Table Of ContentSURFACE AND
RADIOLOGICAL ANATOMY
SURFACE AND
RADIOLOGICAL ANATOMY
FOR STUDENTS AND GENERAL PRACTITIONERS
FIFTH EDITION BY
W. J. HAMIL TON
M.D., D.Se., F.R.C.S., F.R.C.O.G., F.R.S.E.
Emeritus Professor of Anatomy in the University of London
G. SIMON
M.D., F.R.C.P., D.M.R.E.(Cantab.), F.F.R.
Formerly Demonstrator of Radiological Anatomy in the Medical College of
St Bartholomew's Hospital and
Radiologist to the Diagnostic X-ray Department, St Bartholomew's Hospital, and to
the Brompton Hospital, London
S. G. IAN HAMIL TON
M.A., M.B., M.Chir.(Cantab.), F.R.C.S.
Consultant Surgeon, Royal Cornwall Hospital (Treliske)
Truro, Cornwall
CAMBRIDGE: W. HEFFER & SONS LTD
BALTIMORE: THE WILLIAMS & WILKINS COMPANY
1971
ISBN 978-1-349-02801-6 ISBN 978-1-349-02799-6 (eBook)
DOI 10.1007/978-1-349-02799-6
@ W. J. HAMILTON, G. SIMON, S. G. IAN HAMILTON 1971
Softcover reprint of the hardcover 1st edition 1971 978-0-333-19154-5
First Edition by A. B. Appleton, W. J. Hamilton and Ivan C. C. Tchaperoff 1938
Second Edition by A. B. Appleton, W. J. Hamilton and G. Simon 1946
Third Edition by A. B. Appleton, W. J. Hamilton and G. Simon 1949
Fourth Edition by W. J. Hamilton and G. Simon 1958
Fifth Edition by W. J. Hamilton, G. Simon and S. G. Ian Hamilton 1971
PREF ACE TO THE FIFTH EDITION
In this book we have ventured to travel beyond the usually accepted scope of works on surface
anatomy. It has been our aim to provide an introduction to the study of anatomical structures which
are accessible to examination in the living subject.
To the time-honoured methods of physical examination we have added radiological methods.
General recognition, indeed, is now given to the value of radiology for the study of anatomy. A
knowledge of the normal appearances is indispensable as a background to the proper utilization of
radiology for clinical purposes. By the extensive use of illustrations we have attempted to supply a
means of co-ordinating radiological anatomy with those features which can be determined by external
examination and with those details which can be determined only by dissection.
The physical examination may with profit be extended to include percussion and auscultation, and
the examination of internal structures by digital exploration or by the employment or special instru
ments such as the laryngoscope and aural speculum. We have, therefore, in appropriate places,
described the anatomical features which may be thus investigated. The book has been arranged in
sections which correspond with the "parts" in which the body is customarily dissected.
In an introductory section we have set forth some general considerations relating to radiological
technique, to the structure of the skin and to the group action of muscles. In sections that follow,
more detailed information relating to each "part" is given.
Surface contours have been shown in their relation to underlying structures by a series of parallel
illustrations, a method which has also been employed for the elucidation of the more difficult radio
graphic appearances. In this way we believe that a better appreciation of surface and radiological
anatomy can be obtained than by the provision of elaborate descriptions.
We have stressed the study of surface contours for the importance they have in marking the
positions of deeper structures, and have preferred to draw attention to the landmarks by which the
positions of structures may be recognized rather than to apply to the living subject stereotyped
projections based upon the cadaver.
All radiographs except one have been reproduced as negatives in view of the general practice of
examining original radiographs in this form: for a like reason all but one have been reproduced
completely untouched.
In the present edition many of the original radiographs have been replaced by new ones and a
number of new illustrations have been added. The text has been extensively revised and rearranged.
Description of the techniques used in radiology has been moved to the introductory chapter on
general anatomy and methods, leaving the main part of the book for the description of the general and
radiological anatomy unencumbered by points of radiological technique.
