Here is a [illegible] on left [illegible]
J.S. WILSON. 
J.S. WILSON. J.S. WILSON.
NOTES ON ANATOMY
Monday finish bones - &. Artys -
Tuesday Artys
5 Wed- Ullreo & [cross out]
Thurs - " " Bones Lig
5 Friday- Artys - Neres- L. cb.
Morn. - Ery - night.
By WM. B. TOWLES M D.,
PROFESSOR OF ANATOMY AND MATERIA MEDICA
IN THE UNIVERSITY OF VIRGINIA
Lithographed by 
ANDERSON BROS.,
UNIVERSITY OF VIRGINIA
Copyrighted by Wm. B. Towles, M.D.
1888.
July 3rd 92
[illegible] M.D.
$2 - $1



1
-The Articulations -
The study of the joints or articulations is the study
of the relations between bones, more particularly
of the surface of opposition and the means by 
which the bones are held together in the skeleton
and at the same time permitted motion one on 
another - In the study of osteology it has been seen 
that the surface of contact between the different
bones present widely varying appearances, upon 
these differences depends the classification of the 
joints - In certain articulations the opposing surfaces
present interlocking tooth-like processes, so 
that the union of the bones must result in a joint
in which no motion can occur - Such a form of 
articulation is called synarthrosis -
Secondly the contributing surface to a joint may 
be roughened or manipulated, showing the attachment
of ligamentous fibrea which have passed directly
between the opposing faces of the bones, or the attachment
of the fibrea may have been through the medium
of plates of cartilage coating the surfaces: such 
a surface on a bone indicates that it entered into 
the formation of a joint at which motion must 
have been very slight, the result of bending or 
twisting of the interosseous ligamentous fibrea; this 
form of articulation is known as amphi-arthrosis -
Lastly the bony surfaces forming a joint may be 
smooth and polished as a result of mutual friction -
such surfaces are characteristic of a joint at 
which motion is free and constitute a style of 
articulation called Diarthrosis -
There are them three classes of joints; 1st- Synarthrodial,

- Hyoid. Bone.
The H. or lingual bone lies at bore of lingua - Prof. speaking it is 
an apendage of temporal line -
Is divided into (1) body - now posing back from the 
body is grt. connua - and prof. junct. of grt. cm
with body is (2) Cessu cenua ij connect. by means
of a little joint with a capsular lig. same for 
grt cenua 
Body - (1) Ant. foce. convex - rough is divides by a bony.
(2) Prst} ridge - the part of the bone oleve "
(3) Upper pordei} " " looks up. bat below looks
(4) lower " "} foward. - surface is rough &
gen. looks up - on each side of 1 ridge is a depresse
Pest foce looks down & back. rough & mk.
by a deep depression.
Sup - predu. looks back
Port. " " down & fever.
Extremity - presents a rounded Arteo surf. for 
grt. cenua 
Grt. Cenua - is rounder rod of bones at its 
Pest extrem is enlarged at its Ant extrem
it presents an L - is rough for mu 
& lig - acock.
Lers - ceum posses up [illegible] & cun and 
1/4 in long - dentesify 

2
Synarthrodial, or immovable joints; 2d- the amphiarthrodial, 
or slightly movable joints: 3d- the Diarthrodial
or movable joints.
Besides the bones there are other structures which 
contribute to the formation of the joints as follows -
In the amphiarthrodial and diathrodial joints
the bones are bound together by ligaments -
In the amphiarthrodial joints these not only pass
from bone to bone exterior to the joint but are also
found in the joint passing directly between the opposing 
surfaces, these ligaments being called interosseous 
In the Diarthrodial joints as a rule no ligamontous
fibers are attached to the articulating
surfaces of the bones, but the ligaments more or less
nearly surround the joint, attached to both bones
beyond the articular surfaces; the ligamentous fibers
may entirely surround the joint forming a capsular
ligament or they may be gathered into separate,
scattered bundles.
In the Diarthrodial joints the opposing surfaces of 
bone are coated by encrusting or articular cartilage,
which presents a perfectly smooth free surface
towards the joint and on its deep face is firmly attached
to the articular lamella of the bone -
In order to render motion entirely easy and lessen
friction the diarthrodial joints possess a secreting,
serous - like membrane, called the synovial membrane,
which secretes a viscid, glairy liquid
called synovia - The synovial membrane in very 
early life is said to be a closed sac, coating universally
the interior of the joint, but soon the portion
covering the encrusting cartilage is worn away, or 

Classes of Synarthrodial joints -
Denlate or Senate - Skull -
Suture by harmony - Polate procers of Supp
Schindylesis - Vomer sphenoial
Gomphosis - teeth 

3
becomes inconspicuous -
In joints subject to very frequent motion the effect
of friction is further guarded against by a plate 
of fibro-cartilage, called the inter-articular cartilage
or meniscus: this is a more or less flat, generally
circular plate of cartilage interposed between
the encrusting cartilages of the bony surfaces
and attached only by its circumference to the 
ligaments. Then this exists entire the joint will
have two synovial membranes; but occasionally
the plate is worn through and then the two membranes
communicating there is virtually but one.
- Synarthrodial Joints -
The immovable joints are almost confined to the 
articulations between the bones of the skull, which 
are generally spoken of as sutures -
There are several varieties of suture - 1st- Dentate or [illegible]
Serrate, in which the edges of the bones present interlocking
processes generally called dentate when the 
processes are long, tooth like and serrate when they 
are short and resemble the teeth of a saw -
2d- Suture by Harmony; in which two long horned
surfaces come in contact, for example, the inner borders
of the palate processes of the two superior maxillary
bones - 3d- Schindylesis suture, in which
the edge of one bone is received into a groove in another 
as between the vomer and spheroid bone 
4d- Gomphosis, in which one bone is received into a
corresponding cavity of another - This term is applied
to the union between the teeth and their sockets, and 
is really no articulation -  

Classes of Diarthrodial joints -
I Arthrodials. -
II trochlear.
III Condyloid.
IV Saddle Shaped.
V Perot -
VI Ball and Socket. - 

4
The names of the individual articulations of the bones
of the skull are derived from the names of the bones
which form the sutures, but in some instances the 
sutures have also names derived from other sources,
as front-parietal, or coronal suture.
When a bone articulates with its fellow of the opposite
side the name of the suture is formed by the prefix
inter and the name of the bone, as inter-parietal
suture.
- Diarthrodial Joints -
The diarthrodial joints, in accordance with the 
varying shape of the articular surfaces, are divisible
into six varieties -
1s Arthrodial formed by more or less flat plane
surfaces, so that motion is much restricted.
2d. Huge, or trochlear, or ginglymoid, which are characterized
by the presence of a pulley or trochlea on 
one of the articulating surfaces - In this joint motion
can occur, as a rule, only in two directions -
3d- Condyloid, in which one element is a condyle
the other a proper receiving cavity - These joints
are generally capable of very free motion.
4- Saddle-shaped, or concavo-convex joints, or 
joints of reciprocal reception, where both surfaces
are saddle-shaped and mutually interlock.
The examples of this form of joint are, sterno-clavicular,
Temporo-maxillary, Trapegis-metacarpal and 
calcanio-cuboid.
5ð- Pivot or Trochoid joints are only two, axoid and 
radio-uluar -
They present an osseo-ligamentous ring, in which 



5
a part bone of one is received and in which in the 
first example it acts as a pivot around which the 
other bone revolves and in the second rotates on 
its own axis- 
6ð Ball and socket or enarthrodial joints present
a more or less spherical head as one contribution
while a receiving cavity is the other - The two
important examples of this variety are the shoulder
and hip - joints, in both of which motion is 
very free.
In describing a joint then, the following heads have 
to be considered.
1ð The class and variety - 2d- The bony contribution.
3ð The ligaments - 4ð The synovial membrane -
5ð The inter-articular cartilage perhaps -
6ð The motions of which the joint is capable.
As numerous as the motions may seem to be 
they can all be referred to the following (a) Gliding,
which occurs to some extent in all diarthrodial
joints, but which is peculiarly characteristic of 
the arthrodial, and which consists in a slipping
of one more or less flat and plane surface on 
another -
(b) Flexion, which is angular movement of a 
segment of the body in an anters-posterior vertical
plane, generally forward, but in a few instances
backward.
(c) Extension, which is the reverse of flexion -
(d) Abduction, which is the movement of a segment
away from some established mid line,
generally that of the body -
(e) Adduction, which is the reverse of abduction.



6
(f) Circumduction, which consists in partial performance
in rapid and regular succession of the 
four preceding movements, passing in inward
circumduction from flexion to adduction, to extension,
to abduction and again to flexion and in the reverse
order in outward circumduction - In the performance
of this movement the moving segment circumscribes
a cone-shaped space, the apex being at the 
joint and the base being outlined by the distal
end of the segment.
(g) Revolution, or false rotation; this occurs at only
two joints, viz, alto avoid, and radio-ulnar: [illegible]
the former case the atlas revolves around the
odontoid process as an axis; in the latter case,
the radius rotates around its own axis in the 
ring formed by the orbicular ligament and the 
lesser sigmoid cavity -
(h) Rotation, or true rotation; this is almost limited
to two joints, the shoulder and the hip, and as it 
happens can be defined in the same terms for 
both; being movement outward or inward around
an imaginary line drawn from the innermost
point of the head of the humerus or femur to the 
innermost point of the inner condyle of either 
bone -
6ð A statement of the mechanism of motion,
that is of the changes which occur in the relative
position of the articulating surface during the
performance of any given motion -
7ð The muscles that are in contact with the ligaments
of the joint and which may be considered
as imparting strength to the articulation -



7
8ð The arteries and nerves distributed to the joint,
in the case of the important articulations -
The Articulations of the Vertebral Column -
The Articulations of the spinal column may be 
divided into those of the 
1ð Column in general. 2ð Alto-avoid articulation
3ð Occipito-atloid articulation. 4ð The sacro-vertebral
articulation.
The Articulations of the Spine in general -
Each vertebra articulates with the vertebra above,
and with one below by a diarthrodial and arthrodial 
joint on each side, formed by the superior
and inferior articular processes - The ligaments
of these joints are capsular around the 
articulating surfaces and those which find the 
same segments of the different vertebrae to-gether 
and which are generally called the common ligaments
of the Spine -
The Articulation of the Articular Processes -
The articulation between contiguous articular processes
is a diarthrodial joint of the arthrodial
variety presenting a synovial membrane and 
one ligament which is an imperfect capsular 
ligament.
The Ligaments of the Spine in general -
1st The Ligaments of the Bodies
The bodies of the vertebrae are connected by means
of intervertebral disks, and anterior and posterior
common ligaments. The intervertebral disk is found
lying between the opposing surfaces of two adjacent
bodies firmly adherent to each. 


The ant. lig. widens as it descends
1. Port " nanous " " " " - 
here between the axis & at - a between at & rce
bone.

[illustration]
8
in shape it corresponds exactly with that of the 
bodies between which it lies, on thickness it varies 
in the different regions of the spine collectively the 
disks from about 1/4 of the length of the column 4 excepting
the peculiar vertebrae - 1st- and 2d- between
which there is no disk since the atlar has no body.
The intervetebral disk or substance is formed
externally of concentric luminae of fibrous tissue
and fibro-cartilage the centre of the disk being a
soft pulpy mass. The anterior common ligament
is found descending along the front of the bodies od 
the vertebrae from the axis to the sacrum and widening
as it descends. It consists of several superimposed 
layers of fibres, the deepest being the 
shortest and attached to adjacent bodies only the 
most superficial being the longest and extending
over four or five bodies. The posterior common ligament
is found within the spinal canal attached 
to the back of the bodies of the vertebrae from the axis
to the sacrum. It consists like the anterior common
ligament of several layers of fibres, but unlike
it the ligament narrows as it descends and 
instead of having a straight edge has a scalloped
one, widening on each intervetebral disk and 
narrowing over the bodies.
- The Ligaments of the Lammae
Two adjacent lammae are held together by yellowish
ligamentous fibrea called ligamenta sub-flava
attached to the anterior surface of the lamina 
above and to the posterior surface of the lamina
below; this being necessitated by the imbricated

Found only in the dorsal & Lumbar Region


9
arrangement of the laminae -
- The Ligaments of the spinous Processes -
The spinous processes are connected by two ligaments -
supra-spinous and inter-spinous -
The supra-spinous ligament is a rounded cord,
extending from the spinous process of the 7th 
[cross out]
cervical vertebra to the sacrum and attached successively
to the tips of the spinous processes; it is 
continued upward to the occipital bone by the 
ligamentum nuchae which takes its place in 
the neck - which in the humour only is simply a intermus - septer
The inter-spinous ligament is attached to the 
adjacent edges of the spinous processes is unimportant 
and found only in the dorsal and lumbar 
regions - 
- The Ligaments of the transvere Processes -
The transverse processes are held together only in 
the lower dorsal and lumbar regions by thin scattered
fibrea called intertransverse ligaments:
each ligament extending between the adjacent
transverse processes - are made by desertion, (B7.)
- The Atlo-axoid articulation -
The articulation between the atlas and axis consists
of a diarthrodial and arthrodial joint on 
each side, formed by the articular processes, as 
between other vertebrae and of a pivot joint in 
front between the posterior face of the anterior arch
of the atlas and the front of the odontoid process
of the axis - The ligaments of this articulation are 
six in number. 

I Two ant atlo axoid
II Posterior " "
III Transverse
IV Capsular Ligament -
I Two ant. atlo axoid lig
II one Port " "
III Transverse - - "
IV Capsular lig.
Transverse is allocher latterally at.

1st- Two anterior atlo-axoid one of which is a cord [illegible]
tending from the anterior tubercle of the atlas is to 
the front of the base of the odontoid processes; the other 
lying beneath is a membranous layer attached to [illegible]
anterior arch of the atlas and base of odontoid process
and body of the axis.
2d- Posterior atlo-axoid, which is a membrane like
ligament attached above to the posterior arch of the
atlas and below to the laminae of the axis -
3d- Transverse, which passing horizontally across [illegible]
foramen in the atlas behind the odontoid [prsec??e]
binds it to the anterior arch of the atlas, and as it 
passes over the odontoid process it sends a bund[illegible]
of fibrea downward to be attached to the rock of base of the 
*mode process and another upward to be attached to th[illegible]
by [illegible] basilar processes then assuming the shape of a [illegible]
cross and hence often called the cruciform [ligamen?]
4th- Two capsular, which connect the articular process
The Occipito-atloid Articulation -
This is a moveable joint of the condyloid variety; [illegible]
articulating surfaces being the two condyles of the 
surfaces of the atlas below.
The ligaments of this joint are (1ð.) Those that pass 
between the atlas and occipital bone seven in number:
(2ð.) Those between the occipital bone and axis,
four in number. 
1st Anterior occipito-atloid, which consists of two [illegible]
a superficial rounded cord on the middle line extending
from the basilar process to the anterior [tuberc??]
of the atlas and secondly a ligamentous membrane attached
above to the anterior margin of the foramen [magm??]
and below to the anterior arch of the atlas
2d- Posterior occipito-atloid, which is also a broad [membran?]
like ligament passing between the posterior margin of the 
foramen magnum and posterior arch of the atlas. 

Occiptio Atloid
I Ant Occip At. lig.
II Post " " "
III The two capsular lig.
VI Two Transverse by [illegible]
V Occiptio Atloid lig -
IV Odentoid lig 

Joints are classified as to their [illegible] - Not a 
to the movement.
11
3d- Two capsular ligaments, one on each side, each 
of which is attached above to the condyle and below
around (the articulating surface of) the superior
articular process of the atlas.
4th Two Lateral Occipito-atloid one on each side, 
extending from the transverse process of the atlas 
to the transverse ridge (process), of the occipital bone
5th- The occipito-axoid appears to be a continuation
of the posterior common ligament of the spine, being 
attached to the posterior surface of the body of the 
axis it passes up covering over the odontoid process
and cruciform ligament and is attached
to the basilar process.
6th- The odontoid ligament consists of three parts
which have a common attachment to the extremity 
of the odontoid process below, while above
they separate one being attached to the front margin
of the foramen magnum and one to each 
(a) [illegible] side of Condyle.
lateral margin - These three parts are sometimes 
known as the check ligaments. middle one mode 
by desection, 
- Sacro-vertebral articulation -
The joint between the sacrum and last lumbar
vertebra is similar to that between two vertebrae:
the articulating surfaces being the articular processes
of the two bones. The ligaments here are the 
same as at an intervertebral joint and in addition
there are two ligaments on each side, the ilio-lumbar
and lumbo-sacral, these being generally
considered among the ligaments of the pelvis -
The lumbar iliac ligament extends from the 
transverse process of the 5th- lumbar vertabra outward 
Is outer lock [illegible]
of capsular lig.



12
outward to the ilium just above and in front of its 
ear-shaped articular surface. The lumbo-sacral
ligament passes from the transverse process of 
the 5th- lumbar vertebra downward and outward
to the wing of the sacrum -
- The movements of the Spinal Column -
Motion at the intervertebral joints is very slight betwen
any two vertebrae but the aggregate is considerable -
The movements are flexion extension
right and left lateral motion, or right abduction,
left abduction and adduction, rotation and circumduction - 
Flexion, is the bending of the column forward.
The mechanism of this motion is that the inferior
articular processes glide upward and backward
on the superior, the front of the intervertebral
disks being compressed and the laminae and 
spinous processes separating.
Extension is the reverse of flexion.
It is restricted by the anterior common ligament
and by the spinous processes - Its mechanism is 
the exact reverse of that of flexion.
Lateral motion or abduction is a bending of the 
column to one or the other side; it is limited by the 
transverse processes and by the intervertebral disks.
During its performance the inferior articular process,
on the side toward which motion occurs,
glides downward and the opposite one upward.
Rotation consists in the movement of the column
around its own axia -
It can occur, of course, to either side - The mechanism 



13
mechanism of this movement is as follows, the inferior articular
process on the side toward which motion occurs,
moves backward, while the opposite one moves
forward, the fibres of the intervertebral disk being
twisted and stretched and the spinous process
moving away from the side towards which motion
occurs.
Circumduction is the partial performance in 
succession of flexion, abduction, extension, adduction,
so that the trunk and head circumscribe a 
cone-shaped space the apex of the cone being in the 
lumbar region, where the centre of motion is.
In the performance of these various movements the 
cervical portion of the column is freed to move,
the dorsal least so -
The atlo-axoid joint participates in the foregoing
movements, but possesses also the freedom of 
revolution, in which the atlas the freedom of 
odontoid process as an axis carrying the skull
with it - In this movement the inferior articular
process of the atlas, on the side towards which 
motion occurs, glides backward and the opposite 
one forward on the superior articular process of the 
axis, while the anterior arch of the atlas moves on 
the front of the odontoid process - This movement
is restricted chiefly by the odontoid ligaments -
Motion at the occipito-atloid articulation is confined
to flexion and extension; in flexion the 
skull goes forward and downward and the condyles
move upward and backward in their receiving 
cavities; the mechanism of extension
the reverse - 

Vertero steural ref to grey.
Strict. speaking this is not so.
Sellate 

omit summary of the osteology
of the parts [illegible] [illegible] the [illegible]
14
- The Costo-vertebral Articulation -
The parts of the skeleton which enter into a costo-vertebral
articulation are the posterior extremity
of the rib and the body and transverse process of 
the vertebra with the intervertebral disk between
two vertebrae.
omit (The posterior extremity of the rib presents a head 
which is marked by a horrizontal ridge, supporting
the head is a neck which terminates about
an inch from the head in the tubercle the extremity
of which has an articular facet - The 
vertebral column furnishes a proper receiving
pit for the head of the rib the lower lateral margin
of each body in the dorsal region presenting a 
demi-facet and the upper lateral margin of the
body below a similar one; the intervertebral disk
between the two receiving the horizontal ridge
on the head of the rib.
The extremity of the transverse process of each 
dorsal vertebra presents an articular facet for 
the one on the tubercle of the rib -)
This articulation is diarthrodial and arthrodial;
The ligaments which connect the head of the rib
to the vertebral column are 1) anterior-costo-vertebral
2) capsular and 3) inter-articular.
The anterior costo-vertebral ligament is attached
to the anterior aspect of the head of the rib and 
radiating in three bundles, the upper is attached
to the body of the vertebra above, the lower to the body of 
the vertebra below and the middle to the intervertebral
disk between them - This ligament is known 
as the stellate owing to the divergence of its fibres. 

no joint at junction of 1st" Rib and sternum.
[illegible] earth is cont with elnnumd.
motion is very slight gliding motion
in every direction
when head of rib is pulled up the ant 
Extrem tends to move down
these is are named from the ret. not recth.

15
The arrangement of this ligament differs from the 
foregoing description in the 1st=, 11th= & 12th= ribs where 
the ligament of each is attached to the body of only
one vertebra because the articular facet is furnished
wholly by one -
The capsular ligament consists of a few scattered
fibres around the articulation.
The interarticular ligament is attached to the 
horizontal crest on the head of the rib and to the 
intervertebral disk thus dividing the joint into 
two parts which are furnished with separate
synovial sacs - (For the reason above given the 1st=
11th= & 12th= ribs have no interarticular ligament
and but one synovial sac each.)
The articulation between the rib and transverse 
process, known as the costo-transverse, presents
three ligaments, anterior, middle and posterior
costo-transverse - 1) The anterior costo-transverse
ligament extends from the upper aspect of the 
neck of the rib to the transverse process above.
2) The middle costo-transverse or interosseous ligament
extends from the posterior surface of the neck
of the rib, directly backward to the transverse process.
3) The posterior costo-transverse extends from the 
tubercle of the rib to the apex of the transverse process.
- Temporo-maxillary Articulation -
The temporo-maxillary articulation is formed
between the condyle of the lower jaw and the 
glenoid cavity of the temporal bone. (The condyle
is oblong in shape & oblique in direction, its 
long diameter being from without inwards 

[illegible]
[illegible]
[illegible]
Ligaments of the Tempro Max Joint
External Lateral ligament
internal " " " " " " 
Capsular - " " "
Stylo maxilary " " " 
The inter arter felro Carth has the Ext Ptery.
Allocter in fient 95 gray 

[illustration]
16
and backwards on its inner aspect is a depression
for the external pterygoid muscle. The portion
of the glenoid cavity concerned lies in 
front of the fissure of Glaser and presents in 
front of itself the eminentia articularis or the 
anterior root of the zygoma for the cavity lies 
between the two roots of the zygoma.)
This is a diarthesdial and condyloid joint
and presents four ligaments, internal & external
lateral, capsular and stylo, maxillary and an 
inter-articular fibro-cartilage which is sometimes
perforated - when this is the case there is 
but one synovial sac in the joint, otherwise there 
are two one between the inter-articular cartilage
and the other between it and the glenoid cavity
The 1) external lateral ligament is attached to 
the zygoma above, from its tubercle forward, and 
passing downward and backward is attached
to the outer border of the neck of the condyle. [illegible] of Cop. lig.
The 2) internal lateral ligament is attached 
above to the extremity of the spinous process of the Grt wing
sphenoid bone and below to the shelf of bone forming
the lower margin of the interior dental foramen
on the inner face of the ramus of the lower
jaw.
The 3) capsular ligament consists of thin
scattered fibres around the joint.
4) The stylo-maxillary ligament, properly is 
no ligament of this joint, it extends from the near the top of 
styloid process of the temporal bone to the angle 
and posterior border of the ramus of the lower jaw.
The movements of this articulation are four, 1) depression,

The condyes of the 2d or 3d wks have an inter articular ligament each 

17
depression, 2) elevation, 3) a lateral movement and a 
forward movement. In depression the lower jaw
is separated from the upper the lower receding
while the upper is almost stationary. The mechanism
of movement consists in a rolling
forward of the condyle on the eminentia articularis 
and when exaggerated may lead to dislocation -
Elevation is the reverse of depression -
In the lateral movement the lower jaw is 
twisted to one side, as in grinding between the 
molar teeth; this movement is checked by the condyle
of the side towards which motion occurs,
coming in contact with the inner limit of 
the glenoid cavity
- The Costo-sternal Articulation -
The ribs have attached to their anterior extremities 
the costal cartilages which prolong the seven
true ribs to the side of the sternum where the cartilages
are received into pits found there being 
held in place by ligamentous fibres which
pass from the cartilage to the sternum in front
and behind - The cartilages of the 2d= & 3d= ribs have 
also an interarticular ligament each.
- The Articulation of the Pelvis -
The articulations of the pelvis are four, that between
the 5th= lumbar vertebra and pelvis, that between 
the sacrum and cocyx, that between the sacrum
and os innominatum of each side and that 
between the two ossa innominata.

Sacro Sciotve
Common attachment
is joist inf. S-P-
Cdyes{ Coeyx
{ Sacrum.

18
The ligaments which hold the 5th= lumbar vertebra
to the sacrum have been described with those
of the spine. The cocyx is held to the sacrum by 
a small intervening disk and by ligamentous
fibres in front and behind.
The os innominatum is held to the sacrum by
an articulation between the sacrum and ilium
and by two other ligaments known as greater
and lesser sciatic. The sacro-iliac articulation,
or symphysis or synehondosis is effected by the 
auricular surfaces of sacrum and ilium
and two ligaments, anterior and posterior sacro-iliac.
The anterior sacro-iliac ligament consists of a 
thin plane of fibres passing between the front of 
the sacrum and ilium.
The posterior sacro-iliac ligament is a large
strong mass of ligamentous fibres which pass
from the rough surface behind the auricular surface
of the ilium to the similar one of the sacrum
filling the deep depression which would otherwise
exist there -
The two sacro-sciatic ligaments have a common
attachment to the edges of the cocyx and 
sacrum and posterior inferior spinous process
of the ilium as the mass passes forward and 
outward, one part the lesser sciatic ligament
is attached to the spine of the ischium, while the 
rest continues on as the greater sciatic to be attached
to the tuberosity of the ischium and along
its ramus -
The aperture above the lesser sciatic ligament is 


2 plates of felio cartilage.
thicker in front than behin -
and Synovial Sock.
Triangular lig. of the pubes.
Base back. cuesp. to a line drawn
between the tubes. is cleii " fontpab.
sides are attached to the post
edge of the int. border of the 
ramus of the Ischium Pubes whole
length.
Apex forward, cent with Dub pubic lig.
in it is the Urethreal { il foramen
{ aperture
given thus year with the in innominate
ligaments. 

19
known as the greater sacro-sciatic foramen and 
the one between the two ligaments as the lesser sacro-sciatic
foramen.
The Articulation between the two ossa innominata
is found between the two pubic bones on 
the front of the pelvis and is known as the symphysis
pubis -
Each bone presents an oral articular surface,
whose long diameter is downward and backward,
coated by a thin plate of encrusting cartilage, these 
plates being in contact only at the back part 
leaving a wedge-shaped interspace in front
which is filled by fibres passing between the two 
plates - Besides this interarticular ligament
there are four others, superior, which consists of 
fibres passing between the two bones above the 
articulation, anterior, consisting of fibres passing 
across in front posterior, consisting of fibres
passing across behind and inferior which is 
formed by fibres stretching between the bones
below and filling in the angular internal between
the two rami so as to form a smoothly curved
arch -
- The Sterno-clavicular Articulation -
The sterno-clavicular is a movable joint of the 
saddle-shaped variety and is formed by the upper
end of the sternum, cartilage of the first rib 
and inner extremity of the clavicle.
(The upper end of the sternum furnishes an articular
depression on its lateral aspect facing upward
and outward its long diameter from above
downward and separated from the articular



20
articular depression of the opposite side by the semilunar notch
in the top of the sternum.)
The cartilage of the first rib by its upper border aide the 
depression on the sternum in furnishing a receiving cavity
for the inner extremity of the clavicle
The inner extremity of the clavicle presents an articular
surface, oblong and with its long diameter vertical & inward
and which is continued on the lower aspect a short distance.
The ligaments of this joint are three a capsular, the costo-clavicular
and interclavicular; the capsular, attached
to the margins of the articular surfaces on the clavicle,
sternum and cartilage of the first rib, is sometimes divided
into two, anterior and posterior sterno-claviclar
continuous with one another above and below- 1) The costo-
Rhomboid or clavicular ligament is attached to the under surface
of the clavicle at Rhomboid [illegible] and passing downward and inward
seizes the upper border of the cartilage of the first rib.
2) The inter-clavicular ligament seizes the inner extremity
of one clavicle on its upper aspect where it is continuous 
with the capsular ligament and passing across the 
top of the sternum sinking into the semilunar notch, is
fixed to the opposite clavicle in the same manner
The joint is provided with an 3) inter-articular fibro-
cartilage which is attached above to the upper part of 
the articular surface of the clavicle and below to the 
sternum and cartilage of the first rib just where they 
meet; thus it can act as a ligament in holding the 
parts in opposition; it is often

The outer extrem of clav. rests on the 
acromian process.
Inter arte filo Cath.

21
much worn, in a laboring man especially; the degree
of attrition being greater on the right side 
owing to the more frequent action of that side.
The joint of course presents two synovial sacs.
The movements are slight but in every direction
upward, downward, backward and forward.
The [illegible] end of the Clav. fumes in apporet duect to outer exterm.
the 1st= [illegible] aclered as a pivot
- Scapulo-clavicular Articulation -
The scapulo-clavicular is a moveable joint of the 
arthrodial variety (the articulating surfaces being
an oval facet on the outer extremity of the clavicle
and a corresponding facet on the anterior edge of 
the acromion process of the scapula near its apex;
it should also be observed that the clavicle in its 
outward course passes just above the coracoid process
but does not articulate with it through receiving 
a ligamentous attachment to it.)
The ligaments of this joint are two capsular and 
2) coraco-clavicular. The capsular is attached
around the articulating surfaces. The coraco-clavicular
passes up from the coracoid process to the under
surface of the clavicle; when viewed from the 
front this ligament presents a quadrilateral outline
and is called trapezoid, from behind a triangular
outline and is called conoid.
The joint is provided with an inter-articular
fibro-cartilage, often absent a [perf???] - The movements are 
slight but varied-  simply
gliding in a direct. & also rotation.
- The Ligaments of the Scapula -
Stretched between different points on the scapula
are two ligaments, coraco-acromial and transverse.



22
The coraco-acromial, thick and triangular is attached
by its apex to the tip of the arcomion and 
by its base to the coracoid process; serving as a 
protecting arch over the shoulder joint - 2) The transverse 
ligament of the scapula process over the supra-scapular 
notch from one extremity of it to the 
other thus converting it into a foramen -
- The Shoulder Joint -
The shoulder joint or scapulo-humeral articulation,
belongs to the movable class and ball and 
aschet variety.
(The bony surfaces contributed to this joint are the 
upper extremity of the humerus and the glenoid
cavity of the scapula.
The points to be noted on the humerus are, the globular
articular head supported by the anatomical 
neck, the greater and lesser tuberosities separated 
in front by the bicipital groove.
The glenoid cavity is situated at the anterior
angle of the scapula is articular for reception of 
the head of the humerus, shallow oval, its small
end up and its long diameter vertical; the cavity
is surrounded and slightly deepened by the glenoid
ligament which is a fibro-cartilaginous and 
triangular on cross section, attached to circumference
of the cavity; partially continuous with the 
upper part of the glenoid ligament is the tendon
of the biceps muscle -)
Holding the bones connected is a capsular ligament
attached above to the scapula just behind 
the glenoid ligament and below to the anatomical 




23
neck of the humerus, being prolonged thence over the 
tuberosities. [cross out]
The upper part of the capsular ligament is thickened
and often individualized into a separate
ligament under the name of coraco-humeral, extending 
from the base of the coracoid process to the 
greater tuberosity of the humerus. The capsular
ligament is remarkably long and loose surrounding
the head of the humerus but loosely and by its
redundant length allowing separation of the humerus
from the scapula to the extent of an inch;
these characters of the capsular ligament endow the 
shoulder with peculiar freedom of motion - The synovial 
membrane of this articulation often communicates
with a bursa mucosa beneath the tendon
of the subscapularus muscle and sometimes with 
one beneath the infra-spinatus.
Strengthening the various aspects of this joint are 
the following muscles.
Above, the supra-spinatus -
Behind the infra-spinatus teres minor
In front the subscapularis-
Joining a protecting cushion over the joint in 
front, behind, and above is the deltoid muscle,
which covers the insertion of the other muscles and
produces the bulge of the shoulder.
Besides these muscles the joint is further provided
against the effect of violence incident from above
by the overhanging arch formed by the acromion
and coracoid processes and the coraco-acromial
ligament stretched between them.
The movements at the joint are, flexion, extension,

Inguinal Hernia
Lower at of ant abdom wall. ---
Remove skin - from abdom wall - colum & [illegible]
(1) superficial focia - 2 - layers - artificial
" " " vies. mark - " of fossia (&c) 2 los of Sep. &
(2) - Depe up - layer of foccia - lies direct on appen
of Ext. oblique --
are in sup. foscia
{ superes - are of Epeqos.tue ant, its vein.
{ along Poup. lig - gen below - = cercum Iliac -
{ also superficia ext. perdic.
{ Hypo gastric branch of ilo Hypo
{ urgunst branch of " urgured.
Deep. layers of Sup. fascia is adbuant arroud the ext. above ring -
who from there down is collir cuter collum - foscia -
The super layer can be followed lower to form
one of the coreiy of Ustes as is deep layer & both form dart to
The deep layer is adbuact to pereputo lig and lower pt.
fascia late as low as saphenous a piecing
[cross out] on getting into sculum they the (2) layers blend together
get. mus. fibers and from the dortes of 
the serolium et also envelopes the cord from ext.
abdom ring. -
Ext. Abdom mus - its appen is thin & holes in it 
the lower edge. ant sup. spin percers. & sprue of 
pubes. - and is curved on its self. Told of gives
is below porep acts lig. is convex downward. more pt (6) 1/2
of its course is horiz. forward.
Allochir to its inter surface. foscia & foocia later
its direct: varies with resin of [cross out] fascia late
(4) movements of the leg. 

24
extenion, abduction, adduction, circumduction and rotation -
The mechanism of those movements is as 
follows. In flexion the humerus is carried forward
and the head simply spins on its axis in the glenoid
cavity
In extension the reverse occurs, the head of the humerus
of course spinning in the opposite direction
and the humerus is moved backward.
In abduction the humerus is carried outward
from the middle line of the body and its head
moves downward in the glenoid cavity; pressing
against the lower part of the capsular ligament
and were the motion exaggerated rupture of the 
ligament might occur and consequent dislocation
of the humerus.
Adduction is the reverse of abduction.
Circumduction is the combination of the preceding 
motions the head of the humerus rolling around
the glenoid cavity.
In rotation the humerus revolves around an 
imaginary axis represented by a line drawn 
from the centre of the head to the internal condyle, 
the head moving backward in inward rotation 
and forward in outward rotation.
- Rade - iluar Articulation -
The articulation between the two bones of the forearm
forms a movable joint of the trochoid, or pivot
variety. The bones articulate both at their upper and 
lower extremities being separated by the interosseous 
space throughout their shafts -
The upper extremity of the ulna presents the upward


?
(on inner surface, of ext. oblyum is transratde fuscia) - inner in is allochr
to plet. line of pubes to Gembunets lig. apexllt spine of pubes.
a prolongates of " " " up & in. = 4 lig - just behind
sup- adb- viz -
There is a slit in appen of Ext. oblyue. lower ounces pt. conap. to
the crest of pubes. [illegible] direct of split = downward & found.
base down & in. int. to spine of pubes.
Edges of ring are pellers of ring - sup. & inf.
The int. or Sup. pellar interlocks with peller of opposite side.
The right a [illegible] superficial
The axt. or lower. is lost in pouparts lig.
To present the splelters of ung up too for you here inter
Collum fibers. many occurs the upper or outer border of 
ring.
The int oblyue & naus, mus are both mentr into outer 1/2
of pouparts lig. are belended together int. oblique does a little 
farther down. on poup. lig. are fleshy in region & as they 
leave the lig. this form the conj arch rising 1/2 in
above Pouparts lig. as long as they seem fleshy = arch
when they become tendinus = conjoint lend on 
and is insulted behind ext abdom ring into pect. lime
and erect of pubes.
Where the conj arch seases to arrise = outer abltument
" " " lendn cem. to insute = [illegible] " " " 
[illustration] If you cut just below conj arch & above
pouparts lig you cut into abdmr cultry
2 - less mus.
The hans. foreve oasses below conj. arch. and in 
it is a hold just beneoth abt. (outer one) on conj
arch is the deep abdorm ring [illegible] that 

25
upward projection of the olecranon process tipped
by its beak, and the forward protusion of the coronoid
process; occupying the front of the former
and the upper aspect of the latter is the articular
surface, called the greater sigmoid cavity marked
along its centre vertically by a ridge, in order to correlate
it to the trochlea of the humerus on which it 
plays. Encroaching on the outer side of the greater
sigmoid cavity is the concave articular surface 
known as the lesser sigmoid cavity, which receives
the head of the radius -
The upper extremity of the radius presents its 
head surmounted by a cup-like articular surface 
receiving the eminentia capita of the humerus;
the rim of the head being articular to play in the 
lesser sigmoid cavity & supporting the head is a 
neck and below the neck internally is the bicipital
tuberosity -
The lower extremity of the ulna consists of two 
parts, the styloid process and the capitulum
ulnae.
The styloid process projects downward from the 
inner back part and is separated at its base, behind
by a vertical groove, on the summit of the 
lower extremity by a rough pit. The capitulum
ulnae is articular on its summit for the triangular
cartilage of the wrist joint and on the outer 
part of its circumference for the sigmoid cavity of 
the radius. The lower extremity of the radius is quadrilateral -
Projecting downward from the outer side is the styloid
process, which is grooved posteriorly, convex

you see sp= matic cord. which rend down & in 
for 1 1/2 = inq and consl. (6) from deep to superficial
abdem rings. direct down & in.
boundus - above conj- arch.
Below Pouparts lig.
Ant. appen. ext oblique.
Post- inner 1/2 = conj. tendon -
outer 1/2 = trans fascia
Inner surf- of abdom mus- or well
Just below the outer abbulment of conj. arch is int abdem iivj
Deep - Epigastric - acty- cut - to out ring. ring.
The testicle is enveloped by Infum Clit. fascia rose = Jam
tho neck [illegible] up [illegible] to int. ring and is 
allocher to mergin of deep ring to superficial [cross out]
free of Tran. & orcio. = visceral cavity for testicle -
Cremaster mus - on ext. sufoce of Infen. tube - are 
allocher to poup. lig. passing through Ext. abdem
ring. tho other fibes are allocher to conj. Under
& first symph.
(1) Skin
(2) fascia
(3) cremes mus 
(4) Infen deb.
Tunica voy. tests extends only into lower pt of [illegible]
of Inferndib. -
Int. abdem ring - parietal longer of p. senupo [illegible]
int ring forming a little dimple. you see 
also a ridge by Epigastric arty. that pt. of 

26
and sub-cutaneous externally and articular internally -
The summit of the lower extremity is articular
for the first row of carpal bones; this surface is 
crossed antero-posteriorly by two slight ridges, is 
continuous with the articular surface on the inner
side of the styloid process, is concave and is called
the carpal cavity. The inner side of the lower extremity
presents a shallow, articular concavity, the sigmoid
cavity of the radius, whose long diameter is 
antero-posterior and which is separated from the 
carpal cavity by narrow rough margin, to which 
the base of the triangular cartilage is attached.
The front of the lower extremity is protuberant and 
rounded, the back is rough and vertically grooved.
The ligaments holding the bones together are found
at their upper and lower extremities and between
their shafts - Above the two bones are held togehter by 
one ligament, the orbicular, which forms three
fourths of a ring, the other fourth being the lesser
sigmoid cavity of the ulna - The ligament surrounds
the articular rim of the head of the radius
and is attached by its two ends to the extremities of 
the lesser sigmoid cavity.
The lower fibres of this ligament are tightly stretched
around the radius just below the bulge of its rim
and hence it is difficult to release the radius
from its grasp.
The shafts of the two bones are connected by two ligaments,
the oblique and interosseous.
The oblique ligament is a narrow band that 
passes downward and outward from the ulna,
at the base of the coronoid process, to the radius,

inner surface of abdom wall - on inner side of 
ridge is int. ing unol forsa - " Ext. " " 
arty ext. mugul - " "
Ext. abdom ring if a Knife be Dorset bred
you have. & entering int. inq. forsa 
Hersel - breks 
[illustration] - Rulus mus.
tose = poupate lig.
tenure. ala
Epigastic arty
( 2nd= ridge. made by po gastic arty. into 
( internal inquaol fossa.
Descent of testicle.
huckle. of qut.
(1) Pentum - - - coring the mouth of Infum. tube -
complete when it emerges through sup - adom ring.
(1) - Pemtum -
(2) inferred tube
(3) Cumater fascia
(4) culucol fascia 
(5) sup layer of sup fascia
Congenital - hernia. - Cour by non atup by of the pentevol
sac -
Partial aterphy - nearly to deep ring or gut may be 
driven alone the side of the sock as concrete the 
sock.
also cumartmus
proluses of qut
direct hernia opp ext abom [illegible]
(1) Pembin 
(2) Frans foscus 
(3) Conf. tendon
4 inter coll fessia
(5) sup. layn sup fessia
(6) skin 

27
just below the tuberosity -
The interosseous membrane extends from the lower
extremities upward about two thirds the length of the 
shafts leaving an interval above, which is crossed
by the oblique ligament.
The fibres of the interosseous membrane are directed 
downward and inward between the inner
border of the radius and the outer border of the ulna.
The membrane is pierced by a foramen for the anterior
interosseous artery about the lower third of the 
fore-arm.
The two bones are held together at their lower extremities
by two ligaments and the triangular fibro-cartilage 
of the wrist.
The two ligaments are one in front and the other 
corresponding faces of the bones -
The triangular cartilage tips the summit of the 
capitulum ulnae and excludes it from the wrist-joint -
It is attached by its apex to the pit between
the styloid process of the ulna and the capitulum
ulnae; by its base to the narrow rough margin between
the sigmoid and carpal cavities of the radius.
The movements between the two bones are two, in
both of which the radius alone moves.
The radius can move forward, pronation, or backward,
supination; in both the hand is carried along.
In these movements of rotation, or revolution the 
radius rotates around an axis represented by an 
imaginary line drawn from the centre of the head 
of the radius through the centre of the capitulum ulnae.

2 or you may here splitting of conjoint [illegible]
3 " " " " slippin around " " " outer Sides
[cross out]

28
consequently in performing pronation the sigmoid
cavity of the radius moves forward on the articular
rim of the capitulum ulnae, in supination the reverse
occurs; while the head of the radius rotates in 
the orbicular ligament and lesser sigmoid cavity
of the ulna.
- The Elbow Joint -
The elbow joint is of the movable class and hinge
variety; its bony surfaces being furnished by the 
lower extremity of the humerus on the one hand 
and on the other by the upper extremities of the 
ulna and radius; the latter have been described
with the radio-ulnar articulation.
The lower extremity of the humerus presents on 
its lateral aspects the condyles, internal and external.
On its very extremity the humerus carries an articular
surface divided into two parts; the outer is 
the rounded articular protuberance, eminentia
capitata, intended for articulation with the cup
surmounting the radius, the inner one, separated
from the eminentia capitata by a depression, is 
a trochlea, which consists of two prominences with 
an intervening depression; above the trochlea in 
front is the coronoid fossa, above it behind is the 
more capacious olecranoid fossa.
As this is a ginglymoid joint it has no capsular
ligament but the bones are held in opposition by 
ligaments, placed in front, behind an at the sides
of the joint and the radius is confined in the 
lesser sigmoid, which forms about the fourth of 

V.B. The ant is altocher below to [cross out] ulna & orbic Lig.
" Post " " " " ulna groove in [illegible]

29
the periphery of a circle, by a ligament called the 
orbicular which is an incomplete ring attached
by its ends to the extremities of the lesser sigmoid
cavity, thus completing the circle in which resolves
the head of the radius and as the orbicular ligament
is drawn most tightly just beneath the articular
rim of the head of the radius the latter
cannot be pulled out of the grasp of the ligament
without rupturing it.
Since revolution of the radius in the orbicular
ligament and lesser sigmoid cavity is demanded
by full power of movement in the hand and 
since this revolution would be impossible were it 
seized by any ligament attached to the humerous,
for ligamentous fibres are inelastic, it will be 
found that certain ligaments of the elbow joint
in order to avoid this interference with revolution of 
the radius are attached to the orbicular ligament
which bind the humerous to the bones of the fore-arm
are anterior, posterior and two lateral. The anterior
ligament is attached above to the humerous just
above the [cross out] coronoid fossa and below to the coronoid
process and orbicular ligament.
The posterior ligament is thin and weak, attached
to the humerous just above the olecranoid fossa it 
descends to seize the olecranon, the groove just behind
the greater sigmoid cavity.
The external lateral descends from the external
condyle of the humerous to the orbicular ligament.
The internal lateral ligament triangular in 
shape, is attached by its apex to the internal condyle




30
condyle of the humerus and descending divides into 
two fascisuli one of which is attached to the inner
edge of the greater sigmoid cavity on the olecranon
and the other to the inner edge of the greater sigmoid
cavity on the coronoid process.
The muscles which strengthen this articulation
are as follows.
On the front are the brachialis anticus.
Behind are the anconeus and triceps.
Internally are the muscles of the front of the fore-arm
which spring from the common origin.
Externally are the muscles which arise from the
external condyle of the humerus; notedly the spinator
brevis.
The movements are the two characteristic of a huge
joint, flexion and extension.
The mechanism of flexion is that the greater sigmoid
cavity and articular cup of the head of the 
radius more forwad on the articular surface of the 
lower extremity of the humerus, the former on the 
pulley and the latter on the eminentia capitata -
This movement is checked when the apex of the coronoid
process impinges on the bottom of the coronoid
fossa. The mechanism of extension is the exact
reverse of that of flexion and is limited by contact
of the beak of the olecranon process with the bottom
of the olecranoid fossa.
- The First Joint - nov. 13 191
The wrist joint belongs to the moveable class and 
the condyloid variety: the condyle being furnished
by the upper row of carpal bones, scaphoid, semilunar


[illustration]
note lig. is not alloctur to the 
ulna behind.
95/ just the opposite of the Lig at the elbow 

31
semilunar and cuneiform, having its long diameter transverse,
the receiving cavity for the condyle is contributed
by the lower end of the radius and a plate of fibrs
cartilage which lies on the bottom of the ulna.
This plate of fibro-cartilage is triangular in shape
and is attached by its apex to the outer aspect of the 
base of the styloid process of the ulna while its base
is adherent to the inner edge of the articular surface
of the radius thus cutting the ulna off from 
direct participation in the joint.
The ligaments of this joint are four, anterior, posterior
and two lateral. The anterior ligament is attached,
above to the front of the radius and ulna
and below, to the front of the bones of the condyle
The posterior ligament is attached above to the back
of the radius and below to the back of the bones of the 
condyle - The internal lateral ligament passes
from the styloid process of the ulna to the cuneiform
and piriform bones.
The external lateral ligament connects the styloid 
process of the radius with the scaphoid and trapezium.
The joint is strengthened by no muscles though
many tendons run over it they are too slender lax
and free to give support.
The movements are flexion, extension, abduction,
adduction and circumduction - The mechanism
of these is as follows.
In flexion the condyle moves backward in its 
cavity and presses against the posterior ligament
which may be ruptured by exaggerated motion
producing dislocation backward of the corpus and 




32
this may be occasioned by a fall on the back of the 
hand when it is flexed, i.e. when it is bent forward
on the fore-arm.
Extension is the reverse of flexion.
In abduction the hand is moved away from the 
middle line, the condyle moving inward.
Adduction is the reverse of abduction.
- The Articulations of the Carpus & Metacarpus.
The bones of the carpus which lie in the same row 
are held together by ligamentous fibres passing across
them in front and behind, palmar and dorsal
ligaments, and by fibres which seize the opposing
surfaces of adjoining bones called interosseous; their
being no interosseous ligament however between trapezium
and trapezoid.
In the same manner the metacarpal bones of the 
four fingers are held to each other at their bases.
The two rows of carpal bones are bound together by 
ligamentous fibres passing from one to the other in
front and behind, palmar and dorsal ligaments,
and by two lateral ligaments, the external passing
from scaphoid to trapezium, the internal from 
cuneiform to unciform.
The metacarpal bones of the four fingers are attached 
to the second row of carpal bones by fibres in front 
and behind, palmar and dorsal ligaments and 
in one situation by interosseous fibres, extending from 
the adjacent parts of magnum and meciform to 
the bases of the third and fourth metacarpal bones.
- The Trapezis-metacarpal Joint -



33
The articulation between trapezium and metacarpal
bone of the thumb belongs to the movable class
and the saddle-shaped variety. It is invested by 
a capsular ligament and allows five movements,
flexion, extension, abduction, adduction and circumduction.
- The Metacarpo-Phalangeal Articulation -
The knuckle-joint, or metacarpo-phalangeal, is of 
the movable class and condyloid variety; the condyle
is furnished by the head of the metacarpal
bone and the receiving cavity by the top of the corresponding
phalam aided by a plate of cartilage 
known as the anterior ligament of the joint.
The ligaments of this joint are two lateral seizing
both bones on their lateral aspect just beyond the 
articular surface.
The place of a posterior ligament is supplied by 
the exterior tendon of the finger and the anterior
ligament is no ligament at all in the true sense of 
the word being only a mass of fibro-cartilaginous
material attached to the front edge of the articular
surface on the base of the phalam and increasing 
the size of the receiving cavity.
The movements here are the four angular angular
and their combinations circumduction.
- The Inter-phalangeal Articulation -
The articulation between two phalanges is of the 
movable class and hinge variety, the head of 
one phalam presenting the trochlea and the base 
of the other the answering surface. The ligaments
are exactly similar to those of the metcarpo-phalangeal



34
phalangeal articulation but the movements are only
flexion and extension.
Nov. 1491
- The Hip Joint -
The hip joint is of the movable class and ball
and socket variety its bony elements being the 
acetabular cavity of the os innominatum and 
the upper extremity of the femur.
The acetabulum is a cup-shaped surface formed
by the three bones which make up the os innominatum,
the ischium contributes rather more 
than two-fifths of it, the ilium rather less than 
two-fifths and the pubes one fifth. Its margin
is prominent except at the inner aspect where 
there exists a deep notch; leading to this notch
is a rough depression in the bottom of the cavity.
Surmounting this margin in the fresh joint is 
a fibro-cartilaginous ring called the cotyloid
ligament, which is continued over the notch in 
the margin, the part stretched over the notch
being known as the transverse ligament. Occupying
the depression in the bottom of the acetabulum
is a cushion of fatty tissue.
The femur furnishes a head forming about two-thirds
of a sphere having just behind and beneath
its centre a rough depression; supporting the head
is the neck which is directed obliquely upward
and inward from the shaft, the degree of obliquity 
varying with age and sex; its slenderest part
is just above the centre, whence it dilates in both 
directions but much more toward the shaft; its 
greatest diameter is vertical and its upper border

Lig. tens is surrounded by a foed of the synoviol
membrane.


35
is much the shorter and terminates at the greater
trochanter, while the lower border terminates at 
the lesser trochanter; connecting the trochanters
behind is the posterior inter-trochanteric line.
The ligaments which bind together the bony elements
of this joint are capsular and ligamentum
teres. The capsular ligament encloses the joint
closely and its length is such as to keep the bony
surfaces in contact thus differing from the long,
loose ligament of the shoulder. It is attached above
to the rim of the acetabulum and below to the neck
of the femur, extending in front the whole length
of the neck but behind it is attached some 1/2 inch
short of the posterior intertrochanteric line. The upper
part of the capsular ligament is much thicker
than the rest, some five times; there receiving 
the support of what is called the ilio-femoral ligament or "ij" lig.
attached above to anterior inferior spinous
process of the ilium and below to the spiral line
of the femur and front of the greater trochanter.
The Round lign ligamentum teres is a cord of fibres which 
starting from the rough depression on the head of 
the femur, forks to be attached to the sides of the 
notch in the margin of the acetabulum - (6) at bottom of the margin.
Efficient to the amount of about twenty-six
pounds in retaining the head of the femur in 
the acetabulum is atmospheric pressure by virtue
of the exact molding of the socket on the ball, the 
head of the femur fitting air-tight in the acetabulum.
The muscles which strengthen this joint are 
Above, Retus and gluteus minimus.



Wilson James G Nelson- Wilson -
36
In front, Posas Magnus, and Iliacus Internus.
Internally Pectorieus and Obturator Extermus.
Behind The outward Rotators of the thigh, (obturatores,
2nd= internus and 2nd= extermus, 4th= pyriform the 5th= gimelli
and 1st. quadratus femoris.) & posset. gluteus medeus.
Or beginning at random and giving these muscles
in the order in which they successively lie around
the joint we have gluteus minimus, rectus,
iliacus internus, psoas magnus, pectineus, obturator 
extermus, quadratus femoris, genellus inferior,
obturator internus, genellus superior and pyriformis.
This is the order in which they come.
The movements at this joint are six in number
and are the same as those at the shoulder,
their mechanism being also the same. As there
dislocation here occurs by exaggerated motion in 
adduction and abduction though it usually occur
from indirect violence, as in a fall on the 
foot or knee while the joint is in a state of adduction,
thus rupturing the upper part of the capsular
ligament notwithstanding its immense thickness.
Nov 14 91 Exam 92
- The Knee-Joint -
The knee, the largest and most important joint
in the body belongs to the movable class and hinge
variety. The bony elements are the lower extremity
of the femur above, the upper extremity of the tibia
below and the posterior surface of the patella in
front.
The lower extremity of the femur presents the 
articular surface of its condyles, external and internal,
the internal being the longer and narrower 



37
narrowly each condyle bears on its free face the prominence
known as the tuberosity, external or internal; just
beneath the external is a depression for the origin of 
the popliteus muscle. Separating the two condyles
in front is a smooth shallow articular groove; this
to-gether with the two condyles forms a pulley;
behind the two condyles are separated by a deep 
non-articular depression called the intercondyloid
notch, which is continuous with the groove
of the pulley -
The upper extremity of the tibia is surmounted
by two shallow articular depressions called glenoid
cavities external and internal, separated by a 
bifid upward projection, the shine of dissimilar
shape since the condyles of the femur play on them,
each assumes the outline of the corresponding condyle:
i.e the external is nearly circular while the 
internal is oval with its long diameter antero-posterior.
Supporting the glenoid cavities are the tuberosities
internal and external; the external marked
by an articular facet for the upper extremity of 
the fibula and the internal by a horizontal groove
for semi-membranosus. On the front of the tibia,
just below the glenoid cavities and separated from 
them by a triangular surface is the anterior tubercle.
The posterior surface of the patella is articular, 
consisting of two facets separated by a vertical
ridge; these facets play on the condyle and 
as the external condyle is the broader so is the external
of the two facets: - 

Preupo extension cuma
note that post lig. is only attaches
to the tibia below. Just like post Elbow -

38
Lying on each of the glenoid cavities of the tibia
is an imperfect plate of fibro-cartilage called
semilunar external or internal. Each plate is 
thickest at its circumference and slopes off to a 
thin edge towards the centre of the glenoid cavity
on which it lies. The internal is oval with its 
long diameter antero-posterior and its two extremities
terminate at the beginning of the depression
in front and behind the spine. The external 
is nearly circular and its extremities
terminate at the base of the spine, in front and 
behind, as it were between those of the internal.
The circumference of each plate is held down
on the margin of the glenoid cavity by short vertical
fibres, these forming what is called the 
coronary ligament, right or left. Passing across 
from the most prominent part of one semilunar
plate to the other anteriorly is a small cord the 
transverse ligament. which does not always occur.
The ligaments which bind the bones together
are anterior, posterior, two crucial and three
lateral, two external and one internal.
The anterior ligament is known as the ligamentum
patellae and extends from the lower
end of the patella to the anterior tubercle of the 
tibia; the patella being held to the femur by the 
attachment of the biceps? extensor. Buesa - fat.
The posterior ligament, or ligament of Toinslow,
covers the whole of the back of the joint, being attacked
above to the back of the femur above the 
condyles and below to the back of the tibia; its 
middle portion is furnished by the tendon of the 

Int- lat. lig - allocter to shaft of libia
gives same fibres to int. tuberosity
is adherent to [illegible] lunar corttage
Insulin of Lime membranous
{ lig. alaric & mucuosa is but a 
{ fold of synovial membrane.
above - & below looked at.
Synovial mem excludes the crucial lig from the 
joint

It is proceed by foramen.
oblique fibers which interlock.
39
semi-membranosus.
The internal lateral ligament is a flattened
band of fibres attached to the inner tuberosity of 
the femur above and the inner tuberosity of the tibia
below. The long external lateral ligament extends
as around cord from the external tuberosity
of the femur to the head of the fibula.
The short-external lateral ligament lies behind & belows
the lung and has the same attachments as it. It is
the tendon of origin of the popliteus, which connected
with the head of the fibula.
The two crucial ligaments are found within the 
joint and are distinguished as anterior or external
and posterior or internal. The anterior is attached
to the tibia in front of its spine and passes upward,
outward and backward to seize the inner
face of the external condyle of the femur.
The posterior is attached to the tibia just behind the 
spine and passes upward, forward and inward
lays hold of the outer side of the internal condyle
of the femur.
The two crucial ligaments decussate in the joint,
hence their name, and are connected where they cross
Besides the foregoing ligaments there are other so-called
ones, though they are not true ligaments and exert
little or no influence to hold the bones to-gether
Stretching from the notch between the condyles of 
the femur to a mass of fat which lies behind the 
ligamentum patellae is a fold of synovial membrane
which has been called ligamentum mucosum
and the lone edges of this fold or cord are 
known as the alar ligaments.



[illustration]
40
The Synovial Membrane of the knee is the most 
extensive in the body; it is not only sufficient for 
the joint itself but extends upon the front of the femur
from an inch to two inches above the articular surface.
It is worthy of note that the synovial sac is 
not in contact with the posterior face of the ligamentum
patellae but is separated from it by a 
mass of fatty tissue.
Investing all these structures is the continuation of 
the fascia lata over the joint to become the deep fascia
of the leg.
The muscles which strengthen the joint are:
In front, triceps extensor.
Behind, the gastrocnemius, popliteus and semi-membranosus.
Externally the tendon of the biceps flexor. biceps extensa
The movements at this joint are flexion and 
extension.
In flexion, the leg is raised backward on the thigh,
the glenoid cavities of the tibia moving backward
on the condyles: the movement is checked when 
the leg is in contact with the back of the thigh.
Extension is the reverse of flexion.
It should be observed that in a state of semi-flexion
the knee-joint is capable of slight movement
or rotation as in eversion or inversion of the foot.
- The Ankle-Joint -
The ankle joint belongs to the movable class and 
hinge variety; its articular surface being contributed
by the lower extremity of the tibia and lower extremity
of the fibula above and by the upper surface 

note that the ant. lig. is only allotus
to the lebia in front
The fibula has no att for ant or post lig at ankle & knee
assumes a A shape below as it [illegible] out

cerist joints [illustration]
41
of the astragalus below.
The lower extremity of the tibia presents the outer
malleolus which has on its inner aspect a triangular
articular facet.
The upper surface of the astragalus presents an unsymetrical 
pulley; the sides of the astragalus being
each marked by an articular facet the outer being 
the larger and more triangular; these being intended
for the play of the mallesli; the astragalus
being grasped between them in such manner as 
to produce what has been called a tenon and mortice
joint.
The ligaments of the joint are an anterior and 
two lateral, internal and external.
The anterior ligament, thin and fatty extends from the 
front of the tibia to the astragalus in front of its pulley.
The internal lateral or deltoid ligament, triangular
in shape, is attached above by its apex to the inner
malleolus while below its base seizes the scaphoid astragalus
and os calcis - This ligament when cut 
through is seen to consist of two layers and is immensely
strong.
The external lateral ligament is in point of fact 
three distinct ligaments though always described as 
consisting of three fasciculi anterior, middle and 
posterior.
The anterior fasiculus extends from the outer malleolus
to the astragalus in front. The middle fasiculus
passes from the outer malleolus downward
to the outer side of the os calcis - The posterior fasiculus
is stretched between the inner aspect of the 
outer malleolus posteriorly to the astragalus behind

opposite to nodid ulnae/95

42
The place of a posterior ligament in this joint is supplied
by the tendo Achilles - also the transverse.
The movements are flexion and extension - In flexion
the foot is raised forward on the leg, the astragalus
moving backward on its receiving surface. Extension
is the reverse of flexion. It is a disputed point whether
in inversion and eversion of the foot there is any 
lateral movement at the ankle joint.
- The Tibis-fibular Articulation -
Extended between the adjacent edges of the tibia
and fibula from just below the knee to the ankle joint
is a strong ligamentous membrane called the interosseous
membrane, the direction of the fibres being
downward and outward. In the upper part of this
membrane is seen the aperture for the transmission
of the anterior tibial artery.
Besides the interosseous membrane the tibia and 
fibula are held together both at their upper and lower 
extremities.
The upper extremity or head of the fibula presents
a more or less circular articular facet which plays on 
a corresponding one situated on the outer tuberosity of 
the tibia; the bones being here held together by an anterior
and posterior ligament, which passes from
one bone to the other in front or behind. 
The synovial membrane of this joint frequently communicates
with that of the knee.
The outer aspect of the lower extremity of the tibia presents
a rough surface which has a corresponding one 
on the inner face of the lower extremity of the fibula
situated just above the articular inner face of the 
270 gray -
DRE

See Grey/95
Post. Lig. from post Suf of astr.
to up. surf. of os calcis.

43
malleslar process. It must be observed that there is a 
very narrow articular surface just below the rough surface 
of the tibia.
The ligaments are here found to be an anterior and 
a posterior like those at the upper extremities of the 
bones and besides these a large mass of interosseous fibres
which pass between the adjacent rough surfaces.
- The Articulations of the Tarsus -
The articulations of the tarsus consist of the articulation
of the bones of each row and of the union of the 
two rows.
1st. Row.
- Calcanes-astragaloid articulation -
The two bones of the first row of the tarsus are held together
by three ligaments, external, posterior and interosseous.
The external calcanes-astragaloid ligament descends 
from the outer side of the astragalus to the outer
side of the os calcis.
The interosseous ligament is by far the most important 
bond of union between the two bones; it consists
of a large number of fibres filling the sinus tarsi
and passing directly and obliquely between the surfaces
contributed to form that canal.
- The Articulations between the bones of the 2d- Row -
The bones of the second row of the tarsus are held in 
union by fibres across their dorsal and plantar faces
and by interosseous fibres between opposing surfaces.
- The Articulations between the two Rows - 

Lig. asl
Superior Culleaues-cuboid
Internal Culleaues-Cuboid is a thick short bond of fibres
Springing from the depression between the os colcis and 
aslrag. and inserted into the inner side of the cuboid
The long Inf. Culleaues-Cuboid - is alloched behind to
the under suraface of the os calcis. and in gout x
the under " " " " cuboid and adj met. lone { 2 3 4
covering as it passes from
the groove for the Penum
lengus tenden
The gluest Inf. Culleaues-cuboid
lies deeper than the long 
and extends between the under front part of the 
os calcis and the cuboid
{at it origin is closely blended with the Sup.
calcoiuo Scufois 
[illegible]

44
The two rows of the tarsus are held together by three
sets of ligaments, two sets springing from the os calcis.
to the cuboid and to the scaphoid though it does not 
articulate with it, and one set between the astragalus
and scaphoid.
- the ligaments between Os calcis and cuboid.
The ligaments which hold the os calcis to the cuboid
are four two on the dorsum of the foot and two in the 
sole. The superior calcaneo-cuboid ligament is attached
to the upper front of the os calcis and to inner
upper part of the cuboid. This ligament is attached
to the os calcis in common with the superior
calcaneo-scaphoid ligament, the two ligaments diverging
from this attachment and forming the "y" ligament
The long inferior calcaneo-cuboid ligament is tacked
behind to the under surface of the os calcis and in 
front to the under surface of the cuboid and bared on 
adjacent onetatarsal bones. 2d- 3d- & 4th; covering in as 
it passes forward the groove in which lies the tendon of 
the peronsus longer muscle. Internal C.C. Lig.
The short inferior calcanes-calcaneo-cuboid ligament lies deeper
than the long and extends between the under front 
part of the os calcis and the cuboid bone. (6) those 
[????nating] behind the tendon of the Penoreus. long.
- The ligaments between the Os calcis & Scaphoid -
Connecting the os calcis and scaphoid are two ligaments,
superior and inferior calcaneo-scaphoid.
The superior, one arm of the "ij" ligament, passes forward
and inward from the front upper part of the 
os calcis to the scaphoid bone. = Asleagoboid Scaphoid
The inferior calcanes-scaphoid ligament is much stronger
The Sup. " " " lig 



45
than the superior and passes from the inner front aspect
of the os calcis The Susbutaerlum Foli supporting it beneath the head of the astragalus
to the under surface of the scaphoid. relax after causing
"flat foot"
- The Astragalo-scaphoid Articulation -
The only ligament connecting the astragalus to the 
scaphoid is the superior astragals-scaphoid which is 
thin and weak, and passes from the neck of the astragalus 
to the upper surface of the scaphoid.
- The Tarso-Metatarsal Articulation -
The 1st= metatarsal bone articulating with the internal
cuneiform bone; the 2d= with the middle cuneiform
by its base and has lateral facets for articulation
with the internal and external cuneiform bones, being 
jammed between these and extending farther 
back than the other metatarsal bones; the 3d metatarsal
bone articulates with the external cuneiform;
the 4th and 5th with the cuboid bone.
The tarsus is held to the metatarsus by ligamentous 
dorsal and plantar fibres and by three interosseous
ligaments; one from the internal cuneiform bone to 
the 2d metatarsal bone; one from the external cuneiform
to the 2d metatarsal bone and one from the external
cuneiform to the 3d metatarsal
The metatarso-phalangeal, the interphalangeal and 
"intermetatarsal" articulations of the foot are exactly
similar to those of the hand, which see 

Ref to Page 840 Guy -
Passes along the lower border of the 
Zygoma

46
- The Viscera -
- The Alimentary Canal and Appendages -
The Alimentary Canal begins at the mouth and ends at 
the arms, the intermediate portions being found in the 
neck, thorax and abdomen - In the neck are the fauces,
pharynx and part of the oesophagus; in the thorax
is the remaining portion of the oesophagus; the rest
of the canal is found in the abdomen and will be described
with that cavity.
- The Mouth -
The mouth extends from the lips in front to terminate
behind in a short constricted portion of the canal, called
the fauces. It is bounded above by the hard palate;
below by the tongue; on each side by the cheek.
The lips are two, upper and lower separated by a transverse
fissure called the labial. Each is found chiefly
by its segment of the orbicularis oris muscle, covered
externally by skin and internally by mucous membrane;
a crescentic fold of which extends in the middle 
line from each lip to the gum behind and called
fraenum labii - The cheek consists principally of the 
buccinator muscle, covered externally by skin, and internally
by mucous membrane, which is reflected from it 
to the gum, and which presents opposite the second molar
tooth of the upper jaw the opening on a papilla are 
Two's [cross out] duct from the parotid gland - The hard
palate is formed antonally by the meeting in the middle
line of the palate processes of the superior maxillary
bones and posterially by the meeting in the middle line 
of the horizontal plates of the palate bone. It is bounded
in front and at the sides by the alveolar processes of the 


Pa - 840 - G 

47
superior mamillary bones containing the teeth of the upper
jaw. It is covered by mucous membrane both above
and below forming the flow of the nasal fossae above and 
the roof of the mouth below; on the latter aspect the mucous
membrane is roughened by glands called palatial
and is continued on to the gums -
The floor of the mouth is formed by the anterior two thirds
of the tongue, the posterior third of the tongue forms the 
floor of the fauces and below that enters into formation
of the anterior wall of the pharynx - The tongue is 
flattened from above downward, is conical in shape
and is curved in direction, being convex above from before
backwards and extends from the hyoid bone behind
to the incisor teeth of the lower jaw in front, its base is adherent
to the hyoid bone and its apex is free and anterior.
It is formed chiefly of muscular fibres, some of which
are wholly confined to the organ and called intrinsic
muscles of the tongue, the others are the attachment to 
the tongue of muscles belonging to other parts and of 
other muscles, called extrinsic muscles of the tongue,
which arise from neighboring parts and are inserted
into the tongue. The tongue is covered on its superior surface
or dorsum and on its sides by mucous membrane;
running through it from before backwards is a vertical
fibrous septum dividing it into symmetrical halves,
which is thicker behind than in front.
The intrinsic muscular tissue in each half consists
of transverse and longitudinal fibres transverse and
longitudinal lingualis
The lingualis longitudinalis consists of fibres which extend
from the hyoid bone to which they are attached, to 
the tip of the tongue and are found in a superficial

[illustration]
Lingualis Transverse
" " Longitudinal
" " Vertical 
Tongue forms floor mouth
" fauces
ant. wall of Pharynx
Gemo byo glonus WB.
Palato flossus 51 page 

48
layer both on the upper and lower surfaces of the organ;
these two layers being separated by the lingualis transversalis,
which consists of fibres attached to the fibrous septum
and running out to the edge of the tongue.
The so-called vertical lingualis is simply the continuation
of the fibres of certain extrinsic muscles of the 
tongue, and indeed the longitudinal lingualis seems
to consist largely of such fibres.
The extrinsic muscles of the tongue are stylo-glossus,
Hyoglosus and two others, one of which, the Geniohyo-glossus
belongs also with the elevators of the hyoid bone
and is there described the other the Palato glossus is considered
with the soft Palate.
- Stylo-Glossus -
The Stylo-glossus arises from the tip of the styloid process & Stylo hyoid -lig-
cases of the temporal bone and running downward and 
forward as a narrow band is lost on the side of the tongue & hyo-glossus - out which [illegible] -
Action - It draws the tongue backward into the mouth. 
- Hyoglossus -
The hyoglossus is a flat quadrilateral muscle, which
arises from the body and both cornua of the hyoid bone
and passing directly upward is inserted into the side
of the tongue, to the inner side of the stylo-glossus -
Action - It carries the tongue downward and backward,
increasing the size of the fauces - The mucous membrane,
covering the dorsum of the tongue, passes around
the sides and beneath the tip, thus enveloping most of 
the organ; it leaves the lower surface to become continuous
with that lining the gums of the lower jaw. In contact
with the posterior part of the dorsum is the front of 

HB Pharyngeal tonsil 

49
the Epiglottis, which is held to it by three folds of mucous
membrane, the glosso-epiglottic ligaments, middle
and two lateral.
- The Fauces -
The fauces, or isthmus of the fauces is that narrow part of 
the alimentary canal connecting the mouth posteriorly,
with the front of the pharynx - It is about one and a 
half inch long about the same in width and rather
less in depth; the size, however, varying greatly, for its 
walls are chiefly formed of muscular tissue, which is 
peculiarly subject to reflex action.
The roof of the fauces is the soft palate; the floor is a 
part of the dorsum of the tongue; the side is formed by 
two arching muscles and between them the tonsil gland;
the muscle in front is the palato glossus, forming the 
so-called anterior pillar of the fauces; the one behind
is the palato-pharyngeus, forming the posterior pillar 
of the fauces -
The wall in every aspect being covered by mucous 
membrane.
- Soft Palate -
The soft palate, or velum pendulum palate is thin
and flattened from above downward and forward -
It is attached above to the posterior border of the hard palate
and hangs downward and backward, separating
the fauces from the upper part of the pharynx - It is 
prolonged, in the middle line below by a nipple-like
projection, some half inch long, called the uvula.
It is made up chiefly of muscle, tissue and tendon, covered
on both faces by mucous membrane, which, above,
is continuous with that lining the nasal fossal and 

Quadralateral portion of the apex of the 
Petrous portion of the temp.
between these two is the Superior consluate
of the Pharynx

50
below with that of the fauces and mouth. The porker
muscles of the soft palate are three the lavator palati,
the tensor palati, the azygos uvulae: but besides these
there are two others which have their origin in the soft
palate, the palato-glossus and the palato-pharyngous -
- Levator Palati - W.B.
The levator palati arises from the rough surface on 
the basilar face of the petrous portion of the temporal
bone next its apex and from the cartilaginous
portion of the Eustachian tube and descends to be 
lost in the soft palate; its name indicating its action.
- Tensor Palati -
The tensor palati is a small flat muscle which 
forms a right angle on itself hence its synonyme 
of circumflexus - It arises from the acaphoid fossa
of the hterygoid process from the spinous process of 
the sphenoid bone and from the cartilaginous portion
of the eustachian tube and first descending vertically
it then turns transversely inward around
the hamular process and spreads out as a broad
aponeurosis in the soft palate - Its name indicates
its action - 
- Azygos Uvualae - or uvula.
Pendulous from the posterior termination of the soft
palate in the centre is a conical short mass known 
as the uvula, which when dissected is found to consist
of mucous membrane exteriorly and interiorly
of a pair of minute muscles, each of which arises
from the palate spine and descending beside its 
fellow is lost in the mucous membrane of the uvula;
these two muscles were formerly considered as one 

is classed with tongue mus
Jsfuyg Clelson 

51
and hence their name azygos uvulae; it is their presence
in the uvula which accounts for its constant
and varied movement.
- Palato-Glossus - Dec 7.
The palato-glossus muscle arises in the soft palate
and passing downward and forward terminates in 
the side of the tongue. anterior pillar of fauces.
Action- It constricts the fauces hence its synonyme
of constrictor isthm faucium, it can also depress the 
soft palate.
- Palato-pharyngeus - 
The palato pharyngeus arises in the soft palate and 
passing downward and backward, and enters the 
wall of the pharynx, where some of its fibres are lost 
while the rest are inserted into the posterior border of 
the thyroid cartilage - Its action is the same as that 
of the palato-glossus, hence its synonyme constrict or 
isthmi faucium posterior.
- Pharynx -
Food in order to reach the stomach passes through four 
successive portions of the alimentary canal the first two 
of these have been described, viz, the mouth and fauces;
leaving the fauces the food enters the pharynx, traversing
which it is received by the oesophagus in which the 
pharynx terminates; the oesophagus conveying it into 
the stomach.
But the pharynx not serves as a channel for the 
food in its passage to the stomach.
It also conducts air from the nostrils to the larynx and 
as the nostrils are above the mouth and fauces as the 
pharynx must also extend upward beyond them and 
it does extend to the base of the skull to the basilar process

5th Cervical verbtra 95
front of body -

52
of the recipital bone in order to receive the air which 
flows into it from the nostrils through the posterior nares
and which it transmits to the larynx the opening
into which is found on the front of the pharynx just below
the opening of the fauces - And again the air 
which the tympanic cavity of each ear contains is 
supplied through the eustachian tube of each side by 
the pharynx, these two tubes opening into the upper
front portion of the pharynx just behind the posterior 
nares - So that we find seven openings into the 
pharynx and of these let it be observed that six communicate
with the front of the pharynx, viz, the two 
posterior nares, the two Eustachian tubes and the 
opening of the fauces and the opening into the larynx;
the seventh is the termination inferiorly of the pharynx
in the oesophagus - We thus see that the pharynx 
reaches from the base of the skull to the oesophagus
which begins on the front of the body of the 5th cervical
vertebra, i.e. at the same level with the termination 
of the larynx which lies on the front of the pharynx
and with the commencement of the trachea which lies 
on its front; thus making the pharynx about 4 1/2 inches
long-tapering as it descends from the skull along the 
front of the bodies of the 5 upper cervical vertebrae -
- Structure -
The pharynx is lined by mucous membrane resting on 
a thin fibrous coat, external to the mucous coat is a muscular
coat consisting like the intestines of circular and 
longitudinal fibres but differing in this that the muscular
fibres are here red and not pale and are gathered
into bundles which separate bundles are in fact described
as distributed muscles. The circular fibres are placed in 

[illustration of the face]
Inferior [illegible] 4 point - of origin
Middle " " " " " 
Super " 5 " " " 

53
the flattened bundles on each side each bundle meeting 
it fellow of the opposite side on the centre of the back
of the pharynx where they are continuous forming a 
raphi and each pair of bundles overlaps the lower
edge of the pair above, these fibres again differ from 
those of the intestines in that when traced from the raphi
forward they are found not to encircle the entire
pharynx but to pass forward from its sides to seek firm
neighbouring points of attachment from which to exert
traction thus leaning the front of the pharynx devoid
muscular fibres this part of its wall being formed of 
mucous membrane alone, and since as we have seen 
that the larynx is in contact with the lower part of 
the front of the pharynx so it rests on the mucous
membrane and is moreover embraced by the bundles
of the circular fibres as they diverge from the front of 
the pharynx - Now since these circular fibres by their 
contraction lessen the diameter of the pharynx so they 
are known as constrictors of the pharynx and each 
bundle is described as a separate constrictor, as a muscle
arising from points in front of the pharynx and 
running back to strike the side of the pharynx and 
meet the opposite muscle in the raphi on it backward
as there are three of these bundles on each side from below 
up they are known as inferior, middle and superior
constrictors of the pharynx - the direction of their fibres
not being horizontally backward but in a general 
way backward and upward.
- Inferior Constrictor -
The inferior constrictor arises from the oblique line 
on the ala of the thyroid cartilage and surface behind 

Inf. ceres.
The sup. larynx. arty and nerve pass near its
upper border - The inf. by rug. nerve beneath its
[cross out] lower to the larynx.
Middle Curslucten.
Separates from the Sup. ceres. by Stylo 
Pheryn. " " " inf. " " The 
Sup - larynx - nerve.
near its origin it is sepeceter from 
the styo glossus which cevere it by 
the lingual vessels.

