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Regional and Applied Dissection and Clinical
Volume 1
HumanAnatomy
BD Chaurasia’s EighthEdition
Upper LimbThorax
Dr BD Chaurasia (1937–1985)was Reader in Anatomy at GR Medical College, Gwalior.
He received his MBBS in 1960, MS in 1965 and PhD in 1975.He was elected fellow of National Academy of Medical Sciences (India) in 1982.
He was a member of the Advisory Board of the Acta Anatomica since 1981,member of the editorial board of Bionature, and in addition
member of a number of scientific societies.He had a large number of research papers to his credit.
Volume 1
HumanAnatomy
BD Chaurasia’s EighthEdition
CBS Publishers & Distributors Pvt LtdNew Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai
Bhopal • Bhubaneswar • Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand • Dhaka (Bangladesh)
Chief Editor
Krishna GargMBBS MS PhD FIMSA FIAMS FAMS FASI
Member and Fellow, Academy of Medical SciencesFellow, Indian Academy of Medical Specialists
Fellow, International Medical Science AcademyFellow, Anatomical Society of India
Lifetime Achievement AwardeeDMA Distinguished Service Awardee
Ex-Professor and Head, Department of AnatomyLady Hardinge Medical College
New Delhi
Editors
Pragati Sheel Mittal MBBS MS Mrudula Chandrupatla MBBS MD
Associate Professor, Department of Anatomy Professor and Head, Department of AnatomyGovernment Institute of Medical Sciences Apollo Institute of Medical Sciences
Greater Noida, UP Hyderabad, Telangana
Regional and Applied Dissection and Clinical
Upper LimbThorax
ISBN: 978-93-88902-73-1
Copyright © Publisher and author
Eighth Edition: 2019First Edition: 1979Reprint: 1980, 1981, 1982, 1983, 1984, 1985, 1986, 1987, 1988
Second Edition: 1989Reprint: 1990, 1991, 1992, 1993, 1994
Third Edition: 1995Reprint: 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004
Fourth Edition: 2004Reprint: 2005, 2006, 2007, 2008, 2009
Fifth Edition: 2010Reprint: 2011, 2012
Sixth Edition: 2013Reprint: 2014, 2015
Seventh Edition: 2016Reprint: 2017, 2018
All rights are reserved. No part of this book may be reproduced or transmitted in any form or by anymeans, electronic or mechanical, including photocopying, recording, or any information storage andretrieval system without permission, in writing, from the author, Chief Editor and the publisher.
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Disclaimer
Science and technology are constantlychanging fields. New research and experi-ence broaden the scope of information andknowledge. The editors have tried their bestin giving information available to them whilepreparing the material for this book. Although,all efforts have been made to ensure optimumaccuracy of the material, yet it is quite possiblesome errors might have been left uncorrected.The publisher, the printer and the editors willnot be held responsible for any inadvertenterrors, omissions or inaccuracies.
to
my teacher
Shri Uma Shankar Nagayach — BD Chaurasia
This human anatomy is not systemic but regionalOh yes, it is theoretical as well as practicalBesides the gross features, it is chiefly clinicalClinical too is very much diagrammatical.
Lots of tables for the muscles are providedEven methods for testing are incorporatedImproved colour illustrations are addedSo that right half of brain gets stimulated
Tables for muscles acting on joints are givenTables for branches of nerves and arteries are givenHope these volumes turn highly usefulEditors’ hardwork under Almighty’s guidance prove fruitful
The Seventh edition was published in 2016. The newly added fourth volume on brain-neuroanatomyreceived an excellent response from the students and the teachers alike.
The Eighth edition also brings new changes, surprises, modifications and highlights. It has been designedas per MCI BoG Syllabus 2018 featuring the text and headings following the “Competency BasedUndergraduate Curriculum for the Indian Medical Graduate 2018”, prescribed by Medical Council ofIndia.
Many readers and teachers gave a feedback of retaining the cranial nerves in Volume 3, therefore,a brief description of all the cranial nerves has been given in the appropriate chapters.
