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NATIONAL LIBRARY OF MEDICINE   NATIONAL LIBRARY OF MEDICINE   NATIONAL LIBRARY OF
 
 
SPECIAL
ANATOMY
                           AND


HISTOLOGY.
                                BY

            WILLIAM  E.  HORNER, M. D.,
                                *#*
PROFESSOR OK ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA—MEMBER OF THE IMPERIAL
           MEDIC0CIIIRURGICAL ACADEMY OF ST. PETERSBURG—OF THE
                  AMERICAN PHILOSOPHICAL SOCIETY, &.C.
Multum adhuc restat open's, multumque restabit, nee ulli nato, post mille SEecula
  pracluditur occasio aliquid adjiciendi.
                                              SENECA, EPIST.
IN TWO  VOLUMES
            VOL. I.


     SIXTH  EDITION.
      PHILADELPHIA:
LEA  &  BLANCHARD.
1843.
 
Q3
 1943
    Y.l
Entered, according to Act of Congress, in the year 1843, by William
  E. Horner, in the Clerk's Office in the District Court of the Eastern
  District of Pennsylvania. 
TO
     NATHANIEL  CHAPMAN, M. D.,
Professor of the Practice of Medicine in the University of Pennsylvania.

 My Dear Sir,
  From the new aspect which it has assumed, I take the
liberty of dedicating to you the following  Treatise  on
Anatomy, heretofore without the patronage of an illus-
trious name.  That this is done in the spirit of disinte-
rested friendship and esteem, is manifested by the diffe-
rent paths of professional occupation, that we  have fol-
lowed.   I have felt the act as an imperative duty, from
the efficient encouragement in my early years so copiously
lavished by yourself, and  without which my course of
life would, in all  probability, have been very different
and  much less satisfactory to  myself  That a life ren-
dered  valuable by talents of no common order, by the
kindest and most  generous of feelings, and  so  usefully
employed as yours in  mitigating the ills of human  ex-
istence, may be long  preserved  in its present undimi-
nished vigour of mind and body is the sincere prayer of
              your obedient servant and friend,
                                W. E.  HORNER.
  Philadelphia, Sept. 1st, 1843. 
 
      PREFACE

           TO THE


SIXTH  EDITION.
   Since the first appearance of this work in 1826, it has
 had the good fortune to obtain so much of the public
 favour, as to have passed through a series of large editions
 reaching now to the  sixth.   At the period above  men-
 tioned, an evident advance had occurred in  the  science
 of  Anatomy, in regard to methods of description, an im-
 proved arrangement  of its objects, specialities of struc-
 ture, and the value and extension  of the principles of
 General Anatomy.   The  latter was  known but  little
 more than by name  in this country, and in our paren,t
 country had not advanced even that far, in  scientific no-
 tice.   It was strange  almost every where to British ears,
 and by some of their distinguished  teachers professedly
 derided.  Its  familiarity, at present, with both  sides of
 the Atlantic, marks the solidity of the basis upon which
 it was founded, and the  immense acquisition it has been
 to pathology and to physiology ; its actual state has fully
justified the prominent position in which it was placed
 in my first edition.  The same deference  then felt for
 this rich and inviting branch of Anatomy, has been pre-
served in my mind to the present day;  and the  subject
is again presented vastly improved in accuracy and aug-
                          l* 
VI
PREFACE.
mented in observations, by the perfecting processes in the
construction and application of the microscope.  Among
other novelties of decided improvement  in  connexion
with it may be considered the Synonym of Histology, or
the doctrine of Texture; which seems to mark its bounda-
ries and intentions with a defiriitiveness, palliating largely
if not justifying its  substitution for  the original phrase
itself of  General  Anatomy,  though now sanctioned  by
half a century nearly of use, and, almost consecrated by
the choice of Bichat himself.
  If the Anatomy of the period alluded to,  had a decided
impulse  beyond that of  the  preceding  century, so the
Anatomy of 1843 may justly claim  a well-marked and
triumphant advance beyond that of  1826:  organs before
unknown, now discovered—arrangements  of  parts for-
merly in obscurity, now detected—textures not long  ago
of an uncertain and disputable character, now elucidated
and settled.  The anatomy of the  most important mem-
branes, as the  mucous, formerly passed over as if there
was scarcely any anatomy at all in them; now furnished
with a detail—extension—and minuteness of observation,
leaving the impression,  nearly, that there is nothing more
to be learned about them.  Those untractable  and mine-
ral-like bodies, the teeth, exciting once almost the doubt
of intrinsic organization; now penetrated  by the micro-
scope in  a  wonderful manner, and exhibiting  the  most
surprising organization, an organization so characteristic
and permanent that it has become one of  the  most effi-
cient means of discriminating in fragments of animals
the kind to which they  belonged, whether  of the present
or a former order of the world.  Each of the compo-
nent parts  of  the teeth, the cement, enamel and ivory,
exhibiting  a  specific  organization;  its fibrils and  its
tubules, whose arrangement, in  being specific, gives de-
cided character to the specimen in question.
  Bichat laboured but little with the microscope, too im- 
PREFACE.
Vll
perfect an instrument  at  the period of his life, arid  too
discrepant in its indications, his slender use of it may be
considered as marking a profound distrust in  it; other-
wise, with his talents and  energy, much more of  the
ground of modern anatomy would have been covered by
him.  He depended principally  upon  maceration, che-
mical appliances, and  pathological changes.   But it is
now a new instrument, in  virtue of its freedom, from  the
imperfections of a former period, and we may here with
propriety occupy some space in an exposition of its  me-
rits.  Invented first by the Dutch or Italians, its improve-
ments have been slow, both in the mechanical and in  the
optical part.   The latter  has of course been forced to
await the precession of new discoveries in the laws of
Light, and as they have been ascertained and developed,
the results have been applied to the construction of  the
Microscope.   This instrument was not, however, desti-
tute of interest as far back as  nearly two  centuries ago,
for it was in  1674, that by it Hartsoeker discovered  the
existence of animalcules in the spermatic liquor of male
animals.
   The earlier observers generally used single glasses of
a lenticular shape, but in  a  short time  followed the in-
vention  of the compound microscope;  where  the image
formed by the glass nearest the object, became itself  the
subject of a farther magnifying power.   For a long time,
however, the imperfections of both kinds of instruments
were such as to present the most  serious obstacles to  cor-
rect observations, so that every new eye seemed to give
a new cast to microscopical conclusions.  One imperfec-
tion came from  the pencils  of light passing  confusedly
through  a curved surface  of glass, and constituted spheri-
cal aberration : another imperfection arose from the diffe-
rent coloured  rays  of light being transmitted  through
different angles of refrangibility, and  constituted chro-
matic aberration..  These difficulties were to  a large 
vm
PREFACE.
degree at length  surmounted in 1829, by the invention
of Woollaston's doublet; since which, improvements have
been incessantly occurring both in  the  optical and me-
chanical parts of  the microscope, in regard to accuracy,
power, and applicability.  The Berlin  and Vienna mi-
croscopes  of modern construction, have united the most
suffrages in this country, especially the compound instru-
ment of Ploss.  It is the one that I habitually use; admi-
rable as  it is, it  has, however, been forced  to yield  to
those of London construction by Powell and Lealand.
  To appreciate the power of the compound microscope
of the present period, we are  to remember that the hu-
man eye in good order, but  unassisted, sees with diffi-
culty an object whose diameter is the hundredth part of
a line, say the twelve hundredth part of an inch; but the
powers of the microscope are now  so adjusted that the
diameter of such  an object may be  multiplied or ampli-
fied  one, two, or more thousands of  times; thus making
what was previously imperceptible  a broad, well-lighted
and well-defined disc or plane.  The consequence of this
successful construction, is that a surface not more than a
millionth of an inch across, may be satisfactorily exa-
mined.  We  may hence infer the  applicability of the
compound microscope  in ascertaining  the healthy and
the diseased condition of the filaments  and molecules of
the human body; the  state of its excretions and secre-
tions ; the condition of its fluids; and the manner of ger-
minal evolution.
  Of all the fluids of the body, the blood is admitted to
be the most interesting from its quantity, and from its
relation to all the  great functions of life.   Containing as
it does the source  as well as  the issues of life, every one
regards it as no common fluid.  At an early period, there-
fore, the microscope was applied to it and detected, by the
eyes of  Malpighi,  numerous rounded  granules  called
blood corpuscles.   It was for one  hundred and  sixty 
PREFACE.
IX
 years debated whether these corpuscles were spherical
 or  flat, and for a long  time whether they were solid or
 perforated ; also, their exact size, and the relation of the
 colouring matter to them.   In  place of all  this uncer-
 tainty the facts now admitted are, that  they  are minute,
 disc-like  cells,  containing  round  or  oval nuclei,  and
 having incorporated with them the material which gives
 redness to the blood of many animals, though this colour
 does not  exist in all.   Their nucleated state  is not so
 uniform in  man  as  in  some other animals, and  is sup-
 posed to be limited to certain stages of their development
 when it subsequently disappears.  These blood  corpus-
 cles are circular in man, and in all the mammalia, except
 the camel tribe, in which  they are elliptical; all other
 vertebrated animals, including reptiles,  birds, and fishes,
 have them elliptical.  In  man the diameter of these glo-
 bules averages about the 4-^0  part of an inch, or 3y3 of a line,
 some being ^ and others ^0 of an inch ; but in the pro-
 teus, where they are elliptical, their length is as much
 as ^ of a line, or the ^  of an inch.   In  the Napu musk
 deer their diameter descends to  the ^^ part of an inch.
 Omnivorous animals have them  larger than carnivorous,
 and these again larger  than herbivorous.  There is no
 absolute proportion  between their  size and  that of the
 animal  to which they  belong.  Thus,  in  the  elephant
 their diameter is only twice  that of man.
  The microscope  has distinguished in  the  chyle or
 elaborated  part of our  food, numerous  appropriate glo-
 bules of variable size, larger or smaller than those of the
 blood.   These corpuscles, when perfect, consist of gra-
 nules assembled  around a central  one.  Bodies  of this
 kind are found  in  the  lacteals  of  the  mesentery; and
bodies nearly analogous, called lymph globules, are found
in the lymphatic vessels, in  different parts of the system.
  It is well known that human fat  is in large part fluid, 
X
PREFACE.
 and such being the case, the inquiry very naturally arose
 why does not this fluid then gravitate to the legs and feet,
' like water in dropsy ?  A reply of problematical truth
 was given, that this  oil was contained in  oil  or fat cells
 like those of the juice of  an orange; but the parts were
 too fine for positive proof.  The latter we have now got
 indisputably from the microscope; the answer first came
 from Malpighi, but it required near two centuries of ob-
 servations to verify it.
   The cuticle, that  important  covering of the body,
 without which  the  finest satin would feel  harsh and
 excite  pain;  and also without which no internal supply
 of fluids could make up  the rapid loss  from  the  sur-
 face  by  evaporation, the cuticle, I  say,  has its struc-
 ture  presented to us in  a most interesting light under
 the new  powers of  the compound  microscope.   It is
 first of all a remarkable  point in minute anatomy, that
 wherever there is a free  surface, almost without excep-
 tion the surface in question, is provided with an epithe-
 lium, or an analogous structure as the  cuticle, and which
 consists of one or more  layers of primary  cells.  We
 hence  detect this covering on the entire  surface of the
 skin;   of  the  alimentary  canal; of the  genito-urinary
 cavities;  upon the secretory ducts; upon the  free sur-
 face  of the peritoneum, pleura,  pericardium, arthrodial
 membranes, synovial sacs, in the cavities of the blood
 vessels, &c. &c.
    These cuticles or epithelia are all formed of  scales,
 which are found to be cells in a state of compression and
 having a nucleus. A pressed lime or lemon will give some
 idea of the mere mechanism alluded to.  The  minuteness
 of microscopical observation may be understood when it
 is stated, that the nuclei of such cells have  been ascer-
 tained to measure about the ^ of an inch, and that within
 them there are nucleoli estimated at the diameter of the
 iofaninch- 
PREFACE.
XI
  Some of the scales or cells  are  rounded or polygonal,
others are cylindrical or conoidal, and others again are ter-
minated at their free extremities, by a very fine down or
line of fringe called cilia, whose length is from ^ to -j^
of an inch: some observers claim  to have seen them as
short as about the ~m of an inch.  These cilia  have
during life, and even  for some time after death an inces-
sant motion, sweeping backwards and forwards, and whirl-
ing around at their fixed extremities so as  to describe
the figure of a cone.

  The Cellular form is the  universal primary condition
of all vegetable and animal matter.  It lays the  founda-
tion of every thing, and its traces and modifications may
be found in every tissue at every stage of life, from the
earliest rudimentary to the most perfect condition.  To
Schwann we owe this idea, more prolific in consequences
and in philosophical inductions than any other in the ca-
tegory of physiology.  It has  been applied by Dr. Barry
to the tracing of  the Embryo  from the Germinal vesicle
of Purkinje, to the evolution of all the organs of the body.
In every instance it wTould seem from the researches of
Schwann, Valentin,  and others,  that organism is  first
seen as a  single cell;  this cell within its enclosure gives
birth to others, and from them, in  their turn, germinate
others; and so on in an endless succession till life  itself
terminates.
   Nutrition  itself appears to consist in an evolution of
new  cells from pre-existing old  ones,  which becoming
effete, are broken down and carried off.  While the cells
are in a state of active vitality, each set derives from the
blood the organic  compounds most suitable to their na-
ture ; as the structure of every separate portion of the
body has a special affinity for  some of the particular con-
stituents of the blood, and not  for others.  The appropria-
tion of these constituents constitutes assimilation, but the 
Xll
PREFACE.
regulating power which directs this appropriation, is one of
the secrets of vitality, the nature of which we are as little
likely to know as that of gravitation or cohesion in the
phenomena of physics.
  It is a remarkable trait in animal organism that a form
of growth unknown to it in the healthy state, in fact pa-
rasitic, takes possession of certain parts and by its evolu-
tion, destroys the matrix upon which it feeds.  Thus  in
the terrifying and fatal form of disease, called Cancer,
which is so apt to assail  the  glandular textures of the
human  body; it has been shown by Muller and others,
that it consists in the growth of a  mass of cells, which
develope themselves in their successive generations with
extreme rapidity; and  destroy the  surrounding  tissues
both by pressure and by abstracting the blood essential  to
their nutrition.  These parasitic agglomerations, have an
independent power of growth  and of reproduction, and
can  be  propagated into healthy animals by inoculation.
It is even said that vegetable organisms have been latterly
traced in the parasitic state upon the body of animals,
so that a true plant has been found having a regular ap-
paratus of nutrition and of reproduction.*   While this
sheet is passing  through the press, we have it announced
by M. M. Andral and Gavarret, that in all albuminous
fluids, a trivial chemical appliance of a certain kind will
develope an  infusory vegetable, to be found with the aid
of the microscope.f
  Colour, it is now ascertained, depends  upon the ex-
istence of a particular class of vesicles, called Pigment
Cells.   From  them are derived the black pigment of the
eye, and that which marks the distinction of races in the
human family.  In these, as in other instances, the pig-
ment is composed of minute dark granules deposited  in
primary cells.   These  granules  are among  the  most

  * Carpenter.  Human Physio'ojjy, Am. Ed., p. 404.
  t Bulletin of Med. Science, by J. Bell. M. D. Sept. 1843, from Gazette Medicale. 
PREFACE.
Xlll
minute formations of the body, and in their longest dia-
meter measure only _L of an inch.
                 J 20 000
  The nails of  the  fingers and  toes, simple  and  inor-
ganized as they seem  to  be, are  yet found  by the same
searching process  to be formed from an aggregation and
successive growth of cells.
  Muscular tissue has also received a copious elucidation
from this source of observation.   A  point is now defini-
tively settled, that the muscular fibres of the  stomach,
bowels, and other interior organs, are very different  in
their anatomy; from the muscular fibres of the limbs, and
such generally as  are engaged in the larger motions of
the body.   The nerves  heretofore considered  as mere
strings, are  now ascertained to be  tubes.  These tubes
are collected into fasciculi forming a cord of some magni-
tude.   To superficial observation these tubes or ultimate
fibres seem to coalesce by reciprocal anastomosis;  but it
is now settled by the microscope, that from the brain and
spinal marrow to the peripheral or outer termination of
these tubes, they keep perfectly and exactly distinct from
each other.   But as each nervous fibril has its distinct
origin at one point of the brain, and its distinct termina-
tion at the other end upon a muscle or a sentient surface,
the action of the muscles and the perceptions are better
regulated and more precise than they would be under a
different arrangement.
  With such augmented means of anatomical research,
the progress of the science has been immense.  Contri-
butions of the most valuable kind have been made in Ger-
many, France, Switzerland, in the British domains, and
elsewhere.  Modes of elucidation  by plates,  drawings,
models, and injections have been improved.  Cabinets of
great value  have been  collected  and arranged, in every
direction.   Our own country has felt this  salutary im-
pulse, by advancing  in its scientific labours and books,
increasing its medical schools,  multiplying highly in-
  Vol. I.—2 
XIV
PREFACE.
structed  teachers of Anatomy, and  imparting a more
finished  degree of accomplishment to its medical gra-
duates.
  The claims of the present edition are then to have
drawn from the above recent sources of information, to
the extent admissible in preserving the character of a
Text Book, and  to have added  any new observations in
which I may have been personally engaged.  An introduc-
tory portion on  Histology  and Histogeiry is two-thirds
new.  A new chapter on glandular structure has been
added.   The chapter on the blood has been largely re-
formed.   Additions, substitutions and alterations amount-
ing to two hundred pages of manuscript according to the
printer's report have been introduced; a specification of
which would be both tedious and, perhaps, useless, though
it may be proper to state it generally for the information
 of the reader.
   Very  valuable matter on the Histology of the Skeleton,
 Muscular System, and  some other  parts has been pre-
 sented to rne through the pen of my friend, Dr. Meredith
 Clymer of the Medical Examiner; whose acquisitions as
 a scholar enabled  rne to use  most advantageously his
 kindness, at a period when  my own executive duties in
 the profession were too coercive to be set aside for study,
 and  marks of which contributions will appear to the
 readers  of that excellent journal.
   I consider it  also no small matter to have secured in
 connexion with the text, a  volume of plates, the  selection
 and  arrangement of which have been confided to my for-
 mer pupil, Dr. Henry H. Smith.   Where proper plates
 to copy from were wanting, he has had free access to the
 Anatomical Museum of the University, for preparations
 made by myself, and used for illustration in the annual
 course of Anatomical Lectures.
    Anatomy has been assiduously and ardently cultivated
 in this  country for many years, and abounds in teachers 
PREFACE.
XV
of skill and talent, and yet how few original treatises on it
in whole or in part have appeared.  We have been too con-
tent to adopt the systems of our transatlantic brethren, in-
stead of illustrating its condition among us by original
works.   There are many gentlemen whose names might
be mentioned if a proper reserve permitted, highly fitted
for this task  of authorship by their qualifications, oppor-
tunities, and spirit of research, and yet refrain from what
would  be so creditable to themselves and advantageous
to  our  common country.
   The reflection that I have myself assisted in the edu-
 cation of several of the  persons alluded to, is one of the
 high gratifications  attending my period of life and of
 professional service; and if there be a sentiment of pride
 excusable in itself, it is that of the transmission of know-
 ledge into hands so capable of sustaining it, and  of ex-
 tending its boundaries. 
 

TABLE   OF  CONTENTS.
VOLUME  I.
Histology,
Chemical Composition,
Histogeny,
  Page
    vi
  xxvii
xxxviii
                   BOOK I.—SKELETON.

PART I.—Histology of Natural Skeleton,
  Chap. I.—Histology of the Bones,
      Sect. 1.—Number and Texture of Bones,
           2.—Composition of Bones,
  Chap. II.—Sect. 1.—Periosteum,
                2.—Medulla,   -
  Chap. III.—Osteogeny,
      Sect. 1.—Development of Bones,   -
           2.—Growth of Bones,
           3.—Formation of Callus,
PART II.—Bones, individually,
  Chap. I.—Trunk,       -
      Sect. 1.—Spine,
           2.—Development of Spine,  -
           3.—Uses of Spine,
           4.—Ossa Innominata,
           5.—Pelvis, generally,
           6.—Development of Pelvis,  -
           7.—Mechanism of Pelvis, -
           8.—Thorax, -
           9.—Cartilages of Ribs,
          10.—Development of Thorax, -
          11.—Mechanism of Thorax,
  Chap. II.—Head,      ....
      Sect. 1.—Cranium,
           2.—Individual Bones of Cranium,
           3.—Face,
  Vol. I.
 49
 50
 50
 58
 68
 69
 72
 72
 76
 80
 85
 86
 86
 97
 98
104
109
112
113
114
120
122
123
128
129
131
145 
CONTENTS.
   Chap. III.—General Considerations on Head,
       Sect. 1.—Sutures, -
            2.—Diploic Structure of Cranium,
            3.—Internal Surface of Cranium,
            4.—External Surface of Head,
            5.—Nasal Cavities,  -
            6.—Orbits of the Eyes,  -
            7.—National Peculiarities of Face,
            8.—Development of Foetal Head,
   Chap. IV.—Os Hyoides,
         V.—Upper Extremities,
       Sect.  1.—Shoulder,       ...
            2.—Arm,
            3.—Fore Arm,
            4.—Hand,
            5.—Development of Upper Extremities,
            6.—Mechanism of Upper Extremities,
            7.—Motions  of Shoulder,
            8.—Motions of Shoulder Joint,  -
            9.—Motions of Fore Arm,   -
           10.—Motions of Hand,
   Chap. VI.—Inferior Extremities,
       Sect. 1.—Thigh Bone, -
            2.—Leg,   ....
            3.—Foot,
            4.—.Development of Inferior Extremities,
            5.—Standing,
            6.—Locomotion,    ...
PART HI.—Articulations,
   Chap. I.—Cartilaginous  System,
    Accidental Development of Cartilages,
    Perichondrium,     ....
    Articular  Cartilages,
  Chap. II.—Fibro-Cartilaginous  System,
       III.—Ligamentous  Tissue,
       Sect. 1.—Histology of,    -
           2.—Ligaments of Joints, -
           3.—Synovial Articular Capsules,
  Chap. IV.—Articulation of Lower Jaw,
        V.—Ligaments of Spine,
        VI.—Ligaments of Pelvis, 
CONTENTS.
                                                             Page
  Chap. VII.—Articulations of Thorax,   -      -      -      -  284
        VIII.—Articulations of Upper Extremities,    -      •      288
         IX.—Articulations of Lower Extremities,       -      -  304


                            BOOK II.

PART I.—Integuments of the  Body,  -      -      -      -      321
  Chap. I.—Cellular Substance,   -       -      -      -       -  321
        II.—Adeps,   ......      330
PART II.—Dermoid Covering,   -       -      -      -      -  333
  Chap. I.—Skin, generally, .....      333
    Sect.  1.—Cutis Vera,        .....  334
          2.—Rete Mucosum,                                  337
          3.—Cuticula,   -      -       -      -      -       -  341
  Chap. II.—Sebaceous Organs,      -                           346
        III.—Nails,       -      -       -      -      -      -  348
        IV.—Hairs,  -       -       -      -      -      -      351
                           BOOK III.

PART I.—Muscles,      -       -       -       -      -      - 355
  Chap. I.—Histology of Muscles,   ....     355
       II—Muscular Motion,    ..... 363
       HI.—Shape of Muscles,       ....     368
       IV.—Tendons,    -       -       -       -      -      - 369
PART II.—Special Anatomy of Muscles,      -       -       -     371
  Chap. I.—Muscles of Head and Neck,  -       -      -      - 371
    Sect.  1.—Muscles of Face,      -      -      -       -     371
         2.—Muscles of Neck,  ..... 379
  Chap. II.—Muscles of Trunk,      ....     388
    Sect. 1.—Muscles on Front of Thorax,       -      -      - 388
         2.—Muscles and Fascia? of Abdomen,      -      -     391
         3.—Muscles of Upper and Posterior part of Abdomen,  - 402
         4.—Muscles on Posterior Face of Trunk,   -       -     408
  Chap. in.—Of the Fasciae and Muscles of the Upper Extremities,  419
    Sect 1.—Fascia,    -       -       -       -      -      - 419
         2.—Muscles of Shoulder,  -      -      -       -     421
         3.—Muscles of Arm,   ..... 424
         4.—Muscles of Fore-Arm, -                          427
         5.—Muscles of Hand,  ..... 437 
CONTENTS.
                                                              Page
  Chap. IV.—Of the Fascia and Muscles of the Lower Extremities,  443
    Sect.  1.—Fasciae,   ....              -  443
          2.—Muscles of Thigh,     -       -       -             448
          3.—Muscles of Leg,   .....  459
          4.—Muscles of Foot,       ....     466


                           BOOK IV.

Organs of Digestion,     -       -       -       -      -       -  473
PARTI.—Organs of Mastication and Deglutition,     -       -     475
  Chap. I.—Mouth       -       -       -      *      -       -  475
        II.—Teeth,   ......     477
    Sect.  1.—Number of Teeth, and Subdivision, -      -       -  477
          2.—Texture and Organization of the Teeth,       -     480
          3.—Gums,     ---...  485
          4.—Formation of Teeth,    -                           485
          5.—Dentition,  -       -       .      .      .       -491
          6.—Irregularities in Dentition,      -       ,       .     497
  Chap. III.—Tongue,    ---...  500
    Sect.  1.—Muscles of Tongue,    ....     501
          2.—Mucous Covering of Tongue,      -      -      -.  502
  Chap. IV.—Palate,        -                                   505
         V.—Glands of Mouth,   -                               508
    Sect.  1.—Muciparous Glands,    -                           508
          2.—Salivary Glands,   -       -       .      .      -  510
  Chap. VI.—Pharynx and Oesophagus,      -       -       .     514
    Sect.  1.—Pharynx,  -       -       -       .      .      -  514
          2.—OEsophagus,   -       -       .       .       .     514 
HISTOLOGY.
        GENERAL  ORGANIZATION.

   In passing the eye over the structure of the human
 body it is evident that the latter is formed  by an aggre-
 gation of organs and textures;  each adapted to some par-
 ticular function of a vital or of a  mechanical kind; the
 apparatus of the two functions, vital and mechailical,
 being in many instances blended.   Some of the organs
 are of a character so peculiar that their texture is repeated
 no where else;  other organs have  their texture exactly
 renewed in  numerous places;  a good example of which
 is seen in the muscles, where,  from the necessity of mo-
 tion, muscular structure exists at  many points, both for
 locomotion and for the  internal operations of the body.
 Anatomy as a science has for  its object to  pour tray all
 these component parts of the body, both  solid and fluid,
 under whatever circumstances  they may be  presented.
   The application of the science  to  the search of the
same texture in different organs, and wherever it may
indeed be found; the tracing of its degree of extension
and  its modifications under all circumstances; in fine,
a general comparison of  it, one  parcel with another,
                         A* 
VI
HISTOLOGY.
constitutes what  is  called General  Anatomy, or  His-
tology.*   Each  individual texture being  in technical
language called a Tissue.
  Special or Descriptive  Anatomy, in distinction from
Histology, teaches the exterior form of organs, their mag-
nitude, their position, their  connexions with  adjacent
parts;  and their intimate texture or organization.  As in
this way every individual part  is brought under a strict
review, it is this head of the science which gives skill to
the surgeon.
  General Anatomy may be  explained,  as its  great
founder,  Bichat,  himself has done it, by the following
comparison.  Chemistry  has its simple bodies, as heat,
light,  hydrogen,  oxygen,  nitrogen, carbon, and so  on,
whose  several combinations form all  the composite bo-
dies on the face of the globe.  In the same way anatomy
has its simple tissues, whose varied  combinations form
all the organs of the human body and of animals.  These
tissues are,

 \.  The  Cellular,    -                   Vol. I. p. 321
 2.  The  Adipose, or Medullary, -     -     -        330
             r Arterial,    -    -     -        II. p. 183
 3  Vascular i Venous'    -    -     -     -        190
 3.  Vascular<j Exhalen^  _     _     _     .        lg0
             Llnhalent, or Absorbent,     -        301
    ,,       C Animal Life,     -                  334
 4.  Nervous^ _     .  T   '
             i Organic Life,     -.     -,     -        337
 5. Osseous,     ---,_.,    J. p.  50
 6.  Fibrous, or Desmoid,   -                       263
 7. Cartilaginous,    -                           255
 8. The Fibro-Cartilaginous,    -                  261
 9. Muscular ? Animal Life,    -     .    -        357
              l Organic Life,   -                  362

      * From trroi texture, and Xoyes word, doctrine of texture. 
HISTOLOGY.
Vll
10.  Erectile, or Spongy, as Penis,    -   Vol. II. p. 100
11.  Mucous,......48-58
12.  Serous,......         24
13.  Synovial,......        267
14.  Cutaneous......I. p. 334
15.  Epidermic......        341
16.  Pilous.......        351
17.  Glandular,......II. p.  53
18.  And to the above may now be added the
       Corneous,.....        348
  Bichat admits twenty-one elementary tissues, but seve-
ral of them are  but modifications of one and the same.
For example, the arterial, the venous, exhalent and inha-
lent, belong all to the vascular, and I have thought it
useful  to  concentrate them  under one head; and so of
some others.   As the intention of the work did not admit
of the consecutive description of these tissues, reference is
made to the pages on which  they are discussed.   With
this guide they may be studied in immediate succession,
by the  person desirous of a connected outline  of His-
tology, or General Anatomy.
  Many other modes of classification have been proposed
since Bichat's, they have for the most part been received
by the profession with indifference, as not furnishing suffi-
cient inducements for a  change.  That of Bichat  origi-
nating with himself has  become so completely identified
with the ordinary language of anatomy and pathology,
that  it is by no means probable that it can be supplanted
by any other.  Among the most  modern of the  sugges-
tions of change  are those of Schwann, who proposes a
classification of tissues upon the basis of their  cellular
histogen)'.   Valentin and Gerber have also made efforts
at a  new system, and have  had no better success than
their predecessors.*  Some subdivisions and  additions
        * See Encyclop. Anat. vol. vi. p. 131.  Paris, 1843. 
Vlll
HISTOLOGY.
 have it is true been  made with  advantage under the im-
 proved application  of  the  microscope, but no  general
 renewal can take place at present upon existing grounds
 of information.
   The distinctions of tissue do  not rest upon  an imagi-
 nary basis, but  have nature for their foundation.   The
 organization of each has well marked and characteristic
 peculiarities, which  may be ascertained by their diseases,
 and by the influence of different agents, as heat, air, wa-
 ter, acids, alkalis, neutral salts, and putrefaction.  Each
 tissue has its particular strength, and its particular mode
 of sensibility, upon which repose all its vital phenomena,
 and the blood is but  a common  reservoir, where each
 chooses what is  in relation to itself.  An  example, how-
 ever, will serve better for illustrating these several points.
 The stomach  is composed of four  laminae, one is serous,
 another muscular, a  third cellular, and a fourth mucous.
 Each of these laminee has its appropriate sensibilities and
 mode of life, which may cause it to be diseased, while all
 the others are healthy.   Peritoneal  inflammation may
 invade the first, the  cramps of colic the second or mus-
 cular, the infiltration of dropsy the third or cellular, and
 dyspepsia the fourth or mucous.
  The several tissues  may, therefore, be considered as
 animal matters,  each  endowed with its  own  especial
 vital force and physical  properties,  from the  union of
 which results  the special physiological action of the part
under  consideration.
  It thus happens, that  the diversity of the tissue of an
affected organ modifies the symptoms of its diseases,  and
especially their duration.  Hence,  nothing is more vague
in medicine, in regard to duration, than the terms chronic
and acute.   An inflammation in one tissue will  go na-
turally through its stages in a few days, as, for example,
in the  skin,  cellular substance,  mucous membranes;
while in the bones and ligaments, on a natural progress 
HISTOLOGY.
ix
being also observed, weeks and months are required for
its accomplishment.   It is evident, therefore, that a time
which is chronic in the first three tissues, is acute in the
last two.
  A chemical analysis of the body demonstrates only a
few elementary principles; and they are varied  in  their
combinations by a greater or less proportion of one or the
other.   Calcarious  matter, the neutral salts, carbon, hy-
drogen, oxygen, nitrogen, sulphur, iron, wrought up by
the powers of animalization into gelatine, albumen, and
fibrine, which again are  elaborated into  the filamentous
and laminated  tissue, constitute nearly the  sum total of
the results of the experiments of animal chemistry.  It
has yet to find out the  laws which  give  to  these ele-
mentary atoms the condition of blood,  and afterwards
change this blood  into  muscles, nerves, and other tis-
sues.
  The whole body is formed of solids and of fluids.  The
former, when unravelled, consist of filaments, of laminae,
and of molecules;  their mechanical division does not ad-
mit of any greater separation.  Many of the laminae are
arranged into membranes, thus forming hollow viscera,
for containing  either articles of food or  the excretions;
others surround the different solid viscera  and separate
them from the  contiguous  parts.   Other laminae pene-
trate  through the  most  compact structure, and indeed
form the nidus  in which  its  atoms or particles are depo-
sited.   Many of these laminae consist of several thinner
laminae, placed together and united by filaments arranged
into  cells, which cells receive the ultimate particles of
the whole fabric, and constitute its base.   The laminae
also, by being wrought into  cylinders, constitute vessels
of different kinds, which  are distributed in such numbers
through the body, that by far the greater  part of its struc-
ture seems to be formed of them.  In regard to the fluids,
they are extremely abundant in number and in quantity, 
X
HISTOLOGY.
and are found in the cells of the laminated tissue, and in
the several vessels.  One not accustomed to the process
would be astonished to see, when  these fluids evaporate
by exposure to  the air, that nearly all parts of the body,
except the skeleton, lose from one-half to  two-thirds of
their  original bulk, and some parts even more.  The
several solid parts  of the  body are then literally  kept
soaked during life in the fluids;  which have for a prin-
cipal constituent, simply water.
  There are some animals whose  organization is so sim-
ple that they possess only the power of sensation; and of
motion in  one part  upon another.   This is perhaps the
lowest degree in which  animal life does  exist, or pos-
sibly can  exist, without a new order of things.  These
qualities, sensation and motion, are of necessity combined
always; they constitute the first ingredients in  the com-
position of life, both in vegetables and animals, and by
being modified in various  ways by their application to
different organs, may be traced up to the perfect animal,
man.
  Nutrition is the first want of every being, and is one of
the modes of sensation; therefore, before any other appa-
ratus  is provided for animal life,  means are resorted  to,
to carry it on.  Vegetables are fixed to  the soil, and are
furnished  with great numbers of porous roots, which by
spreading in different directions, come in contact with the
moisture of the ground and by simple absorption conduct
it as the aliment of the plant.  There are many animals
which have a vegetative life almost as simple as this, are
fixed permanently to the spot where they came into ex-
istence; others are permitted to  change their places of
abode, and a provision for  nourishment by roots would
not answer; hence comes the necessity of a stomach, or
reservoir in the interior of  the body, into which aliment
may be introduced, and transported along  with the  ani-
mal.   In many instances this stomach seems to constitute 
HISTOLOGY.
XI
the whole animal, as in a hydatid : it receives such sim-
ple fluids as compose the medium in which it resides, and
carries on its digestion, with so little change  of the  ali-
mentary matter, that there seems to be nothing of an ex-
crementitious kind, as commonly understood, thrown off.
These animals are found abundantly in the waters of
tropical regions, exist sometimes  in the brain of man, and
of sheep, in  the uterus, and in  almost every part of the
body.   But,  again, there are stomachs of a more complex
kind, which have opening into them  a great number of
absorbing orifices,  called,  in  the striking language of
Boerhaave, " genuine internal roots."   These stomachs
may admit fluids only, or they  may be large enough to
receive considerable masses of solid aliment.   In the lat-
ter case exists the necessity of teeth, or some mechanical
means of triturating the solid  food  into such fine pieces,
as will admit of its being exposed by an extensive surface
to the action  of the  stomach.   But as much of the matter
thus carried in is unfit for assimilation, and there may be
even  more of it than is  required, an intestinal canal is
provided, by which it is  carried out again.   Here, then,
commence the phenomena of a true digestion, with all its
modifications and stages.
   The very simple structure of a plant, and  its perma-
nent locality is attended with  a  circulation of its juices
equally simple;  which is performed and maintained  by
the capillary attraction of its  pores, and by evaporation
from its higher and  more exposed parts.  This circulation
is the more rapid as the evaporation becomes greater: but
the latter may become changed into  absorption by the
humidity of  the atmosphere;  and the circulation be as a
consequence  reversed from the branches to the roots. But
it is evident that such animals as possess extensively the
powers of locomotion, besides having organs more nume-
rous and more complex than the parallel fibrillae of vege-
tables, will frequently find themselves in such conditions 
XI1
HISTOLOGY.
of temperature and locality, that  a  similar circulation of
the nutritious fluid  in  them  could not be maintained.
Hence it is necessary to have more  powerful and regular
agents for carrying on the circulation.  They, therefore,
are furnished with innumerable blood vessels, called arte-
ries and veins, which have a  common centre, the heart,
for propelling through them  the  blood  or nutritive fluid
to all parts of the system.   From  the heart being fur-
nished with valves, which  are all  in one  direction, the
blood can flow only in a corresponding course; thus it is
forced by the heart into  the arteries, and after moistening
the most minute fibres  it is  received into the capillary
extremities of the veins and  brought back to the heart,
where it  receives another  impulse, and performs again
the round of the body,  and so on  in succession.   This
phenomenon is called the circulation.  When it exists in
animals, blood is always to be found; for the most part
red, but in many species white or transparent.   The use
of the blood in them is to receive  from the alimentary
canal, from the skin and lungs, such matter as has been
assimilated, and to convey it to every part of the body,
for the purpose of repairing its waste, or providing for its
growth.   It is at the very extremities of the arteries that
this deposite occurs, and the blood  getting into the veins
loses its bright vermilion colour, becomes of a modena or
dark blue, and is no longer fit for the purposes of life till
some of the principles which  it has lost by this passage
are restored to  it.   This restoration takes place in the
lungs, where a sort of combustion is  performed by the
absorption of oxygen.   This process is called respiration,
and it exists in all things that live,  under various modifi-
cations of the apparatus performing it.  In man it is per-
formed in two cellular air bags, which have a heart inde-
pendent of the one just mentioned, for propelling the
blood through the ramifications of  their vessels.  In fish
there are gills, which have their  surfaces exposed to the 
SENSATION.
Xlll
water, and are aerated by the air contained in the water,
and the same heart which supplies the general circula-
tion, also  fills a large artery, that is distributed very mi-
nutely through the  gills.   But in insects, where there
are no blood vessels, and the nutritious fluid is contained
in cells, there are, distributed over their bodies, air tubes,
which transmit atmospheric influence.
   The blood vessels, in addition to the function of carry-
ing nutritious matter, perform an essential part of a very
different character.   All the atoms of which the body is
composed, after residing in it for a time, become no longer
fit for use; their farther  residence is, in fact, injurious,
and it is necessary to remove them.   A system of vessels
is provided for this purpose, called the absorbents, which
are the scavengers  of the  body.  Taking up, therefore,
these effete atoms, they convey them into the blood ves-
sels, where they are mixed with the common  mass of
blood.  Several organs are provided, as the liver, the kid-
neys, the surface of the body, and  the  lungs, through
which these effete particles are discharged from the blood
in the form of excretions; as the bile, the urine, perspira-
tion,  and pulmonary exhalation.
   We have now sketched the human machine as far as
its internal existence, or self-preservation, is concerned in
the functions of digestion, circulation,  respiration, and
excretion.  Let  us proceed in the inquiry by  a rapid
glance at those organs by which it is put into a relation
with  surrounding  objects,  and  on which it depends for
the sublime operations of the understanding.
   Sensation  is derived from the nervous system, com-
posed of the brain, the spinal marrow  and the  nerves.
The latter may be  traced to many parts of the body, and
are supposed to be  distributed to all.   They maintain its
different  sympathies, keep the several organs  in one har-
monious course of action, and, in some instances at least,
are indispensable to the performance of their functions. In
   Vol. L—a 
XIV
HISTOLOGY.
 addition to these, many of the nerves have at their extre-
 mities organs of a particular construction, each fashioned
 in the best manner for the performance of its  functions,
 in making us acquainted with exterior objects.  The in-
 terior extremities of all these nerves terminate either in
 the brain or spinal  marrow;  the external  are the points
 intended by nature to be affected by the objects around
 us;  but it is indispensable to consciousness, that their
 line of communication with the brain be not interrupted.
 The sense most extended is that of the touch, which is
 enjoyed by all parts of the surface of the body;  the others
 are thought, by very respectable physiologists, to be only
 more exalted modifications of it, and are  susceptible of
 more delicate impressions.  It is scarcely necessary to
 mention that the other sensations are  executed by  the
 eye, the ear, the tongue, and the nose.

  The Sense of Touch is the most important of all, and
 the least liable  to error in its reports.  To exercise it, it
 is necessary  for the body, under  examination, to come
 into contact with ours: hence, its  operations are so me-
 chanical, that but little is left to the imagination, and they,
 therefore, serve to verify and  to correct the impressions
 on  the other senses, more particular^ those on the eye.
 It is the sense of touch by which we learn accurately the
 dimensions of bodies, and the figures of such as are hard.
 The hand, or any other part, by being  applied to them
 in various directions, informs us whether  they are flat,
 round or angular.  A greater or less degree of pressure in-
 forms us whether they are soft or hard, and by rubbing, we
 ascertain whether they are rough or polished.  The resist-
ance they make to motion, teaches us whether they can or
 cannot be moved, and their being impelled  against  us
 shows the momentum with which  they act, as well as its
direction.  Our ideas of heat and of cold are also derived
from this source. It is not asserted that all parts of the sur-
face of the body enjoy equally the sense of touch; on the 
SENSATION.
XV
contrary, this sensibility is more or less active, according
to the organization of the part, and as its nerves are more
or less numerous and exposed; hence we find it most ex-
quisite and perfect in the ends of the fingers.  This, there-
fore, being the most important of the senses the magni-
tude of its influence on the habits and intelligence of diffe-
rent animals is immense.
   Man, from the nudity and the delicacy of the  texture
of his skin, derives, from this source, a discrimination and
refinement, in regard to the nature of bodies, much  supe-
rior to what many other animals possess.

   The  Sight enables us to distinguish the colour, the
quantity, and the directions of the  rays of  light which
proceed from a luminous body; or,  in other words,  to as-
certain its situation, size, and  figure.   In each, however,
of the latter we are exposed to great deception;  for the
rays of light, by falling on  a  mirror, or any other plane
reflecting surface, before they reach the eye, will induce
us to believe the body to be  in that direction.   Bodies
which are near, reflect more  rays  of light than such as
are distant:  we thus estimate distance by the eye; but  it
happens continually, that some bodies naturally reflect
more rays than others;  in consequence of  which a  very
luminous body, at a great  distance, will frequently be
thought to be much nearer to  us, than such as are  more
within our reach.   Mistakes  of this kind  can only be
corrected  by the sense of touch, and our habitual  refe-
rence to it, and continued experience, finally enable  us to
form prompt and just decisions.  The eye, however, infi-
nitely exceeds the touch in the rapidity with  which  it
communicates ideas, and also, in the extensiveness  of its
application in a single moment.  It  is, therefore, an or-
gan of the first utility in making us acquainted with sur-
rounding objects.  Man does not possess it to that great
perfection that some other animals do; he can neither see 
XVI
HISTOLOGY.
 as  far  as  the vulture or  eagle, nor  so  minutely  as
 the  fly; yet  his ingenuity has  enabled  him to excel
 both.  For, with the  telescope, he examines worlds in
 the  immensity of space, which,  under common  exami-
 nation,  are either invisible, or form  mere points in the
 heavens.   And with the microscope he sees the texture
 of the most minute object.

  The Ear, along with the powers of articulation, enables
 the whole human family to make a common stock of the
 knowledge which each individual may possess.   As con-
 nected with the preservation of the individual, it is much
 less important than the eye or the touch : yet, considering
 it as a means by which we receive knowledge and impart
 it to others, the aggregate of human intellect depends for
 its present state and future improvement, essentially upon
 it.  In its acuteness, we are much inferior to many other
 animals; neither have we,  by instruments, been able to
 do much in improving it: yet, by cultivation and by stu-
 dying its most minute and delicate impressions, an end-
 less source of instruction and amusement has been opened
 to us, in the intonations of  language, and in  the enrap-
 turing strains  of harmony.  It eminently qualifies  man
 for the social state, occasionally warns him of danger, and
 allures him to such  things as are useful to his subsist-
 ence.

  In regard to the Taste and to the Smell, they make us
 acquainted only with such objects as are necessary to our
 subsistence.  They are enjoyed too imperfectly by man,
 for them to become a fruitful source  of his intelligence.
 As they principally lead us to filling the stomach, and to
 debasing the intellectual man into  the beast, that eats and
 dies;  the wisdom of nature is as fully demonstrated in the
imperfection which she has  put upon these senses, and in
our inability to improve them, as in the exalted and va- 
VITAL FUNCTIONS.
XV11
ried degrees to which she  has carried the others.  The
keenness of the scent of the hound, and the discriminating
nicety of the bee, in opening sources of enjoyment merely
physical, would have degraded, instead of elevating us;
by engrossing  our  time  and ingenuity, in the develop-
ment of pleasures incompatible with our constitutions and
destinies.

  Man  being thus constituted, it is worthy of inquiry in
what  his  life  consists.   According to the celebrated Bi-
chat, it  is  " the aggregate of those  functions by which
death is resisted.   For such, indeed, is the condition on
which we live, that every thing surrounding us has a
tendency to produce our dissolution, by the affinities ex-
isting between  their  atoms, and the atoms of which a
living body is composed.   It is  plain, therefore, that the
principle of life, like all other principles  in nature, incom-
prehensible in itself, must be studied by its phenomena."*
  There are two  remarkable modifications of life:  one
is common to the vegetable and  to  the animal, the other
is the exclusive attribute of the latter.   Under the first
modification, are included  assimilation  and  excretion,
which,  though exercised under apparently different cir-
cumstances in animals and in  plants, are probably essen-
tially the same in both.  This modification is termed by
Bichat,  Organic Life.  By the second modification of life,
the animal has a more extended  sphere of existence than
the vegetable, is put into a certain relation with  all the
objects that surround him, is made the inhabitant of the
whole world, and not like the vegetable,  confined for ever
to the place of its birth.  By it the animal feels, and is
conscious of external  objects, reflects upon them, moves
voluntarily, and can communicate, by the voice, his wants
and apprehensions, his pleasures and  his pains.  The

               * • Recberches sur la vie el La Mort. 
XVU1                 HISTOLOGY.
functions  included  under the  second modification,  are
termed, by Bichat, Animal Life.
  Each of these lives has two  orders of  functions, keep-
ing up its connexion with the objects destined for its ex-
istence.  In animal life, one of these orders may be said
to commence at the surface of the  body, and to be ex-
tended towards the centre, the  impression of exterior ob-
jects affecting first the senses, then the trunks of nerves,
and lastly, the brain.   A second  movement, constituting
the second order of functions,  is afterwards made from
the centre to the circumference,  by which the influence
of the brain is exercised on the organs of locomotion and
of voice.   These two functions, in animal life, are  per-
fectly equivalent in their operations.  He who feels the
most, will also act the most.  Early life is the period of
quick  and multiplied sensations, so is  it the period of
quick and multiplied  movements.   A partial, or  a total
privation  of the sense of sight,  causes us to move cau-
tiously  and  slowly  onwards.  The  suspension  of  our
communication,  through sleep,  with exterior  objects,
causes also a suspension  of the  faculties of locomotion
and of voice.
  In  organic life,  the first order of functions  assimi-
lates  to  the animal  the  substances which  must nou-
rish him,  and  includes  digestion,  circulation,  respira-
tion, and  nutrition;  under  the influence of  which  four
functions, every thing must pass  before it can be  assimi-
lated.   But, after a temporary residence, the assimilated
particles becoming effete and noxious, have to be carried
away out of the body: by which  means the second order
of functions in organic  life is established, consisting of
absorption, circulation, exhalation, and secretion.
  The two functions of organic life differ, however, from
those of animal life, in not observing, on all occasions,, an
equivalence  of action: the diminution  of  assimilation
does not  involve a corresponding  diminution in excre- 
VITAL FUNCTIONS.
xix
tion; hence, follow emaciation and marasmus, conditions
in which, assimilation  ceasing in part, disassimilation is
exercised to the usual extent,  or  near it.  From this
sketch, it is seen that  the circulation of the blood is the
connecting link of the  two orders of functions in organic
life, as the brain is the connecting link of the two orders
of functions in animal life.  The  blood is, therefore, in
fact, composed of two parts or descriptions of matter:
one is recrementitial, derived from the aliment, and sub-
servient  to  the renovation and growth  of parts;  the
other is  excrementitial, derived from the  wrecks of all
our organs,  and. under the necessity of being cast away
as useless.
   M. Bichat thinks  the division of  life into animal  and
organic,  fully warranted  by their differing  much  from
each  other  in  the exterior  shape of their respective or-
gans,—in their mode of action—in the duration of their
action,—in. the effects  of custom or habit upon them,—in
their relation to the moral part of man,  and in their vital
force.
   One of the most prominent differences in the two lives,
is the symmetry and duplicity of the Organs of Animal
Life,  and the irregularity in shape  of those belonging to
Organic Life.   The impression of  Light is received  by
two organs  exactly alike.  Hearing—Smelling—Touch-
ing—are likewise performed by organs  having their con-
geners on  the  opposite sides  of the  body; and  even
Tasting, though apparently performed by one organ, has
that organ divided into two equal and symmetrical parts^
thus making it like the other organs.  The whole exte-
rior  surface of the  body is, indeed, manifestly divided
into two equal parts, marked off from each other by  the
fissure in the nose, the upper lip, the chin, the, raphe of
the scrotum and perineum, the spinous processes, and  the
depression  in  the superior posterior part of the neck.
The Brain  and Spinal Marrow, as  belonging to animal
life, consist of two  halves, presenting corresponding ar- 
XX
HISTOLOGY.
 rangements in the development of cavities and  promi-
 nences, and so on, and in sending similar nerves to the
 organs of locomotion and of voice.
   The organs of organic life are marked, on the contrary,
 by the  character  of striking  dissimilitude in their two
 halves, as manifested in the liver, the spleen, the stomach,
 the intestines, the heart, and the great vessels belonging
 to it.  There  are, however, some organs of organic life
 in which the difference is less prominent, as the lungs of
 the  two sides, the pulmonary arteries,  the veins,  the
 trachea,  the kidneys,  the capsulae renales, and the  sali-
 vary glands.
  From  what has been said, we are,  perhaps, prepared
to admit with  M. Bichat, that animal life is double ;  that
its phenomena being executed after the same manner on
 both sides of the body, it is very possible for the actions
 of one side  to  be suspended or destroyed while those of
 the other go on.   This, in fact,  happens  in  certain  pal-
 sies, where  the sensibility and motion  of one side are so
 completely suspended, that it resembles a vegetable; all
 relation with exterior objects being cut off, and nothing
but  the  function of nutrition  being preserved; whereas
the  other side retains all its animal  properties.    For
 these reasons Bichat has very quaintly observed that we
 have a right life and a left life.  In organic life,  on the
 contrary, the functions of  the two  halves of any organ
 are  so allied,  that the lesion  of one  affects the  other.
 The liver, in a disease on one side,  has its functions im-
 paired throughout: it is the same with the intestinal ca-
 nal, and  with the heart.
  Congenital deformities are said to be more frequent in
the organs of  organic  life  than in those of animal  life.
 Several  cases  have  occurred,  and  Bichat  relates  one
which happened  in his own amphitheatre, where there
was a general  displacement of the digestive, the circula-
tory, the respiratory,  and the secretory viscera.   The 
VITAL FUNCTIONS.
XXI
 stomach, the spleen, the sigmoid flexure of the colon, the
 point of the heart, the aorta, and the lung with two lobes,
 were all on the right side.  But the liver, the ccecum,
 the  base of the heart, the venae  cavae, the vena azygos,
 and the lung with three lobes were on the left side.   All
 the organs placed beneath the middle  line, as the medias-
 tinum,  the mesentery, the  duodenum, the pancreas, the
 division of the trachea, were reversed. I have had occa-
 sion to  observe, in our own dissecting rooms, two cases of
 the caput coli removed from the right iliac into the left
 iliac region; the colon was of the common size and length,
 and being confined to the left side of the abdomen, formed
 there a loop, which ascended into the  left hypochondriac
 region,  and then descended as usual.   In these cases, as
 there was no transverse mesocolon, the duodenum had all
 the coats of the other intestines; and was not attached to
 the front of the right kidney and to the spine.   One of
 these was an adult female subject of considerable corpu-
 lency, the other a corpulent male.
   Another difference between organic and animal  life
 exists in the mode of action of their  respective organs.
 Each of the organs of animal life being double, our sen-
 sations  are the more exact, as there exists  between  the
 two impressions, from which they result, a more perfect
 correspondence.   We see badly when the images trans-
 mitted to the brain are derived through eyes of unequal
 strength.  Without  knowing  this law as theorists,  we
 instinctively  show  its influence in  shutting  one  eye
 while looking through a convex glass; whereby we pre-
 vent a confusion of images arising from two impressions
 of unequal force, concerning the same body: when one
 eye is weaker than the other, we squint involuntarily,
and it finally becomes a habit, in order to avoid  the con-
fusion of perception from two unequal images on the
brain.   This accounts for squinting,  both in early life,
from some congenital cause, and for that squinting which 
XXII
HISTOLOGY.
is the result of inflammation, in more advanced life.  A
little reflection on this head will satisfy us; for as a single
judgment or perception is, for the most part, formed from
the two impressions, one on each eye, how is it possible
that this judgment can be accurate, when the same body
is presented at the same  moment with vivid or  faint co-
lours, accordingly as it was painted on the strong or weak
eye?
  The Ear is subjected to the same law as the eye.  If,
in the two  sensations composing the act of hearing, one
is  received upon  an  organ better  developed than  the
other, and  more discriminating in its functions,  it will
leave an impression more, clear  and distinct; but  the
brain being affected simultaneously by the unequal  im-
pressions, will be  the seat  of  an imperfect conception.
This  case constitutes a false ear  in music, and from  the
impressions being continually confused, prevents  the
individual  from judging rightly between  harmony and
dissonance.
   A similar reasoning has been founded by Bichat upon
the structure of the Nose, Mouth, and Organs of Touch.
He believes also that the brain itself, as the seat of the
mind, may become the cause of error in our ideas, when
the two halves of it are  not perfectly alike; for example,
if one of the  hemispheres be more strongly organized
than  the other, better developed  every where, and more
susceptible of a vivid impression.  The brain transmits
to the soul the impression  or  impulse derived from  the
senses, as the latter transmit to the brain their impres-
sions ; it is, therefore, to be believed  that the soul will
perceive confusedly, when the hemispheres, being une-
qual in force, do not blend  into one, the double impres-
sion upon them.  In proof of  this, it is common to see
mental derangements depending on the  compression of a
hemisphere by effused blood, by pus, by depressed bone,
and by an exostosis from the internal face of the cranium. 
                   VITAL FUNCTIONS.              XXui

 Even where every sign of compression  is removed, the
 hemisphere occasionally takes a  long time to regain its
 action, so as to recover from the alienation.
   This harmony of action exists also in the  organs of
 locomotion, and of voice; and any thing which interrupts
 their symmetry destroys the precision with which  their
 functions are executed.
   Opposed to this harmony in the shape and functions of
 the  organs of animal life, the most striking differences
 may take place between the organs of  organic life, with-
 out  much disturbance  in the general result.   For ex-
 ample, in disparities of  the kidneys, of the lungs, of the
 salivary glands,  &c,  their functions are not? by any
 means,  the less perfectly performed.   The  circulation
 remains the same in the  midst of the frequent varieties
 of the  vascular system on the  two sides of the  body,
 whether those  varieties exist naturally, or whether they
 depend upon artificial obliterations of the large vessels,
 as in aneurism.

   Another very striking difference  in. the two lives may
 be observed in  the duration of their action.   All the ex-
 cretions proceed uninterruptedly, though not uniformly.
 Exhalation and absorption succeed each other incessant-
 ly ; assimilation and disassimilation follow the same rule.
 On the  other hand, every  organ of animal life, in the ex-
 ercise of its functions, has alterations  of  activity and of
 complete repose.   The  senses, fatigued by long applica-
 tion, are, for the time, disqualified from farther  action.—
 The Ear is no longer sensible of sounds:—The Eye is
 closed  to  Light;—Sapid  bodies no longer  excite  the
 Tongue;—The Nose is insensible  to odours;—And the
 Touch becomes obtuse.   Fatigued  by  the continued ex-
ercise of perception, of imagination, and of memory, the
brain has  to recruit its  strength,  by a  state of complete
inactivity for some time.   The  muscles, relaxed by fa- 
xxiv
HISTOLOGY.
tigue, are incapable of farther contraction, till they have
been  permitted to rest; hence the necessary intermission,
in every individual, of locomotion and of voice.
  This intermission of action is  sometimes extended  to
all the organs of  animal life at  the same time; on other
occasions, only a part of  them is affected  by it.   It is  in
this way that the brain frequently continues in the active
exercise of thought,  while  the senses, as well as the
powers of locomotion  and of voice are suspended.

  In  addition to the foregoing views,  it has also  been
suggested by  Bichat,  that another striking difference be-
tween organic and animal life, is found  in the epoch and
mode of their origin.   Organic life exists from the  first
moments of conception;  but animal  life  does not com-
mence  till after  birth, when exterior  objects are  esta-
blished in a certain relation  with the individual.  It  is
more  than probable,  that the functions of the Eye, the
Ear, the Tongue,  and the  Nose, do not  exist in  such
manner as to communicate their several sensations in the
foetus; and  that  the  enjoyment of a sort of indistinct
sense  of touch, arising from its striking against  the pa-
rietes of the womb, is the only circumstance which  can
give the latter any  idea of its existence; it is, however,
doubtful whether it has  even  a  consciousness  on that
point.   The organic  life, on the  contrary, of a foetus,
though not so complicated as afterwards is still remark-
able for the promptitude and vigour of some of its func-
tions,  particularly of  assimilation;  and in a  very short
time after birth, all the organs which it  employs reach
their  highest  degree  of  perfection, and thus present  a
very different  case from the organs of animal life.
  The distinction of the  two lives is  farther kept up in
their manner of ceasing in old age.  Natural death, says
Bichat,  is remarkable, in terminating animal life almost
entirely, a long time  before  it does  organic  life.  The 
VITAL FUNCTIONS.
XXV
functions of the first cease successively.   The Sight be-
comes dim, confused, and finally is extinguished.  The
Ear receives the impression of sounds indistinctly, then
faintly, and afterwards they are entirely lost upon it.
The skin becomes shrivelled, hardened, loses many of its
vessels, by their obliteration; and is only the seat of an
obscure and indistinct touch; the hair and beard become
white, and fall from it.  The Nose loses its sensibility to
odours.  Of all the  senses, it has been often remarked,
that the Taste remains the longest, and exhibits the last
efforts of animal life.
   The powers of the mind disappear  along with those of
the senses.   The imagination and the memory are extin-
guished;  the latter, however,  under striking  circum-
stances.   The  old man forgets, in an instant, what was
said to him, because, his external senses being weakened,
do not confirm  sufficiently the impression on his  mind:
he is, however, able  to recollect the transactions of early
life, and sometimes retains a  vivid impression of them.
He differs  from the  infant in this, that the latter forms
his judgments from what  is passing, whereas, the former
forms his from  what  has  already past.  Both are, there-
fore, liable to great errors;  for, the accuracy of knowledge,
in regard to things present, can only be obtained by com-
paring them rigidly with other things.  Locomotion and
voice also participate in the decline of the other organs
of animal life;  their powers are intrinsically weakened;
besides which, a certain degree of inactivity is imposed
on  them,  by the previous decline  of  the brain  and
senses.
   If we now consider, that sleep retrenches about one-
third  of the whole duration  of animal life; that nine
months of it are first lost  in gestation;  and that the ex-
tinction of our senses is the inheritance of old age; it will
be seen how great is the difference  between the whole
duration of animal, and of organic life.
  Vol. I.—c 
XXVI
HISTOLOGY.
  It has been remarked by Bichat, that the idea of death
is painful to us  only because it terminates our animal life,
or those functions which put us in relation with surround-
ing objects.  This is the privation which  plants terror
and dismay on  the borders  of the tomb.   It  is not the
pain of death that we fear, for many dying persons would
willingly commute death  for an uninterrupted series  of
bodily suffering.   But if  it were  possible  for  a man  to
exist whose death would  only effect the functions of or-
ganic life, as the circulation, digestion, and secretions;
allowing the exercise of the senses and the mind to con-
tinue, this man would view  with indifference the extinc-
tion of organic life; because he knows that the  happiness
of living is not attached to it, and that he  would  remain
after this partial death, still  in a condition  to  appreciate
all the delightful ties of existence.*

  * For a detailed exposition of the phenomena of the Animal and  of the Organic
Functions, see  Human Physiology, by  Robley  Dunglison, M. D.,  Professor, &e.,
Jefferson College. Philadelphia, 1841. Principles of Human Physiology, by W. B.
Carpenter, M. D. London, 1842.—And Elements of Physiology, by J. Muller, >I. D.
translated from the German  by W. Baly, M. D.  London, 1840, also the Philarie!-
phia edition of the same, arranged by John Bell, M. D., 1843. 
CHEMICAL  COMPOSITION.
  Upon the death of the body, the liquids and tissues
which compose it are, wrhen submitted to decomposition
by chemical process; found  to consist of a number of ele-
mentary ingredients which are common to it and to inor-
ganic bodies, and amount to about twenty.
  These Chemical Elements as ascertained up to the pre-
sent day to exist in a state of health; are, oxygen, hydrogen,
nitrogen,  carbon, phosphorus, chlorine, sulphur, fluorine,
potassium, sodium, calcium, magnesium, silicium, alumi-
nium, iron, manganese, titanium, and probably arsenic: also
iodine and bromine, which are almost exclusively from ma-
rine plants and animals. The oxygen, hydrogen, nitrogen,
carbon, and phosphorus of themselves make the principal
mass of the solids  and liquids.  The calcium is found in
great quantities in the bones in combination with  phos-
phoric  and carbonic acids,  the other elements exist in
much smaller proportions, there being but little  more than
a trace of  them found upon the  decomposition of any
part.  The metals and the metalloids are not in  their pure
state, but united to chlorine or in that of  oxyd  combined
with carbonic, phosphoric, or sulphuric acid.  They may
be detected in the ashes of most animal substances.   The 
XXV111
HISTOLOGY.
iron is considered generally as an essential ingredient in
hematosin or the colouring  principle of the blood, and
in the pigmentum nigrum, and it has been found also in
the lens and in the hairs.  The existence of arsenic has
been asserted by Raspail and  Orfila, who consider it to
be introduced in phosphoric aliments, which always con-
tain a small  quantity of it.   This unexpected declaration
which must of course have a most important legal bear-
ing; in cases of imputed poisoning has been contested by
Flandin and Danger; who declare that what Raspail and
Orfila consider as arsenical stains in their experiments,
are equally produced by sulphate and phosphate of am-
monia united to an animal substance.
  The most diffused chemical elements are the oxygen,
hydrogen, nitrogen, and carbon, they are the most essen-
tial principles of organic matter, as two  of them at least
must be present in every such compound.  The other in-
organic substances are found in much smaller proportion,
and seem to be merely  incidental to animal organism so
as to make out some physical condition, probably not abso-
lutely essential to life. Among these the phosphate of lime
holds  a high rank from its making about  fifty per cent, of
the skeleton, and next to it the carbonate of lime from its
making about eleven or twelve per cent, of the same: the
other incidental articles are formed in very small fractional
quantities, and appear more  as matters of curiosity than
as striking contributions.   The existence of some is even
contested.
  Between the above inorganized matters and the fully
formed texture, there is an intermediate condition result-
ing from their combination  into a series  of organic com-
pounds, called proximate principles or organizable sub-
stances.  They exist in the Embryo, and are also ob-
tained in the first stages of chemical analysis.   The most
abundant of them are Proteine, Albumen,  Fibrin, Caseine,
and Colla or Gelatine; but there are many others in com- 
CHEMICAL COMPOSITION.
xxix
 paratively small quantities, the traits of which will  be
 presented in place.
   The manner of combination of the simple chemical ele-
 ments to  form the above organic compounds, is not yet
 settled by Chemists.  Some  consider them as equally
 united,  and  view the organic compounds  as ternary  or
 quaternary in degree; others hold that two or three of the
 elements  form a compound radical, to which is  united
 another so as to form a binary compound.  The idea may
 be illustrated from inorganic Chemistry. Ether is formed
 by four atoms of carbon, five of hydrogen, and one of oxy-
 gen,  the  first  two make a hypothetical radical  called
 Ethyl, to which is united the one atom of oxygen; ether
 is thus an oxyd of Ethyl, and the formula of its composi-
 tion is Carbon, 4; Hydrogen, 5; +Oxygen, 1.
   In organic substances it is to be  remarked that an
 union limited to two simple chemical elements is very
 rare, the almost universal rule  being a compound radical
 of two or more substances united to  an  additional one.
 These organized unions of chemical elements are remark-
 ble too for the facility of their dissolution, both during the
 living and the dead state.
   Such obscurity prevails, however, on the "real nature
 or condition of these organic combinations of chemical ele-
 ments, that their reproduction in the laboratory by means
 purely scientific,  has scarcely advanced at all.   The ex-
 amples at present are limited to the  formation in Wohler
 of urea,  from the cyanite of ammonia in depriving it of a,
 little ammonia, by the influence of  heat;—^to allantoine,
 which is analogous to urea;—and to formic acid, which has
 likewise been elaborated by chemistry alone.
  The organic  compounds of animals are found to  a
 large extent  also in vegetables.  The first elaboration
from the inorganic state occurring in  the latter, renders
them, therefore, highly suitable as food for man, the transi-
tion or modification being an inconsiderable one from the
                         «* 
xxx
HISTOLOGY.
 vegetable  to the animal condition.  The  blood is the
 grand reservoir for the  introduction and distribution  of
 these organic compounds, each of which  has its utility,
 insomuch  so that  neither albumen, gelatine, caseine,  or
 fibrine alone will sustain life.

   Of substances, the result of organization and of a cha-
 racter essential to  it is Proteine,  which  is the  base  of
 all albuminous bodies both in the animal and vegetable
 kingdom.   It is found in albumen, fibrine, caseine, &c,
 united to a small quantity of sulphur, of phosphorus, or
 of salts, from which it is easily freed by certain chemical
 processes,  the formula  for which may be  readily found.
 In a humid state, this substance is gelatinous, insipid, in-
 odorous.   It is  insoluble  in water, alcohol, or ether.
 When dried it is brown, hard, and fragile.  When pul-
 verized, it  makes a yellow amber-coloured  powder.  It
 attracts moisture from the air, and when placed in water,
 swells up and resumes its  first condition.   On chemical
 analysis it is found to be composed in a hundred parts of
 16.01 of nitrogen, 55.29 carbon, 7 hydrogen, 21.70  oxy-
 gen.

   Albumen is the most universal of the products of pro-
 teine.  A  striking  example of it is the  white of an egg,
 where it is collected into a large  agglomerated mass, but
 it  is also found in the serum of the chyle, of the lymph,
 and of the  blood, in the serosity of serous cavities, in pus,
 in pathological secretions, and in the greater part of the
 liquids secreted from the blood.  Whatever tissue one
 examines, a proportion of albumen  is always found in it,
 and it is also one  of the constituent principles of the
 brain and of the nerves.   Its natural state is one of fluidi-
 ty, but it is easily evaporated to dryness, and then forms
 a brilliant transparent mass of a yellowish colour.  It is
 rendered firm or coagulated  by heat, mast of  the acids,
and by many of the neutral salts.  Its natural disposition 
CHEMICAL COMPOSITION.
XXXI
is  to remain fluid or semi-fluid, it is only when  under
chemical  influences that it solidifies.   It is so nearly
allied to  proteine, that, according to  Mulder, it differs
from it only by a very small introduction of phosphorus
and of sulphur into it, both together making but one part
in a hundred.*

   Fibrine, another of the productions of proteine is also
found in the blood, the lymph, the chyle, the serosity of
serous cavities, and is remarkable for  the quantity which
is thrown out upon inflamed  surfaces and  in inflamed
tissues.    It constitutes the base of the muscular system.
   It resembles exactly in appearance  albumen, and  the
principal characteristic distinction from it, is that of coa-
gulating  spontaneously.   The blood  of asphyxied per-
sons,  of  animals  dead from fatigue, of certain poisoned
individuals, and of such as die of hemorrhage from trivial
wounds, does  not coagulate.   It is hence inferred that,
in such  cases, the fibrine does not exist, f for  by  some
vital process it has disappeared.
   Under chemical analysis it seems to be almost the same
with  albumen, in Mulder's experiments it  contained a
little  more sulphur with  a trifling variation in the quan-
tity  of  the other ingredients.   It contracts with acids,
neutral salts, and different bases, the same combinations
with  albumen.   The  most remarkable chemical  diffe-
rence between the two is their habit in regard to oxyge-
nated water.  Chlorohydric acid makes a violet  colour
with albumen,—and an indigo blue with fibrine.

   Caseine, another of the products of proteine is found
principally in milk, but  is not confined to it, as it exists
also in the blood, the saliva, the bile, the pancreatic juice,
in pus, in tuberculous matter, and elsewhere.
   There  are  several processes known to  Chemistry for
obtaining  caseine.   One of  the most simple is that of
* Hcnlo, Encyclop. Anat., vol. vi. p. 33.
t Id. p. PP 
XXX11                 HISTOLOGY.
  Mulder, who adds acetic acid to milk, whereby the caseine
  is precipitated, washes the precipitate in pure water re-
  peatedly, squeezes the  water out on each occasion, and
  afterwards removes the grease with boiling alcohol.
    Dissolved in water caseine is of a pale yellow and of a
  consistence somewhat mucilaginous.  On being evapo-
  rated, it exhales the odour of milk, and covers itself with
  a white pellicle which upon  being removed  is renewed.
  On being perfectly dried it forms a mass of a yellow am-
  ber colour, easily reduced to  powder, and which  attracts
  the moisture of the atmosphere.   In the humid or dis-
  solved state, the addition of alcohol makes it opaque, and
  to resemble coagulated albumen,  this is produced by the
  abstraction of  its water.   It is soluble to a small extent
 in boiling alcohol, and from that state of  solution  it  may
 be extracted without any change of its  properties.
   The analogy of caseine with albumen and fibrine is
 very close in many respects, and  especially in regard to
 its power of coagulation, or capacity to change its state,
 so that it is no longer  soluble  in water.
   Caseine is coagulated by  heat, by alcohol, by acids,
 and by  rennet  or the stomach of  young animals.  In
 boiled milk the skin or pellicle which forms upon its sur-
 face,  is  coagulated cheese.  Alcohol precipitates it by
 abstracting the water which held  it in  solution.  Many
 of the acids coagulate it  freely, and notably the lactic
 acid which is produced from the sugar of  milk, when the
 milk sours.   Sugar of Lead is a powerful coagulator of
 the same.  The modus agendi of rennet or the dried sto-
 mach of young animals, in coagulating caseine or milk is
 as yet inexplicable.  Its influence,  however, in this re-
 spect is  truly remarkable.  Berzelius  coagulated 1800
 parts of milk with only one of rennet, and found that the
 latter had  lost only six  per cent, of its  weight.  It is
found upon experiment  that pure  caseine dissolved in
water is  not  coagulated by rennet, but  as the latter has
that power  upon caseine dissolved  in milk, it is  hence 
CHEMICAL COMPOSITION.
XXX111
suggested by Henle* as possible that the rennet only acts
indirectly by the conversion of the sugar of milk  into
lactic acid.
  Cheese which is  prepared by rennet alone is called
sweet cheese, and when prepared by lactic acid it is called
acid cheese.  It is supposed that it exists to. a limited ex-
tent already coagulated in fresh  milk, inasmuch as the
envelopes of the globules of milk appear under the micro-
scope to be insoluble caseine.f
  Common  cheese is a composition of dried caseine and
of butter.   Pure caseine, according to Mulder, contains
in one hundred grains 15.95 of nitrogen; 55.10 of carbon;
6.97 of hydrogen; 21.62 of oxygen, and 0.36 of sulphur;
also a quantity of phosphate of lime amounting indeed to
6,Si Per cent>tne presence of which is of the greatest im-
portance for the nutrition of infants and for the formation
of bone.

  Pepsine.  Is another combination of proteine, and was
discovered by Schwann in 1836.   It is formed and found
in the cells of the follicles and of the  solid  glands of the
stomach, and may be obtained by macerating the mucous
membrane of the stomach of an animal in water distilled.
A solution thus  made may be precipitated  by basic ace-
tate of lead, and afterwards separated  from  the lead by a
particular process.   This pepsine when largely  diluted
with water and mixed with a small quantity of acid con-
stitutes an artificial gastric juice which dissolves albumen
in six or eight hours; it has  the  same effect upon carti-
lage and  upon  cellular  substance.   It  resembles  very
much albumen, but, unlike  it, cannot  be precipitated
from its  combinations with acids by the ferro-cyanite of
potash.
  There  are some substances in  the  composition of the

  * Henle, Encyc. Anat. Vol. vi. p. 46.      f  Henle, ut supr. p. 47. 
xxxiv
HISTOLOGY.
body, which, according to Professor Henle, ought not to
be considered as belonging to  its immediate  materials.
They are Globuline; Spermatine; Mucus; Dacryoline
or the matter of the Tears; and the  Horn-like produc-
tions.
  Globuline.  This  material exists in the blood, and is
the name given by Berzelius to a residuum of it obtained
in a particular  way.  By diluting with  water the red
globules of the blood, they become transparent, swell up,
and at length disappear, seeming to have been dissolved;
but  they may in  fact be brought into view  again by
Iodine, which renders them opaque, thereby showing that
the colouring matter may be extracted by  water, and still
leave the globules behind.  By evaporating to dryness
blood diluted with water, if alcohol be added, the colour-
ing matter will be taken  up by the alcohol, and  the glo-
bules will be left;  this residuum then is the globuline of
Berzelius,  and  the  colouring  matter dissolved  by the
alcohol is the hematozine.
  Globuline upon trial  by chemical  analysis  is almost
identical with albumen and seems to be such in reality ;
only it is surrounded  by the capsule of the blood discs, with
perhaps  the nuclei.  Mulder considers it as belonging to
the combinations of  Proteine.   When extracted  accord-
ing  to the  process  of Lecanu  with  sulphuric acid, its
analysis  furnishes the following parts:  nitrogen 15.70;
carbon 54.11; hydrogen 7.17;  oxygen 20.52; sulphuric
acid, 2.50, which corresponds nearly  with four  atoms of
proteine  to one of anhydrous acid.

  Spermatine is a fluid obtained from the semen of ani-
mals.  At the moment of obtaining the semen in a fresh
state, it is placed in alcohol, upon which it contracts in a
few  minutes an opaline  colour and forms a clot, like a
pack thread, collected into a small bundle or hank.  It
may be dried in  this state when it forms a bunch of fila- 
CHEMICAL COMPOSITION.
XXXV
ments of the colour of snow.  The article thus coagulated
constitutes the spermatine of Berzelius, of Vauquelin, and
of John, by the last  two of whom it was discovered.   It
may be identified  by certain characters or habitudes in
regard to water, mentioned by Berzelius.
  This fluid  shows  under the influence of chemical
agents a close analogy with albumen.  An analysis of it,
however, must, to a large degree, be inconclusive, as the
seminal fluid from which it is obtained is a mixture of
the secretion of the testicles—of the vesiculse seminales—
of the prostate—of the glands of Cowper and of the ure-
thra—besides containing scales of epithelium—corpuscles
of mucus  and spermatic animalcules.

   Mucus.   Heretofore every thing has been considered
mucus which came  from the  surface of a mucus mem-
brane, excepting certain secretions of a decidedly specific
character, as the saliva, the bile, the urine, and a  few
more.   It is now, however, ascertained that in the fluid,
commonly called mucus, there are  at least three dissimi-
lar constituents, to wit:—the waste of the  epidermic mu-
cous membrane, pus, and the mucous secretion itself.
   The epidermic waste  or molt, resembles the scaly ex-
foliation which  is incessantly in progress from the cuti-
cle ; and  is formed  by the desquamation of the superior
layers, which, as  they fall off, are  succeeded by others.
 These scales are washed off by the fluid secretions of the
 part, and make to  the  mucous  membrane a glairy coat-
 ing, which is easily removed by scraping and by a stream
 of water.   The pus is found in catarrh, coryza, blennor-
 rhagia, fluor albus,  and  diarrhoea; and is formed from a
 liquid  mixed with  granules  of a  certain kind, coming
 from beneath the  Epidermis of the mucous membranes.
 The mucous secretion is the product of the muciparous
 glands, and is for the mucous membranes what the per-
 spiration is for the skin. 
XXXV1                HISTOLOGY.
Mucus from the  nose, according to the analysis
  of Berzelius, consists in Mucus essentially   -    5.33
An extract  soluble in alcohol and an alcaline
  lactate       .....    0.30
Chloride of Soda  and of Potash -      -       -    0.56
An extract soluble in water, with traces of albu-
  men and of a phosphate      -       -       -    0.35
Soda     ------    0.09
Water   ------   93.37
                                                100.00

   Lachrymal Matter or Dacryoline.  This is found as
 a residuum upon the evaporation  of the tears  in  the
 open air.  In this condition it forms a yellow and inso-
 luble mucus, which neither heat nor acids coagulate.
 Fourcroy and Vauquelin find in it one per cent, of a solid
 substance seeming to be chloride of soda principally; and
 the  remainder of this  one  per  cent, is probably  mucus
 and the scaly molt of the epithelium.

   The Horn-like tissues, are represented by the nails,  the
 hair, and the epidermis.  It was once supposed that they
 were formed from a fluid which dried up,  but it is now
 known that in the case of each  one, the primordial state
 is that of a  cell, with a contained substance and  a nu-
 cleus; and that it is an aggregation of such cells in a col-
 lapsed state, but  adhering  to one another  which consti-
 tutes the substances above alluded to.
   The cells or scales of the epidermis are held together
 by an intermediate substance which dissolves in  weak
 acids, and allows the scales  to separate and  float  about,
giving to them the fallacious appearance  of being dis-
solved also. 
EXTRACTIFORM SUBSTANCES.
XXXV11
               Extractiform Substances.

  Animal extractive  is very  generally diffused  in  the
tissues and humours of the body, but is found in greater
abundance than elsewhere in the muscular flesh.  This
matter is readily obtained by steeping a part in aqueous
alcohol, and then evaporating the latter entirely.  If pure
alcohol be poured  upon this  dry residuum, it removes
from it a substance called the  alcoholic extract, and what
is left constitutes the aqueous extract being soluble alone
in water, and constituting what Thenard  has called
Osmazome (from wm and C*^«s-, smell and soup) it is found
abundantly in  soups or bouillons, and  in them is mixed
with gelatine in the  proportion of one part to seven of
gelatine.  It is the osmazome which gives flavour spe-
cifically to soups and meats.
  The  above extractiform substances show themselves
under several modifications when tried by chemical tests,
the processes whereby they may be detected are set forth
in the works on organic chemistry, and for a summary
of them we may refer to Henle's General Anatomy.*
It may be here sufficient to state that these modifications
are found in the tissues respectively, and also in the fluids
and in  the secretions as the saliva.  One is called Ptya-
line, from its being  found in the salivary secretion, ano-
ther  Creatine,  from its being found in the liquids of
meat.  There are also  several  others which  may be dis-
tinguished by different chemical agents.

              * Encyclop. Anat., torn, vi., p. 66.
Vol. I.—d 
HISTOGENY*
                        OR THE


     ORIGIN OF THE ELEMENTARY ORGANISMS.

  In animals we find  at an  early period of their evolu-
tion, and during  their whole life, corpuscles so exceed-
ingly fine as to require a microscope  to see  them dis-
tinctly.   They have a certain  characteristic shape and
are called elementary cells, primitive cells, and  also nu-
cleated cells, from  the existence of a small point or nucleus
within'them.  They  are, in fact, vesicles with  parietes
extremely attenuated, contain a fluid of some kind, occa-
sionally granular, and have  attached  to their walls or
lying loosely a smaller body, which  is  called the ker-
nel or nucleus, and  also cytoblast in the  language of
Schwann.   The nucleus presents, on most occasions, one
or two spots or points, of a regularly rounded shape, and
which go under  the name of  nucleoli.   The  nucleus
itself is of a rounded or  ovoidal shape, somewhat flat-
tened, is colourless or of a reddish yellow, smooth, or
granular like a  raspberry, in  which  case  its  nucleoli
are imperceptible.  Its  diameter is from  the two to the
four thousandth  part  of a line, or from  the rT^n to the
                X            '            2 40 00
TsTdoo °f an incn-   This nucleus appears  sometimes itself
to be made  out  of a membranous  envelope with a con-
tained fluid.
     *  l5-T«? texture,  yev*e-/5 generation, Qirvroi cell, germ, j8a«$toS. 
                 ELEMENTARY CELLS.            XXXIX

  The above elementary cells, at an early period of their
existence are soluble in acetic acid, the nuclei being left
behind, the nucleoli are to the same degree indestructible
by this agency.  The nucleoli are of a doubtful charac-
ter, it being unsettled whether they are stains, globules,
lacunae, or  vesicles in  the nuclei.  Schwann says, that
they are upon the outside of the nuclei in the round cells,
and on the inside of the nuclei of the concave cells.
  The w-alls of primary cells  are homogeneous or amor-
phous, i. e. they appear to  have extension with the least
conceivable thickness, are  perfectly smooth under the
highest magnifying  powers, and  have neither filaments
nor granulations, or any thing else indicative of an inter-
rupted surface.  The best idea of them would, perhaps,
be derived  from the inspection  of a very  small soap
bubble.
  The elementary cells are situated in  a substance also
amorphous,  and called  by Schwann Cytoblastema, and
which executes  the  office of an intercellular substance.
When this intercellular substance is liquid, the primary
cells float freely  about in it, as in the case of the  blood ;
but when  the cytoblastema has  more consistence, the
cells  are fixed to their places, and  even glued together
with some tenacity, with a force, in fact, requiring a spe-
cial solvent to free them.
  The progress of these primary cells may  be studied in
the incubated egg, in the tissues of the body which are
in a constant state of reproduction, as the nails and hairs,
and also in  the exudations of  fibrine which occur on in-
flamed surfaces.   The vegetable  kingdom,  also, accord-
ing to Schwann, presents analogies or repetitions of the
process, precisely identical with what occurs in the ani-
mal kingdom.
  The phenomena are as follow.  An amorphous fluid
by some internal change becomes granular:   This-amor-
phous fluid is gum. in. a-,plant,, but albumen, in. an^ animal. 
Xl                    H1ST0GENY.

