- •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 53 )
54 Commentary on plate 23.
The thorax is separated from the abdomen by the moveable diaphragm. The heart, F E, lies upon the diaphragm, L L*. The liver, M, lies immediately beneath the right side of this muscular septum, L*, while the bulging cardiac end of the stomach, O, is in close contact with it on the left side, L. As these three organs are attached to the diaphragm--the heart by its pericardium, the stomach by the tube of the oesophagus, and the liver by its suspensory ligaments--it must happen that the diaphragm while descending and ascending in the motions of inspiration and expiration will communicate the same alternate motions to the organs which are connected with it.
In ordinary respiration the capacity of the thorax is chiefly affected by the motions of the diaphragm; and the relative position which this septum holds with regard to the thoracic and abdominal chambers will cause its motions of ascent and descent to influence the capacity of both chambers at the same time. When the lungs expand, they follow the descent of the diaphragm, which forces the abdominal contents downwards, and thus what the thorax gains in space the abdomen loses. When the lungs contract, the diaphragm ascends, and by this act the abdomen gains that space which the thorax loses. But the organs of the thoracic cavity perform a different office in the economy from those of the abdomen. The air which fills the lungs is soon again expired, whilst the ingesta of the abdominal viscera are for a longer period retained; and as the space, which by every inspiration the thorax gains from the abdomen, would cause inconvenient pressure on the distended organs of this latter cavity, so we find that to obviate this inconvenience, nature has constructed the anterior parietes of the abdomen of yielding material. The muscular parietes of the abdomen relax during every inspiration, and thus this cavity gains that space which it loses by the encroachment of the dilating lungs.
The mechanical principle upon which the abdominal chamber is constructed, enables it to adjust its capacity to such exigence or pressing necessity as its own visceral organs impose on it, from time to time; and the relation which the abdominal cavity bears to the thoracic chamber, enables it also to be compensatory to this latter. When the inspiratory thorax gains space from the abdomen, or when space is demanded for the increasing bulk of the alimentary canal, or for the enlarging pregnant uterus; or when, in consequence of disease, such as dropsical accumulation, more room is wanted, then the abdominal chamber supplies the demand by the anterior bulge or swell of its expansile muscular parietes.
The position of the heart itself is affected by the expansion of the lungs on either side of it. As the expanding lungs force the diaphragm downwards, the heart follows it, and all the abdominal viscera yield place to the descending thoracic contents. In strong muscular efforts the diaphragm plays an important part, for, previously to making forced efforts, the lungs are distended with air, so as to swell and render fixed the thoracic walls into which so many powerful muscles of the shoulders, the neck, back, and abdomen, are inserted; at the same time the muscular diaphragm L L*, becomes tense and unbent from its arched form, thereby contracting abdominal space, which now has no compensation for this loss of space, since the abdominal parietes are also rendered firm and unyielding. It is at this crisis of muscular effort that the abdominal viscera become impacted together; and, acting by their own elasticity against the muscular force, make an exit for themselves through the weakest parts of the abdominal walls, and thus herniae of various kinds are produced. The most common situations of abdominal herniae are at the inguinal regions, towards which the intestines, T T, naturally gravitate; and at these situations the abdominal parietes are weak and membranous.
The contents of a hernial protrusion through the abdominal parietes, correspond in general with those divisions of the intestinal tube, which naturally lie adjacent to the part where the rupture has taken place. In the umbilical hernia it is either the transverse colon S*, or some part of the small intestine occupying the median line, or both together, with some folds of the omentum, which will be found to form the contents of this swelling.
COMMENTARY ON PLATE 23. 55
When the diaphragm itself sustains a rupture in its left half, the upper portion of the descending colon, S, protrudes through the opening. A diaphragmatic hernia has not, so far as I am aware, been seen to occur in the right side; and this exemption from rupture of the right half of the diaphragm may be accounted for anatomically, by the fact that the liver, M, defends the diaphragm at this situation. The liver occupies the whole depth of the right hypochondrium; and intervenes between the diaphragm L*, and the right extremity of the transverse colon, S**.
The contents of a right inguinal hernia consist of the small intestine, T. The contents of the right crural hernia are formed by either the small intestine, T, or the intestinum caecum, S***. I have seen a few cases in which the caecum formed the right crural hernia. Examples are recorded in which the intestine caecum formed the contents of a right inguinal hernia. The left inguinal and crural herniae contain most generally the small intestine, T, of the left side.
The right lung, I*, is shorter than the left; for the liver, M, raises the diaphragm, L, to a higher level within the thorax, on the right side, than it does on the left. When the liver happens to be diseased and enlarged, it encroaches still more on thoracic space; but, doubtless, judging from the anatomical connexions of the liver, we may conclude that when it becomes increased in volume it will accommodate itself as much at the expense of abdominal space. The liver, in its healthy state and normal proportions, protrudes for an inch (more or less) below the margins of the right asternal ribs. The upper or convex surface of the liver rises beneath the diaphragm to a level corresponding with the seventh or sixth rib, but this position will vary according to the descent and ascent of the diaphragm in the respiratory movements. The ligaments by which the liver is suspended do not prevent its full obedience to these motions.
The left lung, I, descends to a lower level than the right; and the left diaphragm upon which it rests is itself supported by the cardiac end of the stomach. When the stomach is distended, it does not even then materially obstruct the expansion of the left lung, or the descent of the left diaphragm, for the abdominal walls relax and allow of the increasing volume of the stomach to accommodate itself. The spleen, R, is occasionally subject to an extraordinary increase of bulk; and this organ, like the enlarged liver and the distended stomach, will, to some extent, obstruct the movements of the diaphragm in the act of respiration, but owing to its free attachments it admits of a change of place. The abdominal viscera, one and all, admit of a change of place; the peculiar forms of those mesenteric bonds by which they are suspended, allow them to glide freely over each other; and this circumstance, together with the yielding nature of the abdominal parietes, allows the thoracic organs to have full and easy play in the respiratory movements performed by agency of the diaphragm.
The muscles of respiration perform with ease so long as the air has access to the lungs through the normal passage, viz., the trachea. While the principle of the thoracic pneumatic apparatus remains underanged, the motor powers perform their functions capably. The physical or pneumatic power acts in obedience to the vital or muscular power, while both stand in equilibrium; but the ascendancy of the one over the other deranges the whole thoracic machine. When the glottis closes by muscular spasm and excludes the external air, the respiratory muscles cease to exert a motor power upon the pulmonary cavity; their united efforts cannot cause a vacuum in thoracic space in opposition to the pressure of the external air. When, in addition to the natural opening of the glottis, a false opening is made in the side at the point K, the air within the lung at I, and external to it in the now open pleural cavity, will stand in equilibrio; the lung will collapse as having no muscular power by which to dilate itself, and the thoracic dilator muscles will cease to affect the capacity of the lung, so long as by their action in expanding the thoracic walls, the air gains access through the side to the pleural sac external to the lung.