Applied Anatomy: The Construction Of The Human Body | by Gwilym G. Davis

The construction of the human body considered in relation to its functions; diseases and injuries

Title	Applied Anatomy: The Construction Of The Human Body
Author	Gwilym G. Davis
Publisher	J. B. Lippincott Company
Year	1913
Copyright	1913, J. B. Lippincott Company
Amazon	Applied anatomy: The construction of the human body

By Gwilym G. Davis M.D., University Of Pennsylvania And Goettingen; M.R.C.S., Eng.; Ll.D., Lafayette, Professor Of Orthopedic Surgery And Formerly Associate Professor Of Applied Anatomy In The University Of Pennsylvania; Consulting Surgeon To St. Joseph's Hospital; Formerly Surgeon To The Episcopal Hospital; Surgeon To The Orthopedic Hospital; Orthopedic Surgeon To The University And Philadelphia General Hospitals; Fellow Of The American Surgical Association, The Philadelphia Academy Of Surgery And Philadelphia College Of Physicians; Member Of The American Society Of Clinical Surgery, The American Orthopedic Association, American Academy Of Medicine, Etc.

With Six Hundred And Thirty-One Illustrations, Mostly From Original Dissections And Many In Color By Erwin F. Faber

Second Edition

Applied Anatomy The Construction Of The Human Body 1

To George A. Piersol, M.D., Sc.D., Professor Of Anatomy In The University Of Pennsylvania, An Ideal Scientist, Teacher, And Friend

Preface: Preface To Second Edition In this edition the general plan of the work has been retained. The text and illustrations have been carefully revised with many corrections and additions. The cuts have b...

The Scalp: The scalp is formed by the movable soft tissues which cover the skull. It is composed of three layers: skin, superficial fascia, and occipitofrontalis muscle with its aponeurosis. It is attached to th...

The Arteries Of The Scalp: The scalp is supplied by the frontal, supra-orbital, and sometimes a small branch from the lachrymal arteries, from the ophthalmic; by the temporal, through its anterior and posterior branches; and by...

Affections Involving The Layers Of The Scalp: Wounds of the scalp are common. Incised wounds bleed more freely and the hemorrhage is more difficult to control than in wounds elsewhere on the surface. This is due to the exceedingly free blood supp...

Affections Involving The Layers Of The Scalp. Continued: Fig 7. Haematoma on the forehead of a child. 2. Subaponeurotic abscesses come from infected wounds, erysipelas, or caries of the bones. It is not desirable to close deep wounds of the scalp too tig...

Affections Of The Blood-Vessels: The arteries or veins alone may be affected, or both may be involved. Arterial varix is the name given to an enlargement of a single artery. It forms a swollen, tortuous, pulsating mass in the cour...

Tumors Of The Scalp: Sebaceous cysts arise from obstructed sebaceous glands; the contents consists of epithelial cells, fat, and cholesterin. They sometimes calcify. They spread in the subcutaneous tissue, stretching and ...

The Skull: The skull is the bony framework of the head. It is divided into the bones of the cranium and those of the face. The hyoid bone is usually classified with the bones of the head. The cranium consists...

The Skull. Continued: Dura Mater The dura mater in children is more firmly attached to the interior of the skull than in adults. If, therefore, a true fracture does occur, laceration of the dura is more liable to be pro...

The Skull In Adults: As the child grows, the bones of the face increase more rapidly than do those of the vault. The bony prominences become marked, due to the action of the various muscles of mastication, expression, etc...

The Skull In Adults. Continued: Mastoid Process The mastoid process is continous with the superior curved line of the occiput. It increases in size from the time of birth, but is composed of cancellous tissue until after the age ...

Fractures Of The Skull: Fractures of the skull are almost always produced by violent contact of the skull with some solid body. In some cases the fracture is produced by a blow from a moving body, as when a person is struck ...

Fractures Of The Skull. Part 2: Fractures By Contrecoup Or Counter Stroke Fractures by counter stroke are now regarded as of much less frequent occurrence than formerly. Charles Phelps found in 147 cases of fracture of the base o...

Fractures Of The Skull. Part 3: Bleeding From The Venous Sinuses Bleeding may occur from the sinuses of the base as well as from those of the vault. In severe injuries of the vault detached fragments frequently penetrate the supe...

The Meninges: The meninges of the brain consist of three separate coverings: the outer being the dura mater, the middle the arachnoid, and the inner the pia mater. The dura mater or fibrous covering of the brain...

The Meninges. Continued: The Arachnoid - Also Called Arachnopia Or Parietal Layer Of The Pia The arachnoid is a thin fibrous membrane, which passes over the convolutions of the brain and does not dip into the sulci between...

Affections Of The Membranes Of The Brain: Both the dura mater and the pia mater are subject to inflammation and hemorrhages. The arachnoid being practically a part of the pia mater is involved in its diseases, so that no mention is made of it...

Affections Of The Membranes Of The Brain. Part 2: Inflammation Of The Pia Mater; Meningitis This, when not of a tuberculous character is called leptomeningitis. It is commonly known as inflammation of the brain, or meningitis. The pia mater of ...

Affections Of The Membranes Of The Brain. Part 3: Pial Hemorrhage Meningeal hemorrhage may be either subarachnoid or subdural. If the hemorrhage has not been violent, it spreads out under the arachnoid in the subarachnoid space. If, however, the b...

The Brain: The affections of the brain of most anatomical interest are those involving its circulation, the motor areas, and the motor paths. Paralyses may arise from (a) interference with the motor areas in the...

The Circulation Of The Brain: The blood reaches the brain by means of the two internal carotid and the two vertebral arteries. The vertebrals enter through the foramen magnum and unite to form the basilar, which at the upper borde...

The Circulation Of The Brain. Part 2: Anterior Cerebral Artery The anterior cerebral(Fig. 31) passes forward and inward over the anterior perforated space, between the olfactory and optic nerves, to the median fissure. It gives off the...

The Circulation Of The Brain. Part 3: Cerebral Softening This occurs in the young from embolism; it then affects the cortex, but the more common variety is caused by thrombosis in arteries which are diseased, usually in the aged. The p...

The Circulation Of The Brain. Part 4: Hemorrhage Into The Pons - Crossed Paralysis Apoplexy may also occur in other portions of the brain. It may occur in the pons (see Fig. 39). This produces two different sets of symptoms, according ...

The Cerebral Lobes: Each cerebral hemisphere is composed of five lobes, called the frontal, parietal, occipital, temporosphenoidal, and central, or island of Reil. The frontal lobe comprises the anterior portion of th...

The Lateral Surface Of The Hemispheres: The frontal lobe has a superior, an inferior, and a precentral sulcus. The first two divide the anterior portion into the superior, middle, and inferior frontal convolutions. That portion of the infer...

The Medial Surface Of The Hemispheres: If now the medial surface of the hemisphere, which forms one side of the longitudinal fissure, be examined, there is seen a large convolution running just above and parallel with the corpus callosum. ...

Functions Of The Cortex Of The Brain: Cerebral Localization: A knowledge of the functions of the various portions of the brain is necessary in order to localize a diseased area. The diseases and injuries to which the brain is exposed oftentimes do not involve t...

Functions Of The Convolutions On The Surface Of The Cerebrum: The frontal lobe may be conveniently divided into three areas; prefrontal, mid-frontal, and postfrontal. The prefrontal area embraces all the superior, middle, and inferior frontal convolutions, with ...

Functions Of The Convolutions On The Surface Of The Cerebrum. Continued: The Sensory Area The portions of the cerebrum involved in cutaneous and muscular sensibility embrace the posterior portion of the parietal convolutions, the precuneus or quadrate lobule, and gyrus ...

Functions Of The Basal Ganglia: Corpus Striatum And Thalamus The exact functions of the corpus striatum, embracing the caudate and lenticular nuclei, and of the thalamus are not known. They are most often affected in apoplexies; ...

The Corona Radiata, Internal Capsule, And Motor Tract: The corona radiata is the bundle of white fibres which spreads out like a fan and connects the cortex of the brain with the basal ganglia and spinal cord. Proceeding downward from the cortex, the coro...

Craniocerebral Topography: For the purpose of operating on the brain it is essential to know the bony landmarks of the skull, the lower level of the brain, and the relation which the various fissures and convolutions bear to th...

Fissures And Convolutions: The conformation of the various fissures and convolutions varies so much within normal limits that it is not possible to outline them on the surface of the scalp or skull with absolute exactness. The ...

Subsidiary Fissures And Convolutions: The precentral and postcentral sulci are about 15 mm. (3/5 in.) anterior and posterior to the fissure of Rolando. The inferior frontal convolution lies between the line of the fissure of Sylvius be...

Subsidiary Fissures And Convolutions. Part 2: The Lateral Ventricles The lateral ventricles sometimes become distended by serous or purulent effusions or, as in apoplexy, by blood. In order to tap them Keen (Reference Handbook of the Medical ...

Subsidiary Fissures And Convolutions. Part 3: Trephining If the abscess arises from middle-ear disease, it is customary to first open the mastoid antrum (see chapter on ear) and then by removing the bone above to explore the surface of the pet...

The Face: The face may be divided into the regions of the forehead, temples, ears, eyes, nose, month, cheek, and upper and lower jaws. The regions of the eyes, ears, nose, and mouth will be considered separatel...

The Frontal Region: The frontal region embraces that part of the face above the eyes and nose in front and anterior to the temples at the sides. The Frontal Suture The frontal bone develops from two centres of ...

The Temporal Region: The region of the temple is on the side of the head as far forward as the eye and as low as the zygoma and infratemporal crest. The floor of the temporal fossa is formed by the posterior portion of th...

The Region Of The Cheek: In this region we may include the parts limited above by the zygoma, in front by the eye, nose, and mouth, below by the lower edge of the lower jaw, and behind by the ear. The soft parts of the cheek ...

Parotid Gland: The parotid gland lies on the cheek, behind the jaw and below the ear. The limits (Fig. 60) of the gland are important because suppuration may occur in any portion of its structure. Its extent is as f...

Parotid Gland. Part 2: Vessels And Nerves Traversing The Gland The external carotid artery enters the gland to divide opposite the neck of the lower jaw into the temporal and internal maxillary. The temporal, before it l...

Parotid Gland. Part 3: Lines Of Incision For Abscess The manner of opening a parotid abscess depends on its location and size. If it is desired to open an abscess anterior to a point 1.5 cm. or about half an inch in fron...

The Upper Jaw: The upper jaw carries the upper teeth and contains the maxillary sinus or antrum of Highmore. The affections of the antrum will be alluded to in the chapter on the nose (see page 103). Fractures of th...

The Upper Jaw. Part 2: Neuralgia Of The Maxillary Nerve The pain involves the cheek from the eye to the mouth and as far forward as the median line, also the upper gums and hard palate. The operations devised for its rel...

The Upper Jaw. Part 3: Removal Of Meckel's Ganglion Operating from the front through the maxillary sinus (Carnochan's operation, or removal of the sphenopalatine (Meckel's) ganglion and maxillary nerve). - The incision i...

The Upper Jaw. Part 4: Operating From The Side Through The Pterygoid Fossa Both the maxillary and mandibular branches have been reached by this route; the former at the foramen rotundum and the latter at the foramen oval...

The Upper Jaw. Part 5: Excision Of The Lingual And Inferior Dental Nerves Neuralgia involving the face below the line of the mouth, the lower teeth, and side of the tongue requires the removal of the inferior dental and ...

