I invite you to share in my gratitude for the donors and their families. As we who view this material are the direct beneficiaries of their generosity. I place no particular premium on fresh tissue dissection over dissection of embalmed tissue. There are advantages and disadvantages to both and neither can lay claim to representing perfectly the living miracle of the human form. Both our methods which grant us different kinds of access and insights.
Embalming bombing allows a slow and methodical dissection and enhances our ability to see certain tissues like the deep Fascia more clearly and embalming nicely fixes the shape of the visceral. For our observation, though the colors and the textures that generates or somewhat off fresh tissue offers some insights into the textures and colors of the body which are lost to the preservation process, but it offers a much shorter timeframe for observation and it can be even more difficult to present. With respect to the aesthetics of the images created. With these considerations in mind, I invite you to observe with me this unpreserved form of an elderly woman. The onion tree model is a functional simplification of the human body. With it, I can reference the whole mass of the Viscera considered together as a deep layer of the onion or is the branching trees as well, at least in the case of the neurovascular trunks and limbs. The skin itself is the of those visceral branches from the neurovascular trunks as they interface directly with the external environment of the body.
The superficial Fascia is a great suspensory web of perception of a particular frequency range within which the neurovascular pathways braid their way out from the core and envelop. Our whole being. Amidst the yellow finery of our sensory fleece, we can separate out tissues and layers and pathways of connection, which we hold dear to our mental conception of the body, but the models conceal the whole as much as they point to it to the extent that we sometimes come to prefer our models to the reality at hand. The fact of the whole remains, in spite of our attempts to parse the whole body into tissues or layers, the viscera are not limited in their physiological function or in their anatomically demonstrable extent to the thorax or the abdomen or the cranium. Though through the conventions of our training, we may have actually limit our ability to see them beyond their designated regions. From an integral viewpoint, the viscera are considered to be non-local phenomenon extending in both form and function through all the textural layers of the body. They are commingled with all the tissues of the body so that with all fairness we can speak of the viscera of the arm or the viscera of the leg or even the viscera of the fashion.
Surely to the extent that these tissues are innervated and vascular, the emotions of Paris style sis and the rhythmic pulsations of the heart and the cascading waves of the brain all re iterate and reverberate and enliven the whole body and are in mutual relationship with the forms and processes of the other layers. If a massage, hydrates, tissue, increases circulation and induces relaxation, it is in some direct measure because the visceral had been touched right there in the muscle tissue and Fascia of the arm or the leg or the back or the belly. Every massage therapist and body worker is doing a form of visceral work. That pulse in the wrist is the arm of the heart. When you stroke the skin, you are literally caressing someone's brain. Touch is an intimate responsibility for the professional because it is only possible to touch the whole person.
So we're working our way down through the superficial fashion of this form and encounter a texture that's quite different from the surrounding superficial fashion. We see that it's at the base of an old incision and what we're looking at is the herniation of some intra peritoneal fat bulging through the base of that incision still covered in peritoneum. As we inspect it, we can notice it's smooth and shiny textures quite different, uh, than the more well bubble wrap like consistency of the surrounding superficial Fascia. The inner form of the deep Fascia woman here is seen emerging from the adipose will. Oregon at this point only partially dissected the presenting morphology is quickly transforming. The superficial Fascia is a shaping layer as are the muscle viscera and bony layers.
And when we draw it away from the body and utterly distinct morphology presents itself to view, dissected away from the body completely in viewed independently. The common texture and substance and mass of the superficial Fascia is here appreciated as an anatomically and physiologically distinct organ in its own right. I wasn't sure when I initiated this dissection whether or not the unpreserved tissue would lend itself to this approach. In fact, it was no more or less challenging to accomplish. The integrity of the superficial Fascia is what creates the possibility of this dissection pressed by the contingencies of the unpreserved tissue. A patchwork of superficial fashional remnants over lays the deep fascia which is nearly translucent in the upper body, especially in the lower limb.
The deep Fascia is a more thickly woven web of fibers looked upon closely. The minute branchings of the heart are present at no point from the center of the chest to these tendrils feeding the deep Fascia of the leg. Do we find any interruption of the flowing continuity of the viscera as they perfuse every textural layer of the human form. When you were first introduced to the form of this elderly woman a few minutes ago, you might not have imagined that this would have been her shape at the level of deep Fascia and muscle. The primary presenting layer which shaped her form was her superficial fashion.