The first perceptible change from this condition of uniform
and unclouded transparency, is the appearance of nume-
rous extremely minute granules, which make the fluid tur-
bid.   This state having remained for a short time, certain
granules larger and more defined than the others are seen,
and appear to augment by collecting the finer ones around
them.   This is the first state of nucleus, or cytoblast, or
cell-germ, as it is also called.*   From the surface of each
cytoblast a delicate membrane rises up in an attitude re-
sembling that of a watch glass to the dial, this membrane
increases in extent and magnitude,  until it envelops  the
cytoblast so completely that the latter is seen  merely as
a nucleus on its wall.   The consistence of the cell is for
some time  very soft, and occasionally it  disappears from
trifling disturbances, as a slight agitation  in the surround-
ing fluid.
   According  to  Schleiden, the function of the nucleus
ends with the evolution of  the cell,  but others hold that
the granules of which  it is composed become the germinal
points of other cells, to be  developed within the original
one.
   The elementary granules  being the first of  form,
[morphonomy) the opinion is entertained, from the pre-
sent state of our knowledge, that they are vesicles con-  #
sisting in a small sphere or goutlette of fat, enveloped by  .
a membrane.  The existence of a membrane, though then
invisible, would  seem to be proved  by the circumstance,
that the spherules are kept apart in this miniature state,
but  when  they have augmented, then the exterior enve-

  *" The discovery of this germinal coagulation as the first formative act
has been attributed to  Schleiden, see Mtiller's Archives, 1838, and to
Schwann  Mikroskopische, &c,  1839, a much more ancient author
may, however, be quoted with greater propriety in the following words,
" Nonne sicut lac mulsisti me, sicut caseum me coagulasti, Job, x. 10.
Hast thou not poured me out as milk and curdled me like cheese." 
ORIGIN OF CELLS.                 Xil
lope is absolutely seen.  The envelope itself is considered
as a modification of proteine, and is soluble in acetic acid,
upon which act the granulations readily coalesce, and are
easily dissolved  in  boiling ether or alcohol, which they
had previously resisted.
  The above modification of proteine is, probably, albu-
men ; and an observation bearing on this point was origi-
nally made by Ascherson.—To wit:  that albumen never
fails to coagulate in a membranous  form when it comes
in contact with fat.  Under this law a particle of grease
cannot for a moment be in contact with albumen, without
the latter  being drawn over  it in a membranous  form.
A drop of each of these substances in a fluid state put in
contact on a plane surface, exhibits instantaneously this
phenomenon,  in the formation of a delicate and elas-
tic  membrane around the fat, and  which covers itself
with  numerous elegant folds.   Oil and albumen shaken
in mass together exhibit the same upon "a larger  scale.
A decisive proof of the existence of  the capsule of albu-
men thus formed,  is that a process  of exosmosis and of
endosmosis occurs in its  parietes, so that a fluid having
an affinity for the oil makes the capsule expand or con-
tract into wrinkles, according to circumstances*  upon its-
being brought into contact with the capsule.
   This striking experiment has been  seized upon by
Henle to elucidate what occurs in the formation o£ living
elementary granules.  Fat and the combinations of pro-
teine are  incessantly introduced into the system by the
action of the animal organism on aliments, so that they
are found in the chyle, in the  blood,  and in all the fluids
of the body.   The fat on its formation becomes  quickly
surrounded by a film of albumen, so as to  prevent  its
particles from collecting into masses of large size, and the

               * Encycl. Anat., vol. vi., p. 164.
                          D* 
 Xlii                  HISTOGENY.

 particles thus situated may become  elementary granules
 in being deposited in the texture of organs.
    It is not, however, pretended  that a process so purely
 physical as the formation of a film  around a drop of fat
 gives all the explanations requisite for the understanding
 of a vital process, for an organic  cell and an artificial one
 are as different from each other as a dead  body is from a
 living one.  Chance alone produces the  resemblance so
 far as it exists in form; the vital  force of one makes after-
 wards an incomprehensible and unlimited  difference.
    It  may here be remarked that the globules of fat com-
 mon to the fluids of the body are kept when in a healthy
 state within certain  limits of magnitude;  and that in the
 case of pus, it is of a bad nature when the fat globules col-
 lect into large drops, hence the latter are seldom or never
 seen in pus of a good quality.
   In the estimate of the sources of elementary cells, it
 may also be  remarked, that there is another act of the
 animal body exhibiting some analogy.  It is known, for
 instance, that fibrine in coagulating, forms  naturally a
 reticulated or cellular arrangement containing serum; in
 some cases even vesicles are thus produced-, when a clot
 remains for some time in a living vessel  or canal;  and
 sometimes such vesicles are seen erecting  themselves so
 as  to be appended only by a pedicle.  Henle has seen
 this assumed  cellular arrangement containing serum, in
 polypi of the heart; in the membrane  of croup ; and in the
 plastic exudations of the womb, and of   the intestinal
 canal.   He concludes, therefore, that many  hydatids
 come  from such cells taking on  a spontaneous growth.
 Dujarden has observed a similar  process to the above in
 an  exudation, which he  calls Sarcode, coming from the
 bodies of dying infusory animalcules, and  from the frag-
 ments of the higher animals.  In this matrix is generated
small  insulated globules, which finally acquire a larger 
EVOLUTION OF CELLS.
xliii
size at the  expense of the matrix, which  ultimately col-
lapses, and is reduced to  a very small  residuary mat-
ter*
  Another hypothesis in histogeny is that of Raspail and
of Schwann, who see in the elementary cells phenomena
analogous to the formation of crystals in inorganic matter,
the difference being that these organic crystals execute
an imbibition of new molecules for  their growth, while
inorganic crystals  grow  merely  by  apposition.   The
points in detail of this theory are so much in the line of
gratuitous assumption, that much remains yet to render
it acceptable.
  Upon the multiplication of cells depends the reproduc-
tion and growth of  the body.   In  some cases these cells
are  secreted  in  succession, from, a matrix which is the
cutis  vera in the case of the epidermis, the nails, and the
hairs.  Each cell in  them  is developed in  an insulated
manner, and  reaches its perfect state by its formative
force  alone.  This occurs in tissues  having but an infe-
rior degree of vitality as the above.   But in the majority
of instances, the formation of one cell depends upon the
action of pre-existing cells.   It becomes an act of gene-
ration, wherein, the new cell forming  at first an appen-
dage of an older one; the older cells finally disappear and
are succeeded  in full by the  new cells;  and this act of
succession  in generations is constantly going on during
the life of the individual.   This process reduces animal
life to an  evolution of  cotemporaneous and intercur-
rent generations of monades:  each  generation parting
with its vitality in behalf of proximate succeeding gene-
rations, but in such a. way that the life of the whole sys-
tem is continually kept up.   In. general death, the act of
regeneration, is of course universally arrested.
  The generation of cells  as above is. produced in two
* Henle, Encycl. Anat, vol. vi., p. 168. 
Xliv                  HISTOGENY.
ways, one called exogenous from its occurring in the form
of an excrescence or sprout on the exterior of preceding
cells.  Henle considers  this act  to be  confined to the
lower conditions  of vegetable  life.*   On the contrary,
Miiller asserts it as of common occurrence in many ani-
mal tissues.  In this case the cytoblastema, or matrix,  of
the new cell is on the exterior of the older  one.  The
other mode is called endogenous, because it occurs within
the circle of the old cell from the cytoblastema which it
contains.   The most conclusive proof of the latter is pre-
sented in the development of the  Embryo at the expense
of the granular contents of the yelk of an egg.  From the
observations of the German  physiologists it appears, that
in certain molluscous animals the  first act of evolution of a
germ is the appearance of three or four globules, these con-
tain others, which grow in their turn, and distend the pre-
ceding; then a third generation occurs within the walls  of
the second, and so on successively until  a homogeneous
mass of cells is formed, which shows almost completely the
form of the young animal.f  Morbid productions assist in
throwing light on this point of inquiry.  Valentin has
observed in carcinoma a cell containing two others, each
provided with a nucleus.   J. Miiller has witnessed young
cell's enclosed in older ones in cases of medullary sarcoma
and some other cancerous affections.
  In healthy tissues the same experience exists, for ex-
ample, in the formation of cartilage and in the growth  of
glands.   The granules  of mucus are nucleated cells,
those of  pus and  lymph also.  Schultz was the first  to.
discover  that the  blood  discs,  or corpuscles,  are of the
same description, the matter which gives them  a colour
being contained within them.!

               *  Encycl. Anfit., p. 172, vol. vi.
               t  Id. p. 173.
               X Muller, Physiol., p. 1644. 
EVOLUTION OF CELLS.
xlv
  In  the  vegetable kingdom  young cells are generated
also by partitions traversing the interior of the older cells:
the divisions which occur in  the interior of the yelk of
an egg are considered as an analogy in the animal king-
dom,  though, with  this exception, the examples are defi-
cient.
  As each tissue of the body can produce cells of an as-
similated  nature, so wThen accidents occur to such tissues,
as in  the case of a ruptured bone or muscle, the ruptured
ends  take on a  similar action for the repair of the acci-
dent.  The proceeding is modified according to the tis-
sue ;  if, however, in those accidents the ruptured ends be
kept too far apart, the  action does not extend to a suffi-
cient  distance, and  the  cure is incomplete, the interme-
diate  substance not conforming  to a proper  nature.   In
most  instances common cellular  substance  supplies the
deficiency.  It is under this law that Henle has asserted
that light  and repeated congestions are followed by simple
hypertrophy,  as in the muscles  and epidermis, while
greater congestions  produce degeneration, induration, and
suppuration.

  In  the  early  state of the foetus we find nothing  but
cells.  They are held together by a substance which is
called hyaline from  its resemblance to glass, that is, being
smooth, shining, destitute of  fibres, and exactly homo-
geneous in its appearance. Occasionally this intercellular
substance is granular or even filamentous.  The cells
themselves in  the ulterior development of the being, un-
dergo for the most part  metamorphoses which finally
bring them into  the condition of the several tissues enu-
merated at the beginning of this  treatise as representing
the classification of Bichat.   Some of the  cells retain,
however,  permanently  their  original  character.   The
formation  of cells is though, as previously remarked, not
limited to any period of life, but  is constantly going on, 
Xlvi                  HISTOGENY.
 as these minute organic bodies are interposed in all the
 functions of life, being involved  in  the  secretions, con-
 nected with nutrition, found floating in  numbers  in all
 the assimilated fluids, and participating largely in inflam-
 matory actions.
   One might infer from the simplicity of this inceptive
 step of an organized being, that is, the presence of a mere
 cell from which others are generated, either internally or
 externally, that wherever an organic compound, as pro-
 teine or any  of its cognates existed, there  would be a
 spontaneous evolution of animal life in it,  without the aid
 of fecundation.  This opinion has in fact had numerous
 supporters and is not destitute  of advocates at the present
 day;  but the progress of knowledge is  revealing con-
 stantly so many exceedingly minute forms of animal and
 of vegetable life, that it leaves as the strongest ground of
 inference,  that in  all cases of apparently spontaneous
 generation, ovula have  been invisibly deposited in and
 around the matrix.   Moreover, recent experiments show
 that neither vegetation nor animalcular evolution will be
 exhibited in fluids which have been subjected to such
 processes as must inevitably kill any germs which may
 have been deposited in them.
   From the state then of nucleated Cell, as described in the
 foregoing pages, all the tissues may be traced as they exist
 in the  perfect and mature animal.  The metamorphoses
of the  cells are found to have affected both its walls and
 the nucleus.
  In some instances the  cells  continue independent of
each other, there being no disposition to coalesce, this habit
is remarkable in the blood corpuscles, in those of the
lymph  and the chyle, in the case of the circulating fluids:
and in  the epidermis, some pigment membranes, and the
fat cells.   In certain  cases such  cells grow largely;  for
example, a young elementary fat cell will be found at
first only the ^ of a line in diameter, and subsequently 
CILIA.
xlvii
grows to be the ~ of a line.   The shape of cells is also
modified very much by pressure, some are flattened, some
are pentagonal or hexagonal, some cylindrical, some pris-
matic, some cuneiform or conical.
  A very singular metamorphosis of certain cells is where
they produce at one side, or at  various  points,  small
thread-like elongations or fringes, called cilia from their
resemblance  to  the eye  lashes.  Such fringed  cells are
generally flattened whatever may be  their shape beside,
as pentagonal,  cylindrical,  or  conoidal, and are placed
upon free or non-adherent  surfaces.
  The Cilia, according  to Purkinje and Valentin,  are
flattened, their points being rounded off; some are fusiform;
and their length is from about j^oto idoo °*an incn* They
are disposed in rows of some regularity. During life, and
for some time after its  extinction, they have a  sensible
waving motion, resembling that of afield of wheat agitated
by a steady breeze, each one bending forwards and back
again, and  having also a gyratory motion.   The action of
the cilia produces a current in the fluid contiguous to them,
the course of which  may be rendered very plain by mixing
with the fluid particles finely powdered charcoal.  The
integrity of the  cells, to which the cilia belong, is essen-
tial to this  motion ;  for if they become dry or altered by
putrefaction or chemically, the cilia  cease to play.  The
scrapings of the throat of a frog are well suited to this dis-
play of epithelial ciliary motion. On one occasion, the lat-
ter was seen to last for seventeen hours, in a frog.  In a tur-
tle's mouth, it was found to last for nine days after decapi-
tation, in the trachea and lungs, for thirteen days; and in
the oesophagus  for nineteen days.f  It appears to be en-
tirely independent of muscular motion,  as the removal of
the brain and spinal marrow in frogs does not affect it,
     * Muller's Physiol., p. 859,
     t Todd and Bowman, Physiol. Anat., p. 62, London, 1843 
xlviii
HISTOGENY.
 neither does  the administration  of hydrocyanic acid,
 opium, strychnine, belladonna, or electricity.
   This phenomenon exists to great extent in the animal
 kingdom. In man it has been observed upon the surface of
 the ventricles of the brain and upon the choroid plexus,
 upon the Schneidarian  membrane, the soft  palate,  the
 pharynx, the Eustachian tube, extending to the cavity of
 the tympanum, upon the lining  membrane of the frontal
 sphenoidal and maxillary sinuses, upon the lachrymal
 passages, upon the lining membrane of the larynx, trachea
 and  bronchial  tubes, upon  the  lining membrane  of  the
 uterus and of the Fallopian tubes.
   To resume in regard to the  metamorphoses of cells,
 they have a faculty of thickening their own walls,  which
 is very  perceptible in the  cylindrical epithelial cells of
 the intestinal  canal  and in the cells of cartilage.   Such
 cells as are thickened by a deposite of internal stratifica-
 tions, present a striated appearance in their progress; and,
 in certain cases, the cell is entirely filled,  becomes flat-
 tened and  solid, and all distinction  is lost between  its
 parts, as occurs in the upper layers of the epithelium.
   Another phenomenon attending the  life  of cells  is
 their rupture or dehiscence and final disappearance.  The
 corpuscles of the lymph and of blood are considered as
 examples of this.  In the blood disc  upon the absorption
 of its nucleus, the investing membrane thins down,  is
 more  easily destroyed by chemical  agents as it grows
older, and finally ends by being dissolved wholly.*   The
cells of glands, commonly called mucous granulations
 when they are evacuated whole, undergo the same pro-
cess naturally.   The dehiscence  or partial destruction of
cells makes them enter into free communication with other
cells, or with the surface of the body; or with the cavities,
being excretory ducts or otherwise, with which they are
* Henle, Anat. Encyclop., vol. vi. p. 185, 
CILIA.
xl^ix
 connected.  It is said that it is such a dehiscence which
 gives to the peripheral ends of excretory ducts, as of the
 salivary glands and mammae, their globular termination.
   Cells are blended with contiguous ones by several modes
 of union.   In one mode, their walls being; thickened as
 explained above, they coalesce with adjoining cells simi-
 larly circumstanced, and with the intercellular substance:
 the cavities of the cells remaining all the time separate.
 Henle thinks  it to be on this  principle that ossific carti-
 lages are developed, consequently, the  bones themselves
 and the cement of the teeth.
   In another  mode of  union, the  cavities of the cells
 communicate freely, in consequence  of the  removal of
 their parietes where they come into contact.  In some in-
 stances they make a continuous tube  in that way, from
 several of them being in the same line.   In other instances
 they are so grouped as to  make a cluster of communi-
 cating cells.   In other instances, still,  they are branched
 so as to make radiating communications.
   There are several  points of a very  minute character
 connected  with the development and transition stages of
 cells, and of their nuclei into tissues: such as their fusion
 with each other, their metamorphoses by the reception of
 the ingredients or organisms of the  tissues respectively,
 and also  their evolution into filaments and canals.  The
 details cannot be very conveniently introduced on the pre-
 sent occasion, but they are subjects of deep interest and
 curiosity; for an exposition of which, see the General Ana-
 tomy of the Tissues under their respective heads, and also
 the same by a very careful  and distinguished observer,
 Professor Henle, in his work on the History of Tissues.*
  The foregoing observations on the primordial cells of the
 human body have their value established by the circum-
stance, that the nutrition of a part consists in the growth

              * See Encycl. Anat., Paris, 1843.
  Vol. I.—e 
1
HISTOGENY.
of individual cells.  The latter derive their  nutriment
from the organic compounds supplied by the blood, each
set of cells making its selection upon the principle of a
special  affinity, for some particular constituent of that
fluid.  Every cell is, therefore, to be considered as parti-
cipating in the phenomena of life and of organization, by
the influence which it exercises in its place.  The modi-
fication  of vital  force,  or the character precisely of that
force, constitutes the problem of life, which, in the present
state of  the human mind, must be inexplicable; it is,  in-
deed, an ultimate  fact of Physiology, of an inscrutable
character, an endowment of matter too subtle for human
investigation.

                    Glue, or Collet.
   Glue  may be  obtained from  many animal tissues, but
never exists in them  in that  state, and is  produced by
boiling  them in water.   The substances most productive
of it, are  bones, cartilages, tendons, cellular tissue, and
ligamentous matter.  The tendons and true ligaments
are so  prone to this  transformation, that they yield a
weight of glue equal to their own weight, both being dry.
   In the process of producing glue by the action of boil-
ing water, there is neither a disengagement of gas, nor
an absorption of any of the constituents of the atmosphere.
Acids, much diluted, favour the process.   The substances
which yield glue in the fully organized body, if treated in the
same way during the earlier periods of development, pro-
duce what is called Pyine,* a matter differing from glue.
The common characters of glue are so well known as not
to require a description on the present occasion : its che-
mical analysis, according to Mulder, yields in one hun-
dred parts, 18.350 nitrogen,—50.048 of carbon,—6.477 of
hydrogen,—and 25.125 of oxygen.   It has also  a very
small quantity of phosphate of lime in it.
* Henle, Anat. Encyclop., t. vi. p. 70. 
            CHONDRINE—PYINE—HEMATINE.          ii


                      Chondrine.

  Chondrine, resembles in many respects glue, and was
first discovered and designated by J. Miiller.*  It is ob-
tained by boiling in water the cartilaginous rudiments of
bones, the  articular cartilages, the fibro cartilages of the
nose, ear, larynx, trachea, and  some other parts,  as  the
cartilages of the ribs.   It  requires  a more protracted
boiling than common glue  to produce it,  and is the base
of the permanent cartilages.  It is precipitated from solu-
tion by alum, sulphate of alumina, acetic acid, and acetate
of lead.  Mulder's analysis showed in its composition 14.44
of nitrogen,—19.56 of carbon,—6.63 of hydrogen,—28.59
of oxygen,—0.38 of sulphur.  Like glue, it contains about
6 per cent, of inorganic matter, chiefly phosphate of lime.

                        Pyine.

  Pyine, discovered by Gueterbock,  in pus, whence its
name; is found also elsewhere as in mucus, and in tuber-
culous matter, in granulations, in false membranes of a
recent date, in the skin of a foetus, in condylomatous pro-
ductions, and  in fine, wherever there is  a  cellular sub-
stance imperfectly developed.  It is obtained by adding
alcohol to pus, which precipitates the pyine with albu-
men, it may then be  separated from the latter by water.
The principal test for it, is alum, which precipitates it in
flocculi from a state of solution.

                      Hematine.

  Hematine is  the colouring matter of the blood, and is
found in the blood discs or  globules, though under cer-
* Elem. Physiol., vol. i., p. 390. 
iii
HISTOGENY.
 tain circumstances, it is free in the liquor  sanguinis  or
 the fluid part.  It is thought that in some certain states
 of the blood, the blood discs being formed as they are, of
 a vesicular envelope and  a contained fluid, when the
 liquor sanguinis  is  too  much inspissated  some  of the
 fluid of the blood discs leaves them by exosmosis and joins
 the liquor sanguinis, the vesicle becoming somewhat col-
 lapsed; and on the contrary, if the liquor sanguinis be too
 fluid, the vesicles absorb some of this fluid  and become
 turgescent.  While in the former process, the solid consti-
 tuent of the blood discs, as the hematine, passes outwardly
 and may become mixed with the  liquor sanguinis.
   Pure hematine may be obtained by several proceedings
 known to the operative chemist, as through the reaction
 of alcohol,  of ether, and of sulphuric acid.*  According
 to Miiller, its chemical composition in 100 parts is, Nitro-
 gen  10.54,—Carbon   66.9,—Hydrogen  5.30,—Oxygen
 11.01,—Iron 6.66.  In a dried state it has a dark-brown
 colour, with a few brilliant  points, and it is insipid and
 inodorous.

                         Bile.

   This secretion is formed by a resin, according to The-
 nard, of a  green colour,  not  very soluble in water and
 completely soluble in  alcohol.  It also contains Picromel,
 or a biliary sugar.  This is  colourless and inodorous,
 has  a sweet taste  which endures for some time in the
 mouth, and  is also in a slight degree bitter.   In addition
 to  the preceding constituents of bile, there is Taurine—
 Cholic acid—and a colouring matter.  In a recent ana-
lysis of the  bile, by Berzelius,  he has been  induced to
believe, that the  principal element of bile is a substance
* See Anat. Encyclop., vol. vi., p. 77. 
UREA AND URIC ACID.
liii
which he calls Biline, easy to decompose, and by the aid
of acids convertible into five other bodies.
                Urea and the Uric Acid.

   Urea is found principally in the urine.  It is also in
 the blood and in the secretions from it, when the function
 of the kidneys has been invaded either by disease or by
 the ablation of these organs.
   It is readily obtained by evaporating the urine to a sy-
 rup, then adding nitric acid to it, so as to make a nitrate
 of urea.   The nitric acid may afterwards be detached
 by carbonate  of barytes, and the urea being then disr
 solved in  alcohol,  the latter is  driven  off by evapora-
 tion.
   Uric acid is found in the urine of carnivorous animals,
 and also in urinary and in arthritic calculi.  The urine
 of serpents and of birds is formed almost wholly from
 the urate of ammonia.  This acid  is. precipitated in a
 state, almost perfectly pure, from  the human urine by the
 influence of a low  temperature.   The precipitate is  at
 first powdery and gray, the colour afterwards changes to
 a pale rose hue—and by drying,  it assumes the  form of
 scales, which are the smaller as the acid  approaches a
 pure state.

   The preceding substances enumerated and described
 as Proteine and its  products—also the Extractiform Suh-
 stances—the Colline, or gluey ones—Hematine—the con-
 stituents of Bile—Urea and Uric acid.are all distinguished
 by a large proportion of nitrogen in their chemical com-
 position.
  We have next to take into consideration certain animal
 matters, which are destitute naturally of Nitrogen—these
are Sugar of Milk—Lactic acid—Saponiflable  Fats—-
                         E* 
hv
HISTOGENY.
the  Non-Saponifiable  Fats—Fatty  Bases—and Fatty
Acids.

                   Sugar of Milk.

   Sugar of Milk is found in the milk of woman and in
that of the females of all mammiferous animals, in some
cases where the secretion of the mamma has  been sup-
pressed, it has been found, or, at least, supposed to be in the
fluids, secreted from the intestines or deposited in the
peritoneal cavity.  A case of the latter kind occurred to
Schreger in the year 1800.*
   It  makes about two-fifths of  the  solid residuum of
milk when this fluid has been evaporated to dryness, and
may be obtained, by depriving the milk of its butter and
cheesy matter, and then evaporating it to the consistence
of a syrup.  When it gets cool the saccharine matter is
deposited in crystals, and it may then  be purified by
successive solutions followed by crystallizations.
   The specific gravity  of  sugar of milk is 1.543.   Its
crystals are four-sided prisms, having  a lamellar arrange-
ment and  ending in  pyramids  with  four faces.  It is
much harder than sugar candy, has a moderately sweet
taste, and one which is somewhat gravelly.   It is solu-
ble in about six  parts of cold water, but does not dis-
solve in pure alcohol or in ether.  The  properties of it
are somewhat  different  when  taken  from the human
female and from the cow.   Its concentrated aqueous solu-
tion  turns  spontaneously into lactic acid.  Its elements,
according to Liebig, are 12 atoms Carbon, 24 of Hydro-
gen, and  2 of Oxygen.   Various compounds are formed
by treating it with chlorine, sulphuric acid, nitric acid,
and other articles.
* Encyclop. Anat., p. 100, vol, vi. 
LACTIC ACID.                    IV
                     Lactic Acid.

  Lactic Acid exists  either free or in combination with
different bases, in all the liquids  and secretions of the
body.  In the free state, it is found in meat, in perspira-
tion, in  urine, and in  milk.  The  bases with which
it is in combination,  are soda, potash, lime, magnesia,
ammonia, and urea.   Tt is not only obtained from animal
matter, but is  produced in the fermentation of certain
vegetables which produce starch and sugar.
  The process for getting it from  milk is as follows.   A
quantity of sour whey is to be evaporated to one-sixth of
its weight, and then filtered.   The phosphoric acid in it
is then precipitated by chalk, and afterwards the excess
of the chalk is to be corrected by oxalic acid.   The liquor
is then filtered again,  the fluid part of it is evaporated, the
lactic acid is then taken  up by alcohol which leaves the
sugar of milk.  The alcohol is then to be evaporated, and
the residuum is Lactic Acid, to purify it, however, per-
fectly, requires some  other steps well known to chemists.
  The lactic acid does not continue in the dry  or anhy-
drous state, unless in combination with some base. When
in the  pure  hydrated  condition,  it forms a colourless
syrup, extremely acid, without smell, and having a spe-
cific gravity of  L.215.  It  is only dissolved to a very
small extent  in ether, but has no limits as regards water
and alcohol.   It coagulates albumen and caseine, and its
action is much accelerated on them by the assistance  of
heat.  It was formerly confounded with acetic  acid, but
the difference is now  well established in its want of vola-
tility and of odour.
  Lactic  acid  dissolves phosphate of  lime very rapidly,
by which quality is  explained the quantity of this salt
held in solution by milk, urine, and other secretions.   It
has also been suggested  by Marchand, that the  presence
of an excessive quantity of this acid in the system, causes 
lvi
HISTOGENY.
a softening of the skeleton by preventing the deposite of
phosphate of lime into the bones, and also dissolving that
which already exists in them.  Its atomic proportions are,
Carbon 6, Hydrogen 10, Oxygen 5.
  It is kept very conveniently  in  the~ form  of lactate
of barytes or of lead, and forms with these bases a mass,
which resembles gum.  Being  superior in  strength  to
acetic acid, it drives it from its combinations.  Boiled in
strong nitric  acid, the latter seizes  to an extent upon its
oxygen, and produces oxalic acid.

                   Fatty Substances.

  These productions of the animal body, are destitute of
nitrogen, and, as  a  common character, are insoluble in
water, but soluble in hot alcohol  and in ether.   Some of
them are saponifiable or capable  of  being converted into
soap by union with an alkali; the same also unite readily
with oxides  of lead, so as to form plasters.  This habit
is in virtue of an acid existing in  them, and which, being
naturally united to  a base, leaves that base and attaches
itself to  another,  as the alkali or the lead.  The acids
and the bases themselves are oxyds of compound radicles,
supposed to be carburets of hydrogen.
  Another series of fatty bodies cannot be converted into
soap, and there is a doubt among  chemists how they
ought to be classed, whether among  the  fats which have
a base, or as  neuter organic matters.  Among  these pe-
culiar organisms, are Cholesterine and Seroline.

  Cholesterine is found in  bile,  hence its name, also in
the blood, and in the medullary nervous matter: it is also
observed in the secretions, in morbid tissues, in cysts, in
hydatids, in the water of dropsy,  in medullary fungi and
in other tumours.
  Cholesterine, in its pure state, crystallizes in laminae, of
a brilliant mother of pearl colour, soft to the touch and 
FATTY SUBSTANCES.
lvii
 sometimes very large.  It is inodorous and insipid, dis-
 solves readily in hot alcohol or ether, but not in water.
 It may be obtained  from biliary calculi by boiling them
 in water, and afterwards in alcohol: when the latter cools,
 the cholesterine is separated by crystallization.   Its che-
 mical components are carbon 85.095, Hydrogen 11.880,
 Oxygen 3.025.  Treated with  nitric  acid, it forms cho-
 lesteric acid.

   Seroline, is called from  its being obtained from the
 blood, an original observation of Boudet.  It may be pro-
 cured by boiling dried blood in alcohol; it separates from
 the latter on its cooling, and floats about in flocculi of a
 pearl colour, of a fatty feel, and acting neither after the
 manner of acids nor of  alkalis.  When examined by the
 microscope, it is  seen to consist in filaments, which are
 swollen out in a globular form from place to place.   It is
 susceptible of sublimation almost without any alteration


               Of the Saponifiable Fats.

   There are three substances which perform the part of
 base  to  animal fat:  glycerine, the oxyd of cetyle, and
 ceraine.  The first forms the base of  human fat, and  is
 most universally diffused in  the  animal kingdom; the
 second exists in spermaceti; and the third in wax.
   Glycerine is separated from fat in the act of the latter
 forming soap with  an alkali, but it  may be  obtained  in
 the highest purity by boiling an oxyd  of lead in fat, the
 acid of the latter attaches itself  to the lead, and the gly-
 cerine is left free, being dissolved  in the water from
 which it may be disengaged and purified by a particular
 process.
  Glycerine is a clear liquor, somewhat yellow, without
odour and somewhat sweet: it is very soluble in water or 
Iviii
HISTOGENY.
alcohol; not soluble in ether.  It dissolves readily iodine,
the vegetable acids, the deliquescent salts, the sulphate of
soda, of potash, of copper, nitrate of silver, and  many
other articles.
  Glycerine being the base of human fat the acids which
are found in combination  with it, are the stearic, mar-
garic, and oleic, and the result of such combinations forms
the fatty textures, called stearine,  margarine, and oleine.
Butter has  also its own peculiarities  in being formed of
glycerine, in union with butyric, capric, and caproic acids;
and even the cerebral matter presents a  peculiar acid
united to glycerine, and  called by Fremy, the  cerebric
acid; and an oleo-phosphoric acid.*
  The Stearic and Margaric acids are obtained pure by
a process which is complicated and prolonged;  they are
very feeble, but at an elevated temperature drive car-
bonic acid  from  its  combinations.  Their union  with
glycerine makes the principal part of the fat of the human
body.  The Oleic acid is an oleaginous liquor, of a clear
yellow: it is very acid, and has a rancid smell and taste.
It is insoluble  in  water,  but very soluble  in  alcohol.
The oleine which it forms by union with glycerine is in a
fluid state naturally, but is kept so at degrees of tempera-
ture varying in the different animals.
  The above acid and basic constituents of animal fats
are seldom found  insulated, being almost always under
the combinations alluded to above; a departure from this
rule exists  occasionally with the acids, but never  with
the  base  or glycerine.   The fats under the  form of
stearine, margarine and oleine are blended in the adipose
tissue of the cellular substance, and in  the fat of the bones
or marrow as it is called.   The consistence of the fat de-
pends upon  their relative quantity in it.  Thus Oleine pre-
dominates in oil or the fluid part of fat, it commonly not
* Encycl. Anat., p. 108, vol. vi. 
                 SAPONIFIABLE FATS.                llX

being in great quantity in the human subject; but there
are individuals of enormous  obesity,  in whom  its pro-
portion is excessive,  so  that in  making  a necropsy of
such in warm weather, the oil runs all about. Margarine
is next in consistence, and forms lard, such as is found in
the hog and in the bear.  Stearine forms suet, and is found
to a remarkable degree in the fat of the sheep, and of the
bullock.
  Fat, besides being in the  cellular  substance  and  in
bones, prevails to a great extent elsewhere in the human
body, as in the composition of the brain.   It is found in
chyle, blood,  pus, bile, milk, and sometimes in urine.
In milk and chyle its globules are in little vesicles.  Its
different modifications exist  in the vegetable kingdom;
as stearine in the cocoa-nut butter; margarine in palm oil;
and oleine in flax-seed oil,  and many others. 
 
A
TREATISE  ON  ANATOMY.
BOOK I.
                         PART I.


               ON THE ANATOMY OF  THE  SKELETON.

   The skeleton is the bony frame-work  of the human body; and,
by its hardness and form, retains in proper shape the whole fabric;
affords points for the attachment of muscles; and protects many of
the viscera.  Anatomists call the  bones, along with their natural
connexions of  ligaments,  cartilages, and synovial  membranes,  a
natural skeleton; and the bones only, but kept together by artificial
means, an artificial skeleton.
   The bones  are inflexible, and in  a recent state  are of a dull
white colour, familiar to most persons from its being the same in
animals;  but  they  are made of an ivory whiteness  by being pro-
perly macerated and prepared. -
   The regional division of the skeleton is into Head, Trunk, Supe-
rior or Thoracic, and Inferior or Abdominal Extremities.
   If a vertical plane be passed from  the top  of  the head  down-
wards, through the middle of  the  skeleton, this  plane will divide
the latter into bilateral, or  two equal portions, called, in  common
language, the right and the left side of the body.  These two sides
  Vol. I.—5 
°v                          SKELETON.

are perfectly alike  in shape  and size.*   Some of the bones are
found in this plane, being intersected by  it into two equal parts or
halves:  others  are somewhat removed  from  it, and  are in pairs.
This arrangement antagonizes the two sides of the body, and qua-
lifies it for all its motions.
                          CHAPTER I.


                   Of  the  Bones, Generally.

                 SECT. I.—NUMBER, TEXTURE.

  The number of the bones is commonly the same in every person
of middle age; but they are  less numerous then, than in infancy,
from several  of them having been  originally formed in pieces
which coalesced afterwards.   The  farther fusion in advanced life,
of contiguous bones  into each other, diminishes still more  their
number.   It is, however, generally agreed  to  view the following
as distinct:—


  For the Head—An occipital bone, a  frontal,  a sphenoidal, an
ethmoidal, two parietal; two temporal, each containing the small
bones of  the  tympanum; two superior maxillary, two palate, two
malar or  zygomatic, two  nasal, two unguiform or lachrymal bones,
two  inferior turbinated, a vomer, and an  inferior  maxillary:


  * The exact harmony or symmetry of form and size,  between the two sides of the
body, as a general rule, is rather hypothetical than real  in nature.  It is a point of
general notoriety, that the right side enjoys  more  force than the left, and this will
be found  attended with greater development.  There are few  persons that have not
the face and the spine somewhat out of shape from the bones on one side growing
larger than  on the other, the right, commonly, prevailing over the left: hence we see
a nose somewhat turned; and a spine curved, the convexity of which is  to the right
side, with the attendant consequences, on the position of the ribs—the scapula and
the sternum.  This condition of false growth is exhibited in all  degrees, from a de-
viation almost imperceptible to one amounting to deformity.  The left side is said,
also, to be more liable to diseases.  Copious  reports on these several subjects as well
as on human stature, generally, at all ages, have been  made by the French Anato.
mists: for  a summary exposition of which, see Malgaigne,  Anat. Chirurg. Vol. I.
Chap. 1.  Paris, 1838. 
SITUATION OF BONES.
51
  For the  Trunk—Twenty-four true or moveable vertebrae, one
sacrum, four caudal vertebras or bones of the coccyx, two innomi-
nata, twelve ribs on each side; a sternum, in three pieces, however,
in the youthful adult:
  One hyoid, in three pieces, sometimes five in the adult, and situ-
ated in the throat:
  The remaining bones compose the limbs, and are, therefore, in
pairs, or correspond exactly on the two sides of the body.   They
are,
  For the  upper Extremities—The  clavicle, the scapula, the os
humeri, the radius, the ulna, the eight bones  of the  carpus, the five
bones of the metacarpus, the two phalanges of the thumb, the three
phalanges  of each of the fingers, the two, and  sometimes more,
sesamoid bones:
  For the lower Extremities—The os femoris, the tibia, the fibula,
the patella, the seven  bones of  the tarsus, the five of the metatar-
sus, the two phalanges of the big toe, the three phalanges of each
of the smaller toes, and the two, sometimes more, sesamoids.
  There are, therefore, twenty-two bones to the head, not including
those of the tympanum ; fifty-six to the trunk of  the body, one in-
sulated  bone to the throat; sixty-eight to the two upper limbs; and
sixty-four to the two lower limbs.  In all, two hundred and eleven.
The redundancy or the deficiency of the sesamoid bones, in a sub-
ject, may cause this number to  be slightly increased or diminished.

   The  situation of the bones  varies; some are profound,  while
others approach very near to the surface of the body.  They are,
as  stated, either symmetrical,—that is,  consist of two lateral por-
tions  precisely alike,—or else  in  pairs, having a perfect  corre-
spondence with each other.  The symmetrical or  bilateral  bones
are the frontal, the occipital, the sphenoidal, the ethmoidal,  the
vomer, the inferior maxillary, the hyoid, the spinal, and the ster-
nal ; and they are situated under the middle vertical line  of  the
body.   The pairs are on the sides of the middle line, more or less
removed from it.
   The  long bones {ossa longa) are those whose  length prevails in
great excess over their breadth, they are generally cylindrical or
prismatic,  and have their extremities enlarged  for the purpose of
articulating with adjoining bones.   The broad  bones (ossa lata)
are those whose breadth and length prevail largely over their thick- 
52
SKELETON.
ness, they have their shapes diversified by muscular connexion and
by the forms of the viscera they contain.   The  thick bones (ossa
crassa) are such as have their several lines of measurement more
nearly of a length, they are situated in the vertebral  column; and
in the hands and feet; and have their surfaces very irregular.
  The bones present, on their periphery, eminences  and cavities,
a proper knowledge of which, is of the greatest  importance to the
surgeon.   The former are called  apophyses or processes, and are
extremely numerous and diversified: they serve  for the origin and
insertion  of muscles, and for furnishing articular  faces.   The cavi-
ties are also numerous:  some of them are superficial, and serve for
articular surfaces; others for the origin of muscles; for the enlarge-
ment of  other cavities, as that of the nose and  ear; and for pur-
poses which will be mentioned elsewhere.
  The articular ends of the long bones are called epiphyses, from
their being formed from distinct points of ossification, whereas, the
shaft  of  the bone is  its diaphysis or body, being the part first
formed.  The epiphysis, therefore, as its name implies, grows upon
the  other.  Many processes grow after the manner  of epiphyses,
from distinct points of ossification, though  they  are seldom called
by the same appellation.  This is the case with  the trochanters of
the  os femoris, with the  processes of the vertebrae, the crista of the
ilium, and the tuber of the ischium.
  Near the centre of some bones a canal is formed  which passes
in an oblique direction,  and transmits blood vessels  to their inte-
rior.  There are  also, at the  extremities of the  long bones, at the
different  points of the thick ones, and near the margins of the flat
ones, a great many large orifices, which principally transmit veins:
in addition to which, a  minute inspection of any bone whatever,
will show its  whole surface  studded with  still  smaller foramina,
also for the purpose of transmitting both kinds of blood vessels.

  The density of bones  is always well marked, and exceeds much
that of other parts of the body.   It is, however, variable in diffe-
rent bones, and in different places of the same bone: hence their
substance has been divided into  compact and cellular, of which
the  former is external and the latter internal.
  The cellular structure, or substance, grows from the internal sur-
face of the other, and is composed of filaments and small laminae,
which pass in every direction, by crossing, uniting, and  separating. 
                       TEXTURE OF BONES.                    53

The cells, resulting from this arrangement, present a great diversity
of form, size,  and completion.   They  are filled  with marrow,
and communicate very freely with each other.  The latter may be
proved in the boiled bone, by the  practicability of  filling them all
with quicksilver from any given point;  and, indeed, by the injec-
tion of any matter sufficiently fluid to run.   The communications
between them are formed by deficiencies in their parietes, after the
same manner that the cells of sponge open into each other.   This
structure does not exist in the earliest periods of ossification, when
the  bones  are  cartilaginous almost  entirely, but  develops  itself
during the deposite  of calcarious matter.   The  manner  of its
formation is imperfectly understood, though it may possibly be the
result  of absorption, and  it is  not completed in the bones, origi-
nally consisting of several  pieces, till they are consolidated  into
one.
   The compact substance is also formed of filaments and laminae,
which we find  to be so closely in contact with each other, that the
intervals between  them are  merely microscopical  in  the greater
part of their extent: they become, however, more  and more dis-
tinct, and larger, near the internal surface; and at the extremities
of the long bones.  The compact  tissue  is gradually blended with
the cellular structure, or lost in it.   Its filaments are directed lon-
gitudinally in the cylindrical bones, radiate from the centres of the
flat ones, and are  blended  so  as to render it impossible to trace
them in the thick ones.  This disposition in the flat  bones is much
better seen in early life; subsequently, it becomes indistinct.   The
compact tissue, particularly in the cylindrical bones, has  in  it a
multitude of longitudinal canals,  visible to the microscope, and
some of them to the naked  eye, which contain vessels and medul-
lary  matter.    Those  canals,  originally described  by  Clopton
Havers,* run parallel with one another in the spaces between the
laminae, and give  off small branches which pass through  one or
more laminae, and anastomose with contiguous  Haversian canals,
thus forming a reticulated communication of osseous tubes which
permeate the compact substance.   They are open  externally and
receive their blood from the periosteum,  and internally merge into
the  cells of the cellular structure.   They  are, according to M.
B^clard, about one-twentieth of a line in diameter, on an average;

                     * Osteologia Nova an. 1729.
                              5* 
54                         SKELETON.

but they are, generally larger near the interior than the exterior
surface of the  bones, and have  frequent  lateral communications
with the  cellular structure, and with the external surface.   Their
diameter, according to Miescher, varies from zis to ^ of an inch,
those nearest the surface being three or four times smaller than
those near the interior.   Their walls are  formed by from  five to
fifteen lamellae of bone, and are 350 to ^£0 of an inch thick.   Each
Haversian canal, whether its course be longitudinal or transverse,
is surrounded like the shafts of the cylindrical bones by a series of
lamellae, arranged concentrically around its axis.   An artery and
vein pass along its axis, and distribute minute branches to the
very soft fat which fill the canal: they are derived, in the external
canals, from the periosteum, and  in |he internal ones from the ves-
sels of the  medullary membrane.  They  anastomose  freely with
adjoining vessels.
  The compact and the cellular  structure  present  themselves
under different circumstances in the three  species of bones.  The
compact has an  unusual thickness in the bodies or diaphyses of the
long bones,  and is accumulated  in quantities particularly great in
their middle, which, from its position, is more exposed than their ex-
tremities, to fracture from falls, blows, and violent muscular efforts.
But as this  texture  approaches the extremities  of  the  long bones
it is reduced to  a very thin lamina, merely sufficient to enclose the
cellular structure and to  furnish  a smooth articular face  for the
joints. The cellular structure, on the contrary, in the long bones,
is most abundant in their extremities, constituting their bulk there,
and is least  so in their bodies.  It is so scattered at the latter place
as to leave a cylindrical  canal in  their middle, almost uninterrupted
for some inches. Th,is canal, cellular in its periphery, has its more
interior parts traversed in every direction by an extremely delicate
filamentous  bony matter, which, from the fineness of its threads and
the wide intervals between them, has been, not unaptly, compared
to the meshes of a net, and is, therefore, spoken  of especially under
the name of the reticulated or cancellated structure or tissue of the
bones, in contra-distinction to the cellular.  It is formed on the
same principle  with the latter; and though the term, from that cir-
cumstance,  has  been rejected, upon high authority, as superfluous,
it appears worthy of retention, as it expresses  a fact of  some im-
portance.   Too weak to contribute in an appreciable degree to the
strength  of the bone, the reticulated or  cancellated tissue seems 
TEXTURE OF BONES.
55
 principally useful in supporting the  marrow and  in  giving attach-
 ment to its membrane.   The extremities of this  cylindrical canal
 gradually  disappear by becoming more and more cellular.
    In the flat bones, the compact  structure forms only their surface
 or periphery, and is of inconsiderable but generally uniform thick-
 ness ; the space within is filled up with the cellular structure, which
 is rather more laminated than it is in the long bones.
   In the thick or round bones, the compact structure  forms their
 periphery also; but, generally, it is thinner than in the flat: their
 interior is likewise filled up by the cellular structure, and  does not
 present differences of importance, from the  ends of the long bones.
   The lamellated state of bone is rendered  more evident under the
 use of the microscope.   In the long  bones this lamellated structure
 is concentric in circles—but in the flat there is simply a  superpo-
 sition  in parallel  plates.   As the Haversian  canals are common to
 all bones, they are uniformly found formed of concentric circular
 laminae  and ending  internally in the cellular  structure.  They
 are in fact miniature or  extremely attenuated representations  of
 what the great medullary canal is in the long bones, and  seem  to
 execute very much the  same function in the accommodation  of
 blood  vessels and fat.
   Microscopic excavations of a  different description  and called
 calcigerous also  exist  in bones.   They are brought  into view by
 examining  a transverse  section of  bone ground  extremely thin
 and then polished.  They consist in cells (Corpuscula Purkinji) from
 which radiate in every direction exceedingly fine tubules,  (Tubuli
 calcigeri, or Calciphori) which  again send out branches, to anas-
 tomose with corresponding branches  of  similar  adjoining  cells.
 The term calcigerous is  applied to them  from  the  belief that  the
 calcarious matter of bones is deposited in them.*

  * Seen originally by Leeuenhoeck and imperfectly figured by Mascagni, the cells
 were first accurately investigated by Purkinje, and described by his pupil Deutsch.*
 They are round or oval, and  flattened, are surrounded by a hyaline or intercellular
subslance and measure according to Miescher from 54V0" to  TeVo"0^*11 'ncn in
length, and are from y^W to Tffso" of an inch in breadth, and according to Henle are
jj-th as thick as they are long.  Their edges are somewhat serrated, and from them the
  * Miiller, Schwann, Henle, Smee and Brunshave since then have carefully investigated thia
structure. 
50
SKELETON.
   When the corpuscules and their canaliculi are viewed by trans-
mitted  light  they appear dark,  whilst the substance  in  which
they are imbedded, if the slice be very thin, is transparent.  If
the same lamina  of  bone be viewed  by reflected  light, and is
on  a  dark  surface, the  corpuscules  and  canaliculi  seem  white.
Acids render them transparent, which shows that inorganic  mat-
ter is contained either in their cavities or their parietes.  They
lie thickly scattered as if compressed between the lamellae, which
surround  the Haversian  canals,  and  are so  placed that one of
their  largest  surfaces  is  turned from  and the  other towards the
axis of  the canal.  The calcigerous tubes run both  between  and
through these several lamellae, and since many of them are directed
towards the axes of the Haversian canals, they look  like a set of
faint  striae  radiating from them  to the exterior  lamellae.  Small
dots  on each  lamella  mark their  apertures, and Mr.  Smee  and
Krause believe them to open  also into  the interior  of the Haversian
canals.   Miiller thinks that the mass of calcarious matter must be
contained not in the corpuscules and their canaliculi, but in the trans-
parent  or*  hyaline substance in which  they lie embedded, and he
founds this  opinion on the fact that when laminae of bone are boiled
with potash, which dissolves all or a greater part of the cartilage,
the earthy salts are still  seen filling the outer spaces between the
radiating  canals.f   Mr. Smee believes that they contain no earthy
matter, and states that they can be injected with  Canada Balsam,
and he  adds that in bones of embalmed persons they are filled  with
a waxen  substance.  Bru:is has  found them quite empty in  cal-
cined bones, and in very  thin sections perfectly transparent.

minute tubules alluded to radiate.  The greatest diameter of these canals is accord-
ing to  Krause -j^ooo to TffofcB 0I" an mcn» and the smallest, according to Mailer
tb^ott to ai>o-(nr of a» inch-
  * Dr. Carpenter thinks that he has detected evident traces of organization in this
hyaline substance intervening between the osseous corpuscules  He has traced a
distinct cellular structure in this situation, and he regards the whole bone as a mass
of cells, of which some have sent out stellate prolongations, and  others have coalesced
into canals, the great bulk of them, however, remaining but little changed, and filled
with a substance so homogeneous as to be scarcely distinguishable as  separate vesi-
cles.  He has  been led to this view of bone from  the microscopic examination of a
thin transverse section of bone.*
  + Mailer's Physiology, by Baly, 2nd Ed. p. 393.
* Human Phys. p. 511. 
TEXTURE OF BONES.
57
  A simple experiment on any of the cylindrical bones will prove
that the tumefaction of their extremities does not add proportion-
ately to their weight, as one inch or any other given section of the
compact part weighs very nearly the same with a section of equal
length from the cellular extremities.   The  swelling at the ends of
the bones adds much to the  safety of their articular union, as the
extent of the surfaces is thereby much increased, and, consequently,
they are less liable to displacement.   The cylindrical and the cel-
lular cavities, thus formed  in  the long bones, by increasing the
volume of the  latter, add  greatly to their strength beyond  what
would  have occurred, had the same weight of material been solid.
The late Dr. P. S. Physick  demonstrated this most satisfactorily
by a scroll of paper, which, on  being rolled  up successively, into
cylinders of various sizes, has, like a lever, its power of sustaining
lateral pressure on one  of its extremities, continually increased as
its volume or diameter is augmented, until the latter reaches a cer-
tain extent.   The  same highly distinguished teacher also  pointed
out another very  important advantage of the cellular structure.
It is that of serving to  diminish, and  in many cases to prevent con-
cussion of the brain, and of the other viscera, in falls and in blows.
The opinion was verified by his  demonstrating the momentum,
which is communicated through a  series  of five ivory balls sus-
pended by threads, when one of them  is  withdrawn from the others,
and allowed to impel them by its fall.  This momentum  is so  com-
pletely  transmitted through the scries, that the  ball  at the  farthest
end is impelled almost  to  the  distance, from which the first one
fell.  This familiar experiment, used  as a preliminary test to the
accuracy of  his views, was  immediately succeeded  by his substi-
tuting  for the middle one of ivory, a ball made of the cellular struc-
ture of bone.  The same degree of impulsion now communicated
at one end of the series, is almost lost, or rather neutralized, in the
meanderings of  the  cellular structure of the substitute;  and parti-
cularly if the latter be previously filled with tallow or well soaked
in water, so as to bring it to a  condition  of elasticity resembling
the living state.
   In persons of  advanced  age, the marrow of the bones becomes
more abundant, and their  parietes  thinner;  and we also observe
then, that the bones break more readily, and are more crumbling,
rotten, or soft, than during the anterior periods of life.   In women,
after the critical period is passed, these traits are especially deve-
loped, and the compact centres  of the long bones have their tex- 
58
SKELETON.
 ture more or less approximated to the spongy tissue. Mr. Velpeau*
 says, that in the amphitheatres of Paris, he has often cut easily
 with a scalpel, the ends of the  femur, tibia, humerus, the bodies
 of the vertebrae and the tarsal bones, when there was apparently
 no morbid lesion in the skeleton.


             SECT. II.—COMPOSITION OF BONES.

   The bones under every  modification of  shape  and  mechanical
 arrangement,  are constituted  by precisely the same elementary
 matters: the principal  of which  are an animal and an earthy sub-
 stance, in intimate combination.  Their minute analysis, accord-
 ing to Berzelius, when  they are deprived of water and of marrow,
 affords 32 parts of gelatine, completely soluble in water;  1 part
 of insoluble animal matter; 51 parts phosphate or rather subphos-
 phale of lime; 11 carbonate of lime; 2 fluate of lime; 1 phosphate
 of magnesia; 1 soda and muriate of soda.  There are some other
 ingredients manifested  in the analysis of Fourcroy and  Vauquelin,
 as iron, manganese, silex,  alumine, and  phosphate of ammonia.
 The relative proportion of the  above ingredients is not uniformly
 the same, as the bones  of the cranium, and the petrous portion of
 the temporal, in a remarkable degree, have more calcarious mat-
 ter in them,  than the other  bones of the same skeleton.  There is
 also a considerable diversity in individuals,  according to their age
 and to certain morbid affections.
  Human bone, well dried, by containing  11 per cent, of carbo-
 nate of lime, presents us thus with three times the quantity  which
exists in the  bones of the ox.   According to Valentin in abnormal
osseous formations, as callus and exostosis,  there is a much  larger
proportion of carbonate of  lime than in healthy human bone, thus
showing an inferior degree  of organization  and  a  correspondence
with the osseous tissue  in animals lower  in the scale.   In  caries
the amount of carbonate of lime is said to be diminished by several
per cent.  The presence of fluoride of calcium in bones has been
 denied, and it  would appear from the  experiments of Dr.  G. 0.
 Rees that its existence  is not constant.  It is said to be found in
 fossil  bone,  and in  considerable quantity in human bones, disin-
 terred from  Herculaneum  and  Pompeii.   The calcarious salts
* Anat. Chirurg. 
COMPOSITION OF BONES.
59
lessen the liability to decomposition in bones, and from bones buried
in the earth or sunk in water, we ascertain the existence of not only
extinct  species of animals, but of entire genera.   Fossil organic re-
mains frequently  exhibit precisely the same character as  bones  of
existing animals which  have been long exposed to the action of air
or water.  At other times they become mineralized, being saturated
with calcarious or silicious matter, and acquire the hardness  of
jasper or marble;  they still  retain their original  structure, as is
shown  by microscopic examination.*   Geologists avail themselves
extensively of this  fact, and from  the  fragment of a bone or tooth
classify species and families, and  tell with certainty whether the
animal  was mammal—reptile or fish.
   In the foetus and in youth the animal  matter predominates, and
the earthy matter increases with age, rendering the  bones of old
persons harder and more brittle.f
   It appears that, in  certain  cases, fluoride of calcium  may take
the place of the phosphate of lime in the bones and teeth; at least,
it is impossible otherwise to explain  its constant presence in the
bones   of antediluvian  animals, by which  they are  distinguished
from those of a later period.  The bones of human skulls found at
Pompeii contain  as much fluoric acid  as those of animals of a for-
mer world, for if they be placed in a  state of powder in glass ves-
sels, and digested with  sulphuric  acid,  the  interior of the vessel
will, after twenty-four hours, be found powerfully corroded whilst
the bones and teeth  of animals of the present day contain only
traces of it.J
   In a parietal bone, found by  Dr. Davy at Cerigo, there was 26-2
per cent, of animal matter, and in a fragment of a zygomatic pro-

   * Gerber, Elements of General and Minute Anat.  London, 1842.
   t Scheger states that the earthy matter in the bones of a child is one-half of the
whole mass;  in  those  of an adult, four-fifths; and in  old persons, seven-eighths.
The proportion of animal and earthy matter  exists as follows in different bones of
the same subject.  Whilst a human scapula contained 54£ per cent, of bone earth,
83£ per cent, was found in the temporal bone.  In mollities ossium the proportion
of bone earth diminishes by 10 per cent.  Bones thus affected contain a large quan-
tity of fatty matter and do not yield gelatine.  The soluble phosphate of lime is ex-
creted by the kidneys in this disease.*   The specific gravity of bone varies with the
density, and the amount of saline impregnation.  It may be stated to be between
1-80 and 2-03.r
   t Organic Chemistry, by Liebig, page 203.   Cambridge, 1841.
* Miiller.
t Gerber. 
60
SKELETON.
cess  of an  ancient  Egyptian  cranium, discovered in  a  tomb at
Thebes, there  was 23-9 per cent, of  animal  matter.   Dr.  Davy
states,* that in the bone Breccia of the  Mediterranean, he has only
been  able to detect a trace  of animal  matter, and that he sought
in vain for it in the teeth of  the squali which  occur in the tertiary
formations of Malta and Gozo.   " Judging from the practical  effect
of a  known period of time, what an idea of vast antiquity is con-
veyed  by the circumstance  of the total  destruction of the animal
matter of bones."f
   The earthy  matter gives to  bones their  hardness  and want of
flexibility, and  is easily insulated  from  the other  by combustion;

  * Researches, Phys. and Anat. vol. i. p. 399.
  t Though the bones of the foetus  and young persons contain generally a less pro-
portion of earthy matter to'animal than those of adults; yet the results  obtained by
Dr. Davy, are at variance with the recognised facts  in the majority of instances, and
are calculated to excite inquiry.  His analyses were as follows :—

                                      Calcarious         Animal
                                        Matter.          Matter.
         Inferior maxillary of an old person    56*6    .    .    43-4
              Ditto     of a child     .    57-2    .    .    42-8
              Ditto      of a foetus     .    56-0    .    .    444

  That the earthy matter does not invariably increase with age, the following com-
parative experiments, instituted by Dr. Davy, would seem to prove.  The parietal
bone thoroughly dried by exposure to a temperature of 212,° until it ceases  to lose
weight, was invariably the subject:
	Calcarious	Animal
	Matter.	Matter.
From a man aged 20	69-9	331
Ditto 31	72-2	29-8
Ditto 52	68-5	31-5
Ditto 45	66-6	334
  According to Dr. Davy there is no constant relation between the degree of hard-
ness  and  softness  in bone, and the proportions of calcarious and animal matter.
These qualities would seem rather dependent on the arrangement of  their particles
than  on the  proportion of the chemical constituents.  Dr. D. obtained the following
results in the recent bones of a  subject set. 15;
	Calcarious	Animal
	Matter.	Matter.
Parietal Bone	58-8	41-2
Tibia .	536	46-4
Fibula .	44-0	56-0
Ilium .	45-0	550
Femur .	47-0	530
 
COMPOSITION OF BONES.
61
which, in destroying the animal part, leaves the earthy in a white
friable state, but preserving the original form of the bone.   If the
heat be of a high  degree,  the  calcarious part becomes vitrified,
and its cells are blended by fusion.   The action of the atmosphere,
long continued, also divests the bones of their animal  matter, and
the calcarious then falls into a powder.  If the bones  be kept be-
neath  the surface of  the ground, by which they are less affected
by changes in temperature and moisture, the animal matter remains
for an immense number of  years.   I have seen in the Hunterian
Museum of London, preparations of the teeth of the Mastodon or
Mammoth, in which  the animal matter was exhibited entire, not-'
withstanding the great  lapse of years since it was in a  living state:
and a repetition here of the same experiments on the  teeth and
bones of  the same animal has exhibited the  same  result.   I was
also informed by the late Mr. Say, a distinguished naturalist, that
animal matter has been detected in fossil shells, the  existence of
which was probably  anterior to that of the human  family.
   The phosphoric acid  of bones gives them a luminous appearance
at night.  Bichat says, that in these cases  he has found an oily
exudation on the  luminous points, probably from  the marrow or
contiguous soft parts.   This phenomenon will account for many
of the superstitions which in all ages have  affected ignorant minds,
on  the subject of burying grounds.
   The immersion of a bone in diluted muriatic  acid is the best
method  of  demonstrating  the  animal part in a  separate state.
The strong  affinity of the acid for the earthy part, and the soluble
nature of the salt thus  formed,  leave the animal matter insulated.
In this state it preserves the original form of the bone, is cartila-
ginous, flexible, and elastic.   The action of hot water alone, upon
a bone,  by continued boiling, will, from the soluble nature of the
cartilage, separate the latter from the  earthy part, and convert it
into gelatine.   The gelatine may be precipitated afterwards from
the water by tannin.   The mode of this  combination of animal
and of earthy matter  is  not understood,  but it is generally supposed
to exist  by the extremely small cavities of the former receiving
earthy particles, in the  same way that sponge  holds water.*

  * If wc conceive the phosphate of lime and the other earthy materials of bone to
be in a state of solution in the blood and scrum with  which the cartilaginous rudi-
ment of the bone is impregnated, any  action which  would precipitate the earthy
   Vol. I.—6 
62                         SKELETON.

  From the unpublished researches of Mr. Tomes,* it appears that
the ultimate structure of bone is granular.  This arrangement is
manifested both by calcination and by steeping in an acid.  These
granules are  intermixed with  the  corpuscles of Purkinje, consi-
dered now by most anatomists  to  be oval lacunae with radiating
branches running into other similar lacunas.   The  latter fact is
established by the facility of  filling them in  a dried bone with oil
of turpentine.
  There are no means for investigating the minute anatomy of the
bones more favourable than the removal of the earthy part by an
acid.  The cartilage thus left is the complete mould, in every par-
ticular of form, into which the particles  of calcarious matter were
deposited.   In this state, the compact part of the bodies of the cy-
lindrical bones may be separated into laminae;  and these laminae,
by the aid  of a  pin or fine-pointed  instrument, may be subdivided
into filaments or threads.
  The laminae, though enclosing one another, are not exactly con-
centric.  I have observed,  that the more superficial come off" with
great uniformity and ease in the adult  bone, but the intertexture
continually increases towards the centre.  Bichat has  objected to
this  dissection of the bones, that the laminae are not formed in na-
ture, but factitiously, by the  art of the anatomist, and that their
thickness depends entirely on the point  at which one chooses  to
separate them; they, therefore, may be  made thick or thin at plea-
sure.  It does not appear to me difficult to account for the manner
in which this laminated arrangement is produced.   The longitu-
dinal filaments of the bones  adhere with more strength  to each
other at  their sides than they do  to  those above or below, in con-
sequence of which a plane of these  filaments may be raised at any
place and of  any thickness.  This  fact does not involve the infe-
rence that  the bones are originally formed  by a successive depo-

materials, would also, of course, impregnate the  cartilage with them, and this pro-
cess may be considered as completed when the bone acquires its proper consistence.
  Considering cellular substance as the parenchyma or primordium of all other parts,
it is probably a  speculation not entirely groundless, that every peculiar tissue or
glandular texture has its elements precipitated from the circulating fluid in a man*
ner analogous to that of the calcarious part of bone.  This idea also affords a clew
to a result almost uniform in protracted macerations of all tissues, to wit, the parts
being brought back to the primordial state, by the peculiar deposites in  them being
dissolved in the water and removed.
  * Physiol. Anat. &c, by Tod and Bowman, p. 108.  London, 1843. 
COMPOSITION OF BONES.
63
site of one lamina over another; it merely inculcates the mode of
union between the filaments or threads.  I  am, however, inclined
to the opinion that the periosteum secretes the external laminae in
the adult bone, inasmuch as they separate  with unusual facility
from the subjacent one.  We know that the periosteum has the
power of this secretion, as a laminated deposite of bone on the
roots of the adult teeth frequently met with, proves without  doubt,
as also the phenomena of necrosis.   The vascular network of the
periosteum is analogous to  that of bone, for which reason it is that
this membrane is one of the tributaries to the supply of bone in its
growing stage, but not in  virtue merely of  its  fibrous character.
The history of the abnormal  formation of bone  in any one or  all
of the tissues of the body, is a  proof that wherever there are vessels
it may in certain cases be secreted.
   The disposition of the cylindrical bones to separate into laminae,
is constantly manifested in such as  are simply exposed to  the at-
mosphere.
   The opinion of the  laminated and filamentous arrangement of
bones has been very generally received by anatomists.   Malpighi,
whose name is inseparably  connected with minute investigations
in anatomy, taught it.   Gagliardi, also, in admitting it, thought he
saw  pins of different forms for holding  the  laminae together.
Havers  also  saw  the  laminated and  thread-like  structure.  In
short, there are few of the  older anatomists who have not adopted
fully the opinion.  Among the moderns, the late M. Beclard, the
distinguished and able Professor of Anatomy in the School  of Me-
dicine in Paris, says, that when  the  earth is removed  from bones
by an acid, if  they be softened  by maceration in water, the com-
pact substance, which  previously offered no apparent texture, is
separated into laminae, united by filaments; the laminae  themselves,
at a later period, separate  themselves  into  filaments;  which, by a
farther continuation of the process  swell, and become areolar and
 soft.  A long bone examined after  this process, divides its body
 into several laminae, the most external of which  envelops the rest;
 and the remainder, by rarefying themselves towards the extremi-
 ties, are continuous  with the cellular structure there.
   J. F.  Mechel,  of  the University of  Halle, has furnished  the fol-
 lowing account in his General Anatomy of the Bones:—
    " The filaments and  the laminae which constitute the bones are
 not simply applied one against the other, so as to extend the whole 
64
SKELETON.
length, breadth, or thickness of a bone, or to go from its centre to
the circumference.  They  lean  in  so many different ways, one
against another, and unite so frequently by transverse and oblique
appendages or processes, that  some  great anatomists, deceived by
this  arrangement, have  doubted the  fibrous structure  of bones.
Nevertheless, their opinion  is not  perfectly correct.  In  spite  of
those inflections and  anastomoses of  fibres, the fibrous structure
always remains very apparent;  and one is warranted in saying,
that the dimension of length exceeds the two others, in the texture
of many bones.   This predominance is chiefly well marked in the
first periods of osteogeny;  for, at  a later time, the fibres are  so
applied against each  other, as scarcely to  be distinguished.  But
these longitudinal fibres never exist alone; there are many oblique
or transverse ones from the first periods of ossification; and they
are even from the beginning so multiplied, that the number of longi-
tudinal fibres does not prevail over them  so  much as at  a subse-
quent period, when the fibres approach nearer, in such way that
the transverse become oblique;  until at  last, from  the increase of
the bone, the latter, at first view, seems  to be  composed only  of
longitudinal fibres.  The transverse  and oblique fibres  do  not form
a separate system; but continue  uninterruptedly with  the  longitu-
dinal, which they unite to each other."*
   The venerable Scarpa, some  years ago, advanced opinions ad-
verse to  the laminated and fibrous or filamentous tissue of bones :f
the latter doctrine he was induced to think a mere mistake, arising
from  careless observation.  Founding his own views upon what
he had seen in the growing  bone, in the adult bone when its earthy
parts were removed by an acid,—and upon certain cases of dis-
ease attended with inflammation of the bone; he denied, without re-
servation, the existence of laminae  and  fibres in bones, declaring
that even  the  hardest of them were cellular  or  reticulated.  It
appears  to me, in looking over his paper, that a desire to overthrow
old doctrines and to establish  new ones, has induced him to make
one omission in  the  report of  his  experiments, otherwise unac-
countable  in a  man  of  his  general intelligence  and  candour.

  * Manuel D'Anat.  Gun. Descr. et Path, traduil de L'Allemand par Jourdan et
Ereschct.  Paris, 1825.
  t A Scarpa.  De penitiori ossium structura commentarius.  Leips. 1795.  See
also Anatomical Investigations, Philadelphia, 1824, by the late J. D. Godman, M.
D-v for an English translation of the same. 
                     COMPOSITION OF BONES.                  65

Having softened the cylindrical bones in an acid, he next proceeds
to a long continued maceration of them; he finds, as other persons
have done, the animal part of the bone finally resolving itself into
a soft cottony tissue.  He  has made but  one jump from  the im-
mersion in  the acid to the last stage of the process of maceration.
Now, if in a short time after the bone had been softened in the
acid, he had admitted an intermediate observation, he would no
doubt,  like  all other  inquirers, have found that the animal part of
the cylindrical bones was readily separable into lamina); and that
by a pin or needle these laminae could be split into fibres, the greater
part of which are longitudinal; and that pounding  the ends of these
fibres with  a hammer would  resolve them into a very fine penicil-
lous or brush-like structure.  There is  no  objection to the conclu-
sion, that these laminae and filaments, as a final condition,  produce
a very fine microscopical  cellular arrangement, which  may be
made  more  apparent in being  distended  by the development  of
gaseous substances, arising from putrefaction  or  maceration; but
there is reason for a decided opposition to the assertion of there
being no fibres in bones,  when we have daily under our eyes pre-
parations showing them;  some  of which  demonstrate  the fibres
running principally longitudinally, others spirally, like the  grain of
a twisted tree, and  others  having a  mixed  course.  Upon the
whole, the  description cited from Meckel, exhibits this subject in a
just and accurate manner.
  The more obvious arrangement of the cellular and compact
structures of the bones, indicates a considerable difference in their
intimate texture:  they  are,  nevertheless, closely allied;  for one
structure  is  converted,  alternately, into  another by disease, of
which  specimens abound in the Wistar Museum.  In both cases,
from the fibres or filaments  are formed cells which  exist every
where, and are only  larger and  more distinct in what we call the
cellular structure;  but the compact part has also its cells, though
they are smaller, more flattened, and for the most part microsco*
pical.

  Organization of Bones.—The  blood vessels of the bones, though
small, are very numerous.  This is well established, by the success
of fine  injections, which in the young bone  communicate a  general
tinge; and by scraping the periosteum from living bones, whereby
their surface  in a little time becomes covered with blood, effused
                              6* 
66
SKELETON.
from the ruptured vessels.   In those operations for exfoliation from
the internal surfaces of the cylindrical bones, where it is necessary
to excavate the  bone extensively, in order to  remove all the de-
lached pieces;  unless the general circulation of the limb be pre-
viously arrested by the tourniquet, the cavity of the bone is flooded
with blood.  Bichat has also  remarked, that the blood vessels of
the bones  become unusually turgid  and  congested, in cases of
drowning and strangulation.   The observations in 1832, on cho-
lera in Paris, showed the same congestion of black blood, to have
been produced by that disease.
   The arteries which supply the bones, from their mode of distri-
bution, are referred to three classes.  The most numerous and the
smallest, are those which penetrate from the  periosteum, by the
capillary pores found over the whole surface of the bones.   The
next are those which penetrate the larger foramina at the extre-
mities of the long bones, and at different points of the surface of
others.  And the  third class,  called nourishing, amounts to but
one artery  for each of the cylindrical  bones which, penetrates by
an appropriate canal, as mentioned, commonly near the centre of
the bone.
   The arteries of the first two  classes are generally extremely
small.   They ramify upon the compact and  cellular structure,
penetrating it in every direction.   At  death, they are commonly
filled with  blood,  which  renders  the injection  of  them difficult.
The third, or, as  commonly called, the  nutritious artery, is of  a
magnitude  proportioned to the bone to* be supplied.  Being single
in almost every instance, it passes through the compact tissue,
and having reached the medullary cavity, it divides immediately
into two branches; each of which  in diverging from  its fellow,
goes towards its  respective extremity of the bone.  These branches
ramify into countless capillary vessels  upon the membrane con-
taining  the marrow,*  and finally terminate by free anastomoses
with the extreme branches of the two other systems.
   The veins of the bones are very abundant: they are uniformly
found in company with the branches of the third, or nutritious ar-
teries, and  their  common trunk goes out at the nutritious foramen
into the general circulation.  These ramifications have been long
known, and bring  back the blood from  the medullary membrane

  » Would not this furnish a hint, that the arteries which  secrete fat are different
fioctv other arteries, and thai this distinction mny prevail generally? 
                       OF THE PERIOSTEUM.                    67

only.   The veins which receive the blood of the other arteries do
not attend them, and were first of all found in the diploic structure
of the cranium, which led to the discovery of them in all the other
bones.  The honour of the  original observation has been claimed
respectively by two very distinguished men of Paris, MM. Dupuy-
tren* and Chaussier.f  These veins issue from the bones by nume-
rous openings distinct from  those furnishing a passage to the arte-
ries.  This  circumstance is remarkably well seen in the flat  and
thick bones, and at the extremities of the cylindrical ones.  Having
left the bone, they terminate, after  a short course, in the common
venous  system.   They arise exclusively from the spongy and com-
pact  structure, by extremely fine arborescent  branches, which,
uniting successively,  form trunks; these  trunks penetrate the cojth
pact tissue,  and  escape  from the bone by orifices which are uni-
formly  smaller than the  bony canals, of  which they are the termi-
nations.  The canals are formed of compact substance,  continued
from  the external surface of  the bone, and  are  lined  by the con-
tained veins.  The parietes of the canals are penetrated by smaller
veins entering into the larger.  M. Dupuytren is of opinion, that
only the internal  membrane of the venous system exists  in this set
of veins; that it  adheres closely  to the bone, so  as to be  incapable
of exerting any action upon the blood; that  it is very thin, weak,
transparent, and  is thrown into numerous valves.
   Lymphatic vessels are generally seen  only on the surface of the
bones.  Mr. Cruikshank, however, on one occasion, while inject-
ing the intercostal  lymphatics, passed his mercury into the absor-
bents of a vertebra, and afterwards saw them  ramifying through
its substance;J  a  fact which, along  with what is known  of the
power of exfoliation  in  bones, proves sufficiently the existence of
such  vessels in  them.   A  few other  anatomists as  Soemmering,
Breschet, and Bonamy lay claim to  similar observations.   The
testimony of the former  may be considered as going far to confirm
the fact, as he has all along been admitted as one of the most ac-
curate and cautious observers of modern times.  The opinion is,
however, denied  by others of almost equal celebrity.   Nerves have
also been traced  into them, accompanying the nutritious arteries.§

   * Propositions sur  quelqties points d'Anatomie, de Physiologie, &c.  Paris, 1803.
   t Exposition de la  Structure de l'Encephale.  Pari*, 1807.
   t Anatomy of Abiorbing Vessels, p. 98.  London, 1790.
   § Teclard, Elcmens d'Anatomie Geucrale.  Paris, 1823. 
68
SKELETON.
                        CHAPTER II.

               SECT. I.—OF THE PERIOSTEUM.

   The membrane which surrounds the bones is called periosteum,
and is extended over their whole surface, excepting that covered
by the articular  cartilages.   As this membrane  approaches the
extremities of  the bones, it  is blended with the ligaments uniting
them  to each other, from which the ancients adopted  the opinion,
that the  ligaments and  periosteum were the same.  Many fibres
pass from the periosteum to the bone, by which it is caused to ad-
here.   These fibres are more numerous and  strong at the extre-
mities than in  the middle of the  cylindrical bones; also upon the
thick  bones, than upon  the flat  ones.   The blood  vessels of the
bones accompany these fibres and contribute to the adhesion.  The
periosteum is united to the muscles and to the parts lying upon it,
by cellular substa.ice.
   The adhesion of the periosteum to the bones varies in the seve-
ral periods of life.  In infancy it may be separated from them with
great  facility : in the adult it adheres more strongly in consequence
of its  internal face having taken  on a secretion of bone, by which
it is blended intimately with  the  bone it surrounds; and in old age
it is still more adherent, from the progress of its ossification.  It is
thick  and soft in  the infant, and  becomes thinner  and more com-
pact as life advances.
   The organization of the periosteum is  fibrous; the fibres pass
very much in the same direction with the fibres of the bones, ex-
cepting  the flat bones,  on which  they are not radiated.  These
fibres  have different lengths,  the more superficial are longer, while
the more deeply seated extend but a small distance.   Inflammation
developes the fibres in a striking  manner, by occasionally making
the membrane as thick as an aponeurotic expansion.
  The blood vessels of the periosteum  are  numerous, and can be
easily injected.  They come from the contiguous trunks, and ramifv
minutely, into a vascular net-work, many of whose branches pene-
trate into  the bone, and  have the distribution already mentioned.
A  few lymphatic vessels have been observed in it.  Its nerves have 
MEDULLA, AND ITS MEMBRANE.                69
 not been clearly discovered, though the sensation of extreme pain,
 when violence is done to it in an inflamed state, may be thought a
 proof of their existence.  In health its sensations are null, or ex-
 tremely obscure.
   The periosteum receives the insertion of tendons, of ligaments,
 and of the aponeuroses.   In early life, owing to the slight attach-
 ment of this membrane to the bones, all  these parts may be torn
 from them, with but comparatively little force.   Bichat* having
 advocated the opinion,  that the internal laminae of the periosteum
 become ossified in the adult, considered that as a means by which
 all the afore-mentioned insertions into it were identified with the
 bones.  This will account for the great  degree of tenacity  with
 which they adhere, and the  immense force they are  capable of
 sustaining, without being  detached from  their insertions.  In this
 tendency to ossify, the  periosteum manifests a great similitude to
 other fibrous membranes, as the dura mater, the sclerotica, and
 the tendons.
   The use of periosteum  is to conduct  the  blood vessels to the
 bones, to protect the latter from the impression of the muscles, and
 other organs, which come in contact with them, to keep the ossifi-
 cation of the bones within its  proper  boundaries, to give shape to
 them, and  to secrete bone in  the growing state or  in fractures;
 and, finally, as has been suggested by the late Dr. Physick, it ex-
 erts a very happy influence in turning from the bones suppurations
 in their vicinity, which would otherwise be pernicious to them.f


 SECT. II.---OF THE MEDULLA, AND ITS MEMBRANE, CALLED
                 THE INTERNAL PERIOSTEUM.

   A greasy  substance,  as already stated, fills  the  cells of  the
 bones: it does not, in its composition,  differ from common fat; its
 granules, however, seem to be somewhat finer.  From its resem-
 blance in position to the pith of vegetables, it has obtained the name
 of medulla or marrow.   It is contained in a very fine cellular and
 vascular membrane, lining the internal cavities of the  bones, and
 sending into their compact substance very delicate filaments.   The

  * Anatomic Gencrale.
  t Mailer contradicts the idea of the bone being cither secreted or  nourished by
the periosteum.—Note, Muller, p. 608. 
70
SKELETON.
existence of this membrane has been denied, but it may be esta-
blished by sawing a bone in two, and approaching the cut end to
the fire, so as to melt out the  marrow, also, by digesting a bone
for some days in hot spirits of turpentine, or by immersing it in an
acid, in which cases the  membrane becomes crisp  and distinct.
Its delicacy  is so  extreme, that it can only be compared to a
spider's web.   In  this state it may be  traced, lining the whole
cylindrical cavity of the  long bones, and extending itself to their
extremities.  It also exists in the diploic or cellular structure of all
the other bones; but it is scarcely possible to demonstrate it there
in a very distinct manner, owing to its extreme tenuity.
   The medullary membrane is composed principally of the minute
and numerous blood vessels spent upon the internal surface of  the
bones, aided  by a  very fine, soft, cellular tissue, merely sufficient
in quantity to fill up the meshes between  the frequent anastomoses
of the vessels.  From the latter cause,  it is  compared to the  pia
mater and to the omentum.  It has been stated, that its blood was
derived from the nutritious artery, which communicates freely with
the other arteries of the bones.  This membrane is so arranged as
to form along the course of the blood vessels small  vesicular  ap-
pendages which contain the marrow, and bear some analogy to a
thick  bunch of grapes, hanging from the several  pedicles of  the
stem.
   Its  nerves are extremely small; they enter by the nutritious fora-
men, and have been particularly observed by Wrisberg and Klint.*
They have not been traced ramifying in the substance of the bone,
but follow for some distance the course of the principal arteries.
   With the exception of Mr.  Cruikshank's solitary injection of a
vertebra, no  lymphatics have  been observed satisfactorily on  this
medullary membrane; and  such lymphatic trunks of the external
periosteum as are supposed  to arise from the medullary membrane,
have  not been traced nearer to it, than the orifice of the nutritious
canal.
   Some differences exist in the nature  of the contents of the  me-
dullary membrane; for example, that part of it which is reflected
over the cells in the extremities of the long bones, and in the whole
interior of the flat, and of the thick ones, contains a much more
bloody and watery marrow, than what  is found in the cylindrical
* Beclard, loc. cit 
                     DEVELOPMENT OF BONES.                  ? 1

cavities of the long bones:  the latter, indeed, resembles closely, as
just stated, common adeps, presenting no essential differences from
it.  These circumstances have  given occasion, without a material
distinction of texture, to divide the medullary membrane into two
varieties.
   That variety contained  in the cellular extremities of the long
bones, and in  the  spongy bones generally, is in a superior degree
vascular.   The part filling the meshes of its vessels  is, however, so
imperfect, that Bichat declared his inability to find  it, and that the
number of the fine vessels was what gave, fallaciously, the appear-
ance of a membrane;  while, in fact, the  intervals  between them
were large, to  allow the fat to  come into contact with the  naked
bone.   The probability of this deficiency is confirmed by the cir-
cumstance, that no one pretends to have found a membrane in the
microscopical  pores of  the compact  substance, yet the existence of
fat in it is proved by its becoming greasy when insulated and ex-
posed to  heat.  It is from the great abundance of blood in  this
variety of the medullary tissue, that the proportion of its adeps  is
 small.
   The second variety of medullary membrane is displayed in the
 cells and  in the cylindrical cavity of the diaphysis  or body of the
 long bones.   Its membranous  cells communicate  freely with one
 another when the membrane is entire ; but, according to the obser-
 vations of  Bichat, not with such as are  in the epiphyses of the
 bones; and the  line  of demarkation  is abrupt and well defined.
 This is proved by attempts  to inflate the one from the other; the
 air, in such cases, passes with great difficulty.   The texture of this
 medullary membrane, from its  extreme delicacy in  a natural state,
 is rather obscure, but  it  is occasionally well developed in disease.  Its
 sensibility has not been very apparent in such cases of amputation
 as I have seen, though it  is said, by some, to be extremely exqui-
 site.  In  whatever degree its sensibility exists in different subjects,
 it is always more apparent in the middle than near the extremities
 of the long bones;  which  may be accounted for by its  nerves
 always entering  at  the nutritious  foramen, and  extending from
 thence towards the extremities.
    The medullary membrane, besides its use in secreting the mar-
 row, is highly serviceable to the nutrition of the bones,  as proved
 in the experiments of Trojat, who, by destroying it, produced their
 death, and an artificial  necrosis, which was cured in the usual way 
72                        SKELETON.
by a new secretion  of  bone from  the  periosteum.  The marrow
which it contains  in  the  adult is not perceptible in the foetus.
Moreover, the quality of this marrow is varied by disease; in con-
sumption, dropsy, and other ailments attended with great emacia-
tion, a considerable part of it  is absorbed, and a serous fluid depo-
sited in its place; a circumstance well  known to  those who clean
skeletons.
                       CHAPTER  III.

                      On Osteogeny.

      SECT. 1.—OF THE  DEVELOPMENT OF THE BONES.

   At birth, though the skeleton is sufficiently solid to preserve the
shape of the individual, yet it  is very  imperfect  in  many particu-
lars, which will be pointed out more in detail hereafter.   At pre-
sent it may be stated, that the  ends of all the long bones are carti-
laginous—the  carpus and  tarsus are nearly in the same state—the
vertebrae, true and false, have  their processes very imperfect; and
consist,  each,  in several distinct pieces, united  by the remains of
the cartilaginous state.  Several of the bones of the head are in
the latter condition; and the sutures are so imperfect that the flat
bones readily ride over each other from the thinness of their edges,
and also have the  angles rounded,  which occasions the vacancies
called fontanels.

   From the early embryo state to the completion  of the skele-
ton, three stages are observed  in the progress of ossification; the
first is  mucous or pulpy,  the  second cartilaginous, and the  third
osseous.

   I. The mucous  stage is seen at a very early period after the
embryo  has been received into the womb, and presents itself under
two modifications.   In the one, from the general softness of the
whole structure of the embryo, and from the apparently homoge-
neous nature of its constituents, the mucous rudiments of bone do
not distinguish  themselves from the other parts: This condition, 
DEVELOPMENT OF BONES.
73
however, is soon changed into one, and that  before the expiration
of the first  month of gestation, in which they assume a solidity and
colour, which mark them off, both to  the  eye and to the touch,
from the still softer parts surrounding them.

   II.  About the expiration of the  first month the mucous stage is
converted into the cartilaginous, and the consistence of the bones
then increases continually by the accumulation of gelatine.   Bichat
makes a remark on this subject which has been confirmed by the
experiments of Scarpa, though erroneous deductions have been
made by the  latter: that we do not see, during the formation of
the cartilages, those longitudinal striae in the long bones, radiated
in the flat, and mixed in the thick bones, which  distinguish the
osseous state.   The cartilaginous state presents another peculiarity
worthy of  observation:  all the bones which  in a  more advanced
stage are to be united by cartilage, as the vertebrae, those of the
pelvis, and of the head, make, in their groups, respectively, but one
piece; while those which are to be united by ligament, and conse-
quently to be moveable, as the femur, the tibia, the clavicle, and so
on, are respectively insulated.  In  the cartilaginous state the bones
have  neither  cells  nor  medullary  cavities, and consist in a solid,
homogeneous mass, the form of which is sufficiently definite; and
has its surface covered  by  periosteum.
   The flat bones of the cranium seem to be  an  exception  to the
general rule of a preliminary cartilaginous state, and are commonly
thought to  be such.  Their appearance is delusive, from the carti-
lage being  extremely  soft and thin, and concealed by the pericra-
nium  on the  one side,  and the dura  mater  on the other; but  a
careful  dissection  enables  one  to  distinguish  it from  this double
envelope.*

   III. The osseous matter begins  to be deposited  when the rudi-
ments of the  bone have become  entirely cartilaginous, with the
exception of a few mucous  points.   In  certain bones this change is
observable about the commencement  of the second monthf after
conception: J. F. Meckel has  placed  it about the eighth week.
The colour of the cartilage first becomes deeper; and, in the region

    * Bichat, loc. cit.              t  Beclard, loc. cit. Bichat, loc. cit.
   Vol. I.-7 
74
SKELETON.
where ossification  is  to  commence, is of a well-marked yellow.
The blood vessels, which before this carried only the transparent
part of the blood, now dilate, so as to  admit the red particles, and
a red point is perceived, called the  punctum ossificationis, from  its
receiving the first calcarious  deposite.  This  deposite  is always
near  the  very centre of the cartilaginous rudiment, and not at its
surface; the portion of cartilage nearest to it is of a  red colour;
but, a little farther off, opaque and hollowed into canals.  The
ossification  increases  on  the surface of the cartilage, and  in  its
interstices, by continual deposites,  which  are always preceded  by
that condition just mentioned.   The canals of  the cartilage trans-
mit the blood vessels, and are large at the beginning of ossification;
but, as the process  advances and is completed, they diminish gra-
dually, and finally disappear.
  During the ossific deposition the cartilage undergoes a chemical
change.   The cartilage of bone yields no chondrin,* but ordinary
gelatine.
  Valentin, Schwann  and Miiller  believe that bone  is elaborated
from cartilage by  an immediate transformation of the  cartilage
corpuscles  into  bone  corpuscles.   Clear  at  first  they  become
opaque by degrees; they are of large size, push out at one or both
points, especially in the first instance, filiform prolongations, which
are  the first indications of radii, and  grow of  a darker hue from
the periphery to the centre.f   The nuclei of the cells during this
process are absorbed at length, and  finally the cells themselves,
and the canals proceeding from them appear to become  filled with
calcarious matter.J   According to Dr.  Sharpey  the process  of
ossification  can be most  satisfactorily studied  at the line of junc-
tion of the  shaft of the  long bone of  any foetal animal, with the
cartilaginous  epiphysis.   The  most distant  cartilaginous corpus-
cles lie very close  to  one another, but have no definite arrange-
ment.  Nearer the line of ossification they are disposed in double
or single lines, with their long diameter directed transversely, more
or less regularly towards the  ossifying surface.   Still  nearer the
bone, the corpuscles are larger, and the rows into which they are

  *  Valentin in Wagner's Physiol,  p. 218.
  T  Schwann in Wagner's Physiol, p. 225.
  X  Gerber asserts that during ossification the cartilage corpuscles are pushed
together and form the Haversian canals, whilst  the osseous matter containing the
bone corpuscles is a new growth.—Gerber's Gen. Anat., vol. 1st., p. 179-80. 
DEVELOPMENT OF BONES.                  75
collected  more  widely separated; and, finally, opaque striae  like
the teeth of a comb, stretch into the spaces between them.  These
striae  are  united  at  their base.   Behind them  are oblong spaces
containing corpuscles,  and surrounded by similar lines of osseous
matter, and when the process of ossification  has advanced  still
farther, the substance  around and  between  the  individual corpus-
cles in these spaces is  opaque.   These observations have  been
confirmed  by  Miescher.*  Miescher's investigations  would seem
to prove satisfactorily  the identity of the corpuscles of bone  with
those of cartilage.  On removing the earthy matter from  a newly
formed bone by muriatic acid, the corpuscles remains as before,
apparently unaltered.  Mr. Toynbee has seen the cartilage corpus-
cles stellate.
   The  progress of ossification is somewhat modified  in the three
classes of bones.
   In  the long  bones a small ring is observed  to form early near
their  centre, and  to be  perforated on one  side  by the nutritious
artery.  This ring has its parietes thin, but  broad, and its cavity
is the beginning of the  medullary canal.   It  is formed  of  very-
delicate fibres which advance towards the extremities of the bone,f
and at the same time  increase in thickness; so that  at birth, the
body or diaphysis is generally finished.  Commonly, at a period
subsequent to birth, but differing  in the several bones, their carti-
laginous epiphyses also begin to ossify, by the development in their
centre of points of ossification, which present the phenomena men-
tioned in the last paragraph but three.  The cartilaginous state of
the epiphysis  gradually  disappears by retiring from  the  articular
end of the  bone towards  its diaphysis; and, just before its complete
removal, it appears as a  thin lamina, gluing the end or epiphysis
of the bone to its body.   Several of the apophyses of the long bones
are also formed from distinct points of ossification.
   The ossification of the  flat or broad bones begins by one  or more
points, according to the  bone being of a simple shape  as the parie-
tal; of a double shape or symmetrical, as the frontal, where there
are two points  of ossification; or of a  compound shape, as the
occipital and temporal, where there are several points.  The com-
mencement of ossification in them, is also manifested by the appear-
ance of a red vascular spot in the cartilaginous rudiment, in which
* Mailer's Physiol, p. 408.
t Bichat, loc. cit. 
76
SKELETON.
 the osseous  matter is deposited, and from which it progresses in
 radiated lines.  The periphery of this circle of rays presents inter-
 vals between the fibres, giving it the appearance of the teeth of a
 fine comb: these intervals are subsequently filled up by the sections
 of radii starting from them, and so on successively till the bone is
 finished.  In the infantile head the several radii grow  with a pace
 nearly equal;  so  that where the bones  are  angular, the angles
 being most distant from  the centre of ossification are  finished last
 of all, from  which  result the fontanels.  Where the bones are in-
 tended to be kept distinct from each other, their fusion is prevented
 by a membranous partition; but when they are to coalesce into
 one piece, only cartilage is found between their edges, and which
 is subsequently ossified.
   In some of the  flat bones, as the sternum and the sacrum,  there
 are, first of all, a great many distinct points of ossification, which
 quickly unite into  a smaller number;  they then remain stationary
 for a number of years, but finally all unite into but one piece.
   The ossification of the thick bones begins  by one or more points,
 according to the simplicity or complexity of their  figures.  The
 bones of the tarsus and  of the  carpus, have  each but one point,
 while those of the spine have several.  The former two, as stated,
 are almost entirely cartilaginous at birth.   The remaining pheno-
 mena of  ossification  in  these several bones are the same as has
 been mentioned.
   The period of ossification varies in different bones.   The lateral
 portions of  the vertebral column  appear at a very early period.
 Ossification in the head begins in the inferior maxilla, then in the
 os frontis, and  afterwards  in the other bones  of  the  face.  The
 central part  of the ribs  are ossified at an early date, and nearly
 simultaneously  the shafts of the  bones of the extremities, the tho-
racic being in advance  somewhat of  the pelvic members.  The
smaller bones  of  the  extremities follow, and,  finally, the bones of
the carpus and  tarsus.
    SECT. II.— ON THE MANNER IN WHICH BONES GROW.

