367 
Cardiac cycle, 615 
ganglion of Wrisberg, 1002 
glands of stomach, 1166 
muscular tissue, 68 
nerves, cervical, 942 
great, 997 
from sympathetic, 997 
thoracic, 943 
from vagus, 942 
notch, 1104 
orifice of stomach, 1161 
plexus of nerves, 1001 
veins, 730 
Cardinal veins, 157 
Caroticoclinoid foramen, 249, 290 
ligament, 251 
Caroticotympanic artery, 648 
nerve, 946, 1056 
Carotid arch, 153 
artery, common, 627 
applied anatomy of, 629 
branches of (occasional), 
629 
peculiarities of, 628 
surface markings of, 1290 
external, 630 
applied anatomy of, 630 
branches of, 630 
surface markings of, 1290 
internal, 645 
applied anatomy of, 647 
branches of, 648 
peculiarities of, 647 
bodies, 1273 
canal, 242, 280 
ganglion, 996 
glands, 1273 
groove, 247, 290 
nerve, internal, 995 
nerves from glossopharyngeal, 
939 
plexus, 996 
internal, 996 
sheath, 477 
skeins, 134, 1273 
triangles, 643 
tubercle, 199 
Carpal arteries from radial, 678 
from ulnar, 682 
bones, 323 
net-work, 678 
Carpometacarpal articulations, 
429 
Carpus, 323 
applied anatomy of, 332 1364 
INDEX 
Carpus, articulations of, 427 
ossification of, 331 
surface form of, 1315 
Cartilage or Cartilages, articular, 
48 
arytenoid, 1081 
of auricula, 1044 
cells, 47 
cellular, 47 
corniculate, 1081 
costal, 48, 224 
cricoid, 1081 
cuneiform, 1082 
of epiglottis, 1082 
epiphysial, 57 
ethmovomerine, 270 
histology of, 47 
hyaline, 47 
intrathyroid, 1080 
lacunae, 47 
of larynx, 1079 
structure of, 1082 
lateral, lower, 1009 
upper, 1009 
of nose, 1008, 1009 
Meckel's, 109, 273 
parachordal, 106 
permanent, 47 
of pinna, 1044 
of Santorini, 1081 
of septum of nose, 1009 
sesamoid, 1009 
temporary, 47 
thyroid, 1080 
trabeculae cranii, 106 
of trachea, 1092 
vomeronasal, 1012 
white fibro-, 49 
of Wrisberg, 1082 
Cartilagines alares minores, 1009 
arytaenoideae, 1081 
corniculatae, 1081 
costales, 224 
- cuneiformes, 1082 
laryngis, 1079 
nasi, 1008 
Cartilaginous ear capsules, 107 
vertebral column, 104 
Cartilago alaris major, 1009 
crus later ale, 1009 
mediate, 1009 
auriculae, 1044 
cricoidea, 1081 
epiglottica, 1082 
nasi lateralis, 1009 
septi nasi, 1008 
thyreoidea, 1080 
triticea, 1083 
Caruncula lacrimalis, 1041 
Carunculae hymeneales, 1257 
Cauda equina, 806 
helicis, 1044 
pancreatis, 1204 
Caudal fold of embryo, 92 
Caudate lobe of liver, 1195 
nucleus, 881 
process of liver, 1195 
Caudatum, 881 
Cavernous arteries, 648 
nerves of penis, 1005 
plexus, 996 
portion of urethra, 1226 
sinuses, 744 
applied anatomy of, 745 
nerves in, 928 
spaces of penis, 1240 
Cavity or Cavities, amniotic, 96 
body or ccelom, 88 
buccal, 1110 
cotyloid, 339 
glenoid, 307 
of lesser pelvis, 341 
mediastinal, 1098, 1100, 1101 
of mouth proper, 1110 
nasal, 292, 1010 
Cavity or Cavities, oral, 1110 
peritoneal, 1149 
of septum pellucidum, 887 
sigmoid, of radius, 321 
of ulna, 313, 318 
subarachnoid, 904 
subdural, 903 
of thorax, 600 
tympanic, 1049 
of uterus, 1250 
Cavum conchae, 1044 
laryngis, 1085 
Meckelii, 914 
nasi, 292, 1010 
oris, 1110 
proprium, 1110 
septi pellucidi, 887 
subarachnoideale, 904. 
tympani, paries carotica, 1052 
labyrinthica, 1050 
mastoidea, 1051 
tympanum, 1049 
paries jugularis, 1049 
membranacea, 1049 
tegmentalis, 1049 
uteri, 1250 
Cecal arteries, 693 
fossae, 1159 
Cecum, 1177 
lymphatic vessels of, 792 
Cell or Cells, animal, 33 
basket, of cerebellum, 842 
of Betz, 891 
of bone, 55 
' centro-acinar of Langerhans, 
1205 
chalice, 37 
chromaffin, 1272 
clasmatocytes, 41 
of Claudius, 1067 
definition of, 33 
of Deiters, 1067 
divisions of, 34 
of Dogiel, 950 
enamel, 1123 
fat, 42 
germinal, of medulla spinalis, 
117 
giant, 51 
of Betz, 891 
goblet, 37 
of Golgi, 892 
granule, 41 
gustatory, 1007 
of Hensen, 1067 
lamellar, 41 
of Martinotti, 892 
intermediate, 88 
Mastzellen, 41 
membrane, 34 
mesamceboid, 142 
nerve, 70 
nucleus of, 34 
olfactory, 1012 
pigment, 42 
plasma, 41 
prickle, 39 
of Purkinje, 842 
reproduction of, 34 
of Sertoli, 1233 
of spinal ganglia, 803, 949 
splenic, 1267 
structure of, 33 
wandering, 42 
Cell mass, inner, 84 
Celia, 877 
Cellulae ethmoidales, 1014 
Cellular cartilage, 47 
Cement of teeth, 1121 
formation of, 1124 
Central artery of retina, 650 
canal of medulla spinalis, 
810 
cells of fundus glands, 1166 
fissure, 868 
Central gray stratum of cerebral 
aqueduct, 854 
ligament of medulla spinalis, 
907 
lobe, 873 
nervous system, 801 
part of lateral ventricle, 877 
sulcus, 868 
tendinous point of perineum, 
518 
tendon of diaphragma, 495 
Centres, higher visual, 864, 909 
lower visual, 909 
of ossification, 57, 864 
Centrifugal nerve fibres, 803 
Centriole, 34 
bodies of ovum, 78 
of spermatozoon, 80, 81 
Centripetal nerve fibres, 803 
Centroacinar cells of Langerhans, 
1205 
Centrosome, 34 
Centrosphere, 34 
Centrum ovale majus, 876 
minus, 876 
Cephalic flexure, ventral, of 
embryonic brain, 121 
fold of embryo, 92 
index, 296 
portion of sympathetic system, 
995 
vein, 747 
accessory, 748 
Ceratohyal of hyoid bone, 277 
Cerebellar artery, anterior in- 
ferior, 661 
posterior inferior, 661 
superior, 661 
fasciculus, direct, 813 
notches, 837 
peduncles, 841 
tract, direct, 816 
of Flechsig, 816, 828 
veins, 739 
Cerebelloolivary fasciculus, 830 
Cerebellospinal tract of Lowen- 
thal, 815 
Cerebellum, 836 
applied anatomy of, 844 
brachia, conjunctiva, 841 
pontis, 840 
development of, 124 
fibrae propriae, 842 
gray substance of, 842 
lobes of, 836 
nucleus dentatus, 844 
peduncles of, 841 
structure of, 839 
surfaces of, 837, 838 
vermis of, 836 
white substance of, 839 
Cerebral arteries, anterior, 651 
middle, 652 
posterior, 662 
aqueduct, 854 
cortex, nerve cells of, 891 
nerve fibres of, 892 
structure of, 891 
types of, 893 
dura mater, 900 
fissure, lateral, 867 
hemispheres, 865 
borders of, 866, 867 
development of, 128 
fibers of, association, 890 
commissural, 890 
projection, 890 
transverse, 890 
fissures of, 867 
gray substance of, 891 
gyri of, 869 
interior of, 875 
lobes of, 869 
localization of, 894 
poles of, 867 INDEX 
1365 
Cerebral hemispheres, structure 
of, 889 
sulci of, 867 
surfaces of, 867 
white substance of, 889 
peduncles, 848 
structure of, 848 
nerves, 907 
abducent, 927 
accessory, 944 
acoustic, 934 
development of, 131 
facial, 929 
glossopharyngeal, 937 
hypoglossal, 945 
oculomotor, 911 
olfactory, 908 
optic, 909 
trigeminal, 914 
trochlear, 913 
vagus, 940 
veins, 739 
ventricles, 845, 864, 877 
vesicles, 88, 120 
Cerebroolivary fasciculus, 830 
Cerebrospinal fasciculus, 815 
fibres of internal capsule, 884 
fluid, 905 
Ceruminous glands, 1047 
Cervical artery, ascending, 663 
deep, 666 
superficial, 664 
transverse, 663 
branch of facial nerve, 933 
cardiac nerves, 942 
enlargement of medulla 
spinalis, 808 
fascia, 476 
applied anatomy of, 478 
flexure of embryonic brain, 121 
ganglion, 997, 998 
lymph glands, 778 
applied anatomy of, 780 
muscles, lateral, 475 
superficial, dissection of, 475 
nerve, 957 
cutaneous or transverse, 957 
of facial, 933 
nerves, 951 
divisions of, anterior, 954 
posterior, 951 
pleura, 1095 
plexus, 954 
applied anatomy of, 958 
branches of, 956, 957 
posterior, 957 
portion of sympathetic, 996 
rib, 201 
applied anatomy of, 226 
vein, deep, 738 
posterior, 738 
vertebrae, 198 
Cervicalis ascendens muscle, 488 
Cervix uteri, 1249 
portio supravaginalis, 1249 
vaginalis, 1250 
of uterus, 1249 
Chalice cells, 37 
Chambers of eye, 1024 
Chassaignac's tubercle, 199 
Check ligaments, 393 
of eye, 1038 
Cheeks, 1110 
Chest, 216 
Chiasma, optic, 862, 909 
opticum, 862, 909 
Chiasmatic groove, 246, 290 
Choanae, 278, 294, 1010 
Chondrin, 50 
Chondrocranium, 106 
Chondroglossus muscle, 1129 
Chondromucoid, 50 
Chondrosternal ligament, 399 
intra-articular, 400 
Chondroxiphoid ligaments, 401 
Chorda obliquii, 423 
tympani nerve, 932 
Chordae tendineae [left ventricle], 
612 
[right ventricle], 610 
Willisi, 741 
Chordal furrow, 91 
portion of base of skull, 106 
Chorioidea, 1021 
lamina choriocapillaris, 1022 
vasculosa, 1022 
Chorion, 99 
f rondosum, 100 
laeve, 99 
Chorionic villi, 99 
Choroid artery, 653 
coat of eyeball, 1021 
structure of, 1021 
plexuses of fourth ventricle, 
846 
of lateral ventricle, 887 
of third ventricle, 864 
vein, 740 
Choroidal artery, anterior, 653 
posterior, 662 
fissure, 135, 888 
Chromaffin cells, 1272 
organs, 133 
Chromatin, 34 
Chromatolysis, 72 
Chromosomes, 34 
Chyle, 768 
Chyliferous vessels, 768 
Cilia, 1038 
Ciliaris muscle, 1023 
Ciliary arteries, 650 
body, 1023 
ganglion, 917 
glands, 1039 
muscle, 1023 
nerves, 916, 917 
processes, 1023 
Ciliated epithelium, 37 
Cingulate gyrus, 873 
sulcus, 869 
Cingulum of cerebral hemisphere. 
890 
of teeth, 1125 
Circle, arterial, of Willis, 653 
Circular folds of small intestine, 
1173 
sinus, 746 
sulcus, 869, 873 
Circulating fluids, 61 
blood, 61 
lymph, 64 
Circulation of blood in adult, 595 
in fetus, 616, 650 
Circulus arteriosus major, 1025 
minor, 1025 
major [iris], 650, 1025 
minor [iris], 650, 1025' 
venosus [mamma], 1260 
Circumduction, 383 
Circumferential fibrocartilage, 50 
Circumflex artery, femoral,lateral, 
716 
medial, 717 
humeral, anterior, 672 
posterior, 671 
nerve, 961 
Circuminsular fissure, 869 
Circumvallate papillae, 1127 
Cisterna basalis, 904 
chyli, 772 
cerebellomedullaris, 904 
chiasmatis, 904 
fossae cerebri lateralis, 905 
interpeduncularis, 904 
magna, 904 
pontis, 904 
venae magnae cerebri, 905 
Cisternae subarachnoid, 904 
subarachnoidales, 904 
Clarke's column, 813 
I Clasmatocytes, 41 
Claudius, cells of, 1067 
Claustrum, 882 
Clava, 824 
Clavicle, 301 
applied anatomy of, 303 
ossification of, 303 
peculiarities of, in sexes, 303 
structure of, 303 
surface anatomy of, 1313 
Clavicula, 301 
Clavipectoral fascia, 528 
Cleft palate, 299 
Clinging fibres of cerebellum, 844 
Clinoid processes, anterior, 249, 
290 
middle, 246, 290 
posterior, 246, 290 
Clitoris, 1257 
frenulum of, 1257 
glans of, 1257 
prepuce of, 1257 
Clivus of sphenoid, 246 
monticuli of cerebellum, 838 
Cloaca, ectodermal, 172 
entodermal, 172 
pelvic portion of, 188 
phallic portion of, 188 
vesicourethral portion of, 188 
Cloacal membrane, 172 
duct, 172 
tubercle, 190 
Cloquet, lymph gland of, 783 
Closing membranes, 108 
Coarctation of aorta, 624 
Coccygeal arteries, 706 
body,1273 
cornua, 209 
gland, 1273 
nerve, division of, anterior, 982 
posterior, 954 
plexus, 992 
skein, 1273 
Coccygeus muscle, 514 
Coccyx, 209 
ossification of, 212 
Cochlea, 1059 
aqueduct of, 243, 280, 1060 
cupula of, 1059, 1060 
hamulus laminae spiralis, 1060 
helicotrema of, 1060 
modiolus of, 1060 
scalae of, 1060 
spiral canal of, 1060 
lamina of, osseous, 1060 
secondary, 1060 
vessels of, 1068 
Cochlear artery, 1068 
nerve, 935, 1068 
nuclei, 836, 935 
root of acoustic nerve, 935 
Cochleariform process, 243, 1052 
Cceliac artery, 688 
axis, 688 
branches of vagus nerve, 943 
ganglion, 1002 
plexus, 1002 
Cog-tooth of malleus, 1053 
Cohnheim, areas of, 66 
Colic arteries of ileocolic, 794 
artery, left, 695 
middle, 694 
right, 694 
flexures, right and left, 1180 
impression, 1192 
valve, 1179 
Collagen, 44 
Collar bone, 301 
Collateral circulation, 619 
eminence, 881 
fissure, 869 
ganglia, 995 
Collecting tubes of kidney, 1212 
Colles, fascia of, 337, 499, 517 
Colliculi, inferior, 853, 854 1366 
INDEX 
Colliculi, superior, 853, 854 
Colliculus of arytenoid cartilage, 
1081 
facialis, 848 
inferior, 854 
nervi optici, 1027 
superior, 854 
Collum anatomicum, 309 
femoris, 345 
mallei, 1053 
tali, 367 
Coloboma, 135 
Colon, 1180 
ascendens, 1180 
ascending, 1180 
descendens, 1181 
descending, 1181 
iliac, 1181 
left or splenic flexure of, 1180 
pelvic, 1181 
right or hepatic flexure of, 1180 
sigmoid, 1181 
sigmoideum, 1181 
structure of, 1184 
tela submucosa, 1185 
transversum, 1180 
tunica mucosa, 1185 
muscularis, 1184 
serosa, 1184 
vessels and nerves of, 1185 
Colored lines of Retzius, 1120 
or red corpuscles, 61 
Colorless corpuscles, 62 
Colostrum corpuscles, 1259 
Columna anterior [medulla spin- 
alis], 809 
fornicis, 886 
lateralis [medulla spinalis], 809 
nasi, 1008 
posterior [medulla spinalis], 890 
vertebralis. 196 
Columnae carneae, 610 
Columnar epithelium, 37 
Columns of Clarke, 813 
of fornix, 886 
of medulla spinalis, 811, 812, 
813 
rectal, of Morgagni, 1184 
renal, 1211 
of vagina, 1255 
vertebral, 196, 212 
Comes nervi phrenici, 664 
Comitans nervi ischiadici, 706 
Comma-shaped fasciculus, 817 
Commissura labiorum anterior, 
1256 
palpebrarum lateralis, 1038 
medialis, 1038 
Commissural fibres of cerebral 
hemispheres, 890 
Commissure of brain, 856 
anterior, 131, 887 
middle or gray, 856 
posterior, 127, 860 
of corpus callosum, 131 
habenular, 859 
hippocampal, 886 
of Gudden, 909 
of labia majora, 1257 
of medulla spinalis, anterior 
and posterior gray, 810 
anterior white, 808 
optic, 862 
Commissures, palpebral, 1038 
Common bile duct, 1200 
lymphatics of, 793 
carotid artery, 627 
dental germ, 1121 
iliac arteries, 698 
glands, 786 
veins, 763 
integument, 1071 
interosseous artery, 680 
peroneal nerve, 989 
Communicans fibularis nerve; 990 
, Communicans tibialis nerve, 988 
Communicantes cervicales, 
nerves, 957 
| Communicating artery, anterior, ' 
651 
from dorsalis pedis, 725 
posterior, 653 
Compact tissue of bone, 50 
Comparison of bones of hand and 
foot, 375 
Complexus muscle, 489 
Compressor naris muscle, 469 
j Concha of auricula, 1044 
cavum conchae, 1044 
cymba conchae, 1044 
nasal, inferior, 268 
articulations of, 269 
ossiffication of, 269 
middle, 254 
superior, 254 
nasalis inferior, 268 
Conchae, sphenoidal, 250 
sphenoidales, 250 
Conchal crest, 258, 266 
Condyle of mandible, 293 
Condyles of femur, 349 
occipital, 230 
of tibia, 355 
Condyloid articulation, 382 
canal, 230 
foramen, anterior, 229 
fossa, 230, 287 
process of mandible, 273 
j Cone of attraction, 83 
bipolars of retina, 1028 
granules of retina, 1029 
of origin of axon, 72 
Cones of retina, 1029 
Confluence of sinuses, 229, 743 
Confluens sinuum, 743 
Coni vasculosi, 1233 
Conical papillae, 1128 
Conjoined tendon of internal j 
oblique and transversalis 
muscles, 505 
Conjugate diameter of pelvis, 341 
j Conjunctiva, 1040 
applied anatomy of, 1042 
; Connecting fibrocartilages, 50 
Connective tissues, 40 
adipose, 42 
areolar, 40 
development of, 47 
lymphatics of, 46 
mucous, 44 
nerves of, 46 
proper, 40 
retiform, 40 
vessels of, 46 
white fibrous, 40 
yellow elastic, 40 
Connective tissue corpuscles, 40 
extraperitoneal, 509 
Conoid ligament, 412 
tubercle, 301 
Constriction, duodenopyloric, 
1162 
Constrictor muscles, 1141, 1142 
pharyngis inferior muscle, 1141 
medius muscle, 1142 
superior muscle, 1142 
urethrae muscle, 520, 521 
Contractile fibre-cells, 68 
Conus arteriosus, 608 
elasticus [larynx], 1083 
medullar is, 806 
Convoluted tubes of kidney, 1212 
Convolution, callosal, 873 
frontal, ascending, 869 
occipitotemporal, 871 
parietal, ascending, 871 
Cooper, ligament of, 502 
Copula, 164 
Cor, 603 
| Coracoacromial ligament, 413 
Coracobrachialis muscle, 534 
Coracoclavicular fascia, 528 
Coracohumeral ligament, 414 
Coracoid process, 307 
tuberosity, 301 
Cord, gangliated, 995 
spermatic, 1229 
spinal, 805 
umbilical, 96 
vocal, false, 1085 
inferior, 1086 
superior, 1085 
true, 1086 
Corium or cutis vera, 1074 
layers of, 1074 
stratum papillare, 1074 
reticulare, 1074 
Cornea, 1018 
structure of, 1019 
Corneal corpuscles, 1020 
endothelium, 1021 
epithelium, 1019 
spaces, 1020 
Corniculate cartilages, 1081 
Cornu anterius, 878 
inferior, 879 
of medulla spinalis, 809 
posterius, 879 
Cornua of coccyx, 209 
of hyoid bone, 275 
of lateral ventricles, 878, 879 
majora [os hyoidei], 275 
minora [os hyoidei], 277 
of sacrum, 207 
of thyroid cartilage, 1080 
Cornucommissural fasciculus, 817 
Cornucopia of Bochdalek, 846 
Corona glandis, 1239 
radiata [brain], 884 
[ovum], 79 
Coronal suture, 277, 282 
Coronary artery of heart, 622 
applied anatomy of, 623 
peculiarities of, 623 
of lips, 634 
of stomach, 688 
ligament of liver, 1151 
ligaments of knee, 442 
plexuses, 1002, 1004 
sinus, 730 
opening of, 608 
sulcus of heart, 604 
veins, 730 
of stomach, 766 
Coronoid fossa, 313 
process of mandible, 273 
of ulna, 315 
Corpora cavernosa clitoridis, 1257 
penis, 1238 
bulbs of, 1238 
crura of, 1238 
mamillaria, 860 
quadrigemina, 853 
brachia of, 853 
structure of, 854 
Corpus albicantia, 860 
Arantii, 610, 612 
callosum, 865, 876 
development of, 131 
genu of, 876 
peduncle of, 875 
rostrum of, 876 
splenium of, 876 
cavernosum, artery to, 705 
urethrae, 1237 
ciliare, 1023 
femoris, 348 
fibulae, 359 
fornicis, 886 
geniculatum laterale, 858 
mediate, 858 
Highmori, 1232 
humeri, 311 
incudis, 1054 
luteum, 1246 INDEX 
1367 
Corpus maxillae, 256 
oss. hyoidei, 275 
ilii, 333 
ischii, 336 
pubis, 337 
pancreatis, 1204 
facies anterior, 1204 
inferior, 1204 
posterior, 1204 
mar go anterior, 1204 
inferior, 1204 
superior, 1204 
papillare [corium], 1074 
penis, 1239 
pineale, 859 
radii, 320 
restiformes, 830, 841 
sphenoidalis, 246 
spongiosum, 1238 
sterni, 218 
striatum, 729, 881 
vein of, 885 
subthalamicum, 860 
tali, 367 
tibiae, 356 
ulnae, 318 
uteri, 1249 
facies intestinalis, 1249 
vesicalis, 1249 
margo lateralis, 1249 
vertebrae, 197 
vitreum, 1030 
Corpuscles, colored, 61 
development of, 142 
colorless, 62 
connective tissue, 40 
genital, 1069 
of Golgi and Mazzoni, 1069 
of Grandry, 1069 
of Hassall, 1265 
of Herbst, 1069 
Pacinian, 1069 
of Ruffini, 1070 
of Wagner and Meissner, 1070 
Corrugator cutis ani muscle, 516 
muscle, 468 
supercilii muscle, 468 
Cortex of cerebellum, 842 
of cerebrum, 891 
Corti, ganglion of, 1060, 1068 
organs of, 1065 
pillars or rods of, 1065 
spiral organ of, 1065 
tunnel of, 1065 
Cortical arches of kidney, 1211 
arterial system of brain, 654 
portion of suprarenal gland, 
1272 
substance of kidney, 1211 
of lens, 1031 
visual centre, 909 
Corticostriate fibres, 882 
Costae, 220 
Costal cartilages, 48, 224 
element or process, 199 
groove, 222 
pleura, 1095 
tuberosity, 303 
Costocentral articulation, 396 
Costocervical trunk, 666 
Costochondral articulations, 401 
Costocoracoid ligament, 528 
membrane, 528 
Costomediastinal sinus, 1097 
Costosternal articulations, 399 
Costotransverse articulations, 
397 
ligaments, 399 
Costovertebral articulations, 396 
ligament, anterior, 396 
Cotyloid cavity, 339 
ligament, 339, 434 
Covering bones, 107 
Coverings of direct inguinal 
hernia, 1188 
Coverings of femoral hernia, 1189 
of oblique inguinal hernia, 1187 
of ovum, 79 
of testes, 1228 
Cowper's glands, 190, 1243 
Coxal articulation, 432 
applied anatomy of, 437 
movements of, 435 
muscles in relation to, 435 
Cranial bones, 227 
fossa, anterior, 288 
middle, 290 
posterior, 291 
nerve, 907 
Craniology, 295 
Craniopharyngeal canal, 166 
Cranium, 227 
bones of, 227 
breadth of, 296 
development of, 105 
fissures in, congenital, 255 
height of, 296 
horizontal circumference of, 
296 
length of, 296 
longitudinal arc of, 296 
Cremaster muscle, 504 
Cremasteric artery, 709 
fascia, 504 
Crescents of Gianuzzi, 1137 
Crest or Crests, basilar, 1064 
conchal, 258, 266 
ethmoidal, 260, 267 
frontal, 235 
of ilium, 336 
incisor, 261 
infratemporal, 248, 282 
internal occipital, 228, 292 
intertrochanteric, 348 
lacrimal, 260, 263 
nasal, 261, 266 
neural, 88, 120 
obturator, 338 
of pubis, 338 
of right atrium, 606, 607 
sphenoidal, 247 
supramastoid, 237 
of tibia, 356 
of tubercles of humerus, 309 
urethral, in female, 1228 
in male, 1225 
Cribriform plate of ethmoid, 252 
Cricoarytaenoideus lateralis 
muscle, 1088 
posterior muscle, 1088 
Cricoarytenoid ligament, 1084 
muscles, 1088 
Cricoid cartilage, 1081 
Cricothyreoideus muscle, 1088 
Cricothyroid artery, 631 
ligament, middle, 1083 
membrane, 1083 
muscle, 1088 
Cricotracheal ligament, 1083 
Crista arcuata [arytenoid car- 
tilage], 1081 
colli costae, 222 
falciformis, 241 
galli, 252 
terminalis [of His], 146 
vestibuli, 1058 
Crossed commissural fibres, 811 
pyramidal tract, 815 
Crosses of Ranvier, 75 
Crown of a tooth, 1118 
Crucial anastomosis, 717 
ligaments, 441 
Cruciate crural ligament, 584 
eminence of occipital bone, 228 
ligament of atlas, 390 
ligaments of knee, 441 
Crura cerebri, 848 
of diaphragma, 495 
of fornix, 887 
of penis, 1238 
Crura of stapes, 1054 
of subcutaneous inguinal ling, 
500 
Crural arch, deep, 509 
muscles, anterior, dissection of, 
578 
lateral, dissection of, 582 
posterior, dissection of, 578, 
579, 581 
nerve, anterior, 980 
septum, 712 
sheath, 710 
Crureus muscle, 566 
Crus cerebri, 848 
commune [semicircular canals], 
1059 
fornicis, 887 
helicis, 1044 
•penis, 1238 
Crusta or pes of cerebral peduncle, 
849 
petrosa of teeth, 1121 
formation of, 1121 , 
Cruveilhier, glenoid ligaments of, 
430, 459 
Crypts of Lieberkuhn, 1174 
Crystalline lens, 1030 
cortical substance of, 1031 
development of, 136 
nucleus of, 1031 
Cuboid bone, 367 
Cuboideonavicular articulation, 
457 
Culmen monticuli [cerebellum],838 
Cuneate nucleus, 825 
tubercle, 825 
Cuneiform bone of carpus, 324 
of tarsus, first, 369 
second, 369 
third, 370 
cartilages, 1082 
tubercle, 1085 
Cuneocuboid articulation, 457 
Cuneonavicular articulation, 456 
Cuneus, 871 
Cup, optic, 134 
Cupula of cochlea, 1060 
of pleura, 1095 
Curvatura ventriculi major, 1162 
minor, 1162 
| Curvatures of stomach, 1161 
I Curved lines of ilium, 333 
! Curves of vertebral column, 
212 
Cushion of auditory tube, 1139 
of epiglottis, 1082 
Cushions, endocardial, 148 
Cusps of bicuspid valve, 612 
of tricuspid valve, 609 
Cutaneous cervical nerve, 957 
nerve, external, 977 
internal, 964, 981 
lesser, 964 
middle, 980 
Cuticle, 1071 
Cuticula dentis, 1123 
Cutis plate, 102 
vera or corium, 1074 
Cutting teeth, 1117 
Cuvier, ducts of, 157 
Cycle, cardiac, 615 
Cylindrical epithelium, 37 
Cymba conchae, 1044 
Cystic artery, 691 
duct, 1200 
vein, 767 
Cyton, 72 
Cytoplasm, 33 
j Cytotrophoblast, 85 
D 
Dacryon, 287, 296 
Dartos tunic, 1228 1368 
INDEX 
Darwin, auricular tubercle of, 
1044 
Daughter chromosomes, 36 
Decidua, 98 
basalis, 98 
capsularis, 98 
parietalis, 98 
placentalis, 98 
stratum compactum of, 98 
spongiosum of, 98 
unaltered or boundary layer of, 
98 
Decidual cells, 98 
Decussation of lemniscus, 827 
partial, of optic nerves, 909 
pyramidal, 822 
Deep abdominal ring, 508 
artery of penis, 703 
auricular artery, 640 
cerebral veins, 740 
cervical artery, 666 
fascia, 476 
lymph glands, 778 
* vein, 738 
crural arch, 509 
epigastric artery, 709 
vein, 760 
external pudic artery, 716 
fascia of arm, 534 
of forearm, 536 
femoral artery, 716 
iliac circumflex vein, 760 
lingual artery, 632 
muscles of back, 485 
palmar arch, 679 
peroneal nerve, 990 
petrosal nerve, 919 
plantar artery, 725 
Sylvian vein, 740 
temporal arteries, 641 
nerves, 922 
transverse fascia of leg, 580 
Degeneration, Wallerian, 815 
Deglutition, 1114 
Deiters, cells of, 1067 
nucleus of, 836, 935 
Deltoid ligament, 450 
muscle, 530 
tubercle, 302 
tuberosity, 312 
Deltoideus muscle, 530 
Demilunes of Heidenhain, 1137 
Demours, membrane of, 1020 
Dendrons of nerve cells, 72 
Dens, or odontoid process of axis 
199 
serotinus, 1118 
Dental artery, inferior, 640 
posterior, 641 
canaliculi, 1120 
formula3, 1116 
furrow, 1122 
germs, 1121 
lamina, 1121 
nerve, inferior, 923 
pulp, 1119 
sac, 1123 
Dentate fissure, 874 
gyrus, 874 
ligament, 907 
Dentes, 1115 
canini, 1117 
decidui, 1118 
incisivi, 1117 
molares, 1118 
permanentes, 1117 
praemolares, 1118 
Dentin, 1119 
formation of, 1123 
intertubular, 1120 
secondary, 1121 
Dentinal canaliculi, 1120 
fibres, 1120 
matrix, 1120 
sheath of Neumann, 1120 
Dentinal tubules, 1120 
Depressions for arachnoid granu- 
lations, 232 
Depressor alae nasi muscle, 469 
anguli oris muscle, 470 
labii inferioris muscle, 470 
septi muscle, 469 
Dermal bones, 107 
Dermic coat of hair follicle, 1076 
Dermis, 1074 
Descemet, membrane of, 1020 
Descendens cervicalis nerve, 957 
Descending aorta, 683 
colon, 1181 
comma-shaped fasciculus, 817 
oblique muscle, 499 
palatine artery, 642 
process of lacrimal bone, 263 
ramus of hypoglossal nerve, 947 
of ischium, 337 
of os pubis, 338 
Descent of testis, 186 
Detrusor urinae muscle, 1223 
Deutoplasm, 78 
Development of adipose tissue, 42 
of allantois, 93 
of amnion, 94 
of anal canal, 172 
of arteries, 152 
of body cavities, 178 
of brain, 120 
of branchial or visceral arches, 
108 
of cerebral nerves, 132 
of chorion, 99 
of chromaffin organs, 133 
of deciduous teeth, 1121 
of digestive tube, 162 
of ear, 138 
of external organs of genera- 
tion, 190 
of eye, 134 
of face, 111 
of fetal membranes, 93 
of glands of skin, 116 
of heart, 143 
of hypophysis cerebri, 166 
of joints, 115 
of kidney, 187 
of limbs, 113 
of liver, 174 
of lymphatic system, 161 
of mammae, 116 
of medulla spinalis, 117 
of mouth, 163 
of muscles, 116 
of nervous system, 117 
of neural groove and tube, 88 
of nose, 111 
of notochord, 90 
of ovaries, 184 
of palate, 112 
of palatine tonsils, 165 
of pancreas, 175 
of parathyroid glands, 166 
of parietes, 102 
of permanent teeth, 1124 
of pharyngeal pouches, 108 
of placenta, 100 
of primitive segments, 91 
streak, 86 
of prostate, 189 
of rectum, 172 
of respiratory organs, 176 
of ribs, 104 
of salivary glands, 164 
of skeleton, 102 
of skin, 116 
of skull, 105 
of spinal nerves, 119 
of spleen, 176 
of sternum, 105 
of suprarenal glands, 134 
of sympathetic system, 133 
of teeth, 1121 
Development of testis, 186 
of thymus, 165 
of thyroid gland, 165 
of tongue, 164 
of umbilical cord, 96 
of urethra, 190 
of urinary bladder, 188 
and generative organs, 180 
of vascular system, 141 
of veins, 155 
of vertebral column, 102 
of visceral arches, 108 
of yolk-sac, 93 
Diameters of pelvis, 341, 342 
Diaphragm, muscles of, 493 
pelvic, 510, 1146 
urogenital, 519 
Diaphragma, 493 
lymphatic vessels of, 798 
sellae, 901 
Diaphragmatic lymph glands, 796 
part of pelvic fascia, 511 
pleura, 1095 
surface of heart, 605 
Diaphysis, 59 
Diarthroses, 381 
Diaster, 36 
Diencephalon, 126, 855 
Digastric fossa, 239 
muscle, 480 
nerve, from facial, 933 
triangle, 644 
Digastricus muscle, 480 
Digestion, organs of, 1109 
Digestive apparatus, 1109 
development of, 162, 168 
tube, 1109 
Digital arteries, foot, 728 
from superficial volar arch, 
hand,682 
682 
fossa of epididymis, 1231 
of femur, 347 
nerves of lateral plantar, 989 
of medial plantar, 988 
of median, 965 
of musculocutaneous. 964 
of radial, 969 
of ulnar, 967 
vaginal ligaments, 540 
veins of foot, 756 
of hand, 747 
Digits, articulations of, 431 
Dilatator naris anterior muscle, 
469 
posterior muscle, 469 
pupillae muscle, 1025 
tubae muscle, 1053 
Diploe, 196 
Diploic veins, 738 
frontal, 738 
occipital, 739 
temporal, 738 
Direct cerebellar fasciculus, 813 
tract, 828 
of Flechsig, 816, 828 
inguinal hernia, 1188 
pyramidal tract, 815 
Discharge of ovum, 1246 
Discus articularis, 395 
proligerus, 1246 
Disk, interpubic, 407 
optic, 1027 
Disks, tactile, of Merkel, 1069 
Dissection of axilla, 525 
of brain, 821 
of crural muscles, 578, 579, 581 
582 
of encephalon, 821 
of femoral muscles, medial, 567 
posterior, 574 
of geniohyoideus muscle, 481 
of infrahyoid muscles, 482 
of left atrium, 610 
ventricle, 611 INDEX 
1369 
Dissection of medulla spinalis, , 
805 
of mesenteric artery, inferior, 
695 
superior, 692 
of muscles of abdomen, 498, 
503, 504, 505 
of arm, 533 
of back, 485 
of eyelids, 467 
of foot, 587, 588 
of forearm, 536, 539, 542 
of gluteal region, 569, 572 
of iliac region, 559 
of leg, 576, 578, 579, 581, 
582 
of mouth, 469 
of palate, 1114 
of scalp, 464 
of shoulder, 530, 531 
of thigh, 562 
of pectoral region, 525 
of popliteal fossa, 718 
of pterygoidei muscles, 474 
of rectus abdominis muscle, 
505 
of right auricle, 607 
ventricle, 609 
of superficial cervical muscle, 
475 
of suprahyoid muscles, 480 
of temporal muscle, 473 
Diverticulum ilei, 1172 
Meckel's, 93, 1172 
Divisions of bronchi, 1105 
of cells, 34 
Dobie's line, 66 
Dogiel, cells of, 950 
Dorsal aortae, 154 
artery of penis, 706 
carpal artery, of radial, 
678 
of ulnar, 682 
ligament, 550 
cutaneous nerve, intermediate, 
990 
lateral, 988 
medial, 990 
fissure of medulla oblongata, 
822 
interossei muscles, 555, 591 
interosseous artery, 681 
nerve, 970 
lamina, 119 
mesogastrium, 168 
metacarpal arteries, 678 
veins, 750 
nasal artery, 650 
nerve of penis, 992 
peripheral band, 818 
pulmonary nerves, 943 
scapular nerve, 960 
spinal artery, 660 
veins of penis, 761 
venous arch of foot, 756 
net-work of hand, 747 
vestibular nucleus, 836 
Dorsalis hallucis artery, 724 
linguae artery, 632 
pedis artery, 724 
applied anatomy of, 724 
branches of, 724 
peculiarities of, 724 
surface markings of, 1332 
scapulae artery, 671 
Dorsoepitrochlearis brachii 
muscle, 524 
Dorsomedian fissure of medulla 
oblongata, 822 
Dorsum ilii, 333 
linguae, 1126 
nasi, 1008 
scapulae, 305 
sellae, 246, 290 
Douglas, pouch of, 1151 
Drum, 1049 
Duct or Ducts, accessory pan- 
creatic, 1205 
of Bartholin, 1137 
of Bellini, 1212 
of bulbourethral glands, 1243 
cloacal, 172 
common bile, 1200 
of Cuvier, 157 
cystic, 1200 
ejaculatory, 1237 
frontonasal, 236 
of Gartner, 1245 
hepatic, 1199 
lacrimal, 1041 
lactiferous, 1258 
of liver, 1198 
lymphatic, right, 772 
Mullerian, 182 
nasolacrimal or nasal, 1042 
pancreatic, 1204, 1205 
parotid, 1135 
pronephric, 180 
prostatic, 1241 
orifices of, 1225 
of Rivinus, 1137 
of Santorini, 1205 
semicircular, 1062 
seminal, 1235 
Skene's, 190 
Stensen's, 1135 
sublingual, 1137 
submaxillary, 1136 
thoracic, 771 
thyroglossal, 165, 1127 
vitelline, 92 
Wharton's, 1136 
of Wirsung, 1204 
Wolffian, 180 
Ductless glands, 1260 
aortic bodies of Zuckerkandl, 
1274 
carotid skeins, 1273 