It should be appreciated that the book has been written for at least three different categories of
readers. First, for medical students to supplement their knowledge of anatomy gained through
dissection. Some of the radiology may be in too great detail for them, especially that of the hilar
vessels of the lung, and the cerebral and coronary arteries. Most of the radiological anatomy will
however be of value later in their clinical course which will include radiological diagnosis.
Secondly, it is hoped that the book may be of value to trainee radiographers, though they need not
learn the names of all the muscles and nerves.
Finally, the trainee radiologist should find the book of value since it is necessary for him to become
familiar with the normal radiological anatomy.
We wish to record our indebtedness to Professor T. W. Glenister, Dr D. Brown and Dr Jean R. W.
Ross of the Anatomy Department, Charing Cross Hospital Medical School, for the help they have
vi PREFACE
given in the revision of the text and figures. To Dr G. du Boulay, Radiologist at St Bartholomew's
Hospital, we are indebted for cerebral angiograms and some other figures and for criticism of the
section on the radiology of the skull. We also wish to express our thanks to Mr E. J. Park, F.I.S.T.,
Chief Technician, Anatomy Department, Charing Cross Hospital Medical School, for the help he has
given with revision.
We owe much to Mr A. K. Maxwell and Mr F. B. Price for the skill and care they have shown in
the execution of the illustrations, and recognize in them an indispensable contribution to the book.
To them we feel deeply grateful.
We have been fortunate in the cordial relationship which has existed between us and Messrs
W. Heifer & Sons Ltd, Printers and Publishers. Finally, we wish to thank Mr H. G. Newman,
Works Director of Messrs W. Heffer & Sons Ltd, and his staff, for their help and patience.
W. J. HAMILTON
G. SIMON
S. G. 1. HAMILTON
CONTENTS
GENERAL ANATOMY AND METHODS
(1) INTRODUCTION - page 1
(2) INDIVIDUAL VARIATION - 1
(3) LANDMARKS - 8
(4) THE SKIN 10
(5) CUTANEOUS NERVES 12
(6) MUSCLE ACTIONS - 15
(7) PHYSICAL SIGNS 23
(8) X-RAYS- 24
THE UPPER LIMB
SHOULDER AND ARM
(1) SURFACE CONTOURS 37
(2) LANDMARKS ON THORACIC SKELETON 41
(3) SKELETON OF THE SHOULDER REGION 41
(4) SUPERFICIAL MUSCLES 44
(5) MOVEMENTS - 50
(6) RADIOLOGY - 55
ELBOW, FOREARM AND HAND
(1) SURFACE CONTOURS 63
(2) SKELETAL LANDMARKS - 63
(3) MUSCLES 66
(4) SYNOVIAL SHEATHS AND FASCIAL SPACES OF THE WRIST AND HAND - 75
(5) MOVEMENTS - 76
(6) RADIOLOGY - 79
VESSELS AND NERVES
(1) ARTERIES 91
(2) SUPERFICIAL VEINS 95
(3) LYMPH VESSELS 95
(4) NERVES- 96
THE CHEST AND BACK
