Sinelnikov Vol III

R.D.
SINELNIKOV
ATLAS
OF
HUMAN
ANATOMY
IN T H R E E VOLUMES
Volume III
The Science
of the Nervous System,
Sense Organs,
and Endocrine Glands
Translated from the Russian
by
Ludmila Aksenova, M.D.
<&vgy
MIR PUBLISHERS
MOSCOW
Created with novaPDF Printer (www.novaPDF.com)

CONTENTS v
The Meninges of the Spinal Cord and Brain . . . 103
T H E SCIENCE O F T H E NERVOUS SYSTEM
The Dura Mater
The Nervous System ' The Spinal Dura Mater
108
The Central Nervous System The Dura Mater of the Brain
2
The Spinal Cord and The Brain | The Arachnoid Mater
2 l l 4
The Spinal Cord The Spinal Arachnoid Mater
l l 5
The White and Grey M atter of the Spinal Cord The Arachnoid Mater of the Brain
7
The Brain The Pia Mater *j
U 7
The Cerebrum The Spinal Pia Mater
l18
Surfaces, Sulci, and Gyri of the Cerebrum . - The Pia Mater of the Brain
The Corpus Callosum
The Lateral Ventricles 119
TheFoniix ^ The Peripheral Nervous System
The Diencephalon The Cranial Nerves (Ya.R.Sinelmkov) **
57
The Third Ventricle The Olfactory Nerves
The Basal Nuclei of the Telencephalon . - fi7 The Optic Nerve *
The Mid-Brain 61 The Oculomotor Nerve . . . . . -
12
TheTectum of the Mid-Brain The Trochl ear Nerve
13
The Cerebral Peduncles The Trigerfrinal Nerve
140
The Isthmus Rhombencephah The Abducent Nerve
14
The Hind-Bram ' The Facial Nerve *
The Pens The Auditory Nerve
l45
4 The Glossopharyngeal Nerve
The Medulla Obbngata ' l 7
75
The Vagus Nerve *
The Fourth Ventricle The Accessory Nerve *
Cranial Nerves Nuclei in the Brain Stem , -
77 The Hypoglossal Nerve * -
The Cerebellum Development and Age Features of the Cranial
Brief Review of the Conducting Pathways of the
Nerves . . . . - -
Spinal Cord and Brain
The Ganglia of the Cephalic Part of the Autonomic
The Grey and White Matter of the Spinal Cord
Nervous System '. * '
and Brain The Spinal Nerves
The Grey Matter of the Spinal Cord , . .
The Posterior Primary Rami of the Spinal Nerves . . Ifl
The White Matter of the Spinal Cord . . . . The Anterior Primary Rami of the Spinal Nerves . . 171
The Cerebral Cortex and Localization of the
The Cervical Nerves
Cortical Ends of the Analysers (Centres) . 92
The Posterior Primary Rami of the Cervical Nerves 171
The White Matter of the Bram
The Anterior Primary Rami of the Cervical Nerves
The Ascending (Afferent) Tracts of the Spinal Cord l
The Cervical Plexus '
and Brain - The Communications of the Cervical Plexus . . 175
The Ascending (Afferent) Tracts Arising in the The Cutaneous Branches of the Cervical Plexus
Spinal Cord The Muscular Branches of the Cervical Plexus . 176
The Ascending (Afferent) Tracts Arising in the
The Brachial Plexus
o &JL . . IOO 1S
bram dtem The Supraclavicular Part *
The Infraclavicular Part (The Long Branches) . 188
The Conducting Tracts of the Cerebellum . . 100 204-
The Descending (Efferent) Tracts of the Brain and The Thoracic Nerves
101
Spinal Cord

6 CONTENTS
T h e Lumbar, Sacral, and Coccygeal Nerves . . . . 212 T h e Nerves of the Intestine . . . . 294
T h e Lumbar Nerves 212 T h e Nerves of the Liver and Gall Bladder 294
T h e Posterior Primary Rami 216 T h e Nerves of the Pancreas 295
T h e Anterior Primary Rami 216 T h e Nerves of the Spleen , , . 296
T h e Lumbar Plexus 216 T h e Nerves of the Kidneys . , 296
T h e Branches of the Lumbar Plexus 216 T h e Nerves of the Urinary Bladder 296
T h e Sacral Nerves 230 T h e Nerves of the Testis 297
T h e Posterior Primary R a m i 230 T h e Nerves of the Uterus . . . 297
T h e Anterior Primary Rami 230 T h e Nerves of the Vagina , , , 298
The Sacral Plexus 231 Development and Age Features of the Nervous System
T h e Short Branches 231 (Ya. R. Siuehukov) 299
T h e Long Branches 231
T H E SCIENCE O F T H E SENSE ORGANS
T h e Coccygeal Plexus 243
[ h e Branches of the Cuccvgeal Plexus . . . . 243 T h e Sense Organs , , 302
The Organ of Sight . , , 303
The Aulimotnic {Vegetative) Nervous System 24-8 T h e Eyeball 303
T h e Sympathetic Part of the Autonomic Nervous T h e Fibrous Coat of the Eye 304
System 248 T h e Vascular Coat of the Eye 304
T h e Cephalic Part of the Sympathetic Nervous T h e Choroid 304
System 249 T h e Ciliary Body , 306
T h e Cervical Part of the Sympathetic Nervous T h e Iris , . , . 307
System 250 T h e Nervous Coat of the Eye . . . . . . . 308
T h e Superior Cervical Ganglion . . . . . . 250 T h e Vitreous C h a m b e r 311
T h e Middle Cervical Ganglion . . . , - . . 252 T h e Accessory Organs of the Eye 313
The Vertebral Ganglion 258 T h e Lacrimal Apparatus 318
T h e Inferior Cervical Ganglion 258 T h e Muscles of the Eyeball. T h e Fasciae of the Orbit 318
T h e Thoracic Part of the Sympathetic Nervous T h e Vessels of the Eyeball 320
System 258 T h e Arteries 320
T h e Branches of the Thoracic Part of the T h e Veins 321
Sympathetic Trunk 262 T h e Nerves of the Eyeball 322
T h e Lumbar Part of the Sympathetic Nervous Development and Age Features of the Organ of Sight 322
System 263 The Organ oj Hearing 324
T h e Coeliac Plexus 263 T h e External Ear 324
T h e Pelvic Part of the Sympathetic Nervous System 276 T h e Auricle 324
T h e Pelvic Plexus 278 T h e External Auditory MeatUS . . . . . . . 327
T h e Parasympalhetie Part of the Autonomic Nervous T h e Tympanic M e m b r a n e 328
System 280 T h e Middle Ear 329
T h e Cephalic Part of the Parasympathetic Nervous T h e Tympanic Cavity 330
System 281 T h e Pharyiigolympanic T u b e 330
T h e Mcsenccphalic Part of the Parasyrnpathelie T h e Auditory Ossicles 332
Nervous System 281 T h e Malleus 332
T h e Rhombencephalic Part of the Parasympa- T h e Incus 335
thetie Nervous System 281 T h e Stapes 335
T h e Sacral Part of the Parasym pathetic Nervous T h e Mucous Membrane of the Tympanic Cavity , 336
System 284 T h e Internal Ear . 338
T h e Intramural Nervous System 284 T h e Bony Labyrinth 338
T h e Visceral Nerves 287 T h e Vestibule 338
T h e Nerves of the Submandibular and Sublin- T h e Semicircular Canals 339
gual Glands 287 T h e Cochlea 340
T h e Nerves of the Heart 287 T h e Membranous Labyrinth 342
T h e Nerves of the Trachea 288 T h e Duct of the Cochlea 343
T h e Nerves of the Lungs 292 T h e Saccule and the Utricle 344
T h e Nerves of the Oesophagus 293 The Semicircular Ducts 346
T h e Nerves of the Stomach 294 T h e Internal Auditory Mcatus 346

CONTENTS 7
346 THE E N D O C R I N E G L A N D S
The Vessels of the Organ of Hearing . . 347 The Thyroid Gland . . . . 366
The Nerves of the Organ of Hearing . 349 The Parathyroid Glands . . . 371
Development and Age Features of the Or < r ; i l 1 0 "H ear ttg The Thymus 373
350 The Suprarenal Glands . . . 377
The Pariganglia . . . . . 377
The Carotid Body . . . . 379
The Organ of Taste sst The Supracardi&l Faraganglion 380
The Lumbo-Aortic Paraganglion 380
Tht Organ of Smell 352
The Aortic Bodies . . . . 381
353
353 The Coccygcal Body . . . 383
The Appendages of the Skin 356 T h e Sex Glands 383
The Glands of the Skin . , . 356 The Hypophysis Cerebri 384
The Nails 357 The Pineal Body 386
357 The Pancreas (Endocrine Part) 387
The Vessels of the Skin 364 Development and Age Features of the Endocrine Glands
The Nerves of the Skin 364

ABBREVIATIONS AND SYMBOLS
A., a.., Aa., aa.arteria, arteriae.
V., v., W . , w. vena, venae.
M., m., Mm., mm. musculus, musculi.
Lig., lig., Ligg., ligg. li game ntum, ligamenta.
Gl.r gl., Gil., gll. glandula, gtandulae.
N., n., Nn., nn. nervus, nervi.
R., r., Rr., rr.ramus, rami,
S., sen, sivenr,
C|, C3, Csfirst, second, third cervical nerve.
Th^Thj, Thjfirst, second, third thoracic nerve.
L], L4, Lj first,second, third lumbar nerve,
Sj, Sj, Safirst, second, third sacral nerve.
Constantly present nerve segments arc put in round brackets, e.g. (Gj, C s ), (Thj, Thj).
Inconstantly present nerve segments are put in routid brackets which are enclosed within square brackets,
e.fr [C^CsJ-CfCs)].
(/i)> (J4) etc. in the captions show the proportion of the size of the drawings to the natural size.

THE NERVOUS SYSTEM
Systema neroosum
T h e nervous system (syskma nervoaum)] (Fig. 721) controls and rection (if nerve impulse conduction is from the dendrites and cell
regulates all functions of the body, coordinates its activity as a body on the axon which branches and comes in contact with the
single whole, and ensures an appropriate reaction to stimuli. cell bodies, axons, and dendrites of die neighbouring neurons.
In the living organism the nervous system is concerned with Contact between the neurons is accomplished through the syn
the introduction of information, its analysis and synthesis, integra apse, a zone specialised in transmitting the nerve impulse.
tion and storage in time, and with conduction of the programmed T h e zone of the synapse is structurally the most complicated in
signals to the effector organs, the neuron svstem. T h e nerve impulse is transmitted here via me
T h e anatomo-physiological basis of this activity is the n e u r o n , diators and with delay in time. T h e n u m b e r of nerve connections
or nerve cell, possessing processes and functioning among the sup of the neuron is determined by the number of dendrite branching
porting cells of the neuroglia. points. It is believed that memory is coded dirough the increase in
T h e neuron has a cell body (corpus murtxyti), a long process the number of these points, i.e. is linked with the formation of new
called the axon (the old name for which is neurit) and short pro contacts between the neurons.
cesses known as dentrites (dtndrita). T h e anatomical and functional union of the neurons creates
According to the number of the processes, the following neu the path for die nerve impulse; this is the reflex arc which is
rons are distinguished morphologically: multiped ar (with multiple formed by at least two neurons.
processes); bipolar (with two processes), and pseudo-unipolar T h e neurons function among the cells of the neuroglia, where
(with one process which eventually becomes T-sbaped). as the .subsequent metabolic processes occur in the nerve tissue.
T h e neuron is a highly specialized cell which perceives stimuli, T h e r e are up to ten glial cells per one neuron.
transforms and then conveys them either to other neurons or to T h e formation of the final structure of an individual's nervous
the effector organs. system is preceded by a complex course of ontogenetic develop
T h e neuron interacts with the neighbouring nerve cells to ment.
transmit the signal, the nerve impulse, to them. T h e common di- T h e nervous system develops from the outer germinal layer,
the ectoderm. T h e system is laid down at first as the neural, or
medullary, plate which is a thickening of the ectoderm along the
1
English equivalents to the Latin terms are given according to dorsal surface of the trunk. T h e plate edges thicken eventually and
Birmingham Revision (BR) of the Paris Anatomical Nomenclature approach each other, while the plate itself becomes deeper to form
(NA) {BuUervorths Medical Didionary, 1978, second edition, the neural, or medullary, groove. T h e edges of the plate, which
Editor-in-Chief MacDonald Critchley). have taken die shape of thickened neural folds, fuse to form the

nceptialon (cerebrum)
Plexus bracli^lii>r;
Rr. ventrales {nn, inlercostales)
Truncus sympathlcus
N. medianus
Medulla spinalis
-N. radial Is
Rexus lurnlxtlts -t
.N, ulnaris Cauda erjuina
PfejtMS sacralis
N, femoral is -
- N . coecygeus
N- peroneus (fibuiaris)
eommunis
721. Nervous system (semischematical representation).

(The body is shown as if transparent.)

12
T H E BRAiN
Neuroporus anterior
722. Brain of embryo; right aspect.

(Stage of three cerebral vesicles.)

THE BRAIN 13
Place of pineal body

formation
Corpora mamiliaria
rosencephaloii
Rhombencephalon
Optic stalk
\ "Mnfundibulum
N. trlgtmtnuS
N. iaclalls
N. vestibulocochlearis
-^ N. gloss opharyngeus
N, accessorlus\\ ,. 3
1 Ti
^nMl s
723. Brain of 10.2-mm-long embryo; right aspect
(Stage of five cerebral vesicles; reconstruction.)

H
T H E BRAIN
-i,,. .
Thalatnus
Place ol' pineal body \
formation
Fissura
transver&a eerebri
Presence phalon
Cerebellum
Rhorabencephalon
Corpus strifltum^'" "7*^PPr

Lamina termlnalis J
Chiasma optlcum
SuJcus KmJtans
724. Brain of10.2~mm-long embryo; right half, inner aspect.

(Cavity of cerebral vesicles.)

T H E BRAIN lr
Sulcus mesodlencephflllctiB
on
,Y\^
Lamina tccti
Place of pineal body
formation
N. trochlearls Corpora tnafflillaria
-Fissura telodiencephaltca
N. accessorlus
^Lobus olfactorlus
N. iaclalls y \ S Q ^ ^
r T K, vestibulacochleafis \ \ ^ ^ ^ ^
^ , hypoglossus \ N. glossopharyngeus ^Hypophysis

N. vagus
725. Brain of 13.6-mm4ong embryo; right aspect.

(Reconstruction,)

16
T H E BRAIN
Pedunculus cerebrf Corpus plneale

Recess us genicuH \
/Aquaeduetus cerebrl
Epitfialamus
*G?/J| ....-Hypothalatnus
Tiislamus
Pallium
Flssura chorloldea
Foramen
InterventrlctiUre^*? ^ J
Corpus strlatum .' X Vl - Cerebellum
Lamina terrnfnalls-^ ^
Rhltieiict'phalon / /
// \
Recessus
1
Recessus opticus ' / / ""indibuli
Chlasma optlcum/ /
Hypophysis Medulla oblonata'
i W*
726. Brain of 13.6-mm-longembryo; right half; inner aspect.

(Cavity of cerebral vesicles.)
neural, or medullary, tube. T h e tube then sinks deeper and sepa

tube considerably changes not only its inner structure but also its
rates from the ectoderm from which it has formed.
appearance and the shape of the cavity.
At the same time, ganghonic plates form at the junction of the
T h e cranial, expanded part of the neural tube develops into the
forming medullary tube and the ectoderm from cells which were
brain (mtephalon), the remaining part gives origin to the spinal
components of the Termer thickened folds. They separate later:
cord (vudulla spinalisj (Figs 722 f 730).
some of them, lying as, crests on the sides of the neural tube nearer
to its dorsal parts, give rise to the spinal ganglia (ganglia Neurons, being components of the developing nervous system,
spmaUa).
part of the nerve cells migrate to the periphery eventually to form connect by means of their processes different parts of the brain or
the neum-ganglicnic conglomerates of the autonomh: (vegetative) spinal cord, in which case they are called the connector neurons,
nervous system. or communicate the nervous system with other organs and are
called the receptor (sensory, or a Hector) and m o t o r - s o m a t i c and
T h e cells of the neural tube differentiate into neuroblasts,
autonomic (effector) neurons.
which form neurons (the nerve cells) and their processes, and into
T h e axons of the receptor and effector neurons are com
spongioblaMs which give rise to the elements of the neuroglia ( a
ponents of nerves fnervi) which arise from the brain and spinal
tissue of auxiliary arid trophic importance).
cord.
T h e highly differentiated and irregular growth of the neural
T h e central nervous s y s t e m - t h e brain and spinal c o r d - i s

T H E BRAIN 17
Sulcus idesodiencephaucus
Polus occipitalis
Cerebellum
J N. optiqus \ Polus fronlulis

Lobus
Tuber dnereum o'factcrius
727. Brain of 50-mm-long embryo; right aspect.

(Reconstruction.)
composed of the grey matter (subdantia grisea) and the white mat the central canal or the spinal cord (mnalis centralis) containing the
ter (sahftantia alba). The grey matter consists largely (but not only) cerebrospinal fluid (liquor cerebrospinalis).
of a collection of nerve cells, while the white matter is Formed of The brain develops from the expanded cephalic part of the
neuronal axons. The grey colour is also characteristic of those neural tube. This pan is separated by two constrictions first into
areas of the nervous system which contain collections of cell bod three primary vesicles (Fig. 722); the anterior cerebral, or cephalic,
ies of neurons which had migrated far beyond the neural tube vesicle developing into the forebrain (prosencephalon), the middle
(sympathetic and other ganglia). cerebral vesicle, developing into the mid-brain (mesentephatonj, and
In the part of the neural tube giving rise to the spinal cord, the the posterior cerebral vesicle, forming the hind-brain (tkowbmit-
nerve cells are concentrated in the circumference of its cavity to fhaloti). Five secondary vesicles form later (Figs 723-729) when the
form the grey matter, in which a posterior horn (cornu posterius), an forebrain separates into two vesicles: the first cerebral vesicle, or
anterior horn {cornu anterius), and a lateral horn (cornu laterak) are the teleneephaloa (the end brain), and the second cerebral vesicle,
distinguished (see Fig, 733). The processes of these cells are ar^ or the diencephahm (between brain). The mid-brain does not sep
ranged on the periphery or the wall of the tube and take part in die arate but becomes the third cerebral vesicle. The hind-brain sepa
formation of the white matter. With the gradual development of rates to form two vesicles: the metencephalon and die myelence-
the spinal cord the cavity of the tube narrows and transforms into phalon.

]H T H E BRAIN
Sulcus postcentralls Sulcus central Is

Lobus partetalfs
Sulcus precentratis
Sulcus Inlraparietalis
Lobus Iron tails
R. posterior Sulcl laterals ^fti"""*
Lobus ocdpitalfs
Fossa laterally cerebri
Diencephalon
^Lobus temporalts
Cerebellum
* -Medulla oblongata
H
728. Brain of13-cm-long embryo; right aspect.
As the result of the irregular growth of the brain, a series of come the fourth ventricle (ventriathts quartus) which communicates
flexures Form at this time: parietal at the level of the raid-brain, posteriorly with the subarachnoid space (cavum stibaraehruiideaU) by
pontine in the region oF the metencephalon, and occipitalin means of lateral and medial apertures and an opening in the infe
the region of the posterior cerebral vesicle at the junction between rior medullary velum.
the spinal cord and the rayelenccphalon. T h e anterior part of the metencephalon, called the isthmus
Due to the marked thickening of the walls of the cerebral vesi rhnmbencephali, gives rise to the superior cerebellar peduncles
cles and the increasingly complicated relief of the brain surface, (pedunculi eerebellares superiores) and the superior medullary velum
the cavities of the vesicles acquire the shape of slits varying in size (vdum medullare superius); the pons develops from the anterior por
and position. These are the ventricles of the brain (ventriculi cerebri) tion of the metencephalon, and the cerebellum from the poste
which are filled with the cerebrospinal fluid. The ventricles com rior middle and lateral portions.
municate with one another and with the central canal of the spinal T h e dorsal wall of the mesencephalon forms the tectum of the
cord. The wall of each cerebral vesicle develops into a definite part mid-brain {tedum mesenccphali), or the tectal lamina; the ventral
of the brain, whereas the cavity becomes the cavity of the corre wall develops into the cerebral peduncles (pedurtculi cerebri). The
sponding ventricle, cavity of the mesencephalon becomes a narrow canal known as the
T h e anterior wall of the posterior part of the rhombence- aqueduct of the mid-brain (aqueductus cerebri) which communicates
phalon, the myelencephalon, develops into the medulla ublongata; the third and fourth ventricles (see Fig. 764).
the posterior wall docs not differentiate and remains a thin lamina The intensively developing lateral walls of the diencephalon
forming the inferior medullary velum (velum medullare inferius). form the thalami, and the ventral wall gives rise to the hypothala-
T h e cavities of the metencephalon and myelencephalon be mus; the dorsal wall gives origin to the pineal body (corpus pine&U)

T H E BRAIN 19
728a. Brain of newborn, right hemisphere; lateral aspect {%).
but remains undifferentiated for a considerable distance to form from the external and internal environment and transforming
the Lamina epithelial is. The cavity of the diencephalon transforms these stimuli into nerve impulses which are transmitted to the spi
into a narrow sagittal slit between the right and left tbalami this nal cord and brain.
is the third ventricle (uentrittilus tertius) which communicates The effector (efferent, or centrifugal) nerves are an aggregate
through the paired interventricular foramen (foramen interventricu- of processes of nerve cells whose bodies form nuclei of the spinal
lart) with each lateral ventricle, respectively. nerves in the spinal cord and nuclei of the crania! nerves in the
The tclcncephalon forms the cerebral hemispheres (hemispfteria brain stem. They terminate on the periphery as effectors which
cerebri) which cover all the other cerebral vesicles and for this rea transmit the impulses From the brain and spinal cord to the effec
son the first cerebral vesicle is known as the pallium (L mantle). tor organs (muscles, glands).
The cavity of the telencephalon Forms two lateral ventricles (ventri- Several neurons take part simultaneously in propagating the
culi laterales) the left one being conventionally considered the first stimulus along the affector and effeelor pathways. They are ar
lateral ventricle. ranged sequentially and come in contact (synapse) to form the re
The spinal eord and the brain developing from the neural flex arc. A simple reflex arc usually consists oF three neurons:
tube, together with the nerves originating from them, are a single affector, intertiuiicial, and effector. Many neurons participate in a
whole, both anatomically and Functionally. complex reflex arc.
The affector (afferent, or centripetal) nerves are an aggregate Taking into consideration the topographic peculiarity of the
of the peripheral processes of cells of the spinal or cranial nerve prevalent localization of most nerve cell bodies in the brain and
ganglia. spinal cord, and the important functional role of the brain and spi
They begin on the periphery as receptors, appreciating stimuli nal cord in the body, the integrated nervous system is arbitrarily

20 T H E BRAIN
Hemispheriurti
Corpus callosum
Septum pellucifjuin 'U.
CommissLira antcrio
Lamina leiminalis
urn medullare <..j[ier:
Corpus mamillare
Chiasma optkmn '
erebellum
111 full :ii!i.ihn:i
robus anterior (adeiiohvpophysjs)
Hypophysis
lobus posterior (neuruiiYpophysis) Pedunculus cerebrr y m medfillare itifertus
/
Jsthmus Pons
rhombencephaU
Medulla spinalis
729. Brain of adult, right hemisphere; medial aspect (%).
divided into the central nervous system (systema. nervusum central)

marked by specific distribution and structure (formation of plex
composed of the brain and spinal cord, and the peripheral nervous uses, presence of nerve ganglia and cells along the distribution of
system (systema nervosutnperipkericum) comprising the Cranial nerves nerves and in the walls of organs).
(nervi eraniales) and the spinal nerves fnervi spinales) with a complex
O n the basis of functional and morphologic features the auto
of ganglia and nerve plexuses (plexus nervosi).
nomic nervous system is subdivided into the sympathetic nervous
Besides, the autonomic (vegetative) nervous system (systema system (pars sympathies systematis nervosi attionomici) and the para-
neroosvm autommiaim) is distinguished. It is a component of the sympathelic nervous system (pan parasympathica systematis nervosi
nervous system, and its central parts have definite points of locali autonomia).
zation in the brain and spinal cord, while its peripheral parts are

THE CENTRAL NERVOUS SYSTEM
Systema nervoswm centrale
THE SPINAL CORD AND THE BRAIN
and the newer brain (enaphalon) lodged hi Lhe cavity of the skull.
T h e central nervous system (systema nervosum, centrale) (or the
central part of the nervous system) consist* of the phylogenetically Both are related genetically, morphologically, and functionally and
older spinal cord (medulla spinalis) situated in the vertebral canal are continuous.
THE SPINAL CORD

taining elements of the nervous tissue, is a connective-tissue for
The spinal cord (medulla spimdis) (Figs 730, 731) is phylogenet
mation penetrating together with the spinal dura mater (dura muter
ically the oldest element of the nervous system with maintained
spinalis) into the sacral canal. They fuse in the canal and are at
rrlarively simple structure (as compared to the brain) and marked
tached at its end. The part of the filum terminale which lies in the
segmental organization.
cavity or the dura mater and is not fused with it is known as the in
T h e spinal cord connects the brain with the periphery and is
ternal Glum terminale, while the part fused with the dura mater is
concerned with scgmetital reflex activity.
the external filum terminale. The filum terminale is accompanied
It stretches in the vertebral canal from the upper border of the
by the anterior spinal arteries and veins and one or two roots of
first cervical vertebra to the first lumbar or upper border of the
the coccygeal nerves.
second lumbar vertebra. It repeats, to a certain measure, the curva-
The spinal cord does not completely nil the cavity of the verte
n u t s of the corresponding parts or the vertebral column. The spi
bral canal: a space containing fatty tissue, blood vessels, meninges,
nal cord of a 3-month-old embryo terminates at Lhe level of the
and cerebrospinal fluid lies between the walls of the canal and the
fifth lumbar vertebra, that of a newborn at the level of the third
himbar vertebra. spinal cord. The size of the space varies with the level.
Proximally the spinal cord is continuous with the medulla ob- The spinal cord of an adult measures Trom 40 to 45 cm in
longata. This junction corresponds to the point of exit of the first length, 1.0 to 1.5 cm in width, and weighs u p to 30 g on the aver
cervical spinal nerve; skeletopkally it lies at the level between the age.
lower margin of the foramen magnum of the occipital bone and Four surfaces are distinguished on Lhe spinal cord: anterior,
the upper bolder of the first cervical vertebra. slightly flattened; posterior, slightly bulging, and two lateral almost
Distally the spinal cord is continuous with the conus medulla- rounded surfaces which are continuous, respectively, with the ante
n i which is in turn continuous with the filum terminalea rem rior and posterior ones.
nant (up to 1 mm in diameter) of the reduced distal portion of the T h e spinal cord is subdivided into four parts: the cervical part
spinal cord. T h e filum terminale, except for its upper parts con (pan cervicalis medullae spinalis), the thoracic part (pars thomcica me-

22
THE SPLNAL CORD
Cullkulus inferior
Pedunculus eerebelliiris
Olive superior
PedunenliB cerebdlaris
Medulla oblortgata mod i us
Fossa rhomboidea
DecussaUo
-Intumescentia
Intumesrcntia CV c-ervicalis
ccrvk:alis
-Fissura medlana Thll

{ anterior)
Suicus medianus
(posterior)
-Suicus laterals
posterior
ThX-
TtiXII -intumescentia
Intumescentia hnnballs
luniijalis
L1I-.
~Conus medullaris
"onus medullaris.
Ftlum terminale -Fllum terminate
730. Spinal cord (medulla spinalis) (%).

Aanteiior aspect; B posterior aspect.
(All spinal cord meningt-si and roots are removed.)

<2:i
T H E SPINAL C O R D
cord lies a deep anterior median Assure (fisura mediana anterior me~
fr/i.. spinaiis), the lumbar part (pars lumbalis medullat spinaiis), and
dullat spinaiis) (Figs 732, 7S3) into which a fold of the pia mater
tbr comis medullaris (Figs 730 and 839). Each part contains a
dips to form the anterior median septum. The fissure is shallower
definite number of segments, i.e. spinal cord segments which give
at the proximal and distal ends of the spinal cord.
origin to one pair of spinal nerves (right and left),
A very narrow posterior median sulcus (sulcus mtdianus posterior
The spinal cord consists of eight cervical segments (segmenta
mtdulhe spinaiis) runs on the posterior surface of the spinal cord,
wxduUat spinaiis cervkalis 1-VUl), twelve thoracic segments (stg-
into which a plate of gtial tissue penetrates to form the posterior
mtnta mtdullae spinaiis thoraticat I-XII), five lumbar segments (stg-
median septum,
motto medullat spinaiis lumbalis l-V), five sacral segments (stgmwta
The fissure and the sulcus divide the spinal cord into the right
matullae spinaiis sacralis l-V), and one to three coccvgea) segments
and left halves which are joined by means of a narrow bridge of
fjegmenta. meddlae spinaiis couygta l-III).
medullary tissue with the central canal of the spinal cord (canalis
It is easier to study the relationships between the white and
cmtralu medullae spinaiis) m the middle.
grey matter on spinal cord sections, especially those made through
Two shallow suki stretch on the sides of each hair of the spinal
the horizontal planes.
cord. These are the anterior lateral sukus of the spinal cord (sulcus
The spinal cord does not have the same diameter for the whole
lakralu anterior medulla* spinaiis) (BNA) running lateral to the ante
distance, but thickens slightly [rom the distal to the proximal end.
rior median fissure and further away from il in the proximal and
Forming spindle-shaped thickenings, it has the largest swelling in
middle parts of the spinal cord than in the distal part, and the pos
two parts: the cervical enlargement (intumescentia cervkalis) which
terior lateral sulcus of the spinal cord (sukus lateral posterior medul-
corresponds to the exit or the spinal nerves passing to the upper
lae spinaiis) lying lateral to the posterior median sulcus. The ante
limbs, and the lumbar enlargement (tntumescentia lumbalis) coiTe-
rior lateral and the posterior lateral sulci run almost the whole
sponding to the exit of nerves which stretch to the lower limbs.
length of the spinal cord and are the site of exit of the anterior and
The diameter of the spinal cord is 1.3-1.5 cm in the region of the
posterior roots of the spinal nerves, respectively.
cervical enlargement, 1 cm in the middle of the thoracic part, and
In the cervical and partly in the upper thoracic portions is an
1.2 cm in the region of the lumbar enlargement; the antero-poste-
indistinct posterior intermediate sulcus (sukus intermedia posterior)
rior width measures up to 0.9 cm in the region of the enlargements
passing between the posterior median and posterior lateral sulci.
and 0.8 cm in the thoracic part.
Still another sulcus is sometimes found in the foetus and the
The cervical enlargement stretches from the level of the third
newborn. It is called the anterior intermediate sulcus (sulcus intcr-
or fourth cervical vertebra to the second thoracic vertebra and is
medius anterior) (BNA). It stretches on the anterior surface of the
thickest at the level of the fifth or sixth cervical vertebra (fifth to
upper parts of the cervical portion of the spinal cord between the
sixth cervical spinal nerves). The lumbar enlargement is between
anterior median fissure and the anterior lateral sulcus, and sepa
the ninth or tenth thoracic vertebra and the first lumbar vertebra
rates the intersegmental tract (fasciculus proprius medullat spinaiis)
and its diameter is largest in the region of the twelfth thoracic ver
from the anterior corticospinal tract (tractus cortkospimlis fjryrami-
tebra (third lumbar spinal nerve).
dalisj anterior),
Along the entire length of the anterior surface of the spinal
THE WHITE AND GREY MATTER OF THE SPINAL CORD

The above described sulci on both halves of the spinal cord
Transverse sections of the spinal cord show the arrangement of
(except for the posterior intermediate sulcus) separate the white
the white and grey matter. The grey matter occupies the central
matter of each half along its length into three white columns of the
part and is shaped like a butterfly with its wings spread or like the
spinal cord (funiculi medulla? spinaiis)'. (1) anterior white column
letter H, The white matter is arranged around the grey matter and
(funiculxs anterior), part of the white substance between the anterior
is on the periphery of the spinal cord (Figs 732, 733).
median fissure and the anterior lateral sulcus, or the line of emer
The white matter of the spinal cord (substantia alba mtdvllae spi
gence of the anterior roots of the spinal nerves; (2) lateral white
naiis) (Fig. 733) is for the most part a complex, varying in length
and thickness, system of medullated and partly of nomnedullatcd column (fankulus latsralis) stretching between the anterior lateral
nerve fibres, supporting cells (neuroglia), and blood vessels which and posterior lateral sulci; (3) posterior white column (fumculus
are surrounded by a small amount ol connective tissue. Posterior) passing between the posterior lateral and posterior me
The white matter of one half of the spinal cord is joined to that dian sulci.
of the other half by a very thin white commissure (commissura alba) In the upper thoracic and the whole cervical portion of the spi
running transversely in front of the central canal. The nerve fibres nal cord, the posterior intermediate sulcus stretching between the
are collected into bundles (fasciculi) in the white matter. posterior lateral and posterior median sulci divides the posterior

'M THE SPINAL CORD
Pedunculus cerebri
-Corpus pineale
-Medulla spinalis
TectUni mesencephaii
Pedtinculus m e b e l i a r i ; Sultus intdfanu
superior f posterior)
Pedunculus cerebcllaris
medius Fossa rhDirholdea Sulcus lateralis-
posterior
Tuberculum nuclei g r a c i l i s j
~9
f*. accessorius,_
(pars spinalis)
Funkulus
Fascicjltis
Fasckulus
posteriory
gracilrs-
ctuwsrt
A
IHura mate.
\,
-10
N a thoracici
M l
htumisceutla cervicslis- t;
Fib radicularia-^1^
r a d k l s dorsalis
> N n . cerviuales
Flla r j H l i c u l a r i * " - ^
radtcts venlralis
Sulcus laicralis posterior- IntuFirescemra--

luuibaljs
^ffadtx dorsalis
n lumbalis
Sulcus meflianus(posterior) ,
COJIU-S itieduilarla-
f
Dura mater spinalis?'' -2
Radix ventralis - ^ Iiiinl>ales
Radi* dorsalis--"'
Cauda cquina*-"
Ganglion spinal?-
Ug. rJenlJtutatum^
thoracki -A
fv. spinalis^
Rarnus venlralis neryi spinalis > V J
Ramus dorealjs neryi spinalis "
FiJuni durae'/
> Nn.sacrales
>---3
\ 'N. f u t r ^ g e u s
731. % K a / cord (medulla spinalis) with roots (radices) and spinal nerves (nervi spinales); posterior
aspect (%).
(Spinal dura mater U opened; roots are removed on the left within the range of cauda eqiiina.)

THE SPINAL CORD 25
Fasciculus interfasciCLilaris
Fasciculus cuneatus. ' (comma tract)
1'rnilu- cortlcospinalis (pyramidalis) lateral!; Fasciculus gracills
Sufciis media mis (posit r in r)
Ttactus splnocetebellarls posterior Septomarynal
\ fasciculus
Fasciculi proprii rnedullae spinal in
Trartus TubrtispijiaJis
Column a pusleTlor
Traclus splncilectalis
el spinothalaTnicus lateral is -J j Substantla intermedia centralis
frauds spinoccrebeiiatls anterior
Tractns vestibuluspinalis Fasciculus proprius
Flla radiculatia medullae spinalis
LTtactus lectospinaUs
radlcls dorsal is
L -Columna anterior
Radix dorsalls
"*"V< j ^ l ~ - - T t a c t u s rorlicosplnalls
fc (pyramidalis) antetior
r-Fila radicuiarla rad
ventralis
Flssura medlana anterior
732. Spinal cord; anterior and partly lateral aspect (semischematical representation).
(Two spinal segments; topography of white matter is shown on the right side; white matter is removed on the left side to show the shape
of the grey matter.)
white column into two fasciculi: one is thinner, lies medially, and distinguished in the grey matter; a narrow transverse strip, the sub-
is known a? the fasciculus gracilis; the other is thicker, passes later stantia intermedia centralis bridges the lateral parts and extends
ally and is called the fasciculus cuneatus. These Fasciculi continue into their middle as the substantia intermedia lateralis.
also into the initial part of the brain, the medulla oblongata The median parts of the grey matter have a very narrow cav
(Figs 732, 733; 769-771). ity the central canal of the spinal cord (amalis eentralis medullat
The funieuli Tuse in the distal parts of the spinal cord and be spinalis). Its size and shape vary at different levels: it is oval in the
come indiscernible on the outer surface. region of the cervical and lumbar enlargements but spherical with
The nerve cells and their processes are the main components a diameter of up to 0.1 mm in the thoracic part. In adults the cav
of the grey matter (Fig. 733). It also contains the processes oF cells ity of the canal may be obliterated in some areas. The central canal
located in other parts of the spinal cord and brain, die neuroglia, stretches for the whole length of the spinal cord and is continuous
and blood vessels with the attendant connective tissue. above with the cavity of the fourth ventricle. Below, in the region
The nerve cells form collections, nuclei, or centres of the spinal of the conus medullaris, it h dilated to 1 mm on the average; this
cord. part of the central canal is called the terminal ventricle (ventriculus
Two lateral parts located in both halves of the spinal cord are terminates).

26
THE SPINAL CORD
*^ ^ ' oimscaiiMs intermedia cetUnlis

Fasciculus jjrsctlts
i / c ,i., J.
Kunicitlus posterior \ \ \ j Suttus latermedfas posterior
I Fasciculus cutiiMliib \ t I '
\ \ (
I' i Columns poiterior
Oormi iiysterlus, \ \ \
Radi* dursalis i \
1
a *' 1^.
i Apex cornus posieriuris
Siikus laleralis
jiosterior
1 >-
1-
Kuntcuiiis laterally
FOHUJUIO rcttcalaris it.

Culumna LaieraJIs
Lornu lalerale'f//
t#\ i f issura median* v \ *,
Fila radicuiari/ Radii venlralis ' (anlcrloi) \ \ JSubstantial intermedia cemralis
[adkis ventrslts j
rmi arueriits \ Cornmissura al5a
Funicuhi-, anterior
733. Spinal cord (medulla spinalis) (%).

( H o r i z o n t a l section of u p p e r p o r t i o n of t h e thoracic p a r t of spinal c o r d )
T h e tissue s u r r o u n d i n g t h e c e n t r a l canal consists mostly of

(tolumna posterior), o r p o s t e r i o r h o r n (cornu posierius); lateral g r e y
n e u r o g l i a a n d a small n u m b e r of n e u r o n s with their fibres, a n d is
c o l u m n {columns, lateralis), o r lateral h o r n (cornu laterals).
k n o w n a s t h e central gelatinous m a t t e r (miitmik gelatinosa centra-
Its). I n t h e region of t h e lower cervical a n d u p p e r t h o r a c i c p a r t s of
the spinal cord, in t h e angle f o r m e d by t h e lateral h o a n d lateral
T h e s u b s t a n t i a i n t e r m e d i a centralis is subdivided into two
m a r g i n of t h e posterior h o r n , t h e grey m a t t e r gives off processes
p a n s : o n e p a r t is in front of t h e central canal, adjoining t h e white
into t h e white m a t t e r to form t h e reticular f o r m a t i o n o f the s p i n a l
c o m m i s s u r e which c o n n e c t s t h e a n t e r i o r white c o l u m n s of b o t h
c o r d (firmatio retkulans medullat spinalis) in whose loops t h e white
halves of t h e spinal c o r d ; t h e o t h e r part is b e h i n d the central
m a t t e r lies,
canal, adjoining directly t h e p o s t e r i o r m e d i a n sulcus or t h e poste
rior m e d i a n s e p t u m . T h e a n t e r i o r h o r n is m u c h thicker b u t s h o r t e r t h a n t h e poste
rior h o r n a n d does n o t reach t h e periphery- of t h e spinal cord,
E a c h lateral p a r t of t h e grey m a t t e r forms three extensions: a
whereas t h e p o s t e r i o r h o r n is n a r r o w e r a n d l o n g e r a n d extends to
t h . r k e s t a n t e r i o r extension, a n a r r o w e r posterior o n e , a n d a small
the o u t e r surface of t h e spinal cord.
lateral extension between t h e m which is particularly distir.ctlv seen
T h e a n t e r i o r h o r n is a collection of a great n u m b e r of m o t o r
to t h e lower cervical a n d u p p e r t h o r a c i c parts of t h e spinal c o r d
n u c l e i : a m e r o l a t e r a l n u c l e u s (nucleus ventrolateralis), anteromedial
b u t c a n b e missing in others.
n u c l e u s (nucleus ventromedialis), p o s t e r o l a t e r a l n u c i e u s (nucleus dor-
These extensions form the grey columns (column* grueae)
solateralis), retroposterolateral nucleus (nucleus rdrodorsotateralis),
s t r e t c h i n g t h r o u g h o u t t h e length of t h e spinal cord. O n cross sec
p o s t e r o m e d i a l nucleus (nucleus dotsamedialii), central n u c l e u s (nuc
tion each c o l u m n is r e p r e s e n t e d by a h o r n (cornu) (Figs 732, 733).
leus centralis), n u c l e u s of accessory nerve (nucleus nervi accessorii),
T h u s , t h e following c o l u m n s a r e d i s t i n g u i s h e d : a n t e r i o r grey c o
n u c l e u s of p h r e n i c nerve (nucleus nervi phrenici).
l u m n (columm anterior}, or a n t e r i o r h o r n o f t h e spinal cord (mm
A n apex of the posterior h o r n (apex cornusposterioris) c a n b e d i s
anierius medullae .spinalis) on cross-section; posterior grey c o l u m n
tinguished, it is t h e narrowest part of t h e dorsal p o r t i o n of t h e

T H E SPINAL C O R D 21
horn. It embraces the head of the posterior h o r n (captit cornus poste T h e anterior rootlets (jila radiadaria ankrioni) arising from
riori?) which is continuous with the neck of the posterior horn (cer each segment emerge from the lateral anterior sulcus or close to it.
vix comtupostmoris) the last named is, in turn, continuous with the They arc the processes of motor cells located in the grey matter of
wide part of the horn called the base of the posterior horn (basis the anterior horn and of cells lying in the grey matter of the lateral
corrnu posteriorisj (Fig. 733). horns (the last named are present only in the thoracic and lumbar
T h e apex of the posterior horn is capped by a layer of neurog- parts of the Spinal cord). The anterior rootlets form the motor an
lia containing many nerve cells, this is the gelatinous matter (sab- terior root of die spinal nerve (radix ventralis nervi spinalis).
stantia gelatinosa). It is circumscribed by a spongy zone which is T h e anterior roots contain centrifugal (efferent) fibres which
continuous with the marginal zone reaching the outer surface of convey motor and autonomic impulses to the periphery of the
the spinal cord. body: the striated and smooth muscles, glands, etc.
T h e lateral horn is a section of the intermedin lateral (autn- T h e posterior rootlets (Jila mdicularia posteriora), which arc
nomic) column {columna inlermedwlaterulis s, aittonomica) stretching made up of processes of cells lodged in the spinal ganglia (ganglia
from the first thoracic to the first or second lumbar segments; in spinale), enter the lateral posterior sulcus. These rootlets form the
the sacral part it contains the sacral parasympathetic nuclei (nuclei sensory posterior root of the spinal nerve (radix dnrsalis neryi spina-
parasympathid sacrales) located in the second to fourth sacral seg- lis).
ments. The posterior roots contain centripetal (afferent) fibres convey
At the medial margin of the base of the posterior horn, is a ing sensory impulses from the periphery, i.e. from all body tissues
small group of nerve cells extending from the level of the seventh and organs, to the central nervous system.
cervical to the third lumbar segment and Forming the thoracic A spinal ganglion (ganglion spinale) (Fig, 732) is a spindle-
nucleus (nucleus tkoracicus). shaped swelling on the posterior root, ft is a. collection mostly of
Between the anterior and posterior horns, at the level of the pseudounipolar nerve cells.
grey commissures, is a transversely lying intermediate part occup T h e process of each pseudounipolar cell bifurcates to form two
ied by intermediate cells. processes, one of which is a long process running to the periphery
Small collections of nerve cells are also found hi the region of in the spinal nerve (nervus spinalis) and terminating there by a sen
the posterior horn. sory nerve ending; the other is a short process stretching along the
T h e location of the horns corresponds to the anterior and pos posterior root into the spinal cord (see Fig. 903).
terior lateral sulci of the spinal cord. This correspondence deter All spinal ganglia, with the exception of the ganglion of the
mines the cross-sectional topography of the white matter (the ante coceygeal root, are closely surrounded by the dura mater; the
rior, lateral, and posterior white columns). ganglia of the cervical, thoracic, and lumbar parts are located in
T h e pattern of the spinal cord cross-sections varies with the le the intervertebral foramina, those of the sacral part lie inside the
vel: it is oval at the level of the lower cervical segments, rounded in sacral canal.
the region of the midthoracic segments, almost square but with a T h e roots stretch differently: they arise almost horizontally in
slightly compressed anterior surface in the upper lumbar seg the cervical part, descend obliquely in the thoracic part, and go
ments, and also almost square but with a mildly flattened posterior right downwards in the lumbar and sacral parts (Figs 731, 8H9).
surface in the sacral portion. Immediately lateral to the spinal ganglion, the anterior and
T h e relationships of the white and grey matter vary m the diff posterior roots merge to form a spinal nerve (nervus spinalis) which
erent regions of the spinal cord. There is much more grey matter is therefore a mixed nerve.
in the cervical part, particularly in the region of the cervical en f.ach pair of spinal nerves (right and left nerve) corresponds to
largement, than in the middle portions of the thoracic part where a certain spinal segment. Consequently, the n u m b e r of spinal cord
the amount of the white matter is much greater, about 10-12 times segments is equal to the n u m b e r of pairs of the spinal nerves.
that of the grey matter. The anterior and posterior horns are mar T h e spinal cord bears 31 pairs of spinal nerves which lie on
kedly larger in the cervical than in the thoracic part, hi the lumbar both side.i almost symmetrically: eight cervical, twelve thoracic,
region, at the level of the lumbar enlargement in particular, the five lumbar, five sacral, and one coceygeal (sec The Spinal Nerves).
amount of the grey matter is greater than that of the white matter. As it is pointed out above, the spinal cord is continuous with
In this region, the horns, mostly the anterior ones, protrude the brain. T h e conditionally accepted topographical junction be
sharply; the amount of the grey matter in the posterior horns also tween these two parts of the central nervous system is the site of
increases. T h e grey matter diminishes in the direction of the sacral exit of the first pair of cervical roots and the lower end of the de-
part, but the grey commissures become thicker and wider and cussation of the pyramids (deaissatio pyramidum) on the anterior
come nearer to the posterior surface of the spinal cord. In the re surface of the brain (see Fig. 743), Skeletopically this junction is on
gion of the conus medullaris the grey matter occupies almost the the level of the upper border of the first cervical vertebra.
whole cross-sectional area, and only a very narrow layer of white
matter is seen on the periphery.

28 THE BRAIN
THE BRAIN
The brain (encephabn) is the central organ of the nervous sys
s- verse dimension 13-14 cm, vertical dimension 10.5-12,5 cm;
tem regulating the relationships between the organism and the en
i- its volume is 1200 cm3 on the average,
vironment and coordinating body functions. In this, the followingg The weight of the brain depends on the age and sex of an indi-
levels are distinguished from the anatorno-functkmal standpoint:t: viduaL The brain of a newborn accounts for 10 per cent of the
Tthe higher level concerned with coordination of the sensor}' y body weight (455 g on the average); in an adult it makes up 2.5 per
and motor activities and higher intellectual functions (the cortexx cent of body weight (1375g on the average in a male and 100 g
of the brain); IIthe centre of emotional control and endocrine le less in a female). The individual variations in the weight of the
regulation, is represented by the limbic system (the hippocampus,s, brain range from 900 to 2000 g. The direct relationship between
hypophysis cerebri, hypothalamus, gyms cinguli, amygdaloid nuc > the weight of an individual's brain and his capabilities has not
leus), and IIIthe lower level coordinating the autonomic bodyy been verified.
functions and transmitting signals to the centres located higher
as Tile brain is conditionally subdivided into the cerebrum, cer
(the reticular formation and the brain stem}.
ebellum, and the brain stem (trutiats cerebri). Each part differs from
The brain is enclosed in the skull. The shape of the inner sur the other phylogenetically, functionally, and anatomically,
face or the cavity of the skull repeats the shape and contours of thee The cerebrum covers the cerebellum and the brain stem, there
brain. fore both these parts of the brain can be seen from the lower
The brain (without the dura mater} of an adult weighs 1375 g aspect.
on the average, its sagittal dimension measures 16-17 cm, trans-
THE CEREBRUM
The cerebrum is the largest part of the brain and occupiess The surface of each hemisphere is covered by many cerebral
most of the cranial cavity. Its outer, bulging surface called the su- sulci (said cerebri) which vary in depth and length. Between the
perolateral surface of the cerebrum (fades superolaieralii cerebri) ) sulci are the cerebral gyri (gyri cerebri) which also vary in size. The
bears a sagittally directed longitudinal fissure of the cerebrumi sulci and gyri are sufficiently exposed when the arachnoid mater
(fissura, longitudinalis cerebri) (Figs 734, 735) which divides the cere and pia mater of the brain are removed (Figs 734, 736, 739, 741).
brum into right and left hemispheres (hemisphermm cerebri dextrum
et sintstrum) which are joined by means of commissures (commmtt-
mt) the largest of which is the corpus callosum.
SURFACES, SULCI, AND GYRI O F THE CEREBRUM
The following surfaces arc distinguished in each hemisphere: of the superolateral and medial surfaces of [he hemisphere. The in-
(1) the convex superolatcral surface of the cerebral hemisphere ferolateral border of the cerebrum (marga inferior s. inferoUteratis
(faaes superolatemlis hemispkerii) adjoining the inner surface of the cerebri) is at the junction of the superolateral and inferior surfaces
skutl-cap; (2) the inferior surface of the cerebral hemisphere (fa of the hemisphere. The inferomedial border of the cerebrum
des inferior hemispherii) whose anterior and middle parts lie on the (margo medialis s. inferomedialh cerebri) consists of two parts: a me
inner surface of the base of the skull in the region of the anterior dial occipital border between the hemispheric surface adjoining
and middle cranial fossae, and the posterior parts lie on the tentor- the tcntorium cerehelli and the medial surface, and a medial orbi
ium cercbelli; (3) the medial surface of thp cerebral hemisphere tal border between the orbital part of the inferior and medial sur
(facia medialis kemispheria) facing the longitudinal fissure of the faces of the hemisphere.
cerebrum which passes between the hemispheres.
Each hemisphere has the following projecting parts: a frontal
The three surfaces of each hemisphere are continuous with one pole (polus frontatis) to front, an occipital pole (polus oedpitalis) be
another to form three borders. The superomedial border of the hind, and a temporal pole (polus temporalis) on the lateral side.
cerebrum (margo superior s. superomedialis cerebri) is at the junction The hemisphere is divided into four lobes of the cerebrum (lobi

THE BRAiN W
Polus frnntalis
Lobua frontal !s
Lobus
parletalis
Lobiis occipital is
Polus uccipitalis
734. Cerebrum; superior aspect (%).

(The incningeFi are removed,)
cerebri) adjoining the corresponding bones of the skull. These are ralis). T h e frontal lobe is separated from the temporal lobe by the
the Frontal lobe (lobus frontalis), the parietal lobe (lobns parietalis), the insula which is lodged in the depth of the lateral cerebral fossa
occipital lobe (lobus accipitalis)t and the temporal lobe (lobus tempo- (fossa lateralis cerebri).

.'til
T H E BRAIN
735. Cerebrum; .superior aspect (semischematical representation).
SULC1 AND GYRl OF THE SUPEROLATERAL SURFACE OF T H E

CEREBRAL HEMISPHERES
The frpn(aJ l o b e ptejto^ j, separa(ed from ^
lebe by a deep central suicu S M * * * * ^ The su|Cus origin^ of the hemisphere. It U bounded anteriorly by the precentral sul-
c sirretentmlu} and by the cemral
o, the reted] surface of the hemisphere and passes ^ Jg ^
perolateml Surf*** m w h i c h it stretches .lightly obliqudv fro m
ZZ *********
back * f r ^ t , usually without reacting the lateral sulcus of the The superior and inferior frontal sulci (sulajrontalv supenor
cerebrum (Fig, 737). f 1
" b ards f
* P ^ n t r a J sulcus; they divide the
Almost parallel to the c c t r a l miens is the precentral gyrus fo- ronta , o b e into the superior frontal g y (^rus fronts atptrht}
w / f f M N ^ "hi<:h, however, does not reach the medial border located above the superior frontal sulcus and extending Z> the
medial surface of the hemisphere, the middle frontal gyrus (gyrus

THE BRAIN St
R, posterior aulcl Sulcus precentralEs

matin
Margo superior
(super medialls)
Polus
n tal is
Sulcus laterals
Polus
occipilatis
LobuIus
semllumrt5
superior--"" f\". tHêminus
Flocculus - ^ H Pons
N. vestibule cohlearis Margo interior (inferolsteraHsJ
Lobulus N- facialls
semilunarls lnkrloi N. abduicns
N. hypoglos5us
Lobus bivetiter
TonsUla ce rebuild
N. vagus' jVtedulia oblongata
N. glossopharjnffeus ' Medulla spirals

Flbrae arnjatae external
736. Brain (encephalon); lateral aspect (%),

(The meninges are removed.)
frontalis mtdius) which is bounded by the superior and inferior whose floor is formed by the outer surface of the insufa. Small
frontal sulci and in whose anterior portions a superior and inferior sulci, called rami, branch oft from the lateral sulcus upwards;
parts are distinguished, and, finally, the inferior frontal gyms (gy- those most constantly present are the horizontal ascending rarnus
rus fiantalis inferior) lying between the inferior frontal sulcus and (ramus ascendens) and the horizontal anterior rain us (ramus anterior);
the lateral sutcua of the cerebrum. T h e rami of the lateral sulcus the superoposterior portion of the sulcus is called the posterior ra
(see below) divide the inferior frontal gyrus into several parts. rnus (ramus postrriur) (Fig, 736).
T h e lateral sulcus (suteus tateralis) is one of the deepest cerebral T h e horizontal ascending and anterior rami run on the inferior
sulci and separates the temporal lobe from the Frontal and parietal frontal gyrus and divide it into three parts (Fig.737): (1) the poste
lobes. It lies on the supero lateral surface of each hemisphere and rior part (pan optrculans) which is bounded in front by the horizon
stretches downwards and to the front. Deep in this sultus is a de tal ascending ratnus; (2) the triangular part (pars triangular is)
pression tailed the lateral cerebral fossa (fossa latcralu cercbri) which lies between the horizontal ascending and anterior rami;

32 THE BRAIN
737. Brain; lateral aspect (semischematical representation).
(3) the orbital part (pars vrbilalis) located between the horizontal superior) lying above the intraparietal sulcus, and the inferior par
anterior ramus and the anteroittferior border or the frontal lobe. ietal lobule (hbulus paridalis inferior) located below this sulcus.
The parietal lobe (lobus paridalis) (Figs 734, 735) is behind the Two large gyri are distinguished in the lower portions of the in
central sulcus which separates it from the Frontal lobe. The lateral ferior parietal lobule (Figs 736, 737): the anterior part of die infe
sulcus separates the parietal lobe from the temporal lobe, and part rior parietal lobule (gyms supramarginalis) which lies anteriorly and
of the parieto-occipital sulcus (sulcus paridn-occipitalis) separates it caps the posterior portion of the lateral sulcus, and the middle part
from the Occipital lobe, of the inferior parietal lobule (gyms angularis) which caps the supe
The postcentral gyrus (gyms postcentralis) passes parallel to the rior temporal sulcus (sulcus lemporalis superior).
central sulcus. To the back oFit, almost parallel to the longitudinal Between the horizontal ascending and posterior rami of the la
fissure of the cerebrum, runs the intraparietal sulcus (sulcus intra- teral sulcus is an area of the frontal and parietal cortex called the
paridalis) which divides the posterosupcrior parts of the parietal frontoparietal operculum (operculumfionloparietale).It is made up
lobe into two lobules: the superior parietal lobule (lobutus parietalis of the posterior portion of the inferior frontal gyrus, the lower por-

THE BRAIN 33
lions of the precentral and postcentral gyri, and the lower portion elongated lateral occipitotemporal gyrus (gyrus ocdpitotemporalis la-
of the anterior part of the parietal lobe. ieraiis) still medial to which h the collateral sulcus (sulcus collatera-
The occipital lobe (lafois occipitalis) (Figs 736, 737) has no lis) bounding the hippocampal gyrus (gyrus pamhippficampalis). This
clearly defined boundaries separating its convex part from the par gyrus is separated by the hippocampal sulcus from a small narrow
ietal and temporal lobes, except for the upper portion of the par- dentate gyrus (gyrus dentatus). The anterior end of the hippocampal
ieto-occipital sulcus (sulcus parieto-oedpitalis) which lies on the me gyrus is mickened to form the uncus, while the posterior part is
dial surface of the hemisphere and separates the occipital lobe continuous with the large medial occipitotemporal gyrus (gyrus oc-
from the neighbouring parietal lobe. The three surfaces of the oc dpitotemparalis medialis) whose posterior portion belongs to the oc
cipital lobe, the lateral (bulging), medial (flat) and inferior (con cipital lobe. The collateral sulcus separates the lateral occipitotem
cave) located on the tentorium cerebelli, bear a scries of sulci and poral gyrus from the medial occipitotemporal gyrus on the inferior
gyri. surface of the hemisphere; its anterior portion is continuous with
In some cases the sulci and gyri on the convex lateral surface the rhinal sulcus (sulcus rhinalis).
of the occipital lobe are absent, and those of one hemisphere may Short transverse temporal sulci (sulci temporales transocrsi) are
differ from the ones of the other hemisphere. found in those areas of the temporal lobe which are directed to the
The transverse occipital sulcus (sulcus oedpitalis transversal) is lateral sulcus of the cerebrum. Between them are two or three
the largest. It is sometimes a continuation of the posterior end of short transverse temporal gyri (gyri tempomlis transversi).
the intraparietal sulcus and is in turn continuous posteriorly with On the orbital, i.e. inferior, surface of the frontal lobe
the inconstantly present lunate sulcus (sulcus lunaius). (Fig. 741), close to the medial border, is an anteriorly directed ol
A pre-occipital notch (indsura pre-nccipitalis) is present on the factory sulcus (sulcus olfactorius). It lodges the olfactory bulb (bulbus
inferior border of the superolateral surface of the hemisphere olfadorius) which is continuous with the olfactory tract (Iractus olfac
about 5 cm to the front of the occipital lobe. torius).
The temporal lobe (lobus temporal^) (Figs 736, 737, 739-742) The olfactory sulcus projects slightly to the front of the ante
has die most defined boundaries. A convex lateral and a concave rior border of the bulb; posteriorly it embraces the olfactory tuber
inferior surfaces are distinguished. The blunt pole of the temporal cle lying on the dorsal surface of the olfactory pyramid (Irigonum
lobe is directed to the front and slightly downwards. The lateral olfadorium).
sulcus of the cerebrum delimits sharply this lobe from the frontal Three olfactory striae (striae olfadoriae) are present in the olfac
lobe. The temporal lobe has on its inferior surface the hippocam- tory pyramid: the medial stria is continuous with the parolfaclory
pal sulcus (sulcus hippocampi) which separates it from the brain area (area subcallosa), paraterminal gyrus (gyrus paraterminalis), and
stem. septum lucidum (septum pellucidum); the intermediate olfactory
The following sulci and gyri are distinguished on the temporal stria runs to the anterior perforated substance (svbstantUi perforata
lobe. There are two sulci located on the superolateral surface, the anterior); the lateral olfactory stria stretches to the uncus.
superior temporal sulcus (sulcus temporalis superior) and the inferior Medial of the olfactory sulcus, between it and the medial bor
temporal sulcus (sulcus temporalis inferior) which run almost parallel der of the hemisphere, is the gyrus rectus which reaches the ante
to the lateral sulcus of the cerebrum and divide the lobe into three rior perforated substance posteriorly. Lateral of the suicus is the
gyri; the superior, middle, and inferior temporal gyri {gyri tempo- remainder lateral part of the orbital surface of the frontal lobe;
rales superior, medius, et inferior). short orbital sulci (svld orhitalts) divide it into a series of small orb
The inferior temporal gyrus passes from the superolateral to ital gyri (gyri orlitaUs),
the inferior surface of the temporal lobe. Medial to this gyrus is an
THE INSULA
The insula (Fig. 738) lies on the floor of the lateral cerebral the limen insulae, lying at the junction with the inferior surface of
fossa (fossa lattralis ctrebri). It is a trihedral pyramid whose apex, the the cerebrum, between the insula and the anterior perforated sub
pole of the insula, is directed forwards and laterally towards the la stance.
teral sulcus. The deep central sulcus of the insula (sulcus ctntralis insulae)
On the periphery the insula is surrounded by die frontal, par stretches on its surface and divides it into a larger anterior and a
ietal and temporal lobes which contribute to the formation of the smaller posterior parts.
walls of the lateral sulcus of the cerebrum. The anterior part has a few short gyri of the insula (gyri breves
The base of the pyramid is surrounded oa three sides by the insulae); the posterior part usually has only one long gyrus f the
circular sulcus (sulcus drcularis insutae) which disappears gradually insula (gyrus longus insulae).
at the inferior surface of the insula. Here is a small swelling, called

'H T H E BRAIN
Gyrus temporal]; superior ^\
738. Right insula; lateral and partly inferior aspect (%).

(The meningcs and margins of lateral sulcus of cerebrum are removed; the temporal lobe is drawn away from the frontal and parietal
lobes; the lateral sulcus of cerebrum is opened widely.)
SULC1 A N D G Y R I O F T H E M E D I A L S U R F A C E O F T H E C E R E B R A L H E M I S P H E R E S
T h e medial surface of the hemisphere (furies mediate hemispht- At the junction with the isthmus the gyrus cinguli is separated
rii) (Figs 739, 740, 764), on which the boundaries between the from the lingual gyrus, lying behind it, by (he calcarine sulcus (sul
lobes arc defined less clearly than on the superolateral surface, has cus calcarinus).
the following sulci and gyri. T h e three described gyridie gyrus cinguli, the isthmus of the
The callosal sulcus (miens carports cathsi) arches the corpus cal- gyrus cinguli, and the hippocampal gyrusform the gyrus fornica-
loMiin and repeats its contours. T h e anterior part of the sulcus ori tus. T h e last named, together with the parolfactory area in front
ginates in the region of the pamifactory area (area subcallosa), the and the uncus behind, form a ring-like area which is part of the
posterior part is continuous with the hippocampal sulcus. rhinencephalon (sec Fig. 807).
Above the corpus callosum and separated from it by the callo- T h e gyms cinguli is bounded above by the sulcus cinguli. T h e
sal sulcus is the arch-shaped gyrus ciuguli. Its anterior end curves anterior part of the sulcus is convex in the direction of the frontal
round the genii of the corpus callosum (gsnu covporis callosi), the pole; the posterior part runs along the gyrus cinguli and, not
posterior end bends round the splenium of the corpus callosum reaching its posterior end, ascends to the upper, medial margin of
(splenium carports callosi) and is continuous through a narrow strip the longitudinal fissure of the cerebrum. Its outer end is to the
called the isthmus of the gyrus cinguli (isthmus gyri cinguli) with the back of the upper end oT the central sulcus.
hippocampa) gyrus (gyrus parakippocampalis). A little more to the front the sulcus cinguli sends off a small

THE BRAIN 35
l
E I t
Commlssura anterior j [ ^ Fasciculus mamil!athfliam.icus
Columns fornjds
739. Cerebrum; right hemisphere; medial aspect {%).

(The brain stem, cerebellum and part of thalamic matter are removed.)
paracentral sulcus which, together with the subfronta! part, A triangular lobule, the cuneus, is dorsal to the precuneus; its
bounds the paracentral lobule (labulus paracentralts). Anteriorly of bulging, outer surface contributes to the formation of the occipital
this lobule is the medial surface of the superior frontal gyrus (gyms pole. The apex of the cuneus is directed downwards and forwards
frantalis superior) which extends to the beginning of the sulcus cin- almost reaching the posterior part of the gyrus cinguli.
guli. Posteroinfcriorly the cuneus is bounded by a very deep calca-
Behind the sulcus cinguli is a small square-shaped lobule riue sulcus (sulcus cakarinus), anteriorly by the parieto-occipital sul
called the precuneus. It is bounded posteriorly by the deep par- cus. As it is said above, the precuneus is in front of the cuneus,
iclo-occipital sulcus (stilats parieto-oaipitalu'j and inferiorly by the and the medial oecipitotemporal gyrus (gyrus occipitotemporalis rrudi-
suprasplenial sulcus (sulcus stibparittalu) which separates the precu itlis) is under it.
neus Irom the posterior portion of the gyrus cinguli.

;i(i THE BRAIN
yrw$ tampo
740. Brain (encephalon); right hemisphere; medial aspect (semischematical representation).

(Form* cerebri and mamillothalamic tract [fasciculus mamillotkalamicusj are removed.)
THE INFERIOR SURFACE OF THE CEREBRAL HEMISPHERES

AND SITES OF EXIT OF TWELVE PAIRS OF CRANIAL
NERVES
To study the inferior surface of the cerebrum the brain is The posterior parts of the olfactory tract flatten out and are contin
placed so that its ba.se faces upwards (Figs 741-743). On it are the uous with the olfactory pyramid (trtgonum dfirtorivm). The lateral
pallium of the encephalon, structures belonging to the brain stem, and medial sides of the pyramid are bounded by thin strips of grey
and the sites of exit of the cranial nerves. matter, the lateral and medial olfactory gyri.
The structures of the brain stem and the sites of exit of the cra The olfactory tubercle lies in the depth of the olfactory sulcus
nial nerves lie on both sides of the median plane of the inferior on the superior surface of the olfactory pyramid as if forming its
cerebral surface. In the anterior parts of the cerebrum, along the apex. O H the inferior surface of the pyramid, on the level of the
olfactory sulcus (sulcus olfartorius) is a white trihedral strip, the ol anterior margin of the anterior perforated substance are three fine
factory tract (tractns olfattorius). Its anterior expanded part forms olfactory striae into which the olfactory tract separates: (a) the
the olfactory bulb (bulbus nlfactorius) which Ifei on the cribriform medial olfactory stria whose fibres terminate in the paroifactory
plate of the ethmoid bone. The perforations of the plate transmit area (area subcallosa), m the paraterminal gyrus (gyrus parakrmina-
into the inferior surface of the olfactory bulb up to 20 very fine ol lis), and in the septum luridum (septumfiellttridum);(b) the inter
factory filaments which form the olfactory nerves (nervi olfadorii} mediate olfactory stria whose fibres terminate in the anterior per
(tiie first pair of cranial nerves). The filaments terminate in the forated substance; (c) the longest, lateral olfactory stria which
cells of the bulb and are the processes of olfactory cells lodged in curves to the side to stretch on the lateral margin of the anterior
the mucous membrane of the nasal cavity (the superior and middle perforated substance; most of its fibres pass through the limcn in-
nasal conchae and the corresponding portion of the nasal septum). sulae to the hippocampal gyms (gyrus parakippocamp&lit).

THE BRAIN 37
FiiSura
Bulhus o l f a c t o r y l o n g i t u d i n a l cerebri ^ ^ ]f3ctnrilJ
Chlasma npticutti Sulcus olfaclfiflns

/ N . opflcus
TriÔnum olfadoriu
[nfundlbitluNi
yîubstiititla perforata
anterior
Slfiii ulfscloria
Corpus mainilhre
Tuber dneirum
Substantla purtorata
Tracttis Qptiws
posterior
'-'.i^;iUirili.i nigra Cms cerebri
Tegmentum
mtcduttUS cerebri
Corpus gcniculatum Collicuius - i-.-L i "

latcrale
Corpus Eenivulatum'
medlale
Splenium erjrporla caltosf
Nucleus rub'
741. Cerebrum; inferior aspect (%).

(Sulci and gyri of cerebral base; the brain stem, cerebellum, hypophysis cerebri, and part of the left olfactory tract are removed.

3S THE BRAIN
742. Cerebrum; inferior aspect (semischematical representation).

(Inferior surface (fiiem inferiorj.)

THE BRAIN 33
Sukus oUadurius Buluus olfactories

Gyrus rectus,
Jractus oUaclorlus
N. opthfus
riguniim olfjctortum
Hypophysis Substantig perlorata

anterior
(iifiMKllhiilinn,
Ttactus opilcus
Tuber slnereum~ Corpus rnamillsre
N. ucjlomotorijfi
|-':.>S:1
--N. t r o t b k j f l s
id terpiu ocular is
Substsiitli perforata
posterior
N. intermedium
N. wstibulocochlearii
Peduncut
cerebrl
glossoptiarytigsus
- N . vagus
occessurlus
Plexus Lhurioideus'
vPyrtuniS (rneriuilae oblongatae)

Cerebellum
\ M e d u l l a oblongata
N. cervlcalis I Mills'iplltltfts D W f l e p>Janridu
743. Brain (encephalon); inferior aspect (%).

(Inferior surface [fades inferior})

40
THE BRAIN
The anterior perforated substance (substantia perforate anterior)

hemispheres. Each peduncle has a base (basis pedunculi cerebri) fac
lies to the back of the olfactory pyramid and is pierced by a great
ing the inferior surface of the cerebrum, and the tegmentum form
number of small vessels. A Fine lamina terminal* (see Fig. 764) lies
ing the dorsal surface of the peduncle.
between the right and left perforated substance; it extends to the
The base of the peduncle is separated from the tegmentum by
anterior commissure (commissura anterior) dorsally and to the optic
the sulcus lateral!, niesencephali laterally and by the medial sulcus
chiasma (chiasma optiwm) venlrally (see Figs 739, 741).
of the cerebral peduncle (sulcus medialis cruris cerebri) medially.
The optic chiasma is the site of partial crossing of the optic
Behind the peduncles of the brain is the thickest part of the
nerves; it has the shape of a strongly developed white plate from
brain stem, the pom, to the back of which is the medulla oblon
the front of which two optic nerves (nem optici) arise (second pair
gata which becomes gradually narrower downwards. The cerebel
of cranial nerves). From the back of the chiasma arise the optic
lum is dorsal to the pons and medulla oblongata (see Fig. 803).
tracts (tracts optici), one on each side, which embrace the cerebral
From the inferior aspect the pons is a slightly convex and
peduncles (fiedunculi terebri).
transversely elongated structure whose sides are continuous with
The following structures are located in the space bounded by
two white cords, the middle cerebellar peduncles (pedunculi cerebel-
the chiasma anteriorly, by the optic tracts laterally, and by the di
lares nudii) which connect the pons with the cerebellum.
verging cerebral peduncles posteriorly. The tuber cinereum pro
On the inferior surface of the pons, where the middle cerebel
trudes directly behind the chiasma and elongates to form the nar
lar peduncles emerge, are the motor and sensory roots of the tri-
row infundiburum on which the hypophysis cerebri hangs. Two
geminal nerve (radix motoria et sensoria nervt trigemini) (fifth pair of
semispherical elevations project, one next to the other, behind the
cranial nerves). The abducent nerve (nervus abducens) (sixth pair of
tuber cinereum; these are the mamillary bodies (corpora mamillaria)
cranial nerves) emerges on the base of the brain behind the pons
containing nerve fibres and collections of nerve cells.
through a transverse fissure between it and the medulla oblongata.
A deep triangular interpeduncular fossa (fossa interpeduncularis) The anterior median fissure (fissura mtdiana anterior) runs on
is bounded by the mamillary bodies anteriorly, the cerebral pedun
the midline of the inferior surface of the medulla oblongata and
cles on the sides, and the pons posteriorly; its floor (when the brain
reaches the decussation of the pyramids (deeussatto pyramidum).
is placed with the base facing upwards) is formed by the posterior
Elongated thickenings lie on either side of this fissure; these
perforated suhstance (substantia perforate posterior) with numerous
are the pyramids (pyramides). Laterally to each pyramid and sepa
small perforations transmitting blood vessels.
rated from it by the anterior lateral sulcus {sulcus lateralis anterior) is
The medial sulcus of the cerebral peduncle (sulcus medialis cruris
an oval structure called the olive (oliva).
cerebri) h to the medial surface of the cerebral peduncle at the la
The roots of the hypoglossal nerve (nervus kypoglossus) (twelfth
teral margin of the interpeduncular fossa; this is the site of exit of
pair of cranial nerves) emerge from the anterior lateral sulcus onto
the oculomotor nerve (nervus ocuhmotorius) (third pair of cranial
the base of the cerebrum.
nerves).
The facial nerve (nervus facialis) and the auditory nerve (nervus
The transverse fissure of the cerebrum (fissura transversa cerebri)
tiestibulocochlearis) (seventh and eighth pairs or crania] nerves)
stretches between the cerebellum and the inferior surface of the
emerge from the brain between the olive and the pons. The acces
occipital lobes. It transmits the trochlear nerve (nervus trochkam)
sory root of the facial nerve (nervus intermedius) runs between these
(fourth pair of cranial nerves) which curves round the lateral sur
face of the peduncle and passes to the inferior surface of the cere two nerves, while to the back of them arise in succession from be
brum. hind the lateral border of the olive the glossopharyngeal nerve
(nervus glossopharyngeus) (ninth pair of cranial nerves), the vagus
The cerebral peduncles (pedunculi certbri) are elements of the nerve (nervus vagus) (tenth pair of cranial nerves), and the acces
mid-brain (mesencephahn) and appear like two massive white cords. sory nerve (nervus accessorius) (eleventh pair of cranial nerves)
They arise at the anterosuperior surface of the pons, diverge later whose roots emerge from the medulla oblongata (the cranial por
ally and upwards, and enter the brain matter behind the anterior tion of the accessory nerve) and from the upper segments of the
perforated substance to connect the brain stem with the cerebral spinal cord (the spinal portion of the accessory nerve).
THE CORPUS CALLOSUM
The corpus callosum (Figs 739, 744, 745, 764) is a white, elon
The corpus callosum lies in the depth of the longitudinal
gated from front to back, and slightly Battened mass measuring
fissure of the cerebrum; the anterior, middle, and posterior por
7-9 cm in length. It is the largest cerebral commissure, or the com
tions are distinguished in it.
missure of the most recently evolved parts of the cerebral hemis
The anterior portion curves forwards, downwards, and then
pheres (commissura neopallti) because it joins the grey matter of the
backwards to form the genu of the corpus callosum (goat arrporis
cerebral hemispheres (the neopallium) which is' of later phyloge-
isetical origin. callmi) which is continuous inferiorly with the rostrum of the cor
pus callosum (rostrum corpris mllosi). The last-named continues as

T H E SEMIOVAL CENTRE
Pissura iongJiiirfinalls cerebri
yGenu torporis callosl
Striae longltudinales
me dial PS
Stria 10-ngltudln.alis
Substantla t t b a ^ j
lalcralli
Truntus corporis
callos!
SplenluiTi corporis csllosi
Sukus cnlcarmus
Substantia tfrisea'
744. Semwval centre (centrum semiovale) and corpus callosum; superior aspect {%),
(The cerebral hemispheres are removed to the level of the semioval centre; part of the brain matter is removed from the right hemisphere
to expose the corpus callosum.)
the lamina terminalis which lies in front of and below the anterior the epiphysis cerebri, or pineal body fa$*$ pistole), and the tectal
lamina (lamina ledi) of the mid-brain.
commissure.
The superior surface of the corpus callosum bears a thin layer
The trunk of the corpus callosum (truncus corpora cdlmi) is its
of grey matter called the mdusium griseum which in some areas
middle part which is the longest and forms a longitudinal convex forms four small longitudinal thickenings in the fonn of striae, two
ity- on either side of the median sulcus. Two medial longitudinal striae
The posterior portion is the thickest and called the splemum of (itrim longitudinal mediates) and two lateral longitudinal striae
the corpus callosum (splenium corpom callosi). It hangs freely over

n THE CORPUS CALLOSUM
iiiiin {-nrporis callt>sl

(forceps minor)
S(Miic longitudinals
mediates
I - -- i: ?_=; 111.: 111 -11 i

laterals
Radiaiio corporis
cattosi
j-i.ral;if
brl
Radiatio curpuriJ: ca]3os1

(forceps major)
745. Corpus callosum and radiation of corpus callosum (radiatio corporis callosi); superior aspect
{Part of the hemispheric matter is removed; the lateral longitudinal stria [stria langitudinalis Lateralis] is removed Oil the left,)
(striae longiludinaks lattralts) arc distinguished. Some of the grey gyrus (gyrus jasdolaris) which is continuous on the medial surface
matter of the anterior portion of the corpus callosum {mainly the of the hippoeampal gyrus with the dentate gyrus (gyrus dentatus).
medial longitudinal stria) is continuous in the region of the ros Besides the longitudinal striae there are also some transverse
trum with the paraterminal gyrus (gyrus pamtcrmintilis). \\\ the pos striae on the superior surface of the corpus callosum which are
terior portions the lateral longitudinal stria curves round the infe seen distinctly between the lateral and medial longitudinal striae.
rior surface of the splenium and continues here as the splenial The arrangement of the white matter of the hemispheres is de-

T H E LATERAL VENTRICLES I'l
monstratcd oil a cross-section made on the level of the superior the occipital part, become thinner gradually and form the roof of
surface of the corpus collosum. It has a semioval outline in each the inferior and posterior horns of lateral ventricles (cornu inferius
hemisphere and is called the semioval centre (centrum stmiovale). et cornu posterius ventrkuli lateralis).
On the periphery the white matter is bordered by a layer of grey The fibres of the corpus callosurn passing through the rostrum
matter forming the cortex of the cerebrum (cortex cerebri). White and genu towards the frontal lobes, and those stretching posteri
fibres arising from the corpus callosurn diverge radially in the orly through the splenium towards the occipital and posterior
depth of each hemisphere to form the radiation of the corpus cal- parts of the parietal lobes are arched so that the concavity of one
losum (radiatio corporis calUsi) in which a frontal, parietal, temporal, arch faces the concavity ol'the other arch, thus forming the forceps
and occipital parts are distinguished corresponding lo the kibes of minor and the forceps major respectively (Fig. 745).
the cerebrum. The posterior portions of the radiation, mainly in
T H E LATERAL VENTRICLES
The lateral ventricles (venfriculi laterales) (Figs 74fi-750, rior surface of die anterior portion of the trunk of the corpus callo
752-75H) lie inside both hemispheres and are cavities originating surn superiorly, and the medial surface of the genu and rostrum of
from the vesicle of the telencephalon. the corpus callosurn anteriorly and infcriorly.
The left lateral ventricle (ventrkulus lateralis sinister) and the The right and left laminae form the septum lucidum (septum
right lateral ventricle (vmtriculus lateralis dexter) are distinguished. pdluddum). Between the laminae is a narrow slit-like cavity of the
Each is located in the corresponding hemisphere, the left one be septum lucidum (tavum. sepii pelluddi) which is seen distinctly after
ing conventionally considered the first and the right one, the sec removal of the corpus callosurn. Part of the septum to the front oT
ond ventricle. They are slit-like cavities lodged in the horizontal the anterior commissure (cvmmksura anterior) forms as the prccoin-
plane. The lateral ventricles have the following structures: (1) the missural septum (septum prtcommissuralt). The vein of the septum
anterior horn (cornu anterius); (2) the central part (pan ctntralis); lucidum (vena stpti pelluddi) runs in each lamina; it drains the ante
(3) the posterior horn (cornu posterius); (4) the inferior horn (cgrntt rior portions of the corpus callosurn, septum lucidum, and head of
mjerius). the caudate nucleus and empties into the internal cerebral vein
Each of these structures corresponds to one of the lobes of the (Hg. 757).
cerebral hemisphere. The anterior horn is lodged hi the frontal An oval interventricular foramen (foramen inierventriciilare) is
lobe and is the frontal part of the lateral ventricle; the central part found in the depths of the posterior parts of the medial wall of the
corresponds to the parietal lobe and is the parietal part of the la anterior horn between the thalamua and the anterior column of
teral ventricle; the posterior horn lies in the occipital lobe and is the fornix (columna fornids). By means of this foramen the cavity of
the occipital part of the lateral ventricle; the inferior horn is in the the lateral ventricle communicates with that of the third ventricle
temporal kibe and is the temporal part of the ventricle. (ventrkulus tertius).
The anterior horn of the lateral ventricle (comu (interim ventri- The anterior horn is continuous posteriorly with the central
euli lateralis) lies in the thickness of the frontal lobe. Its cavity is ac part of the lateral ventricle.
tually shaped like a horn bulging medially; on cross-section The ceulral part of the lateral ventricle (pars ctntralis ventrkuli
through the frontal lobe of the hemisphere the cavity is triangular. lateralis) Is located in the parietal lobe of the hemisphere. Its cavity
The superior and anterior walls of the anterior horn are formed by measures up to 4cm in length and 1.5 cm in width and extends
the anterior portions of the corpus callosurn the frontal part of from the interventricular foramen to the site of origin of the poste
the radiation and the genu of the corpus callosurn. The lateral wall rior and inferior horns of the lateral ventricle. On coronal section
and part of the inferior wall are formed by the medial surface of it appears as a narrow, shallow slit.
the head of the caudate nucleus (caput nuclei caudati) bulging into The parietal part of the radiation of the corpus callosurn forms
the cavity. The head is continuous posteriorly with the body of the the upper wall, or roof of the cavity. The lower wall, or the floor is
caudate nucleus (corpus nuclei caudati) which lies in the central pan formed, counting from the lateral to the medial border, by the
of the lateral ventricle and is in turn continuous with the tail of the body of the caudate nucleus (corpus nuclei caudati), the stria semicir-
caudate nucleus (cauda nuclei caudati) which contributes to the for cularis (stria terminalis), and the thalamus, above which lies the thin
mation of the superior wall of the inferior horn (Fig. 755). lamina affixa and the corresponding part of the choroid plexus of
The fine lamina of the septum lucidum (lamina, septi pellucidi) the lateral ventricle (plexus dioroideus ventriatli lateralis).
(of which there are two, left and right) forms the medial wall of The lamina affixa is an embryonal remnant of the telence
each anterior horn. The lamina is located in the space bounded by phalon wall which is attached here to the superior wall of the di-
the anterior surface of the anterior columns of the fornix (calumiiae encephalon. The inferior surface of the lamina lies on the thala
fornids) and body of the fornix (corpus fernkis) posteriorly, the infe- mus, medially it has a thin curved plate called the taenia choroidea

44 THE VENTRICLES OF THE CEREBRUM
Vtritrtculu* lateral^ sinister Ventrlculus laterals dexter
Lobjs parietalis
Cornu anterias
Recessus supra pine alii veatrtcHlj laterals
Recessus piTieslls
Lobus occfpftsffs
l-obus frontalls
Korameri interveritrlculaK:
Cornu posteriu.
ventrfculi Merit is
entrtrulus tertlus
Lobjs teiTiporalts
F?st ijjJum
Cerebellum
Ventriciifiis ijuartus'
Canalis centralist Recessus lateralis

vemricull quarli
746. Ventricles of cerebrum (ventriculi cerebn); lateral aspect (semischematical representation)

(The spatial relationships between the cerebral hemisphere,, cerebellar hemispheres, brain stem, show,, conditionally transparent, and
the ventricles of the cerebrum.)
(tenk choroidea); it is continuous with the ependymathe epithelial

preoptic nuclei of the hypothalainus and the anterior perforated
lining of the walls of the lateral and other ventricles. substance.
The stria setnicircutaris (stria terminals) is lateral to the lamina
The body of the forabt (empus fimids) borders the central part
affixa and partly covers a small terminal suicus which lies at the of the latei-al ventricle medially.
junction of the caudate nucleus with the thaiamus and transmits
The superior surface of the thaiamus is exposed when the cho
the superior thaiamostriate vein (vena thalamostriata superior). The
mid plexus and lamina affixa are raised and the body of the fornix
fibres of the stria semicircularis arise in the posterior part of the
is drawn aside. The slit-like depression between the border of the
amygdaloid nucleus (corpus amygdakideum), run in the root of the
fornix and the superior surface of the thaiamus, the choroid fissure
inferior horn of the lateral ventricle, and the fornix and connect (jissura choroidea) becomes visible also.
the amygdaloid nucleus with the lamina lucldum, the anterior and
The posterior horn of the lateral ventricle (cornu posterius nentri-

T H E VENTRICLES OF T H E CEREBRUM 4r>
747. Right lateral ventricle (radiograph).

] frontal sinus 4central pait 6posterior horn
2subaradwoid space 5 function yf centra] part aiid inferior bfim 7 inferior hom
ftcavity of third ventricle
'5anterior bom
cuii lakralu) is a continuation of the central part and is located in cavity of the posterior horn is surrounded laterally and superiorly
the occipital lobe, Its cavity measuring 1.2-2.0 cm in length is very by fibres of the corpus callosum.
narrow and triangular on frontal section, and three walls can Posteriorly the posterior horn is bounded by the occipital lobe.
therefore be distinguished in it: a concave medial wall, a convex T h e inferior horn of the lateral ventricle (cernv inferitts ventTiculi
lateral wall, and a narrowest anterior, or dorsal wall; the posterior, lakralis) lies in the depths of the temporal lobe, close to its medial
narrowed end of the cavity is directed to the occipital pole. periphery. Its cavity, measuring 3-4 cm in length, curves down
T h e medial wall bears two longitudinal elevations lying one wards, forwards, and medially.
above the other. T h e upper one, the smallest, is often indistinct T h e anterior parts of the cavity end blindly, failing to reach the
and is called the b u l b of the posterior horn (bulbus cornus poslerioris). temporal pole and reaching only the uncus where the amygdaloid
It is formed by a bundle of fibres stretching from the corpus callo- nucleus (corpus amygduhideum} lies in front of the inferior horn in
sum to the occipital lobe along the floor of the paries-occipital the thickness of the cerebrum (see Fig. 762),
sulcus and contributing to the formation of the forceps major of Four walh delimiting the cavity or the inferior horn are de
the corpus callosum. T h e fibres of the trunk and elevation of the monstrated on a frontal section: the lateral wall, the roof, the floor,
corpus callosum making up the roof and lateral wall of the poste and uhe medial wall.
rior horn and the lateral wall of the inferior horn of the lateral ven T h e lateral wall and the roof are formed by fibres of the corpus
tricle form the tapetum.
callosum.
T h e lower elevation is larger and always distinctly seen. It is T h e floor is formed by a triangular, slightly elevated area called
called the calcar avis and corresponds to the calcarine sulcus (sul the collateral trigone (trigonum tollattraU) whose posterior part con
cus cakarinus) projecting into the wall of the posterior horn. T h e tinues into the cavity of the posterior horn. Anteriorly and laterally

THE VENTRICLES OF THE CEREBRUM
! ! >
Pofus Frontails
1
"V i Erorrâlla
superior
Cornu anterliis
feniricull lateralrs shllstrk
OyrMJ fruntalls
medium
Corns
iriferlus ventricull
lateralls. sinistri
IJTLIS preterit rahs
Bukcis c^ntTEJ]ii
Pars
cenlralis ventrl
later; !i'. slni;
-Gyres
postcenl rails
Aquaednciss ^J.obulu^
Ctrehri ' parfetulla
inferior
Reoessus lateraHs
ventriculJ qiiarfi -
l-obulus parietalts
sujreff&t
VentrirrEilus quartiis
Corriu
jxisterlus van trie a
I a (era Ms sinlsitl-
Polus occipilahs
748. Ventricles of cerebrum (ventrkuli cerehri); superior aspect (semischematical representation).

(The spatial relationships between the cerebral hemispheres, shown conditionally transparent, and ventricles of the cerebrum.}

THE VENTRICLES OF THE CEREBRUM 47
749. Ventricles of cerebrum (radiograph).

(Occipital position.)
1.1 orbits 4 right lateral ventride
2.2 frontal Bnata 5left lateral irrvrrick
3third ventricle. fourth ventricle
the trigone is continuous with an elongated collateral eminence Medially of the hippocampus, between it and the dentate gyms
(emincntia collateralu) resulting from projection of the collateral sul- is a narrow white strand fused with the hippocampus called the
cus (sulctis eollatcralif). fimbria (fimbria hippocampi). It is a continuation of the posterior
The medial wall of the inferior horn is formed by the hippocam column of the fornii (crus jornicU) which descends into the cavity
pus, an elevation bulging into its cavity. The elevation measures up of the inferior horn.
to 3 cm in length and forms due to projection of the hippocampal The choroid plexus of the lateral ventricle (pkxus ekoroideus utn-
sulcus (sulcus hippocampi) into the cavity of the inferior horn. The t-nculi lateralis) also takes part in the formation of the medial wall
hippocampus arises posteriorly in the posterior portion of the cen of the inferior horn. It passes into the inferior honi from the cen
tral part of the lateral ventricle, in front of the calcar avis, at the le tral part of the lateral ventricle which it penetrates through the in-
vel of the collateral trigone; it then stretches along the whole of the terventricular foramen. Running towards the posterior horn but
inferior horn as an arched elevation whose convexity faces the la not entering it, the choroid plexus forms an enlargement in the
teral wall. Its anterior, wider part bears three or four digit-like collateral irigone called the glomns chorioideum, and then passes
ridges, called pes hippocampi, which are separated by small interdi- into the cavity of the inferior hom to be attached there to the mar
gital grooves. The end of the hippocampus forms the uncus. gin of the fimbria of the hippocampus by an epithelial strip known
The most superficial layer of hippocampal tissue lying next to as the taenia of the fornix (tenia fornids).
the ependyma of the inferior horn forms the alvcus of the hippo A strip of the grey matter, the dentate gyrus (gyms dentatus) lies
campus (aheus hippocampi). outside the cavity of the inferior horn between the fimbria and the

48 THE VENTRICLES OF THE CEREBRUM
vum septl pellucldi
^.Lamina sepli pellirddi
C-UfpUS L.7jlt(i!sUm^ Jj
G s p t l nuclei tandnti
Conui antsflus
vcnidcnli luteralis
" Probe in foramen intervtmricuiare

--Plexus d i o r l o i d f u s
vejltricul laltralis
Plexus clioiloldcus -Corpus foruleis

rcalricull laterals.
^ C o r n u jnierius
-cntrJcuti lateratis
Cms fornids
^'h'liTihria
hippocampi
Pts
llppocamp
G J T J S dentatus
-^Hippocampus
Trl<wum.
cnllaterale
-Calcir avia
hnlbus c w n i i posterloris
Cornn poileriLt5 ventrkull lateralis
Spkiiiinn'
corpora cilh>s
Sllltru-j calcsrinus onrips major
750, Lateral ventricles (ventriculi laterales); superior aspect {%).

(The trunk of corpus callosum is removed; the anterior, posterior, and inferior horns and the central part of the lateral ventricles are
opened.)
hippocampal sulqus. Its anterior end is continuous with the uncus, A frontal section through the posterior horn shows a thin plate
while its posterior end ascends and under die splenium of the cor- known as the reticular formation (formatio rdiadaris) (Fig. 755),
pus callosum forms a. grey splenial gyrus (gyrus fatdolaris). This gy- which covers the lateral surface of the hippocampal gyrus (gyrus
rus stretches to the superior surface of the corpus callosum and is parakippocamptdis) in the region of die hippocampal sulcus (sukus
continuous with the lateral longitudinal striae (striae langitudinales hippocampi).
lateraUs) of a thin layer of grey matter called the induseum gri-
sciini of die corpus callosum.

THE FORNIX 40
Genij Corporis csllosl
.Septum petluclduni
Lohus frontalts
Com miss lira anterior

Cavuiti septi pellucid).
Truncus corporis callosi
(inferior surface)
Colurtina fornicis
Carpus inaraillare
Lobus temporal is __
Corpus fornicis
Fasciculus
mamillothafamlcus Ccwnmlssura
Fornicis
Crus fomicfs s' "*

Gyrtts fasciolaris
Splenium
corporis callosi -
1
obus occipitalis
J\ 7
751. Fomix and hippocampal commissure (commissura fornicis); inferior aspect viewed slightly
from the front (%).
(The inferior pails of the temporal and occipital lobes and the brain stem are removed.)
THE FORNfX
The fomix (Figs 751, 754-758; 764) is an arched and elon cerebrum it has the shape of a trihedral prism. Its superior surface
gated band composed almost entirely of longitudinal fibres. A fuses with the inferiur border of the septum lucidum and further
body (corpusfornicis), posterior columns (crurafornicis),and anterior with the inferior surface of the corpus callosum. At the lateral bor
columns (eokttmat famkis) are distinguished in it. der of the body of the Tomix lies the choroid plexus of die lateral
The middle, thickest part of the body of the fornbt (corpus forni ventricle whose epithelial layer fuses with the border to form the
cis) lies under the corpus callosura. On a frontal section of the taenia of the fomix (tenktfornich).The last-named descends along

50 T H E CEREBRUM
Corpus callosum
Ventrlculus laleralis
(cormi anterlus)
/
t
Caput nuclei caudati
Radtatio corpora callos Capsula interna
Lamina sepii pellucldi ^ Nucjeus lertii'forttf
__
Capaula exterrta
Sulcus lateralis
Cavum sepll pehuckli
x
Lohus ti'mporalls
A- cerebri anterior
Oaustrmn
752. Cerebrum; posterior aspect (%).

(Frontal section made in Front of the anterior commissure.)
the posterior column of the fornix into the inferior horn of the lat the laterally located hippocampus. T h e posterior columns are con
eral ventricle. The lateral surfaces of the body of the fornix are di nected by a thin triangular liippocauipal commissure (commissura
rected obliquely downwards and abut freely partly against the up fumkisj from the sites of tiieir divergence to the entry into the infe
per surfaces and partly against the medial superior borders of the rior horns. The apex of the triangle is directed forwards and the
thalami. The rounded inferior border of the body overlies the tela base backwards. T h e commissure is composed of transverse fibres
churioidea of the third ventricle (tela diorioidea ventrkuli tertii). which are seen distinctly at the base. It connects the right and left
The posterior part of the fornix is formed by the right and left hippocampus.
posterior columns (crura j'ornkis) which are fused with the inferior T h e anterior parts of the fornix slightly diverge forming an up
surface of the corpus callosum in their initial parts but do not ex ward convexity and are then continuous with the anterior columns
tend to the splenium. Behind the pulvinar (puhinar tkalami) they of the fornix (columnae fornicis). This segment is called the free part
curve laterally and downwards, diverge, and then, each enters the of the anterior columns. They are located behind the anterior com
inferior horn of the corresponding lateral ventricle. There each missure and above the anterior parts of the thalami, as a result of
posterior column stretches along the course of the hippocampus to which a crescent shaped slit, called the intervetitricular foramen
its uncus to be continuous with the fimbria of the hippocampus (foramen intewentriculare), forms between each anterior column of
(Jimbria hippocampi) between the medially lying dentate gyrus and the fornix and the thalamus. Each foramen transmits a vascular

THE CEREBRUM 51
r'Lssurn longitudinalls cerebrl

i
Corpus callosum (splenium) Gyrus clnguH
,Bulbus COTQU posterjpris
Hadiatio corporis callosi
Fasciculus
longitudinal!; Inferior
Gyrus parahippocampalis trlgonuta collaterals \ Radiatio optlca

Gyrus occipitotemporalis lateralis

(Frontal section made through splenium of corpus callosum fspleniuir. iarporis callcsij.)
plexus and connects the cavity of the third ventricle with that of T h e medial nucleus of the mamillary body gives origin to the
the respective lateral ventricle. nerve fibres which run into the depths of the thatamus as the main
Each anterior column curves behind the anterior commissure, bundle of the mamillary body. O n e part of the bundle, passing to
runs downwards, and plunges into the hypothalamus nearer to the the cells of the anterior nuclei of the thalamus, forms the mamilh]-
medial surface of the thalatnus, i.e. close to the cavity of the third thiilamic tract (jasticulits mamitlnthalamicu.f) (see Fig. 739); the other
ventricle. Alter that, each column enters the corresponding mamil part forms the mamillotegmental tract (fasciculus mamiltottgmenta-
lary body (corpus, mamillars), the medial nucleus of the mamillary lis), whose fibres end in the cells of the regmental nuclei (nuclei teg-
body (nucleus corporis mamillaris medialis). This segment is called the menti).
hidden part of the anterior column of the fornix.
T h e fornix extends, therefore, from the hippocampus to the
mamillary body.

52 T H E DIENCEPHALON
v Corpus callosum
Cms fornicis ,-' /* A , C o r p u s fomfcis
Crus fornlcis
COTtimlssura ioniicis
M / Fasciculus mamillothaiamicus
/
Gyrus fasti oliiris^jS
Coinmissura anterior
Bulbus cotnu posierioris^jf
Colunina fornlds
^Corpus mamlllare
Calcar avIs-Vi JK.-Fimbria hippocampi
^ t ^-Unciis
Trlgonum coilsrersle-J
Flmbria hippocampi
Ventriculus laterals (opened)
Gyrus d m tut us
Hippocampus^ 1 ^Sfcjiif.
^ G y t u s parahippocampalis
J
Pts hippocampi
754. Fornix and hippocampus; superolateral aspect (%).
THE DIENCEPHALON
The diencephaion (see Figs 723-729, 743, 758) develops from trudes freely into the cavity of the third ventricle and forms its la
the Forebrain (prosencephalon) whose anterior part gives rise to teral wall; this surface bears the hypothalamtc sulcus (salcus kypo-
the teleiicephaloti. The diencephaion comprises a number or com tkalamieus) separating the thalamus from the hypothalamus.
plex structures among which the hypothalamus, developing from The dorsal surface of the thalamus carries an anterior tubercle
its inferior wall, is plrylogeneticaily the oldest, whereas the paired (tuberculvm anterius thalami). Between the tubercle, and the corre
thalamus, forming from the lateral walls of the diencephaion, is sponding anterior column (columna fornicis) lies the interventricular
phylogenetically the newest. A ventral tha)amus (thalamus ventralh) foramen.
and a thicker dorsal thalamus (thalamus dorsalis) arc distinguished. A prominence, called the pulvinar, is found on the posterior
Besides, another two regions, also diencephaion derivatives, are re surface of the thalamus; lateral and slightly posterior to it are two
cognized in relation to the thalamus: the epi thalamus and the me- small eminences, the geniculate bodies (svrpoTa geniculata) which
tathalamus, are developmentally related to the metathalamus.
The cavity of the diencephaion is the third ventricle (vtntriatlus The corpus striatum is located laterally and slightly to the
lertittt) (see Figs 746-748, 758, 759). front of the thalami; it is bounded by a layer of the white matter
The thalamus is an egg-shaped structure containing many nuc called the internal capsule (capsula interim) (Fig. 760),
lei which are centres of efferent conduction pathways. As is men T h e superior surface of the thalamus is free and forms a por
tioned ahove, the thalamus develops from the lateral wall of the di tion of the floor of the central part of the lateral ventricle.
encephaion where die optic vesicles project, and is a complex T h e grey matter of the thalamus Forms nuclei (nucUi thalami)
combination of the white and grey matter. Its medial surface pro (Figs 759, 762, 763). These are as follows : (1) the anterior nuclei

THE DIENCEPHALON 53
Capsula extcrna
Clan strum
/ Nucleus jFntiioimls j ^ , ^ intern
Thalamus
Tenla chorioidea-^
- ^BCauda nuclei caudati

Plexus chorioideu5-&M
ventricull lateralis
Tractus opticus
-Ferris fornicis
Cornu iiiferius
ventricull lateralis * ' Fimbria hippocampi
"-Formatio retitularls
Alveus-'
Hippocampus-' -Gyrus parahippocainpalis
-SUIL-LIS collateral is
Cortex cwebri
ûbstantia alba
755. Inferior horn of right lateral ventricle (cornu inferius ventricull lateralis); posterior aspect
(Frontal section; pia mater of the brain is shown red, the ependyma U shown blue.)
of the thalamus (nuclei anteriores thalami) located in the anterior tu leus (nucleus ventralis posterolateralis) and the posteromedial ventral
bercle (tuberculum anterius thalami): diey are represented by (a) the nucleus (nucleus ventralis posteromediatis); (4) the intralaminar nuclei
anterodorsal nucleus (nucleus anterodorsalis), (b) the anteroventra! of the thalamus (nuclei intrahminares thalami) which are small struc
nucleus (nucleus anteroveniratis), and (c) the anteromedial nucleus tures lodged in the medullary laminae oF the thalamus; they in
(nucleus anttromtdialis); (2) the medial nuclei of the thalamus (nuclei clude (a) the central median nucleus (nucleus centromedianus),
mediates thalami) Found at the medial surface of the thalamus in (b) the paracentral nucleus (nucleus paracentralis), (c) the parafasci-
cluding: (a) the anterior and posterior paraventricular nuclei (nuc eular nucleus (nucleus parnfaseicufaris), (d) the central lateral nuc
lei parasentriculares anteriores et posteriores) (b) the rhomboid nucleus leus (nucleus centralis lateralis), and (e) the central medial nucleus
(nucleus rkombaidalis), (c) the reunietis nucleus, and (d) the dorsal (nucleus centralis medialis); (5) the posterior nuclei of the thalamus
medial nucleus (nucleus medialis dorsalis) which lies separately; (nuclei posteriores thalami) located in the pulvinar; (6) the subthal-
(3) the ventrolateral nuclei of the thalamus which are largest and ainic nucleus (nucleus subihalamicus) which lies in the lower part of
located laterally to the anterior and medial nuclei and are as fol the anterior thalamus and is a collection of grey matter pierced by
lows: (a) the posterior lateral nucleus (nucleus lateralis posterior), fibres; (7) the reticular nuclei of the thalamus (nuclei reticulares thai-
(b) the dorsal lateral nucleus (nucleus lateralis dorsalis), (c) the ante ami) located in the anterior thalamus; (8) the zona incetta which
rior ventral nucleus (nucleus centralis anterior), (d) the lateral ventral lies in the anterior thalamus next to the reticular nuclei.
nucleus (nucleus ventralis lateralis), (e) the medial ventral nucleus All the main nuclei listed above, except for the nuclei in the
(nucleus ventralis medialis), and (f) the posterior ventral nuclei (nuclei pulvinar, are separated from one another and divided into smaller
ventrnUs posteriores) represented by the poslerolateral ventral nuc nuclei by medullary laminae. An external medullary lamina of the

54 THE DIENCEPHALON
Corpus caiiosum tgenu}

.Curnu arterius ventricuil tateralia
nuclei caudfiti
^Pltxwi thorloldeus
cntrK'ulL lattiralis
Stria termlngiis
Cavern sept] pellucidi~
Lamina sept! pellucid! J
Curpus f o r n i c l s ^
~*SpleniLini
Comu interlus
ventricuil lateralls'
ThalflmUs o]>tit rrtgORum coilateraie

Cuksr avis
s
BUTriKS cutflu pnsten'osls
Carflti poster!us /
ventr!cuti Lateral is-'
Crus Fomicis/
Commissure fomkis Forcyps major
756. Lateral ventricles (ventriculi laterales); superior aspect (%).

(The trunk of i h e corpus callosum is removed; the anterior, posterior, and inferior horns and central part ot the lateral ventricle are
removed from the left hemisphere; the anterior a n d posterior horns a n d the central part are removed from t h e right hemisphere.)
thalamus (lamina medullaris lakralis tkalami) and an internal m e d the h a b e n u l a r commissure (comrnissnra habeiudarum), is separated
ullary lamina of ihe thalamus (lamina mediillaris medialis tkalami) from the superior quadrigcminal bodies by the h a b e n u l a r sulcus
are distinguished. (minis haknulae), and contains in its depths the medial and lateral
T h e epithalamus consists of the following structures: (a) i h e nuclei {nuclei habenalae medialis et lateralis); (c) the epithalamic
pineal body (corpus pinealis) which is an endocrine (ductless) gland (posterior) commissure (commissitra epitkalamica s. postfrior). These
developing from the posterior area of the roof of the dieiicephalon; structures contribute to the formation of the walls of t h e third ven
(b) the habenula, which consists of t h e trigonuin hahenulae a n d tricle.

r
THE DIENCEPHALON ,r,
X a v u m scpti pellucitti
.Septum ptlEutlJum
^^.--Coirnu antcrius
k ventrlculi latErslis
Corpus striatum
(caput nuclei csudatl)
Plexus churioidcus
v-.ijtri'. IIIL laterally
--V, diurioideo
Tela choriaitk.
vctitnrull tertil _ H
R - - Pcs hippocampi
V. [hulamoilriiita J M
V v . ctrebrl interns. I P l e x u s clioriuiJCLLS

vcnLricuii lateral!;
V. cefebri mag
""^TrlguHUiTi collateral
""Caksr avi*
^Bulbus cnrmi posterloris
Commlssura farnicis ^Corpus t silos urn

Crus fennels' Corpus Somici!
757. Lateral ventricles (ventriculi laterales) and tela chorioidea of the third ventricle (tela ckoroidea
veniriculi tertii); superior aspect (%).
(The corpus callosum and body of the Fornix are divided and reflected to the back.)
T h e metathalamus is made u p oF paired structures, the medial bodies (corpora mamillarid), each containing two collections of grey
geniculate body (corpus geniculaium tmdiale) and the lateral genicu matter. O n e collection lies medially and is called the medial nuc
late body (corpus genitulatum lattrate). These are elongated oval ele leus of the mamillary body (nucleus medialis corporis mamillaris); the
vations lying inferoiateral to the pulviuar, Each geniculate body other is smaller, lies laterally, and is called the lateral nucleus of
contains a collection of grey matter forming the nucleus of the me the mamillary body (nucleus lateralis corporis matnilluris). Most of the
dial geniculate body (nucleus corporis geniatlati medialis) and the nuc fibres of the fornix end in them.
leus uf the lateral geniculate body (nucleus corporis geniculati latera- T h e subthalamie nucleus (nucleus sabthalamicus) (Figs 759, 7til)
Us). These nuclei have dorsal parts (paries dorsales) lying in the is also related to this area; this is a collection of grey matter
metathalamus, and ventral parts (paries ventrales) located in die an pierced by fibres and located in the posteroinfeiior parts.
terior thalamus. Besides, the hypothalamus contains a collection of 32 pairs of
T h e hypothalamus corresponds in position to the anteroinfe- nuclei which are subdivided into anterior, medial, and posterior
rior area of the diencephalon and lies below the thalamus under groups. Some of them are connected with the hypophysis cerebri.
the hypothalamic sulcus (Figs 764, 765), Some of its structures can The nuclei of these groups correlate the parasympathetic and sym
also be seen on the inferior aspect of the cerebrum between its pe pathetic functions. The Following nuclei are distinguished: the su-
duncles, in Front of the pons. This area includes the mamillary praopdc nucleus (nucleus supraopticus), the paraventricular nucleus

.Ill THE THIRD VENTRICLE
Carpus calltjsuin
,Cormi antalus ventriculi

tateralls
Caput nuclei caudati
f Colt!tilnae famid5
Commissure anEerfoiv
Tulrerculum anterlus thalamJ-.. , Adhesio inlerthalaniica
Caininissura posterior
Commlssura habenularum^
Ventriculus tertlus
Pes hlppSKffl
-Stria termirtalis
Lamina affisa
Gyrus dentatus
-Hippocampus
-Flmbria
tiippocampi
Tenla fornicls
Plexus uhorioideus ^Puivinar

vantrk'uU lateral to'
Trlgonurn ôllaterale
Cornu posterius
'-'v. ! I!I lateralis
Cakar avis
Trlgotium haben
Bulbas cornus pusterioris
Tectum mesencephali S u l c u s -.-- 1 m.-, 1-1=-. 1 i-
Corpus pinealc \Cercbdlutn
758. Third ventricle (ventriculus tertius); superior aspect (%).

(Most of the corpus callosum and fornix and the whole roof of the third ventricle are removed.)

T H E THIRD VENTRICLE 57
Striae f-onîtudinalea ntediak'S

Tenia chorioldeji
Fis
hVnfs ' sura lorijitiidinalis cerebri
Tema / Plexus chorloldeus v e n t r k u l i lateralis
Ft>r
V \ ! Corpus tallQsuns /klS''/ Rulaflo corporls callosi
V, ttiaiamostriata \ ! I / ' / *
Pars cenlraHs ventricuh1 lateralls
Stria tenninalis
Caput nudei can da I K
,Lamina affixa
^.,^-Nu-fcus anterior
Tela thorloidea
ventrlculi t*;rtr* ^-Nucleus rtiedialis Thalamns
Tenla ilialaml - * j L ^ N u c l e u s lateralls
Pies us ctK>rio1(]us_
veritric-uli. tertll
Claustrurri^~
V^-Adhesro interrhatamica
Fasciculus
mami llo(haldiTiic:LE5
Capsula esterna -
Capsula Interna-- Nucleus sutHhalfimicns
, - Surjstantia nlgra
Nucleus f ftrfauttof
lentlformls j Olphtis '
1- paltidns ,Jj
-'PeduncLlus terebri
Lamina medullary
Fossa interpeduncularis
G U M fnferins
ventrlculi lak'falis
ot'ulomolorius
PiMta cliojfoldei...
ventrlcuJ; lateralls paraliipp'ocampalis
TradgK opttcus )
NasJei carports mamllTarii
Ventrlt'ujus Itrtlus
759. Third ventricle (ventrkulus tertius), dorsal part; anterior aspect (%).
(Frontal section of cerebrum through the connexus m t e r d i a l a m k u s and mamillary bodies,)
(nucleusparavetitriatlaris), the iuferomedial nucleus (nucleus inferome- formed by the walls of the tuber cinereum, and the hypophysis
dialis), the sup era medial nucleus (nucleus superomedialvi)^ the poste cerebri (see The Dudleys Glands and The Inferior Surface of the Cere-
rior nucleus (nucleus posterior), the tuberal nuclei (nuclei tuberales), brat Hemispheres). T h e optic chiasma (chiasma oplicum) with the op
and the subthalamic nucleus (nucleus subthalamicus) (Figs 759, 765). tic tracts (tmctus optici) (see The Inferior Surface of the Cerebral Hemi
T h e optic part of the hypothalamus includes the tuber ciner- spheres and Sites of Exit cf Twelve Pairs of Cranial Nerves and The
eum, the infundibulum which is the narrowest part of the cavity Third Ventricle) are related to this part of the hypothalamus.
THE THIRD VENTRICLE
T h e third ventricle (oentrkulus tertius) (see Figs 7 4 6 - 7 4 8 , 758, tricuiar foramina (foramina interventriadaria.) located anteriorly,
759) is unpaired. Its slit-like cavity lies in the median sagittal plane avid with the fourth ventricle by means of the aqueduct of the mid-
and communicates with the lateral ventricles through the interven- brain (aquedudus cerebri) (Fig, 764).

&8 THE CEREBRUM
Flssura l o n g i t u d i n a l s cerebri
Cormi anterius ventrieull laleralts ^Genu corporls callosi
C a v n m sepU pellucidl
Lamina septd p c l l u c i d U Caput nuclei caudali
Columns i o r n i
Capsula interna
(cms ;iiif:-| lus .
Ventriculus l e r t i u \
Capsula exlerna
Fasciculus
ma m i I lol hal a m 5 c ns
Clan strum
Pulamen
ubiiii pallldus
Lamina
Capsula Interna medullarls
(crus postcrlus )
lateral Is
Trialamiis
Fimuria
hippocampi
Cautla
rcjdei Csiictsil
Hippocampus
Fastlculus
lurigitudJntlls Inferioi
^](jrnii posterEus
ventrjculi lateralCs
Splt^niuui curporfs callosf
Rarlislio optics*
Commissnra [ocnfci*
Sulcus cakarinus
760. Cerebrum; superior aspect {%).

(Horizontal section made on the level o[ the hippocampal commissure jcommissurajornicis/.)

THE CEREBRUM m
CoimntSsura arlteHory
Fasciculus
mamiHotliaJamicHs
Insuia\
Capsula exten
Cruj posterius
cipsulae Internae
Nucleus
siibtSslainicm
Te^mEntui
Aquseductuf
terebri
Corpus
genicuJatutn
medltil-e
-Nucleus rubsr
Hippocampus
Piilvir
Radlatto
aptica
^Ciornii poster! us
ventricall latEralis
Fimbrla lilppnca
^Tsctetn mewnceptiali
Fasdrulus longituilinalis SulcUS calcarinus

mfErior
Cerebellum
Calcar avl
761. Cerebrum; superior aspect (%).