The Upper Jaw. Part 6: Area Of Distribution Of The Fifth Nerve When the ophthalmic division is affected the pain in neuralgia is over the brow and up toward the vertex of the skull; it also involves the eye. The points o...

The Lower Jaw: The mandible or inferior maxilla is subject to fractures, dislocation, and tumors. In its composition it is very dense, so that in dividing it a groove should be cut with a saw before the use of the b...

The Lower Jaw. Part 2. Movements Of The Jaw: The jaw has four distinct movements. It can be moved directly forward or backward; up and down, a pure hinge motion; a rotary movement on a vertical axis through one of the condyles; and rotation on a...

The Lower Jaw. Part 3. Dislocation Of The Lower Jaw: The forward dislocation is practically the only one to which the jaw is subject. Dislocations in other directions are apt to be accompanied by fractures. An understanding of the mechanism of the produ...

The Lower Jaw. Part 4. Fractures Of The Lower Jaw (Mandible): Fractures of the lower jaw almost never occur through the symphysis; this is on account of its being the thickest and strongest part of the bone. When a fracture of the anterior portion of the jaw det...

The Lower Jaw. Part 5. Displacement: The displacement of the fragments will depend on the line of fracture; and the line of fracture may be determined by the direction and character of the fracturing force. The line of fracture is obliqu...

The Lower Jaw. Part 6. Treatment: The lower jaw is held up in place by a bandage, and the upper teeth act as a splint. Sometimes the teeth or fragments are wired in position, or an interdental splint of gutta percha or other material ...

Region Of The Eye: The eyeball rests in its socket, which is hollowed out of the soft parts contained in the bony orbit. It is covered in front by the lids, which, as they slide over the eye, are lubricated by the tears...

Region Of The Eye. Part 2: Contents Of The Orbit The orbit is lined with a periosteum, and contains the eyeball, the muscles which move it, the veins, arteries, and nerves which go to it together with some which traverse the...

Region Of The Eye. Part 3: Dermoids In the foetus, the frontonasal process comes from above downward to join the maxillary processes on each side. This leaves an orbitonasal cleft to form the orbit. Owing to defects in the d...

Region Of The Eye. Part 4: Emphysema In cases of fracture involving the inner wall and opening up the nasal cavities or sinuses the air, particularly in blowing the nose, may be forced into the orbit, distending the lids and...

The Eyeball And Optic Nerve: The eyeball has three main coats, viz.: a fibrous outer coat, called the sclerotic; a vascular middle coat, the choroid; and a nervous inner coat, the retina. Sclerotic Coat The sclerotic co...

The Eyeball And Optic Nerve. Part 2: Cataract When the lens is opaque it constitutes the disease known as cataract: this name is also applied to opacities of the capsule of the lens. When the lens alone is opaque it is called a lentic...

The Eyeball And Optic Nerve. Part 3: Iris The iris is the continuation of the choroid through the ciliary body, and extends down to the pupil, its free edge resting on the anterior surface of the lens. The iris is composed of a vascul...

The Eyeball And Optic Nerve. Part 4: Optic Nerve The optic nerve reaches from the optic chiasm to the eyeball, a distance of about 5 cm. (2 in.). It enters the apex of the orbit through the optic foramen at the upper inner angle, in c...

Drawn By Mr. Louis Schmidt: Muscles Of The Orbit Six muscles are connected with the eyeball, four straight and two oblique. One muscle, the levator palpebrae, goes to the lid. The four recti muscles, superior, inferior, exter...

Drawn By Mr. Louis Schmidt. Part 2: Nerves Of The Orbit The optic nerve is the nerve of sight. Interference with it produces blindness. The oculomotor or third nerve supplies all the muscles of the orbit except the external rectus an...

Drawn By Mr. Louis Schmidt. Part 3: The Lachrymal Apparatus The lachrymal gland consists of two portions: an orbital or superior portion and a palpebral or inferior portion. The orbital portion is enclosed in a capsule and slung from...

The Ear: The external auditory meatus, the tympanum, and the Eustachian tube are the remains of the first branchial cleft in the foetus. A failure of any portion of the cleft to close normally may leave small ...

The Ear. Part 2: Membrana Tympani The membrana tympani is inclined downward and inward at an angle of about 1400 to the upper wall (Troltsch) and 270 to the lower wall (Bezold) of the meatus; it does not lie direct...

The Ear. Part 3: The Tympanum Or Middle Ear The tympanic cavity is flat and narrow and is situated directly behind and also above the membrane. It has a floor and roof, and external and internal walls. It is divide...

The Ear. Part 4: Mastoid Cells The mastoid cells are continuous with the antrum and permeate the mastoid process down to its tip. The cells come so close to the surface that suppuration within them often bursts thr...

Modified From Georges Laurens: Operations On The Middle Ear The operations on the middle ear, besides those involving the membrane, are done either for the removal of the remains of the membrane and ossicles, or else to clear ou...

Modified From Georges Laurens. Continued: Relations Of The Brain And Lateral Sinus In operating on the skull for middle-ear disease, it is desirable to know how to reach and how to avoid the brain and lateral sinus. The lower level of the ...

The Nose: Externally the nose forms a prominent projection on the face, hence it is frequently injured and its construction should be studied in relation to those injuries. It forms a conspicuous portion of the...

The Nose. Part 2: Injuries To The Nose The bones and cartilages may be fractured or dislocated. This may involve either the outside structures or those forming the septum, and often both. The displacement depends on...

The Nose. Part 3: View From The Anterior Nares In looking into the nose from in front, if the speculum is directed downward, the floor of the nose and the inferior meatus can be seen. On the inner side is the septum...

The Nose. Part 4: The Outer Wall The outer wall has on it the three turbinated bones - superior, middle, and inferior. The inferior is a separate bone, but the middle and superior are parts of the ethmoid bone (Figs...

The Mouth And Throat: The lips are formed mainly by the orbicularis oris muscle with its subdivisions and the accessory facial muscles (buccinator, levator and depressor anguli oris, levator labii superioris, levator labii...

The Mouth And Throat. Part 2: Mouth Surface Anatomy. - In looking into the mouth, one sees the tongue below and the roof above, surrounded in front and on the sides by the teeth. On each side are the inner surfaces of the cheek...

The Mouth And Throat. Part 3: Palatal Arches Farther back in the mouth, one sees the anterior and posterior arches of the palate or pillars of the fauces with the uvula. The anterior pillar runs from the soft palate to the tong...

The Mouth And Throat. Part 4: Lingual Nerve The lingual nerve or gustatory branch of the fifth can be readily exposed in the mouth. On looking into the mouth, a fold can be seen going up and back just behind the last molar toot...

Pharynx: The pharynx is the common air and food tract that lies behind the nose, mouth, and larynx. It extends from the base of the skull above to the oesophagus below. Its lower end is at the cricoid cartilag...

Pharynx. Part 2: Introducing The Eustachian Catheter In introducing the Eustachian catheter, the tip of the nose is to be tilted upward until the anterior nares are raised to the level of the floor of the nose. The...

Pharynx. Part 3: Fossa Of Rosenmuller This is the depression above and behind the openings of the Eustachian tubes. The walls of the pharynx are weakest at this point owing to the superior constrictor muscle not co...

The Larynx: The larynx extends from the top of the epiglottis to the lower edge of the cricoid cartilage. It is composed of the three large cartilages - epiglottis, thyroid, and cricoid - and three pairs of small...

The Larynx. Part 2: Cricothyroid Membrane The space between the cricoid and thyroid cartilages is small. This is due to the increase in width of the cricoid as it proceeds backward. The space is readily felt on the li...

The Larynx. Part 3: Diseases Of The Larynx Syphilis affects the larynx and produces ulcers. These may involve almost *any portion but usually they are anterior, involving the epiglottis. They are often associated with...

The Neck: The neck supports the head. It is a pedestal for the head, and is long in proportion to its thickness; the apparent object of this being to elevate the head and allow it to be moved freely in differen...

Surface Anatomy Of The Neck: For convenience of study we may consider the structures in the median line, and those regions anterior and those posterior to the sternomastoid muscle, between it and the trapezius. The posterior port...

The Cervical Triangles: On viewing the neck from the side the prominent sternocleidomastoid muscle with its thick anterior and thin posterior edge is seen to divide it into two spaces, an anterior and a posterior. They are c...

The Cervical Triangles. Part 2: Arteries The carotid arteries and their branches are found in this triangle. The line of the carotid arteries is from a mid-point between the mastoid process and the angle of the jaw to the sternoc...

The Cervical Triangles. Part 3: Veins The veins found in and near the superior carotid triangle are the anterior and internal jugulars and their branches. A small portion of the commencement of the external jugular may also be in...

The Cervical Triangles. Part 4: Lymphatics The lymphatics are composed of four sets, a superficial set along the anterior border of the sternomastoid muscle, a deep set accompanying the great vessels, a submaxillary set around an...

The Cervical Triangles. Part 5: External Jugular Vein Lying oh the deep fascia and beneath the superficial fascia and piatysma is the external jugular vein. This begins below the ear and posterior to the ramus of the jaw, being f...

The Cervical Triangles. Part 6: Nerves The nerves in the posterior cervical triangle are the spinal accessory, branches of the cervical plexus, and the brachial plexus. The position of the spinal accessory is important because it...

Torticollis Or Wry-Neck: In this affection the head and the neck are so twisted that the face is turned toward the side opposite the contracted muscle and looks somewhat upward. It is usually caused by some affection of the s...

Arteries Of The Neck. - Ligation: Carotid And Subclavian Arteries And Branches Both these arteries are affected at times with aneurisms, necessitating their ligation. Ligation of the main trunks or their branches is also required i...

Arteries Of The Neck. - Ligation. Part 2: Collateral Circulation After Ligation Of The Common Carotid Artery When the common carotid has been tied the blood reaches the parts beyond from the branches of the carotid of the opposite side and...

Arteries Of The Neck. - Ligation. Part 3: The External Carotid Artery Of recent years the external carotid artery has been ligated far more often than formerly, as it was customary to ligate the common carotid instead. The external carotid...

Arteries Of The Neck. - Ligation. Part 4: Ligation Of The Superior Thyroid Artery The superior thyroid is the first branch of the external carotid and is given off close down to the bifurcation or even from the common carotid itself just b...

Arteries Of The Neck. - Ligation. Part 5: Ligation Of The Third Portion Of The Subclavian Artery The head is to be turned strongly to the opposite side and the shoulder depressed. This lowers the clavicle and raises the omohyoid muscle and...

Arteries Of The Neck. - Ligation. Part 6: Ligation Of The Inferior Thyroid Artery The inferior thyroid artery, unlike the superior, lies deep from the surface, and it is a far more difficult vessel to reach. It is a branch of the thyroid a...

The Cervical Fascias: There are two fascias in the neck, the superficial and the deep. The superficial fascia has blended with it anteriorly the platysma muscle and the termination of the nerves, arteries, and veins. The m...

The Cervical Fascias. Part 2: Fig 178. Deep cervical fascia. The pharynx and larynx have been cut away, exposing the prevertebral and pretracheal layers. About 3 cm. (1 1/4 in.) above the sternum the deep fascia splits into two...

The Cervical Fascias. Part 3: Abscesses Of The Neck Abscesses of the neck usually arise in connection with the lymphatic nodes. They may also start from infected wounds, carious teeth, suppuration of the thyroid gland, and othe...

The Cervical Fascias. Part 4: Retropharyngeal Abscess Pus which tends to point into the pharynx may come from disease of the vertebrae, in which case it is posterior to the prevertebral fascia; or it may originate from the lymp...

