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 THE BIG PICTURE
GROSS ANATOMY,
MEDICAL COURSE AND STEP 1 REVIEW
SECOND EDITION

David A. Morton, PhD

Professor
Anatomy Director
Vice-Chair of Medical and Dental Education
Department of Neurobiology and Anatomy
University of Utah School of Medicine
Salt Lake City, Utah

K. Bo Foreman, PhD, PT
Associate Professor
Anatomy Director
Department of Physical Therapy and Athletic Training
University of Utah College of Health
Associate Editor, The Anatomical Record
Salt Lake City, Utah

Kurt H. Albertine, PhD, FAAAS, FAAA

Professor of Pediatrics, Medicine (Adjunct}, and Neurobiology and Anatomy (Adjunct)
Edward B. Clark Endowed Chair N of Pediatrics
Editor-In-Chief, The Anatomical Record
University of Utah School of Medicine
Salt Lake City, Utah

II
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 DEDICATION

To my wife Celine and our children Jared, Ireland, Gabriel, Max, and Jack; and their cousins Lia, Sophia, Joshua,
Cayden, Ethan, Nathan, Kelsey, Robert, Stefani, Ella, Reid, Roman, Marcus, Jared, Hannah, Tanner, Liam, Maia, Riley,
Sydney, Luke, Cole, Desiree, Celeste, Connlan, Isabelle, Nathan, Simon, Thomas, James, Alexandre, Lyla, Logan,
William, Lincoln, Emmett, Andilynn, Greyson, Kennedy, Davis, Caleb, Charlotte, Adeline, and Penny.
I could not ask for a better family.
-David A. Morton

To my devoted family: my wife, Cindy, and our two daughters Hannah and Kaia. I would also like to posthumously dedicate
this second edition to Dr. Carolee Moncur, without her mentorship and inspiration this book would not have been possible.
-K. Bo Foreman

To David and Bo, co-authoring this book (both editions) with you completes a mentoring circle for me. I am proud to have
you as my colleagues and friends. To my wife, Laura Lake, and our adult children Erik and Kristin. Thank you for your
patience with and understanding of my efforts to contribute to biomedical education and research. A delight for me is that the topic
of human anatomy is enjoyed by our four grandchildren Brenee, Marlee, Callan, and Emery, each of whom leafs through the first
edition of the Big Picture Gross Anatomy book. Hopefully, they will do the same with this, the second, edition.
-Kurt H. Albertine
This page intentionally left blank
 CONTENTS

Preface . . . . . . xi Heart Valves 58

Cardiac Cycle 58
Acknowledgments. xii Innervation of the Heart 60

About the Authors. xiv CHAPTER 5 Superior and Posterior

Mediastinum ...................... 63
Divisions of the Mediastinum 64
SECTION 1: BACK Sympathetic Trunk and Associated
Branches 66
CHAPTER 1 Back Anatomy ...................... 3 Azygos Veins, Thoracic Duct,
Superficial Back Muscles 4 and Thoracic Aorta 68
Deep Back Muscles 6 Posterior and Superior Mediastinum 70
Vertebral Column 8 Study Questions 72
Vertebrae 10 Answers 74
Spinal Meninges 12
Spinal Cord 14
Spinal Nerves 16 SECTION 3: ABDOMEN, PELVIS, AND PERINEUM
Study Questions 22
Answers 23
CHAPTER 6 Overview of the Abdomen,
Pelvis, and Perineum ............... 77
Osteologic Overview 78

SECTION 2: THORAX GutTube 80

CHAPTER 2 Anterior Thoracic Wall ......... . ... 27 CHAPTER 7 Anterior Abdominal Wall ........... 83
The Breast 28 Partitioning of the Abdominal Region 84

Thoracic Muscles 30 Superficial Layers of the Anterior

Abdominal Wall 84
Thoracic Skeleton 32
Anterior Abdominal Wall Muscles 86
Nerves of the Thoracic Wall 34
Vascular Supply and Innervation
Vasculature of the Thoracic Wall 36 of the Anterior Abdominal Wall 88
Diaphragm 38
Inguinal Canal 90
CHAPTER 3 Lungs ............................. 41 Scrotum and Spermatic Cord 92

Pleura 42
CHAPTER 8 Serous Membranes of the
Anatomy of the Lung 44
Abdominal Cavity ............ . .... 95
Hilum of the Lung 46
The Peritoneum 96
Ventilation 48

CHAPTER 4 Heart ............................. 51 CHAPTER 9 Foregut ........................... 99

Pericardium 52 GI Portion of the Foregut 100
Overview of the Heart 52 Liver and Gallbladder 102

Coronary Circulation 54 Pancreas and Spleen 104

Chambers of the Heart 56 Vascular Supply of the Foregut 106

To access your complimentary online lecture videos, visit http://mhprofessional.com/usmle-anatomy-review.

viii Contents

CHAPTER 10 Midgut, Hindgut, and GI Vascular CN I: Olfactory Nerve 188

Supply and Innervation ............ 109 CN II: Optic Nerve 188
Midgut 110 CN III: Oculomotor Nerve 190
ffindgut 112 CN IV: Trochlear Nerve 190
Innervation of the GI Tract 114 CN VI: Abducens Nerve 190
Hepatic Portal System 116 CN V: Trigeminal Nerve 192
CN VII: Facial Nerve 194
CHAPTER 11 Posterior Abdominal Wall . .. .... .. 119 CN VIII: Vestibulocochlear Nerve 194
Posterior Abdominal Wall Muscles CN IX: Glossopharyngeal Nerve 196
and Nerves 120 198
CN X: Vagus Nerve
Posterior Abdominal Wall Vessels 122 CN XI: Spinal Accessory Nerve 200
Posterior Abdominal Wall Autonomies 124 CN XII: Hypoglossal Nerve 200
Adrenal Glands, Kidneys, and Ureters 126 202
Autonomic Innervation of the Head

CHAPTER 12 Perineum and Pelvis . .. . . ......... 129 CHAPTER 18 Orbit ............ . ........... .. . .. 207
Perineum 130 Orbital Region 208
Pelvic Floor 132 The Eye 210
Pelvic Vasculature 134 Extraocular Muscle Movement 212
Pelvic Innervation 136 Innervation of the Orbit 216
Rectum and Anal Canal 138
Ureters and Urinary Bladder 140 CHAPTER 19 Ear .... .. .... .. . . .. .. ............ 219
The Ear 220
CHAPTER 13 Male Reproductive System ..... .. .. 143
Male Reproductive System 144 CHAPTER 20 Superficial Face . . ......... .. . .... . 225
The Male Sexual Responses 148 Cutaneous Innervation and
Vasculature of the Face 226
CHAPTER 14 Female Reproductive System ...... 151 Muscles and Innervation of the
Female Reproductive System 152 Face 228
The Female Sexual Responses 156
Study Questions 157 CHAPTER 21 Infratemporal Fossa ............ .. . 231
Answers 160 Overview of the Infratemporal Fossa 232
Innervation and Vascular Supply of the
Infratemporal Fossa 234
SECTION 4: HEAD
CHAPTER 22 Pterygopalatine Fossa . . .. ..... ... . 237
CHAPTER 15 Scalp, Skull, and Meninges ........ 165 Overview of the Pterygopalatine Fossa 238
Anatomy of the Scalp 166
Skull 168 CHAPTER 23 Nasal Cavity ..... ..... . ........... 241
Cranial Fossae 170 Overview of the Nasal Cavity 242
Meninges 172 Paranasal Sinuses 246

CHAPTER 16 Brain . . ........ .. .. . ............ . 177 CHAPTER 24 Oral Cavity ................. . ..... 249
Anatomy of the Brain 178 Palate 250
Ventricular System of the Brain 180 Tongue 252
Blood Supply to the Brain 182 Salivation 252
Teeth and Gingivae 254
CHAPTER 17 Cranial Nerves . . . . . . . . . . . . . . . . . . . . 185 Study Questions 256
Overview of the Cranial Nerves 186 Answers 260
 Contents

SECTION 5: NECK Terminal Branches of the Brachial

Plexus in the Arm 334
CHAPTER 25 Overview of the Neck ............. 265 Vascularization of the Arm 334
Fascia of the Neck 266 Joints Connecting the Arm and Forearm 336
Muscles of the Neck 268
Vessels of the Neck 272
CHAPTER 32 Forearm ......................... 339
Muscles of the Forearm 340
Innervation of the Neck 274
Terminal Branches of the Brachial
Plexus in the Forearm 344
CHAPTER 2& Viscera of the Neck................ 277
Vascularization of the Forearm 346
Visceral Layers of the Neck 278
Joints Connecting the Forearm and Hand 348
CHAPTER 27 Pharynx ......................... 281
Overview of the Pharynx 282
CHAPTER 33 Hand ............................ 353
Organization of the Fascia of the Hand 354
FunctionsofthePharynx 284
Actions of the Fingers and Thumb 356
Neurovascular Supply of the
Pharynx 286 Muscles of the Hand 358
Terminal Branches of the Brachial
CHAPTER 28 Larynx ........................... 289 Plexus in the Hand 360
Laryngeal Framework 290 Vascularization of the Hand 362
Function of the Larynx 292 Joints of the Hand 364
Vascular Supply and Innervation Study Questions 367
of the Larynx 294 Answers 370
Study Questions 296
Answers 298
SECTION 7: LOWER LIMB

SECTION &: UPPER LIMB CHAPTER 34 Overview of the Lower Limb ..... . . 375
Bones of the Pelvic Region and Thigh 376
CHAPTER 29 Overview of the Upper Limb . .. ... 301 Bones of the Leg and Foot 378
Bones of the Shoulder and Arm 302 Fascial Planes and Muscles 380
Bones of the Forearm and Hand 304 Innervation of the Lower Limb 382
Fascial Planes and Muscles 306 Sensation of the Lower Limb 384
Innervation of the Upper Limb by Vascularization of the Lower Limb 386
the Brachial Plexus 308
Sensation of the Upper Limb 310 CHAPTER 35 Gluteal Region and Hip ...... ...... 389
Vascularization of the Upper Limb 312 Gluteal Region 390
Muscles of the Gluteal Region 390
CHAPTER 30 Shoulder and Axilla ....... . ... . ... 315 Sacral Plexus 392
Shoulder Complex 316 Vascularization of the Gluteal Region 394
Muscles of the Shoulder Complex 318 Joints of the Gluteal Region 394
Brachial Plexus of the Shoulder 322
Vascularization of the Shoulder CHAPTER 36 Thigh .. . .... .. ...... . ..... . ...... 397
and Axilla 324 Thigh 398
Glenohumeral Joint 326 Muscles of the Thigh 398
Femoral Triangle 402
CHAPTER 31 Arm. . .... .. ...... . .... ... ..... . .. 331 Lumbar Plexus 402
Arm 332 Vascularization of the Thigh 404
Muscles of the Arm 332 Knee Complex 406
 Contents

CHAPTER 37 Leg .......... ........ ............ 411 Study Questions 431

Muscles of the Leg 412 Answers 434

Innervation of the Leg 418

Vascularization of the Leg 418
Joints of the Leg and Ankle 420
SECTION 8: FINAL EXAMINATION - - - - - -