(Horizontal section tnade on the level of the anterior commissure [commusura anterior jl)

THE CEREBRUM

(Frontal section through the tuber cinereum and to the back of the infundibulum.)
The cavity of the third ventricle is limited by six walls: superior plexus is covered ventrally, i.e. from the aspect or the cavity of the
(roof), anterior, inferior (floor), posterior, and two lateral walls. third ventricle, by ependyma forming the lamina epitheliali_<i chor
The roof of the third ventricle, the tda chorioidea of the third ioidea of the third ventricle. On removal of this lamina the cavity
ventricle (tela chorioidea ventriculi iertii) (Fig. 757), consists of two of the third ventricle is opened. Thus, the lamina epithelialis chor-
layers - a superior, dorsal layer lying under the fornix and the cor ioidea serves directly as the roof of the ventricle. Dorsal to it are
pus cailosum, and an inferior, ventral layer facing the cavity of the the choroid plexus of the third ventricle, then the tela chorioidea
ventricle. Between the layers is loose connective tissue in which of the third ventricle, still higher the fornix and, finally, the corpus
two internal cerebral veins (venae eerebri inttmae) pass on both sides cailosum. When the choroid plexus of the third ventricle is re
of the midline. They drain blood from the veins of the thalamus moved, a transverse depression tan be seen between the splenium
and corpus strratum (venue thalamostriatae), the veins of the septum of the corpus cailosum and the junction of the roof of the third
lucidum (venae septiptUucidi), the veins of the choroid plexus (venae ventricle with the tectum; this is the transverse fissure of the cere
chorioideae), and the lateral ventricles and empty into the great cere brum (fismra trattwersa cerebri).
bral vein (vena eerebri magtiit). The tela chorioidea of the third ven The lateral walls are formed by the medial surfaces of the thai-
tricle, lying under the forntx, is continuous laterally with the supe ami between which, in the median areas, is the connexus interthal-
rior portion of the choroid plexus of the lateral ventricle. Villi atnicus (adhtsia interthalamica). On the thalamus itself are distin
project from the ventral layer into the cavity of the third ventricle guished an anterior part bearing the anterior tubercle of the
to form the choroid plexus of the third ventricle (plexus chorioidem ventri
thalamus (tttberailum anterius tknlami), and a posterior, considerably
culi tertiij. In the anterior parts it is continuous with the plexus of thickened part called the pulvinar which covers partly the lateral
both lateral ventricles. One plexus is continuous with the other at surfaces of the anterior portions of the tectum of the mid-brain.
each interventricula.r foramen. The interventricular foramen forms between the anterior tubercle
Like the tela chorioidea of the third ventricle, the choroid of each thalamus and the anterior columns of the fornix.

THE BRAIN 61
Flssura l o n g i t u d h a l l s cerebri
Oyni5 cinguli Corpus callosutn
Septum p t l l u c l d u m
Corpus fnrnicts Radiatio corporis catlosl
^Venlrtculus lateralis
Plesus claorioicieus
Adhesio intertliaLaniiea
ventficuJi laterals x
Capsula intern a
Capsula esterna
Can da nuclei t a u d a l i
Nucleus anterior
tlialam!
Nucleus medlallSh
thaiainl
Nucleus lentif&fmls
.Nucleus
suKhilamicus
Substantla nigra
N u c l t u s laterals
ihalami
Cornu lnferius -
ventriuuli lateraiis êdunenlus t-erebrl
B ~ - Peduncular CKrebcLlirli
twdba
Flocculus TrscUis pyramidales
Henus c h t t f k k u 5 / N V B i ^ ?
ventrlcull quartl cochlearls / , | I ucleus olivarls
N. gtessopharyngeW N> vgUE

M V a m l s (medulla* ublongatae)
CtretKlItufl (he'les Inferior; ^Decussarin pyramldum
763. Brain (encephalon); anterior aspect (%).

(Transverse section of brain in the direction of the cerebral peduncles and medulla oblongata; in [he left cerebellar hemisphere the
middle cerebellar peduncle is dissected.)

62 T H E BRAIN
porpjs formers
TruntuE corporis calli. Teia ehorloidea vcntricuH lertii
Colurniu fornkis
Lamina sg|
pellucid!
Velum (ucduHire
super IJS
Commissure iintLTi^T
II? quartus
Lamina rerralnalls*'
Adhesio interthalamka y
Tuber cluweufrK
' i. ; ~~i
Corpus [TK'dullare vermin
/1 > .' I i i t cerebelll
Cbiasma o p t l c u m ' t f I I j 1 '
1 1
> ' ! i
/ / ' ! I I i
Kctussus opticus' / ' i i ! i
/ f ! i I '
j
Recfssijs inFuradibutr f i t t
lnluiKHbuluiii' ' ' I t I
Pfetus i-horloldeus verilriculi quart.
Hypaphysls I /j t! ! .
"I'hfiSiirnu.s
I
^Medulla oWottgnU
Suldft hyputhalamfcus j ^ gcftltifnoMni
Co-TfHi? m-amlllurc'
764. Brain (encepkalon), right half; medial surface (%).

(Midsagittal section.)
Vertical b u n d l e s of periventricular fibres (fibres perivmtriculares) T h e stria habenularis becomes wider posteriorly to form a
stretch u n d e r the ependyma of the lateral wall of the third ventri small triangular area called t h e t r i g o n u m h a b e n u l a c . R u n n i n g to
cle. They connect die medial group of thslamic nuclei with the hy- t h e middle, t h e trigonum is continuous with a narrow b a n d of
pothalamic nuclei. white matter, t h e habenula, which joins the contralatcral h a b e n u l a
T h e dorsal surface of t h e thalamus is covered by a d i m layer of t o form t h e h a b e n u l a r commissure (cfimmiauTa hahesiularwm,)
white m a t t e r Forming the stratum zonale. A narrow b a u d called (Fig. 758). T h e groove separating t h e trigonum habenulac and the
t h e stria h a b e n u l a r i s of t h e t h a l a m u s (stria medutiaris thalami) runs dorso-rnedial surface or t h e pulvinar of t h e posterior thalamus is
along the j u n c t i o n of t h e dorsal a n d medial surfaces. It is b o u n d e d designated the sulcus h a b e n u l a c .
medially by the lamina epithclialis of the third ventricle. A In the trigonum habenulac is a collection of grey matter, t h e
notched border called t h e taenia of the t h a l a m u s ftenia tkalami) re h a b e n u l a r nucleus (nucleus kabcnulae), in whose cells most of the
mains after removal of the lamina epithclialis and die choroid fibres of the stria habenularis (medullaris) end. T h e lesser p a r t of
plexus. t h e fibres passes through the h a b e n u l a r commissure, some of them

T H E HYPOTHALAMUS 63
Nucleus psiraventricularis Nucleus posterior

Nucleus dorsomedialls
Sulcus hypotrtalamicus
Nuclei tuberales
Nucleus *uprar>p(jcus.
Chiasma opticura
Nuclei carporis manjillaris
N. oculomotorius
765. Hypotkalamus (semischematical representation.)

(Projection of the hypoUialamic nuclei on the lateral wall of the third ventricle.)

04 T H E CEREBRAL PEDUNCLES
Aijuaediictus cercbrt Subslantia grisea centralis
Tectum mesentephali (colliculus superior^ j d k |D>- >
Tcgmentutn
. . - N u c l e u s ruber
-SubsUntia nigm
Crus cerebri
N. o c u l o m o t o r ! ^ S u icus m E d i 3 |jg c r u r i s c(frebri
766. Cerebral peduncles (pedunculi cerebri); posterior aspect (%).

(Transverse section on the level of emergence of the oculomotor nerve fnervus oculomotoriusj at the height of the superior quadrigeminal
bodies [cotliculi superiores tecti mesenccphalij.)
uniting with the cells of the cOntralateral habenular nucleus, and T h e fornix, its anterior columns, and the anterior commissure
others stretching to the superior quadrigeminal body (collicuhis su adjoining the posterior surface of the lamina terminalis limit ante
perior tecti mesencepkali) of the other side. riorly (he cavity of the third ventricle. T h e interior commissure is
T h e main part of the fibres from the habenular nuclei r u n in a cylindrical bundle of transverse fibres stretching from one cere
the habenulo-interpeduncular tract (tractus kahmulointtrptdunaila- bral hemisphere to the other; only its small middle segment lies at
ris) stretching dorsoventrally to the interpeduncular nucleus (nuc the anterior wall of the third ventricle, while the larger segment,
leus inhrpeduticuiaris) which lies close to the basal surface of the an stretching posteriorly, enters the frontal lobe and reaches its cor
terior perforated substance. tex. Two parts are distinguished in the anterior commissure: the
T h e plueal body (corpus pineaU) is attached to the posterior sur olfactory part (pars anterior) whose fibres connect the cortical cells
face of the habenular commissure (Figs 758, 764, 773); between of both olfactory lobes, and Lite posterior, or interhemispheric, bet
the pineal body and the commissure is the suprapineal recess frt- ter developed part (parsposterior) whose fibres connect the cortical
cesssis siiprapinealis), and below the commissure is the pineal recess cells of the parahippocampal gyri of both hemispheres.
(recessns pinealis) opening into the cavity of the third ventricle, T h e Ventral to the posterior commissure lies a collection of special
pineal body itself, lying between the superior colliculi of the tec- ized ependymal cells called tanycytes, They accomplish a secretory
tuin of the mid-brain, is completely surrounded by the choroid function and take part in the transport of hormonal and mediator
plexus extending from the third ventricle. T h e choroid plexus substances from the neighboring tissue and the cerebrospinal
should be removed with care during dissection so as not to tear fluid. This area of the ependyma of the third ventricle is known as
away the pineal body (see The Endocrine Glands). the ofgiiuum Subcommissurale.
Section through the middle of the cavity of the third ventricle A small triangular depression is found between the diverging
(see Fig. 764) shows the hypothalamic suicus (sulats hypoihalamieus) anterior columns of the fornix and the anterior commissure. It also
lying on the medial surface of the thalamus and stretching from contains a collection of specialized ependymal cells forming; the
the entry into the aqueduct to the interventricular foramen. It sep orgatium suhfornicale. Below the commissure is the lamina termi
arates the thalamus from the hypothalamus. nalis {see Fig, 764) which forms the anterior wall of the third ven-

T H E BRAIN S T E M 65
Fasciculus longitudinalis m c d i a l i s ^ ^ _ _ _ __ ; . Aijuaedudu-s cerc-tn-i

Lemniscus lateralis
a * ikV-Tiattus teumeulsiis cenltalis
Pedunculus cerebellaris superior _j
Tractus rubrospinaEls Bt-Lemn/scus medialis
us pyramldalis(fibrae
icospl nates et rorticu-
nucleares)
Ptdunculus eerebrl
Pedunculus cerebellaris A
medius
Pons
radix
N. Irrgtf-| sensoria
minus I radix / leus basilaiis
motor ia
N. intermedfus f
f* N, vestibulncochleans
-N. glossopharynjrt'us
Pedunculus cerebcllaris inferior

N. vagus
'PyramJs
S
Hssura mediana (anterior) N . accessorius
N. hypoglossun
Decwratto pyranikium
767. Brain stem (truncus cerebri); superoposterior view (semischematical representation).

(Horizontal section on the level of the superior quadrtgeminal bodies jcolliculi superiors kdi mesencepkalij.)

Ii!-i T H E MEDULLA OBLONGATA
Nucleus n. hypoglossi
Fasciculus lungitudlnslis nicdlalis S
. Pormatio rt-tlcularis
Nucleus tractus spinalts
a. trigemlnl
Nucleus amhlguiis
Pedunculus cerebetlaris
inferior
Nucleus ollvarls
accessorlus dorsalis Tractus olivocerebellaris
Tradus rubrospinalls , Nucleus ollvarls accessurius
Tractus tectospfnalls mediaHs
Tractus
jL ^-Nucleus olivaris
spi n ocerebel lari s anterior f
Hitus nuclei ollvarls N . vagus
Raphe
OHvaJ^-.
N. accessorlus
Sulcus laterally anterior -Tractus pyramidal is
N. hypoglossHS
Pyramis
768. Medulla oblongata; superoanterior view slightly from the front (semischematical
representation).
(Horizontal section at the level of the olive foUvaj.)
tricle; the optic recess (recessvs option) is located at the inferior mar postoptic commissures {commusurae svpraopticae dorsalis et omtralis).
gin of the lamina termhialis where it adjoins the optic chiasma; Strictly speaking, the fibres are not commissures but decussations;
d u r i n g early development of the brain it is the end part of the neu they connect the medial geniculate bodies and ensure the trans
ral tube cavity. mission of signals from the retina to the hypothalamic nuclei,
T h e floor of the tilird ventricle is formed by structures indi which is important for biorhythm regulation.
cated in the description of the base of the brain (see Figs741-743). T o the back of the corpus cinereum are the mamillary bodies,
Here we shall simply list them. From front to back is the optic chi and posteriorly to them are the cerebral peduncles with the poste
asma to the back of which is the luher rlnereum. T h e tuber ciner- rior perforated substance lodged between them.
c u m is continuous downwards with the infundibulum whose cavity T h e posterior commissure (commissura posterior) forms the bulk
forms the infundibular recess. T h e infundibulum is joined to the of the posterior wall ol the third ventricle. It is a curved plate bulg
hypophysis (see The Endocrine Glands). ing into the cavity of the ventricle and is made up of transverse
Bundles of fibres which are not related to the optic nerves pass fibres. Below it is the entry into the aqueduct, above is the pineal
dorsally arid in the optic chiasma; these are the dorsal and ventral recess, and still higher is the habenular commissure (Fig.758).

T H E MID-BRAIN
67
T H E BASAL N U C L E I O F T H E T E L E N C E P H A L O N
T h e grey matter lies in the depths of the white matter of the

They are separated by the medial and lateral medullary laminae
cerebral hemispheres, at their base, below the lateral ventricles. It
{laminae medullares mediates et hteratis).
forms variously shaped collections tailed the subcortical (basal)
3. T h e claustrum is lateral of the lentiform nucleus. It is an
nuclei, or central ganglia of the base of the telencephalon
elongated plate measuring up to 2 mm in thickness; the anterior
(Figs 759-763).
part is thickest. T h e medial border of the plate is smooth, the la
Four nuclei are related to the basal nuclei of the brain in each teral border bears small projections of the grey matter.
hemisphere: (1) the caudate nucleus (nucleus caudatus); (2) the len-
4. The amygdaloid nucleus (corpus amygdaloideum) (Fig. 762)
tiform nucleus (nucleus lentiftrrmis); (3) the claustrum, and (4) the
lies in the depths of the temporal lobe, in the region of the tem
amygdaloid nucleus (corpus amygdaloideum).
poral pole, in front of the tip of the inferior horn. Some authors
T h e caudate and lentiform nuclei together form the corpus describe it as a thickening of the temporal lobe cortex.
striattim (Figs 760-763).
A basilateral part (pars basolateralis) and a corticomedial part
1. T h e caudate nucleus (nucleus caudatus) consists of a head fat-
(pars cartkomedialis) are distinguished in the amygdaloid nucleus,
put nuclei caudati) which forms the lateral wall of the anterior horn
T h e corti corned ia I part contains the anterior amygdaloid area (area
of the lateral ventricle and is continuous in the central part of the
amygdaloidea anterior).
ventricle with the tail (cauda nuclei caudati) descending into the
All the basal nuclei of the telencephalon are separated by lay
temporal lobe, in which it contributes to the formation of the roof
ers of white matter called capsules (capsulae) which represent a sys
of the inferior horn of the lateral ventricle.
tem of conduction pathways of the brain.
2. T h e lentiform nucleus (nucleus Untifvrmis) is lateral of the
T h e layer of the white matter separating the thalamus and the
caudate nucleus. It is shaped like a lens and its longitudinal axis
caudate nucleus from the lentiform nucleus is called the internal
runs from front to back.
capsule (capsula interna).
Small layers of white matter separate the lentiform nucleus
T h e layer of the while matter between the lentiform nucleus,
into three parts (nuclei). T h e part lying laterally is called the puta- the claustrum, and the cortex of the insula is called the external
m e n , whereas the remaining two parts are the globus paltidus. capsule (capsula aeterna).
THE MID-BRAIN
T h e mid-brain (mesencephalon) develops from the middle cere
T h e following structures are distinguished on the dorsal sur
bral vesicle (Figs 722-729) and corresponds on the dorsal surface
face of the mid-brain: (a) the tectal lamina (lamina tecti); (b) the in
to an area of the brain stem bounded by the base of the pineal
ferior and superior brachia (brachia collicvli superitiris el calliculi infe-
body (or the level of the posterior commissure) anteriorly and by
rioris). O n the ventral surface are: (c) the cerebral peduncles
the anterior margin of the superior medullary velum (or the site of
(pedunculi cerebri) and (d) the posterior perforated substance fab-
exit of the trochlear nerves) posteriorly. O n the ventral surface the
stantiu perforata posterior).
mesencephalon corresponds to the posterior surface of the mancil
lary bodies anteriorly and the anterior margin of the pons posteri T h e cavity of the mesencephalon is the aqueduct of the mid-
orly. brain (aquaedudus cerebri); it connects the cavity of the third ventri
cle with that of (he fourth ventricle.
T H E TECTUM O F T H E MID-BRAIN
T h e tectum of the mid-brain (tectum mesencepkali) (Figs 758,

764, 769, 773) consists of two pairs of quadrigcmiual bodies (colli-
aili) lying on the tectal lamina (lamina tecti).

68 T H E CEREBRAL PEDUNCLES
T H E QUADRIGEMINAL BODIES OF T H E TECTUM
T h e quadrigeminal bodies are limited by a transverse groove quadrigeminal body (nucleus colliatli inferioris). Several systems of
separating them into two, right and left, superior quadrigeminal conduction pathways end and arise in the cells of these collections.
bodies (cotticuli superiors) and two smaller, also right and left, infe Ventral to the grey matter is a deep white layer.
rior quadrigeminai bodies (coltkuls mferiores). A bundle of fibres connecting both inferior bodies form the
T h e splenium of the corpus callosum overhangs the tectal lam commissure of the inferior quadrigerainal bodies (commissure, colli-
ina and both are covered dorsalty and laterally by the correspond culorum inferiorum). A commissure of the superior quadrigeminal
ing areas of the cerebral hemispheres. bodies (comrnissura colliculorum superiorum) can also be traced be
T h e pineal body lies partly above the superior quadrigeminal tween the superior bodies.
bodies and partly between them. T h e anterior surface of the cere T h e zone of the junction of the mesencephalon and the dience-
bellum stretches above the inferior quadrigeminal bodies. phalon is called the pretectal area (area pretecfalis). It contains col
T h e quadrigeminal bodies, just like the whole tectal lamina, lections oTgrey matter, the pretectal nuclei (nucleiprtiedales), which
are enclosed in a thiti layer of the white matter. In their depths is a have two-way connections with the superior quadrigeminal bodies
collection of the grey matter. In the superior body it is called the and the parasympathetic nuclei of the oculomotor nerves. T h e
nucleus of the superior quadrigeminal bndy (stratum griseum colli- two-way character of these connections ensures the coordinated
cuU superioris), and in the inferiorthe nucleus of the inferior reaction of both pupils to exposure of the retina of o n e eye to light.
THE BRACH1A OF THE QUADRIGEMINAL BODIES
White ridges stretch laterally from each quadrigeminal body. late body, partly passes into the thalamus and partly is continuous
T h e one arising from the inferior body is much thicker. These aie with the lateral root of the optic tract. The inferior brachium
called the superior brachium (brachium coUiculi superiors) and the passes u n d e r the medial geniculate body and fades in it, while the
inferior b r a c h i u m (brachium cdliculi inferioris) {Figs 769, 774). body itself gives rise to a bundle which is continuous with the me
Both brachia reach the elevations formed by the geniculate dial root of the optic tract.
bodies which belong to die iiietathalamus of the diencephalou. T h e optic tract (Iraclus option) by-passes the cervical peduncles,
O n e of the elevations, the medial geniculate body (corpus genicula- approaches the geniculate bodies, and divides into two bundlesa
tum mediate) lies medially, nearer to the cerebral peduncle, the thicker lateral root of the optic tract (radix laterals tractus optici)
other, the lateral geniculate body (corpus geniculatum Uteralc) is lo r u n n i n g to the lateral geniculate body, and a thinner medial root
cated laterally. Both are under the pulvinar of the thalamus and of the optic tract (radix medialis tracius optici) which fades in the m e
are separated from it and from one another by a groove. dial geniculate body.
T h e superior brachium inns between the thalamic pulvinar These roots, just like the optic tract, belong to die optic part of
and the medial geniculate body to the region of the lateral genicu the hypothalamus of the dieucephalon.
THE CEREBRAL PEDUNCLES
T h e cerebral peduncles (pcdunculi cerebri) and the posterior per T h e posterior part of the cerebral peduncles stretches from the
forated substance (substantia perforattt posterior) arc located on the substautia nigra to the aqueduct of the mid-brain and contains the
inferior surface of the brain (see Fig. 741). nuclei of the crania! nerves, collections of reticular formation neu
O n transverse sections of the cerebral peduncles made through rons, and longitudinal bundles of fibres.
different levels, an anterior part (pars ventralis) and a posterior part T h e substantia nigra is rich in pigment; it is crescent-shaped
(pars dorsalis) can be distinguished; the substautia nigra lies at their with its convexity directed towards the anterior part of the cerebral
junction. peduncles. A dorsal compact part (pars cntnpacta) and a ventral reti
T h e anterior part of the cerebral peduncles is crescent-shaped cular part (pars reticularis) are distinguished.
and contains longitudinal bundles of fibres: the cerebrospimll and T h e decussations of the tegtnentum (dtamaliones tegmenti)
c o r t k o n u c l e a r fibres {fibrae corttcospinaUs et corticonudeares) which formed by the intercrossing fibres of the rubrospinal and tectospi-
occupy the middle two-thirds of this part oT the cerebral pedun nal tracta (tractus rubrospmalis et tectosjdnalis) are also components
cles, and the cerebropontine fibres (fibrae cortkvpontinae). of the posterior part of the cerebral peduncles.

THE FOURTH VENTRICLE 69
(CQ1I1CU]U5 superior j
; Tectum mesencephali
iColliculus Inferior I
Frenulum veli meduUaris pup^rioris I i
I F . . .
... .. , . ', - t i Brachium colliculi infenons
Brach um colliculi S U p e r ! o n s ^ ^ ^ ^ | \ ( i
N. trochleariO
Lfngula cerebelli
Peduiiculus cefebellaris -Velum medullare superiuS

superior
^PetJunculii^ cerebellaris
iiledius
-Flocculus cerebelli
Pedunculus floccull' Plexus ctiorioideus

ventrieuli quart!
Venlricuius quattus
-Tubercuium nuclei cuneati
~Tuberculuni nuclei graeiiis
-Sulcus interraediuB posterior
Sulctw lateralis posterior- Fasciculus cuneatus

--Fiiuiculus lateralis
Fasciculus gracills
Sulcus inettianus (posterior)
769. Fourth ventricle (ventriculus quartus) and its tela chorioidea (tela chorioidea ventriculi quarti);
superoposterior view (%).
(The whole cerebellum is removed; the middle eerebellar peduncles are partly removed; the tela chorioidea of the foarth ventricle is
coloured violet.)
tal lamina to the cerebellum; these are the superior cerebellar pe

Another structure of the mesencephalon, the tectal lamina
duncles fadtmadi cerebdlares supenores) (Figs 769. 770, 781). These
(lamina tetti), lies above the tegmentum. In the middle, on the line
are derivatives of the isthmus rhombcncephali. The fibres of each
conventionally separating the right and left quadrigeinmal bodies,
peduncle arise in the cerebellar nuclei and run to the tectum of the
is the opening of the aqueduct of the mid-brain (aquaedvctits cerebri)
mid-brain to embrace the superior medullary velum (velum mtdul-
by means of which the third ventricle communicates with the
lart supenus). After that the fibres stretch ventrally of the aqueduct
fourth ventricle.
and the central grey matter (sufctantia gnsett centralis), cross to form
Two slightly compressed cylindrical bands stretch from the tec

70 T H E ISTHMUS RHOMBENCEPHALI
the decussation of t h e superior cerebellar peduncles (decussatio pe- the vestibular nuclei to t h e nuclei of t h e third, fourth, and sixth
dvnailorum cerehellarium superitxrum), after which most of them termi pairs of cranial nerves. These structures are also connected with
nate in the red nucleus (nucleus tuber) to form the cerebellorubral the motor-neurons of the anterior grey columns of the superior cer
tract; the remaining lesser part of the fibres penetrate the red nuc vical segments of the spinal cord which innervate the muscles of
leus a n d run to the thalamus as the cerebellotbalamic tract. the neck. T h e fibres of the medial longitudinal bundle arc respon
W i t h i n the red nucleus a rostrally lying parvocelluiar part (pars sible for the coordinated movements of the head and eyeballs.
parvocellularis) and a caudally located magnocellular part (pars mag- Longitudinal fibres of t h e dorsal longitudinal bundle (fasciculus
ncicellularis) are distinguished. longitudinalis dorsalis) stretch ventrolateral to the aqueduct of t h e
In front of the red nucleus, level with the cranial end of the mid-brain. They connect t h e thalamus and hypothalamus with the
aqueduct, ties the interstitial nucleus (nttcUuS mterstitialis). Most of brain stem nuclei.
the fibres of t h e medial longitudinal bundle of t h e mid-brain (fasci Rostral to the red nucleus, in the region of the ventral margin
culus longitudinalis medialis) originate in the neurons of this nucleus. of t h e internal capsule, a collection of neurons lies along the dis
T h e bundle extends along the entire length of the brain stem para- tribution of a loop-like structure, the ansa lenticnlaris; the collec
medial ly. It contains fibres connecting the nuclei of the oculomo tion forms the enlopeduncular nucleus (nucleus eittopeduncularis), or
tor, trochlear, and abducent nerves, as well as fibres running from the nucleus of ansa lenticularis (nucleus ansue leniicu.la.ris).
THE ISTHMUS RHOMBENCEPHALI

T h e junction between the mesencephalon and the r h o m b e n - these are the anterior bundles of the middle cerebellar peduncle
cephalon is the narrowest part of the brain stem. This part of the which have separated from the pons.
brain is called the isthmus rhombencephali, a n d is most defined in From the groove separating the inferior quadrigeminal bodies
the foetus d u r i n g infra-uterine development. arises the frenulum veil medullaris superioris which is continuous
T h e isthmus is the superior end of the rhombencephalon a n d posteriorly with the superior medullary velum (velum meduliare su-
the site of its union with the mesencephalon. f I is the upper part of perius). T h e last-named is a n unpaired elongated, quadrangular,
the pons (see Figs 723-727, 729). thin layer of white matter stretching between the superior cerebel
T h e following structures make up the isthmus rhombcncephali lar peduncles (Fig. 763),
(Figs 769, 711): (a) the superior cerebellar peduncles (pedunculi cer- T h e superior medullary velum is joined to t h e inferior quadri
'ebellares superiores) which lie along the dorsolateral walls of the isth geminal bodies and the posterior margins oT the right and left tri
m u s ; (b) Lhe superior medullary velum (velum medulla; t superius) g o n u m lemnisci anteriorly, to the white matter of the anterior part
which forms t h e dorsal wall of the isthmus; (c) the trigonum lem of t h e vennis of the cerebellum (vermis cerebelli) posteriorly, and to
nisci, a paired structure, each located slightly lateral of the supe the superior cerebellar peduncles laterally. T h e middle and poste
rior peduncle. A collection of grey matter is found in the central rior parts of its dorsal, or superior, surface is covered by the gyri of
part of the isthmus. the lingula of the cerebellum (lingula cerebelli): its ventral, o r infe
T h e trigonum lemnisci is b o u n d e d on one side by the inferior rior, surface facing the cavity of the fourth ventricle forms the an-
cerebellar peduncle and the inferior quadrigeminal body, and on terosuperior parts of the roof of this ventricle.
the otherby Lhe cerebral peduncle; it is more or less distinct a n d Intercrossing fibres belonging to the roots of the trochlear
contains fibres forming the lateral lemniscus (lemniscus lateralis). nerves (neni trochleares) pass in the superior velum and form the
Most of the fibres are central auditory conductors located lateral decussation of the trochlear nerves (decussatio ncrvorum trochlearium),
of t h e medial lemniscus (lemniscus medialisf T h e lateral lemniscus, as well as fibres of the bundles of the anterior spinocerebellax
passing in t h e depths of the brain matter, comes closer to the sur tracts (see Fig, 7SO).
face of the brain to form the trigonum lemnisci (Figs 767, 771). Laterally of the frenulum veli medullaris superioris t h e thin
T h e superior cerebellar peduncle stretching towards the cere trunk of the trochlear nerve pierces the superior medullary velum
bellum forms the posteromedial boundary of the trigonum lem and emerges on its surface at the junction of the posterior margin
nisci. Lateral to the superior cerebellar peduncle, in a groove be of the trigonum lemnisci and t h e anterior margin of the velum.
tween it and the middle cerebellar peduncle, lie small bundles of This is t h e only cranial nerve which emerges on the posterior and
lateral pontile filaments which fade in the cerebral peduncles; not the anterior surface of the brain like all t h e others do.

THE FLOOR OF THE FOURTH VENTRICLE 71
Colliculus superior
f \ TeclLiin mesencephah
/ .Colliculus inferior
-Frcnulum vcli medullaris

superioria
^ N . (mchlearis
Velum mediilEare^'3JB^_
super ius
Sulcus medianus
^Fovea .superior
Locus cerukus
Pedunculus cere be I Colliculus facia lis
superior
Peduncular
cerebellaris medium
t -VII
3- N- intermorfius
Pedunculus cerebeilaris vm
inferior "^Striae medullares
IX ventriculi quarti
Plexus chorioideus
ventrtculi quarti
(reflected)
Tuberculum nuclei gracilis
^-Fasciculus gracilis
Sulcus hieralis posterior'' ^ F
Sulcus intermedius Sulcus TTiedianus (posterior)

posterior
770. Floor of fourth ventricle (fossa rhomboidea); superoposterior view (%).

(The cerebellum is removed; the superior medullary velum and the tela chorioidea of the fourth ventricle with the vascular nerwork ;
rellected.)

NUCLEI O F T H E CRANIAL NERVES
Nuclei parasymp. oculomotorii

Nucleus n. oculornotorii
Tectum mesencephal
JUCIÎJS n, trochlearis
Nucleus tractus mesencephalici rt. trigemini

Frenuluru veil &
medullaris superioris M Nucleus motorius i i , trigemini
Nucleus sensorius princlpalis n. trtgemini
Velum meduilare Nucleus ii. abducentis

superius (reflected) ^ -
Nucleus n. facialis
Nuclei vesttbulare'
EmlnerHia medialls Nuclei n. vestibulo-
coehlearis
Peiluncuhis eerebellaris Nuclei cochleares
superior
Colliculus facialasi
Pedunculus eerebellaris / , N. facialis
mediui
Area vestiliularis EZZ&<^-~Nuclei s a l i v a t o r t i . superior e( i n f e r i o r
Velum meduilare Nucleus n. hypojjlossi

inferius (reflected)
;~X"Nucleus ambiguus
Nucleus
traetus spinalis n. trlgeuuni
Sulcus medians
Nucleus
fossae rhomboideae tractus solitarius
N. accessor!us
Trigonum rt. tiypoglossl Nucleus dorsal is n vagi
Nucleus spinalis n. accessor!i
Fasciculus gracili
Sulcus medianus{poster 10
771. Nuclei of cranial nerves (nuclei nervorum cerebralium) in the region of the mid-brain and hind-
brain (semischematical representation).
(Projection of the nuclei on the posterior aspect.)

T H E HIND-BRAIN 73
THE HIND-BRAIN
THE PONS
T h e p o n s is a derivative of the hind-brain proper (metencepk- run to the points at which the facial nerve (nervus fadalis) and the
alon). It is a large almost four-sided white ridge lying to the back of auditory nerve (nernus vedibulacochlearis) emerge.
the centre of the base of the brain. It is sharply delimited from the T h e longitudinal bundles of the pons (fasciculi longitudinales
cerebral peduncles anteriorly and From the medulla oblongata pos pontis) belong to the system of the pyramidal tracts and pass be
teriorly (see Figs 743, 764, 767). tween the transverse bundles but medial to the oblique bundle.
A longitudinal line drawn through the points of emergence of They arise from the cells of the cerebral cortex, pass in the internal
the roots of the trigeminal nerve (nermt trigeminus) (fifth pair of capsule to enter the cerebral peduncle through the pons, and run
cranial nerves) and the facial nerve (nerotts fadalis) (seventh pair of into the medulla oblongata as components of the cmrtieonuclear
cranial nerves) is accepted as the lateral boundary of die pons. T h e tract (tradus corticonudearis) and then to the spinal cord as compo
middle cerebellar peduncle (pedunadus ccrebellaris medius) lies lat nents of the cerebrospinal tract (tmdus cortkospinaUs) (Figs 763,
eral to this line. 767).
T h e pons is therefore connected to the cerebellum by the right T h e reticular formation (formalin reticularis) is detected for the
and left middle cerebellar peduncles. whole length of the tegmentum of the pons and is directly continu
Lying on the clivus of the skull, the pons is directed rather o b ous with the reticular formation of the medulla oblongata and that
liquely, descending from front t o back. As a result a ventral (ante of the mid-brain.
rior) part (pars anterior) and a dorsal (posterior) part (pars posferitrr) T h e central stalk of the tegmentum formed by collections of
are distinguished. T h e ventral part lies on the base of the skull, the reticular neurons and their processes is called die median raphe of
dorsal part contributes to the formation of the anterior portions of the pons (raphe pontis).
the floor of the fourth ventricle (fossa rhomboidea) (see The Fourth Small collections of the grey matter lie in the depths of the
Ventricle). ventral part of the pons; these are the nuclei pontis (proper). Fi
A longitudinal basilar sulcus (sulats laiilaris) lodging the basi- bres arising in the cells of the cerebral cortex and forming the
lar artery (arteria basilaris) stretches on the midline of the bulging cerebropontine tract (tractus corticapontinus) terminate in the cells of
anterior surface of the pons. T o either side of the sulcus is a well these nuclei. The same cells give rise to fibres which intercross with
- pronounced elongated pyramidal eminence in whose depths the the fibres of the contralateral side and form the pontocerebellar
pyramidal tract passes. tract which stretches in die middle cerebellar peduncle to the cor
T h e anterior surface of the pons bears slriations formed by tex of the cerebellum.
bundles of nerve fibres (Kg- 767). At the junction of the ventral and dorsal parts of the pons is a
T h e arrangement of bundles of nerve fibres and collections of bundle of transverse fibres furmiug the corpus trapezoideum.
the grey matter (nerve cells) are demonstrated on frontal sections These Iibres arise from the cells of the ventral cothlcar nucleus
of the pons made through various levels. (nucleus cochkans ventralis), and some of t h e m reach the ventral nuc
T h e ventral part of the pons (pars anterior pontis) is thicker and leus of the corpus trapezoideum (nudeus anterior corp&ris trapezoidei)
the n u m b e r of nerve fibres is greater in it than in the dorsal part whose cells are scattered between the fibres of the corpus trapezoi
(parsposterior pontis), which contains more collections of nerve cells. d e u m , while others terminate in the cells of the dorsal nucleus of
In front of the longitudinal pytamidal bundles in the ventral corpus trapezoideum (nudeus posterior corporis trapezoidei). Both
part of the pons are transverse superficial fibres forming the supe groups of these fibres form synapses in the named nuclei and then
rior pontine bundle. continue in the bundle of the lateral lemniscus (iemnhcus laterals)
More to the hack, between the pyramidal bundles stretch the of the same side. Finally, a large group of fibres of the corpus tra
transverse fibres of the pons (fibrae pontis transversal) to the poste pezoideum run through the layer of the medial lemniscus (lemniscus
rior parts of the middle cerebellar peduncles; they form the infe medialis) and pass to the opposite side to reach the cells of the nuc
rior pontine bundle. leus of the lateral lemniscus (nudeus lemnisa lateralis) (Fig. 767).
Both the superficial and the deep fibres belong to the system of T h e facial nerve (nervus fadalis) emerges medially, closer to the
transverse fibres of the pons (see Fig. 782). Together they form the posterior border of the pons, while the auditory nerve (ntrvus vestib-
corresponding layers of iibres the superficial and deep layers of ulocochlearis) is lateral to it. T h e sensory root of the facial nerve
the middle cerebellar peduncles, and connect the brain stem with (nersus inttrmtdivs) lies between them. Posteriorly the pons is sepa
the cerebellum. T h e transverse fibres intercross on the midline. rated from the anterior parts of the medulla oblongata by a trans
Closer to the lateral surface of the base of the pons passes a late verse groove.
rally arched oblique, or middle, bundle of the pons whose fibres

74 T H E HIND-BRAIN
T H E MEDULLA OELONGATA
T h e medulla oblongata develops from the posterior cerebral From the spinal cord to the medulla oblongata is made indistinct
vesicle and becomes the myelencephalon at the stage of the five by die transverse external arcuate fibres (fibrae arcuatae eitemae)
vesicles (sec Figs 722-729), stretching at the inferior border of the olive to the pyramid. Ante
T h e medulla nblongata is a continuation of the spinal cord ex rior and posterior external arcuate fibres {jibrae arcuatae exUrnac
tending forwards as its thickening (Fig. 743). ventrales et dorsales) are distinguished.
T h e medulla oblongata is cone-shaped, and slightly com T h e anterior external arcuate fibres are processes of cells of the
pressed in the posterior and r o u n d e d in the anterior parts. Its nar a r c u a t e nuclei (nuclei arcuati), which are collections of the grey mat
row end is directed downwards to the spinal cord, the upper, ex ter and lie next to the anterior and medial surfaces of the pyramids
panded end to the pons and cerebellum. T h e site of emergence of the medulla oblongata. These fibres emerge on the surface of
of the superior rootlets of the first cervical nerve, or the lower level the medulla oblongata in the region of its anterior median fissure,
of the decussation of the pyramids (decussatio pyramidum) is ac curve round the pyramid and olive, and run in the inferior cerebel-
cepted as the junction between the medulla oblongata and die spi lar peduncle to its nuclei.
nal cord (see Figs 743, 767), T h e medulla oblongata is separated T h e posterior external arcuate fibres are formed by processes
from the pons by a transverse groove which is easily detectable on of cells of the accessory cuneale nucleus (nucleus cuneatus accessorius)
the anterior surface; the abducent nerve (nervus abducens) emerges and run into the cerebellum in the inferior cerebellar peduncle of
o n t o the surface of the brain from this groove. T h e medulla oblon the same side. T h e accessory cuneate nucleus lies dorsolateral to
gata measures 3 cm in length, u p to L 5 cm un die average in the cuneate nucleus (nucleus cuneatus). From six to ten roots of the
width, and up to 1,0 cm anteroposteriorly. hypoglossal nerve (nervus hypoglossus) emerge on the surface of the
T h e anterior surface of the medulla oblongata lies on the lower medulla oblongata from the depths of the anterolateral sulcus.
part of the clivus and extends to the foramen m a g n u m (Figs 763, Collections of the grey matter are also seen in addition to the
764, 767-771). nerve fibres in cross-sections of the olive; the largest has a folded
T h e anterior median fissure (fissura mediana anterior) stretches structure and is called the olivary nucleus (nucleus olh'aris) which
on the anterior surface of the medulla oblongata and is a continua has a hiluin (hilus nuclei olivaris) with the nlivocerebellar tract (trac
tion of the anterior median fissure of the spinal cord. It ascends tus oliaicerebdlark), T h e other nuclei are smaller; one lies medially
arid terminates by a small pit, the foramen caecum of the medulla and is called the medial accessory oh'vary nucleus (nucleus olivaris
oblongata, lying on the above-mentioned transverse groove sepa atxessorivs medialis), and the other is located to the back and is the
rating the medulla oblongata from the pons. dorsal accessory olivary nucleus (nucleus olk'&ris accessorius dorsalis)
At the site of emergence of the rootlets of the first pair of cervi (Fig. 768).
cal nerves, the anterior median fissure becomes somewhat inter T h e association of fibres of ihe lateral spinothalamic tract in
rupted and shallow due to the decussation of the pyramids. the tectum of the medulla oblongata and the pons is known as the
In the superior parts of the anterior surface of the medulla o b spinal Lemniscus (lemntscus spinalis). In the tectum these fibres lie
longata, on either side of the anterior median fissure, is a conical lateral to the olivary nucleus,
elevation called the pyramid of the medulla oblongata (pyramis me A g r o u p of descending efferent fibres pass in the dorsal part of
dulla? oblongatae). the medulla oblongata; this is the tractus solitarius whose fibres
Transverse sections through the medulla oblongata show that end in the cells of the nucleus of ihe tractus solitarius (nucleus trac
each pyramid is a complex of partially intercrossing bundles (this tus solitarii) lying alongside the tract. T h e tractus solitarius can be
can be seen if the margins of the anterior median fissure are drawn seen along the whole length of the medulla oblongata; it contains
apart) and forming the decussation of the pyramids (decussatio pyr the gustatory and interoceptive fibres of the intermediate (sensory
amidum). T h e fibres then pass into the system of the lateral wliite root of the facial nerve), glossopharyngeal, and vagus nerves.
column of the spinal cord (funiculus lateralis medulla? spinalis) where T h e posterior surface of the medulla oblongata bears the poste
they run as the lateral cerebrospinal, or pyramidal, tract (tractus rior median fissure (sulcus rnedianus posterior) which ascends to reach
corticospinalis fpyramidalisj laterals). T h e remaining, lesser portion the thin m e m b r a n e called the obex. T h e last-named is stretched
of the bundles does not enter the decussation but runs in the sys between the gracile tubercles (tuberculum nuclei gracilis) and is part
tem of the anterior while column (funiculus anterior) as the anterior of the roof of the Fourth ventricle over the posterior angle of its
cerebrospinal, or pyramidal, tract (tractus corticospinalis [pyramidalkj floor (fossa rhomboidea). U n d e r the obex the cavity of the central
anteiior). Together these tracts form the pyramidal tract. canal of the spinal cord is continuous with the cavity oF the fourth
Lateral to the pyramid of the medulla oblongata is an elon ventricle (Figs 769, 770).
gated-rounded elevation called the olive (diva) which projects on Two grooves r u n lateral of the posterior median fissure, one is
the anterior surface of the lateral white column. closer to it and is called the intermediate sulcus, the other
T h e olive is separated from the pyramid by the anterolateral stretches lateral to it and is the postcrolateral sulcus (sulcus lateralis
s u k u s (sukus lateralis anterior) which is a continuation of the ante posterior). Four to live roots of the glossopharyngeal nerve (nervus
rolateral sulcus of the spinal cord. T h e continuation of the sulcus glossopkaryngeus), 12 to 16 roots of the vagus nerve, and three lo six

T H E HIND-BRAIN 75
nucleus of the spinal tract of the trigeminal nerve. I n the tegmen-

roots of the cranial part of the accessory nerve (pars ctrebralis nemi
t u m of the medulla oblongata these fibres lie between the last-
accessorii) emerge from the depths of the posterolateral sulcus o n
named nucleus and the inferior cerebellar peduncle.
the medulla.
A semispherical bundle, the inferior cerebellar peduncle (pe-
T h e posteiior median fissure and the posterolateral sulcus
dunciths arebellaris inferior) (Fig. 770) is located directly at the supe
delimit the posterior white column (funiculus posterior) of the me
rior end of the posterolateral sulcus, above the roots of the glosso-
dulla which is a continuation of the posterior white column of the
pharyngeal nerve, as a continuation of the posterior and lateral
spinal cord. T h e intermediate sulcus divides the posterior white co
white columns. Both the right and left inferior cerebellar p e d u n
l u m n into two bundles. O n e bundle is the fasciculus gracilis which
cles delimit the floor or the fourth ventricle (fossa rkombaidea) dor-
lies between the intermediate sulcus and the posterior m e d i a n
sally and laterally.
fissure, and is continuous upwards with the gracile tubercle (tuber-
Each inferior cerebellar peduncle contains fibres of conducting
culum nuclei gracilis). T h e other bundle stretches between the inter
mediate sulcus and the posterolateral sulcus and is called the fasci systems which form in it a lateral (larger) and a medial (smaller)
culus cu neat us; it is continuous upwards with a less distinct part.
cuneale tubercle (tukcrculv.ru nuclei cuneati). T h e reticular formation (formatio reticularis) of the medulla o b
Both tubercles contain collections of the grey matter: the gra longata is made up of numerous collections of neurons and fibres
cile nucleus (nucleus gracilis) is in the gracile tubercle, and the cu- which intertwine to form a complicated pattern. It lies for the most
neate nucleus (nucleus cuneatus) is in the cuneate tubercle. part in the ventral portion of the medulla oblongata and is contin
Fibres of the corresponding posterior white column terminate uous with the reticular formation of the pons. Some collections of
cells lie close to the nucleus of the hypoglossal nerve and die nuc
in these nuclei.
leus of the tractus solitarius; these are the nucleus paramedianus
T h e tuberculum trigeminale is sometimes found on the dorsal
dorsalis, the nucleus i n t e r c a l a t e , the nucleus parasolilarius, and
surface of the medulla oblongata between the fasciculus cuneatus
the nucleus commissuralis.
and the roots of the accessory nerve. It is formed by the caudal
T h e central core of the tegmentum of the medulla oblongata,
portion Of the nucleus of the spinal tract of the trigeminal nerve
which is formed by collections of reticular cells and their p r o
(nucleus tracius spinalis ncmi trigemini).
cesses, is called the median raphe of the medulla oblongata (rapke
T h e sensory root fibres of the trigeminal nerve enter the brain
medullae oblongatae). G r o u p s of cells of the reticular formation
to form the spinal tract of the trigeminal nerve (tradus spinalis nervi
trigemini). Its descending fibres reach the upper cervical segments lying paramedially are known as the nuclei raphae.
of the spinal cord and terminate in the cells located alongside the
THE F O U R T H VENTRICLE
sides by both superior cerebellar peduncles and forms the anterior,

T h e fourth ventricle (ventriculus quartus) (Figs 764, 769, 770) is
superior, part of.the roof; further to the back the roof is formed by
an unpaired cavity which developed from the cavity oF the poste
the inferior medullary veium (velum meduUare infmus) and the tela
rior cerebral vesicle and the cavity of the vesicle of the anterior
chorioidea of the fourdi ventricle (tela chorhidea ventriaili quarii)
part of the medulla oblongata (see Figs 723-729). T h e isthmus
lined inside by the lamina epithelialis. T h e inferior velum is at
rhomb en cephali also contributes to its formation. T h e fourth ven
tached laterally to the medial border of the inferior cerebellar pe
tricle communicates with the third ventricle superiorly through the
duncles. T h e tela chorioidea together with the inferior velum is
aqueduct of the mid-brain, and with the cavity of the spinal cord,
sometimes called the roof of the fossa rhomboidea.
its central canal, interiorly. Besides, the cavity of the ventricle
communicates with the subarachnoid space (cavum subamthnoideale) T h e roof is shaped like a tent; where the superior and inferior
at three sites. vella are continuous with the vermis of the cerebellum (vermis cere-
belli) (Fig, 764) the angle of the tent, or the apex, is formed which
Like all the other cerebral ventricles, the fourth ventricle is
lies on the anterior surface of the cerebellum, between the lingula
filled with cerebrospinal fluid (liquor certbrospinalis). It is sur
of the cerebellum (lingula cerebelli) in front and the nodulus of the
rounded by the pons and medulla oblongata anteriorly, and by the
vermis behind; both these lobes belong to the vermis of the cere-
cerebellum posteriorly and on both sides.
belluin.
T h e cavity of the fourth ventricle itself is bounded posteriorly
T h e tela chorioidea of the fourth ventricle is uninterrupted in
by the roof of the ventricle, and by the floor (fossa rkomboidea) ante
the first stages of embryonal development, and only later it tears to
riorly.
form openings by means of which the cavity of the fourth ventri
T h e posterior wall, or roof of the fourth ventricle (tegrnen vtntri-
cles communicates with the subarachnoid space (cavum subaracknvi-
cuii quarii), is formed, counting from front to back, by the superior
deale) (Figs 769, 799). T h e r e are three such openings: one is the
medullary velum (velum medTillare supenus) which is delimited on its

I
76 T H E HIND-BRAIN
median aperture of (he fourth ventricle (apertura mtdiana ventrkuli bellar peduncles divides the Iloor of the fourth ventricle into two
quarti), and two are the lateral apertures of the fourth ventricle (ap- triangles, superior and inferior, of unequal size.
ertitrae Literates tisntrieulis quarti). T h e median aperture is larger than O n either side of the median sulcus are two eminentiae medi-
the lateral ones; it lies in lower parts of the roof, slightly above the ales which are defined particularly well in the anterior parts of the
obex, and leads into the cavity of the subarachiioid space, into the fossa. T h e motor nuclei of the cranial nerves lie in the depths of
ccrebellomedullary cisterna (dsttma cerebdlomeduilaris). these eminences. A facial colliculus (coliiculus fadalis) formed by
Each lateral aperture lies in the region of the corresponding the geniculum of the facial nerve lies in the posterior part of each
lateral recess of the fourth ventricle (reussus laterals ventriculi eminence, which corresponds to the posterior parts of the superior
quarti)^ extends to the lobe of the cerebellar hemisphere, called the triangle.
flocculus, and leads into the subarachnotd space. T h e eminentia medialis and the facial colliculus are bounded
T h e (cla chorioidea bears villus-like protrusions on the surface laterally by the sulcus limitans of the fourth ventricle. In the upper
facing the cavity of the ventricle; together with the connective tis parts of the sulcus, nearer to the superior cerebellar peduncle, is a
sue and the ingrowing vessels the protrusions form the choroid small bluish area called the locus coeruleus (locus ceruleus) whose
plexus of the fourth ventricle (plexus chonoideus vmtriculi quarti) colour is due to the presence of pigmented cells.
which is covered in the cavity by the lamina epithelialis. T o the back of the locus coeruleus and at the lateral surface of
In front of the nodulus of the vermis the choroid plexus di the facial colliculus is a shallow depression, fovea superior, appear
vides to form a median choroid plexus, which stretches as two ing as if a widening of the sulcus limitans. In the lower parts the
bands on either side of the median plane to the median aperture of sulcus limitans is continuous with the fovea inferior.
the tela chorioidea, and two lateral choroid plexuses which run A series of thin white bands called the auditory striae (striae me-
towards the lateral recesses. dullares t'tntriatli quarti) pass posteriorly of the lower portion of the
O n removal, the choroid plexus leaves a mark at the site of its facial colliculus, across the intermediate part of the floor of the
attachment to the lateral walls of the fourth ventricle; it is called ventricle. They arise in the cells of the dorsal cochlear nucleus
the taenia of the fourth ventricle (ienia ventriadi quarti). To the which is lodged in the laterally located acoustic tubercle. T h e
back of and above the taenia is the inferior cerebellar peduncle striae run on the surface of the area vestibularis, a flattened eleva
running to the medulla oblongata; the taenia is continuous with tion between the acoustic tubercle and the sulcus limitans.
the gracilc tubercle posteriorly and extends to the obex inferiorly. Inferior to the area vestibularis lies the hypo glossal triangle
Anteriorly and laterally the taenia runs in the region of the lateral (trigonum nervi hypoglossi); medially and slightly downwards of it,
recess (reccssus lateralis) which it borders, and then passes on tile pe under the fovea inferior, is a small dark-brown area called the va-
duncle of the flocculus (pedunculus flacculi) to the free margin of the gal triangle (trigonum nsrvi vagi). Still further downwards is an area
inferior medullary velum and stretches on it to the nodulus. T h e which is speckled with small grooves, posteriorly oT which the me
coutralateral taenia reaches the nodulus in the same manner. T h e dian sulcus of the fourth ventricle is continuous with the central
taenia of both sides are therefore continuous. canal of the spinal cord. This place is covered by the obex, i.e. the
T h e floor of the fourth ventricle is formed by the fossa rhom- terminal area of the inferior border of the roof of the fourth ventri
boidea (whose name corresponds to its shape), which is covered by cle; the entry into the central canal is right u n d e r it.
a thin layer of the grey matter. It is formed ontogenetically of three A narrow elevation bordering the inferior margin oT the vagal
parts: its superior part arises from the isthmus rhombencephali triangle is designated the funiculus separans. Between this funicu-
and lies between the superior cerebellar peduncles; the intermedi lus and the gracile tubercle is a small petal-shaped area postrema-
ate part forms from the nictencephalon and is situated between the Both these structures are covered by specialized thickened epen-
right and left lateral recesses; the inferior part develops from the dyma; its cells are engaged in chemoreceptor function.
myeleucephalon and is located between the right and left inferior T h e posterior median sulcus (sulcus medtanus posterior) runs pos
cerebellar peduncles. terior to the obex, outside the cavity of the fourth ventricle, on the
The fossa rhomboidea (Fig. 770) extends from the aqueduct of midliue of the medulla oblongata, and passes onto the spinal cord.
the mid-brain in front to the spinal cord behind. T h e apex of its Lateral to it is an elongated eminence, the gracile tubercle (tubercu*
acute anterior angle faces the mid-brain, that of the acute poste lum nuda gradlis). Laterally and upwards the tubercle is continuous
rior angle the spinal cord, and the apices of the two obtuse with the inferior cerebellar peduncle; downwards it is continuous
angles face the lateral recesses. with the fasciculus gracitis. T h e tubercle and the fasciculus are
T h e median sulcus (sulcus medianvs) of the fourth ventricle bounded laterally by the intctniediate sulcus. Superior and lateral
stretches along the long diagonal of its floor and is continuous a n to the sulcus is an elongated cuneate tubercle (tuberculum nuclei cs-
teriorly with the aqueduct of the mid-brain on whose floor it runs. nmti). T h e upper end of die cuneate tubercle is continuous with
T h e median sulcus divides the fossa rhomboidei into two, right the inferior cerebellar peduncle, the lower end with the fascicu
and left, triangles. T h e base of each triangle lies at the median sul lus cuneatus. T h e lateral part of die fasciculus cuneatus bears an
cus, while the apex is directed to the widest part of the fossa, the elongated eminence, the grey tubercle, which lies between the cu
lateral recess, located in the region of the anterior part of the infe neate tubercle and the olive, and is separated from the cuneate tu
rior cerebellar peduncle. A line drawn between both inferior cere bercle by a small groove.

T H E HIND-BRAIN
11
CRANIAL NERVES NUCLEI IN T H E BRAIN STEM
In the brain stem the grey matter forms separate collections of

colliculus Nucleus lacrimalis, adjoining the inferior border of the
cells, i.e. nuclei, most of which are located in the dorsal parts of
nucleus of the facial nerve, is also distinguished.
the cerebral peduncles, pons, and medulla oblongata (Figs 7 7 1 ,
T h e nuclei of the auditory nerve (nuclei nervi vestibulocochlearis)
are represented by the vestibular nuclei (nuclei vesiibulares) and (he
T h e nuclei of the oculomotor and trochiear nerves lie in the
cochleae nuclei (nuclei cochleares), which are formed of smaller n u
dorsal parts of the cerebral peduncles.
clei and are located at the j u n c t i o n of the p o n s and meduJIa oblon
be nuclei' of the oculomotor nerve (nuclei nervioathmototii) are
gata; from the aspect of the floor of the fourth ventricle the nuclei
it tegmenrum of the cerebral peduncles, at the level of
are projected on the vestibular area. The inferior, media), and lat-
fbigaaina] bodies of the tectum of the m i d - t r a i n .
eral vestibular nuclei (nucleus oeslibuloris inferior, nucleus vestibularis
* m i l . m i c (vegetative) nuclei are distinguished.
medialis, et nucleus vestibukris laieralis) are distinguished. T h e infe
i f t h e trochiear nerve (nuclei nervi irochlearis) lie in
rior vestibular nucleus is embedded entirely in the medulla oblon
i of the cerebral peduncles, at the level of the infe-
gata. T h e two small cochlear nuclei, the anterior (ventral) and the
ilnal bodies of the tectum of the mid-brain.
posterior (dorsal) cochlear n u c l d (nucleus cochlea anterior s. mm-
eld of the fifth to twelfth pairs of cranial nerves
traUs et nucleus cochlearis posterior s. dorsalis) occupy the extreme
Bdgnf in the dorsal parts of the pons and medulla oblongata
lateral position in the vestibular area.
~! projected on different areas of the floor of the fourth ven-
The glossopharyngeal nerve (nervus glossopharyngeus) has a m o
tor somatic nucleus ambiguus, a sensory nucleus of the tractus sol-
r nuclei of the trigeminal nerve (nuclei nervi trigemini) stretch
itarius (nucleus tractus solitarii), and two autonomic nucleithe in
the whole length of the floor of the fourth ventricle. Motor
ferior salivary nucleus (nucleus salivatorius inferior) and the posterior
ttssory nuclei are distinguished. T h e motor nucleus of the tri- nucleus of the glossopharyngeal nerve (nucleus posterior nervi glosso-
linal nerve (nucleus motorius nervi trigemini) lies in the dorsal part pharyngei). All the nuclei listed are located in the dorsal part of the
be pons, and most of it is projected on the floor of the fourth medulla oblongata. T h e motor and sensory nuclei arc common to
icle medial of the locus coeruleus. T h e superior sensory n u - the vagus nerve.
fcm of the trigeminal nerve (nucleus sensorius principal!* nervi trige-
From the aspect of the floor of the fourth ventricle the nuclei
muk) is lodged in the dorsal part of the pons and is projected on
of the glossopharyngeal nerve are projected on the vagal triangle
t floor of the fourth ventricle in front and slightly lateral nf the (trigmium nervi oagi).
Ida] cnlliculus (allkulus facial*) in the region of the locus coeru-
T h e vagus nerve has three nuclei: an autonomic posterior n u
lens. T h e nucleus of the spinal tract of the trigeminal nerve (nu-
cleus (nucleusposterior nervi nag,), a motor nucleus a m b i g u u s , and a
cUus tract spinalis nervi trigemini) Is elongated and stretches in the
sensory nucleus of the tractus solitaries (nucleus tractus solitarii)
dorsal parts of the medulla oblongata to the cervical segments of
which is projected on the floor of the fourth ventricle lateral of the
e spinal cord. T h e mesencephalic nucleus of the trigeminal
vagal triangle, and lies dorsal to the nucleus ambiguus.
nerve (nucleus tracius mestncephalici nervi trigemini) ascends along the
T h e nuclei of the accessory nerve (nuclei nervi accessorii) arc lo
pons and mid-brain to the posterior commissure in the central
cated in the brain stem and spinal cord. The cerebral a m b i g u u s
grey matter lateral to the aqueduct of the mid-brain.
nucleus lies in the medulla oblongata, the spinal nucleus (nucleus
T h e nucleus of the abducent nerve (nucleus nervi abducent) lies
spinalis nervi accessorii) extends in the grey matter or the spinal cord,
tn the dorsal part of the pons, and from the aspect of the Door of
in the dorsal part of the anterior horns, along the distance of the
the fourth ventricle corresponds to the facial colliculus.
superior five to six cervical segments.
T h e nuclei of the facial nerve (nucleus motorius nervi fadalis, nu
T h e nuclei of the hypoglossal nerve (nuclei nervt hyfoglossi) are
cleus salwatorius superior, nucleus trodus solitarii) are located in from
located in the dorsal parts of the medulla oblongata and are pro
below, and lateral of the nucleus of the abducent nerve, and are jected on the floor of the fourth ventricle in the region of the hy-
projected on the floor of the fourth ventricle lateral to the facial poglossal triangle.
THE CEREBELLUM
T h e cerebellum (Figs 7 7 I W 8 2 ) develops from the middle and

cerebellum measures 9-10 cm and is much larger than the antero-
lateral part of the metencephalic roof (sec Figs 7 2 : W 2 9 ) ; the lat
posterior dimension measuring approximately 3 crn. T h e weight of
eral parts give rise to the cerebellar hemispheres (kemispheria cercb-
the cerebellum in an adult ranges from 120 to 150 g. Above the
e!U), the medial p a r t - t o the vermis which connects both hemi
cerebellum are the frontal lobes of the cerebrum. T h e cerebellum
spheres. The cerebellum occupies almost the whole posterior
is separated from the cerebrum by a deep horizontal fissure (fissura
cranial fossa (fossa cranii posterior). T h e transverse dimension of the
hori&ntalis)H into which a process of the dura mater, the tentorium

7S NUCLEI OF THE CRANIAL NERVES
Corpus genicufcatum mediale
Thalarrius ^ $i
Tractus opticus
Collktilus superior
Nuclei n, oculomotor! i
Nucleus trEictus mesencephaJici ^

a. irigemtni _ _ Pedimculus tcrcbri
Collicuhis inferior " N, oculomotor! us
Nucleus n. trouhlearis
N r trarhlearis'""
Nucleus mo tori us ** Pons

n. trigemini
I N. Irigerninus
Nucleus sensor [us principals kudu sentcria ]
n. trigemini
i K - Nucleus n, lacialis
Nucleus n, shductniis
N, v e st 1 bn Ifieo c h I e d T 5 s
" ^ K . facialis
Nuclei n.vestibulocaclUefl
N, abducens
-^Nuclei salivalorii, superior et inferior
Nucleus dorsal is n. vagi Oliva

V
N. glossophFLrynijOLj?
N
N. hypogtossus
tf, vagus
f
Nucleus n hypoglossi fajf
^ N. accessorius
Nucleus tractus solitflm N
Nucleus ambiguus
Nucleus Iractus spinaHs n, trigemini
Nucleus spinalis n. accessorii
Medulla spinalis
N. acce*sorius
772. Nuclei of cranial nerves (nuclei nervorum cerebralium) in the region of the mid-brain and hind-
,. brain (semischematical representation).
% (Projection of the nuclei on the lateral aspect.)

THE CEREBELLUM 7a
Corpus plaeatev Ventrlculus tertius

Thalamus
Tectum mesetkephali
/ ^,Stria fermlnalis
Tenla chorlofdea Vj
Collieulus superior
PulvSflw.
Lobus central is Collieulus interior
Fissurae cerebelli ^
V
Lobuli
Folia cerebelli -~_. quadrangulares
Lotiulus semilunaris
superior
Cuhuen '
Derive ^
Fissura horizontal is
Folium vermis Lobulus semilunaris Inferior
773. Cerebellum; superoposterior aspect {'/}.

(The cerebrum, except for the lamina tecti and posterior portions of the thalami, is removed.)
cerebelli, stretching over the posterior cranial fossa, is wedged (see superior) which is relatively even and descends obliquely to the bor
Fig. 796). In front of the cerebellum are the ports and medulla ob- ders, and a bulging lower surface (fades inferior).
longata.. Like the cerebrum, the cerebellum is invested in mem T h e lower surface of the cerebellum lies on the medulla oblon-
branes called meninges. O n their removal, separate parts of the gata which is pressed into it to form a hollow called the vallecula
cerebellum and the arrangement of numerous sulci and gyri on its of the cerebellum (vallecula cerebelli) on whose floor lies the vermis.
surface can be seen. T h e vermis is the middle part of the cerebellum lodged be
T h e cerebellum consists of the right and left cerebellar hemi tween its hemispheres. It bears numerous narrow, parallel folia. A
spheres (hemispheria cerebelli dexlrnm et sinistrum) which are sepa superior surface, or part (the superior vermis) and an inferior sur
rated by a shallow anterior cerebellar notch and a deeper posterior face, or part (the inferior vermis) are distinguished.
cerebellar notch. Two small longitudinal grooves, r u n n i n g on either side of the
Each notch is located on the corresponding border of the cer superior and inferior vermis, separate them from the cerebellar
ebellum: the anterior notch lies on the anterior b o r d e r and the hemispheres; the grooves on the anterior surface are shallow, those
posterior notch on the posterior border. T h e most prominent parts on the posterior surface are deeper.
of the anterior and posterior borders form the corresponding ante T h e cerebellum is made u p of the grey and white matter
rior and posterior angles; the most prominent lateral parts fortu (Figs 781, 782). T h e grey matter lying in the superficial layer forms
the lateral angles. the cortex of die cerebellum (cortex cerebelli), while Gt!ji|pctions of
T h e horizontal fissure (fissura horizontal^}, r u n n i n g from the grey matter in the depths of the cerebellum form its cefltal nuclei.
middle cerebellar peduncles to the posterior cerebellar notch, di T h e white matter of the cerebellum (corpus meiullare cerebelli) lies in
vides the surface of each hemisphere into an u p p e r surface (fades its depths and connects its grey matter with the cerebrum and spi-
i

80
THE CEREBELLUM
Fulvlnar Corpus geniajlalum mediate

Collitulus superior Corpus genlcnlslutrt laterals
pttcus
Collicu! m&uvtllarta
- N. optic us
"^Chiasma optimum
Lobulus quadra
lnfundibiilum
Hypophysis
Lobulu* semUmiaris, us cerebri
superior
/
% ^ - N . ficlahs
V
\ N . vestibulocochlearis
''is LA
c ^ f O ^N. abducens
\ N . glossopharyngeus
N. Kypoglossus
m \ TJ. vsffus
1 \
s
Medul!a spinalis
774. Cerebellum and brain stem (truncus cerebri); right aspect ( l / ) .
T h e upper surface (fades superior) of the cerebellar hemisphere

nal cord by means of three pairs of peduncles. These connections
bears the fallowing lobules (Figs 773-776).
are the above-described superior cerebellar peduncles (pedmculi
cerebellum superiors), stretching from the cerebellum to the roof of 1. A lateral extension of the cerebellum, the vineuia lingualia
the mid-brain, the middle cerebellar peduncles (pedunatli cerebel cerebelli, which is a small area of the cerebellar hemisphere con
lum medii) passing from the cerebellum to die pons, and the infe necting the uvula of the vermis with the superior cerebellar pedun
rior cerebellar peduncles (peditneuti cerebellums inferiores) passing cle through which it passes to the middle cerebellar peduncle; it
from the cerebellum to the medulla oblongata. corresponds to the uvula of the vermis.
T h e surfaces of the hemispheres and the vermis arc divided by 2. T h e ala of the central lobule (ah. lobitli c&ntralis) is a lateral
more or less deep fissures of the cerebellum ($SWM cerebdti) into area of this lobule of the verrnis; it contains several small and short
cerebellar folia (folia ctrtbelli) which have the appearance of nu folia.
merous curved leaves of various size; most of them lie almost par 3. T h e anterior lunate lobule (lobulus quadrangularis) has an
allel to one another. Groups of folia form separate cerebellar lob irregular quadrilateral shape with folia stretching anteroposteriorly
ules. T h e contralateral lobules of both hemispheres arc bounded and laterally. An anterior superior groove divides the lobule into
by one and the same groove passing from one hemisphere to the an anterior and posterior parts which correspond to the lobulus
other via the vennis; as a result a definite lobule of the vermis culminis (culmea) and the lobulus clivi (dtdtve) of the vennis.
corresponds to two, right and left, lobules of the same name of These ihrec cerebellar lobules belong to the anterior cerebellar
both hemispheres. lobe.
Some Of the lobules are united to form cerebellar lobes of Still another lobule is related to the upper surface.
4. T h e ansiform lobule, superior surface (lobulus smgm&is su
which there are three: anterior, middle, and posterior. They are
perior) is separated from the anterior lunate lobule by a posterior
separated from one another by constantly present fissures of the
superior groove; it corresponds to the lobulus folii (folium vermis).
cerebellum.

T H E CEREBELLUM Hi
Ala i:iln:M cenfrrallS
Fibsurfiecerebel!
HeniiEpheriijm cerebelli Htl[U?;:Jlr:|in|i CCTcUtllJ

(Jacks superior) {fades superior)
775. Cerebellum; superior aspect (x/\).

(The cerebellar m e m b r a n e s are removed.)
T h e lower surface (jades inferior) of the cerebellar hemisphere by the postnodular fissure (Jissura posterolattralis). A group of small
bears the following lobules (Figs 777-778).
convolutions, called the secondary (or accessory) flocculus, is
I. T h e ansiform lobule, inferior surface (lobulus semiiunaris in- sometimes seen next to the middle cerebellar peduncle. T h e floc
Jenor) is separated From the superior surface of the ansiform lobule culus corresponds to the nodule (nodulus).
by a horizontal fissure. Its folia curve distinctly laterally and poste
T h e biventral lobule, tonsil, and flocculus form the posterior
riorly, and its medial parts are thicker at the posterior notch of the
lobe of the cerebellum.
cerebellum than the lateral parts.
T h e vermis is a narrow part of the cerebellum which is located
A posterior inferior groove separates the inferior surface of the in the median plane a n d connects the right and left hemispheres.
ansiform lobule from a thin lobule; both these lobules correspond
Like the cerebellar hemispheres, the vermis is covered on the pe
to the lobulus tuberis (tuber vermis) and together with the superior
riphery by the grey matter forming the cortex of the cerebellum
surface of the ansiform lobule form the middle lobe of the cerebel
(cortex cerebelli); in the depths of the vermis is the white matter of
lum.
the cerebellum (carpus medullare) (Figs 779, 780).
2. T h e biventral lobule (lobulus biventer) is separated from the Fissures, most of which run transversely, divide the vermis into
inferior surface of the ansiform lobule by an anterior inferior a series of short folia forming the lobules (lobuli).
groove. T h e folia of this lobule can be separated into two parts ac
As it is pointed out above, the vermis is divided into two parts,
cording to their direction: the posterior lateral part has short folia
a superior and an inferior vermis, whose lobules correspond to cer
directed laterally, the anterior medial part has long folia most of
tain lobules of the cerebellar hemispheres.
which run from front to back. T h e whole lobule corresponds to t h e
T h e superior vermis has the following lobules.
p y r a m i d of the vermis (pyratnis vermis).
1. T h e lingula of the cerebellum (lingula certbtlli) is the front
3. T h e tonsil of the cerebellum (iovsilla cerebelli) lies medial to lobule. It consists of four or five narrow, transverse folia forming a
the biventral lobule, in a depression called the nidus avis located plate which covers the middle and posterior parts of the superior
at the inferior medullary velum; its short folia run from front to
surface of the superior medullary velum; posteriorly the lingula is
back. T h e tonsil corresponds to the uvula of the vermis (uvula ver
connected to the centra] lobule (lobulus centralis).
mis).
2. T h e central lobule (lobulus centralis) lies in the region of the
4. T h e flocculus is the smallest lobule of the cerebellar hemi anterior cerebellar notch, partly covers the lingula, and by means
sphere and is suspended on a thin peduncle (peiunculus Jlocculi). ot the alae of the central lobule is continuous with the anterior
T h e peduncle lies behind the middle and inferior cerebellar pe folia of the u p p e r surface of the cerebellar hemispheres.
duncles and is continuous with the inferior medullary velum at the 3. T h e monticulus is the largest part of the superior vermis
medial surface of the tonsil. Posteriorly the flocculus is bounded and connects the anterior lunate lobules of both hemispheres, ft

82 T H E CEREBELLUM
k*
^ângulaTis
semUtmaris
in*"'
776. Cerebellum; superior aspect (represented semischematically).
has an anterior, most prominent part called the lobulus eulminis

VERMIS HEM1SPHERIUM CEREBELLI
(admen) and a posterior, sloping part known as the lobulus clivi
(decline). Lob us Lingula cerebelli Vincula lingualia cerebelii
4. T h e lobulus folii (folium vermis) lies in the region of the pos anterior Lobulus centralis Ala lobuli centralis
terior cerebellar notch, and is a thin plate connecting the superior Culmen, declive Lobulus quadrangularis
surfaces of the an si form lobules of both hemispheres. Lobus Folium vermis Lobulus semilunaris superior
T h e inferior verm is is made up of the following lobules, listed medialis Tuber vermis Lobulus semilunaris inferior
from back to front, Pyramis vermis Lobulus biventer
Lobus
1. T h e lobulus tuberis (tuber vermis) is the posterior end of the Tonsilla cerebelli
posterior Uvula vermis
inferior vermis; it lies in the posterior cerebellar notch and con Flocculus
Nodulus
nects the inferior surfaces of the ansiform lobules of the hemi
spheres.
2. The pyramid of the vermis (pyramid vermis) has very twisted T h e cerebellar structures differ in age phylogenetically. T h e oldest
convolutions whose anterior portions are wider, while the posterior part of the cerebellum, the archeocerebellum, is formed by the
ends are blunt. It connects the biventral lobules of both hemi flocculus, nodule, and lingula which receive afferent connections
spheres. in the vestibulo- and spinocerebellar tracts for the most part. T h e
3. T h e uvula of the vermis (uvula vermis) is a narrow projection anterior lobe, with the exception of the lingula, together with the
with short convolutions which connects the tonsils of the hemi pyramid and uvula of the vermis form the old part of the cerebel
spheres. lum, the palaeocerebellum, whose afferent inllow is supplied by the
4. T h e nodule (noduhis) is the front portion of the inferior ver spinocerebellar tracts. W i t h the development of the cortex of the
mis. It bears shallow transverse grooves. T h e nodule connects the cerebral hemispheres, new cerebellar structures appear to form,
flocculi of both hemispheres by means of the inferior medullary the neocerebellum, which are represented by the middle lobe (ex
velum which is fused with its anterior convolution. cept for the pyramid and uvula of the vermis); the main source oT
T h e relationship between the lobules of the vermis and the afferent signals for this part of die cerebellum are the corlicopon-
lobules of the cerebellar hemispheres is as follows. locerebellar tracts.

THE CEREBELLUM M:<
Velum
medulla re super ius
Vermis
r
I Lingula cercnelli
/ /
/ / PetliiTvculus cerebellaris superior
Velum medullare \
inierius PeduncuLLis cerebeilaris inferior
Peduncuius cerebeliaris medius
Flocculus.
Fissura
posterolateralis
^Pedunciilus floccul!
Fissura horiianlalis
Lohulus^semtlunarls
Inferior
777. Cerebellum; inferoanterior aspect (j/J).

{Thecerebellum is cut away From the cerebrum through the superior and middle cerebellar peduncles and the superior medullary
velum.)
778. Cerebellum; anterior aspect (represented semischematically).

84 THE CEREBELLUM
Vermis
Gyri v r m l s r ^ Laming? aEbse
HemispheriLim oerebelli
(teeies superior)
.Corpus rneduhare
Fissura horizontal^
cere belli
Velum
nredullare infer! u s -
Tel a chorioidea .,
ventriculi quarti'
Hemispheriimi cerebeill
(factes inferior)
779. Cerebellum (l%).

(Midsagittal section tlirough the vennk of the cerebellum.)
780. Cerebellum (represented semischematically).

(Midsagittal section through the vermis of the cerebellum.)

C O N D U C T I N G TRACTS O F T H E SPINAL C O R D AND BRAIN
m
T H E W H I T E AND GREY MATTER OF T H E CEREBELLUM
As it is stated above, the cerebellum is m a d e u p of the white ebellum: (1) the inferior peduncles (peduncult cerebeilares inferiores)
and grey matter (Figs 779-782). T h e white matter (corpus medul- stretch from the medulla oblongata to the cerebellum (sec The Me
tare) lies in the depths of the cerebellum where it branches and dulla Oblongata and The Candueting Pathways); (2) the middle pe
penetrates each folium to form the white laminae (laminae albae) duncles (peduncxti cerebeilares medii) pass from (he pons to the cere
which are covered by the grey matter; as a result, on sagittal sec bellum (see The Pons and The Conducting Pathways); (3) the
tion of the cerebellum the white and grey matter form a tree-like superior peduncles (peduiuuli cerebeilares superiores) stretch from the
pattern which is called (he arbor vitae of the cerebellum (arbor vitae cerebellum to the mid-hrain (see The Tectum of the Mui-brain and
cerebelU). The Conducting Pathways).
T h e cerebellar peduncles. T h e cerebellum is connected to the T h e grey matter forms the cortex of the cerebellum (cortex cere-
cerebrum by three pairs of peduncles (pedunatli). These arc a sys belli) and its nuclei. A molecular layer (stratum mokculare) and a
tem of conducting pathways whose fibres pass to and from the cer granular layer (stratum granulosum.) are distinguished in the cortex.
THE NUCLEI OF T H E CEREBELLUM
T h e nuclei of the cerebellum (nuclei eertbelli) (figs 7 8 1 , 782) are 2. T h e nucleus emboliformis lies medial and parallel to the
paired collections of the grey matter in the depths of the white dentate nucleus.
matter of the cerebellum. T h e following nuclei are distin
3. T h e nucleus globosus is located slightly medial of the nu
guished,
cleus embolifonnis, and on section may have the appearance of
1. T h e dentate nucleus (nucleus dentalus) lies in the inferome- several small globules,
dial areas of the white matter. It is a flask-shaped lamina of the 4. T h e nucleus fasiigu lies in the white matter of the vcrmis to
grey matter with an open mouth in the medial part which is called either side of its median plane, u n d e r the lingula of the cerebellum
the hilum of the dentate nucleus (kilus nuclei dentati). and the central lobule, in the roof of the fourth ventricle,
BRIEF REVIEW OF THE CONDUCTING PATHWAYS (TRACTS)

OF THE SPINAL CORD AND BRAIN
T h e grey matter of the brain and spinal cord is an aggregate of grey columns of the spinal cord and in the brain stem are called
cell bodies of afferent (sensory), tntemuucial (connecting), and motor neurons, because their axons reach the skeletal muscles.
efferent (effector, or motor) neurons. T h e remainder effector neurons on which the axons of afferent
T h e cell bodies of afferent neurons lie in the peripheral gang neurons may terminate are related to the autonomic (vegetative)
lia: the spinal ganglia (ganglia spinalia) and the ganglia of the cra nei-vous system (sympathetic and parasympathetic parts). Their
nial nerves (fifth, seventh, eighth, ninth, and tenth pairs). Their specific feature consists in that (heir axons on emerging from the
dendrites terminate as receptors o n the periphery. T h e axons of spinal cord and the brain form preganglionic fibres. These fibres
the afferent neurons pass into the spinal cord and brain stem
do not reach the innervated organ but terminate on nerve cells of
where they form contacts with a series of internuncial neurons,
the peripheral ganglia of the autonomic nervous system. T h e axons
which either connect them with effector neurons within the limits
of the cells of these ganglia form postganglionic fibres which reach
of the segmental part of the nervous system, or convey impulses to
the innervated organ (glands, vessels, etc.).
the p a n s of the nervous system located above, u p to the brain cor
T h e spinal cord with the neurons located in it and the nerves
tex.
related to them innervates certain parts (segments) of the body
T h e eel! bodies of the effector neurons He in the anterior and thus forming the segmental part of the nervous system. T h e brain
lateral (thoracic and lumbar parts) grey columns (horns) of the spi stem also possesses some features of a segmental structure.
nal cord; in the hrain the cell bodies of the motor neurons lie in The brain cortex is not divided into segments and forms the
the stem. T h e axons of the effector neurons stretch as components suprasegmental part of the nervous system; it is linked with the or
of the spinal and cranial nerves. .* gans and tissues through the segmental part.
T h e effector neurons whose bodies are lodged in the anterior G r o u p s of neurons of the spinal cord and brain stem lying
I iiiil

T H E CEREBELLUM
86
-.Corpus striatum
(Caput nuclei caudati)
V. thalamostriata
Adhesio
intertbalamica _-Tenia chorioidea
Vcnlriculus terUus" Lamina afiixa

Commissura posterior Stria termlnalts
Commissura
Jiabetiularuin
^Corpus pirieale
Thalamus
_ ^Colllculus superior
- T r a c t us cerelidlorubralis
I-'rcnuluni veil medullaris

superiors
Fe.iuncLilus cereteUans ~ - N u c l e u s fastigii

superior
Nucleus (icntatus
Laminae albac^
/
/
/
Hiius nut lei denial'
Nucleus globosus Veriuis
Corpus medullare
Nucleus cmboliformis
781. Cerebellum and tedum of mid-brain (tedum mesencepkali); superior aspect ( / 9

the tractus
( H ^ t a , . * . * * the c e r e b e t a * * above the ^ ^ ^ g S T ^
cerebelloter/mentaUs iriesencephali dexter is tlis5ecr.ea.j
\->
r llllln 'nun;: Mini 'iiii mi

T H E CEREBELLUM o7
Brachium nc^llicviIt supenoris

f
,Brachitim coUiculi inferior is
Pulylnar | I p 0 [ p U S genlculatum laterals
Colliculus superior .Corpus gericulatgm medlale
^^Tractus opticus
Culliculus Inferior %
.orpora roaraillaria
HernispheriuiTi cerebeill ffc-'Chiasma opticuin
f i d e s superi
^ N . opllcus
Laminae atbae ?
"""--InfLiridibulum
-Hypophysis
~~.Pedunciilus cerebri
"" Pons
Fibrae pontis transversae
Corpus inedultare
Medulls oblongata
1
Nucleus olivaris
tiemispherinm cerebetll^
Ftbrae arruatae externae
t facies inferior)
Nucleus denlatus
Trmsilla cerefettit
jvtedulla spinalls
782. Cerebellum and brain stem (truncus cerebri); right aspect {%).
(Sagittal section of cerebellum slightly to the right of the mi dp lane.)
along the path of the afferent or efferent impulses form sensory or the cerebral cortex with the nuclei of the cranial nerves in the
motor nuclei. brain stem:
T h e aggregate of ueuronal axons stretching in the spinal cord (c) the corticoreticular fibres (fibrae (oriiarrdtculares) r u n n i n g
and brain and conveying impulses of the same kind is called the from the cortex to the nuclei of the brain stem reticular formation;
conducting tract. (2) the extrapyramidal tracts which connect the cerebral cor
All conducting pathways of die spinal cord and brain are sub tex, the premolor zone, with the bodies of the efferent neurons via
divided into efferent (descending), association, and afferent (as the subcortical nuclei and nuclei of the diencephalon and mid-
cending). brain: the corpus striatum, substantia nigra, red nucleus, and sub-
T h e association tracts accomplish connections between neu thai atnic nucleus;
rons in the spinal cord or between brain areas within the deriva (3) the efferent tracts of (he autonomic nervous system which
tives of each cerebral vesicle. are believed to pass from the cortex to the hyputhalamus either di
T h e efferent pathways (Figs 786, 792) are subdivided as fol rectly or through the subcortical nuclei.
lows: From the hypothalamus the impulses are transmitted to the eff
(1) the pyramidal tract (tractus pyramidalis) which is made u p erent neurons of the autonomic (vegetative) nervous system.
of; T h e afferent pathways (Fig. 790) convey impulses from the ex
(a) the cerebrospinal fibres (fibrae wrtimspmahs) connecting the tern- and inleroceptors to the cerebellum, thalamus, olives, and
cerebral cortex with the cell bodies of efferent (motor) neurons of tectum of the mid-brain.
the anterior horns of the grey matter of the spinal cord; T h e ascending tracts, each conveying impulses from certain re
(b) the corticonuclear fibres (fibrat wrticonudearzs) connecting ceptors, are represented in the spinal cord by: (1) axons of spinal

88 T H E G R E Y A N D W H I T E M A T T E R O F T H E SPINAL C O R D A N D BRAIN
ganglia cells (Jasdadus gradlis et fasdatlits tumaius), which termi terminate i n the nerve cells of its nuclei. In these nuclei the third
nate in the medulla oblongata; (2) axons of nerve cells of the spi neurons (neuron III) of the ascending tracts begin, along which
nal cord on which axons of afferent neurons of the spinal ganglia the afferent impulses reach die cortex of the cerebrum.
terminate; in the brain they are represented by axons of cells of T h e areas of the cerebral cortex at which the ascending path
the sensory cranial nerves nuclei on which terminate axons of cells ways (from t h e organs of vision, taste, hearing, and smell, a n d from
forming the peripheral ganglia of t h e cranial nerves (the trigeminal the skin a n d viscera) terminate are known as the cortical parts of
ganglion and others). the visual, gustatory, auditory, olfactory, cutaneous, internal (inter-
T h e axons of afferent neurons do not reach t h e cerebral cortex. roceptive), a n d muscular (motor) analysers.
O n t h e way to t h e cerebellum or to the nuclei in the thai ami c T h e analyser comprises the receptor neuron and t h e nerve
brain (thalamencephalon) t h e afferent impulses pass along two cells of t h e spinal cord, brain stem, a n d diencephalon. The dien-
neurons: (a) an afferent neuron lying in a peripheral ganglion, a n d cephalon neurons convey impulses to the corresponding areas of
(b) an intemuncial neuron located in the spinal cord or brain stem the cerebral cortex. All cortical cells responding to impulses in
(the medulla oblongata, pons). duced by stimulation of the receptors are related to analysers.
O n reaching the region of the thalamus the ascending tracts
THE GREY AND WHITE MATTER

T H E GREY MATTER O F T H E SPINAL C O R D
T h e grey matter (see Fig. 733) extends throughout the whole (2) the nucleus proper of the posterior horn is located in its
length of the spinal cord around t h e centra] canal. I n each half of central parts;
the spinal cord (see Fig. 732) it forms anterior, lateral, and poste (3) the thoracic nucleus lies on the medial part of the base of
rior grey columns (mlumnae griseae anterimes, later ahs et posteriores) the posterior horn;
which are joined by an intermediate part (or zone) (pars intermedia). (4) the intermediomedial nucleus lies to the front of t h e thor
T h e intermediate part consists of substanlia intermedia centralis acic nucleus;
surrounding the central canal of t h e spinal cord, and substantia in (5) the intermediolateral nucleus is situated in the lateral horn;
termedia laieralis wedged between the anterior and posterior (6) a group of nerve cells found in the region of the apices of
horns. O n transverse section of the spinal cord (Fig. 786) the co the posterior horn a n d form the gelatinous matter (suhtantia gelat-
lumns of grey matter are identified as the anterior horns (corrnia an- itiosa} and the so-called zona spongiosa;
teriora), lateral horns (carnua later alia), a n d posterior horns (corona (7) cells scattered diffusely in the grey matter and called t h e
postmora). T h e lateral horns are present only from the first thor cellulae disscminatae;
acic to t h e Erst or second lumbar segments and form projections (8) the reticular formation lies lateral to the grey matter of the
called the substantia intermedia lateralis. lateral horn a n d the adjoining parts of the anterior and posterior
The nerve cells of t h e spinal grey matter are grouped as fol horns. It is composed of numerous small islets of grey matter
lows: which are separated from one, another by white vertical and hori
(1) motor cells of the anterior horns which send axons into the zontal fibres.
anterior roots of the spinal cord;
T H E W H I T E MATTER O F T H E SPINAL C O R D
T h e white matter of the spinal cord (see Figs 732, 7 3 3 , 786) is T h e white matter of the spinal cord contains projection fibres
arranged around the grey matter to form the white columns (fitni- consisting of efferent (motor) and afferent (sensory) conducting
culi medulfae spinalis). T h e anterior, posterior, and lateral white co tracts (see below), and association fibres. T h e last-named are re
l u m n s {Junuuli anteriores, potteriores et laterales) a r c distinguished. sponsible for intersegmental links within the spinal cord a n d form

THE CORTEX OF THE CEREBRUM 89
783. Structure of the cortex of the cerebrum (schematical representation).

Acell layers; B cell types; C layers of fibres
I-LITexternal chief zone HIpyrainidai layer (lamina pyramidalaj; small pyramidal cells
IV-VI internal chief ZOTIC (ftlW Brodmann and Vogt) IVinternal granular layer {lamina granuljirii inierna)
]mrtlecular layer {lamina molieulariij Vganghoiiic layer {lamina gang$i*n(tns}\ large pyramidal cells
[1the external granular layer {laniiaa pmuilaru txttmtj VI polymorphous (multiform) layer [lamina taaltiffitTaii fpoiymorphaf)
the irttersegmemal tracts (fasciculi proprii anterior, lateralis et poste thin bundle of descending fibres lying in close contact with the
rior medullas spinalis) which adjoin the grey matter and surround it posterior median fissure; it is found only in the lower thoracic and
completely. They include: (1) the dorsolateral tract (tratius dorsola- lumbar segments of the spinal cord; (3) the interfascicular fascicu
teralish a small bundle of fibres lying between the apex of the pos lus (fasciculus interfascicularis), made up of descending fibres situ
terior horn and the surface of the spinal cord close to the posterior ated in the medial part of the fasciculus cuneatus; it is found in
root; (2) the septomarginal fasciculus (fasciculus septomarginalis), a the cervical and upper thoracic segments.

90 THE CORTEX OF THE CEREBRUM
21 22 37iib
20 h Wop
784. Cytoarchitedonic areas of cerebral cortex; superolateral surface (diagram).

(Moscow Institute of the Brain)
1area poutcentralis intermedia 18 area octipitafis 22/38- area tcmporalis superior polaris
4 area gigantapyrainidali^ 37a<jarea lemporoparietooccLpitatis posterior 47 4 - stibarea orbitalis
3area pe^ceirtriJHi oralis 37bârea lemporoparietoocopiiatis centralia 47 5 - iubar-ei Otbitftltl
2area postcem rails raudalis 37aarea lernporoparietoocopitatis inferior 45a- jubarea triangularis
40$fobirrtt supTumargLnaJis 37s area lei poi-oparietowdpi tali & superior 10- area fnmwpolaris
40area siLpTamarginsiks '^B.barea (emporoparietooccipiialis Ulterior 4S ..!ui triangijla*is
S9H jubarea arigularis superior 22area t e m p o r a l superior +6- area frontalis media
4psubarea fjupramarginalii posterior 21ârc3 Ecmporalh media 44- area operûlari?
7a^subarea parietootici|<it^lis 4flopsuharea. supramargmalis opercularis; 5op- subarea opercularis.
40E subarea supnmiarginilii inferior 20b arra temporal is busaJis B- area fronts] ia intermedia
39 area angnlaris 43*area pmtcentrahs subcentrali s i-.- area frontal is agraunlaria
39psubarea anguJarts posterior 20/98 area temporal is Has^lis polaris fo- wbarra anterior
19area preoccipkalis 21/38 area tcmporalh media polaris 6 p - subarea posterior

THE CORTEX OF THE CEREBRUM 91
23/
flit
31/ 6p 1 2 724 a
7 32 if I I
3 3!
\ 19 ' /7
31 '
na ia H
785. Cytoarchitectonic areas of cerebral cortex; medial surface (diagram).

(Moscow Institute of the Brain)
1 ârca postcentralis iiiLerrnrdia 20i area lemporabs limitans 8- -area Install* intermedia
2 area poateentxoKi caudal is liOtc area temporaiis tetiui corpuscularis 32/8 -subarea rrontaiis intermedia limbica
fi area gigantopyrarTmialiy 253 suh^rta suligtnuaiis inferior 24a- -subarea ajrraTmlitriH vcntralis
31 area limbka limiEans posterior 11 area gyri rccti 24b- -subarea agraiiularU media
7area parietalis superior 12area prefrontalia 24c -subgrca ajrranutaris dorsalis
TIAsubarea parictor>ccipitali& 32'12subarea prefrontahsj bmbita 6a- -subarea anterior
23csubarea l a t o cL prupegranularis dorsals 3 0
' area fron topoiftri s 6 -area
fruntalis agramtlarts
19 area preoccipitalis 31 area I irabi ca I bnita n & posterior 31 /32 limbicoJiniitaii.H media
-area
18 ara occipitalis %?3 area terriporuparietoacci pitalia inferior 6p-"Cufcftm pusleriur
1 7area striala 32-:10subarea frontojiolaris lirnbica 23/24c- -subarea tenui Î-QTILLI^ ns dumalis
3 V 7 subarea limbica limitans posterior 24/32area I imbi ca limitans anterior 23 / 24a --subureii tenui granularis ventraiis
,17darea trniporoparietfrocdpitalij interior limi 9area frontaiis gramiWi* 4- -area ^.ij-iiin;p- : !.!---
tans 3!?/9subarea fruntalis grajiuJaris liinbic& 3 -area postcentralis

THE SPINAL CORD
SeptQBWgiFfil fasciculus
' ~Sukus mediarms (posterior)
Fasciculus graeilU \ *
Fasciculus iuterfasciculaii? (comma tract)
Fasciculus cuneatus Radix dorsal is
i
Fasciculus posterior proprius I
Tractus
corticoBpinalis (pyx-ami daJJs)
lateral Is
Tractus rubrospinali*
T radus
sptnoccrerjellaris Longitudinal bundle
posterior iSieriorgiey cnlumf)
\
fasciculi proprii
>..,,[-.-M;v.- spinalis
(Fasciculi
tnteTsegrnejUa Its)
f-^^^ jt Cornu anterius

Traclus
spincrtecialls ei
tractus
spinothîiiMiici
anterior et lateralis
Traclus vests butospina Us
lateralia -
/
Tractus spinocerebellaris anterior
Tractus olivoapinaUs
Radix ventral is
Fasciculi pfOprir
Tractus vestlbulosplnaUs anterior \ j j Fissura rrsediana \FasCjCll]ug wnudtnalls
J( -anterior)
irir^ri/ir L
Tractus corticospinalts (pyramidalts) anterior j rnedtaUa
Tractus tec lu spinal is
786. Spinal cord (medulla spinalis) (schematical representation).

(Transverse section; distribution of white and grey matter.)
...
THE CEREBRAL CORTEX AND LOCALIZATION OF THE CORTICAL ENDS

OF THE ANALYSERS (CENTRES)
The cortex of the cerebrum (cortex cerebri) is the most highly (3) the pyramidal layer, lamina pyramidalis;
differentiated part of the nervous system. It is heterogeneous ac (4) the internal granular layer, lamina granularis interns;
cording to the time of origin in phylogeny. The oldest cortex, ar- (5) the ganglionic layer, lamina gangiionaris;
chicortex, is represented by the cortex of the hippocampal Forma (6) the multiform, or polymorphous, layer, lamina multiformis.
tion. The old cortex, palaeocortex, is identified in the region of the The structure of the cortex in various areas of the cerebrum
pyrifomi gyrus. The new cortex, neocortex, includes the remainder possesses specific features which are displayed by a different num
parts of the cortex of the cerebral hemispheres. ber of layers as well as a different number, size, topography, and
The cortex of the cerebrum is composed of a great number of structure of the nerve ceils forming it.
nerve cells which can be separated into the following six layers ac Many areas have been described in the cortex to date on the
cording to morphological features (Fig. 783): basis of its morphophysiological study (Figs 784, 785). Each area is
(1) the external zonal, or molecular, layer called the lamina characterized by individual architectural features, which made it
zonalis; possible to construct a diagram of the cerebral cortex areas (cyto-
(2) the external granular layer known as the lamina granularis architectural pattern) and to determine the peculiarities of the ar
externa; rangement of the cortical fibres (myeloarchitectonics).

T H E W H I T E M A T T E R O F T H E BRAIN ;>:;
T h e cortical parts of each analyser have definite areas ill the superior temporal gyrus; slightly to the back, in the posterior part
cerebral cortex in which their nuclei are lodged, and also definite of the superior temporal gyros lies the auditory analyser of speech
groups of nerve ceils outside these areas. T h e nuclei of the m o t o r signals (control of the individual's own speech and perception of
analyser are situated in the paracentral lobule, the precentral gy the speech of others).
m s , the posterior parts of the middle and inferior frontal gyri. T h e visual analyser of written signs is located in the middle
T h e cortical parts of the motor analysers of the lower limb part of the inferior parietal lobule (}grs$ angulnris).
muscles are lodged in the upper parts of the precentral gynts and T h e cortical part of the analyser of general sensation (tempera
paracentral lobule; below lie regions related to the muscles of the ture, pain, tactile, muscle and joint sensation) is situated in the
abdomen, trunk, u p p e r limbs, neck, and, finally, in the lowest part, postcentral gyms; the projection of body regions here is the same
the muscles of the head. as that in the motor analyser. In addition, the superior parietal lob
T h e posterior part of the middle frontal gyros lodges the corti ule (lobulus parietalis superior) contains the cortical area concerned
cal part of the motor analyser of the associate turning of the head widi the ability to recognize objects by louch (stereognosis), where
and eyes. T h e motor analyser of written speech, related to volun as die inferior parietal lobule (lobulus parktatu inferior) lodges the
tary movements linked with writing letters, figures, and other motor analyser responsible for performance of co-ordinated move
signs, is also situated there. ments mastered throughout life (praxis, on the left side in right-
T h e posterior part of the inferior frontal gyms lodges the m o handed individuals).
tor analyser of speech. T h e connection between the cortical end and peripheral (re
T h e cortical parts of the olfactory and gustatory analysers lie in ceptor) part of each analyser is accomplished by the system of con
the uncus (the hippocampal gyros of the temporal lobe); the corti ducting tracts of the brain and spinal cords and the nerves arising
cal part of the visual analyser occupies the borders of the calcarine from them.
sulcus and that of the auditory analyserthe middle part of the
T H E W H I T E MATTER O F T H E BRAIN
T h e white matter of the cerebral hemispheres consists of: pkalicus medialh). This is a system of longitudinal, ascending and
(1) descending projection fibres connecting the cortex of the brain descending, hypothalamic fibres. These are responsible for form
with the parts of the nervous system located below; (2) ascending ing two-way connections between the septum lucidum, hypothala-
projection fibres connecting the th a lam us (neuron III of the sen m u s , and the centres of the tectum of the mid-brain. T h e fibres of
sory tract) with the cerebral cortex, and (3) association fibres link this bundle arc detected throughout the length of the hypoth ala
ing either different areas in one hemisphere or similar contralat- m o s in whose lateral part they stretch;
eral areas in the right and left hemispheres. All these groups of (6) the association tracts interconnecting die subcortical nuclei
fibres stretch in definite regions of the white matter. of the hemispheres and the fibres linking these nuclei with the cor
T h e association tracts of the hemispheres are divided into two tex.
groups; (1) short and long association fibres and, (2) association T h e commissural fibres (Figs 7H9, 791) link similar areas of the
commissural fibres. right and left hemispheres; they include:
T h e short association tracts are represented by the association (1) the corpus callosum connecting all parts of the cerebral
fibres (fibrae arcuatae cerebri) interconnecting the neighbouring gyri cortex of both hemispheres with the exception of the temporal
(Fig. 788). poles;
T h e long association tracts are as follows (Figs 787, 788): (2) the anterior commissure (cammissura anterior) consisting of
(1) the superior longitudinal bundle (fascicuhs longitudinalis su two parts: the olfactory part (pars anterior) linking the olfactory
perior) interconnecting the Frontal, occipital, and temporal lobes; lobules, and the posterior part (pars posterior) connecting the h i p
(2) the uncinate bundle (fasciculus vncmalus) interconnecting pocampal gyri (gyri parahiftpocampaUs);
the region of the inferior frontal gyrus with the uncus of the tem (3) the hippocampal commissure (commissura fomicis) lying in
poral lobe and the neighbouring gyri; the form of a triangular plate under the splenium of the corpus
(3) the inferior longitudinal bundle (fasciculus longitvdinalis infe callosum, between the posterior columns of the forms.
rior) interconnecting the frontal lobe with the temporal lobe; T h e white matter of the hemispheres forms layers, called cap
(4) the cingulum connecting the region of the olfactory pyr sules, between the subcortical nuclei (Figs 7 6 0 - 7 6 3 , 789); these
amid (trigonum olfactorium) and the parolfactory area (area subcal- are:
losa) with the uncus. (1) the external capsule (capsula txlcrna) lying between the
(5) the medial bundle of the lelencephalon (fasciculus telencc- claustrum and the lentifonn nucleus (nucleus lentifonnis);

94 ASSOCIATION PATHWAYS
Sulcus cenlralis
Lobus parietal is
Fasciculus
lungltudinalls superior<r^
l.obus ironlali?
Lobus occlpltalis -
Fossa lateralis cerebri
Cerebellum
Fasciculus uncinatus
Lobus temporalis
-Medulla obkmgata
787. Association pathways; superolateral surface of right hemisphere (semischematical

representation).
(Projection of fibres on the surface of the hemisphere.)
(2) the internal capsule (capsule, interna) separating the lenti- the medial dorsal nucleus of the thalamus (nucleus medialis dorsalis
fomi nucleus from Ihe caudate nucleus (nucleus caudatusj and the thalami) and run radially to the cortex of the frontal lobe. Some of
thalamus. the fibres form connections between the anterior thalamic nuclei
All projection fibres of the hemispheres pass through the inter and the cortex of the medial surface oi the frontal lobe as well as
nal capsule to form the corona radiata in the hemispheric white the anterior part of the gyrus cinguli.
matter. T h e genu of the internal capsule (genu capsulae internac) trans
T h e internal capsule has ati anterior limb, a genu, and a poste mits the corticonudear fibres (fibrae. coHkonucUaris) connecting the
rior limb. cortical motor area with the motor nuclei of the crania] nerves
T h e anterior limb of the internal capsule (crus animus mpmlae (Fig. 792).
internae) is formed by the frontopontinc tract (tradusfnmioponiinia) T h r e e parts are distinguished in the posterior limb of the inter
(Fig. 789) which connects the cortex of the frontal lobe with the nal capsule (cr&s posterius capsulae intemae} \ (a) the (ha la mo lenticu
nuclei of the pons and is a component of the cerebropontine tract lar part (pars Ihalarrwlenticularu) which includes the cerehrospinal
(tradus antkopontinus). In addition, the anterior limb contains the fibres (fibrae aurttcospinales), the cerebrorubral Ebres (fibrae cariicoru-
anterior thalamic radiations (radiationes thaUimkae anterioresj in brales), the corticoreticular fibres (fibrae corticareikulares), the corti-
cluding fibres of the hemispheric white matter which arise from colhalamic fibres (fibrae wrtkotkalamcae), and the thalamoparietal

ASSOCIATION PATHWAYS 9ii
h'lbrae arciiatae cerebrl
Sulcus cingull
Fibrae arcuatae
cerebrl
Lobus parietalis
^ Corpus catlosum
Cyrus cingull
^L Sulcus parietooccipitalis
Cingulum | i 3 ^ t - Thalamus
- Cuneus
Polus frontalis
fm- PolllS OCCipltaliS
Sulcus calcaritius
Uricus
Polus temporahs Fasciculus longitudinal Is

Inferior
Sulcus collaterals
Gyrus parahippftcampalis
788. Association pathways; medial surface of right hemisphere (semischematical

representation).
fibres (fibrae thalamopamtaUs) r u n n i n g as components of the ten* diations optka et acustka) (Fig. 789); (c) the retrolentiform part
tral thalamic radiations (radiationen thalamicae centrales); (b) the len- (pan retrolenliformis) including the fibres of the posterior thalamic
liform part (pars suUeniiformis) which contains the corticotectai radian mis (radiationes thalamicae posteriores) and the parietooccip-
fibres (fibrae airticciiedcdes), the temporopontine fibres (fibrae tempor- itopontine Fasciculus (fasciculus parietoaccipitopontinus).
ttpontinae), and the bundles of the optic and auditory radiations (ra
THE ASCENDING (AFFERENT) TRACTS

T h e ascending tracts of the spinal cord and brain arise from T h e axons of neuron II carry impulses to the cerebellum and the
the nuclei of the spinal and cranial nerves. T h e axons of the cells thalainencephalon (neuron III), from where the sensory tracts run
of the spinal ganglia and cranial nerves (neuron I) end in the cells in the thalamocortical fascicuii to the cerebral cortex through the
of the spinal cord or the cells of the brain stem nuclei (neuron fl). internal capsule.

96 CONDUCTING TRACTS OF THE SPINAL CORD AND BRAIN
Fibres of corpus callowum Genu corporis callosi
Lobus frontalis
Tractus frontopontinus, Mucleus caudatus
Capsula externa
Ventrlculus lateralis
II strum
Insula
Crus anterius
Capsula
Tractus f r o n t o p o n t i n u s
Snterna Genu
Ctus posterius^- Tractus cortfconuclearis
-Putamenl Nttclws
-Olobus \ lenttcularis
pallidus I
Lobus temporalisr"
"* Tractus pyramidalis

(corticospinaltsl
- F a s c i c u l i thalamocorticales
"""" Tractus occipilopontinus
Radiatio acustic et temporopontinus
S Central auditory pathway

Ventrlculus tertius and optic tract
Thalamus
Tractus" occ i p i topont 1 mis
et temporoponiinus ' Corpus pincale
Splenium corporls callosi

Radlatio optica ^
Fibres of corpus eallosum
l.ohus occipital is
789. Capsules and course of tracts through internal capsule {semischematical representation).
THE ASCENDING (AFFERENT) TRACTS ARISING IN THE SPINAL CORD
The cell bodies of neurons I, which are conductors of all types fibres. The medial group of fibres stretches to the posterior while
of sensibility running to the spinal cord, lie in the spinal ganglia column (junicuiusposterior) where each fibre divides into an ascend
(ganglia spinalia). ing and descending branch. The ascending branches come in con
The axons of spinal ganglia cells stretch to the spinal cord and tact with the cells of the spinal grey matter in the gelatinous matter
form the posterior roots (radices dorsalis) (Figs 786, 903). and posterior horn, while some of them reach the medulla oblon-
\ On entering the spinal cord, the posterior roots fibres divide gata to form the fasciculus gracilis and fasciculus cuneatus of the
into two groups: a medial group consisting of thick, richly myeli- spinal cord. The medially situated fasciculus gracilis contains
natcd fibres, and a lateral group formed by thin, less myelinated fibres from the inferior (sacral, lumbar, and inferothoracic) spinal

CONDUCTING TRACTS OF T H E SPINAL CORD AND BRAIN 97
Fasciculi thalamocnflicales
Corpus rallcisum
Lob us pMrietaUa
Tractus splnocerebellarj;;
anterior
Lcibui !! i:\: .ilj -.
790. Ascending tracts of spinal cord and brain; right hemisphere (semischematical
representation).
(Projection of fibres on the surface of t h e hemisphere.)

98
C O N D U C T I N G T R A C T S O F T H E S P I N A L C O R D A N D BRAIN
Cornmissural fibres of
V corpus callosum
Corpus callosum \\ ~ " ^ - ^ k . Fibres from cortex to
nucleus caudatus
Fasciculi cortlcothalamicae 1
radlaflo thalan
Fasciculi thalamocortlcaks f
Cortex
Fibres from cortex to
Nucleus caudatus nucleus lentiformis
; Z . \ - j - T r a c t u s corti c otegm e n ta Its (B NM
Fibrae corticospinales^
(tractus pyramidatis)
Clausfrurn - ,
Capsula i n t e r n a l ____
Nucleus lentiiormfs ~=^=-^^,~L *" - Fibres from nucleus

Fibres conneetiug caudatus to globus pall id us
cortex with .M
nucleus ruber Ventrlculus III
Thalamus - "Ansa lenticularif

Fibrae corticonudeares Fibres connecting nucleus
(tractus pyramidatis) " ruber with thalamus
Nucleus ruber
--Pedunculus cerebrl
;-Tractus cerebellorubralls
Nuclei of crania] nerves
^\^*^Kr~Nucleus dent;
ntatus
J]/~~' Cerebellum
j ^ [Jons
Pyramls -
Ollva
"""^Tractus rubrospinalfs
Medulla oblongata ~"

Tractus
corticosplnalistpjramidalls) anterior [j^Tractus cortlcospinalis
(pyramidalis) Isteralis
791. Descending tracts of spinal cord and brain; frontal section (semischematical
representation).
(Projection of fibres on the surface of the brain.)

C O N D U C T I N G TRACTS OF T H E SPINAL C O R D AND BRAIN 99
segments. T h e laterally lying fasciculus cuneatus contains fibres lateral and anterior white columns, and end in the olivary nuclei.
from the superior (superothoracic and cervical) segments. T h e fibres of this tract carry information from the skin, muscle,
T h e descending branches of the fibres come in contact with the and tendon receptors.
grey matter cells of the posterior columns for the distance of six to 4. T h e spinoreticular tract (tradus spinoretkularis) is formed of
seven segments next below. In the thoracic and cervical parts oT fibres passing in the spinothalamic tracts; the fibres do not inter
the spinal cord some of these fibres Torm a bundle between the fu- cross b u t form bilateral projections in all parts of the stem reticu-
niculus gracilis and funiculus cuneatus, which is comma-shaped lar formation.
on cross-section; in the lumbar part the bundle is shaped like a 5. T h e anterior and lateral spinothalamic tracts (iradus spitw-
medial b a n d ; in the sacral part it is seen as an oval b u n d l e of the thalajnici anterior et latcralis) (Fig. 786) are made up of fibres con
posterior white column lying next to the medial surface of the fas veying impulses of pain, temperature, and tactile sensibility. T h e
ciculus gracilis. neurons. I cell bodies lie in the spinal ganglia. T h e processes of
T h e lateral g r o u p of the posterior root fibres passes into the neurons II begin from the cells of the posterior root nucleus
zona terminalis and t h e n into the posterior grey column to come in proper and run through the white commissure (mmmissura alba)
contact with the funicular cells and with the cells of the posterior into the anterior and lateral white columns on the opposite side.
horn. Ascending, the fibres of these tracts pass in the posterior parts of
Some of the fibres arising from the cells of the spinal cord nu the medulla oblongata, pons, and cerebral peduncles and reach the
clei ascend in the lateral white column (funiculus latcralis) of the thalamus as components of the medial temniscus. Neurons III of
same side, while others pass in the white commissure (commksura these tracts are lodged there; their processes stretch to the cerebral
alba) to the contra! ateral side of the spinal cord and also ascend in cortex in the thalamocortical fasciculus (fasciculus ikaiamocortkalis),
the lateral white column. Besides the ascending tracts, some des passing through the posterior limb of the internal capsule (cruspos-
cending tracts pass in the lateral white column of the spinal cord. terius capsulae intcrnae).
T h e following ascending tracts arise in the spinal cord 6. T h e spinoteclal t r a d (tractus spitiatedalis) passes together
(Figs 786, 790). with the spinothalamic tract in the lateral white columns of the
1. T h e posterior spinocerebellar tract (iradus spinocerebdtaris spinal cord and terminates in the tectal lamina of the mid-brain.
posterior) is a direct cerebellar pathway conveying impulses from 7. T h e fasciculus gracilis and fasciculus cuneatus conduct im
muscle and tendon receptors to the cerebellum. Neuron I is lo pulses from the muscles and joints and the receptors of tactile sen
cated in the spinal ganglion. T h e cell bodies of neurons II lie in sibility. T h e cell bodies of neurons I of these tracts lie in the corre
the thoracic nucleus of the posterior horn throughout the whole sponding spinal ganglia. Their axoiis pass in the posterior roots
length of the spinal cord. T h e long process of neuron II runs later and, on entering the posterior white columns of the spinal cord, as
ally, to the posterolateral part of the spinal cord on the same side, cend to reach the nuclei of the medulla oblongata.
turns upwards and ascends on the lateral white column, and then T h e fasciculus gracilis occupies a media) position and carries
passes on the inferior cerebellar peduncle to the cortex of the ver- Ore corresponding impulses from the lower limbs and lower parts
mis of the cerebellum. of the trunkbelow the fourth thoracic s e g m e n t
2. T h e anterior spinocerebellar tract (tradns spinocerebdlaris an T h e fasciculus cuneatus is formed by fibres arising from the
terior) transmits impulses from the muscle and tendon receptors to cells of all spinal ganglia lying proximal to the fourth thoracic seg
the cerebellum. Neuron I lies in the spinal ganglion, neuron II is ment.
situated in the medial nucleus of the transition zone and sends O n reaching the medulla oblongata, the fibres of the fasciculus
some of its fibres through the white commissure (commisswra alba) gracilis come in contact with the cells of its nucleus in a swelling
into the lateral grey columns on the opposite side, and the rest called the gracile tubercle (tubenulum nuclei gracilis); the fasciculus
into the lateral grey columns o n the same side. These fibres run in cuneatus fibres terminate in the cuneate tubercle (tubcrculum nuclei
front of the posterior spinocerebellar tract and reach the anterola- cuneati). T h e cells of both tubercles are the cell bodies of neu
tcral parts of the lateral columns. T h e r e the fibres of the anterior rons II of these pathways. Their axons stretch forwards and up
spinocerebellar tract turn upwards, pass in the spinal cord, in the wards as the internal arcuate fibres (fibrae arcuaiae internae), pass to
medulla oblongata, in the pons, and then in the superior cerebellar the opposite side, and intercrossing with the contralateral fibres
peduncles to reach the superior vermis. pass as components of the medial lemniscus. After reaching the
3. T h e spino-olivary tract (iradus spmo-olivaris) arises from the thalamus, these fibres come in contact with the cell bodies of neu
cells of the deep grey matter layers; their axons intercross and as rons III of this pathway which send processes to the cortex of the
cend close to the surface of the spinal cord, at the junction of the cerebrum via the internal capsule.

i
100 C O N D U C T I N G TRACTS O F T H E SPINAL C O R D AND BRAIN
T H E ASCENDING (AFFERENT) TRACTS ARISING IN T H E BRAIN STEM
1. T h e cell bodies of neuTons 1 of the cranial nerve sensoiy medial geniculate body (corpus geniculatum mediule) and the inferior
tracts are lodged in the peripheral ganglia: the trigeminal ganglion quadrigeminai body (colhculus inferior) of the tectum of the mid-
(ganglion IrigeminaleJ (fifth pair); the ganglion of the facial nerve brain, through the posterior limb of the internal capsule (ems poste-
(ganglion geniculi) lodged along the course of the seventh pair; the rius capsulae internae), and reaches the middle part of the superior
superior ganglion (ganglion superius) and the inferior ganglion temporal gyrus.
(ganglion inferius) of the glossopharyngeal nerve (ninth pair); and 5, T h e optic radiation (radiatia optica) connects the subcortical
the superior and inferior ganglia [ganglia suptrvus et inferius) of the visual centres with the cortex of the ealcarme sulcus (sulcus cakari-
vagus nerve (tenth pair). mts).
T h e axons of the nerve cells of these ganglia form the sensory T h e optic radiation contains two systems of ascending fibres:
roots of the above-mentioned nerves, which pass into the pons and (a) the geniculocortical optic tract originating from the cells of
the medulla oblongata. T h e r e the fibres of the sensory roots come the lateral geniculate body (corpus genieuhtum laterate);
in contact with the cells of the cranial nerve sensory nuclei. T h e (b) the pulvinar-cortical tract arising from the cells of the nu
cells of the sensory nuclei are therefore internuncial neurons. cleus lodged in the pulvinar; in m a n it is poorly developed.
T h e sensory nuclei of the cranial nerves are a collection of cell Ascending to the cortex of the cerebrum, both systems of these
bodies of neurons IE of the ascending pathways of these nerves. fibres pass through the posterior limb of the internal capsule (cms
T h e nuclei for the fifth pair of cranial nerves (nervus trigemimis) are pusterius capsulae internae), and are known as posterior thalatnic ra
represented by the superior sensory nucleus (nucleus sensorius supe diations.
rior nersi trigemini) and the nucleus of the spinal tract of the trigem 6, T h e th alamo cortical fasciculus (fasciculus thalamocartiealis)
inal nerve (nucleus tractus spinalis nervi trigemini); the sensory nuclei passes through the posterior limb of the internal capsule (erus paste-
of the sensory root of the facial nerve (nervus intermedius), and those rius capsulae internae) and connects the cells of the thalamic nuclei
of the glossopharyngeal nerve (nervus glossopharyngetts) and the va with the cortex of the cerebrum.
gus nerve are united in the nucleus of the tractus solitarius (nucleus T h e components of the thalamic radiations are as follows:
traclus solitarii). (a) the anterior thalamic radiations (rudiationes tkalamkcae anteri-
T h e fibres originating in diese nuclei cross to the opposite side ores) are radially stretching fibres of white matter of the cerebral
(some run on their own side) and stretch to the thalarnus in whose hemispheres, which arise mostly from the dorsomedial nucleus of
nuclei they terminate. the thalarnus (nucleus medialis dorsalis thaiami) and run through the
T h e thalamic nerve cells are the cell bodies of neurons (II of anterior limb of the internal capsule into the cortex of the lateral
die ascending pathways of the crania] nerves. T h e axons of these and inferior surface of the frontal lobe. Some fibres of the anterior
neurons pass in the thalamocortical fasciculus (fasciculus thalamo- thalamic radiations connect the anterior group of the thalamic
cortkalii) to the cerebral cortex (postcentral gyrus) via the internal nuclei with the cortex of the medial surface of the frontal lobes
capsule. and the anterior part of the gyrus cinguli;
2. T h e lateral temniscus (letnnisats lateralis) (Fig. 826) contains (b) the central dialamic radiations (radiatianes thalamkae een-
the ascending decussated fibres of the eighth pair of cranical trales) are radially running fibres connecting the ventrolateral
nerves (see the description of the auditory nerve), g r o u p of the thalamic nuclei with the cortex of the pre- and post-
3. T h e medial lemriiscus (lemniscus jnedialis) is an aggregate of central gyri and with the adjoining parts of the frontal and parietal
ascending fibres arising in the nuclei of the fasciculus gracilis and cortex. They pass in the posterior limb of the internal capsule;
fasciculus cuneatus, the fibres of the spinnothalamic tract, and as (c) the inferior thalamic peduncle (peduntulus tkalami inferior)
cending fibres arising from the sensory nuclei of some cranial contains radial fibres connecting the pulvinar and medial genicu
nerves. late bodies with limited areas of the temporal cortex.
4. T h e auditory radiation (radiatio acusiica) stretches Irom the
THE CONDUCTING TRACTS OF THE CEREBELLUM
T h e white matter of the cerebellum is made up of three groups scending (Figs 790-792), connect it with the spinal cord and brain
of fibres: (1) association fibres interconnecting various convolu stem, with the subcortical nuclei and the cortex of the hemi
tions within one cerebellar hemisphere; (2) commissural, or arci- spheres.
Tomi fibres passing from one hemisphere to the other; (3) projec These fibres form three pairs of cerebellar peduncles, the infe
tion fibres. rior, middle and superior peduncles (peduncuti cerebellares inferiores,
T h e projection fibres of the cerebellum, ascending and de medii et superiores) (see Fig. 777).

