GUIDE 
TO 
DISSECTION. 
HAYNES. Surgical Handicraft. 
-A MANUAL 
OF 
Surgical Manipulations, Minor 
other matters connected with 1 
House Surgeons and Surgical 
By WALTER PYE, F.R.C.S. 
Surgeon to St. Mary’s Hospital and the Victoria Hospital U 
Examiner in Surgery at the University of G 
UPWARDS OF 300 ILLUSTRATIONS 
FIR: 
Lhi, F.R.C.S., 
>r and Joint Lecturer 
01. 
Surgical Register to 
Revised ar 
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British Medical Journal says:—“We had occasion to notice favourably 
the first edition of this manual. The work is a very practical and useful one, and 
the author is to be congratulated upon its success. The book is certainly worthy 
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In One Octavo Volume, 600 pages, and upwards of Three Hundred 
Illustrations. Cloth, $3.50 net; Sheep, $4 net. 
E. B. TREAT, Publisher, 5 Cooper Union, N. Y. A PRACTICAL GUIDE 
FOR 
BEGINNERS TO THE DISSECTION 
OF THE 
HUMAN BODY 
BY 
IRVING S. HAYNES, Ph.B., M.D. 
DEMONSTRATOR OP ANATOMY IN THE MEDICAL DEPARTMENT OF THE 
UNIVERSITY OP THE CITY OP NEW YORK; MEMBER OF 
THE SOCIETY OP THE ALUMNI OF BELLEVUE 
HOSPITAL, ETC., ETC. 
NEWYORK 
E. B. TREAT, 5 COOPER UNION 
1893 Copyright 
By E. B. TREAT, 1893 PREFACE. 
Certain conditions confront every beginner in dis- 
section—namely, bis inexperience, the brief time at his 
disposal with the many demands made upon it and the 
almost entire absence of directions for dissection in the 
standard works on descriptive anatomy, as well as their 
separate grouping of muscles, vessels, nerves, etc. This 
small volume has been prepared to meet as far as possi- 
ble the above conditions. 
It aims to supply the beginner with definite directions 
founded on practical experience in the dissecting-room, 
to economize his time by being short and to the point, 
to fill the gap between the actual dissection of the cada- 
ver and the descriptive anatomy of the standard text- 
books, by giving as clearly as possible the methods 
by which structures are to be exposed; and, above all, it 
aims to answer his constant question, “ What shall 1 do 
next f” thus to supplement, not supplant, the explanations 
of the instructors and enable the beginner to accom- 
plish the most on one subject in the allotted time. 
Methods of exposing the various structures are given 
in as full detail as is thought necessary; but all descrip- 
tion of such structures with their relations, as well as the 
dissection of the joints and of special organs as the brain, 
eye, heart, liver, testicle, etc., is intentionally omitted 
and the student referred to his standard text-books for 
all such information. 
New York, January, 1893. 
Irving S. Haynes. CONTENTS. 
PAGE 
General Remarks, 6 
Head and Neck : 
Head, anterior, 7 
Neck, “ 13 
Head and neck, posterior, 25 
First Course of Three Weeks. 
Upper Extremity and Thorax : 
Thorax, anterior, 30 
Shoulder, “ 31 
Axilla, “ 35 
Arm, u ....... . 37 
Forearm, 39 
Hand, “ 48 
Thorax and viscera, 50 
Shoulder, posterior, 55 
Arm, “ 58 
Forearm and hand, posterior, 58 
Second Course of Three Weeks. 
Third Course of Three Weeks. 
Perineum, Male, 63 
Perineum, Female, 70 
Lower Extremity and Abdomen : 
Abdomen, anterior, 75 
Peritoneum, ........ 84 
Abdominal viscera, 85 
Thigh, anterior, 98 
Leg and foot, anterior, 106 
Gluteal region, . 110 
Thigh, posterior, 114 
Leg, “ , . 115 
Foot, plantar surface, 119 GENERAL REMARKS. 
Every student must do his own dissecting. While this 
is so, in order to facilitate the work he is recommended 
to have a friend present who will read to him from his text- 
book the description of the various structures, as they are 
brought to light. This aids the dissector and prepares the 
reader for the same part. 
The general directions for dissection may be summed up 
as follows: 
Head over the descriptive anatomy of the part in your 
text-book before beginning work upon it. 
Identify the landmarks of the various regions and the 
relation to them of the deeper organs before making a sin- 
gle incision (see Holden’s “ Landmarks ” in Gray’s Anat- 
omy). 
Have the bones of the part by you or where you can 
easily refer to them. 
Closely follow the directions of the dissecting manual 
selected, completing each section in turn before going on 
with the next. Make the first cut through the skin alone 
and remove it from the area indicated. 
Clean muscles from origin to insertion, saving their nerve 
and arterial supply. 
Remove the connective tissue from vessels and nerves, 
trace their branches and examine their relations. Proceed 
carefully. Cut nothing unless absolutely necessary, and not 
then until the overlying parts have been fully dissected. 
When through for the day, replace the parts, fascia and 
skin, and cover all with a damp cloth. 
Keep the fingers and toes wrapped in a damp cloth to 
prevent drying. GUIDE TO DISSECTION. 
HEAD AND NECK. 
FIRST WEEK.—Anterior Region. 
First Day. 
Incisions.—l. From the root of the nose in the me- 
dian line to the occipital protuberance. 
2. Horizontally around the head just above the eye- 
brows and ears. 
Be very careful to remove only the skin, which is very 
thin over the forehead and everywhere closely attached to 
the muscles beneath. 
Parts Exposed. 
Occipito-frontalis. 
Auricular muscles. 
Supra-trochlear and orbital nerves, 
Supra-orbital artery. 
Frontal artery. 
Temporal arteries. 
Facial and auriculo-temporal nerves. 
1. Occipito-frontalis.—This shows as a thin layer of 
muscular fibres in two portions, an anterior and posterior, 
connected by a broad aponeurosis (galea capitis). For pos- 
terior, see later. 
7 HEAD AND NECK. 
8 
2. Auricular muscles.—Superficial to the aponeurosis of 
the occipito-frontalis and just above and in front of the 
ear, are located insignificant remnants of large muscles in 
animals—the superior and anterior auricular muscles. 
3. Supra-trochlear and orbital nerves. Frontal and 
supra-orbital arteries.—Near the median line in front you 
will find the supra-trochlear nerve, the frontal artery, (a 
little external) the supra-orbital nerve and artery coming 
out through the supra-orbital notch or foramen and all 
ascending over the forehead. 
4. Temporal artery. Facial and auriculo-temporal 
nerves.—Laterally in the temporal region you will see the 
temporal artery and its two branches, the anterior and 
posterior. Also look for terminal branches of the temporal 
portion of the facial nerve and a branch or two of the 
auriculo-temporal nerve. 
Second Day. 
Incisions.—l. Continue the median incision to the 
point of the chin. 
2. From the last point carry a cut backward along the 
lower border to the angle of the jaw and upward to the 
lobe of the ear. 
Eeflect the flap from before backward. Much care will 
have to be exercised in removing the integument from the 
face, as it is very thin, especially so over the eyelids, and 
closely attached to the facial muscles, which are thin, pale 
and indistinct. 
Parts Exposed. 
Orbicularis palpebrarum. 
Pyramidalis nasi. 
Corrugator supercilii. HEAD AND NECK, 
9 
Supra-orbital notch. 
Levator palpebrse superioris. 
Tendon and pulley of superior oblique. 
Temporal fascia and muscle. 
Superior labial muscles. 
Infra-orbital foramen, nerve and artery. 
Facial nerve. 
Temporal and orbital arteries. 
Facial vein. 
Inferior labial muscles. 
Facial artery and branches. 
Parotid gland and Stensou’s duct. 
Transverse facial artery. 
Masseter and buccinator muscles. 
5. Orbicularis palpebrarum.—This is the broad sphinc- 
ter muscle of the eye. It consists of a thin layer of mus- 
cular fibres arranged concentrically, and blends above 
with the occipito-frontalis. 
6. Pyramidalis nasi.—This muscle is a continuation 
downward on to the side of the nose of the inner fibres of 
the occipi to-frontalis. 
Divide the aponeurosis of the occipito-frontalis in the 
median line and also over the vertex of the head from ear 
to ear. 
Keflect the triangular portion downward and forward; 
when near the orbital arch the following muscle will be 
exposed: 
7. Oorrugator supercilii.—This small muscle is found 
running from the internal angular process outward and 
upward beneath and blending with the occipito-frontalis. 
Turn the occipitofrontalis still farther downward. 
8. Supra-orbital foramen and contents.—This will ex- HEAD AHD HECK. 
10 
pose the supra-orbital notch or foramen and the artery 
and nerve of the same name issuing through it. The 
course of the artery and nerve can he traced upward 
through the fibres of the occipito-frontalis. 
Reflect the posterior half of the occipito-frontalis—you 
have now exposed the temporal fascia; clearly make out its 
attachments. Out it away from its upper attachment and 
turn it downward. 
9. Temporal muscle.—The temporal portion of the tem- 
poral muscle is now seen, one of the most important of the 
muscles of mastication. 
Eeturn the temporal fascia and occipito-frontalis to their 
natural positions. 
Cut through the orbicularis palpebrarum along the mar- 
gin of the orbit, and open the socket of the eye. 
10. Levator palpebrse snperioris.—By scratching in 
the middle of the upper lid the levator palpebrse superioris 
will be exposed. 
11. Superior oblique and pulley for tendon.—Also find 
the superior oblique and follow its tendon until you come 
to the pulley for the same. 
The contents of the orbit may now be removed by divid- 
ing the above muscles and all other muscles, arteries, and 
nerves, as close to the wall of the orbit as possible. The 
eye may be dissected at the student’s leisure. 
The dissection of the face is now to be resumed. The 
curved scissors—-curved on the flat—will be found best 
adapted to cleaning the fatty tissue from the facial mus- 
cles, cutting in the direction of the fibres of the muscles. 
Be careful to preserve the branches of the facial nerve 
and artery wherever found. As soon as a nerve or artery 
is discovered, trace it out both ways as far as possible, and 
when several structures are thus isolated from each other. HEAD Aif I) KECK. 
11 
the intervening tissue may be carefully pulled and cut 
away. Concerning the labial groups of muscles the origin, 
insertion, and action may be carefully read, and the nerve 
supply learned. 
12. Superior labial muscles.—Below the orbit and from 
the nose outward recognize the following muscles: 
a. Levator labii superioris alceque nasi—elevator of the 
upper lip and wing of the nose. 
b. Levator labii superioris proprius—chief elevator of 
the upper lip—closely blends with the above. 
c. Zygomaticus major and sometimes, between it and the 
preceding, the 
d. Zygomaticus minor. 
e. Beneath this layer of muscles you will find the levator 
anguli oris—elevator of the angle of the mouth. 
f. Orbicularis oris. See No. 18 d. 
13. Infra-orbital foramen, artery and nerve.—Just 
above the origin of the levator anguli oris you will find the 
infraorbital foramen transmitting the artery and nerve 
of the same name. 
14. Parotid fascia, gland and duct.—Covering the par- 
otid gland is a dense layer of fascia which also covers the 
masseter muscle under the name of masseteric fascia. It 
is derived from the first layer of the cervical fascia and 
reaches as high as the zygomatic arch. 
Foukth Day. 
Be very careful in removing this fascia to save all the 
filaments of the facial nerve. 
The duct of the gland—Stenson’s—-runs forward and 
passes through the buccinator muscle. Usually a small 
detached portion of the parotid is found on the masseter 
muscle—the glandula socia parotidis, HEAD AND NECK. 
12 
15. Temporal, transverse facial and orbital arteries.— 
Just above Stenson’s duct and then passing downward is 
the transverse facial artery. Trace it carefully beneath 
the gland until you reach the temporal from which it rises. 
Follow the temporal artery upward and find its orbital 
branch, which passes to the outer part of the orbit. 
16. Facial nerve.—Crossing the face are the temporal, 
malar and infra-orbital branches of the temporo-facial divi- 
sion of the seventh nerve. Trace these branches into the 
parotid gland to the point where the facial divides into the 
upper division just mentioned and the lower or cervico- 
facial division. 
This radiation of branches is called the pes anserinus. 
Follow forward the buccal and supra-maxillary branches 
of the cervico-facial division. 
17. Facial vein.—The facial vein begins below the orbit 
and passes straight downward to just behind the facial 
artery, where it curves over tlie lower jaw. 
18. Inferior labial muscles.—Dissect out the following 
muscles: 
a. Levator labii inferioris, or levator menti. To find 
this little muscle divide the tissues of the chin in the 
median line and separate them. 
b. Depressor labii inferioris. 
c. Depressor anguli oris. 
d. Orbicularis oris. The sphincter muscle of the mouth 
into which all the other oral muscles are inserted. 
e. Platysma myoides. The upper portion that is in- 
serted into the angle of the mouth may be removed, but 
do not disturb the part attached to the lower jaw. 
19. Facial artery and branches.—The facial artery and 
all its facial branches are now to be dissected out. 
Begin where the artery curves over the lower jaw at the HEAD AHD HECK. 
13 
junction of its middle and posterior thirds, and trace the 
artery in its devious course around the angle of the mouth 
up by the side of the nose until it anastomoses at the inner 
angle of the eye with the nasal branch of the ophthalmic. 
In its course the facial gives oif the following branches: 
a. Muscular (masseter and buccinator). 
b. Inferior labial. 
C. Inferior coronary. 
d. Superior coronary. 
e. Lateralis nasi. 
f. Angular (last portion of facial). 
20. Masseter and buccinator.—Clean the surface of the 
masseter and buccinator of all remaining tissue. 
Note the two portions of the former, and where Sten- 
son’s duct pierces the latter muscle. 
21. Mental foramen, nerve and artery.—Find the men- 
tal foramen in the lower jaw and the mental nerve and 
artery issuing from it. 
Fifth Day 
Incisions. —l. Carry the median incision to the top 
of the sternum, 
2. Make a transverse one to this out along the clavicle 
to the point of the shoulder, (Same for upper extremity, 
p. 30, incision 2.) 
Reflect the integument from above downward and as far 
backward as possible. Be sure to remove the skin only. 
Parts Exposed. 
Platysma. Nerve supply. Cervical fascia. 
22. Platysma myoides.—After making out its attach- 
ments, begin below and carefully raise it from the struc- HEAD AHD HECK, 
14 
tufes underneath, being sure to leave them untouched. 
Roll the muscle up on to the lower Jaw. 
In raising it you will find its nerve supply, which recog- 
nize and divide. 
You now have exposed the first layer of the deep cervi- 
cal fascia. 
Its facial portions have already been mentioned as the 
parotid and masseteric fascias. 
Study the description of the deep cervical fascia as given 
in the text-books. 
Parts Exposed. 
External and anterior jugular and facial veins. 
Submaxillarj gland. 
Superficial nerves. 
Sterno-cleido-mastoid. 
Trapezius. 
Spinal accessory and cervical branch to trapezius. 
Facial, submental and submaxillary arteries. 
Digastric. 
Stylo-hyoid. 
Mylo-hyoid nerve. 
23. External and anterior Jugular and facial veins.— 
Trace the external Jugular from the parotid gland to 
where it empties into the subclavian. Clean the facial 
vein and its communications. Follow the anterior Jugular 
to its termination in the subclavian. 
24. Submaxillary gland.—Recognize the submaxillary 
gland and note its relations (as the dissection is carried 
deeper), as it must often be incised for abscess, removed for 
strumous or tubercular disease, and is one of the important 
guides to ligation of the lingual artery. HEAD AHD HECK. 
15 
25. Superficial nerves,—The following nerves are to be 
sought for and cleaned. 
If not readily found note their position in the plate of 
your text-book and then scratch through the fascia in the 
direction of the nerve, in several places if necessary until 
found. Also by tracing the nerves most easily found back 
to the trunk from which they spring, you will locate the 
trunk and find its other branches. 
a. Infra-maxillary branch of the cervico-facial division 
of tlie seventh cranial nerve. 
b. Auricnlaris magnns. Which appears carving over 
the posterior border of the sterno-mastoid muscle above its 
middle and passes vertically upward to the parotid gland, 
where it gives off branches. 
C. Superficial cervical. Passes transversely across the 
sterno-mastoid. 
Nerves b and c arise from the second and third cervical 
nerves. 
d. Small occipital. Issues from the same place as the 
last two and ascends along the posterior border of the 
sterno-mastoid to the side of the head behind the ear. 
This comes from the second cervical nerve. 
e. Several nerves are found passing downward to supply 
the integument over the upper part of the sternum, clav- 
icle and acromion. They take the name of the region they 
supply. They are branches of the third and fourth cervi- 
cal nerves. 
26. Sterno-cleido-mastoid.—Clean the surface of the 
sterno-cleido-mastoid from origin to insertion. Study 
well its relations and the part it plays in forming the tri- 
angles of the neck. 
27. Trapezius.—Clean the anterior portion of the 
trapezius. HEAD AHD HECK. 
16 
Between the last two muscles and bounded below by the 
clavicle is the posterior triangle of the neck. 
This space is filled with dense fascia in which you want 
to find the two nerves below. 
28. Spinal accessory and muscular branch to trapezius.— 
The spinal accessory nerve issues from the posterior, mid- 
dle border of the sterno-cleido-mastoid and passes downward 
and backward to the anterior surface of the trapezius. It 
is closely followed in its course by the muscular branch 
from the third and fourth cervical nerves to the trapezius. 
29. Digastric and stylo-hyoid muscles.—Dissect out 
the anterior belly of the digastric and as much of its pos- 
terior belly with the stylo-hyoid as possible. Note that the 
latter muscle is pierced by the tendon of the posterior part 
of the digastric. 
30. Facial, submaxillary and submental arteries.—Trace 
the facial artery as far as possible and recognize its sub- 
maxillary branches to the gland and the course of its sub- 
mental branch. 
31. Mylo-hyoid nerve.—By drawing the gland down- 
ward and lookiug a little deeper than the submental artery 
and immediately below the lower jaw, you will find the 
small mylo-hyoid nerve passing forward. Trace its dis- 
tribution. 
This completes the dissection for the first five days; the 
sixth day of the week is left to complete any unfinished 
part. 
Nothing is said about removing the brain, as generally it 
is useless, it having by this time become unfit for dissec- 
tion. HEAD AID HECK. 
SECOND WEEK.—Anterior Surface. 
To continue the work on the neck divide the externa] 
jugular vein and sterno-mastoid muscle at their middle and 
reflect. 
First Day. 
Be careful to leave the spinal accessory nerve intact. 
Clean the parts of fascia and adipose tissue. 
Draw the snbmaxillary gland upward and carefully incise 
any remaining fascia, holding the gland down, until the 
deeper structures are fully exposed. 
Parts Exposed. 
Lingual triangle. 
Mylo-hyoid. 
Posterior belly of digastric. 
Hypoglossal, descendens hypogiossi (noni) and muscular 
branches of hypoglossal nerve. 
Omo-hyoid. 
Sterno-hyoid. 
Sterno-thyroid. 
Thyro-hyoid. 
Communicans hypogiossi (noni). 
Carotid artery. 
Internal jugular vein. 
Pneumogastric nerve. 
33. Lingual triangle.—As yon raise the snbmaxillary 
gland you will notice a triangular space that is bounded as 18 
HEAD AND NECK. 
follows: In front by the posterior margin of the mylo- 
hyoid muscle (also sometimes given the anterior belly of 
digastric), behind by the posterior belly of the digastric 
(and stylo-hyoid muscle) and above by the hypoglossal nerve 
(which shows through the fascia). The floor of the space 
is formed by the hyoglossus muscle. By cutting through 
the last transversely to its fibres, the lingual artery will 
be found. 
33. Mylo-hyoid.—Divide the tendon of the anterior 
belly of the digastric and clean the mylo-hyoid muscle. 
Notice how the submaxillary gland is extended under the 
muscle. 
