Book - Handbook of Pathological Anatomy 2.10
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Meckel JF. Handbook of Pathological Anatomy (Handbuch der pathologischen Anatomie) Vol. 2. (1812) Leipzig.
- Ligaments: I. Trunk | II. Head | III. Extremities Muscles: I. Trunk | II. Head | III. Extremities Angiology: I. Heart | II. Body or Aorta Arteries | III. Body Veins| IV. Pulmonary Artery | V. Pulmonary Veins | VI. Lymphatic System | VII. A Comparison of Vascular System Nervous System: I. Central Nervous System
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Section III. Of the Veins of the Body
§ 1533. The veins of the body generally unite in three large trunks, which open into the right auricle (§ 1305), the large coronary vein of the heart and the two venœ cavœ.
Chapter 1 Of the Veins of the Heart
I. LARGE CORONARY VEIN.
§ 1534. The large coronary vein of the heart ( vena coronaria maxima cordis) opens into the right auricle, on the left and lower side of the interauricular septum, a little way from the venous orifice of the right ventricle. It rarely empties itself into the left subclavian vein, (1) in which case the veins of the body do not unite except in two large trunks.
It arises from all the extent of the left ventricle by four or five considerable branches, which proceed downward from the summit to the base of the heart, and among which we observe three which are larger and longer than the rest.
The upper branch follows the upper groove of the convex face of the heart, which marks the upper edge of the septum. The second proceeds along its blunt edge, and the third near the inferior groove.
The smallest branches, which do not descend as low as the preceding, are situated between them.
All correspond to ramifications of the arteries, and empty at right angles into the trunk of the coronary vein, which proceeds in the transverse groove between the left ventricle and left auricle, first downward, then from behind forward to the place where it opens into the right auricle.
II. SMALL CORONARY VEIN OP THE HEART.
§ 1535. The small coronary vein of the heart (F. coronaria cordis minor , s. Galeni) belongs principally to the right auricle. It arises from the summit of the heart, proceeds in the lower longitudinal groove, or a little to the right, along the posterior and inferior edge of the right ventricle, receives the branches which come on the lower face of this ventricle, and almost always empties into the preceding, directly behind its opening. It rarely opens into the 'auricle, a little before the large coronary vein,
III. SMALL ANTERIOR VEINS OF THE HEART.
§ 1536. Besides these two large veins, others also, which are smaller and may be termed the small anterior veins of the heart , arise from the anterior ventricle, from the aorta and the pulmonary artery, and open separately into the anterior part of the right auricle. They extend from the summit to the base of the heart, proceeding before and above the preceding.
IV. SMALLEST VEINS OF THE HEART.
§ 1537. The smallest veins of the heart (V. minima cordis) conv ey the blood in every direction, even in the left half of the heart, but especially into the right auricle, through the foramina of Thebesius ( foramina Thebesii).
(1) Le Cab, in the Mém. de Vac. des sc., 1738, Hist., d. 62.
Von. II. 44
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CHAPTER II.
VEINS OP THE I-IEAD AND UPPER EXTREMITIES.
§ 1538. The veins of the head and of the upper extremities all unite in the descending vena-cava.
ARTICLE FIRST.
VEINS OF THE HEAD.
§ 1539. The veins of the head are distinguished into the superficial or external and the deep or interned. The latter convey the blood from the brain ; the former return it from the other parts of the head. They terminate in two large trunks, the internal and the external jugular vein.
I. SUPERFICIAL VEINS OF THE HEAD.
§ 1540. Almost all the superficial or external veins of the head open into the external jugular vein. A very few of them accompany the arteries ; the largest of them however differ a little in their distribution from that of the large arterial branches to which they correspond.
Those which resume the blood from the tongue, the pharynx, the skin, and the superficial muscles of the face, finally, from the sides and from the posterior part of the skull, unite in two large trunks, an anterior and a posterior, which correspond, the former to the facial artery (§ 1351), the latter to that part of the external carotid artery which is above the facial artery, and to its outer termination, or to the temporal artery (§ 1358). These two trunks unite to form one, which is short and corresponds to most of the external carotid artery, and is called the common trunk of the superficial veins of the head ( truncus communis venarum capitis superficialium), or rather the anterior cephalic vein ( V. cephalica anterior).
A. FACIAL VEIN, OR ANTERIOR BRANCH OF TIIE ANTERIOR VEIN OF / THE HEAD.
§ 1541. The anterior trunk of the veins of the head, the facial vein , the anterior and internal facial vein ( R. vena, cephalica anterioris anticus , s. V. facialis anterior , Walter) is formed by the veins of the anterior and much the larger part of the face.
It follows the direction of the facial artery, but is situated more behind than this vessel, and as it is less tortuous, it is also some distance from it.
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Regarded from above downward, according to the course of the
blood, this vein arises gradually by the union of the following branches :
The upper branches are two in number, an anterior and internal
and a posterior and external. The first is called the supra-orbitar and
the second the frontal vein.
I. SUPRA-ORBITAR VEIN.
§ 1542. The supra-orbitar vein ( V. supra-orbitalis ) is situated below the frontalis muscle, proceeds transversely along the upper edge of the orbit, anastomoses externally with the frontal branch of the temporal vein, and arises from several venous twigs, which come from the orbicularis palpebrarum, the corrugator supercilii, and the frontalis muscles.
II. FRONTAL VSIN.
§ 1543. The frontal vein ( V. frontalis) arises,
1st. From the branches which anastomose with the final anterior branches of the temporal vein and also with the synonymous branches of the opposite side, form thus a very complex vascular net-work on the frontal region, and come from the frontalis muscle, from the skin, and the frontal bone. The trunk formed by the union of these branches which often unites, at the lower part of the squamous portion of the frontal bone, with the synonymous trunk of the opposite side, by a large anastomosis, and frequently forms a median branch.
2d. From an inferior branch, the superior dorsal vein of the nose ( V. dorsi nasi superior), which, after anastomosing very frequently with the inferior dorsal artery of the nose, ascends and unites with the superior branch, which we shall describe.
III. INFERIOR NASAL VEINS.
§ 1544. The supraorbital and frontal veins unite in a common trunk in the inner angle of the eye, which descends along the nose directly below the skin.
This trunk receives from before backward and from below upward, below the inner angle of the eye, first, the inferior dorsal vein of the nose ( V. dorsi nasi inferior ), then the upper anterior vein of the nose (V. nasalis anterior superior), afterward the lower anterior vein of the nose (V. nasalis anterior inferior ), which frequently anastomose together, and with the upper dorsal vein of the nose.
IV. CORONARY VEIN OF THE UPPER LIP.
§ 154G. The trunk of the facial vein next receives, as high as the ala of the nose, the coronary vein of the upper lip, which often forms a common trunk with the anterior and inferior nasal artery, and which frequently anastomoses with it.
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V. LOWER INTERNAL PALPEBRAL VEIN.
§ 1546. The facial vein receives at its upper part, -opposite the anterior and inferior nasal artery, the internal and inferior palpebral vein (V. palpebralis inferior interna). This vein is situated in the lower eyelid, between the skin and the orbicularis muscle ; it forms a very complex network which anastomoses externally with the upper palpebral vein, given off by the temporal vein (§ 1551), and with the external palpebral vein.
VI. LOWER INTERNAL PALPEARAL VEIN.
§ 1547. The external inferior palpebral vein ( V palpebralis externa inferior ) descends directly under the skin, along the external edge of the orbicularis muscle, anastomoses within with the upper external palpebral vein furnished by the temporal vein, outward with the internal inferior palpebral vein, and, passing under the zygomaticus major muscle, before the malar bone,- empties into the trunk of the facial vein much deeper than the preceding.
