“ IvT XT 3A T TXIVI IN PAEVO.” THE VEST-POCKET ANATOMIST (FOUNDED UPON “GRAY.”) BY C. HENRI LEONARD, A. M., M. D., Professor of the Medical and Surgical Diseases of Women and Clinical Gynaecology, Michigan College of Medicine ; Gynaecological Surgeon to the Michigan College Hospital; Member of the American Medical Association; of the Michigan State Medical Society; Wayne County Medical Society, etc. ELEVENTH REVISED EDITION. Enlarged by Sections on the A natomical Triangles and Spaces, Gyncecological Anatomy, Etc. THE ILLUSTRATED MEDICAL JOURNAL CO. 1882. DETROIT : WORKS BY THE SAME AUTHOR. Hair, Its Care, Diseases and Treatment. Cloth, octavo, 320 pages, 116 illustrations. 82.00. 10,000 copies sold. Reference and Dose Book. Cloth, 16mo., 112 pages. Price, 75 cts. 30,000 copies sold. Manual of Bandaging. Cloth, octavo, 112 illustrations, 132 pages. Price, 81.50. 2,000 copies sold. Vest-Pocket Anatomist. Cloth, 16mo., 100 pages. Price, 75 cts. Paper, 50 cts. 10,000 copies sold. Physician’s Pocket Day-Book. Morocco, red edges; flap and pocket. Price, 81.00. Seven editions sold. Physician’s Office Ledger. Cloth; leather back and corners. Price, 82.50. Three editions sold. Any of the above sent, post-paid, on receipt of price, by THE ILLUSTRATED 31 EPICAL JOURNAL CO., Detroit, Mich. [Copyrighted 1875,1878, 1881.1 PREFACE TO THE ELEVENTH EDITION. This little book, virtually a Dissecting-room Companion, has been, from its rapid and large sales, a source of surprise and pardonable pride to the author. It is now in its Eleventh edition, four of these editions having been sold in London alone. Then, too, he has been complimented by having a copy of the London edition put into plates by a large American publishing house, before it was discovered that the work was from an American author, and could not be re-published here. While the larger portion of the work is simply ‘ ‘ Gray ’ ’ condensed and transposed, the author has also used, quite liberally, in the preparation of the new section on “ Triangles and Spaces,” Brown’s Aid to Anatomy and Bryant’s System of Surgery. In the Gynaeco- logical section, the works of Gray, Savage, Hirschfeld, Barnes and Playfair have all been consulted. The section, “ Points Worth Remembering,” the author hopes will prove of use, as well as interest, to the medical student, for whom the little book is mainly intended. C. H. L. Detroit, 89 Miami Ave., January, 1882. REFERENCE AND DOSE BOOK By C. HENRI LEONARD, A. M., M. D. Eighth Edition [30th Thousand], Revised and Enlarged. Cloth, post-paid, 75c. Contains the Doses of more Remedies than any o her Dose-Book or Materia Medica published. It is used in every Medical College in the United States, and by Physicians and Druggists in every State and Territory, the Canadas, Manitoba, hew Brunswick, Nova Scotia, Prince Edward’s Island, Newfoundland, British Columbia, England, Hawaiian Islands Bermuda Islands, India, China, Liberia and Australia. CONTENTS. Medium and maximum DOSES of ALL officinal and non-oflficinal Remedies, and their Preparations, arranged in alphabetical order, wuh Pronunciation (common names in small type below drug name), the Orthography that of the last U. S. P„ RULES for Genitive-case Endings in prescription writing. A complete list of INCOMPATIBLES. List of POISONS and their Antidotes, and Tests for same. Rules for Resuscitation of the Drowned, Treatment of Poisoned Wounds, etc. A complete table of TESTS FOR URINARY DEPOSITS. OBSTETRIC TABLES, and rules for management in difficult cases and accidents. PRONUNCIATION of Medico-Biographical Names. Table of FEES for city and country practice. Visceral Measurements for guides in Auscultation and Percussion. Table of the Exanthemata, and differential diagnosis. Tables of WEIGHTS, MEASURES, DOSES, etc., both French and American. List of ABBREVIATIONS, besides many pages of miscellaneous matter, useful in emergencies. “This Is a work deserving high praise; its completeness, its freedom from errors, the pains taken to embody everything- of value, and to admit nothing extraneous, stamp it as head and shoulders above the ordinary run of dose- books and manuals with which our literature has, of late, been teeming.”— Western Lancet. “ It is e-nphatically a multum in parvo, and contains a fund of valuable infor- mation of every day requirement. Besides being the most complete Dose Book we know of, it is indispensable to the practitioner on account of its other con- tents.”—Peninsular Jour. Med. “ Every one must acknowledge that this author has compressed an immense amount of ready, practical information into the minimum of space.”—Chicago Med. Jour, and Examiner. “ v very complete little volume, containing a rare selection of valuable infor- mation, arranged for ready reference.”—St. Louis Med. Jour. “ One of the best books of its size issued.”—Am. Med. Bi-weekly. Address all Orders (none filled without to the publishers, THE ILLUSTRATED MEDICAL JOURNAL CO., DETROIT, MICHIGAN, U. S. A. HEAD AND NECK. MUSCLES OF THE HEAD—(11 Regions, 39 Muscles). The nervous supply is indicated by [ ] brackets. The — dash divides the origin from the insertion. (REGION 1) EPICRANIAL REGION, 1 MUSCLE. Occip'ito-fronta lis: outer £ superior curved line of occiput, and mastoid process—frontal quadrilateral expan- sion to the facial muscles. [Supra-orbital, facial, occipital, posterior auricular.] (2) AURICULAR REGION, 3. Attol'lens au’rem: occipital fascia—upper part of pinna. [Small occipital.] At trahens au'rem: lateral edge aponeuro'sis of occi- pito-frontalis—front of helix. [Facial, inferior maxillary.] Ret'rahens au'rem: mastoid process—lower cranial surface of the concha. [Facial.] (3) INTRA-AURICULAR REGION, 4. Ten'sor tym'pani: inferior surface petrous bone, Eu- stachian tube—backwards to handle malleus. [Otic gan- glion.] Laxa'tor tym'pani major: spinous process sphenoid, Eustachian tube—back through Glaserian fissure to neck of the malleus. [Facial.] Laxa'tor tym pani mi'nor: superior and posterior part external meatus—for-and inwards to handle of the malleus. [Facial. ] Stapedius: interior of pyramid—forward to neck of stapes. [Facial.] (4) PALPEBRAL REGION (4), 3. Orbicularis palpebra rum: internal angular process frontal bone, nasal process superior maxilla, sphincter of eye. [Facial, supra-orbital.] Corruga'tor supercilii: inner extremity superciliary ridge—under surface orbicularis, opposite the middle of the orbital arch. [Facial and supra-orbital.] Ten'sor tar'si: crest of os lachrymalis—tarsal cartilage near puncta; covers in lachrymal canals. [Facial.] 2 HEAD AND NECK. (5) ORBITAL REGION, 7. Lava'tor pale'brse superio'ris: inferior surface les- ser wing of sphenoid, anteriorly to foramen opticum— upper border superior tarsal cartilage. [Hid.] Rec tus supe'rior: margin optic foramen—sclerotica. [IHd.] Rec tus mfe'rior: optic foramen—sclerotica. [Hid.] Rec tus inter'nus: optic foramen—sclerotica. '[Illd.J Rec tus exter'nus: 2 heads between which pass Hid., nasal branch of Vth, and Vlth nerves and ophthalmic vein; upper from outer margin optic foramen, lower from ligament of Zinn and process of bone at sphenoidal fissure —sclerotica. [Vlth.] Obliq'uus supe'rior: near optic foramen—“pulley” thence at right angles to sclerotica. [IVth.] Obliq'uus infe'rior: depression in orbital plate in superior maxilla—sclerotica, outer surface. [Hid.] (6) NASAL REGION, 7. Pyramida'lis na si : occipito-frontalis—compressor naris. [Facial.] Levator la'bii superio'ris alse'que nasi: nasal process superior maxilla—cartilage of the ala and lip. [Facial.] Dila tor naris ante'rior: Cartilage ala—inner bor- der integument ala. [Facial.] Dila tor na ris poste'rior: nasal notch superior max- illa—skin at inner margin nostril. [Facial.] Compressor naris: above incisive fossa superior maxilla—pyramidal is nasi, nasal fibro-cartilage, its fellow opposite side. [Facial.] Compressor narium minor: alar cartilage—skin at the end of the nose. [Facial.] Depressor alse nasi: incisive fossa superior max- illa—septum and ala nasi. [Facial.] (7) SUPERIOR MAXILLARY REGION, 4. Levator la bii superio'ris: lower margin orbit— lip. [Facial.] Leva tor an'guli o'ris: canine fossa superior max- illa—angle mouth. [Facial.] Zygomat'icus major: in front zygoma—angle oris. [Facial. ] Zygomat'icus minor: malar bone near maxillary suture—angle oris. [Facial.] MUSCLES. b (8) INFERIOR MAXILLARY REGION, 3. Leva tor la'bii Inferio'ris, or Leva tor men'ti: incisive fossa inferior maxilla—skin of chin. Depres'sor la'bii inferio'ris: external oblique line inferior maxilla—integument of lower lip. [Facial.] Depressor an'guli oris, or Quadra'tus men'ti: external oblique line inferior maxilla—angle oris. [Fa- cial.] (9) INTER-MAXILLARY REGION, 3. Orbicularis o ris : sphincter oris. [Facial.] Buceina'tor: alveolar processes superior and inferior maxillae—converges, to the angle of the mouth, and orbic- ularis. [Facial, inferior maxillary.] Riso'rius: fascia above masseter—angle oris. [Facial.] (10) TEMPORO-MAXILLARY REGION, 2. Masse'ter: malar process superior maxilla, lower bor- der zygoma—angle and lower half ramus inferior maxilla, outer surface. [Inferior maxillary.] Temporalis: temporal fossa, curved line of frontal and parietal bones, pterygoid ridge of sphenoid—coronoid process inferior maxilla. [Inferior maxillary.] (11) PTERYGO-MAXILLARY REGION, 2. Pterygoideus inter'nus: pterygoid fossa, tuberos- ity palate bone—lower and inner side ramus inferior max- illa. [Inferior maxillary.] Pterygoide'us externus: upper head from ptery- goid ridge of great wing of sphenoid; lower from external pterygoid plate, tuberosity of palate, and superior maxil- lary bones—pterygoid depression in front condyle infe- rior maxilla. [Inferior maxillary.] MUSCLES OF THE HECK—(11 Regions, Muscles). (REGION 1) SUPERFICIAL CERVICAL REGION, 2. Platys'ma myoide'us: clavicle, acromian process, fascia of deltoid and pectoralis major—inferior maxilla below external oblique line. [Facial, superior cervical.] Ster'no-clei'do mastoide us: sternum and clavicle— mastoid process, superior occipital curved line. [Spinal accessory, cervical plexus.] (2) INFRA-HYOID REGION, 4. Sterao-hyoide'us : sternum and sternal end of clavi- cle—hyoid bone. [Communicating branch of descendens and communicans noni.] 4 HEAD AND NECK. Ster'no-thyroide'us: upper posterior edge sternum— oblique line of ala of cartilage (thyroid) [Communicat- ing branch of descendens and communicans noni. ] Thy ro-hyoide us: oblique line of thyroid cartilage— body and greater cornu hyoid bone. [Hypoglossal.] O mo-hyoide'us: upper border scapula (bound down to clavicle by cervical fascia)—hyoid bone. [Communi- cating branch of descendens and communicans noni.] (3) SUPRA-HYOID REGION, 4. Digas'tricus: mastoid process of temporal (ligament binding hyoid bone)—symphysis inferior maxilla. [Fa- cial, inferior dental.] Sty'lo-hyoide'us: outer surface, middle styloid pro- cess-body hyoid bone, perforated by digastricus. [Facial. ] My'lo-hyoide'us: (forms floor of mouth) mylo-hyoid ridge of inferior maxilla—body of os hyoides. [Inferior dental.] Ge'nio-hyoide'us: inferior genial tubercle of inferior maxilla—body os hyoides. [Hypoglossal.] (4) LINGUAL REGION (5). 4. G-enio-hyo-glos'sus: superior genial tubercle of in- ferior maxilla—os hyoides and whole length inferior sur- face tongue. [Hypoglossal.] Hyo-glos'sus: side of body and greater and lesser cornua hyoid—back and side of tongue. [Hypoglossal.] Lingua'lis : under surface glossa from base to tip, be- tween hyo-glossus and genio-hyo-glossus. [Chorda tym- pani.] Sty'lo-glos’sus: outer and anterior center styloid pro- cess—side of tongue. [Hypoglossal.] (5) PHARYNGEAL REGION (5), 4. Constric'tor infe'rior: sides of cricoid and thyroid cartilages—fibrous raphe of posterior median line of pha- rynx. [Pharyngeal plexus, glosso-pharyngeal, external la- ryngeal Constric'tor me'dius: greater and lesser cornua hyoid—posterior median pharyngeal raphe. [Glosso-pha- ryngeal, pharyngeal plexus.] Constric'tor superior: lower 3d of the margin of internal pterygoid plate, palate and contiguous palatal mus- cles—posterior median pharyngeal raphe and occipital pharyngeal spine. [Glosso-pharyngeal, pharyngeal plexus.] Stylo-pharynge'us: inner side base of styloid pro- cess—constrictor muscles and upper border thyroid carti- lage. [Glosso-pharyngeal and pharyngeal plexus.] MUSCLES. 5 (6) PALATAL REGION, 5. Leva tor pala'ti: under surface petrous portion of temporal, Eustacliian tube—posterior surface soft palate. [Facial.] Ten sor pala'ti: scaphoid fossa of the sphenoid, Eus- tachian tube (bound to hamular process)—anterior surface hard and soft palate. [Otic ganglion.] Azygos uvulae: posterior nasal spine palate bone— uvula. [Facial.] (Is not a single muscle as its name im- plies.) Pala'to-glos'sus: {anterior pillar) anterior lateral sur- face .soft palate—side and dorsum of tongue. [Meckel’s ganglion.] Pala'to-pharynge’us: {posterior pillar) soft palate- joins stylo-pharyugeus to be inserted into posterior border thyroid cartilage. [Meckel’s ganglion.] (7) INTRA-LARYNGEAL REGION, 0. Cri'co-thyroide'us: front and side of cricoid—up- and outwards to lower border thyroid cartilage. [Laryngeal nerve supplies the muscles of this group.] Thyro-aryteenoideus: posterior surface thyroid car- tilages and crico-thyroid membrane—backwards to anterior surface arytenoid cartilage. Cri'co-arytsenoide'us lateralis: superior border cri- coid cartilage—obliquely up- and backwards to external angle base arytenoid cartilage. Cri'eo-arytsenoide'us poste rior: posterior surface cricoid cartilage—up- and outwards to external angle base arytenoid. Arytenoide'us: fills up posterior concave surface of arytenoid cartilage. Vocal Chords: the Inferior or true are the inf. tkyro-nrytenoid ligaments of yellow elastic tissue at- tached, in front, to depression between the two alae of the thyroid cartilage—ant. angle of base of arytenoid cartilage. The Superior or false are the Sup. thyro-arytenoid liga- ments attached, in front, to angle of thyroid cartilage, be low epiglottis—anterior surface of arytenoid cartilage. (8) EPIGLOTTIDIAN REGION, 3. Thy'ro-epiglottide'us: internal surface thyroid car- tilage—upwards to margin of epiglottis. [Laryngeal.] Arytse'no-epiglottide'us superior: apex arytenoid cartilage—to fold mucous membrane between cartilage and side of epiglottis. [Laryngeal ] 6 HEAD AND NECK. Arytae no-epiglottide us inferior: arytenoid car- tilage just above superior vocal chord—forwards and upwards to the margin of the epiglottis. [Laryngeal.] (9) ANTERIOR VERTEBRAL REGION, 4. Rectus capitis anti'cus major: (continuation scalenus anticus) 4 slips from anterior tubercles transverse processes 3d, 4th, 5th and 6tlx cervical vertebrae—basilar process occipital bone. [Suboccipital, and cervical plexus.] Rectus capitis anticus minor: anterior surface lateral mass of atlas and its transverse process—basilar pro- cess occipital. [Suboccipital, cervical plexus.] Rectus lateralis: upper surface transverse process atlas—jugular process occipital. [Suboccipital.] Lon'gus col li: 1st portion from anterior tubercles transverse processes of 3d, 4th and 5tli cervical vertebrae— tubercle of anterior arch of atlas; 2d portion from 1st, 2d (and 3d) dorsal—transverse processes 5th and 6th cervical vertebrae; 3d portion from 1st, 2d, 3d dorsal and 7th, 6th, 5tli cervical—bodies 2d, 3d and 4th cervical vertebrae. [Lower cervical branches.] (10) LATERAL VERTEBRAL REGION, 3 Scale'nus anti'cus: inner border and superior surface 1st rib—anterior tubercles transverse processes 3d, 4th, 5th and 6th cervical vertebrae. [Branches lower cervical.] Scale'nus me'-dius: behind groove for subclavian artery on 1st rib—posterior tubercles transverse processes lower 6 cervical vertebrae. [Branches lower cervical.] Scale'nus posti cus : 2d rib, outer surface—transverse processes lower 3 cervical vertebrae. [Branches lower cer- vical.] (11) POSTERIOR VERTEBRAL REGION, 4. Rec'tus capitis posticus major: spinous process axis—inferior occipital curved line. [Occipital.] Rec'tus cap itis posti cus mi nor: tubercle poste- rior arch atlas—beneath insertion of above. [Occipital.] Obliq'uus inferior: spinous process axis—horizon- tally to transverse process atlas. [Occipital.] Obliq'uus supe'rior: transverse process atlas—occipi- tal bone, between curved lines. [Occipital.] ARTERIES OF THE HEAD AND NECK. CARO TIS COMMUNIS: arises on right side, from innominate, behind sterno-clavicular articulation; on left side, from arch of aorta, highest part, and is more deeply ARTERIES. 7 placed than the right and passes obliquely outwards to root of neck behind sterno-hyoid and sterno-thyroid mus- cles, innominate vein and thymus gland. Starting now from each side of neck, each passes up- and outwards to superior border of thyroid cartilage, there dividing into external and internal carotid. Course indicated by line from sternal end clavicle to point midway between mas- toid process and angle of inferior maxilla. Vein lies to outside, pneumogastric nerve on posterior plane between them, the three being enveloped by same sheath of cer- vical fascia. No branches but terminal. CAROTIS EXTER NA: (8 brs., see above) up be- tween neck of inferior maxilla and external meatus, there "ividing into temporal and internal maxillary. Crossed by hypoglossal nerve, lingual and facial veins, digastric and stylo-hyoid muscles. Is quite superficial. Thy- roide'a superior: greater cornu hyoid, curving down to thyroid gland, anas, with its fellow of opposite side and inferior thyroid. Hyoide'a, runs along inferior border of bone, anas, with opposite fellow. Descen'dens superjicia- lis, down- and outwards across sheath common carotid sup- plying sterno-mastoid and adjacent muscles and integu- ment. Larynge'a supe'rior pierces thyro-hyoid membrane supplying muscles, mucous membrane, glands, etc., of lar- ynx and epiglottis, anas, with opposite fellow. Cri'co- thyroide'a, transversely across crico-thyroid membrane, anas, with opposite fellow. Lingua'lis : up- and in- wards to under surface of tongue (ranine); runs parallel with hypoglossal nerve. Hyoide'a, along superior border bone, supplying muscles, anas, with opposite fellow. Dorsa'lis lin'guce, ascends to dorsum tongue, anas, with opposite fellow, supplying mucous membrane, tonsil, epiglottis, soft palate, etc. Sublingua'lis runs for- and out- wards to sublingual gland, supplies it, adjacent muscles, membranes, etc. Bani'na, on lingualis to tip of tongue, ac- companied by gustatory nerve, anas, with opposite fellow, supplying adjacent parts. Eacia'lis: near angle inferior maxillary obliquely for- and upwards to maxillary gland, then up over jaw, up- and forwards to angle of mouth, along side of nose to inner canthus of eye (angular.) Cer- vical Brs. : Palati’na ascen'dens, between stylo-glossus and stylo-pharyngeus, to outer side pharynx, supplying muscles, tonsil, Eustachian tube, etc.; divides, one branch going up tensor palati to supply soft palate, glands, etc.; the other branch goes to tonsil, anas, with tonsillar. Anas. 8 posterior palatine of internal maxillary. TonsiUa'ns, up to supply this gland and root of tongue. Sub maxilla'res (3 or 4), supplying this gland and adjacent parts. Submen- tal a, off just as facial quits submaxillary gland, running forwards upon mylo-hyoid, supplying it and digastric (anas. with sublingual) to symphysis; tne superficial branch turns round the chin, passing up to anas, with inferior labial, supplying muscles and integument; the deep branch runs up on bone to supply deep muscles and lip, anas. with inferior labial and mental. Facial Bus. : Muscula'- res, to internal pterygoid, masseter, buccinator. Labia'lis infe'mor, beneath depressor anguli oris to lower lip, anas. inferior coronary, mental branch of dental, etc. Corona'- via infe rior beneath depressor anguli oris along edge lower lip, supplying adjacent parts, and anas, with opposite fel- low, inferior labial, and mental branch of inferior dental. Corona'ria supe'rior along edge of upper lip, anas, with opposite fellow, supplying adjacent parts, septum and ala of nose. Latera'lis na'si, supplying side and dorsum of nose, septum, anas, opposite fellow, infra orbital and na- sal branch ophthalmic. Anr/ula'ris, terminal branch, as- cends up to inner canthus, anas, with nasal branch ophthalmic. Occipitalis: from posterior part near in- ferior margin of digastricus, up bet\ve< n atlas and mastoid process, horizontally across occiput, then up to vertex, then dividing imto numerous branches. Muscula'res, to digas- tricus, stylo hyoid, stylo mastoid, splenius capitis, traclielo- mastoid. Auricula'ris, to posterior surface concha. Me- ninc/e'a inferior along side internal jugular vein through foramen lacerum to dura in posterior fossa. Arte'ria prin'ceps cerri'cis, descends back part neck, superficial branch supplying splenius and trapezius, anas, with super- ficial cervical; the deep branch anas, with vertebral and cervical branch superior intercostal; supplies adjacent parts Crania:'les, to muscles and integument of poste- rior surface cranium. Auricula'ris poste'rior: from above stylo-hyoid, ascends beneath parotid gland, to groove between mastoid process and ear cartilage, divid- ing into anterior and posterior branches, the former passes forwards to anas, with temporal, the other back to anas, with occipital. Sty'lo-mastoide'a, enters do foramen sup- plying cells, tympanum and semi-circular canals. Auricula'- ris, to back part of cartilage of ear, and penetrating to its anterior surface Pharynge'a ascen'dens: (smallest branch) deep seated, arising near commencement external HEAD AND NECK. 9 carotid, up between internal carotid and pharynx, to base of skull. External branches, to recti antici muscles, glands of neck, sympathetic, pneumogastric and hypoglossal nerves; anas, with ascending cervical. Pliarynge' a (d or 4) to parts of pharynx and adjacent muscles, etc. Meninge'ce back- wards through foramen lacerum posterius, another branch through foramen lacerum basis cranii, another through an- terior condyloid foramen to dura mater. Temporalis; from parotid gland up to root zygoma, dividing into ante- rior and posterior. Transcer'sa facie'i, ip parotid gland, runs across face, supplying glands, integument and mus- cles, anas, with facial and infra-orbital. Tempora'Its me'- dia, above zygoma to temporal muscle and orbicularis, anas, with lachrymal and palpebral branches of ophthal- mic and deep temporal branches of internal maxillary. Ancula'res anterio'res, to anterior ear, anas, with posterior auricular. Tempora'lis ante'rior forwards over forehead, supplying integument, muscles, etc., anas, with frontal and supra-orbital. Tempora'lis posterior, up- and back- wards over side of head, anas, with opposite fellow poste- rior auricular and occipital. Maxilla'ris inter'na; (see external carotid) inwards to inner side of condyle inferior maxilla into spheno-maxiilary fossa, to supply deep structures of the face. Maxillary Portion: Ca'vi tym'pani (tympanic) up through fissura Glaseri, supplying membrani tympani, laxator tympans; anas, with stylo-mas- toid and Vidian. Meninge'a me'dia, from internal lateral ligament of jaw up through foramen spinosum, dividing into anterior and posterior branches, supplying anterior and posterior surface of dura and bones, facial nerves, and branches to other parts; anas, with opposite fellow, ante- rior and posterior meningeal. Meninge'a par'va, through foramen ovale to Casserian ganglion and dura; also to nasal fossa and soft palate. Alveola'ris inferior, (inf. den- tal) with dental nerve to foramen on ramus, then along dental canal supplying teeth, etc., till opposite bicuspid tooth, then divides into incisor and mental branches, the former to incisor teeth, anas, with opposite fellow; the latter passes out mental foramen, anas, with inferior labial, inferior coronary, submental and supplies adjacent parts. Mylo-hyoid branch given off just as artery enters inferior dental foramen; it runs in its groove to its muscle. Pterygoid Portion : Tempora'les profund'ce (2) anterior and posterior branches up to temporal muscle. Pterygoide'a, to do muscles. Masseter'ica, to do muscles. Bucca'lis, to do mus- ARTERIES. 