C O N D U C T I N G TRACTS O F T H E SPINAL C O R D AND BRAIN
101
T H E A S C E N D I N G (AFFERENT) P A T H W A Y S O F T H E C E R E B E L L U M
1. T h e posterior spinocerebeliar tract (tracltis spinocerebellaris

5. T h e pontocerebellar tract passes through the middle cere
posterior) stretches to the cerebellum in the inferior cerebellar pe
bellar peduncle. It begins from the nuclei pontis cells on which
duncle,
terminate the fibres of the frontopontine (tractus jrontoponiinus),
2. T h e anterior spinocerebeliar tract (trsctns spinocerebellaris an temporopontine (tractus temporopoxtinvs), and occipitopontine (trac-
terior) runs to the cerebellum in the superior cerebellar peduncle. tus oaipitoponlinus) tracts.
(Both these tracts are described in Ascending [Afferent} Tracts Arising
T h e fibres which arise in the nuclei pontis run to the opposite
in the Spinal Cord.)
side and reach the cortex of the cerebellum in the middle cerebel
3. Fibres arising in the nuclei of the fasciculus gracilis and fas lar peduncle.
ciculus cuneatus of the spinal cord on the same and on the contra-
6, T h e oiivocerebellar tract (tradus divBcercbtllarii) passes in
lateral side pass in the inferior cerebellar peduncle.
the inferior cerebellar peduncle and connects the cells of the oliv
4. T h e nucleoc ere bell ar tract passes in the inferior cerebellar ary nucleus of the same and the opposite side with the cortex of
peduncle and connects the sensory nuclei of the trigeminal, glosso- the cerebellum.
pharyngeal, and vagus nerves with the cerebellar cortex; it also
connects the superior vestibular nucleus with the nucleus globosus
and nucleus fastigii.
T H E D E S C E N D I N G (EFFERENT) PATHWAYS O F T H E C E R E B E L L U M
T h e descending projection fibres of the cerebellum connect it

cerebellar peduncle, and crosses over to the opposite side in the
with the nuclei of the brain stem (the lateral vestibular nucleus,
mid-brain. There the fibres of this tract run through the red nu
red nucleus, thalamus). These are as follows.
cleus without relay to its ceils, reach the inferior thalamic nuclei
1. T h e cerebellorubral tract (tradus cerebdlorubralis) begins on whose cells they terminate.
from the cerebellar cortex cells whose processes run to the nucleus
5. T h e cerebellonuclear tract runs from the cortex of the ver-
emboliformis, nucleus globosus, and nucleus dentatus. T h e fibres
mis cerebelli to the nucleus fastigii and reticular formation of the
arising from the cells of these nuclei stretch in the superior cere
medulla obloiigata on the opposite side, after which the fibres pass
bellar peduncle, pass to the opposite side in the mid-brain, and
to the lateral vestibular nucleus.
end in the red nucleus.
T h e cells processes of this nucleus pass as components of the
2. T h e cerebellodentate tract connects the cells of the cerebel
fasciculus longitudirtalis spinalis whose fibres are connected with
lar cortex with the cells of the dentate nucleus; the fibres of the
the cells of the anterior grey columns of the spinal cord and with
tract decussate.
the cells of the motor nuclei of the oculomotor, trochlear, and ab
3. T h e dentalorubral tract (tract dmtatombralis) passes in the ducent nerves.
superior cerebellar peduncles and connects the dentate nucleus
6. T h e arcuate fasciculus connects the cells of the lingula, and
with the red nucleus of the opposite side.
the cells of the nucleus fastigii with the lateral, medial, and supe
4. T h e cerebelloihalamic tract (tract cerekllotkakmkus) be
rior vestibular nuclei (nuclei otstibulares lateralis, mediate et superior).
gins in the dentate nucleus, passes as a component of the superior
THE DESCENDING (EFFERENT) TRACTS

OF THE BRAIN AND SPINAL CORD
T h e descending, efferent, tracts of the brain arise in the cere
T h e motor, projection fibres of the hemispheres arise in the
bral cortex and in the nuclei of the brain stem and terminate
cells of the motor area of the cerebral cortex, pass as components
either in the nuclei of the brain stem or on the cells of the anterior
of the corona radiata, and leave the hemispheres through the inter
grey columns of the spinal cord.
nal capsule.

102 C O N D U C T I N G TRACTS OF T H E SPINAL C O R D AND BRAIN
T h e following are the descending (motor, efferent) tracts terior cerebrospinal tract (tractus cortkospinalis jpyramidalis] ante-
(Figs 79 i, 792). riorj; these fibres decussate level with the segment where they ter
1. T h e corticothalamic fasciculi (fasciculi corikothalamki) con minate on the cells of the anterior white columns.
nect the cortex of the cerebrum with the thai am us, T h e lateral cerebrospinal tract (tractus tortkospinalis jpyramida-
2. T h e corticorubral tract passes from the cortex of the frontal lis] lateralis) stretches throughout the whole length of the lateral
lobe (the pars opercularis) to the red nucleus, white column of the spinal cord, medial of the posterior spinocer-
3. T h e radiation of the corpus striatum is a system of fibres ebellar tract, and comes in contact with the cells of the anterior
connecting the cortical cells (extrapyramidal areas of the frontal grey columns of the spinal cord.
and parietal lobes) with the nuclei of the corpus striatum, and T h e anterior cerebrospinal tract (tractus corticospinalis fpymmida-
fibres connecting the caudate and lentiform nuclei with the thala- lisj anterior) descends in the medial part of the anterior white col
m u s and forming the ansa lenticularis. u m n of the spinal cord. Some of the fibres of this tract r u n , seg
4. T h e cerebropontine fibres (fibrae corticopontitiae) arise in ment by segment, in the white commissure (commissura alba) of the
different areas of the cortex of the cerebral hemispheres and termi spinal cord to the opposite side to come in contact there with the
nate in the nuclei pontis where the pontocerebellar fibres originate cells of the anterior grey columns, A lesser part of the fibres may
and stretch to the contralateral cerebellar hemisphere. T h e cere contact the cells of the ipsilateral anterior grey columns.
bropontine fibres are subdivided into the frontopontine (fibrae T h e cerebrospinal fibres (fibrae corticespinales) are processes of
frontepvntinae) and the parietotemporopontine (fibrae panetotetapor- neurons I of the motor pathway of voluntary movements; neu
optmiinae) fibres, ron II of this pathway is represented by the cells of the spinal ante
(a) the frontopontine fibres begin in the cortex of the frontal rior horns whose processes are components of the anterior roots
lobe, pass in the anterior limb of me internal capsule and the ven (radices anteriores) of the spinal nerves.
tral part of the cerebral peduncle, and terminate in the pontine 6. T h e rubro&pinal tract (tractus rubrospinalis) begins in the red
nuclei; nucleus (nucleus ruber) and stretches to the spinal cord. T h e fibres
(b) the parietotemporopontine fibres arise in the cortex of the descending from the cells of the red nucleus form a deeussation in
parietal and temporal lobes, stretch in the posterior limb of the in the mid-brain with the contralateral fibres and stretch downwards
ternal capsule and in the ventral part of the cerebral peduncle, and in the cerebral peduncles, pons, and medulla oblongata.
end in the pontine nuclei. In the spinal cord the rubrospinal tract passes in the lateral
5. T h e pyramidal tracts (tractus Pyramidalis) arise from die white columns in front of the lateral cerebrospinal tract (tractus cor-
large pyramidal cells of the cortical motor zone (the precentral gy licospinalis jpyramidalisj lateralis), and comes in contact with the
m s ) , run as components of the corona radtata, leave the hemi cfJIs of tile anterior grey columns.
spheres via the posterior limb of the internal capsule, and enter the
T h e rubrospinal tract links the extrapyramidal system and cer
cerebral peduncle. Descending, the pyramidal tracts stretch
ebellum with the spinal cord.
through the base of the cerebral peduncle and on the way form the
7. T h e tectospinal tract (tradus tedospinalis) is formed by the
pyramids (pyramides) on the anterior surface of the medulla ob
descending fibres of the cells of the quadrigeminal bodies nuclei.
longata.
They decussate in the mid-brain with the contralateral fibres and
T h e pyramidal tract fibres which run in the ventral part of the descend in the spinal cord as components of the anterior white col
cerebral peduncles, pons, and medulla oblongata are known as the u m n s to make contact with the cells of the anterior grey columns.
pyramidal fasciculi (fasciculi pyramidales). Some of the crossed fibres terminate on the cells of the pontine
Corticonuclear fibres (fibrae cortiamudeares), corticoreticular nuclei and motor nuclei of the cranial nerves, mostly those inner
fibres (fibrae cortkonticulares), and the cerebrospinal tracts (tractus vating the extrinsic muscles of the eye. These fibres form the tecto-
wrtkospinales) are components of the pyramidal tracts. bulbar tract (tractus iectobulbaris).
(a) T h e eorticonuclear fibres (fibrae corticanuckares) arise from 8. T h e vestibulospinal tract (tractus vestibulospinalis) (see
the inferior parts of the internal capsule and run in the basal part? Fig, 826) is formed by the descending fibres of the lateral vestibu-
of the cerebral peduncle, pons, and medulla oblongata to termi lar nucleus (nucleus lateralis acstibulark). Some of the fibres stretch
nate in the m o t o r nuclei of the cranial nerves on the opposite side. in the lateral white columns of the spinal cord and form the lateral
(b) T h e corticoreticular fibres (fibrae corticoreticulares) stretch ventriculospinal tract r u n n i n g ventral to the rubrospinal tract; the
from the cerebral cortex to the nuclei of the reticular formation. other fibres run in the anterior white column and form the anterior
(c) The cerebrospinal tracts (tradus cortkospinales) stretch to ventriculospinal tract. T h e fibres of this tract which occupy the
wards the spinal cord, and at the junction of the medulla oblon most medial position are known as the sukomarginal fasciculus
gata and the spinal cord, at the decussatiou of the pyramids (de- (fasckulm sulcomarginalis). T h e fibres of the lateral and anterior ven
cussatio pyramidum), become partially crossed, some of the fibres triculospinal tracts make contact with the cells of the anterior
passing to the other side to form the lateral cerebrospinal tract horns.
(tractus corticaspinalis /pyramidalis/ lateraUs) which enters the lateral 9. T h e olivospinal tract is a group of fibres descending from
white columns of the spinal cord, the other fibres stretch uncrossed the olive in the anterior white columns cord and terminating on
into the anterior white columns of the spinal cord to form the an the cells of the anterior grey columns in its cervical segments.

THE MENINGES OF THE SPINAL CORD AND BRAIN 103
10. The bulboreticulospmal tract (tractus bulboretiailospinalis) is 12. The central tegroental Fasciculus (tractus tegmentalis centra-
formed by the axons of large cells of the medulla oblongata reticu- lis) passes in the tectum of the mid-brain lateral to the medial
lar formation. Its Sbres decussate, pass in the lateral white column longitudinal bundle (fasciculus Itmgitudinalis medialis). Its fibres arise
of the spinal cord, and make contact with the internuncial and mo for the most part from the grey matter around the aqueduct of the
tor neurons of the anterior grey columns, mid-brain, basal ganglia, optic thalamus, and red nucleus; de
11. The pontoreticulospinal tract (tractus pontoretkulospmalis) is scending, they connect these structures with the reticular forma
formed by the axons of the cells of the pontine reticular formation. tion of the brain stem and the nuclei of the inferior olive.
Its fibres are uncrossed and descend in the medial part of the ante 13. The otivocochlear tract (tractus olwocechlearis) is formed by
rior white column to come in contact with the internuncial neu the effector fibres of the cochlear nerve innervating the spiral or
rons of the anterior grey columns. As part of the anterior white gan. These fibres originate from the superior olive and stretch to
columns of the spinal cord this tract fibres are designated the reti- the spiral organ, both ipsi- and contralateral.
culospinal tract (tractus retiatlospinatis}.
THE MENINGES OF THE SPINAL CORD

AND BRAIN
The spinal cord and brain are enclosed in membranes called The space between the arachnoid mater and pia mater is inter
meninges (Figs 793-802). sected by a series of trabeculae and filled with cerebrospinal fluid
There are three meninges. (liquor certbrospinalis); it is called the subarachnnid space (cactcm
The dura mater is the outer membrane. subaracknoidesle) (Figs 793A, 793B).
The arachnoid mater (arachnoidta) is the middle membrane ly A space filled with fatty and loose connective tissue forms be
ing between the dura mater and the pia mater. tween the spinal dura mater and the vertebrae; it contains a wide
The pia mater is the innermost membrane. venous network called the internal vertebral plexuses (plexus verwsi
The dura mater is also known as the pachynieninx, while the vertebrates interni), which separate the spinal dura mater from the
aranchnoid mater and the pia mater are united under the term lep- periosteum of the vertebrae. This is the extradural space (cavum ep-
tomeninx. Each of the spinal meninges are directly continuous idurtik).
with the meninges of the brain, though the meninges of the spinal The dura mater of the brain is fused with the periosteum
cord differ from these of the brain in some anatomotopographical (which does not develop in essence) and together they form an in
features, hence their differentiation into the meninges spinales and tegral whole. In contrast to the vertebral canal, there are no venous
meninges encephali. networks between them in the cavity of the cranium. The sinuses
The three meninges develop from the mesenchyma covering of the dura mater (sinus durae matris) (see below) form in places
the spinal cord and the brain, but their development and relation here between the two layers of the dura mater. In the cavity of the
ships in the spinal cord and brain differ. cranium the dura mater is fused with the inner table of the skull
The mesenchyma surrounding the spinal cord and brain gives bones and the extradural space is therefore absent.
rise to two layers, an outer layer (ectomeninx) and an inner layer Nerve roots emerging from the brain and spinal cord pass in
(endomeninx). The ectomeninx develops into a thick membrane, the subdural space (cavum svbdurale) between the dura and arach
the pachynieninx, and later differentiates into two layers: the part noid mater, and are accompanied there by the arachnoid and pia
lying in contact with die walls of the vertebral canal gives origin to mater. Penetrating the dura mater, the nerves and vessels are ac
the layer of the periosteum of the vertebral canal (endorachis) and companied by elements of this meninx which forms the outer
the inner surface of the cranial bones (endocranium); the part fac sheath of their initial segments. The dura mater, like the pia mater,
ing the spinal cord and brain develops into the dura mater proper. is supplied with nerves and vessels; the arachnoid mater has no
The endomeninx develops into the leptomeninx which, just vessels. Since the pia mater not only invests the brain and spinal
like the ectomeninx, differentiites into two layers: the part facing cord but passes into their sulci, the vessels embedded in it run into
the dura mater becomes the arachnoid mater, and the part lying in the depths of the sulci and then into the brain matter itself.
contact with the spinal cord and brain becomes the pia mater.

104 DESCENDING TRACTS OF THE SPINAL CORD AND BRAIN
Fibres coriTietii iig ifiteteus Cyrus precentra] is

ruberwilh (Mamus / Fibres eunneering nucleus rubcr with cortex
Capsuta interns
Sulcus centralism ^Nucleus caudatus

Gyms posieentralis Nucleus lentlcularis
L o b y s parietal is Fibres, W [meeting

nucleus rtibcr with
.nucleus caudatus
Tractus
Kcipitopurtlinus et
ternpoTGpotllJnuii
Thalamus
Lob us
Erontalis
\ ^ v / ^*~-^ Lob us temporal! s

Lob us
oc dp [tali y ^ A j v
Tract us iron tup oriUnus
Fibres connecting nucleus rubcr with nucleus lentiformis
W^K ^ Fihrye ttnticonudcarfc*: (trattu^pyramidalig)

TLU s
\ M J cdunailtJ5 cerebri
m e sencepha I i S~ ^
\ ^Fihrae corticospinales (iractus pyramidalts)
Cerebellum'' ^
Tractrjs terjlosplnalfs
Tractus
cerebeMombrabs PnmS
Nucleus ruber Tractus rubrospi nails
Fibres connecting Nuclei o f crania I nerves

pons with cerebeltom
Medulla oblongata
^Tractus rubrospinaEfs
Tract us corticospinalis
(pyramldaELs) iate-ralis -Tractus ttctospfnails
">Tract5 corticospt nails (pyramldalis)

anterior
v
m Medu]ia spjnails
" N. spirals*
792. Descending tracts of spinal cord and brain; superolateral surface (semischematical
representation).

THE MENINGES OF THE SPINAL CORD 105
Corpus vertebrae
fct**""- Dura mater (partly removed)
Medulla spjnalis : W f f l Atachooidca (partly removed)

.'* .
A. splnalls - f i
posterior r f i M
PlJi rjialer ' i W B
*" N. splnalls.
I*ediculusarcuivcrterjrali5
(vertebral arch is removed)
^ J-Proccssus artlcularls superior

- ^ ^ ^ J , Plexus venosus
Zif vertebraHs intertills { posterior )
Processes Ir^nsversus
793, Spinal cord meninges; posterior aspect (%).

(The arches and spines of two vertebrae are removed.)

106 THE MENINGES OF THE SPINAL CORD
793a. Spinal arachnoid mater {specimen

prepared by V.Kharitonova). (Photograph.)
(Area of totally stained specimen, Trabeeulae of siibaniditioid
space.)
1plate-likt tnibcculac
2ihread-like trabeculae
.. .a?'
nl.
793b. Spinal arachnoid mater

{specimen prepared by
V.Kharitonova), {Photograph.)
2 (Area of totally stained specimen. Trabeculae
entwining a vessel in the subarachnoid space.)
1,3-Hrabtculae m vascular wall
2vessr]

THE MENINGES OF THE SPINAL CORD 107
Processus splnostis
Dura meter
Arachnoidea
Plexus venosus A
; rte bralis i nt emus (posterior) JM
Lig. Navum Pla mater
j / X splnalis pcskrlor
Substantia alba
Arcus vertebrae ,-ifam Radii dorsalis
Substantia grisea v
Medulla s p i n s l l ^ \ ^
l.Sg. dentJr.ulalum
Radix vetitralls ^ \
Ganglion spinale
^.(cotumunlcaas)
grtseus
f I
Ramus
ventral is
[1. spinalts
R.(communicans)
a! bus Ganglion
trund symfatlikl'
Llg. iongltudtnale anlerW \ A. spinall;

Corpus verlebrae anterior
794. Spinal cord meninges; superior aspect (%).

(Transverse section t h r o u g h intervertebral disk.)
THE DURA MATER

T h e d u r a m a t e r is i shiny white m e m b r a n e of d e n s e fibrous tis- b o n e s ; its inner smooth, shiny surface is covered with s q u a m o u s
sue with many elastic fibres. Its o u t e r rough surface faces the inner epitheiioid cells and faces the arachnoid mater. In r e l a n o n t o t h e
surface of t h e vertebral canal a n d t h e i n n e r surface of t h e cranial spinal cord a n d brain it is a closed sac.

108 T H E M E N I N G E S O F T H E SPINAL C O R D A N D B R A I N
T H E SPINAL DURA MATER
T h e spinal dura m a t e r (dura mater spinalis) (Figs 793, 794) lis, where the terminal ventricle (ventriailus termmalis) forms.
forms a wide, elongated from top to bottom, cylindrical sac. Its su Below the conus the d u r a mater is continuous with the filum of
perior border is at the level of the foramen m a g n u m . T h e dura ma the spinal dura mater (filum durue matris spinalis) which is attached
ter fuses with the periosteum of the inner surface of the foramen to the periosteum of the coccyx,
magnum and the first cervical vertebra. It is also fused intimately T h e roots, ganglia, and nerves arising from the spinal cord are
with the membrana tectoria of the atlanto-occipital joint and the invested in the dura mater as in sheaths which become wider to
posterior atlanto-occipital m e m b r a n e (membrana. atlanto-occipitalis wards the intervertebral foramina, which, consequently, also take
posterior), and is pierced here by the vertebral artery (artetiA vtrtebra- part in the fixation of the meninx.
lis). Very short connective-tissue bands join the dura mater to the T h e spinal dura mater is innervated by the meniugeal branches
posterior longitudinal ligament (ligamentum longitudinale posterius). of the spinal nerves (ram menitigri nervi spinalis) and supplied with
Downwards the dura mater sac becomes slightly wider, and at the blood by the branches ol the vertebral arteries and parietal
level of the second or third l u m b a r vertebra, i.e. below the level of branches of the abdominal and thoracic aorta; the venous blood is
the spinal cord, it is continuous with the narrowed cotius termina- collected in the vertebral plexuses.
THE DURA MATER O F T H E BRAIN
T h e d u r a mater of the brain (dura muter encepkali) (Figs 677, T h e inner surface of the dura mater faces the brain. It is
796', 797, H02, HIM) is a strong connective-tissue structure in which smooth, shiny, and covered by endothelium. T h e dura mater of the
the outer and inner surfaces are distinguished. T h e outer surface is brain forms processes which stretch between the parts of the brain
rough and rich in vessels; it is directly adherent to the Cranial and separate them.
bones and is their inner periosteum. Penetrating the foramina Spaces form along the lines of attachment of the processes
through which the nerves leave the cranial cavity, it provides which are prismatic or triangular on section. These are the sinuses
sheaths for them. of the d u r a m a t e r (sinus durae matrix), the collectors draining the
T h e dura mater is poorly connected with the bones of the cal- veins of the brain, eyes, d u r a mater, and cranial bones into the sys
varia, except for the places where the sutures of the skull pass. In t e m of the internal jugular veins (venae jugu.la.res intemae). T h e si
contrast, on the base of the skull it is intimately fused with the nuses are devoid of valves and have tightly stretched walls which
hones. do not collapse when cut. Emissary veins (venae emissariae) open
Before closure of the fontanelies in children, the dura mater is into some of the sinuses and communicate them with the super
closely fused with the m e m b r a n o u s skull at the sites of their loca ficial veins of the head via the canals in the bones of the skull,
tion and is intimately connected with the bones of the calvaria.
T H E P R O C E S S E S O F T H E D U R A MATl'.R O F T H E BRAIN
T h e dura mater of the brain has the Following processes berance and stretches o n the internal occipital crest to the poste
(Figs 796, 797). rior border of the foramen m a g n u m , where it is continuous with
1. T h e falx cerebri lies in the sagittal plane between both two folds bounding the foramen posteriorly. T h e falx cerebelli is
cerebral hemispheres with the anterior part penetrating more deep situated between the hemispheres of the cerebellum in the region
ly. It arises in front from the crista galli of the ethmoid b o n e and of its posterior notch.
is attached by its convex margin to the lateral edges of the sagittal 3. T h e tentorium cerebelli stretches over the posterior cranial
groove of the frontal bone; it reaches the internal occipital protu fossa, between the superior angles of the petrous parts of the tem
berance and is continuous there with the superior surface of the poral bones and the grooves for the transverse sinuses of the occi
tentorium cerebelli. pital bone, and separates the occipital lobes of the cerebrum from
2, T h e falx cerebelli passes from the internal occipital protu- the cerebellum. It is a horizontally situated plate whose middle

ARTERIES AND VEINS OF T H E SPINAL CORD 109
Furtkulus anterior ~ ^ _ _ fea-Cornu anterlus

"---._
Flsaura
Tiled]ana (anterlur j - l H V. splnalis anterior
( a d i j rloisalii
t
S^^^V .Radix ventralis
R. spinalls intercostaSia
pasterioris
A. tplrialis i n f e r i o r '
\i. spinahs'
A
..
Funiculus posterJot
-GorriLJ posteriLis
^-^ -"'X
R. dorsalis
a. intercostalis
\i
K. dorsal is
posteriori? R spinalis V intercostalis
J 1
\
Ci-yngiion spinale/ A spin alii posterior Kaclix !..:

V, spin alls posterior
Radis d o r ^ j i s ^ JT A . spinalfs posterior
BHL^k-'FmiTCiilus latwalls
Cornu poaterius1
1
*Ckjrmi antenna
Radix venltati
"A. sphialis anterior
795. Arteries and veins of spinal cord (artenae et venae spinales) (%).
Aanterior aspect; B posterior aspect; Csuperior aspect.

110 T H E MENINGES O F T H E feRAiN
S&rnis peirosus superior sinister
Venj terebri magna Vv, cerebri superiors j Slnus petrosus inferior

Faijccerebri
Sinus sagittalis superior
Sinus spgittalis inferior

infundibulurr
A. caroiis intern a
N oplicus
Sinus iransversus
Vv. cerebrl inieriores
Tentoriunr cerebelli
Sinus St^TnuiiJtus Irish gain

Bulhus superior v. juûlaris internae
^Sinus inlercavernosus
Sinus petrosus superior dexter
Plexus hasiiaris Sinus spheric pa rietalfs
Sitilre - fiveijioaus.
Uiapttragma scHdif V. cerebri media

superficial is
796. Dura mater of brain (dura mater encephalt); right and left aspect (%).
(The right part of the skull-cap is removed with horizontal and sagittal cuts.)
part is pulled upwards to form a tent. The free anterior margin is In the region of the trigeminal impression fimpressio nervi trigt-
curved and farms the tentoria] notch (indsum tentarii). The brain mini), at the apex of the petrous part of the temporal bone, the
stem passes here, dura mater separates into two layers. These layers form the trige-
4. The diaphragms sellae is a process which roofs the sella minal cavity feetmm tngemnak) in which the trigeminal ganglion is
turcica. The hypophysis ties under it. In the centre of the dia- lodged,
phragma is on opening pierced by the infundibulum on which the
hypophysis is suspended.

THE MENINGES OF THE BRAIN 111
Sirla medullaris ihalami

FaL\ terebrl ~~,
Trancus /
Sinus sagittalis
S superior
LorpttS tgrnicls ^Teh cttfirtiidea
vciitrlcufl terlll
Oeuu corporls callosl
rtidlamiis
Septum pdluci'Jum ..
Gyms cinguli - J
*** pinealls
IS j B L - Splfnluni
I cnrp'orls callosl
Adriesiointfrthaliimira _ 1 ^ _i|M-3*- '~V "."erubrL inagna
rpl4S pineak
(jimnissuca
posterior
mis triniymuj
kqtireshierus Mtebrl
y
Corpus mam til a re
HypophyLs '" j ^ V l t '

N o-.Lll'^llului I i:*''" 'iil '
Pedunculus cerebri JS *YV< .SwfiÊPW 1 '"'
-Mprlulla spinails
Mtdulla oblongata
Trachea
797. Dura mater of brain (dura mater encepkali) (%).

(Sagittal section made slightly to the left of the median plane; the falx cerebri and its relation to the corpus callosum are seen.)

112 T H E M E N I N G E S O F T H E BRAIN
T H E SINUSES O F T H E D U R A MATER O F T H E BRAIN
The sinuses of the dura mater of the brain are as follows 8. The inferior petrosal sinus (sinus petrosus inferior) emerges
(Figs 796, 797, 804). from the cavernous sinus and lies between the clivus of the occipi
1. The superior sagittal sinus (sinus sagittalis superior) is situ tal bone and the petrous part of the temporal bone, in the groove
ated on the bulging side of the superior margin of the falx cerebri. for the inferior petrosal sinus. It ends in the upper bulb of the in
It begins at the crista galli, stretches to the back on the midline, ternal jugular vein.
grows larger gradually, and ends in the transverse sinus (sinus trans- 9. The network of the basilar sinuses (plexus basitaris) is situ
versus) at the internal occipital protuberance. ated on the basilar part of the body of the occipital bone. It forms
To either side of the superior sagittal sinus, between the layers from merging of several transverse communicating venous chan
of the dura mater, are numerous slit-like spaces called the lateral nels running between both inferior petrous sinuses.
lacunae (lacunae laterales) into which granulations project. 10. The occipital sinus (sinus ocripilalis) lies on the internal oc
% The inferior sagittal sinus (sinus sagittalis inferior) runs on cipital crest. It emerges from the transverse sinus and divides into
the inferior margin of the falx cerebri into the straight sinus (sinus two channels which embrace the lateral borders of the foramen
rectus). magnum and end in the sigmoid sinus. The occipital sinus anasto
3. The transverse sinus (sinus transvtrsus) lies in the groove for moses with the internal vertebral plexus (plexus venosus vertebrate in-
it on the occipital bone. It is the largest among all of the sinuses. ternus).
Curving round the mastoid angle of the parietal bone, it is conti The confluence of sinuses (confluent sinuum) is a venous dilation
nuous with the sigmoid sinus (sinus sigmoideus). The last-named de which forms where the transverse, superior sagittal, straight, and
scends in the sigmoid groove to the jugular foramen and is contin occipital sinuses merge. It corresponds in position to the eminentia
uous with the upper bulb of the jugular vein (kitbus venae jugularts cruciata (eminentia cruciformis) of the occipital bone.
superior). The dura mater of the brain is separated from the arachnoid
The sinus drains two emissary veins which are connected with mater by capillary slits containing a small amount of cej-ebro spinal
the external cranial veins. O n e is in the mastoid foramen, the Quid.
other lies on the floor of the eondylar fossa of the occipital bone, The dura mater of the brain is innervated by the mcumgeal
in an inconstant and usually asymmetric posterior condyiar canal. branches of the trigeminal and vagus nerves, the sympathetic
4. The straight sinus (sinus rectus) lies on the line connecting nerves arising from the periarterial plexuses (of the middle menin-
the falx cerebri with the tentorium cerebelli. Together with the su geal artery, vertebral artery), and from the cavernous plexus, by
perior sagittal sinus it ends in the transverse sinus. branches of the greater superficial petrosal nerve, and the otic
5. The cavernous sinus (sinus cavemosus) is named so due to the ganglion; intertruncal nerve cells are sometimes present with hi
presence of numerous septa which lend it the appearance of a some nerves. Most nerve branches of the dura mater follow the
cavernous body. It lies on either side of the sella turcica. On trans course of its vessels, with the exception of the part in the region of
verse section it is triangular and has three wallssuperior, exter Lhe tentorium cerebelli where, in distinction from other areas, the
nal, and internal. In the superior wall lies the oculomotor nerve dura/mater is poorly vasculariaed and most of the nerve branches
(nervus oculomotorius), below lies the trochlear nerve (neruus trochha- pasi on it independently of the vessels.
ris). The lateral wall lodges the first branch of the trigeminal nerve, The first branch of the trigeminal nerve, the ophthalmic nerve
the ophthalmic nerve (nervus opkthalmicus). The abducent nerve (nervus opkthalmicus) sends small branches to the dura mater in the
(nervus abducent) stretches between the trochlear and ophthalmic: region of the anterior cranial fossa, anterior and posterior areas of
nerves. the calvaria, as well as to the falx cerebri as far as the inferior sagit
The internal carotid artery (arteria carotis internet) with its sym tal sinus, and to the tentorium cerebelli (the nerve to the tentor
pathetic carotid plexus (plexus taroticus) passes in the sinus. The su ium jramus lentariif). The second and third divisions of the trigemi
perior ophthalmic vein (vena aphthalmim superior) empties into the nal nerve, namely, the maxillary nerve (nervus maxillaris) and the
cavity of the sinus. The right and left cavernous sinuses communi mandibular nerve (nereus -mundibulans) send the middle meuingeal
cate in the anterior and posterior parts of the diaphragma scllae branch (ramus meningeus medius) and the nervus spinosus (ramus
via the intercavernous sinuses (sinus mtercavernosi). The large sinus meningeus nervi mandibularis) to the dura mater in the region of the
formed in this manner surrounds the hypophysis cerebri lying in middle cranial fossa, to the tentorium cerebelli, and the falx cere
the sella turcica. bri. These branches are also distributed in the walls of the adjacent
fi. The sphettoparietal sinus (sinus sphenoparietalis) is paired. It venous sinuses.
stretches medially along the posterior margin of the lesser wing of The vagus nerve sends a meningeal branch (ramus meningeus
the sphenoid bone and ends in the cavernous sinus. nervi vagi) to the dura mater in the region of the posterior cranial
7. The superior petrosal sinus (sinus petrosus superior) is also a fossa up to the tentorium cerebelli, and to the walls of the trans
continuation of the cavernous sinus. It lies on the superior border verse and occipital sinuses. Besides, the trochlear nerve (nervus
of the petrous part of the temporal bone and connects the caver trochkaris), the glossopharyngeal nerve (nervus glossopharyngeus), the
nous sinus wjth the transverse sinus. accessory nerve (nervus accessorius), and the hypoglossal nerve (tier-

THE MEMNGES OF THE BRAIN
113
Bulbus olfacturius
Lobus front*lis
i j N . oplinis
Ctetema chlasmatls
A. cjrolls hifern
Pia mater encephalL

obus temporalis
Aiqchnoiden ence-pha
(partly removed) Hypophysis
A. rojnmunlcans
posterior
orpus mamiJiare
N. oruloiiiolorius-" T'/^SF'j^ Oisierna interpcdunculari!
{incomplettly opened)
A. i-kTfliri [KJSkTirir 5 ?" - ^ ^ \-A. basliarls
9-N. trljjerninus
Pons
V, eerebrl inferior
N. hypoglossus
A. vertebralis
Cerebellum
Medulla (iblorigat
r~~ Cisterna cerebellomediillarls
798. Arachnoid mater of brain (arachnoidea encephali); inferior aspect (%)

(Inferior surface of the brain; a small area of the arachnoid
mater m the region of the frontal lobe is removed.)
m hypoglossus) may take some part in the innovation of the dura in** rt- , u
mater of the brain. a t t e r y - t h e mastoid branch (ramus ma^deus crime* ocvf>iialis);
hthaln,ic
The dura mater is supplied with blood bv b r ^ r h e , ii i ^f P " t e y - t l * anterior ethmoidal artery fcr-
(1) fa* the mîHary J S j S L ^ ^ X S ^ Z r l Z 1 ^ ^ * " * * ' ***** ""* 2 * *
^ ^ S f r 0 n 7 , e vertebral r n r ^ C : J ^ S T S ? ^ ^ ^ * * " * * * *
branch fr a w ( w WM|i a r f c w ntrttbmlu); (3) from the occipital

114 THE MEN1NGES OF THE BRAIN
Vesselsof pia mater

Arachnoidea (partly removed)
A. cciebn interior
(covered with arachnoid matci)
\
Splenium carports
Fornij callosi
^ 1 *
Plexus choriotdeus
V. cerebrl magna
Septum peltucidum .'
Genu corporis ^ - ^
callosi - t3
Fissura transversa
Thalarnus . cerebri
Lamina tectf
Peclunculus cerebri
Aditus ad
aquatductum cerebrf Ventrlculus quartua
A. cerebrl anterior
('is terra cbtasmatls Cerebellum
N, oprfcus
Cisterns Irtterpeduncularis
A. carotls Inttrna''
Hypophysis
Arathrtotdei
N oculomotorlus' /
A basilans (cut) '
Cisterna cerebtdomedullirt!;
799. Arachnoid mater and pia mater of brain (arachnoidea etpia mater encephali); medial surface
( % )
(Sagittal-median section; an area of the arachnoid mater m die region of the medial surface of the hemisphere is removed.)
THE ARACHNOID MATER

The arachnoid mater (arathnoidea) is thin, transparent, devoid connected to the underlying pia mater by means of subarachnoid
or vessels and made up of connective tissue which is covered by tissue and numerous fibres and trabeculae, and in certain areas is
endothelium. It invests the spinal cord and brain completely and is fused with iL
THE SPINAL ARACHNOID MATER
The spinal arachnoid mater (arachnoidea spinalii) (Figs 79$, the arachnoid and pia mater of the spinal cord. These are more Or
79+), like the spinal dura mater, is a sac encasing the spinal cord less large cavities, particularly in the anterior and posterior parts,
quite freely. Between it and the dura mater is a space of capillary- with a transverse measurement of up to 1-2 cm. They are filled
like slitsthis is the subdural space (cavxm subduraU). with cerebrospinal fluid (Uquor cerebrospinalis).
The subarachnoid spaces (cave suhaTachnoidealia) form between The arachnoid mater is connected to the dura mater in the re
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T H E MENINGES O F T H E BRAIN 115
800* Suharachnoid space (radiograph).

(Right hemisphere; left lateral view; pneumoencephalography [air introduced into the subarachnoid space of the lumbar part of the
spinal cord penetrates into the ventricles and subarachnoid apace of the brain].)
I, l, ] tutwachnoid space
gions where die spinal nerve roots penetrate the spinal dura mater and pia mater by means of special ligaments called the ligamenta
(see above). It is connected with the spinral pia mater by numerous denticulata. These are connective-tissue membranes, 2 0 - 2 5 in
fine connective-tissue bands which Form, particularly in the poste number, which lie in the frontal plane on either side of die spinal
rior part, the subarachnoid septum. cord and run from the pia mater to the inner surface of the dura
The arachnoid mater is also connected with the spinal dura mater.
T H E A R A C H N O I D MATER O F T H E BRAIN
T h e arachnoid mater of the brain (arachnoidta ewepkali) degree, on the sides of the transverse sinus, as well as tiext to other
(Figs 798, 799, 802) is covered, like the spinal arachnoid mater, by sinuses the arachnoid mater gives rise to processes of various size.
endothelium. It is connected to the dura and pia mater of the These are the arachnoid granulations (granulatuntei arachttoideaUs)
brain by epi- and subarachnoid connective-tissue trabeculae. Be which enter the dura mater and together with it penetrate the in
tween the arachnoid mater and the dura mater is a slit-like subdu- ner surface of the cranial bones or the sinuses; the bone tissue be
ral space filled with a small amount of cerebrospinal fluid. comes indented in these areas due to arachnoid granulations leav
The external surface of the arachnoid mater is not generally ing small depressions called the granular pits (foot&lae granui&rcs),
fused with the overlying dura mater. In some places, however, the number of which is particularly great close to the sagittal su
mainly on the sides of the superior sagittal sinus and, to a lesser ture of the skull-cap.

116 T H E MEN1NGES O F THE BRAIN
. .. , Corpus callosum
Sulcus corpons callosl . Fnrnin
cerebri anterior
Sulcus drigull.
A. cerebri anterior
Fissiirs
paTleloocdpitalis
/
A. cerebri anterior''
Sepliiin pellucidum''
A. .: rl :i: ..;! i:: n i ; r
Sulcus cekarinus
Cotrimissura A. cerebri posterior
anlerio Corpus plneale
Lamina termtrsalls
Lamina letti
Chtasma opttcum Pedimculus cerebri
A. cacotts intcrra Adhesio irtterlhalamk'a
I \
RcceSSUS frtfjrldlbull ' I A. cerehri posterior
A, Communicans posterior t o r p u s raamillire
801. Arteries of brain (arteriae cerebri); right hemisphere; medial surface {%).
The inner surface of the arachnoid mater faces the brain. It is (5) along the superior surface and genu of the corpus callo-
intimately fused with die pia mater on die bulging parts of the gyri s u m - t h e eisterna corporis callosi (BNA);
but does not follow it into the depths of the sulci and fissures. The (6) on the floor of the transverse fissure of the cerebrum, be
arachnoid mater, therefore, bridges the gyri, and where it is not tween the occipital lobes of the hemispheres and the superior sur
fused with the pia mater the subaraehnoid spaces (cava subaraeknot- face of the cerebellumthe eisterna ambiens (BNA); this eisterna
dealta) are left. has the appearance of a canal and runs on the sides of the cerebral
The subaraehnoid spaces communicate throughout the whole peduncles to the tectum or the mid-brain;
surface of the brain, as well as the spinal cord. In some areas these (7) under the middle cerebellar peduncles and to the pons
spaces are cjuite large and are railed the subaraehnoid cisternae the eisterna lateralts pontis;
(riiUrnae svbaracknoideales) (Fig, 800), The cistemae are lodged: (8) in the region of the basilar sulcus of the ponsthe eisterna
(1) between the cerebellum and medulla oblongata^the cere- (medialis) pontis.
bellomedullary eisterna (asiema cerebcllojnedullaris); The sabarachnoid cavities of the brain communicate with each
(2) in the lateral sulcus of the cerebrum the eisterna of the other and with the brain ventricles via the median and lateral aper
lateral sulcus (eisterna fossae lattrelis cerebri); tures of the Fourth ventricle.
(3) between the cerebral peduncles the interpeduncular eis The eerebrospinal fluid is collected from different parti of the
terna (cislerna interpeduncularis); brain in the subaraehnoid space. The fluid outflow is effected via
(4) between the oplic chiasma and the frmital lobes of the the perivascular and periiieurai slits and the above-mentioned
brain the chiasma tic eisterna (tisttma chiasmatis); arachnoid granulations into the lymphatic and venous channels.

THK MENINGES OF THE BRAIN 117
Ililllllhllll
V. ecnissarisi
!_'' SuhfiiiiUHji'm'- vein*
of head
Camilla
extema
! J^Cnnniila1:nnt'S
S; urii.-iii rji.i.-nks
Pura mater _
Granulations
Stnsis sagittalls ^^%

superior ] 2 I i
Pia mater
-Cavum
ubara^hnoidtale
Arachnnidefl
802. Meninges of brain (meninges encephali) (represented semischematically).

(Topographo-anatomical relationships between the brain meninges, brain matter, bones and integuments of the skull.}
THE PIA MATER

The pia mater is formed of delicate loose connective tissue narrow slits around them. The slits communicate with the sub-
containing many vessels and nerves. It invests the vessels and dips arachnoid cavities.
together with them into the brain matter as if forming sheaths and
THE SPINAL PIA MATER
The spinal pia mater (pia mater ipinaiis) (Figs 793-795) is median suture. The Iigamenta denticulata which arise from the pia
somewhat thicker and stronger than that of the brain. It fits closely mater between the anterior and posterior roots and are attached to
to the external surface of the spinal cord and dips into its anterior the dura mater, fasten both membranes to each other.

118 T H E MENINGES OF T H E BRAIN
T H E PIA MATER O F T H E BRAIN
The pia mater of the brain (pia mater amphdi) (Figs 798-802), Penetrating into the transverse fissure of the cerebrum and the
in distinction from the two membranes described above, is inti horizonta! fissure of the cerebellum, the pia mater is stretched be
mately adherent to the brain matter and dips into all sulci and tween the parts by which these fissures are bounded and closes the
fissures; only on the projecting parts of the gyri it is fused closely cavities of the diird and fourth ventricles posteriorly.
with the arachnoid mater. The pia mater of die brain is connected The choroid plexuses (plans dwrioutei) and the telac choroideae
with the surface of the brain less intimately than the spinal pia ma (which are described in the sections dealing with the lateral, third,
ter. and fourth ventricles) arc connected with the pia mater of the
The blood vessels embedded in it connect it with the brain brain.
and, according to some authors, merely a narrow slit known as the The pia mater of the brain is innervated mainly by nerves aris
epicerebral, or subpial, space separates it From the brain surface. ing from plexuses which accompany the internal carotid and verte
The perivascular spaces separate the pia mater from the vessels bral arteries. It is supplied with blood by the branches of these ar
and thus form their sheaths. These spaces communicate with the teries.
subarachnoid space.

THE PERIPHERAL NERVOUS SYSTEM
Systema neroosum periphericum
The nerve fibres which are components of nerves are the pro
The living organism functions according to the principle of re cesses of nerve cells differing in morphology and function; (a) mo
flex response and is a unique system capable of autoregulation. tor cells lying in the anterior grey columns of the spinal cord or ,n
This is accomplished by input of information from the perceiving the motor nuclei of the cranial nerves in the brain stem; (b) sen
nerve apparatuses, its processing, and transmission of regulating sory cells forming the ganglia of the spinal nerves (ganglm ^naha)
signals to the periphery. The peripheral nervous system provides or those of the cranial nerves; (c) autonomic nerve cells lying tn
the structural basis Tor information input and ttansmiss.on. From the lateral grey columns of the spinal cord, in the ganglia of the
the periphery the information arrives to the centres of the spinal
sympathetic trunks, or in the nerve ganglia of the interorganic Or
cord and brain along the afferent, sensory nerve* (Mm sensma),
intraorganic autonomic plexuses.
and from the centres it is transmitted to the periphery along the
The nerve fibres are therefore subdivided into motor, or effer
efferent, motor nerves (nervi motorieus).
ent among which autonomic (vegetative) fibres arc distinguished,
The peripheral nervous system consists of nerves ans.ng from
and sensory, or afferent, _
the b r a i u - t h e cranial nerves (mwi Bttwfcg, nerves arising from The motor nerve fibres innervate the somatic muscles, in which
the spinal e o r d - t h e spinal nerves (mtni spinaUs), and nerve cells they terminate by motor endings.
located beyond the ranges of the central nervous system. The sensory nerve fibres begin by a variety of receptors in all
Each nerve is an aggregate of the processes of nerve cells.
body organs and tissues and convey impulses from them to the
Some groups of nerve fibres are surrounded by a connective-tissue
central nervous system.
sheath which is called the perineurium. Its processes penetrate be The fibres of the autonomic (vegetative) nervous system (sym
tween individual nerve fibres to form the inner connective-msue pathetic and parasympathetic) stretch to the internal organs, blood
membrane called the endoneurium (Fig. 805). vessels, skin appendages (hair, glands), to the muscles, etc. (see The
The whole nerve is surrounded by connective tissue forming
Autonomit Nervous Sjutem).
the epineurium. According to the type of fibres prevailing in them, the nerves
A nerve fibre consists of a nerve cell process (an axis cylinder, are jrrouped into motor, sensory, mixed, and autonomic (vegeta^
or axon) which is composed of neurofibrils running throughout its tive) The nerves appear on the brain surface as motor or sensory
length and surrounded by the axoplasm. In some nerves the axon roots. The motor roots are axons of motor cells lying in the spinal
5, surrounded by a myelin sheath which is covered by the neun- cord and brain, the sensory roots are axons of nerve cells of the
lemma; in others the axon is covered by neurilemma only. The spinal ganglia (or ganglia of the cranial nerves).
fibres of the first type are called myelinated, or medullated The The fibres of a motor nerve reach without mtemipt.on the or
myelin sheath, however, is not continuous but mterrupted in
gan which they innervate.
places by nodes in the region of which the axon is covered only by
The sensory nerve is formed distal to the sensory (cranial or
neurilemma. The fibres of the second type are called unmyeh-
spinal) ganglion, so that its fibres running from the ganglion to the
nated. Or nonmedullated. .
periphery are the dendrites of neurons lying in the ganglion.
The myelinated fibres constitute the main mass of the cranial
The motor fibres are only adjacent to these ganglia. The sen
and spinal nerves. The unmyelinated nerve fibres are found for the
sory and motor fibres stretching from the ganglia to the periphery
most part in the autonomic (vegetative) nervous system (postgang-
form a mixed nerve (see Tht Spinal Naves).
lionic fibres), and among fibres of some sensory pathways (e.g. Running to the periphery, the mixed nerves unite, exchange
those of pain sensibility).

120 THE CRANIAL NERVES
Sulcus olfactorius
Bulbus oliactori N, olfactorius (tractus
olfactorius) (!)
Trattus olfactorius Chfasma opticum
Hypophysis K. opticus (II)

Trigonum olfactorium
N. oculoinotorius (ili)
Tractus optkus
N, trochlwria (i.V)
Corpus mamillsre J
k,N. tfigeminus (V)
Pcduncuks cereDrl -*K
N. tri-gemtnus: j N. abducens (VI)

radix rnotoria I
radix sensoria*
Pons
Pedunculus-
cefebrlljaris
tiled! us
S'. facialis (VIO
Oliva - N. Intermedium
Pyramid (medullae
ot>1ong;itae>""" M vestibulocodilearisfVlll)
N, glossepttai'yngeus
Medulla ohlongda-- fix)
Decussatio pyramidum N. vagus (X)
N. accessorius (XI)
Medulla spinalls N. hypoglossus (X11J
803. Cranial nerves (nervi craniales) (%).

(Inferior surface of brain and points of emergence of cranial nerves.)

121
T H E CRANIAL NERVES
,N. opticus
Falxceiebri
rA. t'.iwis interns
Butbits olfactorius
Trail tus olfadori .N. ccubmotorkis

Sinus
iutercavernosus
Diaphragma sellae
InfurulibuluitK. laxilhiris
Sinus
intertavcrnosus jbducens
N. mantlihitlarfs
Sinus cavernos
N. trigeminus
p!exus basilans
N. facialls
Dura mate
enwphal ^N.vesl.ibulo-
Vv. mefilngeac
mediae cochlearis
Ganglion-- |_N. gtossopharytlgeus

trigeminale I N. vagus
Tentorium
cerebelli
Sinus pdros
Inferior
N, hypoglcssus
Sinus petr "- [
superlo
^ **- ^ tiff?-
Sinus sigm Wffi ^Suk'iis -.inns sigmoi<iei
K j ^ p ' ^ N . accessorius
Mty ^Medulla oblongiita
irat?^Sulms sinus fransversi
I^F-Coilfluens sinuutn
y
t s i n u s sagittalis superior
Sinus rectus
804 Inner surface of base of skull with cranial nerves passing through it; superior aspect (%).
ganglion of the trigemmal nerve.)

122 THE CRANIAL NERVES
805. Innovation and blood supply ofn^ve trunk (schematic representation) (after
W
lôuteT epirceuriuiu
-outeT epineuriuin V
2-innertpineurium
-inner epineuriu fiQtcrfaicuIr
(iotcrfawicular tisau:)
tisane) 6internal cpioeural ato
iZ'"^.?"'*' neurovajcular
*l*TplexuipJ~ui
J panfatKicular neurovastulsr ftttm 111L- lamellar
|nre lblrbodies
bodie,inifl perineurium
.,^..
3 penneurjuiu
fi perineural aeurovascular plej,s IS-origin of twig from bundle to sheaths of nerve
+ endaneurium
9endoneuta] neitrovucular plexus 13-WJseh and nerve, penetrating into epuieurium
5 - M t e m a l epintura] neurovajcukr p l n u j
10-laraellar bodie* in epinetirium
fibres, and form loops a n d arcades of vluiom shape. $& ^ ^

rfsxaf&g (o fopographo-anatoniicat features, all peripheral
body ]8 called a nerve pious (pUxus nmm* nerves are grouped b t e : (a) cranial nerves (mm wniaUs) of which
there are 12 pairs; (b) spinal nerves (ntrvi spinaUs} of which there
g u i s h e T " ^ SOatiC Snd ^ f aUton0lnic C * <^- are 31 pairs, and (c) autonomic (vegetative) nerves.
T H E CRANIAL NERVES
The cranial nerves (ncr* cranioUs) are linked anatomically
inly with the brain stem b which their nuclei are located The pass through the foramina of the base of the skull (Fig 804) to di
cranial nerves emerge on the b a s e of the brain (Fig. 803) and then - d e mto terminal branches ^ h i n g the regions which they inner-

THE CRANIAL NERVES 123
Bui bus olfacturlus

Gyrl orbltales
Sinus frontal Is
Tiaclus olfflctorlua
R. nasalis Intertills
D. elhnioldalls
Nn. olfaclorll snteiforta
N_ optlcus a
Sinus sphenoidalis-
Flsaura N. fiasopalatlnus
orbllslls superior
N. maicilJaris " plum nasl
Nn. ptwygopalatini Canalis inciilvus

Ganglion
pierygopalatinuni ,_
Nn. paktlnl
major el m f n o r e s ^ j .
N. paialinus mafor
Lamina lateralis
processus ptcrygoidei
Nn. palatini minors

Nn. palatini minorcs
Palatuin mo Ik'
806. Nerves of nasal septum and hard palate (]/J).

(The right surface of the nasal septum and the left half of the hard palate are shown.)
The 12 pairs of cranial nerves arise from the brain. They are as 11. The accessory nerve (nervus accessories) (XI).
follows. 12. The hypoglossal nerve (nervus hypoglossus) (XII).
1. The olfactory nerves (nervi olfadorii) (I). The first pair of cranial nerves, the olfactory nerve (nermts vifac-
2. The optic nerve (nervus optieus) (II). # torius), arises from the telenccphalon; the second pair, the optic
3. The oculomotor nerve (nervus oatlomoiorius) (III). nerve (nervus opiicus), from the diencephalon; the third and fourth
4. The trochlear nerve (litmus trochlearis) (IV). pairs, the oculomotor and trochlear nerves ( i n w ocukvwtorius et
5. The trigeminal nerve (nervus trigtminus) (V). nervus trachltaris), from the mesencephalon; the fifth, sixths, sev
6. The abducent nerve (nervus abducent) (VI). enth and eighth pairs, the trigeminal, abducent, facial, and audi
7. The Tacial nerve (nervus facialis) (VII) (the sensory root of the tory nerves (nervi trigeminus, abducent, facialis et vestihulocotkharis),
facial nerve [nervus infermediusj). from the metencephalon; the ninth, tenth, eleventh, and twelfth
8. The auditory nerve (nervus vesiibulococktearis) (VIII). pairs, the glossopharyngeal, vagus, accessory, and hypoglossal
9. The glossopharyngeal nerve (nervus glossopharyngeus) (IX), nerves {nervi glo.fsopkaryn.geus, vagus, atxessorias et hypoglossus), arise
10, The vagus nerve (nervus vagus) (X). from the myetencephalon.

T H E OLFACTORY NERVES
124
Septum pellucidum Tmncus curporls callosi

SultliS cinguli SttU Inngivndlnilis medialis
. Fornix fibres extending
/St y into uncus
Nerve cells in y? ^Thalamus
gyrus subcallosus -Fasciculus
Cienu corporis callos.1 ,. marnlllottialainlcus
Stria I or git iid I nil is medial Is ^ Splenlum
Gyriii paraterminalis-^ corporis callus!
Gyrus
fascitflaris
Lotas ironfalls
- Lobus
Bulbils oliactorius occipital! s
Nerv>
bulbos oJfactori Isthmus gyri
CoHCil. cingult
:-:!:: 511]
Corpus mfiinltUre
Nn. Fimbrla hippocampi
olfactorii
Fibres from urttus
<; to corpus mam ilia re
W * Oyrus dentatus
'Gyrus paraliippoearnpalis
Concha. > l
UnCiiS
iiasali" media ' * LobuB lemporalis
\ A re a of cortical olfactory
Concha I analyser
nasalls inferior Stria olfactoria
807. Conducting pathways of olfactory brain; medial surface (represented semischematically).

(Projection of fibres o n the surface of the hemisphere.)
Before leaving the cavity of the skull t h e cranial nerves are Ibl- t h e brain and skull, and the regions of ^ r i b u t i o n of the main
lov.ee! by the meninges. branches are shown in the T a b l e o n p p . 163-167).
T h e location of the cranial nerves nuclei, die sites of exit from
T H E OLFACTORY NERVES
dendrites come in contact with the above-described filaments; the

T h e olfactory nerves (nervi olfactarii) (first pair) (Figs 8 0 3 , 804,
axons r u n centrally to form the olfactory tract.
806-80R) are nerves or sperial sense (the sense of smell). They be
gin from t h e olfactory receptors in the nasal mucosa of the olfac T h e olfactory tract (tradus olfadorius) passes in the olfactory
tory region (regto dfadoria) by 1 5 - 2 0 uiimyelinated nerve fila sulcus (sulcus oljactorius) on the inferior surface of t h e frontal lobe
ments; the receptor (olfactory) cell bodies are also lodged in the of the cerebrum. In the beginning it is triangular on cross-section,
m u c o u s m e m b r a n e . W i t h o u t forming a common trunk, the fila then becomes flattened and thin to form a triangular expansion
ments pass through the cribriform plate of the ethmoid bone (lam which U called the olfactory p y r a m i d (trigonum olfactorium) a n d
ina cribrosa ossis dhmoidalis) into the cavity of the skull to enter the consists mainly of nerve cells on which some of t h e fibres of the ol
olfactory b u l b (bulbus oljactorim). factory tract terminate.
T h e olfactory b u l b is an aggregate of nerve (mitral) cells. T h e i r I n ' t h e olfactory pyramid the olfactory tract divides into three

T H E OPTIC NERVES 125
Bulbus oculi
Bulbus olfactorius
Fissura opticus
longlmrtinalis cereh-i ;
Tractus olfaclorhis
i ^ Chiasnia upticum
Sukus latei-p]is
Trlgormm olfartorium
Substantla perforate
Hypophysis-^ aulerior
Trattus opticus
Infurulirjuluni
Tuber cinereiim I
i N. oculotnotorius
Corpus mamillare - 4 | M
Substantla Pedunculiis
perforats oosterior M cerebri
Fossa
inter peduncular!:-
Corpus gerricuiatuiti
laterals
Substantla c i l g r a - ^ ^ ^
^ - C o r p u s genlcutatum meddle
Nucleus ruber-""" Aqueductus cerebri
" Pulvinar
Teelum mesertcephali
808. Optic nerves and optic tracts; inferior surface of brain (%).
(Most of the frontal lobes and pons are removed.)
olfactory striae (striae olfadoriae): the lateral, intermediate (or mid The medial olfactory stria runs to the medial surface of the
dle), and media] striae, whose fibres run different routes to the cor hemisphere, under the rostrum of the corpus callosum. After that
tical end of the olfactory analyserdie uncus of the hippocampal some of the fibres pass into the septum lucidum (septumpelfaadum)
gyrus. and then on the fomix and the fimbria of the hippocampus to
The lateral olfactory stria is the largest. It runs backwards and reach the uncus; the rest of the fibres stretch in the medial longi
laterally and ends in the cortex of the uncus sending on its way tudinal striae (stria/: longitudinals! mediates), and then on the splenial
some fibres to the amygdaloid nucleus (corpus amygdatoidettm) gyrus (gynisfasciolares) and dentate gyrus (gyrus dentatits) also to the
(Fig. 807). uncus.
Some fibres or the intermediate olfactory stria terminate on the The nervi terminates, made up of several nerve fibres stretch
neurons of the interior perforated substance (subslantia pwjorata ing between the dura mater and the periosteum, sometimes run
anterior) of the same side. The other fibres pass in the anterior parallel and medial to the olfactory tracts. They begin in the mu-
commissure to the opposite side to end there also in the anterior cosa of the olfactory region of the nasal septum, pass through a
perforated substance. The neuronal axons of the perforated sub foramen of the cribriform plate, and reach the medial olfactory
stance pass rnrough the lamina of the septum lucidum into the for- stria by several roots.
nix and then reach the uncus along the fimbria of the hippocam
pus.

126 THE OPTIC AND O C U L O M O T O R NERVES
T H E O P T I C NERVE
The optic nerve (nervus opticus) {second pair) (Figs 803, 804, terna nervi optici) which is formed by the pia mater of the brain.
808, 809) is a nerve of special sense, Its fibres begin from the gang- Slit-like intervaginal spaces (spatia intervaginalia ntrvi optici) sepa
lionic cells of the retina of the eye and pierce the choroid and rate the internal sheath from the external sheath of die optic nerve
sclera to form the intra-orbital part of the optic nerve. After pass (vagina externa nervi optici) formed by the arachnoid mater-and dura
ing through the fatty body of the orbit (corpus adiposum orbifue) the mater. Arteries and veins pass in the intervagina! spaces (Fig,943).
optic nerve stretches through the common tendinous ring (anulus Each optic tract curves round the lateral surface of the cerebral
tendintus commanis) into the optic foramen (canalis opticus) (the sec peduncle and terminates in the primary subcorticai visual centres,
ond part) and leaves the orbit to enter the cavity of the skull (third which are represented on both sides by the lateral geniculate body
part). In the region of the optic groove (svkus ckiasmatis) of the (corpus genkulatum lattrak), the pulvinar, and the nuclei of the su
sphenoid bone partial decussation of the fibres of the optic nerves perior quadrigeminal body (nuclei coUUuli supenoris tecti mesence-
occurs, which is called the optic chiasma (diiasma optUum). pkali).
The lateral part of each optic nerve fibre stretches further on Fibres arising from the cells of the lateral geniculate body and
its own side.
the pulvinar stretch through the posterior limb of the internal cap
The medial part crosses to the opposite side where it joins the sule into the hemisphere, form the optic radial ion (radiatio optica),
fibres of the lateral part of the optic nerve of this side to form the and end in the cortex of the media! surface of the occipital lobe
optic tract (tractus option). j along the sides of the calcarine sulcus (sulats ealcarinus).
Thus, the right optic tract contains fibres from the right halves Fibres which arise from the superior quadrigeminal bodies run
of both retinae, the left optic tractfibres from the left halves. to the nuclei of the oculomotor and other cranial nerves as well as
The optic nerve is surrounded by an internal sheafh (vagijia tn- in the tectospinal tract (tractus tectospinalis).
T H E O C U L O M O T O R NERVE
The-ôculomotor nerve fwraw aculomotorius) (third pair) 1. The superior branch (ramus superior nervi oculwnotarii) is
(Figs 803, 804, 808-810) is a mixed nerve. Its nuclei lie in the teg- smaller and runs on the lateral surface of the opric nerve; it divides
menLum of the cerebral peduncles, on the floor of the aqueduct of into two small branches which approach the levator palpebrae su
the mid-brain at the level of the superior quadrigeminal bodies
penoris muscle and the superior rectus muscle.
(see Figs 771, 772).
2. The inferior branch (ramus inferior nervi ocuUmoiorii) is
The group of nuclei of the oculomotor nerve includes the dor- Stronger and at first lies, like the upper branch, lateral to the optic
soUteral nucleus (nucleus doriolateralis), the ventromedial nucleus nerve. In the orbit the inferior branch divides into three small
(nucleus ventromedialis), the unpaired caudal central nucleus (nucleus branches: the medial one runs to the medial rectus muscle; the
caudahs czntralis), and paired autenomic (parasympathetic) acces
middle, shortest, branch innervates the inferior rectus muscle; and
sory nuclei (nuclei accessorii).
the lateral, longest, branch passes on the inferior rectus muscle to
The oculomotor nerve appears from the depths of the brain the inferior oblique muscle. In addition, the lateral branch gives
matter next to the anterior border of the pons, between the cere rise to the motor root of the ciliary ganglion (radix oculomotoria)
bral peduncles, in the region of the interpeduncular fossa (fossa in- which is formed nf axons of the parasympathetic nucleus cells, and
terpeduncularis). Then it runs forwards, lies in the fissure between stretches to the ciliary ganglion (ganglion dliare) (Figs 809, 811).
the posterior cerebral and superior cerebellar arteries, penetrates Besides the motor fibres described above, the oculomotor
the dura mater, passes in the superolateral area of the cavernous si
nerve contains sympathetic fibres which pass from the sympathetic
nus lateral to the internal carotid artery, and enters the cavity of
plexus surrounding the internal carotid artery and arc called the
the orbit through the superior orbital fissure.
internal carotid plexus (plexus caroticus internus), and sensory fibres
Before entering the orbtt, the oculomotor nerve divides into su arising from the ophthalmic nerve (aervus ophthalmkus) which is a
perior and inferior branches. division of the trigeminal nerve (nervus trigeminus).

THE TROCHLEAR NERVE
Pulvlnar
Lobus temporal Is ' Sybcortical visual centre
Nucleus kntiuularh ' / i n pulviriar
Tlialairiu F o r n i j i (partly r e m o v e d )
Nucleus caudatus
/ .Rsdiatlo optics
^.Subcorticiil visual centre
* i n corpus
Lobus frorrtatisx gcniculatum lateraLe
Sukus calcarinus
Lobus ocdpitalis
Chtasms optlcum-.
Butbus ( v i i i i ...
N, ppficns
Ganglion ic cells ^
in retina A r e a striata (area o f
visual analyser
Nn. dliares breves,T in cortex)
-Cerebellum
SubcorticaJ visual centre
in colliculus superior
Ganglion c i l i a r e / /
Colliculus superior
TractuS o p t i c u s ' Fossa rhomboidea
N. oeuktmotorius' /
A x o n s o f nucleus / Tractus irctospinsks
accessor ius (autonomicus)^ tt. o c u l o m o t o r i i
passing in i in mcscncephakin
n. o c u l o m o t o r i u s , Medulla oblongata
to ganglion ciliare - Thalamus (cut)
Fibres connecting
colliculus superior
w i t h nucleus accessor!us
(autoTuimicus)
n, o c u l o m o t o r i i
809. Course offibresand connections of optic nerve (semischematical representation).

THE TROCHLEAR NERVE
The trochlear nerve (turvus trockleans) (fourth pair) (Figs 803, fissure between the temporal lobe and the cerebral peduncle. Then
804, 810, 811) is a motor nerve. The nucki of the trochlear nerves it runs forwards, pierces the dura mater, and passes in the lateral
lie in the raid-brain, on the floor of the aqueduct, at the level of wall of the cavernous sinus. After that the trochlear nerve enters
the inferior quadrigeminal bodies (see Figs 771^72), the orbit through the superior orbital fissure over the common
The trochlear nerves appear from the brain matter behind the tendinous ring, runs next to the ophthalmic nerve, above the ocu
inferior quadrigeminal bodies, on either side of the frenulum veli. lomotor nerve, and then slightly medially to reach the superior ob
Each trochlear nerve curves round the lateral side of the cerebral lique muscle (musadus obliquus superior).
peduncle. The nerve emerges on the base of the brain from the

128 THE NERVES OF THE ORBIT
Ri". mediates et laterals

s \ n. supraorbitaiis
^W^^^^^ktK . supratrochlearis
M, obliquus superior
1 SupraorbitaliR
CjLmduEa lacriTTitilis
M. levator palpebrae
Bulbus olfactories
N. l&crimsHs
rectus superior
N. fronlalis
N. Innliiearis
( - - D u r a mater
encephali
TntujifJIblilum
N. optilbalmicus
Dorsum seilae
S^'~-=l-fc-Sinus pcfrosus superior
N. oculoirotorius
N. maxlllftris N. mandibulflris
'$ \^ ^ ^ ^ ^ P " * ^ Ganglion triseiflirtale

\ ^ R R,
. t tentorii
I \
Plexus basilarls'
N. irochlearis / ^ N . andneens
N. trigeTninii^
810. Nerves of right orbit; superior aspect (%).

( T h e roof of t h e orbit is r e m o v e d ; t h e cavity l o d g i n g t h e t r i g e m i n a l g a n g l i o n in o p e n e d . )

THE NERVES O F THE ORBIT 129
PjRr. mediate el Latersles

supraorbitalis
/N. supraorbltalis
levator palpebrae superlorls

M, reclus superior
Cilandula lacrimalls
N. Infiatrochlearls
yH lllh:*. oculi
Nn. ell fares breves
N. optic us
I ;ni inn crlbrosju.
N. ettimoldalls M. rectus lateralts

anrcrliK -=-_
M. obliquus superior -^rrLa

M. rectus inferior
Nn. dilates long! <*
R . inferior n.
JM. reriiis medlalls l & S M OLUJomutorii
N. ethmoldalls N- abducens
posterior " *
Ganglion clliare
N, njsoriliarL= *- "*~ ~~
R. sympathicus
ad ganglion qjliare-*
U+*.* x oculornotoria
TRamus cmiimunicans
N. liicmnalii .cum 11. nasociliari
N. frontalls *j
N. trochlearis-
A. carotis Iqleina
. Hypophysis
Plexus cavernOsus
N, M]l!|ll|>ii]i:ic ..h:
Dorsuin sellae
r\'_ maixillaris
Ramus inenlrieeiis (medius)

N. ULUlornoIurius
Ramus iaenir|geus(D.raandibularis)
A. meningea media
N. mandlbularis
Ganglion trigemirule
' N , Iroi-bisarjs
\
N. abducens
Plexus basilarls
811. Nerves of right orbit; superior aspect .(%).

(The roof of the orbit, part of the levator palpebrae superioris muscle, and the superior recius muscle are removed; the cavernous sinus is
opened; the dura mater in the region of the trigeminal ganglion is removed )

130 T H E TRIGEMINAL AND OPHTHALMIC NERVES
T H E TRIGEMJNAL NERVE
The trigeminal nerve (nervus trigemmus) (fifth pair) (Figs 803, the nucleus is not clear to date: some authors consider it to be mo
804, 81U-82!f!) is a mixed nerve. It has a motor and sensory nuclei tor, others sensory.
(sec Figs 771, 772). The trigeminal nerve appears on the base of the brain by two
The motor nucleus of the trigeminal nerve (nucleus motorius parts (roots) - sensory and motorfrom the depths of the pons
nervi trigemini) lies in the posterior part of the pons in the eminen- where the middle cerebellar peduncle (pedunculus cerebellaris medius)
tia medialis tn front of the nucleus of the abducent nervt. From arises, Both parts stretch forwards and laterally into the slit be
the aspect of the floor of the fourth ventricle (fossa rhomboidea) it is tween the layers of the dura rnater. The trigeminal cavity (tuvum
projected medially of the locus coeruleus. trigeminale) forms here along the course of the sensory part be
The processes of the cells of this nucleus descend to form the tween the layers of the dura mater. It is located Ofl the trigeminal
motor part (root) of the trigeminal nerve (portio minor [radix mo- impression (impressio nervi trigemini) on the apex of the petrous part
toris.} nervt trigemini). of the temporal bone.
The sensory nuclei are as follows. The cavity lodges a relatively large (measuring from 15 to
1. Tli e superior sensory nucleus of the trigeminal nerve (nu 18 mm in length) trigeminal ganglion (ganglion trigeminaU) whose
cleus sensonvs printipalis [superior} nervt trigemini) is located in the concavity faces posteriorly, and convexity anteriorly,
posterior pan of the pons lateral and to the back of the motor nuc The trigeminal ganglion is an aggregate of nerve cells. Their
leus in the locus coeruleus. It is composed of cells on which termi afferent processes form the sensory part of the trigeminal nerve
nate the ascending fibres of the sensory pan (root) of the trigemi (portio major nervi trigemini s. radix senstnia) while the processes
nal nerve (portio major [radix sensoriaj nervt trigemini) running from which run to the periphery form the sensory fibres of all branches
the trigeminal ganglion (ganglion ingeminate). of the trigeminal nerve.
2- The nucleus of the spinal tract of the trigeminal nerve (nu The anterior, convex, border of the trigeminal ganglion gives
cleus trachts spinalis nervi trigemini) is elongated and stretches in the rise to three main branches, or divisions, of the trigeminal nerve.
posterior parts of the medulla oblongata to the superior cervical The first division, the ophthalmic nerve (nervus apktkalmicus) leaves
segments of the spinal cord at the gelatinous matter of the poste the cavity of the skull through the superior orbital fissure; the sec
rior horn. The descending fibres of the sensory root of the trigemi ond division, the maxillary nerve (nervus maxillaris) leaves the skuJJ
nal nerve terminate in the cells of this nucleus. These fibres form through the foramen rotuudum; the third division, the mandibular
the spinal tract of the trigeminal nerve (tradus spinalis nervi trige nerve (nervus mandibularis) leaves the skull through the loramen
mini). ovaie.
'&. The mesencephalic nucleus of the trigeminal nerve (nucleus The motor part of the trigeminal nerve {portio minor nervi irt-
tractus mesencepkalid nerm trigemini) ascends along the pons and gemini s. radix motoria) curves round the trigeminal ganglion medi
mid-brain to the posterior white commissure. The cells of this nu ally and runs to the foramen ovale to be a component of the third
cleus accompany the tnesencephalic tract of the trigeminal nerve division of the trigeminal nerve.
aftradus mesencephaliais nervi trigemini). The functional character of
T H E OPHTHALMIC NERVE
The ophthalmic nerve (nervus ophtkalmicus) (Figs 810> 811-81b', After entering the orbit the ophthalmic nerve divides into
819) is a sensory nerve and the most highly located and smallest three main branches.
division of the trigeminal nerve. It runs anterosuperiorly, pierces I, The frontal nerve (nervus frontalis) is the thickest and passes
the lateral wall of the cavernous sinus and receives a small sym forwards directly under the roof of the orbit and divides into three
pathetic branch from the internal carotid plexus- it then stretches main branches.
lateral to the abducent nerve and inferior to the tnichlear nerve to (a) Tlie supratrochlear nerve (nervus supmtrocklearis) passes me
leave the skull through the superior orbital fissure. dially over the trochlea of the superior oblique muscle (musculus ob-
Before leaving the skull, the ophthalmic nctve gives off a small liquus superior), anastomoses with a branch of the infratrochlear
branch which innervates the dura mater in the region of the ttn- nerve (nervus infratrochlearis), pierces the orbicularis oculi muscle
torium cerebelli; this is the nimus lentorii nervi ophthalmici, or and the corrugator muscle of the eyebrow (musculus corrugator super-
the nerve to the lenlurium (Fig. 810), alii), and ends in the conjunctiva ami skin ol the upper eyelid, the

T H E NERVES OF T H E HEAD 131
>J. nasociliaris
R, eornrnijnicans cum n. Tiasodliar N. fronts l b
QariKli ciltare
G l a n i | 11.1 lacrlmalis
A. cerebrt anterior
N . ophthalniieuii R. l i t e r a t i ! It Hi|iraurWtali5
Pedunciikis cereuri N
A. carotrs Interim
R. mcfliali.i n. siiprao]Willis
Pans
N. s u p n t r o r h i t s r i s
Nil, pt*?JgopsUftW
N. lnfratrochl earls
Ganglion trii*mina|p^j
N. peirosus m a j o r ,
N- pelrosips p r o f w i d u s ,
ladix oculomoturia
N. inandJhubrrs- ~N, oouiomotorius

Nn. palaiim - ~ ^ H ^ B
/ "" "" H. infraoTfoUaliii
on ptPrygopnlatiriLUTL
N, Infraorbitalis (pes
A mentngea media anserinus m i n o r )
Rr. alveolares
A, o c d p i i a l i s ^ j superJotcs anterior?!
Rr. a l v M l a r e s R. alveolarts superior m^dlus
superfnres p o s t e r i t i e s Pifxus deritslls superior
A. temporalis Rr. dentales superiores
superficialis(cuLoff)
A. maxillaris' W HT. g i n g i vales superiores
l^N. lingualis
A. auricularis posterior-"
A. carotis e x t e T n a - - M *> N mylohyofdeus
N, acue^soritjs fljH N. menlalts

V. jugularls interna v v f l
N. hypofilossus V
Rr- dentales inferiores
A. carotis i n i e r n a . ^
^Plejus dtnta&S Inferior
R. superior an^&e - A. submentalis
t e r v i c a l i s "" N . alveolaris inferior
Plexus cervlcalls
A, lingi
A, caralis communis
Ansa cervka
A, thyroidea superior
812. Nerves of head; right trigeminal nerve (nervus trigeminus); anterolateral aspect (]/2).
( P a r t o f t h e b r a i n , m a x i l l a , a n d m a n d i b l e are r e m o v e d , )
skin of the root of the nose, the lower part of the forehead, and in medialis) which passes through the frontal notch and ends in the
(he lacrimal sac, innervating these regions. skin of the forehead.
(b) The supraorbital nerve (nervus supra-orbitalis) is the thick 2- The lacrimal nerve (nervus laaimalis) runs along the lateral
est branch. It passes forwards lateral to the supratrochlear nerve wall of the orbit and ends in the skin of the lateral angle of the eye
under the roofof the orbit and divides into two branches: a lateral and the upper eyelid.
branch (ramus laltralu) which passes through the supra-orbital On the way, the Lacrimal nerve gives off a communicating
notch and branches Out in the skin of the forehead, reaching the branch with the zygumalic nerve (ramm communicans cum neroo zygo-
parietal and temporal areas, and a thinner medial branch (ramm matko) which innervates the lacrimal gland.

132 T H E MAXILLARY NERVE
3. The nase-ciliary nerve (nervus nasodliaris) is the third, most nervate the mucous membrane of the anterior part of the nasal
deeply lying branch of Lhe ophthalmic nerve. It runs in attendance septum;
to the ophthalmic artery forwards and medially between the supe
(2) the lateral nasal branches (rami nasales latemles) which end
rior rectus muscle and the optic nerve, stretches between the supe
in the mucous membrane of the anterior part of the lateral wall of
rior oblique and medial rectus muscles, and gives off the following
the nasal cavity;
branches.
(3) the nasal branches of the anterior ethmoidal nerve (torn na-
(a) T h e infratrochlear nerve (nervus infratrochkaris) stretches satts nervi etkmoidalis anteriorisj which innervate the skin on the tip
forwards on the medial wall of the orbit under the superior oblique of the nose.
muscle and ends in the skin of the medial angle or the eye and the
(c) The posterior ethmoidal nerve (nermts etkmvidalis posterior)
root of the nose, first uniting with the branches of the supratroch-
enters the posterior ethmoidal air cells through the posterior eth
lear nerve (nervus suprafrocklearis). T h e infratrochlear nerve inner
moidal foramen (together with the artery and vein of the same
vates also the lacrimal caruncle and the lacrimal sac.
name) and innervates die mucous membrane of these cells and the
(b) The anterior ethmoidal nerve (nervus tthmoidalis anterior) en mucous membrane of the sphenoidal sinus.
ters the skull through the anterior ethmoidal foramen (together
(d) The long ciliary nerves (nerui cilUtres longi) are two or three
with the artery and vein of the same name). It lies under the dura
small branches miming medial of the optic nerve. They reach the
mater in the anterior cranial fossa. Running forwards, the anterior
eyeball, unite with the short ciliary nerves (nerm dliares breves) aris
ethmoidal nerve passes through die cribriform plate of the eth
ing from the ciliary ganglion (ganglion ciliare) and innervate the
moid bone into the cavity of the nose, gives off a thin branch to
choroid and sclera.
the mucous membrane of the frontal sinus, and divides to form the
(e) The conununieating branch with the ciliary ganglion (ramus
following branches:
Eommmicans aim ganglione aliare) can be double and even triple, It
(1) the internal nasal branches (rami namles iaterni) which in runs forwards to the superoposterior angle of the ciliary ganglion.
T H E MAXILLARY NERVE
The maxillary nerve (nervus maxillaris) (Figs 811-813, 816,

O n the way the infra-orbital nerve sends the following
899) is a sensory nerve. On arising from the trigemina! ganglion it branches to the maxillary teeth:
by-passes the cavernous sinus, leaves the cavity of the skull
(a) the posterior superior dental nerves (rami alveolarts superiores
through the foramen r&undum, and enters the pterygopalatine
postertores), two or three in number, arise from the trunk of the in
fossa in which it divides into the main branches. Before leaving the
fra-orbital nerve before it enters the inferior orbital fissure; they
skull the nerve gives off the memngeal branch (ramus meningeus me-
run to the maxillary tuberosity, enter the alveolar (dental) fo
dius) which branches out in the dura mater together with the mid
ramina, traverse the canals lying for the most part in the depths of
dle meningeal artery (Figs 811, 822).
the bone, and reach the roots of the three maxillary molars;
The following branches arise from the maxillary nerve in the
(b) the middle superior dental nerve (ramus alveolaris superior
pterygopalittlrie Fossa.
medius) is a rather Uiick trunk arising from the infra-orbital nerve
I. The infra-orbital nerve (nervus infra-crbitalis) is the strongest in the infra-orbital groove. Running downwards and forwards, it
branch of the maxillary nerve and its direct continuation. It passes branches out in the depths of the lateral wall of the maxillary si
from the pterygopalatine fossa through the inferior orbital fissure nus, anastomoses with the posterior superior and anterior superior
into the orbit. Then it fits into the infra-orbital groove, traverses dental nerves, and reaches the maxillary premolars;
the infra-orbital canal, emerges from the infra-orbital foramen on
(c) the anterior superior dental nerves (rami aheolares superiores
the front of the face in the region of the canine fossa, and divides
antmeres), one or Uiree in number, are the thickest. They arise
into a series of radiating branches, which are:
from the infra-orbital nerve almost before its exit from the infra^
(a) the palpebral branches (rami palpebrales inferiores) innervat orbital foramen, pass through the anterior dental canals in the an
ing the skin of the lower eyelid and the region of the angle of the
terior wall of the maxillary sinus, and run slightly forwards and
eye;
downwards to give off several dental branches and one nasal
(b) the external and internal nasal branches (rami nasales externi branch. The former run to the maxillary incisors and canines, the
et mterni), numerous branches innervating the skin on the side of latter takes part in innervation of the anterior part of the nasal mu-
die nose for its whole length, from the medial angle of the eye to cosa on the floor of the nasal cavity.
the nostris;
These dental nerves communicate in the canaliculi of the max
(c) the labial branches (rami labiates superiores) running to the illary alveolar process and form the superior dental plexus (plexus
skin and mucous membrane of the upper lip, the gums, and the dtntalis superior).
alae of the nose.
The branches of this plexus are known as the superior dental

133
T H E TRIGEMINAL NERVE
R. lateralis n. supraorhitalls
A. frontalis
A. supraorhitaii^,^ R. medial is n. supraorbitalls
N. fronlalis Glandula lacrimaHs

H. reclus Inters! is
M. rectus superior
M. levator R. communicans
palpebrae supenoris \ cum n. zygomatico
N, lacrirnalts^
N. nasociliarls^ R. inferior n ouuiomolorii
N oprithnlirHcus^ \
N. nculoTnotorius M. obilquus Interior
N. troctiJeari
M. lygomsttaii
M. rectus Inferior
Ganglion
trigemlnale :
,^-A. iiifraoriiitiilis
N. maxillarli
glum pterygopalatimim - ^ L ^ î*"ji

^ i S ^ t N . Infraurbitalis
M, rnandibuiarls
N. snails plerygoideK
{Radix facial is)
A. spheTiopaliilina
Nn. palatini
major et minor
A. maxiHans'
FJ_ alveolarea f f^/a'!
superiwes poslerlores J W"
Aa. alveolares j /
superlores poaleriorea ; / /
R. zygomatiewtacialis
A. buccalis
813. Right trigeminal nerve (newus trigeminus); lateral aspect ( / ) .

(The lateral wall of the orbit is removed.)
zygomatic nerve has a communicating branch with the lacrimal

and gingival branches (rami dmtales et gingivahs superiwes); they
nerve (a branch of the ophthalmic nerve), which consists of fibres
run to the maxillary teeth and corresponding areas of the gums.
from the sphenopalatine ganglion (ganglion pterygopalafmum).
2. The ganglionic branches of t i e maxillary nerve (nervipttry-
The zygomatic nerve then enters the zygomatico-orbita! fo-
pfrtlatini), two or three in number, are short and contribute to the
formation of the sphenopalatine ganglion (ganglion pterygopalati- rameu (foramen zygomztko-nrbitaU) and divides in the zygomatic
nmm). Some fibres of these branches enter the ganglion' some bone to form two branches;
(most) or the others unite with the branches arising from the gang (a) the zygomaticofacial branch frame ggomaticofatialis) which
lion. These are the orbital branches (rami arbitahs), the short emerges from the zygomaiicofacial foramen and ends in the skin
sphenopalatine nerves from nasales positriores wperiares), and the of the cheek and lateral angle of the eye;
(b) the zygomatkotempora! branch (ramus qgamatkoUrtiporahs)
palatine nerves.
3. The zygomatic nerve (rurvus zygomaticus) arises from the which emerges From the zygomaticotemporal Foramen and
maxillary nerve in the region of the pterygopalatine fossa, and to branches out in the skin of the temple and lateral forehead.
gether with the infra-orbital nerve passes through the infra-orbital The terminal branches of both nerves unite freely with the fa
fissure into the orbit to stretch on its literal wall. O n the way the cial nerve (nermts fatialis} (Fig. 824).

T H E MANDIIUJLAR NERVE
134
814, Skin branches of infra-orbital and mental nerves (second and third divisions qftrigem
(specimen prepared by A.Mirontsova).
(Photograph of specimen from the aspect of the subcutaneous fat; for contrast, a piece of black silk has been placed undei
1 IIHSSl u i m n i i 7 iiirnlal nerve in rrjrimi of mental foraintr
2 inlra-m+ikal nerve in rtition of Lllfrn-f>rhital foramen 8 - Irfi and righ't connections E medial branches of rcicnktl
'A - lateral branches of infra-orbital nerve ctjiniTiutncalinfi with nerves
branches of facial nerve 9 mental nerve (slightly reflected downwards)
4 medial branches of infrx-orbita.1 ntrvca- 111 branches of facial nerve
5 left and right 5<me* of overlap of medial branr.hrs "f infra- 1 I infra-orbital plexus formed by brandies of facial and \n-
tirbital nerves fra-orbital nervrs
fi OTal fissure
THE MANDIBULAR NERVE
The mandibular nerve (nervus mandibularis) (see Figs 8 1 1 - 8 H , emerges from the skull to its base through the forai
816-819) is a mixed nerve, It is the strongest division (branch) of divides into two main branchesthe anterior, predc
the trigeminal nerve. The mandibular nerve is formed by a sensory tor branch, and the posterior, predominantly sen so i
branrh arising from the trigeminal ganjrlion, which unites with the Before dividing into these branches, the man
motor part (root) of the trigemina] nerve. The mandibular nerve sends off a thin nervus spinosus (ramus mtnmgeus n

THE MANDIBULAR NERVE
815. First division of trigeminal nerve in skin of forehead and upper eyelids (specimen prepa
A.Mirontsova). (Photograph.)
(The nerve branches are dissected from the aspect of the subcutaneous fat; for contrast, silk has been placed under the
ne
1 lateral branch r>f wpflKWtriti! nerve 6 _ n e r v c . f i| e x usin skin of up fit r eyelid
2 - m e d i a l branch nf supra -nrhital nerve 7 - c muni cation of branches o f t i V m i n a I nerve with
S branch of supra-Lnithlcar nerve bWocVa of facial nerve
+ - k i n nf rig-hr upper eyelid 8-branches of facial nerve
5 skin of left upper r j r l i r l
Hi), which returns into the cavity of the skull through the foramen 4, The buccal nerve (nervus buaalis) is quite thick an
spinosurn to innervate the dura mater of the middle cranial fossa. sensory nerve in this group. 11 usually passes between thi
Three or four short twigs originate from the posterior surface or the lateral pterygoid muscle, stretches forwards on the li
the mandibular nerve and run to the otic ganglion (ganglion ati- face of the buccinator muscle, and ends in the skin an
cum). membrane of the cheek; it also innervates the skin of th
The anterior branch gives off the following nerves. the mouth. At the site of its ramification it has branches i
1. The nerve to the masseter (nervm massttericus) which runs eating with those of the facial nerve.
laterally and sends one or two thin branches to the mandibular The Following nerves arise from the posterior brand
joint, and then passes through the mandibular notch to the medial 1. The nerve to the medial pterygoid muscle (nervi
surface of the masseter muscle which it innervates (Fig. 818). dens medialis) begins from the medial surface of the
2. The deep temporal nerves (ntrvi temporalts profundi), two in branch, passes to the medial pterygoid muscle and inn
number (a smaller posterior and a larger anterior nerve), stretch Along the way it unites with another two small branch
laterally into the slit between the lateral pterygoid muscle and the from the otic ganglion:
infra temporal crest (crista infralemporalis), turn upwards onto the (a) the nerve to the tensor palatj muscle (tiervus tensori
medial surface of the temporal muscle and branch out in its iini) innervates the soft palate;
depths (Fig. 817). (b) the nerve to the tensor tympani muscle (nervus It
3. The nerve to the lateral pterygoid muscle (tttrvus plerygoideus paid} ascends to the back and innervates this muscle.
tateralis) is short and usually arises together with the buccal nerve, 2. The auriculotemporal nerve (nervus auriailotempo
It runs to the medial aspect of the lateral pterygoid muscle and in mixed nerve. It contains sensory and secretory fibres \
nervates it proach it from the otic ganglion. The nerve originates by

136 NERVES OF THE HEAD AND NECK
Verter frontalis
Rjateralis
N. supraorbftaiis
R, medialls
Ganglion IrLgemihalc N supratrochlearis
N. monrtiblilifis
K , Lig. palpebrale mediate
N. pterygoldEus laleratii
A. ntentfigea media
A. msutiltarfsj
V ophthalmitus
M, pterygoklnis lateral is , J
N rnaailtails,
Pnrus KUlUciis extemus J Rr. palpebrales inferiors
N. aurK'uIoicriipuralis^ ]
n. tairaorbttalti
N, meatus aciisiici extern! _.] L N. Infraorbitniis
Communicating branches Rr. nasales extern!
n. infraorhitalis
between rt- facialis and M. tevator labii
n. auriculotemporalis ~* ~ superloris
N. facialis-. Ri. labiales superiores
A . auricularis rt, Infraorhitalis
posterior ( r e m o v e d ^ - 3 H
R. muscularis from
11.1'ai-ialislonnlipasfriL'i^ M b *$- r.hrirda [ympden
M. [>Lm'_rfjkkMJS i r n -w- r r i: i ^ *Y' B M |
N. buCCTlii
A. carol is e x t t ' r n a - j g j
Ductui piirotldeus
M. tSjgastrkus (venter p o s t e r i o n J B
N. inylohyotdeus - ^ H N. aiveolaris Inferior
Gang!imi su!>rnaiidibulure^BB M. buccinator
N. lirigitaUs
R. muscularis from Rr. llrgitales
plexus cervicalis to btngfion siiblinguale
m, sternodeidomastoidcus _ Rr, subllnguales
M. stcmocleidomasitoidcuf. - Gtandula. siibilngual.is
(drawn aside) JM, myluhyoldeus
R. muscularisfromn, accessorius ^_--~' '--M. digastrltus (venter anterior!
to m. stemodeidomastoideus -*A. Jaciatss.
RT, iubmandibularcs >*"" T__ n UngLialTs Olandula submandibularis
A, oceipttalis " Os hyoideum
N, accessorius'
nf. hypoglossus "-V, facialis (removed)
M. thyrnbyoidetii
A. carotin esterna
Plexus rervicails
" * * ^ ,
^ R a d is superior anaae cervltalis
V. jugalarte lulorna" ~* --__ ait V- thyroidea superior

Hattiy QUmJula ttiyroldea
inferior ansaCeervlcalfV*
-A, carotis ennnnunis
Ansa i-erv[talisip - ^
-M. sternHhyoitieus
1
R, superficialis -*.^ M. sternnthyrnideus
f ~~,
A, transversa coll
W M. omohyotdcus
M. trapej.iLJ.s/" "-: ~* il (venter superior)
Nn. suprsciaviLutares -^ ^ "*- V. jugularis anterior (removed)
M. scaknus anterior "~"A. sjprascapularis
V. traiiversa colli - - V . brachiocephalica
Plexus hrachlalts ' M . sternoclcidomastoideus
I N. phrenicus ^ (cut and reflected)
j V. subelivia
V . jugularis extema (removed)
816. Nerves of head and neck; right side viewed slightly from front {%).
(Part of the temporal, sphenoid, frontal, and zygomatic bones and the right half of the mandible are removed.)

137
NERVES O F T H E HEAD AND NECK
817. Nerves of right temporal muscle (specimen 818. Nerves of right masseter muscle
prepared by A.Mirontsova). (Photograph.) (specimen prepared by A.Mirontsova).
(Medial surface uF muscle,)
(Photograph.)
I porterior intramuscular branches (of temporal nerw] (Medial surface of muscle.)
JnioVtte intTPTrtiiicubT hraii-chcs I main intramuscular trunk of nerve to msseter
" w intrannusnilai' branches 2posterior intramuscular branches
of temporal mutcte 3anterior intramuscular branches
+ueep layer of roassetrf- muscle {reflected)
5superficial layer ot~ unssracier mustle
Hcubtemporal nerve stretches under the parenchyma of the gland

b a n the posterior surface of the trunk of the mandibular nerve,
_ backwards to embrace the middle meningeal artery (arteria and unite with the temporal branch of the facial nerve. They con
memmêa media), and then passes on the medial surface of the contain mostly secretory fibres from the otic ganglion which m n first
<Moid process (processus condykris) of the mandible. It then in the auriculotemporal ncrvn and then in the branches of the fa
Aetches backwards and upwards on the capsule of the mandibu- cial nerve;
* v joint under the parotid gland and in front of Lhe auditory mea (c) the nerves to the external auditory meatus (nervi meetus aais-
t s . After that it ascends to end in the skin of the temporal region tid cxterm), two in number, enter the wall of the external auditory
ff^. 823). On the way, the auriculotemporal nerve gives off meatua at the junction of its bony and cartilaginous parts and in
nervate the skin of die meatus;
(a) the articular branches arise where the auriculotemporal (d) the auricular branches (nervi avrkulares antsriora), usually
passes next to the joint and reach the capsule of the mandib- two in number, run to the anterior part of the external ear and in
i joint; nervate the skin of the tragus and part of the helix:
<b) the parotid branches (ramiparotidei) originate where the au- (e) the temporal branches (rami tempcrales superficiales) are the

T H E T R I G E M I N A L NERVE
138
N
8. c o m m u n e c m n. B J S o d l i . r ^ -icontalis; N
"P11^5
N. ocidomotorius
N 1lil50Lill3flS
NS. plerygopalatlnU
N. ophttialnikus
N. nanaHs plerygoirlei ]>',
i Radix iacialis ) **>ij*^ upraOrbltalis
N. tnaJillaris "Yip
N. petrusus profundus ^ . ;' Rr. raediales n. supraorbitalls
t^, inandLbulaTis^
flanglion trigemiiuif^ ' , ^ ^ > * - ; " v / ''.'*. ) / j , Qphthaltrttca

acrimalls
clllarc-
R. anasrornoticus
cum si. lacrimilis
-"1^. synnpalhLCLjs ad
ganglion ciliare
Radix
oculomotor] a
N. zygomatlcus
N. itifrBoitltalls
8. alveolarls superior
medlus
Rr. alvEolares
superiors
(WHrlores
"vM. riasopalatinus
. * * N . palaiinus major
^Plexus denudis superior
Ganglion pterygopalaiinum
JtSr. alvcolares superiores
P"" ~. posteriori
" --. ^ N n . palatini major et minor
N. petrosus majoi
~"-.N". tensoris weli
palatini
M o t o r root
A. meningea media'' J>
Ganglion geriiculi .^ "-Rr. sub1lriguals
N tenSurtS tympanl * " ~~- Ganglion
N. glnssnpbaryngeus'' suhlinrjuale
K
R. cotrtrrjafiicara cum plexu tympanici N. mentalis
/ Plexus dentalls
N, petiosus minor'1 '' / / / ' inferior
t' / / / > ,x v "\\ \ \ v
Gang3ion submnndlbularc
N. atiricidotemporalis
Sympathetic root ' j , ' ^ \ \ v, \ \ ^ R. pharyngeus
\ N \ \ ^PICKUS maitillaris eitermis
/
N. lacialls'' / / \ , \ \ Rr ^landularcs
N K. .sympath. ad garigl. submatto.
Chorda Ivinpai i f ?
X ^ v - --
v. \ A- facials
*S, lirigjaiLs' ^
X X "" rJ- alveolarls inferior
>J. palatrnus minor
'-S. -s ^ A tarotis externa
PkxuS caioticus ifjlertltJS
""""-- ' A ciratis interna
'~-A. carotls communts
Nn. cstoliri ejtleml
819 Trigonal mm and autononic Relative) ganglia of head; right aspect (semischematical
s
representation).
mandibolar canal through the mandibular foramen, stretches m it

terminal branches of tbt auriculotemporal nerve. They ramify m
together wtth the artery and vein of the same name, and emerges
,hr .kin of the temporal region and have commumcatmg branch**
through the mental foramen on the face.
with those of the facial, frontal, and greater occipital nerves. O n the way the inferior dental nerve send, the follcwmg
3 T h e inferior dental nerve fnmu* alvtokru mferwr) is mixed
branches: , .
in c h a r a r n r . It is a thick trunk stretching downwards first on the
(a) the mylohyoid nerve ( t a r n mylokyotdw) arises at the point
medial surface of the lateral pterygoid muscle, then between the
where the inferior dental nerve enters the mandibular foramen and
pterygoul muscle, to pass on the lateral surface of the medial
mns forwards and downwards to fit into the mylohyoid groove on
ptervgoid muscle. After that it runs slightly forwards, enters the

THE NERVES OF THE DURA MATER OF THE BRAIN 1H<)
SO. Nerves of dura mater of brain (specimen 821. Nerves of dura mater of brain (specimen
\prepared by D.Sigalevich). (Photograph.) prepared by D.Sigalevich). (Photograph.)
fcompletely stained dvtta mater in the region of the middle (Area of completely stained dura mater in the region of the middle
cranial fossa.) cranial fossa.)
1 nirrirrigcaJ hraneh of maxillary nerve
BCJ1 ttl maxillary DCTVt 2 iriitJrllr rTHTiiriFfsi] artery
artery
iurface nf the mandible. Then it approaches the mylo- and lower lip; it often sends one or two twigs to the mucous mem
le, ramifies in it, and sends a small branch to the ante- brane nf the lower lip,
rf the digastric muscle (musadux digastriais) (Fig. 822). 4. The lingual nerve (ncrvus iingualisj is a sensory nerve. Hav
c inferior alveolar branches (rami alveolares inferiors) arise ing originated from the anterior border of the mandibular nerve it
interior denial nerve for the whole length of the segment runs, like the inferior dental nerve, first on the medial surface of
i the mandibular canal. The branches communicate to the lateral pterygoid muscle, and slightly distatly penetrates into
mfrrior denial plexus (plexus dentalu inferior) which gives the slit between the lateral and medial pterygoid muscles (in front
types of branches: of the inferior dental nerve), Here the lingual nerve receives the
r inferior gingival branches (rami gingimles inferkms) in- chorda tympani (a branch of the facial nerve) which enters it from
in'rig the gums of the lower jaw; ihe back at an acute angle. After that the lingual nerve arches
r
Ae Inferior dental branches (rami dentalts inferiares) running downwards and forwards on the medial surface of the mandible,
M h r Mandibular teeth; passes above the submandibular gland and approaches the inferior
Mental nerve (nervm mmtalis) is the terminal branch of surface of the body of the tongue to send end branches into its
dental nerve. After emerging from the mental foramen depths.
On the way the lingual nerve gives off the following branches:

THE ABDUCENT AND FACIAL NERVES
140
(a) the branches to the oropharyngeal isthmus (rand isthmi fau- (rami tonwtunkantes cum nerve hypoglasso), two or three in number,
dum); these are several small branches stretching to the mucous arch forwards on the lateral surface of the hypoglossus muscle to
membrane of the palatojdossal arch and the tonsil; join the trunk of the hypoglossal nerve;
(b) the branches to the submandibular ganglion^ these are two (e) the branches to the tongue (rami UnguaUs) are the terminal
or diree short twigs composed of their own sensory fibres and branches of the lingual nerve. They run on the inferior surface of
secretory fibres brought here by the chorda tympani; the tongue, penetrate into its depths, unite, and ascend to the mu
(c) the sublingual nerve (newus suUingualis) arises from the an cous membrane to innervate its anterior two thirds (the tip, bor
terior surface of the lingual nerve and innervates the sublingual ders, and dorsum of the tongue), and send twigs to the filiform and
gland, the mucosa of the floor of the mouth in the region of the fungiibrm papillae. At the junction of the root and body of the
sublingual fold, and the raucous membrane of the anterior parts of tongue the rami linguales unite with the lingual branches of the
the lower gums; glossopharyngeal nerve (rami linguales ntrvi glossopkarytigci).
(d) the communicating branches with the hypoglossal nerve
T H E ABDUCENT NERVE
The abducent nerve (nervus abdutens) (sixth pair) (see Figs 803, groove between the pons and the pyramid of the medulla oblon-
804, 810, 811) is a motor nerve. Its nucleus (nucleus nervi abductniis) gata.
lies in the posterior part of the pons. From the aspect of the floor The abducent nerve runs forwards, penetrates the dura mater,
of the fourth ventricle the nucleus is projected in the posterior re and enters the cavernous sinus in which it stretches close to the lat
gion of the emineiilia mediansin the facial colliculus (colliculus eral side of the internal carotid artery. After leaving the sinus, the
facialis) slightly medial and dorsal to the nuclei of the facial nerve nerve enters the orbit through the superior orbital fissure, pierces
(see Figs 771, 772). the common tendinous ring (anulus tmdineus communu), and runs
The fibres which arise from the neurons forming the nucleus of under the oculomotor nerve to reach the lateral rectus muscle of
the abducent nerve run forwards, penetrate the pons throughout the orbit (mvseulus rectus lateralis) which it innervates.
its thickness, and emerge on the inferior surface of the brain in the
T H E FACIAL NERVE
lacrimal nucleus (see The Vagus Nerve). The axons of the cells of
The facial nerve (nenius facialis) (seventh pair) (see Figs 803,
804, 822-825) is a motor nerve. Its nucleus (nucleus nervifacialis) is this nucleus compose the main bulk of the sensory root of the fa
situated in the central part of the pons in the reticular formation cial nerve.
slightly to the back and lateral of the nucleus of the abducent The facial nerve emerges on the base of the brain together with
nerve. From the aspect of the Door of the fourth ventricle the nu the nervus inteniiedius. Further on both these nerves together with
cleus of the facial nerve is projected lateral to die facial colliculus the auditory nerve (nervus vestibulocockkaris) {eighth pair) enter die
(colliculus facialis) (sec Figs 771, 772). internal auditory meatus via the porus acusticus interims of the pe
The processes of cells which form the nucleus of the facial trous part of the temporal bone. There they unite and run into the
nerve first run dorsally, arch round the nucleus of the abducent canal for the facial nerve through the facial nerve area (area mrvt
nerve, and then form the genu of the facial nerve, stretch veutrally, facialis). At the geniculum of this canal the facial nerve is thick
and emerge on the inferior surface of the brain at the posterior ened by the ganglion of die facial nerve (ganglion geniculi).
border of the pons above and lateral to the olive of die medulla ob- The facial nerve follows all the curves of its canal, leaves the
longata. petrous part of the temporal bone through the stykimastoid fo
The facial nerve itself is a motor nerve, but after it is joined by ramen, and stretches into the depths of the parotid gland to divide
the sensory root (nervus intermedia*) formed of taste and secretory into the main branches.
fibres, it acquires a mixed character. In the petrous part of the temporal bone the facial nerve gives
The nucleus of the sensory root, the superior salivary nucleus off the following nerves.
(nucleus salivatvrius superior), is autouomic and lies slightly to the 1. The greater superficial petrosal nerve (nervus petrosus major)
back of and medial to the nucleus of the facial nerve, behind the begins from the ganglion of the facial nerve (ganglion geniculi) and

THE SPHENOPALATINE AND OTIC GANGLIA 141
Dura mater
R, tnenlngsus medius
N. petioaus proiundus A. mcnlngea media
N. mandibularis
(anterior branch)
Ganglion pteryg'opalatiiium.
R. meningcus
(n. mandibularis)
Radix motoria
RT. IBUBIBC posteriory n. trigemini
superiors lalerales
Radix sensoria
Nil. oHflflorii ti. trigemini
Rr. Tissales Ganglion tngeminale

ln_e.llimoidal]s anleriorls )
Concha iiasalis media
M. tensor tympanl
Rf. nasales puslerLores
in;eilt>ies laterals
piujgoideHS medialis
Nn. patalini ^ Jp ^ j 1 N p^linsus riLajm
Mttpt * t minor
SMy
anlb inleMor ~*t*i~^: \ petrosu^ niinor
" " * " f - N . (ensoils tympani
Chorda tympa.nl
durum 'M. farialis
N. auriculoternporaMB
H. palallnus major angllon oilcum
\ ^ A . temporalis superficial!*
K. palallnus minor
\ A meniiigea media
H- pa latin us minor J A. maxillarl!
A, alveolarls IflEerlor
N. alveolaris inferior
A. caiotis enterna
FVi^M, pteiygoideus medialis
822, Right spkenopalatine ganglion (ganglion pterygopalatinum) and otic ganglion (ganglion
oticum); inner aspect (%).
(Sagittal section through anterior parts of the skull and oblique anteriorly tilted section through the posterior parts; the nerves and
vessels of the dura mater are located in its depths; part of the nasal mucosa is removed.)

142 THE FACIAL NERVE
Plexus parotldeus ffliltt superlicialis

Rr. temporales superffctales
i \ Rr. temporales
Venter frontalls
N. snprinrbitalis
1 (r. lateralis)
W/ ,M. orblcularls oculi
R. mediulis n. supraorbitalis
\A \
/
N. supratrochlearis
N. tnfratrochlearis
(1
' \
\R, zygomattcotcmporalis
N,: auricula- | '//< JA n. zygomaticf
teitnporalia .1
f&t.-R- zygomatlcofacifllls
/i ,-V^Vi D. zygomaticl
H ^ D k ^ M . levator lab 11
R, occlpitali* ^X superiorly
HEB^^--\- ^ _. |J urijalis cxternus
n. t-llii!L(>Ui;iii:-
N. occlpHslis ma
"''^B^kib ^fc-~N. Infranrbitalis
-Rr. nasales extern!
n. infraarbitalis
N, eccipitalls '"'"'"-^ffljrrl cML zygomaticus major
/ - :
^- .ê
'Rr, labiates supertores
N. f a u a l i s . - ^ H
R. 1lgastricus-^M
, - V
R, stylohyotdeus 4
Rr. iVgotnatict n. facialis
' M, buccinator
Glandula p a r M i s - j M
N. meittalis
N. auricularis Triagnus^B
M. depressor labii
inferioris
s \
Rr. buccales n. fatbits M, depressor anguli nris
R. colll n. f*811ls>^
N. transversus colli
,1
^ H
M. itiasseter
I
M. stemocleidomastoidein
R. marginalia mandihul.ie
Platysitia
823, Right facial nerve; lateral aspect (J4).

(The platvsma, depressor labii inferioris muscle, and the muscles of the upper lip are partly removed.)