54
it, from the side of the cricoid cartilage & it inf-corun and from the 
two upper rings of the trachea; it runs backward, its 
upper fibres ascending obliquely over-lapping the middle 
constrictor and is inserted into the raphi of the
pharynx - 
- Middle Constrictor -
The middle constrictor arises from the hyoid bone, both 
its cormea and from the stylo-hyoid ligament, which 
is a fibrous cord extending from the hyoid bone to the 
styloid process; the muscle radiates somewhat,
spreads out on the side of the pharynx and is inserted 
into the raphi - The lower fibres are overlapped by the 
inferior constrictor while the upper fibres overlap in 
turn the superior constrictor and to such an extent
that when viewed from behind very little of the superior
constrictor can be seen and indeed the raphi of 
the middle constrictors is extended up to the basilar
process.
- Superior Constrictor -
The superior constrictor lies just beneath the skull 
overlapped by the middle constrictor. It arises from the 
lower 1/3 of the internal pterygoid plate from the hamular 
process of that plate from the pterygo maxillary 
ligament from the extremity of the molar ridge better post port of Alverln ridge
of etc lower jaw and and by a few fibres from the side of the 
tongue: passing backward it is inserted into the raphi
{of pharynx; the raphi of the two muscles being attached 
Spine} to the basilar process; The upper edge of this 
muscle presents a concave border thus leaving an 
ashed interval between it and the skull above and 
over this interval the fibrous tissue beneath the mucous 
membrane of the pharynx is extended and is 

[Reb??] of D -
Tinct
recurrent long -
com int- arty
1 try gland [illustration]
2 Trachea - arch of a - & 3 ves -
Root of left - or left hoelus 
Percard -
Vert - col - & layers colli
Left{ Cem cort - Arts - } 1st poton
{ sup clovion } 
leebind also the left Sut dinon
desend wch a -
& Uenerge 
left rement laryrgeal
Unrone Ouet.
Pleuria 

55
here so much thickened as to form a string fibrous membrane.
brane. 1st opening is Sinus of heorgoyni
The longitudinal muscular fibres of the pharynx
like the circular, are gathered into bundles two 
pairs and these are described as distinct muscles
arising from points above the pharynx and descending
to it. One of these muscles, the palato-pharyngeus 
has already been described as forming part of the 
soft palate - the other is known as the stylo-pharyngeus.
- Stylo-pharyngeus -
The stylo-pharyngeus arises from the inner side of 
the base of the styloid process and descends to the side
of the pharynx, entering its wall between the middle 
and superior constrictors some of its fibres are 
lost thereon and some are continued on to be inserted
into the posterior border of the thyroid cartilage -
Action- It elevates and widens the pharynx -
- Oesophagus - 
The oesophagus continues the course of the alimentary
canal from the termination of the pharynx, at 
the commencement of the trachea and at the lower 
border of the body of the 5th cervical vertebra, down the 
front of the vertebral column through the neck and 
thorax to pierce the diaphragm at the oesophageal
opening opposite the tenth dorsal vertebra and terminate
in the cardiac orifice of the stomach, being 
about nine inches long -
Relations -
It first descends the front of the two lower cervical
and upper six dorsal vertebrae and then continues

Right side
2 [R??] mojeture
Azygos mey-
Rx luna -
3 Aerta - penceed - nungutue R & L
Vena azyosini
Cheram tuct.
Pleura. 

56
its course to its termination steadily diverging forward
and to the left. It first lies on the middle line, but 
in the lower part of the neck and in the upper part of 
the thorax it curves slightly to the left, returning to the 
middle line about 3d dorsal vertebra which it follows
to about the 6th dorsal vertebra, where it finally
inclines to the left and forward.
For study of its relations it may be conveniently divided
into three portions: the 1ð portion extends from its commencement
to opposite 1ð dorsal vertebra and lies in 
the neck: the 2ð portion lies in the upper part of the 
thoracic cavity, in the back part of the superior mediastinum
and extends from the 1ð dorsal vertebra to 
the 6ð: the 3d portion extends from the 6ð dorsal vertebra
to its termination and lies in the posterior mediastinum.
The Relations of the 1ð portion are as follows. In front 
is the trachea, slightly to the left of which it curves as 
it terminates: in the furrow between it and the trachea
on each side is the recurrant laryngeal nerve: behind
it is separated from the vertebral column by 
the longus colli muscle: on side is the common
carotid artery, the left being closer, owing to the 
curve of the oesophagus towards that side, it is also 
in relation laterally with the lower part of the lateral
lobes of the thyroid gland.
- The 2d portion has the following relations.
In front as far down as the 4th dorsal vertebra is the 
trachea, which separates it from the transverse part of 
the arch of the aorta, below this it has in front 1st the 
left bronchus and then the pericardium; behind it 
has the longus colli muscle separating it from the 

Relations of Oesophagus.
Com - at 5th= cervical vertebra - you - long -
1st part form cem - to 1st dorsal vertebra -
gum " " " " to 6th dorsal - [illegible]
gum - " " " to oesoph. opening 
1st part. (1) Troch. and adlurant. (2) recurrent by a 3 nerve. & inf -
this. arty - (4) cem - carotr res - esp - the left. [cross out] thyroid glow -
[cross out] on side Thyion glans
2nd Port - - extent - longus colli.
Infint. (1) Troch. (2) it of left lung - (3) peucordeun. -
on left - 1) recurrent Ling. neve. (in groove.) 2) Thoracic duct.
and curves foward at juret of 1st & 2nd pulers.
(3) left cem cerolr
lon right - right vagus.
" " [illegible] orts.
3rd portion - Extent direct - doren foward & to left shey pt.
on side pleura. only in thus pt of O.
infint. (1) lower pt of root of lung
(2) Pin cerdum.
at conmen. 1st to st. of thoracic ayter - orveny to begaty if [cross out] its
Course it is their much to front & finally deserdly to lef.
Befor. it gets in front of aorta - azyges kein - & thoracic du-.

57
vertebral column: at its commencement it has to the 
right the terminal part of the innominate artery and 
to the left the termination of the 1ð portion of the left 
common carotid artery and the 1ð portion of the left
subclavian artery: to the left and slightly in front above,
is the thoracic duct and in the groove between it 
and the trachea is the left recurrent laryngeal nerve
also to the left, below is the descending part of the arch
of the aorta and the commencement of the thoracic
aorta: to the right of its lower part is the terminal portion
of the right vena azygos: lastly it is covered laterally 
by the pleura-
The 3d portion has the following relations: in front 
is the pericardium and the left pneumogastric nerve
behind it is the right pneumogastric nerve, the vena 
azygos major - some intercostal veins, the thoracic duct
and at its lower part the thoracic aorta, its relations to 
which are these at its commencement it lies to the 
right of the aorta but at once inclines forward and to 
the left so as to get in front, so that at its termination it 
is in front of the aorta and slightly to the left -
It is crated on each side by pleura -
Structure -
The oesophagus consists of three coats, two muscular 
and a mucous; the muscular coats are external, longitudinal
and internal circular -
The longitudinal fibres are uniformly diffused around
the tube through most of its extent, but above are gathered
into three more or less distinct bundles, the front one 
is attached to the cricoid cartilage and the others are 
continuous with the pharynx below this coast becomes
continuous with the stomach. The circular fibres above 

upper Horizontal live is below Cart of [illegible]
Aul Sup S - P of Ilium is place your
drawn lower Horizontal live -
2 Vertical lines an drawn from middle of Pouparts ligament
upwards - 

58
are continuous with the inferior constrictor of the pharynx 
and below with the stomach; this coat is separated
from the mucous membrane lining the tube by 
sub-mucous connective tissue, sometimes called the 
areolar coat of the oesophagus
The fibres of both muscular coats are, above, reddish,
and distinctly striated but below are pale and lose 
striation -
The mucous membrane is loose and thrown into 
longitudinal folds, when the tube is not distended;
it presents the numerous minute orifices of the ducts
of the oesophageal glands, which lie embedded in the 
submucous tissue -
- The Abdominal Viscera -
The cavity of the abdomen is bounded above by the diaphragm,
which is a thin arched muscle with its 
concavity downward, forming the floor of the cavity of 
the chest and the roof of the abdomen - The floor of the 
abdomen is the floor of the pelvis, the structures which 
close the outlet of the pelvis; occasionally it is said to 
be the iliac foreac and the brim of the pelvis, the true
pelvis then being considered as a separate cavity - Laterally 
and in front, from the lower ribs above to the 
ilium below the abdomen wall is formed of soft tissues,
muscles &c and is the soft fleshy front wall of 
the belly - At its upper part the cavity is partly circumscribed
by the lower ribs, and last six or seven below it 
is surrounded by the bony wall of the pelvis, behind
is the lumbar portion of the vertebral column, and on 
each side are above the floating ribs, below the pelvic
wall and between these the soft tissues - For convenience

SPECIMEN ILLUSTRATION FROM
See what grey says -
[illustration]

The highest point are erect of the Ilium is in a 
level with the umbilicus
59
of reference the abdomen is arbitrarily subdivided into three
zones and each of these into three regions by two horizontal 
transverse and two vertical imaginary lines - The upper 
horizontal line is drawn between the extremities of the 
ninth ribs; the lower between the two anterior superior 
spinous processes of the ilia - The vertical lines are projected
upward from the centre of the fold of the groin,
one on each side. The names by which the nine regions,
thus formed are known, are as follows; the central region
in the upper zone is the epigastric the one on either side
hypochondriac, right or left, the central region in the middle
zone is the umbilical the lateral ones, lumbar, right 
or left, the central region in the lower zone is the Hypogastric,
the lateral ones Iliac or Inguinal, right or left -
The contents of the abdomen are, the greater portion of the 
alimentary canal, the accessory organs of digestion, the 
liver, spleen, pancreas, and the genito-urinary organs,
the kidneys and supra-renal capsules, the bladder
and its appendages, the prostate glands, seminal vesicles,
vas deferens; the testicles are considered with the 
abdominal viscera although, in the adult, lying outside 
of the cavity, in the scrotum: in the female are 
the uterus and its appendages and the vagina: enveloping 
most of these organs and lining the interior 
of the cavity is a serous membrane, the peritoneum -
The portions of the alimentary canal in the abdomen
are 1st, the stomach, 2d the small intestine, 3d the 
large intestine - The stomach is the dilated part which 
succeeds the oesophagus and is about twelve inches 
long - It terminates about the line that separates the 
epigastric from the right hypochondriac region, on 
the small intestine. The small intestine is divided 



60
into three parts, the duodenum, the jejunum and the 
ileum - The duodenum is about nine inches long: the 
jejunum and ileum together are some twenty feet
long, the jejunum comprising the upper two fifths
and the ileum the lower three fifths. The duodenum
is again subdivided into three portions, the 1st portion
is called the ascending or oblique duodenum, is about 
two inches long and terminates at the under surface
of the liver, at the neck of the gall bladder in the right 
hypochondriac region, in the 2nd portion, called the 
descending or perpendicular duodenum, which passes 
vertically downward for about three inches into the 
right lumbar region and about on a level with the 
upper border of the fourth lumbar vertebra terminates
in the 3d portion, the transverse duodenum, which
is rather more than 3 inches long and crossing the 
front of the vertebral column obliquely upward terminates
at the left side of the body of the second lumbar
vertebra in the jejunum - The large intestine is 
subdivided into three portions called, coecum, colon,
rectum. The coecum is the commencing two and 
a half inches, lies in the right iliac fossa and terminates
in the colon at the entrance of the small intestine - 
The colon is divided into four parts, ascending,
transverse, descending, synovial flexure: the ascending
colon passes upward through the right lumbar region
into the right hypochondriac region at the under surface
of the liver it curves sharply to the left, forming the hepatic
flexure of the colon and becomes the transverse
colon: the transverse colon passes downward and its 
the left, crosses the abdomen between the epigastric
and umbilical regions and rising into the left hypochondriac

[illustration]

61
hypochondriac region, it forms another abrupt curve at 
the lower cut of the spleen, called the splenic flexure
of the colon, and becomes the descending colon: the descending
colon passes downward through the left lumbar
region into the left iliac fossa, where it becomes the 
synovid flexure of the colon: the sigmoid flexure is 
found by the guto passing upward and to the right 
and then downward and to the left to terminate at 
the brim of the pelvis on the left side in front of the 
left sacro-iliac symphysis by becoming the rectum:
the length of the colon is about four feet: the rectum
is the last eight inches of the large intestine and 
terminates the alimentary canal at the anus about 
the middle of the floor of the pelvis. The liver lies in 
the upper zone of the abdomen, stretching nearly across 
the cavity just beneath the roof. The spleen
is in the left hypochondriac region - The pancreas
lies transversely behind the stomach, between the 
spleen and perpendicular duodenum, crossing the 
front of the body of the 1st lumbar vertebra - Each
of the two kidneys is beside the lumbar portion of the 
spinal column on the front of the posterior abdominal 
wall. The urinary bladder and its appendages
are found in the pelvis just behind the pubes - The 
uterus and vagina, in the female are interposed
between the bladder and the rectum - 
- The Reflection of the Peritoneum -
The peritoneum being a serous membrane is a closed 
sac, one layer covering the viscera and called the 
visceral layer and another lining the wall of the 
abdomen and called the parietal layer. The existence
peritoneum renders the motions of the viscera 



62
upon each other and on the abdominal walls easy
and harmless and furnishes bonds of connection between
different viscera and between them and the 
wall of the containing cavity. Being a closed bag its 
continuity can be demonstrated by the fact that in 
following it vertically or transversely it leads back 
to the point of departure. The folds it makes from 
above downward are the more important and they 
will first be stated. It leaves the under surface
of the diaphragm in two layers which pass to the 
upper and lower edge of the posterior border of the 
liver, the upper layer covers the upper surface of the 
liver, curves around the anterior border and coats the 
lower surface as far back as the transverse fissure, where
it meets the over layer, which has covered the lower
surface from the posterior border to the transverse fissure:
the two layers having thus enveloped the liver
leave it at last the transverse fissure and pass 
downward to the stomach, forming between these two 
organs the gastro-hepatic or lesser omentum: they
reach the stomach at its upper border and one passing 
over the front and the other over the back of the 
stomach, they again meet at the lower border having 
furnished a coat to the stomach: the two layers leaving 
the stomach at its lower border pass downward
in front of the transverse colon, without adhering to 
it and descent almost to the brim of the pelvis just 
behind the anterior abdominal wall, they then reverse 
their course running upward just posterior to 
their descending course they reach the transverse
colon and separating enclose it, that part of the peritoneum
thus extended between the lower border of the 

[illustration]

63
stomach and the transverse colon is called the greater
or gastro-colic omentum: the two layers having enveloped
the transverse colon meet at its posterior
border and pass backward to the posterior wall of the 
abdomen, thus forming the transverse meso-colon,
which loosely holds the transverse colon to the posterior
abdominal wall. The two layers now finally separate,
one goes up the front of the posterior abdominal wall 
to be under surface of the diaphragm, when its 
course was first taken up, thus partially enclosing
a space behind the stomach called the lesser cavity
of the peritoneum and which communicates with 
the general cavity of the peritoneum by an opening 
behind the oblique duodenum, called the foramen of 
Winslow. The other layer of the transverse meso-colon
passes forward to envelop the coils of the jejunum 
and ileum and rectum to the posterior abdominal
wall forming thus a double layered membrane
holding these convolutions to the parietes and called
the mesentery whose attachment may be thus given,
from the left side of the body of the 2d lumbar vertebra
downward and to the right, to the right sacro-iliac symphysis:
after forming the mesentery the peritoneum
descends the posterior abdominal wall, crosses the
brim of pelvis, passes down its posterior wall, covering
the upper half of the rectum completely leaves the 
front of the rectum an inch below its middle, strikes
the back part of the base of the bladder, in the male,
covers the back and sides and posterior half of the top
of the bladder and leaves the bladder to mount the 
posterior face of the anterior abdominal wall and 
thus reach its starting point on the under surface of 

Foramen of Winslow - 
See bottom of 864 gray -
" lesser cavity of Peritoneum -

64
the diaphragm - In the female when the peritoneum
leaves the front of the rectum it passes to the posterior 
wall of the vagina covers its upper inch then the 
back of the uterus, turns down the front of the uteris 
and thus reaches the back of the bladder.
In mounting over the top of the uterus it also passes
over the ovary and its ligament on each side thus 
forming on each side a double-layered fold stretched
between the side of the uterus and the lateral wall of 
the pelvis, called the broad ligament of the uterus;
between two layers are the ovary and its ligament, the 
round ligament of the uterus and the Fallopian
tube.
Followed transversely around the abdomen,
about its middle, the peritoneum presents the following
folds - commencing on the anterior abdominal
wall, here it reaches the descending colon and passes
over its front covering it from half to three fourths around
and leaving it at a corresponding line on the 
inner side reaches the vertebral column when it 
turns forward to envelop the jejunum and ileum
and passes back on itself to the vertebral column
forming the mesentery: it then runs out on the posterior
abdominal wall to the ascending colon passes
over the front of it covering it from half to three fourths
around and leaving it reaches the abdominal wall 
again along which it runs to the place of departure -
- Relations of the Abdominal Viscera -
- Relations of the Stomach -
The stomach lies in the upper zone in the left hypochondriac 
and the epigastric regions, generally terminating 


(u) at the end of the 8th rib - 95
Relations of the Stomach
Above
Left} Diaphragm} Right
Spleen} left lobe of Liver} duodenum
below.
trans Colon
Behind} {in front.
Pancreas} {Ant abdom.
Left Kidney} {wall.
sola hex-
ant frt. res. of abdomen
left lobe liver

65
terminating in the duodenum on the line that separates
the Epigastric from the right hypochondriac region
but occasionally passing more or less into the latter -
Its long axis is directed from above downward, from 
left to right and from behind forward: one surface
looks forward the other backward: one border, the shorter,
or lesser curvature looks upward, the other, the greater
curvature is below: the larger end is to the left, the 
smaller end to the right. It is continuous with the 
oesophagus about three inches to the right of the left
end, at the left end of the lesser curvature: it is continuous
with the duodenum at the right end Its upper
border is held to the under surface of the liver by 
the lesser omentum: its lower border is indirectly
held to the transverse colon by the great omentum: its 
left end is connected to the inner face of the spleen
by the gastro-splenic omentum - Above it is the diaphragm
and the left lobe of the liver: below it is,
the transverse colon: to the right it is continuous with 
the duodenum: to the left is the spleen: behind are 
the pancreas and left kidney: in front the anterior
abdominal wall and part of the left lobe of the liver.
It has a complete peritoneal coat.
-Relations of Oblique Duodenum - = 2 1/2 in
The oblique, or ascending duodenum commences at
the right extremity of the stomach, usually on the line 
that separates the epigastric from the right hypochondriac
region and passes upward and to the right,
in the right hypochondriac region, to terminate in 
the descending duodenum at the under surface of 
the liver, at the neck of the gall-bladder. It lies in 
the right border of the lesser omentum and has behind 
quick

The Duodenum
Olique{behind the hepatic artery} in fold of P.
{common bile duct}
{Portal vein}
{in front The liver}
Perpendecular{Behind the right Kidney inner edge & Inf. Vaneu Curas.
{in front the ascending colon} it Kidney
{or dis. Duodenum
{to the left is adherant to the 
{head of the pancreas.
Transverse{above - the lower border of the 
{pancreas separated by the 
{Sup. mesenteric arty. and vein
{in front is the transverse
{colon
in front Partially by Peritoneum 
behind - is aorta.

his entirely in Peritoneum.
66
it the hepatic artery, the common bile duct and the 
portal vein and in front the liver. It is completely
invested by peritoneum.
Relations of Perpendicular Duodenum - 3 in
The perpendicular, or descending duodenum commences
at the termination of the oblique duodenum
in the right hypochondriac region, at the neck of the 
gall-bladder and descends vertically into the right 
lumber region to terminate by becoming the transverse 
duodenum about on a level with the upper border
of the fourth lumbar vertebra. It lies behind the 
peritoneum, being covered by it only partially in 
front. Behind, it has the right kidney and in 
front, the ascending colon descending duodenum.: to its left it is adherent to 
the head of the pancreas.
- Relations of Transverse Duodenum - 3 in 1/2
The transverse duodenum commences where the 
descending terminates, in the right lumbar region,
on a level with the upper border of the body of the 
fourth lumbar vertebra, and passing upward to the
left across the vertebral column, the body of the 
third lumbar vertebra terminates in the jejunum 
at the left side of the body of the second lumbar vertebra.
It lies behind the peritoneum, between the diverging
layers of the transverse meso-colon, so that it is 
covered by it only in front. Above it is the lower border
of the pancreas, from which it is separted by the 
superior mesenteric artery and vein: in front is 
the transverse colon.
- Relations of Jejunum and Ileum -
The remaining twenty feet of the small intestine
after duodenum, are thrown [i??] coils called the
obliquely and from below upward
2 6"
3 6"
4 7th" upper
border.

[illustration]


23) - 16
67
convolutions of the small intestine, and are found
briefly in the umbilical and hypogastric regions,
falling off however into the surrounding regions, some 
being always found in the pelvis, between the rectum
and bladder, in the male, and between the rectum
and uterus, in the female. The jejunum comprises
the upper two fifths of the convolutions and commences
where the duodenum terminates, at the left 
side of the body of the second lumbar vertebra: the 
ileum is the lower three fifths of the convolutions
and terminates in the right iliac region by opening 
into the large intestine, two and a half inches
above its commencement.
These convolutions are completely enveloped by the 
peritoneum, which holds them by a double layered
fold, the mesentery, to the posterior abdominal wall
In front they are separated from the anterior abdominal
wall, by the great omentum: above is the 
transverse colon: to the right is the ascending colon:
to the left is the descending colon.
- Relations of Coecum - = capet coli cueum. 95
The coecum is the commencement of the large intestine:
it is some two and a half inches long and 
terminates in the colon at the opening of the small 
intestine. It lies in the right iliac fossa, or region
and is generally completely invested by peritoneum
Attached to it is the vermiform appendix, a blind 
tube about the size of a goose quill and from four to 
six inches long.
The appendix opens into the inner back of the caecum, 
just below the opening of the ileum, and not 
into the bottom. The appendix has a complete peritoneal  

Ascending colon
In front abdominal wall
out Side " " " " 
inner " the small intestines
Behind is 1 duodenum and 
right Kidney -
Transverse Colon.
In front the great omentum
Behind the transverse duodenum
Above the Stom, liver, spleen &
Below Are the convolutions of 
the Small intestines
Descendg Colon 
over 

68
peritoneal coat and lies slightly coiled on the inner
side of the caecum and just below the terminal portion
of the ileum.
- Relations of Ascending Colon -
The ascending colon commences where the caecum
terminates, in the right iliac region, at the opening 
for the ileum and passes upward through the right 
lumbar region into the right hypochondriac to terminate
by becoming the transverse colon at the hepatic 
flexure of the colon at the under surface of the 
right lobe of the liver, to which is held by a fold of 
the peritoneum, being covered by it in front from 
half to three fourths around. In front and to the 
outer side is the abdominal wall: to the inner side 
the convolutions of the small intestine: behind are 
the perpendicular duodenum and right kidney
- Relations of Transverse Colon -
The transverse colon commences at the termination
of the ascending colon, at the hepatic flexure of the 
colon, in the right hypochondriac region, at the under
surface of the liver: it passes obliquely downward and to 
the left crosses the abdomen between the upper and 
middle zones and rising into the left hypochondriac
region terminates by forming the splenic flexure
of the colon at the lower end of the spleen and becomes
the descending colon. Its course is curved with the 
convexity downward and forward. It is entirely
covered by peritoneum which holds it by a long double
layered fold, the transverse meso-colon to the 
posterior abdominal wall and by a small band to 
the lower end of the spleen: it is indirectly held to 
the greater curvature of the stomach by the great omentum.

Descending Colon
To front & outer Side - abdominal wall
Behind - Kidney (left)
inner Side Convolutions of Small intest 
Sigmoid flexure
[illustration]

69
omentum. 
In front it is separated from the anterior abdominal 
wall by the great omentum behind is the 
transverse duodenum above are the liver, stomach,
and spleen; below are the convolutions of the small 
intestine.
- Relations of Descending Colon -
The descending colon begins where the transverse colon
ceases, in the left hypochondriac region at the lower 
end of the spleen and passing downward through
the left lumbar region terminates in the left iliac
region in the sigmoid flexure of the colon. It lies
behind the peritoneum, being covered by it in front
from half to three fourths around - To its front and 
outer side is the abdominal wall: behind is the left 
kidney: to its inner side are the convolutions of the 
small intestine.
- Relations of Sigmoid Flexure.
The sigmoid flexure of the colon begins at the termination
of the descending colon in the left iliac 
fossa and curves upward and to the right and 
then downward and to the left to become the rectum
at the form of the pelvis in front of the [le??]
sacro-iliac, symphysis - It is completely invested
by the peritoneum, which holds it to the left iliac
fossa by a long fold, which permits it to fall in 
different directions.
Relations of Rectum
The rectum commences at the termination of 
the colon at the brim of the pelvis on the left side 
in front of the left sacro-iliac symphysis and 
passes first downward and to the right to the 

Flatueson precussion
for enlarged Spleen
{ Get up Liver (relations)
{ " " spleen
{ " " Pancreas
{ " " Kidneys (relations)
{ " " Pectoralos major
{ " " " minor
{ " " Subclavius
1st portion of the rectum is 4 in long
2nd " " " " " " 3 " " " 
3rd " " " " " " 1-1 1/2 " " " 
Relations of Return
In front 
& cts { Bladder
{ appendjes
{ Convolutions of
{ small intestines
Behind
{ Pyraformis muscle
{ Sacral plexus
{ left int. illiac
SV.V. 2nd part of rectum. comisvces 3rd sacro recteta lower in first.
covered in front for its upper in. with P. and is 
sep. from the bladder by small intes. each side in [illegible]
below the 1st in the rectum lutches the base of bladder
on each side the of the base the 
sem. vesceles & vas deferens
on each side is the urter
3rd Part- lugus opss. the letp of Tie coccyx - its [illegible]
is up and [crossed out] forward. - sep by a Sintervol [crossed out] back of [illegible]
3rd  - pt.

and is seurous by the soft tissues of 
the pelvis
70
middle of the front of the sacrum, then down the 
front of the sacrum to a point opposite the lip of 
the cocyx, when it turns slightly backwards and after 
a course of about an inch ends at the arms. For its 
upper half it is entirely covered by the peritoneum,
which holds it to the pelvic wall meso rectum for its lower half
is covered by the peritoneum only its front for about 
an inch at its upper part in other words it is 
three inches from the arms to the peritoneum in 
front and four inches behind, so that the peritoneum
comes an inch farther down on the front of the 
rectum than it does on its posterior aspect.
It has behind it the pyroformis muscle, the sacral 
plexus of nerves and the left internal iliac is behind and to the left
vessels: in front, from above and downward in the 
male are the bladder and the appendages of the bladder,
in the female the uterus and vagina: interposed
between it and the bladder or uterus are some 
convolutions of the small intestine. The meso rectum holds
the rectum to sacrum.
- Relations of the Liver -
The liver is found in the upper zone of the abdomen
the greater part being in the right hypochondriac 
and epigastric regions, but it projects to a greter
or less extent into the left hypochondriac region.
Its long axis is transverse its sharp notched border
is in front and below, nearly corresponding to the 
lower margin of the ribs: its thick border is backwards
resting against the diaphragm, grooved for the 
inferior vena cava and also nearer the left end for 
the oesophagus: its convex surface is above: its larger
and is to the right.
It is held in place by its five ligaments and is 



71
connected to the lesser curvature of the stomach by 
the lesser or gastro-hepatic omentum. Of its five
ligaments four are formed by the peritoneum the 
fifth is called the round ligament and is the obliterated
umbilical vein. The peritoneum reaches
the liver from the diaphragm by two very short layers, 
which seize the one the upper edge, the other, the 
lower edge of the posterior border; these layers are 
separated by a considerable, somewhat triangular,
space on the posterior border but at each end of the 
border come together and here form the two lateral
ligaments, right and left of the liver.
Between these lateral ligaments the layers surrounding
the interspace on the posterior border form
what is called the coronary ligament: the upper layer
is diverted forward from the posterior border, at a 
point about one third of the length of the liver from 
its left end, across the upper surface of the liver so 
as to pass around the round ligament and thus 
forms a double layered fold called the suspensory
or longitudinal ligament holding the liver below,
to the diaphragm, above. The round ligament is 
that part of the obliterated umbilical vein which 
passes backward from the anterior abdominal wall
to the notch in the anterior border of the liver, lying 
between the two layers of the longitudinal ligament.
The peritoneum reaching the liver in the manner
described passes over it, one layer over the upper
surface, around the anterior borders backward on the
under surface to the transverse fissure, where it meets
the other layer, which has run forward on the lower
surface from the posterior border; thus furnishing an 

Above -
Draph.
Liver?
Internal Beluid Ext -
Panerus Left 9-10-11 Ribs
Stone - Kid & cap.
Below 
Colon.
Flexure.
In front
Ant ot. well.

72
almost complete serous coat for the organ.
Above the liver is the diaphragm: below it are, from 
right to left, the right kidney, with its supra-venal
capsule, in front of these the hepatic flexure of the 
colon, behind and to the left of this the oblique duodenum,
then the stomach and lastly the upper
end of the spleen, which is only occasional relation.
- Relations of the Spleen -
The spleen is confined to the left hypochondriac
region; its long diameter is vertical; its thin notched
border is anterior: its smaller end is below: its 
convex surface is external. It has a complete peritoneal
coat and is held in position by folds of th
peritoneum: one fold passes from its upper end 
to the diaphragm and is called the suspensory ligament:
another passes from the inner face to the 
great end of the stomach and is called the gastro-splenic omentum -
A third small fold extends from the lower end
to the splenic flexure of the colon -
Above it is the diaphragm, from which it is sometimes
separated by the liver: below it is the splenic
flexure of the colon: behind its lower end is the left 
kidney and its capsules: in front is the anterior
abdominal wall: internal to it are the great end
of the stomach and the tail of the pancreas: externally
it corresponds to the ninth, tenth and 
eleventh ribs, from which it is separated by the 
diaphragm, the left pleura and the lower border
of the left lung.
- Relations of the Pancreas -

crosses body 1st lumbar
Vertebra.
Relations of Pancreas Blood.
Behind the abdominal aorta spleen
cocliac axis
behind the head is the cocliac axis
also on head of pancreas -
Sup - Muscular arty -
above The spenic arty. & vein
left - Spleen

Relations of Pancreas.
73
The pancreas extends from the inner face of the 
spleen on the left to the descending duodenum on 
the right: its long diameter is therefore transverse:
its larger and is to the right: one surface looks
forward and the other backward: one border is above
the other below -
It rests on the front of the posterior wall of the abdomen,
crossing the body of the first lumbar vertebra.
It is behind the peritoneum, which covers
it only in front - To its right is the perpendicular
duodenum, to which it is closely adherent: to the 
left is the inner face of the spleen to which its tail
is held by the peritoneum: in front is the stomach
behind its left end is the left kidney: below it is 
the transverse duodenum, from which it is separated
by the passage of the superior mesenteric
artery and its vein. The relations of the pancreas
to blood vessels are very complex and may be given 
as follows.
It is separated from the vertebral column by the 
abdominal aorta which produces the coeliac axis
just on a level with the upper border of the head 
of the pancreas, while the superior mesenteric artery
is comitted just behind the head. The latter
descends behind the pancreas to emerge between
its lower border and the transverse duodenum.
The coeliac axis rests on the upper border of the 
head of the pancreas and there divides into three
branches one of which, the splenic artery, pursues
a very [??otions] course along the upper border to the 
inner face of the spleen. The splenic artery is accompanied
by its vein, which passes to the right 

The right Kidney is the lower [illustration]

74
from the spleen, lying in a deep groove on the posterior
face of the pancreas just below its upper
border behind the head of the pancreas the splenic
vein [illegible] with the superior mesenteric vein,
which ascends behind the head of the pancreas as 
the comparison of the artery the two veins forming 
here the portal veins - About the middle of its course
the splenic vein receives the inferior mesenteric
vein which passes behind the body of the pancreas.
Surrounding the coeliac axis are the two semi-lunar 
ganglia of the sympathetic giving off the 
numerous branches of the solar plexus of nerves,
which are in close relation to the head of the pancreas.
- Relations of the Kidneys -
The kidneys lie on the front of the posterior abdominal
wall, extending from about the eleventh
rib downward and slightly outward to near the 
crest of the ileum. The right kidney is perhaps
a little lower than the left, beginning opposite the 
lower border of the eleventh rib: the left opposite
the upper border of the eleventh rib. The kidney
corresponds to the last dorsal and the first lumbar 
vertebra. It is behind the peritoneum embedded
in a considerable mass of loose connection
tissue, which usually contains much fat
the peritoneum is loosely connected to the front 
of the organ by this tissue, and can easily be 
stripped off. The long diameter of the kidney is 
from above downward and slightly outward:
one face looks forward and slightly outward, the 
other backward and slightly inward, the upper 

Pa 78
{I above all is the Peulion
{II then sub serous auolar tissue (to) connection tissue -
{then
III The Pelvic fossa  1st Franosolis 2nd Ilibes - their Pelvic fosia being adherent
to the Pect. line the puses to pelvic viscera -
IV Ler. Ani 
V A Lig pubes. [illustration]
VI Post. of Penis 
Pelvic focia. 

75
and is perhaps the larger: the outer is the convex border,
the inner is the concave border.
The kidney rests on the quadratus lumbarum
through most of its extent, separated from it by the 
anterior lamella of the posterior aponeurosis of the 
transversalis abdominis muscle. Along its inner
edge it lies on the posac magum muscle and behind 
its upper part is the diaphragm, which separates
it from the pleura, the diaphragm here frequently
presenting a fissure, of considerable size
where the muscle tissue is wanting so that in 
this event, all that separates the kidney from the 
pleura is a little loose connective tissue. Each kidney
has upon its upper inner front part the supra-renal
capsule or gland. 1 - is A the alters is C
The outer border is nearly opposite the outer edge of 
the erector spinal muscle and about corresponds to 
the junction of the posterior fourth with the anterior
three fourths of the crest of the ileum.
The right kidney has in front the descending duodenum
and in front of that the ascending colon:
along its inner border is the inferior vena cava: its 
upper end is in contact with the lower surface of the 
liver, which may also rest on the front of its upper
part. The left kidney has on its front the descending
colon and at its upper part the lower end of the spleen,
the tail of the pancreas and the great end of the stomach.
- Relations of the Bladder, in the male -
The urinary bladder occupies the front portion of the 
pelvic cavity being confined to it when empty or even
nearly so, but rising out of it in proportion to its state
of distension, occasionally reaching the level of the umbilicus. 

The direction of the Bladder is more nearly
horinzonal than [illegible] [illegible] 91-92

76
believe. It lies just behind the symphysis pubis
with its long diameter from above downward and 
backward, extending from the upper border of the symphysis
pubis or from some point in the linea alba
between it and the umbilicus, varying with distension
downward and backward and if prolonged
would strike the lower part of the front of the sacrum.
The larger end of the bladder is below and looks 
downward and backward. The bladder is retained
in position chiefly by its ligaments which are ten
in number: five of these being called the false ligaments
and furnished by the peritoneum four formed
by processes of fascia and one being the remain
of a fetal structure, the Urachus; these last five are 
called the true ligaments.
The peritoneum leaves the front of the rectum about 
three inches above the arms and sweeps in a 
drooping course to the back part of the base of the 
bladder; this broad fold extending from the front 
of the rectum, to the bladder is called the two posterior
false ligaments, although the division between 
them is arbitrary being the middle line of the body;
however on each side the fold presents an antero-posterior 
ridges, produced by the passage of the hypogastric
artery from the posterior pelvic wall to the side 
of the lower part of the bladder, the artery then passes
up the side of the back of the bladder to the side of its 
top, then leaps to the anterior abdominal wall and 
approaching its fellow makes for the umbilicus; in 
the fetus this artery carries impure blood from the 
fetus to the placenta emerging at the umbilicus:
after birth it becomes imperious from the umbilicus

2 post. false ligaments.
1 Sup. " " -
2 Lattual " " 8
The urachus formes the sup. live by.
2 ant live by.
2 lattual live by.
92 [illustration] NB 70 - 75 - 8
[illustration]

77
umbilicus as far as the top of the bladder, but from that 
point back to its origin from the internal iliac artery
it transmits during life some blood to the bladder.
The peritoneum reaching the bladder covers the back 
part of its base, the back of the bladder, the posterior
half of each side and the posterior half of the top; and 
then passes to the anterior abdominal wall, to which 
it is guided by the urachus and the two obliterated
hypogastric arteries. That part of the peritoneum extending
from the middle of the top of the bladder to 
the anterior abdominal wall is called the superior
false ligament and that part on each side extending 
from the side of the bladder to the lateral wall
of the pelvis, forms the lateral false ligament.
The urachus in the adult is an inconspicuous fibrus
band extending from the top of the bladder to the 
umbilicus along the linea alba and is called the 
superior true ligament of the bladder -
The four remaining true ligaments are formed by 
the pelvic fascia which lines the cavity of the pelvis
just beneath the peritoneum - From either side of 
the symphysis pubis a process from this fascia is extended
to the lower part of the front of the bladder and 
prostate gland, these two being called the two anterior 
true ligaments of the bladder. From the lateral
wall of the pelvis on each side a process of fascia
passes to the side of the bladder, the two being known
as the two lateral true ligaments of the bladder.
The front of the bladder is separated from the back of 
the symphysis pubis only by a little loose connection
tissue - the neck of the bladder is received into the 
back part of the prostate gland and is continuous 

see ps 74
Levater Ani
Amsis 1st in front from the post surg. of 
the body and ramus of the pubes & ischium 92 on the 
outer side of symph.
Post is arises from the inner
surface of the spine of the ischium 
and from the obturater foscia
Insertion
In to coccyx its tip. post and ant 
inter back to form the floor of the 
pelvis? (a) false foer
Attached to side of bladder & peost. gland.
the & ani becoming the coccygus
mus behind and the compressre
urethra?
(91) Interlocks with its fellow of opposit side 

78
with the urethra, being about an inch behind and 
below the pubic arch.
The posterior face of the bladder is separated from the 
front of the rectum usually by some convolutions of 
the small intestine. The base of the bladder rests on 
the front of that part of the rectum which is found desending
the front of the sacrum usually called the 
second portion of the rectum - Piercing the posterior
part of the base of the bladder on each side is the ureter,
the two being about two inches apart each having just 
internal to the vas deferens, which, entering the abdomen
at the internal abdominal ring passes to the 
side of the top of the bladder, descends to its posterior
face and rims forward and inward along its base
to terminate at the front part of the base by uniting
with the duct, which forms the seminal vesicle,
to produce the ejaculatory duct. The seminal vesicle
lies, one on each side, on the side of the base of 
the bladder; pear-shaped, its base is behind and 
its smaller end forward and inward at the back of 
the prostate gland.
In the female the bladder, in general terms occupies
the same position as in the male.
There are no prostate gland, no vas deferens, and 
no seminal vesicle. The base of the female bladder
rests on the upper part of the anterior wall of the 
vagina and on the lower part of the front of the 
uterus, which two separate it from the front of the 
rectum - Otherwise its relations are about the same 
as in the male -



79
- The Stomach -
In shape the stomach is a curved cone with one side 
shorter than the other and with the other two sides
somewhat flattened (and called its interior and 
posterior faces: the short or, as it is called, border, is above 
and is known as the lesser curvature: the longer is 
below and is called the greater curvature - The large
end of the cone is to the left and is called the splenic
end because it is hugged by the spleen; some two or 
three inches from the end and at the left extremity of 
the lesser curvature is the aperture of the oesophagus
which is called the cardiac orifice and the splenic 
end or cul de sac of the stomach is the dilated portion
belonging to the left beyond this.
Passing to the right extremity of the stomach it is 
found to be much smaller than the splenic and is 
called the hyloric extremity, because the exit from 
the stomach here into the duodenum is known as 
the pylorus and is the smallest part of the alimentary
canal being about one half of an inch in diameter -
In position the stomach is not directly
transverse but is somewhat oblique its long diameter
is from above downward forward and to the 
right: i.e the cardiac orifice is on a higher level and 
farther back than the pyloric. Then empty the anterior 
face of the stomach looks forward almost directly 
forward and the posterior face almost directly
backward but when distended the stomach rotates
on its long axis so that its anterior face looks upward,
its posterior face downward and its greater curvature
becomes anterior -
In size the stomach is about twelve inches in its 

Duodenum [illustration]
{1st porter the asending oblique 2 in long
{2nd porter " descending 3 in long -
(3rd " " " transverse 4 in long 
The duodenum terminates at body of 2nd lumbar
vertebra re(left side)
lower 3/5 of small intestines is the ilium 

80
umbilicus diameter and receives from a quart to two quarts
[?f] food at a time -
- The Duodenum -
The duodenum succeeds the stomach and is some 
[?ght] or nine inches in length, forming in its course
horse-shoe shaped curve, the convexity of the curve
[?ing] to the right - It is divided into three portions,
[?ginning] at the pyloric orifice of the stomach, the 
first two inches, about called the oblique portion
[?ass] upward to the right and backward; then the 
[?ext] three inches, about pass downward and this 
[?ortion] is called the perpendicular and lastly the 
[?ngest] and narrowest portion of the gut is called the 
[?ansverse] and extends from the termination of the 
[?erpendicular] portion, to the left to cross the vertebral
[?lnum] and terminate in the jejunum or the [sec?d]
portion of the small intestine the Duodenum
[?ing] the first portion and the last portion being the 
[?leum]. The point where the duodenum terminates
[illegible] well defind as being at the left side of the second
[?umbar] vertebra, but the subdivision of the remain -
[?er] of the small intestine is arbitrary and ill-defined.
the Jejunum is the second portion of the small 
[?testine], commencing where the duodenum termiates 
i.e at the left side of the second lumbar verbra
it comprises the upper two-fifths of the remainer
of the small intestine which is about twenty
[?eet] in length the lower three-fifths, about, of these 
twenty feet being called the ileum which termiates
in a suddenly dilated portion of the canal
[?alled] the large intestine - The jejunum and ileum



81
lie coiled up principally in the umbilical and 
hypogastric regions producing an appearance somewhat
similar to the upper surface of the brain and 
hence called the convolutions of the small intestines.
The Large intestine begins by a sudden dilation at 
the termination of the small intestine in the right 
iliac region and extends to the termination of the alimentary
canal at the anal orifice, some 5 feet.
It is sinuous in its course and is divided into three
portions, coecum, colon and Rectum -
The entrance of the ileum is not into the extremity
of the large intestine but is so situated some two or 
three inches above its commencement and the 
blind pouch or cul de sac which lies below this 
aperture is called the Coecum which is the largest
portion of the large intestine, about two and a half
inches in length lies in the right iliac fossa, continuous 
with the colon above and below has projecting 
from its lower inner back portion a tail-like 
hollow narrow process called the appendix vermiformis, 
which is from four to six inches in length,
lies coiled up on the back of the coecum has no opening
below but its cavity is continuous with that of 
the coecum above.
The colon is the second portion of the large intestine,
it commences at the entrance of the ileum, which 
is the mark of division between it and the coecum,
in the right iliac region and passes upward
through the right lumbar region to the under surface
of the liver in the right hypochondriac region:
this portion is called the ascending colon: at this 
point the colon makes a bend called the hepatic
[illustrations on the right side]
James Graham
B2



82
flexure and turns to the left across the abdomen to 
the lower extremity of the spleen; this portion is called
the transverse colon and in its course corresponds to 
the situation of the superior horizontal line of the abdomen;
at the lower extremity of the spleen in the 
left hypochondriac region the colon makes another 
bend called the splenic flexure and turns downward
to pass through the left lumber region to the 
left iliac forsa, this portion is called the descending
colon, in the left iliac region the colon makes an 
abrupt turn upon itself first upward and to the 
right and then downward and to the left and this
is known as the signmoid flexure of the colon which 
terminates at the brim of the pelvis, in front of the 
left sacro-iliac symphysis is the third and last
portion of the large intestine commencing where the 
sigmoid flexure terminates (at the left sacro-iliac
synchondrosis) it passes down on the front of the sacrum
to the arms being approximately straight in its
course and hence its name -
- Structure -
Common to the whole extent of the alimentary canal
in the abdomen (with a slight exception) are the 
following coats.
1ð Coat of the visceral layer of the peritoneum -
2d The innermost coat is mucous membrane and 
between these are two muscular coats, the outer one 
beneath the serous coat is 3d the longitudinal; the 
inner lying next to the mucous coat is 4th the circular
muscular coats: the words longitudinal and 
circular indicating that the fibres run in the direction

Mus - Coats of the Stone
1st longitudinal thickest towards
the lesser curverature
2nd Oracular which is thickest
toward the plyloric extrem.
3rd Oblique partial one of the 
oblique fibers collected at 
Cardiac.

83
direction of the canal or pass around it. These several
coats are held the one to the other by means of interposed
areolar tissue - In addition to this each part 
presents some prints peculiar to itself. The Stomach
has 1st externally a serous coat which besides investing 
it passes off to adjoining parts forming the 
ligaments (?), or as they are called the omenta of the 
stomach which serve to retain it in position, it is 
held to the liver by the gastro-hepatic or lesser omentum
to the spleen by the gastro-splenic omentum -
to the transverse colon by the great omentum.
(gastro-colic).
The 2d coat of the stomach just beneath the serous 
is the longitudinal muscular; the 3d just beneath 
this, is the circular muscular which is 
thickest towards the pyloric extremity while the 
longitudinal is the thickest along the lesser curvature -
The 4th coat of the stomach is a partial one
of oblique muscular fibres which diverge from the 
cardiac orifice beneath the circular fibres in an 
oblique direction around the splenic end and terminate
before reaching the plyorus -
The (5th) fifth coat is the internal mucous membrane
which when the stomach is empty is thrown 
into longitudinal ridges called rugae disappearing
when the stomach is filled. At the pylorus the 
mucous membrane is thickened and beneath this 
thickening is an aggregation of the circular muscular
fibres so as to produce a sudden contraction of the 
tube, this appearance is known as the pyloric valve.
The Duodenum has four coats 1st external is the 
serous (partial) 2d longitudinal muscular - 3rd 

The Papella is found about 
4 or 4 1/2 in below the Pyloric
orifice and lower in back 
part. 

84
circular muscular - 4th mucous membrane which 
in the commencement of the gut is smooth but is 
soon observed to be thrown into circular ridges called
valvular cuniventes, which do not surround the 
cavity of the gut entirely but usually stop short at 
3/4 or may reach 5/6 of the circuit. These valvular
conniventes are continued down into the jejunum
and ileum but gradually decrease in size and become
inconspicuous in the lower part of the ileum.
The valvular conniventes are permanent, distension
not affecting them. 
On the lower inner Large part of the perpendicular duodenum
is seen a prominence of the mucous membrane
called a papilla on which is the aperture
for two ducts the common bile duct and the pancreatic
duct. The jejunum and ileum have the 
same coats in the same order as the duodenum -
Studding the inner surface of the small intestines
are numberless hair-like microscopic projections
from the mucous membrane called villi and besides
these and numerous mucous follicles found throughout
the small intestines there are some glandular 
bodies which have special seats -
In the duodenum are numerous small glands the 
size of the head of a pin lying just beneath the mucous 
membrane and opening by ducts on its free
surface, these are known as the glands of Brunner.
Scattered throughout the small intestines but much 
more numerous in the lower part of the ileum are 
small round grayish bodies in the mucous membrane
which have no duct and are called solitary 
glands - In the lower part of the ileum



85
and extending upward some ten feet or more or even
in a few instances in the duodenum are found a 
number, from 20-30 sometimes 40 rarely more-
though in one instance 5 - - of oblong dark colored
patches called the Peyerian glands or Payers pitcher
the long diameter is in the direction of the gut: -
these batches are aggregated masses of the solitary
glands and becomes diseased in typhoid fever.
The opening of the small intestine into the large is 
by means of a horizontal slit-like aperture situated on 
the inner side of the large intestine some 2 1/2 inches
from its commencement and is guarded by a valvular
arrangement called; the ileo-coecal or ileo-colic
valve which consists of two projections into the cavity
of the large intestine one above and the other below the 
slit or button-hole like opening, these segments consist
of folds of the mucous membrane covering circular
muscular fibres.
The Large Intestine as in the previous portions of 
the intestines has four coats external serous internal
mucous and between these two muscular an outer
one longitudinal and an inner circular. From its 
commencement to the rectum the longitudinal
muscular coat is not uniformly distributed around 
the gut; but the fibres are gathered into three narrow 
flat bands placed one in front one on the back and 
one on the concave (lower) aspect of the gut and moreover
these bands are shorter than the other three coats of 
the intestine to which they are attached and in 
consequence of this the other coats are thrown into 
folds or puckered prominence with corresponding
depressions and these appearances are known

Peritoneum is Inch father down on 
the front of the rectum than behind 

[illustration]
86
as the sacculi of the large intestine, towards the 
termination of the colon these bands begin to be diffused
and on the rectum the longitudinal fibres
are again uniformly distributed and of equal
length with the other coats.
The mucous membrane of the large intestine is 
stated above is thrown into sacculi as far down as the 
rectum by reason of the shortness of the longitudinal
muscular fibres; beneath it especially in the
upper portion of the gut are seen a number of solitary
glands which differ from those in the small 
intestine in having a duct.
The Rectum presents some important departures from 
the above description which must here be noticed.
It is usually divided into three portions, the first 
portion extends from the commencement of the gut
until it ceases to incline to the right, that is until
it reaches the middle line of the sacrum; the second 
portion extends from this point to one opposite the 
tip of the coccyx; the third portion is the last inch
of the gut which here inclines backwards to terminate 
in the anus. The Rectum presents the same 
four coats in the same order, as the rest of the intestine
but with the following variations.
1st The serous coat is a partial one, the upper half 
of the gut is entirely surrounded by peritoneum,
but the lower half is devoid of a serous coat behind,
while in front it is continued down only about an 
inch farther than it is. behind; in other words starting
from the arms we say that the rectum has 
no serous coat posteriorly for four inches about; that it 
has no serous coat in front for three inches (at this latter

There is no such thing as an int. agohmeter - B.T. 92 

87
point the peritoneum having left the rectum altogether 
to mount upon the back of the bladder in the male
and on the vagina and uterus in the female.) The fibres
of the longitudinal muscular coat become much 
more distinct and of a reddish color in the lower 
part of the gut and when they reach the very extremity
they do not stop short but turn upward again to 
run up on the inner face of the circular muscular 
fibres being now separated from the cavity of the 
gut only by the mucous membrane and from the 
descending longitudinal fibres by the circular fibres.
These longitudinal fibres which ascend beneath
mucous membrane are gathered into separate bundles
or columns which pass up some inch or two before 
ceasing and these columns throw the mucous
membrane into longitudinal ridges with intertwining
depressions - Towards the lower extremity of the 
rectum, the fibres of its circular muscular coat are 
aggregated into a thickened ring (internal sphincter
arm) and just above this the cavity of the gut is 
seen to be considerably dilated forming a capacious
reservoir in cases of long continued constipation -
- The Liver -
The liver is found stretching across the abdomen
just beneath its roof lying in the right hypochondriac,
the epigastric and to some extent in the left hypochondriac
regions - Above it is the diaphragm below it are the 
hepatic flexure of the colon, the right kidney and supravenal
capsule the ascending duodenum and the 
stomach,. (the left extremity of the left lobe of the liver
sometimes rests upon the upper extremity of the 
spleen) - The liver is semi-ovoidal in shape, in size 

Tumorol. Hernia
Def-- is an abnormal protrusion of a rescues
Desching. 1- integ. 2- 1 layer of Sup. foscia - cut anty= bancle of femoral. - veins
Symph. glando - Size of bean - rec- lymph - ficum - peumun - Qunlats
& lig-  - The orlys gousee is Epigastis & iliac & long soph - vein
& cutaneous nerves -
The superficial layer of fosica pesses from abdom wall to thigh 
& is not adherent
The - deep layer which is beneath the forgoing named res
is adherent to foscia lata for several imebres
ext & below - Saph. openus also to anter Surface of Pouports lig 
Int. to saph. openus it is not adherent & extends
up to Cuhbenats by before becoming adherent.
Foscia - lata. attached outer lip of erect. of Ileum
" " " " surface of Pouports lig
" " " " " Genet.
" " " ant Edge of inner lip ischo pubic
Saphenous opening when you here taken off the superficial
foscia and are long saphenous vein which bents book pucin
the deep fascia and intresting coat of res to enter the 
femoral vein.
That pt of the deep layer of superficial foscia = cuterfon
foscia. (is a peculiar devel. of foscia lata)
Sup. opening. not cucular. is vae. lye end deum & out 
small " up & in 
it is layer than is veas - as it has to move & if it felli
the vein close in movement you would have 
cunctuction -
The pt. of foscia lata- ext- to penis is illiac. attorbr
" " " " " int " " " pubic. [illustration]
Iliac{The sup-cernua is attachr to spine of pubis" pouparts.
{" in " " 

88
it weighs about four pounds, in length it is about 12 
inches in breath about six inches, its greatest
thickness about 3 inches in color it is a dull red occasionally
having a purplish or yellowish tinge - in 
structure it is a solid glandular organ -
The liver is divided for purposes of study into an upper
and a lower surface an anterior and a posterior border,
five ligaments and an excretory apparatus -
The upper surface is smoothly convex being moulded
on the concave under surface of the diaphragm and 
presents the glistering appearance due to the visceral
layer of the peritoneum - which passes down 
from the under surface of the diaphragm to envelop
it in an antero-posterior fold which strikes the upper
surface of the liver much nearer the left extremity
than the right, this fold is known as the longitudinal 
ligament and is the mark of a division
which has been made of the liver all that portion
lying to the right of the longitudinal ligament being 
called the right lobe and all that portion to the left,
the left lobe. The Anterior Border of the liver is thin
and sharp and just where the longitudinal ligament
intersects it is a notch which is another mark 
of separation between the right and left lobes - The 
anterior border is above the lower border of the ribs,
though when the liver is enlarged it may be felt
through the abdominal parietes -
The Posterior Border where it is intersected by the 
longitudinal ligament which is the 3d mark of division
between the right and left lobes (on this border
are the openings of the hepatic veins and it is grooved 

The inner mugen of clove porter is curved lilse a Sicle: falcifoum
lig.
Pubic pubis - att. Gent lig. to front of pubis : ischo pubic ramus
& pares behind the sheath of the femorol ves. : you see there is 
an intervol between the pubic & iliac fosia & : this apuolere
[cross out] conlovin the femol ves.
The sheath. enclosing the veins - aty to two size is femure ferm atr
down -
from abdem down.
you Know bicep felx - femnis. - the femol ves - cutu nerves -
pars beneath pouparts lig.
[illustation] = 1000 Grey-
Pouparts by
illum
body of pubes
giant lig 
The iliac fossia throus an arch way over its ves. but 
the body of it perses behind them & Aesemes centrous with 
the nausoarolis foscia. & as it passes over pouparts lig
it is adherent -
how as has been be for sair the sheath of the ves. is 
too large - & this erylyement extends to opening of sapheun
vein - - & is caller the crural canal. & the reauney
extends que to inner side of femoral vein
& camencement is Known as the fennol ring
int - base of Sub Vig} bondries of few ring
ext by vein}
below bone body of pubis}
above - pouports lig.
Relations of this ring.
I. corener (1) Peritoneum - (2) aeriole tissue - (3) seplum
femerula - is a rubtum process of poscen 

89
by the vena cava inferior).
The Under surface is marked from before backward
by a fissure called the longitudinal, which is just opposite
to the longitudinal ligament on the upper surface
and extends from the notch in the anterior border
to the one in the posterior border, this is the fourth
mark of division between the right and left lobes -
The under surface of the left lobe presents a deep 
groove called the transverse fissure which extends to 
the right from the longitudinal fissure at a point
about one third from its posterior extremity, in this 
transverse fissure are found the hepatic duct to the 
right (and slightly in front); the hepatic artery to 
the left; and between and behind these two the portal
rim - That portion of the longitudinal fissure
which is behind the intersection of the transverse
fissure is called the venosus fissure and that portion
in front the umbilical fissure which is frequently
crossed by a narrow strip of liver tissue
called the bridge of the liver - Pous and Hepatis -
Lying in front of the transverse fissure and producing
an impression on the under surface of the right 
lobe is the gall-bladder and between this and the 
longitudinal fissure is a square-shaped portion of the 
liver which is called the lobus quadratus whose limits
are in front of the anterior border of the liver, behind 
the transverse fissure to the right the gallbladder, to 
the left the longitudinal fissure - Behind the transverse
fissure in another portion of the liver which has 
received the name of the Lobus Spigelii which is 
three-sided and has in front the transverse fissure
to the left the longitudinal fissure (venosus) and to 

Spread over it and is allocatur to borders of ring except
Ext. when it is allocatur to int. pubic of sheath of Vein.
on this sepluir is a gland
having cut this away gow obseve the ring.
Acep - Epigastic -
is above & to outer side -
" " " especaell at its cunenement.
Its pubis branch is above & int. to it.
{now once in 3 1/2 times it passes close to vein see 10 of.
{& :. lers complicating - as you have seen int. any hori -
{or may be a highly developed bonic.
A Knucke of gut foes int femoral vig to the bottom
[illegible] saph. [illegible].
& now pressure cent. it hulges toward = complet.
" dont " " [illegible] " " .
before it escapes his foscia latn
below & ext to spine of pubis - cover by Skin & sup. fere
what duecter does it pers - ?
now as the pubic pubis of foscia latn is not very
adherant you are it pushes it lelf up & in -
If - [illegible] is helme & exit is femoral.
" " " above & lut " Ingremd.
Reduce it by taxes - & relax - foscia lata.
Covering - (1) Peritoneum 
inemp - (2) Areolol tiss
{(3) Septure Cara.
{(4) foscia of feum ves - 

90
the right a deep groove made by the inferior vena-cava.
Priming out to the right from the front of the lobus
Spigelii, just behind the transverse fissure is a 
ridge called the lobus candatus.
Near the anterior border the under surface of the right 
lobe presents an impression made by the hepatic
flexure of the colon and behind this near the posterior 
border another impression made by the right kidney
and supra-renal capsule -
The liver is held in position by processes of the peritoneum
called ligaments - these are five in number -
1st The longitudinal or suspensory consists of two 
layers of peritoneum which pass from the under
surface of the diaphragm to the upper surface of the 
liver these two layers separate on reaching the liver 
and completely invest it with two exceptions, one 
is the space which is occupied on the under surface
by the gall-bladder for the peritoneum when 
it reaches the gall-bladder instead of passing between 
it and the liver leaps over it so as to retain it 
in position the second exception is found on the
posterior border for when the longitudinal ligament
reaches the posterior border its two layers are 
seen to diverge from one another the one to pass to the 
right and of the liver and form the right lateral
ligament the other passes to the left end to form 
the left lateral ligament, these two ligaments
being nothing more than the points where the visceral
layer of the peritoneum covering the liver
becomes continuous with the parietal layer - Now 
between the diverging layers of the longitudinal



[illegible]
91
ligament on the posterior border is space triangular
in shape which is left devoid of serous coat and the 
layers as they [illegible] this space are known as the coronary
ligament - The fifth ligament is called the 
Round and is found as a rounded cord in the 
front edge of the longitudinal ligament (it being 
the shrivelled umbilical vein.)
The Excretory apparatus consists of a series of ducts
and a reservior called the gall-bladder -
The Gall-bladder is a membranous pyriform sac
lying on the under surface of the right lobe of the 
liver, its large end being forward and usually falling
short of reaching the anterior border through occasionally
projecting beyond. Its small end lies
backward terminating at the transverse fissure in
a neck which becomes continuous with a duct
called the cystic, this is about one inch long and
unites with the duct from the liver to form the common
bile duct - The Gall bladder has three coats
its external coat is serous and is only a partial
coat since it passes over the gall bladder from the 
liver leaving that part of the liver and the gall-bladder
which are in contact uninvested - The 
next coat is fibro-muscular. The internal coat is 
mucous which in the neck of the gall-bladder is 
thrown into a fold which is arranged in a spiral
manner so that liquid in following this spiral
can flow but slowly.
In the transverse fissure two ducts one from the 
right lobe and one from the left lobe unite to form a 
duct called the Hepatic duct which is about two 
inches long and descends to unite with the cystic 



92
duct and thus from the common bile duct or ductus 
communis choledochus, which descends for about three 
inches to open into the perpendicular duodenum on a 
papilla seen at its lower inner part.
- Structure of the Liver -
The external investment of the liver is the serous
coat which is complete with the exceptions mentioned
in the description of its ligaments - Beneath the 
serous coat is a white fibrous coat which everywhere
covers the liver tissue and moreover gives off from its 
inner surface numberless processes which pass 
into the substance of the liver and divide it into 
numerous subdivisions called lobules these being 
made up of the proper liver tissue -
Looking at the transverse fissure there may be seen 
the three vessels which ramify in the liver to fulfil
the following three offices. 1st the artery called Hepatic
carrying arterial blood to the liver - 2d A vein
called the Portal which likewise pours a stream of 
venous blood into the organ - 3d Third the Duct called 
Hepatic which has resulted from the coalescence
of numerous smaller ducts from the lobules, conveying
away the bile secreted by the liver -
When traced into the liver these three sets of vessels
are found associated throughout the organ - Now there 
must be some provision to remove the venous blood
from the liver, and this is accomplished by a fourth
set of vessels, called the Hepatic veins, which result
from ramifications which are not associated in position
with the first three vessels, but which open by 
three or four separate apertures on the posterior border



93
of the organ so as to be convenient to the inferior vena
cava into which they empty 
Nov. 21 -91
- The Pancreas -
The pancreas is a lobulated gland of a pale color in 
size from 6 to 7 inches long in the thickness and in 
depth varying in different parts from less than half 
an inch to an inch and a half, in weight somewhere
about three ounces, found lying horizontally behind
the stomach, with its large end or Head embraced
in the concavity of the Duodenum with its 
small end or tail to the left and in contact with the 
inner aspect of the spleen and crossing in its course 
the body of the first lumbar vertebra, which renders
its posterior aspect concave whereas its front is convex -
The head or right extremity of the pancreas is much 
the larger portion of the organ and sends downward
a considerable projection at right angles to the rest
of the organ, owing to which the organ has been likened
in shape to a hammer; and moreover the head 
furnishes a prominence backward and to the left 
which is sometimes called the lesser pancreas and 
is found lying behind the Superior Mesenteric
vessels -
Nov 21 91
- The Pancreatic Duct -
The secretion of the pancreas, the pancreatic juice, is
collected and conveyed away by a duct called the 
pancreatic or Duct of Wirsung, which commences
in the tail of the pancreas by a forked origin; these
two branches in passing to the right soon unite, the 
resulting duct continues along constantly growing 
by momentary accessions until it reaches the right 



94
extremity of the organ where it pierces the coats of the 
perpendicular duodenum to open on the papilla common
to it and the common bile duct.
Somewhere just before leaving the pancreas the pancreatic
duct receives the duct from the lesser pancreas -
In structure the pancreas is a lobulated gland, it 
lies behind the peritoneum and is consequently only
covered in front by a serous coat.
Nov. 21 -91
- The Spleen -
The spleen lies vertically in the left Hypochondriac
region -
It is invested completely by peritoneum
which forms two folds to retain it in position the 
first is called the suspensory ligament which suspends 
the spleen by its upper extremity to the under
surface of the diaphragm, the second is called the 
gastro-splenic omentum which passes between the 
inner surface of the spleen and the contiguous large
end of the stomach -
In color a dark red, shape, semi ovoidal, in 
consistence extremely fragile, (in size, about 6 inches
long, about 3 inches broad, about one inch and a 
half thick and weighs about 7 ounces), the spleen
may be divided for study into two surfaces, two ends
and two borders - The external face is convex to correspond
with the sweep of the abdominal wall; the 
internal face is concave to hug the great end of 
the stomach and presents about its centre a vertical
groove, called the hilum, where the branches of 
the splenic artery find ingress and the veins egress
and where the gastro-splenic omentum is attached.

The right Kidney is the lowest.

95
The upper extremity of the spleen is much larger
than the thinner and more pointed lower extremity.
The posterior border is thicker and more rounded
than the anterior, which latter, almost always presents
several notches.
- Structure -
The Spleen is invested by two coats, the external is the 
serous: beneath this is a fibro-elastic coat which 
sends off from its inner surface processes, called
trabasular, in the interspaces between which is 
found the proper tissue of the gland (or parenchyuma)
or splenic pulp, which consists of numerous corpuscles
called splenis (Malpighian), blood vessels, granules,
and numerous blood corpuscles in varying stages
of degeneration. The spleen is a (blood-vascular) or 
ductless gland and whatever it elaborates is carried
off without the aid of a special duct.
- The Kidneys -
The kidneys are two organs, found, one on each side of 
the vertebral column, in the lumbar regions, the 
left kidney extends from the upper border of the 11th
rib to near the crest of the ileum, the right from the 
lower border of the 11th rib to near the crest of the ileum -
being some 1/2 inch lower than the left; they correspond
to about the 12th Dorsal and 1st & 2d lumbar vertebrae
(diverging somewhat as they descend): they lie 
imbedded in a mass of fat behind the peritoneum
which touches them only for a slight extent at their 
front upper portion, perched on the upper inner
part are the two supra-renal capsules - The Kidneys is 
about four inches long, about two broad, and about one 
thick - It is peculiar in outline, hence the word uniform

right is lowest

96
uniform or kidney-shaped - the anterior surface being convex,
the posterior being slightly flattened the upper
end being larger- the outer being convex, the inner border 
being concave and presenting a depression called 
to hilum through which the blood vessels and duct
of the kidney pass, in the following order, the renal
vein in front, the duct or uretur behind and between
these the renal artery - The hilum leads to a cavity in
the organ called the sinus. It weighs from 4-5 ounces -
- Structure -
The kidney is invested by a fibrous coat which can 
be easily stripped off thus exposing the proper tissue,
to study which the kidney should be split in half
longitudinally and through its width - It is 
then seen to consist of two portions, the outermost
layer is red in color and forms about 3/4 of the organ,
being called the cortical portion: within this is seen
a portion called the medullary portion, of a lighter
red color and formed into conical masses called
the pyramids of Malpighi: these pyramids from 
8-18 in number are arranged with their bases at 
the inner surface of the cortical portion and their 
[cross out] papilla towards the hilum. Each pyramid consists
of hundreds (200-500) of straight minute tubes leading
from the cortical portion, where the urine is 
excreted, to the [cross out] (or papilla) of the pyramid -
where they discharge the urine which they convey.
These pyramids are separated by prolongations of 
the cortical substance which dips between them -
The urine which drops from the apex of each pyramid 
is carried off through coalescing ducts bearing
different names, all of which finally terminate 

[illustration]

97
in one duct called the ureter, which itself opens into
the bladder - The course which the urine takes can
better be understood by following from below upward
the channel through which it flows. Thus beginning
with the ureter we trace it up to a short distance
before it reaches the hilum of the kidney
and observe it here begins to enlarge, this enlarged
part is called the Pelvis of the Ureter, which entering
at the hilum occupies the sinus of the Kidney -
now the Pelvis soon divides into three tubes 
called Infundibula, one infundibulum collecting
the urine from the upper third of the organ, one 
from the middle third and one from the lower 
third. Each infundibulum after a short course
subdivides into a number of smaller tubes called
calices, each calyx terminating by surrounding
the [cross out] papilla of one or more of the pyramids. Hence the 
course of the urine which is secreted in the cortical
portion is 1st through the miniferous tubules
which form the pyramids of Malpigh 2d dropping 
from the [cross out] papilla of the pyramid it falls into a 
calyx which 3d ormites with the other calices of 
its third of the organ to form an infundibulum
which 4th combines with the other two infundibula
to form 4th the Pelvis, which 5th contracts into 
the ureter which 6th and lastly opens into the 
bladder
- Ureter -
The Ureter commencing at the kidney in a dilated
portion called the pelvis takes up its course
for the bladder contracting to a small diameter
(the size of a goose quill) it passes down beside the 



98
vertebral column to the margin of the pelvis, then 
descends into the pelvis behind the bladder and 
approaching the ureter from the other kidney they 
open into the back part of the base of the bladder
by two apertures some two inches apart, perforating
the coats of the bladder in an oblique direction.
In length the ureter is some 16-18 inches.
In structure the ureter lying behind the peritoneum
consists of three coats (and this description applies to 
sinus, infundibula and calices), an external fibrous
an internal mucous and between these the muscular
which consists of external longitudinal fibres
and internal circular and it is to be noted
that in the lower portion of the ureter towards the 
bladder there is another muscular coat which 
consists of longitudinal fibres lying internal to the 
circular fibres between them and the mucous
membrane -
- The Bladder -
The bladder is the reservoir for the urine being a 
membranous sac lying in the pelvis just behind
the symphysis pubis, in the male in the front of the 
rectum, in the female in front of the uterus and 
vagina. Its shape is when distended ovoidal or pyriform
the large end of the ovoid being below, when 
empty it is flattened against the pubes and is 
somewhat triangular. - Its direction is downward
and backward - Its capacity is very variable though 
in health the urine is discharged when it has collected
to the amount of from 1/2 to 1 pint. Its upper
third, about is called the superior summit or apex, its
middle third the body, its lower third the base or fundus.