CHAPTER 38 Foot. .... ...................... ... 423 CHAPTER 39 Study Questions and Answers ...... 439
Joints of the Digits and Fascia of the Foot 424
Directions 439
Muscles of the Foot 426
Answers 451
Innervation of the Foot 428
Vascularization of the Foot 428 Index 457
 PREFACE
If you were asked to give a friend directions from your office
to a restaurant down the street, your instructions may sound
something like this-turn right at the office door, walk to the
exit at the end ofthe hall, walk to the bottom of the stairs, take a
left, exit out of the front of the building, walk across the bridge,
continue straight for two blocks passing the post office and
library, and you will see the restaurant on your right. If you pass
the gas station, you have gone too far. The task is to get to the
restaurant. The landmarks guide your friend along the way to
complete the task.
Now, imagine if an anatomist were to give directions from the
office to the restaurant in the same way most anatomy textbooks
are written. Details would be relayed on the dimensions of the
office, paint color, carpet thread count, position and dimensions
of the desk in relation to the book shelf along the wall, includ-
ing the number, types, and sizes of books lining the shelves, and
door dimensions and office door material in relation to the other
doors in the same building. This would occur over the course of
10 pages-and the friend still would not have left the office. The
difference between you giving a friend directions to a restaurant
and the anatomist giving directions to the same restaurant may
be compared with the difference between many anatomy text-
books and this Big Picture textbook-taking a long time to get to
the restaurant or possibly not finding it, versus succinct relevant
directions that take you directly to the restaurant, respectively.
The purpose ofthis textbook, therefore, is to provide students
with the necessary landmarks to accomplish their task-to
understand the big picture of human anatomy in the context of
health care-while bypassing the minutia. The landmarks used
to accomplish this task are text and illustrations. They are com-
plete, yet concise and both figuratively and literally provide the
"Big Picture" of human anatomy.
The format of the book is simple. Each page-spread consists
of text on the left-hand page and associated illustrations on the
right-hand page. In this way, students are able to grasp the big
picture of individual anatomy principles in bite-sized pieces,
a concept at a time.
Key structures are highlighted in bold when first mentioned.
Bullets and numbers are used to break down important
concepts.
Approximately 450 full-color figures illustrate the essential
anatomy.
High-yield clinically relevant concepts throughout the text
are indicated by an icon.
Study questions and answers follow each section.
A final examination is provided at the end of the text.
We hope you enjoy this text as much as we enjoyed writing it.
-David A. Morton
-K. Bo Foreman
-Kurt H. Albertine
xii
ACKNOWLEDGMENTS
Early in his life my father, Gordon Morton, went to an art
school. He purchased a copy of Gray~ Anatomy to help him
draw the human form. That book sat on our family's bookshelf
all throughout my life and I would continually look through its
pages in wonder of the complexity and miracle of the human
body. After I completed high school my father gave me that
book which I have kept in my office ever since. I acknowledge
and thank my father and my mother (Gabriella) for their influ-
ence in my life. Thank you to my co-authors, Dr. Foreman and
Dr. Albertine-they are a joy to work with and I look forward to
many years of collaborating with them.
I express a warm thank you to Michael Weitz. His dedication,
help, encouragement, vision, leadership, and friendship were
key to the successful completion of this title. I also express great
thanks to Susan Kelly. She was a joy to work with through rain,
shine, snow, tennis competitions, and life in general-I thank
her for her eagle eye and encouraging telephone conversations
and e-mails. Thank you to Karen Davis, Armen Ovsepyan, Brian
Kearns, John Williams, and to the folks at Dragonfly Media
Group for the care and attention they provided in creating the
images for this title. Finally, a warm thank you to my wife and
best friend Celine. Her unyielding support and encouragement
through long nights of writing were always there to cheer me
on. I adore her.
-David A. Morton
I thank my parents, Ken Foreman and Lynn Christensen, as well
as my mentor and friend, Dr. Albertine. A special thank you to
Cyndi Schluender and my students for their contributions to
my educational endeavors. I also express a great thanks to Dr.
Morton for his continued encouragement and support in writ-
ing this textbook.
-K. Bo Foreman
Many medical educators and biomedical scientists contrib-
uted to my training that helped lead to writing medical edu-
cation textbooks such as this one. Notable mentors are C.C.C.
O'Morchoe, S. Zitzlsperger, and N.C. Staub. For this textbook,
however, I offer my thanks to my co-authors Dr. Morton and
Dr. Foreman. Co-authoring this textbook with them has been
and continues to be a thrill because now my once doctoral degree
students are my colleagues in original educational scholarship.
What better emblem of success could a mentor ask for? So, to
David and Bo, thank you! I enjoy watching your academic suc-
cess as your careers flourish as medical educators and scholars.
-Kurt H. Albertine
 xiii

Aerial view of University of Utah campus, Salt Lake City, Utah. Photo taken by Kurt
Albertine, educator and author.
xiv
ABOUT THE AUTHORS
David A. Morton completed his undergraduate degree at
Brigham Young University, Provo, Utah, and his graduate degrees
at the University of Utah School of Medicine, Salt Lake City. He
currently serves as Vice-Chair of Medical and Dental Education
and is a member of the Curriculum Committee at the University
of Utah School of Medicine. Dr. Morton has been awarded the
Early Career Teaching Award. Preclinical Teaching Awards,
Leonard W. Jarcho, M.D. Distinguished Teaching Award. and the
University of Utah Distinguished Teaching Award. Dr. Morton
is an adjunct professor in the Physical Therapy Department and
the Department of Family and Preventive Medicine. He also
serves as a visiting professor at Kwame Nkrumah University of
Science and Technology, Kumasi, Ghana, West Africa.
K. Bo Foreman completed his undergraduate degree in physi-
cal therapy at the University of Utah and his graduate degree
at the University of Utah School of Medicine. Currently, he
is an Associate Professor at the University of Utah in the
Department of Physical Therapy and Athletic Training where
he teaches gross anatomy and neuroanatomy. In addition to
his teaching responsibilities, Dr. Foreman also serves as the
Director of the Motion Analysis Core Facility and has an active
research program in biomechanics. Furthermore, he is an
adjunct Associate Professor in the Departments of Mechanical
Engineering, Neurobiology and Anatomy; Orthopaedics, and
Plastic Surgery. Dr. Foreman has been awarded the Early Career
Teaching Award from the University of Utah and the Basmajian
Award from the American Association of Anatomists.
Kurt H. Albertine completed his undergraduate studies in biol-
ogy at Lawrence University, Appleton, Wisconsin, and his grad-
uate studies in human anatomy at Loyola University of Chicago,
Stritch School of Medicine. He completed postdoctoral training
at the University of California, San Francisco, Cardiovascular
Research Institute. He has taught human gross anatomy for
40years. Dr. Albertine established the Human Anatomy Teacher-
Scholar Training Program in the Department ofNeurobiology &
Anatomy at the University of Utah School of Medicine. The
goal of this training program is to develop teacher-scholars of
human anatomy to become leaders of anatomy teachers on a
national level, contribute teaching innovations, and design and
perform teaching outcomes research for upcoming generations
of medical students. Graduates of this training program include
Dr. Morton and Dr. Foreman.
This page intentionally left blank
 BACK ANATOMY

Superficial Back Muscles .. ..... . .... . ..... .. . . . . 4

Deep Back Muscles . ..................... .. ... . 6
Vertebral Column ..... . .. ................ .. . . .. 8
Vertebrae .... . ... .. . .. .. . . . . .. . . . .. . . . .... . . 10
Spinal Meninges . ... . . .. . . .... . ... .. ... . . .. . . . 12
Spinal Cord ...... . .......... . ........... .. ... 14
Spinal Nerves ........ .. ................. .. . . . 16
Study Questions . .. ... . . ..... . ................ 22
Answers ........ . ... . . ................. .. ... 23

3
4 SECTION 1
SUPERFICIAL BACK MUSCLES
BIG PICTURE
The superficial back muscles consist of the trapezius, levator
scapulae, rhomboid major, rhomboid minor, and latissimus
dorsi muscles (Figure 1-1A; Table 1-1}. Although these mus-
cles are located in the back, they are considered to be muscles
of the upper limbs because they connect the upper limbs to
the trunk and assist in upper limb movements via the scapula
and humerus. Because these are upper limb muscles, they are
innervated by the ventral rami of spinal nerves (brachial plexus
branches), with the exception of the trapezius muscle (which is
innervated by CN XI). These muscles are discussed in greater
detail in Section VI, Upper Limb, but are included here because
these muscles overly the deep back muscles.
TRAPEZIUS MUSCLE
Topography. The most superficial back muscle; has a triangu-
lar shape, with three unique fiber orientations giving rise to
multiple actions.
Proximal attachment(s). Occipital bone, nuchal ligament,
spinous processes of C7-T12.
Distal attachment(s). Scapular spine, acromion, and clavicle.
Action(s). Scapular elevation (superior fibers); scapular
retraction (middle fibers), and scapular depression (lower
fibers); upward rotation (all fibers working together).
Innervation. Spinal accessory nerve (CN XI), which arises
from the spinal cord, ascends through the foramen magnum
into the skull and descends through the jugular foramen
along the deep surface of the trapezius.
LEVATOR SCAPULAE MUSCLE
Topography. Located deep to the trapezius muscle and supe-
rior to the rhomboids.
Proximalattachment(s). Transverse processes of upper cervi-
cal vertebrae.
Distal attachmant(s). Superior angle of the scapula.
Back
Action(s). Elevation and downward rotation of the scapula.
Innervation. Dorsal scapular nerve (CS); branches from
C4-C5 ventral rami.
RHOMBOID MAJOR AND MINOR MUSCLES
Topography. Located deep to the trapezius and inferior to the
levator scapulae muscles.
Proximal attachment(s). Spinous processes ofC7-Tl (minor)
and T2-TS (major).
Distal attachment(s). Medial border of the scapula.
Action(s). Retraction of the scapula.
Innervation. Dorsal scapular nerve (CS).
LATISSIMUS DORSI MUSCLE
Topography. A broad, flat muscle in the lower region of the
back.
Proximal attachment(&). Spinous processes of T7 to the
sacrum via the thoracolumbar fascia.
Distal attachment(s). Intertubercular groove of the humerus.
Action(s). Adduction, extension, and medial rotation of the
humerus at the glenohumeral joint.
Innervation. Thoracodorsal nerve (C6-C8).
SCAPULAR MOVEMENTS
Muscles move the scapula in the following directions
(Figure l-IB):
Elevation. Scapula moves superiorly (as in shrugging the
shoulders).
Depression. Scapula moves inferiorly.
Protraction (abduction). Scapula moves away from the
midline.
Retraction (adduction). Scapula moves away toward the
midline.
Rotation. Rotation of the scapula is defined by the direction
that the glenoid fossa faces (glenoid fossa faces superiorly for
upward rotation and inferiorly for downward rotation).
 Back Anatomy CHAPTER1 5

Rhomboid minor m.
Trapezius m.
Levator scapulae m.
Spinal accessory n.
Supraspinatus m.
Transverse cervical a.
(superficial branch)
(deep branch)
Rhomboid major m.

Infraspinatus m.

Teres minor m.

Teres major m.

Thoracodorsal n.

----Serratus anterior m.
Latissimus dorsi m. --L--~
(cut)

Figure 1-1: A. Superficial muscles of the back. B. Movements of the scapula.

6 SECTION 1 Back

Attachme~s). Muscle fibers arise from a transverse process

.--------DEEP BACK MUSCLES
BIG PICTURE
The deep back muscles are the true back muscles because they
primarily act on the vertebral column. They are also referred
to as intrinsic back muscles, epaxial muscles, and paraspinal
muscles. The deep back muscles consist of the splenius capitis
and cervicis, erector spinae, transversospinalis, and suboccipital
~uscles (Table 1-2). These deep back muscles are segmentally
mnervated by the dorsal rami of spinal nerves at each verte-
bral level where they attach. It is not important to know every
detailed attachment for the deep back muscles; however, you
should realize that these muscles are responsible for maintain-
ing posture and are in constant use during body movements.
SPLENIUS CAPITIS AND CERVI CIS MUSCLES
Topography. Located deep to levator scapulae and rhom-
boid muscles, and superficial to erector spinae muscles
(Figure 1-2A and B).
Action(s). Bilateral contraction: extension of head and neck;
unilateral contraction: lateral flexion and rotation of head
and neck.
Innervation. Segmentally innervated by dorsal rami.
ERECTOR SPINAE MUSCLES
Topography. The erector spinae muscles consist of three
separate muscles (from lateral to medial): iliocostalis, longis-
simus, and spinalis (Figure 1-2A and B).
Attachment(s). The erector spinae muscles ascend through-
out the length of the back as rope-like series of fascicles, with
various bundles arising as others are inserting; each fascicle
spans from 6 to 10 segments between bony attachments.
Action(s). Bilateral contraction: extension of the vertebral
column and control of posture; unilateral contraction: lateral
flexion of vertebral column.
Innervation. Segmentally innervated by dorsal rami.
and ascend between one to six vertebral levels to attach to the
spinous process of neighboring vertebrae.
Action(s). Bilateral contraction: extension of the vertebral
column; unilateral contraction: rotation of vertebral column
to the contralateral side of the contracting transversospinalis
muscle.
Innervation. Segmentally innervated by dorsal rami.
SUBOCCIPITAL MUSCLES
Topography. Located inferior to the occipital bone and deep
to the semispinalis capitis muscle {Figure 1-2C). The suboc-
cipital muscle group consists of the rectus capitis posterior
major and minor and obliquus capitis superior and inferior.
Attachme~s). Occipital bone, Cl and C2 vertebrae.
Action(s). Mainly postural muscles, but may contribute to
extension and rotation of the head.
Innervation. Dorsal ramus of C1 spinal nerve (also known as
the suboccipital nerve).
SUBOCCIPITAL TRIANGLE
Borders. A triangle formed by the rectus capitis posterior
major, obliquus capitis superior, and obliquus capitis inferior
muscles.
Contents. Structures associated with the suboccipital triangle
are the following:
• Vertebral artery. Exits the transverse foramen of the Cl
vertebra, courses across the floor of the suboccipital trian-
gle, ascends through the foramen magnum, and supplies
the posterior region of the brain.
• Suboccipital nerve (dorsal ramus ofC1). Emerges between
the occipital bone and C1 vertebra; innervates the suboc-
cipital muscles.
• Greater occipital nerve (dorsal ramus of C2). Emerges
below the obliquus capitis inferior muscle; supplies sensory
innervation to the back of the scalp.

