meter of the urethra observed, as also in its prostatic part, the verumontanum or caput gallinaginis, the sinus pocularis, and the orifices of the common ejaculatory ducts (p. 961). The junction of the vas deferens and vesicula seminalis to form the common ejaculatory duct is to be displayed; and a longitudinal section of the prostate gland may be made to show its thickness, consistence, and structure: the relations of its base to the neck of the bladder should be particularly observed, with the circle of veins of the vesical plexus in the angle between them. In the female subject the bladder is to be opened and examined as in the male, and the length and diameter of the urethra observed (p. 980). The vagina is then to be cut open a little on one side of the middle line in front, when the ruga of its mucous membrane will be seen; also, at its entrance, the carunculæ myrtiformes, and, projecting into it above, the cervix uteri (p. 981). The ovary with its ligament and mesovarium, the Fallopian tube, the round ligament of the uterus, and, between the ovary and Fallopian tube, the tubules termed parovarium or organ of Rosenmüller, are next to be dissected, and the external configuration of the uterus examined (p. 982). The student will then notice the position and appearance of the os uteri externum, and will open the uterus on its anterior aspect by a line of section which, by dividing into two superiorly, is prolonged to both of the cornua (p. 984). He will thus see the size and shape of the triangular cavity of the uterus, the cavity of the cervix, the ruge of its mucous membrane, and the os uteri internum. 10. The Pelvic Ligaments.—At the conclusion, the articulations of the pelvic bones may be examined, if they are still in a condition fit for dissection (p. 147). The symphysis pubis with its concentric laminæ of fibrocartilage is first to be examined; then the articulation of the pelvis with the fifth lumbar vertebra, especially the sacro-vertebral and ilio-lumbar ligaments: the great and small sacro-sciatic ligaments should be cleaned, and, by removing the remains of the origin of the obturator internus muscle, the obturator membrane. The anterior and posterior ligaments and the intervertebral disc of the sacro-coccygean articulation are to be observed: lastly, the strong posterior and the thinner anterior sacro-iliac ligaments having been dissected, the last mentioned is to be divided, and the cartilaginous surfaces of the sacroiliac synchondrosis are to be brought into view by forcing open the articulation. V.-LOWER LIMBS OR INFERIOR EXTREMITIES. The right and left limbs constitute each a part, the dissection of which should extend over a period of not less than four weeks. It includes the whole limb below Poupart's ligament and the crest of the ilium, but not the perinæum. 1. The Gluteal Region.-The dissection of the gluteal region, the back of the thigh, and the popliteal space is to be completed in the four days during which the subject lies on its face. To remove the integument from the buttock let an incision be carried along the crest of the ilium, brought downwards in the middle line of the sacrum and curved outwards in the fold of the nates, then directed obliquely to the outside of the thigh about five or six inches below the great trochanter. The junior student will at once proceed to clean the gluteus maximus muscle in the direction of its fibres (p. 266). The senior student will examine the arrangement of the GLUTEAL REGION. cutaneous nerves in this region. 1079 Of these he will find, descending over the crest of the ilium, in order from before backwards, the lateral branches of the last dorsal and ilio-hypogastric nerves (pp. 658 and 660), with several branches of the lumbar nerves (p. 634); and, piercing the gluteus maximus muscle near its posterior attachment, some small cutaneous twigs from the posterior divisions of the upper sacral nerves (p. 635); lastly, turning round its inferior border, branches from the small sciatic nerve (p. 675). It will be observed that the fascia lata, which is strongly developed over that part of the gluteus medius which lies in front of the gluteus maximus muscle, on reaching the upper border of the gluteus maximus, divides into two lamina, of which one is continued on the superficial, and the other on the deep aspect of that muscle (p. 292). Care is to be taken to lay bare the inferior border of the gluteus maximus in its whole extent; and a synovial bursa over the tuberosity of the ischium is to be sought for. The muscle is then to be divided close to its iliac and sacral attachment, and in turning it forward, the sciatic artery and the superficial branch of the gluteal