Book - An Atlas of Topographical Anatomy 12

From Embryology

XII. Transverse section of the same body at the level of the mitral valve and eighth dorsal vertebra

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Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.

Plates: 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term
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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)


THIS section, like the one just described, is viewed from above downwards, the thickness of the lamina being about one inch and a half. The section passed through both nipples and the third intercostal spaces, dividing the auricles of the heart and their valves. It passes backwards to the upper border of the eighth dorsal vertebra, and shows the eighth ribs of both sides; it cuts also the inferior angle of the shoulder-blade.


The great value of the plate consists in the fortunate section through the heart, both auricle and ventricle being opened. The left auriculoventricular opening is divided nearly in half, and the right is so cut at its upper border that a view is obtained of the ventricle. At first sight the cut surface of the heart and the space which this organ occupies seem immensely large, and yet a subsequent examination shows their relations to be normal. From the oblique position of the heart in the thorax a transverse section of the body would not divide it transversely but obliquely; therefore its walls appear much thicker than they really are.


The left auricle is divided not far from its base. The portion of it here represented shows a cavity about '3 of an inch in its deepest part, while towards the right side the section rises to the level of the pulmonary veins. A small portion of the aortic segment of the mitral valve has been taken away ; it will be found on the right side of the mitral opening.


Behind the left auricle the great cardiac vein is seen passing to the right auricle to open by the coronary sinus below the remains of the Eustachian valve. The point of opening lies too deeply to be clearly shown in the plate.


As the left ventricle lies more posteriorly and the right extends more anteriorly, the auricular septum is drawn out backwards and to the right side ; the left auricle lies considerably higher than the right.


The inferior vena cava projects upwards into the posterior half of the right auricle, and in front of it are the remains of the Eustachian valve. Still more anteriorly the auricle bulges outwards and downwards to a depth of about an inch and a quarter, rising again to open into the right ventricle and by means of the auriculo -ventricular opening, which is guarded by the tricuspid valve. In front of the tricuspid valve is the right ventricle, which is opened by the section, and from which the section has carried away the root of the pulmonary artery. From the anterior wall of the ventricle (the section of which is seen in front) one of the musculi papillares passes backwards to the anterior flap of the valve, and behind this, deeper in the cavity of the ventricle, are the columns carnese of the hinder wall. By comparison with the under surface of the next section the position of both auricles can be accurately determined. It appears that the cavity of the right auricle attains the level of the lower border of the fourth, to the middle of the third, costal cartilage, and that its corresponding auricular appendix reaches to the upper border of the third costal cartilage. Its greatest breadth extends from the middle of the left half of the sternum to about an inch external to the right border of that bone. The left auricle extends from the upper border of the fourth costal cartilage to the middle of the second intercostal space, and in breadth it corresponds to the eighth dorsal vertebra and its articulations with the heads of its ribs ; its auricular appendix rises to the lower border of the second costal cartilage.


The right auriculo-ventricular opening is at the level of the eighth dorsal vertebra and to the right of the middle line of the sternum ; it also extends across slightly to the left half of the body, nearly in the centre between the vertebra and sternum. Anteriorly its position is marked by the level of the nipple and the fourth costal cartilage.


The left auriculo-ventricular opening commences somewhat to the left of the sternum and reaches nearly to the middle line, lying 2.8 inches behind it at the level of the fourth intercostal space.


A needle pushed into the middle of the third intercostal space, at the distance of rather less than half an inch from the left sternal border, would strike the central point of the mitral opening. In order to pierce the tricuspid opening, it must be thrust into the right half of the sternum at the level of its articulation with the fourth costal cartilage.


The pulmonary orifice would be reached at the upper border of the third costal cartilage, about one fifth of an inch external to the left edge of the sternum, and the aortic orifice at the level of the third costal cartilage.


I have frequently performed such experiments on young male subjects, and I am convinced of the accuracy of these statements. But I am far from insisting on their being absolute for all bodies, still less would I maintain that the positions are exactly the same for the living without further observation, entirely waving the question of pathological changes. According to the position of the body whether it lies on the back, side, or abdomen, so the position of the heart is affected, and further it is considerably influenced by the condition of the diaphragm. The heart is placed between the lungs and the diaphragm, so as to be surrounded by structures which can be displaced from it as soon as something else has taken their place. And owing to this arrangement the position of the heart is somewhat variable. The tender organ is not only perfectly protected from shocks which affect the anterior wall of the thorax, but has, moreover, free room for its own movements.


