A series of anatomical plates

432 Pages·1856·857.256 MB·English

by  Richard Quain

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internal to that vessel, or may turn suddenly outwards across it, becoming in a manner superficial to it, but still covered by the
fascia. Tiedemann says that in such casesthe "radial artery is either enclosed by the aponeurosis of the arm, or, perforating it,
runswith the cephalicvein immediatelyunder the skin."* The latter case must be of rare occurrence. In some instancesthe
radialartery, instead of continuing its course to the loAverpart of the radius, inclines outwards and backAvards a little below the
middleof thefore-arm, and so descends along its outer border, superficial to the extensor tendons. When the radial artery arises
thushigh, andruns superficial, the external or radial recurrentis a branch ofthe brachial artery, or more rarelyofthe ulnar.
When the origin ofthe ulnar arterytakes place high in the arm, it lies beneath the fascia as it descends, and runs superficial
totheflexormuscles. In one instance of a high division, Tiedemann observed across branchconnecting the ulnar andbrachial.
Inafewcases an anomalous branch has been observed to pass doAvn from the brachial and end inthe radial,or in the brachial
itself. This appears to be but a minor degree of that division,and subsequentre-union,instances ofwhich in the brachial and
femoralarteries have been above noticed.
Theinter-osseousartery,in two or threecases, (atleast there are no morerecorded,)arose from the brachial about the middle
of the arm. Its position was internal, and posterior to the main artery; andon reachingthe bend of the elboAV, passed deeply
between the muscles, and assumed the usual position of the vessel. A superficial anteriorinter-osseous artery sometimesexists,
whicharisesalittle below the elbow-joint, and takes the course ofthe median nerve to the palm ofthe hand, where it terminates
byinosculationin the palmar arch.
The brachial artery,when arrived opposite the insertion of the brachialis anticus muscle, dividesinto its ulnarandradial
branches.
The Ulnar artery (plate IX. fig. 2, C, C; arteria ulnaris)inclines,in rather a curved direction, dowmvards and inwards,
passing under cover of the superficial muscles which arise from the inner condyle, viz. the pronator teres, flexorcarpi radialis,
palmarislongus,and flexor sublimis,until it reachesthe flexor carpiulnaris. About the same point, that is,at thejunction ofthe
upperwith the middle third of the fore-arm, the artery comes into contact Avith the ulnar nerve, which had previously been
separated from it by a considerable interval, havinglain behind the innercondyle,but here approaches it, lying to its ulnarside.
Thus placed, theyboth descend towards the inner border of the palm of the hand. In the first part ofits course the artery is
coveredbythe musclesabove enumerated; inthemiddleofthe armit is overlappedbythe flexorcarpi ulnaris; and,in theloAver,
it runs parallel and in close relation with the outer border of its tendon. In this part of itscourse the vessel is covered only by
thecommoninteguments,thefascia ofthe armand a thin layer,bywhich it is connectedto the musclesbehind it. For two-thirds
ofitsextentitlieson theflexorprofundusmuscle; in therest, on thepronator quadratusandannularligament. Itisaccompanied,
initsentireextent,bytwoveins,whichlie oneoneachside. Atits originthearteryis in closerelationAvith themediannerve, from
which,however,it is soon separated by the origin ofthe pronator teres from the coronoidprocess of the ulna; inclining inwards,
it approaches the ulnar nerve, and by it is accompanied in the lowertwo-thirdsofits course,—the nerve lying on the ulnar;ide
oftheartery.
Palmararch (superficial; plate IX. fig. 1, p,p.)—The ulnar artery,guided as it were by the tendon of the flexor ulnaris
muscle,reachesthe radial border of the pisiform bone, where, accompaniedby the nerve, it passes over thecutaneous surface of
the annular ligament of the wrist. At this point the artery begins at once to change its direction,byrunning outwards andfor
wards,across the palm of the hand; and on arrivingaboutmidway between the flexure formed by the bend of the first jointof
thethumb and that of the fore-finger, it terminates by inosculating with a branch (superficialis volae) sent forwardsby the radial
artery,to unite with it. The vessel thus describes acurve, Avhose convexitylooks forwards. This curved part of the artery is
called the superficial palmar arch, (arcusvolae superficialis,) to distinguish it from the deep-seated one formed by the radial
artery. It restson the annular ligament ofthe Avristat its commencement,and afterwards on the tendons of the flexor sublimis;
and iscovered, fora short way, by the palmarisbrevis, and aftenvards by the palmar fascia and integument. The vessel, in the
palm,is usually someAvhat tortuous; and presents not afew varieties in its course and mode oftermination.
