The diaphragm in man : a record of our present knowledge of its development, relationships, structure, and mode of action / by J.F. Halls Dally.

  • Dally, John Frederick Halls, 1877-1944.
Date:
[1908?]
Catalogue details

Licence: In copyright

Credit: The diaphragm in man : a record of our present knowledge of its development, relationships, structure, and mode of action / by J.F. Halls Dally. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    phrenic arteries, this being termed the diaphragmatic plexus. In this plexus small ganglia may be found. ^ ^ i At the point where the phrenic nerve joins the plexus on the right side a ganglion is formed (Schwalbe), which is made up of fibies from the solar plexus and cceliac ganglion, and is called the dia,- phragmatic ganglion j from this filaments proceed to the hepatic plexus, inferior vena cava, and suprarenal body. With the accessory nerve when present (Blandin, Valentin). r]. With the vagus rarely by an extremely slender filament (Sappey). B. The Seventh, Eighth, Ninth, Tenth, and Eleventh Intercostal Nerves.—These nerves pierce the attachments of the transversalis abdominis and diaphragm at the anterior ends of the corresponding intercostal spaces, and supply the costal portion of the diaphragm at its periphery. The terminal branches of the phrenic together with branches from the ninth, tenth, and eleventh intercostal nerves form a plexus within the muscular substance of the diaphragm (*=*). E.—The Lymphatic Supply of the Diaphragm. Both the superior and inferior surfaces of the diaphragm are richly supplied with lymphatic trunks which accompany the blood-vessels. In the more lax connective-tissue they form fairly straight, cylindrical, anastomosing channels; but, where subjected to compression by the dense fibres of the central aponeurosis, they become merely tortuous and flattened chinks. I do not propose in detail to describe their distribution, for this is fully dealt with in the various excellent works on the general anatomy of the absorbent vessels. The main divisions which concern us here are, (a) those draining the upper and lower surfaces of the diaphragm, and (5) those which drain the peritoneal cavity and pierce the diaphragm. In the dis- semination of pathological processes the perforating lymphatics in all probability take large share, since they constitute a direct link between thoracic and abdominal cavities. In animals the existence of these lymph paths has long been recognised ; but it is only of late, through the work of Kuettner (^‘^) and others, that we have learnt that, whilst each half of the diaphragm possesses its own lymph-territory, which communicates with adjacent tracts by means of lymph glands only, the muscle as a whole has anastomotic communication with pleura, peri- cardium, and peritoneum. Exactly how the process takes place is not yet fully understood. Stomata in the diaphragm were described by von Kecklinghausen 1862, and, until recently, his views have met with general acceptance. Some authors, however, deny that these openings exist, amongst them Sabin (‘*®), who regards the lymph paths as a separate
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