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Atlas Table of Contents

Osteology
The Skeleton of the Trunk
The Skull and the Skull Bones
The Appendicular Skeleton
Bone Structure
Röntgen Pictures of the Human Skeleton
Syndesmology
Joints and Ligaments of the Trunk and Head
Joints and Ligaments of the Upper Extremity
Joints and Ligaments of the Lower Extremity
Myology
Muscles of the Back
Muscles of the Thorax and Abdomen, including the Diaphragm and Iliopsoas
Muscles of the Neck
Muscles of the Head
Muscles and Fasciae of the Upper Extremity
Muscles and Fasciae of the Lower Extremity
Regions of the Body
Splanchnology
Digestive Organs
Peritoneum and situs viscerum
Respiratory Organs (including pleura)
Urogenital Organs, apparatus urogenitalis
Excretory Organs (including Suprarenal glands)
The Male Genitalia
The Female Genitalia
Perineum
Angiology and Neurology
The Circulation of the Blood
The Heart
The Fetal Circulation
Vessels of the Heart
Nerves and Vessels of the Neck, Axilla, Back and Thoracic Wall
Nerves and Vessels of the Upper Extremity
Nerves and Vessels of the Head and the Viscera of the Head and Neck
Vessels of the Abdominal Viscera
Vessels and Nerves of the false and true Pelvis and of the Perineum
Nerves and Vessels of the Lower Extremity
The Sympathetic Nervous System
The Spinal Cord
Meninges and Vessels of the Brain
The Brain
Sense Organs
The Eye
The Ear
The Integument
Lymphatic System

Osteology.

The Skeleton of the Trunk.

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The Skull and the Skull Bones.

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The Appendicular Skeleton.

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Bone Structure.

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Röntgen Pictures of the Human Skeleton.

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Syndesmology.

Joints and Ligaments of the Trunk and Head.

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Joints and Ligaments of the Upper Extremity.

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Joints and Ligaments of the Lower Extremity.

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Myology.

Muscles of the Back.

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Muscles of the Thorax and Abdomen, including the Diaphragm and Iliopsoas.

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Muscles of the Neck.

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Muscles of the Head.

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Muscles and Fasciae of the Upper Extremity.

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Muscles and Fasciae of the Lower Extremity.

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Regions of the Body.

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Splanchnology.

Digestive Organs.

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Peritoneum and situs viscerum.

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Respiratory Organs (including pleura).

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Urogenital Organs, apparatus urogenitalis.

Excretory Organs (including Suprarenal glands).

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The Male Genitalia.

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The Female Genitalia.

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Perineum.

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Angiology and Neurology

The Circulation of the Blood.

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The Heart.

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The Fetal Circulation.

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Vessels of the Heart.

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Nerves and Vessels of the Neck, Axilla, Back and Thoracic Wall.

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Nerves and Vessels of the Upper Extremity.

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Nerves and Vessels of the Head and the Viscera of the Head and Neck.

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Vessels of the Abdominal Viscera.

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Vessels and Nerves of the false and true Pelvis and of the Perineum.

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Nerves and Vessels of the Lower Extremity.

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The Sympathetic Nervous System.

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The Spinal Cord.

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Meninges and Vessels of the Brain.

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The Brain.

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Sense Organs.

The Eye.

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The Ear.

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The Integument.

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Lymphatic System.

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Figure A1: Thoracic vertebra, seen from above.
Figure A2: Thoracic vertebra, seen from the side.
Figure A3: The cervical vertebrae seen from behind and from the right.
Figure A4: Cervical vertebra seen from in front.
Figure A5: The fifth cervical vertebra seen from above.
Figure A6: The seventh cervical vertebra (vertebra prominens) seen from above.
Figure A7: The axis (epistropheus) seen from in front.
Figure A8: The axis (epistropheus) seen from behind.
Figure A9: The atlas seen from above.
Figure A10: The atlas seen from below.
Figure A11: A thoracic vertebra seen from in front.
Figure A12: The sixth thoracic vertebra from the left side.
Figure A13: The tenth thoracic vertebra from above.
Figure A14: The twelfth thoracic vertebra from the left side.
Figure A15: The three lower thoracic and the two upper lumbar vertebrae seen from the left side.
Figure A16: A lumbar vertebra seen from in front.
Figure A17: A lumbar vertebra seen from above.
Figure A18: The sacrum from behind (facies dorsalis).
Figure A19: The sacrum from in front (facies pelvina).
Figure A20: The sacrum from above (base).
Figure A21: Horizontal section through the sacrum at the level of the second foramina.
Figure A22: Median longitudinal section of a young sacrum showing the synchondroses between the individual vertebrae.
Figure A23: Sacrum and coccyx from the right side.
Figure A24: Coccyx composed of five vertebrae, from in front.
Figure A25: Coccyx composed of four vertebrae, from behind.
Figure A26: The vertebral column from in front.
Figure A27: The vertebral column from behind.
Figure A28: The vertebral column from the left side.
Figure A29: The right first rib, from above and lateral.
Figure A30: The right second rib, from above and lateral.
Figure A31: The posterior end of the left seventh rib, from behind and somewhat from below.
Figure A32: The left seventh rib, from behind.
Figure A33: The left seventh rib, from within (medial).
Figure A34: The eleventh rib of the left side, seen from behind.
Figure A35: The twelfth rib of the left side, from behind.
Figure A36: The sternum from in front.
Figure A37: The sternum from the left side.
Figure A38: Thorax (in the inspiration position) with the left shoulder girdle, from behind.
Figure A39: Thorax (in the inspiration position) with the left shoulder girdle, from in front.
Figure A40: The axial skeleton divided in the median line, with the shoulder and pelvic girdles, from the left side.
Figure A41: The axial skeleton divided in the median line, with the shoulder and pelvic girdles, seen from the median line.
Figure A42: The skull from in front.
Figure A43: The skull from in front.
Figure A44: The skull from the left side.
Figure A45: The skull from the left side.
Figure A46: The skull from below (basis cranii).
Figure A47: The skull from below (basis cranii).
Figure A48: The base of the skull from within.
Figure A49: The base of the skull from within.
Figure A50: Inner surface of the base of the skull.
Figure A51: The skull seen from above.
Figure A52: The skull cap (calvarium), cerebral surface.
Figure A53: The occipital bone from behind, from without.
Figure A54: The occipital bone from in front, from within.
Figure A55: The occipital bone from below.
Figure A56: The occipital and sphenoid bones seen from above.
Figure A57: The sphenoid bone from in front.
Figure A58: The sphenoid from behind.
Figure A59: A view of the sphenoid from in front.
Figure A60: The right temporal bone, lateral surface.
Figure A61: The right temporal bone, cerebral surfaces.
Figure A62: The right temporal bone seen from the cerebral surface and from the apex of the pyramid.
Figure A63: The right temporal bone from below.
Figure A64: The right temporal bone of a new born child.
Figure A65: The left temporal bone of a four year old child.
Figure A66: Schematic transverse section of the temporal bone at the middle of its length.
Figure A67: Schematic transverse section of the temporal bone near the apex of the pyramid.
Figure A68: The left temporal bone divided along the axis of the pyramid.
Figure A69: The right temporal bone divided in the direction of the external auditory meatus and almost parallel to the axis of the pyramid.
Figure A70: The right temporal bone divided so as to show the tympanic cavity.
Figure A71: The outer surface of the right parietal bone.
Figure A72: The inner surface of the right parietal bone.
Figure A73: The frontal bone from in front.
Figure A74: The frontal bone from behind.
Figure A75: The frontal bone from below.
Figure A76: The ethmoid bone from above.
Figure A77: The ethmoid bone from the side.
Figure A78: The ethmoid bone with attached sphenoidal conchae from above and somewhat from behind.
Figure A79: The vomer from behind.
Figure A80: The vomer from the side.
Figure A81: The frontal bone with the greater part of the ethmoid and nasal bones, from below.
Figure A82: The bony nasal septum from the left side.
Figure A83: The right maxilla from its medial surface.
Figure A84: The right maxilla from its lateral surface.
Figure A85: The left lacrimal bone, outer surface.
Figure A86: The lower portion of the facial skeleton from above.
Figure A87: The right maxilla and palatine bone from within.
Figure A88: The right maxilla, palatine bone and inferior concha, with a portion of the ethmoid, seen from within.
Figure A89: The inferior concha, lateral surface.
Figure A90: The right palatine bone, lateral surface.
Figure A91: The right palatine bone, medial surface.
Figure A92: The right palatine bone, from behind.
Figure A93: The left nasal bone from in front.
Figure A94: The left nasal bone from behind.
Figure A95: The right zygomatic bone, facial surface.
Figure A96: The right zygomatic bone, temporal surface.
Figure A97: The mandible from in front.
Figure A98: The mandible from the left side.
Figure A99: The mandible from below.
Figure A100: The mandible divided in half, from within.
Figure A101: The toothless mandible of an aged woman.
Figure A102: The orbit from in front.
Figure A103: The medial wall of the orbit and pterygopalatine fossa.
Figure A104: The lateral wall of the orbit, the maxillary sinus and the pterygo-palatine fossa.
Figure A105: Frontal section through the anterior part of the skull, showing the orbit, nasal cavities, maxillary sinus and ethmoidal labyrinth.
Figure A106: Lower wall of the left orbit from above.
Figure A107: The maxilla with the palatine bone and lower ends of the pterygoid processes of the sphenoid from below.
Figure A108: The right lateral wall of the nasal cavity (after removal of the septum nasi).
Figure A109: The same as Fig. A108, except that the middle concha has been cut away; the upper concha was not sharply separated from it.
Figure A110: The left pterygo-palatine fossa from the side, exposed by removing the zygomatic bone.
Figure A111: The skull of a new-born child from the side.
Figure A112: The skull of a new-born child from behind and below.
Figure A113: The skull of a new-born child from above.
Figure A114: The hyoid bone from the side.
Figure A115: The hyoid bone from above.
Figure A116: The dorsal surface of the left scapula.
Figure A117: The costal surface of the left scapula.
Figure A118: Dorsal surface of the left scapula.
Figure A119: The left scapula seen from the lateral angle and axillary border.
Figure A120: The left clavicle from below.
Figure A121: The left clavicle from above.
Figure A122: The left humerus from behind.
Figure A123: The left humerus from in front.
Figure A124: The head of the humerus from above.
Figure A125: The lower end of the humerus from below.
Figure A126: Transverse section, at about the middle of their length, of the bones of the left forearm (schematic).
Figure A127: The left ulna from the lateral surface.
Figure A128: The left ulna from the medial surface.
Figure A129: The left ulna from in front.
Figure A130: The left radius from in front.
Figure A131: The left radius, medial surface.
Figure A132: The left radius from behind.
Figure A133: The upper ends of the radius and ulna from above and somewhat from in front.
Figure A134: The lower ends of the radius and ulna from below.
Figure A135: The lower end of the radius and the ulna, the carpal and metacarpal bones in the natural relations. View of the dorsal surface.
Figure A136: The lower end of the radius and the ulna, the carpal and metacarpal bones in the natural relations. View of the volar surface.
Figure A137: The bones of the left hand separated from one another, dorsal surface.
Figure A138: The bones of the left hand separated from one another, volar surface.
Figure A139: The skeleton of the entire hand with the lower ends of the forearm bones, dorsal surface.
Figure A140: The skeleton of the entire hand with the lower ends of the forearm bones, volar surface.
Figure A141: The right innominate bone, lateral surface.
Figure A142: The right innominate bone, medial surface.
Figure A143: The right innominate bone from in front.
Figure A144: The innominate bone of a 5-6 year old child, medial surface.
Figure A145: The innominate bone of a 5-6 year old child, lateral surface.
Figure A146: The right femur from behind.
Figure A147: The right femur, medial surface.
Figure A148: The right femur from in front.
Figure A149: Upper extremity of the femur from behind.
Figure A150: Lower extremity of the femur from below.
Figure A151: The patella from in front.
Figure A152: The patella from behind.
Figure A153: The right tibia from in front.
Figure A154: The right tibia from behind.
Figure A155: The right tibia from the side.
Figure A156: The bones of the left lower leg cut across about the middle of their length (Schematized).
Figure A157: The right fibula , medial surface.
Figure A158: The right fibula, lateral surface.
Figure A159: The tibia and fibula from behind.
Figure A160: The upper ends of the tibia and fibula from above.
Figure A161: The lower ends of the tibia and fibula from below.
Figure A162: The bones of the foot, plantar surface.
Figure A163: The bones of the foot, dorsal surface.
Figure A164: The bones of the foot from the inner side.
Figure A165: The right talus from below.
Figure A166: The right talus from above.
Figure A167: The right calcaneus, medial surface.
Figure A168: The right calcaneus, lateral surface.
Figure A169: The right calcaneus from above.
Figure A170: The right navicular from behind.
Figure A171: The right navicular from in front.
Figure A172: The right cuboid, medial surface.
Figure A173: The right internal cuneiform from in front.
Figure A174: The right middle cuneiform from behind.
Figure A175: The right external cuneiform from behind.
Figure A176: Section through a flat bone of the skull at right angles to the surface.
Figure A177: Frontal section through the upper end of the femur.
Figure A178: Sagittal longitudinal section of the calcaneus.
Figure A179: Frontal longitudinal section through the upper end of the humerus.
Figure A180: Sagittal longitudinal section through the upper end of the tibia.
Figure A181: Sagittal section through a lumbar vertebra.
Figure A182: Ventro-dorsal view of the left elbow joint of an adult woman.
Figure A183: Ventro-dorsal view of the left elbow joint of a young individual. (Youth of 15.5 years.)
Figure A184: The bones of the left wrist region of a young individual (youth of 15.5 years) seen from the volar surface.
Figure A185: Dorso-volar view of the left hand of a child (5.5 years).
Figure A186: Dorso-volar view of the left hand of a young individual. (Youth of 15.5 years.)
Figure A187: Dorso-ventral view of the skeleton of the left hand of an adult man (28 years).
Figure A188: Ventro-dorsal view of both knee joints of a child of three years.
Figure A189: Fibulo-tibial view of the right lower leg of a child of 10 months.
Figure A190: Dorso-plantar view of the left foot of a child of 5.5 years.
Figure A191: Horizontal section of a fibrocartilaginous disk.
Figure A192: The ligaments of the lower part of the thoracic portion of the vertebral column with the posterior ends of the ribs, from in front.
Figure A193: The posterior longitudinal ligament in the lower part of the thoracic and the upper part of the lumbar portion of the vertebral column.
Figure A194: Two thoracic vertebrae with their ligaments, divided in the median plane.
Figure A195: Section through the bodies of the vertebrae, the costo-vertebral articulations and the posterior ends of the ribs.
Figure A196: The ligamenta flava between the arches of the thoracic vertebrae, seen from within.
Figure A197: The posterior longitudinal ligament and intervertebral fibrocartilages of the lumbar vertebrae.
Figure A198: Horizontal section through a thoracic vertebra, showing its costal articulations.
Figure A199: The ligaments of the middle and lower thoracic vertebrae and ribs from behind.
Figure A200: The ligaments of the middle and lower thoracic vertebrae and ribs from the left side.
Figure A201: The sternum and costal cartilages divided in the frontal plane.
Figure A202: A portion of the occipital bone, the atlas and axis (epistropheus) and their ligaments, from behind.
Figure A203: A portion of the occipital bone and the upper three vertebrae, from in front.
Figure A204: Median longitudinal section through the atlanto-axial articulation, somewhat schematized.
Figure A205: The cruciate ligament after removal of the tectorial membrane.
Figure A206: The alar ligaments after removing the cruciate ligament. The preparation otherwise the same as in Fig. A205.
Figure A207: The articulation of the dens of the axis (epistropheus) with the atlas.
Figure A208: The tectorial membrane from behind.
Figure A209: The right mandibular articulation, lateral side.
Figure A210: The right mandibular articulation, medial side.
Figure A211: The tight mandibular articulation opened by a sagittal section.
Figure A212: The two sterno-clavicular joints and the union of the cartilage of the upper rib with the sternum, from in front.
Figure A213: The left shoulder and acromio-clavicular joints from in front and medial.
Figure A214: The left shoulder joint with stumps of the Supraspinatus, Infraspinatus, Teres minor and long head of the Triceps, from behind.
Figure A215: The left shoulder joint with stumps of the same muscles, from behind and above. The acromion has been cut away.
Figure A216: The socket of the left shoulder joint after cutting through the capsule and the tendon of the biceps.
Figure A217: Frontal longitudinal section of the left shoulder joint and the intertubercular sheath, parallel with the tendon of the biceps.
Figure A218: Left elbow joint from in front.
Figure A219: Left elbow joint from the dorsal and radial side.
Figure A220: The two bones of the left forearm with the interosseous membrane; the elbow joint opened; the anular ligament is divided.
Figure A221: Sagittal section of the left elbow joint through the humero-ulnar articulation.
Figure A222: Section through the wrist joint, parallel to the dorsal surface of the hand.
Figure A223: The joints and ligaments of the hand, dorsal surface.
Figure A224: The joints and ligaments of the hand, volar surface.
Figure A225: The joints of the middle finger, from the side.
Figure A226: A female pelvis with its ligaments, from behind.
Figure A227: A female pelvis with its ligaments, from below.
Figure A228: A male pelvis with its ligaments, from in front.
Figure A229: A female pelvis with its ligaments, from in front.
Figure A230: A male pelvis with its ligaments, from above.
Figure A231: A female pelvis with its ligaments, from above.
Figure A232: The right hip joint from in front.
Figure A233: The right hip joint from behind.
Figure A234: The socket of the right hip joint after cutting through the capsule and the ligamentum teres.
Figure A235: A section through the pelvis and both hip joints, almost perpendicular to the axis of the pelvis.
Figure A236: The right hip joint opened by cutting through the anterior wall of the capsule to show the ligamentum teres.
Figure A237: The right knee joint in the extended condition, from in front.
Figure A238: The right knee joint in the extended condition, from behind.
Figure A239: The right knee joint opened by two lateral incisions.
Figure A240: The right knee joint in the flexed position, after removing the capsule and the collateral ligaments.
Figure A241: The condyles of the tibia with the two menisci and the origins of the cruciate ligaments.
Figure A242: Sagittal section of the right knee joint in the region of the lateral condyle.
Figure A243: The bones of the right lower leg with their connections, from in front.
Figure A244: The ankle joint from behind.
Figure A245: Horizontal section through the tarsal joints.
Figure A246: Frontal section through the ankle and talo-calcaneal joints.
Figure A247: The tarsal ligaments, medial surface.
Figure A248: The tarsal ligaments, dorsal and lateral surfaces.
Figure A249: The ligaments of the dorsal surface of the foot after cutting away the talus.
Figure A250: The superficial layer of the ligaments of the plantar surface of the foot.
Figure A251: The deep layer of the ligaments of the plantar surface of the foot.
Figure A252: The superficial layer of the muscles of the back with the neighboring muscles of the neck and abdomen, from behind.
Figure A253: Deeper layer of the flat muscles of the back.
Figure A254: Superficial layer of the long muscles of the back.
Figure A255: Transverse section of the back and posterior abdominal wall in the lumbar region, to show the lumbo-dorsal fascia (schematic).
Figure A256: The deeper layer of the long muscles of the back.
Figure A257: The middle and deep layers of the muscles of the back and the neck, from behind.
Figure A258: The middle and deep layers of the muscles of the back and the neck, from the left side.
Figure A259: The deep layer of the muscles of the back, upper half.
Figure A260: The deep layer of the muscles of the back, lower half.
Figure A261: The superficial layer of the pectoral and abdominal muscles, from in front and from the right.
Figure A262: Diagram of the superficial inguinal ring; only on the right is the share of the aponeurosis of the External oblique in its formation fully shown.
Figure A263: The deeper layer of the pectoral muscles.
Figure A264: Superficial layer of the abdominal muscles, lower portion, with the inguinal ring.
Figure A265: The second layer of the abdominal muscles from in front and from the right.
Figure A266: Transverse sections of the anterior abdominal wall, above the umbilicus and between the umbilicus and the symphysis (schematic).
Figure A267: The deep layer of the abdominal muscles.
Figure A268: The deep layer of the trunk muscles seen from the left side.
Figure A269: The Quadratus lumborum from behind and somewhat from the side (schematic).
Figure A270: The muscles of the posterior abdominal wall and the Diaphragm, from the right and in front.
Plate A1, figure 1: The sternum and the sternal ends of the clavicles and the ribs, with the associated muscles from behind.
Plate A1, figure 2: The fifth to the twelfth thoracic vertebrae and the vertebral ends of the corresponding ribs, with their muscles, from in front.
Figure A271: The cervical and pectoral portions of the right Platysma.
Figure A272: The superficial muscles of the neck and the deeper muscles of the face, from the right side.
Figure A273: Anterior view of the neck muscles.
Figure A274: The Mylohyoid and Geniohyoid muscles seen from above.
Figure A275: The deep layers of the muscles of the neck, from the left side.
Figure A276: The deep muscles of the neck from in front.
Figure A277: Superficial and deeper layers of the muscles of the face, from in front.
Figure A278: The superficial muscles of the head from the right side.
Figure A279: Masseter, Bucinator and temporal fascia from the right side.
Figure A280: The Temporalis and Bucinator of the right side.
Figure A281: The right Pterygoids and Bucinator seen from the side.
Figure A282: The Pterygoids from their medial surface.
Figure A283: The muscles of the posterior surface of the left scapula and the adjacent part of the extensor surface of the upper arm.
Figure A284: The muscles of the anterior surface of the left scapula and the adjacent part of the flexor surface of the upper arm.
Figure A285: The Deltoid and the muscles of the upper arm from the side and behind.
Figure A286: The deeper layer of the muscles of the upper arm from the side and somewhat from behind.
Figure A287: The superficial layer of the muscles of the flexor surface of the upper arm.
Figure A288: The deep layer of muscles of the flexor surface of the upper arm.
Figure A289: The superficial layer of the flexor muscles of the forearm and the Brachioradialis from in front.
Figure A290: The same after division of the Palmaris longus and Flexor carpi radialis.
Figure A291: The middle layer of the muscles of the flexor surface of the forearm.
Figure A292: The deep layer of the muscles of the flexor surface of the forearm.
Figure A293: The superficial muscles of the extensor surface of the forearm, from behind.
Figure A294: The superficial muscles of the extensor surface of the forearm, from the radial side.
Figure A295: The muscles of the extensor surface of the forearm, from behind.
Figure A296: The deep layer of muscles of the extensor surface of the forearm, from behind and radially.
Figure A297: The palmar aponeurosis and the Palmaris brevis exposed by removing the skin from the volar surface of the hand.
Figure A298: Tendons and muscles (Interossei dorsales) of the back of the hand.
Figure A299: The palmar muscles after removal of the palmar aponeurosis.
Figure A300: The deep layer of the palmar muscles and the Pronator quadratus.
Figure A301: The deep palmar muscles.
Figure A302: The deep layer of the palmar muscles.
Figure A303: The tendons of the index finger, half schematic.
Figure A304: The tendon sheaths of the hand, half schematic.
Figure A305: The tendon sheaths in the dorsal region of the wrist joint (schematic)
Figure A306: Schema of the dorsal Interossei and the dorsal aponeuroses of the fingers.
Figure A307: Schema of the volar interossei.
Figure A308: Schema of the lumbrical muscles.
Plate A2, figure 1: Fascia of the left upper extremity from the volar surface.
Plate A2, figure 2: Fascia of the left upper extremity from the dorsal surface.
Figure A309: The origins of the three gluteal muscles from the ala of the ilium.
Figure A310: The superficial layer of the posterior rump muscles.
Figure A311: The middle layer of the posterior rump muscles.
Figure A312: The fossa ovalis of the fascia lata and the crural canal.
Figure A313: The muscles of the true pelvis and the medial side of the thigh.
Figure A314: The superficial layer of the muscles of the anterior surface of the thigh.
Figure A315: The muscles of the anterior surface of the thigh after removal of the Sartorius and the inguinal ligament.
Figure A316: The middle layer of muscles of the anterior surface of the thigh.
Figure A317: The deep layer of muscles of the anterior surface of the thigh.
Figure A318: The deep layer of the muscles of the rump and the superficial flexors of the thigh.
Figure A319: The deep layer of rump muscles and the deep flexors of the thigh.
Figure A320: The muscles in the region of the popliteal space, after the Semimembranosus, Semitendinosus and long head of the Biceps have been cut away.
Figure A321: The superficial muscles of the thigh from the outer side.
Figure A322: The superficial layer of muscles of the calf.
Figure A323: The second layer of the muscles of the calf.
Figure A324: The deep muscles of the calf.
Figure A325: The deepest layer of the calf muscles.
Figure A326: The muscles of the anterior surface of the lower leg and the dorsum of the foot.
Figure A327: The muscles of the lower leg and dorsum of the foot from the side.
Figure A328: The superficial muscles and tendons of the dorsum of the foot.
Figure A329: The deep layer of muscles and tendons of the dorsum of the foot.
Figure A330: The plantar aponeurosis.
Figure A331: The superficial plantar muscles.
Figure A332: The middle layer of plantar muscles.
Figure A333: The deep layer of the plantar muscles.
Figure A334: The tendon sheaths of the region of the lateral malleolus and dorsum of the foot.
Figure A335: The tendon sheaths in the neighborhood of the medial malleolus, of the sole and dorsum of the foot.
Figure A336: Schema of the plantar interossei.
Figure A337: Schema of the dorsal interossei.
Plate A3, figure 1: Fascia of the thigh from in front.
Plate A3, figure 2: Fascia of the thigh from behind.
Plate A4, figure 1: Fascia of the lower leg from behind.
Plate A4, figure 2: Fascia of the lower leg and the dorsal fascia of the foot from in front.
Figure A338: Regiones corporis humani.
Figure A339: Regiones corporis humani.
Figure A340: Regiones capitis et colli.
Figure A341: The male perineum.
Figure A342: The female perineum.
Figure B1: Schema of the relations of the intestines to the peritoneum (red).
Figure B2: Schema of the peritoneal cavity.
Figure B3: Schematic representation of the digestive and respiratory organs.
Figure B4: The region of the chin, mouth, and nose, from in front.
Figure B5: The labial glands from behind.
Figure B6: The mouth cavity from in front.
Figure B7: The floor of the mouth from above.
Figure B8: The mouth cavity and palate after dividing the cheeks.
Figure B9: The palate with the superior dental arch seen from below; the masticatory surfaces of the teeth are seen.
Figure B10: The inferior dental arch, from above. The masticatory surfaces of the teeth are seen.
Figure B11: Longitudinal section of a tooth in its alveolus (schematized).
Figure B12: The upper and lower teeth from the labial or buccal surfaces.
Figure B13: The upper and lower teeth from the lingual surfaces.
Figure B14: Diagram of a canine tooth from the labial side (enlarged).
Figure B15: The crown of the first upper molar, from in front, lingually and above (enlarged).
Figure B16: The upper and lower teeth from the side or behind (contact surfaces).
Figure B17: The complete milk dentition of a three-year old child, from the labial or buccal surface.
Figure B18: The lateral lower milk incisor, the lower milk canine and the two lower milk molars of a two-year old child.
Figure B19: The upper and lower teeth in the skull of a man of 28 years of age, in their normal occlusion position.
Figure B20: The dentition of an almost one-year old child.
Figure B21: The upper teeth of the milk dentition of a child of four years.
Figure B22: The lower teeth of a child of four years.
Figure B23: The skull of a child of five years with the milk dentition and the anlagen of the permanent teeth, from in front.
Figure B24: The skull of a child of five years with the milk dentition and the anlagen of the permanent teeth, from in front.
Figure B25: The skull of a child of five years with the milk dentition and the anlagen of the permanent teeth.
Figure B26: The milk dentition and anlagen of the permanent teeth in a child of nine years, from the left side.
Figure B27: The same preparation as Fig. B24, but from in front.
Figure B28: The upper and lower jaws of a person of twenty years, from the side.
Figure B29: The dates of eruption of the permanent teeth.
Figure B30: The dates of eruption of the milk teeth.
Figure B31: The sublingual region, the mouth being widely opened and the tip of the tongue raised.
Figure B32: The dorsal surface of the tongue as seen when the organ is removed from the mouth entire.
Figure B33: The superficial layer of the muscles of the tongue, from the right side.
Figure B34: The deeper layer of the muscles of the tongue from the right side.
Figure B35: The muscles of the tongue seen from below after separating the Genio-glossi from the mandible.
Figure B36: A median longitudinal section of the tongue.
Figure B37: Transverse section of the middle portion of the tongue.
Figure B38: Transverse section of the tip of the tongue.
Figure B39: Sagittal section through the lower part of the head and upper part of the neck.
Figure B40: The parotid gland.
Figure B41: The submaxillary gland and the submaxillary region.
Figure B42: The submaxillary and sublingual glands seen from the medial surface.
Figure B43: The submaxillary and sublingual glands in position in the submaxillary fossa and the submental region, after cutting the Mylohyoid.
Figure B44: The submaxillary and sublingual glands, greater and lesser, with the tongue, from below.
Figure B45: The pharynx with the constrictor muscles from behind.
Figure B46: The muscular wall of the pharynx from the right side.
Figure B47: The muscles of the soft palate and of the isthmus of the fauces from behind, the wall of the pharynx being divided posteriorly.
Figure B48: The cavity of the pharynx from behind, after cutting through the posterior wall in the median line.
Figure B49: The nasal portion of the pharynx, from behind, after cutting through its posterior wall in the median line.
Figure B50: The nasal portion of the pharynx, the palatine tonsil and the palatine arches.
Figure B51: The upper portion of the oesophagus with the aorta and its branches and the trachea, from the right side.
Figure B52: The lower portion of the oesophagus and the stomach with the aorta and a part of the Diaphragm.
Figure B53: The stomach with its peritoneal covering, from in front.
Figure B54: A portion of the mucous membrane of the stomach (dry preparation).
Figure B55: A portion of the mucous membrane of the small intestine (dry preparation).
Figure B56: The form and position of the stomach as shown during life by Röntgen rays (schematic).
Figure B57: Diagram of the longitudinal musculature of the stomach (after Forsell).
Figure B58: Diagram of the circular and oblique musculature of the stomach.
Figure B59: The superficial musculature of the stomach after removal of the peritoneum, from in front and somewhat from above.
Figure B60: The deeper layers of the musculature of the stomach, from in front.
Figure B61: The stomach and principal portion of the duodenum opened, from in front.
Figure B62: The coats of the wall of the upper portion of the duodenum, from the outer surface.
Figure B63: A portion of the jejunum, half of which is cut open along the line of attachment of the mesentery.
Figure B64: A portion of the ileum prepared as in Fig. B63.
Figure B65: A portion of the lower ileum opened along its entire length by a cut along the line of insertion of the mesentery.
Figure B66: The caecum with the lower part of the ileum and the appendix vermiformis, from behind.
Figure B67: The transverse colon cut across.
Figure B68: A portion of the transverse colon from in front and below. The right end is opened up.
Figure B69: The caecum with the lower part of the ileum and the vermiform appendix, in the distended condition and opened from the side.
Figure B70: The caecum and lower part of the ileum cut by a frontal section.
Figure B71: The rectum from in front.
Figure B72: The rectum cut open longitudinally.
Figure B73: The mucous membrane of the large intestine.
Figure B74: The liver with part of the Diaphragm from in front.
Figure B75: The liver from above and behind (posterior surface).
Figure B76: The liver from below (inferior surface).
Figure B77: The porta with its vessels and lymphatic nodes (lymphoglandulae).
Figure B78: The liver from below.
Figure B79: A sagittal section of the right lobe of the liver.
Figure B80: A frontal section of the hepato-duodenal ligament.
Figure B81: The gall bladder, cystic duct and the adjacent portions of the other bile ducts, opened longitudinally.
Figure B82: The spleen from the hilar surface.
Figure B83: The spleen from the diaphragmatic surface.
Figure B84: A section through the spleen perpendicular to its axis.
Figure B85: The medial surface of the spleen.
Figure B86: The duodenum, pancreas, spleen, kidneys, suprarenal bodies, gall bladder (with a piece of the liver), aorta and inferior vena cava in their relative positions.
Figure B87: The duodenum, pancreas, spleen, kidneys, suprarenal bodies, gall bladder (with a piece of the liver), aorta and inferior vena cava in their relative positions.
Figure B88: The pancreas and the greater part of the duodenum, from in front.
Figure B89: The head of the pancreas and the duodenum with the common bile duct, the portal vein and splenic (lienal) artery, from behind.
Figure B90: Sagittal section through the body of the pancreas, with the splenic (lienal) vessels.
Figure B91: The Caecum with the peritoneal folds and recesses in its neighborhood.
Figure B92: The Descending and Sigmoid Colons with the peritoneal folds and recesses in their neighborhood.
Figure B93: The abdominal contents as seen on opening the cavity from in front. The great Omentum.
Figure B94: The abdominal contents from in front after opening the cavity and reflecting the great omentum.
Figure B95: The first stage in the development of the intestine and the peritoneum. From the side (schematic).
Figure B96: The second stage in the development of the intestines and the peritoneum. From in front (schematic).
Figure B97: The third stage in the development of the intestines and peritoneum. From in front (schematic).
Figure B98: The abdominal organs from in front after reflecting the great omentum and displacing the coils of the small intestine to the right.
Figure B99: The peritoneal relations of the large intestine.
Figure B100: The upper portion of the abdominal cavity with the stomach, liver, spleen and lesser omentum.
Figure B101: The epiploic foramen and bursa omentalis.
Figure B102: The vestibule of the bursa omentalis.
Figure B103: The bursa omentalis.
Figure B104: Diagram of the relations of the peritoneum in a transverse section at the level of the bursa omentalis.
Figure B105: Diagram of the relations of the peritoneum in a median section of a male.
Figure B106: Diagram of the relations of the peritoneum in the upper portion of the peritoneal cavity.
Figure B107: Diagram of the formation of the great omentum in the embryo.
Figure B108: The arrangement of the peritoneum in the female pelvis.
Figure B109: Position of the viscera on the posterior abdominal wall of a child of 8 years.
Figure B110: The so-called retroperitoneal organs of a very thin female body.
Figure B111: The anterior abdominal wall of a newborn child, with the bladder, seminal vesicles, deferential ducts, etc. Seen from behind.
Figure B112: The skeleton of the nose, from the right and somewhat in front.
Figure B113: The skeleton of the nose, from in front.
Figure B114: The skeleton of the nose, from below.
Figure B115: The nasal septum, from the right side. Over its anterior half the mucous membrane is removed.
Figure B116: The medial wall of the nasal cavity (nasal septum) with its mucous membrane, from the right side.
Figure B117: The lateral wall of the nasal cavity, from the left.
Figure B118: The lateral wall of the nasal cavity from the left. The inferior and middle conchae are cut away near their bases.
Figure B119: Frontal section through the head of a young man who had been executed.
Figure B120: Horizontal section through the upper part of the nasal and accessory nasal cavities.
Figure B121: The thyreoid cartilage, from in front.
Figure B122: The thyreoid cartilage from the left side.
Figure B123: The cricoid cartilage from behind.
Figure B124: The cricoid cartilage from the side.
Figure B125: The right arytaenoid cartilage (with the corniculate cartilage) from in front and from the lateral surface.
Figure B126: The right arytaenoid cartilage from the medial surface and in front.
Figure B127: The right arytaenoid cartilage from the lateral surface.
Figure B128: The cartilage of the epiglottis from behind.
Figure B129: The joints and ligaments of the larynx from in front.
Figure B130: The joints and ligaments of the larynx from behind.
Figure B131: The muscles of the posterior surface of the larynx.
Figure B132: The crico-thyreoid muscle from the left side and somewhat from in front.
Figure B133: The muscles of the larynx from the left side.
Figure B134: The larynx opened from behind in the median line.
Figure B135: A frontal section of the larynx.
Figure B136: A sagittal section of the larynx.
Figure B137: The entrance to the larynx from behind and above.
Figure B138: A transverse section through the larynx and thyreoid gland at the level of the glottis.
Figure B139: The hyoid bone, the larynx, the trachea and its principal branches, from in front.
Figure B140: The thyreoid gland, larynx, upper portion of the trachea and the hyoid bone from in front.
Figure B141: The thyreoid and parathyreoid glands with the lower portion of the pharynx and upper end of the oesophagus from behind.
Figure B142: The thyreoid gland in its relations to the trachea and larynx, from in front.
Figure B143: A horizontal section of the thyreoid gland, the trachea, and the oesophagus at the level of the second ring of the trachea.
Figure B144: The right lung, lateral (costal) surface.
Figure B145: The left lung, lateral surface.
Figure B146: The left lung, medial (mediastinal) surface.
Figure B147: The right lung, medial surface.
Figure B148: The two lungs with the trachea and the branching of the bronchi, exposed by removing portions of lung substance. From in front.
Figure B149: A section through a portion of a human lung.
Figure B150: Front view of the thymus gland of a girl of fourteen years, with the neighboring mediastinal structures and the pleurae.
Figure B151: The thymus of a two-year old child, from in front.
Figure B152: The thymus of a man of 24 years after removal of the surrounding fat.
Figure B153: The position of the thoracic organs of an eight-year old boy. From in front.
Figure B154: The position of the thoracic organs of an eight-year old boy. From in front.
Figure B155: The position of the thoracic organs of an eight-year old boy. From in front.
Figure B156: The position of the thoracic organs of an eight-year old boy. From in front.
Figure B157: Diagram of the relations of the pleurae and pericardium; frontal section (the anterior half of the section shown in Fig. B158).
Figure B158: Frontal section of the thoracic and abdominal regions (posterior half). From behind.
Figure B159: A transverse section of the thorax at the level of the fourth thoracic vertebra.
Figure B160: A transverse section of the thorax at the level of the nipples
Figure B161: Arrangement of the pleurae (red) and pericardium (blue) at the hilus of the lung (schematic).
Figure B162: Arrangement of the pleurae (red) and pericardium (blue) below the hilus of the lung (schematic).
Figure B163: Diagram of the arrangement of the pleurae (red), represented in a section similar to that of Fig. B164.
Figure B164: Horizontal section through the upper part of the thoracic cavity. The section passes through the fibrocartilage between the 4th and 5th thoracic vertebrae.
Figure B165: The left pleural cavity of a child.
Figure B166: The right pleural cavity of a child.
Figure B167: Schematic general view of the male urogenital apparatus, with reference to its development.
Figure B168: Schematic general view of the female urogenital apparatus, with reference to its development.
Figure B169: The left kidney from behind.
Figure B170: The right kidney from behind.
Figure B171: The right kidney from in front.
Figure B172: The left kidney from in front.
Figure B173: A frontal section through the kidney and its capsule.
Figure B174: The kidney of a child, distinctly lobed.
Figure B175: The kidney and suprarenal gland of an old fetus.
Figure B176: The renal sinus and pelvis exposed by a frontal section.
Figure B177: The right suprarenal gland from in front.
Figure B178: The left suprarenal gland from in front.
Figure B179: Transverse sections of the suprarenal gland.
Figure B180: Transverse sections of the suprarenal gland.
Figure B181: The bladder and prostate from in front.
Figure B182: A cast of the human renal pelvis.
Figure B183: The bladder with the seminal vesicles, the ampulla of the ductus deferens and prostate, from behind and below.
Figure B184: The bladder and prostate from behind.
Figure B185: A profile view of the male genitalia.
Figure B186: A profile view of the male genitalia.
Figure B187: A median section of the male pelvis with the genitalia.
Figure B188: A median section of the male pelvis with the genitalia.
Figure B189: The right testis, epididymis and adjacent portion of the spermatic cord, from in front.
Figure B190: The right testis, epididymis and the adjacent portion of the spermatic cord, from the outer side.
Figure B191: The testis, epididymis and beginning of the ductus deferens.
Figure B192: Longitudinal section of the testis and epididymis.
Figure B193: Transverse section of the scrotum and both testes.
Figure B194: The prostate with the seminal vesicles and the ampulla of the ductus deferens.
Figure B195: The prostate with the seminal vesicles, from above and in front.
Figure B196: The scrotum and spermatic cord from in front.
Figure B197: The erectile bodies of the penis.
Figure B198: The male urethra with the corpora cavernosa penis, the bulbo-urethral glands and the prostate.
Figure B199: The anterior end of the penis with the preputial sack.
Figure B200: Transverse section of the penis through the middle of the body.
Figure B201: Transverse section of the penis at the hinder end of the glans.
Figure B202: Transverse section of the penis through the middle of the glans.
Figure B203: Transverse section of the penis at its tip.
Figure B204: The female genitalia from above.
Figure B205: The female genitalia from above.
Figure B206: The female genitalia from the left side.
Figure B207: The female genitalia from the left side.
Figure B208: Median section of the female reproductive organs.
Figure B209: Median section of the female reproductive organs.
Figure B210: The uterus with the broad ligaments, the tubae uterinae and ovaries from behind.
Figure B211: The internal female genitalia from in front.
Figure B212: A frontal section through the uterus, tuba uterina, ovary and the upper part of the vagina.
Figure B213: Sagittal section of the uterus and the upper end of the vagina.
Figure B214: Transverse section through the uterus at the level of the body.
Figure B215: Transverse section through the uterus at the level of the boundary between body and cervix.
Figure B216: Transverse section through the uterus at the level of the supra-vaginal portion of the cervix.
Figure B217: The vagina and the external genitalia of a woman who had borne children.
Figure B218: The erectile organs of the female urogenital sinus and the greater vestibular glands.
Figure B219: The vulva of an 18 year old virgin.
Figure B220: The superficial layer of the muscles of the male perineum.
Figure B221: The superficial muscles of the female perineum.
Figure B222: The pelvic surface of the musculature of the pelvic outlet in the male.
Figure B223: The urogenital diaphragm of the male, seen from the perineal surface.
Figure B224: The urogenital diaphragm of the female, seen from the perineal surface.
Figure B225: Diagram of the circulation of the blood.
Figure C1: General view of the principal blood-vascular stems.
Figure B226: The heart from in front, the sterno-costal surface.
Figure B227: The heart from below and behind, the diaphragmatic surface.
Figure B228: The left ventricle of the heart and the ascending aorta, opened by cuts along the middle line of the ventricle and along the anterior longitudinal sulcus.
Figure B229: The left ventricle and atrium of the heart, opened by a cut along the middle line of the ventricle.
Figure B230: The right ventricle and the pulmonary artery, opened by cuts along the right border and along the middle line of the sternocostal surface.
Figure B231: The right ventricle and atrium, opened by a cut long the right border of the heart.
Figure B232: The musculature of the heart from in front.
Figure B233: The musculature of the heart from behind.
Figure B234: The superficial musculature of the heart seen from the apex.
Figure B235: The four openings of the base of the heart seen from above, after removal of the atria and preparation of the superficial musculature.
Figure B236: Frontal section of the heart, especially of the ventricles.
Figure B237: Frontal section of the heart, especially of the atria.
Figure B238: The right ventricle seen from the right side.
Figure B239: The interior of the left ventricle, posterior wall.
Figure B240: The interior of the right ventricle.
Figure B241a: Tawara's node (atrioventricular node) and the right limb of the atrioventricular bundle, dissected from the right ventricle.
Figure B241b: The crus commune of the atrioventricular bundle and its left limb, dissected from the left ventricle.
Figure B242: The heart in the pericardium, from in front.
Figure B243: The sinus transversus of the pericardium seen from the right side.
Figure B244: Anterior view of the pericardium opened from in front, after removal of the heart.
Figure C2: Diagram of the fetal circulation.
Figure C3: The circulation of the fetal liver (schematic).
Figure C4: The arteries and veins of the heart, from in front.
Figure C5: The arteries and veins of the heart, from behind and below.
Figure C6: The superficial nerves and blood vessels of the neck (1st layer).
Figure C7: The superficial nerves and veins of the neck (2nd layer).
Figure C8: The nerves, arteries and veins of the neck (3rd layer).
Figure C9: The nerves and blood vessels of the deeper layer of the neck (4th layer).
Figure C10: The nerves and arteries of the deeper layer of the neck (5th layer).
Figure C11: The branches of the subclavian and the course of the vertebral artery through the neck. (Schematic.)
Figure C12: Schema of the cervical and brachial plexuses.
Figure C13: The nerves and blood vessels of the deep layers of the neck and axilla (6th layer).
Figure C14: The superficial veins of the neck and the subclavicular fossa.
Figure C15: The deep veins and arteries of the neck and the large veins and arteries of the thorax.
Figure C16: Superficial layer of vessels and nerves in the axilla.
Figure C17: The deep layer of vessels and nerves in the axilla.
Figure C18: The large vessels and nerves of the posterior thoracic wall, from in front and somewhat from the right.
Figure C19: The relations of the upper thoracic nerves to the brachial plexus (semi-schematic).
Figure C20: The course of the phrenic nerves through the thorax to the diaphragm.
Figure C21: The blood vessels of the anterior thoracic and abdominal walls.
Figure C22: The large venous trunks of the thorax as seen on the posterior thoracic and abdominal wall, from in front and somewhat from the right.
Figure C23: The superficial and middle layers of the nerves and vessels of the back.
Figure C24: Schema of the Branching of the Spinal Nerves.
Figure C25: Deep layer of the nerves and vessels of the back.
Figure C26: The nerves and vessels of the shoulder region, from in front.
Figure C27: The nerves and vessels of the shoulder region from behind.
Figure C28: The most frequent variations of the veins of the forearm (schematic).
Figure C29: The cutaneous nerves and veins of the flexor surface of the upper arm.
Figure C30: The cutaneous nerves and veins of the flexor surface of the forearm.
Figure C31: The cutaneous nerves and veins of the extensor surface of the upper arm.
Figure C32: The cutaneous nerves and veins of the extensor surface of the forearm.
Figure C33: The nerves and blood vessels of the flexor surface of the upper arm.
Figure C34: The nerves and blood vessels of the flexor surface of the upper arm with the veins omitted.
Figure C35: The superficial nerves and blood vessels of the extensor surface of the upper arm.
Figure C36: The deep nerves and blood vessels of the extensor surface of the upper arm.
Figure C37: The superficial nerves and blood vessels of the flexor surface of the forearm.
Figure C38: The deep nerves and blood vessels of the flexor surface of the forearm.
Figure C39: The deep nerves and vessels of the flexor surface of the forearm.
Figure C40: The vessels and nerves of the ulnar surface of the elbow.
Figure C41: The vessels and nerves of the radial surface of the elbow.
Figure C42: The superficial nerves and blood vessels of the extensor surface of the forearm.
Figure C43: The deep nerves and blood vessels of the extensor surface of the forearm.
Figure C44: The superficial nerves and blood vessels of the palm of the hand.
Figure C45: The superficial nerves and veins of the dorsum of the hand.
Figure C46: Lateral view of the nerves and blood vessels of the forefinger.
Figure C47: The superficial arteries of the dorsum of the hand.
Figure C48: The arteries of the dorsum of the hand and the lower part of the dorsum of the forearm.
Figure C49: The middle layer of the nerves and arteries of the palm of the hand.
Figure C50: The deep layer of the nerves and arteries of the palm of the hand.
Figure C51: The superficial nerves and blood vessels of the head.
Figure C52: The superficial nerves and blood vessels of the head.
Figure C53: The deep layer of the superficial nerves and arteries of the face.
Figure C54: The deep layer of the superficial nerves and arteries of the face.
Figure C55: The nerves and vessels of the head, third layer.
Figure C56: The Nerves and vessels of the head, fourth layer, the deep facial veins.
Figure C57: The branches of the External carotid artery on the head (Schematic).
Figure C58: The nerves and vessels of the head, fifth layer, the internal maxillary artery.
Figure C59: The nerves and vessels of the head, deepest (6th) layer. The mandibular nerve.
Figure C60: The nerves and arteries of the orbit, superficial layer.
Figure C61: The nerves and arteries of the orbit, second layer.
Figure C62: The nerves and arteries of the orbit, third layer.
Figure C63: Nerves and arteries of the orbit, fourth layer.
Figure C64: The nerves and arteries of the nasal septum and of the tongue.
Figure C65: The nerves and arteries of the lateral wall of the nose and of the palate.
Figure C66: The nerves and vessels of the nose, deeper layer, and the spheno-palatine ganglion.
Figure C67: The otic and spheno-palatine ganglia.
Figure C68: The branches of the trigeminus and its connections with the facial and glossopharyngeal nerves, projected schematically on a median section of the skull.
Figure C69: The second division of the Trigeminus, the spheno-palatine ganglion, the intracranial portion of the facial nerve and the tympanic nerve.
Figure C70: The zygomatic and lacrimal nerves, with their anastomosis in the orbital cavity.
Figure C71: The intracranial section of the n. facialis.
Figure C72: The nerves and blood vessels of the posterior and lateral walls of the pharynx.
Figure C73: The intracranial course of the facial nerve and its connections.
Figure C74: The nerves and arteries of the larynx and root of the tongue, from behind.
Figure C75: The nerves and arteries of the tongue and of the larynx from in front and below.
Figure C76: The blood vessels of the stomach and liver.
Figure C77: The branches of the coeliac artery and the roots of the portal vein.
Figure C78: The superior mesenteric artery and vein.
Figure C79: The inferior mesenteric artery and vein.
Figure C80: The blood vessels of the posterior abdominal wail and the nerves of the lumbar plexus.
Figure C81: Schema of the lumbo-sacral, pudendal and coccygeal plexus.
Figure C82: The blood vessels of the posterior abdominal wall.
Figure C83: Vessels and nerves of the lower portion of the anterior surface of the posterior and the posterior surface of the anterior abdominal wall.
Figure C84: The blood vessels of the male genitalia, profile view.
Figure C85: The blood vessels of the female genitalia from the left side.
Figure C86: The vessels and nerves of the penis, spermatic cord and scrotum, from in front.
Figure C87: The arteries of the female internal genitalia, from behind.
Figure C88: The parietal blood vessels and nerves of the pelvis, from the left.
Figure C89: The nerves and blood vessels of the male perineum.
Figure C90: The nerves and blood vessels of the female perineum.
Figure C91: The superficial nerves, arteries and veins of the anterior surface of the thigh.
Figure C92: The superficial nerves and veins of the medial surface of the lower leg.
Figure C93: The superficial nerves and veins of the gluteal region and of the back of the thigh.
Figure C94: The superficial nerves and veins of the posterior surface of the lower leg and dorsum of the foot.
Figure C95: The nerves and blood vessels of the front of the thigh, superficial layer.
Figure C96: The nerves and blood vessels of the front of the thigh, middle layer.
Figure C97: The nerves and blood vessels of the front of the thigh, deep layer.
Figure C98: The superficial layer of the gluteal region and of the posterior surface of the thigh
Figure C99: The nerves and blood vessels of the back of the thigh, superficial layer.
Figure C100: The nerves and blood vessels of the back of the thigh, deep layer, and of the hip, middle layer.
Figure C101: The nerves and blood vessels of the posterior region of the hip, deep layer.
Figure C102: The nerves and blood vessel of the popliteal fossa, superficial layer.
Figure C103: The nerves and blood vessels of the back of the lower leg, superficial layer.
Figure C104: The nerves and blood vessels of the back of the lower leg, middle layer.
Figure C105: The nerves and blood vessels of the back of the lower leg, deep layer.
Figure C106: The nerves and blood vessels of the front of the lower leg and dorsum of the foot.
Figure C107: The arteries of the popliteal fossa.
Figure C108: The superficial veins and nerves of the dorsum of the foot.
Figure C109: The nerves and arteries of the second toe, from the side.
Figure C110: The nerves and blood vessels of the dorsum of the foot, deep layer.
Figure C111: The superficial nerves and arteries of the sole of the foot.
Figure C112: The nerves and blood vessels of the sole of the foot, middle layer.
Figure C113: The nerves and blood vessels of the sole of the foot, deep layer.
Figure C114: The cranial portion of the sympathetic nervous system with some of the cranial and cervical cerebrospinal nerves.
Figure C115: The lower cervical and upper thoracic portions of the sympathetic nervous system, together with the vagus nerve.
Figure C116: The lower thoracic portion of the sympathetic nervous system, together with the vagus nerve.
Figure C117: The thoracic portion of the sympathetic trunk and the thoracic and abdominal portions of the vagus nerves.
Figure C118: The abdominal and pelvic portions of the sympathetic trunk.
Figure C119: The entire central nervous system of a newborn child.
Figure C120: The spinal cord in the vertebral canal, the vertebral arches and the dura mater being removed.
Figure C121: The spinal cord and the nerve roots from behind.
Figure C122: The spinal cord from in front.
Figure C123: Schema of the principal fiber tracts in the spinal cord.
Figure C124: Schema of the spinal meninges.
Figure C125: Schema of the principal tracts and fiber paths in the spinal cord.
Figure C126: Schema of the arrangement of the conducting paths in the funiculi of the spinal cord, and the topography of the grey substance.
Figure C127: A portion of the spinal cord with its membranes from behind.
Figure C128: A portion of the spinal cord with its nerve roots, from in front.
Figure C129: Transverse section of the spinal cord with the two spinal ganglia.
Figure C130: The lower part of the spinal cord from in front.
Figure C131: Transverse section of the spinal cord at the level of the cervical enlargement.
Figure C132: Transverse section of the spinal cord at the level of the thoracic region.
Figure C133: Transverse section of the spinal cord at the level of the lumbar enlargement.
Figure C134: Transverse section of the spinal cord at the level of the conus medullaris.
Figure C135: The dura mater of the brain, its arteries and blood sinuses, the veins of the orbit and the roots of the 12 cranial nerves.
Figure C136: The dura mater and its sinuses, from the side and above.
Figure C137: The superior sagittal sinus and the lateral lacunae; the veins and arteries of the brain, from above.
Figure C138: The course of the internal carotid artery at the sides of the sella turcica.
Figure C139: A frontal section through the cavernous sinus.
Figure C140: A frontal section through the head at the anterior part of the sagittal suture.
Figure C141: A frontal section through the head at the posterior quarter of the sagittal suture.
Figure C142: The diploic veins of the vault of the skull, exposed by removing the outer table of the bones.
Figure C143: The base of the brain, with pia mater and arachnoid; the subarachnoidal cisternae.
Figure C144: Schema of the cerebral meninges.
Figure C145: The upper surface of the brain with the pia mater and arachnoid.
Figure C146: The arteries of the base of the brain.
Figure C147: The arteries of the medial surface of the cerebral hemispheres and of the upper surface of the cerebellum.
Figure C148: The base of the brain, showing the emergence of the twelve pairs of cranial nerves.
Figure C149: A medial section of the brain.
Figure C150: A median sagittal section of a brain of a five-week embryo.
Figure C151: A median sagittal section of the brain of a three months embryo.
Figure C152: Schema of the gyri and sulci of the cerebral hemispheres from the left side.
Figure C153: The gyri and sulci of the cerebral hemispheres from the left side.
Figure C154: The gyri and sulci of the cerebral hemispheres from above.
Figure C155: Schema of the gyri and sulci of the cerebral hemispheres from above.
Figure C156: Schema of the gyri and sulci of the cerebral hemispheres from the basal surface.
Figure C157: The gyri and sulci of the cerebral hemispheres from the basal surface.
Figure C158: The gyri and sulci of the cerebral hemispheres, the medial surface.
Figure C159: Schema of the gyri and sulci of the cerebral hemispheres, the medial surface.
Figure C160: The pallium from the right side.
Figure C161: The fornix, in its natural position, exposed throughout its entire length.
Figure C162: The corpus callosum from above.
Figure C163: The corpus callosum and the left lateral ventricle, from above and slightly from the left.
Figure C164: The two lateral ventricles, the fornix and the septum pellucidum, from above.
Figure C165: The two lateral ventricles and the third ventricle, from above.
Figure C166: The lateral ventricles opened from above; the fornix and the transverse fissure.
Figure C167: The lateral ventricles, corpus callosum, fornix, and tela choroidea of the third ventricle.
Figure C168: The posterior and inferior cornua of the lateral ventricle.
Figure C169: Floor of the descending horn of the lateral ventricle.
Figure C170: A frontal section of the anterior portion of the temporal lobe, after opening the descending horn.
Figure C171: Anterior end of the descending horn of the lateral ventricle.
Figure C172: Anterior end of the temporal lobe with the splenium of the corpus callosum, from behind and below.
Figure C173: The lateral ventricle, third ventricle, quadrigeminal plate and cerebellum, from above.
Figure C174: The structures at the base of the brain.
Figure C175: Some of the principal association paths of the cerebral hemisphere projected upon its lateral surface (schematic).
Figure C176: Some of the principal association paths of the cerebral hemisphere projected upon its medial surface exposed by a median section (schematic).
Figure C177: The optic tracts.
Figure C178: Part of a median longitudinal section of the human brain.
Figure C179: A sagittal section the hypophysis in situ.
Figure C180: The thalami, the epithalamus, the quadrigeminal plate and the rhombencephalon, from behind and above, after removal of the greater portion of the cerebellum.
Figure C181: Schema of the principal conducting paths of the brain. 1.
Figure C182: Schema of the principal conducting paths of the Brain. 2.
Figure C183: The anterior commissure exposed from the base of the brain.
Figure C184: A section of the brain in the plane of the brain stem, from in front.
Figure C185: Schema of a number of fiber tracts of the brain shown in the outlines of Fig. C184.
Figure C186: Schema of the position of the principal fiber tracts in the midbrain.
Figure C187: Schema of a number of fiber tracts of the brain shown in the outlines of Fig. C188.
Figure C188: Horizontal section through the brain.
Figure C189: A frontal section through the thalamus, third ventricle, hypothalamus, fornix and corpus callosum.
Figure C190: A frontal section through the temporal lobe and the adjacent portions of the interbrain and midbrain.
Figure C191: Schema of the relations of the chorioid plexuses of the lateral and third ventricles to the ventricular ependyma.
Figure C192: The course of certain fiber tracts from and to the cerebral cortex.
Figure C193: The course of a number of sensory paths from the spinal cord to the brain, namely of the medial fillet on the left and the auditory path and the beginning of the central optic path on the right.
Figure C194: Schema of the course of the acoustic path in the pons.
Figure C195: A frontal section of the brain in the region of the anterior part of the septum pellucidum.
Figure C196: A frontal section of the brain in the region of the anterior commissure.
Figure C197: Frontal section of the brain.
Figure C198: Schema of the formation and course of the medial fillet and its continuation to the cerebral cortex (central tegmental path).
Figure C199: Diagram of a number of important fiber tracts of the brain and spinal cord.
Figure C200: Diagram of the optic tract, the optic decussation and the connection with the oculomotor nucleus.
Figure C201: Schema of a series of fiber tracts of the cerebral hemispheres, cerebellum and pons.
Figure C202: Schema of a number of fiber tracts passing to or from the cerebellum.
Figure C203: Schema of the paths ascending from the spinal cord to the brain and their associated paths.
Figure C204: Schema of the principal tracts descending from the brain to the spinal cord.
Figure C205: Frontal section of the brain in the region of the third ventricle.
Figure C206: The quadrigeminal lamina and rhomboid fossa, from behind.
Figure C207: The quadrigeminal lamina and rhomboid fossa, from the side and from behind.
Figure C208: The nuclei of the 2nd-12th cranial nerves from the side.
Figure C209: The nuclei of the 2nd-12th cranial nerves from the side.
Figure C210: The nuclei of the 2nd to 12th cranial nerves represented in the outlines of Fig. C206. Schematic.
Figure C211: Diagram of the structure of the midbrain.
Figure C212: Transverse section of the midbrain in the region of the anterior colliculi.
Figure C213: Transverse section of the midbrain in the region of the posterior colliculi.
Figure C214: Transverse section through the middle of the pons and the isthmus.
Figure C215: Transverse section through the lower portion of the pons, at the level of the abducens nucleus.
Figure C216: Diagram of the structure of the upper portion of the pons
Figure C217: Diagram of the structure of the pons at the level of the trigeminal nuclei.
Figure C218: Diagram of the structure of the lower portion of the pons.
Figure C219: Diagram of the structure of the upper part of the medulla oblongata.
Figure C220: Transverse section through the upper part of the medulla oblongata.
Figure C221: Transverse section through the middle part of the medulla oblongata, the middle of the region of the olive.
Figure C222: Transverse section of the middle portion of the medulla oblongata, in the region of the calamus scriptorius.
Figure C223: Transverse section through the lower part of the medulla oblongata, in the region of the decussation of the pyramids.
Figure C224: Diagram of the structure of the medulla oblongata at the level of the vestibular nuclei.
Figure C225: Diagram of the structure of the medulla oblongata at the level of the IX-XII cranial nerves.
Figure C226: Diagram of the structure of the medulla oblongata in the region of the decussation of the fillet.
Figure C227: Diagram of the structure of the medulla oblongata in the region of the decussation of the pyramids.
Figure C228: Transverse section through the middle part of the Medulla oblongata, in the region of the calamus scriptorius.
Figure C229: Transverse section through the lower part of the medulla oblongata, in the region of the decussation of the pyramids.
Figure C230: The cerebellum seen from above and behind.
Figure C231: The cerebellum seen from below.
Figure C232: The cerebellum seen from in front, after cutting the cerebellar peduncles.
Figure C233: The cerebellum seen from below and somewhat from behind.
Figure C234: The boundaries of the fourth ventricle shown by a partial removal of the cerebellum.
Figure C235: Section through the cerebellum in the plane of the brachia conjunctiva.
Figure C236: The fundus of a moderately pigmented eye as seen by the ophthalmoscope.
Figure C237: The fundus of a slightly pigmented eye as seen by the ophthalmoscope.
Figure C238: Horizontal meridional section of the eyeball (schematic).
Figure C239: Schema of the retinal blood vessels of the right eye.
Figure C240: The right eyeball divided meridionally.
Figure C241: The middle coat of the eye, exposed by meridional division of the outer coat.
Figure C242: The middle coat of the eye from in front, after the complete removal of the cornea and sclerotic.
Figure C243: Anterior surface of the human iris.
Figure C244: The anterior half of a right eyeball divided at the equator, from behind.
Figure C245: The posterior half of a right eyeball divided at the equator, from in front.
Figure C246: A portion of the anterior part of a right eyeball divided at the equator, from behind.
Figure C247: The posterior surface of the iris and the ciliary body after removal of the lens.
Figure C248: The blood vessels of the eyeball.
Figure C249: The blood vessels of the eyeball (schematic).
Figure C250: The lens of an adult, with numerous radii, from in front.
Figure C251: The lens, from the side.
Figure C252: The lens, divided at its equator, the capsule partly reflected.
Figure C253: The lens of a child, with three radii, from in front.
Figure C254: A sector of the posterior surface of the iris and the ciliary body after removal of the lens.
Figure C255: The fibers of the ciliary zonule from in front.
Figure C256: Transverse section of the optic nerve.
Figure C257: A horizontal section through both orbits.
Figure C258: The two eyeballs and optic nerves of a child.
Figure C259: The right eye, open, from in front.
Figure C260: The right eye, closed.
Figure C261: The right eye fully opened by forcible separation of the lids, from the temporal side and above.
Figure C262: Vertical section through the upper eyelid.
Figure C263: The orbital septum of the right eye from in front.
Figure C264: The eyelids and lacrimal glands from behind.
Figure C265: The two eyelids from the posterior surface, made transparent by soda-glycerine; Meibomian glands.
Figure C266: General view of the entire lacrimal apparatus.
Figure C267: The lacrimal sac and the lacrimal ducts from in front.
Figure C268: The lacrimal ducts, lacrimal sac and naso-lacrimal duct opened, from in front and from the side.
Figure C269: The muscles of the eye from the lateral side.
Figure C270: The muscles of the eye from the lateral side.
Figure C271: Schema of the insertions of the 8 eye muscles.
Figure C272: Schema of the insertions of the Recti of the right eyeball.
Figure C273: The muscles of the eye from in front and from the side.
Figure C274: The eyeball with stumps of the eye muscles, from in front.
Figure C275: The eyeball with stumps of the eye muscles, from behind and below.
Figure C276: The eyeball with stumps of the eye muscles, from behind and above.
Figure C277: The muscles of the orbit from above.
Figure C278: Horizontal section through both orbits.
Figure C279: Frontal section through the right orbit at the level of the posterior third of the eyeball, from in front.
Figure C280: Frontal section through the orbit behind the eyeball, from in front.
Figure C281: The origins at the optic foramen of the muscles of the left orbit.
Figure C282: Sagittal section through the orbit and eyeball, somewhat schematized as to Tenon's capsule.
Figure C283: Tenon's capsule, fascia bulbi, of the right eye with its openings, after removal of the eyeball.
Figure C284: The tarsi of the eyelids of the right eye with the palpebral ligament and raphe and the lacrimal sac.
Figure C285: The right membranous labyrinth isolated, with the branches of the acoustic nerve that pass to it.
Figure C286: The right membranous labyrinth with the nerves that pass to it, partly exposed by chiseling away the bone.
Figure C287: Schema of the membranous labyrinth.
Figure C288: Transverse section of a coil of the cochlea (schematic).
Figure C289: The right bony labyrinth, from the medial side and behind.
Figure C290: The right bony labyrinth, from the lateral side and in front.
Figure C291: The right bony labyrinth from in front.
Figure C292: The left bony labyrinth.
Figure C293: The two bony labyrinths in their natural relative positions.
Figure C294: A cast of the right bony labyrinth, seen from the lateral side and in front.
Figure C295: A cast of the right bony labyrinth, from the medial side and behind.
Figure C296: A cast of the right bony labyrinth, from below.
Figure C297: The right internal auditory meatus after chiseling away a part of its posterior wall, from the medial side.
Figure C298: The same preparation as Fig. C297 more extensively chiselled, from the medial side and above.
Figure C299: The right bony labyrinth from in front and from the medial side.
Figure C300: The left cochlea bisected.
Figure C301: The lateral wall of the right vestibule.
Figure C302: The right vestibule exposed by removal of its lateral wall.
Figure C303: The right tympanic cavity and mastoid antrum as shown by a section almost parallel with the axis of the pyramid of the temporal bone.
Figure C304: The right tympanic cavity, opened by the removal of the lateral wall and adjacent parts of the anterior and upper walls.
Figure C305: The right tympanic cavity after further removal of the bone.
Figure C306: The right malleus from the lateral side.
Figure C307: The right malleus from in front.
Figure C308: The right malleus from behind.
Figure C309: The right incus from the lateral side.
Figure C310: The right incus from the medial side.
Figure C311: The right stapes from above.
Figure C312: The right stapes from the medial side and below.
Figure C313: The right auditory ossicles of a child.
Figure C314: The right tympanic cavity opened from above.
Figure C315: General view of the right middle and internal ear.
Figure C316: The lateral wall of the right tympanic cavity from the medial side.
Figure C317: The lateral wall of the right tympanic cavity from the medial side.
Figure C318: Lateral wall of the right tympanic cavity from the medial side.
Figure C319: The medial wall of the right tympanic cavity from the lateral side.
Figure C320: The medial wall of the right tympanic cavity, from the lateral side.
Figure C321: The medial wall of the tympanic cavity, with the stapes and the portion of the facial nerve adjacent to the middle ear.
Figure C322: The fenestra vestibuli (ovalis) and fenestra cochleae (rotunda) seen from the tympanic cavity.
Figure C323: A transverse section of the musculo-tubar canal, with the bony part of the tuba auditiva (Eustachian tube) and the Tensor tympani.
Figure C324: A frontal section of the right external auditory meatus, the tympanic membrane and cavity.
Figure C325: A view from the external auditory meatus into the tympanic cavity, after removal of the tympanic membrane.
Figure C326: The lateral wall of the tympanic cavity and the tympanic surface of the tympanic membrane, from the medial side, i.e. from the tympanic cavity.
Figure C327: The right tympanic membrane from the lateral side.
Figure C328: A frontal section of the external auditory meatus, the tympanic cavity and the labyrinth.
Figure C329: The cartilage of the left tuba auditiva (Eustachian tube) in position at the base of the skull.
Figure C330: A transverse section of the cartilaginous portion of the left tuba auditiva (Eustachian tube), near its attachment to the bony portion.
Figure C331: A transverse section through the cartilaginous portion of the left tuba auditiva (Eustachian tube), near its opening into the pharynx.
Figure C332: The right auricle from the lateral side.
Figure C333: The cartilage of the right auricle from in front.
Figure C334: The cartilage of the right auricle from the lateral side.
Figure C335: The cartilage of the right auricle from the medial side.
Figure C336: The right auricle separated from the head, from the medial surface.
Figure C337: The muscles of the medial surface of the auricular cartilage.
Figure C338: The muscles of the lateral surface of the auricular cartilage.
Figure C339: A transverse section through the external auditory meatus, cartilaginous portion.
Figure C340: The right breast of a pregnant woman, from in front.
Figure C341: The right mammary gland of a pregnant woman, from in front.
Figure C342: The right mammary gland of a pregnant woman divided by a sagittal section.
Figure C343: The right mammary gland of a pregnant woman.
Figure C344: The furrows and ridges of the volar surface of a finger tip.
Figure C345: Imprints of the furrows and ridges of two fingers.
Figure C346: The nail plate separated from the nail bed, dorsal surface.
Figure C347: A finger nail in its natural position, dorsal surface.
Figure C348: A finger nail from the dorsal surface.
Figure C349: The nail bed of the great toe after removal of the nail.
Figure C350: The nail bed of the great toe with the wall of the nail removed.
Figure C351: A vertical section through the scalp.
Figure C352: Sudoriferous glands of the axilla.
Figure C353: The lanugo hairs of the human skin.
Figure C354: The lymph nodes of the right side of the neck and head of a child.
Figure C355: The superficial lymph vessels and nodes of the arm, the anterior thoracic wall and the axilla.
Figure C356: Schema of the principal lymphatic trunks.
Figure C357: The superficial lymph vessels of the face and neck of an eight year old child.
Figure C358: The deep lymphatics of the left lower cervical region and the left axilla of an eight year old child.
Figure C359: The lymphatic plexuses and nodes of the false and true pelves and their connections with the lymph vessels of the lower extremity and the viscera.
Figure C360: The lymph vessels and nodes of the mesentery.
Figure C361: The lymph vessels and nodes of the thigh, the inguinal region and the external genitalia.
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The roman numerals indicate the number of the vertebra.