T H E MANDIBULAR NERVE
144
thin trunk which descends to enter the depths

is composed of the nervus intermedius fibres. It emerges from the
muscle after having united with the sympathea
petrous part of the temporal bone through the hiatus for the great
round the external carotid artery.
er superficial petrosal nerve (hiatus canaiis nerm petrosi majons), fits
3. The digastric branch (ramus digasiricus n
into the groove of the same name, and leaves the cavity of the skull
from the main trunk slightly below the origin -
through the foramen lacerum. After that it passes ID the pterygoid
branch and descends on the posterior belly of tf
canal of the sphenoid bone, enters the pterygopalatine fossa, and
to which it sends branches; it has a communk
approaches the sphenopalatine ganglion (ganglion pterygop&lati
the glossopharyngeal nerve (ramus communicans t
num.).
ryngeo).
2. The communicating branch with the tympanic plexus (ra-
On. entering die depths or the parotid giant
mus communicant cum plexu tympanico) arises from the ganglion of
divides into two main branches: a stronger superi
the facial nerve (ganglion geniculi) or the greater superficial petrosal
inferior branch. These branches also divide I
nerve and stretches to the lesser superficial petrosal nerve (nervus
branches which radiate upwards, forwards, and
petfosus minor) (arising from the glossopharyngeal nerve).
muscles of the face. These branches comniunic
3. The nerve to the stapedius muscle (nervus stapedius) is a twig
gland forming the parotid plexus (plexus parotida
which begins from the descending part of the Facial nerve,
The terminal branches of the facial nerve are
stretches to the stapedius muscle and innervates it. (a) the temporal branches (rami temporal*!
4. T h e chorda tympani is the terminal branch of the nervus in number (posterior, middle, and anterior) in
intermedius. It arises from the ganglion of the facia! nerve and and anterior auricular muscles, the frontal be&
separates from the main trunk of the facial nerve close to the stvlo- frontal muscle, the orbicularis oculi muscle, the
mastoid process to enter the anterior canaliculus for the chorda of the eyebrow, and other muscles;
tympani (canaliculus chordae tympani). (b) the zygomatic branches (rami zygomatia
T h e chorda tympani enters the tympanic cavity through a pos sometimes three in number, stretch forwards and
terior canaliculus and arches downward between the handle of the the zygomaticus and orbicularis oculi muscles;
malleus and the long process of the incus; on reaching the squa- (c) the buccal branches (rami buccaUs iurr
motympanic fissure (ftssura petrotympamca) the chorda tympani four rather strong twigs, arise from the superior
leaves the skull through it, facial nerve and send branches to the zygomati
After that it descends, runs between the medial and lateral buccinator, levator labii superioris, depressor .
pterygoid muscles, and enters the lingual nerve (branch of the tor angulus Oris, depressor angums oris, orbic
mandibular nerve originating from the trigeminal nerve). The muscles;
chorda tympani does not send branches along its course, but only (d) the mandibular branch (ramus margin*
at the very beginning, after its exit from the skull, it communicates facialu) runs forwards, passes on the border o
with the otic ganglion (ganglion olkum) by means of several twigs. innervates the depressor labii 1 tilerioris and th*
Some of the fibres of the chorda tympani which are compo (e) the cervical branch (ramus colli nervi jad*
nents of the lingual nerve run to the submandibular and sublin- three twigs, runs behind the angle of the maud"
gual ganglia (ganglia submandibutare et suhlinguaU) (efferent fibres), innervates it, and gives off branches communk
others reach the mucous membrane of the dorsum of the tongue rior (sensory) branch of the cervical plexus.
(afferent fibres, processes of the cells or the ganglion geniculi). T h e sensory root of the facial nerve (ne
After leaving the petrous part of the temporal bone through mixed nerve containing efferent (autonomic)
the styloraastoid foramen and before entering the depths of the pa (taste) fibres. It appears on the inferior surfa
rotid gland, the facial nerve gives origin to the following branches. gether with the facial nerve, stretches between i
1. The posterior auricular nerve (nervus auricuhtrh posterior) be nerve (nervus vestihulocochlearis), enters the p o n s
gins directly under the stylomastoid foramen, turns backwards and and then the internal auditory mealus (mtab
upwards, passes behind the external ear, and divides into two There the intermediate nerve becomes a con
branches: (a) an anterior, auricular branch and (b) a posterior, oc nerve.
cipital branch (ramus ocdpitaUs)- The autonomic fibres of the nervus intt
The anterior branch innervates the auricularis posterior and superior salivary nucleus (nucleus salivatorhis
auricularis superior muscles, the oblique and transverse muscles of components of the chorda tympani to the sub
the auricle, and the antitragicus muscle. lingual ganglia and send secretory fibres to the
T h e posterior branch innervates the occipital belly of the oc- sublingual glands. Some of the secretory i
cipitofrontalis muscle, and joins the great auricular nerve (nermis greater superficial petrosal nerve (nervus pei
auricularis magnus), the lesser occipital nerve (nems ocdpitalis minor) reach the lacrimal gland via the sphenopalatio
(both are branches of the cervical plexus), and the auricular pterygopalaiinvm).
The sensory (taste) fibres of the nervus
branch of the vagus nerve.
2. The stylohyoid branch (ramus stylohyoideus nervi jatialts) is a

T H E AUDITORY AND GLOSSOFHARY1NGEAL NERVES H5
membrane of the anterior two thirds or the tongue and stretch to the brain stem and terminate there in the nucleus of the
in the chorda tympam to the ganglion of the facial nerve tractus solitarius (nucleus tractus solitarii) (a nucleus in common
gesiatli). T h e central processes of the cells of this ganglion with the glossopharyngeal nerve}.
T H E A U D I T O R Y NERVE
EW auditory nerve (nervus oestibulocoMearis s. nervus octavrn) lateral (most of the fibres) and of the same side. Fibres which begin
-
pair) (see Figs 803, 804, 825, 826) is a nerve of special in this nucleus ascend together with the lesser part of the fibres of
insisting of two divisions differing in function; the vestibu- the ventral nucleus as well as with die fibres of the dorsal nucleus
(ptrs vesiibularis ntmi octavi) which carries impulses from (neuron II) to form the lateral lemniscus (lemniscus lateralis) on
apparatus represented by the semicircular canals of the either side; die lemniscus terminates in the subcortical auditory
and the cochlear nerve (pars cockharis nervi vestibulococh- centres the inferior quadrigeminal body (coUiculus inferior laminae
wf *hkfa conducts impulses from the spiral organ of the coch- tertae) and the medial gcniculate body (corpus genkulatum mediale).
The last-named gives rise to new fibres which pass through the in
i W nuclei of the auditory nerve (nuclei nervi vcstibulocochlearis) ternal capsule to the auditory area of the cortexthe middle part
the brain stem between, the pons and the medulla oblongata. of the superior temporal gyrus.
the aspect of the floor of the fourth ventricle they are pro- The vestibular nerve (purs vesiibularis nervi octavi) begins from
m the area vesiibularis (lateral angles of the floor} (see Figs the vestihular ganglion (ganglion vestibuhiTc) situated in the internal
2). O n the inferior surface of the brain the auditory nerve auditory meatus (meatus acusticus internus). T h e ganglion is sub
lateral to the olive of the medulla oblongata by its two divided into two parts: a superior part (pars superior) and an infe
A c vestibular and cochlear nerves. rior part (pars inferior); its cells are bipolar.
peripheral fibres of the cochlear division originate from The peripheral processes of the cells forming the vestibular
ganglion (ganglion spirale cochleae) (neuron I). The peri- ganglion stretch to the receptor cells of the saceule (samilus), utri
processes of the spiral ganglion cells begin in the spiral or- cle (utricufas), and the membranous semicircular canals (canales se-
fmfgxmm spirale) which is the sound appreciating apparatus micirtulares). The central processes are components of the vestibu
t The Organ of Hearing), lar nerve.
mitral processes of the spiral ganglion cells form the O n emerging from the internal auditory meatus the fibres of
(pars cocklearis nervi vestibulocachUaris) which emerges the vestibular nerve dip into the depths of the medulla oblongata
petrous part of the temporal bone through the internal medial to the inferior eerebellar peduncle and divide into two, as
meatus and poms acusticus internus and enters the brain. cending and descending, branches which terminate In the vestibu
of the cochlear nerve terminate in the dorsal and ven- lar nuclei; (1) the medial vesdbuiar nucleus (nucleus vesiibularis me-
nuclei {nuclei cochleares dorsalis et vtntralis) (neuronII). dialis); (2) the superior vestibular nucleus (nucleus vesiibularis
arising in the dorsal nucleus pass on the floor of the superior); (3) the lateral vestibular nucleus (nucleus vesiibularis latera
mJride in the striae rnedullares and then dip into the lis), and (4) the inferior vestibular nucleus (nucleus vesiibularis infe
V cross to the opposite side, and ascend to reach the rior). Fibres arising in the superior nucleus run in the inferior eer
auditory centres, ebellar peduncle to the cerebellum in which most of them
originating in the ventral nucleus dip into the brain terminate in the cells of the nucleus globosus and nucleus fastigii.
terminate on the cells of the dorsal nucleus of the cor- The vestibular nuclei also communicate with some of the cranial
(nucleus dorsalis carpark traperj>idei) of the contra- nerves and with the spinal cord.
THE GLOSSOPHARYNGEAL NERVE
** glowopharyngeal nerve (nervus glossopkaryngeus) (ninth dorsal nucleus of the glossopharyngeal nerve (nucleus dorsalis nervi
>{<* Figs 803, 804, 827, 832) is of a mixed character. It con- glossopkuryngei). The last two arc autonomic nuclei. The first two
wotor, sensory, gustatory, and parasympathetic fibres. and the fourth nuclei are common to the ninth and tenth (the va
^ c k i of the glossopharyngeal nerve (nuclei nervi glosso- gus nerve) pairs of cranial nerves (see Figs 771, 772).
pm^G*) are located in the posterior parts of the medulla oblon- T h e nuclei are projected on the floor of the fourth ventricle in
K t - These are: (1) a motor somatic nucleus ambiguus; (2) a sen- the following manner: the motor nucleus in the depths of the
* fc^fcw of the tractus solitarius (nucleus tractus solitarii); (3) the posterior part of the medulla oblongata in the region of the vagal
* fafivaiy nucleus (nucleus salivatorius inferior), and (4) the triangle; the sensory nucleus in the posterior part of the medulla

146 THE GLOSSOPHARYNGEAL NERVE
oblongata in the reticular formation, lateral to the sulcus limitans; The tympanic nerve gives rise also to the
the autonoinic nuclei in the depths of the posterior part of the (a) small tympanic branches to the m
medulla oblongata in line with the sulcus limitans, in front of the panic membrane and to the air cells of the
nucleus ambiguus. (b) the branch to the pharyngotympamc
The gloss opharvngeal nerve appears on the inferior surface of nervi glossopharyngei);
t h e b rain by four to six rootlets behind the olive, below the emer (c) small branches to the Fenestra vestibd
gence of the eighth pair. It runs laterally and Forwards and leaves cochleae.
the skull through the anterior part of the jugular Foramen. In the % The communicating branch with suriesi
region of the foramen the nerve is slightly thickened by the supe vagus nerve (ramus communicant cum ramo
rior ganglion (ganglion superius); after leaving the jugular foramen II. Branches arising from the trunk of
it is again thickened by the inferior ganglion (ganglion inferius) neive.
which is lodged in the petrosal fossa (fossulapetrosa) on the inferior 1. The pharyngeal branches (rami pharntp
surface of the petrous part of the temporal bone. get), three or four In number, begin from ti
The central processes of the sensory cells of these ganglia nerve where it passes between the external and
stretch on the rootlets of the glossopharyngea] nerve to its sensory teries. They stretch to the lateral surface of th*
nucleus; the peripheral processes run as components of the there with the pharyngeal branches of the vagq
branches. The motor fibres of the nerve arise from its motor nuclei; also arrive here from the sympathetic trunk)
passing to the periphery they only adjoin the sensory nuclei, as it geal plexus (plexus pkaryngeus).
happens in the spinal ganglion (ganglion spinak) of the spinal cord. 2. The branch to the carotid sinus (ramus
From the base of the skull the nerve descends between the inter sopharyngei) (one or two), a thin branch enti
nal carotid artery and the internal jugular vein, then arches forwards
rotid sinus (sinus caroticus) and the depths of
and slightly upwards and enters the root of the tongue thickness.
mtis caroticum).
Along its course the glossopharyngeal nerve gives off the fol
3. The branch to the stylopharyngeus (i
lowing branches.
tyngei nervi glossopharyngei) stretches to the mm
L Branches arising from the inferior ganglion. enter it.
1. The tympanic nerve (nervus tympanicus) arises from the infe 4. The tonsillar branches (rami tonsillara
rior ganglion, enters the tympanic cavity, and stretches on its me arise from the main trunk where it passes
dial wall. There the nerve ramifies and forms the tympanic plexus These are short branches (three or five in n
(plexus tympanicus) in the mucous membrane of the middle ear. The to the mucous membrane of the pharyngo
next segment of the tympanic nerve, which is a continuation of the tonsil.
plexus, leaves the tympanic cavity through the hiatus for the lesser 5. The lingua] branches (rami linguales nem
superficial petrosal nerve (hiatus canalis nervi petrosi minorii) as the the terminals of the main trunk. They penetrate
lesser superficial petrosal nerve (ntmus petrosus minor) (before that root of the tongue and ramify to form
it is joined by a communicating branch jramus communicant} from twigs. The end branchings of these nerves
the greater superficial petrosal nerve). On the surface of the pe and terminate in the mucosa of the posterior
trous part of the temporal bone the nerve fits into the groove for it in the region between the anterior surface of th*
(sulcus nervi petrosi minoris) and leaves the cavity of the skull vallate papillae of the tongue (see Fig. 979).
through the sphenopetrosal fissure (fissura spkenopdrosa) to reach Before reaching the mucous membrane
the otic ganglion (ganglion oticum). their contralateral companions and branches of
These three parts the tympanic nerve, the tympanic plexus, (from the trigeminal nerve) on the midline of tl
and the lesser superficial petrosal nerveconnect the inferior The sensory fibres of the glossopharyngeal
ganglion with the otic ganglion. in the mucous membrane of the posterior third
The tympanic nerve communicates with the facia] nerve (with vey taste stimuli through the peripheral nuclei
its branch, the greater superficial petrosal nerve) and the sympa ryngea] nerve to the nucleus of the tractus solita
thetic internal carotid plexus (plexus caroticus internus) by way of the also arrive here along the fibres of the chorda i\
caroticotympanic nerves (nervi caroikoiympanici) which approach gus. The stimuli reach the thalamus later and
the tympanic plexus. to the region of the uncus (Fig. 828).

T H E VAGUS NERVE 147
St|uania remporalis
wVÊminerttta arcuata
Pars cochtearis .
(n. veatibutocochloaris) V j
i Sinus petrestts superior
A. menlilgea mtciia
1
^
SiriUS .!:'. : -M-.
N . facialis
N, inlcrnietiiiis
J ars petrosa \ Dura mater
\ enceplial i
A . r a r o t l s interna
Purus at-iistlcus internus
N. vestibiilococlilearis 1
Ganglion vestihulare
N. facialis
Pars vostibtiians
( n . nctavi)
V "M'rocessus stylgtdeus
825. Position of nerves in internal auditory meatus; inner aspect (%)

(Part of the medial wall of" (he meatus is removed.)
T H E VAGUS NERVE
The vagus nerve (nervus vagus) (tenth pair) (see Figs 803, 804, of the vagus nerve, is lodged in the anterior parts of the medulla
-" r 1 -8-/4; i> ol a mixed character because it contains tnmoi oblongata deeper than the dorsal nucleus and is projected on the
mmi *enry fibres and fibres of the autonomic system. The vagus floor of the fourth ventricle medial to the vagal triangle. It is also a
has three nuclei in common with the glossopharyrigeal nucleus of the glossopharyngeal nerve,
they are situated in the medulla oblongata (see Figs 771, 3, The nucleus nf the tractus solitaries (nucleus trachis solitarii)
is sensory and projected on the floor of the fourth ventricle slightly
L The dorsal nucleus (nucleus dorsalis nzrvx vagi) {autonomic) lateral to the sulcits limtlans; it is located far to the back of the
the medulla ob Ion gat a lateral to the nucleus of the hypo- nucleus ambiguus. ll is common to the vagus, glossopharyrigeal,
; it is projected on the floor of the fourth ventricle in and itUcnnedius nerves.
of the vagal triangle. The vagus nerve emerges on the inferior surface oi the brain
i The nucleus ambiguus, the ventral (somatic) motor nucleus by 10-15 rootlets from the depths of tlie medulla oblongata be-

T H E A U D I T O R Y NERVE
Nucleus lenticsilnns Gyms lemporgliSi superior
Lubu.s iemparalis
/ CapsjLa IntrrriLT
Claustrum .y^^ * Central auditory pathway
Gapsula estfrn^ Splsmuiii MtJWftJ caltnsi
Lobus frontfllfc Corpus geniculaium mediate

^^(subcorfica! auditory tentre)
Lobus occipitulis
Nucleus caudcitus
SukitL- eslcarinus
Thalamus
Corjtns
geniciilatiitn mediate '
Thalamus (partly removed) ~"~.
Oolliculus inferior
Corpus KtiHculalum laterals " " " (subcortical
Traciuj o p t t o w " S* i' auditory centre)
Nucleus , oculomotorll ** ^W
PcduraculLis certbrl y ~ Ltaratscus lulorisUs
F i b r e s o f l e m n i s c i j s lateralis Nucleus n. iruclilcarls^ - Cerebellum
Connecting n u c l e i cochleares __ " ~ I J ~ ~ I Nucleus lemnisci
w i t h c o r t i c a l centres lateralis
Of I he s a m e side v l , M s r . s superior
Nucleus veslibularEs lateralis
Car h lea
Pars vesiibularis fn. oetavi)
Oanfilion ^pirale * ^ ^ ^ r v " " Ffisciculu^ longitudinal is mediali*
Vest [twin in \\ v \ v v V \ " - v . ^"""i.Nucleus cochleare vt'tur.ilK
Caualcs / \\ v* 'SLV v V i "-^ Nuclei vi'sllbularei
scmiclrculares. * i " ^ J i\ \ \ *\ ^ Y ~"*V ^Traclns vestitiuluspirialis
ostei \ \ ^\ \ X ^ F a s c i c u l u s rOflgifcrftJMliS medialis
Ganglion vestt briar* \ \ \ \M
Pars ccrblearis Nucleus caichlearis dorsalis
(n. ociaYl)
Pars veslibuhris la. aclavtj
826. Course offibresof auditory nerve (semischematical representation).

hind the olive. It runs downwards and laterally and leaves the skull In the region of the inlet of the thorax, the vagus nerve lies be
together with the glossopharytigeal and accessory nerves between tween the subciavian artery (behind) and the subciavian vein (in
which it lies. In the region of the jugular foramen the vagus is front).
thickened by the superior ganglion (ganglion superius nervi vagi); After entering the thoracic cavity, the left vagus nerve (nervus
1.0-1,0 cm distally is another, slightly larger thickening, the infe vagus sinister) lies on the anterior surface of the arch of the aorta,
rior ganglion (ganglion inferius nervi vagi). while the right vagus nerve (nervus vagus dexter) on the anterior
In the space between these ganglia the vagus is approached by surface of the initial segment of the right subciavian artery. After
the accessory branch (ramus interni nervus accessorii). Descending still that both vagus nerves deviate to the back, arch over the posterior
lower, the vagus nerve stretches in the neck on the posterior sur surface of the bronchi, and approach the oesophagus; there they
face of the internal jugular vein to the inlet of the thorax (aperture ramify to form several large and small branches and lose the char
tkoracis superior), in the groove between this vein and first the inter acter of isolated nerve trunks (Figs #34, 906).
nal carotid and then the common carotid arteries running medial These branches of the left and right vagus nerves stretch on
to it. the anterior (mostly those of the left nerve) and posterior (predom
T h e vagus nerve, the internal jugular vein, and the common inantly those of the right nerve) surfaces of the oesophagus to form
carotid artery are invested in a common connective-tissue sheath the ocsophageal plexus (plexus esophageus).
to form a neurovascular bundle on the neck. At the oesophageal opening of the diaphragm (hiatus esopha-

NERVES OF THE HEAD AND NECK 149
Nn_ lemporalps proJundi M. ttmpuralis

\
Corpus calloSHrll
Corpus pineale
V. cerebrl ma^na \
"Return rnejeticephali
Cerebellum
Jr Nn. temporals [irolmidi
A. max Minns
$[TIUS transverse H. masse (trie US
N. buccalis
f Gan^lCTI superljs
N. giosso- M, pterygoltteus laleralis
pharyngeus
Ganglion inferius N. alveolaris inFerior
N. ling jails
l'li>yii.s vt:rlul.ir,i?is - . . . _ M. blK'cinator
N. glossupharyngûs
Ganglion inJerjus n. v*gi 4
Rr, llngunles
Radices (JoTsa I
liypoglossjs
tin, Jiiii .n
iH. genlogloisus
llgastrlCnS (venter anlerior)

M. hyoglnssus.
Dura mater spinalis '\
3r. vwrfrat -it
TruncHS sympathies -
. R. inferior ansae cttvkalls /

Ganglion cervlcale m e d i u m - *
R, <t0Tsslis n. spinalis - j B
N. cardiaciiR superior
A, vertenralls - /
Ganglion cervfaale Inferius-'
Gallglicm [huTackum I -
Costs I "T A.Ihoracica tnterna
Truncus brachioceprifllicus
N, laryngcus recufrens '
A, 5ilt>clavia
827. Nerves of head and neck; right aspect (J4)-

(The vertebral canal is opened; the posterior parts of the skull and brain, the right half of the mandible, part of the masseter muscle and
the common carotid artery are removed.)

150 T H E G U S T A T O R Y FIBRES
p***^ C ^ r c *< ^ ^ ^ ^ "*** Bbresconr.ectmgthalamus

Corpus caJiDsum ^ ,.-"" / y" with area of gustatory
i . ^ analyser
^ 7 * -_
Tfialamus
Untus j j *
Traiuti niweiicfphali
" ^ Pathway connecting nucleus
fasciculi solitarii with ihalamus
Nucleus sensoritis superior n. trigprnlni
-Fossa rhombciitlta
Nucleus trscluS sofititfi
' ^ ^HW^N, ,rl8fminus
^ 7*SsT"~MeduLla obloniliita
Fibres of general sensation v
(from n. lingualis) = , -. * vV
glussuphas'vngeLjs
Gustatory fibres of %,
chorda tympan \ \
\ - ^ ^ U .
* Gartgl ion infer ins B. vagi
Gustatory fibres of &
n. glossopharyngous Ganglinn inferius n. glossopharynjjri
I Ganglion gcritcuH
Gustatory fibres of n. vagus
828. Course of gustatory fibres (semischematical representation).

gees) the anterior arid posterior vagal t r u n k s {trunci vagaUs anterior In the a b d o m e n the anterior and posterior trunks send
el posterior) form, respectively, from the branches of these plexuses branches to the abdominal organs and the cneJiac plexus.
and enter the abdominal cavity together with the oesophagus, Both Along; its course each vagus nerve is divided into Four parts;
the posterior and anterior vagal trunks have the left and right va (1) the cephalic part, (2) the cervical part, (3) the thoracic part,
gus fibres in their composition. (4-) the abdominal part.
T H E CEPHALIC PART
T h e cephalic part of t h e vagus nerves is the shortest. It extends per bulb of the j u g u l a r vein (bulbus venae jugularii superior) to the ju
to the inferior ganglion (ganglion inferius) and gives off the follow gular fossa, and enters the mastoid canaliculus (canalicalus mastni-
ing branches. deus). In the depths of the petrous part of the temporal bone the
1. The meningcal b r a n c h (ramus meningeus nemi vagi) arises di auricular branch exchanges fibres with the facial nerve and leaves
rectly from the superior ganglion, runs into the cavity of t h e skull, t h e petrous part via the tyrnpanomastoid fissure (jissura tympuna-
and innervates the dura mater (the transverse a n d occipital venous mastoidea). T h e n it divides into two branches which appear behinrl
sinuses). the external ear near the outer end of the bony part of the auditory
2. T h e a u r i c u l a r branch (ramus auruularh nervi vagi) arises for meatus. O n e of the branches unites with the posterior auricular
the most part from the superior ganglion or lower, from the nerve nerve (from the facial nerve), the other innervates the skin on the
trunk, stretches to the back, runs on the lateral surface of the u p posterior wall of the external auditory meatus..

T H E FACIAL NERVE
commumcans
cum plexu lympanico^ N. pttrosus majc
ErainentlB anmsta \ N. pelrosus minor
N facialis N \ I M. tensor tympant
R. tubae /
/ S srPk'xus tarotlcus
S interims
\. carols inlerna
acu^ticus exiemus
Osttam pharyngeum
tubae aucMlvje
Processus mastoldeus
829. Right facial nerve (nervus facialis) and tympanic nerve (nervus tympanicus) (%).
(Position of these nerves in the petrous part of the temporal bone.)
Tbe communicating branch with the glo.ssopharyngeal 5. The communicating branch with the accessory nerve is the
conmunkatti cum nervo glussapkaryngeo) is a communica- accessory branch (ramus interims nervi accessorii). This is a rather
the superior ganglion of the vagus nerve and the infe- strong twig which becomes a component of the vagus nerve be
of the glossopharyngeal nerve. tween the superior and inferior ganglia. Besides, the vagus nerve
superior communicating branch (running From the su- sends small branches to the accessory nerve.
i) with the superior cervical sympathetic ganglion.
T H E CERVICAL FART
cervical part of the vagus nerves stretches from the infe- 2. The communicating branches with the hypoglossal nerve.
to die site of origin of the recurrent laryngeal nerve 3. The pharyngeal branches (rami phaiyngei ntn>i vagi) often
fa_pqjmi rtairrms) (Figs 832-834). The following branches branch off from the inferior ganglion, but may arise at a lower site.
| K iram this part of the vagus nerve. There are two of them, a larger superior and a smaller inferior
TW inferior communicating branch with the superior cer- branch. They pass forwards and slightly medially on the lateral
mjpfltfhrtk ganglion. surface of the internal carotid artery and unite with the branches

152 THE VAGUS NERVE
830. Nerves of left pkaryngotymj.

(specimen prepared by D.Ro:
(Photograph.)
(The tympanic cavity and pharyngotympanic tube
laterally; the squamous part and part of the masKs
temporal bone are removed.)
1 cotiuiiiiiiicjtiiijf branch of tympanic plexus with fstial n t r . r
^facial nenrr
3 lateral semicircular canal
4 mastoid air cei]s
5 tyiupanic cavity
H tympanic plexus
7 nrn;r of tympanic cavity
Btympanic nerve
9glossopliaryngrH] nerve
10petrosal fossa
11 branch or ttibc
12 pharyngeal opening r>f pharynjjotyiitpariic tube
13body of sphenoid bone
14 isiternal carotid artrry
ISlesser superficial petrosjl nerve
16legmen tyinpaiii
of the glossopharyngeal nerve and branches of the sympathetic vagi), two or three in number, arise from the t
trunk to form the pharyngeal plexus (plexus pht&yagtw) on the nerve slightly below the depressor nerve. They ran
middle constrictor muscle of the pharynx (musatlus wnstridar pkar- mon carotid artery, the branches of the righi
yngis tntditti). Branches arising from this plexus innervate the mus of-the innominate artery (fruncus brachiocephaliats),
cles and mucosa of the pharynx. The superior branch also sends vagus running in front of the arch of the aorta,
nerves to the levator veli palatini muscle and the musculus uvulae, cardiac branches unite with the cardiac nerves
4. The superior laryngeal nerve (nervus laryngetts superior) be sympathetic trunk and, on approaching the heart,
gins from the inferior ganglion, descends on the internal carotid nents of the cardiac plexus. Branches of the d
artery, receiving on the way branches from the superior cervical arrive here.
ganglion and the pharyngeal plexus, then runs forwards and di 7. The recurrent laryngeal nerve (nervus la\
vides into two branches before approaching the lateral surface of ginates from the main trunk at the level of the si
the larynx: the right and at the level of the arch of the aorta
(a) the external laryngeal nerve (ramus externus nervi latyngei su- curving round the inferior periphery of these vt
perioris) innervates the laryngeal mucosa, part of the thyroid gland back, ihc recurrent laryngeal nerves ascend into
as well as the inferior constrictor muscle of the pharynx (musculus tween the trachea and oesophagus, their terminal
constrictor pkaryngit inferior) and the cricothyroid muscle (musailta ing the larynx.
cricotkyroideus); it often unites with the external carotid plexus Along its course the recurrent laryngeal nervt
(plexus zarottats externus); following branches (Fig. 833).
(b) the internal laryngeal nerve (ramus interims nervi laryngei Stt- (a) The middle cardiac branches are nuino
perioris) stretches together with the superior laryngeal artery, thicker than the upper branches. Running to die I
pierces the thyrohyoid membrane, and sends branches to intiervate the other cardiac branches of the vagus nerve and
the mucous membrane of the pharynx (above the rima glottidis), the sympathetic trunk and also contribute to the
epiglottis, and part of the mucosa of the root of the tongue. It gives cardiac plexus,
rise to the communicating branch with the recurrent laryngeal (b) The tracheal branches (rami tracheales J1CT71 !
nerve (ramus communicant cum nemo laryitgeo inferiors)* tis) arise right after the middle cervical branches a
5. The depressor nerve (reducing arterial pressure) (nervus de anterior surface of the lower trachea. On the wai
pressor (BNAJ) begins from the trunk of the vagus nerve and is the the sympathetic branches and approach the
uppermost cardiac branch. It passes through the inlet of the thorax plexuses.
(apertura tkomtu superior) into the cavity of the thorax and receives (c) The fiesophageal branches (rami esopkaga)
a twig from the superior laryngeal nerve. In the thorax it sends phagus.
some branches to the arch of the aorta and the cardiac plexus to (d) The inferior laryngeal nerve (nervus
provide for their baxoreceptive sensibility. terminal branch of the recurrent nerve. O n its
6. The upper cardiac branches (rami cardiaci superiares nervi two branches: (1) the anterior branch innervating i

I NERVE OF T H E NECK
153
A, rnaxllbris
V. jugular/s Intern,
N. glossopharyrgejs
t A . facialis
N. camtktis Interims^ -
(divided)
Ganglion Merlui n. vei^

^ A. Hngj^lis
Ganglion cervicalc superius
Nerve branch to ^ * I
glomus caroticum
Nn. carotid extern! """^l NH hypoglossits

Truncjs sympathicus - 4 H '-Plexus caroticus externus
A, caj-otls i m m i a J S P A. thyruidea sjpen'nr
N. vaûs -** i W~G1OITIHS carotfcirm

T"*A. csrolis extema
r;
Slnjs taroikiis =-Plexus caroticus
communis
N. cardiacus cervicahs A. cargtls communls
superior
831. Nerves of neck; right aspect (%).
^^^^^^^'Sî^^^t^f^m^^^
Mryteno.d, the thyroarytenoid, thyroepiglottic, vocals, and arye-
glottidis The motor fibres innervate the posterior cricoarytenoid
Wlottic muscles; (2) the posterior, or the communicating branch
and the transverse arytenoid muscles.
i t h the internal laryngeal n e r v e (mmus communicant cum ramo la-
(e) The connecting branch between the recurrent Iarvngeal
ijm&c inter) which U a branch of the superior laryngeal nerve.
nerve and the inferior cervical ganglion (ganglion tmmffarsaam
rhe posterior branch contains motor and sensory fibres. The last-
(stdlatumj) of the sympathetic trunk.
named reach the mucous membrane of the larynx below the rima
THE THORACIC PART
The thoracic part of the vagus nerves extends from the site of
1. The lower cardiac branches (rami cardiaci infmorti nervi r/agij
origin of the recurrent nerves u p to the point where the vagus
arise below the origin of the recurrent laryngea] nerve and enter
nerves pass through the oesophageal opening in the diaphragm (hi-
the cardiac plexus behind the aorta.
**w tsophageus). In the thorax the vagus nerve gives rise to the &>}.
lowing branches (Figs 833, 834, 906). 2. The tracheal branches (ramifrachealesnervi sagi) are several
quite strong twigs running to the trachea. On their way they unite

THE ACCESSORY NERVE
154
with the trachea! branches of the recurrent laryngeal nerve and The branches arising from this plexus unite, ente
with branches of the sympathetic trunk to Form the plexus of the the lungs together with the bronchi and vessels, ami
pulmonary parenchyma.
trachea.
5. The oesophageal plexus (plexus esophegeus>
3, The thoracic cardiac branches (ram cardiaei tkoradd nervi
many nerves differing in diameter which arise fi
vagi) arise below the origin of the recurrent laryngeal nerve, run
nerve below the root of the lung. Along their
downwards and medially, unite with the lower cardiac branches,
with one another and with branches of the four <
send twigs to the hilum of the lung, and enter the cardiac plexus.
thoracic sympathetic ganglia to form a plexus
4, The pulmonary branches (rami bronchioles nervi vagi) divide
whole lower part of the oesophagus and sending
into thinner anterior branches (four or five) and numerous
its muscular and mucous coats.
stronger posterior branches.
6. The branches to the pericardium are thin t
The anterior and posterior pulmonary branches unite with the
its anterior and posterior walls, On their way they
branches of the three or four superior thoracic ganglia of the sym
branches of the oesophageal and pulmonary ptero:
pathetic trunk to form the pulmonary plexus (plexus pulmonalu).
THE ABDOMINAL PART
The abdominal part of the vagus nerves is represented by the The remaining part of the anterior vagal trunk
anterior and posterior vagal trunks (truna vagtdes anterior et poste the anterior periphery of the lesser curvature of tl
rior) (Figs 834, 912). They run on the anterior and posterior sur sends numerous anterior gastric branches ^rami
faces of the oesophagus and enter the abdominal cavity either as nervi vagi) to the anterior surface of the stomach.
solitary trunks or as several branches. The gastric branches of the anterior and posteria
unite in the subserous coat of the stomach with the
In the region of the cardia the posterior vagal trunk sends
here along the left gastric artery and form the ant
some twigs which are called the posterior gastric branches (rami
rior gastric plexuses.
gastrici posteriori nervi vagi) to the posterior surface of the stomach;
The coeiiac branches (ram uHaci nervi vagi) i
the trunk itself deviates to the back and downwards, and retro
the posterior vagal trunk and contribute to the S
grades to form the coeiiac branches (rami cdiari nervi vagi) which
eacfc
coeiiac plexus; as branches of this plexus they rea
stretch along the course of the left gastric artery to the coeiiac
abdominal organs ("see The Coeiiac Plexus). The
plexus (plexus celiacus).
among them are the renal branches (rami renoles ne
The anterior vagal trunk unites in the region of the stomach
run among the coeiiac branches and enter the renal
with the sympathetic nerves accompanying the left gastric artery
renalis).
and gives off one to three branches which pass between the layers
of the lesser omentum to the liver; these are the hepatic branches
(rami hepatici nervi vagi).
THE ACCESSORY NERVE
The accessory nerve (nervus accessorius) (eleventh pair) is a mo the cranial roots. There are four or five of them foi
tor nerve (see Figs 803, 804, 827). There are two nuclei of the ac or cranial root of the accessory nerve (radix cranialii
cessory nerve (nuclei nervi accessorii). One is the nucleus ambiguus The rootlets arising from the lateral white coin
(the cranial nucleus of the accessory nerve). Fibres arising from cord between the anterior and posterior roots of the
this nucleus form the cranial portion of the accessory nerve which are the spinal roots. They unite to form the spinal
emerges on the base of the brain from the groove of the medulla cessory nerve (radix spinalis nervi accessorii) which
oblongata behind the olive. ters the cavity of the skull through the foramen :
The second, spinal nucleus (nucleus spinalh nervi accessorii) lies in In the skull both groups of fibres unite into a
the posterolatcral part of the anterior (grey) horn of the spinal the accessory nerve which leaves the cavity of the
cord for the distance of the upper five or six cervical segments. with the ninth and tenth pairs) through the jugutai
The rootlets emerging from the medulla oblongata are called divides into two branches,

NERVES OF THE NECK 155
Apex Jii:JL;iJ;iL-
V, JugularlS tmerna
N glossopharyngeus _
G a n g l i o n [nfrj-jus J|
n, vagi
Ganglion cervical* sjpeMus^
N. liyniifflussns i ^ l l K j
111
N. bryngtUS Superior-.^!
cardiaeus cervical is
M . levalor stapu]3t-.J|
mperioi
JVI. scalenus posterior

thyroidca
M . scai^nns roedJas
flryngeus recurrens
N, larvngeus fecurrens
Cardiac us inferior
A. vertebra
Communicating branch
Plexus bractifalis between a, depressor [BN A]
A, carotis cummunis dexte*_ and n. laryngeus recurrent
M . scalerius anterior ,
A. suhclavla dMtra~
"-A. csrotls communis
stnistra
Costa [ .
R. cardliaais
Truneus brachlocephaJIc J S i ' inferior
" A . subclavla sfnlslra
Arcus aorta*
Aorta ascendens ~
V . cava superior
Trunctis pulmonaiis""
*" B
832. Nerves of neck; anterior aspect {%) (specimen prepared by O.Stulova)

opener vena cava and fc p l e n a r y artery arc removed; the u i c , t b f t b n . n c h between the right m6 left J L
seen on the anterior surface of the arch of the aorta.) g nerves is

156 T H E HYPOGLOSSAL NERVE
1. The accessory branch to the vagus nerve (ramtts interntis ticrsi supplies the muscle and in its depths communicates with the
accessor!;) approaches the vagus and becomes part of it; this branch branches of the cervical plexus (third cervical nerve). After that
contains more fibres of the cranial part. the nerve emerges about half way down the lateral border of the
2. The branch to the sternocleidotmastoid muscle (mmiu exter- stemocleidomastoid muscle into the region of the posterior tri
nus ncrm acussorii) descends and at the angle of the mandible devi angle of the neck and runs under the trapezius muscle which it in
ates to the back to run under the stemocleidomastoid muscle; it nervates.
T H E HYPOGLOSSAL NERVE
The hypoglossal nerve (nerota hypoglosstts) (twelfth pair) is a (e) communicating branch with the second cervical loop;
motor nerve (see Figs 803, S04, 831). (f) communicating branch with the lingual nerve of the tri-
The nuclei of the hypoglossal nerve (nuclei nemi hypoglossi) lie germnal nerve.
in the middle of the posterior part of the medulla oblongata. From In addition to the communications, the hypoglossal nerve gives
die aspect of the floor of the fourth ventricle they are projected in off the following branches.
the hypoglossal triangle (trigomim nervi hypoglossi) (see Figs 771, 1. Branches co the dura mater of the brain originate in the re
772). gion oT the hypoglossal canal and pass to the walls of the occipital
The hypoglossal nerve emerges From the brain matter by sinus.
10-15 rootlets from the groove between the pyramid and olive of 2. The superior root (branch) of the ansa hypoglossi (ansa cer-
the medulla oblongata. The rootlets unite into a single trunk which pttsBsl contains fibres both of the hypoglossal nerve and those of
leaves the cavity of the skull through the hypoglossal canal, de the first cervical loop which communicates with the hypoglossal
scends between the vagus nerve and the internal jugular vein, nerve (see above).
curves round the lateral surface of the internal carotid artery, pass Tliis root descends on the anterior surface of the internal jugu
ing between it and the internal jugular vein. Then it crosses the ex lar vein next to the branches from the first, second, and third cervi
ternal carotid artery in the form of an arch which loops down cal nerves forming the ansa hypoglossi (ansa (eroicalis) (see The, Cer
wards, runs under the posterior belly of the digastric muscle and vical Plexus).
under the stylohyoid muscle in the region of the submandibular The ansa gives rise to branches running to the muscles of the
triangle, and enters the muscles of the tongue to innervate them. infrahyoid group: the stemohyoid, omohyoid, sternothyroid, and
Along its course the hypoglossal nerve sends branches by means of thyrohyoid muscles.
which it communicates with the other nerves. The size of the ansa is determined by the length of the superior
These communications are as follows: root: the shorter the root, the longer are the branches extending to
(a) communicating branch with the superior cervical ganglion the muscles below the hyoid bone.
of the sympathetic trunk; 3. The terminal branches of the hypoglossal nerve (rami lin-
(b) communicating branch with the superior ganglion of the guatts nervi hypoglossi) stretch to the undersurface of the tongue and
vagus nerve; innervate both its intrinsic and skeletal muscles (the superior and
(c) communicating branch with the lingual branch of the va inferior longitudinal, vertical and transverse muscles of the tongue,
gus; the hyoglossus, genioglossus* and styloglossus muscles) (Figs 835,
(d) communicating branch with the first cervical loop; 836, 837).

NERVES OF THE NECK AND CHEST
157
Ganglion
Inierius n, vagi
Ganglion inferlus n, vagi
Choana \
N. glossopharyngeus
Ganglion cervlcale superius
N. hypoglossus Pharynx (opened)
Isthmus fauclum
VT. pharynge-ae
fe. Ilnguafes n. glossopharyngel
Epiglottis
N. laryngeus superior
V, Jugularls interna
N, vagus sinister
Adllus laryngis
N. laryngeus Inferior
Esophagus M. vagus dexter
Glandula ihyroldfia Truncus sympathies dexter
V. Jugtjlarls Interna sinistra r-A. enrolls communis dextra
A. etrotls comrtiLJiis slnistra
& r ,.
Trachea V ^ - UangJlcm cervlcale medium
reeurrens A. thyroldea Inferior
4 Cupula pleurae
.--; i A. subclavta dextra
Ganglion cervico-
1 "Si thoracicum (stellalum)
". larvngeus
recurrent
rygos
^ * ~ N , vagus
bronchioles
Bronchus principals dexter
Vv. pulmonales
'': -ffr.:rti::jjs< ^ w L _ Plexus esophageus

thoraclcus
A. intercostali? V. cava Inferior

posterior
Esophagus
833. Nerves of neck and chest; posterior aspect (%)

ebral m m and the posterior-pj*; of t h e r i b , are removed; the , U O g , are pulled aside; part'of'the thoracic aorta, the posterior
wall of the pharynx, and the parietal pleura are removed.)

A. occlpltalls
A- carpus externa
*-PiexHS cervtcalls
Ganglion
cervlcale supetijs
truna symptthkJ "
A. laelshs
A. carotls interny -M
Ganglion cervicaie medium

trunti sympalhlcl
Plexus brachlallS
Ganglion cervlcothoraclcum
Truncus sympathicus (cervicaJ part} Istellatiiml
A. subdavla
Osta \
N. cardlacus cervitaHs medins
Arisa subclavla-^
, N'n. cardiac! Inferlores
N. vaeus ,
Areas aortae
laryngeus Tecarrert*
Rr, cardiaci from n. vagus R. anastomotioa
between n. vagus and
trunt'UK aympath
Plexus pulmonalis Aoita thOraCICa

(of vagus nerves)
Esophagus
Rr cnmnjgrticmfei
N. Inlercosta
Pulmo- sinister
~Truncus syropat
(thoracic part)
Plexus V. Lntercosuiis
esophageus posterior
-V. hemiazygos
A, Intercostaiis
posterior
Ganglion tl.
N. splanchnlcus major. trunci sympstta
Diaphragm a
V. cava inierlur
Tfuncus vagall.s anterior

Plexus CeliiCUS
Pancreas
Rr.gastrlcl anleriorc
Veiitrk'uius :
834, Nerves and plexuses of thoracic organs; left aspect (%).

(Specimen prepared by R.Sinelnikov).
(The parietal peritoneum and the endothoracic fascia are removed; the left lung is reflected to the right).

NERVES OF THE GEMOGLOSSUS AND GENIOHYOID MUSCLES
835. Nerves of genioglossus muscle (specimen prepared by Ya. Sinelnikov).
836. Nerves of geniokyoid muscle.

DEVELOPMENT AND AGE FEATURES OF THE CRANIAL NERVES
837, Nerves of styloglossus muscle.
DEVELOPMENT AND AGE FEATURES

OF THE CRANIAL NERVES
The olfactory nerve (I) forms from neuronai fibres of the olfac sory nerve. The hypoglossal nerve (XII): the meg
tory (ethmoid) fossa. The optic nerve (31) is an aggregate of fibres from the cells of the nucleus in the floor of the few
of the retina! cells. The oculomotor nerve (III) is formed of fibres The nerves develop most intensively after ti
arising from the inferior parts of the mid-brain. The traehlear The amount of connective tissue in the nerves
nerve (IV) forms from fibres emerging from the isthmus rhom- and a myelin sheath forms round the nerve fibre*
bencephali. The trigeminal nerve (V): the sensory fibres grow from Myehnization is one of the age-related pec
the cells of the trigeminal ganglion, the motor fibres arise from the This process is not uniform in its course in diffe
nucleus lying in the basal lamina of the brain. The abducent nerve the motor nerves become myelinated, then Lhe n
(VI) is formed of fibres originating in the base of the posterior at last the sensory nerves. This applies both t o l l
cerebral vesicle. The facial nerve (VII); the sensory fibres originate nal nerves.
from the cells of the ganglion or the facial nerve (ganglion geniculi), There is evidence that the cranial nerves
the motor fibres derive from the cells of the nucleus of the facial tion successively, namely, that by the time of
nerve situated is the basal lamina or the medulla oblongata. The nerve has the most developed myelin sheath, hi
auditory nerve (VIII) fibres arise from the cells of the vestibular of nerve function determines to a certain nteajtur d
ganglion and the spiral ganglion of the cochlea. The glossopharyn- the myelin sheath formation. Such a process a
geal nerve (IX) is formed from several sources: the sensory part nerve whose fibres are intensively myelinated in r.
forms from the superior and inferior ganglia of the glossopharyn- birth. It is believed that after birth the myelin
gcal nerve; the motor partfrom the nucleus ambiguus; the secre process goes on and reveals a certain succession
tory partfrom the inferior salivary nucleus. The vagus nerve (X): the motor and sensory nerves: motorthe facia
the sensory fibres arise from the cells of the superior and inferior ducent nerves, the third division of the trigemii
ganglia of the vagus; the motor fibresfrom the nucleus ambi- lomotor nerve; sensorythe auditory nerve,
guus; the parasytnpathetic fibresfrom the dorsal nucleus of the divisions of the trigeminal nerve, the vagus, gk
vagus. The accessory nerve (XI): the motor fibres form from the the optic nerves.
cells of the nucleus ambiguus and the spinal nucleus of the acces

T H E AUTONOMIC GANGLIA
THE GANGLIA OF THE CEPHALIC PART

OF THE AUTONOMIC NERVOUS SYSTEM
autonomic ganglia of the head are part of the autonomic (2) the greater superficial petrctsal nerve (nervuspetrosus major),
e) nervous system. They consist of celis belonging mainly a parasympathetic rootlet which is a branch of the facial nerve
il> parasympathetic part. These ganglia are situated along the containing fibres of its sensory root (nervus intermedius);
of the trigeminal nerve and communicate with it by (3) the deep petrosal nerve (nervus petrosus profimdus), a sym
branches; though the ganglia are not components of the pathetic rootlet arising from the internal carotid plexus.
they are nevertheless described together with it. T h e auto- T h e two last-named nerves approach the sphenopalatine gang
:
K ^ g ^ a f t h c head are approached by twigs of sensory, pa- lion from the back, enter the pterygopalatine fossa through the
hctic, and sympathetic character which are called root- pterygoid canal, and fuse into a single nerve of the pterygoid canal
(nervus canalis pterygoideus jradht fawdis]),
T W fibres of a parasympathetic rootlet terminate on the cells Branches arising from the sphenopalatine ganglion:
these ganglia. T h e postganglionic fibres of these cells form to- (1) the orbital branches (rami orbitahs gangliones pierygopalatini)
with the sensory and sympathetic fibres the peripheral contribute to innervation of the mucous m e m b r a n e of the sphe-
of the ganglia. noidal sinus and the posterior air cells of the ethmoid bone.
T h e nerves originating from the ganglia are called branches. (2) the superior posterior nasal nerves (nervi nasales posteriory
carries sensory and motor, sympathetic and parasympathetic superiores) emerge from the pterygopalatine fossa lodging the
sphenopalatine ganglion via the sphenopalatine foramen and
T h e following five autonomic ganglia are distinguished in the penetrate into the cavity of the nose in which they are named as
head: ( t ) the ciliary ganglion (ganglion, ciliart) (see Figs 8 1 1 , 812); follows in accordance with their topography:
CQ de sphenopalatine ganglion (ganglion pierygopalatinum) (see (a) the short sphenopalatine nerves (lateral) (rami nasales poste-
R p 812, 813); (3) the otic ganglion (ganglion oticum) (Fig. 822); riores superiors laterales) innervate the m u c o u s m e m b r a n e of the
f f l the submandibular ganglion (ganglion submandibulare) (see posterior parts of the superior and middle nasal conchae and the
Kg. 816); (5) the sublingual ganglion (ganglion sublingrtale) (see corresponding regions of the superior and middle meatus;
Kg- 816). (b) the short sphenopalatine nerves (medial) (rami nasales poste-
L T h e ciliary ganglion (ganglion ciliare) is elongated and riores superiors mediates) innervate the m u c o u s m e m b r a n e of the u p
thghfly depressed. It lies deep in the orbit between the lateral rec- per p a n of the nasal septum;
muscle and the optic nerve in the thickness of t h e Fatty tissur (c) the long sphenopalatine nerve (nervus nasepalatimu) runs
-surrounding the eyeball. forwards and downwards between the periosteum of the vomcr and
T h r e e nerve rootlets enter the posterior bordeT of the ganglion: the mucous m e m b r a n e of this region to the incisive canal, pass
(1) the sensory root of the ciliary ganglion (ramus communicans through it, and terminate in the mucous m e m b r a n e of the anterior
o n mwa nasociliari), a sensory branch running from the ophthal part of the palate (Fig. 822);
mic nerve; (d) the pharyngeal branch of the sphenopalatine ganglion (ra
(2) the m o t o r root of the ciliary ganglion (radix oculomotoria), a mus pharyngeus ganglii pierygopalatini) runs slightly downwards and
parasympathetic branch from the oculomotor nerve; to the back and ends in the m u c o u s m e m b r a n e of the superolateral
(3) the sympathetic root of the ciliary ganglion (ramus sympa- surface of the choauae and the lateral surface of the pharynx in the
ad ganglion ciliare), from the internal carotid plexus. region of the pharyngeal opening of the pharyngotympanic tube.
Branches arising from the ciliary ganglion: the short ciliary 3. T h e palatine nerves unite with ganglionic branches from
(nervi tiliares breves) 1 5 - 2 0 in number originate from the an the maxillary nerve (nervi pierygopalatini), and pass through the
terior border of the ganglion and run forwards to the posterior sur- palatine canal and the greater and lesser palatine foramina to the
Eace of the eyeball. They unite here with the long ciliary nerves mucous m e m b r a n e of the nose and palate. They send two
fatnialiares longi) arising from the nasociliary nerve; together they branches:
pierce the sclera and stretch between it and the choroid. T h e long (a) T h e greater palatine nerve (nervus patatinus major) emerges
and short ciliary muscles innervate the coats of the eyeball, the through the greater palatine foramen (foramen palatinum majus)
cornea, the ciliary muscle, the sphincter and the dilator of the pu- and innervates the mucous m e m b r a n e of the soft and hard palate
Pfl- and the gum of the u p p e r jaw. Its terminal branches communicate
II. T h e sphenopalatine ganglion (ganglion pterygopalatinum) is with the long sphenopalatine nerve (nervus nasopalatinus).
triangular and lies in the fatty tissue which fills the pterygopalatine Passing into the palatine canal, the greater palatine nerve gives
fossa. rise to the nasal branches (rami nasales posteriores inferiores laterales)
Nerve rootlets approaching the sphenopalatine ganglion: which innervate the m u c o u s m e m b r a n e of the middle and inferior
(1) sensory ganglionie branches of the maxillary nerve (nervi meatus of the nose, inferior concha, and maxillary sinus.
pierygopalatini); (b) T h e lesser palatine nerves (nervi patatini ntinores) emerge

162 THE AUTONOMIC GANGLIA
from the lesser palatine foramen (foramen palatinum minus) and in oval and slightly depressed. It lies under the lingua
nervate the posterior parts of the soft palate mucosa and the tonsil. the submandibular gland.
III. The otic ganglion (ganglion otkum) is oval and lies on the Its roots are as follows:
medial surface of the mandibiilar nerve at its exit from the fo (1) the sensory rootshort twigs from the li
ramen ovale. (2) the parasympalhetic rootfibres from th<<
The roots of the ganglion: which approach the ganglion as components of |
(1) the sensory root arises from the auriculotemporal nerve lingual nerve.
(branch of the niandibular nerve); The fibres of die sensory and parasympathetic
(2) the lesser superficial petrosal nerve (nervus pttroius minor) the communicating branches with the lingual ne
(parasympalhetic rootlet) is a branch of the glossopharyngeal cantes cum nervo linguali);
nerve; (3) the sympathetic root of t i e suhmandibuUr i
(3) the sympathetic root is a branch of the plexus meningeus sympathicus ad ganglio sKbm.andihuia.re) twigs from
uiediufs which surrounds the middle meningea) artery. rounding the facial artery.
Branches originating from the otic ganglion: Branches arising from the submandibular
(1) the communicating branch with the auriculotemporal (1) the glandular branches (rami glanduiara I
nerve (ramus communicate cum rtervo aurieulottmpmrali) which carries dibularis) innervate the submandibular gland and
secretory fibres to the parotid giand; (2) the pharyngeal branch a twig terminaiiam^,
(2) the communicating branch widi nervus spinosus (ramus glossus muscle and the superior constrictor musck
commvmcans aim ramo metiingeo neroo mandibularis) is a twig running (3) branches running from the ganglion to
to the dura mater of the brain together with the meningea) branch and penetrating together with it the tongue thic
of the niandibular nerve; in its mucous membrane;
(3) the communicating branch with the chorda tympani (ra (4) branches originating from the subn
mus communieans cum chorda tympani); and communicating it with the neuro-gangli
(4) communications to the muscular branches of the niandi sends branches to the submandibular and subhrtf
bular nerve: (a) the nerve to the tensor tympani muscle (nervus the sublingual ganglion.
tensoris tympani); (b) the nerve to die tensor palati muscle (nervus V. The sublingual ganglion is the smallest ai
tmsow uili palatini); (c) the nerve to the medial pterygoid muscle; in the head and lies on the lateral surface of the
(5) communications to die sensory branches of the niandibu The sublingual ganglion has roots in com
lar nerve: (a) the buccal nerve (wrens buccatis); (b) a branch to the mandibular ganglion, It receive* the sublinpual
dura mater of the brain. branches from the lingual nerve.
IV. The submandibular ganglion (ganglion submandibular e) is Branches arising Trom the sublingual gang
lingual gland.

RVU
No. Niin \ii.1n I iicnlinn nl Point i)f niirrrgnrnn

nuclei of in tin
!i inn bruin I nun cavity branches
sensory autoiinmic
of skull
Olfactory Bulbus olfactorius Lamina cribrosa os- Olfactory region of

sis ethnuridalis nasal mucosa
11 Optic Chiaama opticum Canalis Qplicus Retina
III Oculomotor Nucleus ii. Nucleus acces- Central grey matter of Sulcus oculomotorius Fissura orbitalis su- Superior, medial, and
oculomotorii sorius tegmentum at level of pedunculi cerebri perior inferior rcctus mus
superior q uadri genii- cles, levator pafpebrac
nal bodies superioris muscle, in
ferior oblique muscle
IV Trochlear Nucleus n. Central grey matter of Behind tectal lamina Fissura orbitalis su Superior oblique
trochlearis tegmentum at level of on either side of fren- perior muscle
inferior quadrigemi- ulum veli and curving
lial bodies round cerebral pe
duncle
Trige initial Nucleus mo- Posterior part of pons, Anterior surface of Nervus oplithalmi- Skin of forehead,
torius ii. tri in cminentia medialis, pons at junction with CUS fissura orbita bridge of nose, upper
ge mini medial to locus coeru- middle cerebellar pe lis superior eyelid, eyeball, lacri-
leus duncle nial gland, lacrimal
sac, mucous mem
brane of nasal cavity
and sphcnoidal sinus,
dura mater of brain
Nucleus SCil- Posterior part of pons,
sorius superior lateral to and behind
n. trigemini motor nucleus in re
gion of locus coeru-
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Facial nerve Nucleus ti. ia- Centra] ptul of poite- Between middle etc* r'oiu* itniml< im In- Motor llbn inn- <
vu
and nervus cialis rior pons, reticuiar cbcilar peduncle and trniua, canstHs facia- vnte ilapcdlua iniuclc,
formation, beh i n d ol ive o f med ul la ob- Its, foramen stylom- platyima, all musclei
interraedius
and lateral to nucleus longata astoideum of facial expression,
(sensory root
of abducent ucrve muscles of scalp, pos
of facial
terior belly of digas
nerve)
tric muscle, stylohy-
oid muscle
Nucleus trac- Begins in region of Sensory (gustatory)
tus solitarii pon.s, extends to pos fibres innervate ante
(nervus inter- terior part of medulla rior two thirds of
medius) oblongata in reticuiar tongue
formation lateral to
nucleus of facial
nerve (common to
glossopliaryngeal and
vagus nerves)
Nucleus sali- Posterior part of potis A u l o n o m k fibres in
vatorius supe corresponding to sul- nervate the lacrimal
rior (nervus cus limitans, lateral to gland, glands of hard
intermedius) and below motor nuc and soft palate, sub-
leus of facial nerve mandibular and sub-
Lingual salivary
glands, glands of floor
of cavity of mouth
Vrif Auditory Nuclei vestib- Posterior part of pons Behind the pons, be- Porus acusticus in- Ampullae of semicir
(a) Vestibular ulares media- in region or vestibular tween it and olive of temus cular canals, utriculus
ucrvc Ms, lateralis, area medulla oblongata and sacculus
(pars ves- superior et in
tibularis) ferior
(b) Cochlear Nuclei coch Spiral Organ
nerve leares ventralis
(pars et dorsalis
coch leans)
The Cranial Nervts (continued)
Location of Point of emergence Distribution

Name Nuclri
Kc. nuclei of main
from tiraiu from cavity branches
sensory auLOiiomif.
of skull
Deeply in posterior Behind auditory Foramen jugulare M u c o u s m e m b r a n e of

IX Glossopharyn- Nucleus ambi-
part of medulla ob- nerve, From postcrola- middle ear, masloid
geal guus
longata, in region of teral sulcus, dorsal to process, pharyngo-
olive tympanic tube,
vagal triangle
tongue, pharynx, pal
atine arches, and ton
sils; carotid body,
stylopharyugeus m u s
cle, parotid gland
Nucleus trac- In posterior part of

tus solitarii medulla nblongala, in
reticular formation,
lateral to sulcus limi-
tatis (see n. facialis, n.
iutermedius)
Nucleus sali- In depths of posterior
vatorius infe part o medulla ob-
rior longata, in region of
sulcus lirnitans, in
front of nucleus ambi-
guus
In medulla oblongata, Behitid glossopharyn- Foramen jugulare O r g a n s of neck, thor

nerve Nucleus ambi-
lateral to nucleus of geal nerve, from pns- acic and abdominal
guus
glossopharyngeal terolatcra) sulcus organs, dura nialer of
nerve and deeper brain, skin of auditory
than dorsal nucleus of ineatus and ear
vagus (see glossophar
yngeal nerve)
Nucleus trac- Dorsal to nucleus am-
tus solitarii biguus (see glosso-
o Wf
i
CD
05 MrVf
IH '"Hi t,m , ,i
CD |
Q. pJiM KJ ntttitui imbl tuiniMnl lull

KuuinJ gloMuplutryn i I ,| UMim l< .
o RCH! and vngii* nervei white column of upl-
<
03 iiaf cord, in space be
Tl
D tween anterior and
posterior honis
Nucleus spina- In grey matter of pos-

Hs n. acces- R. internus n. acces-
tcrolateral part of an
sorii sorii becomes part of
terior horn of Upper
b vagus nerve
o six cervical segments
<
03 of spinal cord
Tl
a
XII Hypoglossal Nucleus n. hy-
In region of hypogfos- From s u k u s amerola- Canalis ossi Muscles of tongue.
nerve poglossi sal triangle in poste- teralis of medulla ob- Contributes to forma
rior part of medulla longata, ventral to tion ol ansa cervicalis
oblongata olive (hypoglosst) innervat
ing the infrahyoid
group of muscles
L6S THE SPINAL NERVES
THE SPINAL NERVES
There are 31 pairs of spinal nerves (nervi spinales) (Figs 838, Most spinal ganglia are lodged in the inter*!
868) which are distributed as follows; the lower lumbar ganglia lie partly in the venebn
(1) cervical nerves (nervi cmttcales) (C^-Cg), eight pairs; ral ganglia, except for the last one, lie in the vt
(2) thoracic nerves (nervi thoradd) ( T h ^ T h ^ ) , twelve pairs; durally. The spinal ganglion of the coccygeal
(3) lumbar nerves (nervi lumbales) (l^-Lg), five pairs; dural space. The roots of the spinal nerves and
(4) sacra] nerves (nervi saerales) (S1-S5), five pairs; can be studied when the vertebral canal is op
(5) coccygeal nerves (nervi cotcygeus) (Coi-Coj), one, rarety two nants of the arches and articular processes are 1
pairs. All the spinal nerves, except for the first
Each spinal nerve (see Figs 732, 868) is a mixed nerve and and die coccygeal nerves lie in the region of the
forms by fusion of two roots belonging to it: (1) a sensory, or pos ramina; those lying most distally and contrit
terior root (radix dorsalis nervi spinalis) and (2) a motor, or anterior tion of the cauda equina are also situated paid
root (radix ueniralh nervi spinalis). Each root is connected centrally canal. The first cervical spinal nerve (Cj) passes I
with the spinal cord by means oT rootlets of the spinal nerves (Jila ital bone and the first cervical vertebra; the eigti
radiculario, ncrvorum spinaliv.-m). The posterior root is connected with nerve (Ce) lies between the seventh cervical
die spinal cord in the region of the posterior lateral snlcus (suktts vertebrae; the fifth sacral (S5) and the CO
lateralis posterior medaliue spinalis) by means of the rootlets of the through the sacral hiatus (hiatus sacralis).
posterior root (fila radieularia radios dorsalis); the anterior root is The spinal nerves are mixed in character;.
joined to the spinal cord in the region of die autcrolatera) sulcus the vertebral canal each nerve runs for a short 1
by the rootlets of the anterior root (fila radicularia radicis veatralis). diately divides to form the anterior primary 1
The posterior roots are thicker and contain a spinal ganglion and die posterior primary ramus (ramus dorsd
(ganglion spinale). An exception is the first cervical nerve whose an motor and sensory fibres (see Fig. 903). Bv me
terior root is larger than the posterior one. The root of the coccy- eating branch (ramtu communicans), which some I
geal nerve contains no ganglion in some cases. be the third ram us of a spinal nerve, each spin;
The anterior roots do not have ganglia. At the site of formation the corresponding ganglion of the syinpatheti
of the spinal nerves the anterior roots simply run next to the spinal trunk itself.
ganglia (usually in a groove on their medial surface) and are con There are white and grey communicating
nected to them by means of connective tissue. mer carry preganglionic (myelinated) fibres
The roots unite to form the spinal nerve lateral to the spinal lateral horns of the spinal cord and are
ganglion. branches are found running from the eighth
The roots of the spinal nerves pass first in the subarachnoid second or third lumbar [L^-L3] spinal nerves),
space and are invested, directly in the pia mater. The ligamentum nicating branches carry postganglionic (c
denticulatum runs between die anterior and posterior roots in the fibres From the ganglia of the sympathetic
subdural space. The three meninges invest closely the roots ap cord; they are darker (grey) in colour.
proaching the intervertebral foramina, fuse with one another close Each spinal nerve gives rise to a branch
to the spinal ganglion and are continuous with the sheath of die dura mater; it is called the meningeal branch 1
spinal nerve (see Figs 79H, 794). spinalis) and contains, in addition, sympathetic
The roots of the spinal nerves stretch in die subarachnoid geal branch is also known as the recurrent ne
space From the spinal cord to the intervertebral foramen in the fol ters the vertebral canal via the intervertebral
lowing manner (Fig. 839): (1) the roots of the superior cervical vides into two branches: a larger branch asce
nerves stretch almost horizontally; (2) the roots of the inferior cer wall of the canal and a smaller descending br
vical nerves descend obliquely from the spinal cord and before en cates with the neighbouring meningeal brand*
tering die intervertebral foramen are one vertebra below the site of tralatera) branches. The anterior meningeal
their origin from the spinal cord; (3) the roots of the upper ten gens anterior) forms as a result. Similar relati
thoracic nerves descend still more steeply and enter the interverte posterior wall of the vertebral canal where the 1
bral foramen approximately two vertebrae below the level of their plexus (plexus meningeus posterior) forms. These |
origin; (4) the roots of the last two thoracic, the next five lumbar, branches to the periosteum, bones, meninges
the five sacral nerves and the one coccygcal nerve descend verti venous vertebral plexuses, and to the artoii
cally to form the cauda equina with the contralateral roots which canal. In the region of the neck, the spinal ne
is situated in the subdural space. After separating from the cauda formation of the vertebral plexus (plexus
equina, the roots run laterally and unite to form the spinal nerve vertebral artery.
while still in the vertrebral canal.

169
THE SPINAL NERVES
N. auricularls magiius Ganglion cervicale superius

i-N. occipitalls minor
Rr. musculares
c
Nn. supracliiviculares^""*
tr >
Oartglicir i
tervicale medium '
N, (iorsalls scapulae
Cianglion cervicale inferius.
N. subclavl
A. avillaris
N. suprascapularis
Fasciculus medialis
Fasciculus
N. phrenicus Plexus
lateral!s
brachialls
^ PaSCiCUluS
N. subscapulanis
posterior
H. musculocntaneLS
-N_ medianus
H. Lhotacodorsalis
.~-N. cutaneirs
N, axlllaris-. brachii medialis
N. thoraricus 1
longus - -~ "
Rr comniunicanleS-' ^ . N . cutaneus
brachii lateralis
N. radialis
*: N. ulnaris
N-cutaneus
iruebrachii
medialis
Rn venlrales
~^-(nn. intercostales 1
N. splanchnicus m a j o r ' _-Pars lurtibalis diaphfagmatls

N. splanchnicus minor
N. subcostalis
Truncus sympalhicus
{ganglia lumbalia)^,
N. iliohypogastrlcus
Rr, musculares ^ ^g.
N. llfolngulnalis-
N. genitoiemoralis r--N- cutaneus

femOris lateralis
N. glutens superior-^ jangiion sacrale
Riemoralis
(n.genilo femora us)
~ Anast omosi s between
trunci sympathici
R.gcnLtalls 1
(n.geriitofernordisl S,
N, glutens inferior S
S,
is>
R. cutaneus anterior mH, fe morale
" " N . cutaneus
R, anterior femoris posterior
N, obturatorius
R. posterio
~N. ischiadicus
838. Spinal nerves; anterior aspect (semischematical representation).

Os s a c r u m
Os coccyijis Col Cfl 1 P B3

* "
Cam
839. Projection of spinal roots and nerves on verirebral column (diagram)

THE SPINAL NERVES
THE POSTERIOR PRIMARY RAMI

OF THE SPINAL NERVES
171
Each posterior primary ramus divides into a medial and lateral

primary rami of the spinal nerves (rami dorsales
branches (ramus mediate et ramus laterals); they carry sensory and
t), except for those of the upper two cervical
thinner than the anterior rami. From their site of motor fibres. The terminal branchings of the posterior primary
bieral surface of the superior and anterior articular rami are distributed in the skin of all dorsal regions of the trunk,
the posterior rami run backwards between the trans- from the occiput to the sciadc region, in the long and short mus
of the vertebrae; in the region of the sacrum they cles of the back, and in the muscles of the occiput (see Figs 869,
the posterior sacral foramina. 870).
THE ANTERIOR PRIMARY RAMI

OF THE SPINAL NERVES
primary rami of the spinal nerves (rami vtntraks The two first plexuses are united into the cervicobrachia) plexus
i) are thicker than the posterior rami, except for (plexus tervicobrachialis), the remaining-into the lumbosacral
cervical nerves the relationships of which are reverse. plexus (plexus lumbosaeralis) (Fig. 839).
primary rami, except for those of the thoracic All these plexuses form from union of the corresponding pri
tunicate with one another widely and form plexuses. mary rami in the form of ansae (i.e. bops).
, ^ - anterior primary rami of the thoracic nerves, only The cervical and brachial plexuses form in the neck, the lum
T V and Th<>, sometimes Th 3 , contribute to the formation bar plexusin the lumbar region, and the sacral plexus, pudenda I
plexus, and the ramus of Th^to the formation of nerve, and coccygeal plexus-in the cavity of the true pelvis. The
plexus. But they enter the plexuses only partly. plexuses give off branches which stretch to the periphery and, ram
fallowing plexuses are distinguished according to topogra- ifying, innervate the corresponding parts of the body. The anterior
[*. cervical (plexus ctrmadu): (2) brachial (plexus braihialis); primary rami of the thoracic nerves do not form plexuses and con
ar (flatus lumbalis); (4) sacral (plexus sm&$s)\ (5) the pud- tinue directly to the periphery to branch out in the lateral and an
(mavusfmdendus); (6) coccygeal plexus (plexus coaygeus). terior parts of the thoracic and abdominal walls.
THE CERVICAL NERVES

The cervical nerves (ntrvt cervkaUs) (C,-C e ) make up eight
pairs (Figs 838-846).

OF THE CERVICAL NERVES
the suboccipital nerve (ntretts suboedpitolis) (C,) is larger than the
i posterior primary ramus of a cervical nerve (ramus dorsa-
anterior primary ramus; it passes between the occipital bone and
m tmkttlis) divides into a medial and lateral branch (ramus
the first cervical vertebra under the vertebral artery Lhe groove
i et TOBISJ lateralis rami dorsalis nervi cervkalis).
for this artery in the atlas. After that the nerve passes into the tri
the cervical nerves the rami of the first, second, and
angular space formed by the rectus capitis posterior major, obli-
,_j are set apart.
quus capitis inferior, and obliquus capitis superior muscles and di-
. The posterior primary ramus of the first cervical nerve, or

172 THE CERVICAL SPINAL NERVES
N. auncularis ma gnus M. stemodeidomastmdeus

(ramI a uteri ares et (covered with fascia)
posteriores)
V. aurlcularJs posierlc
Platysma (reflected)
N. otdpitalis
major 3A
Ramus nmrgiiiaNs
rn;indiliulae
A. occipitalis % S
retromaiidlbularls
V. occipital
N. occipitalis
minor
p prior s
| N. trarrsversus
colll
jirguliiris extema
V. jugularis
anterior
Nn. supraclavi
lateralesipostcritire 'lalvsnu
Nn, SEjpracla-
viculares
medlales
Nil. supnidHwciiliires^.
inrcrmedii -*=-' " '
840. Cutaneous nerves of right cervical plexus (nervi cutanei plexus cervkalis); lateral aspect {%).
(Part of the platysina is removed.)

T H E CERVICAL SPINAL NERVES 173
N. supraurbitalb
R. laterals (branches of n. frontalis
medial is | from n. ophthalmicus n, trigemini)
R, Jygoniattcottmporalis
T?, jygoJnatlcofaclaUF. J E J E ^ N. infraorbitalis

(branchof n, riiiixill;iris
is. ti igemini)
N. .in: iculutemrx 'i .ih:-

(brartch ofn, mandi-
bularis n. trigemini)
N. occlpltalis
major (r. posteriorly
n. cervicalis) Yfc
N. occipitalis minor N. mentalts

(branch of plexus
(branch ofn alveolaris
cervicalis) -
inferior from n. mandibuliiris
N. auricularis magnus 11. trigemini)
(brunch of pics us
cervicalis)
N. transversus colli
(branch of plexus cervicalis)
g
Nn. supradaviculares
(branches of plexus
cervicalis)
841, Distribution of cutaneous nerves of head and neck, right side (semischematical
representation).
a d s to send branches to these three muscles as well as to the (Cg) is the largest a n d passes initialy between the first a n d second
M K s p m a l i s capitis, longissimus capitis, and rectus capitis posts- cervical vertebrae, t h e n curves round the inferior border of t h e o b
m i n o r muscles. liquus capitis inferior muscle a n d divides into one long; and several
T h e branch r u n n i n g t o the obliquus capitis inferior muscle short branches.
r off a c o m m u n i c a t i n g branch to the posterior primary ramus T h e short branches send twigs to the semispiiialis capitis, sple-
of the second cervical nerve ( Q . ) , O n e branch is supplied to the nius capitis, spleiiius cervicts, and longissimuss capitis muscles.
Je of the atlanto-occipita) joint. T h e long branch is called the greater occipital nerve (nervus o<-
% T h e posterior p r i m a r y r a m u s of t h e second cervical nerve ripitalis major). It perforates the semispinalis capitis muscle a n d the

THE CERVICAL SPINAL NERVES
174
Rr. temporales superset Verier iruntalis

(n. hcUlis)
!&& M orbkularis ocull
M. auricularis superior
N. muxillaris (cm off)

M. tempo rails
erygoideuS lateralls
Rr. zygomatld
N.ophthalmkus; M. orbicularis orls

(crtoff)- /
/ M . levjitoi wtguU orls
N, masseterlcus
G million I r l g e m r M t
N. mandibularis
K, tempuralls profundus'
(n. lrige.mln.us) _ _- - % N. alveoluris inferior
N. pterygoldeus medial i* 3 f c - - '^^--IhPf M- depressor l a b i i

W&^Zp inferioris
Nn auricula res snteriores
" " R . marglnalls mandibulae
N aurltuLms posterior N. mylohyoldeus

N. facialis
*"R. stylohyoldeus
,,-
R. dlgastricus
R eslemus n. accessor!i ^ 'y N. hypoglossus
k superior ansae cervlcalls

R. c o l l l ^ ' v v
r' A! i i n i n c h l o m . omohyoideus
\ \
Branch to m. stcrnohyoideus
V Branch to m. sterrmthyroideus
1 ?-=- Branch t o rmm. scaleni
W. sternocleidutnastoldeus
-A M. si-alcilUS TtiedtliS
,M, scalentis anterior
842. Nerves of head and neck; right aspect (semischematical representation).

(Motor nerves.)

THE CERVICAL SPINAL NERVES
ndon of the trapezius muscle to ramify in the skin of the occipi-

o c c i p u t - t o the lesser occipital nerve (newus xttfitgUs minor) which
J region and reach the parietal region. The greater occipital
is a cutaneous branch of the cervical plexus.
ervr often stretches in attendance to the occipital artery and its
3. The posterior primary rainus of the third cervical nerve
(C 3 ), or the third occipital nerve (nerstts ocripitalis tertius), is incon-
The posterior primary ramus of the second cervical nerve gives
stant and lies in the thickness of the skin medial to the greater oc
n o communicating branches running to the posterior primaiy
cipital nerve often communicating with it. The third occipital
i of the first and third cervical nerves, and in the region of the
nerve ramifies in the skin of the occipital region.
THE ANTERIOR PRFMARY RAMI

OF THE CERVICAL NERVES
J L ^ ^ Z râ'ter6 Z E S S f f 2 t p
2 T TP and the brachiai vh
" * * * * * * * * ** * ^
M
of zfirst5U K I 2 E S 5 3 s *" "** *- -
THE CERVICAL PLEXUS

The cervical plexus (plexus cervicatis) (Figs 838-849) is formed
by the anterior primary rami of the tipper cervical nerves (C,-C + ) The remaining three anterior primary rami, just like all those
(nwM ventraks nervoruw, cervical'mm 1-IV). s e a t e d distally, on separating from the corresponding spinal
nerves pass laterally in the spaces between the anterior and poste
It is situated at the level of the upper four cervical vertebrae in
rior intertransverse muscles (musatli intertransversam anteriores et
front of the insertion of the scalenus medius, Ievator scapulae,
fiestcMfcl); the vertebral artery stretches in front of them in this
splenius capitis, and sptentus cervicis muscles and is covered ante
part. After that the anterior primary rami descend laterally, lie on
riorly by the upper parts of the sternocleidomastoid muscle. The
the anterior surface of the Ievator scapulae and scalenus medius
tour anterior primary rami forming the plexus and the three ansae
muscles, and unite here by means of branches to form three ansae.
with branches originating from them are distinguished in it.
The inferior ramus becomes partly a component of the brachiai
The anterior primary ratims of the first cervical nerve lies first plexus, as a result of which the fourth ansa, connecting both plex
on the atlas under the vertebral artery in the groove for the artery uses, forms, The cervical plexus is joined by communicating
M f srttrm vertebralis); it then runs laterally between the rectos branches with other nerves and itself sends branches to the skit.
capitis anterior and rectus capitis lateralis muscles. and muscles.
T H E COMMUNICATIONS O F T H E CERVICAL PLEXUS
1. The communicating branch of the first cervical nerve run

b o n e ^ t h e sternohyoid, sternothyroid, thyrohyoid, omohyoid, and
ning to the arch of the hypoglossal nerve is continuous with the su
geniohyoid muscles.
perior root (branch) of the ansa hypoglossi (radix framusj superior
2, Communicating branches from the second, third, and
*xxu cereicalts). This branch descends on the anterior surface of the
fourth cervical nerves (those from the third nerve are the largest)
common carotid artery in the thickness of its connective-tissue
descend backwards to approach the branch of the accessory nerve
sheath, and at the level of the intermediate tendon of the omohv-
to the sternomastoid muscle (ramus externus ntrm aatssoni).
nid muscle joins the branches of C ^ C , and the inferior root
(branch) of the ansa c e r v i c a l (radix {ramus} infers ansae arvkaUs) The mentioned communicating branches of the cervical plexus
o Form the ansa hypoglossi (ansa cerekalh) in front of the internal penetrate together with the branches of the accessory nerve into
jugular veinfomajugidaris inttrna) and the common carotid artery the depths of the sternocieidomastoid and trapezius muscles.
(arterid carotis communis). S. Communicating branches with the sympathetic trunk (trm-
cus sympalkicus)- the anterior branches of the first three cervical
nerves join the superior cervical ganglion of the sympathetic trunk,
Nerve branches arising from the ansa hypoglossi (oervicalis) in
those of the fourth cervical nerve communicate with the middle
nervate the whole group of muscles situated under the hyoid
cervical ganglion (ganglion termed* medium) or with the trunk.

176 THE CERVICAL PLEXUS
T H E CUTANEOUS BRANCHES OF T H E CERVICAL PLEXUS
The lesser occipital nerve (ntrvus ocapitalis minor) (see Figs 841), runs, like the greater auricular nerve, to the posterior border of the
841) originates from the second and third cervical nerves (C a and stemocleidomastoid muscle, winds round it, and passes forward*
C s ), stretches to die posterior border of the stemocleidomastoid in the transverse direction on the lateral surface of this muscle be
muscle, comes out from under it and often divides into two tween it and the plarysma where it ramifies into larger superior
branches which ascend to the back (to the occiput) and ramify be branches (rami sitperiores nervi transversi colli) and smaller inferio
hind and above the auricle in the skin region bordering posteriorly branches (rami inferiores nervi transversi colli). These branches perf
upon the ramification of die greater occipital nerve (nervus oaipita- rate the platysma, ramify in the skin of the side and front of die
Its major) and anteriorly upon the region of the great auricular neck, and extend to the inferior border of die mandible superiorly
nerve (neraui auricularis magnus). and almost to the clavicle inferiorly. The cutaneous nerve commu
The lesser occipital nerve has communications with the greater nicates with die cervical branch of the facial nerve (ramus colli ntrm
occipital nerve, trie greater auricular nerve, and the facial nerve facials) and forms with it the superficial cervical loop.
branches (the posterior auricular nerve and the occipital branch). The supraclavicular nerves (nervi supraclavkulares) (see
The greater auricular nerve (nervvs auricularh magnus) (see Figs 840, 841) originate from the third (fourth) (0a, C+) cervical
Figs 840, 841) is the largest nerve of the cervical plexus. It begins nerve, pass along the posterior border of the stemocleidomastoid
from the third (fourth) cervical nerve (C3 or C}, stretches to the muscle, emerge from under it slightly lower (ban the anterior ctf
posterior border of the stemocleidomastoid muscle, winds round it taneous nerve of me neck, and lie in the posterior triangle of the
distal to the lesser occipital nerve, and passes over to the super neck under the fascia. After that they perforate the fascia, descend
ficial surface of the muscle. There the nerve ascends forwards to to the clavicle, and separate radially into three groups.
the auricle and divides into anterior and posterior branches. (a) The medial supraclavicular nerves (nervi supradaviculares m
The anterior branch (ramus anterior nervus auricularis magni) is diaks) ramify in the skin of the suprasternal notch and the manub
thinner and ramifies in the skin in the region of the parotid gland, rium of the sternum below the medial part of the clavicle.
lobule of die auricle, and the concave surface of the concha of the (b) The intermediate supraclavicular nerves (nervi supradaritm
auricle. The posterior branch (ramus posterior nervi auricularis magni) lares inlermedii) are distributed in the skin in the region of the m
ramifies in the skin of the outer surface of the auricle and the skin dial part of the deltoid muscle and anterior surface of the ches
behind the ear. and stretch to the level of the fourth rib.
The greater auricular nerve has connections with the lesser oc (c) The lateral supraclavicular nerves (nervi supradaviculares U
cipital and posterior auricular nerves. textiles Iposterioresj) ramify in the skin in the region of the poster
The anterior cutaneous nerve of the neck (nervus transversus parts of the deltoid muscle and the coracoid process of the seal
colli) originates from the second (Q,) or third (C 3 ) cervical nerves, pula.
THE MUSCULAR BRANCHES OF THE CERVICAL PLEXUS
1. Many short muscular branches arise directly from the ante geniohyoid muscleby Ci-C^;
rior primary rami of some of the cervical nerves (rami ventraUs ntr- sealenus anterior muscleby (C+); C5-C7 (C 3 );
cervicalium) (Fig. 909) and supply certain muscles of the scalenus medius muscleby C7-C s ; (Cj)
head, neck, and back. These are muscular branches running to the sealenus posterior muscleby C v -C+;
following muscles: (c) muscles of the back:
levator scapulae muscleby (C^), C s , C4 (C 5 );
(a) muscles of the head:
trapezius muscleby C 5 -C 4 and branch of accessory nerve;
rectus capitis anterior musclesupplied by C] (C^);
anterior uitcrtransverse musclesby C-j-C;,
rectus capitis latcralis muscle by Q*;
2. The ansa hypoglossi (ansa cervicalis) is made up of mot
longus capitis muscleby C]-Cj (C+);
fibres of the anterior primary rami of cervical nerves which do w
(b) muscles of the neck:
stemocleidomastoid muscleby C 2 - C , and branch of accessory contribute to die formation of the cervical plexus. It is formed b
die superior and anterior roots.
nerve;
sternohyoid muscle by C,-C 3 (C 4 ); ansa cervicalis; (a) The superior root (branch) (radix jramusj superior) consis
omohyoid muscle by C ^ C j . ; ansa cervicalis; of motor fibres of die anterior primary ramus of the first (and, ie
sternohyoid muscle by C1-C5,; ansa cervicalis; frequently, the second) cervical nerve, which first join the hyp.
thyrohyoid muscleby 0 , - 0 ; ; ansa cervicalis; branch of hypoglossal nerve but then, in the region where this nerve forms i
glossa! nerve; arch, separate from it to form the superior root, and oniy a vq

T H E CERVICAL PLEXUS
177
Ac libra remain components of the hypoglossal
root descends on the anterior surface oF the com-

i ray in the thickness of the connective tissue sheath
towwwards, forms the ansa cervicalis with the infe-
Icvcl of the intermediate tendon of the omohyoid
root (radix inferior) is composed of the motor

- primary rami of the second and third cervical
c ntrve (Www phrenicus) (C a , C 4 , Cn mainly C,)

844-849) carries sensory fibres abng with a great
fibres. It descends on the anterior surface of the
muscle, comes close to the medial border of the
tower part of the neck, and passes between the sub-
and subclavian vein into the thorax in front of and
! asvical pleura (cupula phnraz). In the cavity of the
rac nerve lies in the superior and anterior mediasti-
MadKs the diaphragm in which it ramifies freely.
**fc* *nd left phrenic nerves differ in their course. The
* more vertically. In the upper parts of the thoracic
w the right internal thoracic artery (arteria thoracka
*od stretches lateral to the right innominate vein
" * * " ' dfxtra) and the superior vena cava. Then it
the pericardium and the mediastinal pleura (ac-
ihe pericardiacophrenic artery and veins) in front of
- tight lung, in line with the lateral wall of the right
aat of and lateral to the vena-cava] opening the right
** reaches the diaphragm.
fcimic nerve has a slightly arched course. In the up-
e thoracic cavity it crosses the left internal thoracic
i lateral to the arch of the aorta and then in front of
e left lung, closer to the surface than the right
Stretching in line with the lateral surface of the left
Aghtly to the back of the apex of the heart, the left
reaches the diaphragm more to the front and Jater-
t right nerve.
of the phrenic nerve,
fcatiag branches in the neck with the middle and
ical ganglia of the sympathetic trunk, with the nerve
Bunding some of the vessels (the thyrocervical trunk,
cervical artery), and with the ansa subclavia.
ing branch with the nerve to the subciavius mus-
wme cases this branch, and sometimes the root of the 843. Nerves of right scalenus anterior muscle
from the fifth cervical nerve, may be so Jong that (specimen prepared by N.Kurasa).
lo the cavity of the thorax to join the main trunk of
(Photograph,)
nerve. In sueh instances these branches are called the
(MediaJ surface of the muscle.)
phrenic nerves (ntrvi phrtnm acctssorii) (see
e pericardia! branches (rami pericardiad) run in attend-

4. The main trunk of the phrenic nerve terminates by
raa pencardiacophrenica and penetrate into the thick-
am* it ifcc pericardium. branches stretching to the diaphragm. Before penetrating the
depths of the muscle they divide into three branches: anterior
e pieural branches extend to the mediastinal pleura in
* of the root of the lung. runmng to the thoracic part of the diaphragm; lateral, stretching
to the costal part, and posterior, stretching to the lumbar part. The

A. octlpltalls _Jfe:
V. Jugularls inlema ^
N. actvssoriiis-^^Hfe
R, ventralls C
844. Right phrenic nerve (l/2) (drawn from specimens prepared by P.E
(Most of the muscles of the neck are removed; the right half of the thorax is opened

179
THE PHRENIC NERVE
bom C(
MSDM
eh from inferior cervical sympath-
* - - < ?
m trunk of vaûj fitrvc
^ k b n ^ muscle
rf r 4 i ^ m anterior muscle
l rpmcle
845. Right phrenic nerve (specimen prepared by F.Evdokimov). (Photograph.)

o L f h r e n i c * beginning from C+ and C , the , roc, , fa. C and nerve to the aubdav^
:an I muscle.)
tool
_ frts of the central tendon, at its junction with the some branches,

846. Phrenic nerves (specimen prepared by P.Evdokknov). (Photo
^ U t 1 ur c v r
. . -tv, tv._ trunks of the right and left phrta
(Accessory roots arising from the right and left ansae cerv.cale* unue wuh the trunks g

THE PHRENIC NERVE
^ * I B J C nerve to pWiis
*?** of pericardium and
I 01 phrenic li^rve
E v e u d s of peri^
* *rrve; nerve twi^ jy,

* {am the photograph) of
flf the phrenic nerve
* * w i q a l pleura
^!f^f?"(specimen P " p ^ d b
y P- Evdoki, ph )
- w_ ^r P ,;v^;;r,r;l-irtT '

182 NERVES OF THE DIAPHRAGM
M- obllquus e i t e m us
! ! : v ; - ' . : ! :
M. ubltquus
internus
abdonihvJs
N. phrenicus dexter (trunk is cut off)
N. phrenJfus sinister
848. Nerves of diaphragm; superior aspect (%) (drawn from specimen prepared by
P.Evdokimov).
5. The diaphragmatic branches (rami phenicoabdominaks nervo- (b) branches to the hepatic plexus;
rumpkremcontmj arc as follows: (c) branches to the gastric plexus;
(a) branches which are components oF the right and left infe- (d) branches to the peritoneum, liver, and anterior abdon
rior phrenic plexuses (see The Autonomic Nervous System); the right wall,
plexus is the largest and contains the phrenic ganglion (ganglion
pkrenicum) (see Fig. 921);

NERVES O F T H E D I A P H R A G M 183
849. Nerves of diaphragm (specimen prepared by P.Evdokimov). (Photograph.)

(Distribution of branches of phrenic nerves in the diaphragm; superior aspect.)
m k artery (arterin phrenica infe 6lateral branch of phrenic nerve 14lateral branch of phrenic nerve
m arttndant nerve plexus 7 - t r u n k of left phrenic nerve 15-posterior branch of phrenic nerve
of right phrenic nerve (tut off) 8anterior braecb of phrenic nerve 16 intramuscular p l e n a (see 3 on left side)
plexus (formed by scôn- *) secondary branch 17bzaftCA From coctiac plexus (on left aide)
bti from the anterior, lateral, 10branch to intercostal nerve
ior branches of the phrenic II, 12 brant lie-* to inferior part of pericardium and
to central tenckw
branch of phrenic nerve 13anterior branch of phrenic nerve
io central tendon of diaphragm
THE BRACH1AL PLEXUS

T W brachial plexus (plexus brackialis) (Figs 838, 850-852) vel of the fourth cervical to the first (second) thoracic vertebrae.
from union of the anterior priraary rami of the fifth, sixth, Initially the plexus is represented by the trunks of the brachial
and eighth cervical nerves (C 5 -C B ) (rami ventralesnervorum plexus (tranci plexus brackialis) in which an upper, middle, and
V - V H I ) , A small branch from the anterior primary ra- lower trunks are distinguished. T h e upper trunk {truticus supe
<A the fourth cervical nerve (C 4 ) and a large part of the anterior) results from union of the anterior primary rami of the fifth,
ynmary ram us of the first thoracic nerve ( T h , ) also contribute sixth, and partly the seventh cervical nerves, the middle trunk
D formation. In addition, a small part of the anterior primary ftrunkus medtus) is formed by the seventh cervical nerve, whereas
I B of the second thoracic nerve (Th 2 ) and sometimes that of the lower trunk (truncus inferior) is formed by union of the anterior
third thoracic nerve (Th 3 ) join the plexus in the axillary fossa. primary rami of the seventh cervical to first uioracic nerves and
T h e anterior primary rami of the spinal nerves forming the lies on the first rib next to the posterior surface or the subclavian
plexus emerge from the intervertebral foramina at the le artery. Each trunk of the plexus divides into posterior (dorsal) and

THE BRACHIAL PLEXUS
184
anterior (ventral) divisions (divisiones dorsaUs et ventraks). The fossa (fossa supradavicularis major), lateral
trunks Of the plexus stretch in the space between the scalenus mus lower part of the sternocleidomastoid
cles behind and above the subclavian artery. They emerge from the inferior belly of the omohyoid mu
the space into the greater supraclavicular fossa in which they come cervical artery (arietta transversa colli/
close to one another. In a lean person the trunks can be palpated cords of the plexus.
here immediately cranial to the clavicle. The rami forming the The infraclavicular part (pars in/r*
brachial plexus have communicating branches with the sympath lary fossa between the subscapular and
etic trunk and its gangliathe middle ganglion (ganglion cerckak behind the pectoralis minor and major i
medium) and inferior ganglion (ganglion cervkothwaticum fstella- While still in the supraclavicular f
chial plexus unite to form three cord*
tumj).
Two parts, supraclavicular and infraclavicular, are distin (fasciculus lateralis) situated lateral to d
cord (fasciculus medialis) situated medial
guished in the brachial plexus topographically. The supraclavicu
rior cord (fasciculus posterior) lying behind
lar part (pats supradavicularis) lies in the greater supraclavicular
THE SUPRACLAVICULAR PART
The supraclavicular part of the brachial plexus (pan supradavi terior portion of the supraclavicular parti
cularis plexus btachialis) sends muscular branches (rami musculares) tothe nerve to the rhomboids fntnm 1
the deep muscles of the neck, and short nerves to the muscles of to the serratus anterior muscle fa
the shoulder girdle.
The muscular branches supplied to the deep muscles of the
THE NERVE TO THE !
neck arise from the plexus branches immediately after their emer
gence from the intervertebral foramina, and run to the following The nerve to the rhomboids (nercui d
muscles: intertransverse, scalenus anterior, scalenus medius, scale on the anterior surface of the levator vaj
nus superior, and longus cervicis. and the scalenus posterior muscle, and
The short nerves: ing branch of the transverse cervical ai
(1) the nerve to the rhomboids (nemtts dorsalis scapulae); lar artery (arttria scapularis descendens;, i
(2) the nerve to the serratus anterior muscle (nervus tkoracicus the scapula where it sends branches i
longus); rhomboid minor muscles and to tt
(3) medial and lateral pectoral nerves {nervi pedotales mediatis et scapulae muscle.
lateralis);
(4) the nerve to the subclavian muscle [JKTTOI subclasius);
(5) the suprascapular nerve (nervus suprascapularis); THE NERVE TO THE SERRATUS |
(6) the sub scapular nerve (nervus suhsutpularis) and its branch,
The nerve to the serratus anterior I
the nerve to the latissimus dorsi muscle (nervus thoraccdorsalis).
gus) (C5-C7; CB) descends on the lateral 1
Branches arising from the anterior portion of the supraclavicu
terior muscle along the axillary line x
lar part of the brachial plexus and those arising from its posterior
depths of the slips of this muscle (Fig. ""
portion are distinguished. The branches originating from the pos
NERVES ARISING FROM THE ANTERIOR PORTION OF THE SUPRACLAVICL

ftrLKvr,= w w w o p T H E B R A C H I A L pLEXuS
THE MEDIAL AND LATERAL PECTORAL NERVES They descend behind the clavicle and i
The anterior thoracic nerves (C s -C a , Th,} are usually repre tery and vein to enter into the depths of
sented by two trunksthe medial pectoral nerve (nervus pectoralis pectoralis minor muscles; one of the br
mtdtalis) and the lateral pectoral nerve (nervus pectoralis lateralis). lar part of the deltoid muscle.

^ ^_Fasciculus
ijr latcralis
Nn. suuraclaviciilares laterals -\ ^ _ Fasciculus \ pl e J t u s
posterior | brachialfs
Radix lateraUs n. median
N. mLisculocutaneus
N. ax I Harts
N. cutaneus
brachll lateral Is ^ ^ H
R. p r o f u n d u s j
n. rarliaUs^jg
R. superficial!5 ul
n. rsdtalls /Mm
N. cutaneus
anlebrachii lateralls-;
gf-N. cutaneus antebrachii
media Its
Nn. dig I talcs

palm a res communes
I R. superflcialls n ulnaris
R. profundus n. ulnaris
^.Nn. digitales dorsales
Nn. digitales pal mares proprii
850. Brachial plexus and nerves of right free upper limb; anterior aspect (represented
semischematically).

186 NERVES OF THE UPPER LIMB
1cervical and bra.cn ta! plexuses

'I medial and lateral pectoral nerves
3 lateral and medial roots of median DCCVC
4 tilnar neive
5 median nerve
6branches of median atxvt to &uperlicial muscle*
7 t o m m n n i c a i i n g branch between uluar and medial o e r v t i
8communication between d n a r and median nerves on hand
9cutaneous branch of radial nerve
10 i nte ros&eous nerve
11 brachial artery
12 musculocutaneous nerve
851. Nerves of right upper limb of a newborn (specimen prepared by V.Polyakov).

(Photograph.)

GlaiicMa parotid A- facLalls
A. auricularis posterior ' Gland u 3 a iubmenriibularis
M. hypoglussus^ / /
V. jugylarLs itlltrna
A- carotis in tern a
HJ. {itcessorius v
M occJp]iali minor
Ansa corvical
R. I : :-.. i !::!Is
M. staknus medlns
M scaleriLis ant
--, .d
N. phrtnlcrus
A. ih^ft
V. Jugula Is Jntcrna
Nn. supraciav cu LITL-- J
H
V. subdavta ^
Plexus brachialts ^ , tfm
A, sube&vlj
V. cephalic^ ^
A.HM JÎ-.
"*s ^ 1 M H
Fasciculus
LiArntls -s a
Nn. intercostobrachiales ^ Rr. cutaneL anterlores

(from nn. intercostal^ 11 III) (pectorales)
R. cuxaneus Jateralls M . thoraeicus tongus Nan pectaaJes mediAlesel
lateralK
852. JVemes o/necfc and shoulder girdle; right side f1/^).

(Cervical and brachial plexuses; part of the clavicle, pectoralis major niuscle, a n d superficial muscles of the neck are removed.)

188 T H E BRACHIAL PLEXUS
THE NERVE TO THE SUBCl-AVTUS MUSCLE round the neck of the scapula, runs under the spinog
ment (ligamentum transversum scapulae inferius), enters the i
T h e nerve to the subclavius muscle (nermis subdavius) (C % , C s ,
nous fossa, and sends branches to the infraspinatus muscles
C 6 ) is a twig lying in Front of the subclavian artery lateral to the
posterior surface of the shoulder joint capsule (some
lower part of the scalemis anterior muscle and r u n n i n g to the sub
plies the teres minor muscle),
clavius muscle. It often sends communicating branches to the
phrenic nerve which approach the nerve laterally.
THE SUB SCAPULAR NERVE
T h e subscapular nerve (nervvs subscapularis) ( C 5 - C 7 ) I

THE SUPRASCAPULAR NERVE anterior surface of the subscapularis muscle and sendi i
T h e suprascapular nerve (ncrvus sv.prascapti.larh} ( C 5 - C f ) des and to the teres major muscle. Its longest branch is the i
cends to the inferior belly of the omohyoid muscle, passes together the latissimus dorsi muscle (nervus tharaioduTsalis) ([CJ,
with the suprascapular artery (arieria suprascapularis) to the supra- which descends o n the lateral b o r d e r of the scapula to t
scapular ligament (Ugamentum transoersum. scapulae superitts), runs border of the latissimus dorsi muscle and ramifies in it> i
under it through the suprascapular notch (the artery stretches T h e subscapular nerve and the nerve to the latissii
above the ligameiil) into the supraspinous fossa in which it sends muscle may sometimes arise from the axillary nerve,
twigs to the supraspinauis muscle (sometimes il gives off a branch nerve to the latissimus dorsi muscle may originate from (
to the acromioclavicnlar joint). Passing further, the nerve curves
T H E INFRACLAVICULAR PART
(THE LONG BRANCHES)
T h e infraclavicular part of the brachial plexus (pan infmdavicu- tween the coiacobrachialis, subscapularis, and lati
laris plexus brackidis) supplies long nerves to the muscles and skin muscles (Fig. 852).
of the free part of the upper limb and only one short nerve, the ax- I n the axillary fossa the three cords of the infraclavi
illaiy nerve (tttsmt axillaris), t o the shoulder girdle. of the brachial plexus surround the axillary artery on t i
T h e infrascapular part of the brachial plexus enters the axillary medial, and posterior aspects, only the anterior surface r
fossa in which it lies behind the pectoralis major and minor m u s uncovered.
cles, in front of the subscapularis muscle, and lateral to the serra- T h e axillary vein lies on the anteromedial surface i
tus anterior muscle. At the exit from the axillary fossa it lies be Each cord supplies long nerves to the upper limb.
T H E LATERAL C O R D
T h e lateral cord (fasciculus lateralis plexus brackialis) is formed by (2) branches to the periosteum of the h u m e r u s and
the anterior primary rami of the fifth, sixth, and seventh cervical sule of the elbow joint.
nerves (C5-C7). It gives rise to (1) the musculocutaneous nerve A communicating branch between the musculocw
and (2) the lateral root of the median nerve (radix lattraiis nervi me- median nerves may be often found,
diani) (Figs 838, 850. 852). (3) the lateral cutaneous nerve of die forearm '1
antebrachii lateralis) is the end branch of the must
THE MUSCULOCUTANEOUS NERVE nerve.
T h e musculncutaneous nerve (nervus muscubeutaneus) ( C s - C j ) T h i s nerve pierces the brachial fascia in the bend of
(Fig. 853) stretches downwards and laterally, pierces (not always) lateral to the bicipital aponeurosis, fits next to the a
the coracobrachialis muscle obliquely from top to bottom, and fits descends, and ramifies in the skin of the radial bordei
between the brachialis and biceps brachii muscles. It then emerges half of the palmar surface of the forearm down to the
from under the lateral border of the distal t e n d o n of the biceps T h e following communicating branches occur along
brachii and penetrates the brachial fascia proper in the bend of the of this nerve:
elbow to enter the subcutaneous fat as the lateral cutaneous nerve (a) with the superficial branch of the radial nerve
of the forearm (nervus cutaneous antebrachii lateralis). Jicialis nervi radialis);
O n its way the musculocutaneous nerve gives rise to the follow (b) with the dorsal branch of the ulnar nerve (r&aaa
ing branches: mis nervus ulnaris);
(1) muscular branches (rami mustulares) supplying the coraco- (c) with the medial cutaneous nerve of the forearm
brachialis, brachialis, and biceps brachii muscles; neus antebrackii medialis).
MM Hi

NERVES AND ARTERIES OF THE SHOULDER GIRDLE 189
Fasciculus later^lLs
Pit MIS
Fasciculus posterior
brathialjs
Fasciculus medlars
A. thoraco- n . ,."
R
acromialis ' acrora,a"s' ^ ^ ^ A. thoracoiicrocnidlis
\ R. rleltoideu
*--A. Btrflflfrfs
N- pectoralii lateralis ^,^^m
A- Lhoracka latfr^lii
N muvJt>cjlateus
M pectoralis R w
major (cut off) y **
^ . ^ V L . ILTI'.S major
N. axillariS *
A. aubscapuJarts
Ihoratudorsalis
lalisslmus dorsi
N cutantus brachH me dial is

V, "\.-y\^ brachil
\ (cap Lit tongum)
\
A. prolunda brachit
N. rarfUHs
M. brachErtlis
+.14. CUfaWsa anEebracliii

aleralis
S53. JVercw and flames of rfciW shoulder girdle and upper arm; anteromedial aspect (%).

THE BRACHIAL PLEXUS 191
855. Nerves of right supraspinatus and infraspinatus muscles (specimen prepared by

Ya.Sinelnikov). (Photograph.)
(Medial surface of the muscles.)
I - lupraspinatu I uruscl e Smoilnof wpnaapdv Mrw
IIinfraBpiiialus muscle *artaunBlwiiar nerve branches of infrifipinalus
1 intramuscular nerve branches of infraspinatus muscle
muscle
2twig t/> articular cspsule of shoulder joint
THE LATERAL R O O T OF THE MEDIAN NERVE
The lateral root of the median nerve (radix lateralis nervi medt-
anij forma from the sixth and seventh crania] nerves (C 6 , Cj) and
lies lateral to the axillary artery (see below The Median Nerve).
THE MEDIAL CORD
The medial cord (fasciculus madialis plexus brachialis) is formed brackii medialii); (3) the medial cutaneous nerve of the Forearm (ner
by the anterior primary raiui of the eighth cervical and first thor ous aitaneas antebrachii medidis); (4) the medial root of the median
acic nerves (C Th,). It gives rise to; (1) the ulnar nerve (nervus d- nerve (radix medialis neroi medium).
naris); (2) the medial cutaneous nerve of the arm (nerous cutaneous

192 T H E BRACHIAL PLEXUS
856* Nerves of right deltoid muscle {specimen prepared by Ya.Sinelnikov)_|

(Medial surface of the muscle*)
Ideltoid nmscle (part augivi at tug from spinr of acapula) 2ixihary ticrvt {cut, part of it reflected u :
JI deltoid muscle (part originating from clavicle) ?i intrainusf ular branches, of deltoid r o u i d t (
III del la id m list lc (part origilMtillg from acromion) f r o m il-f clavicle)
1 = " -- == =-.- "__- b u n c h e s of d t t t u i d ni u..< \t (part rrigi tial I II^4 i!]Lramun:u]ar branches riFdt-ltuid muse I t . p " H
from s p i n e o f scapula) from .! :..-i.i- :
THE ULtvAR NERVE anterior surface of the forearm betwt

'- T h e ulnar nerve (neraas ulnaris) (C7-C s ) (Figs 85!i-854; fundus and flexor carpi ulnaris muscle
S57-SS2; 864-R67) lies first medial to the axillary artery and the ies and veins (arterine et venae ulnara)-
beginning of the brachia.1 artery, but at the level of the middle In the lower part of the forearm di
third of the u p p e r arm it departs from the last-named to the me vessels is covered by the tendon of t h t l
dial periphery of the upper arm towards the lateral intertnuscular T h e ulnar nerve does not give off 1
septum, often r u n n i n g in its depths, then stretches behind it in the A communicating branch between it
lower half of the upper arm. Here, the ulnar nerve descends In found on the forearm (Fig. 851).
company with the ulnar collateral artery {catena, coUateraiis ulnaris At the junction of the middle ami I
superior) on the medial head of the triceps brachii muscle into the but sometimes above or below this le
groove between the medial epicondyle of the humerus and the into its terminal branchesa thinner i
olecranon; there it lies directly on the bone in the groove for the nerve (ramus dorsalis manus ntrvi u2n
ulnar nerve (sulcus nertii ulnaris) and is covered only with the fascia branch (ramus palmaris mania ncni uix
and skin. T h e branches of the u l n a r n e n e }
O n emerging from this segment, the ulnar nerve passes be 1. T h e muscular branches (rami i
tween the heads of the flexor carpi ulnaris muscle and runs on the the flexor carpi ulnaris muscle and the i

ARTERIES AND NERVES OF THE FOREARM AND HAND 193
M . bleeps brachil
N. ulnaris
Septum trite rnnustjul a r t
A. brjtchialis
brachil media!?
N. medlanus
_ - A . collateral is
ulnaris superior
Apciiieurou* m bLcLpitj^ brachit . - A . t o [lateral is
ulnaris inferior
Rarni musculares
n. median!
Ten do m. blclpltis b r a f h i i _
fc radialis {ramus p n > h j n d u s ) J
A- brachialis T f
M. brachloraclialls- A. recurrent ulnaris
M . extensor carpi M m . EltJtOres et prnnator feres

racJig]is longus - '
A. in(eroasea ^-oTniTiLinls
A recurrens radialis - A . iJiterossea posterior
- A . inlcrossea anterior
N. radialis Sjiirews superficial
r" M . flexor (Jigltoruni protunrtus
M . flexor pnUlcfo lorgus-*
j M . rlexor rarpi ulnaris
T e n d u m flexnris diîtoruna
superficial Es
ft. palitiari.!; R. palmaris

superfldalis a. radiall ^ p m f u r i d i i s a. ulnaris
A. ptiiwwp* poHlc** Arcus palmaris s-uperflclalis
Aa. d i g i t a l s palmaTes
communes
Tendo m. Etexoris
p o i n t s longi v
^ A a . dk/i tales palmares

**r propriae
857. Arteries and nerves of right forearm and hand; palmar aspect (%).
beperfkiaJ layer oF the forearm muscles, the prrmator teres muscle, and the superficial muscles of the hypothenar are remcived.)
mm

194 NERVES OF THE UPPER LIMB
858, Nerves of articular capsule of left elbow joint; uinar 859. Nerves ofrigk ifia
aspect (specimen prepared by E.Strakhova), (Photograph.) profundus muscle (:
-brae Mai is irn;-.i li prepared by G.Pi
2 med [an nerve
3 A 7 Tit-rvc braucLies 10 articular capsule of el (Photo
bow joint (Inner surface QF
nerve brain h to periosteum of huiacnif
1 muscular branch of ulnar n e T t
nerve trunk to pronatur teree muscle
'' ' ' 11 of the m n s c J t
SprfjTMictr tttes muscle (cut and re
2 tvrig communicating iiilraTi]
flected)
median nerves
S^fleito]' carpi ulitarjs muscle
10 ulecranon 3 muscle tendon
11 articular capsule of elbow joint 4muscular branch of median a
12medial epicondyle the muscle thickness
Ifluluamerve
14triceps brachii muscle

N E R V E S O F T H E U P P E R LIMB 195
.. ErnjsHe (running to the ling and little Fingers);

oF the last-named muscle they communicate with
of tbe median nerve innervating the remaining part of
Wkc articular b r a n c h is a thin twig extending to the articu-

of the elbow joint.
' palmar cutaneous b r a n c h (ranaas cutanetts palmaris nervi
aes sometimes in the lower parts of the forearm by two
I a small branch to the ulnar artery, pierces the fascia of
and runs between the flexor carpi ulnaris and the
atgttonim superficialis muscles to the skin on the ulnar bor-
t radiocarpal joint, and to the skin of the hypothenar and
. There is a communicating branch between this branch
A r medial cutaneous nerve of the forearm (nsrvus cutamus an-
L The dorsal branch (ramtis dorsalis mantis: nervi ulnaris), one of

t trr-r"*- 1 branches of the ulnar nerve, passes between the ulna
r to its head) and the tendon of the flexor carpi ulnaris mus-
B tbe dorsal surface of the hand. There it pierces the fascia
i to form twigs supplying the skin o n the ulnar side of
surface of the hand and the dorsal surfaces of the
, and gives rise to the following nerves (Figs 864, 865);
;i* die dorsal digital nerves (nervi digitdles dorsaies nervi ulnares),
e a t number, innervate the skin on the dorsal surface of the little
& ring fingers and the ulnar side of the middle finger (Fig. 865).
I A t little finger they reach the base of the nail, but on the ring
He fingers they spread only in the skin of the proximal
:b: the communicating branches with the superficial branch of

f radial nerve (ramus superficialis nervi radialis) and with the
i of the medial, posterior, and lateral cutaneous nerves of
(nervi cutanei antebradiii medialis, posterior et lateralis).
S. The p a l m a r branch (ramus palmaris nervi ulnaris) is attended
ttf W ulnar artery and is a continuation of the main trunk of the
fair nerve. It approaches the pisiform bone from the lateral
Mfjcct, stretches between the palmaris brevis muscle and the flexor
Jum (ntinaculum jlexorum) and divides into a superficial
859a. Innervation of periosteum of anterior

anface of forearm bones (specimen prepared by
E. Gerkelizhiu).
1 median nerve 6iimjriijlfi'periosLea! branch to periosteum, of 10muscuio-periosteal branches, for perios
2ulnar nerve inleroaseouG border of ulna teum of Ftdfcn
3 nerve branches to articular capsule and la* 7 nerve branch entering thr mil. i rut Foramen 11 imjsculo-perio&teal branches for peri^js-
i ligament of elbow joint uf the UITW [eiun of nhbJL
4Fnuscula-peri osteal branches of ulnar nerve 8anterior interosseous nerve 12 nusculO'perioSiteal branches to periosteum
to periosteum of coronoid process of tihia Dnerve branch entering the depths of the in of distal i- tiphj -I -. of radius
5nerve branch to bttemsscotiH membrane tern sseous membrane

NERVES OF THE UPPER LIMB
196
M. bra^hijradjbdiis. - |
A. ulnarL
A. radialls
rW flexor carpi utnarfa
M. littOT uarpl radiali
N, ulna its
M. flexor digilorum-1
,Os pjstfurme
Rr. isupe rile [ales

n. ulnarls
-Arms paimans
Aa. cliK Li ales pa! mares
N. digilalis paSmans
R. a 11 astom fiii c u s
Vagina fibTusa
ii Lgi toru m manUa
M n . d i g l t a l M palmares
prop Hi
Nn. dictates
palmares prupr
860. Nerves ofrighthand; palmar surface (%).

(The skin, subcutaneous tissue, and p a l m a r aponeurosis are removed.)

NERVES O F T H E UPPER LIMB
197
1 median nerve
2abductor pollicis muscle (palled aside)
3 flexor relinacidum of hand
4nerve bramdi to abductor muscle
5 nerve branch to opponeTm potLkis muscle
e ^ o p p o n e u a pollicis muscle
7 superficial head nf flexor pollicis brcvis
tiLLLr3r
8nerve twig ffom deep branch ofulnar nerve

perforates deep head of flexor pollicis DFC-
vis muscle
9nerve branch to metacarpophalamjeal joint
of thumb
I(1 n m e bra.nch to first lumhrical muscle
11nerve biauch to second lurnbricaJ muscle
12 digital nerves
19 nerve branch to third Luiiihrical musc.lr
14communicating branch from ulmtr nerve to
median nerve
15flexor digiti minimi brcvis muscle
16sbductor dijfiti minimi muscle
17 superficial branch of ulnar nerve
861. Nerves of left hand; palmar surface (specimen prepared by L.Kiseleva), (Photograph.)
terminal branch (ramus superjiaalis nervi ulna) and a deep termi
digitalis palmaris preprint) lies on the ulnar border of Lhe palmar
nal branch (ramus projundus nervi tilnarisj.
aponeurosis along the hypothenar muscles, passes on the palmar
A. The superficial terminal branch gives rise to the following surface of the little linger and innervates the skin on its ulnar bor
branches:
der;
(1} muscular branches (r&mi naaeufaret), one or two quite thin
(5) the common palmar digital nerve (ncrvus digitalis palmaris com-
branches which supply the palmaris brevis muscle (sometimes also
munis) is thicker than lhe last-named nerve, lies above the palmar
the other muscles of the hypothenar);
aponeurosis, along the fourth interossecms space (spatium inleros-
(2) the cutaneous branches pierce the palmaria brevis muscle seum IV), and divides into the proper palmar digital nerves (nervi
and innervate the skin in the region of the hypothenar; digitales palmares prnprii) which have two branches:
(3) the communicating branch with the common palmar digi
(a) the proper palmar (radial) digital nerve of the little finger
tal nerve of the median nerve (newus digitalis palmaris commit-
(nervus digitalis palmaris proprius) supplying the skin on the radial
nis HI);
aspect of the little linger;
(4) the proper palmar digital nerve (to the little finger) (nervus

NERVES OF THE UPPER LIMB
198
A, ulnaris
A. radialis
N. ulnaris
Membrana interossea -
N. interosseus (
anterior {n.m
A. interossea anterior
-M. flexor carpi
M- brachioradialis - -
R. dorsal is IT. L
M: pronator quadratus
R. carpeus pain
R. carpeus palmaris a. r a d i a l i s - r - t L l a. ulnaris
R, palmaris superficial fl. r i l d [ a l i ^ i l J j ] Os pisiforme
Tendo m. abductoris pollicis long! R. palmaris n. u
Tendo rm cxtensoris pollicis brevis R. superficial]* ^
M. abductor
M. abductor pollicis _ ^ | R. muscii!;
Arcus palm
Aa. metaca
R.profundus n. ulriaris
(di
M. flexor pollicis brevis^ M. opponent
M. adductor pollicis -*~^fl| , Rr, must
(divided) to mm, in1.
" Rr. mu:
Mm. fnterossoi palmares
Mm, lumbricales
Mm, flcxores
superficialis ct
(ten dinc
862. Nerves of right hand; palmar surface (%).