TRANSVERSOSPINALIS MUSCLES
Topography. Located deep to the erector spinae muscles. From
superficial to deep, the transversospinalis muscles include
the semispinalis, multifidus, and rotatores (Figure 1-2A
and B).
 Back Anatomy CHAPTER 1 7

Dorsal root Ventral root

Ventral
ramus
Dorsal
ramus
Motor nerve
to deep back
muscle

Iliocostalis m. -----,!'-:T='-1""'==='\9!
longissimus m.---¥~~~~iiiiill

Spinalis m. -----TIV~==;;..---;r===\-'i=l

Erector spinae mm.

Rectus capitis posterior

minor and major mm.

w
A

Occipital a.~ ~

Goeata,occlp;tal "·

r
Vertebral a.
Occipitalis m. [ 1 Obliquus capitis superior m.

am Ooastl """'•""' "· l Suboccipital n. (C1)

Splenius capitis m. ~
C1 vertebra
~~
L
Greater auricular n.

""'"' ooclpltal "·

Stemod~domostold m. ~

Posterior cutaneous branches '\

c of dorsal rami of C4, 5, 6 spinal nn.
piercing the Trapezius m.
Suboccipital triangle

Figure 1-2: A. Deep back muscles with erector spinae muscles on the left and deeper transversospinalis muscles on the right. B. Axial
section of the back showing the dorsal rami. C. Suboccipital region on the right side.
8 SECTION 1
~---VERTEBRAL COLUMN
BIG PICTURE
The vertebral column is approximately 75 em in length and con-
sists of 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral,
and 3-4 coccygeal). These vertebrae, along with their ligaments
and intervertebral discs, form the flexible, protective, and sup-
portive vertebral column that maintains posture, supports the
body and head, and protects the spinal cord. The vertebral
column is versatile in that it is rigid to provide protection and
stability and yet flexible to enable movement.
VERTEBRAL COLUMN OVERVIEW
The vertebral column consists of cervical (C), thoracic (T),lum-
bar (L), sacral (S), and coccygeal (Co) vertebrae (Figure 1-3A;
Table 1-3). To simplify their descriptions, the first letter of its
region refers to each vertebra. For example, the "fourth cervical
vertebra" is simply referred to as the "C4 vertebra."
Cervical vertebrae. Located in the neck (cervical region); the
ligamentum nuchae, a large ligament that courses down the
back of the neck, connects the skull to the spinous processes
of C1-C6. The first spinous process that is palpable deep to
the skin is C7 and is called the vertebral prominens.
Thoracic vertebrae. Located in the thoracic region and artic-
ulate with the 12 pairs of ribs.
Lumbar vertebrae. Located in the lower back and are distin-
guished by their massive vertebral bodies.
Sacral vertebrae. There are five fused sacral vertebrae
(S1-SS), which form a single bone (sacrum).
Back
Coccygeal vertebrae. There are three to four fused coc-
cygeal vertebrae (Co1-Co4), which form the coccyx bone
("tail bone").
VERTEBRAL CURVATURES
The adult spine is curved in four parts due to fetal and postnatal
devdopment of the vertebral column (Figure 1-3B and C).
Primary (kyphotic) curvatures. Devdop during the fetal
period in relation to the flexed fetal position.
• Primary curvatures are concave anteriorly and are located
in the thoracic regions (optimize space for heart and lungs)
and sacral regions (optimize space in pdvic cavity for a
devdoping fetus).
Secondary (lordotic) curvatures. Devdop during the postna-
tal period.
• Secondary curvatures are concave posteriorly and are
located in the cervical region (devdops when the infant
holds its head upright while sitting) and lumbar region
(develops when the infant begins to stand and walk).
Abnormal primary curvatures are referred to as kyphosis
V (excessive kyphosis}, whereas abnormal secondary cur-
vatures are referred to as lordosis (excessive lordosis). Patients
may present with abnormal lateral curvatures (sea liosis), which
may be due to muscular dominance ofone side over the other or
to poor posture or congenital problems. To diagnose scoliosis,
the physician may ask the patient to bend forward to determine
if one side of the thorax is higher than the other due to asym-
metry of the spine. 'Y
 Back Anatomy CHAPTER1 9

Cervical
External occipital ------... "'<..::2'i!=i?,.-- - - vertebrae
protuberance (yellow)

Primary (kyphotic) -----'n-- ---T'-----i

curvature

Cervical
Lumbar
A.,+,f - - - - vertebrae
(blue)
c:::::~"------ Sacral and
coccygeal
B vertebrae
Spine of -----,ry-!;._....,~oE( (purple)
scapula

Thoracic
vertebrae -\-i--!---\-J'-Y-~~~==-~~~r-:-~
(green)

Cervical
~~.----vertebrae
(yellow)

Lumbar Primary (kyphotic) - f - - - - - - 1

vertebrae ------+---------"~'- 'ff curvature
(blue) (green)

Sacral
Secondary (lordotic)-t------1
vertebrae ------;------>;'"""=-~=f==<u
(purple) curvature

A c

Figure 1-3: A. Posterior view of the vertebral column. B. Primary curvature of newborn. C. Normal curvatures of an adult.
10 SECTION 1
VERTEBRAE- - - - -
BIG PICTURE
The 33 vertebrae from each region of the vertebral column have
some common vertebral structures. Additionally, each vertebral
region has unique modifications and characteristics.
COMMON VERTEBRAL STRUCTURES
The 33 vertebrae have the following common structures
(Figure 1-4A and C):
Body. Anterior vertebral region; primary weight-bearing
component of the vertebra.
Vertebral arcb. Posterior vertebral region; formed by the
pedicles and laminae.
Pediclas. Join the vertebral body to the transverse processes.
Transverse processes. Lateral bony processes arising from
the vertebral arch.
Superior and inferior articular facets. Bony projections that
form synovial zygapophyseal (facet) joints with the vertebrae
above and below.
Zygapophyseal ffacet) joints. Synovial joints located between
adjacent superior and inferior articular facets; they enable
vertebral flexion and extension and limit rotation.
Laminae. Connect transverse and spinous processes.
Spinous process. Posteriorly projecting tip of the vertebral
arch; easily palpated beneath the skin.
Vertebral foramea. Hole in the vertebra that contains the spi-
nal cord; the series of vertebral foramina form the vertebral
canal.
Intervertebral (neuraU foramina. Bilateral foramina that
form the space between pedicles of adjacent vertebrae fur the
passage of spinal nerves.
Pars interarticalaris (pars). Region of the vertebra between
the superior and inferior articular facets and the pedicle and
lamina.
Intervertebral (IV) discs. Located between adjacent vertebral
bodies; composed of an anulus fibrosus (tough fibrocarti-
laginous rim}, and a nucleus pulposus (softer fibrocarti-
laginous core} (Figure 1-4C). The IV discs absorb shock and
bear weight because the spread of the nucleus pulposus is
constrained by the anulus fibrosus. Approximately 25% of the
height of the vertebral column is from the IV discs.
Herniated disc. Damage to the anulus fibrosus may allow
V the softer nucleus pulposus to bulge or herniate postero-
laterally (referred to as a "slipped disc"). The herniated disc
may compress and irritate adjacent nerve roots, giving rise to
symptoms typically associated with radicular pain (nerve root
compression). Symptoms may include sensory disruptions
along the associated dermatomallevel (i.e., numbness, pares-
thesia, and pain from the neck down the arm or lower back
down the leg). Occasionally motor disruptions, such as muscle
weakness and hyporefl.exia, may also be present. T
Back
VERTEBRAL MODIFICATIONS
Each class of vertebrae has its own unique modifications:
Cervical vertebrae.
• C1 (atlas} vertebra. Articulates with the skull (occipital
condyles), enabling the skull to nod up and down.
• C2 (axis} vertebra. Has the odontoid process (dens), which
through its articulation with Cl provides rotational move-
ment (i.e., head movement indicating "no").
• Transverse foramen. The transverse processes on Cl-C6
have a foramen for the transmission of the vertebral arteries
(branch from the subclavian arteries) to supply the brain.
• Bifid spinous process. Short, forked spinous process.
Thoracic vertebrae.
• Costal facets. Twelve pairs of ribs articulate with 12 tho-
racic vertebrae at the costal facets.
• Spinous processes. Project inferiorly to the level of the
infra-adjacent vertebral body.
Lumbar vertebrae. Massive vertebral bodies that support the
pressure on the lower back.
• Mammillary processes. Posteriorly located on superior
articular facets; attachment site for multifidus muscle.
Sacral vertebrae. Five fused vertebrae that are called the
sacrum.
• Sacral foramina. On the ventral and dorsal surface for the
exit of ventral and dorsal rami; homologous with interver-
tebral foramina.
Coccygeal vertebrae. Three to four fused vertebrae are called
the coccyx or "tailbone..
VERTEBRAL LIGAMENTS
The vertebral column is stabilized by the following ligaments
(Figure 1-4B):
Ligamentum ftavum. Connects paired laminae of adjacent
vertebrae.
Supraspinous ligament Connects the apices of the spinous
processes.
Interspinous ligament Connects adjoining spinous
processes.
Nuchal ligament Extends from the external occipital protu-
berance along the spinous processes of Cl-C7.
Posterior longitudiaal ligament Courses longitudinally,
down the posterior surface of the vertebral bodies within
the vertebral canal This ligament supports the intervertebral
disc posteriorly, thus reducing the incidence of herniations
that may compress the spinal cord and cauda equina.
Anterior longitudinal ligament. Courses longitudinally along
the anterior surface of the vertebral bodies limiting vertebral
extension.
 Back Anatomy CHAPTER 1 11

Vertebral body

Superior
articular
process

1
Pedicle
Vertebral
arch Lamina

Anterior
longitudinal ligament

1- - Posterior

./>: : : '=;: : :;: t~"·"""""' :::ffie

A

articular
process
Ligamentum--~
flavum

--..Y'Anulus }
..--4"1 fibrosus
~ Inter-
~--- I} Nucleus vertebral
/ pulposus disc

process

Spinal nerve
Vertebral body
-------~

Posterior
longitudinal ligament
r Anterior
longitudinal
ligament

c
Figure 1-4: A. Posterolateral view of a typical vertebra. B. Vertebrae ligaments. C. Lateral view of two vertebrae and intervertebral (IV)
discs; observe the IV discs and facet joints during vertebral flexion and extension.
12 SECTION 1
SPINAL MENINGES
BIG PICTURE
The brain and spinal cord are surrounded and protected by
three layers of connective tissue meninges called the dura mater,
arachnoid mater, and pia mater (Figure 1-SA and B).
DURA MATER
Forms the superficial meningeal layer and defines the epidural
and subdural spaces.
Consists of dense fibrous connective tissue and surrounds
the brain and spinal cord.
The dura mater evaginates into each intervertebral foramen,
becoming continuous with the epineurium around each spi-
nal nerve; nerve roots in the subarachnoid space lack dura
mater and are therefore more fragile than spinal nerves.
Spinal cord dura mater receives general sensory innervation
from recurrent meningeal 1erves from each spinal nerve
segment.
Epidaralspace. The epidural space is the region between
V the dura mater and vertebral canal. An anesthetic agent
injected into the epidural space anesthetizes the spinal nerve
roots exiting the vertebral canal in that region. Epidural blocks
are particularly useful for procedures involving the pdvis and
perineum, such as during childbirth. T
Meningitis. The sensory neurons in the dura mater may
V be involved in referred pain characteristics of spinal dis-
orders and become irritated when the meninges are inflamed as
in meningitis. For example, if a patient with meningitis tries to
touch her chin to her chest, she may experience pain due to the
stretching of the meninges surrounding the cervical spinal
cord. T
Back
ARACHNOID MATER
Forms the intermediate meningeal layer and attaches to the
underlying pia mater via arachnoid trabeculae.
Sl.barachnoid space. The space between the arachnoid and
pial layers, which contains cerebrospi1al fluid (CSF) (sus-
pends and protects the spinal cord. brain, nerve roots, and
large vessds); the inferior portion of the subarachnoid space
between the conus medullaris and S2 vertebral level contains
only spinal roots and the filum terminale (Figure 1-SC).
Lumbar puncture. The spinal cord terminates in an adult
V at the Ll-L2 vertebrallevd, whereas the subarachnoid
space containing CSF extends to the S2 vertebrallevd. Therefore,
CSF can be obtained inferior to the L2 vertebrallevd without
danger of injuring the spinal cord. To perform a lumbar punc-
ture, the patient typically is asked to lie on his/her side or is
placed in a sitting position so that the spine is fully flexed to
open up the intervertebral spaces. T
PIA MATER
Forms the deepest meningeal layer, is inseparably attached
to the spinal cord, and contains a small plexus of small blood
vessds.
Denticulate ligaments. Located in the coronal plane as a
series of sawtooth projections of the pia mater that separate
ventral and dorsal rootlets; the ligaments anchor the spinal
cord laterally to the dura mater maintaining the centralized
location of the spinal cord.
Filum terminal e. An inferior extension of pia mater beyond
the conus medullaris that anchors the spinal cord to the
coccyx.
 Back Anatomy CHAPTER 1 13

