TEXTBOOK OF HUMAN ANATOMY

Contributors
The late Sir Wilfred E Le Gros Clark, MA, MD, DSe, LLD, FRCS, FRS
Professor of Anatomy, University of Oxford
R E Coupland, MD, PhD, DSe, FRSE
Prf!fessor f!fHuman Morphology, University f!f Nottingham
T W Glenister, TO, DSe, MB, BS, PhD
Professor of Anatomy, Charing Cross Hospital Medical School,
University of London
The late W JHamilton, MD, BCh, DSe, FRSE, FRCOG, FRCS
Prf!fessor Emeritus, University of London
J Joseph, MD, DSe, FRCOG
Professor of Anatomy, Guy's Hospital Medical School,
University of London
R M H McMinn, PhD, MD, FRCS
Prf!fessor f!fAnatomy, Royal College f!f Surgeons of England
R J Scothorne, BSe, MB, ChB, MD, FRCS
Regius Professor f!f Anatomy,- University f!f Glasgow
D Sinclair, MA, DSe, MD, FRSE
Director, Postgraduate Medical Education, Queen Elizabeth I I Medical
Centre, Western Australia. Formerly Professor of Anatomy,
University of Aberdeen
J M Yoffey, DSc, MD, FRCS, Hon LLD
Professor Emeritus, University of Bristol
Visiting Professor, Hebrew University of Jerusalem
 Textbook of
HUMAN ANATOMY
Second Edition
Edited by the late W J HAMIL TON

M
 © W. J. Hamilton, 1976

All rights reserved. No part of this publication may

be reproduced or transmitted, in any form or by any
means, without permission

First Edition, 1956

Second Edition, 1976
Reprinted, 1977, 1982

Published by
THE MACMILLAN PRESS LTO
London and Basingstoke
Companies and representatives throughout
the world

ISBN 978-0-333-34029-5 ISBN 978-1-349-06486-1 (eBook)

