[inaudible] [inaudible] at this point, it's time to incise the the peritoneum itself.
It's the visceral layer over the liver, the skin of the liver here.
Now I don't see the greater, I'll lift them straight off, although I do see some yellow fuzzy stuff up here. Now the greater I met him has a moto properties. The greater omentum can move. It's a traveling Oregon. It's comprised of four layers of this type of peritoneal sheeting, four layers of it that's embedded with fat rather, and then it's receiving, it's four layers, two from the stomach and two from the transverse colon, right? The skin of the stomach and the skin of the transverse colon, front and back.
Either one contributes to four shh layers to the greater omentum, and then the greater omentum hangs off of those organs and drapes over here like a blankie, but I don't see it. Maybe it's snuggling somewhere. Okay. Maybe it's snuggling somewhere. That's my first suspicion. You see because when a person is sick, the greater omentum that like a blanket, the greater omentum can flip up and cover the liver. The gray or omentum can gather around a six stomach or draw itself against the peritoneum. If it's peritonitis or there's been a surgical injury scar, a opening wound and that then it's closed up and there's a one there and the greater omentum will cling to that long and protect it.
It's quite amazing that way. It's like your own internal snuggle blanket and over here I see the kind of tissue that normally represents to me. The Greater Omentum, the man is very trim. It's often not uncommon to see a lot of fatty tissue inside of abdomen. We don't see that with Mr. Got pads we noticed in his superficial Fascia was extremely thin too, but I look at this yellow tissue here.
I see the transverse colon and the stomach here
You're saying it can even see a little bit of air. It's a hollow organ. Here we see this intensely green little bag here. That's the tail of our gallbladder. So we're looking at surface projections here we see our liver, right, left lobe of the liver, and then we see a more pale tissue here so that, and it's collapsed on south. Not if I lift it up. It's a tough, meaty. It's uh, it's uh, it's like a leather bag.
This thing that's the stomach or it's not the whole stomach is just a surface projection of the stomach. And so I log in with standing in front of the mirror, right? And we're seeing Oregon's. So what is it doesn't mean that's the whole stomach is huge. It's gone clear to the back. So surface projection and esophagus runs along the spine. So the stomach runs deep, but in front, that presents this little bubble.
We saw our omentum here. Let me see this great green band going across the front here. So transverse colon all through here we see small intestines, small intestines down here coming around. Abandon the ASI s the Anterior Superior Iliac spine on the left side. On the right side we have the seek them. On the left side we have the sigma, my colon taken an s an s curve around a bend here down into the rectum, more small intestine, more small intestine.
All these loops are the small intestine that you are handling when you're lifting the bag. Alan's intestines in your hand.
Reviewing the fibrous and cirrus layers of the abdominal Fascia. We've carefully studied the Trans or Sal's Fascia, the parietal peritoneum, and finally the visceral peritoneum.
And it's possible to sort of tease that away in a not entering a fibrous pericardium. When I do so. In fact, I can rub this stuff off of my hands. Oftentimes there's quite a bit of fatty deposition around a heart. It's very common. The fatty deposition is covered by, by Pleura here. All right, the mania Steinle Pleura. This is stuff in the middle, so it was covered by the mania Steinle Pleura. So even though we're seeing the this shape coming out here, as I scratch away this fatty tissue and we see these little beautiful blood vessels here, those are the blood vessels of the, of the fibers, pericardium as opposed to the blood vessels of the heart itself.
The blood vessels of the heart itself are larger. So I'm just scratching away here with my fingertips and I'm rubbing back the these loose, loose area or Fascia. I'm going to keep on rubbing away these loose areas, this loose area or tissue here to get a sense of where I am when I do. So now I'm on the other side and again I'm, I'm rubbing on peeling up. Basically I'm peeling up as I rub away as fat on peeling up the media Steinle plur on the far side of the body here from, from where you all are viewing.