* = the upwardly bent margin of the vertebral body.

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* = position of the superior articular fovea.

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v.th. = thoracic vertebra.

v.l. = lumbar vertebra.

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In this case the costal facet on the transverse process is wanting in the tenth thoracic vertebra.

* = roughness for the Scalenus medius.

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The frontal bone is violet, maxilla yellow, sphenoid green, parietal brown, lacrimal and vomer red, ethmoid orange, zygomatic red streaked, mandible blue streaked, nasal and temporal white.

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The frontal bone is violet, maxilla yellow, parietal brown, sphenoid green, lacrimal red, ethmoid orange, occipital blue, zygomatic red streaked, mandible blue streaked, temporal and nasal white.

The maxilla is yellow, palatine blue, frontal violet, sphenoid green, temporal white, zygomatic red streaked, vomer red, occipital orange streaked, parietal brown, ethmoid orange.

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Behind the foramen lacerum there is a distinct but unlabelled impression for the trigeminal nerve at the apex of the pyramid. It is stronger on the left side than on the right.

+ = sulcus arteriosus on the frontal bone.

* = the anterior nervous portion of the jugular foramen.

The frontal bone is violet, ethmoid orange, sphenoid green, parietal brown, temporal white, occipital red.

Colors are used to emphasize the extent to which the various bones participate in the base of the skull.

The anterior fossa is blue, the middle white and the posterior red.

x = parietal foramen.

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The bone is represented as separated by a saw-cut (x) from the sphenoid at the level of the ossified sphenooccipital synchondrosis.

A probe is placed in the hypoglossal canal.

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The right anterior clinoid process is united with the middle process; the dorsum sellae which passes laterally into the posterior clinoid processes, the carotid groove which lies between these processes and the sphenoidal lingula and the hypophyseal fossa between the tuberculum and dorsum sellae are not labeled (See Fig. A48).

* = fusion of the anterior and middle clinoid processes (variation).

+ = the position of the pharyngeal canal

++ = processus vaginalis.

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The squamous portion is green, the petrous and mastoid portions yellow and the tympanic portion white.

The squamous portion is green, the petrous and mastoid portions yellow and the tympanic portion white.

After Gaupp.

Simply hatched = petrous portion; cross hatched = squamous portion; stippled = tympanic portion.

Simply hatched = petrous portion; cross hatched = squamous portion; stippled = tympanic portion.

The designations partly refer to the chapters on the ear (see here)

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A sound is placed in the canal for the Eustachian tube (canalis musculo-tubarius) whose wall is partly chiseled away to show the septum.

The parietal protuberance is not well defined.

The arterial sulcus is converted into a canal for a short distance at its commencement; the bone being from a young individual shows no granular foveolae (Pacchionian depressions).

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Some small foveolae granulares are unlabelled.

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The frontal is white, the ethmoid orange and the nasals red.

The frontal, sphenoid, maxilla and palatine bones have been cut away near the median line; so too the lamina cribrosa of the ethmoid and the left ala of the vomer.

The ethmoid is orange, the vomer is red.

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The maxilla is yellow, the palatine blue, the sphenoid green and the ethmoid orange.

The palatine is blue and the maxilla white.

The maxilla is yellow, the palatine blue, the sphenoid green and the ethmoid orange.

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* = place of articulation of the outer lamina of the pterygoid process.

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* = remains of the alveolar portions.

The frontal bone is violet, the ethmoid orange, the maxilla yellow, the lacrimal red, the sphenoid green, the palatine blue and the nasal, parietal, temporal and zygomatic white.

The frontal bone is violet, the ethmoid orange, the maxilla yellow, the lacrimal red, the sphenoid green, the palatine blue and the nasal, parietal, temporal and zygomatic white.

The frontal bone is violet, the ethmoid orange, the maxilla yellow, the lacrimal red, the sphenoid green, the palatine blue and the nasal, parietal, temporal and zygomatic white.

* = frontal sinus.

The frontal is violet, the ethmoid orange, the maxilla yellow, the sphenoid green, the palatine blue, the vomer and lacrimal red, the inferior concha and temporal white. The zygomatic is red.

The frontal is violet, the ethmoid orange, the maxilla yellow, the sphenoid green, the palatine blue, the vomer and lacrimal red, the inferior concha, temporal and zygomatic white.

This figure represents the lower surface of the preparation shown in Fig. A86.

The frontal is violet, the ethmoid orange, the maxilla yellow, the sphenoid green, the palatine blue, the vomer and lacrimal red, the inferior concha and temporal white.

The frontal is violet, the lacrimal red, the ethmoid orange, the maxilla yellow, the palatine blue, the sphenoid green and the other bones white. The parietal is brown.

The frontal is violet, the lacrimal red, the ethmoid orange, the maxilla yellow, the palatine blue, the sphenoid green and the other bones white. The ala of the vomer is red.

* = probe in the opening of the frontal sinus in the hiatus semilunaris.

The frontal is violet, the lacrimal red, the ethmoid orange, the maxilla yellow, the palatine blue, the sphenoid green and the other bones white.

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  1. facet for the supraspinatus,
  2. facet for the infraspinatus,
  3. facet for the teres minor.

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* = attachment of pronator teres.

** = groove and ridge for the extensor tendons.

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Ilium yellow, pubis blue, ischium green.

The iliac crest, the ischial tuberosity and part of the acetabulum are still cartilaginous (white in the figures).

See also Fig. A149.

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* = fovea for the ligaments arising from the lateral malleolus.

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See also Fig. A155).

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The bones that are in contact with the articular surfaces are named in parentheses.

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The joint is in the position of extension, the fore-arm bones in supination.

One sees the lower end of the humerus, about the upper third of the radius and ulna and the joint cavity, especially that of the humero-radial articulation. The structure of the spongiosa is only indistinctly indicated.

The figures denote:

  1. lateral borders of the humerus,
  2. marrow cavity of the humerus,
  3. lateral condyle of the humerus (the official nomenclature does not include condyles for the humerus, only epicondyles),
  4. medial condyle,
  5. lateral epicondyle of the humerus,
  6. medial epicondyle,
  7. upper boundary of the olecranal fossa,
  8. upper boundary of olecranon,
  9. capitulum humeri,
  10. lateral border of trochlea,
  11. medial border of trochlea,
  12. proximal border of trochlea,
  13. humero-radial articulation,
  14. humero-ulnar articulation,
  15. proximal radio-ulnar articulation,
  16. boundary of the upper extremity and shaft of the ulna,
  17. coronoid process,
  18. capitulum radii,
  19. neck of radius,
  20. tuberosity of radius,
  21. shaft of radius (marrow cavity),
  22. shaft of ulna (marrow cavity),
  23. interosseous space.

The articular ends of the three bones are as yet partly cartilaginous and consequently are not seen in a Röntgen picture. Thus the trochlea humeri appears to be wanting, being still purely cartilaginous, but in the region of the olecranon (still almost entirely cartilaginous) there is a very diffuse centre of ossification, and a flat disk-shaped centre has appeared in the capitulum radii. The soft parts form a shadowy frame for the bones.

The figures indicate :

  1. shaft of humerus,
  2. olecranal fossa,
  3. centre for the capitulum humeri,
  4. centre for the olecranon,
  5. proximal end of the shaft of the ulna,
  6. coronoid process,
  7. discoidal centre for the capitulum radii,
  8. proximal end of the shaft of the radius,
  9. tuberosity of radius.

x = focal point of picture.

The figure gives a clear picture of the not yet fully developed bones. It is especially noticeable that the proximal epiphysial centers of the two bones of the forearm have not yet united with the diaphyses; a plate of cartilage, the so-called epiphysial plate, still intervenes and this is transparent to the Rontgen rays. The same holds true for the metacarpal bone of the thumb, whose epiphysis has not yet united with the shaft.

The figures indicate:

  1. trapezium (multangulum majus),
  2. trapezoid ( multangulum minus),
  3. capitatum,
  4. hamatum,
  5. navicular,
  6. lunatum,
  7. triquetrum,
  8. pisiform,
  9. distal epiphysis of radius,
  10. diaphysis of radius,
  11. epiphysis of ulna (capitulum),
  12. styloid process of ulna,
  13. diaphysis of ulna,
  14. epiphysis of the metacarpal of the thumb,
  15. diaphysis of the metacarpal of the thumb,
  16. proximal end of metacarpale II,
  17. distal end of metacarpale V.

The figure shows plainly the developmental stage of the hand skeleton. One sees that at this time certain of the carpal bones are yet entirely cartilaginous, while others show small ossification centers. Contrary to the condition shown by most of the other long bones, which possess both proximal and distal epiphyses, the metacarpal bones and phalanges have each only one epiphysis, all the phalanges and the metacarpal of the thumb having only a proximal and all the other metacarpals only a distal epiphysis.

The figures indicate:
  1. epiphysial centre for the base of the metacarpal of the thumb,
  2. centre of ossification for the trapezium (multangulum majus),
  3. centre for the trapezoid (multangulum minus),
  4. centre for the capitate,
  5. centre for the hamate,
  6. centre for the triquetrum,
  7. centre for the lunate,
  8. epiphysial centre for the radius.

Only some of the carpal bones are shown, the picture illustrating especially the developmental stages of the metacarpals and phalanges. The epiphyses are more fully developed than in the earlier stages, but even as yet they have not fused with the diaphyses, but remain separated from them by a relatively thick plate of cartilage. One may again note that the metacarpal bone of the thumb and the phalanges have only proximal epiphyses and the other metacarpals only distal ones. The sharply defined bones are surrounded by the shadowy outlines of the soft parts.

The figures indicate:
  1. epiphysis of the metacarpal of the thumb,
  2. diaphysis of the metacarpal of the thumb,
  3. epiphysis of phalanx I of thumb,
  4. diaphysis of phalanx I of thumb,
  5. epiphysis of phalanx II of thumb,
  6. diaphysis of phalanx II of thumb,
  7. distal end of metacarpal II,
  8. diaphysis of metacarpal II,
  9. epiphysis of metacarpal II,
  10. trapezium (multangulum majus),
  11. trapezoid (multangulum minus),
  12. capitate,
  13. hamate.

While the bones of the carpus are somewhat confused on account of some overlapping, the metacarpals and phalanges are so clear that the spongiosa of the articular ends and the compacta of the shaft, together with the marrow cavity it encloses, may be made out; the sesamoid bones are also distinct. In correspondence with the concave form of the palm the bones of the thumb are seen almost in profile, those of other fingers from the surface. The outlines of the soft parts are distinct and there are even indications of some of the skin folds.

The figures indicate:
  1. phalanx II of index,
  2. proximal interphalangeal joint of index,
  3. sesamoid bone of the interphalangeal joint of the thumb,
  4. capitulum of metacarpal of thumb,
  5. sesamoid bone of the metacarpo-phalangeal joint of thumb,
  6. sesamoid bone of the metacarpo-phalangeal joint of digit III (this sesamoid bone is inconstant, compare Fig. A224),
  7. first phalanx of thumb,
  8. tuberosity of metacarpal V (Insertion of the Abductor digiti V),
  9. capitate bone.

The picture of the two knee joints, right and left, is a good example of the value of Röntgen photographs for determining the progress of the ossification process. While the femur and tibia have already well developed bony epiphyses, the only epiphyses to ossify before or at the time of birth, an ossification centre is still lacking (or only just indicated) at the proximal end of the fibula. The patella is still altogether cartilaginous, so that a Röntgen photograph of this stage is somewhat striking; the patella, which is so characteristic a feature of the knee-joint does not appear in the picture.

The figures indicate:
  1. Diaphysis of femur,
  2. epiphysis of femur,
  3. joint cavity, strikingly large since the two somewhat thick layers of cartilage are completely transparent,
  4. epiphysis of tibia,
  5. diaphysis of tibia,
  6. first trace of the epiphysis for the head of the fibula,
  7. boundary of the musculature.

The figure shows clearly the extent of the ossification of the bones of the lower leg and foot toward the end of the first year of life. The distal epiphysis of the femur and the proximal one of the tibia, which appear just before or at the time of birth, have enlarged and are now of considerable size; the first trace of the ossification of the distal tibial epiphysis is just visible. In contrast, ossification is entirely wanting in both the cartilaginous epiphyses of the fibula. Ossification is less advanced in the tarsal bones, which are for the great part still cartilaginous. Only the talus and calcaneus show extensive ossification; that of the cuboid is already distinct; the cuneiforms, except for a small center in the third, and the navicular are still entirely cartilaginous and consequently not visible in the photograph. The epiphysial centers of the metatarsal bones are also completely lacking.

The figures indicate:
  1. center for the distal femoral epiphysis,
  2. center for the proximal tibial epiphysis,
  3. center for the distal tibial epiphysis (faint),
  4. center for the talus,
  5. center for the calcaneus,
  6. center for the cuboid,
  7. center for cuneiform III,
  8. diaphysis of metacarpal I,
  9. boundary of the musculature and fatty tissue,
  10. extensor tendons,
  11. tuberosity of the tibia.

Compared with the preceding figure a marked progress in the ossification of the foot bones is evident. All the tarsal bones show centers and epiphysial centers are visible in the metatarsals and some of the phalanges. The centers for the distal epiphyses of the four lateral metatarsals are in some cases double and it is noticeable that no epiphysial centers are to be seen at the proximal ends of the basal phalanges; they are quite evident at the bases of the middle phalanges and the terminal phalanx of the great toe. On account of the arched arrangement of the bones of the foot they overlap in Rontgen photographs, especially the lateral tarsal bones and the bases of the four lateral metatarsals. Röntgen photographs of the foot are consequently less satisfactory than those of the flatter hand.

The figures denote:
  1. proximal epiphysial center of metatarsal I,
  2. center for cuneiform I,
  3. center for cuneiform II,
  4. center for cuneiform III,
  5. center for cuboid,
  6. center for navicular,
  7. center for talus,
  8. center for calcaneus,
  9. capitulum of metatarsal I,
  10. double center for the distal epiphysis of metatarsal V.

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The arches of the vertebrae have been cut away near their roots.

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The section is at an angle of 45?? with the median plane.

The bodies of the vertebrae have been cut away at the roots of the arches. The ribs have been disarticulated on the left side, but remain in their natural relations on the right.

The arches have been cut away at their roots.

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The uppermost rib has been disarticulated.

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On the left side the articular capsule is removed.

The capsular ligaments are removed on the right side.

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The posterior part of the occipital and the arches of the three upper cervical vertebrae have been cut away and, on the right side, the articular capsules have been removed.

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The atlas has been disarticulated at the atlanto-occipital joints, the dens and anterior arch of the atlas have been cut horizontally.

The preparation as in Fig. A205.

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The zygomatic bone is cut through in front.

The right sterno-clavicular joint is opened by a frontal section.

* = communication of the subscapular bursa (not retained) with the joint cavity. Above it the coraco-humeral ligament.

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The articular cartilages are red. The articular disk is stippled red.

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The transverse carpal ligament is removed, and the radial sesamoid bone of the thumb and one of the index finger and the little finger are exposed.

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On the right part of the superficial layer the sacro-tuberous ligament is removed.

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l.s.c.l. = lateral sacro-coccygeal ligament.

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The head of the femur has been removed.

In addition the preparation shows also the symphysis pubis with its interpubic fibrocartilage, the sacro-iliac articulations, the pelvic surfaces of the sacro-spinous and sacro-tuberous ligaments and the anterior and lateral sacro-coccygeal ligaments.

l.s.c.l. = lateral sacro-coccygeal ligament.

l.s.c.a. = anterior sacro-coccygeal ligament.

The head of the femur has been withdrawn from its socket, and strongly rotated outward and backward.

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The quadriceps and the patella are bent downwards.

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The base of the fifth metatarsal is not cut, on account of the arched form of the foot; the calcaneus is cut twice.

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a = the calcaneo-navicular, b = the calcaneo-cuboid portion of the bifurcate ligament.

The participation of the navicular fibrocartilage in the socket of the head of the talus is shown.

* = posterior facet of the navicular bone.

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The anterior portion of the long plantar ligament has been removed exposing the groove for the tendon of the Peroneus longus. The metatarsal phalangeal joint of the great toe has been opened.

On the right side the Rhomboideus major and Teres minor are covered by fascia.

* = origin of the Latissimus from the crest of the ilium.

** = costal serration of the Latissimus.

On the right the Trapezius has been cut away to show the 2nd layer of the dorsal muscles; the Levator scapulae is left in place; on the left the Rhomboids and Latissimus are also removed and the Levator scapulae drawn out to show its origins.

+ = digitations of Latissimus.

* = Sacro-spinalis showing through the fascia.

** = origin of Latissimus from the iliac crest.

On the right the Splenii and Sacro-lumbalis are fully exposed; on the left the Splenii are removed and the Sacro-lumbalis separated into its constituent parts.

* = cut origins of the Latissimus from the ribs.

NOCOMMENT

On the left the Iliocostalis, Longissimus and Spinalis are dissected out. On the right the Spinotransversalis is divided in the lumbar region and the Semi-spinalis capitis reflected to show the Semispinalis dorsi and cervicis.

* = medial digitations of the Longissimus.

On the left the Splenius capitis has been cut and reflected; on the right the Semispinalis capitis also.

The Splenii are cut and reflected.

On the left the muscles are cut away to expose the deep layer; on the right the Multifidus is retained, but the rectus capitis major is removed.

On the left only the deepest muscles are shown; on the right the Multifidus is retained.

NOCOMMENT

NOCOMMENT

On the right the Pectoralis major is divided and reflected; on the left the Pectoralis minor also.

* = subscapular fascia.

** = axillary cavity.

On the right the spermatic cord is drawn upward to show the inferior limb of the ring.

On the left the anterior wall of the sheath of the Rectus is divided lengthwise, exposing the Rectus and Pyramidalis, on the right the Obliquus externus is cut and reflected.

* = linea alba.

NOCOMMENT

On the left the Rectus is exposed and the Pyramidalis and Internal oblique are cut. On the right the Internal oblique has been reflected and the Rectus removed, to show the semilunar and semicircular lines.

Both pectorales are cut, the clavicle is disarticulated from the sterno-clavicular joint and partly cut away, the arm is drawn backwards to show the Serratus anterior in its full extent and the two oblique muscles have been cut. In the neck the Sterno-mastoid, Sterno-hyoid, Omohyoid, anterior belly of the Digastric and Mylohyoid have been cut.

NOCOMMENT

The anterior abdominal wall is opened and its muscles reflected. The abdominal contents above the true pelvis have been removed. The thorax is bent backward, the lumbar vertebrae being made strongly convex anteriorly, and twisted so that the left dome of the Diaphragm is seen completely. On the right a portion of the Psoas minor has been removed.

NOCOMMENT

On the left the internal intercostal ligaments are removed.

In addition to the Sternomastoid, seen in relief, the external jugular vein is also to be seen; pectoral fascia.

+ = position of the clavicle.

* = union of the muscles of opposite sides beneath the chin.

** = Sternomastoid in relief.

In the neck the Platysma and cervical fascia have been removed and the Sternomastoid is drawn slightly backward; in the face the superficial muscles have been partly removed to show the deeper ones; the submaxillary and parotid glands are drawn upwards to show underlying muscles.

+ = cephalic vein in the deltoideo-pectoral triangle.

* = angular head of the Quadratus labii superioris (cut).

+* = insertion of the Zygomaticus (cut).

+*+ = origin of the zygomatic head of the Quadratus labii superioris (cut).

+ + = insertion of the cut Quadratus labii superioris.

** = attachment to the hyoid bone of the intermediate tendon of the Digastric.

*+* = fossa supraclavicularis minor.

On the right side (the left in the figure) the superficial layer is represented, except that the anterior belly of the Digastric is cut and reflected to show the Mylohyoid; on the left side (right of the figure) the Sternomastoid and Sternohyoid are removed.

The ramus of the mandible is cut away on both sides and the two Genioglossi are cut close to their origins and removed.

+ = internal mental spine.

++ = anterior belly of the Digastric (cut).

* = origin of the cut Genioglossi.

** = attachment to the hyoid bone of the intermediate tendon of the Digastric.

*+ = clavicular head of the Sternomastoid (cut).

+* = sternal head of the same.

*+* = deltoideo-pectoral trigone.

The Sternomastoid, anterior belly of the Digastric, Mylohyoid, Sternohyoid and the cervical vessels and nerves have been cur or removed.

+ = insertion of the anterior belly of Digastric.

* = Longus capitis.

The base of the skull is sawn across, the first and second costal cartilages are removed and the Levator scapulae is cut. On the right the Longus capitis and the colli show their parts.

** = scalene opening.

1, 2, 3,indicate the medial, upper lateral and lower lateral limbs of the Longus colli.

On the right the deeper layer is exposed by the removal of the Triangularis, Platysma, Zygomaticus, Quadratus labii superioris and inferioris and of the parotideo-masseteric fascia. Part of the Frontalis is also removed to expose the deeper layer.

The terms in parentheses are those proposed in a recent revision of the nomenclature.

* = origin of the angular head of the Quadratus labii superioris (cut).

+ = origin of the infraorbital head.

** = origin of the zygomatic head.

+ + = origin of the Zygomatic muscle.

+* = insertion of the Quadratus labii superioris (cut).

*+ = origin of the Zygomatic muscle.

+*+ = orbito-palpebral sulcus.

The skin is removed except at the margins of the lips, on the alae of the nose and at the eyebrows; the auricular cartilage is drawn forward.

The terms in parentheses are those proposed in a recent revision of the nomenclature.

* = buccal fat pad.

** = passage of the galea aponeurotica into the temporal fascia.

+ = slip of the Quadratus labii superioris to the ala of the nose.

+ + = slips of the Platysma that spread out in the parotideo-masseteric fascia.

*+ = fusion of the zygomatic head of the Quadratus labii superioris with the Orbicularis oculi.

The parotid gland and duct and also the buccal fat pad have been removed; the Epicranius is cut along the temporal line and the temporal fascia is cut at the upper border of the zygoma and turned upwards.

The zygoma has been cut away, and the Masseter, except in its lowest part, and the temporal fascia have been removed. Otherwise as in Fig. A279.

Dissection as in Fig. A280 except that the mandibular joint is opened, part of the ramus of the mandible cut away and the Masseter entirely removed.

The head is divided close to the median line, the tongue is removed and the soft palate cut away at its root.

The Deltoid is removed, except at its origin and insertion; only stumps are left of the dorsal and pectoral muscles that are attached to the scapula and humerus.

* = lateral and ** = medial axillary foramina.

Stumps of the attached thoracic, cervical and dorsal muscles are shown.

* = Medial axillary foramen.

++ = long head of Triceps.

NOCOMMENT

The Deltoid is divided and partly removed and the antebrachial fascia is split where it covers the Anconaeus. The Teres minor and lateral head of the Triceps are cut and reflected.

* = tendon of the long head of the Biceps.

** = tendon of the Pectoralis major.

* = medial axillary foramen.

** = lateral axillary foramen.

The Deltoid and Biceps are partly removed.

+ = common origin of the short head of the Biceps and the Coraco-brachialis.

NOCOMMENT

The Brachioradialis is drawn laterally to show the Supinator and the insertion of the Biceps tendon; the bicipito-radial bursa is opened.

The Pronator teres, Flexor carpi radialis and Palmaris longus have been removed to expose the Flexor digitorum sublimis. The edge of the Brachio-radialis is drawn laterally.

+ * = cut surface of the removed muscles.

All superficial flexors, except the Flexor carpi ulnaris, have been removed.

* = stump of the ulnar head of the Pronator teres.

+ = stump of the removed superficial flexors.

** = gap in the tendon of the Flexor digitorum profundus for the passage of the dorsal interosseous vessels.

The portion of the antebrachial fascia over the Anconaeus has been removed.

NOCOMMENT

The Extensor digitorum communis and the Extensor digiti V proprius are cut away and the tendon sheaths of the dorsal carpal ligament are partly opened.

  1. sheath for the Extensor digiti V proprius;
  2. sheath for the Extensor digitorum communis;
  3. sheath for the Extensor pollicis longus.

The superficial layer of the extensor and the radial group of muscles have been removed; the tendon sheaths of the dorsal carpal ligament are all opened.

+ = sheath for the Abductor pollicis longus and the Extensor pollicis longus.

* = sheath for the Extensor digiti V proprius.

** = sheath for the Extensor communis digitorum and the Extensor indicis proprius.

The thenar and hypothenar muscles are covered by fascia.

* = continuations of the aponeurosis into the corium of the fingers.

The dorsal carpal ligament has been retained, but the dorsal fascia is removed.

  1. part of the dorsal aponeurosis derived from the Extensor digitorum.
  2. lateral part formed by the interosseous and lumbrical tendons.
  3. continuations upon the terminal phalanx.

The tendon sheath of the middle finger is split open.

The transverse carpal ligament is cut across and also the Abductor digiti V and Abductor pollicis brevis.

The tendons of the Flexor sublimis have been taken out of the carpal canal and after splitting the tendon sheaths on the fingers, have been partly removed.

The carpal canal is opened and the flexor tendons removed, except that of the Flexor carpi radialis.

The vaginal ligaments of the digital tendon sheaths are split open and the Abductor pollicis brevis, the superficial head of the Flexor pollicis brevis and the Abductor digiti V have been removed.

The preparation is much as in Fig. A301 but the Adductor pollicis and the deep head of the Flexor pollicis brevis have also been removed; the tendons of the fingers have been cut near their insertions.

* = tendon sheath for the Flexor carpi radialis, opened.

The volar tendon sheath has been removed.

The sheath of the Flexor carpi ulnaris is partly exposed by cutting away a part of the thenar musculature. On the ring and little fingers the vaginal ligaments are split lengthwise.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The skin and adipose tissue have been removed as far as the wrist.

The gluteal lines are dotted.

NOCOMMENT

The glutaeus maximus is divided and reflected. The superficial layer of the fascia lata is removed where it covers the Tensor fasciae latae.

The abdominal walls and contents and the iliac fascia have been removed as far down as the inguinal ligament. Below this the integument and lymph nodes over the fossa ovalis have been dissected away.

The pelvis and vertebral column have been divided in the middle line; the viscera, fasciae and peritoneum have been removed.

NOCOMMENT

* = tendinous wall of the adductor canal.

The Sartorius, Iliopsoas, Rectus, and Adductor longus have been cut away.

Preparation as in Fig. A316, but the Pectineus, Adductor brevis, Vastus medialis, and Gracilis are also cut away.

The Glutaeus maximus and medius have been cut away.

In addition to the Glutaeus maximus and medius, the Quadratus femoris, Obturator internus, long head of Biceps, and Semitendinosus have been cut away.

* = great sciatic foramen, the infrapiriform part.

** = bursa of Glutaeus medius.

NOCOMMENT

NOCOMMENT

NOCOMMENT

The Gastrocnemius is cut and reflected, the deep layer of the crural fascia is removed down to the laciniate ligament and the peroneal retinaculum.

The Gastrocnemius, Soleus and Plantaris are cut away.

Preparation as in Fig. A324, but, in addition, parts of the Popliteus and Flexor digitorum longus have been removed.

The transverse crural ligament is removed but the cruciate ligament is retained.

The crural fascia is removed down to the retinacula.

NOCOMMENT

The cruciate ligament is removed.

* = continuation of the tendon of the Peronaeus brevis to the little toe.

* = prolongations to the toes.

The plantar aponeurosis has been partly removed.

The Flexor digitorum brevis is partly removed, the tendon sheath of the Peronaeus longus and those of the toes are opened.

* = tendon sheaths of the toes opened.

** = deep head of Abductor digiti v.

In addition to the Flexor digitorum brevis the following are cut away: the Flexor digitorum longus, Quadratus plantae, Abductor digiti V, Abductor hallucis and the tendon of the Flexor hallucis longus.

+ = insertion of Abductor digiti V into the tuberosity of the fifth metatarsal.

NOCOMMENT

The Abductor hallucis and Flexor digitorum brevis are partly cut away.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

  1. an intestine that rests on the posterior abdominal wall;
  2. -5 intestines at a greater or less distance from the body wall.

The posterior abdominal wall is indicated by a black line, the vessels to the intestines are wavy black lines.

The serous membrane is red.

NOCOMMENT

NOCOMMENT

The mucous membrane is removed.

The cheeks have been cut through for a short distance from the angle of the mouth, the jaws are widely separated and the upper and lower lips drawn upwards and downwards.

The tongue is almost entirely removed; only the stumps of the Genioglossi and Hyoglossi are retained; the ramus of the mandible is cut transversely and the mucous membrane is cut away close to the gums.

* = portion of the submaxillary gland above the Mylohyoideus.

On the right the mucous membrane of the palate is partly removed to show the glands; on the left the glands also are removed to show the muscles of the soft palate.

* = openings of the palatine glands.

NOCOMMENT

The gum is slightly separated from the neck (collum) of the tooth to show more plainly the outer surface of the neck.

NOCOMMENT

c = canine, in = incisor, i = inferior, l = lateral, m = medial, mo = molar, pr = praemolar, s = superior.

Thus, for example, inil = incisor inferior lateral; prs2 = praemolar superior 2.

m =medial, l =lateral.

The axis is drawn through the root to show the asymmetry of the crown.

NOCOMMENT

NOCOMMENT

NOCOMMENT

The teeth in the upper row are shown from the labial or buccal side, the lower obliquely from this side and from below. The roots are not yet fully developed and show four different stages.

c = canine, d = deciduous, i =inferior, in = incisor, I =lateral, m = medial, mo = molar, pr = praemolar, s = superior. (For example, indil = incisor deciduous inferior lateral.)

NOCOMMENT

The not yet fully developed, non-erupted teeth have been exposed by chiseling away the anterior alveolar walls.

NOCOMMENT

NOCOMMENT

The permanent teeth and the roots of the milk teeth have been exposed by chiseling away the alveoli.

The permanent teeth and the roots of the milk teeth have been exposed by chiseling away the alveoli.

The permanent teeth are blue.

The same preparation as Fig. B23 and B24, but from the left side.

The anlagen of the permanent teeth are blue.

The roots and the not yet erupted teeth are exposed by chiseling away the alveolar walls.

The anlagen of the permanent teeth are blue.

The permanent teeth are blue.

All the teeth have erupted, except the lower third molars. The roots of the teeth have been exposed by chiseling away the alveolar walls.

On the right are given the dates of eruption, on the left the order of appearance.

On the right are given their dates of eruption, on the left the order of succession.

NOCOMMENT

NOCOMMENT

The mandible is divided to the right of the median line.

The Hyoglossus is divided and the Genio-hyoideus cut away.

On the right the Hyo-glossus is cut.

NOCOMMENT

NOCOMMENT

NOCOMMENT

The section passes about 0.5 mm to the right of the median plane, so that the septum nasi is cut only in its anterior part; posteriorly the mucous membrane of its right surface is seen. The musculature of the neck is only partly shown; the spinal cord is removed.

The skin, platysma and fascia are removed.

The skin, platysma and the superficial layer of the cervical fascia, which forms a capsule for the gland, have been removed. The lower parts of the Masseter and of the parotid gland are visible.

The sublingual glands in the figure appears to be a single gland (see Fig. B44). The mandible is divided in the middle line and the tongue removed as is also the Geniohyoid; the Mylohyoid is divided in the median line and the mucous membrane of the mouth drawn upwards.

* = flat prolongation of the submaxillary gland that lies above the Mylohyoid.

The anterior belly of the Digastric is cut away and the submaxillary gland is drawn backward.

The two Mylo-hyoids have been reflected over the hyoid bone, The Genio-hyoids cut away and the Genio-glossi divided close to their origin from the mandible. The greater and lesser sublingual glands are separated to show the difference in the behavior of their ducts (as in Fig. B42).

* = The process of the submaxillary gland that lies above the Mylohyoid.

The skull has been cut away by a wedge-shaped cut which passes through the occipital bone, the jugular fossa, and the mastoid process. The cervical vertebrae have been removed with the back part of the skull.

* = accessory bundle of the Superior constrictor from the base of the skull.

The hinder part of the body and the entire ramus of the mandible have been removed, as well as the mastoid process and the zygoma. The muscles of mastication and the greater part of the facial musculature is cut away, and so too the hyoid muscles, except the Genio-hyoid. The Bucinator is fully exposed and also the pterygo-mandibular raphe.

* = bundle of the Superior constrictor from the base of the skull.

The preparation is similar to that of Fig. B45 and B48. After removing the mucous membrane of the pharynx the Levator veli palatini is exposed on the left; on the right it is cut away to show the Tensor and the torus tubarius is cut away showing the cut cartilaginous part of the tuba auditiva. On the right the posterior belly of the Digastricus, the Stylo-pharyngeus and Styloglossus are cut and on the left the mucous membrane of the anterior pharyngeal wall is partly removed to show the posterior muscles of the larynx.

The posterior and lateral walls are reflected, horizontal cuts having been made in their uppermost portions.

* = the Levator swelling.

The skull is divided close to the median line, the tongue is drawn a little forward and the uvula is cut away.

NOCOMMENT

The Diaphragm and pylorus of the stomach are drawn upward; the stomach is rather strongly contracted. The superficial muscle bundles are seen through the serous coat.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

* = line of insertion of the oblique musculature.

  1. cardiac radiation on the fundus.
  2. medial longitudinal bundle.
  3. circular portion of the inner layer on the body.
  4. 4 = lower segmental loops.

After Forsell.

* = line of insertion of the oblique musculature.

4. lower segmental loops.

5. supporting loops.

6. fibers connecting the supporting loops.

7. cardiac fibers of the inner layer.

NOCOMMENT

The longitudinal musculature is entirely removed, the circular in the upper portion.

The musculature of the duodenum is not prepared.

Sounds are inserted into the openings of the bile duct and both pancreatic ducts.

The different coats are dissected away up to the submucosa with the duodenal glands.

The pylorus is above and to the right.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The positions of the taeniae from the inner surface are indicated by their names in parentheses.

The vermiform appendix is cut across at about the middle of its length and a sound (x) passed into the caecum.

The vermiform appendix is cut across near its root and a sound (x) inserted.

NOCOMMENT

NOCOMMENT

A solitary lymph node is shown near the middle, where the openings of the glands are wanting.

NOCOMMENT

The Diaphragm is cut away in the region of the coronary ligament. The area of the liver uncovered by peritoneum is recognizable by the roughness of its surface.

* = oesophageal notch.

NOCOMMENT

The inferior vena cava is cut open lengthwise.

* = surface uncovered by peritoneum.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The hilus in this case was on the gastric surface, close to the ridge separating the two medial surfaces.