Lymphatics Of The Neck: The lymphatics of the neck are both superficial and deep. The superficial nodes communicate freely with and end in the deep ones. For the sake of convenience we may divide them into a transverse set, ...

Lymphatics Of The Neck. Part 2: Superficial And Deep Nodes The five sets of nodes just described, viz., the submental, submaxillary, superficial upper cervical, posterior auricular, and superficial occipital, are all regarded as ...

Lymphatics Of The Neck. Part 3: Postpharyngeal Nodes In the retropharyngeal space, toward the sides, between the buccopharyngeal fascia in front and the prevertebral fascia behind are located one or two nodes (see buccopharyngeal...

Operations On The Air-Passages: The Pharynx May Be Opened Just Below The Hyoid Bone subhyoidean pharyn-gotomy. The larynx may be opened in the median line, - thyrotomy. The cricothyroid membrane may be opened, - laryngotomy. The ...

Operations On The Thyroid Gland: The operations which are done on the thyroid gland are ligation of its arterial supply and complete or partial removal. These necessitate a knowledge particularly of its blood supply and structure. Th...

Operations On The Thyroid Gland. Continued: The Veins There are three sets of veins, a superior, a middle, and an inferior thyroid, and, as Kocher has pointed out, an accessory thyroid between the middle and inferior ones. The veins ramify u...

The Parathyroid Bodies: The parathyroid bodies are usually four in number, but rarely there may be five or six. They are 6 to 7 mm. long, 3 to 4 mm. broad, and 1.5 to 2 mm. thick. The most constant site of the superior parat...

Sophagus - Cervical Portion: The oesophagus runs from the level of the cricoid cartilage to the stomach. The cricoid is opposite the sixth cervical vertebra and the cardiac or oesophageal end of the stomach is opposite the lower ...

Cut Throat: The most frequent site of the incision in cases of cut throat is between the hyoid bone and thyroid cartilage. If above the hyoid bone, the incision will divide the mylohyoid, geniohyoid, geniohyoglos...

Affections Of The Neck: Cervical Cysts And Fistulae The neck is the seat of some very peculiar cystic tumors and fistulae which are connected with developmental defects. They are either lateral or median in location. The ...

Affections Of The Neck. Continued: Hydrocele Of The Neck There are other cystic tumors of the neck which are congenital, being noticed at birth, and which grow to a large size. They are often wide-spread, extending not only between ...

The Thorax: The thorax or chest is that portion of the trunk which lies between the neck and the abdomen. It is composed of a bony framework reinforced by soft parts, and contains the main organs of circulation a...

The Sternum: The sternum consists of three pieces: the manubrium or presternum, gladiolus or mesosternum, and xiphoid cartilage or metasternmn. It is developed in two lateral halves. Should these fail to unite an ...

The Ribs And Costal Cartilages: The ribs are frequently fractured, sometimes they become affected with caries, and in operating the chest is frequently opened between them or portions of them are excised. They are both elastic and m...

The Thoracic Vertebrae: The thoracic or dorsal vertebrae are twelve in number and are so articulated with one another as to form a single, regular curve with its concavity forwards and convexity backward. Any sudden change i...

The Intercostal Muscles And Arteries: The intercostal spaces are occupied by the two intercostal muscles, with a fascia above them, one below, and one between them. The external intercostal muscles run downward and forward. They begin ...

Muscles: Covering the chest anteriorly are the pectoralis major and pectoralis minor muscles. The serratus anterior (magnus) winds around its side and posteriorly, above is the trapezius and below the latissim...

Surface Anatomy Of The Thorax: On looking at the chest one should note whether or not it appears normal. It may show the rounded form of emphysema or the flat form of phthisis. One side may be larger than the other, suggesting pleu...

The Mamma Or Breast: The name mammary gland is often given to the breast, yet the latter is composed not only of glandular tissue but also of fibrous and fatty tissue, with the usual vessels, nerves, and lymphatics. In th...

The Mamma Or Breast. Continued: Blood Supply The breast is supplied with blood from above by the pectoral branch of the acromial thoracic artery, which leave's the axillary artery at the inner border of the pectoralis minor muscl...

Abscess Of The Breast: Suppuration in the mammary gland is usually due to infection which has entered the gland either through the lymphatics or the lactiferous ducts. The starting point of the infection is thought to be an...

Abscess Of The Breast. Part 2: Malignant Tumors The malignant growths of the breast are either sarcomata or carcinomata. Sarcomata originate from the fibrous stroma of the breast surrounding the ducts and acini. As it increas...

Abscess Of The Breast. Part 3: Removal Of The Cancerous Breast The origin of cancer is now believed to be local and not general and the more complete its removal the greater is the likelihood of cure. Therefore every effort is m...

The Mediastinum: The mediastinum is the middle space of the chest between the spine behind, the sternum in front, and the pleurae to each side. It is subdivided into a superior mediastinum, which is the part above Lud...

The Mediastinum. Part 2: Anterior Mediastinum This is the space below the second costal cartilages, between the sternum in front, the pericardium behind, and the two pleurae on the sides. It is only a narrow slit in the me...

The Mediastinum. Part 3: Posterior Mediastinum The posterior mediastinum extends from the pericardium and roots of the lungs anteriorly to the vertebrae posteriorly. The pleura' are on each side. Behind the pericardium run...

The Chest Contents. The Longitudinal Lines: For the sake of convenience in description and record, the chest has been divided into various regions and marked by certain longitudinal lines. Seven longitudinal lines are used. They run parallel...

The Regions Of The Chest: In the middle of the surface of the chest anteriorly there are three regions: 1. The suprasternal region is the part above the sternum between the sterno-mastoid muscles. It is the suprasternal notch....

The Pleurae: The pleurae form closed sacs which line the thorax (parietal pleura) and cover the surface of the lungs (visceral pleura). As the lungs expand and contract, the pleurae are only completely in contact ...

The Lungs: The lungs entirely fill the pleural sacs when completely distended, but only partly so in quiet, ordinary respiration. They are encased in a bony cage that is open below, on account of which, when the...

Outline Of The Lungs: Apex The apex of the lung has its highest point opposite the posterior extremity of the first rib. It then follows the plane of the top of the first rib down to the sternoclavicular joint, immediat...

Outline Of The Lungs. Part 2: Paracentesis Where the pleural effusion is serous it is usually drawn off by an aspirating needle or trocar. For diagnostic purposes a hypodermic syringe needle is often used, as the chest-walls...

Outline Of The Lungs. Part 3: Resection Of A Rib For Empyema For the removal of a part of a rib a more formal operation is necessary. The incision is made directly on the rib down to the bone and five or more centimetres in len...

The Pericardium: The pericardium is composed of fibrous tissue lined with a serous membrane. When affected by inflammation the amount of fluid contained in it becomes increased and it becomes distended and may inte...

The Pericardium. Continued: Paracentesis Of The Pericardium Tapping the pericardium by means of a trocar or aspirating needle must be carefully done, or the pleura may be punctured. Fig. 218. - View of the pericardiu...

The Heart: In size the heart is somewhat larger than the clenched fist. It measures 12.5 cm. (5 in.) in length, 7.75 cm. (3 1/2 in.) in width, and 6.25 cm. (2 1/2 in.) in thickness. Its weight in the adult male ...

Outlines Of The Heart: The base of the heart is opposite the upper border of the third costal cartilage. It is here that the superior vena cava ends and the aorta begins. It extends from 1.25 cm. (1/2 in.) to the right of t...

Valves Of The Heart: There are two types of valves in the heart: the bicuspid {mitral') and tricuspid between the atria (auricles) and ventricles, and the two sets of semilunar valves at the entrance of the pulmonary arte...

Location Of Valvular Sounds: The sounds produced by the closure of the valves do not correspond with the position of the valves, but are as follows. The bicuspid sound is heard most distinctly at the apex of the heart as far i...

Variation In Size And Position Of The Heart: The heart becomes enlarged both by being dilated and by being hypertrophied, usually both conditions are present; and its position is often changed by disease both of itself and of adjacent organs. It...

Wounds Of The Heart: Wounds of the heart are usually immediately fatal, but sometimes they are not so. The pleurae are very liable to be wounded at the same time. The right ventricle, on account of lying anteriorly, is th...

The Aorta: The aorta, as it leaves the left ventricle, begins under the left portion of the sternum opposite the lower border of the third left costal cartilage. This is the location of the aortic semilunar valv...

The Aorta. Part 2: Relations In front of the arch the right lung and pleura cover it slightly, but the left more so; the remains of the thymus gland is between them. The left superior intercostal vein crosses its upp...

The Aorta. Part 3: The Descending Aorta The remaining portion of the aorta, from the lower border of the fourth thoracic vertebra down, is called the descending aorta. It is divided into the thoracic and abdominal po...

The Oesophagus: The oesophagus begins at the lower edge of the cricoid cartilage, opposite the lower border of the sixth cervical vertebra, and ends at the cardiac opening of the stomach, opposite the eleventh thorac...

The Oesophagus. Part 2: Relations In the neck the oesophagus rests on the longus colli muscle and vertebrae behind and has the trachea in front. On the left side it lies close to the carotid sheath, the lobe of the thyroi...

The Oesophagus. Part 3: Foreign Bodies Foreign bodies may become impacted at any part of its course; this is particularly the case if they are hard and rough with irregular outlines. If they are smooth and soft and more o...

The Thoracic Duct: The thoracic duct carries not only lymph but also chyle which is emptied into the venous system and goes to nourish the body. Therefore a wound of the duct with the escape of its fluid may result fata...

The Upper Extremity: Morphology The human skeleton consists of two parts, called the axial skeleton and the appendicular skeleton. The axial skeleton embraces the bones of the head, the spine, the ribs, the hyoid bo...

The Shoulder-Girdle: The upper extremity is joined to the trunk by the shoulder-girdle, which is composed of the clavicle and scapula. The main movements are anteroposterior, as in swinging the arm, those of abduction and...

The Bones Of The Shoulder: The bones entering into the construction of, and forming the basis on which the shoulder is constructed are the clavicle and scapula, forming the shoulder-girdle, and the humerus. The clavicle is a...

The Bones Of The Shoulder. Part 2: The Humerus The upper end of the humerus is composed of a head joined to the tuberosities through the medium of the anatomical neck. The head projects inwardly from the shaft at an angle of 120 deg...

The Bones Of The Shoulder. Part 3: The Shoulder-Joint The upper extremity being an organ of prehension and not of support, the shoulder-joint, which is the articulation which connects it with the trunk through the shoulder-girdle, i...

The Muscles Of The Region Of The Shoulder: The shoulder embraces two sets of muscles: one connects the shoulder-girdle with the trunk and the other the humerus with the shoulder-girdle. The inner end of the clavicle articulates with the ste...

Movements Of The Shoulder-Girdle: While the muscles above enumerated comprise all those directly attached to the shoulder-girdle and trunk, they are of course assisted to some extent by the muscles forming the axillary folds, viz., th...

Movements Of The Shoulder-Girdle. Continued: Axilla On raising the arm directly out from the body the armpit and axillary folds become visible. The rounded edge of the anterior axillary fold is formed by the pectoralis major muscle. It follow...

Dislocations Of The Clavicle: Dislocation Of The Sternal End Of The Clavicle The sternal end of the clavicle is most commonly dislocated forward. Other dislocations, which may be upward or backward, are very rare. The range of ...

Dislocations Of The Shoulder: The dislocations of the shoulder are to be studied from the anatomical and not from the clinical standpoint. A knowledge of the anatomical construction of the various parts involved is to be applied t...

