Surgical Anatomy - Joseph Maclise (inspirational books for students .TXT) 📗

verites separees, des qu'elles sont en assez grand nombre,
offrent si vivement a 1'esprit leurs rapports et leur mutuelle
dependance, qu'il semble qu'apres les avoir detachees par une espece de
violence les unes des autres, elles cherchent naturellement a se
reunir."--(Preface sur l'utilite des Sciences, &c.)

The comparison of facts already known must henceforward be the scalpel
which we are to take in hand. We must return by the same road on which
we set out, and reexamine the things and phenomena which, as novices, we
passed by too lightly. The travelled experience may now sit down and
contemplate.

That which I have said and proved elsewhere in respect to the skeleton
system may, with equal truth, be remarked of the nervous system--namely,
that the question is not in how far does the limit of diversity extend
through the condition of an evidently common analogy, but by what rule
or law the uniform ens is rendered the diverse entity? The womb of
anatomical science is pregnant of the true interpretation of the law of
unity in variety; but the question is of longer duration than was the
life of the progenitor. Though Aristotle and Linnaeus, and Buffon and
Cuvier, and Geoffroy St. Hilaire and Leibnitz, and Gothe, have lived and
spoken, yet the present state of knowledge proclaims the Newton of
physiology to be as yet unborn. The iron scalpel has already made
acquaintance with not only the greater parts, but even with the
infinitesimals of the human body; and reason, confined to this narrow
range of a subject, perceives herself to be imprisoned, and quenches her
guiding light in despair. Originality has outlived itself; and discovery
is a long-forgotten enterprise, except as pursued in the microcosm on
the field of the microscope, which, it must be confessed, has drawn
forth demonstrations only commensurate in importance with the magnitude
of the littleness there seen.

The subject of our study, whichever it happen to be, may appear
exhausted of all interest, and the promise of valuable novelty, owing to
two reasons:--It may be, like descriptive human anatomy, so cold, poor
and sterile in its own nature, and so barren of product, that it will be
impossible for even the genius of Promethean fire to warm it; or else,
like existing physiology, the very point of view from which the mental
eye surveys the theme, will blight the fair prospect of truth, distort
induction, and clog up the paces of ratiocination. The physiologist of
the present day is too little of a comparative anatomist, and far too
closely enveloped in the absurd jargon of the anthropotomist, ever to
hope to reveal any great truth for science, and dispel the mists which
still hang over the phenomena of the nervous system. He is steeped too
deeply in the base nomenclature of the antique school, and too indolent
to question the import of Pons, Commissure, Island, Taenia, Nates,
Testes, Cornu, Hippocamp, Thalamus, Vermes, Arbor Vitro, Respiratory
Tract, Ganglia of Increase, and all such phrase of unmeaning sound, ever
to be productive of lucid interpretation of the cerebro-spinal ens.
Custom alone sanctions his use of such names; but

  "Custom calls him to it!
  What custom wills; should custom always do it,
  The dust on antique time would lie unswept,
  And mountainous error be too highly heaped,
  For truth to overpeer."

Of the illustrations of this work I may state, in guarantee of their
anatomical accuracy, that they have been made by myself from my own
dissections, first planned at the London University College, and
afterwards realised at the Ecole Pratique, and School of Anatomy
adjoining the Hospital La Pitie, Paris, a few years since. As far as the
subject of relative anatomy could admit of novel treatment, rigidly
confined to facts unalterable, I have endeavoured to give it.

The unbroken surface of the human figure is as a map to the surgeon,
explanatory of the anatomy arranged beneath; and I have therefore left
appended to the dissected regions as much of the undissected as was
necessary. My object was to indicate the interior through the
superficies, and thereby illustrate the whole living body which concerns
surgery, through its dissected dead counterfeit. We dissect the dead
animal body in order to furnish the memory with as clear an account of
the structure contained in its living representative, which we are not
allowed to analyse, as if this latter were perfectly translucent, and
directly demonstrative of its component parts.

J. M



TABLE OF CONTENTS.

PREFACE

INTRODUCTORY TO THE STUDY OF ANATOMY AS A SCIENCE.


COMMENTARY ON PLATES 1 & 2

THE FORM OF THE THORAX, AND THE RELATIVE POSITION OF ITS
CONTAINED PARTS--THE LUNGS, HEART, AND LARGER BLOOD VESSELS.

The structure, mechanism, and respiratory motions of the thoracic
apparatus. Its varieties in form, according to age and sex. Its
deformities. Applications to the study of physical diagnosis.


COMMENTARY ON PLATES 3 & 4

THE SURGICAL FORM OF THE SUPERFICIAL, CERVICAL, AND FACIAL
REGIONS, AND THE RELATIVE POSITION OF THE PRINCIPAL BLOOD
VESSELS, NERVES, ETC.