VII. UPPER AND ANTERIOR INTERNAL MAXILLARV VEIN.
§ 1548. Some distance below this external inferior palpebral vein the facial receives the upper and anterior internal maxillary vein ( V. maxillaris interna anterior superior ), which arises from the upper teeth and from the upper maxillary bone, from the posterior part of the nasal fossæ, and from the lower and anterior part of the orbit, by the following branches :
1st. The upper alveolar vein ( V. alveolaris superior).
2d. The posterior nasal vein (V. nasa/is posterior).
3d. The anterior ophthalmic vein ( V. ophthalmic a superior).
§ 1549 From this point to the lower maxillary bone the facial vein receives principally,
1st. The lower or external vein of the upper lip ( V . labii superioris inferior , s. externa), which is much smaller than the internal.
2d. The tipper buccal vein ( V. buccalis superior).
3d. The middle labial vein (V. labialis media), which is transverse, and empties itself into the trunk opposite the angle of the lips.
4th. The inferior labial vein ( V. labialis inferior).
5th. The submental vein ( V . suhmentalis).
§ 1550. It receives upward and outward, in its course,
1st. The inferior buccal vein (V. buccalis inferior).
2d. Three or four masseteric veins ( V. massetericœ), a superior, a middle, and an inferior, which arise from the substance of the masseter muscle, and form an extensive network on the surface of this muscle, which anastomoses with all the branches of the facial vein.
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3d. The vein nf the submaxillary gland (V. glandules maxillaris
inferioris).
B. COMMON TEMPORAL VEIN OR THE POSTERIOR BRANCH OF THE ANTERIOR VEIN OF THE HEAD.
§ 1551. The common temporal vein, the posterior branch of the anterior vein of the head ( V. temporalis , s. R primarius, venae cephalicæ anticœ posticus, s. V. facialis posterior externa , Walter), is formed partly of superficial and partly of deep branches. The former arise principally from the middle and lateral parts of the external face of the skull ; the latter come from the deep regions of the face.
The following are the principal branches which unite below and backward to form the temporal vein :
I. EXTERNAL UPPER PALPEBRAL VEINS.
§ 1552. One or two external upper palpebral veins (V. palbebralis superior externa ) receive the blood from the tunica conjunctiva, the orbicularis palpebrarum, the skin of the upper eyelid, and frequently anastomose together, and also with the upper and lower external palpebral arteries, and the following.
II. EXTERNAL SUPRAORBITAL VEIN.
§ 1553. The external supraorbital vein ( V. supraorbitaria externa ) proceeds transversely over the upper edge of the orbit, under the orbicularis palpebrarum and the ligaments of the eyelids, and anastomoses with the external upper palpebratyveins (§ 1552).
III. EXTERNAL FRONTAL VEIN.
§ 1554. The external frontal vein (V. frontalis externa) anses front the skin of the forehead, from the frontalis muscle, from the periosteum of the frontal bone, and from this bone, anastomoses with the internal frontal vein (§ 1543) before, outward with the temporal vein, and communicates with the two or three preceding, at the outer extremity of the upper edge of the orbit.
IV. DEEP TEMPORAL VEINS.
§ 1555. These three branches are situated directly under the skin. The trunk which is formed by them, or the deep temporal vein ( V temporalis profunda ), penetrates the aponeurotic envelop of the temporalis muscle, proceeds upward and backward under this aponeurosis, above the zygomatic arch, turns very frequently, receives in its course several branches which resume the blood from the temporalis muscle and the temporal bone, anastomoses frequently with those of the facial
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DESCRIPTIVE ANATOMY.
vein, and communicates, before the external ear and above the tern
poro-maxillary articulation, with the superficial temporal vein.
V. SUPERFICIAL TEMPORAL VEIN.
§ 1556. The superficial temporal vein ( V. temporalis superficialis) is generally smaller than the preceding, and is formed by an anterior and a posterior branch, which are both situated directly under the skin. The first arises from the sinciput, the second from the upper part of the occipital region, from the upper part of the ear. They most frequently join at a right angle, and form a small common trunk, which is soon united with the deep temporal vein. These two branches frequently anastomose with each other. The anterior also communicates with the branches of the external frontal vein, and the posterior with the occipital vein.
VI. TRUNK OF THE TEMPORAL VEIN.'
§ 1557. The common trunk formed by the union of the deep and superficial temporal veins, descends on the outer face of the malar bone, comes behind the ascending branch of the inferior maxillary bone, penetrates into the parotid gland, goes forward under the angle of the lower jaw, and anastomoses in this place with the facial vein or anterior branches of the veins of the head, and thus produces a short common trunk.
In this course it receives anterior, posterior, and internal branches
VII. ANTERIOR BRANCHES.
a. Anterior articular vein.
§ 1558. The first anterior branch, counting from above downward, is the anterior articular vein ( V. articularis anterior ), which anastomoses very much with the deep temporal vein, and resumes the blood from the parts of the temporo-maxillary articulation.
b. Transverse facial vein.
§ 1559. The transverse facial vein ( V. facialis transversa) empties into the trunk of the temporal vein, a little below the preceding : it is a considerable vessel, and generally arises by a superior and an inferior branch.
The superior branch arises from around the temporo-maxillary articulation, and anastomoses with the anterior articular vein (§ 1558), and with the external infraorbital vein.
The inferior branch arises from the superficial and the deep branches.
The superficial branches carry the blood from the parotid gland, from the outer face of the masseter muscle, from the skin of this region, and from the parotid canal, and anastomose with the maxillary veins.
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The deep veins come from the pterygoideus externus muscle, and
then go between the neck of the jaw and the posterior edge of the masseter muscle, where they communicate with the superficial branches,
c. Parotid veins.
§ 1560. The temporal trunk receives, much lower down and anteriorly, some small parotid veins ( V. parotideœ).
VIII. POSTERIOR ERANCHES.
a. Anterior articular veins.
§ 1561. The posterior branches of the trunk of the temporal trunk, are, besides the following, the anterior auricular veins ( V. auriculares anteriores ), which arise from most of the concha of the ear.
b. Internal and posterior maxillary vein.
§ 1562. The deep branch (R. venez facialis poslerioris profundus , Walter) corresponds mostly to the internal maxillary artery, furnished by the external carotid artery. We may then term it the internal posterior maxillary vein, to distinguish it from the anterior and superior maxillary vein (§ 1548). It is formed by one or two inferior maxillary veins, and by four or five deep temporal veins, proceeds inward, before the common temporal trunk, backward and downw ard, and empties itself at some distance from the angle of the jaw, into the posterior part of the common temporal vein, after giving off a considerable branch, which descends and anastomoses with the external jugular and the occipital veins.
IX. LARYNGEAL VEIN.
§ 1563. The common trunk ot the anterior and posterior veins of the face corresponds to the external carotid artery, and usually receives anteriorly a small branch, the laryngeal vein ( V. laryngea) which arises from the mucous membrane, and from the muscles of the larynx and of the hyoid bone.
II. POSTERIOR CEPHALIC VEIN.
§ 1564. The posterior cephalic vein is formed principally by the veins of the brain, the tongue, and the pharynx.
I. VEINS OF THE BRAIN.
§ 1565. The veins of the brain may be divided into the external and the internal. The large branches produced by their union are all in
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DESCRIPTIVE ANATOMY.
serted in the pia mater of the brain, and carry the blood into trunks
called sinuses (sinus) which are formed by the inner membrane of the
veins and by the dura mater. These trunks are partly surrounded by
the bones of the skull, have principally transverse and longitudinal directions, communicate by several smaller sinuses, which have no constant direction, carry the blood backward and downward, and finally
open into the posterior cephalic vein.
It seems to us more proper to describe the sinuses before we mention the veins of the head.
a. Superior longitudinal sinus.