  After the cartilaginous condition of the bones has been supplied
by the complete deposite of osseous matter, and they are finished,
with the exception of the  epiphyses being fused into  their respec- 
GROWTH OF BONES.
77
 live bodies, the bones still continue to grow till the individual has
 reached a full stature.   This is effected by the successive addition
 of new matter to the old.  The long  bones lengthen at their extre-
 mities;  this is proved  by the following experiment of Mr. John
 Hunter.*  Having exposed the tibia of a pig, he bored  a hole into
 each extremity of the diaphyses, and inserted a shot; the distance
 between the two shots was then accurately taken.   Some months
 afterwards, when the animal  had increased considerably in size,
 the same bone was examined, and the  shots were found precisely
 at their  original distance from each  other, but the extremities of
 the bone had extended themselves much beyond their first distance
 from the shots.   The flat bones  increase in breadth  by  a  deposite
 at their margins, a  circumstance which has been  known a Ions
 time, but it  required the ingenuity  of  Mr. Hunter to prove conclu-
 sively that the long bones increase in  length  by a similar process,
 and not  by  interstitial deposite, as  Duhamel thought.  This obser-
 vation explains most satisfactorily the use of the cartilage between
 the diaphysis and the epiphysis in all bones; that it is merely inter-
 posed for the purpose of offering the least possible resistance to the
 new osseous fibres, which  grow from the epiphyses and from the
 diaphyses:  and that it is  kept for this end,  without any  material
 change in thickness, from the fourth or fifth year to the sixteenth
 or eighteenth, when it disappears, because there is  no longer any
 use for it, in consequence of the bones having attained their full
 length.
  The epiphyses are then manifestly intended to favour the elon-
 gation of the bodies and the development of the extremities of the
 long bones,  to suit the same purposes  in some of the flat bones, as
 those of the pelvis,  and to  permit the general development of the
 bodies of the vertebras.  The ossification of the epiphyses com-
 mences in some bones about fifteen days before birth, as in the in-
 ferior extremity of  the thigh bone, and in others, as those of the
 ossa innominata, not till the fifteenth  year or thereabouts.  Many
 of the processes  from the bones, are also  epiphyses, as the tro-
 chanters of  the os femoris, the tuber of the ischium, the acromion
 scapulas, the  seven processes of a vertebra, and so on, and  are de-
 veloped in the same way.  The  time  at which they all are tho-

  * Transactions of a Society for Improvement voLii. London, 1800.  Experi-
ments and Observations on the Growth of Bones. 
78
SKELETON.
roughly fused into the bones  to which they belong, extends from
the fifteenth to the  twenty-fifth year; depending upon the indivi-
dual bone, and upon varieties  of constitution in different persons:
though this process  may be considered as completed, generally, in
the female at the age of eighteen, and in  the male at twenty-one.
   The increase in thickness of every bone depends upon a conti-
nued secretion from the internal surface of the  periosteum, at first
soft and mucous, then osseous : when this secretion is arrested, the
bones cease to grow in thickness, which commonly occurs some
time after they  have attained their full  length.  The  changes
which subsequently  take place in  them are those of interstitial de-
posite and absorption: the former is  well exemplified in inflamma-
tion of the bones, and in spina ventosa; the latter in the diminution
of the bones in extreme old  age, and in the loss of the alveolar
processes.  A species of interstitial  growth is  also now admitted
to occur by the dilatation of the primary cancelli and of the Haver-
sian canals.   By the observations of Mr. Tomes each of the latter
is found in the experiments with  madder to be  deeply tinged with
this substance.*
   There is no period of life  in which this interstitial absorption
and deposite  is not continually occurring, but it  is much more
rapid in young and  growing animals than  in the  adult and  old.
The experiments of Mr. Hunter and of Duhamel, show, that when
a growing animal is fed upon madder, (rubia tinctorum,) owing to
its affinity for phosphate of lime, the bones are quickly coloured by
its being eliminated  from the blood; when the madder is withheld,
the bones  become again white;  and that the  first appearance of
the restoration of the latter is manifested  by a white lamina being
deposited  on their surface.   The  madder, under such  circum-
stances, is a long time in getting out  of the bones.  I fed a young
pig for one month on it, mixed with other food.   At the expiration
of the  succeeding five months, the  animal, having  grown very
considerably, was killed.  The interior  laminae of all the bones
continued  to be deeply tinged, while their  surface from the depo-
site of  new bone  had become white.   From this it would appear
that deposite is a very permanent thing  in bones: it, of course,
must prevail much  over absorption, else their growth would be
arrested..

           * Phys. Anat., by Tod and Bowman, p. 123.,  an. 1843. 
FORMATION OF CALLUS.
79
  At the same time  that the periphery of each bone is increasing
in its dimensions, the medullary canal  is also augmenting: this
arises from an absorption  going  on internally, while the deposite
is making  externally.   Duhamel* proved  this by a  curious expe-
riment.  He surrounded a cylindrical bone of a young animal with
a metallic  ring;  on  killing the animal some time afterwards,  he
found the  ring covered externally by a secretion of  bone/]; owing
to the growth of  the latter, and  the  medullary canal  as large  as
the ring itself.  Notwithstanding  the obvious conclusion from this
experiment, he  made the mistake of  supposing that the bone had
enlarged  by expansion, and not by a  deposite externally with  an
absorption internally.
  As the individual  advances  in  life, the cylindrical canal, in the
centre of the long bones, continues to enlarge in size by the inter-
nal absorption: so  that  the parietes of  the  bones, which in early
life were much thicker than the canal, and in the adult about the
same diameter, become  exceedingly thin in old age;   resembling
thereby a  stalk of Indian corn, with the pith scooped  out.J   The
cells of  the  cellular structure in  the  several bones  also enlarge,
whereby the whole weight of  the bones is much decreased in.the
very aged.  In the  parietes of the cranium there is rather a ten-
dency to the  absorption of the' diploe, and  the approximation of
their tables in extreme old age.
  The bones, also, become more  brittle in old age, in consequence
of the increase of calcarious, with a diminution of gelatinous  mat-
ter.   The  reverse being the case  in infancy, they are  more flexi-
ble than in the adult, and can even bear to be twisted or bent with-.
out breaking.^

  *  Mem. de l'Acad.  Roy. des Sciences, an. 1739-.41-43t-16
  t  If a string be tied around a growing  tree, the same thing takes place, and it is
finally shut up in the  ligneous part.
  t There are several examples of this in the Anatomical Museum.   More rarely
the reverse takes place,  and the cavity is filled up: of this there  are also  speci-
mens.
  §  The  reported instances are  now  numerous, where, from a defective organiza-
tion of boric, fracture is produced  from very trivial causes; and this state is not con-
fined to any particular age,  for it extends  from infancy to advanced' life.  I have
attended a fractured os femoris in a child  of two years, from a stumble in walking
across a carpeted floor.  In  another child  the os femoris was broken, so far as  could
be learned, by the nurse stooping to reach  something from the floor: the same child
had both clavicles broken, without any one knowing when or where: the left side
was flattened, from the fracture, probably a partial one, of several ribs, equally incx- 
80
SKELETON.
          SECT. III.—ON THE FORMATION  OF CALLUS.

   As this is  a consequence of bones  being fractured, and a mode
that nature takes to repair the accident, there is some resemblance
between it and the primitive formation of  bone.  Owing  to the
rupture of the blood vessels of the bone; of those of the periosteum,
and of the medullary  membrane;  and frequently of  the vessels of
contiguous parts, the first effect of the  accident i*.an effusion of
blood into the cavity of the fracture.  The several contiguous soft
parts then swell, become hardened and inflamed ; and, in the mean
time, an absorption of the  blood is  proceeding, while an effusion
of coagulating lymph from the ruptured vessels occurs in the caviy
of the fracture.  A ring, the thickest part of which is precisely
over the seat of the fracture, is formed by the lacerated parts ossi-
fying : there is  also formed  in  the interior  of  the bone a sort of
osseous pin.   Till this moment the bone  itself remains unchanged,
with the exception of a coating of coagulating lymph  on its broken
faces; but now its extremities begin to coalesce or fuse themselves
into each other; the superfluous bony  matter  (the ring and  the pin)
being no longer necessary, is absorbed, and the cavity of the bone
with the membranes of the latter is re-established.   In  this  case
it  will be seen that the deposite  of  coagulating lymph into the
cavity of the fracture, corresponds with  the  mucous rudiments of
the foetal bone, and  that the remaining phenomena of ossification
are the same.
   Some physiologists have attempted  to give  to  the periosteum the
exclusive credit of  the formation of callus: the view  is erroneous,
because  experiments  show,  that  even  where  the periosteum  is
stripped designedly from the fractured ends of bones, they, never-
theless, unite, and the periosteum  is  restored  when  the  callus is
formed.   The probability then is, that all  the blood  vessels (from
whatever source they come) which  penetrate  the organized co-

plicable.  In a third child the tibia was broken  from a trifling fall  on the floor, and
the clavicle  from striking the shoulder moderately against  the rounded  back of a
chair.
  In these several instances the fragility may arise  either from an abnormal relation
of  the constituents of the  bone to each other, by a  deficiency of animal  matter,
which diminishes the tenacity of the bone, or it may arise from attenuation merely
of the bone, leaving its parietes too thin for  ordinary accidents. 
FORMATION OF CALLUS.
81
 agulating lymph secreted between the fractured extremities, con-
 vey and deposite calcarious matter.
   The celebrated Bichat and some others, were of opinion, that
 in every case of fracture where the ends of the bones are not kept
 in contact, granulations spring  up from the ruptured surfaces of
 the bone, and of its membranes; that these granulations first re-
 ceive into their  interstices  a soft gelatinous deposite, then a carti-
 laginous one, and, finally, a calcarious one, by which the bone is
 united.   This process, however, is much  more  common in com-
 pound fractures which suppurate, and may be considered rare in
 simple ones.
   This subject  recently has  been investigated by Miescher, and
 much elucidated by him.*   The  process he describes as follows :
 Immediately on the receipt of  the fracture, inflammation  of  the
 surrounding soft parts—the cellular tissue, periosteum and muscles
 —occurs, glueing them together, and forming thus a dense capsule
 around the point of injury.  Now, between this capsule and  the
 bone a semi-fluid substance is  exuded, which becomes gradually
 more consistent and very vascular.  A similar action goes on at
 the same  time in the medullary canal, and  the effused masses sub-
 sequently coalesce, forming the  substantia intermedia, which  re-
 sembles fibrous  tissue, whilst the muscles, periosteum and cellular
 tissue, return to their normal  state.  The  inflammatory action in
 the bone takes place at  a  period subsequent to its appearance in
 the soft parts, and commences at that point of the fractured extre-
 mities still surrounded  by periosteum, both interiorly and exteriorly.
 The fibrous substance  becomes now converted  into cartilage, and
 then bone.  According to Miescher, the callus  always arises from
 the bone itself, and never from  the periosteum; this last merely
 supplying the requisite conditions to the bone for the production of
 the callus—vessels essential to the formative and nutritive process.
 Ossification  commences on the surface of  the  capsule next to  the
 bone, and extends from this point.  The callus contains  the pecu-
 liar cartilaginous corpuscles,  and when ossified  assumes the cel-
 lular texture of bone.  The periosteum, as originally shown  by
 Detlef, and since by Miescher, is formed  subsequently to the for-
 mation of the callus on its external rugged  surface.  The views of

  * De inflam. ossium, etc., Bcr. 183G. Traite de Pathologie Externe, &c. par Vidal
de Cassis. Paris, 1839, p. 13. Muiler's Physiology, vol. i., p. 407. 
82
SKELETON.
Miescher  have been  confirmed by Mr. Bransby Cooper, who, at
the suggestion of the late Sir Astley Cooper, undertook about  the
same time, (1835,-'3G,) a series of experiments to determine  the
phenomena which occur in the reparation of fractured bones.  In
support of the osseous system alone being the source of the bony
deposite, he adduces the fact of bones which have an inferior orga-
nization, such as  the bones of the cranium and  the neck  of  the
thigh bone, being but slowly and  imperfectly reproduced.  The
subject is yet open, we think, to observation and experiment, and
will no doubt  receive farther  attention and  study under the new
laws of development recently promulgated.
   In fractures of the  patella, according to  Mr. Gulliver,* the new
bone shoots from the broken extremities into a dense fibrous tissue,
quite unlike the cartilage of which the patella is formed at an early
period.
   The same author thinks that when the broken  portions of bone
form an angle, there is quite a distinct centre of  ossification com-
mencing in the soft parts which lie between the sides of that angle.
This new bone being a provision to meet the  exigencies of an
irregular  case, Mr. Gulliver  has named it the accidental callus.
Though originally unconnected with the old bone, it soon becomes
united with the regular callus, the formation of  the former com-
mencing between the periosteum and bone at a distance from  the
protruded extremities.!
   The consolidation of fractures is influenced by a variety of cir-
cumstances, both in point of time and in the perfection of the pro-
cess.  It  takes place more rapidly in children than in old age;
Delamotte saw fractures of  the  humerus  perfectly united  by  the
twelfth day in young infants; and Mr. J. Cloquet mentions  the
case of a fractured clavicle in a  young girl of  six years, where
there was complete union in nine days.   The actual  state of health
of the patient influences union; and the supervention of acute dis-
eases not  only arrests the formation  of callus, but causes not  un-
frequently its partial or total absorption.  Mr.  Lungin  saw  the
newly formed callus  completely absorbed  in  a healthy individual
attacked with variola.  The size of the bone also is  to be consi-

  * Exp. and Obs. on Fractures of  the Patclhi.  Ed. Med. Pliys. Journ. No. 130.
On Preparation of Fractured Bones.  Ibid. No. 121.
  t See Edin. Med. and Surg. Journ. No. 129.  Gerber's Gen.  Anat.  by Gullin,
p. 13. 
FORMATION OF CALLUS.
83
dered, it taking  a longer period for the formation of callus in a
fractured femur than in a bone of smaller size, as the humerus or
clavicle.  The duration of the time  that the callus is susceptible to
external impressions has been variously estimated; and the practi-
cal importance of the question makes it expedient that it should be
ascertained.   It has been proved that, from the fiftieth day to the
sixth or seventh month, the callus has been broken by mechanical
means without the bone being injured.
   If the coaptation between the fragments is not perfect the pro-
visional callus is more voluminous, and the immediate union of the
osseous  surfaces is  retarded, or does  not occur, and the provi-
sional callus becomes itself definitive;  a tumour exists at the seat
of fracture, depending on the manner of consolidation of the frag-
ments, and  from this results the deformed or vicious  callus, by
which the form, direction, and length of the bones are altered, and
their functions  materially impaired.  This condition depends on
several causes.

   When the calcarious matter begins to take place  in a forming
callus, if the part be much moved, the process is arrested, the blood
vessels no longer deposite even if they carry  calcarious materials,
and an artificial joint is formed.  The  proper period of restoration
being once  passed, the vessels sink into an  inactive state from
which they have little or no disposition to rouse themselves.  Under
these  circumstances, Dr. Physick proposed, many years  ago, the
introduction of  a seton through the  cavity of the fracture, and the
retaining of it there for a long time, for the purpose of stimulating
the vessels.  The plan has  now been  repeatedly tried, with com-
plete success, on the cylindrical bones, and, in  one instance, upon
the lower jaw.*
   Callus being formed much more speedily in young persons than in
old, occasionally, however, we meet with instances in which  the
rapidity of its deposite in the latter is remarkable.   I, for example,
treated, in 1826, a female of ninety, for a simple fracture of the os
humeri, which was cured at the end*of five weeks.

  * Dorsey's Elements of Surgery.  Philadelphia Med. and Phys. Jour. &c. There
is now in the possession of Dr. J. Randolph, a son-in-law of the late Dr. Physick,
the os humeri upon which this experiment was  first tried, and which  shows, very
satisfactorily, the state of union; a hole is still left which the seton occupied. 
 
BOOK  I.
                         PART II.

                   OF THE BONES,  INDIVIDUALLY.

   The  several textures of the body are so intermixed, that the
consideration of one alone, pursued  through all its applications,
excludes for  the time, rather artificially, some one or more of the
others.   This circumstance, inseparable from a clear account, has
always perplexed writers on anatomy, and left them under various
impressions concerning the best point of departure and method for
pursuing their descriptions.  Reasons of value may be urged for
almost  any arrangement: each one will have some peculiar ad-
vantages that the others have not, and which will cause it to appear
to the understandings of its advocates, superior to the rest.  For a
course of study which is intended  to be physiological and surgical
in its combinations, the usual practice of beginning with the skele-
ton is, perhaps, the  most  advantageous;  the young student  will,
however, understand that  if the skeleton have any natural claim to
this  precedence, it is principally  from its furnishing those land-
marks,  as it  were, to which we refer the situation of other parts,
and that it  is only conceded, for the purpose of laying a foundation
for their more easy and intelligible description subsequently.   The
human  frame may be compared  to  an  extended landscape, the
multiplicity of whose features  and the variety of objects spread
over whose  surface, collectively,  bewilder the beholder; but by
seizing first on its prominent outlines, marking  the course of its
mountains and ridges, and determining the bearings of the several
objects according to them, we become able, at length, to define not
only to ourselves, but to others, the precise position  of each point,
or each object which may become the subject of inspection.
  Unfortunately, the  minuteness with which the skeleton  is de-
scribed has been decried as useless, but the zealous and reasonable
  Vol. I.—8 
86
SKELETON.
student ought to bear in mind—that the only rational plan of re-
ducing a dislocated joint must depend upon a proper knowledge of
its articular faces; that many of the  great phenomena of  life
depend  essentially upon the arrangement of the skeleton;  that
locomotion is inseparably connected with it;  and that, in short, it
has a bearing  upon almost every animal  operation.   With these
facts impressed upon him, he  will be prepared to give the historv
of the skeleton a full and perfect attention.
                        CHAPTER I.

                         The  Trunk.

   The trunk  is constituted by the  Spine, the Thorax, and  the
Pelvis.

                    SECT. I.—THE SPINE.

   The Spine, (Columna Vertebralis, Rachis,) is placed at the pos-
terior part of the trunk, and extends from the head to the inferior
opening of the pelvis.   It consists of  twenty-eight or nine distinct
pieces, of which the upper twenty-four are true, or moveable ver-
tebrae.  The twenty-fifth  is the sacrum, or  the pelvic vertebra,
which is fixed;  and the remaining three or four  pieces are  the
caudal vertebras or the coccyx.   The sacrum and coccyx are false
vertebrae, being so called from not turning.
   On the posterior face of the spine, each of the  true vertebra? is
seen to contribute, by a long  process, to that  ridge which is so
readily felt beneath the skin, and from which, probably, the name
of spine was derived.   The  spine increases gradually in size from
the first to the last true vertebra.  The upper part of the sacrum
is extended laterally much beyond the latter, afterwards the spine
diminishes abruptly to  the extremity of the  coccyx.   The spine
lias several curvatures, which  are best  marked in the erect posi-
tion.  For example,  the  lower part of the cervical portion is
convex anteriorly, and concave behind—the thoracic  part is con-
cave in front, and convex behind—the lumbar portion is convex in 
THE SPINE.
87
front, and concave behind—the  pelvic and caudal portion is con-
cave in front, and convex behind.   This arrangement is the result
of the different degrees of thickness in the bodies of the vertebras,
and  especially  in the fibro-cartilages which  unite them  to each
other.   Wherever these cartilages are thin at their anterior margin,
there is a concavity; but where they are thick at the same point,
there is a convexity.
   There are seven vertebrae to the neck, called cervical; twelve
to the  thorax, called dorsal; and  five to  the  loins, called lumbar.
In reckoning the number of the vertebrae, the one next to the oc-
ciput is always the first; and so on, successively, to the last.   Albi-
nus, however, has departed from this  rule, and counts them from
below, upwards.

               General Characters of a Vertebra.

   A vertebra (vertebre) consists in a body, in seven processes or
extremities, and in a canal or foramen for lodging the spinal mar-
row.

   The body of a vertebra is at its fore part; it is  somewhat cylin-
droid or oval, but varies considerably from  these figures  accord-
ing to its position in the spine.  The  anterior part of the body is
convex; but the  posterior part is concave, where it contributes to
the spinal canal.   The superior and inferior surfaces are flat, with
the exception of  a ridge of hard bone at the circumference, more
elevated, and not so extended in some bones  as in others.   These
ridges are, in young  subjects, epiphyses.  There  are many fora-
mina,  large and small, to  be seen  on  the  front and back  surfaces
of the bodies.  They transmit arteries and veins, and some of them
are used for fastening the ligaments  of the spine.  On the poste-
rior face of the body there are two foramina larger than the others,
occupied by veins coming from the interior of the vertebra.   These
veins correspond with the diploic sinuses in  the  head, and have
been particularly described by M. Breschet,  of Paris, in  a thesis
presented to the School of Medicine in 1819.

   The processes are placed at the posterior  part of the vertebra.
Of these there are  four  oblique or articulating  processes, which
articulate with the corresponding ones of the bones, above and be- 
88
SKELETON.
 low; two transverse processes, which  project, one on  either side,
 from between  the  oblique processes ;  and one  spinous process,
 which is placed on the middle of the bone behind.  The two ob-
 lique, and the transverse process on  each side, come from a com-
 mon base or root that arises from the lateral  posterior part of the
 body, and present collectively a very irregular appearance.   Their
 faces and inclinations are much  modified in the several vertebra?.
 The spinous process is also much modified in regard to size, shape,
 and inclination.

  The body and  processes form the  periphery of the  foramen for
 the spinal marrow,  and, by their thickness and strength, afford an
 excellent protection to the latter.   This spinal  foramen is  of a
 triangular or of a rounded shape, presenting  its  base  in front and
 its apex behind.  It is considerably larger than the spinal marrow
 of the part, including its vessels, membranes,  and the  nerves that
 proceed  from it; in  this respect the  foramen differs very mate-
 rially from the cavity of  the cranium, which  is  exactly filled by
 the brain.
  At the upper part of the spinal foramen of  a vertebra, between
 the body and the upper articulating, or oblique process, is a groove.
 There  is another groove  between the  lower oblique  process and
 the body.  These grooves, by the approximation of the contiguous
 vertebrae, are converted into perfect holes, called inter-vertebral
foramina, and are for the transmission of the spinal  nerves and
blood vessels.
  The bodies of the vertebrae are extremely light and spongy, be-
ing formed principally of  the cellular matter of bone,  and are co-
vered,  with the exception of  their upper and  lower surfaces, with
a very thin lamella  of compact substance.  The processes, for the
most part, have a thick  and compact structure, enabling them to
sustain conveniently the  weight of the body and  the action of the
different muscles, as applied to them.


              Of the Cervical Vertebra, generally.

  The cervical vertebrae differ  among  themselves, but are  distin-
guished by certain common properties from the other bones, of the
 spine.  Their bodies and  processes are small, but the spinal fora- 
THE SPINE.
89
men is large, so as to admit of much motion, without pressing on
the spinal marrow.   The  fore and  back parts of the body are
more flattened.   The upper face  is concave transversely, being
bounded on each side by a ridge of  bone;  the  lower face is con-
cave from before backwards, and is bounded by a ridge before
and behind.  This  arrangement permits the bodies of adjoining
vertebrae to embrace each other  in the dried bones, and grants
great facility of motion, in the living body, by  the interposition of
the inter-vertebral substance, as well  as security in the attachment
of the latter.
   The oblique processes  have their articular faces at an angle of
about forty-five degrees.   The superior  face upwards and back-
wards, the inferior  downwards and  forwards.   The  spinous pro-
cess is  short, triangular, nearly horizontal, and  bifurcated at  its
posterior extremity, where  it terminates in two tubercles.  The
transverse processes are short, and perforated by a large canal for
the transmission  of the vertebral  artery and vein; they are con-
cave above, somewhat convex below, and present two points  at
their external extremities for the origin and insertion of muscles.
The inter-vertebral foramen is formed  principally by  the lower of
the contiguous vertebras,  but the difference is  not very considera-
ble between the contribution of the two.


             Of the Cervical Vertebrce, individually.

   The first cervical vertebra, commonly called the Atlas,  from  its
supporting the head, presents the appearance of  a large irregular
ring, much  thicker at its sides than  elsewhere.  It is  deficient
in  body, owing  to  the space allotted  to  that part in the other
vertebrae being occupied  by the processus  dentatus of the second
vertebra.   The place of body is supplied by an arch of bone.
   Its oblique processes are peculiar, both  in  shape and position.
The upper ones are concave and horizontal, their long diameters
being extended from within outwards  and backwards,  so as  to
suit the direction of the condyles of  the occipital  bone with which
they articulate; the greatest depth of their concavity  is, therefore,
internal.  The inferior oblique processes are smaller, slightly con-
cave, and circular; they rest upon the shoulders of the second ver-
tebra.   At the  internal margin of  the oblique processes a rounded
                              8* 
90
SKELETON.
tubercle is found on either side of the bone.  The transverse liga-
ment of the  neclcis extended between the two tubercles, and keeps
the processus dentatus in its place.
   The short thin bridge at the fore part of  the bone, is marked in
front by a tubercle, and behind by an articular face which touches
the processus dentatus.   The  bridge or section of the ring forming
the posterior part of the bone, is  much longer and  more arched
than the  anterior.   It also has in its centre a tubercle, occupying
the position  of a spinous process.   At  the anterior extremity of
this bridge, just behind the upper oblique process, there is a groove,
and sometimes a canal, made by the vertebral vessels, just before
they enter the foramen magnum occipitis.
   The transverse processes of this vertebra are at the sides of  the
thick part of  the  ring.  From their greater length, they project
considerably beyond  the transverse processes below, and are also
perforated at  their bases by  the vertebral  vessels, which have a
very winding course from them into the cranium.
   The spinal  canal of the first vertebra, excluding  the  space  for
the processus  dentatus and transverse ligament, is  the largest in
the spine: by which ample provision is made against injuries of  the
medulla spinalis, notwithstanding the great latitude of the rotation
of this bone upon the second vertebra.   A considerable vacuity is
left between the upper posterior margin of  the  atlas and the con-
tiguous surface of the os occipitis, for  the  ginglymoid motion of
the head  upon the  atlas.

   The second vertebra of the neck  is particularly remarkable  for
the elongation of  its  body above into  the  processus dentatus or
tooth-like process.  This process rises as high as the superior mar-
gin of the atlas, and  almost  touches  the  anterior margin of  the
foramen  magnum occipitis.*   It presents an articular face in front,
where it  touches the first vertebra.   It presents also a smooth face
behind, where it touches  the transverse ligament.  Above the lat-
ter face,  on  each side, is  a flat surface for the origin of the mode-
rator ligament, and the very  point above  presents a small rough
surface for the  vertical ligament going to the margin of  the fora-
men magnum.
   On each  side of the tooth-like process, this bone presents  its
* Sometimes it even forms a joint with it 
THE SPINE.
91
superior oblique process, as a shoulder, nearly horizontal, circular,
and somewhat convex. The inferior oblique process has nothing pe-
culiar either in its position or direction.   The foramen of the trans-
verse process is directed upwards and outwards.   The interior part
of the body, like that of the other vertebras,  is cellular.
   The posterior part of the second vertebra is strong and broad.
The spinous process  is longer than any other except the seventh,
and sometimes  the  sixth; it  is  also  much larger, is triangular,
presents a ridge above and a fossa below, and is  bifurcated at its
extremity.   Just  behind  the upper oblique process there is a very
superficial notch, scarcely discernible,  for the inter-vertebral fora-
men.  The  processus dentatus is the pivot or axle upon which
the head revolves, and is stationary while such motions are going
on.  The spinal canal of this vertebra is cordiform or circular in-
stead of triangular.
   The vertebras of the neck increase gradually in.the size of their
bodies from the second to the seventh; and there is sufficient uni-
formity between  them, with the exception of the last,  to render the
general description applicable, though it is not difficult to  observe
some minute and unimportant points of difference.
   The spinous process of the sixth vertebra  is long, and terminates
in a sharp point.
   The seventh cervical looks like a dorsal vertebra, and has some
peculiarities which are well marked.  Its body is larger, its supe-
rior face is less concave than  in  the others, and its inferior face is
flat.  Its spinous process is the longest of all, is not bifurcated, but
terminates by a rounded tubercle easily felt beneath the skin.  Its
transverse processes  are thrown somewhat backwards, and though
there is a small foramen in them, it is  not large enough to  receive
the vertebral  vessels.  Sometimes on  the side of its body, at the
lower margin, is a small face,  by which  it partially articulates
with the head of the first rib.
   M. Portal*  reports, that in some rare cases he has seen only six,
and in others, eight cervical vertebras, with either of  which devia-
tions I have never met.
* Anat. Medicaie.  Paris, 1803. 
92
SKELETON.
                   Of the Dorsal  Vertebrce.

   General or Common Characters.—The dorsal vertebras, amount-
ing to twelve, being intermediate in position to those of the neck
and  loins, are also intermediate in size.  They diminish in the
transverse  diameter of their  bodies from the first  to  the  third:
afterwards, they increase regularly  in size to the last.
   Their bodies are more cylindroid than those of the  neck, and
the most of them are marked laterally on the upper, and also on
the lower  margins, near the base of the processes, with a small
articular face, which receives one-half of the head of a rib.  The
adjoining fossa of the contiguous vertebra, receives the other half
of the head of the same rib.  The superior of these articular faces
is larger than  the inferior.  The superior oblique processes  are
flat,  and present almost backwards; the inferior are also flat and
present as  directly forwards.  The transverse processes are di-
rected  obliquely backwards:  they are  long, terminate  in  an
enlarged extremity, which  presents  an articular face in front for
the tubercle of  the contiguous  rib.   The transverse processes as
they descend are directed more backwards, and diminish in  length.
The spinal  processes are long, triangular, with a broad base, and
an extremity somewhat rough, swollen, and sharp-pointed, except
in the upper and lower vertebras: they have a ridge above and a
fossa below; are directed obliquely downwards, and overlap each
other.
   The spinal foramen is small and round.   The notch for the inter-
vertebral foramen is formed principally by the vertebra  above.


            Of the. Dorsal Vertebrce—individually.

   These vertebras, though they have many common points of re-
semblance, yet  some of them  present distinguishing peculiarities.
Of these, the first and the  two  or three last, are  the most re-
markable.
   The first has  a complete articular face on  the side of its body
for the head of the first rib, and a partial surface at its  lower
margin for the head of the second rib.  Its spinous process is pro-
jecting and not so oblique as some of the  others: the flatness of its
body makes it look much like a cervical vertebra. 
THE SPINE.
93
   The three lower dorsal vertebras approach in the form of their
 bodies to those of the loins.  Frequently, but not always, the tenth
 has the articular face for the head of the rib, equi-distant from its
 upper and lower margins, and its transverse process so short, and
 inclined  backwards, that the tubercle of the tenth rib does not form
 an articulation with it.   The  eleventh and  twelfth vertebras have
 also the  fossas for the heads of the ribs, in their middle, at the sides
 of the roots of the processes; instead of a partial pit at their upper
 and lower margins. - Their transverse  processes are remarkably
 short, are directed almost  backwards, and  do not  touch the ribs,
 and have, therefore, no articular marks.   The spinous process de-
 parts from the triangular shape, becomes flattened and vertical at
 its sides, is not far from being horizontal, and has a tubercle at its
 extremity.
   The middle vertebras of the  back have  some minute points of
 difference among themselves, the most  of which it would be use-
 less to study.   They increase, as stated, gradually  in size as they
 descend, and their spinous processes are very near to, and overlap
 each other, like  shingles on the roof of a house.


                   Of the Lumbar Vertebrce.

   Common Characters.—Their  number^ has been  stated  at five.
 Their bodies are larger than those of the other true vertebras, and
 are oval on the upper and lower surfaces, with the  long diameter
 transverse.  The  epiphyses at  the  margins  of these faces,  are
 larger and more elevated.   The spinal foramen  is  triangular and
 more capacious  than in the dorsal vertebras.  The  inter-vertebral
 notches for the nerves to pass out, are much  larger than elsewhere
 in the spine, and  are formed principally by  the upper  of the two
 contiguous vertebras, though the  difference is not very remarkable.
   The transverse processes are very long, and stand out at right
 angles.   The  articular  faces of the upper  oblique processes  are
 concave  and vertical, being directed  very much inwards, or look-
ing towards each other; the lower  oblique processes are convex,
and have the articular faces directed very much outwardly.  The
spinous process is short, thick, and horizontal; having  broad, flat
sides, and terminating by an oblong tubercle. 
94
THE SKELETON.
              Of the Individual Lumbar Vertebrce.

  These bones are not so well marked among themselves as the
other vertebras.  They may be distinguished in a single set, by the
successive increase in the size of their bodies.  The first, therefore,
is known by its smallness; by the  comparative shortness of its
transverse process, and  by the deep concavity between the supe-
rior oblique processes.
  The transverse and spinous processes of the three middle verte-
bras are rather longer than those of the others ; the  third has them
the longest of all.   The last lumbar vertebra may be recognised
by its greater size; by its body being flat, and thicker in front than
behind, so as to give it somewhat of a wedge shape; by the greater
size of its spinal foramen : by the obliquity backwards of the trans-
verse process;  and by the  wide interval between the oblique pro-
cesses, as well as by the lower of the latter facing  almost directly
forwards.

                    Of the Pelvic Vertebrce.

  The os sacrum, (sacrum,) the largest  by much  of any of the
bones in the spinal column, has obtained its name from the suppo-
sition of  its having  been offered in sacrifice by the ancients.*  It
forms the posterior and  superior boundary of the  pelvis, as well as
the pedestal of the spine, and may, therefore, be  properly studied
along with either of  them, though  its association with the spine
seems more natural.  In its lateral  boundaries it is triangular: it
is also regularly concave before, and very irregularly convex be-
hind.
  In its forming state this bone consists  of five  pieces, separated
by long narrow interstices  filled with cartilage.   It is in this con-
dition that its  pieces bear  a very strong  resemblance to the true
vertebras, and, therefore, have obtained the name of false vertebra.
They are all fused into  one  by the  progress  and development of
the bone; but the marks of the original separation remain, particu-
larly on its front surface.
  Though the anterior face  of the  sacrum presents  generally a
* Portal. Anat. Med. vol. i. 345. 
THE SPINE.
95
regular concavity; in some subjects, nevertheless, it is flat.   This
surface is pierced on each side by four holes, which communicate
with the spinal cavity and transmit the anterior nerves  of the cauda
equina.   Beneath each range of holes is a notch, which by the cor-
responding one of the coccyx, is converted occasionally into a per-
fect foramen for the thirtieth spinal  nerve, or for  the fifth of the
sacrum.   These foramina diminish in size, from the higher to the
lower: their orifices are funnel-shaped, and directed obliquely out-
wards.   Horizontal ridges of bone, marking the original separation
of the false vertebras,  connect the holes of the two sides.
   The false vertebrae decrease in  size from above, which is mani-
fested by the successive approach  of the foramina, and of the hori-
zontal ridges.  The first of them has almost the same vertical dia-
meter as the last of the loins, besides its great increase of magnitude
by the lateral extension of its base.
   The posterior face of the sacrum  is very convex and rough, and
is equally divided by  its spinous processes.  The processes belong-
ing to its three upper sections or bones, are for ihe most part well
 marked, and decrease in length from the first.  The fourth spinous
 process is resolved into two tubercles, and the fifth is fairly sepa-
 rated also into two tubercles, by an angular fissure, with its base
 downwards  and open.  This  fissure, it may be remarked, some-
 times invades the fourth spinous  process, and even the third, and
 in some rare cases runs the whole length of the posterior surface
 of the bone, leaving a gap from one end  to the other.  The  upper
 margin  of the posterior face of the sacrum  presents on each side
 an oblique process for articulating with the lower oblique processes
 of the last lumbar vertebra.   Just above  the upper spinous process
 is a deep notch, between which, and the  last lumbar  vertebra, is a
 very large vacuity, or gap, exposing the  spinal canal.
    On each side  of the spinous processes are  also four foramina,
 smaller  and thinner than those in front, and  for the passing of the
 posterior nervous cords from the  cauda equina.   At  their internal
 margins some small  and obscure risings of bone are perceptible,
 which may be considered  the rudiments of oblique processes.  On
 the outer side of these foramina, there are several more strongly
 marked  tubercles,  from which  the sacro-iliac  ligaments  arise.
 Beyond these the posterior surface of  the bone slants very  consi-
 derably to its lateral margin, the entire surface of this slant, and 
96
SKELETON.
 which is irregularly pitted, being devoted to the origin of ligamen-
 tous matter connecting it with the ilium.
   The base  of  the sacrum presents in its middle an oval surface
 for articulating with the body of the  last lumbar vertebra.   Be-
 tween this surface and  the oblique  process, may be remarked the
 groove for the fifth lumbar nerve.   The base of the sacrum con-
 tinually thickens, from the side of the oval surface to the place of
 junction with the ilium.   The  anterior margin of this expansion is
 continuous with the linea ilio-pectinea; the posterior margin is ele-
 vated at its extremity, is a substitute for a transverse process, and
 is placed immediately below the transverse process of the last lum-
 bar vertebra.  The point of the sacrum is truncated where it arti-
 culates with  the os coccygis.
   The lateral face of the sacrum is thicker above than below; its
 upper  two-thirds present an irregular, and  somewhat triangular
 articular face for joining the ilium ; the lower third is very  thin,
 and contributes  to form the sacro-sciatic notch of the pelvis.
   The  spinal canal of the sacrum is triangular, and diminishes
 continually to its lower extremity, where it terminates by a small
 orifice, notched  behind, as mentioned, and exposing the last piece
 of the bone.   The foramina on the anterior and  posterior  surface
 of the sacrum, communicating with this canal, correspond strictly
 in their uses and positions with the inter-vertebral foramina of other
 parts of the spine.
   The sacrum is extremely light for its size, and its texture is in
 a high degree spongy;  but its processes  and articular faces are
 quite as compact as  they are in other parts of the spine.


              Of the Coccyx or Caudal Vertebrce.

  The os coccygis  (coccyx) resembles the sacrum  in shape and
 texture, and is so placed  as to continue forwards the line of the
 curvature of  the sacrum.  It consists in four small  pieces, some-
 times only three, united to one  another by  fibro-cartilaginous mat-
 ter, and it  corresponds with the tails of animals.   These pieces
 in the progress of life, are not  only anchylosed together, but also
with the sacrum; so that all the false vertebras, from  the base of
the sacrum to the point of the coccyx, are joined  into  a  single
bone. 
THE SPINE.
97
  The upper bone of the coccyx is the largest, and is the base of
this little pyramidal pile;  it is  united, by its  middle, to the trun-
cated apex  of  the sacrum; and  its  sides,  moreover, are, in  the
perfect specimen,  elongated several  lines beyond this surface of
contact.   From the posterior surface of the first bone, of the per-
fect  coccyx, a tubercle arises on either side, which is curved
upwards, and joins the bifurcated termination of  the  last spinous
process of the sacrum: between  the two bones an inter-vertebral
foramen is thus left for the passage of the fifth sacral nerve from
the canal of the  sacrum.   Immediately  below this tubercle is a
notch, made by the sixth sacral nerve.
  The remaining bones of the coccyx  are much smaller than the
first, and diminish successively.   The surfaces which  they all pre-
sent  to each other are somewhat concave  in the centre.   The
lower end of the last bone terminates in a rough point, to which a
cartilage is  appended.  These  bones are very spongy and light:
their  principal  strength is derived from  a  ligamentous covering.
To them are attached  the sacro-sciatic ligaments, the coccygasi,
levatores ani, and the glutasi magni muscles.


  SECT.  II.—DEVELOPMENT  OF THE VERTEBRAL  COLUMN.

  This column is much longer, in proportion  to the limbs, at birth,
than it is in  adult life, and upon  it depends  the principal  length of
the individual at this period.  The head is always in proportion to
the length of the spine.  This predominance in the head and spine
is, no doubt, connected with the necessity of an early development
in the nervous, respirator)', and  alimentary systems, in  order to
maintain the life of the individual; whereas,  the use of the upper
and lower extremities  being called for only at a more advanced
period, their development  is  not in  proportion.  It  is remarked,
that in adult life the principal difference  in the stature of indivi-
duals depends upon the length of the  lower extremities; the trunk,
including the head, being of nearly the same  length  in all.  This
rule, however, like most  others, has numerous exceptions.   The
spinal  canal and the inter-vertebral foramina are, also, propor-
tionably larger  in the foetus.
  The spine of the foetus is  but badly suited to  the  purposes of
standing and walking.  Its spinous processes  are deficient, in con-
  Vol. I.-9 
98
SKELETON.
sequence of which, the muscles which are intended to keep it erect,
have their insertion so much in  the  line of motion, that they per-
form their part very imperfectly, and the spine is continually bend-
ing forwards, from the erect position.  All the transverse processes
are also  imperfectly developed, those of the loins are particularly
deficient; those of the thorax and  neck are less deficient, as  in
the one case they have  to form  an articular surface for the ribs,
and in the  other to allow passage to the vertebral artery.  The
bodies of the  vertebras are imperfectly ossified, and are separated
by cartilage from  the processes.  The epiphyses,  or upper and
lower  surfaces of  the  bodies, are in the state  of  cartilage: the
bodies, therefore, are rounded  both above  and  below, whereby
their surfaces of contact are much reduced in  extent, and the line
of support  to the trunk  rendered much less firm.   When, at this
age, the  vertebras  are  macerated, their bodies present themselves
as small  rounded  tubercles;  and very  nearly one-half the whole
length of the spine is made up of the cartilaginous  epiphyses and
the inter-vertebral  cartilages.  The  spine, in the foetus, is almost
straight,  and scarcely presents at all those curvatures, for which
it is so remarkable in adult life.   This depends  upon the rounded
form of the bodies of  the vertebras, and the sameness of thickness
in the inter-vertebral matter at its anterior and posterior edge.


   SECT. III.—ON THE USES OF THE  VERTEBRAL COLUMN.

   The vertebral column performs  three  important  offices in the
animal economy.   It affords a secure  lodgement to  the spinal
marrow; is a line of support to the trunk, in  every  variety of
position; and  is the centre  of all its movements.
   In standing, the  spine also supports the head, which it  can do
very conveniently, from the  horizontal  direction of the condyles
and their nearly central position  on the occiput, and from the head
being almost in equilibrium when we stand erect.  The volume of
the head is so much greater before the condyles  than behind them,
that upon a superficial view one would  suppose its preponderance
in front  to be very considerable.   This is, however, less than it
might seem to be, for  two reasons: one  is, that the diameters of
the head are augmented behind  the condyles, and, secondly, it is
formed of solid matter; whereas, in front  a great  deal of it is 
VERTEBRAL COLUMN.
99
hollow, for the construction of the nose and the sinuses bordering
upon it.   The head, though nearly balanced, has some preponde-
rance in front, which is manifested by its falling forwards whenever
we sleep in the  erect position, or when the sudden  suspension of
life destroys the contraction of the muscles on the back of the
neck.
   In the lower  orders of animals, the  obliquity of the condyles,
their situation at one end of the  head, and  the great length of the
face, acting as  a weight upon a long lever, have a continual ten-
dency to incline the head downwards; which is only partially
counteracted by the largeness of the muscles and ligaments on the
back of the neck.
   The horizontal direction of the condyles, and  their location near
the centre of the base of the head, have arrested the attention of
naturalists, and  established for man characters distinguishing him.
from all  other animals, for facility in maintaining the erect atti-
tude.   Bichat happily observes,  that from this conformation result
the following peculiarities in  his organization:  1. Less strength in
the muscles of  the neck than in quadrupeds; 2. Less projection in
the occipital bone, where the muscles are inserted;  and,  3. An
imperfect development of the ligamentum nuchas.
   The thoracic and  abdominal viscera, by being placed in front of
the spine, and  having no counterpoise behind, have a continued
tendency to bend it.  This is only resisted  by  the muscles which
fill up the  long gutter on either side of the spinous processes, and
are inserted into the ribs, the spinous and the transverse processes.
The lumbar vertebras and the appertaining  muscles and ligaments,
having  an increased  duty to perform, from the lownass of  their
position, and the variety of their movements, become  the soonest
affected  by fatigue and  bodily weakness;  and  therefore manifest
sooner the sensation  of lassitude, notwithstanding  the  augmented
volume of the  bodies and processes  of the vertebras,  and of the
muscular masses inserted into them.
   The mechanical arrangement of the spine permits it to perform
the motions of  flexion, extension, lateral bending, circumduction,
and rotation.

   1. Flexion, or that posture in  which the spine is bent forwards,
is  the most extensive of its movements: the general mechanism of 
100                       SKELETON.
 the human body disposes us to approach surrounding objects in
 that direction; and  the  muscles of  the  abdomen, besides their
 intrinsic strength, act most advantageously m producing it,  by be-
 ino- removed  to a great distance from the  centre or line of motion.
 In  this  position the inter-vertebral cartilages  are diminished  or
 compressed in front, and  thickened behind, the  anterior vertebral
 ligament is in a state of relaxation, while the  posterior vertebral
 ligament and those which connect the spinous processes  are in a
 state of proportionate tension.

   2. The motion  of  extension, on the contrary, is  much  more
 limited from several causes.  The muscles which act in this case,
 by arising either from the posterior face of the pelvis, or from the
 transverse processes, and going upwards to be inserted either into
 the ribs, the transverse or the spinous processes, are much  less ad-
 vantageously placed than the abdominal muscles, in regard  to the
 length of  the lever which they employ.  Moreover, mechanical
 obstruction is opposed  to this motion  by the spinous processes  of
 the back and neck, being very near to, and overlapping each  other.
 The abdominal muscles also afford a strong resistance to its be-
 ing carried beyond a certain point as  any one may assure himself
 of, by the tension communicated to these muscles from placing a
 large billet of wood under the loins of a subject; and, when they
 are cut  through transversely,  the immediate consequence is,  a
 great  increase in the posterior  flexion of the spine, through the
 agency of the lower dorsal and the lumbar vertebras.   The ante-
 rior vertebral and  the  inter-vertebral  ligaments, likewise, oppose
 the extension  of  the spine, much more than the elastic and the
 inter-spinous ligaments do its flexion.

   3. The lateral  inclination of the spine is a motion of considera-
 ble extent,  and is obtained both by the very advantageous position
 of the muscles on the side of the trunk and neck, and by the little
 mechanical resistance to it from the shape and arrangement of the
 parts concerned.  A principal impediment to this  motion  being
 carried beyond a certain point, is  presented by the ribs striking
against each other.   The  transverse processes of all the vertebras
are so far  apart, particularly in  the loins, that  they scarcely de-
serve to enter  into the estimate of resistances.  As the muscles of 
VERTEBRAL COLUMN.
101
the one side produce the lateral curvature, so their  resistance on
the other limit it to a certain extent, as may be readily ascertained
by cutting  them through.

   4.  The circumduction of the spine is that motion in which the
trunk is  caused  to describe a cone, the base  of which  is above,
and the apex below.   It is performed on the lower dorsal and the
lumbar vertebras, and  is a  succession  of the  movements already
described.

   5.  The rotation of the spine is a very limited motion.   It is per-
formed almost entirely on the lower dorsal and the upper lumbar
vertebras, and presents in its analysis a series of minute and oblique
slidings of the body of one vertebra upon another, the pivot being
the oblique  processes.  The action occurs by the lateral yielding
of the inter-vertebral  substance;  it must, therefore, be almost in-
conceivably small in any individual substance, particularly when
the latter has  been hardened  and rendered more  fibrous by old
age.  In the very young subject it is more appreciable.


        Of the  Motions peculiar to each Class of Vertebra.

   1. The cervical vertebras, as a whole, enjoy a considerable share
of flexion, extension, lateral inclination: and of circumduction, as
the result of the other  motions.  Their  rotation, or the oblique
sliding of one  vertebra upon  the  other, is very limited.  The ap-
parent facility  with which they are twisted upon each other, when
the face  is  turned  to the shoulders alternately, is almost wholly
the motion of the first vertebra upon  the second, the  participation
of the other vertebras  being very  inconsiderable.  The possibility
of the dislocation of these vertebras, with the exception of the first,
is very stoutly denied by authories of the first standing in  anato-
my, on the  score that too great  a resistance  to  this accident is
afforded  by the inter-vertebral and yellow ligaments, by the inter-
spinal  and  inter-transverse muscles,  by the inter-locking  of  the
bodies of the vertebras through their  reciprocal concavities and
convexities, and by the shape and extent of their oblique processes.
  Some years  ago, I met with  a  case in which there was every
reason to believe  that a partial displacement or dislocation had oc-
curred about the  fourth vertebra, in a boy of eight or ten years.
                              9* 
102
SKELETON.
It arose from his struggling to extricate himself from the grasp of
a school-male,  who held him near the ground  by the back of the
head, with the  spine bent  forwards.  This  position, it  is evident,
was calculated to lift the oblique processes of the vertebras above
over the others; and an oblique force applied at the same time con-
summated the accident, by twirling the lower oblique process over
the upper margin, and in front of the one with which it was articu-
lated below.  The displacement was manifested by inability to
move the neck; by a permanent inclination  and  turn of the head
to the side opposed to the injured one; and by an inequality in the
range of the anterior points  of the  transverse processes of the
side affected.   I succeeded in replacing the  bone by lifting its dis-
located  side over the lower oblique process,  communicating at the
same moment a rotatory motion, the reverse of that by which the
accident had happened.  In  an instant, the patient was relieved;
from extreme  pain, fixed  deformity, and inability to  move the
neck, he performed with freedom all  the motions natural to the
part.*
  The principal motions of the head upon  the first vertebra are
those of flexion and  extension : the power of the condyles to slide
horizontally from one  side to the other in  the cavities formed in
the atlas, is narrowly restricted, both by the  shape of  the proxi-
mate articular surfaces, and by the arrangement of the  ligaments:
this motion is, in fact, so inconsiderable as scarcely to deserve no-
tice.  Even flexion and extension appear greater than they actually
are, in consequence  of the lower vertebras  most commonly con-
curring  in these motions.  When simply the head is flexed upon the
atlas, while the other vertebras are kept erect, the chin approaches
the sternum, and the  skin of the neck  is thrown into  folds;  but
when all the bones are flexed, the head is thrown forwards and the
skin is kept tense.   The flexion  of the head upon the  atlas is re-
stricted  by the  ligamentum nuchas, and by the ligament passing
from the posterior  margin of the occipital foramen to the posterior
bridge of the atlas.   The extension of the head  is restricted by the
vertical, moderator, and anterior vertebral ligaments.
  The motion of the atlas upon the axis is limited strictly to rota-
tion.  The confinement of the processus dentatus by the  transverse

  * I have lately  seen another accident of the same kind from  a full.  Sec ?.k*d.
Examiner, 1842. 
VERTEBRAL COLUMN.
103
ligament behind, and by the anterior bridge of the first vertebra in
front, prevents thoroughly both flexion and extension.  The hori-
zontal direction and  the flatness  of the corresponding articular
faces of these  two vertebras, also prevent any lateral inclination.
In compensation for these restrictions, the rotatory motion  is en-
joyed to great extent, and is amply provided for, by the  extreme
looseness and thinness of the capsular ligament of the oblique pro-
cesses.   In this motion the  arch of the atlas  and the transverse
ligament rotate on the tooth-like process to the right and left alter-
nately;  at the same time the inferior oblique process of the atlas is
slid either forwards or backwards, according to the general  move-
ment upon the upper oblique process of the dentata.   This  move-
ment is  checked, at a certain point, by the moderator ligaments,
which, by the close connexion  of  the head and first vertebra, an-
swer the same purpose as if they were inserted into the latter.  It
is also checked by the capsular ligament, notwithstanding the ge-
neral laxity of the latter.   But still it is not difficult for it to exceed
its natural  bounds, and for the  oblique process of the atlas to pass
completely beyond  the margin of that  of the dentata, and  in re-
turning to lock against it.  This, in fact, happens, in the  great
majority of instances, where violence from  falls, and  so on, has
been  applied to the body, and results in injury to the neck, parti-
cularly; and when, in the abrupt turning of the head, produced by
the action of the muscles, the individual finds himself incapable of
bringing it back.   This articulation is, unquestionably, less pro-
tected, and more exposed to accident, than any other in the  spine;
and, as just stated,  is therefore supposed, by some, to be  the only
one in the  neck admitting of simple luxation.
   Most frequently, in this luxation, when it is  produced by exter-
nal violence, death is  the immediate result, from the spinal marrow
being pressed upon and disorganized above the origin of the phrenic
nerve.  The seat of the principle  of respiration is in the medulla
oblongata,  and its agents are the phrenic and the intercostal nerves;
the communication with  which being thus cut off, respiration, and
consequently circulation, stop immediately.  Bichat  thinks, that
when death is thus suddenly produced, the processus dentatus, by
rupturing its own ligaments connecting it to the occiput, slides by
the falling of the head forwards, beneath the transverse ligament,
and presses upon the spinal  marrow.  On the contrary, when it is
a  simple displacement of the  oblique processes,  as the odontoid
process remains within  its boundaries,  and its ligaments are only 
104
SKELETON.
 stretched, there is no danger of death.  Fatal accidents have hap-
 pened to this articulation, in holding an infant from the ground, by
 the two hands applied to the head, from his struggles to disengage
 himself.  A posture-maker is said to have died  on the spot, from
 communicating a  rotatory motion to his trunk, while its weight
 was  sustained by inverting his head, and  making  the latter the
 base of support.   When the vertebras are  displaced in such per-
 sons, as well as in those hung by the neck, it is supposed that this
 sliding of the processus dentatus from beneath the transverse liga-
 ment takes  place; as, by experiments on the dead body, it is found
 that such displacement occurs much more readily than the rupture
 of the transverse ligament.

   2.  The dorsal vertebras are capable of but very  little motion in
 any direction.   The  rigidity and  length  of the  sternum prevent
 them from  flexion, the overlapping and obliquity of their spinous
 processes prevent them from extension, and the ribs prevent them
 from lateral inclination.   It is, however, to be observed, that  as
 those obstacles are diminished, successively, in the five lower dor-
 sal vertebras, consequently they become more and more capable of
 motion upon each other.  Luxation  among them, at any  point, is
 thought to be impossible, from the strength of their ligamentous
 attachments, and from the arrangement of their articular  faces.

   3. The lumbar vertebras move with  great comparative freedom
 upon one another;  admitting, as stated, of flexion,  extension, and
 lateral inclination.   Below, however, they are  much more  re-
 strained than they are  above; hence, it results, that the principal
 seat of the  motions of the trunk upon the spine, is about the con-
 nexion of the lumbar  and dorsal  vertebras.  Dislocation is here,
 also, thought to be impossible, from the strength of  their ligamen-
 tous attachments, from  the  great  diameters of their bodies, and
 from the deep interlocking of the oblique processes.


            SECT IV.—OF THE OSSA INNOMINATA.

   (Os  Coxaux, ou des Isles.)—These  bones, two in number, are
situated one at either side of the sacrum, and constitute the lateral
and anterior parietes of the pelvis;  forming, along with the sacrum
and coccyx, the whole of this latter cavity.
  The os innominatum, from having  been, in its  original  state, in 
OSSA INNOMINATA.
105
three pieces, notwithstanding they subsequently coalesce firmly in
the adult, and preserve scarcely any vestige of their primitive dis-
tinction, is divided by anatomists into ilium, ischium, and pubes.

   Os Ilium, (Ilion.)—This, the largest of the three portions, forms
all the upper rounded part of the os innominatum, and is the haunch
bone of common language.  Its superior margin  is a semicircle,
rather thicker towards the  extremities than  in  the middle.  The
inequality, when viewed  from above, is  very apparent, as well as
a  slight curvature resembling the letter S.  This margin of the
bone is called its crest or  spine, presents  an internal  lip  for the
origin of the transversalis  abdominis muscle, an external one for
the insertion of the obliquus externus, and an intermediate edge for
the origin of the obliquus internus.  The anterior extremity of the
spine is terminated  by a projecting point, called  the anterior  supe-
rior spinous process, from which arise the tensor vaginas femoris,
the sartorius, and the beginning of Poupart's ligament.  The pos-
terior extremity of the crest is also projecting and pointed, but less
so than the other, and obtains the appellation of the posterior  supe-
rior spinous process.
   The anterior margin of the os ilium is unequal, and divided into
two portions, of nearly the same length,  by a strong, well-marked
projection, the anterior inferior spinous process, which  is  placed
an inch and a-half below the anterior superior, and gives origin to
the rectus femoris.   This margin joins with  the pubes by a  large
flattened elevation, called the ilio pectineal protuberance.  Between
the latter and the anterior  inferior  spinous  process, a  concavity
exists which is occupied by the  junction of the psoas magnus and
iliacus internus muscles, where they pass under Poupart's ligament.
Between the two anterior spinous processes is  another concavity,
from which the  anterior  edge of the gluteus medius arises.
   The posterior margin of the ilium is also very unequal, both in
its direction and thickness.   The posterior inferior spinous process
is about sixteen lines below the posterior superior, and terminates
a  cutting edge running between these two processes.  Just below
it  we find the deep excavation called the sciatic notch, through
which pass out the  pyriform muscle, the sciatic  nerve, and  several
blood vessels.
   The exterior face of  the ilium, called its  dorsum, is  generally
convex and rounded; its margins, however, are  so elevated, that 
106
SKELETON.
partial depressions, or sinkings below the general surface, may be
remarked, especially at its back part.  Just  above the two poste-
rior spinous processes, a  flatness is observable, from which a part
of the gluteus magnus arises.  A semicircular rough ridge begins
at or near the anterior superior spinous process, and may be traced
on this surface of the bone to the sciatic notch.  All that portion
of the dorsum between this ridge and the spine, with the exception
of the little flat surface just above the posterior spinous processes,
gives  origin to the gluteus medius.  The dorsum terminates below
at the acetabulum, and  between the latter and  the semicircular
ridge  is the surface for the origin of the gluteus minimus.
   The internal face of the ilium, or  that which looks towards the
belly, is called its costa or venter.  Its superior part, amounting
to about two-thirds  of the whole surface, is very concave, and is
the iliac fossa, which is  occupied by the  iliacus  internus muscle.
The fossa is continued forwards into the hollow below the anterior
inferior spinous process, and over the acetabulum.  The iliac fossa
is terminated below by a rounded ridge, a  part  of the linea ilio-
pectinea that separates the greater  from  the  lesser pelvis.  The
remaining third of the costa of the ilium .is very rough and unequal,
and is appropriated to the articulation with the sacrum, and to the
origin of some of the muscles of the  back.   Immediately posterior
to the sciatic notch is the surface for the sacrum, which is some-
what  triangular, but irregularly so, and extends from the iliac fossa
to the posterior inferior spinous process.  Behind the  sacral sur-
face is another, twice as large, strongly marked  by its roughness,
and elevated into a vertical ridge at its middle.  Anterior to  this
ridge arise many of the  ligamentous fibres, fastening  the ilium to
the sacrum ;  but posterior to it is the surface of origin to the mul-
tifidus spinas, and the sacro-lumbalis muscles.

   Os Pubis,  (Pubis.)—This bone constitutes  the fore part of the
innominatum, and is much the  smallest of  the three.  It is com-
posed  by a body and  two large branches from it, one running
downwards  to join the ischium, and  the  other  backwards  and
upwards to join the ilium.
   The body of the pubes is joined to its fellow on the opposite side
by a  flat surface, called the symphysis, which is eighteen or twenty
lines in its long- diameter.  The superior part of the body also pre-
sents  a flat surface, called its horizontal portion, which is bounded 
OSSA INNOMINATA.                    107
 outwardly by the spinous process about an inch from the symphy-
 sis.   The horizontal portion and the symphysis form a right angle.
 From the exterior face of the spine two ridges proceed outwardly;
 the  posterior is  the  crista; it is frequently sharp,  elevated,  and
 makes the anterior half of the  linea  ilio-pectinea; the anterior
 ridge is lower down,  increases in  its elevation as it  goes along, is
 rounded, and runs nearly horizontally to terminate  in the anterior
 upper margin of the acetabulum.  Between the two ridges  is a
 superficial triangular  concavity occupied by the origin of the pec-
 tineus muscle; the  base of the triangle is bounded by the protube-
 rance formed at the junction of the pubes  and ilium, and it  is
 exactly over this part that the femoral vessels pass; its apex is the
 spine or spinous process of the pubes.  The extremity of the upper
 branch of the pubes  is  triangular, and much  enlarged where  it
 contributes to the acetabulum.
   The inferior branch of the pubes, technically called its ramus,
 is a  flattened process  about an inch in length, and, as mentioned,
 descends  to  join the ischium.  Its exterior  is plain, and  has no
 mark deserving of  attention; but the internal face, near the ante-
 rior  margin,  is concave for attaching the  crus of the penis or of
 the clitoris.
   The body  of the pubes in front is concave, and gives origin to
 the adductor longus and brevis muscles;  behind, it is  only suffi-
 ciently concave  to participate in  the  general  concavity of the
 pelvis.
   Os Ischium, (Ischion.)—This  bone forms the posterior inferior
 portion of the os innominatum, and is the next in size to the ilium.
 It is of a triangular form, and has the anterior  extremity bent up-
 wards to join with the pubes.  The latter part is its crus or ramus,
 and  the remainder is its body.
   The body  of the ischium is a triangular pyramid, the  internal
 side  of which is smooth and uniform, but the posterior and  the ex-
 ternal sides are very  unequal.   The internal side is  broad above
 and  narrow below; at the middle of its posterior margin  is  the
 spinous process, a projection of considerable magnitude, and sharp-
 pointed, for attaching the lesser  sacro-sciatic  ligament.   Imme-
diately below the spinous process is  a  smooth  concave surface,
forming a trochlea, over which the obturator internus  muscle plays.
 Below this trochlea, and forming the most inferior internal margin
of the bone, is a long ridge, somewhat more elevated behind than 
108
SKELETON.
in front, into which  the great sacro-sciatic ligament is inserted.
The internal face of the ischium, though  technically  called  its
plane, departs from  the perfect  regularity implied  in that name,
by participating in the general concavity of the pelvis.
  The posterior face of the ischium is swollen out, above, into a
rounded surface, for the strengthening  the posterior parietes of the
acetabulum.  This  swell is bounded,  below, by a  transverse de-
pression or fossa;  immediately below  which, is the tuberosity of
the ischium, a large rough surface extending from the fossa to the
beginning of the crus.  This rough surface is subdivided into  four,
two above, and two below.  The one above, which is external,
and nearest to the acetabulum, gives origin to the  semi-membra-
nosus  muscle; the other, which is internal, gives origin to the
semi-tendinosus, and to the long head of the  biceps flexor cruris.
Of the two flat surfaces below, the one which borders on the ridge
for  the insertion of the great sacro-sciatic ligament, is the part on
which we sit, and  the last surface, which is exterior again to this,
gives origin to a part of the adductor magnus muscle.
  The exterior face of the ischium, above, forms the lower part of
the acetabulum, and  is,  therefore, very much excavated; below
this the surface is flat, and sufficiently uniform to dispense with a
particular description.
  The crus of the ischium is flattened internally and externally, and
in the adult  it is fused completely into the crus of the pubes, so
that very  faint marks of their primitive separation are  left.   The
anterior margin of the crus has, for the origin of the crus  penis
and the erector penis muscle, an excavation continuous with that
on the crus of the pubes.

  In examining the general features of the os innominatum, it will
be observed, that its outline is in  some degree like the figure 8; the
narrowing in its centre being produced by the sciatic notch below,
and by the deep concavity above, between the anterior superior
spinous process and the symphysis of the pubes.  The regularly
rounded margin of the ilium above, and of the ischium below, con-
tribute to  the resemblance, but the angle of the pubes interrupts it.
The narrowest part of the bone, or its neck, is between the top of
the sciatic notch and  the fossa below the anterior inferior spinous
process.   It  will  also  be  remarked, that the posterior  margin of 
THE PELVIS.
109
 the sciatic notch is formed by the ilium, and the anterior by the
 ischium.
   The  acetabulum, or the cotyloid  cavity,  (cavite"  cotyloide,) is
 placed immediately on the outside of the neck of the os innomina-
 tum.   In infancy one fifth of  it is seen to  be made by the pubes,
 two-fifths by the ilium, and two-fifths by the ischium.  It is a very-
 deep  hemispherical depression,  having a  sharp  elevated margin
 all around, particularly at its superior part.   The inferior  magin,
 amounting to one-eighth of the whole  circumference, is compara-
 tively shallow,  and  is, indeed, converted into  a notch, sunk  much
 below  the general  surface of the brim.  The greater part of* the
 acetabulum is smooth, and incrusted with  cartilage wherever the
 head of the os femoris is applied to the support of the trunk; but
 the very bottom,  with the intervening  surface continuous with the
 notch, amounting to  rather  more  than one-fourth of the whole
 cavity, is rough, sunk  below the general concavity, and is occupied
 by a soft vascular fat.
   In the fore part  of the innominatum  a  large deficiency, called
 the thyroid foramen, (foramen thyroideum,) exists between the
 pubes and  ischium.   In the male subject it is triangular, with the
 angles rounded; but in the female it is  rather oval.  Leadino- from
 the plane of the ischium is a groove, which  goes along the superior
 end of the foramen, and appears externally  under the anterior ridge
 of the pubes.   It conducts the obturator vessels and  nerve to the
 inner side of the thigh.
   The texture of the  os innominatum is cellular internally, with a
 condensed lamella  externally.   It  is  of very various  thickness.
 The ilium, in its centre, has the external and internal sides so near
 one another, that  in most adults  the light will shine through it.  A
 large foramen is seen  on the venter  of the ilium, and another on its
 dorsum, for the transmission of nutritious arteries.   There are seve-
 ral others, smaller, at  various points of the os innominatum, for the
 same purpose, and for the adhesion  of ligamentous fibres.


          SECT.  V.---OF  THE  PELVIS, GENERALLY.

  The sacrum and  coccyx behind,  and the ossa innominata at the
sides and in front, constitute, as  observed, the whole cavity called
pelvis,  (bassin.)   Its position  is  such, that, in the adult, it divides
  Vol. I.—10 
110
SKELETON.
 the entire length of the body into two parts nearly equal, the head
 and trunk forming one part, and  the lower extremities the other.
 Generally, the former are somewhat the longest;  but  in cases of
 unusual corporeal stature, the excess depends upon an undue length
 of the  inferior extremities.  On the contrary, in persons of little
 height, the latter have not been developed in proportion to the trunk
 of the body.
   The  pelvis, as a whole, is a  conoidal cavity, having its base  up-
 wards, and the summit below.  Its internal surface forms an irre-
 gular floor, on which the viscera of the  abdomen are sustained in
 the erect position;  and its external surface, by projecting conside-
 rably at various  places, establishes  very favourable points for  the
 origin of muscles.
   The internal surface of the pelvis is divided by the  projection of
 the anterior margin of the  base of the sacrum, and  by the linea
 ilio-pectinea, into two cavities; the  upper  one is the  great pelvis,
 and the lower one, the little pelvis.   The  great pelvis  is  the base
 of the cone, and presents at its anterior part  a  large deficiency,
 which is supplied  in  the fresh  subject by the abdominal  muscles.
 The little pelvis is a complete bony canal,  much deeper behind
 and at the sides, than  in front.  Its depth, behind, is formed by the
whole length of the sacrum and coccyx ; at the sides by the bodies
of the ischia and a small part of the ilia; and, in front, only by the
length of the bodies of the pubes.
   The upper orifice of the lesser pelvis is called its superior strait:
it  is somewhat oval,  and looks obliquely forwards and upwards.
Its axis may be  indicated by a line  drawn from the  extremity of
the coccyx to  a point, an inch, or thereabouts, below the umbilicus.
The inferior orifice of the lesser pelvis is called the inferior strait.
Its margins in the naked skeleton are very  unequal, for it  presents
three very deep notches, two lateral, and one  in  front.   The first
are formed by the external  margins of the sacrum  and  coccyx,
contributing to deepen the sciatic notch, which already is formed
in each  os innominatum.   The third one is formed by the conver-
gence of the rami of the pubes and ischia of the opposite sides, and
constitutes the arch of the pelvis of  authors, sometimes called the
arch of the pubes.  The axis of the lower strait, it is clear, must
have a very different direction from the axis  of the superior, and
is indicated by a line  drawn from  the lower part  of the first bone
of the sacrum, through the centre of this opening.  The cavity of 
THE PELVIS.
Ill
the lesser pelvis is increased considerably behind, by the curvature
of the sacrum;  this, however, is not uniform, as the  sacrum  is
much more curved, as well as longer in some individuals than  in
others.  The planes of the ischia are not parallel with one another,
but converge  slightly from  above, in consequence  of  which the
transverse diameter of the  lower strait, is rather smaller than the
transverse diameter, of the superior strait.

        Difference of the Pelvis  in the Male and Female.

   There are  several well  marked peculiarities in the fully deve-
loped pelvis of either sex.
   The ossa  ilia are larger, less concave, and  more horizontal  in
the female.  The superior  strait  is also larger, and more round:
its transverse diameter always exceeds the antero-posterior; where-
as, the latter, in the male, frequently  is found the longest.  The
lesser pelvis is also more capacious in women.  The crura of the
pubes and  ischia, are not so long as in men; but they diverge
more, and join at the under part of the symphysis pubis by a large,
regularly rounded arch; whereas, in men, the arch, as it is called,
is merely an acute angle.
   The os sacrum in women is shorter, more concave, and is also
broader in proportion  to  its length.  The spaces, vertically, be-
tween its foramina in front are very small, forming  ridges, which
give to the bone the appearance  of  having been compressed in its
length.
   The distance between the upper  and lower straits, or in other
words, the depth of the  small pelvis in women, is  not so great as
in men: this arises from the comparative shortness  in the length
of the pubes, of the ischia, and of the sacrum, as just mentioned.
The  cartilaginous joining of the  pubes is thicker in women.  The
diameters of the inferior strait, like those  of the superior, are lon-
ger in females.
   Accoucheurs have attached much  importance to the direction •
and  length of the diameters of  the small pelvis in well  formed
women.  At an average they are as follow.   The superior strait
presents three  diameters:  The  first  or antero-posterior extends
from the upper extremity of the  symphysis pubis,  to the  middle  of
the projection of the sacrum at its superior margin,  and  measures
four  inches: The second diameter, or the transverse, crosses the 
112
SKELETON.
first at right angles, and extends from the middle of  one side of
the strait to the corresponding point on the other; it  measures five
inches : The oblique diameter extends from the sacro-iliac junction
of one side to the linea ilio-pectinia  over the acetabulum of the
other, and measures four inches and a-half, sometimes  more.*
   At the inferior strait, the antero-posterior diameter is  from the
lower part of the symphysis pubis to the lower end of the sacrum,
and measures five inches.f  As the coccyx,  in child-bearing wo-
men, is moveable, its  projection forwards is not taken  into the
account, because it recedes by the pressure of the  child's head, and
does not resist its passage: in some cases, however, it is unfortu-
nately fused into the sacrum, and therefore perfectly rigid, which
will diminish this diameter at least an inch.  The transverse dia-
meter of the inferior strait is drawn from the middle of the internal
margin of the tuberosity of one ischium, to the corresponding point
on the other, and measures four inches.
   The depth of the little pelvis, in the  female, at the symphysis
pubis, is an inch and  a-half; at the posterior part four inches, or
five if we include the coccyx;  and at the side three  inches and
a-half.  There  are many other details  connected with  the  mea-
surements of the pelvis, which are mentioned by systematic writers
on midwifery.
         SECT. VI.—DEVELOPMENT OF THE PELVIS.

   Three points of ossification are observable in  the os innomina-
tum of  the early foetus:  one is  at the superior part of the ilium,
another is at the tuberosity of the ischium, and the third is at the
angle of the pubes.  The radii of ossification  from these centres,
have extended  themselves considerably at birth, so as to sketch
out  the  forms  of the bones to which they respectively  belong.
But these bones are separated from one another by cartilage, and
do not coalesce  till years afterwards.  The union or fusion of the
ilium and pubes then occurs at  the ilio-pectineal eminence, over
the acetabulum, and partly in this cavity; the ilium  and ischium
join in  the  acetabulum  principally, and the  ischium and pubes

        * See Dewees' System of Midwifery, 7th edition, 1835, p. 28.
        t Dr  Dewees says four. Loc. cit. 
                          THE PELVIS.                       113
                                       \
unite by their respective crura at the middle of the internal side of
the thyroid foramen.   All the points of the os  innominatum, most
remote from  the primitive centres of ossification, are cartilaginous
at birth: as,  for example, the crest, the spinous processes, the tu-
berosity, and even the component parts of the acetabulum.  The
latter cavity has then a triangular shape, and from its very flexible
and yielding  condition, is incapable of affording a strong point of
support to the trunk in the erect position.
  At birth, the middle parts of the os sacrum, which are employed
in protecting  the spinal marrow, are  more  advanced in their ossi-
fication than its lateral parts.  The five pieces which compose it,
are, like the bodies of the true vertebras, of a rounded shape.  The
processes  behind are  cartilaginous.   The  coccyx is extremely
small, and scarcely presents any ossification'whatever.
  The pelvis  of  the foetus, at birth, is  smaller  in proportion  than
the  superior portions of the trunk; this is one of the reasons  why
the  abdomen  is  so projecting.  The lesser  pelvis is so small and
shallow, that the bladder, even in  the undistended state, cannot be
accommodated by it, but is contained principally by the abdomen.
Its transverse diameter is much shorter than the others.  The su-
perior strait faces much more forwards than in  the adult.
      SECT. VII.—ON THE MECHANISM OF THE PELVIS.

   The pelvis has an important part in the several actions of stand-
 ing and of locomotion;  besides its usefulness in giving a support to
 the viscera  of the abdomen, and in having attached to, and con-
 tained within it, the organs of generation.
   In standing, the  pelvis  is impelled by two  opposing forces, in
 consequence of the attachment of the vertebral column at its hind
 part, and of the ossa femorum at its anterior  lateral parts.  The
 weight of the head  and of the  upper parts of the body, falling upon
 the sacrum, acts upon a lever,  which is represented by the distance
 between the acetabula and the sacro-iliac junction, and has a ten-
 dency to depress the posterior part of the pelvis, by rotatino- it
 upon the heads of the thigh bones.   This movement is obviated by
the iliacus internus, psoas  magnus, and some other muscles, which
keep the front of the pelvis from rising up.  It is also  prevented by
the principal weight of the trunk being in front of the spine, and
                             10* 
114                       SKELETON.
therefore inclining forwards, so that  the centre of gravity, in the
erect position, gives  a continual tendency to fall forwards instead
of backwards.
   The wedge-like shape of the sacrum is highly favourable to the
erect position: from  having its base upwards, whenever the weight
of the  trunk is thrown upon it, it is driven down between the ossa
innominata, and has the tightness of its articular connexion, there-
fore, much increased by  the position which  it is intended to sus-
tain.   In illustration of the usefulness of the triangular or wedge-
like shape of the sacrum, it may be observed, that it is much less
so in animals which are intended to go upon all fours, than in the
human subject.
   The articulation of the several  bones of the pelvis with  each
other,  is so close as not to admit of any  motion  between them,
with the exception of the os coccygis, and of the relaxation pecu-
liar  to pregnancy.   The  pelvis,  however,  has  upon the spine,
flexion, extension, lateral inclination, and rotation; tho  latter being
performed by a  series of very slight  twists of the lumbar vertebrae
upon each other.  Like all other motions, it is much extended by
habit in early life.  Of this I have  seen an instance, in an adult
Indian,, who, from infancy, had been deprived entirely of the use
of the lower  extremities; but who, by being  seated  in a large
wooden bowl,, with a round bottom, and having his legs drawn up
in a  squatting position, could, by alternate twists of the spine, with
the assistance of a short staff in each hand, move with surprising
speed over a plain surface.


                SECT. VIII.-^-OF THE THORAX.

   The thorax is the upper part of  the trunk, and is formed by the
dorsal  vertebras  behind, by the sternum in  front, and  by the ribs
with their cartilages at the intermediate spaces.  It is of a conoidal
figure, flattened  in front, somewhat  concave behind, and semi-
cylindrical on the sides..   The interior circumference corresponds
with the exterior, with the exception of the  posterior part, where,
owing to the projection of the column of dorsal vertebras, a par-
tial septum exists which has a tendency to divide it into two cham-
bers.  The superior part of the cone, or its summit, is much smaller
than the inferior part or the base, and presents a very oblique cor- 
THE THORAX.
115
diform foramen, much lower in front than behind, owing to the
superior margin of the sternum  being lower than the first dorsal
vertebra.   The  base  of  the  thorax is  a very large  opening:  its
lateral and  posterior  margins, formed by the ribs and their carti-
lages, present  a convexity downwards; but, in  front, where the
latter run up to join the sternum, a large notch is formed between
the cartilages of  the  opposite sides, into the  apex of  which notch
the third bone of the sternum projects.


                          Of the Ribs.

  The ribs, (costce, cotes,) are twenty-four in number, twelve  on
either side.  Of the latter, the upper seven, in consequence of their
cartilages joining the sternum, are called the sternal  or true ribs,
and the lower five, from their cartilages stopping  short of the ster-
num, are called the false or asternal ribs.  Cases are  recorded  bv
several anatomists of  there being eleven or thirteen ribs on  a side:
the latter I  have seen several times, and  the former but once or
twice.  In such cases, the dorsal vertebras correspond in number
with the ribs.   In the instances  of redundance which have come
under my notice, the  last rib looked  like a transverse process of
unusual length, belonging to a lumbar vertebra.  The superabun-
dant vertebra constituted  the thirteenth dorsal;  but was formed
like the first lumbar as it commonly exists, and the last lumbar ver-
tebra  was  entirely anomalous in its  shape, being intermediate in
form to a lumbar vertebra, and to the first  bone of the sacrum.
  All of the ribs are so placed, that they run very obliquely down-
wards and  forwards  from their posterior extremities.  This ob-
liquity becomes the more striking as the ribs  increase successively
in length.   The  first rib,  for example, articulating by its posterior
extremity with  the first vertebra of the  back, has its anterior ex-
tremity nearly on a horizontal line with the lower part of the third
dorsal vertebra.   The seventh rib has its anterior extremity on a
horizontal line with the lower margin of the last dorsal  vertebra.
notwithstanding its posterior extremity articulates with the seventh
vertebra.   The  same sort  of comparison  might  be usefullv insti-
tuted in regard to all the ribs, in which case the rule will be found
closely applicable, with the slight exception  of the two or  three
last ribs.  The ribs are  nearly  parallel  to each other in this obli-
quity, allowance  being made for the  effect which the obliquity of 
116
SKELETON.
 the sternum has in  causing a greater separation of their anterior
 extremities from  each other, than exists  at  their posterior extre-
 mities.

   Common points of resemblance between the  Ribs.—Each  rib is
 paraboloid; presents an external and an internal surface; an upper
 and a lower margin ; a sternal and a vertebral  extremity.
   The external surface of each rib is convex, while its internal sur-
 face is concave.  The former presents, not far from the vertebral
 extremity,  an  oblique ridge, occasioned  by the insertion of the
 sacro-lumbalis muscle.  It is precisely at this line that a curvature
 somewhat abrupt, takes place, which is the angle of the rib.   Be-
 tween the angle and the transverse process of the vertebra, each
 rib is rather more narrow and cylindroid  than  it is in advance of
 the angle.  The superior margin of the rib  is rounded  and some-
 what rough, for the insertion of the intercostal  muscles, while the
 inferior margin is  brought  to  a thin, cutting edge.  Just within,
 and above the latter, is a fossa beginning  somewhat nearer to the
 spine than the angle of the rib, and ceasing about one-third of the
 whole length of the rib, short of its anterior extremity.   It con-
 tains the  intercostal vessels and nerve.  From the upper margin
 of this fossa arises  the internal  intercostal muscle, and from the
 lower  the external.

  The anterior extremities of the ribs are thin and flattened, in the
 upper eight there is some increase in  their breadth at this point,
 and  in all there  is  an oblong pit for receiving the end of the cor-
 responding  cartilage.  The  vertebral extremity of the rib is its
 head, and presents two flat articular surfaces, separated by a ridge.
 This head is received into the inter-vertebral matter, and upon the
 articular faces of the adjoining margins of the vertebras.  A small
 depression exists upon the posterior face of the rib bordering on
 its head,  for containing a little fatty mass.  About an inch beyond
 the head, at the posterior under surface of  the rib, is  a tubercle,
presenting a smooth articular face, for connecting itself with the
transverse process of the vertebra.   Just beyond this, but border-
ing on it, is a much smaller tubercle, not  unfrequently  indistinct,
for the insertion of the external transverse ligament, and below it
is a small pit for the lodgement of fatty matter near the joint.  The
space between the first or greater tubercle  and the  head  of  the rib 
THE THORAX.                      117
 is its neck, which is  in  contact with  the  antero-superior face of
 the  transverse process  of  the vertebra, and  has  a sharp ridge
 on its upper margin, for the  insertion of  the  internal  transverse
 ligament.
   The most of the ribs have a very sensible twist in them, by
 which their  spinal extremity is directed upwards,  and the ster-
 nal  extremity downwards;  from which  it results, that the whole
 length of the rib  cannot  be  brought into contact with a horizontal
 plane.

   Differences in  Ribs.—Though  there are many common points
 of resemblance among  the ribs,  yet  there  are, also,  some well
 marked peculiarities.   Thus the ribs increase successively in length
 from the first to the seventh inclusively ; they then decrease by the
 same rule: the last is not only the smallest, but not unfrequently
 the shortest.  The angles of the ribs increase in their distance from
 the spine, from the first  to  the last rib.   The angle, however, of
 the first rib, is not well  marked, from  its being so near the tuber-
 cle;  neither is the angle of the last, from its being so near the ante-
 rior  extremity.   The oblique ridges constituting or marking  off
 the angles, are placed one above the other, in the same line. This
 gives to the  back of  the thorax a triangular flatness, the base of
 which is below.   The projection  backwards of the angles of the
 ribs, along with that of the spinous processes of the vertebras, forms
 on each side of the latter the gutter, which  is filled up by the large
 muscles  that  keep the  trunk  erect.  This gutter  is, of  course,
 broader below.
   The first rib is more circular than the others.  Its  head  is hemi-
 spherical, instead of presenting two articular surfaces.  This rib
 is flat above and below;  its margins are internal and external.   It
 has no groove  for the intercostal vessels and  nerve.   About the
 middle, the upper surface is marked by a superficial  oblique fossa,
 made by the subclavian  artery ; in front of, and behind  which is a
 small rising, marking  the insertion of  the  scaleni muscles.  The
 second rib is considerably longer than the first, and has its  flat sur-
 faces obliquely  upwards and  downwards, so as to round  off that
 part  of the thorax.  The four inferior  ribs  decrease at their ante-
 rior extremities, or become somewhat tapering.  The last two ribs.
do not articulate with the transverse processes, and, consequently,
have no corresponding tubercles.  As  their heads articulate with 
118
SKELETON.
the middle of the bodies  of their respective vertebras, instead of
with  the  margins, they present  only a single  and somewhat con-
vex surface.   The eleventh rib is marked only for a short distance
in its  middle by the fossa, for the intercostal vessels.   The twelfth
rib has no mark of the kind.
   There is an augmentation in volume from the second to the
eighth rib, inclusively; afterwards they decrease.  The angles of
the ribs are, successively, more and  more obtuse.
   The structure of the rib is spongy, covered  with  a lamella of
compact bone.  The spongy structure predominates at  the ante-
rior extremity, for there the rib is comparatively soft.