(Most of the muscles are removed; the relation of the nerves to the deep palmar arch i
(b) the proper palmar (ulnar) digital nerve of the ring finger B. The deep terminal branch ,
supplying the skin on die ulnar surface of the ring Hnger and the stretches on the radial aspect of I
skin on the dorsal surface of its middle and distal phalanges. through the base of the musdes fom
The end branches of ihe cutaneous digital nerves give rise to the flexor digiti minimi brevis and aij
lamellared coruuscles (corpusatla lametlosa) and pierces the opponens digiti min
with the deep branch of the ulnar ai
NERVES OF THE UPPER LIME 199
arteriae ulnaris), a deep space on the palm between the tendons of chii muscle lateral to the basilic vein; then it passes behind the me
the long flexors and the interossei muscles. It arches slightly, al^ dian cubital vein (vena mediana cubiti) and ramifies in the skin of
most following the course of the deep arterial palmar arch, and the ulnar part of the palmar surface of the forearm down to the re
passes towards the thumb. The deep terminal branch gives rise to gion of the radiocarpal joint.
the following nerves: Along its course the anterior branch communicates with the
(1) the communicating branches with the first common palmar branches of the lateral cutaneous nerve of the forearm (branch of
digital nerve of the median nerve (nervus digitalis palmaris commu- musculocutaneous nerve}.
nis I nervi mediant); (b) The ulnar branch (ramus ulnaris nervi cutanei antebrachii me
(2) the articular branches to the articular capsules and perios alis) lies medial to die basilic vein, descends on the ulnar border of
teum of the hand bones; the forearm and ramifies on its dorsal surface with the rami reach
(3) the muscular branches (rami muscular es) supplying the fol ing the region of the radiocarpai joint.
lowing muscles: On its way the ulnar branch communicates with the posterior
(a) the thenar: the adductor pollicis muscles and the deep head cutaneous nerve of the forearm (branch of the radial nerve) and
of the flexor pollicis brevis muscle; with branches of the dorsal branch of the ulnar nerve.
(b) the hypothenar; the abductor digiti minimi, flexor digiti
minimi brevis, and the opponens digiti minimi muscles;
THE MEDIAL ROOT OF THE MEDIAN NERVE
(c) middle group of hand muscles: third and fourth lumbrical,
and palmar and dorsal interossei muscles; The medial root of the median nerve (radix medialis nervi medi
(4) the perforating branches pass through the interosseous an!) originates from the eighth cervical and first thoracic nerves
spaces on the dorsal surface of the hand where they communicate (C$, Th,) and lies medial to the axillary artery (Figs 852, 853),
with the twigs of the posterior interosseous nerve (nervus intcrosseus
antebrackii posterior),
THE MEDIAN NERVE
THE MEDIAL CUTANEOUS NERVE

The median nerve (nervus medianus) (C^-Th,) (Figs 850-853,
OF THE ARM 857-861) is formed by the union of the lateral and medial roots (ra
dices lateralis et mtdialv: nervi mediant). On uniting at an acute angle
The medial cutaneous nerve of the arm (nervus cutaneous brachii the roots form a loop which lies on the anterior surface of the axil
medialis) (C& Th H Th s , Th a ) (Figs 853, 8fi6) takes origin from the lary artery. Running further as a single trunk, the median nerve
medial cord of the brachial plexus and lies in the axillary fossa in adjoins the radial (lateral) side of the brachial artery and lies to
front of the infraspinatus and Iatissimus dorsi muscles, first in gether with it under the brachial fascia in the medial bicipital
front of and then medial to the axillary artery. groove (stdctts bicipitalis medialis). In the middle of the upper arm
Here it unites with the lateral cutaneous branch of the second me median nerve crosses the artery in front and lies on its ulnar
thoracic nerve (ramus cuianeus lateralis nervi thoracid II) and some (medial) side. Togeuier with the brachial artery die median nerve
times also with the third thoracie nerve Th a ); these nerves are passes in the cubital fossa under the aponeurosis of the bicipitis
called the inter costobrachia! nerves (nervi interwstobrachiales). The brachii muscle, and then stretches on the forearm in front of the
twigs (two, sometimes three in number) perforate the axillary and ulnar artery which accompanies it for some distance. After that,
brachial fasciae and ramify in the skin of the axillary fossa and the the median nerve runs between the heads of the pronator teres
anterior and posteromedial surfaces of the upper arm down to the muscle to the midline of the forearm, passes under the tendinous
region of the medial epicondyle of the humcrus and the olecranon. arch of the flexor digitorum superficialis muscle, and in company
with the median artery (branch of the ulnar artery) extends be
tween the flexor digitorum sublimis and flexor digitorum profun-
THE MEDIAL CUTANEOUS NERVE OF THE
dus muscles to the region of the radiocarpal joint.
FOREARM
Between the tendons of the flexor carpi radialis and palmaris
The medial cutaneous nerve of the forearm (nervus cutaneus an- longus muscles the median nerve passes under the flexor retinacu-
tthrackii medialis) (C s , Th,) (Figs 853, 866) lies in the axillary fossa lum together with the lendons of both flexor digitorum muscles in
next to the axillary artery; in the upper arm it stretches together the carpal tunnel to stretch on the hand where it ramifies into its
with the brachial artery (arteria brackialis) and the median nerve terminal branches.
(nervus medianus). In the middle of the upper arm it runs through On the hand the terminal branches of the median nerve lie un
the fascia at the point where the basilic vein (vena basilica) pierces der the palmar aponeurosis between the superficial palmar arch
the fascia; on entering the subcutaneous layer, the medial cutane (areas palmaris superficialis) in front and the tendons of the flexor
ous nerve divides (sometimes more proximally) into anterior and digitorum sublimis muscle behind.
ulnar branches. Branches of the median nerve are as follows (Figs 858-862).
(a) The anterior branch (ramus anterior nervi mtanei antebrackii 1. The communicating branches (rami commumcanies);
medialis) stretches in front of the aponeurosis of the bicipitis bra (a) on the upper arm with the musculocutaneous nerve (some-

zm NERVES OF T H E UPPER LIMB
Communicating branch between

dorsal and palmar digital nerves/
/
/
/ A. metacarpea dorsalis
A. radialis i r d i c i s v
N. digitalis dorsalis
Rete venosum dorsale r- ;
N. digitalis /
palmaris proprius
Jigftales dorsales'
/
M . extensor poJiicis brevis (tendo)
M, abductor potlfcis lorrjus (tendo)'

A. radiali?
863. Nerves, arteries, and veins of right hand; radial borclci
times two or three in number), inconstantly present, lie in the up terior), between the flexor pollicis fen.
per third of the arm;
fundus muscles, to the pronator qu*
(b) on the forearm with the itlnar nerve (ramm communicant cum It supplies the flexor pollicis \<n._
nervo ulnari) in the depths of the flexor digitorum protundus m dus (the radial part related to the ir
lius-
cle
pronator quadratus muscles,
(c) ou the hand with the superficial terminal branch of the ui- 5. The palmar cutaneous branch
nar nervi* (ramus supajkialis nervi ulnaris) and the superficial branch (sometimes two in number) is a thin
of the radial nerve (ramus supeyficuilis nervi radialis). trunk of the median nerve in (he 1....
2. The articular branches supplying; the articular capsule of tween the tendons of the flexor carpi
the elbow joint and partly the capsules of the carpal joints and muscles. It perforates the aritebraehii
joints of the thumb, index, and middle (ring) lingers on the palmar
of the palm and of the palmar surf a.
surface.
thumb.
3. The muscular branches (rami musculares). The median nerve 6. The common palmar digital i
does not give rise to branches on the upper arm (except lor the dian nerve (nervi digitals* palmar es c -
above mentioned communicating branch with the rnusculocutane- anij form as the result of rarmficaliu:
ous nerve), On the forearm the muscular branches arise from the dian nerve. They arise at the level of
main trunk of the median nerve at the level of the medial epicon- retinaculum, lie under the palmar a-p
dyle of the humerus and run to the pronator teres, flexor carpi ra mar arch in the first, second, and u:
dialis, palmaris longus, and flexor digitorum superficialis muscles. give rise to: (a) cutaneous branches,
4. The anterior interosseous nerve (nervtis interossevs [antehra- proper palmar digital nerves (nervi ;.':.
chuj anterior) (Fig. 861) arises from the main trunk of the median (a) the cutaneous branches arc i
nerve at the level of the pronator teres muscle and runs cUstally in neurosis to penetrate into the skin i
Created with novaPDF Printer (www.novaPDF.com)'arteria interossea an palm;
NERVES O F T H E UPPER LIMB
N. cutaneus anlebrachM
posterior
N. cutaneus ultebrachli
Fascia antebrach
R. superflcialis n. radlalls
Retinacj[jm eslensorntn
R commumearts ulnuris
Fasda clc.rs-.-il!.-, manjs
Nit; JlgHales dorsales
tin. digl tales palmarw pruprii
864. Cutaneous nerves of right hand; dorsal aspect (%).

(The skit! and subcutaneous fat are removed; the nerves arc dissected.)

(b) the w i r d l i
digital nerve and mpp*? *be
(1) the first common paimxr ipfcal
ductor pollicis brevis, flexor pollicis brevil mperfiaal iearfli,
ponens pollicis, and first lumbrical muscle*;
(2) the second common palmar digital nerve innervates d i:.z - i
second lumbrical muscle; The proper (raSaf)

(3) the third common palmar digital nerve innervates (incon vate die skin on the
stantly) the third lumbrical muscle. and send small coroniimicatMy
(c) the proper palmar digital nerves (nervi digitala palmares the radial ner. .
proprii), seven in number, innervate the skin of the radial and uluar The proper palmar digital
borders of the palmar surface of the thumb, index and middle index, middle, and ring finger*
fingers, and the skin on the radial border of the palmar surface of dorsal surface of their middle and
THE POSTERIOR CORD
The posterior cord (fasciculus posterior plexus brachialis) is formed posterior part of the deltoid region a* wefl as i i J L f f l
by the anterior primary rami of the fifth, sixth, seventh, and eighth per part and lateral surface of the upper .
branches may communicate with die postern
cervical, and first thoracic nerves ( C s - C 8 , Th]).
the arm (nervus tutarteus brachii posterior., whin
It gives origin to the circumflex nerve (nervus axillaris) and the
dial nerve, and with the posterior cutaneous n
radial nerve (nervus radialis).
(nervus cutaneus aniebrackii poiiervrr), also a brine
THE CIRCUMFLEX NERVE
The circumflex nerve (nervus axillaris) (C 5 -C 6 ) (Figs 850, 853, THE RADIAL NERVE
854) is a relatively thick trunk. It lies in the axillary fossa, at its
apex, behind the axillary- artery and on the surface of the tendon of The radial nerve (nervus radittlis) (C=-C*. Thi)
tfie subscapularis muscle. It runs slightly downwards, laterally, and 857, 864-867) lies in the axillary fossa behind the
to the back, and in company with the posterior circumflex humeral At the level of the inferior border of the tendon of d
artery passes through the quadrangular space, winds round the dorsi muscle the radial nerve runs backwards. 1
back of the surgical neck or the humerus, stretches between it and downwards and in company with tile profunda b
the deltoid muscle, and gives origin to the following branches: passes between the long and medial heads of die t
(a) the muscular branches (rami musctdans nervi axillarcs), muscle and fits into the spiral groove (allots w n
several small nerve trunks entering the depths of the teres minor humerus. Then in company with the anterior deseenau:
muscle through its inferolateral surface and the thickness of the of the profunda brachii artery (urteria atllater&Us Tadmla,
deltoid muscle through its inner surface. Among the last-named nerve runs between the brachialis and brachioradialis m i
branches is a group of twigs which are distributed in all bundles of the level of the lateral epicondyle the radial nerve divides into
the deltoid muscle (Fig. 856). Some of these twigs perforate the perScial branch (ramus supeifiaalis) and a deep branch (rawxi }m
muscle and enter the skin. Besides, a muscular nerve may send a jundus).
muscular branch to the inferolateral part of the subscapularis mus Branches of the radial nerve (Figs 854, 863-867).
1. T h e articular branch arises from the main trunk of the r
cle.
dial nerve at the level of the surgical neck of the humerus and a
(b) the articular branches are twigs stretching to the articular
tends to the articular capsule of the shoulder joint.
capsule of the shoulder joint between the capsule and the inner
2. T h e posterior cutaneous nerve of the a r m (nervus tv.tamr*i
surface of the deltoid muscle; they also send twigs to the perios
brackii posterior) arises from the main trunk of the radial nerve h
teum of the humerus.
the axillary fossa, runs obliquely backwards, sometimes penetrat
(c) the upper lateral cutaneous nerve of the arm (nervus cutantiis
ing through the thickness of the long head of the triceps brachii
brachii lateralis superior) stretches between the deltoid muscle and
muscle, pierces the brachial fascia approximately at the level of the
the long head of the triceps brachii muscle (in rare cases it passes
tendon of the deltoid muscle, and ramifies in the skin of the po-
through the thickness of the deltoid muscle). It divides into as
tcrolateral surface of the upper arm. Its branches may communi-
cending and descending branches which ramify in the skin of the

NERVES O F T H E UPPER LIMB 203
165. Nerves of right hand; dorsal surface (specimen prepared by V.Bobin). (Photograph.)
1superficial branch of radial nerve 4terminal twigs From median nerve passing to dorsal surface of
2communicating branch between ninai ami radial nerves fingers
Hdoireal digital nerves 5dorsal digital Tierves (from ulnar nerve)
6dorsal branch of ulnar nerve
rirh those of the upper lateral cutaneous nerve of the arm nerve in the caualis humeromuscularis, extends in attendance to
u culaneus brackii latcralis superior) which is a branch of the cir- the main trunk to the lateral Intermuscular septum, pierces it and
tex n a v e (nertiits axillaris). the brachial fascia at the lateral border of the brachioradialis mus
. The muscular branches (rami musatlares) in the region of the cle, arid ramifies in the skin on the posterior surface of the distal
r ann are supplied to the three heads of the triceps brachii part of the upper arm and posterior surface of the foreann down to
i t to the anconeus muscle, and quite often to the lateral part the region of the r&diocarpal joint. Its branches may communicate
c brachialis muscle. with those of the medial and lateral cutaneous nerves of the fore
. The muscular branches (rami mwscutarts) in the region of the arm and with the dorsal branch of the ulnar nerve (ramus dorsalis
r joint stretch to the brachioradialis and extensor carpi radia- manus nervi ulnaris) and the superficial branch of the radial nerve.
agus muscles. 6. The superficial branch arises from the maintrunkof the ra
Fhe posterior cutaneous nerve of the forearm {nerrjus tuta- dial nerve in the cubital fossa at the level of the lateral epicondyle
aiebrathii posterior) arises from the main trunk of the radial and lies medial to the brachioradialis muscle. Dis tally it lies lateral

204 THE THORACIC SPINAL NERVES
to the radial artery. In the middle third of the forearm the super than the superficial branch and lik
ficial branch deviates laterally and, after passing between the ten trunk at the level of the lateral epicon
dons of the brachioradialis and extensor carpi radialis longits mus supinator muscle, winds round the u
cles to the posterior surface of the radial (lateral) border of the descends obliquely to the posterior
forearm, perforates the antebrachia) fascia slightly above the radio- which it lies under (he extensor digitt
carpal joint. Then the superficial branch of the radial nerve ram superficial and deep extensors; after t
ifies in the skin on the lateral region of the radiocarpal joint and in company with the posterior intert
the lateral half of the dorsum of the hand and fingers (see below) dorsal surface of the wrist.
to form the dorsal digital nerves (nervi digitales dorsales neroi radia The deep branch gives origin to:
lis). (a) the muscular branches (rami n
The superficial branch gives origin to the following nerves: forearm which supply the Following
(a) the communicating branches (rami commutikatites) are small carpi radialis brevis, extensor digito
twigs running to the lateral and posterior cutaneous nerves of the extensor carpi ulnaris, abductor pel
forearm in the region of the posterior surface of the lower third of brevis, extensor pollicis longus* extei
the forearm and the radiocarpal joint; the communicating branch (b) the posterior inter osseous nc
with the ulnar nerve (ramus communieans ulnaris) which connects the thii] posterior) originates between the
superficial branch of the radial nerve with the dorsal branch of the the extensors, then lies on the dors;
ulnar nerve (ramus dorsalis warms ncrvi ulnaris) on the dorsal surface membrane of the lorearm between th
of the hand; licis longus and extensor pollicis br
(b) the dorsal digital nerves (nervi digitales dor sales nervi radialis), metacarpus.
five in number, innervate the lollowing skin areas: the radial and Along its course the posterio
ulnar borders of the dorsal surface of the thumb down to the base branches to the interosscous itiembn
of the nail, the radial and ulnar borders of the dorsal surface of the with the anterior interosscous nerve
index finger down to the middle phalanx, and the radial border of anterior) which is a branch of the me
the dorsal surface of the middle finger, also down to the middle and bone thickness of the dorsal su
and to the articular capsules of the
phalanx.
7. The deep branch (ramus profundus neroi radialis) is larger metacarpophalangeal joints.
THE THORACIC NERVES

The thoracic nerves (nervi tkomciri) (Th 1 -Th li? ) (see Figs 839, salis); the medial cutaneous branche-
847-868) make up 12 pairs. As it is pointed out above they form primary rami of the thoracic nerve?
no plexuses (see The Spinal Nerves), four lower rami. On their way the nir
Each thoracic spina! nerve is mixed in character. On emerging branches {ramirnvsatlarcs)to the rotat
from the intervertebral foramen it gives origin to the following nalis thoracis muscles. The cutaneou
branches: meningeal, communicating, posterior primary and ante in the regions corresponding to these
rior pirmary rami. (b) The lateral branch stretche>
1. The meningeal branches (rami meningei) supply the me- longissirnus thoracis muscJes and. If
ninges of the spinal cord. the skin in which gives rise to the lat
2. The communicating branches (rami commtinic&ntes) run to cutaneus lateralh rami dorsaUs). In coir
the sympathetic trunk. branches the lateral cutaneous bran
3. The ptxsterinrprimary rami ffemi A&rsales nenwrs/m ihornfifff- eight posterior primary ram) are ih.
rum). Each arises from the corresponding thoracic nerve in the from the lower four rami. The later
space between two transverse processes of neighbouring vertebrae branches (rami musculares) to the CO?L-
and divides into a medial and a lateral branch. lis, and longissirnus dorsi muscles.
(a) After its origin from the posterior primary ramus the me 4. The anterior primary rami >.
dial branch passes next to the spinous process between the multifl- nervorum thoracic&ritm). Each ramus i-
dus and scmisoinalis muscles and enters the skin in which it gives tween the ribs. The anterior primar.
Created with novaPDF Printer (www.novaPDF.com)inwus mediaiit rami dor- netves arc also called the intercom
NERVES OF THE UPPER LIMB 2m
1 branches of mc.diaJ cutaneous nerve of arm

Imedial cutaneous. Tir-rvr of forearm
iram ill ration of medial cuutriOui nerve of
foromi
4olnar nerve
5 ^ median nerve
fbranches of radial nerve
1nperfkial branch of radial nerve
branches of medial cutaneous nerve of fore
arm mi upper arm
! bartraJ cutaneous nrrve H[ forearm
11poaerior cutaneous nerve of arm
U p o o e i i o r cutaneous nerve of forearm
mperfirial branch of radial nerve
i* dorsal branch of ultutr n a v e Supplied to the
knd
15branches of medial cutaneous nerve of fore-
r65a. Cutaneous nerves of right upper limb (specimen prepared by N.Samoilov). (Photograph.)
Apalmar surface; B dorsal surface
- -Th H ), the anterior primary ramus of the twelfth thoracic upper arm and innervate the skin 011 it or communicate with the
TV
(Th12) ** called the subcostal nerve fnewus mkostalis). The medial cutaneous nerve of the arm.
rater part of the first intercostal nerve (Th,) stretches as a com The subcostal n a v e fnervus .mhtmtalis) (Thit) contributes to the
ment of the braehial plexus; the second (Th2), often the third formation of the lumbar plexus (plexus lumbalis).
lb) and rarely the fourth (Tha) intercostal nerves give rise to in- Each intercostal nerve stretches in the corresponding intercos
costobrachial nerves (nem inleTtnstobrackiales) which pass to the tal space and at its origin lies in front of the external intercostal

N. trims versus to Hi (branch of
plexus cervical is)
Nn, supmclavicuiares (branches of

plexus cervical is)
N. cut an e us brachii
medialis (branch of plexus
brachialis) _^_^
N, cut line us brachii latcralis

(branch of n. axillaris
from plexus brachialis) _
N. cutaneus brachii
posterior (branch of /
ii. radialis from plexus brachialis) /
f /
/
N. cutaneus antebrachii
lateraJis (branch of //
Rr. euta
n. muscuTocutaneus
S (branches of nn.
from plexus brachialis).
Rr. cutanei latcrafc
(branches of nn. thora
(pectorales)
N, cutaneus antebracl
medialis (branch of pic
brachialis)
R. palmaris (branch of
n. medianus from plexus
brachialis) ^
K. superficial is (branch of R. cutaneus palmaris (branch of
n. radialis from plexus n. ulnam from plexus brachialis)
brachialis) -:*-,
^ R. superficialis (branch of n. ulnaris
from plexus brachialis)
^N. digitalis patmaTls
communls ri, ulnaris
1
V Nn. dlgllales pal mares
communes n. medlanl
Nn. digitalis palmares
proprii (branch of _ - > N n . digitales palmares
n, median us from plexus proprii (branches of n. ulnaris
brachialis) from plexus brachialis)
866. Distribution of cutaneous nerves of right half of shoulder girdle and rig
created with novaPDF Printer (www.novaPDF.com)iar) aspect (semischematical representatk
-Rr. cutanei lateralcs
(from rt. dorsaks nn,
thoracici)
Nn. supiadaviculares
(branches of plexus cervical is)
N. cutancus brachii
lateralis (branch of n,
axillaris from plexus
brachialis)
F*~ Rr, cutaaei laterales

r (branches of rr. dorsales nn. thoracid)
> Rr. cutanei lateral cs

branches from rr, ventrales
I (nn. intcrcoslales)nn. thoracid
N. cutaneus brachii
posterior (branch of n. radialis
from plexus brachialis)
medialis (branch of>

plexus brachialis)'
N-cutaneusantenrachii
posterior (branch of n. radialis)
fJOm plexus brachiaJJs)
N- cutaneus a rite brachii

lateral (branch of n. musculo-
N. cutaneusantehrachii cutaneus from plexus brachialis)
medialii (branch of
plexus brachialis)
R. superficial is man us
ft radialis (branch of
plexus brachialis)
R. Jorsalis
(branch of n. uinaris
from pjtxus |-jF-adii<ilis) -*
Nn, digit ales pal mares

proprii (branches of
n- medianus from plexus brachialis) * ^ " 1
\
'. ' \
K
r.- " \
f
867. M * * * * * . * ^ nerves of right half of shoulder girdle and right free uPPer lim
Created with novaPDF Printer (www.novaPDF.com)'
ct (semischematical representation).
20 S T H E THORACIC SPINAL NERVES
R. cutaneus medialis r. dorsals

/ R. cutaneus laterals r. dorsa
Radix dorsal is
v Medulla spinalis I I R. dorsalis n. tliorac;.
Radix ventral is
/ N , spinal:-
Rr. communicants M
jMm. intercostales
extern
R. cutaneus anterior i :
868. Intercostal nerves, arteries, and veins; anterosuperior aspect

(The skin covering of the anterolateral parts of the thorax in the region of the 5th and 6th ribs is removed;
endothoracic fascia are removed.)
muscle covered by the endothoracic Fascia and parietal pleura; the nerves reach the lateral border of the -
only exception is the subcostal nerve which stretches not in the in nis muscle, pierce it, run on the poster;
tercostal space but below the twelfth rib and at the beginning lies a small distance (0.5-1 cm) and then
in front of the quadratic lumborum muscle. Each intercostal nerve nerves give rise to cutaneous brancht
passes between the internal intercostal and intcreostalis intimi wall of the sheath of the rectus nhd :
muscles and approaches the costal groove in company with above skin of the corresponding region, while
stretching intercostal arteries and veins. ify in the thickness of the muscle. Tin
The upper six or seven intercostal nerves (Th t -Th 6 -Th;) run catc with each other. The distal parts
in the intercostal spaces to the lateral border of the sternum and intercostal nerves form plexuses (Fit;- *'
ramify in the skin of this region; the lower intercostal nerves ap 1. The communicating branches
proach the costal cartilages and pass through the cartilage of the from one intercostal nerve to the nev
next below rib to penetrate between the transversus abdominis and 2. The muscular branches (rami rh':
Created with novaPDF Printer (www.novaPDF.com)heir direction, the following muscles: leva tores cost a run:.
N. occipltalis
major
N_ occipltalis
minor-,_
& Rr. dorsales (nti, thoracic!)
Spin a scapulae _^M. lonjjiisinius

Aa. intercos tales posterior
.dorsales)
M. delloideus
Rr. dorsales
knrt, thoracicorum
Rr_ ctitanei / N . cutancus

late.r,-ile<. (from
brachii lateral is
rr. dorsales
nn, thoracicorum)
M. ilkjcostflis
\a. intcrcostale;
poster iores
(rr. dorsales)
M. latisslmus d o r s i - ^
Rr. cutanei
ractiiales (fiorti rr,
doi'salcs riri. ^
J
ttu-irariturum) - * " "
Fascia tlioracolumhalis
Rr. dorsales . Nn. clunimn

nn. lumbaliimi supcriores (from
IT, dorsales
nn, lujnbalium)
Nil. duniuri] medii

(from rr. dorsales
nn. sacrsilium)^
maximus
869. Nerves of trunk; posterior aspect ( ] /).

(Posterior primary rami of spinal nerves; left-cutaneous branches, rightmuscular branches.)

NERVES OF THE TRUNK
Nn. s upraclavicu lares

(branch of plexus cervicalis)
N. cutaneus brachii later
(branch of n. axillan>
from plexus brachialh
<
i
^ J , CUtafleus
h (bianch ot 7
N. email
(branch of n. rai.
Rr.cutanei later
(branches of nn. inter
Rr. cut an .
Rr. cutanet mcdiales (branches of rr. dorsa
(branches of n. dorsales
nn. thoracieorum) i 1
Nn. clunium super'
(branches of rr. dor
nn.lumbalium:
R.cutaneus i
(branch of n. ilioh
plexus lum
Nn. clunium medii

(branches of rr. dorsales
from nn. sacrales) -
N, cutaneus fen
(branch of pi e\
Nn. clunium inferiores N, eulancush

(branches of n. cutaneus posterior (branch
femoris posterior from | sacralisi
plexus sacrahs) ^ ~ B
870. Distribution of cutaneous nerves of trunk; posterior aspect (sei

Created with novaPDF Printer (www.novaPDF.com) representation)
NERVES OF THE TRUNK 211
Pedunculum cerebri
Ganglion .MTvlcale superiiis
Medulla spinalis -|
Ganglion cervieothoracicum ( s t r a t u m )
Gsngtfon tetvicaie m e d i u m ^ y]^. phrenlcuS
M. scalenus anterior-. d
Plexus hracHlalls-
:
. ' - ^ _
Clavlciils ^ . ^ T
A.axiliads^ Truncus aymphflticus
Rr communicant
Rr. ciilanei artterlonSS
(pectorales)
N. medlanus
Nn.iittertostales
M. rectus sbdomlnls
N. subcostal is-^
CoruS Tnedullarls
M. lumtalls N, CiitanfUS
bradili media I is
N.illotiypogastrlcu:
KUiolngulnsl!:
Plexus l u m b a l l s - ^ ^ T - -
M; ubliquiis ftxternjs abdomlnls
>f. cutanûs femorls IateiallS_
V. sapriens magna
N. obturatorlus Funkulus spemiatkus
-Rr. tutarel anteriores

(n.temuralis)
871. Sympathetic trunks and plexuses of spinal nerves; anterior aspect (/ 4 ).

[Right s i d e - t h e cavities of the thorax and abdomen are opened widely and the parietal pleura, parietal peritoneum, and the
end oth^ rack and transversalis fasciae are removed.)
212 T H E LUMBAR NKRVES
serratus posterior inferior, trans versus thoracis, subcostal, mtercos- eral cutaneous branch (it is a
tales intimi, internal intercostal, external intercostal, transversus plexus).
abdominis, internal oblique, external oblique, rectus abdojiiinis, The lateral cutaneous branches r
pyramidalis, and quadratus lumborum. times the third (Th3) and fourth (Ti
3. The pleural and abdominal branches arc twigs stretching in to the skin of the upper arm as the i
the intercostal nerves and branching oil from them to the costal anterior branch of the lateral cutaut
pleura, the peritoneum of the anterolateral walls of the abdomen, tcrcostal, or subcostal flwsrve (Thl5)
and to the serous covering of the diaphragm periphery. small twigs which cross the iliac eres
4. The cutaneous branches (rami cutanei) arise from the inter of the gluteus medius muscle to rear
costal nerves and form two rows of branchesthicker lateral cu greater trochanter.
taneous branches and thinner anterior cutaneous branches. (b) The anterior cutaneous b n
(a) The lateral cutaneous brandies (rami cutanei laterales [pecto [pectoralis et abdominis]) are the tenr
rals et abdommi*;]). They arise From the intercostal nerves and tal nerves. In the region of the thoi;
along the axillary line pierce the external intercostal muscles on tcrcostal muscles and extend to the
the chest to emerge between the slips of the serratus anterior mus as the rami cutanei anteriores peclt
cle, and the internal oblique muscle in the region of the abdomen. fourth pectoral cutaneous branches
After that eacli lateral cutaneous branch divides into an anterior mary gland and are called the mec]
and posterior branch; both branches innervate the skin of the mammarii mediates nervarum tkotddfon
corresponding regions. wall one of the anterior cutaneous b
The anterior branches of the fourth-sixth lateral cutaneous sis of the external oblique muscle at
branches reach the skin of the mammary gland; these are the lat abdominis muscle, while the other
eral mammary branches (rami mammarii laterales nervwum ikoracico- pierce the anterior wall of the sheath
ritm). cle at its medial border to ramify in
The first intercostal nerve (Thj) does not give rise to a lat the rami cutanei anteriores abdomii
THE LUMBAR, SACRAL, AND COCCYGEAL NET

The lumbar, sacral, and eoecygcal nerves (nenri lumbales, mcrales bosacral plexus (plexus lumbosticrali!;
et coctygeus), like all spinal nerves lying above, give rise to four (plexus lumbalis) (Th 1? , E1-L4) and Ih
groups of branches: nieningeal, communicating, and anterior and (L1-L1;, Go t ) are distinguished tsrpoi
posterior primary rami. The specific features of each group are is subdivided into' the sacral plexus
pointed out below in description of the corresponding nerves. (nervus pndendits) (S2-S+), and the cor
Here we shall just mention that the anterior primary rami of (S 4 -Co 1 ,Co 2 ) (see Fig. 839).
these nerves ( L | - I ^ , S,-S s , G&j-Coa) form a single common lum-
THE LUMBAR NERVES
The lumbar nerves (nerai lumbales) (Figs 857, 876), live in num base of the sacrum. Like all the oth
ber, are formed by relatively long spinal roots which pass vertically nerve gives origin to a rrtfenirtgej
in the vertebral canal. The anterior and posterior roots unite to branch, a posterior primary rainus ai
form the spinal nerves which emerge from the vertebral canal via The meningeal branches (rami
the corresponding hiteivettebral foramen so that the first lumbar meninges of the spinal cord.
nrfvc (] ,\ is KjMw^fti thr i\r<it nnrl spmnrl lumbar vertebrae, while The communicating branches ft
Created with novaPDF Printer (www.novaPDF.com) mbar vettebra and the sympathetic trunk,
NERVES OF THE TRUNK
N. cutaneus colli
/ (branch of plexus cervicalis)
/ Nn. supraclaviculares
' (braT)ehen of pfe*us cervical is)
N. cutaneus bracliii
I ateralis superior
h (.branch of n.axillaris
Suam plows brachialis)
Rr. cutanei anterior*?

pectoral es / N. cutancus brachli medialis
(b ranch cs of n n. i n lercostale s) I (branch of plexus brachialis)
Rr, cutanei latcrales
Rr. cutanei anicriorcs j (pectorales et abdominaks)
(abduminafei;) - (branches of nn. intercostales)
(branches of nn. intcrcostales) / R. cutaneus anterior (branch of
n, iliohypogastricus
R. cutaneus laieralis from pluxus lumbalis)
(branch of n. iliohypogastricus R, fe morali s
from plexus lumbalis)
(branch of n. gen i totem oral is
N. dorsalis penis
N. cutancuifemoris '-(branch of n. pudendus
lateratis (branch of from plexus sacra I is)
plexus lumbalis)
M. scrotalis anterior
(branch of n. ilioinguinalis
N, ilioinguinalfs from plexus lumbalis)
(branch of plexus lumbalis)
^r- Ri. cutanei antcriores
(branches of n. femoralis
R, cutaneus from plexus lumbalis)
(branch of n. ubturatorius
Distribution of cutaneous nerves of trunk; anterior aspect (semischematical representation).

NERVES OF THE TRUNK
:H
873, Nerves of right transversus abdominis muscle (specimen prepared by S

(Photograph,)
(Outer surface.)
5 twelfth intercostal nerve 10 ucinmunieating bit
1 Strain jsculaT nerve plenus stretching for the
6 communicating branches from eleventh and nerve
whole sKrttttM of the muscle 11ninth iintcKOKtal iu
2anterior primary rami of second lumbar twelfth intercostal nerves
7eleventh interuostai nerve Vi communicating bra:
nerve nerve
3anterior primary rami of firtt lumbaT nerve 8^commitnieating branch to tenth intercostal
nerve ISeighth intercostal n
Created with novaPDF Printer (www.novaPDF.com) 9tenth intercoHtal nerve
NERVES OF THE TRUNK
874. Nerves and arteries of left recius abdominis

muscle (specimen prepared by S.Gordienko).
(Photograph,)
(Inner surface.)
1 npcrrcr epigastric irtcry ft subcostal tiervt
$branches of superior epigastric ar 9 eleventh intercostal nerve
t n y in nui&cta thickness 10--1- tenth, intercostal nerve
$ J m a alba. 11 brarthes of inferior epigastric ar-
1umbilicus tcry in muscle thickness
5-intramuscular nerve plcjtus 13 ninth intercostal nerve
<- inferior epij^Rsmc artery 13 eighth inlcrcustal nerve
7int lumbar nervr 14 seventh intercostal nerve
216 T H E LUMBAR PLEXUS
The posterior primary rami (ram dorsales nervorum luttibalwm) (b) The lateral branches (rami h
lie between the transverse processes of the lumbar vertebrae, run twigs to the lumbar interspinales at:
dors ally, and each soon divides into a medial (ramus medialh) and a thicker branches to the skin. The lat
lateral (ramus lateralis) branches which innervate the muscles of the posterior primary rami of L l7 L^. L
back proper and the skin of the lumbar and sciatic regions the above-mentioned muscles and il
(Figs 8G9; 870). lumbalis) and descend below the ilia
The posterior primary' rami of the lower two lumbar nerves the gluteal region. They are called tl
(L4-L5) supply the muscles only. terior primary rami of the lumbar 1
(a) The medial branches (rami mediates) are smaller than the Along their course they couiinunica
lateral branches and ramify in the multifidus and the lumbar inter- the skin in the region of the greatei
spinales muscles.

The anterior primary rami (rami uentrales nervorum lumhalium) the distally situated sacral plexus fj
increase in diameter from the first to the tilth and are much sacral plexus (plexus lumbosacratis). H
thicker than the anterior primary rami of the cervical and thoracic means of the lumbosacral trunk
nerves. After arising from the trunks of the lumbar nerves, the an formed by union of the lower pjrl HI
terior primary rami of the first (Lj), second (L5), third (L3), and the fourth (L*) and upper part of the
greater, upper part of the fourth (L.t) lumbar nerve as well as part fifth (L>) lumbar nerves. The hi mix
of the anterior primary ramus of the subcostal nerve (Th1B) unite true pelvis and contributes to the fo
forming three loops called the lumbar plexus which together with
THE LUMBAR PLEXUS

The lumhar plexus (phxus lumbalis) (Th l2 , U-U), (Figs 871, behind and the psoas major muscle
875-877) lies in front of the transverse processes of the lumbar thickness of the last-named musHr
vertebrae. Its loops pass between I he quad rat us lumborum muscle
THE BRANCHES OF THE LUMBAR PLEXUS

T H E MUSCULAR BRANCHES
The muscular branches arise from the anterior primary rami of to the quadratus lumborum muscle
the first to fourth lumbar nerves (Lt-Lj.] before the lumbar plexus terior primary rami of the twelfth 1
is formed and innervate the mlcriransvei'se muscles of the lumbar bar nerves (Th }S , L , - ^ ) supply the
v'.rtn TL T .^W nrisimv FrOiti tbr anterior primary rami of the arising from the anterior prim a ry r:
Created with novaPDF Printer (www.novaPDF.com)nerves (Th12T Lj-U) run bar nerves (Ljv L2) innervate the p
THE LUMBAR PLEXUS
M. iliohypogastricua,
Ji femOfalls
ft. nbturatorlus
N. Illolngul
N. genilofemoralis
R. f emoralis R. genitetis
(from n. genilofeinoralifiy
HIS-(from n. getiitofemoralis)
| p
[ V T " - ^ ^ ' - - K CiirllRUS leillOtils posterior
Hr. iiiii.iu-: anteriorcs
f ^ S Rr, cutanei
liV
1ST peroiteus ^
i tlbulsHs^ comniLiiii^J^ N. Lll-i;i!i.i
N. c-utaneussiLr-ae
(ilbu[grls>profuiidus
me dial is-
N- peioneus
(Tibularl&) superficial!
" - . A . S^phfRUS
surae lateral! s
N. cutancus dorsals
rrtedlalis
N. cutaneus dorsal!*
intermediua
N. culxneuf do/satis
lateral[$
N- ptantarl,H mcdialls
dorsflics pedis
N. pJantoris literati*
875. Lumbosacral plexus and nerves of free part of right lower limb; anterior aspect (represented
semischeniatically).

218 THE LUMBAR PLEXUS
Diaphragma
N. subcostal Is
Tnmcus sviupjathlcus ^- ^ndl(f^H
M. qufldraini lurofnirirm.
to hypo gastric us
Plexus EnmbflJis N. lilolBjjuInalis
Promiwti
kr. cummuHicrinles
Tr unfits
titinhos;icralJs M. psoas major
M cutaneus temorfs
sacralia luteralis
R. yenitalis
Sjsina i||;a;i t~in. gtflftofemwatjs)
autendr superior ^
-* Rr. muKcuiorcs (from plexus
N. ciitaueus lumbalis) t o r n , tllacus
x
f't-ninris lLitralJsÎ=ti^|,
-R. iernoralis
(ft gen itofe moral is;
B~"Li. illguinnle
J - N . femoralis
A, prplumta
Pfexiij sacralis femoris.
f - V . ierniiralls
N. obluratofius \
V femoralis
M. pectineus
(divided) -~-i;_
A, el v. pruFundae j
N. Sfiphenus - ^ A (ertioralls
" M. sartorius (divided)
876. Nerves of lumbar region and pelvis; anterior aspect [%),

( L u m b o & a e r a l p l e x u s ; the psoas m a j o r m u s c l e is r e m o v e d o n the right,)

TH LUMBAR PLEXUS 219
Aorta abdominalis
V. cava inferior
A . lumbalisIV
and accompanying veins Ureter
N. cutaneus A. et v iUacae
femoris lateralis_< communes
sinistrat
K. iliacus a. iltolumbalis
V. Iliaca
and accompanying veins
Interns
M, psoas maJor_ A. .sacral[s
medians
M. femoral Is
A, et vv. circumSkxae sacra I Is medians

Lllum profundae Ganglia sacralla
A. et V. clrcunrilexaej ~ _ A. et v.iUacat
ilium Superlicialea *ML extern ac
N. cutaneus femorisg j N. obturatorlus
anterior (cut off) jjlij yf--~ M. pectincus
R ascenriens a, drcumP (cut and reflected)
flexae femoris iaterallaji
. A. ei v. obturatorlae
A- circumflex's
femoris medialis H. anterioi a. obturatoriac
A. circumftexa K- anterior |
feinorls lateralis^^ N. ohturatorius
"^R. posterior
R. descenderis a,
circumflexae femoris Rr. mustulares
lateraHs^,^"
__ M, adductor loo gus
A. prof un da femoris (divided)
V. profunda lemons
R. muncularis
(to m. vastus latcraUs)^ Rr. muaculares
S
>V: femuralls
Vv. comltantes a,
femoralis ^szH R. cutaneus n. obturatorll
.^_M gracflis
R. muscular is -R- cutaneus n. femoralis
(to m. vastus medialis) MB
_^_A. fernoraUs
M. rectus femoris J
N. saphenus__
T'- A. genus descendens

^ and accompanying veins
Rr, cutanci
ind accompanying veins
^ s * R. articularls
A, genus superior medialis

Rete articulate genu^
(rete patellae} ^ ' ~ -jRr, inf rapate.lt ares n.
sapheni
A. genus inferior medialis
N, sapbenus
877. Nerves and vesseb of right thigh; anteromedial surface (%),

Created with novaPDF Printer (www.novaPDF.com)grjj arc partly removed.)
THE ILIOHYPOGASTRIC NERVE
The iliohypogastric nerve (nervus iliokypogastricus) Ibrms from

the subcostal nerve (Thls>) and anterior primary branch of the first
lumbar nerve (L,). It pierces the superolateral part of the psoas
major muscle and passes to the anterior surface of the quadratus
lumborum muscle and lies here between the muscle and the kid
ney. Then the nerve descends anteriorly, penetrates the trans versus
abdomims muscle above the iliac crest, and stretches between it
and the internal oblique muscle and then between the internal and
external oblique muscles.
In the region ol the deep inguinal ring the iliohypogastru:
nerve pierces the internal oblique muscle and then the aponeurosis
of the external oblique muscle, runs to the region of the superficial
inguinal ring, and ramifies in the skin on the lower abdomen above
the symphysis.
Branches of the iliohypogastric nerve:
(a) the muscular branches stretch to the transversus abdominis
and internal oblique muscles;
(b) the lateral cutaneous branch (ramus cufaneus lattralis nervi
iliokypugaitrid) arises from the main trunk above the middle of the
iliac crest, perforates both oblique muscles, and ramifies in the
skin oa the superolateral area of the thigh where it may communi
cate with the lateral cutaneous branch of the twelfth thoracic
nerve;
(c) the anterior cutaneous branch (ramus cutaneus anterior nerv
iliokyfiogastrici) is a continuation of the main trunk; it pierces the
aponeurosis of the external oblique muscle and ramifies in the skin
above the pub is,
THE ILIO-1NGUINAL NERVE
The ihVinguinal nerve (nervus ilio-inguinalis) (Lt) stretches un

der the iliohypogastric nerve almost parallel to it. On emerging
from under the lateral border of the psoas major muscle, the ilio-
inguinal nerve stretches on the surface of the quadratus lumborum
muscle, then pierces the transversus abdominis muscle and runs
between it and the internal oblique muscle to the superficial ingui
nal ring. After passing through the aponeurosis of the external ob
878. Nerves and arteries of right sartorius muscle lique muscle in the region of this ring, where it is related to the an-
teromcdial surface of the spermatic cord or the round ligament of
(specimen prepared by S.Ostrovsky).
the uterus, the nerve terminates m the skin on the pubis, scrotum
(Photograph.) (the labia majora in females), and inguinal region.
(The middle part of" the muscle; barium solution is injected into Lying between the indicated muscles, the ilio-iuguinal nerve
the vessels; the largest vessels are demonstrated,) forms communications with the iliohypogastric nerve.
1 main artery of muscle (a twig of ascending branch
oi lateral circumflex artery)
Branches of the iiio-inguinal nerve:
2 one of iiif. rummuui rating nerve branches (a) the muscular branches innervate the lower portions nf the
adefending nerve branches
transversus abdominis and internal and external oblique muscles;

THE LUMBAR PLEXUS 221
1 vaslus mediaJis ifiMStfc

IIvastug intermedius muscle
IIIvascus latcialis muscle
1femoral nerve
2anterior cutanecms branches
3 medial nerve trunk
4nerve twigs miming to vajitu* mcdialfc m u s d e
5 inferior nerve trunk ol'vastus tar.etali* muscle
(>communicating branch in substance of fisUi* iriierniediun
muscle
7, &nerve twigs n i t m i n g t o comruriii tendon oi tjiuiilrrccps femri-
ris muscle
), 10iifiti-riding nerve Fwigs arising from interior nciv* trunk (jf
vastus ialeralis muscle
11 ticivc tivig miuiing to vaslus intermediu.ij muscle
12superior nerve trunk to vast us lateiafa muscle
13nerve trunk running to rtxtus femoris muscle
14 lateral nerve trunk
aiutraniu.si-utai: branches ofvastua nmlialis muscle
b - intramuscular branches of inferior nerve trunk of vaslus la-
teralis muscle
( intramuscular blanches of superior n e w t trunk ofvastua la-
leralis muscle.
579. Nerves ofvastus muscles of right thigh (specimen prepared by S.Ostrovsky). (Photograph.)
(The external surface of the muscles is demonstrated.)
(b) the cutaneous branches ramify in the skin of the pubis, up- orts) pass to the skin of the root of the penis, the anterior parts of
er part of the medial surface of the thigh, and the inguinal re- the .scrotum (upper parts of the labia majors in Females). These
ion; brandies may communicate with the genital branches of the geni-
(c) the scrotal (or labial) branches (nervi scrotales /labiaksf anteri- tofemoral nerve.

Nn. strotales postwiorfs % V*. SCTuijlcS
A et v. penis nnSI?riores
Nn.perincales Ny
M . transversus ^^ "V M. transversus pfn-f-
N
perinei superficial^ v Nv SUptTlJCijilS
(divided) j \ \
\ \ \<

JU-Tuher Iscbladicum
N. dorsal Is
perls v pudendae
interrsae
LA pudenda interns
Vv. pudendae .JHj
Vv. rectales
N. pudendus """
inferiorcs
v
Aa. rectales inferiores \^ Anjs
is i M . sphlnctfir ant externus
A_ pudenda Interns
Nr. rectales Irfferlores
880. Nerves, arteries, and veins of male perineum; inferior aspect (%).
(The gluteus maximus muscle on the right is divided; the scrotum is reflected; part of the sacrotuberous ligament is removed.)
THE GEMTOFEMORAL NERVE
The genitofemoral nerve fnertms gemtofemoralis) (L,, L J pauses triangle. A twig of the femoral branch may communicate with the
in the depths of the psoas major muscle to its anterior surface and intermediate cutaneous nerve of the thigh (ram aitaneus anterior
extends behind the ureter towards the inguinal region. In the mus- nermfimoTalis) and with the ilio-inguinal nerve;
cle> or on emergence from it, the nerve divides into two (b) the genital branch frttmus gmitalis tarsi gmitofcmomlis) lies
branches the Femoral (ramus femoralis) and genital (mmus getiita-
on the anterior surface of the psoas major muscle medial to the
lis) branches:
femoral branch but also lateral to the external iliac vessels; it de
(a) the Femoral branch (ramus femoralis nervi gtmtofmoralh) scends into the inguinal canal, passes to the superficial ring, and
stretches lateral to and behind the external iliac vessels (easa iliaca leaves the canal together with the spermatic cord (or the round lig
extenw), at first behind and then in front of the fascia iliaca, and ament of the uterus in females). It then runs into the scrotum,
enters the lacuna vasorum in which it runs lateral to and in front sending on its way small branches to the cremaster muscle, the
(if the rcmora] artery. After that it pierces the fascia lata of the skin or (he scrotum, the dartos muscle (lumca dartos), and the upper
thigh in the region of the fascia cribrosa covering the saphenous areas of the medial surface of the thigh; in females it sends twigs to
opening and ramifies in the skin of this area, Some of its branches the round ligament of the uterus and the skin in the region of the
pass under the inguinal ligament, pierce the fascia lata of the superficial inguinal ring and the labia majora. This branch may
thigh, and are distributed in the skin in the region of the femoral communicate with the femoral branch of the genitofemoral nerve.

881* Nerves of male perineum; left side (specimen prepared by A.Kosov). (Photograph.)
(The left ilium is removed; the urinary bladder arid rectum are opened.)
9 muscular branches oi pudenda! plexus 18left bulb-urethra! gland
1ncruni
10pfrineal nerve 19syiupliysis (secondary cartilaginous joint)
Isacral g^ng'Taa of sympathetic trunk
] 1 branches of perinea! nerve 20nerve twig tiom pcrinesl nerve to bulbo-
1ajittriOT sacral foramina
12bism'h to prostate urethral glaud
Abranches of syni pathetic trunk to pelvic
13bianches of perinea] nerve to skin of peri 2] prostate
plexus
neum 22dorsal nerve of penis
5sacral plexus
14strotum 23Lrriuarv bladder (opened)
<fpelvic splanchnic nerve firtm S^ to pelvic
ISbranches at perinea! nerve to serotuun 2+ rectum (opened)
ptcEUS
16penis 25pelvic plexus (ventral part).
7 ^pudenda] nerve
8inferior haeinorrrirtidal nerves 17branches of dorsal nerve of penis
T H E LATERAL CUTANEOUS NERVE O F THE T H I G H
lateral cutaneous nerve of the thigh (ntrvus cutaneus femoris it descends lateral to the sartorius muscle, pierces the fascia lata,
(L(, t^) emerges from under the lateral border of the and ramifies into some small and two or three larger branches
major muscle, sometimes thruugh the substance or the mus- which reach the knee joint. The branches of the nerve may form
nrrtches on the anterior surface of the iliacus muscle under communications with the intermediate cutaneous nerve of the
sHaca to the anterior superior iliac spine medial to which thigh (ramus cutanens anterior nervi femoralis).
t under the inguinal ligament onto the thigh. On the thigh

THE LUMBAR PLEXUS
24
Ostium urethras Kn_ i^^ pOSieriore$

externum N, dorsal Is clitoridts
Labis mlnora pudendl
Ostlum vsîra^ Labijm majus /
\ Clitoris
Bulbus vtstib'-ili ,' ,' pydendl / k _ A . clttorldls
\
M. dmsalls clltoridts / / / 7 A. Inbialis posterior
M. transversus / f .M. IschlOCavernoSus

* : . / / / /
pwlnei .profimdus ^J fA. transversus peri net

BupeTiictallS
Tuber Lschiadicum J | S
,A. pudenda interns
1 Vv, puderjdae
internac
Sn rectales inierlores
Nil pcrinenles-^^^M
-;3
A. pudenda I n t e r n a l
J
Vv. pudendae Sflterftae
M- gluteus rnaxlmus
N. pudendus
M, levatrtr arli' A rec tails inferior
Vv. rectales inferlof.es' Fossa Istriiorcctalis
M, sphincter ani extern us
882. Nerves, arteries, and veins of female perineum; inferior aspect (%).
(The glutens maximus muscle on the right, is cut; part of the sacrotuberous ligament is removed.)
THE OBTURATOR NERVE
2. The anterior branch (mmus anterior ncrvi obtumtorii) is a con

The obturator nerve (ntrvus obtaratorius) (Ei, L^, L3, E4, L5)
tinuation of the main trunk. It stretches between the adductor lon-
(Figs 875, 877) lies first behind the psoas major muscle but then
R us and adductor brevis muscles and sends muscular branches to
emerges from under its medial border, pierces its fascia, and at the
level of the sacro-diac joint descends to the arcuate line of the pel the adductor longus, adductor brevis, gracilis, and pectineus (in
vis (lima terminate). Stretching parallel to this line for some dis constantly) muscles.
tance, under the cover of the external iliac vessels, it descends to The ohturator nerve passes Further between the adductor lon-
the lateral wall of the true pelvis to enter the obturator Eoramen m gaa and gracilis muscles, pierces the fascia lata between the sarto-
company with the underlying obturator vessels. On entering the rius ami gracilis muscles, and as a cutaneous branch (raimis cuta-
obturator eanal the nerve divides into two terminal, anterior, and neus) ramifies in the skin of the lower parts of the medial surface of
the thigh down to die knee joint. The obturator nerve may com
posterior, branches.
Branches of the obturator nerve. municate with the saphenous nerve which is a cutaneous branch of
1. The muscular branch (ramus musatbiris) takes origin from the femoral nerve.
the main trunk before entering the obturator canal and passes i. The posterior branch (mmusposterior rurvi ubturatorii) pierce
through the canal together with it to ramify in the obturator exter- the obturator extemus muscle (or, rarely, passes through its sub
nus muscle. stance) after origin from the main trunk, runs between the adduc-

Isuperior border a( muscle

[]medial bord er of muse le
lit inferior border of muscle
IVlateral border of muscle
I superior tmnk of inferior '.;l ni I nerve and its i-aindi
cations in the muscle thickness
2inferior trunk of inferior gluteal nerve and its
branches in the iiiustlc thickness.
883. Nerves of right gluteus maximus muscle (specimen prepared by N.Rybakina).

(Photograph.)
(Medial surface of muscle.)
or magnus and adductor brevis muscles, and sends muscular An inconstant accessory obturator nerve (Lj, L s , L*) lies at the me
tranches (rand musadares) to the adductor magnus and adductor dial border of the psoas major muscle above the fascia iiiaca,
ninimus muscles. passes through the pectineal line (ptcten osns pubis), and stretches
In addition, the posterior branch gives rise to articular between the iliopsoas and pecttneus muscles where it ramifies
ranches innervating the articular capsule of the hip joint and sending branches to the peclineus muscle and the hip joint and
tranches to the periosteum of the posterior surface of the femur. communicating with the other branches of the obturator nerve.

THE LUMBAR PLEXUS
226
884. Nerves of right glutens medius muscle (specimen prepared by N.Rybakina). (Photograph.)
(Medial surface of muscle.)
I rtervc twi arising independently iTom sac
Isuperior border of muscle
H posterior border of muscle ral plexus, and it* branches, in the muscle
HIdistal tendwi of muscle thickness
2frank of superior gluteal nerve and its ram
IVantcriurlwrderuf muscle
ifications in the muscle thickness.
THE FEMORAL NERVE
main trunk in the false pelvis and run to the psoas major muscle;
The femoral nerve (nervus femorahs) (L t , Lj, Lji L+)
the shorter branches originate from the lateral surface, the longer
(Figs 875-379) is the largest nerve of the lumbar plexus. At the be
branchesfrom the medial surface of the trunk.
ginning it lies behind the psoas major muscle, then emerges from
2. The nerve of the femoral artery proper branches oft Trom
under its lateral border and stretches in the groove between the
the main trunk of the femoral nerve in the cavity of the pelvis
psoas major and iliacus muscles under the fascia iliaca to the la
slightly above the inguinal ligament, passes together with it
cuna musculorum. Through the lacuna the femoral nerve passes to
through the lacuna musculorum, and runs to the femoral artery
the thigh on which it stretches under the fascia covering the iliacus
immediately below the inguinal ligament. It ramifies in the con
and peelineus muscles in the femoral triangle, lateral to the fem
nective tissue of the walls of the femoral artery and the profunda
oral vessels. Directly in the lacuna musculorum, or slightly distal
femoris artery. One or two branches approach the femur and enter
to the inguinal ligament, the nerve divides into its terminal
it through the nutrient foramina.
branches among which three groups can be distinguished: ante
3, The muscular branches of various thickness and length pass
rior, medial, and lateral.
in the region of the thigh to the following muscles: the sartorius
Branches of the femoral nerve.
1. The muscular branches (rami mtucularts) arise From the (from the anterior and lateral groups of branches), pectineus and

85. Nerves of left glutens minimus muscle (specimen prepared by N.Rybakina). (Photograph.)
] superior border of muscle 1 trunk of superior gluteal nerve and its
[I posit rior border of muse! e branches in musclt thickness.
IIIdistal tendon a( muscle
IVant*ii(.>r border of musdr
us medialis (both from the medial group of branches), rectus and anteromedial surface of the thigh, reaching the region of the
arms vastus intermedius and vastus lateralis (all from the lat- knee joint Those piercing die sartorius muscle and stretching
il group of branches), and the articularis genu muscle, above its anteromedial surface form communications with the cu
The muscular branches which run to the rectus femoris muscle taneous branches of the anterior branch of the obturator nerve.
KJ branches to the articular capsule of the hip joint; those The other group of branches, likewise piercing the sartorius mus
Etching lo the vastus medialis and vastus lateralis muscles send cle but stretching on its anterolateral surface, form communica
gs lo the articular capsule of the knee joint and the periosteum tions with the branches of the lateral cutaneous nerve of the thigh
the femur. and the femoral branch of the genitofemoral nerve.
4. The intermediate cutaneous nerves of the thigh (rawi cuta- 5. The saphenous nerve (nervus saphenus) is the longest branch
a era ftmoratis}, three to five in number, pierce the fascia lata at of the femoral nerve, It originates from the medial group of
[ levels of the thigh and ramify in the skin of the anterior branches and runs initially lateral to the femoral artery. It then en-

M, gluteus medlus
A. glutea superiorÂ ^ j ^ ^ V v . glutaie superiors
M- gluteus maxim us. N. glutens superior
AA. gluteus minimus

N. gluteus inferior
M. pfriformis
A. et v. gluteae
Inferiores-*.^
A. pudenda intern a
A- et v.
comitatites M, tiuadratus
n, Ischladlcl--' femoris
N. cutaneus femoris J Rr. profundl ( a. et w,

posterior (divided) circumflexae remofis
medians)
N, isctiifldlcus
A. et v, perforantes
ft^-A.etv. perforates
Rr. musculares^
A. et v, peTforarrtes
M. semltendinosu
M. semtmembranosus-i;
M, bleeps Femoris
A. poplltea-V!
V, poplltea
N. Ubial1s-\
N, peroneus (Itbularls) communes
Fossa poplltea
M. gastroctiemlus
V. saphena parva
: . - ; * * ^
886, Nerves, arteries, and veins of right thigh; posterior aspect (y 4 ).

Created with novaPDF Printer ( w w w . n o v a P D F . c o m ) ^ muscles and t h e long h e a d of biceps femoris muscle are divided.)
cmilmdinosu? muscle
DO; bead of biceps femoris muscle
emiritTTlbT^r^ftii^ muscle
boil head of biceps femoris muscle {on the left)
oniraon origin of posterior group of thigh mus
ks
itrvie (superior) of jernitendinosus muscle
ommunicaiiiig nerve rviig
Kiwe trunk running to semitendinosus musck
:er*e trunk running to short head of biceps
nnoris muscle
ier*t (iEfcriw) of iemitendiito$u* muscle
kieral popliteal nerve
icr*c trunk nmiiinf to long head of biceps fent-
fii muscle
ncdiaJ popliteal nerve
rialk nerve.
887. Nerves of muscles of right thigh (specimen prepared by S.Ostrovsky). (Photograph.)

(The posterior group of muscles of the thigh, media] surface.)

230 THE SACRAL NERVES
ters the subsartorial canal (canalis adductorius) together with the (sometimes more than one) arises from the nerve trunk at the level
Femoral artery and vein and lies in it in front of and lateral to the of the medial epicondyle of the femur; it then pierces or by-passes
artery. After that the nerve passes through die anterior wall of the the tendon of the sartorius muscle, penetrates the fascia and ram
canal together with the descending genicular artery (arteria gem ifies under the skin in the region of the patella and medial surface
descenders) and stretches in the groove between the vastu.s medial is of the knee and upper parts of the leg (above the tubercle of the
and adductor magnus muscles covered by the posterior surface of tibia);
the tendon of the sartorius muscle. Here it pierces the fascia lata of (c) the medial cutaneous nerves of the thigh (rami cutanei cruri
the thigh, penetrates into the skin, and descends on the anterome- mediatis) are a series of thin branches arising from the saphenous
dial surface of the leg down to the foot in company with the long nei-ve along its length and running to the medial surface of the leg.
saphenous vein. Some of them pass into the skin of the anterior and posterior sur
On its way the saphenous nerve gives rise to the following faces of the leg.
branches: The saphenous nerve stretches on the medial border of the
(a) the communicating branches, in the middle of the medial foot, hut its terminal branches fail to reach the skin of the big toe.
surface of the knee joint, with the cutaneous branches of the obtu On uie foot, the nerve forms communicating branches with the
rator nerve; branches of the musculocutaneous nerve (nervus peroneus superfiria
(b) the infrapatellar branch (ramus injrapatellaris nervi sapkenus) lis).
THE SACRAL NERVES

The sacral nerves (newt sacrales) (S|~S6), five in number, origi branches; the meningeal and communicating branches (described
nate by the longest spinal roots and descend vertically in the lum in the section The Spinal Nerves) and the posterior and anterior pri
bar and sacral parts of the vertebral canal to divide into the main
mary rami.

The posterior primary rami (rami donates nervorum sacralium) surface of the sacrum to form a plexus in the region of the sacro-il-
emerge from the sacral canal through the posterior sacral fo iac joint and upper parts of the sacrotuberous ligament,
ramina; an exception is the posterior primary ranms of the fifth Its twigs innervate the articular capsule of this joint, the neigh
sacral nerve which emerges together with the posterior primary ra- bouring ligaments, the sacral part of the mu hi fid us muscle (S t
mus of the coccygeal nerve through the sacral hiatus. mainly), and the skin in the region of the sacrum and partly of the
The posterior primary rami of the sacral nerves are much thin coccyx;
ner than the anterior primary rami and divide into medial and lat (b) the lateral branches (rami lateraies rami dorsalei neruorum sa
eral branches; only die first three posterior primary rami of the cralium), as it is mentioned above, are formed only by the first three
sacral nerves ( S J - S J ) have lateral branches. posterior primary rami of the sacral nerves. They are much longer
(a) The medial branches (tami mediates rami dorsalts nervorutn than the medial branches, pierce the gluteus maximus muscle at
sacralium) are short and thin. They unite with one another and with the lateral border of the sacrum, and terminate in the skin of this
the posterior primary ramus of the coccygeal nerve on the dorsal region forming the gluteal branches (nervt clunium medii).

The anterior primary rami (rami nentrales nertmum sacralium) The lower, smaller, part of the anterior primary ramus of the
(Figs 874, 875) emerge from the sacral canal through the anterior fourth lumbar nerve (L4), and the anterior primary rami of the
sacral foramina (foramina sacralia pelvina) and reduce in diameter fifth lumbar (L5), first sacral (S,), second sacral (S?) nerves, and the
from the first Lo the fifth ramus. upper part of the anterior primary ramus of the third sacral nerve

THE SACRAL PLEXUS 231
(S3) unite by means of four loops to form the sacral plexus (plexus which passes over the arcuate line of the pelvis flinea terminals)
sacr&lis). The union of the mentioned part of the fourth lumbar into the true pelvis medial to the internal iliac artery to unite with
nerve with the fifth lumbar nerve forms the lumbosacral trunk the first sacral nerve.
(iruncus lumbosacrttlis). This is a rather thick bundle of nerve fibres
THE SACRAL PLEXUS

The sacral plexus (plexus sacralu) (l^-Sj) (Figs 875, 876) is a The plexus is surrounded by loose connective tissue and lies
thick triangular band whose apex is directed at the inferior part of under the parietal pelvic fascia; some branches of the internal iliac
the greater sciatic foramen. The smaller part of the plexus lies on vessels lie medial to it. The sacral plexus gives origin to short and
the anterior surface of this muscle. long nerves.
THE SHORT BRANCHES

THE MUSCULAR BRANCHES
The muscular branches are distributed in the following mus lus muscles (which are usually innervated by branches of the
cles; the piriformis, obturator internus (which can be innervated sciatic nerve).
also by the muscular branches of the sciatic nerve), and the gamel-
THE SUPERIOR GLUTEAL NERVE
The superior gluteal nerve (nervus gluteus superior) (L4, Lj, S|) dius and minimus muscles arching forwards, After giving off twigs
(Fig. 886) emerges from the cavity of the true pelvis in company to these muscles, it ramifies in the substance of the tensor fasciae
with the gluteal vessels superior to the piriformis muscle, curves latae muscle.
round the greater sciatic notch, stretches between the gluteus me-
THE INFERIOR GLUTEAL NERVE
The inferior gluteal nerve {newus gluteus inferior) (L>, S,, S2) of the gluteus maximus muscle. The inFerior gluteal nerve inner
(Fig.886) emerges from the cavity of the true pelvis into the gluteal vates the gluteus maximus muscle and the articular capsule of the
region inferior to the piriformis muscle, stretches under the glu hip joint.
teus maximus muscle lateral to the pudendal nerve and medial to Sometimes it may participate along with other nerves in inner
the sciatic nerve and the posterior cutaneous nerve of the thigh, vating the obturator intemus, gemellus, and the quadratus femoris
and in company with the gluteal vessels ramifies in the substance muscles.
THE LONG BRANCHES

THE POSTERIOR CUTANEOUS NERVE OF THE THIGH
The posterior cutaneous nerve of the thigh (nervtts attaneus fe- emerges from the cavity of the pelvis below the piriformis muscle
wunis posterior) (S,, S a , S3) (Figs 886, 900) initially lies close to the medial to the sciatic nerve, stretches under the gluteus maximus
inFerior gluteal nerve or forms a common trunk with it, then muscle almost on the midline between the ischial tuberosity and

232 THE SACRAL PLEXUS
the greater trochanter, and descends on the posterior surface of 2. The perineal branches frami perineahs nervi cutanei femoris
postaioris), one or two, sometimes more in number, originate as
the thigh.
twigs from the main trunks descend, curve round the ischial tuber-
There it lies immediately under the fascia lata in line with the
osity, stretch forwards, and ramify in the skin of the medial surface
groove between the semitendinosus and biceps femoris muscles;
of the scrotum (labia majora) and the perineum, These branches
descending, the posterior cutaneous nerve sends branches which
communicate with the perineal branches of the pudendal nerve.
pierce the fascia for the whole length of the posterior surface of the
3. The cutaneous branches arise from either side of the main
thigh and ramify in the skin oF the posterior, and particularly the
trunk and ramify in the skin oF the medial and posterior surfaces
medial, surfaces down to the skin of the popliteal fossa.
of the thigh. The terminal branches stretch to the skin of the popli
The branches of the posterior cutaneous nerve of the thigh.
teal fossa and may descend on the leg to communicate there with
1. The gluteal branches (nervi cfanium inferiores) (see Figs 870,
the branches of the medial cutaneous nerve of the calf or the leg
900) are small and two or three in number. They originate from
(nervus cutanats surae medialis) which is a branch of the medial
the main trunk, curve round or pierce the inferior border of the
popliteal nerve (nervus tibialis)*
gluteus maximus muscle, ascend, and ramify in the skin of the glu
teal region.
THE SCIATIC NERVE
The sciatic nerve (nervus isthiadieus) (Li, L5, Si, S2, S*) quadratus femoris. These branches originate either before passage
(Figs 876, 886, 888) is the largest nerve not only in the lumbosac- of the sciatic nerve through the greater sciatic foramen or in it.
ral plexus but in the whole body and is a direct continuation of all II. The articular branch is a small trunk ramifying in the artic
the roots of the sacral plexus. It emerges through the greater ular capsule of the hip joint.
sciatic Foramen under the piriformis muscle lateral to all the IIL The muscular branches in the thigh arise from the medial
nerves and vessels which pass through this foramen. It then popliteal nerve and run to the long head of the biceps femoris and
stretches between the gluteus maximus muscle and the ge- to the semitendinosus, semimembranosus, and adductor magnus
mellus, obturator intern us, and quadratus femoris muscles al muscles.
most on the midline between the ischial tuberosity and the greater Muscular branches from the lateral popliteal nerve run to the
trochanter. short head of the biceps femoris.
On emerging From under the inferior border of die gluteus IV. The articular branches originate from the medial and lat
maximus muscle, the sciatic nerve lies in the region of the fold of eral popliteal nerves and innervate the articular capsule of the
the buttock (sukus glutens) close to the fascia lata; further down knee joint.
wards it is covered by the long head of the biceps femoris muscle V. The lateral popliteal nerve (nervus peroneus [fibwlamj commu
and lies between it and the adductor magnus muscle. In the mid nis) {U, Lj, Si, S2) (Figs 886, 888, 892), on separating from the
dle of the thigh the long head crosses the nerve. Distally the sciatic main trunk of the sciatic nerve, at the proximal apex of the popli
nerve stretches between the semimembranosus muscle lying me teal fossa turns to its lateral side and then stretches under the me
dial and the biceps femoris muscle lying lateral to it, and reaches dial border of the biceps femoris muscle, between it and the lateral
the popliteal fossa in whose upper angle it divides into a thicker head of the gastrocnemius.muscle, curves spirally round the head
medial branch, the medial popliteal nerve (nervus tibialis), and a of the fibula being covered there only by fascia and skin. Distally
thicker lateral branch, the lateral popliteal nerve (nervus peroiuus the nerve pierces the substance of the initial portion of the pero-
Ifibularis} communis). neus longus muscle, and divides there into two terminal
The division of the sciatic nerve into the two branches may branchesthe musculocutaneous nerve of the lower limb (nervus
sometimes occur above the popliteal fossa and even directly at the peroneus fjibularis] superficialis) and the anterior tibia! nerve (nerv
sacral plexus; in such a Case the medial popliteal nerve leaves the peroneus [fibuiarisj profundus).
cavity of the true pelvis under the piriformis muscle, while the lat Branches of the lateral popliteal nerve.
eral popliteal nerve pierces it, For the whole length of the sciatic 1. The muscular branches run into the substance of the short
nerve both branches lie in a common connective-tissue sheath on
head of the biceps femoris muscle.
opening which they are easily separated up to the sacral plexus.
2. The articular branches stretch to the lateral parts of the ar
The companion artery of die sciatic nerve (arteria comiians nervi w-
ticular capsule of the knee joint and the superior tibiofibular joint.
chiaditi) determines the separation of the branches.
3. The lateral cutaneous nerve of die calf of the leg (nervus cu
Branches of the sciatic nerve.
ianeus surae lateralis) arises in the popliteal fossa, stretches to the l
I, The muscular branches ramify in the following muscles: ob
teral head of the gastrocnetnius muscle, pierces the crural Fascia,
turator intern us, gemellus superior and gemellus inferior (both
and ramifies in the skin of the lateral surface of the leg down to the
may also be supplied by twigs from the sacral plexus), and the
region of the lateral malleolus.

THE SACRAL PLEXUS 233
N. tibiaUs-
V. popUtea
^W. biceps femorls
A. poplttea -
'--JSJ. peroneus communis
N. cutaneus N. tutaneus surae lateralis
surae medtalls A. et v. genus superiores laterales
r. mustulares
A. et v. genus
superiores medlales
I / M . gastrocnemlus
Tendo m.""
semitendlnosi (caput laterale)
V. tl blahs posterior
-V saphena parva
M. gastrocnemtus' V. tibialis anterior
(caput medlale)
-A tlbia]fs anterior
A. tlbtalis posterior
Arcus tendlneus m
sole! M. soleus
A. et vv. peroneae
A. et vv. tibi ales- (fibula res)
posit en ores
N. tibiaJis
- M . flexor hallucis longus

jV\. flexor
digttorum longus Mm. soletis et
gastrocnemlus
A. tlblalis posterrc>r~Mj
M. peroneus bre vis
Tendo m ttblalisi Mm (mJibularis brevis)
posterior ^ S
A. et vv, peroneae (fjbulares)
Vv. tlbiales posterlore A. maJleofaris lateral is
Vv. malleoiares
laterales'"i Raml calcanei
Tendo calcaneus
Rami calcane! Rete calcaneum
888. Nerves, arteries, and veins of right leg; posterior aspect (l/4).
0 Created with novaPDF Printer (www.novaPDF.com) sterior tibia} and peroneal veins are partly removed.)
4. The sural communicating branch (ramus communicant pero the anterior and then the medial surface of the vascular bundle,
neus {fibularis}) (Fig. 900) may originate from the main trunk or and lies between the extensor digitorum longus and the tibialis an
from the lateral cutaneous nerve of the calf, It stretches on the lat terior muscles in the proximal parts of the leg; in the distal parts it
eral head of the gastrocnemius muscle and is covered by die crural
stretches between the tibialis anterior and the extensor hatlucis
fascia which it pierces to ramify in the skin, and communicates
longus muscles.
with the medial cutaneous nerve of the calf or the leg (a branch of
On passing to the dorsum of the foot, the nerve runs first un
the medial popliteal nerve).
der the superior extensor retinaculum (retinaculum musatlorum extc
5. The musculocutaneous nerve of the lower limb (nervuspero sorum suptrius) and then under the inferior extensor retinaculum
neus [fibularh] superjicialu) (Figs 892, 897) passes between the heads (retinaculum mmculorutn exknsorum. injerius) and the tendon of t
or the peroneus longus muscle and descends, running for some extensor haltucis longus muscle to divide into two branches, one
distance between the peroneus muscles. After passing to the me extending medially and the other laterally, The first is shorter and
dial surface or the peroneus brevis muscle, the nerve pierces the sends most of its branches to the extensor digitorum brevis mus
cmral fascia in the region of the lower third of the leg, and ram cles. The second is a longer branch which reaches the first inter
ifies into its terminal (dorsal) branchesa medial branch (nervus osseous space in company with the dorsalis pedis artery, where it
cutanens dorsalif medmlu) and a lateral branch (nervus culaneus dorsapasses under the tendon of the extensor hallucis brevis muscle to
lis intermedium). gether with the first dorsal metatarsal artery (arteria mttatarsea dor
Branches of the musculocutaneous nerve of the lower limb. salis prima) and divides into two terminal branches which ramify in
(a) The muscular branches (Fig. 893) innervate the peroneus the skin of the dorsal surface of the adjacent sides or the big and
longus muscle (2-4 twigs from the proximal segments of the nerve second toes.
trunk) and the peroneus brevis muscle (1-2 twigs from the trunk
Branches of the anterior tibial nerve.
in the middle diird of the leg).
In the region of the leg:
(b) The medial branch (nervus cutaneus dorsalis medidis) is one (a) the muscular branches supply the fo I lowing muscles; the
of the two terminal branches of the musculocutaneous nerve of the tibialis anterior (three branches entering the upper, middle, and
lower limb. It stretches on the crural fascia for some distance, runs lower parts of the muscle); extensor digitorum longus and extensor
to the anteromedial border of the dorsum of the foot, sends twigs hallucis longus (two branches to each entering the upper, middle,
to the skin of the medial malleolus, communicates here with the and lower parts of the muscles); the extensor digitorum longus and
twigs of the saphenous nerve, after which divides into two small extensor hallucis longus (two branches to each entering the upper
branches. One of them, medial, ramifies in the skin of the medial and lower parts of the muscles) (Fig, 893).
border 0 r the foot and the big toe up to the distal phalanx, and
(b) the articular branch runs to the articular capsule or the
communicates with the anterior tibia! nerve in the first interosse- ankle joint,
ous space. The other, lateral, branch communicates with the termi In the region of the dorsum of the fool:
nal branch or the anterior tibial nerve and extends to the second
(a) the muscular branches (rami musculares) are supplied to the
interosseous space where it ramifies on the adjacent sides of the
extensor digitorum brevis and extensor hallucis brevis muscles;
second and third toes and gives origin to the dorsal digital nerves
(b) the communicating branch runs to the musculocutaneous
of the foot (nervi digitdes donahspedis) (Fig. 897). nerve;
(c) The lateral branch (nervus eut&nens dorsdis intermedia) (c) the articular branches supply the dorsal surface of the artic
(Fig. 897) stretches, like the aforementioned branch, on the crural ular capsules of the metatarsophalangeal and interphalangeal
fascia and runs on the anterolateral surface of the dorsum of the joints of the big and second toes;
foot. After giving off twigs to the skin in the region of the lateral (d) the dorsal digital nerves (nervi digitales ivrsales pedis) are the
malleolus, which communicate with the branches of the sural terminal branches of the anterior tibial nerve; they divide into two
nerve, it divides into two branches, one extending medially and twigs:
ramifying in the skin of the adjacent sides of the third and fourth
(1) the lateral digital nerve (nervus digitalis dorsalis hallucis latera
toes. The other branch stretches laterally, receives a communicat lis) ramifies in the skin on the dorsal surface of the big toe rrom
ing twig from the sural nerve and runs to the skin of the adjacent the direction or its lateral border;
sides of the fourth and little toe and to the lateral side of the little
(2) the medial digital nerve (nervus digtti setundi medialis) inner
toe, forming here a communication with the terminal branch of vates the medial border of the dorsal skin surface of the second
the sural nerve. All these branches are named the dorsal digital toe.
nerves of the foot (nervi digitdes dersaUs pedis).
VJ. The medial popliteal nerve (nervus tibidis) (L. L,, Sj, S2,
6. The anterior tibial nerve (nervusperoneus [fibularisj profundm) S ) (Figs 888, 889), being a direct continuation of the sciatic nerve,
a
(Fig. 892) pierces the substance of the initial parts of the peroneus is much thicker than the other branch of this nerve, i.e. the iateral
longus muscle, the anterior intermusctilar septum, and the exten popliteal nerve. It begins at the apex of the popliteal fossa, passes
sor digitorum longus muscle, and stretches on the anterior surface almost vertically to the distal angle of the fossa and lies directlv
of the intermuscular septum lateral to the anterior tibial vessels under the fascia, between it and the popliteal vessels (vasa poplitea).
(vasa tibiaim anterkra). After that the nerve descends and passes to fn front of and slightly medial to the nerve is the popliteal vein

THE SACRAL PLEXUS
- V . saphena magna
,-V. pophtea
-~A. tiblaJis posterior

Fascia cruris
N. tiblalis
A, et vv.tibJales M, gastrocnemius
anteriores - ^ ^ (divided)
\
4.
Vv> peronei {Mbulares}
A. perortea (fibuJaris)
N, plantarls lateralis
A. plantaris lateralis
Rr caJcanel
889. Nerves, arteries, and vein of right kg and foot; medial aspect (%).
branchesthe medial and lateral planter nerves (nervus plantaris

medialh et nervus plantaris lateralh).
Branches of the medial popliteal nerve.
1. The medial cutaneous nerve of the calf of the leg (nervus cui-
aneux surae medialis) (Fig. 900) arises from the posterior surface o
the medial popliteal nerve in the popliteal fossa and stretches un
der the fascia between the heads of the gastrocnetnius muscle in
company with the short saphenous vein (vena saphena. parva) whic
stretches medially. In the middle of the leg, approximately at the
beginning of the tendo calcaneus, sometimes higher, the medial
cutaneous nerve pierces the fascia and by means of the sural com
municating branch (ratmts communkans peronetis [fibul&risj') aris
from the lateral cutaneous nerve of the calf of the leg (nervus cuta
neas surae laieralh) forms a single trunkdie sural nerve (nervus su
ralis).
The sural nerve (nervus suralis) runs along the lateral border of
the tendo calcaneus and, in company with the short saphenous
vein (vena saphena parva), reaches the posterior border of the latera
malleolus and sends the lateral calcaneal branches (rami calcanei la
terales newt suratis) into the skin of this region as well as twigs to
the articular capsule of the ankle joint. After that, the sural nerve
curves round the malleolus and passes to the lateral surface of the
foot as the dorsal lateral cutaneous nerve of the foot (nervus cuta-
neus dorsalis lateralis). The last-named ramifies in the skin of th
dorsum and lateral border of the foot and dorsal surface of the
fifth toe, and sends a communicating branch to the lateral branch
of the musculocutaneous nerve (nervus cutaneus dorsaUs intermediu
2. The muscular branches are supplied to the following mus
cles; (a) the heads of the gastrocnemius; the branch to the medial
head is thicker than mat to the lateral head; the medial branch
sends a twig to the popliteal artery; (b) the soleus muscle; two
branches, anterior and posterior, run to this muscle; the anterior
branch may sometimes send a twig to the lateral head of the gas
trocnemius muscle, the posterior branchto the popliteus muscle;
(c) the plantaris muscle; (d) the popliteus muscle; the branches
890. Nerves ofperiosteum of right tibia running to this muscle send twigs to the articular capsule of the
(specimen prepared by S.Bogri), knee joint and the periosteum of die tibia (see Fig. 890) and give
rise to the interosseous branch (nervus interosseus cruris) before
(Photograph.) tering the thickness of the interosseous membrane, the interosse
(A portion of the periosteum is separated from the bone and ous branch supplies die walls of the tibial vessels with twigs, on
stretched.) emerging from the membrane it sends twigs to the periosteum of
the leg bones* to their distal articulation, and to the articular cap
(vena poplitea) and under it is the popliteal artery {ttrtma paphtsa). sule of die ankle joint; (e) tbe tibialis posterior muscle; (f) the
Further the nerve stretches between both heads of the gastro- flexor hallucis longus muscle; (g) die flexor digitorum longus mus
cnemius muscle, lies on the posterior surface of the popliteus mus cle.
cle, and passes under the tendinous arch of the soleus muscle in 3. The medial calcanean branches (rami calcanei medialis)
company with the posterior tibial vessels (vasa tihialia posteriora) pierce the fascia in the region of the groove for the tibialis poste
under cover of the muscle. The medial popliteal nerve then des rior muscle (sulats nwlleolaris), sometimes as a single common twig,
cends under the deep layer of the crural fascia, between the lateral and ramify in the skin of the heel and medial border of the sole.
border of the flexor digitorum longus muscle and the medial bor 4. The medial plantar nerve (nervusplantaris medialis) (Fig. 895)
der of the flexor hallucis longus muscle, to the posterior surface of is one of the two terminal branches of the medial popliteal nerve.
the medial niallcolus where it lies in the middle of the distance be At the beginning it lies medial to the posterior tibial artery in the
tween the malJeolus and die tendo calcaneus. After passing under canal between the superficial and deep layers of the flexor retinac
the flexor retinaculum, the nerve divides into two terminal ulum. After passing through the canal, the nerve stretches under

THE SACRAL PLEXUS TM
the abductor hallucis muscle in company with the medial plantar

artery, and then runs forwards between the flexor digitorum brevis
and abductor hallucis muscles and divides to form two b r a n c h e s -
medial and lateral.
Branches of the medial plantar nerve:
(a) the cutaneous branches are twigs ramifying in the skin of
the medial surface of the sole;
(b) the muscular branches are directed to the following mus
cles; the abductor hallucis, flexor digitorum brevis, flexor hallucis
brevis (the branches to this muscle often originate from the medial
segment of the medial plantar nerve) (Fig. 896);
(c) the proper plantar digital nerve (nervus digitalis plantark
proprius nervi plantaris medialis) is the medial part of the medial
plantar nerve; it pierces the plantar apo neurosis and ramifies in
the skin of the medial surface of the big toe;
(d) the common plantar digital nerves I, II, III (nervi digitales
plantares communes I, II, III) (Fig. 895) are branches of the lateral
part of the medial plantar nerve. They run in company with the
plantar metatarsal arteries (arteriae metatarstae plantares), supph the
first, second, and sometimes the third lumbrical muscles, and
pierce the plantar apon eurosi s at the distal ends of the internsse-
ous spaces. After giving off twigs to the skin of the sole, they divide
to form the proper plantar digital nerves (nervi digitales plantares
proprii) which ramify in the skin of the plantar surface of the adja
cent sides of the big, second, third, and fourth toes; then they pass
to the dorsal surface of the distal phalanges of these toes;
(e) the communicating branch runs to the third common plan
tar digital nerve from the lateral plantar nerve.
5. The lateral plantar nerve (nervus plantaris lateralis) (see
Figs 889, 894, 895) is the second terminal branch of the medial
popliteal nerve. It is much smaller than the medial plantar nerve
and stretches on the sole between the flexor digitorum accessorius
muscle (miisczilus quadratus plantae) and the flexor digitorum brevis
muscle in company with the lateral plantar artery, then lies closer
to the lateral border of the foot between the last-named muscle
and the abductor digiti minimi muscle and, after giving origin to
some muscular branches, the nerve divides into the superficial (ra-
mus superficialis) and deep (ramus profundus) terminal branches.
Branches of the lateral plantar nerve:
(a) the muscular branches arise from the main trunk before it
divides into the terminal branches and supply the flexor digitorum
accessorius muscle (musailus quadratus plantae) and the abductor di
giti minimi muscle;
(b) the superficial branch (ramus superficialis nervi phntaris late
ralis) sends several twigs to the skin of the sole and divides into the
following parts:
(1) a medial part forming the common plantar digital nerve of
891. Nerves of right tibia (specimen prepared
the fourth toe (nervus digitalis plantaris tomtnunis IV) and passing in by S.Bogri). (Photograph.)
the fourth interosseous space in company with the plantar metatar 1 intraosswins segment of nerve
3iiitraosseoiis segment of nerve (in com
sal artery. On approaching the m eta tar soph alangeal joint and pact layer of bone)
sending a communicating branch (ramus communkans) to the me itextraoiseoiis segment of nerve
dial plantar nerve, it divides into two proper plantar digital nerves
(nervi digitales plantares proprii nervi plantaris lateralis) which ramify
in the skin of the plantar surface of the adjacent sides of the fourth

A. genus superior laterails^
7Rete articulate
/ genus
A- genus Inferior fateralls
N. peroneus (flbulari
communis
R- (nuscularis-
\ . recurrens lib!alls
N r peroneus (fibularis) anterior
superflcialls
N. peroneus ffibularls) profurrdus

- A tlblalls anterior
M . piTOIlCIIS i o r l g u s <Jl
Cm. fibularis longus)^
M
M-. extensor tibialts anterior
digibrum lotigus -
Rr. musi:ni;iii.-s -":"^2fc-$
M. extensor
hallueis longus
Septum intermijsculare
Fasda cruris
N. peroneus (fibularls)i
SLiperficialis
N. ciutantujs dorsalis
intejfroedlttS-
N. surallsH
Malleolus l a t e r a l i s j
Rr. calcanel laterales
N, peroneus (fibularis)
R. anastomoticus profandus
N. cutaneus dorsalis
Nn. digitales
late r a i l s - "
dorsales pedi:
892. Nerves of leg andfoot; anterolateral aspect ( %

rrk.
Created with novaPDF Printer (www.novaPDF.com) I S l t q f I i m loTi u
8* muscles are cut and partly removed.)
NERVES OF THE LOWER LIMB
893. Nerves of muscles of left leg (specimen prepared by S.Ostrovsky). (Photograph.)

(The medial surface of the muscles facing the bones.)
gaflitKHiemiuj musck VIIc-xtensur hallucis longus muscle
suleus muscle Kmedial cutaneous nerve of c?]f of ?muscular branch
VHJ eitlf.nsor digitonim longus mus
floor digiloru m lonjfus muscle !eK 9[iiedinl popliteal nerve
cle
nbulis posterior muscle 'Amedial popliteal nerve ](Jlateral popliteal nerve
IX Libiaiis anterior IIIUMJC
kzor ha! I tic is longus muscle 4lateral cutaneous nerve of calf nf 11 nerve to shun head of biceps fem-
XperdTif us loiijjiis muscle
peroneus brevis muscle XIplantaris; muscle
' oris muscle.
5nerve ffrgastrocnemius UIUMIIC
1sciatic nerve
6, 8 nerves for MJICUS muscle

240 NERVES O F T H E L O W E R LIMB
A. tiblalis posterior
R. muscularis *V**1J*-"; t^-Rr. calcanei medtales
M, flexor
hallucls longus
3 _ M- flexor dtgitorum
brevis (cut and reflected)
N. plantaris medialjsJl
IN. plantaris laieralls
M. flexyr tHgltorum longusJ

m^^Br1^- mustularis
^.M. quadratics plantae

i:ri. flexor accessor!us)
M. abductor digili
minimi
M. abductor ha] Juris
R. superficial j N.p]amar|S
M. flexor hallucis brevis ,>Rr. musculares
M, flexor
hallucls longus^ J / I N. digitalis plantaris communis
(from n. plantaris lateralis)
Nn, digitalcs
plan tares communes
(from n, plantaris medialis)
N digitalis Mm, lumbrlcaies

plantaris proprius
M. flexor digitorum
brevis (cut and reflected)
Nn. dlgltales planlares proprli
894. Nerves of right foot; plantar surface (%).

Created with novaPDF Printer (www.novaPDF.com)d p a r t of the subcutaneous tissue are removed.)
NERVES OF THE LOWER LIMB 241
R r calcanci mediates
(from n, tibialis)
Aponeurosis plantaris
V. saptiena magna/
Rr, cutanei (from n

plantaris medialis)
N. plantaris laterals
(r. superficial is)
N, plantari s medlalt:
Rr, cutanei (from nn.
plantares)
Rr. cutanei (from N. digitalis plantaris

plantaris medialis) communis (fromn.
plantaris lateralis)
Subcutaneous fat
Nn. digitales plantares

communes (from n. Rr. cutanei (from n.
plantaris medialis) plantaris lateralis)
- ^ N n , digitales plantares
proprii (from n. plantaris
late ralis)
Nn, digitales plantares proprii

(from (1. plantaris medialis)
895, Nerves of right foot; plantar surface (%).

Created with novaPDF Printer (www.novaPDF.com)n brevis muscles are cut and p a r t l y removed.)
242
T H E SACRAL PLEXUS
and little toe S and pass i the dorsal SU rface of the distal pha
langes; ' of the interossei muscle, on one side and the flexor digitorum lon-
m f e - d the oblique head of the adductor hallucis muscle
m * lateral part forming the proper plantar digital nerve for
on the other. It sends muscular branches to the interossei, second
be Wt t fnmus diptalupkntarisproprius V) whieh r S m i ( i in
third, and fourth lumbrical, adductor hallucis, and flexor hailucis
the skm of the plantar surface of the lateral side of the little toe
brevis (lateraf head) muscles.
thu nerve often sends muscular branches supplying the i n t e r e s t
muscles of the fourth intermetatarsa] space and the flexor digit i Besides the named nerves, twigs are sent bv the superficial and
minimi brevis muscle; deep branches of the lateral plantar nerve to the articular c a p s u l c ,
of the m e t a t a r s i joints and the periosteum of the bones and pha-
(c) the deep branch framus prcfundu, nervi piantaris t&tcralis) lies langes, r
m company with iht plantar arch (artus piantark) between the layer
T H E P U D E N D A L NERVE
The pudendal n e r v e fsmm pudendus) . , , & M

( R g S - W - 8 8 2 ) is the cauda, part of the sacral plexus to w h t h & and runs on the lateral wall of the ischiorectal fossa in the depths
j o t t t d by several branches. The nerve lies under the lower border Of the fascia of the obturator internus muscle. It divides in the
fossa into the following branches:
of the pinfortms muscle on the anterior surface of the coccygeus
muscle; the anterior surface of the nerve ft crossed horizontal!; by (a) the inferior haemorrhoidal nerves (nervi rectal mfmms)
the lateral sacral vessels (mkt sacralia hteralia). occupy the most medial position and run to the perinea] part of
the rectum, the sphincter ani extemus muscle, and the skin in the
The pudendal nerve is connected with the sacral p] e X us and
region of the anus;
^ e c o c c y x ! p exus lying below, as well a s with the a t o m i c
pelvic p I u S (pmt hypogastneus infinor) by means of a few nerve (b) the perinea! nerves (nmiptmddei) (see Fig. 880) stretch in
hHffc The branches of the pudendal nerve contribute to innerva- company w i t h the perinea] vessels (uua $&$ and are most su-
W * of the internal organs of the true pelvis, the external genital perhcial among the terminal branches of the pudendal nerve;
organs, the muscles of the perineum, and the skin of the perineal (c) the scrota! branches (ntrvi stales pestensm) (in females
regton. Topographically, the nerve can be divided into two, intra- the lab.al branches [new labial poster]) are a superficial group
pelvic and extrapclvic (perinea!), parts. or branches supplying the skin of the perineal region and the skin
of the posterior surface of the scrotum (the labia majora in fe
Branches of the intrapelvic part of the pudendal nerve.
males); these nerves communicate with the haemorrhoidal nerves
I. The muscular branches arise from the nerve iu the cavity of
and the perineal branches of the posterior cutaneous nerve of the
the true pel and are directed to the levator ani and coccygeus
thigh;
muscles, these muscles may be innervated by a common branch.
I. 1 he middle recta! nerves unite with the branches of the bv- (d) the muscular branches are deep-lying twigs stretching to
the anterior parts of the sphincter ani extemus, superficial trans
pogastnc plexus, approach the part of the rectum which is above
v e r s e permei, and bulbospor.giosus muscles, and to the isehiocav-
the levator ani muscle; some twigs enter the substance of this mus-
ernosus muscle;
3. The inferior vesical nerves, like the middle rectal nerves (e) the dorsal nerve of the penis (ntrvm dorsalis penis) (the dor
urute w.th the branches of the hypogastric plexus and stretch to sal nerve of the clitoris [nervus dorsalu ditoridis] in females) (see
the floor ol the bladder and to the sphincter vesicae muscle. F-gS 880-882) is the superior branch of the pudendal nerte ft
stretches m company with the artery supplying the penis (a short
* l h c vagmal nerves unite with the branches of the hyposas-
tnc plexus and stretch to the upper parts of the vagina branch of the internal pudendal artery) on the inner surface of the
inferior ramus of the ischium and the pubis, passes through the
Branches of the e x t r a p d v k (perinea!) part of the pudenda!
nerve. urogemtal diaphragm, runs together with the dorsal penis (cliton-
d*s) artery on the dorsum of the penis (clitoris) and ramifies into
The pudenda! nerve emerges from the cavity of the true pelvis
terminal branches to be distributed in the skin and corpora caver-
^ r o u g h the greater sciatic foramen together with the internal pu-
nosa of the penis down to the glans (the labia majora and minora
dendal vessels fmn PMmda into**} which are medial , 0 it (see
in females).
fT 8 8 0 - 8 8 2 ) . Then it fits on the posterior surface of the i s c h S
spine, c u r v e round it, and returns into the cavity of the pelvis On its way the nerve sends twigs to the deep transverse perinei
through the lesser sciatic foramen below the levator ani muscle and sphincter urethrae membranaceae muscles and to the plexus
cavernosus penis (ditoridis) (see Fig. S82).

THE COCCYGEAL PLEXUS <i43
T H E COCCYGEAL PLEXUS
The coccygeal plexus (pkxta cnccygeus) (S 4 , 5, C o t , Gbj) lies on
: anterior surface of the tendinous part of the coccygeus muscle

d ihc sacrospinous ligament; it communicates with the pudenda!
rve and the terminal segment of the sympathetic trunk.
THE BRANCHES OF
THE COCCYGEAL PLEXUS
1. The muscular branches are directed to the coccygeus raus-
: (the coccygeal nerve [nerous coccygeus J), the levator ant and the
irococcygeus ventrylia (inconstantly) muscles.
2- The anococcygeal nerves (nervi anococtygei). three to five fine
igs, stretch on the anterior (ventral) surface of the coccygeus
iscle, between it and the levator ani muscle, and at the lateral
rface of the apex of the coccyx enter the skin to ramify in the re-
>n of the eoccvx, down to the anus,
896. Nerves of flexor digitorum hrevis muscles of

foot (specimen prepared by G.Potapenko).
(Photograph.)

NERVES OF THE LOWER LIMB
244
_Rr. cutanel
Rami n. cutand crui"ls mediates
surae lateralis.
_ N. saphenus
N. peroneus (fibularis)^
superficialis
Retinaculum mm. extensomm
super lus
medialis
In termed! us
Retinaculum mm. extensorum

inferius
Malkolus lateralisH[
N. cutaneus ascia dorsalis pedls

dorsalis lateralis
Communication between n.
c uta n eus dor sal is ~
lateralis and n. cutaneus
dorsalis intermedius
^ N. peroneus {fibularis)
profundus
Nn, digitaks
dorsaks pedis
897. Cutaneous nerves of right foot; dorsal aspect (l/2),

rn LA- ^ subcutaneous fat are removed; the nerves are dissected.)
NERVES OF THE LOWER LIMB 245
898. Nerves ofjlexor digitorum 898a, Cutaneous nerves of right lower limb (specimen
langus muscle of foot (specimen prepared by V.Bezyazychnyi). (Photograph.)
prepared by G.Potapenko). 1cutaneous branch of obturator ncr"e 5anterior cutaneous branches
2subcutanefii nerve 6 obturator nerve
(Photograph.) 3mrdial cutaneous branches of leg 7femoral nerve
4 subpalellar branch Slater*] cutaneous nerve tif thieh,

246 NERVES OF THE LOWER LIMB
Branches from rr, êntrales

(rtn. intercostiiles)
R. cutaneus laterals
(branch of n. iliohypogastricus
from plexus iumbalis)
N. iliohypogastrkus
R. femoralis (branch of plexus lumbalis)
(r), gcmtofemoralis
from plexus lumbalisl,_
_ N. ilkiinguinalis (branch of
plexus lumbal is)
N. ctitaricusfemoris
lateralis (branch of
plexus lumbalis) ! S
w
Rr. cutanei femoris
aaterioMS (branches of. n,
femoral is from plexus J._ R.eutaneuS (branch of
tumbal is) _ - r. anterior from
n. obturarorius)
_R. infrapatcllarisn. sapheni

(branch of n. femora lis
Branches of n. peron cus ^ ^ f l from plexus lumbalis)
(fibu I aris) corn munis C "
I - Rr.craneitruris mediales
n. sapheni (branch of n. femuralis
medialis (branch o. n. peroneus
N. cutancus dorsalis superfieialis from plexus saec alis)
intcrmedius (branch of n. peroneui
Huperficiaiis from plexus sacra! is)
j N. peroneus profundus
N. cutaneus Ctorsalis / (branch of n. pemneus
lateralis (branch of
communis flWn plexus
n, sura I is from pies JS sacralis)
sacralis)
\
Nn. digitales plafltarc^ _ N. digitalis dorsalis. haMucis
pneiprii (branches of nn. digitales lateralis et n. digitalis
p!a n lares com mimes from dorsalis securnjj medialis
n. plantaris latcraiisl > ^ / S i (branches of n. peronens profundus)
Nn. di.gitale.s pi an tares
prnnrii (branches of nr. (ligitales
planlarcs communes from
n. plimtaris media] is)
899. Distribution of cutaneous nerves of right lower limb; anterior aspect (semischematical
representation).
NERVES OE THE LOWER LIMB 247
(Vn, clunium supcriorcs

(branches of rr. posr.eriore.1
from nn. Iiuubales)
Nil. cluniuni medii l_R. cncareiis laterals (brnncti of

ftmncbcs of rr. posteriores I n n. ihobypogastrieuS
(nun tin. sacrates) "% plexus lumbalis)
N, fulaneiis femoris
latcralis (branch of
plexus Tumbalis)
Nn. clunium inferiores

5 tranches of n. cutancus femoris
posterior from plexus sacralis)
N. cutaneus femons
posterior (branch of
pleXBS sacralis)
R. Cutaaeua (branch of
r. anterior from /
n, Obluratorius) /
(piestis lumbalis) '
Rr.CUtanci Claris
media ks n. saphen N. cutaneous surac medialis
(branch of n. femora lis (branch of n, tibialis
from plexus lumbalis). from plexus sacra lis)
N. suralis (formed
from union of
EH N. cuta r>e us surae late ra Hs Rr. cutanei n. cutaneus surac
(branch of n. pcroneu\ [fibularis] fcrnoris mediates medians etlateralis)
copnmurn's from plexus sacralis) (n. Saphenusjf
f N. plajitaris
/lateralis (branchof
R toinijiujiscans (1. libiahsfroni
peroneus (ilburaiis)
plexus sacrafis)
N. plan I at is
N. cutaneus
N. suralis (formed from medialis (branchof
dorsal is
union erf it, eutaneus surae n. : i :!'i from
latcralis
medialia ct laceralis) N, cutaneus dorsalis plexus sucralis)
(branch of
| imermedius (branch of n. perotteus n, surah's)
superficial is from plexus sacralis)
N. cmaneusdorsalis
taterails
(branch of n. sura lis)
10. Distribution of cutaneous nerves of right lower limb; 901. Distribution of cutaneous nerves of
osterior aspect (semischematical representation). right foot; plantar aspect
(semischematical representation)

THE AUTONOMIC (VEGETATIVE) NERVOUS SYSTEM
The autonomic nervous system (systtma nervosum autonomicumj Besides, some authors distinguish a nervous system of the
(Fig. 902), like the somatic nervous system, is a part of the whole viscera (in the walls of the gastrointestinal tract) which is di
nervous system. A central portion (the brain and spinal cord) and rectly connected with the sympathetic and parasympathetic
a peripheral portion (nerves and ganglia situated outside the brain parts.
and spinal cord) are distinguished. The autonomic nervous system takes part in innervation of the
According to the physiological, pharmacological, and partly viscera, blood and lymph vessels, glands, smooth muscles, and part
morphological signs, the autonomic nervous system is subdivided of striated muscles.
into a sympathetic part (pars sympatkka) and a parasympathetic
part (pars parasympathka).
THE SYMPATHETIC PART

The centra] portion of the sympathetic part of the autonomic coccyx where they terminate to unite in the unpaired coccygeal
nervous system consists of numerous multipolar cells (neurocytes ganglion. Each sympathetic trunk has a cervical part (pars cervicalis
multipolares) and is a group of gaugl ionic cells located in the grey trund sympatkici), a thoracic part (pars thararica trund sympatkid), a
matter of the spinal cord and forming in total the sympathetic cen lumbar part (pars lumbalis trunci sympatkici), and a sacral part (pars
trethe mtermediolateral nuclei, right and left, which are situated sacralis trund sympathki).
in the lateral horns oF the spinal cord for the distance from The ganglia of the sympathetic trunk (ganglia trunci sympatkici}
the eighth cervical to the second or third lumbar segments are located along the course of each trunk and are an aggregate of
(Fig. 902). a various number of nerve cells (neurocytes gangliae autonomicae).
The peripheral portion of the sympathetic nervous system con Nerve cells, solitary or collected into small groups, are also present
sists of right and left sympathetic trunks with ganglia and nerves inside each sympathetic trunk for its whole length. The number of
arising from them as well as of plexuses formed by nerves and ganglia, with the exception of the cervical part, corresponds
ganglia Outside Or within Organs. mainly to the number of spinal nerves.
Each sympathetic trunk (trjmcus sympatkiais) (see Fig. 871) is a Cervical ganglia (ganglia cervicalis), thoracic ganglia (ganglia
long strand interrupted along its course by ganglia of the sympath- ikoradca), lumbar ganglia (ganglia lumbalia), sacral ganglia (ganglia
etic trunk (ganglia trunci sympatkici) which vary in size but are sacralia), and ganglion impar inconstantly present in the coccygeal
mostly spindle-shaped. The ganglia are united by interganglionic region, are distinguished.
branches (rami interganglionares gangliormm trund sympatkid) Each ganglion gives rise to two types of branches (Figs 902,
(Fig. 903). 903): (1) communicating branches (rami cemmunicantes);
The right and left sympathetic trunks stretch on either side of (2) branches stretching to the autonomic plexuses (plexus autono-
the vertebral t:olumn from the base of the skull to the apex of the mid).
THE AUTONOMIC NERVOUS SYSTEM 249
Communicating branches are classified into white and grey or third lumbar segments of the spinal cord, the pregangliomc
branches (rami albi et grisei). fibres for the sympathetic trunk ganglia situated above and below
Each white (communicating) branch (ramus albus) is an aggre these segments (i.e. fibres for the region of the neck, lower lumbar
gate of pregangliomc sympathetic fibres connecting the spinal and the whole sacral regions) pass in the sympathetic trunk itself.
cord with the sympathetic trunk, It contains efferent my el mated Each grey (communicating) branch (ramus griseus) unites the
nerve fibres (neurofibrae efferent) which are processes of neurons of sympathetic trunk with a spinal nerve. It contains nonmyelmated
the lateral horns of the spinal cord, passing through the anterior efferent nerve fibres (neuronbrae efferens) of the cells of a sym
root (radix vmtmlis) and connecting the cells of the lateral horn pathetic trunk ganglion, runs into a spinal nerve to become a com
with the cells of the sympathetic trunk, or, after passing through it, ponent of its fibres, and reaches an organ.
with the cells of the prevertebral ganglion of the sympathetic These fibres are called the postgangtionic fibres (neurofibrae
plexus. The fibres, arising from the cells of the lateral horn and postganglionares) and terminate on the periphery.
stretching to the cells of the sympathetic trunk ganglion or to The peripheral part of the sympathetic system is in turn di
those of the ganglion of the sympathetic plexus are called the pre- vided topographically into a cephalic part (pars cephalica), cervical
ganglionic nerve fibres (neurojibrae preganglionures).
part (pars cervkalis)s thoracic part (pars thoratica), abdominal part
Since the lateral horns and, consequently, the intermediotat- (pars abdominalis)f and a pelvic part (pars petvina).
end nuclei, are present only from the eighth cervical to the second
THE CEPHALIC PART

OF THE SYMPATHETIC NERVOUS SYSTEM
The cephalic part of the sympathetic nervous system (Fig.902) artery from the carotid canal. It then unites with the greater super
is represented by a series of plexuses formed by branches of the ficial petrosal nerve (nemus petrosus major) to form the nerve of the
cervical portion of the sympathetic trunk, mainly from the supe pterygoid canal (nervus canalis pttrygoidei) and enters the spheno-
rior cervical sympathetic ganglion, and are directed mainly along palatine ganglion (ganglion pterygopalatimtm) as its sympathetic
the distribution or vessels into various regions of the head. These root;
nerves are as follows. (c) the cavernous plexus (a part of the internal carotid plexus)
1, The jugular nerve (nervus jugularis) is a short branch arising
is a relatively thick network of fine twigs; it surrounds the trunk of
from the upper pole of the superior cervical sympathetic ganglion. the internal carotid artery passing through the cavernous sinus and
It lies in the outer coat of the internal jugular vein and stretches to
sends branches to the nerves and other structures located in this
the jugular foramen where it departs from the vein and gives ori region and in the cavity of the orbit;
gin to two branches: (1) to the oculomotor nerve;
(a) one branch runs to the superior ganglion of the vagus nerve (2) to the troehlear nerve;
(ganglion mperius nervi ttagi)\ (3) to the abducens nerve;
(b) the other branch extends to the inferior ganglion of the (4) to the hypophysis cerebri;
glossopharyngeal nerve (ganglion inferius nervi glossoph&ryngei), (5) to the trigeminal ganglion;
2. The internal carotid nerve (nervus carotiais internus) origi (6) to the orbitalis and tarsalis muscles and the lacrimal gland;
nates from the upper pole of the superior cervical sympathetic (7) to the ciliary ganglion (Fig. 819). The sympathetic root of
ganglion, often together with the jugular nerve. It ascends slightly the ciliary ganglion (ramus sympatkicus ad ganglion eiliare) stretches
to the back of the internal carotid artery and then forms in the ca as fine twigs through the superior orbital fissure into the cavity of
rotid canal a wide-looped network, the internal carotid plexus the orbit, passes through the ciliary ganglion in the region of its
(plexus caroticas internus) round the artery for its whole length (seeposterior border, and unites with the short ciliary nerves to run to
Fig. 819). This plexus passes to the branchings of the internal ca the dilator of the pupil (musctdus dilatatorpupillae) (see The Ophthal
rotid artery to Form a series of plexuses and gives rise to the follow
mic Nerve) and the walls of the vessels of the eye;
ing nerves: (8) to the ophthalmic artery, on whose wall it forms a plexus
(a) the caroticotympanic nerves (nervi caroticctympaniti) pass which sends a twig to the retina in attendance to the central artery
through the caroticotympanic canaliculi, unite with the tympanic of the retina;
nerve (nervus tympanicus) and enter the tympanic plexus (plexus iym- (9) to the anterior cerebral artery;
pankus) (see The Glossopharyngeal Nerve); this plexus supplies the (10) to the middle cerebral artery;
mucous membrane of die tympanic cavity and pharyngotympanic (11) to the choroid artery (arteria charoidea anterior).
tube; All the above-listed branches form nerve plexuses which ac
(b) the deep petrosal nerve (nervus petrosus profundus) arises company vessels of the same name.
from I he internal carotid plexus at the exit of the internal carotid

250 THE SYMPATHETIC NERVOUS SYSTEM
THE CERVICAL PART

The cervical part of the sympathetic trunk (pars cervkalis trunci Three (sometimes four) ganglia arc located in the cervical part
sympalhki) (Figs 902, 904-906) lies in front of the transverse pro of the sympathetic trunk; they form from fusion of eight segwental
cesses of the cervical vertebrae, on the surface of the longus capitis sympathetic ganglia. These are the superior, middle, and inferior
and longus cervicis muscles, medial to the anterior tubercles of the cervical ganglia (ganglia cervkalis xuperius, medium^ et injerius
vertebrae and behind the iieurovascular bundle on the neck, from [BNA]); the last-named fuses in most cases with the first thoracic
which it is separated by a layer of the deep (prevertebral) fascia; ganglion to form the ganglion cervicothoracicum (stellatum); a sma
the sympathetic trunk is attached to the fascia. Above the bifurca vertebral ganglion is often found on the communicating branches
tion of the common carotid artery, the sympathetic trunk lies be of the middle and inferior cervical ganglia in front of the verte
hind the internal carotid artery. bral artery (on the level of the sixth cervical vertebra); this
Along its course the cervical part of the sympathetic trunk ganglion and, to a greater measure, the medial ganglion arc in
crosses the inferior thyroid and the subclavian arteries and sepa constant.
rates to form two loops round them: an inconstant thyroid loop
and an ansa subclavia which is always distinctly seen,
T H E SUPERIOR CERVICAL GANCLION
The superior cervical ganglion (ganglion cervicale superius) artery and is distributed along the branches arising from it
(Figs 904, 905) is the largest among the cervical ganglia; it mea contributing to the formation of plexuses surrounding vessels of
sures up to 2 cm in length and up to 0.5 cm in width and is spin the same name:
dle-shaped. The ganglion lies at the level of the bodies of the sec (a) the superior thyroid plexus;
ond and third cervical vertebrae, sometimes reaching the atlas (b) the lingual plexus;
proximally and the fourth cervical vertebra distaljy. (c) a plexus stretching along the course of the facial artery; it
To the back of the ganglion is the longus capitis muscle, in gives origin to one or two twigs: the sympathetic root of the sub-
frontthe trunk of the internal carotid artery, and lateral to it is mandibular ganglion (ramus sympaihicus ad ganglion submandibu-
the vagus nerve. The ganglion supplies some nerves and ganglia larej;
with twigs and organs and vessels with nerves. Most of these nerves (d) the occipital plexus;
and ganglia contribute to the formation of various nerve plexuses. (e) the plexus auricularis posterior;
The branches of the superior cervical ganglion. (f) the plexus temporalis superficial is;
1. Communicating branches (rami communkantcs) to the first - (g) the maxillary plexus:
fourth cervical spinal nerves. (h) the plexus meningeus.
2. The communicating branch (grey) with the hypoglossal The descending part oF the external carotid plexus descends on
nerve (ramus communicant cum. neroo hypoglosso). the wall of the external carotid artery to the common carotid artery
3. The jugular nerve (nervus jugularis) (see The Cephalic Part of and forms here the common carotid plexus (plexus caroticus eamit
the Sympathetic Nervous System). nu) which accompanies the artery for its whole distance.
4. Communicating branch with the inferior ganglion of the va At the bifurcation of the common carotid artery its nerve
gus nerve (ramus communicant cum ganglio inferiors nerci vagi), plexus receives fine twigs from the glossopharyngeal and vagus
5. The communicating branch (grey) with the phrenic nerve nerves, which together with the common carotid plexus, take part
(ramus communicant cum nervo pkrenico). in innervating the carotid body (glvmus caroiicum) situated here (see
6. The internal carotid nerve (nervus caroticus internus) (see The The Endocrine Glands).
Cephalic Part of the Sympathetic Nervous System). 8. The cardiac branch of the superior cervical ganglion (nervus
7. The external carotid nerves (nervi carotid externi), two or cardiacus cervicalis superior) (Figs 904-906, 915) arises by two o
three, sometimes as many as six twigs, run from the level of the three twigs from the superior cervical sympathetic ganglion,
stylohyoid muscle to the wall of the external carotid artery. Here usually at its inferior pole. The main cardiac branch descends me
they ramify into still smaller twigs which form the external carotid dial to the sympathetic trunk, in front of the longus cervicis mus
plexus (plexus caroticus externus) around the artery (see Fig. 819). cle and prevertebral fascia, and behind the common carotid artery,
The ascending and descending parts are distinguished in this crossing the inferior thyroid artery (usually in front). Along its
plexus. course the cardiac branch may form communications with the su
The ascending part passes on the wall of the external carotid perior and recurrent laryngeal nerves and with the cardiac branch

THE SYMPATHETIC NERVOUS SYSTEM 251
Ganglion ciJIare
Glandula
N. octflomolorius lacrimalis
X pangiion pterygopalaiinum
K Intermedium
N. glossopharyngeus Sr-Ganglion otlcum
N. vagus \ *B^fGlandula
\, \ sublingualis
Glandula parolis
Ganglion submandibulare
Ganglion
cervicak s u p e r i u s - - | r J^^GJanduia submandibularis
"A, carolls communis
N. cardiacus * }l~~^ caroticus inlernus
cervlcalis .: H ^ G f a n d u l a thyroidea
superior ,4 Esophagus
j j ^ ^ N n , cardiaci cervicales superiores,

Nn, Intercostales, medll, inferiores
Rr. cardiaci
cervicales s u p e r i o r s
, P u l m o dexter
TrLtncus
5yni|)athlcus-<î
Hepar
Aorta
Venlrjculus
M sjjlanchnicus I
major ' _-qL. J ' l c x u s ccli.-iijiis
-
!-..,.. ^^_*sf-Pancr<.'as
N. sptanchntcasj
minor--^ * Plexus
-
mesenteticus
Rr. c o n i m u n i a i n l e s - * - ^ "' , superior
(Htj^r*Hntestinum
Plexus crassum
mesenterlcus
inferior * ^ l n test In urn
s% tenue
Plexus
hypogastrlcus
Plexus SacratisJU
v
Ulerns
Vesica urinarta
N. pelviCUS-r
Rectum-T|
902. Autonomic nervous system (represented semischematically).

(The sympathetic part is coloured red, the parasympatheiic partblue).