Text, along with the illustrations, has been thoroughly updated. Many new diagrams have beenadded and the earlier ones modified for easy comprehension. Some selected diagrams from the veryfirst edition have been adapted, recreated and incorporated in these volumes.
Quite a few radiographs and MRIs have been added to keep up with the new developments. Extensiveediting, especially developmental editing, has been done.
Extensive research has decoded the molecular control of development of organ tissues of the body.An attempt has been made to introduce molecular regulation of development of some organs in thebook. Hope the teachers would explain them further for better understanding of the interesting aspectof embryology. It is known that many of the adult diseases have a foetal origin.
The text provides essential and relevant information to all the students. For still better and detailedlearning, some selected bibliographic references have been given for inquisitive students.
The cadaveric dissection is the ‘real/actual anatomy’. Since some of these were introduced in theseventh edition, more diagrams of dissection have been added for the undergraduate students, sothey will not miss carrying out the dissections (due to lack of cadavers).
For testing the knowledge acquired after understanding the topic, Viva Voce questions have beenadded. These would prove useful in theory, practical, viva voce and grand viva voce examinations.Since so much has been added to these holistic volumes, the size would surely increase, though makingthe text as compatible with the modern literature as is possible. Most of it is visual and anatomy as abasic component of medicine remains a subject of practical exploration.
We have satisfactorily modified text to suit requirements of horizontal and vertical integrations ofanatomy with other preclinical, paraclinical and clinical subjects as per BoG NMC (erstwhile MCI)guidelines.
Happy Reading.
Krishna GargChief Editor
email: [email protected]
Preface to the Eighth Edition
The necessity of having a simple, systematized and complete book on anatomy has long been felt.The urgency for such a book has become all the more acute due to the shorter time now available
for teaching anatomy, and also to the falling standards of English language in the majority of ourstudents in India. The national symposium on ‘Anatomy in Medical Education’ held at Delhi in 1978was a call to change the existing system of teaching the unnecessary minute details to theundergraduate students.
This attempt has been made with an object to meet the requirements of a common medicalstudent. The text has been arranged in small classified parts to make it easier for the students toremember and recall it at will. It is adequately illustrated with simple line diagrams which can bereproduced without any difficulty, and which also help in understanding and memorizing theanatomical facts that appear to defy memory of a common student. The monotony of describingthe individual muscles separately, one after the other, has been minimised by writing them out intabular form, which makes the subject interesting for a lasting memory. The relevant radiological andsurface anatomy have been treated in separate chapters. A sincere attempt has been made todeal, wherever required, the clinical applications of the subject. The entire approach is such as toattract and inspire the students for a deeper dive in the subject of anatomy.
The book has been intentionally split in three parts for convenience of handling. This also makes aprovision for those who cannot afford to have the whole book at a time.
It is quite possible that there are errors of omission and commission in this mostly single-handedattempt. I would be grateful to the readers for their suggestions to improve the book from all angles.
I am very grateful to my teachers and the authors of numerous publications, whose knowledge hasbeen freely utilised in the preparation of this book. I am equally grateful to my professor and colleaguesfor their encouragement and valuable help. My special thanks are due to my students who mademe feel their difficulties, which was a great incentive for writing this book. I have derived maximuminspiration from Prof. Inderbir Singh (Rohtak), and learned the decency of work from Shri SC Gupta(Jiwaji University, Gwalior).
I am deeply indebted to Shri KM Singhal (National Book House, Gwalior) and Mr SK Jain (CBSPublishers & Distributors, Delhi), who have taken unusual pains to get the book printed in its presentform. For giving it the desired get-up, Mr VK Jain and Raj Kamal Electric Press are gratefullyacknowledged. The cover page was designed by Mr Vasant Paranjpe, the artist and photographerof our college; my sincere thanks are due to him. I acknowledge with affection the domestic assistanceof Munne Miyan and the untiring company of my Rani, particularly during the odd hours of this work.
