A. (Alfred) Velpeau.

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THE LIBRARY

OF

THE UNIVERSITY
OF CALIFORNIA



PRESENTED BY

PROF. CHARLES A. KOFOID AND
MRS. PRUDENCE W. KOFOID



TREATISE

ON

SURGICAL ANATOMY;

OR THE

ANATOMY OF REGIONS,

CONSIDERED IN ITS RELATIONS WITH SURGERY.

ILLUSTRATED BY PLATES,

REPRESENTING

THE PRINCIPAL REGIONS OF THE BODY.

BY

ALF. A. L. M. VELPEAU, M. D. P.

Agrege Stagiaire to the Faculty of Medicine of Paris, etc.
IN TWO VOLUMES.



TRANSLATED FROM THE FRENCH, WITH ADDITIONAL NOTES, BY

JOHN W. STERLING, M. D.

Member of the Royal College of Surgeons in London ; Fellow of the College of



Physicians and Surgeons of the University of New- York, etc.



NEW-YORK :

PUBLISHED BY SAMUEL WOOD & S
No. 261 PEARL-STREET.
1830.

H. & G. S. WOOD, PRINTERS.




Southern District of JVeto-ForA;, t&.

BE IT REMEMBERED, That on the ninth day of February, in the ritty-
fpurth year of the Independence of the United States of America, John W. Ster-
ling, of the said District, has deposited in this office the title of a book, the right
whereof he claims as proprietor, in the words following, to wit :

" A Treatise on Surgical Anatomy ; or the Anatomy of Regions, considered in
its relations with Surgery. Illustrated by Plates, representing the different Re-
gions of the Body. By Alf. A. L. M. Velpeau, M. D. P. Agrege Stagiaire to the
Faculty of Medicine of Paris, etc. In two volumes. Translated from the French
by John W. Sterling, M. D., Member of the Royal College of Surgeons in London ;
Fellow of the College of Physicians and Surgeons of the University of New- York,
etc."

In conformity of the Act of the Congress of the United States, entitled, "An Act
for the encouragement of learning, by securing the copies of Maps, Charts, and
Books, to the Authors and Proprietors of such copies, during the time therein men-
tioned ;" and also to an Act, entitled, "An Act, supplementary to an Act, entitled,
an Act for the encouragement of learning, by securing the copies of Maps, Charts,
and Books, to the Authors and Proprietors of such copies, during the times therein
mentioned, and extending the benefits thereof to the arts of designing, engraving,
and etching historical and other prints."

FRED. J. BETTS,

Clerk of the Southern District of New-York.






TO

ALEXANDER H. STEVENS, M.D.

Professor of Surgery in the University of New- York ; Surgeon to the New- York

Hospital ; Consulting Physician of the New- York City Dispensary ;

Member of the New- York Literary and Philosophical

Society ; of the Academy of Natural Sciences

of Philadelphia ; of the Linnean

Society of New-England,

&c. &c. &c.

WHO, to Talents of the highest order, great Scientific At-
tainments, and Professional Skill, unites an Indefatigable Zeal for
the promotion of Medical Literature ; and to whose Encouragement
may be attributed this Humble Attempt to introduce to the general
notice of our countrymen, the Unrivalled Treatise of M. VELPEAU
on SURGICAL ANATOMY, is this Work inscribed
By his Greatly Obliged,

And Obed't Serv't,

JOHN W. STERLING.

JVeto-ForAr, Feb. 9, 1830.



M**






PREFACE.



IP it is true that indolence, a false judgment, ignorance, self-love, or
any other mistaken notions, have induced certain persons to say that
one may be a skilful and learned physician without being a good anat-
omist, we may affirm that this paradox will no longer be revived at the
present day : now that it is the universal desire to substitute facts for
chimerical abstractions ; now that the remains of the dead constitute
the principal book in which physicians seek for the cause of diseases,
it is no longer necessary to insist upon the indispensable necessity of
anatomical knowledge ; but there is one branch of medicine to which
this knowledge appertains in a still more intimate manner, and with
this opinion learned men have always coincided, I mean Surgery.

Anatomy, which is only a collection of facts, though it had been
cultivated by some few during a long succession of ages, was re-
strained within very narrow limits, until the progress of civilization,
by banishing existing prejudices, shed upon it the light derived from
other branches of natural philosophy. When dissections were per-
mitted, discoveries multiplied with rapidity, and its details became
formed into a system. The more recent labours of anatomists have
so far enlarged the domain of their science, that subdivisions of it
have become necesary both for the study and the improvement of it.

