- •Inguinal hernia, in which the protrusion of the intestine is limited to the region of the groin.
- •Inflammation of the pleura, often as a complication of a disease such as pneumonia, accompanied by accumulation of fluid in the pleural cavity, chills, fever, and painful breathing and coughing.
- •London University College:
- •VI preface.
- •VIII preface.
- •Introductory to the study of anatomy as a science.
- •X table of contents.
- •XII table of contents.
- •10 Commentary on plates 1 & 2.
- •(Page 13)
- •14 Commentary on plates 3 & 4.
- •I. Temporal artery, with its accompanying vein.
- •(Page 17)
- •18 Commentary on plates 5 & 6.
- •I. Occipital artery crossing the internal carotid artery and jugular vein.
- •(Page 21)
- •I. Layer of the cervical fascia, which invests the sterno-mastoid and trapezius muscles.
- •(Page 25 )
- •28 Commentary on plates 9 & 10.
- •I. Left sterno-thyroid muscle, cut.
- •( Page 29)
- •32 Commentary on plates 11 & 12.
- •I. A layer of fascia, encasing the lesser pectoral muscle.
- •I. Thoracic half of the greater pectoral muscle.
- •(Page 33)
- •34 Commentary on plates 13 & 14.
- •36 Commentary on plates 13 & 14.
- •(Page 37)
- •40 Commentary on plates 15 & 16.
- •(Page 41)
- •42 Commentary on plates 17,18, & 19.
- •44 Commentary on plates 17, 18, & 19.
- •I. Tendon of flexor carpi radialis muscle.
- •I. Tendon of second extensor of the thumb.
- •(Page 45 )
- •46 Commentary on plates 20 & 21.
- •(Page 49)
- •52 Commentary on plate 22.
- •Description of plate 22.
- •I I*. Eighth pair of ribs.
- •(Page 53 )
- •54 Commentary on plate 23.
- •56 Commentary on plate 23.
- •Description of plate 23.
- •I I*. Right and left lungs collapsed, and turned outwards, to show the heart's outline.
- •(Page 57 )
- •Description of plate 24.
- •(Page 61 )
- •62 Commentary on plate 25.
- •64 Commentary on plate 25.
- •Description of plate 25.
- •66 Commentary on plate 26.
- •68 Commentary on plate 26.
- •Description of plate 26.
- •(Page 69)
- •70 Commentary on plate 27.
- •72 Commentary on plate 27.
- •Description of plate 27.
- •I. Superficial epigastric vein.
- •(Page 73)
- •74 Commentary on plates 28 & 29.
- •76 Commentary on plates 28 & 29.
- •I. The sartorius muscle covered by a process of the fascia lata.
- •I. The femoral vein.
- •(Page 77)
- •80 Commentary on plates 30 & 31.
- •(Page 81)
- •I. Transversalis muscle.
- •(Page 85)
- •86 Commentary on plates 35,36,37, & 38.
- •88 Commentary on plates 35, 36, 37, & 38.
- •I. The new situation assumed by the neck of the sac of an old external hernia which has gravitated inwards from its original place at h.
- •90 Commentary on plates 39 & 40.
- •Plate 39--Figure 2
- •Plate 39--Figure 3
- •Plate 40--Figure 1.
- •Plate 40--Figure 2.
- •Plate 40--Figure 3.
- •92 Commentary on plates 39 & 40.
- •Plate 40--Figure 4.
- •Plate 40--Figure 5.
- •Plate 41--Figure 1
- •Plate 41--Figure 2
- •94 Commentary on plates 41 & 42.
- •Plate 41--Figure 4
- •Plate 41--Figure 5
- •Plate 41--Figure 6
- •Plate 41--Figure 7
- •Plate 41--Figure 8
- •Plate 42--Figure 1
- •Plate 42--Figure 2
- •96 Commentary on plates 41 & 42.
- •Plate 42--Figure 3
- •Plate 42--Figure 4
- •(Page 97)
- •98 Commentary on plates 43 & 44.
- •Plate 45.--figure 1
- •Plate 45.--figure 4
- •102 Commentary on plates 45 & 46.
- •Plate 45.--figure 5
- •Plate 45.--figure 6
- •Plate 46.--figure 1
- •Plate 46.--figure 2
- •104 Commentary on plates 45 & 46.
- •(Page 105)
- •106 Commentary on plate 47.
- •Description of plate 47.
- •(Page 109)
- •110 Commentary on plates 48 & 49.