He gore this year the exit of the urethra
as apex of Mgmum Ulsica E

99
fundus. The channel through which the urine escapes
from the bladder is called the Urethra whose aperture 
is seen on the lower front portion and this 
part of the bladder is the Neck which lies imbedded
in the base of the prostate gland - In structure
the bladder consists of three coats, 1st The internal is 
mucous membrane, which at the neck of the bladder
presents a slight prominence, often absent, called
the uvula vesicae seen just at the entrance of the 
Urethra, now between this uvula in front as its 
apex and the openings of the ureters as its two posterior
angles, is a triangular space called the triangules
of the bladder or trigorum vesicae whose base 
is a line connecting the two openings of the ureters
and its sides each found by a line drawn from the 
opening of an ureter to the uvula vesicae the latter
line corresponds to a ridge of the mucous membrane
produced by a bundle of longitudinal muscular
fibres (from the ureter) - This space is by far 
the most sensitive portion of the mucous membrane
and corresponds in position to a similar space on 
the exterior of the base - 2d The muscular coat which
is connected to the mucous membrane by a layer of 
areolar tissue; the muscular fibres (the longitudinal fibres
from two layers between which are found the circular 
fibres) The circular fibres are aggregated into a 
considerable mass at the neck of the bladder so as to 
keep closed by their tonic contraction the opening of 
the urethra - 3d The external coat is a serous one 
and is partial; in the male it covers the summit,
sides, posterior aspect and posterior part of the 

1.25


100
base of the bladder leaving uncovered its front and 
the front part of its base. In other words the visceral
layer of the peritoneum in the male leaves the front
of the rectum some three inches above the arms to 
mount upon the posterior surface and sides of the 
bladder to its summit where it leaves it and passes
to the inner surface of the anterior abdominal wall 
and thus become continuous with the partial layer.
The Urethra - (In the Male) -
The urethra is the last division of the canal which 
the unus traverse in seeking an outlet from the 
body - It commences at the neck of the bladder
and terminates at the meatus urinarius, its opening 
on free extremity of the penis - Its length is 
variously estimated owing to the varying length of the 
penis which it traverses. It is divided into three
portions, the prostatic portion which begins at the 
opening in the bladder and traverse the substance
of the prostate gland to appear at its apex, after a 
course of an inch and a quarter to become 2d the 
membranous portion which extends three quarters
of an inch to enter (the bulb of the corpus spongiorum 
of the) penis and become the spongy portion: the 
spongy portion is continued forward (through the 
corpus spongiosum) to the meatus urinarius and 
is much the longest and most variable portion in 
length; the largest portion being the prostatic - The 
length of the urethra usually given as a whole is 
seven and a half inches -
- The Prostate Gland - 



101
The prostate gland is a small horse-chestnut-shaped
body found in the male lying with its base against
the neck of the bladder and its apex projecting
forward about 1. 4 inches; its base is 1.3 inches about 
and it is about 1/2 inch in depth - It lies invested
in cellular tissue and has a proper fibrous capsule;
it consists of interlacing muscular fibres (unstriped)
in the interstices of which are situated the follicles of 
the gland which secrete a milky fluid -
The gland is divided into three lobes, two lateral
and an inferior (isthmus) - Passing through it is 
the prostatic portion of the Urethra which is nearer
the upper surface than the lower -
On the floor of this portion of the urethra is seen a 
prominence of the mucous membrane some 1/2 inch
long called the verumontanum on each side of which,
where the floor of the urethra is slightly sunken, are 
some 11-15 apertures the openings of the ducts from the 
prostatic follicles, and in front of the verumontanum
is a small saccular cavity projecting backward
and called the sinus peculiaris "relic of a uterus" B.T. - Opening at 
either side, of the orifice of this sinus is seen a small 
aperture; these are the terminations of two ducts, (ejaculatory)
which pass back to two lobulated oblong bodies
seen just behind the prostate gland on the under
surface of the bladder called the seminal vesicles -
- Seminal Vesicles -
Each seminal vesicle is a reservoir for the seminal
fluid and is formed of a tube (size of a goose-quill)
some 5-6 inches long coiled into an oblong mass 
lying on the under surface of the base of the bladder, 

Billy prefers the base to be where the peritoneum
strikes put wall of bladder.

102
its large end projecting backward and outward
from its fellow, the small end being in front just behind
the prostate gland and approaching its fellow -
Drawing a line from the posterior extremity of one 
vesicle to the other, which are about two inches apart,
there is formed a triangular space which is seen 
to be devoid of peritoneum which extend no farther
than the line above designated forming the base of 
the triangular the apex is at the posterior edge of the 
prostate gland and the sides are formed by the diverging 
vesicles and by a small tube which is 
seen passing along the inner side of each vesicle
this is the vas deferens conveying the semen from 
the testicle.
- Vas Deferens -
Commencing at the upper extremity of the testicle
the vas deferens forms one element of the spermatic
cord the others being blood vessels, nerves &c which
ascend to the upper border of the pubes where the 
cord plunges into the anterior wall of the abdomen
(external abdominal ring) and then turns outward
for two inches in the substance of the wall (inguinal
canal) and then turns backward to enter the cavity
of the abdomen (through an opening called the internal
abdominal ring, as soon as the cord has 
entered the abdomen its various constituents disperse
in different directions; the vas deferens passes 
to the upper part of the side of the bladder - thence
down the posterior surface of the bladder thence 
along the inner edge of the seminal vesicle at the 
anterior extremity of which the vas deferens is seen
to be joined by the tube whose convolutions form the 



103
seminal vesicle and the dust thus formed is called 
- The Ejaculatory Duct -
The two ejaculatory ducts lying very near one another
pass forward and upward for about 3/4 inch 
through the substance of the prostate gland to open
on the sides of the aperture of the sinus pocularis
which is found at the base of the front of the verumontanum
on the flow of the urethra, its prostatic
portion.
- The Penis -
The penis consists of three cylinders, two of them lying
side by side are called the corpora cavernosa - the 
third is known as the corpus spongiosum which 
lies below in the groove between these - When dissected
out the corpora cavernosa are seen to commence 
by attachment to the bone (rami of pubes ischium)
this attached portion of each corpus cavernosum, which 
does not extend to the extremity of the penis but 
stops short some little distance behind the meatus 
urinarius - The corpus spongiosum begins by a dilated
portion called the bulb, situated between the 
crura, into which the membranous urethra terminates
by becoming the sponge portion - The corpus 
spongiosum passes forward, tunneled by the urethra,
and lying in the groove below the corpora cavernosa
until it reaches the interior extremity of these when 
it suddenly dilates into a considerable mass which 
covers the extremity of the corpora cavernosa and projects 
in a ridge beyond them - This dilated extremity



104
extremity is called the glans penis or head, the glans presents
its base backward which terminates by a rounded
edge raised above the surface of the corpora cavernosa 
this ridge being called the corona glandis and the 
seemingly constricted portion behind it is called
the neck; from the corona the gland elopes to its termination
around the meatus urinarius. That portion
of the penis extending from the crus, or rather 
from the point where the three cylinders come into 
close relation, forward to the head is called the body
of the organ; and the two crura (and the bulb)
constitute the roof of the penis.
Surrounding and loosely adherent to the body is 
a thin skin which in front is formed into a fold,
movable or the glands called the prepuce: on the under
aspect of the glans the prepuce is attached by a 
precise extending forward to the meatus urinarius,
this attached portion is called the frenum. Passing 
through the corpus spongiosum from the bulb behind
to the meatus urinarius is the spongy portion of the 
urethra, which just before its termination at the meatus
urinarius presents a considerable dilation called
the fossa navicularis - The mucous membrane
lining the urethra presents many mucous follicles
called lacunae opening into the canal, (when the 
membrane reaches the meatus urinarius it is continued
over the glands penis and the under surface
of the prepuce). The structure of the cylinders of 
which the penis is formed, is that known as erectile
tissue - each is enveloped by a strong fibrous 
sheath that of the corpus spongiosum being more delicate
than the others - within this the structure



105
consists of interlacing bands of fibrous tissue the interspaces
between which contain dilated blood vessels 
which are capable of becoming turgid with 
blood to produce erection - The two corpora cavernosa
at the posterior part of the body of the organ are separated
some little distance from each other but as 
they pass forward they come much closer together -
for the fibrous partition between them is thick posteriorly
whereas in front it is thin and presents
numerous slit-like interruptions which have obtained
first the name of septum pecteniforme (pectena 
- a comb )
- The Testicles - Testes -
The testicles are a pair of small organs whose function
it is to secrete the semen -; they are found suspended
by the spermatic cord (see "Vas deferens") in 
the bag called the scrotum lying side by side though
separated from each other - Each testis weighs from 
three-quarters to an ounce or more its length from an 
inch to an inch and a half, its antero-posterior
measurement about an inch and a half and its  
transverse about half an inch. It occupies the back
part of the scrotum and its position is oblique being
from above downward and backward.
The Scrotum in which lie the testicle is thus constituted,
1st an external covering of skin. 2d- beneath
this a musculo-fibrous covering called the dartos
3d- lining the interior of the dartos and also enveloping
the testis is a serous membrane called the tunica 
vaginalis, that portion of which lines the dartos is 
called the parietal layer and that enveloping the 
testis the visceral layer -

[illustration]

106
There are indeed two tunical vaginalis, for the cavity
of the scrotum is divided into two apartments,
in each of which lies a testis invested by the tunica
vaginalis of its apartment and this division is effected
by means of a septum furnished by the dartos
called the septum scroti -
- The Structure of the Testicle -
Dissecting up the visceral layer of the tunica vaginalis
beneath is seen a bluish white fibrous investment
of the testicle called the tunica albuginea,
which is found to be much thicker at its back part 
and this thickened portion is called the mediastinum -
Lining the inner aspect of the tunica albuginea
is a reddish vascular investment called the 
tunica vasculosa. Lying on the posterior aspect of 
the testis is seen a flattened body called the epididymis
which is composed of the convolutions of the tube 
conveying away the semen, the upper portion of the 
epididymis is alone permanently connected with 
the testis for it is here that the ducts emerge which 
transmit the semen from the testis and unite to 
form the epididymis; this upper portion of the epididymis
is called the globus major, its lower portion
the globus minor which terminates in the vas deferens; 
- the intermediate portion is known as the body 
The semen is secreted in what are known as the body
lobules of the testicle, these number from 250-400,
each lobule being separated from adjacent lobules
by septa sent in between them from the tunica albuginea
which septum however is covered on both sides 

[illustration]

107
by a layer from the tunica vasculosa, so that one lobule
is separated from another by two layers of tunica
vasculosa and between these a layer of tunica albunginea -
Each lobule consists of the convolutions of a small 
tube 1/200 inch an diameter (tubules seminiferus) arranged
from before backward with the large and of 
the convoluted mass in front, the small end behind
at the mediastinum and here many lobules unite
to form one duct which being comparatively straight
is called a vas rectum there being in the whole testis
some 20-25 of these vasa. recta which plunge into the 
mediastinum and there unite into from 7-13 ducts.
which ascending through the mediastinum in a 
sinous course one called collectively the rete testis
when the ducts which form the rete testis have reached
the upper extremely of the mediastinum they 
terminate in from 9-30 other ducts called the vasa
efferentia, each of which is thrown into convolutions
assuming a conical appearance, these are known as 
the coni vasculosi which form the globus major or 
beginning of the epididymis; the bases of the cones terminate
in large ducts and these unite in the body
of the epididymis into one duct whose convolutions
(nearly 20 ft long constitutes the body and globus
minor of the pididymis and then becomes the vas 
deferens -
The continuous route of the semen is thus seen
to be lobule (which may be composed of as many as 
3 tubes) 2d vasa recta - 3d Rete testis - 4th vasa efferentia
- 5th coni vasculosi - 6th Epididymis body
and globus minor) 7th vas deferens- 



108
The Aerial Apparatus -
The air reaches the lung from the throat through
a tube which has received different names in its 
[illegible] parts first it is called the larynx then trachea
which divides into two bronchi opposite the 3d Dorsal
vertebra.
The Larynx -
The larynx is found upon a framework of separate
cartilages which require to be studied under the 
individual names which they have received.
Thyroid Cartilage -
The thyroid is the upper front large cartilage of 
the larynx; in front coming to an acute angle it 
produces the prominence called Adams apple;
from this acute or receding angle it passes backward
and outward on either side in a quadrilateral
plate called an ala of the thyroid cartilage; on 
the outer surface of this quadrilateral ala is seen 
an oblique ridge from above downward and forward,
terminated at each end by a prominence
or tubercle; the posterior border is rounded and free
and is prolonged both above and below into a process
called superior and inferior cornu, each terminated
by a tubercle the superior being the longer;
the upper border is sinuous commencing in a notch 
at the receding angle it passes backward to become 
continuous with the superior cornu; the inferior
border is also sinuous and continuous with the 
inferior cornu -
- Cricoid Cartilage -
The cricord cartilage is a ring and lies supporting 

[illustration]
int Sup-
ant L -
Ext Sup-
-" L
Prot 2

109
the thyroid cartilage between whose inferior cornua
it is grasped. It is narrow in front not more than 
4 in deep whereas it becomes a full inch in depth
behind; its upper border slopes upward and backward
presenting in the centre, behind, a slight
notch and on either side of this an articular facet
on which is perched another cartilage the arytenoid
running down the middle line behind is a ridge
and on either side of this a slight depression and 
further forward on the side of the cartilage is seen
a round articular facet on which plays the inferior
cornu of the Thyroid - cartilage -
- Arytenoid Cartilages -
The arytenoid cartilages are found upon the cricoid
occupying the articular facets seen on its upper border
on the sides of the notch in its centre posteriorly -
The arytenoid cartilage is triangular, its [illegible] below and
apex above, its posterior and a concave, and its [anterior] External
equally convex; its inner face, which looks
towards its fellow narrow and flat; its apex is surmounted
by a small separate cartilage called cornicular
laryngis - The two arytenoid cartilages occupy
the interval between the posterior borders of the 
aloe of the thyroid cartilage.
Epiglottis 
The epiglottis lies just above the receding angle of the 
thyroid [illegible] t is leaf-chaped; its apex downward
and forward and its base which presents
light notch upward and backward and lying at 
the base of the tongue its upper end may be sometimes 

The cricoid Thyroid membrane -

110
seen by looking down the throat.
These several cartilages are held to-gether and to
the tongue and hyoid bone by the following ligaments.
The hyoid bone lies just above the superior border
of the thyroid cartilage and passing between
them is an unbroken membrane called the thyro-hyoideum
and in each of the posterior edges of this 
membrane is a round cord which passes from the 
superior cornu of the thyroid cartilage to the posterior
extremity of the hyoid bone and is called the thyro-hyoid
ligament.
The thyroid and cricoid cartilages are held together by 
the following ligaments - The extremity of each inferior
cornu of the thyroid cartilage is held to the facet on the 
side of the cricoid by means of a capsular ligament -
The considerable interval which exists in front between
the lower border of the thyroid and the upper border of 
the cricoid is closed in by a fan-shaped yellow elastic
membrane called the crico-thyroid membrane
which is attached below to the upper border of the cricoid 
and above to the lower border of the thyroid (its 
inner edge). 
Passing now to the epiglottis we find the 
apex of it held to the receding angle of the thyroid by 
a narrow ligament called thyro-epiglottis -
It is connected to the hyoid bone by a ligament
called the hyo-epiglottis (attached to the epiglottis
on its front aspect near its apex.)
The back of the tongue and the epiglottis are connected
by three ligaments one in the centre and one on each
side called glosso-epiglottic middle and lateral.
Lastly we have the ligaments attached to the Arytenoid

The false vocal cords are above the true vocal cords
[illustration]

111
Arytenoid cartilages, the base of each is held to the cricoid
by a capsular ligament and the posterior of this 
capsular ligament is much thickened and is called
the posterior crico-arytenoid ligament - Besides these
the arytenoid cartilage is connected to the receding
angle of the thyroid cartilage by means of two long 
ligaments - They are attached behind to the base of 
the arytenoid one above the other and in front to the 
receding angle of the thyroid the upper one is called
the superior thyro-arytenoid ligament (and with
its below constitutes the [cross out] false vocal chords.)
The Larynx is lined by mucous membrane continuous 
with that of the mouth. Looking into the cavity
of the larynx from below, at a certain point the 
cavity is seen to be suddenly narrowed by two ridges
one on each side running from before where they are 
close to-gether, backward and diverging as they go and 
leaving a triangular interval between them called
the chink of the glottis or rima glottidis: these ridges
are produced by the inferior thyro-arytenoid ligaments
or true vocal chords - Now reversing the larynx
and looking into its cavity from above it is seen that 
the opening into it from the throat (Pharynx) is 
limited in front by the epiglottis which projects
upward and backward; over the opening posteriorly,
are seen the arytenoid cartilages laterally are 
folds of mucous membrane; the ventricular bands;
the opening is heart-shaped - the front being the 
broad end down in the cavity are seen two ridges
on each side one above the other the lower pair, are 
the two which were seen from below the upper
pair correspond to the superior thyro-arytenoid ligaments



112
ligaments and are the false vocal chords being much 
less prominent than the true vocal chords they could
not be seen when the rarity of the larynx was sieved 
from below; the space between the false vocal
chords bears no name but from this nameless interval
to the similar but smaller interval between
the true vocal chords the rima glottidis, is known
as the glottis, now on each side of the glottis is another 
space formed by the recession of the wall of the larynx
between the true and false vocal chords which is 
called the ventricle of the larynx and this ventricle
is continued up on the outside of the false vocal
chord between it and the wall of the larynx some 
little distance and this prolongation of its cavity is 
known as the sacculus laryngis - ("To get a definite 
idea of the ventricle and glottis consider them as having 
the following boundaries, the ventricle is bounded
on the outer side by the wall of the larynx (ala (6) treyal Antonigds
of the thyroid) on the inner side is the space called
the glottis above is the false vocal chords and the 
sacculus laryngis below is the true vocal chord -
The Glottis is bounded above by the nameless interval
between the false vocal chords, below by the rima
glottidis; on each side by the ventricle; for it 
lies between the two ventricles, each ventricle
extending from the wall of the larynx towards
the centre only as far as an imaginary line passing 
from the inner edge of the false to the inner
edge of the true vocal chord

[illustration]
altaclument for Epiglottis
crico thyroid mem.
Relats
begins opp. 4th cen. vetebra. lower Indu of cricoid.
pases down on viluteal cal - into thorax - dendes into
the two bronch - opp 4th dorsal. v.
In front - (1) istlumus of Thyroid - gland. 2-3 rings
(2) A. Thy. & S. Hyoid.
(3) Cervicol fascia
(4) superficial fascia Platesina & * ant Juq Vin
mayhore * (5) * lowest (branch ans) of thy. arty banch of inorn.
(6) Steuro Mosloir us sep. from it by a mub.
of veins.
Behind - (1) oesophagus -
on each side (" the Thyroid gland - (2) Rec. largyol
& Thy - Arty -
Thorax
In front. (1) stemum - S - thy. & S- H or Themus
artys - Aorta - lies in front. & left com corotn
& innorn
vein - left vena innorn.

113
[illustration]
1. Nameless interval between false vocal chords.
2. Glottis.
3. Rima Glottidis 4 Sacculus Laryngis -
5. Ventricle. 6 False Vocal chord.
7. True Vocal chords -
- Trachea -
Succeeding the larynx comes the second subdivision
of the air-tube known as the trachea; commencing
where the larynx terminates opposite the fifth cervical
vertebra it descends in front of the vertebral
column from which it is separated by the oesophagus
and it terminates by forking opposite the [cross out] 5th"
dorsal vertebra into the right and left bronchi -
It is a cylindrical tube flattened on its posterior aspect,
about 4-4 1/2 inches 5 in long - inches long and about 1 inch in
diameter these dimensions being somewhat less for 
the female - Its appearance when viewed from the 
front is annular due to the fact that its largest
element is a number (15-20) of cartilaginous rings
one lying below the other; the flattening of the trachea
posteriorly is due to the fact that each cartilaginous
ring is wanting in its posterior third,
thus leaving this portion of the tracheal wall devoid
of a cartilaginous element; these rings are 
not in contact but are slightly separated and 
maintained in position at the same time by a 
fibro-elastic membrane which covers both surfaces
of the rings for these in fact lie imbedded in the 
substance of the membrane; between the posterior
extremities of the rings, over the interval left by 
their imperfection; the membrane is continued 

left side left side L. Corn cerotes
right " iturour. arty 1st in front then to it.
" " is Right Voqus. - The left ray is is 
not in relation to it.
Behind - oesophagus.
Now it derides but not at the same & are of unequal
length - left 2 in it, in -
" longer.
Relation - of Bronchi - (1) at it. of lung.
(2) " arch of aorta.

114 
and here the portion between the posterior extremities
of the rings, it is strengthened by unstriped
muscular fibres both longitudinal and transverse,
the longitudinal are unimportant but the 
transverse passing between the posterior extremities
of the rings can be their contraction diminish the 
diameter of the trachea -
The interior of the trachea is lined by mucous
membrane, continuous with that of the larynx
above and prolonged below into the bronchi bronchial
tubes and ultimate air-cells of the lungs.
Beneath the mucous membrane between it and 
the fibro-elastic membrane, containing the rings,
is a yellow-elastic membrane which is much
more distinct posteriorly where the fibres which 
compose it are gathered into longitudinal bundles.
To sum up its structure we say the trachea is
lined by mucous membrane, beneath this yellow 
elastic fibres, external to these is a fibro-elastic
membrane lying in which are the characteristic
imperfect cartilaginous rings; besides which 
are found transverse muscular fibres between the 
posterior extremities of the imperfect rings; and 
scattered around the tube some unimportant
longitudinal muscular fibres.
- Thyroid Gland -
Lying in relation with the upper part of the 
trachea and the larynx is a ductless gland called
the Thyroid. It consists of two similar lobes, each 
about two inches long and 3/4 inch in largest diameter,
conical with its base below and apex 

Get Superior. & Inferior Mediasteivere
" Broad ligaeeecut of Plural 
Get Valor identification 

115
above. These two lobes lie one on each side of the 
upper part of the trachea and are usually connected
by a third portion of the gland called its 
isthmus, which is a narrow strip passing from the 
base of one lobe across the front of the 2d & 3d rings
of the trachea to the base of the other lobe the apex
of each lobe extending up beside the larynx. - 
The color is a brownish red (and the gland weighs
about 1 1/2 ounces) its size in the female undergoes
increase at each menstrual period.
In structure the gland consists of numerous lobules
which are made up of many vesicles containing
a peculiar fluid, cells and nuclei; besides
which is a thick network of blood vessels, for the 
gland is extremely vascular, each lobe receiving
two large arteries one from above and the other from 
below; its constituents are held together by areolar
tissue which separates its lobules -
- Bronchi -
Taking up the air tube again, we find that the 
trachea (or wind pipe) when it has reached a 
point corresponding to the front of 5th Dorsal vertebra
forks and the prongs of the fork are the right and 
the left bronchus, each of which extends from its 
origin to the inner surface of the lung, forming one
of the elements of what is called the root of the 
lung - The two bronchi are not similar and the 
difference between them may be thus stated, the 
Right is shorter 1/2 it is larger; it is more nearly horizontal,
coming off nearly at right angles to the 
trachea, whereas the left has considerable obliquity

11 lb. notch on anterior border left Lung -

116
obliquity downward - If the trachea be cut across
near its lower termination and the cavity be looked
into, on its bottom is seen a slight ridge extend on
from above before backward and separating the 
commencement of the bronchi and this ridge is 
not exactly central but lies somewhat to the left;
so that should a foreign body enter the trachea
from above the chances are that it would fall to the 
right of this ridge and thus enter the right bronchus
- In length the left bronchus is about two
inches, the right about one inch. In structure
they exactly resemble the trachea.
- Lungs -
The lungs are a pair of organs found in the thoracic
cavity, one on each side of the middle line,
having the heart enclosed in the pericardium
between them and resting upon the diaphragm
below - Each lung is conical in shape, its base
is below resting on the convex upper surface of the 
diaphragm, it is here concave in correspondence
to the shape of the surface on which it lies. Its apex
is above extending into the root of the neck (some 
1 1/2 inches) Besides the base and apex, each lung
presents the following subdivisions, the posterior
border is long, thick and rounded and contracts
obviously with the Anterior border which is thin,
short and sharp: the surface are two, the outer
surface is convex to correspond to the inner concave
surface of the chest wall against which it lies;
the inner surface which looks towards its fellow is 
concave and the concavity is caused by the heart in 



117
its pericardium which lies between the two lungs,
it being placed on the centre of the upper surface
of the diaphragm; the inner surface of the left 
lung is much more concave owing to the considerable
inclination of the heart to the left. Nearly in 
the centre (a little above and posterior to it) of the 
inner surface of each lung the root of the lung is 
seen to enter its substance, the root consists of various
elements as nerves lymphatic and the bronchial 
arteries, but its chief are the bronchus - the 
pulmonary artery bringing venous blood from the 
heart and the two pulmonary veins carrying back
this venous blood arterialized - the relations which 
these bear to one another are same for each lung in 
the direction from before backward but are different
for the two lungs from above downward.
From behind forward then in booth roots the position
is Bronchus, Artery, veins - (This position of 
the bronchus might be inferred from a consideration
of the relation which the termination of the 
trachea bears to the heart, the bifurcation
taking place behind the heart from 
which the other two elements of the root under consideration
proceed). The relation from above downward
is in the Right Root Bronchus, Artery Veins
in the left Root, Artery, Bronchus, veins -
The veins are thus seen to be the lowest on both sides,
the difference between the two roots, being produced
by a change of relation between the artery and 
bronchus in the left lung and thus is accounted
for by the downward inclination and the greater
length of the bronchus on the left side. 



118
(By making the statement as above it is seen that 
by stating this relation
Bronchus, Artery, Veins, you give not only the relation
from behind, forward of both roots but also
the relation from above downward of the Right Root,
and the deviation from this in the left root is easily
remembered from the fact that the left bronchus 
is long enough and has a sufficient downward
inclination to get below the artery.)
Each lung is divided by fissures into lobes, the 
right lung into three and the left into two; commencing
about 3 inches from the apex on the posterior
border of each lung an oblique fissure passes
through the lung downward and forward to 
near the lower extremity of the anterior border -
Now in the right lung there is another fissure which 
begins about the centre of the oblique fissure and 
runs nearly horizontally forward to the anterior
border thus dividing the right lung into three lobes;
these lobes are called upper, middle and lower, on 
the left lung as there is no horizontal fissure there 
are but two lobes an upper and a lower - Now although
the right lung is slightly larger than the left, this 
is not due to its having three lobes which are only 
the result of an additional fissure, the difference
is due to the encroachment of the heart on the left 
lung this difference however is again reduced
by the fact that the right lobe of the liver lies on 
the right side and being much thicker than the 
left lobe it bulges the diaphragm upward more 
on that side thus rendering the right lung shorter
than the left so that the difference in weight is 



119
reduced to about two ounces; the right lung weighing
22 ounces and the left 20 ounces.
The Pleurae -
Enveloping each lung and lining the chest-wall
is a serous membrane one on each side these membranes
are the pleurae, each lung separate from 
the other and forming a distinct closed bag: one 
side of this closed sac lines the inner surface of the 
chest-wall and the other side inverts the lung completely -
In front behind the sternum the two 
pleurae approach each other closely and sometimes
they are in contact about the centre of the sternum.
In tracing the continuity of the pleura as it is a 
closed sac we can begin at any point and following 
it will return to the same - Beginning then on 
the root of the lung in front, we will trace the layer 
which covers the lung called the visceral, or pleura
pulmonalis and then the layer which lines the 
chest-wall called the parietal or pleura costalis,
these being continuous with each other - From the 
front of the root of the lung the pleura passes
forward on the inner face of the lung to its anterior
border then it passes around the convex outer face
of the lung to the posterior border and lastly it 
passes forward on the inner face of the lung to 
the back of the root of the lung where this visceral
layer ceases and the parietal begins, which 
passes back from the posterior aspect of the root
of the lung to the side of the vertebral column
thence along the inner surface of chest-wall
to the sternum in front where it leaves the chest-wall



120
chest-wall and passes backward between the pericardium
and visceral layer to the front of the root of the lung
where it becomes continuous with the visceral
layer which we have followed. - The free surfaces of 
the two layers of the pleura secrete a small amount 
of liquid which renders the movements of the lungs
in respiration easy and croiscless thus being the 
object of the pleura -
-Structure - neuter left for Phys.
Each lung has an external serous coat the pleura
pulmonalis, beneath this is an areolar elastic
investment which sends processes into the substance
of the lung to separate it into numerous 
subdivisions called lobules where the function of 
the lung the aeration of the blood is effected -
As soon as the bronchus reaches the lungs it forks
into bronchial tubes and these ramify throughout
the lung continuously subdividing, generally by 
forking, until finally they open into the air-cells,
which form the lobules, these being thousands
of these small cells in each lobule (say 20000), every
lobule having one bronchial tube - On the 
walls of these cells ramify the blood vessels, these
walls separating adjacent cells (which open into 
a kind of common cavity called an inter-cellular
space with which the bronchial tube communicates).
The Bronchial tubes differ in their structure
from the bronchus, at first the only difference
is that the cartilages cease to be ring-shape and 
are flat scale-like and scattered all round 
the tube; towards the termination of the tube the 

Dome of the pleura is to upper
extem of 1st" rit behin.; is lying 
beside the body of the 7th" cervical
vertetra.
Superior India stenum Sey Gray 934
(92) he gives sup- m- in additon to what in notes.
The ant mediasternum is a little to the left 
of median line.: its ant under would
be in part the post border of the rels
The pleura come with in cest of 
each other (6) firm in her 1/3 wish
outer 2/3 - of d. oricle. 
[ilustration]
12th"
Ana of Pre-Cow dullum{ * Pleura all nearest hen
{on left side only as for down as 6th"

Here is a notch in the left lung -
121
cartilages disappear entirely and the tube consists
altogether of fibrous tissue (in which are many elastic
fibres) muscular fibres and mucous membrane -
(the diameter of the smallest tubes is from 
50th - 30th of an inch of the air-cell from 200th -
70th of an inch.)
Before birth the lungs are almost colorless, but as 
soon as the blood reaches the walls of the air-cells,
the lung assumes a pink color, which gradually
fades during life to a slate color, this may assume
an almost black hue in the decline of the life, especially
in men and in the posterior part of the lung,
owing to the deposition of minute particles of carbon.
hot OK See Gray p 933
- Mediastinum -
There exists between the inner surfaces of the two 
lungs or rather between the opposing surfaces of the 
two pleurae, a narrow interval extending from the 
back of the sternum in front to the vertebral column
behind, this is known as the mediastinum;
and is divided into three parts anterior, middle
and posterior mediastinum - The middle mediastinum
is that space which the pericardium and 
heart occupy and is much the largest part of the 
mediastinum.
The Anterior mediastinum is the small space between
the back of the sternum and the heart, this 
space is very small owing to the fact that the two 
lungs overlap the heart in front and approach
each other very closely in front sometimes indeed
they actually touch each other behind the centre
of the sternum. It is also seen that the anterior

Pericardium adherent to deaph. below and is adherent
above to great ress. runig from the heart. abt 2 in  

122
mediastinum is not perpendicular but is oblique
from above downward and to the left so as not only
to have the sternum in front but also to some extent
the costal cartilages below. The posterior mediastinum
is the space between the Heart (pericardium)
in front and the vertebral column behind.
- The Heart - See pa 131 nots,
The heart is a hollow muscular organ found in 
the cavity of the chest lying between and almost 
surrounded by the two lungs, resting upon the centre
of the convex upper thoracic surface of the diaphragm
and occupying the space known as the 
middle mediastinum - it is concealed within
a closed cavity formed by the pericardium, lying
for the greatest portion of its extent unattached; but
since its function is to maintain the circulation
of the blood, the vessels which bring this to it and 
carry it from it all communicate with the upper
portion (base) of the heart and thus maintain its 
position: for the rest of its extent the heart pulsates
free in the pericardium and to render its movements
easy and noiseless a serous membrane is 
provided which like all other serous membranes is 
a short sac, one layer lining the inner surface of the 
pericardium (this is usually called the serous
pericardium and the membrane it lines the fibrous
pericardium), and the other layer wrapped
around the heart from the origin of the vessels on 
one side to their origin on the other. The heart is 
conical in shape, its base is above and to the right,
its apex below and to the left & forward its length about 5 inches,

Position of Valves
Pulmonary {just to left of sternum
{at junct of 3rd" cost cart.
arstic {Just to left of sternum
{in 3rd" intercostal
space. behind - 1/2 in to lft.
neutral {same as above only
{an inch to right
is to left of aortic &
behind and little lower
Tucuspid {Just under centre of 
{sternum between 4th
{costal cart.
Depth from before back.

Valves.
Depth from before backward
metral is the deepest (most to left)
Pulmonary most superficial
Aortic this is between the two above and 
a line drawn between the 2 above
would pass through its center
Area of Praecordial dulnus
entirely Urny
Is due to notch in ant. border of left
lung & this coresponds to a space represented
by a circle whose diameter is 2 in
and whose senter on a line drawn from 
the left nipple to steno. ?
- Foules - 

[illegible]

long axis is down. forward and to the left.
123
its transverse measurement about 3 1/2 inches, its antero-posterior
about 2 1/2 inches: its weight varies in 
both sexes being rather larger in the male, from 9-10 female 10-12 male
ounces
The exact position of the heart is thus stated,
the base lies behind the sternum corresponding to a 
line drawn between the upper borders of the extremities
of the third costal cartilages and the apex is
downward and to the left striking the chest-wall
in pulsation at the interspace between the 5th and 
6th ribs of the left side, 2 inches below and one inch
within the left nipple, 3 ref. to 131 note.
The cavity of the heart is separated into a right Venous R 3 and 
a left Arty 13 . 3 90-91 half or apartment by an obliquely vertical
septum which cuts off all communication between
the two halves. The position of this septum can be 
predicated by an interspection of the exterior of the 
heart, for here the line of its attachment to the wall
of the heart is indicated by an obliquely vertical
groove inter ventre qume (Ant Post) passing from the base anteriorly and towards
its left aspect, downwards to the right of the apex to 
rise along the posterior face of the heart and terminate
at the base towards its right aspect; lying in this 
groove, which, for a reason given hereafter, is called
interventricular, is an artery. From the position of the 
groove it is seen that the apex of the heart is formed
entirely by the left half and that the front of the 
heart is formed mainly by the right half, while the 
back of the is the product principally of the 
left half.
When the heart is laid open its entire cavity 
is seen to be lined by a serous membrane (continued

Substitute Venous for right
Arty " left.
In the other portions of the heart except the rt.
auricle the foramina The best are simply
bhind foramina.

124
into the vessels which communicate with it) called
the endocardium and that each lateral half is subdivided
by a partial horizontal septum into two cavities
the uppermost of these is called the auricle and 
the lower is called the ventricle, and to distinguish
the cavities of the two sides they are known as right 
or left auricle or ventricle - The position of the horizontal
septum is indicated externally by a groove
passing around the heart horizontally and called
auriculo-ventricular -
In the adult the venous blood of the entire body with 
the exception of that of the heart itself, is returned
into the right auricle by two great veins called venae
cavae, the one bringing the blood from the head and 
upper extremities is called the superior, the other
bringing the blood from the lower extremities and 
body is much larger and called the inferior: the 
venous blood from the heart is returned into the 
right auricle by a separate vein called the coronary
and just as this is about to enter the auricle it dilates
and this part is called the coronary sinus -
Besides these channels for the rectum of the venous napleve
blood, there exist numerous minute apertures into 
every ?) cavity of the heart thro which its venous blood
may enter its cavity to a small extent; these are 
known as foramma Thebesii - The venous blood thus 
collected by the right auricle is driven by its pulsation
into the right ventricle with which it communicates
by an aperture, the right auriclo-ventricular,
through the horizontal septum from the right ventricle
the blood is sent into the pulmonary artery which 
soon divides into two branches, one to each lung.

Right Anneal.
Sup - vena cava - uper back front -
inf- " " lower " "
between these the ventricle of Lowers
Coronary Sinus
" Valve -
forsa ovalis between the 2 Auricles
Annulus " " 
Euslation value - the ridge runny from 
the inferior v-cava t. forsa ovalis -
Musculi pectinate -
formina thesbesi
Auricular appendix.

125
Taking up now the appearance seen on the cavities
of the heart we begin with the right auricle.
The Right Auricle consists of two portions, the longer
portion of its cavity being called the sinus but communicating
with this and projecting forward is 
an ear-shaped addition called the appendix auricular
and hence the name of the auricle (this
applies to both Auricles) - The sinus of the right auricle,
present, the following objects, the opening of the 
superior vena cava at its upper back part; the opening
of the inferior vena cava at its lower back part;
and the portion of the auricular wall between these
two openings is called the tubercle of Lower (tuberculum
Loweri) from the fact that the wall is thicker
here and sometimes presents a tubercle-like 
prominence the coronary sinus presents an opening 
guarded by a valve-like fold of endocardium and 
called the coronary valve: looking on the septum between
the two auricles is seen an oval-shaped depression
called the fossa ovalis and surrounding
this, except below, a ridge called annulus ovalis: extending
along the wall of the auricle from the opening
of the inferior vena cava to the fossa ovalis is a 
ridge the remains of the Eustachian valve of the foetus;
the lining membrane of the cavity is seen to be 
raised into ridges produced by little muscular
columns called musculi pectinati: and lastly of 
course foramina Thebesii are found, and the opening
into the ventricle right auriculo-ventricular.
To sum up we have five openings. 1st Superior vena
cava - 2d Inferior vena cava - 3d coronary sinus - 4th
Foramina Thebesii and 5th Auriculo-ventricular

Corda Tendinae
columnae carvtoe

126
and six other appearances - 1st Musculi pectunati - } MB
2d Tubercle of Lower - 3d coronary valve - 4th Eustachian }
valve - 5th Fossa ovalis - 6th Annulus ovalis -
Right Ventricle has two openings communicating
with it, one leading into the pulmonary artery and 
the other is the auriculo-ventricular - which is surrounded
by a fibrous oval-shaped ring and in order 
to prevent the blood's regurgitating into the auricle
when the ventricle contracts, this opening is provided
with a valvular arrangement, which consists of three
segments each triangular attached by its base to the 
fibrous ring and freely by its apex, they being formed
of folds of endocardium strengthened by fibrous
tissue and perhaps muscular fibres - When the 
ventricle contracts the blood insinuates itself behind 
these segments which when the ventricle is passive
hang loose in its cavity and forces them before it 
until they come together, their apieces meeting in 
the centre of the opening, now these segments being
quite flexible would be forced by the pressure of the 
blood up into the cavity of the auricle were it not 
that the following arrangement prevents this only
allowing the values to float far enough up to close the 
opening: looking on the inner surface of the walls
of the right ventricle is seen a number of ridges,
muscular columns, which when examined are seen
to consist of three kinds - 1st come from a mere ridge
being attached to the wall of the ventricle by the 
whole of their length - 2d Some are attached to the 
wall of the ventricle only by their two ends being 
free in the centre - 3d Some are attached to the wall
of the ventricle only by one end, the other ends terminate   



127
terminate in small tendons which themselves are attached
to the ventricular aspect of the valvular segments
and being only long enough to allow the segments to 
close they prevent their floating into the auricle;
the valve thus constituted is known as the tricuspid,
the little tendons attached to its segments are 
called chordac tendinae and the muscular columns
which produce them the columnae carneae -
The blood driven by the contraction of the right ventricle
being prevented from flowing into the auricle
by the arrangement above described is forced into the 
pulmonary artery and when the ventricle ceased
its contraction would again rush back into it were
it not for a valvular arrangement found here called
the semi-lunar valves which guard the orifice of 
the pulmonary artery
The semilunar valves are three segments arranged
around the interior of the pulmonary artery just
at its commencement; each segment is semi-lunar
in shape, its convex border being attached and its 
straight border being superior and free; they consist
of folds of lining membrane strengthened by fibrous
tissue, which is aggregated into a projection just 
in the centre of the free edge of each valve, called
corpus Arantii there is a lunated space where
the valve lacks fibrous tissue except that just along
the free edge of the valve are a few fibres of fibrous
tissue. Now when the blood is being forced into the 
artery, there are forced back towards the wall of the 
artery, but behind each valve is a depression caused
by dilation of the coats of the artery and these are called
the sinuses of Valsalva and when the ventricle 

Right ventrical
1/ Columnae 2/ Chordae tendinae
3/ Auricular Ventricular 4/ Pul. arty
5/ Tucuspid valve 6/ Semi lunar
7/ forame Thebesii
Left Aurical
1/ 4 openings for the Pul. veins
2/ left auric - Vent. opening -
3/ musculi pectinate 

128
ceases to contract the blood seeking to reenter the ventricle
enters the sinuses of Valsalva forces the valves
inward until they meet along their free edges
when the corpora Arantii dropping together in the 
centre completely close the orifice these and the attachment
of the valves preventing them from being 
driven too far down -
To sum up then the objects found in the right ventricle
we have 1st Columnae Carnae - 2d Chordae
tendinae - 3d- Auriculo-ventricular opening - 4th The 
Opening into the pulmonary artery - 5th Tricuspid
valve - 6th Semilunar valve - 7th There being of course
foramen Thebesii -
We come now to the left side of the heart and take first
the Left Auricle, its wall is thicker than that of the 
right, being about 1/8 of an inch while that of the 
right is about 1/12 of an inch - It presents musculi
pectunati but fewer than in the right ("confined to appendix
auriculae"), the opening into the left ventricle,
left auriculo-ventricular and the openings of the 
four pulmonary veins which return the blood carried
by the pulmonary artery to the lungs; two coming
from each lung, the two from the left lung sometimes
uniting before opening into the auricle -
To sum up we have in the Left Auricle - 1st four openings
of the pulmonary veins - 2d Left Auriculo-ventriculo 
opening - 3d Musculi pectinate -
Passing to the Left Ventricle we find its wall three 
times as thick as that of the right ventricle (being 7/12
of an inch thick, those of the right 2 1/2 twelfths of an 
inch"); it is thus seen that the left side of the heart
is much more powerful than the right and this 
13/1/11/13

Spaces} Corpea Arantra
[illustration] } lunated Spaces


129
is due to the fact that while the right ventricle has 
only to propel the blood to the lungs the left has to distribute
throughout the system (its work being estimated
at 13 lbs to the pulsation (?)). On the walls of the left
ventricle are seen columnae carneae much more
prominent and more ultimately intersecting than 
in the right ventricle, their arrangement into three
sets is however the same - 1st some attached their whole
length - 2d some attached at one extremity and terminating
by the other in chordae tendinae - 3d and others 
attached by both ends - The blood is forced from the 
left auricle into the left ventricle and when this contracts
it drives it into the aorta, now there are valvular
arrangements guarding both these openings, the left 
auriculo-ventricular and aortic. The arrangement at 
the left auriculo-ventricular is known as the Mitral
or Biscuspid valve and is formed upon the same principle
as the Tricupid valve. It consists of two segments
attached to a fibrous ring surrounding the opening by
their larger extremity, their smaller being free in the 
cavity of the ventricle; it consists of folds of endocardium
strengthened by fibrous and by muscular fibres
and it receives the attachment of the chordae tendinae;
so that it differs from the Tricuspid valve in being
stronger containing more fibrous tissue and in consisting 
of two segments - The opening into the aorta is 
guarded by the Aortic Semilunar valves which in 
every way are the counterpart of the valvular arrangement
in the pulmonary artery, except in being 
larger and stronger; they consist of three segments
folds of lining membrane with fibrous tissue; having 
the corpora Arantic lunated spaces and sinuses of 

[auca???]

130 
Valsalva just as in the pulmonary semilunar and the 
mechanism of their action is the same -
Thus in the Left ventricle there are 1st Columnae
Carnae - 2d Chordae Tendinae - 3d Left Auriculo-ventricular 
opeing - 4th Aortic opening - 5th Biscuspid
Valve - 6th Aortic Semilunar Valves -
- Foetal Circulation -
The variation in the course of the circulation before 
birth from that after birth is due to these facts,
1st that the blood of the foetus has to pass through the 
placenta to become arterialized after being returned from 
the tissue: - 2d that the lungs of the foetus playing no 
part in oxygenating the blood only solicit enough to 
nourish them (and 3d for the development of the important
organs situated in the skull it is demanded 
that they receive the placental blood as pure as possible.)
The foetal heart is vertical in position - Examining
the Right Auricle of the foetus it is seen to prevent the 
following apertures, the opening of the superior vena cava 
which returns venous blood as in the adult; the opening
of the inferior vena cava which returns blood of a 
peculiar hue one between that of arterial and venous
blood the reason for this will be evident on further examination;
the opening into the right ventricle and 
the coronary sinus; now extending from the entrance
of the inferior vena cava along the wall of the auricle
is seen a fold of its lining membrane producing a 
trough-like or valvular arrangement called the Eustachian
valve which can be followed to the inter-auricular 
septum where it is to stop at an opening called
the foramen ovale which occupies the place of the fossa 

Vluation of heart.
lies between 2 pleura.
on cent rind of diph.
1 1/2 rt. side of thorax
3 1/2 lft. " " "
cuesp. from 5 1/2 8 "dorsal vertebra, sep. by the 
struct in the port mediastinum.
apex heat abt opp. the junct of Sternum and 
euse form cart. (u) 7th rib and " "
3 - 3 1/2 in to left of this point
The free order of the rt. Ventricle is the 
lower one and is nearly horiz. and 
corresponds 7th rib (is the lower under of heart)
The upper border
Base is up. to it & back ceresp to 
a line corresp. to center of sternum
or a horiz. line beltare the cart of 
the 2nd ribs thus if the highest
point of base (the upper under of the ribs
Aerar precordial dulluus.
Causes by the connective tissue 
interviewing between the heart & the 
chest wall and is located by.

131
ovalis of the adult, and establishes a communication between
the two auricles, the function of this Eustachian 
valve and foramen ovale is to conduct the comparatively
pure blood brought by the inferior vena cava
through the right auricle without its being mingled
with the vicious blood of the superior vena cava, and 
to transmit it to the left auricle, from thence it is 
driven into the left ventricle which in turns forces it 
into the aorta and it is nearly all distributed to the 
head and upper extremities through the branches
which spring from the arch of the aorta - Following
now the course of the blood poured into the right auricle
by the superior vena cava, it is seen that it cannot 
mix with the oxygenated blood of the inferior vena
cava owing to the Eustachian valve and foramen
ovale but must be driven by contraction of the right 
auricle into the right ventricle, from the right ventricle
it is forced into the pulmonary artery and now as 
the lungs require only enough blood for nutrition the 
pulmonary artery sends only a small branch to each 
lung, the bulk of its contents it transmits through a 
vessel called the ductus arteriosus to the aorta just 
below the transverse portion of its arch, where its blood
mingles with that which is left from supplying the 
head and upper extremities - The ductus arteriosus
is about the size of a goose-quill and 1/2 inch long -
The Aorta continues its downward course to divide
into the two iliac arteries from the internal iliac subdivisions
of these arise two vessels one from each called 
the umbilical arteries which ascend along the inner
surface of the abdominal wall to the navel where 
they escape and forming part of the umbilical cord 



132
they reach the placenta to distribute to it the impure
blood which they convey and have it oxygenated; the 
blood after this process is brought back from the placenta
through a single vessel the umbilical vein
which enters the foetus at the navel and makes for 
the transverse fissure of the liver, the round ligament
of the liver being the shrivelled remains of a part of this 
vessel, at the transverse fissure the umbilical vein 
splits into three vessels and on to the left lobe of the 
liver through which it circulates through the portal
system one to the right lobe of the liver and the third
vessel known as the ductus venosus passes backward
to open into the inferior vena cava thus accounting 
for the character of the blood it transmits to 
the right auricle -
Returning to the aorta, after it has produced the 
umbilical arteries it distributes the blood left it to the 
lower extremities; this blood is returned through veins
which continually uniting finally produce the inferior
vena cava, the venous blood which it conveys
being mingled with the improved blood brought by 
the ductus venosus it pours its contents into the 
right auricle -
(The essential peculiarities of the foetal circulaton
then are 1st The Ductus Venosus - 2d The Eustachian 
value- 3d The Foramen Ovale - 4th The Umbilical arteries -
5th The Ductus Arteriosis -)
About 10 days after birth all the peculiarities above
described have disappeared and the circulation becomes
such as we have seen in the adult.
- The Brain -

Sinuses of Dura mater
here forward?

133
The chain of nervous centres known as the cerebro-spinalexis
is divided into two portions, the one, contained in 
the vertebral column, is called the spinal cord or 
narrow or medulla spinalis; the other contained in 
the cranium is called the brain or encephaloid (the
latter includes the membranes.)
Enveloping each of these portions and lining its [con???ing]
cavity three membranes lying one within the 
other and called its investing membrane (or meninges)
The Membranes of the Brain -
The three investing membranes of the Brain are 1st
next the cranial wall the Dura Mater - 2d next the 
Brain the Pia Mater and 3d between these two the 
Arachnoid
I. The Dura Mater is a grayish white strong fibrous
membrane which lines the inner surface of the cranial
walls adhering pretty closely by its external surface
to the bone particularly at the base of the cranium
and in the course of the suture. Its inner surface
is smooth and glistening because lined by the arachnoid -
Besides lining the inner surface of the cranium
the Dura Mater gives off processes which insinuate
themselves between certain portions of the Brain.
These processes or partitions are three in number and 
are follows - 1st Falx Major (cerebri) is a sickle-shaped
(faleiform) process of the Dura Mater which lies in 
the longitudinal fissure, attached in front to the 
crista Galli it extends along the middle line to the 
anterior occipital protuberance behind, being continuous 
with the Dura Mater along the vault of the 

In front presents a deep notch.
Attaches also to Falx major behind.
not so the Arachnoid has only 
one layer - See recent investigates
" Gray. 
P. M is nutrient Mecubran
of Brain

134
cranium between these points and separating the two
hemispheres of the cerebrum -
For a certain distance forward from the anterior occipital
protuberance corresponding in extent to the 
cerebellum, its lower edge is adherent to the upper
surface of the Tentorium -
2d The Tentorium (cerebelli) is stretched horizontally
across the inferior occipital fossae, attached behind
to horizontal limbs of the occipital cross and in 
front to the upper border of the petrous portion of the 
temporal bone on each side and the clinoid processes - all 3
3d Falx Minor (cerebelli) is a narrow process found
separating the hemispheres of the cerebellum; it is attached
along the lower vertical limb of the occipital
cross and forking as it approaches the foramen
Magnum where it ceases -
II. The Arachnoid [cross out] is a layer of cells resembling a Serous membrane [cross out]
[cross out] one of its layers lining the inner
surface of the Dura Mater and called the parietal
layer, the other investing the Brain from which it is 
separated however by the Pia Mater; this layer is called
visceral; Though enveloping the Brain it does 
not dip into the sulci but leaps from convolution to 
convolution. 
III. The Pia Mater is an extremely thin membrane,
very vascular consisting in fact of interlacing small 
blood vessels and lying on the surface of the Brain
it not only covers the convolutions but passes down to 
the bottom of the sulci, and the space thus left between 
the Pia Mater is an extremely thin membrane, very 
vascular consisting in fact of interlacing small 

opposite Sella Tunica
(Ant Arachnoid space)

135
blood vessels and lying on the surface of the Brain: it 
not only covers the convolutions but passes down to the 
bottom of the sulci and the space thus left between
the Pia Mater as it dips to the bottom of the sulci and 
the arachnoid which passes over the sulci from convolution
to convolution is called the sub-arachnoid space.
wh: Contains a fluid.
viz imporant
- The Brain -
The Brain is subdivided into four parts viz. cerebrum,
cerebellum, Pons Varolii and Medulla Oblongata.
The Cerebrum, seven or eight times the size of the rest
of the Brain, presents that uneven surface called convoluted
consisting of meandering elevations called convolutions 
with corresponding depressions, an inch or so 
deep, called sulci and when examined closely these 
convolutions are seen not to be exactly similar on the 
two sides of the brain - The Cerebrum is subdivided
into parts as follows - Looking upon its upper surface
there is seen a fissure called the longitudinal extending 
along its centre from before backwards this fissure,
as may be seen by looking at the base of the Brain,
extends entirely through both in front and behind,
but for the middle 3d of the cerebrum it extends downwards
only about an inch from the upper surface;
the sides of the Cerebrum thus separated are called 
its Hemispheres (right and left.)
Now when the cerebrum is invested and its under 
surface is viewed, each of its Hemispheres is seen 
to be divided into 3 portions one behind the other and 
called Lobes, anterior, middle and posterior - 1st
The Anterior Lobe rests in the anterior fossa of the 
base of the cranium and is separated from the 



136
middle lobe by an oblique fissure called the fissure
of Sylviers in which lies the lesser wing of the Sphenoid
bone (it is separated from its fellow by the longitudinal
fissure.)
2d- The Middle Lobe rests in the middle fossa of the 
base of the cranium, it is separated from the anterior
lobe in front by the fissure of Slylvius, behind it is 
separated from the posterior lobe by no fissure but the 
line of separation corresponds to the anterior border of 
the cerebellum and also to the upper border of the petrous
bone which leaves a slight groove by its contact -
(it is separated from its fellow above by the longitudinal
fissure but since this does not extend through
the cerebrum between its middle lobes their separation
below is arbitrary being the middle line) - The 
Posterior Lobe begins in front where the middle terminates
and lies upon the Tentorium in the superior
occipital fossa the cerebellum being beneath
and coextensive with it anteriorly - (it is separated
from its fellow by the longitudinal fissure.)
- The Base of the Brain -
The Base of the Brain, that portion which presents
to the flow furnished it by the base of the cranium,
is composed of portions furnished by the four primary
subdivisions and presents many points to be 
investigated.
Beginning in front we here see in the middle line
the longitudinal fissure on either side of this is the 
1st cranial nerve or olfactory nerve which emerging
from the substance of the Brain just at the front of 
the middle lobe extends forward beside the longitudinal

Get-up Sylvian fissure
Get-up{ Laminia Circurcum
{ Pednneles of Corpus Callosum
{ Pons Varolii

137
longitudinal fissure, flattened or somewhat triangular in 
shape, lying in a groove and terminates near the 
front of the Brain in a dilated extremity (olfactory
bulb). Just behind the longitudinal fissure, as 
seen on the front of the Base, are two nerves, the 2d-
pair of cranial nerves or optic, these diverge from 
each other forward from a point where they were united;
this union of the two nerves situated between the 
origins of the olfactory nerves and first behind the 
longitudinal fissure is called the optic commissure
or chiasm and diverging from this chiasm backward
are seen two flattened cords called the optic tracts
which after a short divergent course disappear in 
the substance of the brain - In the angular interval
left on each side of the optic chiasm between the optic
nerve in front and the optic tract behind is seen a
number of small apertures in the substance of the 
Brain left by tearing out small arteries which here 
enter, this appearance on each side is known as the 
ant-substantia perforata - Just behind the optic chiasm
and between the optic tracts is seen a grayish prominence
called the tuber cinersum and projecting 
from the centre of this for about 1/6 of an inch is  a 
small tube-like prolongation called the infundibulum
which is tipped by a small reddish body
called the pituitary gland which (weighing 5-10
grs) consists of an anterior and posterior lobe and lies 
in the sella turcica - Hollow in Early life 
Just behind the tuber cinersum are two round 
small white pea-like bodies, one on each side the 
middle line, lying beside each other and called copora
albicantia) behind these is seen a collection of  

Medula -
The foramen coccum a cul de sac of pia mater at 
junct of pons & ant. med. fusene.
Crma Cerebri

138
apertures, just like those forming the two substantias perforatae,
this is called the locus perforatus or perforated
shot there being but one collection here in the centre, just 
behind this is seen the broad band of transverse fibres
called the Pons Varolii and passing forward from this are 
two flattened large cords diverging from each other 
and intersecting the optic tract of each side before being 
lost in the substance of the Brain; these are known as 
the crura cerebrigata - Between the diverging crura
cerebi postero-laterally and the optic tracts antero-laterally,
the optic chiasm in front and the anterior
edge of the Pons Varolii behind is a circumscribed portion
of the Base of the Brain known as the six sided or 
interpeduncular space; its boundaries are as above
stated, its contents are 1st Tuber Cinereum - 2d Infundibulum -
3d Corpora Albicantia - 4th Locus Perforatus -
- The Medulla Oblongata -
Extending from the foramen magnum (upper border
of the atlas) to the posterior lower border of the Pons 
Varolii the medulla oblongata is found thus establishing
connection between the spinal marrow and 
the Brain, conical in shape, the large end above
and forward, it is about 1 1/4 inches in length.
Passing down its centre in front is the anterior median
fissure and similarly marking its centre posteriorly
is the posterior median these though not entirely
bisecting it serve to indicate its division into 
lateral symmetrical halves each half is subdivided
into four portions by 3 longitudinal grooves;
lying beside the anterior median fissure and separated
by it from its fellow is the portion called the 

Structure of the medula - 667. 9.
Ant. Pyramid - found by [crosse out] cox(ic) crossed & direct pyram.
of the cord - is divider into three sets of fibers
viz - I The internal the chif mass pass pass to crehum
II " middle enclose Obong body & forming
the fillet enter pons
III The ext. fibers pass to restiform body
and enter cerebellum.
Latteral part & Obervy Knly -
Dender into 3 bundles.
I- join restifrm boly & pass to cellum
II " Ant pyr. of opp. side
III " Post pyr. foscuulus teluls -
Restiform body -
Two. forceuli one to creluuer 
& " " culullun.
Port Pyr. - Joins foruulus trerei to crelum.
see 612

note decursation of ant. Col. apparently but 
really of lateral Col.\crossed Pyram if the ant. Col. are drawn
apart slightly.
139
corpus Pyramidale in ant pyr, just behind this, slightly more 
bulging and separated from it by a fissure is the 
second portion, the corpus olivare, being visible for 
about 1/2 inch only - Behind this last is the third portion
called the corpus Restiforme separated by a 
groove from the corpus olivare in front and by another
slight groove from the fourth portion of the posterior
pyramid, which lies behind the corpus restiforme and 
beside the posterior medium fissure by which it is separated
from its fellow; the two posterior pyramids are 
small but as they are followed up they suddenly
dilate into a bulbous enlargement and again as suddenly
decreasing they separate as they ascend the one 
from the other and leave an angular interval called
the calamus scriptorius (writer's pen) - When the 
Medulla Oblongata reaches the Pons Varolii it seems
on superficial view to stop short, but if the surface
fibres of the Pons which are transverse in direction be 
peeled off it is seen that the Pons consists in its contree
of vertical or longitudinal fibres which are continuous 
with the fibres of the medulla oblongata
below and being gathered into two bands emerge from 
the anterior border of the Pons as the two crura cerebri -
- Summary -
In summing up the appearance met with on the 
case of the Brain there are: from before backward:
1. Longitudinal fissure in the centre - 2 Ofactory
nerve and its Bulbous Olfactories - 3 Optic Nerve -
4 optic chiaem - 5. optic Tract - 6 Substantia perforata -
7 Sarber Cincereum - 8. Infundibulum - 9.
corpus Albicansia - 10 Locus perforatus - 11. Crus Cerebri -

Ropbu
n 7 L
S.S.S tran

140
. 2 Pons Varolii - 13 Medulla Oblingata - Of these thirteen
objects the 2d 3d 5th 6th 9th & 11th are double i.e there is 
one on each side of the middle line, the others are each 
single, i.e they lie on the middle line extending on
either side of it more or less -
- Structure of the Cerebrum - Rx-
When a horizontal slice an inch or as thick is removed
from the upper surface of one hemisphere of 
the cerebrum the cut surface shows a central oval
shaped white portion, while around this on the exterior
of the hemisphere is a serrated grayish border,
this is known as the centrum ovale minus - When 
both hemispheres have been cut to the same level
and this level corresponding to the depth of the central
portion of the longitudinal fissure two centra 
ovalia minora are produced connected in the 
centre by transverse fibres forming a connecting 
band called the corpus callosum: this whole appearance
formed by the two centra ovalia minora
and the corpus callosum is known as the centum
ovale majus -
- Corpus Callosum -
The corpus callosum consists almost entirely of 
transverse fibres passing from one hemisphere to the 
other; upon its upper surface is seen a shallow
groove extending along the middle fine from before 
backward and called the raphé: bordering the 
sides of the raphé is a slight ridge produced by 
a bundle of longitudinal fibres, the two ridges being 
called the nerves of Lancisi: external to 
these are seen a few other longitudinal fibres producing 

occupying the middle 2/3 of brain -

141
producing slight ridges and called the lateral longitudinal
striae - When the corpus callosum is bisected longitudinally
it is seen to be about four inches long and 
to bend vertically downward both in front and behind
the bent rounded posterior extremity is called its Bulb
or Splenium; the central portion the body, the anterior
bent portion the Gemi, which turns backward beneath
the body for a short distance under the name of Rostrum
the Rostrum divides into two cords called peduncles
which pass downward and backward to the base of 
the Brain - Contained in the substance of the Brain
between the corpus callosum and the base is an irregular 
cavity divided into several parts, two of these are 
known as the lateral Ventricle -
- Lateral Ventricle -
The corpus callosum forms the roof of an irregular
shaped cavity which is divided into two similar
parts by a septum along the middle line, each part 
being called a lateral ventricle right or left - (this 
right is also called the 1st Ventricle and the left the 
second) - When the corpus callosum has been removed
the floor of the lateral ventricle is brought into view 
which is formed by various objects, in front and external
is the corpus striatum an oblong grayish mass 
with its large end in front: internal to this and 
lying against its inner aspect is a narrow white 
band the Taenia Semicircularis, just within
this is seen a small portion of an olive shaped
white body the Thalamus opticus which is seen, is 
a small bundle of blood vessels running from behind
forward and gathered into a round cord called the 

[illustration]


142
choroid Plexus this runs along the edge of the inner
object seen in the ventricle called the Fornix- The
Fornix forms the inner portion of the floor of each }
ventricle and rises to a ridge in the centre which }
ridge touches the under surface of the corpus callosum }
and their forms the septum between the two ventricles - }
The Fornix is triangular in shape its small 
end being in front and terminating in two cords
called crura which pass downward to the corpora
Albicantia and touching their inner aspect to ascend 
to optic thalami - Behind the edges of the 
fornix are continued towards the base of the Brain
in a torturus course under the name of corpora fimbriata -
The cavity of the lateral ventricle is prolonged
forward by a small triangular cavity called the anterior
cornu posteriorly, it presents a longer larger prolongation
called the posterior cornu; besides these two
cornua there is a third called the middle cornu
into which the corpus fimbriatum disappears -
Now this middle or descending cornu begins just where 
the posterior cornu joins the body of the ventricle and 
its direction is tortuously downward, it first runs outward
and backward then downward and forward
and inward: in it are several objects as follows
[?nonnting] up through it is the bundle of blood vessels
called the choroid plexus these vessels having 
pierced the thin layer of brain substance which seperates
the bottom of the cornu from the base of the 
Brain into the descending come the corpus Fimbriatum,
the continuation of the posterior angle of the 
Fornix, is seen to disappear as a white band which 

Convolutions of the brain
See Gray -
Fissure of brain
See Gray -

143
descends following the course of the cornu to the base of 
the Brain; - in the descending cornu is also seen a 
ridge called the Hippocampus major which following
the course of the cornu terminates at its bottom in an 
enlargement called the Pes Hippocampi - Just where 
the descending and posterior cornua communicate 
with the body of the ventricle is found a projection
between the two cornua called the Pes Accessorius to 
which the Hippocampus Major leads from the descending
cornu and to which a similar but smaller 
ridge seen on the bottom of the posterior cornu also leads,
this ridge being called the Hippocampus Minor -
The septum between the two lateral ventricles as stated
in the ridged centre of the fornix but since the 
fornix is too short to reach to the anterior extremity of 
the ventricle, the separation of the ventricles is completed
here in front for a short distance by a double 
layered septum called the septum lucidum and 
between the two layers of this septum is a minute
interval which is called the 5th ventricle -
Now having examined the lateral ventricles cut 
away the fornix and choroid plexuses and just beneath
them will be exposed another cavity called the 
3d ventricle - lying between the optic thalami, which 
forms its sides, its floor corresponds to the six sided
space of the base of the Brain - its roof was the fornix(?)
its anterior boundary is a white band passing between
the two corpora striata and called the anterior commissure, 
its posterior boundary is another white band 
called the posterior commissure; passing across between
the optic thalami; crossing the centre of the ventricle,
also between the optic thalami is a third band called 

[illustration] inner surface
left hemisphere.
1 Corpus Callosum
2 Gyrus fornicatus
3 In Pt. P. Ocp. fissure
4 Calcarine fissure 
5 Collateral " "
6 dentated " " 
Convolutions. 7 Marginal convolutions
8 Pre central " " " 
9 Pre-cuneus or lobe [illustration]
10 Callosum crurus conv.
11 Gynus Fornacticus
12 Hypocampus 

Ref to 3rd Vent. Pa 145
144
the soft commissure grey-middle - (the space in front of the soft commissure
is sometimes called the foramen commune 
arterius and that behind it the foramen commune
posterius)
In this ventricle may be seen four openings -
1st on the front of the floor opens a canal which leads
into the infundibulum and called the road to the 
infundibulum (iter ad infundibulum). On the 
front part of the roof are seen two small apertures
one on each side of the middle line: these are the foramen
of Monro and exist for the purpose of allowing
the choroid plexuses of the lateral ventricles to pass 
into the 3d ventricle -
The choroid plexus of each lateral ventricle as has 
been seen consists of a rounded mass of small arteries,
these perforate the bottom of the middle cornu of the lateral
ventricle collect into a rounded cord which 
mounts up through the descending cornu passes forward
along the side of the fornix and when it reaches
the anterior extremity of the fornix it disappears by 
notching the edge of the fornix and enters the 3d ventricle
where it meets its fellow on the under surface of 
the formix and the two immediately spread out so as to 
form a membrane-like layer of blood vessels which 
covers the under surface of the fornix and forms in fact 
the true roof of the 3d ventricle; this layer is known
as the velum interposition - The 4th opening into the 
3d ventricle is seen behind just beneath the posterior
commissure and leads backward and downward to 
another cavity called the 4th ventricle which is found
between the cerebellum and medulla oblongata; the 
communication between the 3d & 4th ventricles is  

[illustration]
geneculatum

145
called the aqueduct of Sylvius (iter a tertis ad quartum
ventriculum). Dissecting up either optic thalamus,
there is seen on its under surface posteriorly two 
small oblong elevations, one lying internal to the other 
and separated by the optic tract which passes between
them, the outer of these bodies is called the corpus
[illustration] geniculatum extemum, the inner the corpus geniculatum
internum. Immediately behind the 3d Ventricle
and over the aqueduct of Sylvius (and beneath
the Bulb of the corpus collosum) are seen two pairs of 
elevations collectively called the corpora quadrigemina;
the elevations are placed two anterior, one on each side 
of the middle line, called the nates, and two posterior 
one on each side of the middle line, called the testes;
passing outward and forward to the optic thalamus,
from each side of the corpora quadrigemina are two 
bands or ridges, one from the nates and called branchium
posterius - Lying between the nates is a reddish
conical projecting small mass called the Pineal
gland, having a cavity in its interior containing a 
little viscid liquid and a small quantity of gritty
chalk= matter - It is held in place by four peduncles or cords,
two passing downward from the base of the gland
which rests between the nates ("to the optic thalami")
two pass forward one on each side, skirting the inner
aspect of the optic thalami along the lateral wall of 
the 3d ventricle (to the crura of the formix -)
- The Cerebellum -
The cerebellum is some 8 times smaller than the cerebrum
and is found in the two inferior occipital fossae
lying beneath the posterior lobes of the cerebrum from 

[illustration]
3rd Vent
corpus Stuatum
Terria Serri 0
Thal - Optecus.
Pineal Gland
corp quad.
Testes
Valve View -
c. bella estes
Post Pyr.
Restiform
body - 

146
which it is separated by the tentorium - The appearance
of its surface differs from that of the cerebrum in not 
being convoluted but is marked by numerous furrows
(sulci) more or less curved between which are seen 
plate-like parts of brain substance called lammae
and hence the surface is said to be laminated - It is 
of oblong shape its greatest diameter being transverse
(meaning about 4 inches) - It is divided into two 
sseus hemispheres superiorly by a ridge called vermio superior
which extends along the middle line from a 
notch in the centre of the front edge called the anterior
notch (incisura anterior) to another notch on the 
centre of the posterior border called the posterior notch
(incisura posterior): on the under aspect the two 
hemispheres are separated, or rather the separation is 
indicated by a groove, broad and shallow extending 
from the anterior to the posterior notch, and called the 
valley (vallerula); running along the bottom of which 
from before backward is another ridge called the vermis 
inferior - When a vertical antero-posterior section 
is made of either hemisphere an appearance is 
produced called arborvitae - which resembles the 
trunk of a tree with some 10-12 branches - the trunk of 
the tree is white and placed anterior, the branches are 
also white and diverge from the horizontal trunk superiorly,
inferiorly and posteriorly; the surrounding
substance being gray - About the centre (little above
and posterior) is an irregular mass of gray matter 
called the corpus dentatum.
Beneath the cerebellum between it and the posterior
aspect of the medulla oblongata is the 4th Ventricle -
it is of lozenge shape (triangular in vertical section)



147
and its boundaries are as follows; its floor is the salamn
scruptonus of the medulla oblongata, its roof is formed
by two elements, the lower posterior part is the cerebellum
the front part is a thin membrane-like layer called
the valve of the Brain, valve beiussens; each side is 
found by a thick cord passing from the cerebellum to 
the testes and called processus and cerebello ad testes
The ventricle is closed behind and below by a fold of 
Pia Mater as it passes from the medulla to the cerebellum -
(On the floor of the ventricle are seen two rounded
oblong ridges called fasciculi testes, crossing these
as they are passing from the posterior median fissure
outward are the fibres of origin of the 8th nerves
(auditory); these fibres being white and running transversely 
are called lineae transversae - (on that portion
of the roof formed by the cerebellum are four projections
one in front on the middle line, called the modulus,
one just behind this, called the uvula, and one on 
each side of the uvula called tonsil (Amygdala) -
communicating with the front upper extremity of the 
ventricle is the aqueduct of Sylvius, which passes upward 
and forward beneath the corpora quadrigemina
to the back part of the 3d Ventricle - The 4th Ventricle
was called by the older anatomists the 1st since it is 
more easily reached and more constant in its existence
in the different natural orders.
The different parts of the Brain are connected (generally
by white fibres in order to harmonize the actions
of the various parts - The two hemispheres of the cerebrum
and their subdivisions are connected across the middle
line by 1st- the corpus callosum. 2d- the anterior commissure -



148
commissure- 3d the middle commissure - 4th the posterior
commissure - The different parts of the same hemisphere
are connected by white fibres which have from
before backward, as the crura of the fornix the taenia
synicriculaus brachium arterius and posterius &c -
The two hemispheres of the cerebellum are connected
(by the [?erio?s] superior and inferior) by the transverse
fibres of the Pons (Varolii, which leaving the anterior
part of one hemisphere under the name of crus cerebelli
a thick white cord, pass across forming the transverse
fibres of the Pons and enter the other hemisphere as the 
other crus cerebelli -
The two sides of the Medulla Oblingata are connected
(by a central commissure like the spinal cord) and 
by a decussation of the anterior pyramids across the 
anterior median fissure -
The cerebellum is connected to the cerebrum by the 
two processes e cerebello ad testes, which pass to the 
testes- The Medulla Oblongata is connected to the 
cerebellum by the corpora restiformia which pass into 
it under the name of processus ad Medullam oblongatam -
It is connected to each hemisphere of the 
cerebrum by one of the two crura cerebri which as have 
been seen from the longitudinal fibres of the Pons and 
emerge from its anterior border to reach the cerebrum -
- The Organ of Hearing -
The organ of hearing is connected with the temporal
bone of each side and properly speaking consists of two 
organs one to each side - In the prepared bone a portion
is still preserved for upon the base of the petrous
bone is seen the external auditory meatus (its bony portion),

Get-up muscles
of Ear -

149
portion) on the posterior surface of the petrous portion is 
the internal auditory meatus at the bottom of which 
is seen the internal wall of the inner chamber perforated
by [cross out] numerous apertures, the external wall of the 
inner chamber is seen by looking into the external auditory
meatus; on the anterior face of the petrous portion
is also seen the bulge of the superior semicircular
canal and just external to this a depression corresponding
to the roof of the middle chamber or Tympanum,
the floor of which is the jugular fossa of [t??] Bailar
face of the petrous bone -
The organ of hearing is described as consisting of three portions,
three chambers, lying the one internal to the other,
upon the base and in the substance of the petrous bone:
these three chambers are known as follows, from without 
inward, 1st the external ear consisting of three portions
(a) prima or auricle (B) meatus auditonus externus -
(c) Membrane Tympani - 2d The Middle ear or Tympanum -
3d The Internal Ear or Labyrinth -
- The External Ear -
The external ear as stated consists of three portions,
prima, external auditory meatus and membrane of 
the Tympanum; the function of these is to collect the 
[?onerous] vibrations and conduct them to the middle
ear which in its turn transmits them to the internal
ear where they encounter the sentient nerve of hearing.
The Prima or Auricle is the expanded outer extremity
of the external chamber found on the base of the petrous
portion of the temporal bone and contracting to 
its termination in the external auditory meatus -
It presents a very uneven surface and the various 

Cartilage of ear 
[illustration]
Helix
Concha
Tragius
Ante Helix
g. S Wilson.
Dec. 1087

150
elevation and depression have received individual
names - The central concavity leniting to the external  
auditory meatus is called the "concha, the more or less
folded margi or rim the "Helix"; the pendant lower 
softer portion "Lobulus"; the triangular prominence
jutting out in front of the concha the "Tragus"; behind
and somewhat below this separated from it
by a notch is another projection the Antutagus,
the curved elevation between the helix and concha
or rather behind the concha is the Anti-helix which 
divides superiorly enclosing a depression the fossa
ovalis (triangularis); the deeply sunken surface between
the helix and anti-helix is the fossa senphoilea or 
innominata - The prima varies greatly in appearance
in different people, especially is this true of the lobule -
In structure it consists of a plate of fibro-cartilage
whose folding produce the afore-mentioned prominences
and depressions this cartilage being covered
by the integument and areolur tissue supporting
various insignificant muscles (intimsii) intended
to vary its shape and giving attachment to other small
muscles (extrinsic) intended to move the [cross out] Porteum of 
the prima, though of these latter some few people have 
use, the former never act to produce visible effect.
The cartilage is not continuous through-out the auricle,
for it is altogether wanting in the lobule and besides 
presents several fissures which have received
names - The prima is held to its position by the integument, 
by the extrinsic muscles mentioned
above and by two ligaments: the anterior extends
from the helix to the zygoma: the Posterior from the 
concha to the mastoid process - Besides those there are 



151
several small ligaments passing from one part to 
another of the cartilage the largest is the one the 
tragus and helix -
The External Auditory Meatus is the canal which 
extends from the concha to the Tympanum, separated
from it by the tympanic membrane. It is rather 
more than an inch in length, its direction being inward
and slightly forward, somewhat curved in 
its course having its convexity upward (and smaller
in the centre than at either end - It consists of 
two portions an external cartilaginous portion about 
one third of its length and an internal osseous portion
the remaining 2/3 which terminates internally
at an oblique circular groove for the attachment of the 
membrana tympani; this portion can be seen in the 
dried bone though the septum at its bottom of course
is absent, the external extremity is seen to be rough
and prominent for the attachment of the cartilaginous
portion -
It is lined throughout by the integument which 
towards the exterior is studded with hairs and contains
glands for the secretion of the ear-wax these 
hairs and wax are intended to obstruct the entrance
of insects -
The Membrana Tympani is the septum of division
between the external and middle chamber of the 
ear being situated at the inner extremity of the external
auditory meatus attached in the oblique
groove there found. It is fragile semi-transparent
nearly round, oblique in its direction, from above 
downward and inward striking the floor at an 
angle of 45° and is seen to bulge towards the tympanum 



152
tympanum leaving a corresponding concavity external -
Its frame-work is fibro-elastic consisting of radiating
and concentric fibres the latter especially seen
near its circumference, this is covered externally by 
the integument lining the external auditory meatus
which is exceedingly sensitive internally it is 
coated by the mucous membrane of the tympanum -
- The Middle Ear -
The middle ear or middle chamber or Tympanum
lies in the petrous portion of the temporal bone separated
externally from the meatus auditorias extremus
by the membrana tympani; separated internally
from the internal chamber or labyrinth by a bony
wall having its roof to correspond with the depression
on the anterior face of the petrous bone, its floor to the 
jugular fossa of the basilar face of the petrous bone 
having its anterior wall interposed between it and the 
internal carotid artery and its posterior wall the 
cellular substance of the mastoid portion of the temporal
bone - The tympanum is much narrower below 
than above owing to the obliquity of its inner and 
outer walls the length of its roof from without inward
is about two lines the floor being scarcely more than 
one line - It presents for examination six walls two of 
which floor and roof have nothing noteworthy, the 
outer wall has been described as the membrana tympani
and besides these walls it presents a chain of 
small bones between its outer and inner walls - The 
three walls presenting points of interest are 1st - The 
Internal wall, the bony partition between the tympanum 
and labyrinth, upon this are seen the 

[illustration]

153
following appearances (a) A ridge at its upper part
corresponding to the aqueduct of Fallopius (B) just beneath
this a Kidney-shaped opening into one of the 
apartments of the labyrinth called the fenestra ovalis
(vestibule) this is closed during life by a membrane
(and the foot of the stapes)
(c) Below this is seen a bulging surface the promontory
(d) Beneath this is seen a second opening, oval or triangular,
called the fenestra rotunda which is likewise
closed by a membrane, this establishes communication
with another apartment of the labyrinth
(the cochlea).
2d- The Posterior wall presents several small openings
into the mastoid cells and the opening for the entrance
of the chorda tympani, iter chordae posterius, which 
crosses the tympanum to gain exit on its anterior
wall; there is also seen a conical projection, the pyramid
which has at its summit an opening for the 
stapedius muscle 3d On the anterior wall are seen
(a) the fissure of Glaser: (B) the opening of exit of 
the chorda tympani, iter chordae anterius, or canal
of Huguet, (c) Two small openings separated by a 
thin plate of bone the upper is called the opening
for the tensor tympani the lower the opening for the 
Eustachian tubes the dividing septum the cochlear
if own process (side petrous bone; Stretching across the 
tympanum from the membrana tympani externally
to the fenestra ovaris internally are seen 3 small
bones, malleus, incus and stapes - The Malleus is 
the outmost of the three bones resting against the
membrane tympani externally and articulating
with the incus internally - It consists of a head 



154
for articulation with the incus a neck and 3 processes; 
one of the processes is called the handle (manubrium)
which lies imbedded in the membrana tympani
from above downward half way to the floor, another,
the long process (processus gracilis passes
downward to the fissure of Glasser - the 3d process
the short process bugles outward from beneath the 
neck - The Incus is so called from its resemblance
to the anvil, it consists of a body for articulation with
the head of the Malleus and two processes - The short
process passes backward to the opening of the mastoid
cells in the posterior wall and the long process descends
to articulate with the head of the stapes terminating 
by in enlargment called the os obiculare -
The Stapes (stirrup) projects inward from the os orbiculare
with which it articulates by a head, succeeding
the head comes a neck and diverging from 
this are two crura, one to either side which are united
at their distal extremity by a connecting plate called
the "foot" which is exactly fitted to the fenestra ovalis.
These bones are large as ever they are when the child is 
born, they are held together by ligaments and give attachment
to several small muscles which are intended
to move the bones on one another and thus relax
or tighten the membrana tympani or membrane
of the fenestra ovalis - This membrane is in fact composed
of two layers and the fenestra ovalis is seen to 
be closed excessively by the following parts from without 
inward - 1st the mucous membrane of the tympanum -
2d beneath this is the foot of the stirrup and 
3d on the labyrinthine surface this foot is coated by the 
serous membrane lining the labyrinth: The arrangement



155
arrangement for closing the fenestra outward-rotunda is 
somewhat similar in that it consists of three elements.
1st a fibrous membrane coated - 2d externally by the 
mucous membrane of the tympanum and 3d internally
by the serous membrane of the labyrinth: and 
is constructed so much like the membrana tympani
that it has been called the membrana tympani secund
aria - The ossicula auditus are held to each
other in position by means of small ligaments - 1st The 
head of the malleus is held to the body of the incus by 
a capsular ligament - 2d another capsular ligament
binds the os orbiculare and the head of the stapes. The
two ligaments serve to bind the bones together: Those 
holding the bones in position are three in number -
1st The foot of the stapes is held in contact with the fenestra
ovalis by means of ligamentous fibres - 2d there
is a suspensory ligament of the malleus consisting of 
a few ligamentous fibres passing between its head
and the roof the tympanum - 3d a band of fibres attaches
the short process of the incus to the opening of 
the mastoid cells - These bones thus permitted motion
by the ligaments are moved not alone by the vibrations
of the membrana tympani but also by two small
muscles - 1st The Tensor Tympani which springs from 
the apex of the basilar surface of the petrous bone the 
upper aspect of the cartilaginous portion of the Eustachian
tube and enters the opening into the tympanum,
known by its name and found just above the processus
cochliariformis which separates it from the opening
of the Eustachian tube it also derives a few fibres
from the inner surface of the canal it traverses, when 
it reaches the anterior wall of the tympanum its tendon

1 & 1/2 to 2 in in length.