Subarachnoid space

root
ganglion

Dorsal root--____::;-~ J
ganglion

.,.
1st sacral------.1--- ---=ff''o/
spinal n.

l==iii--- - Coccygeal
ligament

A c

Figure 1-5: A. Coronal section of the vertebral column through the pedicles from a posterior view revealing the dura mater surrounding
the spinal cord. B. T1 segment of the spinal cord showing step dissection of the spinal meninges. C. Caudal spinal cord (filum terminale
is difficult to see).
14 SECTION 1
SPINAL CORD ~---
BIG PICTURE
The spinal cord is a part of the central nervous system (CNS) and
consists of -100 million neurons and -500 million glial cells. The
spinal cord resides in the vertebral canal where it is surrounded
and protected by the meninges (dura mater, arachnoid mater, and
pia mater). Spinal nerves transport sensory input from body tissues
to the spinal cord; the CNS processes these messages and sends
appropriate motor responses to muscles and glands by way of spi-
nal nerves. The spinal cord consists of white matter (longitudinal
tracts ofmyelinated axons) and gray matter (neuronal cell bodies).
TOPOGRAPHY AND OVERVIEW
The spinal cord extends from the medulla to the conus med-
ullaris at the L1 and L2 vertebral levels (Figure l-6A}. In a
term newborn, the spinal cord terminates at the L3 and L4
vertebral levels.
The spinal cord is segmentally organized into the following
31 segments (Table 1-3}:
• 8 cervical spinal cord segments corresponding to the 8 cer-
vical spinal nerves.
• 12 thoracic spinal cord segments corresponding to the
12 thoracic spinal nerves.
• 5lumbar spinal cord segments corresponding to the Slum-
bar spinal nerves.
• 5 sacral spinal cord segments corresponding to the 5 sacral
spinal nerves.
• 1 coccygeal spinal cord segment corresponding to the
1 coccygeal spinal nerve.
There are eight cervical spinal cord and spinal nerve levels but
only seven cervical vertebrae. This discrepancy results because
the basiooccipital bone is a cervical vertebra. However, early
anatomists did not recognize this. Therefore, we actually have
eight cervical vertebrae, but the most superior one is fused to
the base of the occipital bone.
In cross-section, the spinal cord consists of white matter sur-
rounding gray matter, and a central canal (Figure 1-6B).
WHITE MATIER OF THE SPINAL CORD
Consists of vertical columns of myelinated axons that sur-
round a central core of gray matter (the white color is a result
of the myelin that surrounds the axons).
Collections of axons that perform similar functions and
travel to and from the same areas are referred to as tracts.
Ascending axonal tracts transport sensory information from
the dorsal roots and horns to the brain; descending axonal
tracts transport efferent information from the brain to the
ventral horn gray matter.
The volume of white matter increases at each successively
higher spinal cord segment and decreases at each lower spi-
nal cord segment (compare Figures 1-6B-E). For example:
• Cervical spinal cord levels have the most white matter due
to the highest number of ascending and descending axons
corning from and going to the rest of the spinal cord.
Back
• Sacral spinal cord levels have the least white matter because
the majority of ascending axons arise above the sacral spi-
nal cord and most descending axons have already synapsed
in a more superior spinal cord segment.
GRAY MATTER OF THE SPINAL CORD
Consists primarily ofneuronal cell bodies and short interneu-
rons (the gray color is a result of a lack of myelin).
In cross-section, the spinal cord gray matter forms the letter
"H" and consists of ventral, lateral, and dorsal horns.
Ventral hom. Contains cell bodies of motor neurons whose axons
exit the ventral root to innervate deep back muscles (via dorsal
rami) and bodywall and limb muscles (via ventral rami); the ven-
tral horn is not uniform in size along the length ofthe spinal cord.
• Cervical spinal enlargement Ventral horn gray matter in
the C5-T1 spinal cord levels contains a large number of
motor neuron cell bodies to innervate the upper limb mus-
cles. This results in the expanded width (enlargement) of
this spinal cord region.
• Lumbosacral spinal enlargement Ventral horn gray mat-
ter in the U-S3 spinal cord levels contains a large number
of motor neuron cell bodies to innervate the lower limb
muscles. This results in the expanded width (enlargement)
of this spinal cord region.
Lateral horn. Contains cell bodies for preganglionic auto-
nomic motor neurons and is only seen in some regions ofthe
spinal cord, as identified next.
• Sympathetic. Preganglionic sympathetic neuronal cell bodies
arise only in the lateral horns of the Tl-L2 spinal cord levels.
• Parasympathetic. Preganglionic parasympathetic neuronal
cell bodies arise only in the lateral horns of the S2-S4 spinal
cord levels; due to the large ventral horns in this region, it is dif-
ficult to distinguish the lateral horns in the sacral spinal cord.
Dorsal horn. Receives sensory neurons entering the spi-
nal cord via the dorsal roots; also contains cell bodies of
interneurons that communicate with motor neurons in the
ventral horn or ascending tracts of white matter.
Central canal. Located within the middle of the gray matter
as an adult remnant of the neural tube.
Conus medullaris. The most caudal portion of the spinal
cord; contains the sacral and coccygeal spinal cord segments
and is located at the Ll-L2 vertebral level..
Contrasting vertebral and spinal cord levels. The verte-
V bral canal is longer than the spinal cord in adults as a
result of unequal growth during development. Therefore,
a patient with a C3 vertebral fracture potentially could have a
bone fragment that would impinge upon the C3 spinal cord seg-
ment. However, a patient with a no
vertebral fracture poten-
tially could have a bone fragment that would impinge upon the
L1 segment of the spinal cord. ~
Poliomyelitis. A virus that attacks the neurons in the
V ventral horn gray matter and causes paralysis of volun-
tary muscle. ~
 Back Anatomy CHAPTER 1 15

Cervical-------'~~~
enlargement ----c~~--~---=1-- Central
canal

C7 vertebra-----'
T1 vertebra--=-====:±.,rl:_~.'l..L B
fissure
C5 spinal cord level

--!!!!!!!!!!~:_:____-~-- Central
canal

c
TS spinal cord level

-'J!!!!!!!!!!!!!!!!!!!~':---=l~- Central
canal

D
L1 spinal cord level

ca==-==:r-- Central
canal

E
53 spinal cord level

Figure 1-6: A. Posterior view of the coronal section of the vertebral canal. (Levels of the spinal cord are identified within the vertebral
canal.). B-E. C5, T8, L 1, and S3 cross-sections of the spinal cord (compare and contrast gray and white matter at the various levels).
16 SECTION 1
SPINAL NERVES
BIG PICTURE
Spinal nerves consist of ventral and dorsal roots, a spinal nerve
trunk. and ventral and dorsal rami. Each spinal cord level gives
rise to bilateral dorsal and ventral rootlets, which exit the spinal
cord laterally. The rootlets unite to form the segmental dorsal
and ventral roots. The roots unite to form left and right spinal
nerve trunks, which further divide into a ventral ramus (sup-
plying the limbs and anterolateral body wall) and dorsal ramus
(supplying the deep back muscles and skin of the back).
SPINAL ROOTS
Spinal roots arise from the left and right side of each segment
of the spinal cord and are classified as either a ventral root or a
dorsal root. Ventral and dorsal roots are separated from each
other within the vertebral canal by the denticulate ligaments
(Figure 1-7A and B).
fu1ction. Spinal roots are like one-way streets:
• Ventral root. Conveys motor neurons, which conduct their
impulses in only one direction . . . away from the spinal
cord.
• Dorsal root. Conveys sensory neurons, which conduct
their impulses in only one direction . . . toward the spinal
cord (the dorsal root ganglion is a swelling that houses cell
bodies of all sensory neurons entering the spinal cord at
that segmental level on that side).
Course. The vertebral canal is longer than the spinal cord
in adults due to unequal growth during fetal development.
Consequently. nerve roots in the upper vertebral canal
course horizontally, in the middle obliquely and in the
bottom vertically.
• At their respective intervertebral foramen, ventral and
dorsal roots unite to form the spinal nerve trunk.
Cauda equina. The spinal cord terminates at the Ll- L2
vertebral level in adults. Therefore, the lumbar and sacral
nerve roots descending in the vertebral canal below the L1
vertebral level form a vertical collection of nerve roots that
resembles the tail of a horse (hence, the name cauda equina)
(Figure 1-7C).
• The cauda equina floats in the CSF; therefore, a needle
introduced into the subarachnoid space below the U ver-
tebral level will displace the roots with little possibility of
damage to them or the spinal cord
Back
SPINAL NERVE TRUNK
The 31 pairs of spinal nerve trunks are formed by ventral and
dorsal roots, and as such together are considered two-way
streets in that both motor and sensory neurons are contained
within. The spinal nerve trunks are short and are organized as
follows (Figure 1-7A; Table 1-3):
Eight cervical spinal nerves. The CI- C7 spinal nerves exit
the vertebral canal superior to their respective cervical verte-
brae. The C8 spinal nerve exits inferior to the C7 vertebra. All
of the remaining spinal nerves segmentally exit the vertebral
canal inferior to their respective vertebra.
Twelve thoracic spinal nerves. Exit inferior to their respec-
tive thoracic vertebrae.
Five lumbar spinal nerves. Exit inferior to their respective
lumbar vertebrae.
f'IYI sacral spinal nerves. Exit inferiorly through their
respective sacral foramina of the sacrum.
One coccyx spinal 1erve. Exits by the coccyx bone.
Contrasting vertebral and spi•al •erve levels. Cervical
V spinal nerves exit the vertebral column superior to their
associated vertebra (i.e., the C4 spinal nerve trunk exits between
the C3 and C4 vertebrae). All other spinal nerves (thoracic,
lumbar, sacral, and coccygeal) exit the vertebral column inferior
to their associated vertebra (i.e., the L4 spinal nerve trunk exits
between the L4 and LS vertebrae). 'Y
RAMI
Each spinal nerve trunk traverses the intervertebral foramen
and immediately bifurcates into a ventral ramus and a dorsal
ramus (Figure 1-7B}. Similar to spinal nerve trunks, most rami
are mixed (contain both motor and sensory nerve fibers).
Ventral ramus. Transports sensory nerve fibers from and
motor nerve fibers to the anterolateral body wall and upper
and lower limbs in a segmental fashion.
• Ventral rami form the nerve plexuses of the body (i.e.,
cervical plexus, brachial plexus, lumbar plexus, and sacral
plexus).
Dorsal ramus. Transports sensory nerve fibers from the skin
of the back between mid-scapular lines and motor nerve fib-
ers to the deep back muscles (e.g., erector spinae muscles).
 Back Anatomy CHAPTER 1 17

Vertebral Spinal cord Spinal nerve

levels levels levels

Dorsal root Ventral root

Spinal nerve trunk

C7---'fi~.