34. Hypoglossal, descendens hypoglossi, and thyro- 
hyoid branch.—Expose the hypoglossal nerve as far as 
possible. Notice how it curves around the occipital artery 
and where it gives off the descendens hypoglossi (noni), 
and trace this nerve down the sheath of the carotid to its 
muscular distribution. Note the point where the commu- 
nicans hypoglossi joins the descendens. 
Find the separate branch of the hypoglossal nerve to the 
thyro-hyoid muscle. 
35. Digastric and stylo-hyoid.—Complete the dissection 
of the posterior belly of the digastric and the stylo-hyoid 
muscles and endeavor to find their nerve supply. 
Second Day. 
36. Omo-hyoid, sterno-hyoid, sterno-thyroid and thyro- 
hyoid.—Completely clean the omo-hyoid, leaving a small 
loop of fascia to mark where it is bound down to the clav- 
icle, the sterno-hyoid, sterno-thyroid and thyro-hyoid, and 
demonstrate their nerve supply. 
34. Coramunicans hypoglossi (noni).—Go back to the 
loop between the descendens and comm uni cans hypoglossi HEAD AKD KECK, 
19 
(noni), and trace the latter to its origin by two branches, 
one from the second and the other from the third cervical 
nerves. 
35. Common carotid triangles.—Study well the location 
of the common carotid artery and note where it bifurcates. 
Practise bounding the triangles of the neck, and examine 
their contents as far as dissected out and their relations. 
36. Internal Jugular vein.—Expose the internal jugu- 
lar vein as high as possible and trace it downward until 
with the subclavian it forms the innominate. 
37. Pnenmogastric nerve.—Bring the pneumogastric 
nerve into view by separating the carotid and internal Jug- 
ular, and clean it as far as convenient both ways. 
Third Day. 
Divide the nrjdo-hyoid muscle along the median raphe, 
also cut through its attachments to the hyoid bone and 
reflect the muscle. 
Genio-hyoid. 
Genio-hyoglossus. 
Hyoglossus. 
Wharton’s duct. 
Gustatory nerve. 
Submaxillary ganglion. 
Hypoglossal nerve. 
Parts Exposed. 
38. Genio-hyoid, genio-hyogiossus, hyoglossus.—On 
either side of the median line yon will find a genio-hyoid 
muscle. Underneath this (really above) the genio-hyo- 
giossus. More externally the entire extent of the hyo- 
glossus can be made out. HEAD AND NECK. 
20 
39. Wharton’s duct.—Trace the duct—Wharton’s—of 
the suhmaxillary gland forward to the floor of the mouth. 
40. Gustatory nerve.—Along with the duct you will 
find the gustatory branch of the inferior maxillary nerve. 
By drawing the gland well down you can trace the nerve 
hack under the lower jaw between it and the internal 
pterygoid muscle. 
41. Suhmaxillary ganglion.—ln the little space be- 
tween the gland, duct and gustatory nerve is located the 
suhmaxillary ganglion; about as large as the head of a 
small pin. 
42. Hypoglossal nerve.—Trace the final muscular dis- 
tribution of the hypoglossal nerve. 
Divide the posterior belly of the digastric and the stylo- 
hyoid muscles near the hyoid bone. 
Parts Exposed. 
Styloglossus. 
Stylo-pharyngeus. 
Superior constrictor. 
Middle constrictor. 
Glosso-pharyngeal nerve. 
42. Stylo-glossus, -pharyngeus, and constrictor superior 
and middle.—The stylo-glossus muscle passes from the 
styloid process to the side of the tongue, decussating with 
the hyoglossus. 
The stylo-pharyngeus descends to the pharynx and passes 
in between the borders of the superior constrictor above 
and the middle below. The constrictor muscles are only 
slightly exposed. 
44. Glosso-pharyngeal nerve.—The glosso-pharyngeal 
nerve comes out between the internal jugular vein and in- HEAD AND HECK. 
21 
ternal carotid artery. It issues from under the styloid 
process and curves forward around the stylo-pharyngeus 
muscle. Trace it as far as possible. 
Fourth Day. 
Divide the omo-hyoid near its middle, the sterno-hyoid 
and sterno-thyroid near the sternum, and reflect them. 
Divide the internal jugular near the subclavian vein 
(first having ligated it) and as high up near the head as 
possible, and remove it. 
Parts Exposed. 
External carotid and branches. 
Internal carotid. 
Pneumogastric nerve. 
Recurrent laryngeal nerve. 
Phrenic nerve. 
Scalenus anticus. 
Subclavian vein. 
Subclavian artery. 
Thyroid axis. 
Transversalis colli artery, 
Supra-scapular artery. 
45. External carotid.—The external carotid and all its 
branches can now be finished. Most of the branches have 
been partially cleaned in the dissection of other structures, 
but are now to be taken up more particularly. 
As usually found, the branches are given off in the fol- 
lowing order: 
a. Ascending pharyngeal in the fork between the exter- 
nal and internal—but often higher up from the external 
carotid. HEAD ASTI) KECK. 
22 
b. Superior thyroid. In tracing this artery, especially 
notice the crico-thyroid branch. 
c. Lingual. Follow its course and bound the lingual 
triangle. 
d. Occipital. Remember its relation to the hypoglossal 
nerve and follow the artery back under the digastric. 
e. Facial. Complete the dissection of this branch by 
finding the ascending palatine and tonsillar arteries. 
f. Posterior auricular. Runs up behind the ear as its 
name indicates. It is crossed by the facial nerve. 
g. h. Cut away all remains of the parotid gland and 
expose the bifurcation of the external carotid into the in- 
ternal mammary and temporal arteries. 
46. Internal Carotid.—The internal carotid ascends 
vertically to the base of the skull; at first the external car- 
otid is in front, then superficial to the internal. There are 
no branches of the internal in the neck. 
47. Pneumogastric, recurrent laryngeal, and cervical 
cardiac nerves.—Follow the pneumogastric down to the 
chest. On the right side its recurrent laryngeal branch 
curves around the subclavian artery and on the left side 
around the aorta, and then passes up (same now on both 
sides) between the trachea and oesophagus and disappears 
under the lower border of the inferior constrictor muscle. 
With care the inferior cardiac branch may be found. 
It is given off near the clavicle, then passes into the chest. 
48. Scalenus anticus.—This muscle is of great impor- 
tance surgically as furnishing a sure guide to the subclavian 
artery, when the artery is normal. The muscle passes be- 
tween the subclavian vein (in front) and artery (behind). 
It is inserted into the tubercle of the first rib, which should 
be felt by passing the finger down the front of the muscle. 
49. Phrenic nerve.—The phrenic nerve—internal re- HEAD AND KECK. 
23 
spiratory nerve of Bell—crosses the scalenus obliquely from 
above downward and without inward, and passes into the 
chest between the subclavian vein and artery. 
50. Subclavian vein.—After noting the relations of the 
subclavian vein ligature it at its beginning and ending, 
and remove it. 
51. Subclavian artery.—Learn the artery and its rela- 
tions. Notice how high it reaches into the neck and how 
intimately related to the brachial plexus. 
52. Thyroid axis and external branches.—The thyroid 
axis comes olf from the front of the subclavian artery Just 
internal to the scalenus anticus. Trace the two external 
branches of the thyroid axis—the transversalis colli and 
supra-scapular—out across the scalenus anticus muscle and 
phrenic nerve. The former runs outward above and par- 
allel with the clavicle, and the latter passes behind the 
clavicle to the upper border of the scapula. 
Fifth Day. 
Divide the common carotid near its bifurcation and 
draw it upward and forward. 
Divide the scalenus anticus over the subclavian artery. 
Parts Exposed. 
Superior laryngeal nerve. 
Sympathetic nerve and ganglia. 
Eectus capitis anticus major. 
Longus colli. 
Internal mammary artery. 
Vertebral artery. 
Inferior thyroid artery. 
Superior intercostal artery. 
Inferior constrictor muscle. HEAD AND HECK. 
Scalenus medius. 
Brachial plexus. 
Scalenus posticus. 
Levator anguli scapuhe. 
Splenius capitis. 
Internal pterygoid. 
53. Superior laryngeal nerve.—This nerve will be found 
coming off from the pneumogastric high up and. passing 
behind, the internal carotid to the larynx—it has an upper, 
internal branch and a lower, external branch. 
53. Sympathetic nerve and ganglia.—The sympathetic 
nerve will be found directly behind the carotid artery. It 
lies upon the rectus capitis anticus major and longus colli 
muscles. It presents a large superior and inferior and a 
small middle cervical ganglion. 
54. Remaining branches of subclavian artery.—From 
the upper and back part of the subclavian you will find the 
vertebral which ascends vertically and enters the foramen 
in the transverse process of the sixth cervical vertebra. 
Below and behind is given off the internal mammary 
which passes into the chest. 
The inferior thyroid, the remaining branch of the thy- 
roid axis, reaches the thyroid gland by a tortuous course 
behind the common carotid artery and sympathetic nerve. 
The inferior thyroid gives off (usually) the ascending 
cervical artery, which passes upward between the vertebral 
origins of the scalenus anticus and rectus capitis anticus 
major. 
Eaise the subclavian artery and you will find its last 
branch, the superior intercostal, coming otf from the pos- 
terior surface of the artery. 
55. Inferior constrictor. Scalenus medius and posticus. HEAD AM HECK, 
25 
Levator anguli scapulas. Spleuius,—Clean the following 
muscles: Inferior constrictor; scalenus raedius and posticus; 
levator anguli scapulas; splenius capitis et colli. 
56. Brachial plexus.—ln connection with the one dis- 
secting the upper extremity, study the formation of the 
brachial plexus (after disarticulating the clavicle from the 
sternum). 
This completes the dissection for the second week, and 
is intended to take five days, allowing a day extra for un- 
finished work and reviews. 
HEAD AKD HECK. 
THIRD WEEK.—Posterior Surface. 
First Day, 
Incisions. —l. Continue the median incision down the 
back of the neck to midway between the shoulders. 
2. Carry a transverse incision out along the scapular 
spine to the point of the shoulder to meet the anterior in- 
cision (same as 2, p. 55). 
Remove the integument entirely. It will he found 
bound by a dense fascia to the parts beneath. 
Parts Exposed. 
Occipital artery. 
Great occipital nerve. 
Third occipital nerve. 
Trapezius. 
Small occipital nerve. HEAD AND HECK. 
26 
57. Occipital artery.—The occipital artery will be found 
imbedded in the dense fascia of the back of the bead. It 
pierces the trapezius close to the occipital bone and near 
its outer border and ascends over the back of the head. 
58. Great occipital nerve.—Close to and internal to the 
artery will be found the great occipital nerve. The in- 
ternal branch of the posterior division of the second cervi- 
cal nerve. It takes a vertical course. Trace the nerve 
from its exit through the trapezius upward. 
59. Third occipital nerve.—Internal to the great occip- 
ital nerve and close to the median line is a smaller—or 
third—occipital nerve. The internal cutaneous branch of 
the posterior division of the third cervical nerve. 
60. Small occipital nerve.—Recognize the small occipi- 
tal nerve and complete its dissection if not finished (see § 
25, (I, page 15). 
61. Trapezius muscle.—Finish cleaning the trapezius, 
Notice where the spinal accessory and cervical branch 
enter the muscle. In connection with the one working 
on the upper extremity make out its lower portion—origin 
and insertion. 
Second Day, 
Divide the trapezius one-half inch from its superior and 
close to its median origin and turn it downward. 
Parts Exposed. 
Splenius capitis et colli. 
Levator anguli scapulae. 
Posterior scapular artery. 
62. Splenius capitis et colli.—The splenius runs obliquely 
outward and upward to the occipital bone and mastoid HEAD AND NECK. 
process, and also to the three or four upper cervical ver- 
tebras. It is separated from the median line by a triangu- 
lar space, in which is seen the coinplexus. 
63. Levator anguli scapulae.—The levator anguli scap- 
ulae, as its name indicates, reaches from the upper angle of 
the scapula to the three or five upper cervical vertebrae. 
64. Posterior scapular artery.—Underneath the above 
muscle and rhomboids, and showing between them, you 
will find the posterior scapular branch of the transversalis 
colli passing around the upper angle of the scapula. 
Divide the splenius one inch from its cranial and verte- 
bral (upper) attachments, and turn downward and inward. 
Occipital artery, 
Trachelo-mastoid, 
Complexus and biventer. 
Parts Exposed. 
65. Occipital artery.—The entire course of the occipital 
artery is now exposed. It passes under the following 
muscle. 
66. Trachelo-mastoid muscle.—The trachelo-mastoid 
runs vertically downward from the mastoid process to the 
cervical vertebrae, third to sixth. 
67. Complexus and biventer.—The complexus is now 
fully exposed. Its inner portion called the biventer—two- 
bellied—cervicis can easily be distinguished. Note the 
points where the great and third occipital nerves leave the 
muscle. 
Thikd Day, 
Divide the complexus, biventer and trachelo-mastoid mus- 
cles close to their cranial attachments. Cut the levator an- 
guli scapulae from its vertebral origin. (It is intended HEAD AND NECK. 
28 
that the dissector on the upper extremity will have removed 
the rhomboids and serratus posticus superior by this time.) 
Parts Exposed. 
Sub-occipital triangle. 
Sub-occipital nerve. 
Vertebral artery. 
Rectus capitis posticus minor. 
Root of great occipital nerve. 
Root of third occipital nerve. 
Princeps cervicis artery. 
Profunda cervicis artery. 
Scalenus posticus. 
Cervicalis ascendens. 
Transversalis colli. 
Semispinalis colli. 
68. Sub-occipital triangle, boundaries and contents.— 
The sub-occipital triangle can be nicely demonstrated, if 
the student is careful to dissect off the thick fascia which 
envelops the muscles forming the triangle and fills the 
space beween them. Unless care is used in cleaning out 
the triangle, the sub-occipital nerve will be cut away. 
The muscles forming the triangle are to the inside—the 
rectus capitis posticus major. Outside the obliquus supe- 
rior, below the obliquus inferior. 
When the triangle is cleaned, at its bottom will be seen 
the vertebral artery—learn its course. The sub-occipital 
nerve comes out alongside the vertebral artery between the 
occipital bone and posterior arch of the atlas. 
69. Rectus capitis posticus minor.—lnternal to and 
beneath the larger rectus is the rectus capitis posticus 
minor. HEAD AND KECK. 
29 
70. Great and third occipital nerves.—Trace the great 
and third occipital nerves to their roots. 
71. Princeps and profunda cervicis arteries,—The long 
and important anastomosis between the princeps cervicis 
branch of the occipital and the profunda cervicis branch 
of the superior intercostal should be traced. 
The former—princeps cervicis—crosses the superior and 
inferior oblique muscles, the latter ascends on the semi- 
spinalis colli. 
73. Scalenus posticus, cervicalis ascendens, and trans- 
versalis and semispinalis colli.—ldentify by the aid of the 
plates and descriptions in your standard text-books the 
following muscles. It is not necessary to learn them. 
Scalenus posticus. 
Cervicalis ascendens. 
Transversalis colli. 
Semispinalis colli. UPPER EXTREMITY AXD THORAX. 
FIRST WEEK.—Anterior Surface. 
First Day. 
As a preliminary study it is well to map out on tire chest 
with an aniline pencil the bony landmarks and relative 
positions of the thoracic viscera—lungs, heart and its valves 
and great vessels—as given by Holden in his “ Landmarks ” 
in Gray’s Anatomy. 
Incisions.—l. In the median line from the top to the 
end of the sternum. 
2. From the beginning of 1, out along the clavicle to 
the point of the shoulder (same incision as 2, Head and 
Neck, p. 13). 
3. From the lower end of 1, tranversely around the 
body, as far as the posterior axillary line. (No. 2, p. 75.) 
4. From the centre of the clavicle down the front of the 
arm to the elbow. 
Eemove the integument from the chest and upper part 
of arm. 
Parts Exposed. 
Superficial fascia. 
Origin of platysrna. 
Cervical cutaneous nerves. 
Mammary gland (females). 
1. Superficial fascia.—The superficial fascia covers the 
30 UPPER EXTREMITY AND THORAX. 
31 
entire area. It is continuous with that of the abdomen, 
neck, and arm. 
2. Origin of platysma.—The origin of the platysma will 
be seen along the front of the clavicle. 
3. Cervical cutaneous nerves.—Filaments of the sternal, 
clavicular and acromial cutaneous branches from cervical 
nerves may be found in the regions indicated by their 
names (See § 25, e, p. 15). 
4. Mammary gland.—The mammary gland is contained 
between two layers of the superficial fascia. It is freely 
movable upon the deep fascia. 
Remove the superficial fascia from the same area as the 
skin. This.exposes the deep fascia, which is a thin layer, 
and after being demonstrated, should also be removed from 
the parts it covers. 
Parts Exposed. 
Pectoralis major. 
Deltoid. 
Cephalic vein. 
Acromio-thoracic artery and branches. 
5. Pectoralis major and deltoid.—Clean the pectoralis 
major and anterior half of the deltoid. Note the space 
between the two muscles is very narrow in muscular sub- 
jects and contains a vein and artery. 
6. Cephalic vein.—Separate the two muscles and trace 
the vein—cephalic—from the arm until it disappears by 
piercing the costo-coracoid membrane. 
7. Acromio-thoracic artery and branches.—Coming out 
through the same membrane you will find the acromio- 
thoracic artery, which breaks up into three branches—acro- 
mial, descending, with the cephalic vein and thoracic. UPPER EXTREMITY AKD THORAX. 
Second Day. 
Section the pectoralis major at its middle and outer 
thirds. Carefully reflect the inner portion of the muscle 
and expose its nerve supply. 
External anterior thoracic nerve. 
Internal anterior thoracic (sometimes). 
Costo-coracoid membrane. 
Pectoralis minor. 
Snbclavius. 
Parts Exposed. 
8. Anterior thoracic nerves.—The external anterior 
thoracic (outer cord) will be found coming through the 
costo-coracoid membrane to end in the pectoralis major 
(outer muscle). 
The internal anterior thoracic (inner cord), if found at 
this stage, will appear on the outer surface of the pectoralis 
minor (inner muscle), having traversed it to pass to the 
pectoralis major. 
9. Costo-coracoid membrane—The membranous process 
of fascia reaching from the under margin of the clavicle to 
the upper border of the pectoralis minor and from the cor- 
acoid process of scapula to first rib, is called the costo- 
coracoid membrane. The structures which pass through 
it have been mentioned already. 
10. Pectoralis minor.—Clean the pectoralis minor, not- 
ing how at its upper border the above membrane divides 
into two layers enclosing the muscle. 
11. Subclavius.—Incise the costo-coracoid membrane, 
close to the clavicle, and expose the subclavius muscle. 
Remove the costo-coracoid membrane and the connective 
tissue covering the vessels and nerves beneath. UPPER EXTREMITY AHD THORAX. 
33 
Parts Exposed. 
Axillary vein. 
Axillary artery. 
Superior thoracic artery. 
Acromio-thoracic artery. 
Anterior thoracic nerves. 
IS. Axillary vein.—The axillary vein, of large size, will 
first be encountered. It receives the cephalic vein and 
rests upon and to the inside of the artery. 
13. Axillary artery. Superior thoracic and acromio- 
thoracic branches.—The first portion of the axillary artery 
is exposed. It gives off in this locality two branches, the 
superior thoracic, which runs upward to the chest, and the 
acromio-thoracic, the branches of which have already been 
found. 
14. Anterior thoracic nerves.—Finish tracing the an- 
terior thoracic nerves; the external to the outer cord 
across the axillary artery and vein, the internal to the 
inner cord between the artery and vein. 
Third Day. 
Dissect out the floor of the axilla; that is, the portion 
of the axilla external to the pectoralis minor between the 
arm and chest. 
Parts Exposed. 
Long thoracic artery. 
Serratus magnns. 
Long thoracic nerve. 
Intercosto-humeral nerve. 
Axillary vein. 
Axillary artery. UPPER EXTREMITY AXD THORAX. 
34 
Subscapular artery. 
Dorsalis scapulae artery. 
Anterior and posterior circumflex arteries. 
Latissimus dorsi. 
Teres major. 