Anterior Dislocation Of The Shoulder: The head of the bone almost always comes out through the anterior portion of the capsule and slips beneath the coracoid process. From this point it may shift its position either a little farther inwar...

Signs And Symptoms: There is (1) at first elevation then lowering of the shoulder, (2) flattening of the deltoid muscle, (3) projection of the elbow away from the side. (4) The normal hollow below the outer third of the ...

Treatment: Reduction of an anterior luxation of the shoulder can be accomplished in two ways, viz., the direct, in which the head is pulled or pushed back into the socket, and the indirect, in which it is levere...

Treatment. Continued: Indirect Method The indirect or lever method has been best systematized by Kocher of Berne, although Henry H. Smith, a former professor of surgery in the University of Pennsylvania, taught a simila...

Posterior Dislocations Of The Shoulder: Posterior dislocations are always beneath some portion of the spine of the scapula, hence they have been called subspinous. When the head lies anteriorly under the posterior portion of the acromion pr...

Fractures Of The Clavicle: Fractures of the clavicle divide with those of the radius the distinction of being the most frequent of any in the body. The clavicle is most often broken in its middle third, next in its outer, an...

Fractures Of The Clavicle. Continued: Treatment When the line of fracture is oblique and in an adult, healing with a certain, often considerable, amount of deformity is almost constant, the only efficient way of combating its occurrenc...

Fractures Of The Scapula: While fractures of the scapula are not common, there are a few anatomical facts in reference to the scapula and its muscles which are worth calling attention to. The scapula is liable to be fractur...

Fractures Of The Upper End Of The Humerus: Fractures of the upper end of the humerus may occur through the anatomical neck, through the tuberosities, detaching one or both, and through the surgical neck just below the tuberosities. These fract...

Fractures Of The Upper End Of The Humerus. Continued: Fractures Of The Surgical Neck These are the most common fractures of the humerus. The surgical neck of the humerus is usually defined as the portion between the lower part of the tuberosities and ...

Epiphyseal Separations: The epiphyses that are liable to separation are those of the coracoid process, the acromion process, and the upper end of the humerus. Separation Of The Coracoid Epiphysis The coracoid proce...

Amputations And Resections Of The Shoulder. Amputation At The Shoulder-Joint: The many different methods of amputating at the shoulder may for our purposes be divided into two classes, - the flap method and the racket method. The Flap Method One large flap may be made...

Amputation At The Shoulder-Joint. Part 2: Spence's Method A modification of Larrey's procedure, attributed to Spence by the British and to S. Fleury by the French, consists in commencing the incision just outside of the coracoid process in...

Amputation At The Shoulder-Joint. Part 3: Interscapulothoracic Amputation For malignant growths of the axilla, shoulder, or scapula, and, rarely, for injury, the whole upper extremity with the scapula and part or whole of the clavicle have...

Amputation At The Shoulder-Joint. Part 4: Excision Of The Scapula The removal of the scapula necessitates the division of a large number of muscles, for which see pages 226 and 227. The subscapular artery at the anterior border, about 2. 5...

Diseases Of The Joint And Bursae: The shoulder-joint, like other joints, is subject to inflammatory and other diseases. These may be (1) traumatic and later septic; (2) rheumatic or gouty; (3) tuberculous, with suppuration. These a...

Diseases Of The Joint And Bursae. Continued: Subacromial Bursa Separating the greater tuberosity from the deltoid muscle, the acromion process, and coraco-acromial ligament, is the large subacromial bursa. It does not communicate with the joi...

The Axilla: The axilla is a wedge-shaped space with its apex upward, formed between the arm and chest at their junction. It serves as a passage-way for the arteries, veins, nerves, and lymphatics passing between ...

The Axillary Vessels: The axillary artery and vein are both important. The avoidance of hemorrhage in operations in this locality requires skill and knowledge, and venous bleeding is more apt to be troublesome than arteria...

The Axillary Vessels. Part 2: Relations Posteriorly, the artery lies on the first intercostal space and muscle, the second and pare of the third serrations of the serratus anterior, the posterior thoracic nerve (or external res...

The Axillary Vessels. Part 3: Second Portion The second portion of the axillary lies beneath the pecto-ralis minor muscle. It is 3 cm. (1 1/4 in. ) long and while never ligated at this point it is nevertheless frequently expose...

The Axillary Vessels. Part 4: Relations Posteriorly the third portion of the axillary artery lies on the sub-scapularis, the latissimus dorsi, and teres major muscles, with the musculospiral and circumflex (axillary) nerves bet...

The Axillary Vessels. Part 5: Lymphatics Of The Axilla There are two sets of lymphatic nodes in the axillary region, the axillary nodes proper and the subclavian nodes. The number of the nodes varies from about ten or twelve...

The Axillary Vessels. Part 6: Abscess Of The Axilla Pus forms in the axillary region from ordinary pyogenic organisms which may or may not be associated with specific organisms like the tubercle bacillus. Abscesses may be eithe...

The Axillary Vessels. Part 7: Axillary Tumors Tumors of the axilla are almost always due to involvement of the lymph-nodes. They may be either benign and inflammatory in character, forming the ordinary axillary adenitis, or tub...

The Arm: The arm - or upper arm - is formed by a single bone surrounded by muscles, which, with the exception of the biceps, are attached to it. The main vessels and most of the important nerves run down its i...

The Humerus: The humerus is a long bone with a large medullary cavity. Its shaft is composed of compact tissue and its ends of cancellous tissue. In shape it is like the letter f, that is, convex anteriorly above ...

Muscles Of The Arm: In order to operate intelligently it is necessary to know the muscles and interspaces, for the latter carry important structures. The arm possesses four sets of muscles. One, an external set, abducts ...

The Anterior Set: The biceps and brachialis anticus form the muscular mass on the anterior surface of the arm. The biceps has no attachment to the humerus. It spans the bone and is attached to the scapula above and ...

The Posterior Or Extensor Set: The posterior or extensor set includes the triceps and the subanconeous, when present as a distinct muscle. The Triceps Muscle The muscular mass on the posterior surface of the arm is formed...

The Intermuscular Septa: The deep fascia of the arm completely encircles it, like a tube. It is continuous above with the fascia covering the deltoid, pectoralis major and teres major muscles, and axillary fascia. Below, it i...

The Brachial Artery: The arm being abducted, the course of the brachial artery is indicated by a line drawn from the inner edge of the coracobrachialis muscle, at the junction of the anterior and middle thirds of the axil...

The Brachial Artery. Continued: Ligation Of The Brachial Artery In ligating the brachial artery. Heath strongly advises that the arm be held by an assistant in an abducted position with the hand supine and not allowed to rest on ...

Amputation Of The Arm: In amputation one has to deal with a part of the body that is approximately cylindrical in shape and that contains only a single bone entirely surrounded by soft parts. The circular method is more app...

Fractures Of The Humerus: Fractures Of The Shaft Of The Humerus There seems to be but little doubt that in many cases the character of displacement of the fragments in fracture of the shaft of the humerus is due to the mode...

Operations On The Arm: Caries or necrosis of the humerus may necessitate operative interference at almost any part of the arm. The same may be said of wounds. In operative procedures it is sometimes desirable to avoid impor...

Region Of The Elbow: The elbow is so named because at this point the arm is usually bent. A joint is here inserted which permits of flexion and extension; when the arm is fully extended the elbow might be said to have ...

Bones Of The Elbow: Humerus The lower end of the humerus broadens laterally and is slightly concave on its anterior surface; this causes the articular surfaces to look downward and forward and not backward. It carries...

Elbow-Joint: By the term elbow-joint is meant the articulation between the humerus above and the ulna and upper surface of the radius below. The articulation between the upper end of the radius and the ulna forms ...

Ligaments Of The Elbow: The ligaments of the elbow-joint are four in number - anterior, posterior, internal lateral, and external lateral. In all joints there are two kinds of ligaments. One kind serves to retain the syno...

Muscles Of The Elbow: The elbow-joint is interposed between the long bones of the forearm below and the long humerus above. The arm muscles come down and pass over the joint to insert close to it in the bones of the forear...

Muscles Of The Elbow. Continued: The Posterior Or Extensor Muscles These comprise the triceps and anconeus muscles (Fig. 298). The triceps arises by its long head from the lower part of the rim of the glenoid cavity and adjoini...

The Veins Of The Elbow: The flexure of the elbow is occupied by a number of veins which are of importance from the fact that they are frequently used for purposes of saline infusion, sometimes for blood-letting, and not infr...

Brachial Artery: At the bend of the elbow the artery lies to the inner side of the biceps tendon. It is beneath the bicipital or semilunar fascia. The upper edge of this fascia can be felt opposite the crease. In the ...

Dislocations Of The Elbow: In dislocation of the elbow the bones of the forearm are most commonly displaced backward. More rarely they may be partially displaced either inwardly or outwardly and with or without an accompanying ...

Dislocations Of The Elbow. Part 2: Treatment The lower end of the humerus rests in front of the coronoid process (rarely fractured). When the forearm is flexed the triceps becomes tense and holds the bones locked in their displaced ...

Dislocations Of The Elbow. Part 3: Dislocation Of The Head Of The Radius The ulna alone is rarely luxated (when displaced it would practically be a backward and inward luxation of the elbow) but the head of the radius is not infrequ...

Fractures In The Region Of The Elbow: The elbow is frequently the seat of fractures, especially in children. Their diagnosis and treatment are both difficult and the result sometimes unsatisfactory. The bony processes are less distinct...

Fractures In The Region Of The Elbow. Part 2: Fractures Involving The Condyles The condyles (page 280) have been described as the lateral bony projections of the lower end of the humerus which are extra-articular. Therefore the trochlea and ca...

Fractures In The Region Of The Elbow. Part 3: Intra-Articular Fracture Of The Medial Condyle The line of fracture passes obliquely through the condyle, entering just above its tip and emerging on the articular surface of the trochlea either in...

Fractures In The Region Of The Elbow. Part 4: Fracture Of The Olecranon Process The olecranon process may be fractured either close to its extremity near the insertion of the triceps tendon, through approximately the middle of the greater sigm...

Fractures In The Region Of The Elbow. Part 5: Fractures Of The Head And Neck Of The Radius The head and neck of the radius are rarely fractured. When broken, the line of fracture through the head is usually longitudinal and a portion of the he...

Fractures In The Region Of The Elbow. Part 6: Radius The upper articular surface of the radius has a centre of ossification which appears from the fifth to the seventh year, and unites at the eighteenth to twentieth year. There is also a centr...

Disease Of The Olecranon Bursa: Between the skin covering the olecranon process and the bone is a bursa, which, from its exposed position, is not infrequently diseased. It lies in the subcutaneous tissue and resembles in all respect...

Disease Of The Elbow-Joint: The elbow-joint, like others, is affected with rheumatoid and tuberculous disease. The former frequently causes ankylosis, while the latter frequently causes suppuration. The joint becomes distended a...

Resection Of The Elbow: A straight incision is made over the point of the olecranon a little internal to its middle. The upper portion of this incision splits the triceps. Its lower part is carried down to the bone on the po...

Amputation At The Elbow-Joint: Amputation at this joint is peculiar from the fact of the width of the lower end of the humerus. The skin is loose and shows a marked tendency to retract, especially on the anterior surface. This, com...

The Forearm: The forearm is intimately associated with the functions of the hand. It serves as a sort of pedestal or support, enabling the hand to be carried away from the body, and, by possessing certain movement...

