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Anatomy of the Arteries of the Human Body, i's'S-si, fe+*>* /UCl***. U*A~* ANATOMY OP THE AKTERIES OF THE HUMAN BODY, Pejscripttue ant) jihxrgtcal, WITH THE DESCRIPTIVE ANATOMY OF THE HEART; By JOHN HATCH POWER, F.K.C.S.I., LATE PROFESSOR OF DESCRIPTIVE AND PRACTICAL ANATOMY IN THE ROYAL COLLEGE OF SURGEONS, IRELAND ; SURGEON TO THE CITY OF DUBLIN HOSPITAL, ETC. THIRD EDITION, By WILLIAM THOMSON, A.B., F.B.C.S., SURGEON TO THE RICHMOND SURGICAL HOSPITAL; MEMBER OF THE SURGICAL COURT OF EXAMINERS, ROYAL COLLEGE OF SDRGEONS, IRELAND; AND EXAMINER IN SURGERY, QUEEN'S UNIVERSITY, IRELAND, ETC. WITH ILLUSTRATIONS BY B. WILLS RICHARDSON, FELLOW AND SENIOR EXAMINER IN THE ROYAL COLLEGE OF SURGEONS; SURGEON TO THE ADELAIDE HOSPITAL, DUBLIN, ETC. DUBLIN : FANNIN AND CO., GEAFTON STEEET, BOOKSELLERS TO THE ROYAL COLLEGE OF SURGEONS. LONDON : LONGMANS AND CO. : SIMPKIN AND CO. MDCCCLXXXI. ?/?£ SKILL AND COMPANY, EDINBURGH, GOVERNMENT BOOK AND LAW PRINTERS FOR SCOTLAND. ; EDITOR'S PREFACE. The third edition of this book is issued under my supervision at the request of the publishers. Alterations have been made in the arrangement of the text, which has also been corrected in various places, in accordance with the views of the most modern authorities, both English and German. Borne portions have been omitted as being better suited to the pages of a physio- logical work. The notes of cases in the surgical part have been curtailed but the rarest have been allowed to remain in their collected form for facility of reference. It was my intention to give a full record of the ligature of arteries in Ireland during the last twenty years ; and in order to obtain particulars, a circular was sent to every hospital surgeon in this country. The replies did not reach a dozen, and as these obviously did not present anything approaching a complete account of the work clone in this branch of surgery, the attempt to publish " a record" was abandoned. Some important opera- tions have, however, been added. I have to acknowledge the valuable aid given me by Professor Thornley Stoker, Professor of Anatomy in the Eoyal College of Surgeons' School, and by Mr J. F. Knott, Demonstrator of Anatomy in the same school, both of whom kindly revised the proofs, and made many suggestions. My thanks are also due to Mr Bryant, of London, who has placed at my disposal several engravings from his well- known work on surgery. WILLIAM THOMSON. 34 Harcourt Street, Dublin, December 1880. Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons and Harvard Medical School http://www.archive.org/details/anatomyofarterieOOpowe PREFACE. The present work has been undertaken chiefly with the view of assisting the student whilst engaged in the study of Practical Anatomy, and of affording him such practical information in connection with the Anatomy of the Arterial System as may be of advantage to him long after his studies have been completed. For the purpose of effecting these desirable object's, I have endeavoured to simplify as much as possible the anatomical details, and to bring together such material facts in relation to the operations upon the principal arteries of the body, as may lead to correct conclusions relative to the treatment of the various accidents and diseases to which these vessels are ex- posed. I have not overlooked the fact that there are many practi- tioners, particularly those in rural districts, who do not possess any opportunity of refreshing their memories upon anatomical points by actual dissection ; and I am not without hope that to such the present volume may afford some useful hints as to the relations of those blood-vessels which, from time to time, may become the subjects of their operations. The Illustrations have been executed from drawings made expressly for the work by Mr B. Wills Eichardson, Examiner in Anatomy and Physiology in the Eoyal College of Surgeons, and late Demonstrator of Anatomy in the Carmichael School of Medicine. The elevated position to which this gentleman has been raised in the College, and which he continues to fill with so much honour, sufficiently indicates his reputation as an Anatomist. The accurate and beautiful plates of Tiedeman and Cloquet, of Professor Quain and Maclise, have been ren- dered available for the illustrated portion of the work. I cheerfully