coccygeal skein, 1273 
lien, 1266 
parathyroids, 1263 
spleen, 1266 
suprarenals, 1270 
thymus, 1264 
thyroid, 1261 
Ductuli aberrantes [testis], 1236 
efferentes [testis], 1233 
transver si [epoophoron], 1244 
Ductus arteriosus, 616 
choledochus, 1200 
cochlearis, 1063 
cysticus. 1200 
deferens, 1235 
ampulla of, 1235 
structure of, 1236 
ejaculatorii, 1237 
endolymphaticus, 1058, 1062 
hepaticus, 1199 
lacrimalis, 1041 
longitudinalis epoophori, 1245 
lymphaticus dexter, 772 
nasolacrimalis, 1042 
pancreaticus [Wirsungi], 1204 
parotideus, 1135 
Santorini, 1205 
semicirculares, 1062 
submaxillaris, 1136 
thoracicus, 771 
uiriculosaccularis, 1062 
venosus, 156, 618 
development of, 156 
fossa for, 1194 
obliterated, 765 
Duodenal fossae, 1158 
glands, 1175 
impression, 1192 
Duodenojejunal flexure, 1171 
fold, 1159 
fossa, 1159 
Duodenomesocolic fold, 1158 
Duodenopyloric constriction, 
1162 
Duodenum, 1169 
ascending portion, 1171 
descending portion, 1170 
horizontal portion, 1170 
lymphatic vessels of, 792 
superior portion, 1169 
suspensory muscle of, 1171 
vessels and nerves of, 1171 
Dura of brain, 900 
mater, cerebral, 900 
arteries of, 902 
endosteal layer of, 902 
meningeal layer of, 902 
nerves of, 902 
processes of, 900 
veins of, 902 
encephali, 900 
spinal, 902 
structure of, 903 
spinalis, 902 
Dural nerve, 941 
E 
Ear, 1043 
auricula of, 1044 
muscles of, 1045 
cartilaginous capsules of, 107 
cochlea, 1059 
development of, 138 
external, 1043 
internal, or labyrinth, 1057 
applied anatomy of, 1068 
meatus acusticus externus, 
1046 
membranous labyrinth, 1061 
middle, 1049 
osseous labyrinth, 1057 
pinna of, 1044 
semicircular canals of, 1058 
tympanic cavity of, 1049 
applied anatomy of, 1056 
muscles of, 1055 
ossicles of, 1053 
vessels and nerves of, 1056 
vestibule of, 1058 
Eberstaller, medial frontal sulcus 
of, 870 
Ectoderm, 86, 87 
Ectodermal cloaca, 172 
Efferent nerves, 803 
Eighth nerve, 934 
Ejaculator urinae muscle, 518 
Ejaculatory ducts, 1237 
Elastic fibrocartilage, 50 
laminae of cornea, 1020 
membrane of larynx, 1083 
tissue, yellow, 44 
Elastin, 44 
Elbow leone, 314 
Elbow-joint, 418 
anastomoses around, 675 
applied anatomy of, 421 
movements of, 420 
surface anatomy of, 1315 
markings of, 1319 
vessels and nerves of, 420 
Eleidin, 39 
Eleventh nerve, 944 
Embryo, form of, at different 
stages, 191 
separation of, 92 
Embryology, 77 
Embryonic disk, 86 
pole, 85 
Eminence, canine, 257 
collateral, 881 
cruciate, 228 
frontal, 234, 278, 282 
hypothenar, 546 
iliopectineal, 336 
intercondyloid, of tibia, 355 1370 
INDEX 
Eminence, medial, of rhomboid 
fossa, 847 
parietal, 231, 277, 282 
pyramidal, of pons, 833 
of tympanic cavity, 1052 
thenar, 546 
Eminences and depressions of 
bones, 196 
Eminentia arcuata, 241 
articularis, 237 
collateralis, 881 
pyramidalis, 1052 
saccularis, 861 
Emissary veins, 746 
Enamel cells, 1123 
droplet, 1123 
epithelium, 1123 
fibres or prisms, 1120 
organ,1123 
of teeth, 1120 
formation of, 1123 
Enarthrosis, 382 
Encephalon, 821 
dissection of, 821 
End-arteries, 1214 
End-bulbs of Krause, 1069 
End-plates, motor, of Kiihne, 803 
Endocardial cushions, 148 
Endocardium, 613 
Endognathion, 299 
Endolymph, 1061 
Endomysium, 64 
Endoneurium, 802 
Endoskeleton, 195 
Endosteal layer of dura mater, 
902 
Endothelium, 37 
cameras anterioris, 1021 
corneal, 1021 
Engelmann, basal knobs of, 38 
Enlargements of medulla spinalis, 
808 
Ensiform appendix, 220 
Entoderm, 85 
Entodermal cloaca, 172 
Entrance of larynx, 1085 
Eosinophil corpuscles, 63 
Eparterial branch of right bron- 
chus, 1092, 1105 
Ependymal layer, 117 
Epicardium, 613 
Epicondyles of humerus, 313 
Epicranial aponeurosis, 466 
Epidermic coat of hair follicle, 
1077 
Epidermis, development of, 116 
structure of, 1071 
Epididymis, 1231 
Epidural space, 903 
Epigastric artery, deep or in- 
ferior, 709 
applied anatomy of, 710 
peculiarities, 709 
surface markings of, 1309 
superficial, 717 
superior, 666 
fold, 1187 
lymph glands, 786 
region, 1147 
vein, deep, 760 
superficial, 756 
Epiglottis, 1082 
tubercle or cushion of, 1082 
Epimysium, 64 
Epineurium, 801 
Epiotic centre of temporal bone, 
245 
Epiphyses, atavistic, 59 
pressure, 59 
traction, 59 
Epiphysial cartilage, 57 
Epiphysis, 59, 859 
Epiploic foramen, 176, 1155 
glands, right, 788 
Epistropheus,, 200 
Epithalamus, 127, 859 
fasciculus retroflexus [of Mey- 
nert], 859 
ganglion habenulae, 859 
pineal body, 859 
structure of, 860 
posterior commissure, 860 
nucleus of, 860 
trigonum habenulae, 859 
Epithelial cells, 36 
Epithelium, 36 
ciliated, 37 
columnar, 37 
corneae, 1019 
cylindrical, 37 
enamel, 1123 
germinal, of Waldeyer, 184, 
1245 
glandular, 37 
pavement, 37 
simple, 37 
stratified, 39 
of cornea, 1019 
transitional, 40, 1223 
Epitympanic recess, 240, 1049 
Eponychium, 1075 
Epoophoron, 181, 1244 
Equator of lens, 1031 
Erector clitoridis muscle, 521 
penis muscle, 518 
spinae or sacrospinalis muscle, 
488 
Eruption of teeth, 1124 
Erythroblasts, 51 
Erythrocytes, 61 
Ethmoid bone, 251 
Ethmoidal arteries, 650 
bone, 251 
articulations of, 255 
cribriform plate of, 252 
crest, 260, 267 
foramina, 287 
horizontal lamina, 252 
labyrinth or lateral mass of, 
253 
lamina papyracea of, 253 
os planum of, 253 
ossification of, 254 
perpendicular plate of, 
252 
uncinate process of, 253 
vertical plate, 252 
canals, 235, 253 
cells, 253, 1014 
notch, 235 
plate, 107 
process of inferior nasal concha, 
268 
spine, 246, 290 
Ethmovomerine cartilage, 270 
Eustachian tube, 1052 
valve, 607, 608 
Excavation, rectouterine, 1151 
vesicouterine, 1152 
Exner, plexus of, 893 
Exognathion, 299 
Exoskeleton, 195 
Extensor carpi radialis brevis 
muscle, 542 
longus muscle, 542 
ulnaris muscle, 544 
coccygis muscle, 490 
digiti quinti proprius muscle, | 
544 
digitorum brevis muscle, 586 
communis muscle, 544 
longus muscle, 577 
hallucis longus muscle, 577 
indicis muscle, 546 
proprius muscle, 546 
minimi digiti muscle, 544 
ossis metacarpi pollicis muscle, 
545 
pollicis brevis muscle, 545 
longus muscle, 545 
Extensor primi internodii pollicis 
muscle, 545 
proprius hallucis muscle, 577 
secundi internodii pollicis 
muscle, 545 
Exterior of skull, 277 
External abdominal ring, 500 
arcuate ligament, 495 
auditory canal, 1046 
meatus, 1046 
calcaneal artery, 726 
calcaneoastragaloid ligament, 
453 
canthus of eyelids, 1038 
circumflex artery, 716 
cutaneous nerve, 977 
geniculate body, 858 
intercostal muscles, 492 
lateral ligament, 394, 419, 
426 
ligament of malleus, 1055 
malleolar artery, 723 
oblique muscle, 499 
plantar artery, 727 
nerve, 989 
popliteal nerve, 989 
pterygoid muscle, 474 
pudic arteries, 716 
respiratory nerve of Bell, 960 
saphenous vein, 757 
semilunar fibrocartilage, 442 
spermatic fascia, 1229 
sphincter ani muscle, 516 
Extraspinal veins, 754 
Extremitas acromialis [clavicula], 
303 
sternalis [clavicula], 303 
Extremity of penis, 1239 
Extrinsic muscles of tongue, 
1129 
Eye, 1017 
Eyeball or bulb of eye, 1017 
accessory organs of, 1034 
applied anatomy of, 1031 
aqueous humor, 1030 
capsule of Tenon, 1037 
chambers of, 1024 
choroid, 1021 
ciliary body, 1023 
muscle, 1023 
processes, 1023 
conjunctiva, 1040 
cornea, 1018 
crystalline lens, 1030 
development of, 134 
fascia bulbi, 1037 
fibrous tunic, 1017 
hyaloid membrane, 1030 
iris, 1024 
membrana pupillaris, 136 
orbiculus ciliaris, 1023 
pupil, 1024 
refracting media, 1030 
retina, 1026 
pigmented layer of, 1027 
proper, 1027 
supporting frame-work of, 
1029 
sclera, 1017 
tunics of, 1017 
vascular, 1021 
uvea, 1025 
vessels and nerves of, 1031 
vitreous body, 1030 
Eyebrows, 1038 
Eyelashes, 1038 
Eyelids, 1038 
applied anatomy of, 1042 
canthus of, 1038 
development of, 137 
muscles of, dissection of, 467 
structure of, 1039 
surface anatomy of, 1287 
tarsi of, 1039 
Eye-teeth, 1118 INDEX 
1371 
F 
Face, bones of, 255 
development of, 111 
lymphatics of, 774 
surface anatomy of, 1282 
Facial artery, 633 
transverse, 638 
bones, 255 
canal, 241 
hiatus of, 241 
prominence of, 1052 
lymph glands, 775 
nerve, 929 
applied anatomy of, 933 
vein, anterior, 733 
applied anatomy of, 733 
common, 733 
deep, 733 
posterior, 734 
transverse, 734 
Falciform ligament of liver, 1150 
1195 
margin of fossa ovalis, 564 
process of sacrotuberous liga- 
ment, 405 
Fallopian tubes, 1247 
Fallopius, aqueduct of, promi- 
nence of, 1051 
False ligaments of bladder, 1221 
pelvis, 340 
ribs, 220 
vocal cords, 1085 
Falx aponeurotica inguinalis, 505 
cerebelli, 900 
cerebri, 900 
Fascia or Fascise, 463 
of abdomen, 498 
triangular, 502 
anal, 511 
of ankle, 584 
antibrachial, 536 
antibrachii, 536 
of arm, 534 
axillary, 526 
bicipital, 535 
brachial, 534 
brachii, 534 
buccopharyngeal, 477 
bulbi, 1037 
of Camper, 498 
cervical, 475, 476 
clavipectoral, 528 
of Colles, 337, 499, 517 
colli, 476 
applied anatomy of, 478 
coracoclavicular, 528 
coracoclavicularis, 528 
cremasteric, 504 
cribrosa, 563 
cruris, 576 
deep, 464 
of deltoideus, 530 
dentata hippocampi, 875 
diaphragmatic part of pelvic, 
511 
dorsal, of foot, 586 
endopelvic, 512 
of forearm, 536 
general description of, 463 
of hand,546 
iliaca, 560 
iliopectineal, 560 
infraspinata, 533 
infraspinatous, 533 
infundibuliform, 508 
intercolumnar, 1229 
intercostal, 492 
intercrural, 501 
lata, 563 
falciform margin of, 564 
fossa ovalis of, 564 
iliotibial tract or band of, 563 
of leg, 576 
deep transverse, 580 
Fascia or Fasciae, lumbar, 486 
masseteric, 472 
of obturator internus, 510 
orbital, 1038 
palmar, 550 
parotideomasseteric, 472 
pectoral, 526 
pelvic, 510 
plantar, 586 
pretracheal, 477 
prevertebral, 477 
propria of femoral hernia, 1189 
of piriformis, 511 
of psoas and iliacus, 559 
of quadratus lumborum, 510 
rectal, 518 
rectovesical, 512 
renal, 1209 
of Scarpa, 499 
Sibson's, 1096 
spermatic, external, 501, 1229 
subscapular, 531 
subscapularis, 531 
superficial, 463 
supraspinata, 532 
supraspinatous, 532 
temporal, 473 
of thigh, 562 
of thoracic region, 526 
transversalis, 508 
triangular, of abdomen, 502 
of upper extremity, 522 
of urogenital diaphragm, 519, 
520, 521 
region, 517 
vesical, 512 
Fasciculi, intrafusal, 1071 
longitudinales, 834 
Fasciculus, anterior proper, 815 
cerebelloolivary, 830 
cerebellospinal, 816, 828 
cerebroolivary, 830 
cerebrospinal, 815 
cerebrospinalis anterior, 815 
lateralis, 815 
comma-shaped, 817 
cornucommissural, 817 
cuneatus, 817 
gracilis, 817 
lateral proper, 817 
lateralis proprius, 817 
of Lissauer, 817 
longitudinal, inferior, 891 
medial, 851 
posterior, 851 
superior, 891 
occipitofrontal, 891 
olfactory, 887 
olivospinal, 816 
perpendicular, 891 
retroflexus of Meynert, 859 
rubrospinal, 816 
secondary sensory, 817 
solitarius, 833 
spinocerebellar, 816 
ventral, 817 
spinoblivary, 830 
spinotectal, 817 
spinothalamic, 817 
superficial antero-lateral, 816 
tectospinal, 815, 816 
thalamomamillary, 886 
uncinate, 890 
vestibulospinal, 815 
। Fasciola cinerea, 875 
' Fat or adipose tissue, 42 
cells, 42 
Fauces, arches or pillars of, 1112 
isthmus of, 1112 
Female genital organs, 1243 
bulb of vestibule, 1256 
carunculae hymeneales, 
1257 
clitoris, 1257 
development of, 180 
Female genital organs, epo- 
ophoron, 1244 
fourchette, 1257 
glands of Bartholin, 1258 
greater vestibular, 1257 
hymen, 1257 
labia majora, 1256 
minora, 1257 
mons pubis, 1256 
navicular fossa, 1257 
ovaries, 1243 
uterine tubes, 1247 
uterus or womb, 1248 
vagina, 1255 
vestibule, 1257 
pronucleus, 80 
urethra, 1228 
Femoral artery, 710 
applied anatomy of, 715 
branches of, 715 
deep, 716 
peculiarities of, 714 
surface marking of, 1331 
canal, 712 
circumflex arteries, 716, 717 
cutaneous nerve, anterior, 981 
lateral, 977 
posterior, 985 
fossa, 712 
fovea, 1187 
hernia, 1189 
muscles, medial, dissection of, 
567 
posterior, dissection of, 594 
nerve, 980 
applied anatomy of, 992 
ring, 712 
septum, 712 
sheath, 710 
triangle, 565, 712 
vein, 758 
Femur, 345 
applied anatomy of, 352 
articulations of, 352 
condyles of, 349 
head of, 345 
neck of, 345 
ossification of, 352 
spiral line of, 348 
structure of, 350 
surface anatomy of, 1324 
trochanters of, 346, 347 
Fenestra cochleae, 1051 
ovalis, 1051 
rotunda, 1051 
vestibuli, 1051 
Fenestrated membrane of Henle, 
44 * . 
Fertilization of ovum, 82 
Fetal heart, peculiarities of, 161 
membranes, 93 
Fetus, circulation in, 616 
foramen ovale in, 149, 616 
valve of inferior vena cava in, 
616 
vascular system in, peculi- 
arities of, 615 
Fibrae intercrurales, 501 
pontis profundae, 834 
superficiales, 834 
propriae [cerebellum], 842 
Fibre cells, contractile, 68 
! Fibres, arcuate, 831 
dentinal, 1120 
intercolumnar, 501 
intercrural, 501 
intrafusal, 1071 
of muscles, 64 
nerve, 70 
of Purkinje, 69 
of Remak, 76 
sustentacular, of Muller, 1029 
of Tomes, 1120 
। Fibrocartilage, 49 
1 circumferential, 50 1372 
INDEX 
Fibrocartilage, connecting, 50 
in ter articular, 49 
intervertebral, 385 
semilunar, of knee, 442 
stratiform, 50 
yellow or elastic, 50 
Fibrocartilaginous lamina, inter- 
pubic, 407 
Fibrous capsule of Glisson, 1196 
pericardium, 601 
rings of heart, 613 
sheaths of flexor tendons of 
fingers, 540 
of toes, 588 
tissue, white, 43 
tunic of kidney, 1210 
Fibula, 359 
applied anatomy of, 361 
articulations of, 361 
ossification of, 361 
surface form of, 1324 
Fibular artery, 723 
collateral ligament of knee- 
joint, 440 
Fifth metacarpal bone, 330 
metatarsal bone, 372 
nerve, 914 
ventricle, 887 
Filiform papillae of tongue, 1128 
Fillet, 852 
lateral, 853 
mesial, 853 
Filtration angle of eye, 1019 
Filum terminate, 807 
Fimbria hippocampi, 887 
ovarian, 1247 
Fimbriae of uterine tube, 1247 
Fimbriodentate fissure, 875, 887 
First cuneiform bone, 369 
dorsal metacarpal artery, 678 
metatarsal artery, 724 
metacarpal bone, 329 
metatarsal bone, 371 
nerve, 908 
Fissura antitragohelicina, 1044 
calcarina, 869 
cerebri lateralis [Sylvii}, 867 
longitudinalis, 865 
collateralis, 869 
hippocampi, 874 
mediana anterior [medullae ob- 
longatae], 822 
spinalis], 808 
posterior [medullae oblonga- 
tae], 822 
parietooccipitalis, 868 
petrotympanica, 1049 
prima [cerebellum], 124 • 
[rhinencephalon], 875 
secunda [cerebellum], 124 
Fissure or Fissures, anterior me- 
dian of medulla spinalis, 808 
callosomarginal, 869 
central, 868 
of cerebellum, 837, 838 
development of, 125 
floccular, 125 
horizontal, 837 
postcentral, 838 
postnodular, 838 
postpyramidal, 839 
precentral, 838 
preclival, 838 
prepyramidal, 838 
of cerebrum, 867 
calcarine, 869 
callosal, 873, 876 
collateral, 869 
development of, 131 
external rhinal, 128 
fimbriodentate, 875, 887 
hippocampal, 130, 814 
interlobular, 867 
lateral, 130, 867 
longitudinal, 865 
Fissure or Fissures of cerebrum, 
parietooccipital, 868 
of Rolando, 868 
of Sylvius, 867 
transverse, 889 
choroidal, 135, 888 
circuminsular, 869 
congenital, of cranium, 255 
dentate, 874 
Glaserian, 238, 1040 
of liver, longitudinal, 1194 
transverse, 1194 
longitudinal, great, 865 
of lungs, 1104 
of medulla oblongata, 822 
orbital, inferior, 284, 288 
superior, 249, 288, 290 
petrooccipital, 280, 291 
petrosphenoidal, 280 
petrotympanic, 238, 280, 1049 
pterygoid, 250 
pterygomaxillary, 284 
of Rolando, 868 
sphenomaxillary, 284 
of Sylvius, 867 
tympanomastoid, 280 
vestibular, 1060 
Fixation of kidney, 1209 
of muscles, 462 
Flat bones, 196 
Flechsig, cerebellar tract of, 816, 
828 
oval area of, 818 
Flexor accessorius muscle, 589 
brevis minimi digiti muscle, 
554, 590 
carpi radialis muscle, 537 
ulnaris muscle, 538 
digiti quinti brevis muscle of 
foot, 590 
of hand, 554 
digitorum brevis muscle, 588 
longus muscle, 581 
profundus muscle, 540 
sublimis muscle, 539 
hallucis brevis muscle, 589 
longus muscle, 581 
pollicis brevis muscle, 553 
longus muscle, 540 
Flexure, cervical, 121 
colic, left, 1180 
right, 1180 
hepatic, 1180 
pontine, 121 
splenic, 1180 
ventral cephalic, 121 
Floating ribs, 221 
Floccular fissure, 125 
Flocculus, 839 
Floor of fourth ventricle, 847 
Floor-plate, 117 
Fluid, cerebrospinal, 905 
Fluids, circulating, 61 
Fold or Folds, amniotic, 96 
aryepiglottic, 1085 
caudal, 92 
cephalic, 92 
duodenojejunal, 1159 
epigastric, 1187 
gastropancreatic, 1156 
glossoepiglottic, 1082, 1126 
ileocecal, 1160 
malleolar, 1050 
rectouterine, 1250 
sacrogenital, 1153, 1250 
salpingopalatine, 1139 
salpingopharyngeal, 1139 
transverse, of rectum, 1183 
of Treves, 1160 
umbilical, 1187, 1221, 1222 
ventricular, of larynx, 1085 
vestigial, of Marshall, 159, 603 
vocal, of larynx, 1086 
Folium cacuminis, 838 
vermis, 838 
Follicle of hair, 1076 
Follicles, agminated, 1175 
Graafian, or vesicular ovarian, 
1245 
Fontana, spaces of, 1021 
Fontanelles, 294 
Foot, arches of, 459 
fascia of, 586 
muscles of, 586 
dissection of, 587, 588 
ossification of bones of, 374 
phalanges of, articulations of, 
459 
skeleton of, 362 
applied anatomy of, 375 
surface anatomy of, 1325 
Foramen, caroticoclinoid, 249, 290 
cecum of frontal bone, 235 
of medulla oblongata, 822 
of tongue, 165, 1126 
condyloid, anterior, 229 
epiploicum, 170, 1155 
of Huschke, 244, 245 
incisive, 261, 278 
infraorbital, 257, 286 
interventricular, 865, 887 
intervertebral, 197 
jugular, 280, 291 
laCerum, 280, 291 
magnum, 227, 230, 288, 291 
Majendii, 847 
mandibular, 272 
mastoid, 239, 282 
mental, 271, 286 
of Monro, 865, 887 
obturator, 339 
optic, 246, 250, 290 
ovale of heart, 149, 616 
of sphenoid, 248, 280, 291 
palatine, 278 
parietal, 277 
rotundum, 248, 291 
sciatic, 406 
singulare, 242 
sphenopalatine, 267 
spinosum, 248, 280, 291 
sternal, 220 
stylomastoid, 243, 280 
supraorbital, 235, 286, 288 
supratrochlear, 313 
thyroid, 339 
transversarium, 198 
vena-caval, 497 
vertebral, 197 
Vesalii, 248, 291 
of Winslow, 170, 689, 1155 
zygomaticofacial, 263, 286 
zygomaticoorbital, 264 
zygomaticotemporal, 263, 282 
Foramina, ethmoidal, 287 
intervertebral, 197 
for olfactory nerves, 252 
in roof of fourth ventricle, 847 
sacral, 206, 208 
of Scarpa, 261, 278 
of Stensen, 261, 278 
Thebesii, 608 
venarum minimarum, 608 
Forceps, anterior, 877 
posterior, 877 
Forearm, fascia of, 536, 
muscles of, 536 
dissection of, 536, 539, 542 
Forebrain, 90, 125, 855 
Foregut, 92, 162 
Foreskin, 1239 
Form of embryo at different 
stages, 191 
Formatio grisea, 833 
of medulla spinalis, 809 
reticularis alba, 833 
Fornicolumns, 886 
Fornix of brain, 885 
body of, 886 
columns of, 886 INDEX 
1373 
Fornix of brain, crura of, 887 
development of, 131 
pillars of, 886, 887 
of conjunctiva, 1041 
Fossa or Fossae, acetabular, 339 
anticubital, 672 
canine, 257 
cecal, 1159, 1160 
cochlearis, 1058 
condyloid, 230, 281 
coronoid, 313 
cranii anterior, 288 
media, 290 
posterior, 291 
digastric, 239 
digital, of epididymis, 1231 
of femur, 347 
for ductus venosus, 1194 
duodenal, 1158 
duodenojejunal, 1159 
femoral, 712 
for gall-bladder, 1194 
glenoid, 238 
hyaloid, 1030 
hypophyseos, 246, 290 
ileocecal, 1159, 1160 
iliac, 335 
incisive, 256, 271 
incudis, 1052 
for inferior vena cava, 1194 
infraspinatous, 305 
infratemporal, 283 
infratemporalis, 283 
intercondyloid, of femur, 349 
of tibia, 356 
interpeduncular, 848, 865 
intersigmoid, 1160 
ischiorectal, 515 
ischiorectalis, 515 
jugular, 243 
lacrimal, 235, 286 
of liver, 1194 
mandibular, 238, 280, 283 
mastoid, 238 
nasal, 1010 
navicularis [urethra], 1226 
[vulva], 1257 
occipital, inferior, 292 
olecranon, 313 
ovalis of fascia lata, 564 
of heart, 608 
ovarian, 1154, 1244 
pararectal, 1153 
paravesical, 1153 
pericecal, 1159 
peritoneal, 1157 
popliteal, 718 
pterygoid, 250 
pterygopalatina, 284 
pterygopalatine, 284 
radial, 312 
retrocecal, 1160 
retroperitoneal, 1157 
rhomboid, 847 
rhomboidea, 847 
of Rosenmuller, 1138; 1139 
sagittalis sinistra [liver], 1194 
scaphoid, 250, 278 
of skull, anterior, 288 
middle, 290 
posterior, 291 
sphenomaxillary, 284 
subarcuate, 242 
subscapular, 304 
supraspinatous, 305 
supratonsillar, 1139 
Sylvian, 131 
temporal, 282 
temporalis, 282 
triangularis, 1044 
trochanteric, 347 
for umbilical vein, 1194 
venae cavae, 1194 
vermian, 228 
vesicae felleae, 1194 
Fossa or Fossae, zygomatic, 
272 
Fountain decussation of Meynert, 
854 
Fourchette, 1257 
Fourth metacarpal bone, 330 
metatarsal bone, 372 
nerve, 913 
ventricle, 845 
floor of, 847 
Fovea capitis femoris, 345 
centralis retinae, 1026, 1029 
structure of, 1029 
dentis, 199 
femoral, 1187 
inguinal, 1187 
of rhomboid fossa, 848 
supravesical, 1187 
trochlear, 235, 286 
Foveolae, Howship's, 52 
Fracture of bones of foot, 375 
of hand, 332 
of clavicle, 303 
of femur, 353, 592 
of fibula, 593 
of humerus, 313, 557 
of mandible, 300 
of maxilla, 300 
of nasal bone, 300 
of olecranon, 321, 558 
of patella, 355, 593 
of pelvis, 344 
Pott's, 593 
of radius, 321, 558 
of ribs, 225 
of scapula, 309 
of skull, 297 
of sternum, 225 
of tibia, 361, 593 
of ulna, 321, 558 
of zygomatic arch, 300 
Free nerve-endings, 1069 
Freely movable joints, 381 
Frenula of colic valve, 1179 
of lips, 1110 
Frenulum of clitoris, 1257 
of labia minora, 1257 
linguae, 1126 
of prepuce, 1239 
veli, 853 
Frontal air sinuses, 235, 1014 
artery, 650 
bone, 233 
articulations of, 237 
orbital or horizontal part of, 
235 
ossification of, 237 
squama of, 234 
structure of, 236 
convolution, ascending, 869 
procf 
eminences, 234, 278, 282 
gyri, 869, 870 
lobe, 869 
nerve, 916 
operculum, 873 
process of maxilla, 260 
sulci, 869 
suture, 234, 278 
vein, 732 
Frontoethmoidal suture, 288 
Frontomaxillary suture, 287 
Frontonasal duct, 236 
process, 111 
Frontopontine fibres, 850 
Frontosphenoidal process of zygo- 
matic bone, 264 
Fundiform ligament of penis, 
1239 
Fundus glands of stomach, 
1163 
tympani, 1049 
of uterus, 1249 
Fungiform papillae of tongue, 
1128 
Funinculi of medulla spinalis, 814, 
815 
Funiculus separans, 848 
spermaticus, 1229 
Furcal nerve, 975 
Furcula, 164,177 
Furrow, chordal, 91 
dental, 1122 
iliac, 1213 
nasooptic, 112, 137 
sternal, 1208 
Furrowed band of cerebellum, 839 
Fusiform gyrus, 871, 872 
G 
Galea aponeurotica, 466 
Galen, veins of, 740 
Gall-bladder, 1199 
applied anatomy of, 1201 
fossa for, 1194 
lymphatic vessels of, 793 
structure of, 1199 
Gangliated cord, 995 
Ganglion or Ganglia, 803 
aorticorenal, 1003 
cardiac, of Wrisberg, 1002 
carotid, 996 
cervical, 997, 998 
cer vicale inferius, 998 
medium, 997 
superius, 997 
ciliare, 917 
ciliary, 917 
coeliac, 1002 
coeliaca, 1002 
collateral, 995 
of Corti, 1060, 1068 
Gasserian, 914 
genicular, 930 
geniculi, 930 
of glossopharyngeal, 937 
habenulae, 859 
impar, 1001 
inferior, 939 
interpeduncular, 848, 851 
jugular, 938, 941 
jugulare, 941 
Langley's, 1138 
lenticular, 917 
Meckel's, 919 
nodosum, 941 
ophthalmic, 917 
otic, 924 
oticum, 924 
petrosum, 939 
petrous, 939 
phrenicum, 1004 
ridge or neural crest, 88, 120 
of Scarpa, 1068 
semilunar, of abdomen, 1002 
of trigeminal nerve, 914 
semilunare [Gasserf], 914 
sphenopalatine, 919 
sphenopalatinum, 919 
rami nasales posteriores in- 
ferior es, 921 
superiores, 921 
orbitales, 920 
spinal, 948 
spinale, 948 
spiral, of cochlea, 1068 
splanchnicum, 999 
submaxillare, 925 
submaxillary, 925 
superior, of glossopharyngeal, 
938 
mesenteric, 1004 
superius, 938 
of vagus, 940 
vestibular, 1068 
of Wrisberg, 1002 
Ganglionic arterial system of 
brain, 654 1374 
INDEX 
Ganglionic arteries, antero- 
lateral, 653 
antero-medial, 652 
postero-lateral, 662 
postero-medial, 653, 662 
layer of retina, 1028 
Gartner, duct of, 182, 1245 
Gasserian ganglion, 914 
Gaster, 1161 
Gastric arteries, short, 691 
artery, left, 688 
right, 689 
glands, 1166 
impression, 1192 
lymph glands, 788 
nerves from vagus, 943 
plexuses from sympathetic, 
1004 
from vagus, 943 
veins, short, 766 
Gastrocnemius muscle, 578 
Gastrocolic ligament, 1152 
omentum, 1157 
Gastroduodenal artery, 690 
Gastroepiploic arteries, 690, 691 
veins, 766 
Gastrohepatic omentum, 1156 
Gastrolienal ligament, 1155 
Gastrophrenic ligament, 1163 
Gemellus inferior muscle, 573 
superior muscle, 573 
General sensations, peripheral 
terminations of nerve of, 1069 
Generation, development of ex- 
ternal organs of, 190 
Genicular arteries, 718, 720, 721 
ga,nglion of facial nerve, 930 
Geniculate bodies, 858 
Geniculum of facial nerve, 930 
of internal capsule, 883 
Genioglossus muscle, 1129 
Geniohyoglossus muscle, 1129 
Geniohyoid muscle, 481 
Geniohyoideus muscle, 481 
dissection of, 481 
Genital cord, 184 
corpuscles, 1069 
organs of female, 1243 
external, 1256 
of male, 1228 
glands, 184 
ridge, 184 
swellings, 190 
tubercle, 190 
Genitocrural nerve, 977 
Genitofemoral nerve, 977, 
Gennari, band of, 891, 893 
Genu of corpus callosum, 876 
of internal capsule, 883 
Gerlach, tube tonsil of, 1053 
Germ, dental, 1121, 1122 
Germ centres, 770 
Germinal cells, 77 
epithelium, 184, 1245 
path, 185 
spot, 77 
vesicle, 77 
Giacomini, band of, 875 
Giant cells, 51 
of Betz, 891 
Gianuzzi, crescents of, 1137 
Gimbernat's ligament, 502 
Gingivae, 1111 
Ginglymus, 382 
Giraldos, organ of, 1236 
Girdle of inferior extremity, 301 
pelvic, 301 
shoulder, 301 
of superior extremity, 301 
Glabella, 234, 278, 296 
Gladiolus, 218 
Gland or Glands, accessory, of 
mouth, 1138 
part of parotid, 1134 
anterior lingual, 1131 
Gland or Glands, areolar, 1258 
arytenoid, 1091 
of Bartholin, 1258 • 
of Blandin, 1131 
of Bowman, 1012 
Brunner's, 1175 
buccal, 1111 
bulbourethral, 1243 
carotid, 1273 
ceruminous, 1047 
ciliary, 1039 
coccygeal, 1273 
Cowper's, 1243 
ductless, 1260 
duodenal, 1175 
gastric, 1166 
genital, 184 
intestinal, 1174 
labial, 1110 
lacrimal, 1041 
of larynx, 1090 
lenticular, of stomach, 1166 
of Littre, 1226 
Luschka's, 1273 
mammae, 1258 
mammary, 1258 
Meibomian, 1040 
molar, 1111 
of Nuhn, 1131 
oesophageal, 1146 
palatal, 1112 
parathyroid, 1263 
parotid, 1133 
Peyer's, 1175 
preputial, 1239 
prostate, 1241 
salivary, 1133 
sebaceous, 1078 
solitary, 1175 
sublingual, 1137 
submaxillary, 1135 
sudoriferous, 1078 
suprarenal, 1270 
sweat, 1078 
tarsal, 1040 
thymus, 1264 
thyroid, 1261 
of tongue, 1131 
trachoma, 1041 
urethral, 1226 
uterine, 1252 
vestibular, greater, 1258 
Glandula lacrimalis, 1041 
sublingualis, 1137 
submaxillar is, 1135 
thyr eoidea, 1261 
vestibularis major [Bartholini], 
1258 
Glandulae bulbourethrales, 1243 
duodenales [Brunneri], 1175 
intestinales [Lieberkuhni], 1174 
labiates, 1110 
oesophageae, 1146 
Pacchioni, 905 
parotis, 1133 
sebaceae, 1078 
sudoriferae, 1078 
suprarenales accessoriae, 1271 
suprarenalis, 1270 
tar sales [Meibomi], 1040 
thyreoideae accessoriae, 1262 
Glandular epithelium, 37 
Glans clitoridis, 1257 
penis, 1238 
Glaserian fissure, 238, 1049 
Glenohumeral ligaments, 415 
Glenoid cavity, 307 
fossa, 238 
ligament of Cruveilhier, 430, 
459 
of shoulder, 415 
Glenoidal labrum of hip-joint, 
434 
of shoulder-joint, 415 
Gliding joints, 382 
Gliding movement, 383 
Glisson's capsule, 1156, 1196 
Globular processes of His, 111 
Globus major [epididymis], 1231 
minor [epididymis], 1231 
pallidus, 882 
Glomera carotica, 1273 
Glomus coccygeum, 1273 
Glossoepiglottic folds, 1082, 1126 
Glossopalatine arch, 1112 
Glossopalatinus muscle, 1114, 
1129 note 
Glossopharyngeal nerve, 937 
Glottis respiratoria, 1087 
vocalis, 1087 
rima of, 1087 
Glutaeus maximus muscle, 569 
medius muscle, 570 
minimus muscle, 570 
Gluteal artery, inferior, 706 
superior, 707 
lines of ilium, 333 
muscles, 569 
nerve, inferior, 985 
superior, 984 
region, muscles of, dissection 
of, 569, 572 
tuberosity, 348 
veins, 760 
Gnathic index, 296 
Goblet cells, 37 
Golgi, cells of, 892 
organs of, 1070 
Golgi and Mazzoni, corpuscles of, 
1069 
Goll, tract of, 808, 817 
Gomphosis, 381 
Gonion, 296 
Gower's, tract of, 816 
Graafian follicles, 1245 
structure of, 1245 
Gracile nucleus, 824 
Gracilis muscle, 567 
Grandry, tactile corpuscles of, 
1069 
Granular layer of dentin, 1119 
Granulationes arac.hnoideales, 905 
Granulations, arachnoid, 905 
Granule cells, 41 
Gray commissure of brain, 856 
commissures of medulla spinalis, 
810 
or gelatinous nerve fibres, 76 
substance of cerebellum, 842 
of cerebral hemispheres, 891 
of medulla oblongata, 829 
spinalis, 809 
Great auricular nerve, 956 
cardiac nerve, 997 
vein, 730 
cerebral vein, 740 
longitudinal fissure, 865 
omentum, 1157 
sacrosciatic ligament, 404 
saphenous vein, 656 
splanchnic nerve, 998 
transverse fissure of brain, 889 
wings of sphenoid, 248 
Greater cavernous nerve, 1005 
curvature of stomach, 1162 
multangular bone, 326 
occipital nerve, 951 
omentum, 1157 
palatine foramen, 278 
pelvis, 340 
peritoneal sac, 1150 
sciatic foramen, 406 
notch, 336 
sigmoid cavity, 315 
superficial petrosal nerve, 919, 
931 
trochanter, 347 
vestibular glands, 190, 1258 
. Groove, atrioventricular, 604 
1 auriculoventricular, 604 INDEX 
1375 
Groove, bicipital, 311 
carotid, 247, 290 
chiasmatic, 246, 290 
costal, 222 
infraorbital, 258 
interatrial, 604 
intertubercular, of humerus,311 
lacrimal, 258, 287 
musculospiral, 311 
mylohyoid, 272 
neural, 88 
obturator, 339 
occipital, 239 
optic, 246 
primitive, 86 
pterygopalatine, 250 
for radial nerve, 311 
vertebral, 214 
Gubernaculum dentis, 1124 
testis, 186 
Gudden, commissure of, 909 
Gullet, 1140 
Gums, 1111 
applied anatomy of, 1112 
Gustatory calyculi, 1007 
cells, 1007 
hair, 1008 
pore, 1007 
Gyre, medifrontal, 870 
precentral, 869 
subfrontal, 870 
superfrontal, 869 
.Gyri of brain, 869 
angular, 871 
of Broca, 870 
central, anterior, 869 
posterior, 871 
cingulate, 874 
cuneus, 871 
dentate, 875 
frontal, 869, 870 
fusiform, 871, 872 
hippocampal, 874 
of insula, 873 
of limbic lobe, 873 
lingual, 871 
occipital, 871 
orbital, 870 
precuneus, 871 
quadrate, 871 
straight, 870 
subcallosal, 875 
superior parietal lobule, 871 ! 