15. Long thoracic artery.—lmmediately below and par- 
allel with the lower border of the pectoralis minor, is the 
long thoracic artery. Follow it to its source and distribu- 
tion. 
16. Serratus magnus.-—The muscle covering the side of 
the chest in this region is the serratus magnus, a part of 
which only is exposed. 
17. Long thoracic nerve.—The long thoracic nerve is 
found descending upon the serratus magnus at about its 
middle. Only the lower portion of the nerve can be traced. 
The nerve is also called the external thoracic or external 
respiratory nerve of Bell. 
18. Intercosto-humeral.—The intercosto-humeral nerve 
will he found imbedded in the fascia of the floor of the 
axilla. 
Its upper part will be dissected out later. At this stage 
trace its external distribution and find the small branch it 
receives from the lesser internal cutaneous nerve. 
19. Axillary vein.—Examine the formation and rela- 
tions of this portion of the axillary vein. 
20. Axillary artery,—Clean the last or third portion of 
the axillary artery. Study its relations in this locality. 
Its branches in this part of its course are the subscapular, 
which gives off the dorsalis scapulae, and the anterior and 
posterior circumflex. Trace all these branches as far as 
convenient to their distal supply. 
21. Latissimus dorsi and teres major.—Clean the latis- UPPER EXTREMITY AXD THORAX. 
35 
simus dorsi and teres major muscles, and in doing so pre- 
serve their arterial and nerve supply. 
Fourth Day. 
Divide the pectoralis minor at its outer and middle 
thirds, and reflect the parts, saving its nerve supply, which 
will be attached to the inner portion of the muscle. 
You have now opened the axillary space throughout its 
entire extent. Learn its boundaries and contents before 
going farther. 
Parts Exposed. 
Axillary vein. 
Axillary artery. 
Alar-tlioracic artery. 
Brachial plexus. 
Long thoracic nerve. 
Intercosto-humeral nerve. 
Serratus magnus. 
Subscapular is. 
22. Axillary vein.—The axillary vein is now to be fin- 
ished. Then ligate it under the clavicle and near its be- 
ginning, and remove it together with its branches. 
23. Axillary artery and alar-thoracic branch.—The 
axillary artery is also exposed in its entire course. Exam- 
ine its relations as a whole. Its remaining branch, the 
alar thoracic—if present—will be found coming from the 
second portion of the artery to supply the glands and are- 
olar tissue of the axillary space. 
24. Brachial plexus and branches.—Take up the bra- 
chial plexus. Study its formation as given in Gray or Quain 
(the dissection of this part will be omitted uoav, but taken 
up later when the neck is dissected to the proper stage). 36 
UPPER EXTREMITY AX'D THORAX. 
Begin where the plexus issues from under the clavicle 
and clean in turn: 
a. Outer cord and its branches. 
(1) External anterior thoracic (already completed). 
(2) Musculo-cutaneous, Trace to Avhere it enters the 
coraco-brachialis. 
(3) Inner head of median. 
b. Inner cord and branches, viz.: 
(1) Internal anterior thoracic (already completed). 
(2) Lesser internal cutaneous. 
(3) Internal cutaneous and 
(4) Ulnar to the lower border of the latissimus dorsi. 
Find tlie small branch of the lesser internal cuta- 
neous to the intercosto-humeral—already partially 
dissected—and finish it. 
(5) Dissect the inner head of the median. 
C. Posterior cord and branches, viz.: 
(1) Upper, (2) Middle, (3) Lower subscapnlar nerve, 
and trace each to the muscle it supplies. 
(4) Circumflex. Follow it until it disappears in a 
quadrilateral space Avith the posterior circumflex 
artery. Learn the boundaries of the space. « 
(5) Musculo-spiral. Trace it until it enters the mus- 
culo-spiral groove. 
25. Long thoracic nerve.—Follow the long or posterior 
thoracic nerve as far upward as possible, and learn how it 
is formed. 
26. Intercosto-humeral nerve.—Complete the dissection 
of the intercosto-humeral nerve by tracing it to Avhere it 
comes out of the second intercostal space. 
27. Subscapularis and serratus magnus.—Clean the sub- 
scapularis and remaining portion of the serratus magnus 
muscles. UPPER EXTREMITY AND THORAX. 
37 
Incision.—At the lower end of the arm incision, just 
below the elbow, make a transverse cut. 
Reflect the skin from the front of the elbow and lower 
part of the arm and clean the superficial veins and nerves. 
Fifth Day. 
Parts Exposed, 
Superficial veins. 
Median, radial, ulnar (common); median cephalic, 
median basilic; cephalic, basilic. 
Superficial nerves. Branches of 
Internal cutaneous. 
Lesser internal cutaneous. 
Musculo-spiral. 
28. Superficial veins.—Learn the usual arrangement of 
the superficial veins as given in your text-book, and notice 
whether they correspond in the subject with the descrip- 
tion or not. 
Especially notice the position and relation of the median 
basilic vein to the artery beneath. 
29. Superficial nerves.—The superficial nerves found in 
this region are branches of the internal and lesser internal 
cutaneous nerves on the front and inner side of the elbow 
and the inferior cutaneous branch of the musculo-spiral on 
the outer side. 
Remove the superficial veins and deep fascia, and clean 
the muscles, vessels and nerves. 
Parts Exposed. 
Biceps. 
Coraco-brachialis. 
Brachialis anticus. UPPER EXTREMITY AJfD THORAX. 
38 
Musculo-cutaneous nerve. 
Median nerve. 
Ulnar nerve. 
Internal cutaneous nerve. 
Brachial artery and branches. 
Triceps. 
30. Biceps.—ln cleaning the biceps save the broad ex- 
pansion from its tendon to the deep fascia of the forearm. 
Trace up its two origins—the long head in the bicipital 
groove on its way to enter the capsule of the shoulder-joint, 
the short head to the coracoid process. 
31. Ooraco-brachialis.—The coraco-brachialis passes 
from the coracoid process to the humerus. It is pierced by 
the musculo-cutaneous nerve and is the guide to the upper 
portion of the brachial as the biceps is for its lower portion. 
32. Brachialis anticus. —By raising the biceps the upper 
part of the brachialis anticus is exposed. 
S3. Nerves in arm.—Trace the following branches of 
the brachial plexus through the arm: 
a. Musculo-cutaneous. From its exit through the cor- 
aco-hrachialis muscle to where it becomes cutaneous, mak- 
ing out its muscular distribution. 
b. Median. From its formation to the elboAv, noting its 
relations to the brachial artery. 
c. Ulnar. Follow it until it disappears behind the in- 
ternal condyle. 
d. Internal cutaneous. Find its posterior trunk and 
trace it (superficially) behind the internal condyle. (Ante- 
rior branch, § 39, p. 40). 
34. Brachial and its branches.—The brachial artery and 
all its branches can now be cleaned and their relations 
studied. UPPER EXTREMITY AND THORAX. 
39 
a. Superior profunda. This is the first branch. It en- 
ters the musculo-spiral groove with the musculo-spiral nerve. 
b. Inferior profunda. This branch Joins the ulnar 
nerve, and. with it passes behind the internal condyle. 
C. Nutrient. Look for this artery in the middle of the 
arm. It enters the nutrient foramen Just below the attach- 
ment of the coraco-hrachialis to the humerus. 
d. Anastomotica magua. Given oft about two inches 
above the elbow and passes transversely around the arm to 
the inner side. 
e. Muscular. Supply adjacent muscles. 
35. Triceps.—The inner part of the triceps can be dis- 
sected. At its upper part save the muscular branches from 
the musculo-spiral nerve. 
This completes the advance for the first week. More 
work of course can be done. This is only the minimum 
that should be finished in this time. 
UPPER EXTREMITY AXU THORAX. 
SECOND WEEK.—Anterior Surface. 
First Day. 
Incisions. —l. Down the front of the forearm to the 
wrist. 
2. A short transverse cut across the wrist. 
Reflect the integument only. 
Superficial veins. 
Superficial nerves. 
Parts Exposed. UPPER EXTREMITY AJSTD THORAX. 
36. Superficial veins.—No time need be spent in dis- 
secting out the superficial veins of the forearm. Simply 
recognize the main ones as the radial, median and ante- 
rior ulnar. 
37. Superficial nerves.—These are from the nerves al- 
ready dissected out in the arm. 
On the inside of the forearm is the anterior branch of 
the internal cutaneous. 
On the outside of the forearm the external cutaneous 
branch of the musculo-cutaneous nerve. 
Remove the veins and superficial fascia. This exposes 
the deep fascia,which after recognition can also be removed. 
Parts Exposed. 
Supinator longus. 
Pronator radii teres. 
Flexor carpi radialis. 
Palmaris longus. 
Flexor carpi ulnaris. 
Radial artery and branches in forearm 
Radial nerve. 
Posterior interosseus nerve. 
Ulnar artery—beginning and ending. 
38. Superficial muscles of forearm.—Clean the follow- 
ing muscles and in all cases save their nerve supply when 
found. 
Supinator longus—outer boundary of elbow space. 
Pronator radii teres—inner boundary of elbow space. 
Note fhe median nerve passing between the two heads of 
the muscle. 
Flexor carpi radialis. 
Palmaris longus. 
Flexor carpi ulnaris. UPPER EXTREMITY AKD THORAX. 
41 
39. Eadial artery and branches.—Draw the supinator 
longns outward and trace the radial artery to the wrist, 
noting its relations and branches, which are the recurrent, 
muscular, carpal and supcrficialis vohe (only the beginning). 
Follow the recurrent radial up between the supinator 
longus and brachialis anticus, and find its anastomosis with 
the superior profunda. 
40. Eadial nerve.—In drawing outward the supinator 
longus you will find a nerve lying beneath it—the radial— 
which if traced upward will be seen to come off from the 
mnsculo-spiral just in front of the elbow. Trace the nerve 
as far as the wrist. 
41. Posterior interosseus nerve.—The other terminal 
branch of the mnsculo-spiral nerve is the posterior inter- 
osseus which if traced downward will be found to disappear 
in the supinator brevis muscle. 
42. Ulnar artery.—The ulnar artery (at this stage) can 
be traced only a short distance; at its beginning until it dis- 
appears beneath the two heads of the pronator radii teres 
muscle, and at the lower part where it becomes superficial. 
Note its relations above the wrist in the forearm. 
Divide the supinator longus, flexor carpi radialis, pal- 
maris longus and flexor carpi ulnaris muscles, where they 
are becoming tendinous, and the pronator radii teres at its 
outer and middle thirds. 
Parts Exposed. 
Flexor sublimis digitorum. 
Supinator brevis. 
Posterior belly of pronator radii teres. 
Anterior and posterior ulnar recurrent arteries. 
Common and (beginning of) anterior and posterior inter 
ossens arteries. 
Anterior interosseus nerve (beginning). UPPER EXTREMITY AND THORAX. 
42 
43. Flexor sublimis cligitorum, supinator brevis, prona- 
tor radii teres.—Clean the entire surface of the flexor su- 
blimis digitorum, paying attention to its origins. Make 
out the anterior attachment of the supinator brevis and 
the direction of its fibres. 
In turning back the pronator radii teres note its small 
posterior belly, and the median nerve in front of it. 
44. Ulnar artery and recurrent and interossens branches. 
—The ulnar in the first part of its course gives-off the fol- 
lowing arteries: 
a. Anterior recurrent—ascending to anastomose with the 
anastomotica magna and inferior profunda. 
b. Posterior recurrent—passing inward and backward 
behind the internal condyle. 
c. Common interossens—which speedily divides into the 
anterior interossens, running down the front of the fore- 
arm (covered by the flexor sublimis) and the posterior in- 
terosseus which goes to the back of the forearm between 
the two bones. 
45. Anterior interosseus nerve,—ln the space in front 
of the elbow the median nerve gives off many muscular 
branches; one of the largest is the anterior interosseus 
nerve, which disappears under the flexor sublimis muscle. 
Second Day. 
Divide the flexor sublimis near the wrist, cut it away 
from its radial attachment, and reflect. 
Parts Exposed. 
Median nerve (and median artery). 
Palmar cutaneous nerve. 
Anterior interossens nerve and artery. 
Ulnar artery and muscular branches. UPPER EXTREMITY AX'D THORAX. 
43 
Ulnar nerve. 
Dorsal cutaneous nerve. 
Flexor profundus digitorum 
Flexor longus pollicis. 
Pronator quadratics. 
45. Median nerve. Median artery.—Clean the median 
nerve. Note the small (sometimes large) median branch 
of the anterior interosseus artery which accompanies the 
nerve. 
46. Palmar cutaneous nerve.—Save the small palmar 
cutaneous branch of the median nerve. 
47. Anterior interosseus nerve.—Trace the anterior in- 
terosseus nerve between the deep muscles of the forearm 
until it terminates in the pronator quadratics. 
48. Anterior interosseus artery.—The anterior inter- 
osseus artery takes the same course until it reaches the 
pronator quadratics, wdcere it passes back through the inter- 
osseus membrane. 
49. Ulnar artery and muscular branches.—Clean the 
ulnar artery and its muscular branches. Rehearse the re- 
lations in its middle and lowTer thirds by replacing the 
superficial parts. 
50. Ulnar nerve and dorsal cutaneous branch,—Trace 
the ulnar nerve from as high a point as possible. Note 
where it joins the artery and on which side of the artery it 
lies. Save it-s dorsal cutaneous branch. 
51. Deep muscles of forearm.—Complete the forearm 
by cleaning the flexor profundus digitorum, flexor longus 
pollicis, and pronator quadratics. Recognize their nerve 
supply. 
Incisions. —l. Continue the median incision dowm 
the palm and along the front of the middle finger. UPPER EXTREMITY AX'D THORAX. 
44 
2. Make a transverse cut across the palm near the web 
of the fingers. 
3. Incise the skin down the front of the fingers. 
4. Carry an incision from 1, at the wrist along the 
palmar surface of the thumb. 
Eefiect the integument from the palm, thumb and two 
or three fingers. Be very careful in doing so not to injure 
the palmar fascia and cutaneous nerves and vessels, which 
lie close under the integument. 
Parts Exposed. 
Palmaris brevis. 
Palmar cutaneous nerves. 
Palmar fascia and tendon of palmaris longns. 
Digital arteries and nerves. 
Collateral digital arteries and nerves. 
52. Palmaris brevis.—The palmaris brevis muscle will 
be found immediately beneath the integument on the ulnar 
side of the palm. 
53. Palmar cutaneous nerves.—Try to find the palmar 
cutaneous branch of the ulnar—inner side—median, mid- 
dle, and musculo-cutaneous—outer side—of wrist. Proba- 
bly they have been removed already. 
54. Palmar fascia.—Study the arrangement of the 
palmar fascia as given in your text-book, and in the light 
of that description make out its three portions—two lateral 
very thin and middle very thick, the division of the central 
portion into fasciculi, and their digital attachment. 
At the wrist you will find the tendon of the palmaris 
longus and see how it is continued into the median portion 
of the palmar fascia. 
55. Digital and collateral digital vessels and nerves.— 
Between the prolongations of the fascia to the fingers you 45 
UPPER EXTREMITY AMD THORAX. 
will find the digital arteries and nerves imbedded in adi- 
pose tissue. Note that they lie between the metacarpal 
bones, so incisions over the bones will not injure the arte- 
ries and nerves. 
Dissect out one or two fingers to trace the collateral 
digital vessels and nerves. 
Third Day. 
Remove the lateral portions of the palmar fascia—with 
the palmaris brevis muscle—and the central portion in the 
following manner: 
Draw downward on the tendon of the palmaris longus 
muscle and cut it and the fascia carefully away from the 
annular ligament. When the lower border of the annular 
ligament is passed, raise all of the central portion of the 
palmar fascia and separate it from the vessels and nerves be- 
neath. When the attachments of the fasciculi are reached, 
notice how they split for the transmission of the flexor 
tendons, while the lumbricales and digital vessels and 
nerves occupy the space between the fasciculi themselves. 
Then divide the fasciculi and remove the fascia entirely. 
Clean the sheath of one or more of the long flexor ten- 
dons of the fingers. Notice how the sheath is reinforced 
by oblique and transverse cross-bands of fibres, then open 
the sheath. 
Parts Exposed. 
Superficial arch. 
Superficial vohe artery. 
Radialis indicis artery. 
Ulnar artery. 
Deep palmar artery. 
Ulnar nerve and branches. Upper extremity and thorax. 
46 
Median nerve and branches. 
Abductor pollicis. 
Flexor brevis pollicis (outer head). 
Abductor minimi digiti. 
Flexor brevis minimi digiti. 
Tendons of flexor sublimis and profundus digitorum, 
Lumbricales. 
56. Superficial arch.—Clean the superficial palmar 
arch. Note its formation and location with reference to 
the surface of the palm. 
57. Superficialis volas.—Trace the superficialis volse, if 
present, from the radial artery until it is found (usually) to 
disappear at the base of the muscles of the thumb. Later 
on, after the thumb muscles are learned, they can be cut 
away and the artery followed for the rest of its course. 
58. Eadialis indicis. —ln more cases the superficial 
palmar arch will be completed by union with the radialis 
indicis artery, which runs on the outer side of the index 
finger, than by union with the superficialis volae. Often 
it is formed by anastomosing with both. 
56. Ulnar artery and deep palmar branch.—'Follow the 
course of the ulnar artery from the wrist, down over the 
annular ligament, and find its deep palmar branch. 
60. Ulnar nerve and branches.—Also trace the ulnar 
nerve and find its deep palmar branch. This artery and 
nerve take the same course, passing in between the origins 
of the abductor and flexor brevis minimi digiti muscles. 
Trace the ulnar digital nerves and a small branch of 
communication with the median. 
61. Median nerve and branches.—In a similar manner 
clean the median nerve, saving all its muscular and digital 
branches. tJPPER EXTREMITY AND THORAX. 
62. Abductor, flexor brevis pollicis (outer head); abduc- 
tor and flexor brevis minimi digiti.—Clean the following 
muscles, saving their nerve supply: 
Abductor and outer head of flexor brevis pollicis. 
Abductor and flexor brevis minimi digiti. Between 
their origins pass the deep palmar artery and nerve. 
63. Tendons of flexor sublimis and profundus digitorum. 
Lumbricales.—Clean the tendons of the flexor sublimis and 
profundus digitorum. In the fingers note the splitting of 
the former for the passage of the latter. Also note the 
vincula accessoria tendinum. 
In the palm of the hand find the four lumbricales mus- 
cles attached to the deep flexor tendons and follow them as 
far as the sides of the fingers. 
Fourth Day. 
Divide the abductor pollicis, annular ligament, second, 
third, and fourth median digital nerves close to origin, and 
the ulnar artery and nerve immediately below their deep 
palmar branches. 
Parts Exposed. 
Opponens pollicis. 
Central compartment of the annular ligament. 
Lumbricales. 
Opponens minimi digiti. 
64. Opponens pollicis.—Clean the opponens pollicis. 
65. Central compartment of annular ligament.—In the 
central compartment of the annular ligament find the fol- 
lowing structures: 
Median nerve. 
Tendons of flexor sublimis and profundus digitorum. 
Tendon of flexor longus pollicis. UPPER EXTREMITY AXU THORAX. 
66. Lumbricales.—Draw the tendons of the superficial 
flexor toward the fingers, and complete the dissection of 
the lumbricales. 
48 
67. Opponens minimi digiti.—Recognize the opponens 
minimi digiti. 
Divide the tendons of the flexor profundus above the 
wrist and draw them down toward the fingers. Divide the 
pronator quadratus at its middle transversely to the direc- 
tion of its fibres. 
Parts Exposed. 
Flexor brevis pollicis (both heads). 
Tendon of flexor longus pollicis. 
Adductor pollicis. 
Deep palmar arch and branches. 
Deep palmar nerve. 
Anterior carpal anastomosis. 
68. Flexor brevis pollicis. Tendon of flexor longus 
pollicis. Adductor pollicis.—The attention of the student 
is again called to the flexor brevis pollicis and the relation 
its two heads bear to the tendon of the flexor longus polli- 
cis and to the adductor pollicis on the inner and abductor 
pollicis on the outer side of the muscle. 