The branches of the ulnar artery in the fore-arm are the following:—
Theanterior Recurrent branch (plate IX.-fig. 2, p; ramus recurrens anterior) arches inwards from the ulnar artery, near
its origin,running on the brachialis anticus muscle, and covered bythe pronatorteres, to both of Avhich it sends ramusculi. On
reaching the inner condyle, it anastomoses Avith the ramus profundus inferior and anastomoticus, derived from the brachial
artery.
TheposteriorRecurrent branch (plate X. fig. 2,d; r. recurrens posterior) is largerthan the preceding, and comes off lower
down; but not unfrequently they both arise by a small common trunk. It runs backwards someAvhat, and ascends upon the
posterior aspect of the inner condyle; and in the interval betAveen that process and the olecranon, anastomoses Avith the r. pro-
* Itisnecessaryforbleederstorecollectthe anomaloussuperficialpositionof oneof thearteriesatthe bend ofthe arm that is occasionallymetwith.
Intwocasesofthekind Ihavehadtotakeupthebrachialartery,for aneurism followingvenesection. Pulsationwas stopped in the vesselby theligature
used bythe bleeder,andtheemptyvesselpresentedtohisfingerthe elasticfeelingof adistended vein. Inall doubtfulcases letthe operator,beforeusing
»»lancet,slackenhisligatureandascertainwhere thepulsatingvessellies.—J. P.
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fundus inferior, some of its branches extending outwards,so as to communicate with those of the r. profundus superior and
recurrensiuter-osseus.
The Inter-osseous branch (plate IX. fig. 2, D, D; r. inter-osseus, communis) is of considerable size,and is sometimescalled
the common inter-osseous artery, from the circumstance of its dividing into two vessels bearing that name, Avhich lie on the
opposite surfaces of the inter-osseous ligament or membrane. Thisvessel inclines someAvhatbackwardsafter its origin,toreach
the upper border ofthe inter-osseous ligament, Avhere its division takes place.
The anterior Inter-osseous branch (plate IX. fig. 2, D; plate X. fig. 3, g, h: r. inter-osseus anterior) proceeds downwards,
lying on the anteriorsurface of the inter-osseous ligament, and is accompanied by the inter-osseousbranchof the median nerve,
andoverlappedbythecontiguousbordersoftheflexorprofundus andflexorlonguspollicis. Thusplaced,itgivesoffsomemuscular
branches, and the two nutritious arteries (r. medullares) to the radius and ulna. These incline to each side and enter the oblique
foramina in the bones just mentioned, to be distributed to the medullary membranes in their interior. The arterycontinuesits
course directly dowmvards until it reaches the upper border of the pronator quadratus muscle, where it gives off somesmall
branches to supply that muscle and ramify upon the carpus, after Avhich itpasses from before backAvards, throughan openingin
the inter-osseous ligament; and, on reachingits dorsal surface, proceeds alongthe back of the carpus, where it maintains com
munications Avith the posteriorcarpal branches ofthe radial and ulnar arteries.
Theposterior Inter-osseous branch(plate X.figs. 2 and3,e; r. inter-osseusposterior) passes backwards,throughtheinterval
leftbetweenthe oblique ligament and the upper border of the inter-osseousligament. Continuing itscourse downwards,along
the arm,under cover of the extensor muscles,it gives several branches to them, and reaches the carpusconsiderablydiminished
in size,Avhere its terminal branchesanastomosewith the perforatingorterminal branches ofthe anterior inter-osseous artery,and
with the carpal branches of the radial andulnar arteries. In additionto numerous muscularbranches, whichrequire no special
notice,this artery, assoon as it reaches the posterior surface of the ligament, gives off a recurrent branch, (r. recurrensinter
osseusposterior; plate X. fig. 1, c; fig. 2, f; fig. 3, d,) which is nearly aslarge as the continuation of the vessel. This branch
passes directlyupwards,covered by the supinator brevis and anconeus,to reachthe intervalbetAveenthe olecranon and external
condyle, Avhere it divides into several ramusculi,that anastomose Avith the terminal branches of the r. profundussuperiorand
inferior, as Avell as ofthe posterior ulnarrecurrens.