10 HEAD AND NECK. cles. Spiieno-maxillary Portion: Alveola'ris, common branch with following, supplying (superior dental) teeth, an- trum and gums. Infra-orbita'lis, continuation of main ar- tery, along infra-orbital canal, and out infra-orbital fora- men, supplying inferior rectus and inferior oblique, antrum, front teeth, lachrymal sac, etc., anas, with facial, buccal! nasal branch ophthalmic, etc. Palati'na Descendens, down posterior palatine canal to gums, mucous membrane, palate, etc. Vidialna, through its canal, with nerve to pharynx, Eustachian tube and tympanum, Pterygo-palatil na, to up- per part pharynx and Eustachian tube. Spheno-palaWna (nasal), to mucous membrane of nose, septum, antrum, eth- moid and sphenoid cells. CARO'TIS INTERNA: (8 brs.) Superior border thyroid cartilage up through carotid foramen in temporal bone; in the skull it runs forwards in a course represented by v, [italic f laid horizontally.] No branches from cer- vical part. Tonsil is internal to it. Tympanilca: to tym- panum. Reeeptac'ulse: small branches to cavernous sinus, pituitary body, Casserian ganglion, etc. Ophthal'- miea: at inside anterior clinoid process, forwards through optic foramen to inner canthus, dividing into frontal and nasal. Lachrymal Us, to lachrymal gland, conjunctiva; ma- lar and meningeal branches; anas, freely with temporal, pal- pebral, etc. Supra-orbita'Us, out supra-orbital foramen to muscles and skin of forehead and pericranium; anas, with temporal, facial, etc. Ethmoidalles, (2) anterior and poste- rior to ethmoidal cells and meninges. Palpebral les, (2) supe- rior and inferior, encircle eyelids, down nasal duct, anas. with temporal, inferior orbital, etc. Fronta'lis, out inner angle orbit to forehead, supplying adjacent parts, anas. with supra-orbital. Nasa'lis, to lachrymal sac, then down the nose, supplying whole surface; anas, with facial, etc. Cilia'res bre'ves, (12-15) supply choroid and ciliary processes. Cilia'res lon'goe, (2) ciliary ligament and iris. Cilia'res anterio'res, from muscular branches, to iritic arterial circle. Centra'lis refines pierces optic nerve and runs in it to retina. Musculares, (2) superior and inferior to muscles of eye. Cere bri arte'ria ante'rior: at fis- sure of Sylvius forward in the great longitudinal fissure, anas, with its fellow by anterior comma!nicans; curves round anterior border corpus callosum, running back to its posterior part to anas, with posterior cerebral supplying olfactory and optic nerves, inferior surface anterior lobes, 3d venticle, anterior perforated space, corpus callosum and 11 inner surface of hemispheres. Cere'bri arte'ria me'dia: (largest branch,) obliquely outwards along fissure of Syl- vius, dividing into antei'ivr branch to pia of anterior lobe, median branch to small lobe at extremity of Sylvian fis- sure; posterior branch which supplies middle lobe; small branches to corpus striatum through substantia perforata. Commu'nicans posterior: from back part of artery backwards, anas, with posterior cerebral of basilar. Cho- roide'a ante rior: from back part of artery back- and outwards, entering descending horn of lateral ventricle; is distributed to hippocampus major, corpus fimbriatum and choroid plexus. VERTEBR ALIS: (6 brs.) 1st and largest branch of subclavian. Enters foramen in transverse process of 6th cervical vertebra and ascends in the vertebral foramina to the axis, then outwards, piercing occipito-ataloid ligament and dura, passing through foramen magnum along in front of medulla, unites with opposite fellow to form basilar. Spina'les latera'les, enter spinal canal through the interver- tebral foramina and supply (anterior branches) the cord and membranes and (posterior branches) posterior surface of vertebral bodies. Mascula'res: deep muscles of neck, anas, with occipital and deep cervical. Poslerio'res menin- ge'ce, (2) to falx cerebelli. Spina'lis anterior, given oif near termination, unites with opposite fellow, and descends on cord, anas, with spinal branches through the interverte- bral foramina down to sacrum. Supplies pia of cord (be- ing placed beneath it) and cord. Spina'lis posterior, arises at side of medulla and passes down posterior surface of cord, being reinforced similarly to the anterior spinal, to sacrum. Inferior cerebella'ris, winds back over medulla, to under surface of cerebellum, there dividing, the inferior branches going backwards to notch between the two hemi- spheres, the external branch supplying the inferior surface, anas. with superior cerebellar; branches, also, to choroid plexus, and 4th ventricle. BASILLA'RIS: (see above); from posterior to anterior border of pons, there dividing into posterior cerebral. Transver' see, to pons, internal auditory meatus, under sur- face cerebellum (ant. cerebellar.) Superior cerebella'ris, near end basilar, up over cerebellum, supplying it, pineal gland, velum interposition. Posterior cerebra'lis, winds round crus cerebri to inferior surface of posterior cerebral lobes, supplying them, and choroid plexus, anas, with an- terior and middle cerebral. ARTERIES. 12 HEAD AND NECK. Circle of Willis: (10 vessels); forward, from behind forwards, by basilar, 2 posterior cerebral, 2 posterior com- municating, 2 internal carotids, 2 anterior cerebral, ante- rior communicating. Infe rior Thyroide'a: (see arteries of upper extrem- ity) ; branch of thyroid axis, up behind sheath of common carotid and sympathetic nerve to under surface of thyroid gland, anas, with opposite fellow, and superior thyroid. Laryngea'lis, to back part larynx. Trachea'les, to trachea, anas, with bronchial. (Esophagea'les, to the oesophagus. Gervica'lis ascendens, up neck, supplying muscles, vertebrae, cord and membranes. Cervi'cis profun'da: (see arteries of upper extremity); branch of superior intercostal, ascends back part of neck, below complexus, to axis, supplying adjacent parts, and anas, with branches of vertebral and princeps cervicis of occipital. VEINS OF THE HEAD AND NECK. Ve'nse Dip'loes: walls only of epithelium, with many cul-de-sacs. Fronta'lis, opens into supra-orbital through su- pra-orbital notch. Tempora'lis anterior opens into deep temporal. Tempora'lisposte'rior confined to parietal region, opens into lateral sinus. Occipta'lis, opens into occipital vein or sinus. Cerebra'les: noted for their thin coats, muscular tis- sue and absence of valves. Superio'res, (7 or 8 on each side) for- and inwards to superior longitudinal sinus, there receiving interior cerebral which drain the same hemi- sphere. Inferio'res anterio'res, under surface of anterior lobes; terminate in cavernous sinus. Inferio'res latera'les, (3 to 5) terminate in lateral sinus. Inferio'res Me'dice, from posterior lobe, etc., to straight sinus behind venae Galeni. Ve'nse Gale ni (2, one from right, one from left ventricle); formed by ve'na cor'poris stria'ti and ve'na choroide'a; pass back and out of transverse fissure to straight sinus. Cere- bella'res, superior, inferior and lateral sets; the 1st open into straight, the 2d into lateral, the 3d into superior pe- trosal sinus. Si nus: (16 in No.) Supe'rior longitudina'lis, begins at crista Galli, runs back over cerebrum to torcular He- rophili; receives superior cerebral and parietal veins. In- ferior longitudina'lis, along posterior part of free margin of falx cerebri to straight sinus. Tento'rii (straight), junction VEINS. 13 of tentorium and falx cerebri to torcular Herophili; re- ceives inferior longitudinal sinus, venae Galeni, inferior median cerebral, and superior cerebellar veins. Lateralles, (2) from torcular to foramen lacerum posterius, into inter- nal jugular vein; receives straight and occipital sinus, etc. Occipitales, (2) smallest; posterior margin of foramen mag- num to torcular. Caver'ni, (2) sides of sella Turcica from sphenoid fissure to apex petrous part of temporal. Re- ceives ophthalmic vein connecting the frontal with these sinus; also inferior anterior cerebral veins. Circula'ris, surrounds pituitary body, communicates with each cavern- ous. Inferio'res petrosa'les, (2) termination of cavernous to internal jugular vein. Transver'sus, connects the inferior petrosales across basilar process of occipital. Superio'res pelrosa'les, (2) on superior border petrous part of temporal, connecting lateral and cavernous; receives inferior lateral cerebral and anterior lateral cerebellar veins. Ve'na Facia'lis: obliquely across side face from in- ner canthus, to unite, under inferior maxilla, to form a trunk for internal jugular. Receives supra-orbita'lis, supra- palpebra'lis, nasa'lis, infe'rior palpebralIts, frontallis, supra- orbita'lis, supra-labia'lis, infe'rior labia'lis, bucca'lis, masset- er'ica, submental lis, infe'rior palati'na (which arises from plexus about tonsil, etc.), submaxilla'ris, rani'na veins; also communicates with ophthalmic (see cavernous sinus). Temporalis: from side and vertex of head, uniting with internal maxillary, to form temporo-maxillary. Re- ceives parotide'(B auricula!res anterio'res, transver’sa facie! i. Maxilla'ris Inter'na: me'dice meninge'ce, tempora'lis profun'da, pterygoide' a, masseter'ica, buccal lis, palati'nce, in- fe'rior dentallis, forms, with above, temporo-maxillary.' Temporo-Maxilla'ris: union of temporal and inter- nal maxillary; descends in pai’otid gland and divides, one branch going to join facial, the other to external jugular. Receives posterior auricular. Auricula'ris Poste'rior: formed from plexus side of head; receives stylo-mastoide'a and branches from external ear; empties into temporo-maxillary. Occipitalis: from plexus, back part vertex of skull, descends deeply between muscles of neck, lying in course of artery, to internal jugular. Receives mastoide'a, which communicates with lateral sinus. Jugula'ris Exter'na: from temporo-maxillary near an- gle lower jaw, down into subclavian; accompanied by auri- cularis magnus nerve. Has 2 pairs of valves. Receives oc- 14 HEAD AND NECK. cipita'lis, poste'rior jugula'ris exter’na (draining superficial muscles of back of neck), supra-scapula'ris, transoer'sa cer- vi'cis veins. Jugula'ris Ante rior: drains integument and superfi- cial muscles of anterior and middle portion of neck, emp- tying into subclavian. No valves. Jugula'ris Inter'na: from jugular foramen at junc- tion of lateral and inferior petrosal sinus, vertically down the side of neck (outer side of main arteries), uniting with subclavian to form vena innominata; 1 pr. valves, f inch above termination. Receives facialis, lingua'lis, pha- rynge’ce, supe'rior thyroide'a, and me'dia thyroide'a. Vertebra'lis j drains occipital region and deep muscles of back of neck; enters foramen in transverse process of atlas, down through similar foramina of the cervical verte- brae to 6th (or 7tli) where it passes out to enter v. innomin- ata. Receives poste'rior condyloi'da, musculo!res, dorso- spina'les, meniv!gio-rachidia!nee, ascen'dens and profun’da cervica'les; 1 pr. valves guard its mouth. NERVES OF THE HEAD AND NECK CRANIAL. 1st or Ner'vus olfac'tus.—From cor- pus striatum, middle and anterior lobes of cerebrum. Supplies the Schneiderian membrane. Special function, smelling. 2d or Op ticus.—From optic thalami and the corpora geniculata et quadrigemina, out through optic foramen to retina. Special function, sight. 3d or Moto'rius Oc'uli.—From crus cerebri and pons (?) out through foramen lacerum anterius to all the muscles of the orbit, save the superior oblique and external rectus; a few filaments pass to the iris. Is a motor nerve. 4th or Pathet icus.—From valve of Yieussens, through foramen lacerum anterius to superior oblique. Is a motor. 5th or Trigem inus.—The sensory, or posterior root, from the lateral tract of the medulla, the pons, and cere- bellum (middle peduncle). The motor root from the pyra- midal body. The sensory supplies are to the eye-ball (iris, ciliary body, etc.), lachrymal gland, conjunctiva, Schneide- rian membrane, all the muscles and integument about the eye ball, orbit, os frontalis, nose, mouth, cheek, lips, tem- ple, superior portion of pharynx, tongue, gums and teeth. Motor filaments are given to the external and internal pterygoid, temporal, buccinator, and masseter muscles. 15 Special sensation (taste) to mucous membrane of mouth, gums, tongue (anterior and middle portion), sub-lingual gland, conical and fungiform papillae. Bus.—1. Ophthal'- mictts: sensory; forward through sphenoidal fissure from Casserian ganglion, joined by cavernous plexus of sympa- thetic. Lachrymal lis. Fronta'lis; (a) supra-trochlea'ris, (b) supraorbita'lis. Nasa'lis; ganglionic, long ciliary (2 or 3), infra-trochlear branches. II. Supe'rior Maxilla'ris ; sensory: forwards through foramen rotundum from Casse- rian ganglion appearing on face through infra-orbital fora- men. Orbital lis ; (a) temporal, (b) malar branches. Spheno- palati'ni (2). Posterio'res dental les (2); (a) anterior branches, (b) posterior branches. Ante'rior denta'lis. Palpebra'les. Nasa'les. Labia'les. All inosculate with branches from facial. III. Inee'rior Maxilla'ris: sensor root from Casserian ganglion, motor unites with it after passing through foramen ovale. Anterior Division : (a) masse- teric, (b) deep temporal, (c) buccal, (d) pterygoid branches. Posterior Division: Auric'ulo-tempora'lis; (a) anterior temporal, (b) posterior temporal (out under cover of paro- tid, (c) communicating with facial, (d) inferior and superior auricular, (e) 2 branches to meatus, (/) branches to tem- poro-maxillary articulation, (g) branches to parotid gland. Gustato'rius, side of tongue to lip; (a) communicating branches, (b) branches of distribution to tongue, gums, etc. Infe'rior denta'lis, in dental canal inferior maxilla to teeth, etc.; (a) mylo-hyoid to do muscle, etc., (b) dental branches. 8th. or Abdu' cens.—From pons, corpus pyramidale, and medulla through foramen lacerum anterius to supply motor influence to the rectus externus oculi. 7th or Facialis.—From lateral tract medulla and 4th ventricle, out through stylo-mastoid foramen to all the muscles of the face, ear and their integument, the platysma, buccinator, digastric, stylo-hyoid, lingualis, stapedius, lax- ator and tensor tympani, levator palati, and azygos uvulae. Is essentially a motor nerve. Tympan'icus. Ghor'da tym'pani, Posterior auricula'ris ; (a) auricular branch, (b) occipital branch. Stylo-hyoide'us. Digastric branch. Tem- poro-facial lis; (a) temporal branches, (b) infra-orbital, (su- perficial and deep branches), (c) malar branches. Cervico- facia'lis ; (a) buccal, (b) supra-maxillary branches, (c) infra- maxillary branches. 8th or I. Glosso-pharynge'us, II. Pneumogas'tri- cus, III. Spinalis Accesso'rius.—I. and II. from floor of 4th ventricle; III. from lateral tract of cord as low NERVES. 16 as 6th cervico-spinalis, and also from medulla just below origin of I. and II. Part I. passes out through foramen lacerum posterius to supply sensation to mucous membrane of pharynx, Eustachian tube, tympanum, and tonsil; motor influence to the pharyngeal muscles; gustation to posterior third of tongue and its lateral papillae. Branches of communication (sympathetic, facial, tympanic; Carotid branches. Plmryngeal branches. Muscular branches. Tonsillar branches. Lingual branches. Part II, through foramen lacerum posterius to supply moton' and sensor fila- ments to the muscles and parts about the pharynx, larynx and trachea concerned in speech and respiration; motiyn' filaments to the pharynx, heart, oesophagus, stomach, and filaments to the splenic and hepatic plexus. Auricula!ris. Pharyngeal branch. Superior laryngea'lis. Recur'rens (or inferior) laryngea'lis (the motor of larynx). Cerdco-cardiac (2 or 3 in number). Thoracico-cardiac. Anterio'res pulmo- na'res (2 or 3 in number). Posterior pulmona'ns. CEso- phageaHes. Gastric branches. Part III. supplies motor filaments to sterno-mastoideus and trapezius, the acces- sory part arising from lateral tract of cord; the spinal por- tion, as low down as 6th cervical nerve, passing up in spinal foramen into skull, then out, with the accessory portion, through jugular foramen. 9th or Hypoglos'sus.—From floor of medulla. Is the moto')' of the tongue. Out through anterior condyloid for- amen to supply the genio-hyoid, genio-hyo-glossus, hyo- glossus, stylo-glossus, thyro-hyoid, sterno-hyoid, omo- hyoid, and sterno-thyroid muscles. Is deep-seated (beneath internal carotid), but finally curves over externally to the carotid to muscles for distribution. Has branches of com- munication with pneumogastric, sympathetic, 1st and 2d cervical and gustatory. Descen'dens no'ni (on carotid sheath), joining with 2d and 3d cervical. Thyro-hyoid branch. Muscular branches. CERVICA'LES ; each increase in size from 1st to 5th; 8 pairs in all. Have anterior and posterior branches, the latter having ganglionic enlargements. The 1st, or sub- occipital, (anterior branch) has exit between atlas and occi- put; the remaining 7 between their respective vertebrae. The 4 upper (anterior branches) unite to form the cervical plexus; the 4 lower (anterior) with the 1st dorsal form the brachial plexus. Cervi'eis plex'us: suferf. brs. Superficia'lis col'li, from 2d and 3d; obliquely forwards to anterior and lateral HEAD AND NECK. MUSCLES. 17 parts of neck. Auricula!ris mag'nus, from 2d and 3d; ascends to parotid gland, having facial, posterior auricular and mastoid branches. Occipitalis mi'nor, from 2d; ascends to side of head; has auricular branch. Supra-clavicula'res, from 3d and 4tli; downwards, having sternal, clavicular, and acromial branches. Deep Brs. : Communican'tes, loop between 1st and 2d, to sympathetic, hypoglossal, pneumo- gastric, and spinal accessory nerves. Musculo!res, from 1st. Commvlnicans no'ni, from 2d and 3d, uniting with descendens noni. Phreni'cus, from 3d, 4th and 5th; crosses subclavian artery, down to middle mediastinum, thence to pericardium, diaphragm and pleura. The left is the longer. Posterior Branches; each have external and internal divisions supplying the muscles of the hack of the neck, etc. Sub-occipita'lis, from 1st, up to sub-occipital region. Occipitalis ma'jor, the internal branch from the 2d cervical. Occipital branch, from the 3d cervical, internal branch. All the others have only the external and internal branches, supplying the muscles contiguous to them. UPPER EXTREMITY. MUSCLES OF THE UPPER EXTREMITY. (1) REGION ANTERIOR THORACIC REGION, 3 MUSCLES. Pectora'lis major: sternal half clavicle, 34 front of sternum down to 7th rib, cartilage of true ribs, aponeuro- sis of external oblique—anterior bicipital ridge of humerus. [Anterior thoracic.] Pectora'lis mi'nor: 3d, 4th and 5th ribs—anterior border coracoid process of scapula. [Anterior thoracic.] Subcla'vius: 1st rib-cartilage—under surface middle 3d of clavicle. [Branch from 5th and 6th cervical.] (2) LATERAL THORACIC REGION, 1. Serra'tus mag'mis: 9 dictations from the 8 superior ribs—whole length inner margin scapula, posterior surface. [Posterior thoracic. ] (3) ACROMIAL REGION, 1. Deltoide'us: outer 3d anterior border, upper surface, of clavicle; outer margin, upper surface acromian process; whole length lower border spine of scapula—prominence outer surface (middle) humerus. [Circumflex.] (15 Regions, 46 Muscles.) 18 (4) ANTERIOR SCAPULAR REGION, 1. Subscapula'ris: inner £ subscapular fossa — lesser tuberosity humerus. [Subscapular.] (5) POSTERIOR SCAPULAR REGION, 4. Supra-spina'tus: internal £ of supra-spinous fossa of scapula—upper facet greater tuberosity humerus. [Supra- scapular.] Infra-spina'tus: internal £ of infra-spinous fossa— middle facet greater tuberosity humerus. [Supra-scapular. ] Te'res mi'nor: dorso-axillary border scapula—lowest facet greater tuberosity of humerus. [Circumflex.] Te'res ma'jor: dorsum inferior angle scapula—poste- rior bicipital ridge humerus. [Subscapular.] (6) ANTERIOR HUMERAL REGION, 3. Coraco-brachia'lis: apex coracoid process scapula— rough ridge inner (middle) side of humerus. [Musculo- cutaneous.] Biceps: long head above glenoid cavity; short head, coracoid process—bicipital tuberosity radius. [Musculo- cutaneous.] Brachia'lis anti'eus: lower half outer and inner sur- faces shaft humerus, septa—under surface coronoid pro- cess ulna. [Musculo-cutaneous, musculo-spiral.] (7) POSTERIOR HUMERAL REGION, 2. Tri'ceps: long head, depression below glenoid cavity; external head, posterior superior part of humerus; internal head, posterior surface of humerus below musculo-spiral groove—olecranon process ulna. [Musculo-spiral.] Subancone'us: just above olecranon fossa humerus— posterior ligament elbow-joint. [Musculo-spiral.] (8) ANTERIOR BRACHIAL REGION, SUPERFICIAL LAYER, 5. Prona tor ra dii te'res : above internal condyle hume- rus, common flexor tendon, fascia, inner side coronoid process ulna—rough ridge radius, outer (middle) surface. [Median.] Flex or car'pi radia'lis: common flexor tendon, in- ternal condyle humerus, fascia—base of index metacarpal. [Median.] Palma'ris lon'gus: common internal condyle (nu- merus) flexor tendon, fascia—annular ligament and palmar fascia. [Median.] Flex'or car'pi ulna'ris: 1st head, common flexor ten- don, internal condyle humerus; 2d head, internal margin olecranon—pisiform bone. [Ulnar.] UPPER EXTREMITY. 19 Flex'or subli'mis digito'rum: 1st, internal condyle humerus (common flexor tendon); 2d head, inner side coronoid process ulna; 3d head, oblique line radius—lateral margins 2d phalanges; tendon split for passage of flexor profundus digitorum. [Median.] (9) ANTERIOR BRACHIAL REGION, DEEP LAYER, 3. Flex'or profun'dus digito'rum: upper £ anterior and inner surface ulna, inner side coronoid process, inter- osseous membrane—bases last phalanges. [Ulnar, anterior interosseous. ] Flex'or lon'gus pol'lieis: upper £ anterior surface radius, interosseous membrane—base last phalanx thumb, [Anterior interosseous.] Prona'tor quadra'tus: oblique line and lower 4th ulna—lower 4th anterior surface and external border radius. [Anterior interosseous.] (10) RADIAL REGION, 3. Supina'tor lon'gus: upper £ external condyloid ridge humerus, septum—styloid process radius. [Musculo-spiral. ] Exten sor car pi radia'lis lon'gior: lower third ex- ternal condyloid ridge humerus, septum—base metacarpus indicis. [Musculo-spiral.] Exten sor car'pi radia'lis bre'vior: common ten- don external condyle humerus, external lateral ligament, septa—base metacarpus middle finger. [Posterior inter- osseous.] (11) POSTERIOR BRACHIAL REGION, SUPERFICIAL LAYER, 4 Exten'sor commu'nis digito'rum: common tendon external condyle humerus, septa—2d and 3d phalanges. [Posterior interosseous.] Exten'sor min imi dig'iti: external condyle hume- rus, septa—unites with tendon extensor communis digito- rum to be inserted into 2d and 3d phalanges of little finger. [Posterior interosseous.] Exten'sor car'pi ulna'ris: common tendon external condyle humerus, middle 3d posterior border ulna, fascia— base 5th metacarpus. [Posterior interosseous.] Ancone'us: back part outer condyle humerus—side, olecranon and upper posterior 3d ulna. [Musculo-spiral.] (12) POSTERIOR BRACHIAL REGION, DEEP LAYER, 5. Supina'tor bre'vis: external condyle humerus, exter- nal lateral and orbicular ligaments, oblique line ulna— (surrounds radius at its upper part) back part inner surface; MUSCLES. outer edge bicipital tuberosity; oblique line of radius. [Posterior interosseous. ] Exten sor os'sis metacar'pi pol'lieis: posterior sur- face shaft ulna and radius (middle 3d), interosseous mem- brane—base 1st metacarpus. [Posterior interosseous.] Exten'sor pri'mi interno'dii pollicis: posterior surface radius, interosseous membrane—base 1st phalanx of thumb. [Posterior interosseous.] Exten'sor secun'di interno'dii pol'lieis: posterior surface ulna, interosseous membrane—base 2d phalanx thumb. [Posterior interosseous.] Exten'sor in'dicis: posterior surface ulna, interosse- ous membrane—joins tendon extensor communis digitorum to 2d and 3d phalanges indicis. [Posterior interosseous.] (13) THUMB, IIADIAL REGION, 4. Abdue'tor pol'lieis : ridge trapezium and annular lig- ament—radial side base 1st phalanx thumb. [Median.] Oppo'nens pol'lieis: palmar surface trapezium, annu- lar ligament—whole length 1st metacarpus, radial side. [Median. ] Plex'or bre'vis pol'lieis: trapezium, outer £ annular ligament, trapezoid, os magnum, base 3d metacarpus, ten- don flexor carpi radialis—both sides base 1st phalanx thumb. [Median, ulnar.] Abductor pol'lieis: whole length 3d metacarpus- ulnar side base 1st phalanx thumb. [Ulnar.] (14) LITTLE FINGER, ULNAR REGION, 4. Palma'ris bre'vis: annular ligament palmar fascia— skin inner border palm. [Ulnar.] Abdue'tor min imi dig it!: pisiform bone, tendon flexor carpi ulnaris—ulnar side base 1st phalanx little finger. [Ulnar.] Plex'or bre vis min imi dig'iti: tip unciform pro- cess, annular ligament—base 1st phalanx little finger. [Ul- nar.] Oppo'nens min'imi dig'iti: unciform process, annu- lar ligament—ulnar side 5th metacarpus. [Ulnar.] (15) MIDDLE PALMAR REGION, 3. Lumbriea'les: (4); accessories to flexor profundus digitorum—tendon extensor communis digitorum. [Me- dian and Ulnar.] Interos'sei dorsa'les: (4); metacarpi—base 1st pha langes 1st, 2d, 3d fingers. [Ulnar.] 20 UPPER EXTREMITY. Interos'sei palma'res: (3); 2d, 4th and 5th metacar- pi—1st phalanges of same fingers. [Ulnar. [ AIITEUIES. 21 ARTERIES OF TIIE UPPER EXTREMITY. SUB CLAVIAs (4 brs.) Right, 1. from innominate at sterno-clavicular articulation to inner margin scalenus anti- cus. {Left, I. from transverse portion aortic arch opposite 2d dorsal vertebra to scalenus anticus); II. internal border scalenus anticus to outer of scalenus medius; III. from external border scalenus medius to lower border 1st rib, midway along clavicle. Vertebra'lis, upper and back portion of part I.—enters foramen 6th cervical vertebra to be continued upwards (see page 11). Thyroide'us axis, anterior part of first portion, inner side scalenus anticus. Infe'rior thyroide'a (see page 12). Transversa'lis colli, (a) superficial cervical beneath anterior margin trapezius— to trapezius and glands in that region, (b) Posterior scapula'ris to superior angle of scapula to anastomose at the inferior angle with subscapular. Supra-scapula'ris— outwards and backwards, parallel with clavicle, to supra- spinous fossa; distributed to muscles in that region. Sterna'lis inter'na (mammary), origin just below thy- roid axis, behind clavicle along inside chest to 6th inter- costal space,- there dividing into musculo-phrenic and superior epigastric. Go'mesner'viphren'ici, to diaphragm; anastomoses with other phrenic branches. Mediaslina1 les, to areolar of anterior mediastinum, also remains of thymus. Pericardia’les, to upper pericardium, trangularis sterni, anas, musculo-phrenic. Anterio'res intercostal les, to 5 or 6 upper intercostal spaces, to intercostal and pectoral mus- cles and mammary gland; anas, aortic intercostal. Per- foran'tes, to 5 or 6 upper intercostal spaces, to pectoi’al muscles and mammary gland. Mus'culo-phren'ica, per- forates diaphragm at 8th or 9th rib, supplying intercostal spaces, diaphragm and abdominal muscles. Epigas'trica supe'rior—down behind rectus to supply that muscle and others near it; anas, with inferior epigastric. Supe'rior intereosta'les, upper and back portion part II to 1st and 2d intercostal spaces, supplying spinal muscles and cord; anas, aortic intercostals. Profun'da cervi'cis—back to 7th cervical vertebra and between complexus and semi- spinalis colli runs to axis, supplying contiguous muscles; anas, anterior princeps cervicis. 