156
tendon turns outward and is inserted into the malleus
at the junction of the manubrium and long process
2d- The Stapedius is far the smallest muscle in the 
body, it arises from within the hollow pyramid on 
the posterior wall of the tympanum emerging from 
the opening on the summit of the pyramid its tendon
is inserted into the neck of the stapes - The action
of the stapedius to regulate the pressure of the foot of 
the stapes against the fenestra ovalis.
- The Eustachian Tube -
The Eustachian tube is a canal which establishes a 
communication between the air in the tympanum
and the outside atmosphere, which does not otherwise
exist. It passes from the anterior wall of the 
tympanum, where its opening is seen just beneath
the processus cochleariformis, downward, forward
and inward to terminate in the pharynx just behind
the opening of the posterior nares: Its Lower longer
[cross out] 2/3 portion is cartilaginous, its upper 1/3 [cross out] is 
osseous -
- The Internal Ear -
The internal ear or labyrinth is the innermost of the 
three chambers which constitute the organ of hearing
and is intended for the terminal ramifications of 
the nerve of hearing which reaches it through the internal
auditory meatus found on the centre of the 
posterior face of the petrous bone, and for the reception
of the communicated vibrations of the air thro' the 
tympanum - It consists of an osseous and a membranous
labyrinth: the osseous being divided into 
three chambers which however communicate with 

[illustration]
Sup
Horz
Sup 
Ant
Postr
oblique

157
one another: these three parts are placed one behind
the other, the anterior is called the cochlea, the middle
the Vestibule the posterior the 3. Semicircular
canals - They are all lined by a serous coat.
- The Vestibule -
The vestibule is a three-cornered cavity having communication
with the tympanum through the fenestra
ovalis - Each of its corner's is called a ventricle,
and the 3 are anterior, superior and posterior - In 
the anterior corner are seen the following points - 1st
a depression called the Forea Hemispherica - 2d a 
number of minute apertures called the Macula
cribosa - 3d a ridge the eminentia pyramidalis -
4th the opening into the cochlea (scala vestibule)
The Superior corner, we have 1st a depression Forea
Hemi-elliptica - 2d two openings of semicircular
canals - dilated extremities of superior and horizontal.
The Posterior corner presents 1st a depression Forea
sulciformis - 2d The opening of the aqueduct of the 
vestibule - 3d The dilated extremity of the oblique
semicircular canal the common aperture for this 
canal and the superior and the opening of the horizontal
canal -
- The Semicircular Canals -
The Semicircular Canals are channels hollowed in 
the petrous bone; they are about 1/2 in, in diameter
three in number and placed at right angles to one 
another. Each forms rather more than a semicircle
and presents near one extremity on enlargement
called the ampulla and opens by both extremities
and the vestibule. The three canals are called 1st Superior,

traclus

158
Superior, is vertical in direction and produce the ridge
seen on the anterior face of the petrous bone - 2d The Posterior
or Oblique which is also vertical - 3d The External
or Horizontal is horizontal in direction - These
three canals present but 5 openings into the vestibule,
owing to the fact that the superior and posterior have 
a common opening into the posterior corner of the vestibule -
The other openings have been mentioned in the 
description of the vestibule - three being into the posterior
corner and two into the superior corner -
- The Cochlea -
The cochlea lies in front of the vestibule and by its 
base forms the promontory seen on the inner wall
of the tympanum; when entire it resembles a snail
shell and may be described as consisting of a tube
divided into two apartments by a longitudinal septum,
one end of the tube being closed end the closed
end being much smaller than the open from which
it rapidly tapers, the septum is not complete for it
fails to reach to the small closed and thus allowing
a communication between the two chambers. The 
foregoing may thus be represented
Now in reality this tube}
is not straight but coiled}
by two turns and a half}
[illustration]
1. Scala Tympani -
2. " Vestibule -
3 " Media -
4. Helico trema
5. Lamina eprialis
6 cupola
7. Hamulus
around a stem or tapering pillar called (nodislus.
The septum dividing the two chambers called scalae,
is known as the Lamina spiralis which consists
of two layers between which is a narrow space 



159
called the scalia media; the lamina spinalis terminates
in a hook-like projection called the Hamulus -
When examined closely the lamina spiralis
is seen to consist of three structures, the portion next
the Mediolus is bony, farther out it is membranous
and the outermost portion is muscular which is 
sometimes called the cochlearis muscle. The small 
space existing between the extremity of the lamina
spiralis and the cupola is called the Helicotroma
this establishes a communication between the two 
chambers one of which is called the scala Tympani,
the other the scala vestibuli; at the base of the cochlea,
next the vestibule, the scala vestibuli is seen to communicate
with the anterior corner of the vestibule
and the scala Tympanum to communicate with 
the tympanum by means of the fenestra rotunda -
The midiolus is the tapering pillar around which 
the two scalae are turned (in the centre of it is a 
canal called the tubulus centralis modioli) its 
base is next the vestibule and is called the tractus 
spiralis foramina lentus -
- The Membrana Labyrinth -
Besides the parts above described the labyrinth contains
others for within each of the semicircular canals
is a membranous counterpart two-thirds smaller
and separated from the bony canal by liquid
the membranous canals present the same dilations
(ampallae) at one end as the bony -
In the vestibule also are seen two membranous sacs
one above the other; the upper one receives the openings
of all the semicircular canals and lies in the forea 



160
hemi-elliptica (Utriculus or Sacculus) communis)
(The lower is called utriculus or sacculus) proprus)/
In the membranous labyrinth, as the above parts are 
collectively called are found crystalline particles,
carbonate and phosphate of lime[d], called ear dust
(otoconitis).
The Auditory Nerve gains the labyrinth through the 
internal auditory meatus, at the bottom it divides
into a vestibular and a cochlear branch the latter divides
into filaments which [??n] in channels in the 
modulus and [b??ing] outward to ramify in the 
lamina spiralis - The vestibular branch divides into
three, 1 for each of the membranous sacs and one for 
the semicircular canals -
- The Organ of Vision -
The organ of vision is situated in the orbits, two conical
cavities found on the face. Like the organ of hearing
it consists of two similar portions one on each side
called the eye-ball and its appendages -
- The Appendages of the Eye -
The appendages of the eye [t?tamina oculi] are mere
accessories to the true organ of vision, the eye-ball for 
the purpose of protection and oranment - They are 
I. Eyebrow and prominence of the integument curved,
covered with hair and situated above each orbit.
They are intended for ornament and protection from 
dust, perspiration and two vivid light and to break 
the force of a blow falling on the front of the orbit -
II. The Eyelids consist of two movable curtains which 
are constantly playing over the front of the eye-ball 



161 
The aperture which separates the two lids, one called
upper (superior palpebra) the other lower (inferior palpebra
is known as the palpebral fissure and can 
be extinguished or dilated at pleasure- The two lids
meet externally at an acute angle called the external
canthus; internally when they seem about to 
meet they refrain from doing so and the interval between
is prolonged inward towards the nose for some
distance before forming the internal canthus; the triangular
space thus left between the two lids at the 
inner canthus, is called the lachrymal lake (lacus
lachrymalis), in which is seen a conical reddish
projection called the caruncle; bounding the caruncle
externally is a curved fold of mucous membrane,
called the plica semilunaris (its concavity is 
external.)
At the commencement of the lachrymal lake, just 
where the two lids are apparently about to unite is 
seen a projection from the free edge of each lid called
the lachrymal papulla (tubercle) upon the summit
of each of which is seen a minute aperture the punetum
lachrymale - The free edge of each lid is provided
with several rows of curved short hairs the eye-lashes,
intended for ornament to render the contact of 
the lids more intimate, and for protection from 
dust, etc. In structure the eye-lids consist of the 
following parts externally there is a layer of thin
loose skin with subjacent areolur tissue, internally
of mucous membrane called the conjunctions which 
not alone lines the inner surface of the lids but is 
reflected over the front of the eye-ball (palpebral and 
ocular portions); the palpebral portion is studded with



162
papillae; just beneath the integument on the outer
surface of the lid is found a pale thin muscle the 
orbicularis palpebrarum, as named from the fact that 
it is somewhat round passing from one lid to the 
other and surrounding the palpebral fissure; its function
is to close the lids - Beneath the orbicularis palpebrarum
in each lid is found a curved plate of cartilage,
the tarsal cartilage about an inch in length.
The superior is the larger and is semilunar in shape,
the inferior is much the narrower being oval. The two 
are attached along their circumference to the edge of the 
orbit by ligamentous fibres externally they a held
to the outer angle of the orbit by a ligament external
palpebral (tarsal) ligament - internally they terminate
in a ligament called the tendo oculi which
holds them to the edge of the orbit - Lying on the posterior
surface of the lids between them and the mucous
membrane and opening on the edge of the lids 
are seen a number (30 in the upper lid, fewer in the 
lower) of vertical beaded bodies the meibomian glands,
their secretion being discharged on the edge of the lids -
III. The Lachrymal Apparatus - Lying on the depression,
seen on the orbital plate of the frontal bone just 
behind the external angular process is found the 
Lachrymal gland about the size and shape of almonds
resting on the posterior part of the upper tarsal cartilage,
the ducts from 7-12 in number, which convey
the secretion of the gland (tears) are seen to open on the 
posterior surface of the upper lid just beneath the 
grand - The secretion of this gland, the tears being discharged
on the surface of the conjunction is constantly
swept towards the internal canthus of the eye by 

1888-9 gaer
Measurements as 
follows -
11/12 in Antero Posterior
Diameter
1 in transverse
=

163
the frequent movement of the lids, there it disappears
in the lachrymal puncta from each of which these
leads a small channel called lachrymal canaliculi
the upper one first ascends then bends inwards
to terminate in a duct, called the nasal duct or lachrymal
duct; the lower canalicula first descends
from the punctum and then turns inwards to terminate
beside the superior in the nasal duct - The nasal
duct extends a little way above the entrance of the canaliculi
and this portion is called the lachrymal sac;
from this the duct extends downward (backward and 
slightly outward) to terminate in the inferior meatus
of the nostril -
- The Globe of the Eye -
The eye ball is situated in the front part of the orbit
imbedded in a mass of fat - It is nearly globular
its anterior posterior diameter one such and its transverse
diameter being 11/12 of an inch - it receives posteriorly
the optic nerve, at a point about 1/10 of an inch 
to the nasal side of its centre -
On dissection the eye-ball is seen to consist of coeval
concentive layers enclosing a bag of liquid which 
forms about 4/5 of it - These coats or layers are sclerotic 
choroid and retina -
- The Sclerotic Coat -
The sclerotic is familiarly known as the white of the 
eye and is a dense fibrous membrane serving as a protecting
envelope for the rest of the eye-ball. Its anterior
1/6 is seen to be wanting the aperture being filled
by a transparent membrane, the cornea - Posteriorly 

The Sclerotic in front ne: [attac???]
of muscles wh: move the eye & here 
we find Sclerotic is thickened,
Sclerotic is 
thicker behind
The back of cornea focus ant boundary of 
Anterior Chamber of eye.

164
the sclerotic is perforated by the optic nerve, not en
masse, but the nerve splits into fibres thus producing
a number of apertures and this appearance is called
the macula cribrosa (Lamina C) the fibrous sheath
of which becomes continuous with the sclerotic; near 
the termination of the connective tissue hold
it to the Choroid Coat, Called Lamina fusca
- The Cornea -
The cornea forms the anterior 1/6 of the first investment
of the eye-ball; it forms the segment of a smaller
sphere than the sclerotic, being more convex it causes
the preponderance of the antero-posterior diameter of 
the eye-ball - The cornea instead of being opaque like
the sclerotic is transparent and its circumference
is received beneath the anterior bevelled edge of the 
sclerotic with which it is continuous in some of its 
structures - It consists of 5 layers its anterior surface
is an epithelial layer derived from the conjunctiva,
its posterior layer is also epithelial the lining membrane
of the anterior chamber - Next each of these is 
found a layer of elastic tissue these two layers of 
elastic tissue constituting what is called the elastic
cornea and separating these is a layer of fibrous tissue
called the cornea propria, which can be split
into 60 layers formed of spindle-shaped cells with 
branching intervals in which circulate the colorless
plasma of the blood - It is with this cornea
propria that the sclerotic is continuous - The cornea
is of varying convexity in different people and 



165
at different periods of life, it is more convex in youth
and becomes much less so in old age; at the latter
age there is often seen around the rim of the cornea
a yellowish band called arcus senilis -
- The Choroid -
The choroid lies within the sclerotic to which it is 
connected by areolar tissue, which is sometimes
called lamina fusca and is pierced posteriorly by 
the optic nerve - At the same point in front where 
the sclerotic ceases the choroid terminates in a flat 
membrane the iris which in its centre presents a 
round aperture, the pupil - The choroid consists of 
three layers the two outer are red the inner is black
between these i.e the inner of the two red and the 
black, some make a fourth layer membrana limitaus.
The external layer is called the venous muscular 
layer the inner red layer capillary (arterial)
layer or the Ruyschian tunic - The internal layer
or membrana pigment or tapeta is of a black color 
consisting of cells filled with coloring matter - On the 
anterior surface of the choroid just round its interior
margin is seen a whitish band 1/40 in wide, the 
ciliary ligament which binds together the cornea
and sclerotic, and the choroid and iris; Extending
back about 1/8 of an inch on the anterior aspect
of the choroid is a gray circular band the ciliary muscle -
On the posterior aspect of the front of the choroid
are seen about sixty ridges diverging from the rim of 
the choroid and called the ciliary processes -
- The Iris -

[illustation]
cornea
ant cham.
Iris
chrystalline lens
Retina 
Sclerotic
Choroid
Canal Pebt
Cell. Process
Cell. body
Post. Cham. 
Vitreous humor 

Iris
166
The iris is the thin flat membrane which continues
the choroid in front - In its centre is seen the opening
called the pupil. - The various colors of the iris are due 
to the difference of color of the pigmentary matter in the 
cells continued in it and to varying arrangement of 
its blood-vessels -
The color is darkest usually near the centre -
Towards the middle of the iris is a circle of little
shaggy projections - The foundation of the structure of 
the is fibrous tissue, which consists of radiate and 
circular fibres, interspersed through which are pigment
cells, in front and behind this fibrous layer is 
a layer of these pigment cells. In the iris are also
seen unstriped muscular fibres, circular, around the 
pupil; and radiating towards the circumference:
by the action of these fibres the pupil is constantly dilating
and contracting - Blood vessels and nerves ramify 
throughout these structure - On the posterior surface,
the iris is seen to consist of a black layer the 
uvea which is in fact a continuation of the membrana
pigments of the choroid.
Anterior Chamber - Between the iris and pupil
behind and the posterior surface of the cornea in front
is a small cavity called the anterior chamber.
Posterior Chamber Between the iris and pupil in 
front and the lens behind is another smaller cavity
the posterior chamber these two contain a liquid
called the aqueous humous; and they communicate
through the pupil after the sixth month of foetal
life, up to which time the pupil is closed by a membrane
called the pupillary. (Both chambers are 
lined by a membrane the secreting membrane of the aqueous



humor.)
167
The Retina.
The retina is the innermost of the 3 tunics of the eye 
lying just within the choroid. It is wanting in
front for a greater distance even than the two preceding
tunics, for it ceases as it reaches the ciliary processes
on a rough jagged margin called the ora serrata
and is continued hence to the crystalline lens by a 
vascular membrane called the suspensory ligament
of the lens; the outer surface of this membrane is fluted
in correspondence with the ciliary processes against
which it rests.
The Retina is [illegible] and translucent being
partially found by the expansion of the optic nerve
with which it is continuous posteriorly -
Exactly in the centre posteriorly is a yellowish round 
spot called the limbus luteus and in the centre of 
this spot a depression called the forea centralis:
about 1/10 of an inch to the inner side of this is seen
the termination of the optic nerve (optic disk or papilla)
showing in its centre the arteria central is retinae 
breaking up into branches from this point forward
the retina gradually thus to its termination
The Retina may be divided into two layers which 
however may be thus stated 1st externally is a thin
layer (of cells) called Jacob's membrane - 2d a transparent
homogeneous thin layer a membrana limitaus -
3d a series of grannular layers- 4th three layers
nervous in structure furnished by the optic nerve
partially fibrous and partly ganglionic 5th the vascular
layer consisting of the ramifications of the 
arteria centralis retinae. 6th Another Membrana 



164
the anterior centralis retinae - 6th Another Membrana
limitaus -
Besides these which are found in the order stated
from without inward, there are found a number of 
fibres traversing the retina from without inwards
and it were [??inding] its layers together these are 
known as the radiating fibres of Muller
- The Vitreous Humor -
Just within the retina is a bag called the Hyaloid
membrane containing a liquid called the vitreous
humor which is a similar, in composition to the 
aqueous humor 98 per cent being water - Traversing
the centre of this in the foetus is found a branch of 
the arteria centralis retinae making its way to the 
lens and called the capsular artery which disappear
at birth
The Crystalline Lens -
Indenting the front of the hyaloid membrane is found
a double convex transparent body called the crystalline
lens its posterior surface is much more convex
than [illegible] anterior the latter surface being the posterior
wall of the posterior chamber though it forms but
a portion of that wall the most bulging portion, the 
circumference of the wall being formed by the suspensory
ligament of the lens which extends from the ora 
senata of the retina to anterior face of the rim of the 
lens this ligament (?) can be split into two layers
and when it lays hold of the lens leaves a circular
canal around the lens called the canal of Tetit -
The lens is invested by a transparent homogeneous 

In giving mus on exam either 
give then relations to each other or 
give order of dissection.

253
170
elastic membrane the capsule of the lens. In structure 83
the lens consists of a series of concentric layers (of 
parallel fibres) gradually hardening towards the 
centre of the lens - It can also be split into three triangular
segments meeting by their apices in the centre
of the lens.
In growth the lens is more convex and such softer
than in old age as it gradually becomes with advancing 
life firmer and less convex -
- The Muscular System -
When an incision is made into almost any part of 
the body the following parts are met with successively
from the surface inward - 1st skin - 2d superficial
areolar fascia whose existence allows the free movement
observed in almost every part of the integument.
This superficial fascia consists of two layers
between which generally is found a quantity of 
fatty tissue varying in amount in different parts
of the body - 3d Beneath the superficial fascia in
come parts are found the muscles with their proper
investing fascia; while in others there is interposed
between the muscles and superficial fascia a strong
and more or less thick membrane the deep fascia
(which frequently gives off from its inner aspect
partitions which pass into separate different groups
of muscles)
The function of muscles is to produce movement;
the most of them being attached to bones, some however
have no bony attachment and others are only attached
to bone by one extremity the other being inserted
into some of the soft tissues. Now when a 



171
muscle is attached to bone by both extremities, a movable
joint is almost invariably found between its 
two points of attachment - otherwise little or no movement
would occur when the muscle attempted to 
contract so that as a rule those muscles which have
attachment to bone at both extremities lay hold of 
a different bone at either extremity - The two attachments
of a muscle are called the one its origin the 
other its insertion; the origin being that attachment
which is susceptible of less motion than the other attachment
which is the insertion; and as a rule especially
true of the limbs, the origin is the attachment
nearest the body or the middle line of the body - The 
actions of a muscle consist in the shortening of its 
length and thus drawing the parts to which it is attached
nearer, either by moving the parts to which 
both extremities are attached or generally by moving
but one, its insertion, and thus are produced the movements
of the body or its parts some of these motions
being so complex that they cannot result from the 
action of one muscle but are the effect of the coordination
of the actions of many muscles -
The striated muscles are the red, fleshy portions of 
the body though generally a muscle consists of two 
portions the red muscular fibres which are gathered
into [???dles] or fasciculi of greater or less size thus 
producing a [cra??] or a fine muscle and of a white 
tougher stronger portion called its tendon which with 
few exceptions is found at the extremities of the muscle
and being much stronger than muscular fibre
bulk for bulk, the tendon is the smallest part of the 
muscle and thus space is economized at the attachments;

Cal purl.
Orbulat group -
Orbicularis plapeleum
Conngator Supercelii
Tensor Tarsi
Lerator Polpelum.

172
attachments; the portion of the muscle between its tendinous
origin and insertion is called the belly of the 
muscle and in a few instances a muscle has two 
bellies since it becomes tendinous in its centre.
The names of most muscles are derived from one 
of the following facts; a muscle is named 1st from 
the origin it occupies - 2d from its shape - 3d from 
the direction of its fibres - 4th from its attachments.
5th from its action - or 6th from the number of its 
origins -
- The Muscles of the Face -
The muscles of the face are arranged into groups
connected with the orbit, with the nose, with the 
mouth and a very unimportant group connected
with the auricle -
- [cross out] Palpebral - Three Muscles -
Orbicularis Palpebrarum -
The orbicularis palpebrarum is an elliptical muscle
lying just beneath the skin in front of the orbit,
the portion which lies on the lid being thinner
and paler than the rest - It arises, or is attached,
internally (to) the tendo oculi and adjacent bone
and the fibres forming an ellipse around the eye 
lids and orbit return to the point from which 
they started - (The tendo oculi is a tendinous cord
which is attached by one end to the orbital aspect
of the nasal process of the superior maxilla while 
the other end bifurcates to be attached to the inner
extremities of the tarsal cartilages.)
Externally the orbicularis palpebrarum is attached to the 
temporal fasica -
Action - It closes the eyelids - It is one of the sphincter
muscles but differs in action from most of these in 



173
that being immovably attached at the two extremities
of its ellipse when its fibres contract they being the two 
segments together in a lone connecting its opposite
points of attachment whereas most sphincter muscles
close the apertures they surround by an approximation
of all their fibres it the same time and in the same proportion
towards the centre of the aperture; e.g. the sphincter
muscle of the mouth the orbicularis oris in the act of 
whistling since it has no bony attachment.
- Corrugator Supercilii - 
The corrugator supercilii is a small muscle which
arising from the inner extremity of the superciliary
ridge of each side passes outward on the same side to 
be lost in the deep face of the orbicularis palpebrarum -
Action - It is a corrugator of the brow, that is it throws
the skin of the forehead into vertical wrinkles -
- Tensor Tarsi -
The tenor tarsi, or Homer's muscle, is a very small 
muscle which arising from the orbital surface of the 
lachrymal bone passes outward to divide into two portions 
which lay hold of the inner extremities of the 
lids, as far outward as the punctum lachrymale -
Action - It aids the orbicularis palpebrarum in closing
the lids and also draws the puncta lachrymalis 
inward the better to receive the tears.
- The Brular Group - Seven Muscles -
The seven muscle which form this group we found
in the orbit they all except the fifth one, the levator
palpebrae superior ovis are attached to the eyeball and 



174
moreover all except the last two, the two oblique muscles,
arise at the apex of the orbit and pass forward flat 
straight and widening as they advance to their insertions.
Four of these muscles are called Recti from the direction 
of their fibres and are concerned in movements 
of the eyeball they are distinguished as 1st
the superior rectus because it lies above the globe of 
the eye and by its action draws the front of the eye 
upward - 2d the inferior rectus because it lies below the 
eyeball and turns the front of it downward - 3d the external
rectus because it lies external to the eyeball
and draws its front outward and 4th the internal rectus
because it lies internal to the eyeball and draws
its front inward. By a combination of the actions of 
these the front of the eyeball can be moved in all intermediate
directions between those above - mentioned -
All the recti arise from the apex of the orbit that is 
from the margin of the optic foramen and also receive
each an origin from the fibrous sheath which envelopes
the optic nerve; they run forward and are inserted
into the sclerotic coat about 1/4 of an inch behind
the circumference of the cornea - Some say that 
3 of these muscles arise not from the margin of the 
optic foramen but from the ligament of Zinn which is 
a fibrous band attached around the lower portion of 
the circumference of the optic foramen; this however is 
an unnecessary refinement. These muscles differ very
slightly in size and length.
- Superior Rectus -
The superior rectus arise from the upper margin of the 
optic foramen and from the fibrous sheath of the optic



175
optic nerve and passing forward is inserted into the 
upper aspect of the sclerotic coat about 1/4 of an inch
behind the circumference of the cornea - It is the 
thinnest of the recti -
- Inferior Rectus -
The inferior rectus arises from the lower margin of the 
optic foramen and from the sheath of the optic
nerve and passing forward is inserted into the 
under aspect of the sclerotic coat about 1/4 of an inch 
behind the circumference of the cornea -
- External Rectus -
The external rectus arises by a forked origin from the 
outer margin of the optic foramen and from the 
sheath of the optic nerve and passing forward is 
inserted into the outer aspect of the sclerotic coat 
about 1/4 of an inch behind the circumference of the 
cornea - It is important to remember its forked origin
since many nerves pass through the internal 
between its heads -
- Internal Rectus -
The internal rectus arises from the inner margin 
of the optic foramen and sheath of the optic nerve
and passing forward is inserted into the inner 
aspect of the sclerotic coat about 1/4 of an inch behind 
the circumference of the cornea -
- Levator Palpebrae Superioris -
Lying just beneath the roof of the orbit and between
it and the superior rectus is a muscle closely resembling 

Widens as it runs -
Lig. of Zinn thickening of peri - osetum around
the inf. edge of optic foramen.

176
resembling the recti, called the levator palpebrae superioris,
since its action is to raise the upper eyelid - It arises
from the upper margin of the optic foramen and 
from the sheath of the optic nerve and passing forward
is inserted into the upper edge of the superior
tarsal cartilage - ant - face - 
- Inferior Oblique -
The inferior oblique muscle of the eye is narrow and 
thin arising from the orbital surface of the superior
maxilla near the inner side of the orbit it passes outward
beneath the eyeball and inferior rectus to be 
inserted into the sclerotic near the entrance of the optic
nerve, on the outer under aspect of the eyeball -
Action - It rotates the eyeball on its antero-posterior
axis -
- Superior Oblique - (Trochlearis-)
The superior oblique muscle of the eye arises, from the 
inner margin of the optic foramen and sheath of the 
optic nerve and passes forward along the upper inner 
wall of the orbit to the front of the orbit its inner
angle where becoming tendinous it plays through a 
cartilaginous ring fixed to the forea trochlearis, thence
its tendon passes outward and backward beneath
the superior rectus to be inserted into the sclerotic coat
on the outer aspect of the eyeball about half way from 
the circumference of the cornea to the entrance of the 
optic nerve -
Action - Its action is computed from its pulley at 
the forea trochlearis, hence it rotates the eyeball on its 
intero-posterior diameter and draws it forward -
- Muscles of the Mouth -
The muscles of the mouth consist of two groups, superior

Superior Labial Group -
Levater bobi Superoris abaque nose 
" lebia Sup - Prop -
" Anguli oris
2 egoniatic muscles -
3 mus - 

177
and inferior labial groups and one muscle the orbicularis
oris which belongs to both groups -
- Orbiculais Oris -
The orbicularis oris is the sphincter muscle of the 
mouth having but slight attachment to bone this may 
be disregarded - It consists of two segments one in 
each lip which meet and interlace at the angles
of the mouth -
Action - It can close the mouth in two ways, either 
by bringing the lips together in a horizontal line, or 
by approximating the angles of the mouth at the 
same time with the lips -
- Superior Labial Group - Five Muscles -
- Levator Labii Superioris alasque Nasi -
The levator labii superioris alasque nasi arises from 
the nasal process of the superior maxilla and descending 
divides into two slips, one of which is inserted
into the ala of the nose while the other continues
on to be lost in the upper lip - Its name 
indicates its action -
- Levator Labii Superioris Proprius -
The levator labii superioris proprius arises from the 
orbital ridge of the superior maxilla and descends
to be inserted into the upper lip. Its name indicates
its action -
-Levator Anguli Oris -
The levator anguli oris (or canine muscle) arises
from the canine fossa of the superior maxilla and 

Inferior Labial Group.
[illustration] mente -
[illustration] taus 
levator Labia inferior
3 muscles 

178
passes downward and inward to be inserted into 
the angle of the mouth. Its name indicates its 
action -
- The Zygomatic Muscles - Two -
The zygomatic are two small muscles which arise 
from the zygomatic process and malar bones
and pass downward and inward, the zygomaticus
major the lower one to be inserted into the 
angle of the mouth and the zygomaticus [cross out] minor to 
be inserted into the upper lip - (action - They carry
the angle of the mouth upward and outward)
- Inferior Labial Group - Three Muscles -
- Quadratus Menti-
The quadratus menti, or depressor labii inferioris,
is a square shaped thin muscle which arises from 
the oblique line on the front of the lower jaw near 
the symphisis and passing upward is lost in 
the lower lip - Its synonyme indicates its action -
- Triangularis -
The triangularis, or depressor anguli ovis arises
by its base just external to the preceding and is 
inserted by its apex into the angle of the mouth -
Its synonym indicates its action -
Levator Labii Inferioris -
The levator labii inferioris lies just beneath the 
mucous membrane; it arises from the incisive
fossa of the inferior maxilla and is inserted into 
the integument of the chin-
Its action is indicated by its name -

[illustration]
Nasal Group-
3 muscles.
Pyramidules nose
Compression "
De- " " " Alae nose 

179
(- "Cranial Group - One Muscle" -)
- Occipito-frontalis -
The occipito frontalis of either side arises from the 
superior curved line of the occipital bone and [cross out]
mastoid [cross out] bone - At its origin it is tendinous but 
passing forward it soon becomes fleshy and then 
as it is mounting over the vault of the cranium
it forms a broad aponeurosis and descending on the 
forehead it again becomes fleshy to be lost in the 
orbicularis palpebrarum and corrugator supercilii;
its innermost fibres forming the pyramidalis
nasi muscle - prolonged down on the bridge of the nose -
Action - It raises and throws the skin of forehead
into wrinkles -
It is covered by the skin which is quite thick.
and is adherant to the occip front 
- Nasal Group - Three Muscles -
- Pyramidalis Nasi -
The pyramidalis nasi is formed by the innermost 
fibres of the occipiti-frontalis which descending
are lost on the bridge of the nose - (action - It
breaks down the inner extremity of the eyebrow and 
elevates the nose)
- Compressor Naris -
The compressor naris triangular in shape arises
from the canine fossa of the superior maxilla by 
its apex and mounting on the side of the nose 
meets its fellow of the opposite side in a tendinous 
raphé on the bridge of the nose - (action - Two are 
supposed to expand the nostrils -)
- Depressor Alae Nasi -
The depressor alae nasi is found just beneath the 



180
mucous membrane of the upper lip; it arises from 
the incisive fossa of the superior maxilla and is inserted
into the ala of the nose - (Its name indicates
its action-)
The muscles of the face are nearly all small and 
pale and fatty; as a rule they arise from bone and 
are inserted into soft parts; their actions produce
the varying expressions of which the countenance 
is capable -
- The Muscles of Mastication - Five -
The muscles of mastication produce various movements
of the lower on the upper jaw -
- Masseter -
The masseter muscle arises from the zygoma, from 
the lower border of the malar bone and from the malar 
process of the superior maxilla and is inserted
into the outer surface of the ramus of the lower jaw
as far as its angle - The muscle is square-shaped,
its anterior fibres, of origin, passing downward
and backward superficial to the posterior fibres
which pass downward and forward -
- Temporal -
The temporal is a radiated muscle occupying
the temporal fossa; it arises from the whole of the 
temporal fossa from the whole length of the temporal ridge
and from a fascia which covers the muscle called
temporal; it converges downward with an inclination
forward and is inserted into the coronoid
process of the inferior maxilla, its apex and inner
aspect -



181
- Buccinator -
The buccinator, or trumpeter's muscle, is the bulkiest
element of the cheek, it arises from the alveolar 
process of the superior maxilla from the external oblique
ridge of the lower jaw as far forward as the 2d-
bicuspid tooth and from the pterygo-maxillary
ligament and converging is inserted into the angle 
of the mouth - The pterygo-maxillary ligament extends
from the hannular process of the pterygoid 
plate to the posterior extremity of the molar ridge
of the lower jaw; giving origin in front to some of the 
fibres of the buccinator and behind to the fibres of 
another muscle (superior constrictor of the pharynx)
- External Pterygoid -
The external pterygoid muscle arises by a forked
origin there passing through the fork an important
artery (the internal maxillary) from the pterygoid
ridge from the under surface of the outer face 
of the greater wing of the sphenoid bone from the 
external pterygoid plate from the tuberosity of the 
superior maxilla and from the tuberosity of the 
palate bone and passes backward to be inserted
into the neck of the condyle of the lower jaw - & filio cart.
- Internal Pterygoid -
The internal pterygoid arises from the pterygoid
fossa and passing downward backward and outward
is inserted into the inner surface of the ramus 
of the lower jaw as far as its angle -
[illustration]



182
Nov 7
- The Muscles of the Back -
Those muscles of the back which are described here 
lie in three superimposed layers -
- First Layer Two Muscles -
- Trapezius -
The trapezius arises from the superior curved line 
of the occipital bone from the posterior occipital
protuberance and from the spinous processes of 
all the cervical and dorsal vertebrae; the fibres converge
outward, some ascending obliquely, some descending
obliquely and some running transversely,
to be inserted into the outer third of the clavicle  
acromion process and whole length of the spine of 
the scapula, i.e the origin of the Deltoid muscle - 
Extending from the posterior occipital protuberance
down to the seventh cervical vertebra is a fibrous
cord which is attached to the extremities of the spinous 
process intervening between those points
known as the ligamentum muchae, and in fact
the trapezius muscle arises from this and not directly
from the spinous processes which it covers;
through the statement made in the description is 
indirectly true and more easily remembered -
Action - According to the direction of the fibres which 
act it draws the sapula backward or downward 
and backward and backward or upward and 
backward.
- Latissimus Dorsi -
The latissimus dordi arises from the spinous processes
of the lower dorsal vertebrae (4-6), of all 
the lumbar vertebrae from the spinous tubercles of 
(u) Ext to
space on
spine of ref?

if it slips down you lure dislocation of the 
scapula - causing winged scapula

183
the sacrum by means of fascia Lum & Vertb. fascia. from the posterior part of the crest of the } outer
ilium (1/4) and by fleshy slips from the three or four } surface 
lower ribs - At its origin except that from the ribs the }
muscle is tendinous passing upward and outward
converging it becomes fleshy and thicker and passing 
over the lower angle of the scapula and winding around
the teres major is inserted along with it 
into the posterior bicipital ridge of the humerus - in front of teres mag.
Action - It carries the humerus downward and 
backward rotates inwards, is an inspiratory agent
and when the humerus is fixed as in climbing or
by crutches, it moves the body forward - as in climbing 
Nov. 14 - 91
- Second Layer - Two Muscles -
- Levator Anguli Scapulae -
The levator anguli scapulae arises by tendinous slips
from the posterior tubercles of the transverse processes
of the four upper cervical vertebrae, these uniting
from the belly of the muscle which descends obliquely
outward to be inserted into the posterior border of - Sup. L 
the scapula from its superior angle to the intersection
of the spine and posterior border - its name indicates
its action - 
Nov. 14 91 
- Rhomboideus -
The rhomboideus arises from the spinous processes of 
the last 2 & 3 cervical and four upper dorsal vertebrae 
and passing downward and outward is inserted
into the posterior border of the scapula from the spine 
to the inferior angle - Some make two muscles of this 
calling that portion which arises from the spinous
process of the last cervical vertebra Rhomboideus minor 
and the remainder Rhomboideus major. 

amses form - &c - inserter into 4 upper ribs except 1st.
(ameses From lormbar & spinal fascia)
N.B.T.
inserting focia of Levator Spine 

184
(Action - It moves the scapula upward and backward)
Nov 14 91
- Third Layer - Three Muscles -
- Serratus Tosticus Superior -
The serratus posticus superior arises tendinous from 
the spinous processes of the two lower cervical and two 
upper dorsal vertebrae and passing downward and 
outward is inserted by fleshy serrations into the upper
border of the 2d 3d 4th & 5th ribs (just beyond their
angles -
Action - It is an inspiratory agent -
Nov 14 - 91
- Serratus Posticus Inferior 
The serratus posticus inferior arises tendinous from
the spinous processes of the two last dorsal and two 
upper lumbar vertebrae and passing upward and 
outward is inserted by fleshy slips into the lower 
borders of the four inferior ribs -
Action - It is an expiratory agent.)
Nov. 17 91 
- Splenius -
The splenius muscle arises from the spinous processes
of the four lower cervical and four or six upper
dorsal vertebrae and ascending divides into two portions,
one known as the splenius capitus is inserted
into the surface of the occipital bone between its curved
lines and into mastoid portion and process of
the temporal bone; the other known as the splenius
colli is inserted into the transverse process of the 
three upper cervical vertebra (their posterior tubercles) -
Action - Sends the head and upper part of the 

Erector Spinal - is attach. to sacral groove
Spinous process of all lum. vertebra
trans " " " " " " and the 
post 1/4 of in lip of crest of illium
derids app 12th" rib. into ext & int. prceses.
Ext. = Sacro lum. attached to out Surface
of 4-6 ribs. at thu & prov. the oblique line on rib
Lorg is Disi. allmost all spum Proc.
attached to all dosal vet. spinous trans.
process - also the [cross out] 8-10- of lower
ribs is ext. or ant to tub, of the rib (u) because [illegible]
The post lemoea of Apen. of trans. posses over the 
back of the Erector Spinal 
The middle lamella of Post apen of transversall is 
passes in front of the erector spinal 
The an aing of mus & fascias is as
follows. 
1st Ant. demall of post traors, of Trans
2nd" Quad lumbar. 
3rd Middle " " " " " " 
4th Erect. Spine 
5th Posteum " " " " "
[illustration]
middle c 
Post L.
2 L 
Erect S 
Ant L.

185
spine back and rotates the head towards its side -)
- The Muscles of the Thorax - 
Dec 17th
- Triangularis Sterni -
The triangularis sterni is found on the posterior aspect 
of the front wall of the thorax on either side of 
the sternum - It arises from the edge of the sternum
and from several costal cartilages ("3d- to 6th- or 7th-)
and passing upward and outward is inserted
into the 2d 3d 4th & 5th costal cartilages and corresponding
ribs - (Having a corresponding insertion 
to its antagonist the serratus posticus superior)
Action - It is an expiratory agent -) Dec - 17 - 91
- The Inter-costal Muscles -
The interval between two adjacent ribs is occupied
by two layers of muscular fibres which extend between 
adjacent edges of the ribs [cross out] and are known as 
external and internal inter-costal - The external
intercostal muscles (eleveven in number) have a direction
downward and forward like the external
oblique muscle of the abdomen and extend from 
the tubercles of the ribs to the costal cartilages - The 
internal inter-costal muscles (eleven on each side)
have a direction downward and backward and extend 
from the sternum to the angles of the ribs; corresponding
in direction of their fibres to the internal 
oblique muscle of the abdomen -
Actions - They raise the ribs when action from above,
being then inspiratory agents and depress the ribs 
when acting from below, being then expiratory agents -)

anses from foscia from mid. line of sterum to acr. proc
Deep cervical fascia Discipt

186
Nov. 20 91.
- Muscles of the Neck - 
(Superficial Group - Two Muscles -
- Platysnia Myoides - FOP - EXAM.  90.91 Nov. 12 89-1889
When the integument and a thin layer of superficial
fascia has been removed from the side and 
front of the neck there is seen a thin pale broad 
muscle called the platysma myoides - It arises from 
the fascia covering the pectoralis major and deltoid 
muscles and passes upward and inward over the nut attached 
clavicle to cover in the side and front of the neck - [illustration]
Its innermost fibres are interlocked with the opposite 
muscle along the upper part of the middle line
of the neck the others are inserted into the inferior 
maxilla, some passing over it to be lost on the side 
of the face and some continuing to the angle of the 
month; these last are joined by some accessory fibres
which take their origin on the side of the face 
(from the fascia, covering the masseter muscle and 
these are known as the laughing muscle, Risorius 
Santorini).
Action- It depresses the lower jaw; it can draw the 
angle of the mouth downward so as to produce a 
melancholy expression or carry it backward as in 
laughing -
Nov 20 - 91
- Sterno-cleido-Mastoid -
The sterno-cleido-mastoid is the second of the superficial
muscles of the neck and lies beneath the 
platysma between [cross out] dup. layer of cervical fascia - It 
is one of the most important muscles in the body
and derives its name from its origin and part of
its insertion - It arises by a forked origin, tendinous 
from about the inner 3d- of the clavicle, this [ma??]

infra hyoid group =
The separate above.

& font of manubrium N.B.
187
last origin is variable as it may be greater or less
than stated - the muscle ascends obliquely upward
and backward on the side of the neck, there being a 
fissure between its points of origin which extends
some distance before the two parts of the muscle
unite - It is inserted into the mastoid process of the 
temporal bone and adjacent portion of the superior
curved line of the occipital bone -
Action- When both muscles act they bow the head 
forward; when one muscle acts it draws the head 
to that side (turning the face somewhat to the opposite
side.) 
- Depressors of the Hyoid Bone & Larynx - (Four Muscles -)
- Sterno-Hyoid -
The sterno-hyoid muscle derives its name from its 
attachments - It is riband-like in shape and vertical
in direction; arising from the posterior aspect
of the upper part of the sternum and perhaps from 
the inner extremity of the clavicle [cross out] -91
[cross out], it ascends the 
front of the neck beside the middle line to be inserted
into the hyoid bone - body -
Nov 21 - 91
- Sterno-thyroid - The ten nus at rt. queyd an ter & cerfort
Lying behind the sterno-hyoid and slightly broader 
than it is another riband-like vertical muscle
called the sterno-thyroid from its attachments; it 
arises from the posterior surface of the upper end of 
the sternum and perhaps also from the cartilage of 
the 1st rib - It ascends beside the middle line of 
the neck and is inserted into the oblique ridge
on the ala of the thyroid cartilage - 

Its cervical tendon lies beneath the J.C, Anorh. & ant - 2 in above the clovecle.

The cuncol foscia is the invertum foscal of the neck - 91 
188
(It is often traversed below by a tendinous intersection,
as is also the sterno-hyoid.)
-Thyro-hyoid -
The thyro-hyoid is a short riband-like muscle
which continues the course of the sterno-thyroid
to the hyoid bone; its being indicative of its attachments;
it arises from the oblique ridge on the ala
of the thyroid cartilage and is inserted into the hyoid
bone - Frequently some of the fibres of the sterno-thyroid
are continued directly into this muscle -
Nov. 21 - 91 -
- Omo-hyoid - omos. [illegible]
The omo-hyoid derives its name from its attachments;
omo meaning scapulo; it is a double bellied
muscle passing with a curve across the side of the 
neck - Arising [illegible] from the upper border of the scapula
near the supra-scapular notch and perhaps from 
the ligament stretched across the notch, it passes
fleshy forward and upward [illegible] until beneath the sterno-cleido 
mastoid when its posterior belly ceases by 
becoming the central tendon of the muscle, it then 
becomes again fleshy, its anterior belly, and passes
more nearly upward to be inserted into the hyoid
bone, at the junction of its body and cornua - The 
central tendon is held down, so as to give the muscle
its curve by a loop of cervical fascia which passes to the clavicle
cartilage of the 1st rib ("inner end of the sternum")
Actions- The depressors of the hyoid bone as their name 
indicates, draw the hyoid bone down; the sterno-thyroid
draws down the larynx and the two omo-hyoids
acting draw the hyoid bone downward and backward 

Ja Sprigg Wilson M.D.
Wva
[illustration]
= 5000 ft
3500 - 4000 ft
2500-3000
less than 25500 -
comes from the middle of the outer 
Side. (not the hip.)

189
(These muscles are sometimes called infra-hyoid
group).
Nov. 21 91
- Elevators of the Hyoid Bone - Five Muscles - Nov. 12/89
W.N. - Digastric -
The digastric as its name imports is a double bellied
muscle being round in shape, curved in direction
and found at the upper part of the side of the neck -
It arises fleshy from the digastric forsa of the temporal
bone and passing downward and forward, becomes 
tendinous, this portion between its origin and the 
central tendon is called its posterior belly, as soon as 
it becomes tendinous it pierces obliquely the belly of 
a small muscle which lies beside it called the stylo-hyoid,
after emerging the tendon plays through a 
loop of fascia which binds it to the hyoid bone then 
becoming again fleshy to form into anterior belly it 
changes its direction passing upward and forward
to be inserted into the digastric fossa of the inferior 
maxilla - Nov 21/91
WB - Stylo-hyoid -
The stylo-hyoid is a small muscle found lying beside 
the posterior belly of the digastric and deriving its 
name from its attachments - It arises from the styloid 
process of the temporal bone and passing downward
and forward is inserted into the hyoid bone;
just before its insertion it is pierced by the central 
tendon of the digastric -
Nov 21 91 
- Mylo-hyoid -
The mylo-hyoid is a broad thin triangular muscle 
forming the floor of the mouth; it arises from the 
whole length of the mylo-hyoid ridge and passing 
(from Symph. to last)

[illustration]
ant. B. Dig.
My. Ply.
hy. glores/thon
Sub [illegible]
focial Arty & branchs - 
Behaind you hine
The Carotid's.
thyis hyoid} flou ) } [illegible]
hyo glores} ) } [illegible]
Mir & inf} " " )
Crusbeuis & P.} )
[illegible]
[illegible]
1 Sterno thyroid 
2 " Seyus hyoid 
3 Seyus Colli } flou
4 Scolus Antreus }
1 Curoter Arty
2 Inf. thyroid Arty
3 Vertebrae Arty
1 Venylyuler
2 Vertebrae View.
3 + inf. thy view.
Mires are 
1 Pneunajube
filments of orn { Descend. novi
{ Cunmum. novi
Reiluyng -
Symp.

190
downward and inward the greater portion the muscle
meets its fellow of the opposite side on the middle
line forming a raphé, some of its posterior fibres are 
inserted into the hyoid bone - forming the muscular flow of mouth
Nov.
Genio-hyoid -
The genio-hyoid is a small muscle increasing in 
size slightly as it descends and lying beneath the 
mylo-hyoid just beside the middle line - It arises 
from the inferior spina mentalis and descends to be 
inserted into the hyoid bone -
- Genio-hyo-glossus -
The genio-hyo-glossue is a thin radiating fan-shaped
muscle; arising by a narrow tendinous origin from 
the superior spina mentalis it immediately radiates 
fleshy to be inserted into the under surface of the tongue
from base to near its apex, some of its lower fibres
are inserted into the hyoid bone - This muscle lies
close to the middle line and beside its fellow the 
opposite side -
- Surgical Triangles of the Neck -
The surface presented by the side of the neck is quadrilateral 
in outline, the clavicle being below, the body 
of the inferior maxilla and a horizontal line passing 
backward from it being above, the middle line in 
front and the anterior edge of the trapezius muscle
behind -
This space is subdivided into two great triangles one 
anterior and the other posterior by the sterno-cleido-mastoid -
The great anterior triangle is bounded, in 

[illusration]
Hyoid Bone
m. line
clavicle
Trapezeous
I Degastric or Sub. max [illusration]
II Superior carotid [illusration]
III inferior " "
IV Sub occipital "
V Sub clavian " may not 
occur when you have a redundant S.C. [illegible]
[illusration]

nearly the who of neck eov. by Plateryma except below in 
the middle and atr post Sup Angle. 
191
front by the middle line; behind by the sterno-cleido-mastoid,
its base is above and formed by the body of 
the inferior maxilla and a line passing to the mastoid
process -
The great posterior triangle has its base below at the 
clavicle; in front it is bounded by the sterno-cleido-mastoid
and behind by the anterior edge of the trapezius
muscle -
Each of these great triangles is subdivided into 
smaller - The anterior is subdivided into three: 1st
The inferior carotid triangle, which has for its three
sides the middle line of the neck, the sterno-cleido-mastoid
and the anterior belly of the omo-hyoid
2d The superior carotid triangle has for its three boundaries;
the sterno-cleido-mastoid the posterior belly
of the digastric and the anterior belly of the omo-hyoid -
3d The Digastric or submaxillary triangle has 
its base at the body of the inferior maxilla its sides
are formed by the anterior and posterior bellies of the 
digastric -
The great posterior triangle is subdivided into two -
1st The Suboccipital has its base below formed by the 
posterior belly of the omo-hyoid, its sides are formed
by the sterno-cleido-mastoid in front and the trapezius
behind -
2d Subclavian triangle is smaller but vastly more 
important than the suboccipital, its base is the clavicle,
above it is the posterior belly of the omo-hyoid,
in front is the sterno-cleido-mastoid - This contains
the subclavian artery and vein (hence its name)
and brachial plexus of nerves - Observe that the subdivisions
are made, in the great posterior triangle by 

In front of S.D is groove for S. clavian vein
The Scaline
Produced by the inf divergence of the 
2 scoline mus.
Boundaries - in front & inner side by S. anter
Behind & outer sid " 3 medo
its apex abt. middle of side of cerv.
vertebra 3rd e.v. 92
Base is groove for sut. clor. arty.
Contents above Barch Plexus. below & in front  - Sub clavian
arty.
Insertion of S.A.
S. tubucle on the upper surface and the 
ridge running forward from it.

192
the posterior belly of the omo-hyoid; in the great anterior 
triangle by the anterior belly of the omo-hyoid
and by the two bellies of the Digastric -
- The Scaleni Muscles 
The two scaleni muscles form part of a group called 
the prevertebral the rest of the group being unimportant;
the only fact connected with them worthy of 
note being that they are interposed between the common
carotid artery and the transverse processes of 
the cervical vertebrae -
The two scaleni muscles are the scalenus posticus 
and anticus: a small portion of the posticus is 
by some individualized into a separated third scalenus
and called medius - These muscles are of 
great importance owing to the fact that occupying 
a position in the lower part of the side of the neck 
they come into important relation with the subclavian
artery and brachial plexus of nerves -
- Scalenus Anticus -
The scalenus anterior triangle in shape arises 
from the anterior tubercles of the transverse processes
of the 3d 4th 5th & 6th cervical vertebrae by tendinous
slips these uniting, as they descend to form the muscle 
it is inserted into the upper surface of the first 
rib by a narrow tendon - tubercle on up surf & ridge runing - and in front of Sub. cl. arty.  
forward for inch - 92 " behind " " " View 
- Scalenus Posticus -
The scalenus posticus arises from the posterior tubercles
of the transverse processes of all the cervical vertebrae 
except the first; descending and dividing into 

W.R.
Action of these mus.
their lies between the inner face of 
the ala of chyroid cart. & the 
up part of Cuco they - mem
or true vocal cord. is a 
mus - called the thyroid
anlynoid mus.

J Strigg Wilson 
Pre Vertebrae Group
Pa. 192-[illegible]
Rectus Capetes anbcus Inager.
origin 4 slips from ant. but of trans. process
of 3rd 4th 5th & 6th C-Vertebra. and assending 
is insertered into the basilar process.
Rectus Capetes antecus minor is behind [illegible]
origin - from ant. surf. latteral mass of 
attes & root of transverse process and 
passing obliq. upward & inward is 
inserted into vasilar process immediately
behind preceding -
Rectus Lateralis origin from upper
surface of trans. process of atlas & is 
Inserted into Jugular process of 
its under surface of occip bone.
Lonjus Colli
Superior pertion arises from at tut.
of trans. processes of 3rd" 4th" & 5th" cer.v.
assending obliquely inward - is insulted by 
a narrow tendon into the tubercle
on ant. arch of atlas.
Inferior Oblique putem arises from 
the front of the bodies of the 1st two 
or 3 dorsal Vertebra and assending
obliquely outward is inserted into 
the ant. tubercles of the transverse perc.
of the 5th & 6th Cervical Vertebra
Vertical putem lies of front of spine 
extending from 2 cervical to 3rd dorsal
inclusive 

origin. [cross out] sides of borders.
[cross out] from 3rd dorsal to axis
included. insertes attached latb.
to ant tret of Cren. 2 dorm.
(92)
Longus Calli - arrises from the front of trans - proce. & ant
tub. & sides of the bodies of last 3 cer - & 1st' 3 dorsal
insuf - into 2-3-4- Cer: Vertb ant tubercles & side effect
of the body. The mus of both sides meet at the 
ant lut of atlas
The tuo mus - are up below by a poce.
1 in wide 

193
two portions, one is inserted into first rib between
its tubercle and angle and is the part sometimes
called scalenus medius, while the other descends
to the same point on the second rib - behind the groove for 
sub. C Arty.
(Actions- When acting on the ribs the scaleni are 
inspiratory agents, when acting on the vertebral 
column they flex it.) See gray for these mus. (92)
- Muscles of the Larynx -
The movements of the separate cartilages which constitute
the larynx on each other are effected by five
small muscles chiefly, called the intrinsic muscles
of the larynx - 
- Crico-thyroid -
The crico-thyroid, a triangular muscle, arises from 
the front of the cricoid cartilage and passing upward;
backward and outward is inserted into the 
lower border of the thyroid cartilage from the middle
line in front to the inferior cornu -
(Action- It stretches the vocal cords by letting the thyroid
cartilage forward and downward on the cricord -)
- Posterior Crico-arytenoid -
The posterior crico-arytenoid arises from the depression
on the posterior aspect of the cricoid cartilage and 
passing upward outward and forward is inserted
into the outer angle of the base of the arytenoid cartilage.
(Action- It separates the vocal cord from its fellow by 
rotating the anterior angle of the base of the arytenoid
cartilage outward; the vocal cord being attached to 
this angle.) 

ref to page 192

31) 154
150
194
- Lateral Crico-arytenoid -
The lateral crico-arytenoid arises from the side of the
cricoid cartilage and passing upward outward and 
backward is inserted into the outer angle of the base 
of the arytenoid cartilage -
(Action- It is the antagonist of the posterior crico-arytenoid,
for rotating the anterior angle of the base 
of the arytenoid cartilage inward, it thus approximate
the vocal cord to its fellow -)
- Arytenoid -
The arytenoid is a single muscle arising from the 
concave posterior surface of one Arytenoid cartilage
it passes transversely across the interval between the 
two arytenoid cartilages and is inserted into the 
same part of the opposite cartilage - (Action- By 
draining the arytenoid cartilages to-gether it closes 
the glottis -) 
- Thyro-arytenoid -
The thyro-arytenoid arises from the receding angle
of the thyroid cartilage just beside and external to 
the attachment of the vocal cord and passing backward
parallel with the vocal cord is inserted into 
the anterior angle of the base of the arytenoid cartilage -
(Action- By approximating its two points of attachment
it relaxes the vocal cord and is said to 
throw the cord into vocalizing position i.e. the cord 
is thrown with its edge transverse to the length of the 
air-tube -)
-The Abdominal Muscles - Tuesday Nov 5 170
The anterior abdominal wall is formed chiefly by 
six flat thin muscles, three on each side, called 



195
the broad muscles of the abdomen, besides these there 
are two other pairs, the pyrmidales which are small 
and insignificant and the recti which are long 
but narrow - When carefully dissected it is found
to consist of the following structures from without inward -
1st the integument - 2d two layers of superficial 
fascia with fatty tissue interposed - 3rd The 
external of the three broad muscles, the external oblique -
4th The intermediate broad muscle, the internal 
oblique - 5th The innermost of the three broad
muscles, the transversalis - 6th lining the inner face 
of the transversalis muscle is a thin fibrous membrane 
called the transversalis fascia and 7th the 
parietal layer of the peritoneum - The Rectus and 
Pyramidalis have been ignored since their position
needs explanation before it is given. When the integument
and superficial fascia have been removed 
the external oblique muscles is brought into view,
which on the front of the abdomen is seen to be tendinous
and that its fibres reach the middle line 
where there being no bony surface which they can seize 
they are attached by interlacing with the tendinous
fibres of the opposite muscle and along this same
line the internal oblique and transversalis of one 
side are inserted, the former into the internal oblique
and the latter into the transversalis of the other 
side; so that this middle line extending from the 
sternum above to the symphysis pubis below is the 
point of confluence of six muscles, three from each
side meeting and interlacing here; this is known
as the linea alba, about its centre is seen the umbilicus 
or navel and the whole line extending from 



James S Wilson
253
196 
67
the ensiform cartilage to the symphisis pubis is slightly
sunken below the adjoining surface on either side,
this is produced by the bulging of the Rectus muscle
of each side, which ascends beside the linea alba
lying between the tendons of the broad muscles which 
thus form a sheath for it; so that the width of the 
linea alba may be said to be the distance between
the inner edges of the Recti muscles -
Nov. 12 - 91
- External Oblique - Ines Oct Nov. 5th 
The External oblique muscle of the abdomen derives 
its name from the downward and inward obliquity
of its fibres and from its position, being external to 
another oblique muscle - It arises by 8 tooth-like 
processes, digitations, fleshy and interlocking with
similar digitations of two muscles the serratus magnus, 
for its upper 5 digitations (and the latissimus
Dorsi for its 3 lower) from the external or anterior surface
of the right lower ribs & lower under, from their origin the fibres
pass downward and [cross out] forward the digitations gradually
blending together to form the belly of the muscle
which towards the front of the abdomen terminates
in a tendon and as this tendon is flat and spread
out like a membrane it is called an aponeurosis which 
is inserted into the linea alba from sternum to 
symphisis pubis - The posterior fibres descend almost 
vertically to be inserted into the crest of the ilium
its anterior 2/3 or 1/2; the intermediate fibres becoming 
aponeurosis are inserted into the anterior superior
spinous process of the ilium and into the pubis its 
spine and pectineal line - That portion of the aponeurosis
which extends from the anterior superior
outer
lips

The Superficial Ext. Abdom. Ring is a defecenes in the lower border of the 
Apere. of Ext oblique over crest of pubes.
[illustration]
Ant. sup. spine
spine
symphysis
interlock with fellow of opposite Side
inter columal fibres} make
fascia} distinction
{Crural Arch 
{Boundaries 
[illustration] 
Int. Col foscia 
Pellus 
Spine of pubes. 
Abdom Rig.
crest of pubes. 
interlock 
Pellus.
int. Col. fibers.
Int-Col. fascia is a prolongation of the deep layer of 
sup. fascia over ext. abdom. Ring down on [cross out]
to scrotum - 

[illustration]
Pect line 1 in ext. to spine of pubes. = G. lig.
197
spinous process of the ilium to the spine of the pubes
is the lower border of the aponeurosis is free between its 
points of attachment is folded slightly inward on 
itself and is called Poupart's ligament; now for the 
distance of about an inch before Poupart's ligament
reaches the spine of the pubes it sends downward some 
fibres to be inserted into the pectineal line for that 
distance, these form what is called Gimbernat's ligament ref. aloe
(which is triangular in shape, its apex within
and its base about 1 inch without). At the lower 
inner part of the aponeurosis near the symphysis
pubis is seen an opening in it called the external abdominal 
ring which is formed by a separation of the 
fibres of the aponeurosis, it is triangular in shape
and oblique in direction, its apex being upward and 
outward, and base downward and inward at the 
crest of the pubes; the edges of the aponeurosis which 
form the sides of the ring are called its pillars external
and internal, the external pillar being inserted into 
the spine of the pubes (and the internal interlacing
with the internal pillar of the opposite muscle over 
the front of the pubes) The apex of the ring for a short
distance down is obscured by some curved fibres called
the intercolumnar fibres - The external abdominal -
ring transmits in the spermatic cord in women in the female
the round ligament - Intercolumnar fascia -
Summary- Origin- By 8 digitations from the external
surface of the 8 inferior ribs- Insertion, into the linea 
alba its whole length, the spine of the pubes, the 
pectineal line of the pubes, the anterior superior spinous
process of the ilium and the anterior 1/2 of the crest of 
the ilium outer lip - Action of these mus. 

The conjoined arch arches above Pouparts Lig - [illegible] [illegible] -
conj. tendon behind the 
Ext abdomi mus

198
Nov 13. 91
- Internal Oblique -
The internal oblique muscle of the abdomen derives
its names from the upward and inward obliquity of 
its fibres and form its position, being just internal
to the external oblique - It arises by a thin tendinous
membrane called the fascia lumborum from the spinous
processes of the lumbar vertebrae, from last lip to crest of illuas from the anterior
2/3 of the crest of the ilium and from the outer middle lip
1/2 of Poupart's ligament -
The fascia lumborum terminates in fleshy fibres on 
the side of the abdomen and those fibres springing
from the crest of the ilium are also fleshy; these radiate
somewhat, the general direction however being 
upward and inward and are inserted posteriorly
fleshy into the cartilages of the four lower ribs; on the 
front of the abdomen it becomes aponeurotic and is 
inserted into the linea alba its whole length - The fleshy
fibres which arise from the outer half of the Poupart's ligament
are blended with fibres of the transversalis 
which arise from the same part of the ligament;
these blended fibres arch downward and inward
and from what is called the conjoined arch so long 
as they remain fleshy, but as they descend they become
tendinous and are called the conjoined tendon which
is inserted into the ajoining part of pectineal line and crest of the 
pubes - By reason of the arched arrangement of these 
fibres they arise for a short distance above the lower 
border of the aponeurosis of the external oblique - (Poupart's
ligament) and consequently leave a small 
space between their arch above and Poupart's ligament
below, between their descending tendon within 
and their origin without, where the wall of the abdomen

4 poinsts of origins
The post Lum. of [illegible] is same as fascio Lumbum.
Post apore = 3 lamella the Post one is 
the fascia Lumborum.

199
abdomen has but one muscular element viz the aponeurosis
of the external oblique, so that if an incision were 
made into the cavity of the abdomen here it would
pass through - 1st the integument - 2d the two layers
of superficial fascia - 3d the aponeurosis of the external
oblique - 4th the transversalis fascia and 5th the parietal
layer of the peritoneum (it should be borne in 
mind that the conjoined tendon descends immediately
behind the external abdominal ring so that at 
this point the wall is deficient only in the aponeurosis
of the external oblique through which only does the 
aperture penetrate")
Summary- Origin- From the outer half of Poupart's
ligament, the anterior 2/3+ of the crest of the ilium and 
from the spinous processes of the lumbar vertebrae - by fascia [illegible].
Insertion- Into the lower borders of the cartilages of 
the four lower ribs into the whole length of the linea
alba and by means of the conjoined tendon into the 
pectineal line and crest of the pubes -
Nov. 3 - 91
- Transversalis -  Nov 7th 417 G.
The transversalis muscle of the abdomen derives its 
name from the horizontal direction of its fibres and 
lies just internal to the internal oblique being the 
innermost of the three broad muscles of the abdomen -
It arises by means of an aponeurosis from the lumbar
vertebrae (transverse and spinous processes) fleshy
from the inner aspect of the cartilages of the six inferior 
ribs, fleshy from the anterior 2/3 of the crest of 
the ilium and fleshy from somewhat less than the 
outer 1/2 of Poupart's ligament. The posterior aponeurosis
becomes fleshy on the side of the abdomen and these 



200
fibres being reinforced by those arising from the costal
cartilages of 6 lower ribs and from the crest of the ilium pass forward
become aponeurotic and are inserted into the 
whole length of the linea alba -
While the fibres which arise from Poupart's ligament
blend with fibres of the internal oblique to form the 
conjoined arch and conjoined tendon to be inserted
into the pectineal line and "crest" (?) of the pubes (See
internal oblique)
Summary- Origin- From the inner surface of the 
[illegible] six lower costal cartilages, from the lumbar vertebrae,
17 fascia - 3 lamella - from the anterior 3/4 middle lip of the crest of the ilium and 
from a little less than the outer half of Poupart's
ligament -
Insertion- Into the whole length of the linea alba
and into the pectineal line and crest of the pubes -
Nov 13 - 91
- Rectus - Nov 7th
The rectus abdominis muscle derives its name from 
the perpendicular direction of its fibres; its position
is on the front of the abdomen beside the linea alba
lying surrounded by the aponeuroses of the three broad
muscles; its shape is flat, riband like; its origin is 
by a flat tendon from the crest of the pubes and from 
the front of the symphysis pubis, as it ascends it 
becomes fleshy and broader and terminates in three 
digitations which are inserted into the cartilages of 
the 5th 6th & 7th ribs beside the sternum. In the upper
half of its course the rectus presents 3 or 4 tendinous 
intersections which are called lineal transversae
(before the aponeurosis of the external oblique has 
been removed the outer edge of the rectus produces 



201
a curved ridge called the linea semilumaris). The 
rectus as it ascends is enclosed between the aponeuroses
of the broad muscles and these form what 
is called the sheath. The sheath of the rectus is complete
in front, its whole length but behind it is wanting 
for its lesser fourth, about. It is thus found,
1st= for the upper 3/4 of the rectus or in other words
from a point about half way between the umbilicus 
and symphysis pubis upward to its insertion the 
rectus has in front the aponeurosis of the external 
oblique and one half of the aponeurosis of the internal
oblique, for when the internal oblique reaches the 
outer edge of the rectus, between the points mentioned,
its aponeurosis splits into two layers one passing in 
front and the other behind the rectus; so that the 
rectus has behind it for the same extent one half of 
the aponeurosis of the internal oblique and the 
aponeurosis of the transversalis and of course between
this last and the cavity of the abdomen
there will be found the transversalis fascia and 
the parietal layer of the peritoneum - Now for about 
its lower fourth, that is from a point about midway
from the umbilicus to the symphysis pubis, the 
rectus has in front of it the aponeuroses of all three
broad muscles and behind it has no aponeurosis
for the same extent being here separated from the 
cavity of the abdomen only by the transversalis fascia
and parietal layer of the peritoneum where 
the sheath ends behind it is curved and is 
called the fold of Douglas -
Summary- Origin- From the crest & front of the pubes} & [illegible] is forked
and from the front of the symphysis pubis -} in origin

Get-up Diaphragm
" " Quadratus Lumborum
" " Vsvas Magnus
" " " ranus

[illustration] Viscera
202
Insertion - Into the 5th 6th & 7th costal cartilages
External oblique Diagram exhibiting the 
Internal " sheath of the rectus for its 
Transversalis " upper three fourths.
[illustration] rectus
External oblique Diagram exhibiting the 
Internal " sheath of the rectus for its 
Transversalis lower fourth.
[illustration] rectus
Nov. 13 91 
- Pyramidalis -
The pyramidalis abdominis muscle is small and 
derives its name from its pyramidal shape; it is 
frequently absent either on one side or both, it is 
found in front of the lower portion of the rectus
muscle and in its sheath - It arises from the front 
of the crest of the pubes and passes upward and 
inward, tapering as it ascends to be inserted into 
the linea alba at a point about half way to the 
umbilicis -
(Activus- The abdominal muscles are agents of expulsion
as in voiding the urine and faces in 
terminating labor - They are also expiratory agents,
for when they contract they diminish the capacity
of the abdominal cavity, thus squeezing the viscera
and forcing them against the rest of the abdominal
walls they drive the diaphragm up and at the 
same time - by their attachment to the ribs they tend 
to draw down and in this manner diminish the 
size of the thorax.) Nov. 24
- The Diagram - Practical?
1st Definition and Position - The Diagram is the 

The Lig Arcutum Exterum is the 
same as (sometime) the Diap. gets no origin
{from the ant. lamella of the Post.
{apon. of the trans mus.
is ped by disect.
Where the ant lamella othe post apon -
of the tras just below the origin of 
the diaph from it 
Crura. These fibers inter lock. for about [illegible]
of two vertebrae 

203
arched muscular septum between the two cavities
of the trunk, presenting its upper convex surface as 
the floor of the thoracic cavity and its equally concave 
under surface as the roof of the abdomen -
2d Relations- It supports by its upper surface the 
pleura on each side containing the long and the 
pericardium in the centre containing the heart;
below it is covered by pertoneum and is in relation
with many abdominal viscera - (liver, spleen, stomach
and pancras) and kidneys.)
3d Origin- It arises in front from the posterior surface
of the sternum, on each side from the inner
surface of the six lower ribs, on each side by a ligamentum
arcuatum externum, on each side by 
a ligamentum arcuatirm internum and from the 
front of the vertebral column by two crura right 
and left - 4th Its various points of origin studied
individually -
(a) Between that part which arises from the posterior 
surface of the sternum and that part on each 
side which arises from the adjacent rib there usually
exists a fissure for a short distance the muscular
structure here being wanting and the aperture
which would otherwise exist between the thorax
and abdomen is closed by other structures -
(b) The origin from the inner surface of the ribs is 
by digitations which "interlock" with similar ones 
of the transversalis abdominis muscle -
(c) The Ligamentum arcuatum externum arches
across the quadratus lumbonum muscle from the 
apex of the (12th rib to the apex of the transverse process
of the 1st or 2d lumbar vertebra; - usually the 2d

WB. Situation of osophageal opening?