69. Deep palmar arch.—Trace out the deep palmar 
arch, its formation, relations and branches, viz.: perfor- 
ating, interossei and recurrent carpal. 
70. Deep palmar nerve.—The deep palmar nerve fol- 
lows the communicating branch of the ulnar artery into 
the palm. 
71. Anterior carpal anastomosis.—ln front of the carpus 
is the anterior carpal anastomosis. The following arteries 
send branches to enter, into its formation: laterally, radial UPPER EXTREMITY AND THORAX. 
49 
and ulnar—medianly, above, anterior interosseus—below 
deep palmar arch. 
Divide the adductor and inner head of flexor brevis 
pollicis and reflect them. 
Parts Exposed. 
Beginning of deep arch. 
Princeps pollicis artery. 
Eadialis indicis artery, 
Interossei muscles. 
72. Deep palmar arch, princeps pollicis, radialis indi- 
cis.—The beginning of the deep palmar arch is now shown, 
and the princeps pollicis and radialis indicis branches of 
the radial artery can be traced. 
73. Interossei muscles.—Clean the interossei muscles. 
The entire seven can be seen from this side of the hand. 
Study their arrangement, attachment, auji action in the 
text-book and be ready at this stage to identify each muscle. 
Fifth Day. 
The foregoing completes the dissection of the anterior 
part of the upper extremity excepting the study of the 
formation of the brachial plexus, which was purposely 
omitted until the neck had been dissected, Now working 
with the one dissecting the neck disarticulate the clavicle 
at its sternal end (having previously studied the ligaments 
of this joint), divide the subclavius muscle near its costal 
attachment and carry the clavicle outward. This will give 
sufficient room without entirely removing the clavicle. 
Brachial plexus. 
Subclavian nerve. 
Parts Exposed. UPPER EXTREMITY AND THORAX. 
50 
Suprascapular nerve. 
Posterior thoracic nerve. 
Third portions of subclavian artery and vein. 
74. Brachial plexus and subclavian, suprascapular and 
posterior thoracic branches.—The usual formation of the 
brachial plexus must be thoroughly learned from the text- 
book. In dissecting it out in the subject, note whether it 
agrees with or differs from that description. 
The subclavian nerve is a very small one that supplies 
the subclavius muscle. The suprascapular nerve is a large 
one and enters the suprascapular foramen (foramen in the 
fresh state). 
The posterior thoracic should be traced to the nerves 
that form it. 
75. Third portion of subclavian artery and vein.—The 
third portion of the subclavian artery and vein will also be 
seen and their relations examined. 
Remove the sternum and costal cartilages by cutting 
through the latter as close to the ribs as possible, until the 
seventh rib is reached, cut the muscles between it and the 
sixth up to the sternum, and saw through the latter just 
above the point where the seventh costal cartilage articu- 
lates with it. 
Beginning above raise the sternum, dividing the inter- 
nal mammary arteries as close to it as possible, and remove 
the sternum and cartilages from the thoracic contents by 
careful dissection so as not to injure them. 
Parts Exposed. 
On sternum. 
Triangularis sterni. 
Internal mammary arteries. 
Anterior intercostal arteries. 51 
UPPER EXTREMITY AXD THORAX. 
Within thorax. 
Pleurae and lungs. 
Pericardium and heart. 
Phrenic nerves. 
Arteria comes nervi phrenici. 
Remains of thymus gland. 
Great veins. 
76. Under surface sternum.—Recognize the triangularis 
sterni muscle. Trace out the internal mammary artery 
and one or two of its anterior intercostal branches. 
77. Pleurae and lungs.-—lf the sternum and costal carti- 
lages have been carefully removed, the lungs enveloped in 
their costal pleura will be disclosed, but usually the pleura 
is so cut away that only portions of it are left and the 
lungs are found collapsed, and retracted into the back part 
of the chest. The costal and visceral layers of the pleura 
can be demonstrated. 
The description of the mediastinum as given in the text- 
book should be carefully studied before going on with the 
dissection. 
78. Phrenics and accompanying artery,—Trace the 
phrenic nerves to the diaphragm, noting their course. 
Save the small artery which accompanies them—a branch 
of the internal mammary. 
79. Pericardium and heart.—Remove the areolar tissue 
covering the pericardium and great veins. You will find 
the pericardium attached to the diaphragm helow. Make 
two incisions into the pericardium, one vertical and the 
other transverse, and reflect the flaps. You can now see 
how far it reaches up on to the great vessels. 
The heart is also exposed, and you should carefully study 
its position, what portions of the heart are most in view, UPPER EXTREMITY AX'D THORAX. 
52 
and the relations of the two great arteries to each other 
close to the heart. 
80. Great veins and thymus.—Clean the great veins, 
noting the difference between the right and left innominate 
veins. In cleaning them you will find the remains of the 
thymus gland. Ligature the superior vena cava and re- 
move all the great veins. Clean the arch of the aorta. 
Arch of aorta and branches. 
Trachea. 
Pneumogastric nerves. 
Eecurrent laryngeal nerve (left) 
Cardiac nerves. 
Pulmonary artery. 
Coronary arteries. 
Parts Exposed. 
81. Contents of mediastinum.—No detailed description 
of the above structures can be given here. Clean them and 
study their relations, comparing the text-book with the 
subject. 
Sixth Day. 
Divide the branches of the aorta, trachea, and phrenic 
nerves. Lift everything forward and cut the aorta across 
at the beginning of its downward curve. Cut away the 
attachment of the pericardium to the diaphragm and di- 
vide the inferior vena cava. Remove heart, lungs, and 
trachea. Study relations at root of lungs. 
Parts Exposed. 
Pneumogastric nerves. 
(Esophagus. 
82. Pneumogastric nerves.—Trace the pneumogastric 
nerves along the oesophagus to the diaphragm. UPPER EXTREMITY AND THORAX. 
53 
(Esophagus.—Define the relation of the oesophagus 
the aorta and trachea (removed). 
Divide the oesophagus above (high up), also the pneumo- 
gastric nerves where they join it. Pull the oesophagus for- 
ward and carefully separate it from the parts behind. 
When the diaphragm is reached, cut it and the nerves away. 
Parts Exposed. 
Thoracic aorta. 
Intercostal arteries. 
Intercostal nerves. 
Intercostal muscles. 
Azygos and intercostal veins. 
Sympathetic ganglia. 
Splanchnic nerves. 
Thoracic duct. 
84. Thoracic aorta, intercostal arteries.—Recognize the 
course of the thoracic aorta until it disappears through 
the aortic opening in the diaphragm’. 
Trace its intercostal branches, dissecting one or two fully. 
The two upper arteries (intercostal) are derived from 
the superior intercostal branch of the subclavian. The 
other nine come from the thoracic aorta. 
85. Intercostal nerves.—There are twelve intercostal 
nerves, which are the anterior divisions of the dorsal nerves. 
Each one receives a filament from the sympathetic and 
then passes out along under the lower border of a rib. 
Trace out one or two intercostal nerves in their course be- 
tween the internal and external intercostal muscles. 
86. Azygos and intercostal veins, a. Azygos major— 
enters chest through aortic opening, lies to right of aorta 
upon its intercostal arteries, empties into superior vena UPPER EXTREMITY AX'D THORAX. 
cava (now cut away), receives nine or ten lower right inter- 
costal veins, azygos minor and superior right intercostal 
vein (and others). 
b. Azygos minor—enters cliest through left crus of dia- 
phragm, passes under aorta, empties into azygos major at 
sixth dorsal vertebra, receives the six left lower intercostal 
veins (and others), 
c. Right superior intercostal—small size, receives one or 
two upper right intercostal veins (and some others), empties 
into azygos major. 
d. Left superior azygos—'takes up four or six upper left 
intercostal veins and empties into azygos minor (or major). 
e. Left superior intercostal—formed by two or three 
upper intercostal veins, empties into left innominate. 
87. Sympathetic ganglia and splanchnic nerves.—The 
sympathetic ganglia are twelve in number. Clean one or 
two and trace the branch to the intercostal nerve. The 
ganglia from the fifth or sixth to the tenth give off branches 
which unite to form the great splanchnic nerve. The lesser 
splanchnic nerve is formed by a branch from the tenth and 
eleventh ganglia. 
88. Thoracic duct.—Draw the thoracic aorta forward 
and dissect it awray from the vertebrse and veins. Divide 
the intercostal arteries about half an inch from the aorta. 
When the diaphragm is reached cut the artery off. 
If this is done carefully the thoracic duct will be left 
behind. It is about one-sixth of an inch in diameter, 
enters the chest by the aortic opening and lies close behind 
and to the right of the aorta between it and the azygos 
major. Trace it as far as possible. 
Completion of dissection of anterior part of upper ex- 
tremity and thorax. UPPER EXTREMITY AXD THORAX. 
THIRD WEEK.—Posterior Surface. 
Fiest Day, 
Incisions. —l. Continue the median incision from the 
seventh cervical to the last dorsal spine. 
2. Make a cut along the spine of the scapula to the 
point of the shoulder Joining the anterior one (same as 3, 
p. 25). 
3. From the lower end of 1, carry a transverse cut 
around the body to meet the similar one from the front 
(same as 3, p. 110). 
Reflect the integument from the back of thorax, shoul- 
der and upper part of arm. 
To expose the last no farther incisions in the skin are 
necessary; simply reflect it, beginning at the point where 
its anterior dissection stopped, and working from the outer 
to the inner side of the limb. 
This method will also hold for the removal of the integ- 
ument from the back of the forearm, hand and fingers. 
Parts Exposed. 
Trapezius. 
Latissimus dorsi. 
Deltoid. 
89. Trapezius, latissimus dorsi and deltoid.—These 
muscles are covered by a dense layer of fascia, often in- 
filtrated with fluid, which must he removed before the 
boundaries of the muscles can he determined. 
The nerve supply of the trapezius comes from the neck, 
55 UPPER EXTREMITY AX'D THORAX. 
and the one dissecting that region will demonstrate it; that 
of the deltoid will he seen later, and of the latissimus dorsi 
has been already found, but should be again identified (§ 
21, p. 35 and § 24, c. (2), p. 36). 
Second Day. 
Out the trapezius and deltoid close to their scapular and 
clavicular attachments, and roll the former up toward the 
median line and turn the latter downward. 
Disarticulate the clavicle at the acromial articulation; 
divide the coraco-clavicular ligaments and draw the clavi- 
cle out of the way. 
Remove the fascia covering the muscles. 
Levator anguli scapulae. 
Rhomboideus major and minor. 
Supra and infra-spinatus. 
Teres major and minor. 
Triceps, upper part. 
Posterior scapular artery. 
Suprascapular artery and nerve. 
Posterior circumflex artery. 
Circumflex nerve. 
Dorsalis scapulae artery. 
Parts Exposed. 
90. Levator anguli scapulae, rhomboidei, supra- and 
infra-spinatus, teres major and minor, triceps.—Clean the 
muscles in the order given. Remember the relation of the 
rhomboideus and teres major and minor to each other, by 
noting that in each case the smaller muscle is above and 
the larger below. 
The supra- and infra-spinatus are covered by a strong 
fascia, which must be removed to expose the muscles. UPPER EXTREMITY AND THORAX, 
57 
The tAvo teres muscles, the long head of triceps, and the 
humerus enter into the formation of a triangular and 
quadrilateral space; learn the boundaries of each. 
91. Posterior scapular artery.—The posterior scapular 
branch of the transversalis colli artery will be found under 
the levator anguli scapulas and rhomboidei muscles as it 
passes in its course around the superior angle of the 
scapula. 
92. Supra-scapular artery and nerve.—Note the relation 
of the supra-scapular artery and nerve to the transverse 
ligament of the scapula. Their course cannot at this stage 
be traced any farther. 
93. Circumflex nerA’e and posterior circumflex artery.— 
In the quadrilateral space formed by the triceps, humerus, 
and two teres find the circumflex nerve and posterior cir- 
cumflex artery; trace them both to their distribution to the 
deltoid. The artery anastomoses with the anterior circum- 
flex, acromio-thoracic, and superior profunda arteries. 
94. Dorsalis scapulae.—The triangular space bounded 
by the triceps and two teres muscles is occupied by the 
dorsalis scapulae artery, a branch (really the continuation) 
of the subscapular artery. 
Divide the rhomboideus major and minor and latissimus 
dorsi (also cut the last away from its costal origin), and 
reflect them. 
Serratus posticus superior. 
Serratus magnus. 
Serratus posticus inferior. 
Parts Exposed. 
95. Serrati.-—’The serratus posticus superior and infe- 
rior are located, as their names indicate, at the superior 
and inferior part of the chest posteriorly. UPPER EXTREMITY AND THORAX. 
58 
96. Serratus magnus.—By pulling the scapula outward 
and raising it from the chest, you will see the posterior 
surface of the serratus inagnus. 
Third Day. 
Remove the integument from the arm to below the elbow 
as directed on page 55 for the exposure of the upper part 
of the arm. 
Parts Exposed. 
Superficial nerves. 
Triceps. 
Musculo-spiral nerve. 
Superior profunda artery. 
97. Superficial nerves of back of arm.—The cutaneous 
nerves of the back of the arm are derived from the inter- 
costo-humeral, musculo-spiral and lesser internal cutaneous 
on the inner side, and musculo-spiral on the outer side of 
the arm. Find these nerves when removing the skin. 
98. Triceps.—The three heads of the triceps may now 
be cleaned and the muscle studied. 
99. Musculo-spiral nerve, superior profunda artery.— 
Follow the musculo-spiral nerve and the artery that accom- 
panies it—the superior profunda—into the musculo-spiral 
groove. The groove divides the external and internal 
heads of the triceps. Cut away as much of the muscle as 
is necessary to expose the nerve and artery in their course. 
Fourth Day. 
Continue to remove the integument from the forearm, 
hand, and fingers as before directed, page 55. The super- 
ficial veins need not be preserved, as their arrangement UPPER EXTREMITY AKD THORAX. 
59 
can be studied in your own arm, but the superficial nerves 
should be looked for and saved. 
Parts Exposed. 
Superficial nerves. 
Deep fascia and posterior annular ligament of wrist. 
100. Superficial nerves of back of forearm.—On the 
outer side of the forearm you will find the following cutane- 
ous nerves. Above, the inferior cutaneous branch of mus- 
culo-spiral, and below, the radial nerve. 
On the inner side of the forearm above, the posterior 
branch of internal cutaneous, and below, the dorsal cuta- 
neous branch of ulnar nerves. 
Trace carefuli}T the distribution of the radial and dorsal 
cutaneous nerves. 
101. Deep fascia and posterior annular ligament.— 
After the nerves are dissected out the deep fascia can bo 
cleaned and its transversely reinforced portion at the wrist 
—called the posterior annular ligament'—demonstrated. 
Remove the deep fascia, leaving the posterior annular 
ligament in place. 
Dissect the fingers and thumb so as to lay bare the ten- 
dons passing to them. 
Parts Exposed. 
Supinator longus. 
Extensor carpi radialis longior and, brevier. 
Extensor communis digitorum. 
Extensor minimi digiti. 
Extensor carpi uluaris. 
102, Superficial muscles of back of forearm.—After dis- UPPER EXTREMITY AND THORAX. 
60 
secting out the above muscles divide the extensor communis 
digitorum and minimi digiti at their middle; remove the 
aponeurotic origin of the extensor carpi ulnaris from its at- 
tachment to the olecranon and upper part of posterior 
ridge of ulna, saving the muscle beneath (anconeus). 
Fifth Day. 
Parts Exposed. 
Anconeus, 
Extensor ossis metacarpi pollicis. 
Extensor primi and secundi internodii pollicis. 
Extensor indicis. 
Supinator brevis. 
Posterior interosseus nerve. 
Posterior interosseus artery. 
Recurrent interosseus artery. 
Anterior interosseus artery. 
Radial artery and brandies. 
Compartments in posterior annular ligament, 
Interossei and lumbricales. 
103. Deep muscles of back of forearm.—Complete the 
dissection of the muscles of the forearm as given above. 
The origin of the thumb and index finger muscles can 
be remembered easily by the following scheme: The ex- 
tensor ossis from both bones of forearm; the extensor primi, 
from the radius—the first bone of the forearm met with 
in going from the thumb to the forearm; the secundi, 
from the ulna, the second bone; and the indicis from the 
ulna also. Of course it is understood that the terms primi 
and secundi are intended to refer to the phalanges of the 
thumb, but for the sake of remembering the origins of 
the muscles they may be used as here stated. UPPER EXTREMITY AX I) THORAX. 
104. Posterior interosseus nerve and artery, anterior 
interossens and radial arteries.—The posterior interossens 
nerve will he found coming through the supinator brevis 
muscle. Just below tins muscle the posterior interosseus 
artery will be found. Trace them both down the back of 
the forearm. When near the wrist the anterior interosseus 
artery will be seen coming through the interosseus mem- 
brane. The posterior anastomoses with the anterior inter- 
osseus artery, and both with the posterior carpal branch of 
the radial. 
Find the recurrent interosseus passing up under the 
anconeus muscle to enter into the elbow anastomosis. 
The course of the radial artery around the base of the 
thumb beneath its extensor tendons must be carefully 
followed, and its small dorsal branches dissected out as far 
as possible. 
105. The compartments of the posterior annular liga- 
ment.—Recognize the, various compartments of the poste- 
rior annular ligament and the tendon or tendons that pass 
through each. Upon the dry radius and ulna identify 
each groove. 
106. Dorsal and palmar interossei and lumbricales.— 
Clean the dorsal interossei and complete the dissection of 
the palmar interossei and lumbricales. Trace the insertion 
of these muscles, studying their action. 
Finally remove all the soft parts, and study the ligaments 
of the shoulder, elbow, wrist, thumb, and index finger artic- 
ulations. The student is referred to his standard text- 
book for the description of these various joints. In clean- 
ing off the shoulder-joint, complete the dissection of the 
supra-scapular artery and nerve, and when at the elbow, 
trace out the anastomoses at that joint between the supe- UPPER EXTREMITY AND THORAX. 
62 
rior and inferior profunda and anastomotica magna above 
and the radial, ulnar, anterior and posterior and interossens 
recurrent arteries from below. 
Examine the relations of the fixed bony points: at the 
shoulder—acromion, greater and lesser tuberosities of hu- 
merus; at elbow—two condyles and olecranon; and at 
wrist—styloid process of radius and ulna, former one-fourth 
inch lower than latter. 
At the metacarpo-phalangeal articulation, note the an- 
terior ligament or fibro-cartilage which plays such an im- 
portant part in dislocations at that joint. PERINEUM, MALE. 
FIRST WEEK. 
First Day. 
Fill the rectum with oakum and take two or three stitches 
in the anus. 
Incisions. —l. In the median line from the perineo- 
scrotal junction to tip of coccyx (cutting close to anus on 
either side). 
2. Two transverse incisions three or four inches long at 
each end of 1. 
Reflect the integument, and in doing so be sure not to 
cut away the external sphincter of the anus. 
Parts Exposed. 
External sphincter of anus. 
Superficial fascia. 
a. Superficial layer. 
b. Deep layer—perineal fascia, 
Ischio-rectal fossa. 
Inferior hemorrhoidal artery and nerve. 
Obturator fascia. 
Anal fascia. 
Gluteus maximus. 
Fourth sacral nerve. 
Inferior pudendal nerve. 
1. External sphincter.—The external sphincter lies im- 
mediately under the integument. It is a broad but very PERINEUM, MALE. 
64 
thin muscle, and extends from the mid-point of the peri- 
neum to the tip of the coccyx. 
2. Subcutaneous tissue, perineal fascia.—The subcuta- 
neous tissue consists mostly of adipose tissue. This must 
be carefully scraped and picked away until you come to a 
firm fascia in the anterior half of the perineum. It is sel- 
dom, however, that the ordinary subject of the dissecting- 
room will show this fascia in a satisfactory manner. Nor 
is it so thick and easily recognized as the usual descrip- 
tions found in the text-books would lead a beginner to 
expect. 