22 AXILLA' HI A: (7 brs.); lower border 1st rib to tendons latissimus dorsi and teres major; 1st part, 1st rib to pect. minor; II. from superior border pectoralis minor to infer- ior border same; III. from inferior border pectoralis minor to tendon latissimus dorsi. Supe'rior Thorac'ica, 1st part—forwards and inwards along superior border pectora- lis minor, supplying pectoral muscles; anas, internal mam- mary and intercostal. Acromia'les Thorac'ica, 1st part to upper border pectoralis minor; Acromia'les, toward acromian process to deltoid; anas, suprascapular and posterior circumflex. Thorac'icce, 2 or 3 in number, sup- plying serratus magnus and pectoral muscles; anas, inter- costals of internal mammary. Descending branches supply pectoralis major and deltoid, as accompanying cephalic vein. Thorac'ica Ion'ga, II. part, down- and inwards along inferior border pectoralis minor to pectoral muscles, axillary and mammary glands, serratus magnus and subscapularis; anas, internal mammary and intercostal. Thorac'ica ala'ris, II. part, to glands and areolar tissue of the axilla. Subscapula'ris, III. part, oppo- site inferior border do muscle, down and back inferior margin do muscle to inferior angle scapula; anas, post- erior scapular. Dorsa'lis scap'ulee—dividing into 3 branches, “subscapular,” “infra-spinous,” and “median.” Altogether they supply the scapular, latissimus dorsi and serratus magnus muscles. Make a general anastomosis. Poste'rior circumflex'a, opposite inferior border sub- .scapularis, winds around neck humerus to supply deltoid; anas, anterior circumflex, suprascapular, acromio-thora- cic. Ante rior circumflex a, just below above, passes anterior to humerus supplying deltoid; anas, post circum- flex, acromio-thoracic. BRACIIIA'LIS: (5 brs.); inferior border teres major to ■J- inch below bend of elbow. Runs along inner border bi- ceps and coraco-brachialis; is superficial. Supe'rior profun da, opposite inferior border trochanter major, winds backwards in spiral groove down to elbow; anas. recurrent radial; supplies deltoid, coraco-brachialis, triceps. Poste'rior articula'ris, perpendicularly down to back of elbow-joint; anas, interosseous recurrent, posterior ulnar recurrent, anastomotica magna. Nutri'cia, middle of arm to bone near insertion coraco-brachialis. Infe rior profun'da, just below middle arm to anas, posterior ul- nar recurrent and anastomotica magna at elbow; accom- panied by ulnar nerve. Anastomotica mag na, 2 UPPER EXTREMITY. 23 inches above elbow-joint, winds around and down humerus to elbow-joint; anas, posterior ulnar recurrent, inferior profunda, anterior ulnar recurrent. Musculares, 3 or 4, to coraco-bracliialis, bracliialis anticus. BADIA'LIS: (12 brs.); end of the brachialis down radial side forearm, along inner border supinator longus to wrist; then winds around carpus beneath thumb-extensors to enter palm of hand between thumb and index finger to form “deep palmar arch;” anas, deep branch of ulnar. Badia'lis recur'rens, below elbow—up arm supplying brachialis anticus, supinator longus, supinator brevis, anas. superior profunda. Muscula’res, to radial side forearm. Superflcia'lis vo'lse, just as artery about to wind around the carpus—to muscles in ball of thumb; anas, with ulnar forming “superficial palmar arch.” Ante rior carpa'lis, to wrist; anas, anterior carpalis of ulnar. Poste'rior carpa'lis, to wrist; anas, posterior carpalis of ulnar, anterior interosseous, and posterior perforating of deep palmar arch as 2 dorsal interosseous branches. Metacar- pa'lis, (1st dorsal interosseus) supplies adjoining sides index and middle fingers. Dorsa'les pollicis, (2); along dorsum of thumb. Dorsalis in'dicis, radical side back of index. Prin'ceps pol'licis, beginning palmar arch to sides of palmar aspect to thumb. Radialis in'dicis, palmar arch to radial side index. Perforan'tes, (3); to inosculate with 3 dorsal interosseous. Palma'res inter- os'sese, (3 or 4); from arch to anas., at finger-clefts, with digital branches of superficial arch. ULNA'EIS ; (8 brs.); little below bend of elbow—along radial side flexor carpi ulnaris to palm of hand, forming “superficial palmar arch” with superficialis volae. Ante'- rior ulna'ris recur'rens, just below elbow-joint, up-and inwards between brachialis anticus and pronator radii teres, supplying these; anas, anastomotica magna, and inferior profunda. Poste'rior ulna'ris recur'rens, just below preceding—back and inwards beneath flexor sublimis up to internal condyle humerus, supplying joint and neighboring muscles; anas, inferior profunda, anas- tomotica magna, interosseous recurrent. Interos'sea, short trunk below tuberosity radius—backwards to inter- osseous membrane, dividing into; Interos'sea ante'rior, passing down forearm on interosseous membrane, piercing membrane at superior border pronator quadratus to des- cend to back of wrist, supplying nutrient (to radial and ulnar arteries) and muscular branches; gives off median ARTERIES. 24 UPPER EXTREMITY. branch, accompanied by do nerve. Anas, posterior carpal of radial and ulnar. Interos'sea poste'rior, down back forearm, between deep and superficial muscular layers to wrist, supplying these muscles; anas, as preceding. Poste'rior interos'sea recur'rens, near its origin to interval between olecranon and external condyle, beneath supinator brevis; anas, superior profunda, posterior ulnar recurrent. Muscula'res, to muscles of ulnar side of forearm. Carpa'lis ante'rior, beneath flexor profundus, anas. anterior carpal of radial. Poste'rior carpa lis, above pisiform bone, beneath flexor carpi ulnaris, giving small branch to inosculate with posterior carpal of radial, form- ing “Posterior carpal arch”; continued along 5th metacar- pus, forming its dorsal branch. Commu nicans, from commencement palmar arch, deeply inwards, anas, with radial forming “deeppalmar arch.” Digita'les, (4); from convexity of superficial palmar arch, supplying ulnar side 4th and adjoining sides 8d, 2d and 1st fingers. VEINS OF THE UPPER EXTREMITY. uina'ris ante'rior: from anterior carpus and ulnar side hand, up along side forearm to elbow-joint, to form basilica. Communicates with median and posterior ulnar. Uina'ris poste rior: posterior ulnar border hand and vein of little finger (v. salvatel'la)—unites with preceding just below elbow-joint. Basilica: coalescence of anterior and posterior ulnares; receives median-basilic at elbow; ascends inner side arm to vense comites of brachial artery, or axillary vein. Badial'is: dorsum thumb, radial side index and hand —at bend elbow receives median-cephalic to become the cephalic. Cephal'ica: up between deltoid and pectoralis major to axillary veins. Me dia: palmar surface of hand and middle of forearm (communicates with ulnar and radial), to median-cephalic and median-basilic at elbow. Cephal'ica me'dia: obliquely outwards from bend elbow, between supinator longus and biceps; empties into cephalic as a formative branch. Basilica me'dia: obliquely inwards behind biceps and pronator radii teres; empties into basilic as a forma- tive branch. The following are the deep veins, and accompany 25 their respective arteries as ve'nce com'ites, intercommunicat- ing with each other, and the superficial veins, frequently. Digita'les: (2); empty into the superficial palmar. Palma res superficia'les: (2); empty into ulnar and radial. Palma res profun dse: empty into the radial venae comites. Interos'sese: (2); accompany the anterior and posterior interosseous arteries, commencing at the wrist, terminating in venae comites of the ulnar. Com'ites radia'lis : form, with the ulnar, the comites of brachial. Com'ites ulna'ris: with the radial, form comites of brachial. Com ites braehia'lis: receiving veins corresponding to the branches of the brachial artery, and empty into the axillary vein. Axilla ria: is the continuation of the basilic. Com- mences at lower border of the axillary space; receives veins corresponding to branches of its artery, and terminates in the subclavian at outer border 1st rib. [Valves at inferior border subscapularis, terminations of vena scapularis and cephalica.] Subcia via: continuation of axillary, emptying into vena innominata at right sterno-clavicular articulation. Separated from its artery by scalenus anticus muscle and phrenic nerve. Receives external and anterior jugulars, branch from cephalic, and internal jugular. [Valves just external to entrance of external jugular, or about 1 inch from its termination.] VEINS. NERVES OF THE UPPER EXTREMITY. PLEX US BRACHIA'LIS : formed by anterior roots 4 lower cervical and 1st dorsal nerves. 5th and 6th cer- vical unite, then are joined by 7th to form upper trunk. 8th cervical and 1st dorsal unite to form lower trunk. Both trunks accompany the subclavian artery to the axilla, lying upon its outer side. Opposite clavicle, each of the trunks gives off a fasciculus, which, uniting, form a third trunk; in the centre of the axilla the original upper cord lies to the outside of the artery; the original lower cord to the inside; the cord formed from fascicular union, poste- riorly. The plexus lies between the anterior and middle scaleni, beneath the clavicle upon 1st serration of the ser- 26 UPPER EXTREMITY. ratus magnus and the subscapular muscles. (Has 4 brs. above, 9 below the clavicle.) Receives communicating branches from cervical plexus, phrenic, inferior cervical, sympathetic ganglia. Commu means, 5th cervical to phrenic on scalenus anticus. Museula'res, to longus colli, scaleni, rhomboidei and subclavius. Posterior thorac ieus, from 5th and 6th cervical to serratus mag- nus. Passes behind brachial plexus. Supra-scapu- laris, from “outer cord” obliquely outwards beneath trapezius, to supra-spinous fossa through supra-scapular notch, here giving 2 branches to supra-spinatus muscle and 1 to joint; in infra-spinous fossa, 2 branches to mus- cle, 1 to joint, all of these are given off above the clavicle. Those below the clavicle are: Externus ante'rior thorae'icus, “outer cord” inwardly across axillary ves- sels to pectoralis major. Inter'nus ante'rior thorae'i- cus, “ inner cord ” passing up between axillary artery and vein {sometimes perforating tlie vein) to pectorales major and minor. Subscapula'res, (3); “posterior cord” the ttpper to subscapular muscles; the longer to latissimus dorsi; the lower to teres major. Circumflex'us, “pos- terior cord,” down behind axillary vessels to lower border subsoapularis, dividing into upper branch winding round neck of humerus, supplying deltoideus and integument; lower branch to teres minor, deltoideus and integument over posterior surface deltoid. Articula’ris, given off be- fore division, to joint. Mus'culo-cuta'neus, continua- tion of outer cord, perforates coraco-brachialis, obliquely outwards between biceps and brachialis anticus to these muscles, integument to elbow, and to the joint. Anterior branch, down radial border of forearm from elbow, to wrist, supplying integument to ball of thumb; communi- cates with radial. Posterior branch, given off middle of forearm, supplying integument to wrist, on radial side; communicates with radial and external cutaneus. In- ter'nus cuta'neus, “inner cord,” down in company with brachial artery, becoming cutaneous at middle of arm, then dividing into anterior branch, supplying integu- ment of ulnar side of arm to wrist, communicating with branch from ulnar; posteinor branch down, on inner side of basilic vein, over internal condyle, on posterior ulnar side of forearm to wrist, communicating at wrist with dor- sal branch of ulnar; at elbow, with lesser internal cuta- neous. Cuta'neus minor inter'nus, from “inner cord” to integument inner side of arm. Me'dius, (4 branches) arises by 2 roots, one from "outer” and one from “ inner” cord; at first lies to outer side of the artery, crosses it at middle of arm; at forearm runs between the 2 heads of the pronator radii teres, beneath flexor sublimis till near annular ligament, when it lies between flexor sub- limis and flexor carpi radialis; it passes beneath annular ligament to hand. (No branches in the arm.) Muscula'res, from near elbow, to forearm muscles save flexor carpi ul- naris. Ante'rior interos'seus follows course of the artery, to flexor profundus digitorum, flexor longus pollicis, and pronator quadratus. Cuta'neus palma'ris, crosses annular ligament, the outer branch supplying the thumb-region; the inner branch, the palmar. Digita'les, (5); two go to thumb, the 3d to radial side of index; the 4th divides to supply ad- jacent sides of index and middle; the 5th the adjacent sides of middle and ring fingers, communicating with branches from ulnar. Ulna'ris, (7 brs.); continuation of “ inner cord,” down ulnar side of arm and forearm (over the back of inner humeral condyle) upon flexor profundus digit- orum, having ulnar artery externally, crosses annular liga- ment at outer side of pisiform bone, dividing into superfi- cial and deep palmar branches. Articula' res, to elbow joint. Musculo!res, one to flexor carpi ulnaris, the other to flexor profundus digitorum. Both arise near elbow. Co- la! neus, arises middle forearm, has a deep and superficial branch. Dorsa'lis cuta'neus, arises 2 inches above wrist, passes to back of hand, supplying ulnar side of wrist, inner side of little and ring fingers. Articula!res, to wrist. Palma'ris superficial Us, supplies palmaris brevis, and integu- ment inner side of hand, ulnar side of little and adjacent sides of the little and ring fingers. Palma!ris profun'dus, follows course of ‘‘deep palmar arch,” supplying muscles of interosseous spaces, lumbricales, abductor and flexor brevis pollicis. Mus'culo-spira'lis, (4 brs.; largest br. of plexus) continuation of "posterior cord;” winds around the humerus in spiral groove, etc., to front of external condyle, then divides into radial and interosseous. Mus- cula'res, to triceps, anconeus, supinator longus, extensor carpi radialis longior, and brachialis anticus. Cuta'nei, (3); internal branches supply integument of back of arm down to olecranon: external branches perforate external head of triceps, supplying integument lower anterior half of arm, the lower branch running down radial side of forearm (posteriorly) to wrist, supplying contiguous intesrument. Badia'lis, down by outer side of radial artery, just con- NERVES. 28 cealed by supinator longus till within 3 inches of wrist, where pierces deep fascia of outer side forearm; divides to supply radial side of ball of thumb (communicating with external cutaneous nerve), and on back of hand forms an arch with ulnar, giving oil 4 digital nerves; the 1st to ulnar side of thumb; the 2d to radial side of index; the 3d, ad- joining sides of index and middle; the 4tli, adjoining sides of middle and ring fingers. Interos'seus 'posterior, pierces supinator brevis, winding to back of forearm, passing down to wrist, there having ganglionic enlargement. Sup- plies carpus, and all muscles on back of forearm except anconeus, supinator longus and extensor carpi radialis longior. BODY. BODY. MUSCLES OF THE BODY. (10 Regions, Muscles.) (REGION 1) BACK, FIRST LATER, 2 MUSCLES. Trape'zius: inner 3d superior curved occipital line, ligamentum nuchae, spinous processes of 7th cervical and and all the dorsal vertebrae—posterior border clavicle, su- perior margin acromian process and superior border spine scapula. [Spinal accessory, cervical plexus.] Latis'simus dor'si: aponeurosis from spinal pro- cesses 6 lower dorsal, all lumbar and sacral vertebrae, ex- ternal lip iliac crest—twisting upon itself so as to be in- serted into bicipital groove of humerus. [Subscapular.] (2) BACK, SECOND LAYER, 3. Leva'tor an'guli scap'ulse: transverse processes of 3 or 4 superior cervical vertebrae—posterior border scap- ula. [5th cervical, cervical plexus.] Ebomboide'us mi nor: ligamentum nuchae, spinal processes 7th cervical and 1st dorsal vertebrae—down- and outwards to root scapular spine. [5th cervical.] Khomboide'us ma'jor: spinal processes superior dor- sal vertebrae—tendinous arch along vertebral border scap- ula. [5th cervical.] (3) BACK, THIRD LAYER, 4. Serra'tus posti'cus superiors ligamentum nuchae, spinal processes 7th cervical and 2 or 3 superior dorsal vertebrae—superior border 2d, 3d, 4th, 5th ribs. [Poste- rior external brs. cervical.] 29 Serra'tus posti cus infe'rior; spinal processes 11th and 12th dorsal, 1st, 2d and 3d lumbar vertebrae—up and out to inferior border 4 inferior ribs. [External branches dorsal.] Sple'nius: ligamentum nuchae, spinal processes 7th cervical and 6 superior dorsal vertebrae—Capitis, into mas- toid process and occiput; Colli, transverse processes 3 or 4 superior cervical vertebrae. [External posterior branches cervical.] (4) BACK, FOURTH LAYER, SACRAL AND LUMBAR REGION, I. Erector spinse: sacro-iliac groove, 1 umbo-sacral ten- don, iliac crest, transverse processes sacrum—sacro-lum- balis, longissimus dorsi. [External posterior branches lumbar. ] (5) BACK, FOURTH LAYER, DORSAL AND CERVICAL REGION, 10. Sa cro-lumba'lis: (see above)—angles inferior ribs. [Dorsal.] Accesso'rius: angles 6 lower—angles 6 superior ribs. [Dorsal.] Cervica'lis aseen'dens: 4 or 5 superior ribs—trans- verse processes 4th, 5th, 6tli cervical vertebrae. [Cervical.] Longis simus dor si: see erector spinae, of which it is the larger portion; inserted (lumbar region) into trans- verse processes lumbar vertebrae; dorsal, tips transverse processes of all vertebrae, and 7 to 11 ribs, between their tubercles and angles. [Lumbar, dorsal.] Transversa'iis col'li; transverse processes 3d, 4th, 5th, 6th dorsal—transverse processes 5 inferior cervical vertebrae. [Cervical branches.] Trache'lo-mastoide'us : transverse processes 3d, 4th, 5th, 6th dorsal, and articular processes 3 or 4 inferior cer- vical vertebrae—posterior margin mastoid process. [Cer- vical branches.] Spinalis dor'si: spinal processes 1st, 2d lumbar and 11th and 12th dorsal vertebrae—spinal processes of dorsal vertebrae. [Dorsal branches.] Spinalis cervi'eis : spinal processes 5th, 6th cervical (1st and 2d dorsal), vertebrae—spinal process axis (some- times 3d and 4th cervical). [Cervical branches. ] Complex'us: transverse processes 7th cervical and 3 superior dorsal vertebrae, articular processes 4th, 5th, 6th cervical—occipital bone between superior and inferior occipital lines. [Cervical branches, sub-occipital.] Biventer cervi'eis; 2 or 4 tendons from as many MUSCLES. 30 superior dorsal vertebrae—superior curved occipital line of occiput to inside of comp] exus. [Cervical branches. ] (6) BACK, FIFTH LAYER, 8. Semispina’lis dor'si: transverse processes of vertebrae between 11th and 5th dorsal—spinal processes of 6th and 7th cervical and 4 superior dorsal vertebrae. [Dorsal branches. ] Semispina'lis col'li: transverse processes 4 superior dorsal and articular processes 4 inferior cervical vertebrae— spinal processes 2d, 3d, 4th, 5th cervical. [Cervical branches.] Multif ictus spinae : fills groove on either side spinal processes back part sacrum, articular processes in lumbar and cervical region, transverse processes in dorsal region— spinal processes and laminae of the 4 vertebrae above. [Posterior spinal branches.] Rotato'res spinae: (11); upper and back part trans- verse processes of dorsal vertebrae—inferior border and outer surface of laminae of vertebrae above. [Dorsal branches.] Supra-spina'les: on spinal processes of cervical vert- ebrae. [Cervical branches.] Inter-spin a les: in pairs between spinal processes of adjacent vertebrae; 6 cervical, 3 dorsal (1st to 4th, and 11th to 12th), 4 lumbar. [Spinal branches.] Exten sor Coccy'gis: last bone sacrum—inferior part coccyx, lying on posterior surface. Inter-transversa les: 7 cervical, 12 dorsal, 4 lumbar, lying between transverse processes. [Spinal branches.] (7) ABDOMINAL REGION, 6. Obli'quus abdom inis exter'nus: 8 digitations from inferior borders 8 lower ribs—down to anterior £ outer iliac crest, pubic spine and symphysis, linea alba. Poup- art’s ligament formed by its aponeurosis. [Inferior inter- costal, ilio-hypogastric, ilio-inguinal nerves supply this and the 5 following muscles.] Obli'quus inter'nus: outer £ Poupart’s ligament, anterior f middle lip iliac crest, lumbar fascia—pectineal line, linea alba, pubic crest, inferior edges cartilages of 4 inferior ribs. Transversa'lis : outer i Poupart’s, anterior f internal lip ilium, internal surfaces cartilages of 6 inferior ribs, aponeurosis from spinal and transverse processes lumbar vertebrae—pubic crest (forming with above “conjoined tendon”), lineae ilio-pectinea and alba. BODY. 31 Rec tus abdom'iuis: pubic crest and symphysis—cart- ilages 5th, 6th, 7th ribs. (In sheath formed by internal oblique and transversalis aponeuroses.) Pyramida'lis : pubes—linea alba midway to umbili'cus. Quadra'tus 1 umbo'rum: posterior fourth of iliac crest, ilio-lumbar ligament, transverse processes 3d, 4th, 5th lumbar vertebrae and last rib. (8) THORACIC REGION, 5. Intercosta'les exter'ni: (11); outer lip of groove in inferior borders of ribs—down and forwards to superior border rib below. [Intercostal.] Intercosta'les inter'ni: (11); inner lip of groove- down and backwards to rib below. [Intercostal.] Infracosta'les: inferior surface of one rib—internal surface 1st, 2d or 3d rib below. [Intercostal.] Triangularis ster'ni: side of gladi'olus, internal sur- face ensiform appendix, cartilage of 3 or 4 lower true ribs —cartilages of 2d, 3d, 4th, 5tli ribs. [Intercostal.] Levato'res costa'rum: (12); transverse processes dor- sal vertebrae—superior border rib below, near angle. [In- tercostal.] (9) DIAPHRAGMATIC REGION, 1. Diaphrag ma: internal surfaces of 6 or 7 lower ribs, ligamenta arcuata, crures from 2d, 3d, 4th lumbar vertebrae, ensiform cartilage—converge forming common central tendon. Aortic opening for aorta, vena azygos major, thoracic duct; oesophageal, oesophagus and pneumogastric nerves; vena cava for inferior vena cava; right crus trans- mits sympathetic and greater and lesser splanchnics; left crus, vena azygos minor and splanchnics. [Phrenic.] (11) PERINiEAL REGION, 8. Sphinc'ter a'ni: tip of coccyx and fascia in front— common central perinseal tendon. [Hemorrhoidal branch 4th sacral.] Sphinc'ter inter'nus: muscular ring ($■ inch wide), 1 inch from anus, surrounding rectum. Accelera'tor uri'nse: central perinseal tendon and raphe—covers bulb corpus cavernosum, and corpus spon- giosum, and dorsal vessels. Erec'tor pe'nis: internal surface tuber ischii—sides and inferior surface crus. Transver'sus perinas'i: internal surface ascending ischic ramus—obliquely for- and inwards to central per- inaeal tendon. MUSCLES. 32 BODY. Leva'tor a'ni: inside of pubic ramus and body, ischic spine, fascia (angle of division into obturator and vesical)— central perinseal tendon, rectum, coccyx ; assists to form floor of pelvic cavity. Compressor ure'thrae: pubic ramus — surrounds membranous portion. Coccyge us: ischic spine and lesser sacro-sciatic liga- ment—side of coccyx and last sacral segment. (In the female the above perinaeal muscles are essen- tially the same; the erec'tor ditori'dis takes the place of erector penis, being let into the sides of the clitoris; sphinc'- ter vagi'rm represents somewhat the accelerator urinse of the male, surrounding the vagina.) ARCH OP AORTA : (5 branches); from left ventri- cle, opposite middle of sternum, upwards for 2 inches, arch- ing backwards over root of left lung (on level 2d dorsal vertebra); the “ descending portion,” runs down on the left side of 2d and 3d vertebrae, there becoming thoracic aorta. In front, are left pleura, lung, pneumogastric, phrenic and cardiac nerves; behind, trachea, right pulmonary vessels and nerves, root of right lung, cardiac plexus, oesophagus, thoracic duct, left recurrent nerve. Corona'ria dex'tra: above free margin right semilunar valve, between pulmon- ary artery and right auricular appendix; runs round right border of heart to posterior interventricular groove, there dividing into 2 branches, supplying right heart; anas, at apex with left coronary. Coronariasin'istra; (small- er); above semilunar valve, passes forwards between left auricular appendix and pulmonary artery to anterior inter- ventricular groove, dividing into 2 branches, supplying left side of heart. Innomina'ta: commencement trans- verse portion of arch, ascends obliquely up to right sterno- clavicular articulation, dividing into common carotid and subclavian. Caro'tis commu'nis sin istra and Sub- cla'via sin'istra: (see pages 6 and 21.) AOR'TA THORAC'ICA: (see arch); 5 branches; terminates at aortic opening in diaphragm as “ Abdominal Aorta,” there lying upon front of vertebral bodies. Peri- cardiacos: to pericardium. Bronchia les: (3 gener- ally) ; to the left bronchus. CEsophage'ae : (4 or 5); front of aorta, obliquely down to oesophagus, anas, with inferior thyroid, gastric and phrenic. Mediastina'les poste- ARTERIES OF THE BODY. ARTERIES. 