- •112 Commentary on plates 49 & 49.
- •(Page 113)
- •114 Commentary on plates 50 & 51.
- •116 Commentary on plates 50 & 51.
- •I I. The glutei muscles.
- •(Page 117)
- •118 Commentary on plates 52 & 53.
- •Plate 54, Figure 1.
- •122 Commentary on plates 54, 55, & 56.
- •Plate 55--Figure 1
- •Plate 55--Figure 2
- •Plate 55--Figure 3
- •124 Commentary on plates 54, 55, & 56.
- •Plate 57.--Figure 1.
- •126 Commentary on plates 57 & 58.
- •Plate 57.--Figure 15.
- •Plate 58.--Figure 1.
- •Plate 58.--Figure 2.
- •128 Commentary on plates 57 & 58.
- •(Page 129)
- •130 Commentary on plates 59 & 60.
- •Plate 59.--Figure 3.
- •Plate 59.--Figure 12.
- •132 Commentary on plates 59 & 60.
- •Plate 60.--Figure 6
- •134 Commentary on plates 61 & 62.
- •136 Commentary on plates 61 & 62.
- •Plate 62.--Figure 6.
- •138 Commentary on plates 63 & 64.
- •Plate 63,--Figure 1.
- •Plate 64,--Figure 8.
- •142 Commentary on plates 65 & 66.
- •146 Commentary on plates 67 & 68.
- •148 Commentary on plates 67 & 68.
- •I I. The venae comites.
- •(Page 149)
- •International donations are gratefully accepted, but we cannot make
- •Including how to make donations to the Project Gutenberg Literary
( Page 29)
30 COMMENTARY ON PLATES 11 & 12.
The branches which come off from the axillary artery are very variable both as to number and place of origin, but in general will be found certain branches which answer to the names thoracic, subscapular, and circumflex. These vessels, together with numerous smaller arteries, appear to be confined to no fixed point of origin, and on this account the place of election for passing a ligature around the main axillary artery sufficiently removed from collateral branches must be always doubtful. The subscapular artery, Q, Plate 12, is perhaps of all the other branches that one which manifests the most permanent character; its point of origin being in general opposite the interval between the latissimus and sub-scapular muscles, but I have seen it arise from all parts of the axillary main trunk. If it be required to give, in a history of the arteries, a full account of all the deviations from the so-called normal type to which these lesser branches here and elsewhere are subject, such account can scarcely be said to be called for in this place.
The form of the axillary space is conical, while the arm is abducted from the side, and while the osseous and muscular structures remain entire. The apex of the cone is formed at the root of the neck beneath the clavicle, R, Plate 11, and the subclavious muscle, E, and between the coracoid process, L*, of the scapula and the serratus magnus muscle, as this lies upon the thoracic side; at this apex the subclavian vessels, A B, enter the axillary space. The base of the cone is below, looking towards the arm, and is formed in front by the pectoralis major, K H, and behind by the latissimus dorsi, O, and teres muscles, P, together with a dense thick fascia; at this base the axillary vessels, a b, pass out to the arm, and become the brachial vessels, a*b*. The anterior side of the cone is formed by the great pectoral muscle, H K, Plate 11, and the lesser pectoral, L I. The inner side is formed by the serratus magnus muscle, M, Plate 12, on the side of the thorax; the external side is formed by the scapular and humeral insertion of the subscapular muscle, the humerus and coraco-brachialis muscle; and the posterior side is formed by the latissimus dorsi, the teres and body of the subscapular muscle.
In this axillary region is contained a complicated mass of bloodvessels, nerves, and lymphatic glands, surrounded by a large quantity of loose cellular membrane and adipose tissue. All the arterial branches here found are given off from the axillary artery; and the numerous veins which accompany these branches enter the axillary vein. Nerves from other sources besides those of the axillary plexus traverse the axillary space; such nerves, for example, as those named intercosto-humeral, seen lying on the latissimus tendon, O, Plate 11. The vein named cephalic, S, enters the axillary space at that cellular interval occurring between the clavicular origin of the deltoid muscle, G, and the humeral attachment of the pectoralis major, H, which interval marks the place of incision for tying the axillary artery.
