1146 



SURGICAL AND TOPOGRAPHICAL ANATOMY 



spines. The five lumbar arise opposite the eleventh and twelfth thoracic spines; 

 and the origins of the live sacral correspond to the tirst lumbar spines. The dia- 

 gram and table (tig. 705), arranged by Dr. Gowers from anatomical and patho- 

 logical data, show the relations of the origins of the nerves to their exits from the 

 vertebral canal, and the regions supplied by each. 



Scapula, its muscles and arterial anastomoses. — Amongst the landmarks 

 in the back, the student should be careful to trace the angles and borders of the 

 scapula as far as these are accessible. The upper border is the one most thickly 

 covered. With the hands hanging down, the upper angle corresponds to the upper 

 border of the second rib; the lower angle to the seventh intercostal space; and the 



Fig. 709. — Relations of the Abdominal Viscera to the Posterior Parietes. (Treves.) 



root of the spine of the scapula to the interval betw^een the third and fourth tho- 

 racic spines. Fig. 706 shows the chief arteries around the scapula. The anas- 

 tomoses on the acromial process between the suprascapular, acromio-thoracic, and 

 circumflex arteries are not shown. 



Lumbar fascia. — In the loins, the muscles which fill in the space between the 

 last rib and the crest of the ilium should be carefully noted, owing to the frequency 

 of operations here. When the latissimus dorsi, the oblique, the transversalis, the 

 erector spinas, and quadratus have been described, the lumbar fascia (the posterior 

 aponeurosis of the transversalis), and the three layers into which it divides poste- 

 riorly (fig. 707) should be remembered. 



Viscera. — Several of these, which can be mapped in behind — viz. the kidneys, 