And I put my pool, it's covering the fibers, pericardium. So the sac of the heart, the fiber sack of the heart, right is just has this loose fatty tissue over it. Here's the fiber sac of the heart. Your heart is very large. In this instance, he has what I would call an enlarged heart. Okay. Cause here's our sternum here and pretty much anything that you get past this edge of the sternum ending on this side is an indication of enlargement of the heart to heart cheerios or in terms of no more normal, uh, uh, presentation. The heart, pretty much Peters out at the, at the lateral right-side border of the body of the sternum.
But in his case he got another inch of heart over here. So I'm just acknowledging the fact that there's a little bit of an enlargement here. And I'm expecting to other kinds of heart pathology here because I saw the open heart surgery. So I know for a fact that people have been here before and that they done some serious work. So I'm just peeling away this loose Fascia.
Well that's exciting. So right along here I'm finding more, more glandular tissue of the thymus.
The thymus is the place where the t-cells mature. So t-cells, there are immune cells in your blood system and and the t cells are how you recognize yourself. So I've, I've, I've heard it said that the thymus is the place where you learn to recognize yourself in a sense. It's a place of self identity for the child that is, it's learns to recognize a d it's a place where cells learn to recognize the difference between Whoo, who I am, my body and the community of cells that represent my body and those things that are outside of my body, which will be rejected and scavenged and scared out of the blood. All right, so it part of the immune system, the Thymus,
At this point, I'm even lifting it of the lung. It's coming off as the skin of the long hair, so I can just brush my finger through here and I'm actually peeling the skin of the lung back. Now when I do sell and I'm pulling away the Pleura like I am here, what I've actually done is gone and exposed the phrenic nerve, which I can see the phrenic nerve is here, and two, running along the media Steinem. Man, if I grabbed my, my, my hemostat here, I can actually just lift it up. I can scratch along that line. And before you know it, I'll have my, see my friend nick nerve. That's the nerve that's gone to the diaphragm and it just runs along the media Steinem there deep to the Pleura.
So the Pleura covers it and it runs along the stuff in the middle. It's one of those stuff in the middle. Features man scratching and scratching. I can see somehow I cut it up above, but I still have a coming down here. I must have cut it up above when I was opening the chest wall there. I saw. All right. I can follow it on down just like I did on this side.
I have my phrenic nerve on my right side and over here, uh, intact. Still have the phrenic nerve on the left side. He has it enters into the diaphragm, so it's running along the media Steinem on both sides and it's innervating the diaphragm. So good. We've seen our phrenic nerves are thalamic tissue. We've gotten a sense of the parietal and the visceral pleura. Media Steinem just means that which stands in the middle.
So many times you have, if you hear some, I've heard people argue about it, all the media is telling them and they think it's a particular tissue, like, oh, that's the media Steinem. Well, not the I this, and that's an idiot Steinem. That's not a media Steinem, although it's in the middle. It is stuff in the middle, but it's not the media. Stein, I'm the media Steinem is everything that's in the middle. It is not the lungs, it's the media Steinem. So the media Steinem includes the heart, right? The heart muscle and the, and the aorta. Then all our branches coming off of it and the esophagus and the, and the main Bronchi and the, and the thoracic duct.
And anything that's lying in between the Pura on either side is the stuff in the middle of the media Steinem. So there are a whole number of what we will call media style structures and learning about them as part of the thrill of thoracic anatomy. And so we have a fibrous pericardium. Pericardium means around the heart, so we have a fibers bag around the heart. The heart itself has its skin, right? So that's the visceral pericardium. And then adhered the back of the fibrous pericardium. Just like the Pleura was that here to the end of the thoracic fashion, right though the parietal layer was adhere to the fibrous layer in the pericardium. Also the parietal layer, the wall layer of the pericardium is adhered on the inside to this fibrous outer cover.
Now I read about these three bags in the books and I didn't get it at all. I'd scratch around here and I'd make a hole and I think I had scratched off the fatty tissue or something. And then I'd have the heart here and I wouldn't see a bag around it and I wouldn't see a skin on a heart that I could understand. And I was like, well, I don't know what they're talking about. But then I slowly came to realize that the fibrous pericardium here, which has already been gone into by the surgeons and there's staples all over it, staples, staples, staples, staples, and stapled it back up together. Okay. So if I, I can penetrate the fibrous pericardium. See it. It's a bag. It has a sound to it.
