section consists in merely following them from trunk to
branch, I shall give only a Table of them :

OPHTHALMICA CEREBRALIS. Passing into the orbit, by
the foramen opticum, gives these branches : To the
dura mater and'sinus ; 2. lachrymalis, which goes to the
gland, after giving many branches to the periosteum,
optic nerve, &c. ; 3. ciliares ; three or four arterie.s.
dignified with the distinction of inferiorcs, anterior es,
breves, longiores ; 4. supra orbitalis ; 5. centralis retina*
G. aethmoidales ; 7. palpebrales ; 8, nasalis ; 9. fron -
talis.

METHOD OF MAKING CERTAIN PREPARA-
TIONS OF THE EYE.

It will be very useful to preserve some human eyes, to
show the relative situation of the parts : for this purpose :
the eyes must be very fresh.

A student will find it difficult to imitate some of the pre-
parations which are preserved in anatomical museums : but
any one may make suck dissections, as will give a general
idea of the anatomy of the parts, and be of use in planning
operations on the eye. If we remove all the muscles, &r.
from the eye-ball, and cut off about one third of the cornea.



296

raid then insinuate the blade of the scissars between the
ary ligament and the sclerotic, that we may cut oft* about a
third of the sclerotic, the c'horoid, and its connexion with the
iris, will be shown : this forms a very good preparation.
Another eye may be prepared, so far in the same manner ;
it is to be completed, by cutting away the portion of the cho-
roid corresponding to the sclerotic, so as to expose the reti-
na ; but in attempting to do this, we shall often be foiled.
A third preparation may be made, nearly in the same man-
ner ; but in it, we should remove the retina.

This last preparation will be very useful ; for not only wiH
one half of the cornea, the size of the anterior chamber,
fhe ligament-urn ciliare, the iris, and the pupil be shown,
but also the situation of the lens and ciliary processes, and the
vitreous humour, will all be distinct]} 7 seen. As soon as such
a dissection is made, the eye should be put into proof spirit.
By this, however, both the lens and the capsule of the vitre-
ous humour, will be made opaque.

The view of the parts in this section, will prove, that oc*
enlists who say they have put the cataract into the posterior
chamber, must be ignorant of anatomy. The proper place
tor the introduction of the needle, in couching, so as to avoid
the ciliary processes, will be evident. In considering tin/,
subject of couching, there is a point of great importance,
which maybe understood in the dissection of even a sheep's
eye, viz. the possibility of the lens and vitreous humour be-
ing both turned round in the attempt to couch. When thi,<
happens, total blindness may be the consequence, as the ner-
vous matter of the retina may be destroyed by the displace-
ment of the vitieous humour.



SURGICAL DISSECTION,



JYECK dJVD HEAD



THERE are so many important questions connected wiiis
the Surgical Anatomy of the neck and head, that it would be
impossible for me to enter fully into any one ; all that the



297

limits of a book of this land will permit, is, to make such re-
marks, as will rouee the student's attention to the importance
of the subject.

I shall suppose that the student has made himself master
of all the muscles, arteries, nerves, &c. and that he is now
about to make a dissection of the neck, as a part upon which
he may be called on to operate, or to give an opinion as to
the- nature and connexions of a tumour. The vessels should
not be injected.*

Previous to beginning the dissection, the student should
mark all the prominent points with ink ; he should then vary
the position of the head and neck, and compare the chan<ni
which take place in the points which he has marked. In ex-
amining- the neck, he should not only note the appearance,
but also the feel of the parts. It is a good exercise to exam-
ine one's own neck in this manner, before a looking glass.

It is not now necessary to give any rules for the dissection
of each part. As soon as WQ raise the skin, we shall ob-
serve that there is no fascia under it as in the limbs, but a
thin muscle (the platysma) : w r e shall naturally pause and
consider whether we can assign any reason for this differ-
ence. But the important question will be, of what conse-
quence is the recollection of this muscle in operations on the
neck ? If it be forgotten, even in the simple 1 operation of
opening the external jugular vein, the surgeon may be foil-
ed ; for as the vein is under the muscle, the fibres will close,
and prevent the flow of blood, if the incision be not made ob-
liquely. Those who have once dissected a tumour from un-
der this muscle, will never forget the strength of these fibres
in the living body, though they appear so trifling- on the
dead subject. We can now understand why tumours of the 4
neck, when they are enlarged, are pushed inwards ; and that
they may be larger than what a superficial examination would
lead us to suppose.