252 T H E SYMPATHETIC NERVOUS SYSTEM
of the middle cervical ganglion. After passing into the cavity of the small branches to the walls of the pharynx and trachea and to the
thorax and the superior and then the middle (anterior, according thyroid gland; some twigs run to the common carotid and inferior
to BNA) mediastinum, the right cardiac branch of the superior thyroid arteries. The trunk of this cardiac branch contains collec
cervical ganglion lie's in front of the innominate artery, the left tions of nerve cells or solitary cells.
cardiac branchin front of the common carotid artery. 9. The pharyngeal branches of the superior cervical ganglion
Both branches pass to the anterior surface of the aorta and pul (rami laryngopkaryngei) stretch to the larynx and posterior wall of
monary trunk and contribute to the formation of the common the pharynx in company with the pharyngeal branches of the glos-
cardiac plexus (see The Nemes of the Heart). sopharyngeal and vagus nerves, and together with them contribute
The cardiac branch of the superior cervical ganglion sends to the formation of the pharyngeal plexus (plexus pharyngevs).
T H E MIDDLE CERVICAL GANGLION
The middle cervical ganglion (ganglion cervkalt medium) 5. T h e cardiac branch of the middle cervical ganglion (nervus
(Figs 904, 906) is oval and much smaller than the superior gang cardiaais cervicalis medius) (Figs 904, 905) arises by several branches
lion. It lies in front of the longus cervicis muscle, at the level of the either from the middle cervical ganglion or directly from the Sym
transverse processes of the fifth and sixth cervical vertebrae, pathetic trunk. It stretches between the sympathetic trunk and the
usually adjoining the inferior thyroid artery anteriorly. Sometimes, cardiac branch of the superior cervical ganglion, first behind the
instead of it there are a few small accessory ganglia. common carotid artery and then at its lateral border, and, after
The middle cervical ganglion (sometimes the intergangliomc passing in front of or behind the subclavian artery, enters the cav
part of the trunk) gives rise to one (sometimes two or three) fine ity of the thorax (the right branch lies at the division of the innom
twigs forming the ansa su be la via (Figs 904-906) which embraces inate artery, the leftat the lateral border of the left common ca
the subclavian artery from front to back and is usually a compo rotid artery, between it and the subclavian artery). In the thorax
nent of the inferior cervical ganglion. both cardiac branches of the middle cervical ganglion take part in
Branches of the middle cervical ganglion. the formation of the common cardiac plexus (see The Nerves of the
1, The communicating branches from communkantes) to the Heart).
fourth, fifth, and sixth cervical spinal nerves; they originate from Along its course the cardiac branch of the middle cervical
the postern lateral surface of the ganglion. ganglion sends twigs to the common carotid and inferior thyroid
2. The oommutticatfitg brunches with the phrenic nerve (in arteries and takes part in the formation or the corresponding plex
constant). uses.
3. The carotid nerves are two or three very fine twigs running The branch also communicates with the vagus and laryngeal
to the walls of the common carotid and inferior thyroid arteries recurrent nerves, as well as with the cardiac branch of the superior
and entering the plexuses surrounding these arteries: the common cervical ganglion forming plexuses with it.
carotid plexus and the inferior thyroid plexus. 6. The thyroid branches are fine twigs which arise sometimes
4. The inferior thyroid plexus gives origin to twigs which ac from the cardiac branch of the middle cervical ganglion and run
company the inferior thyroid artery and enter with its branches the directly into the substance of the thyroid gland. They send small
parenchyma of the thyroid and parathyroid glands. branches also to the parathyroid glands.
THE SYMPATHETIC NERVOUS SYSTEM
253
Comu laterals (n ucle us i n t erm edicl at eraf is) Fu nic u I us po st e r I or

Cor nu posterius j y Sulcus medianus
I / / (posterior)
%/
Canal Is
/cen trails
/ Coramfssura
/ / anterior
grisea
CorTtu anterlus .' Fissura mediana

{ anterior)
V O r g a n (intestine)
Ganglion trunci sympathici-.

Ganglion plexus
autonomicus
F/brae posiganglionares
903. Course of spinal nervefibresand their communications with sympathetic trunk (diagram).

:Vt NERVES OF THE HEART
>_ftfc dtgastrlcus
(venter anterior)
M. r n a s s e t e r - i N. hypoglossus
Ganglion cervlcale supeYlus
truncl sympathlcl
M . stornoclcido-
maKtoideus (cut off) - ^-N. Isryngeus superior
IKA-IM- thyrohyoideus
M. sptenius c a p i t i s m j ^ -M. sternohyoideus
__> _ - ' ^ f r R . carilirjf.us c m k a l l s superior
At stcriititlvyroLdeus
N. vagus!
- N . cardlacus cervicalls Superior
-Truncus syttipsihlcus
-Glandula thyraldea
\N, cardlacus cervlcalis medlus
Plexus cervlcalis *M. Staienus anterior
-Ganglion cervlcale medium
irunci symnathicl
N. phrenicus^ ''Trachea
M & tsryngieus recurrens
M. scalenus medlus
, Truncus brachlocephallciis
Rr. cardiacl thoracic I
N. cardiac us ceicaJls inferior
Aorta ascend ens
Ganglion cervlcothoracicum (Stella turn) A. pulmonalis dextra

Communicating branch Âuricuia dextra
Truncus sympathlcus
_"^gV. cava superior
(reflected)
Esophagus1 Bfc&Plexujs anterio
N. vagus " j \ ^ dexter
t,V ^Ventrii;ulu5
\V,r dexter
Nodulus lymphaticus'J
"Hi
Branch to hfltiS pulmonis
Vv. pulmonaleS dextrae ^ - - ^ Plexus posterior

dexter
*, cava inferior
Plexus atrll dextrl
904. Nerves of heart; right aspect (%) (specimen prepared by V.P.Vorobiev),

(The superficial muscles of the neck and the internal jugular vein are removed.)

NERVES OF THE HEART 2r>o
N. hypog!ossus
A, carotis Irtterna
Ganglion tnferiijj
n. vagi
Ganglion cervicak
superlus truncl
iaryngeus superior sympathicl
N. card lac us cervicalls superior

N. vagus
Truncus Sympathicus
Glsndula thyroidea
K ' P J e x u s cervicalls
N. cardiacus cervlcalfs medlus
R. cardlacus cervicalis superior

F - N. phrenicus
N, vagus -
Trachea
Ganglion Cervico thoracic urn (stellsturr}
N. cardiac us cervicalls Inferior r. communjcatites
Ansa subclavia
A, carotis communis dextra
M. la rynge us rec u rrens -
A. carotis
communis sinlstra
V. cava superior avla sinisira
Arctts aortse f -]M s sympathicas
A. pulmonalis agijs
dextrs
Auricula dextra^ Jaryngeus rec u rrens
A . puJmonalls sinlstra
Plexus atriorum anterio
r. cardiac! thoracici
Tmricus pulmonails-.
- R r . bronchiales
Aorta
Plexus A[
pW pulmonales
anterior d e x t e r r . f " \ slnlstrae
Sulcus
Inter vent ricu I arts
cordis anterior
" "~~~-iÂnterior surface
eritrjculus dexter --.^ of atria
Plexus ""Auricula sinlstra
n ten or sinister
Pulmo sinister (cut off)
s
Plexus posterior sinister
Ventrlculus sinister
905. Memis of heart; left aspect (%) (specimen prepared by V.P.Vorobiev).

(the; superficial muscles of the neck, the internal jugular vein, and part of the common carotid artery are removed.)

1 glostopharyngeal nerve
2 first cervical nerve
3sinus branch
i~ inferior ganglion of vagus nerve
5 nerve branches from inferior ganglion of
vagus nerve, w nerve plexus (htercarolid)
in the region of bifurcation of common ca
rotid artery
6branch of ansa ceivicalis
7internal carotid artery
8blanches from vagus nerve to common ca
rotid arltry
9common carotid artery
10vagus nerve
11 phrenic nerve
12 beginning of subcJavian artery
If!brachiocephalic trunk
14external carotid artery
15mblingual nerve
16neive plexus (intercartilid) in the region of
bifurcation of common carotid artery
1Jlingual nerve
905a. Nerves of human right common carotid artery (specimen prepared by G.Oleinik).
(Photograph.)

THE VERTEBRAL GANGLION
The vertebral gangiion (ganglion vertebrate) (inconstant) lies im 2. The vertebral nerve (nervvs vcrtebralis) is in most cases ac
mediately under the middle cervical ganglion almost at the level of tually the vertebral branch of the inferior cervical (stellate) gang
the transverse process of the sixth cervical vertebra; behind it is lion. It is formed of two small branches accompanying the verte
the freely lying (outside the canal of the transverse processes) part bral artery, Together with the branches of the sympathetic trunk
of the vertebral artery, and in front j the vertebral vein. they form the vertebral plexus (plexus vcrtebralis) around the artery
The branches of the vertebral ganglion.
1. The communicating branches (rami communicantes) run to
the seventh cerebral spinal nerve.
THE INFERIOR CERVICAL GANGLION
The inferior cervical ganglion (ganglion cervkotkoracicum fstella- 4. Branches to the subclavian plexus (plexus subclaoius) whose
tumj) (Figs 904, 905) is smaller than the superior but larger than twigs accompany the subclavian artery.
the middle and vertebral ganglia, irregularly quadrangular in Branches to this plexus may also arise from the first thoracic
shape and is often fused with the first thoracic ganglion to form sympathetic ganglion.
the stellate ganglion. 5. Branches to the inferior thyroid plexus whose twigs accom
The ganglion is situated at the level of the transverse process of pany the inferior thyroid arteiy and together with its branches
the seventh cervical vertebra and the head of the first rib; it is an reach the thyroid and parathyroid glands.
irregularly quadrangular plate from which many twigs of various 6. Branches to the vertebral plexus (phxus vertebralis) which ac
size and thickness run in different directions. companies the vertebral artery; they reach the meninges along its
Branches of the inferior cervical ganglion, branches.
1, The communicating branches (rami communicantes) extend to 7. Branches to the plexus accompanying the internal mam
the sixth, seventh, and eighth cervical spinal nerves. Like the mary artery (arteria tkoracica interna).
branches of the middle cervical and superior thoracic sympathetic 8. The cardiac branch of the inferior cervical ganglion (nervm
ganglia, these are postganglionic fibres which stretch as compo cardiacus cervkalis inferior) (Figs 904, 905), arising by several
nents of the peripheral nerves of the hrachial plexus and ramify to branches from the cervicothoracic ganglion or the inferior cervical
innervate the walls of the vessels, the glands, skin, and muscles of and first thoracic ganglia of the sympathetic trunk, stretches (on
the upper limb. the right) behind the subclavian and innominate arteries, and (on
2. The communicating branches with the phrenic nerve (rami the left) behind the aorta to the common cardiac plexus (see The
communicantes cum nervo phrenko). Nerves of the Heart).
'i. The communicating branches with the vagus nerve (r&mi On its way the cardiac branch of the inferior cervical ganglion
communicantes cum nemo vago), some of which pass to the recurrent sends communicating branches to the cardiac branch of the mid
laryngeal nerve. dle cervical ganglion.
THE THORACIC PART

The thoracic part of the sympathetic trunk (pars thoracica trunci lia of the sympathetic trunk (ganglia thoracica trunci sympathies) a
sympathies) (Figs 902, 906-908) stretches on either side of the verte included along the course of the trunk. The superior ganglia are
bral column from the first to the twelfth thoracic vertebra. The sym larger than the inferior; the first thoracic ganglion is the largest in
pathetic trunk lies in front of the posterior ends of the ribs, almost in the superior group.
line with their heads, and crosses the intercostal vessels anteriorly The sympathetic ganglia are interconnected by interganglionic
under cover of the eudothoracic fascia and parietal pleura. branches (rami intergang&onares) which consist of one to three bun
Medial to the right sympathetic trunk passes the vena azygos, dles of different length and thickness. Grey communicating
medial to the leftthe inferior vena hem i azygos. branches (rami communkantes grisei) enter each ganglion from the
Up to 10-12 flattened and irregularly triangular thoracic gang lateral border and stretch to the spinal, the intercostal in this case,

A, carotis intern
M . slcmocleidomastoideus
(divided and: p u l l e d upwards)
A. nccipltaJls J
Ganglion cervtcaJe superfus

t r m c l svniDathlci^^. 1 ^ - A . carotis extcrna
N, splnalls J l l
N. cardiacus cervlcalLs superior *^ hypogiossus
A- laclalis
I mini,: >>mpathicus G
(cervical part) --JB A. lingualfs
M- mylohvoldeus
M . digastric us
Ganglion cervii:a|e medium , J J (part of posterior
venter removed)
Plexus brachialis "* A. th.vroldea superior
Ganglion cervlcothoracicum ' * N . vagus (cervical part)
(steliatuml -V
carotis communis
Ansa surxlavia ^ ^ M Glandula thyroldea
A. subtli thyroldea inferior
N. larvngeus returreni hea
A. thyroldea irna
Ganglion thoraclcum
trumci SympathlciJ "runcus brachiocephalkus
V. cava superior
V. fntercostalls posterior & vagus (thoracic part)
V. azygos -^Mm
Plexus pulmonalis
A. IntercoStalis Esophagus
posterior j
Rr. communlcantes
Pulmo (pulled to the left)
Costa V'li Plexus esoptiageus
Djctus
thorar.icLis^JJ
Nil. intercostal** Aorta thoradca.
Diaphragms
I runcus sympathies 'Si; ^ ^ - T r u n c u s vagalls anterior

(thoracic part) _ J,
Ventrlcuius
N. splanchnicus major
M subcostall:
Kami gastric I
anteriores
Proncus vagalis poster
N. sr.KHiH'.linii.'.iis rr.in...i $j
Plexus celiacustffc
Pancreas ^ L ~
: V,
Duodenum -"g Vruncus celiacus
906. Nerves and plexuses of thoracic organs; right aspect (%)

rThe parietal pleura and endothoracic fascia are removed; the liver and part of the diaphragm are removed; the right kmg h drawn to tin
left.)

260 NERVES OF THE OESOPHAGUS
1 communicating branches between sympath

etic trunk and vaûs nerve
2 right vagus nerve
3innominate irein
4bronchial nerve branches
5t%ht lung
6brancliial nerve branches
7oesophagus
.8nerve branches to pericardium
9orsciphageal pi exits
10phrenic nerve
11posterior vaga I trunk
12diaphragm
ISlesser splanchnic, neive
14greater splanchnic nerve
15branches of sympathetic trunk to thoracic
duct plexus
16descending thoracic aorta
17branches of thoracic duct nerve plexus
18thoracic duct
19branches of sympathetic trunk to vena azy-
gos plexus
t)- vena azyjos
21com muni eating branches
22 communicating blanches to oesophageal
branches of vagus nerve
23collateral trunk
24inferior cardiac nerve
25 inferior cervical (stellate) ganglion
26ansst subclavia
27middle cervical ganglion of sympathetic
trunk.
907. Nerves of oesophagus; right aspect (specimen prepared by K. Berezovsky). (Photograph.)

NERVES OF THE OESOPHAGUS
261
m cervical (stellate) ganglion

l from inferior cervical (stellate)
^ S J bcrniazygos
carotg braiiditsof Fourth thoracic
cpagtttM
* synLpatheLic ânglimi
f branches of sixth thoracic
:
8ag'i"
Mo aortic plexus
pUTjerve to fiostcrior ocso-
l o p l trunk
i fnm greater splanchnic nerve to
bUJC n e r v e
aic nerve
I trunk
I branch of left va$jus nerve
aaarfci branches romnmnicating with

paBBBaBBFqtiopbageal plexus
Etrfnta
Serves of oesophagus; left aspect (specimen prepared by K.Berezovsky). (Photograph.)

nerves; branches running to the periphery (to organs, plexuses, times stellate, sometimes irregularly triangular. The first thoracic
etc.) arise from the medial border. ganglion often fuses with the inferior cervical ganglion to form the
The first thoracic ganglion (ganglion tkoradcum prmum) ccrvicothoracic (stellate) ganglion (ganglion cervitotfomrittm [sttlla-
(Figs 906, 907) (see The Inferior Cervical Ganglion) lies behind the turn}), or, less frequently, with the second thoracic sympathetic
subclavian artery, at the level of the head of the first rib. It is some ganglion.
T H E BRANCHES O F THE THORACIC PART O F THE SYMPATHETIC TRUNK
1. The grey communicating branches (rami communicants gri 6. The greater splanchnic nerve (nervus splandinicta major)
st*} arise from the lateral border of each ganglion of the sympa (Figs 906-908) arises by three to five branches from the ante reme
thetic trunk and stretch to the corresponding intercostal nerves; dial surface of the fifth to ninth thoracic ganglia. Lying on the lat
there may be more than two of them, in which case they unite not eral surface of the vertebral bodies, all the branches unite into a
only with the intercostal nerve stretching on the level of the given single trunk (approximately at the level of the ninth-tenth verte
ganglion, but also with the nerves next above and next below. brae) which descends medially to the lumbar part of the dia
% The cardiac branches (nervi cardiari Ikorada) arise mainly phragm. After passing through the lumbar part of the diaphragm,
from the first thoracic ganglion (sometimes also from the second, together with the vena azygos on the right and the inferior vena
or the third, and even from the fourth and fifth thoracic ganglia). hemiazygos on the left, the greater splanchnic nerve enters die ab
Along their course to the heart they have communicating branches dominal cavity stretching for a small distance as a trunk and then
with the cardiac branch of the inferior cervical ganglion as well as becoming a component of the coeliac plexus (plexus celiacus). Along
with the thoracic cardiac branches of the vagus nerve (see The its course the nerve sends small branches to the thoracic aortic
Nerves of the Heart). plexus, to the branches forming the lesser splanchnic nerve, and to
3. The communicating branches with the vagus nerve. the nearlying parts of the mediastinal pleura. The greater splanch
4. The communicating branches with the recurrent laryngeal nic nerve contains solitary nerve cells which form quite often a
nerve. small splanchnic ganglion (ganglion splancknicum).
5. Fine twigs arising from the medial border of the Eve to six 7. The lesser splanchnic nerve (nervus sphnchnicus minor}
tipper ganglia take part in innervation of the vessels and viscera of (Fig. 906) originates by two or three branches from the tenth to
the thoracic cavity.
eleventh thoracic ganglia and usually follows the course of the
Stretching medially, some branches reach the walls of the in greater splanchnic nerve (less frequently together with the sym
tercostal vessels, the vena azygos (on the right) and the inferior pathetic trunk) with which it pierces the diaphragm to enter the
vena hemiazygos (on the left), and the thoracic duct. Other abdominal cavity and ramify into several branches, The lesser part
branches become components of the thoracic aortic plexus (plexus of the branches contribute to the formation of the coeliac plexus,
aortkus tkoradms) which is connected at the beginning with the the greater part become components of the renal plexus (see lite
common cardiac plexus, and inferiorlywith the coeliac plexus Nerves of the Kidneys).
and its derivatives; some of its branches enter the plexuses of the
8. The lowest splanchnic nerve (nervus sphnchnicus imus)
viscera; the oesophageal branches run into the oesophageal plexus
(Fig. 90fi) is an inconstant branch, h originates from the twelfth
(plexus esophagevs), the pulmonary and bronchial branchesinto
(sometimes the eleventh) thoracic ganglion, stretches next to the
the pulmonary plexus (plexus pulmonalis).
lesser splanchnic nerve, and becomes a component of the renal
All the indicated branches, lying medial to the sympathetic plexus.
trunk, are interconnected along their course by small branches of The three splanchnic nerves are components of plexuses which
different length and thickness containing small nerve ganglia take part in innervating the abdominal organs; the stomach, liver,
differing in size; these communicating branches are in turn united pancreas, intestine, spleen, and kidneys, as well as the blood and
by small longitudinal branches as the result of which a collateral lymph vessels of the thoracic and abdominal cavities.
trunk is formed (Fig. 919).

twvji^pLfftiterf aod pdled upwards]
:,rtntra]branch
I branch
p ^ d by branches of 1 eft
I tying i n FrOfit of
pjhMj] branch
1 1 ^ polled upwards)
9 S
909. Nerves ofhilum of lung; posterior aspect (specimen prepared by I.Shapiro).

(Photograph.)
(The aorta and oesophagus are divided and pulled upwards.)
THE LUMBAR PART

of the sympathetic trunk (pars abdominath The lumbar part of the syrnpadietic trunk carries three to five,
(Figs 902, 910-914) passes into the abdominal usually Four, oval-elongated lumbar ganglia along its course. The
i lite crura of the lumbar part of the diaphragm and lowest of them is the largest and most elongated and may stretch
__ anterolateral surface of the bodies of the first to beyond the line of the promontory in which case its lower pole ex
tends into the true pelvis.
r TOtcbrae behind the inferior vena cava (on the right
^h*. m * t bicud surface of die aorta (on the left side), and in Branches of the lumbar part of the sympatherie trunk.
^ m trf ife H 1 * " ' vessels on both sides; within the range of the 1. The grey communicating branches (rami tommunicawles gri-
tmmfm imr wrtebrae the sympathetic trunk lies at the medial bor- sd), after origin from the lateral border of each ganglion, lie be
17 #' !fc pr-1 major muscle, but in the region of the fifth ver- tween die bodies of the lumbar vertebrae and the first parts of the
_ t , i i ihghtly lateral to this border. psoas major muscle which they pierce here to run to the lumbar
iew=r e transverse communicating branches pass between nerves.
npathetic trunks For their whole distance. 2, The branches to the coeliac plexus.

V. cavs inferior.
Yciitriculus
A. gastric a sintstra .
^Ductus hepaticus communis
A. lioiiglis
Ductus c\sticj.s
Plexus Ductus choledochus

a. plireriicae inferior.
V. ports e
Pancryas
Plexus celiacus
Glandula
suprarenalis dextra
Duodenum
reflected to the left)
Ganglion
A. mesenltfrii;,! superior
aorticoremsi
Plexus mesenleritus superior
Aoria
-lên sinister
Ganglion ipesentericum inferlus
A, mesenteries interior
Plexus
aorticus abtbmtnalis V. mesenteilca inferior
Plexus rnesenterlcus inferior
fen dexlt-r
Plexus l i \ pogfSSfitUS superior
V. navn inferior
( N . presai'raiiB)
Plexus tcstlculsri Plexus testlcularis

I. Ire 1ST
reler
V. iliaca communis ulexira
A, Iliaca communis
A. ct v, sacra les inedlariat' Sinisrtra
A iliaca V. iliaca communis
coniriEunls dextra slnlslra
N.hypogastrlcus sinister
Nerve rwigs from
plexus hypogastricus
superior to ureter _ . -PIexus hypogastrlcus
inferior sinister
Plexus pelvlnus sinister)
Ganglion lumrjosacraleq
N. hypogastTicus db-xter-^ Ganglia sacralia

trunci sytnpathicl
PffMiS sat1 rat is, t Plexus sacralis
Plexus bypogastricus
infefior sinister
(Plexus petvinus sinister)
Plexus hypogastricus I n f e r i o r ^ Peritoneum

dexter (Plexus pelvinus Return
dexter) - Plexus rectalfs
A, rectalis superior
-Duetus deferers
Duct us deferens
-Veslca urlnarfa
910, Nerves and plexuses of organs of abdominal and pelvic cavities; (anterior aspect) (J/^)
(specimen prepared by R.Sinelmkov),
(The peritoneum, greater part of the stomach, small and large intestine, and liver are removed; the stomach, d u o d e n u m , and pancreas are
drawn to the left; the rectum and urinary bladder are pulled downwards,)

THE HYPOGASTRIC AND PELVIC PLEXUSES 265
911. Hypogastric plexus and dorsal parts of right and left pelvic plexuses (specimen prepared by
B.Smolkina). (Photograph.)
1ganglia of hypogastric plexus S, 4dnrsfll parts of left and right pelvic plix-
2 nen't Inniks of hypogaslric plexus

<m THE AUTONOMIC NERVOUS SYSTEM
Truncus vagalls anterior

VentTiculus (partly removed
Truncus tagafls posterior
and pulled upward?)
Branches of n. vagus
to plexus celiacus ^Diaphrayina
N. Jplanchnlctis rnaj ^Plexus âstrrcus superhtr
Ganglion truncl r-tien
sympathy! A. pstrfca
Pl.a.phren,1nh>rioM:4 sinlstra
Piexus sunrarenalls Plexus lienalis
Glandula
suprarenalis dextra
Plexus coeliacusij -A. lieralls
(ganglion <r<*llacum Olandula
dcxtrumj< suprarertalts
Gangliun slnislra
mesentery-urn """,Ren sinister
supcrdiS- tm Plexus recalls
A, renalisJS Sinister
Ganglion Colon transverum
aorticorenaleB (partly removed)
Plexus rcnaJi.s d e t t e r l ~*'"- Plexus mesentericus
Ren dexLer ^superior and a. mescnterica
Truncus Sjmpatttetis
superior
Plexus aorticus :=-Rr. Irilesiinales
abdomlnalis-
Vertebra tumbrils I V _ 0 . ^ Intysiinum tenut
V, tava inferior}:
(greater part I Aa. inlfstinaics
is removed) " " j g Mesenlerium
I'oiniiiuJiis de.<clriifl| A. iliaca torn munis

V. LSa Simstra
comrnunis tiextra WB Plexus hyp-ogastneus
Ganglion lumbosaiTl(fi superior (M_ prpsac-
ttuffd sympathies J S refis)
Plexus hypogastricusjj Rectum
i n k ' j i o r [p;-r.S c i c r i a l i ; . / ^ - -Peritoneum
Gangllon truncifl (reflected)
Svm path lei H R J j ^ ^ C . o l r t n slgmnldeum
Plexus deferentially . . .
Ureter C M VMLa urinaria
-Plexus yesfcalis
P'eaus sac X
KM, splanchn
SEcrales "*
Plexus hypo^gstrtc
inferior fpars veritrali
yinphysis pubk-a
Plt-xus rc.tallL- ^ H
Pk'.MiS prosiallfus J ^ H fV dorsali.s penis de.ttcr
N. putlendus &
M. huibocavfrnoRiis - ^
StfdtUlM
912. Nerves and plexuses of organs of abdominal and pelvic cavities; anterior aspect viewed
slightly from the right {%) (specimen prepared by R.Sinelnikov}.
(Part cf the peritoneum, stomach, and .mail and large in.te.tine are removed; the pancreas and right ureter are removed completely)

right kidney
Cfjeliac plexus
ri^ht renal plexus
sympathetic trunk
ritfht reno-aortic nerve
right para-aortic body of luiiabo-aortic pardgaiLg-
lion
7 branch from sympathetic trunk to inferior mes-
enteric aitd hvpogastric plexuses
9-ri^ht Ovarian plexus
9inferior mescntcTic ple-jtus
10 hypogastric plexus
11 communications between hypogastrk and supe
rior rectal plexuses
12caudal part of pelvic plexus
]3 interior, middle, and posterior braiitbei of pel
vic pleXUS
1+anterior primary ramus of third t&Ctfi nerve
15 pelvic nerves
16 branches from pelvic plexus to uterus
] 7 ganglion: c plate of pelvic plexus
I S m u s c u l a r iitrVCS
19 branches of pudendal nerve to sphincter ani cx-
temus muscle
20 posterior v u t ] trunk
21 superior mcscntcric plexus
22 superior meseuterfc artery
23 nerve ganglion at base of Superior nic&enteric ar
tery (superior meaenteric ganglion)
24intcntieieuteric plexus
25 ftervc twig ta ovarian plexus
Wleft para-aortic body of inTnbo-aortic paragan^
Sieo
27 pelvic (sSgiunid) colon
ffl right ureter
?9 uterine tube arid ovary
30 urinary bladder
31 branches from pelvic plexus to vagiua
J2 branches of inferior rrctai piexus
913. Abdominal and right pelvic parts of autonomk system (specimen prepared by E.Melman).
(Seveii-month-old human female fetus; the right hip bone and surrounding muscles are removed; the urinary bladder and other organs
of the pelvis are drawn to the left; the sigmoid colon is distended; (he sciatic nerve is drawn to the right,' black silk IS placed under the
nerve trunks.)

Aorla abdom1n;ilis
V. eava iiiferio
A. uvariga 5 r ^ ~ Pw i ion n]
V. ovarica -HH Plexus aorticirs abdomifiaifg

Ganglion irunri sympathies - j j f l f l
A. iliara COrtlttlimiS dcxtr.i . _^_ U P l e x u s hypbgajfricus superior

/ (N. firesacralis}
Ureter - ~ ^ f 5 |
V. illaca conmLnis sin
V. sacral is medians ' -_.

A. âcrfllis m^diana ^ f l f l | f c ^ N . hypogastripus sinisle-r
A. iliac a extern a dextriu
V. iliaca extema dextra

Plexus ovarjcus
/ Colon KlginolclfNjr!
A. iliaca intprnii *f
Ganglloti truEici sympathies mi
N. riypogasiricus dexter
Ganglion (fund svmpathid ^
Ovatium {Jeilrurti
A. iiinbilkniis ^ , j ^ _
Tuba utcrina dex(ra
Ovartmn smfstruin
Plexti* hvpogaslrir.il?, inferior
I Plexus pelvirais)
N. splandinicus sac rails ^BS-'JH ' 3 t " m uteri
- T u l i . i uterina sinlslra
Plexus siicrail; Uterus
^ - A . ulerlna
A, pudenda interna
Branches of plexus hyptigasiricus
inferior to urerus and vagina
A. rpclalia media " ' . Vagina
914. JVftito and plexuses of organs ofpelvic cavity; anterior aspect (l/t) (specimen prepared by
A.Zhuravlev).
(The pelvic Jsigmoid] colon and uterus with its appendages are drawn to the left; the urinary bladder is cut along the sagittal plane.)

T H E SYMPATHETIC NERVOUS SYSTEM 269
T H E COELIAC PLEXUS
The coeliac plexus {plexus cehafw) with the prevertebral coehac (c) the vagus nerve, communicating with the plexus via its coe
anglia /ganglia csliaca) included in it belongs to the largest aulo- liac branches;
omic plexuses. (d) the first and second lumbar ganglia of the sympathetic
It varies greatly in the number of nerve trunks stretching to it trunk (ganglia lumbalia trund sympathid);
nd the number of ganglia forming it as well as in the shape of its (e) the thoracic aortic plexus (plexus aorticus thoradcus);
irge conglomerate (Figs 910, 912, 913). (f) the phrenic nerve (nervus phrenkus).
The coeliac plexus is unpaired and lies at the origin of the coe- The right and left vagus nerves contribute to the formation of
iac artery, spreading laterally almost to both adrenals. Its upper the parasympathetic part of the coeliac plexus. The greater part of
>arts are connected with the thoracic aortic plexus, the lower the common posterior trunk of both vagus nerves is a component
>artswith the superior mesenteric plexus. of the coeliac plexus.
The plexus is a complex of sympathetic coeliac ganglia (ganglia A great number of nerve branches arise from the coeliac plexus
iliaca) Of various size and shape which are interconnected by and run in all directions to form secondary plexuses. Nerve cells
neans of many communicating branches differing in length and and the secondary plexuses formed by them are lodged along the
hickness. Among the ganglia of a developed plexus there are two course of most of these branches as well as within them. Some of
argest conglomeratesthe right and left coeliac ganglia. the cells form ganglia of various size which extend beyond the
The coeliac plexus receives branches from the following branches, others are scattered as occasional nerve cells in the
lerves: branches.
(a) the greater splanchnic nerve (ntmus splanchnkus major);
(b) the lesser splanchnic nerve (nervus splanchnkus minor) (a
anal! part of its twigs);
T H E SECONDARY PLEXUSES OF THE LUMBAR PART OF T H E

AUTONOMIC NERVOUS SYSTEM
The secondary plexuses are paired and unpaired. 1. The hepatic plexus (plexus kepaticus) is mostly formed by
The paired plexuses (Fig. 910). twigs originating from the coeliac plexus. The common anterior
1_ The phrenic plexus accompanies the inferior phrenic ar- trunk of both vagus nerves as well as the right and left inferior
rr*: iu branches unite with the branches of the phrenic nerve phrenic plexuses also take part in its formation (see The Nerves of
[irnetrating into the abdominal cavity. A small phrenic ganglion the Liver).
^mgtwn pkrenicum) lies here on the right side (see Fig. 921). 2. The splenic plexus (plexus lienalis) is derived from branches
Branches from the phrenic plexus stretch to the adrenal and of die coeliac plexus and the common posterior trunk of both va
b e inferior vena cava, and are components of the hepatic and gas- gus nerves (see The Nerves of the Spleen).
trk plexuses. 3. The left gastric plexus (plexus gastrkus) is formed by
!. The suprarenal plexus (plexus suprarenalis) is derived mainly branches of the coeliac plexus and the vagus nerves. The branches
i branches of the closely lying ganglia of the coeliac plexus and unite and stretch in the form of a plexus on the walls of the gastric
ipanies the ramifications of the suprarenal arteries. It re- arteries and ramify at the cardia of the stomach and the lesser cur
some of the branches From the hepatic plexus and the lesser vature (sec The Nerves of the Stomach), and also follow the gas trod u-
odenal artery and its branches (see The Nerves of the Stomach).
mc nerves.
4. The pancreatic plexus (plexus pancteaticus) is derived from
. The renal plexus (plexus mails) is formed by the aortico-
branches of the coeliac, hepatic, superior mesenteric, and splenic
remal ganglia (ganglia aorticorenalia), branches of the coeliac and
plexuses, and branches of the left renal plexus (see The Nerves of the
abdominal aortic plexuses, and, as it is pointed out above, by part
of ifcr lesser splanchnic nerve and the lowest splanchnic nerve (see Pancreas).
Ik . V P H of the Kidneys). 5. The superior mesenteric plexus (plexus mssenterkus superior
4. The testkular plexus (plexus itstmiam) is formed by (Figs 910, 912, 913) is formed by branches of the coeliac plexus
arising from the abdominal aortic and renal plexuses; in and partly by the abdominal aortic plexus. Its main bulk is situ-
n accompanies the testicular artery and reaches the testis; in atcd at the origin .of the superior mesenteric artery. One or two
it stretches in attendance to the ovarian artery and is small superior mesenteric ganglia (ganglia mesentenca superia) are
the ovarian plexus (plexus ovancus) (see The Nerves of the lodged here. Stretching in attendance to the ramifications of the
L
superior mesenteric artery, the terminal twigs of the branches of
" unpaired plexuses (Fig. 912). the plexus reach the pancreas and the duodenum forming pan-

270
NERVES OF THE HEART
N. iarv
N. cardiacus cervkalis
superior sinister
N. cardiac
superior dexter
^ Plexus cervicalis sinister
Truricus sympathies dexter
K. V;IL< Tfjricus Sympatriicus sinister
N. phrcnicus _ N . vagus sinister
N. phrenlcus sinister
R. Cardiatus cervlcahj superior
M. scalenus anterior
Ganglion cervkaie infe Trachea
dextrum trunci syinpji
Plexus hTachlalls sinister
Ganglion thoraefcum I dex \ subclavia sinistra

"K cardlaejs eervicalis Inferior sinister
R. cartlracus Lervlcails Inferior dexter Truncus braehlocephallcijs
N. laTyngeus recurrens dexter A. carotis eomniutiis sinistra
N. cardlacus cervicalls Inferior htcitB anrtae
V, a*ygos N. laryrijjeus recurrens
Modulus lyrriprratii sinister
Plexus atrlorum anterior
A. jiufrrionalls dex
-^flr-A. puimonafts sinistra
V. cava superior (divided)
^=ft~W pufmonaies
Aorta (divided) Auricula sinistra (reflected)
Auricula dextra (reflected) -Tru ncus pulmonafis
A. coroimrla cordis dextra A. corotiaria cord Is sinistra
Gangljonicfidd Plexus anterior sinister

in region of conus artcriosus""1^
--Veiilriculus sinister
F'lexus anterior dexter
915. Serves of heart; anterior aspect (/ 4 ) (specimen prepared by V.P. Vorobiev)

S U F r vena cava aorta and
Created with novaPDF Printer (www.novaPDF.com) " ' ' patattiisry t n i n k - a t the base.)
i ^ E S O F THE HEART
271
Truncus brachloeephallcus
V
- cava st/penor
A
" NwSfcKb sinistra- Vv
Putoionales
dextrae
A
- pulmonaffs dastra t / ' U s ofrighta t r i u m
Tr
" n c w n^monalls
Vv
- Pulmonales^-
sJm'strae -*.". ,
V. CV* Inferior
Posterior plexus ^ . * ^
of atria
Nervi
nerve foJd
Nerve foJd > * *
VMtrtadm Sinlster/
mterventricularls
P
posterior
^Vttarfeirtus dexter
916- Xmaofheart; diaphragmat.c

, paredb
cnatioxWdeiia] branches and f.
^"p-,,,î[r: r:x xv.p.vor0b,ev).
^ r * one or ^ ^ * * * * - 2
=*
*<g.nd siffJlloid c o l o P
the b a c h e s rf the m w l
0f h
; , < ^ - I o n and the de-
^ a
'"S ** "**** W
* 7 ^^^ctr^tft^ ^ ^ ^
* " * * r and feLa] S ^ f i T * * ^ * *
tend, between the . u p e r i o r a " S . t h c " W w t a d art a and ,
* W nerv and ^ ^ J - - the superior b a T O
- plM ^ ^ . ^ - t 1 0 n of the s u p e r i f ) r r e e .
the
P J
' * h , c h " ^ m u n i c t e , with the P* which is i t s c 0 tin U a t i o n ZJX " * * * hypogastric

l NERVES OF THE OESOPHAGUS
lTl
-4
s
C\ ,-6
. -. 7 l- -left recurrent laryngeal nerve

2- -left trachea! nerve branches
X * 3> -left half of trachea
- r- 5 *,e- - left vagus in ervc
5- -left brunthus
7- -bronfliial (nervel brawliei
8- - left pulmonary vein
9 -dwphraflin
f i?^S 10 -opening of inferior vena cava
is JK 11 -cmiHnucik-atiiifj branches *jf anterior vaga] trunk
is -communicating branches of posterior vaga! trunk
13 - right lung
1+ - ri#ht pulmonary vein
15 -communicating branches of interior oesophagcal
plexus
-light pulmonary artery
17 -bronchial (nerve) branches
:^t^ IS -right vagus ntn't
19 -right bronchus
20 -oesophagus
21 -oe*iOphac;eal (nerve) brandies
22 -right half of trachea
_ _ i? 23 -righl recurrent laryngeal nerve.
917. Nerves of oesophagus; anterior aspect (specimen prepared by K.Berezovsky)

(Photograph.)
(The heart is removed; the trachea is cut longitudinally and hoth of its parts are pulled aside.)

NERVES O F T H E OESOPHAGUS 273
917a, Myenteric nerve plexus of oesophagus (specimen prepared

by V.Kharitonova). (Photograph, 14X.)
(Bundles of circular and longitudinal muscular layers are partly removed.)
. The hypo gastric plexus (plexus kypogastriats superior) The hypogastric plexus receives branches from the inferior
910) lies in the spa.ce bounded superiorly by the site of bi- mesenteric, aortic, and coeliac plexuses, and a few branches from
rJon of the abdominal aorta into the common iliac arteries, la the inferior lumbar and first sacral ganglia of the sympathetic
yby both iliac arteries, and inferiorly by a line 0.5-1,0 cm trunks.
.- the promontorium. It is a flattened, rather thick, elongated The hypogastric plexus sends twigs to plexuses surrounding
top to bottom nerve plate containing nerve ganglia of various the common iliac arteries and veins, The following plexuses are
ind shape. Many nerve cells are present in the substance of distinguished:
:erve trunks of this plexus (Fig. 911). (a) the iliac plexus (plexus iliaats), right and left, entwines the
tlow the promontorium, at the level of the second-Uiird sac- common iliac artery\
Frtebra, the hypogastric plexus bifurcates to form a longer (b) the femoral plexus (piexm femoralii^ right and left, entwines
hypogastric plexus and a shorter left hypogastric plexus. the femoral artery.

X t5
irarn -Mrttt
918. JSfenws of posterior mediastinum; posterior aspect (specimen prepared by K.Berezovsky),

(Photograph,)
{The vertebral column, ribs, and vessels are removed.)
1 right middle cervical ganglion 12com muni eating branches or aortic plexus 22 fifth thoracic ganglion of left sympathetic trunk
2inferior constrictor muscle of pharynjt 18posterior vagal trunk 23 communicating branches of fourth thoracic
itright recurrent laryngeat nerve 14 communicating branches of ninth thoracic gang ganglion of sympathetic trunk
4right inferior cervical ganglion lion of right sympathetic trunk 24arch of aorta (cut off)
0cardiac branch of inferior cervical ganglion 15right greater splanchnic nerve 25left recurrent laryngcal nerve
6oesophagcal branch of right recurrent nerve 16diaphragm 26sympathetic branches to aortic plexus
7 oesophagus 17 oesophageal opening of diaphragm 27left inferior cervical (stellate] ganglion
8collateral trunk 15 left greater splanchnic nerve 28 left middle cervical ganglion of sympathetic
9aortic plexus 19spinal ganglion trunk
10fifth thoracic ganglion of right sympathetic 20oesophageal branch of left vagus nerve
1nmk 21communicating branches of aortic plexus
11 oesophageal branch of right vagus nerve

919. Nerves of aorta of 9-month-old foetus (specimen prepared by B.Smolkina), (Photograph,
1.5X.)
1 wprrior cervical sympathetic ganglion 9 aimmiJTiicationi between sympathetic nerve and lsympathetic branch to aorta
2vagus nerve branch ofvajrus nerve 16collateral trunk and ity branches to aorta and
3aubclaviau artery 10 diaphragm root of Lung
4phrenic nerve 1 \ hran c h <rf vnîs u ervc to aorta 17 branches to arch of aorta
5thymus \2 lesser splanchnic nerve IS-infer tor cervical an^] ion
6 n B l of removed right Lung IS^rttaicr splanchnic nerve 19sympathetic trunk (cervical segment)
Jaerve brandies to pericardium 14 branch from greater splanchnic nerve to aorta 20common carotid artery
3twsophaêat plex.u-5

NERVES OF THE STOMACH
27 ti
A. cystica Plexus tiepaticus plexus hepaticus

/ j (pars iinistva)
Nerve twigs from p k x u s
:*' / hepaticus to
Nerve plexuss 011
011 .'
^ductuscholedochus
wall of vesica fellea r _ _ _ ^ J ^ r . j Mm-'
V, tava inierioi
\ / fa
R. hepat icus (from plexus
/ aa. phrenicae
inferior, dext.)
Plexus a. ptirenitae
K/ interior sinisl
Dwrtus ty&iicus ,. a /
/ Truncus celiacus
/
t l . _ R.hepahcus
Plexus of duclus cystici ^
$feL / ('nun truncus vagalis anterior)
Plexus hepaticus TfUtwus vagalis posterior
{pars d e x t r a ) ^ ;
Truncus vagalis anterior
UTr. codiaci
Duclus ctiuledwrhus. (from truncus
vagalis
K. hepatka propria-jju. posterior)
I'k'XUS of ._ ^_ .. Rr. gastriei

ductuscholedochi I |-(from truncu;
vagalis
;>
A. gaslrlca dc>tF:i -^y1 a anterior)
Rr. hepatici
(from plexus
V. portae- gastiici)
Plexus
gasuoduodeiialis
Plexus hepaticus
et a. hepatica conimunis
Plexua hepaticus
A. Uenalis
A . gaslmepiploica sWstra
A, gastroepiplolca dtxtta
Plexus llenali*
Plexus celiacus
Pancreas
920. mm of stomach, porta hepatis, and gall bladder; anterior aspect (%) (specimen prepared
by I.Shapiro).
THE PELVIC PART
wcralia trund sympatkid) a n d the terminal unpaired ganglion im-
T h e pelvic p a r t of t h e s y m p a t h e t i c t r u n k (parspdmm trund sym-
p a r . T h e n u m b e r a n d size o r t h e g a n g l i a vary.
paikm) (Fig* 902> 9 1 0 - 9 1 4 ) is s i t u a t e d o n t h e pelvic surface of t h e
A series of t r a n s v e r s e twigs r u n o n t h e pelvic surface of t h e s a c
s a c r u m m e d i a l to t h e sacral f o r a m i n a .
r u m b e t w e e n t h e right a n d left s y m p a t h e t i c t r u n k s a n d c o n n e c t
T h e pelvic p a r t of t h e s y m p a t h e t i c t r u n k h a s t h r e e or four
t h e m . C o m i n g g r a d u a l l y closer to t h e m i d p l a n e , b o t h s y m p a t h e t i c
elongated oval g a n g l i a w h i c h b e c o m e g r a d u a l l y s m a l l e r down-
t r u n k s u n i t e o n t h e a n t e r i o r surface of t h e first coccygeal v e r t e b r a
w a r d s . T h e s e a r e t h e s a c r a l g a n g l i a o f t h e s y m p a t h e t i c t r u n k (ganglia

THE SYMPATHETIC NERVOUS SYSTEM 277
i portal vein (divided)

2hepatic plcs.ua
3branches of anterior vagal trunk to liver
4branches at gastric plexus to liveT
5stomach
6branshes of anterior vagal trunk entering ab-
dividual cavity
7left gastric artery
8posterior vagal trunk
9union of branches of posterior vagal trunk with
branches of gastric plexus
10branch of posterior vagal trunk to stomach
11gastric plexus
12branch of posterior vagal trunk to coeliac plexus
IScoeliac plexui
14diaphragm
IStiepatk artery (divided)
16portal vein
17bile duct (cut)
18ganglion of coeliac plexus
19branches of coeliac plexus to right suprarenal
gland
20right phrenic artery
21 branches of coeliac plexus to diaphragm
11right suprarenal gland
2 3 - ganglia of inferior phrenic plexus
i t b r a n c h e s of inferior phrenic plexus to supra
renal tfland
26 hrauches of phrenic artery to suprarenal gland
26branches of righl phrenie nerve to lumbar part
of diaphragm
2 7 branches of pi exus of ri ghl phrenic artery to
posterior surface of liver
28branches of inferior diaphragmatic plexus to
liver
29diaphragmHtk. branches of right phrenic nerve
30 branch of p k x u s of phrenic artery to hepatic
plexus
31 right phrenic nerve
32liver
33inferior vena cava (divided and pulled upwards)
921. Coeliac and right inferior diaphragmatic plexuses

(specimen prepared by I.Shapiro). (Photograph.)
(The lesser oiitentum is divided, the liver is pulled upwards, the stomach is drawn to the
left.)
*) foim a sacral loop in the middle of which lies the ganglion im- muscles of the trunk and lower limbs as well as to the skin glands
par. The sacral and coccygeal ganglia of the sympathetic trunk and dermal muscles,
p w rise to communicating and splanchnic rami. 2, The sacral splanchnic nerves (nervi splancknici sacrales) origi
1. The grey communicating rami originate from the lateral nate for the most part from the medial border of the sympathetic
wtace of each ganglion and run as components of the anterior trunk ganglia and reach the organs of the true pelvis as compo
ximxry rami of the sacral and coccygeal nerves to the vessels and nents of its plexuse*.

278 T H E SYMPATHETIC NERVOUS SYSTEM
H.
922. Nerves of stomach (specimen prepared by R.Sinelnikov). (Photomicrograph.)

(Area of totally stained specimen of nerves of the stomach; the region of the fundus; the subserous and myenteiic nerve plexuses are
stained.)
THE PELVIC PLEXUS
The pelvic plexus {plexus kypogastricus inferior s. plexus pelvinus) The pelvic plexus contains the following structures:
(Figs 910-914) is paired; it is a continuation of the unpaired hypo (a) the lower parts of the hypogastric plexus which is continu
gastric plexus (plexus hypogastricus superior). The right and left plex ous with it;
uses lie on either side of the rectum, between it and the hypogas- (b) the sacral splanchnic nerves (rtervk splanchnia sacrahs)
tric vessels, on the surface of the pelvic diaphragm (Ievator ani which originate from the ganglia of the sacral part of the sympa
muscle). thetic trunk (the second and third, less frequently from the first
The pelvic plexus is a plate with a narrow posterior (dorsal) and fourth ganglia);
part which is a continuation of the hypogastric plexus, and a wide (c) the pelvic splanchnic nerves (nervi sptanchniri pdvini s. nervi
rhomboid anterior (ventral) part, The ventral part is situated in a erigentes) arise from the anterior primary rami of die second, third
space bounded laterally by the anterior primary rami of the second and fourth, and less frequently of the Erst and fifth sacral nerves;
and third sacral nerves, dorsally by areas of the pelvic fascia and they contain also parasympaihetic fibres (see The Sacral Part of the
parietal peritonenm which correspond to the lateral periphery of Parasympathetic Nervous System).
the rectum, and medially and ventrally by the lateral surfaces of The pelvic plexus gives rise to numerous branches of different
the seminal vesicles in the male or the lateral wall of the vagina in length and thickness which contribute to the formation of the sec
the female. The ventral part, and to a lesser degree the dorsal, con ondary plexuses,
tains numerous nerve ganglia of various size and shape.

279
923. Nerves of stomach (specimen prepared by R. Sinelnikov). (Photomicrograph )
THE SECONDARY PLEXUSES O F THE PELVIC PART O F THE

AUTONOMIC NERVOUS SYSTEM
1. The middle rectal plexus g f e w ,*&& fflafe|jr; is f o n M d f(jf

(a) the superior vesica] nerves running to the upper parts of
most part by the middle haemorrhoidal nerves originating
the bladder and ascending partly on the ureter;
n the pelvic plexuses, and to a lesser extent-by branches from
superior rectal plexus. A few of its branches accompany the (b) the inferior vesicai nerves which stretch to the lower parts
die rectal artery, the rest run to the superior and inferior rectal of the bladder and to the ureter where it drains into the bladder.
uses (see Tie Nerves of the Intestine). The vesical plexus communicates with the plexus of the vas de
ferens and the prostatic and cavernous plexuses in males and with
2. The inferior rectal plexus (pkxm rectalh inferior) Is formed
the uterine and vaginal plexuses in females (see The Nerves of the
'ranches of the inferior haemorrhoidal nerves (nervi redales iA-
Urinary Bladder and The Nerves of the Uterus).
j arising from the pudenda! nerves (newt pudmdi), and also by
iches from the pelvic plexus and the middle and superior rec- 4. The plexus of the vas deferens (plexus deferential^) (Fig. 912)
ilexuses (see The JYewes of the Intestine). (only in males) accompanies the vas deferens. Branches from the
The vesical plexus (plexus vesicate) fe, on either side of the pelvic and vesical plexuses contribute to its formation. Along the
course the plexus sends branches to the seminal vesicles.
bladder as a paired structure and is a complex of nerve
5. The prostatic plexus (plexus prostatkus) (only in males) lies
a and nerves among which the following are distinguished-
on the sides and posteroinferior surface of the prostate; it is

290 THE PARASYMPATHETIC NERVOUS SYSTEM
924. Nerves of duodenum and pancreas (specimen prepared by P. Evdokimov). (Photograph

(Posterior surface of head of pancreas and duodenum; plexus of the head of the pancreas.)
1 toelLac plexus
2s:ond pan of duodenum
for tried by branches of the pelvic and vesical plexuses. Small nerve to form the nervus cavernosus penis major and tiervi cavernosi pe
ganglia are included along the course of its branches. Some nis minores which pierce the tunica albuginea of the penis and
branches of the prostatic plexus communicate with those of the ramify in its corpora cavern osa,
plexus of the vas deferens, others reach the walls of the pro static The corpus cavernosus of the clitoris is innervated by branches
part of the urethra, of the pelvic plexus,
6. The cavernous nerves of the penis (ttervi cavernosi penis) are 7. The uterovaginal plexus (plexus uterovaginalis) is lodged in
situated on the dorsal surface of the penis which they reach after the pa ranted nc fat with its main built situated on the lateral sur
passing through the urogenital diaphragm, They are a continua faces of the uterus and vagina as a paired (right and left) plexus. It
tion of the prostatic plexus branches and some twigs of the ante is a collection of nerve ganglia and branches of various size and
rior primary rami of the sacral nerves. On the dorsal surface of the shape. Its branches descend on the sides of the uterus to the infe
penis the small nerve branches unite with those of the dorsal nerve rior parts of the ovarian plexus (see The Nerves of the Uterus).
of the penis (nervus dorsalis penis) (a branch of the pudendal nerve)
THE PARASYMPATHETIC PART

Like the sympathetic system, the para sympathetic system has a The peripheral portion is composed of: (a) fibres passing
central and a peripheral portion (Fig. 902), within some of the cranial and spinal (sacral) nerves to the peri
The central portion comprises a collection of cells lodged in pheral ganglia; (b) the peripheral terminal ganglia (ganglia termi-
various areas of the brain and spinal cord, nalia), the ganglia lying in close proximity to organs (extramural),
The central portion is in turn divided into a cephalic part (pars OT the ganglia lodged in the walls of organs (intramural), their cell
cephalica) and a sacral part (pars sacralis). fibres running to different organs.

THE PARASYMPATHET1C NERVOUS SYSTEM 281
The peripheral part oF the parasympathetic nervous system [testicular], aortic, splenic), the ganglia of the hypogastric plexuses
passes in the trunks of the third, seventh, ninth, and tenth pairs of (pelvic ganglia) with the ganglia of related plexuses of organs of
cranial nerves, and in the trunks of the (first), second, third, fourth the true pelvis.
{fifth) sacral spinal nerves. The numerous collections of nerve cells lodged in the walls of
The peripheral extramural ganglia are as follows: the ciliary the viscera are related to the peripheral intramural ganglia.
ganglion (ganglion ciBaTe), the sphenopalatme ganglion (ganglion The fibres of nerve cells lying in the cephalic and sacral para-
pterygopalatmum), the otic ganglion (ganglion otkum), the subman- sympathetic centres are termed preganglionic (neurofilrae pregm<
dibular ganglion (ganglion submandibulare), the ganglia of the bron glionares); the fibres of nerve cells of the peripheral extra- and in
chial and cardiac extraorganic plexuses, the coeliac ganglia (gang tramural ganglia are termed postgangiionic (neurqfibrae postg&ngtw-
lia celiaca) with the ganglia of related plexuses of abdominal organs nares).
{renal, suprarenal, hepatic, pancreatic, gastric, mesenteric, ovarian
THE CEPHALIC PART

OF THE PARASYMPATHETIC NERVOUS SYSTEM
The cephalic part of the parasympalhetic nervous system is in quadrigeminal bodies, and the rhombcncephalic part, whose cen
rum subdivided into the mesen cephalic part, whose centre is tres He in the pons and the medulla oblongata (sec Fig, 902).
lodged in the aqueduct of the mid-brain at the level of the superior
THE MESENCEPHAL1C PART OF T H E PARASYMPATHETIC NERVOUS SYSTEM
The mesencephalic part of the parasympathetic nervous system nucleus of this nerve and run as components of the motor root of
is Formed of parasympathetic fibres of the oculomotor nerve (nerous the ciliary ganglion (radix oculavtotoria) to enter this ganglion and
ocuhmotorius) which extend to the sphincter of the pupil and the to terminate on its cells; the postganglionic fibres run in the twigs
ciliary muscle. of the short ciliary nerves (nervi ciliares breves) to the above men
The preganglionic fibres passing in the oculomotor nerve origi tioned muscles.
nate from a group pi very small cells in the accessory (autonomic)
THE RHOMBENCEPHAUC PART OF THE PARASYMPATHETIC NERVOUS SYSTEM
The rhombencepbalic part of mis system (see Fig. 902) in ing in the pons and extend as preganglionic fibres in two direc
cludes: (1) the parasympathetic (secretory) fibres of the facial tions:
nerve (navits j'adalis) distributed to the lacrirnal gland, the glands (a) one group of preganglionic fibres passes in the thickness of
of the nasal and palatal mucosa, the submandibular and sublin the greater superficial petrosal nerve (nervus petrosns major) and en
gual glands, the glands of the mucosa of the floor of the cavity of ters the sphenopalatine ganglion (ganglion pterygopalatinum). Some
the mouth, and, possibly, the parotid gland; (2) the parasympath of the postganglionic fibres of the ganglion become components of
etic (secretory) fibres of the glossopharyngeal nerve (nervus gloiso- the zygomatk nerve, and via the communicating branch with the
pharyngeus) to the parotid gland and the glands of the mucous lacrirnal nerve run to the lacrirnal nerve to reach the lacrirnal
membrane of the cheeks and lips; (3) the parasympathetic fibres of gland; the other part of the fibres enters the greater and lesser pal
the vagus nerve to the organs of the neck, the cavity of the thorax atine nerves and reach along them the glands of the nasal and pal
and abdomen, becoming along their course components of sym atine mucosa;
pathetic plexuses. (b) the other group of preganglionic fibres passes in the chorda
1. All parasympathetic (secretory) fibres of the facial nerve be tympani to the lingual nerve (see The Trigeminal Nerve) and then
long to its sensory root (ntruus intermedium). They originate in the enters the submandibular and sublingual ganglia; the postgangli
cells of the superior salivary nucleus (nucleus salivatorius superior) ly onic fibres extend to the submandibular and sublingual glands, the

282 NERVES OF THE PORTA HEPATIS
liver
-round ligament of liver
-cystic artery
-porta hepatis
-ItFt part of hepatic plexui
left pruper hepatic artery
-plexus of hepatic duct
-portal vein
-right part of hepatic plexus
-branches of hepatic plexus to stomach
-right gastric artery
-branches of hepatic plexus to hepatic and bile
ducts
-hepatic plexus
-branches of hepatic plexus to duodenum
-duodenum
-plexus on anterior surface of bile duct
-hepatic plexus (pulled to the right)
-lateral nerve of gall bladder
- medial nerve of jail bladder
-nerve twigs communicating the lateral and me
dial nerves of gall bladder
-nerve hrjucli running mi cystic artery
-gall bladder
-nerve plexus on wall of gall bladder,
925. Nerves ofporta hepatis and gall bladder; anterior aspect (specimen prepared by
I. Shapiro). (Photograph.)

NERVES OF THE PORTA HEPATIS 283
1M1
tver
--'' bladder
lepatic plexus
plexus of posterior surface of bile duct
luodenum
: :!< h of posterior nerve of bile duel
iic duct
'ranch of posterior nerve of bile duct to pan-
neas
snxreas
essel to right lobe of liver from superior ineseii-
cric artery
erve twig connecting plexus of posterior HIT-
ice- of bile duct with superior mesenteric plexus
eive twigs surrounding origin of right hepatic
rtery
upericT mesenteric plexus
.!: i iiiiiiil aorta, (opened)
cpatk plexus
osterior iierv* of bile duct
eive twigs of hepatic plexus
ortal vein
epatic plexus
ranch of hepatic plexus running to liver on pos-
:rior surface of portal rein.
926. Nerves ofporta kepatis; posterior aspect (specimen prepared by I,Shapiro),

(Photograph.)

284 T H E PARASYMPATHETIC NERVOUS SYSTEM
anterior lingual gland, and the glands of the mucous membrane of The postganglionic fibres supply also the raucous membrane of
the floor of the cavity of the mouth. the cheeks and lips, the fauces, and the root of the tongue.
2. The parasympathetic (secretory) fibres of the glossopharyn- 3. The para sympathetic fibres of the vagus nerve arise in tin
geal nerve arise in the cells of the inferior salivary nucleus (nucleus cells of its posterior nucleus (nucleusposterior nervi vagi); as pregang
salwatorius inferior) lodged in the medulla oblongata, and then run lionic .fibres they stretch in the trunk of the nerve and its branches
as preganglionic fibres in the tympanic nerve, and in the lesser su to the nerve cells lodged in the vagus trunk itself and in the extra -
perficial petrosal nerve (nervus petrosus minor) reach the cells of the and intramural ganglia of the organs of the neck, thorax, and ab
otic ganglion (ganglion oticum) in which they terminate in synapses. domen, They synapse on the cells of these ganglia and as post
The postganglionic fibres extend from the otic ganglion via ganglionic nerve fibres run to the organs.
branches communicating it with the auriculotemporal nerve, enter
the trunk of the nerve and along its parotid branches (rami parati-
dei) reach the parotid gland.
THE SACRAL PART OF THE PARASYMPATHETIC NERVOUS SYSTEM

The central portion of this part of the parasympathetic nervous colon), others run to the intramural ganglia of these organs. In
system (see Fig, 902) is situated in the grey matter of the spinal these ganglia the preganglionic fibres synapse on the peripheral
cord in the region of the comis meduilaris, in the (first), second, neurons, whose postganglionic fibres are distributed to the urinary
third, fourth (fifth) sacral segments in the form of a paired (right bladder, the urethra, part of the large intestine (from the left third
and left) parasympathetic sacral nucleus. of the transverse colon to the rectum), and to the internal and ex
The nerve cells processes (preganglionic nerve fibres) stretch ternal genital organ*. The vasodilator fibres distributed to corpora
through the anterior spinal roots in the anterior rami of the (first), cavernosa are known as the pelvic splanchnic nerves (nervi eri-
second, third, fourth (fifth) sacral nerves. On emerging together gentes) (see The Pelvic Plexus and The Nerves of the Urinary Bladder)
with the nerves from the sacral foramina, they separate from them A group of sacral splanchnic nerves is formed of fibres arising
to become the sacral splanchnic nerves (nervi splanchniri sacrales) from one of the sacral rami and running directly to the pelvic
and the pelvic splanchnic nerves (nervi splanchnici pelvini (nervi eri- plexus without connections between them; another group consists
gtntesj); some of these nerves reach the extramural ganglia of the of trunks of splanchnic nerves which at their origin from one of
pelvic plexus (plexus hypogastrkus inferior) and the plexuses of the the branches of the sacral plexus unite immediately with the
pelvic organs and the intestine (extending up to the sigmoid splanchnic nerves arising from another branch of this plexus.
THE INTRAMURAL NERVOUS SYSTEM

The intramural part of the autonomic nervous system is nervous system contribute to the formation of the intramural plex
formed of plexuses lodged in various layers of the visceral walls uses.
(some of the plexuses lie in connective tissue surrounding the or The preganglionic para sympathetic fibres terminate in syn
gans) (Figs 922, 923, 931). apses with the postganglionic parasympathetic neurons in the
Such intramural nerve plexuses are for the most part wide- and ganglia of these plexuses.
narrow-loop networks. They are particularly rich in nerve cells col The intramural plexuses of the heart, trachea, oesophagus, du
lections of various shape and size encountered as intramural gang odenum, jejunum, ileum, large intestine, urinary bladder, uterus,
lia or, sometimes, as separate nerve cells along the loops course. and other organs are demonstrated anatomically particularly well.
The sympathetic and parasympathetic parts of the autonomic

THE PARASYMPATHETIC NERVOUS SYSTEM 2*
927. Intra-organic nerves of liver (specimen prepared by A.Azarova). (Photograph.)

e liver is placed on die superior [diaphragmatic] surface, the parenchyma of the liver is removed to the level of branching of the
portal vein and hepatic artery; for better contrast black silk is placed under the dissected branches of nerves and vessels.)
eft lobt ofliver 9 iipferior vena cava, pulled rJuwnwards IB gail bladder
mints of crossing of neurcvascular b r i d l e s of 10central group a( nerve branclies of right lobe of 17 quadrate lohe of liver
Brtal system and branches of hepatic veins liver with transversely running branches ISiierve branch running on oblique vein of
^wjp of anterior nerve bran d i n of left lobe 11 right lobe of liver quadrate lobe of liver
;rouf> of [irrve branches of middle part of left 12area^ of branches of hepatic artery 19network of twigs connecting nerve branches of
13group of nerve t*$%> stretching Sp anterior and left lobe of liver
rout, of left nerve branches of left lobe oblique branches of portal vein and hepatic 20anteromed ial nerve branch of left lobe ofliver.
loup of posterior nerve branches) of left lobe artery
audate lobe ofliver 14paracystic nerve branch of right lolie
lerve twigs to caudate lobe 15porta hepalis, neurovaiciitar bundle is pulled

286 THE PARASYMPATHETIC NERVOUS SYSTEM
5""
928, Nerves ofpancreas and duodenum (specimen prepared by P.Evdokimov). (Photograph.)

(Anterior surface of pancreas and duodenum; anterior plexus of pancreas.)
1 head of pancTsas ipancreatic duel
2 splenic plexus 5 second part of duode
Stail of pancreas num.
929. Intratruncal nerve cells (specimen

prepared by R.Sinelnikov). (Photograph.)
(Area oF totally stained specimen of superior mesenteric
plexus.)
] nerve trunks
1 intratruncal nerve cells
'i Tatty tissue.

THE PARASYMPATHETIC NERVOUS SYSTEM 28
930. Nerve ganglia and intratruncal nerve cells (specimen prepared by R.Sinelnikov).
(Photograph.)
(Area of totally stained specimen of pancreatic-duodenal plexus.)
1 nerve t^nks 3fiervr ganglia
2intiatniucal nerve cells 4vcss*!s
THE VISCERAL NERVES

THE NERVES OF T H E SUBMANDIBULAR AND SUBLINGUAL GLANDS
The submandibular and subiingual salivary glands are sup The twigs running to the upper parts of the subiingual gland
plied with nerves from the submandibular ganglion (ganglion sub- arise from the subiingual ganglion which lies on the outer surface
mandibtdare), the subiingual ganglion (ganglion sublinguah) (see of the gland and communicates with the distal end of the subiin
Fig. 816 and The Trignminal Hmx) and from the so-called neuro- gual nerve.
ganglionic chain, which is a complex of small ganglia and nerve The neuroganglionic chain gives rise to nerves distributed to
trunks connecting the submandibular and subiingual ganglia and the lower parts of the subiingual gland and to the closely lying
crossing on the way the lingual nerve with which it is connected by areas of the submandibular gland.
short communicating branches.
Small collections of nerve cells are included along the course
The submandibular ganglion gives rise to twigs entering the hi- of most nerve twigs supplying both glands,
lum of the submandibular gland.
THE NERVES O F THE HEART
The heart is supplied with nerves (see Figs 904, 905, 915, 916) All these nerves, on their course to the heart, contribute to the
from three cervical and two to four upper thoracic ganglia of the formation of a single common cardiac plexus in which an extra-
sympathetic trunks, from the cervical and thoracic parts of the va cardiac part (with superficial and deep parts) and an intracardiac
gus nerves and their branches (from the superior and recurrent part are distinguished. Small collections of ganglionic cells and,
laryngeal nerves), and from the right phrenic nerve. quite frequently, a single cardiac ganglion (ganglion cardiaaim) arc

THE PARASYMPATHETIC NERVOUS SYSTEM
288
The anterior plexus of the atria is lodged under the epicardium

found in the extracardiac part. On the heart itself the different
on the anterior wall of both atria and sends twigs to their muscula-
parts of the plexus are characterized by topographic features, the
ture and endocardium, and to the anterior part of the atrial and
site of location, the number, size, and shape of the ganglia, and
ventricular septa.
connections between their portions.
The posterior plexus of the left atrium lies under the epicar
According to V.P.Vorobyev1, two anterior plexuses, two poste
rior plexuses, one plexus in the region of the anterior surface of dium in the superior part of the posterior wall of the left atrium
the atria, and another plexus in the region of the posterior surface and sends twigs to the adjacent parts of the wall.
of the left atrium are distinguished (see Figs 904, 905, 915,916). These six plexuses, being parts of one common cardiac plexus,
The right anterior plexus (longitudinal) and the left anterior have ganglionic fields of different size and occupy a definite terri
plexus (longitudinal) are situated at the beginning on the right and tory, though the number and size of the ganglia as well as the rela
left sides, respectively, of the pulmonary trunk. In the region of the tionships between them often vary. According to V. P. Vorohyev,
conus arteriosus (infundibulum) they penetrate under the epicar- the ganglionic field of the right and left anterior plexuses is situ
diuni and ramify on the respective anterior and anterolateral sur ated in the region of the infundibulum. The ganglionic field of the
faces of the right and left ventricles. The twigs of these plexuses right posterior plexus occupies an area of the right atrium between
enter the myocardium and run to the anterior parts of the ventri the superior and inferior venae cavae and, being bounded laterally
cular and atrial septa, to the vessels, and to the endocardium. The by the sulcus terminalis, continues on the posterior surface of the
plexuses are connected by a series of communicating branches. right atrium to the coronary sinus and fuses with the field of the
The right posterior plexus (longitudinal) and the left posterior left posterior plexus.
plexus (longitudinal) lie under the epicardium. The ganglionic field of the left posterior plexus begins where
The right plexus lies along the upper atrial junction in the the trunks of this plexus pass to the left atrium and spreads mainly
space between the sites where the superior and inferior venae ca- in the region of the posterior wall of the atrium between the left
vae empty into the right atrium and on the posterior wall of the pulmonary veins and the coronary sinus.
right ventricle; it sends twigs to the myocardium and endocardium The ganglionic field of the anterior plexus of the atria is small;
of the lateral and posterior walls of the right atrium and posterior its few ganglia occupy the middle part of the whole anterior wall of
the atrium.
wall of the right ventricle. The left plexus is at first lodged in the
The ganglionic Held of the posterior plexus of the left atrium is
depths of the epicardial fold. It sends twigs into the musculature
and endocardium of the atria and posterior wall of the ventricles, also small and lies on the posterior wall of the atrium between the
as well as to the superior and posterior areas of the atrial and ven trunks of the right and left pulmonary veins.
tricular septa, and to the atrioventricular bundle. Both plexuses
communicate freely with one another and with the neighbouring
twigs of the anterior plexuses.
THE NERVES OF THE TRACHEA

geal nerves), and horn the cardiac branches of the superior and
The trachea is supplied with branches (see Figs 832, 906, 917)
middle cervical ganglia. Being lodged in the space between the tra
running to both its sides from the laryngeal branches of the vagus
chea and oesophagus, the recurrent laryngeal nerves send twigs
nerves (which are connected with the superior laryngeal nerves by
communicating branches), from the superior cervical ganglia of into the posterior segments of the annular ligaments and lateral
the sympathetic trunks (via the communicating branches with the parts of the membranous wall and extend to numerous ganglia
branches of the vagus nerves), from the inferior cervical (stellate) lodged for the whole length of the trachea.
ganglia (via the communicating branches with the recurrent laryn
1
Academician V, P. Vorobiev (1876-1937), a renowned Russian
anatomist, author of Atlas of Human Anatovty (in 5 vols., 1938), de
veloped the theory of macromicroscopy and stereomorphology.-
Ed.

THE FARASYMPATHET1C NERVOUS SYSTEM
289
931. Aeruesof smaftintestine (specimen

prepared by R.Sinelnikov).
(Photomicrograph.)
\rea of totally stained specimen of nerves of small intestine
myenteric nerve plexus is stained.)
931a. Splenic plexus (specimen prepared by L.Ternova). (Photograph.)

1 splenic plextu 5collateral neivc branch
2ganglionic thickenings at union iif nerves 6superior zonal plexus
3main minks of plexus 7inferiorzonal plexus
4splenic artery Bspleen.

290 NERVES AND VESSELS OF THE LARGE INTESTINE
Colon transversum
Rr, colici
A- colica media J - ' Pancreas
^ _ Jejunum (out off)

Va&a mesenterica
superiors
A- iliocolica
H - Anastomosis between a, colic
media et a, colica sfnUtta
plexus mesenterici
supeHorts
Plexus aortlciu abdominalis ^ J B
fc A. colica sinistra
Colon sscendens -Sh
j ^ C o l o n (iescendeti&
Mesenterium (radix) ~ M f l
Vasa iliaca conimunia ~ s E B
s - n ^ f t - A, iiiaca comma
Plexus hypogastricus
I b u m fcul off) _ ~~ superior (N. presacrali:
Caecum "1
J
Appendix vermiform is
^ n . el vasa appendicis
rerraiionnis
~~ Colon sigmoideurtr
Rectum
932. Nerves and vessels of large intestine; anterior aspect (%).

THE MESENTERIC, AORTIC, HYPOGASTRIC, AND PELVIC PLEXUSES 291
ldescending colon
2superior left colic artery and attendant
nerves
3 sigmoid arteries and veins and attendant
nerve plexuses
4 pelvic (sigmoid) colon with vessels and
nerves entering its will
5 superior rectal artery and vein surrounded
by nerve plexuses of the same name
6rectum
7vascular and a w e branches running into
the wall of upper part of rectum
i, 9nerve brandies passing into middle and
lower parts of rectum from ventral part of
pelvic plexus
10cavity of right half ol urinary bladder
11 vesical plexus
12ventral part of right pelvic plexus
13communicating branch between ventral
part of pelvic plexus arid superior rectal
plexus
1<J-ureter and nerves extending to it from pel
vic plexus
ISbranch connecting ventral part cif pelvic
plexus with superior rectal and sigmoid
plexuses
16tight hypogastric nerve
17 hypugasirir; plexus
ISbranches connecting dorsal part of hypo-
gastrit plexus with luinbosacral and infe
rior mesenteric plexuses
19aortic abdominal plexus
2U inferior mesemerir plexus
2[inferior mesenteric artery
22 inferior mesetlterit vein surrounded by
nerves
23right xidtsey-
933. Inferior mesenteric, aortic (abdominal), hypogastric, and pelvic plexuses (3-year-old child)
(specimen prepared by B.Smolkina), (Photograph.)

292 THE AUTONOMIC NERVOUS SYSTEM
934. Submucous nerve plexus of rectum (specimen prepared by E.Melman). (Photograph,)

(Methylene blue stain; view taken perpendicular to long axis of intestine.)
1 deep part of submucous plexus
2long nerve trucil: in superficial part of plexus
3ganglia of deep part of plexus
4poiul of entiy of lung nerve trunk into plexus
6loops of superficial part r>f filesui
THE NERVES O F T H E LUNGS
The lungs are supplied with branches (see Figs 906-909) from Small collections of ganglionic cells occur along the course of
both vagus nerves and frnm the lower cervical and upper three or the plexus trunks, These collections either form small ganglia or
four thoracic: ganglia of the sympathetic trunks. All of these are scattered inside the trunks.
branches form four interconnected plexuses which He in the hilum The branches of the plexuses enter the lungs in company with
of the lungs and communicate with the tracheal and cardiac plex the bronchi and vessels. Small ganglia lie along the course of these
uses, branches in the lungs.

-L)g. umbillcale medianum
Nerve twigs passing over

to posterior surface of
vesica urinar ia
V -- Vesica urinaria
(posterior surface)
Nerve ganglia of \ \
posterior surface of \
Plexus vesicalis
vesica urinaria
Nerve twigs accompanying

ureter
i
Ureter sinister-^! Ureter dexter
^ ^ - Nerve plexuses in
Atrigonum vesicae
Ductus deferens
Ductus dexter
deferens sinister- Plexus deferentialis
dexter
Plexus Ampulla ductus
deferentialis sinister'*'
deferentls dextrl
Ampulla ductus x
Vesicula seminalis dextra
deferentls sinistrf' Prostata and its nerves
Vesicuia seminalis sinistra
and its nerves Urethra (pars membranacea)
935. Nerves of urinary bladder and seminal vesicles; posterior aspect (%) (specimen prepared b
R.Sinelnikov).
(Drawing of the specimen with stained nerves.)
THE NERVES OF THE OESOPHAGUS

The oesophagus receives oesophageal branches (rami esophagei) aortic plexus in particular. The branches of the oesophageal plexus
(see Figs 906-909, 917-919) from both vagus nerves and their enter the thickness of the oesophageal wall and contribute to the
branches (the recurrent laryngeal nerves in particular), and from formation of a wide-loop network between its longitudinal and cir
the sympathetic trunks, both from their thoracic ganglia and di cular muscular layers. Spherical ganglia of various size lie in the
rectly from the interganglionic branches. They all form a powerful trunks of this network. At the junction of the oesophagus and sto
oesophageal plexus (plexus esophagew,) surrounding the oesophagus mach the oesophageal plexus is continuous with the myenteric
and having along its course communicating branches with the plexus of the stomach.
closely lying plexuses of other thoracic organs, with the thoracic

294 THE AUTONOM1C NERVOUS SYSTEM
THE NERVES OF THE STOMACH
The stomach is supplied with branches (see Figs 906, 920, 923) The subserous plexus is a wide-loop network formed by twigs
from both vagus nerves. Descending on the oesophagus, these of various size at the intersection or which lie small ganglia; the
branches eithei- pass directly to the stomach or reach it via the greatest number of the ganglia are found in the region of the lesser
lesser omentum; the gastric branches (rami gastrici) and branches and greater Curvatures.
of the coeliac (sympathetic) ganglia approach the stomach in com The myenteric plexus is connected with the subserous plexus
pany with its arteries. Both groups of branches contribute to the and is also a wide-loop network with ganglia of various size occur
formation of a single common gastric plexus which is subdivided ring along the course of the twigs. The twigs forming the wide
topographically into the anterior gastric branches (ratni gastria an- loops of the plexus are thin in the region of the fundus of the
teriores nervi vagi) lying on the anterior gastric wall and the" poste stomach (Fig.922), slightly thicker in the region of the body of the
rior gastric branches (rami gastrici posteriores nervi vagi) stretching stomach, and are thickest in the region of the pylorus (Fig. 923).
on the posterior gastric wall. The submucous plexus is connected with the myenteric plexus
After penetrating under the serous coat of the oesophagus, the and, just like the first two plexuses, is a network but with a smaller
branches of the vagus and sympathetic nerves take part in the for number of cells.
mation of three plexuses: the subserous plexus (plexus sufaerosus)t Being interconnected, the three plexuses innervate accordingly
the my enteric plexus (plexus; myentericus), and the submucous plexus various elements of the gastric wall.
(plexus submutosus).
THE NERVES O F THE INTESTINE
The intestine receives branches (see Figs 910-914) from the part of the sympathetic trunks, the sacral plexuses, and the plex
superior and inferior mesenteric plexuses (and via them the vis uses of the genitals). AH the mentioned branches approach differ
ceral and splanchnic branches, and branches of the lumbar ganglia ent parts of the small and large intestine, pass into their walls, and
of the sympathetic trunks), branches from the hypo gastric and pel take part in the formation of the subserous, myenteric, and submu
vic plexuses (and via them the visceral branches from the sacral cous plexuses (Figs 931, 934).
THE NERVES OF T H E LIVER AND GALL BLADDER
The liver is supplied with branches (see Figs 920, 921, 925, part of the hepatoduodenal ligament; it extends to the right lobe of
926) from the coeliac plexus, the anterior common trunk of the va the liver in the space between the twigs of the portal vein and the
gus nerves, and the right and left inferior phrenic plexuses. Run bile duct.
ning tn the liver these branches contribute to the formation of the The anterior and posterior hepatic plexuses are freely con
hepatic plexus (plexus kepaticus) which is subdivided topographi nected to each Other by a great number of nerve twigs.
cally into an anterior hepatic plexus and a posterior hepatic Nerve ganglia of various size and shape lie along the course of
plexus. the trunks of the hepatic plexuses. There are also many intratrun-
Both plexuses are situated in the thickness of the hepatoduod- cal nerve cells, either in groups or scattered along the extension of
enal ligament and run to the porta hepatis; on the way they encir the trunk. In the liver, the nerve twigs pass in company to the ram
cle the proper hepatic artery and its branches and lie, accordingly, ifications of the proper hepatic artery and portal vein (Fig. 927).
on the anterior (anterior plexus) and posterior (posterior plexus) The common hepatic plexus sends branches to the gall blad
surfaces of the portal vein. der, most of them originating from the right part of the anterior
The greater part of the anterior hepatic plexus extends in at hepatic plexus. In the thickness of the cystic wall, a superficial
tendance to the hepatic artery. Its trunks are relatively thick at the plexus lying in the subserous and connective-tissue layers, and a
beginning but gradually become thinner as they come closer to the deep plexus lodged between the muscular layer and the mucous
liver. At the division of the proper hepatic artery into the right and membrane are distinguished.
left branches, the anterior hepatic plexus separates into two bun Small nerve ganglia and intratruncal nerve cells are present in
dles, right and left, which are interconnected by numerous twigs. the trunks of the deep plexus.
The main bulk of the posterior hepatic plexus lies in the right

Ductus deferens
A, lesticularls-^
Plexus delerentjalis
Plexus testicularis
Plexus pfHTtpiliformis-^-^ ( \ \ V Ai
--Fascia spermatica intema
A. deferenilaHs
Caput epidid\m!dis
Corpus epfdidymidis
Appendix epididyrnidis-M
Lr, * C l I Cauda epldidymidis
Tunica vaginiilis testis *^'-JUk
Ttstis
936. Nerves of right testis; medial aspect (%) (specimen prepared by B.Neigas).
(The tunicae are opened and partly removed.)
THE NERVES OF THE PANCREAS

branches does not coincide with that of the pancreatic vessels.
pancreas receives branches (Fig. 928) from the coeliac
(b) The posterior plexus of the body and tail of the pancreas is
ind the plexuses lying close to itthe hepatic* splenic, su-
formed by branches arising from the coeliac, superior mesenteric,
mesemeric, and left renal. After entering the gland thick
left renal, and splenic plexuses. Only a few branches of the splenic
est branches form three plexuses.
plexus pass in company to the vessels of the gland.
The anterior pancreatic plexus extends on the tail, body,
(c) The posterior plexus of the head of the pancreas is formed
per part of the head of the pancreas. The branches of the
by many branches arising from the coeliac, superior mesenteric,
anterior hepatic, and splenic plexuses take part in its for-
and posterior hepatic plexuses. These branches run in the direc-
Tj.~i .,*;<=* nMwnrU nf wide IOODS and the course of its
296 T H E AUTONOMIC NERVOUS SYSTEM
tion of the duodenum, communicate, and send twigs to the head of Small nerve ganglia are encountered along the course of
the pancreas. On approaching the wall of the duodenum> some of branches of the posterior plexus of the head of the pancreas.
the branches stretch to the inferior pancreaticoduodenal artery The three plexuses of the pancreas are connected by mean?
and form a plexus around it which accompanies its ramifications. a series of communicating branches.
THE NERVES O F THE SPLEEN
The spleen receives most of the nerve branches (Fig.921) from branches to the head and body of the pancreas and branches
the splenic plexus and a smaller number from the left suprarenal the stomach which accompany the short gastric arteries.
and left phrenic plexuses. The structure of the splenic plexus varies, which is eviden
In it* initial portion the splenic plexus is a network of narrow associated with the architectural pattern of the vessels.
loops surrounding the trunk of the splenic artery. Further on, Occasional minute ganglia and small intratruncal cells ,
larger and longer twigs can be detected in it which communicate present along the course of the branches of the splenic plexus, p
with one another by means of a series of short branches. ticulariy in its initial parts.
As it stretches to the spleen, the plexus sends numerous
T H E NERVES O F THE KIDNEYS
The kidneys are supplied with nerves from the renal plexuses renal artery. It receives inferior branches from the lesser and k
(see Figs 910, 912, 913). The right and left renal plexuses are est splanchnic nerves and sometimes a branch from the first lu
formed by small branches arising from: bar sympathetic ganglion.
(a) the aorticorenal ganglia (ganglia aortkorenaiia); Twigs from the same splanchnic nerves (less frequently frt
(b) the lower parts of the coeiiac plexus; the greater splanchnic nerve) pass to the renal plexus (plexus TO
(c) the sympathetic trunks. lis), by-passing the aorticorenal ganglia.
The aorticorenal ganglion is often paired, in which case a supe Small renal ganglia (ganglia renalia) occur along the course
rior and an inferior ganglion are distinguished. the trunks of the renal plexus. The largest among them, lying ct'
The superior aorticorenal ganglion lies in the upper angle to the root of the ovarian (testicular) artery, stands out.
formed by the beginning of the renal artery and the corresponding The renal plexus is connected with the superior and infer
border of the aorta. A twig runs to it from the lesser splanchnic mesenteric plexuses and the abdominal aortic plexus.
nerve, or, rarely, from the greater splanchnic nerve or the coeiiac The renal plexus gives rise to nerves which run to other orga
ganglion. to the adrenals (plexus suprarenalis), to the ureter (pUxus uretcr
The inferior aorticorenal ganglion is lodged in the lower angle and to the testicular (plexus testiculxris) or ovarian (pUicus ovan
formed by the aorta and the inferior border of the beginning of the
THE NERVES O F T H E URINARY BLADDER
The urinary bladder is supplied with branches (see Figs shape and in tntertruncal nerve cells. The largest ganglion is
910-914, 935) mainly from the vesical plexus (pkxus vesicalis) cated at the opening of the ureter into the bladder; it sen
which is formed on either side of the bladder by branches of the branches to the bladder, ureter, and vas deferens. Some ganglia
corresponding pelvic plexus, by part of the twigs of the hypogastric various size are lodged in the region of the trigone of the bladd
plexus, splanchnic branches of the fifth lumbar and the Erst three fewer are scattered on the walls of the bladder. The nerve branch
or four sacral ganglia of the sympathetic trunk, and the splanchnic stretching from the vesical plexus itself as well as those rumii
nerves of the first three or four sacral nerves. from the mentioned ganglia are lodged in the subserous areolar t
Most of the branches of the vesical plexus approach the blad sue and, on entering the cystic wall, lie between the muscular ]-
der at the site where the ureter drains into it, one group of twigs ers and in the mucous membrane.
runs to the upper parts of the bladder (the superior vesical nerves), Numerous communicating branches connect the vesical plex
the otherto its lower parts (the inferior vesical nerves). The with the rectal plexus (plexus rertalis), the plexuses of the vas def<
branches of the vesical plexus form a ureteral loop round the term ens and seminal vesicles, the prnstatic plexus (plexus prostaficus)
inal part of the ureter; twigs from this loop ascend on the ureter. males, and die uterine and vaginal plexuses in females.
The vesical plexus is rich in nerve ganglia of various size and

T H E AUTONOMIC NERVOUS SYSTEM 297
R, tubarius a, uteri nae Lig. ovarli pioprlum

Plexus tubarius sinister \ _ i Venous plexus of uterus
Tuba V * R.ovaHcus < \ FA.,* ..*... Plexus tubarius dexter
\ \ \ a, u t e r i n e / >\ ,Fu /Tuba uterina dextra
uterina sinlstra^
^Flmbrlae
tubae
Mesosalplnx''
Fimbrla ovarica
Nn. ovarli
.'vartttm
Ductus epoophotl longitudinalis* ^ \ x L l g . latum uteri
Lig. tetes uteri
Epoophoron /
(ductulf transversi)
A. uterina dextra
A. uterina slnistra
Plica rectouterina
A. vaglnaMs
Vagina -
Plexus uterovaglnalis
937. Nerves of uterus and vagina; posterior aspect (%) (specimen prepared by A.Zhuravlev).
(Drawing of the specimen with stained nerves.)
T H E NERVES O F T H E TESTIS
The testis is supplied with branches (Fig, 936) from the lesticu- the latterthe vas deferens. Near to the hilum of the testis they
b r plexus (plexus testiqilarh) and the plexus of the vas deferens unite and then penetrate into the substance of the gland.
(firms tUfereniialU). The former accompanies the testicular artery,
THE NERVES OF THE UTERUS

The uterus receives branches (see Figs 914, 937) from the com- side of the uterus is lodged in well-developed fatty tissue and gives
m uterovaginal plexus (plexus uterovagin&ltf) which is formed the impression of a single large ganglion.
' by the inferoanterior parts of the pelvic plexus. One part of The group of branches arising from the uterovaginal plexus
plexus sends branches to the uterus (the uterine plexus), the and running to the uterus includes those located in the broad liga
part gives origin to branches passing to the vagina (vaginal ment of the uterus and reaching the uterine tube and die ovary it
self (in the substance of the mesorchium). Some of these branches
The part of the uterovaginal plexus sending branches mostly to unite with the twigs of the ovarian plexus.
A c inerus is formed by several large and small ganglia which are Most of the branches of the uterovaginal plexus approach the
. in two or three layers in certain places of the plexus and lateral border of die uterus to be distributed mainly on its anterior
py the territory limited by the level of the fornices of the va- and posterior surfaces. At die beginning they join the branches
arising from die ganglia of die fornix of the vagina; further on they
Thii relatively large meshwork of ganglia arranged on either pass along the length of the body of the uterus to reach its fundus.

298 THE AUTONOMIC NERVOUS SYSTEM
THE NERVES THE VAGINA
The vagina is supplied with branches (see Figs 914T 937) from continue on its walls to form a thick network in whose loops are
the common uterovaginal plexus (plexus uierovaginalis) whose in- lodged smaller ganglia.
feroanteriur parts are known as the vaginal plexus. The vaginal part of the common uterovaginal plexus is con
The uterine and vagina! plexuses arc a relatively thick network nected with the plexuses of the urinary bladder and rectum a |"
o
of numerous ganglia of different size and shape and ntrvt
via the uterine plexus, with the plexuses of the ovaries and LL
branches. The vagina is surrounded by the nerve branches which
nerves surrounding the uterine tubes, %
OF THE NERVOUS SYSTEM1
In trie early stages of development the ectoderm of the neural tube becomes narrow and transforms into the central canal (canalis
groove and then that of the early neural tube is formed of a single centralis medullat spinalis) filled with cerebrospinal fluid (liquor cere
layer of cells. Then, as the result of mitosis or the neuroepithelium, brespin&lis).
the wall of the neural tube acquires multilayered structure. Due to reduction of the caudal part of the spinal cord, a
With the gradual differentiation of the neuroepithehutn, three thread-like structure of nerve tissue forms which becomes the
layers become detectable in it. The inner, ependymal layer, gives filum termlnale subsequently.
rise to ependymal cells lining the central canal of the spinal cord The spinal cord grows slower than the vertebral column in the
and the walls of the ventricles of the brain. The middle, mantle period of infra-uterine development. In the third month at intra-
layer, is rich in cells from which neuroblasts and spongioblasts utetine life, for instance, it occupies the entire vertebral canal; but
form; die neuroblasts develop into nerve cells, the spongioblasts later (he vertebral column grows more rapidly so that the end of
into neuroglial cells. The outer, marginal layer is poor in cells; it is the spinal cord moves upwards and at the time of birth is at the le
composed of a great number of celt processes and becomes the vel of the third or fourth lumbar vertebra.
white matter later.
The differentiation of the neural tube into the forebrain, mid-
The development of the mantle layer of the neural tube is brain, and hind-brain and spinal medulla have already been de
irregular. The number of nerve cells increases most intensively in scribed (see p.Maket),
die lateral parts in which the sulcus litnitans forms later. The sul- The development of the grey and white matter of die brain
cus divides die lateral wall into two laminaethe dorsolateral differs from that of the spinal cord. In the spinal cord, the grey
fomna dorsoLatemlis) and the ventrolateral (lamina ventrokta-alis). matter occupies the centre, the white matterthe periphery. In
The posterior grey columns of the spinal cord form later from the die brain the neurons also develop close to the ventricles, but mi
former and the anterior grey columns from the latter, gration of cells from die site of their origin is characteristic of
The mass of die outer (marginal) layer also increases consider some of its areas (the teJencephalon and the cerebellum). In the
ably through the growth of the iongitudjual arrangement of the cerebral cortex, which is made up of several layers, the large neu
neuron processes of the mande layer. The processes are covered by rons forming the innermost layer are the firstto migrate, while die
myclin and form the white matter of the spinal cord. The groups next layer of grey matter is formed of smaller neurons which mi
of fibres of the white matter are separated from one another by the grate to the periphery through other, already formed layers.
anterior and posterior horns or the grey matter, as a result of which The motor roots of the spinal nerves develop from the neural
die anterior, posterior, and lateral white columns of the spinal cord plate which acquires three layers as it transforms gradually into
can be distinguished. the neural tube. The middle layer is formed of a collection of neu
The irregular growth of the lateral laminae leads to a change in roblasts which give origin to the grey matter of the spinal cord,
the shape of the neural tube and the formation of two longitudinal The bundles of their axons either spread in the substance of the
grooves which divide the spinal cord into two symmetrical parts. outer layer of the neural plate to form the white matter of the spi
Widi the gradual development of the spinal cord, the cavity of the nal cord or leave the neural tube to form metamerically arranged
anterior roots. The axons of the anterior roots grow into the meso-
denn in which they unite with the young muscle cells.
The sensory roots originate from the rudiments of the spinal
In view of the fact that students will study the age features af ganglia situated along the borders of the medullary groove. After
ter they are acquainted in detail with the anatomy of a human the neural plate is converted into the neural tube, two neural crests
adult, in this section as well as in other similar sections we dwell with segmental constrictions form and two rows of spinal ganglia
only on some age peculiarities. For details of development we refer appear on the dorsal side of the embryo. The neuroblasts lodged in
the reader to a textbook of embryology. them acquire the appearance of bipolar nerve cells with some of

300 DEVELOPMENT AND AGE FEATURES OF THE NERVOUS SYSTEM
their processes growing into the neural tube to form the posterior velopment the parts of the spinal cord grow differently, the thor
root and others spreading ventrally and fusing with the anterior acic part growing most of all and the lumbar part growing the
roots on the fourth-fifth week to form the mixed spinal nerves. least. After the age of 6 years the spinal cord grows mostly in its
The cranial nerves differ in origin. The olfactory and optic transverse diameter. Some grooves appearing on the spinal cord of
nerves, for instance, are in essence a continuation of the cerebral the newborn become deeper with age and remain throughout life,
tracts they develop from the forebrain and are its projections, others disappear after birth.
The other cranial nerves differentiate from the spinal nerves; they The specific features of the brain of the newborn are insuffi
originate from the segmental structures of the cephalic region. cient development and weak differentiation of the nervous system
They lose their segmental structure, however, and the transforma of the newborn as compared to the other systems. Al! the main
tion of the spinal nerves into the cranial is associated with the de sulci and gyri can be seen on examination of the brain and the cor
velopment of the sense organs and the branchial arches with their tex of its hemispheres, but they are not clearly denned; the sulci
musculature. Besides, the cranial nerves are characterized by the are shallow, die gyri are poorly manifested. There are indications
absence of connections between the roots or their reduction, due that the sulci and gyri of the second and, mainly, those of the third
to which they are highly specialized. For instance, the third, fourth, order develop after birth particularly intensively in the first year of
and fifth cranial nerves correspond to'the anterior roots and are live, whereas those already present in the newborn become deeper
motor. The fifth, seventh, eighth, ninth, tenth, eleventh, and and more distinct.
twelfth nerves are homologues of the posterior roots; they are asso The dimensions of the occipital iobe of the cerebral hemi
ciated with muscles developing from the branchial apparatus. Be spheres are relatively larger in the newborn than in an adult. The
sides, such nerves as the tenth and twelfth arc more complex in number, shape, and topography of the gyri change with the child's
origin because Lhey include several spinal nerves. growdi. The greatest changes are encountered in the first 5-6 years
The centres of the autonomic nervous system in the brain and of life; by the age of 15-16 years the proportions acquire the adult
spinal cord form as the result of division and differentiation of the pattern. The cerebellum of the newborn is slightly compressed and
neuroblasts of the cerebral vesicles and neural tube. With gradual elongated; the sulci of its hemispheres are also poorly pronounced;
growth their cells migrate to the periphery in the anterior roots the middle part of the cerebellum, the vermis, is developed most.
and establish connections there with the ganglia of the sympath The brain of a newborn weighs 380-400 g which accounts for
etic trunk lying on either side of the vertebral column. The ganglia one eighth of the body weight on the average. By the end of the
of the sympathetic trunk form from neuroblasts of the ganglionic first year of life the weight of the brain increases twofold and
plate, which migrate along the anterior roots of the spinal nerves. makes up one-eleventh to one-twelfth of the body weight. By the
Cells from the paravertebral ganglia later migrate further to the age of 3 years it increases threefold, and by the age of 5 years it ac
periphery to form ganglia and plexuses round the large vessels. counts for one-thirteenth to one-fourteenth of the body weight. By
The autonomic part of the nervous system in the region of the the age of 20 the initial weight of the brain increases Tour- to five
head develops in a similar manner. Neuroblasts from the medulla fold, making up one-fourtieth of die body weight in an adult.
ohlongata and the ganglionic plate migrate along die branches of Among the peculiarities of age changes of the nerves is their
the trigeminal, vagus, and other nerves, and concentrate along myelinization. This process takes a different course for different
their course or form intramural ganglia, nerves: the motor nerves acquire a myelin sheath first of all, then
Both the central and the peripheral nervous system undergo a the mixed nerves, and lastly the sensory nerves. This refers both to
series of changes after birth. the cranial and to the spinal nerves; myelinization of the anterior
The spinal cord of the newborn has features distinguishing it (motor) roots of the spinal nerves occurs first, and later the myelin
from that of an adult. This applies to its position in the vertebral ization of the sensory roots.
canalthe length, breadth, weight, and size of its separate seg There are indications that myelinization of the cranial nerves
ments, development of the fissures and grooves, the position of the occurs in succession, namely, the auditory nerve has the richest
roots of die spinal nerves. There are some peculiarities in the myelin sheath by the time of birth. In general, the degree of nerve
structure of the white and grey matter of the spinal cord. The functioning is determined to a certain measure by the intensity of
lower end of the spinal cord of a newborn is at the level of the formation of the myelin sheath. Such a process occurs in the optic
third lumbar vertebra (the first or upper border of the second lum nerve in which myelinization of the fibres is most intense in the
bar vertebra in an adult). The spinal cord weighs 3-4 g at birth, first days after birth. It is believed that myelinization continues af
the weight increases almost twofold by the age of 6 months, three ter birth and demonstrates a certain succession: in relation to the
fold by the age of 12 months, reaches 16 g by the age of 6 years, motor nerves the facial, sublingual, abducent, third division of
and is S5 g by the age of 20 years (the weight of an adult's spinal the trigeminal nerve, oculomotor; in relation to the sensory
cord). The spinal cord of the newborn measures up to 15 cm in nerves the auditory, first and second divisions of the trigeminal
length, by the age of 10 years the length increases almost twofold. nerve, vagus, glossopharyngeal, optic. Myelinization of the cranial
The cervical and lumbosacral enlargements, which form on the nerves takes place in the first 3-4 months and is completed in the
third month of intra-uterine life simultaneously with die develop second year of life. Myelinization of the spinal nerves continues to
ment of die limbs, are well pronounced in the newborn. With de the age of 3 years.

THE SCIENCE OF
SENSE ORGANS E
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Esthesiologia o
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THE SENSE ORGANS
Organa sensuum
The sense organs (organa. seTtsuum fsensoria]), or the analysers, The peripheral part of the analyser (the receptor or receptive
are complex nerve apparatus specialized in reception, trans - Held) perceives the stimulus and transforms it into nerve excitation
mission, and analysis of nerve excitation. which is transmitted to the centrethe nucleus of the analyser,
The different stimuli originating in the external and internal The analyser nuclei are lodged in the cerebral cortex (cortical nuc
environment of the body arc perceived by receptors (exteroceptors, lei of analysers). The conducting part is represented by sensory
intereceptors, and proprioeeptors), each transforming a definite cranial and spinal nerves.
stimulus into a nerve impulse. The receptors perceive only specific (or appropriate) stimuli.
The excitation arising in the receptor is transmitted along the When inappropriate (nonspecific) stimuli are applied the resulting
nerve conductors to intermediate centres situated either in the spi sensation is poorly differentiated, elementary, and primitive.
nal cord or in the brain stem. Here, the affector neurons are con The peripheral nerve apparatus of each analyser, i.e. the recep
nected to one another and to the effector neurons. tors, together with the accessory structures providing for their bet
From the intermediate nerve centres the nerve excitation is ter appreciation of sensations are called sense organs (orgma sen-
conveyed to the cerebral cortex where h is interpreted. smtrn).
The peripheral receptor and nerve conductors, as well as the The science of the sense organs and sensory phenomena is
nerve centres of the spinal cord and brain stem, and the corre known as aesthesiology (estesiologia).
sponding areas of the cerebral cortex are joined functionally to The Following sense organs are studied in anatomy.
form a single system and are called analysers. 1. The organ of sight (nrganum mms).
The analysers developed due to a need for a rapid and ade 2. The organ of hearing, or the vestibulocochlear organ (otga-
quate response of the organism to external stimuli. Some of them num vestibulocochliare).
specialized into distant (the organs of smell, sight and hearing) 3. The organ of taste (orgarmm. gustus).
and others into contact (organs of taste and general skin sensation) 4. The organ of smell (organum olfactus).
analysers. 5. The organs of skin sensation perceiving temperature, tac
Excitation of the analyser induces a sensation which is the first tile, and pain stimuli.
stage of cognition. The sensation is transformed into notions, con These sense organs have receptors perceiving stimuli from the
cepts, and laws which constitute the highest stage of cognition external environment {esteroceptors).
the thought. fnteroceptors and proprioeeptors, which give information con
From the anatomo-physiological standpoint, each analyser is cerning the condition of the organism's internal environment (the
divided into three parts: peripheral, conducting, central. viscera, muscles, etc.) are described in textbooks of histology.

THE ORGAN OF SIGHT
Organum visits
The organ of sight (organum visits), or the eye (oaths) consists of

the eyeball (bulbus oculi), the optic nerve (nervus optkus), and acces
sory organs (vrgana oculi accessorta): the eyelids, the lacrimal appara
tus, the muscles of the eyeball, vessels, and nerves.
THE EYEBALL
The eyeball (bulbus oculi) (Figs 938, 954) has an irregular spher sponding to the anterior pole with the point on the retina corre
ical shape. Only its anterior, smaller and most projecting part, the sponding (o the posterior pole of the eyeball.
cornea, arid the part surrounding it (see Figs 946, 949) can be ex The largest transverse dimension of the eyeball measures
amined visually; the remaining, larger, part is situated deeply in 23,f> mm, the vertical 23.3 mm, on the average.
the orbit. The line incircling the eyeball midway between its two poles is
The eyeball has two poles: anterior and posterior. The anterior called the equator (equator bulbi oculi). It is 10-12 mm to the back
pole (polus anterior) is the centre of the projecting part of the ante of the cornea] border. Lines drawn perpendicularly to the equator
rior corneal surface; the posterior pole (polus posterior) lies in the and connecting both poles on the surface of the eyeball are called
centre of the posterior segment of the eyeball slightly lateral to the meridians (meridiani bulbi oculi). The vertical and horizontal merid
exit of the optic nerve. ans divide the eyeball into quadrants.
The distance between the anterior and posterior poles is the The contents of the eyeball is formed by its inner nucleus, or
largest dimension of the eyeball and measures 24 mm on the aver transparent media, which is composed of the vitreous body (tatpus
age. vitretttn), the lens, and the aqueous humour (humor aquosus). The
nucleus of the eyeball is enclosed in three coats (Figs 938, 943,
The line connecting both poles is called the external (optic)
949).
axis of the eye (axis bulbi externus), or the geometrical (sagittal) axis
1, The outer, or librous coat of the eye (tunicafibrosabulbi).
of the eye,
2. The middle, or vascular coat of the eye (tunica msculosa
From this axis should be distinguished the internal (visual)
axis of the eye (axis bulbi internus), which measures up to 21.3 mm bulbi).
% The inner, or nervous coat of the eye (tunica interna bulbi).
and connects the point on the inner surface of the cornea corre

THE ORGAN OF SIGHT
304
THE FIBROUS COAT OF THE EYE

contrast to which it is formed of fibres of dense connective tissue
The fibrous coat of the eye (tunka jibrosa htdbi) (Figs 938-940)
with an admixture of elastic fibres and is opaque, At the corneo-
h the strongest of the three coats. The eyeball maintains its charac
scleral junction is a semitransparent rim called the corneal lhnbus
teristic shape owing to it.
(limbus corneae).
The anterior, smaller, part of the outer coat (one sixth of the
The sclera is composed of the substantia propria sclerae, which
total eyeball surface) is called the cornea (Fig. 938). The cornea is
is covered anteriorly with the lamina cribrosa sclerae (lamina epk-
the most projected part of the eyeball and has the appearance of a
dcralis) and with the lamina fusca sclerae on the inner surface.
slightly elongated convexo-concave lens with the concavity facing
The outer surface of the sclera is covered with a connective-tis
to the back. The peripheral parts of the cornea measure 1-1.2 mm
in thickness, the central part0.8-0-9 mm. The horizontal diame sue membrane, or the conjunctiva (tunka conjunctiva) in its anterior
ter measures 11-12 mm, the vertical-10.5-11 mm. The cornea is part, while posteriorly it is covered only with endothelium. The in
made up of a transparent connective-tissue stroma and comeal ner surface of the sclera facing the choroid is also covered with en
bodies which form the substantia propria of the cornea (substantia dothelium. The thickness of the sclera varies in its different parts.
propria corneae). The anterior and posterior elastic laminae (lamina It is thinnest where the fibres of the optic nerve perforate it when
limttans anterior et lamina limttans posterior) lie on the anterior andemerging from the eyeball, and the lamina cribrosa sclerae forms.
posterior surfaces, respectively, of the stroma. The former is a dif The sclera is thickest round the optic nerve where it measures 1 to
ferentiation of the substantia propria, die latter is a derivative of 1.5 mm; it becomes thinner anteriorly and measures 0,4-0.5 mm at
the endofhdium covering the posterior surface of the cornea and the equator; in the area corresponding to the insertion of muscles
lining the whole anterior chamber of the eye. The anterior surface its thickness increases again to 0.6 mm. In addition to the fibres of
of the cornea is covered with stratified epithelium which is contin the optic nerve arteries, veins, and nerves perforate the sclera in
uous widi the epithelium of the ocular part of the conjunctiva. The many points and form openings in it which are called the emissa
cornea is absolutely transparent because its tissue is homogeneous ries of the sclera.
and avascular. A circular sinus venosus sclerae (Fig. 940) passes in the depths
The posterior, larger, part of the outer coat (five sixths of the of the anterior part of the sctera near to its junction with the cor
total) is the sclera. It is gradually continuous with the cornea, in nea.
THE VASCULAR COAT OF THE EYE

(2) a middle part situated at the corneoscleral junction, the cili
The middle vascular coat of the eye (tunica oasculosa bvlbi) (Figs
939-943) consists of three unequal parts: ary body (corbus ritiare);
(3) an anterior, smaller, part called the iris, which can be seen
(1) a posterior, larger part, lining two thirds of the inner sur
through the cornea.
face of the sclera and called the choroid (ehorioidea) \
THE CHOROID
composed of a layer of large vessels (mainly veins) between which
The choroid (ehorioidea) is continuous anteriorly with the cil
are connective-tissue fibres (elastic predominantly) and pigment
iary body; the jagged edge of the retina, called the orfl serrata, may
cells; this is the vascular lamina (lamina oasculosa); the next deeper
be considered the boundary between them.
layer is less pigmented and has medium-size vessels which are con
The choroid lies on the sclera for the whole distance, except for
nected to a dense network of small vessels and capillaries forming
the region of the macula and the area corresponding to die optic
the choriocapillary lamina (lamina choriacapillaris). The capillar
disk. network is developed particularly well in the region of the macula
In the region of the optic disk is an optic foramen transmitting
lutea retinae.
fibres of the optic nerve. The remainder of the outer surface of the
A fibrous structureless layer called the basal lamina is the
choroid is covered with endothelial and pigment cells, and be
tween it and the inner surface of the sclera is a capillary pericho- deepest layer of the choroid. The anterior part of the choroid be
roidal space (spatium ptrichorioidtah). The rest of the choroid is comes thicker and continuous with the ciliary body.

THE ORGAN OF SIGHT 305
Vertex corneae
Axis bulbi externus (polus anterior ocuin
Axis visus s
Cornea /Facies anterior corneae
/ (lamina limitans anterior)
Fades posterior corneae
(lamina limitans posterior)
Iris
Stratum pigmentl retinae
Lig. pectinatuni anguli iridocorneali
M. ciliarls
Tunica conjunctiva
Facies
posterior lends
Ora serrata
Equatorial Nodal point

dimension.
M. rettus
lateralls
Corpus vjtreum
Pars optica retinae ::
#N. optlcus
Vagina externa n. aptici A. centraHs retinae
938, Right eyeball (bulbus oculi); (represented semischematically).

(Horizontal section.)

30fi
THE ORGAN OF SIGHT
Cornea
PupiJJa
Margo pupillarls Iridis
Margo ciliaris iridis

Jrls
A. ciliaris anterior
Anulus ciliaris -^4-w - C i r c u l u s arteriosus iridis major
Aa. ciliares posterior

breves
Chorioidea -iM
Sclera
V. vortlcosa
V. chorioidea ocul
A, ciliaris posterior tonga
Aa. ciliares posterities breves
N. opticus
939. Eyeball; vascular coat (chorioidea); outer surface (X).

(Part of the sciera and cornea are cut and reflected.)
THE CILIARY BODY

The inner surface of the ciliary body (cwptis dliare) is covered
The ciliary muscle (musculus ciliaris) occupies the outer part o
by the basal lamina which is a continuation of the basal lamina of
the ciliary body and lies on the sclera. It is formed of smooth mus
tbe choroid (Fig. 942).
cle fibres among which meridional fibres (fibrm meridionales) and
The main bulk of the ciliary body is formed by the ciliary mus
circular fibres (fibrae drailares) are distinguished. The meridional
cle and stroma consisting of loose connective tissue rich in pig
fibres are strongly developed and form the muscle which stretches
ment cells and vessels.
the choroid they originate from the angle of the anterior chamber
The ciliary body has a ciliary muscle, a ciliary crown, and a cil
of the eye and from the sclera and are directed backwards to be
iary ring.
lost in the choroid. Contraction of the muscle pulls the anterior

Substantis Camera bulbi anterior

Sinus venosus sclerae
propria oorneae Lamina I i mi tans anterior
I Lig. pectlnatum anguli ttidncornealis
I Vv, ciliares anteriores
An stilus mdcrCOrneaJis
Episcleral connective
/ tissuewithaa.ct vv.
episcleralti
,Tunica conjunctive
Facies Pars csltaris retinae
Spalium perichorioidealc
f with lamina suprachoriuiJes
EpiiJiellutn ientts
;
M. sphinner pupjllae / ^Sclera
I ^ ^Choiioirtea
/ I ^Stratum pigment!
I I / retinae
y. Ora serrata
""^ Librae merle! ion a! is
I m. iitlfjttt
* Fibrae circulares
><K"\\ \ \ \ Ctrculus arteriosus iridis ma'yr Pars optlta retina

:,
* \ / > V" \ N \ 'Pmcessus citiarw
\ T I' 2onulares \ \ \
\ jT v V \ Camera bulbi posterior
\
\
fjorlex lentis
Substantia lentis
\ Nucleus lentis
940. Anterolateral part of eyeball.

(Horizontal section.)
part of the choroid and the posterior pan of the ciliary body for the ciliary body; it is arched, has an uneven surface, and is contin
wards, thus relaxing the ciliary zonule (zanula ciliarisj. The circular uous posteriorly with the choroid.
fibres contribute to the formation of the circular part of the ciliary The ciliary crown {corona dltaris) occupies the anteromedia
muscle whose contraction narrows the lumen of the ring formed part of the ciliary body. Small radially stretching ciliary folds
bv the ciliary body and in this way brings the site of attachment of which are continuous anteriorly with the ciliary processes (processu
the ciliary zonule nearer to the equator of the lens. This causes re ciliares) are distinguished in it- These processes, 70 in number,
laxation of the zonule and increases the curvature of the lens; in hang freely into the cavity of the posterior chamber. At the junc
view of this the circular part of the ciliary muscle is called the con tion between the surface of the ciliaiy ring and the ciliary crown is
strictor muscle of the lens. a rounded edge to which the ciliary zonule, holding the lens in
The ciliary ring (orhiculus tiliaris) is the posteromedial part of place, is attached.
THE IRIS
The iris is the most anterior part of the vascular coat and, in ciliary; iridis). It is attached to the fibrous coat by the pectinate liga
contrast to the other parts, does not come in contact with the ment of the iris (ligamentum pedinaium anguli iridotomealis) in whos
fibrous coat but, being a continuation of the anterior segment of thickness are slit-like spaces of the iridocomeal angle (spatia angul
the ciliary body, lies in the frontal plane at some distance from the iridocomealu). The stroma of the iris is composed of vascular con
npctivc: tia.fli.Ei":., * m f :H-ITI l i f t srnuth miifl^lr fnh*~Cft A i i t J :i g r t i ^ f IJ.LIIII-
pupil \pupilla).
ber of nerve fibres. The posterior surface of the iris contains pig
The pupil is bounded by a free pupillary border of the iris ment cells which are responsible for the colour of the eyes.
(margo pupillaris iridis). The opposite border, which passes along its The smooth muscle fibres of the iris stretch circularly and radi
entire circumference, is called the ciliary border of the iris (margo ally. The circular layer lies on the circumference of the pupil and

308 THE ORGAN OF SIGHT
Anulus Iridis major
pupillaris
iridis minor
Margo ciliaris
Lens
Striae
Pt)lus
anterior I e nils seulares
Chorioicfea
ies anterior
Cireulus arterio-sus irjdis mapjr
tin. I'ifiaresl
Plicae iridis
941. Vascular coat (chorioidea), anterior part; outer surface {%),

(Most of the sckra is removed.)
forms the sphincter of the pupil (musculus sphincter papillae); the ra pupiliar part. This part of the iris measures up to I mm in width.
dially arranged muscle fibres form the dilator of the pupil (musculus The remaining part of the anterior surface of the iris measures
dilator papillae). The anterior surface of the iris (facus anterior iridis) 3-4 mm in width and is related to the outer ring of the iris (anulus
(Fig,941) is convex while the posterior surface (fadesposterior iridis) iridis major), or the ciHary part. The surface of this part sometimes
(Fig, 942) is eon cave. bears depressions called crypts of the iris, a series of radial folds,
On the anterior surface of the iris, around the pupil, ia the in and on the periphery a few circular folds of the iris (plicae iridis).
ner ring of the iris (anulus iridis minor) which is distinguished as the
THE NERVOUS COAT OF T H E EYE

The nervous coat of the eye (tunica interna bulhi)h called the re anterior, smaHer, part contains no light-sensitive elements and is
tina (Figs 938, 943, 944), has a complex structure. The whole of its called the blind part of the retina. In relation to the parts of the
outer surface lies on the choroid, its inner surface is in contact vascular coat, the latter is divided into the ciliary part of the retina
with the vitreous body,
(pars ciliaris retinae), and the iridial p a n of the retina (pars iridka r
The retina has two unequal parts: a posterior, larger, part per tinae). The optic part of the retina consists of layers which can be
ceiving light stimuli which is called the optic part (pars optica reti distinguished only microscopically: the pigmented layer of the re
nae) and extends to the ciliary body ending by the ora serrata; the tina (stratum pigmenti retinae) which adheres to the inner surface of

Corona tfliwis
CnoiloJdEg
, ZonutB ciltaris
Orhiculus olliarts (fibratf 2omifares)
Lens
Retina
Ora serrata ^ Sclera
Pars Clltaris retinae

Plicae ettUffW Q
\ ciliare
Processus ciiiares j
Facie^ posterior Jridis
942- Vascular mat (chorioidea), anterior part; inner surface (%}.

the vascular coat, and the cerebral layer of the retina (stratum cere the vitreous body is followed by detachment of the retina without
brate retinae). T h e last-named in turn is formed by the following the pigmented layer.
layers: the neuroepithelial layer (stratum neuroepitketiate retinae) T h e posterior surface of the optic part bears a clearly defined
containing rods and cones which are the light- and colour-perceiv eminence, the optic disk (discus nervi optici). T h e axons of the mul-
ing elements of the retina; the external limiting membrane of the tipolar ganglionic nerve cells of the retsna converge here and per
glia (membrana limitans gliae extenta); the outer granular layer (stra forate the sclera to form the trunk of the optic nerve.
tum granulosum extemum) formed by those parts of the cones and T h e further course of these fibres as components of the optic
rods which contain nuclei; the outer plexiform layer (stratum plexi- nerve, optic chiasma, and then to the cortical end of the visual
forme externum); the inner granular layer (stratum granulosum inter- analyser is described in the section Tke Cranial Nerves.
num)} the inner plexiform layer (stratum plexiforme); the inner nuc In the centre of the optic disk is the excavation of the disk (ex-
lear layer of multipolax nerve (ganglionic) cells (stratum ganglinnare cavalio disci) (Fig. 938) which is the site of entry and exit of vessels
retinae); the layer of optic nerve fibres (stratum jibramm nervosarum)\ supplying the retina with blood. T h e disk also has an area devoid
the inner limiting m e m b r a n e of the glia (membrana limitans gliae in- of light-sensitive elements (the blind spot). At a distance of
terna) which is in contact with the vitreous body. 3 - 4 m m lateral to the optic disk the retina bears the macula lutea,
T h e outermost layer of the optic part of the retina, the pig- which corresponds to the sharp area in the field of vision, T h e ma
rnented layer (stratum pigmenti) is connected anatomically more in cula is spherical or oval and has a small depression in the centre
timately with the vascular coat and more loosely with the remain the fovea central!s. Only cones are present in the region of the m a
der of the retina, so that when the eyeball is opened the escape of cula, T h e posterior regions of the optic part of the retina contain

,1(1 THE ORGAN OF SIGHT
CiftLilus afteriosus iridis major
A. confunctivatis
anterior
V v . conjunct!vales
Lens
Circuliis arferlosils
iridis minor
Vv. vorticosa.
(V. chorfoldta
oculi)
V, eplsdcralh
A, episcleralis
Aa. ctliarcs
l>ostsriores breves
Vessels of
sheath of opt
nrve
___^-V. centra] is
retinae"
A. centralist retinae
943. Right eyeball; superior aspect {schematical representation).

