Branches and Conditions of the Brachial Artery

204 14 CONTENTS. Bracniat Arrery... Brachial Nerves. Ligature of the Brachial Artery Aneurisms of the Brachial Artery Treatment of the various Forms of Ancurism of the Brachial Artery... Compression of the Brachial Artery. Modes of Operation Branches of the Brachial Artery Superior Profunda Artery Arteria Nutritia... Inferior Profunda Artery. Anastomotie Artery Muscular Branches.. ULNAR ARTERY scessseeeseeee Branches of the Ulnar Artery. Anterior Ulnar Recurrent Artery Posterior Ulnar Recurrent Artery. Common Interosseal Artery. Muscular Branches... Anterior Carpal Branch, Posterior Carpal Branch Communicans Profunda Artery. Superficial Palmar Artery... Superficial Palmar Arch and Branches. Operation of Tying the Ulnar Artery... Rapra Anrery.. Branches of the Radial Artery Radial Recurrent Artery. Muscular Branches.. Superficialis Vole. Anterior Carpal Artery. Posterior Carpal Artery. Dorsalis Pollicis. Metacarpal Artery... Radialis Indicis Artery Princeps Pollicis Artery. Palmaris Profunda Arter, 227 227 . 229 229 229 = 229 CONTENTS. 15 Ravar, Arrery (continued). Pace Deep Palmar Arch... 230 Ligature of the Radial Artery, 231 Dzscenpina Aorra..... Tnoracic Aorra.. Branches of the Thoracic Aorta. Appomrnat Aorta... Ligature of the Abdominal Aorta. Tabular View of Operation.. Sir A. Cooper’s case. Mr, James's cas Dr. Murray’s case. Dr. Monteiro’s case. Mr. South’s case.. Branches of the Abdominal Aorta. Cooliac Axis. Gastric, or Coronaria, Ventriculi Artery. Hepatic Artery... Circulation of the Blood in the Liver Umbilical Vein in the Feetu: Vena Ports in the Foetus. Source of the Biliary Secretion. Kiernan’s Observations on the Liver. Todd and Bowman’s Opinions. Splenic Artery... Structure of the Spleen Superior Mesenteric Artery. Branches of the Superior Mesenteric Artery. Inferior Mesenteric Artery. Branches of the Inferior Mesenteric Artery. Proper Phrenic Arteries. Middle Capsular Arteries. Renal Arteries Renal Veins. Arrangement of the Vessels in the Kidney, Spermatic Arteries. Middle Sacral Artery. 16 CONTENTS. PAGE 276 278 280 . 282 283 Common on Priwizive Intac ARTERIES. Ligature of the Common Iliac Artery. Mr. Mott’s case. Sir P. Crampton’s case. ‘Mr. Hey’s case. Inrersan Intac ARTERY..... Internal iae Artery in the Fetus.. Ligature of the Internal Iliac Artery. Dr. Steven’s and Mr. Atkinson’s cases. Mr. White’s case. Branches of the Internal Iliac Artery. Glutwal Artery. Operation of Tying the Glutmal Artery. 289 Mr. Lizars’s metho Mr. Carmichael’s case. Sciatic, or Ischiatie Artery. Branches of the Sciatic or Isebi Obturator Artery.. Branches of the Obturator Artery. Anatomy of the Ano-Perineal Region, Lateral Operation for Lithotom: Internal Pudie Artery Branches of the Internal Pudic Artery. External Heemorrhoidal Artery Long Perineal Artery. Transverse Artery of the Perineum. Artery of the Bulb.. Artery of the Corpus Cavernosum Dorsal Artery of the Penis. Tio Lumbar Artery... Lateral Sacral Artery... Middle Hemorrhoidal Artery. Vesical Artery. Umbilical Artery.. Uterine Artery. Vaginal Artery. Exrernat Tutac ARreRy.. Ligature of the External Iliac Artery. CONTENTS. 17 Exrernat Intac Artery (continued). race Mr. Abernethy’s operation... 822 Sir A. Cooper's operation... . 828 Branches of the External Mine Artery. 825 Epigastric Artery. 827 Internal Circumflexa Ilii Artery 328 Femorat ARrery. Femoral Vein. Operations on the Femoral Artery Professor Porter's Operation. ... Compression on the Femoral Artery Mr. Todd’s cases. Mr. M’Coy’s case. Dr. Hutton’s case. Dr. Cusack’s case... Dr. Bellingham’s eases. Branches of the Femoral Arter Superficial Epigastric Arter; External Pudic Arteries Superficial Circumfexa Iii Artery. Muscular Branches... Anastomoticn Magna Artery Profunda Femoral Artery External Ciroumflex Artery. Internal Cireumflex Artery. Perforating Arteries... . 828 835, Poriireat Spact.... Pornrreat ARTERY. Ligature of the Popliteal Arter; Branches of the Popliteal Artery. Articular Arteries. Ayrenror Trnrat Artery. Ligature of the Anterior Til Branches of the Anterior Tibial Artery. Tibial Recurrent ‘Muscular Branches. Internal Malleolar Artery. 18 CONTENTS. Awrerror Tro1aL Arreny (continued). es External Malleolar Artery. . 