500 



GLUT^AI. REGION. 



With regard to tlie argument in favour of 

 the motal properties of tins nerve, drawn by 

 Midler from its anatomy, it appears to me that 

 this analogical mode of investigation, valuable 

 though it is, must be permitted to yield to the 

 more positive observations obtained from expe- 

 riment. And though it may be granted that 

 the apparent limitation of the ganglion jugu- 

 lare to the posterior filaments of this nerve 

 causes it here to resemble closely the double 

 roots of the spinal nerves, yet we must be 

 wary in drawing analogies between the glosso- 

 pharyngeal and spinal nerves, since we have 

 another ganglion situated immediately below 

 this, viz. the ganglion petrosum, which involves 

 the whole of the nerve, and to this assuredly 

 we have no analogical structure in the spinal 

 nerves. No doubt Miiller supposes that this 

 interior ganglion differs from those placed upon 

 the posterior roots of the spinal nerves, and 

 that it belongs to the sympathetic system. But 

 as nothing like conclusive proof is advanced 

 in support of this opinion, we may in the mean 

 time reasonably suspend our belief as to the 

 probable influence which this lower ganglion 

 may exert upon the functions of the nerve. 



Of course the fact that some of the filaments 

 of the glosso-pharyngeal terminate in the mus- 

 cular fibre, is no proof that these filaments are 

 motal, for the muscular bundles have their sen- 

 sitive as well as their motal filaments. 



(John Reid.) 



GLUT7EAL REGION, (Surgical Anatomy.) 

 (Fr. region J'fssiere.) The gluteal region may 

 be defined with tolerable precision to be all that 

 space external to the pelvis which is covered 

 by the giutei muscles of each side. Its boun- 

 daries s'eem naturally to be the crista of the 

 ilium above; behind, the mesian line as low 

 down as the point of the coccyx ; before, a line 

 drawn from the anterior superior spinous pro- 

 cess of the ilium to the trochanter major; and 

 below, a line drawn from the point of the 

 coccyx to the insertion of the gluteus maximus ; 

 in fact, the inferior margin of this muscle forms 

 the boundary line. These limits, better defined 

 than those of most of the anatomical regions, 

 separate this tract from the lumbar and iliac 

 regions above, from the superior anterior region 

 of the thigh in front, from the perineal and 

 posterior regions of the thigh below, and from 

 the corresponding part of the opposite side at 

 the posterior mesian line. This space, which 

 does not comprise many points of importance 

 in surgical anatomy, is yet not without interest. 

 Here are the gluteal and ischiadic arteries, also 

 the commencement of the course of the great 

 sciatic nerve. The internal pudic artery also 

 skirts along the inferior edge of the glutwal 

 region, but this will be best considered as part 

 of the regfon of the perineum. 



The first thing that strikes us in the exami- 

 nation of this region is the great density and 

 thickness of the integuments; they are inferior 

 in this respect only to the sole of the foot. 

 This density is, however, found greater pro- 

 portionally in the true skin than in the cuticle, 

 which retains much of the softness and pliabi- 



lity of the same covering in other parts of the 

 body, and the end of this is evident, since 

 whatever the pressure may be upon the glukval 

 paits a dense state of the cuticle in any degree 

 similar to the sole of the foot would, in the 

 varied positions and movements of the trunk, 

 be quite incompatible with comfort. On the 

 other hand, the true skin, though pliant, is 

 remarkably dense and strong, its fibres almost 

 tendinous in structure, interlacing each other 

 in every direction, and united underneath to a 

 strong but rather loose cellular tissue which 

 connects it to the glutens muscle. It is to the 

 laxity of this cellular connexion that the inte- 

 guments of this part are partly indebted for 

 that pliability which enables us to rest with 

 ease and comfort upon surfaces of various 

 degrees of hardness and inequality. It contains 

 a considerable quantity of fat, which adds to 

 the softness and elasticity of this cushion, and 

 is very different from the granular hard fat 

 found in the plantar region. The density of 

 the integumental covering of the glnteal region 

 varies somewhat in different parts. It is greatest 

 where it covers the tuber ischii, and gradually 

 diminishes on all sides except on the side next 

 the perineum, where the change is very abrupt 

 from its characteristic density to the extreme 

 thinness and delicacy of the perineal covering. 

 The peculiarity of structure of the integument 

 covering the giutei should be borne in mind 

 by the surgeon in the treatment of diseases of 

 this part. Abscesses should on this account 

 be earlier opened from the obstacle thus pre- 

 sented to their pointing. It is on this account 

 also, probably, that we so generally find 

 abscesses here accompanied with sloughing of 

 the cellular tissue, which is best obviated by an 

 early opening. 



The fleshy fibres of the gluteus maximus 

 are covered by a somewhat denser stratum of 

 cellular tissue, forming an aponeurosis distinct 

 from the fascia lata of the thigh, though conti- 

 nuous with it at the anterior edge of the muscle, 

 where the fascia lata lies upon the anterior half 

 of the gluteus medius. The great gluteus is 

 composed of coarse and loosely connected 

 fasciculi, running in a direction downwards 

 and forwards. It commences by a somewhat 

 semicircular line of origin from the posterior 

 two-thirds of the crista ilii, from the side of the 

 sacrum and of the coccyx. From this origin 

 the fibres run somewhat converging towards 

 the great trochanter and upper part of the 

 linea aspera. This direction of the fibres 

 should be borne in mind in connexion with all 

 remedial manipulations on this part, that the 

 position in which the limb should be placed 

 may be chosen most favourably for the relaxing 

 of the muscle. The other muscles which are 

 in this neighbourhood, and all of which move 

 the thigh-bone, are so much smaller than this 

 great muscle that the relaxing of this is of the 

 first importance, and the position must be 

 chosen with reference almost entirely to this. 



On reflecting the glutens maximus the fol- 

 lowing parts are brought into view : 1st, several 

 large branches of arteries and veins, which were 

 divided in reflecting the muscle, and which 