204
(d). The Ligamentum Arcuatum Internum arches
over the psoas magnus muscle from the apex of the 
transverse process of the 1st or 2d lumbar vertebra to 
be lost in the crus of the same side -
(e) The Right crus arises tendinous from the front 
of the bodies of the 2d 3d & 4th lumbar vertebrae -
(f) The Left Crus arises tendinous from the front
of the bodies of the 2d & 3d lumbar vertebrae; it is 
also smaller than the right as well as shorter -
5th The Appearances which it presents - The muscular
fibres of the Diaphragm as they are making 
for the centre become tendinous, so that the central 
portion is a tendon and this tendinous portion being 
arranged like the clover leaf is known as the trefoil
or central tendon, presenting a right leaflet a 
left leaflet and a middle leaflet.
The Diaphragm is pierced by three large apertures
these are for the descending aorta, and vena azygos 
major. Thoracic Duct and sometimes Sbt. sym:
Nerves, the ascending vena cava and for the Oesophagus
and Pneumogastric nerves - As stated the crura
arise tendinous from the front of the vertebral column,
but ascending they soon become fleshy leaving
a slight interval now over the 12th Dorsal vertebra
each crus gives off from its inner side a bundle of 
fibres which crosses obliquely to join the opposite
crus, the one from the right crus being usually in 
front, this interchange of fibres is known as the 
decussation of the crura and this decussation
leaves between its commencement and the vertebral
column an opening which is the aortic;
which is in front of the centre of the body of the 12th
N.B



Wilson
205
Dorsal vertebra and is behind the Diaphragm - The 
decussating fibres after they have passed into the opposite 
crus again separate from each other leaving an 
opening around which they again unite this is the 
oesophagus opening, it is situated above the aortic between
it and the middle leaflet of the tendinous centre
opposite the 10°, dorsal vertebra - The opening for the 
inferior or ascending vena cava is seen to the right of 
the middle line, between the right and middle leaflets
of the tendinous centre - opp - 9th dorsal -
6th Action- The Diaphragm is a respiratory muscle
and an agent of expulsion - When the Diaphragm contracts 
as it does 18-20 times a minute it descends
becoming less arched and thus increasing the size
the thoracic cavity while it decreases the size of the 
abdominal cavity, this latter is however compensated
by the bulging of the anterior wall of the abdomen,
but should it be necessary to exert a straining
effort as in voiding urine or faces or in parturition
the muscles of the anterior abdominal wall contract
at the same time that the Diaphragm does, so that 
the abdominal cavity is lessened both from above
downward and from before backward and its viscera
subjected to compression - When the Diaphragm relaxes
it again ascends thus again lessening the 
size of the thoracic cavity -
Nov - 24 - 91
- Quadratus Lumborum -
The quadratus lumborum is a quadrilateral muscle
found in the posterior abdominal wall, in the 
lumbar region lying beside the vertebral column -
It arises from the last rib and descends, being attached



Lies between two layers of post aponu. of trans -
206
attached by its inner edge to the transverse processes of 
the lumbar vertebrae, to be inserted into the crest of 
the ilium and ata ilio lumbar ligament -
Action- It draws the vertebral column to one side 
and is an expiratory agent by drawing down the 
last rib -
- Muscles of the Upper Extremity -
Nov. 13 91
- Anterior Thoracic Region - Three Muscles -
- Pectoralis Major -
The pectoralis major or derives its name from its position
on the front of the thorax (pectus the breast)
and from the fact that there is another muscle
smaller than it is the same region - It is coarse in 
structure, triangular in shape, its base being within 
and apex without and it arises fleshy from the 
sternal two-thirds of the clavicle from the front of 
the sternum (its whole length) from the cartilages
of five ribs, i.e. all the true ribs except the first and 
muscle as it passes over the cartilages, and from 
the aponeurosis of the external oblique muscle of the 
abdomen - The fibres converge outwardly those from 
the clavicle passing almost perpendicularly downward,
those from the lower part of the sternum and 
from the aponeurosis of the external oblique ascending 
obliquely outward and the intervening fibres
passing horizontally outward, they all terminate in 
a folded tendon which is inserted into the anterior
bicipital ridge of the humerus - As the fibres are approaching 
their termination some fold over the others,
Pour
1/4

It also arises from the intercutal membrane 

207
those from the lower portion of the origin of the muscle
pass behind and form the upper part of the tendon,
those arising from the clavicle pass in front of the 
others and from the lower part of the tendon -
Action- It draws the humerus across the chest -
Summary- Origin- From the sternal 2/3 of the front 
of the clavicle from the front of the sternum (its whole
length) from the cartilages of all the true ribs except 
the 1st and the 7th and from the aponeurosis of the 
external oblique muscle of the abdomen -
Insertion- Into the anterior bicipital ridge of the 
humerus by a folded tendon -
Nov. 14 . 91
- Pectoralis Minor -
The pectoralis minor derives its name from its situation 
on the front of the chest and from the fact that 
there is another muscle in the same region of larger
size - It is found beneath the pectoralis major is 
triangular in shape, oblique in direction and small -
It arises from the front of the 3d 4th & 5th ribs passing 
outward and upward, fleshy it narrows to a 
tendon which is inserted into the coracoid process of 
the scapula - Near the apex
Action- Rotates the scapula on the thorax and when 
the scapula is fixed it aids in expanding the chest -
Nov. 14 - 91
-Subclavius -
The subclavius derives its name from its position,
just beneath the clavicle; it is a small round muscle 
arising from the cartilage and possibly adjacent
osseous portion of the 1st rib by a tendon it passes 
horizontally outward becoming fleshy and almost 

Morbenheims Infra clavicular 

208
immediately after it ceases to rise it begins to be inserted,
its belly being extremely short; its insertion
is into the whole length of the groove on the under surface
of the clavicle ("this groove occupying about the 
middle 1/3 of the clavicle".)
Action- It draws the clavicle downard -
Thoracic Surgical Triangle - Nov. 14 91 
Lying just beneath the subclavius, which is sometimes
given as its upper limit, is a triangular
space of great surgical importance - Its boundaries
are; above, the clavicle; below, the upper edge of the 
pectoralis minor; its apex is without and is crossed
by the axillary vessels and nerves; its base is within
and is formed by an imaginary line drawn from the 
inner extremity of the clavicle to the commencement
of the origin of the pectoralis minor -
(- Lateral Thoracic Region - One Muscle -)
- Serratus Magnus - Nov. 13
The serratus magnus is a large thin muscle found 
upon the side of the chest - it derives its name from 
its extensive origin by means of digitations or serrations -
It arises by 9 serrations from the anterior surface
of the 8 upper ribs; the lower 5 of these serrations interdigitating
with the external oblique of the abdomen
and two of the serrations arising from one rib,
the 2d- Its origin is fleshy and it continues its course
fleshy, outward and backward over the side of the 
chest to be inserted into the anterior edge of the posterior 
border of the scapula its whole length -
Action- It moves the scapula on the thorax and 

The boundries of the △ in the neck in front 
the clavicle behind & Ext the upper border of the 
Scapula int. the 1st" rib.
Axillary △
Boundries & Situation
Its apx directed towards root of 
the neck. Base out-ward & down 
& is formed by integument &
fascia & extends from the lower 
border of the Pect. may in front 
and lower part of Lat. dorsi 
behind it is broad at the 
chest but narrow behind 
anterior Boundries Pect maj. and 
minor mus  
Post Boundry - is lower than 
the ant. border & is the 
Sub. Scap above the teres maj.
and lat. dorsi below 
on inner side is the Serratu
magnus
next Page 

209
when the scapula is fixed it [illegible] the ribs -
(- The Acromial Region - One Muscle -)
- Deltoid -
The Deltoid is a large coarse triangular muscle forming
the bulge of the shoulder and deriving its names
from the resemblance to the Greek letter △ - It arises 
from the clavicle (outer 1/3 from the acromion process
and from the whole length of the spine of the 
scapula; passing downward fleshy it converges to a 
short tendon which is inserted into the Deltoid "v" of 
the humerus about half way down its outer face -
Action - Raises the humerus; (i.e abducts it and by 
its posterior fibres can carry it backward or by its 
anterior fibres forward - 
- Scapular Group - Five Muscles -
- Subscapularis -
The subscapularis is a coarse flat muscle occupying 
the subscapular fossa; it arises from the whole of the 
fossa except a small portion, near the superior and 
inferior angle and a narrow strip along the posterior
border where the serratus magnus is inserted; it 
passes upward and outward towards the neck of the 
scapula, gathered into fasciculi these being separated
by partitions of its investing fascia which seek attachment
to the oblique ridge on the fossa and some muscular 
fibres also spring from this fascia and these partitions.
The muscle ceases to rise from the fossa for 
the last 3d of its course and narrows to a tendon as it 
approaches the humerus and is inserted into the 
lesser tuberosity of the humerus and the bone below 

and the four ribs & there inter costal
muscles
on the out side where the ant 
and Post boundries converge the 
Space is narrow and bounded
by the humerus the caraco Brachilas
and the Bicep mus.
This space contains the Brachilas
plexus of nerves - by suphatic
glands and arteries 
- FINIS -
The base of this space is the 
skin & fascia between the lower 
boundris of the space 

210
for about an inch -
Action- It is an inward rotator of the humerus -
- Supra-Spinous -
The supra-spinous (or spinatus) muscle lies in the 
supra-spinous fossa on the dorsum of the scapula -
It arises from the fossa (and as the spine forms a part
of this fossa it consequently rises from the upper surface
of the spine) and from its investing fascia; the 
muscle passes forward beneath the acromion process
narrows to a tendon and is inserted into the uppermost 
of the 3 facets on the greater tuberosity of the humerus -
For the last 3d of its course the muscle receives 
no accession of fibres from the fossa -
Action- It aids the Deltoid in raising (abducting)
the Humerus -
- Infra-Spinous -
The infra-spinous (spinatus) arises from the infra-spinous
fossa and its investing fascia, passing upward
and forward it narrows to a tendon which is 
inserted into the middle facet on the greater tuberosity
of the humerus - As the lower surface of the spine 
of the scapula aids in forming this fossa the muscle
also derives fibres from it - The muscle obtains no origin
from the last 3d of the fossa -
Action- It is an outward rotator of the humerus -
- Teres Minor -
The teres minor lies along the lower edges of the infra-spinous
muscle from which it is separated by a septum
of fascia - It arises from the upper 2/3 of the axillary

[illustration]
menus.
T minor
T maj.
Log. heat of lie.

211
axillary border of the scapular and ascends to terminate 
in a tendon which is inserted into the lower facet on 
the greater tuberosity of the humerus -
Action- It is an outward rotator of the humerus -
- Teres Major -
The teres major lies just below the teres minor from 
which, after its origin it is separated by a widening
interval - It arises from a small portion of the dorsum
of the scapula near its inferior angle and from 
the lower 1/3 of the axillary border and passing upward
and outward is inserted by a flat tendon into the posterior
bicipital ridge -
Action- It draws the humerus downward and backward -
- Surgical Triangle -
Between the two teres muscles is a triangular space 
whose base is the humerus and whose sides are, above 
the lower border of the teres minor, below the upper
border of the teres major - Now this triangle is subdivided
by the long head of the triceps into a quadrangular 
space whose sides are; humerus, long head 
of the triceps, teres minor and teres major and into 
a smaller trigangle whose base is the long head of the 
triceps and whose sides are the teres minor and teres
major -
- The Muscles of the Humerus or Arm - Four -
Then the skin and two layers of superficial fascia 
have been removed from the arm (that part of the 
upper extremity between the shoulder and elbow)
there is exposed a strong fibrous membrane called 
the deep fascia which forms a complete investment 



212
for the limb binding down the muscles and sending
in from its inner surface a septum to the external
condyloid ridge and another to the internal condyloid
ridge to separate the muscles on the front and 
back of the humerus these are known respectively as 
the external and intermuscular septa - The muscles
of the arm are divided into two groups, anterior and 
posterior -
Nov. 20 91 
- Anterior Humeral Group - Three Muscles -
- Biceps Flexor -
The biceps as its name indicates has a forked origin
arising by two tendons, one its short head from the 
coracoid process of the scapular the other the long 
head from the upper border of the glenoid cavity of the 
scapula from these two origins the belly of the muscle
is formed which descends on the front of the arm
to the elbow where it terminates in a tendon which 
after giving off a slip from its inner side to the deep
fascia of the fore-arm is inserted into the bicipital
tuberosity of the radius - Post [illegible]
Action- It flexes the fore-arm, i.e. draws it forward
and upward on the arm and is also a supinator of 
the fore-arm - the arm being brought slightly in in being 
flexed on act of duct of troch. of humerus.
- Coraco-brachialis -
The coraco-brachialis is a small muscle which arises
in common with the biceps from the coracoid process
of the scapula, descending on the inner side of 
the biceps and adherent to its short head for several 
inches it is inserted into a vertical ridge on the 
inner surface of the humerus, about its middle -

Nov 20 19
Brachialis{ From lower 1/2 of External Shaft of it
Anticus{ " " 1/2 qutrual "
{ " internal rule muscular Lepler
{ whole length -
{ " small part of external intermuscular 
{ septum
{ Upper part
{ " 2 [illegible] very small digitations 
{ Embracing beltoid V 

213
Action- It flexes the arm, i.e raises it forward, and
it can also carry the arm inward across the chest -
Nov. 20. 91 
- Brachialis Anticus -
The brachialis anticus is the fleshy mass which lies
beneath the lower part of the biceps on the front of the 
humerus - It arises by two fleshy digitations which 
embrace the deltoid "V" from the front of the humerus
from the Deltoid "V" to within an inch of the elbow,
and from the intermuscular Septa, but to a greater extent
from the inner - passing over the front of the elbow
joint it is inserted into the coronoid process of the 
ulna - " base N.B. "
Action- It is a flexor of the fore-arm -
Nov, 20, 91 Axillary - [illegible]
- Posterior Humeral Group - One Muscle -
- Triceps Extensor -
The triceps is the large fleshy mass which covers
nearly the whole of the posterior aspect of the humerus
and is the only muscle found there - Tracing it from 
its tendinous insertion into the olecranon process
of the ulna upward the belly of the muscle is seen
to be produced by the union of three fleshy masses 
about the middle of the humerus, these are called its 
three heads, inner, outer and middle or long - The inner 
head is the shortest, it arises from the inner 
half of the posterior aspect of the humerus from the 
insertion of the teres major or to the internal condyle
and from the internal intermuscular septum -
The External head arises from the outer half of the 
posterior surface of the humerus from the insertion
of the teres minor to the external condyle and from 

P. P. P. R R P P. P. P.
P. P. P
PPPBPP H
BBB VHBudqman
B. B Wilson J Sprigg Wilson PP
BB BBB J. S Wilson
JS
PPP
PBP

214
the external inter-muscular septum - The Middle 
or Long Head arises by a flat tendon from the upper 
inch of the axillary border of the scapula -
Action- It extends the fore-arm on the arm -
- The Muscles of the Fore-arm - 
The muscles of the fore arm are divided into those 
on the front and those on the back of the fore-arm -
The deep fascia of the arm is continued over the elbow
and invests the muscles of the forearm, giving off 
from its inner surface septa, known as intermusclar
or dividing septa which separate the muscles
from each other -
The Muscles on the Front of the Fore-arm - Eight -
The muscles on the front of the fore-arm have for their 
action the production of the following movements -
Either 1st Pronation, which is a revolution of the radius
around the ulna thus turning the palm of the 
hand downward or backward (for the anatomical
portion of the fore-arm exists when the palm of the 
hand looks forward); or 2d Flexion of the hand at
the wrist (i.e raising the hand forward on the fore-arm);
or 3d Flexion of the Fingers on the hand or at
their inter-phalangeal joints (i.e. a movement forward
of the finger at the said joints) or 4th Flexion
of the Thumb on the hand -
To produce pronation there are two muscles called
pronators and to distinguish them one is called 
the round pronator - (teres), the other the square pronator
(quadratus). To produce flexion at the wrist
joint there are three muscles, two of these are known as 



215
flexors of the carpus (i.e. hand), the third has an unfortunate
name being called palmaus longus: these 
three muscles lie side by side the palmaus longus
being in the middle (and should be called the middle
flexor of the hand), the two flexors are distinguished
not as external and internal as they should be but the 
outer one is called radialis because it lies on the radial
side the radius being the outer bone and the inner
one is called ulnaris because it is on the ulnar 
side -
To produce flexion of the fingers there are two muscles
one upon the other and hence they are known as 
the superficial flexor of the fingers (flexor sublimis digitorum)
and deep flexor of the fingers (flexor profundus 
digitorum); both of these sending a tendon each 
to every one of the four fingers)
To produce flexion of the Thumb there is one muscle
on the front of the fore-arm, the long flexor of the 
thumb (flexor longus pollicis) "Long" to distinguish
it from a short flexor of the thumb found in the hand)
These muscles, on the front of the fore-arm seem to 
have a preference as a bony origin to the internal condyle
of the humerus; many of them also take an origin
from the deep fascia, for this deep fascia adheres to 
the muscles closely for several inches, say three below
the elbow; of course no muscle can arise from the deep
fascia which is not superficial at the upper part of 
the fore-arm where the fascia is adherent to the muscles.
Another origin for some of these muscles is the inter 
muscular (or dividing) septa which the deep fascia
gives off from its inner surface - Now many muscles
springing from these several points, they furnish what 

any mus amsing from 3 in of 
[cross out] Int. condyle of h will bein the 
Superficial group excep V+ S.D.
Physiology Lecture -
Physiology Lecture
Lecture
[illeigle]
That strong aponuresis is nothing but the 
investing fascia of anns.

216
is known as the common origin for the muscle on the 
front of the fore-arm; this common origin is thus stated
"internal condyle by common tendon", intermuscular septa" and 
"deep fascia".
The muscles on the front of the fore-arm are divided
into four layers -
- First or Superficial Layer - Four Muscles -
- Pronator Radii Teres - 
The pronator radii teres has a double origin from 
the common origin and from the coronoid process its base
of the ulna; it is inserted into the middle third
of the oblique line of the Radius -
- Flexor Carpi Radialis -
The flexor carpi radialis arises from the common
origin and is inserted into the base of the metacarpal
bone of the index finger; its tendon grooves the 
trapezium bone - & pierces ant annular lig -
- Palmaris Longus - "Flexin carpi anedius"
The palmaris longus arises from the common origin
and is inserted into the palmar fascia and 
anterior annular ligament - & palmar  fascia -
- Flexor Carpi Ulnaris -
The flexor carpi ulnaris arises from the common origin,
from the inner side of the olecranon and from 
the upper 2/3 of the posterior border of the ulna (by a 
strong aponeurosis); it [cross out] contains the pisiform
bone and base of the metacarpal bone of the little finger -
- Flexor Sublimis Digitorum -
The flexor sublimis digitorum has five points of origin -



217
4th internal lateral ligament (of the elbow) 5th= coronoid [illegible] border
process of the ulna - 5th the oblique line of the radius 
(for several inches). The muscle descends beneath
the superficial layer and dividing into four 
tendons at the lower part of the fore-arm these enter
the hand and proceed one to each finger to be inserted
into the sides of the shaft of the second phalanx -
It splits at the base of the finger to allow the tendon
of the deep flexor to that finger to pass, after which 
it reunites and then splits again to be inserted
into the sides of the shaft of the 2d= phalanx -
- Second Layer - Three Muscles -
- Flexor Profundus Digitorum -
The flexor profundus digitorum lies just beneath the 
flexor sublimis and to the ulnar side of the next
muscle; it arises from the upper 2/3 of the ulna
and from the ulna part of the interosseous membrane,
dividing into four tendons they pass into the 
palm of the hand and separating run one to each 
of the fingers to be inserted into the [cross out] base of its last 
phalanx -
- Flexor Longus Pollicis -
The flexor longus pollicis lies to the outer side of the 
preceding muscle, arising from (about) the middle 
1/3 of the front of the Radius and from the radial
part of the interosseous membrane it is inserted
into the base of the last phalanx of the thumb - passing between
the [?] heads of that flex 
of the thumb
- Pronator Quadratus -
The pronator quadratus as its name imports is (95 

mus. on back of fore arm and 
are in the back & sides
3 groups
Radial group 1 group - 4 mus out group.
doutause from mus septum 

218
quadrilateral; occupying about the lower fourth of 
the front of the two bones it thus prevents the origin
of the two preceding muscles for that distance -
It arises from the inner side of the ulna and receives
a few fibres from its front and is inserted
into the front of the Radius as far as its outer side -
The Interosseous membrane mentioned above is a 
strong fibrous membrane stretched across the interval 
between the radius and ulna and forming as 
stable an origin for muscles as bone economizes
weight -
The Muscles of the posterior aspect of the Fore-arm -
Twelve - The muscles on the back and outer
side of the fore-arm are divided into three groups
each containing four muscles - Their actions are 
the reverse of those on the front, i.e. the reverse of 
pronation which is supination and of flexion
which is extension their names being indicative
of their action - Like the muscles on the front, these 
have a favorite bony origin the external condyle of 
the humerus and the deep fascia here also adheres
closely to some of the muscles for several inches below 
the elbow furnishing a point of origin for such and 
giving off dividing or intermuscular septa which 
are also points of origin - So that there is here also a 
common origin for several muscles, composing external 
condyle, investing fascia and intermuscular
septa -
Radial
out group.
*
- (Radial Group) - Four Muscles -
- Supinator Longus -
The supinator longus derives its name from its action
and from the fact that there is a second supinator

[cross out] on. front of {mus septum 
between {Brachilia ant.
Remains mus attached to com. tend.
arrises from the comm. tend. 
[illegible] by a nerve from above 
down & back.

219
supinator shorter - It arises from the upper 2/3 of the external
condyloid ridge and from the external inter-muscular 
septum and after descending for about 1/3 of 
its course terminates in a tendon which is inserted
into the base ant lid of the styloid process of the Radius
- Extensor Carpi - Radialis Longior -
The extensor carpi radialis longior derives its name 
from its action, an extensor of the hand, from its position,
on the radialis side of the fore-arm and from 
the fact that there is another shorter muscle with 
the same action on the same aspect - It arises from 
the lower third of the external condyloid ridge of 
the humerus and from the external intermuscular 
septum and descends to be inserted by its tendon
into the base of the metacarpal bone of the index
finger -
- Extensor Carpi Radialis Brevior -
The extensor carpi radialis brevior, deriving its name 
from facts stated with the preceding muscle, arises
from the common origin and is inserted into the 
base of the metacarpal bone of the middle finger -
Sub. cutaneous
- Supinator Brevis - 
The supinator brevis arises from the external condyle 
from the external lateral and orbicular ligaments and 
from the ulna (its triangular depressed surface) *beneath the less sig cavity -
and oblique ridge) and winding around the radius
is inserted into the upper third of its oblique ridge -
- Superficial Group - Four Muscles -
spuperficial 1
Extensor communis Digitorum - 
The extensor communis digitorum derives its name
3 have the common origin.

{all of the extensor of the [illegible] takes place of lig.
{except [illegible] & [illegible]
MB. tendon is Sub. cutaneous -
lower pt [illegible] long heat

220
from its action as the exterior common to the four
fingers: it arises from the common origin and descending 
divides into four tendons which are each 
inserted into the whole length of the back of a finger -
At the back of the wrist these tendons are bound
down by an oblique fibrous band called the posterior 
annular ligament which crosses from the inner to 
the outer side of the wrist.
- Extensor Minimi Digiti -
The extensor minimi digiti is an off-shoot from the 
common extensor and as its name imports its action
is to extend the little finger separately; & [illegible]
into the whole length of the back of the little finger along
with the slip furnished to that finger by the common
extensor -
- Extensor Carpi Ulnaris - 
The extensor carpi ulnaris derives its name from its 
action as an exterior of the hand and from being on 
the ulnar side of the fore arm - It arises from the 
common origin and from the posterior border of the 
ulna (its middle third) and is inserted into the base 
of the metacarpal bone of the little finger -
-Anconeus Anconeus
The anconeus is a small triangular muscle, arising
by its apex from the external condyle of the humerus it 
is inserted by its base into the obcranon and triangular
surface of the upper extremity of the ulna -
Action- It aids the triceps stensor in extending the 
fore-arm - 
Deep Croup - Four Muscles deep layer 

all to inter osseous membrane.
Sub cutaneous
from the Post Un. lig. to base 1st. Phalongs
the lind of the limb of 2nd. Phal of 
4 dep Senq when the tendons Stint.

221
The four muscles comprising this group lie under the 
muscles of the superficial group and all arise from 
the interosseous membrane as one attachment.
As indicated by their names they are all extensors,
three being appropriated by the thumb and one by the 
Index finger -
Ossis Polisis
- Extensor Opis Metacarpi Pollicis - 
The extensor opis metacarpi pollicis arises from the 
radius, interosseous membrane and ulna and is 
inserted into the base of the metacarpal bone of the 
thumb -
- Extensor Primi Internodii Pollicis - 
The extensor primi internodii pollicis arises from the 
radius and interosseous membrane and is inserted
into the base of the first phalanx of the thumb -
Action- It is an extensor of the first phalanx of the 
thumb.
- Extensor Secundi Intemodii Pollicis - 
The extensor secundi internodii pollicis arises from 
the ulna and interosseous membrane and is inserted
into the base of the [cross out] last phalanx of the thumb -
Action- It is an extensor of the second phalanx of the 
thumb -
- Extensor Indicis -
The extensor indicis arises from the ulna and interosseous
membrane and is inserted into the whole 
length of the back of the index finger blending with 
the tendon furnished that finger by the common extensor -
Action- It is the proper extensor of the fore-finger -

3 divisions


222
- Posterior Annular Ligament -
Is an oblique fibrous band passing downward and inward
across the back of the wrist from the lower extremity
and styloid process of the radius to the cuneiform
and pisiform bones; it holds the extensor tendons
down on the bones and moreover gives off from its deep
face septa, which being attached to the bones make 
six compartments through which the tendons thus
separated play -
- The Muscles of the Hand -
The central portion of the palm of the hand is seen to 
be depressed below the level of an eminence extending
from the base of the little finger upward toward the 
wrist called the Hypothenar eminence and a more 
bulging eminence extending upward from the base of the 
first phalanx of the thumb toward the wrist called 
the Thenar eminence -  
When the skin has been removed from the palm of the 
hand beneath it is found a thick layer of fatty tissue
which serves as a protection for the vessels and nerves
in grasping with the hand, after removing this fat a 
layer of fasia is exposed called the palmar fascia 
which is found to have a thicker central portion and 
two thinner portions covering the muscles which produce
the thenar and hypothenar eminence - Tracing 
this palmar fascia to the wrist it is found to be continuous
there with a strong fibrous band which extends
across the wrist from one side to the other binding
down the flexor tendons which pass beneath it, and 
known as the anterior annular ligament - The Muscles
of the hand consist of two groups the Thenar and Hypothenar



223
Hypothenar groups and four small muscles found in
the depressed portion of the palm called the lumbricales -
Thenar Group - Four Muscles - Nov. 21
The muscles of the thenar eminence are appropriated to 
the movements of the thumb which are easily verified
to be as follows, (a) Abduction, a movement of the thumb 
outward from the index finger (b) Adduction a movement
in the opposite direction, vig, to carry the thumb inward
to the side of the index finger (c) flexion - (d a 
movement in which the thumb is brought in contact 
with the pulp of any finger and in which the metacarpal
bone of the thumb is put in motion, this is effected
by a muscle called the opposing (opponeus)
muscle of the thumb (e) Extension which is effected
by muscles on the back of the fore-arm and which have
been described. It will be found that the muscles which 
produce these varied movements have received names 
indicative of their actions -
-Abductor Pollicis - 21 21 = common origin.
The abductor pollicis arises from the (trapezium bone
and annular ligament) (anterior) and is inserted into 
the outer side of the base of the first phalanx of the thumb.
Flexor ossis Metacarpi Pollicis - Opponeus.
The flexor of the metacarpal bone of the thumb or the opponeus
pollicis arises from the trapezium bone and 
annular ligament and is inserted into the whole
length of the metacarpal bone of the thumb along its 
radial border - 

Os Acceter Mus Dig. arises from 
pisiform bone

224
- Flexor Brevis Pollicis -
W 21
The flexor brevis pollicis consists of two parts one arises
from the trapezium bone and annular ligament (the 
superficial portion); the other from the trapezoid and 
os magnum and Base of Metacarpal bone of Middle 
finger (the deep portion) and the tendon of sheath flexor Cup. radialis: it is inserted into both
sides of the base of the first phalanx of the thumb, its 
tendons of insertion having sesamoid bones in them
Adductor Pollicis - N 25
The adductor pollicis is a flat triangular muscle, arising
by its base from the whole length of the front of the 
metacarpal bone of the middle finger, it is inserted into 
the inner side of the base of the first phalanx of the 
thumb -
Hypothenar Group - Four Muscles -
Palmaris Brevis - -  Nv 21 89 
(The palmaris brevis is a small pale muscle lying 
just beneath the skin of the palm; it arises from the 
anterior annular ligament and palmar fascia and 
passing inward about an inch wide is inserted into 
the skin on the inner border of the hand -)
- Abductor Minimi Digiti - 41. 21-89
The abductor minimi digiti arises from the [cross out] pissiform
bone and is inserted into the inner side of the 
base of the first phalanx of the little finger -
Action- It is an abductor of the little finger, that is,
it draws the little finger inward away from the ring 
finger -
[cross out]
[cross out] 
prcess of 
a bone 

Lumbricalis
arises from [illegible] of deep flex. tendons
inserted tuns around the radial side
of 1st phal. & is [illegible] into 
radial side and dorsum of 
finger 

- and ant annular lig.
225
[cross out]
[crossout]
[cross out]
[cross out]
[cross out]
Flexor Brevis Minimi Digiti 21 Nov
The flexor brevis minimi digiti arises from the unciform
process of the unciform bone and annular ligament
and is inserted into the base of the first phalanx 
of the little finger -
Action It is a flexor of the little finger -
Adductor Ossis Metacarpi Minimi Digiti
The adductor ossis metacarpi minimi digiti arises
from the unciform process of the unciform bone and 
annular ligament and is inserted into the whole
length of the metacarpal bone of the little finger -
Action It draws the metacarpal bone of the little finger 
outward and forward carrying the little finger toward
the Thumb (and hence is called opponeus digitorum 
and are inserted into the radial border of the extensor 
tendons on the back of the finger -
- The Insertion of the Flexor Tendon of the Fingers -
Tracing the tendon of the flexor sublimis digitorum to 
any one of the fingers it is found to spilt so as to leave
an interval through which the deep flexor tendon
passes, each side of the split tendon is inserted into 
the side of the shaft of the second phalanx, the tendons
giving off before its insertion numerous thread-like 
prolongations which are called uncula accessoria and 
are inserted into the side of the finer - Both tendons 

2 compartments ant & Post.

226
deep and superficial, are held down on the finger their
whole course by ligamentous fibres which are called
thecal -
- The Muscles of the Lower Extremity -
The muscles of the lower extremity are divided into 
those of the hip, of the thigh, of the leg, and of the foot
("and the two flexors of the thigh, see p.") - The Hip
is called the gluteal region -
-The Gluteal Region - Nine Muscles -
As in the upper extremity so in the lower the muscles
are covered by an investing fascia which is here 
much thicker and is known on the thigh as the 
Fascia Lata - (or vagina femoris) - The muscles of the 
gluteal region are nine in number and arranged into
three layers; each layer having a muscle called 
"gluteus" -
[illegible]
First Layer - One Muscle -
- Gluteus Maximus -
The gluteus maximus is a quadrilateral muscle, the 
largest and coarsest in the body and forms the bulge
of the buttock - It arises from the posterior 1/5 of the crest outer lip
of the ilium, from the dorsum ilii between the superior 
curved line and crest, from the posterior surface of the 
sacrum and coccyx and from the greater sacro-sciatic
ligament - It passes obliquely downward and 
outward to be inserted into the line leading from the 
trochanter major to the linea aspera of the femur and 
into the fascia lata -
Action - It is an abductor and outward rotator of 
thigh, a tensor of the fascia lata and steadies the 

The upper front part of the Gluteus medius is not covered
(91) Coaleses in ant. post with gluteus maximus : ant edge
is not free
These 2 tendons are separated viz and 
adherant to the Ol luratus interior 

227
pelvis on the femur - & produces the fold of the notes.
Dec 1st
- Second Layer - Six Muscles {= all covered with
- Gluteus Medins - {gluteus max except 1st
The gluteus medius is partially covered by the gluteus
maximus: arising from the anterior 4/5 of the crest of 
the ilium, from the dorsum ilii between the superior
and middle curved lines and from its investing fascia 
it is inserted into the outer part of the trochanter
major -
Action - It is an abductor and outward rotator of the 
thigh, steadies the pelvis on the femur and aids in 
carying the lower extremity forward in progression -
Dec 1st 
- Pyriformis - Dec 
The pyriformis as its name implies is a pear-shaped
muscle, which arises in the pelvis by three fleshy slips
interposed between the anterior sacral foramina from 
the 1st to the 4th and form the adjoining part of the 
ilium and escaping from the cavity of the pelvis
through the greater sacro-sciatic foramen is inserted
into the trochanter major - digital fossa. round tendon. (91)
Action- It is an external rotator of the thigh -
Dec 1st
- The Gemelli - Two -
The gemelli are a pair of small muscles lying one 
above and the other below the tendon of the obturator
internus - The Gemullus Superior arises from the 
spine of the Ischium and is inserted into the digital
fossa of the trochanter Major. The Gemellus Inferior 
arises from the tuberosity of the ischium and is inserted
into the digital fossa -
outer lip
deep face



228
Both are outward rotators of the thigh -
- Oburator Intermus - Dec 1st
The obturator intermus arises within the pelvis from
the inner surface of the obturator membrane, from the 
margin of the obturator foramen and from the inclined
plane of the ischium. Its course is downward
and slightly backward until becoming tendinous it 
escapes from the pelvis through the lesser sacro-sciatic
foramen and passing horizontally outward is 
inserted into the digital fossa of the trochanter major -
Action It is an outward rotator of the thigh -
Dec 1st 
- Quadratus Femoris -
The quadratus femoris as its name indicates is a 
square muscle lying below the tendon of the obturator
internus - It arises from the tuberosity of the ischium 
and is inserted into the linea quadrati (post: Inter-trochanteric
line) (a rough ridge on the posterior part
of the trochanter major.)
Action- It is an outward rotator of the thigh-
Third Layer - Two Muscles -
Dec
- Gluteus Minimus -
The gluteus minimus lies beneath gluteus medius 
and maximus; it is a triangular radiated muscle
arising from the dorsum Ilii between the middle 
and inferior curved lines it descends narrowing 
to be inserted into the trochanter major - ant. Border in front of center of motion of hip joint
Action- It is an abductor and inward rotator of the 
thigh acting from below it steadies the pelvis on the 
femur -
Obturator Extermus - Dec 

arises from ischid pubic pains


Obturator Externus.
229
The obturator externus arises from the outer surface of 
the obturator membrane (its inner 2/3) and from the 
margin of the obturator foramen, narrows to a tendon
which passing outward behind the neck of the femur
is inserted into the digital pit of the trochanter
major -
Action- It is an external rotator of the thigh -
Dec 1st
- Posterior Femoral Region - Three Muscles -
The muscles of the thigh are placed in four groups 
viz-posterior, superficial, anterior and internal femoral
groups - Investing the thigh as before stated is 
a thick string fibrous membrane lying just beneath
the skin and superficial fascia, descending to the 
knee it envelopes the joint and passes on to become 
the investing fascia for the muscles of the leg - From 
the hip-joint to the knee-joint it is known by three
names, investing fascia of the thigh, or vagina femoris
or generally fascia lata - It not only forms a resisting 
firm covering for the muscles but sends in 
between the groups septa two of these dividing septa 
being attached to the external and internal lips of 
the linea aspera are known respectively as the external
and internal intermuscular septa - The fascia
lata moreover consists of two layers between which 
are found some (three) muscles of the thigh called 
the superficial muscles - The posterior femoral muscles
have a common origin from the tuber ischii
and are all three flexors of the leg, i.e, they raise the 
leg backward on the thigh -
[crossed out]
B

not 2/3 but whole length
of the outer lip of the 
linea aspera -
no int inter mus Septum
Sum mem. in as much as it has a broad
tendon and although it is insector in 
front of the semi tendinous bulges 
back so as to grown a guide in 
operations on the back of the Knee 
joint.

Dec 1st
Biceps femoris or Biceps flix. cruris. 
230
The biceps, as its name imports, has an origin by two 
heads, the long head springs in common with the 
semitendinosus muscle from the tuberosity of the ischium, its upper back part
descends adherent to the semitendinosus for 
several inches and is joined by the short-head which 
arises from the [cross out] outer lip of the linea
aspera and from the external intermusclar septum 
and the muscle after descending to the lower 1/3
of the femur in contact with the semitendinosus
leaves it and makes for the outer side of the knee
joint and is inserted into the head of the fibula, chiefly,
(but sends some fibres to the outer tuberosity of the 
tibia and fascia of the leg -  
Dec 1st  
relations to semi membran.
at back Knee joint.
- Semitendinosus -
The semitendinosus as above stated arises in common 
with the long head of the biceps adheres to it 
for several inches then descends in contact with it 
to the lower 1/3 of the femur where it leaves it and descending
toward the inner aspect of the knee joint
is inserted into the inner surface of the shaft of the 
tibia below the inner tuberosity
and sends a slip to the fascia of the leg - (i.e. it is 
one element of the goose-foot insertion, side p. 
Dec 1st 
- Semi-membranosus -
The semi-membranosus arises from the tuberosity of 
the ischium just in front of the two preceding and 
descends in company with them to the lower 1/3 of the 
femur whence it accompanies the semi-tendinosus
towards the inner aspect of the Knee-joint and receives 
a three-fold insertion, into the horizontal 

[illustration]
biceps
above
Semi Membranosus
as it bulges into space.
lower 1/3 femur
in front Knee Joint femur
below
gas bacilluses

[illustrations]
231
groove on the inner tuberosity of the tibia, into the popliteal 
fascia and into the posterior ligament of the 
Knee-joint -
(The Biceps is known as the outer hamstring muscle -
The inner hamstring muscles are the semitendinosus
and semimembranosus -)
- Popliteal Space -
On the posterior aspect of the knee-joint is a surgial
space known as the popliteal; it is diamond-shaped
having an angle above, another below and two lateral.
It is formed by the divergence of the posterior femoral
muscles from each other superiorly and the convergence
of the two heads of the gastro-cnemius muscle
inferiorly - Its boundaries are as follows; its outer
sides are formed, the upper by the biceps, the lower by 
the outer head of the gastro-cnemius; its inner sides 
are formed, the upper by the semitendinosus and 
semimembranosus, the lower by the inner head of the 
gastrocnemius - Its angles are formed as follows; the 
superior by the divergence of the posterior femoral muscles
(at the lower 1/3 of the femur); the inferior by the 
union of the two heads of the gastro-cnemius; the external
lateral by the intersection of the semitendinosus
and semimembranosus with the inner head of 
the gastrocnemius -
The floor of this space is formed by the three parts; the 
upper part its floor is the posterior aspect (of the lower 
1/3) of the femur; the middle portion is the posterior
ligament of the knee-joint; the lower portion is the 
popliteal fascia covering the popliteus muscle
(this last portion corresponds to the upper 1/5 of the 

Gluteus medius is adherant to this 
muscle by its ant edge.
flattened tendon.

232
tibia.)
The importance of this space results from the fact 
that there pass through it from above downward (a)
a large nerve (b) a little deeper a large vein & (c)
deepest of all a large artery; all three called Popliteal.
Superficial mus of the thigh
or
Superficial Femoral Group - Three Muscles - Exam 90-91-
As before stated these three muscles all lie between
two layers of fascia lata -
- Tensor Vaginae Femoris -
The tensor vaginae femoris is short and flat lying 
on the outer aspect of the thigh and between the layers
of the fascia lata; it arises from the crest of the 
ilium near the anterior superior spinous process 
descends with an inclination backward and is 
inserted into the fascia lata between the layers. about 1/4 down the thigh -
Action- It is a tensor of the fascia lata and aids to [illegible]
[illegible] [cross out] the limb -
Exam. 90-91
Sartorius -
The Sartorius muscle is the longest muscle in the 
body; it arises from the anterior superior spinous process
of the ilium and half Part? the notch below, passes obliquely
downward and inward across the upper 1/3
of the thigh, descends vertically down behind the inner 
condyle of the femur, then turns obliquely forward
to be inserted into the inner face of the tibia below 
the inner tuberosity sending a slip to the fascia of 
the leg - It forms one of the three elements of the goose-foot
insertion, the other two being the semitendinosus
and Gracilis. The insertion of each being given 

[illustration]

[illegible]
233
AB
CH
in this wire, front of the tibia below the inner tuberosity
and sends a process to the fascia of the leg - Of the 
three muscles at their insertion, the sartorius is the 
most superficial, then the gracilis and lastly the 
semitendinosus -
Action- It flexes the thigh on the pelvis, the leg on 
the thigh and carries the leg inward across the other -
- Gracilis -
The gracilis arises from the edge of the symphisis pubis 
and from the margin of the rami of the pubes
and ischium by a thin broad tendon and descends
fleshy the inner aspect of the thigh to be inserted, as 
one element of the goose-foot insertion, into the inner
surface of the tibia, just below the inner tuberosity
and sends a process to the fascia of the leg.
Action- Flexes the leg on the thigh and aids in adducting 
the thigh -
- Anterior Femoral Region - Five Muscles -
The muscle in the anterior femoral region are usually 
described as five, but they can very readily be 
considered as three, the Biceps Flexor [cross out] femoris, consisting
of the Psoas Magnus and Iliacus Internus and 
the Triceps Extensor Cruris consisting of Rectus Femoris 
Vastus Externus and bastus Internus - The three -
last named being inserted by a common tendon,
known as the ligamentum patellae, into the anterior 
tubercle of the tibia their action being transmitted 
through the patella to which they are attached - As 
might be inferred from their action they all arise from 
points somewhere near as perpendicular to their insertion -

Biceps felexus femorus 
The tendonous slips going from the 
upper edge of one vertebra to the 
lower edge of same (a). from 
lip to lip. - viz. over the orustucter.
portion of the bodies of a seililia 
There is a bursa between the conjoiner
tendond of three mus.
has a versa behind it which some
time come. with hip joint.

234
insertion- Some make 4 muscles here by subdividing
one and call them Quadriceps extensor -
Psoas Magnus -
The Psoas Magnus is a long spindle-shaped muscle
lying beside the vertebral column and descending
into the thigh - It arises from the bodies and transverse
processes (bases) of the last dorsal and all the 
lumbar vertebrae, from the intervertebral disk between
them and from the tendinous arches attached
to the bodies of the vertebrae, these tendinous arches
are each attached to the body of one vertebra arching
from the upper lipped edge to the similar lower 
edge of the body of the vertebra thus leaving between it 
and the central constricted portion of the body an 
internal through which vessels and nerves pass -
The muscle descends along the brim of the pelvis and 
as it is passing beneath Poupart's ligament into the 
thigh it is joined by the next muscle the iliacus
internus and then blended tendon is inserted into 
the trochanter minor of the femur and the linea
aspera for an inch below -
Action- It is a flexor of the thigh on the pelvis
- Iliacus Internus -
The iliacus internus arises from the iliac fossa 
from the internal lip of the crest of the ilium and 
by a few fibres from the capsular ligament of the hip-joint
it blends with the psoas magnus and is 
inserted into the trochanter minor of the femur [illegible]
linea aspect for an inch - 
alac of Sacrum 90-91

scarsas [illustration]
There is a fissure in the upper back part.
of the vastus internus for passage of 
cords [illustration]
Vastus Intus
Arises. out lip linen asp
in lip linea asp.
ext. [cross out] int inte mus sept
int " " "
whole shaft of femur begining
at spiral line.

* Triceps Extensor Cruiso 
1-2-3
235
- Rectus Femoris -
The rectus femoris derives its name from the straightness
of its course; it arises by a forked tendon one 
fork spinning from the interior inferior spinous
process of the ilium, the other from the upper lip of 
the acetabulum these som unite and the tendon
thus formed after a short course terminates in the 
belly of the muscle whose fibres have a bipenniform
arrangement, the belly terminates at the lower part 
of the thigh in a strong tendon which is inserted
into the upper end of the patella -
- Vastus Externus -
The vastus externus arises from the trochanter its base major, 
from the outer lip of the linea asperus upper 1/3 inch from 
the external intermuscular septum and is inserted
into the outer edge of the tendon of the rectus femoris
and outer margin of the patella - or by one as of lig. Patella
Vastus Internus -
The vastus internus arises from the inner face of the 
femur from the anterior intertrochanteric line downward,
from the front of the femur, from the outer
face from the inner lip of the linea aspera and 
from the internal intermuscular septum and is 
inserted into the inner edge of the tendon of the rectus
femoris and into the inner margin of the patella - or by lig patellae.
The two vasts muscles from a large fleshy mass 
which envelopes the entire femur except the linea 
aspera and the two extremities of the bone - That portion 
of the vastus internus which arises from the 

[illustration]
2 of pubes -

236
front of the femur is sometimes described as a separate
muscle under the name of the crurous muscles -
Internal Femoral Region - Four Muscles -
The muscles of the internal femoral region are adductors
of the thigh that is they carry the thigh towards
[illegible] across its fellow and consequently they must arise
somewhere towards the middle line of the body and 
they to all arise from or near the pubes -
- Pectincus - 
The pectincus arises from the pectineal line and 
triangle of the pubes and passing downward and 
outward is inserted into the line leading from the 
trochanter minor to the linea aspera - only its upper part 
- Adductor Longus -
The adductor longus arises from the front of the pubes
just below its angle and passing downward 
and outward is inserted into the [cross out] whole length of the inner lip
of [cross out] linea aspera - its body It and the pectincus form a layer
behind which is the adductor brevis -
- Adductor Brevis -
The adductor brevis arises from the front of body and ramus 
of the pubes and passing downward and outward
to be inserted [cross out]
i.e. the line leading from the linea aspera
to the trochanter minor.) its whole length
- Adductor Magnus -
The adductor magnus arises from the side of the tuberischii

Also int. codly. ridge. 92 [illustration]
- Hunters Canal - 

237
tuberischii and from the rami of the ischium and 
pubes and passing downward and outward in 
large distinct bundles of fibres is inserted into the 
whole length of the linea aspera and its inner lip of body & int condl. ridge. and by a rounded
tendon into the internal condyle of the femur -
This muscle is pierced by five apertures one above 
the other, the lowest being much the largest for the 
transmission of the femoral artery over the termination
of which the adductor magnus and longus 
throws a tendinous arch to the vastus internus).
forming what is called Hunter's canal, over last
two inches of the artery -
- Scarpa's Triangle -
On the upper front of the thigh is an important surgical
triangle known as Scarpa's; its outer boundary
is the sectorius, its inner as the adductor longus,
its base is Poupart's ligament, its apex is the intersection
of the sartorius and adductor longus -
Entering this triangle at the middle of its base 
and passing through its centre to disappear at the 
apex are the femoral artery and femoral vein -
Hunter's Canal.
- The Muscles of the Leg -
The muscles of the leg are divided into three icyious -
1st Anterior (Tibial) 2d Posterior (Tibial) 3d External
(or Fibular)
- The Posterior Region of the Leg (or Posterior Tibial) -
- Seven Muscles -
The muscles in the posterior region of the leg are 
placed in two layers superficial and deep. 

The sep. of the 2 heads only occur for 
abt. 1 in but dont unto until pass over upper
1/5 of the bone
The superficial group. [cross out] is 
called triceps ext. suras
The tendo ach at its com covers
nearly the whole of the back of 
the leg at its lower part it 
is inserted it is very thin
Begins to be lost in the tendo H.

Swing lig of Retus is a septe ant annular lig 
WILSON J.S.
238
- Superficial Layer - Three Muscles -
- Gastrocnemius -
The gastrocnemius is the large muscle which gives
shape to the calf of the leg - It arises by two heads from
the upper back part of the condyles of the femur
and the [cross out] ridges. which connect condyles with linea (a) lower pt.
aspera - these two heads descend converging as the 
lower lateral boundaries of the popliteal space, to a junct up 1/3 with lower 4/5.
unite and form the belly of the muscle along which 
is continued a groove for some distance; the belly
terminates just below the centre of the leg in a large
tendon called the tendo Achilles, which is inserted
into the lower part of the posterior tuberosity of the os 
calcis, its lower part it being the largest and longest (?) tendon in 
the body - sep. from the up part of is calcis by versa -
Action- It raises the heel and continuing to act 
raises the foot -
- Soleus -
The soleus is a large fleshy muscle lying beneath the 
gastrocnemius it arises from five points from the 
head and upper half of the posterior aspect of the 
fibula, from the popliteal line and middle 1/3 of the 
internal border of the tibia and from a tendinous, 
arch stretched between its bony origins & internus Septum. and descend
to terminate about the middle of the leg in the tendo
achilles - 1
Action- same as that of the gastrocnemius -
These two muscles are sometimes called triceps smae -) 
- Plantaris -
The plantaris is in insignificant muscle lying
between the gastrocnemius and soleus - It arises 
?92
-Plant.

[illustration]
Pop. belonges to its self as it has its 
own peculiar action. BT.
is bound down or tibia by pop. fascia
These 3 mus lie below pop. line
3 mus con. togather

239
from the back part of the external condyle of the femur
in common with the external head of the gastrocnemius,
the belly of the muscle descending obliquely
inward between the gastrocnemius and soleus
terminates in a long small tendon which escapes 
to the inner side of the two muscles and passing 
down beside the tendo Achilles is either lost in 
its inner side or is inserted into the posterior tuberosity
of the os calcis - Action- Same as that of the gastrocnemius -
- Deep Layer - Four Muscles - Dec 10th 91
- Popliteus - note short int. lat. lig. of [illegible] joit.
The popliteus is a small triangular muscle resembling
the anconeus in the upper extremity; it arises
by its tendinous apex from the groove or external condyle
of the femur and passing downward and inward,
adhering to the head of the fibula and posterior
ligament of the knee-joint and the fascia
which covers its surface is inserted into the surface
of the tibia above and as low as the oblique or popliteal 
line W pop. △ and also post. log. of joint on its posterior face and into the under surface
of the fascia which covers it called the popliteal 
fascia- (Action- Flexes [cross out] and rotates 
the leg in a state of semi flexion.)
- Flexor Longus Pollicis - Dec 10th 91
The flexor longus pollicis arises from the lower two-thirds
of the fibula except last inch and intermuscular 
septum tht trans [illegible] and descending behind the inner
malleolus into the sole of the foot crosses the tendon
of the flexor longus digitorum and is inserted into 
the base of the last phalanx of the great toe -
Action- It flexes the last phalanx of the great toe -

At the int mal. the tib. ant of L. Dig enter
fort. togather & alecost also but T.l. policis. [cross out] here
is abt 1 in. ext. to abve mus.
Ten. flx long. dig. tib. post. lie 
lyater behind the rule not 
maleolus 
Flex. layer. Pobus Dig.
lies ext to these to on 
notch 

240
Flexor Longus Digitorum - Dec 10th 91
The flexor longus Digitorum arises from the lower 
two-thirds of the tibia, except last 2 or 3 inches and 
intermuscular septum transverse and passing behind the 
internal malleolus is inserted by four tendons into 
the last phalanges of the four outer toes - having 
been crossed by the tendon of the flexor longus pollicius
Dec 10th 91
Action is indicated by its name - 
- Tibialis Posticus - W.B.
The tibialis posticus arises from the whole length
of the posterior surface of the interosseous membrane
from the adjacent edges of the tibia and fibula and 
from the intermuscular septum transverse and descending behind
the internal malleolus is inserted into the tuberosity
of the scaphoid bone and internal cuneiform
bone - mostly B.T.
Action- It is an extensor and adductor of the foot -
The three last muscles as shown above all rise from 
the intermuscular septum and all pass behind the 
inner malleolus; the flexor longus pollicis arising
from the outer bone of the leg and inserted into the inner
toe and the flexor longus digitorum arising from 
the inner bone of the leg and inserted into the outer 
toes, they must cross each other to reach their destinations 
and they do so in the sole of the foot, their
crossing being called the decussating of their tendons
they being connected at this point by a small slip. The 
interosseous membrane is a strong ligamentous membrane:
passing across the interval between the tibia
and fibula and attached to their adjacent edges,
after the manner of the interosseous membrane of the 

Insertion of Tib Anticus 
" " " Tib Postecus 
Pervncus Leyas.
pases through sving lig

241
fore-arm: this interosseous membrane being entirely
appropriated on its posterior face by the tibialis muscle
It should be observed that the muscle in the deep
layer are separated from those in the superficial
layer by a strong thick fascia -
- Anterior Region of Leg - Three Muscles - Dec 8th
Of the three muscles in this region two have some 
points of origin in common; these four points are 
1st outer tuberosity of the tibia, 2d investing fascia
of the leg; 3d intermuscular septum - 4th interosseous
membrane - 91 - 8th
- Tibialis Anticus -
The tibialis anticus arises from the common origin
and from the upper two-thirds of the outer face
of the tibia and descending terminates in a tendon
which passing beneath the anterior annular ligament 
is inserted into the inner and under surface
of the internal cuneiform bone and base of the 
metatarsal bone of the great toe -
(Action- It flexes the foot and according as it acts 
with the tibialis posticus or with the peronei it 
inverts or everts the foot.) 91- 8th
- Extensor Longus Digitorum -
The extensor longus digitorum arises from the common
origin and from the head and whole lengt
of the fibula and descending lower 1/3 of lig. divides into five tendon
which passing beneath the anterior annular ligament
are inserted, one into the base of the metatarsal
bone of the little toe, the other four into the back 
of the four lesser toes after the manner of extensor

The Peroneus longus lies over the
the " " veris.

242
tendons.
Action- It extends the toes and by its insertion
into the metatarsal bone of the little toe it flexes
the foot). That portion of the extensor longus digitorum
which is inserted into the metatarsal bone 
of the little toe and which arises from the lower 
fourth of the fibula, is by some known as a separate 
muscle and called the peronsus tertius -
Extensor Proprius Pollicis -
The extensor proprius pollicis lies between and is 
overlapped by the two preceding muscles; it is shorter
than they; arising from the middle half of the Letter to [illegible] 2/4
shaft of the fibula and from the interosseous membrane
it terminates in a tendon which passing
beneath the anterior annular ligament is inserted
into the Base of last phalanx of the great toe -
Action is indicated by its name -
The anterior annular ligament is a strong oblique
ligamentous band which binds the tendons of the 
three preceding muscles down on the front of the 
ankle -
- External Region of the Leg - Two Muscles - or Fibula.
- Peroneus Longus - Dec 10th 
The peroneus (or fibularis) longus gives from the 
head and upper two-thirds of the outer aspect of the 
shaft of the fibula, from the investing fascia, and TB. of doret believe.
from the intermuscular septum and descending
to terminate in a tendon which passing behind the 
external malleolus (through the lower groove on the 
outer surface of the os calcis) reaches the sole of the out border.
foot and is directed obliquely forward and inward



243
inward through a groove in the cuboid bone to be inserted
into the base of the metatarsal bone of the 
great toe - 
(Action- It is extensor of the foot)
- Peroneus Brevis - Dec 10th
The peroneus (of fibularis) brevis derives its name 
from its position and because both its origin and 
insertion are short of those of the peroneus longus
beneath which it lies; it arises from the lower two-thirds
of the outer aspect of the shaft of the fibula
and from the intermuscular septum; descending
behind the external malleolus (through the upper
groove on the outer face of the os calcis) its tendon is 
inserted into the base of the metatarsal bone of the 
little toe. runing horizontal. forward.
(Action- It extends the foot) & exert the foot.
The two Peronei muscles as they are passing behind 
the external malleolus are held down by the external
annular ligament & tend to pevent the flattening
of the foot. (a) P. longus.
The Muscles of the Foot -
The foot is divided into two regions, the dorsum or 
back of the foot and the plantar region or sole of the 
foot.
- The Dorsum of the Foot - One Muscle -
- Extensor Brevis Digitorum -
The extensor brevis digitorum arises from the upper 
and outer aspect of the os calcis and passing forward
and inward divides into four tendons, the innermost
tendon is inserted into the base of the 
first phalanx of the great toe and the three outer into 
the backs of the three next toes in common with the long 



244
extensor tendon - Its name indicates its action -
Muscles of the Sole of the Foot -
When the thick skin on the sole of the foot has been removed,
there is brought to view a thick mass of fatty
tissue and beneath this is found the proper fascia 
of the sole called the plantar fascia, which consists of 
a thick strong central portion and on either side of 
this but continuous with it a thinner lateral portion;
the central portion beginning at the under surface of 
the os calcis behind runs forward widening as it 
advances and just beyond the middle of the sole dividing 
into five branches each of which passes forward
to the base of a corresponding toe; now the 
muscles of the sole all lie beneath (or in the erect
position above) the plantar fascia and are disposed
into groups, in accordance with the subdivision of 
the plantar fascia, viz, a central group and two 
lateral groups; and the propriety of this arrangement
is strengthened by the fact that these groups
are separated from each other by two dividing or intermuscular
septa which the plantar fascia sends 
up to the bones of the foot from the line of union between
the middle and lateral portion - But in describing
these muscles they are taken in layers of which 
there are three - when the plantar fascia, the dissection
of which is the first step, has been removed, the 
first layer is seen consisting of one muscle in each 
group, these constitute the second view -
First Layer - Three Muscles -
The three muscles forming the first layer have origins,
called their common origin, which are stated in the 
same terms all of them arising 1st from the under 
surface of the os calcis - 2d from the plantar fascia which 



245
covers them (a) investing fascia 3d from the intermuscular septa which 
separate them - So that in a properly performed dissection
of the plantar fascia it is always left on the 
muscles for two or three inches forward from the os calcius
since this part gives origin to musclar fibres -
- Abductor Pollicis -
The abductor pollicis is the innermost of the three
muscles in the first layer; arising from the common
origin it is inserted into the inner side of the base 
of the first phalanx of the great toe -
Its name indicates its action -
Abductor Minimi Digiti -
The abductor minimi digiti is the outer of the three 
muscles in the first layer; arising from the common 
origin it is inserted into the outer side of the base of 
the first phalanx of the little toe -
Its name indicates its action.
- Flexor Brevis Digitorum -
The flexor brevis digitorum is the centre of the three
muscles in the first layer; arising from the common 
origin it passes forward and divides into four tendons
for the four lesser toes - Each tendon splits to allow 
the passage of the tendon of the long flexor and is 
inserted into the sides of the shaft of the second phalanx.
Its name indicates its action -
- Second Layer - Five Muscles & Two Tendons -
The second layer exposed by removing the first is the 
third view in the direction of the sole of the foot; it 



246
consists of the muscular accessorius; the four lumbricales
and the two tendons of the flexor longus pollicis
and flexor longus digitorum; these two tendons soon
after entering the sole from behind the internal
malleolus cross each other forming what is known as 
their decussation and they are moreover connected as 
they cross by a slip so that one muscle cannot act entirely
independent of the other, but throws the parts
into which the other is inserted into slight motion
when it acts -
- Musculus Accessorius -
The musculus accessorius arises tendinous and 
fleshy from the under surface of the os calcis and 
passing forward is inserted into the outer side 
and upper surface of the tendon of the flexor longus 
digitorum just as it splits into its four branches -
Action- It corrects the obliquity which would otherwise 
be imparted to the motion of the four lesser toes
by the action of the longer flexor -
- Lumbricales -
The lumbricales are four little worm-like muscles,
three of which arise from the bifurcations of the tendons 
of the flexor longus digitorum and the fourth
[f??m] the inner side of the inner tendon of the same 
and passing between the toes are inserted into the 
extensor tendons of the four lesser toes to their tibial
side -
Action- They aid the flexor longus digitorum -
- Third Layer - Four Muscles -
This layer, constituting the fourth view in dissect -

2 [illegible] [illegible] -
[illegible] [illegible] [illegible]

247
seen on the back of the hand or foot and called
hence dorsal interosseous and 3 are found on the 
palmar aspect or in the sole and hence called
plamar or plantar interosseous - The action of these
muscles is to withdraw any finger or any one of the 
four smaller toes from an imaginary axis passing 
along the centre either of the middle finger or 
the toe next the great toe; or on the other hand to carry
the finger or toe towards the imaginary axis; the 
former of these actions is called abduction and is 
performed by the dorsal interosseous muscles, the latter 
is called adduction is produced by the palmar
or plantar interosseous muscles -
In the Hand the dorsal interossei are seen to occupy
the intervals between and to arise by two heads
from the adjacent aspects, of all the metacarpal
bones, passing forward each is inserted into the 
side of a finger opposite to the imaginary axis; now 
the middle finger has two dorsal interossei and the 
little finger more since for the latter the abductor
is a muscle of the hypothenas group, the abductor
minimi digiti - The palmar interossei as stated
are three for each hand; lying between the metacarpal
bones for the index and the middle and 
the middle ring and ring and little fingers they 
rise each from one metacarpal bone and passing
forward are inserted into the finger of the same metacarpal
bone on the side next to the imaginary axis
there being no palmar interosseous muscle for the 
middle finger since its two dorsal muscles supply
its function -
In the foot the arrangement of the interosseous muscles
is similar to that in the hand except that the 
toe next the great toe has two dorsal and no plantar 

arises from sheath of ten. of [illegible] Long. or long
inf. cal. cut. lig.
It lies on the plants face of met tar 
bone of little toe.
outer 90-91

248
ing the sole, is exposed by removing the second layer -
- Flexor Brevis Pollicis -
The flexor brevis pollicis arises from the [cross out]
[cross out] mostly from the expanded
tendon of the tibialis posticus and is inserted into
both sides of the base of the first phalanx of the great 
toe each tendon having in it a sesamoid bone - it has [illegible] tendons.
- Adductor Pollicis -
The adductor pollicis arises from the cuboid bone from 
the sheath of the tendon of the peroneus longus and 
from the bases of adjoining metatarsal bones (2d 3d
& 4th) and is inserted into the outer side of the base of 
the first phalanx of the great toe - (a) outer Sesomoid bone.
- Flexor Brevis Minimi Digiti -
The flexor brevis minimi digiti arises from the base 
of the fifth metatarsal bone and is inserted into the 
[cross out] lower portion of the base of the first phalanx of the little
toe -
- Transverse Pedis -
The transverse pedis arises by slips from the heads of 
the four outer metatarsal bones and passing inward
is inserted into the outer side of the base of first phalanx
of the great toe outer sessamoid bone- Action- It is an adductor of the 
great toe - 
- Interosseous Muscles -
Lying between the metacarpal bones of hand and 
metatarsal of the foot are certain small muscles
called from their position interosseous; in each member
there are seven of these muscles, four of them are 

Base △ lig of pubes -
*
△ Lig of pubes -

249 
interosseous the imaginary axis of the foot passing 
through it -
Nov - 20th 91
- The Outlet of the Pelvis -
The outlet of the pelvis, which in the recent subject is 
closed by various soft parts, in the skeleton is seen 
to be surrounded by the following parts; in front it 
is limited by the pubis arch; behind by the tip of the 
coccyx; on each side about the centre by the tuberosity
of the ischium, running forward from this the rami 
of the ischium and pubes and backward from it the 
greater sacro-sciatic [cross out] notch - or in the recent subject 
the lower border of the gluteus maximus muscle -
In the recent subject the outlet of the pelvis is divided
into two portions by (a transverse line passing between
the anterior edges of the two tuberosities of the 
ischia, or in other words from the indefinite point on 
one side where the ramus and tuberosity of the ischium
meet to the same point on the other the portion lying 
in front of this transverse line is called the perincum
and that lying behind it the ischio-rectal region -)
Nov 20/91
- Ischio-rectal Region -
The ischio-rectal region is bounded in front by the 
*transverse line, behind by the apex of the coccyx, laterally
by the greater sacro-sciatic ligament or the 
lower edge of the gluteus maximus muscle and by 
the tuberosity of the ischium - It contain three parts 
to be examined, the anal orifice with its sphincter
muscle and on each side of this a subdivision of the 
region known as the ischio-rectal fossa -
Anus -
The anus is the termination of the rectum 

apex at x- (6) where Revalis the Ani Sluktes the outer wall
of the pelvis 
[illustration] Leronlin Ani
Obluator Fosein

250
and is kept habitually closed by the tonic contraction
of two muscles called the sphincters internal and 
external - The sphincter ani internus was described
with the structure of the rectum, it being a muscular 
ring around the gut formed by an aggregation of its 
circular muscular fibres about an inch above the 
anal orifice - Surrounding the anal orifice, which is 
seen in the centre of the ischio-rectal region, is a 
thin elliptical muscle called the sphincter ani externus;
arising from and about the tip of the coccyx
it passes forward just beneath and closely adhering
to the skin to surround the anal orifice and be inserted 
in front of it into a point in the centre of the 
transverse line, called the central point of the perineum 
- helping to form the raphi of the Perineum.
Ischio-rectal Fossa -
The ischio-rectal fossa is 
the triangular or wedge-shaped space lying beside
the anus one on each side of it - It is about two inches
deep the base being at the surface and its limits
indicated by the anus within, the tuberosity of the 
ischium without, the transverse line in front and 
the lower edge of the gluteus maximus muscle & [illegible] lig. behind;
the apex being above and formed by the coming 
together of the two sides of the space, the inner 
side being a muscle inserted into the side of the 
lower part of the rectum and called the levator ani,
the outer side being the obturator internus muscle -
The levator ani muscle is thin and flat and has a 
most peculiar origin to understand which some
preliminary remarks are necessary - The transversal 
is fascia, which lies between the transversalis abdominis 

For Levator Ani See pa 77 notes.

251
abdominis muscle and parietal layer of the peritoneum,
when it reaches the iliac fossa where it covers
the iliacus internus muscle takes the name of the 
iliac fascia which in its turn when it reaches the 
brim of the pelvis assumes the name of the pelvis
fascia and this descending into the pelvis when it 
reaches the commencement of the obturator fascia
passes down covering the pelvic face of the obturator
internus muscle; the other layer called the recto-vesical
fascia passes downward and inward to the 
rectum and base of the bladder - Now just in the interval
when the pelvic fascia splits the levator ani
muscle rises, having internal to it the recto-vesical
layer and external to it with a widening interval between
them the obturator fascia; Besides this origin
from the fascia it arises posteriorly from the spine of 
the ischium and anteriorly from the back of the pubes -
The ischio-rectal region thus described is 
found filled with adipose tissue, the absorption of 
which in long continued debilitating disease is 
the cause of the sunken appearance which is then 
seen on either side of the anus -
Perineum - (In the male -)
The peritoneum is that subdivision of the outlet of the 
pelvis which lies in front of the transverse line its 
limits are, in front, the pubic arch; behind the 
transverse line; on each side, the rami of the pubes
and ischium - Crossing along its centre, from behind
forward and continued on to the scrotum, is a 
ridge of the integument called the raphi -
Upon careful dissection the peritoneum is found to be 

91 -
The investing fascia of the Perineum
This forms a pocket when it 
turns on its self and in this [illustration]
is the crura of the penis 
The attachments of the investing fascia
of the perineum. 