supracallosal, 875 
supramarginal, 871 
temporal, 872 
transverse, of Heschl, 872 
uncus, 874 
Gyrus centralis anterior, 869 
posterior, 871 
cinguli, 873 
dentatus, 875 
epicallosus, 875 
frontalis inferior, 870 
medius, 870 
superior, 869 
hippocampi, 874 
marginal, 870 
subcallosus, 875 
H 
Habenular commissure, 859 
Hair cells of spiral organ of Corti, 
1067 
Hairs, 1075 
cuticle of, 1077 
follicle of, 1076 
gustatory, 1008 
olfactory, 1012 
roots of, 1076 
scapus or shaft of, 1077 
structure of, 1077 
Haller, vas aberrans of, 1236 1 
Hamate bone, 328 
Hamstring muscles, 574 
tendons, applied anatomy of, 
575 
Hamulus of hamate bone, 328 
lacrimal, 263 
laminae spiralis, 1060 
pterygoid, 250, 278 
Hand, muscles of, 546 
dissection of, 546 
phalanges of, articulations of, 
431 
skeleton of, 323 
surface anatomy of, 1315 
markings of, 1318 
Hard palate, 1112 
Harrison's sulcus, 226 
Hasner, plica lacrimalis of, 1042 
Hassal, corpuscles of, 1265 
Haversian canals of bone, 53 
systems of bone, 53 
Head, arteries of, 626 
lymphatics of, 774 
muscles of, 464 
veins of, 732 
Head-cap of spermatozoon, 81 
Hearing, organ of, 1043 
Heart, 603 
applied anatomy of, 614 
arteries of, 614 
atrioventricular bundle of His, 
614 
node, 614 
atrium, left, 610 
right, 606 
component parts of, 604 
development of, 143-145 
endocardium, 613 
fibres of atria, 614 
of ventricles, 614 
fibrous rings of, 613 
lymphatic vessels of, 798 
nerves of, 615 
sinoatrial node of, 614 
size and weight of, 604 
structure of, 613 
surface marking of, 1299 
trigonum fibrosum, 613 
veins of, 730 
ventricle, left, 611 
right, 608 
Heidenhain, demilunes of, 1137 
Height index of skull, 296 
Helicine arteries, 1240 
Helicis major muscle, 1045 
minor muscle, 1045 
Helicotrema, 1060 
Helix, 1044 
Hemiazygos vein, 753 
accessory, 753 
Hemispheres, cerebellar, 836 
cerebral, 865 
Hemorrhoidal artery, inferior, 
704 
middle, 701 
superior, 696 
nerve, inferior, 991 
plexuses of nerves, 1005 
vein, middle, 760 
superior, 766 
venous plexus, 761 
applied anatomy of, 761 
Henle, loop of, 1212 
Henle's layer of hair follicle, 1077 
Hensen, canalis reuniens of, 1064 
knot of, 86 
lines of, 66 
stripe of, 1067 
supporting cells of, 1067 
Hepar, 1191 
capsula fibrosa [Glissoni], 1197 
facies inferior, 1192 
posterior, 1193 
superior, 1192 
margo anterior, 1194 
Hepar, tunica serosa, 1197 
Hepatic artery, 689 
branches of vagus nerve, 943 
cells, 1197 
cylinders, 174 
duct, 1199 
flexure of colon, 1180 
lymph glands, 788 
plexus, 1004 
veins, 764 
Hepatoduodenal ligament, 1151, 
1156 
Hepatogastric ligament, 1151, 
1156 
Hepatorenal ligament, 1151 
Herbst, corpuscles of, 1069 
Hernia, complete congenital, 1188 
femoral, 1189 
into funicular process, 1188 
inguinal, 1187 
direct, 1188 
oblique, 1187 
scrotal, 1187 
Herophilus, torcular of, 743 
Heschl, gyri of, 872 
Hesselbach, interfoveolar liga- 
ment of, 505 
triangle of, 1187, 1309 
Hiatus, aortic, 495 
of facial canal, 241 
oesophageal, 496 
semilunaris, 293, 1011 
Higher or cortical visual centres, 
864, 909 
Highest intercostal artery, 666 
veins, 753 
nuchal line, 227 
thoracic artery, 670 
Highmore, antrum of, 259, 1015 
Hilus of kidney, 1209 
of lung, 1102 
of spleen, 1266 
Hind-brain, 122, 821 
Hind-gut, 92, 162 
Hinge-joint, 382 
Hip bone, 333 
articulations of, 340 
ossification of, 340 
structure of, 340 
surface anatomy of, 1324 
Hip-joint, 432 
applied anatomy of, 437 
movements of, 435 
muscles in relation with, 435 
surface marking of, 1330 M 
Hippocampal commissure, 886 
fissure, 130, 874 
gyrus, 874 
Hippocampus, 130, 880 
major, 880 
His, atrioventricular bundle of, 
614 
globular processes of, 111 
Holoblastic ova, 84 
Horizontal cells of retina, 1028 
part of palatine bone, 266 
semicircular canal, 1059 
sulcus of cerebellum, 837 
Houston's valves of rectum, 1183 
Howship's foveolae, 52 
Huguier, canal of, 238, 932, 1050 
Humeral articulation, 414 
applied anatomy of, 417 
bursae in relation to, 415 
movements of, 416 
. vessels and nerves of, 416 
circumflex arteries, 671, 672 
Humerus, 309 
applied anatomy of, 313 
articulations of, 313 
ossification of, 313 
structure of, 313 
surface anatomy of, 1313 
Humor, aqueous, 1030 
Hunter's canal, 713 1376 
INDEX 
Huschke, auditory teeth of, 1065 
foramen of, 244, 245 
Huxley's layer of hair follicle, 
1077 
Hyaline cartilage, 47 
cell, 63 
Hyaloid canal, 1030 
fossa, 1030 
membrane of eye, 1030 
Hyaloplasm, 34 
Hydatid of Morgagni, 182, 1231, 
1247 
pedunculated, of epididymis, 
1231 
Hymen, 1257 
Hyoepiglottic ligament, 1083 
Hyoglossal membrane, 1132 
Hyoglossus muscle, 1129 
Hyoid arch, 109 
arteries, 631, 632 
bone, 275 
applied anatomy of, 277 
body of, 275 
cornua of, 275 
ossification of, 277 
Hyothyroid ligaments, 1082 
membrane, 1082 
Hyparterial bronchi, 1092, 1105 
Hypochondriac regions, 1147 
Hypochordal bar or brace, 104 
Hypogastric artery, 700 
applied anatomy of, 701 
branches of, 701 
in fetus, 616 
obliterated, 700 
peculiarities of, 700 
lymph glands, 786 
plexus, 1005 
region, 1147 
vein, 760 
zone, 1147 
Hypoglossal nerve, 945 
applied anatomy of, 947 
nucleus of, 829 
Hypophysis cerebri, 166, 861 
applied anatomy of, 862 
development of, 166 
lobes of, 862 
structure of, 861 
Hypothalami, pars mamillaria, 127 
optica, 128 
Hypothalamus, 860 
corpora mamillaria, 860 
hypophysis or pituitary body, 
861 
infundibulum, 861 
optic chiasma, 862 
subthalamic tegmental region, 
860 
corpus subthalamicum, or 
nucleus of Luys, 860 
stratum dorsale, 860 
zona incerta, 860 
tuber cinerum, 861 
Hypothenar eminence, 546 
I 
Ileocecal fossae, 1159 
fold, 1160 
Ileocolic artery, 693 
lymph glands, 789 
valve, 1179 
Ileum, 1171 
lymphatic vessels of, 792 
Iliac arteries, common, 698 
applied anatomy of, 700 
peculiarities of, 700 
surface markings of, 1309 
external, 708 
applied anatomy of, 708 
surface markings of, 1309 
internal, 700 
applied anatomy of, 701 
Iliac arteries, internal, peculiar- 
ities of, 700 
circumflex artery, deep, 710 
applied anatomy of, 710 
peculiarities of, 709 
superficial, 716 
vein, deep, 760 
superficial, 756 
colon, 1181 
fascia, 560 
fossa, 335 
furrow, 1301 
lymph glands, 786 
region, 1147 
muscles of, dissection of, 559 
spines, 336 
tuberosity, 335 
vein, common, 762 
peculiarities of, 762 
external, 759 
internal, 760 
Iliacus muscle, 561 
fascia of, 560 
Iliococcygeus muscle, 513 
Iliocostalis cervicis muscle, 488 
dorsi muscle, 488 
lumborum muscle, 488 
Iliofemoral ligament, 433 
Iliohypogastric nerve, 976 
Ilioinguinal nerve, 977 
Iliolumbar artery, 706 
ligament, 404 
vein, 762 
Iliopectineal eminence, 336 
fascia, 560 
Iliosacralis muscle, 514 
Iliotibial band or tract, 563 
Iliotrochanteric ligament, 433 
Ilium, 333 
ala of, 333 
body of, 333 
crest of, 336 
dorsum of, 333 
gluteal lines of, 333 
spines of, 336 
Imbedding or implantation of 
ovum, 97 
Immovable articulations, 380 
Impression, colic, 1192 
duodenal, 1192 
gastric, 1192 
renal, 1192 
rhomboid, 303 
suprarenal, 1194 
trigeminal, 241 
Incisive bone, 262 
canals, 261, 278 
foramen, 261, 278 
fossa, 256, 271 
teeth, 1117 
Incisor crest, 261 
teeth, 1117 
Incisura angularis, 1162 
apicis cordis, 605 
cardiaca, 1162 
fastigii, 125 
radialis, 318 
semilunaris, 315 
temporalis, 874 
tentorii, 901 
Incremental lines of Salter, 1120 
j Incus, 1054 
crus breve, 1054 
longum, 1054 
development of, 141 
ligaments of, 1055 
process of, long, 1054 
short, 1054 
Index, cephalic or breadth, 296 
gnathic or alveolar, 296 
nasal, 296 
orbital, 296 
vertical or height, 296 
Indusium griseum, 875 
I Inferior articular arteries, 721 
Inferior articulation, 423 
calcaneonavicular ligament, 
455 
cerebellar peduncles, 841 
constrictor muscle, 1141 
dental artery, 640 
nerve, 923 
ganglion, 939, 941 
laryngeal nerve, 942 
longitudinal sinus, 741 
maxillary nerve, 921 
medullary velum, 842 
oblique muscle, 1036 
profunda artery, 674 
pubic ligament, 407 
quadrigeminal body, 854 
tarsal plate, 1039 
thyroarytenoid ligaments, 1086 
vocal cords, 1086 
Infraclavicular branches of bra- 
chial plexus, 960 
Infracostales muscle, 492 
Infraglenoid tuberosity, 307 
Infrahyoid artery, 631 
muscles, 480 
dissection of, 482 
Infraorbital artery, 641 
canal, 258 
foramen, 257, 286 
groove, 258 
nerve, 917 note 
plexus of nerves, 919 
Infrapatellar pad of fat, 443 
Infrascapular artery, 671 
Infraspinatous fascia, 533 
fossa, 305 
Infraspinatus muscle, 533 
Infrasternal notch, 1295 
Infratemporal crest, 248, 282 
fossa, 283 
surface of maxilla, 257 
Infratrochlear nerve, 916 
Infundibuliform fascia, 508 
Infundibulopelvic ligament, 1251 
Infundibulum of brain, 861 
of ethmoid bone, 254, 294,1011 
Inguinal aponeurotic falx, 505 
canal, 508 
glands, 783 
applied anatomy of, 784 
hernia, 1187 
ligament, 502 
reflected, 502 
regions, 1147 
ring, abdominal, 508 
subcutaneous, 499 
Inion, 284, 296 
Inlet of pelvis, 340 
Inner cell-mass, 84 
Innominate artery, 625 
applied anatomy of, 626 
bone, 333 
articulations of, 340 
ossification of, 340 
veins, 751 
peculiarities of, 751 
Inscriptions, tendinous, of rectus 
abdominis, 506 
Insertion of muscles, 462 
Insula, 873 
circular sulcus of, 873 
development of, 873 
gyri of, 873 
opercula of, 873 
Integument, common, 1071 
Interalveolar cell-islets, 1205 
Interarticular costocentral liga- 
ments, 397 
fibrocartilages, 49 
sternocostal ligaments, 400 
Interatrial groove, 604 
Intercalatum, 850 
Intercapitular veins, 747, 756 
Intercarpal articulations, 427 
movements of, 428 INDEX 
1377 
Intercavernous sinuses, 746 
Intercellular biliary passages, 
1198 
Intercentral ligaments, 384 
Interchondral ligaments, 401 
Interclavicular ligament, 410 
Interclinoid ligament, 251 
Intercolumnar fascia, 1229 
fibres, 501 
Intercondyloid eminence of tibia, 
355 
fossa of femur, 349 
of tibia, posterior, 356 
Intercostal arteries from aorta, 
685 
highest, 666 
from internal mammary, 664 
superior, 666 
fasciae, 492 
lymph glands, 796 
membranes, 492, 493 
muscles, 492 
nerves, 972 
spaces, 221 
veins, 753 
Intercostales externi muscles, 492 
interni muscles, 492 
Intercostobrachial nerve, 973 
Intercrural fascia, 501 
fibres, 501 
Intercuneiform articulations, 457 
Interfoveolar ligament of Hessel- 
bach, 505 
Interglobular spaces, 1120 
Interior of bladder, 1222 
of larynx, 1085 
of skull, 288 
of uterus, 1250 
Interlobular arteries of kidney, 
1214 
Intermediate cell-mass, 88 
Intermetacarpal articulations, 430 
Intermetatarsal articulations, 458 
Internal abdominal ring, 508 
acoustic meatus, 241 
arcuate ligament, 495 
calcaneal arteries, 727 
calcaneoastragaloid ligament, 
453 
calcaneonavicular ligament. 
495 
canthus of eyelids, 1038 
capsule of brain, 883 
applied anatomy of, 895 
circumflex artery, 717 
cutaneous nerve, 964, 981 
lesser, 964 
geniculate body, 858 
iliac artery, 700 
glands, 786 
vein, 760 
intercostals muscle, 492 
lateral ligament, 395, 418, 426 
malleolar artery, 723, 727 
mammary artery, 664 
applied anatomy of, 666 
gland, 796 
maxillary glands, 775 
oblique muscle, 503 
palpebral arteries, 650 
plantar artery, 727 
nerve, 988 
popliteal nerve, 987 
pterygoid muscle, 474 
pudic artery, 703 
nerve, 991 
veins, 760 
respiratory nerve of Bell, 957 
saphenous nerve, 981 
vein, 756 
semilunar fibrocartilage, 442 
sphincter ani muscle, 516 
Internodal segments of nerves, 75 
Interossei muscles of foot, 590 
of hand,555 
Interosseous artery, anterior, 680 
common, 680 
dorsal, 681 
palmar, 679 
posterior, 681 
recurrent, 682 
volar, 680 
ligament, 399 
membrane of forearm, 423 
of leg, 448 
nerve, dorsal or posterior, 970 
volar or anterior, 965 
Interparietal bone, 231 
Interpeduncular fossa, 865 
ganglion, 848, 850 
Interphalangeal articulations, 
431, 459 
Interpleural space, 1098 
Interpubic disk, 407 
fibrocartilaginous lamina, 407 
Intersegmental neurons, 811 
septa, 102 
Intersigmoid fossa, 1160 
Interspinal ligaments, 387 
Interspinales muscles, 490 
Interspinous ligament, 387 
Intersternal ligaments, 401 
Intertarsal articulations, 452 
Intertragic notch, 1044 
Intertransversales muscle, 490 
Intertransversarii muscles, 490 
Intertransverse ligaments, 387 
Intertrochanteric crest, 348 
line, 348 
Intertubercular plane, 1147 
Intertubular dentin, 1120 
Intervenous tubercle, 608 
Interventricular foramen, 865, 
887 
septum, 612 
Intervertebral fibrocartilages, 386 
foramina, 197 
veins, 755 
Intervillous space, 98 
Intestinal arteries, 692 
glands, 1174 
villi, 1173 
Intestine, aggregated lymphatic 
nodules of, 1175 
applied anatomy of, 1186 
development of, 162 
large, 1176 
lymphatics of, 791 
small, 1168 
structure of, 1172 
vessels and nerves of, 1176 
solitary lymphatic nodules of, 
1175 
surface markings of, 1306 
Intestinum caecum, 1177 
eras sum, 1176 
ileum, 1171 
jejunum, 1171 
rectum, 1182 
tenue, 1168 
tela submucosa, 1173 
tunica mucosa, 1173 
muscularis, 1173 
serosa, 1172 
Intra-articular chondrosternal 
ligament, 400 
ligament, 397 
Intracartilaginous ossification, 57 
Intraepithelial plexus of cornea, 
1021 
Intrafusal fasciculi, 1071 
fibres, 1071 
Intrajugular process, 230 
Intralobular veins, 1197 
Intramembranous ossification, 56 
Intraparietal sulcus, 870 
Intrapulmonary bronchi, 1106 
Intraspinal veins, 755 
Intrathyroid cartilage, 1080 
Intrinsic muscles of tongue, 1130 
Involuntary muscle, 67 
lodothyrin, 1262 
Iridial angle, 1019 
Iris, 1024 
structure of, 1025 
vessels and nerves of, 1025 
Irregular bones, 196 
Ischiocapsular ligament, »433 
Ischiocavernosus muscle, 518, 521 
Ischiorectal fossa, 515 
applied anatpmy of, 516 
Ischium, 336 
body of, 336 
rami of, 337 
spine of, 336 
tuberosity of, 337 
Island of Reil, 873 
Islands, blood, 142 
of Langerhans, 1205 
Isthmus, aortic, 154, 623 
of external acoustic meatus, 
1053 
faucium, 112 
glandula thyreoidea, 1262 
of limbic lobe, 873 
rhombencephali, 122 
of thyroid gland, 1261 
of uterine tube, 1247 
Iter chordae anterius, 1050 
posterius, 1049 
Ivory of teeth, 1119 
J 
Jacob's membrane, 1029 
Jacobson,nerve of, 939,1056 
vomeronasal organs of, 113 
1012 
Jejunum, 1171 
lymphatic vessels of, 792 
Jelly of Wharton, 97 
Joints. See Articulations. 
Jugular foramen, 280, 291 
fossa, 243 
ganglion of glossopharyngeal 
nerve, 938 
of vagus nerve, 941 
nerve, 997 
notch, 217, 230 
process, 230, 281 
surface of temporal bone, 243 
tubercle, 230 
vein, anterior, 736 
external, 734 
applied anatomy of, 736 
internal, 736 
applied anatomy of, 737 
bulbs of, 736 
posterior external, 736 
Jugum sphenoidale, 251 
Junctional tube, 1212 
K 
Karokinesis, 34 
Karyomitome, 34 
Karyomitosis, 34 
Karyoplasm, 34 
Keratin, 39 
Kerckring, ossific centre of, 231 
Kerkring, valves of, 1173 
Kidneys, 1206 
applied anatomy of, 1214 
calices of, 1210, 1216 
cortical substance of, 1210 
development of, 187 
fixation of, 1209 
hilus of, 1209 
lymphatic vessels of, 793 
Malpighian bodies of, 1212 
tufts of, 1212 
medullary substance of, 1210 
minute anatomy of, 1211 1378 
INDEX 
Kidneys, nerves of, 1214 
paranephric body, 1210 
renal artery, 696 
fascia, 1209 
pelvis, 1210, 1216 
sinus, 1210 
tubules, 1212 
structure of, 1210 
surface marking of, 1308 
veins of, 764, 1214 
weight and dimensions of, 1207 
Knee cap, 354 
Knee-joint, 438 
applied anatomy of, 446 
bursae of, 443 
movements of, 444 
surface anatomy of, 1325 
Krause, end-bulbs of, 1069 
membrane of, 66 
Kiihne, motor end-plates of, 803 
L 
Labbe, posterior anastomotic 
vein of, 739 
Labia cerebri, 875 
majora, 1256 
minora, 1257 
oris, 1110 
Labial arteries, 634 
commissures, 1257 
glands, 1110 
grooves, 163, 164 
Labiodental lamina, 1121 
Labrum glenoidale, 415, 434 
Labyrinth, membranous, 1061 
development of, 140 
vessels of, 1068 
osseous, 1057 
Labyrinthus ethmoidalis, 253 
membranaceus, 1061 
osseus, 1057 
Lacertus fibrosus, 535 
Laciniate ligament, 585 
Lacrimal apparatus, 1041 
applied anatomy of, 1042 
artery, 649 
bone, 263 
articulations of, 263 
lesser, 263 
ossification of, 263 
canals, 1041 
caruncula, 1041 
crest, posterior, 263 
ducts or canals, 1041 
ampullae of, 1042 
fossa, 235, 286 
glands, 1041 
groove, 258, 287 
hamulus, 263 
nerve, 915 
notch, 257 
papilla, 1038 
process of inferior nasal concha, 
268 
punctum, 1038 
sac, 1042 
sulcus, 1042 
tubercle, 260 
Lacteals, 768 
Lactiferous ducts, 1259 
Lacuna magna [of urethra], 1226 
Lacunae of bone, 53, 54 
of cartilage, 47 
of urethra, 1226 
venous, 741 
Lacunar ligament, 502 
Lacus lacrimalis, 1038, 1041 
Lagena, 1064 
Lambda, 277, 296 
Lambdoidal suture, 230, 232, 282 
Lamellae of bone, 53 
articular, 379 
circumferential, 53 
Lamellae circumferential, inter- 
stitial, 53 
primary or fundamental, 53 
secondary or special, 53 
Lamellar cells, 41 
Lamina affixia, 885 
anterior elastic, of cornea, 1020 
basalis, 1022 
cartilaginis cricoideae, 1081 
choriocapillaris, 1022 
cribrosa sclerae, 1017 
dorsal or alar, 119 
elastica anterior, 1020 
posterior, 1020 
fibrocartilaginca interpubica, 407 
labiodental, 1121 
lingual, 1121 
medullary, 856, 857 
nasal, 111 
posterior elastic, of cornea, 
1020 
reticular, 1067 
spiral, of cochlea, osseous, 1060 
secondary, 1060 
spiralis ossea, 1060 
suprachorioidea, 1017, 1022 
terminalis, 126, 864 
vasculosa, 1022 
ventral or basal, 119 
of vertebrae, 197 
Langerhans, centro-acinar cells 
of, 1205 
islands of, 1205 
Langhans, layer of, 85 
Langley's ganglion, 1138 
Lantermann, segments of, 75 
Lanugo, 116 
Large deep petrosal nerve, 919 
intestine, 1176 
cecum, 1177 
colic valve, 1179 
colon, 1180 
ascending, 1180 
descending, 1181 
iliac, 1181 
sigmoid or pelvic, 1181 
transverse, 1180 
rectum, 1182 
superficial petrosal nerve, 919, 
931 
Laryngeal artery, inferior, 662 
superior, 631 
nerves, 942 
part of pharynx, 1141 
prominence, 1080 
saccule, 1086 
sinus, 1086 
Laryngotomy, 1094 
Laryngotracheal tube, 176 
Larynx, 1079 
applied anatomy of, 1093 
cartilages of, 1079 
conus elasticus of, 1083 
elastic membrane of, 1083 
entrance of, 1083 
glands of, 1090 
interior of, 1085 
ligaments of, 1082 
lymphatic vessels of, 779, 1090 
mucous membrane of, 1090 
muscles of, 1088 
actions of, 1090 
nerves of, 1090 
rima glottidis of, 1087 
surface marking of, 1289 
ventricle of, 1086 
ventricular folds of, 1085 
vessels of, 1090 
vestibule of, 1085 
vocal folds of, 1086 
Lateral basis bundle, 817 
cartilage, lower, 1009 
upper, 1009 
cornu of medulla spinalis, 809 
cricoarytenoid muscle, 1088 
Lateral sinuses, 742 
thyrohyoid ligament, 1083 
Latissimus dorsi muscle, 524 
Layer of Langhans, 85 
of rods and cones, 1029 
Layers of cerebral cortex, 891 
Least splanchnic nerve, 999 
Left atrium, dissection of, 610 
auricle, 610 
auricular appendix, 610 
coronary plexus, 1002 
vein, 730 
lobe of liver, 1195 
ventricle, dissection of, 611 
Leg, fascia of, 576 
deep transverse, 580 
muscles of, 576 
dissection of, 576, 578, 579, 
581, 582 
Lemniscus, lateral, 853 
lateralis, 853 
medial, 853 
medialis, 853 
Lens, capsule of, 1030 
vascular, 136 
changes produced in, by age, 
1031 
crystallina, 1030 
crystalline, 1030 
development of, 136 
equator of, 1031 
poles of, 1031 
structure of, 1031 
suspensory ligament of, 1030 
vesicle, 134 
Lenticula, 881 
Lenticular ganglion, 917 
glands of stomach, 1166 
nucleus, 881 
process of incus, 1054 
Lentiform nucleus, 881 
Lesser cavernous nerve, 1005 
curvature of stomach, 1162 
internal cutaneous nerve, 964 
lacrimal bone, 263 
multangular bone, 327 
omentum, 1156 
pelvis, 340 
peritoneal sac, 1152, 1155 
sac or omental bursa of peri- 
toneum, 1155 
boundaries of, 1155, 1156 
sciatic foramen, 406 
notch, 336 
sigmoid cavity, 318 
trochanter, 348 
Leucocytes, 62 
Levator anguli oris muscle, 470 
scapulae muscle, 525 
ani muscle, 513 
glandulae thyreoideae muscle, 
1262 
menti muscle, 470 
palati muscle, 1113 
palpebrae superioris muscle, 
1034 
prostatae muscle, 514 
scapulae muscle, 525 
veli palatini muscle, 1113 
Levatores costarum muscle, 493 
Lieberkuhn, crypts of, 1174 
Lien, 1266 
accessorius, 1267 
extremitas inferior, 1267 
superior, 1267 
facies gastrica, 1266 
renalis, 1266 
margo anterior, 1267 
posterior, 1267 
Lienal artery, 691 
plexus of nerves, 1004 
vein, 765 
Ligament or Ligaments, acromio- 
clavicular, inferior, 412 
superior, 411 INDEX 
1379 
Ligament or Ligaments, alar, 393 
of ankle, 450, 451 
annular, of ankle, 584, 585 
of radius, 422 
of stapes, 1055 
of wrist, 547, 550 
anterior, 426 
inferior, 448 
longitudinal, 384 
superior, 398, 448 
apical odontoid, 393 
arcuate, 495 
atlantoaxial, 389 
atlantooccipital, 392 
membrane, posterior, 392 
of auricula or pinna, 1044 
of Bertin, 433 
bifurcated, 454, 455 
of Bigelow, 433 
of bladder, 1221 
broad, of uterus, 1250 
calcaneoastragaloid, 452, 453 
calcaneocuboid, 454 
calcaneofibular, 451 
calcaneonavicular, plantar, 455 
calcaneotibial, 450 
capsular. See Individual Joints, 
caroticoclinoid, 251 
carpometacarpal, 429 
of carpus, 427, 428 
central, of medulla spinalis, 907 
check, 393 
of eye, 1038 
chondrosternal, 399 
intra-articular, 400 
chondroxiphoid, 401 
common, anterior, 384 
posterior, 385 
conoid, 412 
of Cooper, 502 
coracoacromial, 413 
coracoclavicular, 412 
coracohumeral, 415 
' coronary, of knee, 442 
of liver, 1150, 1151, 1195 
costoclavicular, 410 
costocoracoid, 528 
costotransverse, 397, 398 
middle, 399 
posterior, 399 
costovertebral, anterior, 396 
costoxiphoid, 401 
cotyloid, 339, 434 
cricoarytenoid, posterior, 1084 
cricotracheal, 1083 
crucial, 441 
cruciate, of atlas, 390 
crural, 584 
of knee, 441 
cuboideonavicular, 457 
cuneocuboid, 457 
cuneonavicular, 455 
deltoid, of ankle-joint, 450 
dentate, 907 
digital vaginal, 540 
dorsal carpal, 550 
radiocarpal, 425 
radioulnar, 424 
of elbow, 418, 419 
falciform, of liver, 1150, 1195 
fibular collateral, of knee-joint, 
440 
fundiform, of penis, 1239 
gastrocolic, 1151 
gastrolienal, 1155 
gastrophrenic, 1163 
Gimbernat's, 502 
glenohumeral, 415 
glenoid, 414 
of Cruveilhier, 430, 459 
of shoulder-joint, 415 
glenoidal labrum of hip-joint, 
434 
of shoulder-joint, 415 
hepatoduodenal, 1151, 1156 
Ligament or Ligaments, hepato- 
gastric, 1151,1156 
hepatorenal, 1151, 1195 
of Hesselbach, 505 
of hip-joint, 432 
hyoepiglottic, 1083 
iliofemoral, 432 
iliolumbar, 404 
iliotrochanteric, 433 
of incus, 1055 
inferior transverse of scapula, 
413 
infundibulopelvic, 1251 
inguinal, 502 
reflected, 502 
interarticular, of ribs, 397 
sternocostal, 400 
intercarpal, 427 
intercentral, 384 
inter chondral, 401 
interclavicular, 410 
interclinoid, 251 
intercuneiform, 457 
inter foveolar, 505 
intermetacarpal, 430 
intermetatarsal, 458 
interosseous, 399 
interphalangeal, 431, 459 
interpubic fibrocartilaginous 
lamina, 407 
interspinal, 387 
interspinous, 387 
intersternal, 401 
intertarsal, 452 
intertransverse, 387, 406 
intra-articular, 397 
ischiocapsular, 433 
of knee-joint, 438 
laciniate, 585 
lacunar, 502 
of larynx, 1082 
lateral atlantooccipital, 392 
external, 394, 419, 426 
internal, 395, 418, 426 
of uterus, 1250 
left triangular, of liver, 1151 
of left vena cava, 603 
long plantar, 454 
of Mackenrodt, 1251 
of malleus, 1055 
medial palpebral, 468 
metacarpophalangeal, 430 
metatarsophalangeal, 459 
middle cricothyroid, 1083 
mucosum, of knee, 443 
of neck of rib, 399 
nuchae, 387 
oblique cord, 423 
popliteal, 439 
sacroiliac, 404 
occipitoaxial, 393 
odontoid, 393 
orbicular, 422 
of ovary, 1244 
palmar, 427, 429 
palpebral, 1039 
pectinate, of iris, 1021 
of pelvis, 404 
phrenicocolic, 1157 
phrenicolienal, 1155 
phrenicopericardiac, right, 762 
of pinna or auricula, 1044 
plantar, long, 454 
posterior, 426 
cricoarytenoid, 1084 
inferior, 448 
of knee, 439 
longitudinal, 385 
superior, 448 
Poupart's, 502 
pterygomandibular, 471 
pterygospinous, 251, 477 
pubic, 407 
pubocapsular, 433 
pubofemoral, 433 
Ligament or Ligaments, pulmo- 
nary, 1095, 1097 
quadrate, 423 
radial collateral, of elbow-joint, 
419 
of wrist-joint, 425 
radiate, 396 
sternocostal, 399 
of radiocarpal joint, 425 
radioulnar, 424 
reflected inguinal, 502 
rhomboid, 410 
round, of liver, 1195 
of uterus, 1251 
sacrococcygeal, 406 
sacroiliac, 404 
sacrosciatic, 404, 405 
sacrospinous, 405 
sacrotuberous, 404 
of scapula, 413 
of shoulder-joint, 414 
sphenomandibular, 395, 477 
spinoglenoid, 413 
spiral, of ductus cochlearis, 
1064 
stellate, 396 
sternoclavicular, 410 
sternocostal, 399 
sternopericardiac, 602 
of sternum, 400 
structure of, 379 
stylohyoid, 481 
stylomandibular, 395,^477 
subpubic, 407 
superficial transverse of 
fingers, 551 
superior transverse of scapula, 
413 
suprascapular, 413 
supraspinal, 387 
supraspinous, 387 
suspensory, of axilla, 526 
of eye, 1038 
of lens, 1030 
of liver, 1195, 
of mamma, 526 
of ovary, 1244 
of penis, 1239 
talocalcaneal, 452, 453 
talonavicular, dorsal, 454 
talotibial, 450 
tarsometatarsal, 457 
of tarsus, 452 
temporomandibular, 393 
tendo oculi, 468 
teres, of hip, 454 
thyroarytenoid, inferior, 1086 
thyroepiglottic, 1084 
thyrohyoid, 1082, 1083 
tibial collateral, of knee-joint, 
. 439 
tibiofibular, 448 M 
tibionavicular, 450 aa 
transversahs collruten, 1251 
transverse acetabular, 434] 
of atlas, 389 
carpal, 547 
crural, 584 
humeral, 415 
inferior, 449 
of knee, 442 
metacarpal, 430 
metatarsal, 458 
of pelvis, 520 
of scapula, 413 
trapezoid, 412 
triangular, of liver, 1195 
of urethra, 519 
of tubercle of rib, 399 
ulnar collateral, of elbow-joint, 
418 
of wrist-joint, 426 
uterosacral, 1250 
of uterus, 1250 
ventricular, of larynx, 1085 1380 
INDEX 
Ligament or Ligaments of verte- 
brae, 384 
volar carpal, 547 
metacarpophalangeal, 430 
radiocarpal, 426 
radioulnar, 424 
of Wrisberg, 442 
of wrist-joint, 425, 426 
Y-shaped, of Bigelow, 433 
of Zinn,1035 
Lig amenta accessoria plantaria, 
459 
alaria, 393 
auricularia [Valsalva], 1044 
basium [oss. metacarp.] dorsalia, 
430 
interossea, 430 
volaria, 430 
[oss. metatars.] dorsalia, 458 
interossea, 458 
plantaria, 458 
carpometacarpeae dorsalia, 429 
volaria, 429 
collator alia, 459 
costoxiphoidea, 401 
cruciata genu, 441 
cuneometatarsea interossea, 458 
intercarpea dorsalia, 427 
interossea, 427 
volaria, 427 
intercuneiformia interossea, 457 
plantaria, 457 
interspinalia, 387 
intertransversaria, 387 
navicularicuneiformia dorsalia, 
456 
plantaria, 456 
ossiculorum auditus, 1054 
sternocostalia radiata, 399 
suspensoria [of mamma], 526 
tarsometatarsea dorsalia, 457 
plantaria, 458 
vocales, 1086 
Ligamentous action of muscles, 
383 
applied anatomy of, 383 
Ligamentum acromio clavicular e, 
411 
annulare baseos stapedis, 1055 
radii, 422 
arcuatum pubis, 407 
arteriosum, 621 
bifurcatum, 454 
calcaneocuboideum dorsale, 454 
plantare, 454 
calcaneofibulare, 451 
calcaneonaviculare plantare, 455 
capituli costae interarticulare, 
397 
radiatum, 396 
capitulorum [oss, metacarpa- 
lium] interosseum, 430 
carpi dorsale, 550 
transversum, 547 
volare, 547 
collaterale fibulare, 440 
radiale, 419, 426 
tibiale, 439 
ulnar e, 418, 426 
colli costae, 399 
conoideum, 412 
coracoacromiale, 413 
coracoclaviculare, 412 
coracohumerale, 414 
coronarium hepatis, 1195 
costoclaviculare, 410 
costotransversarium anterius, 
398 
posterius, 398 
cricoarytaenoideumposterius, 
1084 
cricothyreoideum medium, 1083 
cricotr acheale, 1083 
cruciatum anterius, 441 
posterius, 441 
Ligamentum cuboideonaviculare 
dorsale, 457 
plantare, 457 
deltoideum, 450 
denticulatum, 907 
falciforme hepatis, 1195 
hyoepiglotticum, 1083 
hyothyreoideum later ale, 1083 
medium, 1082 
iliofemorale, 433 
iliolumbale, 404 
incudis posterius, 1055 
superius, 1055 
inguinale [Pourparti], 502 
reflexum [Colleri], 502 
interclaviculare, 410 
ischiocapsulare, 433 
lacunare [Gimbernati], 502 
latum pulmonis, 1097 
uteri, 1250 
longitudinals anterius, 384 
posterius, 385 
mallei anterius, 1055 
laterale, 1055 
superius, 1055 
malleoli lateralis anterius, 
448 
posterius, 448 
mucosum, 443 
nuchae, 587 
patellae, 439 
plantare longum, 454 
popliteum obliquum, 439 
pubicum superius, 407 
pubocapsulare, 433 
pulmonale, 1097 
radiocarpeum dorsale, 426 
volare, 426 
sacrococcygeum anterius, 406 
laterale, 406 
posterius, 406 
sacroiliacum anterius, 404 
interosseus, 404 
posterius, 404 
sacrospinosum, 405 
sacrotuberosum, 404 
sphenomandibulare, 395 
sterno clavicular e, 410 
sternocostale inter articular e, 400 
stylomandibulare, 395 
supraspinale, 387 
talocalcaneum anterius, 452 
interosseum, 453 
laterale, 453 
mediate, 453 
posterius, 453 
talofibulare anterius, 450 
posterius, 451 
talonaviculare dorsale, 454 
temporomandibulare, 394 
teres femoris, 434 ' 
hepatis, 1196 
uteri, 1251 
thyroepiglotticum, 1084 
transversalis colli uteri, 1251 
transver sum acetabuli, 434 
atlantis, 389 
crus inferius, 390 
superius, 390 
cruris, 584 
genu, 442 
scapulae inferius, 413 
superius, 413 
trapezoideum, 412 
triangulare dextrum, 1195 
sinistrum, 1195 
tuberculi costae, 399 
venosum, 1196 
Ligature of arteries. See each 
Artery. 