DOI 10.1007/978-1-349-06486-1

The paperback edition of this book is sold subject to the

condition that it shall not, by way of trade or otherwise, be
lent, resold, hired out, or otherwise circulated without
the publisher's prior consent, in any form of binding or
cover other than that in which it is published and without
a similar condition including this condition being
imposed on the subsequent purchaser.
PREFACE TO THE
SECOND EDITION
As the proofs of this book were in the press, the sudden death
of Professor W. J. Hamilton deprived British anatomy, and
indeed anatomy throughout the world, of one of its out-
standing personalities. Some time previously, he had decided
that when this Second Edition was published he would retire
from the Editorship and he had asked us to take over the
preparation of any further editions. So it came about that we
find ourselves writing a preface that should rightly be his, for
the whole concept of this edition was his and it is only the
final printing that he has not lived to see.
For this edition there are new contributors and a new two-
column format has been adopted. Some of the chapters have
been extensively revised and the others have been entirely
re-written, the terminology conforming in general with
Nomina Anatomica. While many of the former figures have
been retained, the labelling has been carefully revised to make
them more readable and more pleasing to the eye. In this
respect, considerable attention has been paid to the layout of
the illustrations. Many new figures have been added and the
quality of the draftsmanship displayed by the late A. K.
Maxwell and by Frank Price is outstanding; all readers of
this book must be indebted to them, and as editors-designate
we gladly acknowledge our own debt.
Although Anatomy is a scientific discipline in its own right,
the contributors have borne in mind that this is a book
designed for those who are preparing for careers in medicine
(using that term in its broadest sense), and frequent reference
has been made to the clinical and applied aspects of the subject.
This is not to say that everything included in the text is of
everyday clinical significance; enough anatomical knowledge
has been included for the student to appreciate how the body
is, and has come to be, constructed and how the various
structures of which it is composed are designed to perform
their functions. Sufficient microscopical and developmental
anatomy has been included to allow integration with
topographical anatomy.
Where illustrations have been reproduced with the per-
mission of the authors and publishers, or are based on those
already published elsewhere, due acknowledgement is made
in the accompanying legend. If, by oversight, any such
acknowledgements have been omitted, we offer our apologies
and ask the indulgence of any offended party, as it has been
particularly difficult to ensure that no such omissions have
occurred, much of the required information having dis-
appeared with the death of Professor Hamilton.
On behalf of the late Professor Hamilton, it is our pleasure
to thank our colleagues for their contributions. Professor
Jack Joseph has kindly undertaken the onerous task of
preparing the index and we are particularly grateful to Mr.
Charles Fry, of the Macmillan Press Ltd., who has done so
much to see the completion of this edition through its various
stages of production and without whose help it would have
been difficult, if not impossible, to complete the proof stages
after the Editor's death. Lastly, but not least, we express our
gratitude to the sons of Professor Hamilton who kept the
impetus going after the loss of their father.
We trust that this volume will be a worthy and lasting
tribute to the man whose concept it was.
T.W.G.
London, R.M.H.McM.
January 1976.
PREFACE TO THE
FIRST EDITION
Is there need for yet another Textbook of Anatomy? We
believe there are three major reasons why such a book is
required.
The first arises from the progressive expansion of the
medical curriculum. This makes it essential to reduce the
amount of factual knowledge which the medical student is
called upon to acquire. However, while most of us would
accept the desirability of this aim, the task of eliminating
anatomical detail presents a serious difficulty. We tend to
emphasize the clinical significance of anatomical facts, most
of which may on occasion be of practical importance. But
some facts are either used more frequently or possess far
greater importance than others, and it thus becomes essential
to establish a scale of values in order that the medical student
may view his anatomical knowledge in its correct perspective.
It is this which constitutes the essence of the problem. If it is
insisted that medical students should be prepared for every
possible clinical contingency (even difficult major operations),
the omission of much detail will never be possible. But even
where there is a genuine wish to omit, the assessment of the
relative significance of anatomical data is determined to an
appreciable extent by individual experience and is con-
sequently a somewhat subjective process. It is therefore not
easy to secure a common measure of agreement on how much
topographical detail to exclude and, when discussing the
problem amongst ourselves or with our colleagues, it has
almost been a case of quat homines tot sententiae.
We have curtailed much of the detailed anatomy on the
bones of the skull as considered separately in disarticulated
form, and also on the separate carpal and the tarsal bones.
We have similarly abbreviated the account of the smaller
branches of blood vessels. In addition, it will be found that
there has been a certain amount of pruning of what may be
considered to be topographical minutiae throughout most
sections of the book.
Our second reason for writing a new Textbook1s the need
for a closer correlation between the study of structure and
function. It is a regrettable fact that while all those who are
concerned with medical education are agreed on the need for
greater integration between the different branches of the
medical curriculum in general, and anatomy and physiology
in particular, this attitude has not yet been reflected to any
great extent in students' textbooks. We have therefore
attempted to stress this aspect of anatomy rather more
forcibily than is the case in the existing standard textbooks.
The use of radiological methods in anatomical teaching
has inevitably meant a more functional approach to the study
of many parts of the body, notably the thoracic and
abdominal viscera. The observation of changing structure
during life becomes inseparable from the study of function,
and indeed unintelligible without it. Further, in the field of
experimental anatomy the light which has been thrown on
morphogenetic and histogenetic mechanisms has again served
to direct attention to tissues which are alive and capable of
change rather than on dead and fixed material.
In the present volume it has been mainly in the central
nervous, endocrine, and cardiovascular systems than an effort
has been made to break down the artificial barriers which
have hitherto existed between anatomy and physiology. To
the same end, the bony elements of the skeleton are con-
sidered together with the joints and muscles, so that the student
approaches the study of the locomotor system as a whole.
The third reason is that anatomy is not merely part of the
medical curriculum, but also an independent branch of bio-
logical science with problems and achievements of its own.
We feel it is important that, however briefly and sketchily,
the student should be introduced to the wider biological
implications of his anatomical studies, and that he should be
induced to realize that what he is learning is significant from
other than purely vocational points of view.
In many departments of Anatomy it is now customary to
integrate the teaching of macroscopic with microscopic
anatomy. We believe that the intimate relationship between
the two aspects of anatomy is apt to be overlooked if the
student is not constantly reminded how closely they are inter-
linked. A brief account is therefore given of this histological
appearance of the different organs and tissues. No attempt is
made in this book to give a systematic and detailed review
of embryological development. Brief references to embryology
are made only where it helps to elucidate some particular
aspect of gross or microscopic anatomy.
Without sacrificing any of the topographical information
which will always be essential for the non-specialist medical
practitioner, we believe that this book covers the field of
anatomical knowledge which the medical student is expected
to have acquired by the end of his pre-clinical course. While
designed primarily for medical students, it should also be of
value to students of physiotherapy, radiotherapy, dentistry and
physical education, as well as biologists generally.
Though the book in its present form may have realized
imperfectly the aims with which we set out to write it, we
hope that it will meet a need which we are sure exists, and
which is bound to make itself felt with added force in the
future.
CONTENTS