20
0
_____
120
252
formed of the following constituents from the surface
upward - 1st the integument - 2d several layers of superficial
fascia, which in no wise differs from the 
general superficial fascia found beneath the integument
everywhere, 3d a layer of fascia called [cross out] {Investing fascia of perineum
[cross out] since it is peculiar to the 
perineum being attached to the rami of the pubes
and ischium on each side and in front is continuous
with the dartos of the scrotum, posteriorly this 
fascia is attached to nothing but changes its name 
into [cross out] △ Lig. of pubes - [cross out] since it makes a bend on 
itself at the transverse line and runs back toward
the pubic arch under the name of the [cross out] △ Syphilis;
[cross out] separated from the superficial perineal 
fascia by the root of the penis and the muscles connected
therewith: 4th removing the [cross out] investing perineal
fascia there are exposed the root of the penis 
and its muscles; the root of the penis consists of the 
two crura cavernosa attached one on each side to the 
ami of the pubes and ischium and of the Bulb of 
the corpus spongiosum which lies between these - The 
muscles which are exposed are three pairs - 1st Transverse
Perinei which arises on each side from the 
spot where the ramus of the ischium is continued
into the tuberosity and passes transversely inward
to meet its fellow in the centre; this point where the 
two transversi perinei are inserted into each other
is called the perineal centre and let it be observed
that the course of the transverse perinei corresponds
to the transverse line - (a) base of △ lig of pubes.
2d- Accelerator Urinae This muscle arises from the
perineal centre and from a raphi between it and 

1.25
.75
___
2.00
7.5
2.
______
5.5
This not given as deep Perioneal
fascia simply as the △ Lig -

255
170
_____
83
208
its fellow and the greater portion of its fibres surround the 
corpus spongiosum to meet the fibres of the opposing
muscle on the top of the corpus but some of its fibres
posteriorly are inserted into the [cross out] △ Lig of pubes -
ramus of the pubes while some in front are lost in the 
corpus cavernosum - Its chief action is to drive the
urine forward by contracting on the corpus spongiosum
on which is the urethra -
3d Erector Penis arises from the rami of the ischium
and pubes and passing forward is lost on the upper
aspect of the corpus cavernosum - Sides & under surface -
4th After removing these muscles and the root of the 
penis the deep perineal fascia is displayed.
This, as stated, is continuous at the transverse line 
with the superficial perineal fascia the line of reflection
being around the posterior aspect of the transverse
perinei muscles - from this point it passes forward
to the arch of the pubes attached on each side to the 
rami of the ischium and pubes; just below the arch 
of the pubes it presents a small round opening for 
the passage of the urethra - When the deep perineal
fascia is dissected up it is found to consist of two 
layers, called the superficial and deep layers of the 
deep perineal fascia, which is sometimes called the 
triangular ligament of the pubes - Between the 
two layers are found blood vessels and nerve and 
a pair of muscles called the compressors urethrae -
The Compressor Urethrae arise from the point of 
union between the rami of the pubes and ischium
and running transversely inward divides into two 
fasciculi which meet those of the opposite muscle
and surround the urethra -

15
7
__________
505

250
174
_________
84

335
254
_______
187
254
- The Vascular System
In the vascular system are comprised three sets of 
vessels 1st the capillaries which are minute vessels
ramifying in the various structures of the body and 
in such abundance that were all the other components
of the part removed still would these preserve its bulk
and form 2d the veins which are the channels for the 
transmission of the blood, deoxygenerated in the capillaries
back to the centre of circulation -
3d the arteries which are the vessels bringing the blood
from the heart to the capillaries and which are here 
first dealt with and then the veins the capillaries
being left for consideration in physiology.
The Arteries -
The arterial system consists of two parts, the Pulmonary
and the systemic. The Pulmonary is formed by 
the Pulmonary artery and its branches, conveying 
venous blood from the right ventricle to the lungs.
The systemic arteries comprise the [a??ta] and its 
disturbing branches which convey arterial of the blood
from the left ventricle to all the tissues of the body.
Procurting thence the aorta continuously gives off branches
and [li??ally] itself terminates by dividing into two 
branches the aggregate capacity of the arteries which 
spring from it greatly exceeding its own and if 
these be traced up it is found that the aggregate
culibre of their biogeny as greatly exceeds their own 
and as on for each remove from the original aorta
as that the aggregate capacity of the arteries terminating
in the capillaries in indefinitely larger than 
the capacity of the aorta from which they all remotely



255
remotely derived, and in consequence of this increase
in size of the channel which the blood traverses as it 
is driven from the heart the rapidity of its flow is 
constantly slackening: now in some arteries a special 
provision is made to reduce the momentum of the 
blood current, in order to avoid injury of the delicate
structures in which they terminate by the tortuousness
of their course, e.g. the internal carotid artery
this tortuousness is also seen in arteries which traverse
parts subjected to frequent and violent changes
of dimension in order to avoid rupture of the artery or 
obstruction to the motions of the part, e.g. the facial
artery
The arteries as a rule seek the most sheltered
route they can obtain avoiding the surface when 
practicable and lying near the bones, when passing 
through muscular parts they seek the interstices 
between the muscles and traverse the substance of a 
muscle with the greatest reluctance and when an 
artery is forced to perforate a muscle the aperture 
through which it passes is surrounded by a tendinous 
arch in order to avoid compression which 
could otherwise result when the muscle acted
Another provision for the safety of an artery is found
in the fact that arteries are isolated from the parts
through which they pass by a fibrous investing membrane
called the sheath of the artery thus tending 
to preclude the artery from participation in disease
under which the part may be [illegible] and thus 
[illegible] the parts which the artery is destined to 
supply with blood -
The names of arteries are derived as a rule from 



256
the region which they occupy or from the parts which 
they are intended to supply- As a rule the name of 
an artery remains interchanged irrespective of the size 
or number of branches it produces until it divides
into two or more branches; the two exceptions to this will
be found in the arteries of the upper and lower extremities
each of which is known under three different
names in different parts of its course previous to its 
division - Another fact to be observed is that as a rule 
an artery will supply the part through which it is 
[???ing] and in consequence of this is constantly diminishing
in size otherwise the size would remain 
the same to its termination for the walls of the artery
do not absorb the blood which it is transmitting these 
being nourished by separate branches which ramify
thereon and called vasa vasorum.
The arteries are generally accompanied by the veins returning 
turning the blood to the heart from the parts which 
the arteries supply (the vein may be single and then 
usually bears the name of the artery with which it 
is found or there may be two veins with one artery
and these are known as the Satellite veins of that artery
or its venue conntes) and the venous channel
from any part is found to be about twice that of the arterial
to it and in consequence the venous current is 
much slower than the arterial but it gradually increases
speed as it moves towards the heart owning to 
the fact the area of the veins constantly diminishes 
as they converge towards the right auricle of the heart 
into which all the venous blood is poured through two 
large veins the superior and inferior venae cavae -

336
257
_________
79
origin from conus artenorus

To distinguish it from rt. & left Pul -
257
The Pulmonary Artery - = apply is only to trunk -
The Pulmonary artery begins at the base of the right 
ventricle of the heart, the infundibulum, or conus arteriosus
of that cavity leading up to it. Its origin is 
behind the left edge of the sternum, opposite the third
left costs-sternal articulation, in front of and slightly
above and to the right of the origin of the Aorta. It is
about two inches in length, its direction being upward
backward and very slightly to the left. It lies
in the fibrous pericardium which it pieces and immediately
divides into the right and left pulmonary
arteries - It and the ascending part of the arch of the 
aorta are contained in the same fold of serous pericardium -
It first lies on the front of the ascending part of the 
arch of the aorta, but some gets to the left of that vessel,
more on account of the obliquity of the aorta than its 
own inclination to the left.
On each side of its origin is an appendix of the corresponding
auricle and a coronary artery- Its bifurcation
is immediately below the transverse part of the arch of 
the aorta, to which it is connected by a fibrous cord,
a half inch long the remains of the ductus arteriosus
of foetal life - This cord is attached slightly to the [cross out]
left of the point of bifurcation, so that it is really connected
with the commencement of the left pulmonary
artery.
The two terminal branches of the pulmonary artery
the right and left pulmonary arteries, pass almost horizontally
outward for about two inches each to the inner 
face of the corresponding lung where it bifurcates
for distubrution to the lung. The right is slightly larger 

The Aorta
1st upward forward and to the right -
2nd Backward and to the left- a (convex up)
turn - at left side of the lower border of 
body of the 4th d- v-
3rd Descends beside the body of the 5th
dorsal vertebrae
behind the Pul. arty and duct arteries
Comences at a line drown across the 
Sternum at the 3rd- intercost space.
The Aorta is first we find of rt. or left body then
above their behind
15O
10)240

258
and somewhat longer than the left and passes behind)
the ascending part of the arch of the Aorta and the 
superior vena cava - The left passes in front of the 
descending part of the arch of the aorta. Each forms
an element of the root of to long being between the 
bronchus [illegible] and the two pulmonary veins in 
front - The right is on a lower level than its bronchus,
but the left is higher than the corresponding bronchus.
The Aorta -
The Aorta begins at the base of the left ventricle and terminates
by bifurcating into the common or primitive
Iliac arteries on the front of the body of the fourth lumbar
vertebra, usually a little to the left of the middle
line - It is contained first in the thoracic cavity and 
then in the abdominal - It first passes upward, forward
and to the right, on the fibrous pericardium for 
about two inches, piercing the pericardium it arches
backward and to the left, with the convexity upward 
and strikes the left side of the thoracic portion of the vertebral
column, at the left side and lower border of the body a 
of the fourth dorsal vertebra: it next descends beside the 
body of the fifth dorsal vertebra with a slight inclination
to the right; from the lower border and left side of the 
body of the fifth dorsal verterbra it descends steadily [illegible]
to the right to a point opposite the twelfth dorsal
vertebra, usually on the middle line but frequently a 
little to the left where it passes from the thorax into the 
abdomen through the aortic opening of the diaphragm;
thereafter its course is down the front of the lumbar vertebrae,
generally including to the left to its terminates - 

Aorta Arch - Begins -
at base of left vent of heart - pt. behind the 
left edge of the Sternum at 3rd" inter
costal space - length 2 inc -
Its course - up and to the right -
terminate where trans be-gins at rt edge: Sternum at the 2nd cost. cart-
is enclosed in pericardium -
1/4 in behind the Sternum
It is 2nd" to the right of Pul - arty
at first it is behind the " "
Enveloped in serous pericardium -

259
It is divided for convenience of description into the arch of 
the aorta and the descending Aorta - The arch of the aorta
begins at the base of the left ventricle and extends to the 
left side and lower border of the body of the fifth dorsal
vertebrae and is subdivided into the ascending, transverse
and descending parts - The descending aorta begins where 
the arch ends at the lower border and left side of the body
of the fifth dorsal vertebra and includes the remainder
of the artery, it is divided into the Thoracic and abdominal
aorta, in accordance with the cavity in which it 
lies -
- The Ascending Part of the Arch of the Aorta -
The ascending part of the arch of the aorta, or as it is frequently
called, the ascending aorta, begins at the base of 
the left ventricle of the heart, at a point behind the left
edge of the sternum, at the front end of the third intercostal 
space, on a plane posterior to the origin of the pulmonary
artery and anterior to the left auriculs - ventricular
opening - Its length is about two inches; its course 
is upward and to the right, slightly curving with the 
convexity to the right, it terminates in the transverse
part of the arch where it pierces the pericardium, opposite 
the right edge of the sternum, behind the upper
border of the second costal cartilage of the right side -
Just above its origin it presents three bulging prominences
when distended, which mark the position of the sinuses
of Valsalva - It lies in the fibrous pericardium,
about one fourth of an inch behind the sternum and is 
contained in the same fold of serous pericardium with 
the pulmonary artery -
It first lies behind the origin of the pulmonary artery,
but quickly gets to the right of that vessels owing mostly 

Relations Ascending Aorta.
In front Sternum, at first Pul. arty & conuct =
Behind - root of right lung -
To right 1st Rt. auricle and then Sup V. Cava
To left is pul. arty - in 2nd pt.
left auricle
The transverse Aorta
Begins behind the right edge of the 
Ster. on a lev. with the upper
border of the 2nd costal
Cart- of the right Side
course curved - convex up-
direct - up & back 
terminates - at the lower border
of the body of the 4th dor. V.
com. ceroter is behind slightly the in [illegible]
[crossed out] " in fnt " of " Sut demar

[Cuter??osus]
260
to its own inclination to the right above the point where 
the pulmonary artery leaves its front it is separated from 
the sternum by the pericardium, some loose connective tissue
and perhaps the remains of the thymus gland -
allways given as relations{ It has behind it the root of the right lung - To the right 
{is first the right auricle and then the superior vena cava - NB
{to the left is the pulmonary artery -
- The Transverse Part of the Arch of the Aorta -
The transverse part of the arch of the aorta begins where 
the aorta pierces the the pericardium behind the right
edge of the sternum, on a level with the upper border of 
the second costal cartilage of the right side; its course
is curved with the convexity upward, the direction being 
to the left and backward; it strikes the left side 
and lower border of the body of the fourth dorsal vertebra
and terminates thereby becoming the descending part of 
the arch - not descending aorta -
The top of the arch is about an inch below the top of the 
sternum and from this aspect arise three large branches
the arteria innominata, the left common crusted
and the left subclavian; resting on the arch in front
of the origin of these three branches is the left vena
innominata or great transverse vein of the neck -
Below this part is the bifurcation of the pulmonary
artery to which it is connected by the remains of the 
ductus arteriosus -
The left bronchus lies below, and arching hooked
around the artery here, towards the left, is a nerve
the left inferior, or recurrent laryngeal, which arises
from the left pneumogastric nerve directly on the 
front of this part of the aorta and after passing beneath
[cross out] Phrenic nerve is also in front & is in 
front of the of root of lung -
and the Pneumogastric behind the rt of lung -

The Vena Inom. lies on top & lying on the trans -
pt of arch only at [illegible] - arty as it passes up
& to the left to join the junction of left sub. Clava.
and left int jugular which from it some 
dist up on the sub-clavian 
Descending part of arch of aorta -
commences at the lower border and left 
Side of the body of the 4th dorsal v
terminating at the lower border of
the 5th d. v.
Relations of Descending Aorta.
In front - root of left lung & Plubua-
Behind left side of body of 5th D.V.
To left left pleura & lung - [cross out]
To Right - Osophagus & thoracic duct -
} between the " " & aorta is " " 
} Behind & 

James S Wilson James S Wilson
261
beneath ascends behind it & the Root of left lung -
This portion of the aorta is separated from the sternum
by the left pleura and anterior border of the 
left lung and remains of the thymus gland; it 
is crossed from above downward on this aspect by 
two great nerves, the left pneumogastric and the 
left phrenic, the phrenic being directly in front of 
the pneumogastric and both being to the left of the middle
line; the pneumogastric while lying on the front of 
the artery produces the left recurrent laryngeal -
Behind the transverse part of the arch, on the middle
line is first the trachea and behind that the oesophagus;
to the left of these are the thoracic duct and 
left recurrent laryngeal nerve - in the groove between the trachea & Esophagus
- The Descending Part of the Arch of the Aorta -
The descending part of the arch of the aorta begins
where the transverse part terminates at the lower border
and left side of the body of the fourth dorsal vertebra
and passes downward inclining slightly to the right 
to terminate by becoming the thoracic portion of the descending
aorta, at the lower border and left side of the 
body of the fifth dorsal vertebra -
It has, in front the root of the left lung; behind the 
left side of the body of the fifth dorsal vertbra; to the 
left, the left pleura and lung; to the right, the oesophagus
and thoracic duct -
- The Thoracic Aorta - [illegible] - 62
The thoracic portion of the descending aorta begins by 
being a continuation of the descending portion of the 
arch, at the left side and lower border of the body of the 

Thoracic Aorta terminates at 12 d-v.
Gray gives Pulmonary and left bronchus 
Thoracic Aorta [illustration]
at 1st pt of ante Ductus 
directly behind.
To left is 
To Right-

Left. Sub- clavian
Inom. arty MB
Left com. caroter
262
fifth dorsal vertebra and terminates by becoming the 
abdominal portion of the descending aorta, where the 
aorta enters the abdomen, at the aortic opening of the
diaphragm, on the front of the body of the twelfth
dorsal vertebra, usually on the middle line, but frequently
slightly to the left. Its direction is downward
and steadily, but slightly to the right; it is somewhat
curved being concave in front, in accordance with the 
dorsal curve of the spinal column upon which it
rests - It lies in the posterior mediastinum behind 
the pericardium, covered in front and to the left by the 
left pleura and lung Its great relations are the thoracic 
duct and oesophagus the thoracic duct is continuously {oesophagus except at 1st when it is to Right
behind and slightly to the right the oesophagus
on which are the two pneumogastric nerves, lies 
at first to the right, but as it descends gets gradually
in front of the aorta and where it terminates by piercing
the diaphragm opposite the tenth dorsal vertebra, it is 
not only in front but distinctly to the left of the aorta -
To the right is the right, or great azygos vein, opening
into which, about the sixth dorsal vertebra is the left
azygos vein, which crosses behind the aorta - oesophagus in 1st pt 92 See pas 129
- the ext Vena. azyos passes behind = v. azygos [illegible] -
The Abdominal Aorta -
The abdominal portion of the descending aorta begins
by being a continuation of the thoracic portion, at the 
aortic opening of the diaphragm, on the front of the 
body of the twelfth dorsal vertebra, usually on the middle
line but frequently slightly to the left and terminates
by bifurcating into the common or primitive
iliac arteries on the front of the body of the fourth lumbar 
verterbra, usually slightly to the left of the middle 

And the termination of this arty is rep. as being very just to
be left are behind umbilicus less 1/2 in on local with a 
line drown from [illegible] at of [crossed out] ilia  crest -
Relations of the Abdominal Aorta 
1 Stomach} in front
2 Semi luna ganglia}
3 head of the Pancreas}
4 Renal vein}
5 duo - trans}
6 aortic plxas}
1- com of thoracic duct} Behind 
(2) Receplaculum chili}
(3) Left Lumber Veins} 
95
(1) Left symph nerve} Left -
(2) " crus Draph -}
(1) Right crus- Draph-} Right
(2) Dup Vena Cava}
rt Vena aaygos}
Thoracic Duct -}

263
line but frequently on it. Its direction is downward
and generally slightly to the left, presenting a slight 
curve with its convexity forward, in conformity the 
lumbar portion of the spine, upon which it lies -
It is markedly smaller where it terminates owing to 
the large number and size of the branches which it 
produces -
{It has in front, first, the 1 stomach, then the two 2/ Semi-}
{lunar ganglia of the sympathetic nerve, with their} 
{branches forming the solar plexus; 3/ next is the head of} 
{the pancreas, immediately below which are the 4/ left renal}
{vein, 5/ the transverse portion of the duodenum and}
mesentery; below this the artery is covered in front and} 
at the sides by the 6 peritoneum and the 7 aortic plexus of 
sympathetic nerves -
Behind its upper part is the commencement of the 
thoracic duct, the receptaculum chyli and it is separated
from the lumbar vertebrae by the left lumbar
veins - To the left are the lumbar portion of the left sympathetic
nerve and the left crus of the diaphragm
To the right are the right crus of the diaphragm, separating it from the 
interior vena cava, and at its upper part the right vena
azygos and the thoracic duct -
The termination of the abdominal aorta corresponds to 
a point on the interior abdominal wall a half inch below 
and to the left of the umbilicus and is about on 
a level with a line drawn between the highest parts 
of the crests of the ilia -
- Branches of the ascending Aorta -
The branches of the ascending aorta are two small arteries 
called coronary, left or anterior and right or
posterior, which are distributed to the heart - These 
1/2 MB.
M.B.

The rt. cor. arty arises from aorta just ablove the [illustration] trans. vertebral
semi lunar valves is similar of two and arises
between Pul. Arty & rt. Auric apendx passing
down to rt. & passes down to apex of heart in 
the post inter ventro groove -
The left, coronary Arty - is layer of 2 artys and arises
from aorta higher than other & between Pul. arts and 
left auric apendix and descends to apex of heart in 
ant inter Venter groove gives off as it comences to 
pass down (as does the right arty) a horizontal a transverse
branch to artuculo Ventre Septum -
[illustration]
Ven Inom-
In front
Sternum- Sternohyoid & thryoid and
Thymus gland - and Cordiac brch. of pneumo -
Left - Inominata 
Behind -
Nachea
To the Right is the Right pleura - rt - vena innominata
& " Pneumogastric.
in front { Sternohyoid,
{ " Tyroid - 

Left or ant.
Right " Post -
264
arise close to the origin of the aorta and run in the interior
and posterior interventricular furrows meeting
at the apex of the heart and in the auriculo-ventricular 
grooves, thus forming two vascular zones around the 
heart one horizontal and one vertical - this is not enough [illustration] look up in Gray-
Branches of the Arch of the Aorta -
The branches of the arch of the aorta, as before stated are 
three, the one to the right is the arteria innominata
destined to supply the right-side of the head and neck
and right upper extremity; the middle branch is the 
left common carotid supplying the left side of the 
head and neck; the branch to the left being the left sub-clavian
whose field of distribution is the left upper
extremity -
Thus it is seen that the arteria innominata is destined 
to supply corresponding parts to the other two 
branches it being in fact nothing more than the fusion
of the common carotid and subclavian of the right side 
since after a short course it divides into these two -
- Arteria Innominata -
The arteria innominata is the first and doubly the 
largest branch of the arch of the aorta; ascending obliquely
to the right for something else than 2 inches it 
terminates behind the right sterno clavicular articulation,
by dividing into the right common carotid and 
right subclavian arteries - Relations - In front of it is 
the sternum and in front of its origin is the left 
vena innominata. Behind it first has the trachea,
but owing to its obliquity to the right it gets to the
right side of the trachea - on its right is the right vena
innominata between & behind  is rt. Pneumogastric nerve - To the left and behind of its origin is the left 
[crossed out]

Common Carotid
In front
Integument & fascia 2 Platesina
3 Sterno mastoid
4 " Hyoid 
5 " Thyroid 
6 omo Hyoid
7 Desend. & cornon voni nerves.
8 Sterno mastoid artery
9- Sup and middle thyroid veins
10- Anterior Jugular veins
Externally
Internal jugular vein. Pneumogatric
Internally
Trachea, Thyroid Gland. Recurrent
laryngeal n. Inferior or thyroid a
Larynx & Pharynx.
Behind
longus colli Rectus cap. ant maj.
sympathetic nerve 2 Inferior thyroid
artery & Recurrent laryngeal
[cross out] nerve 
[illustration]
temporal 
post auricles
renpitd
[illegible] Pharngeal
int. max
Tacial 
emgual
Sup thyroid

For common carotid of left Side
See 510 Gray
265
common carotid- It produces none but its terminal
branches -
- Common Carotid - Left & Right.
The common carotid artery of the right side springs
from the bifurcation of the arteria innominata while
the left common carotid is a branch of the arch of the 
aorta consequently the left is as long as the right and 
the arteria innominata added together and the relations
of that portion which corresponds to the arteria innominata
will be similar to the relations of that vessel
though not identical; from behind the left sterno-clavicular
articulation onward to its termination a 
description of the left common carotid would be the 
same as that which will be given of the right -
The right common carotid beginning where the arteria
innominata terminates behind the right sterno-clavicular
articulation, being one, of the two terminal upper [illegible]
branches of that artery, ascends the neck in front of 
the transverse processes of the cervical vertebrae as 
high as the fourth or in other words about on a line
with the upper border of the thyroid cartilage, where it 
terminates by dividing into the external and internal 
carotid: in the female it usually terminates slightly
below this level - Relations - It lies on the anterior tubercles
of the transverse processes of the cervical vertebrae
to the fourth cervical vertebra having interposed between
it and the transverse processes the praeverterbal 
group of muscles- (and the sympathetic nerve -
It is contained in a strong fibrous sheath which also 
includes the internal jugular vein, separated from 
the artery by a partition, and the pneumogastric nerve;
the internal jugular vein is external to the artery 

External In front. Carotid -
1 Integument superficial fascia
2 Plastesma & deep fascia
3 Hypoglossal nerve -
4 Jungual & fascial veins
5 Digastric & stylohoid mus.
6 Parotid Gland, with fascial nerve &
tempro - max vein in its substance
Behind
1 Superior Laryngeal nerve
{Pass in between and the int Carotid.
{2 Stylo glossus, 3 Stylo Pharyngeus
{4 glosso Pharyngeus nerve
{5 Parotid gland
Internally
1 Hyoid bone 2 Pharynx
3 Superior Laryngeal nerve
4 Parotid Gland
5 Ramus lower jaw-

266
and the pneumogastric nerve is between and behind
the two descending on the front of the upper portion of 
the sheath is a branch of the Hypoglossal nerve, called
the descendens noni; this sometimes piercing the sheath
and descending within it- To the inner side of the artery
and separating it from its fellow is, in the first part
of its course the trachea and then the larynx, and 
since the latter is broader than the former the interval
between the two arteries is greater above than below -
In front the artery has the following parts and in the 
order given - 1st integument - 2d Platysma Myorides 3d
Sterno-cleido mastoid - 4th Sterno-hyoid 5th Sterno-thyroid -
6th the [cross out] Ant Belly of the omo-hyoid;
The platysma myoides muscle is a universal covering
for the artery; the sterno-cleido mastoid muscle covers
it from its commencement to within a short distance
of its termination; the point where it draws off to the 
outer side of the artery corresponds to the part of the 
artery crossed by the omo-hyoid and this occurs about 
the middle of the neck on a level with the cricoid
cartilage and here the artery enters the superior carotid
triangle (side muscles of neck Vol. IV. p.) - at
its apex, emerging at the same from beneath the [cross out]
[cross out] ant belly of omo-hyoid and the sterno-cleido mastoid;
it ascends to about the middle of the superior
carotid triangle before bifurcating and all that portion
which lies in this triangle is superficial being covered
only by the integument and platysma myoides muscle -
The sterno-hyoid and sterno thyroid muscles
cover only a small extent (some two inches) of the 
lower part of the artery passing to the inner side - At
its origin the artery has in front integument, platysma 

The omo hyoid covered carotid at line
of croicoid cartilage.
relations of Ext Carotid
Page 265

267
platysma myoides, the origin of the sterno-cleido mastoid,
the sterno-clavicular articulation of the right side,
and the origins of the sterno-hyoid and sterno-thyroid
muscles -
The course of the artery can be thus indicated; draw
a transverse line from the upper border of the thyroid
cartilage to the anterior edge of the sterno-cleido-mastoid
and a perpendicular line from the sterno-clavicular
articulation to the point where the transverse
line intersects the sterno-cleido-mastoid and the 
artery will lie behind the perpendicular one - The 
artery is preferably tied, where it is crossed by the 
[cross out] Ant belly of the omo-hyoid muscle and on the 
front of the sheath at this point will be found a nervous 
anastomis of the descendens noni and nervous
filaments from the cervical plexus, and this is called
the arch of Scarpa -
The common carotid is divided by surgeons into two 
portions, the first extends from its origin to the crossing
of the omo-hyoid muscle, the second from this point
to its termination; some divide it into three portions
saying the first extends to the omo-hyoid, the second
is that part covered by the [cross out] any belly of the omo-hyoid
and the third is that portion lying in the superior
carotid triangle -
- External Carotid -
The external carotid artery, one of the two terminal
branches of the common carotid, begins where that artery
forks about on a level with the upper border of the thyroid
cartilage 4 cervical and continuing the direction of the common
carotid triangle beneath the posterior belly of the 
digastric and stylo-hyoid muscle, enters the substance

a line drawn from condyle of 
lower jaw to to its origin

268
of the parotid gland and terminates in that gland
behind the neck of the condyle of the lower jaw by dividing
into two branches, the temporal artery which
continues the upward course of the external carotid
to mount over the zygoma and be distributed by two branches
to the the side of the head and the internal maxillary
which passes inward behind the neck of the lower jaw -
The first portion of the external carotid lies in the superior
carotid triangle, its length varying as the common
carotid divides on a level with or above or below the 
upper border of the thyroid cartilage, for it extends from 
the bifurcation of the common carotid to the posterior
belly of the digastric and stylo-hyoid muscle, it is covered
by the integument and platysma myoids muscle
and is crossed in front by the Hypoglossal or 12th
nerve; at its commencement the internal carotid artery
lies to its outer side by the time the external carotid
has reached the posterior belly of the digastric and stylo-hyoid
muscles the internal carotid has become 
posterior to it - The second portion of the external carotid
is that which is crossed by the posterior belly of the digastric
and the stylo-hyoid muscles; its coverings are 
integument, platysma myoides and posterior belly of 
the digastric and the stylo-hyoid muscles - The third
and last portion of the external carotid extends from 
the posterior belly of the digastric and the stylo-hyoid
muscles to the termination of the artery behind the 
neck of the condyle of the lower jaw - It lies embedded
in the parotid gland and is crossed superficially
near its termination by the facial nerve - The first 
portion of the external carotid is the most superficial,
the second portion is the shortest and the third portion



269
portion is the longest and deepest-
Branches of the External Carotid -
In studying the branches of the external carotid, it 
should be borne in mind that since the common carotid
produces no branch until it terminates and hence
the parts in its course have to be supplied by other vessels:
the external carotid performs some of this labor -
The external carotid besides its terminal branches gives 
origin to six single branches a set to the parotid gland -
The three first described arise from the anterior aspect
of the artery near its origin and in the order given from 
below up - The next two arise from the back of the artery
and higher up -
- (I) Superior Thyroid -
The superior thyroid forms a curve first passing upward
and inward and then downward and inward
and coursing beneath the depressor muscles of the hyoid
bone, viz, omo-hyoid sterno-thyroid and sterno-hyoid
successively reaches the upper part of the thyroid
gland to which it is distributed - It gives off 
four branches as follows -
(1) Hyoid - which passes forward just below the hyoid
bone to be distributed to muscles -
(2) Superior Laryngeal - which passing forward on to 
the thyro-hyoidean membrane pierces it to be distributed
to the mucous membrane of the larynx -
(3) Inferior Laryngeal - which passes forward across
the crico-thyroidean membrane and gives off branches
which pierce to reach the mucous membrane -
(4) Muscular Branches - which pass downward and 



270
outward and across the common carotid artery.
Sterno Mastoid.
II Lingual
The lingual artery is divided into four portions: - 1st
it ascends obliquely inward over the extremity of the 
hyoid bone covered only by platysma and skin,
2d it passes forward along and above the hyoid bone
covered by the hyo-glossus muscle - 3d it ascends to 
the under aspect of the tongue and 4th it runs forward
on the under aspect of the tongue to its apex
(under the name of ravine) - The first two portions lie 
on the middle constrictor of the pharynx -
Its branches are three -
(1) Hyoid which runs inward along the upper border 
of the hyoid to be distributed to muscles - 
(2) Dorsalis Lingual - which ascends to the dorsum
of the tongue (along the posterior border of the hyo-glossus
muscle -)
(3) Sub-lingual - which runs forward to sub-lingual
gland and muscles 
III. Facial 
The facial artery arises just above the hyoid bone and 
is divided into two portions, one while it is on the neck
the other after it reaches the face; the first portion ascends
forward through the submaxillary gland to 
mount over the body of the lower jaw just at the anterior
inferior angle of the masseter muscle and about 1 1/2
inches in front of the angle of the jaw - (At its origin
superficial being covered only by skin and platysma,
it [illegible] enters the Sub-Maxillary gland and is besides
beneath the posterior belly of the Digastric and 

Supply is all the Syto glossus
Stylo Pharynx 

J Platisma Myoidis Geotown
271
stylo-hyoid muscles; when it leaves the gland and 
mounts on the jaw it is again superficial being covered
only by the integument and platysma and its pulsations
can here be felt.) The second portion of the artery
has a tortuous course over the face upward and inward
towards the angle of the mouth along beside the 
nose to terminate at the inner angle of the eye (as the 
angular artery) Its branches are those below the jaw
or of the first portion, five and those on the face or of the 
second portion, five -
(1) [cross out]
(2) [cross out]
(3) Sub-maxillary - which are from 3-5 in number
and distributed to the sub-maxillary gland -
(4) Submental which runs forward beneath the lower 
jaw-
(5) Muscular - which are branches to neighboring muscles -
The five branches of the second portion are as 
follows-
1. Muscular or Buccal - which are branches to adjacent 
muscles-
(2.) Inferior Labial - which runs forward beneath the 
lower lip - varies innus with Sub-max.
(3) Inferior coronary- which skirts the edge of the lower 
lip -
(4) Superior coronary- which skirts the edge of the upper
lip giving off a branch to the septum of the nose,
arteria septi -
(5) Lateralis Nasi- which is distributed to the side of 
the nose -
IV- Occiptital - 4
The occipital branch of the external carotid passes 

Crosses Int jugular vein and int carotid Arty -
" Pneumogastric & Spinal occessny nerves -
Is crorsid by Sty-Hyoid
Digast - Post belly -

Relations of the Hypoglossal
272
upward and backward to the occipital groove of the 
temporal bone beneath the muscles attached to the 
mastoid process, thence mounting on the posterior aspect
of the occipital bone and piercing some of the 
deep muscles of the back becomes superficial and is 
distributed to the back of the head -
Its branches are two -
(1) Sterno-mastoid - which, sometimes arising directly
from the external carotid, descends to muscles
and glands -
(2) Princeps cervices - which passes down the neck 
lying deep (and is important as establishing collateral
circulation after ligation of the common carotid -)
- V Posterior Auricular - O
The posterior auricular passes upward and backward
behind the ear and is distributed by an 
anterior branch to the auricle and by a posterior
branch to the back of the head - It produces one
branch the Stylo-mastoid, which enters the stylo-mastoid
foramen to be distributed to the ear -
VI. Parotidean Branches - X
The parotidean branches from four to five in number
are distributed to the parotid gland as the external
carotid is cruising through it.
- VII. Ascending Pharyngeal -
The ascending pharyngeal branch springs from 
the external carotid just at its origin and passes
up beside the pharynx to the base of the skull
where it divides into a meningeal branch to enter 

1 1/2 inches above the 3 egoma
Branches
Transverse facial
orbital
middle temporal 

273
the cavity of the cranium (through the jugular
foramen) and a pharyngeal branch to adjacent
parts-
- The Temporal Artery -
The temporal artery, one of the two terminal
branches of the external carotid; begins where
the external carotid forks in the parotid gland
behind the neck of the condyle of the lower jaw,
and ascending emerges from the parotid gland,
mounts over the zygoma and divides about 1 1/2 in 
above the zygoma and lying on the temporal fascia
into an anterior temporal which passes upward
and forward and a posterior temporal 
which passes upward and backward; these two 
being called the superficial temporal branches
since as will appear hereafter there are other and 
deeper temporal branches -
The branches of the temporal artery besides its terminal
ones are four -
(1) Transverse Facial which arises below the zygoma
and passes transversely forward on the masseter 
muscle and parallel with Sterno's duct -
(2) Anterior Auricular - to the front of the auricle
(3) Orbital - which runs forward to the outer angle
of the eye -
(4) Middle Temporal - which plunges into the substance
of the temporal muscle where it is distributed
and its name is derived from its position
between the two superficial temporal branches and 
the deep temporal branches which are the offspring
of another artery - 

The Internal Max.
1st Portion
[illegible]- (1) Tympanic
(2) Meningea media.
can mention it- (3) " " " " Parva.
(4) Inferior Dental
2nd" Portion
(1) Superior Dental
(2) Infra Orbital
(3) Spheno Palatine
(4) Descending " " " 
(5) Ptergo " " " 
(6) Vedian " " "
(7) Post Dental -
The auricular nerve is above ant int
to 1st" portion - (92)
Crosses the inf dental nerve -

Int. Pt.goril mus is int. to 1st partid
274
- The Internal Maxillary -
The internal maxillary artery is the larger of the 
two terminal branches of the external carotid -
The course of the artery is divisible into three portions -
The first portion passes inward forward 
and [Sty???] upward behind the ramus of the inferior is horizontal 
maxilla; between it and the internal to lateral
ligament just above it auricular temporal- the second portion ascends forward between
the external pterygoid muscle within and 
the temporal and masseter muscles without & coronoid [illegible] the 
third portion disappears into the spheno-maxillary
[illegible] the [illegible] of [illegible] fossa - Its branches are sixteen in number, as 
follows - passing between the the. two heads of the Ext Phystoid
From the first portion arise four -
(1) Tympanic - [cross out]
[cross out] not [illegible]. [illegible] - 92
(2) Meningea Media - which ascends to enter the 
cavity of the cranium through the foramen spinoum 
= distributes to devia neoter by ant & post branch - 92
(3) Meningea Parva - which enters the cavity of the 
cranium through the foramen ovale - give - a branch of meningea media
(4) Inferior Dental which descends to enter the dental 
foramen of the inferior maxilla and run forward
on the bone giving a branch to every fang of 
the lower jaw; just before entering the dental foramen
it gives off a branch called mylo-hyordean
and when it reaches the mental foramen it divides,
sending a branch, called Mentalis, through
the mental foramen, and by another called incisive
continuing its course forward in the bone -
From the second portion of the artery arise six 
branches, which are collectively known as muscular 

naso Palatine branch


275
being distributed to the five muscles of mastication:
each muscle receives one branch except the temporal
which gets two and these lying beneath the 
muscle on the bone are called the deep temporal
arteries - From the third portion of the artery arise
six branches -
(1) Superior Dental - which descends upon the 
tuberosity of the superior maxilla and sends its 
branches through small foramina in the bone to 
supply the teeth of the upper jaw -
(2) Infra-orbital - which runs forward along the 
canal in the floor of the orbit, sending branches accorn by 5th nerve
downward to the front teeth of the upper jaw and 
emerges through the infra-orbital foramen to supply
adjacent parts on the face - branches run through the bones
(3) Spheno-palatine, which enters the nose
through the spherno-palatine foramen and divides
into two branches, one being distributed to the 
septum, the other to the mucous membrane of the 
outer wall and antrum maxillae -
(4) Descending Palatine - which descends along the 
posterior palatine canal to emerge in the palate 
through the posterior palatine foramen and send
a branch forward in the groove seen on the side of 
the hard palate (called the anterior palatine
branch which reaches the floor of the nose through
the anterior palatine foramen
(5) Pterygo-palatine = which runs backwards in 
the pterygo-palatine canal to the pharynx Eustachian 
tube and neighbouring parts -
(6) Vidian - which passes backward along the 
pterygoid canal and like the preceding is distributed
or Vidian canal 

The Right Sub Clavian Artery
[illustration]
on [cross out] border of first Rib -
termination of sub clavian [illustration]

Right, Subclav Artery-
276
distributed to the mucous membrane of the pharynx and 
to the Eustachian tube -
- The Right Subclavian Artery 
The subclavian artery of the right side is one of the 
two terminal branches of the inominate artery
and is the first subdivision of the artery of the 
upper extremity which although it does not divide 
until it reaches the front of the elbow joint
is known previous to its division under three
names, subclavian, axillary and brachial.
The right subclavian begins where the arteria
innominata forks behind upper border the right sterno-clavicular
articulation and arches outward forming a 
bow whose convexity is upward, first passing
upward and outward and then outward to the 
top of the bow, and then downward and outward
to pass obliquely behind the clavicle and to terminate
at [cross out] assuming
[cross out] the name of axillary -
The top of the arch lies just behind the scalenus 
anticus muscle and this relation warrants
the division of the artery into three portions; the 
first portion extends from the origin of the artery
upward and outward to the inner edge of 
the scalenus anticus muscle; the second portion
passes outward and its restricted to that part of 
the artery which lies behind the scalenus anticus
muscle; the third portion passes downward
and outward to terminate in the axillary at the 
lower border of the clavicle and in fact may be 
said itself to consist of two parts, viz, that part 
Active} or outer border of 1st- Rib".
outer border of 1st Rib



277
which lies above the clavicle in the subclavian
triangle and is superficial, and that part which 
lies behind the clavicle and is consequently deep -
The third portion disappears under the clavicle
about the middle of the bone but the outward obliquity
of the artery is such that it emerges below 
about the junction of the middle with the 
outer third of the bone -
- Relation -
Covering the artery universally are the intergument
and the platysma myoides muscle: in
front of the origin of the artery of course are the 
same structures that lie in front of the origin &
the right common carotid and of the termination
of the arteries innominata the parent of the two
viz, integument, platysma myoides, sterno-cleido-mastoid,
sterno-clavicular articulation,
sterno-hyoid, and sterno-thyroid but since the 
subclavian has a direction more or less outward
it emerges from beneath the muscles arising at 
the sterno-clavicular articulation much sooner
than the common carotid does since its direction
is upward more or less approximating to that of 
the muscles - Lying to the inner side of the commencement
of the subclavian is the right common 
carotid and since the internal jugular 
vein descends to the outer side of the latter it must 
cross the subclavian artery and it does cross in front
of its first portion uniting just there with the sub-clavian
vein, which has run inward behind the 
clavicle, to form the right vena innominata and as 

Relations of 1st Portion of Sub Clavian
In front
1 Clavicular a region of Sternomastoid & Platism
2 Sterno hyoid & Sterno thyroid 
3 Internal jugular vein & [cross out]
4 Pneumogastric, cartiod Phernic nerves.
Beneath
Pleura
Behind
1 Recurrent Laryngeal nerve
2 Sympathetic, 3 & fenguis colli
4 Transverse process 7th cervical vert

278
the pneumogastric nerve also lies to the outer side of 
the common carotid it likewise crosses the front of 
the first portion of the subclavian - Since the sub-clavian 
artery lies at the root of the neck and since 
the cavity of the thorax lined by its pleura extends
some 1 1/2 inches into the root of the neck, the pleura
will be found in relation with the under aspect
of the artery until the two are separated during the 
course of the third portion of the artery by the intervention
of the first rib upon which the last portion
of the subclavian rests -
A point of interest connected with the coverings of 
the subclavian artery is the extent of the artery which 
lies beneath the sterno-cleido-mastoid; this muscle
usually covers both the first and second portions
but as the extent of its clavicular origin is variable
so its relation to the artery beneath it; for sometimes
it scarcely covers the front two portions and then 
again it may cover a part of the third portion or 
even reaching to the anterior edge of the trapezius 
the whole of it.
Having studied the subclavian as a whole we will 
now take each of its parts and study it separately
in its relations -
- First Portion -
The first portion of the right subclavian is the upward
and outward portion, beginning where the asteria
innominata forks behind the right sterno-clavicular 
articulation it extends to the inner edge
of the sclavenus anticus muscle. It is covered
throughout by the integument by the platysma 

2nd Portion Sub Clavian Arty
In front.
1 Scalenus Anticus 
2 Phrenic nerve. (perhaps)
3 Sub
Above
Brachial Plexus
Below & Behind
Pleura
Behind
Pleura
middle scalenus 

279
myoides and sterno-cleido-mastoid muscles, at its 
commencement by the right sterno-clavicular articulation
by the sterno-hyoid and sterno-thyroid muscles -
crossing the front are the pneumogastric and 
generally the phrenic nerves (through the latter sometimes
crosses the second portion on the scalenus anticus
muscle) and the internal jugular vein which 
just as it has crossed the front of the artery unites
with the subclavian vein to form the right vena
innominata.
To the inner side of its commencement is the right 
common carotid artery.
Beneath, the artery rests on the pleura and is in 
relation as before stated with the subclavian vein,
which forms, so to speak the string to the sub-clavian
bow, for being in contact with the inner
aspect of the termination of the 3d portion it runs 
transversely inward behind the clavicle while the 
artery arches a full 1/2 in above the clavicle and 
the two are in relation again only at the origin of 
the artery -
- Second Portion -
The second portion of the subclavian is the outward
portion, the top of the bow, that portion which lies
behind the scalenus anticus muscle and coextensive 
with the breadth of that muscle -
In front are the integument, the platysma myoides
the sterno-cleido-mastoid and the scalenus
anticus -
Behind and above it and separating it from the 
scalenus posticus muscle is the brachial plexus 

The subclavian vein is in front of Scl. anticus mus.
Relations of 3rd portion Sub clav.
In front
Cervial fascia
External jugular, sub scapular
and transverse cervical veins
Descending branches of cervical 
plexus nerve to Sub clavius
Sub clavius mus Supra
scapular Arty & clavicle
Above
Brachial Plexus & clino Hoyoid
is above & then to outer side.
Below
1st Rib
behind
Scalenus - Medius 

280
of nerve -
Below, the artery rests on the pleura
The subclavian vein is some distance below this portion
behind the clavicle and in front of the scalenus
anticus muscle -
- Third Portion -
The third portion of the subclavian is the downward
and outward portion extending from the outer
edge of the scalenus anticus muscle to the [cross out] outer
border of the [cross out] 1st rib and lying first between the 
two scaleni muscles and then between the clavicle
and first rib -
It is covered by the integument and platysma
myoides and possibly partially or even totally
by a redundant origin of the sterno-cleido mastoid;
besides these muscles is of course the clavicle -
crossing the front of this portion are two vessels;
one an artery, the supra-scapular, a branch of the 
subclavian itself, which passes outward just beneath
the upper border of the clavicle; the other is 
a vein the external jugular, which descends the 
neck - To the outer side is the brachial plexus -
To the inner side is the subclavian vein which 
however is in contact only for a short distance
from the termination of the artery.
This portion rests on the pleura at its very commencement
and then on the first rib which separates
it from the pleura -
For subclavian artery is preferably ligated in its
3d portion where it lies on the 1st rib the clavicle
being moved off it by forcibly depressing the shoulder. 

Branches of the subclavian
I Vertebral
II Inferior Thyroid
Sprigg Wilson 
[illustation]
Mr
Wilson
J Sprigg
Asst Sugeon
u.s.a Oct 1st 1895
[illustation]
yellow.
Red
Pale.
[in the middle of the page]
James Sprigg Wilson m.d.
James Sprigg Wilson
u.s.a James
Kenic
Kenoric
Cluchonidial
Chenchoreial
Qunneial
Qunnindal
Ac: Tannis 

281
This point is selected for the three following reasons -
1st It is most accessible - 2d It is most remote from 
the branches of the artery for these as will be seen
arise from the 1st & 2st portions -
3d- It is separated from contact with the pleura
by the 1st rib -
- Branches -
The branches of the subclavian artery are seven in 
number I. Vertebral - II. Inferior Thyroid III. Supra-scapular -
IV. Transversa colli - V - Internal Mammary -
VI. Superior Intercostal - VII - Cervicalis
Profunda -
These seven branches usually arise by four trunks
these being the (1) vertebral (2) the thyroid axis, (3) the internal
mammary and (4) the common trunk of the 
superior intercostal and the cervicalis profunda -
It should be stated the word axis in arterial
anatomy means a short trunk which quickly divides
into at least three branches -
The branches which the thyroid axis produces are 
usually those above stated, viz - Inferior thyroid,
supra-scapular and transversa colli though 
these vary the inferior thyroid being the most 
constant of its progeny gives name to the axis -
- I. Vertebral - [cross out] OK. Jan 20 91
The vertebral artery, the first and largest branch
of the subclavian arises from the upper posterior aspect
of the artery and ascends through the 
foramina in the transverse processes of the cervical
vertebrae (except the seventh) and winding 

Branches of Vertebral Arty
Lateral Spinal
Muscular
Post. Meningeal 
Ant. Spinal
Post Spinal
Inf. Cerebella
Branches of Basilar
Transverse
Ant. Cerebellum
Post " " " " " " " 
Sup. Cerebella

282
backward around the superior articular process of 
the atlas it enters the cavity of the cranium
through the foramen magnum and unites at the 
lower border of the Pons Varolii with its fellow of the 
opposite side to form a single trunk called the 
Basilar artery which passes forward to the anterior
border of the Pons and divides these into four terminal
branches two to each side -
The branches of the vertebral artery are as follows -
(1) Lateral Spinal - which are given off as the artery
ascends the neck and enter the intervertebral
foramina -
(2) Muscular - which are umimportant branches
to cervical muscles -
(3) - Posterior Meningeal - which is also an umimportant
branch to the Dura Mater of the cranium -
(4) Anterior Spinal- which unites with its fellow
of opposite side to form a common trunk which 
descends from the cranium along the front of the 
spinal cord -
(5 Posterior Spinal which winds around the medulla
oblongata to descend on the posterior aspect of 
the spinal cord -
(6) Inferior Cerebellar - which winds around the medulla -
oblongata to reach the under surface of the 
cerebellum -
The branches of the Basilar Artery are as follows -
(1) Transverse - which are numerous branches given off 
to each side to the Pons Varolii -
(2) Anterior Cerebellum - which runs along the anterior
border of the cerebellum and may be given as 
one of the Transverse -

Don't forget the 
Cervicalis Ascenden's

283
The two terminal branches to each side are:
(3) Superior Cerebellar - which is distributed to the 
upper surface of the cerebellum;
(4) Posterior Cerebral - which is distributed to the 
posterior lobes of the cerebrum - (Just as the basilar
divides it gives off numerous small branches 
which enter the minute foramina constituting
the locus perforatus of the base of the brain) -
- II - Inferior Thyroid -
The inferior thyroid is the most constant branch of 
the thyroid axis which arises from the upper aspect
of the subclavian near the termination of its 
first portion -
The inferior thyroid artery first ascends and then 
turns inward behind the sheath of the common
carotid artery to reach the thyroid gland -
Its branches are some unimportant turys to the 
larynx trachea and osophagus and a large branch
called the Cervicalis Ascendens - which arising
from the inferior thyroid just as it makes its inward
turn ascends the neck on the anterior tubercles
of the transverse processes to be distributed to 
muscles and glands -
III. Supra-Scapular -
The supra-scapular artery, arising usually from 
the thyroid axis, first descends and then turns outwards
behind the clavicle and across the 3d portion
of the subclavian to the dorsum of the scapula 
("over the transverse ligament of the scapula") to be 
distributed to muscles there - and passing around beneath
the spine of the reaponeve to inferi spuous fossa
to anos weate with dervolis scupulve 

49
83
______
245
492
________
5165
96)
47.
.75
________
235
329
_________
3525
5165
_______
8730
768
____
1050
790
47
49
____
96
(81
two branches
near the inner border of the 
scalenus antreus 

284
James S Wilson
IV. Transversa Colli -
The transversa colli artery, arising usually as a 
branch of the thyroid axis, passes outward across
the side of the neck to the anterior edge of the trapezius
muscle, where it divides into two branches:
(1) Cervicalis Superficialis - which ascends beneath
the trapezius and (2) Posterior Scapular - which 
passes to the scapula and descends along its base -
- V Internal Mammary -
The internal mammary artery arises from the under
aspect of the subclavian and descending behind
the costal cartilages about 1/2 of an inch from 
the edge of the sternum, to the diaphragm where it 
divides into its two terminal branches superior Epigastric and 
musculo-phrenic -
Its branches are as follows:
(1) Anterior Intercostal - which are given off to the 
intercostal spaces over which the internal mammary
passes each passing outward soon divides
into two branches to course along the adjacent borders
of the ribs sometimes these branches spring separately
from the artery -
(2) Perforating - which generally six in number,
pass forward to the front of the thorax and run
outward, being chiefly distributed to the mammary
gland in the female -
(3) Mediastinal - which are unimportant branches
to the anterior mediastinum -
(4) Pericardiac - which are also unimportant branches 
to the pericardium -
(5) Comes Nervi Phrenici - which is a small branch 

terminal branches [illustration] {

285
to accompany the phrenic nerve -
(6) Musculo-phrenic - which is one of the terminal
branches of the artery and passes outward and 
downward to the last intercostal space, behind
the cartilages of the false ribs -
(7) Superior Epigastic - which is the other terminal
branch; entering the sheath of the rectus 
abdominis muscle, it there anastomoses with 
the inferior epigastric, a branch which ascends
from the external ilias artery - This is the largest (?)
arterial anastomis in the body and taken
in connection with the number of branches
produced by the internal mammary
renders that artery one of the most remarkable
in the body -
- VI. Superior Intercostal -
The superior intercostal usually springs by a common 
trunk with the cervicalis profunda from 
the second portion of the sub-clavian artery -
It descends in front of the neck of the first rib 
and gives off branches to the first two intercostal
spaces -
VII. Cervicalis Profunda -
The cervicalis profunda artery passes backward between 
the transverse process of the 7th cervical vertebra
and 1st rib or transverse process of the 1st
Dorsal vertebra and ascends the neck to inosculate
with the princeps cervicis branch of the occiptal 
artery, thus establishing an important
collateral circulation in ligation of the common 
carotid artery - 

BD.
opposite to post. fold of axila
tendon of Sub Scapulous
(1) Serat - mag - (2) sub seap.} mus behind arty - nes
(4) Teres mag - & (3) Lotes dersi} there which it cursty 

286
- Axillary Artery -
The axillary artery is the second subdivision of 
the artery of the upper extremity begining where
the subclavian cease it passes downward and 
outward over upper lateral aspect of the chest, the 
first four ribs and down the inner aspect of the 
arm to terminate at the lower edge of the tendons
of the latissimus dorsi and teres major muscles
by becoming the brachial; the direction of 
that portion of the artery on the arm varies of 
course with the movements of the limb -
- Relations -
It is covered throughout by the pectoralis major
muscle and beneath this is the pectoralis minor
muscle, which covers a portion of the artery; this 
relation of the pectoralis minor warrants the subdivision
of the artery into three portions, the first 
extends from its commencement to the upper 
edge of the pectoralis minor, being continued in 
the triangular space between the clavicle and 
pectoralis minor (See Vol: IV. p. 43) and covered
by the pectoralis major; the second portion lies beneath
the pectoralis minor and is covered by it 
and the pectoralis major; the third portion extends
from the lower edge of the pectoralis minor to the termination
of the artery and is covered by the pectoralis
major - As the artery is crossing from the 
chest to the arm it lies on the tendon of the sub-scapularis 
muscle and as soon as it strikes the 
inner side of the arm it lies along the inner side 
of the coraco-brachialis muscle, which relation it 

outer side - medine
Pect. Suog.
deep fascia acriy the ax - arty -{ Castco Cricoid hunt
& forming a grene{ 
Sub Clavicus
Ex - Ant. thoracic nerve
Acnm thoracic Veins 
Broch Plex [illustration] Axillary Vein
1st inter-cost space & mus 
" Senatn of See. Mog -
Post thoracic nerve -
2d Portin -
O.K.
3d Portion -
see note -
also has lotes - dorsi & Teres moj beliv -

287
maintains to its termination.
Besides these relations to muscles the artery has 
important ones to cords as follows - 555 gran
The axillary vein is continuously to its inner
front aspect -
The brachial plexus of nerves is first to its outer
side and then to its outer and posterior and inner 2nd pt.
aspect and finally the cords which lie to its sides
each produce a branch which unites with its fellow 
in front of the artery to form the median nerve,
thus surrounding the artery - (1) The median nerve
descends along the outer side of the artery to the 
termination of the latter. { (1) ulva - &c - Surguay - 
{ Cut out.
mus cut. n - also ext.
- Branches of the Axillary -
The branches of the axillary artery are seven - I.
Short Thoracic: II. Acromial Thoracic: III. Thoracic
Alaris - IV. Long Thoracic: V Anterior circumflex:
VI Posterior Circumflex: VII. Subscapular - The two 
first arise from the 1st portion of the axillary, the 
next two from the 2d portion and the other three
from the 3d portion -
I. Short Thoracic -
The short (superior) thoracic artery arises from the 
first portion of the axillary and passes inward
on the pectoralis minor muscle to be distributed to 
the pectoral muscles and the mammary gland -
- II Acromial Thoracic
The acromial thoracic artery arises from the first 
portion of the axillary by a short trunk which 

passing through □ space of tunpoc.

288
divides into three branches as follows:
(1) Pectoral, which supplies the pectoral muscles:
(2) Acromial, which gives name to its parent though
the smallest of its progeny passing outward it is 
distributed to the parts around the acromion
process -
(3) Descending - which descends in the inter-space
between the deltoid and pectoralis major -
III. Thoracica Alaris -
The thoracica alaris artery is a small branch given 
off from the second portion of the axillary to 
structures in the axilla -
IV. Long Thoracic -
The long thoracic artery arises from the second portion 
of the axillary and descends supplying the 
chest-wall.
- V Anterior Circumflex -
The anterior circumflex artery arising from the third
portion of the axillary passes outward on the 
front of the humerus just below the shoulder -
joint to which it is distributed, anastomising
externally with the following-
- VI - Posterior Circumflex -
The posterior circumflex artery springs from the 
third portion of the axillary running outward
on the back of the humerus is distributed to the 
shoulder joint and inosculates on the outer side of 
the humerus with the anterior circumflex, the two 

Relations behind Triceps
Mus. Spinal nerve
Sup profunda Arty -
Correo Broch - its insertion
Broch - Anticus - 

289
arteries thus forming a vascular zone around the upper
extremity of the humerus, the posterior being
larger than the anterior -
- VII - Subscapular -
The subscapular artery arises from the third portion
of the axillary and descends along the lower border
of the subscapularis muscle to inf. L of Scap. to be distributed its adjacent
parts - About an inch and a half from its 
origin it gives off a branch the Dorsalis Scapulae
which mounts upon the dorsum of the scapula
to be there distributed -
- Brachial Artery - high division - Exam
The brachial is the third subdivision of the artery
of the upper extremity, being a continuation of the 
axillary it commences where that artery ceases
at the lower border of the tendons of the latissimus 
dorsi and teres major muscles and passing downward
and outward terminates about 1/2 an inch 
("a finger's breadth") below the middle of the front 
of the elbow joint by dividing into the radial and 
ulnus arteries; being first to the inner side of the 
arm and then on its front as thust in order to 
check the circulation in it by pressure the artery
in the first part of its course must be pressed outward
against the humerus and in all the lower 
part directly backward -
- Relations -
The muscular relations of the artery are as follows.
To its outer side at first, is the lower half of the 

Behind OK - { & Brochalis anticus lies behind
Int int mus. Sptum:. triceps -
The ulna nerve lies to inner side of arty
until it reaches the int condyle of the
humerus? nes upper 1/2 of its extint.
lower 1/2 not in relation -
mus. spiral -
int cutaneous -
In the upper 1/2 of its course the internal
cutaneous nerve lies int. to arty 
The median vein (a) Basilic lies int & Sup.
The Basilic Vein

290
coraco-brachialis muscle and when this relation
is lost by the insertion of the muscle, is true to its 
outer side for the rest of its course the bicepa flexor
whose belly when the muscle is bulky may overlap 
it to some extent. At the bend of the elbow the 
artery passes beneath the slip given off from the 
inner side of the tendon of the biceps -
Its relation to cords are as follows -
The artery is accompanied by satellite veins one to 
either side, the inner of the two being the larger - 95
(side p. 40).
To its inner side are the basilar vein and the internal
cutaneous nerve - nerves nerve - 95
The median nerve lies first to the outer side of the 
artery then about the middle of the arm crosses it;
usually in front, and descends along its inner
side - It should be observed that the basilic vein
and the in lower 1/2 internal cutaneous nerve are superficial & internal
to the artery in the lower part of its course, they here
lying upon the investing fascia of the arm and in 
the layers of the superficial fascia while the artery
is beneath the investing fascia. - [cross out]
[cross out] give it. (92) 95. give
- Relations of the Brachial Artery at the Elbow -
Exam 91-
The relations of the brachial artery at the elbow are 
of such importance that they must be given separately -
It lies on the middle of the front of the 
joint with its satellite veins, one on each side -
On it outer side is the tendon of the biceps muscle -
on its inner side is the median nerve -
In front of it is the bicipital fascia and lying on 
this are the median basilic vein and internal cutaneous
lies in tendon of 13 - [ant??]

It lies on tendon of Broh. anticus mus
above " " " " " coroeo Brach. & above
this it lies on the biceps.
N.B.
between the [illegible] of triceps/95 -

291
cutaneous nerve - The Brachial artery frequently
(once in five times) divides before it reaches the point 
stated in its description and this is called high 
or premature division; when this occurs it will be 
found that the ulnar artery continues the course
of the brachial and that the radial descends superficial
to the ulnar -
- Branches -
The branches of the brachial are three besides numerous
twigs to the muscles in its course and collectively 
called muscular branches -
I Superior Profunda -
The superior profunda artery arises from the upper 
part of the brachial and passes downward, backward
and outward winding around the humerous in 
the groove on its posterior face to reach the outer aspect
of the elbow joint where it lies in the interval
between the supinator longus and brachialis anticus
muscles - accom. the mus. Spiral nerve 95
II. Inferior Profunda -
The inferior profunda artery arises from the brachial
just below the superior profunda and descends
to the inner side of the elbow joint - passing down 
& in accom the ulna nerve. 95
- III. Anastomotica Magna -
The anastomotica magna runs inward from 
the brachial about two inches above the elbow and 
then runs outward on the back of the arm to the 
external condyle - anastamosing with every arty surrounds
the joint.

Get up Section at 
middle of Arm
fore "
& leg. & thigh.
Is upper 1/3 - is deep - 92
Relations - Behind 95- { 565 right & in grey
Tendon of Bicep's
Serpurator Brevis 
Flex-Sub - Dig -
Pro Rod - Teres
Flex-Lig Pol.
Pro. Quar.
Rohus -

292
- The Arteries of the Fore-arm -
The arteries of the fore-arm are the radial, ulnar
and their branches -
- The Radial Artery of the fore-arm -
The radial artery one of the two terminal branches
of the brachial commences where that artery divides,
about half an inch below the middle of the front of 
the elbow, and passes downward with such an inclination
outward as to bring it to the outer side of 
the front of the wrist joint, where it lies on the front 
of the styloid process of the radius -
- Relations -
The muscular relations of the radial artery are as 
follows; - To its outer side it has throughout its 
course the (1) supinator longus, the belly of the muscle
overlapping it and with this exception the artery is 
superficial being the one usually chosen to furnish
the pulse -
To its inner side is (1) first the pronator radii teres
and when this muscle meets its insertion its place
is taken by the (2) flexor carpi radialis which continues
to the inner side of the artery to the wrist -
Its relations to cords are as follows - It is accompanied
by satellite veins and in its middle third
the radial nerve is to its outer side the nerve then
passing beneath the supinator longus to the back of 
the fore-arm - This nerve is to the outer side in the 
upper 1/3 of the artery but is too remote to be called a 
relation until it reaches the middle 1/3 -
- Ulnar Artery on the Fore-arm -

Divider into deep & superficial portion
95 Sees on the brochialis Anticus for its upper
portion for its lower portion on the Flex -
Prof - digitorum -
The flex Sub - Dig - lies to its outer Sides - 

293
Ulna Arty.
The ulna artery the second and larger of the two 
terminal branches of the brachial begins where that 
artery forks half an inch below the middle of the 
front of the elbow and first passing downward and 
inward to the inner side of the front of the fore-arm
(to the commencement of the middle 1/3) then descends
to the inner side of the front of the wrist - to the pesefum
bone 
- Relations -
The muscular relations of the ulnar artery are as 
follows - In the first part of its course, while it is 
passing downward and inward, it lies beneath
four muscles, pronator radii teres, flexor carpi radialis,
palmaris longus and flexor sublimis digitorum,
that is, all the muscules in the 1st & 2d layers
on the front of the fore-arm except the flexor carpi
ulnaris; when it emerges to the inner side of these 
muscles it descends with the tendon of the flexor
carpi ulnaris to its inner side and the flexor sublimis
digitorum to its outer- lying in Profundus dig.
Its relations to cords are as follows -
It is accompanied by satellite veins one to either 
side and for its lower two thirds it has to its inner
side the ulnar nerve - Soon after it begins it is crossed by 
the median nerve.
- Continuation of the Ulnar into the Hand -
When the ulnar artery reaches the wrist it continues
its course into the palm of the hand lying 
close to and on the outer side of the pisiform bone (a) radial Side
and on the anterior annular ligament; after passing
down a short distance into the palm it turns
outward and runs across the palm of the hand 
} deep 
} Superficial 

[illustration]

294
to its outer side, being covered only by skin and fascia
and lying on the flexor tendons - Its course across
the palm is known as the superficial arch (arcus
sublimis) and though its direction is not transverse
still its position is more or less clearly defined by a 
transverse line across the palm from the bottom of 
the interval between the thumb and fore-finger -
The ulnar nerve continues its relations to the artery
into the hand lying to its inner side -
- Branches -
The branches on the fore-arm are four as follows -
I. Anterior ulnar Recurrent -
The anterior ulnar recurrent arises from the ulnar 
artery just below its origin and passes upward
to the front of the inner side of the elbow - (a) inner Condyle.
II - Posterior Ulnar Recurrent -
The posterior ulnar recurrent arises just below the 
preceding and passes upward and backward to 
the internal condyle - (a) behind it
III. Interosseous -
The interosseous is a large branch which arising
from the ulnar just below the elbow quickly forks
into the anterior and posterior interosseous - while it is lying under the [illegible] radii teres.
(1) The anterior interosseous descends on the front of 
the interosseous membrane between the flexor profundus
digitorum and flexor longus pollicis
muscles to the pronator quadratus passing beneath
which it perforates the interosseous membrane
and appears on the back of the fore-arm

Sometimes passes between the Superficial 
and deep mus. of the back of arm 
Please notice that there are few 
questions asked abt. muscles. 

295
to innculate with the posterior interosseous artery -
It supplies the muscles on its route and gives off
a companion branch to the median nerve -
(2) Posterior Interosseous as soon as it is produced
passes above the interosseous membrane between
the bones to reach the back of the fore-arm and 
descend on the posterior aspect of the interosseous
membrane to the wrist - Just as it gains the 
back of the fore-arm it gives of a large branch
called posterior interosseous recurrent which 
ascends to the back of the elbow - nothing but a [illegible] 92
The posterior interosseous artery is distributed
to the muscles adjacent -
IV. Muscular -
The muscular branches of the ulnar artery are numerous 
twigs to the muscles on its course -
The branches at the wrist are two -
I Anterior Carpal -
The anterior carpal is a branch which passes outward
on the front of the wrist to inosculate with 
the anterior carpal of the radial - unimportant things
II. Posterior Carpal -
The posterior carpal passes backward and runs
outward on the back of the wrist to anastomose 
with the posterior carpal of the radial -
The branches in the hand are as follows -
beneath the Extensor tendons of the 
thumb.
I. Communicating. deep branch 
The communicating branch dips between the abductor 

no such thing as dorsal digital branches -
The radial arty. in passing to the 
back of the hand goes between the 
Ext. oss met- pol-
" pumi inter-nodi pd-
" Second- " " " 
in passing back into the hand
it passes through the 1st. dorsal
interossus muscle,

296
abductor minimi digiti flexor brevis minimi digiti
muscles to join the termination of the radial -
II. Digital -
It should be observed that the thumb and the
four fingers each have four arteries running from 
base to tip; two on the sides of its palmar aspect
called palmar collateral digital arteries and two 
smaller ones on the sides of the back called dorsal
collateral digital; and this statement will also
be found true of the nerves - The digital arteries
under consideration are four in number, from 
the superficial palmar arch the first is a small
one which supplies the inner side of the palmar
aspect of the little finger - The second passes forward
to the cleft between the little and ring fingers where 
it divides and forms the collateral digital arteries
for the adjacent sides of those fingers on their palmar
aspect; the third does the same for the adjacent
sides of the ring and middle fingers and the 
fourth does the same for the adjacent sides of the 
middle and fore fingers -
- Continuation of the Radial Artery -
When the radial artery reaches the wrist it turns
outward, backward and downward beneath the 
extensor tendons of the thumb, viz, the extensor ossis
metacarpi extensor primi internodii and extensor
secundi internodii, in the order or relative sequence
and passing through what is known as the snuff -
box, that is the sunken interval between the extensor
ossis metacarpi pollicis and extensor primi
[illegible] [illegible] back of hand
Met. 
{Cart. 
{lobe of 
{thumb 
{& index 
{finger 

Branches of the Radial
Recurrent Radial
Muscular 
Superficalis Valae
Anterior Carpial
Posterior "
Dorsallis Policis

297
intermodii pollicis on one side and extensor secundi
internodii pollicis on the other; the artery thus
reaches the back of the hand where however its appearance
is only momentary for it at once dips
into the palm of the hand by passing between the 
two heads of the 1st dorsal interosseous muscle
and passes across the palm from its outer to its
inner side there terminating by anastoming with 
the communicating branch of the superficial
palmar arch - The position of the radial in the 
palm is deep lying on the bases of the metacarpal
bones and beneath the flexor tendons which separate
it from the superficial arch; this portion of
the artery in the palm of the hand is called the 
deep palmar arch and it is situated about 1/2 an 
inch nearer the wrist than the superficial arch -
- Branches of the Radial Artery -
The branches on the fore-arm are as follows -
I- Recurrent Radial -
The recurrent radial arises from the radial artery
just below the elbow and passes upward and 
outward to the outerside of the front of that joint. mus. with Suf [illegible].
II Muscular -
The muscular branches are numerous twigs to 
the muscles in the course of the artery -
At the wrist the branches are as follows -
I Superficialis volae -
The superficial volae leaves the radial artery just 
as it turns outward and passes on to the muscles
of the thenar group usually perforating the Abductor
pollicis - and anis. with ulna - 92 

lies on back of wrist joint


298
II. Anterior Carpal -
The anterior carpal branch passes inward on the 
front of the wrist - joint to form the anterior carpal 
arch by uniting with the anterior carpal of the 
ulnar artery -
III. Posterior Carpal -
The posterior carpal passes inward across the back 
of the wrist to inosculate with the posterior carpal
of the ulnar and form the posterior carpal
arch - From this posterior carpal arch there pass 
down on the dorsal interosseous muscles two 
branches called posterior interosseous besides
another which runs along the dorsal aspect of 
the ulnar border of the hand to supply the ulnar
side of the dorsal aspect of the little finger: the 
two posterior dorsal interosseous pass downward 
and divide the one at the cleft between the little 
and ring to form dorsal collateral digital branches
for adjacent sides of those fingers; while the other 
furnishes dorsal collateral digital branches for 
adjacent sides of the ring and middle fingers -
IV. Dorsalis Pollicis -
Just as the radial is passing the root of the thumb
it gives two small branches, each to course along 
the side of the dorsal aspect of the thumb; these 
being called dorsalis pollicis -
- V Metacarpal -
The metacarpea is a branch which descends on 
the second dorsal interosseous muscle to the cleft
between the middle and index fingers and there 

The digital artys in dorsum of hand dorsal
run but to 1st" Pholous
Perforating artys -

299
divides to form dorsal collateral digital branches
for those fingers -
VI Dorsalis Indicis -
The dorsalis indicis is a small branch which 
passes forward to form the dorsal collateral digital
branch for the outer side of the index finger -
- VII. Princeps Pollicis - Wilson
The princeps pollicis arises just as the radial 
dips into the palm and passes forward and outward
to divide and form the collateral digital arteries
for the palmar aspect of thumb -
The branches in the palm of the hand or from the 
deep palmar arises are as follows -
I. Radialis Indicis -
The radialis indicis passes forward to form the 
collateral digital branch for the outer side of the 
palmar aspect of the index finger -
II. Interosseous (anterior)
The anterior interosseous branches are three or four 
small branches which pass forward on the front 
of the interosseous muscles to unite with the digital
branches of the superficial Arch -
Besides the deep arch gives off two sets of unimportant
branches called perforantes and recurrentes -
- The Left Subclavian Artery -
The left subclavian artery differs from the right 
in its first portion only which extends from its 
origin to the inner edge of the scalenus anticus 

I Cardiac death to connect tissue around
heart 

300
muscle- Arising as the last of the three branches
from the arch of the aorta it ascends almost perpendicularly
to the inner edge of the scalenus anticus
muscle and then turns suddenly outward
behind that muscle to pursue a corresponding course
to the artery of the opposite side -
Relations - In front of it is the confluence of the left 
internal jugular and left subclavian veins to 
form the left vena innominata and the left pneumogastric 
and phrenic nerves descend on its
front into the thorax - To its inner side are the 
left common carotid artery and the trachea -
Behind it the thoracic duct - On its outer side 
the left pleura and lung - (The muscular relations
of the first portion of the left subclavian are 
about the same as those of the right.)
- Thoracic Aorta -
The course and relations of the thoracic aorta have 
been already given - (vide pp - 41-43.)
- Branches -
The branches of the thoracic aorta are as follows,
except some small ones to the pericardium called
pericardiac and others to the posterior mediastinum
called posterior mediastinal -
I. Bronchial -
The bronchial arteries usually three in number 
two to the left lung and one to the right, course
along the branches to the lung and ramify with 
the bronchial tubes - descending pt of arch (gen)

1st. one comes from the transverse pt of arch or aorta -
comes off from back aorta -
Behind vena azygos.} 
& Thoracic duct}
Come off from front - 4-5 in no

301
II. Intercostal -
The intercostal are ten pairs of arteries which arise
from both sides of the thoracic aorta and run out 
in the intercostal spaces, the uppermost intercostal
space being supplied by the superior intercostal
of the subclavian artery -
Each intercostal artery passes outward in the intercostal 
space to run [cross out] 92
[cross out] in the inter cost- mus- and going some distance gives off a branch
which sinks to course along the upper border of the 
rib below - The intercostal arteries for the right side 
are longer than those for the left owing to the position
of the aorta forcing them to cross the vertebral 
column - These intercostal branches of the thoracic
aorta are sometimes known as the posterior intercostal
arteries in contradistinction to the anterior 
of the internal mammary and the superior of the 
subclavian -
IIII. Oesophageal -
The oesophageal are four or five small twigs which 
are furnished to the oesophagus successively -
- Abdominal Aorta -  
The course and relations of the abdominal aorta are 
given on pp - 41-44. 
- Branches -
The branches of the abdominal aorta are nine in
number and are arranged into three sets, those distributed
to the abdominal walls and called parietal
branches; those distributed to the abdominal 
bifurates 
at head 
of int going 
off a small 
post. branch
262 page

- gives off twigs to Supra renal artys - 
The run arround under tendion arches of Psous Plagnum
& divide into 2 sets - 

302
viscera, which are the organs of the digestion and accessory
there to and those distributed to the genito-urinary
organs; there being three arteries in each of 
these sets (some of the arteries however being double,
that is one to each side-)
- 1st Parietal Branches -
I. Phrenic Arteries -
The phrenic are a pair of small arteries arising
from the front of the aorta soon after it enters the 
abdomen sometimes singly, sometimes by a common
trunk and sometimes from neighboring arteries -
Each artery runs upward and outward on the under 
surface of the diaphragm and is there distributed
by two branches one passing inward to inosculate
over the oesophageal opening with the opposite 
artery, while the other runs outward to supply the 
circumference of the diaphragm -
- II. Lumbar Arteries -
The lumbar arteries are four or five pairs of small 
branches which spring sucessively from the side of the back 
of the abdominal aorta and run outward to ramify 
in the broad muscles of the abdomen, resembling 
the intercostal branches of the thoracic aorta. beneath
the ten- arches of Psoas [illegible] -
III- Sacra Media -
The arteria sacra media is a small slender artery 
which arises just at the fork of the aorta or 
sometimes from one of its forks and runs down on 
the centre of the front of the sacrum to the coccyx - behind left 
iliac vein
2d Visceral Branches - 

Close to the Edge of the aortic opening of 
the Diph.
on each side and surrounding it 
is the sern luna ganglia 
Is behind the stern. slightly .
Splenic Vein is below and behind the arty
" " " " " " a "canal."

303
I Coeliac Axis -
The coeliac axis is a short trunk, some 1/2 inch in 
length, which arises from the front of the abdominal
aorta, near its commencement, just above the 
head of the pancreas (a) resting on it and about on a level with the 
lesser curvature of the stomach - Its branches are 
three, gastric, splenic and hepatic -
(1). The Gastric Artery -
The gastric artery passes to the left to reach the cardiac
extremity of the stomach and then turns to 
the right to run along the lesser curvature to near 
the pylorus where it inosculates with the pyloric 
branch of the hepatic artery - It distributes branches
to both sides of the stomach -
(2) The Splenic Artery -
The splenic artery passes tortuously to the left along
the upper border of the pancreas to the hilus
of the spleen where it splits into numerous branches
to be distributed to that organ - The branches of the 
splenic artery are as follows -
(a) Pancreatic - Magna & Parva.
The pancreatic are numerous small 
branches which descend into the pancreas from 
the splenic artery as it is coursing along the 
upper border -
(6) Vasa Brevia -
The vasa brevia are five or six branches
which leave the splenic artery near its terminal
branches and are distributed to the splenic end 
of the stomach (c) - Gastro-epiploica Sinistra -

In the folds of the qt. omentum.
Relations to duct. & to vein.?
also lies behind oblique duodenum
Pancreatic Duodeuolis  

304
The Left Gastro-epiploic is a large
branch which leaves the splenic artery near the 
spleen and runs to the right along the greater curvature 
of the stomach until it meets the right 
gastro-epiploic about midway of the curvature - It is
distributed from the greater curvature of the stomach
by branches to both its faces and to the great 
omentum, hence its name, epiplorn = omentum.
(3). The Hepatic Artery -
The Hepatic is a large branch which ascends to 
the right to the under surface of the liver where it 
divides into three branches, one to each lobe of the 
liver and a third called the cystic artery which is 
distributed to the coats of the gall-bladder - Besides
its three terminal branches the hepatic produces
two others - lying in the [crossed out] border of the omentum. 
((a) The Pyloric artery -
The pyloric branch passes to the 
left along the lesser curvature of the stomach until
it meets the gastric artery, being distributed to both
faces of the stomach - comes off appoit the upper border of pyloric 
extund of the seond
(b) The Gastro-duodenalis -
The gastro-duodenal is a 
large branch which descends from the hepatic artery
behind the pylorus and divides into two -
1st Pancreatico-duodenalis superior - which descends
between the pancreas and duodenum and is 
there distributed -
2d Gastro-epiploica Dextra - which passes to the left 
along the greater curvature of the stomach to 
meet the left gastro-epiploic -

[illustration]
lies between the folds of the mesentery

305
II The Superior Mesenteric Artery -
The superior mesenteric is a large artery which arising
from the front of the aorta, just below the coeliac
axis and behind the head of the pancreas descends
between the lower border of the pancreas and the 
transversa duodenum to reach the right iliac fossa
presenting in its course a curve whose convexity is 
to the left and lying between the layers of the mesentery -
- Branches -
Besides a small branch called inferior pancreatico-duodenal 
which ascends between the head of 
the pancreas and the duodenum, the branches of 
the superior mesenteric artery are as follows.
(1) Vasa Intestini Tenuis -
Arising successively from the convex aspect of the 
superior mesenteric artery are fifteen or [twenty] 10
branches which are distributed to the small intestine
from the duodenum to near the ileo-colic aperture 
and called the vasa intestine tenuis - After
running a short distance these branches divide
and unite with adjacent ones so as to form arches
from which branches proceed and these again divide
and unite so as to form another series of arches
and from this 2d series a third is produced
from which small vessels pass to supply the 
intestine - these vessels (a) last ones are straight
(2) - Ileo-colic Artery - 3
The ileo-colic artery is the lowest of the three branches
given off from the right or concave aspect of the 

insstomass with the colica media? does it
[illustration]
abt 2 in above its bifurcation.