To examine the organic systems and whatever they possess in com-
mon in every part of the body, is the object of general anatomy ; to
study the apparatuses in succession ; to describe the figure, volume,
position, density and composition of each organ is the province of
descriptive or special anatomy ; to take a certain portion of the econ-
omy, describe all the elements which are comprised within it, and
point out the peculiarities which each of them present ; the direction
and exact relations of the most important objects ; the varieties of
thickness and position produced by diseases or aberrations of devel-
opement ; to proceed from the skin towards the bones, or from the
hones towards the surface, and thus observe successively, and layer by



Vi PREFACE.

layer, in their relative and natural position, the different parts, withou;
entering into minute details ; this is what constitutes the anatomy oi*
regions or of relations, or topographical anatomy.

The first, more particularly concerned with the fibrillary arrange-
ment, and the analysis of the intimate structure of the tissues, is the
basis of all sound physiology ; without it, medicine would never have
emerged from that confusion of principles which so long prevailed in
the schools : it truly deserves the title of medical anatomy.

The second, displaying the organs in the manner which nature pre-
sents them, describing their most prominent characters, without in-
vestigating their molecular disposition, or those unknown vital proper-
ties from which they derive life and motion, appertains, more directly
to surgery, which owes to it its rapid progress and the certainty with
which it is honoured : without it, the surgeon would be but a danger-
ous man.

The third is as yet altogether new, and can only be considered as a
complement of the two others. It differs from common descriptive
anatomy, both by the end which it proposes and the means it employs.
This takes up one apparatus of organs and follows it to every part to
which it is distributed, previous to taking up the consideration of the
others ; that, on the contrary, passes in review all the elements of a cir-
cumscribed point, without investigating either their origin or termina-
tion. The one tends to make known the special functions of the econo-
my ; the other to expose the different characters of this or that part of the
body ; to give the mechanical reason for the diverse phenomena which
we remark in it ; to explain the difference in the dangers and forms of
diseases, by the difference in the relative and visible disposition of the
systems which compose this or that region ; it dwells upon some or-
gan?, passes lightly over others, always seeks to place itself in relation
with operations ; in a word, it is the anatomy which is most intimately
connected with external pathology, and which, for this reason, is called
Surgical.

Some positive notions upon surgical anatomy and the anatomy of
regions, were first promulgated by Desault, in his oral lectures ; and
all who enjoyed the benefit of hearing this celebrated surgeon, agree in
saying that he felt its great importance ; but baron Boyer is the first
author who has written upon this subject, and his immortal work on
anatomy contains a sketch of an anatomy of regions which must dispose
us to regret that he did not enter more fully into this matter. I say the
first, for the Treatise on Surgical Anatomy by Palfin, published in the
beginning of the last century, is a very indifferent work, decorated with



PREFACE. Vll

a vain title. That of Petit was composed after the same model, and
deserves, in a great measure, the same censure ; neither of these au-
thors had, in fact, investigated this subject under its proper aspect.

Professor Roux next attempted to incorporate it with his course of
lectures, and he undoubtedly deserves the honour of directing the at-
tention of the students of the school of Paris to this particular branch
of anatomy. Several theses, written after the model of his lectures,
shew that M. Roux then considered, and, from what I have heard him
express, still considers surgical anatomy under two different points of
view. On the one hand, he would that all the organic apparatuses
were examined in succession, according to their relations with surge-
ry: thus, the skin, cellular tissue, muscles, etc., should be successive-
ly studied in this manner, and the theses of M. Baget upon the cellu-
lar tissue, of Bajeard upon the muscular tissue, were arranged accord-
ing to this method ; this is what M. Roux proposed calling general
surgical anatomy. On the other hand, he thought that we should in-
vestigate all the organs in their relative situations, which would consti-
tute the anatomy of regions, properly so called. But he who under-
took to continue the descriptive anatomy of the most brilliant genius of
our age, was shortly after called upon to attend to other duties, and the
impulse, which had been given with so much advantage to anatomical
students, sensibly diminished. Its utility, however, was not forgotten.
Already had it attracted the attention of Beclard, who entered upon its
investigation with so much assiduity, that he soon transformed the
projects of M. Roux into reality. To the natural divisions of the body,
he added secondary divisions ; he circumscribed the principal regions,
and the sketch which he made of topographical anatomy, in his course
to the Faculty of Paris, presented itself under an aspect so imposing
to the numerous students who were eager to hear him, that it thence-
forth became the favourite study of the greater proportion of them.
Indeed, it is sufficient to turn to the articles Axilla, Jlrm, Elboiv, Fore-
arm, Ham, etc., which he has contributed to the Nouveau Dictionnaire
de Medicine, in order to have an idea of the interesting remarks which
accompanied his descriptions. It is from him, from his instructive
lessons, as well as those of an equally revered professor, M. Marjolin,
that young surgeons imbibed a taste for this subject; but students
wanted a guide, an elementary work to direct them ; Beclard had pro-
mised to furnish it; it was eagerly anticipated, and every thing favour-
ed the belief that it would soon have been presented to the public, if a
premature death had not deprived anatomy of one of its brightest orna-
ments and firmest supports. This professor has left, in this respect,



