3 jo SURGICAL APPLIED ANATOMY. iChao xvu 



since it is connected on the one hand with the plexuses 

 that supply the stomach and liver, and on the other 

 hand with these very dorsal nerves that are distributed 

 about the lower interscapular space. Much discussion 

 has taken place as to the cause of the " shoulder tip " 

 pain often complained of in liver ailments. Some 

 imagine that the pain is conducted along the hepatic 

 plexus . to the vagus, thence to the spinal accessory, 

 and so to the point of the shoulder. Others trace it 

 from the liver plexus to the phrenic, thence to the third 

 and fourth cervical nerves (from whence the phrenic 

 is in great part derived), and finally to those branches 

 of these cervical trunks that go to the shoulder tip 

 (the acromial brandies). 



There would seem to be but little connection 

 between a disease in the sigmoid flexure and a pain in 

 the knee, yet in cases of .cancer of the flexure, and in 

 instances where it has been distended with faeces, such 

 a pain has been complained of. The pain is conveyed 

 along the obturator nerve, which lies beneath the 

 sigmoid flexure, and could be readily pressed upon by 

 the gut when diseased. 



The blood-vessels of the abdomen. Some 

 of the visceral branches of the abdominal aorta are of 

 large size, and would bleed very copiously if wounded. 

 Thus, the cffiliac axis, and the superior mesenteric 

 artery, are as large as the common carotid ; the splenic, 

 hepatic, and renal vessels are about the size of the 

 brachial ; while the largest part of the inferior inesen- 

 teric trunk has dimensions equal to those of the ulnar 

 artery. Aneurisms of the aorta are especially apt to 

 occur at the cceliac axis, that being a point where a 

 number of large branches are abruptly given off, and 

 where the course of the circulation undergoes in con- 

 sequence a sudden deviation. 



When it is remembered that the lumbar glands 

 lie about the vena cava and iliac veins, it will be 