(See also Fig. B86 and B87).

NOCOMMENT

The spleen is drawn away from the left kidney to show its renal surface. The peritoneum is removed except over the spleen. (The pancreas is lower than usual.)

1) Behind this is the left renal vein; passing downward is the splenic (lienal) artery and to the right the hepatic artery.

2) In the prolongation of this, above the pancreas, is the portal vein.

3) To the right is the hepatic artery. Between and behind both is the portal vein and behind this the inferior vena cava with the right renal vein.

The spleen is drawn away from the left kidney to show its renal surface. The peritoneum is removed except over the spleen. (The pancreas is lower than usual.)

The pancreatic ducts are exposed by cutting away the substance of the gland from the anterior surface; the duodenum is opened from in front.

* = opening of the greater pancreatic and common bile ducts.

* = boundary of peritoneum.

NOCOMMENT

Sounds are inserted into the inferior ileocaecal and upper retrocaecal recesses.

The mesocolon is put on the stretch by drawing the sigmoid colon upward and to the right.

The abdominal cavity is opened by crucial incisions. The skin and muscle flaps have been cut away above the costal arch; below they are reflected.

* = the transverse colon showing through.

The transverse colon is also drawn somewhat upwards. The preparation otherwise is as in Fig. B93.

colon I = the later ascending and transverse colons; colon 2 = the later descending and sigmoid colons and rectum.

In the mesogastrium I indicates the portion in front of the liver and 2 the portion behind it.

The vessels are black, the peritoneum red.

The liver is removed and the two layers of the ventral mesogastrium (lesser omentum) are cut.

The vessels are black, the peritoneum red.

Beginning of the formation of the final arrangement. The large intestine has surrounded the small and so has assumed its horse-shoe shape. The small intestine is greatly elongated and contorted; the stomach has attained its final position.

Peritoneum red, vessels black.

The preparation otherwise is as in Fig. B94. Sounds are placed in the duodeno-jejunal and ileocaecal recesses.

* = point of bifurcation of the abdominal aorta.

** = the external iliac artery.

The small intestine, except the duodenum and the terminal portion of the ileum, is cut away along the line of attachment of the mesentery. The transverse colon with the great omentum is drawn upward. A sound is passed into the inferior ileocaecal recess.

* = line of fusion of the great omentum with the transverse colon.

+ = flexures of the colon.

*+ = position of the retroperitoneal portion of the duodenum, in the region of its inferior flexure, visible only as a low elevation on account of fat tissue in the peritoneum.

+* = duodeno-jejunal fold.

++ = entrance to the pelvis.

+*+ = mesenteriole of the vermiform process.

Compare also Fig. B98.

The left lobe of the liver is drawn upwards and a sound (**) has been passed into the vestibule of the bursa omentalis, showing through the flaccid portion of the lesser omentum, as does also the papillary process of the caudate lobe of the liver. The anterior layer of the greater omentum (the gastro-colic ligament) is cut so that the inferior recess of the bursa omentalis is opened and one sees the transverse colon.

* = cut edge of the anterior layer of the great omentum.

** = sound in the epiploic foramen.

+ = caudate lobe of the liver showing through the lesser omentum.

The entire liver is drawn upwards, the hepato-duodenal ligament to the left to show the epiploic foramen and the stomach upwards, after cutting the gastro-colic ligament just below the greater curvature, thus opening into the bursa omentalis and exposing the pancreas. A sound is passed through the epiploic foramen and behind it is the hepato-renal ligament, made tense by raising the liver. This ligament passes over into the duodeno-renal ligament and thus with the hepato-duodenal ligament forms the boundary of the epiploic foramen. The sound is seen in the bursa omentalis through the flaccid portion of the lesser omentum, as is also the papillary process of the caudate lobe of the liver. At the isthmus of the bursa omentalis the sound appears again over the upper border of the pancreas (principal part of the bursa). The posterior surface of the stomach, covered by the peritoneum of the bursa omentalis, is seen over the greatest part of its extent.

** = sound in the epiploic foramen.

The liver is drawn upwards so as to show its lower surface and expose the lesser omentum. The flaccid portion of the lesser omentum is cut to give a view of the vestibule with the caudate lobe of the liver and the tuber omentale of the pancreas. A sound is passed through the epiploic foramen.

Preparation similar to that of Fig. B102, except that the lesser curvature of the stomach is drawn downwards and to the left, to show the isthmus of the bursa omentalis with the gastropancreatic fold. One looks, therefore into the main portion of the bursa omentalis.

The peritoneum is red, that of the bursa omentalis being also streaked with black. The parts of the primary parietal peritoneum obliterated by the pancreas taking a position on the posterior abdominal wall are not represented.

The peritoneum is red, that of the bursa omentalis being also streaked with black. The portions of the peritoneum that later disappear are shown by broken red lines and the portions of the peritoneal cavity that disappear are stippled with black.

The peritoneum is red, that of the bursa omentalis being streaked with black. The elongated circle indicates the epiploic foramen; the extension of the bursa omentalis to the left, to the lines of reflexion of the peritoneum from the stomach and pancreas (gastro-splenic and pancreatico-splenic ligaments) is to be noted.

A median section. The peritoneum is red, that of the bursa omentalis also streaked with black.

The transverse mesocolon has not yet fused with the great omentum (compare Fig. B105).

A median section. Peritoneum red.

The anterior abdominal wall and the anterior part of the Diaphragm are cut away by a frontal section, except for a lower left flap. The stomach is removed, except for the cardia and pylorus, and thereby the posterior wall of the bursa omentalis is exposed. The liver is completely removed and the parietal peritoneum, together with the ascending and descending mesocolon, is dissected away from the kidneys, the most of the duodenum, the great vessels and the musculature, but retained in the true pelvis, being split, however, for a short distance over the ureters. The diaphragm is represented as covered by the fascia transversalis, which has been removed from the Iliopsoas and the Quadratus lumborum. On the right the ductus deferens is exposed by opening up the inguinal canal down to the scrotum. The urinary bladder is rather strongly distended. The arteries are injected with red wax mass. The pancreas is higher than is usual (youthful condition).

* = cut edge of the peritoneum of the bursa omentalis.

The anterior abdominal wall is largely removed. Of the abdominal viscera the following have been removed: the stomach, the spleen, the large intestine, the small intestine up to the duodenum and the liver, except for a small portion in relation to the inferior vena cava. The mesentery has been removed with the intestine so that the lines of its origin from the parietal peritoneum are shown. The latter is left undisturbed, as are also the contents of the true pelvis. The so-called retro-peritoneal organs (pancreas, duodenum, kidneys and suprarenal glands) as well as the organs of the true pelvis are seen through the parietal peritoneum.

* = the so-called splenic compartment.

** = areas of contact of the ascending and descending colons with the posterior abdominal wall.

+ = bifurcation of the abdominal aorta.

++ = position of the promontary.

The anterior abdominal wall has been removed by a frontal section through the hip-joint and a horizontal one passing slightly above the umbilicus. The ligamenta teres and falciforme of the liver have been cut short.

* = the linea semicircularis (line of Douglas).

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

A sound is in the blind pouch-like rudiment of Jacobson's organ.

NOCOMMENT

NOCOMMENT

The section passes behind the eye-balls. Accessory nasal sinuses, maxillary sinus and ethmoidal cells.

The section cuts the cranial cavity above, below that the two orbits (behind the eye-balls) and between them the ethmoidal cells, with the upper part of the nasal cavity; below these the maxillary sinuses are cut and between these the lower part of the nasal cavity with the middle and inferior meatus. Beneath is the mouth cavity. The figure shows the spatial relations of the nasal cavities, their relative height and their great diminution in width above.

The section passes through the upper, very narrow part of the nasal cavities; in addition it cuts both orbits, the sphenoidal sinuses behind the nasal cavities, the ethmoidal cells between the orbits and the nasal cavities. Only the anterior parts of the skull and brain are shown.

* = frontal septum of the ethmoidal cells.

+ = conjunctival cleft.

NOCOMMENT

* = articular surface on the inferior cornu.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

* = foramen in the thyreo-hyoid membrane for the superior laryngeal nerve.

Hyaline cartilage is blue, elastic fibro-cartilage and hyoid bone yellow. The right crico-arytaenoid joint is opened.

NOCOMMENT

NOCOMMENT

The greater part of the left lamina of the thyreoid cartilage is cut away.

The left false vocal cord is drawn upwards, the mucous membrane of the left true vocal cord is divided.

NOCOMMENT

* = position of the tip of the vocal process.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

* = boundary between pharynx and oesophagus.

The gland, divided by deep notches, shows a well developed pyramidal lobe, arising from the left lobe and extending upwards to the hyoid bone. The isthmus is also exceptionally large.

The section passes through the isthmus of the thyreoid gland and shows clearly the investment of the gland by a connective tissue capsule and its topographic relations. It shows, further, the mutual relations of the trachea and oesophagus, the recurrent nerve lying in the groove between them, and the relations of the lateral lobes of the thyreoid gland to the great vessels of the neck and to the muscles of the tongue.

* = interior epithelial body.

** = sheath of the cervical vessels.

NOCOMMENT

* = tongue-shaped process of the upper lobe of the left lung which rests on the pericardium.

* = tongue-like projection of the upper lobe that rests on the pericardium.

NOCOMMENT

NOCOMMENT

NOCOMMENT

The anterior mediastinal pleurae have been entirely removed, the pericardial pleurae partly; the anterior borders of the lungs are greatly retracted. The left gland is decidedly the larger and shows a short cervical portion.

NOCOMMENT

The gland is exceptionally well preserved for this age.

* = continuation of the gland into the neck.

The thoracic wall has been removed back to near the mamillary line by cutting the ribs, etc. The pleural cavities are opened by the removal of the portion of the costal pleura corresponding to the portion of the costal wall that was removed. Above the thymus gland the large vessels and the trachea are exposed.

The thoracic wall has been removed back to near the mamillary line by cutting the ribs, etc. The pleural cavities are opened by the removal of the portion of the costal pleura corresponding to the portion of the costal wall that was removed. Above the thymus gland the large vessels and the trachea are exposed.

The preparation is similar to that of Fig. B153, B154, except that the pericardial pleurae have for the most part been removed, so as to expose the pericardium and thymus gland. With the same object the anterior borders of the lungs have been drawn back.

The preparation is similar to that of Fig. B153, B154, except that the pericardial pleurae have for the most part been removed, so as to expose the pericardium and thymus gland. With the same object the anterior borders of the lungs have been drawn back.

The pleurae is red, the pericardium blue.

NOCOMMENT

NOCOMMENT

* = endocardium.

NOCOMMENT

* = costo-mediastinal sinus.

NOCOMMENT

The pleural sacks, lungs, oesophagus and the vessels and nerves of the upper mediastinum. The trachea is cut close above its bifurcation and the terminal portion of the azygos vein opening into the superior vena cava is cut through almost its entire length; the arch of the aorta is cut, its convexity together with the great vessels arising from it being removed. One looks upon the upper surface of the section.

* = retrosternal fat with remains of the thymus gland.

By a sagittal section the ribs and clavicle are cut through and thereby the lateral wall of the pleural cavity is removed. The lung has been cut out close to the hilus. One looks into the empty pleural cavity, upon the parietal pleura covering all the walls of the cavity. The hemiazygos vein has in this case its principal outflow in a supreme intercostal vein.

* = opening of the azygos vein into the vena cava superior.

+ = anastomosis to the azygos vein.

NOCOMMENT

The portions that degenerate are indicated in red; earlier stages of development by dotted outlines.

The portions that degenerate are indicated in red; positions occupied before the descent by dotted outlines.

NOCOMMENT

* = accessory branch of the renal artery.

* = accessory branch of the renal artery.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The vessels and the fat tissue of the sinus are removed.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The bladder and prostate are opened from their anterior surfaces by a longitudinal incision and the bladder also by a horizontal cut.

* = openings of the prostatic glands. Sounds are placed in the openings of the ejaculatory ducts.

NOCOMMENT

The prostate is partly divided longitudinally to show the ejaculatory ducts.

The superficial musculature has been dissected away.

The sacrum and coccyx are divided a few centimeters from the median line and the peritoneum is dissected away from the lateral wall of the bladder.

The sacrum and coccyx are divided a few centimeters from the median line and the peritoneum is dissected away from the lateral wall of the bladder.

NOCOMMENT

The corpus cavernosum penis is blue, the corpus cavernosum urethrae, yellow.

The coverings of the testis, including the tunica vaginalis, are divided and drawn apart.

Preparation as in Fig. B189.

The tunica albuginea is mostly removed and the seminiferous tubules of the lower portion of the testis are frayed out. The ducts of the epididymis and the ductus deferens are dilated by an injection. The vessels of the testis are cut off short.

NOCOMMENT

* = cavity of the tunica vaginalis.

The left seminal vesicle is uncoiled.

* = the blind end of the vesicle.

X = the apparent end of the vesicle as it lies on the bladder.

The left vesicle and ampulla of the ductus deferens are divided frontally; the urethra is cut off at its exit from the bladder, so that one sees the concave base of the prostate.

On the left the cremasteric fascia is split and the Cremaster muscle exposed. On the right all the coverings of the spermatic cord are split and a window is cut in the tunica vaginalis. The penis is drawn upwards and its fascia and the superficial perineal fascia are partly removed, so that the anterior end of the Bulbo-cavernosus muscle is exposed.

The glans penis and the anterior part of the corpus cavernosum urethrae are raised.

* = point of contact of the two in the natural position.

The cavernous portion of the urethra is opened along its under surface.

** = sounds in the openings of the bulbo-urethral glands.

The skin of the penis is divided at the side and the prepuce is drawn away from the glans.

Corpus cavernosum urethrae, yellow; corpus cavernosum penis, blue.

Corpus cavernosum urethrae, yellow; corpus cavernosum penis, blue.

Corpus cavernosum urethrae, yellow; corpus cavernosum penis, blue.

Corpus cavernosum urethrae, yellow; corpus cavernosum penis, blue.

NOCOMMENT

NOCOMMENT

The pelvis is divided near the median line. On the left the ovary and tuba uterina are cut away and the urethra and fornix of the vagina are opened by oblique cuts.

The pelvis is divided near the median line. On the left the ovary and tuba uterina are cut away and the urethra and fornix of the vagina are opened by oblique cuts.

NOCOMMENT

NOCOMMENT

The right tuba uterina is in its natural position, the left is separated from the ovary by stretching the broad ligament.

The broad ligaments are moderately stretched and the uterus is drawn somewhat upwards.

The uterus and tuba are straightened.

NOCOMMENT

NOCOMMENT

NOCOMMENT

* = position of the parametrium.

The vagina is opened on its lateral surface.

The Bulbo-cavernosus is for the most part removed; the labia minora are retained up to the clitoris.

NOCOMMENT

The skin of the posterior part of the scrotum is cut away, as is also that of the perineum as far back as the medial bundles of the Glutaeus maximus; the fat is removed from the ischiorectal fossa.

* = union of the External sphincter ani with the Bulbo-cavernosus.

On the right side the Bulbo-cavernosus is fully exposed, but on the left only partly. The Ischiocavernosus is dissected only on the left side. Otherwise the preparation is the same as in Fig. B220.

* = union of the External sphincter ani with the Bulbo-cavernosus.

The pelvis is divided a few centimeters from the middle line, the vessels and nerves are removed, as are also the bladder and the greater part of the rectum.

The lower fascia is partly retained in order to show its connection with the musculature.

The inferior fascia is completely removed.

The portions of the vascular system carrying arterial blood are red; those carrying venous blood, blue; lymph vessels, black.

* Division of art. iliaca comm.

*** Anastomosis of vena azygos and vena hemiazygos.

NOCOMMENT

The pericardium has been cut away along the line of its reflexion upon the great vessels; these have been cut at a short distance from the heart.

* = bifurcation of the pulmonary artery.

The interior of the ventricle with the bicuspid valve is shown; also the interior of the aorta with the origins of the two coronary arteries from the lateral aortic sinuses. The left cusp of the semilunar valve is divided.

The left ostium venosum is opened and one looks into the cavities of the left ventricle and left atrium.

* = origin of the left coronary artery from the aortic sinus.

** = origin of the right coronary artery from the aortic sinus.

*** = myocardium of the ventricle.

One looks into the right ventricle and upon the right ostium venosum with the tricuspid valve. The semilunar valves of the ostium arteriosum are shown and also the interior of the pulmonary artery.

The cut passes through the right ostium venosum and shows the inner surfaces of the right ventricle and atrium. The right auricle is also opened to show the musculi pectinati.

* = the great vein of the heart.

** = the right border of the heart.

In the wall of the right ventricle a portion of the superficial layer is removed to expose the middle layer.

In the wall of the left ventricle a portion of the superficial layer is removed to expose the middle layer.

NOCOMMENT

The valves are shown in the closed position.

* = intermediate cusp.

View of the anterior half of the section from in front.

View of the posterior half of the section from behind.

The black line marks the incision made in Fig. B240

NOCOMMENT

The line of the incision is shown in Fig. B238.

* = Tawara's node (atrioventricular nodule).

NOCOMMENT

The pericardium is opened from in front. 1 and 2 after vena cava superior indicate the portions outside and within the pericardium.

The aorta and superior vena cava are drawn apart.

The pericardium has been divided from above downwards and the cut edges drawn apart. The eight vessels that arise from or enter the heart and penetrate the pericardium are cut so as to allow the removal of the heart. In this preparation there happens to be an especially deep pocket between the two left pulmonary veins.

* = Connection of the place of reflexion of the pericardium upon the vena cava inferior.

The vessels that contain so-called arterial blood are red; those that contain venous blood are blue; and those that contain mixed blood are violet. The arrows show the direction of the blood stream.

NOCOMMENT

A piece is cut out of the conus arteriosus and the beginning of the pulmonary artery, to show the left coronary artery.

NOCOMMENT

The skin is removed from the border of the mandible to below the clavicle and behind the Platysma the superficial layer of the cervical fascia is also removed.

* = external jugular vein covered by the Platysma;

** = accessory cutaneous branch of the cervical plexus.

The Platysma is divided, the upper portion reflected toward the lower jaw, the lower part removed; the fascia is split over the facial veins.

** = Anastomosis of the spinal accessory nerve with the cervical plexus.

+ = Connection of the external jugular with the deep veins.

+ + = The vena transversa colli, opening into the external jugular.

+* = Upper perforating branches of the internal mammary artery and vein, appearing between the two origins of the sterno-mastoid.

The superficial layer of the cervical fascia and the superficial veins have been removed, so that the superficial muscles are exposed. The superficial cervical artery was relatively weak in the subject from which the illustration was drawn and was partly replaced by the ascending branch of the arteria transversa colli; otherwise it was as in Fig. C7.

X = cut surface of the posterior auricular vein, the anterior jugular and the connection with the external jugular.

The Sterno-mastoid is removed except for small portions at its origin and insertion. The superficial veins of the neck have been removed (XX = cut surface of the external jugular near its opening; *=cut surface of the anterior jugular near its opening), as have also the common facial (X = cut surface near its opening) and smaller veins. The nerves of the cervical plexus have been cut, except the lesser occipital, the phrenic and muscle branches.

* = branch of the cervical plexus to form the ansa hypoglossi.

** = cut surface of the superior thyreoid vein.

+ = sterno-mastoid branch of the superior thyreoid artery.

The Omohyoid has been removed, also the internal jugular vein. (XX = its cut surfaces, X = the cut surface of the external jugular.) The Sterno-mastoid is turned upwards at its insertion and the Splenius capitis divided along the course of the occipital artery.

* = the thoraco-acromial vein cut at its opening into the cephalic vein.

NOCOMMENT

(Simplified from P. Eisler).

* = anterior thoracic nerves.

Compare Fig. C17.

The infrahyoid muscles and the common carotid artery have been for the most part removed, the clavicle has been disarticulated at the sterno-clavicular joint and divided at about its middle. The Pectoralis major and minor are cut and the Deltoid divided along the course of the thoraco-acromial artery.

+ = accessory sympathetic ganglion.

** = first rib.

* = branch of the spinal accessory nerve to the Sterno-mastoid (cut).

On the left side the Sterno-mastoid is cut and for the most part removed; the clavicular portion of the Pectoralis major is divided and the anterior belly of the Digastricus and the Mylohyoideus are cut. The rest of the superficial musculature is exposed.

* = Union of the external jugular vein with the common facial.

** = occipital root of external jugular vein.

+ = perforating branches of the internal mammary vessels.

On each side the Sterno-mastoid, infrahyoid muscles, Mylohyoideus and Digastricus have been cut away.

* = Point of formation of the right innominate vein.

** = posterior root of the external jugular vein.

+ = mucous membrane of the mouth.

+* = anastomosis of hypoglossal and lingual nervus.

X (on the vein) = opening of the anterior jugular vein into the external jugular.

The skin and fat have been reflected below the lower border of the Pectoralis major and the superficial fascia has been removed.

* = twigs of the thoraco-dorsal vessels that go to the chest wall and the Serratus anterior.

The Pectoralis major and the Sterno-mastoideus are cut and reflected.

* = phrenic nerve.

** = Scalenus anterior.

+ = clavicle.

* = ilio-hypogastric nerve.

** = connection between the azygos and hemiazygos veins.

+ = Lumbar ganglion of the sympathetic trunk.

* = trunk of the brachial plexus formed by the anterior ramus of the eighth cervical nerve and the principal part of the same ramus of the first thoracic nerve.

The thoracic wall is cut lateral to the mammary line; the right lung is divided in the plane of the section, the left partly in a deeper plane. The pericardial pleurae are dissected from the pericardium to show the phrenic nerves and the pleuro-pericardial vessels; half of the left innominate vein is removed and the musculature of the diaphragm split along the branches of the phrenic nerve.

The posterior thoracic and abdominal walls are removed by a frontal section and the viscera cut away; the portion of the diaphragm in front of the plane of section is retained. One looks from behind on the posterior surface of the anterior thoracic and abdominal walls. On the left only the arteries are shown; on the right the veins also. In addition the Transversus thoracis is removed on the right to expose the internal mammary vessels. The Rectus abdominis is divided over the branches of the epigastric vessels (superior and inferior) to show the anastomosis (XX).

The aorta is removed; the superior vena cava is cut just before it enters the pericardium and the inferior vena cava below the diaphragm. The latter is almost completely removed. On the right the internal intercostals are removed in two intercostal spaces.

* = transverse connection between the azygos and hemiazygos veins.

On the left the Trapezius, Sterno-mastoideus, Splenius and Levator scapulae are cut.

* = occipital tributary of the external jugular vein.

NOCOMMENT

On both right and left the Semispinalis capitis is cut to expose the suboccipital triangles; the veins are retained on the left. On the right the Trapezius is partly divided, on the left it is cut and the Rhomboidei partly divided.

* = branch of the dorsal scapular nerve to the Levator scapulae.

** = branch of the occipital vein to the mastoid emissary.

+ = connection between the occipital and external jugular veins.

+* = connection between the 2nd and 3rd cervical nerves.

I = Multifidus cervicis.

II = Semispinalis cervicis.

* = long head of Triceps.

The Deltoideus is partly cut away and reflected; a piece of the acromion is removed and the Supraspinatus, Infraspinatus and Teres minor are divided and partly separated.

* = branch of the axillary nerve to the Teres minor.

NOCOMMENT

NOCOMMENT

The skin and fatty tissue are removed but the fascia is retained.

* = anastomosis between the lateral antibrachia] cutaneous nerve and the superficial branch of the radial (musculospiral) nerve.

** = the radial artery seen through the fascia.

NOCOMMENT

* = accessory cutaneous branch of the axillary nerve.

** = anastomosis between the posterior brachial and the dorsal antebrachial cutaneous nerves.

*** = anastomosis between the dorsal antebrachial cutaneous and radial nerves.

+ = cutaneous branch of the posterior humeral circumflex artery.

+* = cutaneous branches of the thoraco-acromial vessels (rete acromiale).

NOCOMMENT

The Biceps is drawn outwards.

NOCOMMENT

* = cut twigs of the deltoid branch of the deep brachial artery.

** = lateral axillary foramen.

The lacertus fibrosus is cut and the Brachio-radialis drawn aside.

The Pronator teres, Palmaris longus and Flexor carpi radialis are partly removed and the tendon of the Flexor carpi ulnaris is cut.

+ = entrance of the deep radial nerve into the Supinator.

All the superficial flexors and pronators are cut away; the median nerve and the Flexor digitorum profundus are drawn ulnarly.

The flexors and pronators of the forearm are cut away or incised.

The radial group of forearm muscles is cut away and the Supinator divided over the deep radial (posterior interosseous) nerve.

* = the cut radial head of the Flexor digitorum profundus.

** = anastomosis of the ulnar recurrent artery with the inferior ulnar collateral.

The Extensor digitorum and the Extensor digiti V are drawn to the side.

The Extensor digitorum and Extensor digiti V are drawn strongly to the ulnar side. The Extensor pollicis longus is cut and the Supinator is divided for a short distance over the deep branch of the radial.

* = cutaneous branch of the ulnar nerve.

** = volar cutaneous branches of the median and ulnar nerves.

+ = volar digital artery of the thumb.

++ = anastomosis between the ulnar and radial nerves.

NOCOMMENT

The fascia is removed.

The tendons of the Extensors, with the exception of the Abductor pollicis longus and the Extensor pollicis brevis, have been cut and partly removed. The dorsal carpal ligament has been partly cut away and the first dorsal Interosseus is cut.

* = twig of the volar digital arteries.

** = twigs of the volar digital nerves bending around to the dorsal surface.

+ = entrance of the terminal branch of the radial artery into the palm.

The palmar aponeurosis is removed and the Abductor pollicis brevis divided along the superficial volar branch of the radial artery.

* = Anastomosis of the median and ulnar nerves.

The Abductor pollicis brevis, Adductor pollicis and Flexor digiti V are cut. The tendons of the Flexors, the median nerve, the superficial volar branch of the ulnar nerve and the superficial volar arch have been removed.

+ = articular branch of the deep branch of the ulnar nerve.

The branches of the facial nerve are black, those of the cervical nerves white, those of the ophthalmic division of the trigeminus yellow, those of the maxillary division blue and those of the mandibular division green.

A portion of the platysma is removed and the Quadratus labii superioris is cut.

A portion of the platysma is removed and the Quadratus labii superioris is cut.

The parotid gland is largely removed and a number of facial muscles are either cut or divided for a distance or partly removed.

The branches of the facial nerve are black, those of the cervical nerves white, those of the ophthalmic division of the trigeminus yellow, those of the maxillary division blue and those of the mandibular division green.

The parotid gland is largely removed and a number of facial muscles are either cut or divided for a distance or partly removed.

The masseter is divided in the middle and reflected; the two layers of the temporal fascia are reflected from the upper border of the zygoma; the parotid gland and a facial nerve are completely removed; several of the facial muscles are removed; and the mandibular canal is opened.

* = anastomosis between the supra- and infratrochlear nerves.

** = tributary to the posterior facial vein from the pterygoid plexus.

The zygoma is removed, the Temporalis with the coronoid process of the mandible is reflected upwards, the neck of the mandible is removed, the outer ear is cut away and the mandibular canal is opened throughout its entire length.

* = anastomosis between the infra- and supratrochlear nerves.

** = branches to the buccinator muscle which pierce the muscle to supply the mucous membrane of the cheek.

+ = mylohyoid nerve.

X (on the vein) = cut connection with the external jugular vein.

NOCOMMENT

The preparation as in Fig. C56, except that the insertion of the Temporalis and the coronoid process of the mandible are completely removed and the muscle divided over the temporal arteries.

++ = the deep auricular and anterior tympanic arteries.

+* = deep auricular branches of the auriculo-temporal nerve.

The preparation as in Fig. C58, except that the condyloid process of the mandible is disarticulated; the right half of the mandible and the lower half of the Bucinator have been almost entirely removed.

+ = posterior auricular nerve. ** = nerves to the external auditory meatus from the auriculotemporal.

* = digastric branch of the facial nerve.

+ + = Mylohyoideus cut.

+-+ (on the artery) = cut surface of the internal maxillary artery.

Շ󔇳 (on the artery) = ascending palatine artery.

Շ󠽠stump of the Sterno-mastoid artery.

+*=submaxillary duct.

The roof of the orbit and the periorbita are removed, also the upper part of the lateral wall. The dura mater is divided along the course of the middle meningeal artery and over the semilunar ganglion and nerves to the orbital muscles.

* = accessory branches to the lacrimal gland from the zygomatico-orbital branch of the superficial temporal artery.

The preparation as in Fig. C60, except that the frontal nerve is almost completely removed, as is some of the orbital fat on the lateral side. The rectus superior and Levator palpebrae superioris are drawn aside.

Obliquus superior and Levator palpebrae superioris are cut. The Rectus lateralis is drawn aside.

* = branch of oculomotor to Rectus medialis.

Preparation as in Fig. C62, but, in addition, the Rectus lateralis, the optic nerve and the anterior end of the ophtalmic artery are cut. The eyeball, with the stump of the optic nerve is reflected forward, to show the branching of the inferior branch of the oculomotor nerve; furthermore, the canals for the anterior and posterior ethmoidal arteries and nerves are opened.

+ = zygomatic nerve.

++ = arteria carotis interna.

** = branch of the oculomotor to the rectus inferior.

*** = to the Obliquus inferior.

* = sphenoidal sinus.

The tongue is displaced and the nasal septum removed except in its lowest part; the mucous membrane of the isthmus of the fauces is divided over the glossopharyngeal nerve and the ascending palatine artery.

* = Sphenoidal sinus.

+ = cut branches to the nasal septum.

** = connection of the naso-palatine and anterior palatine nerves.

*+ = mucous membrane of the hard palate.

The preparation as in Fig. C65. In addition the pterygo-palatine and pterygoid canals are opened and the pyramid of the temporal bone is divided obliquely. The tongue is removed.

The preparation as in Fig. C66, but the body of the sphenoid is almost completely removed, the foramen ovale and the palatine foramina opened, the temporal bone sawed away as far as the jugular foramen, the Pterygoideus internus cut and the soft palate removed.

+ (in white on the middle meningeal art.) = the lesser superficial petrosal nerve (cut).

The nerves contained in bony canals are grey, the others black.

The orbit is opened from the lateral side by a sagittal section and its contents removed; the pterygoid canal is opened; the temporal bone is sawn through obliquely; the tympanic cavity and facial canal are opened.

* = lateral plate of the pterygoid process.

** = infraorbital nerve with the zygomatic nerve resting upon it.

+ = the caroticotympanic nerve.

++ = connection between the facial and tympanic nerves.

*+ =connection between the greater and lesser superficial petrosal nerves.

The orbit is opened from the medial side, about half its wall being cut away; its contents, except the lacrimal gland and the nerves in question, have been removed.

o = position of the inferior orbital fissure.

oo = entrance of the zygomatic nerve into the zygomatic bone.

The canalis facialis opened, the tympanic cavity with the proc. mastoideus is sawed through from behind.

On the right arc veins and arteries, on the left the nerves and some of the arteries are shown. The posterior part of the skull is removed by a section passing through the jugular foramina. The sympathetic cord is shown only on the right side.

The nerves are schematically projected on Fig. A70.

The mucous membrane of the anterior wall of the larynx is removed, as is also that of the tongue over the glosso-pharyngeal nerve.

The veins of the tongue are shown on the left, on the right the Hyo-glossus is cut.

The abdominal cavity is opened, its anterior wall being cut and reflected; the great omentum is left in position; the left and right lobes of the liver are drawn upward, the coeliac artery is exposed at its origin, the anterior layer of the great omentum is divided along the greater curvature of the stomach, the lesser omentum and the peritoneum of the vestibule of the bursa omentalis are removed.

* = cut edges the great omentum.

Preparation as in Fig. C76. The stomach is turned upwards after cutting through the anterior layers of the great omentum, so that its posterior surface looks forward; the pancreas is divided over the superior mesenteric vessels.

* = cut edge of the gastro-colic ligament at the greater curvature of the stomach; above is the inferior portion of the duodenum.

** = cut edge of the lesser omentum at the lesser curvature of the stomach.

The transverse colon with the great omentum is reflected upwards, the coils of the small intestine are drawn aside, the ascending mesocolon is completely and the transverse mesocolon partly removed; the right layer of the mesentery is removed.

* = cut edge of the transverse mesocolon.

** = retro-peritoneal fat in the region of the ascending mesocolon.

Preparation as in Fig. C78 except that the coils of intestine are displaced to the right, the branching of the inferior mesenteric vessels is exposed by removing the parietal peritoneum in the region of the descending mesocolon and cutting out portions of the pancreas and the transverse mesocolon.

* (on the artery) = abdominal aorta.

** = bifurcation of abdominal aorta.

*** = cut edges of the transverse mesocolon.

+ = the promontory.

*+ = inferior pancreatico-duodenal artery (the branches to the pancreas are cut off).

All the abdominal viscera are removed and the unpaired branches of the aorta and the renal arteries cut. On the left, portions of the common iliac vessels and their branches have been removed and the Psoas has been dissected away to show the lumbar plexus. On the right only the peritoneum and the fascia transversalis have been removed. The stump of the right renal artery has been drawn out from behind the inferior vena cava.

After P. Eisler.

The abdominal cavity is opened, below by two reflected flaps, above by the removal of the anterior and lateral walls. All the abdominal viscera have been removed except the kidneys, suprarenal bodies and ureters. By removing the parietal peritoneum and the fascia transversalis the muscles of the anterior surface of the posterior abdominal wall are exposed. The nerves are not represented. In the true pelvis also the peritoneum and fascia have been removed, but not the viscera. The left lower flap of the abdominal wall still retains its parietal peritoneum, but on the right this has been partly removed to show a portion of the rectus abdominis muscle.

* (after ureter) = spindle of ureter.

** = junction of the two common iliac veins to form the inferior vena cava.

(In part from Schultze-Lubosch.)

The antero-lateral abdominal wall is separated from the ilium along the iliac crest. The viscera, except those of the true pelvis, are removed as is also the peritoneum from the false pelvis, except in the regions of the femoral and inguinal rings. The fibrocartilage between the third and fourth lumbar vertebrae has been cut through and, at the same level, the musculature of the posterior abdominal wall. The thin portion of the posterior layer of the sheath of the Rectus that is below the linea semicircularis has been removed.

* = Transverse Section of the long dorsal musculature.

The left half of the pelvis has been almost entirely cut away by a sagittal section and the vessels passing to the rectum and genitalia from the left side have been cut. The peritoneum has been removed except where it covers the abdominal wall.

X = left ureter cut shortly before its entrance into the bladder.

XX = left ductus deferens.

Preparation as in figure C84. The left ovary and tuba uterina are drawn downwards and forwards, those of the right side upwards.

* = vaginal branches of the inferior vesical artery.

** = right ovary.

+ = left ureter cut shortly above its entrance into the bladder.

From the penis the skin and fascia have been largely removed; the coverings of the right spermatic cord have been divided to show the vessels of the cord.

The lower part of the broad ligament is removed, the left ovarian ligament is cut and the peritoneum of the mesosalpinx is divided along the vessels.

The pelvis is divided in the median line and the pelvic viscera are removed.

* = branches to Coccygeus.

** = branch to the Levator ani, cut.

+ = position of the abdominal inguinal ring.

++ = branches to the Piriformis.

The superficial perineal musculature is exposed and the fat is removed from the ischio-rectal fossa. On the left the Transversus perinei superficialis and the urogenital diaphragm are divided and the Ischio-cavernosus drawn laterally.

* = point of division of the internal pudendal artery into the perineal artery and the artery of the penis.

On the right the Bulbo-cavernosus is partly removed and the bulbus vestibuli exposed. The Transversus perinei superficialis is cut and the urogenital diaphragm divided.

** = roots of the internal pudendal vein from the bulbus vestibuli.

NOCOMMENT

* = connection with deep veins.

** = connection with the small saphenous vein.

* = anastomotic veins from the great saphenous.

The fascia is divided along the small saphenous vein and the lower part of the posterior femoral cutaneous nerve.

** = opening of the small saphenous vein into the popliteal.

*** = connection of the small saphenous with the deep veins.

The fascia only is removed.

* = branch of the femoral nerve to the Pectineus.

The Sartorius and Pectineus are cut.

* = branch of the obturator artery to the hip joint.

Preparation as in Fig. C96, but the Rectus femoris and Adductor longus are also cut.

** = stronger muscular branch of the deep femoral artery.

From Schultze-Lubosch, Topographische Anatomie.

The fascia is removed except over the gluteal region; the Biceps femoris is drawn aside to expose the sciatic nerve.

Only the fascia is removed.

* = connection of the small saphenous vein with branches of the deep femoral vein.

The Glutaeus maximus is divided and reflected, also the long head of the Biceps.

* = connection of the small saphenous with the deep veins of the thigh.

** = long head of the Biceps cut.

The Glutaeus maximus, Glutaeus minimus and Quadratus femoris are cut, and also the sciatic nerve.

* = muscular branch to the Gemelli.

** = to the Quadratus femoris.

+ (on the Figure) = the lesser trochanter.

* (on the Figure) = tuberosity of the ischium.

NOCOMMENT

The Gastrocnemius is divided and reflected.

The Gastrocnemius is divided and reflected. The Soleus is divided and drawn aside.

Preparation as in Fig. C104, except that the popliteal canal is opened and a portion of the lower part of the Flexor hailucis longus is cut out. The tibial nerve is drawn aside.

* = muscular branch.

The Peroneus longus and Extensor digitorum longus are cut to show the division of the common peroneal nerve. The Extensor hallucis longus and the peroneal nerve are drawn aside and one limb of the cruciate ligament is removed.

The two heads of the Gastrocnemius and the Soleus are cut and a portion of the Biceps and of the Semimembranosus is removed.

* = anastomosis with the deep veins.

** = terminal branch of the saphenous nerve.

NOCOMMENT

The cruciate ligament is removed and the greater part of the following muscles : Extensor digitorum longus, Extensor digitorum brevis, Extensor hallucis brevis. The superficial nerves are removed down to the toes.

+ = lateral (motor) terminal branch of the deep peroneal nerve.

++ = articular branches.

The laciniate ligament is divided.

* = plantar cutaneous branch of the medial plantar nerve.

** = plantar cutaneous branches of the lateral plantar nerve.

The Abductor hallucis is divided and the Flexor brevis digitorum with the plantar aponeurosis is for the most part removed.

* = branch to the Flexor digitorum brevis.

** = branch to the Quadratus plantae.

*** = cutaneous branch, cut.

Preparation as in Fig. C112, but the tendon of the Flexor hallucis longus, the Quadratus plantae and the tendons of the Flexor digitorum longus, the oblique head of the Adductor hallucis and the medial plantar nerve are also cut.

After Braeucker.

The cranial cavity has been opened and the brain removed. The skin and facial musculature is completely removed and the orbit opened from the lateral side; the base of the skull is cut away up to the foramen rotundum and the temporal bone cut along the facial canal. Only the anterior part of the mandible is retained; the zygomatic bone and arch, with the muscles of mastication, are removed and also parts of the maxilla. In the orbit, in addition to the nerves to the orbital muscle, branches of trigeminus I are shown and some branches of trigeminus II; of trigeminus III only the lingual nerve is fully retained. In the neck, by the removal of the Sternomastoideus and the internal jugular vein, the glossopharyngeal, vagus and hypoglossal nerves are shown.

* = lacrimal artery.

** = facial canal.

*** = palatine nerve.

+ = anastomotic branch to glossopharyngeal nerve.

+* = part of submaxillary gland above the Mylohyoideus.

*+* = wall of carotid canal.

**+ = submaxillary duct.

After Braeucker.

In the neck the superficial muscles and the blood-vessels, except the upper part of the common carotid artery, have been removed. The vagus nerve is drawn somewhat forward in order to expose the cervical portion of the sympathetic trunk. In the thorax the wall has been removed up to the vertebral column and the posterior parts of the ribs. The (right) lung is reflected so as to show the oesophagus throughout its whole length; the great vessels are cut away up to the origin of the innominate artery and a part of the superior vena cava.

1 after ansa subclavia indicates its posterior and 2 its anterior limb.

After Braeucker.

The figure follows immediately on Fig. C115, the preparation differing only in that the vena azygos and the descending thoracic aorta are retained and the thoracic duct (green) is shown.

* = thoracic ganglion XI of the sympathetic trunk.

The anterior thoracic wall is removed by a frontal section; the veins are excised and of the arteries only the aorta and some of its branches are retained. The thoracic viscera up to the main bronchi and the abdominal viscera, except the stomach, have been removed.

The anterior abdominal and pelvic walls have been cut away and the lumbar plexus exposed by removing the Psoas major; the aorta is retained as far as its bifurcation.

* = visceral branches of the pudendal plexus.

Viewed from behind. The skin and dorsal muscles have been removed; the vertebral arches have been cut away and also the greater part of the vault of the skull. The membranes of the brain and cord have been removed.

NOCOMMENT

The dura mater is opened.

The anterior roots are cut close to their origin from the cord.

Motor cells and fibers red; posterior roots with collaterals and posterior funicular fibers blue; tract cells black. The arrows indicate the direction of the tracts.

The dura mater blue, arachnoid and pia mater red. The spinal cord and nerve roots are schematic.

Red denotes the pyramidal tracts with their collaterals, nerve cells and root fibers.

* = direct. ** = crossed pyramidal tract; blue denotes the posterior root fibers with their collaterals and, in addition, the column of Goll (crosshatched), the column of Burdach (striated) and the dorsal spinocerebellar tract (stippled).

White substance: on the right the principal conducting paths are outlined; on the left ascending paths are blue, descending red; intrinsic fibers violet. The solid blue in the blue cross hatched posterior funiculus is the comma bundle; the solid red between dotted and cross hatched red in the lateral funiculus is the rubro-spinal tract.

Grey substance: On the left the grouping of the cells is shown; on the right the motor root fibers are red, the sensory are blue and the tract fiber cells black.

White substance: on the right the principal conducting paths are outlined; on the left ascending paths are blue, descending red; intrinsic fibers violet. The solid blue in the blue cross hatched posterior funiculus is the comma bundle; the solid red between dotted and cross hatched red in the lateral funiculus is the rubro-spinal tract.

The dura mater is shown unopened below, above the arachnoid is removed.

NOCOMMENT

NOCOMMENT

The dura mater is opened lengthwise.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The left orbit is opened by the removal of its roof, the superficial muscles and nerves of the orbit are removed to show the arrangement of the veins; on the right the tentorium cerebelli is removed, the terminal portion of the transverse sinus is opened and the dura mater is divided over the issuing nerves and the middle meningeal artery.

* = the meningeal nerve and its anastomosis with the spinosal nerve.

** = cut edge of the tentorium.

The skull is divided horizontally almost to the middle line and then sagittally; the brain is removed, but the hypophysis is left in position in the sella turcica. On the left a large and on the right a smaller portion of the tentorium is removed. The veins are blue, the arteries red, the nerves white.

* = internal carotid artery.

+ = hypophysis.

+* = optic nerve.

A portion of the dura mater is retained along the superior sagittal sinus, the sinus itself is opened and also a lateral lacuna on the right.

* = openings of veins into sinus.

  1. after the name of the artery denotes its emergence from the foramen lacerum;
  2. its S-shaped bend beside the sella turcica;
  3. 3. its passage upon the brain.

NOCOMMENT

The dura mater is white, the pia mater red.

The dura mater is white, the pia mater red.

NOCOMMENT

Arrows are placed in certain of the cisternae; the lower end of the medulla oblongata is cut.

The dura mater is black, the pia mater and arachnoid red, the veins blue.

NOCOMMENT

On the right the tip of the temporal lobe, the cerebellum and the optic nerve have been removed.

* = branches of the pons.

The left cerebral hemisphere has been removed by a medial section through the corpus callosum, etc. and by and oblique section of the brain stem (*).

On the left the whole semilunar ganglion is retained. The hypophysis is drawn somewhat backwards, to show the infundibulum. The roman numerals denote the cranial nerves.

NOCOMMENT

After the model by W. His.

  1. optic recess.
  2. optic chiasma.
  3. hypophysis.
  4. infundibular recess.

After the model by W. His.

There is as yet no corpus callosum.

The cerebellum and brain stem have been removed.

The cerebellum and brain stem have been removed.

  1. behind the interparietal sulcus indicates the oblique portion of the sulcus, the transverse limb marking out the posterior central gyrus.

NOCOMMENT

NOCOMMENT

The brain stem and cerebellum are removed.

The brain stem and cerebellum are removed.

The brain is divided in the median line and the brain stem, and cerebellum removed by an oblique cut passing through the thalamus.

The brain is divided in the median line and the brain stem, and cerebellum removed by an oblique cut passing through the thalamus.

The gyri of the insula are exposed by cutting away the portions of the frontal, parietal and temporal lobes that cover them.

The brain is divided in the median line and the brain stem and cerebellum are removed by an oblique cut passing through the thalamus; so much of the hippocampal gyrus is removed as is necessary to expose the fimbria and dentate fascia; the pars tecta of the pillars of the fornix and the thalamo-mamillary fasciculus are exposed by removing the lateral wall of the third ventricle to the corpus mamillare. The view is medial and from below.

The cerebral hemispheres are cut away to the level of the centrum semiovale; on the right the insula is exposed; anteriorly and posteriorly a certain amount of brain tissue has been removed to show the genu and splenium of the corpus callosum.

Preparation similar to that of Fig. C162, except that the roof of the lateral ventricle has been removed.

Preparation as in Fig. C162, except that somewhat more brain substance and the middle portion of the corpus callosum are removed. On the left the chorioid plexus is cut and reflected.

The trunk and splenium of the corpus callosum, the body of the fornix and the tela chorioidea of the third ventricle have been removed. The hemispheres have been cut across transversely a little below the corpus callosum, and the left temporal lobe has been cut away as far as the tip of the inferior cornu. A sound passes through the interventricular foramen.

Preparation as in Fig. C164, except that the inferior cornu is opened on both sides and the splenium of the corpus callosum is removed.

Preparation as in Fig. C164 and C166, except that the corpus callosum and fornix are cut and reflected, after cutting through the septum pellucidum. In this way the transverse fissure and tela choroidea of the third ventricle are exposed. The corresponding cut surfaces of the corpus callosum, fornix and septum pellucidum are indicated by the numbers 1, 2.

Preparation as in Fig. C166.

The relations of the hippocampus and the hippocampal gyrus and fimbria are shown. Preparation as in Fig. C168.

From behind and above.

Preparation as in Fig. C169 and C170, except that the uncus is displaced to show the band of Giacomini.

+ = Band of Giacomini.

* = Section-surface of the anterior end of the hippocampus.

The passage of the dentate fascia into the fasciola cinerea is shown.

** = Transverse Section of the gyrus dentatus.

+* = Transverse Section of the fimbria hippocampi.

Preparation as in Fig. C166, but the corpus callosum, the tela chorioidea of the third ventricle and the temporal and occipital lobes of the cerebral hemispheres have been removed.

The anterior ends of both temporal lobes are cut away and the optic nerves are cut close to the chiasma. A portion of the left optic tract is removed. The roots of the cranial nerves are retained on the left side.

3 = oculomotor, 6 = abducens.

NOCOMMENT

NOCOMMENT

The brain stem has been removed by a transverse section passing through the anterior colliculi.

Compare Fig. C149.

* = tuber cinereum.

NOCOMMENT

The corpus striatum, thalami and third ventricle are exposed by the removal of the corpus callosum, the fornix and the tela chorioidea of the third ventricle. The cerebellum is removed on the left side up to the flocculus, on the right side a part of the medullary substance and the hemisphere. The tela chorioidea of the fourth ventricle is divided in the middle line and reflected.

* = position of the interventricular foramen.

Red: pyramidal tracts (broad line crossed, narrow line direct) and motor cells of the anterior column of the spinal cord.

Blue: in central hemisphere: short association paths and the central tegmental path; in spinal cord: sensory path of the posterior funiculi; in brain stem: the lemniscus; in cerebellum: fibers from dentate nucleus to red nucleus.

Yellow: in spinal cord and brain stem: the rubro-spinal tract (Monakow); in hemisphere: frontal and occipitotemporal cerebro-pontile tracts.

Centrifugal paths red or yellow; centripetal blue.

Red: thalamic peduncle, tectospinal path (ventral and lateral) and tectobulbar tract.

Blue: fibers from the cerebral cortex to the caudate nucleus, from nucleus ruber to the thalamus; spinocerebellar and spino-tectal tracts.

Yellow: fiber bundles from the cerebral cortex to the nucleus ruber and the corpora quadrigemina, from the pons nuclei to the cerebellar cortex.

While the cerebellum, medulla oblongata and pons, as well as the region of the midbrain remain undisturbed, the bulk of the cerebral hemispheres is so far removed as to expose the anterior commissure. Only the middle portion of the commissure is seen; its final radiations are not represented.

On the left the section through the hemisphere is somewhat dorsal to that on the right. I, II, III indicate the anterior, medial, and lateral nuclei of the thalamus.

Red: On the right: pyramidal tracts (heavy line crossed, light line, direct) and a motor cell of the trigeminus; on the left: the corticobulbar tract to the latter.

Blue: cerebro-pontile tract and fibers from the thalamus to the cortex.

Yellow: motor nerve cells of the facial nerve and the fibers of the cortico-bulbar tract leading to them.

In the basis of the peduncles the pyramidal tracts are red; the frontal cerebro-pontile tract blue; the occipito-temporal cerebro-pontile tract violet. In the tegmentum the lateral lemniscus is red, the medial blue.

On the left is shown the arrangement of the paths traversing the internal capsule, in the anterior limb: the anterior thalamic radiation yellow, the frontal cerebro-pontile tract blue, the cortico-bulbar tract red striated (the genu of the capsule). In the posterior limb: the pyramidal tract for the arm red, for the leg cross hatched red ; the tegmental path and the occipito-temporal cerebro-pontile tract violet; the central optic and auditory paths yellow.

In addition the following are shown:

  • Yellow : fibers from the cortex to thalamus (left) and vice versa (right), passing partly through the internal capsule, partly through the lenticular ansa ; fibers from anterior colliculus and thalamus to occipital cortex (central optic radiation).
  • Blue : fibers from the posterior colliculi and medial geniculate body to temporal cortex (central auditory tract).
  • Red : fibers from visual cortex to the primary optic centre and from the auditory cortex to the auditory centers in the midbrain; fibers from the cortex to the caudate nucleus and nucleus ruber.

On the left the section passes through the thalamus; on the right, about 1 cm deeper through the corpora quadrigemina and the hypothalamic nucleus.

Compare Fig. C205.

The pia mater and blood vessels are retained.

* = small arterial twig.

Chorioid plexuses and pia mater red, ependyma blue.

Red: thalamic peduncle.

Blue: fibers from the cortex to the corpus striatum (caudate nucleus and putamen) and from the latter to the thalamus.

Yellow: On the right: fibers from the globus pallidus to the thalamus and from the thalamus to the cortex (lenticular ansa); on the left: from the cortex to the nucleus ruber and the corpora quadrigemina.

On the right: yellow = lenticular ansa; yellow + red = the peduncular ansa.

On the left the course of the medial fillet (sensory path of the spinal cord), the spinal ganglion cells and the nuclei of the posterior funiculi, blue; the sensory cranial nerves, red; the spino-thalamic tract, yellow; and its continuation (the central tegmental tract from the thalamus to the cortex), blue.

On the right (and in Fig. C194) the acoustic path and the connections of the corpus striatum and thalamus, blue; the beginnings of the central visual path and callosal fibers, red.

NOCOMMENT

One looks upon the posterior surface of the section.

One looks upon the posterior surface of the section.

The section passes through the anterior part of the third ventricle close behind the anterior commissure. One sees the anterior surface of the section.

V (red) = trigeminal nerve.

Blue: fibers of posterior funiculus of spinal cord, cells of the nuclei of the posterior funiculi and their fibers to the thalamus; continuation of the medial fillet to the cortex (central tegmental path).

Red: sensory cells of the glossopharyngeus - vagus and trigeminus and the course of their fibers in the medial fillet to the thalamus.

Yellow: cells and fibers of the spino-thalamic tract.

Red: pyramidal tracts (heavy line the crossed tract; light one the direct tract) and motor cells of the anterior column; also fibers from the dentate nucleus to the corpora quadrigemina.