BD Chaurasia
Preface to the First Edition (Excerpts)
Acknowledgements
Foremost acknowledgement is the extreme gratefulness to almighty for ‘All Time Guidance’ during the preparation of the Eighth edition. All the editors are sincerely obliged to Dr BG Sawant, Dr NA
Faruqi, Dr Gayatri Rath, Dr Ritesh Shah, Dr SN Kazi, Dr N Vasudeva, Dr Sabita Mishra, Dr Mangla Kohli,Dr Satyam Khare, Dr Nisha Kaul, Dr Azmi Mohsin, Dr Medha Joshi and Dr Surbhi Garg for making thisedition noteworthy.
The suggestions provided by Dr DC Naik, Dr Ved Prakash, Dr Mohini Kaul, Dr Indira Bahl, Dr SH Singh,Dr Rewa Choudhary, Dr Shipra Paul, Dr Anita Tuli, Dr Shashi Raheja, Dr Sneh Aggarwal, Dr RK Suri,Dr Vadana Mehta, Dr Veena Bharihoke, Dr Mahindra Nagar, Dr Renu Chauhan, Dr Sunita Kalra, Dr RKAshoka, Dr Vivek Parashar, Mr Buddhadev Ghosh, Mr Kaushik Saha, Dr Dinesh Kumar, Dr AK Garg,Dr Archana Sharma, Dr Shipli Jain, Dr Poonam Kharab, Dr Mahindra K Anand, Dr Daisy Sahni, Dr KiranVasudeva, Dr Rashmi Bhardwaj, Dr Arqam Miraj, Dr Joseph, Dr Harsh Piumal, Dr Yogesh Sontakke, HABuch, Umang Sharma, Dr Nikha Bhardwaj and many friends and colleagues are gratefullyacknowledged. They have been providing help and guidance to sustain the responsibility of upkeepingthe standard of these volumes.
Videos of bones and soft parts of human body prepared at Kathmandu University School of MedicalSciences were added in the CDs along with the Frequently Asked Questions. I am grateful to Dr R Koju,CEO of KUSMS and Dhulikhel Hospital, for his generosity. This material is now available at our mobileApp CBSiCentral.
The moral support of the family members is appreciated. The members are Dr DP Garg, Mr SatyaPrakash Gupta, Mr Ramesh Gupta, Dr Suvira Gupta, Dr JP Gupta, Mr Manoj, Ms Rekha, Master Shikhar,Mr Sanjay, Mrs Meenakshi, Kriti, Kanika, Dr Manish, Dr Shilpa, Meera and Raghav. Dr Shilpa Mittal andDr Sushant Rit, Mr Rishabh Malhotra have been encouraging and inspiring us in the preparation of thevolumes.
The magnanimity shown by Mr SK Jain (Chairman) and Mr Varun Jain (Director), CBS Publishers &Distributors Pvt Ltd, has been ideal and always forthcoming.
The unquestionable support of Mr YN Arjuna (Senior Vice President—Publishing, Editorial and Publicity) and his entireteam comprising Ms Ritu Chawla (GM—Production), Mr Sanjay Chauhan (graphic artist) with his untiringefforts on drawings, Ms Jyoti Kaur (DTP operator), for excellent formatting, Mr Surendra Jha (copyeditor),Mr Neeraj Sharma (copyeditor) and Ms Meena Bhaskar (typing) have done excellent work to bring outthe eighth edition. I am really obliged to all of them.