acknowledge my obligations to the labours of the late Professor Harrison, Professor Alcock, and particularly to those of rny former colleague in the Carmichael School of Medi cine, the late Dr Flood. In the year 1850 I brought out a new edition of this last gentleman's work upon the arteries, which has for some time since been out of print, but of which the principal part has been embodied in the present work. The greater number of the illustrations have been executed by Mr Oldham of this city, and the remainder by Messrs L'utterworth and Heath of London. JOHN HATCH POWEB, 95 Haucoukt Stjiekt, Dublin, October 1 860. CONTENTS. page The Pericardium, 2 General Description of the Heart 4 Structure of the Heart, 21 Pulmonary Artery, 29 Aorta, .... 32 Arteria Innominata, 44 Ligature of Arteria Innominata, 47 Common Carotid Artery, 53 External Carotid Artery, 65 Ligature of External Carotid ArteryRY, . 67 Internal Carotid Artery, 97 Subclavian Arteries, . 102 Ligature of Subclavian Artery, 116 Ligature of Subclavian and Carotid Arteries simultaneously, 128 Axilla, .... 143 Axillary Artery, 145 Ligature of Axillary Artery, 148 Veins of the Arm and Forearm, 158 Brachial Artery, 160 Ligature of the Brachial Artery, 163 Ligature of the Ulnar Artery, 176 Ligature of the Radial Artery, 183 Descending Aorta, 187 Thoracic Aorta. 188 CONTEXTS. PAGE Abdominal Aorta, 193 Ligature of the Abdominal Aorta, . 194 Common Iliac Arteries, 223 Ligature of Common Iliac Artery, 226 Ligature of the Internal Iliac Artery, 231 Ligature of the Gluteal Artery, 233 Ano-Perineal Region, . 239 Lateral Operation for Lithotomy-, . 249 External Iliac Artery, 2G3 Ligature of the External Iliac Artery, 264 The Femoral Artery, . 271 Ligature of the Femoral Artery, 278 Compression of the Femoral Artery, 283 The Popliteal Space, . 290 The Popliteal Artery, . 293 Ligature of the Popliteal Artery, . 294 The Anterior Tibial Artery, . 297 Ligature of the Anterior Tibial Artery, 299 Ligature of the Dorsalis Pedis Artery, 303 Posterior Tibial Artery, 305 Ligature of Posterior Tibial Artery', 307 Ligature of the Peroneal Artery, . 311 ANATOMY HEART AND ARTERIES. DESCRIPTIVE ANATOMY OF THE HEART. Method of Dissection. —In order to expose the heart within the pericardium, together with the great vessels con- nected with it, 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 injecting apparatus inserted from below upwards into this vessel, about two inches above the origin of the common iliac arteries ; the injection is directed upwards towards the heart. By this method the thoracic aorta, the arch of the aorta, its relation to the sternum, together with its other numerous important relations, 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 situation, the arch of the aorta. The following dissection should now be per- formed : an incision is carried from below the centre of the clavicle, passing obliquely outwards across the second, third, fourth, fifth, sixth, and seventh ribs of the left side. These bones are sawn through a little in front of their centres, and the car- tilage of the first rib of the same side divided. A perpendicular incision is next 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 incisions should now be connected by means of an oblique A 2 PERICARDIUM. incision, and the parts included within them should be raised off carefully from below upwards, and then forcibly turned backwards upon the front of the neck ; or the sternum may be sawn across, about an inch below the episternal notch, or disarticulated from the clavicles. Whilst making this dissec- tion, 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. By adopting the plan now recommended, the student will be 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 inno adnata, may be 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 envelope of the heart, and of certain portions of the great vessels entering into and issuing from it. Its form is somewhat conoid ; the apex corresponding to the large vessels in immediate connection with the heart, in which situation the fibrous layer of the sac may be seen extended over them, and identified with their external tunic : the base resting on the cordi- form tendon of the diaphragm, to which it adheres so firmly in the adult as to be with great difficulty separated from it.
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