306
superior mesenteric and is distributed to the termination
of the ileum and beginning of the large
intestine -
(3) Colica dextra -
The colica dextra artery is the middle of the three 
arteries arising from the right side of the superior
mesenteric and is distributed to the ascending colon.
(4) Colica Media -
The colica media artery is the first of the three
branches arising from the right aspect of the superior
mesenteric and turning upward is distributed
to the right half of the transverse colon and termination 
of the ascending colon - All these branches of 
the superior mesenteric anastomose with each other 
successively in the order in which they are given 
and the colica media anastomoses with the colica
sinistra branch of the inferior mesenteric -
III. Inferior Mesenteric -
The inferior mesenteric artery, rather smaller than
the superior, arises from the front of the aorta near 
its termination and descends obliquely to the left 
iliac fossa giving off the following branches -
(1). Colica Sinistra -
The colica sinistra passes outward to the left and 
divdes into two branches, one of which is distributed
to the descending colon while the other ascends 
to supply the left half of the transverse colon and 
inosculate with the colica media branch of the 
superior mesenteric - 

passes over, the front of the left 
com. iliac
[illustration]

307
- (2) - Sigmoideal -
The sigmoideal are several branches distributed 
to the sigmoid flexure of the colon - all 3-4 large branches
(3) Superior Hemorrhoidal -
The superior hemorrhoidal is the continuation of 
the inferior mesenteric artery; it descends along the 
middle of the posterior aspect of the rectum to 
about its middle where it divides, being distributed
to the rectum -
(The branches of the inferior mesenteric anastomose 
with each other and its colica sinistra branch
with the colica media of the superior mesenteric -
Summary of the arterial supply of the stomach 
and intestines - The stomach is supplied with 
blood by the following arteries the lesser curvature by 
the gastric and pyloric branch of the hepatic; the 
greater curvature by the right gastro-epiploic for 
its right half and by the left gastro-epiploic towards
the left; the former being a branch from the gastro 
duodenal is a branch of the hepatic artery and the 
latter a branch of the splenic artery; the splenic
end of the stomach is supplied by the vasa brevica 
of the splenic - The duodenum is chiefly supplied
by the superior pancreatico-duodenalis 
branch of the gastro-duodenalis from the hepatic
artery -
The small intestine from the duodenum
to near the large intestine is supplied by the vasa 
intestine tenuis of the superior mesenteric artery -
The termination of the small intestine and the 

The left S - vein emply is into renal [cross out] at a it L from below.
" rt " " " " inf. Vena cava " an oblique L " " 
The rt is in the front of inf. Vena cava
" " " " " " " ext illiac
The left is on the front of the ext lilliac
" " " behind the the Sig flex colon.
They both cross the ureters.
At - [illegible]- { in front renal vein
{ Behind ureter
{ Arty between -

308
commencement of the large are supplied by the 
ileo-colic branch of the superior mesenteric -
The ascending colon is supplied by the colica dextra
branch of the superior mesenteric artery -
The right half of the transverse colon is supplied 
by the colica media of the superior mesenteric artery -
The left half of the transverse colon and the 
descending colon are supplied by the colica sinistra
of the inferior mesenteric artery -
The sigmoid flexure of the colon is supplied by the 
sigmoidiac branches of the inferior mesenteric artery.
The upper half of the rectum is supplied by 
the superior hemorrhoidal branch of the inferior 
mesenteric -
3d Genito-Urinary Branches -
I. The Spermatic Arteries -
The spermatic are a pair of small arteries which 
arise from the front of the aorta and descend behind 
the peritoneum to the brim of the pelvis, one 
on each side; in the male the artery passes thence
to the internal abdominal ring and accompanies 
the spermatic cord to the testicle, whereas in the 
female most of the artery is expended on the ovary
and Fallopian tube -
II. Renal Arteries -
The renal artery arises from either side of the 
aorta and passes outward to be distributed to the 
kidney being a large branch - The left renal artery
is somewhat higher than the right owing to 
the relative positions of the two kidneys.  

aorta terminates at the lower 
border of the 4th Lumber V -
The com iliac is crossed by ureter gen.
omit- (The vein of the right & lefr iliac veins are to rt & on a plane
(post. to it 
In front - { Ureter
outer Side { [illegible] -
{ 
behind { left com Iiliac Vein.
Grey gives begin of Venra Cava.

309
III. Supra-renal Arteries -
The supra-renal are a pair of small arteries
which arise from the side of the aorta about the 
origin of the renal arteries and pass out one on 
each side to be distributed to the supra-renal
capsule -
- The Common Iliac Arteries -
The common or primitive iliac artery of each
side begins where the abdominal aorta bifurcates
at the left side of the lower border of the body of the 
fourth lumbar vertebra as a rule, though the exact
point of division may vary as much as an 
inch: from this point the common iliac passed
downward and outward to the brim of the pelvis 
where it terminates, on the Side of the disk between the 5th=
lumbar vertebra and sacrum, by dividing into 
the external and internal iliac arteries - The 
right artery is slightly the longer - the average
length of each being about two inches -
- Relations of the Right Common Iliac -
The right common iliac artery is crossed in front 
by the right ureter, near its bifurcation. 
To its outer side is the psoas magnus muscle -
Behind and somewhat external is the right 
common iliac vein and crossing behind it is 
the left common iliac vein -
- Relations of the Left Common Iliac -
The left common iliac artery is crossed in front 
by the sigmoid flexure of the colon by the superior 

Grey gives the vena Cava as an ext relation
of right Com Iliac 
1{ In font is the ureter - on rt Side } -
{ " " " " " [cross out] rectum 92- rectum on left side Peritoneum }
(2) To its out Side is the edge of psoas magnus -
(3) Behind is the lumbo Sacral nerve and 
" " " int iliac Vein
" " Pyreformis muscle -
at 1st rectum is on front of left int iliac but later 
it drops to its inner side & :. getts between
the too artys. 92 

310
hemorrhoidal artery and by the left ureter near 
its termination -
External to it is the psoas magnus muscle -
Its vein is behind and internal to it - It is 
thus seen that each vein is more or less to the 
right of its artery and behind, the left vein being 
forced to cross behind the right artery in order to 
unite with the right vein and form the inferior 
vena cava which lies to the right of the aorta -
584 Grey - 95 - The Internal Iliac artery -
The internal iliac artery one of the two terminal
branches of the common iliac begins where that artery
forks at the brim of the pelvis on the intervertebral
disk between the 5th lumbar vertebra and 
sacrum and descends into the pelvis on the front 
of the sacro-iliac symphysis to the upper margin
of the great sacro-sciatic notch and there divides
into an anterior and posterior trunk - The artery 
varies in length from an inch to two inches in - The 
only relation besides those given is that its vein
is immediately behind - see other page.
The distribution of the internal iliac artery is to 
the viscera and walls of the pelvis and it will
be found with trifling exceptions that the parietal
branches spring from the posterior trunk 
while the visceral are the offspring of the anterior -
It should be remembered that the hypogastric artery
of the foetus is a branch of the internal iliac
passing from this upward and inward beside
the bladder to reach the umbilicus after coursing
along the posterior aspect of the anterior abdominal

Branches of Obturator
In Pelvis -
(3-) 1 vesicle
2 Iliac.
3 Pubic with epigastric Anos -
out- I int - Branch - Adductors anoat inl cucun
Passes Kick II Ext " out Rot. " Scialic
& hip Joint 
Ref to page 315 = 315 
Obturator [illustration]

311
wall and that after birth this artery becomes impervious
from the umbilicus as far back as the 
side of the bladder, but from this point to its origin
it remains open and gives origin to some of 
the arteries which supply the bladder, viz, those 
which supply its upper and middle portions and 
called the superior and middle vesical arteries -
- Branches of the Anterior Trunk -
I. Inferior Vesical -
The inferior vesical artery is distributed to the base 
of the bladder and in the male also to the prostate
and seminal vesicle -
II. Middle Hemorrhoidal -
The middle hemorrhoidal artery aids to supply
the rectum and derives its name from the fact that 
there are two other hemorrhoidal arteries one supplying
the upper part of the gut and the other the 
anus while the middle takes the intermediate
portion - Besides these two branches there are some 
peculiar to the female - viz - vaginal to the vagina
and uterine to the uterus -
III. Obturator -  587 - gray - read - 95 
The obturator artery passes forward along the wall 
of the pelvis just below the brim and escapes through
the upper part of the obturator foramen to divide
into an internal and external branch which are
distributed around the front of the obturator foramen -
The obturator artery is frequently a branch
from the posterior trunk and once in three & 1/2 dissections
will be found descending to the obturator foramen

J. S. Wilson 
3050 Pst
Washington
D.C. 
[illustration]
along the false form dig.
J.S. Wilson

312
foramen from the epigastric branch of the external iliac - with [illegible]
After giving off the foregoing branches the anterior 
trunk forks into two terminal arteries, the [cross out]
or sciatic and the internal pudic -
IV. [cross out] Ischial Artery - See gray - 587/95
The ischiatic artery one of the two terminal branches 
of the anterior trunk of the internal iliac leaves
the pelvis through the great sacro-sciatic foramen
below the pyriformus muscle and descending between
the trochanter major and tuber ischii 
breaks into numerous branches the most important
of which are muscular - See 590 gray -
V. Internal Pudic Artery - 588 Gray/95 Read 95
The internal pudic artery, the second of the two 
terminal branches of the anterior trunk of the internal
iliac leaves the pelvis through the great 
sacro-sciatic foramen below the pyriformis muscle
and passing across the spine of the ischium
re-enters the pelvis through the lesser sacro-sciatic
foramen and runs forward and upward about an
inch above the lower edge of the tuber ischii and 
then along the inner aspect of the rami of the ischium
and pubes towards the symphysis pubis -
- Branches of the Internal Pudic -
I. Inferior Hemorrhoidal -
The inferior hemorrhoidal are several small
branches given to the anus as the internal pudic
is passing near it.
II. Superficial Perineal -
below

ramus ischi - & pubes this junction -
crus penis And ramus pubes & junct -
Relations -
In pelvis -
Behind
Pyriformis 
Sacral plexus 
out of pelvis
covered by gluteus max -
in pelvis -
Inf ???} {on obturator internus & [illegible] [illegible] of S.S. lig
Sup- Pei {above
{nerve
{& vein.
Arty of Bacb - {Punus the deep - layer of deep - Per. fascia
mus along ramus of pubes 
& punus the Superficial layer first dividing
and giving off the Arty of corpus cavernosum & then 
the Dorsal Arty which pierces the sup [illegible] & 

Superficial Perineal -
313
The superficial perineal passes forward through
the perineum as far as the scrotum and on its 
course gives off the Transversa Periner branch which 
crosses the perineum -
III. The Artery of the Bulb- Impatient in Suth.
The artery of the bulb enters the bulb of the corpus
spongiosum and is distribtued there - Short beneath deep fossia 
is Sup- layer -] 95
IV. Artery of the Corpus Cavernosum -
The artery of the corpus cavernosum enters the 
crus penis and is distribtued to the corpus
cavernosum -
V. Dorsal Artery of the Penis -
The dorsal artery of the penis runs along the 
dorsum of the penis and as far as the glans -
- Branches of the Posterior Trunk -
I. Lateral Sacral Arteries -
The lateral sacral are a pair of small arteries
the superior of which enters the first anterior sacral
foramen and the inferior passes down on 
the side of the front of the sacum and sends a 
branch into each anterior sacral foramen except 
the first.
II. Ilio-lumbar Artery -
The ilio-lumbar artery is a recurrent branch 
which ascends beneath the external iliac artery 
and divides into two branches, one continues upward
to the psoas magnus and quadrat is lumbarum

49
4) 95
_______
26
25
95
______
125
225
_____
23.5
The gluteal Arty passes out of the Sacro-Sciatic
foramen above the pyraformis
mus - but both the int Pudic and 
and Ischiatic pass out below the Pyr.
mus -
92{ along the inner edge of the Psoas Maj -
{ is covered by a process of iliac fascia. & also lies
{ on [cross out] the iliac fascia
In front{ (1) crossed by ureter & 3 - Spermatic ves -
{ (2) Peritoneum - process of fascia  
{ (3) Vas deferens - 
{ (4) iliac fascia
outer Side{ (1) Psoas mag -
{ (2) Iliac fascia
{ (3) Spermatic Arty
Also relation of Veins
Qunto Crurol Nerve. Grut Kanet -
{ Behind Iliac lumbar Arty - ?
{ Ext Iliac Vein
{ Psoas.

314
lumbarum muscles while the other turns outward -
III. Gluteal Artery - & obturator 
The gluteal artery is the continuation of the posterior
trunk of the internal iliac, it passes backward
through the upper part of the great sacro-sciatic
foramen above the pyriformis muscle and 
divides into three branches, a superficial which 
is distributed between the gluteus maximus
and gluteus medius muscles and two deep
branches which ramify between the gluteus medius
and minimis muscles -
- The External Iliac Artery -
The external iliac artery begins where the common 
iliac forks into it, and the internal iliac,
at the brim of the pelvis on the disk between the 
5th lumbar vertebra and sacrum and continues 
the course of its parent downward and outward
to enter the thigh and become the femoral artery 
by passing beneath Poupart's ligament at a point 
about half way from the anterior superior spinous
process of the ilium to the symphysis pubis -
Its course and that of the common iliac may be 
indicated by drawing a line from a point just 
to the left of the umbilicus, which corresponds to 
the bifurcation of the aorta downward and outward
to a point half way from the anterior superior
spinous process of the ilium to the symphysis
pubis -
- Relations -

W.B. Reference to pa. 311
Obturator Arty. sometimes arrises (from)
in common deep epigastic.
I By a common branch with it 
in which case it will descend
(in common) close to the 
inner Side of the external
illiac Vein.
II As a highly developed pubic 
branch of the Epigastric in which 
case it will descend to the 
inner Side of the Femoral Ring. 
once in 3 1/2 times the obturator arty. arrises
in common with the deep Epig.
gen they arrise by a com. trunk &
will pass down with ext. Illiac
vein, somtimes it is a high dev.
pubic branch of the deep Epig. 
Arty. this is the arty that grooves the lower 
border of the body of the pubes 
Pubic branch - comes from the obturator Arty -
having to [illegible] [illegible]

Ext Iliac 92
315
on front [cross out] at its termination is the vas deferens 
crossed by ureter. 
James S Wilson
See Gray 592
To the outer side of the artery is the psoas magnus 
muscle separated from it by iliac fascia which 
throws covering over them - In front of it is the 
peritoneum and soon fascia - (Spermatic Arty; = to outer side)
Each artery is accompanied by a vein the relation
to which is different on the two sides -
The vein of the left artery is internal to it through 
out - The vein of the right artery is first behind and 
external then behind and then internal; so that 
each vein at Poupart's ligament is internal to its 
artery - and fully almost to it - on left side the vein is to rt and 
at is to rt -
- Branches -
Exam I. Deep Epigastric Artery -
The epigastric artery arises from the inner side of 
the external iliac near Pouparts ligament and runs 
upward and inward on the inner face of the anterior
abdominal wall lying just beneath the peritoneum
and transversalis fascia which it raises
into a ridge Just internal to int [A????y] - and enters the sheath of the rectus muscle at [illegible]
where it anastomoses with the superior epigastric
branch of the internal mammary artery thus forming
the most remarkable inosculation in the body -
Soon after its origin the epigastric artery gives off 
a small communicating branch which descends
to the obturator artery and indeed sometimes supplies 
the place of the obturator. - gives off a pubic branch 
to inosculate with obturator
II. Deep Circumflex iliac Artery -
The circumflex ilii arises from the outer side of the 
external iliac just above Poupart's ligament and 
passes upward and outward along the crest of the 
ilium and about the middle of it gives off a large 



316
ascending branch which is distributed between the 
internal oblique and transversalis muscles -
- The Femoral Artery -
The femoral artery is the continuation of the external
iliac, commencing where that artery terminates beneath
Poupart's ligament at a point about midway
between the anterior superior spinous process of the 
ilium and the symphysis pubis where it can be 
felt pulsating beneath the skin; it descends the 
front of the thigh to its lower third where it pierces
the insertion of the adductor magnus muscle to 
reach the back of the thigh and become the popliteal;
as long as it lies on the front of the thigh, that 
is for the upper two-thirds of the thigh the artery
is called femoral as soon however as it reaches the 
back of the thigh which it does at the commencement 
of the lower third of the thigh by piercing the 
adductor magnus the artery takes the name of Popliteal -
The course of the femoral artery may be indicated
by a line drawn from the point where the artery 
commences beneath Poupart's ligament which 
is usually half way from the anterior superior spinous 
process of the ilium and the symphysis pubis,
down the front of the thigh to the inner aspect of the 
internal condyle of the femur; the artery will lie 
behind the upper two-thirds of this line; the point
where this line should begin can be better determined
by feeling for the pulsation of the artery beneath
Poupart's ligament -
not Pouparts lig.

rests on the upper border of the body of the
pubes sep. by pectineus.
And is opp. the middle of the head of the 
femur -

317
- Relations -
For the first half 1/3 varying of its course the femoral
artery lies superficial in Scarpa's triangle
(see vol IV p) having the sartorius muscle to its 
outer side and the adductor longus muscle to its 
[crossed out] back side; it enters the triangle about the middle 
of its base and passing through its centre it 
usually leaves it at the apex by passing beneath
the sartorius muscle and descends lying on the 
front of the insertion of the adductor longus behind which 
relations it maintains to within about an inch 
or so of its termination but that extent it is separated
from the posterior face of the sartorius by the 
tendinous arch which the adductor longus and 
adductor magnus behind throw over it to the vastus internus
muscle; so that the last inch or two of the 
femoral artery is the deepest being covered by the 
skin, superficial fascia, fascia lata, sartorius
muscle and the tendinous arch above mentioned.
Let it be observed that the artery lies throughout 
its course between the sartorius and adductor
longus muscles, in the upper half of its extent it 
has three muscles to its sides, the sartorius external
and the adductor longus internal; in the 
lower half of its extent has the sartorius in front 
and the adductor longus behind; though just as 
the artery terminates it is separated from the 
sartorius by the tendinous arch -
The relations of the femoral artery to cords are as 
follows - It lies in a sheath which also contain
the femoral vein, the vein at Pouparts ligament
is internal, and fully almost but as it descends it gradually gets 
Pect & Psoas 
behind

The arty is covered by the saphenous nerve
which after crossing is continued down
the side of the leg 
The int. cut. nerve cross the Arty, abt middle
of its couse.
The nerve called the mus brach to Vest. int &
is ext to arty.
inner Side of F. Arty 

& behind in last 1 in or so
318
behind the artery and then external to it. 
In the first few inches of its course the artery has 
from one fourth to the half of an inch to it, outer
side the anterior crural nerve which here divides
into numerous branches and one of these the long 
saphenous nerve descends close to the outer side of 
the artery but not within the sheath - : is in course of Pouport's 
this [illegible] some times crosses it in [illegible] crural - } long Saphenous
" " always lies on front of arty in " " }
- The Branches of the Femoral Artery -
Soon after its commencement the femoral artery
gives off four small branches all of which are cutaneous:
they are the first four as follows - 
I. Superficial Epigastric -
The superficial epigastric artery passes upward
and inward towards the umbilicus beneath skin
and fascia -
II. Superficial Circumflex Iliac -
The superficial circumflex iliac runs upward and 
outward along the crest of the ilium -
III. Superficial to femoral Vein External Pudic -
The superficial external pudic artery passes inward
in front of the femoral vein toward the 
genital organs -
IV. Deep Behind the femoral Vein External pudic artery -
The deep external pudic artery runs inward behind 
the femoral vein to be distributed to the integument 
of the external organs of generation -
(a) lower 1/2 
& are cutaneous.

give an inch and a half 

319
V Profunda Femoris Artery -
At a variable distance from its commencement,
generally from one to [cross out] 3 inches, though sometimes it 
is less and sometimes more than this, the femoral 
artery gives off from its outer posterior aspect a 
branch the profunda femoris artery which is almost 
as large as the continuation of the femoral 
itself - The direction of the profunda is first for a 
very short distance downward and outward but then 
curving inward almost immediately from its origin,
it descends vertically lying behind the femoral artery 
and having no muscle interposed until the 
two arteries reach the upper edge of the adductor 
longus muscle when this muscle thence forward
separates them, the femoral passing down on the 
front of it and the profunda descending it behind 
it some distance and then perforating the adductor 
magnus muscle to reach the back of the thigh 
and be there distributed -
The profunda artery is contained in a sheath in 
which lies also its vein, the vein being in front of 
the artery; now as the profunda artery is descending
behind the femoral artery it is separated
from it by the two veins femoral and profunda, so 
that from the origin of the profunda artery down to 
the upper edge of the adductor longus muscle that 
is to the commencement of the middle third of 
the thigh; the vessels lie one behind the other in 
this order from before backward femoral artery, femoral
vein, profunda vein, profunda artery -
- Branches of the Profunda Artery -

outter Side of the P  [illustration]
in-ner back part of the P [illustration]

320
(1) External circumflex -
The external circumflex artery arises from the early
portion of the profunda and passes outward around 
the upper extremity of the femur giving off two sets 
of branches, one, ascending, to the gluteal region and 
the other, descending, to the outer aspect of the thigh
and knee-joint.
(2) - Internal circumflex -
The internal circumflex artery arises from the profunda
near its commencement and is much 
smaller than the external circumflex; it passes
inward around the upper extremity of the femur 
and anastomoses with the external - 
(3) The three Perforating Arteries -
As the profunda femoris artery is descending it 
gives off in succession three branches, each called 
perforating, superior, middle and inferior; these 
derive their name from the fact that they pierce
the adductor magnus muscle and the superior the 
adductor brevis muscle also, to reach the back of 
the thigh and supply the posterior femoral muscles -
VI. Anastomica Magna -
The anastomotica magna the last branch of the 
femoral artery arises from it just as that artery
is about to perforate the adductor magnus and descends
towards the knee after dividing into a superficial 
and a deep branch -
Besides the six foregoing branches the femoral artery
gives off muscular branches to the muscles 

J. Sprigg Wilson M.D. (91)
Dear Doctor -
You are infamous 
pettifogger "You know"
Yours in health
Guy C.M. Godfues M.D. (98)
Guy goes Condyles alo
J.W./95
The post border of Semi meint -
forms a garde to this arty-
Dixon 

321
on its route -
- The Popliteal Artery - 002 E 95
The popliteal artery is the continuation of the femoral;
beginning where that artery terminates on 
reaching the back of the thigh by perforating the 
adductor magnus muscle at the junction of the 
middle and lower thirds of the thigh the popliteal
artery passes downward and outward (the outward
inclination being greatest at first) through the popliteal
space (vide vol. IV. p. 84) to terminate at the 
lower border of the popliteus muscle where it is 
passing beneath the tendinous arch of the soleus
by dividing into the anterior and posterior tibial 
arteries -
The artery rests successively on the posterior aspect 
of the lower third of the femur, the posterior ligament
of the knee-joint and the popliteal fascia which 
separates it from the popliteus muscle and is surrounded
by the mass of fat which fills the popliteal 
space - It has on its outer side above the knee 
the tendon of the biceps and then the outer head of 
the gastrocnemius - & Plantoris - Semi memb - & inner vein 
of Gastric -
The relations to cords are as follows -
The artery is accompanied by the popliteal vein
and the internal popliteal nerve -
The artery is the deepest of the three cords; next it 
and hugging it closely is the vein which is external 
to the artery as well as superficial; the nerve is 
the most superficial and also somewhat external to 
the vein separated from it by the interposition of 
some fat. Now when the artery reaches the commencement
of the lower third of its course these relations



322
relations change for here the vein and nerve cross, superficially,
to its inner side, where they continue
to the termination of the artery -
It should be observed that at the commencement
of the artery and its vein lie some distance to the 
inner side of the internal popliteal nerve because 
the nerve enters the popliteal space at its superior 
apex whereas the artery and vein enter the space 
some little distance down on the inner side; but 
since the vein and artery have an outward inclination
and the nerve slightly the opposite they 
soon come into closer relation - This internal popliteal
nerve is one of the two terminal branches of the 
great sciatic which descends the centre of the back 
of the thigh and divides just as it reaches the 
superior apex of the popliteal space sending its 
other terminal branch, the external popliteal 
downward along the outer side of the space -
- Branches -
The branches of the popliteal artery six in number -
I. Superior External Articular - II. Superior Internal 
Articular. III. Inferior External Articular. IV Inferior
Internal Articular - V Azygoas Articular - VI. Muscular -
The superior articular arteries surround the 
lower extremity of the femur just above the knee, the 
external passing beneath the tendon of the biceps and 
the internal beneath the tendon of the adductor 
magnus - The inferior articular arteries surround
the upper extremity of the tibia just below the knee.
The azygos articular is a single branch which perforates

Branches{ Post. Tibial
{ Peroneal, ant. Peroneal, muscular
{ nutrient? communicating and 
{ internal calcanean 
divides between the int malleolus
And (tendonis Achillis) middle
of post border of os Calus. /95 Myeth.
95 Gray
In front.
Tib. Post
Flex long dig
Tibial
Ante joint 

323
perforates the posterior ligament to enter the knee-joint.
The muscular arteries may be divided into two sets,
superior muscular, which are distributed to the 
hamstring muscles and inferior muscular or 
sural, which are given to the gastrocnemius muscle -
- The Posterior Tibial Artery -
The posterior tibial artery one of the two terminal
branches of the popliteal begins where that artery
terminates, at the lower border of the popliteus muscle
beneath the tendinous arch of the soleus muscle
and descends the back of the leg with a steady
inclination inward to the inner aspect of the os 
calcus where it divides between the internal
malleolus and [cross out] and middle of post border of os. Calcus, into the internal
and external plantar arteries -
95 wyeth -
- Relations -
The posterior tibial artery is about the upper two-thirds
of its course lies deeply covered by the triceps
surae but for the rest of its course it is superficial,
having emerged to the inner side of the tendo
Achillis, because of its own inward inclination and 
because of the narrowing of the triceps surae to a 
tendon -
The artery is accompanied by satellite veins and 
by the posterior tibial nerve -
The posterior tibial nerve is for the first few inches
of the artery (to the lower part of the upper third 
of the leg) to the inner side of the artery and 
then crosses posteriorly to assume a continuous 
external relation -
crosses just where the peroneal 
arty - oryets R.T.



324
- Branches -
Besides muscular to the muscle in its course
and its two terminal branches, the posterior tibial
produces two branches, Peroneal and internal calcanean;
One of its earliest muscular branches
gives off a recurrent branch which passes upward
to the knee-joint.
I. Peroneal Artery -
The peroneal artery is nearly as large as the continuation
of the posterior tibial and arises from 
that artery high up near its origin, the distance
being about two inches - It first passes obliquely
downward and outward to the origin of the flexor 
longus pollicis muscle and then descends vertically
beneath that muscle to terminate on the outer 
side of the os calcis -
- Relations -
The peroneal in the upper, oblique, part of its course 
is covered like its parent by the triceps but after 
reaching the flexor longus pollicis it is covered
by that muscle in addition; in the lower part 
of the leg the difference in depth between the peroneal
and posterior tibial arteries is very great 
since here the posterior tibial is superficial where -
as the peroneal is covered still by the tendo 
Achillis and flexor longus pollicis -
- Branches -
Just above the posterior tuberosity of the os calcis the 
peroneal and posterior tibial arteries are connected

[illustration]
int Planti
ext planti -
magna policis a branch of 
ant. tibial -
The Relations 1st" part beneath abt pol
flx in dig.
between { " " "
{ " [illegible] Dig.

analyne of ant & Post interun 
in ann -
325
by a small transverse communicating branch - The 
peroneal gives muscular branches to the muscles
in its course - About the lower third of the leg the 
peroneal gives off a large branch the anterior peroneal
which pierces the interossous membrane to 
reach the front of the leg - The termination of the peroneal
is distributed on the outer side of the heel by 
branches called external calcanean -
II. Internal Calcanean Branches -
The internal calcanean branches of the posterior 
tibial artery are three or four in number and distributed
to the inner side of the heel -
- The Internal Plantar Artery -
The internal plantar artery, one and much the 
smaller of the two terminal branches of the posterior
tibial, begins where that artery bifurcates between
the internal malleolus and [cross out] middle of ant inner of os calis, and
passes forward along the inner side of the sole to 
terminate on the inner side of the great toe having 
given off muscular branches in its course -
- The External Plantar Artery -
The external plantar artery is the second, the larger
and more important of the two terminal 
branches of the posterior tibial and begins where 
that artery forks between the internal malleolus
and [cross out] side post and passes outward and 
forward [cross out] beneath the 3 - layers of muscles in 
the sole to the base of the 5th metatarsal bone and 
then turns inward beneath the 3d layer of muscles

The ext plantar arty. lies first between the os. colcis & abduct Pollicis
Then between Fl. Br. Dig. beneath Flex occesonous above -
at base of little toe between flex Rev. Dig & Ab - rum Dig 
The remaing puten is deep being on interosseus muscles -
Ant. & Post perforating - Artys 

326
see Gray 95
to cross to the inner side of the sole and terminate
there at the posterior extremity of the first interosseous 
space by anastomosing with the artery of 
the dorsum of the foot which sends a branch through 
to meet it - That portion of the external plantar
artery which crosses the foot from the outer side of 
the sole to the inner is called the plantar arch -
see
- Branches -
Besides muscular branches the external plantar
gives off the following Digital and posterior Perforating  -
I. Digital Arteries -
The digital branches are four and running forward
to the clefts of the toes they there divide into collateral 
digital branches which supply the plantar
aspect of the sides of the toes except the great toe 
and the inner side of the next toe: the outermost 
of the digital branches is appropriated to the outer 
side of the little toe - Just before the digital arteries 
divide at the clefts of the toes they send up each 
between the metatarsal bones a branch called anterior 
perforating to open its digital branches on the 
dorsum -
II. Posterior Perforating -
The posterior perforating, three in number, pass up 
between the heads of the three outer interossous 
muscles to anastomose with the metatarsea artery
on the dorsum of the foot -
- The Anterior Tibial Artery -
its relations in ref. to mus will 
be asked on Final oval. 

Ant. Tibial
Branch{ Recurrent Tibial? Int. Malleolar
{ muscular Ext. " " " " 
MB, To find it on toes of lig tun over the pot literal
& you see it.
begins just int to neck of fibula
[illustration]
Ext. L.D.
Ext.
Ext
Ext. P.P.
Int Ant.
Int Ant.
Int Ant.

Anterior Tibial
327
The anterior tibial artery begins where the popliteal
forks, at the lower border of the popliteus muscle beneath
the tendinous arch of the soleus and passes
directly forward between the tibia and fibula to the 
front of the leg, which it descends, lying for the upper
two-thirds of its course on the interosseous membrane
and for the lower third on the front of the tibia, it 
terminates on the middle of the front of the ankle-joint
beneath the anterior annular ligament by assuming 
the name of the Dorsalis Pedis artery.
- Relations -
The anterior tibial artery is divided into three portions,
upper, middle and lower thirds.
In its upper third it lies on the interosseous membrane
and between the tibialis anticus muscle on 
its inner side and the extensor longus digitorum on 
its outer In its middle third it still lies on the 
interosseous membrane but it has here reached the 
origin of the extensor proprius pollicis and this 
muscle lies to its outer side while internally it
still has the tibialis anticus - 
In its lower third it lies on the front of the tibia and 
is obliquely crossed by the tendon of the extensor proprius
pollicis which then lies to its inner side dispossessing
the tibialis anticus, while to the outer side 
of the artery is the extensor longus digitorum again 
which was separated from it in its middle third 
by the extensor proprius pollicis.
The artery is accompanied by satellite veins and 
the anterior tibial nerve, the nerve is at first to its 
outer side then for a short distance in front of it 

Post behind has one} Malleolar
ant " " 2}
Peroneal " 1
Dorsalis Pedis
Branches{ Tarsal, Metatarsal
{ Dorsalis hallucis
{ Communicating
{ Interosseous 
[illustration]
middle front ankle joints
doral Hollutin
communicating
metatarsal branch - or arch.
Doralis Pedis
Out  in
Ext. long digit 
Ext. Prop pol
in front 
Ext Brevis digit.

To indicate the ant. tibial draw a line from the 
head of fibula to middle of ankle joint
328
and then again to its outer side -
- Branches -
The branches of the anterior tibial artery are 
muscular a recurrent branch which ascends to the 
front of the knee through the tibialis anticus muscle
and two [illegible] mallsolar branches, external and 
internal, these surround the tibia just above the 
ankle joint and supply the joint -
- The Dorsalis Pedis Artery -
The dorsalis pedis artery is the continuation of the 
anterior tibial from the middle of the front of the 
ankle joint beneath the anterior annular ligament, 
along the inner side of the dorsum of the foot to 
the posterior extremity of the first interosseous 
space, where it terminates by dividing into two 
branches, communicating and doralis hallucis
- Relations -
The doralis pedis has the same relations to 
muscles and cords as the lower third of the anterior 
tibial; to its inner side is the extensor proprius 
pollicis tendon, to its outer side is the 
extensor longus digitorum tendon and near its 
termination it is crossed by the tendon of the 
extensor brevis digitorum to the great toe -
It lies between satellite veins and has the anterior 
tibial nerve to its outer side -
- Branches - 
I. Tarsea -  4
The tarsea branch passes outward on the tarsus -
II. Metatarsea -  L
The metatarsea branch passes outward on the 

Int. carotid
I In front. Parotid Gland Stylo glossus.}
" Phar}
Stylo hyoid lig.
Internally Pharnyx, tonsil gland.
Behind Trans. process. (ant. (tub.) of the 
3 upper cerv. vertebra Sep. by the rectus capt.
ant. maj.
Relations to cords.

329
James S Wilson
bases of the metatarsal bones and receives the posterior
perforating branches from the plantar arch -
The metatarsea sends forward three branches called
interosseous, which after receiving the anterior 
perforating branches of the plantar digital arteries,
divide at the clefts of the toes to form collateral
digital branches for the dorsal aspect of the 5th= 4th=
& 3d= toes and outer side of the second toe -
III. Dorsalis Hallucis -
The dorsalis hallucis is one of the two terminal
branches of the Dorsalis pedis and runs forward
to divide and supply the dorsal collateral digital
branches to the great toe and to the inner side 
of the second toe -
IV. Communicating
The communicating passes through the first interosseous
space to anastomose with the termination 
of the external plantar, giving off a branch the 
magna pollicis which passes forward and divides
to form plantar collateral digital branches for 
the great toe and inner side of the second toe -
- The Internal Carotid Artery -
The internal carotid artery is one of the two terminal
branches of the common carotid and begins
where that artery bifurcates more or less on a level 
with the upper border of the thyroid cartilage and 
ascends on the front of the transverse processes of 
the three upper cervical vertebrae to the carotid foramen
situated about the centre of the basilar face 
mus

[illustration]
eye
clieasur
corpora Quad
9th gene Pharmgeal Mucl
3rd nerve 
[cross out]
Suplaryngeal nerve 
& asending Phar arty:
Styloid process Separates the Ext & Int carotid -
Tonsil gland is in front of Arty -

330
of the petrous portion of the temporal bone then runs 
forward and inward along the carotid canal of 
the petrous bone then emerges at the apex of the petrous
bone passes forward in the cavernous groove
beside the sella. Tunica and lastly turns upward
beside the anterior choroid processes and divides
into its four terminal branches anterior cerebral,
middle cerebral, posterior communicating and
anterior choroid - 
- Relations -
Its relations to muscles and structures other than 
cords are as follows -
Behind it are the transverse processes (their anterior
tubercles) of the three upper cervical vertebrae
being separated from them however by the origin
of [cross out] The pre vertebral group of mus & of The Sup vertebral ganglia of Sympth -
- or between the Ext & int carotid Artys
In front of it and separating it from the second 
and third portions of the external carotid artery
are the parotid gland the stylo-glossus and stylo-pharyngeus
muscles and stylo-hyoid ligament -
To its inner side are situated the pharynx and 
the tonsil gland = {1 in 1 1/2 inches - is in front
Its relations to cords are as follows:-
At its commencement it lies external to the external
carotid artery but by the time that the external
carotid has reached the posterior belly of the 
digastric and the stylo-hyoid muscles the internal 
has gotten behind it and is thence forward
separated from it by the structures mentioned
above and by the glosso-pharyngeal nerve -
Behind the internal carotid artery where it is 

Int. Carotid
Comences at.
ends. at.
In front.
Skin, Sup. fascia deep fascia. parotid gland
Stylo glosus
" Pharyngeous mus G"oso phar nerve.
Behind
Rectus capites anticus major, Sympathetic
Sup. laryngeal nerve. ext. carotid
Internally
Pharynx
Sup. Laryngeal nerve, ascending Pharyngeal Arty.
Tonsil.
Externally
Int. Jugular vein. Pneumogastric nerve.

The Hypoglossal cross the int carotid between it
" Glosso Pharyn. and the int jugular Vein
331
entering the carotid foramen is situated the 1) jugular
and anterior condyloid foramen and from 
these emerge the internal jugular vein, the 3) pneumogastric,
and the 2) glosso-pharyngeal nerves; consequently 
these cords are here behind the artery but 
speedily get to the outer side as they descend - The 
internal jugular vein and pneumogastric nerve 
continue external to that artery throughout, but 
the glosso-pharyngeal and Hypoglossal nerves
cross over the front of the artery, the hypoglossal
near the commencement of the artery, the glosso-pharyngeal
higher up - The internal carotid artery
is divided into four portions: the four portions: the first portion
extends from its origin to the carotid foramen and 
is also known as its cervical portion, the relations
of this portion have been given above; the second
portion or petrous portion is that part of the artery
which lies in the carotid canal of the petrous
bone; the third or cavernous portion extends from 
the apex of the petrous bone along beside the sella
Tunica in the cavernous sinus to the anterior clinoid
process; the fourth or cerebral portion ascends
beside the anterior clinoid process -
- Branches -
The first portion gives off no branch -
The second portion produces one unimportant branch 
to the tympanian and called tympanic -
The third portion gives origin to three branches, two 
of these the arteriae receptaculi are unimportant
being distributed to the cavernous sinus and 
dura mater but the third is an important branch, 
4 Spinal Accesory nerve. 
Employ behind 
for 1/2 in

Ophthalmic Arty.
Branches.
(1) Lachrymal arty
(2) Supra Orbital
[3 & 4] Ant. & Post Ethmoidal 
(5) The Two Palpebral 
(6) The Frontal} terminal branches
(7) The nasal} 
(8) The Arteria Centralis Retina
(9) The muscular
(10) cilliary (ie) long. Shert. Anterior-
[illustration]

[illegible] 
332
the ophthalmic artery -
[crossed out]
- The Ophthalmic Artery -
The ophthalmic artery springs from the internal
carotid about the termination of its third portion
and passes forward into the orbit through the optic
foramen first lying below and external to the optic
nerve it crosses to the inner side of the nerve crosses over it and 
runs forward along the inner wall of the orbit to = up edge of rectus
divide at the internal angle of the orbit into two } it. pallyatiod
branches, frontal and nasal - } (a) just below " "  
-Branches-
The branches of the ophthalmic are ten -
(1) Lachrymal- (1) according to way the come off
The lachrymal artery runs forward along the outer
wall of the orbit and after supplying the lachrymal
gland passes on the upper eye-lid - It
gives off temporo-malar branches which pass
through the bone to the temporal muscle -
(2) Supra-orbital (4)
The supra-orbital runs forward on the levator 
palpebrae muscle and escaping to the fore-head
through the supra-orbital foramen is there distributed
by a superficial and a deep branch -
(3) & (4) Anterior & Posterior Ethmoidal -
The posterior and anterior ethmoidal arteries escapes 5 & 6
the one through the posterior ethmoidal foramen
the other through the anterior and are distributed
to the dura mater ethmoidal cells and nasal 
fossae -



333
(5). Palpebral - (7)
The two palpebral arteries, superior and inferior, arise
from ophthalmic near its termination; the superior
runs outward on the upper lid near its free between
the orbicularis palpebrarum and tarsal cartilage
and is distributed; the inferior does the 
same for the lower lid; the two sometimes arise by 
a common trunk -
(6) Frontal - (9)
The frontal one of the two terminal branches of the 
ophthalmic artery emerges at the inner angle of the 
orbit and ascends to be distributed along the middle 
of the forehead - (10)
(7) Nasal -
The nasal the other terminal branch of the ophthalmic
artery emerges at the inner angle of the 
orbit and is distributed along the ridge of the nose -
(8) Arteria Centralis Retinae - (3)
The arteria centralis retinae pierces the optic 
nerve and runs forward in it to reach the retina 
and be there distributed -
(9) Muscular - (2)
The ophthalmic artery gives off numerous muscular
branches in its course and these may be divided
into two sets, superior and inferior, the superior
springing by one trunk and the inferior by another -
(10) Ciliary - 3 + 2 one below & 1 employ (2)
The ciliary arteries consist of three sets;
1st short ciliary branches, are numerous small arteries
are really branches of short cell. 

[illustration]
poses out & back

334
arteries which pierce the sclerotic around the optic
nerve and supply the choroid -
2d Long ciliary arteries; which are two branches (a) 2 in no piercing
the sclerotic on opposite sides and running forward
between it and the choroid are distributed to 
the iris 
3d Anterior ciliary branches, are offsprings of the muscular
branches and pierce the sclerotic near the front 
of the eye to reach the iris -
The branches, from the fourth or cerebral portion of the 
internal carotid are four -
- Anterior Cerebral artery -
The anterior cerebral artery, one of the terminal branches
of the internal carotid runs forward in the longitudinal
fissure then ascends the germ of the corpus 
calloseum and runs backward along the upper surface
of the corpus calloseum Passing from the anterior
cerebral artery of one side to that of the other soon after
there origin is a communicating branch called the 
anterior communicating artery -
Middle Cerebral Artery - or Sylvian Arty
The middle cerebral artery arising as one of the terminal 
branches of the internal carotid passes outward
along the fissure of the Sylvius to be distributed
to the anterior and middle lobes of the cerebrum
and to the convolutions forming the island of Reil -
Anterior Choroid Artery -
The anterior choroid artery pierces the base of the 
brain to enter the descending cornu of the lateral 



335
ventricle and form the choroid plexus -
- Posterior Communicating Artery -
The posterior communicating artery the last of the 
four terminal branches of the internal carotid passes
backward to anastomose with the posterior cerebral 
of the basilar artery -
Circumscribing the six sided space of the base of the 
brain is a series of arteries and their communications 
forming what is called the vascular circle of 
Trillis; thus beginning in front, is the anterior communicating
and following the arteries back on one 
side they come in this order, anterior cerebral, internal
carotid, posterior communicating; posterior
cerebral and the termination of the basilar, following
them forward from the basilar on the outer side 
they come in the reverse order -
- The Veins 
The veins are the vessels which return the blood
which the arteries have carried to the capillaries,
consequently the course of the venous current is the 
opposite of arterial, viz, towards the heart into which 
they open after having converged to two trunks, superior 
and inferior venae cavae - The veins as a rule
accompany the arteries either singly or in pairs as 
satellite veins and the size of the vein or veins which 
return the blood from a given part is much greater 
than that of the artery or arteries supplying that 
part But it must be observed in the extremities
there are two sets of veins a superficial set which 
335
254
_______
81



336
course just beneath the skin in the superficial fascia
and a deep set the satellite veins so that here the 
veins accompanying the arteries remarkably 
small, especially in the upper extremity where the 
superficial are long and numerous; still ultimately
after a longer or shorter course the two sets coalesce 
The companion vein of an artery as a rule receives
accessions corresponding to the branches emitted by 
its artery, through to this there are some notable exceptions -
- The Veins of the Lower Extremity -
The veins of the lower extremity consist of two sets
the superficial and deep or satellite -
Beginning then with the satellite veins we find 
that those of the posterior tibial artery have been 
formed where that artery terminates by the coalescence
of the four satellite veins of the two plantar
arteries, and ascend receiving tributaries in correspondence
with the branches of the artery until they
reach the point where the popliteal artery terminates
and there unite with the satellite veins of the 
anterior tibial artery to form the popliteal vein -
The satellite veins of the anterior tibial artery are 
the continuation of those of the dorsalis pedis and 
ascending and growing by accessions corresponding
to the branches of the artery they terminate by coalescing
with the posterior tibial veins to form the 
popliteal vein - The Popliteal vein thus formed lies 
at first to the inner side of its artery but as it ascends 
it crosses superficially to the outer side and 
there remains to where it terminates at the lower 
third of the thigh by becoming the femoral - The popliteal

femoral aperture at about the junction with 
middle and lower third of the thighs by the 
femoral artery (aductor magnis)
note that short saphenous is behind ext.
maleolas and being is in front of int. m. 

337
popliteal vein receives not only tributaries corresponding
to the branches of the popliteal artery but also one 
of the superficial veins called the short saphenous -
The Femoral vein the continuation of the popliteal
commencing where that vein ceases at the opening
in the adductor magnus muscle for the femoral 
artery (?) ascends in company with its artery lying
at first external, then behind and finally internal 
to it and terminates by becoming the external
iliac vein at the same point where the femoral artery
commences -
The femoral vein receives accessions
as it advances corresponding to the branches of its artery
and also the second of the two superficial veins,
the long saphenous which opens into it just below 
Poupart's ligament. Thus, it is seen that from the 
commencement of the femoral artery to the termination
of the popliteal the artery of the lower extremity
is accompanied by but one vein -
The Superficial Veins of the lower Extremity - The 
superficial veins of the lower extremity consist of two 
trunks called external and internal or shorter and 
long saphenous -
- Short Saphenous Vein -
The short saphenous vein begins on the outer side 
of the dorsum of the foot, ascends behind the external
malleolus and with an inclination inward
gains the groove between the two bellies of the gastro-cnemius 
muscle and continues its course upward
to open into the popliteal vein, having received numerous
accessions on its course - 



338
- Long Saphenous Vein -
The long saphenous vein commences on the inner
side of the dorsum of the foot at dorsal arch - 92 and ascends in front of 
the internal mallelous behind the inner condyle
of the femur and then after ascending the inner side 
of the thigh for some distance inclines to the front 
and just below Poupart's ligament pierces the fascia 
lata and opens into the femoral vein gathering as 
it runs tribute from many smaller superficial
veins and receiving just as it is about to terminate
the veins of the four first branches of the femoral artery 
- Externak Iliac Vein -
The external iliac vein is the continuation of the 
femoral from Poupart's ligament upward and inward 
along the brim of the pelvis to unite with the 
internal iliac vein on the disk between the 5th lumbar
vertebra and base of the sacrum to form the common
iliac vein - It receives accessions corresponding
to the two branches of the external iliac artery epigastric
and circumflex iliac -
The two external iliac veins bear different relations -
The vein of the left side is internal to its artery -
The right vein is first internal then behind and 
then behind and external -
The Internal Iliac Vein -
The internal iliac vein is formed by the coalescence
of the veins accompanying the branches of the internal
iliac artery, the veins of the visceral branches
are so numerous and intersecting that they form 
plexuses - The vein thus formed ascends behind

[illustration]


339
its artery and unites with the external iliac vein 
on the disk between the 5th lumbar vertebra and 
sacrum to produce the common iliac vein.
- The Common Iliac Vein -
The common iliac vein is the result of the union
of the external and internal iliac veins at the brim
of the pelvis on the disk between the 5th lumbar vertebra
and sacrum and passes upward and inward
to unite with its fellow of the opposite on the 
right side of the disk between the 4th & 5th lumbar
vertebrae to form the inferior vena cava - The average
length of the vein is two inches though the vein of 
the left side is the longer - The relation of each vein
to its artery is as follows -
The left vein is behind and internal to its own artery
and crosses behind the right artery -
The right vein is behind and external to its artery -
The Inferior Vena Cava -
The inferior vena cava begins by the union of the 
two common iliac veins on the right side of the disk
between the 4th & 5th lumbar vertebrae and ascending
to the right of the abdominal aorta perforates the diaphragm
and opens into the right auricle.
The inferior vena cava receives tributaries corresponding
to only some of the branches of the aorta it is true
that it eventually receives all the blood circulating
through those arteries but not from accompanying
veins of all of them for the veins corresponding to 
the arteries distributed to the organs of digestion coalesce 
into a trunk the portal vein which discharges



340
discharges itself into capillaries of the liver and from these the 
blood is gathered by the hepatic veins and by them
discharged at the posterior border of the liver into the 
inferior vena cava -
- The Portal Vein -
The portal vein is formed by the union of the superior 
mesenteric and Splenic veins behind the head 
of the pancreas and ascends in the right border of 
the lesser omentum between and behind the hepatic 
artery and duct to the transverse fissure of the liver 
where it divides into a branch for each of the two lobes
of the liver, being about four inches long - Now although
the portal vein is found directly by the union of the 
superior mesenteric and splenic veins still it conveys 
the blood from the inferior mesenteric vein and 
the gastric vein for these two open into the splenic vein -
As stated the blood carried to the liver by the portal
vein is collected by the hepatic veins which emerge
by 3 or 4 apertures on the posterior border of the liver and 
open into the inferior vena cava -
The Spermatic Vein -
The spermatic vein begins in the testicle by a plexus 
which ascends as numerous small veins along 
the spermatic cord to the internal abdominal ring 
where uniting into two veins these pass upward 
and inward and soon unite to form a single vein:
the vein of the right side opening into the inferior
vena cava and the left veins into the left renal 
vein having been crossed by the sigmoid flexure -
- The Vein of the Upper Extremity - 



341
The veins of the upper extremity comprise two sets
the superficial and deep -
- The Deep Veins -
The deep or satellite veins of the upper extremity 
are remarkably small owing to the great amount of 
blood flowing through the superficial veins -
The satellite veins of the radial and ulnar
arteries formed by the coalescence of the veins of 
the branches of those arteries, unite to produce
the satellite veins of the brachial artery a finger's 
breadth below the middle of the front of the elbow
The brachial satellite veins having collected the 
blood from the veins of the branches of the brachial
artery unite where the axillary artery terminates
to form the axillary vein which passes upward
and inward and lying to the inner front aspect of its 
artery to cease at the lower border of the clavicle by 
becoming the subclavian vein having received accessions 
in correspondence with the branches of the 
axillary artery -
- The Superficial Veins -
The superficial veins of the upper extremity are 
seven -
- Anterior Ulnar -
The anterior ulnar vein begins on the inner side 
of the front of the fore-arm and ascends to unite 
with the posterior ulnar vein just below the elbow.
- Posterior Ulnar -
The posterior ulnar vein passes up the inner side 
James S Wilson

[illustration]

342
of the back of the fore-arm to turn forward and 
unite with the anterior ulnar just below the elbow 
to form the common ulnar vein -
- The common Ulnar -
The common ulnar vein ascends to the inner side 
of the front of the elbow to unite with another vein
the median basilic and form the basilic vein -
- Radial -
The radial vein commences on the outer side of 
the back of the hand and ascends with an inclination
forward and inward to terminate at 
the outer side of the front of the elbow by uniting
with the median cephalic vein to form the cephalic
vein -
- Median -
The median vein ascends along the middle of the 
front of the fore-arm from the hand to a little below 
the front of the elbow where it divides into two 
veins one, the median - cephalic passes upward and 
outward to unite with the radial vein and form the 
cephalic vein while the other the median - basilic
passes upward and inward to join the common 
ulnar vein and forms the basilic vein -
- Basilic -
The basilic vein commences at the inner side of the 
front of the elbow by a union of the common ulnar 
and median basilic veins and ascends the inner
side of the arm lying to the inner side of the brachial
artery, first superficial to it and then pierces 



343
the deep fascia to reach the level of the artery and 
where the satellite veins of the brachial unite it 
coalesces with them to produce the axillary vein -
- Cephalic -  92
The cephalic vein begins at the outer side of the  
front of the elbow being formed by the union of the 
medium - cephalic and radial veins and ascends
the arm skirting the outer edge of the biceps muscle 
then lying in the interval between the Deltoid  } with accesso 
{thoracic Arty. and pectoralis major it terminates in the 
axillary vein near its termination = The cephalic
vein receives a communication near its termination 
which passes over the clavicle from a vein of 
the neck, external jugular -
- The Subclavian Vein - N.B.
The subclavian vein is the continuation of the axillary;
it passes horizontally inward behind the 
clavicle to unite just behind the sterno-clavicular 
articulation with the internal jugular vein and 
form the vena inominata - The subclavian vein is 
in relation with its artery only where the artery
terminates there lying internal and where the artery 
begins there lying below or external intermediate 
between these points the vein is below the artery
and separated from it by the scalenus anticus
muscle -
- The Right Vena Inominata -
The right vena inominata begins behind the right 
sterno-clavicular articulation by the union of the 
right subclavian and internal jugular veins and 
Just above 
flexure-



344
descends nearly perpendicularly to unite with the
left vena innominata to form the superior vena cava
being about 1 1/4 in long, lying external to the arteria 
innominata -
- The Left Vena Innominata -
The left vena innominata, or great transverse vein,
is formed behind the left sterno-clavicular articulation
by the junction of the left subclavian and internal 
jugular veins and passes almost horizontaly
to the right lying upon the arch of the aorta and 
in front of the origins of the three arteries springing
there from and unites with the right vena innominata
to form the superior vena cava - The vena
innominata receives accessions corresponding to the 
branches of the subclavian artery except the veins accompanying
the supra-scapular and transversa
colli arteries which open into a superficial vein of 
the neck the external jugular and this shows into 
the subclavian vein -
- The Superior Vena Cava -
The superior vena cava is formed at the lower border 
of the second costal cartilage of the right side by the 
confluence of the two venae innominatae and descends
to the right of the ascending aorta for about three inches
to open into the right auricle of the heart -
- The Azygos Veins -
The two azygos veins, right and left, are a means of 
communication between the two venae cavae -
- Right Vena Azygos - 



345 
The right vena azygos begins in the right lumbar region
by a communication with one of the lumbar
veins or the renal vein or even the inferior vena cava
itself and ascends along the front of the vertebral 
column through the aortic opening of the diaphragm 
to the right of the descending aorta until it reaches 
the 3d dorsal vertebra, where it arches forward over 
the right bronchius and opens into the superior vena
cava - It receives the right intercostal veins as far 
up as it extends and also the left vena azygos -
- The Left Vena Azygos -
The left vena azygos begins in the left lumbar region
in the same way as the right does and ascends piercing 
the left crus of the diaphragm and lying beside 
the vertebral column as high as the 6th Dorsal vertebra 
where it crosses behind the forta and opens into 
the right vena azygos - It receives the left intercostal
veins as high up as it extends - The intercostal veins 
of each side which lie above the termination of the 
vena azygos open into a vein called the right or left
superior intercostal: the right superior intercostal
opens into the right subclavian vein the left superior
intercostal vein opens into the left vena innominata -
- The Veins of the Head and Neck -
The veins of the head and neck comprise three veins
called jugular external, internal and anterior and 
their formative branches -
J.S. Wilson
- The Internal Jugular Vein -
The internal jugular vein begins at the foramen lacerum

comences at the termination of lateral cerius -.

346
lacerum posterius by the convergence of the blood from 
the interior of the cranium and descends the neck lying
first behind then external to the common carotid
artery to terminate behind the sterno-clavicular articulation
by uniting with the subclavian vein to form 
the vena innominata of that side -
It receives nearly all the blood returned from the ramifications 
of the external carotid artery the veins converging 
this blood may be thus described - The temporal
and internal maxillary veins having collected
the blood from the distribution of their arteries coalesce
in the parotid gland to form a common trunk
called the temporo-maxillary, which after descending 
a short distance divide into two branches one mounting 
over the sterno-mastoid muscle to become the external
jugular vein and the other opening into the 
facial vein; the facial vein begins on the forehead
under the name of the frontal vein this descends
near the centre of the forehead to the internal angle 
of the eye where it is called the internal angular 
vein and then downward with the facial artery taking 
thence the name of facial; soon after reaching
the neck it is joined by a branch of the temporo-maxillary
vein and then opens into the internal jugular
vein about on a level with the upper border of the 
thyroid cartilage - It sometimes receives the lingual 
vein and the superior thyroid vein though usually
these open into the Internal Jugular vein -
- The External Jugular Vein -
The external jugular vein commences in the parotid
as a branch of the temporo-maxillary vein which 

Sometimes empt. its self into int jug.

J Sprigg Wilson
W.S.A.
347
is joined by the posterior auricular vein and sometimes
by the occipital and descends across the outer 
surface of the sterno-cleido-mastoid muscle and 
then along its posterior border to cross the third portion
of the subclavian artery and open into the subclavian
vein - It receives just before terminating 
the supra-scapular ani transversa colli veins and 
has a communication across the clavicle with the cephalic 
vein -
Jas S Wilson
- The Anterior Jugular Vein -
The anterior jugular vein descends the front of the 
neck beside the middle line and just above the 
sternum turns outward beneath the sterno-cleido-mastoid
muscle and opens into the subclavian vein -
It is always small and sometimes inconspicuous -
- The Sinuses of the Dura Mater -
The veins which return the blood from the brain consist
of those on the surface of the brain called the 
superficial cerebral; those of the interior of the brain
and certain canals in the layers of the dura mater
which receive the blood from the foregoing called sinuses -
- The superficial Cerebral Veins -
The superficial cerebral veins although they may be 
seen on the whole surface of the brain are especially 
long and numerous on the upper aspect; these veins
open into the sinuses which are near them -
- Deep Cerebral Veins -
The blood from the interior of the brain is collected 



348
by veins which ultimately coalesce into two (the venae
Galeni) which emerge beneath the posterior lobes of the 
cerebrum one on each side and open into a sinus of the 
tentorium; the straight -
- The Sinuses of the Dura Mater -
The sinuses of the dura mater are nine as follows -
- Superior Longitudinal Sinus -
The superior longitudinal sinus is found running 
from before backward in the attached margin of the 
falx major; beginning in front at the foramen coccum
it passes backward grooving the vault of the cranium
to terminate at the anterior occipital protuberance 
by dividing into the two lateral sinuses - It receives
the superior superficial veins which open into it 
from behind forward -
- The Lateral Sinus - 
The lateral sinus begins at the anterior occipital protuberance
and passes outward along the horizontal 
limb of the occipital cross then curves downward over
the inferior posterior angle of the parietal bone the 
mastoid portion of the temporal bone and again on 
the occipital bone to terminate in the jugular vein at 
the posterior foramen lacerum, the position of the 
lateral sinus is indicated in the dried bone by a 
groove -
- The Occipital sinuses -
The occipital are two small sinuses which commence
around the foramen magnum and ascend in the 
attached margin of the falx minor to open at the 
anterior occipital protuberance into the commencement
of the lateral sinuses - 

Relation of carotid 
Arty.
Gray 621 P

349
- Inferior Longitudinal Sinus -
The inferior longitudinal sinus is a small and unimportant;
it runs backward in the lower free concave 
edge of the falx major to terminate when to it
reaches the tentorium in the straight sinus -
- The Straight Sinus -
The straight sinus triangular in shape runs horizontally
backward along the centre of the upper surface
of the tentorium between the layers of the falx
major to terminate at the anterior occipital protuberance -
It is thus seen that four sinuses superior longitudinal,
straight and two occipital, convey their tide
to the anterior occipital protuberance and that the 
blood is removed from this point by the two lateral
sinuses hence this place is called the Torcular Herophili -
The sinuses above described are found at the 
upper and back part of the brain but there are others
situated at the base as follows -
- The Cavernous Sinus -
The cavernous sinus occupies the groove at either 
side of the sella turcica, commencing in front by 
receiving the ophthalmic vein it passes backward to 
terminate at the apex of the the petrous bone by dividing
into two, superior and inferior petrosal - Passing through
the cavernous sinus from behind forward are the 
internal carotid artery and several nerves - The sinuses 
of the two sides are connected by transverse
communications, one in front and one behind across
the sella Turcica thus forming an arrangement
called the circular sinus or sinus of Ridley - 



350
- The Superior Petrosal Sinus -
The superior petrosal sinus passes outward and backward
along the upper border of the petrous bone of to 
open into the lateral sinus just where it curves
downward -
- The Inferior Petrosal Sinus -
The inferior petrosal sinus passes backward and outward
along the (lower) posterior border of the petrous 
bone to terminate with the lateral sinus at the posterior
foramen lacerum to form the internal jugular
vein -
- The Transverse Sinus -
The transverse sinus consists of one or more channels
of communication across the basilar process between
the two inferior petrosal sinuses -
- The Veins of the Diploë -
Ramifying between the tables of the bones of the 
skull are numerous veins called diploetic - They 
take the name of the region they occupy and finally
converging to four trunks these open either into 
the sinuses of the interior or the veins of the exterior -
Connecting the sinuses of the interior with the veins 
of the exterior of the head are several veins (called
emissary) which pass through foramina as the 
mastoid and parietal.
- The Spinal Veins -
The spinal veins consist of three sets as follows -
- Dorsi spinal Veins -
The dorsi-spinal are numerous veins forming a network
on the exterior of the vertebrae - 



351
- Meningo-rachidian Veins -
The meningo-rachidian are four veins perpendicular 
in direction which lie within the spinal canal between
the bone and dura mater, two being in front
and two behind.
- Medulli-spinal Veins -
The medulli-spinal are numerous veins ramifying
beneath the arachnoid membrane of the spinal 
cord -
- The Cardiac Veins -
The veins of the heart are two as follows -
The Great Cardiac Vein -
The great cardiac vein ascends in the anterior ventricular 
groove winds around the left auriculo-ventricular
groove and opens into the right auricle, the 
last inch of its course is known as the coronary sinus.
- The Posterior Cardiac Vein -
The posterior cardiac vein is small and ascends
in the posterior ventricular groove to open into the 
great cardiac vein -
- The Lymphatic System -
The lymphatic system consists of numerous small 
vessels ramifying in nearly every tissue of the body 
and of reddish pea-like bodies lymphatic glands
found at intervals along the course of the lymphatic
vessels - The lymphatic vessels are intended for the 
most part to remove from the tissues the detritus of 
assimilation consisting chiefly of unexpended plasma; 
consequently the course of their circulation is 
from the circumference towards the centre and on 
their route they will be found accompanying the veins. 



352
Wherever they are found lymphatics consist of two sets 
a superficial set, on the extremities lying just beneath
the integument, in the viscera ramifying on 
the surface, and of a deep set which in the extremities
are distributed in and among the muscles and in 
viscera throughout their structure - The greater portion
of the lymphatic vessels of the body converge to form 
one large vessel called the Thoracic duct which conveys 
their contents into the venous current near the 
heart -
- The Thoracic Duct -
The thoracic duct begins on the front of the body of the 
second lumbar vertebra by considerable dilation
called the receptaculum chyli and narrowing to a 
tube of the size of a goose-quill it ascends on the 
front of the vertebral column behind the descending 
aorta, thro' the aortic opening of the diaphragm as 
high as the fourth dorsal vertebra where it inclines
to the left and continues thence an oblique ascent 
behind the arch of the aorta to a point on a level 
with the seventh cervical vertebra it there arches
forward and downward and opens into commencement
of the left vena innominata - Opening
into the commencement of the right vena innominata
is another much smaller lymphatic duct
(called the ductus lymphaticus dexter) which 
conveys lymph furnished it chiefly by the lymphatic
vessels of the right upper extremity and 
right side of the head and neck -
- The Lympathic of the Lower Extremity -
The superficial lymphatics of the lower extremity 



353
are found crowding upward in immense number 
along the course of the saphenous veins and reaching
the saphenous opening in the fascia lata where the 
long saphenous vein terminates just below Poupart's
ligament they there pass through a set of lymphatic 
glands. The deep lymphatic vessels accompany the 
deep veins upward to the groin where they are connected
with a set of glands lying beneath the fascia
lata and superficial muscles called the deep lymphatic
glands of the groin; along the previous course
of these vessels are found a few glands some in the 
popliteal space and one on the front of the interosseous
membrane of the leg. The Lymphatic vessels
from the external organs of generation and from 
the abdominal parietes can be traced to a third
set of glands which form a chain along Poupart's
ligament lying superficial and above the glands
around the saphenous opening -
All these vessels pass beneath Pouparts to become 
the external iliac lymphatics which accompanying 
the external iliac vessels unite the internal iliac
lymphatics to form the common iliac lymphatics 
which accompanying the common iliac vessels
unite with those of the opposite side to form the lumbar
lymphatics. Scattered at internals along these 
vessels from Poupart's ligament are lymphatic glands.
The lumbar lymphatics ascend along the aorta
constantly increasing in size by accessions from the 
abdominal viscera having passed through numerous 
glands and lessened in number as they increased 
in size they eventually open into the receptaculum
chyli which is so named from the fact 



354
that the lymphatics it receives from the small intestines
during the period of digestion are filled with 
chyle -
- The Lymphatics of the Upper Extremity -
The lymphatic vessels of the upper extremity like 
those of the lower consist of a superficial set and a 
deep set the superficial ascend in company with 
the superficial veins and the deep accompany the 
deep veins both converging to the arm-pit where there
are some 12 or 15 lymphatic glands; besides the vessels
from the upper extremity these glands also receive 
vessels from the chest wall and mammary
gland - A few glands are found along the course
of the lymphatic vessels before they reach the axilla,
some at the elbow and some along the brachial vessels,
these however are small and unimportant -
From the axillary glands the vessels proceed along
the course of the subclavian vein, on the left side
opening into the termination of the thoracic duct 
and on the right into the ductus lymphaticus 
dexter -
- The Lymphatics of the Head & Neck -
The lymphatics of the neck consist of vessels which 
have come from the exterior of the head and others 
which have converged from veins supplying the 
internal and external jugular veins, no lymphatics 
however being found in the substance of the 
brain -
These vessels descend along the external and 
especially the internal jugular veins and on the 
right side open into the ductus lymphaticus dexter
while on the left they join the thoracic duct.



355
- The Lympathics of the Thorax -
The lymphatic vessels accompanying the inter-costal
vessels open into the thoracic duct, those from
the right lung, some from the thoracic parietes,
diaphragm; and even upper surface of the liver
and slight border of the heart seek the ductus lymphaticus 
dexter; those from the left lung left side 
of the thorax and most of the heart join the thoracic
duct - The vessels from the lungs pass through 
a set of glands situated around the bifurcation
of the trachea called the bronchial glands -
- The Nervous System -
- The Cranial Nerves -
The cranial nerves comprise twelve pairs, that is 
twelve nerves on each side, those of one side having 
their counterparts on the opposite side -
The definition of a cranial nerve is that it appears
at the base of the brain and emerges through an 
aperture in the base of the skull - The point on the
base of the brain the nerve appears is called its apparent
origin, since it may be traced into the interior 
of the brain to what is called its real origin;
the real origin of many of these nerves being still 
a subject of dispute.
The cranial nerves are named numerically in 
pairs from before backwards there being twelve pairs:
besides which each pair is known by another or 
several other names derived usually from the 
part to which it is supplied - The following table 
gives the synonymes of the twelve pairs - 



James S Wilson
356
1st Pair, Olfactory -
2d " optic -
3d " Motores Oculorum -
4th " Pathetic (Trochleares) -
5th " Trifical, Trigeminal -
6th " Abductentes - Motor Exterus 
7th " Facial, Portio Dura -
8th Pair, Auditory - (Portio Mollio -
9th ", Glosso-pharyngeal -
10th " Pneumogastric, Par Vagum,
Vagus -
11th " Spinal Accessory -
12th " Hypoglossal (Lingual) 
These twelve pairs were formerly considered as only
nine from the fact that, as will be seen they emerge
through nine foramina in the base of the cranium; this 
classification into nine pairs is known as that of Frillio,
the one given above as that of Soemmering; the two 
classifications are similar for the first six pairs; the 
seventh pair in Frillio's classification comprised
[illegible] auditory, while the eight consisted
of glosso-laryngeal pneumogastric and spinal 
accessory, and the ninth of the Hypoglossal) -
There will first be given a general outline of all the 
cranial nerves successively from their apparent origins
to their points of emergence from the cranium 
and afterwards each pair will be taken up and described -
Of the cranial nerves the first seen on the 
base of the brain from before backwards is the first 
nerve; it lies on the under surface of the anterior lobe 
of the cerebrum in a groove a little external to the 
longitudinal fissure, having its commencement by 
a three-forked origin, just in front of the anterior
perforated space it enlarges into an oval-shaped
mass near the anterior extremity of the anterior
cerebral lobe which lies upon the cribriform plate of the 
ethmoid bone and sends its branches of distribution
through the foramina seen there - The second nerve 



357
is first seen under the name of the optic tract, approaching 
its fellow from the outer aspect of the crus 
cerebri and passing beside the tuber cinerum
unites with its fellow in front of it to form the optic 
chiasm or commissure from which the two optic 
nerves diverge forward to enter the orbits through the 
optic foramina - The third nerve is seen emerging
to the inner side of the crus cerebri just in front 
of the pons Variolii and running forward to leave 
the cavity of the cranium by the anterior foramen
lacerum. The fourth nerve has its apparent origin
external to that of the third, on the optic side of the 
crus cerebri and it has its exit also through the anterior
foramen lacerum - The fifth nerve is the largest
of the cranial nerves and is first seen just behind 
the origin of the fourth nerve, piercing the 
lateral aspect of the Pons Varolic and after splitting
into three branches, called ophthalmic, superior  
maxillary and inferior maxillary (?), requires three
apertures to give it exit from the cranium; the 
ophthalmic leaves through the anterior foramen 
lacerum, the superior maxillary through the foramen
rotundum and the inferior maxillary through the 
foramen ovale - 
The sixth nerve takes its apparent origin behind 
that of the fifth from the upper constricted portion
of the medulla oblongata just behind the pons Varolii 
and passes forward to gain egress through the 
anterior foramen lacerum which is thus seen to 
transmit three entire cranial nerves and a part 
of another these being the 3d 4th 6th and the Ophthalmic 
branch of the 5th - The seventh nerve, the eighth, 

Deep origin -
ext root nuclus grey matter in tempro sphere. lobe.
middle - " " Ant. lobe 
int " Gyrus fumcatus - 

358
the ninth, the tenth and the eleventh, all arise in 
this order from above downward in the groove between
the corpora olivare and restiforme of the medulla
oblongata; the seventh and eighth both leave
through the same foramen the internal auditory
meatus - the remaining three, 9th 10th & 11th all gain 
exit through the posterior foramen lacerum - 
The twelfth nerve has its apparent origin to the inner 
side of the five preceding nerves from the groove
between the corpora olivare and pyramidale, by numerous
filaments which are speedily collected into 
two cords which unite to form the nerve as it 
emerges through the anterior condyloid foramen -
1st Nerve -  Olfactory -
The first nerve, or the olfactory nerve, arises by a 
three-forked origin close to the anterior perforated space,
the external or long root consists of white fibres and 
may be traced along the fissure of Sylvius into the 
middle lobe of the cerebrum the middle root is of 
gray matter and springs from the posterior part 
of the anterior lobe, the inner or short root is of 
white fibres and also arises from the posterior part 
of the anterior lobe - The three roots unite to form the 
nerve just in front of the anterior perforated space,
which passes forward triangular in shape and 
grayish in color lying in a groove on the under surface 
of the anterior lobe of the cerebrum a little external
to the longitudinal fissure and swells into 
an oblong grayish enlargement called the bulbous 
olfactories, which lies beside the crista galli on 
the cribriform plate of the Athmoid bone - From the 



359
[illegible] surface of the olfactory bulb are given off some 
twenty filaments which descend into the nose through 
the foramina of the cribriform plate to be distributed
to the mucous membrane of the nose as far down as 
the middle tubinated bone; these filaments may be 
arranged in three sets, those to the septum manum,
those to the external wall and those to the roof of the 
nose -
- 2d Nerve - [crossed out]
The second nerve or optic nerve has its apparent
origin just external to the crus cerebi, whence it 
may be traced to its deep or real origin from various 
parts of the optic thalamus and from the corpora
quadrigemina, winding around the outer side of the 
crus cerebri it passes forward and inward beside
the tubes cinerum and in front of it unites with 
its fellow to form the optic commissure or chiasm;
this portion of the nerve from its origin to the chiasm
is called the optic tract - From the optic chiasm
the two optic nerves diverge anteriorly to enter
the orbits through the optic foramina, each pierces
the sclerotic and choroid coats of the eyeball and expands
into the Retina -
The connection between the optic tract chiasm and 
nerve is as follows - The optic tract is composed of 
filaments, the outermost of which pass into the nerve
of that side the innermost curve over through the 
chiasm to form the innermost fibres of the opposite 
tract; the middle fibres of the tract of one side 
cross through the chiasm to form the middle fibres
of the nerve of the opposite side; the innermost fibres
of one nerve arch over through the chiasm to become

Lentic. Ganglin. lies just where the apth. Arty crosses the optic nerve
it lies to out Side of the optic nerve. & is connect with inf dif 
of motor occuli.
3rd nerve.
723 grey
411 notes
3rd 
Supplyes all the mus in the orbit except the Sup - oblqu
And external rectus
External rectus double head -  
[illustration]
3  } Cape Sevus -
4  }
5  }
6t }
Max- Arty 
4th Supplyes - the Supuin oblique - 
[illustration]
rut. Loch.
Sup. Dir 3-
none
inf. Di 3
6th 
op. vein
arises by v. roots

Abduceus= 6th"
Partheticus= 4th"
360
the innermost fibres of the opposite nerve and thus 
all the fibres of either nerve are accounted for -
3d= Nerve - motor Oculi 
The third nerve or motor oculi, leaves the brain to the 
inner side of the crus cerebri close to the front of the 
pons Varolii passes forward in the outer wall of the 
cavernous sinus centers the orbit through the foramen 
lacerum anterius and divides into two branches which 
supply all the muscles within the orbit except the superior 
oblique and external rectus - As it enters the 
orbit it lies between the two heads of the external rectus
and thence one of its branches ascends to supply
the superior rectus and levator palpebrae while the 
other is distributed to the internal rectus the inferior
rectus and the inferior oblique; all its fibres enter
the muscles on their ocular aspects - N.B.
- 4th Nerve - Partheticus
The fourth nerve, or partheticus, appears external to 
the apparent origin of the 3d nerve, viz, to the outer 
side of the crus cerebri and passes forward in the 
outer wall of the cavernous sinus, enters the orbit 
through the foramen lacerum anterius and is distributed
to the superior oblique from its orbital surface -
is the highest nerve in Sph fissure even above the orig of the mus.
" To the inner side 
- 5th Nerve - = Tri facial
The fifth nerve, or trifacial, or trigeminal appears
just behind the fourth nerve emerging from the lateral
aspect of the pons Varolii - It arises by two roots,
one is known as the anterior or small or motor root,
the other as the posterior, or large or sensitive root - The  
highest

Gasserian ganglia at anterior face of relations bone
(a) in the digital depression - 
Opthalmic Splits into 3 branches } Lach
} Tooth
} Nasal
Gasserian Ganglia = { Opthalmic
{ Superior Maxillary
{ inferior " " (motor)
Opthalmic (dir) } Lachrymal
} Frontal
} Nasal
J Sprigg
Frontal branches - } Supra Orbital
} " trochlea  

361
large root passes forward over the superior border of the 
petrous bone near its apex and then sivello into a ganglion 
known as that of Gasser; which lies in the digital
depression on the anterior face of the petrous bone - The 
small root passes forward beneath the large and is 
found lying under the ganglion of Gasser without participating 
in its formation -
The ganglion divides into three branches ophthalmic,
superior maxillary and inferior maxillary; the latter is 
joined bodily by the small root of the nerve and is 
therefore the only one of the three branches of the 5th nerve
which possesses motor endowments -
I. The Ophthalmic Nerve - 
The ophthalmic branch passes forward and soon divides
into three branches, lachrymal, frontal and nasal,
which enter the orbit through the foramen lacerum 
anterius -
- (1.) Lachrymal Nerve -
The lachrymal nerve passes forward along the outer 
wall of the orbit to supply the lachrymal gland and 
not being exhausted in this duty continues its course 
to emerge at the outer angle of the orbit and supply the 
integument adjacent - 
(2) Frontal Nerve - is most External in [illegible]
The frontal branch passes forward on the levator palpebrae 
muscle to divide into two branches supra-orbital 
and supra-trochlear - in back of orbit.
1st The supra- -orbital branch emerges from 
the orbit at the supra-orbital foramen to supply the 
upper lid and the muscles and integument of the 
{ Surses at through f. ovale
{ in company with Euf. der. [illegible]
{ Enters the abt [illegible] Sph [illegible]
{ [illegible] in the outer [illegible] of [illegible]
{ [illegible]
NB

nasal divides in the nasal forsia 
into a branch to the mucus mem. of the nose.
a " " the pot as pect of " } spinal bone
} notch
a " the infra trochlea " " 
notes on anatin 
Washington D.C.
notes
Washington D.C.