§ 1566 . The superior longitudinal sinus ( sinus longitudinalis s. falciformis superior) is the longest sinus of the brain, and is situated on the median line. It occupies the convex edge of the falx of the cerebrum, directly under the frontal suture, the sagittal suture, and the upper half of the squamous portion of the occipital bone, from the crestu galli process of the ethmoid bone to the internal occipital protuberance. It has the form of a triangle, the base of which is turned upward, the apex downward ; it gradually enlarges from before backward very much, and terminates in the internal occipital protuberance, where it generally anastomoses with the right transverse sinus, in an irregular depression called the torcular herophili. We usually remark within a greater or less number of transverse cords (trabeculae) : these extend from one side to the other, and are formed internally by the dura mater, externally by the internal membrane which is reflected upon the latter.
The longitudinal sinus receives on each side, in its inferior and lateral parts, ten or twelve veins, which arise from the upper and external face and from the internal face of the brain, and which proceed in the pia mater and principally above the grooves between the circumvolutions.
The veins of the outer and upper face are the largest and the most numerous. Before they empty into the upper longitudinal sinus, they receive those which ascend along its internal face. They always proceed from before backward, increasing considerably in volume.
Most of them, with the exception sometimes of the anterior, arrive at the longitudinal sinus at very acute angles and in a direction opposite to that of the blood which passes through it.
The posterior vein, also, before opening into the sinus, usually proceeds some distance, frequently an inch between the fibres of the dura mater, which separate to receive them, and in the intervals of which they frequently curve very much.
The curves of these posterior veins are also generally supplied with single more or less apparent valves, which the anterior do not possess, because as they open into the sinus more transversely, there is less danger of the regurgitation of the blood.
The superior longitudinal sinus also receives, above, a considerable number of little veins, some of which come from the bones, while others
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pass through the skull, and establish the communication between the
internal venous system of the head, and the external branches of the
temporal and facial veins. This results from the numerous ramuscules,
and especially those of one or two larger veins, which passing through
the parietal foramina (F. parietalia ) carry the blood from within outward.
Finally, the dura mater also gives venous branches, wririch empty into the upper and lateral parts of the superior longitudinal sinus.
6. Inferior longitudinal sinus.
§ 1567. The inferior longitudinal sinus ( S. longitudinalis, s.falciformis inferior , s. v.falcis inferior )( 1 ) is much smaller than the superior. It extends from the beginning of the middle third of the falx of the cerebrum to its posterior extremity, where it anastomoses, generally dividing into two trunks, the inferior of which proceeds along the lower and unattached edge of the cerebral falx, and empties itself into the anterior extremity of the fourth sinus, while the superior reascends between the layers of the falx and penetrates downward into the centre of the same smus.
This smus receives the veins of the falx, and in some rare cases some inferior veins of the internal face of the brain and of the corpus callosum.
c. Right sinus.
§ 1568. The fourth, right , or more properly the oblique sinus, the sinus of the tentorium (S. rectus, s. perpendicularis, s. quartus, s. obliquas, s. tentorii\ properly speaking, is only the posterior part of the preceding, but it is much larger than it. It descends obliquely from before backward, on the middle of the tentorium of the cerebellum, and occupies all the space between it and the union of the superior longitudinal sinus (§ 1566) with the transverse sinuses (§ 1571).
It gradually becomes broader from before backward and is triangular.
The transverse and oblique cords are more numerous in the anterior part than they are in the superior longitudinal sinus.
Forward and upward it receives the inferior longitudinal sinus (§ 1567). The two large internal cerebral veins, or those of Galen ( V. magnæ Galeni ), also open into its anterior extremity, below the anterior and inferior root of the inferior longitudinal sinus.
d. Large internal sinus.
§ 1569. The large internal sinus takes up the blood from the inn er parts of the encephalon, and is formed principally on each side by the
VOL. II.
(1) Bichat, Anal, desc., vol. iv. p. 394.
45
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DESCRIPTIVE ANATOMY.
union of two vessels, the choroid vein and the vein of the corpus
striatum.
The first proceeds in the choroid plexus, along the pes hippocampi, goes forward with the choroid plexus between the corpus striatum and the posterior large cerebral ganglion, and receives in the latter part of its course numerous ramuscules of veins, which go from below upward, through the substance of the large cerebral ganglion, and extends to the anterior pillar of the fornix.
The second is formed by small veins, which arise from the substance of the large anterior cerebral ganglion or the corpus striatum. It goes from behind forward, in the channel grooved between the corpus striatum and the thalami optici, until it anastomoses by its anterior extremity with the corresponding extremity of the choroid vein.
It is sometimes double ; the posterior then passes above the thalami optici, and usually opens into the vein of Galen.
The latter, arising from the point mentioned, proceeds directly from before backward, that is, in a direction contrary to that of the two branches which produce it, under the fornix, in the prolongation of the pia mater, which penetrates within the brain, and on that of the arachnoid membrane, which accompanies it. It generally receives, near its posterior extremity, the superior and anterior veins of the cerebellum. It opens into the anterior extremity of the right sinus, very near that of the opposite side, with which it sometimes unites to form a trunk of but slight extent, the direction of which it sometimes but not always crosses.
e. Superior veins of the cerebellum.
§ 1570. The fourth sinus also receives the superior veins of the cerebellum, that is, the posterior, for the anterior empty in the veins of Galen.
These veins, which, like the anterior, cross the transverse grooves of the cerebellum, go backward, and the anterior forward. Proceeding at first from before backward and then forward, they penetrate to the posterior part of the fourth sinus, and sometimes also into the commencement of the transverse sinus.
f. Transverse or lateral sinuses.
§ 1571. The transverse or lateral sinuses (S. transversi, s. laterales ) are the largest, and descend on each side, in the transverse groove of the occipital bone, anastomose there with the fourth sinus and also with the upper longitudinal sinus, and terminate in the foramen lacerum, in the groove of the internal jugular vein.
That of the right side usually unites, but that of the left rarely, with the superior longitudinal sinus to form a short common trunk. Sometimes also the posterior extremity of the latter passes directly between the two lateral sinuses.
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That of the right side is most generally larger than that of the left.
We not uncommonly observe that one or even both of them is divided in a greater or less part of its course, by a transverse layer, into a superior and an inferior portion.
When this layer exists through the whole extent of the lateral sinus, the latter is completely double.
One of these two lateral sinuses is sometimes deficient. The superior longitudinal sinus then descends to the large occipital foramen, around which it turns to go to the posterior foramen lacerum.
The lateral and inferior veins of the cerebrum and the inferior veins of the cerebellum open into the lateral sinus.
The lateral and inferior veins of the cerebrum , the inferior cerebral veins, arise at nearly the centre of the skull, on the outside of the hemispheres, and usually unite in three trunks ; these are joined by a fourth, which comes from the lower face of the posterior lobe, separate from the cerebrum, go forward, and open separately from above downward at about the centre of each lateral sinus.
The inferior veins of the cerebellum, arise from the lower face of this organ, unite in two or three trunks, go backward and outward, and open from from below upward into the transverse sinus.
g. Superior petrous einu3.
§ 1572. In the place where the transverse sinus touches the posterior extremity of the petrous portion of the temporal bone, and leaves its horizontal direction to go obliquely upward, we see detached, from its outside, a much narrower sinus, the superior petrous sinus (S. pelrosus superficialis, s. superior ), which proceeds downward, inward, and forward, along the upper edge of the petrous portion of the temporal bone, where it terminates in the cavernous sinus, consequently unites this and the transverse sinus by anastomosis.
h. Inferior petrous portion.
§ 1573. The inferior petrous sinus (S. petrosus inferior, s. profundus) arises at the lower extremity of the transverse sinus, directly above the posterior foramen lacerum, from the anterior side of this sinus ; this is broader but shorter, and is situated between the anterior part of the petrous portion of the temporal bone, and the body of the occipital bone and is almost wholly situated in a fossa hollowed from the latter bone the posterior part of which is sometimes changed into a canal. This sinus proceeds from before backward and from without inward, which direction is preserved at its extremities better than in its centre ; it opens into the back part of the cavernous sinus, and establishes another large anastomosis between it and the transverse sinus.