It sounds like a tough fasha actually. So if I just lifted and cut it, I'm opening the fibers, pericardium to come to this precious heart space. So I, I get inside of here and I'm feeling also now adhesions. Okay. Cause there are adhesions of the fibrous pericardium to the heart in this example. So I'll go up and down openness. This, this space with my scalpel.
I'll scratch along these adhesions. Right? This is not a sliding surface I'm encountering, right? The, the visceral, the visceral pericardium is adhered to the parietal pericardium so that I have to peel it away. Okay. So that's not the normal manner because this is going to limit of the movement of the heart within its sack and will ultimately have a repercussion. So I'm also on countering these many staples here. So there's a bunch of staples. Uh, there's stapling the layers together somehow here. So this scar is scarring and stapling.
And then if I come here, I can continue to push this adhered tissue away and try to open open this heart.
You see I can slip in there easier. This is a sliding surface down deep below. But on, on these other portions, I'm having adhesions and very many adhesions of the fibers parasol I'm pulling now I'm pulling down the fibers, pericardium, and I'm revealing the visceral pericardium and skin of the heart. So if I flipped the fibrous pericardium over, then I'm looking here at the cirrus membrane, the Sirus layer. So can you see the different sexually? There's a line here where I've cut it. Okay. So this shiny sheen here, that's the parietal pericardium. It is adhered to the fibrous pericardium.
So I saw from the outside, the fibrous pericardium and I opened it up and I see already, no, I didn't cut that. Someone else cut that. So you, so that's actually a line from the where the or the, uh, where the, uh, parietal pericardium was cut in the surgery and then the was put back together here. So we have a little missing patch even. And then of course we are having scar tissue here, right? So this is, this is what happens. We've, we've saved a life perhaps in games some years, but we've lost some movement, uh, which ultimately has its ramifications that we can discuss. So now I'm pushing back to layers, the fibrous layer and the parietal layer in order to expose the visceral layer here. So you can see my fingers sliding along here. What I'm doing is I'm breaking down the adhesions of the visceral pericardium on the inner surface of this fabric to the, I'm sorry, the parietal pericardium on the inner surface of this fabric to the visceral pericardium, which is the skin apart. So I'm going to cut across here, cutting across the fibrous pericardium at this point so I can continue to open the bag of the heart space and reveal what is within it.
I have to always acknowledge whenever I come across challenging surgical work, you know, I feel like I'm going where someone has gone before except they were doing while the person is alive. So it's, it's a tremendous skill that's involved. Now I'm sliding, uh, again s s freeing the heart from ITSAC here
We had anticipated this continuity earlier with our model. The shiny surface of the parietal pericardium freed of its adhesions now presents the normal sliding surface which we had hoped for in the healthy relation of that layer with the surface of the heart, the visceral pericardium. The heart space is a dance space and we should facilitate and support the freedom of our hearts dynamic and versatile movements whenever possible. The heart musculature wrapped in its visceral pericardium occupies the center of this image as well as a vital center of our living bloods, a journey through our body. The continuity of the heart itself with its prolongation in the form of the great vessels branching throughout our body is complete.
The whole heart as I prefer to envision it has arms and legs and head and Viscera. It extends itself perfectly through the entire form and there is no place where one can say the heart is not present from a conventional anatomical perspective. Of course we could pass our scalpel through the great vessels and essentially amputate the heart, but as an exercise in the study of integral anatomy, I choose to emphasize its continuity's. Now the visceral pericardium, the skin of the heart is very thin like the other visceral layers we've encountered so far. By slowly scratching it away a little at a time along with the loose area or fatty tissue that smooths the contours of the Oregon.