362
fore head as far back as the vertex of the skull.
2d The supra-trochlear branch advances to the inner
angle of the orbit where it emerges above the forea
trochlearis, hence its name and is distributed to 
the inner angle of the eye and the integument of 
the root of the nose and middle of the forehead -
(3) The Nasal Nerve - floor of 4th ventricle -
The nasal branch crosses the optic nerve advances
along the inner wall of the orbit reenters the cavity 
of the cranium through the anterior ethmoidal foramen 
and is there found lying in the slit beside
the crista galli whence it sinks into the cavity of 
the nose and divides into a branch for the mucous 
membrane of the nose and another to descend along 
the posterior aspect of the nasal bone to its lower edge
where it emerges through the notch found there and 
supplies the integument of the nose to its tip. Just
as the nasal nerve is entering the ethmoidal foramen
it gives off a branch called the infra-trochlear,
which passes forward to emerge at the inner angle
of the orbit below the forea trochlearis and supply
the lachrymal sac and inner angle of the eye - It 
also gives off besides the infra-trochlear three other 
branches in the orbit, one to the ophthalmic ganglion
of the sympathetic system, and two ciliary branches 
which pierce the sclerotic coat and pass forward
between it and the choroid to be distributed to the iris -
II. Superior Maxillary Nerve -
The superior maxillary branch of the fifth nerve like 
the ophthalmic has a forward course it gains egress
through the foramen rotundum continues its forward
2 heads of 
Rectus -
- Ant
- Separation
& Shape. 

Spheno maxillary passes across the 
" " fossa -
lower lid, cheek, & Side of nose - [cross out]
has to curee out in spheno maxi fossae - is getting from the foramen Potundun
to pass into the orbit (into the infra orbital groove)
branches of the orbital are temporal and 
malae -
emmerges
emerges 

363
direction across the spheno-maxillary fossa along a 
groove on the floor of the orbit sinks beneath the floor
and emerges at the infra-orbital foramen on the face
to give sensibility to adjacent parts, viz, lower lid,
cheek, side of the nose and upper lid -
- Branches -
Besides the terminal ones to the face the branches of 
the superior maxillary are the following and emitted
in this order -
(1) - Orbital -  or [illegible]
The orbital or temporo-malar branch enters the orbit
through the spheno-maxillary fissure and divides 
into two branches, viz, temporal and malar- The temporal
branch enters the temporal fossa through the 
outer wall of the orbit while the malar branch continues
along the outer wall of the orbit to emerge on the 
cheek at the outer angle - (a) integument. through malar. canal.
(2)- Spheno-palatine -  communicating.
The spheno-palatine are two branches of communication 
which descend to Meckels ganglion of the 
sympathetic in the spheno-maxillary fossa -
(3) Dental Branches -
The chief distribution of the superior maxillary nerve
is to the teeth and gums of the upper jaw and this 
is effected by two branches posterior and anterior
dental - The posterior dental is first emitted and 
supplies the three molar teeth and bicuspid; the 
anterior dental leaves the main trunk just as it is 
about to emerge on the face and supplies the two incisor 

no such thing as otec ganglia suuply a communication -
of 6 nerves 
for exam 92 -
pass out through the foramen ovale.
Ext. to Eustachian tube - )  90-91
behind " " Peterygoid process.) 
motor influence to the muscles of 
mastication
inf. Dental enters the dental foramen -
mylo by odicus - digit.
gives off some fib
at the mental foramen to lower lip.

364
incisor teeth, the canine and the front bicuspid -
The anterior and posterior dental nerves anastomose
in the bone and supply each tooth with as many filaments 
as the teeth has fangs besides giving twigs to 
the gums.
- III. Inferior Maxillary Nerve -
The inferior maxillary branch of the fifth nerve consists
of a branch from the ganglion of Gasser and the 
small or motor root of the fifth nerve; these unite
and their course is downward through the foramen
ovale; immediately after emerging from which the 
nerve divides into an anterior and a posterior trunk -
The distribution of each trunk is as follows -
(1) The anterior trunk breaks up into branches which 
supply the muscles of mastication each branch bearing 
the name of the muscle to which it is distributed
and conferring motor influence -
(2) - The posterior trunk divides into three branches,
inferior dental, gustatory and auriculo-temporal.
1st Inferior Dental -
The inferior dental branch curves forward and downward 
to enter the dental foramen of the lower jaw
and runs along a canal in the bone giving filaments
to all the teeth of the lower jaw; as it passes the mental 
foramen, it gives off a branch which escapes
there and supplies the integument of the lower lip -
Just before entering the dental foramen the nerve
gives off a branch called the mylo-hyoidean, which 
descends along the groove on the inner surface of the
inferior maxilla and is distributed to the mylo-hyoid
muscle and anterior belly of the digastic -
sub. max ganglion
730 - Gray -
Jan. 91
90-91
between the 
int. lat lig
and rumus of 
lower jaw -

Relations of the Gustatory Branch - 
Pude Tympanic
Communicate with the 12 move -
1st paralel ant with max aty.
2nd behind the [illegible] Arty. 

365
2d The Gustatory Branch -
The gustatory nerve passes downward and forward
first behind the external pterygoid muscle then between
the pterygoid muscles, then between the internal
pterygoid and rumus of the lower jaw and reaching 
the side of the tongue and splits into many filaments
to supply the anterior part of the tongue -
The gustatory nerve while between the two pterygoid
muscles and receives at an acute angle the chorda
tympani nerve a branch of the seventh nerve, which 
it transmits to the submaxillary ganglion of the 
sympathetic; The gustatory gives off a branch of 
communication to the twelfth nerve beneath the 
tongue -
3d The Auriculo-temporal Branch -
The auriculo-temporal branch arises by two roots
and first passing backward behind the articulation
of the lower jaw it then ascends between the 
meatus auditorius externus and condyle of the lower
jaw, and emerging from beneath the parotid gland
divides into branches called anterior and posterior
temporal which supply the integument of the temporal
region - It gives off branches to the articulation
of the lower jaw, to the parotid gland, to the prima,
to the meatus auris and two communicating
branches to the facial nerve. 
- 6th Nerve- Gray Mass - Floor of 4th Ventricle -
The 6th nerve, or abducens has its apparent origin
from the upper constricted part of the medulla oblongata
just behind the pons Varolii and advances
along the inner wall of the cavernous sinus to 

(Facial nerve or 7th -)
comences in the groove between the 
corpus olivare and restiformi 
and going into petrous bone by the 
int. auditory meatus it passes out
of the petrous bone by means of the 
Stylo mastoid foramen passing 
through the parotid gland over the 
external carotid arty is distributed
to the muscles of the face
except the muscles of mastication
Branches
Beside its terminal branches it gives off 
the following
I Auditory
II Tympanic
III Corda Tympani
IV Stylo hoyoid 
V Digastric
VI Post Auricular 
Porto Porteo
Portro

366
enter the orbit through the anterior foramen lacerum
and be distributed after passing between the two 
heads of the external rectus muscle to the ocular
face of that muscle -
- 7th Nerve - Motor nerve of face
The seventh or facial nerve is the uppermost of the 
five nerves which spring from the groove between the 
corpus olivare and corpus restiforme; just beneath
it in the same groove is another nerve called the 
portio intermedia which unites with it and if 
this nerve be counted separately there may be said 
to be six nerves springing from the same groove successively -
It makes for the internal auditory meatus
which it enters in company with the auditory
and when the two reach the bottom of that short
canal the facial parts from its companion by entering 
another canal in the petrous bone called
the aqueduct of Fallopius which conducts it first 
outward then backward and then downward to the 
stylo-mastoid foramen, emerging from which it 
passes forward through the parotid gland over the 
external carotid artery and divides into numerous
branches which are distributed to all the muscles of 
the face except those of mastication and of these the 
buccinator gets a branch from the facial - (a) Suplyes mus of 
expression
connect with auriculoe tenp - = motor to the buccinator -
- Branches -
Besides its terminal filaments on the face [of] the 
facial gives off the following branches -
1st Auditory which is furnished the auditory
nerve while the facial is in the internal auditory

Intumasentia gangliformis -
Canal of H.
Intercresentic gangliformis which is in 
the hiatus Fallopii has the communicatoins
Petrosus Superficialis major
Petrosus " " minor
major with McKels ganglia
minor " The Olrc " " "
and external petrosal to the 
carotid plexus.

367
meatus.
2d Tympanic, which arises from the facial while
it is in the aqueduct of Fallopius and is distributed
to a muscle of the tympanic cavity - Stapedeous -
3d Chorda Tympani, which is emitted from the 
facial just above the stylo-mastoid foramen and 
first ascends through the petrous bone and enters
the tympanum at the base of the pyramid on its 
posterior wall, then crosses on the inner surface of the 
membrana tympani and leaves through the fissure
of Glaser; having emerged from which it joins the 
gustatory nerve between the two pterygoid muscles
and continues with it to the submaxillary ganglion -
After emerging from the stylo-mastoid foramen the 
facial gives off the following branches - 4th Stylo-hyoid,
which supplies the stylo-hyoid muscle - 
5th Digastric which is distributed to the posterior belly
of the digastric muscle
6th Posterior Auricular, which ascends behind the 
ear and after communicating with the auricular
branch of the pneumogastric is distributed by an 
anterior branch to the auricle and by a posterior
branch to the back of the head.
Besides the foregoing the facial has numerous communicating
branches three of these proceed from a 
gangliform swelling of the nerve called the intumescentia
gangliformis situated at the hitatus Fallopii;
they are the nervous petrosus superficialis major
to Meckel's ganglion the nervous petrosus superficialis 
minor to the otis ganglion and the external petrosal
to the carotid plexus -
After emerging the facial communicates with the 
{ glosso phargeal
{ ancularis magnus
{ anculo tempral 

7 or { 8th & 9th nerves
July 12th/89 - { Ligraece Euls of Sacrum - ventebro-Costal
{ Costo-Sbimal - Tempero - Maxillary
{ Eliuid. claircular - Scapulo-claircular
9th or Glosso Pharyngeal 4 Ventricle
3rd nerve arising from the groove between
the corpus olivare and Restiforum and 
escapes from the cranium with 10th & 11th
through the post lacerated foramen
behind the int. carotid. and after
crossing the ant carotid it terminates
in the muscles mem. of the tongue
Branches
1 Tympanic branch { a lining mem lymp. & Eust tube
{ b fenestra Rotunda
{ c " ovalis
{ d carotid plexus of the Sympth
{ e nervous petrosus Superficil. maj
{ f " " " minor 
2 muscular branch
3 Pharyngeal on post pt. of Ph.
4 Tonsilitic branch.
Branches of communiation are 
first 2 are from the petrous ganglion
1st & 2nd

368
glosso-pharyngeal, auricularis magnus of the cervical
plexus and receives two large branches from 
the auriculo-temporal -
- 8th Nerve - Floor of 4th Ventricle -
The eighth nerve, or portio mollis, or auditory is the 
second of the nerves arising from the groove between
the corpus Olivare and restiforme [on passes [illegible]
[??enter] along with the 7th nerve the internal auditory
meatus at the bottom of which it divides into a cochlear
branch and three vestibular branches, these being distributed
to corresponding parts of the labyrinth -
- 9th Nerves Floor of 4th Ventricle -
The ninth nerve, &  glosso-pharyngeal is the third
nerve arising from the groove between the corpus olivare 
and restiforme and escapes along with the 10th
& 11th nerves from the cranium through the posterior
foramen lacerum lying behind the internal carotid
artery it then passes forward between the artery and 
internal jugular vein to the outer side of the artery
then crosses the artery in front to the posterior border of 
the stylo-pharygeus, then crosses this muscle to be distributed
by its terminal filaments to the mucous
membrane of the posterior part of the tongue - Soft palate - & Tonsil filaments -
last part is beneath the hyo glossus -
Ext - to " 1 [illegible] gland -
- Branches -
Besides its terminal branches the 9th nerve gives off 
four branches of distribution - While in the jugular 
foramen the nerve presents the gangliform enlargements
the uppermost of these is small and unimportant 
called the jugular ganglion while the lower 
- in front
of 10-11 [illegible]
of Jug foramen

at base of Skull you have a ganlion
on the nerve - (a) in jug - foramen
Lu facial
Branches - of communication -
I 1 to the ganglion of the 10th nerve
II one to the Superior cervical ganglion
- of the Sympathetic
III one to the 7th nerve
IV One to carotid plexus - 

369
is larger and called the petrous ganglion; from the 
latter proceeds one branch of distribution, the tympanic -
1st The tympanic branch passes to the tympanum
through a canal which opens on the ridge of bone between
the carotid and jugular foramina; after reaching
the tympanum it is distributed by six branches
as follows - (Jacksons nerve -)
(a) one to the lining membrane of the tympanum and 
the Eustachian tube -
(b) one to the fenestra rotunda -
(c) one to the fenestra ovalis -
(d) one to the carotid plexus - of the sympathetic
Eustachian tube -
(e) one to the nervous petrosus superficialis major -
(f) One to the nerous petrosus superficialis minor -
2d The muscular branch - which supplies the stylo-pharyngeus
posterior belly of the digastric and stylo-hyoid -
3d The pharyngeal branches, which are found on 
the posterior part of the pharynx aiding to form a 
plexus called the pharyngeal from which the 
pharynx is supplied; the other nerves entering into
this plexus are from the 10th nerve, the Pharyngeal
and superior laryngeal branch of the 10th and the 
sympathetic -
4th The Tonsillitic branches which form a plexus 
on the tonsil -
The branches of communication of the 9th nerve are 
as follows, the first two are from the petrous ganglion -
1st One to the ganglion of the 10th= nerve -
2d One to the superior cervical ganglion of the sympathetic -

10th nerve or Pneumogastric
is the 4th nerve arising from the groove between
the corpira olivare and restiformi escaping 
from the cranium [cross out] by the jugular 
foramen termates by supplying the Stomach
Branches
I Pharyngeal
II Superior Laryngeal
III Recurent " " "
IV Post Pulmonary
V Anterior Pulmonary
VI Oesophagus or Ol is ophageal
VII Cardiac
The right nerve crosses the 1st portion of the rt Sub-clavian
The left nerve enters the throax 1st portion of 
Sub clavian crosses front arch of aorta 

370
3d One to the 7th nerve -
4th Carotid filaments, which descend with the cartoid
artery -
- 10th Nerve - Floor of 4th Ventricle -
The tenth nerve, or pneumogastric, or vagus, or par
vagum, in the fourth nerve arising from the groove
between the corpora olivare and restiforme, it escapes
from the cranium through the jugular foramen
and descends the neck, enters the thorax
through which it passes along the oesophagus 
and with the latter gains the abdomen where it 
is found running from left to right along the lesser 
curvature of the stomach - In the neck the 
course and relations of the nerve are the same on 
both sides, that is each nerve lies first between
the internal jugular vein and internal carotid
and common carotid artery, until it reaches the 
root of the neck when the relations thenceforward
vary according to the side; the right nerve at the 
root of the neck crosses the first portion of the right
subclavian artery enters the chest reaches the posterior 
aspect of the root of the right lung descends
thence along the posterior aspect of the oesophagus
to the stomach and runs along its lesser curvature
being distributed by its terminal branches to the 
posterior face of the stomach; the left nerve enters
the thorax lying on the front of the first portion of 
the left subclavian artery crosses the front of the 
arch of the aorta reaches the posterior aspect of the 
root of the left lung and thence to the stomach 
is found on the front of the oesophagus, reaching 
[illegible]
[illegible]
rt. of [illegible]
os [illegible]
trach.



371
the stomach it runs along the lesser curvature and 
is distributed to the anterior face - While in the jugular
foramen the nerve presents a gangliform enlargement
called the ganglion of the root and about 
1/2 in below thus a second larger one on the ganglion
of the trunk -
- Branches -
The branches of distribution besides the terminal or 
gastric, are;
1st Pharyngeal -
The pharyngeal branch arises from the ganglion of 
the root and descends to the posterior aspect of the 
pharynx to aid in forming the pharyngeal plexus -
2d Superior Laryngeal -
The superior laryngeal branch arises from the ganglion
of the trunk and descending pierces the thyro-hyoidean
membrane and is distributed to the mucous 
membrane of the larynx (and gives a filament
to the arytenoid muscle) - Just below the thyro-hyoidean
membrane it gives off a branch called
the external laryngeal, which is distributed to the 
thyroid gland and circo-thyroid muscle and 
furnishes some filaments to the pharyngeal plexus
- 3d Recurrent Laryngeal -
The recurrent or inferior laryngeal branch arises at 
a different point on the two sides; on the left it arises
as the nerve is crossing the aorta and winds backward
around the aorta; on the right side it comes 
off as the nerve crosses the subclavian artery and 
turns upward behind that artery; either nerve after 

communications of the [????gastric] are as follow
ganglion of the root - 11th nerve
9th nerve
Sup. cerv. ganglion of Sympth.
and important branch the 
auricular
ganglion of the trunk communicates with 
the 12th nerve and the loop
between the first & 2nd. cervical nerves.

372
its origin ascends the groove between the oesphagus
and trachea giving filaments to those parts and is 
distributed to all the muscles of the larynx except
the crico-thyroid -
4th Posterior Pulmonary -
The posterior pulmonary branches from an intricate
plexus on the back of the root of the lung whence
filaments are sent into the lung along the bronchial
tubes -
- 5th Anterior Pulmonary -
The anterior pulmonary branches form a smaller plexus
on the front of the root of the lung -
6th Oesophageal  -
The oesphageal branches are filaments furnished to 
the oesophagus before the name are in relation with it 
the two nerves communicating frequently around the 
tube surrounding it with numerous anastomoses
thus forming the oesphageal plexus -
7th Cardiac
The cardiac branches are numerous, they arise in the 
upper part of the neck in the lower part of the neck 
in the thorax and from the recurrent laryngeal 
nerve and are destined for the heart.
The communications of the pneumogastric are 
as follows - The ganglion of the root communicates
with the 11th nerve with the 9th nerve and with the 
superior cervical ganglion of the sympathetic besides
which gives off an unimportant branch called the 
muscular which joins the facial nerve in the aqueductus

This is the only one arising from the 
Corpra olivare and paramydalis 

373
aqueductus Fallopii - The ganglion of the trunk communicates 
with the 12th nerve and with the loop between
the 1st & 2d cervical nerves -
- 11th Nerve -
The eleventh nerve, or spinal accessory, is the fifth nerve
arising from the groove between the corpora olivare and 
restiforme and escapes from the cranium through the 
posterior foramen lacerum along with the 9th & 10th nerves.
The nerve consists of two portions; 1st A cranial or accessory
portion which arises from the groove between the 
corpora olivare and restiforme and after communicating
with the spinal portion goes to the pneumogastric nerve.
2d A spinal portion which arises by successive filaments
from the side of the spinal cord as low as the 
6th cervical nerve and ascends between the two roots of 
the spinal nerves; this to enter the cranium through 
the foramen magnum and after communicating with 
the accessory portion emerges through the jugular foramen
passes downward and outward pierces the sterno-cleido-mastoid 
muscle and reaches the trapezius 
muscle to which it is distributed giving on its way 
filaments to the sterno-cleido-mastoid - The two portions
of this nerve are never closely united but after the spinal
portion has ascended to the cranium several communicating 
branches pass between them -
- 12th Nerve -
The twelfth nerve, or hypoglossal, the [illegible] one arises from the groove
between the corpora olivare and pyramidale by ten or 
twelve filaments which are gathered into two bundles,
these pass outward and just as they are leaving the 
cranium through the anterior condyloid foramen unite 



374
to form the trunk of the nerve -
The nerve then descends between the internal jugular
vein and internal carotid artery and when it reaches
a point on a level with the angle of the jaw it curves forward
in front of both external and internal carotid
arteries and after communicating with the gustatory
nerve is distributed to the muscle of the tongue -
- Branches -
The branches of distribution besides the terminal are 
two, descends noni a very important branch and the 
thyro-hyoidean of small importance -
1st Descendens Noni Nerve - better "Descendens cumus" -
The descendens noni nerve leaves the hypoglossal just 90 91
as it is crossing the external carotid artery and derives
its name from its descending direction and from the 
fact that the parent, the 12th nerve, was in Frilli's classification
of the cranial nerves called the 9th nerve (vide 
p. 50) - The descendens noni passed down the neck on 
the front of the sheath of the external carotid and then 
on the front of the sheath of the common carotid artery;
occasionally it descends within the sheath; about the 
middle of the neck it anastomoses with filaments of 
the 2d & 3d cervical nerves, the communicans noni 
thus forming what is called the arch of Scarpa which 
lies in front of the sheath of the common carotid artery
about the middle of the neck - From this arch 
branches proceed to the depressor muscles of the hyoid 
bone except the thyro-hyoid muscle -
- 2d Thyro-hyordean Branch -
The thyro-hyordean branch descends from near the 
termination of the hypo-glossal nerve to supply the thyro-hyoid

Begins at lower border of foramen magnum.

375
thyro-hyoid muscle -
- The Spinal Cord -
The spinal cord, or spinal marrow, or medulla spinalis,
is that portion of the cerbro-spinal axis of the 
nervous system which is found in the spinal canal -
It does not extend in the adult the whole length of the 
canal but beginning at the foramen magnum terminates
in a pointed extremity at the lower border of the 
body of the 1st lumbar vertebra, thence onward the canal 
is occupied by the nerves to which it has given birth -
In the young subject the spinal cord will be found to 
reach the whole length of the spinal canal but as development 
proceeds the canal increases in length
much faster than the cord elongates -
The spinal marrow like the brain is invested by three
membranes dura mater arachnoid and pra mater 
which are continuous with the similar membranes
of the brain - The dura mater of the cord however is 
not adherent to the interior of the wall of the canal 
but is separated by a considerable interval the wall
being provided with a proper periosteum -
The spinal marrow is composed of white matter externally
and of gray matter within and is marked 
down its middle both in front and behind by grooves
called the anterior and posterior median fissures, the 
posterior being much the deeper, the lateral halves of the 
cord thus formed are connected by a band whose thickness 
is measured by the interval between the bottoms
of the anterior and posterior median fissures; the 
front and back of this band are white fibres and 
called the white commissures of the cord but in the 
centre the sand is gray called the gray commissure 



376
the white commissure connect the white matter on 
the exterior of each lateral half and the gray commissure
the gray matter of the interior; this gray matter
is found to be placed in the interior of each half in 
a cresentic shaped mass the convexity of the crescent 
looking towards the opposite side and receiving
the gray commissure while the horns of the crescent 
pass, one, the anterior outward and forward, and 
the other, the posterior horn outward and backward in 
the white matter, the posterior horn coming nearer
to the surface than the anterior - (Each lateral half
the spinal cord is marked by two longitudinal fissures
these being slight much more so that the anterior
and posterior median fissures; thus each lateral
half of the cord is subdivided into three columns by 
these grooves known as the antero-lateral and postero-lateral
sulci in contra-distinction to the median 
fissures) -
- The Spinal Nerves -
Emerging from each lateral aspect of the spinal
marrow and proceeding as the result of its termination
are nerves known as the spinal nerves there being 
thirty-one pairs of these, a pair consisting of a nerve to 
one side having its exact counterpart on the other - A
spinal nerve arises by two roots; one from the antero-lateral
sulcus of the cord and called its anterior or motor
root and the other from the postero-lateral sulcus and 
called the posterior or sensory root; soon after its origin
the posterior root presents a gangliform enlargement
immediately after the formation of this ganglion the two 
roots combine to form the nerve which escapes from the 
spinal canal c through an intervertebral foramen, except



377
except the 1st nerve which makes its exit between the atlas
and occipital bone and the two last spinal nerves which 
leaves the canal through the aperture at the lower extremity
of the sacrum -
The thirty one pairs are arranged into groups around 
from the region of the spine where they emerge, thus cervical
nerves consisting of the 8 first pairs
Dorsal " 12 vent.
Lumbar " " " " 5 "
Sacral " " " " 6 "
It is sometimes said the the six last nerves, consist
of 5 sacral nerves and coccygeal -
Immediately after each nerve has emerged from the 
spinal canal it divides into two branches or cords
one called posterior which is intended for the supply
of the elements of the back in which the nerve 
finds itself and as the structures of the back are of 
small importance these posterior cords of the spinal 
nerves will be no further considered, the other branches
of the spinal nerve are called the anterior cords and 
are of vast importance as they supply the important
structures of the front of the body and the extremities -
In all the regions of the spine except the dorsal the 
nerves before proceeding to their distribution intercommunicate
and form separate intricate networks in 
the various regions called plexuses from which 
branches proceed to supply the parts for which the 
nerves are intended four or five nerves usually uniting
to form a plexus - The first plexus formed by 
spinal nerves is the cervical.
- The Cervical Spinal Nerves -

resting on 95/
gray
Levator L guli scapuli, Scalenus Anticus & Melo
Has 2nd
Cerival} 3rd
plexus.} 4th
} 5th a filament.
[illustration]

378
The cervical spinal nerves are 8 pairs, the posterior cords
of these as the structures of the back of the neck, while
the anterior cords of the four upper form the cervical
plexus, and of the four lower go to the brachial plexus.
- The Cervical Plexus -
The cervical plexus is formed by the intercommunications
of the four upper cervical nerves (their anterior
cords) and is found beneath the middle of the sterno-cleido
mastoid muscle. The principal distribution of 
the plexus is to the integument and muscles of the 
neck - Its branches are divided into two sets, a superficial
set to the skin and a deep set to muscles -
The superficial branches are the four following -
I Superficial Colli - of 2d & 3d Cervical -
The superficialis Colli emerges around the posterior
border of the sterno-cleido-mastoid muscle about its 
middle and runs forward and upward on that 
muscle to be distributed to the integument of the front 
of the neck, as high as the chin, going off in its course 
a descending branch - to front of neck. lobes pt.
II. Auricularis Magnus - of 2d & 3d Cervical
The auricularis magnus branch coming out about the 
middle of the posterior border of the sterno-cleido-mastoid
muscle ascends on that muscle and is 
distributed by two branches to the front and back of 
the ear having given off filaments to the skin in its 
course -
III. Occipitalis Minor - of 2d Cervical -
The occipitalis minor branch ascends parallel with 
the posterior border of the sterno-cleido-mastoid muscle and 
is distributed on the side of the head behind the ear as 
high as the vertex - 

arrising by the large trunks -
Deep - branches V-VI-VII
descendens noni - is not a branch of 
the Hypo glossal but of the cervical
plexus - 92 B.T. 
Communicates with synpth system at 
rt of neck,
Inner end of clevicle &, in. abve
it = Place for pole of boltey -

descendens noni 
379
- IV. Descending Superficial Branches - of 3 & 4° -
The descending superficial branches supply the integument
of the lower part of the neck and crossing the 
clavicle terminate in the integument of the upper
part of the thoracic wall from the sternum to the acromion 
process - These descending branches are sometimes
divided into three sets, sternal, clavicular and acromial,
these names indicating the directions of the 
various fibres - The deep branches of the plexus comprise 
the following three -
- V Muscular Branches -
The muscular branches supply the praevertebral
group of muscles, i.e. all the muscules of the neck
except the depressors of the hyoid bone -
- VI Communicans Noni -
The communicans noni branch is formed by two 
filaments, from the 2d & 3d nerves and curving downward
and forward communicates with the descendens 
noni from the hypoglossal nerve and with it 
forms Scaipa's arch in front of the common carotid
sheath about the middle of the neck, from which 
filaments supply the depressor muscles of the hyoid 
bone except the thyro-hyoid. 
VII. The Phrenic Nerve -
The phrenic nerve is formed by contributions from the 
3d & 4th cervical nerves and after descending a short 
distance these are reinforced by a filament from the 5th
nerve - The course of the nerve on the two sides is different;
descending on the front of the scalenus anticus
muscle, on the right side it generally slips to the inner
side of that muscle and crosses in front of the 1st portion 

In the application of pole of the fatty to Slim the phrenic
nerve I behind the midd - of S.C. morloid but " at root
of the neck you apply it in the interal between the 
sternol and Cloric - origin - of the S.C. morloid -
[illustration]
What nerve lies behind the Brachial Arty
" " " Ext to " " " " "
" " " int to " " " " " 

Jas. S. Wilson
380
of the right subclavian artery between it and its vein
and continues its downward course into the thorax beside
the right vena innominata and superior vena
cava, downward in front of the root of the right lung
thence onward between the pleura and pericardium
and reaching the diaphragm pierces it and is distributed
to it from its under surface; the nerve of the left 
side differs from this in two particular only it enters
the chest lying on the front of the 1st portion of the 
left subclavian artery and then crosses the arch of the 
aorta otherwise its course is the same as that of the 
right nerve except that it has no relation to the left
vena innominata and superior vena cava - Occasionally
the right nerve does not get to the inner side of 
the scalenus anticus muscle until it has passed the 
subclavian and in this case it crosses the 2d portion of 
that artery -
- The Brachial Plexus -
The brachial or axillary plexus is the second plexus
formed by the anterior cords of the spinal nerves and 
is the result of the intercommunications between the 
anterior cords of the four lower cervical nerves - (5th & 6th,
7th & 8th) and the greater portion of the 1st dorsal: the 
manner of its formation is as follows, the 5th & 6th cervical
nerves invite at once and the cord thus formed
is soon joined by the 7th cervical, the 8th cervical
nerve and 1st dorsal unite to form one cord and thus 
at one time there are but two cords to the plexus, but 
soon these two cords each give off a branch which unite to 
produce a third cord - The course of the plexus is downward
and outward; it first lies between the two scaleni
muscles then lies in relation to the second and third portions
of the the subclavian artery, above and to its outer side, behind -
above & to outer Side of 3rd. pt. of Subclavian
on the 1st ret it lies behind the " " " 

1st pt of ax. arty
[illustration]
2nd pt. of ax
[illustration]
3d pt of ax
[illustration]
unite on front of arty - 3rd pt-
The median nerve infront - then to out. Side -
Ext. Respiratory nerve. ?
Sub. Scapular nerves. ?

381
1st. portion- and then comes into relation with the axillary artery
lying first to its outer side, then to its outer side and 
behind, 2nd portion then to its outer side behind and to its inner
side and finally the two lateral cords producing each a 
branch these unite to form the median nerve and the 
artery is entirely enveloped - = 3rd pt. of axilary - (a) first pt. 3d portion -
- Branches -
The distribution of the brachial plexus is chiefly to the 
upper extremity supplying its muscles and skin but 
before reaching the upper extremity it gives off some muscular
branches - The branches of the plexus are divided
into two sets, muscular and terminal -
- Muscular branches -
As the brachial plexus is coursing with the subclavian
and axillary arteries it gives off numerous filaments
to neighboring muscles viz, to the scaleni thomboid
and subclavius; (these being collectively known as 
the superior muscular branches); besides which there are 
other muscular branches bearing specific names as follows -
Supra-scapular Branch - of outer cord -
The supra-scapular branch passes outward to gain 
the dorsum of the scapula through the supra-scapular
notch and be distributed to the supra and infra-spinati -
- Anterior Thoracic Nerves - of outer and inner cords
below Scapula -
The anterior thoracic nerves arise one from the inner
cord of the plexus and the other from the outer cord and 
after forming a loop of communication over the axillary 
artery are distributed to the pectoral muscles -
- Posterior Thoracic Nerve - of 5 & 6 Cervical -
The posterior thoracic nerve, or external respiratory, is 

branch of the ext. cord -

382
the nerve for the serratus magnus muscle - It is formed
by a filament from the 5th and another from the 6th
cervical nerves and descending behind the axillary
vessels is distributed to the serratus magnus muscle as 
it courses down on it -
- Sub-scapular Branches - of post cord -
The subscapular are several branches (3) to the sub-scapularis,
teres major and latissimus dorsi muscles -
- The Terminal Branches -
The terminal branches of the plexus are seven in number 
as follows; musculo-cutaneous, internal cutaneous
lesser internal cutaneous, median, ulnar, musculo-spiral
and posterior circumflex. (The plexus gives origin
to these branches after the following manner, the external
cord produces the musculo-cutaneous, and one head of 
the median the internal cord splits into the internal 
cutaneous lesser internal cutaneous, ulnar and one 
head of the median; the posterior cord gives origin to 
the musculo-spinal and posterior circumflex -)
I. Musculo-cutaneous Nerve -
The musculo-cutaneous nerve pierces the coraco-brachialis
and pierces downward and outward between
the biceps and brachialis anticus muscles to become superficial
at the outer side of the front of the elbow where 
it divides into two cutaneous branches (external cutaneous)
which are distributed to the integument of the 
outer side and outer portion of the front of the fore-arm
as far as the wrist. Besides its terminal distribution
it supplies the coraco-brachialis, biceps and brachialis
anticus muscles -

Lesser int. cutaneous
arrises with the ulnar and int cut. nerves
it receives fibres from 8th cervical & 1st dorsal
nerves passes through axilary Space at 1st
lying behind then on inner Side of [cross out]
axilary [arty.] vein and communicates
with intercosto humerol nerve descends on 
inner side of brachial arty to middle
of arm where it pierces the fascia at middle of lower 3rd of [illegible]
is distributed to to Skin of lower 1/3 of 
arm
Rec - a communicating branch. name?
Intercostal humeral
P.S. it communicates with post 
branch of int. cutaneous 

int-cord
distrib to all except
out - Side & post Side
of [cross out] arm -
383
II. Internal Cutaneous Nerve -
The internal cutaneous nerve descends to the inner
side of the axillary and brachial arteries and about 
the middle of the arm pierces the deep fascia to become
superficial and divides into branches which are distributed
to the inner side and inner part 1/2 of the front - up pt 
font of arm
of the fore-arm as the wrist - It gives filaments
also to supply the integument of the front of the arm - is :. Superficial 
in lower pt.
and give [h??] to 
int. cord.
III. Lesser Internal Cutaneous Nerve -
The lesser internal cutaneous nerve, or nerve of Wrisberg,
descends the inner side of the arm and divides
into filaments which are lost in the integument of 
the lower third of the posterior aspect of the arm - It is 
the smallest of the terminal branches of the plexus
and as seen is soon exhausted -
ext & cut cord
IV. Median Nerve - [cross out]
The median nerve arises by two roots, one from each 
lateral cord of the plexus, which unite in front of the 
axillary artery just below the pectoralis minor muscle
it descends first to the outer side of the axillary
artery, then to the outer side of the brachial artery and 
then about the middle of the arm crosses usually in 
front to the inner side of the brachial artery which 
relation it maintains to the front of the elbow where 
it first earns the name of median being here for the 
first time in the middle of the limb; from its origin to 
the elbow it is superficial entering the fore-arm it becomes 
deep for passing into it between the two heads of 
the pronator radii teres muscle it descends the fore-arm
beneath the 

Branches median nerve
2 supply the palmer aspect of thumb 
sending off branches which supply all of 
the palmer aspect of the fingers but ulnar
Side of ring finger and little finger.
A Branch to all the thenar group which 
arrise from the annular lig. and trapezium 
The ulnar nerve supplys all the mus on
front of arm except the 1/2 of flexor carpi
ulnaris - 

385
flexor sublimis digitorum muscle and enters the 
palm of the hand beneath the anterior annular
ligament and divides into its terminal branches
which are distributed as follows; two to supply the 
sides of the palmar aspect of the thumb one to the radial
side of the index finger, one which divides to supply
the adjacent sides of the index and middle fingers,
one to divide for the adjoining sides of the middle
and ring fingers and lastly a muscular branch which 
supplies the following muscles of the thenar eminence 
abductor pollicis, flexor ossis metacarpi pollicis and 
superficial head of the flexor brevis pollicis (i.e. all
the muscles arising from trapezium and annular
ligament). Until it reaches the elbow the median
emits no branch, while at the elbow and lying beneath
the aponeurotic slip of the biceps it produces 
a number of muscular branches which supply all 
the muscles of the front of the fore-arm except one 
and a half flexor carpi ulnaris and the ulnar half 
of the flexor profundus digitorum these being appropriated
by the ulnar nerve - The branch to the pronator 
quadratus descends on the front of the interosseous 
membrane from the elbow and is called the 
anterior interosseous nerve - At the lower part of the 
fore-arm the median gives off a cutaneous branch
which descends in front of the anterior annular
ligament to the skin of the palm -
- V. Ulnar Nerve int cord
The ulnar nerve descends at first to the inner side 
of the axillary and brachial arteries but as it passes 
down the inner side of the arm it diverges from the 

note it supply: 1 1/2 [illegible] in hour & 1 1/3 om ann.
Ulnar.
all mus Hypo thena Enn.
and the adductor Pollicis
deep bed of flex brev. " " "
403
78
_________
23

386
brachial artery making for the inner side of the back 
of the elbow where it lies in the groove between the internal
condyle and olecranon forming what is called
the "femur bone" entering the fore-arm between the two 
heads of the flexor carpi ulnaris muscle it comes into 
relation at the commencement of the middle third of the 
fore-arm with the ulnar artery and lying to the ulnar
side of that vessel it enters the palm of the hand 
and divides into a superficial and a deep palmar
branch. The superficial palmar branch supplies the 
palmaris brevis muscle, the integument of the inner 
border of the hand and divides into two branches
one of which supplies the inner side of the little finger
and the other after giving a communicating branch
to the median nerve divides to supply the adjacent
sides of the little and ring fingers - The deep branch 
disappears between the abductor minimi digiti and 
flexor, brevis minimi digiti and after supplying the 
muscles of the hypothenar eminence passes across
the palm with the deep palmar arch of the radial 
artery and is distributed to one (muscle and a half of 
the thenar eminence, adductor pollicis and deep
head of the flexor brevis pollicis - On the fore-arm the 
ulnar nerve emits the following branches;
1st muscular branches to the flexor carpi ulnaris and 
ulnar half the flexor profundus digitorum -
2d An unimportant cutaneous branch which descends
superficially into the palm to be lost in the skin -
3d A dorsal branch, which arises about two inches above 
the wrist and passes backward beneath the tendon
of the flexor carpi ulnaris muscle to the dorsum of the 
hand when it communicates with the radial nerve 

Terminal branches of mus Spiral
Radial and inter osseous
also gives off brances
1 front of arm
1 back " arm 
1 back of fore arm. 
[illustration]

387
and divides into branches which supply the integument
of the inner portion of the dorsum and two fingers
and a half, viz, the little finger, the ring fingers
and the ulnar side of the middle finger -
VI. Musculo-spinal Nerve -  Post Cord
The muscles spinal branch springs from the posterior
cord of the brachial plexus and is the largest
branch of that plexus - It passes downward and outward
behind the humerus between it and the triceps
muscle, lying in the musculo-spinal groove on the 
posterior surface of the humerus, until it washes
the space between the supinator longus and brachialis 
anticus and then descends to the outer side of 
the front of the elbow where it divides into two branches,
radial and posterior interosseous - Besides its two terminal
branches the musculo-spinal nerve gives off 
cutaneous branches which supply on the front of the 
arm, one the back of the arm and one the back of the 
fore-arm: it also gives branches to the following muscles,
triceps, brachialis, anticus, supinator longus, extensor
carpi radialis longior and anconeus -
(1) The Radial Nerve -
The radial nerve, dervied from the musculo-spinal
at the outer side of the front of the elbow, descends the 
radial side of the front of the fore-arm lying at first 
too remotely to the outer side of the radial artery to 
be considered a relation of it; it comes into relation
with that artery at the middle third of the fore-arm
and lies to its outer side until it reaches the 
lower third of the fore-arm some three inches above
the wrist, when it seeks the back of the fore-arm by 

Post Interosseous Suplys all mus 
on back of fore arm except the following
Musculo Spinal, supenator longus
Extensor carpi cadalis long -
and anconeous.

388
passing beneath the tendon of the supinator longus 
and divides into an outer branch, which supplies
both sides of the the thumb and an inner branch which 
supplies the index finger and radial side of the middle
finger The radial nerve communicates with 
the dorsal branch of the ulnar nerve on the dorsum of 
the hand -
(2) The Posterior Interosseous Nerve -
The posterior interosseous branch of the musculo-spiral
immediately pierces the supinator brevis muscle 
to reach the back of the fore-arm and then descends
between the superficial and deep layers of muscles
being distributed to all the muscles of the back of the 
fore arm except the three supplied by the musculo-spiral
supinator longus extensor carpi radialis longior
and [encon??]
VII. Posterior Circumflex Nerve  Post Cord
The posterior circumflex arising from the posterior cord
of the brachial plexus, winds around behind the Surgical
neck of the humerus in company with the posterior
circumflex artery and is distributed by an upper
branch to the deltoid muscle and by a lower branch to the 
teres minor and integument covering the shoulder
- Dorsal Spinal Nerves -
The dorsal spinal nerves are twelve pairs the posterior
branches are distributed to the structures of the back 
while the anterior cords from the intercostal nerves
and unlike other spinal nerves they do not form a 
plexus but are distributed separately -
The Intercostal Nerves -
The intercostal nerves are the anterior cords of the 
twelve dorsal nerves during their name from these 

Washington D.C.
J Sprig Wilson
is America.
[illustraion]
Sternum 

389
come forward between the ribs The first dorsal nerve
sends almost all its bulk to the brachial plexus and 
the twelfth usually gives a branch to the lumbar plexus -
The intercostal nerves are intended for the supply of 
the muscles among which they course and of the integument
of the front and sides of the thorax and abdomen -
Each intercostal nerve runs forward in the intercostal 
space between the intercostal muscles to near the 
edge of the sternum where it turns forward becoming 
superficial and called anterior lanerus it is distributed
to the integument of the front of the chest
and abdomen most of the filaments passing outward
in a recurrent course; the six upper nerves appear as 
the anterior cutaneous through the corresponding intercostal
spaces while the six lower pierce the sheath of 
the rectus muscle and are called the anterior cutaneous 
nerves of the abdomen; these six lower nerves after 
reaching the anterior extremity of the intercostal spaces
pass onward between the broad muscles of the abdomen
and the last one though called intercostal is 
really not such since it lies below the last rib - Whilst
running forward the intercostal nerves supply the 
intercostal muscles and the broad muscles of the 
abdomen and about midway its course each nerve gives 
off a branch called lateral cutaneous which divides
into two one branch passing forward and the other backward
both being distributed to the integument of the 
side of the chest or abdomen - The first intercostal nerve,
owing to the fact that most of the cord from which it is 
divided goes to the brachial plexus gives off no lateral
cutaneous branch and to compensate for this delinquency
the lateral cutaneous branch of the 2d nerve is remarkably

The Lumbar Plexus
Branches
ilio hypogastric
" inguinal
Ext. Cutaneous
Anterior cural
Genito " " 
Obturator
communicating branch
to the sacral plexus.

390
remarkably large and not only fulfils the office of the lateral
cutaneous branches of the 1st nerve and itself but under
the name of the intercosto-humeral nerve passes into 
the axilla communicates with the lesser internal cutaneous
nerve and is distributed to the integument of 
the back of the arm and axilla, sometimes entirely replacing
the lesser internal cutaneous - The lateral cutaneous
branch of the 12th intercostal nerve and descends 
over the crest of the ilium and is distributed to the integument
of the gluteal region -
- The Lumbar Spinal Nerves -
The lumbar spinal nerves are five pairs the posterior
cords supply the structures of the back in their region
and the anterior cords have the following disposition
the upper four with usually, a branch from the 12th
dorsal constitute by their communications the lumbar 
plexus, the 5th having fun joined by the communicating 
branch from the lumbar plexus descends 
into the pelvis (under the name of lumbo-sacral) to join
the sacral plexus ........
- The Lumbar Plexus -
The lumbar plexus is formed by the intercommunications
of the anterior cords of the four upper lumbar
nerves usually aided by a branch from the 12th dorsal 
nerve - It lies entangled in the back part of the Psoas
magnus muscle and behind that muscle - (It is distributed
to all the thigh, except the posterior femoral
region, to the inner side of the leg and foot and to the 
lower part of the anterior abdominal parietes). Its branches
are seven, ilio-hypogastric, ilio inguinal, external
cutaneous, anterior crural, genito-crural, obturator
and the communicating branch to the sacral plexus -
Dorsi Lumbar.



391
Although this is the order in which the branches appear
from the plexus from above downward, it will be more 
convenient to describe them in a somewhat different order -
The first three branches have a course outward and
downward one above the other across the posterior wall
of the abdomen and disappear from it on its lateral
aspect.
I. Ilio-hypogastric Nerve - of 1 Lumbar -
The ilio-hypogastric branch passes outward across
the quadratus lumborum muscle to pierce the transversalis
muscle and run forward piercing successively
the internal and external oblique to become cutaneous
just above the external abdominal ring and beside
the linea alba and be distributed to the integument of 
the hypogastric region, having furnished on its route 
branches to the broad muscles of the abdomen and given 
off a branch called iliac which descends over the crest
of the ilium to supply the skin of the hip -
II Ilio-inguinal Nerve - of 1 Lumbar
The ilio-inguinal branch passes outward parallel
with a little below the ilio-hypogastric to pierce the transversalis
and then the internal oblique and thus gaining
the external abdominal ring escapes to supply the 
integument of the scrotum and upper part of the inner
aspect of the thigh - On its way it gives branches to the 
broad muscles of the abdomen and communicates
with the ilio-hypogastric -
Com. Jan 25/90
III. External Cutaneous Nerve -
The external cutaneous nerve passes downward and 
outward across the iliacus internus muscle to escape 
into the thigh through the notch beneath the anterior
superior spinous process of the ilium where after a 

Remember - (1) that the obturator corn -
with the femoral plexus - also N.B. that 
the artecutor branch passes down on
the adductor magnus and supplyes
the Knee Joint (hence pain there in 
hip joint disease -) it is a branch of 
the post trunk 

392
course of a few inches in the thickness of the fascia lata
it becomes superficial and is distributed to the integument
of the outer front aspect of the thigh by a posterior 
branch encroaching on the back of the thigh.
- IV. Genito-crural Nerve -
The genito-crural branch pierces the psoas magnus 
muscle from behind forward and then runs down on 
the front of that muscle to divide just above Poupart's
ligament into two branches, genital and crural, the 
genital branch enters the internal abdominal ring
and descends along the spermatic canal to be lost in 
the cremaster muscle or round ligament: the crural
branch passes beneath Poupart's ligament to be distributed
to the integument of the front of the thigh as far 
as the middle.
V. Obturator Nerve - of 3 & 4 Lumbar -
The Obturator nerve passes forward just below the brim
of the pelvis in company with the obturator artery
to escape through the upper part of the obturator foramen
grooving the under surface of the pubes and divide
into an anterior and a posterior branch which
are distributed to the adductor muscles of thigh, the 
three adductors the pectineus and gracilis (i.e. the 
muscles arising from the pubes and ischium (?) and 
to the obturator externus: the posterior branch lies behind
the adductor brevis; the anterior branch descends in 
front of that muscle and is distributed to the integument
of the inner side of the thigh and furnishing
filaments to a plexiform communication of different
nerves over the front of the lower part of the femoral artery

Anterior Crural Nerves.
Branches{ middle cutaneous
{ Internal " " " "
{ " " " Saphenous branch

393
artery and called the femoral plexus -
VI. Anterior Crural Nerve -
The anterior crural is the largest branch of the lumbar 
plexus It descends in the interval between the iliacus
internus and psoas magnus and entering the thigh
beneath Poupart's ligament lies about 1/4 or 1/2 inch to 
the outer side of the femoral artery - Almost immediately
upon entering the thigh it splits into branches
which may be divided into two sets, a superficial or 
cutaneous set and a deep or muscular set The cutaneous
branches are, middle cutaneous, internal cutaneous
and internal saphenous -
(1) Middle Cutaneous Branches -
The middle cutaneous branches are distributed to the 
integument of the front of the thigh to the knee one 
or more of them piercing the sartorius muscle and 
giving filaments to it.
(2) Internal cutaneous Branch -
The internal cutaneous branch passes inward over 
the fermoral artery and divides into an anterior and a 
posterior branch, these being distributed to the integument
of the inner front aspect of the thigh, as far 
as the knee; the posterior branch descends along the 
posterior edge of the sartorius muscle and pierces
the fascia lata about the knee the anterior branch 
becomes superficial about the lower third of the thigh.
(3) Internal Saphenous Branch -
The internal or long saphenous nerve descends in close 

[illustrations]
int Cut.
int Sup.

394
contact with the outer side of the sheath of the femoral
vessels to their termination and then descends between
the sartorius and gracilis muscles continues
its course down the inner side of the leg in front 
of the ankle and along the inner side of the foot as 
far as the great toe, being distributed to the integument
of the inner side of the leg, inner side of the 
foot and inner side of the great toe -
The long saphenous furnishes filaments to the femoral
plexus side obturator nerve) the elements of which
are derived from it, from the obturator and from the 
internal cutaneous. Just above the knee the long 
saphenous gives off a branch called cutaneous, patellae
which is joined by filaments from the external, 
middle and internal cutaneous nerves to form
an intricate inter communication over the front of 
the patella called the plexus patellae -
- Muscular Branches of the Anterior Crural
Nerve -
The muscular branches of the anterior crural
nerve are distributed to the anterior femoral muscles
i.e the rectus and the two vasti, and sometimes to the 
pectinus: the sartorius is supplied by the middle
cutaneous branches as the pierce it, and the tensor 
vaginae femouris is supplied by the gluteal branch
of the sacral plexus -
VII. Communicating Branch -
The communicating branch joins the anterior cord 
of the fifth lumbar nerve and descends into the pelvis 
to aid in forming the sacral plexus - by the name 

Sacral plexus
gluteal
Int. Pudic.
Less Sciatic
Greater " " " 

395
of Lumbo-sacral.
The Sacral Plexus -
The sacral plexus is formed by a fusion of the lumbo
sacral nerve and the anterior cords of the three
upper sacral nerves with half the anterior cord of the 
fourth sacral - This plexus differs from others in this 
that it is not a simple intercommunication but 
the elements blend into a broad continuous band.
The plexus extends from its base formed by its roots
downward and outward to the great sacro-sciatic
foramen where it breaks up into its four terminal
branches. It lies on the lateral front face of the sacrum
and on the front of the pyriformis muscle.
The distribution of the plexus is to the viscera and 
walls of the pelvis, to the gluteal region to the posterior
femoral region, to all of the leg except the inner 
side and to all the foot except the inner side and to 
all the toes except the inner side of the great toe -
Branches -
Besides its four terminal branches the sacral plexus
produces a set of visceral branches to the pelvic
viscera (which are in part supplied by branch derived
from that portion of the fourth sacral nerve
which does not enter into the plexus, and a second
set to muscles, there being the levator ani and all the 
outward rotators of the thigh except the obturator externus 
which gets its nerve from the obturator.
The four terminal branches of the plexus are (superior)
Gluteal Internal Pudic, Lesser Sciatic and 
Greater Sciatic.

Gleutal nerve above P -
Int Pudic nerves below P -
Peritoneal branch is distributed to the mus -
( of Perineum & by an ant branch runs forward
to supply Skin of perineum & Scrotum also 
( muscles in its course

396
I. Gluteal Neve -
The (superior) gluteal nerve comes off from the upper
part of the sacral plexus and leaves the cavity
of the pelvis through the greater sacro-sciatic foramen
above the pyriformis muscle and divides into 
two branches which ramify between the gluteus medius
and minimus being distributed to those two muscles
and by its terminal filaments to the tensor vaginae
femoris -
II. Internal Pudic Nerve -
The internal pudic nerve arises from the lower part 
of the plexus and leaves through the greater sacro-sciatic
foramen below the pyriformis muscle crosses
the spine of the ischium and reenters through the 
lesser sacro-sciatic foramen dividing into [illegible] two
branches, a superior or dorsalis penis and a [cross out]
perinatal: having emitted before dividing the inferior 
hemorrhoidal branch which is distributed to 
the sphincter ani and integument around the anus -
(1). Dorsalis Penis Nerve -
The dorsalis penis branch passes upward and forward
along the ramus of the ischium and pubes
pierces the suspensory ligament of the penis continues
its course forward on the dorsum of the penis 
supplying the integument and corpus cavernosum 
and terminates in the glands penis - It gives off a 
lateral cutaneous branch to the side of the organ -
(2) Perineal Nerve -
The perineal branch divides into two sets of branches 

[illustration]
What structures pas through the sciatic foramina
Supplys the glutens maximus

397
cutaneous and muscular - The cutaneous branches are 
two anterior and posterior and pass forward being distributed
to the integument of the perineum scrotum 
and under surface of the penis - The muscular branches
are distributed to the muscules of the perineum, viz,
transversus perinsi, erector penis, accelerator urinae
and compressor urethrae - Several of the deep filaments
also supply the corpus spongiosum -
III. Lesser Sciatic Nerve -
The lesser sciatic nerve usually arising by two roots
escapes through the greater - sacro-sciatic foramen below 
the pyriformis muscle along with but superficial
to the great sciatic nerve, and descends the middle 
of the back thigh beneath the fascia lata to terminate
on the back of the upper part of the leg -
- Branches -
The branches of the lesser sciatic are chifly cutaneous
but it supplies one muscle the gluteus maximus -
The cutaneous distributions comprises the filaments
distributed to the integument in the downward
course of the nerve on the back of the thigh and upper 
back part of the leg and may be called descending cutaneous
branches - Secondly it sends cutaneous
branches upward to the integument of the lower portion
of the gluteal region and these are known as ascending
cutaneous - Thirdly it gives off internal or 
perineal cutaneous branches which supply the integument
along the inner posterior aspect of the thigh;
one of these is known as the inferior pudendal 



398
nerve which curves upward and forward to communicate 
with the perineal branches of the internal
pudic and aid in supplying the integument of the 
perineum -
- IV - Great Sciatic Nerve -
The gret sciatic is the largest nerve in the system
and seems a continuation of the plexus through the 
greater sacro-sciatic foramen below the pyriformis
muscle being the last of the structures which have to 
be traced through that aperture these are eight in
number the pyriformis muscle being the bulkiest and 
almost filling the foramen besides it four nerves and 
three arteries emerge through the opening, one artery
and nerve above the pyriformis muscle, viz, the gluteal
artery and nerve, and two arteries and three
nerves below the muscle, viz, the internal pudic and 
ischiatic arteries and the greater and lesser sciatic 
and internal pudic nerves -
After escaping the great sciatic nerve descends the 
middle of the back of the thigh, lying on the adductor
magnus muscle beneath the biceps and separated
by it from the lesser sciatic to divide usually
at the upper angle of the popliteal space into the 
internal and external popliteal nerves Sometimes
the great sciatic divides before it reaches the point 
designated and its two terminal branches may even 
come off separately from the sacral plexus - Before 
dividing it gives off branches to the posterior femoral
muscles and adductor magnus - 
(1) Internal Popliteal Nerve - 

comes off gen in the middle of pop. Space.

399
The internal popliteal descends through the popliteal
space to pass beneath the tendinous arch of the 
soleus muscle and there become the posterior tibial
nerve - It is a relation of the popliteal artery lying
for the upper two-thirds of the popliteal space superficial
and external to the artery and then crossing 
superficially to its inner side which relation it maintains 
until both terminate -
- Branches -
The internal popliteal nerve gives off muscular
branches to the triceps surae and to the popliteus 
muscle. Besides these it produces a cutaneous branch,
external saphenous -
- The External Saphenous Nerve -
The external or short saphenous nerve descends from 
the internal popliteal in company with the external
saphenous vein lying first in the groove between
the two heads of the gastrocnemius muscle
then beside the outer edge of the tendo Achillis and 
passing behind the external malleolus runs forward
on the outer side of the dorsum of the foot to 
the little toe - about the middle of the back of the leg
it is joined by a branch from the external popliteal
nerve called communicans peroner. The external
saphenous is distributed to the integument of the 
outer side of the heel, outer side of the dorsum of the 
foot and outer side of the little toe.
- Posterior Tibial Nerve -
The posterior nerve, the continuation of the internal 



J S Wilson
3315 P St
Washington DC
400
popliteal, begins at the tendinous arch of the soleus
descends the back of the leg lying beneath the triceps
surae and terminates between the internal malleolus
and tendo Achillis by dividing into the internal 
and external plantar nerves - The posterior tibial
nerve is a companion of the posterior tibial artery
lying at first to the inner side of the artery but 
crossing it superficially after a course of a few inches
to preserve thenceforth a relation to its outer side -
- Branches -
Besides its terminal branches the posterior tibial nerve
gives off muscular branches to the deep layer of 
muscles on the back of the leg except the popliteus 
and a cutaneous branch (internal calcansan) to 
the integument of the heel -
- The Internal Plantar Nerve -
The internal plantar nerve runs forward between
the abductor pollicis and flexor brevis digitorum
and divides into branches (4) which are distributed
as digital branches to the great toe the second toe, the 
third toe and inner side of the fourth toe - Besides
these the nerve emits cutaneous branches to the integument
of the inner side of the sole and muscular
branches to the muscles in its course viz abductor
pollicis, flexor brevis pollicis and flexor brevis digitorum;
the digital branches furnish filaments finally
to the two inner lumbricales -
The External Plantar Nerve - 

run under the flexor brevis
digatorum and abductor muni -
digiti.

James S Wilson
401
The external plantar nerve takes the course of the 
[cross out] external plantar artery, running first outward
on the musculus accessorius and then forward between
the flexor brevis digitorum and abductor minimi 
digiti it divides into two digital branches which 
supply the little toe and outer side of the fourth toe -
The digital distribution is exactly similar to that of 
the ulnar nerve in the hand while that of the internal
plantar is the counterpart of that of the median.
Besides its digital branches the external plantar
gives filaments to the integument of the inner side 
of the sole, gives branches to the muscles in its course
viz, musculus accessorius, abductor minimi digiti,
flexor brevis minimi digiti, two outer lumbricales
and two outer interosseous, sends a communicating
branch to the internal plantar nerve and last 
gives off a branch which accompanies the plantar
arch and supplies the adductor pollicis, transversus
pedis and the interosseous muscles except those in 
the outer metatarsal space -
(2) External Popliteal Nerve -
The external popliteal nerve very much smaller 
than the internal popliteal passes outward and 
downward from its origin as one of the two terminal
branches of the great sciatic, crossing the outer head
of the gastrocnemius muscle it enters the substance
of the peroneus longus and just below the head of the 
fibula divides into two branches, anterior tibial
and musculo-cutaneous -

The alnar nerve supply 1 1/2 in front
" " " " 2 1/2 on back
The Ext Plant " 1 1/2 & all mus except ab. p. & 7 BD & 2 in branches -
The Int Plant rest -
Dorsum of foot
Int saph - unite of pt toe 

402
- Branches -
Besides its terminal, the external popliteal emits
cutaneous filaments to supply the integument of 
the outer side of the leg and a communicating
branch to the external saphenous which is called
communicans peronei, the external popliteal being
merely known as the peroneal nerve -
- Communicans Peronei -
The communicans peronei leaves the external popliteal
nerve near the head of the fibula and crossing 
downward and inward on the back of the leg joins
the external saphenous about the middle of the leg
having given filaments to the integument in its 
course -
1st Anterior Tibial Nerve -
The anterior tibial branch of the external popliteal
nerve passes inward through the fibres of the extensor 
longus digitorum muscle to gain the outer side 
of the anterior tibial artery with which it descends
the front of the leg lying first to the outer side of 
the artery on the interosseous membrane then in 
front of the artery and again to the outer side lying 
now on the front of the tibia; having thus reached
the termination of the anterior tibial artery it passes
forward on the dorsum of the foot lying to the 
outer side of the dorsalis pedis artery and where 
that artery terminates, at the base of the first metatarsal
space it also divides into two branches
which supply the adjacent sides of the great and 
second toes on the dorsal aspect. 



403
- Branches -
Besides its two terminal digital branches the anterior
tibial nerve produces muscular branches to the 
muscles in its courses viz, those of the anterior tibial
region and the extensor brevis digitorum, the latter
muscle being supplied by a branch which passes
outward on the tarsus to be distributed to it and the 
articulations.
2d The Musculo-cutaneous Nerve -41
The musculo-cutaneous nerve the second terminal
branch of the external popliteal, descends in and 
among the muscles of the outer region of the leg, lying
first in the peroneus longus then between it and the 
peroneus [illegible] then between the two peronei, and the 
extensor longus digitorum and at the lower third of 
the outer aspect of the leg pierces the deep fascia
and thus becoming superficial is distributed to the 
dorsum of the foot by two branches (inner and outer)
not only supplying the integument of the dorsum
of the foot but giving digital branches to adjacent
sides of the 2d & 3d, 3d & 4th, 4th & 5th toes - (The inner
branch giving off a twig which aides the internal
saphenous in supplying the inner side of the great toe 
Whilst coursing among the peronei muscles it also 
gives branches to those two muscles - END
- Nervous Supply to Dorsum of Foot 
The nervous supply of the dorsum of the foot is 
chiefly derived from the musculo-cutaneous but it 
is aided on the inner side of the dorsum and on 

Plexuses of the Sympathetic
3 cervical
12 dorsal
4-5 Lumbar
4 Sacral -
Branches of the Ganglion
1st are assending
2nd are descending
3rd are External - Spinal nerve
4th are internal (death)

404
the outer side of the dorsum and outer side of the 
little toe are supplied by the external saphenous;
while the adjacent sides of the great and second toes
are supplied by the termination of the anterior tibial.
4th, 5th & 6th Sacral Nerves -
The fourth sacral nerve sends half its bulk to aid 
in forming the sacral plexus, of the other half a 
part goes to furnish visceral branches to the pelvic 
viscera and as part aids the small and important
fifth and sixth sacral nerves in supplying the coccygeus
and levator ani muscles and the integument
over the coccyx between it and the anus -
- Sympathetic Nerves -
The sympathetic nervous system consists of a vertebral 
and cranial portion.
- The Vertebral Portion of the Sympathetic -
The vertebral portion of the sympathetic consists of 
two similar series of ganglia lying one on each side 
of the vertebral column extending from the skull to 
the coccyx and of the nerves which are connected
with these ganglia - Of these ganglia there are about 
twenty four and they are divided into cervical, of 
which there are three, dorsal of which these are twelve,
lumbar, of which there are four or five, and sacral 
of which there are about four - Each ganglion is provided
with four sets of branches, the 1st are ascending
branches to connect it with the ganglion above, the 2d
are descending to connect it with the ganglion below,
the 3d are external to connect it with a contiguous 

Plexuses, of Preal vertebral Symp -
cardiac, solar, Hypogastric 
Superior, middle & inferior ganglia
Superior - on the 2 & 3rd.
cervical vertebra 

405
spinal nerve and the 4th are internal or branches of 
distribution - The first three sets of branches are the 
communicating branches and each of the connections,
indications, viz, with the ganglion above the 
ganglion below and the spinal nerve, is effected by 
two filaments one of which is gray and the other 
white - The fourth set of branches, the internal or distributing,
pass as a rule, inward and forward to 
supply the organs of their various regions; these
branches going either singly to their destinations or as 
in some cases several branches from one side meet
similar ones from the opposite side and communicating
with them on the front of the vertebral column
form plexuses and from these branches of distribution
proceed; three such plexuses exist and are 
known as the cardiac, solar and hypogastric - these
constituting what is called the praevertebral sympathetic -
As a rule each ganglion is connected with 
but one spinal nerve, but to this there are exceptions
since there are thirty one spinal nerves and but
twenty-four ganglion these exceptions will be found in 
the cervical portion -
- Cervical Portion -
The cervical portion of the sympathetic is that part 
of the sympathetic chain or trunk which is found 
in the cervical region - Although there are here eight 
cervical spinal nerves there are only three sympathetic
ganglia these being known as superior, middle 
and inferior respectively - 
- Superior Cervical Ganglion -
The superior cervical ganglion lies on the front lateral 
aspect of the 2d & 3d cervical vertebral being of a 
fusiform shape and pinkish color -
Its external branches connect it with the first four 

Is connected with the 1st 4 spinal
nerves and the glosso pharengeal
Pneumogastric 
Hyperglossal 
Branches of distribution
Pharyngeal
Laryngeal
Superior Cardiac { Sup  
{ Mid  
{ inf
Cervical ganglion middle 
on the 5th cervical vertebra
its external branches communicate
with the 5th and 6th Cer. Spinal nerv
Branches of distribution are 
middle Cardiac & Thyroid

406
cervical spinal nerves and also with three of the cranial
nerves, viz, glosso-pharyngeal, pneumogastrtic
and hyperglossal -
Its ascending branches pass up along the internal
carotid artery one on the inner side of that vessel
to form in the cavernous sinus by communications
the cavernous plexus; the other on the outer side of the
carotid by communications along that artery forms
the carotid plexus -
Its descending branches connect it with the middle
cervical ganglion -
This ganglion gives off branches from its front face
which twine around the external carotid artery and 
are called nervi molles -
The internal branches or branches of distribution of 
this ganglion are three as follows -
1st Pharyngeal, which joins in the pharyngeal
plexus before mentioned (vide Vol VI. p)
2d Laryngeal which distributed to the larynx
3d Superior Cardiac, which is distributed to the heart
in a manner which will be hereafter explained, this 
is called superior cardiac because the three cervical
ganglia each give off a cardiac branch these being
distinguished as superior, middle and inferior -
- Middle Cervical Ganglion -
The middle cervical ganglion is situated opposite the 
5th cervical vertebra, in small and sometimes altogether
wanting -
Its external branches communicate with the 5th & 6th
cervical spinal nerves -
Its ascending and descending branches connect it with 
the superior and inferior cervical ganglia respectively -
Its branches of distribution are two
1st Middle cardiac - 2d Thyroid, which joins the inferior

Inferior Cervical his opposit
the 7th cervical vertebra
Its external branches comunicate
with the 7th & 8th cervical Spinal
nerves 
Branches of distribution
Inferior Cardiac
one forming a plexus arround
the vertebral Arty -
Cardiac plexuses
Superficial in left on the ductus Arteriosus
Deep - Bifurcation of trachea 

407
thyroid artery just where it makes its inward turn 
and accompanies it to the thyroid gland
- Inferior Cervical Ganglion -
The inferior cervical ganglion lies opposite the 7th cervical -
Its external branches connect it with the 7th
& 8th cervical spinal nerves -
Its ascending branches bring it into connection with 
the middle cervical ganglion -
Its descending branches are to the 1st Dorsal ganglion -
Its branches of distribution are two -
1st Inferior Cardiac: 2d A branch which comes off from 
the outer side of the ganglion and forms a plexus along 
the vertebral artery -
- The Cardiac Nerves -
The cardiac branches from the cervical sympathetic
are three on each side, superior, middle and inferior,
proceeding from the respective ganglia they descend into 
the thorax and form the cardiac plexus, the first 
of the praevertebral plexuses -
The cardiac plexus consists of two portions a superficial
or the lesser cardiac plexus and a deep or the 
greater cardiac plexus -
The superficial portion is found on the ductus arteriosus,
is quite small and often contains a mass of 
ganglionic matter (called the cardiac ganglion) It is 
found by the superior cardiac nerve of the left side and 
by the cardiac branches of the left pneumogastric nerve -
The deep portion very much larger than the superficial
in situated in the bifurcation of the trachea &
is formed by the three cardiac nerves of the right side
and the middle and inferior cardiac nerves of the left 
side with the cardiac branches of the right pneumogastric.
From these two portions which are connected by a communicating
branch, filaments descend to the heart.

12 ganglia each on the heal of a rib -

408
forming along the anterior coronary artery the anterior
coronary plexus and along the posterior coronary
plexus - 
- Thoracic or Dorsal Sympathetic -
The dorsal portion of the sympathetic consists of 
twelve ganglia on each side connected by ascending 
and descending branches to contiguous ganglia -
Each ganglion lies on the front of the head of a rib
and besides its ascending and descending branches of 
communication is connected by its external branches
with one neighboring dorsal spinal nerve -
The internal branches of the dorsal ganglia have 
the following disposition - Those from the upper five 
ganglia (about) are furnished to the aorta and oesophagus
giving a few filaments to the lungs and heart;
the internal branches from the lower seven dorsal
ganglia descend to the abdomen as they are not needed
in the thorax; in doing so they form what are 
called the splanchnic nerves whose formation and 
destination are as follows. The internal branches
from the 6th, 7th, 8th, 9th and part of that from the 10th
Dorsal ganglia unite successively to form a large cord 
called the great splanchnic nerve which pierces the 
crus of the diaphragm and terminates in a ganglionic
body called the semilunar ganglion, the two 
semilunar ganglia right and left surround the 
cardiac axis and give off an immense number of 
branches which radiating like the rays of the arm
constitute the solar plexus. The internal branch of the 
11th dorsal ganglion and part of that of the 10th unite 
to form the lesser splanchnic nerve which descends
piercing the diaphragm to terminate in the semilunar
ganglion of that side. The inches

Branches of Semi { lunar plexuses
{ or Solar plexus -
Phrenic
Gastric
Hepatic
Splenic
Supra Renal
- " "
Sup - mesenteric
Spermatic
Inf - mesenteric
aortic 

409
[4??]
inches of the twelfth dorsal ganglion usually
a branch from the lesser splanchnic form the 
[illegible] nerve which proceeds to the kidney
[illegible] of distribution of the semilunar ganglia
the solar plexus are intended to supply the 
[illegible] viscera and walls; the nerves proceed along 
[illegible] to any viscus and are known as a 
[illegible] the name of the artery it accompanies -
[illegible] are consequently as many as the arte-
[illegible] [?bdomen] -
[?lexus] accompanying the phrenic artery to
[illegible].
[??exus] accompanying the various gastric arte- 
stomach -
plexus accompanying the spatic artery to the 
" " " splenic " to the spleen
[illegible] " " " supra renal " " " supra 
[illegible].
[??exus] accompanying the Renal artery to the 
[illegible] plexus accompanying the supe-
[illegible] artery to the small intestines -
[illegible] plexus accompanying the spermatic arte-
testes - 
[illegible] plexus accompanying the inferior
[illegible] artery to the large intestines -
[illegible] plexus which descends along the aorta
producing by most of its bulk the inferior
[illegible] plexus continues into the pelvis to aid 
[illegible] a praevertebral plexus on the front of the 
known as the hypogastric 



410
The venal and super-venal plexuses are [illegible]
for the large size and numbr of their nerves, the [illegible]
receiving some fifteen large filaments -
- The Lumbar Sympathetic -
The lumbar portion of the sympathetic system is [illegible]
tumorous above with the dorsal by means of branch
which pass beneath the ligamentum arcuatum [internum?];
inferiorly its descending branches communicate 
with the sacral portion - Besides the ascending
and descending branches each ganglion of which there 
are some four or five found lying along the inner [illegible]
of the psoas magnus, has external branches to a lumbar 
spinal nerve - of the internal branches the upper 
[illegible] to the aortic plexus and the lower descend to the 
front of the promontory of the sacrum where they join 
the hypogastric plexus which is distributed to the pelvic
viscera by plexus accompanying the branches of the 
internal iliac artery -
- Sacral Sympathetic -
The sacral portion of the sympathetic consists of four 
or five ganglia with the [??cral] communicating branches
and branches of distribution to aid the hypogastric
plexus in supplying the pelvic viscera -
The ganglia lie on the front lateral aspect of the sacrum
near the anterior sacral foramina, the ganglia
of each side meaning below until the last pair meet 
on the middle and fuse into one (called the ganglion
[illegible]
- The Cranial Sympathetic -
The cranial portion of the sympathetic consists of 
four ganglia lying in and around the skull with 
the branches of communication and distribution 

[illustration]
John Smith
[illustration]
3
1.75
.75
______
9.50

411
of the carotid and cavernous plexus
ascending branch of the superior cervica
Each cranial ganglion will be found [illegible]
with two cranial nerves or two branches of the [illegible]
cranial nerve, receiving from one a motor branch
and from the other a sensitive branch and is also connected
with the rest of the sympathetic system by a 
communicating branch; these various communicating
branches forming the roots of the ganglion - The 
four cranial ganglia are the ophthalmic, the sphenopalatine,
the otic and the submaxillary 
- Ophthalmic Ganglion - 
The ophthalmic or lenticular ganglion is found in 
the orbit lying on the outer side of the optic nerve 
close to the optic foramen -
Its sensitive root is furnished by the nasal nerve;
its motor root by the branch of the 3rd nerve sent to
the inferior oblique muscle; its sympathetic root by 
the cavernum plexus -
Its branches of distribution known as ciliary [illegible]
5 or 6 in number pierce the sclerotic coat around 
the optic nerve and ramifying between the tunics 
of the eyeball terminate in the iris -
- Spheno-palatine Ganglion -
The spheno-palatine or Meckel's ganglion is the largest
of the cranial ganglia lying in the spheno-maxillary
fossa just [cross out] internal to the superior maxillary
} below 

Its connection with the facial nerve is most important