33 rio'res: glands and areolar tissue therein. Intercos- ta'les: (10 pairs); right longer than left; pass out to do spaces, there dividing into anterior branches ascending to inferior border rib above, the smaller branch of it on the superior border rib below, running towards sternum, anas. with internal mammary, thoracic branches of axillary, su- perior intercostal, epigastric, phrenic, lumbar, etc, Poste- rior branch passes backwards, supplying vertebra, cord, and muscles of back. (1st space supplied by superior in- tercostal of subclavian.) AOR TA ABDOM INIS; (9 brs.); from aortic open- ing of diaphragm, in front last dorsal vertebra, terminates on body 4th lumbar, in the “Common Iliacs.” Phren'icse: (2); obliquely outwards to supply diaphragm, inferior vena cava, oesophagus and suprarenal capsules; anas, freely. Cceli'aca: (axis | inch long); horizontally forwards, div- iding into Corona'nr a ventric'ttli (gastric), which passes round lesser curvature stomach from cardiac end to pylorus, there inosc. with hepatic. Hepat'ica, to the transverse fissure of liver to supply right and left lobes, giving off pylo'ric branch to stomach, running from right to left; gas'tro duodena'lis that supplies greater curve of stom- aca (gas'tro epiplo'ica dex'tra which inosc. with gas'tro- -epiplo'ica sin istra of splenic), pancreas and duode'num (pancreat'ico-duodena'lis, with which duodenal branch of superior mesenteric); cys'tica, small branch to gall blad- der. Splen'ica, horizontally left to spleen: pancreatim [mag'na and par'voe) small branches to pancreas; va'sa bre'- cia, 5 to 7 small branches to cardiac end of stomach; gas'- tro-epiplo'ica sin'istra, around greater curve stomach from left to right, anas, gas'tro epiplo'ica dex'tra. Supra- rena’les: obliquely up- and outwards to supra-renal cap- sules. Mesenter'ica supe'rior: \ inch below ccelic axis, to the intestines. Infe'rior pancreat'ico-duodena'lis, up to head pancreas and lower f duode'num, anas, with pancreat'ico-duodena'lis of hepatic. Va'sa intesti'na ten'- uis, 12 to 15 looping branches to jejunum and ileum, ll'io- col'ica, down right obliquely, to ileum and caecum. Col'ica dex'tra, horizontally to right to ascending colon. Col'ica me'dia, up to transverse colon, inosc. colica dextra and col- ica sinistra. (Free anastomosis of all these vessels.) Rena'les: sides aorta just below superior mesenteric, hor- izontally outwards to each kidney. Spermat'icse: slen- der vessels supplying testicles, or ovaries. Mesenter'ica infe'rior: left side aorta 2 inches above bifurcation, to sig- 34 moid flexure of colon, and rectum. Col'ica sin'istra, hori- zontally to left to descending colon. Sigmoide'ce, branches passing obliquely downwards to sigmoid flexure. Ilcemor- rhoida'lis supe'rior, termination of inferior mesenteric, sup- plying superior part of rectum, anas, with middle lioemor- rhoidal of internal iliac, and inferior lisemoi-rhoidal of in- ternal pudic. The branches of both mesenteric arteries are in free anastomosis. Lumba'les: 4 pairs arising from back aorta, dividing near transverse processes into abdom- inal branches (supplying muscles, and anas, with epigas- tric, internal mammary, intercostal, ilio-lumbar and cir- cumflex iliac branches) and dorsal branches (supplying back muscles, etc., with a spinal branch to meninges and cord), anas, intercostal. Sa'cra media: back of aorta at its bifurcation, down median line to coccyx, there anas. with lateral sacral, supplying adjacent parts, ILI'ACAD COMMU NES: from bifurcation of aorta, obliquely out- and downwards to intervertebral substance between sacrum and last lumbar vertebra, there dividing into Internal and External Iliac; each about 2 inches long. Give small branches to peritoneum, ureters, psoae, etc. The left is the larger. ILl'ACA INTER'NA: (see above); 1| inches long, dividing at greater sacro-sciatic foramen into anterior and posterior trunks. Branches from the Anterior trunk are: Vesica'lis supe'rior: part of foetal-hypogastric that remains pervious; to fundus of bladder, and vas deferens. Vesica'lis me dia : base of bladder and vesi- culse seminales. Vesica'lis infe'rior: base bladder, pros- tate, and vesicuke seminales. Haemorrhoida'lis me- dia: rectum, anas, with hemorrhoidal branch of inferior mesenteric and internal pudic. (Uterine: to neck, and ascends to fundus, giving branch to ovary and tube, etc. Vaginal: corresponds to inferior vesicle, supplying vagina, urethra, etc.) Obturato'ria: forwards to superior border obturator foramen, escaping there, dividing into an internal (curving round inner border foramen, supplying adjacent muscles, etc., anas, with external branch and internal cir- cumflex) and external branch (round outer margin foramen supplying adjacent muscles). The branches inside the pelvis are iliac, vesical and pubic; the latter anas, with epigastric. Sometimes rises from epigastric, then liable to be wounded in an operation for hernia. Pudi'ca inter'na: terminal branch; supplies external generative organs; out of pelvis in front of pyriformis (great sacro-sciatic foramen), crosses BODY. ARTERIES. 35 ischic spine, re-enters pelvis, through lesser sacro-sciatic foramen, ascends ischic ramus up to pubes. Hcemor rhoida'les, inferio'res, 2 or 3 to rectum, etc. Superficial Us perince'i, to scrotum and perinaeum. Transver'sa perince'i. A. corpo'ris bulbo'si, to bulb and Cowper’s gland. A. cor- po'ris caverno'si, terminal branch running forwards in this structure. Dorsal Us pelnis, forwards to glands. Seiat'ica: terminal branch (see lower extremity). Branches from the Posterior trunk are: Glute'a superior; (see lower extremity.) Ilio-lumba'lis: divides at upper part iliac fossa into lumbar (to psoas and quadratus muscles, branches to spinal canal; and iliac branch (to iliacus internus, anas. with gluteal, epigastric, etc.) Saera'les latera'les; (2); superior enters 1st or sacral foramen, anas, with fellow and middle sacral; inferior, descends on sacrum, anas. over coccyx with middle sacral and opposite fellow. ILI'ACA EXTERNA: from bifurcation common iliac to femoral arch. Line drawn from left of umbili'cus to a point on Poupart’s ligament midway between pubes and anterior superior spinal process of ilium, indicates its course. Epigas'trica; few lines above Poupart’s, up- and inwards to umbili'cus, there anas, with internal mam- mary and inferior intercostal. Spermat'ica exlerna'lis, to cremaster. Pudic branch. Muscula'res. Circumflex'a il'ii: origin opposite above, from outer side artery, runs obliquely up- and outwards on iliac crest, supplying adja- cent muscles, and anas„ with gluteal, epigastric and lum- bar arteries. VEINS OF THE BODY. Innomina'tse: right is short (1| inches long), running from sterno-clavicular articulation to join left innominate at inferior border cartilage of 1st rib, forming vena cava superior. Is external to artery, and receives right lym- phatic duct, right vertebral, right internal mammary, right inferior thyroid and right superior intercostal veins. Left is 3 inches long, runs in front of the three large arterial branches of aorta; receives corresponding venous branches as right. Neither have valves. Mamma'ria interna: 2 to each artery; unite in single trunk, emptying into innominate. Thyroide'a infe rior: (sometimes 3 or 4); from thyroid venous plexus, emptying into right and left innominate. Intereosta'les superio'res: from 2 or 3 superior 36 BODY. intercostal spaces, emptying into innomiatse. Left bron- chial empties into left intercostal. Vena cava superior: 2| to 3 inches long, formed of venae innominatae, emptying into right auricle; receives vena azygos major, and pericardial veins. No valves. Az ygos ma jor: opposite 1st or 2d lumbar vertebra, from right lumbar veins, up through aortic diaphragmatic opening to right side 3d dorsal vertebra, arching over root right lung, emptying into vena cava. Receives the 10 lower right intercostal veins, vena azygos minor, several oeso- phageal, mediastinal, vertebral, and right bronchial veins. Imperfect valves, though its branches have complete ones. Az'ygos mi'nor infe'rior: lumbar region of left side from lumbar veins, or branches of renal, through left crus of diaphragm to 6th or 7th dorsal vertebra, there crossing to terminate in azygos major. Receives 4 or 5 lower intercostal, and some oesophageal and mediastinal veins. Az'ygos mi'nor supe rior: from branches intercostal and azygos minor inferior veins; empties into one of the other azygos veins. Bronchia'les: from lungs; the right terminating in azygos major; the left in the left superior intercostal. ►Spina'les: dor si-spina'lis, whole length of back of spine, forming network, terminating in the vertebral (of neck), the intercostal (of thorax), lumbar and sacral veins. Longitudina'les spina'les anterio'res, whole length vertebral foramen; anterior surface terminating at dorsi-spinal, etc. Longitudina'les spina'les posterio'res, whole length verte- bral foramen, posterior surface, terminating in dorsi-spinal. V. ba'sis vertebra'rum, from bodies of vertebrae, termina- ting in anterior longitudinal. Medul'li-spina'les, cover cord, between pia and arachnoid, from sacrum to occiput; anas, freely with those contiguous. No valves in any of the spinal veins. Ili aca exter'na, inter'na and commu'nis, see lower extremity. Ve'naea'va infe'rior: junction of the 2 common iliacs, up on right side of aorta, terminating in lower and back part of right auricle. It receives: the lumbar branches (3 or 4 in No.) from muscles and integument of loins; the right spermatic (the left emptying into left renal), both having valves; ovarian, have same termination; the renal, the left being the longer; the right supra-renal (the left terminating in the left renal, or phrenic); the rightphrenics (the left superior emptying into superior intercostal or in- ternal mammary, and the inferior into the left renal); the hepatic, 3 branches (no valves), these commencing as the m£ra-lobular veins (in the centre of the lobule), forming the swAlobular, and these last finally the larger hepatic trunks. Ve'napor'ta: 4 inches long; no valves in it or its branches; formed by mesenter'ica infe'rior, (draining rectum, sigmoid flexure, and descending colon; its branches inosc. with internal iliac); mesenter'ica supe'rior (draining small intestines, caecum, ascending and transverse colon); splen'im (5 or 6 branches from spleen; receiving branches of va'sa bre'via, left gas'tro-epiplo'ica, pancreat'ica and pancreat'ico-duodena’lis veins); gas'trica, from lesser stomachic curvature. Cardi'acse: ve'na cor'dis mag'na, from apex, up anterior interventricular groove to base ventricles, curving to left side to back part of heart, emptying into coronary sinus, guarded by 2 valves; receives posterior cardiac and left cardiac veins. Ve'na cor'dis me'dia, (posterior cardiac) from apex, up posterior interventricular groove, termina- ting in coronary sinus, guarded by valve. Ve'nce par'ter, (anterior veins), 3 or 4 small branches from anterior sur- face of right ventricle, emptying into lower part right auricle. Ve'nce thebe'sii drain muscular substance, opening into right auricle. Pulmona'les: 4 in number; commence in capillary net-work upon bronchial cells, uniting to form a trunk for each lobe; the one of the middle lobe of the right lung unites with the one from the superior lobe, hence 2 veins from each side. No valves; carry arterial blood. NERVES. 37 NERVES OF THE BODY. SPINAL NERVES: 31 pairs, viz.: 8 cervical, 12 dorsal, 5 lumbar, 5 sacral, 1 coccygeal. Each have an anterior and posterior root, hence have moto-sensor functions. Cervica'les: (see pages 16 and 17). Dorsales: 1st from between 1st and 2d dorsal vertebrae, the last from between 12th dorsal and 1st lumbar. The Posterior branches have external and internal branches. The cuta- neous branches are the 6 upper from the internal branches, the 6 lower from the external branches. These nerves supply the structures of the back. Anterior branches supply walls of the chest and abdomen, each having. 38 branches from the sympathetic. Superio'res Intercostalles, pass forwards with the arteries, giving off numerous branches, the chief being the lateral cutaneous, which have anterior and posterior branches. The 1st intercostal has no lateral branches; the 2d has a large one (the inter- cos'to-humera'lis,) which supplies the integument of upper inner half of arm. Intercosta'les inferio'res, having nearly the same course as the superior, supplying the anterior cutaneous nerves to abdomen, and having lateral branches. Lurnba'les: have largest roots of all; have anterior and posterior branches; the latter having external and internal branches; the anterior branches unite to form the lumbar plexus. Supply muscles and integument in their region. The anterior branches communicate with sympathetic. Sacra'les and Coccygea'les : (see nerves of lower extremity.) LOWER EXTREMITY. LOWER EXTREMITY. MUSCLES OP THE LOWER EXTREMITY. (REGION 1) ILIAC REGION, 3 MUSCLES. Pso'as mag'nus: last dorsal and all lumbar vertebrae (transverse processes)—lesser trochanter, in union with iliacus. [Anterior branches lumbar.] Pso'as par'vus: sides of bodies last dorsal and 1st lum- bar vertebrae—ilio-pectineal eminence. [Anterior branches lumbar ] Iliacus: iliac fossa, crest and anterior spinous processes of ilium, base sacrum—outer side tendon psoas magnus. [Anterior crural.] (2) ANTERIOR FEMORAL REGION, 7. Ten'sor vag inae fem'oris: outer crest ilium, anterior superior spinous process—fascia lata £ way (laterally) down the thigh. [Superior gluteal.] Sarto'rius : (longest muscle of body); anterior superior spinal process ilium, part of notch below—upper, inner side of tibial shaft, having crossed the anterior surface of the thigh obliquely. [Anterior crural.] Quad riceps exten sor: (vas'ti inter'nus and exter'- nus, rec'tus and crure'us); the Rec'tus from anterior inferior spinal process ilium and groove above acetabulum,—the (14 Regions, 57 Muscles.) Vas'tus Exler'nus from anterior border great trochanter, linea aspera,—the Vas'tus Inter'nus and Ci'ure'us from inner lip of linea aspera and nearly all internal, anterior and external surface of femur-shaft—all joining into a common tendon to be inserted into patella. [Anterior crural.] Subcrure'us: lower anterior surface of femur—syno- vial pouch behind patella. [Anterior crural.] (3) INTERNAL FEMORAL REGION, 5. Grac'ilis: inner margin rami of pubes and ischium— inner side upper part tibia above insertion semitendinosus and beneath sartorius. [Obturator.] Pectine'us: Gimbernat’s ligament, linea ilio-pectinea —rough line between trochanter minor and linea aspera. [Obturators and anterior crural.] Adduc'tor lon'gus; front of pubes—middle 3d of linea aspera. [Obturators.] Adduc tor bre'vis: descending ramus of pubes between gracilis and obturator—upper part linea aspera, behind pectineus. [Obturators.] Adduc'tor mag'nus : ramus of pubes and ischium, and tuber ischii—from great trochanter to inner condyle. [Obturator and great sciatic.] (4) GLUTEAL REGION, 9. Glutse'us max'imus: superior curved line of ilium down to coccyx and sacro-sciatic ligaments—rough line be- tween great trochanter and linea aspera. [Inferior gluteal branch sacral plexus.] Glutse'us me'dius; between superior and middle iliac curved lines, crest, fascia—great trochanter. [Superior gluteal.] Glutse'us min'imus: between middle and inferior curved lines, margin great sacro-sciatic notch—impression anterior border trochanter major. [Superior gluteal.] Pyrifor'mis: front of sacrum, anterior margin great sacro-sciatic foramen and anterior surface great sacro- sciatic ligament, etc.—through great sacro-sciatic foramen to superior border great trochanter. [Sacral plexus.] Obtura'tor inter'nus: inner margin obturator fora- men, pubic and ischic rami, and obturator membrane— through lesser sacro-sciatic foramen to superior border great trochanter, in front pyriformis. [Sacral plexus.] Gemellus supe'rior: outer surface of spine of ischium—horizontally outwards to superior border great MUSCLES. 39 40 trochanter, in company with obturator internus. [Sacral plexus.] Gemel'lus inferior: superior outer border tuber is- chii—superior border great trochanter with obturator in- ternus. [Sacral plexus.] Obtura tor exter'nus: inner side obturator foramen, pubic and iscliic rami, internal f- of external surface obtur- ator membrane—out- and backwards to digital fossa of femur. [Obturator.] Quadra'tus fem'oris: outer border tuber ischii—hor- izontally outwards to linea quadrati of posterior surface of trochanter. [Sacral plexus.] (5) POSTERIOR FEMORAL REGION, 3. Bi'eeps: long head from tuber ischii, short head from linea aspera—outer side head fibula, covering external lat- eral ligament. Forms outer “ ham-string[Great sciatic.] Semi-tendino'sus: tuber ischii in company with bi- ceps, and the aponeurosis—tendon (inner side popliteal space) curves round internal tibial tuberosity to inner sur- face of shaft (external and beneath sartorius.) [Great sciatic.] Semi-membrauo'sus: tuber ischii, above and exter- nal to biceps and semi-tendinosus—back of tibial tuberos- ity in 3 digitations, beneath internal lateral ligament. The preceding, with this, and gracilis and sartorius, form inner ‘ ‘ ham-string. ” [Great sciatic. ] (6) ANTERIOR TIBIO-FiBULAR REGION, 4. Tibia'lis anti'eus: outer tibial tuberosity and the su- perior shaft, external surface—inner under surface internal cuneiform and base 1st metatarsus. [Anterior tibial.] Exten sor pro'prius pol licis: middle anterior sur- face fibula and interosseous membrane—base last phalanx great toe. [Anterior tibial.] Exten'sor lon'gus digito'rum: external tuberosity tibia, upper § anterior surface shaft of fibula, interosseous membrane—3 tendons distributed to 4 lesser toes. [Ante- rior tibial.] Perone'us terti'us: (part of above); lower outer fourth fibula—base 5th metatarsus. [Anterior tibial. ] (7) POSTERIOR TIBIO-FIBULAR REGION, SUPERFICIAL LATER. 3. Gastrocne'mius: 2 heads, one from each femuric condyle—unites with soleus to form tendo Achillis, inserted into posterior surface os calcis. [Internal popliteal.] LOWER EXTREMITY. MUSCLES. 41 Sole'us: oblique line tibia, back of head and superior portion of fibular shaft—os calcis. [Internal popliteal. 1 Planta'ris : outer surface external femuric condyle and posterior ligament knee-joint—os calcis, posterior surface. Noted for long, slim tendon. [Internal popliteal.] (8) POSTERIOR TIBIO-FIBULAR REGION, DEEP BAYER, 4. Poplitse'us: (forms floor popliteal space); depression below tuberosity of external femuric condyle—inner £ tri- angular space above oblique line on posterior surface tibia. [Internal popliteal.] Plex or lon'gus pol'lieis: lower internal £ fibular shaft, interosseous membrane, muscular septum and fas- cia—through grooves in tibia, astragalus, and calcis to base last phalanx big toe. [Posterior tibial.] Flex'or lon'gus digito'mm: posterior surface tibia below oblique line, intermuscular septum—behind inner malleolus, calcic arch, joined by tendon flexor acces- sorius, divides into 4 tendons,which pass through slits in the tendons of flexor brevis digitorum to be inserted into bases of last phalanges of the 4 outer toes. [Posterior tibial.] Tibialis posti'eus: interosseous membrane, superior £ posterior surface tibial shaft, superior £ fibula, inner sur- face—behind inner malleolus, beneath calcaneo-scaphoid articulation to tuberosity scaphoid and internal cuneiform. [Posterior tibial.] (9) FIBULAR REGION, 2. Peronse'us lon'gus: head, and upper, outer £ fibular shaft, muscular fascia and septa—behind external malle- olus, through cuboid groove to outer side base 1st meta- tarsus. [Musculo-cutaneous.] Peronae'us bre'vis: middle £ outer surface fibular shaft, muscular septa—behind external malleolus to dor- sal surface base 5th metatarsus. [Musculo-cutaneous.] (10) FOOT, DORSAL REGION, 1. Exten'sor bre'vis digito'rum: outer side os calcis, astragalo-calcanean ligament, anterior annular ligament— 4 tendons; 1st into 1st phalanx of great toe, the rest into outer sides of tendons of long extensor to 2d, 3d, and 4th toes. [Anterior tibial.] (11) FOOT, PLANTAR REGION, 1ST LAYER, 3. Abduc'tor pol'lieis: inner tuberosity os calcis, inter- nal annular ligament, plantar fascia—inner side base 1st phalanx great toe. [Internal plantar.] Flex or bre vis digito'rum: internal tuberosity os calcis, plantar fascia, muscular septa—4 tendons, sides 2d phalanges of outer toes. [Internal plantar.] Abduc tor minimi dig'iti: outer tuberosity os cal- cis, plantar fascia, muscular septum—outer side base 1st phalanx little toe; joins tendon of short flexor. [External plantar.] (12) FOOT, PLANTAR REGION, 2d LAYER, 2. Flex or accesso rius : inner head from inner surface os calcis and calcaneo-scaphoid ligament; outer head, infe- rior surface os calcis and plantar ligament—tendon flexor longus digitorum. [External plantar.] Lumbrica'les ; (4); tendon of long flexor—inner sides bases of 2d phalanges of 4 outer toes. [Internal plantar to 1st and 2d, external plantar to 3d and 4th.] (13) FOOT, PLANTAR REGION, 3d LAYER, 4. Flex'or bre'vis pol'licis: internal border of the cuboid and contiguous surface of external cuneiform, ten- don of tibialis posticus—outer and inner sides base first phalanx big toe. [Internal plantar.] Adductor pol'licis; tarsal extremity of 2d, 3d and 4th metatarsi and sheath of peroneus longus—outer side base 1st phalanx big toe. [External plantar.] Flex'or bre'vis min'imi dig'iti; base of 5th meta- tarsus and sheath peroneus longus—outer side base 1st phalanx of little toe. [External plantar.] Transver'sus pe'dis; under surface head 5th meta- tarsus, transverse ligament of metatarsus—outer side 1st phalanx of big toe. [External plantar.] (14) FOOT, PLANTAR AND DORSAL INTEROSSEOUS REGIONS, 7. Interos'sei dorsa'les: (4); bipenniform, from adjacent sides of metatarsi—bases of 1st phalanges, outer (except the 1st) side of the 4 outer toes. Planta'res; (3); arise from the shafts of the 3d, 4th and 5th metatarsi, inner side— inner sides of the bases of the 1st phalanges of the same toes, and common extensor tendon. 42 LOWER EXTREMITY. ARTERIES OF THE LOWER EXTREMITY. SCIAT'ICA : (5 branches); larger terminus of anterior trunk of internal iliac; out through lower part of the great sacro-sciatic foramen resting on pyriformis, descending Alt TE KIES. 43 between tuber ischii and great trochanter, to supply mus- cles of the thigh. Coccygea'lis : inwards, 'piercing great sacro-sciatic ligament, supplying glutaeus maximus and integument. Glutae'se inlerio'res: 3 or 4 supplying glutaeus maximus. Co mes ner'vi ischiad'ici: accom- panying great sciatic nerve, and finally pierces it and is lost in its substance. Muscula'res: to back part of hip, anas, with gluteal, superficial perforating—external and internal circumflex. Articula'res: to hip-joint capsule. GLUT JE'A SUPE RIOR: largest branch of internal iliac; out above pyriformis, dividing into deep and super- ficial branches; supplies iliacus, obturator internus, pyri- form. Superficial branch, beneath glutaeus maximus, sup- plying it; anas, with posterior branch sacral. Deep branch, between glutaeus medius and glutaeus minimus, the superior division anas, at anterior superior spinous process of ilium with circumflex iliac and external circum- flex; the inferior division goes to great trochanter, anas. with external circumflex. Branches supply all muscles in this region, also joint. FEMORALIS: (7 branches); from Poupart’s liga- ment to opening in adductor magnus. A line drawn from the middle of said ligament to internal femuric condyle lies over its course. Vein lies on inside; anterior crural nerve on the outside of artery. Superficia'lis epigas'- trica: i inch below Poupart’s ligament, through saphe- nous opening upwards to umbili'cus in the fascia covering the external oblique abdominis; anas, deep epigastric and internal mammary. Superficia'lis circumflex'a ili- aca: arises close to above, outwards to iliac crest, supply- ing glands fascia and integument; anas, circumflex iliac, gluteal, external circumflex. Superficia'lis exter'na pudi'ca: inner side, i inch below Poupart’s ligament, pierces fascia lata, crosses spermatic cord, supplies integ- ument of lower part of abdomen, penis, scrotum (or labia); anas, internal pudic branches. Profun'da exter'na pudi'ca: passes inwards on pectineus, piercing fascia at pubes, supplies integument of perinajum, scrotum (or labia); anas, superficial perinaeal. Profun'da fem'oris: outer and back part, 1 to 2 inches below Poupart’s liga- ment, passing back of artery and the femoral vein to inner side femur, terminating in adductor magnus, lower 3d; anas, with popliteal and inferior perforating. Circum- flex'a exter'na, having ascending, descending and trans- verse branches, supplying muscles in that region, and 44 anas, with gluteal, circumflex iliac, superior articular of popliteal, near great trochanter with sciatic, superior perforating and internal circumflex. Circumflex'a in- ter'na, inwards to joint, supplying contiguous muscles, and head of femur; anas, with obturator, sciatic, external circumflex and superior perforating. Perforan'tes, the “superior,” supplying adductors magnus and brevis, bi- ceps, glutseus maximus and anas, with sciatic, internal circumflex and middle perforating; “middle” one sup- plies flexors of thigh and nutrient artery, anas, with its fellows; the “ inferior ” supplies the thigh flexors, anas. with its fellows and terminal branch of profunda. Mus- cula'res: 2 to 7 in number, supplying sartorious and vastus internus. Anastomot'ica mag'na: arises just before the femoral, pierces the adductor magnus, dividing into superficial branch, accompanying long saphenous nerve, to supply integument; deep branch descends to inner side of knee, where it anas, with superior internal articular and recurrent of anterior tibial, and supplies knee-joint and contiguous parts. POPLITJE'A: (7 branches); from termination of fem- oral down to lower border of popliteus muscle, dividing into anterior and posterior tibial. Nerve and vein super- ficial to artery. Muscula'res: superior (2 or 3), supply vastus externus and thigh flexors; anas, inferior perforat- ing, terminal branches profunda. Inferior (2), supply gastrocnemius heads and plantaris; arise opposite knee- joint. Cuta'nei; supply integument of calf of leg. Artieula'res superio res: internal, running inwards over femuric condyles, anas, with anastomotica magna, inferior internal articular and superior external articular, supplying vastus internus and knee-joint. External, run- ning circularly outwards over femuric condyles, supply- ing vastus externus, knee-joint, etc.; anas, with external circumflex, and with anastomotica magna, forming an arch. Az ygos articula'ris: opposite bend of joint, piercing posterior ligament, supplies ligaments, synovial mem- branes and joint. Artieula'res inferio'res: wind round tibial head; the internal, beneath internal lateral ligament, to front and inner side of joint, supplying tibial head and joint. The external, beneath external lateral ligament, etc., to front of joint, anas, with the one of op- posite side, superior articular and anterior tibial recur- rent. TIBIALIS ANTE RIOR; (3 branches); forward LOWER EXTREMITY. through interosseous membrane and 2 heads of tibialis posticus, lying upon anterior surface of interosseous mem- brane down to front of ankle, there becoming dorsalis pe- dis. A line drawn from inner fibular head to midway between the 2 malleoli indicates its course. Has venae comites; the anterior tibial nerve lies a little superficial and to its outer side. Recur'rens: arises just as artery passes through interosseous membrane, running up in tib- ialis anticus muscle to front of joint, anas.'with the artic- ulares. Muscula'res: numerous, suppling integument and muscles throughout the course, anas, with branches from posterior tibial and peroneal. Malleola'res: inter- nal arises 2 inches above articulation, inwards, beneath tendons ramifying upon inner malleolus, anas, with branches from posterior tibia and internal plantar. Exter- nal, outwards beneath tendons, supplying outer malleolus, anas, with anterior peroneal, and tarsea branch of dorsalis pedis. DORSALIS PEDIS: (4 branches); from bend of ankle to 1st interosseous space, there dividing into commu- nicating and dorsalis liallucis. Has venae comites; anterior tibial nerve lies on outer side. Tar'sea: arises over scaphoid, passing outwards beneath extensor brevis digit- orum, supplying that muscle and tarsal articulations; anas. metatarsal, external malleolar, peroneal, and external plan- tar. Metatar'sea; outwards over metatarsal heads, giv- ing off 3 interos'sece branches which pass forwards to clefts of the 3 outer toes, there dividing to supply adjacent sides of the toes, and outer side of little toe. Anas, with tarsea and external plantar; the 3 interosseous, each, receive a posterior perforating branch from plantar arch near their origin, and each a branch from anterior perforating of digital near the toe-clefts. Dorsalis hallu'cis: for- wards along outer border 1st metatarsus to 1st toe-cleft, there dividing to supply inner side of big toe, and the adjacent sides of big and 2d toes. Commu'nicans : dips down into sole, anas, with external plantar to form plan- tar arch, there dividing to supply toes same as dorsalis hallucis. TIBIALIS POSTE'RIOR: (5 brs.); from lower border popliteus, parallel inner border tendo Acliillis, to fossa between inner ankle and heel, there dividing into the plantar arteries. Has venae comites; nerve to the out- side for the lower £ of its course. Peronae'a: from 1 inch below popliteus, obliquely outwards to fibula, de- ARTERIES. 