PLATE XIX.
Thearteriessupplyingtheanteriorparietesofthechestand abdomen, andthesuperficialblood-vesselsinthegroin,arehereshown.
No. 1. Thesternumcoveredbythetendinous interlacementsofthegreatpectoralmuscleandanteriorsterno-costalligaments. 2. The
ensiformcartilage. 3,3. The clavicles. 4. The sterno-mastoid muscle. 5,5. Thesterno-hyoidmuscles. 6. Theinferiorbelly
ofthe omo-hyoid muscle. 7. Aprocess of the deep fascia of the neck,which holdsdownthetendonoftheomo-hyoidmuscle,
permittingtheplayofthetendonthroughitasthroughapulley. 8. Thedeltoidmuscle. 9. Thegreatpectoralmuscle. 10.The
subclavius muscle. 11. The coracoid process. 12. The lesser pectoral muscle divided. 13. The.coraco-brachialis muscle
14, 14. Digitations of the serratus magnus muscle. 15. Latissimusdorsi muscle. 16, 16. The external oblique muscle of the
abdomen. 17, 17. The aponeurosis of the external oblique muscle proceeding to its attachment in the linea alba. 18. The
transversalis muscle of the abdomen; the external oblique,internal oblique,and rectusmuscleshavingbeenremoved. 19. The
aponeurosis ofthetransversalismuscleformingtheposteriorlayerofthesheathoftherectusmuscle. 20. Theinferiorpartofthe
sheath of the rectus, becoming thin beforeitisentirelylost. 21. Thelower part of the aponeurosisofthetransversalismuscle
passing in front of the rectus muscle. 22. The rectus muscle cut acrosstodisplaytheepigastricartery. 23. Thepyramidalis
muscle seen through the aponeurosis ofthe transversalis muscle. 24. Theinterlacementofthetendinousfibresof theexternal
obliquemuscle,infrontof thesymphisisof thepubis. 25,25. Theanteriorsuperiorspineof the ilium. 26,26. Poupart's liga
ment. 27.Theformofthesartoriusmuscleapparentthroughthefascialata. 28.Thesaphenousopeninginthefascialata. 29.Ab
sorbentglandsrestingonthefascialata. 30. Thespermaticcord,issuingfromtheexternalringintheaponeurosisoftheexternal
oblique muscle. 31,31. Thevasdeferens crossingtheepigastricarteryasitcurvesinwardstothesideofthebladder. 32. The
pectineus muscle. 33. The iliacus muscle. 34. The sartorius muscle. 35. The anterior borderoftheglutaeusmediusmuscle.
36. Thetensorvaginaefemorismuscle.
a. Theinternalmammaryartery, b,b. Superficialbranchesof theinternalmammarysupplyingthefrontofthesternum, c,c. Inter
costalbranchesoftheinternalmammary, d, d. Intercostalbranchesfromthesuperiorintercostalartery, e,e. Intercostalarteries
fromtheaorta,inosculatingwith theanteriorintercostalbranchesoftheinternalmammary, f,f. Externalmammarybranchesfrom
theinternalmammaryartery.
A. Theexternaliliacartery,givingofftheepigastricand circumflexiliiarteries. B. Thefemoralartery.
g,g. Small cutaneousbranchesfrom theepigastricartery, h. Inosculationoftheinternal mammary arterywiththeepigastric, i,i.The
epigastricartery, k. Thecircumflexiliiarteryatitsoriginfromthetrunkoftheexternaliliac. 1. Thecontinuationoftheartery
uponthe transversalismuscle, m. Thebranch whichfollowsthecurveofthecrestoftheilium, n,n.Thesuperficialcircumflex
ilii arteryfrom the femoral: on the right side itis seen piercing the fascia lata,andrunningoutwardstothecrestoftheilium.
o, o. Thesuperficialepigastricartery; ontheleftsideitisdividedimmediatelyafteritsorigin, p. Asmallbranchtotheinguinal
glands, q,q. Superficial external pudic arteries, r. D'-epexternal pudic artery, s. Thedeferential artery fromtheepigastric,
ramifyingalongthecourseofthevasdeferens.