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DESCRIPTIVE ANATOMY.
i. Cavernous sinus.
§ 1574. The cavernous sinus (S. cavernosus ), a considerable dilatation and of a very irregular form, is situated, on each side, on the lateral part of the body of the sphenoid bone. It anastomoses posteriorly with the posterior extremities of the two petrous sinuses, forward with the coronary sinus, and backward with the anterior occipital sinus.
Its cavity has numerous soft reddish irregular filaments which intercross and are arranged in a reticular form, from whence it takes its name.
The internal carotid artery and the sixth pair of the cerebral nerves pass through it, covered by its inner membrane, which is reflected on them and unites them.
It receives superiorly the anterior and middle inferior cerebral veins, forward the ophthalmic veins, downward, on the sides, the venous branches from the dura mater.
k. Coronary sinus.
§ 1575. The coronary sinus (S. circulons, s. coronoideus ) is generally much broader anteriorly than posteriorly, and surrounds the pituitary gland. Its anterior or posterior portion is often deficient. It is sometimes also partly double, which depends on the existence of a transverse branch which passes below the gland. It receives the vein from the pituitary gland, and sometimes also the ophthalmic veins.
/. Anterior occipital sinus.
§ 1576. The anterior occipital sinus (S. occipitalis , s. basilaris anterior ) extends transversely on the posterior face of the basilar process, from the union of the two petrous sinuses on each side, and the posterior extremities of the cavernous and coronary sinuses to the corresponding point of the opposite side. It thus forms a considerable anastomosis between the sinuses of the two sides, and represents a second crown, situated below the preceding, which communicates below with the analagous sinuses of the vertebræ.
m. Posterior occipital sinus.
§ 1557. The posterior occipital sinus ($. occipitalis , s. basilaris posterior) is sometimes single, sometimes and more frequently double. In the latter case we find a right and a left. It extends from the inner extremity of the two transverse sinuses, and the external occipital protuberance, along the posterior edge of the circumference of the large occipital foramen, encircles the posterior and the lateral portions of this foramen, and anastomoses in front with the lower extremity of the
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transverse sinus ; so that it forms a greater or less anastomosis between
the lower and the upper part of this sinus.
It is sometimes double at its summit and single in the centre, but it always divides very high up, above the occipital foramen, into a right and a left portion. It is generally not very large ; but it is frequently broad, and then the transverse sinus is smaller in a direct ratio.
It sometimes but not very often replaces this sinus either on one or both sides.
In other subjects, on the contrary, we cannot trace it in the least.
§ 1578. The transverse sinuses empty through the posterior foramen lacerum into a very short common trunk, which may be termed the internal and ‘posterior cephalic vein, or the encephalic vein ( V. cephalica interna posterior, s. cephalica encephalica, s. cerebralis), and thus contrast it, according to the analogy of the arteries, to the external and anterior cephalic vein, or to the facial vein.
This trunk is situated very deeply, and descends outside of the trunk of the internal carotid artery, on the inside of the' posterior belly of the digastricus muscle. It extends from the posterior foramen lacerum to the upper edge of the larynx, where it anastomoses with the anterior cephalic vein.
It receives anteriorly the pharyngeal and the lingual veins, which generally empty separately, although they often unite with each other and with the superior thyroid vein.
II. PHARYNGEAL VEIN.
§ 1579. The pharyngeal vein (V. pharyngea) descends on the posterior and lateral part of the pharynx, and anastomoses very frequently with that of the opposite side. It is often double on one side ; in this case, one of the two most generally arises from the thyroid vein.
III. LINGUAL VEIN.
§ 1580. The lingual vein ( V. lingualis ) arises from the end of the
tongue, enters between the myio-hyoideus muscle, the genio-glossus
muscle, and the submaxillary gland, proceeds along the upper edge of
the hyoid bone, before the hyo-glossus muscle ; thus its direction is
backward, and it opens into the internal cephalic vein, either by a
common trunk with the preceding, or below it.
III. INTERNAI, JUGULAR VEIN.
§ 1581. The anterior and posterior cephalic veins unite near the hyoid bone, to form the internal jugular vein ( V. jugularis internal), which might be more properly termed by analogy with the arteries, the common cephalic vein ( V. cephalica communis). This vessel descends almost perpendicularly on the anterior and lateral part of the neck, out
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side of the primitive carotid artery and the pnenmo-gastric nerve, inside of the sterno-cleido-mastoideus and the omohyoideus muscles,
comes to the anterior extremity of the clavicle under whieh it passes
and unites with the subclavian vein, to form the trunk of the innominata.
I. SUPERIOR THYROID VEIN.
§ 1582. In this course the internal jugular vein receives some distance below the union of the external and internal cephalic veins, a vein sometimes single and sometimes double, which often forms a common trunk with the pharyngeal and lingual veins, this is called the superior thyroid vein ( V. thyroidea superior) : it corresponds exactly in its distribution to the artery of this name, but differs from it very constantly in its termination. It always empties into the common trunk of the external and internal cephalic veins. It not unfrequently divides, some distance from its insertion, into an upper and a lower branch, one of which ascends and the other descends. The superior thyroid artery, however, sometimes imitates the vein in this respect, and this anomaly frequently occurs, because it resembles the normal form of the vein.
II. INFERIOR THYROID VEIN.
§ 1583. The internal jugular vein also receives in its course, one or two inferior or middle thyroid veins ( V. thyroideœ mediœ, s. inferiores , s. descendentes), which arise from the outside of the lower half of the thyroid vein and empty higher or lower into it.
This formation is remarkable also, as the superior or the inferior thyroid artery sometimes partially or wholly arises on one or both sides, from the common trunk of the carotid arteries, and consequently resembles the normal arrangement of the veins.
IV. EXTERNAL JUGULAR VEIN.
§ 1584. The external jugular vein (V. jugularis externa) is much smaller than the internal, and forms the superficial or cutaneous vein which corresponds to the latter. It arises as high as the angle of the lower jaw, from the back side of the internal, goes outward under the parotid gland, and receives first in this place the posterior auricular vein ( V. auricularis posterior ), and then descends vertically between the platysma myoides and the sterno-cleido-mastoideus muscles, crosses the direction of the latter, and is placed on the inside of the omohyoideus muscle. Its lower portion corresponds to the inside of the sterno-cleido-mastoideus muscle, and is much deeper than the superior. It opens into the subclavian vein outside of the internal jugular vein. In order to this, it generally passes on the inside of the clavicle, but it is also sometimes reflected on this bone, from without inward.
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359
Its lower extremity is often divided into two branches which ascend
more or less high.
Not unfrequently that part of its upper extremity which we have before mentioned as being that by which it arises from the internal jugular vein, is only a small anastomotic branch, and the external jugular vein is so large above this point, that it receives the common trunk of the temporal vein and of the posterior internal maxillary vein, which does not enter as usual into the anterior cephalic vein.
I. SUPERIOR SUPERFICIAL OCCIPITAL VEIN.
§ 1585. The external jugular vein receives a little way below the inferior posterior auricular vein (§ 1584) the superior superficial occipital vein ( V. occipitalis superficialis superior ), which descends between the skin and the occipitalis muscle.
Next come some deeper branches, which arise from the lateral and posterior muscles of the neck.
II. INFERIOR SUPERFICIAL OCCIPITAL VEIN.
§ 1586. The inferior superficial occipital vein ( V. occipitalis superficialis superior) arises behind the superior, between the trapezius and the splenius muscle, some distance behind the external jugular vein, descends and empties into the latter at the lower part of the neck.
III. POSTERIOR AND SUPERIOR SCAPULAR VEINS.
§ 1587. Below, the external jugular vein receives posteriorly, the superior and the posterior scapular veins which accompany the arteries of the same name, and anastomose together and with the cephalic vein of the arm.