The process of dissection eventually reveals the actual cardiac muscle fibers and vasculature as well as in this case the additional bypass vessels will save a detailed tour of the many beautiful structures which are merge here for another volume in the series. Suffice it to say for now that the heart is a center of life and movement and deep feeling and I am honored and humbled by the opportunity to experience and learn from the heart of another.
In the case of the central nervous system, we have a bony casing. The skull here, and adherent to its inner surface is a fibrous, a fibrous layer called the Dura Mater, the tough mother. Now that fibers layer serves as the, the periosteum of the inner lining of the skull and vertebral column in the same way that the endo thoracic fascia creates an inner lining, uh, and, and a periosteum for that, the inner surface of the rib cage immediately deep to the Dura and adhering to it is the Arachnoid, the spider like layer a thin membranous layer, which has as its analog and the other visceral spaces, the parietal layers, whether they'd be the, the parietal Pleura, the parietal pericardium, parietal peritoneum, um, the arachnoid serves as that wall layer, a parietal layer adhering to the outermost fibrous layer, uh, in the cranial space, in the vertebral column. And then just as in the case of those other visceral spaces, deep to that parietal layer. In the case of the cranium and vertebral column in the central nervous system, we have a fluid layer intervening between the, the two inner membranous layers, the skin of the organ and that parietal layer.
So in this case, instead of a cirrus fluid, we call it the cerebro spinal fluid. It's a very watery fluid with only a minor component of proteins, et cetera. Nonetheless, it reiterates the pattern that we saw in the other visceral spaces. We have this membrane here with a fluid layer deep to it. We'll let this, these white pockets represent the fluid layer.
A because of the convolutions of the shape of the brain, the Pia, the PIA mater, or the skin of the brain or the skin of the spinal cord follows all of these convolutions of the shape of the organ. And in the consequence, um, intervening space between the arachnoid and the Pia, we have and find circulating cerebral spinal fluid. Now, this wouldn't be a completely blank space in reality. On the, in our model there are very many little microscopic Tribeca lie that relate the tissues of the PIA to the tissue of the arachnoid. But for the sake of our model, we let it look like a space where fluid, uh, can circulate.
So for the cranium, I've cut the bone off camera on several different cadaver models and with some effort separated the bone from its own inner lining, leaving that fibrous periosteal layer, the dura mater intact. We can see here that the bones are knit closely together in the skull, the joints of which are very difficult to disarticulate. We call these joints sutures and they very much represent a stitching together of the bones. I cut the skull in a circular way, but this doesn't follow any anatomical contour except the beautiful egg shape of the skull and general. The sutures are the cranial bones fuse over time and the degree of fusion is an indicator of age. I've had craniosacral therapists in my class almost expecting the cranial bones still fall apart based on their felt perception of movement of the cranial bones of their clients.
The heightened perception of a sensitive hand is capable of acting as an amplifier for motions whose actual range is very limited. The inherent active contractility of myofibroblasts and the Dura Mater may also transmit sensation as well as general tensions through the Living Bony Matrix. Finally, therapists can also perceive with their touch rhythmic energetic phenomenon which are surely under described in conventional literature. The river in paths which we see on the inner boney surface are the impressions of the blood vessels of the Dura. Mater, the bony tissue is deposited and formed in the fabric of this periostial membrane and its textural features are consequently mirrored in the skull. Different tissue qualities from one form to another.
Enable us to highlight one aspect or another of the nature of the form here. The vessels which pattern the door are easy to see. In the case of the form here, which I refer to as Mr I got bay, the incredible sheen of the tissue is evident while the vasculature is invisible. A particular feature of the Dura Mater is that it is actually a double layer. The surface we see exposed here from which the bone has been removed is called the periosteal layer and its deep surface is called the meningeal layer.
The periosteal layer adheres to the cranial bones and the men in Geo layer adheres to the arachnoid deep to it. We don't see the arachnoid immediately though because the two duro layers come together in such a way that number of special channels called sinuses are formed between them. The sinuses function as veins for the brain. They're aligned with the very same lining as the veins elsewhere. In the body. These are also an outlet for excess cerebral spinal fluid.