Vlll PREFACE.

as well as in many others, a chasm which it is very difficult to fill up,
and which is so much the more severely felt in the science, as we begin
generally to admit, at the present day, that the anatomy of the regions
is less dry, and that it is of still more immediate application in sur-
gery than descriptive anatomy, such as it is exposed in our best treati-
ses. It is with the view of closing this hiatus that I have undertaken
to present to the public an Essay on Surgical Anatomy, and the Anat-
omy of Regions. I do not presume sufficiently upon my own abilities
to suppose that I have fully accomplished my object : I merely thought
that it would be agreeable, to students especially, to possess some book
upon this subject, whilst waiting for some more capable person to en-
gage in it, or until I could produce a better myself. However, I have
neglected nothing that might render this work useful to the greater
number, and I must say that I did not undertake it until I had long re-
flected upon it. It is to M. J. Cloquet, one of my first preceptors in
Paris, that I am indebted for the first idea of it ; we began together at
the Hospital Saint Louis, in 1821; the regions were already traced,
when the attention of this learned anatomist was called to other la-
bours. Nevertheless, I did not abandon this project, and in 1822, 1
submitted our plan to some students, to whom I gave a course upon
this subject in the amphitheatre of the E' cole- Pratique. Since then I
have not ceased occupying myself with it, and I have closed my ana-
tomical demonstrations every year with some lectures upon surgical and
topographical anatomy : thus, by teaching, I have been enabled to make
trial of several different methods. That which I have at length adopted,
is not altogether the same with the plan which I pursued at first; nei-
ther is it analogous to that of Professor Beclard. Having no model to
copy after, I was obliged to depend upon my own judgment; I sought,
however, to enlighten myself by every possible means previous to
deciding. For the divisions I consulted the manual of Rosenthal, pro-
fessor at Berlin,* but the only one I am acquainted with, in which all
the regions of the body are described ; an essay of Doctor Bock,f
printed at Leipsic, in 1824, accompanied with three figures, in which
arbitrary lines, serving to limit a certain number of sections, are trac-
ed ; the thesis of M. Gerdy, my colleague to the Faculty, published in
1823,+ and in which we find a topographical sketch of the different
parts of the body of man considered in nearly the same point of view as
in the work of M. Boyer. It will be easy to see how far I differ in
this respect, from these authors, and in what degree I approximate to

*Handbuch der chirurgischen Anatomic. Berlin, 1817. f Der raenschlische
Korper, etc. von Dr. August Carl Bock. J No. 143, page 29.



PRKFACE. IX

them. For several years also, my friends, MM. Bouvier, associate,
Blandin, Bogros, prosectors, and Amussat, anatomical assistant to
the faculty, have been engaged in teaching the anatomy of regions
with much success, but as they have not published the plan which they
follow, I have not been able to profit by their knowledge, nor ascer-
tain in what measure their method differs from mine.

