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By A, M. PATERSON, M.D., Senior Demonstrator of Anatomy, and Lecturer on Dental Anatomy and Physiology in the Owens College, Manchester

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By A, M. PATERSON, M.D., Senior Demonstrator of Anatomy, and Lecturer on Dental Anatomy and Physiology in the Owens College, Manchester THE LIMB PLEXUSES OF MAMMALS.1 By A, M. PATERSON, M.D., Senior Demonstrator of Anatomy, and Lecturer on Dental Anatomy and Physiology in the Owens College, Manchester. (PLATE XIV.) INTRODUCTION. THIS research was originally undertaken with the object of discovering, if possible, the significance of the spinal nerve plexusess. The primary aim was to find out why and how the spinal nerves came to be joined together to form nerves of distribution. Why do the plexuses exist? Why does not any given nerve spring from a single primary division instead of from several? In other words, why does not one primary division contain within itself all the strands of the nerve? How is it that a nerve does not pass directly to the parts which it supplies; but, on the contrary, gives fibres to, and gets fibres from, adjacent nerves in its course ? These plexuses are constant in their presence in the higher vertebrates, but no satisfactory reason for their existence is assigned by either the anatomist or the physiologist. Confining my attention in the first place to the morphology of the 'spinal nerves in mammals, I have made -complete dissections of ten different animals, with the object of discovering if there is any fundamental plan upon which the formation of the plexuses and the distribution of the nerves is based. These dissections have led to certain conclusions regarding the constitution of the plexuses, which are supported by a reference to the condi- tion of things which obtains in man, and still further to the formulation of a general hypothesis which is adequate to explain the existence of these plexuses in relation to the limbs. In the present paper I propose to take up the subject in the following order: 1 The following memoir embodies some of the results of an investigation on the spinal nervous system of the Mammalia, which was presented to the University of Edinburgh as a Graduation Thesis for the degree of Doctor of Medicine in 1886 for which a Gold Medal was awarded by the Faculty of Medicine. 612 DR A. M. PATERSON. Firstly, To describe the constitution of the limb plexuses in a typical mammal. Secondly, To compare together the limb plexuses in different animals. Thirdly, To state the general conclusions derived from this comparison. I. DESCRIPTION OF THE LIMB PLEXUSES IN THE PORCUPINE (Atherura fasciculata). The porcupine has been selected for this description, as it affords a typical example of the constitution of the plexuses, and the arrangement of the nerves to the limbs. In the follow- ing account the nomenclature adopted is as follows:-The two primary divisions of the nerve, resulting from the division of the original mixed nerve, are called the superior and inferior primary divisions. When these latter subdivide, the chief trunks are called dorsal and ventral. A. Brachial Plexus (Plate XIV. fig. 1). This plexus is formed by the inferior primary divisions of the last three cervical, and the greater part of the first thoracic, nerves. The nerves emerge between the scaleni muscles, the plexus formation occurring in the axilla. The sixth cervical nerve (6th), on its appearance, gives off, firstly, -a branch which joins the phrenic nerve (Phr.),-formed by the fifth and sixth cervical nerves. From the branch thus given of, before its junction with the phrenic, comes the small nerve to the subelavius (Subcl.). The phrenic nerve courses backwards over the roots of the posterior cervical nerves into the chest. The inferior division of the sixth nerve then divides into one ventral and three dorsal branches. Of the dorsal, the first is the suprascapular (Ss); the second, a small nerve, is the first short subscapular (1 sub.); and the third is the first root of the circumflex nerve (Ci). This joins the second root, from the dorsal division of the seventh nerve. The ventral branch of the nerve forms a loop (x) with part of the ventral division of the seventh nerve, and gives rise to the musculo-cutaneous (M. C.). These nerves arise in the order given from before backwards. The seventh nerve (7th) splits into dorsal and ventral parts. The ventral part subdivides into anterior and posterior branches. The THE LIMB PLEXUSES OF MAMMALS. 