(Horizontal section; arrangement of arteries and veins in the eyeball.)

ênula lemporalis
/ retinae superior
Arteriola macularfs
superior .,
Arteriola lemporalis
retinae superior
Venula
macularig superior Venula nasalis
retinae superior
Arteriola nasal 19
retinae superior
Discm n, oplfcl-
-Atteriola medial is
retinae
Venula me dial Is
retinae
Macuja --Arteriola nasalis
retinae inferior
Venula nasalis
Fovea centralis retinae Inferior
maculae
Arteriola temporalts Venula temporally

retinae inferior -"' retinae inferior
944. Fundus oculi; right eye (l%).

(Examination with an ophthalmoscope [ophthalmoscopy].)
many rods and cones; the rods reduce gradually in n u m b e r to the and an inner layer of epithelial cells which contains pigment in the
front and are absent at the ora serrata. region of the iris.
T h e part of the retina lining the inner surface of the ciliary These retinal layers are joined here more intimately than in the
body (pars aliaris retinae) and the posterior surface of the iris (pars region of the optic part of the retina and are continuous with o n e
iridica retinae) has two layers: on outer pigmented layer which is a another in the region of the pupillary border of the iris (margo pu-
continuation of the piginented layer of the optic part of the retina pillam iridis).
THE VITREOUS CHAMBER

T h e vitreous c h a m b e r consists of the vitreous body and the approached by the hyaloid canal (canalis kyaloideus) which is a rem
lens (Figs 9 3 8 - 9 4 0 ) . nant of the embryonic vascular tissue. In some cases the canal con
The vitreous body (corpus vitreum) is covered o n the outside by tains the hyaloid artery (attend hyaloidea).
a fine transparent hyaSoid m e m b r a n e (membrana vitrea) and occup T h e remaining part of the vitreous body lies in contact with
ies the greater part of the cavity of the eyeball. T h e vitreous body the inner surface of the retina and is almost spherical in shape.
is formed of an absolutely transparent jelly-like substance devoid T h e lens is a biconvex body. Its posterior surface (fadesposterior
of vessels and nerves. It contains a fine network of intertwined Units) is more convex and is in contact with the vitreous body,
fibrils and fluid rich in proteins which is called the vitreous hu whereas the anterior surface (fades anterior Untis) faces the iris.
m o u r (humor vitreus). T h e anterior surface of the vitreous body T h e lens has the anterior and posterior poles (polus anterior et
faces the posterior surface of the lens and bears for it an accor posterior lentis) which are the most projected central points of its
dingly shaped depression, the hyaloid fossa (fossa hyaloidea). It is anterior and posterior surfaces.

( M l B i ^ .
Supeirilliini
~Pars orl,itaM
* 1 PaTpefea
_ { ! * tarsalls J superior
Angulu? oculi
medlalis
Anfrulus Mm.i |iiil|uhranin

ocuLr Istffdlfs *
/
Pfllpeiira inferior
{facie5 anterior)
/
r
'Sulcus InfrapalpebraHs
Cilia ^
945. Eyelids of right eye; anterior aspect.

(The eyelids are closed; the anterior surface of the eyelids [fades anteriorpalpebrantm].)
The line joining the anterior and posterior poles of the lens is stretched zonular fibres (fibrae zpnvlares). The medial ends of the
called the axis of the lens (axis lentis); it measures 3.6 mm on the fibres are inserted into the capsule of the lens, the lateral ends
average. arise from the ciliary body. The sum of these fibres form a liga
The substantia lentis is absolutely transparent and, just like ment round the lens which is called the ciliary zonule (zonula cilia
the vitreous body, is devoid of vessels and nerves. ris). Between the fibres of the ciliary zonule are zonular space* (spa
The main mass of the lens consists of fibres of the tens (fibrae tia zonulariaj.
lentis) which are elongated hexahedral epithelial cells. The aqueous humour (humor aquosus) is a transparent colour
The peripheries of the anterior and posterior surfaces of the less fluid filling the anterior and posterior chambers of the eye
lens are covered with the capsule of the lens (capsula lentis). The The chambers are slit-like cavities in front of and behind the iris.
capsule is a homogeneous transparent membrane which is thicker The posterior chamber (camera posterior bulbi) is bounded by
on the anterior surface of the lens where it overlies a layer of ep the anterior surface of the lens, the ciliary zonule, and the ciliary
ithelial cells. body posteriorly, and by the posterior surface of the iris anteriorly.
The substantia lentis differs in consistency; it is firmer in the The ciliary processes hang freely in it. The posterior chamber com
centre and is called the nucleus of the lens (nucleus lentis), on the municates with the zonular spaces.
periphery it is less firm and is named the cortex of the lens (cortex The anterior chamber (camera anterior bulbi) is formed by the
lentis). posterior, concave, surface of the cornea in front and by the ante
The lens is situated between the vitreous body and the iris and rior surface of the iris behind-
is attached by its peripheral circumference, known as the equator The anterior and posterior chambers of the eye communicate
of the lens (equator lentis)* to the ciliary body by means of fine with each other through the pupil.

THE ORGAN OF SIGHT
31
Siiperciliuin,
| i , Cornea with iris

fiK. seen through
Tunica conjunctiva
Plica seniilunaj-js
Paipehra K conjunct ivae
superior':
CJaiifmiyyuia
pars orlXlaliS" paipebrarum
jraed ialis-
pat* ursali _^
Limlitis corricae
B ^ - A n g u l u s oculi
medlalis
CoTninissurj ;
palperirarum S
r
lateralis - ""
-aruricuia Jacrimalis
An yulus
oculi Inteijtlis-'
S \
y / 'N> apilla lacrlinnlls
S /
Lirobus ,jf .'
palpt-bralJs a n t e r i o r - ^
\
S
SUICUB irfrapalpcbfalii
Limlius palpetirulis posterior 1
Palpebra inferior
Pftpflta
946* Eyelids of right eye; anterior aspect.

(The palpebral fissure [rims palpebratis] is opened.)
The aqueous humour is produced by the vessels of the ciliary the system of the venae vorticosae. Besides, the humour may flow
body and iris. It is drained as follows: from the posterior chamber from the chambers into the sinus venosus sclerae and then enter
the aqueous humour flows into the anterior chamber and then, via the ciliary arid conjunctiva! veins in the venous blood.
the spaces of the iridocorneal angle (spatia, anguli mdocorntalis) into
THE ACCESSORY ORGANS OF THE EYE

The eyelids and the lacrimal apparatus are the accessory or
pebrarum anterior et posterior) and a margin which together with the
gans of the eye (organa oculi acassona).
margin of the other eyelid forms die palpebral fissure.
The eyelids, upper and lower (palpebrae, superior et inferior)
The anterior surface of the eyelid (fades anteriorpalpebrarum), is
(Gk Uepharon) (Figs 945-949) are folds of skin situated in front of
convex and covered with skin in which many sebaceous and sweat
the eyeball. When the lids are closed they cover the eyeball com
glands are lodged. The upper eyelid is bounded superiorly by the
pletely; when they are opened the palpebral fissure (rima paipdrm-
eyebrow (superdlium) which is an eminence of skin along the upper
rum) forms between their margins. The upper eyelid is larger than
border of the orbit. The medial part of the eyebrow is more
the lower one.
arched, the lateral part is thinner. The surface of the eyebrow is
Each eyelid has an anterior and a posterior surface (fades pal- covered abundantly with short hairs. When the upper eyelid is

947. Glands of conjunctiva and skin of right upper eyelid (specimen prepared
V.Kharitonova). (Photograph.)
(Area of totally stained specimen; viewed from the aspect of the conjunctiva.)
948. Glands of conjunctiva and skin of right lower eyelid (specimen prepared
V.Kharitonova). (Photograph.)
(Area of totally stained specimen; viewed from the aspect of the conjunctiva.)

THE ORGAN OF SIGHT
Limbus palpebralis
anterior
Palpebra superior.
^.Limbus palpebralis
posterior
Papilla lacrimalis
Angulus superior
oculi laterals
Puticlura lacrimale
superius
1-iifiIJUM i-iimeae -&-** Lacus lacrimalis
AnguJus oculi medialis
"aruncdJa lacrimalis
Tunica Conjunctiva,
buibi
'unciuin lacrlmaie
Inferius
conjunctivas 1
inferior , _
-Papilla lacrimalis
inferior
'lies semilunaris
conjunctive
Pelpebra inferior
Tunica Conjunctiva
palpebrarum
949. Eyelids of right eye; anterior aspect.

mm upper eyelid is drawn upwards, the lower eyelid is everted; the inferior fornix of the conjunctiva cm be seen.)
raised, its skin forma a distinctly seen upper palpebro-orbital fold.the upper and lower'eyelids unite to form the lateral palpebral
A poorly pronounced groove under the lower eyeltd separates commissure (ammksura palpebrarum laterals) and the acute lateral
it from the cheek. When the eyelid is lowered, its skin on the level angle of the eye (angidus oculi lateralis)*
of the inferior orbital border forms the lower palpebro-orbital fold. Between the margins of the upper and lower eyelids, at the me
The orbital margin of the eyelid is the site at which its skin is con
dial angle of the eye, is a pink eminence called the laerimai caruncle
tinuous with the skin of the neighbouring regions, (caruncula lacrimalis): it is surrounded by the lacus lacrimalis. A small
A vertical fold of skin, tbe palpebronasal fold (plica palpebrona-
vertical conjunctival fold forms medially of the laerimai caruncle;
salis), sometimes stretches along the medial margin of the surface this is the plica semilunaris conjunctivae which corresponds to a
of the eyelid curving medially round the medial palpebral liga
tfnrd eyelid (nictitating membrane) in lower vertebrates.
ment.
The margin of the eyelid is separated from its anterior and su
The free margin of the eyelid measures up to 2 ram in thick perior surfaces, respectively, by the anterior and posterior borders
ness. It is arched Forwards for most of its distance, but the curva of the eyelid (limbus palpebralis anterior et posterior). The anterior
ture disappears in the medial portion. Here the margins of the up border is slightly rounded. Numerous hairs, eyelashes (cUk)
per and lower eyelids become rounded upwards and downwards, (Fig. 946) arise behind it from the substance of the eyelid; they
respectively, and joined to each other by means of the medial curve downwards on the lower eyelid and upward* on the upper
palpebral commissure (commissura palpebrarum medialh) to form the eyelid. The ducts of the sebaceous and modified sweat glands open
rounded medial angle of the eye (angulus oculi medklis). Laterally here and are connected with the hair follicles of the evelids.

316 T H E ORGAN OF SIGHT
950. Sebaceous glands oflacrimal caruncle 951. Lacrimal glands (specimen prepared by
(specimen prepared by V. Kharitonova). V. Kharitonova). (Photograph.)
X
(Photograph.) (Totally stained specimen; 14-week-old embryo.)
(Isolated glands from a totally stained specimen of the lacrimal 1orbital part of low*r lacrimal gland
caruncle.) 2palpebral part of uppcT lacrimal gland
S^gianduiar lobules
] root af hir
4dWts-
2sacs of sebaceous glands. '
The free margin of the upper and lower eyelids carries at the The sites of reflexion of the conjunctiva from the eyelid to the
medial angle of the eye, at the level of the lateral periphery of the eyeball are called the superior and inferior fornices of the con
lacrimal caruncle, a small eminence called the lacrimal papilla (pa junctiva (fornices conjunctivae superior et inferior) (Figs 949, 953).
pilla lacrimalis). The upper and lower lacrimal canaliculi (canaliculi gether with the other parts of the conjunctiva the fornices form the
lacrimalts, superior et inferior) begin here, They have distinctly seen boundaries of the conjunct! val sac (saccus conjunctivae) which
openings on the apex of the papillae, which are called the puncta open anteriorly along the line of the palpebral fissure.
tacrimalia, superius et hiferius. The conjunctiva forms a series of folds in the region of the su
The posterior border of the eyelid is continuous with the poste perior and inferior fornices.
rior surface of the eyelid (fades posterior palpebrae). The part of the eyelid between the skin and the conjunctiva is
The posterior surface of the eyelid is concave and covered en formed of the following structures. Immediately under the skin is
tirely by the palpebral part of the conjunctiva (tunica conjunctiva the orbicularis oculi muscle, behind which in die upper eyelid is
palpebrnrum). The conjunctiva begins from the posterior border of the tendon of the levator palpebrae superioris muscle. The muscle
the eyelids, extends to their orbital margin, and is reflected onto begins from the periosteum of the roof of the orbit in front of the
the front of the eyeball. Covering the anterior parts of the eyeball, optic foramen, stretches forwards, and near to the upper margin of
the conjunctiva reaches the comeal limbus (limbus corneae); this is the orbit continues as a flat tendon. The last-named enters the sub
the ocular part of the conjunctiva (tunica conjunctiva bulbi). It is stance of the upper eyelid and divides into two parts: an anterior
loosely joined to the sclera. part which is first behind the orbicularis oculi muscle but then per-

THE ORGAN OF SIGHT
317
952. Accessory lacrimal glands

(5-year-old child; specimen
prepared by V.Kharitonova).
(Photograph.)
(Area of totally stained specimen of the
region of the superior fornix of the
conjunctiva.)
1 accessory laciiuial glands.
2oitjital part of Itmet lacrimal gland
Alymphatic follicle*.
forates it and runs to the skin of the eyelid; and a posterior part Stretching forwards, the superior tarsal muscle separates from
which is attached to the upper edge of the eyelid cartilage. The re the levator palpebrae superioris muscle and is inserted by the mid
maining part, situated nearer to the free margin, is occupied by the dle part of its medial surface into the upper edge of the tarsus,
tarsus of the upper eyelid (tarsus superior). It in formed of dense thus encircling the lateral part of the last-named. The inferior tar
connective tissue fibres and is rather firm. The tarsus has the ante sal muscle (musatlus tarsalis inferior) is also composed of smooth
rior and posterior surfaces, and the orbital and free edges. muscle tissue; it is at first part of the inferior rectus muscle of the
The posterior surface of the tarsal plate is convex in accord orbit, but then runs forwards, separates from this muscle and is in
ance with the convex surface of the eyeball and is intimately ad serted into the lower edge of the tarsus of the lower eyelid; some of
herent to the palpebral part of the conjunctiva, which ensures the fibres reach the inferior margin of the orbit.
smoothness of the conjunctiva in this region.
The tarsal plates of the upper and lower eyelids contain mo
The anterior surface of the tarsus is convex and is connected dified sebaceous glands called the tarsal glands (glanduhe tarsala);
with the orblcularis oculi muscle by a loose connective tissue. there are 27-40 of them in the upper and 17-22 in the lower eye
The free edges of the tarsus of the upper eyelid and tarsus of, lid (Figs 947, 948).
(he lower eyelid (tarsus superior et tarsus inferior) are relatively
The ducts of these glands open into the intermarginal space,
smooth and face each other. The orbital edges are rounded, the
nearer to the posterior edge, while the ocular parts are directed to
curvature being more marked in the tarsus of the upper eyelid.
the orbital margin or the eyelids and are curved sagittaly in ac
The free edge measures 20 mm in length and 0.8-1.0 mm in thick
cordance with the contours of the tarsi. The ends of the main parts
ness; the tarsus of the upper eyelid measures 10-12 mm in height,
of the glands do not extend beyond the tarsi. In die superior eye
that of the lower eyelid 5-6 mm.
lid, the glands leave free the upper edge of the tarsus, in the lower
In the region of die medial and lateral angles of the eye the eyelid they occupy the whole tarsal plate.
tarsi unite and are attached at the respective bony walls of the or
In the upper eyelid the glands differ in length: they are longer
bit by means of the medial and lateral palpebral ligaments (liga-
in die middle but shorter to the sides. In the lower eyelid they do
menta palpebramm mediate et lateraU).
not differ so sharply in size.
The tarsal plates situated near to the free margin of the eyelid
The ducts of the ciliary (sweat) glands (glanduia aliarts) also
lend it a certain firmness due to which it is known as the tarsal
open on the free margin of the eyelid between the eyelashes; the
part, in contrast to the remaining less firm part of the eyelid, which sebaceous glands (gl&nduUe sebaceae) pass to the hair follicles of the
is called the orbital part. eyelashes.
The superior and inferior tarsal muscles stretch to the superior The tarsi of the upper and lower eyelids sometimes contain
and inferior tarsi. The superior tarsal muscle (musatlus tarsalis supe also lacrimal tarsal glands.
rior) is formed of smooth (nonstriated) muscle tissue which is part
of the tevator palpebrae superioris muscic.

aiB ,THE ORGAN OF SIGHT
THE LACRIMAL APPARATUS

The lacrimal glands and their ducts, the lacrimal sac, the lacri
The lacrima] fluid running from the lacrimal gland into the
ma] canaliculi and the nasolacrimal duct form the lacrimal appara
conjunctival sac, flows over the eyeball and collects in the lacus
tus (apparatus lacrimalis) (Figs 949-953).
lacrimalis. Some authors describe a triangular prismatic canal
The lacrimal gland (glandula lacrimalis) is lodged in the super-
formed by the outer surface of the eyeball and the anterior border
olateral angle of the orbit in the fossa glandulae lacrimalis and sec
of the dosed eyelids. It is called the rivus lacrimalis, Iu this posi
retes the lacrimal fluid, the tear (lacrima). The tendon of the levator
tion of the eyelids their posterior borders do not come in contact
palpebrae superioris muscle passes through the body of the gland
and the tears flow along the slit-like pathway to the lacus lacrima
and divides it into two unequal parts: a superior, larger, part called
lis. From the lacus lacrimalis the tears flow through the lacrimal
the orbital part (pars orbitalis glandulat kcrimalis) and a lower,
canaliculi into the lacrimal sac and then, via the nasolacrimal
smaller, part known as the palpebral process (pars palpebraUs gland-
canal, into the inferior meatus of the nose (Fig. 953).
ulae lacrimalis).
Each lacrimal canaliculus (upper and lower) (canaliculi lacri
The orbital part of the lacrimal gland has an upper convex sur
malis, superior et inferior) begins at the medial angle of the eye on
face which is in contact with the bony fossa of the lacrimal gland,
the apex of the lacrimal papilla (papilla lacrimalis) by a small
and a lower concave surface which is in contact with the lower part
(0.25 mm in diameter) opening called the punctum lacrimale. The
of the gland.
lacrimal canaliculus has two parts, a vertical and a horizontal. The
The orbital part has a compact structure; its length along the vertical part of the upper and lower canaliculi measures 1.5 mm in
superior orbital margin measures 20-25 mm, its anteroposterior length; it runs, respectively, upwards and downwards, and becom
dimension measures 10-12 mm. The palpebral part of the lacrimal ing narrower gradually, turns medially to take a horizontal direc
gland is situated slightly to the front and downwards of the orbital tion. The horizontal part of the lacrimal canaliculus measures
part, immediately above the fornix of the conjunctiva! sac. The 6-7 mm in length. Its beginning is slightly expanded in the direc
gland is formed of 15-40 lobules; its length along the superior tion of its convex surface to form the ampulla of the lacrimal can*
border measures 9-10 mm, the anteroposterior dimension is 8 mm, aliculus (ampulla canalkuli lacrimalis). Stretching medially, both
and thickness 2 mm. canaliculi narrow again and open into the lacrima] sac, either se
The ducts of (he lacrimal gland (ductnli excrdorii glandule lacri parately or united.
malis) arc 3 to 5 in number in the orbital part; they pass through a
The lacrimal sac (saccus lacrimalis) is lodged in a bony fossa
certain area of the palpebral part, receive some of its ducts, and
(fossa, sscci latrimalli) whose shape it repeats entirely, its upper
open on the superior fornix of the conjunctiva.
blind, slightly narrowed end is called the fornix of the lacrimal sac
The palpebral part has, in addition, 3 to 9 special ducts which, (fornix sum lacrimalis). The lower end of the lacrimal sac is also
like the above mentioned ducts, open in the lateral areas of the su slightly narrowed and is continuous with the nasolacrimal duct
perior fornix of the conjunctiva.
(dudtts nasolacrimalis). This duct ties in the nasolacrimal canal of
Besides these large lacrimal glands the conjunctiva contains the maxilla, measures 1 2 - H m m in length and 3-4 mm in diame
some (1 to 22 in number) small accessory lacrimal glands (glandu ter and opens in the anterior part of the inferior meatus of the
le lacrimales accessorial) which may be lodged in the upper and nose under the inferior nasal concha.
lower eyelids (Fig. 952). They are found in the region of the lacri
mal caruncule where sebaceous glands are also present.
THE MUSCLES OF THE EYEBALL.

THE FASCIAE OF THE ORBIT
The muscles of the eyeball (mttsaili bulbi) (Figs 954-956) make
and the superior orbital fissure. The tendons of these muscles sur
it move. There are four rectus muscles: (1) the superior rectus
rounding the optic nerve fuse to form the common tendinous ring
muscle (musatlus rectus superior), (2) the inferior rectus muscle (mus- (anulus tendineus communis) which is joined to the external sheath of
atlas rectus inferior), (3) the medial rectus muscle (musmlus rectus me-the optic nerve.
didis), and (4) the lateral rectus muscle (musculus rectus kieralis);
Each of the four rectus muscles stretches along the correspond
and two oblique muscles; (5) the superior oblique muscle (musculus
ing wall of the orbit, pierces the fascial sheath of the eyeball fW
ohliqws superior), and (6) the inferior oblique muscle (musculus oMi-
gina bulbi) and approaches the eyeball. Here the short tendons of
quus inferior).
the muscles fuse with the sclera along a line stretching in front of
All the muscles of the eyeball, with the exception of the infe the equator at a distance of 7-8 mm from the edge of the cornea.
rior oblique muscle, arise deep in the orbit around the optic nerve At the site of its insertion the lateral rectus muscle is continu-

THE ORGAN O F SIGHT 319
Papilla lacrlmaliE Punctum lacrlmak

superior suuerlus F Ampullacana)icu|i lacnmalis
Palpebra superior / superiors
-Suoerdlam
niaiulnla lacTimalli.
Fornlx
conjunctivas
superior.
. Canal iculus laeriisiaJis
superior
lacrimalii
-Caruncula lacfimalls
Tunica conjunctiva tiulh

fLaeus lacclinalls
Forntx
conjunctivas Sactus l:si.-:n:ai:'.
Inferior
g 1 - Canaliculus tacrimafis
interior
Palpebra Interior -
' - Ampulla eanaliculi

larrimalls Inferior!;
HS3 Ductus nasolacrlmalls

Punctum
lacrimale Inlerliis
B^-Processus frcntalis
iriaxillae
Papilla lacrimalls 1
inferior
Sil-.j.i ir!. -. il l a r i s
953. Right lacrimal gland (glandula lacrimalis) and nasolacrimat canal (canalis nasolacrimalis);
anterior aspect (%).
(The skin and superolateral part of the upper eyelid are cm and reflected; the nasolacrimal canal is dissected and opened.)
ous with the museums larectus musculi recti laterahs most of perior rectus muscle and the eyeball, and is inserted into the eye
whose fibres merge in the sclera, ball behind the equator at a distance of 18 mm from the edge of
It should be pointed out that a. bundle of smooth (nonstriated) the cornea.
muscle fibres forming the orbitalis muscle (musculus orbitalis) is si The inferior oblique muscle (musculus obliqum inferior) origi
tuated in the substance of the initial part of the lateral rectus mus nates in the medial part of the orbit from the lacrimal crest, the
cle. adjacent surface of the maxilla, and the infraorbital margin. It ex
The superior oblique muscle (musculus obliqum superior) extends tends backwards and laterally, passes between the floor of the orbit
from the margin of the optic canal forwards along the medial wall and (he inferior rectus muscle, and is inserted into the lateral sur
Of the orbit above the medial rectus muscle. Near to the superior face of the eyeball behind the equator.
orbital margin, at the trochlear fossa (foota trodikaris), it is continu The lateral and medial rectus muscles (musculi recti, latemlis et
ous with a long cylindrical tendon. The tendon passes through the medialis) rotate the eyeball laterally and medially, respectively. The
trochlea and turns backwards and laterally, passes between the su superior rectus muscle (musculus rectus superior) rotates it upwards

and slightly laterally. The inferior rectus muscle (musculus rectos in- In the anterior parts of the orbit, the sheath of the eyeball is
fertor) is an antagonist of the superior rectus and rotates the eye connected with the palpebral fascia which delimits the orbital cav
ball downwards and slightly medially. ity anteriorly.
The superior oblique muscle rotates the eyeball downwards In the orbit, behind the sheath of the eyball is the fatty body of
and laterally, the inferior oblique musclelaterally and upwards, the orbit (corpus adiposse orUtae) through which nerves pass. The
The eyeball occupies the anterior part of the orbit and is sepa lesser part of the fatty body lies outside the cone formed by the
rated from the other parts of the orbit by the fascial sheath of the aggregate of muscles of the eyeball, between them and the orbital
eyeball (vagina bulbi) which is connected with the fascia of the eye walls covered by the periosteum of the orbit, the periorbit (perior-
ball muscles and the sheath of the optic nerve. The fascial sheath bita); the greater part lies inside this cone, around the optic nerve.
of the eyeball is connected with the sclera by a series of trabeculae
and together with its surface delimits the episcleral space (spalitim
episderale).
THE VESSELS OF THE EYEBALL

THE ARTERIES
The eyeball is supplied by branches of the ophthalmic artery the eyeball} after that they pierce the sclera, enter the substance of
(arteria ophthalmica) (see Figs fi21,623). The ophthalmic artery sends the ciliary muscle which they supply with blood, and send
long, short, and anterior ciliary arteries to the eyeball supplying its branches to the greater arterial circle of the iris.
fibrous and vascular coats, as well as the central artery of the retina 4. The central artery of the retina (arteria centrulis retinae)
ramifying in the retina, (Figs 943, 944) originates from the ophthalmic artery, runs to the
1. The long posterior ciliary arteries (arteriaeriliaresposteriori optic nerve and enters its thickness at a distance of IS-20mm
longae) (Fig. 943), two in number, approach the eyeball alongside from the eyeball-
the optic nerve. On piercing the sclera, they enter the pericho- Stretching along the axis of the nerve, the artery reaches die re
roidal space (spa tium perichoroideah) and stretch on the lateral and tina in the region of the optic disk.
medial surfaces of the eyeball to the ciliary body, Here they divide The blood vessels of the retina are represented by arterioles
into ascending and descending branches which run on the ciliary and venules.
border of the iris, and unite with one another and with the anterior The arterioles are the terminal branches of the central artery of
ciliary arteries to form the greater arterial circle of me iris (tirculus the retina which divides in the optic disk into two branches, supe
arterio.ws iridis major). rior and inferior. Each branch^ emerging from the optic nerve
The last-named sends branches to the ciliary muscle and to the forms on the surface of the disk (sometimes in its depths) the cir
iris in whose pupillary border forms the lesser arterial circle of tbe culus vasculosus of die optic nerve, from which the following term
iris (draihis arteriosm iridis minor). inal branches originate:
The long posterior ciliary arteries also give rise to recurrent ar (a) the superior macular branch (arteriola macularis superior
teries which communicate with the short posterior ciliary arteries. which stretches upwards and laterally:
2. The short posterior ciliary arteries (arteriaeriliarespvstmores (b) the inferior macular branch (arteriola macularu inferior)
braves) (Fig.943) arise from the ophthalmic artery by 4-6 branches. which stretches horizontally and laterally to the macula:
Running to the eyeball, they ramify to form 18-20 rami approach (c) the medial retinal branch (arteriola medialis retinae) which
ing its posterior periphery and then sending small branches to the a relatively small vessel running medially and slightly upwards:
sclera and optic nerve. They then pierce the sclera around the exit (d) the superior nasal branch (arteriola nasalis retinae superior
of the optic nerve and enter the vascular coat in which they form a which ascends vertically:
dense capillary network in the choriocapillary lamina (lamina cho- (e) the inferior basal branch (arteriola nasatis retinae inferior)
roidacapillaris). The branches of the short posterior ciliary arteries which descends slightly medially:
unite with one another around the optic nerve to form the circulus (f) the superior temporal branch (arteriola temporalis retinae sup
vasculosus of the optic nerve (circulus oasculosus newi optici) in the rior) which is quite a large vessel running upwards and laterally:
thickness of the sclera. (g) the inferior temporal branch (arteriola temporaUs retinae in
3. The anterior ciliary arteries (arteriae riliares anteriores) rior) which descends laterally:
(Fig, 943) arise from the arteries of the four rectus muscles. They In the region of the macula is a well developed vascular
approach the corneal border and send episcleral arteries (arteriae network, whereas the central fovea is devoid of vessels. The system
episderales) to the anterior parts of the sclera and anterior conjunc of die central artery of the retina unites with the system of the cil
tiva! arteries (arteriae conjunctioales anUrions) to the conjunctiva of iary vessels at die exit of the optic nerve from die eyeball.

Oista galJi
,Labyrinthii5 ethmoid a] I;
Jrotfilea
Lamina orbital is
Cornea
Tendo L ,Biilbas oculi
obliqui
JjL-Pars palpebralis glandulae
aerimalis
M. rectus medlaits
M. rectus sjperfor Lamina crlbrosa
M. redus tatera
^N. optlcus
(pars orbiialis)
Anutus
tend In a us ;
commurJa -'' <|
M. temportlia
Dura ma ter"'{' , | ' *

ncephai! <
A caroI1s
N. opticus / Chlaama optlcum - interns "tracivs options M. ievator palpebrae
(pars intracramaUs) superloria
954. Muscles of eye (musculi oculi); superior aspect (%).

(Horizontal section; the levator palpehrae superioris muscle is removed completely o n the left and partly on the right; the optic tracts are
dissected,)
THE VEINS
All the arterioles of the retina (branches of the central artery of and posterior ciliary veins. T h e anterior ciliary veins (venue dtiares
the retina) are attended by venules of the same name (branches of anteriores) originate from the veins of the ciliary muscle and receive
the central vein of the retina) (Figs 939, 9 4 3 , 944, 623) among on the way vessels from the sinus venosus sclerae. After piercing
which are the superior a n d inferior branches (of the central vein the sclera, these veins receive the episcleral veins (venae episderales)
of the retina) [otnuhe maculares superior et inferior), the medial reti and the conjunctival veins (venae conjunctivales) and open into the
nal branch (vtnuia medialis retinas), the superior and inferior nasal veins of the muscles of the eyeball.
branches (venulae nasales retinae, superior et inferior), superior and T h e posterior ciliary veins (venae dliares posteriores) receive
inferior temporal branches (venulae temporaks retinae, superior et in blood from the posterior parts of the eyeball.
ferior). All the venules (branches) drain into the central vein of the T h e venae vorticosae, 4 - 6 in n u m b e r , form along the equator
retina (vena centralis retinae) which opens into the superior ophthal in t h e thickness of the vascular coat. They drain blood from the
mic vein (vena ophtkalmka superior), or, less frequently, into the cav choroid, the ciliary body, and the iris and empty into the ophthal
ernous sinus (sinus cavernosus). mic veins which, in turn, anastomose with the veins of the face.
T h e remaining part of the eyeball is drained by the anterior

322 THE ORGAN O F SIGHT
V. ophthalmic^ N. lacrimaSls N. fronts Us N. trochlearis M. rectus superior

superior
. M. levatgr palpebrae
superior);
N. oculomotnrlLj
Flssura orbttalis (r. superior)
superior-. __
, A, OphthalmEca
B P " ~ W. obliquus superior

N. nawcfllarls
iT*~N. opHcus
M. rectus lateralls
M, rectus medialis
N. abducena
N. oculontotorius
(r. inferior^
Fissura orbilalls V- ophthaliiilra

Inferior f inferior
\ V
M . rectus inferior
AV obllquna inferior
955. Muscles of right eye; anterior aspect (%),

(The initial parts of the muscles are preserved; the relation of the muscles to the optic nerve can be seen.)
T H E NERVES OF T H E EYEBALL
The eyeball is supplied by the long and short ciliary nerves nerves, in the region of the ciliary muscle, is the ciliary plexus
(nervi dliares longi et breoes) which arise from the nasociliary nerve (plexus dliaris) containing nerve cells; the plexus branches run to
(nervus nasodliaris) and the ciliary ganglion (ganglion allure) (see the iris and the ciliary muscle.
Figs 810, 811, 939, 941). On reaching the posterior part of the eye- The skin of the eyelids receives nerves from the first (upper
hall, the ciliary nerves pierce the sclera, stretch between it and the eyelid) and second (lower eyelid) divisions of the trigeminal nerve.
vascular coat, and send twigs to them. Along the course of these

THE ORGAN O F SIGHT 323
O? fronts I e
M. rectus superior
Trochlea
M, obllquus
superior
Bulb us oculi 29
Proressus frontalis
M. rectus lateralis
fe,Crista Lacrimalis
posterior
Cornea
f~""CaJt*Iii nasolacrimaliK
Tunica "M. reclns medlaiis

conjunctiva bulbi
M, oMiquus Inferior
M, rectus inferior Foramen Infraorliilale
Os zygoma ticuir
956. Muscles of right eye; anterior aspect (%).

OF THE ORGAN OF SIGHT
The organ of sight, the eye, is laid down in the embryo on the eyebali measures 16.7 mm in the newborn and up to 24 mm in the
third week of the intra-uterine period, its development is com adult; the longitudinal diameter measures, respectively, 17.3 mm
pleted during the first school years. The eye is made up of several and up to 24.3 mm, The eyeball develops most intensively in the
Structures, each developing from different embryonal elements. first 5-7 years of life.
The lens, for instance, develops from the ectoderm a 1 epithelium of The various structures of the eyeball possess specific age fea
the cephalic region, The retina is derived from the anterior germ tures. The lens of a newborn and a child of the first years of life is
of the wall of the anterior cerebral vesicle. The sclera and the vas more transparent and more convex than that of an adult, the cor
cular coat develop from the surrounding mesenchyma. The mus nea is slightly thicker, the vascular coat is thinner, the iris is poorly
cles which cause movement of the eye form from the cells of the pigmented; the sclera is very thin, pliable, and siretehable. With
mesenchyma. The eyelids develop from skin areas. Since the cavity growth, the mentioned peculiarities, in particular the shape of the
of the orbit is insufficiently developed in the newborn, the eyeball cornea and lens, undergo some changes, as the result of which by
and the structures surrounding it do not lit completely into the or the age of 9-12 years, the eyeball of the child gradually becomes
bit but protrude forwards slightly. The trans verne diameter of the like that of an adult.

THE ORGAN OF HEARING
Organum vestibulocochleare
The ear (amis) (Fig. 957) consists of three parts: the external organs the organ of hearing proper which appreciates and differ
ear (amis externa), the sound-collecting part; the middle ear (auris entiates the sound stimuli, and the organ of static sense, which
media), the sound-conducting part; and the internal ear (auris in- reacts to the position of the body in space and changes of equilib
terna), the sound-appreciating part. The internal ear consists of two rium.
THE EXTERNAL EAR

The external ear (auris externa) (Figs 957-962) includes the au the junction of the external and middle ear and is related to the
ricle (auricula) and the external auditory meatus (meatus acusticus ex- last-named (tympanic cavity).
(emus); the tympanic membrane (membrana iympani) is situated at
THE AURICLE
The auricle (auricula) (Fig. 958) is formed by a fold skin con form the helix which begins above the lobule by the tail of the he
taining the cartilage of the auricle (cartilage auriculae). The carti lix (cauda keliris) which thickens upwards. Ascending, the helix
lage corresponds in shape, on the main, to the external shape of sometimes bears a tubercle (darwinian) of the auricle (tuberatlum
the auricle. The skin adheres to the cartilage more intimately on auriculae) at the junction of the posterior and superior margins of
the lateral surface than on the medial surface where it is movable. the auricle. The helix then passes along the superior margin of the
The lower end of the auricle contains no cartilage but has a well- auricle and turns downwards to form the anterior margin of the
developed layer of fatty tissue which together with the skin forms upper part of the auricle; after that it deviates slightly to the back
the lobule of the auricle (lobulm auriculae). The skin of the auricle and passes on the lateral, concave, surface of the auricle on which
is covered with hairs in the region oF the tragus and antitragus (see it is separated from the supratragal Euberculum situated below by
below) and on the convex surface. Sebaceous and sweat glands are the anterior notch of the auricle (incisura anterior auris) above which
lodged in the thickness of the skin, is the spine of the heltx (spina kdicis).
The free margin of the auricle curves groove-like forwards to In front of the helix, aiong its margin, lies a furrow-like depres-

THE ORGAN OF HEARING 325
ReceSsus membra nae

tympani superior
Caraiis serniclrcularis
Recessus / posterior
epltympanicus CanalEs semk'ircularis
anterior
Meat us jgtt
Canalia semklrcuJaris
acust icus mj^^M
laterals
exterrtus K
f jJfc^^ Stapes
Meatus [
acusticus 1 Vestit>u]ucn
exlermJi i Meatus Cochlea
Cavuiti tympani
externus cartilaginous fjj ^ Apex, (partis petrosae)
/
Aiifla externs,.
Auris
Concha auriculae iiiferua
-Auras media
-Membrana tvmpani
. tensor, tympani
Tuba audillva
Csrtilago meatus
atustici Cartilage tubae auditivae
Glandula parotis
Lolulus auriculae T E
957. Right external, middle and internal ear C%).

(Frontal section through the external auditory meatus.)
sion called the scaphoid fossa (scapha) which expands from bottom The medial surface of the auricle carries a series of grooves and
to top. The scaphoid fossa is bounded in front by a ridge called the eminences corresponding to the relief of its lateral surface. The la
antihelix (antkelix) which begins from the antitragus, being sepa teral margin of the medial surface is rounded in conformity with
rated from it sometimes by the posterior sulcus of the auricle (sul the anteriorly curved margin of the helix. Medial to the lateral
cus auriculae posterior), ascends, and then curves forwards to divide margin is the eminence of the scaphoid fossa (eminentia scaphae).
into two crura of the antihelix (crura antitkelicis) between which lies Anterior to it are two other eminences, a larger eminence of the
the triangular fossa (jossa triangularis). cimcha (eminentia conchae) and a smaller eminence of the triangular
To the front of the antihelix, and bounded by it posteriorly, is fossa (emmentia fossae triangularis). The last-named is separated
a large depression which is continuous with the external auditory from the eminence of the concha by a small transverse sulcus of
meatus; this is the concha of the auricfe (concha auriculae). the antihelix (sulcus anthelich iransversvs) which is continuous
The poms acusticus externus (Fig. 957) is situated in the mid downwards with the fossa of the antihelix (fossa anthelicis).
dle of the lateral surface of the auricle, it is bounded anteriorly by The cartilage of the auricle (cartilage auriculae) (Figs 961, 962)
a small projection, the tragus, above which is a small supratragal is elastic and its shape repeats the contours of the auricle. Its ante
tubercle (tuberculum supratragicum). The tragus is continuous rior suface bears a few (1-2) vertical notches of the cartilage of the
downwards with the iticEsura intertragica, to the back of which is a external auditory meatus.
projection whose apex is directed upwards; this is the antitragiis. The posterior margin of the cartilage is separated interiorly
The upper margin of the helix projects into the concha as the from the antitragus by the fissura andtragohelicma which together
cms of the helix (cms hdicis) dividing it into two parts. The upper, with the posterior margin of the cartilage delimits a small islet
smaller part is called the eymba conchae, the lower, larger part is called the tail of the helix (cauda heUcis),
the cavity of die concha (cuvum conchae). The ifiristtra termmalis of the auricle (incisura terwwlis auris)

326 T H E ORGAN OF HEARING
Helix
Crura antticllcls
Fossa irianfltjlaris
,Cru$ hettctj
Tuberculum auriculae
, ludsura anterior
[aurisl
Seaptia
r^-Ti3bercuium
5L-ptatj"agii:um
tyniha conftiae.
Lone ha
__, -Trafrus
auriculae Cavura tuUChiie
^-Meatus a<msikus
extttnus
B Incisura intertragica
V
1 X
X
W '"-Antitragus
Anttielix'
"Lobulus auriculae
Helix
Sulcus auriculae posterior
958. Right auricle (auricula); lateral aspect.

(The auricle of an elderly male.)
is situated between the beginning of the helix and the posterior surface of the lamina of the tragus,
wall of the cartilage or the external auditory meatus. 4. The antitragicus muscle (musculus antiimgicus) begins on the
The parts of the cartilage of the auricle communicate by means lateral surface of the posterior parts of the antitragus, ascends
of the auric ularis muscles (musculi auriculares). Besides, the auricle backwards, and is inserted into the base of the tail of the helix
is the site of insertion of some muscles arising on the bones of the (cauda helicis).
skull: the auricularis anterior, superior, and posterior muscles 5. The oblique muscle of die auricle (musculus obliquus auric
(musculi auriculares anterior, superior et posterior). las) lies on the medial surface of the auricle and extends from the
The following are the intrinsic auricular muscles. eminence of the triangular fossa (eminentia fossae triangularis) to th
1. The helicis major muscle (musculus helicis major) originates eminence of the concha (tminenlia conchae)*
on the spine of the helix (spina kelicu), ascends on the anterior mar 6. The transverse muscle of the auricle (musculus tratisversus a
gin of the cartilage, and is inserted into the anterior parts of the riculae) lies below the oblique muscle. It begins from the eminence
helix; some of the fibres extend to the eminence of the triangular of the concha (eminentia conchas) and is inserted into the eminenc
fossa (eminentia fossae iriangularis). of the scaphoid fossa (eminentia scaphae).
2. The helicis minor musde (musculus helicis minor) also arises 7. The pyramidalis muscle of the auricle (musculus pyramidali
on the spine of the helix, runs downwards and laterally on the la auriculare) is a superficial bundle arising from the tragic us muscle
teral surface of the concha to be inserted into crus of the helix. and terminating on the spine of the helix,
3. The tragicus muscle (musculus tragicus) lies on the lateral

THE ORGAN O F HEARING 327
8. The musculus incisurae helicis stretches between the tail of

the helix and the supra-auricular margin of the fissura antitrago-
helicina whose upper part it occupies.
All these muscles are innervated by the branches of the facial
nerve (nervus fadults).
The .skin of the auricle is continuous with the skin of the adja
cent regions; the cartilage is attached to the temporal bone by
three ligaments of the auricle (ligamenta auricularis).
(a) The anterior ligament of the auricle (ligamcntum avricufore
anterior) runs from the lamina of the tragus and the helix to the
root of the zygomatic arch.
(b) T h e superior ligament of the auricle (ligamenfaan auficulitrt
supenus) extends from the spine of the helix to the bony part of the
external auditory meatus.
(c) The posterior ligament of the auricle (ligamtntum auricuUire
posterius) stretches from the eminence of the concha to the mastoid
process.
THE EXTERNAL AUDITORY MEATUS

The external auditory meatus (meatus aaisticus externus)
(Fig. 957) is a direct continuation of the auricle. It is a curved tube 959. Glands of skin of auricle (specimen
passing first backwards and upwards and then forwards and prepared by M.Chernyavsky).
downwards and ending blindly at the tympanic membrane (mem- (Photomicrograph,)
brana tympani).
(Area of totally stained specimen of auricular skin.)
The external auditory meatus measures 3.5 cm in length. Its in
ner surface is lined with skin containing sebaceous glands, hair fol
licles, and glands secreting cerumen (ear wax) called the cerumi-
nous glands (glandulae ceruminosae) (Figs 959, 960). The number of
hair.s and glands reduces towards the tympanic membrane.
The deepest part of the external auditory meatus is called the
sinus and contains neither glands nor hairs. The skin of the mea
tus adheres to the underlying perichondrium and periosteum.
The lateral part (%) of the wall of the meatus consists of carti
lage and connective tissue which form the cartilaginous part of the
external auditory meatus (meatus aaisticus extemus cartilagineus), the
rest of the wall (%) is formed by the temporal bone and is the bony
part (meatus aaistiats externus osseus).
The cartilage is curved to form only the inferior and anterior
walls of the meatus, while the posterior and superior walls consist
of connective tissue. The cartilage of the external auditory meatus
is a continuation of the cartilage of the auricle with which it is con
nected by the isthmus of the last-named. The cartilaginous part is
connected with the bony part by a round ligament which is com
posed of thick connective tissue. This ligament connects the me
dial margin of the cartilaginous part of the meatus with the margin
of the external auditory meatus of the temporal bone.
The bony part of the external auditory meatus has four walls;
the superior wall is formed by the squamous part of the temporal
bone, the other threeby the tympanic part. The walls of the ex
ternal auditory meatus differ in length. The inferior wall is longer
than the superior and forms an acute angle with the tympanic
960. Glands of skin of external auditory meatu
membrane; the superior wall meets the tympanic membrane at an (specimen prepared by M.Chernyavsky).
obtuse angle. (Photomicrograph.)

328 THE ORGAN OF HEARING
M. auricularls superfor
Helix
Crura anthelicls
Fossa triangularis
Scapba^
Anthellx-^
. M. helicfs major
M. auricularls anterior
Spina helicts
hellcis
minor
-* Inclsura
tertnlnalls aurfs
M. antftragicusôj
Fissura antltragohelicina
Antltragus ^ M . traglcus
Cauda hellcis
Inclsura intertragica
961 Cartilage of right auricle (cartilago auriculae); lateral surface; anterior aspect (%)
THE TYMPANIC MEMBRANE

The tympanic membrane (membrana tympani) (Gk myrinx) malleolar folds. Both fold* arise at the prominence of the malleus
{Figs 957, 962, 963) is situated at the junction between the exter (prpminentia malkariij formed by the handle of the malleus and
nal and middle ear and is actually one of the walls of the middle run, respectively, forwards and backwards to the greater and lesser
ear (tympanic cavity); it is inclined forwards and downwards. tympanic spines of the tympanic part of the temporal bone (spina
The membrane is composed of connective tissue which is tympanka major et minor).
covered with skin on the surface facing the external auditory mea- The outer surface of the tympanic membrane is drawn in like a
tus and with a mucous membrane on the surface facing the middle funnel whose central part is attached to the handle of the malleus
ear, and is called the umbo of the tympanic membrane (umbo membra
Its periphery is thickened to form the border of the tympanic nae tympani).
membrane which is attached for the greater distance in the tym The handle of the malleus is situated on the inner surface of
panic groove (sulcus tympanicus) by means of the fibrocartilaginous the membrane, It can be seeu through the membrane and forms
ring (analtts Jtbrocartilagineus). This larger and tightly stretched part the stria mallearis which stretches on the outer surface of the
of the tympanic membrane is called the tense part (pars teiisa), A membrane, from the umbo to the union of the tympanic mem
small area of the tympanic membrane at the tympanic notch is less brane with the lateral process of the malleus, i.e. to the promi
stretched and is known as the flaccid part (parsflaccida);it is sepa nence of the malleus (prominentia malkaris).
rated from the rest of the membrane by anterior and posterior

Eminentia scaphae
M, auricularis superior
Eminentia v \
v
fossae triangular^ ^3ai^
V M. obllquus auriculae
v
x \
Sulcus anthelicis ^
transverSuS
V
"v
Fossa anthellcis
M, aurioilaris "x
anterior (prgfutidus)
X ,^, M- trans versus
M J t * - ^ " XPi/' auriculae
Splna hellcli I
Sulcus crurls hellcis,

Ponticulus
\
Meatus acusticus externus cartilagineus \
-Eminentia conehae
Meatus acusticus externus osseus
M. auricularls posterior
Umbo membranae issura anlitragohelictita

tympanf
> Cauda helicis
Membrana tympani
Cartiiago meatus / Ij.obulus auriculae

acustici *
Incisura termlnalis auris
Isthmus cartllaglnis auris
962. Cartilage of right auricle and external auditory meatus; posterior surface; posterior aspe
CAY
T H E M I D D L E EAR
The middle ear (auris media) (cavum tympani) (Fig. 957) in-
d u d e s the lympaaic cavity (catmm tympani), the auditory ossicles
(otsicula uuditus), and the pharyngotympanic tube (tuba auditiva).

THE TYMPANIC CAVITY

The tympanic cavity (cavum tympa.ni) (Figs 69, 957, 963) is slit- mation of the jugular fossa (fossa jvgularis) and is called the paries
like and situated in the petrous part of the temporal bone. Its six jugularis cavi tympani.
walls are lined with a mucous membrane which is continuous with The posterior wall (paries mastoideus) of the tympanic cavity ha
the mucous membrane of the air cells of the mastoid process of the an opening called the aditus to the tympanic antrum (adittis ad an-
temporal bone posteriorly and with the mucous membrane of the trum) leading into the tympanic antrum (antrum mastoidev.m), which
pharyngotympanic tube anteriorly. in turn communicates with the mastoid air cells (cellular mastoi
The lateral, or membranous, wall (paries membranacem) of the deae).
tympanic cavity is formed for the greater distance by the inner sur The medial wall of the aditus bears the prominence of the la
face of the tympanic nicmbrane, above which the superior wall of teral semicircular canal (prvtninentia canalis semicircularis lateralis
the bony part of the external auditory meatus contributes to its below which is the prominence of the facial nerve canal (prominen-
formation. tia canalis faciatis) curving from front to back and downwards.
The medial wall (paries labyrinthicus) is at the same time the la In the upper medial part of this wall is the pyramid of the tym
teral wall of the vestibule of the internal ear. panum (eminentia pyramidalis) with the stapedius muscle (musatlus
The upper part of this wall bears a small depression called the stapedius) lodged in it.
fossula of the fenestra vestibuli (fossula fenestrae vestibuli) in which The surface of the pyramid of the tympanum has a small fossa
the fenestra vestibuli, an oval opening covered by the base of the for the incus (fossa incudis) which receives the short process of the
stapes, is lodged (Fig. 970). incus.
In front of the fossula of the fenestra ovaJis, on the medial wall, Slightly below the fossa For the incus, on the anterior surface of
the septum of the musculotubal canal terminates by the processus the pyramid, under the prominence of the facial nerve canal is the
cochleariformis. posterior sinus (sinus posterior) of the tympanic cavity; still lower
Below the fenestra vestibuli is a spherical eminence called the above the styloid prominence, is the tympanic aperture of the can*
promontory (promontorium) which bears on its surface a vertical altculus for the chorda tympani (apertura tympamca canalkuli chor
groove of the promontory (sulcus promontorii). dae tympani).
Below and to the back of the promontory is a funnel-like de The anterior wall (paries caroticus) of the tympanic cavity bear
pression termed the fossula of the fenestra cochleae (fossula fenes tympanic air cells (celyllae tympamcae)', its lower part is Formed b y
trae cochleae) and an opening called the fenestra cochleae (Fig.970). the bony substance of the posterior wall of the carotid canal above
The fossula is bounded superiorly and posteriorly by the subicu- which is the tympanic opening of the pharyngotympanic tube fas-
lum promontorii. Hum, tympanicum tubae auditivae).
The fenestra cochleae is closed by the secondary tympanic Clinicians divide the tympanic cavity conditionally into three
membrane (membrana tympani secundaria) which is attached to the parts: lower, middle, and upper.
rough edge of this opening, the crest of the fenestra cochleae (cruta The lower part of the tympanic cavity (hypotympanum) is that
fenestrae cochleae). between its floor and a horizontal plane drawn through the inferior
A small depression called the sinus tympani is located above border of the tympanic membrane.
the fenestra cochleae and behind the promontory. The middle part of the tympanic cavity (mesatympanutn) occu
The roof, or the tegmentai wall (paries tegmentalis) of the tym pies most of it and corresponds to the part bounded by two horiz
panic cavity is formed by the bony substance of the corresponding ontal planes drawn through the inferior and superior borders of
area of the petrous part of the temporal bone. It is also called the the tympanic membrane.
tegmen tympani. The upper part of the tympanic cavity (epitympanum) is above
The floor of the tympanic cavity contains tympanic air ceils the middle part, between its superior border and the roof of the
(txllulae tympankae) and the opening of the canaliculus for the tym tympanic cavity.
panic nerve. The bony substance of the floor contributes to the for
THE PHARYNGOTYMPANIC TUBE

The pharyngotympanic (auditory) tube (tuba auditim) slightly laterally, and opens on the anterior wall of the tympanic
(Figs 957, 968) connects the cavity of the pharynx with the cavity cavity.
of the middle ear. It begins on the superolateral wall of the pha The pharyngotympanic tube measures 3.5-4.0 cm in length. It
rynx by the pharyngeal opening of the pharyngotympanic tube (os- consists of two parts: a large (%), cartilaginous part (pars cartilagi
tium. pharyngeum tubae auditivae), extends backwards, upwards and nea tubae auditivae) and a smaller, bony part (pars ossea tubae aud

Capltulum mallei
Ug, mallei su perl us-
Recessus \ / ArtlCulatiO incudomalleolarls
epltympanlcus \,
Plica malleares anterior V 1 .^ î' /' *rjt. tHTJi'V ^'S 1 Incudis superlus
Recessus \ . Ym * ; * *~^_ ^^^^^m ,' ^ r u s brave Incudis
Pars flacclda membranae tympani /
membranae \i8fi j ' / A n t r u m tympanicum
Irlfisura tympsnlca ' / tympani **& f > Lig. incudis posterior
anterior ' *f*'''
Prominentla mallearls^ \ * ' "
Stria melletris Crus longtim

mallearis Jjf, Incudis
anterior ( J
Plica mallearis
j Mf posterior
Recess us membranae
tympani posterior
-Processus lentlcularis
Incudis
Manubrlum mallei
-Canalis n. faclatls
Chorda tympani
f&^M N. faclalis
/ / AfluluS ilb'rtxiartllagineus
f Pars tensa mem b ran a o tympani Tuba auditiva S
limbo membranae tympani
Pars tensa membranae tympani
Ail u I us f I brocartila gi heus
B
Carialls semicLrcularis anterior
Canalis jlarls posterior
2miclrcu!arls lateralis
Llg. mallei superlus^
Jendo m. stspedll
Recessus epflympamousv
N, laclalts
Capltulum mallei s^.
Lig. mallei l a t e r a l ^
wy "^
N. vestibulococ hi earls
> Probe in fenestra cochleae
^--Cochlea
Recessus membranae
tympani superior-^
^.~M tensor tympani
'Canalis CarotlcuS
Processus anterior mallei
Manubrlum mallei
Pars tens a membranae'

tympani
Tuba auditiva
Stapes
963. Tympanic membrane, middle and internal ear.

tight tympanic membrane (lateral aspect); B right tympanic membrane, malleus, and
incus (inner aspect); C tympanic cavity, vestibule of labyrinth, and bony cochlea.

33<2
me) situated in the depths of the petrous part of the temporal

The lumen of the bony part of the pharyngotympanic tube is
bone.
trihedral; its walls are formed by the bony substance of the petrous
The cartilaginous part of the tube is formed of hyaline and part of the temporal bone which delimits the canal of the pharyn
partly fibrous cartilage and is shaped like a gutter, The cartilage is gotympanic tube (semkanalk tubae auditivae) and contains air cells
wider in the region of the pharyngeal opening of the tube (1 cm (cellulae pneumatkae).
wide and 2.5 mm thick) and occupies the medial and superior
The inner surface of the tube is lined with mucous membrane
walls of the tube and only a small part of the lateral wall. The rest
(tunka mucosa) which is continuous with the mucous membrane of
of the lateral wall and the inferior wall have no cartilage which is the pharynx in the region of the pharyngeal opening and with the
replaced here by a fibrous tissue forming the membranous lamina mucous membrane of the tympanic cavity in the region of the tvm-
of the pharyiijrotympamc tube (lamina membranaeed tubae auditivae). panic opening The mucous membrane is thickest at the pharyn
The cartilage forming the medial wall of the pharyngotym- geal opening and becomes thinner gradually towards the middle
pauic tube is called the medial lamina of the pharyngotympanic ear.
tube (lamina fcartilaginisj medialis tubae auditivae)) the cartilage
The mucous membrane lining the bony part of the tube is tigh
forming the lateral wall is termed the lateral lamina of the pharyn-
tly bound to the periosteum; the cartilaginous part has a well-deve
gotympanic tube (lamina fcartilaginx] lateralis tubae auditivae).
loped submucous layer. The mucous glands of the pharyngotym
The cartilaginous part of the tube is widest in the region of the panic tube (glandulae tubariae) are found only in the mucosa of the
pharyngeal opening where the thickened edge of the cartilage to cartilaginous part and in the region of the pharyngeal opening;
gether with a mucous fold form the tubal elevation (torus tubarius). they are arranged in three layers along its entire length. Their
The slit-like cavity of the tube becomes narrower posteriorly, and number is greatest in the mucous membrane of the anterior parts
at the junction with the bony part forms the isthmus of the tube of the tube (Figs 969, 969a). In the other portions of the tube carti
(isthmus tubae auditivae), behind which the bony part begins. The lu lage the glands are found in its anterior and posterior walls, where
men of the bony part widens gradually towards the tympanic they form two layers. Occasional glands are encountered in the re
opening of the pharyngotympanic tube (odium, tympankum tubae au gion of the tympanic membrane.
ditivae). The superior wall of the cartilaginous part of the tube is
The mucous membrane of the tube contains a few small lymph
attached at the base of the skullin the groove for the pharyngo-
glands which are located at the pharyngeal opening of the tube
tympanie tube (sulcus tubae auditivae) anteriorly and in the waits
and in the region of the tympanic membrane.
and connective tissue lilting the sphenopetrossal fissure (fissura
sfikenopetrosa) posteriorly.
THE AUDITORY OSSICLES

The auditory ossicles (osncula auditits) (Figs 957, 963-967) are
shape the malleus (L hammer), incus (L anvil), and stapes (L stir
situated in the tympanic cavity (cavum tympani). rup). They form a jointed arch lodged between the lateral and me
These are the three small ossicles named according to their dial walls of the tympanic cavity.
THE MALLEUS
The malleus (Figs 964-965) fits against the lateral wall of the
The handle of the malleus is a bony stem which deviates
tympanic cavity and is fused with the tympanic membrane.
slightly medially. Its lower end is fused with the tympanic mem
It has a head (esjpui mallei), neck (collum mallei), handle (menu- brane. Connective-tissue fibres of the membrane fuse here with the
brium mallei), an anterior process (processus anterior mallei), and a la
periosteum of (he malleus and form on the outer surface of the
teral process (processus lateralis mallei).
membrane a funnel-like depression; the corresponding projection
The head of the malleus is in the upper part of the tympanic on the inner surface of the membrane is called the umbo of the
cavity (epkympanum). It is the largest part of the malleus, oval in tympanic membrane (umbo membraneae tympani).
shape, wider towards one of its ends, and bears on its posterior and
Two processes arise from the base of the handleone is the
partly on its medial surface a saddle-like articular facet which is
anterior process (proceisus anterior) which begins at the neck, ex
covered by cartilage. Inferior to the articular facet a small projec
tends forwards and slightly laterally and fits into the squamotym-
tion, or a spur of the malleus, forms. The lower portion of the head
panic fissure (fismra petratympanka); the other is the lateral process
is narrowed and continuous with the neck which connects the head
(process lateralk) which is directed laterally; its end abuts firmly
with the handle of the malleus.
against the tympanic membrane and, as a result, the prominence

THE ORGAN OF HEARING 3&
Articulatio iircudomallearis
Caput m a l l e i - J j ^
Malleus
,Crus posterius
Processus anterior
Manubrlum mallei Basis

stapedls
964. Right auditory ossicles (osskula auditus); superomedial aspect (%).
^ p u t mallei
Facies articularis
Facies artlcularij
.Xollum mallei
Cotlum malle
Processus anterior
Processus lateralis
Processus \
lateralis'"^ Manubrlum mallei
-rManubrlUin
/ mallei
Processus anterior
B C
965. Right malleus (%).

Aanterior aspect; B posterior aspect; Gmedial aspect.

Fades articularis
Corpus incudis
Corpus incudis
Crus breve
Crus longum
Crus longum
Processes Processus
Processus lenticularis lentlcularis
lenticularis
966. Right incus (%).

Alateral aspect; B anterior aspect; Cmedial aspect.
Caput staped is Caput stapedis Caput stapedis
Crus posterius
Cms anterius
(stapedis) Crus stapedis
Crus anterius
Membrana
stapedis^,
Mem bran a
Metnbrana
stapedi5 / Basts stapedis
stapedis ^
Basis stapedis
967. Right stapes (%).

Asuperior aspect; B inferior aspect; Clateral aspect.
of the malleus (prviJimentia malkaris) forms on the outer surface of lis) arises from the superior wall of the external auditory meatus
the membrane at the junction of the tense and flaccid parts. and stretches to the neck of the malleus. It is considered an area of
T h e malleus is fastened to a certain degree in the tympanic the flaccid part of the tympanic membrane.
cavity by the following ligaments, 3. T h e anterior ligament of the malleus (ligamentum mallei ante
1. T h e superior ligament of the malleus (ligamtntum mallei su- rius) begins from the spine of the sphenoid (spina sphenoidalis} and
perius) descends vertically from the roof of the tympanic cavity to extends to the squamotympanic fissure (fissura petTOtymp&nica) to be
inserted into the anterior process and neck of the malleus.
the head of the malleus.
2. T h e lateral ligament of the malleus (Ugamentum mallei laUra- T h e tendon of the tensor t y m p a n i muscle is inserted into the

medial periphery of the base of the handle, It originates from the tensor tympani (semkanalis musculi tensoris tympani) the muscle en
circumference of the lateral orifice of the musculotubal canal (can- ters the tympanic cavity and extends to the handle of the malleus.
alis musculotubanus), the petrous part of the temporal bone, the The muscle is innervated by the nerve to the tensor tympani mus
greater wing of the sphenoid bone, and from the cartilage of the cle (nervus tensoris tympani) from the otic ganglion (ganglion oticum
pharyngotympanic tube. After passing through die canal for the
THE INCUS
The incus (Figs 964, 966) has a body (corpus incudis) and two tened at the medial and partly at the upper periphery of the
processesa short process (crus breve incudis) and a long process articular capsule.
(crux longum incudis). The posterior periphery of the body of the incus is continuous
The body of the incus is situated in the epitympanum behind with the short process.
the head of the malleus. It is attached at the roof of the tympanic The short process (crus breve incudis) stretches backwards and
cavity by means of the superior ligament of the incus (ligamentum narrowing cone-like, is inserted into the posterior wall of the tym
incudis supenus). panic cavity in the region of the fossa for the incus by means of the
The anterior surface of the body has a cartilage-covered sad posterior ligament of the incus (ligamentum incudis posterius).
dle-shaped articular facet for the corresponding articular facet of The long process (crus longum incudis) arises from the body of
the malleus to lorm the incudomalleolar joint (artiadatia incudomal- the incus and descends to be situated in the mesotympanum me
learis). Due to the presence of a braking spur on the malleus and a dial to the handle of the malleus. The lower end of the long pro
corresponding notch on the incus, this is a braking joint. The cap cess becomes thinner gradually and curves medially. On its free
sule of the joint is attached along the borders of the articular fac surface is a small lentiform nodule (processus lenticularis) which art
ets. The cavity of the joint contains an articular disk which is fas- culates with the stapes.
THE STAPES
The stapes (Figs 964-967) has a head (caput stapedis), a base The posterior limb is slightly arched and more bulky than the
(basis stapedis), an anterior limb (crus anterius stapedis), and a posteanterior limb which is almost straight.
rior limb (crus pasterius stapedis). The peripheral ends of both limbs unite with the base and
The posterior surface of the head of the stapes bears a concave form together with it a closed ring.
articular facet covered with cartilage, which articulates with the On the inner surface of the ring is a groove to which the obtu
lentiform nodule of the incus forming a ball-and-socket joint. rator membrane of fhe stapes (membrana stapedis) is attached.
The tendon or the stapedius muscle is inserted into the head of The base of the stapes has two borders: an upper convex and a
the stapes close to the origin of the posterior limb. This muscle ori lower concave border which are continuous with each other. The
ginates in the depression u n d e r the pyramid of the t y m p a n u m free surface of the base of the stapes is covered with cartilage. The
(enttttentia pyramidslis) and after emerging from it runs to the base of the stapes is fastened in the fenestra vestibuli by means of
stapes. connective-tissue fibres of the annular ligament of the base of the
The muscle is innervated by the nerve to the stapedius muscle stapes (ligamentum anulare stafiedis) producing the lympanostape-
(nerous stapedius), a branch of the facial nerve. dial syndesmosis (syndesmosis tympanostapedia).
The anterior part of the head is continuous with the anterior
and posterior limbs; between the head and the crura is a con
stricted portion the neck of the stapes,

336 THE ORGAN O F HEARING
1 roof (ttgmental wall) of tympanic cavity

2prominences of semicircular canal $
'isuptalympanic depression
4tympanic srttrum
5 incuj
6external auditory mcatus
7 malleus
8tympanic cavity
9 pharyiigal opening of phiryngolyim panic tube
10pharyngotyin panic tube
11 musculoLuba! canal
12 fjrotid caiiai
13 internal carotid artery
It body of sphenoid bone
15trigeminal itripTesjsicm
968. Pharyngotympanic tube (specimen prepared by D,Rozengauz). (Photograph.)

(The squamous part and an area of the mastoid part are removed; the external auditory meatus and the tympanic cavity are opened.)
THE MUCOUS MEMBRANE OF THE TYMPANIC CAVITY

The mucous membrane of the tympanic cavity (tunica mucosa the fenestra vestibuli, and the tendon of the stapedius muscle.
cam tympani) lines the cavity and covers all its components forming The mucous membrane of the tympanic cavity forms the fol
a series of folds and recesses. lowing recesses.
The following are the folds of the mucous membrane of the 1. The superior recess of the tympanic membrane (recessu
tympanic cavity. metnbranae tympani superior) is located medial of the flaccid part o
1. The anterior maileolar fold (plica mallearis anterior) extends the tympanic membrane.
from the handle to the greater tympanic spine. It is formed by an It is hounded by the indicated part of the tympanic membrane
area of mucous membrane covering the anterior process of the laterally, by the head and neck of the malleus and the body of the
malleus, the anterior ligament of the malleus, and the anterior por incus medially; by the lateral process of the malleus inferiorly, and
tion of the chorda tympani. by the superior ligament of the malleus superiorly.
2. The posterior maileolar fold (plica mallearh posterior) is 2. The anterior recess of the tympanic membrane (returns
stretched between the handle of the malleus and the edge of the membranae tympani anterior) is bounded by the tympanic membran
tympanic notch. It covers the lateral ligament of the malleus and laterally and by the anterior maileolar fold medially.
the posterior portion of the chorda tympani. li. The posterior recess of the tympanic membrane (recessu
3. The fold of the incus (plica incudisj descends from the poste mtmbmnae tympani posterior) is situated between the tympanic mem
rior wall of the tympanic cavity to the incus on whose lentifonn brane and the posterior maileolar fold.
nodule it terminates. The anterior and posterior recesses of the tympanic cavity are
4. The fold of the stapes (plica stapedis) is stretched between separated from each other by the handle of the malleus and com
the pyramid of the tympanum (emauntia pyramidalis), the margin of municate with the mesotympanum inferiorly.

THE ORGAN OF HEARING 3:
969. Glands of mucous membrane of right pharyngotympanic tube (specimen prepared by

D.Rozengauz). (Photograph.)
(Totally stained specimen of the pharyngotympanic tube mucous membrane.)
1lateral collection of glaEids 3medial roLleelinTi :jf glands
2isthmus uf the tube 4 pharytigeal collection of glands
969a. Glands of mucous membrane ofpharyngotympanic tube (specimen prepared by

D.Rozengauz). (Photomicrograph.)
(A gland isolated from a totally stained specimen of the mucous membrane of the pharyngotympanic tube.)
1 glandular part 3main duct
1ducts 4 ~ glandular lobule along the course fifths

Canalis
setnldrcularis anterior^
Cochlea
Cupula cochleae
Crus commune
Canalis
semtclrcularls
lateraliS.
Canalis
semicircular^
posterior^-"'
Crus simplex
Ampulla ossea^ -enestra vestibttll ,

posterior ^ t Coils of
Fenestra cochleae vesttbulum mchlea
\ Basal
970. Right osseous labyrinth (labyrintkus osseus); anterolateral aspect (%) (a cast).
THE INTERNAL EAR

T h e internal ear (auris interns) (Figs 957, 970-978) is lodged in sue membrane. T h e bony labyrinth is Riled with fluid called the
the petrous part of the temporal bone and has two parts: the bony perilymph (perilympha); the membranous labyrinth is filled with
labyrinth (labyrinihus osseus) and the membranous labyrinth (laby endolymph (endolympha) and fits loosely in the cavity of the bony
rintkus membranaceus). labyrinth,
T h e walls of the bony labyrinth are lined with a connective-tis
THE BONY LABYRINTH

T h e bony labyrinth (labyrintkus osseus) (Figs 970-974) is di- (vestibulum), an anterior part, or the cochlea, and a posterior part
vided into three parts: a middle (central) part called the vestibule consisting of three semicircular canals (canales semiarailares).
THE VESTIBULE
T h e vestibule (oestibulum) is an oval cavity situated between the T h e medial wall of the vestibule forms die fund us of the inter
tympanic cavity and the internal auditory meatus. nal auditory meatus. It bears two depressionsthe spherical and
T h e lateral wall of the vestibule is the medial wall of the elliptical recesses (reKssut sphericus et dlipticus) separated by a verti
middle ear; in it, facing the middle ear, is the fenestra vestibuh' de cal vestibular crest (crista vestibuli) whose anterior end terminates
scribed above, which is closed here by the base of the by a small elevation termed the pyramid of the vestibule (pyramis
stapes, vestibuli).

Cartalis
semicircularls anterior
Ampulla ossea
j anterior
Recessus eilipticus
Macula crlbrosd
superior
Maculs cribrosa
medla
Crlsta vestibuli /
Cochlea
y Cupula cochleae
C r l l l . i IIS
semicircular] s
lateral is ^Recessus
spheric us
Canalis
semicircularls Canahs splralls
posterior - - cochleae
-Lamina spjralis ossea
Orifice
crus coiniimtie Scaia lympani
Seals vestibuli
Arnpulla ossea posterior'
^Lamina splralls secundaria
Apertura interna * Macula cribrosa inferior
aquaeductus vestibuli "Apetuira interna
canaliculi cochleae
971, Right bony labyrinth (labyrinthus osseus); inferolateral aspect (%).

(A cast; the semicircular canals, vestibule, and the basal coil of the cochlea are opened.)
T h e surface of the pyramid and the bony subs lance around it T h e spherical recess (recessus spkericas) is in front and inferior of
are perforated by a great n u m b e r of small openings which form the crest of the vestibule. It is spherical in shape and bears on its
areas called the maculae cribrosae. T h e macula cribrosa superior inner wall many openings forming the area of the macula cribrosa
communicates the vestibule with the internal auditory meatus. T h e media which corresponds to the inferior vestibular area (area vesti-
upper portion of the fundus or the internal auditory meatus corre bularis inferior) on the fundus of the internal auditory meatus.
sponds to the macula cribrosa and is called the superior vestibular In the posteminferior part of the spherical recess, on its medial
area (area vestibularis superior). wall, is a small depression called the cochlear recess (recessus mcktea-
Downwards and to the back of the vestibular crest is a small ris) which lodges the blind end of the membranous cochlea (duct
opening termed the internal opening of the aqueduct of the vesti of the cochlea).
bule (apertura irtterna aqu(a)eductus vestibuli). From it begins a nar T h e elliptical recess (recessus etlipticus) is to the back of and
row cattahculus called the aqueduct of the vestibule (aqu(a)eductus above the crest of the vestibule and is elongated in shape. Its walls
vestibuli) which terminates on the posterior surface of the petrous have five openings of the three semicircular canals.
p a n of the temporal bone by the external opening of the aqueduct
of the vestibule (apertura externa aqu(a)eductus vestibuli).
THE SEMICIRCULAR CANALS

T h e semicircular canals (canales semicirculares asset) occupy the semidrcularis later aUs), a superior (or sagittal) semicircular canal
posteroinferior part of the bony labyrinth and lie in three mutually (canalis semidrcularis anterior), and a posterior (or frontal) semicircu
perpendicular planes. lar canal (canalis semmrcularis posterior) (Fig. 970).
There are a lateral (or horizontal) semicircular canal (canalis T h e semicircular canals have the appearance of curved tubes.

34<) THE ORGAN OF HEARING
Each canal has two ends, or osseous crura (crura ossei) which are called the prominence of the lateral semicircular canal (prominentia
connected by means of its arched part. One crus of each canal is canalis semidrcularis lateralis).
dilated and termed the ampullary crus (crus osseum ampullae) in The superior semicircular canal (amahs semicircularis anterior
contrast to the other, nondilated crus simplex (cms osseum simplex). measures 18-20 mm in length, Its ampullary end opens in the ves
The crura simplex of the Superior and posterior semicircular ca tibule next to the aperture of the ampullary part of the lateral
nals join to form the crus commune (crus osseum commune). That is semicircular canal, directly above the fenestra vestibuli. The crus
why the three semicircular canals open into the vestibule by five simplex of the superior semicircular canal, as it is pointed out
apertures. above, joins the crus simplex of the posterior canal to form me
There are three bony ampullae (ampullae osseae), in accordance crus commune (crus osseum commune) which opens on the media
with the number of semicircular canals: (a) the superior bony am wall of the posterior part of the vestibule, to the back and above
pulla (ampulla ossea anterior)', (b) the posterior bony ampulla the inner orifice of the aqueduct of the cochlea.
(ampulla ossea posterior); (c) the lateral b o n y ampulla (ampulla ossea The convexity of the superior semicircular canal faces up
laferalis). wards, producing the arcuate eminence (eminentia arcuata) on the
The lateral semicircular canal (canalis semidrcularis (ateralis) anterior surface of the petrous part of the temporal bone.
measures 14-16 mm in length. Its ampullary end opens in Front of The posterior semicircular canal (canalis scmiriradaris posterior
and lateral to the Fenestra vestibuli; the crus simplex Opens in the measures 22 mm in length. Its ampullary crus opens on the
vestibule between the aperture of the crus commune and the am posteroinferior wall of the vestibule where the macula cribrosa in
pullary part of the posterior semicircular canal. The convexity of ferior is located. The foramen singufare of the internal auditory
the lateral semicircular canal bulges into the tympanic cavity and meatus correspond to this macula.
produces an elevation on the medial wall of the epitympanum
THE COCHLEA
The cochlea (Figs 971-974) begins in the anteroinferior part of which terminate in the spiral canal of the modiolus (canalis spiralis
the lateral wall of the vestibule where there is a depression to modioli). The apex of the modiolus does not reach the cupola of the
which corresponds a promontory (promontorium) on the surface fac cochlea but continues as a thin bony lamina of the modiolus (lam
ing the tympanic cavity. The spiral canal of the cochlea (canalis spi ina modioli) forming a wall between the second and third coils of
ralis cochleae) begins here. It is called so because it curves spirally to the cochlea.
form 2J^-2% coils. The walls of the canal are formed by the bony The coils are separated from one another by an intermediate
Substance of this part of the labyrinth. wall formed by the bony substance of the cochlea, The osseous spi
The beginning of the canal of the cochlea is separated from the ral lamina (lamina spiralis ossea) (Fig. 973} projects from the modio
tympanic cavity by the medial wall of the last-named and forms lus into the cavity of the spiral canal for its whole length. It begins
the promontory (promonlorium) on it. on the inner wall of the vestibule near to the fenestra cochleae, as
The Erst coil of the cochlea is called basal, the secondmid cends winding round the modiolus, and terminates in the region of
dle, and the lastapical. the last coil by a curved edge called the bamulus of the spiral lam
The cochlea has the shape of a cone and has a base (basis coch ina (kamttlus laminae spiralis).
leae) measuring 7-9 mm in width and a cupola (aipula cochleae). The The base of the spiral lamina is thicker than the free border
distance from the base to the cupola measures 4-5 mm. The base and contains the spiral canal of the modiolus (canalis spiralis modi
of the cochlea faces the internal auditory meatus (meatus acusticus oli) for the whole distance. This canal communicates by means of
internus), the cupola faces the tympanic cavity and the musculotu- lhe longitudinal canals of the modiolus (canales longitudinales mod
bal canal. oli) with the openings in the region of the base of the cochlea, and
The spiral canal of the cochlea measures 28-30 mm in length with the spiral organ by means of a slit-like spiral fissure passing
and ends blindly at the cupola. It is widest (measuring 6 mm) at for the whole length of the spiral lamina.
the beginning but narrows gradually to a diameter of 2 mm as it The cochlea also has a secondary spiral lamina (lamina spiralis
approaches the cupola, secundaria). This is a small bony plate (measuring 0.5 mm in width)
In the centre of the cochlea is a pillar around which the coils which projects from the outer wall of the cochlea half-way into its
wind; it is called the modiolus. The modiolus is made up of spongy cavity.
bone and forms the inner wall of the spiral canal. Its wide part, A basilar membrane (membrana spiralis) stretches from the Fre
base of the modiolus (basis modioli) faces the internal auditory mea edge of the osseous spiral lamina to the outer wall of the cochlea for
tus and has numerous openings forming the tractus spiralis for- the whole length; it is part of the membranous cochlea (see below),
aminosus (Fig. 972). These openings are continuous with the lon The osseous spiral lamina together with the cochlear canal di
gitudinal canals of the modiolus (canalcs longitudiualcs modioli} vides the cavity of the spiral canal into two stair-like passages; the

Cupula cochleae.
Hamnlus laminae
Lamina modioli / splralis
-'Helicotrema
Cochlea
Lamina spiralis
ossea ,Sca!a vestibull
Lamina spiralis
ossea
Modiolus - Seala tympani
Tractus spirali
foramlnosus
Tract us spiral
foramlnosus.^*^ Fusion of wall ^ ^ Modiolus
of cochlcar coil
with modiolus
972. Right cochlea; inferior aspect (%).

^ modiolus of cochlea and osseous spiral lamina (lamina spiralis ossea); B ^ partly opened
cochlea.
Cupula cochleae
J.amlrm modlotl
Haoiulus Samtnae
Cochlea : pi rails ^
Lamina spiralis
Lamina spiralis ossea i ossea
Modiolus Fusion ofeocblear

coil
N K
Area cochleae'' /
V /
Basis cochleae Traettts spiralfs
foramlnostis
A B
973. Right cochlea (Yy).

Awall of bony cochlea; B osseous spiral lamina; C modiolus of cochlea.

42
Apical coil of cochlea
Hamulus
laminae spiralis. Modiolus
Hellcotrema.
,Canalls longitudinal la
raodioli
CanaHs
spiralis inodiolt Scala vestibuli
Scala tympani
Lamina spiralis
0SK4B
Scala vestibuli
Canalls spiralis
cochleae
Scala tympan
Canalls spiralis
modioli
Tracuis 3plral1s Meatus acustlcus
toramlnosus
Intemus
974. Right cochlea (%) (section).

scala tympani ends blindly at the beginning of the hamulus. Here,
upper is called the scala vestibuli, and the lower is termed the scala
on the outer wall of the scala tympani, Is the fenestra cochleae
tympani. Both are related to the perilymphatic space (%atim pen-
which is closed by the secondary tympanic membrane fwflsfewia
lymphaticum) to which is also referred the extension of this space
tympani seaindaria). The anterior edge of the fenestra cochleae
into the aqueduct of the cochlea (durtus perilymphaticus).
bears a crest (vista fenesim axhltae) in front of which, in the floor of
The scala vestibuli begins in the anterior part of the vestibule,
the scala tympani, is the internal opening (apatum interna) of the
ascends on the superior surface of the spiral lamina to the cupola
cochlear canal iculus (canaliadus cochleae).
of the cochlea to be continuous with the scala tympani in the re
gion of the hamulus of the spiral lamina. The junction between the This canaliculus begins by a funnel-like expansion and, after
two sealac is termed the belicotrema of the cochlea. passing through the thickness of the petrous part of the temporal
The scala tympani (Fig. 974) begins in the region of the helico- bone, terminates on its inferior surface by the external opening of
trema and passes on the inferior surface of the spiral lamina to the cochlear canaliculus (apertura extema. canaliaili cochleae) in fr
wards the base of the cochlea. After making 2%-T/, turns, the of the jugular fossa.
THE MEMBRANOUS LABYRINTH

bony one, as the result of which there is a cavity between them
The membranous labyrinth (labyrinth membraneous)
which is called the perilymphatic space (spatium penlymphaticum)
(Figs 975-978) has the same parts as the osseous labyrinth. These
filled with perilymph (perilympha). The cavity of the membranou
are: a vestibule represented by two sacs, an elliptic utricle (utncu-
labyrinth contains endolytnph (mdoiympha).
lus) and a spherical sacculc (sacculus); (he membranous semicircu
The wall of the membranous labyrinth consists of three layers:
lar ducts (ducivs semirirculares), and the membranous cochlea, or the
an outer layer of connective tissue,'a middle layer formed by the
duct of the cochlea (ducttts cochleans).
basement membrane, and an inner epithelial layer.
The membranous labyrinth is enclosed in the bony labyrinth
The membranous cochlea, or the duct of the cochlea (dudui
and all its parts are smaller than the corresponding parts of the

Ampulla mcmbrauacea anterior
975. Right bony and membranous labyrinth (represented semi schematically).
cochkam) is the place of distribution of the peripheral apparatus of the saccule are the site of distribution of the peripheral apparatus
the cochlear nerve (pars tocklearis nervi ottavi). It is related to the or of the vestibular nerve (pars vestibulans nervi ortavi). They compos
gan of hearing and forms the spiral organ (organum sphah). the vestibular apparatus and are the organ of balance.
The membranous semicircular duets as well as the utricle and
THE DUCT OF 1
The duct of the cochlea (dudus cochkarisj (Figs 975, 976) is situ of the cupola of the cochlea and is termed the caecum cupulare (u-
ated inside the spiral canal of the cochlea and, following its course, cum atpulare}.
makes 2',4-2% coils. It is trihedral and has two blind ends: one is at The duct of the cochlea is situated in the lateral part of the spi
the beginning of the cochlea in the vestibular region and is termed ral canal, between the free edge of the osseous spiral lamina and
the caecum vestibulare (cetmm vertibulare}, the other is in ihe region the outer wall of the cochlea; together with the lamina it separates
the scala vestibuli from the sea la tympani except for the hehco- tributes to the formation of the floor of the duct; it enters the cav
trema where both scalae communicate in the region of the cupola ity of the duct.
of the cochlea. At the junction of the spiral ligament of the cochlea with the
The cavity of the duct communicates with the sacculus via the basilar lamina is a spiral prominence (pTominentia spiralis) which
ductus reuniens and is bounded by three walls: the lateral wall (pa- contains vessels. Medial to it is the external spiral sulcus (sakus spi
ties txternus dudus cocklearis) is connected with the outer wall of the ralis externus).
cochlea; the other wall is called the vestibular membrane (paries A vessel called the vas spirale is situated in the substance of
vesiihularis ductus cocklearis [membrana vestibular^j ) ; the third wall isthe basilar lamina below the spiral organ; it is a capillaiy receiving
at the junction with the sea I a tympani and is termed the floor (pa arterioles, which approach it through the osseous spiral lamina,
ries tympankus ductus cocklearis [membrana spiralis]). It is a continuaand small veins running from the spiral ligament of the cochlea.
tion of the osseous .spiral lamina and is called here the basilar la The thickened limbus laminae spiralis contains connective-tis
mina (lamina basilaris), or the membranous spiral lamina. sue and epithelial elements. A vestibular lip (labium limbi vestibx-
The lateral wall of the duct is fused with the periosteum lining lare) hangs freely from it into the cavity of the duct of the cochlea
the inner surface or the cavity of the bony cochlea. It consists of and is continuous with the membrana tectoria. At the junction of
three layers; an outer connective-tissue layer is a continuation of the basilar lamina with the osseous spiral lamina the limbus lami
the spiral ligament of the cochlea (ligamentum spirale cochleae), by nae spiralis forms a projection called the tympanic lip (lahium limbi
means of which the basilar lamina is attached to the outer wall of tympanicum).
the cochlea; a middle layer of fibrous vascular tissue called the These two lips are separated from each other by the internal
stria vascularis whose vessels are concerned with secretion or spiral sulcus (sulcus spiralis internus). The border of the tympanic li
maintenance of endolymph; and an inner layer of epithelium lin is perforated by foramina for nerves (foramina, nervasa) by means o
ing the cavity of the duct. A vessel called the vas praminens passes which the slit-like spiral fissure of the osseous spiral lamina opens
between the periosteum of the cochlea and the lateral wall of the into the duct of the cochlea.
duct; it forms from union of two eanaliculi arising from the saccu The spiral organ (organum spirale) is situated in the cavity of
lus and utricle and draining into the aqueduct of the vestibule. the duct for the whole length of the basilar lamina. It is a complex
The vestibular membrane of the ductus of the cochlea arises structure located lateral to the tympanic lip and consists of three
on the surface of the osseous spiral lamina facing the cavity of the groups of epithelial cells among which are the inner and outer sen
seal a vestibuli. Stretching towards the outer wall of the cochlea, sor}' (auditory) hair cells. The spiral organ is covered by a reticular
the vestibular membrane forms an angle of 45 degrees with the membrane (membrana reticularis) which is a complicated entirety o
osseous spiral lamina. It is the thinnest wall of the duct and con membranes bounding the upper surface of the spiral organ cells.
sists of connective tissue covered with epithelium. The spiral organ contains the receptor apparatus of the cochlea
The tloor of the duct, the basilar lamina, stretches between the nerve (pars cochkaris nervi octavi) (Fig. 976). Dendrites of cells form
free end of the osseous spiral lamina and the outer wall of the ing the spiral ganglion of the cochlea (ganglion spirale cocklearis) ru
cochlea to which it is attached by the spiral ligament of the coch to the spiral organ in the substance of the osseous spiral lamina;
lea. The extreme lateral part of the osseous spiral lamina also con the axons of these cells form the cochlear nerve.
THE SACCULE AND THE UTRICLE

The saccule and the utricle (Figs 975, 977, 978) are situated in nective-tissue strands running from the walls of the saccule and ut
the cavity of the bony vestibule, in the spherical and elliptical re ricle to those of the bony vestibule.
cesses, respectively. A wide peri lymphatic slit termed the peri lymphatic cistern of
The saccule communicates with the duct of the cochlea, the ut the vestibule separates the surface of the saccule and utricle from
riclewith the cavity of the three semicircular ducts. Besides, the the outer wall of the bony vestibule. At the entrance of nerves the
saccule and the utricle communicate with each other as follows: a medial surface of the saccule and utricle is fastened to the corre
small duct arises from the saccule and joins the duct from the utri sponding wall of the vestibule.
cle and is called the utriculosaccular duct (ductus utrkulosaccularis). The saccule (sacculus) is spherical and slightly compressed. Its
This duct is continuous with the endolymphatic duct, or the aque upper (medial) end is slightly expanded, while the lower (lateral)
duct of the vestibule (dudus enddymphatiats jaquaeductus vestibulij) end narrows gradually to be continuous with the ductus reunions,
which passes through the petrous part of the temporal bone and by means of which the cavity of the saccule communicates with the
ends on its posterior surface by an endolymphan't sac (saccus endo- cavity of the cochlea.
lymphaticus). Between the saccule and utricle and the bony walls of On the inner surface of the anteromedial wall of the saccule is
the vestibule is the perilymphatic space (spatium perilymphatrcum) the macula of the saccule (macula sacculi) on which the saccular
filled with perilymph. The perilymphatic space is pierced by cast* nerve (nervus sacadaris) terminates. The wall of the saccule is thick

T H E O R G A N O F HEARJNG 345
DuCtuS cochlearls
Scala vestibuli
v \ I ^
J *\ \ I Central processes
/ V I' , \\> of ganglion spirale
Ganglion spiraie
L Lig, spirale
cocfileae \ Peripheral processes of
ganglion spirale cells
\
Osseous wall of cochlea Sea!a tympaiii
976. Section through basal coil of cochlea (represented semischematically).
cued here, whitish due to the presence of otoliths (statoconiaj, and otoliths (statoconia) which are rich in lime crystals and contain sen
contains sensory, or hair (sensory-epithelial) cells (cdlvlat [sensori- sory hair cells on their surface. The otoliths are held in place by
epitkeiialesj pilosae)* the m e m b r a n e of the otoliths (membrane, statoconiorum) which is a
The utricle (utricutus) is elongated. It bears on its. inner surface thin mucous membrane lining the inner surface of the utricle. O n
the macula of the utricle (macula utriaili) which Occupies part of the outer surface the region of the macula is separated from the
the lower, anterior, and outer walls. T h e utricular nerve (nervus utri- rest of the utricle by a constriction; this part of the cavity of the ut
cvlaris) ramifies there. ricle is termed the elliptical recess (reassus dlipticus) (Fig. 971) and
The macula of the utricle measures up to 3 mm in length and communicates with the semicircular ducts.
nr> to 2_,1 into in wiiilh. is whitish in m l o n r diif to the presence of
THE SEMICIRCULAR DUCTS

The Superior, lateral, and posterior Semicircular ducts (dad-US the bony walls in such a manner that the convex, or outer wall of
semiarcwlaTes anterior, lateralis, et posterior) are lodged in the corre the ducts is bounded more intimately with the bony walls than the
sponding bony semicircular canals. Repeating the shape of the concave surface.
canals, each semicircular duct has a curved part (loop) and two The peri lymphatic space of the semicircular ducts is wider on
ends, one terminating by an ampulla-like expansion and the other the side of the concave surface.
opening into the utricle. The nonexpanded ends of the superior The expanded, or am pullary ends of the ducts communicate
and posterior ducts unite to form the crus mem bran ace urn com freely with the cavity of the utricle. Each membranous ampulla
mune which is regarded as the posterior projection of the utricle. superior, lateral, and posterior (ampullae membranaceae anterior, po
The walls of the semicircular ducts are attached to the bony terior et lateralis) carries on each outer surface a transverse am-
walls of this part of the cochlea by connective-tissue bands. The pullary sukus (sukus ampullaris) transmitting the nerves of each
wall of die duct itself is formed by the proper membrane of the ampulla.
semicircular duct (mcmbrana propria dudus semicirailaris) which is a On the inner surface of the ampulla is the ampullary crest
suhepithelial layer of connective tissue, and the basal membrane (crista ampulians) corresponding to the ampullary sulcus. It occu
of the semicircular duct (membrana basalis ductus semicircularis) bearpies %r% of the circumference of the ampulla and is covered with
ing the epithelium of the semicircular duct (epithelium dudus semi- sensory epithelium (neuroeptthelium) (epithelium sensorium fneurose
circularis). soriam}) on which the fibres of the ampullary nerves (nervi ampul-
The semicircular ducts are placed eccentrically in relation to lares) arise.
THE INTERNAL AUDITORY MEATUS

The internal auditory meatus (meatus aatsticus internus) (see brosa superior on the medial wall of the vestibule. The openings
Fig. 825) begins on the posterior surface of the petrous part of the are bounded inferiorly by the transverse crest (crista transversa).
temporal hone by the poms acusticus intemus. It stretches back Below this crest the anterior part of the fundus has a depres
wards and slightly laterally and ends as the fundus of the internal sion termed the cochlear area (area cochleae) which bears a series o
auditory meatus (fundus meatus aeustici interni). small spirally arranged openings leading into the tractus spiralis
The rundus forms the medial wall of some parts of the internal foramtnosus.
ear (the base of the modiolus and the vestibule). The uppermost To the back of the cochlear area is the inferior vestibular area
part of the fundus has a small depression called the facial nerve (area vestibularis inferior) containing a group of openings corre
area (area nervifadalis) from which the canal of the facial nerve be sponding to the macula cribrosa media on the vestibular wall.
gins. The posteroinferior part of the fundus has a foramen singulare
Lateral to the facial nerve area is an area of bony substance to which corresponds the macula cribrosa inferior on the vestibu
perforated by numerous openings forming the superior vestibular lar wall (Fig. 971).
area (area vestibularis superior) to which corresponds the macula cri-
THE AUDITORY NERVE

The auditory nerve {ntrvus vestibulocochtearis s. nervus ortavus) tral processes of the spiral ganglion unite to form the cochlear
(Fig. 977) consists or the cochlear nerve (pars cocklearis nervi odavi) nerve.
and the vestibular nerve (pars vestibularis nervi odavi). The vestibular nerve begins from the vestibular ganglion (gang
The cochlear nerve arises from the spiral ganglion (ganglion spi lion vtstibutare) which lies on the fundus of the internal auditory
rals) which is lodged in the spiral canal of the modiolus (tanalis spi- meatus. The vestibular ganglion has two partsa superior (pars su
ralis modioli). perior) and an inferior part (pars inferior). The peripheral processes
The peripheral processes of the ganglion cells run through the of the cells of the superior part of this ganglion enter the superior
foramina nervosa to the spiral organ. vestibular area of the internal auditory meatus and extend through
The central processes of the nerve cells pass through the lon the macula cribrosa superior into the internal ear. Here they are
gitudinal canals of the modiolus and emerge from the cochlea distributed in the macula of the utricle and the superior and la
through the openings of the tracius spiralis Foraminosus and the teral ampullary crests to form the utriculo-ampullar nerve (nervus
cochlear recess into the internal auditory meatus. There the cen- utriaduampullaris), the anterior ampullary nerve (nervus ampullaris

Ductus semlciiculsns anterior

N. utricularis
M. empullarls anterior \
Pars vestibujarf.^
(h. octavi) N. facialls
ârs cochleans \ \ I .Ampulia mtmbranacea lalcralis
(n, octavi) ^
DllCtLS
cochlearl
Ductus utrlculosat'.cularls
Crus membranaceu* commune
N. sacculoris Ductus
sernicifculaiis
posterior
N, ampulJarls posterior^ Ductus endolymphatlcus ' /
Sdccuius , / /
Ductus reunlens ' l Saccus endolymphalicus
Ampulla memhranatea posterior' Ductus iemiclrculaiis laleralfs
977. Right membranous labyrinth (labyrinihus memhranaceus) (a cast).

anterior), and the lateral ampullary nerve (nervus ampullarh latera The central processes of the vestibular ganglion cells form the
ls). vestibular nerve (pars vestibularis nervi odavi) which unites with Lhe
The peripheral processes of the cells of the inferior part of the cochlear nerve to form the auditory nerve (nervvs vestibulitcoMearu
vestibular ganglion enter the inferior vestibular area and the for s. newus odavus). T h e auditory nerve passes in the internal auditory
amen singulars of the internal auditory meatus. meatus (see Fig.826) and enters the cavity of the skull through the
The part of the inferior branch which extends to die vestibular porus acusticus internus and then runs to the corresponding nuclei
area is termed the saccular nerve (riervus saccularis). It enters the in of the auditory nerve (nervi nuclei vestibulococklearis) lying in the
ternal ear through the macula cribrosa media and stretches to the pons (in the floor of the fourth ventricle), where they are projected
macula of the saccule. on die vestibular area, or area acustica (the further course of the
The posterior ampullary nerve (nervus ampullaris posterior) en fibres of this nerve is described in the section The Cranial Nerves;
ters the internal ear through the foramen singular? and macula cri see also Fig. 82f>).
brosa inferior to ramify in the ampullary crests, mainly in the crest
of the posterior membranous ampulla.
THE VESSELS OF T H E ORGAN OF HEARING

The vessels of the external ear. T h e lateral surface of the auri- perfidalis) (see Fig. 618). T h e medial surface receives blood from
cle is supplied with blood by the auricular branches of the super- the auricular branch of the occipital artery (ramus auricularis arterial
ficial temporal artery (ram auriculares anteriorts artmae temporalis su- occipitalis) and the posterior auricular artery (arteria auricularis pnstt-

Ductus semidrculaTia
anterior
Ampulla membranatea anterior
\ 1
Rr cochleae a. labyrinth! N, ampullarls lateral!?
\
vestibulares a. labyrinthl ^
Ductus coclilearis a Ampulla rtiembranacea
lateralls
Cms commune
Vein of spiral Aaipulla membriTiatea

membrane
/ I' / I i posterior
posterio
Anterior spiral vein , ' ( N . S ^ t l ^ y f / Duc,nS Mdol
>Phs,ta" V g u t t e r . * postert
Posterior spiral vein Vv, vestitmlares i i

/
V. cariailculi cochlea?
978, Blood vessels of right labyrinth; inner aspect (schematical representation, after
F.Siebemann).
tier) which is a branch of the external carotid artery (arteria carotis from the adjacent parts of the mucous membrane. These arteries
externa). ramify in the tympanic membrane to form two vascular net
The venous blood is drained by the anterior auricular veins fffe- worksan outer one in the skin and an inner network in the mu-
nae auriculares posteriores) emptying into the retrornandibular vein, cosa of the tympanic membrane.
and by the posterior auricular vein (vena auricularh posterior) which In conformity with the arteries, the veins form venous plex
empties into the external jugular vein (oena juguhris externa). uses, the veins of the lateral surface communicating with those of
The vessels of the external auditory meatus. The external audi the medial surface of the tympanic membrane.
tory meatus is supplied with arterial blood by the auricular The vessels of the middle ear. The following arteries supply the
branches of the superficial temporal artery (rami auriculares anted- middle ear.
ores) and by the deep auricular artery (arteria aadeularis prqfunda) 1. The anterior tympanic artery (arietta tympanka anterior) (a
which is a branch of the maxillary artery (arteria maxillaru). branch of the maxillary artery) enters the tympanic cavity through
The venous blood is drained by the system of the maxillary the squamotympanic fissure (fiiiura petratympanka).
vein fews maxitlaris). 2. The inferior tympanic artery (arteria tympanka inferior) (a
The vessels of the tympanit membrane. From the side of the branch of the ascending pharyngeal artery) penetrates into the
external auditory meatus the tympanic membrane is approached tympanic cavity through the petrosal fossa (fossuta petrasa) and the
by a branch of the deep auricular artery and by other arteries of canaliculus for the tympanic nerve (canalituha, tympanicus),
the skin of the external auditory meatus. From the side of the mid 3. The superior tympanic artery (arteria tympanka superior) (a
dle ear the tympanic membrane receives branches from the tym branch of the middle meningeal artery) extends into the tympanic
panic artery (maxillary artery) and other arteries extending to it cavity.

4. T h e caroticotympanic branches (rami airoticotympaniri) of posterior auricular artery (arteria auricularis posterior).
the internal carotid artery enter the tympanic cavity through the 1. T h e internal auditory artery (arteria labyrinthi) is a branch of
carolicotympanic foramina in die posterior wall of the carotid the basilar artery (arteria basilaris). It enters the internal auditory
canal. meatus and divides into the cochlear branch (ramus cochtearis) and
5. T h e stylomastoid artery (arteria stylomastoidea) (a branch of the vestibular branches (rami vestibulares) (Fig. 978).
the posterior auricular artery) enters the canal For the facial nerve (a) T h e cochlear branch sends arteries to the first (basal) coil of
through the stylomastoid Foramen and sends into the tympanic the cochlea and, stretching along the axis of the cochlea, gives off
cavity via the anterior canaliculus for the chorda tympany the pos branches to the spiral ganglion, the osseous spiral lamina, to the
terior tympanic artery (arteria tympanica posterior), the slapedial middle and apical coils, and to the periosteum (endosteum) lining
branch (ramus stapedius) to the stapedius muscle, and the mastoid the scala tympani.
branches (ram mastoidei) to the mucous membrane of the air cells (b) T h e vestibular branches supply the membranous vestibule,
ot the mastoid process. the semicircular ducts, and the periosteum (endosteum) of the ves
T h e branches of these vessels unite to form a thick arterial net tibule.
work in the mucous membrane of the tympanic cavity; the deep 2. T h e stylomastoid artery (arteria stylomastoidea) in the canal
layers of the mucous m e m b r a n e contain large arterial trunks, ca for the facial nerve gives off a small branch which enters the mid
pillary networks prevail in the superficial layers. dle ear through the fenestra cochleae and runs to the cochlea.
T h e vessels of the pharyngtitympanic tuhe. T h e tube is sup T h e internal ear is drained by the following veins,
plied with arterial blood by: (1) the pharyngeal branches (rami 1. T h e vein of the cochlear canaliculus (vena canalicvli cochleae)
pharyngei) of the ascending pharyngeal artery (arteria pkaryngea as- drains blood from the vein of the spiral lamina, the veins of the
cendms); (2) the artery of the pterygoid canal (arteria eanalis pterygoi- spiral ligament of the cochlea and those or the spinal ganglion (the
dei) from the descending palatine artery (arteria palatina descenders) anterior and posterior spiral veins are located in the scala tym
which is a branch of the maxillary artery; (3) the superficial petro- pani), and from the veins of the saccule and utricle,
sal branch (ramus petrosus) of the middle meuingeal artery (arteria T h e vein of the cochlear canaliculus stretches on it and emp
meningeti media); (4) branches of the inferior tympanic artery (arte ties into the upper bulb of the jugular vein.
ria tympanica inferior), which is a branch of the ascending pharyn 2. T h e vein of the aqueduct of the vestibule (vena aquaedudus
geal artery, to the bony part of the tube. vestibuti) drains blood from the veins of the semicircular ducts and
T h e veins of the middle car drain blood into the maxillary and the utricle; it emerges from the petrous part of the temporal bone
middle meningeal veins (venae maxillares et m-eningeae mediae), the along the aqueduct of the vestibule and empties into the superior
internal jugular vein (vena jugularis internal and the pharyngeal petrous sinus.
plexus (plexus pheryngeus). 3. T h e internal auditory veins (aenue labyrinthi) collect blood
The vessels of the internal ear. T h e internal ear is supplied by from the walls of the internal auditory meatus, the auditory nerve,
the internal auditory artery (arteria labyrinthi) and by a branch of and spiral nerves of the cochlea; they empty into the inferior pe
the stylomastoid artery (arteria stylomastoidea) originating from the trous sinus.
THE NERVES OF THE ORGAN OF HEARING

Trie nerves of the internal ear. T h e following nerves are sup branch of the vagus nerve, and sends twigs to the auricularis supe
plied to the lateral surface of the auricle. rior and posterior muscles, the oblique and transverse muscles of
1. T h e anterior branch of the great auricular nerve (ramus ante the auricle, and the antitragus muscle;
rior ncrvi auricularis magni) which is a branch of the cervical plexus (b) the temporal branches (rami temporales) run to the helicis
(see Fig. 823). major and minor, tragicus, and auricularis anterior muscles.
2. T h e auricular branch of the vagus nerve (ramus auricularis T h e nerves of the external auditory meatus. T h e following
nervi vagi), nerves innervate the external auditory meatus.
3. T h e auricular branches of the auriculotempural nerve (nerai 1. T h e nerve to the external auditory meaLus (nervus meatus
aurictdares anteriores) (from the trigeminal nerve) (see Fig, 813), acustici externi) which arises from the auriculotemporal nerve (third
T h e medial surface of the auricle is innervated by the posterior division of the trigeminal nerve).
branch of the great auricular nerve (ramus posterior nervi auricularis 2. T h e auricular branch (ramus auricularis) of the vagus nerve.
magni). T h e nerves of the tympanic m e m b r a n e . T h e following nerves
In addition to the listed nerves (sensory), branches of the facial extend to the tympanic membrane from the side of the external
nerve run to the auricle: ear,
(a) the posterior auricular nerve (nervus auricularis posterior) 1. A branch of the auriculotemporal nerve arising from the tri
geminal nervethe nerve to the external auditory meatus (nervus
T H E ORGAN OF HEARING
meatus amstici extimi) sends a branch to the tympanic membrane formed for the most part by the tympanic nerve (nervus tympanicus),
(mnm membranae tympani), a branch of the glossopharyngeal nerve,
2. The auricular branches of the vagus nerve (rami auriculares 2. Nerves from the communicating branch with the tympanic
ntroi vagi) form the tympanic plexus; its branches form another, plexus of the Facial nerve (ramus communicant cum pUxu tympanko
subepithelial, plexus supplying the skin and the proper lamina of nervi fackdis).
the tympanic membrane.
3. The caroticotympanic nerves (nervi caroticotympanid) origi
Branches of the tympanic plexus (plexus iympankus) run to the nating from the internal carotid plexus (plexus caroticus internus).
tympanic membrane from the side of the middle ear (see Fig. 829), The nerves of the pharyngotympanic tube. The pharyngotym-
The nerves of the middle ear. The mucous membrane of the panic lube is supplied by branches from the tympanic and pharyn
middle ear is innervated by die following nerves. geal plexuses (see Fig. 829),
1. Nerves from the tympanic plexus (plexus tympanicus) which is

OF THE ORGAN OF HEARING AND EQUILIBRATION
Among the three parts of the earthe external, middle, and the width; in an adult the height is almost double the width. The
internal the first two develop from the wall of the first branchial external auditory meatus in a newborn is narrow but relatively
(pharyngeal) pouch. The internal ear forms from the external em long. Due to the insufficient development of the temporal bone
bryonic ectoderm and is first laid down at the beginning of the and the tympanic ring and the position of the external auditory
third week of the intra-uterine period. The membranous labyrinth meatus, the tympanic membrane in the newborn is set more obli
develops phylogenctically and ontogenetically earlier than the quely than that in an adult.
other structures of the ear. It is laid down as an auditor)' pit of the
The auditory ossicles of the newborn are the same size as the
ectoderm close to the first pharyngeal pouch; later the edges of the
ossicles of an adult, but cartilaginous areas are still present in the
pit fuse to form the otic vesicle which is submerged in the mesen-
body of the incus and head of the malleus. The pharyngotympanic
chyma. By forming protrusions of various shape, folds, and con
tube in a newborn is shorter and wider than the tube in an adult
strictions, the vesicle acquires a more complex shape and forms
and its pharyngeal opening is at the level of the hard palate; but it
the membranous labyrinth; the mescnchyma around the germ of
rises with age to the level of the posterior end of the inferior con
the internal ear forms the connective tissue and then the cartilagi
cha, and sometimes a little higher. The internal ear of the newborn
nous covering, a rudiment of the bony labyrinth and the peri lym
hardly differs from that of an adult t and the differences are mostly
phatic spaces. The auditory ossicles develop from the first and sec
related to the ossification and development of some of the struc
ond pharyngeal arches.
tures, e,g. the bony labyrinth.
In a newborn, the height of the auricle only slightly exceeds
THE ORGAN OF TASTE
Organum gustus
The organ of taste (organum gusius) comprises the peripheral (2) in the mucous membrane of the anterior surface of the soft
apparatus of the taste analyser which are situated in the cavity of palate (velum, palatinum);
the mouth (Fig. 979). The receptors responding to taste stimuli are
(3) in the mucous membrane of the epiglottis;
the taste buds.
(4) in the mucous membrane of the posterior wall of the pha
The taste bud (caliadus gvstatorin) is oval; its wide base extends rynx.
to the connective-tissue tela submucosa, while the apex reaches the The taste stimuli, perceived by the taste buds, are conducted
free surface of the epithelium on which it opens by the taste pore along the branches of the glossopharyngeal nerve, the chorda tym-
(poms gustatorius). The total number of taste buds in a human
pani, and the vagus nerve to the nuclei of the brain stem and then
adult varies from 2000 to 2500. Due to the presence of specialized
to the region of the cortical end of the taste analyser which, it is
taste cells they are capable of sensing selectively the quality of
believed, is located next to the cortical end of the olfactory ana
Food with due account for its taste characteristics; sweet, bitter,
lyserin the region of the uncus (gyrus pctr&kippocampalh) (s
acid, salt.
Fig. 828).
The taste bud is composed of two types of epithelial cells: taste The course of the central fibres arising from the nerve endings
(gustatory) cells (cetlulae [sensoriepithdialesj gustatorwe) occupying responsible for the general and special sensations of the tongue are
the central part of the bud, and supporting cells situated on the described in the section The Cranial Nerves (the fifth, seventh, ninth
periphery.
and tenth pairs).
The food, dissolved in the saliva, enters the taste pores of the
buds and stimulates the nerve endings lodged in the taste celJs,
The taste buds are distributed as follows:
(1) in the mucous membrane of the tongue in the vallate papil
lae, folia linguae, and the fungiform papillae (papillae vall&tae, joli-
atae et Jungijormes)^
979. Innervation of mucous membrane of tongue; taste

(gustatory) areas of mucous membrane of tongue
(represented semischematically)
(The region innervated by the superior laryngeal nerve [branch of the
vagus nerve] is coloured yellow; the region innervated by the
glossopharyngeal nerve is coloured violet; the region innervated by the
lingual nerve [branch of the trigeminal nerve] is coloured pink.)
I epiglottis fuiigiforin papillae
' ^ l i n g u a l follicles coiiical papillae
ivallate papillae M i a linguae.
+filiform papillae

THE ORGAN OF SMELL
Organum olfadus
receptor apparatus and is composed of three types of cells: olfac
The organ of smell (organum olfactus) is the peripheral appara
tory (cdlulae [nswosmseriat] olfadonae), supporting (ipithdiocytis sis,
tus fiF the olfactory analyser. It lies in the mucous membrane ol
tentans), and basal (epitheliocytu basdis) cells.
the cavity of the nose and occupies the region of the superior mea-
The olfactory cells are spindle-shaped and terminate on the
tua of the nose and the postcrosuperior part of the septum; these
regions are termed the olfactory region of the mucous membrane surface of the mucous membrane by olfactory vesicles which are
of the nose fregio olfadoria tvnkae mucosae nasi) (Fig. 980). supplied with hairs (cilia)- The other end of each olfactory cell is
continuous with a nerve fibre. Such fibres unite into bundles to
This part of the mucous membrane of the cavity of the nose is
form the olfactory nerves (nervi olfadoru) (see Fig. 806) which, after
distinguished From all the other parts by its thickness and a yellow
ish-brown colour; it contains the olfactory glands (glantlulat dfac- entering the cavity of the skull through the openings in the cribri
form plate of the ethmoid bone, transmit the stimulation to the ol
toriae).
factory centres, and from these to the cortical end of the olfactory
The epithelium of the mucous membrane of the olfactory re
analyser (see Fig-807 and The Olfactory Nerves).
gion is called olfactory (epithelium olfactcrium). This is the olfactory-
980. Olfactory region (regio olfadoria).