artery will come into view. The branches of these arteries and of the small sciatic nerve which enter the muscle are to be followed out to some extent, and they may then be divided to permit the complete reflection of the muscle. While this is being done a large synovial bursa will be found between the trochanter major and the insertion of the gluteus maximus into the fascia lata. The fascia lata is to be removed from the upper part of the gluteus medius muscle, and the parts exposed by the removal of the gluteus maximus are to be cleaned in their order from above downwards, viz.: the back part of the gluteus medius muscle, the gluteal vessels (p. 429), the pyriformis muscle, the sciatic vessels and the great and small sciatic nerves (p. 674), the gemelli muscles, superior and inferior, with the tendon of the obturator internus muscle between them (p. 268). The tendon of this muscle may now be dissected from between the gemelli, divided and turned back, to show the synovial cavity in which it plays upon the smooth trochlear surface of the ischium. The quadratus femoris, the tendon of the obturator externus muscle situated more deeply, the upper part of the adductor magnus muscle, and the origin of the hamstring muscles are then to be exposed. From the small sciatic nerve the inferior pudendal branches will be seen given off, in addition to those already mentioned, and from the sciatic artery, besides muscular branches, the coccygeal branch, the branch to the great sciatic nerve, and that by which it anastomoses with the internal circumflex artery may be traced. On the spine of the ischium also will be seen the pudic vessels and nerve, and the nerve to the obturator internus muscle (pp. 425 and 670); and descending under cover of the tendon of the obturator internus and the gemelli is the small nerve to the quadratus femoris. The gluteus maximus muscle having been entirely removed from its upper attachment, and the tendon of insertion being left, the gluteus medius is to be raised from the ilium in three-fourths of its extent; its anterior border and that of the gluteus minimus muscle being left for dissection from the front. The attachments of the gluteus medius muscle are to be observed, as also the superior and inferior deep branches of the gluteal artery, and the distribution of the gluteal nerve (pp. 429 and 667). The posterior part of the gluteus minimus may then be raised from the ilium to show the extent of its attachment to that bone, and its relation to the capsule of the hipjoint. 2. The Popliteal Space.-It is advisable to dissect this space before the posterior femoral region. In order to open it the integument may be divided by a longitudinal incision of considerable length, which may be crossed if necessary by a transverse one in the middle of the space, sufficient to allow the integument to be thrown freely back. On removal of the superficial fat, the fascia lata, which is strong in this region, will come into view, and, in the lower part of the space, the terminal twigs of the small sciatic nerve (p. 675), and the upper part of the short saphenous vein (p. 476). The fascia lata is to be divided, and the fat carefully removed from the space, its boundaries cleaned, and the vessels and nerves with their branches traced. Superiorly the biceps muscle on the outside, and the semitendinosus and semimembranosus muscles on the inside, and inferiorly the heads of the gastrocnemius muscle with the small belly of the plantaris will thus be exposed. Lying in the space the dissector will find the external and internal popliteal nerves giving off their articular and sural branches (pp. 676 and 679), and more deeply the popliteal vessels in a common sheath (p. 441). He will follow out the branches of the popliteal artery, viz., its five articular branches, the superior, azygos, and inferior, and its sural branches. On the surface of the popliteal artery, where it enters the space, may be found a twig of the obturator nerve (p. 663). When the dissection of the popliteal space has been completed, it is to be united to that of the gluteal region by an incision along the posterior part of the thigh. The course of the small and great sciatic nerves will thus be laid bare, together with the biceps, semitendinosus and semimembranosus muscles, the twigs of the great sciatic nerve supplied to these muscles, and to the adductor magnus, and the four perforating branches of the deep femoral artery (p. 439); the posterior aspect of the adductor magnus muscle will also be exposed. 3. The Front of the Thigh.