T1---~

B Sensory nerve
from skin

L4 spinal n. - - - -
T12 ---=---
L1 -----,=----

Figure 1-7: A. Coronal section of the vertebral canal from the posterior view. B. Cross-section through the back showing spinal roots,
nerves, and rami. C. Caudal end of the vertebral canal with the cauda equina.
1a SECTION 1
DERMATOMES
A dermatome is defined as an area of skin supplied by a sin-
gle spinal cord level, on one side, by a single spinal nerve.
Dermatomes are arranged in a segmental fashion and reflect
their associated spinal cord levels. Adjacent dermatomes are
often located so close together that their territories overlap,
which explains why the clinically detectable areas of sensory
loss caused by a segmental nerve lesion may be smaller than the
dermatome itself( ... and in some cases there may be no detect-
able sensory loss at all). Touch is used to test these areas of skin
in a conscious patient in order to localize lesions to a specific
nerve or spinal cord level. The following are the primary places
to touch in order to test specific dermatomes (Figure l-7D):
C5. Lateral side of the elbow.
C&. Dorsal surface of the proximal phalanx of the thumb.
C7. Dorsal surface of the proximal phalanx of the middle
finger.
Ca. Dorsal surface of the proximal phalanx of the little finger.
T1. Medial side of the elbow.
T4. Midclavicular line at the level of the nipple.
no. Midclavicular line at the level of the umbilicus.
L3. Medial femoral condyle above the knee.
L4. Over the medial malleolus.
L5. Dorsum of the foot over the third metatarsal phalangeal
joint.
S1. Lateral aspect of the calcaneus (heel).
S2. Midpoint of the popliteal fossa.
S4--S5. Perianal region just beside the opening of the
sphincter.
Back
MYDTDMES
A myotome is defined as a group of skeletal muscles inner-
vated by a single spinal cord level, on one side, by a single spinal
nerve. Myotomes may be more difficult to test than dermatomes
because each skeletal muscle in the body is usually innervated
by nerves derived from more than one spinal cord level. The fol-
lowing are the myotomes that represent the motor innervation
by the cervical and lumbosacral spinal cord levels (thoracic lev-
els are not included because these levels are easier to test from
sensory levels):
C5. Elbow flexors (bend the elbow).
C&. Wrist extensors (straightening the wrist).
C7. Elbow extensors (straightening the elbow).
Ca. Finger flexors (bending fingers).
T1. Finger abductors (spreading fingers apart).
l2. Hip flexors (lift knee off the ground).
13. Knee extensors (straightening the knee).
L4. Ankle dorsiflexors (lift foot off the ground).
L5. Long toe extensors (lift toe off the ground).
S1. Ankle plantar flexors (stand on tip-toes).
S4--S5. Voluntary anal contraction.
 Back Anatomy CHAPTER 1 19

Lateral

• Key
sensory
points

D Posterior Anterior

Figure 1-7: (continued) D. Dermatomes mapping key sensory points to test spinal cord levels.
20 SECTION 1 Back

TABLE 1-1. Superficial Muscles of the Back

Muscle Proximal Attachment Distal Attachment Action Innervation
Trapezius Occipital bone, nuchal Spine of scapula, Elevates, retracts, Motor: spinal root
ligament, and spinous acromion, and lateral depresses, and of accessory n. (CN
processes of C7-T12 third of clavicle upwardly rotates XI); proprioception:
vertebrae scapula cervical nn. (C3-C4)

Levator Transverse processes of Medial border of the Elevates and rotates Dorsal scapular
scapulae C1-C4 vertebrae superior angle of scapula; lateral flexion n. (C5)
scapula of the neck

Rhomboid Spinous processes of T2-T5 Medial margin of Retracts scapula Dorsal scapular
major vertebrae scapula n. (C5)

Rhomboid Spinous processes of C7-T1 Medial margin of Retracts scapula Dorsal scapular
minor vertebrae scapula n. (C5)

Latissimus Spinous processes of T7 Intertubercular groove Extends, adducts, Thoracodorsal

dorsi sacrum, thoracolumbar of humerus and medially rotates n. !C6-C8)
fascia, iliac crest. and inferior humerus
ribs
 Back Anatomy CHAPTER 1 21

TABLE 1-2. Deep Muscles of the Back

Muscle Proximal Attachment Distal Attachment Action Innervation
Splenius capitis Nuchal ligament, Mastoid process of Bilaterally extends the head Segmentally
spinous processes of temporal bone and and neck; unilaterally bends innervated by
C7-T4 vertebrae occipital bone and rotates head dorsal rami

Splenius cervicis Spinous processes of Transverse processes

T3-T6 of C1-C3

Erector spinae group (a group of muscles that extends from the sacrum to the skull}

• Iliocostalis Iliac crest, sacrum, Thoracolumbar fascia, Bilaterally, extends the Segmentally
ribs ribs, cervical vertebrae vertebral column innervated by
Unilaterally, lateral flexes the dorsal rami
• Longissimus Thoracodorsal fascia, Vertebrae and mastoid vertebral column
transverse and process of temporal
cervical vertebrae bone

• Spinalis Spinous processes of Spinous processes of

vertebrae vertebrae

Transversospinalis group (a group of muscles that extends from transverse to spinous processes)

• Semispinalis Transverse processes Spinous processes of Bilaterally, extends vertebral Segmentally

of thoracic vertebrae thoracic and cervical column; unilaterally innervated by
vertebrae and occipital rotates vertebral column dorsal rami
bone contralaterally

• Multifidus Sacrum and Spinous processes of

transverse processes lumbar, thoracic, and
of lumbar, thoracic, lower cervical vertebrae
and cervical vertebrae

• Rotatores Transverse processes Lamina immediately

of C2 vertebra to the above the vertebra of
sacrum origin

TABLE 1-3. Vertebral, Spinal Cord, and Spinal Nerve Levels

Region Number of Vertebrae Number of Spinal Nerve Levels Number of Spinal Cord Levels
Cervical 7 8 8

Thoracic 12 12 12

Lumbar 5 5 5

Sacral 5 (fused) 5 5

Coccygeal 3-4 (fused)

22 SECTION 1
STUDY QUESTIONS
Directions: Each of the numbered items or incomplete state-
ments is followed by lettered options. Select the letter that most
likely represents the best option for each question.
1. A 48-year-old man goes to his physician because of pain and
paresthesia along the lateral aspect of the leg and the dorsum
of the foot. The patient's symptoms suggest impingement of
the LS spinal nerve resulting from a herniated intervertebral
disc. The LS spinal nerve most likely exits between which of
the following vertebrae?
A. L3-L4 vertebrae
B. L4-L5 vertebrae
C. LS-Sl vertebrae
D. Sl-S2 vertebrae
2. The muscles of the posterior aspect of the thigh, or ham-
string musculature, are responsible for flexing the knee joint.
Beginning with the motor neuron cell bodies in the gray
matter of the spinal cord, identify the most likely pathway
that axons would travel from the spinal cord to the ham-
string muscles?
A. Ventral horn, ventral root, ventral ramus
B. Ventral horn, ventral root, dorsal ramus
C. Lateral horn, ventral root, ventral ramus
D. Lateral horn, dorsal root, dorsal ramus
E. Dorsal horn, dorsal root, ventral ramus
F. Dorsal horn, dorsal root, dorsal ramus
3. A 27-year-old man is brought to the emergency depart-
ment after being involved in an automobile accident.
Radiographic imaging studies indicate that he has sustained
a fracture of the L1 vertebral arch and has a partially dislo-
cated bone fragment impinging upon the underlying spinal
cord. Which spinal cord level is most likely compressed by
this bone fragment?
A. Cl
B. L2
C. S3
D. T4
Back
4. A 50-year-old man is diagnosed with flaccid paralysis limited
to the right arm, without pain or paresthesias. No sensory
deficits are noted. Laboratory studies reveal that the patient
is infected with West Nile virus. The target that the virus
has infected resulting in this patient's symptoms is most
likely the
A. Ventral horn of spinal cord gray matter
B. Ventral rami of spinal nerves
C. Dorsal horn of spinal cord gray matter
D. Dorsal rami of spinal nerves
5. A 6-year-old boy is stung by a wasp between his shoulder
blades. Identify the pain sensation pathway the axons would
travel to course from the skin of his back to the spinal cord.
A. Ventral horn, dorsal root, dorsal ramus
B. Ventral horn, dorsal root, ventral ramus
C. Ventral horn, ventral root, dorsal ramus
D. Ventral horn, ventral root, ventral ramus
E. Dorsal ramus, dorsal root, dorsal horn
F. Dorsal ramus, dorsal root, ventral horn
G. Dorsal ramus, ventral root, ventral horn
H. Dorsal ramus, ventral root, dorsal horn
6. Which of the following paired muscles ofthe back is primar-
ily responsible for extension of the vertebral column?
A. Iliocostalis
B. Latissimus dorsi
C. Levatorcostarum
D. Rhomboid major and minor
E. Trapezius
1. A 44-year-old woman is suspected of having meningitis. To
confirm the diagnosis, a lumbar puncture is ordered to col-
lect a sample of the cerebrospinal fluid (CSF). Identify the
last layer of tissue the needle will traverse in this procedure
before reaching CSF.
A. Arachnoid mater
B. Dura mater
C. Ligamentum flavum
D. Piamater
E. Skin
 Back Anatomy
- - -ANSWERS
1----C: Spinal nerves in the thoracic and lumbar vertebral
region exit the vertebral canal below their associated verte-
bra. Therefore, the LS spinal nerve exits below LS, between LS
and Sl.
2-A: The ventral horn of the spinal cord gray matter houses
motor neuron cell bodies and conveys motor neurons out
through the ventral root into the segmental spinal nerve. All
muscles of the limbs and body wall are innervated by ventral
rami. Although the muscles are present along the posterior
aspect of the thigh, muscles are still innervated by the ventral
rami. Dorsal rami innervate the skin of the back and the deep
back muscles, such as the erector spinae.
3---C: In an adult, the caudal end of the spinal cord is at the
Ll-L2 vertebral level. Therefore, a bone fragment from the Ll
vertebra would have the potential of touching the caudal end of
the spinal cord, not the Ll spinal cord level. Cl, L2, and T4 are
spinal cord levels superior to the fracture.
4--A: The patient has no sensory deficits and presents with only
motor deficits. Therefore, the virus affects the ventral hom of
the gray matter because that is the location of the motor neuron
cell bodies.
CHAPTER 1 23
5--E: All skin of the back is segmentally innervated by the dor-
sal rami branches of spinal nerves. Sensory information is then
conducted through the dorsal root into the dorsal hom of the
gray matter of the spinal cord.
&-A: The paired iliocostalis muscles, part of the erector spinae
musculature, are postural muscles that help to extend the verte-
bral column and thus keep the spine erect The latissimus dorsi,
rhomboids, and trapezius muscles act primarily on the upper
limb. The levator costarum muscles help elevate the ribs during
inspiration but will not extend the vertebral column.
7-A: A lumbar puncture collects cerebrospinal fluid and,
therefore, the needle has to enter the subarachnoid space, which
is located between the arachnoid and pia mater. Therefore, the
last layer of tissue the needle would traverse to enter the suba-
rachnoid space is the arachnoid mater.
This page intentionally left blank
This page intentionally left blank
 ANTERIOR THORACIC
WALL

The Breast ...... . ... ... ..................... 28

Thoracic Muscles ...... . ................. .. . .. 30
Thoracic Skeleton .... .... . .... . .... . ... .. ..... 32
Nerves of the Thoracic Wall .... . ... .. ...... .. . .. 34
Vasculature of the Thoracic Wall ............ ... . . . 36
Diaphragm ..... .. ... .. ..... . ............... . 38