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Muscular branches (r. musculares.)—Several branches are distributed to the muscles by the ulnar artery in its course alon°
the arm.
The dorsal Carpal branch (plate X. fig. 1, h; fig. 3, p: r. carpi dorsahs) is a branch of variable size, whichinclines back
wards from the ulnar artery a little before it reaches the pisiform bone. It Avinds back under the tendon of the flexor carpi
ulnaris,and reaches the dorsal surface ofthe carpus; there it gives some ramuli which anastomose with similar offsets from the
metacarpal branch ofthe radial artery, after Avhich it runs along the metacarpal bone of the little finger, and forms its dorsal
branch. From the archofanastomosis, just referred to, the second and third dorsal inter-osseous branches are derived.
The palmar Carpalbranch (r. carpi palmaris) is a very smalltwig, which runs on the anterior surface of the carpus, and
anastomoses Avith a similar offset from the radial artery.
Branches given off by the palmar arch:
The communicating branch (plate IX. fig. 2, r; r. communicans) arises alittle beyondthe pisiformbone,and sinks deeply
betweenthe flexor brevis and the abductorofthe little finger; it inosculates with the terminationofthe radialartery,and thereby
completesthe deep palmar arch.
Palmar branches (ramuli palmares.)—From the concavity and dorsal surface of the palmar arch, small branches are given
tothe parts in the palm ofthe hand.
The digitalbranches, (plate IX. fig. 1, t, u; r. digitales,) four in number,proceedforwardsfrom the convexity ofthe palmar
arch,to supply the fingers. The first branch inclinesimvards to the ulnarborder of the hand, and after giving ramusculi to the
small muscles of the little finger, runs along the inner margin of its phalanges. The secondruns along the fourth metacarpal
space,and at the root of the fingers divides into two ramusculi,which proceed along the contiguous bordersof the ring and little
fingers. The thirdis similarly disposed ofto the ring and middle fingers, and the fourth to the latter and the index;—the radial
side ofthe index fingerand the thumb are supplied from the radial artery. Eachpair ofcollateralbranches, on arriving at about
themiddleof the last phalanx of the finger, converge and form an arch,from the convexity of Avhich small ramusculi run for
wards to its termination.
The radial artery, (plate IX. figs. 1 and 2, B; plate X. figs. 1 and 3, i: arteria radialis,) in direction though not in size,
appearsto be the continuation of the brachial. Its direction is from the point of division above indicated toAvards the styloid
processofthe radius, lying obliquely along the anterior aspectofthe fore-arm, its course'being indicated bya line drawn fromthe
middle ofthe bend of the elbow to the narroAV interval betAveen the trapezium bone and the tendons of the extensors of the
thumb. These can be readily felt towards the outer border ofthe Avrist. The artery is covered by thefasciaof the arm and inte
gument,andfor some Avay is overlapped by the fleshypart ofthe supinatorlongus,whichmustbe drawn asideinordertoexpose
it. Itis at first supported by the branchesof the musculo-spiralnerve, and some cellular tissue,which separate itfrom the supi
natorradii brevi muscle; it then passes over the insertion ofthe pronator teres and the radial origin of the flexor sublimis5 after
Avhich,itlies on the flexor pollicis longus and pronator quadratus, until it reaches the end ofthe radius. To its inner side lies the
pronatorteres in the upper part of its course, and the flexor carpi radialisin the rest; its outer side being in apposition with the
supinatorlongus all the way doAvn. Two venae comites run parallel with the artery. The radial branch of the musculo-spiral
nerve liesto itsradial side during the middle third of its extent; but above thatpart the nerve is separatedfrom it by a consider
able interval,and lower down it turns backAvards, to reach the dorsal aspect of the arm, and loses all anatomical relation to it.