If you were an artist drawing the lines of this body, it would be the shape of the superficial Fascia which you would need to account for to render her accurately Marcel than the muscle. No, I have been saying that the viscera reach beyond their spaces into the layers surrounding them. The Oregon's in this particular body did not define the woman's shape as they sometimes do. Learning to tell which layer is primarily shaping someone's body is a practical undertaking. The shaping layer may offer clues about a given person's life experience when observing a person's body.
It's a fair question to ask then what layer is presenting itself to my attention when I observe this person shape? If it is the superficial Fascia, you would probably do well to attend to its particular needs as opposed to skipping past that layer because you are personal or professional experience may be to work with the muscles or the Oregon's who are the Fascia construed as distinct objects of touch. When each textural layer is given, its due. The possibility for an integrated experience of one's body is built into the approach. Having noted the new farmers primarily shaped by the superficial Fascia. We reintroduced the male form with which we're already familiar, noting that his body primarily presents the shape of his muscle layer and defined by his deep Fascia with the superficial Fascia removed from them.
Both the unembalmed form and the male example look surprisingly similar. Both have concave abdomens. Neither form present the viscera prominently as does the female form from the first volume whose viscera present clearly in her gross morphology. Her abdomen is more convex then concave with or without the superficial fashion. So among these three examples, we see one shaped particularly by the superficial Fascia, one by the muscle and one by the viscera.
When attempting to palpitate the viscera of people with different gross morphologies, it is important to note the variations which create the anatomical context for such work. Leveraging the bony layer to create tension in the deep Fascia of the abdomen, we can create vectors of pull generated by torsion and watch the translation of the movement through the scars in the anterior rectus sheath. We're not often privy to witnessing these normally hidden motions.
So as I reflect through on back to the anterior superior ILIAC spine, I reveal that deep to the external Oblique Fascia here. We immediately see the muscle tissue of it, internal oblique. But I'm going to make a big sweeping circle actually to increase our window size. So in a sense we can also say I've got the anterior rectus sheath in my hemostat right now and the tissue is, although not embalmed, uh, if I'm careful, don't hit any major vessels, it'll stay pretty clean for our, for our view. But now I'm coming into scar tissue here. You see how it doesn't want to yield to my scalpel anymore, how smooth and easy the tissue is differentiated here.
And then I come up to there and all of a sudden can hear it scratchy and there's a network of collagenous fibers that have woven in and tacked the layers down to each other here. And I'll have to scratch my way through them and dull my blade on scar tissue and nylon. So now we've just placed that external oblique and it's Fascia. We've exposed the rectus abdominous. We can see that this rectus abdominis has been excavated.
Right? That fatty deposition there really represents the, the filling in of the rectus abdominis, which was the rectus Abdominis, looks like it didn't survive the surgery saying, yeah, look it. That's right. That's right. Exactly. I stilled in the space. So here's rectus abdominous in its fullness, but this one was intruded upon. We have muscle fiber, muscle power, muscle fiber, and then a gap. So now I'll lift the remnant of that rectus abdominis. I know there's more tissues, stitches underneath that we didn't see. So now create stitches here and then displace the muscle tissue. Cut through, stitch underneath it on their way out. Yeah, that's right. They do. They do it in layers.
And then I have a great consciousness. So the surgeons are incredibly attentive to all the layers that they've gone through to make sure that they put them all back together,
We will return our attention to the unembalmed female form again later. Her body is both instructive and riveting, but it is important first to establish an understanding of more normal anatomical relationships as we can. In this male example before exploring the artifacts of surgery which influenced the relationships of the viscera in the female form.
The fatty lobes revealed along the transverse colon. Our deposits within the transverse Mezzo Colon. We saw the same types of deposits in the embalmed female form. Uh, looking closely, we can see the visceral layer of the peritoneum overlying the transverse colon and extending to form the membranous structure of the greater omentum.
It flexes. That's the flexor. And where is it flexing? It's flexing at this organ that we saw from behind. And there we can see it down here. It's the spleen. See the spleen. I just popped the peritoneum out from around the spleen, hooked in at the Fletcher to the transverse colon, uh, at the spleen.
Dick Fletcher of the Colon. Transitions from the transverse colon to the descending colon at this point. And over here we have our s spleen, o gastric, uh, ligament. The peritoneum spanning across from the spleen here to this, to this, to the stomach, because the stomach is really big. It goes all the way around to the back. So we saw this tiny little bubble here, the surface projection in the stomach, right? So this tiny little bubble. Here it was, I'm gonna say that's the stomach. And you're like, all right man.