Bones Of The Forearm: The forearm contains two bones, instead of one as in the arm. One of these bones, the ulna, is directly continuous with the humerus; the other, the radius, is continuous with the hand. In other words,...

Movements Of Pronation And Supination: The radius revolves on the ulna about an axis which passes through the centre of the head of the radius above and the styloid process of the ulna below, which line if prolonged would pass through the ...

Muscles Of The Forearm: The movements of the hand and fingers are so intricate and complex as to necessitate a large number of muscles for their performance. It is probably easiest in order to understand the construction of ...

1. The Flexors And Extensors Of The Fingers: The fingers are moved by two sets of muscles, a long set arising from the forearm and a short set which is confined to the hand. At present we are concerned only with the long extensors and flexors wh...

2. The Flexors And Extensors Of The Wrist: The muscles which flex and extend the fingers of course also move the hand as a whole, but in addition to these muscles there are five others, - two flexor muscles and three extensor muscles, - which ...

3. Pronators And Supinators Of The Hand: The movements of pronation and supination have already been described (page 304). They are performed by five muscles, two pronators and three supinators. The pronators are the pronator radii teres and...

Surface Anatomy Of The Forearm: The forearm has the shape of a somewhat flattened cone, being large above and small below. This is because the bellies of the muscles lie above and their tendons below. Most of the muscles of the fore...

Surface Anatomy Of The Forearm. Continued: Posterior Surface The posterior surface differs from the anterior in the bones being more conspicuous - they are subcutaneous. Of the two the ulna is the more evident. At the elbow the olecranon an...

Arteries Of The Forearm: A knowledge of the arteries of the forearm is necessary on account of the troublesome hemorrhage which they cause when wounded. At the bend of the elbow, a finger's breadth below the crease and opp...

Arteries Of The Forearm. Continued: Ligation Of The Ulnar Artery In The Forearm The ulnar artery between the elbow and wrist is so large that when wounded it may require ligation in any part of its course. On account of the artery be...

Nerves Of The Forearm: Injuries of the large nerves of the forearm are followed by much disability. When these nerves are divided in wounds it is desirable to unite the ends immediately. The reunion of nerve-trunks which ha...

Nerves Of The Forearm. Part 2: Wounds Of The Median Nerve The median nerve may be wounded in any part of its course in the forearm, but it is superficial only in its lower portion for about 5 cm. above the wrist. From this point...

Nerves Of The Forearm. Part 3: The Ulnar Nerve The ulnar nerve passes downward in the groove on the back of the medial (internal) condyle and between the condyle and olecranon process. It passes between the two heads of the flex...

Fractures Of The Forearm: Fractures of the forearm may involve either the radius or ulna, or both. The radius is the bone most often broken. The preservation of the interosseous space and functions of pronation and supination ...

Fractures Of The Forearm. Part 2: Fractures Of The Shaft Of The Radius Fractures of the shaft of the radius are not common. They are produced by both direct and indirect injury. The hand is attached to and articulates mainly with t...

Fractures Of The Forearm. Part 3: Fractures Of The Shaft Of The Ulna The shaft of the ulna is more often broken by direct violence than is the shaft of the radius. When the arm is raised to ward off a threatened blow the thumb is t...

Fractures Of The Forearm. Part 4: Displacement Posterior When the displacement is posterior the lower end of the upper fragment is tilted backward by the contraction of the triceps muscle. This causes a marked projection on the bac...

Amputation Of The Forearm: The lower half of the forearm is so largely tendinous that musculocutaneous flaps are unsuitable; by the time the tendons are cut short there is little tissue left but skin, superficial and deep fasci...

Operations On The Bones And Other Structures Of The Forearm: The forearm may require to be operated on for disease or injuries of the bones, tumors, foreign bodies, wounds, etc. In operating on this region of the body it is to be constantly borne in mind that i...

Pus Beneath The Deep Fascia: The deep fascia of the forearm is continuous with that of the arm. It forms a complete covering for the muscles and sends septa between them. It is especially strong posteriorly. It is attached to the...

Region Of The Wrist: By the wrist is meant the constricted portion of the upper extremity by which the hand is joined to the forearm. We will include in its consideration the lower portion of the forearm for about 4 cm. (...

Bones Of The Wrist: We may include among the bones of the wrist the lower ends of the radius and ulna and the first row of bones of the carpus, - the scaphoid, lunate (semilunar), cuneiform, and pisiform. Of the bones...

The Inferior Radio-Ulnar Articulation: The joint between the lower ends of the radius and ulna embraces not only the portion between these two bones but also that between the lower end of the ulna and the upper surface of the triangular fi...

The Radiocarpal Or Wrist-Joint: The wrist-joint is formed by the radius and triangular cartilage above and the navicular (scaphoid), lunate (semilunar), and cuneiform bones below. These are joined by the anterior, posterior, interna...

The Radiocarpal Or Wrist-Joint. Part 2: Muscles The flexor tendons cover the wrist anteriorly and the extensors posteriorly. With the flexor group we may consider the pronator quadratus. A third or radial group comprises the extensor car...

The Radiocarpal Or Wrist-Joint. Part 3: Posterior Annular Ligament As the tendons pass down over the posterior surface of the radius and ulna they are bound down by processes of the deep fascia which form canals in which they run. The de...

Surface Anatomy Of The Wrist: The bellies of many of the muscles, mainly the superficial ones, cease as they become tendinous about the middle of the forearm. Hence the rapid decrease in size as one descends. When the wrist is rea...

Surface Anatomy Of The Wrist. Continued: Compound Ganglion Large effusions into the sheath of the flexor tendons of the wrist, usually purulent or tuberculous in character, sometimes cause two swellings, one in the palm of the hand and th...

Fractures Of The Lower End Of The Radius And Ulna: The lower end of the ulna is rarely fractured, but that of the radius vies with fracture of the clavicle in being the most frequent of all fractures. Fig. 353. - Colles's fracture of the lowe...

Fracture Of The Lower End Of The Radius With Displacement Forward: This fracture, though rare, occasionally occurs, and if union has taken place the deformity is marked and the injury is liable to be diagnosed as a luxation. It has been particularly described by Dr. ...

Fracture Of The Lower End Of The Ulna: Previous to the use of the X-rays for diagnostic purposes, fracture of the lower end of the ulna was considered extremely rare. Fractures of the ulna above the head resemble practically those of the s...

Dislocations At The Wrist: The dislocations at the wrist may be due to traumatism or may occur spontaneously. There may be either a displacement of the carpus at the radiocarpal joint or of the ulna at the inferior radio-ulnar ...

Excision Of The Wrist: Formal excisions of the wrist are undertaken for tuberculous disease. It is desirable that all the affected tissues be removed. To do this is difficult, on account of the number and extent of the vari...

Amputation Through The Wrist-Joint: When it is possible to do so the interarticular fibrocartilage over the lower end of the ulna is not to be interfered with. The lower radio-ulnar joint is therefore not injured and the movements of pr...

The Hand: As has already been stated, the hand is the essential part of the upper extremity, and mobility is its main characteristic. It terminates in five digits which possess a bony support or framework. In o...

Bones Of The Hand: The carpus contains 8 bones, the metacarpus 5, the phalanges 14; 27 bones in all. The Carpal Bones The carpal bones are in two rows. The upper row is convex above and the lower row is convex...

Bones Of The Hand. Continued: The Phalanges The thumb has two phalanges and the fingers each three. These are called the proximal, middle, and distal phalanges, also the first, second, and third phalanges. The thumb has only a ...

Joints Of The Hand: The carpal bones besides being connected by short ligaments running from one to another on their dorsal and palmar surface also have their adjacent surfaces connected by interosseous ligaments. The th...

Muscles Of The Hand: The hand contains not only the tendons of the long muscles which descend into it from the forearm, but also some short muscles. They may be divided into three sets, viz: a middle set, embracing the in...

Surface Anatomy Of The Hand: The hand is twice as long as it is broad. The length of the middle finger from the metacarpophalangeal joint to its extremity is equal to the distance from the metacarpophalangeal joint to the radioca...

Surface Anatomy Of The Hand. Continued: Branches As soon as the ulnar artery passes the pisiform bone it gives off its deep branch which passes down between the abductor and flexor brevis minimi digiti to join the termination of the radi...

Nerves Of The Hand: The hand is supplied by the median, ulnar, and radial (musculospiral) nerves. They are of clinical importance on account of the paralysis of the muscles or disturbance of sensation which accompany the...

Dislocations Of The Hand: The carpal bones are so firmly held in place by their ligaments that they are rarely luxated. Dislocations of the scaphoid and semilunar however are sometimes encountered. Dislocations Of The B...

Fractures Of The Hand: Fractures of the carpal bones are often only suspected or detected by-means of a skiagraph. They are quite rare and are almost impossible to distinguish clinically from ordinary sprains. Fractures ...

Wounds Of The Hand: Wounds of the hand, owing to the free blood supply, heal rapidly. An exception, however, is to be made in the case of the tendons. These frequently slough. If the tendons are divided they are to be im...

Abscesses Of The Hand And Fingers: Purulent collections in the palm of the hand are located either beneath the palmar fascia or are connected with the sheaths of the flexor tendons. When the fingers are affected the pus may be either i...

Abscesses Of The Hand And Fingers. Continued: Suppuration Involving The Fingers When suppuration occurs in the middle or proximal phalanx the pus may occupy the tissue between the skin and tendon and not involve its sheath, hence is not liable...

Lymphatics Of The Hand: The hand and fingers are abundantly supplied with lymphatics which begin in a plexus around the matrix of the nail and the pulp of the fingers and unite to form lymphatic trunks which proceed up the w...

Amputations Of The Thumb And Fingers: In these amputations it is particularly necessary to be able to accurately locate the joints. The distal phalanx when flexed always passes under the proximal one. When the flexor and extensor tendons ...

The Abdomen: The abdomen comprises that part of the body anterior to the spine and erector spinae and quadratus lumborum muscles, and from the diaphragm above to the rim of the pelvis below. The true pelvis is not...

Surface Anatomy Of The Abdomen: The rounded form of the abdomen is influenced by its bony support, by the muscles and fascias attached to these bones, and by the organs within. In the upper portion of the abdomen the tip of the ensi...

Surface Anatomy Of The Abdomen. Continued: Lines, Or Lineae There are certain lines on the abdomen, called linea alba, lineae semilunares, lineae transversae, and sometimes there are present lineae albicantes. Linea Alba The linea...

The Position Of The Abdominal Viscera: Liver Upper Border. - The highest point of the liver is on the right side just to the inner side of the nipple where it rises to the middle of the fourth interspace. To the left it crosses the xiph...

The Position Of The Abdominal Viscera. Continued: Spleen The spleen lies under the ninth, tenth, and eleventh ribs of the left side. Its long axis follows the tenth rib. Its anterior end is at the midaxillary line, while its posterior end reaches ...

The Abdominal Walls: The abdominal walls are composed of the skin, superficial fascia, muscles, trans-versalis fascia, subperitoneal tissue, and peritoneum. Skin The skin of the abdomen is moderately thin and la...

Muscles Of The Abdomen: The muscles of the abdomen are arranged in two distinct groups: a longitudinal group embracing the recti and pyramidales and a transverse group embracing the external and internal oblique and the tran...

Vessels Of The Abdominal Walls: The vessels of the abdominal walls comprise arteries, veins, and lymphatics. The arteries are superficial and deep; of these the deep are the more important. The arterial twigs in the subcutaneous tis...