45 scending along inner border of it to outer ankle, supply- ing contiguous structures, anas. with, external malleolar, tarsal and external planter. Ante'rior peronce'a, given off 2 inches above ankle, pierces interosseous membrane, passes down to front of outer ankle and tarsus, supplying adjacent structures, anas, with tarsal and external malleo- lar. Nutri'tia, to fibula. Muscula'res, to fibular muscles. Nutri'tia: near origin of posterior tibia, being largest of its kind in the body; enters tibia just below oblique line, liluscula'res: to soleus and deep muscles. Commu'ni- cans: transversly across tibia 2 inches above its inferior extremity to anas, with peroneal. Calca'nese inter- na'lcs: several branches arising just before division of posterior tibial, supplying fat and integument about heel, and muscles of inner side of foot; anas, with peroneal, internal malleolar. PLANTA'RIS INTER'NA: forwards along inner side of foot to big toe, anas, with digital branches, sup- plies adductor pollicis, flexor brevis digitorum, etc. PLANTA'RIS EXTERNA: (2 brs.); out- and for- wards to base 5th metatarsus, then turning obliquely in- wards to 1st interosseous space, inosc. with communicat- ing branch from dorsalis pedis, forming plantar arch. Perforan'tes posterio'res: (3); ascend through back part of the 3 outer interosseous spaces; anas, with inter- osseous branches of metatarsal. Digita'les: (4); arise from arch and supply both sides of the 3 outer toes and outer side of the 2d toe, bifurcating at the respective toe- clefts to do this. At each bifurcation a branch (the ante- rior perforating) is sent upwards through the interos- seous space; anas, with interosseous branches of the met- atarsal. LOWER EXTREMITY. VEINS OF THE LOWER EXTREMITY. Saphena interna: or long saphenous: from plexus at dorsum and inner side of foot, ascends, in front of inner ankle, behind inner margin of tibia, bends behind inner femuric condyle, empties into femoral through saphenous opening, inches below Poupart’s ligament, where it receives superficia'lis circumflex'a ilinca, superfi- cia'lis epigas'trica, and superficial lis exter'na puii'ca. Com- municates with internal plantar, tibial, etc. 2 to 6 valves. Saphe na exter'na: plexus at dorsum and outer side of foot, up behind outer ankle to median line of leg. VEINS. 47 accompanied by external saphenous nerve; empties into popliteal vein, between heads of gastrocnemius; 2 valves, one near termination. Communicates with deep veins of foot. Tibia'les posterio'res: formed from external and internal plantar joining with the peroneal. Course same as artery. Tibia'les anterio'res: continuation of re'nee dorsa'les pe'dis, pierce interosseous membrane at upper part of leg, and form, by junction with the posterior tibial veins, the popliteal. Poplitae'a: (see tibial anterior); up to tendinous aper- ture of adductor magnus, there becoming the femoral; receives sural, articular, and external saphenous veins. 4 valves. Crosses artery from within outwards. Femora'lis: (see above); up to Poupart’s ligament, there becoming external iliac. Lies (below) to outside, but crosses beneath the artery to its inside. Receives muscular branches, and profun'da fern'oris, and internal saphenous, at 1-J- inches below Poupart’s ligament. 4 or 5 valves. m 'aca exter'na: (see above); to sacro-iliac symphy- sis, there uniting with internal iliac to form common iliac. On right side, lies to inside of artery at first, but grad- ually passes behind it. On left side, altogether on inside of artery. Receives epigastric and circumflex iliac. No valves. Hi 'aca inter'na: formed by venae comites of all the branches of the iliac artery, but the umbilical; lies first to inside, but finally gets behind the artery. No valves, though the plexus that help form it are abundantly sup- plied. 1. Hcemorrhoidal plexus; 2. vesico-prostatic plexus; 3. vaginal plexus; 4. uterine plexus; 5. dorsalis penis plexus; these all intercommunicate very freely. Hi aca commu'nis. (see iliaca externa); terminates at intervertebral substance between 4th and 5th lumbar ver- tebrae, there, with its fellow of opposite side, forms vena cava inferior. On the right it is the shorter, and nearly vertical. Receives ilio-lumbar, and sometimes lateral sacral veins. Middle sacral empties into left common iliac. No valves. 48 LOWER EXTREMITY. NERVES OF THE LOWER EXTREMITY. LUM BAR PLEXUS: formed by anterior roots of the 4 upper lumbar nerves communicating with each other. It furnishes different nervous brandies to supply the inferior extremities. Ilio-hypogas'trica: 1st lum- bar, outwards to iliac crest, piercing there the transversa- lis, the iliac branch being distributed to gluteal integu- ment ; the hypogastric supplies the integument in umbilical region. Ilio-inguina'lis : 1st lumbar; escapes at exter- nal ring, supplying inner thigh, scrotum (labia in female) and inguinal region. Genito-cruralis : 2d lumbar and branch from 1st; pierces psoas, and near Poupart’s liga- ment divides; the genital branch to genitals, the crural to integument on anterior upper aspect of thigh; communi- cates with middle cutaneous. Cuta'neus exter nus: 2d lumbar; perforates psoas, and at Poupart’s ligament divides; the anterior branch supplying the anterior and external part of thigh to knee; the posterior supplying surface of thigh to its middle. Obtura tor: 3d and 4tli lumbar, and at upper part of obturator foramen enters thigh, dividing into: anterior branch supplying adductor longus and brevis, pectineus and femoral artery, giving articular branch to hip-joint; posterior branch pierces ob- turator externus, passes to front of adductor magnus, dividing into muscular branches; articular branch is given off for knee-joint. Obtura'tor accesso'rius: either from obturator, or filaments from 3d and 4tli lumbar; supplies pectineus, hip-joint, and a cutaneous branch to leg. Sometimes wanting. ANTERIOR CRURA LIS; 3d and 4th lumbar, through psoas beneath Poupart’s ligament to thigh, exter- nal to artery in pelvis, supplies iliacus, and femoral artery; without, all the muscles on front of the thigh but the tensor vaginae femoris. Cuta'neus me'dius, through fascia lata below Poupart’s ligament, dividing into 2 branches, supplying sartorius and integument in front as low as knee. Cuta'neus inter'nus, obliquely across up- per part femoral sheath, the anterior branch perforating fascia at lower 3d of thigh, supplies integument of inside of thigh to knee-joint; the inner branch descends along posterior border sartorius to knee, piercing fascia, giving off numerous branches, descending still farther, supplying integument of inner side of leg. Saphe'nus inter'nus, 49 downwards beneath sartorius to knee, inner side, then along inner side of leg in company with internal saphe- nous vein, dividing into 2 branches, one terminating at inner ankle, the other distributed to integument of dor- sum of foot. Supplies muscles and integument in its course, giving off branches communicating with internal cutaneous and obturator nerves; another to patellar integu- ment and forms a “plexus patellae ” with other branches. Muscula'res, all muscles of front of leg but tensor vaginae femoris. Artieula'res, 2 to knee-joint ligaments. SACRA'LES: 5; the 4 upper through anterior sacral canals; the 5th through the sacro-coccygeal foramen; the posterior are smaller and through posterior sacral canals, except the 5th, which is through posterior sacro- coccygeal foramen. Have long roots. Posterior internal branches supply multifidus spinae. Posterior external branches supply integument over sacrum, coccyx and pos- terior gluteal region, forming many anastomosing loops. Anterior, the 4 upper supplying rectum, bladder, (vagina), and pelvic viscera (communicating with sympathetic); with their muscular branches they supply levator ani, coccy- geus, sphincter ani, and integument between anus and coccyx, communicating with coccygeal. COCCYGEA'LIS: posterior branch receives branch of com. from posterior sacral and is lost in fibrous cover of coccyx. Anterior branch pierces sacro-sciatic ligament, supplying integument about coccyx. Anas. 5th sacral. SA CRAL PLEX US: is formed by lumbo-sacral, the anterior branches of 3 upper (and part of the 4th) sacral nerves. Is triangular in form, the base correspond- ing to the exits of nerves, and rests on pyriformis, anterior surface, covered by fascia. Muscula'res, supply pyri- formis, obturator internus, gemelli, and quadratus femo- ris. Glutseus superior: back part lumbo-sacral, passes through great sacro-sciatic foramen, the superior branch supplying glutaeus minimus and medius, the inferior branch supplying glutseus minimus and medius, and lower portion tensor vaginae femoris. Pudi'cus: plexus, lower part; out great sciatic foramen, in through the lesser sacro-sciatic foramen, terminating in perinea1, and dorsal nerves of penis. Inferior hcemorrhoida'lis, near origin pudic, supplies external sphincter and adjacent integument; communicates with inferior pudendal and superficial perineal. Perinm'us, terminal branch, accom- panies perineal artery; the anterior cutaneous branches NERVES. supply scrotum and under part of penis, (labia), and leva- tor ani; the posterior branches supply sphincter ani and integument in front of anus, and back part scrotum. The muscular branches supply transversus pcrinaei, accelerator urinse, erector penis, compressor urethrae, and bulb. Dor- salis pe'nis, along ramus ischii, with pudic artery, follows it and its branches to the glans penis, which it supplies. Anas, with sympathetic, and supplies integument of pre- puce and of penis, and corpus cavernosum. (In female, to the analogous parts.) SCIAT'ICUS PAR VUS: supplies integument of perinaeum, back part of thigh and leg, and glutaeus maxi- mus. Two branches from sacral plexus unite to form it; follows course of sciatic artery in distribution, piercing fascia in popliteal region, accompanies external saphe- nous vein to middle of leg. Inferio'res glutes'i, to glutaeus maximus, several large branches. Inter'nal cuta'nei, to skin of upper and inner side of thigh, posterior aspect; scrotum by inferior pudendal that curves around tuber ischii. Ascenden'tes cuta! nei, run upwards and supply in- tegument of gluteal region, and muscles. Branches to integument of thigh, popliteal region and upper part of leg. SCIAT'ICUO MAGNUS: f inch wide, and contin- uation of lower part sacral plexus, passing out of great sacro-sciatica foramen below pyriformis, down between great trochanter and tuber ischii to lower 3d of thigh, there dividing into internal and external poplitseus. Ar- ticula'res, to hip-joint and capsule. Musculo!res, to flexors of the leg, adductor magnus; integument of thigh also supplied by this nerve. POPLITJE'US LNTER'NUS: (see above); largest terminal branch; down through middle of popliteal space, beneath soleac arch, becoming posterior tibial. Articu- la'res, (3); knee-joint, accompanying superior internal articular, and azygos arteries. Musculo!res, (4 or 5) to gas- trocnemius, plantaris, soleus and popliteus. Saphe'nus exter'nus, down, between gastrocnemius heads, to middle of leg, there piercing fascia and anas, with communicans peronsei, then down along outer margin of tendo Achillis, in company with vein, supplying integument of outer side of foot and little toe; communicates with musculo-cutaneus. TIBIA LIS POSTE RIOR : from lower border pop- litseus, passes down leg with posterior tibial artery, between heel and internal ankle, there dividing into external and 50 LOWER EXTREMITY. NERVES. 51 internal plantar; above, lies to inside of artery; below to outer side. Muscula'res; to tibialis posticus, flexor longus digitorum, and pollicis. Cuta'neus planta'ris: perforates internal annular ligament, supplying integu- ment of heel and inner side of sole of foot. Planta'ris inter'nus: (see above); largest terminal branch; accom- panies internal plantar artery along inner side of foot. Cuta'nei, to sole of foot. Muscula'res, to flexor brevis digi- torum, and abductor pollicis. Articula'res, to tarsus and metatarsus. Digita'les, (4); supplying the first 3 toes (both sides) and inner margin of the 4th toe, integument, articu- lations, nails, etc., and 1st and 2d lumbricales. Plan- ta'ris exter'nus: (see tibial posterior); follows course of its artery to outer side of foot, supplying little toe and outer half of 4th toe, and structures adjacent, flexor acces- sorius, and abductor minimi digiti. Superficid Us branch goes to outer side of 5th and adjacent sides of 4th and 5th toes, flexor brevis minimi digiti, and the 2 interossei of 4th metatarsal space. Deep branch supplies remaining in- terossei, 2 outer lumbricales, adductor pollicis, transversus pedis. POPLITiE'US EXTER/NTTS (or peronse'us): $ size of internus poplitseus (see great sciatic); descends along outer margin of popliteal space to fibula, and about 1 inch below its head divides into anterior tibial and musculo- cutaneus. Articula'res : (2); accompany external artic- ular arteries to outer side of knee. Sometimes a 3d is given off as a recurrent, which supplies front of knee. Cuta'nei: (2 or 3); supply integument of back and outer side of leg as far as its lower 3d. Commu'nicans per- onse'i: arises near fibular head, joining external saphenus at middle of leg. Tibialis anterior: (see above); passes obliquely forwards to front of interosseous membrane, reaching outer side of anterior tibial artery at middle of leg, descending thence to front of ankle it divides into external and internal branches. Muscula'res, to tibialis anticus, extensor longus digitorum, extensor proprius pol- licis. Exter'nal or tar'seus, outwards across tarsus, sup- plies external brevis digitorum, and articulations of tarsus and metatarsus; becomes ganglionic. Internal branch accompanies dorsalis pedis artery, supplying 1st interosse- ous space and adjacent sides 1st and 2d toes; communi- cates with internal division of musculo-cutaneus. Mus'- culo-cuta'neus; supplies muscles of fibular side of leg and dorsal integument of foot (see poplitae'us exter'nus). 52 At lower 3d of leg (its front and outer side) divides into in- ternal and external branches. Musculo!res, to fibular mus- cles and integuments. Internal branch, down in front of ankle to supply inside of great toe and adjacent sides of 2d and 3d toes, integuments of inner ankle and inside of foot; communicates with internal saphenus and anterior tibial. External branch, down from outer side dorsum of foot to supply adjacent sides of 3d, 4th and 5th toes, integument of outer ankle and outer side of foot; communicates with external saphenus. OSTEOLOGY. OSTEOLOGY, Noth.—Muscles in italics, are muscles of insertion. Figures in [ ] show the primary number of ossific centres, and date of appearance of ossification. COMPOSITION: Gelatine and blood-vessels, 33.30; calcic phosphate, 51.04; calcic' carbonate, 11.30; calcic fluoride, 2.00; magnesic phosphate, 1.16; sodic chloride and oxide, 1.20; total, 100.00. NUMBER: vertebral column (including sacrum and coccyx) 26; cranium, 8; ossiculi auditus, 6; face, 14; hyoid, sternum and ribs, 26; upper extremity, 64; lower extremity, 60; total, 204. To this may be added the patellae and teeth, making a grand total of 238. SPINE has 33 vertebrae, viz.: 7 cervical, 12 dorsal, 5 lumbar, 5 sacral, 4 coccygeal. They each have a body, 7 processes, 2 pedicles, 2 laminae, 4 notches and a foramen. The Cervical are noted for the smallness and broadness of body, bifid spinous processes, bifid and perforated transverse processes, etc. The peculiar are the 1st, or atlas, which is like a “ring;” the 2d, or axis, having a large (odontoid) process; the 7th, or prominens, having a long, spinous process. The Dorsal have body largest antero-posteriorly, spinous processes directed downwards, facets for ribs. Peculiar are the 1st, having one whole facet; the rest demi-facets for the ribs; 1C)th, 1 lth and 12tli, each one having a distinct facet for a rib. Muscles: to the atlas are attached 10; to the axis, 11; to the remain- ing (anteriorly) 10, (posteriorly) 22. [The vertebrae are developed from 3 centres by ossification, the first appear- ing at 6th week; at sixteen 4 secondary centres appear, and at twenty-one a circular plate for superior and inferior surfaces of body. A few exceptions, as atlas (2 primitive centers), axis (6), 7th cervical and the lumbar (5).] 53 Sa crum: triangular, anterior and posterior foramina, lateral masses, laminae, tubercular transverse processes, promonotory, sacral canal and groove, auricular surface. Articulations, (4); 2 innominate, 5 th lumbar, coccyx. Muscles, (5); pyriform, coccygeus, glut tens maximus, erector spinae, latissiinus dorsi. [85, 8th week.] Coccyx; cornua. Articulation, (1); sacrum. Muscles, (4); coccygeus, glutaeus maximus, sphincter and levator ani. [4, birth to puberty.] Occipita'le: superior and inferior curved lines, crest, protuberance, foramen magnum, condyles, basilar and jug- ular processes, pharyngeal spine, anterior and posterior condyloid foramina; fossa) cerebri et cerebelli, torcula protuberance, grooves for occipital, lateral, inferior, pe- trosal, superior longitudinal sinfls and medulla, jugular fossa. Artie. (6); 2 parietal, 2 temporal, sphenoid, atlas. Muse. (12); occipito-frontalis, trapezius, sterno-cleido-mas- toid, complexus, splenius capitis, obliquus superior, rectus posticus major and minor, rectus lateralis, rectus anticus ma- jor and minor, superior pharyngeus constrictor. [4,10th w.] Parieta'le: eminence, foramen, temporal ridge; Pac- chionian depressions, middle meningeal groove, superior longitudinal and lateral sinus. Artie. (5); fellow, occip- ital, frontal, temporal, sphenoid. Muse. (1); temporal. [!•] Fronta'le: eminence, superciliary ridges, external and internal angular processes, supra-orbital notches and arches, temporal ridges and fossae, nasal eminence and spine;, orbital plates, lachrymal fossa, pulley depression, ethmoid notch, anterior ethmoid foramina, foramen caecum, menin- geal grooves, Pacchionian depressions, frontal and superior longitudinal sinus (frontal suture). Artie. (12); 2 parietal, sphenoid, ethmoid, 2 nasal, 2 superior maxillae, 2 lachry- mal, 2 malar. Muse. (3 pr.); corrugator supercilii, orbic- ularis palpebrarum, temporal. [2.] Tempora'le: zygoma, articular eminence, glenoid fossa, Glasserian fissure, vaginal, styloid, mastoid and auditory processes, mastoid foramen, superior and inferior petrosal and lateral sinus, aquaeductus vestibuli, meatus auilitorius internus, hiatus Fallopii, opening for smaller petrosal nerve, depression Casserian ganglion, carotid canal, openings for Jacobson’s and Arnold’s nerves, aquae- ductus cochleae, jugular fossa, stylo-mastoid foramen, auricular fissure, canal for Eustachian tube, and tensor tympani. Artie. (5); occipital, parietal, sphenoid, inferior OSTEOLOGY. 54 OSTEOLOGY. maxilla, malar. Muse. (14); temporal, masseter, occipito- frontalis, sterno-mastoid, splenius capitis, trachelo-mastoid, di- gastric, retrahens aurem, stylo-pliaryngeus, stylo-hyoid, stylo-glossus, levator palati, tensor tympani, stapedius. {4, 8th week.] Sphenoi'des: ethmoid spine, optic groove, olivary process, sella turcica, anterior middle and posterior clinoid processes, cavernous groove; foramina opticum, lacerum an- terius, rotundum, Yesalii, ovale, spinosum; spinous, ham- ular, vaginal and external and internal pterygoid processes; rostrum, pterygoid notch and ridge, scaphoid, pterygoid, temporal and zygomatic fossae, Yidian and pterygo-pala- tine canals. Artie. (12); all of cranium and 2 malar, 2 palate and vomer. Muse. (12 pr.); temporal, external and internal pterygoid, superior constrictor, tensor palati, laxa- tor tympani, levator palpebrae, obliquus superior, internal and external recti, superior and inferior recti. [10, 8th w.] Ethmoi'des: crista galli, infundibulum, os planum, unciform process,. olfactory foramina, superior meatus, anterior and posterior cells. Artie. (15); sphenoid, frontal, 2 sphenoidal turbinated, 2 nasal, 2 superior maxillary, 2 lachrymal, 2 palate, 2 inferior turbinated, vomer. Muse. none. [3, 4th m.] Nasa'le: groove for nasal nerve. Artie. (4); frontal, ethmoid, fellow, superior maxilla. Muse. none. [l,8thw.] Maxilla're supe'rior: nasal process lachrymal tuber- cle, orbicular surface, infra-orbital groove and foramen, canine and incisive fossa, canine eminence, alveolar pro- cess, posterior dental canals, maxillary tuberosity, middle and inferior meatus, palate process, anterior and posterior palatine canals; antrum. Artie. (9); frontal, ethmoid, na- sal, malar, lachrymal, inferior turbinated, palate, vomer, fellow! Muse. (9); orbicularis palpebrarum, inferior obli- quus oculi, levator labii superioris akeque nasi, levator labii superioris proprius, levator anguli oris, compressor naris, depressor al;e nasi, masseter, buccinator. [4, early.] Lachryma'le: lachrymal groove. Artie. (4); frontal, ethmoid, superior maxilla, inferior turbinated. Muse. (1); tensor tarsi. [1, 8th week.] Mala re: frontal, zygomatic, orbital and maxillary processes, temporo-malar canal, Artie. (4); frontal, sphe- noid, temporal, superior maxilla. Muse. (5); levator labii superioris proprius, zygomaticus major and minor, masse- ter, temporal. [1. 