Here's the gastric impression. The impression that the stomach makes on the liver. All right? Hanging out there for seven years together, it makes an impression on each other. So there's this, the stomach, but that's just a little tiny bit of the stomach. Can you pull it back apart and you see this whole tremendous,
So we have our hepato splenic ligament in our spleen. Oh, gastric ligament, spleen. Oh, colic will ligament here. So the spleen is, this is like a, it's like a slingshot coming kind of through these ligaments coming off of the liver and the stomach and that call in and we're seeing that at this point. There's a, there's an arc of tissue and this arc of tissue is the hiatus and the diaphragm through which the esophagus passes, right? It's a beautiful shot of the, of the hiatus here. So a hiatal hernia is when this tissue, this arc of the diaphragm loses its integrity for some reason. And the stomach, which is trying to get sucked up into the thorax after all anyway, but it's usually blocked by the diaphragm. Okay. It goes through this space and room, a bubble, a bubble of the stomach. Usually this upper portion here, a bubble of the stomach will will slide up into the thorax through this arc of tissue here, this arc of tissue in the diaphragm.
So at this point, the pathway of your food transitions from the thorax to the abdomen. That's neat. We can see the st get a sense of the expanse of the stomach and see that the stomach is also jointed with the spleen. We were remarking about the joint of the spleen with the lung, but here we can see the interior surface of the spleen is jointed with stomach. Those are sliding surfaces there. See the spleen and the stomach, spleen sliding on the stomach in each breath, spleen and the stomach are sliding from relative to each other.
The spleen and the lung are sliding relative to each other, the stomach and the lung, the stomach and the liver. Fabulous. So I draw down my stomach here. The fundus of the stomach and I trace along this great bag and then it gets very skinny over here. The bag gets skinny and the pyloric portion of the stomach. And as we get over to here and to the pyloric valve itself, so it's quite an expanse. The stomach has got to be a foot across practically and it's arking this way around the form and it's also in this plane here.
So it's an arc. The greater curvature of the stomach is an arc following the arc basically of the costal margin as well. So we, oh, it's actually above that. It's higher than that and the stomach is right inside your ribcage, just like the, uh, the liver is on this side. So the stomach of course can drop down if it's really filled up the whole sack and sort of sag, eat thanksgiving dinner in your stomach, bloats and sags and it can be hanging out, down over your intestines here. I've seen that in radio graphis where, where the stomach is, you know, sagging down into the pelvic brim. Even at this point, we see the peritoneum coming across a to the left log with the lover and it, and it sort of gets into this little little point here.
And that's called the left triangular ligament of the liver. And then here we see that, uh, the continuation of the, here's the parietal or the wall layer. The peritoneum is coming here and it's diving down underneath the a heart here and it's sweeps down to the liver. Uh, all along this crown, it crowns the liver, there's a corona across the, the liver and that we call the coronary ligament of the liver. The falciform ligament, I'm cutting at this point started like a s a septum that comes from the parietal peritoneum down to form the skin of the liver. And then this cord, like terminus of the falciform ligament, which actually comes clear underneath here, you can see it. It's kind of a chord. It's like a cord. It's, it's roundish and it's like a vein. Uh, but it's not a vein at this point. It was a vein in the, in the fetus, but now, now it's, um, it's more like a cord.
It's the round ligament of the liver and it, it makes its way onto the navel. So you have the coronary ligament on the right side here. It's just the peritoneum sliding down to form the skin and the coronary ligament on this side. Your parents, Neil sack has been drawn away.
Here it's embalmed and toughened and uh, that's quite aggravated blood in it so it doesn't have the same texture, but what a glorious shape it has. And I'm really wanting to explore these shapes and their relationships with the Oregon and, and, and all that. The liver is dropping down from the contraction of these diaphragmic fibers. The liver is pushing down, displacing the abdominal organs. In this margin of the liver, we'll, we'll drop past the margin of the rib cage and the rib basket, costal margin here.
We'll drop down past it and the liver will expose itself from behind the bone. And because it has this ligament here, the coronary ligament and the triangular ligament that we've been indicating, your liver is rocking forward along this orientation of its triangular ligaments. And it's, it's doing a motion like this. Why that motion? Well too, because it wants to, I don't know, because it is, the motion is defined by the peritoneal relationships. That's why why we bother learning about these ligaments. It gives us a sense of how our organs mow their, their mobility, the way that they move around inside of the visceral space relative to one another. And the motility would define the emotion of the organ within itself, its own intrinsic, um, uh, life activity. And then if we, if I lift up now, we've explored the top of the livers, the bottom of the liver. Okay.