Vessels Of The Abdominal Walls. Continued: Superficial Abdominal Veins The upper part of the abdomen is drained by small branches emptying into the superior epigastric, the intercostal, and laterally into the axillary veins. Below, there ar...

Abdominal Incisions: These are made through all portions of the abdominal walls according to the organs it is desired to gain access to. They should be so planned as to avoid unnecessarily wounding the muscles, arteries, ...

Herniae: Abdominal herniae occur most often in the umbilical and inguinal regions. Sometimes the recti muscles separate and a median protrusion results; or they may occur at the site of a previous operation. ...

Herniae. Part 2: Inguinal Hernia There are two forms of inguinal hernia, the congenital and the acquired. These are subdivided into several varieties which can only be understood by having a knowledge of the develo...

Herniae. Part 3: Hydrocele Hydrocele is an accumulation of fluid in the tunica vaginalis testis. It is usually an acquired affection of adult life, and then does not appear to be dependent on congenital anomalies. ...

Herniae. Part 4: Coverings Of An Indirect Or Oblique Hernia As the intestine descends to form an oblique inguinal hernia it pushes in front of it the following structures: peritoneum, subperitoneal fat, transversal...

Herniae. Part 5: Coverings Of A Direct Inguinal Hernia The conjoined tendon is prolonged outward from the edge of the rectus muscle two-thirds of the distance to the epigastric artery, and sometimes more. A direct ...

Herniae. Part 6: Femoral Hernia Femoral hernia is always acquired and descends through the femoral canal beneath Poupart' s ligament to make its appearance at the saphenous opening on the thigh. Beneath the inner e...

Herniae. Part 7: Point Of Strangulation As a femoral hernia descends it may be strangulated on the sharp edge of Gimbernat's ligament or at the upper portion of the falciform process (Fig. 404). Division Of ...

The Lumbar Region: This region is at times affected with abscesses or hernial protrusions and through it incisions are made to reach the kidney (Fig. 407). Muscles The quadratus lumborum muscle arises from the...

The Lumbar Region. Part 2: Petit's Triangle (Trigonum Lumbale) Above the middle of the crest of the ilium is a small triangular space formed by the edge of the external oblique in front, of the latissimus dorsi behind, and t...

The Lumbar Region. Part 3: Longitudinal Incision If it is desired to expose the kidney, a straight incision 10 cm. (4 in.) long may be made between the last rib and middle of the crest of the ilium along the outer edge of th...

The Interior Of The Abdomen: The abdominal cavity extends only to the brim of the pelvis; the pelvic cavity is separate. The peritoneal cavity is not synonymous with the abdominal cavity: some of the abdominal organs project comp...

The Interior Of The Abdomen. Continued: Viewing The Body In Transverse Section On examining a transverse section made below the foramen of Winslow, the peritoneum is seen coming from the parietes and passing over the ascending colon, lea...

The Abdominal Viscera: The abdominal contents should first be studied as to their positions and general relations, so that they can be readily found and identified, and then studied as to their intimate relations to the imm...

The Stomach: When the stomach is moderately distended it is a pear-shaped organ lying almost entirely to the left of the median line and occupying the epigastric and left hypochondriac regions. It has an average c...

The Stomach. Continued: Relations The stomach rests on the transverse mesocolon, which covers the pancreas, solar plexus, aorta, thoracic duct, vena cava, and crura of the diaphragm posteriorly; farther to the left are th...

Affections Of The Stomach: In disease the stomach may be contracted or dilated, and is often the seat of ulcer and carcinoma. Contracted stomach occurs either as a normal or pathological condition; it has already been allude...

Operations On The Stomach: The following operations are performed on the stomach: gastrotomy, or the opening of the stomach to remove foreign bodies or to treat ulcers; gastrostomy, or the making of a gastric fistula to introdu...

The Small Intestine: The small intestine begins at the pylorus and ends at the ileocaeal valve. It has an average length of 6.75 metres (22 ft. 6 in.) in the adult, independent of the age, weight, and height of the indivi...

The Duodenum: The duodenum is the thickest, widest, and most fixed portion of the small intestine. Its diameter is from 3.75 cm. to 5 cm. (1 1/2 to 2 in.) and its muscular and mucous coats are thicker than those of...

Jejunum And Ileum: The jejunum is about 8 1/2 ft. long and the ileum about 12 1/2 ft. They are bound to the spinal column by the mesentery, which extends from the left side of the body of the second lumbar vertebra to t...

Operations: The small intestines are frequently resected and anastomosed with themselves or other portions of the gastro-intestinal canal. Gastro-enterostomy has been alluded to on page 406. On opening the abd...

The Mesentery: The mesentery extends from the left side of the body of the second lumbar vertebra to the right sacro-iliac joint. It is from 15 to 20 cm. (6 to 8 in.) long at its root and spreads out like a fan, to ...

The Large Intestine: The large intestine comprises (1) the caecum and appendix, (2) ascending colon, (3) transverse colon, (4) descending colon, (5) sigmoid flexure, composed of the iliac colon and pelvic colon, and (6) t...

CaeCum And Appendix: The caecum is the blind pouch of the large intestine which extends beyond the opening of the ileum. It is about 7.5 cm. (3 in.) broad and 6.25 cm. (2 1/2 in.) long. Its three longitudinal bands conver...

CaeCum And Appendix. Part 2: Position Of The Appendix The position and direction of the appendix have been variously described and much discussed. This has arisen from the fact that it is so curled, curved, and twisted on itse...

CaeCum And Appendix. Part 3: Appendicitis Diagnosis. - The most fixed part of the appendix is its root. This corresponds to a point on the linea semilunaris opposite to the anterior superior spine of the ilium. The painful tip...

The Colon: The ascending colon lies in contact with the anterior abdominal wall from its lower end to above the iliac crest; here it dips down to lie on the kidney and form the hepatic flexure above (Fig. 427). ...

The Liver: The liver is wedge-shaped and has three surfaces. These are superior, inferior, and posterior. The posterior forms the base of the wedge and its anterior edge is the apex. The liver is divided into fi...

The Liver. Part 2: Relations Of The Liver The superior surface lies in contact with the diaphragm, except the portion extending about 7.5 cm. (3 in.) below the xiphosternal junction in the median line and sometimes t...

The Liver. Part 3: Portal Obstruction The veins of the portal system have no valves. The portal vein is formed by the union of the splenic and superior mesenteric veins and the gastric, pyloric, and cystic veins. The...

Gall-Bladder And Biliary Passages: The gall-bladder lies in the fissure of the gall-bladder, with its fundus just about level with the edge of the liver and its body pointing inward, upward, and backward; its neck, which is S-shaped, i...

Gall-Bladder And Biliary Passages. Continued: Gail-Stones These and carcinoma are the main affections of the biliary passages. The latter is almost always secondary to pyloric cancer and involves the lymphatic nodes; metastatic deposits may al...

The Pancreas: The pancreas is composed of two portions joined at right angles to each other. Together they measure about 20 cm. (8 in.). It is divided into a head, neck, body, and tail. The neck is about 2 cm. (3/4...

The Spleen: The spleen lies high up in the left posterior corner of the abdomen in contact with the diaphragm. It follows the direction of the tenth rib, being covered by the ninth, tenth, and eleventh ribs and e...

The Kidneys: The kidneys when normal are about 12 cm. (4 1/2 in.) long, 6 cm. (2 1/2 in.) broad and 3 cm. (1 1/4 in.) thick. The right is the thicker and the left a little the longer. They lie in the lumbar reg...

The Kidneys. Part 2: Renal Vessels The renal arteries come off opposite the first lumbar vertebra. The right one, a little the longer and higher, passes out beneath the vena cava, head of the pancreas, and second porti...

The Kidneys. Part 3: Displacement Of The Kidneys The kidney is held in place by the attachment to the diaphragm of the perirenal fascia, by its vessels, peritoneum, ureter, and by intra-abdominal pressure. Normally it ...

Operations On The Kidney: Access to the kidney is demanded for fixing it in place when movable, for the removal of calculus, for the treatment of cystic conditions, abscesses, growths, and even for the entire removal of the or...

Operations On The Kidney. Part 2: Pleura The pleura reaches the lower border of the posterior portion of the twelfth rib; it crosses the rib posterior to its middle, if the rib is of normal length, to pass to the eleventh rib. Ther...

Operations On The Kidney. Part 3: Operations The abdominal portion of the ureter can be reached for operative purposes by prolonging the oblique incision used in kidney procedures downward. It should pass about 2.5 cm. (1 in. ) in ...

The Pelvis: The pelvis is composed of the two innominate bones, the sacrum, and the coccyx. It is constructed with a view to connecting the lower extremities with the trunk, to support the weight of the trunk and...

The Pelvis. Part 2: Pelvic Walls On looking laterally at the inside of the pelvis, the iliopecti-neal line is seen separating the abdominal from the pelvic portion. On the iliac or abdominal portion lie the iliacus an...

The Pelvis. Part 3: Prolapse The rectum and vagina as they pierce the pelvic floor may prolapse or protrude through the anus or vulva. Prolapse of the rectum is a common affection and if marked may drag down the perit...

The Pelvis. Part 4: Ligation Of The Iliac Arteries The iliac arteries can be reached for ligation through an incision 2 cm. above and parallel to Poupart's ligament, reaching from the inner side of the external iliac ...

The Pelvic Viscera. Rectum And Anal Canal: The rectum extends from the level of the third sacral vertebra to where it pierces the levator ani muscle, 3.7 cm. (1 1/2 in.) in front of the tip of the coccyx, but at a lower level, and opposite the...

The Pelvic Viscera. Rectum And Anal Canal. Continued: Peritoneal Relations The posterior portion of the rectum has no peritoneal covering, the mesosigmoid ceasing opposite the third sacral vertebra, about 12.50 cm. (5 in.) from the anus. From this poi...

Blood-Vessels: Arteries The rectum and anal canal are supplied by the superior, middle, and inferior hemorrhoidal, and middle sacral arteries (Fig. 446). The superior hemorrhoidal artery is the terminal branch...

Affections Of The Rectum And Anus: Examination If the buttocks are drawn aside the mucous membrane of the anus is everted and a considerable portion of the anal canal becomes visible. The lower part of the columns and crypts of Morg...

Affections Of The Rectum And Anus. Continued: Fistula Fistula in ano may start as an ischiorectal abscess which perforates internally into the rectum or anal canal and externally through the skin. It may also start as an ulcer of the mucous me...

The Bladder: When fully distended the normal bladder contains approximately 500 c. c., or a pint. Its capacity varies much, and it is capable of great distention without rupture. In cases of retention of urine it ...

The Bladder. Part 2: Peritoneum In children the bladder is practically an abdominal organ; when it is empty the peritoneum sinks about to the level of the top of the symphysis, but when distended it rises from 2.5 to 6...

The Bladder. Part 3: Base Of The Bladder On the interior of the base of the bladder the ureters open about 2.5 cm. (1 in.) posterior to the urethral orifice, and the same distance (or more if the bladder is distended) ...

The Bladder. Part 4: The Bladder In The Female In the female the vesico-uterine pouch reaches the level of the internal os and the bladder is in contact with the cervix from there down to the cervicovaginal junction or...

The Prostate: The normal prostate gland is of the shape of a large chestnut. It is 3 to 4 cm. (1 1/4 to 1 1/2 in.) wide, 2.5 to 3 cm. (1 to 1 1/4 in.) long, and 3 cm. (1 1/4 in.) thick. An indistinct furrow on its ...