8th week.] Os pala'ti: orbital, maxillary, and sphenoid processes, spheno-palatine foramen, superior meatus and superior turbinated crest, middle meatus and inferior turbinated crest, inferior meatus; posterior palatine canal, tuberosity, posterior nasal spine. Artie, (7); sphenoid, ethmoid, supe- perior maxilla, inferior and superior turbinated, vomer, fellow. Muse. (4); tensor palati, azygos uvulae, internal and external pterygoid. [1, —.] Turbina'tum inferior: lachrymal, ethmoid and maxillary processes. Artie. (4); ethmoid, superior maxilla, lachrymal, palate. Muse. none. [1, 4th month.] Vomer: naso-palatine groove, Artie. (6); sphenoid, ethmoid, 2 superior maxilla, palate. Muse. none. [2, 8th week.] Maxilla're infe rior: coronoid process, condyle, ra- mus, sigmoid notch, mental foramen and process, sym- physis, groove for facial artery, inferior dental foramen, mylo-hyoid groove and ridge, sublingual and submaxillary fossae, genial tubercles. Artie. (2); 2 temporal. Muse. (14 pr.), levator menti, depressor labii inferioris, depressor anguli oris, platysma, buccinator, masseter; genio-hyo- glossus, genio-hyoid, mylo-hyoid, digastric, superior con- strictor, temporal, internal and external pterygoid. [2, early.] Hyoi'des: greater and lesser cornua, body. Artie. none. Muse. (11); sterno-, thyro-, omo-, stylo-, mylo- and genio-hyoid, genio-hyo-glossus, liyo-glossus, middle con- strictor, lingualis, pulley of digastric. [5, 8th month.] Ster'num: manu'lrrium, gladiolus, en'siform appendix, facets for 7 superior ribs. Artie. (16); 7 pairs ribs, 2 clavi- cles. Muse. (10); pectoralis major, sterno-mastoid, sterno- hyoid and sterno-thyroid, triangularis sterni, obliquus ex- ternus and internus, transversalis, rectus, diaphragm. [6, 5th month.] Cos tae (ribs): head, neck, tuberosity, articular and non- articular protuberances, angle, facets for superior and infe- rior vertebrae. Artie. (24); vertebra? and costal cartilages. Muse. (19); [3 each, save the last two, these but 2; early.] Peculiar ribs: 1st, shortest, most curved, horizontally placed, having grooves for subclavian artery and vein; 2d, some larger than 1st, is not twisted, etc.; 10th, single artic- ular facet; 11th and 12th, single articular facet, no neck or tuberosity. Costal cartilages: artic. with sternum and ribs. Muse. (10); subclavius, sterno-thyroid, pectoralis major, internus obliquus, transversalis, rectus, diaphragm, internal OSTEOLOGY. 55 and external intercostal, triangularis sterni. (The last 3 :are muscles of origin and insertion.) Clavicular shape of letter/; sternal and acromial extremity; oblique line, tuberosity, rhomboid impression. Artie. (3); sternum, scapula, 1st costo-cartilage. Muse (6); sterno-mastoid and sterno-hyoid, trapezius, pectoralis major, deltoid, subclavius. [2, first of all.] Scap'ula: acromian and coracoid processes, glenoid cavity, neck, subscapular fossa, ridges; supra-scapular notch, supra- and infra-spinous fossae, spine, groove for dorsalis scapulae vessels. Artie. (2); clavicle, humerus Muse. (17); subscapularis, supra- and infra-spinatus, trape- zius, deltoid, omo-hyoid, serratus magnus, levator anguli scapulae, rhomboideus major and minor, triceps, teres major .and minor, biceps, coraco-brachialis, pectoralis minor, latis- simus dorsi. [7, 8th week.] Hu 'merus: head, anatomical and surgical necks, greater and lesser tuberosities, bicipital ridge and groove, poste- rior bicipital ridge, rough deltoid surface, internal and ex- ternal condyles, coronoid and radial depressions, radial head, trochlear surface; musculo-spiral groove, olecranon depression. Artie. (3); scapula, ulna, radius. Muse. (24); supra and infraspinatus, teres major and minor, subscapu- laris, pectoralis major, latissimus dorsi, deltoid, coraco-brach- ialis, brachialis anticus, triceps; pronator radii teres, flexor carpi radialis, palmaris longus, flexor sublimis digitorum, flexor carpi ulnaris; supinator longus, extensor carpi ra- dialis longior and brevior, extensor communis digitorum, extensor minimi digiti, extensor carpi ulnaris, anconeus, supinator brevis. [7, early.] Ul na: olecranon, greater and lesser sigmoid cavities, coronoid process, nutrient foramen, styloid process; oblique line, groove for extensor carpi ulnaris. Artie. (2); humerus, radius. Muse. (13); triceps, anconeus, flexor and extensor ■ carpi ulnaris, brachialis anticus, pronator radii teres, flexor sublimis and profundus digitorum, pronator ‘quadratus, supinator brevis; extensor ossis metacarpi and extensor secundi internodii pollicis, extensor indicis. [3, 5th w.] Radius; head, neck, bicipital tuberosity, oblique line, nutrient foramen, styloid process, 2 grooves; 4 grooves for extensor muscles. Artie. (4); humerus, ulna, scaphoid, semi-lunar. Muse. (9); biceps, supinator longus and brevis, flexor sublimis digitorum, flexor longus pollicis, pronator quadrat us, extensor ossis metacarpi pollicis, extensor primi internodii pollicis, pronator radii teres. [3.] OSTEOLOGY. OSTEOLOGY. 57 CARPUS: (8); [1 after birth]: Scaphoi'des: artic. (5); radius, trapezium, trapezoid, magnum, semi-lunar. Semi-luna're: artic. (5); radius, magnum, unciform, scaphoid, cuneiform. Cuneifor'me: artic. (3): semilu- nar, pisiform, unciform. Pisifor'me: artic. (1); cuneiform. Muse. (2); flexor carpi ulnar is, abductor minimi digiti. (Lower Row.) Trape'zium: artic.(4); scaphoid, trape- zoid, 1st and 2d metacarpal. Muse. (3); abductor, flexor ossis metacarpi and flexor brevis pollieis. Trapezoi'des: artic. (4); scaphoid, 2d metacarpal, trapezium, magnum. Muse. (1); flexor brevis pollieis. Os mag'nnm: artic. (7); scaphoid, semi-lunar, 2d, 3d, 4th metacarpal, trapezoid, unciform. Muse. (1); flexor brevis poliicis. Uneifor'me: artic. (5); semi-lunar, 4tli, 5th metacarpal, cuneiform, os magnum. Muse. (2); flexor brevis and flexor ossis meta- carpi minimi digiti; anterior annular ligament. METACARPI: (5); bones are prismoid, curved longitudinally, convex behind, concave in front. [2, 6th week.] 1st: artic. (2); trapezium; 1st phalanx. Muse. (3); flexor and extensor ossis metacarpi pollieis, 1st dorsal interosseous. 2d: artic. (5); trapezium, trapezoides, magnum, 3d metacarpus, 2d phalanx. Muse. (5); flexor car- pi radialis, extensor carpi raclialis longior, 1st and 2d dorsal interosseous, 1st palmar interosseous. 3d: artic. (4); mag- num, 2d and 4th metacarpal, 3d phalanx. Muse. (5); exten- sor carpi radialis brevior, flexor brevis pollieis, adductor poliicis, 2d and 3d dorsal interosseous. 4th.: artic. (5); magnum, unciform, 3d and 5th metacarpal, 4th phalanx. Muse. (3); 3d and 4th dorsal and 2d palmar interosseous. 5th: artic. (3); unciform, 4th metacarpal, 5th phalanx. Muse. (5); flexor and extensor carpi ulnaris, flexor ossis meta- carpi minimi digiti, 4th dorsal and 3d palmar interosseous. (An error in “ Gray” here.) PHALANGES: (14); [2, 6th w.] First row: artic. metacarpal and 2d row. Muse. 1st or thumb, (4); extensor primi internodii, flexor brevis, abductor and adduc- tor poliicis. Index, (2); 1st dorsal and palmar interosseous. Middle finger, (2); 2d and 3cl dors/d interosseous. Ring 2, Ath dorsal, and 2d palmar interosseous. Little finger, (3); 3d palmar interosseous, flexor brevis and abductor minimi digiti. Second row: thumb, (2); flexor longus and extensor secundi inter nodii poliicis. To the others, (4); flexor sublimis and extensor communis digitorum, with extensor indicis to index and extensor minimi digiti to little finger. Third row : flexor prof undus, and extensor com- munis digitorum. 58 OSTEOLOGY. Innomina'tum: crest, superior, middle and inferior curved lines, anterior and posterior superior and inferior spinal processes, greater and lesser sacro-sciatic notches, ilio-pectineal eminence line and groove, acetabulum, coty- loid notch; body, crest, spine, angle of pubes, ischic spine and tuberosity, obturator foramen, ischic and pubic rami; internal iliac fossa, groove for obturator and pubic vessels, symphysis pubis, auricular and sacro-iliac rough surfaces. Artie. (3); fellow, sacrum, femur. Muse. (33); tensor vag- inae femoris, obliquus externus and internus, latissimus dorsi, transversalis, quadratus lumborum, erector spinae; 3 glutaei, rectus, pyriformis, iliacus, sartorius; (ischium) obturator externus and internus, levator ani, 2 gemelli, coccygeus, biceps, semi-tendinosus, semi-membranosus, quadratus femoris, adductor magnus, transversus perinsei, erector penis; (pubes) psoas parvus, pectineus, adductor longus and brevis, gracilis, compressor urethrae (accelera- tor urinae). [8; 3 primary, 5 secondary.] Fe'mur: head, depression for ligamentum teres, neck, greater and lesser trochanters, spiral line, shaft, internal and external tuberosities and condyles; digital fossa, tro- chanteric line, inter-condyloid notch, linea aspera. Artie. (3); innominatum, tibia, patella. Muse. (23); glutceus me- dius and minimus, pyriformis, obturator internus ami exter- nus, 2 gemelli, quadratus femoris; psoas magnus, iliacus; 2 vasti, glutceus maximus, biceps, 3 adductors, peclineeus, crureus and suberureus, gastrocnemius, plantaris, popli- teus. [5, 5th w.] Patella; subcutaneous surface; outer and inner facets. Artie, condyles of femur, (ligamentum patellae attaches it to tibia.) Muse. (4); rectus, crureus, vastus externus and internus. [Sesamoid, 3d year.] Tib'ia; head, spine, internal and external tuberosity, tubercle, fibular facet, crest, internal malleolus; popliteal notch, oblique line, nutrient foramen, common groove for flexor longus digitorum and tibialis posticus, another for flexor longus pollicis. Artie. {3); femur, fibula, astragalus. Muse. (10); semi-membranosus-, tibialis anticus, extensor longus digitorum; sartorius, gracilis, semi-tendinosus; pop- liteus, soleus, flexor longus digitorum, tibialis posticus, ligamentum patellae. [3, 5th w.] Fib ula: head, styloid process, shaft, external malleo- lus ; groove for peroneus longus and brevis, nutrient fora- men. Artie. (2); tibia, astragalus. Muse. (9); bleeps, soleus, 3 peronei; extensor longus digitorum and pollicis, tibialis posticus, flexor longus pollicis. [3, 6th w. ] TAR'SUS ; (7): Cal'cis : greater and lesser processes, tubercle, superior and inferior grooves. Artie. (2); astrag- alus, cuboid. Muse. (8); tibialis posticus, tendo Achillis, plantaris, abductor pollicis and minimi digiti, flexor and extensor brevis digitorum, flexor accessorius. [1, 6th m.] Cuboi'des : artie. (4); calcis, external cuneiform, 4th and 5th metatarsi (occasionally scaphoid.) Muse. (1); flexor brevis pollicis. [1, 9th m.] Astrag'alus: artie. (4); tibia, fibula, calcis, scaphoid. Muse. none. [1, 7th m.] Scaphoi'des: artie. (4); astragalus, 3 cuneiform (some- times cuboid.) Muse. (1); tibialis posticus. [1, 4th y.] Cuneifor'me inter'nus: largest of the three; artie. (4); scaphoid, middle cuneiform, 1st and 2d metatarsal. Muse. (2); tibialis anticus and posticus. [1, 3dy.] Cun- eifor'me me'dius: smallest; artie. (4); scaphoid, inter- nal and external cuneiform, 2d metatarsal. Muse. none. [1,4th y.] Cuneifor'me exter'nus: artie. (6); scap- hoid, middle cuneiform, cuboid, 2d, 3d, 4th metatarsi. Muse. (2); tibialis posticus, flexor brevis pollicis. [1, 1st y.] METATARSI: (5): shaft straight; posterior ex- tremity wedge-shaped, anterior rounded. [2, 8th w.] 1st: greater size, shortest. Artie. (3); internal cunei- form, phalanx, 2d metatarsus. Muse. (3); tibialis anticus, peroneus longus, 1st dorsal interosseous. 2d: longest; Artie. (6); 3 cuneiform, 1st and 3d metatarsi, 2d phalanx. Muse. (3); adductor pollicis, 1st and 2d dorsal interosseous. 3d: artie. (4); external cuneiform, 2d and 3d metatarsi, 3d phalanx. Muse. (4); 2d and 3d dorsal and 1st plantar interosseous, adductor pollicis. 4th: artie.. (5); external cuneiform, cuboid, 3d and 5th metatarsi, 4th phalanx. Muse. (4); adductor pollicis, 3d and 4th dorsal and 2d plantar interosseous. 5th: tubercular eminence. Artie. (3); cuboid, 4th metatarsus, 5th phalanx. Muse. (5)\ per- oneus brevis and tertius, flexor brevis minimi digiti, 4th dorsal and 3d plantar interosseous. PHALAN GES: (14): shaft convex above, concave below; posterior extremity concave, anterior is convex. [2, after metatarsus.] 1st row: artie. metatarsal and 2d row. Muse.: big toe, (5); extensor brevis digitorum, trans- versus pedis, abductor, adductor and flexor brevis pollicis. Second, (2); 1st and 2d dorsal interosseous. Third, (2); 3d dorsal and 1st plantar interosseous, Fourth, (2); 4th dorsal and 2d plantar interosseous. Fifth, (3); flexor brevis and adductor minimi digiti, 3d plantar interosseous. 2d row : artie. 1st and 3d phalanges. Muse, big toe, (2); extensor OSTEOLOGY. 59 60 RESUME OP OSTEOLOGY. and flexor longus pollieis. Remaining toes, (4 each); flexor brevis digitorum, and ext. longus and brevis digitorum, lum- bricales. 3d row: artic. 2d phalanges. Muse. (3 each); extensor longus and brevis, and. flexor longus digitorum. OSSICULA AUDITUS, (3): Mal leus: head, neck manubrium (handle), processus brevis and gracilis. Artic. (1); incus. Muse. (3); laxator major and minor tympani, tensor tympani. In'cus: body, short and long processes, os orbiculare. Artie. (2); malleus, stapes. Muse. none. Stapes: head, neck, base, crura. Artic. (1); incus. Muse. (1); stapedius. Name of Bone. Occipital Parietal Frontal Temporal Sphenoid Ethmoid Nasal Maxillary Sup. Lachrymal.... Malar Palate Number of Articulations. .... 6 .... 12 .... 12 .... 15 .... 4 .... 9 .... 4 .... 4 7 Number of Muscles attached. 12 3 14 .... 12 .... 9 . .. . 1 .... 5 4 Primary Developmental Centres. 4 1 2 .... 4 10 3 1 4 1 1 1 Turbinated Inf. .... 4 1 Y omer G 2 Maxillary Inf.. .... 2 .... 14 2 Hyoid .... 11 5 Sternum .... 16 . . . . 10 6 Ribs(12) .... 24 Clavicle 3 6 2 Scapula .... 2 .... 17 7 Humerus .... 3 .... 21 7 Ulna .... 2 .... 13 3 Radius ... 4 .... 9 3 Scaphoid 5 ... .none.... 1 Semilunar .... 5...... ... .none. .., 1 Cuneiform .... 3 1 Pisiform .... 2 1 Trapezium .... .... 4....... .... 3 1 Trapezoid .... 4 .... 1 1 r£sum£ of osteology. Name of Bone. Os Magnum Unciform Metacarpal (5).. Phalanges (14).. Vertebrae (24).., Sacrum Coccyx Innominatum... Femur Number of Articulations. .... 7 .... 5 .... 19 .... 23 .... 72 .... 4 .... 1 ... 3 ... 3 Number of Muscles attached. .... 1 .... 18 .... 39 .... 4 .... 33 23 Primary- Developmental Centres. 1 1 85 11 4 5 Patella .... 1 .... 4.. ... Tibia . ... 10 3 Fibula .... 9 3 Calcis ... 2 .... 8 1 Cuboid ... 4 1 .... 1 Astragalus ... 4 . .. . 1 Scaphoid ... 4 .... 1 .... 1 Int. Cuneiform. ... 4 0 .... 1 Mid. Cuneiform. ... 4 .... 1 Ext. Cuneiform. ... G .... 2 .... 1 Metatarsal (5)... ... 21 ... 13 .... 10 Phalanges (14).. ... 23 .... 23 .... 23 Malleus ... 1 ... 3 V Incus ... 2 .... ? Stapes ... 1 ... 1 .... ? RESUME OF OSTEOLOGY. 61 ACTION OF MUSCLES. Head is moved forwards by platysma myoideus, sterno- mastoid, rectus capitis anticus major, rectus capitis anti- cus minor (assisted by, when jaw is fixed), mylo-hyoid, genio-hyoid, genio-hyoglossus, digastricus. Backwards by trapezius, splenius capitis, complexus, trachelo-mastoid, rect. capt. post, maj., rect. cap. post, min., obliquus cap. superior. Sideways by platysma myoideus, sterno-cleido- mastoid, trapezius, splenius capitis, splen. colli, trachelo- mastoid, complexus. Heck: forwards platysma myoideus, sterno-cleido-mas- toid, digastricus, mylo-hyoid, genio-hyoid, genio-hyoglos- sus, omo-hyoid, sterno-hyoid, thyro-hyoid, rect. cap. ant. major and minor, iongus colli. Backwards by trapezius, 62 ACTION OF THE MUSCLES. rhomboideus minor, serratus posticus superior, splenius capitis, splenius colli, complexus, trachelo-mastoid, trans- versalis colli, inter-spinales colli, rect. cap. post maj. and minor, obliquus capitis superior and inferior, scalenus posticus, levator anguli scapulae. Sideways by the above in conjoined action, and the scaleni, inter-transversales, recti-laterales. Trunk; forwards by rectus abdominis, pyramidalis, obliquus externus and internus abdominis, psoas magnus and parvus; assisted by (when arms are carried forwards) pectoralis major and minor, serratus magnus. Backwards, trapezius, rhomboideus major, latissimus dorsi, serratus posticus superior and inferior, sacro-lumbalis, longis- simus dorsi, spinales dorsi, semi-spinalis dorsi, multifldus spinae, inter transversalis dorsi et lumborum. Laterally, obliquus externus and internus, quadratus lumborum, longissimus dorsi, sacro-lumbalis, serratus posticus, latis- simus dorsi. Scapula: forwards by pectoralis minor, serratus mag- nus. Backwards, trapezius, rhomboidei, latissimus dorsi. Upwards, trapezius, levator scapulae, rhomboidei. Down- wards, trapezius, latissimus dorsi, pectoralis minor. Humerus :forwards, deltoid, pectoralis major; assisted, sometimes, by biceps, coraco-brachialis. Backwards, del- toid, teres major and minor, triceps (long head), latissimus dorsi. Inwards, pectoralis major, latissimus dorsi. Ro- tated inwards, subscapularis, assisted by pectoralis major, lat. dorsi, teres major. R outwards, supra-spinatus, infra- spinatus, teres minor. Forearm: forwards, biceps, brachialis anticus, prona- tor radii teres; assisted by flex, carpi rad., flex, sublimis digitorum, flex, carpi ulnaris, supinator longus. Back- wards, triceps, anconeus. Rotated inwards, pronator radii teres, flex, carpi radialis, palmaris longus, flexor sub- limis dig., pronator quadratus. R. outwards, biceps, supinator brevis, extensor secundi internodii pollicis. Carpus; forwards, flex, carpi radialis, palmaris longus, flex, sublimis and profundus dig., flex, carpi ulnaris, flex, longus pollicis. Backwards, ext. carpi rad. long, and brev., ext. secundi internodii pollicis, ext. indicis, ext. com. dig., ext. prop, pollicis. Outwards, flex, carpi rad., ext. carpi rad. long, and brevior, ext. ossis metacarpi pol., ext. primi internodii pol. Inwards, flex, sublim. and ACTION OP THE MUSCLES. 63 profund, digitorum, flex, and ext. carpi ulnaris, ext. com. dig., ext. min. digiti. Thumb : inwards and forwards, opponens, flex, brevis and flex. long, pollicis. Outwards and backwards, ext. ossis metacarpi, ext. primi and secundi internodii pollicis. Upwards and away from fingers, abductor, flex. brev. pollicis. Backwards and towards fingers, adductor, ext. primi and secundi pollicis. Fingers: flexed, flex, sublimis and profundus dig., lumbricales, flex, and abductor mimimi digiti. Backwards, ext. communis, ext. minimi digiti and indicis. Outwards, interossei, abductor indicis and minimi digiti. Inwards, interossei, abductor minimi digiti. Thigh: forwards, psoas mag., iliacus, tensor vaginae fern., pectineus, adductor longus and brevis. Backwards, glut. max. and med., pyriformis, obdurator intern., add. mag., biceps, semitend., semi-membranosus. Inwards, psoas mag., iliacus, pectineus, gracilis, the 3 adductors, obturator extern., quad, femoris. Outwards, tens. vag. fern., the 3 glutaei, pyriformis. Rotated inwards, tens, vag. fem., glut, med., and, if leg extended, sartorius, semi-tendinosus. R. outwards, glut. max. and med., pyriformis, gemelli, obturatores, quad, fem., psoas mag., iliacus, the 3 adductors, biceps femoris. Leg: flexed, semi-tendinosus, biceps, semi-membranosus, gracilis, sartorius, popliteus. Extended, rectus fem., crureus, 2 vasti. Foot: inwards, ext. prop, pollicis, flex. long, dig., flex. long, pol., tibialis posticus. Outwards, the 3 peronei, ext. long. dig. Flexed, tibialis anticus, ext. prop, pol., ext. long, dig., peroneus tertius. Extended, gastrocne- mius, plantaris, soleus, flex. long, dig., flex. long, pol., tib. posticus, peroneus longus and brevis. Toes: flexed, adductor, abductor, flex, longus and brevis pollicis, abductor and flex. brev. minimi digiti, flex, brev. and longus digitorum, flex, accessorius, lumbricales, interossei. Extended, ext. long, and brevis digitorum, ext. prop, pollicis. Inwards, abductor pollicis, interossei. Outwards, add. pollicis and min. digiti, interossei. 64 TRIANGLES AND SPACES. TRIANG-L.ES AND SPACES. ANTERIOR TRIANGLE OP NECK. The ante- rior triangle of the neck is the space in front of the ante- rior border of the sterno-mastoideus, and is limited by the following boundaries:—in front, median line of the neck from chin to top of sternum; behind, the anterior border of sterno-mastoideus; above, body of lower jaw, and a line continued from its angle to mastoid process of temporal bone, forming the base of the triangle, the apex being at top of sternum; the floor, is formed by the following muscles: sterno-thyroideus, sterno-hyoideus, thyro-hyoideus, inferior and middle constrictors of phar- ynx, anterior belly of digastricus, stylo-hyoideus, mylo- hyoideus, and hyo-glossus The floor is crossed by the anterior belly of the omo-hyoideus and posterior belly of the digastricus, which subdivide the anterior triangle into three smaller ones, viz.—(1) Inferior carotid triangle; (2) Superior carotid triangle; (3) Sub-maxillary tri- angle; Roof, this triangle is covered in by integument, superficial fascia, platsyma myoides, and deep fascia. Between the layers forming the roof are the cutaneous branches of the facial and superficial cervical nerves. The contents will be enumerated in the description of the sub- divisions. (1) Inferior Carot'id Triangle. This is the lowermost subdivision of the anterior triangle of the neck, and has the following boundaries; in front, median line of neck; behind, anterior border of the sterno-mastoideus; above, anterior belly of the omo-hyoideus; the muscles met with on the floor of space are sterno-hyoideus and sterno- thyroideus; it is covered in by integument, superficial fas- cia, platysma myoides muscle, and deep fascia. Con- tents: This space contains the following structures: thy- roid gland, lower part of larynx and trachea; internal jugular and inferior thyroid veins; common carotid and inferior thyroid arteries; pneumogastric, recurrent laryngeal, descendens noni, communicans noni, and sympathetic nerves. (2) Superior Carot'id Triangle. This is the middle of the three subdivisions of the anterior triangle of the neck, its boundaries being: be- hind, anterior border of sterno-mastoideus; above, poste- TRIANGLES AND SPACES. 65 rior belly of digastricus; below, anterior belly of omo-liyoi- deus; the muscles forming the floor are the thyro-hyoideus, hyo-glossus, and the inferior and middle constrictors of the pharynx. The roof is formed by the same struc- tures as cover in the inferior carotid triangle. Con- tents: Upper part of larynx and lower part of phar- ynx; Internal jugular, and those which open into it, viz.—lingual, facial, superior thyroid, pharyngeal and sometimes the occipital veins; termination of common caro- tid, external carotid, internal carotid, superior thyroid, lingual, facial, ascending pharyngeal, and occipital arfe- ries/pneumogastric, superior laryngeal, external laryngeal, hypo-glossal, descendens noni, spinal accessory, and sym- pathetic nerves; (3) Sub-maxillary Triangle. This is the most superior of the three subdivisions of the anterior triangle, and has the following boundaries: behind, posterior belly of digastricus; above, lower border of the jaw, and line continued from angle of jaw to the mastoid process; in front, median line of neck from the chin to the hyoid bone. (Some anatomists limit this space in front by the anterior belly of the digastricus.) The muscles forming the floor are the anterior belly of the digas- tricus, the mylo-hyoideus, and the hyo-glossus, and its roof is formed by the same structures as cover in the superior and inferior carotid triangles. Contents: Por- tion of parotid and submaxillary (salivary), and sub- maxillary lymphatic glands and vessels; internal jug- ular, commencement of external jugular and venous radicles of anterior jugular, the facial, submental, sub- maxillary, inferior palatine and ranine veins; external carotid, internal carotid, facial, sub-mental, mylo-hyoidean (and several smaller branches) arteries; within this space are the mylo-hyoid (branch of inferior dental), the infra- maxillary branches of facial, and the ascending branches of the superficial cervical nerves. (The two latter, strictly speaking, are not contents of the triangle, as they ramify in the structures which form its roof.) Deeply situated at the back part of the space are the pneumogastric and glosso-pharyngeal nerves. (That portion of the hypoglos- sal nerve, which lies on the hypoglossus muscle, should be included as one of the contents.) The stylo-hyoideus, the stylo-glossus, origin of the stylo-pharyngeus muscles, and stylo-maxillary ligament, may also be given as con- tents of the space. The stylo-hyoideus is sometimes given as a part of the posterior boundary. 66 POSTERIOR TRIANGLE OP THE NECK. The posterior triangle of the neck is the space behind the poste- rior border of the sterno-mastoideus, and has the follow- ing boundaries: in front, posterior border of sterno-mas- toideus; behind, anterior border of trapezius; below (base), upper border of the middle third of clavicle; apex, meet- ing of anterior and posterior boundaries at the occiput; floor (from, above downwards), splenius capitis, levator an- guli scapulae, scalenus medius, scalenus posticus and upper digitation of serratus magnus. The space is covered in by the superficial and deep fascia, and at its lower part by the platysma myoides. The contents will be named in the two following subdivisions of this space which are made by the crossing of the space by the posterior belly the omo-hyoid, about 1 inch above the clavicles. (1) Oecip'ital Triangle. This is the larger of the two divisions. Is bounded in front by sterno-mastoid; behind by trapezius; below, by omo-hyoid. Its floor is, formed by (from above downwards) splenius, levator anguli scap- ulae, by middle and posterior scaleni. Is covered by integument, platysma (below), superficial and deep fas- cia. Contents: Spinal accessory nerve, transversalis colli artery and vein, and chin lymphatic glands. (2) Subcla vian Triangle. So called because best situa- tion for tying subclavian artery in the third part of its course. Is bounded, above, by posterior belly of omo- hyoid; below, by clavicle; base (directed forwards) by pos- terior border of sterno-mastoid. Varies greatly in size in different subjects, and different positions of same sub- ject. Is covered in by same structures as the Occipital. Contents: Descending branches of superficial cervical plexus; brachial plexus nerves; subclavian artery (third part of its course); transversalis colli artery and vein; transversalis humeri (supra-scapular) artery and vein; external jugular vein, and commuuicating branch with cephalic vein; lymphatic vessels and glands. SUB-OCCIP ITAL TRIANGLE. This is situated immediately below the occipital bone, and beneath the upper part of the complexus muscle. Its boundaries are as follows: above, obliquus superior; below, obliquus in- ferior; behind, rectus capitis posticus major; the roof is formed by the complexus muscle, and the floor by the posterior occipito-atloid ligament and posterior arch of the atlas. Contents: Vertebral artery and sub-occip- ital nerve (post. br. of first cervical). TRIANGLES AND SPACES. TKIANGLES AND SPACES. 