27
28 SECTION 2
~----THE BREAST
BIG PICTURE
The functional component of the breast is the mammary gland,
which synthesizes, secretes, and delivers milk to the newbom It is
only during a pregnancy that the mammary glands reach a mature
state of development by way of circulating female hormones. Both
men and women have breasts but the male mammary glands do not
develop under normal circumstances. Lobules within mammary
glands produce milk and the lactiferous ducts transport the milk
into openings in the nipples. Branches of the internal thoracic, axil-
lary, and intercostal arteries supply the mammary glands. Lymph
from the mammary glands primarily drains into axillary lymph
nodes, and also into the pectoral, clavicular, and parasternal nodes.
MAMMARY GLAND STRUCTURE
The mammary gland is located within the superficial fascia and
is surrounded by a variable amount of adipose tissue. The breast
overlies the pectoralis major and serratus anterior muscles on
ribs 2-6 (Figure 2-1A and B).
Lobules. Each mammary gland consists of 15 to 20 radially
aligned lobes of glandular tissue, which synthesizes and pro-
duces milk; each lobe has a lactiferous duct that opens onto
the surface of the nipple.
Nipple. The nipple is positioned on the anterior surface of
the breast and is surrounded by a circular hyperpigmented
region called the areola; small collections of smooth mus-
cle at the base may cause erection of the nipple when breast-
feeding or when sexually aroused.
Suspensory (Coope(s) ligaments. Bands of fibrous connec-
tive tissue that support the breast and maintain its normal
shape; the fibrous bands course from the deep fascia, through
the breast tissue, and terminate in the dermis.
Reb'omammary space. A layer ofloose connective tissue that
separates the breast from the deep fascia overlying the pecto-
ralis major and serratus anterior muscles.
Axillary tail. Mammary gland tissue that extends along the
inferior border of the pectoralis major muscle into the axilla.
Breast cancer. Breast cancer is cancer that arises from
V breast tissue. The phrase "adenocarcinoma of the breast"
can be thought of as an overarching term for breast cancer
because "adeno" refers to "glands" and "carcinoma" refers to "can-
cer:' The breast is primarily composed of the glandular tissue
(lactiferous ducts or lobules of the mammary gland). Breast ade-
nocarcinomas are classified as either noninvasive (referred to as
ductal carcinoma in situ or DCIS) or invasive. DCIS tumors are
abnormal epithelial cells that remain contained in the mammary
gland. Invasive tumors spread from the original site (either lactif-
erous ducts or lobules) into the lymphatic system and could
travel to downstream lymph nodes (often axillary nodes).
Inflammatory carcinoma of the mammary gland is a very rare
but aggressive disease whereby neoplastic cells block the local
lymphatic drainage, which causes the breast to appear red and
swollen. One of the criteria used to diagnose inflammatory breast
cancer is a "peau dorange" (dimpled or pitted skin) appearance of
the skin overlying the breast. The dimpling occurs because as the
Thorax
breast swells the skin remains tethered to the deep fascia via the
suspensory ligaments (of Cooper) and appears much like the
peel of an orange (hence the French name "peau dorange"). T
ARTERIES, VEINS, AND LYMPHATICS OF THE BREAST
Arteries, veins, and lymphatics of the breast (Figure 2-1C and D):
Arteries. Perforating branches from the internal thoracic
(mammary), lateral thoracic, and posterior intercostal arteries.
Veins. Tributaries from the internal thoracic, lateral thoracic,
and posterior intercostal veins.
Lymphatics. Most of the lymphatic drainage from the breast,
including the nipple, drain into the axillary lymph nodes;
some lymph from the medial region of the breast drain into
the parasternal and supraclavicular lymph nodes, and may
cross the midline or reach inguinal lymph nodes.
• Lymph from the right breast eventually drains into the
right lymphatic duct at the junction of the right brachioce-
phalic vein.
• Lymph from the left breast (not shown in figure) drains
into the thoracic lymphatic duct at the left brachiocephalic
vein junction.
• Some of the prominent lymph nodes in the axillary region
are as follows:
• Humeral (lateral) nodes. Located posteriorly to the axil-
lary vein and receive lymph from the upper limb.
• Pectoral ~anterior) nodes. Located along the distal border of
the pectoralis minor muscle; drain the breast and body wall
• Subscapular ~posterior) nodes. Located along the poste-
rior wall ofthe axilla; drain the axilla, shoulder, and body
wall.
• Central nodes. Embedded in the axillary fat and receive
lymph from the humeral, pectoral, and subscapular nodes.
• Apical nodes. Surround the axillary vein near the pectoralis
minor muscle; drain all other axillary nodes and lymphatic
vessels from the mammary gland into the subclavian vein.
Lymphedema. Lymphedema, the accumulation of fluid in
V tissues, may result when lymph nodes or lymphatic ves-
sels are blocked or surgically removed. A patient with breast
cancer, who has undergone axillary lymph node dissection or
radiation therapy, or both, is at risk of developing lymphedema
because of the removal or damage ofthe lymph nodes and small
lymphatic vessels. Symptoms include persistent accumulation
of a protein-rich fluid in the interstitial tissues and swelling of
the upper limb on the affected side. T
INNERVATION OF THE BREAST
Sensory innervation:
Intercostal nerves. Lateral and anterior cutaneous branches
of the second to seventh intercostal nerves provide general
sensory innervation to the skin overlying the breast.
The nipple is located within the T4 dermatome level.
Note: Physiologic changes in the breast are not mediated by
nerves but by circulating hormones (ie., high prolactin levels result
in milk production, and oxytocin causes the milk "letdown" reflex).
 Anterior Thoracic Wall CHAPTER 2 29

A
-Intercostal mm.

IT=if---Pectoralis major m.
Internal
thoracic a. lii-l..!---Deep (pectoral)
fascia
Lateral
thoracic a.

1-H-:::++---Deep layer of
superficial fascia

Mammary --~=l=l~
branches
Posterior
intercostal aa.

Lymphatic and venous

drainage passes from
medial part of breast
parasternally

D Areola

Figure 2-1: A. Breast surface anatomy. B. Sagittal section of the breast. C. Arterial supply of the breast. D. Lymphatic drainage of the breast.
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 38. Seizure of Private Property at Sea[118]

The essence of the question involved in the seizure of “private

property” at sea is transportation; and with three such conspicuous
instances[119] within a century its effectiveness is historically
demonstrated. The belligerent state, in the exercise of a right as yet
conceded by international law, says in substance to its adversary, “I
forbid your citizens the maritime transportation of their commercial
property. Articles of whatever character, including the vessels which
carry them, violating this lawful order will be seized and
condemned.” Seizure is made contingent upon movement; otherwise
the property is merely bidden to stay at home, where it will be safe.
All this is in strict conformity with the execution of law under
common conditions; and the practice is now regulated with a
precision and system consonant to other legal adjudication, the
growth of centuries of jurisprudence directed to this particular
subject. Its general tendency I have indicated by certain specific
instances. It is efficient to the ends of war, more or less, according to
circumstances; and by distributing the burden over the whole
community affected it tends to peace, as exemption from capture
could not do. If the suffering of war could be made to fall only on the
combatants actually in the field, the rest of the nation being
protected from harm and loss by the assured ability to pursue their
usual avocations undisturbed, the selfishness of men would more
readily resort to violence to carry their ends.
In support of the widespread effects of interruption to
transportation, I gladly quote one of the recent contendents for
immunity of “private property” from maritime capture. Having on
one page maintained the ineffectiveness of the seizure, because
individual losses never force a nation to make peace, he concludes
his article by saying:
“The question interests directly and vitally thousands of people in
every country. It is of vital importance to those who go down to the
sea in ships, and those who occupy their business in great waters. It
appeals not only to every shipowner, but also to every merchant
whose goods are shipped upon the sea, to every farmer whose grain
is sent abroad, to every manufacturer who sells to a foreign market,
and to every banker who is dependent upon the prosperity of his
countrymen.”
I can do little to enhance this vivid presentation by an opponent;
yet if we add to his list the butchers, the bakers, the tailors,
shoemakers, grocers, whose customers economize; the men who
drive drays to and from shipping, and find their occupation gone; the
railroads, as the great common carriers, whose freights fall off; the
stockholders whose dividends shrink; we shall by no means have
exhausted the far-reaching influence of this intermeddling with
transportation. It is a belligerent measure which touches every
member of the hostile community, and, by thus distributing the evils
of war, as insurance distributes the burden of other losses, it brings
them home to every man, fostering in each a disposition to peace.
It doubtless will not have escaped readers familiar with the subject
of maritime prize that so far I have not distinguished between the
interruption of transportation by blockade and that by seizure on the
high seas. The first, it may be said, is not yet in question; the second
only is challenged. My reason has been that the underlying military
principle—and, as I claim, justification—is the same in both; and, as
we are dealing with a question of war, the military principle is of
equal consideration with any other, if not superior. The effect
produced is in character the same in both. In efficacy, they differ,
and their comparative values in this respect are a legitimate subject
for discussion. In principle and method, however, they are identical;
both aim at the stoppage of transportation, as a means of destroying
the resources of the enemy, and both are enforced by the seizure and
condemnation of “private property” transgressing the orders.
This community of operation is so evident that, historically, the
advocates of exemption of private property from confiscation in the
one case have demanded, or at the least suggested, that blockade as a
military measure cannot be instituted against commerce—that it can
be resorted to only as against contraband, or where a port is
“invested” by land as well as by sea. This was Napoleon’s contention
in the Berlin Decree; and it is worthy of grave attention that, under
the pressure of momentary expediency, the United States more than
once, between 1800 and 1812, advanced the same view. This I have
shown in my history of the War of 1812.[120] Had this opinion then
prevailed, the grinding blockade of the War of Secession could not
have been applied. If we may imagine the United States and the
Confederate States parties to a Hague Conference, we can conceive
the impassioned advocacy of restricted blockade by the one, and the
stubborn refusal of the other. This carries a grave warning to test
seeming expediency in retaining or yielding a prescriptive right.
There is no moral issue, if my previous argument is correct; unless it
be moral, and I think it is, to resort to pecuniary pressure rather than
to bloodshed to enforce a belligerent contention. As regards
expediency, however, each nation should carefully weigh the effects
upon itself, upon its rivals, and upon the general future of the
community of states, before abandoning a principle of far-reaching
consequence, and in operation often beneficent in restraining or
shortening war.
It has been urged that conditions have so changed, through the
numerous alternatives to sea transport now available, that the
former efficacy can no longer be predicted. There might be
occasional local suffering, but for communities at large the streams
of supply are so many that the particular result of general popular
distress will not be attained to any decisive degree. Has this
argument really been well weighed? None, of course, will dispute
that certain conditions have been much modified, and for the better.
Steam not only has increased rapidity of land transit for persons and
goods; it has induced the multiplication of roads, and enforced the
maintenance of them in good condition. Thanks to such
maintenance, we are vastly less at the mercy of the seasons than we
once were, and communities now have several lines of
communication open where formerly they were dependent upon one.
Nevertheless, for obvious reasons of cheapness and of facility, water
transport sustains its ascendancy. It may carry somewhat less
proportionately than in old times; but, unless we succeed in
exploiting the air, water remains, and always must remain, the great
medium of transportation. The open sea is a road which needs
neither building nor repairs. Compared with its boundless expanse,
two lines of rails afford small accommodation—a circumstance which
narrowly limits their capacity for freight.
[It is shown that water transportation still plays an immense part
in commerce, even in the case of inland watercourses in competition
with railroads, and that any interruption of commerce throws a
heavy burden on the nation involved.—Editor.]
Such derangement of an established system of sea transportation
is more searching, as well as more easy, when the shipping involved
has to pass close by an enemy’s shores; and still more if the ports of
possible arrival are few. This is conspicuously the case of Germany
and the Baltic States relatively to Great Britain, and would be of
Great Britain were Ireland independent and hostile. The striking
development of German mercantile tonnage is significant of the
growing grandeur, influence, and ambitions of the empire. Its
exposure, in case of war with Great Britain, and only in less degree
with France, would account, were other reasons wanting, for the
importunate demand for naval expansion. Other reasons are not
wanting; but in the development of her merchant shipping Germany,
to use a threadbare phrase, has given a hostage to Fortune. Except by
the measure advocated, and here opposed, of exempting from
capture merchant vessels of a belligerent, with their cargoes, as being
“private property,” Germany is bound over to keep the peace, unless
occasion of national safety—vital interests—or honor drive her, or
unless she equip a navy adequate to so great a task as protecting fully
the carrying-trade she has laboriously created. The exposure of this
trade is not merely a matter of German interest, nor yet of British. It
is of international concern, a circumstance making for peace.
The retort is foreseen: How stands a nation to which the native
mercantile shipping, carrying-trade, is a distinctly minor interest,
and therefore does not largely affect the question of transportation?
This being maintained by neutrals, the accretion of national wealth
by circulation may go on little impaired by hostilities. The first most
obvious reply is that such is a distinctly specialized case in a general
problem, and that its occurrence and continuance are dependent
upon circumstances which frequently vary. It lacks the elements of
permanence, and its present must therefore be regarded with an eye
to the past and future. A half-century ago the mercantile marine of
the United States was, and for nearly a century before had been, a
close second to that of Great Britain; to-day it is practically non-
existent, except for coasting-trade. On the other hand, during the
earlier period the thriving Hanse towns were nearly the sole
representatives of German shipping, which now, issuing from the
same harbors, on a strip of coast still narrow, is pressing rapidly
forward under the flag of the empire to take the place vacated by the
Americans.
With such a reversal of conditions in two prominent examples, the
problem of to-day in any one case is not that of yesterday, and may
very well not be that of to-morrow. From decade to decade
experience shifts like a weather-cock; the statesman mounted upon it
becomes a Mr. Facing-Bothways. The denial of commercial blockade,
the American national expediency of 1800, suggested by such
eminent jurists as John Marshall and James Madison, would have
been ruinous manacles to the nation of 1861–65. A government
weighing its policy with reference to the future, having regard to
possible as well as actual conditions, would do well before
surrendering existing powers—the bird in the hand—to consider
rather the geographical position of the country, its relation to
maritime routes—the strategy, so to say, of the general permanent
situation—and the military principles upon which maritime capture
rests. In that light a more accurate estimate will be made of
temporary tactical circumstances, to-day’s conditions—such, for
instance, as set forth by the present Lord Chancellor of Great Britain.
[121]
In his letter, favoring immunity from capture for “private
property,” disproportionate stress is laid upon the dangers of Great
Britain, the points which make against her; a serious tactical error.
The argument from exposure is so highly developed, that the possible
enemies whose co-operation is needed to secure the desired
immunity for “private” property might well regard the request to
assist as spreading the net in the sight of the bird; a vanity which
needs not a wise man to detect. On the other hand, the offensive
advantage of capture to Great Britain, owing to her situation, is, in
my judgment, inadequately appreciated.
The writer has fallen into the mistake which our General Sherman
characterized as undue imagination concerning what “the man on
the other side of the hill” might do; a quaint version of the first
Napoleon’s warning against “making a picture to yourself.” The
picture of Great Britain’s dangers is overdrawn; that to her enemies
—“the full measure of the mischief we could do to a Continental
nation”—is underdrawn. It would seem as if, in his apprehension,
“the disastrous consequences[122] which would flow from even slight
depredations by commerce destroyers on British shipping” could
find no parallel in the results to a Continental trade from British
cruisers. France or Germany, for example, shut off from the sea, can
be supplied by rail from, say, Antwerp or Rotterdam; but it is
apparently inconceivable that, in the contingency of a protracted
naval war, the same ports might equally supply Great Britain by
neutral ships. Alternate sea routes close, apparently automatically;
only alternate land routes stay open. Thus undue weight is laid upon
defensive motives, where the offensive requires the greater
emphasis. The larger merchant tonnage of Great Britain involves a
greater defensive element, yes; but are not defensive conditions
favorably modified by her greater navy, and by her situation, with all
her western ports open to the Atlantic, from Glasgow to Bristol and
round to Southampton? And is not the station for such defense
identical with the best for offense by maritime capture? The British
vessels there occupy also a superior position for coal renewal; the
difficulty of which for an enemy, threatening the Atlantic approaches
to Great Britain, seems too largely discounted by imaginations
preoccupied with hostile commerce destroyers.
The concluding sentence of Lord Loreburn’s letter contains a
warning familiar to military thought. “Great Britain will gain much
from a change long and eagerly desired by the great majority of other
Powers.” The wish of a possible enemy is the beacon which suggests
the shoal. The truth is, if the British Navy maintains superiority, it is
to the interest of her enemies to have immunity from capture for
“private property;” if it falls, it is to their interest to be able to
capture. The inference is safe that probable enemies, if such there be,
and if they entertain the wish asserted, do not expect shortly to
destroy the British Navy.
While unconvinced by the reasoning, it is refreshing to recognize
in this letter a clear practical enunciation which sweeps away much
sentimental rhetoric. “I urge [immunity for private property] not
upon any ground of sentiment or humanity (indeed, no operation of
war inflicts less suffering than the capturing of unarmed vessels at
sea), but upon the ground that on the balance of argument, coolly
weighed, the interests of Great Britain will gain much from the
change.” I more than doubt the conclusion; but its sobriety contrasts
pleasantly with the exuberances, “noble and enlightened action,”
“crown of glory,” and the like, with which it pleases certain of our
American advocates to enwreathe this prosaic utilitarian proposition.
A possibility which affects the general question much more
seriously than others so far considered, is that of neutral carriers
taking the place of a national shipping exposed to capture under
present law. This is one phase of a change which has come over the
general conditions of carrying-trade since the United States became
a nation, and since Great Britain, three quarters of a century
afterwards, formally repealed her Navigation Acts. The discussion
preceding this repeal, together with the coincident Free Trade
movement, preceded by but a few years the Treaty of Paris in 1856,
and gave an impulse which doubtless facilitated the renouncement in
that treaty by Great Britain of the right to capture enemy’s property
under a neutral flag. The concession was in the air, as we say; which
proves only that it was contagious, not that it was wise. Like many
hasty steps, however, once taken it probably is irreversible.
The effect of this concession has been to legalize, among the
several great states signatory to the treaty, the carriage of belligerent
property by neutral ships, in which previously it had been liable to
seizure. In its later operation, the condemnation of the enemy’s
property had not involved the neutral carrier further than by the
delays necessary to take her into port, adjudicate the question of
ownership, and remove the property, if found to be belligerent. Such
detention, however, was a strong deterrent, and acted as an
impediment to the circulation of belligerent wealth by neutral
means. It tended to embarrass and impoverish the belligerent; hence
the removal of it is a modification of much importance. Neutral
shipping thus is now free to take a part in hostilities, which formerly
it could only do at the risk of loss, more or less serious. To carry
belligerent property, which under its own flag would be open to
seizure, is to aid the belligerent; is to take part in the war.
In considering such an amelioration, if it be so regarded, it is
possible to exaggerate its degree. If a nation cherishes its carrying-
trade, does a large part of its transportation in its own vessels, and is
unable in war to protect them, the benefit of the innovation will be
but partial. Its own shipping, driven from the sea, is an important
element in the total navigation of the world, and the means to
replace it will not be at once at hand. Neutrals have their own
commerce to maintain, as well as that of the weaker belligerent. They
would not undertake the whole of the latter, if they could; and, if they
would, they will not at once have the means. Steamships driven off
the sea, and for the moment lost to navigation, cannot be replaced as
rapidly as the old sailing-vessels. Moreover, neutral merchants have
to weigh the chances of hostilities being short, and that the banished
shipping of the belligerent may return in its might to the seas with
the dawn of peace, making their own a drug on the market. In short,
while the belligerent profits from a change which gives him free use
of neutral ships, whereas he formerly had only a limited use, a
considerable embarrassment remains. The effect is identical in
principle and operation with that before indicated, as resulting from
blockading a few chief harbors. A certain large fraction of
transportation is paralyzed, and the work done by it is thrown upon
ports and roads which have not the necessary facilities. It is as
though a main trunk line of railroad were seized and held. The
general system is deranged, prices rise, embarrassment results, and
is propagated throughout the business community. This affects the
nation by the suffering of thousands of individuals, and by the
consequent reduction of revenue.
It would seem, therefore, that even under modern conditions
maritime capture—of “private” property—is a means of importance
to the ends of war; that it acts directly upon the individual citizens
and upon the financial power of the belligerent, the effect being
intensified by indirect influence upon the fears of the sensitive
business world. These political and financial consequences bring the
practice into exact line with military principle; for, being directed
against the resources of the enemy, by interrupting his
communications with the outer world, it becomes strictly analogous
to operations against the communications of an army with its base—
one of the chief objects of strategy. Upon the maintenance of
communications the life of an army depends, upon the maintenance
of commerce the vitality of a state. Money, credit, is the life of war.
Lessen it, and vigor flags; destroy it, and resistance dies. Accepting
these conclusions, each state has to weigh the probable bearing upon
its own fortunes of the continuance or discontinuance of the practice.
From the military point of view the question is not merely, nor
chiefly, “What shall our people escape by the abandonment of this
time-sanctioned method?” but, “What power to overcome the enemy
shall we thereby surrender?” It is a question of balance, between
offense and defense. As Jefferson said, when threatened with a
failure of negotiations, “We shall have to begin the irrational process
of trying which can do the other most harm.” As a summary of war,
the sentence is a caricature; but it incidentally embodies Farragut’s
aphorism, “The best defense is a rapid fire from our own guns.” For
the success of war, offense is better than defense; and in
contemplating this or any other military measure, let there be
dismissed at once, as preposterous, the hope that war can be carried
on without some one or something being hurt; that the accounts
should show credit only and no debit.
For the community of states a broader view should be taken, from
the standpoint that whatever tends to make war more effective tends
to shorten it and to prevent it.
 39. The Moral Aspect of War[123]

