Book - An Atlas of Topographical Anatomy 8

From Embryology

VIII. Transverse section of the same body through the apices of the lungs and shoulderjoints at the level of the first 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 plate represents the upper surface of the last section made from an uninjected body, which has also afforded material for the previous plates ; it is therefore unnecessary to mention anything further with regard to this body, as the essentials will be found with the explanation of Plate V.


The section is so made that it passes directly through both subclavian arteries at the level of the arches which they describe over the cupola of the lung, and very fortunately the trunk of the left subclavian artery remains intact ; whilst that of the right side is divided together with that portion of the lung which lies immediately beneath it. It extends moreover to the level of the isthmus of the thyroid body, to the lower edge of the first dorsal vertebra, and to the coracoid process of the humerus above the tuberosities. One consequence of the high position of the shoulders of this individual is, that the lateral portions of the shoulder- joint are seen in this section, whilst in the case of less powerfully developed bodies they are not met with till the level of the sterno -clavicular articulation is reached.


With regard to the relations of the spinal column, we first notice a small portion of the body of the under surface of the first dorsal vertebra, behind it the connexion between it and the second, which in consequence of the curvature of the spinal column has been sawn through obliquely. Small portions of the transverse processes of the second dorsal vertebra appear behind the intervertebral substance. The second ribs are seen attached to these processes and also to the bodies of the vertebra. In the mass of muscle in front of them lie the first ribs in section. Nothing is seen of the sternum and the sternal end of the clavicle, since these parts lie considerably deeper, as is shown by an examination of the thyroid body. The section of the clavicles passes through their middle, and the subclavian muscles are readily seen. The upper portion of the thorax is opened by the section, which also implicates the region of the neck in front. Hence it is impossible to determine by means of a horizontal plane where the region of the neck terminates and where that of the thorax commences, but the boundary must be carried obliquely backwards, and even then the neck may be said to lie not only above the thorax but partially in front of it. Consequently it cannot then be wondered at that wounds penetrating the neck horizontally above the clavicle frequently involve the lung, and this fact must he kept in view in the examination and diagnosis of the course of stabs or gunshot wounds of the lower region of the neck. As the left lung is clearly seen through its exposed and uninjured pleura, whilst the right lung and the subclavian artery are divided, one might perhaps imagine that the saw had been depressed on the right side ; this, however, was not the case. Although the horizontal plane was adhered to as accurately as possible, still the head of the right humerus has been divided at a considerably higher level than the left. We might suppose, therefore, that in this body the right lung attains a higher level than the left. This difference is clearly seen in the plate, and as it occurs in the case of a young and perfectly formed normal subject, it is obvious that this disposition is of importance in percussion of the apex of the lung. One would naturally expect in a young muscular individual a . fuller percussion note above the clavicle on the riglit side than on the left, and if the reverse condition should present itself the existence of some abnormality may be expected.


On both sides of the muscular masses of the longus colli, between it and the lung, is the second cervical ganglion of the sympathetic ; in front of and above the cupola of the lung is the subclavian artery, and laterally appears the obliquely-divided surface of the brachial plexus. As the artery does not exceed the highest level of the apex of the lung, but lies more on the anterior slope of the pleura, the brachial plexus forms a sort of niche with the spinal column to receive the absolute apex of the lung. On the left side especially this arrangement is well seen.


The left subclavian artery is intact, but sections of two of its branches are represented. The inner of these is the vertebral, the outer the thyroid axis. In front the superficial cervical artery winds round the anterior scalene muscle and the phrenic nerve, and mounts up obliquely above the brachial plexus in order to gain the nape of the neck. It has been divided at the commencement of its course, and immediately below; the posterior belly of the omo-hyoid overlaps it, a small portion of the muscle having been cut off, but almost the whole of it is shown in the section immediately preceding. On the hinder border of the subclavian are the openings of two small arteries which are not very clearly defined. The transverse cervical artery, the extremity of which is seen in the preceding plate, sprang, in common with the inferior thyroid, from the large trunk in the mass of the scalenus anticus, and the continuation of its trunk (the posterior scapular is seen to be covered by the rhomboid muscle.