The general course of the main vessels through the axillary space would be indicated with sufficient accuracy by a line drawn from the middle of the clavicle, R R, Plate 11, to the inner border of the biceps muscle, N. In this direction of the axillary vessels, the coracoid process, L*, from which arises the tendon of the pectoralis minor muscle, L, is to be taken as a sure guide to the place of the artery, b, which passes, in general, close to the inner side of this bony process. Even in the undissected body the coracoid process may be felt as a fixed resisting point at that cellular interval between the clavicular attachments of the deltoid and great pectoral muscles. Whatever necessity shall require a ligature to be placed around the axillary in preference to the subclavian artery, must, of course, be determined by the particular case; but certain it is that the main artery, at the place B, a little above the clavicle, will always be found freer and more isolated from its accompanying nerves and vein, and also more easily reached, owing to its comparatively superficial situation, than when this vessel has become axillary. The incision required to be made, in order to reach the axillary artery, b, from the forepart, through the skin, both pectoral muscles, and different layers of fasciae, must be very deep, especially in muscular, well-conditioned bodies; and even when the level of the vessel is gained, it will be found much complicated by its own branches, some of which overlie it, as also by the plexus of nerves, D, Plate 12, which embraces it on all sides, while the large axillary vein, a, Plate 11, nearly conceals it in front. This vein in Plate 11 is drawn somewhat apart from the artery.
COMMENTARY ON PLATES 11 & 12. 31
Sometimes the axillary artery is double, in consequence of its high division into brachial branches. But as this peculiarity of premature division never takes place so high up as where the vessel, B, Plate 11, overarches the first rib, F, this circumstance should also have some weight with the operator.
When we view the relative position of the subclavian vessels, A B, Plate 11, to the clavicle, R, we can readily understand why a fracture of the middle of this bone through that arch which it forms over the vessels, should interfere with the free circulation of the blood which these vessels supply to the arm. When the clavicle is severed at its middle, the natural arch which the bone forms over the vessels and nerves is lost, and the free moving broken ends of the bone will be acted on in opposing directions by the various muscles attached to its sternal and scapular extremities. The outer fragment follows more freely than the inner piece the action of the muscles; but, most of all, the weight of the unsupported shoulder and arm causes the displacement to which the outer fragment is liable. The subclavius muscle, E, like the pronator quadratus muscle of the forearm, serves rather to further the displacement of the broken ends of the bone than to hold them in situ.
If the head of the humerus be dislocated forwards beneath L, Plate 11, the coracoid attachment of the pectoralis minor muscle, it must press out of their proper place and put tensely upon the stretch the axillary vessels and plexus of nerves. So large and resistent a body as the head of the humerus displaced forwards, and taking the natural position of these vessels and nerves, will accordingly be attended with other symptoms--such as obstructed circulation and pain or partial paralysis, besides those physical signs by which we distinguish the presence of it as a new body in its abnormal situation.
When the main vessels and nerves pass from the axillary space to the inner side of the arm, they become comparatively superficial in this latter situation. The inner border of the biceps muscle is taken as a guide to the place of the brachial artery for the whole extent of its course in the arm. In plate 11, the artery, b*, is seen in company with the median nerve, which lies on its fore part, and with the veins called comites winding round it and passing with it and the nerve beneath the fascia which encases in a fold of itself all three structures in a common sheath. Though the axillary vein is in close contact with the axillary artery and nerves, yet the basilic vein, d*, the most considerable of those vessels which form the axillary vein, is separated from the brachial artery by the fascia. The basilic vein, however, overlies the brachial artery to its inner side, and is most commonly attended by the internal cutaneous nerve, seen lying upon it in Plate 11, as also by that other cutaneous branch of the brachial plexus, named the nerve of Wrisberg. If a longitudinal incision in the course of the brachial artery be made (avoiding the basilic vein) through the integument down to the fascia of the arm, and the latter structure be slit open on the director, the artery will be exposed, having the median nerve lying on its outer side in the upper third of the arm, and passing to its inner side towards the bend of the elbow, as at b*, Plate 12. The superior and inferior profunda arteries, seen springing above and below the point b, Plate 12, are those vessels of most importance which are given off from the brachial artery, but the situation of their origin is very various. The ulnar nerve, f, lies close to the inner side of the main arterial trunk, as this latter leaves the axilla, but from this place to the inner condyle, Q, behind which the ulnar nerve passes into the forearm, the nerve and artery become gradually more and more separated from each other in their descent. The musculo-spiral nerve, g, winds under the brachial artery at the middle of the arm, but as this nerve passes deep between the short and long heads of the triceps muscle, P, and behind the humerus to gain the outer aspect of the limb, a little care will suffice for avoiding the inclusion of it in the ligature.