Opposite the end of the radius the artery inclines outwards, passingbetweenits styloid process and the trapezium, andbeneath
thetwo first extensors ofthe thumb. It then runs forwardsfor a short way, (lying in the angularintervalbetween the tendons
ofthe two firstextensorsofthe thumb and thatofthe third,) to gain the angle between the two first metacarpalbones, and makes
itsfinal turn into the palm ofthe hand, by passing between the headsofthe abductor indicis muscle.
Palmararch (deep-seated; plateIX. fig.2, r, r.)—Theterminal part of theartery (arcusvolae profundus)runs transversely
acrossthe palm ofthe hand,lying on the heads ofthe inter-osseous muscles(towhich it gives branches)and thecarpalextremities
of themetacarpal bones, and opposite the fourth bone of that name inosculates with the communicating branch from the ulnar
arterywhich completes the deep palmararch. This differs from the superficial arch, not only in being more deeply seated,(being
coveredby all the flexor tendons,) but also in retaining its size almost undiminished,and lying near the carpus.
The radial artery gives off the followingbranches:
The recurrent branch (plate IX. 1; plate X. figs. 1, d, 3, b; ramus recurrens) arches upwards from the artery soon after its
origin,runningbetAveen the branches of the spiral nerve. It lies on the supinatorbrevis,covered by the supinator longus; and
opposite the external condyle anastomoses with the terminal branches of the r. profundus superior, having in its course given
ramuli to the extensor and supinator muscles.
Muscular branches (ramuli musculares.)—Several unnamed branches are given to the muscles on the fore part ofthe arm.
The superficial Palmar branch (plate IX. fig. 1, o; fig. 2, n: r. superficialis volse) proceeds directly forwards from the
artery, Avhere it is about to turn towards the back ofthe hand, and seems like the propercontinuation of that vessel in direction,
though not in size, as it is usually small and tapering. In this respect, hoAvever, it is subject to many varieties.* This branch
*Thisvolararteryisoccasionallysolarge,thatwhendivided ithasbeenfoundnecessary,inordertostopthehemorrhage,tosecureitwithaligature.—J. P.
38 •
runs over the small muscles of the thumb at their origin, lying upon the annular ligament, to Avhich it is bound down by
a thin process of fascia, and terminates by inosculating with the radial extremity of the superficial palmar arch,Avhichitthus
completes.
Theposterior Carpalbranch (plate X. figs. 1 and 3, k; r. carpi posterior, r. dorsalis carpi radialis) arises close by the ten
dons of the radial extensor muscles,beneath which it runs upon the dorsal surface of the carpus, to anastomose withasimilar
Dranch, proceeding from the ulnar artery.
The anterior Carpalbranch (r. carpi anterior.)—Asmall branch will be found also on the anterior surface of the carpus,
arisingfrom the radial artery somewhathigherup. It is usually called ramus anterior carpi radialis, to distinguish it from a
similarbranch ofthe ulnar artery, Avith which it anastomoses.
Metacarpalbranch (plate X. fig. 1, o; figs. 3, s: r. metacarpi.)—When under the extensors of the thumb, a branch goes
offobliquely forwards as ifto gain the interval between the second and third metacarpalbones. It gives from itsulnarside one
or two ramuli,which join with small branches from the posteriorcarpalbranchofthe ulnar artery,andformanarchornet-work
ofvessels upon the carpus. The continuation of the metacarpal branch runs upon the second dorsalinter-osseousmuscle; atthe
cleft between the fingers it gives off ramuli to the dorsal surface ofthe middle and fore-finger,andcommunicateswiththe palmar
digital branch at its point ofdivision. Thispart ofthe artery is sometimes called the first dorsal inter-osseousbranch, the second
and third being derived from the arch ofarteries above noticed.
The Dorsalarteriesofthe thumb (plate X. fig. 1, 1; fig. 3, 1, m: r. dorsales pollicis) are two, which sometimes arise sepa
rately, at others by acommon trunk, Avhich dividesinto two ramnsculi thatrun alongupon the dorsal aspect of thebonesof the
thumb,one at its radial,the other at its ulnar border.