IV. ANTERIOR CUTANEOUS VEINS.
§ 1588. Before, it receives the anterior cutaneous veins of the neck, distinguished into the upper, the middle, and the lower. These veins arise from the skin and the anterior muscles of the neck, and frequently anastomose above with the inferior branches of the facial veins.
t
ARTICLE SECOND.
VEINS OP THE UPPER EXTREMITIES.
§ 1589. The blood of the upper extremities returns to the heart by the deep and the superficial veins.
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DESCRIPTIVE ANATOMY.
I. DEEP VEINS.
§ 1590. The deep veins follow the arteries of the same name, each of which is usually attended by two veins which proceed at its sides.
II. SUPERFICIAL VEINS.
§ 1591. The superficial or the cutaneous veins are much larger than the preceding, and proceed under the skin, between it and the brachial aponeurosis.
Their roots, or the digital veins, arise principally from the back of the fingers, where we find from six to eight branches, situated at the side of one another, which frequently anastomose together. These branches also receive the largest veins which proceed along the palmar face of the fingers, which, at the height of the second or the first phalanx, leave this face to go to the dorsal.
We may refer these veins to two principal trunks, the radial vein, and the ulnar vein.
I. CATANEOUS RADIAL VEIN.
§ 1592. The cataneous radial vein, or the brachial cephalic vein (V. brachialis radialis catanea s. cephalica ), arises from the thumb and the index finger, and is called the cephalic vein of the thumb ( V. cephalica pollicis) proceeds on the back of the hand, in the space between the first two metacarpal bones, at first along the radial edge of the forearm, then along the anterior side of the arm, outside the biceps flexor muscle, passes between the pectoralis major and the deltoides muscle, and empties in the subclavian vein, below the clavicle.
II. CUTANEOUS ULNAR VEIN.
§ 1593. The cutaneous ulnar or basilic vein (V . brachialis cutanea ulnaris, s. basilica) arises from the dorsal face of the third finger, often also from all the space between the back of the index and that of the little finger, and forms, on the back of the hand, a considerable network, which anastomoses in front with the cephalic vein of the thumb. Sometimes, when it comes on the back of the carpus, it goes forward toward the radius, and anastomoses, from the lower extremity of the forearm, with the preceding, with which it always communicates on the anterior and posterior faces of the limb, by means of several large branches, which form a broad network. It almost always forms in the forearm the anterior cutaneous ulnar vein ( V. ulnaris cutanea anterior ■), and the posterior cutaneous ulnar vein ( V . ulnaris cutanea posterior), the latter being generally larger than the former.
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361
After leaving the articulation of the elbow it ascends, under the brachial aponeurosis, on the inside of the arm, along the ulnar nerve which
it covers, and empties into the lower extremity of the axillary vein.
III. MEDIAN VEIN.
§ 1594. The median vein (V. mediana) is a large branch which serves to anastomose the radial and ulnar veins and also the superficial and the deep veins of the arm. It is generally single, but is sometimes double ; its length varies, and it extends obliquely upward and backward, from the ulnar to the radial vein, as high as the flexor carpi ulnaris muscle. It generally sends one or more considerable branches, which anastomose with the anterior part of the deep brachial vein, or of the deep radial or ulnar vein. These branches are sometimes replaced by others of the cutaneous radial vein. The lower part of this vein is called the median cephalic , and its upper part the median basilic vein.
Sometimes the median vein ascends on the anterior face of the forearm, between the cephalic and the basilic vein, with which it communicates by numerous anastomoses ; it is generally termed the common median vein ( V. mediana communis).
III. AXILLARY VEIN.
§ 1595. The axillary vein ( V. axillaris) arises at the lower extremity of the axilla, from the union of the basilic with one of the brachial veins, most frequently the internal and posterior. It ascends directly before the axillary artery, receives in the centre of its course the second' vein of the arm, the external thoracic and subscapular veins, finally comes under and behind the clavicle, and is called the subclavian vein when it reaches the upper extremity of the serratus magnus muscle.
IV. SUBCLAVIAN VEIN.
§ 1596. The term subclavian vein ( V . subclavia) is usually applied to all that part of the system of the descending vena-cava which is included between the latter and the upper extremity of the axillary vein. Some anatomists, as Bichat, consider the upper part of the veins of the pectoral extremity, which extends to the scalenus anticus muscle, as also belonging to the axillary vein, and consider the subclavian vein as commencing only in this place, contrary t.o all analogy with the arrangement of the arteries. It would be more proper then to confine it to the external portion of this trunk, which extends from the upper extremity of the serratus posticus to the scalenus anticus muscle.
This proper subclavian vein receives the external jugular vein, which then empties into it (§ 1584) from below upward.
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DESCRIPTIVE ANATOMY.
ARTICLE THIRD.
INNOMINATA VEIN.
§ 1597. The innominata vein ( V. anonyma ) is generally known as the subclavian vein ; but it is more convenient to conform with the analogy of the arteries, and to apply to it the first term. It is formed on each side by the union of the internal and external jugular and the subclavian veins. The scalenus anticus muscle separates it from the corresponding artery ; it passes before this muscle while the artery proceeds behind it.
The left innominata vein is nearly twice as long as the right. It goes almost transversely or at least very obliquely downward and to the right, directly before and above the arch of the aorta, and above the upper edge of the sternum, leaving the sternal extremity of the left clavicle.
The right leaves the sternal extremity of the right clavicle, goes more vertically downward and to the left, unites at an acute angle with that of the left side, above the cartilages of the first rib, and thus gives rise to the descending vena-cava.
We may consider the inner third of the left subclavian vein as corresponding to the upper part of the arch of the aorta. The trunk of the descending vena-cava represents the beginning of this latter artery. The innominata vein of the right side corresponds perfectly to the innominata artery.
The innominata vein receives on each side the vertebral , the superior intercostal , the internal mammary , the superior diaphragmatic , the thymic, the superior cardiac, and the lowest thyroid veins.
I. VERTEBRAL VEIN.
§ 1598. The vertebral vein (V. vertebralis) accompanies the vertebral artery, before which it is placed. It anastomoses above with the occipital sinus, in its course from above downward and inward, by intermediate branches, with the vertebral sinuses of the neck, resumes the blood of the deep muscles of the neck by external branches, and often divides, at its lower extremity, into two roots, of which the upper emerges with the vertebral artery, through the vertebral foramen of the sixth cervical vertebra, while the lower emerges from that of the seventh either alone or at least attended only by a small arterial vessel.(l)
According toBichat, that of the right side passes before, and that of the left side behind the pneumo-gastric nerve and the subclavian artery.
(t) Eustachius, Dc ossibus, in Opp. omn., p. 191.
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But this arrangement is by no means general. At most, the inferior
root of the right vertebral vein, which passes through the vertebral
foramen of the seventh cervical vertebra, usually goes behind these
parts.
II. SINUSES OF THE VERTEBRAL COLUMN.
§ 1599 . The sinuses of the vertebral column ( S . columnœ vertebralis)( 1 ) are situated on the posterior face of the bodies of the vertebra, before the dura mater, are formed by two long lateral trunks and by numerous transverse anastomosing branches, which are not, like the sinuses of the skull, formed by the dura mater of the inner membrane of the veins, and which, instead of adhering intimately to the meningeal sinus, are retained between it and the bone by a loose cellular tissue.
The two trunks descend on the two sides of the posterior face of the bodies of the vertebrae, empty principally into the vertebral vein, with which they continue through the anterior condyloid foramen of the basilar bone, empty also the blood into the anterior occipital sinus, with which they communicate at least by considerable anastomoses, contract very much on the intervertebral ligaments, especially in the lumbar region, diminish singularly in caliber at the sacrum, approach each other in this place, and arise by several minute branches from the fat which surrounds the dura mater.