(The area of the mucous membrane of the lateral wall of the right half of the nasal cavity and nght surface of the septum of the nose are
coloured.)

THE COMMON INTEGUMENT
Integumentum commune
THE SKIN
The skin (cutis) (Figs 981-990) forms the common integument ridum) formed of 3 Or 4 rows of cells filled with a peculiar shining
of the body (integumentum commune) in which are lodged the sen substance called e lei din.
sory nerve endings, the sweat and sebaceous glands, muscles, hairs, The outermost layer of the epidermis is called the horny layer
and nails. (stratum comeum) which consists of flattened keratinized cells.
The skin performs a protective Function, takes part in ther- These cells transform into squames which are continuosly shed
moregulation and metabolism, in the processes of excretion, secre from the surface of the epidermis to be replaced by new cells pro
tion and respiration, and possesses a vast receptive area. duced in the deeper layers. Between the epidermis and the true
The skin is composed of two layers: skin lies the basement membrane.
(1) the epidermis; The true skin or dermis (corium s. dermis) is a derivative of the
(2) the true skin (corium or dermis) with subcutaneous tissue mesoderm and consists of fibrous connective tissue. Its fibres inter
(telu subcutanea). lace in various directions and form a thick network lodging vessels,
The epidermis is a derivative of the embryonic ectoderm and nerves, muscles, glands, and hair follicles.
forms the superficial layer of die skin. It measures 0.07 to 0.4 mm The dermis is formed of two layers: (1) the corpus papiliare
in thickness and is thickest on the sole. (stratum papiliare) and (2) the reticular body (stratum reticulare).
The epidermis is made up of stratified epithelium and keratinl- The corpus papiliare consists of loose connective tissue; it is
zation occurs continously in its outer layers. Its deepest layer, con named so because its surface bears papillae projecting into the epi
sisting of 5 to 15 rows of cells, is termed the germinative layer. dermis. Nerve endings, blood capillaries, and blind projections of
Some of the cells of this layer which are directly adherent with the lymph capillaries of the superficial (subepidennal) network of the
true skin and are prismatic in shape are set apart as the basal-cell skin are lodged in the papillae.
layer (stratum basalc [tylmdriaimj). As the result of cells division The skin is rich in elastic and -collagen fibres which are di
new layers of epidermis are produced to replace gradually the rected from the fascia into the subcutaneous fat and dermis. The
outermost keratinized layer. elastic fibres form networks under the papillae; fine nets and sepa
The germinative layer contains pigment the amount of which rate fibres extend from the networks to the papillae, thus causing
determines the colour of the skin. elasticity of the skin.
The prickle-cell layer (stratum spinomm) overlies the germina Figs 987 and 988 represent schematically the distribution of
tive layer and is covered by the granular layer (stratum gramilosum) elastic and collagen fibres in the skin. The network also interlaces
which is composed of several rows of cells containing keratohyalin the sebaceous glands and hair follicles. The elastic tissue of the
in the cytoplasm. skin is developed better in skin areas most exposed to pressure (the
palms, the soles, the regions of the joints}.
Superficial to the granular layer lies the clear layer (stratum fa-
354
Duct of giandula
sudorifera
Porl sudoriferl | M. arrector pill
Fatty lobules^ I
/
* .... , . ^
Glandula seoacea
\ II.
\ Follicuius pill
Û
V x
v Radix plli
lula sudorifera
Qlandula iiiHnrifpra Papilla pili Bulbus pill
Retlnacula cutis
981. Vertical section through skin (semischematical representation).
The last-named are grouped into fatty lobules. Large collections

The dermis also contains smooth muscular tissue. The cells of
of these lobules form the subcutaneous fatty tissue (pannkulus adip-
this tissue ran mainly to the hair follicles and sebaceous glands as
esvs). Bundles of connective tissue surrounding the lobules are
the arrectores pilomm muscles (musaiii mectom pikrum)
called the retinacula cutis (Fig. 981). Vessels and nerves pass in
(Fig. 981). Contraction of the muscle fibres causes the appearance
of "goose flesh" (cutis anserina) and secretion of the skin glands. them.
The eyelashes, eyebrows, and the hairs of the apertures of the nose The presence of a loose connective tissue in the tela subcuta-
are devoid of muscles. Smooth muscle cells are present m the skin nea and the degree of its adherence to the underlying tissues deter
of the scrotum and the skin around the nipples of the mammary mine the mobility of the skin and the possibility of forming folds.
glands; they are not connected to the hair follicles but form a mus^ The skin on the palms and soles is poorly mobile because it is con
cular layer in the corpus papillare and partly in the areolar tissue. nected with the underlying aponeurosis by dense connective-tissue
The deep layers of the dermis are continuous with the subcu bands between which compartments filled with fatty lobules form.
taneous tissue (Ula mmml which is composed of collagen and The development of subcutaneous fat is specific for different indi
elastic fibres of connective tissue forming a wide-loop network. viduals and body areas, which depends on metabolism, sex, age.
The loops are filled with loose connective tissue rich in iat cells. and occupation.

THE C O M M O N INTEGUMENT 355
982. Glands of skin of upper eyelid (specimen prepared by V.Kharitonova). (Photograph.)

(Area of specimen of totally stained skin of eyelid,)
-Kwcai glandn (climer) 2 ~ d u c t of sweat gland 3Kbateous glands
Fatty tissue may occur in large amounts in the region of the Elevations of skin rich in fat and containing connective-tissue
mammary glands, the anterior abdominal wall, and die thighs. Its bands and nerves form on the palms and soles; they are called the
amount is greatest in the gluteal region and the soles. T h e collec tortile elevations (Fig. 984). They occur on the palmar surface of
tion of subcutaneous fat in the cheek is enclosed in a connective- the distal phalanges of the fingers, over the metacarpophalangeal
tissue capsule and is called the buccal pad of fat (corpus adifrosum joints, on the thenar and hypothenar. The skin ridges in the region
htccae) (see Fig. 266 of Vol.11), of the tortile elevations have a very complicated pattern of loops,
Some skin areas are always devoid of fat, e.g. the skin of the arches, and coils, which is strictly individual and does not change
eyelids, the auricles, the mammary areolae, the scrotum and penis. with age. T h e permanent character and individuality of the pattern
T h e surface of the skin is uneven because it bears many folds allows establishing the identity of persons by examining their
(plicae), grooves (mid), elevations, or ridges (cristae), and pores fingerprints (dactyloscopy) (Figs 983, 983a, 983b).
(pori). The skin folds are classified into permanent and inconstant. T h e skin of the eyelids, auricles, the prepuce of the clitoris, the
The epidermal grooves run in different directions and form rhom pudendal tips, etc. is related to die permanent skin folds. Folds
boid and triangular fields. also occur in the regions of the joints, e,g, the elbow joint, the
T h e permanent folds are those on the palms and soles, the inguinal fold, etc.
ridges of the skin (cristae aitisj, which are separated by grooves of The inconstant folds of skin form on muscle contraction in
the skin (said cuiis). T h e folds are formed by the corpus papillare areas of poorly developed tela subcutanca, e.g. the transverse folds
projecting as the ridges of the true skin separated from one an of skin on the forehead, the vertical fold between the eyebrows, in
other by the grooves of the true skin. In the ridges the papillae are the region of the eyelids, etc.
arranged in paired parallel rows. The ducts of sweat glands open The skin surface bears some grooves, for instance, the nasolab-
on the apices or the ridges, these openings are called the pores of ial groove (sulcus nasolabialis), the mentolabial groove (sulcus mento-
the sweat glands (pori svdoriferi) (Fig. 981), labialis), sulci of elbow joint, etc.
Created with novaPDF Printer (www.novaPDF.com)|

356
H^^^
ilil$i&
983a. Fingerprint showing skin pattern.

(Right index finger.)
locrine secretion. In shape they are simple branching aetnous

glands; they are lodged in the skin throughout the body surface,
except for the skin of the palms and soles.
The sebaceous glands are connected to the hair follicles into
which their ducts open. One to three glands open into one follicle.
In the regions of the eyelids, vermilion border, mammary areo-
l u , glaus penis (clitoridis), the deep surface of the prepuce, and
the anus, i.e. in areas devoid of hairs, the sebaceous glands open
directly on the skin surface. The glands secrete sebum, a fatty sub
stance,' which is a lubricant For the skin and hairs and prevents
their desiccation.
The sweat glands (glandulae sudonferae) are related to meroc-
rine glands, their cells remain intact during secretion. According
to the character of secretion, the merocrine glands are in turn sub
divided into eccrine and apocrine.
The eccrine glands are simple merocrine glands discharging a
fluid secretion. The apocrine glands are atypical merocrine be
cause in the process of secretion their glandular cells are partly re
jected but do not disintegrate.
:
- : .
^w- The sweat glands are scattered almost on the whole surface of
the body and occur in particularly large amounts on the palms and
soles. They are absent from the vermilion border, glans penis (cli
toridis), and inner surface of the prepuce.
The sweat glands lie at the junction of the dermis and tela sub-
983. Prints of ridges of skin (aristae cutis) and cutanea or in the tela itself. They are related to simple tubular
grooves of skin (sulci cutis) {l/i% glands and are coiled to form a tuft. The wall of the tube is lined
(Palm of right hand.) with a single layer of cuboid cells in the vicinity of which smooth
muscle cells are placed longitudinally.
The duct of the sweat gland (dudus sudoriftrus) takes a tortuous
course in the epidermis and opens on the ridge of the skin (crista
THE APPENDAGES OF THE SKIN cutis) by a sweat pore (porus sudoriferus).
The apocrine glands are situated mostly in the skin of the pu
THE GLANDS OF THE SKIN bic region, the axillary fossae, the bend of the thigh, the mammary
areolae, and the labla majora. Their secretion has a specific odour.
The glands of the skin (glandulae cutis) (Figs 981, 982) com
By discharging sweat (sudor), or perspiring, the skin contributes to
prise the sebaceous (glanduke sebaceae) and sweat (glandulae sudonf-
thermoregulation in the body and excretion of harmful metabo
erae) glands. lites From it.
The sebaceous glands (glandulae sebaaae) are related to the ho- The breasts (mammae), which are skin structures, are described
locrinc glands in which the glandular cells disintegrate during ho- in Volume II.
:*_ mmmm
THE C O M M O N INTEGUMENT 357
THE NAILS
The nails (ungais) (Gk eyrytW) (Figs H84-986) are derivatives
of the epidermis. They are horny plates, slightly convex transver
sely, situated on the dorsal surfaces of the distal phalanges of the
fingers and toes.
The nails begin developing in the third foetal month. In a full-
term fetus they protrude above the ends of the phalanges.
The nail has a body (corpus unguis), a root (radix unguis), and
four borders: a free border (margo liber) extending beyond the tip
of the phalange, a hidden border (margo occultus) in the proximal
part of the nail, and two collateral borders (margined lattrales).
The nail lies on the nail bed (matrix unguis) formed by the con
nective tissue of the dennis and the germinative layer of the epi
dermis. The nail bed bears on its surface longitudinal ridges (cristae
matrias ungttif) and is bounded proximally and on the sides by a
groove (mkus matrias ungais) which is deepest where the root of the
nail sinks into it. A nail wall (vallum unguh) overlaps the sides and
proximal end of the nail.
The germinative epithelium of the nail bed, which is responsi
ble for the nail growth, is particularly well developed in the region
of the root. A whitish crescent-shaped area can be seen here
through the nail, it is called the lunula. In the region of the root of
the nail is the eponyehium, a band of comified layer covering the
lunula of the nail. A slightly thickened epidermis under the free
border of the nail is the hyponychium.
THE HAIR
The hairs (pili) (Gk trickos) (Figs 981, 982) are the epidermis
derivatives and start developing on the third foetal month. They
cover the whole skin surface with the exception of the palms, soles,
vermilion border, labia minora, glans penis, and the deep surface
of the prepuce.
The primary hairs are fine and have a downy appearance; they
are termed down (lanugo). Eventually they are replaced by stronger
secondary, or permanent hairs. The downy hairs of the body (lan- 983b. Grooves (sulci), ridges (cristae), and pores
ago), the hairs of the head (capilli), the hairs of the eyebrows (super-
cilia), and the eyelashes {alia) are the permanent hairs. Tertiary
of shin of finger; palmar surface (%).
I su3ci cutts 2 cristae cutis 3 pori aiidftrifrri
hairs appear in the period of puberty under the effect of increased
activity of the organs of internal secretion (sex glands); these are eyelids emerge perpendicularly. Sometimes, the hairs are directed
the beard (barba) and whiskers, the axillary hairs (hira), the pubic so that they form cross-like figures which are called hair eruces
hairs (pubes), the hairs of the nose (vibrus&e) and the hairs of the ear (eruces pilorum); this determines the boundaries of skin areas (for
(tragi). instance, the expanded depression in the region of the sacrum, the
The hairs usually emerge obliquely from the skin surface their Michaelis's rhomboid), the measurement of which is very import
direction coinciding, on the main, with Langer's lines (Figs 987, ant in clinical practice.
988), and form the hair streams (flumina pilorum). The hairs are ar The hair has a root (radix pili) embedded in the skin, and a
ranged in groups (2-7 hairs in each group) stretching one after an shaft (srnpus pili) raised above the skin. The root of the hair is set at
other. Since these lines are spiral in some areas of the skin, the an angle in relation to the skin surface. Its thickened part is called
hairs following their pattern form hair whorls (vortices pilorum) the bulb of the hair (bulbuspili) at the bottom of which the hair pa
where they are arranged fan-like, particularly around a centre. The pilla (papilla pili) is lodged. The hair papilla is a modified papilla
hairs of the external auditory meatus, of the nostrils, and of the of the skin and carries vessels.

r>s
Margo laieralis
Sulcus matricis unguis
Margo occultus \
Radix unguis
Margo liber
MatrU unguis Cristae matricis unguis
Vallum unguis
Sulcus matricis unguis
984. Nails of right hand (%).

{An area of skin with the subcutaneous fat removed from the thumb; the tortile elevation ftomlus iacHlk] is exposed.)
The hairs grow at the cost of producing cells covering the hair and an internal circular layer. The arrectores pilnrum muscles are
papilla; when nutrition of these cells is disturbed, the production inserted into the external layer, their contraction raises the shaft of
of new cells ceases. The cells of the bulb in this case become kerat- the hair.
inized, the bulb takes the shape of a fla.sk and separates from the The hair is composed of a medullary substance called the me
papilla, the hair dies and is shed, and a new hair forms from a new dulla pili, a cortical substance termed the cortex pili, and the cuti
papilla. cle, or cuticula pili. The medulla is located along the axis of the
The root of the hair is invested in a sheath which has an inter hair; it is absent from the downy hair.
nal and an external layer and is a continuation of the germinative The cortex forrns the main bulk of die hair; it consists of
layer of the epidermis. tightly packed keratin cells and contains pigment giving the hair its
The sheath of the root is enclosed in a hair follicle (folliailw colour.
pili) formed of epidermal cells and connective tissue. The connec The cuticle covers the hair on the outside and is formed of
tive tissue of the follicle forms two layers: an external longitudinal amicleated horny overlapping squames.

THE COMMON INTEGUMENT 359
COTpMS ullguls Msrfio ouculms

/ / , Phalanx diatalis
I Vallum unguis
/ Radix uneuis . Arliculatio mlerphelangea inanus
:V,,iiri utlguli I 4
Mflrgo liber
1
\ Phalanx media
M. flexor digltofniTi prDfuntlu1; (tetldQ)
Stratum granulosam j
TurjeroMtas. pllalatigis distalis
\ \ Epidermis
S
Stratum cOrneurtl
985. Nail and distal (ungual)phalanx (%).

(Longitudinal section through the distal phalanx and nail of index finger.)
Vallum unguis
Corpus unguis
Stratum coraeum Stratum germlnativutn

unguis
Linguis
Matrix unguis
Sulcus matrlcls unguis
Mergo lateral Is unguis
Phaltnx distaLis
Tubetositas phajangia dL&talis
'-^= B l o o d vessels
986. Nail and distal phalanx (%).

(Cross-section through distal phalanx and nail of index finger.)

360 T H E C O M M O N INTEGUMENT
Muscles:
1 teniporalia
2masseler
S ptacymia
4 sternoc I <? idem astoideus
5omohyaid ens
6jterriohyoideus
7levator scapulae
8trapearns
9stcrnothyroidens
10deltoidcus {part originating from the cfavide)
11 deltoideus (part originating from the aciomion)
12pe^toralis major
13coracobrachialis
14triceps brachii {caput louguni)
16biceps brachii
16brachialis
17pronator teres
ISbra c h iorad i.il i a
19tlexor carpi radial is
20flexor digilorum superficialis
21flexor pollicis lonûs
22ibductOT pollicis fongus
2Sabductor pollicis brevis
24flexor pollicis bTevis
25opponens pollicis
26abdtittor dijiti minimi
27palmaris longus
28cbliquus extern us abdominis
29reetus abdominis
30 tensor fasciae latae
31pectineus
32sartorius
33adductor longtiS
i)4reetus femoris
35gracilis
36vastus lateral is
37adductor tnagtms
33vastus medialig
39peroneus lorijgug
40tibialis anterior
41 extensor digilorum
42peroneus brevis longus
43extesisor hallucis longus
44exteiiior digitonim brevis
45 intcrossei dor-sales
46ejtiensor hallucis brrvis
47abductor liallucis
48soleus
50gastrocnemiua (caput mediate).
987. Main directions of tension of connective

tissue fibres in skin; anterior aspect
(schematical representation).
Lines of tension and cleavage, Langer's lines, (left half); and point
of stimulation, or motor points (right half).

THE COMMON INTEGUMENT 96]
Muscles;
1infraspinatuE
2teres miner
3 deltoid ens (part originating from spine of scapula)
+Jeltoidtus- {part originating Froiw fttfQ?tti&tt)
Starei major
6triceps brachii (caput longum)
7 triceps brachii (capul lateral e)
8 brach iorad iali s
&extensm- carpi radLalia krngus '
1Qsmconcus
11 supinator
12 extensor carpi radial is brtvi?
IS eJEtgfilox carpi ulnarU
i4extensor dijjjilomiTi comntunis ~ -
15 abductor pollicis longus Ww
1-6 extensor pollicis brcvLs
17adductor pollicia
IShiterussei dcrWes
19abductor digiti minimi
7fi-extensor indicit
21 rxtemor pollkis lonjyfus
22 cxttdKH; digiti minimi prop rt us
23flexor dEgitoruin pro-ftindua
24flttor carpi ulcaris
25triceps brachii (caput mcdiale]
26latisE-imus dorsi
27gluten* medius
26glutcus- majfiimis
23 adductor magnu*
30 biceps femorii (caput longum)
31 seuiitcndinosus-
32 biceps femoria (caput breve)
33wkttl
34 flexor hallutts longu?
55abductor digiti minimi
36 flexor digrt>niiTi bTevis
37 flexor digitoruiik longus
38gastrctfnenu us
S9scm irnembraiios-Lis.
988. Main directions of tension of connective-

tissue fibres in skin; posterior aspect fW^ ,35.
(schematical representation).
Lines of tension and cleavage, Langer's lines (left half); points of
stimulation, or motor points (right half).

N. ophthalmic u s . ,
K. maxiHarts
N. mandibitJsrls
K. aurlcularls mflgmis
NTI. supraclavlculares
Rr. ; ii !.!;
antcriorcs laler&les
N, tutaneus
hracbfl lateralI
R r cjtanel l i t e r a l *
N. cujaneui
brachll medial is ~
Rr. cutancl
anterloTes mediates.
N. cuianeus
brachii posterior
l y lliohypogastrlcus A
N. iliolngulnalls
R. femorsUa
n. gSTiltoienmralJs
R. palmaris
n. roetfiani
R. sup*rfic1alis
n. radiali5 v
R. tutaneus
patmarls
n. ulnaris^
Nn, dlgitales paimares,
n. medianl^--^'
R. Superficial^ >
ri. u l r m i s X
N. cutarELS dorsalts
medians
N. tutaneus dursalls
inlermedius
Nn. dlgltales
pJantares pmprll
N. peroneus
ffJbulsrls) profundus
created with novaPDF Printer (www.novaPDF.com) anterior aspect (schematical representation).

N . occipital]; major
,.-
1 N. occipltalls. minor
-N. surleularls magnus
NTI- supraelavlculares
N. rutMTiL-iiS brachll
Lite rails
Rr. cutanel dorsals

laterals
_ M. cutaneus hrach.ll
medlalls
Rr. cutanel dorsales
medlales
N. cutarieus bradill
posterior
R cntflJieuJ anfebracfill
posterior
Nn, - i: 11!i ;i
super? ores
N. -.-: J l. i ;-ij- aritebraclill
medlalls
Nn. clrjnium meull
N. cutaneus antebrachli
laterally
R. cularteus lateralls
R, SuperllclalLs
^ m s n u s n. radial is
^ R . dprgalls
(""_} man us
J 11. ulnarls
^Nn_ digits I es
^"paJmarespropfli
N- eutfltieua dorsails
pedis lateral Is
N, cutaneus plentarls
medlalls
^.*N. ciitancus
plantarls laterally
created with novaPDF Printer (www.novaPDF.com)f^'J posterior aspect (schematical representation).

THE VESSELS OF THE SKIN

The vessels of the skin arise partly from muscular branchess The veins form four plexuses in the skm: the first is formed by
and partly from the arteries of the skin proper. They anastomosee postcapillaries of the hair papillae, glands, and muscles; the sec-
and form a deep cutaneous arterial network (rett arlcriosum aita-
i- ond lies under the papillae, below it is the third venous plexus; the
neum) at the junction between the subcutaneous Fat and the der
fourth plexus lies at the junction between the subcutaneous tissue
mis. The network gives rise to small arterial branches which run to
j and the dermis. The veins arising from this plexus pass through
the tufts of sweat glands, to the hair papillae, and to the subcu
the subcutaneous fat and unite to form larger subcutaneous veins.
taneous fat.
The lymph channels of the skin are formed, firstly, by two net
Vessels run vertically from the cutaneous network to the over works of lymph capillariesa superficial, or subepidermal and a
lying skin layers in which they ramify and anastomose with one an deep network. The superficial network sends blind capillary pro-
other to form the subpapillary arterial network (rete arimomm sub-- jections into the papillae of the dermis. Secondly, the deep capil
papilhre). This network supplies with blond the hair follicles, the lary network is continuous with lymph vessels. These vessels anas-
ducts of sweat glands, and the sebaceous glands and sends small
I tonôse with one another to form the Intracutaneous network of
branches to the papillae in which they ramiFy into arterial capilla
- lymph vessels in the reticular body of the dermis (and at the junc
ries continuous with wider venous capillaries; the venous capilla
tion between it and the subcutaneous tissue); this network gives
ries are continuous with the veins of the skin.
rise to the extra-organic lymph vessels.
The arterial networks of the skin are best developed on the
soles, palms, and buttocks.
THE NERVES OF THE SKIN

The skin is innervated (Figs 9B9, 990) by sensory, motor, va- in great numbers on the palmar surface of the fingers and plantar
somotor, and secretory nerves. surface of the toes, and are particularly abundant in the region of
Nerves approaching the skin form plexuses in the subcutane the tactile elevations,
ous layer which are continuous with thicker nerve plexuses situ The subcutaneous tissue, periosteum, and joints contain large,
ated in the corpus papillare. oval lameilaied corpuscles (corpuscula lamdlosa) measuring from 2
The sensory nerve endings lie in the epidermis, dermis, and die to 4 mm. They are Formed by lamella arranged concentrically
subcutaneous tissue throughout the skin. Nerve endings situated around a central core containing the axial cylinder of the nerve
in the epidermis respond to pain stimuli. The cells responsible for fibre terminating by a dilatation,
the sensation of touch are also found in the epidermis. The papil Besides sensory nerves supplying the skin segmeiitally from the
lae of the dermis contain oval corpuscles, (curpuscula tadus) sur~ corresponding spinal nerves (Figs 989, 990), die skin contains sym
rounded by a connective-tissue membrane. The nerve fibres enter pathetic and secretory nerve fibres which innervate the smooth
ing the corpuscles are curved spirally. These corpuscles are found muscles, vessels, and glands of the skin.
E
o
o
THE ENDOCRINE GLANDJ CD
Glandulae endocrinicae
The endocrine glands (glandular endocrinicae), in contrast to the 1. Branchiogenous glands developing From the epithelium of
exocrine glands, have no ducts. The ductless glands and paragang- the pharyngeal pouches. This group includes the thyroid gland,
lia produce hormones, which enter the blood (venous) or lymph the parathyroid glands, and the thyrnus.
capillaries. The tissue structures of these gJands are braided with a 2. Enlodermal glands represented by the endocrine part of the
thick network of blood and lymph capillaries. The ductless glands pancreas.
are as Follows (Fig.991): the thyroid gland (glandula thyroidea), the 3. Mesodermal glands developing from the coelomic epithel
parathyroid glands (glanduhc parathywideae), the thymus, the su ium. These are the cortex of the suprarenal glands and the sex
prarenal glands (glandulne suprarewles), the paraganglia, the sex glands.
glands (the testes and ovaries), the hypophysis (glanduia pituitaria), 4. Ectoderm a I glands developing from the sympathetic ele
the pineal body (corpus pineale), and the endocrine part of the pan ments. The medulla of the suprarenal glands and the paraganglia
creas. are related to this group.
Though some glands are related functionally with one another, 5. Neurogenic (ectodermal) glands associated with the devel
they differ in embryonal origin. According to the genetic signs, the opment of the diencephalon. This group includes the hypophysis
endocrine glands can be divided into five groups. and the pineal body.
E
o
o
LL
Q
Q.
CD
>
O
THE THYROID GLAND c

i
The thyroid gland (glandula thyroidea) (Figs 991-995) is un has the shape of a horseshoe with the concave part facing to t
CD
paired and the largest endocrine gland. It is situated in the ante back and consists of two lobes differeing in size, the right lobe \
rior part of the neck, in front of and lateral to the trachea, and oc Q
bus dexter) and the left lobe (lobus sinister), and an unpaired isthma.
cupies the thyroid region which is within the range of the medial of the thyroid gland (isthmus glandulae thyroidme) connecting the cco>
triangle (the last-named is bounded by the hyoid bone, the ster- The isthmus may be absent, in which case the lobes adhere loosi
nocleidomastoid muscles, and the suprasternal notch). The gland to each other. T3
CD
-i
CC
CD
o
THE ENDOCRINE GLANDS
Hemtspherium
Corpus callosum cerebrl
Corpus pttieale- nfundibulum

f'".
Tectum mesencephali -#?r**" ypophysis
Cerebellum~<ige
G lorn us caroiicum^.
Larynx-
Glandulae parathvroideae SSKGiandula Ihyroidea

^ . . i - J hiu'hf.i
Thvmus __ ^M^M
^^PulmO
/
Paraganglion
//
supracardiale
// \,
//

/ / %
PV-Perlcardfimi
,,-~
s
-" 1
h Medulla
Giandula
Hepar''j[
B l x ,- . suprarenalis
Giandula suprarenalis J B^- Cortex J
Pancreas-"*?" B-Ren
Corpora
paraaortica' f-lniCStinL[ni tenue
Inteslimim crassuiii' H-Aorla

V. cava inferior
wt-Vesica urinarla
;
4S-Glomus coecygeum
-Testls
991. Endocrine, or ductless, glands of a child (general scheme).

Os hyoideum
Li g, Uiyrohyoideum medianum
A. Uryngea superior
A. thyrotdea superior'
Lobus pyramidalis
M. thyrobyoideus
A, thyroidea superior
Cartilago ihyroidea
V. thyroidea superior _^, jjj

i
Lobus sinister
/
R. crtcothyroideus ' \
Lobu3
!: xlrr Isthmus, gtandulae
thyroid eae
M. cricothyroideus
V. ihyroidea inferior
Ortilago crlcoidea PJexus thyroideus Impar
T~ Trachea
A. Ihyroidea inferior
A. thyroidea inferior-
A. ihyroidea ima
992. thyroid gland (glandula thyroidea); anterior aspect (%).
The accessory thyroid glands fctsMu tkyroideae accessorise) junction with the isthmus. It may reach the thyroid notch or the
are sometimes encountered They are similar in structure 10 the body of the hyoid bone.
thyroid gland and are either fused with it or connected to it by a The thyroid gland is invested in two (internal and external)
small thin strand. connective-tissue capsules. The internal fibrous capsule feepwla
A pyramidal lobe (lobus pyramidalis) often (in 30 to 50 per cent fihrosa gianduUe tkyroideae} is a fine fibrous lamina which is Fus
of cases) extends upwards from the isthmus or the left lobe at the with the parenchyma of the gland and sends processes into its sub-

. . . . . . . : : . : ' . . .
Palatum molle
A. carotls exlerna
Vv. pharyngeae
Pliaryni Glandula submandtbuians
Plexus phaiytigeus
aS^-'A. thyroidea superior
GliruLuli]
paiflthyroldea superior
N, la ry age us inferior
Glandula
parathyroidea inferior
Glandula Ihyroidea
" " T - V . thyroldea inferior
R. Csophageus
- A . t h y r o l d e a inferior
Esophagus
N, laryngeas reeurrens
Trachea
993. Thyroid gland (glandula thyroidea) andrightparathyroid glands (glandulae parathyroideae);

lateral aspect (%).

370 THE ENDOCRINE GLANDS
M. constrictor pharyngis^,
medius
Lig. thyrohyoideum $
Raphe pharyngis.
_M. constrictor
'pharyngis inferior
Glandula parathyroidea
superior
Glandula thyioidea Glandula thyroidea

(lobos sinister) (lobus dexter)
Glandula parathyroidea
inferior
-,-,Cariilagines tracheales
Esophagus
994. Thyroid gland (glandula thyroidea) and parathyroid glands (glandulae parathyroideae).
posterior aspect (%).
stance to divide it into lobules. In the substance of the gland itself lobes to the lateral surfaces of the cricoid cartilage and the nearest
thin layers of connective tissue rich in vessels and nerves form the cartilaginous rings of the trachea.
stroma of the thyroid gland (stroma glandulae thyroideae). The folli In addition, the external capsule is connected to the connec
cles (foltiadae glandulae thyroidea) lie in its loops. tive-tissue sheath of the neuro-vascular bundle of the neck.
The fibrous capsula is covered by the external capsula of the Between the external and internal capsules is a slit-like space
thyroid gland which is a derivative of the cervical fascia. The con filled with loose fatty tissue in which the extraorganic vessels of the
nective-tissue bundles of the external capsula fasten the thyroid thyroid gland, lymph glands, and the parathyroid glands are
gland to the neighbouring organsthe cricoid cartilage, the tra lodged.
chea, and the stern ohyo id and sternothyroid muscles; the thickest The anterolateral surfaces of the thyroid gland are covered by
of these bundles form specific ligaments stretching from the gland the sternohyoid and sternothyroid muscles and by the superior
to the organs lying close to it. bellies of the omohyoid muscles.
Three bundles are developed best; these are the middle liga At the junction of the anterolateral and posteromedial sur
ment of the thyroid gland attaching the capsule in the region of faces, the thyroid gland is in relation with the neuro-vascular bun
the isthmus to the anterior surface of the cricoid cartilage, and dle (the common carotid artery, internal jugular vein, and vagus
two, right and left, lateral ligaments of the thyroid gland which nerve). The recurrent laryngeal nerve runs on the posteromedial
fasten the capsule in the region of the inferomedial parts of the surface, and the tracheal lymph glands are also found here.

T H E E N D O C R I N E GLANDS 371
T h e lower parts or the right and left lobes reach the fifth or Its arteries proper supply the parenchyma and anastomose with
sixth trachea! ring, the vessels of the neighbouring organs. The venous blood is col
The posteromedial surfaces of the gland are in relation with lected in a wide subcapsular venous plexus (plexus venasus suhcapsu-
the lateral surfaces of the upper tracheal rings, the pharynx, and laris) which is developed best in the region of the isthmus and the
the oesophagus, and superiorlywith the cricoid and thyroid car anterior surface of the trachea.
tilages.
Innervation: nerves from the cervical ganglia of the sympath
The isthmus of the gland lies at the level of the first to third (or etic trunks (nervi thyroidei), taking part in die formation of plexuses
second to fourth) tracheal cartilages. Its middle part is covered round the vessels approaching the gland, and from the cervical
only by the fused pretracheal and superficial layers of the cervical part of the vagus nerves (the superior laryngeal, external laryngeal,
fascia and the skin. and recurrent laryngeal nerves).
The weight of the gland differs with the individual and ranges Blood supply: the right and left superior thyroid arteries from
from 30 to 60 g. The longitudinal dimension of each lobe mea the external carotid arteries; the right and left inferior thyroid ar
sures up to 6 cm, the transverse dimension4 cm, and thickness
teries from the thyrocervical trunk; sometimes the thyroidea ima
2 cm.
artery from the innominate artery of the arch of the aorta (less fre
The gland grows in the period of puberty. Its dimensions may quently from the common carotid artery or the subclavian artery).
change depending on its blood filling. At old age connective tissue Veins: the right and left superior thyroid veins (empty into the
develops in the gland and its dimensions diminish. internal jugular veins or common facial veins); right and left infe
T h e thyroid gland produces thyroxine, triiodothyronine, thyro- rior thyroid veins (drain into the innominate veins); the inconstant
calcitonin, and calcitoninthe hormones regulating die metabolic thyroidea ima vein (empties into the left innominate vein or the in
(calcium and phosphorus) rate and intensifying processes of bone ferior thyroid vein).
formation in the organism. The lymph vessels mostly accompany the arteries and empty
The thyroid gland is rich in arterial, venous, and lymph vessels, into the tracheal, deep cervical, and mediastinal lymph glands.
THE PARATHYROID GLANDS

T h e parathyroid glands (glandulat parathyroids^ or epithelial ferior border of the cricoid cartilage. T h e inferior glands are
bodies (Figs 991, 993, 994), are situated on the posterior surface of usually larger and lie on the posterolateral surface of the lower
the lobes of the thyroid gland to both sides of it (sometimes to one parts of the lateral lobes of the thyroid 0.5-1 cm above their infe
side only), close to the large branches or the thyroid arteries, in the rior border; sometimes they are found in the areolar tissue below
loose areolar tissue lying between the external and internal cap the thyroid gland.
sules of the thyroid gland; sometimes they are situated outside the Both the superior and the inferior glands are arranged asym
capsules. metrically.
T h e parathyroid glands are small, slightly flattened, oval or elon Each parathyroid gland is invested in a connective-tissue cap
gated, less frequently spherical, and have a smooth shiny sur sule which sends processes into the gland's substance to separate it
face. In children they are pale-pink and slightly transparent but into poorly detectable lobules.
with age they become yellowish-brown which makes them poorly The parenchyma of the parathyroid glands is composed of ep
distinguishable Trom the adjacent lymph glands. T h e parathyroid ithelial cells forming strands between which are layers of connec
glands are denser in consistency than the thyroid gland. tive tissue rich in blood vessels.
There are two pairs of glands: two superior parathyroid glands The parathyroid hormone (parathormone) produced by the
(gUndulae parathyroideae wperiores) and two inferior parathyroid glands regulates calcium and phosphorus metabolism in the body,
glands (glanduke pamtkyroideat inferiores). Innervation: branches from the superior and inferior laryngeal
Their number varies from 1 to 7-8. nerves (vagus nerves); sympathetic branches.
T h e average weight of a separate gland varies from 0.05 to Blood supply: branches to the glands arising from the superior
0.09 g. The gland measures 4 - 8 mm in length, 3-4 mm in width, and inferior thyroid arteries.
its thickness varies from 1.5 to 3 mm. Veins: the thyroidea ima veins (usually empting into the left
The right and left superior glands are usually located at the innominate vein); the superior and inferior thyroid veins forming
junction of the upper and middle thirds of the lateral lobes of the venous plexuses and anastomosing with the vessels of the phaiynx
thyroid gland on their posteromedial surface, at the level of the in- and larynx.

WZ THE ENDOCRINE GLANDS
Carlilago thyioidea
Lotus pyramidalls M. ctleothyroideus

k
E-Glandula Ihyroidea
i * j V. brachioctphalica
thoracica interna
A. thymica
Aorta
Pulmo minister
/ .
/ WL fi. pericardiacus
H Pericardium
995. Thyroid gland (glandula ihyroidea) and ikymus; anterior aspect (%,).
(A child of the first year of life.)

THE E N D O C R I N E GLANDS 373
THE THYMUS
The thymus (Figs 995, 996) is an unpaired gland. In it are dis

tinguished two intimately adherent lobes which are connected to
1
each other by loose connective tissuethe right lobe (lobits dixier)
and die left lobe (lobus tinkler). Sometimes they are joined by an in
serted part. Three or Four lobes are a rare occurrence. The lobes of
the gland are elongated and asymmetrical. T h e anterior surface is
convex, the posteriorconcave.
The lower, widest part of the gland is called the base.
The thymus is situated in the upper part of the anterior medi
astinum, behind the manubrium and upper part of the body of the
sternum in the region known as the triangle of the thymus.
The posterior surface of the upper parts nf the gland are in re
lation with the trachea, the anterior surfacewith the site of inser
tion of the steniothyroid muscles. The posterior surface of the rest
-3
of the gland is in relation with the large blood vessels (the superior
vena cava, the innominate veins, and the arch of the aorta with the
-4
arteries arising from it), and the pericardium; the sides of the
gland are related to the mediastinal pleurae.
The upper parts of the gland are narrowed and are called the
apex of the thymus. They may extend beyond the anterior medias
tinum; in the newborn they reach the thyroid gland and occupy
the space above the suprasternal notch (pretracheal space). The
5
lower borders of the gland are at the level of the cartilage of the
third rib.
The thymus is greyish-pink in colour, but becomes yellowish
with age because fat prevails in it. The gland weighs up to 20 g in a
2-year-old child, and up to 29 g by the age of 15. In the newborn it
measures up to 5 cm in length, from 2 to 3 cm in width, and from 996. Arteries of thymus of 7-year-old boy (%
8 to 10 mm anteroposteriqrly. In the period of involution the gland (specimen prepared by E.Pankov).
reduce? sharply in size.
(Angioradiograph.)
The thymus is covered with a thin connective-tissue membrane 1,6apical main arterial tnntkl
forming septa between its lobules. The parenchyma of the lobules 2 branches of second order, arising from main arterial trunk
3 anastomose* farmed \>y brunches of second urckr
consists of a cortex lying on the periphery and a medulla situated 4branches of first order
in die centre of the lobules. Both the cortex and the medulla are 5mar^nal branches
made up of a reticulum whose loops are filled with lymphocytes. 1 lateral arterial trunk.
T h e medulla is characterized by the presence of concentrically ar

ranged bodies, the corpuscles of Hassall. the internal mammary artery); branches of the foar lower cervical
The fibrous capsule of the gland is surrounded by fatty and spinal nerves and three cervical sympathetic ganglia contribute to
areolar tissue attaching the gland to the adjacent organs and ves the formation of the thoracic plexus. The capsule of the thymus is
sels; the anterior mediastinal lymph glands are lodged in the sub supplied with twigs from the phrenic nerves and ansa cervicalis hy-
stance of the capsule. The gland is loosely connected with the poglossi.
fibrous capsule. Blood supply: the thymic branches of the internal thoracic, in
The thymus is the central organ of the system inducing im- ferior thyroid, pericardiacophrenic, and superior phrenic arteries
munologic competence of the organism. It produces a protein hor (sometimes from the superior thyroid and innominate arteries).
mone called thytnosin which stimulates lymphopoiesis and con Veins: large veins forming a single venous trunk which empties
trols the development of immune responses. Besides, thymosin into the left innominate vein; small branches emptying into the in
takes part in developing the adaptation reactions of the body and ternal mammary, inferior thyroid, pericardiacophrenic veins and
in the processes of growth and formation of the skeleton. the phrenic branch of the vena azygos (sometimes into the jugular
Innervatioii: branches to the thymus From the vagus nerves veins).
and internal thoracic plexus (runs along the thymic branches of The lymph vessels empty into the mediastinal lymph glands.

A a, suprarenales super lore*

K
Olatidula supramnalis
A. Supraren^lis media
V. stiprarenjslip superior
Aorta
V. cava inferior
,K suprarenal is inferior
/ A. renalis
I k ,- Ren
Vv- steliarse
testic^laris
sinislin
Ureter
\ I \
A. mesenteries superior
Aa. testtenlares
dexlra
997. Left suprarenal gland (glandula suprarenalis); anterior aspect (%).

THE ENDOCRINE GLANDS 375
V. suprartrialis
Facies anterior
Htlus
Area
related to
" v. cava inferior
-Margo medialls-
' - ^ / \
H||us
Faciess anterior*1' VTN,

Faciesrenalis
998. Suprarenal glands (glandulae suprarenales); anterior aspect ( ] /),

Aright; B-left.
Fades
posterior
Margo
medialis
Facies renal is
Facies rcnaiis
999. Suprarenal glands (glandulae suprarenales); posterior aspect {x/\).

Aright; B left.

376 THE AUTONOMIC NERVOUS PLEXUSES
1communications of inferior part of mtermesen-

Lerie plexus with plexus of aortie body
2superior arched fibres in plexus of aortic body
3right aortic body
iinferior arched fibre* in plexus of aortic body
Sright root of hypogastric plexus
6right ureter
J branches from hypogastric pJexus to right ureter and
tesiifiilar piexus
8collection of chromaffin tissue in hypogastric plexus
9intermediate part of hypogastric plexus
1(1inferior part of hypog-astric plexus
11right hypogastric nerve
12superior part of intermesenleric plexus
13inferior meseuterk vein
14lateral branches of infermesenterk plexus
15întermediate part of intermesenteric plexus
16medial branches yf intcrniesenteric plexus
11 left aortic hody
18inferior mesenterie plexus
19left root of hypogastric plexus
20 wmmnnications of ascending nerves with superior
rectal plexus
20a left ureter
21bifurcation of hypogastric plexus
5J2 left hypogastric nerve
23twigs running between pelvic plexuses.
1000. Inferior mesenteric and hypogastric plexuses ojautonomic nervous system; anterior aspe
(specimen prepared by E.Melman). (Photograph.)
(A newborn male infant; most of the vessels are removed; the ureters a * left intact, m e t h a n e blue .stain with subsequent d i c t i o n
under a binocular lens,)

THE SUPRARENAL GLANDS

The suprarenal glands (glandulae suprarenales) (Figs 991, The gland is invested in a fibrous capsule containing an admix
997-999) are paired. Each gland lies at the level of the eleventh ture of smooth-muscle cells. The capsule sends processes into die
and twelfth thoracic vertebrae, above but medial to the kidney in substance of the gland.
the retroperitoneal fat, and is invested in die renal fascia. The parenchyma of the suprarenal gland consists of two lay
The right suprarenal gland is pyramidal in shape, narrower ersthe external layer, or the cortex, and the internal layer, or the
and higher than the left gland, lies above the upper end of the medulla; they differ in development and function.
right kidney, and adheres intimately to the inferior vena cava. The The cortex is yellowish-brown; it is a thicker layer formed of
greater part of the right gland is not covered with die peritoneum, glandular and connective tissue. The medulla contains chromaffin
except for the lower part of the anterior surface which is applied to and sympathetic nerve cells.
the liver on which the gland leaves the suprarenal impression (iiA- The cortex of die suprarenal glands secretes a number of hor
premo suprarenalis). mones which are united under the common name corticosteroids
The left suprarenal gland is crescent-shaped and partly lies and are divided into three main groups: mineralocorticoids (aldos-
above the upper end of the left kidney and partly is applied to its terone), glucocorticoids (hydrocortisone, corticosterone) and sex
medial border. It is covered with the peritoneum in front, mainly hormones (androgens). The action of these hormones is extremely
in the upper part. The left gland is in relation with the cardial por variable. They increase sodium reabsorption, facilitate the excre
tion of the stomach, the spleen, and pancreas. The right and left tion of potassium ions and regulate the concentration of chlorine
suprarenal glands are related to the diaphragm posteriorly. in die blood, and take part in regulating metabolism (carbohy
Each suprarenal gland has an anterior surface (fades anterior), a drate, fat, protein, and water-salt) in the body.
posterior surface (Jades posterior), and a concave renal surface Adrenaline and noradrenaline are the medullary hormones.
(fades renalis) which is applied to the respective kidney. A Superior They increase the cardiac output and are potent stimulators of the
border (margo superior) and a medial border (margo medialu) are sympathetic nervous system producing a vasoconstrictive effect,
also distinguished. and in this way causing an increase of arterial pressure.
The anterior and posterior surfaces of the suprarenal gland Innervation: branches of the coeliac, renal, and suprarenal
bear grooves. The deepest one lying on the anteromedial surface is plexuses containing branches of the sympathetic, vagus, and
termed the hilum (kilus glandulae suprarewdis). phrenic nerves.
The hilum is situated closer to the apex in the right gland but Blood supply: the superior suprarenal artery (from the phrenic
closer to the base in die left one. The hilum transmits the central artery), middle suprarenal (from the abdominal aorta), and infe
vein (vena antralis glandulat suprartttalis) which after emergence rior suprarenal (from the renal artery); dieir branches form an ar
from the gland is termed the suprarenal vein (vena suprarenalis). terial network under the capsule of the suprarenal gland, whose
The right suprarenal vein empties into the inferior vena cava, the twigs penetrate into the gland.
leftinto the left renal vein. The lymph vessels are also lodged in Veins: the central vein is situated in the organ and brings
the hilum, whereas the arterial branches and nerves may penetrate blood into the suprarenal vein, which empties into the inferior
the substance of die gland on the anterior and posterior surfaces. vena cava on the right and into the renal vein on the left.
The weight and size of the suprarenal gland are extremely indi The lymph is drained into the aortic lymph glands (nodi lym-
vidual. The weight of each gland varies from 11 to 18 g (or from 7 phatid Ittmbales) lying round the aorta and die inferior vena cava.
to 20 g) in an adult and reaches 6 g in the newborn. The height is
up to 6 cm, the widthup to 3 cm, the thickness 1 cm (some
times more).
THE PARAGANGLIA
The paraganglia (or free remnants of the adrenal System) are cific affinity to chromium salts. They are stained yellow or dark-
structures associated genetically with the sympathetic ganglia, brown by these salts, just like the cells of the meduIJa of the su
thence their name. prarenal glands producing adrenaline.
The cell elements, components of these structures, possess spe- In different periods of intra- and extra-uterine development of

Funlculus spermaticus
Fascia cremasterlca
M. c remaster
Fascia spermatica interna
A. testicularis
Lex us pampiniroimla
,'LL J-r-Tunica vagina]is testis
Corpus epididymidts
~~w~ Caput epididymidls
I--Appendix epldidymidis
Appendix testis
Tunica dartos ^Scrotum
Cauda epididymldls
Testis
1001. Testis andpampiniformplexus (%),

(The skin, dartos muscle, and coats of testis itself are cut and drawn aside.)
man, as well as in adulthood, the chromaffin tissue is scattered in present, are referred to as the parasympathetic paraganglia.
different parts of the body, but is always in association with the au- The largest and constantly present paraganglia are the carotid
tonomic nervous system. body {intercarotid pa raga ngiion), the supracardiac paraganglion,
Some o f the chromaffin -tis sue structure s h ave m ore d efined ch ro- and the lu mbo - aortic paraga ngiion.
maffin cells and are related to sympathetic paraganglia; others, The paraganglia resemble the medulla of the suprarenal glands
in which the chromaffin cells are less defined or inconstantly in function.

I
THE ENDOCRINE GLANDS 379
R. tubartus a. uterinae
^ ; V. Ulbarla
î^MdL j T u b a uterins
Epoophoron
* Â. ovarlca
r* V v . ovaricae
A. orsrics
"^Gvarisim
"Llg. teres uteri

V v . ovarlcae
Vagina
1002. Uterus, right ovary and uterine tube; posterior aspect (%).
T H E CAROTID BODY
T h e carotid body (intercarotid paraganglion) (gtomus carotkum) the sympathetic trunk; from the trunk itself; from the vagus nerve
(Figs 831, 991) is a paired spindle-shaped, greyish-pink structure, (inferior ganglion); from the glossopharyngeal nerve (which sup
measuring 5 to 8 m m in length, 1.5 to 5 m m in width, and up to plies the paraganglion and the carotid sinus adjacent to it with the
1.5 mm in thickness. It lies aL the base of the bifurcation of the sinus nerve whose twigs penetrate into the substance of the carotid
common carotid artery, between the internal and external carotid body and the wall of the sinus).
arteries close to either the posterior or the medial surface of the Blood supply: branches from the common and external carotid
common carotid artery. It is bound to the wall of the iu-tery by con arteries; their twigs form a thick vascular network in the substance
nective tissue. of the paraganglion.
T h e fibres of the connective-tissue capsule of the carotid body Veins: the venous blood is collected into a venous plexus lying
penetrate into it to form layers transmitting vessels and nerves. in the connective tissue surrounding the paraganglion.
Innervation: branches from the superior cervical ganglion of

A. com mun leans anterior

A. cerebr! arneiior
Tractus olfactortus Chlasma optieurrt
A. earoiis interna A. cerebri media
Tuber clneTeum - rnfundibulum
A. hypophyses I is \ ^Hypophysis
A, commumcani?
posterior - ^ N. oculomotorius
Pedunculus cerebrj A. cerebri posterior
A. cerebetH superior-.J|
A. labyrinth!
A. basilarls
1003. Hypophysis cerebri, or pituitary gland (glandula pituitaria); inferior aspect (%)
(Inferior surface of brain.)
THE SUPRACARDIAL PARAGANGLION

The supracardial paraganglion (paraganglion supracajdiale) the site of emergence of the left coronary artery. The supracardial
(Fig, 931) is a structure of two collections, superior and inferior paraganglion is connected with the nerve plexus located in its vi-
(paraganglion suprauir&iak superius et inferius). Each is inconstant, cinity.
the inferior one in particular, which undergoes involution with Many blood vessels are iodged in the substance of the para-
age. In an adult the superior collection is larger than the inferior ganglion.
one; it lies between the pulmonary trunk and the arch of the aorta Besides the paraganlia indicated, there are occasional subperi-
with which it is intimately fused; the inferior collection is found at cardial collections of chromaffin cells.
THE LUMBO-AORTIC PARAGANGLION

Right and left parts are distinguished in the lumbo-aortic para face of the aorta. The paraganglion is connected with the branches
ganglion (paraganglion aortkolumbde). Each part is a strand stretch of the lumbar ganglia of the sympathetic trunk.
ing on the sides of the abdominal aorta, the right being slightly The paraganglion is supplied with blood by the nearest vessels
longer than the left (the length of the right part varies from 8 to running in the surrounding areolar tissue (small branches of the
20 mm, that of the left from 8 to 15 mm; their thickness varies abdominal aorta, intestinal arteries, etc).
from 2 to 3 mm). The strands are sometimes joined to each other The venous blood is drained by the inferior vena cava and the
by a small band of chromaffin tissue lying across the anterior sur left renal vein.

N. Opttcas
Infundlbulum
/ Vv. hypophyseaies
A. hypophysealis /
A. carotis interna f I
Dlaphragma sellae î.'-*. '
\ \ '< / //
\ \ / [ E / A . hypophysealis
A. comtnunicans posterior \ \ f-^ *V'
/ / M
/ S

N. ophtrialmlcus i
^ Sinus
inter cavemosus
Vv. hypophyses les
s-'Z? j A. carotis interns

/^S' .''Tin sinus cavemosus)
A. cerbelH ^ B E
superior
Aa, chornlrieae
posteriores'
A. basilaris^
A. cerebrl posterior _-.-
N. abducens
Hypophysis
1004. Hypophysis cerebti (glandula pituitaria); superior aspect, viewed slightly from the right
(The dlaphragma sellae on the right and the roof of the cavernous sinus are removed.)
THE AORTIC BODIES

In early childhood the aortic bodies (glomera amtka) (Figs 991, Besides the large collections of chromaffin tissue mentioned,
1000) are the largest structures among the large conglomerate of other collections of this tissue of various size are scattered in
chromaffin tissue collections arranged along the course of the ab- places which are genetically associated with the sympathetic ner-
dominal aorta; by the age of 2 or 3 years they undergo involution. vous system: in some areas of the retroperitoneal fat, in the region
The largest body lies on the anterolateral surface of the abdominal of the ovaries and testes, along the wall of some vessels, etc.
aorta, mainly where the inferior mesenteric artery arises from it.

HI THE ENDOCRINE GLANDS
Stria longitudinal is lateral Is

\ Stria loflgltudlnalis ^Corpus callosum
\ medi&Ha /
/ /
C&vum sepii pellucid! Comu snterius
Laminae septl pellucid!
Column a fornici*
Nucleus csudatus
V. thalaninstriala
V. chorioidea
Ventrlculus III
Vv, Cerebri Irtternae

Tel a chorioidea
ventriculi 111 (cut) J
Plexus chorloideus
ventrieult laferalls ^
Corpus pineale
V. cerebri magna
G lorn us chorioldeum
Cerebellum
Comu postsrius
1005. Pineal body (epiphysis cerebri s. corpus pineale); superior aspect (Yi).
{The corpus callosum and foriiix are removed; t h e tela chorioidea of t h e third ventricle is cut a n d drawn aside.)

_ J _ _ _ . _ m _ . m m J m M J J _ M _ _ _ . ^ . , M _ ^ . , . , -_.. , ,.. . ... , .,
T H E E N D O C R I N E GLANDS
THE COCCYGEAL BODY

The coccyges! body {glomus coaygeump (Fig.991) is an unpaired In the substance of the coccygea] body itself the vascular net
structure measuring up to 2.5 ram in length, lying on the anterior work ramifies in the form of glomeruli.
surface of the apex of the coccyx.
The coccygcal body is supplied with blood by twigs arising
from the adjacent median sacral artery.
THE SEX GLANDS

The iiicretory structures of the male gonads, the testes (Figs the spermatic cord. The blood from this plexus flows in the testicu
550-554 of Vol. II, 1001), and the female gonads, the ovaries lar vein (sometimes two in number) and then into the inferior vena
(Figs 565 of Vol. II, 1002), are also related to the endocrine glands. cava on the right or into the left renal vein on the left side.
The incretory function of the testes is commonly attributed to The lymph vessels stretch to the aortic lymph glands.
the interstitial cells lodged in the loose connective tissue found be Some authors attribute the incretory Function of the ovaries,
tween the seminiferous tubules. These cells produce testosterone, just like that of the testes, to the interstitial cells. Most authors,
the male sex hormone. however, associate it with the lutein cells of the corpus luteum.
The interstitial cells are epithelial in character with a micro- These cells form frotn the inner layer of the connective-tissue
granular protoplasm containing roddike lipoid crystals. The num membrane of the follicles and the follicular epithelium. The pres
ber of diese cells varies with age and individually. The aggregate of ence of the female sex hormone, oestradiol (folliculin), in the fol
these cells was set apart by some authors as a special pubertal licular fluid has been proved.
gland, Other authors claim that the incretory part of the testis is Innervation. The ovary is innervated by the following nerves:
formed by its sexual part, i.e. the glandular apparatus of the semi (1) branches from the ovarian plexus which is formed by the coe
niferous tubules, while die interstitial cells are concerned with me liac, renal, and aortic abdominal plexuses: the ovarian plexus
tabolism. sends thin branches to surround the ovarian artery, and a smaller
Innervation: branches from the coeliac, renal, and the aortic number of fine twigs run in attendance to the artery; both reach
abdominal plexuses to the testicular artery and running along it to the ovary; (2) branches from the uterovaginal plexus, in whose for
the testis. In the substance of the testis itself the nerve twigs pass mation the hypogastric plexus takes part, reach the ovary along the
on the connective-tissue septa and send small branches which communicating branches between the uterine and ovarian arteries.
cover the seminiferous tubules. T h e nerves form plexuses in the ovary, whose branches stretch to
Blond supply. The main vessel is the testicular artery arising its vessels, follicles, and stroma.
from the abdominal aorta. It penetrates the spermatic cord and ex Blood supply. The ovary receives branches from the ovarian
tends to the testis and epididymis and anastomoses there with the artery (which is a branch of the abdominal aorta) and small ovar
branch of the artery of the vas deferens (from the umbilical artery ian branches from the uterine artery; these branches anastomose
or the anterior branch of the internal iliac artery), with the artery with each other, reach the hiluni of the ovary to enter it, and form
to the cremaster (from the inferior epigastric artery), and with the a capillary network in the medullary and cortical tissue to supply
external pudendal artery (from the femoral artery); the testicular the follicles, corpus luteum, epithelium and stroma.
artery anastomoses with the last two arteries in the coat of the tes Veins. In the ovary the veins run in attendance to the arterial
tis. The arterial branches enter the testis, in which they first'run on branches and form at the hilum of the ovary a thick network, from
the connective-tissue septa, and then enter each lobule and cover which blood enters the wide venous uterovaginal plexus lying to
the seminiferous tubules with a capillary network. both sides of the uterus and vagina and other plexuses of organs si
Veins. From the above-mentioned arterial network of capilla tuated in the cavity of the true pelvis.
ries arise venous capillaries which unite to form venous branches The lymph vessels empty into the lymph glands situated along
emptying into the pampiniform plexus which is a component of the aorta and the inferior vena cava.
1
It is now believed that this structure is an arteriovenous anas
tomosis but not a glomus.

V. cava Inferior Pylorus

/
V. gastroepiploica dextra
V. llertalis
A, pancteatlcoduodenalis superior i
A. Henalls /
V, pancreaticoduodenalis T rune us cdiacus
/ '
Caput pancreatis
Rr. inte&tlnales
(\
, I \ V
:
-}* I
^
Gaud a pancreails
j ^ * 4 ^ Corpus pantreatis
A. mesenterica superior
-V. mesenteries superior
fc#-A intestinal is
^_Fiexura duodenojejunalls
-A, mesenterica inferior
Aorta
Processus uncinatus
V. pa n creatlcod node n alls
A. pancTeaticoduodenalls interior
1006- Pancreas; anterior aspect (l/i).
T H E HYPOPHYSIS CEREBRI
The hypophysis cerebri, or pituitary gland (hypophysis s. glan the floor of the third ventricle. The hypophysis is related on the
dule pituitaria) is sometimes called the lower appendage of the sides to the cavernous sinuses.
brain (Figs 743, 951 t 1003, 1004). This is an unpaired elongated- The dimensions of the hypophysis vary with the individual; the
spherical structure slightly compressed anteroposteriorly. anteroposterior dimension ranges from 5 to 11 mm, the superoin-
The hypophysis is invested in a dense connective-tissue coating feriorfrom 6 to 7 mm, and the widthfrom 12 to 14 mm; its
and lodged in the sella turcica. It is covered by the dura mater weight varies from 0.3 to 0.7 g.
stretched between the anterior and posterior clinoid processes of The hypophysis is composed of an anterior part (anterior lobe,
the sphenoid bone and the dorsum seliae. This is the diaphragma adenohypophysis) and a posterior lobe (the neurohypophysis).
seliae which roofs the hypophyses I fossa (fossa hypopkyseos). The The two lobes differ in development, structure, and function.
diaphragma seliae has a small aperture transmitting the infundibu- The anterior part (anterior lobe, adenohypophysis) (pars distalis
him which connects the hypophysis with the tuber cinereum on [lobus anterior]) is the glandular part of the hypophysis. It is larger

than the posterior lobe and brownish-red on section due to the these cells is brought to the neurohypophysis along their nerve
great number of blood vessels. In the adenohypophysis are distin fibres forming the supra-opticohypophyseal and paraventriculohy-
guished an anterior main part lying in the hypophyseal Fossa of die pophyseal tracts. It is stored in the neurophypophysis and secreted
aella turcica, a distinctly visible narrow area at the junction with from it into the blood. The hormones of the posterior lobe of the
the neurohypophysis, which is the middle part (pars intermedia), hypophysis intensify contraction of the smooth muscles of the ves
and, finally, a small part lying outside the hypophyseal fossa sels and uterus, regulate secretion of the mammary glands (prolac-
(above the diaphragms sellae) and termed the infundibular part tin); vasopressin (VP) has an effect on reabsorption of water in the
(pan infundibularis). renal tubules.
Epithelial cells of various size, shape, and structure are lodged Innervation. Nerve fibres from the internal carotid plexus
in the anterior lobe. (from the superior cervical ganglion of the sympathetic trunk) run
The posterior lobe (neurohypophysis) (lobus posterior) is some on the walls of the vessels stretching to the distal part of the hypo
times called the nervous part of the hypophysis or neurohypophy- physis; fibres from the hypothalamic nuclei and nuclei lying above
sis. It is greyish-yellow on section due to the presence of a yellow the optic chiasma pass to the posterior lobe along the infundibu-
ish-brown pigment; a posterior main part and a median eminence lum.
are distinguished in it. Blood supply. T h e hypophysis is supplied with blood by the
The posterior lobe is composed of a large amount of neuroglial superior and inferior hypophyseal arteries which anastomose with
tissue and a small number of ependymal cells. each other. The superior arteries arise from the internal carotid ar
The pigment mentioned above lies between the glial fibres and tery (at its emergence from the cavernous sinus) and from the pos
increases in amount with age. terior communicating arteries. The inferior hypophyseal arteries
The anterior lobe of the hypophysis produces a group of tropic also arise from the internal carotid artery, but from the part pass
hormones. One of the most important among them is the somato- ing in the cavernous sinus. Without ramifying in the distal part of
tropif hormone (STH) which regulates growth and development of the hypophysis, these vessels pass into the neurohypophysis in
the organism and has an effect on the activity of the pancreatic is which they branch out to form capillaries.
lets. Other hormones stimulate, mainly, the function of the other Veins. T h e venous genua of capillaries in the neurohypophysis
endocrine glands. The adenocorticotrapic hormone (ACTH), for fuse to form venules which are continuous with die portal veins of
instance, stimulates the activity of the cortex of the suprarenal the hypophysis. These extend to the distal part (adenohypophysis)
gland, the thyrotropic hormone (TTH)that of the thyroid gland, in which they give off small branches emptying into a network of
the gonadotropic hormone (GTH)die function of the sex sinusoid capillaries. Thus, the portal veins of the hypophysis and
glands, etc. not the arteries are the afferent vessels of the main anterior part of
It has been established that the hormones of the posterior lobe the adenohypophysis. The venous blood flows from it into the cav
of die hypophysis (vasopressin and oxytocin) are actually the pro ernous and intercavernous sinuses of the dura mater of die brain.
ducts of neurosecretion of die nerve cells of the supra-optic and The specific features of the anatomy of the intra-organic hypophy
paraventricular nuclei (nwUvs supm-opticus et nucleus parctaetiiricula- seal vessels are of functional importance.
ris) of the hypothalamus and diencephalon. The neurosecretion of
386 T H E E N D O C R I N E GLANDS
THE PINEAL BODY

The pineal body {corpus pineal* s, epiphysis cerebri) is sometimes
A small suprapincal recess (recessns suprapinealis) h a blind pro
called the superior appendage of the brain (Figs 758, 991, 1005). It
trusion above the gland; its walls are formed by a vascular network
is a small unpaired triangular- ova I gland slightly flattened antero-
superiorly and by the upper surface of the gland inferiorly.
posteriorly.
The parenchyma of the gland Is composed of lobules which are
The apex of the gland is directed to the back, the b a s e - t o the
separated by a thin layer of trabeculae penetrating into the sub
front. It lies under the splenium of the corpus callosum, on the su
stance of the organ from the connective-tissue membrane covering
perior quadrigemiual bodies not covering them but filling the lon
it. The lobules are outlined by glial tissue richly supplied with
gitudinal groove between them.
blood vessels. The number of cells reduces with age while the
The pineal body is covered by a fold of the pia mater (during amount of connective tissue increases, and deposits of lime salts
dissection of which the gland may be easily removed together with called brain aand (ctcervutui cerebri) form in abundance in the form
it).
of yellowish granules.
The pineal body of an adult measures 1-1.2 cm in length,
The pineal body produces the hormone melatonin. This hor
5-8 mm in width, and 4-5 mm in thickness, and weighs 0.25 g. [n
mone inhibits the activity of the hypophysis and sex glands and
a child these dimensions are slightly smaller.
takes part in the activity of other endocrine glands (the thyroid
Its usual greyish-pink colour may change depending on the ex and suprareuals) which are responsible for many types of metabo Eo
o
tent to which its vessels are filled with blood. The surface is rather lism. Besides, melatonin activates the division of the pigment celh Q LL
rough and consistency moderately firm. of the skin. The pineal body plays the rale of a peculiar 'biological >
Q.
CO
O
The pineal body is connected with the thalamus by habenulae clock1 regulating the diurnal and seasonal activity of the organism,
which arise from the sides of the base of the gland and are contin Innervation. Sympathetic fibres from the superior cervical
uous with the striae habenularis of the thalamus (striae meduliares ganglia of the sympathetic trunks and fibres connected with the CD
ihahmi). At the end of the habeuula is a triangular expansion habenular nuclei run to the pineal body along the walls of the ves
called the trigonum habenulae in which the habenular nucleus sels. Q
fnucUtts habenulae) is lodged. The right and left habenulae are con a.
Blood supply. Arterial branches stretch from the posterior ar > CO
nected by means of the habenular commissure (tommissura kabenu- O

tery of the vascular plexus.
krum) in front of which, from the direction of the posterosuperior
Veins, Venous blood is drained by the choroid plexus of the T3CD
part of the third ventricle, is the pineal recess {mesm pinealis). The
third ventricle. -i
CO
CD
recess is a remnant of the cavity existing in the gland in the period o
of embriomc development.
THE. PANCREAS (ENDOCRINE PART)

The pancreas (Figs 471-47S of Vol. II, 1006) is a compound nerve twigs some of which run round the vessels of the pancreas,
alveolar gland of mixed secretion. It has two parts an exocrine, others extend beyond these vessels; in addition, some branches in
or excretory, (see Vol. II) and an endocrine, or incretory, part. The nervating the stomach and duodenum send twigs to the pancreas.
endocrine part is composed of islets (or microtubuiar collections) Blood supply. The superior pancreaticoduodenal arteries and
lying in different areas of the pancreatic parenchyma. branches of the gastroduodenal arteries (from the hepatic artery)
The parenchyma of the gland consists of alveoli, or acini with supply mainly the head of the pancreas from its anterior surface;
ducts, and islets of Langerhans which are the glandular structures the inferior pancreaticoduodenal arteries and branches of the su
concerned with the endocrine activity of the pancreas. perior mesenteric artery (or the jejunal artery) bring blood to the
T h e islets, just like whole pancreas, are derivatives of the ecto head of the pancreas predominantly from its posterior surface;
derm and develop from the glandular epithelium of the duode these arteries anastomose with one another both on the surface
num. They are oval or spherical structures about 0.3 mm in size; and in the substance of the gland; the splenic artery and its pan
some of them measure 1 mm in diameter. The islets lie throughout creatic branches supply the body and the tail of the gland.
the substance of the pancreas, but mostly in the tail. They have no Veins. The superior posterior pancreaticoduodenal vein (BNA)
ducts and are distinguished from the surrounding tissues by their drains blood from the head of the pancreas into the portal vein;
yellowish colour. the superior anterior pancreaticoduodenal vein (BNA) also drains
T h e numer of islets differs in early age; it is greatest in a foetus the head of the pancreas and empties through a system oF veins
and in an infant of the first year of life but reduces gradually with into the superior mesenteric vein; two pancreaticoduodenal veins
age. (inferior [BNA]), just like the two superior veins, drain blood from
The islets consist of epithelial cells surrounded by connective the head of the gland into the superior mesenteric vein (or into the
tissue which contains a thick sinusoid-type network of blood capil jejunal veins); the pancreatic veins drain the body and tail of the
laries (rete vasarum hemccapiilarium, sinusotdeorum). gland and empty into the splenic vein; the venous blood from the
The cells of the islets produce a hormone (insulin) which is pancreas flows into the system of the portal vein.
secreted into the blood. The lymph vessels stretch to the coeliac, pancreatic, splenic,
Innervation. The coeliac, hepatic, and splenic plexuses send and other lymph glands.

DEVELOPMENT AND AGE FEATURES O F THE ENDOCRINE GLANDS
The thyroid gland develops from the pharyngeal epithelium of ium of the third and fourth pharyngeal pouches. In a newborn
the branchial part of the primary gut to the back of the tongue they are closely bound with the thyroid gland and are therefore de
germ (Fig, 1007). The Foramen caecum of the tongue, which is the tected with difficulty. The activity of the parathyroid glands is
site of laying down of the epithelial germ of the thyroid gland, is a highest in children of 4 to 7 years of age.
remnant of the closed thyroglossal duct. The last-named is present The thymus develops from die entgderm in the region of the
in ihe embryonic period in the pyramidal process and closes in the third pharyngeal pouch and is a lympho-epithelial organ. It is
fourth week of intra-uterine life. The weight of the gland is about large in the newborn and infant, 2-year-olds in particular, and
2 g in the newborn and increases with growth of the whole body, grows slowly from this age till puberty when it is at the height of its
most intensively in the pubertal period. Iii the newborn the thy development. After that it undergoes involution, connective tissue
roid is situated at a relatively high level: its isthmus reaches the in with a great number of fatty cells develop in it; the parenchyma of
ferior border of the cricoid cartilage superiorly and the fifth tra- the gland remains in the form of small islets. Rarely the gland per
cheal ring inferiorly. It acquires the shape characteristic of the sists in adults (status thymicolymphaticus), The weight of the
human adult only by the age of 5-6 years. gland in a newborn ranges form 10 to 15g, by the end of the pu
The parathyroid glands develop as thickenings of the epithel bertal period the gland weighs 30 g. During puberty the amount of
1007. Development of thyroid gland and derivatives ofpkaryngeal (branchial) pouches (repr
schematically) (from several sources).
1-Vbranchial pouches
1 glandular lolje ofhypophysis cerebri 5 thyroid gland 9 trachea
2pharynjral cavity 6inferior parathyroid gland 10amygdaloid sinus, the branchial pouch is opened
'i hypophysis cerebri (anterior lob^} 7 thymus on the right.
4superior parathyroid gland 8oesophagus

DEVELOPMENT AND AGE FEATURES O F T H E E N D O C R I N E GLANDS 389
fatty and connective tissue increases, while the amount of the cor gland. The posterior lobe develops later than the anterior lobe
tex and medulla becomes much less. from the infundibular process (Fig. 723) of the diencephalon and
The cortex of the suprarenal develops from the mesoderm, the joins the anterior lobe. The hypophysis of the newborn is usually
medulla appears later and is a derivative of the ectoderm. In a triangular in shape. It measures 4 mm in height, 7.5 mm in length,
child of the first year of life the cortex prevails over the medulla; in 8,5 mm in width, and weighs 0.125 g; the posterior lobe is much
an adult both are equally developed. At old age, hi contrast, the smaller than the anterior lobe in children under 10 years of age.
amount of die cortex is about half diat of the medulla. Bodi glands The pineal body develops from the diencephalon in the region
weigh about 7 g in the newborn; the weight increases by the age of of the epithalamus as a small pouch into which vessels grow later,
fi-S months of life and continues growing to the age of 30 years. and a systepi of tubules surrounded by mesenchymal elements or
The paraganglia (the chromaffin organs) develop in a ganizes in it. The differentiation of the pineal body is completed
16-f7-tnm embryo as two types of cells sympathe to blasts and by the age of 7 years. In the newborn the pineal body measures
chromaffinoblasts; the Srst form the sympadietic ganglia, the sec 3 mm in length, 2,5 mm in width and 2 mm in thickness; it weighs
ond contribute to the formation of the chromaffin organs the 0.7 g at birth, by the age of 6 years its weight is equal to that of the
paraganglia. The paraganglia are developed best by the age of 12 gland in an adult. The pineal body reaches maximum develop
to 18 months, and almost all of them undergo regression by 10 to ment by the age of 14 years.
13 years of age. The pancreas is layed down in the form of two outgrowths of
The sex glandsthe testes and ovariesare layed down in the entodermal epithelium of the duodena! wall. The dorsal out
itially as indifferent germs of the sex glands, in the mesodermal ep growth unites with the duodenum and may determine the forma
ithelium of the embryonic body cavity on the inner surface of the tion of the accessory duct; the odier, ventral, outgrowth fuses with
pronephros. Later they begin differentiating into the male or fe the dorsal one to form a single organ (at the end of the second foe
male glands. The testes develop slowly till the pubertal period. tal month) which communicates with the duodenum via the main
They measure 10-10.5 mm in length in the newborn, 15 mm in a duct. The epithelium forms strands in the substance of the out
5-year-old child, and 20 mm in a 15-year-old child; the anteropos- growths which transform into tubules, while the epithelium lining
terior dimension of the testis in the newborn measures about them gives origin to the glandular tissue.
5 mm. The testis weighs 0.3 g in the newborn, 1 g at the age of The endocrine part of the pancreas, the islets or Langerhans,
12 months, 8 g at the age of 16 years, and 20 g by the age of 20. develop from the entoderm; their formation continues after birth
The ovary of a newborn girl is slightly elongated and cylindri also. The islets measure from 0.1 to 0.3 mm in size.
cal. It is usually situated at a high level, even at the level of the The pancreas of the newborn resembles a trihedral prism in
promontory and begins descending in the first four years of life. shape and its head is smaller but die body and tail longer than in
The surface of the ovary is smooth in young girls but becomes irre the gland of an adult. These proportions persist to the age of 5 or
gular later. T h e ovary weighs 5-6 g in the newborn, 6-8 g in an 6 years, after which the pancreas acquires the adult shape. In the
adult woman; its weight reduces to 2 g by old age. newborn the pancreas measures 4 to 5 cm in length on the average
T h e anterior lobe of the hypophysis eerebri develops from the and weighs from 2.5 to 3 g. The weight doubles by the age of
epithelial diverticulum of the dorsal wall of the oral pit as a pouch 4 years. The connective tissue surrounding the pancreas of the
facing the inferior surface of the brain, in the region of the floor of newborn is poorly developed as a result of which the gland is very
die third ventricle wThere it joins the future posterior lobe of the mobile.

SUBJECT INDEX
INDEX TERMINORUM
parolfactory, 33, 34, 36 innervation, 386
pretectal, 68 veins, 387
subcailosa, 33, 34, 36 bodies, aortic, 381
vestibular(is), 76, 145 geniculate, 52
Acini, 387
inferior, 339, 346 lateral, 55,126
adenohypophysis, 384
superior, 339, 346 medial, 55, 68
air cells, tympanic, 330
arteries, ciliary, anterior, 320 mamiUary, 40, 51, 55
ampullae, bony, 340
posterior, long. 320 quadrigeminal, 68
analyser(s), 88, 93, 302
short, 320 brachiae, 68
auditory, 88, 93
artery, auditory internal, 349 inferior, 68
contact, 302
central of retina, 320 superior, G8
cutaneous, 88
stylomastoid, 349 brain, stt aho cerebrum, 16, 27
distant, 302
tympanic, anterior, 348 base of, 36
gustatory, 88, 93
inferior, 348 development, 17,299,300
interoceptive, 88
superior, 348 stem, 28
motor, 88,93
auricle, 324 branches, intergaiiglionic, 248, 258
olfactory, 88, 93
anterior notch, 324 bulb, olfactory, 33, 36,124
visual, 88, 93
cartilage, 324, 325 of posterior horn of lateral ven
ansa, hypoglossi (cervicalis), 175-176
concha, 325 tricle, +4
roots of, 175
lobule, 324 bundle(s), longitudinal, dorsal, 70
lenticularis, 70
tail, 325 inferior, 93
subdavia, 250, 252
tubercle, 324 medial, 70
antihelix, 325
axis, of eyeball, 303 superior, 93
antitragus, 325
of lens, 312 pontine, inferior, 70
antrum, tympanic, 330
axon(s), 85, 119 middle, 73
aditus, 330
superior, 73
apparatus, lacrimal, 318
of telencephalon, 93
vestibular, 343
aqueduct, of mid-brain, 18, 57, 69 B uncinate, 93
of vestibule, 339
arachnoid mater, 103,114
of brain, 115
Body, carotid, 379
blood supply, 379 c
spinal, 114 innervation, 379
ciliary, 304, 306 Calcar avis, 45
arbor vitac, of cerebellum, 85
coccygeal, 383 canal(s), central, 299
archeocerebellum, 82
fatty, of Orbit, 320 hyaloid, 311
archicortex, 92
pineal, 54, 64, 386 semicircular, 339
area, amygdaloid anterior, 67
blood supply, 386 lateral, 340
cochlear, 346
development, 18, 388 posterior, 340
facial nerve, 140, 346

SUBJECT INDEX 39]
superior, 340 parahippoqampal, 33 temporal, inferior, 33

spiral, of cochlea, 340, paraterminal, 33 middle, 33
of modiolus, 340 postcentral, 30 superior, 32
canaliculus, for chorda tympani, 330 precentral, 30 white matter, 43, 93
cochlear, 342 rectus, 33 chamber, anterior, 312
external opening, 342 splenial, 42, 48 posterior, 312
laerimal, 316, 318 supramarginal, 32 chorda tympani, 139, 144
ampulla, 318 temporal, inferior, 33 choroid, 304
caruncle, laerimal, 315 middle, 33 cingulum, 93
cauda equina, 168 superior, 33 circulus, vasculosus of optic nerve, 320
cavity, trigeminal, 110 transverse, 33 cistern(ae), ambiens, 116
tympanic, 330 hemispheres, 28 cerehellomedullary, 116
cellulae disseminatae, 88 borders, 28 chiasmatic, 116
centre, semioval, 43 development, 19 corpus callosi, 116
Sympathetic, 243 nuclei, 67 interpeduncular, 116
cerebellum, 28, 77 surfaces, 28 of lateral sulcus, 116
cortex, 70, 81, 85 lobes, 28 perilymphatic of vestibule, 344
development, 18 frontal, 30 pontis, lateralis, 116
grey matter, 85 occipital, 32 medialis, 116
lobes, 80 parietal, 32 subarachnoid, 116
lobules, 80, 81 temporal, 31 claustrum, 67
ansiform, 81 lobules, 32 cochlea, 340
anterior lunate, 80 paracentral, 35 co I lieu I us, facial, 76
biventral, 81 parietal, inferior, 32 column(s), grey, anterior, 26, 88
central, ala of, 80 superior, 32 lateral, 26, 88
lobulus, clivi, 80, 82 peduncles, 40, 68 posterior, 26, 88
eulminis, 80, 82 base, 40 intermediolateral, 27
follii, 80, 82 tegmentum, 40 white, anterior, 23, 74
tuberis, 81 sulcus, basifar, 73 lateral, 23, 74, 99
nuclei, 85 calcarine, 34, 35, 45 posterior, 23, 74
peduncles, 18, 68, 80 callosal, 34 commissura neopalii, 40
inferior, 75, 80, 85 central, 30 commissure(s), anterior, 64, 93
middle, 70, 80, 85 circular, 33 epithalamic, 54
superior, 18, 70, 80, 85 collateral, 33, 47 habenular, 54, 62
white matter, 85 frontal, inferior, 31 hippocampal, 50, 93
cerebrum, see also brain, 28 superior, 30 palpebral, 315
capsule, external, 67, 93 habemilae, 54, 62 posterior, 66
internal, 67, 94 hippocampal, 39,47, 48 postoptic, 66
genu, 94 hypothalaroic, 52, 64 of (juadrigemina) bodies, 67
limbs, 94 of insula, central, 33 white, 23
cortex, 43, 92 infraparietal, 32 confluence of sinuses, 112
grey matter, 40 lateral, 31 connexus iiiterthalamicus, 60
gyms, dentate, 33, 42, 47 anterior, 40 conjunctiva, 304
fascicularis, 42, 48 lunate, 33 ocular part, 316
fornicatus, 34 Occipital, transverse, 33 palpebral part, 316
frontal, inferior, 31 olfactory, 33, 36 cord, lateral, 188
middle, 30 orbital, 33 medial, 192
superior, 30, 35 paracentral, 35 posterior, 202
hippocampal, 33, 34, 36, 50 par!eto-occipital, 32, 33, 35 cornea, 304
of insula, long, 33 of peduncle, medial, 40 corona radiata, 94
short, 33 postero lateral, 74 corpus, callosum, 28, 34, 41, 93
occipitotemporal, lateral, 33 precentral, 30 genu, 34, 40
medial, 33, 35 rhinal, 33 radiation, 43
orbital, 33 supra splenial, 35 rostrum, 40

392 SUBJECT INDEX
spleuium, 34, 41 nerves, 350 septomargirial, 89

trunk, 41 vessels, 347 fenestra, cochlea, 330
stria turn, 52, 87 internal, 338 vestibuli, 330
trapezoideum, 73 vessels, 349 fibre (s), arcuate, external, anterior, 74
corpuscles, of Has sail, 373 middle, 329 posterior, 74
iamellated, 198, 364 nerves, 350 internal, 99
oval, 364 vessels, 348 association, 88, 93
papillare, 553 elevations, tortile, 355 cerebropontinc, 68, 87, 102
cortex pili, 358 tubal, 332 cerebrospinal, 68, 87, 102
crest, ampul lary, 346 eminence, arcuate, 340 circular, 306
transverse, 346 collateral, 47 corticonuclear, 68, 87,102
vestibular, 338 of concha, 325 corticoreticular, 87, 102
crura, fornicis, 50 of scaphoid fossa, 325 frontopontine, 102
osseous, 340 of triangular fossa, 325 meridional, 306
crus, ampullary, 340 eminentia medialis, 76 parietotemporopontine, 102
commune, 340 endolymph, 3.38, 342 pcriventricular, 62
simplex, 340 eudoneuriurn, 119 postganglionic, 85, 249
membranaceum commums, 9, 346 epidermis, 353 preganglionic, 85,249
cuneus, 35 epineurium, 119 transverse of pons, 73
cuticle, 358 epithalamus, 52, 54 zonular, 312
cymba conchae, 325 epithelium, sensory, 346 filum terminate, 21,299
epitympanum, 330 fissure, antitragohelicina, 326
eponychium, 357 choroid, 44
I) eye, 303, 304 horizontal, 77, 79
Diaphragma sellae, 110, 384 angles, 315 longitudinal, 28
decussation, of pyramids, 40, 74 development, 323 median, anterior, 23, 40, 74
of superior cerebellar peduncles, 70 nervous coat, 308 posterior, 74
of tegmentum, 68 eyeball, 303 palpebral, 313
of trochiear nerves, 70 arteries, 320 postnodular, 78
dendrites, 10 axis, external (optic), 303 flocculus, 81
derm is, 353 internal (visual), 303 fluid, cerebrospinal, 17
diencephalon, 17, 52 coat, fibrous, 304 fold, of incus, 336
dilator of pupil, 308 vascular, 304 malleolar, anterior, 336
disc, optic, 309 equator, 303 posterior, 336
excavation, 309 fascial sheath, 320 palpebronasal, 315
down, 357 meridians, 303 palpebro-orbital, 315
ducts, of cochlea, 342, 343 muscles, 318 of stapes, 336
endolymphatic, 344 nerves, 322 folia, cerebellar, 80
semicircular membranous, 342 eyebrow, 313 foramen caecum of medulla oblongata,
utriculosaccular, 344 eyelashes, 315 74
duct us reuniens, 344 eyelids, 313 forceps, major, 43
dura mater, 103, 107 borders, 315 minor, 43
blood supply, 112 forebrain, 17
of brain, 103, 108, 111 fornices of conjunctiva, 316
intiervaiion, 112 fortiix, 43
of sinuses, 103, 108, 112 body, 43, 44, 49
spinal, 21, 108 Falx, cerebelli, 108 column, anterior, 43, 50
filum, 108 cerebri, 108 posterior, 47, 50
fasciculus, arcuate, 101 taenia, 47, 49
central tegmental, 103 fossa, of amihelix, 325
corticothalamic, 102 hyaloid, 311
Ear, 324 cuneatus, 25, 76, 96, 99 hypophyseat, 384
development, 350 gracilis, 25, 74, 76, 96, 99 interpeduncular, 40
external, 324 interfascicular, 89 rhomboidea, 76

SUBJECT INDEX 393
triangular, 325 parasympathetic root, 162 hind-brain, 17

for uncut, 330 sensory root, 162 hippocampus, 47
fossula of fenestra vestibuli, 330 sympathetic root, 162, 252 alveus, 47
fovea, central is, 309 trigeminal, 99, 130 fimbria, 47, 50
inferior, 76 of vagus nerve, inferior, 148, 249 horn(s), anterior, 26, 88
superior, 76 superior, 148 lateral, 26, 27, 88
frenulum veli medullaris superioris, 70 vertebral, 258 posterior, 17, 26, 88
funiculus separans, 76 vestibular, 146 apex, 26
gland(s), apocrine, 356 base, 27
G branchiogenous, 366
ceruminous, 327
head, 27
neck, 27

eccrine, 356 hyponychium, 357
Ganglia, 119
ectodermal, 366 hypophysis cerebri, 40, 384
aorticorenal, 296
endocrine, 366 blood supply, 386
Cardiac, 287
entodermal, 366 development, 388
cervical, 249
lacrimal, 318 innervation, 386
ciliary, 161, 322
accessory, 318 hypothalamus, 52,55
coeliac, prevertebral, 269
ducts, 318 development, 18
of cranial nerves, 85
mesoderma), 366 hypotympanum, 330
of facial nerve, 99
of glossopharyngeal nerve, 99 neurogenic, 366
lumbar, 249 olfactory, 352
mcsenteric inferior, 271 parathyroid, tif parathyroid glands
renal, 296 pituitary, see hypophysis cerebri Incisura, intertragica, 325
sacral, 249, 276 sebaceous, 356 terminalis, of auricle, 325
sphenopalatine, 161 suprarenal, see suprarenal glands incus, 335
spinal, 1 6 , 2 7 , 8 5 , 9 6 sweat, 356 processes, 335
mblingual, 287 ducts, 356 induseum griseum, 4 1 , 4 8
submandibular, 287 thyroid, see thyroid gland infundibulum, 40, 57
of sympathetic trunk, 248 glob us pallidus, 67 insula, 33
thoracic, 249 glomus chorioideum, 47 iris, 304, 307
of vagus, 99 granulations, arachnoid, 115, 116 border, ciliary, 307
ganglion, cervical, inferior, 258 groove, medullary, 10 pupillary, 307
branches, 258 neural, 10, 299 islets of Langerhans, 387
middle, 252 development, 388
cardiac branches, 252 H isthmus, of gyms cinguli, 34
rhombencephali, 18,69
thyroid branches, 256
superior, 250 Habenula, 54
cardiac branches, 256 hair, bulb, 357
pharyngeal branches, 256 cells, 345
cervicodioracicum, 250 cruses, 357 Joint, incudomalleolar, 335
ciliary, 126,161,281 follicle, 358
sympathetic root, 250 papilla, 357
of glossopharyngeal tierve, 145, 249 root, 357
of facial nerve, 140 shaft, 357 Labyrinth, bony, 338
impar, 249, 276 streams, 357 membranous, 342
otic, 146, 161, 162,281 whorls, 357 lacunae lateral, 112
branches, 162 hairs, 357 iacus lacrimalis, 318
sphenopalatine, 161 permanent, 357 humna(e), affixa, 43
branches, 161 hamulus of spinal lamina, 340 choriocapillary, 304
spinal, 168 helix, 324 cribrosa sclerae, 304
spiral, 145 cms, 325 elastic, anterior, 304
stellatum, 250, 258 spine, 324 posterior, 304
sublingual, 161, 162 hilum, of dentate nucleus, 85 epithelialis, 19, 60, 75
submandibular, 161, 162 of olivary nucleus, 74 of epyphysis cerebri, 4-1

394 SUBJECT INDEX
fusca sclerae, 304 matter, grey, 17,23, 27 N

ganglionaris, 92 central gelatinous, 26, 27
granularis, extern a, 92 white, 17, 23, 27 Nail, 357
interna, 92 meatus auditory, external, neocerebeilum, 82
medullary, of rhaiamus, 53 cartilagionous part, 327 neocortex, 92
of modiolus, 340 nerves, 349 nerves, 19
multiformis, 92 vessels, 348 abducent, 40, 74, 112, 123, 140,
pyramidalis, 92 internal, 346 156
of septum lucidum, 43 fundus, 346 nucleus, 77
spiral osseous, 340 medulla oblongata, 21, 40, 74 accessory, 40, 123, 154, 160
secondary, 340 development, 18 branches, 154
tectal, 18,41,69 pilli, 358 nuclei, 154
tenninahs, 40, 41,64 melatonin, 386 affector, 19
vascular, 304 membrana tectoria, 344 afferent, 19
white, of cerebellum, 85 membrane, hyaloid, 311 ampullary, 346
zonalis, 92 reticular, 344 anterior, 346
lemniscus, lateral, 70, 73,100, 145 of semicircular duct, basal, 34 lateral, 347
medial, 70, 73, 100 proper, 346 posterior, 347
lens, 311 tympanic, 328 auditory, 40, 73, 123,145, 160, 346
axis, 312 nerves, 349 nuclei, 77, 145
capsule, 312 vessels, 346 auricular, greater, 176
cortex, 312 meninges, 103 auriculotemporal, 135
equator, 312 encephali, 103 branches, 137
leptomeninx, 103 spinal es, 103 autonomic, 119,123
ligament(s), of auricle, 327 mesencephalon, 17,67 buccai, 135, 162
denticulate, 115 mesotympanum, 330 carottcotympanic, 146,250
of incus, 335 metathalamus, 52, 55 cervical, 168
of malleus, 335 metencephalon, 17,18 carotid, external, 252
palpebral, 317 raid-brain, 17, 67 internal, 249, 252
pectinate, of iris, 307 mndiohis, 340 ciliary, 322
spiral of cochlea, 344 monticulus, 81 long, 132, 161
limb us, comeal, 304 muscle(s), antitragicus, 326 short, 161
laminae s pi rales, 344 arrectores pilorum, 354,358 circumflex, 202
limen insulae, 33 auriculares, 326 branches, 202, 203
lip, tympanic, 344 of auricle, oblique, 326 coccygeal, 168,212,243
vestibular, 344 pyramidal is, 326 cochlear, 145
lobe, pyramidal of thyroid, 368 transverse, 326 of clitoris, dorsal, 242
locus coeruleus, 76 helicis, major, 326 cranial, 40, 122
loop, thyroid, 250 minor, 326 development, 299
incisurae helicis, 327 eighth pair, 40, 123
M levator palpebrae superioris, 316 eleventh pair, 40, 123
orbicularis oculi, 316 fifth pair, 40, 123
Macula(e), cribrosa, inferior, 339, 346 orbitalis, 319 first pair, 36,123
media, 339 rectus, inferior, 318, 320 fourth pair, 40, 123
superior, 339, 346 lateral, 318, 319 ninth pair, 40,123
of saccule, 344 medial, 318, 319 second pair, 40, 123
of utricle, 345 oblique, 318, 319 seventh pair, 40, 123
malleus, 332 superior, 318, 319 sixth pair, 40, 123
handle, 332 stapedius, 330 tenth pair, 40, 123, 147
head, 332 tensor tympairi, 334 third pair, 40, 123
ligaments, 334 tragicus, 326 twelfth pair, 40, 123
processes, 332 myelencephalon, 17, 18 cutaneous, of arm, medial, 199
prominence, 332 myelinization, 160, 300 median, 199
spur, 332 branches, 199

: . . . . . . ; . . - . - . i
SUBJECT INDEX 395
infra-orbital, 132 branches, 177-182

posterior, 202
branches, 132 plantar, lateral, 236
upper lateral, 202
infratrochlear, 132 medial, 236
of calf of leg, lateral, 232
intercostal, 204 popliteal, lateral, 232
medial, 236
intercostobrachial, 199, 212 medial, 232, 234
of foot, lateral dorsal, 236
intermediate, 74 of pterygoid canal, 161, 250
of forearm, lateral, 188
inlcrossei, anterior, 200 pudendal, 171,212,242
posterior, 203
posterior, 204 radial, 202
of neck, anterior, 176
jugular, 249, 252 branches, 202-204
of thigh, intermediate, 227
lacrimal, 131 rectal, middle, 242
lateral, 223
laryngeal, external, 152 saccular, 347
medial, 230
inferior, 152 sacral, 168,212, 230
posterior, 231
internal, 152 saphenous, 227
dental, anterior superior, 132
recurrent, 152 sciatic, 232
inferior, 138
superior, 152 sensory, 119
middle, superior, 132
posterior superior, 132 to lateral pterygoid muscle, 135 to serratus anterior muscle, 184
depressor, 152 to latissimus dorsi muscle, 188 sphenopalatine, long, 16!
digital, dorsal, 195,204 lingual, 139, 281 short, lateral, 161
of foot, dorsal, 234 branches, 139 medial, 161
lateral, 234 lumbar, 168, 212 spinal, 20, 27, 119, 122, 168
medial, 234 mandibular, 112, 134 rootlets, 168
plantar, common I, II, III, 237 branches, 134 splanchnic, greater, 262
of fourth toe, 237 to masseter muscle, 135 lesser, 262
for little toe, 242 maxillary, 112,132 lowest, 262
proper, 237 branches, 133 pelvic, 278, 284
palmar, common, 197, 200 to media! pterygoid muscle, 135 sacral, 277, 284
proper, 198,202 mental, 139 to stapedius muscle, 144, 320
effector, 19 mixed, 119 to subclavius muscle, 188
efferent, 19, 119 motor, 119 subcostal, 205
ethmoidal, anterior, 132 suboccipital, 171
musculocutaneous, of lower limb,
subscapular, 188
posterior, 132 212
supraclavicular, 176
facial, 40, 73, 123, 140,160, 281 branches, 234
intermediate, 176
branches, 140 mylohyoid, 138
lateral, 176
nuclei, 77, 140 nasal, superior posterior, 161
medial, 176
root, accessory, 40 nasociuary, 132, 322
supra-orbital, 131
sensory, 73, 140 obturator, 224
suprascapular, 188
femoral, 226 accessory, 225
temporal, deep, 135
branches, 226 occipital, greater, 173
to tensor palati muscle, 135, 162
of femoral artery proper, 226 lesser, 176
to tensor tynipani muscle, 135, 162
frontal, 130 third, 175
to tentorium, 130
genitofemoral, 222 oculomotor, 4 0 , 1 1 2 , 1 2 3 , 126
terminal, 125
glossopharyngeal, 40, 74, 112, 123, olfactory, 36, 123, 124, 352
thoracic, 168, 204
145,160,284 ophthalmic, 112, 130
branches, 146 palatine, 133 branches, 204-208
nuclei, 77 greater, 161,281 tibia I anterior, 234
gluteal, inferior, 231 lesser, 161, 281 branches, 234
pectoral, lateral, 184 trigeminal, 112,123,130
superior, 220
medial, 184 motor part, 130
haemorrhoidal, inferior, 242
of penis, cavernous, 250 nuclei, 130
hypoglossal, 40, 74, 112, 123,156,
dorsal, 242 sensory part, 130
160
petrosal, deep, 161,250 trochlear, 40, 112,123,127, 156
branches, 156
superficial greater, 140,161, 281 tympanic, 146, 284
nuclei, 77, 156
iliohypogastric, 220 lesser, 161,284 branches, 46
ilio-inguina), 220 phrenic, 177 ulnar, 192

396 SUBJECT INDEX
branches, 192 peroneus (fibularis) communis, 232 emboliformis, 85

utricular, 345 profundus, 232 entopeduncuiar, 70
utriculo-ampullar, 346 superficial is, 232 of facial nerve, 77
vaginal, 242, 123, H 7 , 281,294, rectales inferiores, 242 fastigii, 85
294 spinosus, 112, 134 globosus, 85
abdominal part, 156 thoracodorsalis, 188 of glossopharyngeal nerve, dorsal,
branches, 150-152 vest ibulo cochlea ris, 123 145
cephalic pail, 150 neurilema, 119 posterior, 77
cervical part, 151 neuro blasts, 16 sensory, 100
left, 148 neuroglia, 10, 16 gracile, 75
nuclei, 148 neuro hypophysis, 12-14 habeuular, 62, 386
parasympathetie fibres, 278 neuron(s), see also nerve ceils, 10 inferomedial, 57
right, 148 afferent, 85 intercalate, 75
thnradc part, 148, 153 association, 16 interpeduncular, 64
vertebral, 258 connector, Ifi, 85 interstitial, 70
vesical, inferior, 242, 279 effector, 16, 85, 85 lacrima], 77
superior, 279 efferent, 85
lateral, 55
vestibulax, 145 internuncial, 85
of lateral geiiiculate body, 55
zygoma tic, 133 motor, 85
of lateral lemniscus, 73
branches, 133 receptor, 16
of lens, 312
nerve cells, see also neuron{s), autonomic, notch, cerebellar, anterior, 78
lentiform, 167
119 posterior, 78
of mamillary body, lateral, 55
motor, 119 preoccipilal, 33
medial, 51
sensory, 119 tentorial, 110
medial, 55
nerve fibres, afferent, 119 nucleus, of abducent nerve, 77
of medial gcniculate body, 55
autonornic, 119 of accessory nerve, 26, 77, 154 motor, 85
effector, 119 accessory, of oculomotor nerve, 5-8 of oculomotor nerve, 77
medullated, 119 ambiguus, 77, 145, 147, 154 olivary, 74
motor, 119 amygdaloid, 44, 45 accessory, dorsal, 74
myelinated, 119 anterodorsal, 53 medial, 74
nonmedullated, 119 antero lateral, 26 paracentral, 53
sensory, 119 anteromedial, 26, 53 paramedianus dorsalis, 75
nervous system, 10 of auditory nerve, 77 parasolitarius, 75
autonornic, 20, 4 - 3 , 243 caudate, 43 para ventricular, anterior, 53
development, 299 central, 26 posterior, 53
intramural, 284 caudal, 126 of phrenic nerve, 26
central, 20 lateral, 53 ponds, 73
development, 19 medial, 53 posterior, 57
parasympathetie, 20, 243 median, 53 lateral, 53
central portion, 284 cochlear, 77 posterolateral, 26, 53
cephalic part, 280, 281 dorsal, 76, 145
posteromedial, 26
me sen cephalic part, 281 ventral, 73, 145
ventral, 53
rhombencephalic part, 281 commis surahs, 75
pretectal, 68
sacral part, 280 of corpus trapezoideum, dorsal, 73, of quadrigeminal bodies, 68
peripheral, 20, 119 145 red, 87
sympathetic, 20, 243 ventral, 73 reuniens, 53
cephalic part, 249 cuneate, 74, 75 rhomboid, 87
cervical part, 250 accessory, 74 sacral parasympathetic, 27, 284
lumbar part, 263 dentate, 85 salivary, 77
thoracic part, 258 dorsal, 147 inferior, 145
vegetative, see nervous system, auto lateral, 53 sensory, 87
nornic medial, 53 of sensory root of facial nerve,
nervus, intermedius, 73, 123 dorsolateral(is), 26, 126 100
interosseous cruris, 236 dorsomedialis, 26 superior, 100, 130

SUBJECT INDEX 397
spinal, 77,154 dental, superior, 132

subthalainic, 53, 55, 87
P femoral, 271
of superior quadrigeminal body, Pachymenmx, 103 gastric, left, 269
126 palaeocerebellum, 82 of heart, anterior, left, 288
superomedial, 57 palaeocortex, 92 right, 288
supraoptic, 55 pallium, 19 posterior, left, 288
of thalamus, anterior, 53 pancreas, 387 right, 288
intralaminar, 53 blood supply, 387 hepatic, 269, 294
medial, 5,3 development, 388 hypo gastric, 273
posterior, 53 innervation, 387 inferior, see plexus, pelvic
reticular, 53 veins, 387 iliac, 273
ventrolateral, 53 papilla, lacrimal, 316, 318 in termes enteric, 271
thoracic, 27 paraganglia, 366, 377 of left atrium, posterior, 288
of tractus solitarius, 100, 145, 147 development, 387 lingual, 252
of trigcminal nerve, 77 paraganglion, lurnbo-aortic, 380 lumbar, 171, 205,212
mesencephalic, 77,130 supracardial, 380 lurnbosacral, 171, 212
motor, 77 parathyroid glands, 371 maxillary, 252
of spinal tract, 77, 100,130 blood .supply, 371 meningeal, anterior, IBS
superior sensory, 77, 130 development, 387 posterior, 168
of trochlear nerve, 77 inferior, 371 rneningeus, 252
superior sensory, 77 innervation, 371 mcsenlcric, inferior, 271
tubeTal, 57 superior, 371 posterior, 272
of vagus nerve, 77 veins, 371 myenteric, 294
ventral, lateral, 53 pariesjugularis cavi tympani, 330 occipital, 252
medial, 53 pathway(s), jeetract(s) oesophageal, 148, 154, 262,293
posterior, 53 perilymph, 338 ovarian, 269, 280
ventrolateral (is), 26, 53 perineum, 119 of pancreas, body and tail, poste
ventromedial(is), 26, 126 pes hippocampi, 47 rior, 295
vestibular, 145 pia mater, 117 head, posterior, 295
of brain, 118 pancreatic, 269
spinal, 117 pharyngeal, 146,152
o pits, granular, 115
plate, medullary, 10
phrenic, 269
inferior, 294
neural 10 prostatk, 279, 296
Obex, 74 plexus(es), 20, 122 pulmonary, 154, 262
olive, 40, 74 aortic, 271 rectal,
operculum frontoparietal, 32 thoracic, 262 inferior, 279
optic chiasma, 40, 126 of atria, anterior, 288 middle, 279
ora serrata, 304, 311 auricularis, posterior, 252 superior, 271
organ of sight, 303 brachial, 171,175, 183 renal, 296
of smell, 352 infraclavicular part, 184, 188 submucous, 294
spiral, 145, 344 supraclavicular part, 184 subscrous, 294
of taste, 351 trunks, 183 suprarenal, 269
orgaftum, subcommissurale, 64 cardiac, 152 testicular, 269, 297
subfornicale, 64 carotid, 252 tympanic, 146, 250, 350
ossicles, auditory, 332 common, 252 uterovaginal, 280, 297
otoliths, 345 external, 252 vaginal, 298
ovaries, 383 internal, 126,250 ofvasdeferens, 279, 297
blood supply, 383 cavernous, 250 vertebral, 168
development, 387 cervical, 171, 175 internal, 168
innervation, 383 cervicobrachial, 171 vesical, 279, 296
veins, 383 ciliary-, 11-15 plica semilunaris conjunctivae, 315
coccygeal, 171,243 pons, 40, 73
coeliac, 269, 294 porus acustktis externus, 325

398 SUBJECT INDEX
precunius, 35 complex, 19 posterior median, 23

processus conch learifo rims, 330 simple, 19 precommissural, 43
prominence, of facial nerve canal, 330 r-eticular formation, 26, 48 sinus, basilar, 112
of lateral semicircular canal, 330 of medulla oblongata, 75 cavernous, 112
of malleus, 328 of pons, 75 intercavernous, 112
spiral, 344 of spinal cord, 89 occipital, 112
promontory, 330 retina, 308 petrosal, inferior, 112
presence pha I on, 17 arteriolcs, 321 Superior, 112
pulvinar, 50, 52, 126 cerebral layer, 309 sagittal, inferior, 112
puncta lacrimalia, 316, 318 ciliary part, 308 superior, 112
pupil, 307 iridial part, 308 sigmoid, 112
putamen, 67 neuroepithelial layer, 309 straight, 112
pyramid (s), 40 optic part, 308 transverse, 112
of medulla oblongata, 74 pigmented layer, 308 veuosus, sclerae, 304
olfactory, 33, 36, 124 venuies, 321 tympani, 330
of vermis, 81,82 retina cula cutis, 354 skin, 353
of vestibule, 338 rhombencephalon, 17 folds, 355
ring, common tendinous, 318 glands, 356
rivus lacrimalis, 318 layer, basal-cell, 353
root(s), of ansa hypoglossi, inferior, 175
R superior, 175, 176
clear, 353
sêrmi native, 353
of ciliary ganglion, 126 * Unfitly, 353
Radiation (s), auditory, 100 sensory, 119 prickle-cell, 353
of corpus stria turn, 102 sympathetic, 161 nerves, 364
optic, 126 cranial, 154
true, 353
thalamic, anterior, 94, 100 of median nerve, lateral, 191
vessels, 364
central, 95, 100 medial, 199 space(s), episcleral, 320
posterior, 95 motor, 119 extradural, 103
rarni, anterior primary, of cervical of optic ganglion, sensory, 162 intervaginal, 126
nerves, 175 sympathetic, 162 perichoroidal, 304
branches, 175 of optic tract, 68 perilymphatic, 342, 344
of lumbar nerves, 212 sensory, 119 perivascular, 118
of sacral nerves, 230 of spinal nerves, 154 subarachnoid, 18, 103,114
of spinal nerves, 168, 171 anterior, 27, 168 Subdural, 103
horizontal, anterior, 31 posterior, 27, 96, 154, 168 subpial, 118
ascending, 31 of submandibular ganglia, para- zonular, 312
posterior, 31 sympathetic, 162 spongio blasts, 16
posterior primary, of cervical sensory, 162 stapes, 335
nerves, 171, 175 sympathetic, 162 stratum zonal e, 62
of lumbar nerves, 212 rootlets, anterior, 27 stria(e),
of sacral nerves, 230 posterior, 27 habinularis of thalamus, 62
of spinal nerves, 168, 171
longitudinal, lateral, 41
of thoracic nerves, 204
medial, 41
of pons, median, 73
mallearis, 328
rece$s, cochlear, 339 Sac, conjunct!val, 316 olfactory, 125
elliptical, 338, 345 endolymphatic, 344 semicircularis, 43
pineal, 64, 386
lacrimal, 318 substance, perforated, anterior, 33, 40
optic, 66
saccule, 343, 344 posterior, 40, 68
suprarenal, 64
scala, tympani, 342 substatitia, intermedia, centralis, 25, 88
of tympanic membrane, anterior, vestibuli, 342 iateralis, 25, 88
336 septum, lucid am, 33 lends, 312
posterior, 336 cavity, 43 nigra, 68, 87
superior, 336 vein, 43 propria, cornea, 304
reflex arc, 10 pellucidum, 33 sclerae, 304

SUBJECT INDEX 399
nuclei, 52 spino-olivary, 99
sulcus, ampullary, 346
ventral, 52 spinoreticular, 99
anterior media.ll, 23
thymus, 373 spinotectal, 99
anterolateral, 74
blood supply, 373 spinothalamic, anterior, 99
of antihelix, transverse, 325
development, 387 lateral, 99
of auricle, posterior, 76
innervation, 373 tectospinal, 68,102
of fourth ventricle, median, 76
limitans, 299 lobes, 373 temporopontiiie, 101
olfactory, 124 veins, 373 of trigeminal nerve, raesencephalic,
posterior, intermediate, 23 thyroid gland, 366 130
lateral, 23 accessory, 366 spinal, 130
median, 23 blood supply, 371 vestibulospinal, 102
spiral, internal, 344 capsules, 368 tractus, solitarius, 74
suprarenal glands, 377 development, 387 spiralis foraminosus, 340, 346
blood supply, 377 innervation, 371 triangle, hypoglossal, 76
cortex, 377 isthmus, 387 vagal, 76
development, 387 ligament(s), lateral, 370 trigone, collateral, 45
hilum, 377 middle, 370 trigonum, habenulae, 54, 62, 386
innervation, 377 lymph vessels, 371 trunk sympathetic, 248,263
left, 377 stroma, 370 cervical, 248, 250
medulla, 377 tissue, subcutaneous, 354 lumbar, 248,263
right, 377 fatty, 354 branches, 263
surfaces, 377 tract(s), afferent, 87, 88 pelvic, 276
veins, 377 ascending, 87, 88,99 sacral ganglia, 248, 276
sweat, 356 association, 87 thoracic 248, 258
bulboreliculospinal, 103 tube, auditory, 300
pore, 356
cerebellodentate, 101 medullary, 16, 299
synapse, 10
cerebellonuclear, 101 neural, 16, 299
syndesmosis, tympanostapedial, 335
cercbellorubral, 101 pharyngotympansc, 330
cerebellothalamic, 101 canal, 332
cerebrospinal, 73, 74, 102 cartilaginous, 332
conducting, 87 isthmus, 332
corticonuclear, 73 lamina, lateral, 332
Taenia, choroidea, 43
corticorubral, 102 medial, 332
of fornix, 47, 49
denlatorubral, 101 membranous, 332
of fourth ventricle, 76
descending, 87, 101 mucous glands, 332
of thalamus, 62
dorsolateral, 89 nerves, 350
tanycytes, 64
efferent, 87, 88 opening(s), 332
taste buds, 351
extrapyramidal, 87 vessels, 34-9
tapetum, 45
Erontopontine, 101 tuber cinerenm, 40
tarsus of eyelid, 317
maraillotegmental, 51 tubercle, of auricle, 324
tcetuin of mid-brain, 18, 67
mamillothalamic, 51 cuneate, 75, 76, 99
tegmen tympani, 330
nucleocerebellar, 101 gracile, 75, 76,99
tela chorioidea, of fourth ventricle,
occipitopontine, 101 grey, 76
75
olfactory, 33, 124 olfactory, 36
subcutanea, 354 olivocerebellar, 101
of third ventricle, 50, 60 supratragal, 325
olivocerebral, 74 of thalamus, anterior, 52, 60
telencephalon, 17 olivospinal, 102
teuton um cerebelli, 108 tuberculum, trigeminale, 75
optic, 57,68, 126
testes, 383 pontocerebellar, 101
blood supply, 383
development, 383
pon toreticulosp ina), 103 u
pyramidal, 74, 87 Umbo of tympanic membrane, 328, 332
innervation, 383 rubrospinal, 68, 102
uncus, 33
veins, 383 spinoccrebeilar, anterior, 99
utricle, 342, 344, 345
thalamus, 43, 2-9 posterior, 99
uvula of vermis, 81, 82
dorsal, 52

400 SUBJECT I N D E X
aperture, lateral, 76 floor, 66

median, 76 veimis, 77, 79, 81
Vallecula of cerebellum, 79 development, 18 lobules, 81
vas, prominens, 344 floor, 76 vesicle(s), cerebral, 17
spiral e, 344 roof, 76 olfactory, 352
velum, medullary, inferior, IS, 75 lateral, 18, 43 vestibule, 338
superior, 18, 70, 70, 75 development, 18 vincula lingualia cerebelli, 80
veiii(s), of aqueduct of vestibule, 346 horns, 43 vitreous, body, 311
auditory, internal, 349 anterior, 43 chamber, 311
ciliary, 321 inferior, 4 3 , 45 humour, 311
of cochlear canaliculus, 349 posterior, 4 3 , 44
conjunctivae, 321 central part, 73
episcleral, 321 choroid plexus, 43
of retina, central, 321 terminal, 25, 108 Zona, incerta, 53
venae vorticosae, 321 third, 19, 52, 57 spongiosa, 88
ventricle(s). Fourth, 18 development, 18 ionule, ciliary, 307, 312
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R.D.

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.N, ulnaris Cauda erjuina

721. Nervous system (semischematical representation).

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722. Brain of embryo; right aspect.

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Place of pineal body

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Corpus strifltum^'" "7*^PPr

724. Brain of10.2~mm-long embryo; right half, inner aspect.

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^ , hypoglossus \ N. glossopharyngeus ^Hypophysis

725. Brain of 13.6-mm4ong embryo; right aspect.

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Pedunculus cerebrf Corpus plneale

726. Brain of 13.6-mm-longembryo; right half; inner aspect.

neural, or medullary, tube. T h e tube then sinks deeper and sepa

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J N. optiqus \ Polus fronlulis

727. Brain of 50-mm-long embryo; right aspect.

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Sulcus postcentralls Sulcus central Is

R. posterior Sulcl laterals ^fti"""*

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728a. Brain of newborn, right hemisphere; lateral aspect {%).

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Septum pellucifjuin 'U.

729. Brain of adult, right hemisphere; medial aspect (%).

divided into the central nervous system (systema. nervusum central)

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THE SPINAL CORD AND THE BRAIN

THE SPINAL CORD

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-Fissura medlana Thll

Ftlum terminale -Fllum terminate

730. Spinal cord (medulla spinalis) (%).

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THE WHITE AND GREY MATTER OF THE SPINAL CORD

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Sulcus laicralis posterior- IntuFirescemra--

Radix ventralis - ^ Iiiinl>ales

Rarnus venlralis neryi spinalis > V J

Ramus dorealjs neryi spinalis "

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Flssura medlana anterior

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*^ ^ ' oimscaiiMs intermedia cetUnlis

FOHUJUIO rcttcalaris it.

733. Spinal cord (medulla spinalis) (%).

T h e tissue s u r r o u n d i n g t h e c e n t r a l canal consists mostly of

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SURFACES, SULCI, AND GYRI O F THE CEREBRUM

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734. Cerebrum; superior aspect (%).

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735. Cerebrum; .superior aspect (semischematical representation).

SULC1 AND GYRl OF THE SUPEROLATERAL SURFACE OF T H E