                       Of the Sternum.

   This bone  constitutes the middle front  part of the thorax, and,
owing to  the  obliquity of the ribs, has its superior end on a hori-
zontal line with  the  third  vertebra of the back, while its inferior
extremity is on a horizontal line with the eleventh dorsal vertebra.
It is also placed  in a slanting direction, so that the lower part re-
cedes from the spine much farther than the upper.
   The sternum is oblong, somewhat curved, like a bow, so as to
be convex in front, and  concave behind.  It  is divided, in  the
adult, into three distinct pieces; an upper, middle, and lower,
which are held  together by cartilage and  by ligament; but  not
unfrequently in advanced life these pieces  are all fused into one, by
bony  union.  The first and middle parts join where the second rib
is articulated, and the middle and  lower where the seventh rib
articulates.  At  these  points there  is  a  well marked  transverse
ridge, both anteriorly and posteriorly, and  between them on the
front  of the bone, there are other ridges  not so  strong, indicating
the original separation of the bone into several other distinct pieces.
The lateral margins of the sternum are  somewhat elevated where
the ribs articulate.
   The upper end of the sternum is both  thicker and broader than
the lower end.   Where the first and second parts join, there is a
narrowing of  the two: the same occurs where the  second  and
third  pieces unite.

   The first or upper bone of the sternum, has an irregular square
figure; it projects somewhat above, and  is  slightly hollow below. 
THE THOBAX.
119
It is scooped  out  at  the superior margin, and presents a point at
each end of the scoop.   At the side of the latter is a concave and
rounded  surface, for articulating  with the clavicle;  just  below
which is a  rough surface, for the  cartilage of the first rib.   The
bone diminishes  much in breadth from this  point, and terminates
by a narrow oblong  face, joining it to the second piece.  At each
side of this junction both pieces contribute to a fossa for the carti-
lage of the second rib.
  The second bone of the sternum  is longer and narrower than the
first.  At its lower part it increases somewhat in breadth, and then
terminates  by  being  rounded off on either side, so that  its margins
converge towards each other.   The sides of this piece afford com-
plete pits for  the  third, fourth, fifth, and sixth  ribs;  the pit for the
seventh is  common  to it  and  the third bone, as the  pit for the
second  rib is common to  it and  the first  bone.  The sixth and
seventh pits  are  in  contact, the fifth is very near  the sixth, the
fourth is about half an inch above the fifth.   On viewing the whole
side of  the sternum, it will be observed that the distances between
the pits decrease, successively, from the first to the last.

  The third bone of the sternum, in the young adult, is frequently
in a great degree  or  wholly cartilaginous, hence,  the name of
xyphoid cartilage (cartilago xyphoides  or  ensiformis) has  been
applied to it.   It  is thin, varies remarkably  in its breadth in diffe-
rent individuals,  and has  the lower extremity sometimes  turned
forwards and sometimes  backwards, but most frequently it is in-
clined  only slightly  forwards.  The base of this  piece presents a
narrow oblong surface for articulating with the second bone, at
each end of which is the half fossa for the seventh rib.   The  mar-
gins of the ensiform cartilage are thin, and have  the transverse
muscles of the abdomen inserted into them.  Sometimes the lower
extremity,  instead of being pointed, is bifurcated.

  The sternum is composed of a  spongy texture, enveloped by a
thin layer of  compact substance.   Its strength depends, in a great
degree, on its ligamentous covering. 
120                        SKELETON.
        SECT.  IX.—OF THE CARTILAGES OF THE RIBS.

   These are placed at the anterior  extremities of all the ribs, the
 seven superior of which they unite to the sternum by the sychon-
 drosis articulation.   The  length, breadth, and  direction of these
 cartilages are far from being uniform.
   The first costal cartilage is short; the following  ones increase
 in length, successively, to the seventh, inclusively.  The cartilages
 of the false or abdominal ribs decrease, successively, in length from
 the eighth to the twelfth, inclusively; the last is a mere tip to the
 end of the rib.   The breadth of the  first cartilage is considerable
 near the  sternum; the succeeding ones  are not so  large  at this
 point.  With the exception of the first three, the costal extremities
 of the cartilages are larger than the sternal;  and  they become
 more rounded  as they advance to the latter.  The  cartilages, in
 point of magnitude, generally, will be found  in  proportion  to the
 size of the ribs  with which they articulate.  The sixth and seventh
 are joined together, and are spread out at their middle, which gives
 there an increase of breadth, and permits them to touch, and some-
 times to  coalesce.
   The first cartilage goes obliquely downwards in  the direction of
 the rib to which it  belongs, in order to join the  sternum.  The
 second and the third cartilages are nearly horizontal, but inclining
 a  little upwards in their  progress; the fourth, fifth,  sixth, and
 seventh,  pass, successively, more and more obliquely upwards  to
 the sternum, in  consequence of the increasing length of the ribs
 requiring them to traverse a longer space to reach this bone.   From
 the direction  of  the cartilages being obliquely upwards, while that
 of the ribs is obliquely downwards, the angle formed near  the rib
 at the base of the cartilage, where the latter  begins first to turn
 upwards, is less  obtuse  in the lower  cartilages than in the upper.
 The obliquity of these  cartilages  is  also  very manifest, by com-
paring them with the side of the sternum: with it they form  a very
acute angle below, and a very obtuse one above.
  The cartilages of the false ribs, successively, decrease in length,
to terminate in  front by small tapering extremities.   The  first is
united  by ligaments, somewhat closely, to the  last  true or sternal,
and is occasionally sent forwards fully to the sternum.  The others
are united more loosely, in  such a  way that the anterior extremity 
CARTILAGES OF THE RIBS.
121
of the one lies against  the inferior margin of that which is above.
The eleventh and twelfth cartilages are generally too short to touch
the  ones above, they  therefore are  fixed principally  by  a con-
nexion with the abdominal  muscles.   Their ribs are  much more
moveable than any others, and have been called floating, from  that
cause.
  There is some difference between the two extremities of the  car-
tilages ; the posterior or costal is a small, convex, unequal surface,
very closely united to the anterior extremity  of the corresponding
rib.   The other or sternal extremity in the sternal cartilages, offers
a smooth articular face, which is angular or  convex, according to
the shape of the cavity in the sternum, with which it has  to arti-
culate.   The three first asternal, and the  last  sternal  cartilage,
make, to the lower part of the  thorax, a broad and well marked
margin, convex in front and concave behind.
  The cartilages of the  ribs are, in persons  of middle age, white,
flexible, and very elastic. They are dissolved  very slowly in boiling
water; by which they, if young, are reduced  to gelatine, otherwise
their solubility is very imperfect.   They have a structure differing*
in some respects, from  other cartilages ; when dried, and exposed
to the action of the atmosphere, they are seen to consist of an im-
mense number of  small  thin plates, placed end  to end, and sepa-
rated by deep fissures.   M. Herissant describes these plates as
interlaced one with another, and forming a  kind of spiral, the re-
gularity  of which is interrupted  by small cartilaginous projections,
uniting the plates to each other.*   These cartilages  have a great
disposition  to ossify, which is manifested in most  individuals some-
what advanced in life.   The ossification begins in their centre, and
advances to the circumference,  and is  always preceded by a yel-
lowish tinge.  When  they are  fully ossified, like  the ribs,  they
are cellular  within, and compact externally, and are  continuous
with the  ribs, there being no interval: in such cases, the distinction
from  the sternum  is generally kept up by the preservation of the
joint,  with  the exception of the  first, which  is fused into it.  The
complete ossification of the first cartilage is not uncommon; the
others, though there  is generally in old persons a considerable de-
posite of bone in them, are seldom fully ossified.   In  neither case,

                   * Acad, des Sciences, an. 1748.
  Vol. I.—11 
122
SKELETON.
however, is it common to see such a perfect  continuity of bone
between the rib  and sternum, that  the  junction may not be dis-
solved at one point or another of this space by the action of boiling
water: at least, after very numerous observations on this subject, I
do not remember to have met with a single instance of it.
     SECT. X.—OF THE DEVELOPMENT OF THE THORAX.

  In the foetus the shape of the  thorax differs much  from that of
the adult, in the greater comparative extent of its antero-posterior
diameter, and in the projection of the  sternum.   The state of the
thoracic viscera, at this period, calls for such an arrangement; as
the heart and thymus gland, which are in the middle, have a con-
siderable  extent, whereas, the lungs are  still collapsed  from the
emptiness of their air  cells.  The ribs are but little curved at their
posterior parts, the angle being by no means well formed, in con-
sequence of which, the fossa on each side of the bodies of the ver-
tebras, in the thorax, is not so deep; neither  is the fossa behind, on
each side of the  spinous processes, so fully marked.   The superior
opening of the  thorax  is more  round from the  increase of the
antero-posterior  diameter.  The  inferior opening  is  extremely
large, both from the elevation of the sternum, and  from the pres-
sure of the abdominal viscera, of which the liver,  from its great
extent, is a principal agent.   The vertical diameter of the thorax
is small, from the ribs,  particularly the lower ones, being pressed
up one against the other, by the diaphragm, acted on  by the abdo-
minal viscera.

  The bones  individually are in  the following state  at birth.  The
ribs are almost  completed, the heads,  where they join  the spine,
being in a state  nearly as perfect as at any subsequent  period of
life, and not by any means in the condition of a cartilaginous epi-
physis, as is presented  in the extremities  of the cylindrical bones
generally.  These bones, as Bichat very justly observes, are de-
stined  to  a function which  commences  immediately upon  birth,
and which requires  in them as much perfection then, as they have
in the adult.  For respiration is  different from locomotion, the lat-
ter requires a species of education, which  may be given gradually, 
MECHANISM OF THE THORAX.               123
whereas one respires from the beginning as he will respire always.
The sternum, which is less immediately connected with breathing,
and only contributes to the general solidity of the thorax by com-
pleting  its  circumference, is  in a  state almost cartilaginous, and
presents only nuclei of ossification in its several pieces.
  At the instant of birth, a great change is produced in the dimen-
sions of the thorax.   The  lungs, from  being in  a collapsed and
solid state, suddenly  suffer an expansion of their cells by the intro-
duction of air into them, and increase twice or three times in mag-
nitude.  This is accomplished by the elevation of the ribs, and the
consequent  increase in the transverse diameter of the thorax:  it
becomes a condition that for ever afterwards remains, so that the
lungs, even  upon death, continue  to have their air cells distended,
and do  not return to a perfectly collapsed state.   The action of the
diaphragm is but small in the earliest periods of life, owing  to the
size and pressure of  the abdominal viscera against it;  respiration
is then  principally carried  on by the elevation and  depression of
the ribs, and by their being rolled  outwards, a motion which the
flexibility of their cartilages and the looseness of their  articulating
surfaces favour very much.
  At the age of puberty the thorax experiences a  remarkable aug-
mentation.  Its transverse diameter is sensibly increased, and there
is a general expansion of its volume, indicative of a healthy and
vigorous constitution.   Should this not take place, and the sternum
be projected, it  is supposed  to mark a  disposition to consumption.
The enlargement of the thorax is undoubtedly also connected with
a development of the organs of generation at  the same  time.   The
exercise of the latter requires greater vital  powers than exist in
early life, and the provision for it is manifested by the general in-
crease of  vigour and firmness in the human  frame; but  it is not
possible to point out in what manner the  sympathy exists, which,
on the  development of the organs of generation, extends their influ-
ence to the bony structure of the thorax.


      SECT. XI.---OF THE MECHANISM OF THE  THORAX.

  The thorax  performs two very important  offices in  the animal
machine:  the first is to contain and protect the organs of circula- 
124                        SKELETON.
  tion and respiration, the second to assist in the function of respira-
  tion, and perhaps that of circulation.*
    The mechanism of the thorax is such that the solidity of its
  materials, and  its rounded  shape, present a  very efficacious de-
  fence of its viscera, from the influence  of blows  on its outside.
  The effects of the latter are also materially diminished by the thick-
  ness and contraction of the several large muscles which are placed
  on its surface.   On  its back  part the thick longitudinal muscles of
  the spine, as well as  those running to the superior extremities, fill
  up the gutters on each side  of the spinous processes, and make a
  fleshy protuberance, divided  into two by the raphe which extends
  the length of the  back  over the spinous  processes.   In front it is
  less protected, owing to  the  sternum being  immediately under the
  skin.   Nevertheless, when blows  are inflicted on this part, their
  effects are  much diminished by the elasticity of  the cartilages of
  the ribs, and by the  direction,  obliquely downwards, of the ribs
  themselves;  both of  which dispose the sternum  to retreat back-
 wards, and  to yield  to the  impelling force.   The recession will
 take place more readily at the  moment of expiration; and when
 the muscles which elevate the ribs are not on their guard.  In
 those  deliberate exertions of  the strength of the thorax, exhibited
 by individuals lying down on their backs, and  sustaining a heavy
 weight on the sternum, the ribs are saved from injury by  different
 means.  The arched  form, itself, of the  front of  the thorax, is of
 considerable service  in  the resistance under such circumstances;
 this, however, would be easily overcome, and the ribs would break,
 if the arch were not sustained in its elevation  by the contraction
 of the large muscles on its sides; as the serratus major, the pecto-
 ralis major, and  minor, each  of which, by acting on the depressed
 anterior extremities of the ribs and their cartilages, has a tendency
 to keep them elevated.  Fractures of the ribs, from blows or force
 applied in front, are not so  liable to occur in the part  stricken  as
 in the  point feeling the greatest  momentum, which from the semi-
 circular form of  the ribs is in or near their middle: this exhibits a
true example of  what the French writers  call the contre-coup.
Bichat says, that  the fracture  by contre-coup is  much  more com-

   A very interesting paper, on this subject, was presented to the French Institute
by M. Barry some years ago. 
MECHANISM OF THE THORAX.
125
 mon when the individual being struck unexpectedly, has not had
 time to throw his  muscles into a state of contraction, for the pro-
 tection of the ribs.
    The lateral convexity of the  thorax being greater than that in
 front or behind, and having the same assistance from  the muscles
 mentioned, presents a stronger resistance when blows are inflicted
 directly on it.  Each rib represents an arch, the summit of which
 is its centre, and  the base its two extremities.   The abutments of
 the base are, the sternum at one end and the spine at  the other: a
 displacement from them is completely prevented  by  the  strength
 of the ligamentous attachments, as well as by the form of the sur-
 faces.  Under these circumstances, as fracture  occurs preferably
 to dislocation, it is generally at the point stricken.
    The abdominal  or false ribs, from  their want of attachment to
 the sternum, present  a very different condition.  Their  anterior
 extremities,  therefore,  yield readily, and  are driven  inwards to-
 wards the abdomen.

    The second function of the  thorax, relating to its  influence on
 respiration, is  executed by its dilating and  contracting, whereby
 the air is received  into, and expelled from it.   The spine is the fixed
 point for the motions of the ribs in respiration.  In the act of  dila-
 tation, the capacity of the thorax is augmented in three directions,
 vertically, transversely, and antero-posteriorly, or from the sternum
 to the spine.   The vertical augmentation is  accomplished by the
 diaphragm;  and,  as mentioned, is much greater proportionally in
 the adult than in  the infant, from the  greater comparative size of
 the abdominal viscera in the latter.  The transverse augmentation is
 produced by the successive contraction of the intercostal muscles,
 which raise the ribs upwards. The first rib is moved inconsiderably,
 in consequence of its shortness and of its continuity with the sternum.
 The attachment of the  scaleni  muscles to its upper surface, serves
 rather to give a fixation to it, and to prevent it from being drawn
 down by the other  ribs, than to produce by their contraction an  ele-
 vation of it.   The  first rib may, therefore,  be  considered as a fixed
 point.   The first intercostal muscles contracting from  it, draw up
 the second  rib, which, in  its turn, becoming  a fixed point for  the
 second intercostal   muscles, they contract  and draw up the third
rih, and so on successively to the last.   It  is  the obliquity of  the
                              11* 
 126                       SKELETON.

 ribs from behind, downwards and  forwards* which enables this
 elevation of them to produce an increase in the lateral diameter of
 the thorax: without such obliquity, their elevation would not have
 the effect.   But the obliquity alone could be of but little service, if
 the anterior extremities of the  ribs were not attached to the ster-
 num by cartilages,  which have to ascend in order to reach it;  for
 it is obvious  that the angle of  the  cartilage and rib, during their
 elevation by the intercostal  muscles, has  a tendency to  enlarge
 itself;  and will, in doing so, increase the  horizontal distance  be-
 tween the anterior end of the rib and the sternum, and consequently
 increase the  transverse diameter of the thorax.   The upper ribs,
 from the shortness as well as direction of  their cartilages, can do
 little or nothing in increasing this diameter.
  According  to  some  anatomists, the  capacity  of  the thorax is
 also augmented by a rocking motion of the rib, in which the two
 extremities being stationary, the middle is drawn upward and out-
 ward.   It is not, however, very clear, that this  motion  exists to.
 much extent, in the adult, as the posterior articulations of the thorax
 are opposed to it.
  While the  transverse enlargement of the thorax is  going  on, a
 simultaneous motion occurs in the sternum, and in consequence of
 the oblique direction in which  the ribs run to  it, the sternum is
 caused, by the elevation of their bodies, to recede from the spine.
 But, as the ribs increase successively in length from the first to. the
 seventh, each lower one, in  its elevation from the oblique towards
the  horizontal  line, has  its anterior extremity carried  proportion-
 ably farther off from the spine; hence, the sternum has a combined
 movement resulting from  its several  attachments to the ribs: one
 motion elevates it as a  whole, another causes it to recede from the
spine as a whole: and  the third causes  its  lower  end, from the  in-
 creased length of the ribs there, to be pushed farther from  the  spine
 than the upper;  giving it, thereby,  during respiration, a slight
 motion backwards and forwards, resembling that of a pendulum.
This latter motion, however, though its existence is clear, is not
very considerable, from the sternum  being kept  in  check by the
tendinous centre of the diaphragm, as one may prove  by examining
his own  body.   The enlargement of the thorax,  in its antero-pos-
terior diameter, is much more considerable at  the anterior extre-
mities  of the  ribs, because  there they are comparatively free.  la 
MECHANISM OF THE THORAX.
127
this case, the cartilages of the ribs are bent forwards, besides being
elevated.
   In expiration, the movements of the thorax are exactly  the re-
verse of what they are  in  inspiration, and all its diameters  are,
consequently, diminished.   Whatever may  be  said of muscular
influence in producing this  change, it is much exaggerated.  It is
true, that there are certain  muscles which  may  be applied to this
end, as the abdominal, and  also some on the back, as the  lonsris-
simi dorsi  and  sacro lumbales;  but that  they  are  actually so
engaged, under  ordinary  circumstances,  is  rather  questionable.
In observing the phenomena of natural respiration, when, by posi-
tion, all these muscles are put into a state of relaxation, it does not
appear that the process  is at all  impaired  by their being thrown
out of action.  The only muscles, therefore, that  seem to be espe-
cially  appropriated to produce expiration, are few and small: they
are the serrati inferiores postici, one  on either side of the spine.
But, when  the lower  ribs are fixed by the several  muscles inserted
into them,  they become points of support to the  upper ones;  and
then the intercostal muscles  may officiate in expiration, by draw-
ing the ribs successively  downwards,  as they do,  in inspiration, by
drawing the ribs successively upwards.
   The elasticity of the  cartilages, by which these bodies are en-
abled  to return from the constrained state in which  they were
placed by inspiration, has also been supposed  important to expira-
tion, by Haller, and others.   The power thus derived is certainly
of some value; but has much  less than has  been attached to it.  It
unquestionably exists in early and middle life, but  is lost in old age,
when the cartilages ossify, and, therefore, are deprived of elasticity.
The true and efficient cause of expiration appears to be atmospheric
pressure, upon the external  parietes  of the ihorax, acting along
with  the natural  elasticity of the lungs.   The  lungs, it is well
known, when  in a  state  of repose, and removed  from the thorax,
are much  smaller  than  the cavities which they  fill  during  life.
They have, therefore, a continual disposition, in the living state, to
return  to the size which  is most easy to them; and, when they are
dilated by inspiration, they subsequently contract.   These positions
are proved  conclusively,  by  the condition of ihe inferior surface of
the diaphragm, in a healthy and entire thorax; where this muscle,
in  consequence of atmospheric pressure from without, is driven
liigh  up into its cavity.   Its  contraction in inspiration draws it 
128
SKELETON.
 down, and the instant that the contraction  ceases, it is impelled
 upwards again.  Now, the same power  is applied to the  whole
 periphery of the thorax: and its cavity being enlarged by the con-
 traction of the several muscles appropriated to the elevation of the
 ribs; the moment this contraction ceases, the latter  are impelled
 downwards.   From all this it will be understood that the muscles,
 by creating a vacuum in the lungs, cause the vacuum to be filled
 by the introduction  of air through  the trachea;  and upon their
 ceasing to contract,  the several agents mentioned cause the expul-
 sion of the same air.   It is generally believed, that the surface of the
 lung is every where  in contact with the thorax ;  it appears, how-
 ever, doubtful, whether there is not a space between the pleura pul-
 monalis and diaphragmalis, particularly at the most posterior and
 inferior part of the diaphragm.   Certain it is, that adhesions  there,
 are much less common than in other parts of the thorax.
   The ligaments  at the spinal extremities of the ribs, by being  put
 on the stretch  in inspiration, have also some tendency to throw
 down the ribs in expiration.  In short, the contraction of the thorax
 may be set  down as the result of the joint action of the atmosphere,
the cartilages of the ribs, the ligaments, the contraction of the lungs,
and the muscles.  When the structure of the lung is so altered that
its elasticity is impaired or  destroyed, expiration  becomes then
much more difficult.
                       CHAPTER II.

                       Of  the  Head.

  The head is placed  upon the upper extremity of the vertebral
column, and  consists in a considerable number of bones, which
are either in pairs, or, if single, have the two sides symmetrical.
Some of these  bones form a large  cavity, the cranium, for con-
taining the brain; the others are employed in the formation of the
nose; of the orbit for the eye-ball; and  of the mouth.  The head,
for the most part ovoidal,  presents very striking varieties of form
between different individuals and different nations.   It is thought
by physiologists, that the  moral or intellectual condition of a
people, their habits, climate, and food^have  a powerful influence 
THE CRANIUM.
129
 in producing these diversities.   The head is divided into Cranium
 and Face.

                  SECT. I.—OF THE CRANIUM.

    The Cranium is composed of eight bones.   The Os Frontis, the
 Os Occipitis, two  Ossa Parietalia, two  Ossa Temporum, the Os
 Sphenoides, and  the Os Ethmoides.  The Os  Frontis  is at the
 front of the cranium; the Os Occipitis is at its hind part; the Ossa
 Parietalia, one on each side, form its superior  lateral parts; the
 Ossa Temporum,  also one on  each side, form its  inferior lateral
 parietes; the Os Sphenoides is in the middle of its bottom part;
 and the Os Ethmoides is at the fore part of the centre or body of
 the last bone.
   The cavity thus formed for the brain, has three diameters, which
 may  be learned by sawing vertically through the middle line of
 one skull, and horizontally through the  cavity  of  another.  The
 first diameter is the longest, and  extends from  the lower  part of
 the frontal bone to the protuberance on the middle of the interior
 surface of the os occipitis;  it is commonly about six inches and  a
 half long.  The second diameter includes the space between the
 superior margins of the temporal bones,  where they are most dis-
 tant from each other, and passing over the middle of the great
 occipital  foramen, is about five inches.  The  third diameter is
 taken from  the centre of the large hole  in  the  occipital bone, to
 the centre of the suture  between the parietal bones; it is about five
 inches, also.  Rather more than  one-third  of the  cavity  of the
 cranium is  placed behind the  second diameter, and it diminishes
 somewhat abruptly;  but in front of this diameter the cavity is
 finished more gradually.
   When the  face is separated from the cranium, the exterior sur-
 face of the latter, excepting its base, represents tolerably accurately
 the form and proportions of its cavity: allowance being made for
 the large sinuses in the lower part of the  frontal  bone, and for the
 thinness of the upper parts of the temporal bones.  The diameters
 mentioned, can only represent  what most frequently happens, for
 daily observation proves remarkable departures from them.  Some-
times  the  transverse diameter is increased  at  the expense of the
longest, which gives to the head a flatness before and behind.  On
other  occasions, the vertical diameter is increased, whereby the 
130
SKELETON.
head  receives a  conical form.   In many individuals the first dia-
meter is  increased, which  makes the two sides of the cranium
more parallel and flat than  usual.   The elongation of the trans-
verse diameter is the most  common, and that of the  vertical the
least so.  The capaciousness of the  cranium is much the same  in
adult individuals of the same sex; from  which  it may be inferred
that the excess of one diameter is obtained generally at  the ex-
pense of  the other.   The male cranium is more capacious and
thick than the female.
   The female sex is  less liable to variations in  these proportionate
diameters than the male.   Stature has  but little influence on  the
capaciousness of the cranium,  as giants and dwarfs have it of the
same size; hence, the former seem to have very small heads,  while
the latter appear to have  very  large  ones, the  eye being deceived
by the relative magnitude of their bodies.
   The fact seems  to be now well ascertained, that continued pres-
sure, or rather, resistance in a fixed  direction,  made upon the cra-
nium of  a  growing  infant will change its natural form.  Peculiar
ideas of  beauty have  induced  certain tribes of savages to  adopt
this barbarous and unnatural  practice.   The  late Professor Wis-
tar* showed to his class, in 1796, a  Choctaw Indian  having this
peculiarity; and a tribe now existing near the  sources of the Mis-
souri, continues  the practice of flattening both the occiput  and the
os frontis.
   In the Wistar Museum we have ten headsf of Peruvian  Indians,
brought from the Pacific Ocean, nine of which bear the strongest
evidence of having been flattened by pressure, on the  os frontis
and on the os occipitis.J   The  possibility of effecting such a change

   * System of Anat. 3d edit. vol. i. p. 73, 1824.
   t Presented by Dr. James Corneck, U. S. Navy,  to the late Dr. Physick.
   I The following letter, from a distinguished .Missionary, the Rev. Mr. Dc Smet,
S. J., who has spent some years among the Indians, on the west side of the Rocky
 Mountains, will be read with interest.
      To Professor William E. Horner, M. D.
   The process of flattening the head exists  among several tribes on the Colombia
 river. Among the Indians at the cascades, and the Tchenouks at Fort Van Couver,
 I remarked several babes, who were undergoing the barbarous process.  They attach
 them to boards of about two feet in length.  This sort of cradle is covered with a
 skin, with the hair outside; the child  is stretched on it; its little arms are tied close
 to the body with soft leather bandages ; another skin  is fastened to each extremity
 of the board and covers the child.  A smooth strip of cedar bark, or of other elastic 
THE CRANIUM.
131
in the form of the cranium has been strongly contested ; and Bichat,
who admits it, acknowledges that he was  unable to produce like
modifications  in puppies, kittens, and India  pigs.  The singular
change, however, which is wrought upon the feet of Chinese ladies,
strongly corroborates the opinion of the head being also susceptible
of artificial modifications in its form.*
  SECT. II.—OF THE INDIVIDUAL BONES  OF THE CRANIUM.


             1.  Frontal Bone, (Os Frontis, Frontal.)

  The frontal bone forms the whole anterior, and a portion of the
superior, lateral and inferior  parietes  of the cranium.   It is sym-
metrical, and, occasionally, is  completely divided into two bones
by the continuation of the suture between the parietal bones.
  Its external face is  convex,  and the internal concave.   On the
former  may be observed a  line, or slightly raised ridge,  running,
on the middle  of  the bone from  above downwards, which is ex-
pressive of the  original  separation between its two halves.   The
front surface of the  bone is  terminated  on  either  side, below, by
the orbitary or superciliary ridge, a  sharp  and arched elevation,
forming the  upper anterior boundary to the orbit of the eye.   This

wood, four or five inches broad, is fastened over the forehead of the  babe, so tight,
that the eyes of the infant appear to start from their very sockets.  In this painful
situation, I was told, they have them for the space of about a year, after which, the
head has taken the form they wish to give it, and which they consider as a mark of
distinction and of great beauty.  This deformity in children is very apparent; the
forehead and the upper part of the head is in a straight line.  The deformity disap-
pears partly as they grow old.  These Indians have slaves, who are forbidden, under
the severest  penalty, to flatten the heads of their offspring.  The cascade Indians
and Tchenouks are remarkable for their ingenuity in  constructing convenient and
beautiful canoes, nets, and wooden utensils; they are, in no ways, considered infe-
rior to their round  head neighbours.  Their  constant intercourse with the whites
has rendered them more vicious, poor and indolent; they are much addicted to lying,
stealing and immorality.
                                                  P. I. DE SMET.
    Philadelphia, February 10th, 1843.

  * In an examination of an adult female of this nation, Among Foy, the measure-
ments were  two inches and one-eighth from the heel to the end  of the small toe;
four inches and three-quarters from the heel to  the end of the great toe; and the
circumference of the ankle six inches and six-tenths. 
132
SKELETON.
 ridge terminates outwardly by  the  external angular process, and
 inwardly, by the internal angular process.  Just above the internal
 half of the orbitary ridge the bone is raised, by the separation of
 its tables, into the superciliary or nasal protuberance or boss.  Be-
 tween the  internal angular  processes  a broad  serrated surface
 exists, by which the frontal bone is united to the nasal bones, and
 to the nasal processes of the  superior maxillary bones.  The cen-
 tre of this surface is elevated into the nasal spine, which serves as
 an abutment to the nasal bones, and resists any force which might
 tend to drive them inwards.  On  its  exterior lateral  surface, be-
 hind the external angular process, the frontal bone presents a con-
 cavity, bounded above  by a well marked semi-circular ridge, and
 intended for the lodgement of a part of the temporal muscle.
   On each side of the  front of  the  bone near its middle  a  promi-
 nence exists, most frequently  better marked in infancy than  in ad-
 vanced life, and called  by the French the frontal protuberance.

   Proceeding backwards from  the inferior part  of the bone are
 the  two orbitar processes, concave  below and  convex above.
 They are much thinner than other parts of the bone, and are sepa-
 rated by  an oblong opening  which receives  the  ethmoidal  bone.
 A depression, large enough to receive  the end of a finger, is  at the
 exterior anterior part of the orbitar process, being protected by the
 external angular process: this depression contains  the lachrymal
 gland.  Half an inch above the  lower margin  of the internal an-
 gular process, a much smaller depression exists, occasioned by the
 tendon of the superior oblique muscle where it  plays upon its tro-
 chlea.  In the orbitary  ridge,  just without the latter depression, is
 the supra-orbitary foramen or notch, for the passage of the frontal
 artery and nerve.
   The internal  margins  of  the  orbitar  processes are  broad and
 cellular, where  they join the ethmoid bone;  and at their fore part
 is  seen a large opening  on each  side leading into the frontal sinus.
 These margins, in common with the ethmoid bone, form two fora-
 mina, one anterior, another posterior,and called internal orbitary;
 the first transmits the  internal  nasal  branch  of  the ophthalmic
nerve and the anterior ethmoidal artery and vein, the latter trans-
mits the posterior ethmoidal artery and vein.  Externally and be-
hind, the orbitar process presents a broad triangular serrated sur-
face for articulating with the sphenoid bone. 
THE CRANIUM.                     133
  The interior or cerebral face of the os frontis is strongly marked
by depressions corresponding with the convolutions  of the brain;
on its middle exists a vertical ridge, becoming more  elevated as it
approaches the ethmoidal bone.   This ridge is situated below, ex-
tends about  one-half  of  the length of the bone, and terminates,
above, in a superficial fossa, made by the longitudinal sinus of the
dura mater; at its lower extremity is the foramen ccecum, common
to it and the  ethmoid bone, and which  is occupied  by a process
from  the great falx of the dura mater, and also affords passage to
some very small veins, which  go from  the  nostrils to the com-
mencement of the longitudinal sinus.*

   The frontal sinuses consist  in  one or  more large cells, placed
beneath the nasal protuberances. There is  a very great variety
in their magnitude and extent; sometimes they proceed as far out-
wards as the external angular process, and backwards for half an
inch into the orbitar plates.   In a few instances in the adult they
do not exist, but the cases are very uncommon.   The cells of the
opposite sides  have  a  complete partition.   They  communicate
with  the cavity of the nose through the anterior  ethmoidal  cells.
   With the exception of the inferior part, where the  processes and
sinuses exist, the os frontis is of a very uniform  thickness,  and the
diploic or cellular structure is found constantly  between its exter-
nal and internal faces.
   This bone is united to the parietal, ethmoidal, and sphenoidal of
the cranium; and to several bones of the face.


       2. Parietal Bones, (Ossa  Parietalia, Os Parietaux.)

   These bones, it has been stated, form  the  superior and  lateral
parts of the  middle of the cranium.   They are  quadrilateral, con-
vex externally, and concave internally.  Their external and inter-
nal tables  are  uniformly separated by a  diploic structure, which,
from being more abundant at the superior part of the bones, occa-
sions there an increased thickness.
   The external  surface of the parietal bone is raised about its mid-
dle into the parietal protuberance.  Just below this protuberance

                      * Portal. Anat. Medicale.
   Vol. I.—12 
134
SKELETON.
is an arched, rough, broad, but slightly elevated ridge, marking the
origin of the temporal fascia and muscle, and continuous with the
ridge on the side of the frontal bone.   The internal surface of the
jbone is  marked by the convolutions of the brain; there is also  a
dumber of furrows upon it, having an arborescent  arrangement,
and  produced by the ramifications of the middle artery of the dura
mater.  The furrows all proceed from two large ones at the ante-
rior  and at the inferior part of the bone: not unfrequently at the
latter point they are converted into perfect tubes, by the deposition
of bone all around the arteries.   Of the two furrows, the foremost
may be traced from the greater wing  of the sphenoidal bone, and
running somewhat parallel with the anterior margin of the parietal;
and  the other passing from the squamous portion  of  the temporal,
is commonly a  little behind the  middle of  the parietal bone, and
inclines towards its posterior superior angle.  The internal  face of
the parietal bone also presents an imperfect fossa at its superior
margin, which  is completed by  junction with its  fellow, and ac-
commodates the longitudinal sinus of the dura mater.   Near  this
edge it is not uncommon to see  one or more small  irregular pits
passing  through the internal table, and looking somewhat ulcerated:
these are formed by the  glands  of Pacchioni, in  the dura  mater.
At the inferior posterior corner  of the bone, there is also a fossa,
which is made by the lateral sinus of the dura mater.

   The  superior, posterior,  and  anterior  margins  of the parietal
bone are  regularly serrated, and nearly straight.  The  inferior
margin  is concave, presenting  a thin, bevelled, radiated  surface
before, for articulating with the squamous portion of the temporal
bone: behind this concavity, the angle  of the bone is truncated  and
serrated, for articulating with the angular portion of the os  tempo-
ris.  The anterior inferior angle is the most remarkable, from its
being elongated  so  as to join the sphenoid  bone in  the temporal
fossa.
   A  foramen, called parietal, is  found at the  superior margin of
this bone, nearer to its posterior than to the anterior edge; it trans-
mits  an  artery between the integuments and dura  mater, and  also
a vein from the integuments to the longitudinal sinus.   M. Portal
says, that in some  protracted headachs this  vein swells considera- 
THE CRANIUM.
135
bly;  and that he has seen much good in such cases, arise from the
application of leeches to the part: he has also seen, in a child, its
tumefaction the precursor of the paroxysms of epilepsy.
   The parietal bone articulates with its fellow, with the frontal,
the sphenoid, the  temporal, and the occipital bones.

       i
          3. Occipital Bone, (Os Occipitis, Occipital.)

   This bone is quadrilateral, resembling a trapezium.  It is con-
vex  externally, and concave internally; but both of these surfaces
are  much modified by  ridges and processes.  Its thickness is also
very unequal; though like the other bones, it has two tables, with an
intermediate diploe.   It is  so  placed as to form  a  considerable
share of the posterior and inferior parietes  of the cranium.

   The foramen magnum is found in the lower section of this bone,
and  constitutes a  very conspicuous feature in it.  This hole is oval,
the long diameter extending from before backwards.  Its anterior
inferior  margin,  on  either side,  is furnished with a  condyle, for
articulating with  the first vertebra of  the  neck.   These condyles
are  long eminences tipped with cartilage, which converge for-
wards, so that lines drawn through their length  would  meet an
inch in front of the foramen magnum; they recede behind : their
internal margins  are deeper than their external.  The condition of
their articular surfaces is therefore such, that they permit flexion
and extension of the head, but not rotation.  The  anterior edge of
the  foramen is thicker than the  posterior.  This foramen trans-
mits the medulla  oblongata, the  vertebral  arteries and veins, and
the spinal accessory nerves.

   The external surface of the occiput presents,  half way between
the foramen magnum and the upper angle of the bone, the external
occipital protuberance, from the  lower part of which a small ver-
tical ridge is extended in the  middle line  to that foramen.   Into
the ridge is inserted the Ligamentum Nuchae.  From  either side
of the protuberance an arched ridge is extended to  the lateral angle
of the bone;  it  is the superior  semi-circular ridge  or line, from
which arise the occipito frontalis and the  trapezius muscles, and
into  it is inserted a part of the sterno cleido-mastoideus.  Below 
136
SKELETON.
this about an inch is the inferior semi-circular ridge, more protu-
berant, but not so distinctly marked in its whole course.   Tnto the
inner space, between the upper and lower ridges, is inserted the
complexus muscle, and into the outer space between the same, the
splenius muscle.   The lower ridge is  principally occupied by the
insertion of the superior oblique muscle of the neck.
  The inner space between this ridge and the great foramen, gives
insertion to the rectus posticus minor, and  the outer space affords
insertion to the rectus posticus major.   Into a small elevation,
leading from the outside  of the condyle  directly to the margin of
the bone, is inserted the rectus capitis  lateralis.

  In a depression behind each condyle is  the posterior condyloid
foramen,  which conducts a  cervical vein to  the  lateral sinus.
Passing through the base of the condyle, and  having its orifice in
front, is the anterior condyloid foramen  for conducting the hypo-
glossal nerve to the tongue.
  That part  of the bone before the condyles  is the cuneiform  or
basilar process:  the base  of  which is marked  by depressions for
the insertion of the recti muscles, which are situated on the front
of the  cervical vertebras;  and its fore  part, which is truncated at
the end, overhangs the pharynx, and is placed against the  body of
the sphenoid bone.   The superior external part  of the os occipitis
is uniformly convex, being covered by the occipito frontalis.

  The internal surface of the os occipitis is strongly impressed by
ridges  and depressions.  On  that  portion  of  it behind the great
foramen, is a rectangular cross, forming at its centre the  internal
occipital protuberance, which is  much larger than the external.
The upper limb of the cross is marked by a fossa for the posterior
end  of the longitudinal sinus; the two  horizontal limbs  are also
marked, each by its respective fossa, which  receives the corre-
sponding lateral sinus.  The right fossa  is frequently the  largest.
The inferior vertical limb of the cross has attached to it the small
falx of  the dura mater, and is slightly depressed by a small sinus.
The spaces between the limbs of  the cross are much thinner than
other parts of the bone, and present  broad concavities, the  two
superior of which receive the posterior lobes of the cerebrum, and
the two inferior, the lobes of the cerebellum. 
THE CRANIUM-
137
   The superior face of the cuneiform process is excavated, longi-
 tudinally, to receive the medulla oblongata.  On each side of the
 foramen magnum, a short curved fossa is observed, which receives
 the lateral sinus of the dura mater just before its exit from the cra-
 nium.

   The two superior margins of the occipital bone are regularly
 serrated.   The inferior margins have each, in their centre, a pro-
 cess termed the jugular eminence, in front of which is a rounded
 notch, forming a part of the jugular fossa; this notch is continuous
 with the semi-circular fossa which  holds the inferior end of the
 lateral sinus, which transmits  the  internal jugular  vein and the
 eighth pair of nerves.  The edge of the bone above this eminence
 is serrated, but below it  is rather smooth and  rounded, being pa-
 rallel with the temporal bone, and  having an imperfect adhesion
 to the petrous part of it, before the jugular fossa.

   The occipital bone articulates above with the parietal, laterally
 with the temporal; and in front with the sphenoidal.


       4. Temporal Bones, (Ossa Temporum, Temporaux.)

   These bones form portions of the inferior lateral  parietes, and of
 the base of the cranium.
   Their figure is very irregular.  Their circular anterior portion
 is called  squamous: behind  it is the mastoid, and between  the
 others is the petrous.

   The squamous portion  is  thinner than the other  bones  of the
 cranium that have been described, from the temporal muscle and
its fascia covering it, so  as  to contribute also to the  protection
 of the brain.  Its exterior  surface is smooth  and slightly convex.
The interior is formed into  depressions  by the  convolutions  of
 the brain.  At  the  anterior inferior part of the latter surface, a
groove is made by the middle artery  of the dura  mater, im-
mediately after it gets  from the foramen spinale of the sphenoid
bone on its way  to the  parietal.   This  groove  bifurcates, one
branch runs backwards  to join the posterior groove of the pa-
rietal bone; and the other  ascends  to join the anterior groove of
                             12* 
138
SKELETON.
 the same,  frequently,  however, impressing the top of the great
 wing of the sphenoid, just  before  it reaches  the  parietal.  The
 greater part of the  circumference of this portion is sloped to a
 sharp  edge, but at the anterior  inferior part  it is serrated and
 thicker.   On the outside of the latter is the glenoid cavity, for ar-
 ticulating with the lower jaw:  the length of it is transverse, with
 a slight inclination backwards and  inwards, so that a line drawn
 through it  would strike the  foramen magnum  occipitis.   The an-
 terior margin of this cavity is formed by a tubercle, on which the
 condyle of the lower jaw rises when the mouth is widely opened.
 The outer  margin of the glenoid  cavity  is formed  by the root of
 the zygomatic process.  The zygomatic  process has a broad hori-
 zontal root, from which it extends outwardly,  and  then diminish-
 ing, runs forwards to join  the  malar bone.  Posterior to the root
 of  the  zygomatic process, a  small vertical groove may be seen
 occasionally, made by the middle temporal artery.

   The mastoid portion of the temporal bone, is thick and cellular.
 Its upper  part forms an angle,  which is  received between the pa-
 rietal and occipital bones : both margins of this angle are serrated.
 Below, is the mastoid process, a large conical projection eight lines
 long, into  which are  inserted  the  sterno-mastoid,  and  trachelo-
 mastoid muscles.  At the inner side of its base  is a  fossa affording
 origin to the digastric  muscle.  The inner face  of the mastoid por-
 tion is marked by a  deep large fossa for the lateral  sinus of the
 dura mater.  In the posterior part  of the suture, uniting the mas-
 toid portion and the occipital bone, or in the former near the suture,
 is the mastoid foramen, for conducting a vein from the integuments
 into the lateral sinus.

  The cells in  the mastoid  portion  are large and  numerous, and
 obtain  the name of sinuses; they communicate with  the tympanum
 by one large orifice.  On the outer side of these  sinuses  a thin
 diploic structure is observable in some heads.

  The petrous portion  of the temporal bone is a triangular pyra-
 mid, arising by a broad  base from  the inner side of the  mastoid
 and squamous portions.  It is fixed obliquely forwards, between the
 sphenoid and  occipital bones.   Its  anterior surface is marked by
the convolutions of the brain. Near the centre of this surface, and 
                         THE CRANIUM.                      1,3y

having a little superficial  furrow leading to if, is a small foramen
called the Hiatus Fallopii, through which passes the Vidian nerve.
The posterior surface of the petrous portion presents a large fora-
men, the meatus auditorius internus, through which pass the seventh
or the auditory and the facial nerve.   Half an inch behind this ori-
fice, is a very small  one, overhung by a flat shelf of bone; this is
said to  be  the  aqueduct of the vestibule.  Just above the meatus
auditorius internus is a foramen more  patulous than the aqueduct,
for transmitting small blood vessels.
   In the base of the petrous portion, between the mastoid and zygo-
matic processes, is the  meatus auditorius externus, a  large open-
ing conducting to the tympanum.  It is oval, about half an inch
deep, and varies  much  in its size in  different subjects: its margin
is called  the auditory process, the lower  part of  which is very
rough, for  attaching the cartilage of the external ear.

   The lower surface of the petrous  bone is exceedingly irregular.
Immediately below  the meatus externus,  is a depression which
seems like a part of the glenoid cavity, and is improperly consi-
dered such  by some anatomists, inasmuch as it  does not  form a
portion of the articular surface for the lower jaw, but simply allows
room for its  motions, the parts which it contains (consisting of ves-
sels, and a portion of the parotid gland) being pressed back when
the jaw opens.  Between  this cavity and  the  glenoid is the gle-
noidal fissure, separating the petrous from the squamous bone.  In
this fissure, leading to the tympanum, is a foramen which contains
the processus gracilis of the malleus with its muscle, and the chorda
tympani.  The posterior margin of the depression just alluded to
in the petrous bone, is made by a long rough ridge, called processus
vaginalis;  just behind which, and partially surrounded by it, is the
styloid  process.   The styloid  process  is  round, tapering, and an
inch and a-half long; but frequently absent  in prepared skulls, from
accidental fracture and from being in  a cartilaginous state.  From
it arise the styloid muscles.

   Behind the root of the styloid process, is the stylo mastoid fora-
men, which  transmits the  portio dura or facial nerve  to the face.
Just within the styloid  process and the foramen  is a deep depres-
sion, called  jugular fossa, large  enough to receive  the tip of the
little finger.   The fossa, along with a corresponding one in the os 
140
SKELETON.
 occipitis, is occupied by the internal jugular vein  and the eighth
 pair of nerves.  Immediately before the lower end of this fossa is
 the foramen caroticum, being the lower orifice of a crooked canal,
 which terminates at the apex of the petrous bone, and transmits
 the  carotid  artery and  the upper extremity  of the  sympathetic
 nerve.   At the  inner side of the  carotid  canal, a superficial ser-
 rated groove is perceived,  which  receives the adjoining  edge of
 the occipital bone.   Just in advance of the inner part of the jugu-
 lar fossa is a small spine  of bone, at  the foot of  which  is a pit,
 containing the orifice of the supposed aqueduct  of the  cochlea.
 The  spine  separates ihe eighth pair of nerves from the  internal
 jugular vein.
   In the angle  between the squamous and  petrous parts, within
 the glenoid  fissure, is the orifice  of the Eustachian tube.   The
 tube  is divided longitudinally, by a bony  partition.  The upper
 division contains the tensor tympani muscle.
   A small groove exists along the superior angle of the  petrous
 bone, and  another along the inferior angle, adjoining the  basilar
 process of the occipital bone, and formed in part by it: they are
 made by the superior and inferior  petrous sinuses.    •
   The temporal bone  articulates with  the occipital, the parietal,
 the sphenoid, and the malar.


         5. Sphenoid Bone, (Os Sphenoides, Sphinoide.)

   The sphenoid is a symmetrical, but very irregular bone, placed
 transversely in the middle of the base of the cranium.
   It consists of a cuboidal body in the centre; of a very large pro-
cess called the  great wing, spreading laterally to a considerable
distance on either side of the body;  and it has, also, a number of
angular margins and additional processes about it.
   In regard to the body of the sphenoid bone, from its upper ante-
rior part arise, one  on each side, the apophyses of  lngrassias, or
the little wings.  These wings  have a broad horizontal base, and
extending themselves outwardly, terminate in a sharp point.  Their
anterior edge  is serrated for articulating with the  os frontis: the
posterior edge is smooth.   Between the two wings, in front, is a
prominence united to the ethmoid bone.  The base  of the wing is
perforated by the foramen opticum, for transmitting the optic nerve
with the ophthalmic artery.   Below and behind this foramen, the 
THE CRANIUM.
141
little wing  terminates in a point, called  the  anterior clinoid pro-
cess.   Between the foramina optica is a ridge of bone, sometimes
called processus olivaris, and just above the ridge a groove, made
by the  optic nerves where they unite.  Behind  the  ridge is a de-
pression, the Sella  Turcica, for containing the pituitary gland.
This depression  is bounded  behind by a very elevated transverse
ridge, called the posterior clinoid process.  At either extremity of
the base of the latter, a  groove (sulcus caroticus) is made by the
carotid artery, which groove may be traced indistinctly under the
anterior clinoid process, where it forms a notch, and sometimes a
foramen.
   The posterior face of the  body of  the sphenoid bone, presents a
flat surface for articulating with the cuneiform process of the oc-
cipital.  In the adult, these  bones  are anchylosed at this junction.
The inferior part of the body of the sphenoid presents a rising, in
its middle, called the sphenoidal or azygous process, being for arti-
culation with the vomer, and with the nasal septum of the ethmoid.
On each side of  this process, in front, is the orifice of  the sphe-
noidal  cells.   These cells consist, most commonly, of one on each
side, and  are  separated  by  a bony partition.  In the very young
bone they are not formed.  The body of the  sphenoid undergoes
so many changes between early infancy and adult life, by the con-
version of its  diploic structure into sinuses or cells, and is also so
much modified in different  individuals, that a general description
of it will not answer for all specimens.
   The two great wings  arise from  the sides of the body of the
sphenoid, by a small irregular base.  From  their lower part pro-
ject downwards, on either side, the two pterygoid processes called
external and internal.  These processes have a common base, are
partially separated  behind by a groove called  pterygoid fossa, and
below  by  a notch.  The internal is the longest,  and is terminated
by a hook, on the outer side of which is  a trochlea made by the
tendon  of the Circumflexus  Palati muscle.   The external ptery-
goid process is the broadest.  By  applying together  the temporal
and sphenoid  bones, a groove, common to the two, leading to the
Eustachian tube, will be seen.  This groove is continued obliquely
across  the root of the internal pterygoid process, and  indicates the
course of the  cartilaginous  portion of the Eustachian tube.  The
internal pterygoid process sends out from its  base a small shelf of
bone, separated by a fissure from the under part  of the body of the 
142
SKELETON.
sphenoid.   The posterior edge of the vomer rests against this pro-
jection.  The fissure is filled up in advanced life.
  The great wings of the sphenoid bone present three faces.  One
is anterior, and called orbital, from its forming a part of the orbit;
another is external, and called temporal;  and the third  is towards
the brain, and forms a considerable part  of the fossa for contain-
ing its middle lobe.  The orbital face is square and slightly con-
cave.  The temporal face is an oblong concavity, at the lower part
of which is a triangular  process, giving an origin to the external
pterygoid muscle.  The  cerebral face is concave and  marked  by
the convolutions of the brain, as well as by a furrow made by the
principal trunk of the great artery of the dura mater as it passes
from  the temporal bone to the temporal angle of the parietal.  The
inferior portion of the great wing is elongated backwards into a
horizontal angle, called the spinous process, which is fixed between
the petrous  and squamous portions of the temporal  bone.   From
the point of  the spinous  process  projects downwards the  styloid
process.   The great wing presents a triangular  serrated  surface
above, at its outer end, by which it articulates with the os  frontis;
just below  this, in front, is a short serrated edge, by which it arti-
culates with the malar bone; and externally, is a semicircular ser-
rated edge, by which it  articulates with the squamous  portion of
the temporal bone.  The tip of the large wing  generally articu-
lates also with the parietal bone.

   Between  the apophysis of Ingrassias and  the greater wing is the
foramen sphenoidale, called also  foramen lacerum superius of the
orbit.  It is broad near the  body  of the bone, and becomes a mere
slit at the extremity of the little wing.  Through it pass the third,
fourth, the first branch of the fifth, and the sixth pair of  nerves.
Two  lines below the base of this hole is the foramen  rotundum,for
transmitting the second branch of the fifth pair of nerves.   Eight
lines, or thereabouts, behind the foramen rotundum, is the foramen
ovale, for transmitting the third branch of the fifth pair of  nerves.
Two  lines  behind  the foramen  ovale is  the  foramen spinale, for
transmitting the middle artery of the dura mater.  In  the under
part of the bone, and  passing  through the root of  the pterygoid
processes, is the foramen pterygoideum, for  transmitting the ptery-
goid nerve;  it being a recurrent branch  of the second branch of
the fifth pair of nerves. 
                         THE CRANIUM.                       A'*«5

  The sphenoid*  bone articulates above and in front  with the
vomer, the frontal, ethmoidal, malar, and parietal bones: laterally
with the  temporal, behind with  the occipital, and by its pterygoid
processes with the palate bones.


          6.  Ethmoid Bone, (Os Ethmoides, Ethmoide.)

  This bone is placed between the orbitar processes of the os
frontis, and, as has been stated, fills the vacuity between them.  It
is cuboidal, extremely cellular, and light.
  The horizontal portion  between the orbitar processes is the crib-
riform plate called so from  its numerous perforations.   This is
divided,  longitudinally, above and below,  by a vertical process;
and from the under surface on each  side, is suspended the cellular
portion.

  The vertical process on the superior, face of the cribriform plate
is the crista galli, which  extends sometimes from the back to the
front of  this  plate, and is thickest in  the middle.  The commence-
ment of  the great falx  arises from it, and occasionally it contains
a cell or sinus opening into the nose.   Between the front of the
crista galli and the os  frontis, is the foramen  ccecum. already de-
scribed.   On either side of the crista galli the cribriform plate is
depressed into a gutter for holding the bulb of the olfactory nerve,
and is  perforated with many holes  for transmitting  its ramifica-
tions.   The most anterior foramen on each side is oval, and trans-
mits to the nose the  internal  nasal nerve, after it has got into the
cranium through  the anterior internal orbitar foramen.   The  mar-
gins of  the cribriform  plate show many imperfect cells, which are
completed by joining their congeners in the margins of the orbitar
processes of the os frontis.

   The vertical process below the cribriform  plate is called nasal
 lamella.   It generally  divides the nostrils equally, but is occasion-
 ally inclined  to one side.  It joins  below, to  the vomer  and the
 cartilaginous septum of  the  nose;  in front is  in contact with the
 nasal spine of the frontal bone and  with the nasal bones; and be-
 hind, with the azygous process of the sphenoid.
  * This bone is, by some anatomists, described in common with the os occipitis,
as the os basilare, in consequence of their early junction into a single piece. 
144
SKELETON.
   Each cellular portion of  the  ethmoid forms,  by its exterior, a
part of the orbit of the eye, which surface is called os planum.
The internal  or nasal face forms  part  of the nostril.  The fore
part of this face is flat,  but, posteriorly, in its middle,  is a deep
sulcus, called  the superior meatus of the  nose.  The upper turbi-
nated  bone, a small  scroll, constitutes the upper  margin of this
meatus.   The inferior internal  margin of the cellular portion  of
the ethmoid, is formed by another scroll of bone, running its whole
length.   This is the middle turbinated  bone.  Moreover, from the
inferior margin of the cellular portion, one or more laminae, of an
irregular form, project so as to diminish the opening into the upper
maxillary sinus.

   The  cells in the ethmoid  bone  are numerous  and large, the
posterior ones  discharge, by one or more orifices, into the upper
meatus.   The anterior discharge into the middle  meatus of the
nose by several orifices,  concealed  by the middle turbinated bone.
The most anterior of these  cells is funnel-shaped, and joining the
frontal sinus, conducts the discharge of the latter into the nose.

   In children  of from three to eight years of age, there is attached
to the posterior part of each cellular portion of the ethmoid, a tri-
angular hollow pyramid, consisting of a single cell.   This pyramid
arises, not only from the cellular portion, but also from the posterior
margin of the  cribriform plate, and of the nasal lamella, by which
it gains a large and  secure  base.  The processus  azygos of the
sphenoid bone is received between the two pyramids.  In the base
of the pyramid, communicating with the  nose, is a foramen, which
is known in adult life as  the orifice of  the sphenoidal sinus.  The
pyramid, towards puberty, becomes a part of the sphenoidal bone,
and then detaches itself, by a suture at its base,  from the ethmoidal.
As life advances it is greatly developed, no indication of its original
condition remains, and it becomes fairly the sphenoidal cell; singu-
larly differing  in shape from what it was in the beginning.*

  Being put upon  the investigation of this pyramid by the late
Professor Wistar, with the view of ascertaining its different phases
of development, it has occurred to me to see it in every stage, from
that of a simple triangular lamina, arising from the posterior mar-
* Wistar's Anatomy, vol. i. p. 31, 3d edit. 
THE FACE.
145
 gin of the cribriform plate, to the perfect hollow pyramidal state.
 The preceding anatomists describe it but imperfectly; it remained
 for that distinguished individual to elucidate its real history.

   Several of the articulations of the ethmoid have been mentioned ;
 the remainder will be introduced with the bones of the face.


                   SECT. III.—OF THE FACE.

   The face being situated at the inferior anterior part of the  base
 of the cranium, is  bounded above  by this cavity, laterally by the
 zygomatic arches and fossa?, and posteriorly by the  space occupied
 by the pharynx.   The  best way of obtaining precise information
 concerning its form and composition, is from the head of an infant,
 of from five to ten years, in which the bones can be easily parted.
 In the adult, somewhat  advanced in life, the bones cannot be sepa-
 rated so perfectly, from their being united  more or  less together
 by the obliteration of the sutures.
   The face is composed by fourteen bones, of which thirteen enter
 into the upper jaw.   Twelve of the thirteen are in pairs: they are
 the ossa maxillaria superiora, ossa malarum, ossa nasi, ossa ungues,
 ossa turbinata inferiora, ossa palati.  The thirteenth is the vomer.
 A single  bone, with  corresponding or symmetrical  sides, consti-
 tutes the maxilla inferior.

 1. Superior Maxillary  Bones, (Ossa Maxillaria Superiora, Max-
                       illaires Suptrieurs.)

   These may be known by their superior size, and by their com-
 posing almost the  whole front of the upper jaw.  They are  too
 peculiar in their figures to admit of comparison with any common
 object.
   The superior face of  these bones is formed  by a  thin triangular
 plate, the  orbitar  process, which  is the floor of the orbit.   In  the
 posterior part of this plate is a groove, leading to  a canal  termi-
 nating in the front of the bone, at a foramen  called infra-orbitar.
 This foramen is situated just below the middle of the lower margin
 of the orbit, and gives passage to the infra-orbitar nerve, and an
artery.  Externally, the orbitar plate is terminated by  a rough sur-
face, the malar process, which articulates with the malar bone.
  Vol. I.—13 
146
SKELETON.
   The nasal process arises, by a thick, strong root, from the front
upper part of the bone at its inner side.  Its front edge is thin, the
posterior margin is thicker, and the upper edge  is short, being ser-
rated for articulating with  the  os frontis.   A deficiency exists be-
tween  the orbitar  process  and the  nasal  process, for accommo-
dating the os unguis, and  the  lachrymal sac.   A groove, leading
to the nose, is formed on the posterior face of the nasal process,
and marks the situation and extent of the lachrymal sac.  On that
side of the root of the nasal process, next to the cavity of the nose,
a small transverse ridge is seen, to which is attached the anterior
part of the inferior turbinated bone.

   The under surface of the os maxillare superius is marked by the
alveolar processes for lodging the teeth.  These processes are broader
behind than  before, corresponding in  that  respect with the teeth.
Within the circle of the alveoli is the  palate process, arising from
the internal face of the body of the bone.   The palate process has
a thick root, is thin in  the  middle, and, where  it joins its fellow,
has its margin turned upwards towards the nose into a spine or
ridge, whereby its articular surface is increased.  It presents an
oblong concave surface above,  constituting the floor of the nostril;
below, it, with its fellow, and the alveolar processes, form one con-
cavity, having a surface somewhat rough, which is the roof of the
mouth.  The palate process does not  extend the whole length of
the superior maxillary bone, but stops half an inch short of it, pos-
teriorly, and  with a serrated margin for the palate bone.   When
the two maxillary bones are in  contact, we  find  in the suture, just
behind the front alveolar processes, the foramen incisivum,  which
bifurcates, above, into  each nostril.    This foramen contains  a
branch  of the  spheno-palatine  nerve, and a  ganglion  formed
from it.

   In front, just below the infra otbitary foramen, the bone is de-
pressed, which depression  is filled up  in the living state with fat
and muscles.  But, behind, the maxillary bone  is  elevated into a
tuberosity, between which and the malar process is a broad groove,
in which the temporal muscle plays.

   The inner face of the upper maxillary bone presents a view of
the large cavity in the centre of it, called Antrum Highmorianum. 
THE FACE.
147
The orifice  by which  this cavity communicates with the nose is
much diminished by the palate  bone behind, the ethmoid above,
and  the inferior spongy bone below.  When the antrum  is  cut
open a  canal  is seen  on its posterior part,  which conducts  the
nerve of the molar teeth to their  roots, and a similar canal is seen
in front of the antrum, for the  nerves  of the  front teeth.  The
nerves,  in both  instances, come from  the  infra orbitary.  The
nerves, till  they begin  to divide  into filaments, are  between  the
lining membrane and the antrum, but afterwards they make com-
plete canals in the alveolar processes.   The antrum frequently com-
municates with the frontal sinus, through the anterior  ethmoidal
cells, which circumstance is omitted  bj' most anatomists.

   This bone is articulated with the frontal, nasal, unguiform, malar,
and ethmoid, above; to the palate bone behind ; to its fellow, and
to the vomer, at its middle; and  to the inferior spongy bone by its
nasal surface.

            2.  Palate  Bones, (Ossa Palati, Palulins.)

   The palate  bones, two in number, are placed at the  back part
of the  superior maxillary, between them and the pterygoid pro-
cesses of the sphenoid.
   For descriptive purposes they may be divided into three por-
tions—the  horizontal  or palate plate, the vertical or  nasal plate.
and the orbitar or oblique  plate, placed at the upper extremity of
the latter.

   The palate plate is  in the same  line with  the  palate  process of
the superior maxillary  bone, and supplies the deficiency  caused by
its abrupt termination.    It  is square.  The inferior surface is flat,
but rough for the attachment of the lining membrane of the mouth.
The superior surface is concave, and forms about one-third of the
bottom  of the  nose.   The anterior  margin  is serrated where it
articulates with the palate process of the maxillare superius.   The
posterior margin is thin  and crescentic.   The  internal  extremity
of the crescent is  elongated into a  point, from which  arises  the
azygos uvula) muscle.   The internal  margin of the palate plate is
thick and serrated  for  articulating with its fellow, the upper edge
of it being turned upwards to join the vomer.   The exterior edge 
148
SKELETON.
 touches the internal  side of  the  maxillare  superius, and from it
 arises the nasal plate.

   The nasal plate forms the posterior external part of the nostril,
 and is much thinner than the  palate plate.   Its side next the nose
 is slightly concave, and is divided into two unequal surfaces, of
 which the lower is the smallest, by a transverse ridge, that receives
 the  posterior extremity of the lower turbinated or spongy  bone.
 The external face is in contact with the internal face of the maxil-
 lary bone, and presents a surface corresponding with it.  The
 nasal  plate  of the  palate bone diminishes  the opening  into the
 Antrum Highmorianum  by overlapping it  behind.   Backwards it
 joins the pterygoid process of the sphenoid bone,  and overlaps its
 anterior internal surface.

   At the inferior and posterior part of  the nasal plate, where the
 crescentic edge of the palate  plate joins it, the palate bone is ex-
 tended into a triangular process, called  the pterygoid.  This pro-
 cess, on its posterior surface, presents three  grooves, the  internal
 of which receives the internal  pterygoid  process of the sphenoid
 bone, and the external groove  receives the external perygoid pro-
 cess of the same bone.  The middle fossa has its surface continuous
 with the pterygoid fossa of the sphenoid bone, and  may be seen, in
 the articulated  head, to contribute to this fossa.   The anterior sur-
 face of the pterygoid  process of the palate  bone presents a small
 serrated  tuberosity, which is  received  into  a corresponding con-
 cavity on the posterior surface of the maxillary bone, and contri-
 butes to the firmer junction of  the two.

  On the external surface of the nasal plate, between  it and the
 base of  the pterygoid  process, a vertical groove is formed, which
 is converted  into a complete canal by the maxillary bone.   The
lower orifice of this canal is  near  the posterior margin of the pa-
late.   It  is called the posterior  palatine foiamen,and transmits the
palatine nerve and artery to  the soft palate.  Immediately behind
this canal there is, not unfrequently, a smaller one, running through
the base of the  pterygoid process of the palate bone, and transmit-
ting a filament  of the same nerve to the palate.

  The upper extremity of the  nasal plate is  formed by two pro- 
THE FACE.
149
 cesses, one in front and the other behind, separated either by a
 round notch or a foramen.  The posterior of the two, called also
 pterygoid  apophysis, is  inclined over towards the cavity of the
 nose.   It is thin, and fits upon the under surface of the body of the
 sphenoid bone, and  upon the inner surface of  the internal base of
 the pterygoid process of the same.  Its  upper edge touches the
 base of  the vomer.  The anterior process is the orbitar portion of
 the palate  bone.

   The orbitar portion or  plate is longer  than  the  pterygoid apo-
 physis, and is hollow and very irregular.  It may be seen  in the
 posterior part of the  orbit wedged  in  between the ethmoid and
 maxillary  bone.  The portion of it which is there seen, is the orbi-
 tal face, and is triangular.   On  the  side  of the ethmoid  bone its
 cells are seen, which are completed by their contiguity to the eth-
 moid and sphenoid.   The cells, in young  subjects, are not always
 to be met  with.  The posterior face of the orbitar portion  is wind-
 ing and  looks towards the zygomatic fossa.

   The notch between  the orbitar portion and the pterygoid  apo-
 physis is converted into a foramen, by that part of the body of the
 sphenoid, bone which is immediately below the opening of the sphe-
 noid cell.  Through this foramen, called spheno-palatine, pass the
 lateral nasal nerve, the spheno-palatine artery and  vein.

   This bone can scarcely be studied advantageously except in the
 separated  head.  A single application of it to  the maxillary, will
 then show  how it extends from the palate  of the mouth to the  orbit
 of the eye; and how it is the connecting bone between the maxil-
 lary bone and the pterygoid process of the sphenoid.

  The palate  bone articulates with six others.   With the upper
 maxillary,  the sphenoid,  the ethmoid, the  inferior spongy, the
 vomer, and with  its fellow.  The places of junction have  been
 pointed out in the description of the bone.

           3. Nasal Bones, (Ossa Nasi, Os du Nez.)

  The  ossa nasi, two in number, fill  up the vacancy between the
nasal processes of the superior maxillary bones.  They are oblono-
                             13* 
150
SKELETON.
and of a dense compact structure, being so applied to each other
as to  form a strong arch called the bridge of the nose, which is
further sustained by the nasal spine and  the  contiguous  oblique
serrated surface of the os frontis.
  The ossa nasi  are  thick and serrated at their  upper margins;
below, they are thin and irregular.  The surfaces by which they
unite  with each other are  broad, comparatively smooth, with the
exception of one or two small serrated  processes, and have their
edges raised where they join the nasal lamella of the ethmoid bone.
The edge by which they join the nasal process of the upper max-
illary bone is concave; the upper part of this  edge is overlapped
by the nasal process, but the lower part of it  oveilaps  the nasal
process.
  On the posterior face of  the os nasi is to be seen a small longi-
tudinal groove, formed by the internal nasal branch of the ophthal-
mic nerve, which nerve penetrates the foramen orbitale anterius
and the cribriform plate of the  ethmoid bone.

  The ossa nasi articulate with each other in front, with the nasal
processes of the  upper maxillary behind, with  the septum narium
where they  are in contact with one another, and with the os fron-
tis above.


      4.  Unguiform Bones, (Ossa Ungues, Os Lacrymaux.)

  The unguiform is a very small thin bone, apt to be incompletely
ossified, so that it puts on  a cribriform  condition;  it is placed at
the  internal side of the orbit,  between the nasal  process of  the
upper maxillary and  the os planum of  the ethmoid.  Its orbitar
surface is divided  into a face which is in a line with that of  the
os planum, and into an oblong vertical concavity, continuous with
the  concavity on  the posterior  surface of the nasal process, for
lodging the lachrymal  sac.  Its inferior anterior corner is elongated
into the nose, so as to  join with  a process of the inferior turbinated
bone,  whereby the ductus ad  nasum is rendered a complete bony
canal.
  This bone lies on the orbitar  side of the most anterior ethmoid
cells,  and completes them in that direction.
  An  important variety in  the  structure of this part of  the orbit
occasionally  occurs in which  the whole  fossa for  lodging  the 
THE FACE.
151
lachrymal sac, is formed by the unusual breadth of the nasal pro-
cess of the upper maxillary bone.  In this  case, the only part of
the os unguis which  exists, is  that in the same plane with the os
planum.  Several examples have come under  my  own notice.
Duverney has also mentioned it.  Sometimes  it is entirely want-
ing, in which case the  os planum  joins the  nasal process.*  A
variety still more uncommon is  mentioned by Verheyen, where the
lachrymal fossa  is formed exclusively by the os unguis.
  This bone  articulates very loosely with  the adjoining bones, so
that it is frequently lost from the skeleton.  It joins the os frontis
above, the os maxillare  superius before and  below, the os planum
behind, and the inferior  spongy bone in the nose.


 5. Cheek Bones, (Ossa  Malarum,  Jugalia, Os de la Pommette.)

  These bones, two in number, are also called zygomatic by many
anatomists.   They are situated at the external part of the orbit of
the eye, and form the middle external part of the face.
  The cheek bone is quadrangular, and has irregular  margins.   It
consists of two compact tables  with but little intermediate diploic
structure.
  There are three surfaces to it.   That which contributes to  the
orbit is crescentic, and is called the  internal orbitar process.  The
exterior one is convex,  and forms part of the face; and behind it
is a third surface, which is concave, and forms a part of the zygo-
matic fossa.   Of the four margins, two are superior, and two infe-
rior.  The anterior of the first two is  concave, and rounded off, to
form the external and one-half of the lower edge of the orbit. The
posterior upper  border  above,  is  thin  and irregular, and  to it is
attached the temporal fascia: it terminates behind by a short ser-
rated  margin, for articulating with the zygomatic process of  the
temporal bone.  The anterior inferior margin, is serrated its whole
length, for  articulating  with the superior  maxillary bone.  The
posterior inferior  margin gives origin to part of the masseter
muscle.  Some anatomists admit, also, to this bone a fifth margin,
which is towards the  bottom of the orbit, part of which articulates
above with the great wing of the  sphenoid bone, and another part
joins  below  with the superior maxillary.   Between  these two
• Bertin, Traite D'Osleol. vol. ii. p. 143. Paris, 1754. 
 152                        SKELETON.

 parts is a notch, forming the outer extremity of the sphenomaxil-
 lary  slit.
   The angles of this bone are called processes.  The upper one,
 which  is continuous with the external angle of the os frontis, is the
 superior orbitar, or  angular process.  The orbitar margin termi-
 nates below, in the inferior orbitar, or angular process.  That
 portion of the bone which joins with the zygoma of the temporal,
 is the zygomatic  process;  and the fourth  angle is the maxillary
 process.

   The os mate articulates  with four bones; to wit, with the max-
 illary, frontal, sphenoidal, and temporal.
   There are some few small foramina in this bone, which transmit
 nerves  and blood vessels.


 6. Inferior  Spongy Bones, (Ossa  Spongiosa aut  Turbinata Infe-
                   riora, Cornets Inferieurs.)

   This pair of bones is situated at the inferior lateral parts of the
 nose, just below the opening into the antrum Highmorianum.  They
 are very thin and  porous, and their  substance is extremely light
 and spongy.
   The  internal face of the  spongy bone is  towards the septum of
 the nose, and presents an oblong  rough convexity.  The external
 face has  a  corresponding concavity  towards the maxillary bone.
 The superior margin  presents, in front,  an upright process, which
joins with the anterior inferior angle of the unguiform bone, to form
 the nasal duct.   Just behind this, the  margin of the bone is  turned
 over towards the antrum, forming a broad hook, which rests upon
 the lower margin of the  orifice of the antrum, and diminishes its
 size.  From the superior margin, also, one or two processes not
 unfrequently arise, whereby this  bone joins the ethmoid.  The in-
ferior margin is  somewhat thicker than the superior.
  The anterior extremity of this  bone rests upon the ridge  across
 the root of the nasal process of the upper maxillary.   The poste-
rior extremity rests, in like manner, upon the  ridge  across the
nasal  plate of the palate bone."

  * In some rare cases this bone  adheres to the ethmoid, so as to become a part
of it. 
THE FACE.
153
                    The Ploughshare, (Vomer.)

   This single bone is placed between the nostrils, and forms a
 considerable part of their  septum.   It is frequently more inclined
 to one side than to the other.  It is formed of two laminae, between
 which there is a very  thin diploic structure.
   The sides of the  vomer  are smooth and  parallel.  It has four
 margins.   The superior is the broadest, and has a furrow in it for
 receiving the azygous  process of the sphenoid bone.   The anterior
 margin being directed obliquely downwards and forwards, its front
 part joins the cartilaginous septum of the nose, and the posterior
 part receives, in a narrow groove, the nasal plate of the ethmoid.
   The posterior margin of the  vomer  is smooth  and  rounded,
 making the partition of  the nostrils  behind.  The inferior margin
 articulates with the spine  or ridge of the superior maxillary and
 palate bones, which exists at their internal border.


    Lower Jaw, (Os Maxillare Inferius, Maxillaire Inferieur.)

   This bone forms  the lower boundary of the face, and is the only
 one in the head  capable of motion.   In early  life, its two halves
 are separable, being joined at  the middle line only by cartilage;
 but, in the course of two or three years after birth, they are con-
 solidated, and the original cartilage disappears.
   It consists of a body or region which corresponds with the teeth,
 and two extremities or branches.
   The inferior part of the body presents a thick and rounded edge,
 which is the base.   The upper part  of the body is  formed by the
 alveolar cavities  for receiving the teeth.   The line  of union be-
 tween the halves, being called  the symphysis, is marked in front
 by an elevated  ridge,  terminated  below by the  anterior  mental
 tubercle  a triangular  rising.   In  many subjects this tubercle is
 bounded on each side  by a rounded prominence of bone, which
gives  to the forepart of the jaw an unusual  squareness in the living
subject.  Just above the  latter prominence, there is, on each side,
a transverse  depression,  from which  arises the  levator muscle of
the lower lip.  On a line with this depression, and removed a little
distance from its external extremity, under the interstice between
the second small and the first large  molar tooth, is  the anterior 
154
SKELETON.
 mental or maxillary foramen; the termination of a large canal in
 either side of the bone, which conducts the inferior maxillary blood
 vessels and nerve to the teeth.  The foramen is directed obliquely
 upwards and backwards, and transmits the remains of these blood
 vessels and the nerve to the face.   The chin is  that  part of the
 bone between the anterior mental foramina.  As the alveolar pro-
 cesses do not exist in early life, and in very advanced age when
 the teeth are lost; the anterior mental  foramen in such cases is
 very near the superior margin of the bone.  At it an obtuse ridge
 of bone commences, and which ends in the root or anterior edge
 of the coronoid process.   The alveolar processes of the last three
 molar teeth are placed within this  ridge, and project over the in-
 ternal face of the bone.
  The internal or posterior  face of the lower jaw is also marked
 at the symphysis by a ridge passing from the superior to the infe-
 rior margin.   At the lower  part of this ridge is a  cleft process, the
 posterior mental tubercle.  Below this tubercle, on either side, is
 a shallow fossa, for receiving the digastric muscle.  Between the
 lower margin of the bone and the protuberance occasioned by the
 alveolar  processes  of the larger molar teeth, is an oblong large
 fossa, made by the pressure  of the sub-maxillary gland.

  The alveolar processes form a semi-circle, the  extremities of
 which are carried backwards with a slight divergence.  The pa-
 rietes of  the processes are thin, and present cutting edges.   They
 of course correspond, in number and shape, with  the roots  of the
 teeth which they have to accommodate.   The anterior ones are
 deeper than the  posterior.   As  a general  rule, the  alveolar pro-
 cesses may be said to come  and depart with the teeth; but, when
 a single tooth is extracted, the alveolar cavity not unfrequently is
 filled up with osseous matter, the edge of  it alone being removed.
 This occurs more frequently in the lower than in the upper jaw.
  The base of the lower jaw does not present many marks worthy
 of attention.  It should be observed, that its anterior part is thicker
 than the posterior; and that  sometimes, just before the angle of the
 bone, we see  a concavity of this edge, but generally it is straight,
 or nearly so.

  The extremities or rami of the lower jaw are quadrilateral, and
rise up much  above the level of the  body.  The  superior margin 
THE FACE.
155
presents  a thin  concave edge, bounded in front by the coronoid,
and behind by the condyloid  process.  The coronoid process is
triangular, and receives the insertion  of the temporal muscle; its
base is thick, but its apex is a  thin rounded point.  The condyloid
process is a transverse cylindrical ridge, directed inwards, with a
slight inclination backwards, its middle being somewhat more ele-
vated than the extremities.  It springs from the ramus by a  nar-
row neck. There is a concavity at the inner forepart  of  its neck
for the insertion  of the pterygoideus externus, and a convexity be-
hind.
   The external face of the ramus is flat, but marked by the inser-
tion of the masseter muscle.   The internal face, at  its  lower part,
is flat and rough, for the insertion of the pterygoideus internus.
At the upper  part of this roughness is the posterior mental or max-
illary foramen, through which the inferior maxillary vessels and
nerve  pass.  It  is  partially concealed  by a  spine of bone, into
which a  ligament from the os temporis is inserted.   Leading from
this foramen  is a small superficial groove, made by a  filament of
the inferior maxillary nerve.
   The angle  of the  inferior maxillary bone, formed by the meeting
of the base and the  posterior margin of  the ramus, presents diver-
sities well worth attention, at different epochs of life, and  in diffe-
rent individuals.  In very early life, and in very advanced when
the alveoli are absorbed, it is remarkably obtuse.  In most middle-
aged individuals it is  nearly rectangular.  Besides which, its cor-
ner is sometimes bent outwards and sometimes inwards, increasing
or diminishing thereby the breadth of the face at its lower part.
   The substance of  this  bone, externally, is  hard  and compact.
Internally there is a cellular structure, through the centre of which
runs the  canal for the nerves and blood vessels.  From this canal
smaller ones are detached, containing  the vascular and  nervous
filaments which  go to the  roots  of  the teeth.  The condyles or
condyloid processes of the os maxillare inferius articulate with the
temporal bones,  by  means of their glenoid  cavities.

   Remarks.—The maxillare inferius has a greater influence on the
form of the face than any other bone entering into its composition.
Sometimes it is much smaller  in  proportion in certain individuals
than in others.   Sometimes its sides, being widely separated, cause
a great shortening to  the chin, and breadth to the lower hind part 
156
SKELETON.
of the face.  In many instances, the  alveolar processes, in front,
incline obliquely over the outer circumference  of the  bone, and
thereby give to the chin the appearance of receding considerably.
In others, the alveoli incline over the  inner circumference, which
causes the chin to project unusually.
                       CHAPTER  III.

           General  Considerations on the  Head.

  Having described the individual bones of the head, it will now
be proper to consider it as a whole.
                 SECT. I.—OF THE SUTURES.

  Except in advanced age, the bones  of the  cranium and of the
face are very distinctly marked off and united by sutures.
  The latter are formed by the proximate edges of the contiguous
bones, presenting a multitude of sharp serrated points, and of deep
narrow pits, by which they interlock by an accurate and firm
contact.  Here and there, in the sutures which unite the flat  bones
of the cranium, we find not only sharp points, but complete  dove-
tail processes of the one bone received  into corresponding cavities
of the other.  The denticulation of the sutures  is much more com-
mon, and  much better marked, on the external than on the internal
surface of the cranium.  On the latter, the union of the bones is, in
several instances, by a joint nearly straight;  in which case, the
denticulation  is almost exclusively confined to  the external table
and to the diploic structure.

  The Coronal Suture, (Sutura Coronalis,) so named from its cor-
responding in  situation with the  garlands worn by the ancients,
begins at the  sphenoid bone, about an  inch and a quarter behind
the external angular process of the os frontis.   It inclines so  much
backwards in its ascent, that when we  stand  erect, with the head
in its  easiest position, a vertical line, dropped  from its point of 
THE SUTURES.
157
union with  the sagittal suture, would  pass through the centre of
the base of the cranium, and would cut another line drawn from
one meatus auditorius externus to the other.  It unites the frontal
bone to the two parietal.

   The Sagittal Suture (Sutura Sagittalis) unites the upper mar-
gins of the two parietal bones, and is immediately over the division
between the hemispheres of the cerebrum.   It has been stated in
the account of the os frontis, that sometimes it is continued through
the middle of this bone down to the root of the nose.

   The Lambdoidal  Suture (Sutura Lambdaformis)  is named from
its resemblance to the Greek letter lambda, and consists of two
long legs united angularly.   It begins at the posterior termination
of the sagittal suture, and continues down to the base of the cra-
nium, as far as the jugular eminences  of the occipital bone.   Its
upper half unites the occipital to the parietal bones, and the lower
half the occipital to the temporal bones.   The latter half  is some-
times called the Additamentum Sutura? Lambdoidis.

   The Squamous Suture (Sutura Squamosa) is placed on the side
of the head, and  unites  the  parietal to  the  temporal bone.  The
convex semi-circular  edge of the latter  overlaps the concave edge
of the former.  The  squamous suture  is converted into the com-
mon serrated one, where the upper edge  of the angle  of  the tem-
poral bone joins the parietal.  This portion  is called  the Addita-
mentum Suturae Squamosas.
   The squamous mode of suture  unites, likewise,  the great wing
of the sphenoidal to the temporal angle of the parietal.

   In the upper part of the lambdoidal suture, particularly, we find
in many skulls one  or more small bones, connected to  the parietal
and occipital  bones  by serrated margins.   They  are called the
Ossa Wormiana  or Triquetra.  They vary very  much in  their
magnitude,,being in different subjects from  a line to one inch, or
an inch and a-half  in diameter.  I have seen them of the latter
size, and even larger, occupying entirely  the place of the superior
angle of the os occipitis.  Most commonly, but not always, when
one of these bones exists on one side of the body, a corresponding
one exists on the  other.  A congeries of these  bones, united suc-
   Vol. I.—14 
158
SKELETON.
cessively, is sometimes fpund  in the lambdoidal  suture;  in such
cases they are, for the most part, small.   Commonly these bones
consist, like the other bones of the  cranium, of two tables and an
intermediate diploe, and form an integral portion  of the thickness
of the cranium; sometimes, however, they compose only the ex-
ternal table.  M. Bertin says, that  he  has seen them, also, com-
posing only the internal table of the cranium.
  All the sutures mentioned besides the  lambdoid, may exhibit, at
any of their points, the Ossa Triquetra  or Wormiana.   We have
examples of them in the coronal,  the sagittal, and  the squamous,
but in  such cases they are small.   The lambdoid unquestionably
has them most frequently.   M. Bertin has seen a large square bone
at the fore  part of the sagittal suture, occupying the  place, and
presenting  the form, of what was  once the anterior fontanel: he
has also  seen triquetral bones  in the articulations of the bones of
the face.*

  The sutures described belong exclusively to the  cranium, but
there are others common to it and  to the face.   The  sphenoidal
suture surrounds  the bone  from which its  name  comes;  the eth-
moidal suture surrounds the ethmoidal bone; the zygomatic suture
unites the temporal and malar bones; the  transverse suture runs
across the root of the nose, and also unites the malar bones to the
os frontis.  The other articular lines of the face derive their names
from the bones they unite, and  do  not merit a particular attention
at this time, as enough has  been said in the description of the bones
themselves.
  The base of the cranium is remarkably different, in the manner
of its articulations, from the upper part.  The surface, in  the first
place,  is  very rugged, and  much diversified by its connexion with
muscles and bones: besides which, there is a considerable number
of large  foramina and fissures in it for the blood vessels and nerves.
To guard against the weakness arising from  the latter arrange-
ment, nature has given a very increased  thickness to the base, par-
ticularly where much pressure from the weight of the head exists,
and has applied unusually  broad surfaces of bone to each  other to
secure them from displacement by concussion, and different kinds
of violence.  These arrangements are particularly manifest at the
* Bertin, loc. cit. 
THE SUTURES.
159
junction of the cuneiform process of the occipital  bone with the
body of the sphenoid, which, in middle age, or rather shortly after
puberty, is anchylosed ;—at the lower part of the lambdoidal su-
ture ;—and at the  margins of the petrous portion of the temporal
bones where  they touch  the contiguous bones.  Whence it results
that the several fastenings of the base of the cranium, and also of
the upper maxilla, are so complete and strong, that they are most
generally perfectly  exempt from dislocation;  and when the vio-
lence offered to  them  is  sufficiently  great, the bones, in place
thereof, are fractured.

