Licence: Public Domain Mark
Credit: The anatomy of the human body / By J. Cruveilhier. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
886/944 (page 862)
![anastomose with the left cardiac nerves, and are arranged as we shall soon describe. In some rare cases, the right superior cardiac nerve goes directly to the cardiac plexus, Vi-ithout anastomosing with the middle and inferior cardiac nerves. During its course along the neck, the right superior cardiac nerve receives the small superior cardiac branches of the pneumogastric, and gives ofT several filaments, some to the pharynx, others to the trachea and the thyroid body, while several assist in forming the plexus of the inferior thyroid artery ; it often gives off three or four branches which anastomose with the recurrent nerve. In the thorax, the superior cardiac nerve is joined by the cardiac branch given off by the pneumogastric in the lower part of the neck, and which is sometimes of very consid- erable size, and evidently re-enforces the cardiac nerve ; this branch of the pneumogas- tric sometimes terminates directly in the cardiac plexus. The Middle Cardiac Nerve.—This nerve arises from the middle cervical ganglion, or, when that is absent, from the trunk of the sympathetic, at a variable distance from the inferior cervical ganglion. It is rather frequently the largest of the cardiac nerves, and has, therefore, been called by Scarpa the great cardiac nerve {magnus, profundus). At other times it is in a rudimentary state, and is replaced either by the superior or the in- ferior cardiac nerve, or by branches from the recurrent: it frequently divides into sev- eral twigs, between which the sub-clavian passes ; it almost always anastomoses with the superior and inferior cardiac nerves of the same side, runs along the recurrent nerve, for which it might be mistaken, and with which it is always connected, and then terminates in the cardiac plexus. TTie Inferior Cardiac Nerve.—This is generally smaller (cardiacus minor) than the pre- ceding nerve, though it is sometimes larger; it usually arises from the inferior cervical ganglion, but rather fequently from the first thoracic ; it accompanies the middle cardi- ac nerve, anastomoses with that nerve, and, hke it, descends vertically in front of the trachea, and terminates in the cardiac plexus. The connexion of the middle and inferior cardiac nerves with the recurrent nerve de- mands especial attention. Sometimes the recurrent sends off certain large branches which join the cardiac nerves, and form their principal origin. I have seen the middle and inferior, cardiac nerves united together, crossing over the recurrent nerve at right angles, and adhering intimately to it without presenting that admixture of filaments which constitutes an anastomosis.* The Left Cardiac Nerves. The peculiarities of the left cardiac nerves may be stated in a few words :t in the neck, they are situated in front of the oesophagus, on account of the position of that canal. The connexions between the cardiac nerves and the recurrent on the left side appear to me more numerous than those on the right. In one case, the superior and inferior car- diac nerves gave off a series of four rather large filaments, which ran along the recur- rent, left that nerve opposite to its point of reflection, and then terminated in the usual manner. I ascertained that, in this case, the two nerves were merely in contact, and did not anastomose. In the thorax, the superior and middle cardiac nerves of the left Side descend between the carotid and sub-clavian, and then run upon the concavity of the arch of the aorta ; the inferior cardiac nerve, which is the largest of all the cardiac nerves in a subject which I have now before me, passes to the left of the trunk of the pulmonary artery, turns round its back part, and embraces it in a loop, so as to enter that portion of the cardiac plexus which is situated between the aorta and the right division of the pulmo- nary artery. Lastly, on the left s;de, more commonly than on the right, the anterior nulmonary plexus sends off some flaments to this same part of the cardiac plexus. The Cardiac Ganglion and Plexuses. We have seen that the cardiac nerves of the same side anastomose with eacn other on the sides or in front of the trachea. Besides this, the right cardiac nerves anasto- mose with the left upon the concavity of the arch of the aorta ; also in front of the tra- chea, above the right pulmonary artery ; and, lastly, in the anterior and posterior coro- nary plexuses. Wrisberg was the first to describe a ganglion in the situation of the first-named anas- tomosis, that is to say, upon the concavity of the arch of the aorta, between that vessel and the pulmonary artery, to the right of the remains of the ductus arteriosus. This ganglion, which is by no means constant, is named the cardiac ganglion ; it is joined [so as to form the superficial cardiac plexus] by the superior cardiac nerve of the right side, * It is especially in these anastomoses between the cardiac and recurrent nen'es that I have been able, from the ditferent aspect of the filaments of each, to ascertain that the anastomoses of nerves are often mere- ly apparent, and consist of a simple juxtaposition of two nerves without any communication of their component fasciculi, which can lie traced uninterruptedly from their entrance to their emergence. The same observa- tion applies also to some of the anastomoses between nerves of the same kind. t In one subject, three filaments arose from the left superior cervical ganglion, and united in a small gan- glionic nodule, which also received a twig from the laryngeal nerve. This ganglionic nodule gave off several pharyngeal twigs, and also the superior cardiac nerve.](https://iiif.wellcomecollection.org/image/b21196801_0886.jp2/full/800%2C/0/default.jpg)
