Part 48 (2/2)

In support of this a.n.a.logy of both organs, which is here, so far as I am aware, originally enunciated for anatomical science, I record the following observations:--1st. Between the opposite parts of the same organic ent.i.ty (between the opposite leaves of the same plant, for example), nature manifests no such absolute difference in any case as exists between the leaf of a plant and of a book. 2ndly. When between two opposite parts of the same organic form there appears any differential character, this is simply the result of a modification or metamorphosis of one of the two perfectly similar originals or archetypes, but never carried out to such an extreme degree as to annihilate all trace of their a.n.a.logy. 3rdly. The liver and the spleen are opposite parts; and as such, they are a.s.sociated by arteries which arise by a single trunk (coeliac axis) from the aorta, and branch right and left, like indices pointing to the relations.h.i.+p between both these organs, in the same manner as the two emulgent arteries point to the opposite renal organs. 4thly. The liver is divided into two lobes, right and left; the left is less than the right; that quant.i.ty which is wanting to the left lobe is equal to the quant.i.ty of a spleen; and if in idea we add the spleen to the left lobe of the liver, both lobes of this organ become quant.i.tatively equal, and the whole liver symmetrical; hence, as the liver plus the spleen represents the whole structural quant.i.ty, so the liver minus the spleen signifies that the two organs now dissevered still relate to each other as parts of the same whole.

5thly. The liver, as being three-fourths of the whole, possesses the duct which emanates at the centre of all glandular bodies. The spleen, as being one-fourth of the whole, is devoid of the duct. The liver having the duct, is functional as a gland, while the spleen having no duct, cannot serve any such function. If, in thus indicating the function which the spleen does not possess, there appears no proof positive of the function which it does, perhaps the truth is, that as being the ductless portion of the whole original hepatic quant.i.ty, it exists as a thing degenerate and functionless, for it seems that the animal economy suffers no loss of function when deprived of it. 6thly.

In early foetal life, the left lobe of the liver touches the spleen on the left side; but in the process of abdominal development, the two organs become separated from each other right and left. 7thly. In animals devoid of the spleen, the liver appears of a symmetrical shape, both its lobes being equal; for that quant.i.ty which in other animals has become splenic, is in the former still hepatic. 8thly. In cases of transposition of both organs, it is the right lobe of the liver--that nearest the spleen, now on the right side--which is the smaller of the two lobes, proving that whichever lobe be in this condition, the spleen, as being opposite to it, represents the minus hepatic quant.i.ty. From these, among other facts, I infer that the spleen is the representative of the liver on the left side, and that as such, its signification being manifest, there exists no exception to the law of animal symmetry. ”Tam miram uniformitatem in planetarum systemate, necessario fatendum est intelligentia et concilio fuisse effectam. Idemque dici possit de uniformitate illa quae est in corporibus animalium. Habent videlicet animalia pleraque omnia, bina latera, dextrum et sinistrum, forma consimili: et in lateribus illis, a posteriore quidem corporis sui parte, pedes binos; ab anteriori autem parte, binos armos, vel pedes, vel alas, humeris affixos: interque humeros collum, in spinam excurrens, cui affixum est caput; in eoque capite binas aures, binos oculos, nasum, os et linguam; similiter posita omnia, in omnibus fere animalibus.”

--Newton, Optices, sive de reflex, &c. p. 411.]

X.--The heart, though being itself the recipient, the prime mover, and the dispenser of the blood, does not depend either for its growth, vitality, or stimulus to action, upon the blood under these uses, but upon the blood circulating through vessels which are derived from its main systemic artery, and disposed in capillary ramifications through its substance, in the manner of the nutrient vessels of all other organs.

The two coronary arteries of the heart arise from the systemic aorta immediately outside the semilunar valves, situated in the root of this vessel, and in pa.s.sing right and left along the auriculo-ventricular furrows, they send off some branches for the supply of the organ itself, and others by which both vessels anastomose freely around its base and apex. The vasa cordis form an anastomotic circulation altogether isolated from the vessels of the other thoracic organs, and also from those distributed to the thoracic parietes. The coronary arteries are accompanied by veins which open by distinct orifices (foramina Thebesii) into the right auricle. Like the heart itself, its main vessels do not depend for their support upon the blood conveyed by them, but upon that circulated by the small arteries (vasa vasorum) derived either from the vessel upon which they are distributed, or from some others in the neighbourhood. These little arteries are attended by veins of a corresponding size (venules) which enter the venae comites, thus carrying out the general order of vascular distribution to the minutest particular. Besides the larger nerves which accompany the main vessels, there are delicate filaments of the cerebro-spinal and sympathetic system distributed to their coats, for the purpose, as it is supposed, of governing their ”contractile movements.” The vasa vasorum form an anastomosis as well upon the inner surface of the sheath as upon the artery contained in this part; and hence in the operation for tying the vessel, the rule should be to disturb its connexions as little as possible, otherwise its vitality, which depends upon these minute branches, will, by their rupture, be destroyed in the situation of the ligature, where it is most needed.