Ligulae, 846 
Limbic lobe, 873 
Limbs, development of, 113 
Limbus fossae ovalis, 608 
laminae spiralis, 1065 
Limiting membranes of retina, 
1029 
Line or Lines, arcuate, of ilium, 
335 
colored, of Retzius, 1120 
curved, of ilium, 333 
gluteal, of ilium, 333 
incremental, of Salter, 1120 
intercondyloid, 350 
intertrochanteric, 348 
mylohyoid, 272 
Nelaton's, 1239 
nuchal, 227, 281 
oblique, of fibula, 360 
of mandible, 271 
of radius, 320 
pectineal, 348 
popliteal, of tibia, 357 
of Schreger, 1120 
spiral, of femur, 348 
temporal, 231, 235, 278, 282 
Linea alba, 507 
aspera, 348 
quadrata, 348 
semicircularis, 507 
splendens, 907 
Lineae semilunares, 507 
Lingua, 1125 
facies inferior, 1126 
tunica mucosa, 1131 
Lingual artery, 631 
applied anatomy of, 632 
deep, 632 
bone, 275 
branches of glossopharyngeal 
nerve, 939 
gyrus, 871 
lamina, 1121 
lymph glands, 775 
nerve, 923 
tonsil, 1131 
veins, 736 
Lingula of cerebellum, 837 
of mandibulae, 272 
of sphenoid, 247, 290 
Linin, 34 
Lip, tympanic, 1065 
vestibular, 1065 
Lips, 1110 
Liquor amnii, 95 
sanguinis, 61 
Lissauer, fasciculus of, 817 
Littre, urethral glands of, 1226 
Liver, 1191 
applied anatomy of, 1200 
bare area of, 1151 
bile ducts of, 1198 
common, 1200 
cystic duct, 1200 
development of, 174 
excretory apparatus of, 1198 
fissures of, longitudinal, 1194 
fossae of, 1194 
gall-bladder, 1199 
hepatic artery, 689, 1197 
cells, 1197 
duct, 1198 
veins, 764 
ligaments of, 1195 
lobes of, 1194, 1195 
lobules of, 1197 
lymphatic vessels of, 792 
nerves of, 1196 
portal vein, 764, 1198 
structure of, 1197 
surface markings of, 1307 
surfaces of, 1191 
vessels of, 1196 
Lobe or Lobes, cacuminal, 838 
of cerebellum, 836 
of cerebral hemisphere, 869 
frontal, 869 
insula, 873 
limbic, 873 
occipital, 871 INDEX 
1381 
Lobe or Lobes of cerebral hemis- 
phere, olfactory, 874 
parietal, 870 
precuneus, 871 
quadrate, 871 
temporal, 871 
of liver, 1194,1195 
of lung, 1105 
nodular, 839 
Spigelian, 1195 
of thymus, 1264 
of thyroid gland, 1261 
tuberal, 839 
uvular, 839 
Lobule of auricula, 1044 
paracentral, 870 
parietal, 871 
postero-inferior, 839 
postero-superior, 838 
Lobules of liver, 1195 
of testes, 1232 
Lobuli glandulae thyreoideae, 1261 
hepatis, 1197 
Lobulus centralis, 838 
parietalis inferior, 871 
superior, 871 
semilunaris inferior, 839 
superior, 838 
Lobus caudatus, 1195 
clivi, 838 
culminis, 838 
frontalis, 869 
hepatis dexter, 1194 
sinister, 1195 
noduli, 839 
occipitalis, 871 
olfactorius, 874 
parietalis, 870 
pyramidis, 839 
quadratus, 1195 
semilunaris, 838 
temporalis, 871 
tuberus, 839 
uvulae, 839 
Localization, cerebral, 894 
Lockwood, tendon of, 1035 
Locus coeruleus, 848 
Long bones, 195 
buccal nerve, 922 
calcaneocuboid ligament, 454 
ciliary nerves, 916 
external lateral ligament, 440 
or internal saphenous nerve, 
981 
root of ciliary ganglion, 916 
saphenous nerve, 981 
vein, 756 
subscapular nerve, 961 
thoracic artery, 671 
nerve, 960 
Longissimus capitis muscle, 489 
cervicis muscle, 488 
dorsi muscle, 488 
Longitudinal fasciculus, inferior, 
891 
posterior, 851 
superior, 891 
fissure, cerebral, 865 
great, 865 
of liver, 1194 
sinuses, 740, 741 
striae, lateral and medial, 875 
sulci of heart, 604 
Longitudinalis linguae inferior 
muscle, 1130 
superior muscle, 1130 
Longus capitis muscle, 484 
colli muscle, 403 
Loop of Henle, 1212 
Lowenthal, cerebellospinal tract 
of, 815 
Lower extremity, arteries of, 710 
articulations of, 432 
bones of, 333 
lymphatic vessels of, 782 
Lower extremity, muscles of, 559 
surface anatomy of, 1323 
markings of, 1329 
veins of, 755 
jaw, bones of, 271 
lateral cartilage, 1009 
visual centres, 864, 909 
Lower, tubercle of, 608 
Lumbar aponeurosis, 486 
arteries, 698 
enlargement of medulla spi- 
nalis, 808 
fascia, 486 
lymph glands, 787 
nerves, divisions of, anterior, 
974 
posterior, 953 
plexus of nerves, 975 
applied anatomy of, 992 
regions of abdomen, 1147 
triangle, 524 
vein, ascending, 753, 763 
veins, 763 
vertebrae, 204 
Lumbocostal arch, 495 
Lumbodorsal fascia, 486 
Lumbosacral plexus, 974 
trunk, 975 
Lumbricales muscles of foot, 589 
of hand,555 
Lunate bone, 323 
surface of acetabulum, 339 
Lung-buds, 177 
Lungs, 1101 
applied anatomy of, 1108 
development of, 177 
fissures and lobes of, 1104 
nerves of, 1107 
root of, 1105 
structure of, 1106 
surface marldngs of, 1298 
vessels of, 1107 
Lunulae of nails, 1075 
of semilunar valves, 610 
Luschka's gland, 1273 
Luys, nucleus of, 860 
Lymph, 64 
capillaries, 64 
path,770 
sacs, 161 
sinus, 770 
Lymph Gland or Glands of abdo- 
men, 785 
aortic, 787 
applied anatomy of, 770 
auricular, 774, 775 
axillary, 780 
buccinator, 775 
cervical, anterior, 778, 779 
of Cloquet, 783 
deltoideopectoral, 779 
diaphragmatic, 797 
epigastric, 786 
facial, 775 
deep, 775 
gastric, 788 
gastroepiploic, right, 788 
of head, 774 
hepatic, 788 
hypogastric, 786 
iliac, 786 
ileocolic, 789 
infraorbital, 775 
inguinal, 783 
applied anatomy of, 784 
intercostal, 797 
lingual, 775 
of lower extremity, 782 
lumbar, 787 
mammary, internal, 796 
mastoid, 774 
maxillary, 775 
mediastinal, 798 
mesenteric, 789, 791 
mesocolic, 789 
Lymph Gland or Glands of neck, 
778 
obturator, 787 
occipital, 774 
pancreaticoduodenal, 792 
pancreaticolienal, 768 
pararectal, 791 
paratracheal, 779 
parietal of abdomen and 
pelvis, 786 
parotid, 775 
of pelvis, 785 
popliteal, 782 
applied anatomy of, 784 
preauricular, 775 
principal gland of tongue, 
778 
retropharyngeal, 776 
of Rosenmuller, 783 
sacral, 787 
splenic, 788 
Stahr, middle gland of, 778 
sternal, 796 
structure of, 769 
subinguinal, 783 
submaxillary, 778 
submental, 778 
suprahyoid, 778 
supramandibular, 775 
supratrochlear, 779 
of thorax, 796 
tibial, anterior, 782 
tracheobronchial, 798 
of upper extremity, 779, 780 
visceral of abdomen and 
pelvis, 787 
Lymphatic duct, right, 772 
nodules, aggregated, 1175 
solitary, 1175 
of spleen, 1268 
system, 768 
trunk, bronchomediastinal, 798 
intestinal, 772 
jugular, 772, 773 
lumbar, 772 
subclavian, 772, 773 
vessels, 768 
of abdominal viscera, 791 
wall, 787 
of anal canal and anus/792] 
applied anatomy of, 770 
of auricula and external 
acoustic meatus, 776 
of cecum, 792 
of colon, 792 
of common bile-duct, 793 
development of, 161 
of diaphragma, 798 
of ductus deferens, 794 
of duodenum, 792 
of external genitals, 787 
of face, 776 
of gall-bladder, 793 
of gluteal region, 784 
of heart, 798 
of ileum, 792 
of jejunum, 792 
of kidney, 793 
lacteals, 768 
of larynx, 779 
of liver, 792 
of lower extremity, 784 
of lungs, 799 
of mamma, 797 
of mouth, 777 
of nasal cavities, 776 
of neck, 779 
of oesophagus, 800 
of ovary, 795 
of palatine tonsil, 777 
of pancreas, 793 
of pelvis, 787 
of perineum, 787 
of pharynx, 779 
of pleura, 800 1382 
INDEX 
Lympathic vessels of prostate, 
794 
of rectum, 792 
of reproductive organs, 794 
of scalp, 776 
of spleen, 793 
of stomach, 792 
structure of, 768 
of suprarenal glands, 793 
of testes, 794 
of thoracic viscera, 799 
wall, 797 
of thymus, 800 
of thyroid gland, 779 
of tongue, 778 
of upper extremity, 781 
of ureter, 793 
of urethra, 794 
of urinary organs, 793 
of uterine tubes, 795 
of uterus, 795 
of vagina, 795 
of vermiform process, 792 
of vesiculae seminales, 795 
Lymphocyte, 63 
Lymphoglandulae, 768 
auriculares anteriores, 775 
posteriores, 774 
axillares, 780 
cervicales profundae, 778 
superficiales, 778 
epigastricae, 786 
faciales profundae, 775 
gastricae inferiores, 788 
superiores, 788 
hepaticae, 788 
hypogastricae, 786 
inguinales, 783 
intercostales, 797 
linguales, 775 
lumbales, 787 
mediastinales anteriores, 798 
posteriores, 798 
mesentericae, 789 
mesocolicae, 791 
occipitales, 774 
pancreaticolienales, 788 
popliteae, 782 
sternales, 796 
subinguinales profundae, 783 
superficiales, 783 
submaxillar es, 778 
tibialis anterior, 782 
Lymphoid tissue, 45 
Lyra of fornix, 886 
M 
Macewen, suprameatal triangle 
of, 238 
Mackenrodt, ligament of, 1251 
Macula acustica sacculi, 1062 
utriculi, 1062 
cribrosa media, 1058 
superior, 1058 
lutea, 1026, 1029 
structure of, 1029 
Majendie, foramen of, 847, 905 
Malar bone, 263 
process of maxilla, 260 
Male genital organs, 1228 
bulbourethral glands, 190, 
1243 
ductus deferens, 1235 
ejaculatory duct, 1237 
penis, 1237 
prostate, 1241 
testes and their coverings, 
1228 
vesiculae seminales, 1236 
pronucleus, 83 
urethra, 1225 
Malleolar arteries, 723 
internal, 727 
Malleolar folds, anterior and pos- 
terior, 1050 
sulcus, 360 
Malleolus, lateral, 360 
medial, 358, 359 
Malleus, 1053 
development of, 141 
ligaments of, 1055 
Malpighian bodies of kidney, 
1212 
of spleen, 1268 
capsules of kidney, 1212 
tufts of kidney, 1212 
Mamillary process, 205 
Mammae, 1258 
applied anatomy of, 1260 
development of, 116 
lymphatic vessels of, 797 
nerves of, 1260 
papilla or nipple of, 1258 
structure of, 1258 
vessels of, 1260 
Mammary artery, external, 671 
internal, 664 
gland, 1258 
internal, 796 
veins, internal, 751 
Mandible, 271 
angle of, 273 
articulations of, 274 
body of, 271 
changes in, due to age, 275 
condyloid process of, 273 
coronoid process of, 273 
ossification of, 273 
ramus of, 272 
Mandibula, 271 
Mandibular arch, 109, 
branches of facial nerve, 933 
canal, 273 
foramen, 272 
fossa, 238, 280, 283 
nerve, 921 
notch, 273 
Mantle layer, 117 
Manubrium of malleus, 1053 
of sternum, 216 
Margin, supraorbital, 234 
Marginal gyrus, 870 
layer, 117 
veins of foot, 756 
Margins of heart, 606 
Marrow of bone, 51 
Marshall, oblique vein of, 159, 
603,731 
vestigial fold of, 159, 603, 731 
Martinotti, cells of, 892, 
Massa intermedia, 856, 865 
Masses, lateral, of atlas, 200 
Masseter muscle, 472 
Masseteric artery, 641 
fascia, 472 
nerve, 921 
Mastoid canaliculus, 243, 280 
cells, 240 
foramen, 239, 282 
fossa, 238 
glands, 774 
notch, 239, 280 
portion of temporal bone, 239 
process, 239 
Mastzellen, 41 
Matrix of nail, 1075 
Maturation of ovum, 79 
Maxilla, 256 
articulations of, 262 
changes in, due to age, 262 
ossification of, 262 
Maxillary artery, external, 633 
applied anatomy of, 635 
peculiarities of, 635 
internal, 638 
glands, internal, 775 
nerve, 917 
inferior, 921 
Maxillary process of inferior nasa 
concha,268 
of palatine bone, 267 
of zygomatic bone, 265 
processes of fetus, 109 
sinus, 259, 1015 
tuberosity, 257 
vein, internal, 734 
Meatus acusticus externa, 1046 
externus cartilaginous, 1047 
osseus, 1047 
auditory, external, 1046 
external acoustic, 244. 283, 
1046 
applied anatomy of, 1048 
internal, 244, 291 
urinarius, 1226 
urinary, 1257 
Meatuses of nose, 293, 1010, 1011 
Mechanism of pelvis, 408 
of respiration, 497 
of thorax, 401 
Meckel's cartilages, 109, 273 
diverticulum, 93, 1172 
ganglion, 919 
Media, refracting, of bulb of eye, 
1030 
Medial geniculate body, 858 
longitudinal fasciculus, 851 
wall of nasal cavity, 1012 
Median antibrachial vein, 749 
basilic vein, 747 
nerve, 965 
Mediastinal arteries from aorta, 
685 
from internal mammary, 664 
cavity, 1098 
anterior, 1100 
applied anatomy of, 1101 
middle, 1101 
posterior, 1101 
superior, 1098 
lymph glands, 798 
pleura, 1095 
Mediastinum testis, 1232 
Medicornu, 879 
Medidural artery, 640 
Medifrontal gyre, 870 
Medulla of hair, 1077 
oblongata, 822 
anterior district of, 822 
applied anatomy of , 833 
arcuate fibres of, 830 
development of, 123 
fasciculus cuneatus, 827 
gracilis, 827 
fissures and sulci of, 822 
gray substance of, 829 
formatio reticularis, 832 
lateral district of, 823 
olive of, 824 
posterior district of, 824 
pyramid of, 823 
restiform bodies of, 830 
structure of, 826 
spinalis, 805 
anterior white commissure 
of, 808 
applied anatomy of, 820 
central canal of, 810 
columns of, 809 
development of, 805 
dissection of, 805 
distribution of nerve cells in, 
811 
enlargements of, 808 
fissures of, 808 
gray commissures of, 810 
substance of, 809 
lig amentum denticulatum, 905 
meninges of, 900 
applied anatomy of, 907 
neuroglia of, 809 
sulci of, 808 
veins of, 755 INDEX 
1383 
Medulla spinalis, white substance 
of, 814 
Medullary artery of bone, 52 
lamina, lateral, 856 
medial, 857 
laminae of lentiform nucleus, 
881 
membrane of bone, 51 
portion of suprarenal gland, 
1272 
segments of nerves, 75 
sheath of nerve-fibres, 73 
spaces of bone, 58 
substance of kidney, 1210 
velum, 842, 845 
Medullated nerve-fibres, 73 
Meibomian glands, 1040 
Meissner's plexus, 1176 
tactile corpuscles, 1070 
Melanin, 46 
Membrana atlantooccipitalis an- 
terior, 392 
posterior, 392 
granulosa [of Graafian follicle], 
1246 
hyothyreoidea, 1082 
interossea antebrachii, 423 
cruris, 448 
pupillaris, 1026 
tectorias [of atlas and occipital 
bone], 393 
Membrane, anal, 174 
arachnoid, 903 
atlantooccipital, 392 
basilar, 1063, 1065 
of Bowman, 1020 
costocoracoid, 528 
cricothyroid, 1083 
of Demours, 1020 
of Descemet, 1020 
elastic, of larynx, 1083 
fenestrated, 596 
hyaloid, 1030 
hyoglossal, 1132 
hyothyroid, 1082 
intercostal, 492 
interosseous, of forearm, 423 
of leg, 448 
Jacob's, 1029 
of Krause, 66, 
limiting, 1029 
medullary, of bone, 51 
of Nasmyth, 1123 
nuclear, 34 
obturator, 572 
pharyngeal, 163 
pupillary, 136, 1026 
of Reissner, 1063 
tectorial, of ductus cochlearis, 
1067 
thyrohyoid, 1082 
tympanic, 1050 
structure of, 1050 
vestibular, 1063 
vitelline, 83 
Membranes, basement, 45 
of brain and medulla spinalis, 
900 
fetal, 93 
synovial, 379 
Membranous cochlea, 1063 
cranium, 106 
labyrinth, 1061 
portion of urethra, 1226 
semicircular canals, 1062 
vertebral column, 102 
Meningeal artery, accessory, 640 
anterior, 648 
from ascending pharyngeal, 
637 
middle, 640 
applied anatomy of, 640 
surface marking of, 1281 
from occipital, 636 
from vertebral, 660 
Meningeal branch of spinal nerve, 
951 
layer of dura mater, 902 
nerve from hypoglossal, 947 
from maxillary, 917 
Meninges of brain and medulla 
spinalis, 900 
Menisci, 49 
of knee-joint, 441 
Meniscus, articular, 395 . 
lateralis, 442 
medialis, 442 
Mental foramen, 271, 286 
nerve, 924 
point, 296 
protuberance, 271 
spines, 271 
tubercle, 271 
Mentalis muscle, 470 
Merkel, tactile disks of, 1069 
Meroblastic ova, 84 
Mesamoeboid cells, 142 
Mesencephalon, 90, 125, 848 
Mesenteric artery, inferior, 694 
dissection of, 695 
superior, 691 
dissection of, 692, 695 
lymph glands, 789 
plexuses of nerves, 1004, 1005 
veins, 766 
Mesenteries, 1156 
mesentery proper, 1157 
sigmoid mesocolon, 1153, 1157 
transverse mesocolon, 1157 
Mesenteriole of vermiform pro- 
cess, 1178 
Mesenterium, 1157 
Mesocardium, arterial, 603 
venous, 603 
Mesocolic lymph glands, 789 
Mesocolon, sigmoid, 1153, 1157 
transverse, 1157 
sigmoideum, 1157 
transversum, 1157 
Mesoderm, 88 
formation of, 86 
Mesogastrium, 168 
Mesognathion, 299 
Mesonephros, 180 
Mesorchium, 184 
Mesosalpinx, 1251 
Mesovarium, 184, 1244 
Metacarpal bones, 329 
applied anatomy of, 332 
articulations of, 331 
characteristics of, 329 
ossification of, 332 
Metacarpophalangeal articula- 
tions, 430 
Metacarpus, 329 
Metanephros, 187 
Metaphase of karyokinesis, 36 
Metatarsal arteries, 724 
bones, 371 
characteristics of, 371 
veins, 758 
Metatarsophalangeal articula- 
tions, 459 
Metatarsus, 371 
ossification of, 374 
Metathalamus, 127, 858 
Metencephalon, 122 
Metopic suture, 234 
Meynert, basal optic nucleus of, 
861 
fasciculus retroflexus of, 859 
fountain decussation of, 854 
substantia innominata of, 884 
Microcytes, 62 
Mid-brain, 90, 126, 848 
Mid-carpal joint, 427 
Middle capsular artery, 696 
cerebellar peduncles, 841 
commissure of brain, 856 
constrictor muscle, 1142 
Middle costotransverse ligament, 
399 
cutaneous nerve, 980 
dental nerve, 919 
subscapular nerve, 961 
thyrohyoid ligament, 1082 
tibiofibular ligament, 448 
Milk teeth, 1118 
Mitochondria sheath, 81 
Mitral cells, 894, 1013 
orifice, 611 
valve, 612 
Moderator band, 610 
Modiolus of cochlea, 1060 
Molar glands, 1111 
teeth, 1118 
Molecular layer of cortex of 
cerebellum, 842 
of cerebrum, 891 
Monakow, rubrospinal, tract of, 
816 
Monaster or mother star, 36 
Monro, foramen of, 865, 887 
sulcus of, 125, 865 
Mons pubis, 1256 
Veneris, 1256 
Morgagni, hydatid of, 182, 1231, 
1247 
rectal columns of, 1184 
sinus of, 1142 
Morula, 84 
Moss fibres, 844 
Mother star or monaster, 36 
Motor areas of cerebral cortex, 
894 
end-plates, 803 
nerves, 803 
neurons, lower and upper, 896, 
897 
tract, 896 
Mouth, 1110 
development of, 163 
lymphatics of, 777 
mucous membrane of, 1110 
muscles of, dissection of, 469 
Movable articulations, 381 
Movements admitted in joints, 
383 
Mucigen, 37 
Mucous glands of tongue, 1131 
sheaths, 380 
of tendons around ankle, 586 
on back of wrist, 550 
on front of wrist, 548 
tissue, 44 
Muller, orbitalis muscle of, 
1037 
sustentacular fibres of, 1029 
Mullerian duct, 182 
eminence, 182 
Multangular bone, greater, 326 
lesser, 327 
Multicuspid teeth, 1118 
Multifidus muscle, 489 
spinae muscle, 489 
Muscle or Muscles of abdomen, 
498 
abductor hallucis, 587 
digiti quinti (foot), 588 
(hand), 554 
indicis, 556 
minimi digiti, 554 
pollicis, 552 
brevis, 553 
longus, 545 
transversus, 554 
accelerator urinae, 518 
accessorius, 488 
of foot, 589 
adductor brevis, 568 
hallucis, 589 
longus, 567 
magnus, 568 
obliquus hallucis, 589 
pollicis, 554 1384 
INDEX 
Muscle or Muscles, adductor pol- 
licis obliquus, 554 
transversus, 554 
of anal region, 515 
anconaeus, 544 
anterior crural, 576 
femoral, 562 
vertebral, 483 
anterolateral, of abdomen, 498 
antitragicus, 1046 
applied anatomy of, 410 
of arm, 533 
arrectores pilorum, 1077 
articularis genu or subcrureus, 
566 
aryepiglotticus, 1089 
arytaenoideus, 1088 
attollens aurem, 1045 
attrahens aurem, 1045 
of auricula or pinna, 1045 
auricularis, 1045 
axillary arch, 524 
azygos uvulae, 1114 
biceps, 534 
brachii, 534 
femoris, 574 
flexor cubiti, 534 
biventer cervicis, 489 
Bowman's, 1023 
brachialis, 535 
anticus, 535 
brachioradialis, 542 
buccinator, 470 
bulbocavernosus, 518, 520 
caninus, 470 
cardiac, 68 
cervical, 475 
cervicalis ascendens, 488 
chondr oglossus, 1130 
ciliaris, 1023 
coccygeus, 514 
columns, 65 
complexus, 489 
compressor naris, 469 
urethrae, 520 
constrictors, 1141, 1142 
pharyngis inferior, 1141 
medius, 1142 
superior, 1142 
urethrae, 521 
coracobrachialis, 534 
corrugator, 468 
cutis ani, 516 
supercilii, 468 
cremaster, 504 
cricoarytaenoideus, 1088 
cricoarytenoid, 1088 
cricothyreoideus, 1088 
cricothyroid, 1088 
crureus, 566 
deep, of back, 485 
deltoid, 530 
deltoideus, 530 
depressor alae nasi, 469 
anguli oris, 470 
labii inferioris, 470 
septi, 469 
detrusor urinae, 1223 
development of, 69, 116 
diaphragma, 493 
digastric, 480 
digastricus, 480 
dilatator naris, 469 
pupillae, 1025 
tubae, 1053 
dorsal antibrachial, 542 
dorsoepitrochlearis brachii, 524 
ejaculator urinae, 518 
epicranius, 465 
erector clitoridis, 521 
penis, 518 
spinae, 488 
extensor carpi radialis brevior, 
542 
brevis, 542 
Muscle or Muscles, extensor carpi 
radialis longior, 542 
longus, 542 
ulnar is, 544 
coccygis, 490 
digiti quinti proprius, 544 
digitorum brevis, 586 
communis, 544 
longus, 577 
hallucis longus, 577 
indicis, 546 
proprius, 546 
minimi digiti, 544 
ossis metacarpi pollicis, 545 
pollicis brevis, 545 
longus, 545 
primi internodii pollicis, 545 
proprius hallucis, 577 
secunda internodii pollicis, 
545 
■ external sphincter ani, 516 
of eyelids, 467 
fasciculi of, 64 
fibres of, 64 
fixation, 462 
flexor accessorius, 589 
brevis minimi digiti, 554, 590 
carpi radialis, 537 
ulnar is, 539 
digiti quinti brevis [of foot], 
590 
[of hand], 554 
digitorum brevis, 588 
longus, 581 
profundus, 540 
sublimis, 539 
hallucis brevis, 589 
longus, 581 
pollicis brevis, 553 
longus, 540 
of foot, 586 
of forearm, 536 
form of, 461 
frontalis, 466 
gastrocnemius, 578 
gemellus, 573 
genioglossus, 1129 
geniohyoglossus, 1129 
geniohyoid, 481 
geniohyoideus, 481 
glossopalatinus, 1114, 1129 note 
glutaeus maximus, 569 
medius, 570 
minimus, 570 
of gluteal region, 569 
gracilis, 567 
hamstring, 574 
of hand, 546 
dissection of, 546 
of head, 464 
helicis major, 1045 
minor, 1045 
hyoglossus, 1129 
of iliac region, 559 
iliacus, 561 
iliococcygeus, 514 
iliocostalis, 488 
cervices, 488 
dorsi, 488 
lumborum, 488 
iliosacralis, 514 
incisivus labii inferior is, 472 
superioris, 472 
infracostal, 492 
infrahyoid, 480 
infraspinatus, 533 
insertion of, 462 
intercostal, 492 
inter co stales, 492 
intermediate volar, 555 
internal sphincter ani, 516 
interossei, dorsal, 591 
of foot, 590 
of hand, 555 
plantar, 591 
Muscle or Muscles, inter spinales, 
490 
intertransversales, 490 
inter transversarii, 490 
involuntary, 67 
ischiocavernosus, 518, 520 
of larynx, 1088 
lateral cervical, 475 
crural, 582 
vertebral, 484 
volar, 552 
latissimus dorsi, 524 
of leg, 576 
levator anguli oris, 470 
scapulae, 525 
ani, 513 
glandulae thyreoideae, 1262 
menti, 470 
palati, 1113 
palpebrae superior is, 1034 
prostatae, 514 
scapulae, 525 
veli palatini, 1113 
levatores costarum, 493 
lingualis, 1130 
longissimus capitis, 489 
cervicis, 488 
dorsi, 488 
longitudinalis linguae, 1130 
longus capitis, 484 
colli, 483 
of lower extremity, 559 
lumbricales [of foot], 589 
[of hand], 555 
lymphatics of, 67 
masseter, 472 
of mastication, 472 
medial femoral, 567 
volar, 554 
mentalis, 470 
of mouth, 469 
multi ft dus, 489 
spinae, 489 
mylohyoid, 481 
mylohyoideus, 481 
nasalis, 469 
nasolabialis, 472 
nerves and vessels of, 67 
of nose, 468 
oblique, 499, 503 
inferior, 1036 
superior, 1035 
obliquus auriculae, 1046 
capitis, 491 
externus abdominis, 499 
inferior, 491 
internus abdominis, 503 
oculi inferior, 1036 
superior, 1035 
superior, 491 
obturator externus, 573 
internus, 572 
occipitalis, 466 
occipitofrontalis, 465 
ocular, 1034 
omohyoid, 482 
omohyoideus, 482 
opponens digiti quinti [of foot], 
590 
[of hand], 555 
minimi digiti, 555 
pollicis, 553 
orbicularis oculi, 467 
oris, 471 
palpebrarum, 467 
orbitalis of H. Muller, 1037 
origin of, 462 
of palate, 1113 
palatoglossus, 1114, 1129 note 
palatopharyngeus, 1114 
palmaris brevis, 554 
longus, 538 
pectineus, 567 
pectoralis major, 526 
minor, 528 INDEX 
1385 
Muscle or Muscles of pelvis, 510 
perineal, superficial transverse, 
518, 520 
of perineum, 514 
peronaeus brevis, 583 
longus, 582 
tertius, 578 
pharyngopalatinus, 1114 
of pharynx, 1141 
of pinna or auricula, 1045 
piriformis, 571 
plain, 67 
plantar, first layer, 587 
fourth layer, 590 
second layer, 589 
third layer, 589 
plantar is, 579 
plate, 102 
platysma, 475 
popliteus, 581 
posterior crural, 578 
femoral, 574 
procerus, 469 
pronator quadratus, 540 
teres, 537 
psoas magnus, 560 
major, 560 
minor, 561 
parvus, 561 
pterygoid, 474 
pterygoideus externus, 474 
internus, 474 
pubococcygeus, 514 
puborectalis, 514 
pubovesicales, 1221 
pyramidalis abdominis, 507 
nasi, 469 
quadratus femoris, 573 
labii superioris, 469 
inferioris, 470 
lumborum, 510 
menti, 470 
plantae, 589 
quadriceps extensor, 565 
femoris, 565 
recti [of eyeball], 1035 
rectococcygeal, 1185 
rectovesicales, 1221 
rectus abdominis, 506 
capitis anterior, 484 
lateralis, 484 
posterior major, 491 
minor, 491 
anticus major, 484 
minor, 484 
posticus major, 491 
minor, 491 
femoris, 565 
retrahens aurem, 1045 
rhomboideus major, 525 
minor, 525 
risorius, 472 
rotatores, 490 
spinae, 490 
sacrospinalis, 488 
salpingopharyngeus ,1143 
sarcous elements of, 66 
sartorius, 565 
scalenus anterior, 484 
anticus, 484 
medius, 484 
posterior, 485 
posticus, 485 
of scalp, 464 
semimembranosus, 575 
semispinalis capitis, 489 
cervicis, 489 
colli, 489 
dorsi, 489 
semitendinosus, 575 
serratus anterior, 529 
magnus, 529 
posterior inferior, 493 
superior, 493 
posticus inferior, 493 
Muscle or Muscles, serratus pos- 
ticus superior, 493 
soleus, 579 
sphincter ani, 516 
externus, 516 
internus, 516 
pupillae, 1025 
recti, 514 
urethrae membranaceae, 520, 
521 
vaginae, 520 
vesicae, 1223 
spinalis capitis, 489 
cervicis, 489 
colli, 489 
dorsi, 489 
splenius capitis, 486 
cervicis, 487 
colli, 487 
stapedius, 1055 
sternocleidomastoideus, 478 
sternohyoid, 482 
sternohyoideus, 482 
sternomastoid, 478 
sternothyreoideus, 482 
sternothyroid, 482 
striped, 64 
structure of, 64 
styloglossus, 1130 
stylohyoid, 481 
stylohyoideus, 481 
stylopharyngeus, 1142 
subanconeus, 536 
subclavius, 528 
subcostales, 492 
subcrureus, 566 
suboccipital, 490 
sub scapular is, 531 
superficial cervical, 475 
supinator, 544 
brevis, 544 
longus, 542 
suprahyoid, 480 
supraspinatus, 532 
suspensory, of duodenum, 1171 
synergic, 462 
temporal, 473 
temporalis, 473 
tendons of, 463 
tensor fasciae femoris, 565 
latae, 565 
palati, 1113 
tarsi, 468 
tympani, 1055 
veli palatini, 1113 
teres major, 533 
minor, 533 
of thigh, 562 
of thorax, 492 
thyreoarytaenoideus, 1089 
thyreoepiglotticus, 1090 
thyrohyoideus, 482 
thyroarytenoid, 1089 
thyrohyoid, 482 
tibialis anterior, 576 
anticus, 576 
posterior, 582 
of tongue, 1044 
trachealis, 1093 
trachelomastoideus, 489 
tragicus, 1046 
transversalis, 504 
cervicis, 488 
transversus auriculae, 1046 
abdominis, 504 
linguae, 1130 
menti, 470 
nuchae, 466 
pedis, 589 
perinaei, 518, 520 
profundus, 521, 522 
superficialis [in female], 520 
[in male], 518 
thoracis, 492 
trapezius, 522 
Muscle or Muscles, triangularis, 
470 
sterni, 492 
triceps, 535 
brachii, 535 
extensor cubiti, 535 
surae, 579 
of trunk, 485 
of tympanic cavity, 1055 
of upper extremity, 522 
of ureters, 1222 
unstriped, 67 
structure of, 67 
urogenital region [female], 520 
[male], 517 
of uvula, 1114 
vastus externus, 566 
intermedins, 566 
internus, 566 
lateralis, 566 
medialis, 566 
vertebral, anterior, 483 
lateral, 484 
verticalis linguae, 1130 
vocalis, 1089 
volar antibrachial, 537 
voluntary, 64 
zygomaticus, 470 
major, 470 
Muscular fibres of heart, 613 
process of arytenoid cartilage, 
1081 
tissue, 64, 68 
triangle, 483, 643 
Muscularis mucosae, 1173 
Musculi oculi, 1034 
ossiculorum auditus, 1055 
papillares [of left ventricle], 612 
[of right ventricle], 610 
pectinati [of left auricle], 611 
[of right auricle], 607 
pubovesicales, 1223 
Musculocutaneous nerve of arm, 
962 
of leg, 990 
Musculophrenic artery, 666 
Musculospiral groove, 311 
nerve, 968 
Musculus accessorius, 488 
ciliaris, 1023 
incisivus labii inferioris, 472 
superioris, 472 
nasolabialis, 472 
suspensorius duodeni, 1171 
uvulae, 1114 
Myelencephalon, 122 
Myelocytes, 51 
Myeloplaxes, 51 
Mylohyoid artery, 641 
groove, 272 
line, 272 
muscle, 481 
nerve, 924 
Mylohyoideus muscle, 481 
Myocardium, 613 
Myoccel, 91 
Myology, 461 
N 
Nails, 1075 
Nares, 1008, 1009 
Nasal aperture, anterior, 294 
.artery, 650 
lateral, 635 
bones, 255 
articulations of, 256 
ossification of, 256 
cartilages, 1008 
cavities, 292, 1010 
applied anatomy of, 1015 
arteries of, 1012 
lymphatic vessels of, 776 
mucous membrane of, 1012 1386 
INDEX 
Nasal cavities, nerves of, 1012, 
1013 
veins of, 1013 
vestibule of, 1010 
concha, inferior, 268 
middle, 254 
superior, 254 
crest, 261, 266 
duct, 1042 
fossa, 1010 
index, 296 
laminae, 111 
mucous membrane, 1012 
nerve from ophthalmic, 916 
nerves from nasopalatine gan- 
glion, 921 
notch of frontal bone, 235 
of maxilla, 257 
part of frontal bone, 235 
of pharynx, 1138, 1139 
process of frontal bone, 235 
of maxilla, 260 
processes of fetus, 111 
septum, 293, 1012 
spine, anterior, 257, 262 
of frontal bone, 235 
posterior, 266, 278 
Nasalis muscle, 469 
Nasion, 235, 285, 296 
Nasmyth's membrane, 1123 
Nasociliary nerve, 916 
Nasofrontal vein, 745 
Nasolabialis muscle, 472 
Nasolacrimal duct, 1042 
Nasooptic furrow, 112, 137 
Nasopalatine nerve, 921 
recess, 1012 
Nasopharynx, 1139 
Nasus externus, 1008 
Navicular bone of carpus, 323 
of tarsus, 368 
fossa, 1257 
Neck, lymphatic glands of, 778 
vessels of, 779 
muscles of, 475 
triangles of, 642 
veins of, 734 
Nelaton's line, 1329 
Neopallium, 128 
Nerve cells, 70 
of cerebellar cortex, 842 
of cerebral cortex, 891 
of medulla spinalis, 811, 812 
endings, free, 813, 1069 
fasciculi of medulla spinalis, 
814 
fibres of cerebral cortex, 