Krishna GargChief Editor
Handle me with little love and careAs I had missed it in my life affair
Was too poor for cremation or burialThat is why am lying in dissection hall
You dissect me, cut me, section meBut your learning anatomy should be precise
Worry not, you would not be taken to courtAs I am happy to be with the bright lot
Couldn't dream of a fridge for cold waterNow my body parts are kept in refrigeratorYoung students sit around me with friends
A few dissect, rest talk, about food, family and moviesHow I enjoy the dissection periods
Don't you? Unless you are interrogated by a teacher
When my parts are buried post-dissectionBones are taken out for the skeleton
Skeleton is the crown glory of the museumNow I am being looked up by great enthusiasm
If not as skeletons as loose bonesI am in their bags and in their hostel rooms
At times, I am on their beds as wellOh, what a promotion to heaven from hell
I won't leave you, even if you pass anatomyWould follow you in forensic medicine and pathology
Would be with you even in clinical teachingMedicine line is one where dead teach the living
One humble request I'd makeBe sympathetic to persons with disease
Don't panic, you'll have enough moneyAnd I bet, you'd be singularly happy
Thus spoke the cadaver
Preface to the Eighth Edition viiPreface to the First Edition (excerpts) viii
Section 1 UPPER LIMB
Clinical Anatomy 33Sesamoid Bones 33Mnemonics 33Facts to Remember 33Clinicoanatomical Problem 33Further Reading 34Frequently Asked Questions 34Multiple Choice Questions 34Viva Voce 34, 35
3. Pectoral Region 36
Introduction 36Surface Landmarks 36Dissection 37Superficial Fascia 37Breast 38Lymphatic Drainage 41Clinical Anatomy 43Deep Fascia 45Muscles of the Pectoral Region 45Serratus Anterior 48Dissection 49Mnemonics 49Facts to Remember 49Clinicoanatomical Problem 49Further Reading 49Frequently Asked Questions 50Multiple Choice Questions 50Viva Voce 50
4. Axilla 51
Introduction 51Dissection 51Boundaries 51Contents of Axilla 53
1. Introduction 3
Parts of the Upper Limb 3Evolution of Upper Limbs 4Study of Anatomy 5Frequently Asked Questions 5
2. Bones 6Introduction 6Clavicle 6Ossification 8Clinical Anatomy 8Scapula 8Ossification 12Clinical Anatomy 13Humerus 13Ossification 16Clinical Anatomy 17Radius 18Ossification 21Clinical Anatomy 21Ulna 22Ossification 23Clinical Anatomy 23Ossification of Humerus, Radius and Ulna 24Importance of Capsular Attachments and
Epiphyseal Lines 24Clinical Anatomy 25Carpal Bones 25Ossification 27Clinical Anatomy 27Metacarpal Bones 27Ossification 31Clinical Anatomy 31Phalanges 32Ossification 32
Contents
xii HUMAN ANATOMY—UPPER LIMB AND THORAX
Clinical Anatomy 54Axillary Artery 54Relations of Axillary Artery 54Clinical Anatomy 58Axillary Vein 58Axillary Lymph Nodes 58Clinical Anatomy 59Spinal Nerve 59Brachial Plexus 59Dissection 62Clinical Anatomy 62Mnemonics 63Facts to Remember 64Clinicoanatomical Problem 64Further Reading 64Frequently Asked Questions 65Multiple Choice Questions 65Viva Voce 65
5. Back 66
Introduction 66Surface Landmarks 66Skin and Fasciae of the Back 67Dissection 67Muscles Connecting the Upper Limb with the
Vertebral Column 68Dissection 68Additional Features of Muscles of the Back 70Trapezius 70Latissimus Dorsi 70Dissection 71Facts to Remember 71Clinicoanatomical Problem 71Further Reading 72Frequently Asked Questions 72Multiple Choice Questions 72Viva Voce 72
6. Scapular Region 73
Introduction 73Surface Landmarks 73Muscles of the Scapular Region 73Deltoid 73Dissection 76Clinical Anatomy 77Rotator Cuff 78Intermuscular Spaces 78Dissection 79Axillary or Circumflex Nerve 79Anastomoses Around Scapula 80Clinical Anatomy 81Mnemonics 81Facts to Remember 81Clinicoanatomical Problem 81