The cervical surgical triangles considered in reference to the position
of the subclavian and carotid vessels, &c. Venesection in respect to the
external jugular vein. Anatomical reasons for avoiding transverse
incisions in the neck. The parts endangered in surgical operations on
the parotid and submaxillary glands, &c.


COMMENTARY ON PLATES 5 & 6

THE SURGICAL FORM OF THE DEEP CERVICAL AND FACIAL REGIONS,
AND THE RELATIVE POSITION OF THE PRINCIPAL BLOOD VESSELS,
NERVES, ETC.

The course of the carotid and subclavian vessels in reference to each
other, to the surface, and to their respective surgical triangles.
Differences in the form of the neck in individuals of different age and
sex. Special relations of the vessels. Physiological remarks on the
carotid artery. Peculiarities in the relative position of the subclavian
artery.


COMMENTARY ON PLATES 7 & 8

THE SURGICAL DISSECTION OF THE SUBCLAVIAN AND CAROTID
REGIONS, AND THE RELATIVE ANATOMY OF THEIR CONTENTS.

General observations. Abnormal complications of the carotid and
subclavian arteries. Relative position of the vessels liable to change
by the motions of the head and shoulder. Necessity for a fixed surgical
position in operations affecting these vessels. The operations for tying
the carotid or the subclavian at different situations in cases of
aneurism, &c. The operation for tying the innominate artery. Reasons of
the unfavourable results of this proceeding.


COMMENTARY ON PLATES 9 & 10

THE SURGICAL DISSECTION OF THE EPISTERNAL OR TRACHEAL
REGION, AND THE RELATIVE POSITION OF ITS MAIN BLOOD VESSELS,
NERVES, ETC.

Varieties of the primary aortic branches explained by the law of
metamorphosis. The structures at the median line of the neck. The
operations of tracheotomy and laryngotomy in the child and adult, The
right and left brachio-cephalic arteries and their varieties considered
surgically.


COMMENTARY ON PLATES 11 & 12

THE SURGICAL DISSECTION OF THE AXILLARY AND BRACHIAL
REGIONS, DISPLAYING THE RELATIVE POSITION OF THEIR CONTAINED PARTS.

The operation for tying the axillary artery. Remarks on fractures of the
clavicle and dislocation of the humerus in reference to the axillary
vessels. The operation for tying the brachial artery near the axilla.
Mode of compressing this vessel against the humerus.


COMMENTARY ON PLATES 13 & 14

THE SURGICAL FORMS OF THE MALE AND FEMALE AXILLAE
COMPARED.

The mammary and axillary glands in health and disease. Excision of these
glands. Axillary abscess. General surgical observations on the axilla.


COMMENTARY ON PLATES 15 & 16

THE SURGICAL DISSECTION OF THE BEND OF THE ELBOW AND THE
FOREARM, SHOWING THE RELATIVE POSITION OF THE VESSELS AND NERVES.

General remarks. Operation for tying the brachial artery at its middle
and lower thirds. Varieties of the brachial artery. Venesection at the
bend of the elbow. The radial and ulnar pulse. Operations for tying the
radial and ulnar arteries in several parts.


COMMENTARY ON PLATES 17, 18, & 19

THE SURGICAL DISSECTION OF THE WRIST AND HAND.

General observations. Superficial and deep palmar arches. Wounds of
these vessels requiring a ligature to be applied to both ends. General
surgical remarks on the arteries of the upper limb. Palmar abscess, &c.


COMMENTARY ON PLATES 20 & 21

THE RELATIVE POSITION OF THE CRANIAL, NASAL,
ORAL, AND PHARYNGEAL CAVITIES, ETC.

Fractures of the cranium, and the operation of trephining anatomically
considered. Instrumental measures in reference to the fauces, tonsils,
oesophagus, and lungs.


COMMENTARY ON PLATE 22

THE RELATIVE POSITION OF THE SUPERFICIAL
ORGANS OF THE THORAX AND ABDOMEN.

Application to correct physical diagnosis. Changes in the relative
position of the organs during the respiratory motions. Changes effected
by disease. Physiological remarks on wounds of the thorax and on
pleuritic effusion. Symmetry of the organs, &c.


COMMENTARY ON PLATE 23

THE RELATIVE POSITION OF THE DEEPER ORGANS
OF THE THORAX AND THOSE OF THE ABDOMEN.

Of the heart in reference to auscultation and percussion. Of the lungs,
ditto. Relative capacity of the thorax and abdomen as influenced by the
motions of the diaphragm. Abdominal respiration. Physical causes of
abdominal herniae. Enlarged liver as affecting the capacity of the
thorax and abdomen. Physiological remarks on wounds of the lungs.
Pneumothorax, emphysema, &c.


COMMENTARY ON PLATE 24

THE RELATIONS OF THE PRINCIPAL BLOODVESSELS TO THE
VISCERA OF THE THORACICO-ABDOMINAL CAVITY.