892 
medullated, 73 
non-medullated, 76 
posterior, 948 
roots, anterior, 948 
Nerve or Nerves, abducent, 927 
accessory, 944 
acoustic, 934, 1067 
alveolar, anterior superior, 919 
middle, 919 
posterior, 918 
inferior, 922 
anococcygeal, 992 
anterior crural, 979 
interosseous, 965 
superior alveolar, 919 
thoracic, 961 
tibial, 990 
antibrachial cutaneous, 963, 
964 
Arnold's, 941 
auditory, 934 
auricular, great, 956 
of auriculotemporal, 923 
posterior, 933 
of vagus, 941 
auriculotemporal, 923 
axillary, 961 
Nerve or Nerves of Bell, 960 
brachial cutaneous, lateral, 962 
medial, 964 
posterior, 969 
bronchial, 943 
buccal, of facial, 933 
long, 922 
buccinator, 922 
calcanean, medial, 988 
cardiac, cervical, 942 
great, 997 
of sympathetic, 997 
thoracic, 943 
of vagus, 942 
caroticotympanic, 996, 1056 
carotid of glossopharyngeal, 
939 
cavernous, of penis, 1005 
cerebral, 907 
abducent, 927 
accessory, 944 
acoustic, 934 
facial, 929 
glossopharyngeal, 937 
hypoglossal, 945 
oculomotor, 911 
olfactory, 908 
optic, 909 
trigeminal, 914 
trochlear, 913 
vagus, 940 
cerebrospinal, structure of, 801 
cervical, 957 
cutaneous, 957 
divisions of, anterior, 954 
posterior, 951 
of facial, 933 
transverse, 957 
chorda tympani, 932, 1056 
ciliary, 916, 917 
circumflex, 961 
coccygeal, division of, anterior, 
982 
posterior, 954 
cochlear, 935, 1068 
cceliac, of vagus, 943 
cranial, 907 
crural, anterior, 980 
cutaneous cervical, 957 
external, 977 
internal, 964, 981 
lesser, 964 
middle, 980 
deep branch of radial, 970 
of ulnar, 968 
peroneal, 990 
petrosal, 919 
temporal, 921 
descending ramus of hypo- 
glossal, 947 
development of, 119, 131 
digastric, from facial, 933 
digital, of lateral plantar, 988 
of medial plantar, 988 
of median, 966 
of radial, 970 
of superficial peroneal, 990 
of ulnar, 968 
dorsal antibrachial cutaneous, 
969 
branch of ulnar, 967 
cutaneous, lateral, 988 
medial, 990 
of penis, 992 
scapular, 960 
of dura mater, 902 
dural, 941 
eighth, 934 
eleventh, 944 
end-organs of, 1069 
endoneurium of, 802 
epineurium of, 801 
external nasal, 919 
plantar, 989 
popliteal, 989 
Nerve or Nerves, external saphe- 
nous, 988 
spermatic, 977 
facial, 929 
femoral, 980 
cutaneous, anterior, 980 
lateral, 977 
posterior, 985 
fifth, 914 
first, 908 
fourth, 913 
frontal, 916 
ganglia of, 803 
gastric branches of vagus, 943 
genitocrural, 977 
genitofemoral, 977 
glossopharyngeal, 937 
gluteal, 984, 985 
great auricular, 956 
greater occipital, 951 
splanchnic, 998 
superficial petrosal, 919 
hemorrhoidal, inferior, 991 
hepatic branches of vagus, 943 
hypoglossal, 945 
iliohypogastric, 976 
ilioinguinal, 977 
incisive, 924 
inferior dental, 924 
infraorbital, 917 note 
infrapatellar, 981 
infratrochlear, 916 
intercostal, 972 
intercostobrachial, 973 
intermedius of Wrisberg, 929 
internal cutaneous, of arm, 964 
carotid, 995 
plantar, 998 
popliteal, 987 
saphenous, 981 
interosseous, dorsal, 970 
volar, 965 
Jacobson's, 939, 1056 
jugular, 997 
labial, superior, 919 
lacrimal, 915 
laryngeal, 942 
laryngopharyngeal of sympa- 
thetic, 997 
lateral antibrachial cutaneous, 
963, 964 
brachial cutaneous, 962 
femoral cutaneous, 977 
plantar, 984 
lesser splanchnic, 999 
lingual, 923 
of glossopharyngeal, 940 
long ciliary, 916 
saphenous, 981 
subscapular, 961 
thoracic, 960 
lowest splanchnic, 999 
lumbar, divisions of, anterior, 
974 
posterior, 953 
lumboinguinal, 977 
lumbosacral trunk, 975 
mandibular, 921 
of facial, 933 
masseteric, 921 
maxillary, 917 
inferior, 921 
medial antibrachial cutaneous, 
964 
brachial cutaneous, 964 
sural cutaneous, 998 
plantar, 998 
median, 965 
meningeal, of hypoglossal, 947 
of maxillary, 917 
middle, 917 
of spinal nerves, 947 
of vagus, 941 
mental, 924 
motor, 803 INDEX 
1387 
Nerve or Nerves, musculocuta- 
neous, of arm, 962 
of leg, 990 
musculospiral, 968 
mylohyoid, 924 
nasal, of ophthalmic, 916 
from sphenopalatine gan- 
glion, 921 
nasociliary, 916 
nasopalatine, 921 
ninth, 937 
obturator, 979 
accessory, 980 
occipital, greater, 951 
smaller, 956 
third, 951 
oculomotor, 911 
oesophageal, 943 
olfactory, 908 
ophthalmic, 915 
optic, 909 
orbital, 917 
their relation, in cavernous 
sinus, 928 
in orbit, 928 
in superior orbital fis- 
sure, 928 
origins of, 803 
palatine, 920, 921 
palmar cutaneous, of median, 
965 
of ulnar, 967 
palpebral, inferior, 919 
perforating cutaneous, 991 
perineurium of, 801 
plexus of, 802 
peroneal, 989, 990 
petrosal, deep, 919, 996 
external, 997 
greater superficial, 919 
smaller superficial, 1056 
large, deep, 919 
superficial, 919, 931 
pharyngeal, of glossopharyn- 
geal, 940 
of sphenopalatine ganglion, 
921 
of vagus, 942 
phrenic, 957 
plantar, 988, 989 
pneumogastric, 940 
popliteal, external, 989 
internal, 987 
of pterygoid canal, 920, 996 
to pterygoideus internus, 921 
externus, 922 
pterygopalatine, 921 
pudendal, 991 
inferior, 985 
pudic, 991 
internal, 991 
pulmonary, 943 
radial, 970 
rami communicantes, gray and 
white, 949, 950, 995 
recurrent, 942 
respiratory, of Bell, 957 
to rhomboids, 960 
roots, 818, 948 
sacral, 982 
saphenous, 981 
internal, 981 
short, 988 
sciatic, 985 
scrotal, posterior, 991 
second, 909 
seventh, 929 
short ciliary, 917 
sixth, 927 
smaller occipital, 956 
spermatic, external, 977 
sphenopalatine branches of 
maxillary, 918 
spinal, 947 
accessory, 944 
Nerve or Nerves, spinal, develop- 
ment of, 119 
divisions of, anterior pri- 
mary, 954 
posterior primary, 951 
roots of, 818, 948 
spinosus, 921 
splanchnic, 998, 999 
to stapedius, 932 
stylohyoid, 933 
to subclavius, 960 
suboccipital, 951, 954 
subscapular, 961 
superior labial, 919 
superficial branch of radial, 969 
of ulnar, 968 
supra-acromial, 957 
supraclavicular, 957 
supraorbital, 916 
suprascapular, 960 
suprasternal, 957 
supratrochlear, 916 
sural, 998 
sympathetic, 994 
structure of, 803 
of taste, 1008 
temporal, deep, 922 
of facial, 933 
temporomalar, 917 
tenth, 940 
terminations of, 803 
third, 911 
thoracic, divisions of, anterior, 
972 
posterior, 952 
lateral anterior, 961 
medial anterior, 961 
thoracodorsal, 961 
thyrohyoid, 947 
tibial, 987 
anterior, 990 
of tongue, 1132 
tonsillar, 940 
transverse cervical, 957 
trifacial, 914 
trigeminal, 914 
trochlear, 913 
twelfth, 945 
tympanic, of glossopharyngeal, 
939,1056 
ulnar, 967 
collateral, 969 
of urethral bulb, 992 
vagus, 940 
vestibular, 935, 1068 
Vidian, 920, 996 
volar digital, 966 
interosseous, 965, 968 
of Wrisberg, 964 
zygomatic, 917 
of facial, 933 
zygomaticofacial, 918 
zygomaticotemporal, 918 
Nervi anococcygei, 992 
auriculares anteriores, 923 
carotid externi, 997 
cavernosi penis minores, 1005 
cerebrates, 907 
cervicales, 951, 954 
ramus lateralis, 951 
medialis, 951 
ciliares longi, 916 
clunium inferiores, 985 
coccygeus, 954, 982 
communicantes cervicales, 957 
digitales dorsales hallucis, 990 
plantares communes, 988 
proprii, 988 
ethmoidales, 916 
inter co stales, 972 
rami cutanei laterales, 973 
labiates anteriores, 974 
posteriores, 953 
lumbales, 953 
nervorum, 802 
Nervi olfactorii, 908 
palatini, 920 
sacrales, 953, 982 
sphenopalatini, 918 
spinales, 947 
radix anterior, 948 
posterior, 948 
rami anteriores, 954 
posteriores, 957 
subscapular es, 961 
supraclaviculares anteriores, 957 
medii, 957 
posteriores, 957 
temporales profundi, 922 
thoracales, 952 
anteriores, 961, 972 
ramus lateralis, 953 
medialis, 952 
Nervous system, description of, 
801 
development of, 117 
tissue, 69 
Nervus abducens, 927 
accessorius, 944 
ramus externus, 945 
internus, 944 
acusticus, 934, 1067 
radix cochlearis, 935 
vestibularis, 935 
alveolaris inferior, 923 
auricularis magnus, 956 
posterior, 933 
auriculotemporalis, 923 
rami parotidei, 923 
temporales superficiales, 
923 
axillaris, 961 
buccinatorius, 922 
canalis pterygoidei, 920 
cardiacus inferior, 998 
medius, 997 
superior, 997 
caroticotympanicus inferior, 939 
superior, 939 
cavernous penis major, 1005 
cochlearis, 1068 
clunium inferior medialis, 991 
communicans fibularis, 990 
tibialis, 988 
cutaneus antebrachii dorsalis, 
969 
lateralis, 964 
medialis, 964 
ramus ulnaris, 964 
volaris, 964 
brachii medialis, 964 
posterior, 969 
colli, 957 
rami inferiores, 957 
ramus superior, 957 
dorsalis intermedius, 990 
medialis, 990 
femoris lateralis, 977 
posterior, 985 
rami perineales, 985 
surae lateralis, 990 
medialis, 988 
descendens cervicales, 957 
dorsalis penis, 992 
scapulae, 960 
facialis, 929 
rami buccales, 933 
temporales, 933 
zygomatici, 933 
ramus colli, 933 
digastricus, 933 
marginalis mandibulae, 933 
stylohyoideus, 933 
femoralis, 980 
frontalis, 916 
furcalis, 975 
genitofemoralis, 971 
glossopharyngeus, 937 
ganglion inferius, 939 
superius, 938 1388 
INDEX 
Nervus glossopharyngeus, rami 
linguales, 940 
pharyngei, 940 
tonsillares, 940 
ramus stylopharyngeus, 940 
glutaeus inferior, 985 
superior, 984 
haemorrhoidalis inferior, 991 
hyoglossus, 945 
ramus descendens, 947 
thyreohyoideus, 947 
iliohypogastricus, 976 
ramus lateralis, 977 
ilioinguinalis, 977 
infratrochlearis, 916 
intermedius [of Wrisberg], 929 
interosseus dorsalis, 970 
volaris, 965 
ischiadicus, 985 
rami articulares, 985 
musculares, 985 
lacrimalis, 915 
laryngeus superior, 942 
ramus externus, 942 
internus, 942 
lingualis, 923 
lumboinguinalis, 9T7 
mandibularis, 921 
massetencus, 921 
maxillaris, 917 
rami alveolares superiores 
posteriores, 917 
labialis superiores, 919 
nasales externi, 919 
palpebrales inferiores, 919 
ramus alveolaris superior an- 
terior es, 919 
medius, 919 
meatus auditorii externi, 923 
medianus, 965 
rami musculares, 965 
ramus cutaneus palmaris n. 
mediani, 965 
meningeus medius, 917 
musculo cutaneus, 962 
ramus dorsalis, 964 
volaris, 964 
mylohyoideus, 923 
nasociliaris, 916 
obturatorius, 979 
accessorius, 980 
ramus anterior, 979 
posterior, 980 
occipitalis major, 951 
minor, 956 
ocuLomotorius, 911 
ophthalmicus, 915 
opticus, 909 
palatinus anterior, 920 
medius, 920 
posterior, 921 
perinei, 991 
peronaeus communis, 989 
rami articulares, 990 
profundus, 990 
petrosus profundus, 919 
superficialis major, 919 
phrenicus, 957 
plantaris lateralis, 989 
ramus profundus, 989 
superficialis, 989 
medialis, 988 
pterygoideus externus, 922 
internus, 921 
pudendus, 991 
radialis, 968 
rami musculares, 969 
ramus superficialis, 969 
recurrens, 942 
saphenus, 981 
spermaticus externus, 977 
spinosus, 921 
splanchnicus imus, 999 
major, 998 
minor, 999 
Nervus stapedius, 932 
sub scapular is, 960 
supraorbitalis, 916 
supratrochlearis, 916 
thoracalis longus, 960 
thoracodorsalis, 961 
tibialis, 987 
rami articulares, 987 
calcanei mediates, 988 
musculares, 987 
trigeminus, 914 
trochlearis, 913 
tympanicus, 939 
ulnaris, 967 
rami musculares, 967 
ramus cutaneus palmaris, 967 
dorsalis manus, 967 
profundus, 968 
superficialis, 968 
volaris manus, 968 
vagus, 940 
rami bronchioles anteriores, 
943 
posteriores, 943 
cardiaci inferiores, 943 
superiores, 942 
coeliaci, 943 
gastrici, 943 
hepatica, 943 
oesophagei, 943 
ramus auricularis, 941 
meningeus, 941 
pharyngeus, 942 
vestibularis, 1068 
zygomaticus, 917 
ramus zygomaticofacialis, 918 
zygomaticotemporalis, 918 
Net-work, carpal, dorsal, 678 
volar, 678 
malleolar lateral, 724 
medial, 723 
Neumann, dentinal sheath of, 
1120 
Neural arch, 197 
canal, 88 
crest, 88, 120 
folds, 88 
groove, 88 
tube, 88 
Neurenteric canal, 88 
Neuroblasts, 118 
Neurocentral synchondrosis, 210 
Neuroglia, 70 
of cord, 810 
Neuro keratin, 75 
Neurolemma, 75 
Neurology, 801 
Neuromeres, 806 
Neuromuscular spindles, 1071 
Neuron theory, 805 
Neurons, motor, lower, 897 
upper, 896 
sensory, highest, 899 
intermediate, 899 
lowest, 899' 
Neurotendinous spindles, 1070 
Neutrophil colorless corpuscles, 
62 
Nidus avis of cerebellum, 839 
Ninth nerve, 937 
Nipple or papilla of mamma, 1258 
Nissl's granules, 72 
Node, atrioventricular, 614 
sinoatrial, 614 
Nodes of Ranvier, 75 
Nodular lobe, 839 
Nodule of cerebellum, 839 
Noduli lymphatici aggregati, 1175 
solitarii, 1175, 1185 
Nodulus vermis, 839 
Non-medullated nerve fibres, 76 
Normae of skull, basalis, 278 
frontalis, 285 
lateralis, 281 
occipitalis, 284 
Normae of skull, verticalis, 277 
Normoblasts, 51 
Nose, 1008 
accessory sinuses of, 1014 
alar cartilages of, 1009 
applied anatomy of, 1015 
arteries of, 1009, 1012 
cartilage of septum of, 1008 
cartilaginous frame-work [of, 
1008 
cavities of, 1010 
development of, 111 
external, 1008 
lateral cartilage of, 1009 
lymphatics of, 776 
mucous membrane of, 1012 
muscles of, 468 
nerves of, 1013 
veins of, 1013 
Notch, acetabular, 339 
cardiac, 1104 
cerebellar, anterior, 837 
posterior, 837 
ethmoidal, 235 
intertragic, 1044 
jugular, 230 
lacrimal, 257 
mandibular, 273 
mastoid, 239, 280 
nasal, of frontal, 235 
of maxilla, 257 
parietal, 239 
preoccipital, 867 
presternal, 217 
of Rivinus, 1049 
scapular, 306 
sciatic, 336 
sphenopalatine, 268 
superior thyroid, 1080 
supraorbital, 235, 286, 288 
ulnar, of radius, 321 
umbilical, of liver, 1194 
vertebral, 197 
Notochord, 90 
Nuchal line, 227, 281 
Nuck, canal of, 187, 1251 
Nuclear layer of cerebellar cortex, 
843 
layers of retina, 1028 
matrix, 34 
membrane, 34 
substance, 34 
Nucleated sheath of Schwann, 
73 
Nuclei of cochlear nerve, 836,^935 
of glossopharyngeal and vagus 
nerves, 829 
of oculomotor nerve, 911 
olivary, 830 
of origin of motor nerves, 908 
pontis, 835, 908 
of termination of sensory 
nerves, 908 
of trigeminal nerve, 835, 855 
of vestibular nerve, 836, 935 
Nucleoli, 34 
Nucleus of abducent nerve, 835 
of accessory nerve, 830, 944 
ambiguus, 829 
amygdalae, 883 
amygdaline, 839 
arcuatus, 831 
of Bechterew, 836, 935 
caudate, 881 
caudatus, 881 
of a cell, 34 
of Darkschewitsch, 860 
of Deiters, 836, 935 
dentatus [of cerebellum], 844 
dorsalis, 813 
emboliformis, 844 
of facial nerve, 836, 929 
fastigii, 844 
globosus, 844 
of hypoglossal nerve, 829 INDEX 
1389 
Nucleus, inferior central, 833 
intercalatus, 848 
of lateral lemniscus, 935 
lateralis, 833 
of lens, 1031 
lenticular, 881 
lentiform, 881 
lentiformis, 881 
of Luys, 860 
of medial longitudinal fascicu- 
lus, 851 
nervus abducentis, 835 
acustici, 836 
facialis, 836 
trigemini, 835 
of oculomotor nerve, 855, 911 
olivaris superior, 835 
olivary, 830, 835 
of posterior commissure, 860 
pulposus, 104 
red, 850 
of Roller, 833 
segmentation, 84 
sensory, 930 
trapezoid, 835 
of trochlear nerve, 855, 913 
of vagus nerve, 829 
Nuel, space of, 1067 
Nuhn, glands of, 1131 
Nutrient artery of bone, 52 
Nutritive yolk, 78 
Nymphae, 1257 
O 
Obelion, 278, 296 
Obex, 846 
Oblique cord, 423 
inguinal hernia, 1187 
ligament, 423 
line of fibula, 360 
of mandible, 271 
of radius, 320 
muscles, 499, 503 
inferior, 1036 
superior, 1035 
popliteal ligament, 439 
ridge of clavicle, 302 
sinus of pericardium, 603 
vein of left atrium, 603, 731 
of Marshall, 603, 731 
Obliquus auriculae muscle, 1046 
capitis inferior muscle, 491 
superior muscle, 491 
externus abdominis muscle, 499 
inferior muscle, 491 
internus abdominis muscle, 
503 
oculi inferior muscle, 1036 
superior muscle, 1035 
superior muscle, 491 
Obliterated ductus venosus, 765 
hypogastric artery, 700 
umbilical vein, 765, 1150 
Obturator artery, 702 
peculiarities of, 703 
crest, 338 
externus muscle, 573 
foramen, 339 
groove, 339 
internus muscle. 572 
fascia of, 510 
lymph gland, 787 
membrane, 572 
nerve, 979 
accessory, 980 
applied anatomy of, 992 
tubercle, 339 
vein, 760 
Occipital artery, 635 
bone, 227 
articulations of, 231 
basilar part of, 230 
lateral parts of, 229 
Occipital bone, ossification of, 231 
squama of, 227 
structure of, 231 
condyles, 229 
crest, internal, 228, 292 
fossae, 228 
groove, 239, 280 
lobe, 871 
lymph glands, 774 
nerve, 951, 956 
point, 296 
protuberance, 227, 228, 282 
sinus, 743 
sulcus, 871 
triangle, 483, 645 
vein, 734 
Occipitoaxial ligaments, 393 
Occipitofrontal fasciculus, 891 
Occipitofrontalis muscle, 465 
Occipitomastoid suture, 282 
Occipitotemporal convolution, 
871 
Ocular muscles, 1034 
applied anatomy of, 1038 
Oculomotor sulcus, 849 
nerve, 911 
applied anatomy of, 913 
Odontoblasts, 1119, 1123 
Odontoid ligaments, 393 
process of axis, 200 
(Esophageal arteries, 663, 685 
glands, 1146 
hiatus in diaphragm, 496 
nerves, 943 
plexus, 943 
(Esophagus, 1144 
abdominal portion of, 1145 
applied anatomy of, 1146 
cervical portion of, 1144 
lymphatic vessels of, 800 
nerves of, 1146 
structure of, 1145 
tela submucosa, 1145 
thoracic portion of, 1144 
tunica mucosa, 1146 
muscularis, 1145 
vessels of, 1146 
Olecranon, 315 
fossa, 313 
Olfactory areas, 111 
bulb, 874, 893 
structure of, 894 
cells, 1012 
fasciculus, 887 
hair, 1012 
lobe, 874 
nerves, 908 
applied anatomy of, 909 
development of, 134 
pits, 111 
sulcus, 870 
tract, 874 
trigone, 875 
Oliva, 824 
Olive, 824 
peduncle of, 830 
Olivary body, 824 
nucleus, 830, 835 
Omental bursa, 1152, 1155 
boundaries of, 1155, 1156 
recess, 1156 
Omentum, gastrocolic, 1157 
gastrohepatic, 1156 
greater, 1157 
lesser, 1156 
majus, 1157 
minus, 1156 
small, 1156 
Omohyoid muscle, 482 
Omohyoideus muscle, 482 
Ontogeny, 77 
Oocytes, primary, 77 
secondary, 80 
Oogonia, 77 
Ooplasm, 77 
Opening of aorta in left ventricle, 
612 
aortic, in diaphragma, 495 
atrioventricular, left, 611 
right, 609 
caval, in diaphragma, 495 
of coronary sinus, 608 
of inferior vena cava, 607 
oesophageal, in diaphragma, 
496 
of pulmonary artery, 609 
veins, 611 
saphenous, 562 
of superior cava, 607 
of thorax, 601 
Openings in diaphragma, 495 
in roof of fourth ventricle, 847 
Opercula of insula, 873 
Ophryon, 296 
Ophthalmic artery, 648 
ganglion, 917 
nerve, 915 
veins, 745 
Opisthion, 281, 296 
Opisthotic centre of temporal 
bone, 244 
Opponens digiti quinti muscle, 
555 
minimi digiti muscle, 555 
pollicis muscle, 553 
Optic axis, 1017 
chiasma, 862, 909 
commissure, 862 
cup,134 
disk, 1027 
foramen, 246, 250, 290 
groove, 246 
nerve, 909 
applied anatomy of, 911 
radiations, 857, 864 
recess, 865 
stalk, 126, 134 
thalamus, 855 
tracts, 863, 909 
vesicle, 126, 134 
Ora serrata, 1026, 1029 
Oral cavity, 1110 
part of pharynx, 1139 
Orbicular ligament, 422 
Orbicularis oculi muscle, 467 
lacrimal part, 468 
orbital part, 468 
palpebral part, 468 
oris muscle, 471 
palpebrarum muscle, 467 
Orbiculus ciliaris muscle, 1023 
Orbitae, 286 
Orbits, 286 
relation of nerves in, 928 
Orbital fascia, 1038 
fissure, inferior, 284, 288 
superior, 249, 288, 290 
gyri, 870 
index, 296 
nerve, 917 
operculum, 873 
plates, 235 
process of palatine bone, 267 
of zygomatic bone, 264 
septum, 1039 
sulcus, 870 
vein, 734 
Orbitalis muscle of H. Muller, 
1037 
Orbitosphenoids, 249 
Organ, enamel, 1123 
of Giraldos, 1236 
of hearing, 1043 
of Rosenmuller, 181, 1244 
of sight, 1017 
of smell, 1008 
spiral, of Corti, 1065 
Organa genitalia muliebria, 1243 
virilia, 1228 * 
oculi accessoria, 1034 1390 
INDEX 
Organon auditus, 1043 
gustus, 1007 
olfactorius, 1008 
spirale [Corti], 1065 
visus, 1017 
Organs of digestion, 1109 
genital, of female, 1243 
of male, 1228 
of Golgi, 1069 
of the senses, 1007 
of taste, 1007 
urogenital, 1206 
vomeronasal, of Jacobson, 113, 
1012 
Orifice, atrioventricular, left, 611 
right, 609 
cardiac, of stomach, 1161 
mitral, 611 
of mouth, 1110 
pyloric, of stomach, 1162 
urethral, external, 1226, 1257 
internal, 1222 
of uterus, external, 1250 
internal, 1249 
vaginal, 1257 
Orifices of ureters, 1222 
Orificium urethrae externum, 1226, 
1257 
Origin of muscles, 462 
Os acetabuli, 340 
calcis, 362 
capitatum, 327 
coccygis, 209 
cordis, 613 
coxae, 333 
articulations of, 340 
ossification of, 340 
structure of, 340 
cuboideum, 367 
Cuneiforms primum, 369 
secundum, 369 
tertium, 370 
ethmoidale, 251 
lamina cribrosa, 252 
perpendicularis, 252 
frontale, 233 
hamatum, 328 
hyoideum, 275 
ilii, 333 
incisivum, 261 
innominatum, 333 
ischii, 336 
lacrimale, 263 
lunatum, 323 
magnum, 327 
multangulum majus, 326 
minus, 327 
naviculare manus, 323 
pedis, 368 
occipitale, 227 
palatinum, 265 
pars horizontalis, 266 
perpendicularis, 266 
parietale, 231 
pisiforme, 326 
planum, 253 
pubis, 337 
sacrum, 206 
facies dorsalis, 207 
pelvina, 206 
sphenoidale, 245 
alae magna, 248 
parva, 249 
temporale, 237 
trigonum, 367 
triquetum, 324 
zygomaticum, 263 
Ossa carpi, 323 
cranii, 227 
extremitatis inferioris, 333 
superior is, 301 
faciei, 255 
metacarpalia, 329 
metatarsalia, 371 
nasalia, 255 
Ossa sesamoidea, 376 
tarsi, 362 
Ossein, 56 
Ossicles, auditory, 1053 
development of, 141 
ligaments of, 1054 
Ossicula auditus, 1053 
Ossification of atlas, 210 
of axis, 210 
of clavicle, 303 
of coccyx, 212 
of ethmoidal, 254 
of femur, 352 
of fibula, 361 
of foot, 374 
of frontal, 237 
of hand, 331 
of hip bone, 340 
of humerus, 313 
of hyoid, 277 
of inferior nasal concha, 269 
intracartilaginous, 57 
intramembranous, 56 
of lacrimal, 263 
of lumbar vertebrae, 212 
of mandible, 270 
of maxilla, 262 
of nasal, 256 
of occipital, 231 
of os coxae or innominatum, 340 
of palatine, 268 
of parietal, 233 
of patella, 355 
of radius, 321 
of ribs, 224 
of sacrum, 212 
of scapula, 308 
of seventh cervical vertebra, 
211 
of sphenoidal, 251 
of sternum, 220 
of temporal, 244 
of tibia, 359 
of ulna, 319 
of vertebral column, 210 
of vomer, 270 
of zygomatic, 265 
Osteoblasts, 51 
Osteoclasts, 51, 1124 
Osteodentin, 1121 
Osteogenetic fibres, 56 
Osteology, 195 
Ostium, abdominal, of uterine 
tube, 1247 
maxillare, 1011 
pharyngeal, of auditory tube, 
1139 
primitive urogenital, 190 
primum [heart], 149 
secundum [heart], 149 
Otic ganglion, 924 
Otoconia, 1063 
Outlet of pelvis, 341 
Ova, primitive, 184 
Oval area of Flechsig, 818 
bundle, 119 
Ovaria, 1243 
Ovarian arteries, 697 
fossa, 1154, 1244 
plexus of nerves, 1004 
veins, 764 
Ovaries, 1243 
applied anatomy of, 1246 
descent of, 184 
development of, 184 
ligaments of, 1244 
lymphatic vessels of, 795 
nerves of, 1246 
structure of, 1245 
vesicular or Graafian follicles 
of, 1245 
vessels of, 1246 
Oviduct, 1247 
Ovula Nabothi, 1252 
Ovum, 77 
Ovum, corona radiata of, 78 
coverings of, 77 
discharge of, 1246 
fertilization of, 82 
germinal spot of, 79 
vesicle of, 79 
implantation or imbedding of, 
97 
maturation of, 79 
mature, 80 
segmentation of, 84 
structure of, 77 
yolk of, 77 
zona pellucida or radiata of, 
79 
Oxyntic cells, 1166 
glands, 1166 
Oxyphil colorless corpuscles, 62 
P 
Pacchionian glands, 905 
Pacinian corpuscles, 1069 
Pad, retropubic, 1219 
Palatal process of maxilla, 260 
Palate, 1112 
applied anatomy of, 1115 
arches of, 1112 
bone, 265 
development of, 112 
hard, 1112 
muscles of, dissection of, 1114 
soft, 1112 
aponeurosis of, 1112 
muscles of, 1113 
Palatine aponeurosis, 1112 
artery, ascending, 634 
of ascending pharyngeal, 637 
descending, 642 
bone, 265 
articulations of, 268 
horizontal part of, 266 
orbital process of, 267 
ossification of, 268 
pyramidal process or tuber- 
osity of, 267 
sphenoidal process of, 268 
vertical part of, 266 
foramen, 278 
nerves, 920 
process of maxilla, 260 
processes of fetus, 112 
tonsils, 1139 
uvula, 1112 
velum, 1112 
Palatoglossus muscle, 1114, 1129 
note 
Palatopharyngeus muscle, 1114 
Palatum, 1112 
durum, 1112 
molle, 1112 
Palmar aponeurosis, 550 
arch, deep, 679 
superficial, 682 
cutaneous branch of median 
nerve, 965 
of ulnar nerve, 967 
fascia, 550 
interossei muscles, 556 
interosseous arteries, 679 
ligaments, 427, 429 
nerve of ulnar, deep, 968 
superficial, 968 
Palmaris brevis muscle, 554 
longus muscle, 538 
Palpebrae, 1038 
Palpebral arteries, internal, 650 
lateral, 649 
medial, 650 
commissures or canthi, 1038 
fissure, 1038 
ligaments, 1039 
medial, 468 
nerves from maxillary, 919 INDEX 
1391 
Palpebral raph6, lateral, 468 
Pampiniform plexus of sper- 
matic cord, 763 
Pancreas, 1202 
accessory duct of, 175, 1205 
applied anatomy of, 1206 
body of, 1204 
development of, 175 
duct of, 175, 1204 
head of, 1203 
lymphatic vessels of, 793 
neck of, 1203 
nerves of, 1204 
structure of, 1205 
surface marking of, 1307 
tail of, 1203 
uncinate process of, 1203 
vessels of, 1204 
Pancreatic arteries, 691 
duct, 1206 
accessory, 175, 1205 
veins, 766 
Pancreatica magna artery, 691 
Pancreaticoduodenal artery, 
inferior, 692 
superior, 690 
lymph glands, 792 
veins, 766 
Pancreaticolienal lymph glands, 
788 
Papilla, lacrimal, 1038 
foliata, 1132 
mammae, 1258 
Papillae, circumvallate, 1127 
conical, 1128 
filiform, 1128 
fungiform, 1128 
of skin, 1074 
of tongue, 1127 
Papillary layer of skin, 1074 
process, 1194 
Paracentral lobule, 870 
Parachordal cartilages, 106 
Paradidymis, 1236 
Parallel striae of Retzius, 1120 
Paramastoid process, 230 
Paramedial sulcus, 870 
Parametrium, 1249 
Paranephric body, 1210 
Paranucleus, 1205 
Paraplasm, 34 
Paraplexus, 887 
Pararectal fossa, 1153 
lymph glands, 791 
Parathyroid glands, 1263 
applied anatomy of, 1264 
development of, 166 
structure of, 1264 
Paravesical fossa, 1153 
Paraxial mesoderm, 88 
Parietal bone, 231 
articulations of, 233 
ossification of, 233 
cells of fundus glands, 1166 
convolution, ascending, 871 
eminence, 231, 277, 282 
foramen, 231, 277 
lobe, 870 
gyri of, 871 
notch, 239 
operculum, 873 
pleura, 1095 
veins, 157 
Parietomastoid suture, 282 
Parietooccipital fissure, 868 
Parietotemporal artery, 653 
Parolfactory area of Broca, 875 
Paroophoron, 181, 1245 
Parotid duct, 1135 
gland, 1133 
accessory part of, 1134 
applied anatomy of, 1138 
nerves of, 1135 
structure of, 1135 
surface marldng of, 1283 
Parotid gland, vessels of, 1135 
lymph glands, 775 
plexus, 930 
Parotideomasseteric fascia, 472 
Parovarium, 1244 
Pars abdominalis s. sympathici, 
1001 
analis recti, 1184 
basilaris pontis, 833 
cephalica s. sympathici, 995 
cervicalis s. sympathici, 996 
ciliaris retinae, 135, 1023, 1026 
dorsalis pontis, 834 
endopelvina fasciae pelvis, 512 
externa, interna et media [ex- 
ternal acoustic meatus), 
1046 
flaccida [tympanic membrane], 
1050 
intermedia [vestibular bulb], 
1258 
iridica retinae, 135, 1025, 1029 
laryngea pharyngis, 1141 
mamillaria hypothalami, 127 
nasalis pharyngis, 1139 
optica hypothalami, 127 
oralis pharyngis, 1139 
pelvina s. sympathici, 1001 
thoracalis s. sympathici, 998 
Partes genitales externae mulei- 
bres, 1256 
Parumbilical veins, 767 
Patella, 354 
applied anatomy of, 355 
articulations of, 355 
movements of, 444 
ossification of, 355 
structure of, 355 
surface anatomy of, 1324 
Patellar plexus, 979, 981 
retinacula, 439 
surface of femur, 350 
Pavement epithelium, 37 
Pectinate ligament of iris, 1021 
Pectineal line, 348 
Pectineus muscle, 567 
Pectiniforme septum, 1238 
Pectoral region, dissection of, 525 
Pectoralis major muscle, 426 
minor muscle, 428 
Peculiar thoracic vertebrae, 203, 
204 
Peculiarities of fetal heart, 161 
Pedicles of a vertebra, 197 
Peduncle of carpus callosum, 875 
of olive, 830 
Peduncles of cerebellum, 841 
cerebral, 848 
Pedunculus cerebri, 848 
Pelvic colon, 1181 
diaphragm, 510 
fascia of, 510 
fascia, 510 
endopelvic part of, 512 
girdle, 301 
plexuses, 1005 
portion of sympathetic cord, 
1001 
Pelvis, 340, 1147 
applied anatomy of, 344 
articulations of, 404 
axes of, 342 
boundaries of, 340 
brim of, 340 
cavity of lesser, 341 
diameters, 341, 342 
in fetus, 344 
greater or false, 340 
inferior aperture or outlet of, 
341 
lesser or true, 340 
ligaments of, 404 
linea terminalis of, 340 
lymph glands of, 785 
major, 340 
Pelvis, male and female, differ- 
ences between, 343 
mechanism of, 408 
minor, 340 
position of, 342 
renal, 1216 
superior aperture or inlet of, 
340 
surface anatomy of, 1324 
Penis, 1237 
applied anatomy of, 1240 
body of, 1239 
corona glandis, 1239 
corpora cavernosa, 1238 
corpus cavernosum urethrae, or 
corpus spongiosum, 238 
crura of, 1238 
deep artery of, 705 
dorsal artery of, 706 
veins of, 761 
extremity of, 1239 
fundiform ligament of, 1239 
glands, 1238 
nerves of, 1240 
prepuce or foreskin of, 1239 
root of, 1239 
septum pectiniforme, 1238 
structure of, 1239 
suspensory ligament of, 1239 
Perforated substance, anterior, 
875. 