67 TRIANGLE IN FRONT OF ELBOW-JOINT. This is bounded, externally, by the supinator longus; internally, pronator radii teres; above (base) a line— imaginary—drawn across the arm two inches above the condyles; apex, meeting of the supinator longus and pronator radii teres. This space is covered in by skin, superficial fascia and bicipital fascia; the floor is formed by the lower part of the brachialis anticus and the oblique fibres of the supinator brevis muscles. Contents: (from within outwards): Median nerve; brachial artery and venae comites (about the centre of the space the artery divides into radial and ulnar); tendon of biceps; musculo- spiral nerve. (The supinator longus and brachialis anti- cus must be slightly separated in order to expose this nerve.) SCARPA’S TRIANGLE. This is situated at the upper part of the anterior surface of the thigh, with apex downwards, immediately below the fold of the groin, and has the following boundaries: Externally, sar- torius; internally, adductor longus; above (base), Poupart’s ligament; apex, meeting of the sartorius and adductor lon- gus muscles. The space is covered in by skin, superficial fascia, fascia lata, and cribriform fascia, and the floor is formed (from without inwards) by the iliacus, psoas, pectineus, and small portion of adductor brevis muscles. Contents: Femoral sheath (derived from the iliac fas- cia and fascia transversalis); femoral artery (giving otf cutaneous branches and a large deep branch—the profunda femoris); femoral vein (here joined by the saphena and profunda veins); anterior crural nerve and its branches; deep lymphatic glands and vessels and fatty tissue. This is the best point for ligation of femoral artery, the artery lying between the vein (inside) and nerve (outside.) HES'SELBACH’S TRIANGLE. This space is sit- uated at the lower part of the abdominal wall, on either side, and is of surgical importance as being the spot where direct inguinal hernia makes its escape from the abdomen. Its boundaries are: Externally, epigastric artery; internally, outer margin of rectus abdominis muscle; below (base), Poupart’s ligament. The structures entering into the formation of the abdominal wall at this spot are (from without inwards); skin; superficial fascia; inter-columnar fascia; conjoined tendon of internal oblique and transver- salis muscles; fascia transversalis; subserous cellular tis- sue; peritoneum. These seven structures form the coverings of direct inguinal hernia. 68 TRIANGLES AND SPACES. AXILLARY SPACE. This is of conical form, and is situated between the upper part of the side of the chest, and the inner side of the arm, and has the following boundaries: In front, pectoralis major and minor muscles; behind, subscapularis, teres major, and latissimus dorsi; inner side, upper four ribs and inter- costal muscles, and upper part of serratus magnus; upper part of the humerus, the coraco-brachialis and biceps; the apex of the cone is directed upwards, and is formed by an interval between the first rib, the clavicle and the upper border of the scapula; its base is formed by the skin and axillary fascia stretched across from the lower border of the pectoralis major to the lower border of the latissimus dorsi. Contents: Axillary artery and vein and their branches; brachial plexus of nerves, and branches of distribution below the clavicle; a few branches of the intercostal nerves; about ten or twelve lymphatic glands, and a quantity of loose fat and areolar tissue. POPLITEAL SPACE. This space is situated at the back of the knee-joint; and forms what is called the ham. It is lozenge-shaped, and has the following bound- aries: Externally, above the joint, biceps; below the joint, outer head of gastrocnemius and plantaris; internally, above the joint, semi-tendinosus, semi-membranosus, gra- cilis and sartorius; below the joint, inner head of gas- trocnemius. The floor is formed by the lower part of the back of the femur, the posterior ligament of the knee-joint (ligamentum posticum Winslowii) and the popliteus muscle covered by its fascia. The space is covered in by skin, superficial fascia and fascia lata. Contents: Popliteal vessels and their branches; termin- ation of external saphenous vein; internal and external pop- liteal nerves and branches; branch of small sciatic nerve; articular branch of obturator nerve; four or five small lymphatic glands, and a quantity of fat and loose areolar tissue THE MEDIASTI NUM. This is the space in the middle line of the thorax, formed by the approximation of the pleura on either side, and extends from the ster- num in front to the bodies of the vertebrae behind. In no place do the reflected pleurae come in contact with each other, so that the space between them forms a complete septum, dividing the two pulmonary cavities. The me- diastinum is divided into three portions. (1) anterior, (2) middle and (3) posterior which contain all the viscera of the chest, with the exception of the lungs. The boundaries and contents of the three divisions are as follows. (1) Anterior Mediasti num. Boundaries: In front, the sternum; behind, pericardium; laterally, pleurae; contains origin of sterno-hyoideus muscles; origin of sterno-thy- roideus muscles; triangularis sterni muscle; left inter- nal mammary artery and venae comites; (the right in- ternal mammary vessels being covered by pleura, are not included among the contents of the space); remains of thymus gland; lymphatic vessels from convex surface of liver, and loose areolar tissue. (2) Middle Medias- tinum. Boundaries: In front, anterior mediastinum; behind, posterior mediastinum; laterally, pleurae. Contains the heart enclosed in pericardium; ascending portion of aorta; superior vena cava; bifurcation of trachea; pul- monary artery and veins; phrenic nerves (from third, fourth and fifth cervical); arterise comites nervi phre- nici (from internal mammary). (3) Posterior Medias- tinum. Boundaries: In front, pericardium and root of lungs; behind, vertebral column; laterally, pleurae. Con- tains descending aorta; vena azygos major; vena azygos minor; superior intercostal veins; pneumogastric nerves; greater splanchnic nerves; oesophagus; thoracic duct and lymphatic glands and vessels. ROOT OF LUNG. This is formed by bronchus; pul- monary artery; pulmonary veins; bronchial vessels; bron- chial glands; anterior and posterior plexuses of nerves; connective tissue. The following are the relations of the pulmonary veins, pulmonary artery and bronchus: Right side, from before, backwards : veins, artery, bronchus. From above, downwards: bronchus, artery, veins; Left side, from before, backwards,, same as right side. From above, downwards: artery, bronchus, veins. THE INGUINAL CANAL and HER'NIiE. The inguinal or spermatic canal commences at the internal abdominal ring, and terminates at the external abdominal ring, its length being about one and a half inches. It serves for passage of the spermatic cord, with its vessels, in the male, and the round ligament in the female. This canal is bounded in front, by the integument, superficial fascia, aponeurosis of external oblique and partly by the outer third of the internal oblique; behind, by the conjoined ten- don, triangular ligament, fascia transversalis, areolar tissue, fat, peritoneum; above, by the arch of the internal oblique and transversalis; below, by union of fascia transversalis. TRIANGLES AND SPACES. 69 with Poupart’s ligament. It is of great surgical importance -on account of being the channel through which In guinal Hernise escape from the abdomen. Inguinal hernise are of two kinds, oblique and direct. The former enters the in- guinal canal through the internal abdominal ring, passes obliquely along the canal and through the external ring to descend into the scrotum. Direct inguinal hernia escapes from the abdomen at Hesselbach’s triangle, and then passes through the external ring. External ring is H inches above Poupart’s ligament; has for its inner pillar the fascia of the external oblique; for its outer pillar, Poupart’s ligament and fibres of fascia. The intercolumnar fascia ex- tends between the pillars at their lower portion. Internal ring is inch above Poupart’s, in the transversalis fas- cia, between pubes and anterior spine of ilium. Is an oval opening, long axis being perpendicular. On the internal margin, just above peritonaeum, are the epigastric vessels; the transversalis fascia here gives the infundibuliform to cord and testes, and transversalis covering to hernia. Coverings of Hernia. Oblique: Integument; superfi- cial fascia; intercolumnar fascia; cremaster muscle; fas- cia transversalis, or infundibuliform fascia; areolar tissue and peritonaeum. Direct: Integument; superficial fascia; intercolumnar fascia; conjoined tendon of internal oblique and transversalis muscles; fascia transversalis; areolar cel- lular tissue; peritoneal sac. CEU'RAL, or FEM ORAL CANAL, and FEM- ORAL HERNIA. This canal is a funnel-shaped in- terval which exists within the femoral sheath between its inner wall and the femoral vein; it is of great sur- gical importance as being the space into which the sac -of femoral hernia is protruded. It is \ to £ inch long, •extending from Gimbernat s ligament to saphenous opening. Its anterior wall is formed by transversalis fascia, falci- form process and Poupart’s ligament; its posterior wall, by iliac fascia and pubic portion of fascia lata; outer wall, by the septum,between it and femoral vein; inner wall, by junction of transversalis and iliac fascia; upper orifice, •closed by septum crurali and a small gland; lower, or saphenus orifice, by cribriform fascia. It is limited above by the crural or femoral ring, and is lost below by the adhesion of the sheath to the coats of the vessels. In the normal state the canal is occupied by loose cellular tissue, and numerous lymphatic ves- sels which perforate the cribriform fascia, covering the 70 TRIANGLES AND SPACES. 71 saphenous opening in the fascia lata, and the walls of the sheath to reach a lymphatic gland situated at the crural ring. This gland is retained in its position by a thin layer of sub-serous cellular tissue—sep'tum crura'le—which, together with the peritoneum, separates the canal from the- abdominal cavity. The Crural ring is the point where femoral hernise leave the abdomen, and is the most fre- quent seat of strangulation; its boundaries are: In front, Poupart’s ligament; behind, pubes, covered by pectineus and pubic portion of fascia lata; externally, septum sepa- rating femoral vein; internally, the sharp margin of Giin- bernat’s ligament, conjoined tendon, transversalis fascia and deep crural arch. Fem oral sheath is formed, ante- riorly, by transversalis fascia, and anterior portion of fascia lata; posteriorly, by iliac fascia and pubic portion of fascia lata. Cribriform fascia is from deep layer of superficial fascia; is attached to falciform process. Super- ficial fascia: Superficial layer, over Poupart’s ligament connecting abdominal fascia with fascia lata; deep layer up to Poupart’s, above, from its connection with femoral sheath. Fascia lata: The iliac portion from spine ilium and Poupart’s, throwing falciform process over pubic por- tion, almost transversely to the pubes; at top it is adherent to the femoral sheath; the pubic portion, from Poupart’s ligament and pubes, lying below internal saphenous vein, passes beneath femoral sheath to become attached to pecti- neal line and capsule of hip-joint. The Coverings of Fem'oral Hernia, commencing at the surface, are: In- tegument; superficial fascia; cribriform fascia; femoral sheath or fascia propria; septum crurale; areolar tissue and fat; peritoneal sac. TRIANGLES AND SPACES. Deciduous, 20 in number: central incisors, 7th mo. lateral incisors, 7—10 mo.; ant. molars, 12—14th mo.; canine, 14—20 mo.; post, molars, 18—86th mo. Permanent, 82 in number: first molars, 6| years; two- mid. incisors, 7th year; two lat. incisors, 8th year; first bi- cuspids, 9—10th year; sec. bicuspids, 10—11th year; canine, 11—12th year; sec. molars, 12—14th year; wisdom, 17—21st year. Those of the lower jaw generally precede those of the upper by one or two months. ERUPTION OF TEETH. GYNAECOLOGICAL SECTION. GYNAECOLOGICAL SECTION. THE 13 MUSCLES OF THE FEMALE PERINEUM. Erec tor Clitori'dis (2, or a pair); arise from anterior region of pubic and iscliic rami—into clitoris, at junction of cru'ra clitori'dis. Bul'bo Caverno'sus (2): arise from perineal body and aponeurosis, superior portions—portion into crus of same side, near insertion of erector muscle; the outer portion winds inwards, under erector muscle to the bulb of the vagina, near its isthmus (under the clitoris). A. few fibres pass up over the clitoris, and also up to the pubes. Tranver'sus Perinse'i Superficia'lis (2): arise from ramus of ischium, in front of tuberosity, and from anterior aponeurosis of the perineal septum—perineal body and integument in front of anus. Sphinc ter A'ni Exter'nus: deep portion, from tip of coccyx; superficial pot'tion, from integument—perineal body, central portion. Pu'bo-Coccygae'us (2): from posterior surface of pubes, and aponeurosis—outer margin, into the last two bones of coccyx; inner margin of each muscle commingles with its fellow of the opposite side, forming loops that pass between the vagina and rectum, and that unite with the deep sphincter ani. Obtura'to-Coeeygse us (2): from ilio-pubic line of junction between obturator and recto vesical fascia—sides of last two bones of coccyx. (Has no rectal connection.) Is'chio-Coceygse’us (2): from spine of the ischium and aponeurosis—sides of the bones of the coccyx. Note—The three last named muscles go to form, in the male, what is known as the levator ani muscle. , , The pvbo- and obturate- coccygeal muscles draw forwards, and assist in closing, Ihe rectum. The pubo-coccygeal is also the con- strictor of the vagina, not the bulbo-cavernosus, as usually given ; this muscle (the bulbo-cavernosus) is the compressor of the vagmal bulb, and in contracting draws the labia together. ARTERIAL SUPPLY of the FEMALE GENITALIA. UTERUS : This organ receives its supply on each side from three sources: I. The Ovarian (or spermatic) arte- ries, branches of the abdominal aorta. IT. A Branch of the Epigastric (which passes along the round ligament) which ARTERIAL SUPPLY OP THE FEMALE GENITALIA. 73 is from the external iliac. III. The Uterine, which is a branch of the internal iliac. VAGT'NA: This organ receives its blood supply from 5 arteries, all Branches from the Internal Iliac, anterior trunk—except the circumflex uterine, which is a branch of the uterine—viz.: 1st. Vaginal artery, a branch from the anterior trunk of the internal iliac, supplying lower third anterior wall; 2d. Vaginal branches from the uterine artery, supplying middle and upper third; 3d. Vaginal branches from circumflex uterine, supplying upper third. 4th. Vaginal branches from inferior vesical, supplying lower third. 5th. Vaginal branches of hemorrhoidal, sup- plying lower third. OVA RIA: The ovaries are supplied by the Ovarian arteries, branches of the abdominal aorta. These, having reached the inferior border of the glands, suddenly give off ten or twelve branches, which ascend, in a fan-shaped plexus, dividing and intertwining, to the hilum, or inferior portion; then they penetrate the substance proper of the ovary to still further subdivide and anastomose, and finally enmesh the walls of the Graffian follicles. PEREN'iE'UM and PUDEIST'DA: These portions of the female anatomy are supplied with the following branches from the Internal Pudic: 1st. Inferior hemor- rhoidal (2 branches.); 2d. Transverse perineal; 3d. Vulvar, or superficial perineal; 4th. Bulbar branches; 5tli. Deep branch to crus; 6th. Dorsal branch to clitoris. Also the Superficial External Pudic, a branch of the femoral, arising about i inch below Poupart’s ligament; after piercing the fascia lata at saphenus opening it runs inwards to supply the labia of that side, anostomosing with branches of the internal pudic. Deep External Pudic, another branch of the femoral, given off near the former, passes inwards, on pectineus muscle, to pierce fascia lata and be distributed to the labia of that side, anastomising with the vulvar. ABDOMTNA.L AOR'TA: Extends from the dia- phragmatic opening to the body of the 4th lumbar vertebra. See page 33. The branches being in order, 1st, Phrenic; 2d, Ccelic axis; 3d, Supra-renales; 4th, Superior mesenteric; 5th, Renales; 6th, Ovarian or Spermatim; 7th, Inferior mesenterica; 8th, Lumbales: 9th, Sacra media and the two terminal branches, Common Iliacs. Ovaria'nse or Sperina- ticce arise from the front part of the aorta abdominalis, a lit- tle below the renal; are long slender vessels (though shorter than in the male) one on each side, and pass down and out- 74 wards across the ureter of their respective sides, beneath the peritoneum, lying on the psoas muscle; arriving at the pelvis each passes inwards between the broad ligament, lamina} to be distributed to the ovary. Two small branches are given to each Fallopian tube, and another to the uterus, which anastomoses with the uterine arteries. Other small branches are continued down the round ligament, through the inguinal canals, to integument of the groins and labia. ILTAOZE COMMU NES ; See page 34. Ili'aese Exter'na; See page 85; from the junction of sacrum with the last dorsal vertebra around pelvic brim to femoral arch; terminal branches being epigastric and circumflex iliac. Arte'ria Epigas'trica: from a few lines above Poupart’s ligament, it descends to this ligament, then ascends obliquely upwards and inwards, between peri- toneum and transversalis fascia, to the umbilicus. It lie3 behind the inguinal canal, to the inner si le of internal abdominal ring (just above the margin of the femoral ring) and in front of the round ligament. It here gives a bran-h to this ligament, that follows the round ligament back to and supplying the uterus, as well as ligament, with arte- rial blood. Ili'aese Inter'na: See also page 34. From sacro-dor- sal veriebral junction to the great sacro-sciatic foramen, then dividing into its two terminal branches, I. the Ante- rior and II. Posterior trunks. Is a short, thick vessel. POSTERIOR, TRUNK. This is a short, rather thick artery dividing into 1st, Superior; 2d, Ilio-lumbar; 3d, Lateral Sacral branches, and which arteries supply the muscular parts in these regions. ANTERIOR TRUNK; This is the most important branch. For the 3 vesical branches of this trunk and middle hemorrhoidal, see page 34. Arte'ria Uteri'na, a large branch on each side descending between the two laminae of the broad ligaments, near their sacro-iliac attachment, in company with the ureter, to a point somewhat below the level of the ostium externum uteri, then it turns upwards, between the uterine attachments of the broad ligaments, and, in a tortuous course, close to the uterine body, it reaches the Fallopian tube, there inosculating with the terminal branches of the ovarian (spermatic) artery. In its course it gives numerous small branches to the sub- stance of the uterus and adjacent organs. Its main branch is the circular artery. Obtura tor: this is fre- quently a branch of the uterine artery, passing out of ARTERIAL SUPPLY OP THE FEMALE GENITALIA. the foramen of same name, below the obturator nerve. Vesica'lis Inferior, with its “Inferior vaginal branch,” passes down to supply the lower portion of the bladder and vagina. Vaginal Branches, that supply the middle part of the vagina. A. U'tero-cervica' lis, the largest branch, which inosculates with its fellow and forms the so-called “circular artery” about the neck of the uterus. This is the artery that is liable to be wounded in perform- ing trachelorrhaphy. Fallopian branches: these go to furnish the tube with a part of the arterial supply. A. Vagina'lis: descends to lower third of vagina to supply structures there adjacent. Hemorrhoid a'lis Infe'rior: passes down to lower portion of rectum, furnishing there a small vesical branch and numerous small vaginal branches. Pudi'ca Inter'xa: this is the smaller of the terminal branches of the anterior trunk, though the one that mainly supplies the pudenda. It passes down and outwards to greater sacro-sciatic foramen, emerging from pelvis through it, lying between the pyriformis and coceygeus muscles; it then crosses spine of ischium, re-entering pelvis through lesser sacro-sciatic foramen, and ascends, on the rami of the ischium and pubes, in a canal in the obturator fascia, to terminate in the dorsalis clitoridis. The branches in its course are, the supe'rior vesica'lis, sometimes with its re- mains of the impervious foetal hypogastric. Two inferior or external hemorrhoidal branches that supply, in part, the lower portion of rectum. A. perince'i transversa'lis, runs transversely inwards, just beneath the transverse per in seal muscle, supplying the adjacent structures. Vulvar branch or perincdi superficia'Us, which is larger than corresponding branch in the male, ascends midway through the anterior per- ineal space, beneath the superficial fascia, supplying lower portion of vulva and superior perinaeum. Bulbar branch, supplying the bulb of the vagina, lying beneath the labium majus. Profun'da vulvar branch, running deeply upwards to supply the crus clitoridis. Arte'ria dorsa'lis clitoridis which runs downwards and forwards on the dorsum to the glans clitoridis, there inosculating with its fellow. A. Sciat'ica: this is the larger of the terminal branches of the anterior trunk, and is distributed to the muscles at the back of the pelvis; see pages 35 and 42. ARTERIAL SUPPLY OP THE FEMALE GENITALIA. 75 76 NERVOUS SUPPLY OF THE FEMALE GENITALIA. NERVOUS SUPPLY OF THE FEMALE GENITALIA. UTERUS: This organ is poorly supplied with cere- bro-spinal nerve fibres, the main nervous supply being from the sympathetic system; however, branches from the second, third and fourth sacral nerves, and a few filaments of the sacral plexus, go to help form the Inferior Hypogastric Plexus which is its main source of supply, through the uterine nerves that follow closely the course of the uterine arteries. The Fundus is supplied with branches from the Ovarian (spermatic) Plexuses. The Middle portion, with branches from a prolongation of the Hypogastric Plexuses. The Lower portion, with the anterior branches from the Inferior Hypogastric Plexus. All these plexuses inosculate freely with themselves, between the folds of the broad lig- ament, and literally enmesh the uterus. OVARIA: These organs are supplied, mainly, with branches from the Ovarian Plexuses; a branch, however, of the Hypogastric plexus, by the way of the uterus and Fal- lopian tube (uterine nerve) also reaches each of them. VAGI NA: The main sentient nerve is the Pudic, and its branches; which see further on. The vagina is, more- over, completely enmeshed with the numerous inosculat- ing branches of the Inferior Hypogastric Plexus of the sym- pathetic system, and which plexus has frequent communi- cation with the cerebro-spinal system through the branches of the Internal Pudic. PERINiE UM and VUL VA: These parts are sup- plied by the various terminal branches of I. Pudic (from sacral plexus); II. The pudendal branch of the Small Sci- atic (from lower part of sacral plexus); III. Terminal branches of the Ilio-Inguinal (branch of 1st lumbar); IV. Genital branch of the Genito-Crural nerve (branch 2d lum- bar) ; V. The Sympathetic System through numerous branches from the Inferior Hypogastric Plexus. Ner'vus Pudica: This nerve arises from lower por- tion of the Sacral Plexus [this plexus is made up of 5 nerves, viz.; the lumbosacral, and the anterior branches of the three upper, and part of the fourth, sacral nerves] soon joins company with the internal pudic artery, and leaves the pelvis through the greater sacro-sciatic foramen, to cross the ischic spine and re-enter the pelvis through the lesser sacro-sciatic foramen. It then ascends, lying to the inside of its artery, the ischic and pubic rami, in a sheath of the obturator fascia, to end in the terminal branch, the dorsal nerve of the clitoris. Ilcemorrlioida'its inferior: from near origin of pudic [sometimes arises from the fourth sacral] traverses the ischio-rectal fossa, to be distributed to the external sphincter, and anal integument, inosculating with inf. pudendal and superficial perineal. Muscula'res posterio'res: several branches given off to supply the triform muscle, and upper border of sphincter ani. Pos e'rior Super- ficia'lis: given off just below tuberosity of ischim, passes up- wards and inwards to mesial line, supplying perineal mus- cles and integument, and lower portion of labia. Ante'rior Superjicia'Us: given off at point abont one-half inch above tuberosity, passes upwards and inwards to supply upper f of the labia. Anastomot'ica: small branch given off a little below level of meatus urinarius, to inosc. with the puden- dal branch of the small sciatic. Dorsa'lis GlitoH'dis: the pudic is continued up the pubic rami to the root of the clitoris, piercing the suspensory ligament, and becomes the dorsal nerve of the clitoris. It (one on each side) accompanies the dorsal artery to the glans, where it, through its numerous branches and inosculations with the sympathetic system, hoods over this organ. Savage asserts that the clitoris, in comparison with its size, has four or five times the nervous supply that the penis has. Ner'vus Pudenda'lis: This nerve is a small branch of the small sciatic nerve (formed usually by the union of two branches from lower part of sacral-plexus, see page 50), and is given off from that nerve just at the back of the tuberosity iscliii. It passes diagonally upwards and inwards, over the course of the ischic and pubic rami, and gives branches to supply the labia, and overlying integu- ment, gracilis muscle; its terminal branches reach the pu- bes, supplying the crus, clitoris and integument, anastomis- ing freely with the terminal branches of the ilio-inguinal, and pudic nerves. Ilio-Inguina'lis: The ilio-inguinal nerve, a branch from the 1st lumbar, runs around the abdominal walls, above the brim of the pelvis, and escapes at the external abdominal ring; its terminal branch runs down to the pubes supplying the mons and the superior portions of the labia and clitoris with its filaments, which here inosc. with the terminal branches of the pudic and pudendal branch of the small sciatic nerves. NER'VUS SYMPATHET'ICUS. This is the nerve of all nerves that supplies the female (as well as male) genita- NERVOUS SUPPLY OF THE FEMALE GENITALIA. 