The best way to recognize the fascia is to scrape away 
the overlying adipose tissue until a smooth plane of fascia 
is found—usually so thin that the muscles (erector penis 
and accelerator urinoe) show through it. This is the deep 
layer of the superficial fascia, or perineal fascia, or fascia of 
Colies. It passes through the scrotum as the dartos and 
thence into the abdomen. (See § 22, p. 76.) 
3. Ischio-rectal fossa.—In the posterior half of the peri- 
neum you will find that the fat fills a deep pouch on either 
side of the rectum, the ischio-rectal fossa. Clean the fat 
out carefully and study the boundaries of this fossa. 
4, Inferior hemorrhoidal artery and nerve.—Crossing 
the fossa from the outer side to the rectum, you will find 
the inferior hemorrhoidal artery and nerve. They are 
branches of the internal pudic artery and nerve. 
5. Obturator and anal fascia, pndic artery.—At the 
bottom of the ischio-rectal fossa you find the very thin 
anal fascia covering the levator ani muscle and on the 
outer side of the fossa the obturator fascia. 
Through the obturator fascia feel the internal pudic 
artery (injected with plaster) about one inch from the 
margin of the ischium. PERINEUM, MALE. 
6. Gluteus maximus.—The superficial boundary of the 
ischio-rectal fossa behind is the gluteus maximus muscle; 
only a very small part of the muscle is exposed here. 
7. Fourth sacral nerve.—Close to the coccyx look for a 
branch of the fourth sacral nerve curving over the gluteus 
maximus. 
8. Inferior pudendal nerve.—Scratch through the super- 
ficial fascia about one inch external to the tuberosity of the 
ischium and you will find the inferior pudendal nerve from 
the small sciatic passing forward to the scrotum. 
If the perineal fascia has been shown as a continuous 
layer incise it in the median line and along its posterior 
borders, and turn the flaps aside. 
If, as is usually the case, it is partially cut away here 
and there, complete its removal and expose the parts be- 
neath, carefully cleaning them. 
Erector penis and. crus penis. 
Accelerator urinas. 
Transversus perinese. 
Superficial perineal artery and nerve. 
Transversalis perineal artery and nerve. 
Parts Exposed. 
9. Perineal triangle.—The erector penis, transversus 
perinees, and accelerator urinee form the perineal triangle. 
The first forms the outer side, the second the lower (pos- 
terior), and the third the inner side. 
10. Vessels and nerves in the perineal triangle.—The 
superficial perineal artery and nerve run together through 
the perineal triangle from behind forward. The transver- 
salis perineal artery and nerve are very small and pass along 
the base of the triangle into the transversus perineae muscle. PERINEUM, MALE. 
66 
Cut away entirely the erector penis, accelerator urinae, 
and transversus perineoe muscles. 
Clean the parts presenting. 
Parts Exposed. 
Corpus spongiosum. 
Bulb. 
Crura of penis. 
Triangular ligament (anterior layer). 
11. Corpus spongiosum, bulb, crura of penis.—Byre- 
moving the accelerator urinae the corpus spongiosum and 
its posterior portion called the bulb is exposed. 
A crus penis is seen when an erector penis muscle is cut 
away. Notice the attachment of the crus to the ramus of 
the ischium, and then cut it away close to the bone and 
pull the <yus outward. 
12. Triangular ligament, anterior layer.—Draw the bulb 
first to one side and then to the other, so as to expose in 
turn the deeper fascia, viz.: the anterior layer of the 
triangular ligament. It is also called the superficial layer 
of the triangular ligament or the deep perineal fascia. 
From the names and descriptions given of this plane of 
fascia, the student expects to find a dense membrane closing 
the anterior part of the pelvic outlet. He will be disap- 
pointed. If the perineal fascia (§ 2, p. 64) was recognized 
with difficulty, this layer will be found much more difficult 
to demonstrate, and in the usual dissecting-room subject 
will be missed altogether. 
If the subject is a poor one, the tissues dark and infil- 
trated with fluid, it may be impossible for the student to 
demonstrate the following parts: Compressor urethrae, 
Cowper’s glands, posterior layer of triangular ligament, 
anal fascia; however, he should do his best to find them. PEKIN BUM, MALE. 
67 
Second Day. 
If the anterior layer of the triangular ligament has been 
found, incise it along its margins and remove it. 
Parts Exposed. 
Compressor urethrae muscle. 
Membranous urethra and Cowper’s glands. 
Internal pudic artery and nerve and their branches. 
13. Compressor urethrae.—This muscle reaches from 
side to side, filling the space between the two layers of the 
triangular ligament. 
14. Membranous urethra and Cowper’s glands.—The 
membranous portion of the urethra will be exposed by 
drawing the bulb upward (really forward); at the same time 
two little bodies on the posterior upper portion of the bulb 
will be found; these are Cowper’s glands. 
15. Internal pudic artery and nerve and their branches. 
—The internal pudic artery and nerve come through the 
posterior layer of the triangular ligament and pass for- 
ward. The artery gives otf the branch to the bulb, and 
then divides into the branch to the corpus spongiosum and 
the dorsal artery of the penis. The nerve follows the same 
distribution. In a good subject trace all these branches. 
Carefully remove the compressor urethrae muscle and the 
nerve and artery and their branches. 
Remove the hemorrhoidal vessels and nerves. 
Section a portion of the gluteus maximus. 
Parts Exposed. 
Posterior layer triangular ligament. 
The mid-transverse line of fascial junction. 
Anal fascia. PERINEUM, MALE. 
68 
16. Posterior layer of triangular fascia, anal fascia, 
mid-transverse fascial junction.—Though the stretch of 
fascia covering the levator ani muscle is divided in the 
descriptions into two portions—the anterior or posterior 
layer of the triangular ligament, the posterior or anal 
fascia—it is really the same fascia under two names. And 
united to it in the mid-transverse line you find the (ante- 
rior layer of the) triangular ligament and the perineal fascia. 
Eemove the posterior layer of the triangular ligament 
and the anal fascia. 
Levator ani. 
Coccygeus. 
Parts Exposed. 
17. Levator ani and coccygeus.—These two muscles 
taken together are termed the diaphragm of the pelvis. 
The levator ani not only slings the anus (and rectum), but 
its anterior portion supports the prostate and bladder. 
Eemove the levator ani by cutting it away from its mar- 
ginal and anal attachments. 
18. Eecto-vesical fascia.—This exposes the recto-vesical 
fascia, which supports the rectum, prostate, and bladder, 
and passing in between them forms their true ligaments. 
The various fasciae to which reference is here made by 
name alone must be carefully studied up in the text-books. 
Draw the rectum backward, and keeping close to it cut 
the fascia between it and the prostate and bladder until 
the recto-vesical fold of peritoneum is reached. Clean the 
prostate and base of bladder. 
Parts Exposed. 
Prostate. 
Yesiculae seminales. PERINEUM, MALE. 
69 
Vasa deferentia. 
External trigone, 
19. Prostate.—The tissue removed from the prostate is 
part of the recto-vesical fascia and forms the prostatic 
capsule. 
20. Vesiculse seminales, vasa deferentia.—Reaching up- 
ward and backward, diverging from each other, you find 
the vesiculse seminales, and internal to them the vasa def- 
erentia. 
21. External trigone.—The external trigone is bounded 
above by the line of attachment between bladder and rec- 
tum; laterally by the vesiculse seminales and vasa deferen- 
tia, and its apex is at the prostate. This area represents 
the extent of attachment between the bladder and rectum. 
ARRANGEMENT OF STRUCTURES FILLING PELVIC 
OUTLET (Diagrammatic). 
MALE, 
Posterior, Mid-Point. Anterior, 
1. Rectum Ureters 1. Vasa deferentia 2. 
Vesiculse serniuales 3. Bladder 4. 
Prostate 5. 
Urethra 6. 
2. Recto- Vesical fascia 7. 
3. Levator ani (et prostatas) 8. 
4. Anal fascia Post, layer triang. ligament 9. 
Urethra 10. 
Compressor urethrae 11. 
Ant. layer triang. ligament 12. 
5. Adipose tissue Perineal triangle 13. 
Bulb—corpus spongiosum 14. 
Crura penis 15. 
6. Anus Perineal fascia 16. 
7. Sphincter ani Subcutaneous tissue 17. 
8. Integument 18. 
FROM WITHIN OUTWARD. PEBIKEXJM, FEMALE. 
FIRST WEEK. 
First Day. 
With a few changes the directions just given for dissect- 
ing a male perineum can be applied to the female. 
Identify the following external genital organs: 
a. Mons veneris. 
b. Labia majora and minora. 
c. Clitoris. 
d. Vestibule—the gutter which leads down from the 
clitoris to the meatus urinarius, 
e. Posterior commissure of labia majora. 
f. Fossa navicularis—depression between e and g. 
g. Fourchette—transverse fold of mucous membrane 
Just inside posterior commissure. 
h. Orifice of vagina. 
i. Hymen or carunculae myrtiformes. 
Take a few stitches in the labia majora and anus, pre- 
viously filling them with oakum. 
Incisions.—l. Similar to incisions in male perineum, 
excepting the anterior part of the median incision divides 
to pass along the margins of the labia majora. 
2. Transverse incisions at the upper and lower part of 1. 
§§ 1 to 8 (see male perineum, pp. 63-65),—Remove the 
integument and follow the directions given on pages 63- 
65, and find the structures §§ Ito 8 inclusive. Note the 
remarks made on page 64. Note that the perineal fascia 
70 PERINEUM, FEMALE. 
71 
gives passage to the vagina as well as urethra. This will 
be found to be the case with the remaining fasciae and 
median muscles anterior to the centre of the perineum. 
9. Superficial perineal artery and nerve.—In addition 
to the structures above (1 to 8) you will find the superficial 
perineal artery and nerve outside of the perineal fascia 
instead of beneath it as in the male. 
Incise the perineal fascia along its margins and remove 
it. (See remarks, page 64.) 
Parts Exposed. 
Erector clitoridis (penis, male). 
Transversus perinese. 
Sphincter vaginse (same as accelerator urinse in male). 
10. Perineal triangle.—These muscles together form 
the perineal triangle as in the male. 
Divide the transversus perinese and sphincter vaginee 
and reflect them. Cut away the erector clitoris. 
Draw the clitoris forward, and remove the mucous mem- 
brane between it and the urethral orifice. 
Parts Exposed. 
Orifice of urethra. 
Bulb of vaginse. 
Crus of clitoris. 
Artery and nerve to bulb. 
Artery and nerve to corpus cavernosum and dorsal artery 
and nerve of clitoris. 
Anterior layer of triangular ligament. 
11. Bulb of vagina.—The bulb of the vagina consists of 
a venous plexus embracing the upper portion and sides of PERINEUM, FEMALE, 
the vaginal orifice; it is analogous to the corpus spon- 
giosum. 
12. Crura, of clitoris.—The crura of the clitoris are 
very small. They occupy similar positions to the crura of 
the penis. 
13. Branches of internal and pudic artery and nerve.— 
By drawing the bulb one side and dissecting away the crura 
of the clitoris, the small branches of the internal pudic 
artery will be found, viz.: artery to the bulb, to corpus 
cavernosum, and the dorsal artery of clitoris. 
The internal pudic nerve gives off similar branches. 
14. Anterior layer of triangular ligament.—Remove the 
bulb and superficial vessels and nerves and make out the 
attachments of the anterior layer of the triangular liga- 
ment, (See remarks, page 66.) 
Second Day. 
Remove the anterior layer of the triangular ligament in 
the same way the perineal fascia was removed. (See re- 
marks, page 66.) 
Parts Exposed 
Compressor urethrae (constrictor vaginae). 
Glands of Bartholin (Cowper’s, male). 
Internal pudic artery and nerve. 
Posterior layer triangular ligament. 
15. Compressor urethrae (constrictor vaginae).—The 
compressor urethrae muscle occupies the same position in 
the female as in the male. Besides its urethral function 
it also constricts the vagina. Various small muscles are 
described in this plane by various dissectors, but it is suffi- 
cient if the student now recognizes the above muscle. PERINEUM, FEMALE. 
73 
16. Bartholin’s glands.—Opposite the middle of the 
vaginal orifice and imbedded in or behind the above mus- 
cle you will find a small gland—Bartholin’s—similar to 
Cowper’s in the male. 
The internal pudic artery and nerve will be exposed by 
removing the muscle. They lie upon the posterior layer 
of the triangular ligament. 
17. Posterior layer, triangular ligament.—This layer— 
the posterior—of the triangular ligament is similar to 
that in the male, and should be carefully exposed by re- 
moving the above structures. 
You will notice that it is continuous with the anal 
fascia. (Same remarks apply here as to fascia in male, 
page 68.) 
Remove the fasciae above and the hemorrhoidal vessels 
and nerves. 
Section the gluteus maximus near the coccyx. 
Parts Exposed. 
Levator ani. 
Coccygeus. 
18. Muscles.—See under male perineum, § 17, p. 68, 
19. Recto-vesical fascia.—Remove the levator ani from 
its marginal, anal, and vaginal attachments, and expose the 
recto-vesical fascia. 
20. Recto-vaginal fossa.—Draw the rectum backward 
and separate it from the vagina until the fold of perito- 
neum passing between them is reached. 
21. Base of bladder. Ureters.—Similarly separate the 
vagina from the urethra and bladder until the ureters are 
exposed. Note their position. PERINEUM, FEMALE. 
ARRANGEMENT OF STRUCTURES FILLING THE PELVIC 
OUTLET (Diagrammatic). 
FEMALE, 
FROM WITHIN OUTWARD. 
Posterior. Mid-Point. Anterior. 
1. Rectum Uterus 1. Bladder 2. 
Vagina 3. Urethra 4. 
2. Recto- Vesical fascia 5. 
3. Levator ani (et vaginae) 6. 
4. Anal fascia Post, layer triangular lig. 7. 
Compressor urethrae (Constrictor vaginae) 8. 
5. Adipose tissue Ant. layer triangular lig. 9. 
Perineal triangle 10. 
6. Anus Bulb vagina 11. 
Perineal fascia 12. 
7. Sphincter ani Subcutaneous tissue 13. 
8. Integument 14. LOWER EXTREMITY AXD 
ABDOMEX. 
FIRST WEEK.—Abdomen. 
Third Day. 
Before any dissecting is begun on the abdomen, the 
student is again referred to Holden’s “ Landmarks” in 
Gray’s Anatomy, and, following the directions there given, 
to locate the bony landmarks and superficial relations of 
the principal abdominal viscera. 
Incisions.—l, In the median line from the lower end 
of the sternum to the pubes. 
2. Transversely around the body from the upper end of 
1 (same as 2 for thorax, page 30). 
3. From the lower end of 1, along Poupart’s ligament 
and over the crest of the ilium. 
Eemove the integument alone over the whole area as far 
around the side as possible. 
Parts Exposed. 
Subcutaneous tissue. 
Superficial epigastric artery. 
Superficial external puclic artery. 
Inguinal lymphatics. 
Cutaneous branch of ilio-hypogastric nerve. 
22. Subcutaneous tissue.—The subcutaneous tissue or 
75 ABDOMEN. 
76 
superficial fascia will be found of variable thickness due to 
the amount of adipose tissue it contains. It is backed by 
a denser plane of fascia called the deep layer of the super- 
ficial fascia. This deeper layer is attached to the linea 
alba, front of pubes, and Poupart’s ligament. It loosely 
covers the cord and passes into the scrotum as the dartos 
to end in the perineum as the perineal fascia. (See §2, 
p. 64.) 
23. Subcutaneous arteries.—lmbedded in the subcuta- 
neous tissue you will find the superficial epigastric artery 
passing upward over the middle of Poupart’s ligament 
toward the umbilicus, and the superficial external pudic 
arching over the pubes to anastomose with the correspond- 
ing artery of the other side. The latter gives off at the 
side of the penis the superficial dorsal artery of that organ. 
24. Subcutaneous nerves.—The subcutaneous nerves are 
very small and will hardly repay the time necessary for 
their dissection. One nerve, the cutaneous branch of the 
anterior division of the ilio-hypogastric, will be found after 
coming through the aponeurosis of the external oblique, 
about two inches above the spine of the pubes. 
25. Inguinal lymphatics.—Small lymphatic glands in 
the inguinal region take the name of this locality. Unless 
enlarged, they may escape observation. They lie over and 
above the middle of Poupart’s ligament. 
Remove the superficial fascia beginning on a transverse 
line at the umbilicus. Turn it down over the thigh (hav- 
ing cut through it in the median line from umbilicus to 
pubes), and in doing so note its attachment to the linea 
alba. Leave it attached by its lower portion to the front 
of the pubes and Poupart’s ligament. Mark that it is not 
firmly attached to the spermatic cord. It is through this 
gap that sometimes extravasated urine finds its way from ABDOMEN". 
77 
the perineum through the scrotum into the front of the 
abdomen. 
Clean away the upper portion of the superficial fascia. 
Farts Exposed. 
External oblique muscle. 
Linea alba. 
Liuea semilunaris. 
Line* transversae. 
Poupart’s ligament. 
External abdominal ring. 
Spermatic cord (or round ligament). 
Intercolumnar fascia. 
External spermatic fascia. 
Suspensory ligament of the penis. 
Cutaneous branches of the deep and superior epigastric 
arteries. 
Ilio-hypogastric nerve. 
26. External oblique.—Note the direction of the fibres 
of the external oblique muscle and aponeurosis. 
Learn this as well as all the other abdominal muscles 
thoroughly. 
27. Linear markings of the abdomen.—The union of 
the aponeuroses of the lateral abdominal muscles in the 
median line in front is called, from its light color, the linea 
alba. 
Similarly the line of union of the internal oblique and 
transversalis at the outer border of the rectus is called from 
its curved direction the linea semilunaris. 
The transverse tendinous markings of the rectus show 
through its sheath as the linea3 transverse? and are three 
in number. ABDOMEK. 
78 
28. Ponpart’s ligament.—The fibres of the aponeurosis 
of the external oblique, which pass from the anterior supe- 
rior iliac spine to the spine of the pubes, form what is 
called Poupart’s ligament, one of the most important land- 
marks in the body. 
28. External abdominal ring, spermatic cord (round 
ligament).—Just above and outside the spine of the pubes 
is an opening in the fibres of the external oblique aponeu- 
rosis for the exit of the spermatic cord (or round ligament). 
This is the external abdominal ring. The edges of the 
aponeurosis bounding the ring are termed the pillars or 
columns of the ring. 
30. Intercolumnar fascia.—You will notice between the 
anterior superior iliac spine and the external abdominal 
ring there are scattered fibres which are superficial and 
nearly at right angles to the fibres of the external oblique 
aponeurosis. These fibres become more numerous in the 
region of the ring and stretch across from one column to 
the other, reinforcing the ring at what would otherwise be 
a weak point. 
This layer of fibres has on this account been called the 
intercolumnar fascia. 
31. External spermatic fascia.—From the lower margin 
of the intercolumnar fascia and from the edges of the ring 
a very thin membrane is reflected on to the spermatic cord 
(or round ligament). This is the external spermatic fascia 
(and will be easily demonstrated later, though it is men- 
tioned now to show its connection with the fascia above). 
32. Suspensory ligament of the penis.—ln reflecting the 
superficial fascia a portion of it will be found attached to 
the front of the pubes and passing down to the penis. 
This forms the suspensory ligament of the penis. 
33. Cutaneous arterial branches.—-The deep and supe- ABDOMEN. 
79 
rior epigastric arteries give oft cutaneous branches which 
perforate the upper two-thirds of the sheath of the rectus 
muscle. 
34. Ilio-hypogastric nerve.—The ilio-hypogastric nerve 
will be found issuing from an opening in the aponeurosis 
of the external oblique as before mentioned. (§ 24, p. 76.) 
Just above the level of the anterior superior iliac spine 
make a small transverse cut through the aponeurosis of the 
external oblique, until the internal oblique is seen. Insert 
a knife-handle in this opening, and, raising the external 
oblique, divide it transversely toward the median line, 
until its aponeurotic Junction with the internal oblique is 
reached. This will be about one-half inch to the inside of 
the linea semilunaris. 