Blue: fibers from the pons nuclei to the cerebellar cortex and the occipito-temporal cerebro-pontile tract.

Yellow: cerebello-olivary fibers and the frontal cerebro-pontile tract.

Red and blue: paths of the crossed and uncrossed fibers and their connection with the oculomotor nucleus.

Yellow: oculomotor nucleus and oculomotor nerve roots.

Red: fibers from the dentate nucleus of the cerebellum to the thalamus and red nucleus and their crossing in the decussation of the brachia conjunctiva; also, as a broken circle, Deiter's vestibular nucleus.

Blue: thalamic radiation, fibers from the pons nuclei to the cerebellar cortex and from this to Deiter's nucleus and the dentate nucleus; also association fibers of the cerebellum; as a broken line, the cortex of the vermis.

Yellow: the lenticular ansa (yellow and blue, right = ansa peduncularis) and fibers ascending to the cerebellar cortex through the restiform body from the spinal cord and medulla oblongata.

Red: Flechsig's lateral cerebellar tract, the cerebello-olivary fibers, fibers of the brachium conjunctivum to the nucleus ruber and thalamus.

Blue: sensory path of the posterior funiculi, with its continuation from the nuclei of the posterior funiculi to the cerebellar cortex; Gower's lateral cerebellar tract; also (by a broken line) the olive.

Yellow: fibers of the brachium pontis and fibers from the anterior colliculi to the pons.

Red: lateral cerebellar tract and the associated fibers that pass from the cortex of the vermis and the dentate nucleus to the red nucleus and thence to the thalamus; also callosal fibers.

Blue: sensory path of the posterior funiculus, nuclei of the posterior funiculi and their connection with the thalamus; the connection thence to the cerebral cortex; also (broken line) the cortex of the vermis.

Yellow: the spino-thalamic tract.

Red: pyramidal tract.

Blue: tecto-spinal and rubrospinal tracts.

Yellow: lateral and anterior vestibulo-spinal tracts; the region of Deiter's vestibular nucleus is indicated by a broken yellow circle.

The anterior surface of the section is shown.

* = faciculus pedunculo-mamillaris.

The cerebellum and pineal body are removed; the posterior end of the thalamus is shown.

* = position of the facial colliculus.

The cerebellum and pineal body are removed; the posterior end of the thalamus is shown.

The motor nuclei and roots are shown (red, red broken lines represent roots of the hypoglossal).

The general sensory nerves are indicated by blue, those of the special senses by violet (the cochlear nerve however, by blue).

The sensory nuclei blue, the motor red; of the sensory nuclei those of the optic and vestibular nerves are violet, that of the cochlear nerve blue. The motor nuclei are on the left side, the sensory on the right. The different vestibular nuclei are not distinguished.

After M??ller-Spatz.

NOCOMMENT

The somewhat oblique section has also cut a part of the superficial layer of the pons. From preparations stained with Weigert's medullary stain. The white substance (nerve fibers) dark, grey substance light.

White substance dark, grey substance clear.

Of the facial nerve only the second part is cut lengthwise and the genu obliquely; the first part is not visible. Laterally is the brachium of the pons, separated from the cerebellum.

After M??ller-Spatz.

In general the descending paths are yellow or red, the ascending paths blue.

After M??ller-Spatz.

In general the descending paths are yellow or red, the ascending paths blue.

After M??ller-Spatz.

* = brachium.

? = fibers from the cerebellar cortex to the pons nuclei.

?? = pontocerebellar fibers.

After M??ller-Spatz.

* = cells of origin of the cochlear nucleus (spiral ganglion).

? = fibers from the dorsal cochlear nucleus decussating to join the lateral lemniscus.

Dotted blue area in middle line = the medial longitudinal bundle (a fiber is shown passing to it from the vestibular nucleus).

Blue lines crossing the middle line = fibers from the sensory trigeminus nucleus to the middle fillet.

The roman numerals indicate the nuclei of cranial nerves (a after VIII denotes the vestibular and b the cochlear nucleus.

= position of the ala crinerea).

White substance dark, grey substance light.

* = position of the ala cinerea.

The roman numerals indicate the cranial nerve nuclei. White substance dark, grey substance light.

NOCOMMENT

After M??ller-Spatz.

? = semicircular canal.

?* = olivocerebellar fibers.

?? = fibers from the nucleus of the solitary tract to the middle fillet.

* = fibers from the vestibular nerve to the triangular nucleus.

** = the same to the lateral nucleus.

*?* = afferent fibers to the visceromotor vagus nucleus.

After M??ller-Spatz.

? = semicircular canal.

?* = olivocerebellar fibers.

?? = fibers from the nucleus of the solitary tract to the middle fillet.

* = fibers from the vestibular nerve to the triangular nucleus.

** = the same to the lateral nucleus.

*?* = afferent fibers to the visceromotor vagus nucleus.

After M??ller-Spatz.

After M??ller-Spatz.

The roman numerals denote the nuclei of the cranial nerves. White substance dark, grey substance light.

White substance dark, grey substance light.

NOCOMMENT

The cerebellar peduncles have been cut and the pia mater removed.

NOCOMMENT

The right tonsil has been removed and the pons cut transversely, so that a portion of the fourth ventricle is seen.

The vermis of the cerebellum is removed as far as the lingula and nodulus, the posterior portions of the hemispheres are removed by an almost vertical section, and from the left hemisphere the tonsil and lobus biventer are also removed, in order to show the posterior medullary velum. The roots of the trochlear nerve are removed.

NOCOMMENT

From Haab, Atlas der Ophthalmoskopie.

The retinal vessels show distinct reflex striae. The optic papilla shows a distinct scleral, but a diffuse chorioidal ring.

From Haab, Atlas der Ophthalmoskopie.

The chorioidal vessels are visible, shining through. The optic papilla has both the scleral and chorioidal rings distinct.

pno = papilla of the optic nerve.

fc = central fovea.

vsr = retinal blood vessels.

* = retinal veins.

** = chorioidal ring.

X = retinal arteries.

The inner membrane is indicated by blue, the middle one by red.

n = nasal, t = temporal.

NOCOMMENT

The vitreous humor is removed.

n =nasal, t =temporal.

* = cut edge of the pectinate ligament.

** = remains of the sclerotic (placed over the pectinate ligament).

The outer coat of the eye is removed; around the iris the ciliary anulus is visible. Pigment flecks in the iris and several circular folds of contraction are seen.

The vitreous humor is removed.

n =nasal.

The vitreous humor is removed.

t = temporal.

The vitreous humor is removed. Same preparation as Fig. C244.

On the left the zonula fibers are removed; in the pupil the posterior surface of the cornea is visible.

* = folds of the posterior surface of the iris.

Schematically represented after Th. Leber.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

Same preparation as Fig. C247, more highly magnified.

On the left is the nasal part of the ora serrata; upon it is the orbiculus ciliaris, then the corona ciliaris with the ciliary processes and folds and, finally, the dark posterior surface of the iris.

*=coarser outer radiating folds.

*+ = dense and fine inner radiating folds.

The outer coat of the eye is completely removed and also the most of the iris. One sees the anterior ends of the ciliary processes and folds, with the zonular fibers passing to their insertion on the lens.

NOCOMMENT

The section is somewhat oblique in its posterior part, so as to cut the entire length of the optic nerves.

The orbits have been opened from above and their entire contents removed, except the eyeballs and the optic nerves.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The external skin and the Orbicularis oculi have been removed.

NOCOMMENT

From O. Schultze, Topographische Anatomie.

From O. Schultze, Topographische Anatomie.

A piece is sawed from the frontal bone to expose the upper lacrimal gland; similarly a part of the frontal process of the maxilla and the medial palpebral ligament are removed to expose the lacrimal sac and the upper part of the nasolacrimal duct.

The skin and musculature is divided and partly removed, partly reflected. The medial palpebral ligament is cut.

Preparation as in Fig. C267, but a piece of the maxilla has been chiselled away to expose the naso-lacrimal duct.

The lateral wall of the orbit is cut away and the other contents, together with the fascia and eyelids are removed. The Levator palpebrae superioris is in large part retained.

Preparation as in Fig. C269, but the Rectus lateralis and the optic nerve are cut. The eyeball is rotated so that its lower pole with the stump of the optic nerve is directed laterally. The Levator palpebrae superioris is largely removed.

  1. from above.
  2. from the medial side.
  3. from below.
  4. from the lateral side.

The measurements of the tendons and their distances from the corneal margin (in mm) from Merkel-Kallius (Graefe-Saemisch' Handbuch).

The muscles are shaded:

r.i. = Rectus inferior.

r.l. = Rectus lateralis.

r.m. = Rectus medialis.

r.s. = Rectus superior.

The skin, eyelids and fascia are removed. In addition to the eyeball and the muscles, only the superior lacrimal gland and a portion of the orbital fat are retained.

NOCOMMENT

NOCOMMENT

NOCOMMENT

On the left the superficial layer; only the roof of the orbit and the periorbita have been removed. On the right the deep layer; the Levator palpebrae superioris is largely removed and the orbital fat entirely so.

* = iris.

NOCOMMENT

NOCOMMENT

The orbit is divided in the frontal plane, and one looks from in front on the posterior surface of the section. The optic nerve is cut close to the optic foramen, and the stumps of the muscles which surrounded the optic nerve are retained. Of the other nerves only the lower branch of the oculomotor is retained.

After H. Virchow.

* = point of fusion of the capsule with the muscle.

Both eyelids are divided to the base by a sagittal incision and reflected.

* = inner lip of the muscle opening.

For explanation see here and here.

The skin and musculature of the eyelids have been removed; the tendon of the Levator palpebrae superioris is cut.

For explanation see here and here.

Somewhat schematic.

Somewhat schematic.

The cochlea is opened laterally.

The membranous labyrinth (endolymph) blue.

* = beginning of the basal coil.

The endolymphatic spaces black, the bone shaded.

The cavity of the cochlear duct is stippled.

NOCOMMENT

* = apical coil of the cochlea.

** = middle coil of the cochlea.

*** = basal coil of the cochlea.

The semicircular canals and the greater portion of the spiral canal of the cochlea are opened.

+ = beginning of the spiral lamina.

++ = vestibular opening of the cochlear canal.

Preparation as in Fig. C291, but the vestibule is opened and the cochlea up to its cupula.

* = opening of the common limb of the posterior and superior semicircular canals.

** = margin of the vestibular fenestra.

Schematic.

On the left the nerves that pass to them are shown.

* = the beginning of the basal coil of the cochlea.

* (after cochlea) = basal coil, ** = middle coil.

* = beginning of the basal coil of the cochlea.

** = chiselled wall of the meatus.

NOCOMMENT

The cochlea is opened from the side.

* = basal coil.

** = middle coil.

*** = apical coil.

The temporal bone is divided by a cut parallel to the axis of the pyramid.

* = basal coil of the cochlea.

NOCOMMENT

* = opening of the pyramidal eminence for the tendon of the Stapedius.

From the lateral side and in front.

The carotid, facial and musculo-tubar canals are opened, the external auditory meatus is completely removed and the mastoid cells are opened.

* = opening on the pyramidal eminence.

** = cavity of the pyramidal eminence for the Stapedius.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

* = the spur of the malleus.

** = attachment of Tensor tympani.

+ = attachment of Stapedius.

The tegmen tympani, the upper wall of the musculo-tubar canal and the roof of the mastoid antrum have been removed; a small portion of the facial nerve in the vicinity of the geniculum has been exposed

* = folds of the mucous membrane of the antrum.

From Schultze-Lubosch, Topogr. Anatomie.

The temporal bone is divided after having been decalcified; the tendon of the Tensor tympani is divided and also the joint between the stapes and incus. The two halves of the preparation are separated in the region of the tympanic cavity. The course of the facial and acoustic nerves and the relation of the labyrinth to the tympanic cavity and its walls are shown.

The malleus, incus, tympanic membrane and tuba auditiva (Eustachian tube) are shown in position, the medial wall of the tympanic cavity being removed by a section almost parallel to the tympanic membrane; the canal for the Tensor tympani and the muscle have also been cut away, as well as the insertion of the tendon into the malleus.

Preparation in general as in Fig. C316, but the bone is cut so as to expose the chorda tympani and the foramen by which it enters the tympanic cavity. The tendon of the tensor tympani is cut close to the malleus.

The preparation differs from that of Fig. C316 and C317 in that a much greater amount of the roof of the tympanic cavity is retained. In this way a greater length of the Tensor tympani is retained and is exposed as far as the cochleariform process by cutting away the greater portion of the septum of the musculo-tubar canal. The insertion of the muscle into the manubrium is thus rendered evident.

The layer of periosteum ** (compare Fig. C323) is largely removed.

In addition to the lateral, the upper wall is also removed, as well the greater part of the external auditory meatus. The tympanic membrane is removed except for a small fragment. The malleus and incus are removed and the chorda tympani cut where it enters the tympanic cavity. The septum of the musculo-tubar canal is partly cut away so as to show the Tensor tympani, whose tendon is cut near the cochleariform process. The facial nerve is exposed for a short distance near the geniculate ganglion.

Preparation similar to Fig. C319, but the posterior wall of the tympanic cavity is partly cut away, the Stapedius exposed by cutting away the wall of the pyramidal eminence and the lower part of the facial canal opened, as is also the lateral semicircular canal; the carotid canal is also opened for a short distance.

The tympanic cavity has been opened by a section almost parallel to the axis of the pyramid of the temporal bone; the lateral wall with the tympanic membrane, malleus and incus has been removed; the tendon of the Tensor tympani is cut, the musculo-tubar canal is opened and the septum cut away as far as the cochleariform process, to expose the muscle. The facial canal is opened from the hiatus to the stylo-mastoid foramen, as is also the lateral semicircular canal.

* = geniculum of the facial nerve.

The pyramidal eminence is opened, the Stapedius removed, also the stapes. The bone is chiseled away as to expose the fenestra cochleae (rotunda), with the secondary tympanic membrane and the neighboring folds of the mucous membrane.

NOCOMMENT

The Tensor tympani is cut across almost transversely at its transition into its tendon.

* = apex of the tympanic cavity.

** = posterior wall of the tympanic cavity.

The wall of the external meatus is chiselled away up to the tympanic membrane and this is practically all removed. One sees the chain of auditory ossicles, which in this view partly overlap each other, further, the tendons of the Tensor tympani and the Stapedius, the malleolar folds, the promontory, the fossula of the fenestra cochleae (rotunda) and the end of the septum of the musculo-tubar canal covered by mucous membrane.

The bone has been divided by a section almost parallel with the axis of the pyramid of the temporal bone. The contents of the tympanic cavity together with its mucous membrane have been removed; only the manubrium of the malleus on the tympanic membrane has been retained.

The wall of the external auditory meatus is largely removed.

+ = the apical recess of the tympanic cavity.

++ = oblique section of the wall of the external meatus.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The cartilage is shown in its natural relation to the temporal bone. The anterior part of the squamous portion of the temporal is cut away.

NOCOMMENT

NOCOMMENT

* = the cut edge of the external skin.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The skin is removed up to the nipple.

NOCOMMENT

A circular area of skin around the nipple has been cut and the skin immediately around the nipple has been reflected over it to show the lactiferous ducts.

* = cut edge of skin.

NOCOMMENT

NOCOMMENT

NOCOMMENT

NOCOMMENT

The nail is divided longitudinally and on the left the nail bed is exposed.

NOCOMMENT

NOCOMMENT

* = club shaped hair.

NOCOMMENT

* = fields of scurfy scale.

+ = borders of these fields.

Portions of the Sterno-mastoideus, Omohyoideus, Pectoralis major and minor are cut away to show the deep nodes. The Platysma is removed.

The lymph vessels have been injected with india ink.

NOCOMMENT

The lymph vessels have been injected with india ink. In the neck the Platysma has been removed and the Sternocleidomastoid divided.

* = small node interposed between the submental and deep cervical nodes.

** = small superficial cervical nodes.

+ = superficial node of the anterior cheek region.

The lymphatics have been injected with india ink. In the neck the Sternocleidomastoid and the clavicle have been removed; in the thoracic region the Pectorales major and minor have been divided.

* = sternoclavicular articulation.

+ = left subclavian artery.

The lymph vessels have been injected with india ink.

Injection with india ink.

Injection with india ink.

Preface

Preface From Volume I

From the Preface to the First German Edition.

I have endeavored in this work to produce an Atlas that will serve the practical needs of students of medicine and practicing physicians. It is not intended to be an Atlas for the use of experts in Anatomy. Consequently in the make-up of the book a limitation to what was absolutely necessary seemed to me a prime consideration.

In its outward form this first volume of the work is treated throughout as an Atlas, is arranged primarily for use by classes in dissection and follows closely the usual methods employed in such classes. Any difficulty that might arise for the beginner by an unusual method of presentation of the figures has, therefore, been carefully avoided.

The illustrations are so arranged that there is to be found on the opposite page, in addition to the explanation of the figures, a brief descriptive text. This enables the student using the book during his dissection to review rapidly the chief points in his preparation. In the Myology the explanatory text takes the form of tables which give at a glance the origin, insertion, nerve supply and action of the muscles. As regards the methods of reproduction of the figures, polychromatic lithography is used for the first time - so far as I am aware - in anatomical illustrations. Of the 34 colored plates 30 are reproduced by this process, the remaining 4 by the method of three (four)- color printing, again used for the first time in this connection. Nearly all the figures in the Myology are reproduced in this manner. For the other illustrations the so-called autotype process is used, and its suitability for the purpose may be seen from the Atlas itself. In addition key-figures, diagrams, etc. have been reproduced by line etching.

For greater convenience special colors have been extensively used in the illustrations reproduced by the autotype process, a chamois tint for the bones in illustrations of the articulations and many of the muscle figures, different colors for the individual skull bones in representations of the entire skull and in topographic figures of the skull bones. For the names of parts the Basel Nomenclature has been used.

The publishers have spared no pains in producing a book that certainly surpasses in excellence of reproduction all previous works, while at the same time it does not materially fall behind the most of them in the number of illustrations.

Würzburg, October 1903.

The Author.

Preface to the Second German Edition.

The second edition of the first volume shows very important changes. In the first place the former lithographed plates of the Myology have been entirely omitted and replaced by polychromatic autotypes, as had already been done in the second and third volumes of the first edition. This was done partly for uniformity in reproduction, partly because the illustrations of the first volume were not pleasing to many readers on account of the colors being too bright and glaring on the white paper. I have especially decided to provide new illustrations of the muscles, since those of the first edition frequently did not give a sufficiently natural impression owing to the position of the cadaver. Instead of using photographs of the cadaver, those of an athletic man of small stature were taken as a foundation. These photographs were prepared by the illustrator Mr. K. Hajek and within outlines prepared from them the muscles were drawn from dissections. In this way one obtains correct and expressive figures which, furthermore, are more in keeping with the format of the book. The use of yellow, red and blue colors is naturally merely conventional, although they approximate the natural tints. At the same time the number of the illustrations for the Myology was considerably increased and, furthermore, for the trunk, and especially the thorax and abdomen three-quarter views were employed instead of complete profiles. Mr. K. Hajek has drawn the illustrations in a thoroughly satisfactory manner.

The portions of the book dealing with the Osteology and Syndesmology have also been expanded in various places.

Würzburg, July 1913.

The Author.

Preface to the Seventh and Eighth German Editions.

Unlike the earlier editions the seventh and eighth have undergone some not unimportant changes. Some Röntgen figures from Grashey's Atlas have been included, new figures of the muscles of the neck and face replace the older ones and a number of the osteological figures have been renewed. In correspondence with these changes the text has been somewhat enlarged.

Bonn, November 1929 and February 1932.

The Author.

Preface to the Second Englished Edition.

This first volume of the second Englished edition of Sobotta's Atlas of Descriptive Anatomy is translated and edited from the sixth German edition. Compared with the first Englished edition there are a number of differences, the chief one being that the text-book feature has disappeared, the book being more strictly an anatomical Atlas. The descriptions of the structures shown in the illustrations are greatly condensed and, as far as possible, are on the pages facing the illustrations under consideration. The labels on the figures are the B. N. A. terms in their original Latin form; in the text, however, it has seemed advisable to translate them, for the most part, into their English equivalents or, in rare cases, to use a term more familiar to English-speaking students. Where misunderstandings might occur the B.N.A. term in also given.

The text, however, is relatively unimportant; the illustrations are the chief glory of the book and to give these English explanations and to render them available for English-speaking students of anatomy is the object of this edition.

The Editor.

Preface From Volume II

From the Preface to the first German Edition.

This second volume of the Atlas of Descriptive Anatomy treats of the anatomy of the viscera including the heart. It has seemed advantageous to include the heart since in dissection it is usually considered with the other viscera of the thorax.

The choice of preparations for illustration and their manner of representation follow the plan used in the first volume, the object being to present them from the standpoint of topographic anatomy.

Würzburg, August 1904.

The Author.

From the Preface to the Second German Edition.

In this second edition a series of changes have been made in that the lithographic plates have been replaced by others, reproduced partly by so-called three-color printing partly by polychrome autotype printing. In so doing some plates were greatly altered and especially for the situs of the abdominal viscera and the peritoneum and partly for the female genitalia new figures have been added. All the figures are from the skilled hand of K. Hajek.

Würzburg, February 1914.

The Author.

Preface to the Sixth German Edition.

In contrast to the third, fourth and fifth editions, which were essentially the same as the second, this sixth edition presents a number of new illustrations, especially of the stomach, intestines, liver, lungs and pericardium.

Bonn, November 1927.

The Author.

Preface to the Seventh German Edition.

In this seventh edition all colored figures have been reproduced by the same method, i.e. by the polychromatic autotype process. Some additions have been made, of which there may be especially mentioned a series of new figures (mouth cavity, accessory cavities of the nose, thoracic viscera, conducting bundles of the heart). Further, some of the figures have been replaced by new ones.

Bonn, June 1931.

The Author.

Preface From Volume III

From the Preface to the First Edition.

An experience with the work of the Anatomical Laboratory, extending over many years, has convinced the author of the advisability of presenting illustrations of the peripheral nervous system and of the blood vessels as they are seen by the student in his dissections, i.e. the nerves and arteries of any region in the same figure. Consequently in the majority of the figures representing these structures arteries and nerves, arteries, veins and nerves, or arteries and veins are shown in each figure, and only occasionally is there a departure from this plan, when, for the sake of clearness, accessory figures showing only the arteries or the nerves (for example, the cranial nerves) are added.

This method of arrangement has the advantage for the student, that he finds on a single page of the Atlas representations of all the structures he has seen at any one stage of his dissection, and is not obliged to waste time in turning from page to page of the Volume. Each figure is one of a series of topographic anatomical illustrations.

The simultaneous representation of blood vessels and nerves makes reproduction in colors necessary. The arteries are shown red, the veins blue and the nerves yellow. For the reproduction in color autotypes have been used, prepared in a most satisfactory matter by Messers. Angerer and Göschl of Vienna and the various plates have at the same time been adapted for the coloration of the other tissues shown (muscles, bones, fat, skin etc.). In this way colored illustrations have been obtained, which do not, it is true, show an absolutely natural coloration, but nevertheless approximate it sufficiently to give an extraordinarily accurate general impression. All the figures of the Volume are from originals by K. Hajek, whose artistic talent and skill in anatomical illustrations are again fully manifested.

As was stated in the Preface to the first Volume, the endeavor has been to make of the Atlas a work that would be of use to students and practitioners, not one intended for expert Anatomists. Whoever wishes information in special fields of anatomy, will necessarily turn to special treatises on those fields, and this Atlas, even were it twice as extensive, would not be sufficient for him. On the other hand an undue expansion of the book and overloading it with illustrations of interest only to specialists, would only render it more difficult for the student or practitioner to get the information he desires. The chief object has therefore been to limit the illustrations to the necessities of the case, but to present these in a series of comprehensive figures, showing step by step the stages usually followed in dissection.

In correspondence with the arrangement followed in the first and second volumes, this one presents alternately pages of text and figures. The latter show the principal figures of the Atlas, the former, in addition to accessory and schematic figures and the explanations of the chief figures, a brief text intended for review during the use of the Atlas in the dissecting room, this being accompanied by references to other illustrations in the volume where the structures under consideration are shown.

Würzburg, May 1906.

The Author.

From the Preface to the Second German Edition.

The Second Edition of this Atlas differs from the first by an increase in the number of illustrations. For the brain, especially, and for the sense-organs a number of new figures have been added. The representation of the principal fibre tracts has been extensively altered and in this connection some of the schematic figures have been replaced by new ones. In addition a considerable number of schemata have been added, which have in many cases been adapted from the admirable figures by Villiger.

The alphabetical index at the end of the Volume refers to the figures. In the text brief references are given to pages on which further statements as to the structures under consideration are to be found, and a special page reference was therefore unnecessary.

Würzburg, Spring, 1915.

The Author.

Preface to the Sixth German Edition.

In contrast to the third, fourth and fifth editions, which were essentially the same as the second, this sixth edition presents a number of new illustrations, especially of the nerves and vessels of the lower limb, of the brain, the eye and the auditory organ.

Bonn, 1927.

The Author.

Preface to the Seventh German Edition.

This seventh edition, compared with the sixth, has been improved, apart from lesser modifications, by the addition of three large, full-page, colored representations of the cranial, cervical and thoracic portions of the sympathetic nervous system, taken, by kind permission, from the admirable publications of Mr. Braeucker of Hamburg.

Bonn, November 1930.

The Author.

Preface to the Eighth German Edition.

The eighth edition differs but little from the seventh, but contains some new illustrations of the blood vessels (and nerves), especially those of the posterior abdominal wall; and of the lymphatic vessels. Further the structure of the medulla oblongata, the pons and the corpora quadrigemina is shown in some schemata taken from the diagrams of Müller-Spatz, published by the J. F. Lehmann's Verlag.

Bonn, March 1933.

The Author.

Abbrevations

Explanation of the abbreviations used in the illustrations.

  • ant. or anter. = anterior, anterius, anteriores etc.
  • a. or art. = arteria, arteriae etc.
  • art. or artic. = articulation
  • cart. = cartilago
  • duct. = ductus
  • ext. = external, externus, -na, -num
  • gangl. = ganglion
  • gland. = glandula, glandulae etc.
  • inc. = incisura
  • inf. or infer. = inferior, -ius
  • int. = internal, internus, -na, -num
  • lat. or later. = lateral, lateralis, -le
  • lig. or ligam. = ligament, ligamentum
  • ligg. = ligaments
  • m. = musculus, muscle (as a rule m. or musculus is omitted and that the structure is a muscle is indicated by its name being spelled with a capital initial letter.)
  • mm. = musculi, muscles
  • med. = medial, medialis, -le
  • n. = nervus, nerve
  • nn. = nervi, nerves
  • oss. = bone
  • post., poster. = posterior, -ius, -es
  • proc. = process
  • prof. = profundus, profunda etc.
  • prot. = protuberance
  • r., ram. = ramus, rami.
  • spin. = spine
  • sup. or super. = superior, -ius
  • superf. = superficialis, superficiales etc.
  • sut. = suture
  • tr. = truncus, trunci etc.
  • tuberc. = tubercle
  • tuberos. = tuberosity
  • v. or ven. = vena, venae

Abbreviations not listed may be determined by the context.

X after a name denotes that the part indicated has been cut away or cut through.

( ) denotes that the part is seen through another structure. In the case of the facial muscles, however, ( ) denotes the proposed new nomenclature.

1, 2, 3, etc. after a term indicates that the part concerned is shown in different parts of its course.

If a part is not named, as a rule it has already been named on the preceding figure.

Osteology.

For the structure of bone see here.

The Skeleton of the Trunk.

The skeleton of the trunk consists of the vertebral column together with the ribs and sternum.

The Vertebrae.

True and False Vertebrae may be distinguished. The former are represented by 7 cervical vertebrae, 12 thoracic and 5 lumbar, while the latter are two composite bones, the sacrum and coccyx.

The essential parts of a vertebra are the body (corpus), the arch (arcus), the transverse processes, the spinous process and the articular processes.

The body (Corpus) forms the principal part of the vertebra; it lies anteriorly and has a low cylindrical form. From it arises by means of the pedicles (radices) the arch (arcus), between which and the posterior surface of the body is the vertebral foramen, usually more or less transversely elliptical in form: Each pedicle (radix) presents an upper shallower and a lower deeper notch (incisura vertebralis). When the vertebrae are articulated the notches of successive vertebrae form foramina (foramina intervertebralia) through which the spinal nerves pass. Those vertebrae with which ribs articulate present toward the posterior part of both the upper and lower border of the body on each side an articular surface (fovea costalis superior and inferior) for the head of the rib.

The transverse processes are paired processes that project laterally from the anterior part of the arch or, in the case of the cervical vertebrae, from the pedicles. Their extremities, in the case of the thoracic vertebrae, present on their anterior surface an articular surface (fovea costalis transversalis) for the tubercle of the rib.

The Cervical Vertebrae.

The unpaired, median spinous process arises from the posterior part of the arch and is directed backwards or backwards and downwards. The portion of the arch between the spinous and transverse process on each side is termed the lamina.

The paired articular processes serve for the articulation of the vertebrae with one another. Each vertebra bears two superior and two inferior articular processes. They arise from the arch close behind the pedicles and bear articular surfaces, which lie in different planes in different vertebrae.

The Cervical Vertebrae have small, transversely elliptical bodies, the upper concave surface of each overlapping laterally the lower convex surface of the vertebra next above. The arches are of moderate height and the vertebral foramen relatively large, especially in its transverse diameter, and of a rounded triangular form. The articulating processes have their almost flat surfaces situated obliquely in a plane intermediate between the frontal and the horizontal. The transverse processes enclose a foramen (foramen transversarium), the anterior portion of each process representing a rudimentary rib fused with the body and transverse process. The rib element of the seventh vertebra occasionally remains separate, forming a cervical rib. Each transverse process presents on its upper surface a groove for the spinal nerve (sulcus nervi spinalis), which extends from the vertebral foramen over the foramen transversarium to the tip of the process, where it separates an anterior from a posterior tubercle. This is due to the origin of the transverse processes from the pedicles, whence they lie in the regions of the vertebral incisures. The spinous processes are short and bifid at their tips; they are almost horizontal or only slightly inclined except that of the seventh vertebra (vertebra prominens), which inclines downwards like those of the thoracic vertebrae and is never bifid, resembling the spinous processes of the thoracic vertebrae rather than those of the other cervicals. On account of its long spinous process the seventh (vertebra prominens) is the first vertebra that can be felt in the living body. Furthermore its foramen transversarium is small. It is a typical cervical vertebra, presenting, however, characters transitional to those of the thoracic series.

The atlas and axis (epistropheus) are on the contrary atypical vertebrae. The atlas has no body. Instead there is both an anterior and a posterior arch. The vertebral incisures and the spinous process are also lacking. In place of the latter there is a posterior tubercle and opposite this on the anterior surface of the anterior arch there is ani anterior tubercle. In the place of the lacking articular processes there are articulating surfaces on the upper and under surfaces of what are termed the lateral masses of the bone. The large transverse processes have a foramen transversarium, but no tubercles and no groove for the spinal nerve. The posterior arch is low; on the posterior surface of the anterior arch is a roundish, slightly concave articular surface for the odontoid process (dens) of the axis (epistropheus). The vertebral foramen is very large and consists of a smaller anterior and a larger posterior portion; it is bounded laterally by the prominent lateral masses. Over the upper surface of the posterior arch there runs a shallow groove (sulcus arteriae vertebralis) for the vertebral artery; occasionally it becomes deeper or is even converted into a canal.

The axis (epistropheus) possesses a conical process, the odontoid process (dens) arising from its body. Upon this process there is an anterior and usually a posterior articular surface. The upper articular processes are replaced by articulating surfaces and the superior vertebral incisure is wanting. The transverse processes are very small; there are no tubercles and no groove for the spinal nerve. The spinous process is especially strong and bifid and it, as we)l as the under surface of the bone, resembles the corresponding part of typical cervical vertebrae.

The Thoracic Vertebrae.

The thoracic vertebrae have moderately large bodies which increase both in height and depth from above downwards. The surfaces of the bodies are flat and heart-shaped. The vertebral foramen is absolutely and relatively small and almost circular. On the posterior part of both the upper and lower borders of the lateral surfaces of the body are articular facets (fovea costalis superior and inferior) which, with the corresponding half facets of adjacent vertebrae, form the articular surfaces for the heads of the ribs. The articular processes have nearly flat surfaces which lie almost in the frontal plane; the lower ones hardly project beyond the surface of the arches. The transverse processes are strong, directed laterally and distinctly backward and bear upon the anterior surfaces of their thickened, free ends articular surfaces for the tubercles of the ribs (foveae costales transversales).

The spinous processes are very strong, triangular, thickened at their ends and directed distinctly downwards; those of the middle thoracic vertebrae overlap each other like the shingles on a roof.

The first thoracic vertebra has on each side a complete fovea for the first rib and a half fovea for the second rib, that is to say one and one half instead of two half foveae. The last two thoracic vertebrae have on each side a complete fovea, each articulating with only one rib. The eleventh and especially the twelfth thoracic vertebrae form a gradual transition to the lumbar vertebrae, since the spinous processes are directed straight backwards and are laterally compressed, the foveae costales transversales are lacking and, associated with a rudimentary condition of the transverse processes, accessory and mamillary processes may occur (12 Thoracic). Also the articular surfaces and the lower articulating processes of the twelfth thoracic vertebra are already sagittal in position.

The Lumbar Vertebrae.

The lumbar vertebrae are the largest of all the true vertebrae. They have high and broad bodies with flat, bean-shaped (that is to say, the contact surface for the adjacent vertebra is elliptical, but somewhat concave posteriorly) not quite parallel surfaces (the surfaces are not parallel because the lumbar portion of the vertebral column is strongly convex forwards, the vertebral bodies being noticeably higher in front than behind), as well as high and strong arches with very strong processes. The anterior as well as the lateral surfaces of the bodies are hollowed out (consequently the contact surfaces are larger than the transverse section through the middle of the bodies). In size these vertebrae increase continuously and quite distinctly from the first to the fifth. The vertebral foramen is narrow and rounded triangular. The surfaces of the articular processes stand almost in the sagittal plane; they are distinctly curved, the superior processes being concave and directed medially while the inferior are convex and directed laterally.

The upper articular processes bear on their upper margins a rounded tubercle, the mamillary process. The transverse processes are long, flat, rib-like and directed almost exactly laterally. At the base of each is a sharp process directed backwards, the accessory process, which corresponds to the tip of the transverse process of a thoracic vertebra, the main portion of a transverse process corresponding to a rib fused with the vertebra. The spinous processes are strongly compressed laterally, are directed almost exactly backwards and are slightly thickened at their ends.

The Sacrum.

The sacrum is a curved, shovel-shaped bone, broader above and narrower below. Its posterior surface (facies dorsalis) is convex and roughened, the anterior surface (facies pelvina) is concave and relatively smooth, the broader upper surface is termed the base and the lower more pointed end the apex.

The dorsal surface presents a rough median ridge or crest, which in many cases is frequently interrupted. It is formed by the fusion of the spinous processes of five sacral vertebrae. In addition to this unpaired median crest there are on the dorsal surface on each side two lateral, rarely continuous ridges, which are separated by four foramina, the posterior sacral foramina. Medial to these foramina lies the sacral articular crest formed by the fusion of the articular processes and lateral is a crest (crista sacral is lateralis) formed by the fusion of the transverse processes. The upper articular process of the first sacral vertebra remains distinct for articulation with the last lumbar vertebra, while the lower process of the last sacral vertebra forms a process, the sacral cornu, for articulation with the coccyx (but without an articular surface). The two sacral cornua bound the lower opening (hiatus sacralis) of the canal contained within the sacrum (canalis sacralis).

The pelvic surface presents four pairs of anterior sacral foramina corresponding to but larger than the four posterior foramina. Extending between the foramina of each pair is a low, rough ridge (linea transversa), which indicates the boundary between the bodies of two fused sacral vertebrae. The anterior foramina diminish in size from above downwards.

The apex of the sacrum appears as if cut off and possesses a small elliptical surface to which the coccyx is apposed.

The base shows a surface corresponding with the under surface of the last lumbar vertebra, with which it articulates. Between this bean-shaped surface and the superior articular process is a superior vertebral incisure, which, with the inferior incisure of the last lumbar vertebra, forms the last intervertebral foramen. Behind the surface for the last lumbar vertebra lies the upper end of the sacral canal and laterally are the lateral masses. The base of the sacrum is separated from the concave pelvic surface by a feeble line, which is the sacral part of the linea terminalis (see here).

In a lateral view of the sacrum one sees the articulating surface of the lateral mass, which serves for articulation on each side with the innominate bone and through this for the completion of the pelvic limb-girdle. It is formed anteriorly by an uneven, ear-shaped auricular surface, which is covered with cartilage, and posteriorly by a rough, depressed area, the sacral tuberosity, which is not covered by cartilage. Below this the lateral surface of the bone, which is fairly broad above, becomes exceedingly narrow; i.e. the bone which is relatively thick at the base now becomes quite thin.

The sacral canal, the continuation of the vertebral canal, traverses the entire length of the sacrum. Posteriorly it is bounded by a flattened bony mass formed by the fused arches of the sacrum, which bear the medial sacral crest. The canal opens in front and behind into the sacral foramina by means of the intervertebral foramina, which, in the sacrum, in contrast to the true vertebrae, are contained within the bone and consist of short canals. The posterior wall of the sacral canal does not extend to the apex of the bone, but terminates at about the boundary between the fourth and fifth sacral vertebrae. There is thus formed the hiatus of the sacral canal (see here).

The Coccyx.

The Coccyx is a small bone formed by the fusion of four or five rudimentary coccygeal vertebrae. The first of these vertebrae possesses two upwardly projecting cornua which are the rudiments of articular processes and serve for articulation with the sacrum. Furthermore, this same vertebra has feebly developed transverse processes. The upper end of the coccyx unites with the apex of the sacrum.

The second to the fifth (sixth) coccygeal vertebrae represent merely the bodies of these vertebrae and are usually irregular in shape, mostly flattened spherical. The individual coccygeal vertebrae are either united with one another by synchondroses or have a bony union (synostosis).

The Vertebral Column.

The vertebral column is a bony column with several curvatures and is composed of 26 separate bones, i.e. 24 true vertebrae, the sacrum and the coccyx. Its curvatures are as follows: One in the cervical region slightly convex anteriorly, one in the thoracic region strongly concave anteriorly, one in the lumbar region strongly convex anteriorly and one in the sacral and coccygeal regions strongly concave anteriorly. The transition from the lumbar convexity to the sacral concavity is somewhat abrupt; the region of the last intervertebral disc is termed the promontary.

The width of the column is greatest at the upper part of the sacrum; from this level the vertebrae become gradually smaller toward the coccyx and also upwards toward the middle of the thoracic region. From there upwards the vertebrae again broaden to the upper thoracic and lower cervical regions, diminishing again up to the axis (epistropheus), while the atlas, with its strongly developed transverse processes, is again notably broader. The greatest thickness of the column is in the lumbar region.

The bodies of the vertebrae are not in actual contact with one another, but are joined together by intervertebral discs. On the other hand the articular processes are in immediate contact by their articular surfaces. Each adjacent pair of vertebral incisures form an intervertebral foramen; the uppermost pair of these lies between the second and third cervical vertebrae and the lowest pair between the fifth lumbar vertebra and the sacrum, so that there are altogether 23 pairs of foramina. They are largest in the lumbar region and smallest in the thoracic. In the cervical region the foramina lie in the intervals between the transverse processes, in the thoracic and lumbar regions they are anterior to these processes.

The intervertebral foramina lead into the vertebral canal, which represents the sum of the separate vertebral foramina and is an almost cylindrical cavity that begins at the atlas and is continued below into the sacral canal (see here).

The Ribs (costae).

The ribs (costae) are long flat bones and may be regarded as consisting of a bony rib and a costal cartilage,. In the bony rib there may be noted a rounded enlargement at the posterior, vertebral end, the head (capitulum), with an articular surface for articulation with the vertebral bodies. This surface, at least in the ribs that articulate with the bodies of two vertebrae, is divided into two portions by the capitular crest. On the head there follows a distinct constriction of the rib, the neck (collum), whose upper border is provided with a ridge (crista colli) that gradually fades out on the body of the rib. Where the neck passes over into the body of the rib there is a rough tubercle bearing an articular surface for articulation with the transverse process of a thoracic vertebra.

The body (corpus) of the rib forms the principal part of the bony rib. It is a long, flat, vertically placed bone curved in correspondence with the curvature of the thorax. Near the tubercle it presents a rough surface, the angle of the rib, and at this point the rib, which at first was directed somewhat backwards, bends anteriorly. At the lower border, or more exactly, on the inner surface of the body, is a groove (sulcus costae), which gradually fades out toward the anterior end of the rib. This is slightly hollowed out for the reception of the costal cartilage.

The third to the tenth bony ribs have a typical form. The first and second and the eleventh and twelfth are atypical.

The first rib is short and broad. It is not placed vertically, but almost horizontally and its surfaces are directed upwards and somewhat outwards, and downwards and somewhat inwards. As a rule it has no capitular crest and no angle. On its upper surface, not far from where it joins its costal cartilage, there is a distinctly roughened area, the scalene tubercle for the insertion of the Scalenus anterior, and behind this a slight furrow, the subclavian groove for the subclavian artery. Behind this again is a rough surface for the insertion of the Scalenus medius. The neck of the first rib is long and thin.

The second rib is markedly longer and smaller than the first. Its posterior part is similar to that of the first, one surface looking upward and outward and the other downward and inward, but its anterior part is placed nearly vertical, as in the typical ribs. The angle and the tubercle coincide, but on the other hand there is a capitular crest. At about the middle of the length of the rib its lateral surface shows a roughened area, the tuberosity, for the insertion of a serration of the Serratus anterior.

The eleventh and twelfth ribs are quite rudimentary. They possess only a head, which however has no capitular crest. The tubercle is usually wanting on the eleventh rib and frequently the angle; on the twelfth rib also both are wanting. In both the costal sulcus is absent. The twelfth rib is often very short and it varies greatly in length.

The Sternum.

The sternum is a flat, elongated bone in which three parts may be recognized, a manubrium, a body (corpus) and a xiphoid process.

The manubrium is the upper, broadest, slightly curved portion of the sternum and is separated from the body of the bone by the sternal synchondrosis. There may be distinguished on the manubrium an upper, shallow depression, the jugular notch or incisure, lateral to which on the two upper angles of the bone are two lateral, stronger depressions, the clavicular incisures, for the reception of the sternal ends of the clavicles. Immediately below these lie two broad shallow depressions, the first costal incisures, for the attachment of the cartilage of the first rib. At the lower end of the manubrium there is on either side a half incisure for the second rib.

The body (corpus) of the sternum is narrower and thinner but longer than the manubrium. For the most part it broadens from above downwards. It unites with the manubrium at a very obtuse angle, the sternal angle, which is not always very distinct. Its anterior surface is termed the sternal plane. The lateral borders show incisures for the reception of the second to the seventh costal cartilages. Frequently low transverse ridges upon the anterior surface of the bone unite the incisures of the two sides (see Fig. A39). Only the lower half of the incisure for the cartilage of the second rib is found on the body of the sternum, the incisures for the fifth to the seventh lie close to one another, while those for the second to the fifth rib are placed at quite distinct intervals. That for the seventh rib is in the angle between the body and the xiphoid process.

The xiphoid process is usually only partly bony, being usually cartilaginous in its lower part. It is often perforated or cleft below and is especially variable in form. Its upper bony portion usually fuses with the body of the sternum in advancing years.

The Thorax.

The thorax is formed by the twelve thoracic vertebrae, the twelve pairs of ribs and the sternum.

The ribs increase in length from the first to the seventh and then diminish rapidly. The costal cartilages of the uppermost and lower-most ribs are the shortest.

The seven upper ribs which are attached by their cartilages directly to the sternum are termed the true ribs (costae verae), in contrast to the five lower ones, the false ribs (costae spuriae), which are attached to the sternum only through the intervention of the seventh costal cartilage, or, as in the case of the eleventh and twelfth ribs, have no connection with the other ribs or with each other (floating ribs). The cartilages of the sixth (in some cases even of the fifth) to the tenth rib are united with one another by upwardly and downwardly directed processes and form the costal arch. The union may be a synchondrotic one or else diarthrotic. In the region of the costal arch the cartilages are frequently greatly broadened. They always diminish in breadth from their outer ends towards the sternum. Not infrequently the middle ribs especially form what is termed a costal window, a rib dividing, usually in its bony portion, and then uniting again in the neighbourhood of the cartilage. The eleventh and twelfth ribs have only cartilaginous tips, which are very short and end freely.

The ribs, which form the principal part of the thoracic wall, are so placed that between each two ribs there is an interspace, the intercostal space, which is considerably wider than the rib itself. There are eleven of these spaces on each side. The last is very short and, like the next to the last, is open anteriorly.

The first and second costal cartilages slope slightly downwards toward the sternum, the third to the fifth are almost horizontal, while from the sixth downwards the cartilages are directed sharply upwards, especially in expiration, during which a distinct angle is developed at the junction of the bony rib with its cartilage, an angle which is almost completely obliterated during inspiration.

The sternum with the costal cartilages and the adjacent portions of the bony ribs forms the anterior wall of the thorax. It does not lie exactly in the frontal plane, but its upper end is directed somewhat backwards and is therefore somewhat nearer the vertebral column than is the lower part. The greater distance of the lower part from the column is mainly due to the strong concavity of the thoracic portion of the column.

The anterior wall of the thorax is markedly shorter than the posterior, since the upper border of the manubrium sterni corresponds to the interval between the second and third thoracic vertebrae in the neutral position, being lower during expiration and higher in inspiration. The tip of the xiphoid process lies at the level of the ninth thoracic vertebra, or, in accordance with its variable length, occasionally at that of the eighth or tenth.

The posterior wall of the thorax is formed by the twelve thoracic vertebrae and the posterior portions of the twelve pair of ribs. Since the bodies of the former project strongly into the thoracic cavity there is a deep groove on each side of the vertebral column, the pulmonary groove (sulcus pulmonalis).

The lateral wall of the thorax is formed by the bony ribs. It is longer posteriorly than in front, where the eleventh and twelfth ribs are lacking, and during expiration reaches, opposite the twelfth rib, the level of the second lumbar vertebra.

The walls of the thorax enclose the thoracic cavity, which is almost conical in shape, the apex being directed upwards. This cavity has an upper and a lower aperture, the upper one being markedly smaller than the lower. It is bounded by the first thoracic vertebra, the first rib and the upper border of the manubrium sterni. The much larger lower aperture is bounded by the twelfth thoracic vertebra, the twelfth, eleventh and tenth ribs, the costal arch and the xiphoid process. The angle that the costal arch forms with the xiphoid process is known as the infrasternal angle.

In transverse section the thoracic cavity is heart-shaped or kidney-shaped on account of the manner in which the bodies of the vertebrae project into it. As a result the sagittal diameter of the thorax is small, much smaller than the transverse, especially in the upper part.

The Skull and the Skull Bones.

The Skull as a whole.

The bones of the head taken together form what is termed the skull (cranium). Two groups of skull bones are usually recognized, the bones of the cranium and the bones of the face. To the former belong the occipital, the sphenoid, the temporals, the parietals, the frontal and the ethmoid.

The bones of the face are the nasals, the lacrimals, the vomer, the inferior concha, the maxillae, the palatines, the zygomatics, the mandible and the hyoid.

The Occipital Bone.

In the occipital bone the following parts may be distinguished:

  1. the basilar portion,
  2. the lateral (condylar) portions and
  3. the squamous portion.

The basilar portion lies in front of the foramen magnum, the lateral portions form the lateral boundaries of this and the squamous portion lies behind it.

The basilar portion in the skull of the adult is continuous at its anterior end with the body of the sphenoid. It presents a horizontal, roughened, lower surface, which has in the median line a tubercle, the pharyngeal tubercle. Its upper or cerebral surface is concave. This latter surface forms the larger and posterior part of the clivus and shows a shallow groove at the margin of the petro-occipital fissure, the inferior petrosal groove.

The lateral portions bear upon their under surfaces the elongated, convex occipital condyles and pass without any sharp boundary into the basilar portion anteriorly and the squamous portion posteriorly. Behind the condyles is a shallow depression, the condyloid fossa, in which a short condyloid canal usually opens. When this canal is present its inner opening is on or near a broad groove, the sigmoid sulcus (Fig. A56). This, on the cerebral surface of the lateral portion, arches around the jugular process, beginning at the jugular notch, which, together with a similar notch on the temporal bone forms the jugular foramen. A small projection (intrajugular process) on each of these two bones divides the foramen into a small anterior (medial) and a larger posterior (lateral) portion (Fig. A55). The jugular process projects strongly laterally and serves for the articulation of the lateral portion of the occipital with the pyramid of the temporal bone. Medial to the jugular process. There is on the cerebral surface of the lateral portion a rounded elevation, the jugular tubercle (Fig. A56). Between this and the condyle there passes almost transversely through the bone the hypoglossal canal for the nerve of that name.

The squamous portion is by far the largest portion of the occipital bone. It is rather flat but is curved like a shovel, being concave on the inner surface and convex on the outer. It is typically triangular. Along the occipito-mastoid suture it articulates with the mastoid portion of the temporal bone and at the lambdoid suture with the two parietal bones. The upper angle abuts in the middle of the lambdoid suture upon the posterior end of the sagittal suture. Its cerebral surface presents a cross-like figure, whose upper and lateral arms are formed by grooves, while the lower arm is formed by a ridge, the internal occipital crest, which passes toward the posterior border of the foramen magnum. The groove forming the upper arm of the cross is the lower portion of the sagittal sulcus, while the transverse grooves are the transverse sulci; the similarly named blood sinuses of the dura mater occupy these sulci. The central point of the cross-like figure is the internal occipital protuberance. The arms of the cross-like figure separate two shallow superior occipital fossae from one another and from two deeper inferior occipital fossae.

The outer surface of the squamous portion of the occipital is divided into two parts by the superior nuchal lines, which pass laterally from the external occipital protuberance. The upper, triangular, relatively smooth part is the occipital surface, the lower rough part the nuchal surface. Above the superior nuchal lines there are usually two arched supreme nuchal lines. From the external occipital protuberance the external occipital crest extends downwards toward the posterior border of the foramen magnum, and from about its middle the inferior nuchal lines curve outwards, parallel to the superior ones.

The Sphenoid Bone.

The sphenoid bone has an unpaired body (corpus), two great wings (alae magnae), two lesser wings (alae parvae) and two pterygoid processes.

The body (corpus) unites in later life by its posterior surface with the basilar portion of the occipital. It contains a cavity filled with air, the sphenoidal sinus, which is divided into two parts by a septum and communicates by two apertures with the posterior part of the nasal cavity. The septum shows itself on the anterior surface of the body as the sphenoidal crest. The anterior wall is formed by two thin bony plates, the sphenoidal conchae, which originally belong to and are often united with the ethmoid bone. The sphenoidal crest is continued upon the under surface of the body as the rostrum and serves for articulation with the wings of the vomer. The upper surface of the body is partly formed by the sella turcica, in front of which is a flat surface, which posteriorly bounds the sulcus chiasmatis of the sella turcica and anteriorly projects towards the lamina cribrosa as the ethmoidal spine. The posterior boundary of the sella turcica is the dorsum sellae with the two posterior clinoid processes at its outer ends; in front of it is the deepest part of the sella, the hypophyseal fossa, which is bounded in front by the tuberculum sellae (Fig. A48). In front of the tuberculum sellae there is a shallow, transverse groove, the sulcus chiasmatis. From the lateral parts of the tuberculum sellae the short middle clinoid processes project. At the sides of the hypophyseal fossa and on the root of the great wing there is a shallow, but broad, longitudinal groove, the carotid groove, for the internal carotid artery. It is bounded laterally by a small bony plate, the sphenoidal lingula (Fig. A48). The anterior part of the clivus, behind the dorsum sellae, belongs to the sphenoid bone (Fig. A48).

The lesser wings (alae parvae) are small horizontal plates of bone which arise from the lateral surfaces of the body of the sphenoid, each by two roots which enclose the optic foramen. Their anterior borders articulate with the orbital portion of the frontal bone in the spheno-frontal suture; their posterior sharper borders form a boundary for the anterior and middle cranial fossae and end medially, toward the sella turcica, in sharp hook-like points, the anterior clinoid processes. The lesser and greater wings are completely separated by the superior orbital fissures.