If the body be thin and anasarcous, instead of the fibres of
the platysma being distinct and connected, they will appear
scattered ; and the cellular membrane between and under
them, will have the form of a fascia. It is this appearance
which has led some surgeons to attach more importance to
what they call the fascia of the neck, than to the platysma.
Yet I must admit, that though the cellular membrane will
not resemble fascia, in a body where the muscles, &c. are

* Perhaps it may be advantageous to inject the Arteries
with a strong solution of glue, coloured with vermilion iu
this case, but a very small quantity should be thrown k
;he injection easily passes into the vein?*



298

plump, still, it will generally be so thickened, in e-
quence of the pressure of a tumour, that it will, in certain ca
;ses, be almost as strong as a distinct fascia : it is important
to recollect this in performing operations on tumours of the
neck.

The branches of nerves which 'are seen when the integu-
ments only are taken off, are not of much importance in a
surgical view.

The dissection of the skin should now be carried up to a
line drawn from the tube of the ear to -the nose. We shall
then see that there are no muscular fibres on the parotid, but
that it is covered by a dense layer of fascia. This fascia wilJ
in some degree account for the violent pain which attends
cynanche parotidea ; for not only will the nerves be compres-
sed by the fascia, but it will also form a natural obstacle to
the free exit of matter. I have seen a patient actually deli-
rious from the pain he suffered from inflammation of the pa-
rotid. Under this fascia, several branches of the portio du-
ra will be seen ; these muscles must not be forgotten ; bo-
cause, in the very simple operation of taking out a small tu-
mour from this part of the face, we may, by cutting these
nerves, cause a degree of distortion in the lips of the patient.
The risk of producing a certain degree of paralysis, ought to
be explained to the patient before we commence any opera-
tion on this part.

We should now raise the platysma, by cutting it through
in the middle, and then dissecting one portion towards the
clavicle, and the other to the base ofthe jaw. We shall now
have exposed the sterno cleido mastoideus, and tjie superfi-
cial muscles which are connected with the larynx. There is
much to study in this view. The first question that will
strike us, is, where ought the operation of laryngotomy to
be performed ? The nature of the case will have much influ-
ence on our decision : but looking to the parts, as they no\v
appear, we should decidedly fix upon the space between the
ihyroid and cricoid cartilages, because it is the most superfi'
cial, and there are very few vessels upon it ; but we ought
to know, that a portion of the thyroid gland very often cros-
ses this part, to pass up to the os hyoides. If the case be,
such that we cannot operate at this point (but luckily, this
does not occur once in ten times,) then the operation must
be performed lower down. This will be very difficult ; for
we must not only go below the thyroid gland, but to a great
depth between the muscles, to reach, the trachea. Howe^
ver, this is not all the difficulty ; if we put our finger upon
our own larynx, and then breathe, as a patient does who is
gj we shall be able to form some idea ofthe tension



299

f)f the muscles, of the.distended state of the small veins, and
of the frequent change in the position of the larynx. We
must net, at the same time, forget that the patient must be
sitting almost upright. These considerations will give us
some, notion of the difficulty of performing the operation of
tracheotomy.

The histories of the operations on the larynx are most im-
portant ; because, by them only, can we judge of the difficul-
ties. Some excellent cases and remarks will be found in
Mr. Charles Bell's Surgical Observations, and in the Medi-
co Chirurgical Transactions. There is also a case related
by Dr. Johnson in the Medico Chirurgical Journal, which is
highly descriptive of what really takes place during the op-
eration of laryngotomy. This case is also remarkable, as
the patient was still, at the end of three years, obliged, and
able, to wear a tube in the larynx.

If we should be c- lied upon to perform an operation, to
relieve a child which has sucked a pebble or pea into the
larynx, the space between the two cartilages will proba-
bly be the most proper part in which to open the larynx-
I have dissected a child whose death was occasioned by
a pebble sticking- exactly opposite to this part : had assist-
ance been brought sufficiently early, the child might have
been saved by a cut with the lancet.

The success attending a case which is related by M. Che-
valier, would induce us to open the larynx at this part,
when a child is dying of croup.

We may now consider the Surgery of the Arteries.