Here I'm demonstrating the superior sagittal Sinus
Here we see the joining channels of the superior longitudinal or Sagittal sinus with the lateral or transverse sinuses in a female form. The tissue pulls in at the center point and this pattern leaves an impression on the bone as well. The cranial bones are constantly conforming to the membranous stresses and tensions placed upon them, whether normal or pathological. There are leaf of these distorting stresses through manual therapies can go a long way in relieving the chronic problems which can arise from distortions of the membranous. Tensions in sizing the fibrous dura mater at a place other than the sinus pathways enables us to reflect the Dura back, revealing the arachnoid layer, draping and containing the convoluted Gyri of the brain on a different form.
I've cotton folded the Dura back to reveal the arachnoid layer over the cerebrum and cerebellum. A closer look reveals the very different texture of the meningeal surface of the Dura, which is to say its underside. The side normally in contact with and adhered to the Arachnoid, the doers underside is quite smooth as compared to the periosteal surface. There is some debate in the literature over the very existence of a potential space between the Dura and the arachnoid referred to commonly as this subdural space. When differentiating the Dora from the arachnoid at the gross level, they seem to come apart quite easily when inspected at a microscopic level. Tears in the Mesothelium of either membrane indicate their intimate connection in the living.
The particular convergence of the arachnoid and the Dura at the center line also derives from the fact that a number of cerebral veins are draining into the sinus. At this point as I sever the relationship, we were able to gain our first view of the Fox Cerebri, that arching sickle shaped prolongation of the Dura Mater, which creates a fiber Septem between the hemispheres of the brain where it meets this center line, the arachnoid drapes down or on either side of the Fox covering the deeper mid line surfaces of the hemispheres, removing the right hemisphere of the cerebrum. We gain a full view of the internal prolongations of the Dura while they remain in place. The remainder of the Dura both aligns the skull and covers the cerebellum with that trans verse. Fabric known familiarly as the tint the tentorium Sarah Belly. The Fox Cerebri is a front to back extension of the Dura arking in the sagittal plane moving posteriorly, the dural membrane sweeps into our relatively transverse plane to the tent of fibrous Fascia over the cerebellum tension on any part of the fabric of the Dora transmit throughout the whole of it.
Whether those tensions are generated locally through hypertonicity of the membrane from its own inherent active contractility or even if the tension is generated by torsional forces, how to distance in the form. Many times I've witnessed the twists and rotations in the spine or hips of a cadaver form. Reiterated clearly in the cranium. An educated and healing hand can leverage those same torsions at the head or at a distance to create relief and restore balance to the whole person
This time surrounding the central nervous tissues. Looking down the body with the occipital bone of the cranium removed, we can observe the continuity of the Dura through the fromm and Magnum at the base of the skull and along the vertebral column here with the Bony Neural Arches removed at the tail end of the spinal cord. A window through the Dora has been cut the neural tube with its fibrous dural wrapping actually extends clearly all the way into the sacrum.
So all the digging in the world is never going to surpass a little bit of yoga. Okay, that's beautiful. Cool. Okay, that's awesome. And I'm going right down the spine. I'm falling all the way down. I'll lay down in the end action extension, stretching the door and as you can [inaudible]
Even in the circles I need. You do a five, six, seven, 10 times and all of a sudden [inaudible] oh on bars, exercise and you can no really want to do it globally. Yes, yes.
The web of the ARACHNOID presents itself as a veil of great beauty and complexity along with the other member and its layers. It's structure belies functions not merely mechanical, but also conductive and electromagnetic, which we can leverage for greater health. With the upper portion of the Dura removed and the Fox, sorry, re no longer obscuring the view. It is possible to follow the arachnoid down between the hemispheres of the cerebrum and follow it as it crosses from one side to the other over the Carpus Callosum, that brain tissue relating the right and left hemispheres by cross sectioning that white matter of the carpus colossal. I necessarily cut their act annoyed as well.