XI.--The branches of the systemic aorta form frequent anastomoses with each other in all parts of the body. This anastomosis occurs chiefly amongst the branches of the main arteries proper to either side. Those branches of the opposite vessels which join at the median line are generally of very small size. There are but few instances in which a large blood vessel crosses the central line from its own side to the other. Anastomosis at the median line between opposite vessels happens either by a fusion of their sides lying parallel, as for example (and the only one) that of the two vertebral arteries on the basilar process of the occipital bone; or else by a direct end-to-end union, of which the lateral pair of cerebral arteries, forming the circle of Willis, and the two l.a.b.i.al arteries, forming the coronary, are examples. The branches of the main arteries of one side form numerous anastomoses in the muscles and in the cellular and adipose tissue generally. Other special branches derived from the parent vessel above and below the several joints ramify and anastomose so very freely over the surfaces of these parts, and seem to pa.s.s in reference to them out of their direct course, that to effect this mode of distribution appears to be no less immediate a design than to support the structures of which the joints are composed.

XII.--The innominate artery. When this vessel is tied, the free direct circulation through the princ.i.p.al arteries of the right arm, and the right side of the neck, head, and brain, becomes arrested; and the degree of strength of the recurrent circulation depends solely upon the amount of anastomosing points between the following arteries of the opposite sides. The small terminal branches of the two occipital, the two auricular, the two superficial temporal, and the two frontal, inosculate with each other upon the sides, and over the vertex of the head; the two vertebral, and the branches of the internal carotid, at the base and over the surface of the brain; the two facial with each other, and with the frontal above and mental below, at the median line of the face; the two internal maxillary by their palatine, pharyngeal, meningeal, and various other branches upon the surface of the parts to which they are distributed; and lastly, the two superior thyroid arteries inosculate around the larynx and in the thyroid body. By these anastomoses, it will be seen that the circulation is restored to the branches of the common carotid almost solely. In regard to the subclavian artery, the circulation would be carried on through the anastomosing branches of the two inferior thyroid in the thyroid body; of the two vertebral, in the cranium and upon the cervical vertebrae; of the two internal mammary, with each other behind the sternum, and with the thoracic branches of the axillary and the superior intercostal laterally; lastly, through the anastomosis of the ascending cervical with the descending branch of the occipital, and with the small lateral offsets of the vertebral.

XIII.--The common carotid arteries, Of these two vessels, the left one arising, in general, from the arch of the aorta, is longer than the right one by the measure of the innominate artery from which the right arises. When either of the common carotids is tied, the circulation will be maintained through the anastomosing branches of the opposite vessels as above specified. When the vertebral or the inferior thyroid branch arises from the middle of the common carotid, this vessel will have an additional source of supply if the ligature be applied to it below the origin of such branch. In the absence of the innominate artery, the right as well as the left carotid will be found to spring directly from the aortic arch.

XIV.--The subclavian arteries. When a ligature is applied to the inner third of this vessel within its primary branches, the collateral circulation is carried on by the anastomoses of the arteries above mentioned; but if the vertebral or the inferior thyroid arises either from the aorta or the common carotid, the sources of arterial supply in respect to the arm will, of course, be less numerous. When the outer portion of the subclavian is tied between the scalenus and the clavicle, while the branches arise from its inner part in their usual position and number, the collateral circulation in reference to the arm is maintained by the following anastomosing branches:--viz., those of the superficialis colli, and the supra and posterior scapular, with those of the acromial thoracic; the subscapular, and the anterior and posterior circ.u.mflex around the shoulder-joint, and over the dorsal surface of the scapula; and those of the internal mammary and superior intercostal, with those of the thoracic arteries arising from the axillary. Whatever be the variety as to their mode or place of origin, the branches emanating from the subclavian artery are constant as to their destination. The length of the inner portion of the right subclavian will vary according to the place at which it arises, whether from the innominate artery, from the ascending, or from the descending part of the aortic arch.

XV.--The axillary artery. As this vessel gives off throughout its whole length, numerous branches which inosculate princ.i.p.ally with the scapular, mammary, and superior intercostal branches of the subclavian, it will be evident that, in tying it above its own branches, the anastomotic circulation will with much greater freedom be maintained in respect to the arm, than if the ligature be applied below those branches. Hence, therefore, when the axillary artery is affected with aneurism, thereby rendering it unsafe to apply a ligature to this vessel, it becomes not only pathologically, but anatomically, the more prudent measure to tie the subclavian immediately above the clavicle.