THORACIC WALL
(1) SURFACE CONTOURS 101
(2) SURFACE LANDMARKS 105
(3) SUPERFICIAL VESSELS AND NERVES - 107
(4) MOVEMENTS OF THE CHEST WALL - 109
vii
V111 CONTENTS
THORACIC CONTENTS
(1) DIAPHRAGM - 112
(2) SURFACE RELATIONS OF PRINCIPAL THORACIC CONTENTS 117
PHYSICAL EXAMINATION OF THE THORAX
(1) INSPECTION AND PALPATION - 127
(2) PERCUSSION OF THE LUNG AND HEART AREAS - 128
(3) AUSCULTATION 129
(4) RADIOLOGICAL EXAMINATION - 131
(5) BRONCHOSCOPY 182
GREAT VESSELS - 184
OESOPHAGUS
(1) RADIOLOGY - 188
(2) OESOPHAGOSCOPY - 189
ABDOMEN
ABDOMINAL WALL
(1) SURFACE CONTOURS 190
(2) SURFACE LANDMARKS 191
(3) ABDOMINAL PLANES 193
(4) RELATIVE LEVELS OF LANDMARKS ON THE FRONT AND BACK OF THE BODY - 197
(5) STRUCTURE OF THE ANTERIOR ABDOMINAL WALL 198
(6) SUPERFICIAL VESSELS AND NERVES - 201
PHYSICAL EXAMINATION OF THE ABDOMEN
(1) INSPECTION - 204
(2) PALPATION - 204
(3) PERCUSSION - 204
(4) AUSCULTATION 205
(5) RADIOLOGICAL EXAMINATION - 205
ABDOMINAL CONTENTS
(1) STOMACH 209
(2) DUODENUM - 219
(3) JEJUNUM AND ILEUM 220
(4) LARGE INTESTINE - 223
(5) LIVER AND GALL BLADDER 232
(6) SPLEEN 235
(7) PANCREAS 236
(8) KIDNEYS 236
(9) URETER 237
(10) BLADDER 240
(11) SUPRARENAL GLANDS 241
(12) FEMALE PELVIS 241
CONTENTS ix
PERINEUM - 245
DEEP BLOOD-VESSELS OF THE ABDOMEN 250
HEAD AND NECK
GENERAL FEATURES
(1) SURFACE CONTOURS 252
(2) SURFACE LANDMARKS 253
(3) CRANIAL SUTURES - 257
(4) GROWTH CHANGES 259
THE NECK
(1) SUPERFICIAL MUSCLES 260
(2) MOVEMENTS - 263
SPECIAL ORGANS AND REGIONS
(1) THYROID GLAND - 264
(2) OESOPHAGUS - 264
(3) PAROTID GLAND - 265
(4) THE EYES AND EYELIDS - 266
(5) THE EAR 268
(6) NASAL CAVITIES 270
(7) THE MOUTH 272
(8) PHARYNX 276
(9) LARYNX 278
VESSELS AND NERVES 278
THE BRAIN AND ITS ASSOCIATED VESSELS -
(1) CEREBRAL SULCI - 288
(2) CORTICAL AREAS - 289
(3) VESSELS- 290
RADIOLOGY
(1) NECK - 291
(2) SKULL - 294
(3) RADIOLOGY OF THE TEETH 313
(4) VENTRICLES OF THE BRAIN 313
(5) CEREBRAL ANGIOGRAPHY 315
THE VERTEBRAL COLUMN
(1) CURVES 321
(2) MUSCLES 322
(3) MOVEMENTS - 323
(4) RADIOLOGY - 325
(5) THE SUBARACHNOID SPACE AND SPINAL CORD - 330
x CONTENTS
THE LOWER LIMB
BUTTOCK AND THIGH
(1) SURFACE CONTOURS 332
(2) SKELETAL LANDMARKS - 336
(3) SUPERFICIAL MUSCLES 337
(4) MOVEMENTS AT THE HIP JOINT 340
(5) RADIOLOGY OF THE HIP REGION 342
REGION OF THE KNEE
(1) SURFACE CONTOURS 345
(2) SKELETAL LANDMARKS - 348
(3) SUPERFICIAL MUSCLES AND TENDONS 351
(4) MOVEMENTS AT THE KNEE JOINT 352
(5) RADIOLOGY - 354
LEG AND FOOT
(1) SURFACE CONTOURS 356
(2) SKELETAL LANDMARKS - 359
(3) SUPERFICIAL MUSCLES 359
(4) MOVEMENTS OF THE FOOT 362
(5) RADIOLOGY - 364
VESSELS AND NERVES 367
APPENDICES - 377
INDEX - 383