The Dorsalbranch ofthe indexfinger(r.dorsalisindicis)arises lowerdown than the preceding,and aftersendingramusculi
to the abductor indicis, runs along the dorsal surface of the index finger. Its size isvery variable.
The Digito-palmar branch of the thumb (plate IX. fig. 2, o; plate X. fig. 1, m; fig. 3, n: r. princeps pollicis) commences
where the artery isabout to turn across the palm of the hand, and after proceeding forwards between the abductor indicis and
abductorpollicis,divides, near the extremity of the first metacarpal bone, into two ramusculi,Avhich run alongthe bordersof the
phalanges of the thumb at its palmar aspect. These form its collateral branches, and unite by anastomosing upon itssecond
phalanx,in the same Avay as those of the otherfingers,derived from the superficial palmar arch.
The Digito-radial branch ofthefore-finger (plate IX. fig. 1,r; fig. 2, s; plate X. fig. 1,n; fig. 3,o; r. radialis indicis.)—
Close to the preceding, a branch arises, variable in size,but very regular in its course. It runs along the external border of
the index finger, and at its last phalanx anastomoses with the corresponding collateral branch derived from the superficial
palmar arch.
Recurrent branches (ramuli recurrentes.)—From the concavity of the deep palmar arch,ramuli proceed backwards,and
communicate Avith the carpal arteries.
Inter-osseous branches (plate IX. fig. 2,t; r. inter-ossei.)—From the convexity of the arch others run forwards along the
metacarpal spaces, supplying theinter-osseousmuscles, and anastomosing with the digital branchesof the ulnarartery.
Perforatingbranches (plateX.fig. 3,r; r. perforantes.)—These are smallramuli,usuallythree in number, whichpassback
Avards through the metacarpal spaces at theirsuperior extremities,andinosculate with the dorsal inter-osseous branches.
Varieties.—The distribution of the arteries in the hand presents,in very many instances,deviations from the arrangement
here indicated. We occasionally find the superficial palmar arch formed by the ulnar artery alone, the superficialis volae
branch being too small to extend farther than the muscles of the thumb, upon Avhich it is expended. In such cases the digital
branches of the thumb,as Avell as those of the other fingers,are derived from the ulnar artery,which is necessarily alittlelarger
than usual.
PLATE XX.
Thearteriessupplyingtheuterus,inawomanwhodiedsixdaysafterdelivery; showing theirenlargementand tortuousdistribution.
Nos. 1, 1. Thekidneys. 2,2. The ureters. 3,3. The quadratus lumborum muscles. 4,4. The small psoas muscles. 5,5. The
greatpsoasmuscles. 6,6.Theiliacusmuscles. 7,7.Theanteriorsuperiorspinousprocessoftheiliumon eachside. 8,8.Pou
part'sligamentateachside. 9. Theprominenceof thesacrum. 10. The rectum cut across. 11. The bodyofthe uterus,dis
playingitsenlargedformafterrecentdelivery. 12, 12. Theovariesconnectedby theirligamentstotheupperanglesoftheuterus.
13, 13. TheFallopiantubesterminatinginthefimbriatedextremities.
A. Theabdominal aorta. B. Thedividedtrunkofthesuperiormesentericartery. C,C. Therenalarteries. D. Thedividedinferior
mesentericartery. E, E. Thecommoniliacarteries. F, F. Theexternaliliacarteries. G,G. Theinternaliliacarteries.
a,a. Thespermaticarteriesarisingfromthemaintrunkoftheaorta,enlargedandtortuous intheircoursethrough the broadligaments
of the uterus. Theyare distributedtotheovariesand sidesof the uterus,communicatingfreely withtheuterinearteries, b,b.
Lumbar arteries, c. The middle sacral artery, d,d. The uterine arteries, arising from the internal iliacs,and ramifyingina
tortuouscourseuponthesidesandfundusoftheuterus, e,e. Thecircumflex ilii branches oftheexternal iliacarteries,ramifying
roundthecrestoftheilium,and inosculatingwithbranchesfrom the ilio-lumbararteries.
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