In the body of a young and powerful individual, such as the one here represented, the lungs gradually contract to an extent which is never the case during life. Consequently the external air presses equally on the surface of the abdomen and upon the diaphragm.


When the lungs contract, the heart, which lies between them, naturally moves upwards with the diaphragm, and so attains after death a higher level than is possible during life.


If the elasticity of the lungs be lost, as is the case in old people and in those affected with disease of the lung-tissue, we must expect a deeper position of the heart.


  • By sections in the bodies of young powerful men I found the pulmonary orifice at the upper border of the third left costal cartilage, and at the level of the sixth dorsal vertebra ; in persons of from fifty to sixty years it lay below the fourth costal cartilage at the level of the eighth dorsal vertebra.


In the event of tympanites the inflated intestines push up the diaphragm and the heart until the latter lies between the yielding and more contracting lungs, so that the pulmonary orifice corresponds to the level of the second costal cartilage.


FIG. 7. Adult male thorax. Hydro-pericarditis. Pirogoff, ii, 14, 4,

1. (Esophagus. 2. Descending aorta. 3. Right auricle. 4. Left ventricle. 5. Left auricle. 6. Left ventricle.


The diameters of the chest have been discussed -with Plates IX to XII, and the relation 1 : 3 has been tolerably well established. It will be seen that these relations are subject to essential changes in disease. For the purpose of comparison I reproduce two of Pirogoff's plates in woodcut.


The section, Fig. 1, is taken a vertebra higher than mine, consequently a small portion of the bulbus aorta3 remains in front of the left auricle, of which a considerable amount is left. The aortic portion of the mitral valve is clearly seen lying stretched flat over the apex of the hinder flap. The right auricle exhibits in its posterior half the point of entrance of the superior vena cava, which has been somewhat compressed by the pericardial exudation, and in its anterior part is seen the entrance to the right ventricle.


If these relations be compared with the normal condition one is struck with the altered form of the thoracic cavity. The antero-posterior diameter is considerably enlarged ; it amounts to the half of the transverse diameter, whereas it should be only one third.


Owing to the great distance of the sternum from the spinal column, space is permitted for the extensive exudation. The heart appears driven backwards, but this is not really the case, as the parts between the heart and vertebra, the ossophagus and descending aorta, have clearly ample room. But it is rolled over entirely to the left side.


The axis of the left side of the heart passes in a direction transverse to the section of the fifth rib, whereas normally it points obliquely forwards towards the left nipple. The axis of the right side of the heart shows a similar change in direction. The lungs are considerably compressed, to give more room for the pericardial exudation. Whilst in my plate they enclose the entire heart and closely approximate its anterior boundaries, they are here widely separated from each other and sunk back, notwithstanding that pleuritic effusion exists on the right side. The pleural cavities should be especially studied with reference to paracentesis pericardii, in opnsequence of their attachment to the chest- wall. In this section they are but slightly dislocated, only a small space near the sternum being left free, so that a trocar would have to be introduced very close to the border of the sternum in order to avoid wounding the pleura.


The section in *Fig. 2 is taken almost exactly at the same level as mine, and the relations of the heart are similar, this organ being slightly pushed over, and at the same time rotated on its axis toward the left side. The left lung is considerably diminished, so that it is not applied to the anterior surface of the heart. The pleurae, however, reach as far as the sternum, a very small space existing between them ; they exhibit so many adhesions (according to Pirogoff's description) that the cavity of the pleura was considerably interfered with. In addition to the dislocation of the heart, the remarkable pushing over of the oesophagus to the left side is of interest ; but unfortunately Pirogoff gives no further account of this matter.


Fig. 2. Adult male thorax. Partial cystic empyema of the right side. Pirogoff, ii, 11, 2, .

1. (Esophagus. 2. Descending aorta. 3. Bight auricle. 4. Left ventricle. 5. Left auricle. 6. Left ventricle.



Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)
Braune Plates (1877): 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term

Reference

Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.


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Cite this page: Hill, M.A. (2019, September 21) Embryology Book - An Atlas of Topographical Anatomy 12. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_12

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© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G