Symmetrical arrangement of the vessels arising from the median
thoracico-abdominal aorta, &c. Special relations of the aorta. Aortic
sounds. Aortic aneurism and its effects on neighbouring organs.
Paracentesis thoracis. Physical causes of dropsy. Hepatic abscess.
Chronic enlargements of the liver and spleen as affecting the relative
position of other parts. Biliary concretions. Wounds of the intestines.
Artificial anus.


COMMENTARY ON PLATE 25

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

The vessels conforming to the shape of the skeleton. Analogy between the
branches arising from both ends of the aorta. Their normal and abnormal
conditions. Varieties as to the length of these arteries considered
surgically. Measurements of the abdomen and thorax compared.
Anastomosing branches of the thoracic and abdominal parts of the aorta.


COMMENTARY ON PLATE 26

THE RELATION OF THE INTERNAL PARTS TO THE EXTERNAL SURFACE.

In health and disease. Displacement of the lungs from pleuritic
effusion. Paracentesis thoracis. Hydrops pericardii. Puncturation.
Abdominal and ovarian dropsy as influencing the position of the viscera.
Diagnosis of both dropsies. Paracentesis abdominis. Vascular
obstructions and their effects.


COMMENTARY ON PLATE 27

THE SURGICAL DISSECTION OF THE SUPERFICIAL PARTS AND
BLOODVESSELS OF THE INGUINO-FEMORAL REGION.

Physical causes of the greater frequency of inguinal and femoral
herniae. The surface considered in reference to the subjacent parts.


COMMENTARY ON PLATES 28 & 29

THE SURGICAL DISSECTION OF THE FIRST, SECOND, THIRD, AND
FOURTH LAYERS OF THE INGUINAL REGION, IN CONNEXION WITH THOSE
OF THE THIGH.

The external abdominal ring and spermatic cord. Cremaster muscle--how
formed. The parts considered in reference to inguinal hernia. The
saphenous opening, spermatic cord, and femoral vessels in relation to
femoral hernia.


COMMENTARY ON PLATES 30 & 31

THE SURGICAL DISSECTION OF THE FIFTH, SIXTH, SEVENTH, AND
EIGHTH LAYERS OF THE INGUINAL REGION, AND THEIR CONNEXION WITH
THOSE OF THE THIGH.

The conjoined tendon, internal inguinal ring, and cremaster muscle,
considered in reference to the descent of the testicle and of the
hernia. The structure and direction of the inguinal canal.


COMMENTARY ON PLATES 32, 33, & 34

THE DISSECTION OF THE OBLIQUE OR EXTERNAL,
AND OF THE DIRECT OR INTERNAL INGUINAL HERNIA.

Their points of origin and their relations to the inguinal rings. The
triangle of Hesselbach. Investments and varieties of the external
inguinal hernia, its relations to the epigastric artery, and its
position in the canal. Bubonocele, complete and scrotal varieties in the
male. Internal inguinal hernia considered in reference to the same
points. Corresponding varieties of both herniae in the female.


COMMENTARY ON PLATES 35, 36, 37, & 38

THE DISTINCTIVE DIAGNOSIS BETWEEN EXTERNAL AND INTERNAL
INGUINAL HERNIAE, THE TAXIS, SEAT OF STRICTURE, AND THE OPERATION.

Both herniae compared as to position and structural characters. The
co-existence of both rendering diagnosis difficult. The oblique changing
to the direct hernia as to position, but not in relation to the
epigastric artery. The taxis performed in reference to the position of
both as regards the canal and abdominal rings. The seat of stricture
varying. The sac. The lines of incision required to avoid the epigastric
artery. Necessity for opening the sac.


COMMENTARY ON PLATES 39 & 40

DEMONSTRATIONS OF THE NATURE OF CONGENITAL AND
INFANTILE INGUINAL HERNIAE, AND OF HYDROCELE.

Descent of the testicle. The testicle in the scrotum. Isolation of its
tunica vaginalis. The tunica vaginalis communicating with the abdomen.
Sacculated serous spermatic canal. Hydrocele of the isolated tunica
vaginalis. Congenital hernia and hydrocele. Infantile hernia. Oblique
inguinal hernia. How formed and characterized.


COMMENTARY ON PLATES 41 & 42

DEMONSTRATIONS OF THE ORIGIN AND PROGRESS
OF INGUINAL HERNIAE IN GENERAL.

Formation of the serous sac. Formation of congenital hernia. Hernia in
the canal of Nuck. Formation of infantile hernia. Dilatation of the
serous sac. Funnel-shaped investments of the hernia. Descent of the
hernia like that of the testicle. Varieties of infantile hernia.
Sacculated cord. Oblique internal inguinal hernia--cannot be congenital.
Varieties of internal hernia. Direct external hernia. Varieties of the
inguinal canal.


COMMENTARY ON PLATES 43 & 44

THE DISSECTION OF FEMORAL HERNIA AND THE SEAT OF STRICTURE.

Compared with the inguinal variety. Position and relations. Sheath of
the femoral