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Surgical Anatomy, by Joseph Maclise 152 года кн...docx
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Description of plate 24.

A. The thyroid body.

B. The trachea.

C C*. The first ribs.

D D*. The clavicles, cut at their middle.

E. Humeral part of the great pectoral muscle, cut.

F. The coracoid process of the scapula.

G. The arch of the aorta. G*. Descending aorta in the thorax.

H. Right bronchus. H*. Left bronchus.

I. Oesophagus.

K. Vena azygos receiving the intercostal veins.

L. Thoracic duct.

M M*. Seventh ribs.

N N. The diaphragm, in section.

O. The cardiac orifice of the stomach.

P. The liver, in section, showing the patent orifices of the hepatic veins.

Q. The coeliac axis sending off branches to the liver, stomach, and spleen. The stomach has been re­moved, to show the looping anastomosis of these vessels around the superior and inferior borders of the stomach.

R. The inferior vena cava about to enter its notch in the posterior thick part of the liver, to receive the hepatic veins.

S. The gall-bladder, communicating by its duct with the hepatic duct, which is lying upon the vena portae, and by the side of the hepatic artery.

T. The pyloric end of the stomach, joining T*, the duodenum.

U. The spleen.

V V. The pancreas.

W. The sigmoid flexure of the colon.

X. The caput coli.

Y. The mesentery supporting the numerous looping branches of the superior mesenteric artery.

Z. Some coils of the small intestine.

2. Innominate artery.

3. Right subclavian artery.

4. Right common carotid artery.

5. Left subclavian artery.

6. Left common carotid artery.

7. Left axillary artery.

8. Coracoid attachment of the smaller pectoral muscle.

9. Subscapular muscle.

10. Coracoid head of the biceps muscle.

11. Tendon of the latissimus dorsi muscle.

12. Superior mesenteric artery, with its accompanying vein.

13. Left kidney.

Plate 24

COMMENTARY ON PLATE 25.

THE RELATION OF THE PRINCIPAL BLOODVESSELS OF THE THORAX AND ABDOMEN TO THE OSSEOUS SKELETON, ETC.

The arterial system of vessels assumes, in all cases, somewhat of the character of the forms upon which they are distributed, or of the organs which they sup­ply. This mode of distribution becomes the more apparent, according as we rise from particulars to take a view of the whole. With the same ease that any piece of the osseous fabric, taken separately, may be known, so may any one artery, taken apart from the rest, be distinguished as to the place which it occupied, and the organs which it supplied in the economy. The vascular skeleton, whether taken as a whole or in parts, exhibits characteristics as apparent as are those of the osseous skeleton itself. The main bloodvessel, A B C, of the trunk of the body, possesses character, sui generis, just as the vertebral column itself mani­fests. The main arteries of the head or limbs are as readily distinguishable, the one from the other, as are the osseous fabrics of the head and limbs. The visceral arteries are likewise moulded upon the forms which they supply. But evidently the arterial system of vessels conforms most strictly with the general de­sign of the osseous skeleton.

In Plate 25, viewed as a whole, we find that as the vertebral column stands central to the osseous skele­ton, so does the aorta, A B C, take the centre of the arterial skeleton. As the ribs jut symmetrically from either side of the vertebral column, so do the inter­costal arteries follow them from their own points of origin in the aorta. The one side of the osseous sys­tem is not more like the other than is the system of vessels on one side like that of the other. And in addition to this fact of a similarity of sides in the vascular as in the osseous skeleton, I also remark that both extremities of the aorta divide into branches which are similar to one another above and below, thereby conforming exactly with the upper and lower limbs, which manifest unmistakable points of analogy.

The branches which spring from the aortic arch above are destined to supply the head and upper limbs. They are, H, the innominate artery, and I K, the left common carotid and subclavian arteries. The branches which spring from the other extremity of the aorta are disposed for the support of the pelvis and lower limbs; they are the right and left common iliac arte­ries, L M. These vessels exhibit, at both ends of the main aortic trunk, a remarkable analogy; and as the knowledge of this fact may serve to lighten the dry and weary detail of descriptive anatomy, at the same time that it points directly to views of practical im­port, I may be allowed briefly to remark upon it as follows:--

The vessels which spring from both ends of the aorta, as seen in Plate 25, are represented in what is called their normal character--that is, while three vessels, H I K, spring separately from the aortic arch above, only two vessels, L and M, arise from the aorta below. Let the anatomist now recall to mind the "peculiarities" which at times appear amongst the vessels, H I K, above, and he will find that some of them abso­lutely correspond to the normal arrangement of the vessels, L M, below. And if he will consider the "peculiarities" which occur to the normal order of the vessels, L M, below, he will find that some of these correspond exactly to the normal order of the vessels above. Thus, when I K of the left side join into a common trunk, this resembles the innominate artery, H, of the right side, and then both these vessels per­fectly correspond with the two common iliac arteries below. When, on the other hand, L and M, the com­mon iliac arteries, divide, immediately after leaving the aortic trunk, into two pairs of branches, they cor­respond to the abnormal condition of the vessels, H I K, above; where H, immediately after leaving the aortic arch, divides into two branches, like I K.

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