Further Reading 81Frequently Asked Questions 82Multiple Choice Questions 82Viva Voce 82
7. Cutaneous Nerves, Superficial Veins andLymphatic Drainage 83
Introduction 83Cutaneous Nerves 83Dissection 85Dermatomes 86Clinical Anatomy 87Superficial Veins 88Individual Veins 88Clinical Anatomy 89Lymph Nodes and Lymphatic Drainage 90Clinical Anatomy 91Facts to Remember 92Clinicoanatomical Problems 92Further Reading 92Frequently Asked Questions 93Multiple Choice Questions 93Viva Voce 93
8. Arm 94
Introduction 94Surface Landmarks 94Compartments of the Arm 95Anterior Compartment 95Muscles 95Nerves 95Musculocutaneous Nerve 95Median Nerve 99Ulnar Nerve 99Radial Nerve 99Dissection 99Clinical Anatomy 99Brachial Artery 100Dissection 101Clinical Anatomy 102Changes at the Level of Insertion of
Coracobrachialis 102Cubital Fossa 103Dissection 105Clinical Anatomy 105Posterior Compartment 105Triceps Brachii Muscle 106Dissection 107Clinical Anatomy 107Radial Nerve or Musculospiral Nerve 107Clinical Anatomy 109Profunda Brachii Artery 110Mnemonics 110Facts to Remember 110
xiiiCONTENTS
Clinicoanatomical Problem 110Further Reading 110Frequently Asked Questions 111Multiple Choice Questions 111Viva Voce 111, 112
9. Forearm and Hand 113Introduction 113Surface Landmarks of Front of Forearm 113Muscles of Front of Forearm 114Superficial Muscles 116Deep Muscles 116Dissection 119Arteries of Front of Forearm 119Radial Artery 119Ulnar Artery 120Dissection 121Nerves of Front of Forearm 121Median Nerve 122Ulnar Nerve 122Radial Nerve 123Dissection 123Palmar Aspect of Wrist and Hand 124Dissection 124Flexor Retinaculum 124Clinical Anatomy 126Intrinsic Muscles of the Hand 127Testing of Some Intrinsic Muscles 127Dissection 133Arteries of Hand 133Ulnar Artery 133Clinical Anatomy 134Radial Artery 134Dissection 135Nerves of Hand 136Ulnar Nerve 136Clinical Anatomy 137Median Nerve 138Clinical Anatomy 138Fascial Spaces of Hand 141Clinical Anatomy 143Back of Forearm and Hand 143Surface Landmarks 143Dorsum of Hand 143Anatomical Snuffbox 144Extensor Retinaculum 145Dissection 146Muscles of Back of Forearm 146Superficial Muscles 146Deep Muscles 147Dorsal Digital Expansion/Extensor Expansion 147Dissection 149Posterior Interosseous Nerve 149Dissection 150Posterior Interosseous Artery 150Arches of Hand 151
Mnemonics 151Facts to Remember 152Clinicoanatomical Problems 152Further Reading 153Frequently Asked Questions 153Multiple Choice Questions 153Viva Voce 154
10. Joints of Upper Limb 155
Introduction 155Shoulder Girdle 155Sternoclavicular Joint 155Dissection 156Acromioclavicular Joint 156Movements of Shoulder Girdle 156Dissection 158Shoulder Joint 158Movements of Shoulder Joint 160Dissection 161Clinical Anatomy 162Elbow Joint 164Dancing Shoulder 164Carrying Angle 166Dissection 166Clinical Anatomy 166Radioulnar Joints 168Interosseous Membrane 168Middle Radioulnar Joint 169Supination and Pronation 169Dissection 170Clinical Anatomy 170Wrist (Radiocarpal) Joint 170Dissection 173Clinical Anatomy 173Joints of Hand 174Intercarpal, Carpometacarpal and
Intermetacarpal Joints 174First Carpometacarpal Joint 174Dissection 175Clinical Anatomy 175Metacarpophalangeal Joint 175Interphalangeal Joints 175Mnemonics 177Facts to Remember 177Clinicoanatomical Problem 177Further Reading 177Frequently Asked Questions 178Multiple Choice Questions 178Viva Voce 179
11. Surface Marking, Radiological Anatomyand Comparison of Upper and LowerLimbs 180
Introduction 180Surface Marking 180
xiv HUMAN ANATOMY—UPPER LIMB AND THORAX