77 78 lia. Through its perverted influence is to be attributed the tliousand-and-one reflex ills that female flesh is heir to. Plex us Ovaria'nus or Spermat'icus: this is derived from the lienal Plexus (the Renal is formed from branches from the solar plexus, semi-lunar ganglion, aortic plexus, and greater and lesser splanchnic nerves); it also receives branches from the aortic plexus. It descends on the sides of the vertebrae to the ovaries, there supplying them; it then follows, down the tubes to the uterus (supplying both these organs) there inosculating with branches from the hypo- gastric plexus. Plex us Hypogas'tricus : is situated in front of the promonotory of the sacrum, between the com- mon iliac arteries. It is formed by a union of filaments from the aortic plexus, all the lumbar and the first two sacral gan- glia. It bifurcates below, forming the two inferior hypo- gastric (pelvic) plexuses. It supplies upper portion of rec- tum and a few branches to the uterus. Plex'us Hypo- gas'tricus Infe'rior: This is the pelvic plexus (one on each side) and is the source of chief nervous supply to the rectum, vagina, bladder and uterus. It is formed by the con- tinuation downwards of the bifurcated hypogastric plexus, branches from the second, third and fourth sacral nerves, and a few filaments from the sacral ganglia. This plexus spreads out and enmeshes the viscera in the pelvic cavity with its inosculating filaments; these have received, from the placement of several aggregations of the filaments, the names of inferior hcemorrhoidal, vesical and vaginal plexuses. All the above mentioned plexuses are in free communi- cation with all the minor plexuses (phrenic, coeliac axis, gas- tric, hepatic, splenic, supra-renal, superior and inferior mesenteric) and the large solar plexus, and the cerebro- spinal system, through their many inosculating branches, from one plexus to another; hence this furnishes the physi- ological and anatomical reason for the many reflex symp- toms seen in distant organs when the uterus and ovaries are diseased. NERVOUS SUPPLY OP THE FEMALE GENITALIA. POINTS WORTH REMEMBERING. Largest artery—Abdominal aorta. * nutrient artery—Tibial. * synovial membrane.\—At the knee-joint. “ muscle—Glutaeus maximus. “ nerve—Sciaticus magnus. “ vein—Vena cava. 79 Longest muscle—Sartorius. “ tendon—Plantaris. Branchless artery—Common carotid (except the terminal branches.) There are also no branches from the cervical 'portion of the internal carotid. Veins carrying arterial blood—Pulmonary. (In the foetus, the veins carrying arterial blood are the umbilical, hepatic and inferior vena cava.) Artery carrying venous blood—Pulmonary. (In foetus, umbilical, also.) Nerve perforated by an artery—Sciatic by the comes nervi ischiadici; the arteria centralis retinae also pierces the optic nerve. Nerve perforated by a vein—Those just named. Muscle perforated by a muscle—Stylo-hyoid by the digastric. “ “ “ large nerve—Coraco-brachialis by the musculo-cutaneus. Vein perforated by a nerve—Occasionally the axillary vein by the internal anterior thoracic nerve. Ligament perforated by a nerve—Sacro-sciatic by the ante- rior branch of the coccygeal nerve. Ligament pierced by an artery— The greater sacro-sci- atic, by the coccygeal branch of the sciatic artery. The azygos articularis artery also pierces the posterior liga- ment of the knee-joint. Membrane pierced by an artery—The thyro-hyoid by the superior laryngeal artery. Tendons perforated by tendons—These of the flexor sublimis digitorum, of the hands, for the passage of the tendons of the flexor profundus digitorum. In the feet, the tendons of the flexor brevis digitorum are split for the passage of the tendons of the flexor longus digitorum. Largest branch of the internal carotid artery—Is the middle cerebral; this is the artery that is liable to become plug- ged by an embolus. Bones icith no muscular attachments—10; ethmoid, nasal, in- ferior turbinated, vomer, scaphoid, semi-lunar, cunei- form, astragalus, middle cuneiform, incus. Pillars of the palate—Anterior, formed by projection of palato-glossus muscle; posterior, by projection of palato- pharyngeus muscle. False vocal cords—Formed by superior thyro-arytamoid lig- aments. True vocal cords—Formed by tne inferior thyro-arytienoid ligaments POINTS WORTH REMEMBERING. 80 POINTS WOKTH REMEMBERING. Hamstrings—Outer formed by tendon of biceps; inner, by the tendons of the gracilis, sartorius, semi-membranosus, and semi-tendinosus. The palatal veins and muscles, called azygos—Are double, although the term azygos signifies not paired. Veins with only epithelial walls—Those of the diploe. Amnios was a term given us by Empedocles (B. C. 450). Aorta was named by Aristotle (B. C. 384), though he sup- posed it contained air. Cataract— The first removal of the lens for this disease was made by Herophilus. Celsus cured the trouble by de- pressing the lens (couching?). Dissection—First human dissection after Herophilus’ time (Herophilus is said to have dissected 700 subjects) was by Mondini de Luzzi, Prof, of Anatomy at Bologna. Old Alexandria, in times before our era, was famous as being the possessor of two human skeletons; all Greece and Rome flocked there to see them. Montagana (A. D. 1460) boasted that he had examined fourteen human sub- jects. Duodenum was named by Herophilus; he also showed the heart to be the beginning of arterial circulation. In fact, he is the father of anatomy. Fallopius (16th century) said of him, “ That to contradict him, was like contra- dicting the gospels;” that he was “the evangelist of anatomists.” Gynaecologists—The most prominent ones of early date, so far as surgical procedures are concerned, were Paulus (early part of the 7th century) though Aetius (close of the 5th century), Galen (A. D. 131), Soranus (A. D. 98-138), Celsus (about A. D. 60), and even Hippocrates (460 B. C.) treated quite lengthily of the subject. Indeed five Hippocratic treatises on female troubles, were, in early days, in the hands of the medical profession. Leeches were first employed by Themison (B. C. 30.) Lexicographer, Medical. The first one was Rufus Epliesius, about A. D. 98 or 117. Lithotomy was extensively pi'actised in old Alexandria, and the famous oath of Hippocrates (460 B. C.) recognized it as undignified for the physician and surgeon. Nerves—Their functions were discovered by Herophilus; he overthrew the doctrine that they sprang from the brain-membranes, and proved them to come from the brain itself; their crossing, near their cranial organ, was first proposed by Aretaeus, and he, in this way, ac- CIRCULATION. 81 counted for a left-sided head injury resulting in a right- sided paralysis. Physician—This term was first applied to doctors by the people of Charlemagne, A. D. 805. Pharmacopoeia—The first one was issued by an Arabian, Sabor-Ebr-Sahil (9th century) and was called Krabadin. Rhinoplasty was devised by Vincent Yianso, an Italian, who lived in the 15th century; also performed by Brauca and Bojani. Vein valves were first discovered by Frabricius, during the latter portion of the 10th century. Tricuspid valves of the vena cava were discovered by Era- sistratus, a contemporary of Herophilus. He called them triglochine. Torcula Herophili first described (with Calamus scriptorius) and named by Herophilus (about 250 B. C.). Tinctures were first introduced by Arnold, about the year 1315. He was then a professor at Barcelona. CIRCULATION. Cardiac and pulmonic : The venae cavae receive the systemic venous blood, and convey it into the right auricle; then it passes into the right ventricle through the tricuspid, or auriculo-ventricular valves, to be thrown into the pulmonic artery (going through the semilunar, or pul- monary valves); is then conveyed to the lungs and oxygen- ized in the capillary plexus about the intercellular struct-, ure and the air-cells, and returned, by the pulmonary veins (4 in number) to the left side of the heart, into the left auricle; it then passes into the left ventricle (through the mitral valve) to be forced into the aorta (through the semilunar valves), and from thence to support the system at large. Foetal: from the placenta through the umbilical vein to the liver; from thence, by the hepatic veins and ductus renosus Arantii, to the inferior vena cava, to the right auricle; the most of the current, guided by the Eustachian valve, passes through the foramen ovale into the left auricle, and from thence into the left ventricle, and from thence into the aorta and system at large. A part of the current, however, enters the right ventricle, is then forced into the pulmonary artery, and from the imperviousness of the foetal lungs is most all conveyed to the aorta by the ductus arteriosus Botalli. The blood is at last conducted by the umbilical arteries (branches of the internal iliac) to the placenta for re-oxygenation. 82 INDEX. INDEX. PAGE. Arteries: Body 32 Extremity (lower) 42 “ (upper) 21 Female Genitalia 72 Head and Neck 6 Body 28 Circulation 81 Extremity (lower) 38 “ (upper) 17 Eruption of Teeth 71 Femoral Canal and Hernia 70 Gyncecological Section 72 Head and Neck 1 Inguinal Canal and Herniaa 69 Muscles: Action of 61 Body 28 Extremity (lower) 38 “ (upper) 17 Female Perina3um 72 Head and Neck 1 Nerves: Body 37 Extremity (lower) 48 “ (upper) 25 Female Genitalia 76 Head and Neck 14 Osteology 52 Resume Table of 60 Points Worth Remembering 78 Triangles and Spaces 64 Veins: Body 35 Extremity (lower) 46 “ (upper) 24 Head and Neck 12 —OF— BANDAGING By C. HENRI LEONARD, A. M., M. D. One hundred and ten Original Illustrations. CLOTH, OCTAVO, 132 PACES. - - PRICE, $1.50. Included in List of Text-Books at several Medical Colleges. COWTE1VTS. Chapter L—Charpie and Cotton-wool. Chapter II.—Compresses. Chapter III.—Bandages in general. Chapter IV.—Classification of Bandages. Chapter V.—Bandages of the Head (30 are given). Chapter VI.—Bandages of the Neck (10 are given). Chapter VII.—Bandages of the Upper Extremity (32 are given). Chapter VIII.—Bandages of the Body (24 are given). Chapter IX.—Bandages of the Lower Extremity (56 are given). Chapter X.—Immovable Dressings. Chapter XI.—Strappings. Chapter XII.—Knots. Chapter XIII.—Poultices. “It describes and gives cuts of almost all conceivable bandages. To those who have never enjoyed the opportunities which a large hospital can alone afford, this book will prove a very valuable aid.”—Peninsular Jour. Med. “Every student should possess it; and as it is the most explicit and best illustrated English work of its kind, there will be few phy- sicians who will not prize its worth.”—St. Louis Med. Jour. “ The wood-cuts are very instructive. It is chal-ming to look, at least, upon a new set of these. We heartily commend the book, especially to recent graduates and students.”—Louisville Med. News. “ This is an excellent compend, and will be found of great value by the student and young practitioner. The illustrations are well adapted to the purpose intended.”—St. Louis Clinical Record. “ This treatise on bandaging is very neatly illustrated, and, be- sides a very comprehensive description of bandages proper, con- tains chapters on knots, poultices, strappings and immovable dress- ings.”—Med. and Sun/. Reporter. “There is no practitioner who would not be rejoiced to master the art of bandaging. To all such this book is recommended with- out qualification. It is the best work on the subject ever published; thorough and complete.”—Am. Medical Bi-Weekly. Sent post-paid on receipt of price, by THE ILLUSTRATED MEDICAL JOURNAL CO., DETROIT, MICH. PHYSICIANS’ POCKET DAY BOOK By C. HENRI LEONARD, A. M., M. D* Published Annually. Post-paid, $1.00 ; your Name on Side in Gold-Eeaf, $1.25; your Name, Town and State, $1.50. It is 3% inches by 7 inches in size, is bound in full maroon-colored Russia, icith flap, pocket, pencil loop, gilt side stamp and red edges. It is so arranged that it will accommodate forty families daily for thirteen months. Also there is a complete record for obstetrical cases, and daily memoranda for Dr. and Cr. cash account for the year. It is always good for thirteen months from the first of any month. If your practice is not large, family name needs to be written but once a month; if large practice, but three times a month, the rest of the account keeping being in figures, the amount of daily charges. The Sale of this Book has been unprecedented. “ We commenced using one of these Pocket Day-Books when they first appeared, and, having tried several, we have found nothing better in this country. It furnishes, in the most compact form, a means for recording a physician's daily business.’’'—New Remedies. “For neatness, convenience and cheapness, it is equaled by few and surpassed by none.”—Michigan Medical News. “It is lighter and handier than any we have yet seen,”—Virginia Southern Clinic. “It accommodates forty families weekly, and is conveniently arranged for the purpose.”—Buffalo Surg. and Med. Journal. “ It is of convenient size; well bound, and well arranged. The reasonable price at which it is offered is a commendable feature.” —St. Louis Clinical Record. “ A very compact and convenient thing for the pocket.”—Pacific Medical and Surgical Journal. “It is a promising candidate for medical favor in a field where there are already numerous entries.”—Kings Co. Proceedings. “ Presents a simple method for keeping a physician’s accounts in such form as to reduce the labor of book-keeping to a minimum.” —Canada Lancet. “The book is handsomely bound, and is all that is claimed for it.” —Phila. Chemist and Druggist. “This is one of the most compact of Pocket Day Books, for the daily use of the physician, with which we are acquainted.”—Physi- cian and Pharmacist. “Is surpassed by none, and has but few equals, especially in re- gard to the simplicity of keeping daily accounts.”—Med. Summary. This book will be sent post-paid on receipt of price, by The Illustrated Medical Journal Co., DETROIT, MICH. Physicians’ Ledger By C. HENRI LEONARD, A. M., M. D. Leather and Cloth, post-paid, $2.50. Is beautifully bound in green cloth sides, and red leather back and corners, with gold leaf side-plate. Is especially designed for the Day-Book, though it can be used with any Day-Book system, and greatly facilitates posting. It is virtually a “ ledger index. ” It does away with all the paging and most of the figuring required in the old ledger system. On a single line of a leaf the entire debit and credit account of a patient, in monthly statements, is seen for the entire year. It is divided into five portions, and will accommo- date 400 families a year for five years, or over 800 yearly for two and a half years. “ With this Ledger and Day-Book, by the same author, that bug- bear of a doctor’s existence (book-keeping) is shorn of its terror.” —Michigan Medical News. ‘‘This Ledger is worth ten times its own price to any doctor whose practice is worth booking at all ”—Va. Southern Clinic. “Small accounts can be kept compactly, so as to he seen at a glance, and in many other respects it deserves favorable consider- ation.”—A'. C. Medical Journal. * * * These books (the Day-Book and Ledger) we have put to use, and find them complete and convenient, and would urge our readers to send on the little cash asked for such useful account books.”—Phila. Chemist and Druggist. Physicians’ Statements Four Hundred, Bound with Board Sides, in Two Books, Post-paid, $3.50. Each Bill has your name and address printed upon it, besides five lines for “Dr.” and “Cr.” entries, and columns for monthly state- ment of office and visit totals; also, “Balance due,” “ No.,” etc. A “stub ” is attached to each, so, when torn out, a complete record of the statement belonging to it is securely filed away. Size of each 3J4 by 6% plus 2 (the “stub”) inches. Samples on receipt of stamp. THE CODES OF ETHICS Paper, Octavo, Sixteen Pages, Post-paid, 25 Cents. It contains the Code of Ethics of the American Medical Associa- tion; the Code of Ethics of the American Institute of Homoeopathy, and the Code of Ethics of the National Eclectic Medical Society. Either of the above sent post-paid on receipt of price, by The Illustrated Medical Journal Co., DETROIT, MICH. The HAIR ITS GROWTH, CARE. DISEASES and TREATMENT. By Ci HENRI LEONARD, A. M., M. D. Cloth, 320 Pages, $2.00. Illustrated by over 100 Engravings, showing the Microscopical Appear- ance in Health and Disease. PARTIAL TABLE OF CONTENTS. Chapter I. —Chemistry of the Hair. Chapter II.—Shedding and Regrowth of Hair. Chapter III.—Hairs from Different Animals Compared. Chapter IV.—Why Hair Curls.—Hair in its Social Bearings. Chapter V.—The Strength of the Hair.—Weight of Hair. Chapter VI.—The Color of the Hair.—Hygiene and Sociology of Hair Coloration. Chapter VII.—Hair in Singular Places. Chapter VIII.—Hygienic Treatment of the Hair. Chapter IX.—Excess of Hair Growth.—Treatment of Superflu- ous Hair. Chapter X.—Blanching or Turning Gray of the Hair. Chapter XI. —Abnormal Coloring of the Hair. Chapter XII.—Baldness; Description, Causes and Treatment. Chapter XIII.—Coloring, Bleaching or Dyeing the Hair. Chapter XIV.—Dandruff —Its Prevention and Treatment. Chapter XVII.—Milk Crust.—Causes.—Treatment. Chapter XVIII.—False Barbers’ Itch.—Cause and Treatment. Chapter XIX.—Vegetable Parasitic Diseases. Chapter XX—Ringworm of the Scalp.—Treatment. Chapter XXI.—Honeycomb Ringworm of the Scalp.—Treatment. Chapter XXin.—Barbers’ Itch.—Diagnosis.—Treatment. Chapter XXIV.—Animal Parasites in General. Chapter XXV.—Head-louse.—Crab-louse.—Body-louse.—Grub of the Nose.—Itch Insects.—Fleas. Chapter XXVI.—Different Modes of Dressing the Hair. Chapter XXVII.—Hair of the Ancient Assyrians and Peruvians. Chapter XXVIII.—The Beard.—The Barber and His Calling. “This volume in its title and subject is unique in medical literature, and although the author is the first to present the profession with a hook on this subject, he has certainly accomplished the labor with the hand of a master,” —Cincinnati Lancet and Clinic. “ * * * In short the book is a compilation of facts which may afford inter- esting reading for Physicians or laity, and an unassuming treatise upon the diagnosis and treatment of diseases of the hair. * * * It is entertaining reading, suggestive, will prove of use to the general practitioner, and does credit to the energy and industry of the writer.”—Boston Medical Journal. “The work before us is full in its information in regard to the hair. * * » The author has given the subject very profound consideration, and the infor- mation presented is very great, and will prove very valuable to the physician who is called upon often to treat these affections. We very cordially recom- mend the work.”—Cincinnati Medical News. “Dr. Leonard has produced a very interesting and valuable book out of rather unpromising materials. * * * The book is a model of elegance, and the many illustrations add greatly to its value and attractiveness.”—St. Louis Clinical Record. This book will be mailed post-paid on receipt of price, by The Illustrated Medical Journal Co., DETROIT, MICH. PURE BOVINE VACCINE The Best in the World! FROM CHINA. Ningpoo, China, Nov. 21, 1877. * * * It is more than a year ago since I wrote you, and nearly a year since I received your kind answer with the Vaccine. The Points you sent gave satisfaction. * * * I shall be very much obliged if you will send me, by earliest opportunity, three dollars’ worth of Ivory Vaccine Points (I enclose $3.00), so that they may reach here before warm weather. S. P. BARCHET, M. D. 16 Abington St., Northampton, England, Jan. 13, 1881. * * * I duly received the Animal Vaccine. Have used it aH, Three-fourths of the cases were successful. * * * Yours very truly, A. C. CLIFTON, M. D„ FROM ENCLAND. Guatemala, Feb. 15, 1880. I owe you my sincere thanks for the crusts of vaccine virus whioh you sent me, and which arrived perfectly good 41 days after leaving your hands, and after having been subject to so many changes of temperature—from extreme Northern winter to extreme tropical summer, and then into this land of perpetual spring. * * How- ever, I used your crusts (.three of them), on 29 cases, with 27 perfect characteristic results. FRED. C. VALENTINE, M. D. FROM CENTRAL AMERICA. Toronto, 3,10, 79. Please send me by return mail 5 XX Animal Vaccine Points. Enclosed $1.00 Canada money and U. S. stamps to cover Postage. I can always rely on the excellence of your matter, and hope you will find your enterprise remunerating. D g qlIPHANT M D FROM ONTARIO. HOME TESTIMONIALS. In 1877 we furnished the city of Detroit the Virus used for the General Vaccination then ordered; also for the General Vaccination in 1881; also the Detroit House of Correction; the Eastern Michigan Insane Asylum; the General Vaccination in Pontiac, Birmingham and Walled Lake, Michigan; Wauseon, Ohio, etc., etc. 10 Large XX Double Dipped Ivory Points, - • - $2 00 5 Large XX Double Dipped Ivory Points, - - - - 1 00 10 Large X Ivory Points, - - 100 [The above are charged on both sides of the points.] Crusts, weighing two grains, • - - - - - - 2 00 All Yirus is warranted ; though a little higher priced than some cheap “commercial brands," it is the cheapest in the end. Address all orders to ) PRICES ( THE ILLUSTRATED MEDICAL JOURNAL CO., DETROIT, MICH. Vaginal Speculum. DESIGNED BY C. HENRI LEONARD, A. M., M. D., Professor of the Medical and Surgical Diseases of Women, and Clinical Gynaecology, Michigan College of Medicine. PRICE, - - - $8.00. This cut shows Dr. Leonard’s new Specu- lum as made into a Sim’s. To do this, re- move the lower (dotted) blade from the perineal bar, and replace it in a reversed position, screwing its milled-head screw closely home, and elevating the superior blade (by its thumb- screw) as far as possi- ble. In case it is only wanted as a bi-valve, the dotted line shows the inferior or longer blade in its usual position on the perineal bar. It can be adjusted at any point upon the perineal bar to gain space for operations upon tumors, or the uterus. The posterior blade is slotted, so as to admit of an easy prob- ing of an acutely ante-flexed uterus, by pressing the sound down through the slot, without widely distending the blades. The anterior blade is slotted to admit the urethra, so this organ •will not be unduly pressed upon, when the perinseum is distended by the pressing down of the lower blade of the instrument. When fully expanded, the base of the blades are 3% inches apart, and the tips 5J4 inches. This is now by far the best and cheapest Valvular Speculum made, costing but $8.00 (express paid). You also get two instruments in one. On all orders for the Speculum, The Illustrated Medical Journal will be sent one year free. Address all orders to The Illustrated Medical Journal Co., DETROIT, MICH. THE Uterometric Sound DESIGNED BY C. HENRI LEONARD, A. M., M. D. The total length of this instrument is twelve inches; the shaft is made of the best untempered steel, and is flexible enough for use in a flexed uterus. Instead of being marked in inches, as the ordinary sound, it has a sliding steel ribband, and the depth of the uterus is read from the proximal end of this when the distal end of the ribband is against the os. The bougie a boule movable heads (six in number), are made of German silver, and are in sizes from No. 11, of the French scale, up to No. 24; corresponding to Nos. 7 and 16 of the American scale. As a diagnostic instrument it is to be found of the greatest value; indeed, by no other instrument can the same definite results be obtained. You can not only measure the length of the uterine canal, but can also definitely measure its diameter, at all points, by the use of the different sized olive heads; you can thus locate exactly any narrowing or stricture, and also at the same time determine the size and the length of the same; cer- tainly an important desideratum before any operation is performed to relieve it. These bulbs are not only useful as a means for diagno- sis, but also serve excellently as dilators ; you can read- ily change from the usual size, No. 11 or 12, of the point, to one the next larger, and so on, till No. 18 or 20 is inserted, in any nulliparous uterus, and with but little discomfort to the patient; thus effectually relieving the dysmenorrhoea dependent upon a narrowed canal. It is a much safer and less painful method than using tents. It answers equally well for the diagnosing or the dila- tation of urethal strictures in either sex. Sent postpaid on receipt of price, $3.50, and with it the Journal for one year, by The Illustrated Medical Journal Co., DETROIT, MICH.