So we see this gallbladder and the gallbladder was tucked, tucked here and we kind of flip it out a little bit and we see it's this nice sack. And is it broken? No, no. People Think, oh, it's all green in here that it must be broken. But really this did the Billy Verdun of the bile has sort of perfused as whole form at this point. So things are a little green. Seize a little hole here, a little window. I didn't put that there and that's, that's there normally, but I'm indicating it because I'm pointing out this ligament here that had Patto to Waddell ligament. Okay. And [inaudible] duodenal ligament is simply that skin of the liver. Now coming off of the liver and heading on over to cover the duodenum to join up with the stomach here as well. In that, and if I, if I go through this little forearm, this little openings, little famous opening is a little opening. It's, it's, I'm going beneath something. See there's like, ah, oh, I'm, I'm tugging up now. There's a, there's a something to tug here.
Okay. There are three structures in there.
Now the the bile duct going from the, the, the liver and the gallbladder, the common bile duct to the Duodenum, which is where the bile empties in is two more structures here. The hepatic artery, which is the blood supply to the, to the organ of the liver. And then there's the portal vein of portal vein
I'm pulling back my liver so we can peek into this place in my Gosh, look, we see this stomach here. The pylorus is this tough, rubbery part here, the pyloric portion of the stomach, and then the Pi lures itself for the pyloric valve. And then as I draw the stomach down, I see this kind of a, another filmy Fascia here. Somebody tell me fashion is in the body. Oh, filmy fashion. Now if I get my hand underneath that, that firearm and that opening, I can see, look my fingers behind that film, that filmy fashion filmy fashion going from the stomach over to the liver. It's spanning between the lesser curvature of the stomach, the small curve of the stomach here. This is the big curve of the stomach, this outer curve, the big curve of the stomach, it's called the greater curvature and the smaller curve of the stomach on the inside is called the lesser curvature. So this would be called the lesser omentum. It's the peritoneum, the skin of the liver and the skin of the stomach connecting to each other and creating a span, a little circular span of tissue here between the two.
So I can sneak into that. The epilogue for, for Ramen of the lesser home, mental versa. We're getting really technical here and I sneak my finger underneath that, the artery and the vein and the common bile doc. Then I get underneath him. Now I'm in like I'm in a space. It's this, it's the space behind. The lesser omentum is very fan. You can see the blue of my glove here and actually my fingers on a pancreas now, because when you draw the stomach down, when you draw the stomach down and you see this, this lesser omentum here, this little sack deep to it is the hand Chris
We're not surprised to see more right here. Here's the remnant. Now that falciform ligament that I indicated a moment ago, and there are adhesions, Sam pulling away these adhesions and even as I do so I disrupt the liver tissue here just a little bit, doesn't yield so easily as I pull away the adhesions, but this falciform ligament, then this is normal. See, we have the adhesion. I've pulled that away. But now we have a relationship of the liver through here. So we have the skin of the liver rising up into the diaphragm, covering the peritoneum, the parietal peritoneum here swooping down over the liver to the skin or the liver. So as we follow along the crown of the liver, here's another adhesion.
By the way, to that adhesion, this should be a sliding surface, but here, the visceral peritoneum covering the liver, the skin to deliver is adherent to the parietal peritoneum. I can break it with my finger and as I do so I get to scoop underneath the massive, the liver and what an enormous and beautiful organ it is. And as I displace it laterally, I've see its connection here to the diaphragm through the peritoneum. The liver and the diaphragm have an intimate relationship. The diaphragm is like a stocking cap over the liver.
So every contraction of the fibers of the diaphragm represent emotion for the liver. And as I slide that stocking cap off of the liver and reveal the organ itself, we see it has more relationships in the back here along here. It's like a Tiara or a crown. We call it the coronary ligament and at its lateral extent, we call it the right to triangle. We're looking at this tissue here, of course is peritoneum, but it's covering an organ. The kidney, the kidney in its subserosal, fashional packing has a sliding surface right here with the liver. Isn't that beautiful? Look at that supple Oregon sliding against the kidney and then back up here we have that relationship with the liver to the colon, so here's the liver to the colon and here's the liver to the diaphragm and the triangular. Looking back on the right side, if I brush away here, they'll see more of this massive organ.