Axillary or Circumflex Nerve 191Radial Nerve 192Median Nerve 194Ulnar Nerve 194Clinical Anatomy 196Arteries of Upper Limb 198Sympathetic Innervation 200Embryology of the Upper Limb 200Molecular Regulation of Limb Development 200Clinical Terms 200Further Reading 202Frequently Asked Questions 202Multiple Choice Questions 202Spots on Upper Limb 205Answers 206
Arteries 180Nerves 182Joints 184Retinacula 184Synovial Sheaths of the Flexor Tendons 185Radiological Anatomy of Upper Limb 185Comparison of Upper and Lower Limbs 188Further Reading 190Frequently Asked Questions 190
Appendix 1: Nerves, Arteries andClinical Terms 191
Introduction 191Musculocutaneous Nerve 191
Section 2 THORAX
12. Introduction 209
Surface Landmarks of Thorax 209Skeleton of Thorax 210Formation 210Clinical Anatomy 212Shape 212Clinical Anatomy 212Superior Aperture/Inlet of Thorax 213Clinical Anatomy 215Inferior Aperture/Outlet of Thorax 215Facts to Remember 217Clinicoanatomical Problem 217Further Reading 217Frequently Asked Questions 217Multiple Choice Questions 217Viva Voce 218
13. Bones and Joints of Thorax 219
Introduction 219Bones of Thorax 219Ribs or Costae 219Ossification of a Typical Rib 221Ossification 222Ossification 223Costal Cartilages 223Clinical Anatomy 224Sternum 224Development and Ossification 226Clinical Anatomy 226Vertebral Column 227Ossification 231Clinical Anatomy 231
Joints of Thorax 232Respiratory Movements 234Clinical Anatomy 236Mnemonics 237Facts to Remember 237Clinicoanatomical Problem 238Further Reading 238Frequently Asked Questions 238Multiple Choice Questions 238Viva Voce 239
14. Walls of Thorax 240
Introduction 240Thoracic Wall Proper 240Intercostal Muscles 240Intercostal Nerves 242Dissection 242Clinical Anatomy 244Typical Intercostal Spaces 245Intercostal Arteries 245Intercostal Veins 247Lymphatics of an Intercostal Sapce 248Internal Thoracic Artery 248Azygos Vein 249Hemiazygos Vein 250Accessory Hemiazygos Vein 250Thoracic Sympathetic Trunk 250Clinical Anatomy 251Facts to Remember 253Clinicoanatomical Problem 253Further Reading 253Frequently Asked Questions 253Multiple Choice Questions 254Viva Voce 254
xvCONTENTS
15. Thoracic Cavity and Pleurae 255
Thoracic Cavity 255Dissection 255Pleura 257Nerve Supply of the Pleura 260Clinical Anatomy 261Mnemonics 262Facts to Remember 262Clinicoanatomical Problem 262Further Reading 262Frequently Asked Questions 263Multiple Choice Questions 263Viva Voce 263
16. Lungs 264
Introduction 264Dissection 264Fissures and Lobes of the Lungs 265Root of the Lung 267Bronchial Tree 269Dissection 269Development of Respiratory System 272Molecular Regulation 272Histology 273Clinical Anatomy 274Mnemonics 275Facts to Remember 275Clinicoanatomical Problems 276Further Reading 276Frequently Asked Questions 276Multiple Choice Questions 277Viva Voce 277
17. Mediastinum 278
Introduction 278Superior and Inferior Mediastina 278Dissection 278Superior Mediastinum 278Inferior Mediastinum 279Anterior Mediastinum 279Middle Mediastinum 279Posterior Mediastinum 280Clinical Anatomy 280Mnemomics 281Facts to Remember 281Clinicoanatomical Problem 281Frequently Asked Questions 282Multiple Choice Questions 282Viva Voce 282
18. Pericardium and Heart 283
Introduction 283Pericardium 283
Fibrous Pericardium 284Serous Pericardium 284Dissection 285Clinical Anatomy 285Heart 286External Features 286Clinical Anatomy 286Right Atrium 288Dissection 288Right Ventricle 290Dissection 292Left Atrium 292Dissection 293Left Ventricle 293Dissection 294Clinical Anatomy 294Structure of Heart 294Valves 294Clinical Anatomy 295Fibrous Skeleton 296Musculature of the Heart 296Conducting System 297Clinical Anatomy 298Right Coronary Artery 298Dissection 299Left Coronary Artery 299Dissection 300Cardiac Dominance 300Clinical Anatomy 301Veins of the Heart 301Nerve Supply of Heart 302Clinical Anatomy 303Developmental Components 303Molecular Regulation of Cardiac