The great wing (ala magna) arises from the lateral surface of the body of the sphenoid. In its root there are three foramina, the foramen rotundum directed obliquely forward and leading into the pterygopalatine fossa, the elliptical foramen ovale also placed obliquely and the small, round foramen spinosum. The great wing has three principal surfaces, cerebral, temporal and orbital, and the following borders, a squamous border (margo squamosus) for the squamous portion of the temporal, a frontal border (margo frontalis) for the orbital portion of the frontal, a zygomatic border (margo zygomaticus) for the zygomatic and a parietal angle for the parietal. The lateral posterior process which bears the external opening of the foramen spinosum and is directed toward the under surface of the pyramid of the temporal bone is termed the spine of the sphenoid (spina angularis). The cerebral surface is concave and, in addition to the three foramina, shows digitate impressions. The orbital surface is almost flat and forms a part of the lateral wall of the orbit. A sharp orbital crest separates it from the small spheno-maxillary surface. Similarly the temporal surface is divided by the infratemporal crest into the upper temporal and the lower infratemporal surfaces, the latter, again, passing into the spheno-maxillary surface, there being frequently between the two a sphenomaxillary crest. The infratemporal surface bears the external openings of the foramen ovale and foramen spinosum, the spheno-maxillary surface that of the foramen rotundum.

The pterygoid processes extend almost vertically downwards, almost parallel with one another, from the under surface of the body of the sphenoid; they arise on each side by two roots which enclose between them the pterygoid(Vidian) canal, which is directed almost horizontally in the sagittal plane. It unites the foramen lacerum with the pterygo-palatine fossa. Below, the pterygoid processes divide into a smaller inner and a broader outer plate (lamina) separated in their upper part by a groove, the pterygoid fossa, in their lower part by a cleft, the pterygoid fissure, which is filled by the pyramidal process of the palatine bone. The inner plate has at its base an elongated shallow depression, the scaphoid fossa, and at its lower end and separated from it by a groove, the hamulus. A small process projecting toward the body of the sphenoid, the processus vaginalis, encloses the pharyngeal canal by uniting with a process of the palatine bone. From the scaphoid fossa a shallow groove, sulcus tubae auditivae extends toward the spinous process along the spheno-petrous suture. On the anterior surface of the pterygoid process is a groove, the pterygo-palatine groove, extending downwards from the anterior opening of the pterygoid canal. It forms with the corresponding grooves on the palatine bone and maxilla the pterygo-palatine canal.

The Temporal Bone.

The temporal bone has four parts:

  1. the squamous portion (squama temporalis),
  2. the mastoid portion,
  3. the petrous portion or pyramid and
  4. the tympanic portion.

These four parts group themselves around the external auditory opening, in such a way that the squamous part lies above it, the mastoid part behind, the tympanic part below and anterior, and the petrous part medial and anterior.

The squamous portion (squama temporalis) articulates by a strongly curved, irregular border with the great wing of the sphenoid (margo sphenoidalis) and with the parietal (margo parietalis), the margins of the temporal bone overlapping those of the other hones in a squamous suture. Except for a small lower portion the squama is vertical in position and has an outer temporal and inner cerebral surface, the latter having ridges and depressions for the convolutions of the cerebral hemispheres and also grooves for the middle meningeal artery. It is more or less separated from the petrous portion by a petro-squamosal fissure, which tends to become obliterated in the adult. The temporal surface is smooth and presents a shallow groove for the middle temporal artery, beginning just above the external auditory opening. In addition there arises from the temporal surface the long zygomatic process, which articulates with the temporal process of the zygomatic bone. The process arises by a root from the vertical portion of the squama and by a second root from the small, lower, horizontal portion. Between the two roots lies the articular cavity for the head of the mandible (fossa mandibularis), in front of which is an articular tubercle, also partly covered with cartilage. The zygomatic process is at first almost horizontal, but later twists so as to lie in the sagittal plane. From its posterior extremity the hinder part of the temporal line passes upwards and backwards to be continued upon the parietal bone. Above the external auditory opening there is usually a sharp projection, the suprameatal spine.

The mastoid portion has as its chief part the large mastoid process, which forms the whole outer surface of this portion of the bone; it articulates by the parietal notch with the mastoid angle of the parietal and by its occipital margin with the squamous portion of the occipital (occipito-mastoid suture). It possesses a concave inner (cerebral) surface and a strongly convex roughened outer surface. The latter forms the broad, conical mastoid process which contains cavities filled with air, the mastoid cells, which communicate with the tympanic cavity. It gives attachment to several muscles and towards its posterior border has a deep groove (mastoid incisure) for the Digastric. Near the occipito-mastoid suture is a shallow groove for the occipital artery and the external opening of the mastoid foramen.

The principal part of the temporal bone, the petrous portion, is also termed the pyramid and is a three-sided pyramidal structure lying almost horizontally. In the adult only its three surfaces can be seen, the base being almost covered by the tympanic portion of the bone; in the new-born child and even somewhat later it is visible on the outer surface of the bone (Fig. A64, A65). The schematic sections (Fig. A66 and A67) show the arrangement of the four surfaces as well as the formation of the tympanic cavity and its continuation as the Eustachian tube (musculo-tubar canal) through the petrous and tympanic portions.

In the description that follows the parts of the bony labyrinth lying within the pyramid are not considered, nor is the tympanic cavity fully described. These parts will be described later (see here).

Two surfaces of the petrous portion, the anterior and the posterior, look toward the skull cavity; the third, inferior, is at the base of the skull, while the base (not labelled) forms the medial wall of the tympanic cavity. The three surface are separated by angles; the superior angle separates the anterior and posterior surfaces, the anterior separates the anterior and inferior and the posterior the posterior and inferior surfaces. The axis of the pyramid is oblique to the long axis of the skull passing from behind and lateral, anteriorly and medially. The apex of the pyramid lies at the foramen lacerum.

The anterior surface forms a portion of the middle fossa of the skull. It is separated by the petrosquamous fissure from the squamous portion of the bone, and bears a slight transverse elevation, the arcuate eminence, which is formed by the underlying semicircular canal.

Further towards the median line is a slit-like opening the hiatus of the facial canal, with a groove for the great superficial petrosal nerve extending toward the foramen lacerum.

Lateral and anterior to this is a second opening, the aperture of the superior tympanic canaliculus, with a similarly directed groove for the lesser superficial petrosal nerve. The part of the anterior surface of the pyramid that lies between the petro-squamous fissure and the arcuate eminence forms the roof of the tympanic cavity, the tegmen tympani. Near the apex of the pyramid is a very shallow trigeminal impression (see Fig. A48). The superior angle bears the superior petrosal groove and the anterior angle bounds the spheno-petrous fissure and the foramen lacerum. The posterior surface of the pyramid forms a part of the posterior cranial fossa. It presents a roundish opening, the internal auditory opening (porus acusticus internus), which leads into a canal, the meatus acusticus internus, running obliquely into the bone. Above this opening, immediately below the superior angle, is small depression, the subarcuate fossa, and lateral to the auditory opening there is a fissure-like opening, the external opening of the aquaeductus vestibuli, which lodges a portion of the internal ear. A shallow groove, the inferior petrosal sulcus, runs parallel to the posterior angle, being a continuation of the similarly named groove on the occipital bone. The apex of the pyramid has an opening with an irregular boundary, the internal carotid foramen (see below). Beside it, near the anterior angle of the pyramid, is the opening of a large canal, the Eustachian canal (canalis musculo-tubarius), which leads into the tympanic cavity.

The posterior angle is separated from the occipital bone by- the petro-occipital fissure and bears a shallow jugular notch, which, with the corresponding notch on the occipital forms the jugular foramen (see Fig. A48).

The inferior surface of the pyramid presents the stylomastoid foramen at the base of the mastoid process; it is the outer opening of the facial canal. In front of it lies the slender, often very long styloid process, whose base is partly ensheathed by a plate-like projection of the tympanic portion, the vaginal process. Close to the styloid process is a broad, elongated groove, the jugular fossa, which abuts medially upon the jugular notch and receives the bulb of the jugular vein. In the floor of the groove is the small sulcus of the mastoid canaliculus. On the posterior margin close to the jugular fossa is a small opening, the external aperture of the cochlear canaliculus; in front of this is the large round external carotid foramen and between this and the jugular fossa is a small depression, the petrous fossula, from which a small canal, the tympanic canaliculus, passes through the floor of the tympanic cavity.

The base of the petrous portion forms the medial wall of the tympanic cavity. In the adult it is covered in by the tympanic portion of the bone, so that only a small strip of it is visible at the surface along the petro-tympanic fissure.

The tympanic cavity is an air-containing cavity lying between the petrous and the tympanic portions. The external auditory meatus leads into it from without; its roof is formed by a thin part of the petrous portion, the tegmen tympani, while its floor is formed partly by the petrous and partly by the tympanic portion. Anteriorly and medially the cavity is continued into the canal for the Eustachian tube (canalis musculo-tubarius) and posteriorly and laterally it has opening into it the antrum and the mastoid cells. It contains the three small auditory ossicles, which together with the walls of the cavity will be described in connection with the auditory organ (see here).

The tympanic portion of the temporal bone is a small trough-shaped plate of bone which forms the sides and floor of the external auditory meatus and the lateral wall of the tympanic cavity. It is separated from the petrous and squamous portions by the petro-tympanic fissure (fissure of Glaser), from the mastoid portion by the tympano-mastoid fissure and it forms the vagina of the styloid process.

The temporal bone of the new-born child differs markedly from that of the adult in that the tympanic portion has the form of a ring that is open above, and there is practically no mastoid process. The squamoso-mastoid suture is still quite distinct, separating the squamous portion from the mastoid and petrous portions, which form a single mass. In the course of the first year the tympanic ring becomes the trough-like structure, which at first has in its floor a constant foramen.

Canals in the temporal bone.

The facial canal, mainly for the facial nerve, begins at the bottom of the internal auditory meatus and runs at first horizontally and almost transversely to the axis of the petrous portion to the hiatus of the facial canal. There it bends at a right angle and runs in the medial wall of the tympanic cavity, again almost horizontally, but in the line of the axis of the pyramid, until it reaches the pyramidal eminence of the tympanic antrum (see here). Here it bends to assume a vertical direction and opens by the stylomastoid foramen. From the lower portion of the canal the canaliculus for the chorda, tympani leads to the tympanic cavity.

The carotid canal is a short, but wide canal, situated near the apex of the pyramid. It begins at the external carotid foramen and runs at first vertically, but later bends almost at a right angle so as to run horizontally, and ends at the internal carotid foramen. Small canals, the carotico-tympanic canaliculi, lead from it into the tympanic cavity.

The canal for the Eustachian tube (canalis musculo-tubarius) runs parallel with and immediately adjacent to the horizontal portion of the carotid canal, almost in the axis of the pyramid. It begins as a notch on the anterior angle of the pyramid, between that part of the bone and the squamous portion, and ends on the anterior wall of the tympanic cavity of which it seems to be a direct prolongation. An incomplete horizontal septum divides it into an upper canal for the Tensor tympani and a lower one for the Eustachian tube (tuba auditiva).

The tympanic canaliculus leads from the petrous fossula into the tympanic cavity, where it becomes the sulcus promontorii, and then leaves the cavity by its upper wall to open by the superior aperture of the tympanic canaliculus on the anterior surface of the pyramid.

The very narrow mastoid canaliculus begins as a groove in the jugular fossa, passes through the lower portion of the facial canal and opens in the tympano-mastoid fissure.

The Parietal Bone.

The parietal bone is large quadrangular flat bone, convex on its outer surface and concave on its inner. The four borders are

  1. the frontal, which articulates with the frontal bone in the coronal suture;
  2. the sagittal, which articulates with the other parietal in the sagittal suture;
  3. the occipital, which articulates with the occipital bone in the lambdoid suture and
  4. the squamosal, which articulates with the temporal bone in the squamous suture.

The four angles of the bone are the frontal situated at the junction of the sagittal and coronal sutures, the occipital at the junction of the sagittal and lambdoid sutures, the mastoid at the parieto-mastoid suture, where it occupies the parietal notch of the temporal bone, and the sphenoidal which articulates in the spheno-parietal suture with the great wing of the sphenoid. This last angle is the sharpest.

The outer convex surface presents at the region of greatest curvature the tuberosity and also stronger superior and weaker inferior temporal lines, both of which have an arched course. Below the latter line the parietal forms a part of the temporal surface (see Fig. A44, A45). In this region the squamosal border is rough, being overlapped by the squamous portion of the temporal bone. Near the posterior end of the sagittal border and close to the sagittal suture is the parietal foramen.

The inner (cerebral) surface shows well marked arterial grooves, especially on the anterior part of the bone, produced by the branches of the middle meningeal artery. At the sagittal border there is the one half of the sagittal sulcus and at the mastoid angle one sees a short portion of the sigmoid sulcus. Not infrequently the cerebral surface presents digitate impressions and juga cerebralia and frequently also Pacchionian depressions (foveolae granulares) which may be of considerable depth, especially in middle and old age.

The Frontal Bone.

The frontal bone consists of two unpaired portions, the frontal plate and the nasal portion, while the orbital portions are paired.

The frontal plate forms the principal part of the bone. It articulates by its parietal border with both parietals in the coronal suture and by its sphenoid border with the great wing of the sphenoid in the spheno-frontal suture. The outer surface is strongly convex and presents at the middle of each half the tuber frontale. Above the margins of the orbits are two arched projections, the supraciliary arches, and between these the somewhat depressed glabella. The upper border of the orbit separates the frontal plate from the orbital portion. Its lateral part is formed by the zygomatic process which unites with the fronto-sphenoidal process of the zygomatic bone in the zygomatico-frontal suture. From the zygomatic process the temporal line takes origin and separates from the frontal surface a small almost vertical portion, the temporal surface. In the inner half of the supraorbital border are two notches, the medial frontal notch and the lateral supraorbital notch, this latter being frequently converted into a foramen, the supraorbital foramen.

The cerebral surface of the frontal plate possesses in its lower portion a median ridge, the frontal crest. This begins below at a foramen, the foramen caecum, bounded by the frontal arid ethmoid bones in common, and running upwards into the sagittal sulcus. The surface is smooth, except. for some digitate impressions and juga cerebralia, as well as Pacchionian depressions (foveolae granulares). It passes over without sharp demarcation into the cerebral surface of the orbital portion.

The orbital portions are separated from one another by a deep ethmoidal notch which receives the lamina cribrosa of the ethmoid. Each possesses an upper cerebral and a lower orbital surface. The former shows very abundant digitate impressions; the latter is concave and forms the roof of the orbital cavity. It presents on its medial portion a small depression, the fovea trochlearis (occasionally also a trochlear spine), and on its lateral part a shallow depression, the lacrimal fossa, for the lacrimal gland. The borders of the ethmoidal notch are broad and rough since they bear the ethmoidal foveolae, which complete the ethmoidal cells. Furthermore they bear an anterior and posterior groove (or short canal), which serve to form the anterior and posterior ethmoidal foramina.

The nasal portion of the frontal is the small, median part that unites the two supraorbital margins. It has an irregular, rough surface, for articulation with the nasal bones and the frontal processes of the maxilla and, in addition, the frontal spine, directed downwards and serving for the fixation of the bones that form the skeleton of the nose. Near the spine lie the openings of the frontal sinus, which is divided into two parts by a septum. Above the spine on the outer surface of the bone is a smooth flattened area, the glabella.

The Ethmoid Bone.

The ethmoid is an irregular, cubical bone in which a middle unpaired and two lateral paired portions may be distinguished. The middle portion consists of a horizontal plate, the lamina cribrosa, and a vertical plate, the lamina perpendicularis. The paired lateral portions are attached to the lateral edges of the lamina cribrosa and are known as the ethmoidal labyrinths.

The lamina cribrosa occupies the ethmoidal notch of the frontal bone and is a rectangular plate situated between the nasal and cranial cavities. It is perforated by a number of roundish foramina, through which the branches of the olfactory nerve pass to the nasal cavity. At its middle it bears a -thick ridge, high in front and diminishing posteriorly, the crista galli. In front of this are two small processes of the lamina cribrosa, the alar processes, which usually assist in the boundary of the foramen caecum.

The lamina perpendicularis is a thin pentagonal plate which forms the upper anterior part of the nasal septum. It is attached by its anterior, upper border to the frontal spine of the frontal, by its upper border it is fused with the lamina cribrosa, by its posterior border it articulates with the sphenoidal crest, by its lower border with the upper border of the vomer and by its anterior lower border with the cartilaginous nasal septum (see also Fig. A82).

The ethmoidal labyrinth hangs almost vertically downwards from the lateral border of the lamina cribrosa. It contains numerous, air-containing, imperfectly separated spaces, the ethmoidal cells, which in part are completely in the ethmoid itself, but for the most part are also bounded by other bones, the maxilla, lacrimal, frontal, sphenoid and palatine. The lateral wall of the labyrinth, by its thin lamina papyracea, forms a part of the medial orbital wall. Upon it or in the suture between it and the orbital portion of the frontal lie the anterior and posterior ethmoidal foramina.

The medial wall of the ethmoidal labyrinth forms the greater part of the lateral wall of the nasal cavity. It possesses two parallel projections, having the form of thin plates, curved upon themselves at their lower border, the nasal conchae. The superior concha is markedly smaller and shorter than the middle (see here). The latter projects beyond the labyrinth both anteriorly and posteriorly and is attached by its ends to the ethmoidal crests of the maxilla and palatine bones. It sends downwards a hook shaped processus uncinatus, which partly covers the opening of the maxillary sinus (see here and Fig. A88).

The Vomer.

The vomer is a flat, quadrangular bone which forms the lower and posterior portion of the nasal septum. Its upper end is thickened and cleft into two alae, which enclose the rostrum of the sphenoid. The small anterior border articulates with the cartilaginous part of the nasal septum, the upper border with the lower border of the lamina perpendicularis of the ethmoid, the lower border with the nasal crest of the maxilla and palatine and the posterior border forms the septum of the choanae.

The Maxilla.

The maxilla is a paired bone which takes part in the boundaries of the orbital, nasal and oral cavities. In it may be distinguished the body (corpus) and four processes. The body is irregularly cubical and encloses a large air-containing cavity, the maxillary antrum or sinus, which communicates by a wide opening with the nasal cavity. The body has four surfaces. The anterior is the facial surface and is convex; its upper infraorbital border forms part of the lower border of the orbit, below which is the infraorbital foramen, the opening of the infraorbital canal, and below this a shallow depression, the canine fossa. The orbital surface is triangular and forms the greater part of the floor of the orbit, bounding the inferior orbital fissure medially. It possesses a groove, the infraorbital groove, which gradually becomes converted into a canal. The lacrimal notch near the root of the frontal process, receives the hamulus of the lacrimal bone. The infratemporal surface is the posterior surface and forms the boundaries of the infratemporal and pterygopalatine fossae. The swollen end of this portion of the bone is termed the tuberosity; it presents several small alveolar foramina and also a pterygo-palatine groove, which completes the canal of the same name (see here).

The nasal surface forms the lower part of the lateral wall of the nasal cavity, but in its posterior portion it is covered in by the posterior part of the perpendicular portion of the palatine bone. It presents the wide irregular opening of the maxillary sinus, in front of which is a broad groove, the lacrimal groove (see below), and at the junction of the nasal surface with the frontal process the horizontal conchal crest (see below).

The frontal process of the maxilla is directed upwards and articulates by its upper border with the nasal portion of the frontal bone in the fronto-maxillary suture, by its lacrimal border with the lacrimal bone and by its medial border with the nasal bone.

It presents an outer and inner surface; the latter forms part of the lateral wall of the nasal cavity and bears an ethmoidal crest for articulation with the anterior part of the middle concha and below this a conchal crest for the inferior concha. Behind the process is the broad lacrimal groove, which, with a similar groove on the lacrimal bone forms the fossa for the lacrimal sac. The anterior wall of the groove is termed the anterior lacrimal crest. The zygomatic process is a broad, short, triangular process, projecting laterally to articulate with the zygomatic bone in the zygomatico-maxillary suture. The alveolar process is convex externally and concave on its inner surface, passing without distinct demarcation into the body on the one side and the palatine process on the other. The processes of the two maxillae meet in the intermaxillary suture, which ends anteriorly in the anterior nasal spine. The alveolar process forms the lateral and lower boundary of the piriform aperture. Its lower border is the alveolar border (limbus alveolaris) and bears the sockets for eight teeth, separated by interalveolar septa. The anterior surface of the process usually shows juga alveolaria, corresponding to the roots of the anterior teeth. The palatine process forms the greater portion of the hard palate and projects medially from the inner surface of the body. It is rough and uneven on its oral surface, smooth and concave on its nasal surface. The two processes unite by thickened borders to form the anterior part of the median palatine suture, which, on the nasal surface, forms the nasal crest. Anteriorly in the line of the suture is the incisive canal, which begins in an incisive notch on each maxilla and terminates on the nasal surface in two incisive foramina one on either side of the nasal crest.

The Lacrimal Bone.

The lacrimal bone is a very thin, flat, quadrangular bone that lies in the medial wall of the orbit between the frontal process of the maxilla and the lamina papyracea of the ethmoid. It presents orbital and ethmoidal surfaces. The latter closes certain of the ethmoidal cells and articulates on the lateral wall of the nasal cavity with the lacrimal process of the inferior concha. The former presents anteriorly the lacrimal groove, which is bounded posteriorly by the posterior lacrimal crest. This ridge runs downwards and terminates in a hook-like process, the hamulus, which fits into the lacrimal notch of the maxilla. Behind the ridge the orbital surface of the lacrimal forms a part of the medial wall of the orbit.

The Inferior Concha.

The inferior concha is a small, thin, porous bone whose free medial border is curled on itself, while the lateral border is attached to the conchal crests of the maxilla and palatine bone. It has three processes; the maxillary process extends downwards and laterally to the maxilla and closes a considerable portion of the opening of the maxillary sinus; the lacrimal process ascends to the lacrimal bone and forms a part of the posterior wall of the nasolacrimal canal; the ethmoidal process articulates with the uncinate process of the ethmoid, anterior to the opening of the maxillary sinus.

The Palatine Bone.

The palatine bone is a flat bone formed of two plates arranged at right angles to one another; one is the horizontal portion and the other the perpendicular portion. The horizontal portions of the two bones form the posterior part of the hard palate and resemble in every particular the palatine processes of the maxilla, from which they are separated by the transverse palatine suture. At the hinder end of the median palatine suture they form the posterior nasal spine and enclose on each side the greater palatine foramen, the inferior opening of the pterygopalatine canal.

The perpendicular portion is narrower, but longer than the horizontal. Its maxillary surface overlies the posterior part of the nasal surface of the maxilla, while its nasal surface forms a part of the lateral wall of the nasal cavity. It bears two parallel, horizontal ridges, a lower stronger conchal crest for the inferior and an upper ethmoidal crest for the middle concha. Posteriorly it articulates with the pterygoid process of the sphenoid, its posterior border showing a furrow, the pterygo-palatine groove, which, with corresponding grooves on the pterygoid process and maxilla, forms the pterygo-palatine canal.

Three processes of the palatine bone are recognized. The pyramidal process is directed backwards and is short and broad. It fits into the pterygoid notch of the pterygoid process, completing the pterygoid fossa. It usually presents the posterior openings of the lesser palatine foramina. The orbital and sphenoidal processes arise from the upper border of the perpendicular portion and are separated by the spheno-palatine notch. The larger orbital process looks laterally and anteriorly, forms a small part of the floor of the orbit and articulates with the lamina papyracea of the ethmoid in the palato-ethmoidal suture and with the maxilla in the palato-maxillary suture, closing along these sutures the adjacent ethmoidal cells. The sphenoidal process is directed medially and posteriorly and articulates with the under surface of the body of the sphenoid. In addition the perpendicular portion gives origin at its base to a variable, but constant, process, the maxillary process. It is crescentic in shape and closes in, according to its size, a greater or less portion of the opening of the maxillary sinus, coming into relation with the maxillary process of the inferior concha (Fig. A90).

The Nasal Bones.

The nasal bones form a part of the bony arch of the nose. They are small, flat, oblong bones, separated from each other by the internasal suture. They have a shorter medial and a longer lateral border, the latter articulating with the frontal process of the maxilla in the naso-maxillary suture. The upper and lower borders are irregular; the former articulates with the nasal portion of the frontal, the latter with the nasal cartilage. The posterior surface presents an ethmoidal groove, from which one or several nasal foramina pass to the outer surface of the bone.

The Zygomatic Bone.

The zygomatic (malar) bone is a rather thick triangular bone. Of its three surfaces the malar forms part of the face and is convex; it passes over into the zygomatic process of the maxilla and presents a zygomatico- facial foramen. The orbital surface is slightly concave and forms part of the lateral wall of the orbit; in half the cases it is a boundary of the anterior part of the inferior orbital fissure and presents one or two zygomatico-orbital foramina. The temporal surface is concave and presents the zygomatico-temporal foramen.

The bone has two processes. The temporal process projects horizontally backwards and articulates with the zygomatic process of the temporal to form the zygomatic arch (zygoma). The fronto-sphenoidal process- is directed upwards to form part of the lateral wall of the orbit and articulates with the zygomatic process of the frontal and with the zygomatic border of the great wing of the sphenoid.

The Mandible.

In the mandible there may be recognized a body (corpus) and two rami. The body is a thick curved plate from the posterior part of which the rami extend upwards almost at right angles.

The lower part of the mandible is termed the base and the tooth-bearing part the alveolar portion. The free border of the latter is termed the limbus alveolaris and bears the dental alveoli, separated from one another by interalveolar septa; it also presents juga alveolaria corresponding to the roots of the teeth. The outer surface of the body has in the middle line a roughened flat ridge, the mandibular protuberance, and lateral to this on the base on each side is a mental tubercle and further laterally the mental foramen, the anterior opening of the mandibular canal which traverses the bone. In addition there passes downwards upon the body from the anterior border of the ramus a smooth ridge which gradually diminishes in height and is termed the oblique line.

The inner surface of the body shows close to the middle line on each side a shallow digastric fossa, and between the two fossae and somewhat higher a sharp prominence, often doubled, the mental spine. Lateral to this is a distinct depression, the sublingual fovea for the sublingual gland and more laterally a much shallower, frequently indistinct, depression, the submaxillary fovea for the submaxillary gland. A rough line, beginning on the inner surface of each ramus, runs downwards and forwards upon the body, gradually becoming less distinct; it is the mylohyoid line and below it is a groove which extends downwards and forwards from the mandibular foramen, the mylohyoid groove.

Each ramus presents a medial surface, turned towards the oral cavity, and a lateral surface. Its lower posterior angle is termed the angle of the mandible. At about the middle of the medial surface is the mandibular foramen, which has a somewhat oblique position and opens into the mandibular canal; its inner border is raised into a projecting spine, the lingula. Above, each ramus divides into two processes separated by the mandibular notch. The anterior is the coronoid process, which is transversely flattened and sharp at its extremity; from its base a ridge, the bucinator ridge, extends to the neighbourhood of the last molar tooth. The posterior process is the condyloid process.

On the lateral surface of the angle of the mandible is the masseteric tuberosity and opposite it, on the medial surface, the pterygoid tuberosity for the attachment of similarly named muscles.

The condyloid process, situated posterior to the mandibular notch, bears at its upper end a head (capitulum) with an articular surface for the mandibular fossa of the temporal bone. It has the shape of an almost transversely directed cylinder. The constriction below the head is termed the neck (collum) and a depression on the anterior surface of this is termed the pterygoid fovea.

The shape of the mandible depends largely upon the age of the individual, since it is determined to a great extent by the action of the muscles of mastication and by the presence or absence of teeth. Just as the alveolar portion developes with the eruption of the teeth and degenerates with their loss, so too the muscles of mastication modify the form of the mandible. In the new-born child the ramus joins the body at an oblique angle (see Fig. A111, which only later gradually becomes a right angle.

The mandible is the only bone of the skull that articulates with other skull bones in a moveable joint, the only bone (except the hyoid) that can be readily separated from the others, which are more or less firmly united by sutures.

The Orbit.

The orbit is a paired cavity having the form of a four-sided pyramid placed horizontally; its apex is formed by the optic foramen and its base is surrounded by the margins of the orbit, the supraorbital and infraorbital. The four sides of the pyramid form the orbital walls, one of which is superior, one medial, one inferior and one lateral. Seven bones enter into the boundaries of the orbit, the frontal, sphenoid, ethmoid, lacrimal, maxilla, zygomatic and palatine.

The superior wall is horizontal and slightly concave. It is formed partly by the orbital portion of the frontal and to a lesser extent posteriorly by the lesser wing of the sphenoid.

The medial wall is almost sagittal an~ is mainly formed by the lamina papyracea of the ethmoid and, in front of this, by the lacrimal. The fronto-ethmoidal and fronto-lacrimal sutures form the boundary between this and the upper wall. In addition the maxilla takes part in the formation of the medial wall, firstly, by the orbital surface of its body below the lamina papyracea (see below) and, secondly, by its frontal process, which forms a narrow strip of the medial wall adjacent to the lacrimal bone.

The inferior wall passes without any boundary into the medial, but in the posterior two-thirds of the orbit and towards the lateral wall it is bounded laterally by the inferior orbital fissure. It is almost horizontal in position and is formed principally by the orbital surface of the maxilla and, to a small extent posteriorly, by the orbital process of the palatine.

The lateral wall is slightly concave and almost sagittal in position. It is more definitely bounded than the other walls in that in the whole of the hinder part of the orbit it is separated from adjacent walls by fissures. Between it and the upper wall is the superior orbital fissure and between it and the lower wall is the inferior orbital fissure. In its anterior part it is formed by the orbital surface of the zygomatic, in the posterior part by the orbital surface of the great wing of the sphenoid, the spheno-zygomatic suture separating these two surfaces.

The supraorbital margin is formed by the frontal bone, the infraorbital margin by the maxilla and zygomatic. The less sharply defined medial border is formed by the frontal process of the maxilla (anterior lacrimal crest) and the lateral border by the zygomatic.

The foramina and fissures in the orbit are:

  1. the optic foramen in the lesser wing of the sphenoid;
  2. the superior orbital fissure between the greater and lesser wings of the sphenoid;
  3. the inferior orbital fissure between the maxilla (and palatine) on one side and the greater wing of the sphenoid on the other;
  4. the upper opening of the nasolacrimal canal;
  5. the anterior and posterior ethmoidal foramina in or near the fronto-ethmoidal suture.
  6. the zygomatico-orbital foramina on the orbital surface of the zygomatic.
  7. the infraorbital canal forming the continuation of the infraorbital groove on the orbital surface of the maxilla,
  8. the frontal and supraorbital notches or foramina on the supraorbital margin.

In addition in the orbit, on the frontal bone, is the trochlear fossa (sometimes a spine) and the fossa for the lacrimal gland; in the region of the frontal process of the maxilla and the lacrimal bone, the fossa for the lacrimal sac, bounded by the anterior and posterior lacrimal crests; the infraorbital groove on the orbital surface of the maxilla; and the spine for the rectus lateralis on the great wing of the sphenoid.

The Hard Palate.

The hard palate forms the roof of the mouth cavity. It is an elongated, semi-elliptical, strongly concave plate of bone, in whose formation the palatine processes of the maxillae and the horizontal portions of the palatines and partly also their pyramidal processes participate. It shows a median palatine suture, a transverse palatine suture and traces of an incisive suture. Anteriorly towards the front end of the median suture is the unpaired incisive foramen, by which the bony oral cavity communicates with both nasal cavities. Posteriorly in the horizontal portion of the palatine bone there is, on either side, the greater palatine foramen and in each pyramidal process the lesser palatine foramen. These paired foramina are the openings of the pterygo-palatine canal.

The Nasal Cavity.

The bony nasal cavity is unpaired, but is divided into two symmetrical cavities by a median partition, the nasal septum, which is often oblique or not quite in the median line. Nine bones take part in the formation of the cavity; the nasal, frontal, ethmoid, sphenoid, maxilla, palatine, inferior concha, vomer and lacrimal. Its anterior opening is the piriform aperture, its posterior the choanae. The former is bounded by the nasal bones, the frontal processes and bodies of the maxilla; the choanae by the palatine bones, the medial plates of the pterygoid processes and the body of the sphenoid. The roof of the cavity is formed anteriorly by the two nasal bones and the nasal portions of the frontals, in the middle by the lamina cribrosa of the ethmoid and, posteriorly, by the body of the sphenoid. Its floor is the upper surface of the hard palate and is formed by the palatine processes of the maxillae and the horizontal portions of the palatine bones.

The nasal septum forms the medial wall for each nasal cavity and is itself formed by the lamina perpendicularis of the ethmoid anteriorly, and posteriorly and below by the vomer (see Fig. A82); the remaining portion is cartilaginous (see here).

The lateral wall of each cavity bears three nasal conchae. The lowest is a distinct bone, the inferior nasal concha, and is the largest and longest of the three, the uppermost being the smallest and shortest. The middle and upper conchae are projections of the ethmoid bone. By these three conchae the lateral portion of each cavity is divided into three passages (meatus); the superior meatus is between the superior and middle concha, the middle meatus between the middle and inferior and the inferior meatus between the inferior concha and the floor of the cavity. Above the superior concha, between it and the roof of the nasal cavity, there is a pocket-like depression, the spheno-ethmoidal recess. The part of the cavity medial to the conchae, between their medial edges and the septum, is termed the common meatus, the part behind the posterior ends of the concha the nasopharyngeal meatus. The following bones take part in the formation of the lateral wall; the ethmoid above and behind, the nasal surface of the frontal process of the maxilla above and in front, the body of the same bone below and in front, the perpendicular portion of the palatine behind and the medial surface of the lacrimal, which forms a small part in the anterior portion of the middle meatus. In addition to the principal nasal cavities there is a number of accessory cavities, which are air-containing, in most of the skull bones and especially those of the maxilla, the frontal, the sphenoid and the ethmoid (see here). The openings into the nasal cavities are also numerous and are:

  1. in the roof, the foramina of the lamina cribrosa of the ethmoid;
  2. in the floor, the upper openings of the incisive canal on each side of the nasal crest;
  3. in the inferior meatus, the inferior opening of the nasolacrimal canal;
  4. in the middle meatus, in the neighbourhood of the infundibulum, the opening of the frontal sinus by the hiatus semilunaris, that of the sinus maxillaris and the openings of the anterior ethmoid cells;
  5. in the upper meatus, the openings of the middle and posterior ethmoidal cells; and
  6. in the upper posterior part of the nasal cavity, the opening of the sphenoidal sinus, the small posterior ethmoidal foramen and the large, round spheno-palatine foramen.

The Pterygo-palatine Fossa.

The small pterygo-palatine fossa is situated between the anterior surface of the pterygoid process of the sphenoid, the perpendicular part of the palatine and the posterior end of the maxilla. It is funnel-shaped and passes below, without any demarcation, into the pterygoid canal, bounded by the same three bones. Above it opens into the inferior orbital fissure and laterally by the pterygo-maxillary fissure into the infratemporal fossa. Into it there are three openings; the foramen rotundum leading from the skull cavity, the opening of the horizontal pterygoid canal, which passes backward in the root of the pterygoid process to the foramen lacerum, and the spheno-palatine foramen leading into the nasal cavity.

The Skull of the New-Born Child.

The Hyoid Bone. The skull of the new-born child differs in many points from that of the adult. Instead of meeting in sutures the bones of the vault of the skull are connected by membrane, which in several places forms fontanelles (fonticuli). There are of these two unpaired and two paired. The frontal or great fontanelle (fonticulus frontalis) is rhomboidal in shape and lies at the meeting of the frontal, coronal and sagittal sutures, that is to say, between the two halves of the frontal bone, separated by a frontal suture, and the two parietals. The occipital or lesser fontanelle (fonticulus occipitalis) is triangular and lies at the hinder end of the sagittal suture, between the two parietal bones and the occipital. The sphenoidal fontanelles (fonticuli sphenoidales) are irregularly quadrangular and lie on each side between the sphenoidal angle of the parietal bone and the parietal angle of the great wing of the sphenoid, where later is the spheno-parietal suture. The mastoid fontanelles (fonticuli mastoidei) are, like the sphenoidal, of irregular shape and lie on either side between the mastoid angle of the parietal and the mastoid portion of the temporal, where later is the parieto-mastoid suture.

The squamous portion of the occipital shows a sutura mendosa, and the bone is represented by four distinct portions, the squamous, two lateral and basilar portions, separated by anterior and posterior intraoccipital synchondroses. In the temporal bone in place of the tympanic portion there is the anulus tympanicus (see here); the mastoid process is completely absent and the squamoso-mastoid suture separates the squamous portion from the pyramid, i.e. from the petrous portion and the mastoid. On the parietal the tuberosity is very distinct, as is also that of the frontal bone, which is still in two portions separated by the frontal suture. Between the sphenoid and the occipital there is a sphenooccipital synchondrosis and in the body of the sphenoid an intrasphenoidal synchondrosis.

The maxilla and mandible are low, the alveolar portions being quite wanting. The incisive suture is quite distinct on the hard palate. Between the two halves of the mandible the remains of a suture are visible; the rami are almost in the same line as the body, i. e. they form with it a very obtuse angle.

The hyoid bone is a small, flat bone situated at the base of the tongue. Although it has no direct connection with the skull and is situated in the neck below the mandible, it is usually described as a cranial bone. It presents a body (corpus), convex in front and concave behind, and two pairs of cornua. The greater cornua are long and thin and enlarged into a knob at their ends; they arise from the sides of the body and are directed upwards and backwards. The lesser cornua often remain cartilaginous, and are much smaller than the greater ones; they arise near the base of the greater ones and are directed posteriorly laterally and upwards.

The Appendicular Skeleton.

The Skeleton of the Left Upper Extremity.

The Left Shoulder Girdle.

The girdle of the upper extremity is formed of two bones, the scapula and the clavicle.

The Scapula.

The scapula is a typical flat bone of triangular shape. Its anterior surface, turned toward the ribs, is termed the costal surface, its posterior surface, the dorsal surface. Its three angles are termed medial, inferior and lateral and its three borders, the superior, vertebral or medial and axillary or lateral.

The costal surface is smooth except for some transverse lines, lineae musculares, for the attachment of the subscapular muscle, and it is slightly concave, forming the subscapular fossa for the muscle of that name.

The dorsal surface is divided into two areas by a strong, roughened ridge the spine; the upper smaller area is the supraspinous fossa and the lower larger one the infraspinous fossa, which lodge muscles of the same names. The spine of the scapula is flat at the vertebral border, but becomes higher as it passes transversely across the dorsal surface, and at the neck of the bone it is prolonged into a flattened process, projecting over the lateral angle and termed the acromion. It presents a small surface for articulation with the clavicle (facies articularis).

The vertebral border is usually slightly and obtusely angled at the base of the spine; the axillary border is thick and rough for the attachment of muscles. The superior border presents a notch in the neighborhood of the lateral angle, the scapular notch, and between the notch and the lateral angle it gives rise to a strong hook-shaped coracoid process. This arises by a broad base and is at first directed upwards, but then bends forward and laterally.

The lateral angle bears the pear-shaped, slightly concave glenoid cavity for the reception of the head of the humerus. Both above and below it is a roughened area, the supraglenoid and infraglenoid tuberosities, which, give origin respectively to the tendons of the long heads of the biceps and triceps. The constriction of the scapula medial to the borders of the glenoid cavity is called the neck (collum) and in this region the supraspinous and infraspinous fossae become continuous. The medial angle is a right angle, the inferior one is more acute, but strongly rounded.

The Clavicle.

The clavicle is an S-shaped, long bone in which a middle portion, the body (corpus), and two extremities may be recognized; of the latter the medial is termed the sternal and the lateral the acromial extremity after the bones with which they articulate. The bone is convex anteriorly at its sternal extremity and concave anteriorly at its acromial extremity. The sternal end is thick and almost triangular-prismatic; the acromial end on the contrary is flattened.

At the sternal end there is a triangular sternal articular surface, which forms part of the sterno-clavicular articulation. Lateral from this on the anterior, lower border is a roughened area, the costal tuberosity, for the attachment of the costo-clavicular ligament. The body of the bone, like the sternal extremity, is almost triangular, but with strongly rounded angles.

The flattened acromial extremity at its boundary with the body and at its posterior and lower border bears a roughened area, the coracoid tuberosity, for the attachment of the coraco-clavicular ligament and, at its very end, an acromial articular surface for articulation with the acromion.

The Humerus.

The humerus is a typical long bone, in which may be distinguished a long shaft or body (corpus) and two thickened extremities, superior and inferior. The superior extremity bears an articular head (caput), placed at an angle with the body and directed medially, It is almost hemispherical and is separated from the shaft of the bone by a shallow, circular groove, the anatomical neck (collum anatomicum). In addition to the head, the upper extremity bears two roughened elevations for muscular attachment; a larger one, the greater tubercle directed laterally, and a smaller one, the lesser tubercle, directed medially and anteriorly. Between the two is a distinct intertubercular groove. At the junction of the upper extremity with the body below the tubercles, there is a distinct diminution in the diameter of the bone, termed the surgical neck (collum chirurgicum).

The upper end of the shaft is almost cylindrical, but below the middle it becomes somewhat triangular and, at the same time, flattened. From each tubercle a ridge (crista) passes downwards, continuing the intertubercular groove for some distance. Below the greater tubercular crest there is a large, flat, roughened area; the deltoid tuberosity, for the attachment of the deltoid muscle; it is on the lateral, posterior part of the bone, which, at this level, is still cylindrical. At about the middle of the shaft on its medial surface there is a roughened area, not always distinct, for the attachment of the coraco-brachialis muscle and near this is a frequently large nutritive foramen.

From the middle of its length downwards the shaft of the humerus presents three surfaces, posterior, anterior medial, and anterior lateral. The two anterior surfaces are separated by a low elevation, but at the lateral angles there are sharp borders, medial and lateral. The lateral border begins below the deltoid tuberosity, being separated from it by a shallow groove, the groove for the radial nerve (musculo-spiral groove). This contains the radial (musculospiral) nerve and winds around the middle portion of the shaft in an open spiral, passing from above and medially, downwards and laterally and gradually flattening out. Its borders serve for the attachment of two heads of the triceps muscle. Towards the inferior extremity the humerus becomes markedly flattened and at the same time broader. The two borders are continued into two rough muscle projections, the medial border into the strongly projecting medial epicondyle and the sharper lateral border into the smaller lateral epicondyle. The former has on its posterior surface a shallow groove for the ulnar nerve, which is bounded laterally by the border of the trochlea.

Below the epicondyles is the lower articular head of the humerus, for the bones of the forearm. There is a separate surface for each of these, the large trochlea, hour-glass shaped, on the medial side for the ulna and the smaller, hemispherical capitulum laterally, for the radius. Above the trochlea on the medial anterior surface there is at the level of the epicondyle a rather deep depression, the coronoid fossa, and above the capitulum at the lower part of the lateral anterior surface there is a much smaller and shallower one for the head of the radius. Opposite these two fossae there is on the lower part of the posterior surface a broad and deep olecranal fossa.

The Ulna.

The ulna is a distinctly triangular-prismatic long bone, thick above and much thinner below. It presents a superior extremity, a body or shaft (corpus) and an inferior extremity. The stout superior extremity carries the semilunar notch with the constricted, or even divided, articular surface for the trochlea of the humerus. Its anterior portion lies on the upper surface of the coronoid process, a broad, beak-like projection, while its posterior portion is on the anterior surface of a very strong, upwardly projecting process, the olecranon. On its lateral side the upper extremity has a notch lined with cartilage, the radial notch for the reception of the head of the radius. From it a rough ridge extends downwards on the upper part of the dorsal surface, the supinator crest, for the muscle Immediately below the coronoid process is a broad rough area, the ulnar tuberosity.

The shaft (corpus) of the bone is much thicker above than below, and at the same time becomes rounded below, the upper distinctly triangular portion becoming cylindrical in the lower fourth. An anterior or volar, a posterior or dorsal and a medial or ulnar surface may be recognized. The dorsal border separates the dorsal and medial surfaces and the volar border the volar and medial surfaces. The third border, turned toward the radius, is sharp; it separates the volar and dorsal surfaces and is termed the interosseous crest. The volar surface bears the nutrient foramen, otherwise the surfaces present no special markings.

The distal end of the bone, the inferior extremity, is the capitulum; it is rounded and covered by cartilage. On the radial side there is also an articular surface for the radius, the articular circumference, as well as a sharp process, projecting distally beyond the capitulum on the medial side, the styloid process.

The Radius.

The radius is the more lateral of the two bones of the forearm. In contrast to the ulna it is small above and broad and thick below.

The superior extremity is formed by the disk-shaped capitulum and a distinct circular constriction below this is termed the neck (collum). In its upper part the bone is almost cylindrical. The capitulum bears on its upper surface an articular depression or fovea for the capitulum of the humerus and a second articular surface, the articular circumference, that completely surrounds its margin. Below the neck on the upper part of the volar surface there is a distinctly elevated rough area, the tuberosity, which gives attachment to the biceps muscle.

The shaft (corpus) of the radius, like that of the ulna, is triangular-prismatic. The three surfaces are also placed as in that bone, so that a volar, a dorsal and a lateral (radial) surface may be distinguished and volar and dorsal borders as well as an interosseous crest. The last lies opposite the similarly named crest of the ulna and is the only sharp border of the radius, the others being rounded. The three surfaces present no markings of importance except some roughenings for muscles, such as that for the pronator teres. Usually a nutrient foramen occurs on the volar surface.

The inferior extremity is greatly broadened and flattened, so that in its region only a volar and a dorsal surface may be distinguished. The interosseous crest passes below into a slightly concave surface, the ulnar notch, which furnishes an articular surface for the capitulum of the ulna. Opposite it a styloid process projects beyond the general inferior surface of the bone; it is broader and less pointed than the similarly named process of the ulna.

The volar surface of the inferior extremity is smooth and slightly concave, the dorsal surface on the contrary presents distinct grooves with intervening ridges for the extensor muscles of the hand and fingers, one, especially deep and with an oblique course, being for the tendon of the extensor pollicis longus. On the distal terminal surface, which is turned toward the hand, there is a concave carpal articular surface, usually distinctly divided into two areas. By means of this surface the radius articulates with the navicular (scaphoid) and lunate bones of the hand.

The Bones of the Left Hand.
The Carpus.

The eight bones of the carpus are arranged in two rows, a proximal and a distal. Those of the proximal row, named from the radial side are the navicular (scaphoid), the lunate, the triquetrum or cuneiform, and the pisiform; those of the distal row named in the same order are the trapezium (greater multangular), the trapezoid (lesser multangular), the capitate or os magnum, and the hamate or unciform. The bones of the proximal row do not lie in a straight line, but form an arch, slightly convex proximally and deeply concave distally. Similarly from the row of distal bones, one, the capitate, projects strongly towards the bones of the proximal row and fills their concavity.

The carpal bones are very irregular in shape; they do not lie in a plane but form a dome, convex dorsally and concave volarly. The dome is increased by two bony projections on the radial and ulnar sides of the volar surface of the carpus, a deep groove, the carpal groove, lying between them. These projections are the ulnar and radial eminences. The latter is formed by the tubercle of the navicular (scaphoid) and the tubercle of the trapezium (greater multangular), the former by the pisiform and the hamulus of the hamate (unciform). The small, almost spherical pisiform bone lies on the volar surface of the carpus; all the other bones of the carpus have each a dorsal and a volar, more or less roughened surface. In the cases of the four bones at the sides of the carpus, the navicular (scaphoid), trapezium (greater multangular), triquetrum (cuneiform) and hamate (unciform), the dorsal and ventral surfaces are united by lateral ones, radial or ulnar. The numerous remaining surfaces are smooth, articular surfaces for articulation with the radius, the metacarpal bones or adjacent carpal bones. The pisiform has only one small, flat, articulating surface for articulation with the triquetrum (cuneiform); all the other bones have several. The more important of these surfaces are the following: The navicular (scaphoid) and lunate have each a convex surface for articulation with the distal end of the radius; the triquetrum (cuneiform) does not, however, articulate with the ulna, but with a triangular cartilage that separates it from the ulna. Between the proximal and distal rows, the joint between the convex head of the capitatum (os magnum) and the concavity formed by the lunate and navicular (scaphoid) is the most important. The first metacarpal articulates by a distinctly saddle-shaped surface with the trapezium (greater multangular), the second with the trapezoid (lesser multangulum), the third with the capitate (os magnum), while the hamatum (unciform) bears the two ulnar metacarpals.

The Metacarpus.

The metacarpal bones are typical long bones, in which a proximal portion or base, a body (corpus) and a distal portion or capitulum may be distinguished. The bases articulate with the distal row of carpal bones, the capitula with the proximal row of phalanges. The metacarpal of the thumb is the shortest, that of the index the longest, and from this toward the little finger they gradually diminish in length.

The bases of the metacarpals are irregularly cubical; that of the thumb bears a saddle-shaped surface for articulation with the trapezium (greater multangular), the rest, in addition to the surfaces for the carpal bones, have also lateral surfaces for articulation with one another. The base of the third metacarpal bears a styloid process, which is directed laterally (radially).

The almost triangular prismatic bodies of the metacarpals, except that of the thumb, have each a volar and a dorsal angle; the latter broadens to a surface towards the capitulum, the former flattens towards the base. The capitula are spherical in shape; at their sides are depressions that give attachment to ligaments.

The bases are closely applied to one another, except in the case of the freely moveable metacarpal of the thumb; on the other hand, the bodies and the capitula are separated by considerable intervals, the interosseous spaces.

The Phalanges.

Each finger has three phalanges, the thumb only two. The basal phalanx is termed the first phalanx, the middle one the second phalanx and the distal or terminal one the third phalanx. The thumb lacks the second phalanx. The lengths of the phalanges diminish toward the finger tips, so that the basal phalanges are much the longest, terminal phalanges the shortest.

The longest phalanx is the basal one of the middle finger. The phalanges are long bones with a proximal extremity or base, a body (corpus) and a distal extremity or trochlea. The bases of the proximal phalanges have hollow spherical sockets for the capitula of the metacarpals, those of the middle and distal phalanges are hollow cylindrical, with a median elevation, corresponding in form to the trochleae.

The bodies of the phalanges are convex dorsally and flat or very slightly concave on the volar surfaces, with sharp lateral borders. The terminal phalanges have no trochleae, but the short bodies pass into a rough horse-shoe shaped enlargement, the unguicular tuberosity. At the distal ends of the proximal and middle phalanges there are foveae for the attachment of ligaments, similar to those on the metacarpal capitula.

In addition to the bones that have been mentioned there are in the hand a variable number of sesamoid bones. Two occur constantly at the metacarpo-phalangeal joint of the thumb and occasionally others are found at the corresponding joints of the index and little fingers and at the interphalangeal joint of the thumb. In the little finger they may be replaced by fibro-cartilage. In the thumb they are usually covered with cartilage on one side and are connected with the joint (see Fig. A224).

In the region of the metacarpus and fingers the bones of the hand do not form a flat surface, but a dome convex dorsally and concave volarly, which may be markedly deepened by the action of the muscles of the hand and also not a little flattened. The highest point of the convexity of the back of the hand is the metacarpal of the index finger. From this the curvature falls gradually toward the little finger and quite suddenly toward the thumb. The bones of the thumb, the metacarpal as well as the two phalanges, are placed with their surfaces directed laterally and medially, instead of dorsally and volarly as in the other fingers; the bones of the thumb, therefore; turn towards the dorsum of the hand a border and not a surface. In the metacarpal of' the little finger, also, the dorsal surface looks distinctly medially.

While the metacarpal bone of the index is the longest the phalanges of the middle finger are longer than those of the index, so that the middle finger is the longest of all the fingers. The phalanges of the ring finger are also usually longer than those of the index. Corresponding to the function of the hand as a grasping organ the fingers are strongly developed, forming almost half the length of the entire hand. The length of the carpus is about only 1/6 the length of the entire hand.

The Skeleton of the Right Lower Extremity.

The Right Pelvic Girdle.
The Innominate Bone (os coxae).