   The  use of the  sutures, in the cranium  and upper maxilla, is
somewhat problematical; for as none of the bones move, the head
might have been equally well  arranged by being made of a single
piece.  In proof of which it is only necessary to recollect, that in
the very aged there is  frequently not  a bone of the cranium and
upper maxilla to be found in an insulated state: they are all fused
into the adjoining bones, by the obliteration of their sutures.  The
old notion that sutures existed  for the purpose of arresting the
course of fractures, and for opening in some diseased conditions
of the  brain, has  been  very justly exploded.   We  know that a
fracture will traverse a suture readily, and that the opening of the
sutures from hydrocephalus is an occurrence  only of very early
infancy, where the sutures have not arrived at the  serrated and
dove-tail arrangement,  by which they are subsequently secured.
It is much more probable that the true reason for the existence of
sutures, is found among  the laws peculiar to  the growing state;
and which most commonly are suspended  after the  several deve-
lopments have been accomplished.  Thus, the head, in consequence
of being separated by sutures into many pieces, is more  readily
wrought from its form  and size in the embryo state, to the form
and size required by adult life.  This necessity of subdivision into
many pieces, does not depend  so much on the size, as on the shape
of the  head.   For we  find the largest  animal, as  the  elephant,
having no more sutures than the smallest, as the mouse.   This opi-
nion is also sustained by what we see  in other bones.  Bones of a
very  simple shape, as those of the tarsus and carpus, consist from
the very beginning of but one piece.   But where  the shape  of a
bone  is complicated, we find it, while growing, submitted to the
same law as the head at large, and consisting of many pieces.   In 
160
SKELETON.
such cases these pieces are united by a  species  of suture corre-
sponding precisely with the form of suture observed between some
of the bones of the cranium; as, for example, between the occipital
and the sphenoid.  Thus, the os femoris, till adult age, consists of
five pieces: its two articular extremities, its body, its trochanter
major, and its trochanter minor.   The cranium itself, before birth,
and for some  time  after, has  several of its individual bones con-
sisting each of two or more pieces, which favours still  more the
idea.
   Some persons  think that the sutures of the  adult are only re-
mains of an arrangement intended exclusively for the benefit of the
parturient  state,  by maintaining  a plasticity of the  head of the
foetus, which  admits of its  diameters  accommodating themselves
to the diameters of the pelvis of the mother.  This theory is rather
too exclusive, though it may be admitted that the sutures in a foetal
head have that use, and  are in some cases of parturition a most
fortunate coincidence, by which the lives of both parties are saved.
But it should  be  observed that  in  a  great number of cases, the
head of the foetus never changes its form  in passing through the
pelvis, because the  passage is quite large enough  without it;  and,
again,  if  the  sutures were  intended  expressly  for the parturient
state, we ought not to find  them in birds, and in  such animals as
are hatched, because the necessity for them there does not exist.*
   Upon the whole we may safely conclude, that the sutures of the
cranium and  face are simply a provision for  the growing state,
and that, like  all other provisions  for this state,  it also  ceases at
its appropriate period, and  sometimes leaves  not a vestige of its
existence.  Occasionally, indeed, we  find the latter to  have  oc-
curred in one  or  more sutures, even before the age of puberty, as
I have repeatedly witnessed in the  sagittal, the squamous, and the
lambdoidal sutures.

   The manner in which the sutures are formed is sufficiently inte-
resting : they  are generally said to  be made by the radii of ossifi-
cation, from the  opposite bones meeting and passing each other,
so as to form a serrated edge.   This  explanation may account

  * A gentleman  whose anatomical writings have some vogue in this country, has
cut the Gordian knot, by telling us that they are "accidental merely, and of little
use !.'"—Anat. of the Human Body, by John Bell, Surgeon, Edinburgh. 
THE SUTURES.
161
partially for the shape of the edge of the sutures, but not for their
invariable position; inasmuch as we  always find the sutures in the
same relative situation, and  having the same course.   If they de-
pended exclusively on so mechanical a process, as the rays of one
bone shooting  across the  rays of another by their own force, we
ought to find, occasionally, the sagittal suture more on one side of
the head than on  the other, and not straight, because in some in-
stances  ossification  is a more rapid  process on one side than on
the other.   Moreover, in all cases where bones arise from diffe-
rent points of ossification, and meet, the  serrated edge should be
formed ; and particularly in the flat bones.  Observation, however,
proves that the os occipitis,  which is formed originally from four
points of ossification, and therefore has as many bones composing
it in early life, does not present  these bones afterwards united by
the serrated edge.  The acromion process of the scapula, though
originally  distinct from  the  spinous, never unites to it by suture,
but always by fusion.  The mode of junction in the three bones
of the sternum is always by fusion.   In short, the observation holds
good in  numerous other instances.
   Bertin and Bichat, reject fully the mechanical doctrine concern-
ing the sutures, and  present one founded  upon reason and obser-
vation, and susceptible of  confirmation by any accurate observer.
The dura mater and the pericranium, before ossification com-
mences, form one membrane consisting of two laminae.  Partitions
pass from one of these  laminas to the other, which  mark off the
shape, or constitute  the mould of the bones  long before they are
perfected.  The peculiar shape of the bony  junction, or, in other
words, of the sutures or edges of the bones  in adult  life, depends,
therefore,  exclusively upon the original  shape of the partitions.
When the latter are  serrated, the points of ossification will fill up
these serras; but when they  are oblique, the squamous suture will
be subsequently formed.
  This theory also accounts for modes of junction intermediate to
the squamous and serrated suture; for the formation of the Ossa
Triquetra or Wormiana; for their existence, form, size, and num-
ber, in some skulls, and  their total absence  in others.  The infe-
rence will  also  be obvious, that in all ossifications from different
nuclei, a suture will not be formed, where the membranous partitions
do not exist; but that the bones will unite  after the manner of
                            14* 
162
SKELETON.
such as are fractured.  We shall also understand, that when these
partitions are weak  and imperfect, either from their  congenital
condition, or from advanced age, as happens  in all  sutures, but
with some differences of time, the bones of the opposite sides are
fused together completely.

   The  partitions which determine the places of the sutures, may
be demonstrated in a young adult skull by removing with muriatic
acid the calcarious portion of the bones, so as  to  leave only the
animal part.  On  opening the  suture after this process, it will be
seen, that the pericranium sends in its partition, which  is met by
the partition coming from  the dura mater.  Or, if either of these
membranes be peeled off, its contribution of partition will appear
very plainly projecting from its surface, in the form of a ridge.
   Owing to congenital  hydrocephalus, the sutures of the vault of
the cranium have been known to remain open  for years after
birth, from the continued augmentation of the volume of the brain.
In such cases additional bones are sometimes  formed, manifesting
a  strong  attempt, on the part of nature, to cover the  brain with
bone.  I obtained, some years ago, a  specimen of this kind belong-
ing to a foetus of nine months, whose head was as  large as it is
commonly in adult life, and in whom there were two  ossa parie-
talia on one side.   Morgagni,* whose  authority is  proverbial in
morbid  anatomy,  states, that a learned colleague  and intimate
friend of his, Bernardin  Rammazzani, aged seventy, had the  su-
tures open at that period of life.   He does not  say at what time
this condition of them appeared.  I  think  it  more  probable that
they had never been closed, though Morgagni  leaves the reader to
infer, that it was a  circumstance which had arisen from a violent
hemicrania, with which the patient had  been  seized  when he was
advanced in life.   Diemerbroek found, in a woman of forty,  the
anterior fontanel not ossified.  Bauhius' wife, aged  twenty-six, had
the sutures not yet closed.  Indeed, there is no deficiency of well
authenticated similar instances, more of which it will be unneces-
sary to adduce.  It may be observed here, that when from con-
genital hydrocephalus, attended with much extension of the brain,
the bones of the cranium are compelled to grow beyond their usual
diameters, they are uncommonly thin, and the diploic structure is
* Causes and Seats of Disease, Letter 3d, Art. 8th. 
                   STRUCTURE OF THE CRANIUM.                1 63

very imperfectly developed:  which will account for their  separa-
tion at any period of life, from the fastening being so slight.


  SECT. II.—OF THE DIPLOIC STRUCTURE OF THE CRANIUM.

   The bones of the cranium, in  the  adult, consist of an  external
and of an internal table; united  by a bony reticulated or  cellular
substance, which does  not manifest  itself very distinctly till two,
three, or even more years are passed, by the infant.  The internal
table of the skull is thinner and more brittle than the external, and
has obtained, from that cause, the name of vitreous table.
   The cells of the diploic structure are not to be confounded with
the large sinuses that exist  in  the frontal, the temporal, and the
sphenoidal bones.  They are  formed under different circumstances,
and do not communicate with  them.   The  sinuses are lined by a
mucous  membrane, whereas the lining membrane of the  cells of
the diploe corresponds with the internal periosteum of other bones.
I have a preparation now before me, in which  a diploic structure
of the os frontis exists between its sinuses and the external table of
the bone: in  the same  head,  a similar circumstance existed in re-
gard to the temporal bone;  from which we infer  that the diploic
structure, in these  places, is caused to recede, and even to  be par-
tially obliterated, when  the development of the sinus commences,
which is not until some time after the evolution of the diploic struc-
ture.  The sphenoidal bone, when fully evolved in its body, is  a
remarkable instance of the  recession of diploic structure  for the
purpose of forming a sinus.
   In the diploe* of the  dried  bones, several  arborescent channels*
may be  seen by the removal of the external table.  They were
discovered about the year 1805, by M. Fleury, while he was Pro-
secteur at the School of Medicine  in Paris: and  engaged, at the
instigation of the venerable Chaussier, in some inquiries relative to
the structure  of the cranium.   The account given by the latter is,
that these channels are occupied in  the recent subject, by veins,
which, like all others, are intended to  return the blood to the heart.
These veins  are furnished with small  valves, have extremely thin
and delicate  parietes,  and commence by capillary ramifications,
* Chaussier, Exposition de la Structure de l'Encephale.  Paris, 1807. 
164
SKELETON.
coming from the different points of the vascular membrane, which
lines the cells of  the  diploe.  Their roots are at first extremely
fine and numerous, form  by their frequent anastomoses a kind of
net-work, and produce  by their  successive junction, ramuscles,
branches, and large trunks, which, becoming still more voluminous,
are directed  towards  the base of the cranium.  Some variations
exist in regard to the  number, size, and disposition of these trunks;
but generally one or two of them are found on either side of the
frontal bone, two in the parietal bone, and one  on either side of
the occipital  bone.   Anastomoses exist  between  these  several
trunks, by which the veins in the parietal bone are joined to those
in the frontal and in  the occipital.  Branches from the right side
of the  head  also anastomose with some from the left side.   Besides
the branches already  mentioned, one or two smaller than the others
are directed towards the  top of the head, and  terminate in the
longitudinal sinus.

   The descending veins of the diploe  communicate in their pas-
sage with the contiguous superficial veins, and  empty into them
the blood which they  receive from the several points of the diploe-
These communications  are passed through small foramina, which
penetrate from the surface of the bone to the diploe.   The trunks
of such diploic veins as  are continued to the base of the cranium,
open partly  into the sinuses of the dura mater, and partly into the
venous plexus at the base of the pterygoid apophyses of the sphe-
noid bone, and form there the venous communications  through the
foramina of the base of the cranium, called the emissaries of San-
torini.  Moreover, there are communications sent from the diploic
veins,  through the porosities of the internal table of the skull, to
the veins of the dura mater.  This fact is  rendered very evident
by tearing off the skull-cap, when the  surface of the  dura mater
will be found studded with dots of blood, and the internal face of
the bone also, particularly in apoplectic subjects.  It  appears, in-
deed, that the arteries of the cranium  are principally distributed
on its external surface, and the veins on  its internal  surface and
diploe.
   In the infant, the diploic veins are small, straight, and  have but
few branches: in the adult, they correspond with  the description
just given, and, in old age, they are still more considerable, form-
ing nodes and seeming  varicose.   In children, when the bones are 
SURFACE OF THE CRANIUM.
165
diseased, they partake of the latter character.  In order to see
them fully, the external table of the skull must be removed, both
from its vault and base, with a chisel and mallet.   This operation
will be much facilitated  by soaking the head previously in water
for two days.
   The diploic sinuses as well as the corresponding channels in the
bodies of the vertebrae are now considered as an enlarged deve-
lopment of Haversian canals.
   SECT.  III.—THE INTERNAL SURFACE OF THE CRANIUM.

 m  The points for study in  viewing the cranium as a  whole, are
 generally the same as have been presented in the detail of each
 bone.  It is, nevertheless, useful to regard the structure in its con-
 nected state, as new views are thus presented of the relative situa-
 tion of parts, and of the formation of the several fossas and cavi-
 ties.
   The cavity for containing the brain is regularly concave above,
 and is there called the arch or vault; but below, it is divided into
 several fossae, and is called the base.
   The whole cavity is lined by the dura mater, and, in the adult,
 presents round  superficial depressions made by the convolutions of
 the brain.   These depressions are seldom deep enough to prevent
 the internal periphery of the vault and sides of the cranium, from
 being nearly parallel with  their external surface.

   On the Vault, or  arch,  are to be seen, on the  middle line, the
 frontal spine, extending from the  ethmoid bone half way or more
 up the os  frontis: also, the gutter for the longitudinal sinus leading
 from this  spine along the  sagittal suture, and terminating at the
 internal occipital protuberance.   On  either side of this gutter are
 the arborescent channels, made  by the great middle artery of the
 dura mater.  In this section, we also see the internal face of the
 os frontis, excepting  its orbitar processes;  the parietal bones; and
the superior fossae in the occipital bone, for the posterior lobes of
the cerebrum.

   The Base of the cranium internally presents a very unequal sur-
face, abounding in deep depressions, processes, and  foramina.   On 
166
SKELETON.
its middle  line,  extending from  before backwards, the following
objects should be remarked.  The foramen coecum at the front of
the crista galli; and, at either side of the latter, the ethmoidal gut-
ter, perforated with holes.   These gutters are bounded, laterally,
by the internal margin  of the orbitar processes of the os frontis,
and behind by the sphenoid  bone.  At the fore part  of the gutter
is  the  oblong foramen  for  transmitting to the nose the  internal
nasal nerve, and  about half an inch behind  this  foramen, in the
suture, with the os frontis, is the inner orifice of the foramen, called
the anterior internal orbitar, which leads  the same nerve from the
orbit.  Immediately behind  the ethmoidal fossae the sphenoid bone
presents  a plane  surface, upon  which are placed the olfactory
nerves and the contiguous part of the brain.  Behind this plane is
the fossa, running from one  optic foramen to the other, for lodging
the optic nerves.  Behind this, again, is the sella turcica or pitui-
tary fossa, bounded  at  its two anterior angles by the anterior cli-
noid processes, and behind by the posterior clinoid process.   Pos-
terior to the latter is a plane square surface of the sphenoid bone,
continuous with the internal surface of the cuneiform process of
the os occipitis.   On the  latter is the depression called basilar gut-
ter, for receiving the medulla oblongata, and which is  bounded
below by the great occipital foramen.  From  this foramen to the
internal occipital protuberance, proceeds  the  inferior limb of the
occipital cross.

   On both sides of the ethmoidal bone is a convex surface; called,
however, the anterior fossae  of the base of the cranium, and formed
by the orbitar processes of the os frontis and the little wings of the
sphenoid bone, for lodging  the  anterior  lobes of the  cerebrum.
This surface is terminated behind by the  rounded edge of the little
wing, which is received  into the fissure between  the anterior and
middle lobes of the brain.  Just anterior to this edge is the fronto-
sphenoidal suture.

   On the sides of the sella turcica are the middle fossae of the base
of the cranium for lodging the middle lobes of the cerebrum.  They
are very wide externally, where they are bounded  by the squamous
portions of the temporal  bones, but narrow internally, where they
are  bounded by the Sella Turcica.   The little wings of the  sphe-
noidal bone terminate them in front, and  form there a  crescentic 
SURFACE OF THE CRANIUM .
167
edge hanging over their cavity.  Their posterior margin is  the
superior  ridge  of  the  petrous bone.  This  bone is placed very
obliquely, inwards  and forwards, and its  point almost reaches the
posterior clinoid process.  At the anterior part of the fossa is the
sphenoidal fissure or foramen, of the sphenoidal bone.   Just above
the base of  this fissure is  the  foramen opticum, partially  con-
cealed by the anterior clinoid  process.   Just  below the base of
the fissure  is the  foramen rotundum.   At the point of the  pe-
trous bone, by the side of the posterior clinoid process,  is the in-
ternal orifice of the carotid canal.  On a line with the latter, ex-
teriorly,  is the foramen ovale.  Two lines behind the latter is the
foramen spinale.  The groove formed by the middle artery of the
dura mater, may  be traced from the foramen spinale  along the
anterior margin of the squamous  bone.   Near the upper part of
this bone the groove bifurcates; the larger channel runs upwards
into a  groove on the tip of the great sphenoidal wing, into the prin-
cipal groove of the parietal bone, which commences at the tempo-
ral angle of the latter.   The smaller groove runs horizontally back-
wards, and just above the  base of the petrous bone is continued
also into the parietal bone.  On the front of the petrous  portion
 may be seen  the  hiatus Fallopii.  The sphenoidal  suture runs
through these fossae, in the examination of which, the reception of
the spinous process of the  sphenoid bone, between the  squamous
 and petrous  portions of the temporal, will be readily understood.

   On  each side of the foramen  magnum occipitis are the two pos-
 terior fossae of the base of the cranium, formed by the posterior
 faces  of the petrous bones, the  angles of the  mastoid portions of
 the temporal bones  and by that  surface of the occipital bone below
 its  horizontal  ridges.  These two fossae are very partially sepa-
 rated  by the inferior ridge of the occipital  cross and receive the
 hemispheres of the cerebellum.  The additament of the lambdoidal
 suture traverses these fossae.  At  the junction between the petrous
 bone and the basilar process of the occipital, in the course of the
 suture, is a groove for the inferior petrous sinus.  The groove con-
 ducts to the posterior foramen  lacerum, which has  a  small part
 separated  from it by the little  spine of the petrous  bone, which,
 with the assistance of the dura  mater, forms  a distinct foramen for
 the eighth pair of nerves.  The posterior foramen lacerum being
 common to  the temporal and occipital bones, is occasionally much 
168
SKELETON.
larger on the right than on the left side: in which case, the groove
that leads from it along the  angle  of the  temporal bone, the infe-
rior corner of the parietal, and the horizontal limb of the occipital
cross, is also larger.   Above the foramen  lacerum are the meatus
auditorius internus and the internal orifice of the aqueduct of the
vestibule.   Between  the foramen lacerum and foramen magnum
occipitis  is  the anterior condyloid foramen.  The two posterior
fossae of the base of the cranium contain the cerebellum.
   SECT. IV.—OF THE EXTERNAL SURFACE OF THE HEAD.

   Anatomists consider the external surface  of the head as form-
ing or representing three ovals and two triangles, each of which
constitutes a region.   The first oval is  the whole superior convex
part of the cranium; or, in other words, the external surface of its
vault.  The second oval  is  formed by  the inferior surface of the
cranium, and of the face.  The third oval is formed by the lower
front part of the os frontis, and  by the face.  Each side  of the
head forms one of the triangular regions.
   The superior region  is so  simple, and  its  parts have been so
closely sketched, that it is unnecessary to  repeat the description.
   The inferior  region or oval, extends  from  the chin to the occi-
pital protuberance, and  is bounded in  its  transverse diameter by
the superior semi-circular ridges of the os  occipitis, by the mastoid
processes, and by the rami and base of  the lower jaw.  This sur-
face is subdivided into Palatine, Guttural, and Occipital sections
or regions.
   The Palatine region or section, is formed  by the superior max-
illary and palate bones, above, and  by the inferior maxillary bone,
laterally  and below.   It  is  a deep fossa, the circumference of
which is  represented by the  letter U, the  open part being behind.
The whole upper surface of the palatine region, presents a number
of small  rough elevations and fossae, for the  attachment  of the
lining membrane of the mouth.  The surface is divided into two
equal parts by the  long  or middle palate suture, which  is crossed
at its posterior part by the transverse palate suture.   The poste-
rior margin of  the hard palate is  concave  on each side of the
mouth; and from it is suspended the soft palate.   The point in the
centre of this margin gives origin to the azygos uvulae muscle. 
SURFACE OF THE HEAD.
169
    The foramina on this surface, are the anterior palatine or fora-
  men incisivum, in the long palate suture  just behind  the incisor
  teeth, and on either side, behind, between the palate and pterygoid
  process of the palate bone, bounded exteriorly by the upper max-
  illary, is the posterior palatine foramen.  About one  or two lines
  behind this, is another foramen,  in the  base of the pterygoid pro-
  cess of  the palate bone, through which pass fibrillae,  of the  same
  nerve that occupies the posterior palatine foramen.  The posterior
  palatine foramen  also transmits an artery to the  soft  palate, the
  mark of whose course may be seen at  the base of the  alveolar pro-
  cesses for the molar teeth.
    The internal surface of the lower jaw has  been sufficiently de-
  scribed in the account of that bone.
    The depth  of the palatine fossa depends on the state of the teeth.
  When  they are  removed  by old age, and the alveolar processes
  also, what  was palatine fossa  of the  upper maxilla is almost a
  plane surface: and in many instances of extreme old  age, entirely
  so, excepting the part formed by what  remains of the lower jaw.
  The separation from the nose is also  extremely thin, and not un-
 frequently imperfect.  The transverse diameter of the  mouth is
 much decreased, in consequence of the absorption of the alveolar
 processes taking place, from the outside towards the inside.
   The Guttural Region of the base of the head is formed by the
 cuneiform process  of the os occipitis, in the centre; by the inferior
 face of the petrous bones, laterally and behind; by the body and
 great wing of the sphenoid  bone, laterally and in front; and by the
 several bones contributing to  the orifice of the  posterior nares.
   It is bounded anteriorly by the pterygoid  fossae and  the openings
 of the nose, and behind  by the mastoid and condyloid processes.
 It consists, consequently,  in one  part, which is horizontal, and in
 another, which is vertical.  In regard to the horizontal portion, its
 inequalities, processes, and  fossae, have  been already stated.   The
 relative position of its foramina, cannot, however, be  studied ex-
 cept in the united bone.  The following rules will afford some as-
 sistance in determining their position, even on the living bodv.
   A line passing from the  anterior margin near the  end of one
 mastoid process to the corresponding point of the other, will  sub-
tend the stylo-mastoid foramina, and the posterior margin of the
foramina lacera; it will also touch the base of the styloid processes
and cut into halves the condyles of the occiput.   A line, three-
   Vol. I.—15 
 170                        SKELETON.              »

 eighths of an  inch  in  advance of this, run through the middle of
 the meatus auditorius externus, will indicate the posterior margins
 of the glenoid cavities,* and cut in half the inferior end of the caro-
 tid canals or foramina, and  touch the  anterior margins of the an-
 terior condyloid foramina.   Another line, one fourth of an inch in
 advance  of the latter, will cut through the centre of the  glenoid
 cavity, and subtend the styloid process of the sphenoid bone, and
 the bony  orifice of the Eustachian tube in the temporal bone.   A
 line passing between the external ends  of the tubercles of the tem-
 poral  bones, will  subtend  the  foramina ovalia and the  foramina
 lacera anteriora.  The foramen  spinale is about equi-distant from
 the last two lines.
   The foramen lacerum anterius, being at the point of the petrous
 bone, is occasioned  by the latter not filling up the space between
 it and the sphenoidal and occipital bones.  The deficiency is sup-
 plied, in the recent state, by cartilage.  Precisely opposite to the
 point of the petrous bone, is the  posterior orifice of the foramen
 pterygoideum, from which emerges the  pterygoid nerve, and pene-
 trating this cartilage immediately divides into two branches:  one
 going to the carotid canal, becomes one of the roots of the sympa-
 thetic nerve; and  the other, ascending  into the cranium, becomes
 the Vidian nerve or  superficial petrous.
   The vertical portion of the Guttural  Region presents the poste-
 rior orifices of the nostrils, separated from each other by the vomer.
 On each side are the pterygoid processes of the sphenoid bone, and
 above  is its body.  The pterygoid fossa, formed between the ex-
 ternal and internal process, and the long unciform  termination of
 the latter  with the broader and shorter termination of the former,
 will also be observed.
   The Occipital region of the  base of  the head, placed immedi-
 ately behind the other, may be considered to include the mastoid
processes, and the foramen magnum  occipitis, and to be bounded
 behind by the  tuber of the occiput and  its superior transverse
ridges.  Its marks have been  sufficiently dwelt upon, in  the  de-
 scription of the os occipitis.

   The third oval will be described in detail in a short time.

  * By glenoid cavity  in this paragraph  is meant the whole of the depression in
 the temporal bone, and not merely the surface for the condyle of the lower jaw. 
SURFACE OF THE HEAD.
171
  On the side of the head, where we consider the triangular region
to exist, the arch formed by the malar bone and the zygomatic pro-
cess  of the temporal, forms a very conspicuous feature.  The an-
terior abutment of this arch is formed  by the greater part of the
malar bone,  and a considerable  portion of  the  malar process of
the superior  maxillary.  The posterior  abutment is formed by the
root  of the zygomatic process of the temporal bone.   Its superior
margin is thin, for the insertion of the  temporal aponeurosis: the
inferior  margin is thick, and is divided, by a projection in its  mid-
dle, into an anterior  and a posterior surface, marking  the origins
of the two portions of the masseter muscle.  There is a very  con-
siderable vacancy between the zygoma and the side of the head,
occupied, by the coronoid process of the lower jaw, the temporal
and  the  external pterygoid muscles.  The coronoid process is just
within the zygomatic arch, and the tip rises three or four  lines
above its inferior margin.
  The large depression within the zygoma is the temporal fossa.
All that portion of the side  of the head, beneath  the ridge called
parietal, leading from the external angular process of the os frontis,
and  running along the surface  of the  parietal bone, is tributary
to the temporal fossa.   The bones, therefore, which  contribute to
form it, are the frontal, the  parietal, the temporal, the great wing
and  the external pterygoid process of the sphenoid bone, and the
posterior face of the superior maxillary and malar  bones.   The
arrangement of the squamous suture is  well seen in this fossa, also
the  junction  of the pterygoid bone with the parietal and frontal,
by the overlapping of the great  wing of the former.   At the  infe-
rior  part of the latter, is the  pointed process, from which one head
of the external pterygoid muscle arises.
  At the bottom of the temporal fossa there is a narrow slit parti-
tioned from  the nose by the nasal plate of the palate bone.   This
slit, from its position, is called the Pterygo-maxillary fossa.  It is
triangular, the base being  upwards and the  point downwards.
The  base reaches to the bottom of the orbit.   From the base there
leads into ihe nose  the  spheno-palatine foramen for transmitting
the lateral nasal nerve and blood vessels.  Externally to this fora-
men, and somewhat above  it, is the foramen  rotundum  for the
upper maxillary  nerve.' On a level with the spheno-palatine fora-
men, and running  horizontally through the base of the pterygoid
process, is the pterygoid foramen for the nerve of the same name. 
172
SKELETON.
 Running vertically downwards from the point of the pterygo-max-
 illary fossa,  is the posterior  palatine canal for transmitting the
 nerve and artery of the same name.  The upper part or base of
 the pterygo-maxillary fossa, is continuous with a large fissure in
 the bottom of the orbit called the Spheno-maxillary.


              SECT. V.—OF THE NASAL CAVITIES.

   The nose consists of two large cavities  or fossae, in the middle
 of the bones of the upper  jaw, and has a very irregular surface.
 Its cavities are separated from one another by a vertical septum,
 consisting of  the vomer and  of  the nasal lamella of the ethmoid
 bone.  This  septum  presents a  surface which is perfectly plane,
 with  the exception, that in some subjects  it is slightly convex on
 one side, and concave on the  other.  It is deficient in front.
   The upper part of either  nostril is formed by the cribriform plate
 of the ethmoid bone; in front of this the surface is very oblique, be-
 ing made by the  ossa nasi; posteriorly there is a vertical gutter on
 the body of the sphenoid bone, in  the middle of which is the orifice
 of the sphenoidal cell.  The distance between the cellular part of
 the ethmoid and the septum nasi  is  not more than  three lines.  The
 double row of foramina in the cribriform  plate is very well seen,
 also the  foramen at its anterior  part for  transmitting the nasal
 branch of the ophthalmic nerve;  the gropve formed by the latter
 on the posterior face of the ossa nasi is also very distinct.
   The bottom of either nostril, called its floor, is formed  by the
 palate process of the  superior maxillary and  palate bones; it is
 somewhat concave, and about half  an inch wide; its width, how-
 ever,  is not uniform, as it is sometimes wider or narrower in front
 than it is in the middle.  In it is seen the upper orifice of the fora-
 men incisivum at the anterior  point  of the vomer.
   The external or orbitar surface of the  nasal cavity is very irre-
 gular, presenting  a number of projections  and fossae, over which
 the Schneiderian membrane  is displayed.  It  is formed by the
 upper maxillary, the ethmoid,  the unguiform, the palate, the nasal,
 the lower spongy, and the  sphenoid bones. In the middle of the
posterior part  of the ethmoid  is the upper meatus of the nose, a
deep fossa, bounded above by the  cornet of Morgagni, or the supe-
rior turbinated bone, and receiving  the contents  of the posterior 
NASAL CAVITIES.
173
  ethmoidal cells, by one or more orifices.  At the  posterior termi-
  nation of this fossa is the  spheno-palatine foramen.  The middle
  spongy bone forms the lower boundary of the ethmoid;  between it
  and the lower spongy or turbinated  bone, is  the middle meatus of
  the nose, a fossa of considerable size, but of  unequal surface.  At
  the fore part of the middle meatus is a vertical projection, formed
  by the ductus ad nasum and lachrymal  canal.   Just behind  this
  ridge, is an  interval  between it and  the anterior part of  the  eth-
  moid, through which the os unguis may be seen.   When the mid-
  dle spongy  bone is broken off, immediately beneath its  anterior
  part a channel  obliquely vertical, is seen in  the  ethmoid, which
  leads to the frontal sinus, through the  anterior  ethmoidal  cell.
  This cell, from its peculiar  shape and  function, is called  infundi-
  bulum.  Behind this oblique channel is another oblique channel,
  parallel, but smaller; in which several orifices may be found of the
  anterior ethmoidal  cells.  The anterior channel  has, indeed, for
  the ethmoidal cells other orifices besides the  infundibulum, which
  are smaller,  and below the latter.   It  is bounded, in front, by  a
 sharp, thin  ridge of the ethmoid,  the  lower extremity  of which
 contributes to close the large opening into the sinus maxillare.
   Commonly about the middle of the middle meatus of the nose,
 but varying  very much in  different subjects, is the orifice of  the
 sinus maxillare, or antrum  Highmorianum.  Its  precise situation
 and direction are so very uncertain, that  its orifice is found with
 some difficulty in the fresh state, in a great number of persons. Not
 unfrequently I have seen this orifice high up, under the anterior
 extremity of the middle spongy bone.
   The inferior meatus of the nose is bounded above by the lower
 spongy bone, and below by the palate  processes.   It extends  the
 whole length of the nostril.  At the  anterior part of this  meatus
 above, is the orifice of the ductus ad nasum, which  communicates
 with the orbit of the eye.
   The nostril presents an increased width, anterior to the points,
 where the spongy bones  cease:  this space is bounded on the orbi-
 tar side  by the  nasal  bone,  and the  nasal process of the  upper
 maxillary.   There  is an increase of  transverse diameter also  at
 the posterior part of the  nostril, behind the points where the spongy
or turbinated bones cease.   This space is bounded externally by
the nasal plate of the palate  bone, and  by the  internal pterygoid
process.
                             15* 
174
SKELETON.
   The posterior nares, or orifices of the nostrils, are oval, and are
completely separated by the posterior  margin of the vomer.  In
the dried skeleton, on  the contrary, the anterior nares  have a
common orifice, from the deficiency of the bony  septum between
them.

              SECT. VI.—ORBITS OF  THE EYES.

   The orbits of the eyes are the conoidal  cavities  in the face, pre-
senting their bases outwards and forwards, and their apices back-
wards ; so that the diameter of either  orbit,  if continued,  would
decussate that of its fellow in  the  pituitary fossa or sella turcica.
Seven bones form the orbit, the os frontis, the ossa malarum, the os
maxillare superius, the os planum, the os unguis, the os sphenoides,
and the ossa palati.  Its cavity is somewhat quadrangular, besides
being conoidal.  The angles are particularly well marked, in most
subjects, at its base or orifice; which resembles an oblong, having
its long diameter in some persons placed almost horizontally, and
in others obliquely downwards and outwards.  Immediately within
the orifice the cavity is enlarged, behind the projection of the orbi-
tary ridge of the os frontis, and the elevation of the anterior inferior
margin of the orbit, so  that the greatest diameter  is there rather
vertical than horizontal.  From  this point the  orbit decreases gra-
dually in size to the sphenoidal fissure, or  the superior foramen
lacerum of the orbit which forms its apex.  The internal walls of
the two orbits are  nearly parallel,  in  consequence of the cuboidal
figure of the os ethmoides, which is placed between them.
   The superior face or roof of the orbit  is triangular and concave:
it is very thin, and presents but  a  slight septum between the eye
and the brain.  Almost the whole of it is formed by the orbitar
process of the  os frontis, its point  only being made  by the little
sphenoidal wing.   The  depression for the lachrymal gland, at its
external anterior part,  is  very perceptible.  The trochlea for the
superior oblique muscle of  the eye, is also well seen  about six or
eight lines above the point of the internal angular process of the os
frontis.   Just at the outer side of this  depression is the foramen or
notch for the supra-orbitar  artery and nerve.   The optic foramen
may be seen, very readily, passing through  the little wing of the
sphenoid bone.

   The inferior face, or the floor  of the orbit, is also triangular and 
ORBITS OF THE EYES.
175
concave, and  is formed by the orbitar process of the upper max-
illary bone  principally;  being assisted,  however, at its  anterior
external margin, by a portion of the malar bone;  and, at its point
behind, by the orbitar process of the palate bone.   The latter can-
not be seen  very distinctly in the  articulated  bones, owing to its
great depth  in the orbit;  but, when the external side of the orbit is
removed with a saw, its  position  is placed in  an interesting light.
The floor of the orbit is  thinner than  its roof, and forms  a  very
slight separation from the maxillary sinus.  It is terminated behind
by the spheno-maxillary fissure, or  inferior foramen lacerum of the
orbit; a large slit, which,  commencing  at the base of the sphe-
noidal fissure, separates  the great wing  of the  sphenoidal  bone
from  the  ethmoidal, the palate, and  the upper maxillary bones.
This  fissure runs obliquely  outwards,  so as  to  have its  external
extremity terminated  by the malar bone.  Near  the external ex-
tremity  is seen the commencement of  the  infra-orbitar canal, for
transmitting the infra-orbitar nerve and artery.
  The external face of the  orbit is also  triangular, and  very ob-
lique.  It  is  formed by the  malar bone, and by the orbitar face of
the great  sphenoidal wing.   It is  defined  below  by the  spheno-
maxillary fissure, and above by the suture which unites the frontal
to the malar, and to the great wing of  the  sphenoidal bone.  It is
terminated, at the apex of the orbit, by the sphenoidal fissure.
  The internal face of the orbit is  an oblong square, nearly paral-
lel, as mentioned, with the  corresponding face of  the other orbit.
It is formed principally by  the orbitar face of the ethmoid, called
the os planum, but at  the apex of  the orbit a small portion of the
body of the sphenoid  bone  contributes to it, and anteriorly is the
os unguis.   It is bounded behind by the sphenoidal fissure, in front
by the lachrymal ridge on the nasal  process of the os maxillare
superius, and above and  below by  the upper and lower ethmoidal
sutures.   In the upper of these sutures there are generally the two,
sometimes three, orbital, or ethmoidal foramina, the  anterior of
which transmits the  anterior ethmoidal artery, and vein,  and  the
internal  nasal nerve, to the nose; the posterior  transmits the poste-
rior ethmoidal artery and vein to the same.

  The lachrymal fossa  is well worthy of attention:  it is  seen to
commence small at the upper part of the os unguis, and to increase
in size till it  is formed into a complete canal, the ductus ad nasum, 
176
SKELETON.
leading to the nose, by the upper maxillary and the inferior spongy
bones.  The direction of the canal is almost vertically downwards,
inclining very slightly backwards.   It was  stated, that  the fossa
in the fore part of  the os unguis is  sometimes supplanted  by the
increased breadth of the nasal process, a fact of some importance
to an operator for fistula lachrymalis.
 SECT. VII.—OF THE FACE, TOGETHER WITH SOME REMARKS
  ON THE FACIAL ANGLE, AND ON NATIONAL PECULIARITIES.

   The anterior oval of the head extends from the frontal protube-
 rances to the base of the  lower jaw, and from the malar bone of
 one side to the malar of the other inclusively.  This oval  is divided
 into two symmetrical or equal halves, by the vertical suture, which
 unites the bones of the opposite sides of the face.
   In the infant, the frontal  protuberances are always well marked,
 from their being the centres of ossification for the two  halves of
 the os frontis;  in the adult, they are frequently not raised above
 the common level of the bone.  The superciliary protuberances
just above the internal half of the  orbitary or superciliary ridges,
 are generally somewhat prominent, but they vary very much in
 this respect  in  different individuals.  Between these ridges  the
 frontal  bone is  sometimes raised  into a  vertical  elevation, con-
 tinuous  with the dorsum of the nose, as is more frequently seen in
 young persons.
   The  nose, or pyramidal  convexity, formed by the nasal pro-
 cesses of  the superior maxillary, and by the nasal bones, is con-
 cave above, and extremely prominent below.  The prominence of
it  depends upon  the development  of the  ossa  nasi.  I have fre-
quently  seen the latter curtailed to about one-half, and even one-
 third of their usual breadth, and also diminished in length; which
is  followed by an unusual flatness of the nose: the peculiarity had
been presented to me till lately only in negroes; but, since then, I
have also  met with it in the skulls of white subjects: it is, how-
ever, much more uncommon in the latter.   The anterior  orifice of
the nose is cordiform, the base being below: the centre of the base
is  marked by a rough point, called the anterior nasal spine.

   The cheek bones form, on either side of the face, a considerable 
THE FACE.
177
prominence, depending much upon the length of the malar process
of the upper maxillary bones.  In savage tribes, this prominence
is frequently a  characteristic  trait,  and may depend upon  the
greater development of the upper maxillary sinuses, probably from
the  more intense employment of the organs of smelling and of
mastication.  The elevation of the cheek bone is always conspi-
cuous in emaciated  subjects, from the fat around its  base being
absorbed.
   The alveolar processes with  the teeth produce, in certain  sub-
jects, a very conspicuous projection  in  the face; varying,  how-
ever, considerably in different  individuals, and in different tribes
of human beings.  There  is but little  doubt of  the organization
of some men being  more course and  animal  than that of others,
even in  members of  the  same  family.   The circumstance occa-
sionally manifests itself by unusually large and long teeth, and by
alveolar processes of corresponding dimensions.   Savage nations
have almost  invariably this peculiarity, which is kept up among
them, not only by hereditary influence from father to son, but also
by the actual habits of the individual being productive  of, and fa-
vourable to this  arrangement.  It would be interesting  to know
whether from their articles  of food generally being harder to mas-
ticate than such as are used by civilized people, they do  not con-
tribute to, or even produce a greater development in the organs of
mastication.  Analogy is in favour of  the opinion, because  the
arms or the legs are  always developed in proportion to the vigour
and  frequency of the exercise to which they  are put.  Ploughmen
have large legs.  Blacksmiths  have large arms.   Persons whose
habits of exercise do not call into action any part of the body, to
the exclusion of other parts, have finer  and  more graceful forms
than labourers.   It is therefore, probable, that the ease and grace-
fulness of movement, said to mark the polished and accomplished
man of  fashion, depend upon the harmonious action  of his whole
frame, derived from this proportionate development of all its parts.
Besides  the influence of exercise upon  the organs of mastication,
the passions or faculties of the mind not unfrequently  manifest
themselves there.   Individuals of unusual ferocity and savageness,
have frequently large teeth and alveolar processes.   The gnashing
of the teeth has, in all ages, been considered one of the most striking
signs of anger.
  While speaking of these indications  of man in a savage and un- 
178
SKELETON.
cultivated state, it will be understood that I allude to such tribes as
are engaged in the chase, and in other active modes of subsistence,
and whose habits are not settled down into the agricultural or pas-
toral condition.   It is quite possible for one in the latter situation
to be equally uninstructed, on every point of mental improvement,
and to be much inferior in capacity, to one of the former; yet his
articles of food, and the sensations and passions in which he in-
dulges, will give  no very prominent outline  to his  face, but only
mark it by the general expression of dulness and ignorance.

   The outline of the face is marked also by depressions or fossas.
Those for the eyes and for the nose have been studied, and arrest
at once the attention of the most superficial inquirer.  Immediately
below  the orbits are the canine fossae formed in the centre  of the
front of the upper maxillary bones.  Just  above the incisor teeth
of these bones are the superior incisive fossae.  Below the inferior
incisor teeth, on each side, also, is the inferior incisive fossa.
   In most adults the face projects  somewhat beyond the cranium,
but there is a considerable diversity in this respect between diffe-
rent tribes of human beings.  Camper,* who has paid much,atten-
tion to this arrangement, has  designated it under the term of the
facial  angle, which  he marks off by  two straight  lines.  One is
drawn from the lower front part of the  frontal bone to the point
called the anterior nasal spine at the  orifice of the nose, and be-
tween the ends of the roots of the incisor teeth of the upper jaw;
the other, from this latter point to the  middle of the meatus audi-
torius externus, or thereabouts.  The  facial  angle is included be-
tween  these two lines.  In Caucasian, or  European heads, this
angle  is about eighty degrees.  In the negro, or  Ethiopian, it is
about seventy degrees; and in the Mongolian or copper-coloured
man, about seventy-five degrees.
   An invariable relation is established between the degrees of the
facial  angle, the capaciousness of the  cranium, and the size of the
nasal and palatine cavities.  The nearer the approach is to a rec-
tangle, the smaller is the cavity of the nose,  and of the mouth, and
the greater is that of the cranium, thereby manifesting a more vo-
luminous and intellectual brain.  On the contrary, the more acute
that the facial angle is, the smaller is  the volume of brain, and the

  * Dissertation sur les Differences du Visage chez les  Hommes.  Utrecht, 1791. 
THE FACE.
179
 larger are the nose  and mouth.   This is  so  frequently the  case,
 that Bichat considers it almost a rule in our organization, that the
 development of the organs of taste and smell, is in an inverse ratio
 to that of the brain, and consequently to the degree of intelligence.
   This, like other general rules, is subject  to exceptions, in conse-
 quence of the facial angle varying in  its size, from causes which
 have no connexion with the  degree  of development  of  the brain.
 Thus an unusual prominence and thickness in  the lower part  of
 the os frontis, from an increased capaciousness of the sinuses, will
 make the facial  angle appear less acute.  The  absorption of the
 alveolar  processes, after  the loss of the  teeth, will produce the
 same result in our measurements of the facial angle.  The heads
 of infants, previously to the  appearance and full  growth of the
 teeth, have  always  the facial angle less acute  than the heads  of
 adults: in some  cases an  angle  of ninety degrees  is presented  in
 them. On  the  contrary, a growth of teeth, and consequently  of
 the alveolar processes, disproportionate to  the size of the bodv  of
 the upper jaw, will cause the facial angle to project very conside-
 rably even in an individual of the Caucasian race.  Similar objec-
 tions may be brought against the  indications of  the  inferior line.
 The fair state of this argument appears then  to  be, that the doe-
 trine of the facial angle, though correct in a majority of instances,
 has  numerous exceptions  from  individual  peculiarities, and  that
 there is no race  of human beings which does not present the facial
 angle in all its ranges from seventy to ninety degrees.

  With the view to  meet  such objections and establish  a rule of
 more uniformity, M. Cuvier has proposed to ascertain results  from
 a vertical section, by which it appears that  the Caucasian cranium
 is four times the area of the face; whereas  in the negro the face  is
 a fifth larger than the Caucasian face  by the same rule of mea-
 surement.

  In regard to the various configurations of the  human face and
stature, depending upon habits and circumstances continued through
a long succession of ages and generations, the following views of
one,* pre-eminently qualified to judge, will not be uninstructive.

     * Regno Animal, par M. lc Chev. Cuvier, torn. 1, p. 94.  Paris, 1817. 
180
SKELETON.
   " Although there appears to be but one human species, since all
 its individuals can couple promiscuously, so as to produce a  pro-
 lific offspring, we  yet remark in  it certain hereditary conforma-
 tions, which constitute what are called races.   Of these there are
 three which are eminently distinct in appearance: they are, the
 white or Caucasian; the yellow or Mongolian;  the negro or Ethio-
 pian.
   " The Caucasian race, to which we  belong, is distinguished by
 the beautiful oval form of the head; and it is this which has given
 birth to the most civilized nations, and  to those which have gene-
 rally ruled over the others.  It  has some differences in the shade
 of the complexion, and in the colour of the hair.

   " The Mongolian  is known by its  prominent cheek bones, flat
 face, narrow and oblique eyes, straight and  black hair, thin beard,
 and olive complexion.  It has formed vast  empires in China  and
 Japan, and has sometimes extended its conquests on this side of
 the Great Desert; but its civilization has  always remained  sta-
 tionary."

   The Negro race is confined  to the south of Mount  Atlas;  its
 complexion  is  black, its  hair woolly, its skull compressed, nose
 flattish; its prominent mouth and  thick lips  make it manifestly ap-
 proach the monkey tribe; the people which compose this race have
 always remained in a state of barbarism.

   " The  race from which we are  descended is called Caucasian,
 because tradition and also the lineage of nations, would appear to
 trace it to the group of mountains situated between the Caspian
 and the Black seas, (on the borders  of Europe,) from  whence it
 has radiated in every direction.   The people of Caucasus, as also
 the Georgians and  Circassians, are considered,  even at the present
 day, the handsomest  in the world.   The principal branches of this
 race are distinguishable by the  analogies of language.   The  Ar-
 menian or Syrian division, directed its  course  towards the south,
 and has given birth  to the Assyrians, the Chaldeans, and the un-
tameable Arabs, who, after Mahomet, were very near  becoming
 masters of the world; to  the Phenicians, the Jews, and  the Abys-
sinians, which were Arabian colonies; and it is very probable that
the Egyptians also are descended from the same source.  It is 
THE FACE.
181
from this branch, (the Syrian,) always inclined to mysticism, that
the most  widely extended religions have sprung.   Science and
literature  have flourished  among them  occasionally, but always
under fantastic forms, and with a figurative style.
   " The Indian,  German, and  Pelasgic branch, is infinitely more
extended,  and  was divided at a much earlier period;  we, never-
theless,  recognise the greatest  resemblance between its four prin-
cipal  languages; which are, the Sanscrit, at present  the  sacred
language of the Hindoos, and mother of all the dialects of Hindo-
stan; the ancient language of the Pelasgi, which is the common
mother  of the Greek, the Latin, of many tongues which are  now
extinct, and of almost every language spoken in the south of Eu-
rope; the Gothic or  Teutonic, from which  are derived the lan-
guages  of the  North and North West,  such as the German,  Dutch,
English, Danish, Swedish, and their dialects;  and  lastly, the lan-
guage called Sclavonian, from which come those of the north-east,
as the Russian, Polish, Bohemian, &c.
   " It is this great and respectable branch of the Caucasian race,
which has carried farthest Philosophy, the Arts and Sciences, and
which has been for ages the  depository of them.
   " This branch was preceded in Europe by the Celts, who came
from the north, and were formerly very much extended, but are now
confined to  the most western parts; and  by  the Cantabrians, who
passed  from Africa  into Spain, and  are, at present, almost  con-
founded with the numerous  nations whose posterity has been
blended in this peninsula.
   "The ancient Persians have the same origin with  the  Indian
branch; and their descendants, even at the present  day, bear the
strongest  marks  of affinity to the European nations.
   " The Scythian or Tartarian branch, first directing their course
to the north and north-east, always led  erratic lives  in the vast
plains of those countries: and they have only left them to return
and destroy the more comfortable establishments of their brethren.
The Scythians,  who, at so  remote a period of antiquity,  made
irruptions into Upper Asia ;  the Parthians,  who destroyed there
the power of the Greeks and Romans; the Turks, who overthrew
there that of the Arabs, and  subjugated  in Europe the unhappy
remnant of the Greek nation, were swarms of this stock ; the Fin-
landers  and the  Hungarians  are colonies of it, in  some measure
astray among  the  Sclavonian and Teutonic nations.  The north
   Vol.  I.—16 
182
SKELETON.
and east of the Caspian Sea, their original  country, are still inha-
bited by people of the same origin, and speaking similar languages;
but they are there intermixed with  an infinity of other petty na-
tions, of different origins and  languages.   The Tartar nation has
always remained more  unmixed  in all that tract of country, ex-
tending from the mouth  of the Danube, to beyond the Irtisch, from
which  they  so long threatened  Russia, and where they have at
last been subdued by her.  The Mongolians, however, in their
conquests have blended  their blood with these people, and many
traces  of this intermixture are discovered,  principally among the
Western Tartars."

  " The Mongolian race  commences  to the east of this Tartar
branch of the Caucasian, and prevails thence to the Eastern Ocean.
Its branches, the Calmucks and Halkas, still nomadic or unsettled,
occupy the  Great Desert.   Thence have  their ancestors, under
Attila,  under Genghis, and under Tamerlane, spread far and wide
the terror of their name.  The Chinese come from this  race, and
are not only the most  anciently civilized of it,  but, indeed, of any
nation  yet known.   A third  branch, (the Montchoux) has recently
conquered China, and  continues to govern it.   The Japanese and
Coreans, and almost all  the  hordes which extend to the nerth-east
of Siberia, under the domination  of Russia, belong also to it in a
great measure.  If we  except a few Chinese literati, the whole
Mongolian race is universally addicted  to the different sects of the
worship of Fo.
  " The origin of this  great  race appears to have been in the Altay
Mountains,* as ours was in  the Caucasian; but it is impossible to
follow  so well  the  clue  of its  different branches.   The  history of
these wandering people, is as fugitive as their establishments; and
the records of the Chinese, from being  confined to their own em-
pire, afford us but short  and  vague accounts of their neighbouring
nations.   The affinities  of their  languages  are also but too little
known to guide through this labyrinth.
   "The languages of the north of the peninsula beyond the Ganges,
and also that of Thibet, bear some affinity  to the Chinese, at least,
in their monosyllabic  nature, and the  people who speak them are
not without traits of resemblance to the other Mongolian nations;
* A range in the north of Asia, about 5000 miles long, 
THE FACE.
183
but the south of this peninsula is inhabited by the Malays, a much
handsomer people, whose race and language are spread over the
coasts of all the islands of the Indian Archipelago, and have occu-
pied almost all those of the Southern Ocean.   On the largest of the
former, especially in  the uncultivated and  savage parts, we find
other men, who  have woolly hair, black  complexion, and negro
visage, and who  are  all  extremely barbarous.   The most known
are the Papuas, a name  by which they may be generally denomi-
nated.
   " It is  not easy to refer either the Malays or Papuas, to any one
of the three great races;  but  can the former be plainly distin-
guished from their neighbours, the Caucasian Hindoos on one side,
and the  Mongolian Chinese on the other?   We must  confess that
we do not find them to  possess  sufficient characteristics  to ena-
ble  us to  answer  this question.   Are the Papuas negroes, who
formerly straggled along  the Indian Ocean 1  We have neither
drawings  nor  descriptions  sufficiently clear to reply to this  ques-
tion.
   " The inhabitants  of  the north  of the two  continents, the Sa-
moiedes, the Laplanders,  and the Esquimaux, sprung, according
to some authorities,  from  the  Mongolian race.   Agreeably  to
others, they are  but a degenerate  offspring of the Scythian and
Tartarian  branches of the Caucasian race.
   " It is impossible  to  refer, satisfactorily, the Americans  them-
selves to either of our races of the  old continent; and yet they
have not characteristics precise and  constant enough  to constitute
a distinct  race.   Their  copper-coloured complexion  is not  suffi-
cient; their hair, which  is generally black, and their scanty beard,
 would lead us to refer them to  the Mongolians, did not their well
marked  features, and their moderately prominent noses, oppose
such an  arrangement; their languages are as innumerable as their
tribes, and we have yet been unable  to discover either any ana-
logies among them, or with those of the ancient world."*

   * On this  subject, see also Lectures  on the Physiology, Zoology, and Natural
History of Man, by W. Lawrence.  London, 1822.
   Dictionnaire des Sciences Med. tome XXI.   Paris, 1817.
   Histoire Naturelle  de L'Homme, par Lacapede.  Paris,  1821.
   Blumenbach de Variet. Gen. Hum. Nat. 1794—also Decades, 1790—1814. 
184
SKELETON.
 SECT. VIII.—OF THE DEVELOPMENT OF THE FffiTAL HEAD.

  The foetal head, in  The very early stages of gestation, forms an
oval vesicle, constituting the greater part of the bulk of the em-
bryo, and at this period has the face scarcely visible.  The parietes
of this vesicle are formed by a thin membrane, consisting of two
layers, the  external of which is the pericranium, and the internal
layer is the dura mater.   These layers adhere so closely that they
cannot be accurately separated by the knife.
  About the third month of the  embryo, or even earlier, ossifica-
tion may be seen at several points of the cranium, but more exten-
sively about its base.  These points are the centres of ossification,
which  progressively increase towards their  respective circumfe-
rences, by the deposite of new bony matter.  Generally the  base
of the cranium begins to ossify before the vault, and is entirely
ossified at birth, with the exception  of a few parts, as the clinoid
processes and  the ethmoid bone.
  The following nuclei of ossification show themselves  between
the laminae of the  foetal cranium, from the third to the fourth
month.  One at the anterior part, for the centre of either side of
the os frontis; one  for the  centre  of each parietal  bone, on the
upper side of the head; one on the side of the head below, for the
squamous portion of the temporal bone; and there are several for
the occipital bone.  These points extend themselves in radii;  and,
as the intervals  between the latter become wider by their diver-
gence, new radii, as observed elsewhere,  are  deposited  between
them.  In some of the bones, the radii, from opposite points, in the
progress of ossification before and after birth, meet and coalesce:
this occurs in  the os frontis and in  the os occipitis.
  At birth the  contiguous  margins of the flat bones simply ap-
proach each other, but  have not interlocked.   These bones con-
sist then of but  one table, the edges of which are very finely ser-
rated, and  thereby  show the radii  of ossification.  The edges are
held together by the dura mater, internally, and the pericranium,
externally; but the fissure  between them is very obvious, and so
large that it allows very readily considerable motion and the mount-
ing of one bone upon  the other b}' slight pressure.  It is always to
be observed that the base of the cranium is an exception to the lat-
ter  rule, both from the breadth of its articulating surfaces, and from 
F(E,TAL HEAD.
185
its comparatively advanced ossification.   In parturition, therefore,
the vault of the cranium, by its mobility, is adjusted to the contour
of the pelvis, but the base does not yield in either of its diameters
to the expulsive powers of the uterus.   The latter provision, how-
ever inconvenient in parturition, is of the greatest consequence im-
mediately afterwards; for without  this immobility in the  base of
the cranium, whenever the weight of the head was thrown upon it,
the pressure of the vertebral column would drive  it upwards, to
the injury of the brain and of the nerves proceeding from it.  This
resistance, it may be added, is still farther assisted by the arched
figure of the base of the cranium.   On this subject, it is not a little
remarkable, that even the heads of hydrocephalic foetuses have the
bones of the base fully ossified, and  in contact, so as to support the
weight of the head  in the vertical position.
   Fontanels.—In consequence of the flat bones of  the cranium
ossifying always towards the circumference, their angles, as ob-
served, being the longest radii from their centres, are the  last in
ossifying.  These  angles are commonly incomplete at  birth, and
the membranous spaces which represent them  are the Fontanels.
Of these there are six, two on  the middle line of the head, above,
and two  on either side.   The former afford highly important indi-
cations to the  midwife.
   The anterior fontanel is the largest of all.  It is at the fore part
of the sagittal suture, and is produced by a deficiency in the angles
of the parietal bones, and of the contiguous angles of the os frontis.
It is quadrangular  or lozenge-shaped;  and the anterior angle is
generally longer than the others.  This  is remarkably  the case,
when the sagittal suture is continued down to the root of the nose.
The posterior fontanel is at the other extremity of the sagittal su-
ture, and as there  are only three points  of bone defective there,
two for the parietal bones, and one  for the occipital, this suture is
triangular.  In many children, at birth, it is so far filled up as to
be scarcely visible; the three membranous sutures, however, which
run into it, make its position sufficiently discernible by the finger.
   Of the two fontanels,  on either side, one is placed at  the angle
of the temporal  bone where  it runs up between  the occipital and
the parietal.  The  other is in the  temporal fossa, under the tem-
poral muscle, at the junction between  the parietal and  the sphe-
noidal bones.  These two fontanels are  but little referred  to by the
accoucheur in delivery, as they are irregular and indistinct.  The
                              16* 
186
SKELETON,
pulsations of the brain may be readily felt  through the fontanels.
They ossify  rapidly after  birth,  and  are frequently closed  com-
pletely by the end of the first year; but if there be  an accumula-
tion of water in the ventricles of the brain, they remain open for
an indefinite period.
  The longest diameter of a child's head  is from  the vertex or
posterior extremity of the sagittal suture to the chin, and measures
five inches and a quarter.   From the middle of the frontal bone to
the tubercle of the occipital is four inches,  from one parietal pro-
tuberance to the other is about three inches  and a  half.
  At  birth the os frontis consists, most commonly, of two pieces,
united by the sagittal suture.  The parietal  bone is a single piece,
incomplete at its  angles.  The temporal bone consists of  three
pieces:  one is the squamous, the other is the petrous, and the third
is a small ring which afterwards  constitutes the meatus externus;
it is deficient in styloid and  mastoid  processes.  The os occipitis
is in four pieces: one extends from the angle of  the lambdoidal
suture to the  upper edge of the foramen magnum;  on either side
of the foramen magnum is another, with the condyle growing on
it, and the cuneiform  process is the fourth.  The ethmoid bone is
cartilaginous.   The sphenoidal bone is in three pieces.  The  body
and little wings, being united, form one; the great wing and the
pterygoid process, being also united, form  on either side of the
body another piece.
  At birth there is a great disproportion in  size between the cra-
nium and face.   This disproportion diminishes in  the progress of
life, by the development of the sinuses and of the alveolar processes
in the latter.  At  birth, indeed, there is no cavity either in the
sphenoidal, the frontal, or  the upper maxillary bones; the orbitar
and the  palate plates are very near each other, and  the rudiments
of the teeth are hidden in the bodies of the upper and  lower jaw
bone.   The latter consists of two pieces, united by  cartilage at the
chin, and its angle is very obtuse. 
HYOID BONE.
187
                       CHAPTER IV.

         The Hyoid Bone, (Os  Hyoides, Hyoide.)

   The Os Hyoides is placed at the root of the tongue, within the
 circle of the lower jaw.  It is an insulated bone, having no con-
 nexion with  any other, except  by muscles and ligaments.   It is
 said,  very properly, to  resemble  the letter U,  and consists of a
 body  and two cornua.
   The body is in the middle; it is the largest part of the bone, and
 forms nearly a semicircle.  Its anterior face is convex, and  its
 upper part is flattened  by the insertion of the  muscles from the
 lower jaw.   The posterior face is concave.
   The cornua, one on either side, are about an inch long, and are
 placed at the extremities of the body, being united  to it by the  in-
 terposition of cartilage  and ligamentous fibres.   They are  some-
 what  flattened rather than cylindrical, and diminish towards the
 posterior extremities, where they terminate in  a round  enlarge-
 ment  like a head.
   At  the cartilaginous  junction of the cornu and body,  on each
 side, there is a small cartilaginous body three or four  lines long,
 fastened  by  ligamentous  fibres.  It is frequently  found  ossified.
 This  is  the  appendix or lesser cornu.  A  round ligament passes
 from  it  to  the extremity  of the styloid process of the temporal
 bone.
   The texture of this bone is cellular, with a thin compact lamina
 externally.   M.  Portal  says, that he has found  it carious from
 venereal  contamination;  in which case,  the  patient  had  been
afflicted with violent sore throat and purulent expectoration.  Sau-
vages and Valsalva have  met  with a case, where, from  luxation
of the cornu, the patient spoke with great difficulty.  The ligament
to the styloid process is, in some  rare instances, ossified to a con-
siderable extent, which  produces  difficulty in swallowing and  in
talking. 
188                       SKELETON.
                       CHAPTER V.

               Of  the Upper Extremities.

  This portion of the skeleton is divided on either side of the body,
into shoulder, arm, fore arm, and hand.


               SECT. I.—OF THE SHOULDER.

  The shoulder consists of two bones, the clavicle and the scapula,
and occupies the superior,lateral, and posterior part of the thorax.
Its shape and position  are  such, that it augments considerably the
transverse diameter of the upper  part of  the trunk, taken as a
whole: while  the thorax alone, at this  place, is actually smaller
than it is below.  The  clavicle is longer, in  proportion, in  the
female than in  the male,  which increases in her the  transverse ex-
tent of the shoulder, and gives a greater space on the front of the tho-
rax for the development of the mammae.   This coincidence between
the length of the shoulder and the development of the mamma, has
been particularly  noticed by Bichat, who  says  that it is  almost
always well marked, that very rarely a voluminous bosom reposes
on a small pectoral space,  or a small bosom is found upon a large
pectoral space.  In the male, on the contrary, this diameter of the
trunk is increased principally by the breadth of the scapula, which,
from its position on the thorax, and its great size, gives the bulky
appearance to  this part.   It is evident that these modifications in
the frame-work of the shoulders, are connected with the natural
destinations of the two sexes.   In woman the  length  of the clavicle
is adverse to its strength, and it is indistinctly marked by muscular
connexipns; whereas, in man it  is short, strongly marked, and
large.  Anatomists who are  fond of extending such comparisons,
say,  also, very justly, that the pubes, which perform the same
office for the lower extremities that the clavicles do for the upper,
that of keeping the two apart, are, in the female, both smaller and
longer than in  the male; that their shape is  not so favourable to
strength  or  locomotion, and  has  a special view  towards  the
lodgement of the genital organs, and to  the passage of the child.
In man the increased size of the whole  skeleton, and the greater 
THE SHOULDERS.
189
development of the muscular system, indicate that he was intended
for more laborious exertion than the female.
  The thorax and the shoulder are connected by a  reciprocal de-
velopment, both being indicative, when large, of a  robust and vi-
gorous constitution;  and when small, of a weakly  one.  As both
of these parts are acted on  by the same muscles, the necessity of
this coincidence is sufficiently apparent.  The height  of the shoulder
depends upon the scapula  alone; its elevation, therefore, is greater
in males and in vigorous persons generally, than in  females and in
weakly individuals.  The  direction of the shoulder is such, that the
articular face of the scapula for the os humeri, looks outwards, there-
by proving that the quadruped position in man is unnatural; for by
it, the weight of the fore part of the trunk is directed upon the back
part of the capsular ligament of the joint instead of upon the gle-
noid  cavity, as in quadrupeds.  This, and  many  other  circum-
stances, prove that the natural  intention  of -the  upper extremities
in the human subject, is to seize upon objects, and not to maintain
the horizontal  position.


           Of the Shoulder Blade, (Scapula, Omoplate.)

   The Scapula is placed  upon the posterior superior part of the
thorax, and extends from  the second to the seventh rib inclusively;
its posterior  edge is nearly parallel with the spinous processes of
the vertebrae, and not far  from them.
   Its general form is triangular.   It therefore presents two faces,
of which one is anterior,  and the other posterior,—three edges, of
which one is superior,  another  external, and  the third internal or
posterior—and three angles, of which one is superior, another in-
ferior, and the third exterior or anterior.
   The posterior face of the scapula is called its dorsum; is  some-
what convex, when taken.as a  whole; and is unequally divided by
its spine into two surfaces or cavities, of which the  lower is twice
or three times as large as the upper.  The spine is a very large
process that begins at the  posterior edge of the  bone, by a  small
triangular  face;  rapidly  increases in its elevation, and  running
obliquely towards the anterior angle, ceases somewhat short of it;
it is then elongated forwards and upwards, so as to overhang the
shoulder joint, and to  form the acromion  process.  The cavity 
190
SKELETON.
above the spine is owing principally to the elevation of the latter,
and is called the fossa supra-spinata;  it is occupied by the supra-
spinatus  muscle.   The  cavity below the spine  is the fossa infra-
spinata, and is for the infra-spinatus  muscle: it  is bounded below
by a rising  of the external  margin of the bone.  The middle of
this fossa presents a swell or convexity, which is a portion of the
general convexity presented by the  posterior face of the  bone.
The spine of the scapula is always prominent in the outline of the
shoulder, and has a well secured  base along  the whole of its at-
tachment to the bone, to where it terminates in the acromion pro-
cess.   It  leans upwards, and from  the  increased breadth  of  its
summit, is concave both above and below.   The summit itself is
somewhat rough, and  has  inserted into its superior margin the
trapezius muscle, while  the inferior margin gives origin to the del-
toid.   The little triangular face at the commencement of the spine
is made by the tendon of  the trapezius muscle gliding over it.
The acromion process arises from the spine by a narrow neck, is
triangular, nearly horizontal,  and overhangs  the  glenoid  cavity,
being elevated about one inch above it.  It  is slightly convex
above and concave below:  the external  and the internal margins
are the longest.   The posterior margin is continuous with the in-
ferior edge of the spine of  the scapula; and the internal is  on a
level with the clavicle.  At the fore extremity of the internal mar-
gin, is a small, oval, articular face, by which  the acromion unites
with the clavicle.  The margins of the acromion, with the excep-
tion of the internal, are rough, and give  origin  to  the  deltoid
muscle.

   The anterior or costal  face of the scapula is concave, and  ob-
tains the name of the sub-scapular fossa or the venter.   It is occu-
pied by the sub-scapular muscle; the divisions of which, by leaving
deep inierstices between them, produce corresponding ridges upon
the  bone, that run obliquely upwards and outwards.   Along  the
 whole posterior margin of this face of the scapula, is inserted the
 serratus major anticus.

   The posterior  or vertebral margin  of the scapula is the longest
 of the three, and is called the base.   It is  not perfectly straight,
 but somewhat rounded, especially above the spinous process; and
 has there varied  degrees of  obliquity in different persons.  This 
THE SHOULDERS.
191
margin, below the spine, receives the rhomboideus major muscle,
and above the spine, the levator scapulae;  at  the part between the
other two, the rhomboideus minor is inserted.

  The external or axillary margin  of the scapula, also called the
inferior costa, is  much the thickest of the three.   A superficial
fossa placed somewhat posteriorly,  forming the inferior boundary
of the fossa infra-spinata, begins about two inches from its inferior
extremity, and running up to the neck of the bone, lodges the teres
minor muscle.  On the exterior face of the inferior angle is a flat
surface, from which the teres major muscle and a slip of the latis-
simus dorsi arise.  At  the  fore part of this surface the inferior
costa is elongated into a kind of process.  Just below the glenoid
cavity is a small ridge for the origin of the long head of the tri-
ceps muscle.

   The  superior margin or costa of the scapula, is the shortest and
thinnest of the three, and is terminated  in front by the coracoid
notch betweert it and  the coracoid process.   The  notch is con-
verted  into a hole by a ligament,  in the living state, and through
it pass  the upper scapular nerve and blood vessels.

   The  glenoid cavity for articulating with the  os humeri, supplies
the place of the anterior angle of the scapula.   It is very superfi-
cial, and ovoidal, with  the small end upwards.  Just at the upper
end is a small flat surface, from which the long head of the  biceps
arises.  The glenoid cavity is fixed on the neck or cervix, as it is
called,  at which  a general increase in the thickness of the bone
occurs, in  order to give a strong foundation to  this cavity.   From
the superior part of the  cervix arises the coracoid process, the
base of it being bounded in front by the glenoid cavity, and behind
by the  coracoid notch.  The base rises upwards and inwards for
half an inch, and what remains of  the process, then, runs horizon-
tally inwards and forwards, to  become  smaller,  and terminate in
 a point.  This point is advanced beyond the glenoid cavity, about
 an inch from its  internal margin.   The upper surface of the cora-
 coid process is rough and undulated; below it is concave, forming
 an arch under which passes the sub-scapularis  muscle.   On the
 clavicular side of its base is a  tuberosity, from which arises the
 conoidal ligament.   The extremity is marked by three surfaces: 
192
SKELETON.
tjie interior is for the insertion of the pectoralis minor, the middle
for the origin of the coraco-brachialis, and the external for that of
the short head of the biceps.  The acromial margin  of  the cora-
coid process  gives origin to the triangular ligament of the scapula,
which is inserted into  the acromion just below the face for the
clavicle.
   The scapula is composed of cellular and compact substance.
The two laminae  of  the latter are in contact in  the  fossa supra-
spinata, and  infra-spinata; from which cause the bone is diapha-
nous at these points.


             Of the Clavicle, (Clavicula, Clavicule.)

   The Clavicle is a long bone, situated transversely  at the upper
front part of  the  thorax, and extends from the  superior extremity
of the sternum to the acromion of the  scapula.   It is cylindrical
in its middle  third, flattened at its  external, and  prismatic or tri-
angular at  its sternal extremity.   Besides being shorter, it is more
crooked and  robust in  man than  in woman, and different indivi-
duals present it  under considerable varieties of curvature.  The
sternal two-thirds of it  are convex in front, and  concave behind,
while the humeral third is concave in  front, and convex behind :
this double curvature induces anatomists to compare it  with the
letter S, though it is  by  no  means so crooked.
   We have to consider  its  superior and inferior face, its anterior
and posterior edge,  and the two  extremities.  The superior face
is smooth, and does not  present any marks of importance except-
ing a depression near the  sternum, for the origin of the  sterno-
cleido mastoid muscle.  The inferior face, near  the  sternal end,
has a rough  surface, to which is  attached the  costo-clavicular or
rhomboid ligament: about fifteen lines from the humeral extremity
is a rough  tubercle for the  attachment of  the coraco-clavicular or
conoid ligament.  Between the two ends, a superficial fossa is
extended for  lodging the sub-clavius muscle.  The sternal two-
thirds of the anterior margin are marked by the origin of the pec-
toralis major; it is there thick: the other part of this margin is
thinner, and  gives origin  to the  deltoid  muscle.   The  posterior
margin  presents, near its middle, one or more foramina  for the
nutritious vessels.  The triangular  internal end of the clavicle is 
THE ARM.
193
unequal where it joins the sternum, and is elongated considerably
at its posterior inferior corner.   The  external flat end presents at
its extremity  a small oval face, corresponding  with  that on  the
acromion scapulae.
   This bone is very strong from the  abundance of its condensed
lamellated structure; but, like other round bones, the cellular mat-
ter predominates at its extremities.


     sect. n.—of the arm,  (Os Humeri, TJ Humerus.)

   The arm extends from the shoulder to  the elbow,  and has but
one  bone in it, the os humeri.  The latter, in its general appear-
ance, is cylindrical, with an enlargement of both extremities;  the
superior end presents a general swell,  while the inferior is flattened
out.
   The superior extremity of the os humeri, which is also  called its
head, is very regularly hemispherical,  and  has its axis directed ob-
liquely upwards and backwards, to apply  itself with more facility
to the glenoid cavity of the scapula.   The base on which the head
reposes is termed neck, it is not more than four or five lines long,
and  is marked off by a  superficial  furrow, surrounding the bone.
This furrow is more conspicuous  above, where it separates  the
head from two knobs called the tuberosities.
   One of these tuberosities, the external, being placed beneath the
acromion scapulas, is much larger than the other, and bears on its
upper face the marks of the tendinous insertion of three muscles.
The most internal mark  is for the supra-spinatus scapulae, the mid-
dle for the infra-spinatus, and  the  external,  or  posterior, for  the
teres minor.   The smaller tuberosity is internal, and  placed on a
line with the coracoid process;  it has  but one mark, and that is on
its upper face, for the  tendinous insertion of the  sub-scapularis
muscle.  The  two tuberosities  are  separated by a  deep  fossa,
named bicipital, from its  lodging the tendon of the long head of the
biceps muscle.  This  fossa is  continued, faintly, for some  inches
down the os humeri; its lower  part being  bounded, externally, by
a rough ridge, indicating the insertion of the pectoralis major, and
internally by another ridge, not quite so strong or rough, indicating
the insertion of the teres major  and latissimus dorsi.
  Vol. I.—17 
 194                       SKELETON.

   The body of the os humeri is the part extended between its ex-
 tremities.  The superior half presents a more cylindrical appear-
 ance than the inferior, which is rather triangular.  On the middle
 of the bone, externally, two inches below the insertion of the pec-
 toralis major, exists a triangular elevation into which  the deltoid
 muscle is inserted.   At the internal margin of the bone, and on a
 transverse level with the latter, is the insertion of the coracobra-
 chialis muscle; and between the two is the orifice of the canal for
 the nutritious artery.  The  front of the os humeri, in its lower
 half, is flattened on each  side  down to  its inferior end;  on these
 surfaces  is placed the  brachialis internus muscle.  On a line with
 the posterior end of the greater tuberosity, and a little below it, an
 elevation is  formed  for the origin of the second head of the triceps
 extensor cubiti.  The  posterior face of  the  bone is flattened from
 this point down to its lower extremity, and accommodates the last
 named muscle.

  The articular surface for the elbow joint is very irregularly cylin-
 drical.   The part that joins the radius,  presents itself  as a small
 hemispherical head, placed on  the front  of the bone, and with its
 axis looking forwards.  Just above it, in front, is a small depres-
 sion for the  head of the radius  in its flexions.  The surface which
 articulates with  the ulna, is more cylindrical, but still irregularly
 so; for its middle is depressed, while the sides are elevated:  the
 internal side is much broader and more elevated than the external.
 The lesser sigmoid  cavity is just above the front of the ulnar arti-
 cular surface, and  receives  the  coronoid process.  The greater
 sigmoid  cavity is in a corresponding place behind, and receives
the olecranon  process : the bone  where it separates these cavities
 is very thin: sometimes it is even deficient.

  The external condyle is just  above the radial articular surface;
 it is continuous with a ridge of three or four inches long, forming
the external margin of the bone, and from it, and the ridge toge-
ther, arise the extensor muscles of the fore  arm and  hand.  The
 ridge, itself,  is bounded, above,  by a small spiral fossa, descending
 downwards  and forwards, made by the spiral artery and the mus-
 cular spiral nerve.   The internal condyle is placed  just above the
 internal  margin of  the ulnar articular surface: it  is much more 
THE FORE ARM.
195
 prominent and distinct than the external, and may be  readily felt
 beneath the skin.  A ridge also leads from it and extends upwards
 as high as the insertion of the coracobrachialis, but  it is by no
 means so elevated as the external ridge, though  it  is much longer.
 From the  internal  condyle, and the adjoining part of the ridge,
 arise the flexor muscles of the hand and fore arm.

   The os humeri is composed of  compact  and cancellated sub-
 stance ; the latter predominates at the extremities,  and  the  former
 in the body.


               SECT. III.---OF THE FORE  ARM.

   The fore arm is placed between the arm and the hand, and con-
 sists in two straight bones, the Ulna and the Radius, of which the
 former is on the  side of the little finger, and the latter on that of
 the thumb.

                     Of the Ulna, (Cubitus.)

   The ulna, though  nearly straight, is  not wholly so.  It is much
 larger at the upper than at the lower extremity, and in  its general
 features is triangular.  It has to be considered in its humeral and
 carpal extremities, and in its body.

   The humeral, or upper extremity, presents the  olecranon  pro-
 cess at its termination; the  coronoid a  little  below and in  front;
 the greater sigmoid cavity between the two; and the lesser sigmoid
 on the radial surface of the coronoid.

  The olecranon  process is rough on its upper face,  for the inser-
 tion of the triceps muscle, and terminates in front in  a sharp edge
 and point, which  are  received into the  greater sigmoid cavity of
 the 6s humeri.  The coronoid process is a triangular sharp ridge,
 much elevated, and having a large base; on the lower front of the
 latter is a roughness for  the  insertion  of the brachialis internus
 muscle.   The greater sigmoid  cavity forms all the articular sur-
face between the margins of  the two  processes.   It is divided,
transversely,  at  its  bottom,  by a  superficial roughness, which 
 196                       SKELETON.

 distinguishes  the olecranon from the coronoid  portion of it.   Be-
 sides  which,  a rising  exists  in its vertical  length, which is re-
 ceived into the  corresponding depression of the os humeri.   The
 lesser sigmoid cavity has  its  surface continuous with  that of the
 greater, and presents itself as a small semi-cylindrical concavity,
 for articulating with  the side  of the  head of the radius.  A small
 fossa, for fatty matter exists just above it, and below is a triangu-
 lar excavation affording space to the tubercle of the radius.

   The carpal, or lower extremity of the ulna, presents, on the side
 of the little finger, a  process of variable  length, the  styloid, from
 which  arises  the  internal  lateral ligament of the wrist.  At  the
 radial side of this process  is an  articular face or small head, one
 surface of which looks towards the wrist, and the other is in con-
 tact with the  radius,  being semicylindrical.   On  the back of  the
 ulna, between the styloid process and this head, is a groove for a
 passage of the extensor carpi  ulnaris.

   The body of the  ulna  is triangular,  in  consequence of three
 ridges, which extend  from the  brachial to the carpal  extremity.
 The first or most prominent of  these ridges  is on its radial sider
 and, beginning at the posterior end of the lesser sigmoid cavity,
 continues very distinct  almost to the lower end;  it then, however,
 gradually subsides.  From it arises the interosseal ligament.  The
 supinator radii brevis muscle,  also arises from its beginning for the
 distance of a couple of  inches.   Within this ridge, on the anterior
 or palmar face of the bone, is a second, more rounded, which,  be-
 ginning at the internal  margin  of the  coronoid  process, extends
 down to the styloid process.   For the greater part of its length it
 gives origin to the flexor profundus digitorum, but just above the
 carpus, the  pronator  quadratus  arises from  it.   The third ridge
 begins at the external margin of the olecranon,  and runs in a ser-
 pentine way to the inferior end of  the ulna, but becomes almost
 indistinct at its lower part. To  the upper fourth of this ridge, is
 attached the anconeus muscle, which reposes in a hollow between
 it  and the beginning of the  first mentioned ridge.   On the posterior
 surface of the bone, just below the olecranon, is a triangular face
 an inch and a-half long on which  we lean, and which is  placed
just under the  skin, it  may, therefore, be readily felt in  the living
 body, 
THE FORE ARM.
197
    The three  ridges of the ulna divide it  into as many surfaces,
  which are each  modified  by the muscles  lying upon them.  The
  anterior surface  presents, just above the middle of the bone, the
  canal for the nutritious artery, running obliquely upwards.

    The  body of  the ulna is compact, the extremities, and more
  abundantly the upper,  are cellular.


                     Of the Radius, (Radius.)

    The radius  is  shorter than the ulna, is  placed  on its external
  side, and extends from the  os humeri to the wrist.  It is smaller
  at the  humeral than at the carpal extremity, and though  nearly
  straight is somewhat convex outwardly.  It is to be considered in
  its extremities and body.

    The superior or humeral extremity presents a cylindrical head,
  which bears all around it the marks of a cartilaginous incrustation,
  broader on the ulnar than  on the other  side.  The  broader part
 plays in the lesser sigmoid cavity of the ulna, while the other is in
 contact with the annular ligament.  A superficial fossa also exists
 on the upper surface of this head, which receives the convexity of
 the articular face of the external condyle of the os humeri.* The
 head of the radius is placed upon a narrow part called the neck,
 of about half an inch in length.  Immediately below the neck, on
 the ulnar side, is  a  rough protuberance or  tubercle, the bicipital,
 for the insertion of the biceps flexor cubiti.

   The lower or carpal extremity of the bone, is augmented con-
 siderably in volume, and is flattened out transversely.  The carpal
 surface  presents a long  superficial cavity, it is bounded  externally
 by the styloid  process,  from which proceeds  the external lateral
 ligament;  and  ends on  its ulnar side, by a small cylindrical con-
 cavity, for receiving the  lower end of the  ulna.  The  former  or
 superficial cavity is divided  into two by a slight ridge in its short
 diameter;  the division next the styloid process receives  the  scap-
 hoid bone, and the other the os lunare.  At this extremity also a
ridge exists on the front  of the bone for forming the margin of the
articular face, and giving  origin to the capsular ligament.  The
                              17* 
198
SKELETON.
 posterior and external faces of the  bone, here, are  rendered  irre-
 gular by several grooves and  ridges.  The large  groove next to
 the cylindrical concavity for the ulna, transmits the tendons of the
 extensor communis digitorum and indicator, also the tendon of the
 extensor major pollicis, which forms a channel somewhat distinct,
 and on the styloid side of the groove.  Next to this is another large
 groove for the tendons of the  extensor carpi radialis brevior and
 longior; and on the styloid side of the radius is  the third groove
 for transmitting  the tendon of  the extensor minor pollicis, and of
 the extensor ossis metacarpi  pollicis.   The anterior  margin of this
 groove is formed  by a small spine or ridge, into which is inserted
 the tendon of the supinator radii longus.

   The body of-the radius is somewhat triangular, and therefore
 presents three  ridges.   One, on its  ulnar side, extends from the
 bicipital protuberance to the lower end,  and gives origin to the
 interosseous ligament: it is sharp and well marked.  Another, on
 the outer or styloid margin of the bone, also begins at the bicipital
 protuberance, and terminates in the  styloid process.  The upper
 part of this ridge is curved, has the supinator brevis inserted into
 it, and a portion  of the flexor digitorum sublimis arising from it;
 at its# lower part the pronator  quadratus is inserted.   The  third
 ridge is on the posterior  face of the radius, and, arising insensibly
 from  below its neck, is principally conspicuous in the middle third
 of the bone: it rups down, however, to the carpal extremity, and,
 becoming more prominent there, separates the two larger grooves
 from  each other.  This  ridge is shorter, and  not so elevated as
 the other two.
  These three ridges form as many surfaces to the radius, of which
 the anterior augmenting gradually in its descent, affords attach-
 ment  to the flexor longus pollicis above, and to the  pronator qua-
dratus below; at its. upper part is a canal, slanting upwards, for
the nutritious artery.  The posterior surface  has the extensor mus-
cles of the thumb and the indicator  lying upon it.   The external
surface presents a roughness, just above its  middle, for the inser-
tion of the pronator teres; and  below it  is  covered  by the radial
extensors, which are  crossed by the extensor metacarpi pollicis
and the extensor minor.
  The body of the radius is compact; its extremities are cellular. 
THE HAND.                      199
                 SECT. IV.—OF THE HAND.

  The hand consists of the carpus, metacarpus, and phalanges, and
has in its composition twenty-seven  bones, to which number may
be added the two sesamoids.


                   Of the Carpus,  (Carpe.)

  The carpus, or wrist, is next to the bones of the fore arm.  Eight
bones compose it, which  are arranged into two rows, one adjoin-
ing the fore arm, and the other the  metacarpus:—they are called
first and second rows.  These bones present very diversified forms,
and a number of articular faces, which render them difficult to be
distinguished  from each  other.
  The first or antebrachial row has in it the os scaphoides, lunare,
cuneiforme, pisiforme.   The second or metacarpal  row has in it
the os trapezium, trapezoides, magnum, and unciforme.


                Of the Scaphoides,  (Scaphoide.)

  This bone is on the styloid half of the end of the radius, and is
distinguishable in  a  set  by its greater length.  It is convex above
and concave  below..  The convexity forms only a half of its upper
surface, the other half being rough, and making a knob  at its ex-
tremity-  The concavity on the lower surface is large enough to
receive the end of a  finger.  Between the concavity and the con-
vexity, and on the dorsal surface of  the bone, at its outer end, is a
second convexity, of an oblong shape.  Between  the two convex-
ities is a  small fossa  for the capsular  ligament.   The palmar, or
anterior face,  shows a crook in the bone.  The knobbed extremity
projects  beyond the styloid process of the radius.   The  other ex-
tremity, which is narrow, joins the os lunare.


                 Of the Lunare, (Semilunars)

  This bone is at the ulnar side of the preceding,  and may be dis-
tinguished by  the semi-lunated shape of  the surface joinino- the
scaphoides.  Its upper surface  is convex where it articulates with 
200
SKELETON.
 the radius; the lower face is concavely cylindrical.  The ulnar
 side is a  plain surface which joins the os  cuneiforme.   Its dorsal
 side is rather thinner than its palmar.


          Of the Cuneiforme or Pyramidale, (Pyramidal.)

   This bone  is placed at the ulnar side of the  last, and  may be
 distinguished  by its  representing somewhat a triangular pyramid.
 The surface  next the lunare is plane, but  the  other  extremity,
 being the boundary of the wrist in that  direction, is rough.  Above,
 it presents a small convexity, adjoining the surface for the lunare,
 whereby  it enters partially into  the upper wrist joint.  Its  inferior
 surface is concavo-convex, the convexity being towards the ulnar
 end.  On its  palmar side it presents a circular  plane surface for
 the os pisiforme.

                 Of the Pisiforme, {Pisiforme.)

   This bone is placed on the front or palmar surface of the last,
 and may be distinguished by its being  smaller than  any other in
 the  carpus, by its  spheroidal shape, and by its presenting but one
 articular face, which corresponds with one on the cuneiforme.  It
 is always so prominent as to be felt, without difficulty, at  the ulnar
 extremity of the wrist, and is very moveable.


                 Of the Trapezium, (Trapeze.)

   This bone is placed at the radial end of  the  second  row; its
 shape is exceedingly irregular, but it may be generally distinguished
 by being  a bone of the third magnitude as regards the second row.
 It is better for the student to find out first the surface by  which it
 articulates with  the  metacarpal  bone of the thumb, which  he can
 do in a short time   by a  comparison of the surfaces of the two
 bones. This being successful, will establish a clew to the other
 surfaces,  and to the relative position of the bone.  The thumb sur-
face is a concave cylindrical trochlea, placed on the radial  side of
the trapezium, and looking  downwards and outwards.  On the
reversed  or  upper side is a small concavity, which receives the
dorsal convexity of the scaphoid  bone.   Continuous with this con-
cavity is another on the ulnar side, which receives  a corresponding 
THE HAND.
201
convexity of the trapezoides.   Between this concavity and the one
for the thumb is a small plane surface, by which  the  trapezium
articulates partially with the  metacarpal bone of the fore finger.
The dorsal face is rough and unequal.  The palmar face is un-
equally divided  by a  high ridge or process, at the ulnar side of
whose root is  a deep fossa  for  the  tendon of the flexor  carpi
radialis.