With respect to the fundamental part, I have drawn from all the
sources which I have been able to discover ; and I mention them here,
in order that I may avoid too frequent citations in the text, and also
that every person may there resume whatsoever appertains to him.
I have especially had recourse to such works as treat particularly of a
given point of the body ; and I will mention, among others, for the
Eye, the works of Zinn, Simmering, Demours ; some numbers of
the Bibliotheque Chirurgicale of Langenbeck, the book published at
Berlin in 1822 by Weller ; for the lachrymal passages, a very good
thesis of M. Vesigne, that of M. Dubois, Jun. ; for the anatomy of
the Neck and Head, the treatise of Allan Burns, one of the best worksj
on this subject, which have appeared in England, although it does not
merit all the praise which it has received in the country of its author.
In fact, it is not a treatise on surgical anatomy, nor of the regions of
the head and neck ; it would be better intituled Chirurgical Obser-
vations, accompanied with anatomical remarks ; that of Doctor Col-
les, published in 1811, and which also treats of the surgical anatomy
of the thorax, abdomen and pelvis ; it enters less into detail than that
of Burns, but is more purely anatomical ; a very fine engraving of
the neck by Astley Cooper, in one of the German journals for 1825 ;*
other plates of M. Langenbeck, representing the parotideal region and
divers other points of the head and neck ; the fourth table of Santo-
rini, one of Scemmering upon the nasal fossae, mouth and pharynx ;
the works of J. Fabrice and Duverney upon the Ear ; of MM. Des-
champs and H. Cloquet, upon the nostrils, etc.; for the axilla the
theses of M. Mey (1817, No. 63) ; and of M. Beulac (1819,,
No. 220) arranged according to the lectures of M. Roux ; that of M.
Senelle (1822, No. 143) upon the thoracic extremity ; for the shoul-
der, the fingers, foot thigh, perinaeum of the female, the canal of the
urethra, etc. several memoires of M. Lisfranc ; for the different parts
of the pelvis, perinaeum, groin, the researches of Camper, and the
plates executed in part under the inspection of this celebrated author ;
the splendid work of W. Hunter upon the pelvis and gravid uterus ;
that of Hesselbach, who has so correctly described the disposition of

* Chirurgische Kupfortafeln.



X 1'REFACJi.

the aponeuroses of the fold of the groin, and the relations of the epi-
gastric artery in hernia, in 1806, 1816, and 1819 ; those of M. J. Clo-
quet, Astley Cooper, Hey, Lawrence, upon the same subject and her-
nia in general ; the thesis of M. Breschet, on crural hernia ; the re-
searches of Langenbeck, in 1802, and of M. Dupuytren, in 1812,
upon lithotomy and the perinaeum ; of MM. Carcassonne and Bou-
vier, upon the aponeuroses of the pelvis ; Bogros, upon the iliac re-
gion ; Sanson and Scarpa, upon the recto-vesical lithotomy ; several
memoires of the latter, and his elegant plates upon aneurisms, herniae
and hydrocele ; the first part of the system of surgical anatomy by Dr.
W. Anderson, upon the groin, pelvis and perinaeum, published at New-
York, in 1822 ; the essay whicn Dr. Ashton Rey has just published in
London, upon the section of the prostate in lithotomy, according to the
process of Cheselden, and his plates upon the pelvis ; finally, the
thesis of M. Senn, of Geneva, upon the perinecum and the different
forms of perinseal lithotomy. I ought also to note three drawings
which are found in the memoir of Dr. Liston, published in London, in
1811, upon the fold of the groin ; the work of Groefe upon amputa-
tions, printed at Berlin, in 1812 ; (on this subject, I would remark,
that I have passed by the name of this celebrated surgeon in silence,
when speaking of the staphyloraphy, not because I was ignorant of his
having performed this operation in 1816, and a considerable number
of times since ; but because the method of M. Roux, which actually
seems to have originated with him in France, deserves the preference
in every respect); the system of surgical operations, began by Charles
Bell in 1821 ; the Manual of Jlnatomy by Stanley, and which is in
fact an abridgement of the anatomy of regions ; that of Green ; and
even that of Shaw ; the Anatomical System of Lizars, just published
in London ; lastly, I would cite a treatise upon the aponeuroses by
Dr. Godman of Philadelphia, and another meritorious work upon the
surgical anatomy of the arteries, by Robert Harrison of Dublin, both
of which appeared in 1824-5.