XVI.--The brachial artery, When this artery is tied immediately below the axilla, the collateral circulation will be weakly maintained, in consequence of the small number of anastomosing branches arising from it above and below the seat of the ligature. The two circ.u.mflex humeri alone send down branches to inosculate with the small muscular offsets from the middle of the brachial artery. When tied in the middle of the arm between the origins of the superior and inferior profunda arteries, the collateral circulation will depend chiefly upon the anastomosis of the former vessel with the recurrent branch of the radial, and of muscular branches with each other. When the ligature is applied to the lower third of the vessel, the collateral circulation will be comparatively free through the anastomoses of the two profundi and anastomotic branches with the radial, interosseous, and ulnar recurrent branches. If the artery happen to divide in the upper part of the arm into either of the branches of the forearm, or into all three, a ligature applied to any one of them will, of course, be insufficient to arrest the direct circulation through the forearm, if this be the object in view.

XVII.--The radial artery. If this vessel be tied in any part of its course, the collateral circulation will depend princ.i.p.ally upon the free communications between it and the ulnar, through the medium of the superficial and deep palmar arches and those of the branches derived from both vessels, and from the two interossei distributed to the fingers and back of the hand.

XVIII.--The ulnar artery. When this vessel is tied, the collateral circulation will depend upon the anastomosis of the palmar arches, as in the case last mentioned. While the radial, ulnar, and interosseous arteries spring from the same main vessel, and are continuous with each other in the hand, they represent the condition of a circle of which, when either side is tied, the blood will pa.s.s in a current of almost equal strength towards the seat of the ligature from above and below--a circ.u.mstance which renders it necessary to tie both ends of the vessel in cases of wounds.

XIX.--The common iliac artery. When a ligature is applied to the middle of this artery, the direct circulation becomes arrested in the lower limb and side of the pelvis corresponding to the vessel operated on. The collateral circulation will then be carried on by the anastomosis of the following branches--viz., those of the lumbar, the internal mammary, and the epigastric arteries of that side with each other, and with their fellows in the anterior abdominal parietes; those of the middle and lateral sacral; those of the superior with the middle and inferior haemorrhoidal; those of the aortic and internal iliac uterine branches in the female; and of the aortic and external iliac spermatic branches in the male. The anastomoses of these arteries with their opposite fellows along the median line, are much less frequent than those of the arteries of the neck and head.

XX.--The external iliac artery. This vessel, when tied at its middle, will have its collateral circulation carried on by the anastomoses of the internal mammary with the epigastric; by those of the ilio-lumbar with the circ.u.mflex ilii; those of the internal circ.u.mflex femoris, and superior perforating arteries of the profunda femoris, with the obturator, when this branch arises from the internal iliac; those of the gluteal with the external circ.u.mflex; those of the latter with the sciatic; and those of both obturators, with each other, when arising--the one from the internal, the other from the external iliac.

Not unfrequently either the epigastric, obturator, ilio-lumbar, or circ.u.mflex ilii, arises from the middle of the external iliac, in which case the ligature should be placed above such branch.

XXI.--The common femoral artery. On considering the circles of inosculation formed around the innominate bone between the branches derived from the iliac arteries near the sacro-iliac junction, and those emanating from the common femoral, above and below Poupart's ligament, it will at once appear that, in respect to the lower limb, the collateral circulation will occur more freely if the ligature be applied to the main vessel (external iliac) than if to the common femoral below its branches.

XXII.--The superficial femoral artery. When a ligature is applied to this vessel at the situation where it is overlapped by the sartorius muscle, the collateral circulation will be maintained by the following arteries:--the long descending branches of the external circ.u.mflex beneath the rectus muscle, inosculate with the muscular branches of the anastomotica magna springing from the lower third of the main vessel; the three perforating branches of the profunda inosculate with the latter vessel, with the sciatic, and with the articular and muscular branches around the knee-joint.

XXIII.--The popliteal artery. When any circ.u.mstance renders it necessary to tie this vessel in preference to the femoral, the ligature should be placed above its upper pair of articular branches; for by so doing a freer collateral circulation will take place in reference to the leg.

The ligature in this situation will lie between the anastomotic and articular arteries, which freely communicate with each other.

XXIV.--The anterior and posterior tibial and peronoeal arteries. As these vessels correspond to the arteries of the forearm, the observations which apply to the one set apply also to the other.

[Footnote]

[Footnote: For a complete history of the general vascular system, see The Anatomy of the Arteries of the Human Body, by Richard Quain, F.R.S., &c., in which work, besides the results of the author's own great experience and original observations, will be found those of Haller's, Scarpa's, Tiedemann's, &c., systematically arranged with a view to operative surgery.]

THE END.

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