PXEUMO-GASTRIC.-SPINAL ACCESSORY NERVE. 625 



Fig. 418. VIEW OF THE DISTRIBUTION AND CONNECTIONS OP THE PNEUMO-GASTRIO AND 

 SYMPATHETIC NERVES ON THE RIGHT SIDE (from Hirschfeld and Leveille). f 



a, lachrymal gland ; b, sublingual gland ; c, submaxillary gland and facial artery ; 

 d, thyroid gland, pulled forwards by a hook ; e, trachea, below which is the right 

 bronchus cut across; /, the gullet; g, the stomach, divided near the pylorus ; i, trans- 

 verse colon, with some folds of intestine below. 



A, heart, slightly turned aside to show the cardiac plexus, &c. ; B, aortic arch, drawn 

 forward by a hook ; C, innominate artery ; D, subclavian artery, of which a portion has 

 been removed to show the sympathetic ganglia ; E, inferior thyroid artery ; F, a divided 

 part of the external carotid artery, upon which runs a nervous plexus ; Q-, internal 

 carotid, emerging from its canal superiorly; H, thoracic aorta; K, intercostal vein; L, 

 pulmonary trunk, the right branch cut ; M, superior vena cava ; 0, intercostal artery. 



1, ciliary nerves of the eyeball ; 2, branch of the oculo-motor to the inferior oblique 

 muscle, connected with the ophthalmic ganglion ; 3, 3, 3, the three principal divisions of 

 the trifacial nerve ; 4, ophthalmic ganglion ; 5, spheno-palatine ; 6. otic ; 7, submaxillary ; 

 8, sublingual ; 9, sixth nerve ; 10, facial in its canal, uniting with the spheno-palatine 

 and otic ganglia; 11, glosso-pharyngeal; 12, right pneumo-gastric ; 13, left pneumo- 

 gastric spreading on the anterior surface of the stomach ; 14, spinal accessory ; 35, hypo- 

 glossal ; 16, lower nerve of the cervical plexus; 17, middle nerve of the brachial 

 plexus ; 18, intercostal nerves ; 21, superior cervical ganglion of the sympathetic, con- 

 nected with, 22, tympanic nerve of Jacobson ; 23, carotid branch of the Vidian nerve ; 

 24, cavernous plexus; 25, ophthalmic twig; 26, filament to the pituitary gland; 27, 

 union with the upper cervical nerves ; 28, points to the pneurao-gastric nerve, close to 

 the pharyngeal and carotid branches : 29, points to the superior laryngeal nerve, close 

 to the pharyngeal and inter-carotid plexuses ; 30, laryngeal branch joining the laryngeal 

 plexus ; 31, great sympathetic nerve ; 32, superior cardiac nerve ; 33, middle cervical 

 ganglion ; 34, twig connecting the ganglion with, 35, the recurrent ; 36, middle cardiac 

 nerve ; 37, great sympathetic nerve ; 38, inferior cervical ganglion ; below 37, branches 

 from the ganglion, passing round the subclavian and vertebral arteries ; 39, the line from 

 this number crosses the nerves proceeding from the brachial plexus ; 40, sympathetic 

 twigs surrounding the axillary artery ; 41, branch of union with the first intercostal 

 nerve ; the line from the letter e, pointing to the trachea, crosses the superior, middle, 

 and inferior cardiac nerves ; 42, cardiac plexus and ganglion ; 43, 44, right aud left coro- 

 nary plexuses ; 45, 46, thoracic portion of the great sympathetic nerve and ganglia, showing 

 their connections with the intercostal nerves ; 47, great splanchnic nerve; 48, semilunar 

 ganglion ; 49, lesser splanchnic ; 50, solar plexus ; 51, union with the pneumo-gastric 

 nerve ; 52, diaphragmatic plexus and ganglion ; 53, coronary plexus ; 54, hepatic ; 55, 

 splenic ; 56, superior mesenteric ; 57, renal plexus. 



trachea, and its divisions in the lungs. These nerves give branches likewise 

 to the heart and great vessels by means of their communication with the 

 cardiac plexus. Each pneumo-gastric nerve is connected with the following 

 cranial nerves the spinal accessory, glosso-pharyngeal, facial, and hypo- 

 glossal ; also, with some spinal nerves ; and with the sympathetic in the 

 neck, thorax, and abdomen. 



SPINAL ACCESSORY NERVE. 



The spinal nerve accessory to the vagus, or, as it is shortly named, the 

 spinal accessory nerve, consists of two parts : one (accessory) joins the 

 trunk of the pneumo-gastric ; the other (spinal) ends in branches to the 

 stern o-mastoid and trapezius muscles. 



The internal or accessory part, the smaller of the two, joins in the foramen 

 of exit the ganglion on the root of the pneumo-gastric, by two or three 

 filaments ; and having passed from the skull, blends with the trunk of the 

 pneumo-gastric beyond its second ganglion, as already said. 



It is stated by Bendz that a filament is given from the spinal accessory to the pha- 

 ryngeal nerve above the place of junction with the pneumo-gastric, and that fibrils of 

 the same nerve have been traced into each of the muscular offsets of the pneumo- 

 gastric nerve. (Bendz, " Tract, de connexu inter nerv. vag. et acces." 1836.) 



The external portion of the nerve communicates with the accessory part 