                Of the Trapezoides, (Trapezoide.)

   It is placed at the ulnar side of the last bone, and is the smallest
in the second row.  There  is no liability of  confounding it with
any  other bone of the carpus, as it is the least of any, excepting
the pisiforme.  The greater difficulty is the adjustment of it  in the
separated bones:  the following rule, however, will serve.   It is
surrounded by articular faces on its sides, but the dorsal surface
presents  a broad base,, while  the palmar extremity is  reduced in
size.  Holding the bone with a reference to  these, it will be ob-
served that one side  is very crooked and concave, while the re-
versed or opposite one is convex.  The latter  fits against the sur-
face of the trapezium which  has been indicated, while the former
embraces the side of  the os  magnum  just below its head.   The
metacarpal surface of the trapezoides  is long and  elevated in  its
middle for being received into the root of the  metacarpal bone of
the fore finger, while  the upper surface presents  a long concavity
for receiving a part of the dorsal convexity of the scaphoides.


                  Of the Magnum, (Grand Os.)

   It is placed at the ulnar side of the  trapezoides, and, from  its
being larger than any other  bone in the  carpus, will scarcely be
mistaken.  Its ulnar side is  flat, and presents  a plane  surface for
articulating with the unciforme.  The  radial  side is  uneven and
rather indistinctly marked where it joins the trapezoides, but the
latter surface will be found near the middle of this side just below
the head.   The  upper surface of the magnum is  formed into a
spherical head, the radial side of which reposes in the concavity
of the scaphoides, while the ulnar side is in  the concavity of the
lunare.   Its metacarpal surface is triangular, convex, and winding,
by which it joins the metacarpal bone  of the  middle finger.  On 
202
SKELETON.
the radial side of this surface is  a small one continuous with  it,
whereby the magnum articulates partially with the metacarpal
bone of the fore finger.   The posterior  or dorsal face  is  broad,
while the palmar is more narrow.


                Of the Unciforme, (Os Crochu.)

  It is placed at the  ulnar side of the magnum, is nearly of the
same size, but readily distinguishable from it by its long crooked
process as well as by its peculiar shape.   Its radial side is plane
where it joins the magnum;  the reversed or ulnar side is brought
to a thin edge.   The metacarpal surface presents two distinct  con-
cavities ; the one next to the ulnar edge is for the metacarpal bone
of the little finger, and the other for that of the ring finger.   The
upper  surface is convex  and winding, having its ulnar margin
almost touching  the  surface  of the metacarpal bone of  the  little
finger.  The most considerable portion of the upper surface re-
poses upon the cuneiform, and the remainder upon a part of the
concavity of the lunare.   The posterior face is broad and  rough,
while the palmar is narrower.  From the ulnar side of the latter,
projects the unciforme process already alluded to.
  The two ranges of carpal bones, thus shaped, present, when ar-
ticulated or united together, an oblong body, the greatest diameter
of which is transverse.   Its posterior face is semi-cylindrical and
arched, while the anterior face is  concave for the passing of the
flexor tendons.   Two protuberances are found on each extremity
of the palmar surface.  Those at the ulnar end are the pisiforme,
and the unciform process of the unciforme; those at the radial end
are the protuberance at the radial  end of the  scaphoides and  the
sort of unciform process  from the  trapezium  bounding the radial
margin of its groove.  These several prominences may, with a
little  attention, be readily distinguished  beneath the skin.   The
superior face of the carpus, which articulates  with  the lower end
of the radius and ulna, presents an  oblong  convex head formed by
the scaphoides, the lunare, and very partially  by the  cuneiforme.
The inferior face of the carpus presents a very diversified surface,
subdivided into five distinct ones, each of which is fashioned ac- 
THE HAND.
203
cording to the shape of the metacarpal bone with which it has to
articulate.

  The central joint of the wrist, formed between the two rows of
bones, is very deserving of attention.  The first row is convex on
its radial end, the convexity being formed  on one half of the sca-
phoides : to the ulnar side of this there is a deep concavity formed
by the other half of the scaphoides,—by the lunare and the cunei-
forme.   The upper surface of the second row fits very accurately
upon the lower surface of the first:  its radial end is, therefore, a
concavity formed by the trapezium and  trapezoides, which  re-
ceives the convexity of the scaphoid; then a very large prominent
head is formed by the magnum and unciforme, and received into
the  concavity of the first row.  The magnum reposes upon the
scaphoides and  part of the lunare, the  unciforme upon  the  re-
mainder of the  lunare, and the whole  of the  cuneiforme.  The
carpal bones consist of cellular matter enclosed by condensed la-
mellated substance.

                      Of the Metacarpus.

   The metacarpus, is situated  between the carpus and  the pha-
langes of the fingers and thumb.  It consists of five bones, one for
the thumb and one for  each finger.  The  latter are parallel or
nearly so with each other; but the first diverges considerably, and
is so placed as to traverse the others  in front during its motions.
These bones are rounded in their middle, are enlarged at their ex-
tremities, and are bent so as to be concave on the anterior face,
and convex behind.   Their sides are impressed by the intervening
muscles.  That  of the thumb is the shortest, the others decrease
successively in length from the  fore to the little finger.

   Of the First  Metacarpal Bone, or  that  of the Thumb.—It is
placed upon the  trapezium:  and besides being the shortest, is also
the thickest of any.  Its upper end is semi-cylindrical and slightly
concave from side to side, to present a fit surface to the trapezium.
Its lower end  is  slightly convex, and elongated  in front into  a tro-
chlea, on either side of which reposes a sesamoid bone.  The pos-
terior face  of its body is flat and very slightly bent; the anterior is
concave in its length, and is divided into two surfaces by a middle 
204
SKELETON.
ridge.   A roughness exists on either side, at its lower end, for the
attachment of the lateral ligament.

   Of the Second Metacarpal Bone, or  that of the  Fore Finger.—
The greater length of this bone gives it  a distinctive character.
It is placed upon the trapezoides, and articulates laterally also with
the trapezium and the magnum.  Its carpal or upper end presents,
in the middle, a deep concavity for  receiving the trapezoides, at
the radial side of which is a small plane face for articulating with
the trapezium, and at the ulnar side  an oblong surface, the upper
margin  of which joins the  magnum, and the remainder is in con-
tact with the third  metacarpal bone.  The lower end presents  a
convex  head extended in front to concur in the flexion of the fin-
ger, on  each side of which head is a  concave rough surface for
the lateral ligament.  The posterior face  of the bone presents  a
triangular flat surface, the  base of which  is towards the finger or
phalangial end.  The palmar face is concave, longitudinally, and
divided  by a middle  ridge, into  two surfaces, each of which is
compressed by the interosseous muscles.   A tubercle exists on the
back of the  bone just below its carpal  end for the insertion of the
tendon of the extensor carpi longior, and another in front  for that
of the flexor radialis.

   Of the Third Metacarpal Bone.—This  is a  little shorter than
the last, and is nearly of  the same size, but its carpal extremity is
very different.  The latter is triangular, and is bounded on its ra-
dial side by  a sort of styloid process, with  a tubercle on the poste-
rior face of  it, into  which the tendon of the extensor radialis bre-
vior is inserted.  It is placed upon the  magnum, to which  it joins
by a slightly concave, winding  surface.  It also  presents, conti-
nuous with the same surface, an oblong face which joins  the  se-
cond metacarpal bone, and, on the reversed side, two round facets,
which are contiguous to  the fourth  metacarpal bone.   In regard
to its lower or phalangial extremity and body, this bone resembles
closely the one  last  described.

   Of the Fourth Metacarpal Bone.—This  bone is placed upon the
unciforme, and  has a very small articulating surface with the mag-
num : it is much smaller and shorter than the  third  metacarpal,
and readily  distinguishable by these circumstances.   The carpal 
THE HAND.
205
 surface, by which it joins the unciforme, is triangular and slightly
 convex; its radial edge touches  the  magnum.  Continuous with
 this edge are two small faces, slightly convex, which join the con-
 tiguous faces of the third metacarpal bone.  On the  reversed side
 of the fourth metacarpal is an oblong face which joins the carpal
 end of the fifth metacarpal bone.   In regard to its body and phalan-
 gial extremity, this bone resembles the two preceding, and there-
 fore does not require a particular  description.

   Of the Fifth Metacarpal Bone.—It is placed upon the unciforme
 exterior to the last, and is both smaller and shorter than the fourth.
 The carpal  extremity presents a cylindroid and slightly convex
 face, for articulating with the  unciforme, at the radial margin of
 which is an oblong  facet, for joining  the fourth metacarpal:  just
 below the outer margin is a small  tuberosity, into which is inserted
 the tendon  of the extensor ulnaris.  The lower or phalangial  ex-
 tremity, like that of the  others, presents a convex  articular face,
 extended in front for the flexion of the first phalanx.  The body
 also corresponds with that of the  others, excepting that it is more
 flat in front.

                       Of the Phalanges.

   The fingers are named numerically/beginning at the fore finger;
 they are also named from their functions, as Indicator, Impudicus,
 Annularis, and Auricularis.
   Each finger has three bones in it,  called its phalanges: the bone
 adjoining the metacarpus is the first phalanx, the middle  bone is
 the second, and the other the third.

   The first  phalanx is the largest.  Its  posterior face is semi-cylin-
 drical, the anterior  face is  flattened and  concave in its  length.
 The two surfaces run into each other by forming a ridge on either
 side, from which arises the theca of  the flexor tendons.  The me-
 tacarpal extremity is enlarged, and presents a superficial  cavity,
 which receives the end of the metacarpal bone.  On either side of
 this end of the bone is  a small tuber for the lateral ligament.  The
lower extremity is also enlarged  and  flattened at  its sides.  Its
articular face is extended in front, and presents two condyles,  or
small heads, for joining the second phalanx.
  Vol. I.—18 
206
SKELETON.
   The second phalanx is likewise second in size and length.  It is
semi-cylindrical on  its posterior face, flattened on  its anterior,
which is somewhat  concave in its length, and  the two surfaces
form a  ridge, on either side, into which the tendon of the flexor
sublimis is inserted, and from, which arises the theca of the flexor
tendons.  Its extremities are slightly enlarged:  the articular face
of the upper presents two superficial cavities  for the condyles of
the first phalanx:  the articular face  of the lower  extremity pre-
sents a trochlea, with a slight elevation  at each side.

   The third phalanx is the smallest of the three, and is very diffe-
rent from the others.  Its superior extremity  being enlarged, pre-
sents an articular face, having two  superficial cavities, which ad-
just themselves to the corresponding face of the last described bone.
The inferior extremity is semicircular, thin, and flattened, its mar-
gin being very rough, and  somewhat  expanded.   The posterior
face of the body is convex, and the anterior flat.

   The phalanges of the middle finger (Impudicus) are larger and
longer than the others.  The phalanges  of the fore finger (Indica-
tor) are next in size, but not in  length, as the  ring finger is rather
longer than it.   The phalanges of the ring finger (Annularis) are
next in size, and those of the little finger (Auricularis) the smallest
and shortest of any.
  The thumb (Pollex) having but  two  phalanges, the first corre-
sponds sufficiently in its general form  with the first one of  the fin-
gers: it may be distinguished, however, by its shortness  and addi-
tional size.   The second phalanx of the thumb, corresponding with
the third of the  fingers, is only to be distinguished by its additional
bulk and length.
  All the metacarpal and phalangial bones  have  condensed lamel-
lated structure externally, and  a cancellated one internally: and,
like other  bones, are more compact in  their  bodies than  at their
extremities.
  There are two small hemispherical bones, called sesamoid, placed
upon the trochlea, at  the lower extremity of the metacarpal bone
of the thumb.   They answer the purposes of patellae, and facilitate
the action of the short flexor muscle.   The metacarpal bones of
some of the fingers are, in robust individuals, occasionally furnished
in the same way. 
DEVELOPMENT OF THE UPPER EXTREMITIES.
207
SECT.  V.—OF THE  DEVELOPMENT OF  THE UPPER EXTRE-
                           MITIES.

  At birth  the upper extremities  are larger in proportion to the
lower than they are at  any subsequent  period of life, owing, per-
haps, to the umbilical arteries, which carry off to the  placenta of
the mother the greater part of the blood which afterwards goes to
the lower extremities.   The nearer a foetus may be to  the embryo
state, the more marked is this relative size of the extremities, which
becomes gradually less obvious  till the age of puberty, when  it
almost entirely disappears.
   At birth, the ends of the clavicles are, in consequence of their
advanced ossification, much less cartilaginous than those of the
other cylindrical bones.   Its shape, also, approaches nearly to that
of the adult state.
   The scapula is also  in  an  advanced stage of ossification, and
large.  The glenoid cavity, though  still cartilaginous, is well sus-
tained by a bony basement coming from the central point of ossifi-
cation of the scapula, and is much  farther ossified than the aceta-
bulum.   The  acromion, the coracoid process, and the angles, are
still cartilaginous.
   The os humeri  is cartilaginous at both extremities, which are
also larger, proportionally, in consequence of this state.   Its infe-
rior extremity is remarkable for the  size of that portion of it which
articulates with the radius.
   In the fore arm the extremities of its bones are cartilaginous.
The ulna has the olecranon large, while  its coronoid process  is
comparatively small; the greater sigmoid  cavity is, consequently,
not so concave as in  the adult.   The position of the radius, at its
upper end, is somewhat peculiar, for it is much more anterior than
in the adult;  a circumstance  depending upon  the greater size of
the little head of the humerus, upon which  it rests.  This arrange-
ment renders  pronation more extended  in the foetus, as the  radius
always crosses the ulna with additional facility, by being placed
more anterior to it.   This fact is strongly exemplified in the bones
of a fore extremity of animals.  Bichat observes, that  this greater
extent of pronation exposes the annular ligament to being stretched
considerably  behind, and, consequently, the radius to  luxations at
its  head; an  accident  by no means unfrequent  among children^ 
208                       SKELETON.

The late Dr. Physick says, that he has often seen it in consequence
of nurses incautiously seizing them by the fore arm to help them
over gutters, or to render them other assistance.  It happens while
the arm is in a state of pronation; for the weight of the body, by
hanging from it, increases, the position distends  the ligaments, and
produces luxation.  As the bones of the fore arm in the foetus are
nearly straight,  the interosseal  space  decreases gradually from
above downwards.
  The carpus  is entirely cartilaginous at birth, and consists in the
same number  of  pieces that  it does in the adult.   Its articular
cavities are well formed.   Its size is proportionate to what it is in
the adult: in this respect it differs from the cartilaginous extremities
of the round  bones, which are always larger from being in  this
state.  The carpus, therefore, appears small in the foetus.
  The metacarpus  is  cartilaginous at  its extremities, but ossified
in the middle.   The phalanges are in the same state.
 SECT.  VI.—OF  THE  MECHANISM  OF  THE  UPPER  EXTRE-
                           MITIES.

   The scapula and clavicle are for the superior extremity what
 the os innominatum is for the  inferior; in consequence of which,
 some anatomists consider them as a part of the trunk of the body.
 Though the convenience  of anatomical  description  generally re-
 quires them to  be associated with the upper extremity, I  shall de-
 part from the rule on the present occasion, and view them only as
 the basis of the attachments and motions of  the os humeri, and of
 the remaining parts of the superior extremity.
   The upper extremities, considering them  as commencing with
 the os humeri, differ  materially in their position from the lower.
 They are  placed much farther behind; of which one may be satis-
 tied fully by drawing  a line from the middle  of the glenoid cavity,
to the middle of the acetabulum of the same side;  the  body  being
perfectly erect  at the time, the line  will be found oblique.   The
advantage of this arrangement is to give greater latitude of motion
to the upper extremity than if it had been placed more in  front.
Another important benefit is, that by the bulk of the shoulder  being
placed behind the  centre 'of gravity, the erect  position  is  more
easily preserved; a different position of it, by throwing its weight 
MECHANISM OF THE UPPER EXTREMITIES.
209
forwards, would have had  a  continual tendency to produce falls,
and to effect somewhat, in  man, the same inconvenience which is
felt by the quadruped in the erect position.   Another point, also of
some  interest  in the position of the upper extremities, is the dis-
tance to which they are separated from each other by the lateral
projection of the scapulae,  and, consequently, of the glenoid  cavi-
ties.  A distance owing to  the  length of  the clavicles, and which
considerably exceeds the disiance between the heads of the ossa
femorum.
   When the whole length of the superior is compared with that of
the inferior extremities,  the difference is not so great as one may
suppose.   The former  is ascertained by a  line drawn from  the
head of the os humeri to the end of the middle finger: as the hand
is  parallel with the bones of the fore arm, its length is also included,
which amounts to  a considerable portion of the whole.  On  the
contrary, from the foot  being articulated at right angles with  the
leg, only its thickness contributes  to the length of the lower extre-
mity.  As far, however, as individual bones are concerned,  those
of  the upper  extremity, with the exception of its phalanges,  are
uniformly shorter than the corresponding bones of the lower extre-
mity.  The os humeri  is  much shorter than the os femoris—the
bones of the fore arm than the bones of the leg—the carpal and
metacarpal bones than the  tarsal and metatarsal.
   The bones  of the upper extremity are much less  robust than
those of  the lower,, a very certain indication of the difference of.
the Uses for which they were intended.   Their articular surfaces
are arranged for great variety and extent of motion, in the seizing
and handling of bodies; whereas in the lower extremity, they  are
fashioned so  as  to suit  the comparatively limited number of mo-
tions requisite to progression,  and to sustain the body firmly in  the
upright position.  The carpus and metacarpus are much smaller
than the tarsus and the metatarsus, because the  latter are intended
to support a great weight.  On the contrary, the phalanges of  the
fingers are much better developed than the phalanges of the toes,
because the latter are not destined to hold bodies and to examine
them, and may be dispensed with both in standing and in progres-
sion.
   The motions of the upper extremity are immensely varied, and
by a short attention to them, some useful  hints  may be obtained in,
regard to dislocations.
                             18* 
210
SKELETON.
      SECT. VII.—OF THE  MOTIONS OF THE SHOULDER.

  The clavicle performs  a very important office in the actions of
the  shoulder, by preserving  it in  a fit attitude for  the motions of
the  upper extremity.   The  simple  movements of  the  clavicle, of
which the sterno-clavicular articulation is the centre, are those of
elevation, depression, advancing, and retreating, and a rapid suc-
cession of these  produces  circumduction.   The  weight  of  the
shoulder is also sustained by the clavicle, by the latter being fast-
ened at the extremity next to the  sternum, and having in the car-
tilage of the first  rib  a fulcrum,  intermediate to this  attachment
and to the weight at its  other end.  This is proved conclusively
by its fracture; for in  that case the shoulder  invariably falls down,
from the lever being broken  which kept it up.
  The clavicle, also, by keeping the glenoid cavity at a distance
from  the side of  the  thorax, and  directed  outwards, gives great
facility and latitude to certain motions in the human subject; and
which are performed with difficulty, and  very imperfectly,  in ani-
mals not having a clavicle.   A  principal one of these motions is
circumduction, manifested by the elbow  being turned  inwards or
outwards, and in  most persons extends to three-fourths or even an
entire circle.   This motion concurs in the action which brings the
hand to the mouth, in  consequence of which  such an action is per-
formed with difficulty  when the clavicle is broken.  After an acci-
dent of the kind, the head, instead  of remaining stationary as usual,
is advanced towards  the  hand, without which the act cannot  be
accomplished.  A certain length  in the clavicle  seems indispensa-
ble to the vigorous and perfect action of the  shoulder in particular
movements;  if the clavicle  be disproportionately long,  as in fe-
males, these movements are executed with inevitable awkwardness
and imbecility; as, for example, in throwing a stone.

  The scapula presents a moveable basis, on which the motions of
the arm are accomplished.  Its primary  motions are such as have
been assigned to the clavicle, in consequence of the Qonnexion be-
tween these bone; besides which, in all the extreme motions of the
humerus, backwards or forwards, the scapula is  caused to perform
a partial rotation, the  axis of which is indicated by a line drawn
from  the end of the acromion to the inferior angle*  When the 
MOTIONS OF THE SHOULDER JOINT.
211
arm is brought very far forwards, the inferior angle of the scapula
is  carried outwards, and somewhat elevared, while the superior
angle is directed  towards  the  spine, and somewhat depressed.
But, when the arm  is carried  very far  backwards, the inferior
angle is directed  towards the spine, and  the superior angle looks
forwards and upwards.  The clavicle in these cases moves incon-
siderably, as the scapula enjoys a pendulous motion, and its point
of suspension is the outer end of the clavicle; at which place the
oblong articular surfaces slide laterally upon each other and decus-
sate.  The extreme degrees of these motions tend to dislocate this
articulation, but the accident is prevented by the strong coraco-cla-
vicular ligament, which, by  its peculiar position  and confirmation,
resists firmly at a  certain point.  In the abduction and  adduction
of the arm the  scapula is motionless.
  SECT. VIII.—OF THE MOTIONS OF THE SHOULDER JOINT.

  The os humeri is susceptible of elevation, depression, advancing,
retreating, circumduction, and rotation.
  In elevation, the head of the os humeri slides downwards in the
glenoid cavity, and distends the lower part of the  capsular liga-
ment.   In this motion the scapula is apt to follow it; in  which
case there will be  a less degree of distention in the capsular liga-
ment.   If the os humeri  be carried forwards, its elevation  is per-
formed with much  more ease, from the readiness with which the
scapula follows it;  but if it be  carried backwards, this facility is
much diminished.   It is in  the latter position, therefore, that dislo-
cations downwards are most disposed to occur when  violence is
offered to the joint.  If  in every case  the scapula could follow the
motions of the os humeri, so as  to present fairly its glenoid cavity,
luxations would be comparatively rare; but generally the violence
offered transmits its momentum so speedily to the  joint, that the
muscles of the scapula are taken by surprise, and have not time to
adjust properly the glenoid  cavity.
  In the depression of the os humeri, the parts  constituting the
shoulder joint are in their  most natural and easy position.  The
capsular ligament  becomes very loose below, and  is somewhat
stretched above.  Any degree of force which might be applied  to
the  member, is warded off  and its direction changed by the inter- 
 212                       SKELETON.

 vention of the trunk of the body.   Should, however, the force be
 applied directly in the axis of the bone, the projection of the acro-
 mion process, and the strength of the triangular ligament of the
 scapula, would arrest the dislocation.
   When the os humeri is advanced, the posterior part of the cap-
 sular ligament is put upon the stretch; but the form and arrange-
 ment of the  articular  surfaces are somewhat favourable  to this
 position, and  accordingly  it is  one of  but  little inconvenience.
 When the os humeri is  retracted, its head, by being directed for-
 wards, exercises considerable force upon the  fore part of the cap-
 sular ligament, and  when  assisted  by an external  momentum is
 disposed to dislocation, forwards and inwards.
   The motion of  circumduction is very extensive in the shoulder
joint; and by it the os humeri  describes a cone, of which the gle-
 noid cavity is the apex.   It is a regular succession of the  move-
 ments already mentioned, and  in  consequence of all the motions
 forWards of the os humeri being more easy and natural, the axis
 of the cone, instead of being directly outwards, is somewhat for-
 wards.
   By rotation, is meant the revolving of the os humeri upon itself.
 The centre of this  movement is not the axis of the bone, but is re-
 moved to one side  of it, by the lateral projection of the head.  The
 neck, however, is too short and thick  to  permit  any great  extent
 to this motion; it,  accordingly, is limited  in such  a  way as never
to amount to luxation.  Its greatest extent, in most persons, does
not exceed the describing of  half a circle, which may be  ascer-
tained by applying a finger upon the internal condyle  of the os
humeri.  By it the  capsular ligament is rendered, alternately, loose
and tense on  its  front and  back parts.   Bichat  observes, that in
the anchylosis of  the elbow joint, this motion, by habit, is  much
augmented, so as to supply the want of rotation of the head  of the
radius upon the ulna.  The scapula and  the  clavicle do not vary
their position in rotation.


      SECT. IX.—OF THE MOTIONS OF THE FORE ARM.

  There are two kinds of motion in  the fore arm.  In the one, the
fore arm is flexed,  or extended upon the arm,  and  in the other, the
radius only changes its position in regard to the ulna. 
MOTIONS OF THE FORE ARM.
213
      1.  The ulna is the essential agent of the first, in consequence of
    its manner of articulation with the os  humeri; the radius is only
    accessory, and is drawn by the ulna into a participation in its mo-
    tions.   These two bones, it will be recollected, are disposed of in an  >
    inverse manner, the larger part o£ the ulna being  above, while the
    larger part of the radius is below.  This  arrangement causes the
    ulna to present the principal articular  surface for union with the
    os humeri, while the radius affords the principal surface to the car-
    pus;  it also gives to the whole fore arm a great  uniformity in its
    transverse diameter.  The fore arm executes, upon the arm, flexion,
    extension, and lateral inclination.
      Where the flexion  is complete, the coronoid process is received
    into its cavity, on the  front of  the os humeri; and the olecranon,
    having left its cavity, is placed  below the  condyles.   In this state
    the capsular ligament is stretched at its posterior part, while the
    anterior is thrown into folds, and  is relaxed along with the lateral
    ligaments.   In the demi-flexion of the  arm, there is a more equal
    degree of tension  of the several ligaments.  When the os humeri
    is reposing in its most easy attitude, at  the side of the body,  if the
    fore arm be flexed, its line of motion directs the hand towards the
    mouth;  a circumstance which  is accounted for by the peculiar
    obliquity of the trochlea, on the lower part of the  os humeri, upon
    which the ulna revolves, and is  independent of any special act of
    volition.  It is said that man, above all other animals, has the me-
    chanism of the upper extremity most particularly  addressed to the*
    latter motion, to the perfection  of which the clavicle is indispensa-
    ble.   It is in consequence of this  application of the clavicle, that -
    if it be broken, man, like animals which are entirely deprived of it,
    will, in the flexions of the fore arm, more easily carry the hand to
    the opposite shoulder than to the mouth.
      In the full extension of the fore arm, the olecranon process  being
    received into its cavity, is much above the  condyles of the os hu-
    meri.   The lateral  ligaments, as well as that part of the capsule
    on the front of the  joint, are in  a state of tension.  When the ex-
    tremity is in  this position, a fall  upon  the hand  may produce  a dis-
    location backwards.   In  this case the fore arm  being  fixed, the
r^  coronoid process affords the surface upon which the principal mo-
    mentum of the fall  is felt.  If the ligaments on the front of the
   joint be not  strong enough to  withstand the force, they are lace-
    rated, and the  articular surfaces, passing  each  other, the upper 
214
SKELETON.
parts  of  the ulna and radius  are driven behind the os humeri.
Bichat asserts, that nothing is more easy than to produce  such a
luxation  on the  dead body by a similar proceeding, and that he
has repeatedly done it—that it is  about  as easy to produce  this
dislocation, as it is  difficult to  effect one at  the scapulo-humeral
articulation.  In a moderate extension of the fore arm, produced
by a small  weight suspended on the hand at arm's length, there is
a well marked pressure of the  inferior extremity of the os humeri
against the ligaments in  front of  the articulation, which  is aug-
mented by  a tendency of the ulna to  describe the arc of a circle,
from above downwards, and to separate itself from the os humeri.
In this case the muscles which flex the fore arm are kept so much
in the line  in which  they contract, or are so little removed from
the axis of  their own motion, that they contribute but little to sus-
tain the  fore arm in situ; the weight is, therefore, actually sus-
tained by the ligaments in front of the articulation.  But they being
pressed and drawn in the  manner mentioned, such great pain and
weariness are produced as to render a continued suspension of the
weight insupportable, the  experimenter is, therefore,  in a short
time,  under the  necessity either of casting off the weight or  of
giving such a  degree of flexion to the fore arm as will allow the
muscles to  contract more advantageously.
   Besides flexion and  extension, the ulna has a sort of rocking
motion when the fore arm is only half bent; but when the latter is
at either extreme of  the former positions, this motion is impercep-
tible,  owing to the nature  of the articular surfaces  and the resis-
tance of the ligaments.

   2.  In the rotations of the radius upon the ulna, the latter is al-
most  motionless, excepting the case specified in the last  paragraph.
The position of the  radius on  a plane  somewhat anterior to the
ulna, its  small cylindrical  upper extremity, and its  broad lower
one, all concur in facilitating  rotations  forwards and backwards.
It is owing to the hand  following these motions that the first is
expressed by the term pronation, in which the palm of the hand is
directed  downwards;  and the  second, supination, in which the
palm is upwards and the back of the hand downwards.
   Pronation  is  the  most  common, and,  consequently, the easiest
position  to  the  fore arm, when not  carried to an extreme:  it is
adopted involuntarily, simply by the  action of  the ligaments and 
MOTIONS OF THE HAND.
215
the particular shape of the articulating surfaces of the bones.   It is
the posture most generally suited to the examination and grasping
of surrounding bodies.  In order that it may be accomplished fully,
the superior extremity of  the radius rolls on its own axis, in the
loop formed by the annular ligament and the lesser sigmoid cavity
of the ulna;  while the lower extremity revolves around the little
head of the ulna below.   The middle  part of the radius crosses
that of the ulna, and the interosseous space is diminished.  An ex-
cess of this motion will produce  luxation either above  or below,
but more easily at the latter place; both on account of the greater
extent of  motion there, and of the comparative weakness of the
ligaments.
   In supination, a  movement the reverse of what is  described,
takes place; the radius revolves outwardly, and is brought parallel
with the ulna.   If by any force  it  be carried beyond this'line, a
dislocation may occur, in which  the little head of the ulna, aban-
doning the sigmoid cavity of the  radius, will  be thrown  in front of
it.   An accident, however, said to be very unusual.
   Bichat  considers the cartilage  between the ulna  and  the cunei-,
forme as a principal obstacle to these luxations; but when it is in-
sulated or separated from the cartilage of the radius, as  sometimes
occurs, the joint is very much weakened thereby,  and  more ex-
posed to dislocations.
         SECT. X.—OF THE MOTIONS OF THE HAND.

  The hand, as a whole, performs upon the fore arm, flexion, ex-
tension, lateral inclination, and circumduction.   As it only follows
the  motion of the radius in pronation and supination, and does not
contribute in the slightest degree to either, its appropriate motions
can all be performed independently of them.
  In flexion  the convex head, formed by the first range of carpal
bones, slides from before backwards in the concavity which re-
ceives it.  The posterior part of the capsular ligament is stretched,
and the anterior thrown into  folds, while the lateral ligaments re-
main  at their ease.   In extension, with the exception of the lateral
ligaments, the  phenomena are reversed.  This extension, as  is
well known, not only brings the hand into  the same line with the
bones of the fore arm, but carries it  beyond that line till it forms 
216
SKELETON.
 almost a right angle with it.   The wrist joint, in this respect, dif-
 fers from the other ginglymous articulations; but what it gains in
 extension it loses in flexion, as it cannot be bent so much as either
 the elbow or knee.  The arrangement, however, gives great  faci-
 lity to the use of the hand.
   In the lateral inclinations of the hand, the capsule in front of and
 behind the wrist, is but little affected, but the lateral ligaments are
 alternately relaxed and tightened.  As the articular surfaces are
 extensive in the  line of these motions, dislocations in the direction
 of either  of them are very uncommon, and when they do occur
 they are for the  most part incomplete.
   Circumduction is produced by a regular succession of the mo-
 tions described;  it, therefore, does not require a specific  notice.

   Of the  Partial Motions of the Hand.—Well marked changes of
 position occur between the first and  second rows of the carpus:
 these are principally flexion and extension.   Lateral inclination or
 abduction and adduction  are extremely limited, and circumduction
 does not exist.   The motions, such as they are, are confined within
 much narrower limits than those of the radio-carpal articulation,
 and have for their main fulcrum the head of the magnum.
   The lateral  articular surfaces of the several bones of the carpus,
 though they present the arrangement of joints, have not  an  appre-
 ciable  motion  upon each other.  Whatever changes of position
 happen among them, are  probably so obscure that they  never ap-
 pear, except under the influence of  great  and  sudden violence.
 The complexity of the mechanism of the wrist, seems to  have a
 double object in view: for ordinary circumstances of impulse  and
 motion, the flexion and extension of the first row upon the second,
 as a whole, is  sufficient;  but when a great momentum is commu-
 nicated to the structure, the number of pieces which form it, and the
 variety of their shapes and mode of attachment, diffuse the  vio-
 lence throughout the whole wrist, and generally save it from dislo-
 cation or fracture.  The fracture of a single bone, excepting from
gun-shot wounds, is a very unusual circumstance:  I have, how-
ever, in possession a scaphoides which was broken through trans-
versely, and had probably  been  in that state for  a long time; as
 all appearance of inflammation, at the period of my finding it,
 was  absent, and  as the  fractured surfaces had  become  highly
polished by rubbing against one another. 
MOTIONS OF THE HANDS.
217
   The pisiform bone moves with much freedom inwardly and out-
wardly on the cuneiform, but its motion up and down is  resisted
by the muscles which  are attached to it.  Owing to its articular
cavity being insulated, and to its own remoteness, a dislocation of
it, if it did occur, would interfere but little with the general uses of
the hand.
   The metacarpal  bone of  the thumb has a very free  motion on
the trapezium, in flexion, extension, adduction, abduction : and  cir-
cumduction is the result of the other four.  In consequence of this
variety of movement in it, of its  position on a plane anterior to
that of the fingers,  and of a corresponding obliquity of the trape-
zium, the thumb can, in all cases of grasping and examining bodies,
antagonize the fingers.   The circumduction of the thumb resembles
very much that of the  wrist, or shoulder joint, though the mechan-
ism of  the articular surfaces is different.   In  this motion, it de-
scribes a cone  or circle, the anterior  segment of which is  larger,
and performed with more facility than the posterior.

   The second and third metacarpal bones are so closely bound to
the carpus, that  their  motion above  is almost imperceptible; in
consequence of their length, the motion is more appreciable below,
but even there it is  very much restricted.  The fourth metacarpal
bone has a limited ginglymous movement, which is sufficiently de-
monstrable, and the fifth  has it in a  considerable degree;  it also
admits of a sort of adduction, by which it is brought nearer to the
other bone.

   The  first phalanges admit  of flexion, extension, adduction, ab-
duction ; and circumduction, by the successive performance of the
others.   The first phalanx of the thumb has  the three last motions
very much curtailed,  in  consequence of the necessity of great
strength and  stability in this joint, so  as to  antagonize firmly  the
fingers.  The remaining  phalanges perform, simply, flexion  and
extension.  The latter, as in the knee and elbow, rarely goes  be-
yond the axis of the limb, whereas the former, from the extent of
the articular surfaces and  the  particular  mechanism of the joint,
permits the hand to  be  closed and doubled.

  From what has been said, it will not be difficult to form a o-ene-
ral conception of the great variety of motions resulting from the
  Vol. I.—19 
218
SKELETON.
number and arrangement of the  pieces constituting the upper ex-
tremity.  The os humeri being the basis of them, may be presented
in any direction; the bones of the fore arm  may be  alternately
retracted or protruded, and by the revolving of the radius, will
permit the  palm of the hand to  apply itself at any point; and,
again, the multiplicity of simple motions of the hand, and the ex-
haustless variety of their  compounds, contribute  to  give  to  the
upper extremity, in man, a perfection of mechanism infinitely be-
yond any thing which can  be devised by the powers of art: a sen-
timent cogently  expressed by the late Professor  Wistar: who
remarked, that " The human hand, directed by the human mind, is
the  most perfect instrument that man ever saw or ever will  see."
                      CHAPTER VI.

              Of the  Inferior Extremities,

  The bones of the  inferior extremities are the os femoris, the
tibia, fibula, patella, and a large number which enter into the com-
position of the foot.


  sect. i.—of the thigh bone,—(Os Femoris, Femur.)

  This is the only bone in the  thigh, and extends from the trunk
to the leg.  It is considerably the  longest and largest bone in the
skeleton, and presents a conformation  entirely peculiar.  For the
purposes of description, it is divided into the two extremities and
the  body.
  The superior or iliac extremity presents three well marked emi-
nences, the head, the great and the little  trochanter.   The head is
the articular surface above, and forms rather more than one-half of
a perfect sphere.  Its smoothness indicates the existence of a car-
tilaginous crust on it during life, and is only interrupted by a small
pit  a little below its centre, which gives attachment to  the round
ligament of the hip joint. Its articular surface is more extensive
above than  below, as that part is chiefly employed  in  sustaining 
THIGH BONE.
219
the trunk, and comes in contact with a corresponding surface of
the os innominatum.  The head is supported on a branch of  the
os femoris called the neck, which, projecting from the internal face
of the bone between the trochanters, is directed inwards and  up-
wards at an angle of about thirty-five degrees, but varying  in diffe-
rent subjects.  The neck is two inches in length, oval, or resembling
a flattened cone, the greater diameter of which is vertical; and
arises by an extensive base along the upper end of the os femoris.
It has a great multitude of foramina dispersed over it, which pene-
trate to its interior, and give passage to blood vessels;  the largest
of them are on its posterior  surface.   Some of these foramina  are
also occupied by fibres.  A superficial horizontal fossa, formed by
the tendon of the  obturator externus, may be seen crossing the pos-
terior face of the  base of the neck.

   The great trochanter is situated at the superior part of the base
of the neck,  and though presenting a well  marked, elevated sum-
mit, rising  straight upwards, does not reach the altitude of  the
head, but falls short of it half an inch.  The trochanter major
rests upon a  broad base, has its surface much diversified, is some-
what prominent in front and externally; but presents on the side
which is next to the head  of the bone a deep rough  concavity,
which is occupied by the insertion of  the small rotatory muscles
on the back of the pelvis.   On its summit is a small smooth spot,
marked by the insertion of the pyriformis muscle;  below this, and
also externally, is a broad surface, slightly convex, into which  the
gluteus medius is inserted ; below this, again, is a second  promi-
nent and rounded  surface, over which a part of the tendon of  the
gluteus magnus plays.   On  the front of the trochanter, and just in
advance of  the insertion of the  gluteus medius, is an oblong sur-
face, proceeding  obliquely downwards  and outwards, into which
is inserted the gluteus minimus.

   The trochanter minor is much smaller than the other, and  is a
conical process^, placed, on the internal posterior face of the bone,
at the lower  end of the root of the neck.  It receives the common
tendon of the iliacus internus and psoas magnus muscles.  A broad
elevated ridge joins the two trochanters on the posterior  face of
the bone, and into-its middle half is inserted the quadratus femoris
muscle.   A  much smaller  ridge, and by no means so elevated, 
 220                       SKELETON.

 runs in front, from the one process to the  other, and indicates the
 line of attachment of the capsular ligament of the hip joint.

   The inferior extremity of the  os femoris is much more volumi-
 nous than the superior, and is divided into two  parts, called  the
 internal  and the external  condyle.   These condyles are of very
 nearly the same size, but, being separated by a notch behind, they
 are placed somewhat  obliquely in regard  to each  other; and  the
 internal, from being the most oblique, and, consequently, the most
 protuberant,  also seems to be the larger.  If the  os femoris be
 placed exactly vertical, the internal condyle has the appearance of
 being the longest; but, if  it be placed in its natural obliquity,  the
 lower face of the condyles is on the same plane.   In front,  the
 condyles unite to form an articular trochlea, on which the patella
 plays: this trochlea is  unequally divided by a vertical depression,
 so as to have its more extensive surface external.   This latter sur-
 face is the anterior  part of the external condyle, and is much more
 elevated than the internal  part of the trochlea, which belongs to
 the internal  condyle.  Posteriorly, the internal  condyle  projects
 more than the external, and both have the articular surfaces, there,
 so much elongated backwards and upwards, as to admit of a very
 great flexion of the  leg.

  Each condyle presents an internal  and an external face.  The
 internal condyle has on its internal face a tuberosity, from which
 proceeds the internal lateral ligament of the knee;  on its  external
 face it forms one-half of  the  notch  which separates  it from  the
 other condyle, and  at  its  anterior part in  the  notch may be  ob-
 served a"small depression, from which proceeds the posterior cru-
 cial ligament.  The external condyle, also,  has on its external face
 a tuberosity, from which proceeds the external lateral ligament of
 the knee, and just below it a depression for the  origin of the popli-
 teus  muscle.   Its internal face forms the other half of the  notch
just mentioned, and  on  the posterior  part of this face is  a small
 depression for the  attachment of the anterior crucial ligament.
 The  inferior face of the condyles  is somewhat flattened, the trans-
 verse diameter of that of the external being rather longer than  the
 other.  The inferior extremity of the  os femoris is beset with fora-
 mina, large and small, for the  passage of vessels and  the attach-
 ment of fibres. 
THE LEG.
221
   The body of the os femoris begins at the trochanters, and termi-
 nates in  the condyles.   It is slightly bent, so as to present the con-
 vexity of the curve forwards.   Its size is gradually diminished to
 the middle; it  then begins  to enlarge, and continues  to  augment
 till it terminates in the large inferior extremity.   The body is very
 nearly round, and departs from that  figure  only on its  posterior
 face, where an elevated rough ridge is found, occupying the supe-
 rior two-thirds of the bone, and  called  the linea aspera.   The linea
 aspera begins broad, rough, and flat, on a level with the trochanter
 minor; it narrows as it descends, and becomes, at the same time,
 more elevated.  In the whole course of the linea aspera, an  inter-
 nal and an external margin is very obvious.   Its  lower extremity
 bifurcates into two superficial, slightly marked ridges, one on each
 side, which may be traced into  the posterior extremity of its cor-
 responding condyle.  Between these ridges the surface of the bone
 is flattened.  The superior half of the  external margin of the linea
 aspera is occupied by the insertion of the gluteus magnus, and the
 remainder by the origin of the biceps flexor cruris.  This margin
 also gives origin to the vastus externus.  The internal margin of
 the linea aspera is  mostly occupied by the insertion of the triceps
 adductor, and by the origin of the vastus internus.
   In the linea aspera, near the middle  of the bone, is the canal for
 the nutritious artery, which slants upwards: occasionally one or
 more canals, besides, are found  in it for the same purpose.
   The texture of the os femoris  is compact in its body.   Its extre-
 mities are cellular, with the exception of a  thin  lamina forming
 their periphery : the cylindrical cavity  in its middle, like that in all
 the other long bones, is reticulated.  The ossa femorum approach
 each other very closely at their inferior extremities, but are widely
 separated at their superior, in consequence of the length of  their
 necks, and of the distance of the acetabula from one another.


                   SECT. II.—'OF THE LEG.

  Two bones form the leg, the tibia and the fibula, to which  may
be added the patella, from its attachment to the tibia.
                             19* 
 222                       SKELETON.


                      Of the Tibia, (Tibia.)

   The tibia  is placed at the internal side of the  leg, and extends
 from the thigh to  the foot.   After the os femoris, it  is the longest
 and the largest  bone in  the  skeleton.  It is divided  into the body
 and the two  extremities.

   The superior extremity of the tibia  is  oval, transversely, and
 presents an extent of surface suited to the articular face of the two
 condyles of the os femoris, to which it is joined.  It  has here two
 superficial cavities for receiving  the ends of the condvles;  one of
 them is internal  and  the other external.   The internal is the deeper
 and more  extensive  of the two,  and, being oval, has its long dia-
 meter in an antero-posterior direction.  The external,  besides being
 smaller and more superficial, is more  circular; and, from the want
 of elevation in its margins, scarcely presents at all the appearance
 of a cavity.   These two cavities, which approach to within  half
 an inch of each other, are kept entirely  separated by an elevated
 triangular ridge, with  a  broad base, called  the spinous process of
 the tibia.   The summit of the ridge presents two tubercles, one at
 each end, separated by a pit, which serves to attach  the posterior
 end  of the external semi-lunar  cartilage.  The ridge  is placed
 nearer the posterior than  the anterior  margin of the tibia.   Its
 base, in front, is depressed for the attachment of the  anterior cru-
 cial  ligament, and just before this is a  rough, triangular space,
 extending to the anterior margin  of the bone, and covered by fat
 in the recent  subject.   Between the ridge and the posterior margin
of the bone is a deep depression for the attachment of the posterior
 crucial ligament.

  The circumference of  the superior part of the tibia, just  below
its articular surface,  is flat  before, somewhat flat and concave be-
hind, and bulging at the sides.  The flatness, in front, is triangular,
having its base  upwards and the apex downwards, the latter ter-
 minates in a well marked, broad,  rough rising, which is the tuber-
 cle of the tibia,  and  serves for  the insertion of  the tendon of the
 patella.   The concavity  behind is made by the popliteus muscle,
 and  slopes from above obliquely inwards and downwards.  The
projection is great  on the internal side of the upper  extremity of 
THE LEG.
223
the tibia, and at its  posterior part has  a depression  made by the
insertion of the semi-membranosus tendon.  The external projec-
tion is thicker  in front than behind; at the latter point it has a
small articular face,  looking  downwards,  for  the  head of the
fibula.

   The  inferior extremity  of the  tibia  is  much  smaller than the
superior.   It is terminated  by a transverse quadrilateral cylindrical
concavity, by which it articulates with  the astragalus.   This con-
cavity is  narrower  and  deeper internally than externally, and is
traversed from before backwards by a low broad  ridge.   It is
bounded  internally by the  internal malleolus,  a  large process of
half an inch in length, the external side of which is  a continuous
surface with the cylindrical concavity, and forms part of the joint.
The other side of the malleolus is superficial, being just  beneath
the skin.  A  shallow groove  exists in its posterior part, which
transmits  the  tendons of  the  tibialis  posticus and of the flexor
longus  digitorum pedis.   Inferiorly, the malleolus is notched, or
presents a depression, for the origin of the internal lateral ligament,
and just before the depression  it is  elongated  into a point.   The
lower end of the tibia presents, before  and behind, a slight swell,
running transversely just above the articular surface.   The poste-
rior swell is occasionally  slightly marked by the tendon of the
flexor longus pollicis pedis.

   Externally, the circumference of the  lower end of  the tibia pre-
sents, longitudinally, a concavity which is  in contact with  the
lower end of  the fibula.   This concavity terminates insensibly
above, but is deep below,  where it is  bounded before and behind
by an elevated  point of bone, of which the  posterior is the  highest.
The concavity is  placed  nearly in  the  vertical  line of  the little
articular face for the fibula, on the  head of  the  tibia;  and at its
lower margin, there  is frequently a small lunated  surface, which is
continuous with the articular  surface for  the astragalus, and is
consequently a  part of the  cavity  of the ankle joint.   Just above
this lunated surface  the bone is  rough for the origin of short liga-
mentous fibres, which  unite it to the fibula.

   The body of the tibia commences just below the enlarged upper
extremity, and  terminates near the ankle.  In the front view of it, 
224
SKELETON.
 it diminishes continually in descending, in  its superior two-thirds:
 afterwards  it enlarges gradually to the lower extremity; in the
 lateral view it diminishes downwards  almost to the lower extre-
 mity.  It  is  slightly  bent  forwards, and is  generally prismatic,
 more particularly above: one of its faces is internal, another ex-
 ternal, and the third posterior.  The internal  face is rounded, and,
 with the exception of its upper part, where the flexor tendons  are
 inserted, it is only covered  by the  skin.  Its  external  face is flat,
 excepting  below, where it is rounded and is  covered by the mus-
 cles on the front of the leg.   The posterior face is slightly rounded,
 except at  its upper part where it  is  crossed  by a line running
 obliquely from the articular surface for the fibula, downwards and
 inwards: above which line, is the superficial triangular depression
 for the popliteus muscle.

   The three sides of the tibia are marked off from each other by
 ridges  of  bone.  The  anterior ridge, called  the  spine or crest,
 begins at  the external margin of the tubercle for the insertion of
 the tendon of the patella, and  may be traced very distinctly, in the
 form of an S very slightly curved, almost to the malleolus internus:
 it is more elevated in its middle.  The external  ridge is a straight
 line running from one extremity of  the  bone to the other; to it is
 attached one edge of the  interosseous ligament.   The internal
 ridge is rounded, but also runs the whole length of the body of the
 bone, being more distinct below.  The internal lateral ligament of
 the knee and the soleus muscle are attached to it, above; and
 below, the flexor longus digitorum pedis.
  Foramina large  and  small, for  blood vessels and  fibres,  are
 found on the circumference of both extremities of the  tibia.  On
 its posterior face, about one-fourth of its length from the head, is a
 large canal sloping  downwards, through which  passes the  nutri-
 tious artery.   Its structure, like that of the other long bones, is
cellular at its extremities; but compact  in the  body, where it pre-
sents  a cavity occupied by cancellated  matter.  It will now be
 understood  how it articulates with  the  fibula, externally, at both
ends; with  the os femoris above; and with the astragalus below. 
THE LEG.
225
                    Of the Fibula, (P^ronL)

  The fibula is placed at the external side of the tibia, and extends
from the head of the latter to the foot: it is much smaller, and not
quite so long as the tibia, and is so articulated with  it as to be on
a line with its posterior face.  It is to be studied in its  two extre-
mities and in its body.

  The upper extremity  of  the fibula  is considerably enlarged and
irregular.  Its presents, above, a small articular face directed up-
wards and very slightly concave, by which it joins the correspond-
ing face of the tibia.  This surface is bounded behind by a sort of
styloid  process, into which is inserted the tendon  of  the biceps
flexor cruris.   The circumference of the bone, in advance of this,
furnishes attachment to the external lateral ligament of the knee.

  The inferior extremity of the fibula is also enlarged, being flat-
tened on its tibial side, but  more rounded externally.   This part of
the fibula is called the malleolus externus.   It descends lower than
the internal ankle, and is also more prominent and large.   Its tibial
side presents, below, a small triangular slightly convex articulating
surface, which reposes against the side of the astragalus; behind,
and somewhat below it, is  a small rough depression, which, with
the adjoining inferior margin of the bone, gives origin to the three
fasciculi of the external lateral ligament of the ankle.   Above the
articular surface, the bone is  rough and slightly rounded where it
is received into the side of the tibia, and sends off many short liga-
mentous fibres to it.  The  anterior margin of this extremity of the
fibula is thin and projecting, the  posterior surface is flat and broad,
and is slightly scooped out into a longitudinal groove, which trans-
mits the tendons of the two peronei muscles.  The pointed termina-
tion below, of the malleolus externus, is sometimes called the coro-
noid process.

  The body of the fibula extends between  its  extremities.   It is
irregularly triangular, somewhat smaller  above than below, thick
posteriorly, thin anteriorly, and slightly convex  in  its  length be-
hind. 
226
SKELETON.
  There are three faces to the fibula, one is external, another inter-
nal, and the third  posterior.  The first is  semi-spiral, and turned
forwards above; its superior third gives origin to the peroneus lon-
gus muscle, and the middle third to  the  peroneus secundus:  its
lower third exhibits the semi-spiral arrangement which may be
traced into the groove on the posterior part of the malleolus exter-
nus, and thereby indicates the course of the tendons of these pero-
nei muscles.   The internal face is directed towards the tibia; it is
divided  by a  low longitudinal ridge into two parts, of which the
anterior is the more narrow.   The ridge itself, well marked in the
middle two-fourths of the bone, is indistinct above and below; and
furnishes attachment to the interosseous ligament.   The space in
front gives origin to the extensor proprius pollicis, and the exten-
sor communis digitorum:  and the space behind gives origin to the
tibialis posticus.  The posterior face is also somewhat  semi-spiral,
its superior end  being  outwards, and  the inferior end inwards.
The superior third gives origin to the soleus  muscle,  and the  re-
mainder to the flexor longus pollicis pedis.

   The angles of the fibula which are  formed by the junction of
the three surfaces described, differ  somewhat among  themselves.
The anterior angle is  frequently very sharp  and elevated in its
middle  half, and below  it bifurcates into two ridges, including  be-
tween them a triangular space, which  is only covered  by the inte-
guments.  The posterior angle is well marked, and winds so as to
be external above, and posterior near the foot.   The internal angle,
formed by the union of the internal and the posterior surfaces, is
only very well marked  in its middle half.   The projection  of this
angle gives to the  bone the  appearance of inclining  inwards to-
wards the tibia, besides which it  has  actually a little bend in  that
direction.

   Near the  middle of the posterior face of  the fibula, a canal,
 sloping downwards, conducts the nutritious artery.   The circum-
 ference of the extremities, like that of the other  long bones, pre-
 sents a multitude  of foramina for vessels and the filaments of fibres
 to pass.  It  is composed  in its  extremities  of cellular or spongy
 structure, and in its body of compact matter, enclosing a cavity
 occupied by cancellated structure. 
THE LEG.
227
                    Of the Patella (Rotule.)

  The patella is a small bone, intermediate to the thigh and to the
leg, and placed on the  fore part of the knee joint;  it is smaller  in
proportion in females than in males.
  Its anterior face is uniformly convex and rough, and is studded
with a considerable number of foramina for the passage of vessels,
and for the attachment of fibres.  The course of the longitudinal
fibres composing the front of the bone, is also well marked.   The
posterior face of the patella is an extensive articular surface, di-
vided  unequally  by a  broad  longitudinal elevation,  which  runs
from the superior to the inferior margin of the bone.   The part of
this surface external to the ridge, is  the largest and the most con-
cave, and is applied to the trochlea, in front of the external  con-
dyle of the os femoris; while the smaller surface is on the internal
side of the ridge, and is applied to the trochlea of the internal con-
dyle.

   The circumference  of the patella is nearly oval, the long diame-
ter being transverse.   Its  thickness is  much  augmented above,
where it presents a rough, and somewhat unequal flatness for the
insertion of the tendon of the rectus  femoris.   Below, the bone is
thinner, and elongated into a conical point, from which proceeds
the tendon of the patella to be inserted into  the tibia.  Laterally,
the margins are  thinner still.

   The texture of the patella is cellular, covered  by a  lamina of
condensed bony  matter.  It is developed in the tendon of the ex-
tensors of the thigh, and with the exception  of its posterior face
remains in a state almost entirely cartilaginous, for a year or two
after birth.  Its  base is fibrous, in which is deposited, subsequently,
the  calcarious matter.  In its fracture union is effected more fre-
quently by the fibrous base alone, than by perfect ossification.  In
order to put it into  its proper position, turn the point downwards,
 and apply the greater surface behind, to the trochlea of the  exter-
 nal  condyle.  The patella is said to  be  to the  tibia, what the ole-
 cranon is to the  ulna;  and is, therefore, a sort of appendage to it,
 united by ligament  instead of being continuous with it, as  is the
 case with the olecranon. 
228
SKELETON.
                   SECT. III.—OF THE FOOT.

   The foot forms the third section of the inferior extremity, and is
 placed at a right angle to  the  bones of the leg.  The size of its
 bones varies  much  in  different individuals, depending much upon
 their modes of life,  and dress : it also varies much in the two sexes,
 being, for  the most part, smaller in the female.  The foot is ob-
 long, narrower behind  than  before;  presents  one surface above,
 which is its back, and another below, which is the sole; a posterior
 extremity called  the  heel, and an anterior extremity called the
 point; also its internal  margin is much  thicker, longer and more
 concave, than the external margin.

   The foot is divided  into Tarsus, Metatarsus, and Toes or Pha-
 langes.

                    Of the Tarsus, (Tarse.)

   The tarsus forms the posterior half of the foot, and is composed
 of seven distinct bones, which are arranged on a plan, and present
 features  having  scarcely a single  point of resemblance with the
 carpus.   These bones are, the Os Calcis, the Astragalus, the Navi-
 culare, the Cuboides, the Cuneiforme Externum, Cuneiforme Me-
 dium, and Cuneiforme Internum.


                Of the Os Calcis, (Calcaneum.)

  The calcaneum, or heel bone, forms, almost exclusively, the pos-
 terior half of the tarsus, and may be readily distinguished by its
 greater magnitude.   Its shape is very irregular.   Its greatest dia-
 meter is in the length of the foot; it  is also thicker vertically than
 transversely.

  The superior face is deeply scooped out, at its fore part, and is
formed there  into two articular  surfaces, for joining with the astra-
galus : these faces are separated from each other by a rough fossa,
which runs from  within obliquely forwards and outwards.  The
anterior external part of this fossa is deep, broad, and  triangular; 
THE FOOT.
229
the posterior part is narrow, is occupied by a ligament, and allows
the two articular surfaces to come nearer.  Just behind  the fossa
is  the  first  articulating surface, lying parallel with it; being ob-
long, convex, semi-cylindrical, and looking obliquely upwards and
forwards.  Before the fossa is  the second surface: it is oblong,
much smaller than the first, and  is very frequently divided into two
by a transverse notch, and is concave.   The part of the bone upon
which this face is wrought, is called, by the French, the little apo-
physis.   I  have frequently remarked, that  the face posterior to
the first mentioned fossa is smaller and more vertical in the  Afri-
can than in  the European; the os  calcis, behind it, is also smaller
and  longer.  The upper posterior face of the bone is somewhat
concave.

   The under surface of the os  calcis is slightly concave, longitu-
dinally.  It is  bounded, behind, by two tuberosities, of which the
internal  is  larger than the  external;  they  both give  origin  to
muscles of  the sole of the foot and to the aponeurosis  plantaris.
There is also a tuberosity bounding the same surface in front, from
which arise the ligaments  that connect this bone with the adjoin-
ing ones.

   The anterior extremity of the os calcis forms  the  greater apo-
physis, and  is terminated in front by a triangular and slightly con-
cave surface, by which it  articulates with the os cuboides.  The
posterior extremity is convex and  rough:  constitutes the heel, and
near its middle receives the tendo-achillis; the upper part  is sloping
and  more smooth,  in  order to  accommodate this tendon in the
flexions of the foot.

   The external surface of  the os calcis is flat, with  the exception
of a gentle  rising in its middle; it is  marked, occasionally, by a
superficial groove, indicating the course of the tendons of  the pe-
ronei  muscles.  The internal surface is very concave, and obtains
the name of sinuosity; along it pass the tendons of several muscles
from the back of the  leg, of which that of the flexor longus pol-
licis pedis makes  a  conspicuous groove on  the under surface  of
the little  aphophysis.
  Vol. I.—20 
230
SKELETON.
                Of the Astragalus, (VAstragale.)

   This is the  next  in size to the os  calcis, and is placed on the
superior  part of the latter, between it and the bones of the leg.

   The astragalus presents, above, a semi-cylindrical surface, by
which it is put in contact with the tibia.   This  surface is nar-
rower, and continued farther behind than it  is before;  is slightly
depressed, longitudinally, in  its middle, and, consequently, pre-
sents an  elevated margin on either side, of which  the  external is
the broadest  and highest.   This articular face continues on each
side of the bone, and  is more extensive externally,  where it comes
in contact with  the fibula or malleolus externus, than internally,
where it  touches the malleolus internus.

   The inferior face of  the  astragalus is traversed by an oblique
rough fossa, going  from within  outwards and forwards, and cor-
responding in size  with  that  on the  upper face  of the os calcis.
Behind the fossa, and parallel to it, is a  deep oblique semi-cylin-
drical concavity, suited to the adjoining face of the os calcis; and
before the fossa is a narrow oblong convexity, suited to the corre-
sponding  articular concavity of the same bone.  When the latter
is divided into two facets, the concavity of the astragalus presents
also two  facets, separated by a small ridge.

  The anterior extremity of this bone is  terminated by a convex
head, the horizontal diameter of which is the greatest.  This head
articulates with the scaphoides, and is continuous with the surface
that rests upon the  little apophysis of the os calcis.   On the inter-
nal side of the head is a small triangular surface, continuous with
the others, that  rests upon a strong ligament going from the os
calcis to  the scaphoides.  Above, immediately before the surface
for the tibia, is  a small depression, which, in the  flexions of the
foot, receives  the anterior margin of the articular  surface of that
bone.  The posterior extremity of the astragalus is thin, and has
a notch,  or groove, formed in it by the tendon of the flexor longus
pollicis pedis. 
THE FOOT.
231
         Of the Naviculare, or Scaphoides, (Scaphoide.)

  It is situated at the internal  side of the tarsus, between the astra-
galus  and the cuneiform bones, and has its greatest diameter trans-
verse.  Its circumference is oval, thicker  above than below, and
at its  internal side  presents a large tuberosity; into which is in-
serted the tendon of the tibialis posticus.  Sometimes the external
margin has a small articular face, where it comes in contact with
the cuboides.

   The  scaphoides,  presents,  behind,  a  deep  concavity,  which
receives the head of the astragalus;  anteriorly, it is somew7hat
convex, but this surface is divided by small ridges into three trian-
gular  faces, for the three cuneiform  bones.  Of these  faces  the
internal is broader below than above; the others are broader above
than  below.

                  Of the Cuboides, (Cuboide.)

   It is situated at the external side of the  tarsus, between the os
calcis and the metatarsal bones.   Its figure is irregular, but, per-
haps, sufficiently indicated by its name.  It  is  narrower externally
than internally, and  has the posterior extremity oblique.

   The superior face of the  cuboides is rounded, but rough.   The  ,
inferior  face  has in  its  middle a broad  elevated ridge  running
almost transversely, but somewhat forwards.  The external extre-
mity  of  this ridge is marked by  a trochlea,  on which plays the
tendon of the peroneus longus; the tendon is then conducted along
a groove between the ridge and the anterior margin of the bone.

   The internal face is flat, and has in its  middle a circular facet
where it comes in  contact with  the cuneiforme externum.   The
posterior face joins the os calcis, is  triangular, and  semi-spiral.
The  anterior face  is oblong, transversely, and  is divided by a
slight vertical rising into two, for articulating with  the last two
metatarsal bones. 
232
SKELETON.
       Of the Cuneiforme Internum, (Premier Cuneiforme?)

  It is placed at the internal anterior extremity of the tarsus, be-
tween the scaphoides and  the first metatarsal  bone, and may be
distinguished from the other cuneiforms by its greater size.  Its
thickest part is  below.

  The anterior face presents a long vertical convexity, which joins
the first metatarsal bone.  The posterior face is not so  extensive
and is formed into a triangular concavity, having the broadest part
below, which joins the  internal facet of the scaphoides.   The in-
ternal side is semi-cylindrical and rough; it is marked, anteriorly,
near its middle, by the tendon of the tibialis anticus.   The external
side is  somewhat concave, and generally rough, and is marked
just below its superior margin  by two  articular  facets, of which
the anterior is the smaller,  and  comes in contact with the second
metatarsal bone;  the posterior, from  its  concave obliquity, gives  a
slope to the  upper margin of the bone, and is in  contact with the
cuneiforme medium.


        Of the  Cuneiforme Medium, (Second  Cuneiforme.)

  The middle or  second cuneiform bone  is  placed  upon the sca-
phoides, immediately on  the outside  of  the cuneiforme internum.
It may be distinguished by being the smallest bone of the tarsus.
Its  figure resembles  sufficiently well  a wedge;  the base of which
is above, and the  edge below.

  Its posterior face is  slightly  concave where it joins the sca-
phoides; the anterior face is slightly convex, and articulates with
the second metatarsal bone.  The internal face presents, superiorly,
an  oblong,  slightly  convex, and oblique  articular  facet, which
touches the cuneiforme internum : what remains of this  side  is
rough, for the origin of ligamentous fibres.   The external face  is
somewhat concave, and  presents, at its posterior part, a vertical
articular face for  joining the cuneiforme externum ; but, anteriorly,
it is rough for the origin of ligamentous  fibres.
  In the articulated foot the lower part of this bone  is almost con-
cealed between the other two cuneiforms. 
THE FOOT.
233
      Of the Cuneiforme Externum, (Troisieme Cuneiforme.)

  The external or third cuneiform bone  is placed upon  the sca-
phoides, between the second cuneiform and the cuboides.   Of the
three bones it is the second in size, and is also appropriately named
from its shape.   The base is upwards.

  The posterior face furnishes, on its  superior half to join the sca-
phoides, a quadrangular articular facet, sloping  outwardly, below
which the  bone projects into the sole of the foot.   The  anterior
face is flat, and articulates with the third metatarsal bone.  The
internal face presents, above, two articular facets, of which the one
at the posterior end is larger than the other, and joins the second
cuneiform; the  other, at the anterior end, is very small, and touches
the  second  metatarsal bone.   Below these facets the bone is rough,
and gives origin to ligamentous matter.   The external face, at the
middle of the base, forms an angular projection, behind which is a
small oval articular surface  that joins  the cuboides.   The  remain-
der of this face is rough, for the  origin of the ligaments, with the
exception of a  very small articular facet at the anterior superior
corner, which joins the fourth metatarsal bone.
   The structure of the bones of the Tarsus is uniformly cellular
within,  the cells being enclosed  by a thin lamina of condensed
matter.   The astragalus is rather stronger and more compact than
any of the  others.   I have seen one instance, however, in which it
had been separated into two pieces by a transverse vertical frac-
ture, going from  the  ankle joint to the articulation  with the os
calcis.  The observation was made after it had  been boiled: the
callus had completely united  the two fragments, and  no displace-
ment had occurred.

   If a vertical section  of  the os  calcis and of the astragalus be
made, the  parietes of  these  cells are found  to  radiate from  the
upper articular surfaces like  columns, so as to prevent the bones
from being crushed by the vertical weight of the body.
                             20* 
234
SKELETON.
                Of the Metatarsus, (Metatarse.)

  The metatarsus succeeds  to  the tarsus, and is formed  by five
long parallel bones like the metacarpus.  They are called numeri-
cally, beginning on the inner  side, or that of the great toe.  There
are four intervals between them, which are filled up by the inter-
osseous muscles.

                 Of the First Metatarsal Bone.

  Placed at the inner side of the foot  upon the cuneiforme inter-
num, and forming the base of the great toe, it may  be readily dis-
tinguished in the separated bones by its greater size and shortness.

  The posterior extremity presents an  oblong  articular concavity,
the greatest length of which is vertical, for joining the cuneiforme
internum.   The internal semi-circumference  of this extremity is
convex, while the  external is slightly  concave or flat;  below, it
presents a prominent tubercle, into which is inserted the tendon of
the peroneus longus.

  The anterior extremity, also  called  the head, is  rounded  and
convex, forming an  articular surface  for  the  first phalanx of the
great toe.   This surface is continued far back below, and presents
there, for the sesamoid bones, a trochlea with  a longitudinal ridge
in  its middle.   The  lateral surfaces of the head are rough  and
concave, for the origin of the lateral ligaments.

  The body is much smaller than the extremities, and is prismatic.
Its internal side is rounded, the  external side flattened, and the in-
ferior side concave, longitudinally, for  lodging the muscles of the
great toe.

                Of the Second Metatarsal Bone.

  This is the  longest of any, and may be distinguished from  the
others principally by that circumstance.

  The posterior extremity is triangular, the  broadest part being 
THE FOOT.
235
 above.  It presents  a surface  very slightly concave, almost flat,
 which rests upon the cuneiforme medium.   The sides of this ex-
 tremity being flattened, laterally, it  is locked in between the inter-
 nal and external cuneiforms;  on  its  internal side, above, is  an
 articular facet,  where it comes  in  contact  with  the cuneiforme
 internum,  and, externally, it has two articular facets.  The poste-
 rior one of the latter touches the cuneiforme externum, and the an-
 terior, which is smaller, comes in contact with the third metatarsal
 bone.   These  two  facets  run  into each  other by an  angular
 rising.

   The anterior extremity is convex and rounded;  its vertical dia-
 meter is more considerable than its transverse, and the articular
 face which it furnishes to the second toe is continued considerably
 below, in order to assist the flexion of the first phalanx.   Its cir-
 cumference is rough and flattened laterally, for  the origin of the
 capsular ligament.

   The body  is smaller than either of the extremities, and decreases
 gradually from behind forwards.  It is flattened on each side, and
 elevated longitudinally above and below, into a ridge.  There is a
 curvature  in its  length, which makes it convex above, and con-
 cave below, for the lodgement of muscles.


                  Of the Third Metatarsal Bone.

   This is rather shorter than the second, but has  very much the
 same shape.

   Its posterior  extremity, or base, is triangular, has the broadest
 part above, and articulates with the third cuneiform; the surface
 for the  latter, slopes outwardly.  Its circumference is flattened
 laterally, and presents, internally, at its superior corner, a small
 face, which articulates with  the second metatarsal;  externally, it
 also presents, at its superior corner, an a-ticular facet, which joins
 the fourth metatarsal.

  Its body and anterior extremity,  do not present any essential
points of difference from the second metatarsal. 
236
SKELETON.
                 Of the Fourth Metatarsal Bone.

   It is somewhat shorter than the third, and is placed upon the in-
ternal of the two anterior faces of the cuboides.

   The posterior extremity, or base, is more quadrangular than the
base of the preceding bones.  It presents an articular face to the
cuboides, and which is also square or nearly so, flat, and slopes
outwardly.  On its sides it is irregular; internally, at the superior
margin, it  has two  articular facets, continuous with each other,
but forming thereby an obtuse angle;  the  anterior joins the third
metatarsal; and the posterior, which is much the smaller,  touches
the cuneiforme externum.   Below  these,  the surface is rough.
The articulation with the cuneiforme externum is occasionally de-
ficient.   I have observed the latter, particularly in the negro, and
it seems to arise from  the  unusual  development of the  cuboides.
The external surface of the base has at its superior corner an ar-
ticular facet for the fifth metatarsal bone, and below it an oblique
deep fossa, before which is a tubercle.

  The anterior extremity and the body of this bone, though smaller
than those of the preceding, do not  present any essential points of
difference.

                 Of the Fifth Metatarsal Bone.

  This is shorter than  any of the others, excepting the  first, and
is placed on the front of the cuboides, externally.

  Its  base is  remarkable, and distinguishes  it strongly, by being
projected considerably beyond the external margin of the cuboides,
and forming there a  large tubercle, into the superior part of which
is inserted the tendon of the peroneus tertius, and into the posterior
part, the  tendon of the peroneus  secundus.   The base, also, has a
triangular flat surface,  sloping considerably outwards, which arti-
culates with the cuboides.  On the  internal side is the  articular
facet, whereby it joins the  base of the fourth metatarsal bone.
The base is flattened below, rough, and somewhat convex above. 
THE FOOT.
237
  The anterior extremity is more rounded than that  of the other
metatarsal bones, but in other respects similar.  The body is pris-
matic ; being flat below, flat internally, and slightly rounded exter-
nally.

                         Of the Toes.

  The toes are five in number, and named  numerically, by begin-
ning  at  the  great  one.  They each are  formed by three bones
called the phalanges, with the  exception  of the great toe, which
has but two of them.   The phalanges are distinguished into first,
second, and third.  In these several respects the toes correspond
with the  fingers.

                   Of the First,  or Great  Toe.

  The first phalanx of the great  toe is  longer  and much larger
than any other.  Its base is large, and forms a deep concavity for
receiving the  end  of the metatarsal bone.   Its anterior extremity
is formed into two small condyles, for being received into the se-
cond  phalanx.  This bone  is broad and strong, being semi-cylin-
drical above, and flat below.

  The second phalanx corresponds in its  appearance  with the
third  of the other toes, but is much larger than any of them.  Its
base is broad and flat, and has two superficial cavities for  the con-
dyles of the first phalanx.  The  anterior extremity is expanded
semi-circularly, and converted  into a very scabrous surface, for
the firmer attachment of the soft parts about it. The body of this
phalanx  is constricted  in  the middle, rounded  above,   and  flat
below.

  Connected with the great toe, are two small hemispherical bones,
lying  upon the trochlea  of  its  metatarsal  bone, and imbedded in
the tendons  of the  small muscles which  move the  first  phalanx.
They are the sesamoids, and present, superiorly, an articular sur-
face, covered with cartilage, which enters into the  composition of
the joint; and below, a rounded surface, which has nothing re-
markable. 
238
SKELETON.
  The sesamoid  bones, though  generally appropriated solely to
this joint, are yet frequently found elsewhere.  For example, in
the second joint of the same toe—in the first joint of the other toes
—in the articulation of the first phalanx of the thumb, with its me-
tacarpal bone—in the first joint  of the fingers—in the knee joint,
behind each condyle—and, in advanced life, in tendons where they
slide upon bones.   Ancient luxations give a disposition to their de-
velopment in the capsular ligaments of the ginglymous joints, of
which a very interesting specimen may be seen in the Anatomical
Museum,  occasioned  by  an external  lateral dislocation of  the
elbow.

                     Of the Smaller Toes.

  Their phalanges bear a  general resemblance to  those of  the
fingers, but are neither so large nor so long.
  The first phalanges are successively diminished to that of the
little toe, and are almost precisely like each  other.   Their poste-
rior extremities, or  bases, form a cavity deeper in proportion than
in the fingers, for receiving the ends of the metatarsal bones.   The
anterior extremities are fashioned into two small condyles for form-
ing a hinge-like joint with the second  phalanges.  The bodies  are
smaller than the extremities, more  rounded and narrower than in
the fingers.

  The second phalanges are very short, the  extremities being so
near each other that the body is of  inconsiderable length,  particu-
larly as regards the last two, where it forms  a  mere line of sepa-
ration.  The posterior  end has two  superficial cavities for re-
ceiving the first phalanx; the anterior end is imperfectly fashioned
into two little condyles for joining the third phalanx.

  The third phalanges have  a  well-formed  articular surface for
joining the second.  The anterior  extremity is rough, for the at-
tachment of the  adjoining  soft structure.   This phalanx of the
fourth and fifth toe  is frequently  very imperfectly developed, being
a mere tubercle with an articular face at one end.

  The structure of the metatarsal and phalangial bones resembles 
           DEVELOPMENT OF THE INFERIOR EXTREMITIES.         239

that of other long bones.  Porous and cellular at the extremities,
their bodies are composed of compact lamellated matter, enclosing
a cancellated* texture.
    SECT.  IV.— OF THE DEVELOPMENT OF THE  INFERIOR
                        EXTREMITIES.

   The comparatively small quantity of blood which is sent to the
lower extremities of the foetus, is the cause  of their not  being so
large in proportion to the upper, at the time of birth, as they are
subsequently.   Our wants  immediately after birth,  and during the
first months of life, are naturally such as to require but little ser-
vice from the lower extremities, in which is seen a striking corre-
spondence  between the internal arrangements of the animal econo-
my and its actual necessities; or, in other words, a continued and
rigid adaptation of means to produce a certain effect.

   The os femoris at birth presents  several peculiarities.   The su-
perior extremity being in  a cartilaginous state, is  placed more at
a right angle to the body of the bone than it is in the adult.  The
neck is  short, which by diminishing the base of  support to the
trunk, makes the progression of infants more tottering and infirm.
The lower extremity is also cartilaginous and large.   The body
of the bone has but a very slight degree of curvature, which like-
wise increases  the difficulty of standing and  walking in very young
subjects.   The patella is cartilaginous.
   In the leg the bodies  of the tibia and fibula are ossified, but their
extremities are cartilaginous.   The bones of the tarsus, with the
exception of parts of the os calcis and of the astragalus are carti-
laginous.   The metatarsus and the phalanges are  ossified in their
middle, but cartilaginous at their extremities: their development is
not so complete as that of the corresponding bones  of the hand.
   About the fifteenth year, the bones of the lower extremities have
very nearly the same forms as in the adult: they are all fully ossi-
fied, with the exception of their  extremities not  being  fused or
joined to their bodies; but still in the state of epiphyses, and, there-
fore, separable either by  boiling  or long-continued  maceration.
Exclusively of  this condition, which  sometimes remains  to the 
240
SKELETON.
 twentieth or twenty-fifth year, the epiphyses are as fully ossified
 as at any subsequent period of life.


 SECT. V.—ON THE  MECHANISM  OF  THE INFERIOR EXTRE-
              MITIES IN REGARD TO STANDING.

   The os femoris is well adapted by its shape and  position to the
 erect attitude.  The curvature which its body makes in front has
 the effect of advancing the  lower part of it, and thereby keeping
 it in a line with the centre of the trunk ; but if it had been perfectly
 straight, the erect position would have been maintained with great
 difficulty, owing to  the centre of the trunk being in advance of this
 bone.   Under the latter circumstances, an  incessant tendency to
 fall forwards would have manifested itself, which could  have  been
 obviated only by flexing the ossa femorum very much  at the hip
 joint, or by  keeping one foot always in  front of  the other.  Even
 under the actual arrangement  of the skeleton, when  muscular sup-
 port is withdrawn from it suddenly, it falls forwards, owing to the
 weight of the parts  anterior  to the spine  being greater than that of
 the parts  posterior to  it. When muscular action is weakened or
 badly regulated, the same tendency to fall forwards is manifested:
 children continually tumble  in that direction: a person  in a state
 of intoxication, somewhat short of the entire loss of locomotion,
 not being able to sustain the trunk of the body erect by the mus-
 cles of the back, inclines forwards, and  would be precipitated to
 the ground,  were it not that at this  crisis one leg is involuntarily
 advanced, so that the  base of support is much augmented.  But if
 the individual attempt to walk, the continued necessity of keeping
 a large basis of support to prevent the body from falling forwards,
 urges him into a slow running or trotting gait.

  The arrangement of the whole upper extremity of the os femoris
 is also highly favourable to  the erect attitude and to locomotion.
 The neck of the bone, by its length and  oblique position in regard
to its body, enlarges transversely the base of its support, and gives
great stability in preventing the trunk from falling either to  the
right or left; while  it  contributes at the  same time to the facility
of progression, in permitting the os femoris to bend forwards and 
             MECHANISM OF THE INFERIOR EXTREMITIES.         241

backwards.  The lateral or transverse extent of the base, thus ob-
tained, cannot be supplied with equal effect in any other way, as
a certain proportion between  the diameters of the pelvis and the
length of the neck of the thigh bone is indispensable.   In females,
where the transverse diameter of the pelvis  is greater than in
males, though standing is equally secure as in  the latter, yet their
progression is always marked by a want of firmness strongly cha-
racteristic  of the  sex.  The strength of the articular connexion of
the os femoris with the innominatum is confirmed by the acetabulum
being placed where  the latter is re-enforced  by the linea ilio pec-
tinea, and by the anterior  inferior spinous  process;  and as the
principal weight  of the trunk  is sustained  by the acetabulum, im-
mediately below  the latter process, we  accordingly find it at this
point of the greatest depth.   It  is  also  to  be stated, that the cap-
sular ligament at this part is stronger than  elsewhere, thereby con-
forming strictly to the general purposes of the articular connexion.
The capsular ligament is assisted by the ligamentum teres, which,
by arising from the  lower margin  of the acetabulum and passing
upwards to the  head  of  the os femoris, prevents the head  from
sliding upwards, while it permits it to swing freely backwards and
forwards in its socket.

   In  erection, the bones of  the  leg are in  a line with  the vertical
diameter of the trunk: in this respect  they differ very materially
from  the os  femoris, which not only inclines forwards in  its de-
scent, but also  leans towards  its fellow  internally,  and  almost
touches it at the knee.  This relative position of the leg and thigh
is obtained by the greater length of the internal condyle of the os
femoris, and also by the other peculiarities of form in the latter;
whereas the tibia is nearly straight in the direction of its long dia-
meter, and has a horizontal articular surface above, whereby it
and the os femoris make an entering angle externally and a salient
one internally.  Under common circumstances, the weight of the
trunk is transmitted to the foot exclusively through the tibia, owing
to the fibula not entering  into the  composition of the knee joint,
and not being sustained by any bony basement at its inferior part.
The fibula  is principally intended for the origin of muscles, and for
the lateral security of the ankle joint; and may be broken without
the accident suspending either erection or locomotion.
  Vol. I.—21 
242
SKELETON.
   The position and shape of the foot concur largely in the general
object of maintaining the human being in the erect attitude.  Fixed
at right angles to the leg, and articulated by a surface in the centre
of its most solid structure, the tarsus, it receives the weight of the
body perpendicularly upon the astragalus.   The latter  being the
key-stone to the arch, diffuses the pressure through the remainder
of the structure, so that the whole foot is planted against the ground,
an attitude more fully executed by man than by any other animal.
The tendency of the body to fall forwards, requires a very consi-
derable elongation of the foot in front of the tarsus, in order to
increase  the extent of the base of support in that direction.  We
accordingly find the metatarsal bones  not only forming bases for
the flexion of the phalanges;  but also by their great length,  by the
flatness of the articular faces which they present to  the tarsus, and
by their consequent immobility at these  points, extending and se-
curing the base of the body in that direction to which its gravita-
tion  most  inclines it.  The  first metatarsal  bone,  though  corre-
sponding  in place with the first  metacarpal, is very unlike it  in
other respects.  Of predominating magnitude, but parallel with the
other bones and immoveable at its  base, it  is obviously  intended
for sustaining the body, and least of  all for prehension and for an-
tagonizing the other bones, as is the  case with the thumb.

  The points on which the  foot  is  particularly pressed  when we
stand, are the tuberosity of the oscalcis, the tuber of the base of
the last metatarsal bone, with the under surface  of the  cuboides,
and the anterior extremity of the first metatarsal bone.  The arch
of the foot, upon which this  depends,  may be considered in  two
ways: one is in the longitudinal  direction, and has its abutments
in the os  calcis behind, and in the ends of  the metatarsal bones in
front, the  other is transverse, is  but slightly elevated externally,
indeed almost flat, while it is raised to a  considerable height in-
ternally.   This double  arrangement is  eminently  serviceable  in
many respects: it permits a concavity in which the muscles of the
toes may repose and act without being pressed upon by the super-
incumbent weight of the body—it also permits a free flow of blood
and of nervous energy to this structure, gives a  very elastic  base
to the whole body, and allows itself to  be applied to such  inequali-
ties of surface as it meets with. 
             MECHANISM OF THE INFERIOR EXTREMITIES.         243
                                            i
   It has been  agitated, by some ingenious inquirers into the ori-
ginal condition of man, whether  the erect attitude is  natural to
him and not the result  of an advancement in civilization.  Inde-
pendently of the proofs derived  from the authentic reports of tra-
vellers concerning the varieties of the human family, from none of
whom have we reason to believe that the latter have any  where
been found  adopting  habitually  the attitude of quadrupeds; there
are evidences derived from the general mechanism of the skeleton,
still more  conclusive, that standing is fully natural to  us.   For
example, 1st, The position of the foramen magnum occipitis, evi-
dently farther forwards in man than in animals, indicates that his
voluminous head  is to be kept in equilibrium by a vertical line of
support near the centre of its base.  2d.  The ligamentum nuchae,
weak in man, is strong in quadrupeds.  3d. The curvatures of the
spine are so varied  as  to diminish  the  tendency to fall forward
when we are erect.  4th. The direction of the orbits of the eyes,
which looking  forwards, when we stand, and enabling the eye to
apply itself to a vast circumference,  would, in the quadruped posi-
tion, be directed towards  the ground, and thereby have the sphere
of  observation  reduced to a  few yards.   5th. The opening of the
nostrils, when we  stand, permits odours  to ascend easily into the
nose; in the other attitude this opening would  be directed  back-
wards.   Such  are  the circumstances, in connexion with the head
only, which indicate the necessity of the biped position for the full
enjoyment  of the  functions  which the Creator has given  to  us.
But there are, also, others equally evident in the  mechanism  of the
extremities, and of the parts of the trunk to which they are attached.
Thus, 1st, The breadth  of the pelvis, and the actual obliquity of its
superior strait,  in  regard  to  the spine, prevents us from  falling to
one side, and, at the same time, brings the lower extremities im-
mediately in a line with the spine.   2d.  The length of the neck of
the os femoris,  and the size of its condyles.   3d.  The articulation
of the knee, which permits the  leg to be brought  into a line with
the os femoris,  a position impracticable  in quadrupeds.   4th. The
foot being articulated at a right angle with the leg, and  having its
tarsus and metatarsus so well developed.   5th. The predominance
of the transverse diameter of the thorax over the vertical, which,
with the great length of the clavicle, and the shape of the scapula,
unfit the latter for  assisting much in  progression.   6th. The shape
of the hand, calculated  to seize upon objects, but from the length 
244
SKELETON.
 of its phalanges not suited to sustain the body.   7 th. The mode of
 articulation at the wrist, which, from  its mobility and weakness
 in the direction to which the weight of  the body would be applied
 to it, could not be brought to support it advantageously.   And,
 lastly, the great disproportion of length, in the adult, between  the
 upper and lower  extremities, when an attempt  is made to walk
 like the quadruped.

   In considering the skeleton of the very young child, it is worthy
 of remark how closely its mechanism,  with  the exception of  the
 head, corresponds with the habits  of early life.   A spine, nearly
 straight, and a pelvis, the  lateral diameter of whose cavity is so
 small that the transverse base of support is much diminished, ren-
 der erection inconvenient.   Lower  extremities shorter  in propor-
 tion than the upper ones, having thigh bones nearly straight;  also,
 the articulations of the knee not admitting of a full extension of
 the leg.  All these  circumstances prove that  the quadruped posi-
 tion, inconvenient  and  intolerably irksome when continued for a
 length of time in the adult, is natural to  the young infant.

  The space between the ossa femorum, produced  by the breadth
 of the pelvis and the length of their necks, and, therefore, always
 considerable above, varies below in different individuals.  A cer-
 tain distance at the latter point seems to be indispensable to con-
 venient and graceful progression.   Thus, when  it is in excess, it
 produces the deformity  called  bandy legs, and causes a tottering
gait, such as may be mimicked, at  any  time, by walking with the
legs  in a  state of abduction: but, when diminished, it  is called
knocked  knees, and interferes with the firmness of the step  by
causing the centre of gravity to pass, alternately, through the  in-
ternal  condyles of the  ossa femorum,  instead of falling exactly
between them.

  The firmest position  in which we can stand is that in  which the
feet are perfectly straight and parallel  with each other, so as to
form a square  base for the support of the trunk.  If from this  posi-
tion the toes be turned either inwards or outwards,  the consequent
reduction of the antero-posterior diameter of the base, causes less
resistance to the natural inclination of the trunk forwards.   What-
ever may be the grace and the ultimate intention of the first  posi- 
              MECHANISM OF THE INFERIOR EXTREMITIES.          245

 tion in dancing, to wit, that of having the feet nearly in the same
 line, with the heels touching and the toes outwards, it is certainly
 the most unfavourable attitude for ease in'keeping the body erect
 that can be  adopted;  for the  base of support diminished, both by
 the length of the body  of the os  calcis, and by that of the foot,
 anterior to the ankle joint, the trunk is continually inclining either
 forwards or backwards, and is prevented from falling only by the
 alternate action of the muscles behind and in front.