posterior, 848 
Perforating arteries, of hand, 
679 
from internal mammary, 666 
from plantar, 728 
from profunda femoris, 717 
cutaneous nerve, 991 
fibres of Sharpey, 54 
Perforator of spermatozoon, 81 
Pericardiac arteries, 664, 685 
Pericardiacophrenic artery, 664 
Pericardial area, 87 
pleura, 1095 
Pericardium, 601 
applied anatomy of, 603 
diverticula of, 602 
fibrous, 601 
nerves of, 603 
oblique sinus of, 603 
relations of, 601 
serous, 602 
structure of, 601 
transverse sinus of, 603 
vessels of, 602 
vestigial fold of, 603 
Pericecal folds, 1159 
possse, 1159 
Perichondrium, 47 
Perilymph, 1061 
Perimysium, 64 
Perineal arteries, 705 
body,1184 
branch of fourth sacral nerve, 
992 
muscle, superficial transverse, 
518,520 
nerve, 991 
Perineum, boundaries of, 514 
central tendinous point of, 518 
lymphatic vessels of, 787 
muscles of, 514 
Perineurium, 801 
Periosteum, 51 
Peripheral end-organs, 1069 
nervous system, 801 
organs of special senses, 1007 
terminations of nerves of 
general sensations, 1069 
Periscleral lymph space, 1037 
Peritoneal cavity, 1149 
fossae or recesses, 1057 
applied anatomy of, 1161 
sac, greater, 1150 
lesser, 1152, 1155 1392 
INDEX 
Peritoneum, 1149 
epiploic foramen of, 1155 
lesser sac of, 1155 
ligaments, 1156 
main cavity or greater sac of, 
1150 
horizontal disposition of, 
in lower abdomen, 1154 
in pelvis, 1153 
in upper abdomen, 1154 
vertical disposition of, 1150 
mesenteries, 1157 
omenta, 1156 
omental bursa of, 1155 
vertical disposition of, 1152 
parietal portion of, 1149 
visceral portion of, 1149 
Permanent cartilage, 47 
choanae, 113 
kidney, 187 
teeth, 1117 
development of, 1124 
Peronaeus brevis muscle, 583 
longus muscle, 582 
tertius muscle, 578 
Peroneal artery, 726 
anterior, 726 
peculiarities of, 726 
nerve, common, 989 
applied anatomy of, 993 
deep, 990 
superficial, 990 
retinacula, 585 
septa, 576 
tubercle, 165 
Perpendicular fasciculus, 891 
line of ulna, 318 
plate of ethmoid, 252 
Pes or base of cerebral peduncle, 
849 
hippocampi, 881 
Petit, canal of, 1030 
triangle of, 524 
Petrooccipital fissure, 280 
Petrosal nerve, deep, 919 
external, 997 
large deep, 919 
superficial, 919, 931 
superficial, greater, 919, 931 
smaller, 1056 
process, 246 
sinuses, 736, 746 
Petrosphenoidal fissure, 280 
Petrosquamous sinus, 743 
suture, 241, 243 
Petrotympanic fissure, 238, 280 
Petrous ganglion, 938 
portion of temporal bone, 241 
Peyer's glands, 1175 
patches, 1175 
Phalangeal processes of Corti's 
rods, 1067 
Phalanges digitorum manus, 331 
pedis, 373 
of foot, 373 
articulations of, 459 
ossification of, 374 
of hand, 331 
articulations of, 431 
ossification of, 332 
Pharyngeal aponeurosis, 1143 
artery, ascending, 637- 
bursa, 1139 
grooves, 108 
membrane, 163 
nerve from glossopharyngeal, 
940 
from sphenopalatine gan- 
glion, 921 
from vagus, 942 
ostium of auditory tube, 1139 
plexus of nerves, 940, 942, 997 
pouches, 108 
recess, 1139 
tonsil, 1139 
Pharyngeal tubercle, 230, 280 
veins, 737 
Pharyngopalatine arch, 1112 
Pharyngopalatinus muscle, 1114 
Pharynx, 1138 
aponeurosis of, 1143 
applied anatomy of, 1143 
development of, 168 
laryngeal part of, 1141 
lymphatic vessels of, 779 
mucous coat of, 1143 
muscles of, 1141 
nasal part of, 1139 
oral part of, 1139 
structure of, 1143 
Philtrum, 472 
Phrenic artery, inferior, 697 
superior, 686 
nerve, 957 
plexus of nerves, 1003 
vein, inferior, 764 
superior, 751 
Phrenicocolic ligament, 1157 
Phrenicocostal sinus, 1097 
Phrenicolienal ligament, 1155 
Phrenicopericardiac ligament, 
right, 762 
Phylogeny, 77 
Pia of brain, 906 
of cord, 906 
mater, cerebral, 906 
encephali, 906 
spinalis, 906 
spinal, 906 
Pigment, 46 
of iris, 1025 
of skin, 10^4 
Pigmentary layer of retina, 1027 
Pigmented connective-tissue 
cells, 46 
epithelial cells, 46 
Pili, 1075 
Pillars of Corti, 1065 
of external abdominal ring, 500 
of fauces, 1112 
of fornix, 886, 887 
Pineal body, 859 
development of, 859 
structure of, 860 
eye of lizards, 860 
recess, 127, 865 
Pinna, 1044 
cartilage of, 1044 
ligaments of, 1044 
Piriformis muscle, 571 
fascia of, 511 
Pisiform bone, 326 
Pisohamate ligament, 427 
Pisometacarpal ligament, 427 
Pits, olfactory, 111 
Pituitary body, 861 
Pivot-joint, 382 
Placenta, 100 
circulation through, 101, 616 
cotyledons of, 101 
fetal portion of, 100 
maternal portion of, 100 
previa, 101 
separation of, 101 
Plain muscle, 67 
Plane, intertubercular, 1147 
subcostal, 1147 
transpyloric, 1147 
Plantar aponeurosis, 586 
arch, 727 
applied anatomy of, 728 
arteries, 727 
cutaneous venous arch, 756 
net-work, 756 
digital veins, 759 
fascia, 586 
interossei muscles, 591 
ligament, long, 454 
metatarsal arteries, 728 
nerves, 988, 989 
Plantaris muscle, 579 
Planum nuchale, 227 
occipitale, 227 
Plasma cells, 41 
Plate or Plates, cribriform, of eth- 
moidal, 252 
ethmoidal, 107 
orbital, of frontal, 235 
perpendicular, of ethmoidal, 
252 
pterygoid, of sphenoidal, 250 
tarsal, 1039 
Platelets of blood, 64 
Platysma muscle, 475 
Pleura, 1095 
applied anatomy of, 1098 
cavity of, 1095 
cervical, 1095 
costal, 1095 
cupula of, 1095 
diaphragmatic, 1095 
lymphatic vessels of, 800 
mediastinal, 1095 
nerves of, 1097 
parietal, 1095 
pericardial, 1095 
pulmonary, 1095 
reflections of, 1095 
structure of, 1097 
surface markings of, 1297 
vessels of, 1097 
Plexiform layers of retina, 1028 
Plexus, aortic abdominal, 1004 
Auerbach's, 1176 
basilar, 746 
brachial, 958 
cardiac, 1001 
carotid, internal, 996 
cavernous, 996 
cervical, 954 
posterior, 951 
choroid of fourth ventricle, 846 
of lateral ventricle, 887 
of third ventricle, 864 
coccygeal, 992 
cceliac, 1002 
of cornea, 1021 
coronary, 1002, 1004 
of Exner, 893 
gastric, 1004 
hemorrhoidal, 1005 
venous, 761 
hepatic, 1004 
hypogastric, 1005 
infraorbital, 919 
lienal, 1004 
lumbar, 975 
lumbosacral, 974 
Meissner's, 1176 
mesenteric, 1004, 1005 
myenteric, 1176 
cesophageal, 943 
ovarian, 1004 
parotid, 930 
patellar, 979, 981 
pelvic, 1005 
pharyngeal, 940, 942, 997 
phrenic, 1003 
prostatic, 1005 
pudendal, 991 
venous, 761 
pulmonary, 941, 943 
renal, 1004 
sacral, 982 
solar, 1002 
spermatic, 1004 
splenic, 1004 
of submucosa, 1176 
subsartorial, 981 
suprarenal, 1004 
tonsillar, 940 
tympanic, 1056 
uterine, 1005 
venous, 761 
vaginal, 1005 INDEX 
1393 
Plexus of veins, vesicoprostatic, 
761 
vesical, 1005 
venous, 761 
Plexus aorticus abdominalis, 1004 
arteriae ovaricae, 1004 
brachialis, 958 
cardiacus, 1001 
caroticus internus, 996 
cavernosus, 996 
cervicalis, 954 
ramus anterior, 956 
posterior, 957 
chorioideus ventriculi lateralis, 
887 
tertii, 888 
coeliacus, 1002 
coronarius anterior, 1002 
posterior, 1002 
gastricus superior, 1004 
hepaticus, 1004 
hypogastricus, 1005 
lienalis, 1004 
lumbalis, 975 
lumbosacralis, 974 
mesentericus inferior, 1005 
phrenicus, 1003 
prostaticus, 1005 
pudendus, 991 
renalis, 1004 
sacralis, 982 
spermaticus, 1004 
suprarenalis, 1004 
venosi basilaris 746 
haemorrhoidalis, 761 
pterygoideus, 734 
pudendalis, 761 
vertebrates externi, 754 
interni, 755 
vesicalis, 761 
Plica circulares [Kerkringi], 1173 
fimbriata [tongue], 1126 
gubernatrix, 186 
lacrimalis of Hasner, 1042 
semilunaris [conjunctiva], 1041 
[tonsil], 1140 
sublingualis, 1137 
triangularis [tonsil], 1140 
vascularis, 186 
ventriculares [laryngis], 1085 
vesicalis transversa, 1153 
Plicae uretericae, 1222 
vocales, 1086 
Pneumogastric nerve, 940 
Polar bodies or polocytes, 79 
Poles of cerebral hemispheres, 
867 
of eyeball, 1017 
of lens, 1031 
Polymorphonuclear leucocytes, 
62 
Polyspermy, 83 
Ponium Adami, 1080 
Pons, 833 
applied anatomy of, 836 
development of, 124 
hepatis, 1194 
structure of, 834 
Varoli, 833 
Ponticulus [auricula], 1044 
Pontine arteries, 661 
Popliteal artery, 718 
applied anatomy of, 719 
branches of, 720 
peculiarities of, 719 
surface marking of, 1331 
fossa or space, 718 
dissection of, 718 
line of tibia, 357 
lymph glands, 782 
nerve, external, 989 
internal, 987 
surface of femur, 348 
vein, 758 
Popliteus muscle, 581 
Pore, gustatory, 1007 
Porta of liver, 1194 
Portal vein, 764 
applied anatomy of, 767 
development of, 764 
Position of pelvis, 342 
Postanal gut, 174 
Postaxial borders of limbs, 114 
Postcentral sulcus, 870 
Postcornu, 879 
Posterior annular ligament, 550 
calcaneoastragaloid ligament, 
453 
circumflex artery, 671 
common ligament, 385 
cornu of medulla spinalis, 809 
costotransverse ligament, 399 
cricoarytenoid muscle, 1088 
deep cervical vein, 738 
dental artery, 641 
inferior ligament, 448 
interosseous artery, 681 
nerve, 970 
ligament, 426 
pillar of fauces, 1112 
pulmonary nerves, 943 
radial carpal artery, 678 
radioulnar ligament, 424 
sacrosciatic ligament, 404 
scapular artery, 664 
nerve, 960 
superior ligament, 448 
talotibial ligament, 450 
temporal artery, 638 
ulnar carpal artery, 682 
vertebral vein, 738 
Postero-inferior lobule, 839 
Postero-lateral ganglionic arteries, 
662 
Postero-medial ganglionic arte- 
ries, 653, 662 
Postero-superior lobule, 838 
Postgemina, 854 
Postnodular fissure, 838 
Postpartum hemorrhage, 101 
Postpyramidal fissure, 839 
Postsphenoid part of sphenoid, 
251 
Pott's fracture, 593 
Pouch of Douglas, 1151 
of Prussak, 1055 
of Rathke, 166 
Pouches, pharyngeal, .108 
Poupart's ligament, 502 
Praeputium clitoridis, 1257 
Preauricular lymph glands, 775 
point, 1279 
sulcus of ilium, 335, 336 
Preaxial borders of limbs, 114 
Precentral gyre, 869 
sulcus, 869 
Prechordal portion of base of 
fetal skull, 106 
Preclival fissure, 869 
Precommissure, 887 
Precornu, 878 
Precuneus, 871 
Pregemina, 854 
Pregnancy, abdominal, 83 
ovarian, 83 
tubal, 83 
Premaxilla, 261 
Premolar teeth, 1118 
Preoccipital notch, 867 
Prepatellar bursa, 566 
Prepuce of clitoris, 1257 
of penis, 1239 
development of, 190 
Preputial glands, 1239 
sac, 1239 
Prepyramidal fissure, 838, 839 
tract, 816 
Presphenoid, 251 
Pressure epiphyses, 59 
Presternal notch, 217 
Pretracheal fascia, 477 
Prevertebral fascia, 477 
part of base of skull, 106 
Prickle cells, 39 
Primary areolae of bone, 59 
oocytes, 77 
spermatocytes, 82 
Primitive aortae, 143 
atrium, 145, 149 
costal arches, 104 
digestive tube, 92 
fibrillae of Schultze, 74 
groove, 86 
jugular veins, 157 
ova, 184 
palate, 112 
segments, 91 
sheath of nerve fibre, 75 
streak, 86 
urogenital ostium, 190 
ventricle of heart, 145 
Princeps cervicis artery, 636 
pollicis artery, 678 
Prismata adamantina, 1120 
Proamnion, 87 
Procerus muscle, 469 
Process or Processes, accessory, 
of vertebrae, 205 
alveolar, 260 
articular, of vertebrae, 197 
ciliary, 1023 
clinoid, anterior, 249, 290 
middle, 246, 290 
posterior, 246, 290 
condyloid, of mandible, 273 
coracoid, 307 
coronoid, of mandible, 273 
of ulna, 315 
costal, 199 
descending, of lacrimal, 263 
of dura mater, 900 
ethmoidal, of inferior nasal 
concha, 268 
frontal, of maxilla, 260 
frontonasal, 111 
frontosphenoidal, of zygomatic, 
264 
globular, of His, 111 
intrajugular, 230 
jugular, 230, 281 
lacrimal, of inferior nasal 
concha, 268 
lateral nasal, 111 
lenticular, of incus, 1055 
malar, of maxilla, 260 
mamillary, of vertebrae, 205 
mastoid, 239 
maxillary, of fetus, 112 
of inferior nasal concha, 268 
of palatine bone, 267 
of zygomatic bone, 265 
muscular, of arytenoid, 1081 
nasal, of frontal bone, 235 
of maxilla, 260 
odontoid, of axis or epistro- 
pheus, 200 
orbital, of palatine bone, 267 
of zygomatic bone, 264 
palatal, of maxilla, 260 
palatine, of fetus, 112 
of maxilla, 260 
papillary, of liver, 1194 
paramastoid, 230 
petrosal, 246 
phalangeal, of Corti'srods, 1067 
pterygoid, of sphenoidal bone, 
250 
pyramidal, of palatine bone, 
267, 278 
sphenoidal, of palatine bone, 
268 
of septal cartilage of nose, 
1009 
turbinated, 250 
spinous, of ilium, 336 1394 
INDEX 
Process or Processes, spinous, of 
vertebrae, 197 
styloid, of fibula, 359 
of radius, 321 
of temporal bone, 244, 280 
of ulna, 319 
temporal, of zygomatic, 265 
transverse, of vertebrae, 197 
trochlear, of calcaneus, 365 
uncinate, of ethmoid, 253 
vaginal, of sphenoid, 250 
of temporal, 243, 244 
vermiform, 1178 
vocal, of arytenoid, 1081 
xiphoid, 220 
zygomatic, of frontal, 235 
of maxilla, 260 
of temporal bone, 237 
Processus alveolaris [maxillae], 
260 
brevis [malleus], 1054 
ciliar es, 1023 
cochleariformis, 243, 1052 
condyloideus [mandibulae], 273 
coracoideus [scapulae], 307 
coronoideus [mandibulae], 273 
[ulnare], 315 
frontalis [maxillae], 260 
gracilis [malleus], 1053 
orbitalis [os palatinum], 267 
palatinus [maxillae], 260 
pterygoidei, 250 
pyramidalis [os palatinum], 267 
spinosus, 197 
splenoidalis [os palatinum], 268 
transver si, 197 
tubarius, 250 
vermiformis, 1178 
xiphoideus, 220 
zygomaticus, 260 
Proctodeum, 174 
Prodentin, 1124 
Profunda arteries, 674 
brachii artery, 674 
cervicalis artery, 666 
femoris artery, 716 
vein, 759 
linguae artery, 632 
Projection fibres of cerebral hemi- 
sheres, 889 
Prominence of aqueduct of Fal- 
lopius, 1051 
of facial canal, 1051 
laryngeal, 1080 
Prominentia canalis facialis, 1051 
Promontorium, 1051 
Promontory of tympanic cavity, 
1051 
Pronator quadratus muscle, 540 
teres muscle, 537 
Pronephric duct, 180 
Pronephros, 180 
Pronucleus, female, 80 
male, 83 
Prootic centre of temporal bone, 
244 
Prophase of karyokinesis, 35 
Prosencephalon, 88, 125, 855 
Prostata, 1241 
facies anterior, 1241 
posterior, 1241 
Prostate, 1241 
applied anatomy of, 1242 
development of, 189 
gland, 1241 
lobes of, 1241 
lymphatic vessels of, 794 
nerves of, 1242 
structure of, 1241 
vessels of, 1242 
Prostatic ducts, orifices of, 1225 
plexus of nerves, 1005 
portion of urethra, 1225 
sinus, 1225 
utricle, 1225 
Prosthion, 296 
Prothrombin, 64 
Protoplasm, 33 
Protoplasmic process of nerve 
cells, 72 
Protuberance, mental, 271 
occipital, 227, 228, 282 
Prussak, pouch of, 1055 
Psalterium, 886 
Pseudocele, 887 
Pseudonucleoli, 34 
Pseudopodium, 63 
Psoas magnus muscle, 560 
major muscle, 560 
applied anatomy of, 562 
fascia covering, 559 
minor muscle, 561 
parvus muscle, 561 
Pterion, 249, 282, 296 
ossicle, 255 
Pterotic centre of temporal bone, 
245 
Pterygoid canal, 250, 278 
fissure, 250 
fossa of sphenoid, 250 
hamulus, 250, 278 
muscles, 474 
plates, 250 
plexus of veins, 734 
processes of sphenoid, 250 
tubercle, 250 
Pterygoidei muscles, dissection 
of, 474 
Pterygoideus externus muscle, 
474 
internus muscle, 474 
Pterygomandibular ligament, 471 
raph6, 471 
Pterygomaxillary fissure, 284 
Pterygopalatine canal, 258, 267 
fossa, 284 
groove, 250 
nerve, 921 
Pterygospinous ligament, 251, 
477 
Pubic arch, 341 
bones, articulation of, 406 
ligaments, 407 
region, 1147 
tubercle or spine, 338 
vein, 760 
Pubis, 337 
angle of, 338 
body of, 337 
crest of, 338 
iliopectineal eminence of, 338 
obturator crest of, 338 
rami of, 337 
symphysis of, 406 
tubercle or spine of, 338 
Pubocapsular ligament, 433 
Pubococcygeus muscle, 514 
Pubofemoral ligament, 433 
Puborectalis muscle, 514 
Pubovesicales muscles, 1221 
Pudendal artery, accessory, 704 
external, 761 
internal, in female, 706 
in male, 703 
cleft or rima, 1170 
nerve, 991 
inferior, 985 
plexus, nervous, 991 
venous, 761 
veins, internal, 760 
Pudendum, 1256 
Pudic arteries, external, 716 
internal, 703 
nerve, internal, 991 
veins, internal, 760 
Pulmonary artery, 620 
applied anatomy of, 621 
opening of, in right ventricle, 
609 
ligaments, 1095, 1097 
Pulmonary nerves, 943 
pleura, 1095 
semilunar valves, 610 
veins, 730 
openings of, in left atrium, 
611 
Pulmones, 1101 
facies costalis, 1102 
mediastinalis ,1102 
margo anterior, 1104 
inferior, 1103 
posterior, 1103 
Pulp cavity of teeth, 1119 
dental, 1119 
of spleen, 1267 
Pulvinar, 855 
Puncta lacrimalia, 1041 
vasculosa, 875 
Pupil, 1024 
congenital atresia of, 136 
Pupillary membrane, 136, 1026 
Purkinje, cells of, 842 
fibres of, 69 
Putamen, 882 
Pyloric antrum, 1162, 1163 
artery, 689 
glands, 1166 
orifice of stomach, 1162 
part of stomach, 1162, 1163 
valve, 1164 
vein, 766 
Pyramid, 1052 
of cerebellum, 839 
of medulla oblongata, 823 
of temporal bone, 241 
of vestibule, 1058 
Pyramidal cells of cerebral cortex, 
891 
decussation, 823 
eminence of tympanic cavity, 
1052 
lobe of thyroid gland, 1261 
process of palatine bone, 267, 
278 
tract, crossed, 815 
direct, 815 
Pyramidalis muscle, 507 
nasi muscle, 469 
Pyramids, renal, 1210 
Pyramis medullae oblongatae, 823 
Q 
Quadrate lobe of liver, 1195 
Quadratus femoris muscle, 573 
labii inferioris muscle, 470 
superioris muscle, 469 
lumborum muscle, 510 
fascia covering, 510 
menti muscle, 470 
plantae muscle, 589 
Quadriceps extensor muscle, 565 
femoris muscle, 565 
Quadrigeminal bodies, 853 
R 
Radial artery, 676 
applied anatomy of, 676 
branches of, 678 
carpal, 678 
peculiarities of, 676 
recurrent, 678 
surface marking of, 1322 
fibres of cerebral cortex, 893 
fossa, 312 
nerve, 968 
sulcus, 311 
tuberosity, 320 
Radialis indicis artery, 679 
Radiate ligament, 396 
sternocostal ligaments, 399 
Radiocarpal articulation, 425 INDEX 
1395 
Radiocarpal articulation, applied 
anatomy of, 426 
movements of, 426 
Radioulnar articulation, distal, 
423 
movements of, 425 
proximal, 422 
movements, 423 
ligaments, 424 
union, middle, 423 
Radius, 319 
applied anatomy of, 321 
articulations of, 321 
grooves on lower end of, 321 
oblique line of, 320 
ossification of, 321 
sigmoid cavity of, 321 
structure of, 321 
surface anatomy of, 1314 
tuberosity of, 320 
ulnar notch of, 321 
Radix arcus vertebrae, 197 
linguae, 1126 
periis, 1239 
pili, 1075 
pulmonis, 1105 
Rami communicantes, 949, 950, 
995 
of ischium, 337 
of pubis, 337 
Ramus inferior ossis ischii, 337 
pubis, 338 
of mandible, 272 
mandibulae, 272 
superior oss. ischii, 337 
pubis, 337 
Ranine artery, 632 
vein, 736 
Ranvier, crosses of, 75 
nodes of, 75 
Raph6, anococcygeal, 516 
lateral palpebral, 468 
of medulla, 822 
of palate, 1112 
pterygomandibular, 471 
of scrotum, 1228 
Rathke, pouch of, 166 
Receptaculum chyli, 772 
Recess, epitympanic, 240, 1049 
nasopalatine, 1012 
omental, 1156 
optic, 865 
pharyngeal. 1139 
pineal, 127, 865 
sphenoethmoidal, 293, 1010 
Recesses, lateral, of fourth ven- 
tricle, 845 
peritoneal, 1157 
of Troltsch, 1055 
Recessus ellipticus, 1058 
infundibuli, 864 
inter sigmoideus, 1160 
pinealis, 127, 865 
sacciformis, 425 
sphaericus, 1058 
suprapinealis, 865 
Reciprocal reception, articulation 
by, 382 
Rectal ampulla, 1183 
columns of Morgagni, 1184 
layer of pelvic fascia, 513 
Rectococcygeal muscles, 1185 
Rectouterine folds, 1250 
Rectovesical excavation, 1151 
folds, 1153 
layer of pelvic fascia, 512 
Rectovesicales muscles, 1221 
Rectum, 1182 
ampulla of, 1183 
anal part of, 1184 
development of, 172 
Houston's valves of, 1183 
lymphatic vessels of, 792 
relations of, 1183 
surgical anatomy of, 1190 
Rectus abdominis muscle, 506 
dissection of, 505 
sheath of, 506 
capitis anterior- muscle, 484 
anticus major muscle, 484 
minor muscle, 484 
lateralis muscle, 484 
posterior major muscle, 491 
minor muscle, 491 
femoris muscle, 565 
muscles of eyeball, 1035 
Recurrent artery, interosseous, 
682 
radial, 678 
tibial, 722, 723 
ulnar, 680 
branches from deep volar arch, 
679 
laryngeal nerve, 942 
nerve, 942 
Red corpuscles, 61 
nucleus, 850 
Reflected inguinal ligament, 502 
Reflections of pleurae, 1095 
Refracting media of eye, 1030 
Region, iliac, 1147 
lumbar, 1147 
pubic, 1147 
Regions of abdomen, 1147 
Reil, island of, 873 
Reissner, vestibular membrane 
of, 1063 
Renal arteries, 696 
columns, 1211 
fascia, 1209 
impression, 1192 
pelvis, 1210, 1216 
plexus, 1004 
pyramids, 1210 
sinus, 1210 
tubules, 1212 
veins, 764 
vessels, afferent and efferent, 
1212, 1214 
Renes, 1206 
extremitas inferior, 1209 
superior, 1209 
facies anterior, 1207 
posterior, 1208 
margo lateralis, 1209 
medialis, 1209 
substantia corticalis, 1211 
medullaris, 1210 
vascula glomerulus, 1212 
Reproduction of cells, 34 
Respiration, mechanism of, 497 
Respiratory apparatus, 1079 
development of, 177 
nerve of Bell, 957, 960 
system, 1079 
Restiform bodies of medulla, 841 
Rete canalis hypoglossi, 746 
foraminis ovalis, 747 
testis, 1233 
Retia venosa vertebrarum, 755 
Reticular lamina, 1067 
layer of skin, 1074 
tissue, 44 
Reticularis alba, 833 
grisea, 833 
Retiform tissue, 44 
Retina, 1026 
central artery of, 650 
development of, 135 
fovea centralis, 1026 
layers of, 1027 
macula lutea, 1026 
membrana limitans interna, 
1029 
externa, 1029 
ora serrata, 1026 
structure of, 1027 
supporting frame-work of, 1029 
Retinacula of hip-joint, 432 
patellar, 439 
Retinacula peroneal, 585 
Retrahens aurem muscle, 1045 
Retrocecal fossa, 1160 
Retroglandular sulcus of penis, 
1239 
Retroperitoneal fossae, 1157 
Retropharyngeal lymph glands, 
776 
space, 477 
Retropubic pad, 1219 
Retzius, colored lines of, 1121 
Rhinal fissure, external, 128 
Rhinencephalon, 128, 874 
Rhodopsin, or visual purple, 46, 
1026 
Rhombencephalon, 90, 122, 821 
Rhombic grooves, 124 
lip, 123 
Rhomboid fossa, 847 
impression, 303 
ligament, 410 
Rhomboideus major muscle, 525 
minor muscle, 525 
Rhomboids, nerve to, 960 
Ribs, 220 
applied anatomy of, 179 
common characteristics of, 221 
development of, 104 
false, 220 
floating or vertebral, 221 
ossification of, 224 
peculiar, 223 
structure of, 224 
true, 220 
vertebrochondral, 221 
vertebrosternal, 220 
Ridge, ganglion, 88, 120 
supracondylar, lateral, 311 
medial, 312 
trapezoid or oblique, 302 
Ridges, bicipital, 311 
Right atrium, dissection of, 607 
auricle, 606 
auricular appendix, 606 
coronary plexus, 1002 
veins, 730 
gastroepiploic glands, 788 
ventricle, dissection of, 609 
Rima glottidis, 1087 
of mouth, 1110 
palpebrarum, 1038 
pudendal, 1256 
Ring, abdominal, external, 500 
internal, 508 
femoral, 712 
inguinal, abdominal, 508 
subcutaneous, 500 
tympanic, 245 
Rings, fibrous, of heart, 613 
Risorius muscle, 472 
Rivinus, ducts of, 1137 
notch of, 1049 
Rod-bipolars of retina, 1028 
Rod-granules of retina, 1029 
Rods and cones, layer of, 1029 
of Corti, 1065 
of retina, 1029 
Rolando, fissure of, 868 
substantia gelatinosa of, 809 
tubercle of, 825 
Roller, nucleus of, 833 
Roof plate, 117 
Root of lung, 1105 
of penis, 1239 
Root-sheaths of hair, 1077 
Roots of spinal nerves, 818, 948 
of teeth, 1116 
of zygomatic process, 237 
Rosenmuller, fossa of, 1138, 1139 
lymph gland of, 783 
organ of, 181, 1244 
Rostrum of corpus callosum, 876 
sphenoidal, 247 
Rotary joint, 382 
Rotation, movement of, 383 1396 
INDEX 
Rotatores muscles, 490 
spinae muscle, 490 
Round ligament of liver, 1195 
of uterus, 1251 
Ruffini, corpuscles of, 1070 
Rust-colored layer of cerebellar 
cortex, 843 
S 
Sac, dental, 1123 
lacrimal, 1041 
of peritoneum, greater, 1150 
lesser, 1152 
preputial, 1239 
Saccule, laryngeal, 1086 
of vestibule, 1062 
Sacculus, 1062 
Saccus lacrimalis, 1042 
vaginalis, 186 
Sacral arteries, lateral, 707 
artery, middle, 698 
canal, 208 
cornua,207 
crests, 207, 208 
foramina, 206, 208 
groove, 207 
hiatus, 207 
lymph glands, 787 
nerves, divisions of, anterior, 
982 
posterior, 953 
nucleus of medulla spinalis, 813 
plexus, 982 
applied anatomy of, 992 
tuberosity, 208 
veins, 760, 762 
Sacrococcygeal ligaments, 406 
Sacrogenital folds, 1153, 1250 
Sacroiliac articulation, 404 
ligaments, 404, 405 
Sacrosciatic ligaments, 404, 405 
Sacrospinalis muscle, 480 
Sacrovertebral angle, 206 
Sacrum, 206 
ala of, 208 
apex of, 208 
articulations of, 208 
auricular surface of, 208 
base of, 208 
ossification of, 212 
structure of, 208 
variations of, 209 
Saddle-joint, 382 
Sagittal fossa of liver, 1194 
sinus, inferior, 741 
superior, 740 
sulcus, 228, 232, 235 
suture, 232, 277 
Salivary glands, 1133 
development of, 164 
parotid, 1133 
structure of, 1137 
sublingual, 1135 
submaxillary, 1135 
Salpingopalatine fold, 1139 
Salpingopharyngeal fold, 1139 
Salpingopharyngeus muscle, 1143 
Salter, incremental lines of, 1120 
Santorini, cartilages of, 1081 
duct of, 1205 
Saphenous nerve, 981 
external, 988 
internal, 981 
long, 981 
short, 988 
opening, 564 
veins, 756, 757 
applied anatomy of, 757 
Sarcolemma, 64 
Sarcomere, 66 
Sarcoplasm, 65 
Sarcostyles, 65 
Sarcous elements of muscles, 66 
Sartorius muscle, 565 
Scala media [cochlea], 1063 
tympani, 1060 
vestibuli, 1060 
Scalene tubercle, 224 
Scalenus anterior muscle, 484 
anticus muscle, 484 
medius muscle, 484 
posterior muscle, 485 
posticus muscle, 485 
Scalp, applied anatomy of, 466 
lymphatic vessels of, 776 
muscles of, dissection of, 464 
skin of, 465 
Scapha, 1044 . 