The Prostate. Part 2: Relations The apex rests on the posterior layer of the triangular ligament I to 2 cm. (1/2 to 3/4 in.) behind and a little below the subpubic angle and just inside the upper end of the anal canal. ...

The Prostate. Part 3: Prostatectomy This consists in removing the hypertrophied glandular elements. It is performed either suprapubically or through the perineum. When done through a suprapubic incision a median enla...

The Seminal Vesicles: The seminal vesicles are about 5 cm. (2 in.) long and lie on the bladder above the prostate. They diverge on each side toward the ureters, which they overlap and which intervene between the vesicles a...

The Vas Deferens: When the vas deferens leaves the internal abdominal ring it winds around the outer side of the deep epigastric artery and dips down over the brim of the pelvis 4 or 5 cm. (11/2 to 2 in.) posterior to ...

Development Of The Urogenital System: In the early stages of development of the human embryo there arises from the parietal mesothelium on each side a tube known as the Wolffian duct with a collection of tubules known as the Wolffian body...

The Female Generative Organs. The Uterus: The female pelvic organs are so often the subject of operative procedures that an exact knowledge of the relations of the uterus, vagina, ovaries, Fallopian tubes, round and broad ligaments, and urete...

The Ovary: The ovary is about 4 cm. (1 1/2 in.) long, 2 cm. (4/5 in.) wide, and 1 cm. (2/5 in.) thick. It is connected with the posterior surface of the broad ligament by a very short mesentery, the mesovarium. ...

The Vagina: The vagina is about 7.5 cm. (3 in.) long; its posterior wall is longer than the anterior, being 8.75 cm. (3 1/2 in.) long. It will thus be seen that if the uterus is slightly-depressed, as it often is...

The Vagina. Part 2: Blood-Vessels The main blood-vessels of the pelvic genital organs are the uterine and ovarian arteries, described by some authors as the single utero-ovarian artery. The uterine artery comes fro...

The Vagina. Part 3: Pelvic Examinations In making a digital examination the introduced finger recognizes that in the nullipara the vagina is narrow, admitting only one finger, and rugous on its anterior and posterior ...

Operations On The Female Pelvic Organs: The Most Usual Operations Are The Removal Of The Uterus hysterectomy, - removal of the ovary, - oophorectomy, - removal of the Fallopian tubes, - salpingectomy. The ovaries are often removed with t...

Operations On The Female Pelvic Organs. Part 2: Hysterectomy (Abdominal) The uterus is to be drawn to one side and the posterior portion of the broad ligament is grasped out toward the pelvic wall. As the ovarian artery and veins run along the t...

Operations On The Female Pelvic Organs. Part 3: Tumors Of The Broad Ligament (Intraligamentary Tumors) Certain tumors originating either from the structures of the broad ligament or ovary, or side of the uterus, grow between the layers of the br...

The Female External Genitals: The labia majora meet anteriorly in the anterior commissure and posteriorly in the posterior commissure. The space between the posterior commissure and the anus, about 3 cm. (1 1/4 in.) is the peri...

The Female Perineum: The perineum in the female is much like that of the male. It has a central point at which converge the external sphincter ani from behind, the superficial transverse perinei muscles from each side and...

The Male External Genitals: Penis The penis is composed of the two corpora cavernosa attached posteriorly to the rami of the ischia and pubes and terminating in blunt ends anteriorly, and the corpus spongiosum, commencing at ...

The Male External Genitals. Part 2: Amputation Of The Penis The penis is frequently amputated for carcinoma, which disease is favored in the aged by the irritation resulting from a long-existing phimosis. In operating two things are ...

The Male External Genitals. Part 3: Testicles The testicles begin to develop early in fetal life - about the third month - below and in front of the kidneys, opposite the second lumbar vertebra. Descent Of The Testes The te...

The Male External Genitals. Part 4: Epididymis The vas deferens descends to the lower end of the testicle and becoming much convoluted forms the globus minor or tail, thence ascends, forming the body, and finally at the top, receivin...

The Male External Genitals. Part 5: Application The cord is involved in operations for varicocele, hernia, and castration. In varicocele after the skin incision is made a second incision is required to open the sheath of the cord. Th...

The Urethra: The male urethra is variable in length, as it can be stretched, therefore only average measurements can be given. Its length is 20 cm. (8 in.) in the adult, 8 to 10 cm. at 5 years, and 10 to 12 cm. at...

The Urethra. Continued: Urethral Muscles There are two sets of muscles in connection with the urethra; one set might be said to aid in expelling the urine and the other in retaining it. The expulsors are the longitudinal ...

The Male Perineum: The name perineum in its broad sense is applied to the structures of the outlet of the pelvis, superficial to the levator ani muscle. In its restricted anatomical sense it is applied to the subpubic t...

The Male Perineum. Part 2: Perineal Spaces There are two perineal spaces, one superficial space between the triangular ligament (superficial layer) and the deep layer of the superficial fascia (Colles's fascia), and the othe...

The Male Perineum. Part 3: Practical Application The perineum is involved in extravasations of blood and urine in cases of rupture of the urethra; also in operations on the deep urethra and bladder for the retention of urine...

The Male Perineum. Part 4: Lateral Lithotomy The incision is begun to the left of the median line 3 cm. (11/4 in.) in front of the anus and carried outward and back midway between the anus and tuberosity of the ischium. The ...

The Back And Spine. Surface Anatomy: On examining the back of a person standing upright a median furrow is seen (Fig. 477). In the bottom of this the tips of the spinous processes can be felt. If the back is bent these processes can be d...

The Vertebral Column: Normally the spinal column is composed of seven cervical, twelve dorsal, five lumbar, five sacral, and four to five coccygeal vertebrae. The sacral vertebrae tend to fuse together, forming a single bo...

Deformities Of The Spinal Column: The weight of the head is borne on the condyles of the occiput, and a perpendicular let fall from the condyles passes through the points where the spinal curves pass one into the other and thence thro...

Deformities Of The Spinal Column. Continued: Scoliosis A normal spine is either absolutely straight or very slightly convex to the right in the dorsal region, probably due to the increased use of the right hand. While scoliosis is called late...

Affections Of The Spinal Column: Caries Of The Spine While caries of any part of the vertebrae may occur from injury, it is almost always the result of tuberculous disease in the bodies; the pedicles, laminae, and processes remain...

Injuries Of The Spinal Column: The vertebras may be dislocated and fractured. Dislocation is rarer than fracture; it is most common in the cervical region. The cervical vertebras have their articular facets sloping downward and ...

Spinal Cord And Its Membranes: The spinal cord in the male is 45 cm. (18 in.) long. In the foetus of three months the cord extends to the end of the spinal canal; at birth it has risen to the third lumbar vertebra, and in the adult...

Transverse Spinal Lesions: In endeavoring to localize transverse lesions of the cord, such as result from traumatism, tumors, etc., one must bear in mind that the spinal nerves originate from segments in the cord some distance ...

Spinal Meninges: The cord is covered by a continuation downward of the cerebral meninges. It has a dura mater, arachnoid, and pia mater. Dura Mater The outer or endosteal layer of the cerebral dura mater end...

Spinal Meninges. Continued: Spinal Vessels Three arteries supply the spinal cord, an anterior spinal in the median line of the anterior surface and two posterior spinal just behind the posterior spinal roots (Fig. 489). The v...

Functions Of The Cord And Spinal Localization: The direct or anterior pyramidal tract is motor; the impulse coming from the cerebral cortex passes down the spinal cord on the same side and thence to the anterior horn of the opposite side to supply...

Lesions Of The Cord: The lesions affecting principally the gray matter of the cord are anterior poliomyelitis, syringomyelia, progressive muscular atrophy, and arthritic muscular atrophy. Anterior Poliomyelitis ...

Operations On The Spine: Spinal Puncture Spinal puncture may be performed either for diagnostic purposes, for relief of accumulations of subarachnoid fluid, or for the purpose of producing spinal anaesthesia. The lumbar...

The Lower Extremity: General Considerations The lower extremity is designed to bear the weight of the body and serve as a means of locomotion. It is composed of a pelvic girdle, thigh, leg, and foot. The pelvic g...

The Bony Pelvis: The pelvis is composed of the pelvic girdle on each side (innominate bones), and the sacrum and coccyx posteriorly. It serves two purposes. It supports and protects the abdominal and pelvic viscera, a...

Mechanism Of The Pelvis: As was pointed out by Henry Morris (The Anatomy of the Joints of Man, p. 115), the bony pelvis is composed of arches. The two main arches are the femorosacral and the ischiosacral. These are strengt...

Fractures Of The Pelvis: The flaring wings or alae of the ilium are not infrequently fractured by direct violence. The line of fracture is usually transverse (Fig. 493). The displacement is slight on account of the muscular a...

The Attachment Of The Lower Extremities To The Trunk: The human body usually occupies one of three positions: standing, sitting, or lying. The functions of the lower extremity are to afford support to the body and accomplish locomotion, therefore any dis...

The Attachment Of The Lower Extremities To The Trunk. Continued: Lateral Equilibrium In the upright position the centre of gravity falls midway between the ankles of the two feet. The fact of there being two points of support adds to the stability, which increas...

Deviations Of The Spine Above The Sacrum: When, as in lateral curvature or scoliosis, there is a pathological curve developed, the centre of gravity is shifted from the midline to one side and it falls nearer the foot of the side toward which...

Distortions Accompanying Affections Of The Lower Extremities: The hip-joint is capable of flexion, extension, adduction, abduction, and rotation. From the hip to the foot is a straight line; it can be shortened by disease or injury of the bones of the thigh or l...

Measurement Of The Lower Limbs: The ability to determine accurately the length of the lower extremities is essential to diagnosis and important in treatment. It is a difficult thing to do and requires knowledge, care, and practice. ...

Walking: As locomotion is one of the main functions of the lower extremity, derangements of this function are to be explained by a knowledge of the normal action of its mechanism. The means by which support is...

Region Of The Hip: The hip is that portion of the body joining the lower extremity to the trunk. It differs in construction from the shoulder, because it is designed for strength as well as mobility; hence it is that th...

Muscles Of The Hip: The muscles of the hip are numerous and their action is often intricate: many muscles are usually used to produce a single movement. Some muscles not only cross the hip-joint but another joint as well...

Muscles Of The Hip. Continued: Ligation Of The Gluteal, Sciatic, And Internal Pudic Arteries To ligate the gluteal artery incise the skin and part the fibres of the gluteus maximus in the upper two-thirds of a line joining the p...

The Hip-Joint: The hip-joint, like the shoulder, is a ball-and-socket joint, and, like it, moves in all directions. The main function of the shoulder is mobility, but the functions of the hip are mobility and suppor...

The Hip-Joint. Continued: Iliofemoral Ligament (Bertins' Ligament Or Y Ligament Of Bigelow) This is the strongest ligament in the body. The single stem of the Y ligament is attached to the upper edge of the rim of the aceta...

Dislocations Of The Hip: Classification Dislocations of the hip are either anterior or posterior (Allis)1. If the innominate bone is held horizontally it will be seen that the Roser-Nelaton line from the tuberosity to the ...

Dislocations Of The Hip. Part 2: Luxation By Adduction If the thigh is flexed and adducted the angle of the neck and shaft prevents any bony fulcrum from forming. If now the shaft is strongly rotated inward the iliofemoral or Y li...

Dislocations Of The Hip. Part 3: Injuries To The Nerves Rarely the anterior crural nerve may be injured by being stretched over the head of the femur. The sciatic nerve has been injured, and Allis has shown how, when a dorsal is r...