   When we are upon the knees, the base of support for the trunk
 being  entirely withdrawn in front, it is necessary, in order to main-
 tain the position, and  to prevent falling forwards, that the hip joint
 be flexed so  as to throw the weight of the body entirely behind the
 thigh bones.  The position is one of so much restraint and fatigue
 upon the muscles, that it can  be maintained for a long time, only
 by some artificial support in front,  or by the buttocks falling down
 upon the legs, and resting against them.

   The position we assume on being seated in a chair, is the easiest
 of any of those in which  the trunk is kept erect, or nearly so.   The
 length of the lever, represented by the whole  length of the skeleton,
 is then diminished one-half; consequently,  any preponderance of
 it at particular points, above, bears with less force upon the base.
 The base itself is much  augmented by the amplitude of the  but-
 tocks, and by the horizontal position of  the  thigh bones in front;
 and may be also increased,, at pleasure, by the extension of  the
 legs.   If,  under  such  circumstances, the trunk of the body be
 slightly advanced, its equilibrium is so easily maintained as to re-
 quire but a very little  muscular action to continue it.  The most
exposed part of the base  is backwards; and, if the trunk be kept
perfectly erect, there is some tendency of it to fall in that direction.
Hence, the utility of backs to seats, and the fatigue from such as
have not.
21* 
246
SKELETON.
SECT. VI.—ON THE  MECHANISM OF  THE  INFERIOR EXTRE-
            MITIES IN REGARD TO LOCOMOTION.


                1. Of the Motions of the Thigh.

  These, like  the  motions of the os humeri, upon the scapula,
consist in extension, flexion, abduction, adduction, rotation, and
circumduction; but, in consequence of  being performed upon an
immoveable basis, the  acetabulum, they are much  less extensive.
In order that  they may be  understood well, it will be useful  to
assume  certain points  of reference  in  the os  innominatum and
femoris.  These are the trochanter major, the pubes, and the ante-
rior superior spinous process of the ilium.  In standing, the lower
external part of the trochanter major, where it forms a bulge on
the side of  the thigh bone, is  on a horizontal line with the upper
part of the symphysis pubis.   A triangle, described by lines drawn
from the anterior superior spinous process to the symphysis pubis—
from the latter to the point mentioned of the trochanter, and from
the latter to the anterior superior spinous process, will be nearly a
rectangle, of which the  base is above, and  the  shortest side be-
hind.

  The flexion  of the os femoris is that  motion in which its lower
extremity is carried forwards.   It is performed  with great  ease
and freedom, in consequence of the arrangement of the articular
surfaces of the bones, and of the  capsular ligament.   The head
revolves freely in the acetabulum, the ligamentum teres is  put into
a slight tension, and the  end  of the trochanter major  approaches
the sciatic  notch.   The  extreme point of this  motion is  the one
preserved by the os femoris of the foetus in utero.
  Extension is the reverse of flexion.   When the latter has been
performed, extension restores the thigh bone to its vertical position,
and carries it  some degrees farther, but cannot be executed to the
same extent behind, that flexion is in front.   When  pushed to an
extreme, it brings  the trochanter major under the inferior  anterior
spinous process of the  ilium, and the round ligament is put very
much upon the stretch;  it is, finally, arrested by the lower part of
the neck of the os femoris lodging against the posterior elevated 
             MECHANISM OF THE INFERIOR EXTREMITIES.         247

margin of the acetabulum, and by the thickened part of the cap-
sule, in front  and above, being so  much distended as not to yield
farther without laceration.

  Abduction  is the  act  by which  the thigh bones are separated.
When carried to an extreme, the under part of the head of the os
femoris leaves the acetabulum, and distends very forcibly the cap-
sular ligament at this point.   The  superior fasciculus of the round
ligament is strongly extended; but the  inferior fasciculus is kept
easy, and, indeed, somewhat relaxed.  This motion is arrested by
the trochanter major striking against the  ilium; without which it
would be much more extensive, as  the capsular ligament is strained
at its weakest point, and relaxed at the strongest.

  Adduction  is the  reverse of the  last.   The  muscles which pro-
duce it, the adductors, from their situation and course, are unable
to give an extent to this motion much beyond the act of reinstating
the thigh when it  has  been abducted.   In  this respect  they are
much less influential than the great pectoral muscle which adducts
the os humeri.   The articular surfaces of the  bones are  suited to
a much greater  latitude of this movement, but it is arrested both
by d  deficient power in  the muscles,  and by the strong upper part
of the capsular ligament being put  upon the stretch.

  Circumduction is the  regular succession in  a circle of the four
preceding motions,  and  is much less extensive in the os femoris
than in the os humeri, for the reasons  stated.   The centre of the
circle, or cone,  thus described, is  the head of  the bone, and it is
much more  extensive  anteriorly and externally  than  posteriorly
and internally.

  Rotation, owing to the length  of the neck of the os femoris, is
extremely well marked, and is indicated by the trochanter major
moving backwards  and forwards.  The radius of the circle thus
described, is  the distance between  the centre of the head  of the os
femoris and  the bulging external  part of the trochanter major.
The rotation  outwards or backwards is more fully and easily per-
formed than the reverse, owing to  the number and favourable po-
sition of  the muscles causing it, many of  which are specially ap-
propriated to its production, and some others  partially so.   This 
248
SKELETON.
   movement is arrested by the neck of the bone striking against the
   acetabulum behind, and by the tension of the capsular ligament in
   front.  Rotation, forwards, having but few muscles to produce it,
   and they neither specially devoted to it, nor acting very advanta-
   geously for the purpose, is arrested by the neck of the bone striking
   against the fore part of the acetabulum, by the  tension, behind, of
   the capsular ligament,  and also, by that of the ligamentum teres.
   When the convexity and the neck of the os femoris look directly
   forwards, it is indicated by the great toe pointing  in the same di-
   rection.

                   2. Of the Motions of the Leg.

    The movement of the leg upon the thigh  is  that of flexion, of
   extension, and a very partial degree of rotation.

    In flexion, the head of tho tibia slides  backwards upon the con-
   dyles of the os femoris, which are prolonged behind,  for the pur-
   pose of extending this motion.   It is checked, when carried to an
   extreme, by the posterior margin of the  tibia  striking  against the
  os femoris, and by the tension of the  ligament of the patella.   In
   the mean time, the lateral, the crucial, and the posterior ligaments
  are relaxed.  The patella, always stationary, and at the same  re-
  lative distance in regard to the head of the tibia, slides downwards
  upon the trochlea of the os femoris, and in the flexed position sinks
  between the condyles, so as to come in contact with the ligamen-
  tum mucosum.

    In extension, the patella rises  upon the condyles, and becomes
  prominent; the lateral ligaments are rendered somewhat tense, and
  the motion is finally checked, by the resistance of the  crucial and
  of the posterior ligaments of the articulation.

    The rotation of the bones of the leg can only be performed when
  they are flexed, and the  ligaments, generally, thereby relaxed, in
  which  position  a very  limited motion, inwards  and outwards, is
  perceptible.  The motion, outwards, is the more extensive of the
  two, in consequence of  the arrangement  of the crucial ligaments,
  which are separated from each other by it.  The motion, inwards,
(  is limited  by these ligaments being brought immediately by it into 
             MECHANISM OF THE INFERIOR EXTREMITIES.          249

 close and resisting contact with each other.   In either case, how-
 ever, the posterior and  the  lateral ligaments all contribute, ulti-
 mately, to arrest the motion.

   In all  these conditions of the leg, the semi-lunar cartilages slide
 somewhat upon the head of the tibia.
   The articulation between the tibia and the fibula is such as to
 admit of no motion whatever below; but, above, a limited sliding
 backwards and forwards is performed by the fibula upon the tibia.
 This movement is made more perceptible in cases of extreme ema-
 ciation, and in general relaxation of the muscular  system.


                  3. Of the Motions of the Foot.

   The general motions of the foot  upon the  bones of the leg are
 flexion, extension, and an inconsiderable  inclination inwards  and
 outwards.

   In flexion, the astragalus rolls backwards in the  articular cavity
 formed by the tibia and the fibula, and is  arrested by the anterior
 upper part  of the astragalus coming in contact with the articular
 margin of  the  tibia.  The ligamentous fibres  and the synovial
 membrane, in front of the articulation, are relaxed; those  behind
 are in a state of tension, as well as the tendo-achillis, and  the other
 tendons there.   Luxation from an excess of  this motion is  almost
 impossible.

   In extension, the foot  is  brought with the  point downwards, so
 as to have its upper surface almost  on a line with the  bones of the
 leg.   The astragalus glides forwards;  the tendons, on the back of
 the joint, are very much relaxed.   The joint itself  is in a state the
 reverse ol the preceding.

   In the  lateral motions, the sole  of the foot is caused to present
 itself either obliquely inwards or outwards, whereby it may  be ac-
 commodated to any inclined  surface on  which we walk.   The
first position is checked by the  internal malleolus,  and  the tension
of the external lateral ligaments;  the second,  by the external mal-
leolus, and  by the tension of the internal lateral ligament.   These
motions constitute the adduction  and the  abduction of the  foot; 
250
SKELETON.
and by a regular succession with its flexion  and extension, com-
municate a very limited and  embarrassed species of circumduc-
tion.

  The bones of the tarsus, for the most part,  have a very obscure
motion upon each other, with the exception of the articulation be-
tween the astragalus and the scaphoides, and between the os calcis
and cuboides.  At these points the movement upwards and down-
wards, makes a sort of flexion and extension of the fore part of the
foot, which  is very distinct.  A species  of  twisting, or  oblique
gliding, is also slightly perceptible there.

  The bones of the metatarsus are susceptible of a slight elevation
and depression, which, almost imperceptible at their bases, become
sufficiently obvious at their anterior extremities.   They also may
be slightly approximated, at their fore parts, by the action of mus-
cles, and by external compression.  When the weight of the body
is thrown upon them, they separate from each  other,  and the me-
tatarsus loses, in some degree, the arched form of its  anterior ex-
tremity below.

  The phalanges of the toes have the same motions with those of
the fingers, except that they are  more restricted.   The first ones,
therefore, perform flexion, extension, adduction, abduction, and cir-
cumduction;  the last two have only flexion and  extension.  The
extension of the first phalanges is more extensive than  their flexion,
from  whence results an important advantage in walking or in
standing upon the toes.  The shortness of the second and  third
phalanges of the small toes, together with  the thickness of the sole
of the foot contiguous to them in  their extreme flexion, causes them
rather to be doubled up on themselves, than on the sole of the foot.


        On the General Motions of the Lower Extremities.

  These  may be  resolved  into  three;  walking, running,  and
leaping.

  In walking, though the first step  may be taken in  a variety of
relative positions of the lower extremities  to each other, yet it will
make the investigation more clear to suppose the individual stand- 
MECHANISM OF THE INFERIOR EXTREMITIES.         151
ing erect, with the two feet precisely on the same plane, and giving
equal support to the trunk.  The first step is then taken, by de-
taching the foot of one side from the ground; in order to do which,
the thigh is bent upon the trunk, the  leg  upon the thigh, and the
limb by being thus elevated becomes shorter.   At this period the
ankle joint remains at rest, with a slight inclination  of the toes
downwards.  By the subsequent relaxation of the muscles of the
limb advanced, with an inclination of the trunk to the same side,
the limb is caused to descend upon  the  ground.   These are the
only motions when the step  is short and  easy;  but, when a long
stride is taken, by which the limb is put very much in advance of
its fellow, in order to bring it to the ground, the pelvis is  caused to
rotate  forwards on the head of the stationary thigh bone, whereby
the trunk of the body, instead of presenting the sternum  forwards,
has it  turned to one side.
   When a step has been taken so as to  leave  one inferior extre-
mity advanced before the other, for example the  left, the limb be-
hind is brought forward  by the  following mechanism;—The left
foot, remaining fixed, becomes the point of support to the trunk;
and the right, which is  behind, is elevated successively, from the
heel to the toes, by the action of the muscles on the back  of the
leg, and rests upon the phalanges.  The effect of this position is to
elongate the  right inferior extremity to the amount of the distance
between the  fore  part of the ankle joint and the anterior extremity
of the metatarsus, whereby that side of the pelvis is pushed for-
wards, and a rotation in advance impressed  upon it.  By the lat-
ter  impulse, the  foot  of that side  is wholly detached  from  the
ground, the thigh being flexed at the same moment at the hip joint,
and the leg flexed at the knee, the whole extremity is carried for-
ward  and fixed upon the ground, after the manner described in the
first step.  Ordinary progression results, then, from the regular
succession of the last motion in  the two extremities.   In regard to
the impulsion of the pelvis from the foot  behind, this will probably
take place in every case, more or less; it  may, however, be re-
duced very much by a certain extent of flexion at the knee joint;
 and the want of it not be felt, because other powers concur to pro-
 duce the same impulsion; as certain muscles, and also the momen-
tum of swinging  the lower extremity forward.
   An  equality of length in the  lower extremities is indispensable
 to graceful  and  regular progression.   If one of them be short-1 
252
SKELETON.
 ened from any cause whatever, it is manifested in the  gait, by an
 unusual sinking of the pelvis on the defective side, at the moment
 the foot is brought to the ground, and  from the continuity of the
 pelvis with the  upper parts of the body, a considerable lateral  in-
 clination is communicated to the latter in the same instant.  The
 pains frequently taken to conceal this defect, disguise it very im-
 perfectly, unless the shortness be only such as may be supplied  by
 a shoe with a sole thicker than  that of the other foot.   Where the
 shortness arises from luxation upwards of the os femoris, a crutch
 is the best substitute for sustaining that side of the pelvis.

   In running, the position of the feet is somewhat different from
 what it is in walking; they are extended so as to support the trunk
 on the phalanges alone, instead of on their soles: whereby a double
 advantage is  obtained, that of keeping the  lower  extremities  at
 their greatest possible length, and also of enabling them to detach
 themselves  quickly from the ground.   The  velocity here is the
 principal difference between it  and walking, yet  there  are some
 peculiarities.
   The trunk of  the body is kept continually and  largely inclined
 forwards, which  enjoins the necessity of a quick  successive ad-
 vance of the lower extremities  to prevent it  from  falling.  This
 position,  also, by  advancing the  bony points, from which arise
 several of the muscles used in the extension of the thigh, removes
 these muscles more from the line of their contraction, and thereby
 enables them to act more advantageously and  promptly.   As each
 pace on  these occasions is taken to the fullest  stretch, the pelvis is
 rotated forwards from side to side,  alternately upon the head of
 the os femoris, which may be fixed  at the time.   The  face being
 directed  forwards, whatever rotation in the vertebrae can  occur,
 is then performed.  As the pelvis communicates its motions to the
 trunk, so the latter carries its own to the upper extremities; which
 are thereby slung, alternately, backwards and forwards, and are
 brought, continually, to adjust the centre of gravity, which is then
 more in danger of being lost than in  ordinary walking.
  The ascent of an inclined  plane, either by walking or running,
 is attended with  unusual fatigue and difficulty, for  the following
 reasons: In  order to advance the thigh, it is  necessary to give it
 great flexion at the hip joint, the knee must also be bent in an equal
degree, and  the foot be flexed, in order to adjust it to the surface 
MECHANISM OF THE INFERIOR EXTREMITIES.
253
against which it reposes.   To bring forward the other extremity, it
requires an equal flexion at the  hip and  knee; besides which, its
heel being below the phalanges, the foot must  perform a full rota-
tion at the ankle joint.  The difficulty is somewhat diminished by
stepping only on the phalanges.  As, in these  cases, the  trunk of
the body, to preserve its  equilibrium, must be inclined forwards,
there are certain acclivities, which, though they furnish a  base
sufficiently large for the foot, are yet impracticable from not allow-
ing the trunk to be thrown forwards.
   The descent of an inclined plane is  more  easy, because it re-
quires but little flexion,  in the articulations mentioned, to bring the
extremity behind on a line with that in  front; and its subsequent
descent is produced by keeping it almost straight, and shortening
the extremity which is fixed.  Running is then attended with some
inconveniences, for the impulsion, forwards,  which  this motion
communicates to the trunk, assisted by the inclination of the plane
in that direction, determines a fall, inevitably, without a  succes-
sively accelerated advance of the  hind  leg.  We see frequently,
in the descent of a very inclined  hill, a  step, at first  guarded and
leisurely taken, converted, unavoidably, into a  full  run, to prevent
the body  from being precipitated  forwards to the ground.

   In jumping, the  whole body  is projected  abruptly from the
ground, either in a vertical or oblique direction.
   In the  first, the lower  extremities are shortened by a general
flexure of their  articulations, and, by a very sudden and  simulta-
neous extension of them, the resistance of the ground causes the
whole frame to mount upwards, till its gravitation causes the mo-
mentum to cease; it then  descends  on the same principle with  pro-
jectiles, generally.   In  the oblique  leap, there  is the same flexion
in all the  articulations of  the lower extremities, with the  addition
of an inclination, forwards, of the trunk.  At the moment when
the limbs straighten themselves, the trunk  is projected, not only
upwards,  but forwards, owing to its inclination, and describes in
its ascent  and descent a  parabola.  In this effort, the space tra-
versed will be more  considerable, if a previous horizontal  momen-
tum  has been communicated to the trunk  by running several steps
before the leap be made.
  The more oblique the leap is, the greater will be its extent, to
effect which the trunk must  be inclined  proportionably forwards.
   Vol. I.—22 
254
SKELETON.
But, to obtain this  inclination without  falling, it is  necessary for
one of the lower extremities to be very  much  advanced at the mo-
ment of springing with the other, so as to convert the motion into
a very long  step.   With  this position of the lower extremities, a
much longer space can  be cleared  than if  they were kept toge-
ther.*

  * For a farther exposition of  the principles of locomotion, see Joh. Alph. Borelli
de Motu Animalium, 1710.  Haller, Element. Physiol, lorn. iv. 1757.  Bichat, Anat.
Descript. 1801.  Barthez, Nouvelle Mechanique des Movemens de l'Homme et dea
Animaux, 1798. 
BOOK  I.
PART  III.
                        CHAPTER I.

                        ARTICULATIONS.

              OF THE CARTILAGINOUS SYSTEM.

  Cartilages  (Cartilagines,  Systeme Cartilagineux,)  supply the
place of bone in many parts of the human skeleton, as in the space
between the ribs and sternum, in the larynx, in the external  ear,
in the  nose, and  elsewhere.   They  are also  to  be found in all
the moveable, and  in  several  of  the immoveable articulations.
Wherever placed they may be recognised by their whiteness, by
their flexibility, by their  great elasticity, and by  a  hardness only
short of that of the bones.  There are many animals whose skele-
tons are entirely cartilaginous, as the chondropterous or cartilagi-
nous fishes, so excellent a substitute is cartilage for bone.
  Cartilages  have neither  canals nor cells in them like those of
bones.   They appear homogeneous; and, upon  a  superficial in-
spection, present neither laminae nor  fibres.  The immersion  of
them in boiling water dissolves into a jelly, such as are found upon
the articular surfaces of the bones, and a few others; but, such  as
supply the  place of bone, though softened by the  process, are not
rendered by any means so gelatinous.  Their chemical analysis,
according to Mr. I. Davy, is gelatine, 44.5; water, 55.; phosphate
of lime, 0.5.   The testimony of different experimenters, upon the
latter point, does not coincide, and their results must vary accord-
ing to the kind of cartilage, and the period of life. 
256                        SKELETON.
   Cartilages are composed  of a tissue exclusively their own, and
 of parts which they have in  common with other organs.  The
 first has some  very distinguishing properties.  It resists putrefac-
 tion,  either with or without maceration, longer than any other
 tissue, except the bones.  In the midst of gangrene it preserves its
 appearance almost unchanged.  Boiling gives it a yellow colour,
 causes it to swell, and, if protracted, the gelatinous portion is dis-
 solved.  When dried,  it becomes of a semi-transparent  yellow,
 diminishes in bulk, and loses its elasticity;  in  these respects re-
 sembling ligaments and tendons.
   Cellular substance exists, in very small quantities, in cartilage,
 and is therefore, not  readily demonstrated; it is, however, made
 manifest by maceration, and by the  action of boiling  water: the
 latter, by dissolving the gelatinous portion, leaves a  membranous
 and cellular structure.  It is also stated, that in  certain diseases,
 the gelatinous portion  being less abundantly secreted, the  cellular
 is left in  a  soft  spongy condition.
   In a healthy state, no blood vessels can be  seen in  cartilages;
 yet there are the strongest proofs of a species of  circulation going
 on in  them, either by very fine capillary vessels, or an interstitial
 absorption.  All  experienced anatomists  have  seen,  in  subjects
 affected  with jaundice, the  entire  cartilaginous system losing its
 brilliant whiteness,  and becoming of a light yellow: also, the con-
 version into bone, in extreme old age, to which all cartilages, with
 but few,  perhaps no exceptions, are subject; and this ossification
 sometimes  beginning in the centre of the cartilage, prove that the
 calcarious  matter  has been conveyed there by some  kind of
 channel.
   Neither absorbents nor nerves have been traced into them, and
 it is not  possible to prove conclusively, their existence  by  the cir-
 cumstances of  disease.  We only know, that in  inflammations of
 the joints, terminating  by anchylosis, the cartilages are absorbed;
 and that in some cases, even without evident  inflammation, the
 cartilage is removed from a joint as if it had  been worn  away.
 Ulcerations of  the arytenoid cartilages are spoken of as common,
by the  French  anatomists; and I have, since the first edition of this
work, seen several instances  in chronic Laryngitis; but it  has not
occurred to me to see  any others  unequivocally in this state: the
late Dr.  Physick's experience is also the same with my own.
Possessed of no animal sensibility in the natural state, it is doubtful 
THE CARTILAGINOUS SYSTEM.
257
 whether they ever have it, or Can inflame, as the pains in inflam-
 mations of the joints may arise from the synovial membranes.
   In the embryo, the osseous and cartilaginous  systems are con-
 founded, so as to present a homogeneous, mucous or pulpy appear-
 ance; they only  become distinct by the deposite  of  calcarious
 matter in the  bones: when the latter are somewhat  advanced, the
 cartilages, which are to remain  such, have also additional consis-
 tence, and more of a proper cartilaginous look ;  but the appearance
 is generally unsatisfactory, by which one can learn  to distinguish
 the cartilages that are to remain such, from the cartilaginous rudi-
 ments of the  bones.   The  following  circumstance, however,  is
 pointed out  by Bichat:  in the cartilages of ossification, there is a
 vascular net-work between the cartilage  and the ossification which
 has occurred, and owing to  the interposition of it, the two may be
 easily separated.  But, in the permanent cartilage,  this  net-work
 does not exist between the proximate surfaces, consequently they
 adhere with a tenacity not  admitting of a rigid  separation from
 one  another.

   In no structure of the animal body does there exist so great a
 similarity of structure to that of the vegetable kingdom  as in car-
 tilages, the mode of origin of the cells being identical.

   The distinctive character of cartilaginous tissue is  the large
 quantity of extremely consistent cyto-blastema it  contains.   The
 first  formation and growth of cartilage  is  the production of cells
 in the cyto-blastema, whilst fresh cyto-blastema is formed, within
 which fresh cells are evolved, and in this manner  the process con-
 tinues.  The formation  of new  cells occurs exclusively on  the
superficies of the substance, or in its vicinity, where,  therefore, the
cartilaginous mass is in immediate contact  with the nutritive mat-
ter.*
  Cartilages are divided into permanent  and  ossific.  The first
remain as cartilages until  old age; the latter  are always destined,
sooner or later to become bone.   The  original  structure is identi-
cal.   There is,  however, a  chemical difference  discovered  by
* Schwan in Wagner, p. 223.
         22* 
258
SKELETON.
Miiller, the permanent cartilages yielding on  long boiling a proxi-
mate principle called chondrin.
   In true cartilage there is a hyaline or transparent basis in which
are  scattered the cartilage corpuscles,  which are small, round,
oval, or flat  and elongated Cavities, from the ToVo to ^Vo- of an
inch  in diameter.*   These  corpuscles  are regarded by  Bruns,
Schwan, and Henle as genuine cells, when walls during develop-
ment have become amalgamated with the inter-cellular substance,
and not as mere cavities  hollowed out in  the hyaline or vitreous
substance, for by long boiling the basis structure  is dissolved, and
they remain  as distinct  corpuscles, with  frequently a  lining mem-
brane.f  Each cell contains a nucleus, enclosing several nucleoli,
and are sometimes surrounded by cells.   The nuclei are  some-
times filled with minute particles of oil, and sometimes they are so
numerous as to cause them to resemble fat  cells.   In  the articular
cartilages the corpuscles are most numerous  and smallest at the
portion farthest from  the bone.  Their long axes lie vertical to the
surface of the bone,  except a thin layer next the joint, in which
they are flattened and lie parallel to the articular surface, as is seen
in tearing  a  cartilage.   In the cartilages of the  ribs the interna]
corpuscles are arranged  in rows radiating from the axis.
   The basis  substance is generally homogeneous and structureless,
but in some cartilages it ultimately becomes  fibrous  at the same
time that fat is developed in the  nuclei, the pearly hue colour is
exchanged for a yellow-ish hue.  These would seem to  be the initia-
ting steps  to  the ossific deposite.

   According to  the  recent  researches of Mr. ToynbeeJ the nu-
trition of cartilages is effected without  the medium of the blood
vessels, which never penetrate it in a healthy state.'

   As the  individual  reaches adult  age, the cartilages acquire the
strength, whiteness, and  great elasticity which distinguish  them.
In old age they become yellowish, more brittle, and  are, as said,
generally disposed to ossify.  Those of the ribs  and larynx  are
frequently ossified at forty years of age.   The  ossification of those

  * Meckauer. De penit. curt, struc. Breslau, 1836.  Bruns, All. Anat. p. 215.
  t Bruns, I. c.  p. 211.  Schwan. Mikrosk Unter. Henle All. Anat. p. 794.
  t Phil. Trans. 1841. 
DEVELOPMENT OF CARTILAGES.
259
 of the  moveable joints  is rare, and  begins at a  more advanced
 period.  In the first two it begins commonly near their centre, and
 in the last on the surface.


        ACCIDENTAL DEVELOPMENT OF CARTILAGES.

   The unnatural  development of  cartilages, in the tissues and
 organs of the body, to which they are very slightly allied in their
 nature, is a  circumstance, by no means  uncommon, and is met
 with annually, in  most of its varieties, in our  dissecting-rooms.
 As there is a great disposition in such cartilages  to ossify, they are
 presented in  the several gradations  from a soft gelatinous body to
 that of-perfect  bone.  They  occur in  the articulations; in the
 lungs, and form  there fistulous passages; very frequently on the
 surface of the spleen; in the pleura; in the fibrous coat of the large
 arteries, particularly the arch of the aorta; and  in  the semi-lunar
 valves of the same; in the ovarium,  when it  becomes dropsical;
 and also in many other parts of the body.
   The cartilages which  are found loose in the joints and floating
 about there, begin, for the most part,  in the fibrous  structure* ex-
 terior to the synovial  membrane; the  latter  is protruded inwards
 by them, and  gives them a covering  resembling the  finger of a
 glove.   As these bodies are  small  and rounded, when they pro-
 trude into the joint the synovial membrane forms  a pedicle or base
 to them, which is finally ruptured, and then the cartilage becomes
 loose.   These bodies are generally ossified in their centre, of course
 they have gone through the usual  progress and phenomena of ossi-
 fication.  The other  forms of preternatural cartilage are  much
 disposed to ossify in the arteries, but not so  much so in the other
organs.  In these cases  they are  laminated  and adhere by their
surfaces, very closely, to  the contiguous  structure, so  as  to  be
membranous.  M. Laennec has seen  a cartilaginous transforma-
tion of the mucous membrane of the urethra;  M. Beclard of the
mucous membrane  in  the  vagina, attended with prolapsus uteri,
and also of the prepuce of an old man who had a phymosis from
birth.
* Beclard, Anat. Gen. 
260
SKELETON.
                  OF THE PERICHONDRIUM.

  All the cartilages, except  the  articular  ones, are invested  by a
membrane called perichondrium, (perichondre.)  It is best seen on
the larynx, and  on the cartilages of the ribs.  Its  structure  is
fibrous, and corresponds so  fully with that of the periosteum that
it may be considered the same sort of membrane.   It is, however,
less vascular than  the periosteum, and adheres to the cartilages
with less force, owing to the  fibrous connexion between them being
not so abundant.  Bichat's experiments prove that the cartilage is
much less affected by the loss of this membrane, than the bone is
by that of the periosteum: its uses  are no  doubt the same.


              OF THE  ARTICULAR  CARTILAGES.

  To this class we refer, exclusively,  such  as adhere by one surface
to the articular facings of the bones,  and present the other surface
to the cavity of the joint.  Every  moveable, and some of the im-
moveable articulations, have  their surface uniformly thus incrusted.
to a  thickness  varying from the fraction of a line in the smallest
joints, to one line in the  largest.  The cartilage  itself is  rather
thinner near the margin of the articular surface, when the latter is
convex, than it is near the centre;  on the  contrary, when the sur-
face is concave, the cartilage is thickest near its periphery.
  These cartilages, when subjected to a maceration of six months,
are stripped of the reflection of synovial membrane, which  covers
their  articular  surfaces, and are resolved into fibres, one  end of
which adheres  to the bone and the other end points to the joint.
If the preparation be then dried, the  distinction of fibres becomes
more manifest.
  The most successful injections, closely examined  with a  micro-
scope, demonstrate  the defect of blood vessels in them. The ves-
sels are uniformly seen to terminate at the circumference of the
cartilage and at the face which adheres to t|?e bone, but never to
penetrate it.  Their organization  is, therefore, extremely  simple,
and such as subjects them to  but few morbid alterations.   When
partially removed from the bone the  latter occasionally reproduces
them, but the edges of the new and  of the old production  do not 
FIBR0 OR LIGAMENTO-CARTILAGINOUS SYSTEM.
261
unite.   I have, in cases of inflammation  of the joints, seen  the
fibres of these cartilages  much  longer than  usual and  detached
from each  other.   When a  joint  is  laid  open  by a wound, and
suppurates, the cartilage softens  and disappears from the circum-
ference to the centre.*
                          CHAPTER II.

    Of the  Fibro or  Ligamento-Cartilaginous  System.

   This set of organs (Systeme fibro-cartilagineux) has been placed
by anatomists, indiscriminately in  the cartilaginous or in the liga-
mentous system, in consequence of its participating in the charac-
ters of both; it, however, from its importance, should have  a dis-
tinct position as it occupies a place between cartilage and ligament.
It forms the intermediate substance in all the articulations  by syn-
chondrosis, the bones being  united by concentric laminae of  fibres
crossing one another obliquely  in  opposite directions.   The verte-
bral column, except the atlas, is connected in this way, as well as
the bones of the pelvis at the pubes.  It is highly elastic, of a yel-
lowish white colour,  and consists  of  a dense interlacing of fibres,
with sometimes an intermixture  of elastic tissue.   The direction
of the fibres  varies in different  specimens;  those of the symphysis
pubis and intervertebral matter being parallel, whilst  those of  the
cartilages of the ear and epiglottis are  matted and blended toge-
ther, f  There are three varieties of this system.   The first presents

  * Bichat, Anat. Gen. The same author speaks of the idiopathic ulceration of the
cartilage, as a result of its inflammation.  The late Dr. Physick, whose experience
is equal, denies both.
  t Henle thus divides the tissues usually called cartilages and fibro-cartilages, ac-
cording to their minute anatomy.  1. True cartilages: the articular, (with excep-
tions to name,) the costal, ensiform, nasal, trochlea, and nearly all those of the whole
respiratory tract.  2. fibrous cartilages : the intervertebral ligaments, the synchon-
droses, the cartilage of the ear, epiglottis, and Eustachian tube, the Santorinian and
Wrisbergian, 'Jie sterno-clavicular interarticular discs, and the cartilages of the infe-
rior maxillary articulation.  3. Ligamentous discs: the interarticular ligaments of
the lower jaw, wrist, and knee joints, (except the sharp edges of the latter,) the tar-
si  cartilages, the glenoid  and  cotyloid ligaments, and the fibro-cartilages of the
sheaths and pulleys for tendons. 
262
SKELETON.
itself in  a membranous state, and  is represented by the external
ear, by the alae of the nose, by the cartilage of the eye-lids, and by
the trachea.  The second is represented by the inter-articular car-
tilages of the moveable articulations,  as  of the  knee, the wrist,
lower jaw, and also by the inter-vertebral matter which holds the
bodies of the vertebrae  together.   And  the third is represented by
the trochleas and sheaths, formed on the surface of bones for the
gliding of tendons.
  The principal constituent of this system is a strong fibrous mat-
ter, which is intermixed with the cartilage, and has in some places
its surface covered  by the latter.  The fibres even by superficial
observation  may be  traced in various directions: in some  places
they are  parallel; in others intermixed and crossed very much;  in
others concentric.   Their strength is of the first degree.  The car-
tilaginous part fills up the intervals between the fibres, and gives  to
the whole structure its whiteness and elasticity.
  The Fibro-cartilages. may be  converted by  the action  of hot
water into gelatine, but the process is  slower than in the simple
cartilage.  The membranous, or first variety, differs, however, from
the other two in this respect; for  if it  can be reduced at all into
gelatine,  the quantity it  yields is not perceptible.
  This system is destitute of perichondrium, with the exception  of
the first variety, in which it is distinguishable; but the others either
adhere to the bone, or are covered by a synovial  reflection; their
margins  adhering in such cases to  the  contiguous ligamentous
structure.
  There is a very small quantity of cellular tissue in this system.
Artificial injection manifests  but few blood vessels in it; if the ani-
mal, however, be strangled for  the purpose, the blood by accumu-
lating in  the capillaries  becomes sufficiently apparent. 
LIGAMENTOUS TISSUE.
263
                       CHAPTER  III.

         Of  the Ligamentous or  Desmoid  Tissue.

                           SECT. I.

   The Desmoid Tissue, (Textus Desmosus, Systeme  Fibreux,) is
very generally diffused in the human body, has a very close con-
nexion with the cellular texture, and is continuous with it in divers
places.   It may be known by its whiteness, the firmness and  un-
yielding  nature of its materials, and its fibrous arrangement.   It is
most commonly employed in fastening the  bones to each other at
their articulations, and in enveloping the muscles, but it is also ap-
plied in many other ways.   Its application in  the  former  is  our
present object, but before that is  particularly noted,  it  will be use-
ful to enter into  some general considerations  in regard  to its inti-
mate structure, and the observations now made can be applied on
all other occasions when this tissue is in question.

   A desire to generalize, and consequently to simplify,  has induced
anatomists to seek for some fountain or source  from which all the
reflections and applications of the desmoid tissue might be traced.
The Arabians thought that the dura  mater was this source; and
the error was sanctioned for a long time by the authority of Syl-
vius.   The celebrated  Bichat, in observing the connexions of  this
tissue, finding that all its points  of application might  be  traced
either mediately or directly to the periosteum, considered  the latter
as its centre, as  the heart is the centre of the circulation, and  the
brain of  nervous energy; not that  he thought  the periosteum ra-
diated its influence on all its dependent organs, but  because anato-
mical inspection demonstrated all  the  fibrous  organs to be con-
nected with  it, and communicating through  it with  each other.
The late Professor Bonn, of Amsterdam, reversed  the idea  of
Bichat, and considered the aponeuroses  of  the extremities, and of
the trunk, which send their  partitions between the muscles, and
down to  the periosteum and  joints, as the much desired centre of
the desmoid system.   The latter idea has been reiterated by others, 
264
SKELETON.
and the supposed emanations from the superficial aponeuroses dili-
gently traced.  As means of studying the position and connexions
of parts, notwithstanding the  construction is  a very forced  one,
which makes desmoid tissue cellular membrane, and cellular mem-
brane desmoid tissue, alternately, so as to suit the arrangement of
the anatomists, instead of that of nature; yet,  any or all  of  these
plans have their use, and may be followed advantageously, after
the study at large of the human fabric.
  The desmoid tissue is essentially fibrous, but without  a uniform
arrangement, as its fibres are either parallel, crossed, or mixed.
In some places the fibres  are very  compact, and separate  with
difficulty, but generally prolonged maceration will cause them to
part  into filaments as fine as the thread of the silk-worm.   Anato-
mists differ in regard to the ultimate  structure of these fibres.  By
M. Chaussier they are thought to be  primitive and peculiar;  Mas-
cagni* supposed that they were lymphatics enclosed in  a  vascular
web; Isenflam, that they were cellular substance imbued  with
gluten and albumen.  And M. Beclard, observing that maceration
resolves  them  into a  species of mucous  or  cellular  substance,
teaches that they are  the latter in a condensed state.  Bichat's
opinion is  probably correct that the tissue is  peculiar, and  that
maceration  only brings into  view the cellular  substance which
unites its fibres.  Though maceration and chemical  management
evolve some striking coincidences with cellular membrane, yet in
the natural and ordinary state there  are some very strong points
of difference from it.   Among these may be remarked its great
want of elasticity, which causes it to tear sooner than  to stretch;
and  in  general anasarca, its  being  only  very partially  affected,
merely rendered a  little more moist and humid, which even then
may  arise from the small quantity of cellular substance in it.
Many parts of it, however, are unaffected in the latter way, as the
tendons and their sheaths.  This tissue naturally contains a consi-
derable quantity of  water, which it loses by exposure  to the air;
it then is much reduced, and becomes hard and  yellowish, and  is
made semi-transparent by being put into spirits of turpentine.
  The fibrous tissue according to the present state of microscopi-
cal anatomy, consists of ultimate transparent undulating filaments,
having a diameter from the ^^ to the T7£oo of an inch.   The
* Prodromo della Grande Analomia. 
LIGAMENTOUS TISSUE.
265
fasciculi into which they are collected, measure from the 7jo^ to
the 57^ of an inch broad, and  have their ultimate filaments  held
together by an amorphous substance called  cytoblastoma.   The
ultimate fibres appear to be identical in fibrous, fibro-cellular, and
cellular tissue.  The more  obvious differences arise from the me-
chanical apposition of the  ultimate filaments, whether they  are
parallel or interwoven, or a combination of the two.   If the fasci-
culi be absolutely straight, but a very small elasticity exists, as in
the case of tendons amounting  to almost  nothing, but in the  case
of some of the ligaments, as the  yellow ones of the spine, the inter-
texture of  their filaments and fasciculi  imparts a  high  degree of
elasticity.  Like a muslin bandage, which if torn out straight, yields
but little, and if cut bias, then  is highly elastic, a modification of
property highly applicable in certain surgical dressings.
   The desmoid tissue, by being subjected to the heat  of boiling
water, contracts, becomes more solid, and is elastic; but if  it be
continued  there, it gradually softens, becomes  semi-transparent,
and gelatinous;  The mineral acids reduce it to a pulpy state, and
if concentrated, will dissolve it entirely.  The alkalis  loosen  its
texture, cause the fibres to separate easily, and to assume a diver-
sity of colours.  It putrefies but slowly, in this respect being  next
to the cartilages.
   The strength of this texture is remarkable, and adapts it to the
sustaining  of  enormous weights; a faculty which is continually in
requisition, both to retain the articular surfaces of bones in  con-
tact, and the muscles and  tendons in their places.  It is well known
that the patella, die olecranon, and  the os calcis, break  frequently
before their tendinous attachments will give way.   In the history
of punishments, where criminals have been fastened to four horses,
it is said that it has been found necessary to use a knife to assist in
their disarticulation.   All these phenomena  occur  when abrupt
violence is resorted to, so little are the ligaments disposed to yield;
but when the causes of distention act slowly and gradually, as in
dropsies of the joints, the fibres  separate, and are sometimes com-
pletely disunited.   When  the distending cause ceases to operate in
the latter case, the ligaments have the power of contracting in the
same gradual  way, and of restoring  themselves.
  Some  of the desmoid  tissues, besides having their fibres  sur-
rounded and their interstices occupied by cellular substance, con-
tain a very small quantity of oily or fatty matter.  This is not very
  Vol. I.—23 
266
SKELETON.
 obvious in their recent state;  but, by drying them, it will be seen
 in small quantities on  their surface, like a greasy exudation:  this
 probably comes from  the  cellular substance in them.  They are
 furnished but sparingly with blood vessels, which  for the most
 part, are capillary.  The periosteum and the dura mater are, how-
 ever, exceptions to this  rule.   Lymphatic vessels  have been  ob-
 served in some of them, but it  is doubtful whether  they generally
 have nerves*
   The  sensibility  of this system  is extremely obscure, and is not
 manifested under the usual mechanical and chemical irritants; it
 may, however, be elicited by communicating to the joints  a twist-
 ing motion, as the experiments of Bichat prove.  Inflammation aug-
 ments their sensibility, in which case it  becomes extremely acute,
 as in gout and rheumatism, or any other cause productive of it.


        SECT. II.—OF THE LIGAMENTS OF THE JOINTS.

   The ligaments, (ligamenta,) properly speaking, are those organs
 which tie the bones together, and in the  moveable joints are either
 capsular (capsules fibreux) or funicular, (ligamensfibreux fascicu-
 laires.)   The  first are like a  bag open  at the ends, at either of
which the articular extremity of a bone is  included.  These  are
much more complete in  some joints than  in others; the shoulder
 and the  hip joints afford the most perfect examples; in other joints
they are divided into  irregular fasciculi of fibres, permitting  the
 synovial membrane to  appear  in  their interstices, and sometimes
they are still more widely separated.
  The funicular ligaments are  mere cords, extending from  one
 bone to  another;  some of them  are  flattened, some  rounded, and
others  oval  or cylindroid.   They are variously placed;  in some
 instances they are within the capsular ligament, and in others, on
 its outer surface, and  sometimes so blended with it as not to be
 separated without  an  artificial  dissection.   Their  names  are  de-
 rived either from  their position or shape, and  are  generally suffi-
 ciently appropriate*
* Beclard, Anat. Gen. 
SYNOVIAL ARTICULAR CAPSULES.
267
    SECT. III.—OF THE SYNOVIAL ARTICULAR CAPSULES.

  Each moveable articulation is lined by a membrane, (Membrane
Synoviale,) reflected  over the  internal face of  the capsular liga-
ment and  the articular  cartilages.  This membrane is a perfect
sac; and unlike the capsular ligament, has no opening  in it.   It is
remarkably  distinct where it is not attached to  the articular carti-
lages; and,  by  being inflated, is caused to protrude in  small vesi-
cles, or pouches, between the fasciculi of the ligamentous structure.
Its  connexion with  the cartilage, and its continuation over it, are
not quite  so obvious, and require more  management  to  demon-
strate : it  is, indeed, so thin and transparent at this part,  and ad-
heres so closely, that  its existence there has been questioned, but
may be proved in a variety of ways.  By maceration  it becomes
so loose, that, with a  pair of forceps, shreds  of it may be raised
along the  whole extent of the cartilage.  If a flap of cartilage be
raised up  by a knife, its base being left attached, in attempting to
tear away the base it will be found that the synovial membrane is
continued from this base to the  contiguous cartilage.  Saw a bone
through to its articular cartilage, then  tear through the cartilage
gently, in  which case the continuity of the synovial membrane will
also be manifested.
  From these several proofs the fact is established, that the syno-
vial membranes are bags, closed at  both extremities, and differ
thereby from the capsular ligaments.

  The synovial capsules are liable to  a fungous degeneration which
occurs equally upon the cartilaginous  and  capsular  portions of
them.  Factitious bridles sometimes form in the joints, attached
indiscriminately to either portion  of the synovial membrane.  M.
Beclard says, that protracted inflammation will, finally, redden the
cartilaginous portion, and that  it  extends from  the circumference
to the centre, the hues being lighter  the nearer it is to  the latter.
It has not occurred to me to meet with this proof; though I have
made frequent dissections in subjects, of inflamed joints,  the red-
ness has  always ceased  at  the margin of the articular cartilage.
Dr. Physick's  experience, most valuable on  all  occasions, affords
support to my own.—Some years ago I had an opportunity of in- 
268
SKELETON.
 vestigating, somewhat fully, this point, in  a subject, all  of whose
 large joints were in a state of inflammation.

   These synovial capsules, or membranes, are white, thin, semi-
 transparent, and soft.  Wherever there is a deficiency of capsular
 ligament, they adhere to the contiguous cellular substance, and are
 so blended with  it as to appear absolutely continuous.   Dissection,
 inflation, and  maceration, prove them  to be laminated, and deve-
 lope their structure in such a way that it resolves itself into a cel-
 lular tissue, the  more interior layers of which had  been  in a very
 compacted  state.  In all this they resemble the serous membranes,
 generally, and are ranked among them ; Bichat, therefore, consi-
 ders them only as an interlacement of  absorbents, and  of exha-
 lents.  But, for  the farther exposition of this point, see the article
 on the Serous Membranes.

   The synovial  sacs  have, on  their outer  surface, but projecting
 into the cavity  of the joint, adipose  cushions of different sizes,
 called  the  Synovial  Glands  of Havers, from which, till  lately, it
 was supposed that the lubricating liquor of the joints is exclusively
 secreted.   These cushions have their  projecting  margins fringed
 and  unusually vascular, and occupy the small spaces left between
 the articular  faces of the  bones.  As they are covered  by the
 synovial membrane, they no doubt assist  in the secretion of the
 synovia.

  The moveable articulations are all furnished with the fluid called
 Synovia; this  name was given  to it by Paracelsus, from its resem-
 blance to the albuminous part of an egg, to the  consistence and
 colour of which it has a close affinity, and, like it, is  thick, ropy,
 and somewhat yellowish.   The chemical  analysis  of  it  indicates
 the presence of water, albumen, and a kind  of incoagulable mucus.
 It was once supposed to be  a mixture of serum, with the adipose
 matter of the  bones, which found its way into the joints  by trans-
 udation; but as it  contains upon experiment no oil, the opinion is
evidently erroneous.   It is  secreted from the whole internal sur-
face  of the synovial membrane, and, perhaps, in greater quantities
from the fringed  fatty cushions in  the joints in consequence of their
increased vascularity,  M. Beclard teaches, that it is neither  a 
ARTICULATION OF THE LOWER JAW.
269
follicular  nor a glandular secretion, nor a  transudation,  but  a
perspiration,  in which a perfect equilibrium  is kept up  between
•its exhalation and  its absorption.  Its use is to diminish  friction,
and, consequently, to facilitate the sliding of the bones upon each
other.
                        CHAPTER IV.

             Articulation of the Lower Jaw.

   The articular connexion, here, is formed  by that portion of the
 glenoid cavity  anterior  to the fissure, and  by the condyle of the
 lower jaw.  Each surface is covered by thin cartilage; and a thin,
 loose, irregular, fibrous, capsular ligament, arises from the articular
 margin of one bone, to be inserted into that  of the other.  Besides
 this, there are four other ligaments for  strengthening the joint, an
 inter-articular cartilage, and two synovial membranes.

   The External Ligament (Membrana Articularis Ligamentosa)
 arises from the inferior margin of the root  of  the jugal or zygo-
 matic process of the  temporal bone, and from the anterior side of
 the meatus externus, and is inserted into the neck of the condyloid
 process.  It  is  somewhat  triangular, having the base upwards.
 Just in advance of this, and  separated from it by a  small fissure,
 is another triangular ligament, the discovery of which is claimed
 by Caldani.*  It arises from the anterior part of the  inferior mar-
 gin of the zygomatic process of the temporal bone, and is inserted
 into  the neck of the bone in advance of the other.

   The Internal Ligament (Lig. Maxilla Lalerale) or spino-maxil-
 larv, arises from the extremity of the spinous process of the sphe-
 noid bone, and from the posterior margin of the glenoid  cavity,
 that  is the processus vaginalis of the temporal bone, and going
downwards and  outwards, is inserted into the spine bordering the
posterior mental foramen, and for some distance lower  down  on
* Tabul. Anat.  Venetiis, 1802.
          23* 
270
SKELETON.
the ramus of the jaw.   It is  placed  between  the two pterygoid
muscles, and is in  contact with the maxillary vessels and nerves,
as they run between  it and the condyle  to the posterior mental
foramen.  It is thought by Caldani to be not so useful in restricting
the motion of the jaw forwards, as in holding the vessels and nerves,
and regulating their position,  lest in  the  various motions of the
lower jaw they should be displaced and injured.  .

  The Stylo-maxillary Ligament  is thinner than  the  above.  It
arises from the external side of the styloid process, and is inserted
into the posterior margin of the jaw, near its angle, between the
masseter and internal pterygoid  muscles.  The stylo-glossus mus-
cle is  much  connected with it,  and is thereby assisted in elevating
the base of the tongue, the fascia profunda of the neck is in  con-
tinuation with  it.

  There are two synovial membranes, the one reflected between
the glenoid cavity and the upper surface of the interarticular car-
tilage, and the other between this latter substance and the condyle
of the lower jaw.   They  may  be seen at different points  pro-
truding  between  the fibres of the capsular ligament.

  The inter-articular cartilage, by being placed between the two
synovial membranes, separates completely  the two bones.  Above,
its surface corresponds to the convexity of the tubercle of the  tem-
poral  bone, and to the glenoid  cavity;  below, it is simply concave
for receiving the condyle.  It is thicker at the circumference  than
in its  middle, and at the  posterior than the anterior margin.  A
longitudinal  section  of it from  before backwards and near its  mid-
dle resembles the letter S.  Sometimes it is open in  the centre, in
which case the two synovial cavities  run into one  another.  Its
structure is fibro-cartilaginous.  It moves  very readily backwards
and forwards.

  On  the posterior face of the capsular ligament, I have found, in
several  cases,  indeed, on all occasions of  special examination for
it, since the  first observation, an erectile tissue or structure resem-
bling  the corpus cavernosum  penis.   It has  not been filled  with
blood  like the  latter, but is, probably,  an  arrangement for giving
great  mobility forwards to the lower jaw. 
LIGAMENTS OF THE SPINE.
271
  The movements of this bone  may be  simply hinge-like, by its
depression, in  which  the  mouth  is regularly  opened; or, by the
action of the pterygoid muscles, it may be slid forwards.   When
the muscles of but one side act, a species of rotation is communi-
cated; in which one condyle advances on the  tubercle of the tem-
poral bone, while the other reaches to the back part of the glenoid
cavity.  The looseness and length of the capsular ligament of the
articulation, along with  the  extreme facility of motion from the
interposition of a moveable cartilage, contribute very materially
to this movement.   The  sliding  backwards and forwards of the
intermediate  cartilage of this  articulation,  during  mastication,
sometimes  produces a crackling; audible to the by-standers, and
extremely annoying to the individual who is the subject of it, from
the noise being so near his ear.
   Some persons are liable to a spontaneous dislocation of this bone,
from yawning too widely.  I am disposed to believe, that, in such
cases, the accident  arises from the posterior boundary of the gle-
noid cavity, (as established  by that margin of  the temporal bone
W'hich is continuous with  the vaginal process,  and forms a part of
the meatus externus,) being more advanced and higher than usual;
in consequence of which,  whenever the bone is depressed to a cer-
tain point,  its neck strikes against this ridge, and not being able to
go farther  back, the  ridge acts as  a fulcrum, and starts the con-
dyle over  the  tubercle of the temporal  bone  into the zygomatic
fossa.  The fact is certain, that very strongly marked differences
of the glenoid cavity, in  this particular, occur in different  indivi-
duals.
                       CHAPTER V.

            Of  th*  Ligaments  of  the  Spine.

            Ligaments of the Bodies of the Vertebra.

  1. Inter-vertebral Substance, (Ligamenta Intervertebralia, Liga-
mens Intervertebraux.)—The bodies of the true vertebrae are united
by a substance blending the nature of ligament and that of carti-
lage, and therefore, called fibro or  ligamento-cartilaginous matter. 
272
SKELETON.
  It occupies all the space between the contiguous bodies of the ver-
  tebrae, and adheres  most closely to their  substance.  This  inter-
  vertebral matter increases successively in thickness, as it is placed
  lower down on the spine, whereby the lumbar vertebra? are mutu-
  ally at a much greater distance than any others.   The curvatures
  of the spine, as formerly stated, depend  considerably upon the ar-
  rangement of this substance:  between the vertebras of the neck it
  is thicker at its anterior  margin than  at the posterior; on the con-
  trary, between the dorsal vertebrae it is thinner  in front.  In the
  loins, it is  again  much thicker in front  than  behind, and this fea-
  ture is unusually marked between the  last lumbar vertebra and the
  sacrum.
   This inter-vertebral matter is formed of concentric lamellae, the
  texture of which  is ligamentous.   These lamellae are more abun-
  dant anteriorly and  laterally than  behind.  Their fibres cross in
 every direction, leaving  between  them  interstices  or cells,  filled
 with a soft, pulpy substance:  this  substance  is  not very obvious
 near the circumference, but in approaching the centre, it becomes
 more and more abundant, as  the interstices  are  larger, until the
 centre seems to be constituted almost entirely by it. The pulpy
 mass in the centre is  in a state of considerable compression, which
 may be proved by separating the bodies of adjoining vertebrae, or
 by making a  vertical section  through them; in  which case the
 pulpy mass will be freed from  compression, and will rise up into
 the form  of a cone.   This experiment will succeed remarkably
 well in the loins; from which it is evident, that this  mass is a soft
 and  elastic  ball, on which the bodies of the vertebrae play.
   The pulpy matter is proportionately much more abundant in in-
 fancy than in  the subsequent periods of life; it is also much softer,
 whiter, and more transparent.   In advanced life there is great di-
 minution of its volume, as well  as of its elasticity, which accounts,
 in some measure, for  the comparative stiffness of the spine in old
 people.  The fibrous part in  them  is always  more abundant, and
 is much disposed to ossify.  When the trunk  is kept erect for se-
 veral hours in succession, it becomes shorter, from its weight bear-
 ing upon the inter-vertebral mass; but a short  period of rest in the
 horizontal position, restores it to its original  length.

   2. Anterior  Vertebral Ligament,  (Fascia Longitudinalis Ante-
rior, Ligament Vertebral  Anterior.)—This ligament  is placed on 
LIGAMENTS OF THE SPINE.
273
the front part of the spine, and extends from the second vertebra
of the neck  to  the first bone of the sacrum, inclusively.   It in-
creases gradually in breadth, from its commencement to its termi-
nation, but is not every where of the same thickness; for it is thin
on the neck, thicker in the thorax, and  again becomes thin in the
loins:  in the latter, however, it is strengthened by an accession of
fibres from the tendinous crura of the diaphragm.
   This ligament adheres very closely to the inter-vertebral sub-
stance, and to the projecting margins of the bodies of the vertebra?,
but less closely to the middle or concave parts  of the  latter.  Its
fibres do not run out its whole length, for the more  superficial ex-
tend from one vertebra or inter-vertebral substance, to the fourth
or fifth below: the middle ones extend to the second or third be-
low;  ana1 the deepest seated  are  applied between  the proximate
vertebrae only.  In general, more  of the fibres are inserted into,
and arise from the fibro-cartilaginous matter than  the bones.   In
several parts, but particularly in the neck, small  slips are sent off
obliquely to the vertebra below.  The  laminae of this  ligament
leave intervals between them for the passage of blood vessels.
   Beneath the anterior vertebral ligament are found a great many
short and insulated ligamentous fibres, extended obliquely from one
vertebra, to another which is contiguous.  These fibres have diffe-
rent directions, and cross each other at acute angles; they adhere
very closely to the fibro-cartilaginous matter, and leave interstices
between themselves, through  which the anterior vertebral  ligament
adheres to the same substance.  Moreover, there are at  the sides
of the bodies  of the vertebras, a number of short straight fibres,
passing from the edge of the bone above to the edge of  the bone
below.

  3. Posterior Vertebral Ligament, (Ligamentum Commune Poste-
rius, Ligament Vertebral Posterieur.)—This  is placed on the hind
part of the bodies of the vertebras, within the  spinal-canal, and  ex-
tends  from the cuneiform process of the occiput just  beyond the
foramen magnum, to  the os coccygis.  It  is more narrow and
thick  in the thoracic vertebrae than elsewhere.  At each inter-ver-
tebral substance  it increases in breadth and adheres more closely,
whereas, opposite the  body of a vertebra it is narrower and more
loose, by which arrangement a kind of serrated or unequal edge
is formed on each side. 
274
SKELETON.
  This ligament is more dense and compact than the anterior, and
presents a smooth, shining  surface, resembling a tendinous expan-
sion.  Its fibres, also, do not run individually the whole length of
the spine, but are in  laminas; the more superficial  of which  have
their fibres inserted into the fourth or fifth inter-vertebral substance
or vertebra, below their origin.  The middle laminae are  inserted
into the second or third below, and the deeply seated  into  the first
below.  The blood vessels  do not penetrate the ligament,  but pass
by its sides into the vertebras.  The superior extremity of this liga-
ment going from the second vertebra to  the  margin  of the  fora-
men magnum, is sometimes considered as distinct.


           Ligaments of the Processes of the  Vertebra.

   1. Articulation of  the Oblique Processes.—These processes are
faced with cartilage, and  a  synovial  capsule  is  displayed  upon
them  so as to shut  up completely the cavity of the articulation.
The capsular ligament is not uniform and fully developed, but is
represented by a few irregular fibres, passing from  one bone to the
other.

   2. Articulation of  the Spinous Processes.—With the exception
of the neck, ligamentous fibres are found to occupy the spaces be-
tween all the spinous processes, bypassing their whole length from
the spinous process above, to the spinous  process below.   Muscles
supply their places in the neck, and in the upper part of the thorax.
These ligaments have much of a cellular  structure above, but in
their descent they become  more ligamentous and large, till, in the
loins, they  assume a very decided character, and  have a quadri-
lateral shape.
   At the extremities of the spinous processes there is, also, a liga-
mentous band, belonging to the dorsal and  lumbar vertebras; com-
mencing at the seventh cervical, it terminates on  the spinous pro-
cesses of the sacrum.   It is thin in the  back, but on  the loins it is
very thick, and  so blended with the  tendinous origins of  the mus-
cles, that it is not very distinguishable from them.   The  fibres of
which it consists are of unequal lengths, being extended  between
two, three, four, or five vertebrae, accordingly as the fibres are su-
perficial or deep-seated. 
LIGAMENTS OF THE SPINE.
275
  3- Owing to the shortness of the spinous processes of the neck,
an arrangement exists there called Ligamentum Nuchas, (Ligament
Cervical,) or the Descending  Ligament of  Diemerbroeck.  This
ligament, though continuous with the one last described, may be
considered, for  the  sake  of perspicuity, as  distinct.  It begins,
therefore, at the seventh cervical spine,  ascends between  the mus-
cles of the opposite sides of the neck, and is inserted into the pos-
terior occipital protuberance.   It  is blended very much  with  the
tendons of muscles, and is distinguished from them with some  dif-
ficulty, occasionally.   Its  posterior margin  is thick, but  the ante-
rior is  a thin membranous expansion, which runs to the ends of
the spinous processes of the cervical vertebras, and to the vertical
ridge of the occipital bone, leading from  the occipital  protuberance
to the foramen magnum.  The ligamentum nuchas, therefore, forms
a complete septum between the muscles  of the opposite sides of the
neck, and is  continuous with the sheaths in  which they play.  In
quadrupeds  it is remarkably strong; but in  man, who,  from  the
proportions  of his  head and  his  erect  position, keeps  the head
nearly  in equilibrium, it is comparatively feeble.

  4 Articulation of the Bony Bridges of the  Vertebra.—The in-
tervals between the vertebras, at the posterior part  of the spinal
canal, are filled up by the Yellow Ligaments, (Ligamenta Flava,)
so called from their peculiar colour.   These intervals exist between
all the  true vertebras, being bounded laterally by their oblique pro-
cesses, and are very considerable in the loins,  particularly that
below the last vertebra; they are not so large in the neck, and  are
still smaller  in the back ; and their shape varies considerably in the
several portions of the spine.
  The yellow ligaments are two in number, forming a pair in each
of these intervals: the two approach, behind,'at an angle, in a line
with the spinous processes, but are kept  separated by a small ver-
tical fissure filled up  with cellular substance.   They  extend to the
oblique processes laterally;  are connected to the anterior face of
the  bony bridge of the vertebra above;  whereas, they are inserted
into the superior margin of that of the vertebra below.  From this
arrangement, the yellow ligaments may be best seen on  the side
of the spinal canal.  The angle which  they form, behind, is con-
tinuous with the ligaments between the spinous processes. 
276
SKELETON.
   These yellow ligaments  are smooth and  shining on their ante-
 rior surfaces, but  behind  they are  rough and  unequal.   Their
 fibres  are  numerous and  extremely compact, their strength is,
 therefore, very great.  Their  elasticity is well marked and pecu-
 liar to them, and assists greatly in erecting the spine when it has
 been curved out of the proper line.   Bichat says that there is but
 little cellular tissue between their fibres: that they are  dissolved
 with extreme difficulty in  boiling water, and  resist its  action to
 such a degree, that it is manifest they contain much less gelatine
 than the greater number of analogous organs.
   The first pair  of yellow ligaments is between the second and
 third cervical vertebras, and the last  between  the last lumbar and
 the sacrum ; there are, consequently, only twenty-three pairs in all.

            Particular Articulations of the  Spine.

   1. Articulation  of Occiput with Atlas.—The anterior Liga-
 ment is placed at the  anterior  part of the  occipital  foramen, and
 extends from it to  the corresponding edge of the  atlas.  On its
 centre in front is a fasciculus,  which being  narrow and somewhat
 rounded, descends from the middle  of  the  cuneiform  process to
 terminate in the tubercle on the front of the atlas; and consists in
 parallel fibres.  The  remainder is called by Caldani, Membrana
 annuli anterioris atlantis, (Ligament occipito-atloidien anterieur.)
 It  occupies and shuts  up the whole space between the basilar pro-
 cess of the os occipitis, from which it takes its origin near the oc-
 cipital  foramen; and  the anterior arch of the  atlas, into  the supe-
 rior margin of which it is inserted: in it are many oblique fibres,
which run  from within outwards.
   The posterior Ligament is placed  at the  back part of  the occi-
pital foramen, and extends  from  it to the  corresponding edge of
the atlas.   It  is  called by  Caldani, Membrana annuli  posterioris
atlantis, (Ligament occipito-atloidien  posterieur;) and arising from
the whole posterior  margin  of the occipital  foramen between the
condyles, it is extended to  the upper contiguous  margin  of the
atlas, so as to fill up completely this space.  Bichat says that it
also consists  in two laminae, the anterior of which is fibrous, and
runs into the dura mater of  the spine instead of into  the bone: the
posterior is of a much looser texture, and resembles  common eel- 
LIGAMENTS OF THE SPINE.
277
lular substance.   A part of this membrane runs obliquely from the
transverse process of the atlas to the part of  the occiput just be-
neath the insertion of the rectus posticus minor.

  The articulating surfaces of the condyles, and the superior ob-
lique  processes of the first vertebra, are  covered with cartilage,
and furnished with a synovial membrane arising from their mar-
gins.   On the exterior of the  synovial membrane there are irre-
gular ligamentous fibres going between the bones, and forming a
capsule.

  2. Articulation of the second  Vertebra with the Occiput, and with
the first.—The second vertebra has  no articular  surface joining
the occiput, but some strong ligaments  are passed  between them.
When the posterior vertebral  ligament is removed  at  its com-
mencement  from the occipital bone, we see on each side of it, and
beneath it, ligamentous bands (Lacerti Ligamentosi,) coming from
the internal  face of the os occipitis, to be affixed  to the body of
the second vertebra  behind.  Some of these  fibres arise from the
margin of the occipital foramen, and  others from the internal face
of the condyloid processes.*  They are joined at their external
margins by  a few fibres from the first vertebra, near its upper ob-
lique  process.

  The Transverse Ligament (Ligamentum Transversale Atlantis,
Ligament Transverse,) is placed immediately behind the processus
dentatus, and divides the atlas into two  unequal  rings  by being
stretched from one side to  the other.   It  is  larger in the  middle
than at the extremities, and has the latter inserted into  the little
tubercle at the internal side of the atlas, between  the upper and
the lower articular surfaces.   It is  a thick, strong  fasciculus  of
fibres, and binds the processus dentatus so as  to form for it  a sort
of collar, amounting to about one-fourth of a circle.   The superior
appendix of this ligament arises by a broad base from the anterior
margin of the foramen magnum, and terminates below by a nar-
row end in the upper margin of the transverse ligament.   The in-
ferior appendix arises from the lower edge of the transverse liga-

             * Caldani, Icon. Anat. Explicatio, vol. i. p. 255.
  Vol. I.—24 
278                      SKELETON.

ment, and  is attached, by a  somewhat converging end, into the
posterior face of the body of the vertebra dentata.
   The surfaces of contact belonging to the processus dentatus, and
to the anterior ring of the atlas, are covered with  cartilage, and
have a synovial membrane, so as to form a perfect joint called the
vaginal ligament.  A joint with a  distinct synovial membrane is,
in like manner, formed between the posterior face of the processus
dentatus and the anterior of the transverse ligament, where they
come into contact.

   The Oblique or Moderator Ligaments (Lig. Lateralia, Ligamens
Odontoidiens) are two, one on either side of the tooth like process.
They may be seen  most advantageously by cutting through the
transverse  ligament, and arise from the side  and summit of the
processus  dentatus,  to be inserted into  the internal  margin of the
occipital condyle.   They are  thick, short, and strong, and consist
in parallel fibres; their lower margin has been considered  as a dis-
tinct ligament by Weitbrecht, and described  by him as coming
from the neck of the process.   There is some cellular tissue at the
front, in which the process revolves.

   The Middle Straight Ligament, (Lig. Medium Rectum, Liga-
ment droit Moyen,) or Occipito-Dentate, arises from all that part
of the  summit of the processus dentatus anteriorly which is be-
tween the  moderator ligaments, and is inserted into all that part of
the interior  circumference of  the  foramen  magnum between the
Insertion of the  moderator ligaments.  It is a  thin ligamentous
membrane, disposed to form in its  middle a vertical fissure, sepa-
rating its  two halves.  It cannot  be  seen well, unless the whole
membrana annuli anterioris be dissected  away, and the  anterior
bridge of the first vertebra sawed off; it will then be found imme-
diately behind the bursa or vaginal ligament of the processus den-
tatus.  It is separated from the superior appendix of the transverse
ligament by a layer of condensed fatty substance.   This ligament
should  not be confounded with the  superior appendix of the trans-
verse ligament, nor  with  the beginning of the  posterior vertebral
ligament, as has  been done by Bichat and others.  The difference
is well established by Caldani, as it lies deeper than either of them
when viewed from  the vertebral cavity; though, from the close 
                     LIGAMENTS OF THE SPINE.                 *'y

connexion of the fibres of the ligaments among themselves, as well
as with others, the mistake may readily occur.*

   The Articulation between the oblique process of the first and of
the second cervical vertebra  is very moveable, as the atlas is per-
mitted to revolve around the  processus dentatus to the  amount of
one-fourth  of a circle at least.   This articulation has  a synovial
capsule which is  strengthened by an anterior  and by a posterior
ligament.
   The anterior ligament of the articulation  between the oblique
processes arises from  the inferior margin of the atlas and from its
anterior tubercle,  and is  inserted into the  base of the processus
dentatus, and into the front of the body of  the second vertebra.
The fibres of the latter insertion are  long  and  frequently distinct
from the first.
   The posterior ligament is placed between the first and second
vertebras behind, and  is connected to their contiguous margins so
as to fill up the interval between them, and to supply the place of
the yellow ligaments.   It is extremely loose and  thin, so as not to
interfere in the movements of the vertebras, and is almost of a cel-
lular structure.
   The synovial membrane of these oblique  processes is unusually
lax, and is reflected from the  margin of the one articular surface
to the other.   It is in  contact in front with the anterior ligament;
behind with the posterior and with much cellular substance;  inter-
nally with the ligaments within the spinal  canal, and  externally
with the carotid artery.  The latter obtains from it a serous cover-
ing, without which, according to Bichat, it would be bathed in the
synovial fluid.

  * Its existence is, however, scarcely to be considered uniform, as it is often want.
ing where the processus dentatus is very long, for example when it reaches the an.
tcrior part of the foramen magnum and forms a joint there, as it sometimes does. 
280
SKELETON.
                       CHAPTER VI.

             Of  the  Ligaments  of the Pelvis.

   The mode of junction between the sacrum and the last lumbar
 vertebra, is, in every respect, the  same as that described for the
 bones of the spine generally, with  the addition of a ligament on
 each side, sometimes met with, called Sacro-vertebral, which arises
 from the transverse process of the last lumbar vertebra, and going
 obliquely downwards, is inserted into  the superior part of the sa-
 crum by blending itself with the anterior fibres of the sacro-iliac
 junction.

   The  Sacrum  is united  to the coccyx by a  fibro-cartilaginous
 substance, resembling that  between the bodies of the true vertebras,
 with the exception of  there being less pulpy matter  in its centre,
 and of its fibrous lamellas being more uniform.   The bones of the
 coccyx are also united with  one another in  the same way; in
 consequence of  which they are very flexible till  the approach of
 old age.

   The  Anterior  Coccygeal  Ligament,  (Lig.  Sacro-coccygeum
 Anterius) is placed on the forepart of the coccyx; runs its whole
 length, and arises from the inferior extremity of the sacrum.  Its
 fibres are rather  indistinct, from their being blended wTith  fat: on
 the lateral margins of the coccyx they are better marked.

   The  Posterior Coccygeal  Ligament, (Lig. Sacro-coccygeum
 Posterius,) as its name implies, is placed on the back part of the
 coccyx.  It arises from  the inferior margin  of  the spinal canal of
the sacrum, and forms a  sort of  membranous expansion, which
 covers and adheres to the first bone of the coccyx, and is inserted
into the second.   There are  also a few other  ligamentous fibres
 connecting the bones of the coccyx.

  The Ilio Lumbar Ligament (Lig. Ilio Lumbare) arises from the
transverse process of the last lumbar vertebra, and from its infe- 
LIGAMENTS OF THE PELVIS.
281
 rior oblique process, and going outwards is inserted for two inches
 into the  crista of the ilium.   It  is often blended with  adipose
 matter,  which  separates it into several  fasciculi.  Caldani de-
 scribes it as  two ligaments, making a distinction between the one
 part from the transverse, and the other from the oblique  process.

   The Sacro-iliac Articulation is formed by the corresponding
 surfaces of the sacrum and  ilium.  Each bone is incrusted with its
 own cartilage, the one on the sacrum being somewhat more thick.
 Their surfaces are slightly rough, and between them exists a thick
 yellow fluid in a very small quantity, which lubricates them, and
 is more abundant in early life.

   The Sacro-Spinous Ligament (Lig.  Sacro-Spinosum)  is placed
 superficially on this  articulation behind.  It is very strong, flat,
 long, and perpendicular.  It consists of two laminae, of which the
 more superficial arises from the posterior superior  spinous process
 of  the ilium, and is inserted into the fourth  transverse process of
 the sacrum.   The deep-seated lamina arises from the same point,
 and is  inserted into the third  transverse process of  the sacrum.
 Bichat describes, connected with the inferior margin of  this liga-
 ment, a fasciculus, which comes from the posterior inferior spinous
 process of the ilium.

  The  Sacro-iliac Ligament (Lig. Sacro-lliacum) is next to the
 articular faces of the bones.  It surrounds the joint, but is much    •
 stronger on its posterior face.   It consists in an assemblage of liga-
 mentous fasciculi,  some of which have obtained, by the writers on
 Syndesmology, particular names, but which it would-scarcely add
 to the student's information  to designate.  On the front of the joint
 this ligament  is uniform,  and  consists of a plane of short, strong
 fibres, passing from the margin of  one  bone to that of the other.
 But, on the posterior surface, it is much more irregular, and arises
 from the first two eminences near the lateral margin of the sacrum,
 and from that surface of the sacrum between these eminences and
 its articular face.  From  thence the  sacro-iliac ligament goes to
 be inserted into the rough surface of the ilium, immediately behind
 its articular face; it fills up  there a considerable space, and, from
its position, must be extremely irregular.  Its strength is  so great,
 that in forcing  the joint the ligament does not rupture,  but parts
                             24- 
282
SKELETON.
preferably from the surface of the ilium, and sometimes brings with
it a lamella of bone.
  The bones of the pelvis are  also fastened  by two other  very
strong ligaments, the sacro-sciatic.

  The Posterior Sacro-Sciatic (Lig. Sacro-Ischiadicum majus) is
the most considerable of the two.  It arises from the posterior in-
ferior spinous process of the ilium, from  the margin of the sacrum
below this bone, and somewhat from its posterior surface, and from
the first bone of the  coccyx.  It goes downwards and outwards,
becomes thicker in its  middle, but narrow;  it then spreads out,
and is inserted  along the internal margin of the tuberosity of the
ischium.  Its anterior extremity is  extended along the internal face
of the crus of the ischium for some distance, and has the obturator
internus  muscle adhering to it.   Its fibres,  where they converge
from  their origin,  are separated into  planes by masses of fat and
by  blood vessels.

  The Anterior Sacro  Sciatic Ligament (Lig. Sacro-Ischiadicum
minus) is much smaller  than the other, and is placed in front of it.
It arises from  the  margin, and somewhat from the posterior sur-
face of the sacrum, below the ilium; and from the lateral margin
of  all the bones of the coccyx.  The fibres  converge, and  are in-
serted into the spinous  process of the ischium, by embracing it.
The fibres constituting  its  base, have their fasciculi separated by
cellular adipose matter  and by vessels,  and are also intermingled
with  the fibres of the coccygeus muscle,  and of the posterior sacro-
sciatic ligament.
  The two sacro-sciatic ligaments  supply, in some degree, the
place of bone, and  form  a part of the inferior lateral parietes of the
pelvis.  They convert the sciatic notch  into a foramen, or, rather,
form  with it two foramina; the upper and larger of which trans-
mits the pyriformis muscle, the sciatic nerve, and the gluteal blood
vessels;  while  the  lower, placed between the insertion of the two
ligaments, transmits the obturator  internus muscle, and brings the
internal pudic artery into the pelvis.

  The Obturator  Ligament (Membrana Obturatoria) is  extended
across the foramen thyroideum, so as to close it up, with  the ex-
ception of a foramen at its upper part, for transmitting the obturator 
LIGAMENTS OF THE PELVIS.
283
vessels and nerves.   It is  a thin, but strong membrane, having its
fasciculi of fibres passing in various directions, and arising from
the margin of the foramen.  It affords origin to many of the fibres
of the obturator muscles.  Frequently portions of it are defective.

   The Articulation of the Pubes is formed between the bodies of
the two ossa pubis.   It consists principally in a fibro-cartilaginous
matter, which has a  strong resemblance to that of  the vertebrae.
When the bones are torn apart by bending them forwards, the
fibrous arrangement becomes very apparent, and is seen to consist
in concentric lamellas, the fibres of which cross one another.  Some-
times in the male, but most frequently in the female, the posterior
third of the articulation is deprived of these fibres, in place of which
we find, in the  middle of the cartilage, a small longitudinal cavity,
the surface of which  is smeared with a kind  of mucosity.   There
is no central pulpy matter in this  articulation, as there is between
the vertebras.   On its posterior surface it often makes a ridge pro-
jecting into  the cavity of the pelvis.  From frequent observations
made in our dissecting-rooms, I  have no doubt that  this articula-
tion is always very much relaxed  in  the  parturient  and pregnant
female, which is  manifested not by the  bones separating,  but by
their sliding upwards  and downwards with great readiness.  The
sacro-iliac junction also becomes relaxed.  It was upon the obser-
vation of these  facts, that the celebrated, but now exploded, Sigaul-
tian operation was founded.

   The Anterior Pubic ligament is not very distinct.   It lies in front
of the last articulation, and consists in a few oblique and transverse
fibres going from the one bone to the other.

   The Sub or  Inter-Pubic Ligament (Lig. Pubis Inferius) occu-
pies the summit of the  arch of  the pelvis.   It is of a triangular
form, about half an inch in  breadth, and  passes from the  margin
of the crus of the pubes  of the one side, to a corresponding line on
the other.   It is remarkably strong, and  is rather more so below
than above.   It seems rather an extension of the  ligament of the
symphysis pubis, than a  distinct structure. 
284
SKELETON.
                       CHAPTER VII.

              Articulations of  the  Thorax.

               Posterior Articulations of the Ribs.

   As mentioned, in the account of the bones, the articulations here
are double; being formed at one point  between  the heads of the
ribs and  the bodies of the vertebras with  the inter-vertebral matter;
and at the  other, between the tubercles of the ribs and the trans-
verse processes.  In either case the respective surfaces are covered
by articular cartilage, and have a  synovial membrane.   The first
joint is the Costo-vertebral, and the second the Costo-transverse.

   1. The Costo-vertebral articulation  presents  an anterior  liga-
ment, an inter-articular ligament,  and  two synovial  membranes.
The Anterior or  Radiating  Ligament, (Lig.  Capituli Costarum,)
is  fixed, as its name expresses, in front of the joint.  It arises from
the margin of the head of the rib by  the whole breadth of the lat-
ter, and diverging towards the spine,  is fixed, by its superior fibres,
into the  vertebra above; by its  inferior fibres, into the vertebra
below; and, by its middle fibres, into  the inter-vertebral substance.
It  is a thin, flat, fibrous membrane, leaving intervals in  it for the
passage of blood vessels, and may,'indeed, be considered as a cap-
sule to the articulation, and  is frequently described  as such.   The
inter-articular ligament passes from  the ridge on the head of the
rib, to a corresponding line of the inter-vertebral  substance.   It is
short and strong, and divides the articulation of the  head of the
rib into two cavities, which have no communication.  It is in con-
sequence of the latter, that there are two synovial membranes to
the head  of every rib which  has a double  articular face; but the
ribs which are  articulated with a  single vertebra, as  the first, the
eleventh, and the  twelfth, have not  the inter-articular  ligament,
and, therefore, only one synovial membrane.
   The synovial membranes are not very apparent, neither  is the
fluid abundant; the cavity is occasionally very small from the en-
croachment of  the inter-articular ligament.  Anchylosis occasion- 
ARTICULATIONS OF THE THORAX.
235
ally takes place here, but is more rare than in the anterior articu-
lations of the thorax.

  2. The Costo-transverse articulation has, in addition to the joint
formed between the tubercle of the rib  and the end of the trans-
verse process, several ligamentous  fasciculi which  pass in varied
directions.
  Its synovial membrane is  much more distinct than in the pre-
ceding articulation, and contains more synovia.  The joint is  more
loose, and is never anchylosed, except  by disease.  There are a
few fibres around it having the semblance of a capsule.
  The Internal Transverse  Ligament (Ligamentum Transversa-
rium- Internum, or Costo-Transversarium  Inferius,) arises  from
the inferior margin of the transverse process, between its  root and
external  extremity, and  proceeding  downwards and  inwards, is
inserted into the upper  margin of the neck of the  rib below.  In
many of the ribs  there  is  a plane of ligamentous fibres parallel
with this ligament, but just behind, and  arising  from a more pos-
terior situation of  the transverse process to go to the neck of the
rib, somewhat more towards the tubercle of the latter.  It is de-
signated  by some writers as the posterior transverse ligament, but
the distinction between it and the lig. trans, internum is  so slight
that it scarcely seems necessary to consider them apart.   The In-
ternal Transverse Ligament is much more conspicuous in  the mid-
dle eight ribs, and in extremely emaciated subjects; in others, it is
obscured by cellular adipose matter around the heads of the ribs.
  The External Transverse Ligament (Ligamentum  Transver-
sarium  Externum, or  Costo-Transversarium Posterius) is a
well-marked quadrangular plane of ligamentous fibres, placed  on
the posterior surface of the costo-transverse articulation.   It arises
from  the extremity of the transverse process, and going outwardly,
is  inserted into  the  proximate rib, just beyond its articular  tu-
bercle.
  The Middle Costo-Transverse Ligament (Ligamentum Cervi-
cum  Costarum, or Costo-Transversarium Medium)  is extended
between and concealed by the neck of the rib and  the contiguous
transverse process, and cannot  be seen well without separating
them, or  by sawing through their length.  It is  a collection  of
short  fibres,  somewhat irregular,  resembling condensed cellular
substance, and slightly  red. 
286
SKELETON.
  These posterior articulations all require a  patient dissection, as
they are surrounded by small parcels  of adipose matter, have the
intercostal nerves and blood vessels in  contact with them  before,
and the muscles of  the spine behind.  The ligaments between the
transverse processes and the ribs are, of course, not found in the
eleventh and twelfth, from the bones not touching there.
  Besides what has been described, an aponeurosis or ligamentous
membrane is extended from the transverse process of the first and
second lumbar vertebras, to the inferior margin of the last rib.  A
ligamentous membrane is also found near the spine, extended be-
tween the contiguous  margins of  the last two ribs.


              Anterior Articulations of the Ribs.

  The surface of each pit in the  side of the sternum is covered by
a thin cartilaginous plate, to receive  the corresponding  cartilage
of the rib, and the articulation presents an anterior  and a posterior
ligament, also  a  synovial capsule.

  The anterior ligament arises from the extremity of the cartilage,
and, going over  the front of the sternum, radiates very considera-
bly in every direction.  Some of its fibres are continuous with the
corresponding fibres of the opposite side; others are lost in the pe-
riosteum and in  the tendinous origin of the great pectoral muscle;
others  join the fibres  of the ligament above, and  of that  below.
The  more superficial the fibres are, the longer they become; but
the more deeply seated pass only  from the margin  of the cartilage
to the margin  of the cavity in the  sternum.   The thick ligamen-
tous  covering  found on the front of the sternum, may be considered
as only the continuation  of these anterior ligaments.  The fibres
from the two lower articulations  on the opposite  sides, form, by
their junction,  a  striking triangular  ligamentous plane, just on the
lower end in front of the second bone of the sternum.   Besides
which, there are several strong ligamentous fasciculi running in a
great variety of directions.

  The posterior  ligament has  a  similar arrangement with the an-
terior, in the radiation of its fibres  into the contiguous ligaments,
and in their origin from the costal cartilage.  Altogether they form, 
ARTICULATIONS OF THE THORAX.
287
on the posterior face of the sternum, a strong, smooth covering,
the fibres of which do not run in fasciculi, but make a uniform
polished membrane, and are  closely interwoven with each other.
Some of these fibres are  longitudinal, and, of course, cannot be
referred to the posterior ligaments, but are independent of them.

   The synovial membrane, though its existence is admitted, is not
in a very distinct state.  It scarcely gives a polish to the articular
surfaces, and has so little  looseness in its reflection  from the one
to the other, as to indicate clearly that but an inconsiderable mo-
tion is  admitted  in these joints.   The synovia  is in very small
quantity, not abundant  enough for satisfactory  examination, and
its character is rather inferred than proved.  The first cartilage is
continuous with the sternum, and not separated from  it by any
joint, except in rare instances.  The second cartilage has its  joint
with the  sternum, separated into two, one above and the other
below, by a ligamentous partition  resembling that at  the heads of
the  ribs.   The  lower articulations become, successively, more
moveable than the upper.
   Besides the attachments mentioned as connecting the cartilages
of the true ribs to the sternum, there is  one superadded to the se-
venth cartilage,  called the  Costo-Xiphoid Ligament.   It arises
from the inferior margin of the seventh cartilage, near the sternum,
and going obliquely downwards and inwards, is inserted into the
anterior face of the xiphoid cartilage, and has its upper fibres run-
ning into  the corresponding fibres of its fellow.  It  is, of course,
placed behind the rectus abdominis  muscle, and  fills up, in some
measure,  the angle between the seventh cartilage and the  third
bone of the sternum.
   At the surfaces where the sixth and  seventh cartilages come
into contact by their edges, also the seventh and eighth, a synovial
membrane exists.  A similar articulation is sometimes  found be-
tween the fifth and sixth,  and the eighth  and ninth cartilages, but
not uniformly.  These synovial membranes are covered by strong
fibres.
   It has been already stated  that the anterior extremity of  each
of the first three cartilages of the false ribs, is united by ligamen-
tous fibres to the cartilage above.  These  ligaments are strong and
extensive, and give great solidity to  the  common margin of the
cartilages.  The last two cartilages being much smaller than the 
288                       SKELETON.

others, no ligaments pass from them; but they, with their ribs, are
held  in their position by the intercostal and abdominal muscles.
  The cartilages adhere very closely  to  their respective  ribs,
which receive them into the oblong fossae, at their  anterior extre-
mities.  The periosteum of the rib is continuous with the perichon-
drium of the cartilage, and the membrane, which  is, in fact, one
and the same, adheres very closely to  the margins of the  articu-
lation ; it is also re-enforced by some ligamentous fibres beneath it.
No motion whatever is admitted at this articulation.
                      CHAPTER VIII.

   Of the Artieulations of the Upper Extremities.

             Of the Articulations of the Shoulder.

  These articulations consist in the junction of the clavicle to the
upper part of the sternum, and  to the first rib; of the scapula to
the clavicle, and of the os humeri to the scapula.

            Of the Sterno-Clavicular Articulation.