Eeflect the upper part of the muscle, first raising it care- 
fully from the one beneath, and dividing its aponeurosis 
Just over the linea semilunaris, cut away the two or three 
upper costal attachments of the muscle and turn it back- 
ward as far as it will go. 
The lower triangular piece is to be removed in a similar 
manner, cutting it away near its median fascial Junction, 
but leaving it attached by its base, i.e., Poupart’s liga- 
ment. 
Internal oblique. 
Linea semilunaris. 
Conjoined tendon. 
Triangular ligament. 
External ring and its columns, 
Intercolumnar and external spermatic fasciae. 
Cremaster muscle and fascia. 
Spermatic cord (or round ligament). 
Inguinal canal. 
Parts Exposed. ABDOMEN-. 
80 
Ilioinguinal nerve. 
Iliohypogastric nerve. 
35. Internal oblique, linea semilunaris, conjoined ten- 
don.—Mark the direction the fibres of the internal oblique 
take, that its aponeurotic junction with the transversalis at 
the outer border of the rectus is called the linea semi- 
lunaris, and that the common tendon of the internal 
oblique (and transversalis) behind the external abdominal 
ring and its inner pillar forms the conjoined tendon and 
strengthens an otherwise weak spot in the abdominal wall. 
36. Triangular ligament.—You will find the conjoined 
tendon crossed by a narrow band of fibres from the pecti- 
neal line to the linea alba. These fibres constitute the 
triangular ligament and are between the conjoined tendon 
and internal pillar of the ring. They serve chiefly as a 
source of bother and confusion to students. 
37. External ring, external spermatic fascia.—Yow 
again examine the external abdominal ring; by following 
down the cord with the finger the external spermatic fascia 
will be found, and its reflection on to the cord appreciated. 
38. Cremaster muscle and cremasteric fascia.—ln ex- 
amining the cord you will see that it is inclosed within 
loosely arranged muscular loops. The muscle is the cre- 
master, and it, with the connective tissue uniting its loops, 
is called the cremasteric fascia (neither exists in the female). 
39. Inguinal canal.—-Trace the spermatic cord (or 
round ligament) internal to the external ring until it dis- 
appears by passing under the arch of the internal oblique 
and transversalis. This part in the course of the cord is 
called the inguinal canal. Learn all its boundaries. 
40. Ilio-inguinal nerve.—Parallel with and just above 
Poupart’s ligament is the ilio-inguinal nerve, which joins ABDOMEN'. 
81 
the cord on its outer surface and with it passes out through 
the external ring to the scrotum. 
41. Ilio-hypogastric nerve.—This nerve will have been 
found in reflecting the lower portion of the external oblique. 
It comes through the internal oblique about on a level 
with, and one inch internal to, the anterior superior iliac 
spine, and takes a course downward and forward to pass 
through the external oblique as stated in § 34, p. 79. 
Fourth Day. 
Beginning at the point where the ilio-hypogastric nerve 
pierces the internal oblique (see above), carefully divide 
the fibres of the muscle in a vertical direction to the ribs 
and along their free border to the outer margin of the 
rectus. 
You can tell when you have divided all the fibres of the 
internal oblique through to the transversalis, by finding 
the shiny intermuscular septum or muscular arterial 
branches and intercostal nerves which lie between the 
muscles. 
Leave the vessels and nerves lying upon the transversalis 
and reflect the internal oblique inward until its aponeuro- 
tic junction with the transversalis is reached. 
The lower portion of the muscle should be left in posi- 
tion. 
Parts Exposed. 
Transversalis muscle. 
Muscular branches of the deep circumflex iliac artery. 
Intercostal arteries (two or three lower ones). 
Lower intercostal nerves. 
Ilio-hypogastric nerve. 
Xlio-inguinal nerve. ABDOMEN. 
82 
42. Transversalis vessels and nerves.—All the above 
structures can be easily found. 
The intercostal nerves run forward to the rectus, as will 
be seen later (§ 44), and the intercostal arteries (ninth to 
twelfth) take the same course. 
The deep circumflex iliac artery gives otf two or more 
good-sized branches, which pass upward between the two 
muscles. 
The ilio-hypogastric and ilio-inguinal nerves can be 
easily traced to where they disappear through the trans- 
versalis. 
Turn the internal oblique back into place. 
Incise the sheath of the rectus from top to bottom about 
three-fourths of an inch from the linea alba and reflect the 
two parts. In doing this be very careful not to cut into 
the rectus at the places where the sheath is attached to the 
linea; transverse. 
Parts Exposed. 
Rectus and sheath. 
Pyramidalis. 
Superior and deep epigastric arteries. 
Lower intercostal nerves. 
43. Rectus pyramidalis.—These two muscles are to be 
learned, Note the transverse tendinous markings in the 
rectus, and that phantom tumors are sometimes caused by 
the contraction of a segment of the muscle. 
Consult the text-book for the formation of the sheath of 
the rectus. 
44. Epigastric arteries and intercostal nerves.—By 
raising the muscle, beginning at its inner edge you can 
demonstrate the two epigastric arteries and on the outer 83 
ABDOMEN. 
border of the muscle how the intercostal nerves enter it. 
(See § 42.) 
Divide the rectus at its middle and reflect the two por- 
tions, cutting the intercostal nerves and deep epigastric 
artery close to the muscle, leaving the latter in position. 
Parts Exposed. 
Deep epigastric artery. 
Superior epigastric artery. 
Posterior part of sheatli of rectus. 
Semilunar fold of Douglas. 
45. Deep epigastric artery.—The deep epigastric artery 
can be traced downward until it passes behind the internal 
oblique and transversalis; do not follow it any farther at 
present. 
46. Superior epigastric artery.-—The superior epigastric 
enters the upper part of the rectus and descends to anas- 
tomose with the deep epigastric in the substance of the 
muscle. 
47. Posterior part of sheath of rectus, semilunar fold of 
Douglas.—The posterior layer of the sheath of the rectus 
is now exposed. The lowrer free edge of the posterior part 
of the sheath is called the semilunar fold of Douglas. Out 
through the transversalis (and anterior part of sheath of 
rectus) from just below the semilunar fold of Douglas to 
the anterior superior spine of the ilium. Do not divide 
the ilio-hypogastric and ilio-inguinal nerves, but draw 
them outward. 
Take the lower portion of the internal oblique and 
transversalis, wdiich have been left united, and turn them 
outward, trying to leave behind the aponeurosis of the 
transversalis, which is very thin above but becomes thicker 
as you near the internal abdominal ring. 84 
ABDOMENS 
Cut through the linea alba from the inner part of 
Douglas’ fold to the ensiform appendix, and cut the trans- 
versals away from its costal attachment, and turn it (and 
the internal oblique) as far backward as possible. 
In raising the upper portion of the transversalis, great 
care will have to be used to escape perforating the perito- 
neum, and in the lower part to leave behind the transversalis 
fascia. 
Parts Exposed. 
Transversalis fascia. 
Internal abdominal ring. 
Infnndibularform fascia. 
48. Transversalis fascia.—As stated above, this fascia 
is very thin except close to the internal ring, where it be- 
comes reinforced. 
49. Internal abdominal ring.—The cord (or round lig- 
ament) passing through it forms the internal abdominal 
ring. 
50. Infundibularform fascia.—The fascia which is 
(really a part of the transversalis fascia) reflected on to the 
cord is called the infundibularform fascia. 
Raise the transversalis fascia and demonstrate the inter- 
nal ring and infundibularform fascia by passing the finger 
into the ring. 
If the transversalis fascia should have been raised in re- 
moving the muscle, make out the above points and proceed 
to clean the lower surface of the peritoneum of its sub- 
peritoneal fat. 
Parts Exposed. 
Peritoneum. 
Urachus. ABDOMEJST. 
85 
Obliterated hypogastric arteries. 
Deep epigastric artery, its relations and branches. 
51. Peritoneum. —Carefully study the text-book descrip- 
tions of the peritoneum, and at this stage examine as far as 
possible its parietal attachments, and later on as the dis- 
section progresses make out its various visceral reflections. 
52. Urachus. Obliterated hypogastric arteries.—From 
the umbilicus you will find three thin fibrous cords leading 
down to the bladder. 
The outside ones are the obliterated hypogastric arteries. 
The middle one, the urachus, once an open canal between 
the bladder and allantois. 
53. Relations of deep epigastric artery to internal ring. 
—Raise the peritoneum (and its contents) from the iliac 
fossa, clean the cord for a short distance, trace the epigas- 
tric artery to the external iliac, and then carefully note 
the relations between the cord and internal ring and the 
deep epigastric artery. 
54. Cremasteric and pubic arteries.—ln this locality 
you will find that the deep epigastric gives off a branch to 
the cord, the cremasteric, and one to the inner surface of 
the pubes, the pubic. 
By stripping up the peritoneum (without opening it) 
from the iliac fossa you can demonstrate how ligation of 
the iliac arteries can he accomplished without cutting into 
the peritoneum. 
Incise the peritoneum from the ensiform appendix to 
the pubes and transversely just below the umbilicus. 
Turn back the four segments. Attached to the right 
upper one are two ligaments of the liver—preserve these, 
Fifth Day. ABDOMEN". 
Parts Exposed. 
Cavity of greater peritoneum. 
Liver and gall bladder. 
Ligaments of liver. 
Stomach, spleen. 
Gastro-colic (great) omentum. 
Gastro-hepatic (lesser) omentum. 
Gastro-splenic (third) omentum. 
Foramen of Winslow. 
Small intestine. 
Large intestine. 
Caecum and vermiform appendix. 
Ascending colon. 
Transverse colon. 
Descending colon. 
Sigmoid flexure. 
Rectum. 
Mesentery. 
Bladder and ligaments (false). 
Uterus and ligaments. 
Ovaries and tubes. 
Only brief summaries can be given here to fix the more 
important relations of the viscera in the mind of the 
student. 
For detailed descriptions of the various relations of the 
viscera to each other and to the surface landmarks, the 
text-books must be consulted. 
55. Liver, its ligaments. The gall bladder.—The liver 
occupies a position immediately beneath the diaphragm (to 
which it is attached) on the right side and reaches to the 
left a hand’s breadth beyond the median line. ABDOMEN. 
87 
Make out its four peritoneal ligaments and one—the 
remains of the umbilical vein—in the free border of the 
suspensory ligament. 
The gall bladder lies under the middle of the liver and 
reaches to—and if distended beyond—its anterior border. 
66. The stomach.—The stomach (with the spleen) fills 
a place beneath the diaphragm on the left side correspond- 
ing to that of the liver on the right side, excepting that 
toward the middle it lies under the left lobe of the liver 
and only reaches about two inches to the right of the 
median line. 
57. Gastro-hepatic (lesser) omentum.—Between the 
liver and stomach you will find a process of peritoneum 
folded around the hepatic artery and duct and portal vein. 
This is the lesser or gastro-hepatic omentum. 
58. Spleen, gastro-splenic (third) omentum.—Feel in 
behind the stomach and find the spleen, which caps its left 
end posteriorly and will be found to be joined to it by the 
gastro-splenic or third omentum. 
59. Gastro-colic (great) omentum.—From the greater 
curvature of the stomach a broad apron of peritoneum 
reaches down to cover the intestines. This is the great or 
gastrc-colic omentum. 
By raising it upward over the chest you will expose the 
colon, to which it is attached in its transverse portion. 
60. Small intestine, large intestine, and its divisions.— 
Examine the loops of small intestine which fill the central 
portion of the abdomen. Trace them to the right iliac 
fossa and there find the caecum and, extending off from the 
caecum, the vermiform appendix. It usually passes upward 
and inward behind the caecum, but is often found at its 
lower end or lying by its inner side. 
From the caecum you can trace the ascending colon up ABDOMEN. 
88 
Under the liver whore it bends (hepatic flexure) to the 
left, forming the transverse colon, which crosses to the left 
side of the body until under the spleen it turns (splenic 
flexure) downward, forming the descending colon. Com- 
ing into the left iliac fossa the descending colon changes 
its name to the sigmoid flexure, and this in time becomes 
the rectum as the gut changes its course to enter the pelvic 
cavity. 
61. Mesentery.—The intestine, large and small, is fast- 
ened to the posterior abdominal wall by a process of peri- 
toneum called the mesentery. 
62. Bladder, uterus, ovaries, tubes. Their ligaments.— 
In the pelvic cavity you will also find the bladder and in 
a female subject the uterus, ovaries, and tubes. Make out 
the folds of peritoneum forming the various false ligaments 
of these organs. 
63. The foramen of Winslow.—Turn down the great 
omentum, pass your hand up under the liver behind the 
lesser omentum from right to left, and insert your finger 
in an opening you will find there, viz.: the foramen of 
Winslow. 
64. Cavity of lesser peritoneum.—Make a transverse 
cut in the great omentum between the stomach and colon. 
This will open the cavity of the lesser peritoneum, and 
in it you can feel the posterior surface of the stomach, 
under surface of the liver, anterior opening of the fora- 
men of Winslow, the spleen to the left, and the pancreas 
and kidneys behind. 
Turn the great omentum (and transverse colon) upward 
over the chest and fasten it there. 
Dissect off the anterior layer of mesentery from the 
arteries. ABDOMEN. 
89 
Parts Exposed. 
Superior mesenteric artery. 
Vasa intestini tenuis. 
Ileo-colic. 
Colica dextra. 
Oolica media. 
Inferior mesenteric artery. 
Colica sinistra. 
Sigmoid artery. 
Superior hemorrhoidal. 
65. Superior mesenteric and branches.—It will not be 
necessary to completely dissect out the above arteries. 
Strip off enough of the mesentery to expose the superior 
mesenteric as high up as possible. Find the beginning of 
the twelve or more branches to the small intestine and 
carefully dissect out about six inches of their intestinal 
anastomosis. 
Then follow the main branch, ileo-colic, to the caecum 
and end of ileum. On the ileum side note its anastomosis 
with the vasa intestini tenuis and on the caecum side the 
union with the colica dextra branch of the mesentery, 
and this in turn with the colica media supplying the trans- 
verse colon. 
66. Inferior mesenteric artery and branches.—The last 
anastomoses with the colica sinistra—the first branch of 
the inferior mesenteric. 
Trace the sigmoid and superior hemorrhoidal, the two 
remaining branches of the inferior mesenteric artery. 
This completes the intestinal anastomoses excepting the 
duodenum and middle portion of the rectum, which you 
will examine later. ABDOMEN. 
90 
Sixth Day. 
Ligate the rectum and small intestine near the duodenum 
in two places, and divide the gut between the ligatures. 
Begin at the rectal end and remove the large and small 
intestine, dividing the mesentery close to them. 
Raise the liver and ribs as far upward as possible, draw 
the stomach downward and trace the arteries seen above its 
lesser curvature. 
Parts Exposed. 
Ooeliac axis. 
Gastric. 
Hepatic, pyloric, gastro-dnodenalis, cystic. 
Splenic. 
67. Cceliac axis.—Clean the coeliac axis, demonstrating 
its three branches. 
68. Gastric artery.—First trace the gastric artery, not- 
ingl its direction and three distinct anastomoses it enters 
into, viz.: with the aortic oesophageal and splenic branches 
and the pyloric branch of the hepatic. 
69. Hepatic and branches.—Then follow the hepatic 
artery to the under surface of the liver, where it divides 
into its two terminal branches (from the right one comes 
the cystic artery). 
In its course the hepatic gives off the pyloric branch 
to inosculate with the gastric and the gastro-duodenalis, 
which disappears behind the duodenum close to the pylorus. 
Turn the stomach upward and fasten it to the ribs, 
getting all the room possible. 
70. Gastro-duodenalis.—Complete the dissection of the 
gastro-duodenalis and its two branches, the gastro-epiploica 
dextra and superior pancreatico-duodenalis. 
71. Splenic and branches.—-Trace the splenic artery to ABDOMEN. 
the spleen and identify the following branches derived 
from it: pancreatic (parvse and magna), gastric (vasa bre- 
via), and gastro-epiploica sinistra. Note the latter’s an- 
astomosis with the dextra. 
72. Inferior pancreatico-duodenalis.—With the recog- 
nition of the inferior pancreatico-duodenalis (a branch of 
the superior mesentery) and its anastomosis with the supe- 
rior pancreatico-duodenalis you have completed the exami- 
nation of the arterial supply for the entire alimentary canal 
below the diaphragm (rectum excepted). 
73. Pancreas duodenum.—Glean the anterior surface of 
the pancreas and duodenum, and see how the former is 
embraced by the latter. 
Notice the superior mesenteric artery and vein lying 
upon the duodenum, but passing behind the pancreas. 
74. Portal vein.—Coming out from behind the pan- 
creas, you will find the portal vein; raise the pancreas and 
find how the portal vein is formed by the junction of the 
splenic and superior mesenteric veins. Then trace the 
portal vein—already partially dissected—to the under sur- 
face of the liver. 
75. Common bile duct.—Accompanying the vein you 
have already found the hepatic artery. Now draw out the 
gall bladder and you will be able to find the common bile 
duct and follow it back to the space between the duodenum 
and pancreas. 
76. Pancreatic duct.—Try to find the pancreatic duct 
as it Joins the bile duct and where the latter empties into 
the duodenum. 
Proceed as follows to remove the liver, stomach, duo- 
denum, spleen, and pancreas: 
Tie a ligature around the portal vein and cut the vein 
between the ligature and liver. ABDOMEN-. 
92 
To the left of the aorta find the inferior vena cava; 
ligate it and divide it also on the hepatic side of the liga- 
ture. 
Pull down the stomach; ligature the oesophagus as close 
to the stomach as possible and cut above the ligature. 
Cut the suspensory-ligament of the spleen. 
Draw down the liver; divide all its peritoneal ligaments, 
proceeding carefully; recognize the upper part of the vena 
cava inferior as it goes through the diaphragm above the 
liver; ligate it as close to the former as possible and cut 
through it on the lower side. 
Eemove the entire mass, dividing the coeliac axis and 
superior mesenteric artery as they come into view. 
Clean the under surface of the diaphragm and the re- 
maining contents of the abdomen, beginning above and 
working downward. 
Parts Exposed- 
Abdominal aorta. 
Phrenics. 
Coeliac axis. 
Superior mesenteric. 
Suprarenals—suprarenal capsules. 
Reuals—kidneys. 
Spermatic (or ovarian). 
Inferior mesenteric. 
Lumbar. 
Vena cava inferior. 
Diaphragm. 
Semilunar ganglia. 
Greater splanchnic nerves. 
Sympathetic ganglia. 
77. Abdominal aorta: phrenics, suprarenals,—Clean ABDOMEN. 
the abdominal aorta and trace its remaining branches: 
the phrenics to the diaphragm, the suprarenals to the 
suprarenal capsules. These arteries are very slender and 
will have to be carefully dissected or they will be torn 
away from the aorta. 
78. Suprarenal capsules.—The capsules cap the upper 
and inner part of the kidneys. Unless care is used in cut- 
ting away the adipose and areolar tissue which envelops 
them, they will be removed before they are recognized. 
(Consult § 82, below.) 
79. Renals, kidney, ureter.—Follow the renal arteries to 
the kidney. 
Strip off the fatty tissue it lies imbedded in after ex- 
amining its position with reference to the posterior ab- 
dominal wall. Trace the ureter to the cavity of the pelvis. 
80. Spermatics.—Sav;e the long slender spermatic (ova- 
rian in female) arteries, and see how after joining with the 
vas deferens it leaves the abdomen by the internal abdomi- 
nal ring (in female passes to ovary). 
81. Vena cava inferior; lumbar arteries.—Before you 
can dissect the lumbar arteries you will need to remove 
the remains of the inferior vena cava. Strip it downward, 
ligate it at its lower end and remove the upper part. 
Then make out the four lumbar arteries. 
82. Diaphragm. —Co back to the diaphragm, trace its 
crura downward, noting the difference between the right 
and left one. Recognize the three large openings—caval, 
aortic, and oesophageal. 