862 Tarsal Artery... Metatarsal Artery .. Dorsalis Pollic Ramus Communicans. Posterior TrBrat, ARTERY. Ligature of the Posterior Tibial Artery. Branches of the Posterior Tibial Artery. Muscular Arteries. Nutritious Artery, Peroneal Artery... Ligature of the Peroneal Artery. Internal Plantar Artery. External Plantar Arter; Branches of the External Plantar Artery. Some or THE PrinciraL VARIETIES OR ANOMALIES OF THE ARTERIES... ANATOMY or THE HEART AND ARTERIES. DESCRIPTIVE ANATOMY OF THE HEART. PRELIMINARY DIRECTIONS. For the purpose of exhibiting the heart contained within its envelope the pericardium, together with the great vessels connected with it, particularly tho aorta, the student is advised, in the first instance, to make a longitudinal incision through the abdominal parietes of about six inches in length, the centre being situated at the umbilicus: the bifurcation of the abdominal aorta should then be exposed, and a full-sized pipe of the in- jecting apparatus inserted from below upwards into this vessel, about two inches above the origin of the common iliac arteries; the injection should then be directed upwards, towards the heart. By this method the tho- racic aorta, the arch of the aorta, its relation to the ster- num, together with its other numerous important rela- tions, will be best seen, whilst the arteries of the head, neck, and upper extremities will be much better filled than if the subject were injected from the ordinary situa- tion, the arch of the aorta. The following dissection should now be performed : a perpendicular incision should be made, commencing from below the centre of the cla- vicle, and passing across the second, third, fourth, fifth, 19 20 PERICARDIUM. sixth, and seventh ribs of the left side: these bones should then be sawn through, a little in front of their centres, and the cartilage of the first rib of the same side divided. A second perpendicular incision should next be made through the integument covering the sternum, and then through the bone, keeping a little to the right side of the middle line. The lower extremities of these two in- cisions should now be connected by means of an oblique incision, and the parts included within them should be next raised off carefully from below upwards, and then forcibly turned backwards upon the front of the neck. Whilst making this dissection, the soft parts lying behind the divided portions of the ribs and sternum should be carefully detached from these bones. The mammary artery is particularly liable to injury in this stage of the dissection. By adopting the plan now recommended, the student will bo able to expose the pericardium, and to observe its relation to the parietes of the thorax, whilst the relations of the arch of the aorta, the proximity of this vessel to the right side of the sternum, and to the cartilage of the second rib, at its junction with the former bone, will attract his attention. The same plan of dissection may afterwards be pursued at the right side, with this difference, that the cartilage of the first rib should not be disturbed, in order that the dissection of the lower portion of the neck at that side, together with the dissection of the arteria innominata, may bo pursued with advantage. THE PERICARDIUM. The pericardium, properly speaking, is a specimen of what Bichat calls a fibro-serous membrane, consisting of two layers of membrane, an external or fibrous, and an internal or serous layer. It is the immediate en- velope of the heart, and of certain portions of the great PERICARDIUM. 21 vessels entering into and issuing from it. Its form is somewhat conoid; the apex corresponds to the large vessels in immediate connection with the heart, in which situation the fibrous layer of the sac may be seen ex- tended over them, and identified with their external tunic: the base may be seen resting on the cordiform tendon of the diaphragm, to which it adheres so firmly in the adult as to be with great difficulty separated from it; it also rests on a small triangular portion of the fleshy fibres of the diaphragm, to the left of the tendon, from which it may very easily be separated. In the foetus the pericardium is but loosely connected with the tendon and fleshy fibres of the diaphragm. The anterior surface of the’pericardium is covered by the thymus gland in the foetus, and in tho adult by a considerable quantity of loose areolar tissue, which oc- cupies the situation of the thymus gland; by the internal and anterior portion of cach lung and pleura, and by the sternum: and inclining towards the left’ side infe- riorly, we find lying in front of it also the cartilages of the fourth, fifth, sixth, and seventh ribs. The sides of the pericardium are over-lapped by the lungs, and are covered by the pleure, the phrenic nerve