OF THE GREAT ANTERIOR VEINS. 
161 
(St. Thomas’s, B(ehmer and Theune, Murray, Lemaire (?), Meckel, Beclard, 
Breschet, Otto, Houston, Sharpe y, the Author*.) 
Only those examples of left vena cava superior can be included in the present 
group, in which the cross branch at the root of the neck has been duly formed, the 
instances in which that characteristic preliminary step in the development has not 
taken place, being referable to the second class of peculiarities of the great anterior 
veins. Unfortunately, the descriptions of most of the known examples of double 
vena cava superior are incomplete, particularly as regards the existence of the trans- 
verse branch in the neck, and the condition of the azygos veins. 
In two instances only is the presence of the cross branch placed beyond a doubt 
(Nos. 29, 30) f. 
In six cases, in which the vessels appear to have been examined and preserved 
sufficiently high up in the neck to have determined the point one way or the other, 
the cross branch seems as certainly to have been wanting (Nos. 2, 3, 4, 17, 18, 19):|;. 
With regard to a large number of the examples, it is quite impossible, on reference 
to the descriptions or figures, to decide whether any transverse branch had ever 
existed or not (Nos. 1, 5, 7, 8, 9, 10, 11, 12, 16, 21, 22, 23, 24, 25, 26, 27, 28, 31) §. 
* Rosenthal’s case, already mentioned (p. 154), has usually been considered an example of additional left 
superior cava, but it appears rather to be one of prolonged subdivision of the right vena cava. Le Cat’s in- 
teresting specimen (p. 158) might be considered to have been an example of a small left upper cava, closed at 
its lower end. 
t No. 29. Professor Sharpey met with this specimen in Edinburgh in 1833 or 1834. The preparation 
(injected and dried) is now in the Museum of Anatomy of University College, London. It is represented in 
Prof. R. Quain’s work on the Arteries, &c. (pi. 58, figs. 9, 10, pp. 371, 432). In all respects in which it can 
be compared, it resembles the following case. No. 30. 
No. 30. The Author’s example, described in pages 162—164. 
+ The references to these six cases are given in pages 164, 165. 
§ No. 1. In the Museum of St. Thomas’s Hospital there exists a specimen of double vena cava superior. 
'The preparation in question. No. 1 1 78, is an adult heart, which has been injected and dried. The cavities, which 
are now empty, are laid open. The left vena cava superior is smaller than the right, excepting its intrapericardial 
portion, which is much dilated. There are indications of a transverse branch, but its existence cannot now be 
confidently asserted. The azygos vein, which is of ordinary size, opens as high as usual in the right superior 
cava. The middle cardiac vein opens directly into the auricle. The coronary vein appears to be small. There 
is no azygos visible on the left side. The wide orifice of the left cava has, on its upper and right border, a 
narrow ridge, but there is no Thebesian valve. A small perforated Eustachian valve exists. Cheselden 
(Philosophical Transactions, 1713, vol. xxviii. p. 282) has described “a heart with the vena azygos inserted 
into the right auricle, and the descending cava coming round the basis of the heart, above the aorta and pulmo- 
nary vessels, to enter the auricle at the lower part with the ascending cava.” This case has usually been re- 
garded as an example of double vena cava superior. The preparation at St. Thomas’s, the history of which is 
not known, but which Mr. South informs me is one of the oldest in the collection, may possibly be the speci- 
men described by Cheselden ; but as his account is so brief, and no drawing accompanies it, the point must 
remain doubtful. There is a discrepancy between the specimen and the account in the Philosophical Transac- 
tions in regard to the termination of the vena azygos. 
No. 5. Ring (Med. and Phys. Journal. London, vol. xiii. 1805, p. 120, with two figures). The prepara- 
tion is in St. Thomas’s Hospital Museum. This case shows a right and a left superior cava, with want of sepa- 
MDCCCL. Y 