The innominate bone ( os coxae) consists until puberty of three bones united by synchondroses, the ilium, the pubis, and the ischium. All three bones meet in the articular cavity for the femur (acetabulum). The ilium forms the upper portion of the compound bone; it is the largest of the three bones and forms the upper third of the acetabulum. It consists of a body (corpus) and an ala. The pubis forms the lower and anterior portion of the innominate and the lower anterior third of the acetabulum. It is separated from the ischium by a large roundish foramen, the obturator foramen, but is also united with it in the inferior boundary of the foramen. It has a body (corpus) and two rami, a ramus superior, forming the upper boundary of the obturator foramen, and a ramus inferior. The ischium forms the lower posterior portion of the innominate, the lower posterior third of the acetabulum and the lower and posterior boundary of the obturator foramen. It consists of a body (corpus) and two rami, superior and inferior.

The Ilium.

The ala of the ilium has somewhat the form of a broad flat shovel. At its central part it is often as thin as paper, but its upper border is thickened and rough and is termed the iliac crest. Upon this may be seen three parallel rough lines, most distinct at the middle of the crest, where it reaches its highest point. These lines are termed the outer lip, the inner lip and the intermediate lip. Anteriorly the crest ends in a projection, the anterior superior spine; at its posterior end is a less distinct posterior superior spine, and below this, separated from it by a slight notch, is the posterior inferior spine. Upon these there follows at the posterior end of the innominate a deep, parabolic notch, the great sciatic notch (incisura ischiadic a major); its upper boundary is the posterior border of the ala of the ilium. and its lower and anterior boundaries are the bodies of the ilium and ischium. Below the anterior superior spine, on the body of the ilium, is the anterior inferior spine.

The lateral surface of the ala is rough and convex and its principal markings are three rough lines, the posterior, anterior and inferior gluteal lines. The posterior line runs almost vertically over the posterior part of the ala to the upper boundary of the great sciatic notch. The longer anterior line runs from the anterior superior spine as an arch, at first almost horizontal and then almost vertical, to the upper border of the great sciatic notch where it ends not far from the posterior line. The inferior gluteal line is markedly shorter than the anterior, and forming a weak arch beginning between the anterior superior and anterior inferior spines, it runs above the acetabulum and almost horizontally to the middle of the great sciatic notch.

The medial surface of the ala of the ilium has two portions, a larger anterior one which is slightly convex and is termed the iliac fossa and an uneven posterior one. On the latter again there may be made out two portions, corresponding to portions of the sacrum with similar names, the lower and anterior auricular surface and the posterior and upper, very much roughened iliac tuberosity. The auricular surface is bounded by a slight paraglenoid groove. The iliac fossa is separated from the rest of the innominate by a line which is continued upon the pubis and is called the arcuate line; it forms a part of the boundary line (linea terminalis) separating the false and the true pelves. The body of the ilium forms the upper part of the acetabulum; it passes on the inner surface into the ala without demarcation and in the adult, in a similar manner, into the bodies of the pubis and ischium.

The Pubis.

The pubis of the adult is intimately connected with the ilium and ischium and forms part of the acetabulum. Where the pubis and ilium meet there is a low, rounded elevation, the iliopectineal eminence. From the body of the bone there arises the triangular superior ramus, which lies almost horizontally and bears at its anterior end the elongated symphyseal surface for union with the bone of the opposite side; it also forms the upper boundary of the obturator foramen. On its upper surface is a sharp ridge, the pecten, which is a continuation of the arcuate line of the ilium. This ends anteriorly in a small elevation, the tubercle, not far from the symphyseal surface. Where the superior ramus arises from the body there is a broad obturator groove on the medial surface of the bone; it is bounded medially by the obturator crest. At the obturator groove anteriorly there is an elevation, the anterior obturator tubercle, directed toward the obturator foramen, and on the ischium a posterior tubercle. The inferior ramus passes obliquely downwards and laterally from the symphyseal surface.

The Ischium.

The ischium forms the lower posterior part of the acetabulum, and in the adult passes over without demarcation into the ilium and pubis. It forms the lower anterior boundary of the great sciatic notch, below which it projects as a broad, flattened, but sharp spine. Below this is the lesser sciatic notch (incisura ischiadic a minor), which lies entirely in the ischium and whose lower boundary is a strong roughened protuberance, the tuberosity. From the neighborhood of this the inferior ramus ascends at a sharp angle to the superior ramus. With the lower ramus of the pubis it forms the lower boundary of the obturator foramen. The acetabulum is formed by the bodies of the three bones, but the lines of separation between these can be seen only in youthful bones. It is almost hemispherical, with elevated borders, and looks almost laterally. Below towards the obturator foramen there is a notch in its border, the acetabular notch. The bottom of the cavity shows two portions, the lunate surface, covered with cartilage, which forms the upper and lateral portions of the cavity, and the almost square, rough and uneven acetabular fossa, almost surrounded by the lunate surface.

The Skeleton of the Right Free Lower Extremity.

The Right Femur.

In the femur there may be distinguished a superior extremity, a body or shaft (corpus) and an inferior extremity. The superior extremity bears the head (caput) at the extremity of a neck (collum), which passes into the shaft at an obtuse angle. The head is somewhat more than a hemisphere and is covered with cartilage, except at a slight depression near its center, the fovea. The neck (collum) is strongly constricted near the head but enlarges laterally toward the shaft of the bone; it has a long lower border and an upper border about half as long. At the upper end of the shaft, at the union of this with the neck are two large, strong processes, the trochanters. The greater trochanter is much larger than the lesser one and looks laterally. Its upper extremity, whose tip is slightly bent posteriorly and medially, projects above the neck and bears on the medial surface below the apex a trochanteric fossa. The great trochanter forms the entire lateral part of the upper extremity of the femur. The lesser trochanter is opposite the greater on the medial surface of the upper part of the femur and is a short conical projection directed medially and slightly backward; it lies at a somewhat lower level than the great trochanter. The two trochanters are connected on the anterior surface of the bone by a rough intertrochanteric line, and on the posterior surface by a distinct ridge, the intertrochanteric crest.

The shaft (corpus) of the femur is almost cylindrical, but toward its lower end it broadens and becomes triangular-prismatic with rounded borders. In this region there is an anterior medial, an anterior lateral and a posterior surface. It is distinctly convex anteriorly.

While the anterior and lateral surfaces of the bone are exceptionally smooth, the posterior surface shows a rough line, the linea aspera. This possesses two distinct lips, a medial and a lateral. Throughout the middle portion of the bone both lips lie close together, but above they diverge toward the two trochanters and below toward the epicondyles (see below). The lateral lip passes above into an elongated roughened ridge, the gluteal tuberosity, which is occasionally greatly enlarged to form the so-called third trochanter. The medial lip becomes less pronounced in its upper part and unites with the intertrochanteric line in the region of the lesser trochanter, without actually uniting with this latter, and so ends on the greater trochanter. Parallel with and somewhat lateral to it is a second rough line, the pectineal line, which passes upward toward the lesser trochanter.

Towards the lower end of the femur the two lips of the linea aspera gradually diverge from one another to bound a triangular, almost flat area on the posterior surface of the bone; this is the popliteal plane. Upon the linea aspera, above its middle, there is usually one or several nutrient foramina, that lead into canals directed distinctly proximally.

The inferior extremity of the femur is much broadened. It bears the two convex, backwardly directed articulating condyles, the larger medial condyle and the smaller lateral condyle, separated from one another behind by the intercondyloid fossa. The intercondyloid line separates the intercondyloid fossa from the popliteal plane. Anteriorly the cartilaginous surfaces of the condyles pass into a common articular surface, the patellar surface, which is concave transversely and convex sagittally; consequently, the whole cartilaginous surface at the lower end of the femur has a horse-shoe shape. Above the condyles are two rough, but only slightly prominent, processes, the medial and lateral epicondyles.

The Patella.

The patella is a flat disk-shaped bone, which is really a large sesamoid bone in the tendon of the Quadriceps femoris. Its upper border is broad and is termed the base, while below the bone passes into a point, the apex. The anterior surface is rough, the posterior smooth and in 2/3 of its extent covered with cartilage, this area taking part in the formation of the knee-joint and being called the articular surface. The posterior surface of the apex is, however, not covered with cartilage but is rough like the anterior surface.

The Tibia.

The tibia is the medial and the larger of the two bones of the lower leg. It has a superior extremity, a shaft or body (corpus) and an inferior extremity.

The superior extremity is much the thickest portion of the bone. It bears medial and lateral condyles for articulation with the condyles of the femur. Their upper surfaces are the slightly concave medial and lateral superior articular surfaces which are separated by a median elevation, the inter condyloid eminence, surmounted by two tubercles, the medial and lateral intercondyloid tubercles. Both behind and in front of the eminence is a small shallow groove, the anterior and posterior intercondyloid fossae. Below the articular surfaces there is the rough, almost perpendicular border of the upper part of the bone, the infraglenoid border, and on the lateral and posterior part of this is an articular surface for the head of the fibula. Below the infraglenoid border on the anterior surface of the bone is a large roughened area, the tuberosity.

The shaft (corpus) of the tibia is distinctly triangular-prismatic. It is thick in its upper part, becomes gradually thinner lower down and then enlarges again below. It presents three surfaces and three borders. The medial and lateral surfaces are separated by the anterior crest, while the very sharp interosseous crest, directed toward the fibula, separates the lateral and posterior surfaces. The third, rounded border, the medial, separates the medial and posterior surfaces.

On the upper part of the posterior surface there is an oblique line, the popliteal line, which runs from the articular surface for the fibula downwards and medially to the medial border. Below this line is the nutrient foramen, usually large and distinct; it leads into a canal that runs obliquely downwards. The medial surface, like the anterior border, is subcutaneous and readily felt; the lateral surface shows no special markings. Towards the lower end the borders of the bone are rounded so that this part of the shaft is almost cylindrical.

The inferior extremity, which is thicker than the lower part of the shaft, is decidedly smaller than the superior extremity. It bears on its under surface a slightly concave inferior articular surface for articulation with the tarsus (talus). On its medial side there is a strongly projecting process, the medial malleolus, whose outer surface is also an articular surface for the tarsus and passes without demarcation into the inferior articular surface. On its posterior surface the medial malleolus has a broad medial malleolar groove for a muscle tendon. On its lateral surface the lower end of the tibia has a fibular notch for articulation with the lower end of the fibula; it is not, however, covered with cartilage.

The Fibula.

The fibula is a long bone, very thin in proportion to its length; it is scarcely shorter than the tibia, beyond which it projects below. It lies on the lateral side of the lower leg and has a superior extremity, a shaft (corpus) and an inferior extremity. The superior extremity forms the head (capitulum) and the inferior extremity the lateral malleolus. The head is distinctly enlarged as compared with the slender shaft; its uppermost part is behind and somewhat lateral and is termed the apex. It bears, for articulation with the tibia, a small, almost flat surface, the capitular articular surface.

The shaft is very distinctly triangular-prismatic. The three surfaces are medial, lateral and posterior, the sharp borders, which are not always straight are termed crests. The anterior crest separates the medial and lateral surfaces, the posterior crest the posterior and medial surfaces and the lateral crest the posterior and lateral surfaces. In addition to these there is a feebly developed interosseous crest at about the middle of the medial surface, so that the fibula has really four borders.

The inferior extremity forms the lateral malleolus. This is longer and more pointed than the medial one and has upon its medial surface an articular surface, which immediately adjoins the inferior articular surface of the tibia. On the lateral surface of the malleolus there is a shallow groove for the peroneal tendons.

The Bones of the Right Foot.

The Skeleton of the Foot as a Whole and the Tarsus.

Like the hand, the foot consists of three portions:

  1. the tarsus,
  2. the metatarsus, and
  3. the phalanges,

but it differs from the hand not only in the number and form of its constituent bones, but also in certain special particulars. While the axis of the hand is the direct continuation of that of the forearm and arm, that of the foot is almost at right angles to that of the leg, and while in the hand the fingers are almost the half of its entire length, in the foot the tarsus forms almost the proximal half and the metatarsals and toes the distal half, the latter being only a fifth of the entire length of the foot.

The foot is more strongly arched than the bones of the hand and the arch is less capable of being modified. Its convexity is dorsal and the concavity plantar, the deepest point of the latter being at the sharp, lower edge of the second cuneiform bone. Similarly the dorsal surface of the second cuneiform is the highest point of the middle of the arch. The lower supports for the arch are the calcaneal tuberosity behind and the heads of the metatarsals in front. It is formed exclusively by the tarsus and metatarsus and is open medially, since the medial border of the foot is much higher than the lateral, which rests on the ground through almost its entire length.

The phalanges of the second to the fifth toes do not lie in a single plane, even when the toes are extended, but are strongly convex upwards and seem to be curved in a claw-like manner upon the heads of the metatarsal bones, so that only their distal ends are in contact with the ground. The second toe is the longest and is that through which the axis of the foot passes.

The Tarsus.

There are seven tarsal bones:

  1. the talus (astragalus),
  2. the calcaneus,
  3. the navicular,
  4. the cuboid,
  5. the first or internal cuneiform,
  6. the second or middle cuneiform and
  7. the third or outer cuneiform bone.

The arrangement of these bones is such that on the medial side of the foot there are three bones, the talus, navicular, and cuneiform, whereas on the lateral side there are only two, the calcaneus and cuboid. In contrast to the condition in the hand only a single bone, the talus, articulates with the lower leg bones.

The Talus

The talus is a short bone with an irregular cubical form, and presents for examination a body (corpus), a head (caput), and a constricted portion between these, the neck (collum). The body is the thickest and most posterior part of the bone and bears on its upper surface an articular surface, the trochlea, covered with cartilage and articulating with the tibia and fibula. The trochlea extends also upon the lateral surface of the talus and upon a strong projection of the bone, the lateral process, forming the lateral malleolar surface; it extends also upon the medial surface forming the medial malleolar surface, but this is smaller in extent than the lateral one, a part of the medial surface being rough. Behind the trochlea is a backwardly projecting part of the bone, the posterior process, which bears a broad groove for the tendon of the Flexor hallucis longus. The under surface of the body bears a distinctly concave posterior calcaneal articular surface, in front of which is a broad depression, the sulcus tali. Anterior to this, in the region of the neck, there is on the under surface an elongated second articulation for the calcaneus, the middle calcaneal articular surface, and adjoining this, on the head of the talus, is an anterior calcaneal articular surface. The constricted neck (collum) is to be seen distinctly only on the upper and lateral surfaces; on the medial and lower surfaces it is clearly separated from neither the head nor body. The head (caput) is the rounded anterior end of the bone and bears the almost hemispherical navicular articular surface, for articulation with the navicular bone and navicular fibro-cartilage.

The Calcaneus.

The calcaneus is the largest bone of the tarsus. Its principal part is termed the body (corpus), the posterior thickened end of which is termed the tuberosity (tuber calcanei) and projects backwards behind the other bones of the foot. On its under surface are two projections, the medial and lateral processes. Looking from above one sees three surfaces (posterior, middle, and anterior) for articulation with the talus; the posterior is the largest and is convex, the other two are slightly concave. Between the middle and posterior articular surfaces lies the calcaneal groove, which is broadly open laterally; with the sulcus tali it forms the sinus tarsi.

From the strongly concave medial surface of the calcaneus a broad process, the sustentaculum tali, projects towards the talus and bears the middle articular surface for that bone. On its under surface is the broad groove for the tendon of the Flexor hallucis longus, continuous with the similar groove on the talus. A similar, but much shallower, groove for the peroneal muscles lies on the lateral surface, which is otherwise flat, except that a small, blunt trochlear process sometimes occurs above the groove. The anterior surface bears the articular surface for the cuboid, which is somewhat saddle-shaped.

The Navicular.

The navicular lies between the talus behind and the three cuneiforms in front. Its long axis is transverse to that of the foot and it is convex anteriorly and concave posteriorly; its dorsal surface is also distinctly convex. On its plantar surface, near the medial border, there is a strong rounded projection, the tuberosity.

The Cuboid.

The cuboid lies on the lateral border of the foot, between the anterior end of the calcaneus and the bases of the fourth and fifth metatarsals. It has an irregular cubical form, tapering toward the lateral border of the foot. Its anterior surface bears an articulating surface divided into two parts for the fourth and fifth metatarsals; its posterior surface is saddle-shaped and its medial surface has an articular facet for the external cuneiform. The plantar surface has a flat projection, the tuberosity, which is rounded and sometimes covered with cartilage; it serves as a pulley for the tendon of the Peroneus longus, which lies in a groove, the peroneal groove, in front of the tuberosity.

The cuneiform bones are wedge shaped; the internal one is the largest and has its sharp edge dorsally, while in the others it is turned plantarwards. The middle one is the smallest. They articulate with the navicular behind and the bases of three metatarsals in front; the internal one usually articulates also with the cuboid.

The Metatarsals.

The metatarsals have each a base, a head (capitulum) and a body (corpus). They lie between the bones of the tarsus behind and the phalanges in front, articulating with both. In addition the bases of the second to the fifth articulate with each other. The first metatarsal is short and thick; the second is the longest. The base of the first has a broad tuberosity directed plantarwards and laterally, and a tuberosity also occurs on the base of the fifth which projects markedly upon the lateral border of the foot.

The Phalanges.

The phalanges resemble those of the hand but are markedly shorter. The great toe has two phalanges, which are much thicker than those of the other toes. Each phalanx has a base, a body, and a trochlea, this on the terminal phalanges being replaced by an unguicular tuberosity.

Bone Structure.

According to their outer form bones may be divided into three groups, long bones (ossa longa), short bones (ossa brevia) and flat bones (ossa plana). It is not, however, only on account of their external form that these three groups may be distinguished; they differ also in their structure, that is to say, in the arrangement of the two kinds of bone substance of which they are composed. These two kinds of bone substance are termed

  1. compact bone (substantia ossium compacta) and
  2. spongy bone (substantia ossium spongiosa).

To the long bones belong all the bones of the free extremities, with the exception of those of the carpus and tarsus and of the patella. Thus, the long bones are the humerus, ulna, radius, metacarpals, and the phalanges of the fingers; the femur, tibia, fibula, metatarsals, and the phalanges of the toes; the clavicle also belongs to this group. All these bones possess a marrow cavity. Notwithstanding their shape the ribs are not classified with the long bones since they do not possess a marrow cavity.

The short bones are the vertebrae, the bones of the carpus and tarsus, the patella, sesamoid bones and the hyoid.

The flat bones are the sternum, the scapula, the innominate bone ( os coxae), the ribs and most of the skull bones, including the mandible.

Certain bones of the human skeleton are not readily referable to any one of these groups, especially such bones as are formed by the fusion of several short bones or of short and flat bones. Such are known as irregular bones. Typical examples of these are the sacrum and the coccyx, both formed by the fusion of several short bones, and various skull bones, such as the temporal, the occipital and the sphenoid, which may be regarded as formed by the fusion of short and flat bones to a single skeletal structure.

The short bones have the simplest structure. They consist almost entirely of spongy substance, only a thin layer of a kind of compact bone, the so-called substantia corticalis, enclosing the spongiosa and forming the external boundary for the small marrow cavities (filled with red marrow) which occur between the bone trabeculae.

In the flat bones the part played by the spongy substance is markedly less and the more or less parallel bounding plates of compact bone are appreciably thicker. Indeed, where a flat bone is very thin the compact lamellae may be in contact, the spongy substance being entirely wanting. The fine spaces between the trabeculae of the spongy substance are occupied by usually red marrow. The flat bones of the skull present certain differences of structure. In place of a central spongiosa they have a much larger meshed, but still trabecular bone substance, the so-called diploë. This is enclosed between two relatively thick plates of compact bone, the outer one being usually thicker than the inner; these are termed the outer and inner vitreous tables. The wide spaces of the diploë contain blood-vessels, especially venous plexuses but no red marrow; where the bones become thin the diploë is greatly reduced and may even be wanting.

The greatest difference is seen in the structure of the long bones. The shaft (corpus) of these consists in almost its entire thickness of compact bone, which here reaches a greater development than in other bones. It forms a cylinder of compact substance and only towards the articulating ends does it enclose any considerable amount of spongy substance. These ends, however, are almost entirely formed of spongy substance, this being enclosed, as in the case of the short bones, only by an outer quite thin layer of compact cortical substance. At the junction of the articular extremities with the shaft, the small cavities between the trabeculae of the spongiosa, which contain red marrow, communicate with the cylindrical marrow cavity of the shaft; this contains yellow (in old age gelatinous) marrow.

The trabeculae and plates of the spongy substance, which are for the most part slender and thin, are not altogether irregular in their arrangement, but are influenced to a large extent both in their structure and their arrangement by pressure on the one hand and by the pull of muscles on the other. The spongiosa trabeculae strengthened in response to stress or strain are termed trajectories.

Röntgen Pictures of the Human Skeleton.

All figures are taken from the "Atlas typischer Röntgenbilder vom normalen Menschen" by R. Grashey (J. F. Lehmann, Munich).

While it is usual to study the bones of the human body in the macerated condition there is a method by which the parts of the skeleton may be made visible even in the living body, namely, the use of Röntgen rays. These readily penetrate all the soft parts of the body (all organic substance) and also cartilage, but cannot pass through the inorganic bone substance, and so by the use of Röntgen photography the bones alone are shown on the photographic plate. If the bones are not too far from the sensitized surface of the plate they appear relatively sharply outlined and undistorted, so that not only is their form made visible, but also the structure of the spongiosa is more or less evident. On the other hand, bones that are some distance from the sensitized surface of the plate appear distorted and with poorly defined outlines.

Consequently Röntgen pictures of the skull and of the pelvis are never anatomically satisfactory. But while a Röntgen picture of a bone is less satisfactory for study than the macerated bone itself, and while especially, the clearest Röntgen picture of the spongiosa is far inferior to what may be seen anatomically of the architecture of the substance in a macerated bone (Fig. A177, A178, A179, A180, A181), nevertheless the study of the bones in the living by means of the Röntgen rays is a material aid to their study by the direct, anatomical method. This is especially true in the case of young skeletons still developing; in these the Röntgen pictures are the more satisfactory since they show the ossification centres in their natural position in the transparent cartilage.

Table of Ossification (from Grashey)

The wavy lines indicate the amount of variation in the appearance of the centres.

No portions of the skeleton are so well adapted for Röntgen photography as the bones of the hand, since the hand is flat and may be brought relatively close to the sensitized surface of the photographic plate; furthermore the bones have no great thickness and the defects (distortion and blurring) of Röntgen photography, sometimes so pronounced, are here hardly noticeable.

Consequently Fig. A187 not only shows the bones with almost perfectly sharp outlines, but the spongiosa and compacta of which they are formed are also evident. So too the marrow cavity of the long bones is shown. Since the figure is that of the hand of an individual of 28 years the development of the bones has been completed; the epiphyses of the long bones (see Figs. A184, A185, A186) have completely united with the diaphyses, whose ossification began in embryonic life.

The cavities of the joints always appear very broad in Röntgen photographs, since the articular cartilages do not show. The spaces between the bones in Röntgen photographs represent accordingly the articular cavities plus the articular cartilages of both bones concerned (compare Fig. A187 and A222).

Röntgen photographs also give exceedingly important information as to the ossification of the skeleton of the lower extremity. Of the epiphyses of long bones those that are the earliest to appear are those of the ends of the bones that enter into the formation of the knee-joint, the distal epiphysis of the femur and the proximal of the tibia, the former regularly and the latter frequently beginning to ossify before birth. That the ossification of the proximal end of the fibula begins much later is clearly shown in the accompanying figure, from which it may also be seen that the ossification processes not infrequently do not go on synchronously on the two sides of the body. Considerable variation also occurs in the time of the appearance of the ossification centres (see table here; ~~ = variation).

The ossification of the epiphyses proceeds in such a way that eventually there is a fusion with the diaphysial bone, the cartilaginous epiphysial disk that first separates them undergoing conversion into bone. On the other hand, on that surface of the epiphysis which forms the articular surface the ossification fails to invade the terminal layer of cartilage, which persists throughout life, forming the articular cartilage. According to the thickness of this cartilage, which varies to a considerable extent in the various joints, the articular cavity in Röntgen pictures will sometimes appear exceedingly wide and in other cases, narrow; Röntgen pictures can never give definite evidence as to the width of the articular cavity.

Syndesmology.

Joints and Ligaments of the Trunk and Head.

Articulations of the Bodies of the Vertebrae.

The bodies of the true vertebrae are united by fibrocartilaginous disks, the intervertebral fibrocartilages . Each of these consists of a firm ring, anulus fibrosus , of interlacing and concentric connective tissue bundles and of a central pulpy nucleus. The latter is compressed within the fibrous ring and bulges out when the disk is cut across. The fibrocartilages are in relation to the opposing surfaces of the bodies of adjacent vertebrae, these surfaces being covered by a thin layer of cartilage. The fibrocartilages are larger than the surfaces of the vertebrae between which they lie; their greatest height is at the middle, where they are in relation to the slightly concave surfaces of the vertebrae. There is no disk between the first and second vertebrae; the first lies between the second and third vertebrae and the last between the fifth lumbar vertebra and the sacrum, so that there are 23 fibrocartilages. In general they increase both in circumference and height from above downwards, just as do the vertebrae. In the cervical region they are, however, smaller but higher than those between the upper and middle thoracic vertebrae; those between the lumbar vertebrae are the largest and highest of all. The lowest fibrocartilages are wedge-shaped, being distinctly higher (about 1/3) in front than behind, especially in the case of the last one, the promontory.

The Intervertebral Articulations.

In addition to the mixed synarthrotic union of the bodies, the true vertebrae are also connected by intervertebral articulations. Each pair of superior articular processes unite with the pair of inferior articular processes of the vertebra next above. Each joint has an articular capsule , loose in the cervical vertebrae but compact in the lower ones; it encloses the cartilaginous surfaces. There are no accessory ligaments.

The Ligaments of the Vertebral Column and those between the Ribs and the Vertebrae.

Throughout the whole length of the vertebral column, in the region of the bodies, there is both an anterior and a posterior longitudinal ligament, covering respectively the anterior and posterior surfaces of the bodies and the intervertebral disks. The anterior one is a broad band, which begins quite small at the anterior tubercle of the atlas and broadens greatly below, where it ends on the anterior surface of the sacrum. It is very closely connected with the intervertebral fibrocartilages, but over the middle of the bodies, whose anterior surfaces are concave, it is more loosely attached. It consists of long superficial and deep fibers passing from vertebra to vertebra.

The posterior longitudinal ligament lies on the posterior surface of the bodies. It is much smaller than the anterior one and diminishes in breadth from above downwards. It begins as an independent ligament at the second vertebra, but is continued above this to the skull as the tectorial membrane (see here); below it ends in the sacral canal. It broadens distinctly over each intervertebral fibrocartilage and is closely connected with these, but has no attachments to the posterior surfaces of the bodies of the vertebrae.

The ligaments between the arches, ligamenta flava, are strong elastic bands, owing their name to their marked yellow color. They completely cover in the intervals between adjacent arches, extending anteriorly to the posterior borders of the capsules of the intervertebral articulations. Consequently they close in the vertebral canal up to the margins of the intervertebral foramina. Their inner surfaces are perfectly smooth and form a common surface with the inner surfaces of the arches. On account of their elasticity the posterior wall of the vertebral canal remains smooth during bendings of the column and they aid in the return of the vertebrae to the resting position. They begin between the second and third cervical vertebrae and extend to the last lumbar. They show a distinct groove in the middle line. Their number is 23 pairs.

The intertransverse ligaments, extending between the transverse processes of adjoining vertebrae, are unimportant. They are constant only in the thoracic region. The spinous processes of successive vertebrae are united by interspinous ligaments, which are most strongly developed in the lumbar region. They are united on one edge with the ligamenta flava and on the other. with the supraspinous ligament. This unites the tips of the various spinous processes and also runs over the tips as a continuous ligament. The interspinal and supraspinal ligaments occur through the entire extent of the true vertebrae and extend somewhat upon the sacrum also. For the sacral and coccygeal articulations see here.

The ribs unite posteriorly with the thoracic vertebrae in a joint; anteriorly they unite in a joint or a synchondrosis with the sternum or with one another. Only the last two ribs fail to unite with skeletal parts at their anterior ends. In the costo-vertebral articulations the head of a rib articulates with two adjoining vertebrae and the tubercle with a transverse process, except that this latter connection is wanting in the last two ribs, which articulate with only one vertebral body. The capitular articulations with the exception of the first and the two last, are characterized by the fact that the intervertebral fibro-cartilage between the two vertebrae which form the socket is attached to the head of the rib, forming the interarticular ligament and dividing the joint into two portions. The radiate ligaments, which radiate from the head of the rib upon the lateral surfaces of the articulating vertebrae, strengthen the weak articular capsules.

The costo-transverse articulations possess a loose capsule and are characterized by possessing a whole series of accessory ligaments. As a reinforcing band for the posterior surface of the capsule there is a quadrangular, short, tense tubercular ligament, which completely fills the space between the neck of the rib and the transverse process. The anterior and posterior costotransverse ligaments pass between the necks of the ribs and the transverse processes. The posterior are much weaker than the anterior and are attached to the articular processes of the vertebrae as well as to their transverse processes. The body of the vertebra together with the anterior ligament bounds a costo-transverse foramen, through which the anterior (intercostal) ramus of the spinal nerve makes its exit.

The Sterno-costal Articulations and those between the Atlas, Axis and Skull.

The cartilages of the true ribs unite with the sternum by the sternocostal articulations. The first cartilage, however, is always united to the manubrium by a synchondrosis. In the articulation of the second cartilage there is always a band passing to the end of the cartilage from the sternal synchondrosis; it is the interarticular ligament and it makes the joint two-chambered. In the sternal articulations of the third to the seventh rib the interarticular ligament is inconstant and frequently, when it is present, it divides the joint cavity unequally. Reinforcing the anterior surface of the joints are the radiate ligaments, which radiate out fan-like from the end of the cartilage upon the anterior surface of the sternum (see Fig. A212). Those of the lower ribs form by the interlacing of their fibres on the lower part of the sternum the sternal membrane. Between the cartilages of the seventh to the tenth ribs interchondral articulations may occur. Sometimes the sternal synchondrosis between the manubrium and the body of the sternum has a joint cavity.

The Atlanto-occipital and Atlanto-axial (Atlanto-epistrophic) Articulations.

For the movement of the head upon the vertebral column there is a combination of joints, including the atlanto-occipital articulations and the atlanto-axial (atlanto-epistrophic). Peculiar to the union of the first two cervical vertebrae with the occipital bone are the atlanto-occipital membranes, which serve to close the wide intervals between the atlas and the occipital and between the atlas and axis (epistropheus). The anterior membrane extends between the occipital and the anterior arch of the atlas, the posterior one, a continuation of the ligamenta flava, closes principally the gap between the occipital and the posterior arch of the atlas, but also extends between the posterior arch of the atlas and the arch of the axis (epistropheus).

The Atlanto-occipital articulations act as a symmetrical double joint. They are formed by the union of the occipital condyles with the superior articular surfaces of the atlas and according to the form of the articulating surfaces are ellipsoid joints. The articular capsule is rather broad and loose and lacks reinforcing ligaments.

The atlanto-axial (atlanto-epistrophic) articulation is formed by three separate joints;

  1. The paired joints between the lower articular surfaces of the atlas and the upper of the axis (epistropheus); these show no special peculiarities except that the articular surfaces are usually greatly incongruent, both often being convex;
  2. the joint between the dens of the axis (epistropheus) and the anterior arch of the atlas; and
  3. that between the posterior surface of the dens and the transverse ligament (see below). This third joint is a rotary joint with incompletely formed articular surfaces, since the dens is covered by cartilage only on its anterior and posterior surfaces and not on its sides.

The capsules of the atlanto-axial joint are wide and loose and are reinforced by a series of accessory ligaments. The very strong and firm transverse ligament arises from the medial borders of the lateral masses of the atlas and traverses its vertebral foramen, enclosing the dens from behind. It is cartilaginous where it passes over the dens and articulates with that process. From the middle of the ligament there is an upper and a lower prolongation. The upper one passes to the occipital bone, the lower inserts into the posterior surface of the body of the axis (epistropheus). The cruciform ligament so formed is termed the cruciate ligament. Three other ligaments belonging to the articulation are attached to the dens, a weak middle one and two strong lateral. The middle one, the apical ligament of the dens, is an unimportant thin band passing from the apex of the dens to the margin of the foramen magnum. The lateral ligaments, the alar ligaments, are much stronger and pass obliquely upward from the dens to the medial border of the occipital condyles, uniting the axis (epistropheus) directly with the skull. The ligaments of the joints are covered, towards the vertebral canal, by a broad firm sheet of fibres, the membrana tectoria, which is continuous with the dura mater at the foramen magnum and with the posterior longitudinal ligament below (see here).

The Ligaments of the Skull and the Mandibular Articulation.

The mandibular articulation is between the capitulum of the mandible and the mandibular fossa and articular tubercle of the temporal bone. The joint cavity is completely divided into two parts by an articular disk, whose circumference is united with the articular capsule. The capsule is rather loose and thin. It surrounds the mandibular fossa (except the non-cartilaginous portion), the articular tubercle and the head of the mandible, having its insertion on the neck. It is reinforced by a temporo-mandibular ligament, which passes from the zygomatic arch to the neck of the mandible.

The Independent Ligaments in the Head.

Near the mandibular articulation, but without any direct connection with it, are the spheno-mandibular and stylo-mandibular ligaments. The former arises from the under surface of the great wing of the sphenoid near the angular spine and inserts into the lingua of the mandible. The latter arises from the styloid process and goes to the angle of the mandible. Both ligaments are weak and somewhat fascia-like, the stylomandibular spreading out directly into the fascia of the internal pterygoid muscle (bucco-pharyngeal fascia).

Besides these there are two other independent ligaments in the head. The pterygospinous ligament runs between the angular spine of the sphenoid and the upper end of the lateral plate of the pterygoid process. Sometimes it ossifies and then forms the pterygospinous process (Civinini). The stylo-hyoid ligament runs from the styloid process of the temporal to the lesser cornu of the hyoid. It frequently contains pieces of cartilage or bone, remains of the middle portion of the second branchial or hyoid arch from which the lesser cornu of the hyoid and the styloid process are formed.

Several clefts between the bones of the skull are also completely or partly closed by ligamentous masses as, for instance, the two orbital fissures, the spheno-petrous and petro-occipital fissures and the foramen lacerum, except where these give passage to nerves and vessels.

Joints and Ligaments of the Upper Extremity.

The Sterno-Clavicular and Acromio-clavicular Articulations.

The sterno-clavicular articulation is between the clavicular notch on the manubrium of the sternum and the sternal articular surface of the clavicle. The two articular surfaces are made congruent by the interposition of an articular disk, which divides the joint cavity into two portions. The loose and thin articular capsule is strengthened over its entire surface by strong reinforcing ligaments. The sterno-clavicular ligament is fused with the anterior surface of the capsule and the interclavicular ligament unites the sternal ends of the two clavicles, extending across the jugular notch and resting on the upper border of the manubrium; it thus strengthens the upper surface of both sterno-clavicular joints. The costo-clavicular ligament is only functionally apart of the sterno-clavicular articulation. It is an independent, exceedingly strong ligament, passing between the cartilage of the first rib and the costal tubercle of the clavicle, and almost filling the interval between the sternal end of the clavicle and the first rib. Its rather short fibres are put on the stretch by a relatively slight abduction of the clavicle from the thorax.

The acromio-clavicular articulation is between the acromial articular surface of the clavicle and the articular surface of the acromion. Also in this joint there is a weak articular disk, which is frequently incomplete and may be entirely wanting. The articular capsule is strengthened over its upper, stronger portion by the acromio-clavicular ligament, which unites the ends of the adjoining bones. A very strong coraco-clavicular ligament unites the acromial end of the clavicle with the scapula, arising from the upper surface of the base of the coracoid process and passing to the coracoid tuberosity of the clavicle. It consists of two portions, an anterior flat, quadrangular trapezoid ligament and a posterior, triangular conoid ligament, small below and broad above (see Fig. A216).

The Ligaments of the Shoulder Girdle and the Shoulder Joint (articulatio humeri).

On the scapula there are three independent ligaments:

  1. The coraco-acromial ligament is a strong, dense but flat band uniting the anterior border of the acromion process with the posterior border of the coracoid process. It lies directly above the shoulder joint, separated, however, from its capsule by loose tissue.
  2. The superior transverse ligament is a short, firm band that bridges over the scapular notch, converting it into a foramen. Occasionally the ligament is replaced by bone and occasionally it is divided into two parts. When it is divided into two parts the suprascapular nerve passes through the space below it and the transverse scapular artery between the two parts. If the ligament is undivided the artery passes over it.
  3. The inferior transverse ligament is much weaker than the superior, consisting of only quite delicate fibre bundles, which lie below the root of the acromion, where the supraspinous and infraspinous fossae communicate at the neck of the scapula. It is closely interwoven with the fascia of the Infraspinatus muscle and is not really an independent ligament.

The Shoulder joint (articulatio humeri).

The shoulder joint is between the glenoid cavity of the scapula and the head of the humerus. The glenoid cavity is relatively small arid only slightly concave, but it is materially enlarged and deepened by a strong, fibrous glenoidal lip, which surrounds the whole border of the bony socket. Nevertheless the socket of the joint is decidedly smaller than the articulating head, and free movement, accordingly, is not hindered by the socket, the joint being the most freely moveable joint in the body.

The articular capsule of the shoulder joint is wide and loose, as is necessary in a joint with free movement. Although it is on the whole thin, it receives strong reinforcements from the tendons of the muscles that pass over it (behind, the Supraspinatus, Infraspinatus, Teres minor; in front the Subscapularis) and from a strong reinforcing band, the coraco-humeral ligament. The articular capsule arises from the border of the glenoidal lip and inserts on the anatomical neck of the humerus. The coracohumeral ligament arises at the root of the coracoid process and is at first independent, but later becomes completely fused with the capsule and passes to an insertion in the neighborhood of the two tubercles on the anatomical neck of the humerus.

A peculiarity of the shoulder joint is that it is traversed throughout its entire length by a tendon, that of the long, head of the Biceps. The tendon arises at the supraglenoid tubercle, where it is fused with the upper part of the glenoidal lip, and runs through the cavity of the joint beneath the coraco-humeral ligament, and then along the intertubercular groove, being enclosed in this portion of its course by a prolongation of the capsule, the intertubercular sheath. The intertubercular groove is lined with cartilage throughout the extent of the sheath. Furthermore a thin-walled subscapular bursa, lying beneath the tendon of the subscapular muscle, also communicates with the joint cavity. This bursa is situated below the concave anterior surface of the coracoid process, between the coracohumeral ligament and a slight thickening of the medial surface of the capsule.

The Elbow Joint (articulatio cubiti).

The elbow joint is a typical composite articulation, being composed, firstly, of the articulation of the trochlea of the humerus with the semilunar notch of the ulna, the humero-ulnar articulation; secondly, of that of the capitulum of the humerus with the capitular fovea of the radius, the humero-radial articulation; and, thirdly, of that of the radial notch of the ulna with the articular circumference of the radius, the proximal radio-ulnar articulation.

All three articulations are enclosed by a common articular capsule, which is broad and loose, especially anteriorly and posteriorly. It surrounds the olecranal, coronoid and radial fossae at the lower end of the humerus and is attached below to the ulna, close below the tip of the olecranon, to the border of the semilunar notch and to the tip of the coronoid process. The entire head of the radius and the greatest part of its neck is within the capsule. The radial collateral ligament extends from the lateral epicondyle of the humerus to the anular ligament, with which its fibres partly intermingle. The ulnar collateral ligament arises on the medial epicondyle of the humerus and passes, broadening as it goes, to the border of the semilunar notch of the ulna. The anular ligament is a dense firm band that surrounds the head of the radius like a sling. It arises from the anterior border of the semilunar notch of the ulna and is inserted into the posterior border of the radial notch of the same bone, forming with the latter notch the socket of the proximal radio-ulnar joint, 3/4 of this socket being formed by the ligament and 1/4 by the notch. On its inner surface, which is turned toward the cartilage-covered articular circumference of the head of the radius, the ligament is perfectly smooth. Below it the capsule is thin and projects slightly at the neck of the radius to form the sacciform recess.

Functionally considered the elbow joint is a combination of only two joints, since the humero-radial articulation does not act as an independent mechanism. There is, then, in the first place, the humero-ulnar articulation, which is a hinge joint, and, secondly, the proximal radio-ulnar articulation, which is a pivot joint.

The obtuse angle, open radially, formed by the upper and lower arm bones when the limb is extended, is termed the arm angle.

The Distal Radio-ulnar Joint and the Interosseous Membrane.

The radius and ulna are connected throughout almost their entire length by the interosseous membrane, which is attached to the interosseous crests of the two bones, except above, where the interosseous space persists. In addition the two bones are united by the the chorda obliqua, which passes from the coronoid process of the ulna to the lower border of the tuberosity of the radius.

The Radio-carpal Articulation.

The distal radio-ulnar articulation is between the articular circumference of the head of the ulna and the ulnar notch of the radius and also the articular disk which separates the head of the ulna from the cuneiform (triquetral) bone, the socket for the head of the ulna being formed partly by the ulnar notch and partly by the articular disk. Part of the socket is, therefore, nearly in the vertical plane and part almost horizontal, so that the head of the ulna rests upon the lateral as well as the lower surface of the socket. The capsule sends a sacciform recess upwards between the two bones of the forearm. The articular disk is attached on the one hand to the ulnar border of the lower part of the radius, where it is continuous with the articular cartilage, and on the other hand to the styloid process of the ulna.

The joints and Ligaments of the Hand.

The joints of the hand are those of the carpus and those of the fingers. The carpal joints are:

  1. the radio-carpal;
  2. the intercarpal;
  3. that of the pisiform;
  4. the carpo-metacarpal and
  5. the carpo-metacarpal of the thumb.

The finger joints are the metacarpo-phalangeal and the inter-phalangeal.

The radio-carpal articulation is between the carpal articular surface of the radius, together with the articular disk, and the proximal surfaces of the first row of carpal bones, the navicular and lunate articulating with the radius and the triquetrum (cuneiform) with the disk. The joint is completely separated from the intercarpal joint by short ligaments extending between the three bones, the navicular (scaphoid), lunate and cuneiform (triquetrum). The articular capsule is lax and thin and encloses the cartilaginous articulating surfaces.

The intercarpal articulation is between the first and second rows of carpal bones, the first row forming essentially the socket for the head of the capitate (os magnum) and the proximal part of the hamate (unciform). The line of the joint is S-shaped and its cavity usually communicates between the capitate (os magnum) and lesser multangular (trapezoid) with the carpo-metacarpal joint. The articular capsule is thin.

The articulation of the pisiform bone is between the pisiform and cuneiform (triquetral) bones. The piso-uncinate (piso-hamate) and the piso-metacarpal ligaments, passing respectively from the pisiform to the hamulus of the unciform (hamate) and to the base of the fifth metacarpal, are merely continuations of the tendon of the flexor carp ulnaris.

The common carpo-metacarpal articulation is between the bases of the second to the fifth metacarpals and the distal articular surfaces of the lesser multangular(trapezoid), capitate (os magnum) and hamate (unciform). The joint cavity usually communicates with that of the intercarpal joint and sometimes is divided transversely into two parts. The articular capsule is tense and firm. The joint cavity extends a short distance between the bases of the metacarpals.

The carpo-metacarpal articulation of the thumb is always independent, neither communicating with the other carpo-metacarpal joints nor with the intercarpal. The articulating surfaces are saddle-shaped, more markedly so than in any other joint in the body.

Only one of the carpal ligaments arises from the ulna, the ulnar collateral ligament, which arises from the styloid process of that bone and is attached to the triquetrum (cuneiform). Corresponding to it on the radial side is the radial collateral ligament, passing from the styloid process of the radius to the navicular (scaphoid). In addition, the dorsal radio-carpal ligament extends obliquely from the dorsal surface of the lower end of the radius to the dorsal surfaces of the bones of the first row of the carpus, and the corresponding volar radio-carpal ligament passes, not only to the bones of the first row, but also to the capitate (os magnum). In the depth of the carpal groove, ligaments converge to the capitate (os magnum) forming the radiate ligament. The remaining carpal ligaments, which unite the carpal bones either with each other or with the metacarpals are the volar and dorsal intercarpal, the volar and dorsal carpo-metacarpal and three volar and four dorsal interosseous ligaments, these last filling the intervals between the bases of the metacarpals.

The metacarpo-phalangeal articulations are between the heads of the metacarpals and the bases of the proximal phalanges. Collateral ligaments strengthen their sides and accessory volar ligaments their volar surfaces, while the transverse capitular ligaments unite the heads of the four ulnar metacarpals. The articular capsules of the interphalangeal articulations are strengthened laterally by collateral ligaments. Imbedded in the metacarpo-phalangeal joint of the thumb there are two sesamoid bones, and smaller and inconstant ones may be found in the corresponding joint of the index and little fingers.

Joints and Ligaments of the Lower Extremity.

The Joints and Ligaments of the Pelvic Girdle and the Sacro-coccygeal Ligaments.

The Sacro-coccygeal Ligaments.

The apex of the sacrum and the first coccygeal vertebra are united by the sacrococcygeal symphysis and also by a number of rather unimportant ligaments. On the anterior surface is the anterior sacro-coccygeal, at the sides the lateral sacro-coccygeal and behind the posterior sacro-coccygeal ligaments, The last have a superficial portion, which unites the sacral and coccygeal cornua, and a deep portion, which is the lower end of the posterior longitudinal ligament (see here).

The Ligaments of the Pelvic Girdle.

The symphysis pubis is an amphiarthrosis uniting the symphyseal surfaces of the two pubic bones. The union is by an interpubic fibrocartilage, which frequently contains a slit-like cavity. Strengthening the symphysis there is a superior pubic ligament, which stretches from one pubic tubercle to the other over the upper border of the symphysis, and an arcuate ligament at the lower border.

The posterior joint of the pelvic girdle, the sacro-iliac articulation, is paired and is formed by the auricular surfaces of the sacrum and ilium. It is an almost immoveable joint, since the irregular curved and uneven surfaces do not lend themselves to any extensive movement. The contact of the two bones is further maintained by a strong ligament, the interosseous ligament, which unites the tuberosities of the bones, so that these are united anteriorly by a joint, posteriorly by a syndesmosis.

In addition to the interosseous ligament there is also a posterior sacro-iliac ligament, which consists of a superficial long and a deep short sacro-iliac ligament and is formed by a number 'of oblique fibre bundles that pass from the posterior part of the tuberosity of the sacrum to the crest of the ilium in the neighborhood of the posterior superior spine. A weaker anterior sacro-iliac ligament is merely a thickening of the anterior surface of the articular capsule.

Finally the ilio-lumbar ligament unites the ilium to the fifth lumbar vertebra. It is a strong band which passes from the transverse process of the fifth (sometimes also the fourth) lumbar vertebra to the crest of the ilium. By it the last lumber vertebra and the last intervertebral fibrocartilage become part of the boundary of the pelvis.

The Independent Ligaments of the Pelvis.

The obturator membrane closes the obturator foramen, except for a small area at the upper part of the foramen where the obturator groove begins.

The sacro-tuberous (great sacro-sciatic) ligament arises from the lateral portions of the posterior surfaces of both the sacrum and coccyx, from the posterior part of the crest of the ilium and its posterior superior and inferior spines. It concentrates to a broad firm band which is attached to the ischial tuberosity. A prolongation of it along the lower borders of the inferior rami of the ischium and pubis is termed the falciform process.

The much shorter sacro-spinous (lesser sacro-sciatic) ligament lies on the pelvic side of the sacro-tuberous and arises from the lateral border of the lower part of the sacrum and of the upper part of the coccyx; it is inserted into the spine of the ischium. It converts the great sacro-sciatic notch into a roundish, quadrangular foramen, the great Sacro-sciatic foramen. With the sacro-tuberous ligament it converts the lesser sacro-sciatic notch into the lesser sacro-sciatic foramen. The sacro-spinous ligament separates these two foramina and forms part of the pelvic outlet.

The Pelvis as a Whole.

The pelvis is bounded by the following bones, the innominates (coxae), the sacrum, the coccyx, and the fifth lumbar vertebra. In addition certain ligaments or membranes take part in its boundaries, the interpubic fibrocartilage, the obturator membrane and the sacro-spinous, sacro-tuberous and ilio-lumbar ligaments.

There may be distinguished a great or false pelvis (pelvis major) and a small or true pelvis (pelvis minor). The former is much more capacious than the latter and it is only partly bounded by bones, the ala of the ilia and the fifth lumbar vertebra. Its separation from the true pelvis is indicated by the linea terminalis.

The true pelvis is a short canal with for the most part bony walls, the front wall being quite short, while the posterior one is markedly longer.

The inlet of the true pelvis (apertura superior) is bounded by the promontory, the three parts, sacral, iliac (linea arcuata) and pubic (pecten), of the terminal line and the upper border of the interpubic fibrocartilage or rather the superior pubic ligament.

The boundaries of the pelvic cavity are, behind, the concave pelvic surface of the sacrum and the anterior surface of the coccyx; laterally the pelvic surfaces of the bodies of the ilium, ischium and pubis, the sacro-tuberous and sacro-spinous ligaments, the rami of the pubis and ischium and the obturator membranes; anteriorly, the symphysis pubis and the anterior ends of the pubic bones. The anterior wall is by far the shortest, the posterior the longest. Posteriorly on the lateral walls are the two sacrosciatic foramina, the upper and larger one being rounded quadrangular, and the lower smaller one triangular.

The outlet (apertura inferior) is bounded by the arcuate ligament, the symphysis, the ischial tuberosities, the inferior rami of the pubes and ischia, the sacro-tuberous ligaments and the apex and lateral borders of the coccyx. In contrast to the inlet the boundary of the outlet is not in one plane. Its deepest point is formed by the coccyx and the ischial tuberosities also project strongly downwards, while in the region of the sacro-tuberous ligament and symphysis pubis the boundary slopes to a higher level. The angle that the two lower pubic rami form with the symphysis is termed the pubic angle and is somewhat rounded off to a pubic arch by the arcuate ligament.

The pelvis is not placed horizontally in the body but is inclined. Its inclination varies, being on the average about 60°(inclination of the plane of the inlet to the vertical). The pelvis, and especially the true pelvis, more than any other part of the skeleton shows sexual differences. In the female the false pelvis is lower, broader and flatter, and the ala of the ilium are usually less strongly concave. The cavity of the true pelvis is larger. Its inlet in the male is heart-shaped on account of the greater projection of the promontory; in the female it is transversely oval. The outlet in the male is more strongly narrowed than in the female, owing to the ischial tuberosities being somewhat convergent. The pubic angle in the male is acute, about 75-80°; in the female it is a right angle or obtuse, 90-100°. For the inguinal ligament see here.

The Inguinal ligament (Poupart's) arises from the anterior superior spine of the ilium and passes, tensely stretched, to the pubic tubercle, where it has a broadened insertion. An almost horizontal reflexion of the ligament extends from the insertion to the upper border of the superior ramus of the pubis, forming the lacunar ligament (Gimbernat's). The inguinal ligament is the tendinous lower edge of the aponeuroses and fasciae of the abdominal muscles, and does not properly belong to the ligaments of the pelvis.

The Hip Joint (articulatio coxae).

The hip joint (articulatio coxae) is between the acetabulum of the innominate bone and the head of the femur. The socket is materially deepened by a strong, fibrocartilaginous glenoidal lip, triangular in cross section, so that it embraces more than half the spherical head. Consequently the joint is a typical ball and socket arrangement (enarthrosis). The glenoidal lip bridges the acetabular notch, converting it into a wide foramen; in this part of its extent the lip is termed the transverse ligament.

The articular capsule is greatly strengthened by reinforcing bands and is the strongest in the body. It takes origin around the base of the glenoidal lip and encloses not only the head of the femur but also the greater part of its neck. Anteriorly it is attached to the intertrochanteric line, but posteriorly it does not extend so far down, enclosing on that surface only a little more than half the neck. On account of the thickness of the capsule the extent of the joint cavity is somewhat less.