It is that Pia and not they are actinide which lines the ventricles interiorly. Since the arachnoid adheres to the meningeal layer of the Dura, we can trace it down the spinal column as well. At the base of the cerebellum near the foramen magnum of the skull, the arachnoid spans the hemispheres creating a larger space for cerebro spinal fluid to circulate. Yeah, pull back here. Excellent. The sound of the Dura and arachnoid being pulled apart indicates even at the gross level, their intimate relationship, the arachnoid reflecting light here as it spans over the dorsal nerve roots and spinal cord curls up and vanishes at the touch of a scalpel.
Okay. I'm going to peel away some Arac night now. Okay. And just it's, it has some integrity. Then the um, the PIA is on the spinal cord. Okay. With the DUROC cut and the diaphanous film of the arachnoid reflected the spinal cord presents the PIA mater as its surface coat. The string like white fibrous matter running along the spinal cord deep to the dorsal nerve roots are called the denticles ligaments, which are fibrous prolongations of the otherwise thin and soft p a mater is things here. These are the nerve roots. All these little babies are, they're called the dorsal nerve roots cause we're of course approaching this from the back. Now the dorsal nerve roots themselves are covered in pia mater as well, so that unlike the Dura and the Arachnoid, which Peter out, where the nerves exit, the pia continues along as a surfacing layer along the extent of the nerve, the nerve roots become longer and longer as we move down the spinal cord. Ultimately forming a horse like tail in the lumbar region, the Cauda Equina.
If you look very closely at the midline of the Cauda Equina, you can see us slender, Whitish filament and Mitch, the Brown red nerves. This extension of the PIA is known as the field them terminology. I must admit, I find the membranes and the structures at the center of the nerve tree, breathtaking here with the whole brain removed with the PA covering the cord and the arachnoid still mostly intact over the brain. We are witness to and find ourselves unwrapping a most extraordinary and extremely underestimated gift. The poorest beggar and the most honored kings and Queens stand as equals.
With respect to the untapped powers of the deliberately intending and carefully attuned human mind with the infinite potential of the brain at its service. The power inherent in this form has from my judgment, not yet been tapped steadfastly awaiting our commitment to our own creative potential. Here are the three layers have been prepared in a way that each can be reviewed. First, the double layered and fibrous Dura Mater Opaque and imprinted with its vascular branchings. Next, the Arachnoid, this transparent filmy membrane with its many large blood vessels and finally at the surface of the brain itself, the Pia Mater, the extremely thin surface covering of the brain. Also a highly vascular membrane whose most fine blood vessels actually penetrate into the brain tissue itself.
When I first started doing dissection, I was quite confused by the fashional and membranous wrappings of the this or I and particularly of the cranium. I'd confused the Arachnoid, which I'm dissecting away from the brain here with the pm because I couldn't relate to the surface of the brain is a membrane in itself. The PM Mater though technically and histologically a membrane with different cellular properties than the nerve cells, which it covers. It doesn't really give the impression of a sheet or a fabric the way the other membranes we've seen do the PIA mater is only a few cells thick. You can't really peel it away. You can push your finger through it. It's so soft without much resistance. It nonetheless functions as a membrane, as do the skins of all the other large organs of the body.
So the removal of the arachnoid along with these blood vessels is actually creating a numerable breaks in the continuous fabric of the PIA itself. The piano follows all of the convolutions of the surfaces of the central nervous tissue including of course the delicate and leaf like in foldings of the cerebellum here seen in cross section with the arachnoid still draped around its outer surface from the looping tissue of the cerebrum run. Then to the horses tail and the tapering conus med, two hours at the end of the spinal cord. The soft and gentle mother, the Pia Mater or absent and folds the whole of the nervous tissue if it's
The images are ultimately more important than the language, and to truly grasp, absorb this material, it will be worth while to view it several times over beyond even the images. Integral Anatomy is ultimately an invitation to an experience of the whole person. Bringing it to that level is a matter of introspection, shared reflection, and a commitment to self responsibility for life experience. Joy is our birthright. The breadth of life, a gift of the most profound order, and our creative potential is unlimited. There's always more to come.