We now know that if we were to turn up the edge of tho
sterno cleido mastoideus, that we should corne upon the
sheath of the carotid artery; but before we expose it, wr
should think of all the diseases and accidents to which the
artery is liable.

The cases already recorded of aneurism of the carotid ar-
tery, prove, that it generally takes place at the bifurcation.
Seeing the proximity of this, to the sensible part ofthr
larynx, we can understand how the aneurismal tumour may
be pressed in upon it, by the platysma, and thus produce irri-
table cough, and symptoms referable to pressure on thf
n erves of the larynx. This irritation has been the cause of
the death of some patients, upon whom, even the operation
of tying the carotid was performed ; but this is no reason
H gainst the operation ; on the contrary, it is a motive for
its early performance, and before the tumour is much enlarg-
ed.

Before an operation is decided on, we should carefully
;ii all tho circumstances of the case. It is important



300

Me collect, that a small tumour situated over the an
so as to be moved at each pulsation, has heen occasionally
mistaken for aneurism. I have not only heard of such in-
stances, but I have even been consulted in a case of enlarge-
ment of one lobe of the thyroid gland, for which the patient
was sent a journey of forty miles, that the carotid artery
might be tied, to cure the supposed aneurism.

The question will force itself upon us, where is the arte-
ry to be tied? If the aneurismal tumour be lower down
than the bifurcation of the carotid, then it will be very diffi-
cult to decide, and probably the operation will be unsuccess-
ful, as we must either come too close on the tumour, or too
near the origin of the carotid; however, if we may judge
from the cases already recorded, the tumour will generally
be formed at the bifurcation, and when it is so, the most
advisable point to tie the carotid, will be, where it is cros-
sed by the omo hyoideus. (a)

When the edge of the sterno cleido mastoideus is raised
in a strong man, neither the artery, vein, nerve, nor even
the sheath of the vessols will be sen, but only the omo
hyoideus, covered with a broad and smooth membrane.
If we mark the lower edge of this muscle, and cut the mem-
branous expansion, and then draw the muscle towards the

(a) Th muscles at the side of the neck, after the platys-
ma myoides has been dissected off, exhibit several triangu-
lar figures, in which the corotid and subclavian vessels are*
comprehended. To present this appearance, let the head
(the subject lying on its back,) be turned to one side, in a
manner, that the base of the lower jaw and clavicle of the
other side may lay parallel with each other. The -side of
the neck thus adjusted, will present a paralellogram, which
the sterno cleido mastoid muscle will divide into two trian-
gles ; and those are further subdivided as follows. Is?
Between the feet of the sterno cleido mastoid a triangu-
lar form is seen, having for its base a portion of the clavicle,
near the sternum ; in this, the subclavian artery is situated
before, it has passed the scaleni muscles. 2d Another
space will be found bounded in front by the trachea,
above by the anterior belly of the digastricus muscle, and
toward the shoulder by the inner leg of the sterno cleido
mastoid ; in this, the carotid artery, at the lower
half the neck, is placed. 3d, Another is bounded by the
posterior belly of the digastricus above ; by the anterior
edge of the upper half of the sterno cleido mastoid muscle
below; and by the anterior belly of the omo hyoideus on
the fore part ; in this the carotid arter/ is situated at the



301

fear, we shall expose the sterno thyroideus, and the gene-
ral sheath of the vessels and nerve/'-" If we open the sheath,
by scratching- upon it close to the edo-e of the sterno tlr
deus, we shall then open only that division of it, which "con-
tains the artery ; so that neither the jugular vein nor the
par vagum will be exposed, nor will the recurrent nerve be
endangered; but if we draw the omo hyoideus towards th<
Srachea, then we shall be obliged to cut upon the middle
nf the sheath, by which we shall come on the groat vein and
nerve, and perhaps on branches of the superior thyroid arto-
ly, which will make it more difficult to tie the carotid neat-
ly. It will now be evident, that the great vein will be
endangered if the ligature be introduced between the vein
and artery. It need hardly be mentioned, that the sympa-