They anastomose together on each vertebra by several large tortuous transverse branches (circelli venosi). Hence each of these bones has a proper venous crown, similar to that at the base of the skull, and corresponds finally to the whole venous system of the interior of the skull, and opens externally into the adjacent veins, between each pair of vertebra.
The two longitudinal trunks are also united at their inferior extremity by a large transverse posterior branch, which corresponds to the anterior transverse branch of the coronary sinus of the skull (§ 1575 ).
These trunks anastomose outwardly with the posterior branches of the vertebral, intercostal, lumbar, and sacral veins, through the intervertebral foramina. The transverse branches receive anteriorly numerous branches, which come from the substance of the bodies of the vertebras, and posteriorly those which arise from the dura mater.
The branches which enter the external veins, which we have mentioned first, carry outward the blood which the sinuses of the vertebral column have received from the dura mater and from the vertebra.
From this description it follows that each vertebra, consequently also each corresponding section of the spinal marrow, particularly in the early periods of life when the spinal cord occupies the whole vertebral column, has its proper venous system, and that all these systems anastomose together and form a chain of rings.
(I) G. Breschet, Essai sur les veines du rachis, Paris, 1819.
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DESCRIPTIVE ANATOMY.
III. SUPERIOR INTERCOSTAL VEIN.
§ 1600. The superior intercostal vein (V. imtcrcostalis supremo) is almost as large as the azygos vein (§ 1605), is much larger on the left than on the right side, and is often only a branch of the vertebral vein. When it is distinct and separate from the latter, it empties from below upward into the trunk of the innominata. Its roots extend below the eighth rib. It arises from the intercostal spaces, the left lung, the left bronchial vein, the esophagus, the aorta, &c., and anastomoses by its lower branches with the right and left azygos veins, unites to the first, and always proceeds at the left side of the second. It is as much longer as the left azygos vein is shorter, and resembles the right azygos vein as the branches of anastomosis between it and the left are larger. It proceeds downward, along the vertebral column, behind the pleura.
§ 1601. The internal mammary vein, the superior diaphragmatic vein, &c., correspond precisely to the arteries of the same names. The lowest thyroid vein alone differs.
IV. LOWEST THYROID VEIN.
§ 1602. The innominata veins receive from above downward, usually on the right and left, or at least on one side, the lowest thyroid vein (V. thyroidea ima ). The right is nearer the outer extremity of the right innominata vein than the left is to that of its own ; and the latter almost corresponds to the median line, while the other is thrown still more to the right, although the latter arises from the left lobe of the thyroid gland.
Its constant existence deserves attention, because the lowest thyroid artery, which is not common, is a repetition of it.
CHAPTER III.
TRUNK OF THE SUPERIOR VENA-CAVA.
§ 1603. The superior or descending vena-cava ( V . cava superior , s. descendens ) is formed by the union of the two innominata veins, a little above the arch of the aorta, near the cartilage of the first rib on the right side. Thence it descends to the upper and right part of the right ventricle. Its direction is nearly vertical, a little oblique however from right to left and from behind forward. It proceeds on the right side of the aorta, and it is inclosed for the space of about two inches in the sac of the pericardium. Its upper part is loose and covered on the right b} r the summit of the right lung, on the left by the aorta, backward by the right superior pulmonary vein, forward by the cartilage of the upper eighth rib of the right side. It is situated entirely on the right.
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365
§ 1604. This is its usual arrangement; but sometimes, although
very rarely, we find two descending venæ-cavæ, and then the two
trunks of the innominata vein are not united. We have before us two
instances of this anomaly, which has been mentioned also byBœhmer,(l)
Murray, (2) and Niemeyer.(3) In this case the right descending venacava descends before the aorta, turns backward and outward around
the left auricle, comes on the lower face of the heart, goes forward in
the circular groove, reaches the right auricle, and opens into its lower
and posterior part.
This anomaly is very curious, on account, of its analogy with what is seen in several mammalia and in several reptiles.
CHAPTER IV.
AZYGOS VEIN.
§ 1605. The descending vena-cava receives no branch in the pericardium: at least it is extremely rare that the azygos vein empties into it within the pericardeal sac. (4)
But directly after leaving the pericardium, it receives at its posterior part, the azygos vein ( V . azygos , s. sine pari), which opens still more rarely into the right auricle than into that portion of the vena-cava enveloped by the pericardium, and it more frequently opens into the venacava much higher than usual.
This vessel forms a large anastomosis between the descending and the ascending vena-cava, for it arises from the latter by numerous branches, and empties into the former.
It does not perfectly deserve its name, since we find on the left side also a vessel which corresponds to it, the small semi-azygos -vein (F, hemiazygos) : this latter does not however extend as high.
In the cases where this vein is thought to be doubled, (5) there is no new and unusual trunk, but generally, only a simple change in respect to capacity. This second azygos vein, which always exists on the left side, is only ah extraordinary development of the left superior intercostal vein, which constantly anastomoses by considerable branches with the right and left azygos veins. In this case there is only a diminution, a contraction of the branches which anastomose between the common left and the right azygos vein, and likewise between the latter and left superior intercostal vein, with a considerable increase of the left azygos vein, whence a trunk is formed which occupies the left side, but Avhich always,, empties into the corresponding subclavian vein at the usual place. •
(1) De confluxu triarum venarum cavarum, Halle, 1763.
(2) Neue Schwedische Abhandlungen, vol. ii. p. 286.
(3) Defœtu ; puellari difformi , Halle, 1814.
(4) Cheselden, Phil. TV., No. 337.
(5) See our Handbuch der pathologischen Anatomie, vol. ii. p. ii, p. 127.
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DESCRIPTIVE ANATOMIC,
We have sometimes observed, in a similar case, a very curious
formation, the insertion of the right azygos vein much higher than
usual, and once even in the trunk of the vena-innominata of the right
side.(l)
This greater development of the left azygos vein, and its union with the left upper intercostal vein in a common trunk are not rare, but the lateral insertion of this vessel is much less common ; here the right azygos vein empties into the left, which is much larger, and its trunk does not terminate in the descending vena-cava, but in the left subclavian vein. (2)
The azygos vein arises below on the' two sides, by considerable branches, either directly from the ascending vena-cava, or from the renal or the first lumbar veins, most generally by several of these vessels at once.
The trunks formed by the union of these branches, the right and the left, the former of which is the proper, or rather the right azygos vein, and the latter the semi-azygos, or more properly the left azygos vein, pass, sometimes with the aorta through its opening, sometimes more outwardly, through the diaphragm.
The trunk of the right side proceeds forward and to the right on the side of the esophagus, before the right intercostal arteries, on the anterior face of the vertebral column. It receives behind and on the right the ten or eleven inferior intercostal veins, of which the inferior ascend, the central are transverse, and the superior descend. Two or three of the latter generally unite in a single trunk. They all proceed below and before the intercostal arteries.
The right azygos vein receives anteriorly the esophageal and the right bronchial veins.
It receives on the left side, and nearly upon the seventh or the eighth dorsal vertebra, the semi-azygos or the left azygos vein, which passes behind the thoracic canal and on the vertebral column to come to it, after receiving the five or six inferior intercostal veins.
This left azygos vein is sometimes double ; when this is the case, another, which is superior and smaller, anastomoses with it, and empties into the right azygos vein, when the superior left intercostal vein is smaller than usual.
The right azygos vein anastomoses, by transverse branches, on the anterior face of the bodies of the vertebrae, with the superior intercostal vein.
Similar anastomoses exist also between it and the left trunk, so that the formation of the venous system on the anterior face of the bodies of the vertebrae resembles that on their posterior face.
(1) Wrisberg has once observed the same thing ( loc . cit., vol. i. p. 136.) This arrangement of the right azygos vein does not necessarily exist whenever the left is unusually developed.
(2) We have seen this case once. Wrisberg is the only author (loc. cit., obs. iii. p. 142-145) who mentions it.
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367
CHAPTER V.