Look at how stents clear across her body. It's almost to the ribs on this side. I can feel the tip of the 11th rib with my thumb right here and I see the tip of the left lobe of her liver. Now, I'm not telling you this liver is enlarged only that it's a big organ, big and soft. Well, you know what I'm noticing it's a little different here in a normal configuration of a body. Is that the Gr, the greater omentum is, is that here into the bottom edge of the liver? Isn't that different? Because the greater omentum is in Oregon that's coming from the stomach
What am I pushing? I'm pushing the stomach, which is also adhered here to the liver. The liver and the stomach normally have a sliding surface.
Now you see we have our greater omentum and we have [inaudible]
There are numerous loops, loops. See here we do get the round or look scoop the ones out of the deep pelvis here. More loops. Got there was nothing there for a minute, Huh?
No shortage of intestines here. Huh? Oh my goodness. Look, now I have this tremendous,
So I've gathered up the loops, but I've also gathered up the mesentery. What's the mesentery and mesentery is the fabric along which this set of loops rides. The mesentery is this fabric here. Now the fabric is made up of the peritoneum except here it's called the mesentery. So we have a layer in the front or I'll layer on one side and a layer on the other side coming off the skin of the organ and the same way that the greater omentum was formed, we have this, the skin of the organ here, the visceral peritoneum, and then the the sheets here of peritoneal them that form this fabric, this fabulous fabric here, like a sea plant.
This fabric is called the mesentery and mesentery has its root meaning it arises from the back of the abdominal space as it comes up and arises to form this complex running through them. As in Terry are blood vessels. I'm back lighting the mesentery so you can see how arising from the intestine and through the mesentery. Oh my gosh, that's pretty [inaudible]
The military just got a little thicker here and you can't see through it as well as the other spot. I just keep going and going and going through the whole nine yards as they say. Well, the intestines, I'm following the pathway I'm keeping and going and going.
Now I can feel like I'm coming to a transition point here. [inaudible] another couple of feet and then we done. We're back to the ileocecal valve. The transition between the cecum and the small intestine. That was amazing. Quite a pathway, so the man's and Terry and then this is the mezzo colon. It's that part of the mesentery or that part of the peritoneum really is the parietal peritoneum here, the visceral peritoneum here.
Here the peritoneum is named Mezzo Colon. It's in the midst of the colon, the Mezzo Colon, and here it's called [inaudible] Terri and the transition point between the Mezzo Colon and the Mesentery, we call the root the root of the mesentery. Let me see the roots from the far side as well as see, I'm tugging, but I'm not getting anywhere. I'm tugging at the root of the c plant, Mezzo Colon, Mezzo Colon, transverse Mezzo Cohen, Mez, and Terry Mez and Terry root of mesentery. Excellent. What's through here? Well, golly, that's the aorta and the inferior Vena Kayvon. They're lying on the anterior lumbars.
Look at this guys, you have an enormous sea plant rooted on your lumbar spine. Does it have an impact? Do organs impact the musculoskeletal system? Of course they do. They're all one animal, and we have this fabric rocking the whole body here, and not that your intestines ever get that active, but you kind of get the picture that this bouquet rooted down onto your aorta and your lumbar spine.
It's going to have a relationship to it. That's important. As I pull up, I'm pulling on the arterial and venous roots as well, and so the whole body is moving because the stitches of grandma's doily here, Grandpa, in this case, it's like a crocheted doily really is like a crocheted doily and the and the stitches of that fabric are from the heart. This is the intestine of the heart, and if we look carefully at this as well, it's easy enough to recognize the form of the brain. So the more that folks study neuropeptides and gut intelligence, we can start to acknowledge this loopy c plant as the brain of your belly.
The second brain is a marvelous read for any generalist hoping to grasp the reality of the enteric nervous system more deeply. The nerve count of the Interra nervous system is higher than that of the spinal cord and dispersed as it is between the layers of the intestinal muscle wall. It literally has the shape of a brain, though the Gyri, in this case, our hollow, the functions of the enteric brain governing peristyle, sis, and many other complex issues of digestive timing and chemistry are truly a wonder how form impacts function and vice versa are points which constantly sparked my curiosity. Forms of nature repeat in the body. We are not thrown out of the garden. The garden lives within us. Weather, brain, intestines, or the ovary or the inner lining of the stomach.
Our shapes are marked by the stunning intelligence of nature active within us.