upper half of the neck. 4th There is another triangular
space, in the centre of which the submaxillary gland is sit-
uated : this is bounded on one side, by the base of the lower
jaw ; and on the other two sides by the two bellies of the
digastricus muscle. 5th. The scapular three fourths of the
clavicle, becomes one side to a fifth triangle ; while the outer
belly of the omo hyoideus, with the outer edge of the outer
leg of the sterno cleido mastoid, afford the other two sides.
In this triangular space the subclavian artery is to be found.,
after it has passed the scaleni muscles in its way to the axil-
la. The belly of the omu hyoideus which takes a part in
forming this triangle, lies nearly parallel with the clavicle in
the natural state of parts, being connected with it, by a deep
seated fascia of the neck $ therefore naturally, this muscle
runs in a curved line from the os hyoides to the shoulder ;
when it is freed from the connexion with the clavicle, it rises
in the neck, making this fifth, almost an equilateral trian-
gle. In the operation for tying the artery after it has pas-
sed the scaleni, it is the duty of the surgeon carefully t<
make the separation spoken of, iuthe course of his dissection ;
otherwise, 1 know not, how he will be led to the proper situ-
ation of the artery. Gth. The last triangular space found
on the side of the neck, completes the parallelogram. It i, -
bounded by the outer edge of the sterno cleido mastoid mus-
le, for two thirds its length from above ; by the outer belly
of the omo hyoideus ; and by the edge of the trapezias mus-
de, extending from the shoulder to the tubercle of the os oc-
oipitis. In this triangle, no important vessels lie, but her<-
.-3 found that chain of lymphatic glands, occupying the sid
the neck, that are occasionally affected by scrofula.

*Some branches of the descendens noni, will be seen
v >n the sheath and the muscle.
Bb



302

tlielic nerve lies close on the spine, and quite/ separated
from the general sheath of the vessels.

In making this dissection, we must not forget that the
head is lying in a very different position from that of a pa-
tient on whom an operation is to be performed. As the pa-
tient will probably be sitting-, with his head reclining on a
pillow, we ought to elevate the neck of the subject into that
position.- The manner in which the artery is 'here advised
to be tied, is nearly the same as that which is given, in the
illustrations of the Grand Operations of Surgery, by Mr.
Charles Bell. It differs considerably from the manner of
operating recommended by Mr. Cooper, and by several other
Surgeons. But before such a serious operation is perform-
ed, I would recommend the operator to read every thing
that has been written on the question, and to compare the
several modes proposed. Many interesting cases will be
found in the Medico- Chirurgical Transactions, related by
Mr. Cooper, Mr. Dalrymple, Mr. Vincent, and Mr. Coates":
and also many excellent remarks on the principle of the op-
eration, in the illustrations of Surgery, by Mr. Bell.

At the place just pointed out, the artery may be cut
down upon, so as to be compressed between the linger and
thumb, or tied, when a very severe operation is to be per-
formed below the angle of the jaw.

It is hardly necessary to consider how the carotid should
be tied, when cut by the suicide ; for when it is opened by
a large incision, the patient will probably be dead before the
surgeon is brought to him ; but still, such a question rnay
offer. Mr. John Bell tied i! one case, with success ; but the
circumstances were peculiar, for the unfortunate person wa*
so cool, and so determined to commit suicide, that after
having read the description of the artery, in Mr. Bell's Work
on Anatomy, he stood before a mirror, and calculated the
situation of the carotid so nicely, as to pierce it with a pen- !
jorife; but in consequence of the small size of the external
orifice, the haemorrhage was not very great, the external
. wound closed, and an aneurism formed, lor which, Mr. Bel]
performed the common operation..

The necessity of making ourselves intimately acquainted
with the bearings of this artery, \vas strongly impressed up-
on- me, Eome years ago, by a surgeon relating a case to me,
where, after a stab in the neck, there was repeated ha?morr-
hage : on saying to him, Why did you not tie the carotid ':
with a most significant shake of his head, he replied, " Catch
me at the carotid !" But the times are now altered ; for,
that it is not now considered a difficult operation to tie this'
artery, is proved, by some, surgeons having ^ven trirr 1



303

iinont of tying it for head-ache, and fur tumours, Ov
but it is to be hoped, that even the great ease with which the
artery maybe found, will not induce us to repeat any of
fhose experiments.

We may now prosecute the dissection towards the an-.
of the jaw, and consider the manner of securing the vessels,
when cut at the root of the tongue, by the suicide.