613 anterior branch forms a loop (x) with the ventral part (v) of the sixth nerve. Before doing so, it gives off two fine nerves (P. M.) to the pectoralis major muscle. From the loop (x) come, at the one end the musculo-cutaneous nerve (M. C.), continuing outwards the direction of the nerve from the sixth; at the other end, the external anterior thoracic nerve (E. A. .T.), continuing outwards the branch from the seventh nerve. The latter nerve supplies the pectoralis major, and, piercing the muscle, gives small branches to the skin over it. The posterior branch of the ventral division of the seventh nerve forms the first root of the median (M.). The dorsal division also splits into anterior and posterior branches. The anterior branch forms the second root of the circumflex (Ci), joining part ofthe dorsal division of the sixth nerve. The posterior branch forms the first root of the musculo-spiral (A. S.). From each of these branches a nerve is given off before they join their companion nerves. From the anterior branch a special subscapular nerve to the teres major (T. M.) arises, before the formation of the circumflex. From the posterior branch the long subscapular nerve is given off (L. sub.) to the latissimus dorsi. The circumflex nerve in the axilla gives origin to two small nerves, the middle subscapular (M. sub.) supply- ing part of the subscapularis and the teres major; and the second short subscapular nerve (2 sub.) to the muscle of the same name. lThe eighth nerve (8th) divides into ventral and dorsal portions. The ventral and larger portion is in two parts, one passing outwards to form the second head of the median (M.), the other passing back- wards to join the ventral division of the first thoracic nerve, and being the first root of the " lateral cutaneous nerve of the thorax 2 1 (L. C. T.). The dorsal smaller portion forms the second (and hprger) root of the musculo-spiral (A. S.). This nerve is thus derived from the dorsal divisions of the seventh and eighth nerves. The first thoracic nerve (T. 1st) divides at its emergence into five branches, as follows: 1. A large branch which passes backwards a short distance, and is joined by part of the ventral division of the eighth nerve to form the "lateral cutaneous nerve of the thorax" (L. C. T.). This nerve, soon subdivides into three large branches, which are distributed over the chest-wall. One (a) enters the panniculus carnosus and supplies it and the skin of the posterior part of the body wall. The other two branches (b) pass backwards and under cover of a large muscle, which extends forwards from the abdomen to the sternum, its fibres directed forwards and downwards; beneath this muscle these two nerves can be traced into the abdominal wall. 1 This nerve, which is fairly constant as a considerable trunk in mammals,- being found in seven out of the ten animals dissected, -may be looked upon as the homologue of the nerve of Wrisberg (lesser internal cutaneous) of human anatomy. Its origin is the same (from the ventral trunks of the eighth cervical and first thoracic nerves) ; and it supplies the integument of the fold of the axilla, communicating in its course with the intercostal nerves. In these animals, moreover, there is no other nerve corresponding to the nerve of Wrisberg. 614 DR A. M. PATERSON. 2. The internal anterior thoracic (I. A. T.). This nerve passes above the first root of the last named nerve, and supplies the pector- alis minor. It is but small. 3. The third head of the median (M.). This nerve, formed from the ventral divisions of the seventh and eighth cervical nerves, and from the first thoracic, is the largest in the plexus. 4. The ulnar nerve (U.). Smaller than the median, and arising behind it. 5. The internal cutaneous nerve (I. C.). Small and arising behind the ulnar. The three last nerves, median, ulnar, and internal cutaneous, pass together to the fore-limb. The remaining smaller portion of the first thoracic nerve con- tinues downwards through the first intercostal space, supplying the muscles, but giving no cutaneous branches. It is to be remarked, regarding the part which this nerve plays in the formation of the brachial plexus, that it gives no trunk corre- sponding to the dorsal trunks of the other nerves engaged. In this respect it is an exception. In eight out of the other nine animals dissected the axillary portion of the first thoracic nerve resembled the other nerves joining the plexus, and, like them, divided into dorsal and ventral parts, which combined with the corresponding cords of anterior nerves to complete the plexus. The other exception was the rat, in which animal the nerve agreed with the one now under consideration in giving off no dorsal branch. Distribution of the Nerves of the Brachial Plexus. The nerve to the serratus magnus muscle is formed by two roots, one from the seventh, one from the eighth cervical nerve, in the substance of the scalene muscle. It emerges at the superior border of the serratus, and enters the substance of the muscle. Beyond this there is little to add. The musculo-cutaneous and internal cutaneous nerves have their usual distribution. The median supplies the muscles of the fore-arm and hand, and the skin of 31 digits in the palmar aspect radial.
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