The supra-scapular artery lies behind the subclavian, and is again seen near the coracoid process, behind the conoid and trapezoid ligaments, whence it passes towards the supra-scapular notch. It runs over the transverse ligament of the scapula to the supra-spinous fossa, whilst the accompanying nerve passes below the ligament.


The section has removed a strip of the upper surface of the right subclavian artery, and at the inner end there is a bulging out of the wall of the artery corresponding with the origin of the thyroid axis, and indicating the point of origin of the superficial cervical artery. Further outwards, between the subclavius and serratus magnus are the supra-scapular nerve and artery to which we have already alluded.

On comparing the subclavian arteries of the two sides it is evident that on account of the higher level of the right over the cupola of the lung, that the first portions of both have very different directions. These differences are dependent on the variation of origin of the two vessels. The ascending portion of the left subclavian (from the aorta) lies further backwards, and is in relation with a considerable portion of the pleura, whilst the right passes in the opposed direction of the blood-stream, forwards, to unite with the common carotid to form the innominata. The portion of each artery here shown belongs to the middle part of its course. The direct proximity of the lung and pleura indicates clearly enough the danger of ligature in this situation, and all cases hitherto undertaken have been attended with unfortunate results.


In front of the subclavian artery on either side is the common carotid, and between these vessels is the trunk of the vertebral and deep cervical veins ; and in the middle line is the long cardiac nerve.


The vertebral vein is subject to many variations. Although in the vertebral canal it is generally a single trunk, it may form a plexus. In rare instances it joins with the deep cervical vein, and passing down behind the articular process, forms a trunk which receives the blood from the sinuses in the canal. It has also many variations in its point of termination, the most frequent of which is in the commencement of the innominate vein, and it may pass down hence either in front of or behind the subclavian artery.


In one case, on the left side of the body, it was found as a trunk in the vertebral canal, in front of the vertebral artery, and at its point of exit from the canal was directed forwards, and passed over the subclavian artery in front in order to terminate in the left innominate vein near the junction of the internal jugular. Thus it formed with this large trunk, on the inner side of the vertebral artery, a V, in which lay the thoracic duct before emptying into the subclavian vein.[1]


In a second case the vertebral vein came forwards from behind the subclavian artery, between it and the pleura, and terminated in the lower end of the internal jugular, so that after the removal of the pleura the vessel could be seen lying free, and crossing the subclavian artery from behind forwards. Into the horizontal portion of the vertebral, a vein opened corresponding to the deep cervical, in front of the subclavian artery. On the right side of the body, in a third case, it passed behind the subclavian artery, whilst on the left it passed in front of it, and in a fourth case it passed down on both sides of the body in front of the subclavian artery.


These relations are important, inasmuch as in ligature of the ascending portion of the subclavian artery they are frequently met with, and care must be taken to avoid them. Directions are given for the avoidance of nerves and arteries, but no notice is taken of the vertebral vein, or of the thoracic duct, which on the left side lie close up. On the outer side of the carotid, immediately behind the sterno-cleido-mastoid, is the internal jugular vein, and between it and the carotid, the vagus nerve.


The external jugular vein is seen on the left side, between the clavicle and omo-hyoid muscle. On the right side it opens into the divided transversus scapulas vein. The subclavian vein is not seen as yet, as it lies below the section.


In front of the trachea is the thyroid body, which is divided directly through its isthmus. It appears to be completely normal, both as regards structure and size, which in this country (Saxony) is seldom the case, as most subjects show enlargement of this gland.


The oesophagus at the level of the gland begins to leave the mesial line to get to the left side.


In Plate X, which gives the structures at the level of the sterno-clavicular articulations, the oesophagus already lies to the left side of the trachea. Although this lateral deviation of the oesophagus is the rule, still the exact level at which the greatest deflection takes place appears to vary. I find this lateral position complete in PirogofPs atlas (tab. i, fasc ii), in which the section has passed between the first and second dorsal vertebras, as in Plate VIII, where the oesophagus first begins to leave the middle line.