Scaphoid bone, 323, 368 
fossa of sphenoid, 250, 278 
Scapula, 304 
acromion of, 306 
applied anatomy of, 309 
articulations of, 309 
coracoid process of, 307 
glenoid cavity of, 307 
ligaments of, 412 
ossification of, 308 
spine of, 306 
structure of, 308 
surface anatomy of, 1313 
surfaces of, 304,.305 
Scapular arteries, 663, 664 
circumflex artery, 671 
nerve, posterior, 960 
notch,307 
Scapuloclavicular articulation, 
411 
Scapus or shaft of hair, 1077 
pili, 1077 
Scarpa, fascia of, 499 
foramina of, 261, 278 
ganglion of, 1068 
triangle of, 712 
Schindylesis, 381 
Schlemm, canal of, 1018 
Schreger, lines of, 1120 
Schultze, primitive fibrillae of, 74 
Schwann, white matter of, 75 
Sciatic artery, 706 
foramen, 406 
nerve, 985 
applied anatomy of, 993 
small, 985 
notch,336 
veins, 760 
Sclera, 1017 
structure of, 1018 
Scleral spur, 1019 
Scleratogenous layer, 102 
Sclerocorneal junction, 1018 
Sclerotome, 102 
Scrotal arteries, posterior, 705 
nerves, posterior, 991 
Scrotum, 1228 
applied anatomy of, 1230 
dartos tunic of, 1229 
integument of, 1228 
nerves of, 1229 
raphe of, 1228 
vessels of, 1229 
Sebaceous glands, 1078 
Second cuneiform bone, 369 
metacarpal bone, 329 
metatarsal bone, 372 
nerve, 909 
Secondary areolae of bone, 58 
dentin, 1121 
oocytes, 80 
sensory fasciculus, 817 
spermatocytes, 82 
tympanic membrane, 1051 
Secretion, internal, 1260 
Segment, internodal, 75 
of Lantermann, 75 
medullary, 75 
Segmentation of cells, 34 
of fertilized ovum, 84 
Segmentation nucleus, 84 
Segments, primitive, 91 
spinal, 806 
Sella turcica, 246, 290 
Semicanalis m. tensoris tympani, 
243, 1052 
tubae auditivae, 243, 1052 
Semicircular canals, bony, 1058 
membranous, 1062 
ducts, 1062 
structure of, 1063 
Semilunar bone, 323 
fibrocartilages of knee, 441, 442 
ganglion of abdomen, 1002 
of trigeminal nerve, 914 
lobules of cerebellum, 838, 839 
Semimembranosus muscle, 575 
Seminal duct, 1235 
vesicles, 1236 
Semispinalis capitis muscle, 489 
cervicis muscle, 489 
colli muscle, 489 
dorsi muscle, 489 
Semitendinosus muscle, 57# 
Sensations, general, peripheral 
terminations of nerves of, 
1069 
Senses, organs of, 1007 
development of, 117 
special, peripheral organs of, 
1007 
Sensory areas of cerebral cortex, 
894 
decussation, 827 
neurons, lower and upper, 896, 
897 
tract, 897 
Separation of embryo, 92 
Septum, aortic, 150 
canalis musculolubarii, 243, 
1052 
crural, 712 
femorale, 712 
inferius of heart, 149 
intermedium, 148 
interventricular, 612 
lucidum, 887 
mobile nasi, 1009 
nasi, 293 
of nose, 293, 1012 
orbital, 1039 . 
pectiniforme penis, 1238 
pellucidum, 887 
cavity of, 887 
primum, 149 
secundum, 149 
spurium, 146 
subarachnoid, 905 
of tongue, 1132 
transversum, 178 
of semicircular ducts, 1063 
urorectal, 172 
ventricular, 149, 612 
ventriculorum, 612 
Serosa, or false amnion, 96 
Serous glands of tongue, 1131 
pericardium, 602 
Serratus anterior muscle, 529 
magnus muscle, 529 
posterioi- inferior muscle, 493 
superior muscle, 493 
posticus inferior muscle, 493 
superior muscle, 493 
Sertoli, cells of, 1233 
Sesamoid bones, 376 
cartilages, 1009 
Seventh nerve, 929 
Shaft of hair, 1077 
Sheath or Sheaths of arteries, 597 
carotid, 477 
crural, 710 
dentinal, of Neumann, 1120 
femoral, 710 
fibrous, of flexor tendons, 540 
of flexor tendons of fingers, 540 INDEX 
1397 
Sheath or Sheaths of flexor ten- 
dons of toes, 588 
mucous, 380 
of tendons around ankle, 586 
on back of wrist, 550 
in front of wrist, 548 
of rectus abdominis muscle, 506 
Shin bone, 355 
Short bones, 196 
calcaneocuboid ligament, 454 
gastric veins, 766 
plantar ligament, 454 
saphenous nerve, 988 
vein, 757 
Shoulder blade, 304 
girdle, 301 
muscles of, 530 
dissection of, 530, 531 
Shoulder-joint, 414 
applied anatomy of, 417 
burs® near, 415 
movements of, 416 
vessels and nerves of, 416 
Sibson's fascia, 1096 
Sight, organ of, 1017 
Sigmoid arteries, 695 
cavity of radius, 321 
of ulna,315,318 
colon, 1181 
flexure, 1181 
mesocolon, 1153 
sinus, 743 
sulcus, 240 
Simple epithelium, 36 
papillae of tongue, 1128 
Sinuses or Sinuses, accessory, of 
nose, 1014 
aortic, 612 
basilar, 746 
cavernous, 744 
cervicalis, 110 
circular, 746 
confluence of, 743 
coronary, 730 
costomediastinal, 1097 
cranial, 234 note 
of dura mater, 740 
of epididymis, 1231 
of external jugular vein, 735 
frontal, 235, 1014 
intercavernous, 746 
laryngeal, 1086 
lateral, 742 
longitudinal, superior, 740, 741 
maxillary, 259, 1015 
of Morgagni, 1142 
occipital, 743 
of pericardium, 603 
petrosal, 746 
petrosquamous, 743 
phrenicocostal, 1097 
pocularis, 1225 
prostatic, 1225 
pyriformis, 1141 
renal, 1210 
rhomboidalis, 88 
sagittal, 740, 741 
septum, 146 
sigmoid, 743 
sphenoidal, 247, 1014 
sphenoparietal, 744 
straight, 741 
tentorial, 742 
tonsillaris, 111 
transverse, 742, 746 
urogenital, 188 
of Valsalva, 610, 612 
venarum, 606 
venosus, 145 
Sinus or Sinuses, cavernosus, 744 
coronarius, 730 
durae matris, 740 
frontales, 1014 
intercavernosi, 746 
maxillaris, 295, 1015 
Sinus or Sinuses, occipitalis, 743 
paranasales, 1014 
petrosus inferior, 736, 746 
superior, 746 
rectus, 741 
sagittalis inferior, 741 
superior, 740 
sphenoidales, 1014 
tarsi, 362, 367 
transversus, 742 
venosus, 606 
sclerae, 1018 
Sinusoids of Minot, 599 
Sixth nerve, 927 
Skein, or spirem, 35 
coccygeal, 1273 
Skeins, carotid, 1273 
Skeletal muscular tissue, 64 
Skeleton, 195 
development of, 102 
Skene's duct, 190 
Skin, 1071 
appendages of, 1075 
hairs, 1075 
nails, 1075 
sebaceous glands, 1078 
sudoriferous or sweat glands, 
1078 
arteries of, 1074 
corium or cutis ver a, 1074 
development of, 116 
epidermis or cuticle, 1071 
furrows of, 1072 
nerves of, 1074 
papillary layer of, 1074 
reticular layer of, 1074 
of scalp, dissection of, 465 
stratum corneum, 1072 
mucosum, 1072 
true 1074 
Skull, 226 
applied anatomy of, 297 
development of, 105 
differences in, due to age, 294 
diseases of, 298 
exterior of, 277 
fossa of, anterior, 288 
middle, 290 
posterior, 291 
interior of, 288 
norma basalis, 278 
frontalis, 285 
lateralis, 281 
occipitalis, 284 
verticalis, 277 
sexual differences in, 295 
surface anatomy of, 1275 
tables of, 196 
upper surface of base of, 288 
Skull-cap, inner surface of, 288 
Slightly movable joints, 381 
Small cardiac vein, 730 
cavernous nerves, 1005 
intestine, 1168 
areolar or submucous coat 
t of, 1173 
circular folds of, 1173 
duodenum, 1169 
glands of, 1175 
ileum, 1171 
jejunum, 1171 
lymphatic nodules of, aggre- 
gated, 1175 
solitary, 1175 
vessels of, 792 
Meckel's diverticulum of, 
1178 
mucous membrane of, 1173 
muscular coat of, 1173 
nerves of, 1176 
Peyer's glands of, 1175 
serous coat of, 1172 
valvulae conniventes of, 1173 
vessels of, 1176 
villi of, 1173 
Small saphenous vein, 757 
sciatic nerve, 985 
wings of sphenoid, 249 
Smaller occipital nerve, 956 
Smallest cardiac veins, 731 
Smell, organ of, 1008 
Soft palate, 1112 
aponeurosis of, 1112 
arches or pillars of, 1112 
muscles of, 1113 
Solar plexus, 1002 
Sole of foot, muscles of, first 
layer, 587 
fourth layer, 590 
second layer, 589 
third layer, 589 
Soleus muscle, 579 
Solitary cells of medulla spinalis, 
813 
glands, 1175 
Somatic cells, 77 
fibres of spinal nerves, 950 
layer of mesoderm, 88 
Somatopleure, 88 
Space or Spaces, of angle of iris, 
1021 
of Burns, 477 
corneal, 1020 
epidural, 993 
interpleural, 1098 
of Fontana, 1021 
intercostal, 221 
interglobular, 1120 
of Nuel, 1067 
popliteal, 718 
retropharyngeal, 477 
of Retzius, 1224 
subarachnoid, 904 
suprasternal, 477 
Spatia zonularis, 1030 
Spatium per ichor ioideale, 1017 
Special dental germ, 1122 
end-organs of nerves, 1069 
Spermatic artery, internal, 697 
canal, 508 
cord, 1229 
applied anatomy of, 1230 
structure of, 1230 
fascia, external, 501, 1229 
plexus of nerves, 1004 
applied anatomy of, 1004 
veins, 763 
applied anatomy of, 763 
Spermatids, 82, 1233 
Spermatoblasts, 1233 
Spermatocytes, 82, 1233 
Spermatogonia, 82, 1233 
Spermatozoon 80, 1233 
body or connecting piece of, 81 
formation of, 1233 
head of, 80 
neck of, 80 
perforator of, 81 
tail of, 82 
Sphenoethmoidal recess, 293, 
1010 
suture, 288 
Sphenofrontal suture, 282, 288 
Sphenoid bone, 245 
Sphenoidal air sinuses, 247, 1014 
bone, 245 
articulations of, 251 
body of, 246 
ossification of, 251 
pterygoid processes of, 250 
wings of, great, 248 
■ small, 249 
conchae, 250 
crest, 247 
process of palatine bone, 268 
of septal cartilage of nose, 
1009 
rostrum, 247 
spine, 248, 280 
turbinated processes, 250 1398 
INDEX 
Sphenomandibular ligament, 395, 
477 
Sphenomaxillary fissure, 284 
fossa, 284 
Sphenopalatine artery, 642 
foramen, 267 
ganglion, 919 
nerves, 918 
notch, 268 
Sphenoparietal sinus, 744 
suture, 282 
Sphenosquamosal suture, 282 
Sphenozygomatic suture, 282 
Sphincter ani externus muscle, 
516 
internus muscle, 516 
pupillae muscle, 1025 
recti muscle, 514 
urethrae membranaceae mus- 
cle, 520, 521 
vaginae muscle, 520 
Spigelian lobe of liver, 1195 
Spina angularis [sphenoid], 248, 
280 
helicis, 1044 
scapulae, 306 
vestibuli, 146 
Spinal, accessory nerve, 944 
arteries, 660 
bulb, 822 
column, 196 
cord, 805 
dura of, 902 
pia of, 906 
ganglia, 948 
structure of, 949 
nerves, 947 
arrangement into groups, 
947 
connections with sympa- 
thetic, 949 
development of, 81 
divisions of, 951 
anterior, 954 
posterior, 951 
points of emergence of, 947 
roots of, 818, 948 
size and direction of, 949 
somatic fibres of, 950 
structure of, 950 
sympathetic fibres of, 950 
segments, 806 
Spinalis capitis muscle, 489 
cervicis muscle, 489 
colli muscle, 489 
dorsi muscle, 489 
Spindle, achromatic, 36 
aortic, 624 
neuromuscular, 1071 
neuro tendinous, 1070 
Spine or Spines, ethmoidal, 246, 
290 
of frontal bone, 235 
iliac, 336 
ischial, 336 
mental, 271 
nasal, anterior, 257, 262, 286 
posterior, 266, 278 
pubic, 338 
of scapula, 306 
sphenoidal, 248, 280 
suprameatal, 244, 283 
of tibia, 355 
trochlear, 235 
Spinoglenoid ligament, 413 
Spinoolivary fasciculus, 830 
Spinotectal fasciculus, 817 
Spinothalamic fasciculus, 817 
Spinous process of a vertebra, 197 
Spiral canal of modiolus, 1060 
ligament, 1064 
line of femur, 348 
organ of Corti, 1065 
thread of spermatozoon, 81 
tube of kidney, 1212 
Spirem or skein, 35 
Splanchnic fibres of spinal 
nerves, 950 
layer of mesoderm, 88 
nerves, 998, 999 
Splanchnology, 979 
Splanchnopleure, 88 
Spleen or lien, 1266 
accessory, 1267 
applied anatomy of, 1270 
bloodvessels of, 1267 
development of, 176 
lymphatic nodules of, 1268 
vessels of, 793 
Malpighian bodies of, 1268 
relations of, 1266 
size and weight of, 1267 
structure of, 1267 
supernumerary, 1267 
surface marking of , 1307 
Splenial centre of ossification, 274 
Splenic artery, 691 
distribution of, 1267 
cells, 1267 
glands, 788 
flexure of colon, 1180 
plexus, 1004 
pulp,1267 
vein, 765 
Splenium of corpus callosum, 876 
Splenius capitis muscle, 486 
cervicis muscle, 487 
colli muscle, 487 
Spongioblasts, 118 
Spongioplasm, 34 
Spring ligament, 456 
Spur of malleus, 1053 
scleral, 1019 
Squama, frontal, 233 
frontalis, 234 
occipital, 227 
occipitalis, 227 
temporal, 237 
temporalis, 237 
Squamosal suture, 282 
Squamous epithelium, 37 
Stahr, middle gland of, 778 
Stalks, optic, 126, 134 
of thalamus, 857, 858 
Stapedius muscle, 1055 
Stapes, 1054 
annular ligament of, 1055 
crus anterius, 1054 
posterius, 1054 
development of, 141 
Stellate ligament, 396 
veins of kidney, 1214 
Stensen, duct of, 1135 
foramina of, 261, 278 
Stephanion, 282, 296 
Sternal angle, 218 
end of clavicle, 303 
foramen, 220 
furrow, 1295 
glands, 796 
plate, 105 
Sternebrse, 216 
Sternoclavicular articulation, 409 
applied anatomy of, 411 
movements of, 411 
surface anatomy of, 1315 
Sternocleidomastoid artery, 631, 
636 
Sternocleidomastoideus muscle, 
478 
Sternocostal ligaments, 399 
surface of heart, 605 
Sternohyoid muscle, 482 
Sternohyoideus muscle, 482 
Sternomastoid artery, 631, 636 
muscle, 478 
Sternopericardiac ligaments, 602 
Sternothyreoideus muscle, 482 
Sternothyroid muscle, 482 
Sternum, 216 
Sternum, applied anatomy of, 225 
articulations of, 220 
development of, 105 
ossification of, 220 
structure of, 220 
Stomach, 1161 
applied anatomy of, 1167 
bed, 1163 
body of, 1163 
cardiac glands of, 1166 
orifice of, 1161 
component parts of, 1163 
curvatures of, 1162 
development of, 168 
fundus of, 1163 
glands of, 1166 
incisura angularis, 1162 
interior of, 1163 
lymphatic vessels of, 792 
mucous membrane of, 1165 
muscular coat of, 1164 
nerves of, 1167 
openings of, 1161 
position of, 1163 
pyloric antrum, 1162, 1163 
glands, 1166 
orifice, 1162 
valve, 1164 
serous coat of, 1164 
shape and position of, 1161 
structure of, 1164 
subdivisions of, anatomical, 
1163 
clinical, 1163 
sulcus intermedius, 1162 
surface marking of, 1295 
surfaces of, 1161 
teeth, 1118 
vessels of, 1167 
Stomodeum, 163 
Straight gyrus, 870 
sinus, 741 
tubes of kidney, 1212 
Strands of posterior nerve root, 
819 
Stratified epithelium, 39 
Stratiform fibrocartilage, 50 
Stratum cinereum, 854 
compactum [decidua], 98 
corneum, 1072 
dorsale, 860 
germinativum, 1073 
granulosum, 1073 
intermedium [choroid], 1022 
lemnisci, 854 
lucidum, 1073 
mucosum, 1072, 1073 
opticum [retina], 1027 
[superior colliculus], 854 
spongiosum [decidua], 98 
zonale, 854, 855 
Streak, primitive, 86 
Stria terminalis, 855, 885 
vascularis, 1064 
Striae acusticae, 935 
gravidarum, 1301 
longitudinal,lateral and medial, 
875 
medullares [rhomboid fossa], 
848,935 
Striate arteries, 653 
veins, inferior, 740 
Stripe of Hensen, 1067 
Striped muscle, 64 
Stroma, intertubular, of kidney, 
1214 
of iris, 1025 
of ovary, 1245 
Styloglossus muscle, 1130 
Stylohyal part of styloid process, 
244 
Stylohyoid ligament, 481 
muscle, 481 
nerve, from facial, 933 
Stylohyoideus muscle, 481 INDEX 
1399 
Styloid process of fibula, 359 
of radius, 321 
of temporal bone, 244, 280 
of ulna, 319 
Stylomandibular ligament, 477 
Stylomastoid artery, 636 
foramen, 243, 280 
Stylopharyngeus muscle, 1142 
Subanconeus muscle, 536 
Subarachnoid cavity, 904 
cisternse, 904 
septum, 905 
space, 904 
Subarcuate fossa, 242 
Subcallosal gyrus, 875 
Subcardinal veins, 157 
Subclavian arteries, 655 
applied anatomy of, 657 
branches of, 659 
first part of left, 655 
of right, 655 
peculiarities of, 657 
second portion of, 656 
surface anatomy of, 1278 
marking of, 1291 
third portion of, 656 
triangle, 483, 645 
vein, 750 
Subclavius muscle, 528 
nerve to, 960 
Subcostal arteries, 686 
zone, 1147 
Subcostales muscles, 492 
Subcrureus or articularis genu 
muscle, 566 
Subcutaneous inguinal ring, 500 
Subdural cavity, 903 
Subepithelial plexus of cornea, 
1021 
Subfrontal gyre, 870 
Subinguinal lymph glands, 783 
Sublingual artery, 632 
gland, 1137 
vessels and nerves of, 1137 
Sublobular veins, 1197 
Submaxillary artery, 634 
duct, 1136 
ganglion, 925 
gland, 1135 
vessels and nerves of, 1137 
lymph glands, 778 
triangle, 481, 644 
Submental artery, 634 
lymph glands, 778 
triangle, 481 
Subnasal point, 296 
Suboccipital muscles, 490 
nerve, 951 
triangle, 491, 660 
Subparietal sulcus, 871 
Subperitoneal connective tissue, 
509 
Subpleural mediastinal plexus, 
664 
Subpubic ligament, 407 
Subsartorial plexus, 981 
Subscapular angle, 305 
artery, 671 
fascia, 531 
fossa, 304 
nerves, 961 
Subscapularis muscle, 531 
Subserous areolar tissue, 1149 
Substance, perforated, anterior, 
874 
posterior, 848 
Substantia adamantina, 1120 
alba, 814 
eburnea, 1119 
ferruginea, 848 
gelatinosa centralis, 810 
of Rolando, 809 
nerve cells in, 813 
grisea centralis, 809 
innominata of Meynert, 884 
Substantia nigra, 850 
ossea, 1121 
perforata anterior, 875 
propria [cornea], 1019 
Subthalamic tegmental region, 
860 
Successional permanent teeth, 
1124 
Suctorial pad, 471 
Sudoriferous glands, 1078 
Sulci and fissures of cerebral 
hemisphere, 867 
development of, 131 
of medulla, oblongata, 822 
spinalis, 808 
Sulcus, anterior longitudinal, of 
heart, 604 
antihelicis transversus, 1044 
arteria vertebralis, 199 
basilaris, 833 
calcaneal, 365 
central, 868 
centralis [Rolandi], 868 
cingulate, 869 
cinguli, 869 
circular, 869, 873 
circular is corneae, 1019 
coronary, of heart, 604 
frontal, 869 
horizontal, of cerebellum, 837 
intermedius [stomach], 1162 
intraparietal, 870 
lateral cerebral, 849 
of cerebral peduncle, 849 
limitans [rhomboid fossa], 847, 
848 
lunatus, 871 note 
malleolar, 360 
medial frontal, of Eberstaller, 
870 
median, of rhomboid fossa, 847 
of tongue, 1126 
medianus posterior, 808 
of Monro, 125, 865 
occipital, 871 
oculomotor, 849 
olfactory, 870 
orbital, 870 
paramedial, 870 
postcentral, 870 
posterior longitudinal, of 
heart, 604 
preauricular, of ilium, 335, 336 
precentral, 869 
radial, 311 
retroglandular, 1239 
sagittalis, 228, 232, 235 
sigmoid, 240 
spiralis externus, 1064 
internus, 1065 
subparietal, 871 
tali, 367 
temporal, inferior, 872 
middle, 872 
superior, 872 
terminal, of right atrium, 606 
of tongue, 1126 
tubae auditivae, 249, 280 
tympanic, 243, 1050 
valleculae, 838 
Superadded permanent ' teeth, 
1124 
Supercilia, 1038 
Superciliary arches, 278, 234, 282 
Superficial cervical artery, 664 
lymph glands 778 
muscle, 475 
dissection of, 475 
nerve, 957 
epigastric artery, 715 
external pudendal artery, 716 
pudic artery, 716 
iliac circumflex artery, 716 
long plantar ligament, 454 
palmar arch, 682 
। Superficial perineal artery, 705 
peroneal nerve, 990, 991 
Sylvian vein, 739 
temporal artery, 637 
applied anatomy of, 638 
vein, 733 
transverse ligament of hand, 
551 
perineal muscle, 518, 520 
volar artery, 678 
Superficialis volae artery, 678 
Superfrontal gyre, 869 
Superior articular arteries, 720 
calcaneocuboid ligament, 454 
' cerebellar peduncles, 841 
constrictor muscle, 1142 
dental nerve, 918 
intercostal artery, 666 
lingualis muscle, 1130 
longitudinal sinus, 740 
maxillary nerve, 917 
medullary velum, 842 
nasal concha, 254 
nuchal line, 227 
oblique muscle, 1035 
orbital fissure, 249, 288 
petrosal sinus, 746 
profunda artery, 674 
sagittal sinus, 740 
semicircular canal, 1059 
tarsal plate, 1039 
thoracic artery, 670 
tibiofibular articulation, 448 
tympanic artery, 640 
vesical artery, 701 
vocal cords, 1085 
Supernumerary spleen, 1267 
Supinator brevis muscle, 544 
longus muscle, 542 
muscle, 544 
Supra-acromial nerves, 957 
Supporting cells of Hensen, 1067 
of Sertoli, 1233 
frame-work of retina, 1029 
Supracallosal gyrus, 875 
Supraclavicular branches of 
brachial plexus, 960 
nerves, 957 
Supracondylar process, 312 note 
ridges, 311, 312 
Supraglenoid tuberosity, 307 
Suprahyoid aponeurosis, 481 
artery, 632 
lymph glands, 778 
muscles, 480 
dissection of, 480 
triangle, 481, 644 
Supramarginal gyrus, 871 
Supramastoid crest, 237 
Suprameatal spine, 244, 283 
triangle, 238, 283 
Supraorbital artery, 649 
foramen, 235, 286, 288 
margin, 234 
nerve, 916 
notch, 235,286,288 
vein, 732 
Suprarenal arteries, inferior, 697 
middle, 696 
superior, 698 
glands, 1270 
applied anatomy of, 1272 
development of, 134 
lymphatic vessels of, 793 
nerves of, 1272 
structure of, 1271 
vessels of, 1272 
impression, 1194 
plexus, 1004 
veins, 764 
Suprascapular artery, 663 
ligament, 413 
nerve, 960 
Supraspinal ligament, 387 
Supraspinatous fascia, 532 1400 
INDEX 
Supraspinatous fossa, 305 
Supraspinatus muscle, 532 
Supraspinous ligament, 387 
Suprasternal nerves, 957 
space, 477 
Supratonsillar fossa, 1139 
Supratrochlear foramen, 313 
nerve, 916 
Sural arteries, 720 
cutaneous nerve, medial, 988 
nerve, 988 
Surface anatomy and surface 
markings of abdomen, 
1303 
regions of, 1303 
surface lines of, 1303 
accessory nerve, 1291 
acoustic meatus, external, 
1228 
acromioclavicular j oint, 1315, 
1319 
adductor canal, 1331 
ankle-joint, 1326, 1330 
anterior tibial artery, 1329, 
1332 
aorta, abdominal 1301, 1309 
ascending, 1300 
aortic arch, 1300 
auscultation, triangle of, 
1296 
axillary artery, 1318, 1320 
nerve, 1323 
back, 1291 
bones of cranium, 1279 
of lower extremity, 1324 
of thorax, 1296 
of upper extremity, 1312 
brachial artery, 1318, 1321 
plexus, 1291, 1318 
brain, 1280 
Bryant's triangle, 1330 
calcaneus, 1325 
carpal bones, 1315 
caruncular lacrimalis, 1287 
cecum, 1307 
cerebellum, 1280 
cerebral hemisphere, 1280 
cervical cutaneous nerve, 
1291 
clavicle, 1313 
cceliac artery, 1309 
colon, ascending, 1307 
descending, 1307 
iliac, 1307 
transverse, 1307 
common carotid artery, 1290 
iliac artery, 1309 
peroneal nerve, 1329, 1334 
deep peroneal nerve, 1334 
deltoideus muscle, 1316 
diaphragma, 1297 
dorsalis pedis artery, 1329, 
1332 
duodenum, 1306 
ear, 1288 
elbow-joint, 1319 
epigastric artery, inferior, 
1309 
external carotid artery, 1290 
main branches of, 
1290 
iliac artery, 1309 
eye, 1287 
facial nerve, 1291 
femoral artery, 1328, 1331 
triangle 1331 
femur, 1324 
fibula, 1324 
fissures of brain, 1281 
fold of groin, 1301 
frontal sinus, 1282 
gall-bladder, 1307 
gluteal arteries, 1331 
fold, 1323 
great auricular nerve, 1291 
Surface anatomy and surface 
markings of head and neck, 
1275 
heart, 1299 
coronary sulcus, 1299 
longitudinal sulcus, an- 
terior, 1299 
orifices of, 1299 
Hesselbach's triangle, 1309 
hip bones, 1324 
hip-joint, 1325, 1330 
humeral circumflex artery, 
1321 
humerus, 1313 
hyoid bone, 1289 
ileocolic junction, 1307 
iliac artery, common, 1309 
external, 1309 
furrow, 1301 
infrasternal notch, 1295 
inguinal rings and canal 
1303 
innominate artery, 1300 
veins, 1300 
internal pudendal artery, 
1331 
intestines, 1306, 1307 
joints of fingers, 1315 
of foot, 1330 
jugulai notch, 1295, 1297 
veins, 1291 
kidneys, 1308 
knee-joint, 1300, 1325 
lacrimal puncta, 1287 
sac, 1187 
larynx,1287,1289 
lateral plantar artery, 1332 
thoracic artery, 1320 
ventricle of brain, 1282 
latissimus dorsi, 1316, 1319 
left common carotid artery, 
in thorax, 1300 
lesser occipital nerve, 1291 
linea semilunaris, 1301 
liver, 1302, 1307 
lower extremity, 1323 
lumbar triangle, 1301 
lungs, 1298 
mamma, 1296 
mammary artery, internal, 
1300 
maxillary arterv, external, 
1282 
sinus, 1282 
medial plantar artery, 1332 
median nerve, 1323 
medulla spinalis, 1294 
mesenteric arteries, 1309 
metacarpal bones, 1315 
middle meningeal artery, 
1282 
mouth, 1284 
mucous sheaths around 
ankle, 1331 
of wrist and hand, 1319 
muscles of abdomen, 1303 
of arm, 1316 
of buttock, 1326 
of foot, 1327, 1328 
of forearm, 1317 
of head and neck, 1276, 
1277, 1289 
of hand, 1318 
of leg, 1328 
of thigh, 1326 
nasal part of pharynx, 1287 
nasolacrimal duct, 1287 
neck, 1291 
Nelaton's line, 1329 
nose, 1284 
oesophagus, 1299 
palatine arches, 1285 
palmar or volar arches, 1322 
palpebral fissure, 1287 
pancreas, 1303, 1307 
Surface anatomy and surface 
markings of parotid duct, 
1283 
gland, 1283 
patella, 1324 
pectoralis major muscle, 
1316,1319 
minor muscle, 1316, 1319 
pelvis, 1324 
perineum, 1309 
peroneal artery, 1332 
nerves, 1334 
phalanges of foot, 1325 
of hand, 1315 
phrenic nerve, 1291 
plantar arch, 1332 
arteries, 1332 
pleurae, 1297 
plica semilunaris, 1287 
popliteal artery, 1328 
fossa, 1331 
posterior tibial artery, 1329, 
1332 
profunda brachii artery, 1321 
femoris artery, 1331 
pupil, 1287 
radial artery, 1318, 1322 
nerve, 1323 
radioulnar joints, 1315 
radius, 1314 
rectum and anal canal, 1310 
Reid's base line, 1279 
renal arteries, 1309 
sacroiliac joint, 1330 
saphenous veins, 1334 
scapula, 1313 
scapular circumflex artery, 
1321 
sciatic nerve, 1334 
serratus anterior muscle, 1316 
shoulder-joint, 1315 
spinal nerves, 1295 
spleen, 1307 
sternal angle, 1295, 1297 
sternoclavicular joint, 1315 
sternocleidomastoideus 
muscle, 1277 
stomach, 1305 
striae gravidarum or albi- 
cantes, 1301 
subclavian artery, 1291,1318 
subdural and subarachnoid 
cavities, 1294 
submaxillary gland, 1291 
subscapular artery, 1320 
supraclavicular nerves, 1291 
talus, 1325 
tarsus and foot, 1325 
temporomandibular joint, 
1276 
tendinous inscriptions of rec- 
tus abdominis, 1301 
thoracoacromial artery, 1320 
thorax, 1295 
surface lines of, 1296 
tibia, 1324 
tibial nerve, 1334 
tongue, 1285 
tonsil, 1286 
trachea, 1289, 1299 
transverse sinus, 1282 
trapezius, 1319 
trigeminal nerve, 1283 
tympanic antrum, 1289 
membrane, 1288 
ulna, 1314 
ulnar artery, 1322 
collateral arteries, 1322 
nerve, 1319, 1323 
umbilicus, 1301, 1303 
upper extremity, 1312 
urogenital organs, female, 
1311 
male, 1310 
vena cava, inferior, 1300 INDEX 
1401 
Surface anatomy and surface 
markings of vena cava, 
superior, 1300 
vermiform process, 1307 
vertebral column, 1291 
volar or palmar arches, 1322 
wrist and hand, 1314 
wrist-joint, 1314, 1319 
Suspensory ligament of axilla, 526 
of eye, 1038 
of lens, 1030 
of ovary, 1244 
of penis, 1239 
Sustentacular fibres of Muller, 
1029 
Sustentaculum lienis, 1157 
tali, 365 
Sutura dentata, 381 
harm onia, 381 
limbosa, 381 
notha, 381 
s err at a, 381 
squamosa, 381 
vera, 381 
Sutural bones, 255 
applied anatomy of, 255 
Suture, coronal, 277, 282 
frontal, 278 
frontoethmoidal, 288 
frontomaxillary, 287 
frontozygomatic, 282 
interparietal, 233 
lambdoidal, 230, 232, 277, 282 
metopic, 234 
occipitomastoid, 282 
parietomastoid, 282 
petrooccipital, 291 
petrosquamous, 241, 243 
sagittal, 277 
sphenoethmoidal, 288 
sphenofrontal, 282, 288 
sphenoparietal, 282 
sphenopetrosal, 290 
sphenosquamosal, 282 
sphenozygomatic, 282 
squamosal, 282 
zygomaticofrontal, 282 
zygomaticomaxillary, 288 
zygomaticotemporal, 582 
Sweat glands, 1078 
Swellings, genital, 190 
Sylvian fossa, 131 
veins, 739, 740 
Sylvius, aqueduct of, 821, 854 
fissure of, 867 
Sympathetic fibres of spinal 
nerves, 949 
nerves, 994 
connections with spinal 
nerves, 995 
plexuses, 1001 
cardiac, 1001 
cceliac, 1002 
hypogastric, 1005 
pelvic, 1005 
solar, 1002 
system, abdominal portion of, 
1001 
applied anatomy of, 1005 
cephalic portion of, 995 
cervical portion of, 996 
development of, 133 
pelvic portion of, 1001 
thoracic portion of, 998 
trunks, 995 
Symphysis of mandible, 271 
ossium pubis, 406 
pubis, 406 
sacrococcygea, 406 
Synarthroses, 380 
Synchondrosis, 381 
neurocentral, 210 
Syncytiotrophoblast, 85 
Syncytium, 85 
Syndesmology, 379 
Syndesmosis, 381 
tibiofibularis, 448 
Synergic muscles, 462 
Synovia, 380 
Synovial membrane, 380. See 
also Individual Joints. 