-On the day on which the subject is laid upon its back, the student should begin the dissection of the front of the thigh, by studying the fascia connected with the descent of femoral hernia. For this purpose an incision is to be made from the neighbourhood of the anterior superior spinous process of the ilium inwards, in the line of the groin, and carried half away down the inside of the thigh. The large flap of integument thus marked out is to be raised and turned outwards. The subcutaneous fascia is then to be laid bare by the removal of any fat, and it will be advantageous if this can be done in concert with the dissector of the abdomen (p. 292). Various small superficial arteries and veins will be seen, viz. the superficial epigastric, superficial circumflex iliac, and superior and inferior superficial pudic (p. 437). The fascia lata will be laid bare, and the cribriform fascia overlying the saphenous opening. On the surface of the fascia lata will be brought into view the internal or long saphenous vein passing into the saphenous opening, frequently presenting two branches (p. 475); nearly in front of the femoral artery, the crural branch of the genito-crural nerve; and in front of the anterior superior spine of the ilium, the external cutaneous nerve (p. 660). A twig of the ilio-inguinal nerve may also be seen distributed to the skin of a small part of the thigh close to the pubes. The border of the saphenous opening is to be made distinct by removing the cribriform fascia, and in doing this the attachment of the superior cornu or falciform process to the pubic portion of the fascia lata is to be shown (p. 293). This falciform process is then to be separated from the fascia lata and turned to the outside sufficiently to expose the infundibuliform or crural sheath, investing the femoral vessels, and the dissector ANTERIOR FEMORAL REGION. 1081 may examine the three compartments into which this sheath is divided, and which contain respectively the artery, the vein, and a lymphatic gland; the latter blocking up the crural aperture between the femoral vein and Gimbernat's ligament, through which femoral hernia descends. All the relations of these parts are to be carefully studied with special reference to the operations for strangulated femoral hernia (p. 1036). The incision on the inner side of the thigh is now to be prolonged downwards towards the middle line beyond the knee, and the dissection of the front of the thigh continued. The two middle and the two internal. cutaneous branches of the anterior crural nerve, together with the branch from the internal saphenous nerve to the integument of the knee, and the internal saphenous vein, will be dissected out, and the fascia lata in front of the thigh made clean (p. 664). The fascia is then to be removed, and the communications of the internal cutaneous, internal saphenous, and obturator nerves sought in the lower part of the inner aspect of the thigh (p. 666). Scarpa's triangle is now to be cleaned, and the dissection of the femoral vessels both in that space and in the after part of their course is to be studied (p. 434). Towards its termination below the middle of the thigh, the femoral artery will be observed to be covered by a tendinous expansion, which conceals it for a part of its course before it pierces the tendon of the adductor magnus muscle: in the passage so formed, known as Hunter's canal, the femoral artery, which is accompanied by the internal saphenous nerve, will be seen to give off the anastomotic branch (p. 293). The deep femoral artery should be dissected as far as the upper border of the adductor longus muscle; and the origins of its first branches are to be brought into view, viz. : the internal circumflex artery, dividing into ascending, transverse, and descending branches. One or both of the circumflex arteries often arise from the femoral artery immediately above the origin of the deep femoral (p. 438). The sartorius muscle is to be cleaned, and likewise the gracilis muscle, and the surface of the other adductors; the relations of the inferior tendons of the sartorius, gracilis, and semitendinous muscles may also be exposed (pp. 273 and 276). The student will then direct his attention to the outer part of the thigh near the hip. He will there dissect the fascia lata from the remaining part of the gluteus medius muscle, and from the tensor vaginæ femoris muscle, leaving at first a strip of the fascia extending down to the knee on the outside of the leg, and he will afterwards expose the deeper band of the fascia which passes inwards to the hip-joint from within the upper part of the muscle (pp. 273 and 292). He will also find the branch of the gluteal nerve to the tensor vaginæ femoris by dissecting between it and the gluteus medius muscle (p. 667). Let him divide