83. Semilunar ganglion.—Now at the side of the aorta 
at the coeliac axis find the large sympathetic semilunar 
ganglion. It lies upon the crus of the diaphragm near 
the suprarenal bodies. 
84. Or eater splanchnic nerve.—lt receives the splanch- ABDOMEN. 
94 
Nic nerves, the greater one of which you can find if not 
the smaller. 
85. Lumbar ganglia.—Find the four lumbar sympa- 
thetic ganglia and trace their connecting cords. They lie 
upon the front of the lumbar vertebrae to the outer side of 
the aorta. 
SECOND WEEK. 
Fiest Day. 
Carefully remove any remaining peritoneum and all 
areolar tissue from the lumbar and iliac regions. 
Parts Exposed 
Twelfth intercostal nerve. 
Lumbar plexus. 
Ilio-hypogastric. 
Ilio-inguinal. 
External cutaneous. 
Genito-crural. 
Anterior crural. 
Obturator. 
Quadratics lumborum. 
Psoas magnus and parvus. 
Iliacus. 
Common iliac artery and vein. 
External iliac artery and vein. 
Femoral opening. 
G-imbernat’s ligament. 
Relations beneath Poupart’s ligament. 
86. Last intercostal nerve.—Just below the last rib you 
will find the twelfth intercostal nerve. 
87. Lumbar plexus.—Learn the formation of the him- ABDOMEN. 
bar plexus and trace its iliohypogastric and ilio-inguinal 
nerves through the transversalis. 
Then cut away the internal oblique and transversalis close 
to the crest of the ilium and Poupart’s ligament. 
Below the above nerves find the external cutaneous 
traversing the iliac fossa upon the iliacus muscle and dis- 
appearing beneath Poupart’s ligament immediately in front 
of the anterior superior iliac spine. 
You will see the genito-crural lying upon the psoas mag- 
nus muscle. It divides into -two branches. One branch 
joins the cord and the other passes under Poupart’s liga- 
ment with the psoas magnus muscle. 
In the groove between the psoas magnus and iliacus lies 
the anterior crural nerve. It passes also under Poupart’s 
ligament. 
The obturator nerve will be found passing forward below 
the pelvic brim to leave the pelvis by the obturator fora- 
men. 
88. Quadrat us lumborum.—Turn the kidney toward 
the other side and make out the quadratus lumborum 
muscle. 
It will be more fully exposed later in the dissection. 
89. Psose. Iliacus.—Also clean the surface of the psoas 
magnus and parvus and iliacus muscles. Do not cut away 
the nerves and arteries which lie in or upon them. 
90. Common and external iliac vessels.—Now carefully 
compare the relations of the common and external iliac 
arteries and veins on the two sides. Trace the deep cir- 
cumflex iliac branch of the external iliac artery. 
91. Femoral opening, Gimbernat’s ligament; relations 
under Poupart’s ligament.—To the inner side of the exter- 
nal iliac (femoral) vein you will see a dimple—or a depres- 
sion—beneath Poupart’s ligament. This depression is the ABDOMEN. 
96 
femoral opening. It is now closed by the septum crurale, 
and in the depression you will find a small lymphatic gland 
inclosed in areolar tissue. 
To the inner side of the (closed) opening you have Gim- 
bernat’s ligament; above Poupart’s ligament, and to the 
outer side, the femoral vein; then the artery, and last the 
anterior crural nerve. 
Divide the psoas magnus and parvus. Clean the lower 
part of the lumbar plexus and the internal iliac artery and 
branches as far as convenient. 
Parts Exposed. 
Obturator nerve. 
Lumbo-sacral cord. 
Internal iliac artery and branches. 
Ureter. Bladder, 
Yas deferens. 
92. Obturator nerve, lumbo-sacral cord.—Finish the 
dissection of the obturator nerve. Also find the lumbo- 
sacral cord which connects the lumbar with the sacral 
plexus. It passes over the base of the sacrum close to the 
body of the last vertebra. 
93. Internal iliac and branches, ureter, vas deferens.— 
Take up the internal iliac artery, and make out its bifur- 
cation. Trace its obturator branch, which accompanies 
the nerve of the same name; the ilio-lumbar, to its iliac 
(deep circumflex iliac) and lumbar (last lumbar) anastomo- 
ses and the vesical arteries. To follow the last it will be 
necessary to inflate the bladder with air, using for this 
purpose an ordinary syringe; tie a string around the penis 
and draw the bladder well out of the pelvis. 
Note that the superior vesical gives of! a fibrous cord, ABDOMEN. 
which is the obliterated hypogastric artery (§ 52, p. 85), 
and a small branch to the vas deferens. Follow the ureter 
and vas deferens around the back of the bladder. 
Divide the ureters, the vasa deferentia, and arteries pass- 
ing to the bladder. Cut away any remaining peritoneal 
folds or recto-vesical fascia holding the bladder (uterus, 
vaginal in female) and rectum and remove them through 
the pelvic outlet. 
Parts Exposed. 
Remaining branches of internal iliac artery. 
Sacral plexus. 
Obturator internus. 
Pyriformis. 
Coccygeus. 
. 94. Internal iliac finished.—ldentify the remaining 
branches of the internal iliac artery. From the anterior 
trunk the middle hemorrhoidal (should be noticed when 
the rectum is removed) and the pudiac and sciatic (termi- 
nal branches). From the posterior trunk the lateral sacral 
(two) and gluteal (continuation of trunk). 
95. Sacral plexus.—In this locality determine the broad 
cord of the sacral plexus and the roots of origin from the 
lumho-sacral cord and first three sacral nerves. 
Recognize the obturator internus, pyriformis, and coccy- 
geus muscles. 
This completes the dissection of the abdomen. LOWER EXTREMITY. 
Second Day, 
Incision.— 1. From the middle of Ponpart’s ligament 
down the front of the thigh to below the patella. 
2. Two short transverse cuts at the lower end of 1. 
Eemove the skin only, turning it off laterally as far as 
possible. 
Parts Exposed. 
Superficial fascia. 
Superficial arteries. 
Superficial veins. 
Superficial nerves. 
Femoral lymphatics. 
Prepatellar bursa. 
96. Superficial fascia.—The superficial fascia is of vary- 
ing thickness. It consists of two layers between which the 
superficial vessels and nerves will be found. 
97. Superficial arteries.—The superficial arteries are 
(a) the superficial epigastric, (b) the superficial external 
pudic, which have already been dissected distally (§ 23, p. 
76), and now only need to be traced until they disappear 
by passing deeply through the fascia lata, (c) the superficial 
circumflex iliac, which runs outward below Poupart’s liga- 
ment and the crest of the ilium, {cl) down the front of the 
thigh some superficial branches of muscular arteries which 
perforate the fascia lata, and (e) on the inner side of the 
knee the anastomotica magna becoming superficial. 
98. Superficial veins,—The superficial veins are those 
98 LOWER EXTREMITY. 
99 
which accompany the above arteries, and are of no special 
importance excepting one, the internal or long saphenous, 
which follows no artery. Trace this vein from below where 
it appears along the inner side of the knee until it disap- 
pears through an (artificial) opening in the fascia lata (to 
be dissected later). 
99. Superficial nerves.—The superficial nerves will be 
demonstrated as the fascia lata is cleaned, but filaments of 
the main branches may be found at this stage, though it is 
not advisable to delay the dissection to look especially for 
them. 
The subcutaneous nerves are branches of the external 
cutaneous, the middle and internal cutaneous branches of 
the anterior crural, the crural branch of the genito-crural 
nerve, and the internal saphenous branch of the anterior 
crural. 
100. Femoral lymphatics.—The femoral lymphatics 
will be found below the middle of Poupart’s ligament and 
clustered about the veins and arteries coming out of the 
saphenous opening. 
101. Prepatellar bursa.—Cut through the superficial 
fascia over the patella; separate the sides of the cut and you 
will find the prepatellar bursa. 
Now remove all of the superficial fascia, leaving the ves- 
sels and nerves lying upon the fascia lata. At the saphe- 
nous opening care will have to be used or all form of this 
opening will be lost. 
The only directions that can be given are to work from 
all points toward the opening, isolate the vessels and nerves 
which pass through it, then cut the intervening tissue 
carefully away. 
If done properly you will see defined the denser outer 
border of the opening and a looser layer of tissue (cribri- LOWER EXTREMITY. 
100 
form fascia) passing inward to the inner border of the 
opening. 
In the lower third of the thigh the superficial fascia can 
be removed in a layer after making similar incisions in it 
to those in the skin. Here care must also be used to 
leave the fascia lata behind, for it is thin, especially over 
the front and inner surfaces of the thigh. 
Parts Exposed. 
fascia lata. 
Saphenous opening. 
Cribriform fascia. 
Deep external pudic artery. 
102. Fascia lata.—The fascia lata—or deep fascia of 
the limb—incloses the thigh like a tight sheath. 
A t this time learn ail its anterior attachments above and 
below. Notice how it thins out over the inner part of the 
thigh, but how dense it is between the ilium and tibia on 
the outer side of the thigh where it forms the ilio-tibial 
baud. 
103. Saphenous opening.—Study carefully the descrip- 
tion of the saphenous opening in your text-book. 
Do not confuse your mind with the many names applied 
to the borders of the opening. On the outer side recog- 
nize the curved band of fibres reaching from the spine of 
the pubes and inner part of Poupart’s ligament downward 
and then inward under the saphenous vein to join the 
inner portion of the fascia. 
This curved baud forming the outer border of the open- 
ing is the falciform process of the fascia lata. 
104, Cribriform fascia,—As before stated, the opening- 
does not exist as such until the connective tissue filling it LOWER EXTREMITY. 
101 
and stretching from one border to the other and pierced 
by the internal saphenous vein, lymphatics, and nerves is 
removed. This is the cribriform fascia, and is really the 
deeper part of the superficial fascia which is attached 
around the margins of the opening. 
105. Structures passing through the opening.—Re- 
move the cribriform fascia; make out now clearly the 
borders (outer very distinct, inner not well defined) of the 
opening and the structures passing through it. They are 
the internal saphenous vein, superficial external pudic and 
superficial epigastric arteries, and the genito-crural nerve. 
You will also see the femoral vein and artery covered by 
their sheath. 
106. Deep external pudic artery.—The deep external 
pudic artery will be found coming through the fascia lata 
on a level with and about one inch to the inner side of 
the saphenous opening. 
Third Day. 
Divide the saphenous vein and its tributaries near the 
saphenous opening. 
Incise the fascia lata in the middle line from Poupart’s 
ligament to the patella. Cut the fascia away from Pou- 
part’s ligament, working outward until the tensor vaginas 
muscle is reached. Follow the muscle and the ilio-tibial 
band downward, dividing the fascia at their anterior bor- 
der, and remove this portion entirely. 
Leave the stub of the external cutaneous nerve upon the 
sartorius. 
Raise the inner portion of the fascia. Cut it away from 
Poupart’s ligament and front of the pubes. Dissect it oil 
from the deeper structures—carefully avoiding cutting 
into them—until the gracilis muscle is reached and passed. LOWER EXTREMITY, 
102 
Then divide the fascia along the inner border of the mus- 
cle and remove it. 
In removing the fascia note its intermuscular septa and 
where it is pierced by the cutaneous nerves and vessels. 
Carefully dissect the connective and adipose tissue from 
the structures presenting. 
Parts Exposed. 
Tensor vaginae femoris. 
Ilio-tibial band. 
Sartorius. 
External cutaneous nerve. 
Internal saphenous nerve. 
Anastomotica magna artery. 
Eectus. 
Femoral artery and vein. 
Anterior crural nerve. 
Iliacus. 
Tendon of psoas magnus. 
Pectineus. 
Adductor longus. 
Scarpas triangle. 
Gracilis. 
Clean the parts above in the order in which they are 
given. The muscles are to be exposed from origin to in- 
sertion and their arterial and nerve supply saved. 
107. Tensor vaginas femoris, ilio-tihial band.—Recog- 
nize how the tensor vaginae femoris is inserted into the 
fascia lata, and by the so-called ilio-tibial band is contin- 
ued into the tibia. 
108. Sartorins, external cutaneous nerve.—In cleaning 
the origin of the sartorins, note the external cutaneous 103 
LOWER EXTREMITY. 
nerve which comes out from under Poupart’s ligament 
close to the anterior superior iliac spine. 
109. Anastomotica magna, internal saphenous nerve.— 
As you follow the muscle around the internal condyle of 
the femur you will discover the internal saphenous nerve 
and superficial branch of the anastomotica magna artery. 
Make out the inverted J-shaped insertion of the muscle, 
also the bursa common to its tendon and the tendons of 
the gracilis and semitendinosus. 
110. Pectus.—Find the two tendons of origin of the 
rectus. Remove the fat between it and the tensor vaginae 
femoris. 
Notice the dense baud from the fascia lata at the ter- 
mination of the latter, which reaches upward to be attached 
Just above the posterior tendon of the former muscle. 
111. Femoral artery (and vein), anterior crural nerve. 
—Clean the femoral artery and its branches (as far as con- 
venient) to the upper border of the adductor longus. 
Trace dowmvard the various branches of the anterior 
crural nerve. 
112. Iliacus, tendon of psoas magnus, pectineus, ad- 
ductor longus.—The iliacus, pectineus and adductor longus 
are now to be freed from areolar tissue. Leave the fibrous 
aponeurosis passing from the last muscle to the vastus 
internus. 
In cleaning the iliacus you will find the tendon of the 
psoas magnus at its inner side. 
113. Scarpa’s triangle.—You are now to study carefully 
the triangular space bounded by the sartorius, Poupart’s 
ligament, and the adductor longus—Scarpa’s triangle—the 
floor of which is made by the iliacus, tendon of psoas, pec- 
tineus and adductor longus muscles. Its contents are the 
femoral vessels, the anterior crural nerve and their branches. LOWER EXTREMITY. 
104 
In this connection refer again to the femoral opening 
and rim over its boundaries (§ 90, p. 95). 
114. Gracilis.—Clean the gracilis muscle from end to 
end; above, its wide but very thin origin, and below, its 
narrow but thick insertion. At the knee you will see the 
internal saphenous nerve and anastomotica magna artery 
in front of the tendons of the muscle. 
Fourth Day, 
Divide the ilio-tibial band just below the tensor muscle 
and turn the latter upward; at the same time look for its 
nerve supply. 
Divide the sartorius and rectus at their middle and re- 
flect their ends, saving their nerves. 
Parts Exposed. 
Vastus externns. 
Gluteus minimus. 
Gluteus medius. 
Vastus internus and crureus. 
Hunter’s canal. 
Femoral artery and vein. 
Internal saphenous nerve. 
Anastomotica magna artery. 
Profunda femoris. 
Internal and external circumflex arteries. 
Nearly all the structures mentioned above will have been 
more or less exposed by this time; complete the dissection 
of what remains unfinished. 
115. Vastus externus, gluteus minimus and medius. 
—Demonstrate the extensive origin of the vastus externus, 
and when working above recognize also the gluteus minimus 
and medius; the former internal to the latter. LOWER EXTREMITY. 
105 
116. Vastus interims and crnreus.—The vastus interims 
and crnreus are really one muscle covering the front and 
lateral surfaces of the femur, and reaching around on the 
inner side to the linea aspera. Do not try to separate 
them. 
117. Hunter’s canal and contents.—Study the forma- 
tion of Hunter’s canal, then incise the fascia stretching 
across the front of the canal and expose the femoral artery 
vein and internal saphenous nerve. What are their relations 
to each other here? 
118. Anastomotica magna.—While in this region com- 
plete the dissection of the anastomotica magna artery by 
tracing it to where it comes off from the femoral, and follow 
down its deep branch between the vastus interims and ten- 
dons of adductor magnus. 
119. Profunda and circumflex arteries.—You should 
now dissect the profunda artery (upper portions) and its 
two branches, the internal and external circumflex. 
Divide the adductor longus at its middle and lower thirds 
(below where the nerve enters it). Draw the pectineus 
upward, dividing it through the middle if necessary. Cut 
through the iliacus under Poupart’s ligament and turn the 
lower part downward. Divide the femoral artery below 
the origin of the profunda. 
Parts Exposed. 
Adductor brevis. 
Adductor magnus. 
Obturator externus muscle. 
Obturator nerve and artery. 
Capsular origin of iliacus muscle. 
Profunda and its perforating branches. 
ISO. Adductor brevis.—When dissecting the adductor LOWER EXTREMITY. 
106 
brevis, you will find the anterior branch of the obturator 
nerve lying upon and the posterior branch behind the mus- 
cle. Divide the muscle and reflect its ends. 
121. Adductor magnus,—The adductor magnus has 
already been partially cleaned; complete the unfinished 
parts, Notice its broad insertion, where its tendon ends in 
the adductor tubercle, and that it is pierced by the femoral 
artery. 
122. Obturator externus.—Only the anterior portion of 
the obturator externus can be seen. It is pierced by the 
posterior branch of the obturator nerve. 
123. Obturator nerve and artery.—With the obturator 
nerve you will find the internal branch of the obturator 
artery. Both can be traced to their exit from the obtura- 
tor foramen. 
124. Capsular origin of iliacus.—It is important to 
notice the fibres of the iliacus which arise from the capsule 
of the hip-joint. They are more numerous than usually 
stated. Between the tendon of the ilio-psoas and capsule 
of the joint is a bursa that often communicates with the 
joint. 
125. Profunda and branches.—Finish the anterior por- 
tion of the thigh by completing the dissection of the pro- 
funda artery and its perforating branches. 
Fifth Day 
Incisions.—1. Continue the incision down the front 
of the leg and foot to toes. 
2. Make liberating transverse cuts at the ankle and one 
across the base of the toes. 
3. Carry incisions along the top of the toes. 
Remove the integument from the leg, foot, and toes. 
Leave the superficial veins and nerves lying upon the LOWER EXTREMITY. 
107 
deep fascia. In removing the skin from the toes look out 
for and save the digital nerves. 
Internal saphenous vein. 
Internal saphenous nerve. 
Musculo-cutaneous nerve. 
External saphenous vein. 
External saphenous nerve. 
Anterior tihial nerve (digital branch). 
Deep fascia. 
Annular ligament. 
Parts Exposed. 
126. Internal saphenous vein and- nerve.—The internal 
saphenous vein and nerve will be found running together 
down the inner side of the leg and ankle. The vein con- 
tinues forward to form with the external saphenous a 
venous arch on the dorsum of the foot. 
127. Musculo-cutaneous nerve.—At the lower third of 
the leg on the outer side you will see the musculo-cutaneous 
ner.ve piercing the deep fascia. 
Carefully trace the branches of this nerve to their digital 
distribution, also the branch of communication it gives to 
the anterior tihial nerve. 
128. External saphenous vein and nerve.—You will 
find the external saphenous vein and nerve below the ex- 
ternal malleolus and passing forward on the outer side of 
the foot. The vein takes part in the formation of the 
venous arch (see § 126); the nerve sends a branch of com- 
munication to the musculo-cutaneous and supplies the 
outer side of the foot and small toe. 
129. Deep fascia; annular ligament.—Read the descrip- 
tions of the deep fascia of the leg. Just above the ankle 
notice that the fascia is reinforced by transverse fibres LOWER EXTREMITY. 
108 
passing between the tibia and fibula. This band consti- 
tutes the upper portion of the annular ligament. 
There is a second band lower down reaching from below7 
the external malleolus across the front of the ankle. It 
is wTell marked on the outer side and front of the ankle, 
but becomes more indistinct over the inner side; how- 
ever, its fibres can be seen to run to the internal malleolus 
(upper leg of ) and to the inner side of the sole of the 
foot (lower leg of )• 
Divide the musculo-cutaueous nerve in front of the 
ankle, Eemove all the deep fascia from the leg and foot 
except those portions constituting the two annular liga- 
ments. 
Separate and clean the muscles, vessels, and nerves. 
Parts Exposed. 
Tibialis anticus. 
Extensor proprius pollicis. 
Extensor longus digitornm. 
Peroneus tertins, brevis and longus. 
Anterior tibial artery and brandies. 