INTRODUCTION W J Hamilton and J M Y offey Development, Ossification and Growth of the

Vertebral Column 51
The Scope of Anatomy 1
Structural Variations of the Vertebral Column 52
Anatomical Nomenclature 1
Methods of Study 2 THORAX 53
Normal Anatomy and Individual Variations 4
Ribs 53
BLOOD AND CONNECTIVE TISSUE 5 Sternum 55
Costal Cartilages 55
Constituent Elements of Connective Tissue 5
fu~~ 56
Blood and Blood-Forming Organs 9
Movements of the Chest Wall 56
Blood Formation 14
Cell Ultrastructure 16 SKULL 58
LOCOMOTOR SYSTEM J Joseph 19 Skull from above 59
Skull from below 60
General 19
Skull from in front 62
Evolution of Locomotor System of Man 20
Skull from the side 62
The Human Skeletal Pattern 21
Cranial Cavity 66
Changes in the Mechanics of Locomotion 23
Nasal Cavity 68
CARTILAGE AND BONE 24 Paranasal Sinuses 70
The Separate Bones of the Skull and their
Cartilage 25
Development 70
Bone 26
Temporomandibular Joint 82
JOINTS 35 Age Changes in the Skull 83
Variations in the Form of the Skull 84
Synovial Joints 36
Cartilaginous and Fibrous Joints 38
UPPER LIMB~BONES AND JOINTS 84
Development of and Changes in Joints 38
Radiological Appearances of Joints 38 Shoulder Girdle and Humerus 84
Joints of Shoulder Girdle and Glenohumeral Joint 91
MUSCLES 38
Movements of Shoulder Girdle 92
Functional Aspects of Contracting Muscle 42 Bones of the Forearm, Wrist and Hand 94
Joints of the Elbow, Wrist and Hand 101
FASCIA 43
VERTEBRAL COLUMN 43 LOWER LIMB~BONES AND JOINTS 109
Cervical Vertebrae 45 Pelvic Girdle 109
Thoracic Vertebrae 46 Pelvis as a Whole 113
Lumbar Vertebrae 46 Measurements of the Female Pelvis 114
Sacrum and Coccyx 47 Sex Differences in the Pelvis 115
Intervertebral Discs 47 Joints of the Pelvis 116
Joints of the Vertebral Column 48 Femur and Hip Joint 117
The Vertebral Column as a Whole 50 Bones of the Leg and Knee Joint 123
Movements of Vertebral Column 50 Skeleton of the Foot 130
 MYOLOGY 138 DIGESTIVE SYSTEM W J Hamilton and R M H
McMinn 329
Fascia and Muscles of the Trunk 138
Muscles of the Head 154 ALIMENTARY CANAL 329
Fascia and Muscles of the Neck 158
General Structure of the Alimentary Canal 330
Fascia and Muscles of the Upper Limb 163
Development of the Digestive System 332
Fascia and Muscles of the Lower Limb 179
Mouth 334
MAN'S POSTURE 196 Dental Arches and Teeth 336
Palate 341
LOCOMOTION 198
Tongue 344
Pharynx 350
CARDIOV ASCULAR SYSTEM J M Yoffey 201 Oesophagus 358
GENERAL ARRANGEMENT 201 ABDOMINAL AND PELVIC CAVITIES 361
Heart: Pulmonary and Systemic Circulation 201 Regions of the Abdomen 361
Network of Blood Vessels 202 Peritoneum 364
Structure of the Arteries 204 Stomach 375
Function of the Arterial Wall 206 Intestine 381
Structure of the Capillaries 207
LIVER 395
Structure of Veins 211
Anastomosis and Collateral Circulation 212 PANCREAS 403
Growth of Blood Vessels 214
Innervation of Blood Vessels 215 UROGENITAL SYSTEM T W Glenister 405
Vitelline and Placental Circulation 216
General Development of the Heart and Great Vessels 217 General Disposition of the Organs of Excretion and
Fetal Circulation 221 Reproduction 405
Examination of Living Blood Vessels 224 Phylogenetic and Ontogenetic Considerations 407
Homologues of the Organs of Reproduction 410
HEART AND PERICARDIUM 225
Kidneys 410
General Configuration of the Heart 225 Ureters 423
Interior of the Heart 227 Urinary Bladder 426
Tissues of the Heart 233 Urethra 433
Examination of the Living Heart 239
FEMALE REPRODUCTIVE ORGANS 435
BLOOD VESSELS 242 Ovaries 435
Aorta 242 Ovarian Cycle 436
Descending Thoracic Aorta 258 Uterine Tubes 441
Uterus 444
VEINS 270
Vagina 453
Veins of the Head and Neck 270 Vulva, or External Genitalia of Female 455
Veins of the Upper Limb 275 Mammary Gland 456
Superior Vena Cava and its Drainage Area 275
MALE REPRODUCTIVE ORGANS 461
Veins of the Lower Limb 276
Inferior Vena Cava and its Drainage Area 276 Testis and Epididymis 461
Portal Vein and its Tributaries 277 Spermatic Cord 469
Ductus (Vas) Deferens 470
L YMPHA TIC SYSTEM 279
Seminal Vesicles 472
Lymphatic Vessels 279 Prostate 473
Lymph Node Disposition, Structure and Relation to External Genitalia of the Male 478
Lymph Vessels 280
Main Collecting Lymphatic Channels 283
ENDOCRINE SYSTEM R E Coupland 481