VEINS OF THE LOWER EXTREMITIES.
§ 1606. The veins of the lower extremities like those of the upper extremities, are divided into deep and superficial veins.
I. DEEP VEINS.
§ 1607. The deep veins which accompany the arteries, and with which they are closely connected on both sides, are double almost to the knee, but in such a manner that the two synynomous veins already unite with each other at some distance from then: upper extremity. After leaving the ham they are single.
I. POPLITEAL VEIN.
§ 1608. The popliteal vein ( V. poplitea) is single, and arises from the union of the anterior and posterior tibial and fibular veins ; it is situated backward and a little on the outside of the popliteal artery. It is more superficial than this artery, and intimately adheres to its parietes.
II. CBURAL VEIN.
§ 1609. The superficial crural vein (V. femoralis superficialis), by which term the preceding vein is designated, after it passes through the tendon of the adductor magnus muscle, comes on the inside of the crural artery, which partly covers it ; it is then situated more deeply than this artery.
III. DEEP CRURAL VEIN.
§ 1610. The deep crural vein (V. femoralis profunda) is generally more superficial than the artery of the same name.
IV. COMMON CRURAL VEIN.
§ 1611, The superficial and the deep crural veins unite and give origin to the common crural vein (V. cruralis s. femoralis communis), which is situated more inward and backward, and consequently more deeply than the corresponding artery. It is placed on the inside of this vessel, and is separated from it by the crural nerve. It passes under the crural arch to enter the abdomen.
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DESCRIPTIVE ANATOMY.
II. SUPERFICIAL VEINS.
§ 1612. There are two superficial veins called the saphena (V. saphena,), which carry back the blood from the skin of the lower extremities. They are distinguished into external and internal.
I. INTERNAL SAPHENA VEIN.
§ 1613. The internal saphena vein ( V. saphena , s. saphena interna, s. magna , s. cephalica pedis ) ' arises by a deep branch, situated below the layer of cellular substance, from most of the inside of the toes, like the superficial veins of the arm, and is composed on the back of the foot of several branches, which form a considerable network ; it proceeds forward and backward along the internal and upper part of the tarsus, passes from the internal malleolus to the internal and anterior part of the leg, thus comes behind the inner condyle of the femur, then goes to the inside of the thigh, ascends along its inferior part before the gracilis or the adductor longus muscle, passes through the fascia lata aponeurosis, about one inch below the crural arch, and empties outward and backward into the common crural vein.
A second branch which is more superficial, and situated directly below the skin, arises from the inner and anterior part of the leg, sometimes also only ’ from the inside of the tibio-tarsal articulation, often anastomoses with the preceding in this place, ascends on the anterior internal side of the thigh, and unites with the preceding, directly below its confluence with the crural vein. There it receives the superficial internal crural vein, and also most of the external pudic and subcutaneous abdominal veins, which descend outward to come to it.
II. EXTERNAL SAPHENA VEIN.
§ 1614. The external saphena vein ( V . saphena externa) is much smaller than the internal with which it communicates at its origin. It arises on the outside of the back of the foot, goes backward and upward under the external malleolus, approaches the tendo Achillis, reaches the centre of the posterior part of the summit of the leg, is situated in the ham on the inside of the tibial nerve, and empties a little above into the popliteal vein.
HI. EXTERNAL ILIAC VEIN.
§ 1615. The external iliac vein (F. iliaca externa, s. anterior ) is the direct continuation of the common crural vein, (§ 1612) and ascends behind and on the inside of the external iliac artery and along the iliacus internus muscle. At its lower extremity it receives the epigastric and the circumflex iliac veins.
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IV. HYPOGASTRIC VEIN.
§ 1616. The hypogastric vein ( V. hypogastrica, s. iliaca posterior, s. inferior) arises by branches which correspond to those of the hypogastric artery, from the external and internal parts of the pelvis, consequently from the glutei muscles, the genital organs, the bladder, and the lower part of the rectum. The umbilical arteries which are the continuation of the hypogastric trunk in the fetus, alone have no corresponding vein, as the umbilical vein goes to the liver.
The twigs are here very considerable in proportion to the branches, so that these vessels form plexuses, which are termed according to the parts whence they arise, the hemorrhoidal plexus {plexus hemorrhoidalis),ih.einternalandexternalpudicplexus (P . pudendalis internus et externus ), the vesical plexus (P. vesicalis ), the sacral plexus (P. sacralis), the vaginal plexus (P. vaginalis), and the uterine plexus (P. uterinus).
V. PRIMITIVE ILIAC VEIN.
§ 1617. The external iliac and hypogastric veins unite to form a short trunk called the primitive iliac vein ( V. iliaca primitiva , s. communis). This trunk proceeds from below upward, and from without inward. It unites at an obtuse angle with that of the opposite side, on the anterior face of the fifth lumbar vertebra, and on the right to form the ascending vena-cava.
The right trunk is shorter than the left, exactly as the common trunk of the subclavian and jugular veins on the right side, a little less so however than the latter. It also ascends a little more vertically.
The right is placed behind and outside of the primitive iliac artery, the left behind and on the inside of this artery, before which its upper part passes.
These two trunks always unite below and on the right of the bifurcation of the primitive iliac artery, so that the upper part of the left primitive iliac vein is situated below the commencement of the right primitive iliac artery.
CHAPTER VI.
ASCENDING VENA-CAVA.
s
1618. The inferior or ascending vena-cava {vena-cava inferior , s. ascendens) extends from the fourth or the fifth lumbar vertebra, to the lower part of the right amide. It is always much larger than the superior. In its whole course, it is situated on the right of the vertebral column, at the side of the aorta which is partly covered by it.
Below and in most of its extent, it proceeds perpendicularly upward, but its upper part inclines to the right, so that it there takes an oblique
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37a
DESCRIPTIVE ANATOMY.
direction. This part is situated in a particular depression of the posterior edge of the liver, sometimes even it is surrounded entirely by the
substance of this gland, from which it can be easily separated.
Directly below the liver, it passes through the square opening of th diaphragm, enters the chest, and opens there directly from below upwards, into the right auricle.
§ 1619. This is the common arrangement of the ascending venacava.
The anomalies it presents, relate to the number , the situation , and the insertion of the vessel.
1st. A rare anomaly is where the ascending vena-cava divides into two trunks ; it presents several degrees.
The least anomaly seems to be that where the left side of the ascending vena-cava gives off, a little below the renal veins, a vessel which ascends behind the aorta to go to the left renal vein, with which it anastomoses, so that these two veins form around the trunk of the aorta a plexus, whence arise all the renal veins of the corresponding side.
We have seen this arrangement several times. In fact there seems then to be a double renal vein ; but when we consider that this vessel passes behind the aorta to empty itself into the upper renal vein, and when we regard the following series of anomalies, we cannot but consider it as indicating the doubling of the trunk of the ascending venacava.
We sometimes see too, in the place where the ascending vena-cava arises from the confluence of the two primitive iliacs, an accessory vessel which varies in size, and ascends on the left of the aorta, and opens either into the vena-cava or into the left renal vein.(l)
When the division is more marked the two trunks which proceed on the right and the left of the aorta are still more similar. Zimmermann, (2) Wilde, (3) and Pætsche,(4) have described cases of this kind The division always commenced as high as the renal veins, and the two trunks anastomose together, on the fifth lumbar vertebra, by a small transverse branch.
The division of the ascending vena-cava into two trunks more rarely depends on the fact that the hepatic veins do not unite with it. The first degree of this anomaly is where the hepatic veins open into the ascending vena-cava higher than usual, above, and not below, the diaphragm, as Huber(5) and Morgagni(6) have observed. It exists in the highest possible degree when the trunk of the hepatic veins empties the blood into the right auricle. (7)
(1) Morgagni, Dc.sed. el. cans, morb., tp. 47, a. 30. — Peh!, De venar. var., 1773. —We have seen this anomaly several limes.