We see the larnyx and the sterno cleido mastoideus pro-
tect tho carotid, and that the branches most exposed, aiv
those of the lingual and facial arteries. The cornu of the OH
hyoides should be carefully marked ; for this is the part
which we should feel for, as a guide, by which we shall ea-
sily find. the lingual and 'facial arteries. The vessels will
generally be easily secured in the wound made by the sui-
cide ; for, there will be a large open incision, and before we
are brought to him, the quantity of blood lost, will have di-
minished the arterial force. In some cases, it maybe diffi-
cult to tie the arteries neatly. I have been obliged, in sc-
c jndary haemorrhage under the tongue, to pass a needle and
' uread coarsely round a bleeding surface. This was against
ile; but I was forced to do it, because the state ofth<
parts was such, tiiat I could not discover the bleeding ves-
sel, and as the source of the hsemorrliage was exactly in
the middle of the throat, I was afraid, that if I tied one caro-
tid, I should be obliged to tie the other also; and that, even
if J tied the carotid from which the vessel arose, there
would still, from the anastomosing vessels, be bleeding suf-
ficient to destroy a jmtient who had already, for the second
time in six days,, lost two pounds of arterial blood. The pa-
tient did well.

We have now brought the dissection up to the angle of the
jaw ; and here comes the very important question of extir-
,11 of tumours.

In dissecting up the platysma, we exposed parts of the
maxillary, and parotid glands ; under the margin of the
submaxillary, and sometimes within its substance, we shall
ihi'l a small lymphatic gland, when this becomes diseased,
and grows large and hard, it presses up the submaxillary
gland, so as to give it the appearance of being affected ; and
thus we have narratives of the extirpation of the submaxil-
lary, when, most probably, the disease has been only in the
lymphatic gland ; for the salivary glands are very seldom
scirrhous. The dissection will show, that an encysted tu-
mour may sometimes betaken out, without much haemorr-
hage. In such a case, we should first mark the situation of
1 he facial artery and vein, and, voiding them, make an inci-
on the edge of the submaxillary gland, so that we m >y



.304

lift up itsejge, and scoop out the tumour ; but if it be very
hard, and adhering to the gland, then we may have con-
siderable bleeding, but not necessarily dangerous ; for it
will probably be from the facial, or lingual artery, and
either of these arteries may be tied, the cornu of the os hyoi-
<les being the principal guide; for the lingual artery 'lie>
above it, and the facial a little higher. We must not for-
get that the lingual nerve is situated between these vessels.

These remarks upon the liability of a scirrhous lymphatic
being mistaken for disease of the salivary gland, apply more
forcibly to the tumours which are connected with the paro-
tid. Every student who examines the anatomy of the paro-
tid gland, and, particularly when it is injected with quick*
silver, will suspect that the histories of operations, in which
a diseased parotid is said to have been wholly extirpated,
are erroneous. The external carotid artery passes through
the substance of the gland, but this is no objection to the
accuracy of the report ; for it maybe tied both above and
below; but, is there no danger of cutting the internal caro-
tid, or the internal jugular, or the par vagum, in the attempt
to extirp ite those parts of the gland which are situated so
deep as the space between the occuput and atlas ? These
considerations induce me to believe, that we cannot extir-
pate the parotid gland.

It is frequently necessary to cut off a portion of the paro-
tid, when a scirrhous tumour is imbedded in it : in these op-
erations, the blood issues as from a sponge, so that it is very
difficult to find all the vessels ; but in the greater number of
cases, the graduated compress will restrain the bleeding
from the smaller arteries. If We must tie the external caro-
tid previous to such an operation, we may proceed thus :
If we cut through the skin, from the lobe of the ear, towards
the cornu of ihe os hyoides, and then dissect through the
platysma myoides, we shall come upon the digastric ; and if
we then dissect along the upper edge of this muscle, we
shall expose the stylo hyoideus, by forcing this last muscle*
downwards, we shall find the continued trunk of the exter-
nal carotid.

In extirpating tumours from this part, we must cut across
many branches of the portio dura,* which will cause partial
paralysis of the face.

* Since the use of the portio dura has been illustrated by
the facts of comparative anatomy, and by various experi-
ments instituted by Mr. Bell, we have been able to explain
many symptoms of disease, which have hitherto puzzled eur-



305

v

The dissection of the duct of the parotid should now bo
made, and its situation accurately marked, that we may avoid

That I may direct the student's attention more particular-