The poet’s words, “The Parliament of man, the federation of the

world,” were much in men’s mouths this past summer. There is no
denying the beauty of the ideal, but there was apparent also a
disposition, in contemplating it, to contemn the slow processes of
evolution by which Nature commonly attains her ends, and to
impose at once, by convention, the methods that commended
themselves to the sanguine. Fruit is not best ripened by premature
plucking, nor can the goal be reached by such short cuts. Step by
step, in the past, man has ascended by means of the sword, and his
more recent gains, as well as present conditions, show that the time
has not yet come to kick down the ladder which has so far served
him. Three hundred years ago, the people of the land in which the
Conference was assembled wrenched with the sword civil and
religious peace, and national independence, from the tyranny of
Spain. Then began the disintegration of her empire, and the
deliverance of peoples from her oppression; but this was completed
only last year, and then again by the sword—of the United States.
In the centuries which have since intervened, what has not
“justice, with valor armed,” when confronted by evil in high places,
found itself compelled to effect by resort to the sword? To it was due
the birth of the United States, not least among the benefits of which
was the stern experience that has made Great Britain no longer the
mistress, but the mother, of her dependencies. The control, to good
from evil, of the devastating fire of the French Revolution, and of
Napoleon, was due to the sword. The long line of illustrious names
and deeds, of those who bore it not in vain, has in our times
culminated—if indeed the end is even yet nearly reached—in the new
birth of the United States by the extirpation of human slavery, and in
the downfall, but yesterday, of a colonial empire identified with
tyranny. What the sword, and it supremely, tempered only by the
stern demands of justice and of conscience, and the loving voice of
charity, has done for India and for Egypt, is a tale at once too long
and too well known for repetition here. Peace, indeed, is not
adequate to all progress; there are resistances that can be overcome
only by explosion. What means less violent than war would in a half-
year have solved the Caribbean problem, shattered national ideas
deep rooted in the prepossessions of a century, and planted the
United States in Asia, face to face with the great world problem of the
immediate future? What but the War of 1898 rent the veil which
prevented the English-speaking communities from seeing eye to eye,
and revealed to each the face of a brother? Little wonder that a war
which, with comparatively little bloodshed, brought such
consequences, was followed by the call for a Peace Conference!
Power, force, is a faculty of national life; one of the talents
committed to nations by God. Like every other endowment of a
complex organization, it must be held under control of the
enlightened intellect and of the upright heart; but no more than any
other can it be carelessly or lightly abjured, without incurring the
responsibility of one who buries in the earth that which was
entrusted to him for use. And this obligation to maintain right, by
force if need be, while common to all states, rests peculiarly upon the
greater, in proportion to their means. Much is required of those to
whom much is given. So viewed, the ability speedily to put forth the
nation’s power, by adequate organization and other necessary
preparation, according to the reasonable demands of the nation’s
intrinsic strength and of its position in the world, is one of the clear
duties involved in the Christian word “watchfulness,”—readiness for
the call that may come, whether expectedly or not. Until it is
demonstrable that no evil exists, or threatens the world, which
cannot be obviated without recourse to force, the obligation to
readiness must remain; and, where evil is mighty and defiant, the
obligation to use force—that is, war—arises. Nor is it possible,
antecedently, to bring these conditions and obligations under the
letter of precise and codified law, to be administered by a tribunal.
The spirit of legalism is marked by blemishes as real as those
commonly attributed to “militarism,” and not more elevated. The
considerations which determine good and evil, right and wrong, in
crises of national life, or of the world’s history, are questions of
equity often too complicated for decision upon mere rules, or even
upon principles, of law, international or other. The instances of
Bulgaria, of Armenia, and of Cuba, are entirely in point; and it is
most probable that the contentions about the future of China will
afford further illustration. Even in matters where the interest of
nations is concerned, the moral element enters; because each
generation in its day is the guardian of those which shall follow it.
Like all guardians, therefore, while it has the power to act according
to its best judgment, it has no right, for the mere sake of peace, to
permit known injustice to be done to its wards.
The present strong feeling in favor of arbitration, throughout the
nations of the world, is in itself a subject for congratulation almost
unalloyed. It carries indeed a promise, to the certainty of which no
paper covenants can pretend; for it influences the conscience by
inward conviction, not by external fetter. But it must be remembered
that such sentiments, from their very universality and evident
laudableness, need correctives, for they bear in themselves a great
danger of excess or of precipitancy. Excess is seen in the disposition,
far too prevalent, to look upon war not only as an evil, but as an evil
unmixed, unnecessary, and therefore always unjustifiable; while
precipitancy, to reach results considered desirable, is evidenced by
the wish to impose arbitration, to prevent recourse to war, by a
general pledge previously made. Both frames of mind receive
expression in the words of speakers among whom a leading
characteristic is lack of measuredness and of proportion. Thus an
eminent citizen is reported to have said: “There is no more occasion
for two nations to go to war than for two men to settle their
difficulties with clubs.” Singularly enough, this point of view assumes
to represent peculiarly Christian teaching. In so doing, it willfully
ignores the truth that Christianity, while it will not force the
conscience by other than spiritual arguments, as “compulsory”
arbitration might, distinctly recognizes the sword as the resister and
remedier of evil in the sphere “of this world.”
Arbitration’s great opportunity has come in the advancing moral
standards of states, whereby the disposition to deliberate wrong-
doing has diminished; consequently, the occasions for redressing
wrong by force are less frequent to arise. In view of recent events,
however, and very especially of notorious, high-handed oppression,
initiated since the calling of the Peace Conference,[124] and resolutely
continued during its sessions in defiance of the public opinion of the
world at large, it is premature to assume that such occasions belong
wholly to the past. Much less can it be assumed that there will be no
further instances of a community believing, conscientiously and
entirely, that honor and duty require of it a certain course, which
another community with equal integrity may hold to be inconsistent
with the rights and obligations of its own members. It is, for
instance, quite possible, especially to one who has recently visited
Holland, to conceive that Great Britain and the Boers are alike
satisfied of the substantial justice of their respective claims. It is
permissible most earnestly to hope that, in disputes between
sovereign states, arbitration may find a way to reconcile peace with
fidelity to conscience, in the case of both; but if the conviction of
conscience remains unshaken, war is better than disobedience,—
better than acquiescence in recognized wrong. The great danger of
undiscriminating advocacy of arbitration, which threatens even the
cause it seeks to maintain, is that it may lead men to tamper with
equity, to compromise with unrighteousness, soothing their
conscience with the belief that war is so entirely wrong that beside it
no other tolerated evil is wrong. Witness Armenia, and witness Crete.
War has been avoided; but what of the national consciences that
beheld such iniquity and withheld the hand?
 40. The Practical Aspect of War[125]