RESPIRATORY SYSTEM J M Yoffey 297 Pituitary Gland (Hypophysis Cerebri) 482

THE RESPIRATORY PASSAGES 297 Pineal Body 487

Nose 297 Thyroid Gland 488
Nasal Cavity 297 Parathyroid Glands 492
Nasal Pharynx 302 Thymus 493
Larynx 303 Endocrine Islets of the Pancreas 495
Trachea and Bronchi 314 Adrenal (Suprarenal) Glands 497
Mediastinum 315
LUNGS 318 SPLEEN J M Y offey 501
CENTRAL NERVOUS SYSTEM W E Ie Gros Clark 505 Nerve Terminations 611
Nerve Components 614
Anatomy of the Neuron 506
Distribution of Cranial Nerves 616
Anatomy of the Reflex Arc 511
General Plan of Central Nervous SPINAL NERVES 637
System 512
Roots of the Spinal Nerves 637
General Connections of Brain 518
Primary Rami of Spinal Nerves 640
Spinal Cord and its Membranes 521
Cervical Plexus 642
THE BRAIN 533 Brachial Plexus 643
Ventral Primary Rami of the Thoracic Nerves 655
Main Features of the Internal Structure of the Brain
Lower Five Intercostal and Subcostal Nerves 657
Stem 538 Ventral Primary Rami of Lumbar, Sacral and
Nuclei of Cranial Nerves 540
Coccygeal Nerves 657
Ascending Tracts in the Brain Stem 550
Lumbar Plexus 657
Descending Tracts in the Brain Stem 552
Sacral Plexus 663
Association Tracts of the Brain Stem 553
Cerebellum 553 AUTONOMIC NERVOUS SYSTEM 667
THE FOREBRAIN (PROSENCEPHALON) 558 Sympathetic and Parasympathetic Divisions 670
Sympathetic Division 670
Cerebral Cortex 558
Parasympathetic Division 680
Sensory Systems of Thalamus and Cortex 574
Auditory System 576 ORGANS OF THE SPECIAL SENSES 682
Visual System 576 A M Hamilton
Olfactory System 584
Organ of Sight 682
Gustatory System 585
Eyeball 683
Motor and Premo tor Areas of Cortex 586
Eyebrows and Eyelids 694
Corpus Striatum 587
Organ of Hearing 696
Association Fibres of Cerebral Cortex 589
The Skin 706
Association Areas of Cerebral Cortex 589
Commissural Connections of Cerebral Cortex 591
GROWTH D Sinclair 713
Ventricular System and Circulation of
Cerebrospinal Fluid 591 Growth Curves 714
Intracranial Dura Mater 596 Growth of the Body as a Whole 714
Arterial Supply of the Brain 597 Cross-Sectional Growth Standards 717
Venous Drainage of Brain 601 Growth of Systems 718
Maturation 724
Factors Influencing Growth and Maturation 725
PERIPHERAL NERVOUS SYSTEM R J Scothorne 603
Structure of Peripheral Nerve Fibres and Nerves 606 INDEX 729