Development 304Foetal Circulation 304Mnemonics 307Facts to Remember 307Clinicoanatomical Problems 307Further Reading 308Frequently Asked Questions 308Multiple Choice Questions 308Viva Voce 309
19. Superior Vena Cava, Aorta and PulmonaryTrunk 310
Introduction 310Dissection 310Superior Vena Cava 310Clinical Anatomy 311Aorta 311Ascending Aorta 312Arch of Aorta 312Descending Thoracic Aorta 314Clinical Anatomy 316
xvi HUMAN ANATOMY—UPPER LIMB AND THORAX
Pulmonary Trunk 317Development of Arteries 317Development of Superior Vena Cava 318Mnemonics 318Facts to Remember 319Clinicoanatomical Problem 319Frequently Asked Questions 320Multiple Choice Questions 320Viva Voce 320
20. Trachea, Oesophagus and 321Thoracic Duct
Introduction 321Trachea 321Histology of Trachea 322Clinical Anatomy 323Oesophagus 323Dissection 323Histology of Oesophagus 325Clinical Anatomy 326Thoracic Duct 327Facts to Remember 328Clinicoanatomical Problem 328Further Reading 328Frequently Asked Questions 329Multiple Choice Questions 329Viva Voce 329
21. Surface Marking and RadiologicalAnatomy of Thorax 330
Introduction 330Surface Marking 330
Parietal Pleura 330Surface Marking of Lungs 331Borders of the Heart 332Arteries 333Veins 334Trachea 335Right Bronchus 335Left Bronchus 335Oesophagus 335Thoracic Duct 335Radiological Anatomy 335Numericals 337Further Reading 337
Appendix 2: Autonomic Nervous System,Arteries, Nerves and Clinical Terms 338
Introduction 338Autonomic Nervous System 338Sympathetic Nervous System 338Thoracic Part of Sympathetic Trunk 339Nerve Supply of Heart 340Nerve Supply of Lungs 340Typical Intercostal Nerve 341Atypical Intercostal Nerves 341Arteries of Thorax 341Clinical Terms 341Frequently Asked Questions 344Multiple Choice Questions 345Spots on Thorax 347Answers 348
Index 349
xviiCURRICULUM
Ethical Aspects of Cadaveric Dissection
The cadaver, the dead body, that we dissect, plays an important role in the teaching of anatomy to medicalstudents. The cadaver and the bones become an important part of our life as medical students as some
academics have even referred to the cadaver as the ‘first teacher’ in the medical school.
We must pay due respect to the cadavers and bones kept in the dissection hall or museum. In somemedical schools it is mandatory to take an ‘oath’ before beginning the cadaveric dissection which aims touphold the dignity of the mortal remains of the departed soul while other medical schools help the student toundertake dissection in a proper manner and empathise with the families of the donor. During the course ofdissection the student is constantly reminded of the sanctity of the body he/she is studying so that the nobledonation of someone's body is used only as a means of gaining scientific knowledge/progress. Each and everydissected part afterwards is disposed or cremated with full dignity.
Honour of the donor and his/her family is the prime responsibility of the health professional. ‘The dead teachthe living’, and the living pledge to use this knowledge for the upliftment of humankind.
Three-dimensional models and computer simulations cannot replace the tactile appreciation achievedby cadaveric dissection and we should always be grateful to those who have donated their bodies and striveto respect them. We have the privilege to study the human being through a body of a fellow human and haveto be humble and carry forward the legacy of nobility and selflessness in our careers.
(Contributed by Dr Puneet Kaur)