If it be true, as I have expressed my own conviction, that moral

motives are gaining in force the world over, we can have hope of the
time when they shall prevail; but it is evident that they must prevail
over all nations equally, or with some approach to equality, or else
discussion between two disputants will not rest on the same plane. In
the difference between the United States and Spain, I suppose the
argument of the United States, the moral justification to itself of its
proposed action, would be that misgovernment of Cuba, and
needless Cuban suffering, had continued so long as to show that
Spain was not capable of giving good government to her distant
dependency. There was no occasion to question her desire to give it,
the honesty either of her assertions or measures to that end; but it
was quite apparent that it was not in her to give effect to her efforts.
Now, presuming Spain to take that view, it is conceivable (to the
imagination) that her rulers might say, “Yes, it is true, we have failed
continuously. The Cubans have a moral right to good government,
and as we have not been able to give it them, it is right that we should
step out.” But, assuming Spain unequal to such sublime moral
conviction and self-abnegation, what was the United States to do, as
a practical matter? What she did was perfectly practical; she used the
last argument of nations as international law stands; but, suppose
she had gone to arbitration, upon what grounds would the Court
proceed? What the solid prearranged basis of its decision, should
that be that Spain must evacuate Cuba? Is there anything in the
present accord of states, styled International Law, that would give
such power? And, more pertinent still, are states prepared now to
concede to an arbitral Court the power to order them out of territory
which in its opinion they misgovern, or which in its opinion they
should not retain after conquest? e. g., Schleswig Holstein, Alsace
and Lorraine, the Transvaal, Porto Rico and the Philippine Islands?
Or, take another impending and very momentous instance, one
fraught with immeasurable issues. If I rightly appreciate conditions,
there is, among the English-speaking communities bordering the
Pacific, a deep instinctive popular determination, one of those before
which rulers have to bow, to exclude, from employment in the
sparsely settled territories occupied by them, the concentrated
crowded mass of mankind found in Japan and China. More than
anything else this sums up the question of the Pacific. Two seas of
humanity, on very different levels as to numbers and economical
conditions, stand separated only by this artificial dyke of legislation,
barring the one from rushing upon and flooding the other. I do not
criticize an attitude with which, whether I approve or not, I can
sympathize; but as I look at the legislation, and contrast the material
conditions, I wonder at the improvidence of Australasia in trusting
that laws, though breathing the utmost popular conviction and
purpose, can protect their lands from that which threatens. “Go
home,” said Franklin to a fellow colonist in the days of unrest in
America, “and tell them to get children. That will settle all our
difficulties.” Fill up your land with men of your own kind, if you wish
to keep it for yourselves. The Pacific States of North America are
filling up, and, more important, they back solidly upon, and are
politically one with, other great communities into which the human
tide is pouring apace; yet in them, too, labor may inflict upon its own
aims revolutionary defeat, if for supposed local advantage it
embarrasses the immigration of its own kind. It is very different for
those who are severed from their like by sea, and therefore must
stand on their own bottom. All the naval· power of the British
Empire cannot suffice ultimately to save a remote community which
neither breeds men in plenty nor freely imports them.
We speak of these questions now as racial, and the expression is
convenient. It is compact, and represents truly one aspect of such
situations, which, however, are essentially economical and territorial.
In long-settled countries race and territory tend to identity of
meaning, but we need scarce a moment’s recollection to know that
race does not bind as do border lines, nor even they as do economical
facts. Economical facts largely brought about the separation of
America from Great Britain; economical facts brought about the
American Union and continue to bind it. The closer union of the
territories which now constitute the British Empire must be found in
economical adjustments; the fact of common race is not sufficient
thereto. Now, economical influences are of the most purely material
order—the order of personal self-interest; in that form at least they
appeal to the great majority, for the instructed political economists
form but a small proportion of any community. Race, yes; territory—
country—yes; the heart thrills, the eyes fill, self-sacrifice seems
natural, the moral motive for the moment prevails; but in the long
run the hard pressure of economical truth comes down upon these
with the tyranny of the despot. There are, indeed, noble leaders not a
few, who see in this crushing burden upon their fellow millions an
enemy to be confronted and vanquished, not by direct opposition,
but by circumvention, relieving his sway by bettering environment,
and so giving play to the loftier sentiments. But that these men may
so work they need to be, as we say, independent, released from the
grip of daily bread; and their very mission, alike in its success and its
failures, testifies to the preponderant weight of economical
conditions in the social world....
If with wealth, numbers and opportunity, a people still cannot so
organize their strength as to hold their own, it is not practical to
expect that those to whom wealth and opportunity are lacking, but
who have organizing faculty and willingness to fight, will not under
the pressure of need enter upon an inheritance which need will
persuade themselves is ethically their due. What, it may be asked, is
likely to be the reasoning of an intelligent Chinese or Japanese
workman, realizing the relative opportunities of his crowded country
and those of Australia and California, and finding himself excluded
by force? What ethical, what moral, value will he find in the
contention that his people should not resort to force to claim a share
in the better conditions from which force bars him? How did the
white races respect the policy of isolation in Japan and China,
though it only affected commercial advantages? I do not in the least
pronounce upon the ethical propriety of exclusion by those in
possession—the right of property, now largely challenged. I merely
draw attention to the apparent balance of ethical argument, with the
fact of antagonistic economical conditions; and I say that for such a
situation the only practical arbiter is the physical force, of which war
is merely the occasional political expression.
In the broad outlook, which embraces not merely armed collision,
but the condition of preparation and attitude of mind that enable a
people to put forth, on demand, the full measure of their physical
strength,—numerical, financial and military,—to repel a threatened
injury or maintain a national right, war is the regulator and adjuster
of those movements of the peoples, which in their tendencies and
outcome constitute history. These are natural forces, which from
their origin and power are self-existent and independent in relation
to man. His provision against them is war; the artificial organization
of other forces, intrinsically less powerful materially, but with the
advantage which intelligent combination and direction confer. By
this he can measurably control, guide, delay, or otherwise
beneficially modify, results which threaten to be disastrous in their
extent, tendency, or suddenness. So regarded war is remedial or
preventive.
I apprehend that these two adjectives, drawn from the vocabulary
of the healer, embody both the practical and moral justification of
war. An ounce of prevention is worth a pound of cure. It will be well
that we invoke moral power to help heal the evils of the world, as the
physician brings it to bear on the ills of the body; but few are
prepared to rely upon it alone. We need material aid as well. The
dikes of Holland withstand by direct opposition the natural mission
of the North Sea to swallow up the land they protect. The levees of
the Mississippi restrain and guide to betterment the course of the
mighty current, which but for them would waste its strength to
devastate the shores on either hand. These two artificial devices
represent a vast expenditure of time, money, and energy; of
unproductive labor so-called; but they are cheaper than a flood. The
police of our great cities prevent the outburst of crime, the fearful
possibilities of which manifest themselves on the happily rare
occasions when material prevention has from any cause lapsed. The
police bodies are a great expense; but they cost less than a few days
of anarchy. Let us not deceive ourselves by fancying that the strong
material impulses which drive those masses of men whom we style
nations, or races, are to be checked or guided, unless to the argument
of a reasonable contention there be given the strong support of
organized material power. If the organized disappear, the
unorganized will but come into surer and more dreadful collision.
 41. Motives for Naval Power[126]

There is one further conclusion to be drawn from the war between

Japan and Russia, which contradicts a previous general impression
that I myself have shared, and possibly in some degree have
contributed to diffuse. That impression is, that navies depend upon
maritime commerce as the cause and justification of their existence.
To a certain extent, of course, this is true; and, just because true to a
certain extent, the conclusion is more misleading. Because partly
true, it is accepted as unqualifiedly true. Russia has little maritime
commerce, at least in her own bottoms; her merchant flag is rarely
seen; she has a very defective sea-coast; can in no sense be called a
maritime nation. Yet the Russian navy had the decisive part to play
in the late war; and the war was unsuccessful, not because the navy
was not large enough, but because it was improperly handled.
Probably, it also was intrinsically insufficient—bad in quality; poor
troops as well as poor generalship. The disastrous result does not
contravene the truth that Russia, though with little maritime
shipping, was imperatively in need of a navy.
I am not particularly interested here to define the relations of
commerce to a navy. It seems reasonable to say that, where merchant
shipping exists, it tends logically to develop the form of protection
which is called naval; but it has become perfectly evident, by
concrete examples, that a navy may be necessary where there is no
shipping. Russia and the United States to-day are such instances in
point. More and more it becomes clear, that the functions of navies
are distinctly military and international, whatever their historical
origin in particular cases. The navy of the United States, for example,
took its rise from purely commercial considerations. External
interests cannot be confined to those of commerce. They may be
political as well as commercial; may be political because commercial,
like the claim to “the open door” in China; may be political because
military, essential to national defense, like the Panama Canal and
Hawaii; may be political because of national prepossessions and
sympathies, race sympathies, such as exist in Europe, or traditions
like the Monroe Doctrine. The Monroe Doctrine in its beginnings
was partly an expression of commercial interest, directed against a
renewal of Spanish monopoly in the colonial system; it was partly
military, defensive against European aggressions and dangerous
propinquity; partly political, in sympathy with communities
struggling for freedom.
A broad basis of mercantile maritime interests and shipping will
doubtless conduce to naval efficiency, by supplying a reserve of
material and personnel. Also, in representative governments,
military interests cannot without loss dispense with the backing
which is supplied by a widely spread, deeply rooted, civil interest,
such as merchant shipping would afford us.
To prepare for war in time of peace is impracticable to commercial
representative nations, because the people in general will not give
sufficient heed to military necessities, or to international problems,
to feel the pressure which induces readiness. All that naval officers
can do is to realize to themselves vividly, make it a part of their
thought, that a merchant shipping is only one form of the many
which the external relations of a country can assume. We have such
external questions in the Monroe Doctrine, the Panama Canal, the
Hawaiian Islands, the market of China, and, I may add, in the
exposure of the Pacific Coast, with its meagre population,
insufficiently developed resources, and somewhat turbulent attitude
towards Asiatics. The United States, with no aggressive purpose, but
merely to sustain avowed policies, for which her people are ready to
fight, although unwilling to prepare, needs a navy both numerous
and efficient, even if no merchant vessel ever again flies the United
States flag. If we hold these truths clearly and comprehensively, as
well as with conviction, we may probably affect those who affect
legislation. At all events, so to hold will do no harm.
 APPENDIX

CHRONOLOGICAL OUTLINE

1840. September 27, Alfred Thayer Mahan born at West Point,

New York, son of Professor Dennis Hart Mahan of the U. S.
Military Academy.
1854–1856. Student at Columbia College in the City of New York.
1856. September 30, entered the third class, U. S. Naval Academy,
as acting midshipman. Appointed from the 10th
Congressional District of New York.
1859. June 9, graduated as midshipman.
1859–1861, Frigate Congress, Brazil station.
1861. August 31, promoted to lieutenant. Converted steamer
James Adger for ten days.
1861–1862. Steam corvette Pocahontas, in the Potomac flotilla;
capture of Port Royal, November 7, 1861; South Atlantic
Blockading Squadron.
1862–1863. Naval Academy at Newport, Rhode Island. First
lieutenant in the Macedonian during the summer practice
cruise to England in 1863.
1863–1864. Steam corvette Seminole, West Gulf Blockading
Squadron.
1864–1865. James Adger; staff of Rear Admiral Dahlgren, South
Atlantic Blockading Squadron; James Adger.
1865–1866. Double-ender Muscoota.
1865. June 7, promoted to lieutenant commander.
1866. Ordnance duty, Washington Navy Yard.
1867–1869. Steam sloop Iroquois, to Asiatic station, via Cape of
Good Hope. Detached in 1869; returned via Rome and Paris.
1869. Commanding gunboat Aroostook, Asiatic station.