Dislocations Of The Hip. Part 4: Direct Method For Anterior Luxations In pubic luxations first slightly abduct the thigh and rotate the shaft of the femur inward so as to transform the pubic to a thyroid luxation. For thyroid luxa...

Dislocations Of The Hip. Part 5: Reversed Luxations In certain few cases, either from the peculiar character and direction of the primary injury or from an ordinary anterior or posterior luxation becoming subsequently more widely ...

Dislocations Of The Hip. Part 6: Congenital Luxations Of The Hip In congenital luxations the acetabulum may be shallow, the head deformed, and the neck somewhat twisted on its shaft. These luxations are usually posterior. S...

Dislocations Of The Hip. Part 7: Attihide Owing to the pain in the affected limb the weight of the body is borne mainly on the healthy limb. Viewing the patient anteriorly 'in an early case of the disease the external rotation is ...

Dislocations Of The Hip. Part 8: Hip-Abscess Tuberculosis of the hip probably begins in the neighborhood of the epiphyseal line of the femur and involves the joint secondarily. The epiphysis of the head begins above near the edge ...

Operations On The Hip-Joint: The operations on the hip are usually done either for hip-disease or congenital luxations. More rarely traumatic or pathological luxations or intracapsular fractures may be operated on. The joint may ...

The Thigh Structure: The thigh is composed of the femur imbedded in three main sets of muscles, and is supplied and traversed by the femoral vessels and sciatic and anterior crural nerves. The femur serves as a support...

Muscles Of The Thigh: There are three main sets of thigh muscles, viz.: extensors, flexors, and adductors. We will limit our consideration to the long muscles. Extensor Muscles The extensor muscles consist of the...

Muscles Of The Thigh. Part 2: Scarpa's Triangle This occupies approximately the upper third of the thigh. Its base is formed by Poupart's ligament, its outer side by the sartorius muscle, and its inner side by the adductor long...

Muscles Of The Thigh. Part 3: Hunter's Canal Hunter's canal occupies approximately the middle third of the thigh. It has an outer wall formed by the vastus internus muscle; a floor formed above by the adductor longus, and below...

Muscles Of The Thigh. Part 4: Lymphatics Of The Groin The lymphatic nodes of the groin are frequently the seat of infection necessitating operative measures. They are superficial and deep. For clinical purposes there is no bett...

Fractures Of The Femur: The femur is usually fractured through the neck, greater trochanter, upper third of the shaft, middle of the shaft, or just above the condyles. Fractures Of The Neck Of The Femur These are o...

Fractures Of The Femur. Continued: Impaction Impaction of the other fragment by the neck of the bone is not rare, and firm union may occur. If the fracture is close to the head, the neck is impacted into and penetrates the head, but...

Amputation: Amputation At The Hip-Joint In amputating at the hip-joint, hemorrhage is especially to be guarded against. This comes from two sources, the femoral artery anteriorly and the branches of the intern...

Region Of The Knee. Surface Anatomy: The bony landmarks are the patella, the two condyles of the femur, the tibia, and the fibula (Fig. 543). The patella is pointed below where the tendo patellae is attached, is slightly convex on its...

The Knee-Joint: As the functions of the lower extremity are support and mobility, it is evident that in order to obtain mobility without unduly weakening the limb the ligamentous connection of the bones must be excep...

The Knee-Joint. Part 2: Ligaments Of The Knee-Joint To provide for the support required to be given by the lower extremity, the ligaments and tendons binding the bones of the knee together are both numerous and strong. Th...

The Knee-Joint. Part 3: Internal Lateral Ligament A band of the capsule to which the name internal lateral ligament has been applied runs from beneath the adductor tubercle to the tibia below the internal tuberosity; it i...

The Knee-Joint. Part 4: Semilunar Cartilages, Coronary And Transverse Ligaments The semilunar cartilages are used to deepen the joint in the same manner as the cotyloid of the hip and glenoid of the shoulder. It is their ...

The Knee-Joint. Part 5: Posteriorly On the outer side of the joint there may be present (1) a bursa beneath the external head of the gastrocnemius which may communicate with the bursa between the popliteus tendon and exte...

The Knee-Joint. Part 6: Treatment The method of treatment to be employed varies according to the character of the injury. When the fracture is from indirect force, means must be employed not only to hold the fragments tog...

The Knee-Joint. Part 7: Dislocation Of The Knee The knee is rarely luxated and then only by such extreme trauma as sometimes to rupture the popliteal vessels and require amputation. It is frequently compound. The tibia ma...

The Knee-Joint. Part 8: Resection Of The Knee In making the skin incision care should be taken to carry it back sufficiently far to allow of division of the lateral ligaments; in so doing, however, one should not divide t...

The Knee-Joint. Part 9: Knock-Knee And Bow-Legs These conditions most frequently result from rachitis or paralysis. Bowing inward of the knee is called knock-knee or genu valgum. Bowing outward is called bow-legs or in so...

The Knee-Joint. Part 10: Amputation Through The Knee-Joint Disarticulation at the knee-joint is usually done either with a long anterior and short posterior or two lateral flaps. This amputation differs from others in the ...

The Leg: The leg having to support the weight of the body has its bones strongly made. The tibia bears nearly all the weight because it articulates with the femur above and astragalus below and transmits the p...

Muscles Of The Leg: The muscles of the leg are composed of four distinct groups of three each. They are extensors, flexors, abductors, and muscles of the calf. The extensor group comprises the tibialis anterior, exten...

Fascia Of The Leg: The deep fascia of the leg is attached above to the tubercle of the tibia, the tuberosities of the tibia, and the head of the fibula. It gives off two septa from its under surface, one in front separa...

Arteries Of The Leg: The leg has three main arteries, the anterior tibial, posterior tibial, and peroneal. The popliteal artery divides into the anterior and posterior tibial at the lower border of the popliteus muscle ju...

Veins Of The Leg: The deep veins of the lower extremity accompany the arteries. The femoral and popliteal veins are single, but the arteries below have venae comites. These deep veins all have valves and there are freq...

Fractures Of The Leg: Fractures of the bones of the leg are most often due to direct violence, but sometimes to indirect. The tibia is rarely broken alone, but either it or the fibula may be fractured by a direct blow. On ...

Amputation Of The Leg: Amputation of the leg is best performed at the place of election, a hand's breadth below the knee-joint. This site is preferred because it gives a sufficient length to the stump below the knee and all...

Region Of The Ankle: The ankle-joint is composed of the tibia and fibula above and the astragalus below. Surface Anatomy A knowledge of the contour of the ankle aids considerably in determining the character of ...

The Ankle-Joint: Ligaments And Movements The ankle-joint is a pure hinge-joint and its motion is anteroposterior except in complete extension, when a small amount of lateral movement is possible. The range of movem...

The Ankle-Joint. Continued: Tuberculosis Of The Ankle This most often affects the body of the astragalus. Sometimes the disease is located in the lower end of the tibia. In the former case other of the tarsal bones are also f...

Dislocations Of The Ankle: The foot may be dislocated from the leg in nine different manners. 1. The foot as a whole may be carried outward. This is almost always associated with fracture of the fibula, and sometimes of the ...

Fractures Of The Ankle: Fractures of the ankle are usually the result of a force applied laterally, though sometimes a turning of the foot on the vertical axis of the leg may assist. The force applied causes fracture by inve...

Amputations At The Ankle: When amputation is performed at the ankle it is usually either by the method of Syme or that of Pirogoff. Syme's Amputation A transverse incision should be carried across the sole of the fo...

The Foot: The foot is intended for support and locomotion. The locomotion takes place in the upright position and, in moving, the weight is shifted from one foot to the other. Hence we see that if the foot is t...

Bones Of The Foot: A knowledge of the bony structure of the foot is the key which unlocks its pathology. The bones of the foot are numerous, so as to give it mobility and to lessen shocks. If the bones become ankylosed ...

The Joints And Ligaments Of The Foot: The amount of movement that takes place between the bones of the foot is not as great as would be expected from their number. It is only in the subastragaloid joint that any considerable motion takes ...

The Joints And Ligaments Of The Foot. Continued: The Midtarsal Joint (Chopart's Joint) This is composed anteriorly of the scaphoid and cuboid bones and posteriorly by the astragalus and os calcis. The movements are not extensive and consist of fl...

The Muscles Of The Foot: The foot is acted upon by long muscles which come down from the leg and short muscles which arise in the foot itself. Of these the long muscles are the more important because they influence the positi...

The Action Of The Muscles In Supporting The Tarsal Arch: Tibialis Anterior The tendon of the anterior tibial descends along the anterior edge of the internal malleolus and inserts into the lower inner surface of the internal cuneiform bone and base of th...

The Action Of The Muscles As Flexors And Extensors: The peroneus group of muscles exert so little influence on flexion and extension that in many cases they may be ignored. The peroneus tertius flexes the ankle, while the longus and brevis extend it. T...

The Action Of The Muscles As Abductors And Adductors: Lateral movements of the foot are comparatively weak when compared with those of flexion and extension. They are intended largely to maintain the balance or equilibrium and to adapt the position of th...

Surface Anatomy Of The Foot: For the clinician and operator an exact knowledge of surface anatomy is absolutely essential. It can readily be acquired because the various bony points and tendons are usually evident both to touch a...

Surface Anatomy Of The Foot. Continued: The Tendons It is difficult to identify the position of the tendons, especially if one does not know where to look for them. The tendo calcanetis (Achillis) is usually easily recognized, as it c...

The Arteries Of The Foot: The dorsalis pedis artery runs from the middle of the front of the ankle to the base of the first metatarsal interspace. The extensor longus hallucis tendon is on the medial side and the extensor long...

Amputations Of The Foot: The foot may be amputated through the midtarsal or tarsometatarsal joints. Ordinarily they give unsatisfactory stumps owing to the heel being pulled up by the tendo calcaneus (Achillis), and the shape...

Plantar Abscess: Abscesses of the sole of the foot are usually caused by infected punctured wounds, or by the extension of infection from wounds of the toes, etc. The plantar fascia lies on the flexor brevis digito...

Deformities Of The Foot: The common deformities of the foot are those in which the parts affected are deformed or turned to an abnormal degree in the direction of their normal movements. Thus in talipes varus the foot is turn...

Deformities Of The Foot. Part 2: Talipes Valgus In talipes valgus the foot is abducted or everted. It is sometimes associated with equinus and sometimes with calcaneus. It is more usually an acquired than a congenital deformity. I...

Deformities Of The Foot. Part 3: Talipes Equinus This sometimes exists as a pure form but it often accompanies varus and sometimes valgus. It is caused by a paralysis of the extensor muscles. The tendo calcaneus is contracted and ...

The Toes: The toes are shorter than the fingers and are not so often injured. When injured or diseased healing may be delayed by the constant motion to which they are subjected. For this reason rest should be e...

The Toes. Continued: Metatarsalgia Or Morton's Disease This is a painful affection of one of the metatarsophalangeal joints, usually the fourth. Its pathology is not settled, but treatment is based on the supposition t...

Frozen Sections: Fig. 605. - Median sagittal section. Fig. 606. - Sagittal section through about the middle of the left clavicle. Fig. 607. - Median sagittal section of the head and neck. ...

Frozen Sections. Continued: Pig. 619. - Horizontal transverse section through the body of the fourth lumbar vertebra. Fig. 620. - Oblique section of the upper part of thigh parallel to and just below Poupart's lig...

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Applied Anatomy: The Construction Of The Human Body | by Gwilym G. Davis

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