(2) Dc notanclis circa naturcc h umanœ machinœ lusis , Duisburg, 1750, p. 54, 55.
(3) Comm. Petrop.. vol. xii. p. 312, vol. viii. fig. 1-2.
(4) Sylloge, obs. an., in the Hall. coll, dis., vol. vi.
15) Obs. anat ., Cassel, 1760, p. 34.
rfj) De sed. et caus. morb., ep. 60, a. 6.
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All these anomalies are remarkable, as they establish an analogy
between man and most reptiles and fishes, and also between the abdominal and the thoracic veins.
2d. The ascending vena-cava exists sometimes on the left, and not on the right side of the vertebral column, not only where the viscera generally are inverted, but even when the latter case does not exist. ( 1 )
3d. The anomaly is greatest when the vein opens into the left auricle, (2) which depends on the development being arrested.
§ 1620. The ascending vena-cava receives the lumbar , the spermatic, the splenic , the capsular , the inferior diaphragmatic, and the hepatic veins.
I. LUMBAR VEIN'S.
§ 1621. There are three or four lumbar veins (V. lumbares ) which correspond to the lumbar arteries and empty into the ascending venacava. The left, which pass behind the aorta, are longer than those of the right. All anastomose with each other, and with the vertebral sinuses, through the intervertebral foramina (§ 1599).
II. SPERMATIC VEINS.
§ 1622. The spermatic veins (V. spermaticce ) usually open the right into the anterior part of the ascending vena-cava, some distance below the right renal vein ; the left opens more externally than the preceding into the left renal vein.
These veins, particularly the left, are divided at a greater or less distance from their union, an arrangement remarkable as being a greater development of the type of the left side. Hence results a plexus called the corpus pampiniforme.
III. RENAL VEINS.
§ 1623. The renal or emulgent veins ( V. renales emidgentes ) are usually single, and are numerous more rarely than the arteries, even where the latter vary. They are situated also farther forward than they.
The left is much longer than the right. It arises higher than it, opens into the vena-cava at more of a right angle, and usually passes before the aorta to go to it.
We not unfrequently find it behind the aorta, (3) an anomaly, to which that leads where the vein divides into an anterior and a posterior trunk, which pass, the latter behind, the former before the aorta, beyond which they are frequently again blended into one,
(1) Morgagni, Ep. anat., m. 56, a. 31.
(2) Ring, in the Med. and phys. journ., vol. xiii, p. 120.— Lemaire, in the Bull, des sc. mêd., vol. v. 1810.
(3) Albinas, Annot. acad., b. vii. c. 2.— Sandifort, 05«, an. path., b. i. c. 5 ; b, iv. c. 8.
We have often seen this anomaly.
372
DESCRIPTIVE ANATOMY
IV. CAPSULAR VEINS.
§ 1624. The capsular veins (V. capsulares) open, the right almost always into the ascending vena-cava, the left, on the contrary, into the left renal vein, nearly about its centre.
V. HEPATIC VEINS.
§ 1625. We may distinguish the hepatic veins (V. hepatic«) into large and s'mall.
The small are more numerous than the large. They empty into that portion of the ascending vena-cava, which ascends behind the liver, and are arranged irregularly in pairs one at the side of another. We number about twelve.
The large are much larger. They emerge from the posterior edge of the liver, much nearer its upper than its lower face, and empty into the anterior part of the vena-cava, directly below its passage through the square opening of the diaphragm.
There are usually two which open into the vena-cava near each other.
The right is smaller, and almost always a little deeper, and belongs entirely to the right lobe.
The left is much larger, especially in the fetus, and divides directly below its insertion into the ascending vena-cava, into two trunks, of which the right belongs to the inner part of the right lobe, and the left to the left lobe only.
VI. INFERIOR DIAPHRAGMATIC VEINS.
§ 1626. The inferior diaphragmatic veins ( V. phrenicœ inferiores) accompany the arteries of the same name, and empty either into the large hepatic veins or enter into the vena-cava, directly before it passes through the diaphragm.
CHAPTER VII.
SYSTEM OF THE VENA PORTA.
§ 1627. The vena porta (V. portarum)(l), an extremely curious phenomena in the organism, is a small separate system, inclosed in the large, the roots of which arise from the intestinal canal, where it communicates with the system of the aorta by branches of the visceral and mesenteric veins, and which are distributed, like arteries, in the liver, where it unites by means of the hepatic veins (§ 1628) in the venous system of the body.
(1) Walter, De venä port, exerc. anat ., Leipsir, 1739, Exerc. anat ., vol. ii. 1740. — Hœnlein, Descriptiovenæ portarum, Frankfort, 1809.
It is very unfrequently directly continuous with the venous system
of the body, and then it does not ramify in the liver, but empties
directly into the ascending vena-cava, of which it forms a ramification^ 1) In this case the hepatic artery is larger than usual.
1. VENOUS PORTION.
§ 1628. The venous portion of the vena-porta is formed principally by three large trunks, the coronary vein of the stomach, the splenic and the mesenteric veins, which unite to produce the middle part or the trunk of the vena-porta.
I. CORONARY VEIN OF THE STOMACH:
§ 1629. The coronary vein of the stomach ( V . coronaria ventriculi superior) corresponds to the artery of the same name. It is the smallest of the three branches. It empties from left to right, and from above dow’mvard into the trunk of the vena-porta, behind the piloric portion of the stomach. The constancy of its separation with the two other veins seems to be the cause why the cœliac artery divides so frequently into several trunks.
II. SPLENIC VEIN.
§ 1630. The splenic vein (V. splenica ) not only takes up the blood from the spleen, the omentum, most of the- stomach, the pancreas, and the duodenum, but receives also, shortly before it terminates, the last epiploic vein, and thus corresponds to the inferior mesenteric artery, so that consequently this latter is a subordinate trunk.
III. MESENTERIC VEIN.
§ 1631. The mesenteric vein ( V . mesenterica , s. mesaraica ) receives the veins of the small intestine, of the ascending and transverse colon. Consequently, it corresponds to the superior mesenteric artery. In the early periods of fetal existence, it receives the omphalo-mesenteric vein, which arises from the umbilical vesicle and commonly disappears at the third month of pregnancy.
(1) These cases are extremely rare. We know of but four instances, only two of which are authentic. Lieutaud mentions one of the first class from Bauhin, (Hist, anat. meet ., vol. i. p. 190), and Huber mentions another ( obs . anal., p. 34) ; but perhaps he means the trunk of the hepatic veins, which is probable. The authentic instances have been mentioned by Abernethy (Ph. XV., 1793, vol. i. p. 59-63), and Lawrence (Med. ch. tr., vol. v. p. 174). These anomalies are very important in the history of the secretion of bile, and likewise for the theory of the primitive part of the venaporta, and because they establish an analogy with the invertebral animals.
II. TRUNK AND ARTERIAL PORTION OF THE VENA-PORTA,
§ 1632. These last two branches, in uniting at a right angle, form the trunk of the vena-porta, the walls of which are thicker than those of its venous portion. This trunk proceeds obliquely upward to the right, behind the second curve of the duodenum, having in front the hepatic artery, the biliary ducts, the lymphatic glands, and the hepatic plexus, with which parts it is united by a common envelop, which comes from the peritoneum, the capsule of Glisson ( capsula Glissonii). It ascends before the vena-cava, and is much larger than it. Near the right extremity of the transverse fissure of the liver, it divides at an acute angle into from two to five branches, of which the right is larger and shorter, goes directly to the right lobe of this gland, while the left is smaller and longer, proceeds transversely in the fissure, and enters into the left lobe.
The latter, in the fetus, receives the umbilical vein, and gives off posteriorly the venous canal, which goes into the ascending vena-cava. These two vessels will be mentioned in the history of the fetus.
In describing the liver, we shall mention the distribution of the arterial portion of the vena-porta.
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