PHARYNX. 
leave its inferior fundus uncovered by it; con- 
sequently the bladder when distended may be 
punctured above the pubis or through the 
rectum without injuring the peritoneum. 
In the mesenteries, omenta, and other peri- 
toneal duplicatures, where the external surface 
of the peritoneum adheres to itself, the adhesion 
is generally extremely intimate. They are most 
Separated where deposits of fat have taken 
place between them. The recto-vesical folds 
and the broad ligaments of the uterus alone, 
of all the peritoneal duplicatures, have their 
layers loosely adherent. 
The peritoneum is very frequently the seat of 
extensive inflammation, the lymph effused in 
which process, besides causing adhesions of 
the abdominal viscera to one another and to 
the parietes, frequently covers the free peri- 
toneal surface with a thick adherent layer or 
false membrane; and this, like some other 
tissues formed from lymph, shrinks or cicatrizes 
in every direction, and thereby produces some 
very curious secondary effects. In such cases, 
if the great omentum is free at its lower border, 
it becomes tucked up to the greater convexity 
_ of the stomach and apparently obliterated; or 
if adherent, as to a hernial sac, the shrinking 
of the new tissue that covers it drags down the 
stomach. The thin sharp edges of the liver 
become rounded by this agent, and the calibre 
of the intestinal tube diminished; sometimes 
the intestine is even strictured by the contrac- 
tion of an unusually large deposit at a par- 
ticular part. The tendency of this tissue to 
shrink, however, being controllable by suffi- 
cient mechanical resistance, is most manifest in 
those directions in which it experiences no 
such opposition ; for which reason it tells more 
on the length than on the circumference of an 
intestine, and Cruveilhier met with a case of 
chronic peritonitis in which the small intestine 
measured only seven feet in length. If the 
hand is placed on the belly of a person in 
whom this condition exists, the muscles are 
felt to glide loosely over the peritoneum ren- 
dered tense beneath them. 
For the minute anatomy of the peritoneum 
see Serous Membrane. 
(Simon Rood Pittard.) 
PHARYNX and Mourn. (Gr. Qaguré.)— 
The pharynx is a large, muscular, and membra- 
nous pouch, placed behind the nose, mouth, and 
larynx, and resting upon the cervical vertebre : 
it extends from the base of the skull above to a 
level with the fourth or fifth cervical vertebra 
and the lower border of the cricoid cartilage, 
and is at this point continued into the cesopha- 
gus: it occupies the middle line of the body 
and is a symmetrical organ : of a very irregu- 
larly funnel-shaped form, it is wide above and 
open in front to the cavities of the nose and 
mouth, and contracts as it descends behind the 
larynx : by the relation of this latter organ the 
interior of the pharynx is converted into a tube 
to be continued downwards to the stomach 
under the name of esophagus. A common 
channel to the digestive and respiratory pas- 
VOL. III. 
945 
sages, it is alike beautifully adapted by its con- 
struction, on the one hand to receive the food 
and convey it onward to the alimentary canal, 
and on the other to preserve a perfectly free 
communication between the atmospheric air and 
organs of respiration: to this latter function may 
be added the power of modulating vocal sounds. 
As the pharynx is so closely associated, both 
in function and anatomical relation, with the 
mouth and palate, I shall subjoin to its de- 
scription that of these latter organs. In the 
further examination of the pharynx the fol- 
lowing arrangement will be adopted. 1st. The 
description of its aponeurosis and muscles, 
2ndly. Its attachments considered generally. 
3rdly. To examine its cavity with the several 
Openings related to it. 4thly. The mucous 
membrane and glandular apparatus; and, 
lastly, the vessels and nerves distributed to it. 
1. The fibrous membrane.—This aponeurosis, 
named cephalo-pharyngeal, contributes to the 
formation of the pharyngeal parietes above, 
and is essentially the means by,which the pha- 
rynx is affixed to the base of the skull: it forms 
a sort of framework for the support of the mus- 
cular and mucous tunics above, and is imper- 
ceptibly lost as it descends between these 
Structures: it is thin but strong and well- 
marked superiorly, and connected, by uniting 
intimately with the periosteum, to the under 
surface of the basilar process of the occipital 
bone, and, by a particularly dense slip, to its 
spine centrally; this latter may be considered 
as the origin of that tendinous raphé which, 
descending in the median line along the back 
of the pharynx, acts as an uniting medium to 
the constrictor muscles of either side: the 
basilar attachment of the cephalo-pharyngeal 
aponeurosis occurs immediately anterior to the 
insertions of the recti capitis antici muscles, 
and is consequently some little distance in ad- 
vance of the occipital condyles and foramen : 
extending laterally, the aponeurosis next springs 
from the under surface of the petrous portion 
of the temporal bone as far outwardly as the 
external orifice of the carotid canal, just an- 
terior and internal to which it turns suddenly 
forwards and inwards, forming a sharp angle, 
then passes beneath the inner surface of the 
levator palati muscle, to attach itself to the car- 
tilaginous portion of the Eustachian tube, near 
the anterior extremity of which it terminates by 
being gradually lost upon the mucous mem- 
brane: descending from these several points, 
and bounding the upper part of the pharyngeal 
cavity posteriorly and laterally, it insinuates 
itself between the mucous membrane and su- 
perior constrictor muscle, and splitting up into 
filaments which pass between the numerous 
mucous glands that are found at this part of 
the pharynx is lost from an inch to two inches 
below the base of the skull: posteriorly, on 
either side the median line, and between the 
upper semicircular margins of the superior 
constrictor muscles and the base of the skull, a 
considerable part of this aponeurosis is unco- 
vered by muscular fibres, constituting what are 
called the sinuses of Morgagni: the fibrous 
3 P 