The reinforcing ligaments of the capsule are firmly united with it and may be either longitudinal or circular. The latter, forming the orbicular zone, surround the neck of the femur at its narrowest part and have a circular course in the inner layers of the capsule, firmly united to the longitudinal fibre bundles. A longitudinal ligament arises from each of the constituent parts of the innominate bone and they are thus three in number, the ilio-femoral, the pubo-capsular and the ischio-capsular.

Much the strongest of the three ligaments is the thick ilio-femoral ligament, one of the thickest ligaments of the body. It arises from the body of the ilium in the region of the anterior inferior spine and passes obliquely on the anterior surface of the capsule to the intertrochanteric line, which is produced by the ligament. The pubo-capsular ligament arises from the upper ramus of the pubis and passes on the medial surface of the capsule toward the lesser trochanter. The ischio-capsular ligament arises from the body of the ischium and passes on the posterior wall of the capsule for the most part to the orbicular zone, but in part also beyond this towards the lesser trochanter.

It is a peculiarity of the hip joint that its socket is not lined with cartilage over the area of the acetabular fossa, this being occupied by a pad of fat. From it as well as from the acetabular notch a characteristic ligament arises, the ligamentum teres, which is a flat, but sometimes strong, band, containing blood vessels, that is inserted into the fovea on the head of the femur. In the complete joint it lies upon the fat pad of the acetabular fossa and on account of its length and weakness does not limit materially the movements in the joint.

The thinnest parts of the capsule are situated on its lower wall, between the pubocapsular and ischio-capsular ligaments and above the orbicular zone, between the ischiocapsular and ilio-femoral ligaments. The anterior wall is also thin between the ilio-femoral and pubo-capsular ligaments, where occasionally a communication occurs between the joint cavity and the ilio-pectineal bursa, situated beneath the ilio-psoas muscle.

The Knee Joint (articulatio genus).

The knee joint (articulatio genus) is between the condyles and patellar surface of the femur on the one hand and the condyles of the tibia on the other. In addition, the articular surface on the posterior surface of the patella takes a passive part in the formation of the joint.

On account of its form and the multiplicity of its parts the knee joint is one of the most complicated joints of the body. The line of attachment of the articular capsule follows in general the margins of the cartilage-covered surfaces; on the posterior surface of the femur the intercondyloid line indicates the line of attachment, so that the whole intercondyloid fossa is excluded from the joint cavity.

The tibial collateral ligament is connected with the capsule. It arises from the medial epicondyle of the femur and passes, always intimately connected with the capsule, by its superficial fibers to the medial border of the tuberosity of the tibia and by short deep fibres, directed obliquely backwards, to the medial meniscus and the infraglenoid margin of the medial condyle of the tibia. The fibular collateral ligament, on the contrary, is for the most part separated from the capsule by fat tissue and consequently appears as an independent firm, rather flat and relatively small ligament, extending between the lateral epicondyle of the femur and the head of the fibula.

On the posterior wall of the capsule there are two reinforcing ligaments. The oblique popliteal ligament is a prolongation of the tendon of the semi-membranous muscle and runs obliquely from below and medial, upwards and laterally over the posterior surface of the capsule, in which it loses itself. The arcuate popliteal ligament is an arched band which curves over the tendon of origin of the popliteus muscle and also radiates out in the capsule. Some of its fibres pass to the head of the fibula and form what is termed the retinaculum of the arcuate ligament.

The anterior wall of the knee joint is formed almost entirely by the tendon of the quadriceps muscle and the patella. The quadriceps tendon is actually attached to the base of the patella, but it is continued by the flat, very strong patellar ligament, which passes from the apex of the patella to the tuberosity of the tibia. It is independent of the knee joint and unconnected with its capsule. A constant deep infrapatellar bursa, separates the ligament from the anterior surface of the upper part of the tibia. Tendinous prolongations from the quadriceps tendon, the medial and lateral patellar retinacula, strengthen the anterior part of the articular capsule.

The synovial folds of the knee joint are the alar and patellar folds. The former are formed largely of fatty tissue and lie behind the patellar ligament, where masses of fat covered by the synovial membrane of the joint bulge into the joint cavity forming medial and lateral alar folds. The patellar fold (ligamentum mucosum) is a fibrous and usually fat-containing band of variable thickness, that arises, between the alar folds and connected with them, from the front wall of the capsule and is attached behind in the intercondyloid fossa.

Of the outpouchings of the joint cavity the largest is the suprapatellar bursa, which extends for almost a hand's breadth beneath the tendon of the quadriceps. It is in wide communication with the joint cavity and into its upper wall the fibers of the quadriceps that form the articularis genus muscle are inserted. The posterior wall of the bursa does not rest directly on the femur, but on an interposed fat pad. Two or three much smaller outpouchings of the capsule occur on its posterior wall, the popliteal bursa under the tendon of the popliteus, the semimembranosus bursa under the tendon of the semimembranosus, and the medial gastrocnemial bursa under the tendon of the medial head of the gastrocnemius. The last two may unite. (See Figs. A323 and A324.)

Two discoidal or semilunar fibrocartilages rest on the condyles of the tibia, the medial and lateral menisci. They are not attached to the condyles, but to the capsule by their outer margins and to the intercondyloid eminence and the cruciate ligaments. In section they are wedge shaped. The medial meniscus is smaller than the lateral and almost semicircular; it forms, however, an arc of a greater circle than does the lateral, which is almost circular and open only at its attachment to the intercondyloid eminence. It is broader than the medial and, since its radius is smaller, it covers the condyle of the tibia except over a relatively small central area. The lateral meniscus is attached to the anterior intercondyloid fossa and to the lateral intercondyloid tubercle, the medial one extends from the anterior border of the medial condyle of the tibia to the posterior inter-condyloid fossa. The two menisci are connected anteriorly by a very variable transverse ligament.

In addition to the menisci there are associated with the knee joint two remarkably strong ligaments, the cruciate ligaments. They arise from the intercondyloid fossa of the femur and pass to the intercondyloid tubercles or fossae of the tibia. The anterior cruciate ligament passes between the medial surface of the lateral condyle of the femur and the anterior intercondyloid tubercle and fossa of the tibia, and the posterior cruciate ligament arises from the lateral surface of the medial condyle of the femur and passes to the posterior intercondyloid tubercle and fossa of the tibia. The two ligaments, of which the posterior is usually the stronger, cross one another in passing from one bone to the other. The posterior one is usually connected with the lateral meniscus.

The Tibio-fibular Articulation, the Interosseous Membrane and the Tibio-fibular Syndesmosis.

The tibio-fibular articulation is between the fibular articular surface of the femur and the articular surface on the head of the fibula. It is a pronounced amphiarthrosis, with almost flat articular surfaces and with strong connecting bands on its anterior and posterior surfaces, the fibular capitular ligaments. Rarely the joint communicates with the knee joint through the popliteal bursa.

The interosseous membrane is very similar to that of the forearm and like this, extends between the interosseous crests of the two bones. In its upper part it has a large perforation for the passage of vessels.

The tibio-fibular syndesmosis is formed by two ligaments, rich in elastic fibres, extending on the anterior and posterior surfaces between the lower ends of the tibia and fibula. They are the lateral malleolar ligaments and are put on the stretch when the broader anterior part of the talus is brought between the two bones, the stretching being possible on account of the elastic fibres of which the ligament is largely composed.

The Joints and Ligaments of the Foot.

The ankle joint (talo-crural articulation) is between the talus and the two bones of the lower leg. The articular surfaces are the trochlea of the talus on the one hand and on the other hand the inferior surface of the tibia, the articular surface of the medial malleolus and that of the lateral malleolus. The thin articular capsule surrounds the articular surfaces.

The group of ligaments that radiate from the medial malleolus to the talus, calcaneus and navicular constitutes what is termed the deltoid ligament. It consists of four not very distinctly separate ligaments, the anterior and posterior talo-tibial, the calcaneo-tibial and the tibio-navicular. The first of these passes to the anterior part of the neck of the talus and is completely covered in by the calcaneo-tibial. This is attached to the border of the sustentaculum tali, while the posterior talo-tibial goes to the posterior process of the talus and the tibio-navicular to the dorsal surface of the navicular.

Three distinctly separate ligaments pass from the lateral malleolus to the talus and calcaneus, the anterior and posterior talo-tibular and the calcaneo-tibular. The first of these runs almost horizontally from the anterior surface of the malleolus to the anterior border of the trochlea of the talus; the second, also horizontal, passes to the lateral tubercle of the posterior process of the talus; and the calcaneo-fibular passes obliquely downward and backward to the lateral surface of the calcaneus.

The talo-calcaneal articulation is between the posterior articular surface of the calcaneus and the posterior calcaneal facet of the talus. The latter is concave, the former convex. Occasionally the joint cavity communicates with that of the ankle joint.

The talo-calcaneo-navicular articulation is between the head of the talus on the one hand and the anterior and middle articular surfaces of the calcaneus, the posterior surface of the navicular and the navicular fibrocartilage in the plantar calcaneo-navicular ligament (see here). The socket for the head of the talus is thus formed by four different cartilage-covered surfaces. It is a composite joint, being a combination of the anterior and middle talo-calcaneal and the talo-navicular articulations.

The ligamentous connections of the talus and calcaneus are, firstly, the interosseous talo-calcaneal ligaments which fill the sinus tarsi and, secondly, reinforcing ligaments of the posterior talo-calcaneal joint, the medial, lateral, posterior and anterior talo-calcaneal ligaments. The lateral and anterior ligaments, which bridge over the sinus tarsi, are united with the interosseous ligament, the posterior one extends between the lateral tubercle of the posterior process of the talus and the upper surface of the calcaneus, and the medial passes from the tubercle of the talus to the sustentaculum tali.

The calcaneo-cuboid articulation is between the cuboid surface of the calcaneus and the posterior surface of the cuboid. The surfaces are almost saddle-shaped. With the talo-navicular articulation it formes the transverse tarsal articulation (Chopart's).

The cuneo-navicular articulation is between the anterior surface of the navicular and the posterior surfaces of the three cuneiform bones and extends between the cuneiform bones themselves, and between the lateral surface of the cuboid and the corresponding surfaces of the navicular and lateral cuneiform. As a rule the joint also communicates between the medial and middle cuneiforms with the second tarso-metatarsal articulation.

The tarso-metatarsal articulations (Lisfranc's articulation), together with the intermetatarsal articulations, are three joints, one between the metatarsal of the great toe and the medial cuneiform, a second, between the bases of the second and third metatarsals and the middle and lateral cuneiforms, and a third, between the fourth and fifth metatarsals and the cuboid. The line of the joints is a curve convex anteriorly with a deep backward indentation between the middle cuneiform (short) and the base of the second metatarsal (long).

The dorsal tarsal ligaments pass from the talus and calcaneus on the one hand to the navicular and cuboid on the other. They are the dorsal talo-navicular, the dorsal calcaneo-navicular and the bifurcated ligaments. The latter unites the anterior medial angle of the calcaneus with the dorsal surfaces of the navicular and cuboid, dividing into two parts corresponding to the two bones.

The dorsal naviculari-cuneiform ligaments unite the navicular bone with the cuneiforms; the dorsal cuboideo-navicular, the cuboid with the navicular; the dorsal intercuneiform, the three cuneiforms with one another; and the dorsal cuneo-cuboid, the lateral cuneiform and the cuboid. The dorsal tarso-metatarsal ligaments unite the bases of the metatarsals with the tarsal bones and the four dorsal basal ligaments unite to one another the bases of the metatarsals.

By far the strongest ligament of the sole of the foot is the long plantar ligament. It arises from the whole of the under surface of the calcaneus and from the medial and lateral tuberosities of the tuber calcanei, covering the entire width of the bone, and passes with very strong longitudinal fibres to the tuberosity of the cuboid. From this principal portion of the ligament superficial slips pass out, which pass over the tendon sheath of the groove on the cuboid and reach the basis of the lateral metatarsals. They form the retinaculum for the tendon sheath of the Peroneus longus.

Almost as strong is the plantar calcaneo-navicular ligament. It runs with oblique, very strong fibres between the sustentaculum tali and the navicular. On its dorsal surface it contains the navicular fibrocartilage, which forms part of the socket for the head of the talus.

The plantar naviculari-cuneiform ligaments unite the navicular and the cuneiforms; the plantar cuboideo-navicular the cuboid and the navicular; the plantar cuneo-cuboid, the cuboid and the lateral cuneiform; and the plantar intercuneiform, the three cuneiforms with one another. In addition, there are plantar tarso-metatarsal and three plantar basal ligaments which correspond with the dorsal. The plantar calcaneo-cuboid ligament, which reinforces the capsule of the calcaneo-cuboid joint, unites with the dorsal surface of the long plantar ligament.

Those ligaments that are on neither the dorsal nor the plantar surfaces, but connect adjacent surfaces of the tarsal and metatarsal bones, are termed interosseous ligaments. In addition to the interosseous talo-calcaneal ligaments there is an interosseous cuneo-cuboid, interosseous intercuneiform, interosseous cuneo-metatarsal (especially between the medial cuneiform and the base of the second metatarsal where an interosseous basal ligament is wanting), and interosseous basal ligaments.

The metatarso-phalangeal and interphalangeal articulations of the foot are, with slight differences, similar to those of the hand, and present the same ligaments. The meta-tarso-phalangeal joint of the great toe shows a special structure in that two large sesamoid bones are imbedded in its capsule on the plantar surface.

Myology.

Muscles of the Back.

1. The Flat Muscles of the Back.

First Layer.

The Trapezius arises from the squamous portion of occipital above the superior nuchal line, from the lig. nuchae, and from the spines of the last cervical and all the thoracic vertebrae. It is inserted into the acromial third of the clavicle, the acromion and spine of the scapula. Nerve: The spinal accessory (and branches of the cervical plexus). Action: The upper fibres raise the scapula, the lower depress it; all acting together draw the scapula backward; those to the skull rotate the head toward the opposite side, the lower fibres draw the lower angle of the scapula medialwards.

The Latissimus dorsi arises from the spinous processes of the lower six thoracic and all the lumbar vertebrae, from the dorsal surface of the sacrum, and the lateral lip of the iliac crest. Accessory slips arise from the lower three or four ribs and frequently from the lower angle of the scapula. It inserts into the crest of the lesser tuberosity of the humerus, together with the teres major from which it is separated by a bursa. Nerve: The thoraco-dorsal from the brachial plexus. Action: It draws the arm backward, adducts it and rotates it inward.

Second Layer.

The Rhomboideus major arises from the spinous processes of the upper four thoracic vertebrae and inserts into the vertebral border of the scapula, below the spine.

The Rhomboideus minor arises from the lig. nuchae and the spinous process of the last cervical vertebra and is inserted into the vertebral border of the scapula, above the spine. Nerve: Both rhomboids are supplied by the dorsal scapular from the brachial plexus. Action: They draw the scapula towards the vertebral column and upwards.

The Levator scapulae arises by four heads from the posterior tubercles of the transverse processes of the four upper cervical vertebrae and inserts into the medial angle of the scapula. Nerve: The cervical plexus and the dorsal scapular. Action: Draws the medial angle of the scapula upwards and medially.

Third Layer.

The Superior serratus posterior arises from the spinous processes of the two lower cervical and the two upper thoracic vertebrae and is inserted into the second to the fifth ribs, lateral to their angles.

The Inferior serratus posterior arises, through the posterior layer of the lumbodorsal fascia, from the spinous processes of the lower thoracic and upper lumbar vertebrae. It inserts into the lower borders of the four lower ribs. Nerve: Both serrati are supplied by intercostal nerves. Action: They act on the ribs in inspiration.

2. The Long Muscles of the Back.

I. The Splenial Muscles.

The Splenius capitis arises from the lig. nuchae and the spinous processes of the last cervical and first thoracic vertebrae and inserts into the lateral half of the superior nuchal line, as far out as the mastoid process. Nerve: The posterior branches of the 1-4 (5) cervical nerves. Action: Both muscles draw the head backwards; acting singly, they rotate the head to the same side.

The Splenius cervicis arises from the spinous processes of the third or fourth to the sixth thoracic vertebra and is inserted into the posterior tubercles of the transverse processes of the upper three cervical vertebrae. Nerve: The posterior branches of cervical nerves. Action: Draws the head backwards and rotates the upper cervical vertebrae and head to the same side.

II. The Sacro-spinalis.
Superficial layer, the spino-transversalis.

The Spino-transversalis consists of the lateral Ilio-costalis and the medial, stronger Longissimus. Medial to the latter and fused with it is the Spinalis.

The Iliocostalis has three parts which pass over into one another without any sharp lines of demarcation. The Iliocostalis lumborum arises with the Longissimus dorsi from the dorsal surface of the sacrum and from the lateral lip of the iliac crest. It inserts into the angles of the fifth to the twelfth ribs. The Iliocostalis arises by digitations from the twelfth to the seventh ribs and inserts into the angles of the upper six ribs and the transverse process of the seventh cervical vertebra. The Iliocostalis cervicis arises from the upper and middle ribs and inserts into the transverse processes of the middle cervical vertebrae. Nerves: Posterior branches of the cervical, thoracic and lumbar nerves. Action: Extends the vertebral column and bends it backward, acting with the other long muscles.

The Longissimus also consists of three parts. The Longissimus dorsi arises with the iliocostalis lumborum from the dorsal surface of the sacrum and from the spinous processes of the lumbar and lower thoracic vertebrae. It inserts into the accessory processes of the upper lumbar and the transverse processes of the thoracic vertebrae, and, more laterally, into the tip of the transverse processes of the lumbar vertebrae and into all the ribs, between their angles and tubercles. The Longissimus cervicis is not clearly separated from the upper part of the Longissimus dorsi; it arises from the transverse processes of the upper thoracic vertebrae and inserts into the transverse processes of the upper and middle cervicals.

The Longissimus capitis (Trachelomastoid) arises from the transverse processes of the upper thoracic vertebrae and from the transverse and articular processes of the middle and lower cervicals. It is inserted into the posterior border of the mastoid process. Nerves : Posterior rami of the cervical and thoracic nerves. Action: Extends the vertebral column and bends it backwards; the Longissimus capitis acts also on the neck and head.

The Spinalis again has three portions. The Spinalis dorsi arises from the spinous processes of the upper lumbar and the lower thoracic and inserts into the same processes of the middle and upper thoracic vertebrae. The Spinalis Cervicis (inconstant) passes between the spinous processes of the lower cervical vertebrae and those of the upper thoracic. The Spinalis capitis is properly a portion of the Semispinalis capitis, representing its inconstant spinal head. Nerves: Posterior rami of the cervical, thoracic and lumbar nerves. Action: Bends the vertebral column sidewise; acting on both sides, it extends.

The Deep Layer, the Transverso-spinalis.

The Semispinalis has three portions. The Semispinalis dorsi and cervicis arise from the transverse processes of the thoracic and lower cervical vertebrae and, passing steeply upward and inward, inserts into the spinous processes of the middle and upper thoracic and lower cervical vertebrae. The lateral portion of the Semispinalis capitis arises from the transverse processes of the third cervical to the fifth or sixth thoracic vertebrae, the medial portion (the spinalis capitis) from the spinous process of the upper thoracic and lower cervical vertebrae. Its insertion is into the squamous portion of the occipital, between the superior and inferior nuchal lines. Nerves: Posterior rami of the cervical and thoracic nerves. Action: Extends the vertebral column and head. Acting on one side only it rotates the head toward the opposite side.

The Multifidus is a series of small muscles that arise from the dorsal surface of the sacrum and the transverse processes of all the vertebrae up to the lower cervical and pass upwards and inwards to the second or third spinous process next above.

The Rotatores longi and breves pass between the bases of the transverse processes of the thoracic vertebrae and the spinous process of the vertebra next (breves), or next but one (longi), above. Nerves: The Multifidus and Rotatores are supplied by the posterior rami of the spinal nerves. Action: Extension of the spinal column and rotation the opposite side.

3. The Short Muscles of the Back.

I. The Suboccipital Muscles.

The Rectus capitis posterior major arises from the spinous process of the axis (epistropheus) and is inserted into the inferior nuchal line. The Rectus capitis posterior minor arises from the posterior tubercle of the atlas and ascends to the inferior nuchal line. The Rectus capitis lateralis (see Fig. A276) takes its origin from the transverse process of the atlas and passes to the jugular process of the occipital.

The Obliquus capitis superior arises from the transverse process of the atlas and passes upwards to the inferior nuchal line. The Obliquus capitis inferior arises from the spinous process of the axis (epistropheus) and passes outwards and upwards to the transverse process of the atlas.

Nerve : All five muscles are supplied by the suboccipital nerve, the posterior ramus of the first cervical. Action: They serve for the extension and rotation of the head. The Obliquus inferior and Rectus major and minor rotate toward the same side, the Obliquus superior to the opposite one; the Rectus lateralis bends the head forward.

II. The Interspinales and Intertransversarii.

The Interspinales are wanting in the thoracic region. Elsewhere they extend from spinous process to spinous process. The first are between the atlas and axis (epistropheus), and throughout the cervical region they are paired, the spinous processes being bifurcated.

The Intertransversarii are, as a rule, absent in the thoracic region. In the cervical there are Anterior intertransversarii between the anterior tubercles of successive vertebrae, and Posterior intertransversarii between successive posterior tubercles. In the lumbar region there are Medial intertransversarii, between the accessory and mamillary processes of succeeding vertebrae, and Lateral intertransversarii between the transverse processes; the latter are much the larger.

Nerves: Posterior rami of the spinal nerves. Action: The interspinales bend the spinal column backwards, the intertransversarii bend it laterally.

The Levatores costarum are really the posterior portions of intercostal muscles. They arise from the transverse processes of the thoracic vertebrae and pass to the succeeding rib (Levatores costarum breves), or to the next but one (Levatores costarum longi) inserting between the tuberosity and the angle. Action: Raise the ribs, extend the vertebral column and bend it laterally.

The Fasciae of the Back.

The strongest fascia of the back is the lumbo-dorsal fascia whose relations are shown in Fig. A255. The superficial layer of muscles is covered by the general fascia, but the different layers of the long muscles are not distinctly separated by fascia and the short muscles are destitute of it.

Muscles of the Thorax and Abdomen, including the Diaphragm and Iliopsoas.

The Pectoral Muscles.

The Pectoralis major arises by a clavicular portion from the sternal half of the clavicle, by a sterno-costal portion from the anterior surface of the manubrium and body of the sternum and from the second to the sixth costal cartilages and by an abdominal portion from the abdominal aponeurosis (sheath of the Rectus). It is inserted by a broad tendon, resembling a two-layered pouch with the opening upward, into the crest of the great tuberosity of the humerus. Nerve: The anterior thoracic from the brachial plexus. Action: Adducts the arm, draws it medially and forward, rotates it inwards.

The Pectoralis minor arises from the second to the fifth ribs, near the cartilages, and inserts into the apex of the coracoid process of the scapula. Nerve: The anterior thoracic from the brachial plexus. Action: Draws the scapula downwards; if the scapula is fixed it raises the ribs.

The Subclavius is a small muscle arising from the first costal cartilage and inserting into the under-surface of the acromial end of the clavicle. Nerve: The subclavian from the brachial plexus. Action: Fixes the clavicle in the sterno-clavicular joint, drawing it forward and downward.

Serratus anterior arises by digitations from the first to the ninth ribs. The upper portion, from the first and second ribs, is inserted into the medial angle of the scapula; the middle portion, from the second and third ribs, into almost the entire length of the vertebral border of the scapula; the lower portion, from the fourth to the ninth rib, converges on the inferior angle of the scapula. Nerve: The long thoracic from the brachial plexus. Action: Draws the scapula forward and laterally, especially its lower angle, the scapula thus being rotated on the chest wall, as in raising the arm.

The Abdominal Muscles.

The Oblique Abdominal Muscles.

The Obliquus externus arises by seven or eight digitations from the fifth or sixth to the twelfth rib. It is inserted into the lateral lip of the iliac crest and into the inguinal ligament and the anterior wall of the sheath Rectus. Nerve: The lower intercostal nerves and branches from the lumbar plexus, the ilio-hypogastric and ilio-inguinal. Action: Compresses the abdomen, draws the trunk forward or rotates it to the same side, raises the pelvis.

The Obliquus internus arises from the intermediate line of the iliac crest, from the lumbo-dorsal fascia and from the lateral two-thirds of the inguinal ligament. It is inserted into the lower borders of the last three ribs and the linea alba, its tendon forming the anterior wall of the sheath of the Rectus and the upper part of its posterior wall. Nerves: The lower intercostals and branches of the lumbar plexus (ilio-hypogastric, ilio-inguinal and genito-femoral). Action: Similar to that of the external oblique.

The Cremaster arises from the lower bundles of the Internal oblique and from the anterior wall of the sheath of the Rectus, and is continued down over the spermatic cord to the scrotum. Nerve: External Spermatic. Action: Draws the testis upwards.

The Transversus.

The Transversus arises from the inner surfaces of the last six ribs (fleshy), from the lumbodorsal fascia (tendinous) and from the inner lip of the iliac crest and the lateral third of the inguinal ligament (fleshy). It is inserted at the linea semilunaris into the posterior wall of the sheath of the Rectus and, below, into the anterior wall. Nerves: The lower intercostals and branches from the lumbar plexus (iliohypogastric, ilioinguinal, and genito-femoral). Action: Compresses the abdomen.

The Rectus Muscles.

The Rectus abdominis arises from the cartilages of the fifth to the seventh rib and from the xiphoid process, and inserts by a short tendon into the upper border of the pubis between the tubercle and the upper border of the symphysis. The muscle fibres are interrupted by tendinous inscriptions, of which three are constant; an upper, in the region of the costal arch; a lower in the neighborhood of the umbilicus; and a middle between these. A fourth sometimes occurs below the umbilicus and usually only in the lateral part of the muscle. At the inscriptions the muscle unites with the anterior wall of its sheath, from which elsewhere it is separated by loose connective tissue. The posterior wall does not unite with the inscriptions; it ends below at the semicircular line (Douglas' line), not always very distinct, the lower part of the muscle having behind it only the fascia transversalis. Nerves: The middle and lower intercostals and occasionally the first lumbar. Action: It bends the trunk forward or raises the pelvis; it also aids in compressing the abdominal contents.

The Pyramidalis is an inconstant muscle that arises immediately in front of the origin of the Rectus. It is inserted into the linea alba above the symphysis. Nerves: The lower intercostals. Action: Tenses the linea alba.

The superficial Inguinal Ring.

In the aponeurosis of the Obliquus abdominis externus a triangular cleft occurs, no fibres inserting between the pubic tubercle and the upper border of the symphysis. The lateral angle of the cleft is rounded off by superficial, arched intercrural fibres, and the medial angle by the reflexed inguinal ligament, extending upwards from the insertion of the inguinal ligament. The irregularly quadrangular opening so formed is the subcutaneous inguinal ring, through which the spermatic cord passes in the male and the ligamentum teres of the uterus in the female (see Fig. A262). The borders of the aponeurosis that bound the ring are termed the crura (superius and inferius).

The Abdominal Aponeuroses.

The tendon of the Obliquus internus forms both walls of the sheath (vagina) of the Rectus, which is strengthened in front by the Obliquus externus and behind by the Transversus. In the lower third of the abdomen the posterior wall is completely wanting below the semicircular line (Douglasi) (see here), all three muscles passing to the anterior wall. In the middle line the sheaths of the two Rectus muscles unite to form a broad, tendinous strip, the linea alba, that extends from the xiphoid process to the upper border of the symphysis pubis (see Fig. A266).

The Posterior Abdominal Muscle.

The Quadratus lumborum arises from the medial lip of the iliac crest, the iliolumbar ligament and the transverse processes of the lower lumbar vertebrae. Its fibres form two parallel layers which are partly interwoven. It inserts into the medial half of the twelfth rib and into the transverse processes of the upper and middle lumbar vertebrae. Nerves: Branches from the lumbar plexus and the twelfth intercostal. Action: Draws the last rib downwards and bends the lumbar vertebrae laterally.

The Diaphragm and Iliopsoas.

The Diaphragm arises by its sternal portion from the xiphoid process of the sternum, by its costal portion from the inner surface of the last six ribs and their cartilages, and by its lumbar portion from the lumbar vertebrae by three pairs of crura. The medial crura are attached to the anterior surface of the third and fourth vertebrae, the intermediate crura to the lateral surfaces of the body of the second vertebra and the lateral crura to the transverse processes of the first vertebra and to the lumbo-costal arches. From these origins the fibres radiate to a trifoliate central tendon. Between the medial crura is the aortic opening (hiatus); in the muscular part of its lumbar portion, the oesophageal opening; and in the central tendon, the foramen for the vena cava. Between the medial and intermediate crura and between the latter and the lateral there are gaps, and also between the costal and sternal portions. Nerve: Phrenic from the cervical plexus. Action: A muscle of respiration, inspiratory.

The Iliopsoas consists of two or three parts, the Psoas major, Psoas minor, and Iliacus. The Psoas major arises from the upper and lower borders of the bodies of the twelfth thoracic to the fourth lumbar vertebra, and from the fibrocartilages between these; also from the transverse processes of all the lumbar vertebrae. The Psoas minor is inconstant; when present it arises from the bodies of the last thoracic and first lumbar vertebrae and is inserted by a long slender tendon into the iliac fascia and the iliopectineal eminence. The Iliacus arises from the whole of the iliac fossa. It unites with the psoas major, and the combined muscle passes over the crest of the pubis and over the capsule of the hip joint, separated from this by the iliopectineal bursa, and inserts into the lesser trochanter of the femur. Nerves: Branches from the lumbar plexus. Action: Flexes the thigh, rotates it inwards and aids in adduction. The Psoas minor tenses the iliac fascia.

The Muscles of the Thoracic Wall.

The External intercostals pass between the opposed borders of successive ribs, beginning behind the tuberosity and ending in front shortly before the junction of the ribs and their cartilages. Their fibres are directed from above downwards and inwards, like those of the External oblique. In the region of the costal cartilages they are continued as tendinous bundles, the external intercostal ligaments.

The Internal intercostals are covered by the external, except in the region of the cartilages. Their fibres are directed upwards and inwards, like those of the Internal oblique, and are lacking at the hinder ends of the ribs, between the angles and the tuberosities, where they are replaced by the internal intercostal ligaments.

The Subcostales immediately succeed the Internal intercostals. They are not quite constant and differ from the Internal intercostals in that they occur at the hinder portions of the ribs and pass over one or more. They occur only on the lower ribs and are usually largely tendinous.

The Transversus thoracis (triangularis sterni) arises from the posterior surface of the body of the sternum and the xiphoid process and is inserted into the inner surfaces of the cartilages of the second (third) to the sixth rib.

Nerves: The Intercostals are supplied by the intercostal nerves which run between the external and internal. The Transversus thoracis and Levatores costarum are also supplied by these nerves. Action: The Intercostals are respirator muscles; the externals and the portions of the internals between the costal cartilages serve in inspiration, as do also probably the rest of the Intercostals and the Subcostals, though they have been held to act in expiration.

For the Levatores costarum see here.

The Pectoral Fasciae.

The pectoral fascia, which covers the Pectoralis major and Serratus anterior, is merely a portion of the general fascia and as such is continued downwards over the superficial abdominal muscles and backwards over the dorsal muscles (Latissimus). Directly continuous with it is the axillar fascia, perforated by numerous blood vessels. an in part much stronger sheet, the coraco-clavicular fascia lies between the Pectoralis major and Pectoralis minor, covering the Subclavius and the axillary vessels. It is especially strong where it rests on the Subclavius, and is attached to the under surface of the clavicle and to the coracoid process. The endothoracic fascia covers the inner surfaces of the ribs and Intercostal muscles and also the upper surface of the Diaphragma; it is in contact with the parietal layer of the pleurae.

The Abdominal Fasciae.

The superficial layer of the abdominal muscles is covered by the general fascia, but this, in the region of the inguinal ring in the lower region of the abdomen, acquires a very considerable strength and is continued as the cremasteric fascia (Cooper's) upon the spermatic cord. It is also continuous with the fascia penis and forms the ligamentum fundiforme penis (in the female the much weaker ligamentum fundiforme clitoridis) which arises from the linea alba, to which the fascia is closely united, and, dividing into two portions, surrounds the root of the penis; it is rich in elastic fibres. The sheath of the Rectus serves as its fascia. The inner surface of the Transversus, the anterior surface of the Quadratus lumborum and the posterior surface of the posterior wall of the sheath of the Rectus are covered by the transversalis fascia. Over these structures the fascia is especially strong and it is firmly fused with the tendinous portion of the Transversus and the posterior wall of the sheath of the Rectus. Below the linea semicircularis it alone forms the posterior wall of the sheath. Above the symphysis it fuses with a triangular, tendinous offset from the superior pubic ligament, the adminiculum lineae albae. At the inguinal ligament, with which it unites, the Transversalis passes over into the iliopectineal fascia and it also passes over into that portion of the iliac fascia that covers the anterior surface of the Psoas. Above it is lost on the under surface of the Diaphragm. It is in contact with the parietal layer of peritoneum.

Muscles of the Neck.

The Platysma.

The Platysma arises from the skin covering the pectoral and deltoid fasciae and is inserted into the skin over the base of the mandible, the chin and face. Nerve: Ramus colli of the facial nerve. Action: contracts the skin of the neck and upper part thorax and tenses the cervical fascia.

The Sterno-mastoid.

The Sterno-mastoid (sterno-cleido-mastoid) arises by a sternal head from the anterior surface of the manubrium sterni and by a clavicular head from the sternal end of the clavicle. It is inserted into the lateral part of the base of the mastoid process and the lateral half of the superior nuchal line. Nerve: The spinal accessory. Action: Fixes the head, turns the face upwards. If only one acts, the head is drawn to the same side and rotated towards the opposite one.

Hyoid Muscles.

a) The Infrahyoid Muscles.

The Sterno-hyoideus arises from the upper border of the first costal cartilage, the posterior surface of the manubrium and the sterno-clavicular joint. It has frequently a tendinous inscription in its lower part and inserts into the body of the hyoid bone.

The Sterno-thyreoideus arises from the inner surface of the first costal cartilage and from the posterior surface of the manubrium. It also frequently has a tendinous inscription in its lower part, and inserts into the outer surface of the thyreoid cartilage.

The Thyreo-hyoideus arises from the outer surface of the thyreoid cartilage and is inserted into the lateral third of the body of the hyoid and into the root of the greater cornu. The Omohyoideus arises from the upper border of the scapula between the medial angle and the scapular notch. It is divided in the middle of its course into two bellies by an intervening tendon, and is inserted into the lower border of the lateral part of the body of the hyoid.

Nerves: All four muscles are supplied from the ansa hypoglossi. The Thyreo-hyoideus usually has a direct branch from the hypoglossal. Action: Draw the hyoid bone and larynx downwards and assist in swallowing. The Omohyoideus by the union of its intermediate tendon with the cervical fascia, tenses that fascia.

b) The Suprahyoid Muscles.

The Digastricus is divided into two bellies by an intermediate tendon which is attached to the hyoid bone. The posterior belly (venter) arises from the notch on the mastoid process and the anterior belly is attached to the digastric fossa of the mandible. Nerves: The anterior belly is supplied by the mylohyoid and the posterior by the facial. Action: Opens the mouth, raises and fixes the hyoid bone.

The Stylo-hyoideus arises from the styloid process of the temporal and is inserted by two slips into the anterior and posterior borders of the lateral part of the hyoid. The intermediate tendon of the digastric passes between the two slips of insertion. Nerve: The facial. Action: Fixes the hyoid, drawing it upward and laterally.

The Mylo-hyoideus arises from the mylohyoid line of the mandible. The muscle forms the floor of the mouth extending across the arch of the mandible. Its more median fibres unite in a median raphe; the lateral insert into the upper border of the body of the hyoid. Nerve: The mylohyoid from the third division of the trigeminus. Action: Raises the floor of the mouth, depresses the mandible, aids in deglutition.

Th Genio-hyoideus arises from the mental spine and inserts into the anterior border of the body of the hyoid. Nerve: Hypoglossal. Action: Aids the Mylohyoid, fixes the hyoid, and depresses the mandible.

The Scalene Muscles.

The Scalenus anterior arises from the anterior tubercles of the transverse processes of the third (fourth) to the sixth cervical vertebrae and is inserted into the scalene tubercle of the first rib.

The Scalenus medius arises from the anterior tubercles of the transverse processes of all the cervical vertebrae. It is inserted into the first rib, lateral to the preceding. The Scalenus posterior arises from the posterior tubercles of the transverse processes of the fifth to the sixth (seventh) cervical vertebrae and inserts into the upper border of the second rib.

Nerves: From the cervical and brachial plexuses. Action: Elevate the upper two ribs. Muscles of respiration.

The Praevertebral Muscles.

The Longus colli arises by a medial limb from the bodies of the upper thoracic and lower cervical vertebrae; by an upper lateral limb from the anterior tubercles of the transverse processes of the upper cervical vertebrae; and by a lower lateral limb from the lateral surfaces of the bodies of the upper thoracic vertebrae. It inserts by its medial limb into the bodies of the upper cervical vertebrae; by its upper lateral limb into the anterior tubercle of the atlas and the bodies of the succeeding vertebrae; and by its lower lateral limb into the transverse processes of the lower cervical vertebrae, especially the sixth.

The Longus capitis arises from the anterior tubercles of the transverse processes of the third to the sixth cervical vertebrae and inserts into the lower surface of the basilar portion of the occipital.

The Rectus capitis anterior has its origin from the root of the transverse process of the atlas and is inserted close to the preceding muscle. Nerves: Special branches of the cervical plexus. Action: Bend the vertebral column and head anteriorly; acting singly bend the head to the same side.

Muscles of the Head.

I. The Facial Muscles.

The facial muscles include the Epicranius with the associated auricular muscles, the Orbicular muscle of the eyelids, the muscles of the mouth and those of the nose.

The differ from most of the other skeletal muscles in many respects; they are in the deeper layers of the skin, they generally lack fascia, they are entirely fleshy or have very short tendons. In certain regions they form sphincters. Frequently adjacent muscles are imperfectly separated; thus the muscles of the mouth region unite together in the upper and lower lip.

The Epicranial Muscles.

The epicranial muscles are attached to a common tendinous sheet, the galea aponeurotica, which covers the whole vault of the skull.

The Frontalis arises from the upper border of the orbit and is attached above to the galea aponeurotica.

The Procerus is attached to the nasal bones and is inserted into the skin over the glabella.

The Occipitalis arises from the supreme nuchal line and passes to the galea aponeurotica.

The Epicranius auricularis is a superficial muscle that is divided by the branches of the superficial temporal artery into three parts, which are quite distinct from the deeper Auriculus anterior and posterior and do not all reach the auricular cartilage.

Nerve: The facial. Action: Move the scalp.

The Auricular Muscles.

The Auricularis anterior (attrahens) arises from the superficial temporal fascia and from the margin of the galea aponeurotica; the Auricularis superior (attollens) arises from the galea aponeurotica in the temporal region; and the Auricularis posterior (retrahens) from the tendon of insertion of the sterno-mastoid. The three muscles insert into the root of the auricular cartilage. Nerve: The facial. Action: Move the auricle.

The Muscle of the Eyelid.

The Orbicularis oculi has three portions: The orbital portio arise the frontal process of the maxilla at the medial angle of the orbit and its fibres surround the opening of the orbit like a sphincter; some of the fibres insert into the eyebrow (depressor capitis supercilii). The palpebral portion has its origin in the medial palpebral ligament and inserts into the lateral palpebral raphe, while the lacrimal portion (Horner's muscle) is attached medially to the posterior lacrimal crest and fuses laterally with the palpebral portion. A portion arising from the nasal part of the frontal bone and inserting into the skin of the eyebrow is termed the Corrugator supercilii. Nerve: The facial. Action: Closes the eyelids, compresses the lacrimal sac.

The Muscles of the Lips and Cheeks.

The Quadratus labii superioris arises by three heads. The angular head arises from the frontal process of the maxilla and passes partly to the ala of the nose and partly to the upper lip. The infraorbital head arises from the infraorbital border and the zygomatic head from the malar surface of the zygomatic bone; these two heads pass to the upper lip.

The Zygomaticus arises from the malar surface of the zygomatic bone and passes to the angle of the mouth.

Nerve: The facial. Action: Movement of the upper lip, the ala of the nose and the angle of the mouth.

The Risorius, usually part of the Platysma or of the Triangularis, arises from the parotideo-masseteric fascia and passes to the angle of the mouth.

The Triangularis (depressor anguli oris) arises from the anterior end of the base of the mandible and passes to the angle of the mouth and the lower lip.

The Caninus (levator anguli oris) arises from the canine fossa of the maxilla and passes to the upper lip and the angle of the mouth.

The Quadratus labii inferioris arises from the anterior part of the base of the mandible and passes to the lower lip.

The Incisivus labii superioris arises from the jugum of the upper lateral incisor tooth and passes to the upper lip. The Incisivus labii inferioris arises from the jugum of the lower lateral incisor tooth and passes to the lower lip. The Incisive muscles probably should not be regarded as distinct muscles any more than the slip of the Nasalis that passes to the cartilaginous septum of the nose (Depressor septi).

The Bucinator arises from the bucinator crest of the mandible, the posterior end of the alveolar process of the maxilla and the pterygo-mandibular raphe. Its fibres at the angle of the mouth are continued into the upper and lower lips, arching around the mouth to form the Orbicularis oris.

The Mentalis (levator menti) arises from near the jugum of the lower medial incisor tooth and passes to the skin of the chin.

Nerve: The facial. Action: Move the lips, cheeks and chin.

The Muscles of the Nose.

The Nasalis consists of two portions, a transverse portion arising from the maxilla and passing transversely to the bridge of the nose, and an alar portion from the jugum of the upper canine tooth to the ala of the nose and the septal cartilage. Nerve: The facial. Action: Slight movement of the nose, especially of the ala.

II. The Muscles of Mastication.

The Masseter arises by its superficial fibres from the lower border of the zygoma, by its deeper fibres from the posterior part of the lower border and from the inner surface of the zygoma. It is inserted into the lateral surface of the ramus of the mandible from the mandibular notch to the angle (masseteric tuberosity). Nerve: The masseteric nerve from the third division of the trigeminus. Action: Closes the jaws.

The Temporalis arises from the temporal fossa, below the inferior temporal line, and from the deep lamina of the temporal fascia. It inserts into the apex and medial surface of the coronoid process of the mandible. Nerves: The deep temporal nerves from the third division of trigeminus. Action: Closes the jaws.

The Pterygoideus externus arises by its chief head from the lateral surface of the lateral plate of the pterygoid process and from the tuberosity of the maxilla; by its accessory head from the infratemporal crest of the greater wing of the sphenoid. It is inserted into the pterygoid fovea on the condyloid process of the mandible and into the articular disk of the mandibular articulation. Nerve: The external pterygoid from the third division of the trigeminus. Action: Draws the mandible forward. By the alternate action of the two muscles lateral movements of the mandible are produced.

The Pterygoideus internus arises from the pterygoid fossa, from the pyramidal process of the palatine and from the medial surface of the lateral plate of the pterygoid process. It inserts into the medial surface of the angle of the mandible (pterygoid tuberosity). Nerve: The internal pterygoid from the third division of the trigeminus. Action: Closes the jaws.

The Fasciae of the Head and Neck.

Over the vault of the skull there is no fascia, since the galea aponeurotica is directly connected with the deeper layers of the skin.

The parotideo-masseteric fascia is a sheet that passes over the parotid gland and the Masseter muscle. At the zygoma it is continuous with the temporal fascia, at the anterior border of the Masseter with the bucco-pharyngeal and at the angle of the mandible with the cervical (Fig. A264).

The temporal fascia is the strongest fascia of the head. It extends as a dense membrane from the superior temporal line to the zygoma and at about the middle of its course it splits into two laminae, a superficial and a deep, between which there is some fat tissue. The interval between the two laminae increases downwards, the superficial lamina inserting into the lateral and the deep into the medial border of the zygoma. At its upper edge it is connected with the galea aponeurotica.

The bucco-pharyngeal fascia rests in its anterior part on the bucinator muscle and is connected with the parotideo-masseteric fascia; its posterior part is stronger and covers the inner surface of the Internal pterygoid muscle. It is in this that the pterygo-mandibular raphe and stylo-mandibular ligament are developed. This posterior part of the fascia bounds the lateral posterior wall of the mouth cavity and the lateral wall of the pharynx (see here).

In the neck the fascia colli (cervical fascia) and the praevertebral fascia may be distinguished. The former is divided into a superficial and a deep lamina, this latter being sometimes termed the middle layer. The former covers the superficial muscles of the neck and also the larynx, trachea and submaxillary gland, but is of variable strength in its different parts, being very thin over the lateral surface of the Sternomastoid. At the anterior border of the Trapezius it passes into the fascia of the back of the neck. The deep, distinctly stronger lamina covers the Omohyoid and the posterior surfaces of the other infrahyoid muscles and, anterior to the larynx and trachea, fuses with the superficial lamina. The quite distinct praevertebral fascia covers the anterior surface of the praevertebral muscles and the bodies of the cervical vertebrae, where these are uncovered by muscles; it is strong and partly tendinous.

Muscles and Fasciae of the Upper Extremity.

The Muscles of the Shoulder.

The Supraspinatus arises from the supraspinous fossa of the scapula and is inserted into the upper facet of the greater tuberosity of the humerus. The Infraspinatus arises from the lower border of the spine of the scapula, from the infraspinous fossa and the infraspinatus fascia. It inserts into the middle facet on the greater tuberosity of the humerus. Nerve: The subscapular from the brachial plexus. Action: The Supraspinatus abducts the arm; the Infraspinatus rotates it outwards.

The Teres minor arises from the lower part of the infraspinous fossa, from about two-thirds of the lateral border of the scapula and from the infraspinatus fascia. It inserts into the lower facet of the greater tuberosity of the humerus. Nerve: The axillary from the brachial plexus. Action: External rotation of the arm.

The Teres major arises from the middle third of the axillary border of the scapula and has a tendinous insertion into the crest of the lesser tuberosity of the humerus. Its tendon is posterior to that of the Latissimus dorsi, from which it is separated by a bursa. Nerves: The lower subscapular from the brachial plexus. Action: Assists the Latissimus (see here), rotates the arm inwards.

The Subscapularis arises from the subscapular fossa and its muscular lines and inserts by a strong tendon on the lesser tuberosity of the humerus and the upper part of its crest. A subscapular bursa, between the tendon and the capsule of the shoulder joint, communicates with the latter. Nerves: Subscapular nerves from the brachial plexus. Action: Internal rotation and adduction of the arm.

The Deltoid arises from the acromial third of the clavicle, from the acromion and the spine of the scapula. It is inserted into the deltoid tuberosity of the humerus, a subdeltoid bursa being interposed between its tendon and the bone. Nerve: The axillary. Action: Abducts the arm to the horizontal position.

The Muscles of the Upper Arm.

Eleven muscles of the trunk are attached to the skeleton of the upper limb, especially to the shoulder girdle. These are:

  • Neck:
    1. Sternomastoid, clavicular head (sternal end of clavicle).
    2. Omohyoid (upper border of scapula).
  • Thorax:
    1. Pectoralis major (crest of the greater tuberosity of humerus).
    2. Pectoralis minor (coracoid process of scapula).
    3. Serratus anterior (medial angle, vertebral border and inferior angle of scapula).
    4. Subclavius (acromial end of clavicle).
  • Back:
    1. Trapezius (acromial end of clavicle, acromion and spine of scapula).
    2. Rhomboideus major (vertebral border of scapula).
    3. Rhomboideus minor (vertebral border of scapula).
    4. Levator scapulae (medial angle of scapula).
    5. Latissimus dorsi (crest of the lesser tuberosity of humerus).
The Muscles of the Extensor Surface.

The large Triceps is the only muscle of the extensor surface of the upper arm, covering its entire surface and being continued upon the forearm as the Anconaeus. It takes origin by three heads. The long head arises from the infraglenoid tuberosity of the scapula; the lateral head from the lateral and posterior portions of the upper part of the shaft of the humerus, below the greater tuberosity, and also from the upper two-thirds of the lateral intermuscular septum; the medial head from the whole length of the medial intermuscular septum down to the medial epicondyle, from the posterior surface of the humerus below the crest of the great tuberosity, following the groove for the radial nerve, and from the lateral intermuscular septum down to the lateral epicondyle. From these three heads the fibres concentrate to a broad tendon that is attached to the posterior part of the upper surface of the olecranon, fibres also passing to the antebrachial fascia.

The Anconaeus is in close relation to the lower part of the medial head of the triceps. It arises from the lateral epicondyle of the humerus and inserts into the dorsal surface of the ulna, immediately below the olecranon. Nerve: The radial supplies both muscles. Action: Extension of the forearm.

The Muscles of the Flexor Surface.

The Biceps brachii has two heads of origin. The long head arises from the supraglenoid tuberosity of the scapula and the short head from the tip of the coracoid process. The two heads unite to form a common tendon which is inserted into the tuberosity of the radius and by means of the lacertus fibrosus into the antebrachial fascia. A bicipito-radial bursa lies between the tendon and the radius. Nerve: The musculo-cutaneus. Action: Supinates and flexes the forearm, tenses the antebrachial fascia; the long head abducts, the short head adducts the arm.

The Coraco-brachialis arises together with the short head of the Biceps from the tip of the coracoid process. It is inserted into the anterior and medial surfaces of the humerus, below the crest of the lesser tuberosity, and into the medial intermuscular septum. Nerve: The musculo-cutaneus, which pierces it. Action: Aids in raising the arm and in its adduction.

The Brachialis arises from the lower parts of the anterior and medial surfaces of the humerus, from the lateral surface below the deltoid tuberosity, and from the medial and lateral intermuscular septa almost down to the epicondyles. It passes over the anterior surface of the capsule of the elbow joint and is inserted into the tuberosity of the ulna. Nerve: The musculo-cutaneus and frequently also a branch from the radial. Action: Flexor of the forearm.

Between the flexor and extensor muscles there is, in the lower portion of the upper arm, on either side an intermuscular septum. The stronger medial one ends at the medial epicondyle, the much weaker lateral at the lateral epicondyle. They serve for the origin of both groups of muscles, the lateral also for that of the radial group.

The long head of the Triceps passes between the Teres major and Teres minor and divides the interval between these two muscles into a lateral quadrangular space, through which pass the axillary nerve and the posterior circumflex artery, and a medial triangular one, which gives passage to the circumflex scapular artery.

The medial head at the intermuscular septum adjoins the Brachialis and at the medial epicondyle the Anconaeus, which continues its fibre-course. The lateral head at the lateral intermuscular septum adjoins from above downwards, the Brachialis, the Brachio-radialis and sometimes also the Extensor carpi radialis longus.

The Muscles of the Forearm.

Superficial Layer of Flexors.

The superficial layer of the flexor muscles of the forearm arises by a common tendon from the medial epicondyle of the humerus. All the muscles of the group, except the Pronator teres, pass over the wrist joint and have more or less long tendons. They occupy the ulnar side of the volar surface of the forearm and in their upper portions are firmly attached to the antebrachial fascia. A deep furrow separates them above from the muscles of the radial group, and in this groove the biceps tendon descends to its insertion.

The Pronator teres arises by a humeral head from the medial epicondyle of the humerus and the antebrachial fascia and by an ulnar head from the coronoid process of the ulna. It inserts into the middle of the lateral surface of the radius. Nerve: Median, which passes between the two heads. Action: Pronation; assists also in flexion.

The Flexor carpi radialis arises from the medial epicondyle and the antebrachial fascia and is inserted into the volar surface of the base of the second metacarpal. Nerve: Median. Action: Volar flexion and radial abduction; also pronation.

The Palmaris longus is not always present. It arises from the medial epicondyle and the antebrachial fascia and inserts into the palmar aponeurosis and the transverse carpal ligament. Nerve: Median. Action: Tenses the palmar aponeurosis and assists in flexion. The Flexor digitorum sublimis arises from the medial epicondyle by a humeral head and from the volar surface and volar border of the radius by a radial head. It is inserted by four long tendons into the middle phalanges of the second to the fifth fingers. Nerve: Median. Action: Flexes the middle phalanges of the four ulnar fingers; assists in flexion of the forearm.

The Flexor carpi ulnaris arises by a humeral head from the medial epicondyle and by an ulnar head from the olecranon and, through the antebrachial fascia, from the upper two-thirds of the posterior border of the ulna. It inserts into the pisiform bone and, by means of the ligaments of that bone (Fig. A224), into the base of the fifth metacarpal. Nerve: Ulnar. Action: Volar flexion and ulnar abduction.