successively the tensor vaginæ femoris and the remains of the gluteus medius and minimus, and dissect the two last muscles down to their inferior attachments, so as to exhibit the bursæ between them and the trochanter major, and the connection of the gluteus minimus with the capsule of the hip-joint (p. 268). While engaged with this proceeding he will be enabled to dissect more particularly the ascending and transverse branches of the external circumflex artery, and to examine their anastomoses with the gluteal artery (p. 438). Let him then clean the rectus muscle, trace its anterior and posterior heads close to their origins, and observe the positions of the limb in which they are respectively tightened (p. 274). The trunk of the anterior crural nerve is now to be cleaned, its branches to the extensor muscles are to be dissected, the internal saphenous nerve laid bare as far as the knee, and the slender twigs to the pectineus muscle seen passing behind the femoral vessels. These last may be most easily found if the common femoral artery be previously divided (p. 664). If the accessory obturator nerve is present, it will now be seen passing over the brim of the pelvis to the outer border of the pectineus muscle which it partly supplies (p. 666). The pectineus and adductor longus muscles are then to be divided, and their attachments carefully dissected. The continuation of the profunda femoris artery behind the adductor longus is to be cleaned; and its four perforating branches, of which the fourth is the continuation of the artery, will be seen piercing the adductor magnus muscle (p. 439). When the pectineus muscle has been reflected, the accessory obturator nerve may be traced to its communication with the main obturator nerve, to the pectineus muscle, and to the hip joint. The anterior division of the obturator nerve is to be traced down in front of the adductor brevis muscle, and on division of the pectineus muscle its posterior division to the adductor magnus will come into view. The obturator nerve will be observed to supply all the adductor group of muscles (p. 662). The dissector will now trace the internal circumflex artery; he will find it dividing into two branches, one of which passes inwards in front of the obturator externus and adductor brevis muscles, while the other is directed backwards to anastomose with the sciatic artery, and gives off a branch to the hip-joint which enters it by the notch of the acetabulum (p. 439). The obturator externus muscle is to be cleaned, and the external and internal divisions of the obturator artery are to be laid bare from among its fibres (pp. 269 and 423). The adductor magnus muscle is then to be cleaned and examined (p. 277); and after it the conjoined insertion of the psoas and iliacus muscles (p. 271); the vastus externus, vastus internus and crureus muscles, together with the deep fibres of the latter, called subcrureus, which are inserted into the synovial membrane of the knee-joint (p. 275). 4. Hip-joint.-When this stage of the dissection has been reached, the student may either saw through the femur and leave the hip-joint to a more convenient opportunity, or dissect the joint at this time, and afterwards disarticulate the femur. The latter plan is usually to be preferred. In that case, the attachments of all the muscles which act upon or are related to the hip-joint are to be reviewed, and those which remain uncut are to be severed; the capsular ligament is to be cleaned; its thinness or deficiency on the posterior aspect, and the thick accessory or ilio-femoral ligament, strengthening it in front, are to be noted (p. 151). The relation of the head of the femur to the acetabulum in the various positions of the limb and foot are to be observed. The capsule may then be opened, and the cotyloid, transverse, and round ligaments examined, together with the articular surfaces and synovial membrane: the limb may then be removed from the body. 5. The Back of the Leg.-After the separation of the limb from the trunk, and when the divided structures have been cleaned and cut conveniently short, the student will proceed with the dissection of the calf and back of the leg, by directing an incision down the middle of the limb to the heel, and reflecting the skin to each side. He will trace the external and internal saphenous veins as far as the outer and inner ankle (p. 475); accompanying the latter he will find the internal saphenous nerve (p. 666), and along with the former he will find the external saphenous nerve arising from the union of the communicans tibialis and communicans fibularis branches of the internal and external popliteal nerves respectively (p. 677). He will also |