being inter- posed at the left, and thrown more anteriorly, so as to bend over the pericardium at a point corresponding to the apex of the heart. Its posterior surface lies in front of the posterior mediastinum and the parts contained within this region, more particularly the esophagus and descending aorta. An incision may now be made through the anterior part of this envelope, when its in- ternal or serous layer will be exposed: this consists of two portions,—the one lining the inner surface of the fibrous layer, and the other, with which the former is perfectly continuous, surrounding the heart. The con- tinuity of these two portions of the serous membrane 22 PERICARDIUM. may be demonstrated, in the first place, by tracing that lining the inner surface of the fibrous layer from off that structure, to form a cylindrical sheath which en- closes both the aorta and pulmonary artery; and se- condly, by following the course which that membrane takes in forming partial investments for the two vena cave and the four pulmonary veins. These two portions of the serous layer, viz., that lining the fibrous layer of the pericardium, and that lining the exterior of the heart itself, are perfectly continuous with each other, thus constituting a completely shut sac, so that the vessels going to, or issuing from, the heart, do not perforate the serous membrane, but receive coverings more or less perfect from it. Nine openings have been enumerated in the fibrous layer of the pericardium, viz., one for the aorta, two for the right and left branches of the pulmonary artery, four for the four pulmonary veins, and two for the superior and inferior vena cave. In the foetus there is another for the ductus arteriosus. Strictly speaking, these are not openings in the fibrous layer of the peri- cardium, for this structure becomes incorporated with the external tunic of the vessels where they come in con- tact with it. When the pericardium has been opened, the following parts will be exposed :—the anterior superior surface of the heart, the two vene cave, the aorta, the pulmonary artery, the right auricular appendix and a portion of the auricle, and the tip of the left auricular appendix. The left auricle is concealed chiefly by the aorta and pulmo- nary artery. GENERAL DESCRIPTION OF THE HEART. The Heart is a hollow muscular organ of a somewhat. conical form, consisting of four chambers, grouped to- HEART. 23 Fig.1.—Anterior View of the Heart, © af Sublavian Artery. D, Aorta, Rew erior or Descending. Wena Cava.” MH, 'K, Left Aurieular Appendls. Ly Anterior terior surface of Kight Ventrile, on iene Corounyy Arie Tet Coronary Vein. 2d HEART. gether so as to form an individual mass; two of these are called the auricles, the other two the ventricles. The apex of the heart is formed (in the adult) by the ex- tremity of the left ventricle; and looks downwards, forwards, and to the left side, towards the interval be- tween the fifth and sixth ribs: in many subjects it is curved a little backwards. The base is turned upwards, backwards, and to the right side, and corresponds to the right side of the fifth, sixth, seventh, and, sometimes, partly to the eighth, dorsal vertebra. The posterior in- Serior surface is flat and triangular, and the anterior su- perior surface convex and more extensive : these surfaces are separated by two margins: the anterior margin is thin, and looks downwards, forwards, and to the right side: the posterior margin, which is shorter but consider- ably thicker, looks in the opposite direction. The chief bulk of the heart is formed by the ventri- cles, particularly by the left; and the auricles seem like appendages situated at its base. The two auricles are situated at the base of the ventri- cles, and towards its posterior part. When injected, and viewed as one, they form a crescentic mass, the con- cavity of which looks forwards and rather upwards, and embraces within it the aorta and pulmonary artery. The convexity looks backwards and somewhat down- wards. The two extremities of the crescent are formed by the tips of the right and left auricular appendices. The two ventricles taken together form a conical mass, which gives the peculiar form to the heart; it is ob- liquely situated, the apex being directed downwards, forwards, and to the left side; the base upwards, back- wards, and to the right side. The anterior superior surface of this mass is convex, and presents a fissure which runs from the base to the right side of the apex; this fissure lodges the anterior