Deep Layer of Flexors.

The deep layer of the flexor surface of the forearm is almost completely covered by the superficial layer and consists of two deep flexors of the fingers and the Pronator quadratus. Strictly speaking it represents two layers, since the two flexors completely cover the Pronator quadratus.

The Flexor digitorum profundus arises from the volar surface of the ulna and from the interosseous membrane. It divides into four long tendons which pass to the terminal phalanges of the second to the fifth fingers. Nerve: Ulnar for its ulnar portion and for its radial part the median. Action: Flexion of the terminal phalanges of the 2-5 fingers; assists in flexing the forearm.

The Flexor pollicis longus arises by a principal radial head from the volar surface of the radius, below the insertion of the supinator, and by an inconstant humeral head from the medial epicondyle. It is inserted into the terminal phalanx of the thumb. Nerve: The volar interosseous from the median. Action: Flexes the terminal phalanx of the thumb. The Pronator quadratus (see Fig. A300) passes across from the volar border of the ulna to the volar border and surface of the radius. Nerve: The volar interosseous from the median. Action: Pronation.

The Muscles of the Radial Group.

The Brachio-radialis arises from the lateral border of the humerus and from the lateral intermuscular septum of the upper arm and is inserted by a flat tendon into the upper end of the styloid process of the radius. Nerve: The radial (musculo-spiral). Action: Flexion of the forearm; if the arm is flexed, either pronation or supination.

The Extensor carpi radialis longus arises from the lower end of the lateral intermuscular septum and the lateral epicondyle of the humerus and inserts into the dorsal surface of the base of the second metacarpal. The Extensor carpi radialis brevis arises from the lateral epicondyle of the humerus and from the antebrachial fascia and is inserted into the dorsal surface of the base of the third metacarpal. Nerve: The radial (musculo-spiral). Action: The brevis especially gives dorsal flexion of the hand; the longus radial abduction; the latter supinates if the arm is extended, pronates if it is flexed.

The Superficial Layer of Extensors.

The Extensor communis digitorum arises from the lateral epicondyle of the humerus and from the antebrachial fascia. Its four tendons, which are connected by tendinous slips, pass into the dorsal aponeurosis of the second to the fifth digits. The Extensor digiti quinti proprius also arises from the lateral epicondyle of the humerus and from the antebrachial fascia and is inserted into the dorsal aponeurosis of the fifth finger. Nerve:The deep radial. Action: Extend the fingers and indirectly the hand.

The Extensor carpi ulnaris is separated from the two preceding muscles by an intermuscular septum and arises, like them, from the lateral epicondyle of the humerus and from the antebrachial fascia. It is inserted into the dorsal surface of the base of the fifth metacarpal. Nerve: The deep radial. Action: Dorsal flexion of the hand and ulnar abduction.

The Deep Extensor Layer.
The Deep Oblique Group of Extensors.

The Abductor pollicis longus (abductor ossis metacarpalis) arises from the dorsal surface of the ulna, the interosseous membrane and the dorsal surface of the radius, and is inserted into the base of the metacarpal of the thumb, slips passing to the trapezium (greater multangular) and to the Abductor pollicis brevis. The Extensor pollicis brevis arises from the dorsal surface of the radius and the interosseous membrane and inserts into the basal phalanx of the thumb. Nerve: The deep radial. Action: Abduction and extension of the thumb; the Abductor may also abduct the entire hand and assist in supination.

The Deep Straight Group of Extensors.

The Extensor pollicis longus arises from the dorsal surface of the ulna and the interosseous membrane and is inserted into the terminal phalanx of the thumb. The Extensor indicis proprius arises from the same parts and inserts into the dorsal aponeurosis of the index finger. Nerve: The deep radial. Action: Extension of the thumb or index finger; the Extensor pollicis assists in abducting the thumb.

The Supinator arises from the lateral epicondyle of the humerus, the radial collateral and annular ligaments and the supinator crest of the ulna. It is pierced by the deep radial nerve and so divided into a superficial and a deep layer. It is inserted into the volar surface and border, the lateral surface and dorsal border of the radius, both above and below the tuberosity. Nerve: The deep radial. Action: Supination.

The Muscles and tendons of the Hand.

The flexor tendons in the palm of the hand are covered by a strong tendinous membrane, the palmar aponeurosis, which is usually the direct expansion of the tendon of the Palmaris longus. It is always united to the transverse carpal ligament and passes laterally and medially into the thenar and hypothenar fasciae. Small at the transverse carpal ligament, it broadens toward the fingers and sends off bands which are lost in the skin of the basal portions of the second to the fifth fingers. In addition to the longitudinal fibres there are transverse fasciculi, especially distally. These bound proximally the gaps between the bands passing to the fingers, through which gaps pass nerves and vessels for the adjacent sides of the individual fingers and also the tendons of the lumbrical muscles.

The Palmaris brevis arises from the ulnar border of the palmar aponeurosis and occasionally from the trapezium (greater multangular). It is usually formed of a number of separate bundles and is inserted into the skin of the hand on its ulnar border. Nerve: Superficial volar branch of the ulnar. Action: Tenses the skin of the hand on the ulnar side.

The Hypothenar Muscles.

The Abductor digiti quinti arises from the pisiform bone and is inserted into the dorsal aponeurosis of the little finger. The Flexor digiti quinti brevis is inconstant. It arises from the transverse carpal ligament and the hamulus of the unciform (hamate) bone and is inserted into the basal phalanx of the fifth finger. The Opponens digiti quinti has the same origin as the preceding and inserts into the ulnar border of the fifth metacarpal. Nerve: The deep volar branch of the ulnar. Action: Indicated by their names.

The Thenar Muscles.

The Abductor pollicis brevis, Opponens pollicis and the superficial head of the Flexor pollicis brevis form a superficial sheet of thenar muscles, and the deep head of the Flexor and the Adductor pollicis a deep layer.

The Abductor pollicis brevis arises from the transverse carpal ligament and receives a slip from the tendon of the Abductor pollicis longus. It inserts into the basal phalanx of the thumb. Nerve: Median. Action: Abducts the thumb and aids in opposing it.

The Opponens pollicis arises from the transverse carpal ligament and the trapezium (greater multangular) and is inserted into the whole of the radial border of the metacarpal of the thumb up to its capitulum. Nerve: Median. Action: Opposes the thumb and aids in abduction.

The Flexor brevis pollicis arises by its superficial head from the tuberosity of the trapezium (greater multangular) and from the transverse carpal ligament; by its deep head from the trapezium (greater multangular) at the bottom of the carpal canal. It is inserted into the radial sesamoid bone at the metacarpo-phalangeal joint of the thumb. Nerve: The median for the superficial head, the deep volar branch of the ulnar for the deep head. Action: Flexes the basal phalanx of the thumb.

The Adductor pollicis has two heads. The oblique head arises from the os magnum (capitate) and unciform (hamate) at the bottom of the carpal canal; the transverse head arises from the volar surface of the third metacarpal. The insertion is into the ulnar sesamoid bone of the metacarpo-phalangeal joint of the thumb. Nerve: Deep volar branch of the ulnar. Action: Adducts the thumb and helps to oppose it.

The Interossei.

The Interossei lie in the intervals between the metacarpal bones. They insert by expanded tendons into the dorsal aponeurosis of the fingers on the basal phalanges. The dorsal Interossei arise each by two heads from the borders of adjacent metacarpal bones.

The First dorsal interosseus arises from the first and second metacarpal, the Second from the second and third, the Third from the third and fourth and the Fourth from the fourth and fifth. The first and second insert into the radial side of the dorsal aponeurosis of the second and third fingers and the third and fourth into the ulnar side of the aponeurosis of the third and fourth fingers. Nerve: Deep volar branch of the ulnar. Action: Abduction of the fingers. Extension of the two distal phalanges and flexion of the basal ones.

The Interossei volares arise each by a single head, the first from the ulnar border of the second metacarpal, the second from the radial border of the fourth and the third from the radial border of the fifth. The first inserts into the ulnar side of the dorsal aponeurosis of the second finger, the second and third into the radial sides of the fourth and fifth fingers. Nerve: Deep volar branch of the ulnar. Action: Adduction of the fingers. Extension and flexion as with the dorsal interossei.

The Lumbricals.

The Lumbrical muscles arise from the tendons of the Flexor digitorum profundus, the two radial usually each by a single head and the two ulnar each by two heads from the sides of adjacent tendons. They insert into the radial side of the dorsal aponeuroses of the second to the fifth fingers. Nerve: The one or two radial by the median, the two or three ulnar by the ulnar. Action: Flex the basal phalanges and extend the terminal ones, the interossei assisting.

The Tendons of the Hand.

The extensor tendons or dorsal aponeuroses, as they may be termed on account of their forming flat expansions on the dorsal surfaces of the digits, include; first, the tendons of the Extensor digitorum communis together with those of the proprii where these occur (index and little fingers), since they fuse with the tendons of the Extensor communis; second, the tendons of the Interossei and Lumbricals which, spreading out fan-like, pass into the expanded tendons of the extensor tendons on the dorsal surfaces of the basal phalanges, but are also continued upon the middle and terminal phalanges. These latter are not reached by the tendons of the Extensor. Consequently, the Extensor extends only the basal phalanges, while the two distal ones are extended by the continued action of the Interossei and Lumbricales.

In the flexor tendons it is to be noted that the tendons of the Flexor digitorum sublimis, which are perforated by the profundus in the region of the basal phalanges, have their insertions in the middle phalanges, while the perforating profundus tendons insert on the terminal phalanges. None of these tendons insert into the basal phalanx, which may be flexed by the action of the Interossei and Lumbricales. Only the small vincula tendinea fasten the tendons of the Flexores digitorum to the volar surfaces of the basal phalanges.

Synopsis of the Muscles of the Upper Extremity.

The muscles of the upper extremity fall into four main groups:

  1. The Shoulder muscles, i.e. muscles that arise from the shoulder girdle, have their principal mass in its region and at no great distance from it are inserted into the skeleton of the free extremity: Deltoid, Supraspinatus, Infraspinatus, Teres minor, Subscapularis, and Teres major.
  2. The Upper arm muscles, i.e. muscles that in the greater part of their course lie in the upper arm. They are subdivided into
    1. Muscles of the flexor surface (Biceps brachii, Coraco-brachialis, Brachialis).
    2. Muscles of the extensor surface (Triceps brachii and Anconeus).
  3. The Forearm muscles, i.e. muscles that in the greater part of their course lie in the forearm, at least so far as their fleshy portions are concerned. They fall into three subgroups:
    1. Muscles of the flexor surface. Arranged in two layers:
      1. A superficial layer including the Pronator teres, Palmaris longus, Flexor carpi radialis, Flexor digitorum sublimis (considered by many as forming a middle layer since it lies deeper than the other muscles of the superficial layer) and Flexor carpi ulnaris.
      2. A deep layer, including the Flexor digitorum profundus, Flexor pollicis longus, and Pronator quadratus.
    2. Muscles of the radial border of the forearm. Includes the Brachio-radialis, Extensor carpi radialis longus, and Extensor carpi radialis brevis.
    3. Muscles of the extensor surface. Among these the Supinator and Anconeus hold a special position. The other muscles of the group fall into
      1. A superficial set (Extensor digitorum communis, Extensor digiti V proprius, and Extensor carpi ulnaris).
      2. A deep oblique set (Abductor pollicis longus, and Extensor pollicis brevis).
      3. A deep straight set (Extensor pollicis longus and Extensor indicis proprius).
  4. The Hand muscles, i.e. muscles that both arise and insert into the hand skeleton. They are divisible into:
    1. The thenar muscles or muscles of the ball of the thumb (Abductor pollicis brevis, Flexor brevis pollicis, Opponens pollicis, and Adductor pollicis).
    2. The hypothenar muscles or muscles of the ball of the little finger (Abductor dig. V. brevis, Flexor dig. V. brevis, and Opponens dig. V.).
    3. Four Lumbricales.
    4. Seven Interossei (4 dorsal, 3 volar).
    In addition there is the Palmaris brevis, a dermal muscle of the palm.

The Fasciae of the Upper Extremity.

The muscles of the upper extremity are enclosed in a common fascia, which receives different names in different regions. At the shoulder there is an axillary fascia, a supraspinatus, an infraspinatus, and a subscapular; on the upper arm the brachial fascia; on the forearm the antebrachial fascia and in the hand the dorsal fascia and the palmar aponeurosis.

The axillary fascia (see also here) is a thin membrane which forms the base of the axillary cavity. It is pierced by many blood vessels and possesses a few stronger deeper bundles extending from the Latissimus to the Pectoralis, these being sometimes muscular and then termed the axillary arch. Anteriorly it becomes directly continuous with the pectoral fascia, posteriorly with the dorsal fascia. The supraspinatus fascia covers the muscle of that name and is partly tendinous in character. The infraspinatus fascia is a very thick, tendinous fascia covering the Infraspinatus and Teres minor and partly also the Teres major, giving origin to some of the fibres of the two former, with which it unites to form an aponeurosis. The rather dense subscapular fascia covers the muscle of that name.

The brachial fascia is continuous above with the fasciae just mentioned and reaches its greatest thickness below the insertion of the Deltoid, but is in general thin and weak. It consists largely of transverse fibres and anteriorly is moulded over the Biceps, on either side of which is a groove, a medial and less noticeable lateral bicipital groove. In the lower part of the upper arm it gives off septa, separating the two muscle groups of that region, a strong and broad medial intermuscular septum extending to the medial epicondyle and a frequently thin lateral intermuscular septum ending at the lateral epicondyle. These septa are attached to the medial and lateral borders of the humerus, respectively, and serve partly for the origin of the muscles which they separate. The medial septum is usually perforated by the ulnar nerve.

The antibrachial fascia is continuous with the brachial in the region of the cubital fossa. Below the elbow joint, especially, it becomes aponeurotic and gives origin to fibres of the proximal portion of the superficial layer of the flexors and extensors of the forearm. The lacertus fibrosus of the Biceps tendon (see here and Fig. A289) is essentially a portion of the fascia, becoming continuous with it. The fascia is weakened in the cubital fossa and over the muscles of the radial group, especially the Brachioradialis and the Extensor carpi radialis, neither of which arise from it. Toward the wrist joint it becomes thickened both dorsally and volarly by bundles of more or less transverse fibres to form the volar carpal ligament (not to be confused with the transverse carpal ligament which is also volar in position) over the flexor tendons and the dorsal carpal ligament, a broad somewhat oblique and very strong fascial band. This latter forms the six tendon compartments for the eight tendon sheaths of the eleven extensor tendons (see Fig. A305), by uniting firmly with the dorsal surfaces of the lower portion of the forearm bones and especially with the ridges on the dorsal surface of the lower end of the radius. In contrast to the brachial fascia the antibrachial has well developed longitudinal fibres, which are especially strong and tendon-like where the fascia becomes aponeurotic and muscle fibres arise from it. This always occurs only in the proximal portion of the forearm (see above) and only rarely extends to its middle portion; in the lowest third of its length, where most of the muscles have become tendons, it does not occur.

The dorsal fascia of the hand passes distally from the dorsal carpal ligament, gradually becoming thinner. In contrast the palmar aponeurosis (see here) is very strong, by far the strongest portion of the entire fascia of the upper extremity.

Muscles and Fasciae of the Lower Extremity.

The muscles of the lower extremity may be classified as those of the rump, those of the thigh, those of the lower leg and those of the foot. The rump muscles pass from the innominate bone to the upper part of the thigh. The muscles of the thigh are arranged in three groups; an anterior extensor group, a posterior flexor and a medial adductor. In the lower leg three groups may again be distinguished: an anterior extensor group, a lateral peroneal group and a posterior flexor group. This last consists of two layers, a superficial and a deep. In the foot are the dorsal extensor and the plantar flexor muscles. The latter may be grouped into the medial muscles, those of the great toe, those of the little toe, the Lumbricals and the Interossei.

The Muscles of the Rump.

The Glutaeus maximus arises from the posterior part of the ala of the ilium behind the posterior gluteal line, from the dorsal surface of the sacrum and from the sacro-tuberous ligament. It is inserted into the gluteal tuberosity of the femur, also sending a slip to the iliotibial band of the fascia lata. Nerve: The inferior gluteal. Action: Extension of the thigh; aids also in adduction and outward rotation.

The Glutaeus medius arises from the lateral surface of the ala of the ilium, above the anterior gluteal line, and is inserted into the lateral surface of the great trochanter. Nerve: The superior gluteal. Action: Abduction of the thigh, assists also by its posterior portion in outward rotation and by its anterior portion in inward rotation.

The Glutaeus minimus arises from the lateral surface of the ala of the ilium, between the anterior and inferior gluteal lines. It inserts into the tip of the great trochanter. Nerve: The superior gluteal. Action: Abduction of the thigh and external and to some extent inward rotation.

The Piriformis arises from the lateral part of the pelvic surface of the sacrum, in the region of the second to the fourth sacral foramina. It passes outward through the great sciatic foramen and is inserted into the tip of the great trochanter. Nerve: Branch from the sciatic or the sciatic plexus. Action: External rotation of the thigh, assists also in abduction.

The Obturator internus arises from the pelvic surface of the circumference of the obturator foramen and from the obturator membrane. It passes out through the lesser sciatic foramen, bends around the base of the ischial tuberosity and inserts into the trochanteric fossa of the femur. The Gemellus superior takes origin from the spine of the ischium and the Gemellus inferior from the ischial tuberosity; they join the tendon of the obturator internus. Nerve: Branches from the sacral plexus. Action: External rotators and adductors.

The Quadratus femoris arises from the lateral border of the ischial tuberosity and passes outwards to the intertrochanteric crest. Nerve: A special branch from the sciatic plexus. Action: External rotation and adduction.

The Tensor fasciae latae arises from the anterior superior spine of the ilium and is inserted into the ilio-tibial band of the fascia lata. Nerve: The superior gluteal. Action: Tenses the fascia lata and assists in flexion and inward rotation of the thigh.

The Fasciae of the Lower Extremity.

The muscles of the lower limb are enclosed in a fascia, which, in places, is exceptionally strong. That part that covers the Ilio-psoas is termed the iliac fascia, that which invests the muscles of the thigh, the fascia lata, that of the lower leg, the crural, and in the foot there is a dorsal fascia and the strongly tendinous plantar aponeurosis (see here).

The iliac fascia invests the ilio-psoas muscle and, at its medial border, passes over into the pelvic fascia. Below it passes upon the muscles of the thigh and unites with the pectineal fascia to form the ilio-pectineal fascia. This divides the space below the inguinal ligament into two compartments or lacunae, a lateral lacuna musculorum for the Ilio-psoas and the femoral nerve and a medial lacuna vasorum for the femoral vessels.

The fascia lata consists of two layers, separable only in certain areas and varying much in thickness. It is stronger on the posterior and lateral surfaces of the thigh than on the anterior and medial. Its superficial layer, just below the inguinal ligaments, forms a free medial border, the falciform border, which, with the deep layer, the pectineal fascia, forms the boundary of the fossa ovalis. The lower border of the fossa is termed the inferior cornu and the upper the superior cornu. The fossa is closed by a somewhat sieve-like portion of fascia, the fascia cribrosa, a larger opening in this transmitting the great saphenous vein. The fossa represents the external or subcutaneous ring, that is to say, the lower opening of the femoral canal (see here).

On the posterior surface of the thigh the fascia lata covers the Glutaeus maximus by its superficial layer, here quite thin, the deep layer passing beneath the muscle; on the part of the Glutaeus medius that is not covered by the maximus, the fascia forms a dense aponeurotic sheet (fascia glutaea). Some strong transverse fibres run in the gluteal groove at the lower border of the maximus. Over the flexor muscles the fascia lata is of moderate strength and shows predominating transverse fibres, which become especially developed in the region of the popliteal fossa, whose roof is formed by the fascia lata.

The strongest part of the fascia lata occurs on the lateral surface of the thigh; it is the ilio-tibial band (tractus) and is formed mainly of strong tendinous longitudinal bundles of fibres, which are attached below to the lateral condyle of the tibia. Between the groups of thigh muscles the fascia in the lower part of the thigh sends in to the lips of the linea aspera a medial and a lateral intermuscular septum, the medial becoming continuous with the tendon of the Adductor magnus. On the anterior surface of the thigh the fascia is divided in its upper part into two layers; the superficial one covers the surface of the Sartorius and the femoral vessels, the deeper one passes behind the Sartorius, lines the ilio-pectineal fossa and the furrow between the Vastus medialis and the Adductors. Over the Adductors the fascia is thin. The portion covering the Pectineus is termed the pectineal fascia; it unites with the lower end of the iliac fascia to form the ilio-pectineal fascia which lines the floor of the ilio-pectineal fossa.

The crural fascia invests the muscles of the lower leg and covers the muscle-free medial surface of the tibia. It is strongest anteriorly below the knee joint, where it fuses with the extensor and peroneal muscles and with the tendons of the pes anserinus. It sends the anterior intermuscular septum to the anterior crest of the fibula between the Extensors and the Peronaei, and the posterior intermuscular septum to the lateral crest of the fibula, between the Peronaei and the Flexors. On the posterior surface of the lower leg it splits into a superficial and a deep layer, the former covering the Triceps surae, the latter the deep group of Flexors. A special thickening of the crural fascia, in addition to those forming the retinacula (see here), is the transverse crural ligament, which passes transversely between the tibia and fibula above the ankle joint.

The Muscles of the Thigh.

The Muscles of the Anterior Surface.

The Sartorius arises from the anterior superior spine of the ilium and, crossing the thigh obliquely, inserts into the medial border of the tuberosity of the tibia. It forms with the Adductor longus the femoral trigone (Scarpa's triangle), and covers the adductor canal. At its insertion it forms with the tendons of the Gracilis and Semitendinosus the pes anserinus, beneath which are one or two bursae. Nerve: The femoral. Action: Assists in flexion and abduction of the thigh, flexes the lower leg and rotates it inwards when flexed.

The Rectus femoris arises from the anterior inferior spine of the ilium and the upper margin of the acetabulum. Associated with it and uniting with it in a common tendon are three other muscles. The Vastus medialis arises from the medial lip of the linea aspera and is stronger below than above; the Vastus lateralis arises from the lateral lip of the linea aspera and from the base of the great trochanter, being stronger above than below; and the Vastus intermedius arises from the anterior surface of the femur between the other two, with which it fuses, especially with the medialis: These four muscles constitute what is termed the Quadriceps femoris and unite to form a common tendon, that is inserted into the upper and lateral borders of the patella and, by means of the patellar ligament, into the tuberosity of the tibia. Some of the deep fibres of the intermedius insert into the capsule of the knee joint, forming what is termed the Articularis genu. Nerve: The femoral. Action: Draws the patella upwards, extends the lower leg, and flexes the thigh.

Behind the tendon of the Quadriceps is the supra-patella bursa, which communicates with the knee joint, so that the tendon forms part of the anterior wall of the capsule of that joint. Extensions from the tendon to the fascia of the lower leg form the patellar retinacula. Behind the patellar ligament is a deep infrapatellar bursa.

The Muscles of the Medial Surface.

The Pectineus arises from the pecten of the pubis and is inserted into the pectineal line of the femur. Nerve: The femoral. Action: Adducts the thigh and aids in flexion and external rotation.

The Gracilis arises from the pubis close to the symphysis and is inserted into the medial border of the tuberosity of the tibia. Nerve: The obturator. Action: Adducts the knee when the lower leg is extended, aids in flexion at the knee and rotates the flexed knee inwards.

The Adductor longus arises from the junction of the upper and lower rami of the pubis and is inserted into the middle third of the medial lip of the linea aspera. Nerve: The obturator. Action: Adduction of thigh; assists in flexion and outward rotation: The Adductor brevis arises from the upper ramus of the pubis, nearer to the obturator foramen than the Adductor longus, and is inserted into the upper third of the medial lip of the linea aspera. Nerve: The obturator. Action: Adduction of the thigh; assists in flexion and outward rotation.

The Adductor magnus arises from the lower rami of the pubis and ischium and from the lower border of the ischial tuberosity. The portion arising from the lower ramus of the pubis is sometimes termed the Adductor minimus. The muscle inserts into the medial lip of the linea aspera, from the medial epicondyle to near the gluteal tuberosity. The lower part of the tendon is pierced by the adductor hiatus. Nerve: The obturator and sciatic (tibial). Action: Adducts the thigh, partly assists the glutaeus maximus.

The Obturator externus arises from the outer surface of the circumference of the obturator foramen and from the obturator membrane. It inserts into the trochanteric fossa of the femur. Nerve: The obturator. Action: External rotator of the femur; aids in adduction and flexion.

The Muscles of the Posterior Surface (Flexors).

The Biceps femoris arises by its long head from the tuberosity of the ischium and by its short head from the lower half of the lateral lip of the linea aspera. It is inserted into the head of the fibula. Nerve: The long head by the tibial, the short head by the peroneal. Action: Flexion of the lower leg and extension of the thigh, together with external rotation.

The Semitendinosus arises from the tuberosity of the ischium, with the long head of the Biceps, and is inserted into the medial border of the tuberosity of the tibia, forming part of the pes anserinus. Nerve: The tibial. Action: Flexion of the lower leg, together with internal rotation. Extension and adduction of the thigh.

The Semimembranosus arises from the tuberosity of the ischium and is inserted into the posterior part of the medial condyle of the tibia and into the oblique popliteal ligament. Nerve: The tibial. Action: Flexion and inward rotation of the lower leg; extension and adduction of the thigh.

Where the Glutaeus maximus passes over the great trochanter a trochanteric bursa is interposed and lower down one or several glutaeo-femoral bursae. Under the insertion of the Glutaeus medius there is a bursa, and, similarly, under that of the Glutaeus minimus. Where the Obturator internus tendon passes at an acute angle over the lesser sciatic notch there is an elongated bursa. Between the Ilio-psoas and the ilio-femoral ligament there is an ilio-pectineal bursa that occasionally communicates with the hip joint.

The Muscles of the Lower Leg.

The Muscles of the Posterior Surface.
Superficial Layer.

The Gastrocnemius, which has two heads, together with the Soleus forms a muscle mass sometimes termed the Triceps surae. The Gastrocnemius arises by its medial head from the medial condyle of the femur and by its lateral head from the lateral condyle. The two heads unite together and at about the middle of the lower leg the muscle unites with the Soleus lying beneath it. The Soleus takes its origin from the head, posterior surface and lateral crest of the fibula, from a tendinous arch between the tibia and fibula over the popliteal vessels and from the posterior surface of the tibia at and below the popliteal line. The muscle unites with the Gastrocnemius to form a powerful tendon (tendo Achillis) which is inserted into the tuberosity of the calcaneus. Nerve: The tibial. Action: Plantar flexion of the foot; raises the heel.

The Plantaris is a small muscle with a long slender tendon. It arises from the lateral condyle of the femur and is inserted at the heel into the deep layer of the crural fascia and the tendo Achillis. Nerve: Tibial. Action: Tenses the tendo Achillis.

The Popliteus arises from the lateral condyle of the femur and from the arcuate popliteal ligament and is inserted into the posterior surface of the tibia above the popliteal line. Nerve: The tibial. Action: Tenses the capsule of the knee; flexes the knee and rotates it inwards.

A bursa lies beneath the origin of the medial head of the Gastrocnemius and another beneath the origin of the Semimembranosus; both may communicate with the knee joint. A popliteal bursa, beneath the origin of the Popliteus, also communicates with the knee joint.

Deep Layer.

The Tibialis posterior arises from the upper part of the posterior surface of the tibia, from the interosseous membrane and the medial surface of the fibula. It inserts into the tuberosity of the navicular bone and the plantar surface of the first or all of the cuneiforms. Nerve: The tibial. Action: Plantar flexion and elevation of the inner border of the foot (supination); fixes the head of the talus.

The Flexor digitorum longus arises from the posterior surface and interosseous crest of the tibia. It divides into four tendons which insert into the terminal phalanges of the four lateral toes. Nerve: The tibial. Action: Flexes the terminal phalanges of the four lateral toes, assists in plantar flexion and supination.

The Flexor hallucis longus arises from the posterior surface and the lower two-thirds of the lateral crest of the fibula and from the interosseous membrane. It inserts into the terminal phalanx of the great toe. Nerve: The tibial. Action: Flexes the great toe, acting also on the others (see below), and assists in flexing and supinating the foot. The tendons of the Flexor digitorum longus and Tibialis posterior cross one another above the medial malleolus, so that that of the latter muscle is the more medial at the level of the laciniate ligaments (see Fig. A335). On the sole of the foot there is a crossing of the tendons of the Flexor hallucis longus and Flexor digitorum longus, by which both tendons fuse, so that the strong Flexor hallucis acts not only upon the great toe, but also on the other four.

The Anterior (Extensor) Group.

The Tibialis anterior arises from the lateral surface of the tibia, the interosseous membrane and the crural fascia. It inserts into the medial border of the base of the first metatarsal and into the plantar surface of the medial cuneiform. Nerve: The deep branch of peroneal. Action: Dorsal flexion and supination of the foot; elevation of its inner border.

The Extensor hallucis longus arises from the medial surface of the fibula, the interosseous membrane and the crural fascia. It is inserted into the dorsal surface of the great toe. The Extensor digitorum longus arises from the anterior crest of the fibula, the interosseous membrane and the crural fascia and inserts by four tendons into the dorsal aponeuroses of the four lateral toes. The Peronaeus tertius splits off from the lower part of the Extensor digitorum longus and is inserted into the dorsal surface of the fifth metatarsal. Nerve: The deep branch of the peroneal. Action: Extension of the toes; the Peronaeus tertius assists in dorsal flexion of the foot, the Extensors in supination also.

The Lateral (Peroneal) Group.

The Peronaeus longus arises from the head of the fibula, the crural fascia, the upper two-thirds of the lateral surface and lateral crest of the fibula. It passes across the sole of the foot in the peroneal groove and is inserted into the tuberosity of the first metatarsal. The Peronaeus brevis arises from the lower half of the lateral surface and the anterior crest of the fibula and inserts into the tuberosity of the fifth metatarsal, sending prolongations to the fifth toe. Nerve: Both Peronaei are supplied by the superficial branch of the peroneal. Action: raise the lateral border of the foot (pronation) and assist in plantar flexion.

The Muscles of the Foot.

Muscles of the Dorsum pedis.

The Extensor digitorum brevis arises from the dorsal and lateral surfaces of the calcaneus, anterior to the sinus tarsi. It passes by three slender tendons into the dorsal aponeurosis of the three middle toes. The Extensor hallucis brevis arises from the dorsal surface of the calcaneus and inserts into the dorsal aponeurosis of the great toe. Nerve: The deep branch of the peroneal. Action: Extensors of the toes.

The Fascia of the Foot.

While the dorsal fascia of the foot is an unimportant thin sheet, the plantar aponeurosis is the strongest of all the fasciae of the leg. At the middle of the sole of the foot it is a thick, tendinous sheet, whose bundles are chiefly longitudinal, but have an oblique direction towards the borders of the foot. The proximal part of the aponeurosis is firmly united to the long plantar muscles and arises with them from the medial and lateral processes of the calcaneal tuberosity; it is much thicker than the distal portion. With this, it presents three plantar eminences, medial, lateral and intermediate. A fibular portion covering the Abductor digiti quinti may be distinguished from the broader tibial portion covering chiefly the Flexor digitorum brevis. From the aponeurosis numerous fine bundles pass to the skin. Towards the toes the tibial part of the aponeurosis divides into several processes, which practically agree in number with the toes, but transverse fasciculi are hardly noticeable, a condition contrasting with that of the palmar aponeurosis where they are very noticeable (see here). In the toes the prolongations of the aponeurosis are lost in the connective tissue of the skin.

The Plantar Muscles.

The Flexor digitorum brevis arises from the medial process of the calcaneal tuberosity and from the plantar aponeurosis. It inserts by four tendons, which are perforated by the tendons of the long flexor, into the middle phalanges of the four lateral toes. Nerve: The medial plantar. Action: Flexes the toes.

The Quadratus plantae arises by two heads from the plantar surface of the calcaneus and from the long plantar ligament. It is inserted into the tendon of the Flexor digitorum longus. Nerve: The lateral plantar; Action: Assists the flexor digitorum longus, correcting its oblique pull.

The Muscles of the Great Toe.

The Abductor hallucis arises from the medial process of the calcaneal tuberosity and from the plantar aponeurosis. It inserts by means of the medial sesamoid bone into the basal phalanx of the great toe. The Flexor brevis hallucis arises from the plantar surfaces of the second and third cuneiforms and from the long plantar ligament. It is inserted by two heads into two sesamoid bones and the basal phalanx of the great toe. The Adductor hallucis consists of two distinct portions. The oblique head arises from the plantar surface of the third (lateral) cuneiform and the plantar ligament. The transverse head arises from the tarso-metatarsal joints of the fifth to the third toe. It is inserted into the lateral sesamoid bone and basal phalanx of the great toe. Nerves: For the Abductor and Flexor brevis the medial plantar; for the Adductor and part of the Flexor the lateral plantar. Action: Adduction and flexion of the great toe.

The Muscles of the Little Toe.

The Abductor digiti quinti arises from the lateral process of the tuberosity of the calcaneus and from the plantar aponeurosis, further, by a deep head, from the medial process of the calcaneal tuberosity. It inserts into the lateral border of the basal phalanx of the little toe and into the tuberosity of the fifth metatarsal. The Flexor digiti quinti brevis and the Opponens digiti quinti arise in common from the anterior part of the long plantar ligament. The Flexor inserts into the basal phalanx of the little toe, the Opponens into the lateral border of the fifth metatarsal. Nerve: The lateral plantar. Action: Abduction, flexion and opposition of little toe.

The Lumbricals.

The Lumbricals of the foot arise from the tendons of the Flexor digitorum longus, the first by a single head from the medial edge of the first (medial) tendon, the other three by two heads. In the region of the metatarso-phalangeal joint they pass to the medial side of the dorsal aponeurosis of the four lateral toes. At their points of insertion there are usually small bursae. Nerves: They are supplied in a variable manner by the medial and lateral plantars. Action: Flexion of the basal phalanges and extension of the others.

The Interossei.

The Interossei (see Fig. A336 and A337) are seven in number, four Dorsal and three Plantar. They occupy the inter-metatarsal spaces and the plantar arise by single heads, the dorsal by two. The first dorsal inserts into the dorsal aponeurosis of the second toe on the tibial side, the other three into the fibular side of the aponeurosis of the second, third and fourth toes. The plantar insert into the tibial side of the aponeurosis of the third, fourth and fifth toes. Nerve: The lateral plantar. Action: Flexion of basal phalanges, extension of the others.

The dorsal aponeurosis of the toes are essentially like those of the fingers. They are formed by the tendons of the Extensor brevis and Extensor longus, those of the Interossei and those of the Lumbricales.

The Tendon Sheaths of the Foot.
The Tendon Sheaths of the Region of the Malleolus.

The three groups of muscles passing from the lower leg into the foot have their tendons invested by tendon sheaths, which, like those of the upper extremity, are protected by retinacula. For the two Peronaei there is a double retinaculum, which is actually a thickening of the deep layer of the lateral portion of the crural fascia. The superior peroneal retinaculum extends from the neighborhood of the lateral malleolus to the calcaneus, the inferior peroneal retinaculum from the neighborhood of the trochlear process of the calcaneus, above which it blends with the cruciate ligament, to the lateral border of the plantar surface of the bone. If the trochlear process is well developed it separates the tendons and tendon sheaths of the two Peronaei. While the sheath of the Peronaeus brevis tendon ends a little beyond the process that of the longus extends into the sole of the foot, where it receives a new retinaculum, formed by the anterior part of the long plantar ligament (see here).

At the medial malleolus the retinaculum for the flexor muscles, the Tibialis posterior, Flexor digitorum longus and Flexor hallucis longus, is formed by the broad laciniate ligament, which is indistinctly separated from the crural fascia.

On the dorsum of the foot the cruciate ligament is a forked strengthening of the dorsal fascia of the foot, which forms the retinaculum for the Extensor tendons. It consists of a usually strong transverse portion (see Fig. A328), which passes from the medial malleolus to above the trochlear process of the calcaneus, and a band, at right angles to the transverse one, extending from the dorsal surface of the navicular to the anterior part of the calcaneus. The ligament contains three compartments for the tendons of the Tibialis anticus, the Extensor hallucis longus and the Extensor digitorum longus plus the Peronaeus tertius.

Regions of the Body.

The body can be divided into a number of regions that are shown on Fig. A338, A339, A340, A341 and A342.

Splanchnology.

Digestive Organs.

The Mouth Cavity (cavum oris).

The mouth cavity (cavum oris), the beginning of the entire digestive tract, is an irregularly shaped, longish cavity in the lower part of the face, and has partly bony, and partly muscular walls. It is divided imperfectly into two portions by the teeth, the oral vestibule and the mouth cavity proper.

The vestibule is a small, somewhat semicircular space, between the lips and cheeks on the one side and the teeth on the other. When the teeth are in contact, it communicates behind the last molar with the actual mouth cavity and in front through the mouth cleft (rima oris) with the outer world. The two lips (labia) form the greatest part of the anterior wall of the vestibule and unite at the angles of the mouth in the labial commissures. The upper lip is somewhat longer than the lower one and on its outer surface presents a flat, rather broad, median furrow, the philtrum. An oblique, slightly arched groove, the nasolabial groove, passes from the ala of the nose toward the cheek. On the outer surface of the lower lip the mento-labial groove separates the lip from the chin (mentum). The lips consist of the skin with hairs, the Orbicularis oris muscle and mucous membrane. This last contains the labial glands, which are mucous glands of small size. The posterior surfaces of the lips in the middle line are connected with the mucous membrane, gingiva, covering the alveolar process of the maxilla and mandible, by thin folds of mucous membrane, the frenula, that of the upper lip being usually the larger and more distinct.

Lateral to the lips the cheeks (buccae) form the wall of the oral cavity. Like the lips they consist of the skin, with stronger hairs in the male, of the Bucinator muscle and of mucous membrane. The last is thin in this region and contains the buccal glands, which are embedded in the Bucinator muscle or even lie on its outer surface. In the angle between the Bucinator and the Masseter there is a strong development of fat tissue, the buccal fat pad (corpus adiposum buccae) which extends in the new-born child over the whole region of the cheek.

The mouth cavity proper is bounded above by the palate, which separates it from the nasal cavity. The floor of the mouth is formed principally by the tongue, which, when the mouth is closed, fills the cavity, except for a relatively small cleft between its dorsal surface and the palate. The anterior and lateral boundaries are formed by the dental arches, the posterior partly by the soft palate and the palatine arches (pillars of the fauces) and, further, at its posterior wall, it communicates with the oral portion of the pharynx by the isthmus of the fauces.

The palate consists of two portions, the hard palate and the soft palate. The former repeats the form of the palatal plates of the skeleton; its mucous membrane is thick and firm, connected closely by submucous bundles of fibres to the periosteum of the bones. It contains numerous mucous glands. In the median line the mucous membrane is raised into a low ridge, the raphe, and at the anterior end of this, at a point corresponding to the incisive foramen, there is an elongated, wart-like elevation, the incisive papilla, and anteriorly on either side three or four transverse palatine folds, which often disappear in old age, but may be in greater number in the new-born child.

The soft palate is a soft plate separating the mouth cavity from the nasal portion of the pharynx. It is muscular, is abundantly supplied with glands and is covered by mucous membrane on both surfaces. It is attached by its base to the posterior border of the bony palate, its mucous membrane passing directly into that of the palate, and it hangs obliquely downwards and backwards and ends in a rounded conical process, the uvula. This, when the palatal muscles are at rest, lies in such a position that its tip is directed forwards. The mucous membrane of the soft palate is rather smooth, much thinner than that of the hard palate, and is usually well supplied with glands. The lateral parts of the soft palate, the palatine arches (pillars of the fauces) are folds of mucous membrane containing muscles; they bound the isthmus of the fauces i.e. the transition from the mouth cavity to that of the pharynx (see here).

The Teeth.

The teeth (dentes) are conical structures imbedded by their roots (radices) in the alveoli of the jaws. The part surrounded by the gingiva is termed the neck (collum), the part projecting into the mouth cavity the crown (corona). Of the three principal constituents of the teeth, the enamel, dentine and cement, the enamel occurs only on the crown, the cement only on the root; at the neck the enamel and cement meet. The enamel has a shining surface and is white with a bluish or yellowish tinge, while the cement is pale yellow and dull. On each crown there is a masticatory surface turned toward the teeth of the upper jaw; the surface turned towards the lips or cheek is the labial or buccal surface; that turned towards the tongue the lingual surface; and those in contact with adjacent teeth the contact surfaces.

The root of a tooth is simple or multiple and is in general conical in shape. It bears at its apex a foramen that leads into a root canal, which traverses the whole length of the root and at the level of the neck broadens to a large cavity, the pulp cavity (cavum dentis), in the interior of the crown, filled with a soft tissue, the pulp. The pulp cavity has in general the form of the tooth, but possesses, almost regularly, fine processes corresponding to the relief of the crown. The tips of the canines are slightly worn. The root canal is also a part of the tooth cavity and accordingly also contains pulp.

The dentition of an adult consists of thirty-two teeth which are arranged in an upper and lower row, the upper and lower dental arches. The upper teeth are implanted in the alveoli of the maxillae, the lower in those of the mandible. The teeth of the two rows resemble each other in form and size, without being exactly alike. The number in each row is sixteen.

The teeth of both jaws may be divided according to their form into four groups, the incisors, canines, praemolars and molars. In each half of each row there are two incisors, one canine, two praemolars and three molars. The teeth of each group represent a well-defined type, without transitions to the others, but within each type there are individual differences, as, for instance, between the corresponding teeth of the upper and lower jaws. The incisors are the most anterior, those of the two sides being in contact in the median line; then follows the canine, then the praemolars, the molars being the most posterior. The human dental formula is as follows:

The incisors have chisel-shaped crowns, convex on the labial and concave on the lingual side; they are thicker but narrower at the base, but become broader and thinner towards their free edge. The labial surface has frequently three indistinct longitudinal ridges separated by furrows. Their crowns are in the frontal plane, so that their contact surfaces are medial and lateral. On account of their chisel-shaped crowns they have no masticatory surface, but a cutting edge, originally three-lobed. The medial angle of this edge is sharp, the lateral rounded. At the base of the crown immediately above the neck there is a thickening, the tubercle. The roots are round, of moderate length and usually almost straight, those of the lateral incisors are usually shorter and slightly flattened. The upper ones are usually larger than the lower and the upper medial is always larger than the lateral, while in the lower jaw the lateral is the larger (Length up to 24 mm).

The canines have a long conical form. Their large and thick crown is conical and stands almost in the frontal plane, so that they present labial and lingual surfaces and medial and lateral contact surfaces, Their rounded tips are not exactly in the axis of the tooth, but slightly to the medial side, the labial surface is strongly convex and the lingual is provided with a tubercle. The root is very long and also conical, yet, especially in the lower ones, distinctly flattened. The canines, especially the upper ones, are the longest teeth in the dentition (on account of their long roots - 35 mm).

The praemolars possess bitubercular (bicuspid) crowns, flattened from before backwards; their contact surfaces are anterior and posterior and their lingual and buccal surfaces convex. The two tubercles are separated by an almost sagittal furrow that follows the curve of the dental arch, so that there is a weaker lingual and a stronger buccal tubercle. The lingual tubercle of the first lower praemolar is usually feebly developed and the lingual of the second lower (also low) is often double, so that this tooth may be tritubercular. The roots of the lower praemolars are always simple, of moderate length and distinctly flattened; those of the upper sets vary greatly, that of the first being usually double or at least cleft, that of the second only strongly flattened or furrowed. One root is buccal, the other lingual. The first upper praemolar is larger than the second.

The molars all possess large, low crowns with several tubercles and have two or three roots, these, as well as the positions of the tubercles differing in the upper and lower teeth. The upper molars have three roots, the larger, lower ones only two. The first molar in both the upper and lower sets has the largest and highest crown, the third the smallest and lowest. The tubercles are four, rarely five in number, two being on the lingual and two on the buccal side. In the lower molars a rather regular crucial furrow separates the four tubercles, of which the lingual are higher than the buccal. The first lower molar has usually five tubercles, three buccal and two lingual. In the upper molars the buccal tubercles are higher than the lingual and the intervening furrow has the form of an oblique H, so that the lingual and buccal tubercles are not exactly opposite one another. Frequently, but not always, the first upper molar has a super-numerary tubercle, usually very small, at the base of the anterior lingual tubercle. It is the so-called anomalous (Carabelli) tubercle. The contact surfaces of the molars are anterior and posterior.

The lower molars have two conical roots, an anterior (somewhat the stronger) and a posterior; they are flattened in the frontal plane, are furrowed and of considerable size, and their tips are usually curved backwards. The upper molars, on the contrary, have three conical roots, two buccal and one lingual or palatal; their tips are also curved. All three roots are usually well developed in the first upper molar; in the second they show, not infrequently, more or less fusion, and this is the rule in the third upper one in which the roots are almost parallel. In the upper molars the tips of the roots are often slightly curved backwards.

The third molars, also called wisdom teeth (dentes serotini), are usually more or less rudimentary. The upper is always much smaller than the lower and its roots usually fuse to a single mass with indications, in three root canals, of their original triple division. Often they possess only three tubercles, sometimes more than four. The lower wisdom tooth has usually two short roots and a crown that departs somewhat from the type.

The Milk Dentition.

The permanent dentition of the adult, consisting of thirty-two teeth, is preceded in childhood by a Milk dentition of only twenty teeth (dentes decidui) including eight incisors, four canines and eight molars. The formula for the milk dentition is therefore:

The incisors and canines of the milk dentition resemble the corresponding teeth of the permanent dentition not only in general but also in particular, though they are relatively smaller and the furrows are wanting on the labial surfaces of the crowns of the incisors. These teeth also occur in the same position as their successors, while the milk molars appear in the places later occupied by the praemolars. The milk molars, while resembling the permanent ones, represent a specific type; they have more than one root and have several tubercles. The second (posterior) are larger than the first; the upper ones have usually three roots like the permanent molars, two buccal and one lingual, while the lower have two roots. The crowns have three (anterior) to five (posterior) irregularly placed tubercles, which are separated by very irregular furrows.

The first milk tooth to erupt, on the average, in the sixth or seventh month after birth, is the medial incisor of the lower jaw, the teeth of the lower jaw as a rule appearing earlier than those of the upper. Then, in the seventh or eighth month the corresponding tooth of the upper jaw appears. The lateral incisors erupt usually from the eighth to the twelfth month; the anterior molars of the lower jaw from the twelfth to the sixteenth month; those of the upper jaw some months later; after these the canines, from the sixteenth to the twentieth month; and, finally, the posterior molars from the twentieth to the thirtieth month.

The milk dentition is gradually replaced by the permanent teeth, so that for a time representatives of both dentitions are present. The first, lower, permanent molars erupt at the fifth to the eighth year and soon after the corresponding teeth of the upper jaw appear. Later the process of replacement begins and, in the sixth to the ninth year, the median milk incisors are replaced by the permanent ones, and then the lateral ones in the seventh to the tenth year. The first praemolars erupt in the ninth to the thirteenth year; the permanent canines in the ninth to the fourteenth; the second praemolars in the tenth to the fourteenth; Replacement now ends and soon after, in the tenth to the fourteenth year, the second molars appear; the third molars erupt much later, in the sixteenth to the fortieth year or not at all. The upper praemolars usually appear before the lower, but otherwise the lower teeth precede the corresponding upper ones.

The Tongue.

The tongue (lingua) presents for examination three parts, a body (corpus), the largest, middle portion, adherent to the floor of the mouth, an apex projecting freely into the mouth cavity anteriorly and a root (radix) posteriorly, attached to the hyoid bone and the epiglottis.

The inferior surface of the body is attached; the convex upper surface, lined throughout its whole extent by the oral mucous membrane, is termed the dorsum. The entire surface of the tongue facing the palate is also termed the dorsum linguae. The lateral border is free in the anterior part of the tongue, but behind passes into the soft palate by means of the glossopalatine arch. The boundary between the body and the root is indicated on the dorsum by the foramen caecum, which leads into a quite short, blindly ending canal, the lingual (thyreoglossal) duct. The vallate papillae extend outward and forward from the foramen caecum, forming an angle open anteriorly and with its apex at the foramen (V-shaped). Frequently, immediately behind and parallel to the vallate papillae there is a groove, the terminal sulcus, which, when present, marks the boundary between the body and the root. The root is connected with the epiglottis by three folds of mucous membrane, a median glosso-epiglottic fold and two lateral glosso-epiglottic folds. Between these there is on either side a roundish depression, the epiglottic vallecula.

The tongue is composed of two principal constituents, the mucous membrane and muscles. The mucous membrane of the dorsum is intimately connected with the subjacent muscle tissue, that of the under surface is only loosely connected with it. The mucous membrane of the under surface is smooth and thin and in the median line below the apex forms a sagittal fold, the frenulum. On either side of this there is a low fold with lobed edges, the plica fimbriata, which is well developed in the new-born child, but often less distinct in the adult. It runs from the anterior end of the frenulum posteriorly and laterally. At the margins of the tongue another fold of mucous membrane, the sublingual fold, runs obliquely anteriorly and median ward, to terminate at the root of the frenulum in a sublingual caruncle; it corresponds to the submaxillary duct (see here) which lies close beneath the mucous membrane. The mucous membrane of the dorsum of the tongue is divided by the terminal sulcus or vallate papillae into that of the body and tip, the papillary portion, and that of the root, the tonsillar portion.

The papillae of the mucous membrane of the anterior part of the tongue are in general conical; they project above the surface of the mucous membrane and give it a satiny appearance. They are divided by their form into:

  1. Filiform papillae which are thread-like, more or less cylindrical structures, and occur closely packed over the whole papillary surface and especially in its anterior and lateral portions; at their tips they have a conical, often very long epithelial thickening.
  2. Conical papillae which have a more conical form; they are scattered among the filiform papillae, especially in youth, and pass over into them.
  3. Fungiform papillae which are scattered among the filiform papillae at the side and anterior border of the tongue. Their heads are broader than their bases, they are smooth and are covered by a relatively thin epithelium, whence they appear redder than the filiform papillae.
  4. The lenticular papillae are merely modification of the fungiform, being somewhat lower.
  5. The vallate (circumvallate) papillae are so-called because they are surrounded by a wall-like fold of the mucous membrane often higher than the papillae themselves. In their outward form they resemble the fungiform, but often are larger and broader and, at the same time, lower and of almost the same diameter at the base as at the summit. They have a constant position, forming a V-shaped figure in front of the foramen caecum (see here); they are seven to twelve in number.
  6. The foliate papillae are merely rudimentary in man. They form parallel, weakly defined, transverse folds on the lateral borders of the tongue, immediately in front of the root of the glosso-palatine arch (Fig. B32).

Quite different from the anterior, papillary portion of the lingual mucous membrane is the posterior tonsillar portion, characterized by the occurrence in it of lymphatic lingual follicles, which in their sum total form the diffuse lingual tonsil. Each follicle is a small round elevation 2-3 mm in diameter, with a central, fine depression. As a whole they form on the actual root of the tongue a closely packed, almost defined mass, while towards the epiglottis and the neighbouring palatine tonsils they are more scattered.

The Muscles of the Tongue.

The muscles of the tongue consist of two groups:

  1. those which take origin from the skeleton (skull and hyoid bone) and end in the tongue;
  2. those that are entirely confined to the tongue, both their origin and insertion being in it.
Group I.

The Genio-glossus arises from the internal mental spine and passes mainly to the under surface of the mucous membrane of the dorsum of the tongue and partly also to the hyoid bone and the epiglottis.

The Hyoglossus and Chondro-glossus arise from the body and greater cornu of the hyoid bone (the Chondro-glossus from the lesser horn). They pass anteriorly and upwards to the lateral portions of the tongue, interlacing with the fibres of the second group.

The Stylo-glossus arises from the styloid process of the temporal bone and passes to the border of the tongue, interlacing with the fibres of Group II.

Group II.

The Longitudinalis inferior lies on the under surface of the tongue between the Genio-glossus and Hyoglossus and extends from the root to the tip