The head of the left humerus is divided nearly in its middle, and in front is part of the greater tuberosity, into which is inserted the tendon of the infra-spinatus. Under this tendon, and close to its insertion, is the thinnest part of the capsular ligament. The supraspinatus, the mass of which is seen between the two bony ridges which belong to the scapula, is divided at its anterior extremity, at the point where it ascends to its insertion into the greater tuberosity. Its tendon is blended with the fibrous structures on the anterior surface of the articulation.


The deltoid with its intermuscular septa is well developed, and between it and the insertions of the muscles attached to the greater tuberosity is a bursa, the cavity of which is indicated by a black line.


As the glenoid cavity has been divided nearly in the middle, the tendon of the long head of the biceps lies free in the joint. Beneath it was found a thin fold of synovial membrane, but higher up the tendon was completely free. On the anterior surface of the coracoid process are the tendinous origins of the biceps and coraco-brachialis, and internal to them the fleshy mass of the pectoralis minor. On the posterior and inner side of this process the conoid and trapezoid ligaments are seen in section. The head of the right humerus is divided considerably higher than that of the left, namely, at the level of the upper border of the glenoid cavity. In consequence of this the articular cartilage appears completely encrusting the bone. The capsule is free all round, and the tendon of the long head of the biceps is seen coming up to be incorporated with the glenoid ligament.


Too much must not be expected from the plate, as the bundles of the tendinous masses can be only represented in general. The individual fibres of the tendon of the infra-spinatus, for instance, cannot be followed out round the head of the humerus. They become lost deeper down on the greater tuberosity, and are intimately blended with the insertion of the supra-spinatus.


If the section in this plate be compared with Plate IX in the large coloured atlas (also the section of a young powerful man) as well as with that of a man fifty years of age, its massive mould would be evident.


The individual layers of muscle are everywhere broader, although the skeleton itself does not appear larger or stronger.


The difference, therefore, between the longitudinal and horizontal measurements does not show itself in the manner which one would be led to expect from a superficial examination. For though the lower outline was drawn exactly to the section (and therefore closely corresponds with the plane in Plate IX in the large atlas), the breadth of the shoulder is nearly an inch more than in the old man, whereas the antero-posterior diameter is half an inch more in the old than in the young man. Plate IX in the large atlas should not be incorporated with the series of the plates, as in the old man more abnormalities exist. There was a considerable enlargement of the liver, and a very great development of the thyroid body, so that the relations of the parts in the neck (as seen in Plate XXV) are much altered. The thyroid gland was enlarged below and on the left side, so as to encroach on a portion of the superior aperture of the thorax. It also pressed the left subclavian artery inwards and backwards upon the cupola of the lung ; the oesophagus also was pushed out of its place against the trachea, embedding itself between it and the vertebral column. The relation of the carotid artery to the sixth cervical vertebra has been already described, and it has been stated that the position of the arteries is to be defined not by the bone, but by the directions of the muscles and fasciae, and that the bony prominences alone should not be considered of value as landmarks for finding the arteries. The same remark applies to the veins, nerves, trachea, and oesophagus in the region of the neck. These structures are so freely movable in the anterior region of the neck that the movements of the trunk or the pressure of a tumour may materially alter their position. This is particularly evident in Plate IX in the larger coloured atlas ; it can be estimated also in the present plate.


Such a change of position with regard to the skeleton is owing to the presence of the loose cellular tissue which envelopes these structures. But the relation of these important structures with regard to the muscles and fasciae is constant, and consequently if an operation such as tracheotomy, oesophagotomy, or the extirpation of a tumour, has to be performed, the surgeon must make himself well acquainted with the fasciae and muscles.


  1. I have on more than one occasion observed the thoracic duct to terminate in the lower part of the vertebral vein. TE.
Historic Disclaimer - information about historic embryology pages 
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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)
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 17) Embryology Book - An Atlas of Topographical Anatomy 8. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_8

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