Systemic circulation, 595 
veins, 729 
Systems, Haversian, 53 
T 
Tables of the skull, 196 
Tactile corpuscles of Golgi and 
Mazzoni, 1069 
of Grandry, 1069 
of Pacini, 1069 
of Ruffini, 1070 
of Wagner and Meissner, 
1070 
Taenia pontis, 833 
semicircularis, 885 
thalami, 856 
ventriculi quarti, 846 
Taeniae coli, 1184 
of fourth ventricle, 846 
of muscular coat of large intes- 
tine, 1177 
Talocalcaneal articulation, 452 
Talocalcaneonavicular articula- 
tion, 454 
Talotibial ligaments, 450 
Talus, 366 
ossification of, 374 
Tangential fibres of cerebral 
cortex, 892 
Tapetum of choroid, 1022 
of corpus callosum, 877 
Tarsal arteries, 724 
bones, 362 
glands, 1040 
plates, 1039 
Tarsi of eyelids, 1039 
Tarsometatarsal articulations, 
457 
Tarsus, 362 
applied anatomy of, 375 
articulations of, 452 
inferior, 1039 
ossification of, 374 
superior, 1039 
surface markings of, 1330 
synovial membranes of, 458 
Taste, nerves of, 1008 
organ of, 1007 
Taste-buds, 1007 
Tectorial membrane of ductus 
cochlearis, 1067 
Teeth, 1115 
applied anatomy of, 1125 
bicuspid, 1118 
canine, 117, 1118 
cement or crusta petrosa of, 
1121 
crown of, 1117 
cutting, 1117 
deciduous, 1118 
dental canaliculi of, 1120 
dentin of, 1119 
development of, 1121 
enamel of, 1120 
eruption of, 1124 
eye, 1118 
general characters of, 1113 
incisive, 1117 
incisors, 1117 
ivory of, 1119 
milk, 1118 
molar, 1118 
multicuspid, 1118 
necks of, 1116 
permanent, 1117 
successional, 1124 
superadded, 1124 
Teeth, premolar, 1118 
pulp cavity of, 1119 
roots of, 1116 
stomach, 1118 
structure of, 1119 
substantia adamantina of, 1120 
eburnea of, 1119 
ossea of, 1121 
temporary, 1118 
wisdom, 1118 
Tegmen tympani, 240, 1049 
Tegmental part of pons, 835 
Tegmentum, 850 
Tela chorioidea [fourth ventricle], 
846 
[third ventricle], 888 
Telencephalon, 126, 127, 865 
Telophase of karyolanesis, 36 
Temporal artery, deep, 641 
middle, 638 
superficial, 637 
bone, 237 
articulations of, 245 
mastoid portion of, 239 
ossification of, 244 
petrous portion of, 241 
pyramid of, 241 
squama of, 237 
structure of, 244 
tympanic part of, 243 
fascia, 473 
fossa, 282 
gyri, 872 
lines, 231, 235, 278, 282 
lobe, 871 
muscle, 473 
dissection of, 473 
nerves of auriculotemporal, 923 
deep, 922 
of facial, 933 
operculum, 873 
process of zygomatic bone, 265 
veins, 733 
Temporalis muscle, 473 
Temporary teeth, 1118 
Temporomalar nerve, 917 
Temporomandibular articulation, 
393 
applied anatomy of, 396 
surface anatomy of, 1276 
Temporomaxillary vein, 734 
Tendinous arch of pelvic fascia, 
512 
inscriptions of rectus abdomi- 
nis muscle, 506 
Tendo Achillis, 579 
calcaneus, 579 
oculi, 468 
ligament, 468 
Tendon, central, of diaphragma, 
495 
conjoined, of internal oblique 
and transversalis muscles,504 
of conus arteriosus, 608 
structure of, 44 
superior, of Lockwood, 1035 
of Zinn, 1035 
Tendons, 463 
on back of wrist, relations of, 
550 
Tendril fibres of cerebellum, 844 
Tenon, capsule of, 1037 
Tensor fasciae femoris muscle, 
565 
latae muscle, 565 
palati muscle, 1113 
tarsi muscle, 468 
tympani muscle, 1055 
semicanal for, 243, 1052 
veli palatini muscle, 1113 
Tenth nerve, 940 
Tentorial sinus, 741 
Tentorium cerebelli, 901 
Teres major muscle, 533 
minor muscle, 533 1402 
INDEX 
Terminal crest of right atrium, 
606, 607 
sulcus of right atrium, 606, 
vein, 740 
ventricle, 119, 810 
Terminations of motor nerves, 
803 
of nerves of general sensations, 
1069 
Testes, 1228, 1230 
appendages of, 1231 
applied anatomy of, 1234 
coni vasculosi of, 1233 
coverings of, 1228 
descent of, 186 
development of, 186 
ductuli efferentes, 1233 
ductus deferens, 1235 
gubernaculum testis, 186 
lobules of, 1232 
lymphatic vessels of, 794 
mediastinum testis, 1232 
rete testis, 1233 
structure of, 1232 
tubuli recti, 1233 
seminiferi, 1232 
tunica albuginea, 1232 
vaginalis, 1231 
vasculosa, 1232 
Thalamencephalon, 855 
Thalami, 126, 855 
connections of, 857 
development of, 126 
intermediate mass of, 126, 856 
stalks of, 857, 858 
structure of, 856 
surfaces of, 855, 856 
Thalamomamillary fasciculus, 886 
Thebesius, foramina of, 608 
valve of, 608, 730 
veins of, 731 
Thenar eminence, 546 
Thigh bone, 345 
fascia lata of, 563 
superficial, 562 
muscles of, 562 
dissection of, 562 
Third cuneiform bone, 370 
metacarpal bone, 330 
metatarsal bone, 372 
nerve, 911 
trochanter, 348 
ventricle of brain, 864 
choroid plexuses of, 864 
Thoracic aorta, 683 
applied anatomy of, 683 
peculiarities of, 683 
arteries, 670, 671 
axis, 670 
cardiac nerves, 943 
duct, 771 
applied anatomy of, 773 
nerves, anterior, 961 
applied anatomy of, 974 
divisions of, anterior, 972 
posterior, 952 
portion of gangliated cord, 998 
vertebrae, 201 
Thoracoacromial artery, 670 
Thoracodorsal nerve, 961 
Thoracoepigastric vein, 756 
Thorax, 216 
boundaries of, 216 
cavity of, 600 
lower opening of, 216, 601 
lymph glands of, 796 
lymphatic vessels of, 797, 798 
mechanism of, 401 
muscles of, 492 
parts passing through lower 
opening of, 601 
upper opening of, 601 
skeleton of, 216 
surface anatomy of, 1295 
markings of, 1296 
Thorax, upper opening of, 216, 
601 
Thromboplastin, 64 
Thumb, carpometacarpal articu- 
lation of, 429 
Thymus, 1264 
applied anatomy of, 1266 
development of, 165 
glands, 1264 
lymphatic vessels of, 800 
nerves of, 1265 
structure of, 1264 
vessels of, 1265 
Thyreoarytaenoideus muscle, 
1089 
Thyreohyoideus muscle, 482 
nerve to, 947 
Thyreoidea ima artery, 626 
Thyroarytenoid ligaments, infe- 
rior, 1086 
muscle, 1089 
Thyrocervical trunk, 662 
Thyroepiglottic ligament, 1084 
muscle, 1090 
Thyroglossal duct, 165, 1127 
Thyrohyals of hyoid bone, 275 
Thyrohyoid ligament, lateral, 
1083 
middle, 1082 
membrane, 1082 
muscle, 482 
Thyroid artery, inferior, 662 
superior, 631 
applied anatomy of, 631 
axis, 662 
body,1261 
cartilage, 1080 
foramen, 339 
gland, 1261 
applied anatomy of, 1263 
development of, 165 
isthmus of, 1261 
lobes of, 1261 
lymphatic vessels of, 779 
nerves of, 1262 
pyramidal lobe of, 1262 
structure of, 1262 
vessels of, 1262 
notch, superior, 1080 
veins, inferior, 751 
middle, 737 
superior, 737 
Thyroids, accessory, 1262 
Tibia, 355 
applied anatomy of, 361 
articulations of, 359 
condyles of, 355 
ossification of, 359 
spine of, 355 
surface anatomy of, 1324 
tuberosity of, 356 
Tibial artery, anterior, 722 
applied anatomy of, 722 
branches of, 722 
peculiarities of, 722 
surface marking of, 1332 
posterior, 725 
applied anatomy of, 725 
branches of, 726 
peculiarities of, 725 
surface marking of, 1332 
recurrent, anterior, 723 
posterior, 722 
collateral ligament of knee- 
joint, 439 
nerve, 987 
anterior, 990 
surfaces of femur, 350 
veins, 758 
Tibialis anterior muscle, 576 
anticus muscle, 576 
posterior muscle, 582 
Tibiofibular articulation, 448 
ligament, middle, 448 
syndesmosis, 448 
Tibionavicular ligament, 450 
Tibiotarsal articulation, 449 
Tissue, adenoid, 45 
adipose, 42 
areolar, 40 
connective, 40 
lymphoid, 45 
mucous, 44 
muscular, 64 
nervous, 69 
retiform or reticular, 44 
white fibrous, 43 
yellow elastic, 44 
Tomes' fibres, 1120 
Tongue, 1125 
applied anatomy of, 1132 
development of, 164 
frenulum of, 1126 
glands of, 1131 
lymph gland of, 778 
lymphatic vessels of, 778 
mucous membrane of, 1131 
muscles of, 1128 
nerves of, 1132 
papillae of, 1127 
septum of, 1132 
structure of, 1131 
vessels of, 1132 
Tonsil, 1139 
lingual, 1131 
pharyngeal, 1139 
Tonsilla cerebelli, 839 
Tonsillae intestinales, 1175 
palatinae, 1139 
Tonsillar artery, 634 
nerves from glossopharyngeal, 
940 
sinus, 1140 
Tonsils, palatine, 1139 
applied anatomy of, 1141 
development of, 165 
lymphatic vessels of, 777 
nerves of, 1141 
structure of, 1141 
vessels of, 1141 
Torcular Herophili, 229, 743 
Torus of auditory tube, 1139 
uretericus, 1222 
uterinus, 1154 
Trabeculae carneae [left ventricle], 
612 
[right ventricle], 610 
cranii, 106 
of penis, 1239 
of spleen, 1267 
of testis, 1232 
Trachea, 1091 
applied anatomy of, 1093 
nerves of, 1093 
relations of, 1092 
structure of, 1092 
vessels of, 1093 
Trachealis muscle, 1093 
Trachelomastoideus muscle, 489 
Tracheobronchial glands, 798 
Tracheotomy, 1094 
Trachoma glands, 1041 
Tract or Tracts, anterior basis 
bundle, 815 
of Burdach, 808, 817 
cerebellar, of Flechsig, 816 
cerebellospinal, 815 
comma, 817 
dorsal peripheral band, 818 
of Goll, 808, 817 
of Gowers, 816 
lateral basis bundle, 817 
of Lowenthal, 815 
motor, 896 
olfactory, 874 
optic, 863, 909 
prepyramidal, 816 
pyramidal, crossed, 815 
direct, 815 
sensory, 897 INDEX 
1403 
Traction epiphyses, 59 
Tractus iliotibialis, 563 
olfactorius, 874 
peduncular is transversus, 850 
note 
solitarius, 128 
spiralis foraminosus, 242,1060 
Tragicus muscle, 1046 
Tragus, 1044 
Transitional epithelium, 40 
Transpyloric plane, 1147 
Transversa colli artery, 663 
Transversalis cervicis muscle, 488 
colli artery, 663 
fascia, 508 
muscle, 504 
Transverse acetabular ligament 
of hip-joint, 434 
aorta, 623 
carpal ligament, 547 
cervical arteries, 663, 664 
nerve, 957 
colon, 1180 
crural ligament, 584 
facial artery, 638 
vein, 734 
fibres of cerebral hemispheres, 
890 
fissure of brain, 889 
of liver, 1194 
folds of rectum, 1183 
ligament of atlas, 389 
of fingers, 551 
humeral, 415 
of knee, 442 
metacarpal, 430 
metatarsal, 458 
of pelvis, 520 
ligaments of scapula, 413 
lingualis muscle, 1130 
mesocolon, 1157 
occipital sulcus, 871 
process of a vertebra, 197 
scapular artery, 663 
sinus, 746 
of pericardium, 603 
temporal gyri, 872 
Transversus abdominis muscle. 
504 
auriculae muscle, 1046 
linguae muscle, 1130 
menti muscle, 470 
nuchae muscle, 466 
pedis muscle, 589 
perinaei muscle, 518 
profundus muscle in female 
521 
in male, 520 
superficialis muscle, in fe- 
male, 520 
in male, 518 
thoracis muscle, 492 
Trapezium, 326 
Trapezius muscle, 522 
Trapezoid, 327 
body, 835 
ligament, 412 
nucleus, 835 
ridge, 302 
Treves, bloodless fold of, 1160 
Triangle of auscultation, 524 
Bryant's, 1330 
carotid, 481, 483, 643 
digastric, 480, 644 
femoral, 565, 712 
of Hesselbach, 1187, 1309 
lumbar, 524 
muscular, 483, 643 
of neck, 642, 644 
occipital, 483, 645 
of Petit, 524 
Scarpa's, 712 
subclavian, 483, 645 
submaxillary, 481, 644 
submental, 481 
Triangle, suboccipital, 491, 660 
suprahyoid, 481, 644 
suprameatal, 238, 283 
Triangular articular disk, 424 
bone, 324 
fascia of abdomen, 502 
ligament, 519 
of liver, 1151 
Triangularis muscle, 470 
sterni muscle, 492 
Triceps brachii muscle, 535 
extensor cubiti muscle, 535 
muscle, 535 
surae muscle, 579 
Tricuspid valve, 609 
Trifacial nerve, 914 
Trigeminal impression, 241 
nerve, 914 
applied anatomy of, 925 
surface marking of, 1283 
Trigone, olfactory, 875 
Trigonum collateral?, 881 
femorale, 712 
habenulae, 859 
hypoglossi, 848 
olfactorium, 875 
vagi, 829 
vesicae, 1222 
Trochanter, greater, 347 
lesser, 348 
major, 347 
minor, 348 
third, 348 
Trochanteric fossa, 347 
Trochlea of humerus, 312 
Trochlear fovea, 235, 286 
nerve, 913 
applied anatomy of, 914 
process of calcaneus, 365 
spine, 235 
Trochoid joint, 382 
Trolard, anastomotic vein of, 739 
Troltsch, recess of, 1055 
Trophoblast, 84 
True nucleoli, 34 
pelvis, 340 
skin, 1074 
vocal cords, 1086 
Truncus arteriosus, 145, 150 
costocervicalis, 666 
sympathicus, 995 
thyreocervicalis, 662 
Trunk, arteries of, 683 
articulations of, 384 
costocervical, 666 
thyrocervical, 662 
Tuba auditiva, 1052 
par cartilaginea, 1052 
ossea, 1052 
uterina [Fallopii], 1247 
Tube, auditory, 1052 
tonsil of, 1053 
'digestive, 1109 
Eustachian, 1052 
Fallopian, 1247 
neural, 88 
uterine, 1247 
Tuber cinereum, 825 
frontale, 234 
omentale [liver], 1192 
[pancreas], 1204 
parietale, 231 
valvulae, 839 
vermis [cerebellum], 839 
Tuberal lobe, 839 
Tubercle, adductor, 348 
articular, of temporal bone, 
237, 280 
auricular, of Darwin, 1044 
carotid, or Chassaignac's, 199 
conoid, 301 
cuneate, 825 
cuneiform, 1085 
deltoid, 302 
1 of epiglottis, 1082 
Tubercle of femur, 348 
of humerus, 309 
intervenous, 608 
jugular, 230 
lacrimal, 260 
of Lower, 608 
mental, 271 
obturator, 339 
peroneal, 365 
pharyngeal, 230, 280 
pterygoid, 250 
pubic, 338 
of rib, 222 
of Rolando, 825 
scalene, 224 
Tuberculum acusticum, 848, 935 
anterius, 199 
caroticum, 199 
impar, 164 
intervenosum, 608 
majus [humeri], 309 
minus [humeri], 309 
posterius, 199 
sellae, 246, 290 
Tuberosity, calcaneal, 365 
coracoid, 301 
costal, 303 
of cuboid, 368 
deltoid, 312 
of fifth metatarsal bone, 372 
gluteal, 348 
iliac, 335 
infraglenoid, 307 
of ischium, 337 
maxillary, 257 
of navicular bone, 369 
of palatine bone, 267 
radial, 320 
supraglenoid, 307 
of tibia, 356 
of ulna, 315 
Tubules, renal, 1212 
Tubuli lactiferi, 1259 
recti [testis], 1233 
seminiferi, 1232 
Tuft, Malpighian, 1212 
Tunic, dart os, 1228 
fibrous, of kidney, 1210 
Tunica adventitia, 597 
albuginea [ovary], 1245 
[testis], 1232 
conjunctiva bulbi, 1041 
dartos, 1229 
elastica externa, 597 
fibrosa oculi, 1017 
intima, 596 
media, 596 
serosa, 1149 
vaginalis, 1231 
communis [testis et funiculi 
spermatid], 1229 
development of, 187 
propria testis, 1231 
lamina parietalis, 1232 
visceralis, 1231 
vasculosa [testis], 1232 
oculi, 1021 
Tunics of eyeball, 1017 
Tunnel of Corti, 1065 
Turbinated bone, 268 
processes, sphenoidal, 250 
Turner, intraparietal sulcus of, 
870 
Twelfth nerve, 945 
Tympanic antrum, 240 
entrance to, 1051 
artery, 639 
from ascending pharyngeal, 
637 
from internal maxillary, 
639 
canaliculus, inferior, 243, 280 
cavity, 1049 
applied anatomy of, 1056 
arteries of, 1056 1404 
INDEX 
Tympanic cavity, attic or epi- 
tympanic recess of, 1049 
carotid or anterior wall of, 
1052 
development of, 141 
jugular wall or floor of, 1049 
labyrinthine or medial wall 
of, 1050 
mastoid or posterior wall of, 
1051 
membranous or lateral wall 
of, 1049 
mucous membrane of, 1055 
muscles of, 1055 
nerves of, 1056 
ossicles of, 1053 
tegmental wall or roof of, 
1049 
vessels of, 1056 
lip, 1065 
membrane, 1050 
nerves of, 1050 
pars flaccida, 1050 
secondary, 1051 
structure of, 1050 
vessels of, 1050 
nerve (Jacobson's), 939, 1056 
plexus, 939, 1056 
ring, 245 
sulcus, 243, 1047, 1050 
Tympanohyal part of styloid 
process, 244 
Tympanomastoid fissure, 243, 
280 
Tympanum, 1049 
U 
Ulna, 314 
applied anatomy of, 321 
articulations of, 321 
coronoid process of, 315 
olecranon of, 315 
ossification of, 319 
radial notch of, 318 
semilunar notch of, 315 
sigmoid cavities of, 318 
structure of, 319 
styloid process of, 319 
surface anatomy of, 1314 
tuberosity of, 315 
Ulnar artery, 679 
applied anatomy of, 680 
branches of, 680 
carpal, 682 
collateral, 674, 675 
branch of radial nerve, 969 
peculiarities of, 679 
recurrent, 680 
surface marking of, 1322 
notch of radius, 321 
Ultimobranchial bodies, 166 
Umbilical arteries in fetus, 99, 
. 616 
cord, 96 
folds, 1187, 1221, 1222 
fossa of liver, 1194 
notch of liver, 1194 
veins, 100, 145, 156 
obliterated, 765, 1150 
zone, 1147 
Umbilicus, 507 
Umbo of membrana tympani, 
1050 
Unciform bone, 328 
Uncinate fasciculus, 890 
process of head of pancreas, 
1203 
Uncus, 874 
Ungual phalanges, 331, 373 
Ungues, 1075 
Unstriped muscle, 67 
Upper extremity, arteries of, 655 
articulations of, 409 
Upper extremity, bones of, 301 
lymphatics of, 779 
muscles and fasciae of, 522 
surface markings of, 1319 
veins of, 747 
jaw, bones of, 256 
lateral cartilage, 1009 
motor neurons, 896 
Urachus, 189 
Ureter, 1216 
abdominal part of, 1216 
arteries of, 1217 
lymphatic vessels of, 793 
muscles of, 1223 
nerves of, 1217 
orifices of, 1222 
pars abdominalis, 1216 
pelvina, 1216 
pelvic part of, 1216 
structure of, 1217 
tunica adventitia, 1217 
mucosa, 1217 
Urethra, development of, 190 
female, 1228 
male, 1225 
applied anatomy of, 1226 
cavernous portion of, 1226 
crest or verumontanum of, 
1225 
lymphatic vessels of, 794 
membranous portion of, 1226 
prostatic portion of, 1225 
sinus of, 1225 
structure of, 1226 
muliebris, 1228 
virilis, 1225 
pars cavernosa, 1226 
membranacea, 1226 
prostatica, 1225 
Urethral artery, 705 
bulb, 1226 
crest, in female, 1228 
in male, 1225 
glands, 1226 
orifice, external, 1226, 1257 
internal, 1222 
plate, 190 
Urinary bladder, male, 1218 
female, 1221 
meatus, 1257 
organs, 1206 
development of, 180 
lymphatic vessels of, 793 
Urogenital apparatus, 1206 
diaphraem, 519 
fold, 181 
organs, 1206 
ostium, primitive, 190 
Urorectal septum, 172 
Uterine artery, 701 
glands, 1252 
plexus of nerves, 1005 
plexuses of veins, 761 
tube, 1247 
abdominal ostium of, 1247 
ampulla of, 1247 
appendices vesiculosae, 1247 
applied anatomy, 1247 
development of, 182 
fimbriae, 1247 
infundibulum of, 1247 
isthmus of, 1247 
Uterosacral ligaments, 1250 
Uterus, 1248 
in adult, 1252 
after parturition, 1252 
applied anatomy of, 1254 
body of, 1249 
cervix of, 1249 
development of, 182 
during menstruation, 1252 
pregnancy, 1252 
in fetus, 1251 
form, size, and situation of, 
1251 
Uterus, fundus of, 1249 
interior of, 1250 
isthmus of, 1249 
ligaments of, 1250 
lymphatic vessels of, 795 
masculinus, or prostatic utricle, 
1225, 1226 
nerves of, 1253 
in old age, 1252 
at puberty, 1251 
structure of, 1252 
tunica mucosa, 1252 
muscularis, 1252 
vessels of, 1253 
virgin state of, 1249 
Utricle, prostatic, 1226 
of vestibule, 1062 
Utriculus, 1062 
Uvea, 1025 
Uvula of cerebellum, 839 
palatine, 1112 
vermis, 839 
vesicae, 1222 
Uvular lobe, 839 
V 
Vagina, 1255 
columns of, 1255 
fornices of, 1255 
lymphatic vessels of, 795 
structure of, 1255 
tunica mucosa, 1255 
muscularis, 1255 
Vaginae mucosae, 380 
Vaginal artery, 702 
bulb, 1257 
orifice, 1257 
plexus of nerves, 1005 
plexuses of veins, 762 
process of temporal bone, 243, 
244 
processes of sphenoid bone, 250 
Vagus nerve, 940 
applied anatomy of, 943 
■ ganglion of root of, 941 
of trunk of, 941 . 
nuclei of, 829, 940 
Vallecula cerebelli, 837 
Vallecular of tongue, 1082 
Vallum, 1128 
Valsalva, sinuses of, 610, 612 
Valve, bicuspid, 612 
colic, 1179 
of coronary sinus, 608, 730 
Eustachian, 607, 608 
ileocolic, 1179 
of inferior vena cava, 607, 762 
mitral, 612 
pyloric, 1164 
Thebesian, 608, 730 
tricuspid, 609 
of Vieussens, 842 
Valves, anal, 1184 
of heart, development of, 151 
of Houston, 1183 
of Kerkring, 1173 
of lymphatics, 768, 769 
right and left venous, 146 
semilunar aortic, 612 
pulmonary, 610 
of veins, 599 
Valvulabicuspidalis [metralis], 612 
coli, 1179 
sinus coronarii [Thebesii], 608 
tricuspidalis, 609 
venae cavae inferioris, 608 
Valvulae conniventes, 1173 
Vas aberrans of Haller, 1236 
deferens, 1235 
spirale, 1065 
Vasa aberrantia [from brachial 
artery], 673 
afferentia [lymph glands], 770 INDEX 
1405 
Vasa brevia arteries, 691 
efferentia [lymph glands], 770 
intestini tenuis arteries, 692 
vasorum [arteries], 597 
[veins], 600 
Vascular areas of yolk-sac, 141 
capsule of lens, 136 
system, changes in, at birth, 
618 
development of. 141 
peculiarities in fetus, 615 
Vasomotor nerve fibres, 802 
Vastus externus muscle, 566 
intermedius muscle, 566 
internus muscle, 566 
lateralis muscle, 566 
medialis muscle, 566 
Vater, ampulla of, 1200 
Vein or Veins, of abdomen, 759 
anastomotic, of Labbe, 739 
angular, 733 
auditory, internal, 1067 
auricular, posterior, 734 
axillary, 750 
azygos, 753 
basal, 740 
basilic, 748 
median, 747 
basivertebral, 755 
brachial, 750 
brachiocephalis, 751 
of brain, 739 
bronchial, 754, 1108 
cardiac, 730 
anterior, 731 
great, 730 
small, 730 
smallest, 731 
cardinal, 157 
cava, inferior, 762 
superior, 753 
cephalic, 747 
accessory, 748 
cerebellar, 740 
cerebral, 739, 740 
anterior, 740 
choroid, 740 
deep middle, 740 
external, 739 
great, 740 
inferior, 739 
internal, 740 
middle, 739 
superior, 739 
terminal, 740 
cervical, deep, 738 
choroid. 740 
coats of, 599 
comitans, of hypoglossal nerve, 
736 
common facial, 733 
iliac, 762 
peculiarities of, 762 
coronary, 730 
of stomach, 766 
of corpus striatum, 885 
cystic, 767 
deep cerebral, 740 
facial, 733 
of forearm, 750 
of hand, 750 
of lower extremity, 758 
of upper extremity, 750 
development of, 154 
digital, of foot, 756 
of hand, 747 
diploic, 738 
dorsal digital, 747 
metacarpal, 747, 750 
of penis, 761 
emissary, 746 
applied anatomy of, 747 
epigastric, 760 
deep, 760 
superficial, 756 
Vein or Veins, extraspinal, 754 
facial, 733 
anterior, 733 
common, 733 
deep, 733 
posterior, 734 
transverse, 734 
femoral, 758 
frontal, 732 
of Galen, 740 
gastric, short, 766 
gastroepiploic, 766 
gluteal, 760 
of hand,747,750 
of head and neck, 731 
of heart, 730 
hemiazygos, 753 
hemorrhoidal, inferior, 761 
middle, 760 
superior, 766 
hepatic, 764 
highest intercostal, 753 
histology of, 599 
hypogastric, 760 
iliac, circumflex, deep, 760 
superficial, 756 
common, 762 
external, 759 
internal, 760 
iliolumbar, 762 
inferior cava, 762 
thyroid. 751 
innominate, 751 
intercapitular, 747, 756 
intercostal, highest, 753 
interlobular, of kidney, 1214 
of liver, 1198 
internal mammary, 751 
intervertebral, 755 
intralobular, of liver, 1198 
intraspinal, 755 
jugular, anterior, 736 
external, 734 
posterior, 736 
internal, 736 
primitive, 157 
of Labbe, posterior anasto- 
motic, 739 
labial. 733 
lateral sacral, 760 
of left atrium, 603 
lienal or splenic, 765 
lingual, 736 
of lower extremity, 755 
lumbar, 763 
ascending, 753 
mammary, internal, 751 
marginal, of foot, 756 
masseteric, 733 
maxillary, internal, 734 
median antibrachial, 749 
basilic, 747 
of medulla spinalis, 755 
mesenteric, 766 
metatarsal, 758 
middle cardiac, 731 
sacral, 762 
nasofrontal, 745 
of neck, 734 
oblique, of left atrium [Mar- 
shaUi], 159, 603, 731 
obturator, 760 
occipital, 734 
ophthalmic, 745 
orbital, 734 
ovarian, 764 
palpebral, 733 
pancreatic, 766 
pancreaticoduodenal, 766 
parumbilical, 767 
of pelvis, 759 
penis, dorsal of, 761 
peroneal, 758 
pharyngeal, 737 
phrenic, inferior, 764 
Vein or Veins, phrenic, superior, 
751 
plantar, 758 
popliteal, 758 
portal, 764 
applied anatomy of, 767 
posterior of left ventricle, 731 
primitive jugular, 157 
profunda femoris, 759 
prostatic plexus, 761 
pterygoid plexus, 734 
pubic, 760 
pudendal internal, 760 
plexus, 761 
pudic, 756, 760 
pulmonary, 730 
pyloric, 766 
ranine, 736 
renal, 764, 1214 
sacral, 760, 762 
saphenous, 757 
applied anatomy of, 757 
sciatic, 760 
short gastric, 766 
spermatic, 763 
of spinal cord, 755 
splenic or lienal, 765 
striate, inferior, 740 
structure of, 599 
stylomastoid, 734 
subcardinal, 157 
subclavian, 750 
sublobular, of liver, 1198 
submaxillary, 733 
submental, 733 
superficial, 729 
of lower extremity, 756 
applied anatomy of, 757 
of upper extremity, 747 
applied anatomy of, 749 
superior cava, 753 
mesenteric, 766 
phrenic, 751 
supraorbital, 733 
suprarenal, 764 
Sylvian, 739, 740 
systemic, 730 
temporal, 733 
temporomaxillary, 734 
terminal, 740 
of Thebesius, 731 
thoracoepigastric, 756 
of thorax, 751 
thyroid, inferior, 751 
middle, 737 
superior, 737 
tibial, 758 
transverse cervical, 735 
facial, 734 
scapular, 735 
Trolard, great anastomotic of, 
739 
umbilical, 100, 145 
obliterated, 765, 1150 
of upper extremity, 747 
uterine plexuses, 761 
vaginal plexuses, 762 
valves of, 599 
vena azygos major, 753 
minor inferior, 753 
cava, inferior, 762 
superior, 753 
vertebral anterior, 738 
plexuses, 754 
posterior, 738 
of vertebral column, 754 
vesical plexus, 761 
vesicoprostatic plexus of, 761 
visceral, 155 
vitelline, 144, 155 
volar digital, 747, 750 
metacarpal, 750 
Velamentous insertion of um- 
bilical cord, 102 
Velum interpositum, 888 1406 
INDEX 
Velum medullare anterius, 842 
posterius, 842 
medullary, 842, 845 
palatine, 1112 
Vena angularis, 733 
anonyma dextra, 751 
sinistra, 751 
auricularis posterior, 734 
axillaris, 750 
azygos, 753 
major, 753 
minor inferior, 753 
superior, 753 
basilica, 748 
capitis lateralis, 160 
medialis, 160 
cava inferior, 762 
applied anatomy of, 762 
development of, 157 
fossa for, 1194 
peculiarities of, 762 
valve of, 762 
superior, 753 
applied anatomy of, 754 
development of, 157 
surface marking of, 1300 
caval foramen in diaphragm ,496 
cephalica accessoria, 748 
cerebri magna, 740 
media, 739 
cervicalis profunda, 738 
circumflexa ilium profunda, 760 
comitans of hypoglossal nerve, 
733,736 
cordis magna, 730 
media, 731 
parva, 736 
coronaria ventriculi, 766 
corporis striata, 740 
cystica, 767 
epigastrica inferior, 760 
facialis anterior, 733 
posterior, 734 
femoralis, 758 
frontalis, 732 
gastroepiploica dextra, 766 
sinistra, 766 
haemorrhoidalis media, 760 
hemiazygos, 753 
accessoria, 753 
hypogastrica, 760 
iliaca, externa, 759 
intercostalis suprema dextra, 
753 
sinister, 753 
jugular is anterior, 736 
externa, 734 
interna, 736 
posterior, 736 
linealis, 765 
magna [Galeni], 740, 889 
maxillaris interna, 734 
mediana antibrachii, 749 
cubiti, 747 
mesenterica inferior, 766 
superior, 766 
obliqua atrii sinistri [Marsh alii], 
731 
obturatoria, 760 
occipitalis, 734 
ophthalmica inferior, 746 
superior, 745 
poplitea, 758 
portae, 764 
posterior ventriculi sinistri, 731 
profunda femoris, 759 
saphena magna, 756 
parva, 757 
subclavia, 750 
supraorbitalis, 733 
temporalis super facialis, 733 
terminalis, 740 
thyreoidea superioris, 737 
vertebralis, 738 
Venae advehentes, 155 
Venae anonymae, 751 
basivertebrales, 755 
brachiales, 750, 754 
cerebelli inferiores, 740 
superiores, 740 
cerebri, 739 
inferiores, 739 
internae, 740 
superiores, 739 
comitanles, 729 
cordis, 730 
minimae, 608 
digitales plantares, 758 
diploicae, 738 
dor sales penis, 761 
Galeni, 889 
gastricae breves, 766 
glutaeae inferiores, 760 
superiores, 760 
hepatrcae, 764 
iliacae communes, 762 
intervertebrales, 755 
linguales, 736 
lumbales, 763 
mammariae internae, 751 
ovariacae, 764 
pancreaticae, 766 
pancreaticoduodenales, 766 
parumbilicales, 767 
pharyngeae, 737 
phrenicae inferiores, 764 
propriae renales, 1214 
pulmonales, 736 
rectae [kidney], 1214 
renales, 764 
revehentes, 156 
sacrales later ales, 760 
mediates, 762 
spermaticae, 763 
spinales, 755 
stellatae [kidney], 1214 
suprarenales, 764 
thyreoideae inferiores, 751 
tibialis anteriores, 758 
posteriores, 758 
vorticosae, 1022, 1031 
Venesection, 749 
Venous arch, dorsal, 756 
plantar cutaneous, 756 
lacunae of dura mater, 741 
mesocardium, 603 
plexus, ovarian, 764, 1246 
pampiniform, 763,1230,1246 
pharyngeal, 737 
pterygoid, 734 
pudendal, 761 
spermatic, 763, 1230 
uterine, 761 
vaginal, 762 
sinuses, 727 
of dura mater, 740 
valves, right and left, 146 
Ventral aortae, 145 
cochlear nucleus, 836 
fissure of medulla oblongata, 
822 
lamina, 119 
mesogastrium, 168 
pulmonary nerves, 943 
spinal artery, 660 
Ventricle of fornix, 886 
fourth, floor of, 847 
of mid-brain, 854 
terminal, of medulla spinalis, 
810 
of Verga, 886 
Ventricles of brain, fourth, 845 
lateral, 877 
third, 864 
of heart, left, 611 
primitive, 145 
right, 608 
of larynx, 1086 
Ventricular folds of larynx, 1085 
ligament of larynx, 1085 
Ventricular septum, 149, 612 
Ventriculus, 1161 
dexter, 608 
laryngis [Morgagni], 1086 
lateralis, 877 
pars centralis, 877 
quartus, 845 
tela submucosa, 1165 
tertius, 864 
tunica mucosa, 1165 
muscularis, 1164 
fibrae obliquae, 1164 
stratum circular is, 1164 
longitudinale, 1164 
serosa, 1164 
Ventromedian fissure of medulla 
oblongata, 822 
Verga, ventricle of, 886 
Vermian fossa, 228 
Vermiform process or appendix, 
1178 
structure of, 1178 
Vermis of cerebellum, 837 
Vernix caseosa, 116 
Vertebra, anticlinal, 202 note 
prominens, 201 
ossification of, 211 
Vertebrae, 196 
cervical, 198 
cervicales, 198 
characteristics of, 197 
coccygeal, 205 
ligaments of, 384-386 
lumbales, 204 
lumbar, 204 
ossification of, 210 
sacral, 205 
sacrales, 205 
structure of, 197 
thoracales, 201 
thoracic, 201 
Vertebral arch, 197 
arches, articulations of, 386 
artery, 659 4 
canal, 214 
column, 196, 212 
applied anatomy of, 214 
articulations of, 384 
curves of, 212 
ossification of, 210 
surface form of, 1293 
veins of, 754 
foramen, 197 
groove, 214 
notches, 197 
part of base of skull, 106 
ribs, 221 
vein, 738 
venous plexuses, 754 
Vertical index of skull, 296 
lingualis muscle, 1130 
part of palatine bone, 266 
Vertical is linguae muscle, 1130 
Verumontanum, 1225 
Vesica fellea, 1199 
tunica mucosa, 1199 
muscularis, 1199 
serosa, 1199 
urinaria, 1218 
tela submucosa, 1223 
tunica mucosa, 1223 
muscularis, 1223 
serosa, 1223 
Vesical artery, 701 
layer of pelvic fascia, 512 
plexus of nerves, 1005 
of veins, 761 
Vesicle, auditory, 138 
blastodermic, 85 
germinal, 78 
lens, 134 
optic, 126, 134 
Vesicles, cerebral, 88, 120 
Vesicoprostatic plexus of veins, 
761 INDEX 
1407 
Vesicouterine excavation, 1152 
Vesiculae seminales, 1236 
applied anatomy of, 1237 
lymphatic vessels of, 794, 795 
nerves of, 1237 
structure of, 1237 
vessels of, 1237 
Vesicular ovarian follicles, 1245 
Vestibular arteries, 1068 
bulb, 1257 
fissure, 1060 
ganglion, 1068 
glands, greater, 1258 
lip, 1065 
membrane, 1063 
nerve, 935, 1068 
nuclei of, 836, 935 
root of acoustic nerve, 935 
Vestibule, aortic, 612 
of internal ear, 1058 
of larynx, 1085 
of mouth, 110 
of nasal cavity, 1010 
of omental bursa, 1156 
of vagina, 1257 
Vestibulospinal tract, 815 
Vestibulum, 1058 
oris, 1100 
vaginae, 1257 
Vestigial fold of Marshall, 731 
of pericardium, 603 
Vicq d'Azyr, bundle of, 857, 
860, 886 
Vidian artery, 642, 648 
nerve, 920 
Vieussens, valve of, 842 
Villi, arachnoid, 905 
of chorion, 99 
of intestine, 1173 
Vincula brevia, 540 
longa, 540 
tendina, 540 
Visceral arches, 108 
veins, 155 
Visual area of cortex, 893 
centres, higher or cortical, 864, 
909 
lower, 864, 909 
purple, 1026 
Visuopsychic, area, 893 
Visuosensory area, 893 
Vitelline circulation, 93, 143 
duct, 168 
fluid, 93 
membrane, 83 
veins, 144, 156 
Vitreous body of eye, 1030 
development of, 136 
table of skull, 196 
Vocal cords, false, 1085 
inferior, 1086 
superior, 1085 
true, 1086 
folds, 1086 
process of arvtenoid cartilage, 
1081 
Vocalis muscle, 1089 
Voice, organs of, 1079 
Volar arch, deep, 679 
Volar arch, superficial, 682, 
applied anatomy of, 682 
surface markings of, 1322 
branch of ulnar nerve, 968 
carpal artery, 678 
ligament, 547 
net-work, 678 
digital arteries, 682 
nerves, 965 ■ 
interosseous artery, 680 
nerve, 965 
metacarpal arteries, 679 
veins, 750 
venous arches, 750 
Volaris indicis radialis artery, 679 
Voluntary muscles, 64 
Vomer, 269 
articulations of, 271 
ossification of, 270 
Vomeronasal cartilage, 1012 
organs, 113, 1012 
Vulva, 1256 
W 
Wagner and Meissner, cor- 
puscles of, 1070 
Waldeyer, germinal epithelium 
of, 184 
odontoblasts of, 1119 
zona vasculosa of, 1246 
Wallerian degeneration, 815 
Wandering cells, 42 
Wharton, duct of, 1136 
jelly of, 97 
White fibrocartilage, 49 
fibrous tissue, 43 
line of pelvic fascia, 512 
nerve fibres, 73 
nervous substance, 70 
of cerebellum, 839 
of cerebral hemispheres, 
889 
of medulla spinalis, 814 
of Schwann, 73 
Willis, circle of, 653 
Windpipe, 1091 
Wings of sphenoid, 248, 249 
Winslow, foramen of, 170, 689, 
1155 
Wirsung, duct of, 1204 
Wisdom teeth ,1118 
Wolffian body, 181 
bulbs, 191 
duct, 137 
tubules, 180 
Womb, 1248 
Wormian bones, 255 
applied anatomy of, 255 
Wrisberg, cardiac ganglion of, 
1002 
cartilages of, 1082 
ligament of, 442 
nerve of, 964 
nervus intermedius of, 929 
Wrist-joint, 425 
applied anatomy of, 426 
surface anatomy of, 1319 
X 
Xiphoid appendix, 220 
process, 220 
¥ 
Y-shaped cartilage of acetab- 
ulum, 340 
ligament of Bigelow, 433 
Yellow elastic fibrocartilage, 50 
tissue, 44 
spot of retina, 1026, 1029 
Yolk, formative, 78 
nutritive, 78 
Yolk-sac, 93 
Yolk-stalk, 168 
Z 
Zigzag tubule, 1212 
Zinn, ligament or tendon of, 1035 
zonule of, 1030 
Zona arcuata, 1065 
fasciculata, 1272 
glomerulosa, 1272 
incerta, 860 
orbicularis, 432 
pectinata, 1065 
pellucida, 79 
reticularis, 1272 
striata, 79 
vasculosa [ovary], 1246 
of Waldeyer, 1246 
Zones of abdomen, 1147 
Zonula ciliaris, 1030 
Zonule of Zinn, 1030 
Zygomatic arch, 282 
bone, 263 
articulations of, 265 
foramina of, 264 
frontosphenoidal process of, 
264 
maxillary process of, 265 
orbital process of, 264 
ossification of, 265 
temporal process of, 265 
branch of facial nerve, 933 
fossa, 273 
nerve, 917 
process of frontal bone, 235 
of maxilla, 260 
of temporal bone, 237 
Zuckerkandl, aortic bodies of, 
1274 
Zygomaticofacial foramen, 263, 
286 
nerve, 918 
Zygomaticofrontal suture, 282 
Zygomaticoorbital foramina, 264 
Zygomaticotemporal foramen, 
263,282 
nerve, 918 
suture, 282 
Zygomaticus muscle, 470