Anterior peroneal artery. 
Anterior tibial nerve. 
Musculo-cntaneous nerve. 
Extensor brevis digitornm. 
Dorsalis pedis artery and branches. 
Digital branch of anterior tibial nerve. 
Dorsal interossei muscles. 
130. Anterior and lateral muscles of leg.—These mus- 
cles are easily separated and cleaned. From within out- 
ward they are the tibialis anticus, extensor proprius pol- 
licis, extensor longus digitorum, peroneus tertius, brevis 
and longus. Their tendons should be followed to their LOWER EXTREMITY. 
109 
insertion and the relations of the anterior tendons under 
the annular ligament and the external tendons behind the 
outer malleolus carefully noted. 
131. Anterior tibial artery and branches.—The anterior 
tibial artery will be found lying deep on the iuterosseus 
membrane to the outer side of the tibialis anticus muscle. 
Examine its relations throughout its course. Trace its 
recurrent, various muscular and malleolar branches. 
132. Anterior peroneal artery.—Find the anterior per- 
oneal artery as it comes through the interossens membrane 
about two inches above the outer malleolus, and follow it 
down the outer side of the ankle to its anastomosis with 
the external malleolar artery. 
133. Anterior tibial and musculo-cntaneous nerves.— 
Examine the relations of the anterior tibial nerve to the 
artery. Then trace it and also the musculo-cntaneous to 
their source—the external popliteal nerve. 
134. Extensor brevis digitorum.—The extensor brevis 
digitorum lies upon the front and outer side of the foot 
beneath the long extensor tendons. Notice the number 
and method of insertion of its tendons. 
135. Dorsalis pedis artery and branches.—Clean the 
dorsalis pedis artery and its tarsal, metatarsal, dorsalis 
hallucis and communicating branches as far as convenient 
without cutting away the overlying muscles and tendons. 
Draw them to one side or the other. 
136. Anterior tibial digital nerve.—Trace the digital 
branch of the anterior tibial nerve to the first and second 
toes. 
137. Dorsal interossei.—Dissect out the four interossei 
muscles on the dorsum of the foot, following their tendons 
to their insertion. 
This finishes the dissection of the anterior part of the 
lower extremity. LOWER EXTREMITY. 
THIRD WEEK.—Posterior Surface. 
Fibst Day. 
Incisions. —l. Continue the median incision of the 
trunk to the tip of the coccyx. 
2. Make a transverse cut from the last dorsal vertebra 
outward (same as 3, page 55). 
3. From the middle of the sacrum carry a curved in- 
cision outward over the crest of the ilium to join the simi- 
lar anterior one. 
Remove the integument from the lumbar, gluteal and 
posterior crural regions. 
To expose the hack of the thigh (and for that matter the 
leg) it will not be necessary to make median and trans- 
verse incisions. But reflect the integument from the outer 
to the inner side of the limb and from above downward as 
far as necessary, here to below the knee. Do not cut this 
large flap of skin away. 
Parts Exposed. 
Superficial fascia. 
Superficial nerves. 
Fascia lata. 
138. Superficial fascia and nerves,—The student need 
not delay to dissect out the superficial nerves, as they are 
not of enough consequence to repay the time and labor 
spent upon them. 
He may proceed at once to remove the superficial fascia, LOWER EXTREMITY, 
111 
which will be found distended and soaked with gravitated 
injection fluid. 
The same incisions used in removing the skin may bo 
followed and the fascia removed in layers, or it may bo 
scraped and cut away piecemeal, care being taken not to 
cut into the deep fascia beneath. 
139. Fascia lata.—By the removal of the superficial 
fascia you expose the posterior portion of the fascia lata. 
Learn its attachments above and below, and examine its 
reinforcement in the popliteal space by transverse fibres. 
Remove the fascia lata from the gluteus maxknus mus- 
cle, cutting in the direction of the fibres of the muscle. 
Expose the muscle entirely. 
Incise the fascia in the middle line from the gluteus 
maximus to below the knee and remove it from the deeper 
parts, noting the compartments for the muscles. Save 
the small sciatic nerve. 
Farts Exposed. 
Gluteus maximus. 
Small sciatic nerve. 
140. Gluteus maximus.—This large coarse muscle will 
be seen to have been inclosed between two layers of the 
fascia lata, one layer having been removed, the other lies 
between it and the gluteus medius muscle. 
141. Small sciatic nerve.—From under the lower edge 
of the gluteus maximus you will find the small sciatic 
nerve appearing to pass down the back of the thigh. 
Divide the gluteus maximus at its outer and middle 
thirds and reflect the two portions. 
The outer portion is to be carefully dissected to demon- 
strate the double insertion of the muscle and the bursa 
between it and the great trochanter, and the inner portion LOWER EXTREMITY. 
112 
to be lifted up and turned back on to the sacrum to show 
its extensive origin and the bursa which intervenes be- 
tween the muscle and the tuberosity of the ischium. 
Note the nerve and arterial supply, then divide them 
close to the muscle. 
Now remove entirely the inner portion of the muscle by 
cutting it away from its origins. 
Parts Exposed. 
Great sacro-sciatic ligament. 
Gluteus medius. 
Pyriform is. 
Gluteal artery, superficial branch. 
Great sciatic nerve. 
Small sciatic nerve. 
Sciatic artery. 
Great sacro-sciatic foramen. 
Gemellus superior. 
Obturator interims. 
Gemellus inferior. 
Small sacro-sciatic foramen. 
Pudic nerve. 
Pudic artery, 
Nerve to obturator internus. 
Quadratus femoris. 
Obturator externus. 
142. Great sacro-sciatic ligament.—The outer surface 
of this strong ligament is exposed by the removal of the 
gluteus maxknus. It is usually found pierced by the coccy- 
geal branch of the sciatic artery. 
143. Gluteus medius and pyriformis.—Remove the re- 
mains of the fascia lata covering the upper part of this LOWER EXTREMITY. 
113 
muscle, then clean the pyriformis and make out the latter 
muscle’s attachment to the margin of the great sacro-sciatic 
foramen. 
144. Gluteal artery.—Between the gluteus medius and 
pyriformis you will find the superficial branch of the 
gluteal artery. 
145. Great and small sacro-sciatic foramina and what 
they transmit.—Below the pyriformis you will see the 
great sciatic nerve, small sciatic nerve and sciatic artery 
issuing from the great sacro-sciatic foramen. Carefully 
clean out the foramen and close to the spine of the ischium 
you will discover the pudic nerve, pudic artery and the 
nerve to the obturator internus, which also leave the pelvis 
by the great sacro-sciatic foramen, curve around the spine 
of the ischium, and re-enter the pelvis through the small 
sacro-sciatic foramen. 
Trace the sciatic nerves and artery downward to the 
thigh and find the branch the artery sends off to the great 
sciatic nerve. 
146. Obturator internus, gemelli.—Return now to the 
small sacro-sciatic foramen, where you will find the tendon 
of the obturator internus coming out. Above it is joined 
by the gemellus superior and below by the gemellus inferior. 
The method of insertion of the pyriformis and the above 
muscles will be understood by cutting their tendons apart 
up to the great trochanter, when it will be seen that the 
posterior muscles have the anterior insertion. 
147. Quadratus femoris, obturator externus —Clean the 
quadratus femoris. Draw it downward and the muscles 
above it upward, and in the interval look for the tendon of 
the obturator externus passing to its insertion into the 
digital fossa of the femur. 
Cut through the gluteus medius at its outer and middle LOWER EXTREMITY, 
114 
thirds. Reflect the two parts and make out the extent of 
origin and manner of insertion of the muscle. 
Second Day. 
Parts Exposed. 
Gluteus minimus. 
Superior gluteal nerve. 
Gluteal artery, deep branch. 
148. Glutens minimus.—The glutens minimus lies the 
deepest of the gluteal muscles. Its tendon passes in front 
of that of the medins to the front of the great trochanter. 
The gluteal muscles are inserted into the great trochanter 
from before backward in order of size, beginning with the 
smallest, as minimus, medius and maximus. This may 
help the student to remember the order of their insertions. 
149. Superior gluteal nerve, gluteal artery.—The supe- 
rior gluteal nerve and deep branch of the gluteal artery 
will be found between the gluteus medius and minimus 
muscles. Trace them from their exit at the great sacro- 
sciatic foramen to their distribution. 
Clean the muscles of the thigh and the upper part of 
the popliteal space. 
Save the nerves and arteries. 
Parts Exposed. 
Biceps, 
Semitendinosus. 
Semimembranosus. 
Adductor magnus. 
Great sciatic nerve. 
Branches of internal circumflex and profunda arterjes, LOWER EXTREMITY. 
115 
150. Biceps, semitendinosus, semimembranosus, adduc- 
tor magnus.—These muscles are to be dissected out from 
origin to insertion and the following points about them 
noted. 
The two heads of the biceps and its fibular and tibial 
attachments. The common origin of the semitendinosus 
with the biceps and its insertion with the inner hamstring 
muscles (see § 108, p. 102, and § 114, p. 104). The origin 
of the semimembranosus above and to the outside of 
the above muscles—demonstrated by cutting their united 
tendons apart—its passage under the above muscles, inser- 
tion into the tibia and reflected tendon across the knee- 
joint (seen better when the popliteal space is finished). 
Save the nerve and vascular supply to these muscles and 
also to the adductor magnus, which is to be carefully 
cleaned. 
151. Great sciatic nerve. Save all the muscular 
branches of the great sciatic nerve and clean its two pop- 
liteal branches. 
152. Branches of internal circumflex and profunda 
arteries.—From above downward find the following arterial 
branches: Between the quadratus femoris and adductor 
magnus, the terminal branches of the internal circumflex 
(see “crucial anastomosis” in Gray); coming through the 
adductor magnus close to its femoral attachment, the three 
perforating branches of the profunda and the termination 
of the profunda itself piercing the muscle Just above its 
femoral opening. 
Third Day. 
Remove the integument from the back of the leg, follow- 
ing the general directions on page 110 for exposing the 
thigh. 
When the heel is reached, cut the skin flap away entirely. LOWER EXTREMITY. 
116 
Parts Exposed. 
External saphenous vein. 
External saphenous nerve. 
Posterior branches of internal saphenous nerve. 
Deep fascia. 
153. External saphenous vein and nerve.—The external 
saphenous vein and nerve accompany each other from 
the middle of the leg around below the external malleolus. 
Eorward of this point they have been already dissected 
(see § 128, p. 107). At the middle of the leg the nerve 
leaves the vein, going beneath (in reality coming out 
through) the deep fascia, while the vein passes up to the 
lower part of the popliteal space before it disappears. 
154. Deep fascia.—Examine the deep fascia of the leg. 
Notice the additions it receives from the tendons of the 
hamstring muscles and how it is reinforced in the popliteal 
space by transverse fibres (see § 139, p. 111). 
After cutting through the fascia in the middle line re- 
move it together with the external saphenous vein, but 
leave the nerve behind. 
Clean out the popliteal space. 
Parts Exposed. 
External popliteal nerve. 
Internal popliteal nerve. 
External saplienous nerve. 
Popliteal vein. 
Popliteal artery and upper branches. 
Gastrocnemius. 
Plan tails. 
Popliteal space, boundaries, LOWER EXTREMITY. 
117 
155. Popliteal and external saphenous nerves.—Trace 
the external popliteal nerve, which lies just below the ten- 
don of the biceps, to the outside of the leg where it divides 
into its two terminal branches. 
Save the branch which goes to help form the external 
saphenous nerve. Follow the internal popliteal nerve 
through the centre of the popliteal space and trace its 
muscular branches and the external saphenous nerve. 
156. Popliteal vein and artery.—Beneath the internal 
popliteal nerve you encounter the popliteal vein a little to 
the inside of the former, and a little deeper and to the inner 
side of the vein you find the artery. Clean carefully the 
vein and artery and save the branches of the latter. 
157. Gastrocnemius and plantaris.—The gastrocnemius 
and plantaris should be thoroughly cleaned at their origin 
and their nerve supply saved, and the former muscle exam- 
ined to see what part it takes in the formation of the 
tendo Achillis. 
158. Popliteal space.—"Now study the popliteal space; 
learn its boundaries and examine the relation its contents 
(nerve, vein and artery) bear to each other. Clean the 
floor of the space and from above downward see that it is 
formed by the lower end of femur, posterior ligament of 
knee-joint, upper end of tibia and popliteus muscle. These 
can be more clearly demonstrated after the superficial mus- 
cles are removed. 
Divide the two branches that go to form the external 
saphenous nerve, and the inner and outer head of the gas- 
trocnemius just above their junction. 
Turn the lower part of the muscle downward and sep- 
arate the upper heads, saving their nerve supply. Eemove 
the connective tissue from the muscles presenting. 118 
LOWER EXTREMITY, 
Plantaris. 
Popliteus, 
Soleus. 
Parts Exposed. 
159. Plantaris, popliteus, soleus.—Demonstrate these 
muscles and their nerve supply. 
The nerve to the popliteus curves around its lower bor- 
der and is distributed to its anterior surface. 
The long tendon of the plantaris muscle is distinct from 
the tendo Achillis, though it follows it closely along its 
inner side. 
Divide the tendon of the plantaris and tendo Achillis 
near their insertion and cut the soleus away from its tibial 
origin. 
Turn the muscles outward. Clean the deep layer of 
muscles, and the vessels and nerves. 
Parts Exposed. 
Posterior tibial nerve. 
Popliteal artery and lower branches. 
Anterior tibial artery. 
Posterior tibial artery. 
Peroneal artery. 
Flexor longns digitorum. 
Flexor longns pollicis. 
Tibialis posticus. 
Eolations at the ankle. 
160. Posterior tibial nerve.—The floor of the lower part 
of the popliteal space can now be plainly seen. Note the 
arbitrary point selected for changing the name of internal 
popliteal to posterior tibial nerve. 
161. Popliteal artery and branches.—Complete the dis- LOWER EXTREMITY. 
119 
section of the lower part of the popliteal artery, its \ower 
articular branches and bifurcation. 
163. Anterior, posterior tibial and peroneal arteries. 
—See how the anterior tibial artery passes forward over 
the interosseus membrane. Follow the posterior tibial 
artery (and nerve, noting their relations) to the inner side 
of the ankle. Trace the peroneal artery along the outer 
side of the leg and heel. Find its anterior peroneal 
branch. 
163. Deep posterior muscles of leg.—Complete the dis- 
section of the flexor longus digitorum, tibialis posticus and 
flexor longus pollicis muscles. Between the first and sec- 
ond lie the posterior tibial artery and nerve, and between 
the second and third the peroneal artery. 
164. Relations at the ankle.—Study the relations at 
the inner side of the ankle behind the internal malleolus. 
Take the posterior tibial artery as the central structure 
and you find two others in front of it, the tendons of the 
flexor longus digitorum and tibialis posticus; and two be- 
hind it, the posterior tibial nerve and tendon of the flexor 
longus pollicis. 
Fourth Day. 
No incision through or around the sole is necessary. 
Working from the heel forward, dissect the skin off in 
one piece to the sides of the sole and toes (where its re- 
moval was stopped when on the dorsum of the foot). 
Cut away the entire flap. 
The superficial fascia will be found as a thick pad of 
fatty and connective tissue covering the sole. 
It is to be entirely removed so as to thoroughly expose 
the deep fascia. For this purpose the curved scissors will be 
found the most useful. LOWER EXTREMITY, 
120 
Be careful not to cut away the digital nerves which lie 
imbedded in the fat between the processes of the plantar 
fascia. 
Parts Exposed. 
Plantar fascia. 
Digital nerves. 
165. Plantar fascia.—Learn this fascia as given in the 
text-book. It is a most important structure surgically 
considered. Examine its outer and inner portions and 
especially the thick central one and its digitations. 
166. Digital nerves.—Between the fasciculi of the cen- 
tral portion of the plantar fascia you will find the digital 
branches of the plantar nerves, and their branches to the 
toes. 
Remove the plantar fascia by cutting away altogether 
the thin outer and inner portions. Incise the central part 
transversely across about three inches from the heel, raise 
the anterior portion from the muscle beneath and carefully 
dissect it forward, dividing the strong intermuscular sep- 
tum on each side of the muscle, until the insertions of the 
fasciculi are reached. Stop here to examine how the flexor 
tendons pass through the divided fasciculi while the digital 
nerves, vessels, and lumbrical muscles lie between the fas- 
ciculi themselves, then remove the fascia entirely. Leave 
the posterior portion attached to the muscle. 
Parts Exposed. 
Flexor brevis digitorum. 
Abductor pollicis. 
Abductor minimi digiti. 
Internal plantar nerve. 
Internal plantar artery. LOWER EXTREMITY. 
121 
167. First layer of plantar muscles.—The flexor brevis 
digitorum, abductor pollicis and abductor minimi digiti 
constitute the first layer of the plantar muscles. They 
should be cleaned and carefully separated and their origin 
and insertion examined. 
168. Internal plantar nerve and artery.—The internal 
plantar nerve appears from between the abductor pollicis 
and flexor brevis digitorum muscles and passes forward to 
supply the three and one-half inner toes. 
The artery of the same name, usually very small, appears 
at the same point in the sole with the nerve, but passes 
forward along the inner side of the foot. 
If the artery is not found at this stage, it can be after 
the abductor pollicis is divided. 
Fifth Day. 
Section the internal plantar nerve where it appears in 
the sole. Divide the abductor muscles about one inch in 
front of their origin, and the flexor brevis digitorum trans- 
versely across at its middle. 
Reflect the parts. 
Parts Exposed. 
Internal plantar nerve and artery. 
External plantar nerve and artery. 
Posterior tibial nerve and artery. 
Flexor longus pollicis tendon. 
Flexor longus digitorum tendons. 
Flexor accessorius. 
Lumbricales. 
169. Plantar nerves and arteries,—Follow the internal 
plantar nerve and artery to their origin from the posterior LOWER EXTREMITY. 
122 
tibial nerve and artery respectively. From this point of 
bifurcation trace forward the external plantar nerve (and 
its digital branches to the one and one-half outer toes) and 
artery until they pass under the lumbricales and tendons 
of the long flexor muscle. 
170. Second layer of plantar muscles.—The tendons of 
the flexor longus pollicis and digitorum are to be cleaned. 
Notice the slip connecting the two tendons. Also clean 
the accessorius and lumbricales, examining their origin 
and insertion. 
Divide the tendon of the flexor longus digitorum just in 
front of the accessorius and reflect it with the lumbricales 
forward. 
Clean all the remaining muscles and tendons. 
Parts Exposed. 
Flexor brevis pollicis. 
Adductor pollicis. 
Flexor brevis minimi digiti. 
Transversus pedis. 
Interossei. 
Tendons of tibialis posticus, tibialis anticus and pero- 
neus longus. 
Plantar arch. 
171. Completion of foot.—The above parts are to be 
exposed one after the other. The first four muscles consti- 
tute the third layer of plantar muscles, while the interossei 
alone form the fourth. 
The last muscles are to be studied with reference to their 
action. 
The tendons of the three leg muscles should be traced to LOWER EXTREMITY. 
123 
their insertion and their action demonstrated by drawing 
upon the tendons separately. 
Follow the external plantar artery to its anastomosis with 
the communicating branch of the dorsalis pedis. This 
will show you the formation of the plantar arch. 
After the completion of the foot the student should 
proceed to cut away all the soft parts and dissect the ankle, 
knee, and hip joints. 
Should the parts about the joints become dry and hard, 
they can be softened up by wrapping cloths about them 
and keeping them wet for a day or two. 
Usually the hip is in condition to begin work upon it at 
once. 
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and A. D. Rockwell, M.D Third Edition. 282 pages, $2.75. 
19. 20, 21. INTERNATIONAL MEDICAL ANNUAL- (1889-00-91.) A 
Dictionary of Medical and Surgical Progress of the past year. Edited by P. W. Will- 
iams, M.D,, Secretary of Staff: Assisted by a corps of Thirty-seven Collaborators, European 
and American—Specialists in their several departments. 600 octavo pages. Illustrated. Each,