With respect to classic treatises, I have principally derived assist-
ance from those of Bichat, MM. Boyer, Portal, H. Cloquet, and J.
Cloquet, for the anatomy ; the manual of the celebrated F. Meckel,
has also been of much service to me, especially as it regards the varie-
ties and anomalies of position. For the surgical part I have made use
of the excellent book of Sabatier, as well as the additions of its new
editors. I might cite at every page the treatise on Surgical Diseases
by M. Boyer, and the Nosographie of M. Richerand, I have especially
borrowed from the latter professor a part of the lines which be first in-



PREFACE. XI

dicated for the purpose of discovering the direction of the principal
arteries of the extremities. In a word, I have endeavoured to profit
by the numerous works which have been published, during a century,
upon anatomy and surgery, in France as well as hi England, Ger-
many, Italy, etc.; and, as regards this, I take this opportunity of pre-
senting my acknowledgements to Dr. Crawford of London, for the
zeal and activity which he has manifested in procuring for me the
works which I had need of, and to M. Wessley, doctor in medicine
of the University of Gottingen for the assistance he has afforded in
enabling me to understand the numerous publications in the German
language. Also to M. Paillard, internal surgeon to the civil hospitals,
my friend and former condisciple at the Hospital St. Louis, who, hav-
ing been for a long time prosector to M. Lisfranc, and engaged for
several years in surgical anatomy, has collected an abundance of ma-
terials, both on the subject of general surgical anatomy and the anat-
omy of regions, which cannot fail being useful to the science, if he
publishes them, as he has promised. By placing his manuscripts at
my disposal, he has given me a proof of confidence which does honour
to his character, and which it is my duty thus publicly to acknowledge.
A combination of circumstances so favourable imposes upon me,
I am well aware, great obligations. My province has been rather to
make a selection among a multitude of facts than to search too mi-
nutely after new ones. Nevertheless as the subject was not before
surveyed from the same point of view, and as the objects of it were
appreciable ; as the most scrupulous exactness in the relative posi-
tion of the parts is the chief merit and distinguishing character of a
Treatise on Surgical Anatomy, I have considered it my duty to de-
rive this from Nature alone. Therefore, all the regions have been
circumscribed upon the dead body, and I have not indicated a part,
described a layer, or given a measurement without having a subject
before me. It was not until I had repeatedly examined the different
elements of a region that I had recourse to authors or ventured com-
mitting them to paper ; then if my descriptions coincided with those of
the most accurate anatomist, I considered them correct ; but if, on the
contrary, they differed, I again returned to interrogate the dead body
and forbore to contradict until I had established the certainty that some
circumstance had deceived them. In this manner, I have only dwelt
upon the description of parts in proportion to their degree of import-
ance, and with some I have entered more into detail than is usually
done in elementary treatises : such, as for example, the cellular tis-
sue, the different aponeuroses, and the layers which are derived from



Xll .

them. It is, in fact, only in investigating anatomy by regions that we
can conveniently dwell upon the disposition of these laminae, which
actually deserve additional investigation ; on the other hand, I have
thought proper to omit many indifferent minutiae which relate to sur-
gery, although they might afford great interest in a treatise on de-
scriptive anatomy.

With respect to the numerous preparations required, and all that por-
tion of this labour which it was necessary to perform in the dissecting
room, I have derived assistance from several persons, and I cannot.
on this occasion, give too much credit to my prosector M. Bintot, for
the accuracy which he has exhibited. To M. Ch. Delange, an enter-
prising student of the Faculty of Medicine of Paris, more than any
other, I owe a testimonial of gratitude for the entire devotion which he
has shewn me in this respect, and for the active part which he has not
ceased to take in every thing that concerns this work.

Detained a long time by the first step, that is to say, by the division
which it would be most proper to establish, and by the number of re-
gions which might be usefully admitted, I was apprehensive of falling
into two opposite extremes : too multiplied, they would fatigue the
memory and occasion incessant repetitions ; too few, they would not
enable us to display advantageously every important part contained
within them. The great natural sections of the body being insufficient,
I have substituted for them arbitrary lines, which I have connected, as
much as was possible, with osseous or muscular eminences. These
lines seem to me to present the inappreciable advantage of embracing
in a given region, objects which can only afford surgical interest so
long as we consider them united and in their natural connexions : thus,
should we separate the arm from the fore-arm, the elbow would remain
without importance ; the considerations relative to blood-letting, to the
formation of aneurism in this region, would no longer be applicable ;
if the arm ceased to be connected with the shoulder, the axilla would
no longer exist ; finally, it is in the environs of the principal folds of
the limbs that the most severe and important surgical operations are
performed. But these lines might have been established in diverse
manners ; they might have been more or less approximated or differ-
ent directions given them, etc. Every one doubtless will have his



Online LibraryA. (Alfred) VelpeauA treatise on surgical anatomy, or, The anatomy of regions : considered in its relations with surgery → online text (page 1 of 44)