  The uneven triangular face of the internal end of the clavicle,
and the concavity of  the sternum, at its upper corner, form the
surfaces  which enter into  this articulation.  The first is much
more extensive than the articular surface of the sternum, projects
on every side beyond its margins, and is very prominent  in case of
extreme emaciation.   The twro  surfaces are covered by  cartilage,
of which that on the clavicle is the thickest, and serves to fill up
its inequalities; while the one on the sternum is thin and  smooth.
  The joint is invested by a thick fibrous capsule, the anterior por-
tion  of  which presents a strong fasciculus of fibres, somewhat
separated by  small interstices.   This portion, called  by some the
radiated ligament, arises from the anterior extremity of  the clavi-
cle, and, going downwards and inwards, is inserted  into the mar- 
              ARTICULATIONS OF THE UPPER EXTREMITIES.         289

 gin of the articular cavity of the sternum.  It is placed just behind
 the origin of the sterno-cleido mastoid muscle.   The capsular liga-
 ment is  also strengthened on  its posterior  surface by additional
 fibres, not so distinct as the  preceding, but obtaining  the name of
 the posterior ligament.

    Of the Inter-Clavicular Ligament, (Lig. Inter-Claviculare.)—
 Closely connected with the capsule of the preceding joint, this liga-
 ment is placed  on the superior end of the sternum, and  extends
 from the internal  end of one clavicle  to  that of the other.   It is
 flat before and  behind, thin and narrow, is blended with the conti-
 guous ligamentous structure of the sternum,  and might, with pro-
 priety, be considered only an appendage to the capsular ligaments,
 or a process sent between them.  In front it  corresponds with  the
 integuments, and behind with the sterno-hyoid  muscles.

    Of the Inter-Articular Cartilage.—When the capsule of  the
 joint is cut open, this is brought into view.  It separates the bones
 completely from each other by  its extent, and supplies  by its shape
 the want of correspondence in  their articular faces.  It is thicker
 above than below; its centre is  thin, and sometimes  perforated.
 Its margins adhere closely to  the capsular  ligament; it is also  fixed
 by adhesion to  the upper posterior margin of the surface of the
 clavicle, and below to the union of  the sternum with the cartilage
 of the first rib; in consequence of which it has but little motion,
 and in luxations must be lacerated.  Its  structure is fibro-cartila-
 ginous.

   Of the Synovial Membranes.—There are two of these, one  on
 each side of the inter-articular cartilage; in consequence of which,
 a  double  cavity exists in this  articulation, excepting the cases
 where the cartilage is perforated.  These  membranes contain but
 little synovia: they adhere closely to the  adjoining surfaces, and
 cannot be made very distinct, except in   points where there are
 small interstices  in the capsule, when, by pressing the bones strongly
 together, they protrude in little vesicles.

   Of the  Costo-Clavicular  Articulation.—It  consists  in  a short
fasciculus of ligamentous fibres,  frequently called the  Rhomboid
Ligament, which, arising  from the upper surface of the cartilage of
  Vol. I___25 
290
SKELETON.
the first rib, ascends obliquely outwards, and is implanted into the
roughness on the inferior face of the clavicle, near its sternal end.
Its fibres are parallel, all oblique, and longer at its external than at
its internal margin.  It corresponds in front with the origin of the
subclavius  muscle, and  behind with the subclavian vein.   It has
for its object the strengthening of the junction of  the clavicle with
the sternum.

            Of the Scapulo-Clavicular Articulations.

   These exist at three places; the first by a junction between the
acromion scapulas and the external end of the clavicle; and the
last two by ligaments sent from  the coracoid process to the under
surface of the clavicle.

  The Acromio-Clavicular Articulation presents, on each bone, a
small oblong face, covered with cartilage.  The fibrous capsule
which invests it is very strong and thick, so as to give the appear-
ance of a much greater extent to the articular faces of the bones
than really exists.  This capsule is strengthened by additional fibres
on its upper surface, passing from one bone to the other, and some-
times called the superior ligament: they are parallel to each other,
and somewhat blended with the tendinous fibres  of the deltoid and
trapezius muscles.  The capsule is also strengthened on its lower
face, by additional fibres, constituting the inferior ligament; they
are not so abundant  as the superior, and pass from the margin of
one bone to that of the other, after the same  manner.   A synovial
membrane  is reflected over these articular  surfaces,  and contains
but a very small quantity of fluid.   In some instances, an  inter-
articular fibro-cartilage is found in this joint; as  in the sterno-cla-
vicular; in such case there is a double synovial membrane.

   Of the Coraco-Clavicular Ligament.—This ligament  is double,
one part being called the Conoid (Lig. Conoides,) and the other,
the Trapezoid (Lig.  Trapezoides.)  It arises from the roughness
at the root of the coracoid process, and is  attached  to  the  under
surface of the clavicle.  The conoidal portion, having its base up-
wards, is inserted into the tubercle, near the external  end of the
clavicle.   Its fibres  are  compact,  strong,  and  diverging.  The
trapezoid is placed at the acromial side of the other.   Jt is ouadri- 
            ARTICULATIONS OF THE UPPER EXTREMITIES.         291

lateral, longer, broader and thinner than the other, having its fibres
separated by small interstices;  and arising  also from the root of
the coracoid process, it is inserted into an oblique line leading from
the tubercle of the clavicle to its acromial end.  The union of these
two portions behind forms a projecting  angle; in  front there is a
depression between them filled with fat and cellular substance, also
a bursa mucosa.  Tlfese ligaments are bounded in front by the
subclavius, and behind by the trapezius muscle.

   The Bifid Ligament (Ligamentum Bicorne) is placed in front of
the subclavius muscle.  It arises  from the  root of the coracoid
process, at the sternal  side of the conoid ligament; and proceed-
ing with  but little elevation, inwards and upwards, increases in
breadth and bifurcates.  The superior horn is inserted along the
under margin of the clavicle, to near the rhomboid or costo-clavi-
cular ligament; but the lower one goes to the end  of the first rib,
under the tendon of the  subclavius muscle.  This ligament  is a
sort of  fascia placed  over the subclavius  muscle, to bind and
strengthen it.*   Some of the fibres of the superior horn sometimes
proceed farther, and leaving the clavicle, go with  the rhomboid
ligament into the cartilage of the first rib.f


                   Of the Scapular Ligaments.

   The Coracoid  Ligament (Lig. Coracoideum) stretches across
the notch on the superior costa of the scapula, and  converts it into
a foramen.   It runs from the posterior margin of the notch to the
base of the coracoid process, and has some of its  fibres blending
with  the conoid ligament.  It  consists of a small  fasciculus of
fibres, and is of very little consequence, excepting in its relation to
the superior scapular vessels and nerves.

   The Triangular Ligament (Lig. Coi-aco-Acromialis) of the Scapu-
la, as its name implies, extends from the coracoid to the acromion
process above the shoulder joint.   It arises from nearly the whole
superior margin  of the coracoid process, in two  divisions, sepa-

   * This ligament is called the clavicular fascia by M. M. Vclpeau and Blandin, in
their treatises on surgical anatomy.
   t Caldani, Plate XLI. 
292
SKELETON.
 rated partially by cellular tissue.   Its fibres converge in their pro-
 gress, by which it becomes thicker, and  is inserted into the point
 of the acromion process, just beneath its junction with the clavi-
 cle.   This ligament is covered  by the deltoid muscle and the cla-
 vicle, and has the supra-spinatus beneath it.  Its anterior margin
 is  continuous with  a condensed cellular membrane beneath  the
 deltoid.

               Of the Scapulo-Humeral Articulation.

   The glenoid cavity of the scapula, and the head of the os humeri
 form this joint.   As usual, each articular  surface is covered with
 cartilage, of which that on the  os humeri is thicker in  the middle
 than near its circumference, while  the reverse occurs on the sca-
 pula.  From  the shallowness of the  glenoid cavity and the much
 greater size of the head of the  os  humeri, but very few points of
 their opposed surfaces can come into contact at the same moment,
 though they may all do  so  in  succession:  hence,  a  considerable
 portion of the head of the os humeri is always against the capsule
 of the joint.   The remaining parts of this  articulation are the cap-
 sular ligament, the synovial membrane, and the glenoid ligament.

   The capsular ligament  invests completely this joint, though it is
 thinner in some places than  at others.  It arises from the margin
 of the glenoid cavity, and  is inserted into the  neck of the  os humeri,
 including a larger space of  the neck  below, than  it  does above.
 The tendons of the muscles which  arise from the external and  in-
 ternal surface of the scapula, to  be  inserted into the tuberosities of
 the os humeri, as they approach their points of insertion  adhere
 very  closely to the capsular ligament, and  are,  indeed, more  or
 less blended with it.   Bichat considers, that the tendon of the sub-
 scapularis muscle  supplies the place of the capsular ligament en-
 tirely at its lower part.  This ligament is formed by fibres, which
 are very much intermixed with  one another, and have a greater
 degree of thickness  above than below, or,  indeed, at  any other
point.  The former is due to a  thick fasciculus,  the  Coraco-Hu-
 meral Ligament, also  called by some Ligamentum Adscititium,
 which takes its origin from  the  posterior  and external margin  of
the coracoid process, and  proceeding beneath the triangular liga-
ment to the upper part of the os humeri, joins the capsular ligament, 
              ARTICULATIONS OF THE UPPER EXTREMITIES.         293

  and adheres very firmly to it.  This ligament keeps the head of
  the os humeri  on its proper level  in regard to the glenoid cavity;
  but the moment  it  is cut, the length of the capsular ligament per-
  mits the head of the os  humeri to fall about an inch, and, indeed,
  to suffer a partial dislocation.   The strength of the joint, however,
  depends essentially upon the  muscles which  surround  it,  as the
  deltoid,  supra-spinatus, infra-spinatus, teres minor, sub-scapularis,
  long head of the triceps, and some others, which are farther re-
  moved from it.

    The synovial membrane  is a perfect sac, which covers the gle-
  noid  cavity, the  internal face of the capsular ligament, and  the
  neck and head  of the os  humeri.  On the lower part of the neck it
  is reflected over some small fatty masses, commonly called glands.
  Just beneath the  root of the coracoid process, from there being a
  deficiency of the capsular ligament, the synovial membrane covers
  the articular side of  the tendon of the  sub-scapularis, and is  re-
  flected for ten or  twelve  lines,  between it and the scapula, forming
  a sort of pouch, resembling a bursa mucosa.

    The tendon of  the biceps muscle runs through this articulation
  from the superior end of the glenoid cavity.   The cavity itself is
  deepened by a fibrous margin  all around, called the glenoid liga-
 ment; a considerable part of whose fibres may be traced from the
 tendon of the biceps by its bifurcating.   The tendon is bound down
 in  the bicipital  groove by fibres passing from  one to the other of
 the bony margins, and which  may be considered a continuation
 of the capsular  ligament.  As the tendon is about emerging from
 the  groove  at the lower margin of the  tuberosities, the synovial
 membrane which lines the groove thus far,  is  reflected from it, to
 the surface of the tendon, and continues to cover and enclose it up
 to the origin  at the glenoid cavity.   It is thus evident that though
 the tendon passes  through the joint, the  cavity  of the  synovial
 membrane is  kept entire.

                      Of the Elbow Joint.

  This articulation is formed by the lower end of the  os humeri
and the upper end of the ulna and of the  radius.  The articular
faces which were  described in  the  account of these  bones  are
                            25* 
294
SKELETON.
covered, as usual,  with  cartilage, the particular arrangement of
which will be presently pointed out.   A strong capsular ligament,
an annular or coronary ligament, and  a synovial membrane, hold
these several bones  together.
  The Capsular Ligament  invests completely the  articular extre-
mities of these bones, and conceals them from view.  It is attached
to the sides of the os humeri at the lower part of its condyles near
the  articular surface; but in front it arises some distance from the
articular face at the upper margins of the sigmoid cavities, for the
head of the radius and for the coronoid process of the ulna: behind,
it arises in like manner from the upper margin of  the cavity for
receiving the olecranon process; so  that the depressions,  both
before and behind, are included within  the circumference  of
the  articulation.   The  lower part of the capsular  ligament is. in-
serted into  the  margin of the articular surface of the  ulna, all
around, including, also, the whole of the head of the radius, and
the  upper part of its neck.
  This capsule is strengthened very much at particular points, and
as the joint is hinge-like,  the strengthening is more abundant at its
sides, constituting lateral  ligaments.

  The external  Lateral, or the  Brachio Radial Ligament, (Lig.
Cubiti Externum,) is connected above  to the lower part of the ex-
ternal condyle, and  is fixed below into the annular ligament which
surrounds the neck of the radius.  It is  very much  confounded
with the  tendinous mass common to the muscles at this part of the
arm,  more particularly that of the supinator radii brevis.  It is a
round fasciculus of  parallel and condensed fibres, spreading some-
what  below into the annular or orbicular ligament.  The  Internal
Lateral or the Brachio  Ulnar Ligament, (Lig. Cubiti Internum)
arises from the lower part of the internal  condyle, and spreading
out  so as to assume a  triangular shape, divides into two  portions,
one of which is inserted  into the internal margin of the coronoid
process of the ulna, and the other into the internal  margin of the
olecranon process.  It  also  is much blended with the tendons of
the  muscles which lie over it.  Intermediately to the lateral liga-
ments, both before and  behind, the fibrous structure of the capsular
ligament is  very distinct, but  thin, in order to accommodate the
motions of the joint; many of the fibres are insulated, and have
interstices between  them  filled with fat. Some of these fibres are 
             ARTICULATIONS OF THE UPPER EXTREMITIES.          295

oblique, and  others straight: they are called, in  common, Acces-
sory ligaments.

   The Coronary Ligament of the Radius  (Lig. Radii Orbiculare)
is brought more distinctly into view by cutting open the joint.  It
is then seen to arise from the anterior margin of the lesser sigmoid
cavity of the ulna, and surrounding two-thirds of the neck of the
radius, to be inserted  into the posterior margin of the same cavity.
It is a strong, flat, narrow fasciculus, the fibres of which  go in  a
circular direction.  Its superior  margin is blended with the exter-
nal lateral ligament:  its inferior margin is loose, being  connected
with the lower part of the neck of the radius  only by a reflection
of the synovial  membrane, with the exception  that a  few  fibres
pass from it behind, to the contiguous part of the ulna.   Its density
is very considerable,  sometimes  almost cartilaginous.

   The Synovial Membrane  lines the whole  internal face of the
capsular ligament, from which it is separated behind  by a  large
mass of  fat in the  olecranon depression of the os humeri, and in
front by another mass in the coronoid depression.  A small circu-
lar ridge of fat also projects into the joint around the head of the
radius, and there is another at the internal margin of the olecra-
non.  The object of these masses seems to be to  fill up the partial
vacancies which exist between the articular faces of the bones,
and they are all so directed by their attachment to the capsular
ligament, as  to  be preserved from  being  pinched.  The synovial
membrane is also reflected from the capsular ligament to the arti-
cular faces of the  bones, so as to line the several depressions on
the os humeri, and  to  include the neck of the radius. _

   The head  of  the radius is  completely invested with  cartilage.
The greater sigmoid cavity of the ulna has its articular cartilao-e
separated transversely into two portions,  by a small laver of fat
traversing its bottom.   The cartilage elsewhere is  uniformly spread
over the articular surfaces of the bones.

   Of the Interosseal  Ligament, (Membrana  Interossea.)—It fills
up the space between the two bones of the fore  arm almost entirely,
by commencing  just below the tubercle of the radius and ending
near the wrist.  It consists in oblique parallel fibres, which pass 
296                        SKELETON.
 from the ulnar edge of the radius downwards to the radial edge of
 the ulna.  It  is thin, but extremely strong, being covered  in front
 by the flexor  muscles; and behind by the  extensors; and, as Mr.
 Boyer observes, seems to be intended rather to  afford origin to
 muscles than to unite the bones.   Its superior part is thinner above,
 and a large opening exists there for the passing of the interosseal
 vessels  to  the back of the fore arm.  Its inferior  part is thick,
 where  openings also  exist, but small, for the passing of  vessels.
 There are  some other  smaller perforations in  this  ligament, but of
 less note than the preceding, also for vessels.   On its posterior face
 there are one or two bands, the fibres of which decussate the other
 fibres.
   Besides  the interosseal ligament, there is one called Round
 (Teres,) situated obliquely between the  two  bones  at the upper
 part of the interval which separates them.  It arises from the base
 of the coronoid process, just below the insertion of the brachialis
 internus; and descending obliquely outwards, is inserted  into the
 radius below its tubercle.   Its object is to bind the bones together,
 at a point which is weakened by the deficiency of the  interosseal
 ligament.  This deficiency is, in fact, much larger than the simple
 passing of the vessels requires; for it is also large enough to allow
 the tubercle of the  radius to rotate freely, a motion which  would
 have been checked by  the presence of the ligament.


               Of the  Articulations of the Wrist.

  Several articular cavities present themselves at this point.  One
 is between  the lower part of the ulna  and the radius, another be-
 tween the carpal bones and those of the fore arm, and a third be-
 tween the two rows of carpal bones.   One general capsule invests
 these parts.

  1.  The Lower Radio-Ulnar Articulation—is surrounded by a
 section of the fibres belonging to the general capsular ligament of
 the wrist: their  attachment, however,  is  so loose, that they allow
 the bones to rotate freely upon each other, besides  which they are
 not so abundant as in other places.   When this joint  is cut open,
it will be seen that the  head of the  ulna is covered with cartilage,
and that the  cartilage  which covers the  carpal articular face of
the radius, projects between the  ulna  and  the  os cuneiforme.  It 
ARTICULATIONS OF THE UPPER EXTREMITIES.
297
 covers also the sigmoid cavity of the  radius; so that a cavity for
 receiving the convex head of the ulna is formed by the cartilage
 of the radius.  The margins of the above projecting point  of the
 radial cartilage are fibrous, which has induced the French  anato-
 mists to speak of it  under the name of triangular ligament.   It is,
 in fact, an inter-articular  fibro-cartilage, and  is said to be occa-
 sionally detached from the radius, but I have not seen it in  that
 state:  its centre not  unfrequently is perforated, so that  a commu-
 nication exists between this  joint and the next of  the wrist.   Its
 margins adhere very closely to the capsular  ligament, and its point
 is fixed into the depression which separates  the  styloid process of
 the ulna from its head.  The synovial membrane which lines this
 cavity is unusually loose,  both  before  and behind, in consequence
 of the great motion of the bones: it is also very loose above.  This
 joint is sometimes called the Sacciform, from its looseness.

   2. Of the  Radio-Carpal Articulation.—The radius  above,  and
 the scaphoides, lunare, and 'cuneiforme below, form the basis of
 this articulation.  An oblong, elliptical cavity, the ulnar extremity
 of which is made by the projection of the above cartilage  of the
 radius, receives the convexity of the bones of the wrist.  The sca-
 phoides and the lunare come  in contact with the radius, while  the
 cuneiforme rests against the projecting cartilage.  There is a  slight
 elevation of the radial cartilage opposite to  the interstice between
 the first two bones.   The  oblong elliptical cavity is filled by a cor-
 responding head, on the part of the bones of the  carpus just enu-
 merated.   Each of the latter  bones, in  a fresh  state, is covered by
 its appropriate cartilage.   The cartilages are connected, or rather
 continued  into one another, by a narrow fibro-cartilaginous sub-
 stance placed at the margin of the interstice between these bones.
 This substance separates the cavity of the radio-carpal articulation
 from that of the proper carpal articulation.

   The Capsular  Ligament arises, before and  behind, around  the
 margin of the  articular face of the bones of the fore  arm, from  the
 styloid process of the radius to that of the ulna, adhering very
 closely to the margins of the fibro-cartilage insinuated between  the
 ulna and the cuneiforme.   It is inserted below, into  the circumfe-
rence of the head  formed by the scaphoides, lunare, and cunei-
forme, though  many of its fibres may be traced to the bones of the 
298
SKELETON.
second row.  It is  a loose and thin membrane, the fibrous fasci-
culi of which  leave interstices at several points  between  them,
through which the synovial membrane may be seen.  The capsu-
lar  ligament is  strengthened  at  particular places,  by additional
fasciculi of fibres having appropriate  names.  For example, the
Internal lateral ligament arises from  the styloid  process of the
ulna, and is inserted into the cuneiforme, some of  its fibres being
extended to the  anterior annular ligament, and to the pisiforme.
The External lateral ligament arises  from the  styloid process of
the radius, and is inserted into the radial  end  of the scaphoides;
some of its fibres being continued on to the trapezium, and  to the
anterior annular  ligament.  The anterior ligament arises  from
the vicinity of  the styloid process of  the  radius, and  passing
obliquely downwards and  inwards, is  inserted  into the  anterior
face of the scaphoides, lunare, and cuneiforme.   Its fasciculi are
not very evident  or well marked.  The posterior  ligament is not
so broad as the last, and is more distinct.  It  also arises from the
radius, by and near its  styloid process, and  descending obliquely
inwards, is inserted into the lunare and cuneiforme.  The last two
ligaments have no connexion with the  ulna, the  rotation  of the
fore arm is, therefore, unimpeded by them.*

   The synovial membrane of the radio-carpal  articulation is dis-
played on the articular faces of  the bones and  their intermediate
fibro-cartilage, and lines the internal face of the capsular ligament.
When  the joint is pressed upon, this membrane is protruded, in the
form of little vesicles, in the interstices between the fasciculi of the
capsular ligament.  A fold of it containing  a small quantity of
 adipose matter is observed on the back of the cavity of the joint,
 passing from the junction of the scaphoides and lunare to the cor-
 responding point of the radius; it is  the ligamentum mucosum  of
 some  writers.

   3.  Of the Articulation between the two rows of the Carpal
 Bones.—The scaphoides, lunare, and  cuneiforme  of the  first row,
 and all the bones of the second  row, are the  foundation  of this
 joint,  the surfaces of which have been described  already.   These

   * The ligamentous character of these several fasciculi is best seen on the surface
 next the cavity of the joint. 
ARTICULATIONS OF THE UPPER EXTREMITIES.         299
 surfaces are covered with cartilage, each bone having its appro-
 priate cartilage, which is  continued on its side where the bone
 touches the adjacent one*   The joint is furnished with a capsular
 ligament and a synovial membrane.

   The Capsular Ligament surrounds the articulation, passing on
 every side from the upper to the lower row, and adhering strongly
 to the bones.  It is in a great degree a continuation of the capsule
 of the radio-carpal joint, and has, at the same points, an increase
 of thickness, called after the same names.  The internal lateral
 ligament is attached by one end  to  the cuneiforme, and by the
 other to the side of the unciforme.  The external lateral ligament
 arises from  the extremity of the scaphoides, and  is inserted  into
 the side of the trapezium.   The posterior and anterior ligaments
 have the course of their fibres more distinctly seen on the side of
 the synovial membrane.  The first consists  in many fibres arising
 from the bones of the  first row and going to the second row; its
 fibres are shorter and more compact.  The anterior arises and is
 inserted after the same way, some of them  terminating in the an-
 terior ligaments of the  hand.

   The Synovial Membrane  is not only displayed on  the opposite
 surfaces  of the two carpal rOws, but also is reflected upon the la-
 teral  faces  of the  bones  belonging to  each row.  It, therefore,
 sends processes, two of which are found, above; one between the
 scaphoides and the lunare, and the other between the lunare and
 cuneiforme.  These processes are arrested at their upper extremi-
 ties  by the  fibro-cartilaginous matter between  the bones, which
 was  spoken of in the radio-carpal articulation.  It also sends three
 processes downwards, one between the  trapezium and the trape-
 zoides, another between the latter and the magnum, and the third
 between the magnum and the unciforme.  Those latter processes
 communicate with or are continuous with the synovial  membrane,
 between the carpal and the metacarpal bones of the fingers.*   The
 connexions and reflexions of this membrane are  of the greatest
 importance, as they form  a  communication from  the  top  of the
wrist to the  base of the metacarpal bones;  not only covering the
articular surfaces, but being prolonged in some instances beyond
* Bichat, Anat. Descr, 
300
SKELETON.
  them, as on the back of the os magnum, where it answers as a pe-
  riosteum.
    In addition  to  the articulation just described, between the two
  rows of carpal bones, the individual bones of each row have par-
  ticular  fastenings of ligamentous fibres,  which  run transversely
  from the margin of one bone to the  margin of the next.   These
  fibres, from their position, are called dorsal and palmar ligaments.
  The upper row has one dorsal ligament between the scaphoid and
  lunar, and another between the latter and  the cuneiform—it has in
  the same way two palmar ligaments  on  its front  surface.  The
  lower row has, after the same plan, three dorsal and three palmar
  ligaments between its bones.  These  several ligaments are  best
  seen on  the side of the synovial  membrane, as  externally their
 fibres are very much mixed with those of the capsular ligament.
 It is obvious that  they are highly useful in  preventing the  bones
 from sliding laterally on each other, except to a small extent.
   The Pisiform Bone has an articulation with the cuneiform com-
 pletely distinct from any other.   The  articular faces of this joint
 are covered with cartilage and invested  by a synovial membrane
 and a capsular ligament, which allow,  from their looseness, consi-
 derable motion.  The  capsule, though  generally thin, is strength-
 ened by accessory fibres, which are well  marked  below.   These
 fibres arising from the inferior extremity of the pisiform,  some of
 them are attached to the extremity of the  unciform  process of the
 os unciforme, and others to the base of the fifth metacarpal  bone.
 The insertion of the tendon of the flexor carpi ulnaris answers as
 a ligament  to  this bone  above, and there is a very strong fasci-
 culus of  ligament, passing  from  the pisiforme to the end of  the
 unciform process, and  by that means conveying the action of  the
 flexor ulnaris  to  it.   It has  but  little  motion  from above down-
 wards, and a good deal laterally.


            Of the Carpo-Metacarpal  Articulations.

  The bony articular surfaces, here, as well as all the  others of
the hand, have  been sufficiently  described and are in the recent
state covered with cartilage.  It  will therefore be unnecessary to
renew the observations on these subjects.
  The first of these articulations, or that of the metacarpal  bone
of the thumb, with the trapezium, is much more  moveable than 
            ARTICULATIONS OF THE UPPER EXTREMITIES.        dUI

any of the others, and presents some peculiarities.   It is  entirely
distinct, slightly removed  from  the next, and is  surrounded by a
capsule which is attached by its ends to the articular margins of
the bones.  This capsule is strengthened by additional fibres, which
are particularly distinct and abundant, posteriorly and externally.
The synovial  membrane  is displayed, as usual, on the  internal
face of the capsule, and  over the articular faces.
   The other four  metacarpal  bones are articulated as follows:
The second  one is  joined to the trapezoides, trapezium, and mag-
num—the third unites to the magnum alone—the fourth to the un-
ciform, with a small portion of the magnum—and the fifth to the
unciform.  The ligaments are placed before and  behind, and may
also be termed dorsal and palmar.

   The dorsal ligaments descend from the carpal to the metacar*
pal bones.  The second metacarpal  bone receives two ligaments,
one  from the  trapezium, and another from the  trapezoides—the
third receives  one from  the magnum—the fourth receives two, one
from the magnum, and  the other from the unciform—the fifth re-
ceives one from the unciform.   Transverse fibres pass between
these dorsal ligaments  to connect the bases  of the metacarpal
bones.
   The palmar ligaments are arranged  on a plan corresponding
with that of the dorsal; but, from the length  of their superficial
fibres, are not  so distinct from each other.   Transverse fibres pass
also between the metacarpal bones of the fingers at their base, and
form interosseous ligaments which keep  them together.
   The articulations  thus  formed and held together, are  covered
by two synovial membranes, being processes from  that between
the two rows of carpal bones.   One of these processes, sent down
between  the trapezoides and the magnum, displays itself over the
inferior surface of these bones  and  the head  of the metacarpal
bone of the  fore and of the middle  finger.  The second  process
which is  sent down  between the magnum and the  unciforme, is
reflected  over the last two  carpo-metacarpal articulations.   These
processes have a septum  between  them, at the ulnar side of  the
base of the third metacarpal bone, and do not  communicate with
each other, except  through the  proper carpal  articulation.  The
specification of this arrangement is overlooked by anatomists ge-
nerally.
  Vol. I.—26 
302
SKELETON.
   The Inferior Palmar Ligaments are three in number, and are
 between the lower ends of the metacarpal  bones  of  the fingers,
 each one consists in a transverse fasciculus, placed between the
 flexor tendons and the interosseous muscles, and on a level with
 the anterior part of the first joint of the fingers.  Their  more super-
 ficial fibres may be traced across  the  bones, and  are somewhat
 blended with the capsular ligaments;  the more deep-seated are
 short, and pass from one bone to the other.


         Of the Met a carpo-Phalangial Articulations.

   These are formed by the lower ends of the metacarpal  bones,
 and  the upper ends  of the first phalanges.  Each one  presents an
 anterior ligament, two lateral ones, and a synovial  membrane.
   The anterior Ligament* is  a flat fibrous semicircle, on the front
 of the articulation, of considerable thickness.   It goes transversely,
 and  has its two extremities attached to the ridge on either side of
 the articular margin of the metacarpal bone.  Its inferior margin
 descends a little, and comes  in contact with the synovial  mem-
 brane.   In front, many of its  fibres are obtained from the fibro-
 cartilaginous sheath of the flexor tendons, so that it may be  consi-
 dered as made by two planes—the palmar one facing towards the
 tendons, and forming the trochlea, in which they play, and the
 other being next to the joint, and continued to the lateral ligaments.
 The  thickness of the anterior ligament, besides  communicating
 great strength  to the joint is useful in removing the tendons from
the line of motion of the phalanges, and thereby giving increased
 power and delicacy of motion to the muscles.  Bichat considers
 himself to have first indicated particularly this structure, which he
 thought was intended to protect the articulation from  the impres-
 sion  of the tendon:  to which  may be added, in  the firm grasping
of bodies, and  to make the movements  of the joint more delicate.
On the sides of this ligament  belonging to  the  thumb, and in its
thickness,  are developed the sesamoid bones.

  The Lateral Ligaments  are situated  one on  each side.   They
 arise from  the sides of  the metacarpal  bone behind  the former,
 and in connexion with it, and, descending obliquely forwards, are
* Bichat, loc. cit. 
             ARTICULATIONS OF THE UPPER EXTREMITIES.         303

fixed into the sides of the upper end of the  first phalanx.  They
are  round, distinct, and strong, and are  formed from  numerous
parallel fibres.

   The Synovial Membrane lines this articulation, being displayed
over its lateral and anterior ligaments, and  on the articular faces
of the bones.  It is reflected on the metacarpal bone, some little
distance from the  margin of its  cartilage  in front, whereby the
cavity is enlarged, and the flexion of the fingers is favoured.   It is
in contact, behind,  with the tendon of the extensor muscle, which
there supplies the place of ligament.


               Of  the Phalangial Articulations.

   There are two of these to each finger, and  one only to the thumb.
They are provided with an anterior ligament, a lateral ligament
on each side, and a synovial membrane.

   The  anterior Ligament corresponds so exactly with what has
been said  in the  preceding  article  on the same  structure, that,
with the exception of its being  smaller,  the description already
given, will suffice.  It seems to answer, in every respect, the same
objects.

   The Lateral Ligaments, also, arising from the sides of the pha-
lanx above, run downwards and somewhat forwards to be inserted
into  the upper part  of the sides of the phalanx below.

   The Synovial Membrane has reflections corresponding with those
of the preceding articulations, with the addition that it covers more
of the anterior inferior face of the first  and second phalanges.
Thus, by cutting through the anterior ligament, longitudinally, and
turning it aside, it will  be seen that the cavity of the  second  and
third joints of the finger is, by this reflection of the synovial mem-
brane, extended upwards between the phalanx and the flexor ten-
dons nearly one-third  of the whole length of the phalanx,* a cir-
cumstance  worth attending to  in the  accidents of the part.
Bichat, loc. cit. 
304
SKELETON.
                       CHAPTER IX.

   Of the Articulations of  the  Lower Extremities.

          Of the Ilio-Femorat, or Hip Articulation.

  The basis of this articulation is laid by the head of the os femo-
ris being received into the acetabulum.  Both surfaces are covered
by thick cartilage: in the former it is interrupted, however, by the
depression near the centre, and becomes very thin near the margin;
and, in the latter, the cartilage  is deficient  in the whole extent of
the rough surface at its lower part.   A cotyloid ligament, a fibrous
capsule, the round or inter-articular ligament, and a synovial mem-
brane, are moreover, concerned in this joint.

  The Cotyloid  Ligament (Lig. Cotyloideum) is  a fibrous  pris-
matic ring which tips the margin of the acetabulum, and thereby
increases  its depth; it can only be seen by cutting open the cap-
sule.  Its thickness is unequal, being considerable on the anterior
third of the  circumference of the acetabulum, where it assists in
converting the notch into a foramen, but not so much so elsewhere.
Just below the anterior inferior spinous process,  the acetabular
head of the rectus femoris  sends some  tendinous  fibres to  it.  Its
base is broader than its margin, and is marked off from the articu-
lar  cartilage  by a crevice, or narrow groove, between them.  Its
acetabular side is covered by the synovial membrane;  the other
side has  the capsular ligament  adhering to it, and the third side
adheres to the bone.   Where it  subtends the notch of the acetabu-
lum, the cotyloid ligament is  re-enforced by additional ligamentous
fibres, placed beneath it, and going from the upper to the lower
end of the notch: these fibres consist of two planes, one internal
and the  other  external, partly crossing each other, and  adhering
closely to the cotyloid ligament.
                 s
  The Inter-Articular, or Round Ligament, (Lig. Teres,) is a true
ligamentous  band, which is  attached at the one end to the pit on
the  head of the os femoris, and  afterwards  by a  slight dissection, 
              ARTICULATIONS OF THE LOWER EXTREMITIES.         305

 is easily separated  into two fasciculi.  Of these,  the lower  one
 may be traced to the inferior end of the cotyloid notch, where,
 winding around the prominence of bone, it begins to  adhere to the
 ischium, and continues to do so from that point along the anterior
 face of the ischium, just below the  acetabulum, to a point between
 the latter and the  upper anterior  part of the tuber.  The other
 portion is directed towards the superior end of the  notch, and  is
 attached there by two extremities, one near the margin of the ace-
 tabulum, and  the  other three or four lines from it within.*  The
 fibres of the round  ligament are somewhat  intermixed also with
 those of the cotyloid ligament subtending the notch.

   The Capsular  Ligament (Capsula Fibrosa) is the  strongest in
 the  body, and represents a conoidal sac, open at both extremities,
 by which it adheres to the bones.  It is  fixed by its base to the
 circumference of  the  acetabulum,  beyond the  cotyloid ligament,
 and into this ligament itself, where the latter subtends the notch.
 It embraces that part of the head of the os femoris which  projects
 above the margin of the acetabulum, and descends along the neck
 to its  root.   It is longer in front; is fixed  there to the oblique  line
 which runs between the two trochanters, and, behind, into the root
 of the neck, a little in advance of the posterior oblique ridge, and
 in such a manner  as to leave a small part, six or eight lines broad,
 of the neck of the os femoris bare  below it.  Above, it is fixed to
 the neck, just below the rough fossa in the trochanter major; and
 on  the under  surface of the  neck it adheres, just above the tro-
 chanter minor.  It is strengthened  in several places  by processes
 from the fascia lata femoris, which descend to it between  the mus-
 cles surrounding the hip joint.f   Its thickness is considerable, but

  *  Antonius et Caldani, Tabula II.
  t Soemmering, De Corp. Hum. Fabrica, vol. ii. p. Gl, 1794.  Andrew Fyfe, Com.
 pendium of Anat. Philad.  1807, vol. i. p. 179.
  For an interesting account of the connexion of this capsule with the fascia femo-
 ris, see  Anatomical Investigations, by J. D. Godman, M. D., Philad. 1824.   The
 author, in following the sheaths of the muscles, or, in other words,  the processes of
 the fascia lata, between the  muscles, to the capsule, with great attention, has been
 brought to the conclusion that the capsule is formed entirely from them.  He has
 presented the same views  in regard to the shoulder joint, and others. Though not
disposed to concur in so general an inference on the  source of capsular ligaments,
inasmuch as their peculiar texture is opposed to it, and many other circumstances
in their anatomical arrangement, I have yet to express great satisfaction in the
fidelity with which these connexions of the larger joints have been traced.
                               26* 
306
SKELETON.
variable.  In front, and above, it is  remarkably strong, is two or
three lines thick, where it is re-enforced  by a large fasciculus of
fibres coming from the anterior inferior spinous process of the ilium,
and descending, longitudinally, to the anterior oblique ridge of the
os femoris.  The internal and posterior portions of the  capsular
ligament are not so thick; it is, indeed, very thin  near the poste-
rior  ridge of the os femoris, being not more than half a  line, and
has  a  number of holes  in  it  for the passage of vessels.   It is
strengthened, internally, by some fibres  coming from  the superior
margin of the thyroid foramen.
   This capsular ligament keeps the bones closely  applied to each
other,  and  is  by no  means so loose  as the  corresponding one
of the shoulder joint.  Its fibres  are very irregular, generally, in
their course, and  difficult to follow.
   The strength of this  articulation depends principally on the mus-
cles which surround it, of which the  rectus femoris, and the iliacus
internus and psoas magnus united, are in front; between the latter
two and the capsule, is a bursa mucosa.   Within, are the pectineus
and  the obturator externus;  behind, are the  quadratus, the gemini,
the obturator internus, and the pyriformis;  above  and behind, are
the glutaoi.

   The Synovial Membrane  is  a complete sac, displayed over the
articular surfaces of the bones, and the internal face of the cap-
sule.   It is  separated from the roughness at  the bottom of the ace-
tabulum, by the existence there of a pad of very vascular, fine,
fatty matter, from which, according to Bichat, it may be raised by
blowing beneath the ligament  of the  notch,  at the  point where the
blood vessels enter.  Coming from the  acetabulum, it covers, the
articular face of the cotyloid ligament, and  is then reflected to the
capsule, to which it gives a polished  internal face,  and from  which
it may be dissected.   On  reaching the  root of the neck  of  the os
femoris, it forms small  duplicatures, and is reflected upwards  along
the neck to the head, being separated from the neck by periosteum, or
by a fibrous tissue, which M. Boyer considers  a continuation of the
capsule.  It covers all the head, except  the point of attachment for
the round ligament, and  to  the latter it gives a sheath, which, at
the  other end, is continuous with the part  of the synovial  mem-
brane  covering the fatty matter.  From  the  latter circumstance, 
ARTICULATIONS OF THE LOWER EXTREMITIES.
307
arises a deceptive appearance of the round ligament being inserted
into the roughness in the bottom of the acetabulum.*

                       Of the Knee Joint.

  It is formed by the os femoris, the tibia, and the patella, the par-
ticular modelling of whose articular surfaces, for the purpose, has
been  described.  These  surfaces are  all covered by an uniform
lamina of cartilage, and are held  together by an apparatus which
for the number of its parts and their  arrangement, makes this the
most composite joint in the skeleton.
  The most superficial layer of the knee joint is the fascia lata of
the lower extremity, which, in  passing down from the thigh to the
leg, is so near the  cavity of the articulation on each side of the
tendon of the patella, that it is by Weitbrecht spoken of under the
term of  Common Investment (Involucrum Generate.)  It is here
not only a continuation of the fascia femoris, but  this fascia is in-
creased  and thickened by an aponeurosis, which springs from the
inferior  extremity  of the extensor muscles on  the  thigh.  The
membrane  thus formed  covers both the patella  and its ligament,
and extends on each side  to the lateral  ligaments of  the joint, to
which it adheres; it may  be traced even behind them, but there it
becomes indistinct,  loose, and  blended with  common  cellular and
adipose membrane.   The involucrum adheres strongly to the inter-
nal and external  condyles, and  to the head of the tibia; it has ob-
lique fibres  on the patella, transverse  ones on the ligament of the
latter, and longitudinal ones on each  side.   It is in  contact with
the synovial membrane of the  joint, except in the middle portion,
where it is separated from it  by the patella, and its  tendon, and
some adipose matter.   It  may  be dissected without difficulty from
the subjacent parts, by which the ligament of the patella, and the
synovial membrane  are brought into view.

  The Ligament of the  Patella being situated at the fore  part of

  *  I have found, in  one instance, Dec. 10, 1838, the capsular ligament of this joint
with a large opening, nine by eighteen lines, in front, and the synovial membrane
communicating through it with the bursa between the trochlea of the ilium and the
iliacus internus muscle.  A similar arrangement existed on both sides of the body,
every thing else being normal.  Such  a condition must, of  course, favour, under
suitable circumstances, the internal dislocation of the os femoris.  It was repeated
in another subject, Jan. 2, 1839. 
308
SKELETON.
the articulation, though separated from  the extensor muscles  by,
the intervention of the patella, is, nevertheless, their tendinous  in-
sertion into the leg.  It arises from the whole inferior  margin of
the patella, and is inserted into the tubercle of the tibia.   It con-
sists in longitudinal, closely compacted  fibres, of a character en-
tirely tendinous; the more superficial  of them give a layer to the
front of the patella, and in the fracture of the latter sometimes pre-
vent a separation of its fragments.  In front, as  just mentioned, it
is in contact with the involucrum; behind, is a large mass of fat
placed between it and the synovial membrane of the joint; and  on
the same surface, but lower down, it  is  in contact with a bursa
mucosa fixed between  it and the triangular flatness of the  tibia
above the tubercle.

  A posterior ligament, an  internal and an external lateral  liga-
ment, two crucial  ligaments, two semi-lunar cartilages,  and a
synovial membrane, compose the  remaining apparatus of the joint.

  The Posterior Ligament  {Lig. Posticum,) is a  fibrous  expansion
on  the back  of the knee joint, which may be  considered as the
proper capsular ligament at this point, and  has its fibres  extending
obliquely from the external condyle of the os femoris to  the poste-
rior part of the head of the tibia.  It  is frequently called the  liga-
ment of Winslow, and by the French anatomists is considered  as
one of the divisions  of  the tendinous insertion of the semi-mem-
branosus  muscle, in  consequence  of its  close connexion with it.
There  are several foramina or interstices in it, which permit a
passage of blood vessels to the fatty matter placed between it and
the crucial ligaments; and beneath it there  are some  transverse
fibres.

  The Internal Lateral Ligament (Lig. Laterale Internum) is a
flattened fasciculus of fibres placed at  the internal side of the joint.
It arises from the tuberosity on the inner side of the internal  con-
dyle, and  descending vertically is slightly attached to  the inner
semi-lunar cartilage, and is then inserted into the superior margin
and the internal face of the head of the tibia  for two inches or
more, increasing in breadth as it descends.  * On  the  one side it is
in contact with the synovial membrane, and on the other, with the 
ARTICULATIONS OF THE LOWER EXTREMITIES.
309
involucrum and the tendon of the sartorius, the semi-fendinosus,
and the gracilis.

   The External Lateral Ligament (Lig. Laterale Externum Lon-
gum,) placed on the external side  of the joint, is nearer its poste-
rior face than the internal ligament.  It arises from the tuberosity
on the outer face of the external  condyle, above and behind the
tendinous origin of  the popliteus muscle, and is  inserted  into the
external part of the superior extremity of the fibula, being covered
in almost its whole extent by the tendon  of the biceps.  Its  inner
face is  in  contact with the synovial membrane,  and  the articular
vessels.   Its rounded form and shining appearance make it look
very much like a tendon.  Behind it, occasionally,  is  a small fas-
ciculus, called by some the short external  lateral ligament, which
passes from the external condyle to the head of the tibia.

   The  Crucial Ligaments (Lig.  Cruciata,) two in  number, are
named from their crossing one another laterally, and thereby form-
ing a figure, resembling the letter X, or a Malta cross.  They are
situated at the posterior part of the articulation between the poste-
rior ligament and the synovial membrane.   One of them is called
anterior, and the  other posterior, from their relative  situations to
each other.  The first arises from the internal face  of the  external
condyle, by a depression near the posterior end of  the notch and
just at the margin of the articular surface; it descends forwards,
and is inserted immediately in front of the little ridge between the
articular faces of the tibia.  The second arises from the bottom of
the notch between the condyles, just  behind the  trochlea  for the
patella, upon a  surface that may be considered as belonging to the
internal condyle; it  descends  backwards, and is inserted  into the
rough  surface  behind the  aforesaid spine  or  ridge  of the  tibia.
The crucial ligaments are large, round, and composed of parallel
fibres very closely compacted; their strength is very considerable,
and they serve not only to limit the extension of  the  leg,  but also
to check any thing like rotation inwards.
   The Semilunar Cartilages (Cartilagines Semilunares, falcata,)
are two in number; one placed on either side of the superior face
of the tibia, between it and  the condyles of the os  femoris.  Their
shape is sufficiently indicated by their  names, and  as they are
placed on the circumference of each articular surface of the tibia, 
310
SKELETON.
leaving the middle uncovered, they increase considerably the depth
of the concavities for receiving the condyles.   Their external cir-
cumference is thick, whereas, the internal is reduced by a gradual
diminution of their thickness, to  a  very thin edge.  The internal
cartilage is but little more than a  semicircle, and is longer in its
antero-posterior diameter than in its transverse: on the other hand,
the external is almost circular; an  arrangement by which each is
suited to its respective surface.   They adhere by their greater cir-
cumferences to the fibrous matter  surrounding the joint, particu-
larly the lateral ligaments, but not  so  closely as to  prevent their
sliding backwards and forwards in  the flexions of the  leg.  The
tendon of the popliteus adheres to  the external, either directly or
by the intervention of a small synovial sac.
  The internal semilunar cartilage is  attached by its fore extre-
mity to the anterior internal side of the roughness in front of the
ridge, called spinous process, on the  top of the tibia, and by the
hind extremity  to the posterior face of the base  of the ridge, just in
advance  of the  posterior crucial ligament.  The external cartilage
is attached by its anterior end, also, to the roughness in front of the
ridge; but this  attachment is considerably behind the correspond-
ing one of the internal cartilage, and is somewhat blended with the
anterior crucial ligament: the  posterior  end is fixed into the de-
pression on the  summit of the ridge or spinous process, and is there
between  the two crucial  ligaments.  The anterior extremities of
the two cartilages are united by a transverse ligamentous fascicu-
lus a line in thickness, which is rather inconstant; but when found,
is in front of the anterior  crucial ligament.  These bodies, though
presenting an appearance corresponding with  cartilages, on their
surface, are, nevertheless, formed principally from concentric liga-
mentous  fibres; the character of which  is  very evident at their
extremities, and when they are lacerated.

  The Synovial Membrane is thin, loose, and  delicate, and, as in
other joints, is a perfect  bag, covering the articular faces of the
bones, and reflected from the  one  to the other.  As there  is no
regular capsular ligament to the knee joint, the synovial  membrane
is  very distinct on each  side of the tendon of the patella; and
comes in contact  there with the fascia lata, or involucrum, as it
passes from the thigh to the leg.   The synovial membrane, after
covering  the articular faces of the tibia, is reflected from their 
ARTICULATIONS OF THE LOWER EXTREMITIES.
311
 margin upon the semilunar cartilages, so as to invest their inferior
 and superior surfaces;  it then ascends to the condyles of the os
 femoris.  It covers the condyles, laterally, as well as on their arti-
 cular faces, and  leaves thereby half an inch or more of their cir-
 cumference on each side of the trochlea of the patella, included in
 the  periphery of the joint.   The synovial membrane, anteriorly,
 being separated from the tendon of the patella,  by the large mass
 of fat, then covers the posterior face of the  patella, and,  rising up
 still farther, lines the posterior face of the tendons of the extensor
 muscles for the distance of three inches or thereabouts.   The supe-
 rior end of this reflection is formed into a small pouch, communi-
 cating freely with the general cavity, but  marked off from it by a
 partial and variable  septum  on each side.   Some anatomists con-
 sider the pouch as a  bursa, but it is so seldom seen entirely distinct
 from the joint, that it answers better  to describe it as a  part only
 of the general reflection.  The synovial membrane, at  the sides of
 the joint, is in contact with the lateral ligaments.  Behind, it is re-
 flected on the anterior surface of the tendinous origins of the gas-
 trocnemius, and envelops the tendon of the popliteus; it also invests
 the crucial ligaments, but in such a way  as to  leave them out of
 its cavity.
  The mass of fat behind the tendon of the patella forms, just be-
 low the latter, a ridge on each side, protruding  into the articula-
 tion, and having a fringed summit formed  by a doubling of the
 synovial membrane.   The external ridge is the Ligamentum Alare
 Minus Externum, and the other the Ligamentum Alare Majus In-
 ternum.  These ridges converge at their lower extremities, and
 from their  point of union proceeds a duplicature of the  synovial
 membrane, in front of the anterior crucial  ligament; the other end
of the duplicature is attached to  the  posterior extremity of the
groove, in the middle of the trochlea, for the patella.  This dupli-
cature is the Mucous Ligament, (Ligamentum Mucosum.)
               Of the Peroneo-Tibial Articulation.

  The tibia and fibula are held together by three places of union,
one above, another below;  and, thirdly, the  ligament which fills
up the space between the bodies of the bones. 
312                       SKELETON.
    1. The Superior Articulation, formed by the upper extremity of
 the fibula and the outer side of the head of the tibia, is entirely dis-
 connected with the cavity of the knee joint, and  has nothing in
 common with its  apparatus, except the external lateral ligament,
 which  has been described.   The articular  faces  are small, and
 covered with cartilage; an anterior and a posterior ligament, and
 a synovial membrane, hold the bones together at this point.
   The anterior ligament is attached by one end to  the front of the
 head of the fibula, and proceeding upwards and inwards, is inserted
 by the  other into the contiguous  part of the head of the tibia, be-
 fore the articular facet.  The fibres are separated  into fasciculi,
 leaving interstices between them  for cellular substance.
   The  posterior ligament is  narrower  than  the anterior, but its
 fibres are more compact;  and,  like the  anterior,  they observe a
 transverse course, being attached  by the one end  to the head of
 the fibula, and, by the other, to  the head of the tibia.  The  pop-
 liteus muscle covers them.  This joint is  also strengthened by
 other ligamentous fibres, and by the insertion of the tendon of the
 biceps.
   The  synovial membrane is reflected over the articular faces and
 the ligaments described, and has nothing of particular interest in
 it.   Occasionally,  the synovial membrane of  the knee joint runs
 into it.

   2. The Inferior Articulation, which is formed between the lower
 extremities of the bones, is not incrusted by cartilage, except to
 the breadth of a line at  its lower part, bordering on the  ankle
joint.
   Its anterior ligament is broad, and  covers the face of the bones
 which are in apposition.   Attached by the one side to the front of
 the lower extremity of the fibula,  its fibres pass obliquely upwards
 and  inwards,  to be inserted into the corresponding part of the
 tibia.  Several interstices exist  in it for the  passage of vessels,
and it is covered by the peroneus  tertius.  Its  lower margin is in
contact with  the astragalus, and forms a portion of the ankle joint.
  The posterior ligament, in the arrangement and course of its
fibres, corresponds with the anterior; being attached by one side
to the posterior face of the fibula, and by the other to  the corre-
sponding part of the tibia.  Like the other, its fibres are longer 
            ARTICULATIONS OF THE LOWER EXTREMITIES.         313

near the ankle joint than above.  Its lower margin is  in contact
with the astragalus, and is connected with other ligaments coming
from the fibula.
   In the space between the anterior and the  posterior ligament,
where the  bones touch, they are agglutinated  by a short, strong,
fibrous tissue, leaving intervals occupied by adipose matter.   It
contributes much to  the solidity and immobility of this articula-
tion.

   3. The Interosseous  Ligament (Membrana  Interossea,) is ana-
logous to that in  the fore arm,  by being a membrane  stretched be-
tween the two bones.   It arises from the ridge on  the  outer face
of the  tibia, and is attached to the corresponding ridge on the inner
face of the fibula.  It is broader above than below,  being  at  the
latter  point continuous with the  fibrous structure which aggluti-
nates the bones.  Just below the head of the fibula is a large hole
for transmitting the anterior tibial vessels,  and the origin  of  the
tibialis posticus muscle.  It also  presents,  in  its  descent, several
smaller foramina for the passage of vessels.  Its fibres are  strong
and unyielding, and run obliquely downwards from the tibia to the
fibula.  It  is covered in its whole length, both  before and behind,
by muscles, and  serves  as  an  origin to them  and as a means of
attachment between the bones.


                       Of the Ankle Joint.

   The articular  surfaces, here, being covered  by cartilage as  in
other moveable joints, are formed by the astragalus being received
into a  deep cavity made by the tibia and the fibula.  The capsular
ligament, properly speaking, does not exist  either on the front or
the back of the joint, and is represented, there,  by a few scattered,
loose fibres, on the periphery of  the synovial membrane.   An inter-
nal and an  external lateral ligament, with the synovial membrane,
constitute the whole apparatus.

   The Internal Lateral  Ligament,  also  called the Deltoid, (Lig.
Deltoideum) arises from the whole inferior margin of the malleolus
internus, and with particular strength from  the depression which
exists in it:  it  then descends and  is inserted  into the internal face
of the  astragalus, and into  the lesser apophysis of the os  calcis,
  Vol. I.—27 
314
SKELETON.
which lies just below it, being also strongly attached at its anterior
part to the Internal Calcaneo-Scaphoid Ligament.  This ligament
is broad, thick, quadrilateral, and composed of fibres which de-
scend  obliquely backwards.  The tendon  of the  tibialis  posticus
runs in a trochlea which is formed on the internal face of this liga-
ment.

   The External Lateral  Ligament  (Lig.  Triquetrum) consists in
three distinct fasciculi, of which one is anterior, another posterior,
and the third in the middle.  The anterior arises  from the lower
extremity of the malleolus externus,  and, running inwards  and
forwards, is inserted  into the outer face of the astragalus in front
of the surface  for the fibula.   The posterior arises from the de-
pression  in the extremity of the  malleolus externus, and, running
inwards  and backwards, is attached to the point of the astragalus,
at the outside of the groove, for the  tendon of the flexor pollicis.
The middle arises from the  pointed termination of the malleolus
externus, and, descending beneath the tendons of the peronei mus-
cles, is attached  to the external  face of the  os calcis, below the
surface for the  astragalus.   These  fasciculi are composed of
strong longitudinal and parallel  fibres.  The posterior is  larger
than either of  the others, and occasionally detaches a part  which
is inserted  into  the posterior margin  of the articular face  of the
tibia.

  The Synovial  Membrane is reflected, as usual,  over the articu-
lar surfaces, and from one bone to the other.   It sends up a short
process of a line in  length  between the tibia and the fibula,  it is
remarkably loose in front and  behind,  and has on its superficial
face a  considerable quantity of adipose matter, which cannot be
easily detached from  it.  It commonly  contains an unusual quan-
tity of synovia.


                 Of the Articulations of the Foot.

   Of the Tarsal Articulations.—1. The Os Astragalus  is  united
to the  Os Calcis by  a double  articular surface, which  has been
described.   The ligaments which hold them together are  as fol-
low :— 
            ARTICULATIONS OF THE LOWER EXTREMITIES.         315

  The Interosseous Ligament is placed between the two bones, so
as to occupy the  large oblique  fossa between the double articular
surface in  each.   It  is a collection  of very strong, short  fibres,
with interstices for fatty  matter, which, arising from the whole
length  of the groove in the astragalus, descends to be inserted into
corresponding  points in the groove of the os  calcis.   Where the
fossa is narrow, as it is behind, the ligament is thin and flat, but it
augments considerably in front, where there is more room for it.

   The posterior Ligament arises from the posterior margin of the
astragalus, and, descending  obliquely inwards, is inserted into the
adjacent portion  of the  os  calcis.  Its fibres, are  blended  with
those of the Deltoid  Ligament, and on their posterior face  they
form a ligamentous trochlea for the tendon of the flexor pollicis
pedis.
   This articulation is also strengthened by the insertions stated, of
the lateral ligaments of the ankle joint into the os calcis.

   The Synovial  Membrane forms  a distinct cavity on the poste-
rior and larger articular  face of the two bones, and  is in contact
with the fatty matter in advance of the tendo-achillis.

   2. The Articulation of the  Astragalus with the  scaphoides is
formed by the convex head on the part of the former, and by the
concavity on the part of the latter.  It is covered, above, by a thin,
broad  ligament,  with parallel  and oblique  fibres, which, arising
from the superior and internal face of the astragalus, are implanted
into the upper  face of the scaphoides, some of its fibres extending
over to the cuneiform bones.  It is covered,  above, by the tendons
of the  extensor muscles of the toes, and of the tibialis anticus.

   On the under  surface of  the foot, this  articulation  is supported
by two ligaments, called the Calcaneo  Scaphoid, (Lig. Plana,)
from their origin and insertion.   The  Internal one arises from the
internal margin of the lesser apophysis of the os calcis, and, run-
ning obliquely forwards and inwards, is inserted into the under and
internal surface of the os scaphoides.   It is a very thick, flattened
fasciculus, on the under surface of which is formed  the ligamen-
tous trochleas, in  which run the tendons of the flexor pollicis and
flexor longus digitorum, and which surface  is also in  contact with 
316
SKELETON.
 the tendon of the tibialis posticus.  By subtending the head of the
 astragalus, the Internal Calcaneo Scaphoid Ligament contributes
 largely to keeping it in place, in the erect position.   The External
 Calcaneo Scaphoid Ligament, placed  at  the outer margin of the
 last, arises from the under surface of the  greater apophysis of the
 os calcis, and running obliquely inwards and forwards, is implanted
 into the under external surface of the  scaphoides.  It consists in
 two or more short, strong fasciculi.

   The Synovial Membrane of the articulation between the astra-
 galus and the scaphoides covers the articular faces of these bones,
 and lines the ligaments above and below.   A reflection of  it, also,
 lines the articulation between the os calcis and the astragalus, in
 front of the rough fossa which is  occupied by their interosseous
 ligament.

   3. The Calcaneo Cuboid  articulation, formed by the two bones
 indicated in the name, is maintained by two ligaments, one above,
 the other below, and by a synovial  membrane.

   The Superior Calcaneo Cuboid Ligament arises from the upper
 anterior surface of  the os calcis, and is inserted into the adjoining
 upper  surface of the cuboides.  It is broad, thin, and quadrilateral,
 with short parallel fibres, and is in  contact, above, with the pero-
 neus tertius tendon.

  The Inferior Calcaneo Cuboid Ligament, (Lig. Plantare,) placed
 on the plantar  surface of  the foot,  is remarkable for its  size  and
 extent.  It consists of two horizontal planes of fibres, of which the
 superficial is the longest.  The  latter arises from  the  back under
 surface of the  os calcis, and,  advancing forwards, its fibres are
 inserted into the summit of the ridge which traverses the cuboides
 obliquely; the greater part of them, however, go beyond this point,
 and, dividing into fasciculi, are inserted into the base of the fourth
 and fifth metatarsal bones.   The tendon of the peroneus longus is
 confined between  these fasciculi  and the  under surface of the cu-
 boides.   The other plane of this ligament being more deeply seated*
is also  shorter.  It  arises  from the front  under  surface of the os
calcis,  where the tuberosity exists at this point, and, by advancing,
is inserted entirely into the oblique ridge of the cuboides. 
ARTICULATIONS OF THE LOWER EXTREMITIES.
317
   The Synovial Membrane being reflected over the articular sur-
 faces of the bones, and lining the ligaments, is uncovered at several
 places above, where interstices exist between the fibres of the supe-
 rior ligament, and externally it is contiguous to the tendon of the
 peroneus longus.

   4. The Scaphoid  and the Cuboid bones touch at the  external
 posterior angle of the cuneiforme externum, and form, there, occa-
 sionally,  a  distinct articular surface, with  a synovial membrane.
 Besides this mode of union, an interosseous ligament is introduced
 between  them.  On  the dorsum of the foot there is  a transverse
 ligament  running from one bone to the other beneath the extensor
 tendons;  and  on the sole of the foot there is an oblique ligament,
 which, arising from the under surface of the scaphoides, is inserted
 into the anterior internal margin of the cuboides.

   The  articular  surfaces of the Cuboides  and  Cuneiforme Exter-
 num, which are in contact, besides a distinct synovial membrane,
 are  secured by transverse and oblique  ligamentous  fibres  going
 from the  one bone to the other.

   5.  The Articulation between the scaphoides and the three cunei-
 form  bones  is  secured by a dorsal and  a plantar ligament.   The
 dorsal, arising from the  back  of the scaphoides, is divided into
 three fasciculi, that go, respectively, to the back of each cuneiform
 bone; of  these, the internal is  the strongest, and is particularly
 well  marked  on the  internal  face of the  cuneiforme internum.
 The plantar ligaments are, also, three in number, and, having a
 sort of common base  from  the under surface of the scaphoides, by
 being divided  into three  fasciculi, as the above, are  inserted into
 each cuneiform bone.  They are not so well marked as the upper
 ones.

  The cuneiform bones  are also connected together  above and
 below, by  short transverse ligaments going from one bone to the
other, and holding their lateral surfaces in contact.  Those below
are not so distinct as the  upper ones, and are blended with the in-
sertions of the tibialis posticus.

  One synovial membrane  covers the articular surfaces of the
                            27* 
318
SKELETON.
scaphoides and of the cuneiform bones which are in contact; and
it extends itself by digital processes between the first and second,
and the second and third cuneiforms, so  as to line also the articu-
lations there.  The process between the latter two is much shorter
than the process between the former two, which extends itself into
the tarso-metatarsal  articulations, after the same principle which
is observable in the hand.


             Of the Tar so-Metatarsal Articulations.

  The articular faces of the bones, here, having  been sufficiently
described, it is  to be noted in addition, that besides being  covered
with cartilage, they have the apparatus of the moveable articula-
tions  generally, in ligaments  which hold them together,  and  in
synovial membranes.   The ligaments are above and below.

  1. The articulation of the first metatarsal bone with the cunei-
forme internum is one-third of an inch in advance of the next, and
completely insulated by its  synovial  membrane:  it is  strongly
secured by ligamentous fibres above, internally and below, which
give it almost a complete capsule.

  2. The  dorsal or upper ligaments of the remaining metatarsal
bones are arranged  as follows.   There are three for the second
metatarsal; one comes from the second  cuneiform, one from the
first, and another from  the third : the  latter two are oblique; and
they all converge to be inserted into the base of the bone to which
they belong.  One dorsal ligament passes from the third cuneiform
to the base of the third metatarsal; it is  sometimes assisted by a
fasciculus from  the cuboides.  From  the superior face of the cu-
boid bone  a fasciculus  is sent to the  base of  the  third and fourth
metatarsals.

  The plantar or  under ligaments are arranged on  the same plan
with the dorsal.   Not being quite so strong, they are re-enforced
by the fibrous sheaths of the  flexor tendons which lie upon them.

  The synovial membrane, which is  reflected over the articular
surfaces between the second and third metatarsals and their cor-
responding cuneiforms, is the elongation of the digital process sent 
            ARTICULATIONS OF THE LOWER EXTREMITIES.        319

from the scaphoid articulation between the first and second cunei-
forms.  This  process, besides  extending to the aforesaid  tarso-
metatarsal articulations, insinuates itself to the  articular surfaces
on the sides of the second metatarsal bone;  but a distinct synovial
capsule is sometimes formed  between  the  base of  the third and
fourth metatarsals.

  One synovial membrane is reflected over the  surfaces, between
the cuboides and the last two metatarsals, and sends in a process
between the latter.   In  all  these  cases  the synovial  membranes
line the dorsal and plantar ligaments  of their respective  articula-
tions.

                 Of the Metatarsal Articulations.

  The metatarsal bones, with the exception of the first, articulate
with each other by the contiguous faces  of their roots; which has
just been  stated;  along  with the manner of their getting at these
points, a lining of synovial membrane.  They are farther fastened
to each other by short transverse ligamentous fasciculi, which pass
from  the base of one to the base of the adjoining.   These  fasciculi
exist both on the upper and  under surface  of the bones, and are,
therefore, denominated  dorsal  and plantar metatarsal ligaments.
There is also  a description of interosseous ligament between the
bases of these bones, occupying the space intermediate to the dor-
sal and plantar ligaments of each.
  The anterior extremities of the metatarsal bones are not in con-
tact;  they are, however, fastened to each other by a transverse or
Anterior  Plantar Ligament on their  under  surface, the fibres of
which are somewhat  blended with the capsular  ligaments of the
first joints of the toes.


                 Of the First Joints of the  Toes.

  The surfaces of the bones here being covered with cartilage, are
formed into an arthrodial articulation.   There is a fibrous capsule
surrounding the articular  faces, and enclosing the synovial mem-
brane.  This^capsule is  considerably thickened below, where the
flexor tendons pass over it; above, it does not exist, as the extensor
tendon is there lined by  the synovial membrane:  on each side it is 
320
SKELETON.
also thickened, so as to form a lateral ligament, but much weaker
than the corresponding ligament of the fingers.  In the great toe
the external lateral  ligament is either inserted into the outer sesa-
moid rather than into the first phalanx.  In  the  under part of the
capsule of the great toe, we find on each side a sesamoid bone.
   These joints resemble so strongly the corresponding joints of the
fingers, that a farther description is unnecessary.


           Of the Second and Third Joints of the Toes.

   From the shape of  the surfaces  of  the bones  composing them,
these are simply ginglymous  articulations.   They have  their car-
tilaginous incrustations, synovial  membrane, and capsular liga-
ment.   The under part of the latter is much thickened, and forms
a trochlea for the flexor tendons; on each side it is arranged into
a lateral ligament, and above it is defective,  as the synovial mem-
brane is in  contact with the extensor tendon.  These joints also
resemble so  strongly the corresponding  ones of the fingers, that
farther description is unnecessary. 
BOOK II.
               OF THE INTEGUMENTS OF THE BODY.

  The integuments of the body consist in the Cellular and Adipose
Substance, and in the Dermoid Covering.
                         PART I.
                Cellular and Adipose Substance.

                        CHAPTER I.

               Of the Cellular Substance.

   The Cellular Substance (Textus Cellulosus, Mucosus) is an ele-
mentary tissue, and is  more generally diffused than any other of
the body, for it seems to be quite as indispensable to the latter  as
the corpus mucosum is to vegetables.  It is found abundantly be-
neath the skin ; between muscles; in the interstices of muscles and
of other parts; connecting membranes to one another; surrounding
organs; entering into their composition; glueing them together; in
fine, under  every variety of  circumstance and locality of  which
the human organization admits.  Indispensable as it is to the tex-
ture of all other parts, we find it, as may be expected, preceding
them in the development of the foetus; at which period it is in the
condition of a fluid slightly coagulated.
  When examined with a microscope, as it winds around a mus-
cle and introduces itself between the fasciculi  of  its fibres, it will
be seen that, however fine the latter may be, yet this body is inter-
posed between them in thin  lamina?.  On separating these fibres, 
322
INTEGUMENTS.
the intervening laminae are  resolved or  drawn  out into fine fila-
ments, which, finally, break after being stretched to  a  certain ex-
tent.   The lamina which surrounds the whole body of the muscle,
and constitutes its sheath, on being put upon the  stretch, also tears
after  having been attenuated into still  thinner  laminae and into
fibres.
   If air be blown into the sheath of a muscle,  this sheath is dis-
tended into a multitude of cells of various forms and sizes, which
have no determined shape, and do not upon expulsion  of the air
return to the same shape upon a repetition of the inflation.  Such
cells  communicate very freely;  all limpid  fluids  pass  with  the
greatest ease from one to the other, so that  from any single point
they may, by the force of injection, be distributed throughout the
body; this is manifested in emphysema, where from a small wound
in the thorax,  air becomes universally  diffused.   Fluids of any
kind, except they be inspissated, when  deposited in these cells, are
subject to the common laws of gravity, and continue to descend
successively from the higher to  the  lower cells, as in anasarca.
Blood traverses them very readily in ecchymosis.
   Cellular tissue enjoys a good deal of elasticity, for when stretched
it readily returns  upon itself.  When very thin, as between the
fibrillas of muscles, it is colourless or nearly  so, and of a gelatinous
or glue-like consistence; but when its laminae are thicker, it is of
an opaque  white, and  has a strength amounting almost to that of
ligamentous matter.   When dried it becomes crisp and of a dark
brown; but may be restored  to its colour and condition by soak-
ing in water.   It is only very slightly affected  by the  usual heat
of the culinary processes of roasting or boiling, as our dishes of
meat daily prove; but may be resolved  into gelatine after a pro-
tracted ebullition.  Its putrefaction is slow,  and  cannot be accom-
plished, by  maceration, under several months.
   The cellular substance is pervaded by a  large number of blood
vessels, the majority of  which do not, in a natural state, convey
obviously red blood; but if any portion of it be exposed for a short
time to the air, or to any other unusual stimulus, it quickly becomes
suffused with red blood, circulating through an  infinitude of chan-
nels.  It cannot, however, be conceded, as  Ruysch supposes, that
it is formed exclusively of blood vessels.  Some  anatomists, indeed,
 as Haller and  Prochaska, allow that though blood vessels ramify
 through it,  yet they are  not spent upon it, or do not form a part of 
CELLULAR SUBSTANCE.
323
its organization.  The distinction is rather too subtle, to be readily
admitted, and seems, moreover, to be refuted by the continued ex-
halation and absorption which  is  going on within.   It does not
appear that nerves  are spent  upon the cellular substance, though
they pass abundantly through  it to their respective organs.
   It is probable that the granulations on which injured parts of
the body depend for their restoration, arise from this cellular sub-
stance.   The late Professor Wistar  attended a patient for com-
pound fracture of the leg, with a large wound, which was  subse-
quently covered with luxuriant  granulations.   The limb was sud-
denly attacked with an cedematous swelling, which extended itself
to the sore, and caused its granulations to  tumefy, so that  they
pitted upon pressure precisely like other  parts.*

   The  most generally received opinion  of anatomists,f in  regard
to the arrangement of cellular tissue is, that it results from the
assemblage of a multitude of lamellae, and of fine soft filaments,
which,  being variously interwoven, produce  a series  of cells all
communicating one with another, but varying in  their shape and
size; so that the whole cellular substance maybe considered  to
represent a single  cavity subdivided into an infinitude of smaller
ones.  To this it is objected,;}; that when this tissue is accurately
examined,  it appears rather as a  homogeneous, viscid, and only
partially solidified substance;  particularly in the inferior orders of
animals, and in the embryo state of the more exalted, where it has
still to admit  the  deposite or  formation  of  the  several  organs.
That the same is manifested at any period of life; for  neither with
the naked  or  assisted  eye does  it  assume any other appearance.
That its laminated  and filamentous condition, when such does ap-
pear, is owing to  its  glutinous or  glue-like consistence, which
causes it to assume a factitious arrangement upon being drawn or
inflated.  For example, if one separates two muscles for a short
distance, the cellular  substance between  them becomes unequal
and furrowed without  losing its cohesion;  but if they be  farther
separated,  filaments and cylindrical columns are produced.   If the

  * System of Anat. vol. i. p. 388, 2d edition.
  t Haller, BSclard, Bichat, Wm. Hunter &c.
  t Bordeu, Recherches sur  le Tissu Muqueux et Celluleux.  Paris, 1790.  J, F.
Meckel, Manuel D'Anat. vol. i. p. 105. 
324
INTEGUMENTS.
traction be then suspended, and the muscles replaced, the filaments
shorten, and are finally united into a consistent  mass whose parts
all adhere together.*
  While such tractions are going on, it most frequently happens
that air is insinuated into the cellular substance, from which comes
the appearance of small  cells and vesicles:  upon the escape of
this  air, the primitive  state of cohesion is restored, and upon a
renewal of the traction, cells of a different shape, size, and appear-
ance arise.  Again, if air  be so introduced, one may push it in
any  direction, separate  its  globules, collect them  again, and  into
larger masses; vary their shape, and, in fine, by such means mould
the supposed cells  into an infinity of forms.  From these conside-
rations, the inference is  plain,  that  when cellular substance is
drawn it must yield itself into filaments; when inflated, as the air
acts in every direction, its  supposed  lamellae must  be separated
and  assume a  cellular shape; and, by the application of both forces
at once, it may be  caused  to assume  both a cellular and a fila-
mentous appearance.   Upon the whole, Meckel conceives that the
term Mucous  Tissue, adopted by Bordeu, is much more exact than
the one of Cellular Tissue, now most generally used.
  Notwithstanding the general  similarity of cellular substance
wherever found, there  is a well  marked difference between por-
tions of it, for example, the  intermuscular and subcutaneous cellu-
lar substance,  when inflated and dried, remains permanently lamel-
lated, whereas, that which makes  a regular tunic to the alimentary
canal and other hollow  viscera, when treated by the same process
is permanently filamentous and resembles so much carded cotton,
that  at a little distance  the distinction  of the two is very obscure.
The former is also much more glutinous to the feel and sight than
the latter.   The filamentous cellular substance is in its normal con-
dition free from fat cells, a disposition  indispensable to the preser-
vation  of the cavities to which it belongs.
  The cellular tissue like all others pre-exists in  the condition of a
homogeneous formative mass called cytoblastoma.   It corresponds
in animals with the gum so abundant in the nascent part of plants.
This gum or  cytoblastoma appears to  become,  according to the
observations  of Schleiden,f turbid from the  presence  of minute

              * J. F. Meckel, loc. cit.
              t Mailer's Physiology p. 49.   Bell's Edition. 
CELLULAR SUBSTANCE.
325
molecules.  In a short time larger molecules are noticed.  These
secondary molecules augment in size by agglomeration or coagu-
lation, and in that state  constitute Cytoblasts, in which the secon-
dary granules are visible as nuclei.  A cytoblast finally reaches
its full size, and then a small vesicle appears on it, which enlarges
and becomes a cell.   The cytoblast  is more or less permanent, and
is for some time visible either attached to the interior of the cell
or free in its cavity.  The observations of Schwann are admitted
to have proved the exact identity, of the process as described, both
in plants and in animals.   The process of primitive evolution, there-
fore,  in every case exhibits the  stages of  nucleoli, nuclei or cyto-
blasts, and germinal cells surrounding the  latter.  Mirbel had pre-
viously shown that the ultimate form of  all vegetable  tissue was
that of cells.
   In  the earlier stages of the cell it bears the relation to the cyto-
blast which a glass has  to a watch, but  finally enlarges so as to
enclose it.  Some nuclei are permanent, but dthers finally disappear
entirely.  The cells thus formed have others developed in their
interior, which  by their reciprocal  pressure  become  polyhedral.'1*
The cells of cellular tissue pass from the  above nascent state into
one of an elongated  spindle-like shape, having  its extremities re-
solved into  fine  filaments.   The filamentous structure  finally in-
vades the whole cell except the nucleus,  and the transformation is
now  complete by its running into similar adjoining filaments.
   Dr. M. Barryf advances the opinion that the blood  corpuscles
or globules  are the nuclei or cytoblasts of the primitive cells, from
which all the animal tissues arise.  The crystalline lens he consi-
ders  one  of the best proofs of this conversion.
   Notwithstanding  the  perfect continuity of the mucous or cellu-
lar substance throughout the  body, anatomists  for the ease of de-
scription  have divided it into External  and Internal.
   The  External Cellular Substance (Textus Cellulosus  Interme-
din, seu  laxus) has the general extent  and shape of the body and
of its organs, so  that if it were  possible to extricate the latter from
their envelope, it would present a chamber  for the lodgement of

  * The above subject has also been treated of with  great perspicuity by Valentin,
who has investigated closely these primordial laws of growth.  See Bells's Mailer,
p. 114.
  t Phil. Trans., 1840-41.
     Vol. I.—28 
326
INTEGUMENTS.
 each part.   But the walls of these chambers would not all be of
 the  same  thickness, as the quantity of  cellular substance varies.
 In the cranium and spinal cavity there is very little of  it: on the
 surface of the head and in the orbits more: about the trunk, both
 internally and externally, it is abundant; in the extremities  still
 more so, where  it penetrates  between the  muscles.  In  the arm
 pit, in the groin, and in the neck, all parts where much motion is
 enjoyed, it is unusually abundant.  The foramina of the cranium
 and of the spine, establish the points of  connexion of the cellular
 substance of  these parts with  others adjacent.  The cellular sub-
 stance of the face is continued into that of the neck; that of the
 latter is continued through the upper opening of  the  thorax upon
 the viscera of this cavity; and thence  through the openings of the
 diaphragm, along  the  great vessels and  oesophagus  upon the vis-
 cera of the abdomen and  pelvis.   The cellular substance of these
 cavities is again continuous with the deep-seated cellular substance
 of the limbs at the arm pit and  at the  groin.  The trunk of  the
 body being enveloped by  one  broad sheet of cellular substance, it
 is continued  superficially to the limbs.*
  With this general sketch of the distribution and extent of cellu-
 lar  substance, it is not surprising  that  in certain bad cases of en>
 physema, the air shows itself every where, even at points the most
 remote from  the lungs, and apparently  the  least exposed to  the
 accident, as the interstices of muscles,  of glandular organs, and so
 on.   It will also now be understood how this varied distribution of
cellular substance  and its proteiform  shape, have been the inex-
haustible but delusive source of anatomical  discoveries and  sup-
posed novelties, under the  name of fasciae, sheaths of vessels, and
so on; and will continue to be so, to such as do not recollect that
all these things are included under the general character of this
tissue; and  that each  muscle, each viscus,  each  nerve, and each
blood vessel, has its own particular chamber under this  multiform
arrangement, which chamber may be traced to or from  any other

  *  For a detailed account of the inflections of  the cellular substance, the student
may consult with advantage, Bordeu, loc.  cit. Tliese inflections are the fascice of
modern Surgical Anatomy.
  Bichat, Anntomie Generale; Systeme Cellnlare.  Paris, 1818.
  Andreas Bonn, de Contimiationibus Membranarum, in  Sandifort's Thesaurus
 Dissertationum, Rotterdam, 1769.
  Haller, Element. Physiol, vol. i. 1757. 
CELLULAR SUBSTANCE.
327
 point, according to fancy.  At the same time it should  be noted
 that many of the laminas have a condensed form, which renders a
 special knowledge of them of the greatest use to the surgeon, and
 which is elsewhere succinctly pointed out, with the description of
 their respective organs.
    Anatomists who lived at a period much less illuminated than the
 present on the subject of the elementary tissues of the  body, seem
 to have seized upon the idea of the universal inflection of cellular
 substance over the surfaces, and through the texture of the  several
 organs.    Mangetus,*  without pretending  to  originality,  but in
 alluding  freely to  the  observations of others, says, " Membrana
 adiposa,  est  expansio cellulosa, quae totum corporis habitum, pau-
 cissimis, iisque  minimis partibus exceptis, circumambit;  et in qua
 materia  albicans unctuosa, sensu expers, ad  partes fovendas ac
 lubricandas  colligitur.—Hasc membrana cellulosa seu pinguedinosa,
 non tantum  in  exterioribus corporis reperitur; sed interius in intes-
 tinis, mesenterio, aliisque prope  omnibus partibus, non  exceptis
 etiam vasis sanguiferis, ut suo  loco videbimus, observatur."  And
 in describing the  aponeurotic covering of the  body and  of  the
 limbs, which in  his day was called Membrana Musculosa, from
 some false notions of  its  nature, he adds, " Dicitur oriri a dorsi
 vertebris, quia scilicet earum spinis firmiter adhasret, inibique multo
 quam alibi usquam robustior conspicitur.  Usus est, musculos uni-
 versim in sua sede  firmare, iisque quasi thecam prasstare, in  qua ut
 supra innuimus  laxius sibi  cohasrente, lubrice  moveri queant."
 The cellular investments of the muscles the same author calls Mem-
 brana Musculi Propria, and he speaks of their penetrating between
 the fasciculi  of muscles, and most evidently those of the glutasus
 maximus and deltoides.

   The Internal  Cellular Membrane (Textus  Cellularis Stipatus)
 presents itself under different arrangements according to the organ
 or part whose interstices  it penetrates.  As it forms in the mus-
 cles an envelope for each fasciculus and fibre, if the latter by any
 art could  be withdrawn, it would  represent a congeries  of fine
 parallel  tubes.  In  the case of glandular bodies the internal cellu-
lar membrane imitates  the shape of their lobes, lobules, and acini
or small graniform  masses, and  may, therefore, be compared to a
*■ Thcatrum Anatomicum, Geneva, 1716, vol. i. Ch. iii. 
328
INTEGUMENTS.
sponge.  In  the  hollow viscera, as  the  stomach  and  bladder, it
unites their  successive laminas to one another.   In the  ligaments,
even where the  fibrous structure is perfectly evolved, the fibres
are united by cellular tissue in their interstices.  This tissue is not
sufficiently abundant in the bones, tendons, or cartilages, to be
very distinct; but from what  is seen of  it in the forming stage of
the embryo, it is  nevertheless ascertained to be  the base of every
part.   In glandular textures it is frequently spoken of under the
name of parenchyma in connexion with  their acini.

   Most of the membranous textures of the body may by macera-
tion be resolved  into this pulpy or cellular tissue,  so that we hear
anatomists, without hesitation, asserting, that under various de-
grees of consistence, it forms  the skin, the serous  membranes, the
vessels, the ligaments, in short, almost every thing excepting the
bones, the muscles, the nervous system,  and the glands, and they
only depart from it in  having their globules deposited in its inter-
stices.*  Meckel even adds to the list the epidermis.

   The term mucous tissue was substituted for that of cellular, by
Bordeu,f owing  to its glue-like consistence, and  to its resemblance
to the corpus  mucosum  of  vegetables.  Notwithstanding its pro-
priety on these grounds, yet as the lining membrane of all the hol-
low viscera has  the same name, some confusion may be produced
unless one bears in mind the distinction.  Bordeu has expressed
the character of the internal  cellular membrane very forcibly in
saying, that in embryos all their organs are species of buds, which
vegetate in the cellular tissue, like plants do in the open  air, or
their roots in the ground, and  that each  one having  an apartment
of its own, this  apartment is to  it  a  cellular atmosphere, which
keeps in a perfect relation with the action  of the organ.J

   In  tracing  many of  the  laminas  of the cellular  substance, we
find, that as life advances, they assume a  more fibrous character

  * Beclard, Anat. Gen. p. 141. Haller, loc. cit. p. 19; vol. i. p. 113.
  t Loc. cit.
  t Loc. cit. p. 65.  Recherches Anatomiques sur les Glands, Paris, 1752.  Also,
An Exposition of the Physiol, and Pathol. Doctrines of Theoph. Hordeu, \mderstood
to be from the pen of a learned friend, R. La Roche, M. D., in  the North American
Med. and Surg, Journal. Philad. April, 1826. 
CELLULAR SUBSTANCE.
329
than what they possessed in infancy; this also occurs when they
are pressed upon by tumours, or irritated from many other causes.
This disposition of the cellular substance to assume a ligamentous
character, in many of the attachments which are formed between
the two tissues, frequently leaves it doubtful with which  the mem-
brane under examination should be classed;  in  some individuals
the fibrous substance is  predominant, and  in others the cellular.
This deposite  of fibrous  matter into  cellular substance, or rather
the change of the latter into it, may be compared to the  partial or
even perfect conversion  of  the cartilages of the thorax  into bone
by an increased deposite of  the phosphate of lime.  It perhaps will
be better understood by repeating that this cellular tissue  is an ele-
mentary one, whereas, the ligamentous is composed of it and liga-
ment.

   In addition  to the uses of the cellular substance  in forming a
nidus for the deposite of all the molecules of the body, and  in cir-
cumscribing each organ, so as to  keep  it distinct from the conti-
guous  ones of a  different  character, its elasticity and  yielding
nature permit  it, in the movements  of the several parts upon each
other, to change its position, and upon the cessation of the  active
cause, to re-establish itself.  Its extreme flexibility is kept up by a
continued  exhalation of moisture   from the  arteries that ramify
through  its texture.  This  cellular serosity, when  an  animal is
recently killed, and its internal parts exposed to a cold atmosphere,
rises in  the form of vapour, and has a  particular smell.  It is more
abundant in certain parts than in others; and, as a general rule,
where there is the least adipose matter.  Indeed, these two sub-
stances seem to exist in an inverse ratio: in a person, for  example,
who has died very fat, the parts are comparatively dry;  whereas,
in such  as  have all the adipose matter wasted  by a  lingering dis-
ease, there is a humidity  which quickly disposes to putrefaction; a
fact frequently exemplified in our dissecting-rooms.  The cellular
serosity is, consequently, more  abundant in the scrotum, in the
eyelids, and in the penis.  Bichat informs us, that he has satisfied
himself  by  experiments,  of its augmentation  during  digestion,
during heavy perspirations,  and after sleep;  which will  account
for the swelling of the eyelids, so commonly observed in the  morn-
ing, upon rising.
  This serosity is  albuminous, as proved by  its being coagulated
                             28* 
330
INTEGUMENTS.
by alcohol, and by the  mineral acids.   It  is removed  by the ab-
sorbents;  assisted by the tonic contraction of the cellular mem-
brane, according to M. Beclard.*  The latter author, indeed, goes
on to say, that the cellular membrane is the essential organ of ab-
sorption, by which the skin and the villosities of the internal mem-
brane of the hollow viscera perform this function.  That the sub-
stances  introduced through it into the  blood vessels, no doubt, in
doing so, undergo some kind of elaboration, in the same way that
those do, which  are deposited in its  interstices for the growth,
repair, and changes of the body.
                       CHAPTER  II.

                    Of  the Fat, (Adeps.)

  The Adeps, in subjects  not  much  emaciated, is found beneath
the skin, between it and the fascias; and in the layers of common
cellular substance which are next to  the muscles;  as on the face,
the neck, the trunk of the  body, the buttocks, the limbs, the palms
of the hands, and the soles of the feet.  In the adult, it is also found
between the serous membranes and the cavities which they line,
as in the thorax and abdomen; it is also found between the laminas
of these membranes, as in the omenta, mesentery, and so on.  It,
likewise, exists between the  interstices of  muscles; in  the  bones,
and elsewhere; so that its whole amount  is  estimated at about one-
twentieth of the entire weight of the body.  There are, however,
certain  portions of the body, where its presence would have been
very inconvenient: they, accordingly, are  destitute of it; to wit,
the interior of the cranium, of the ball  of the  eye, the nose, the ear,
the intestinal canal, the eyelids, the  scrotum, the  penis, the labia
interna, and the substance of the glands.
   The adeps is of a  yellowish colour, and of a semifluid state in
the living body: when after death it has got a few degrees below
the standard of animal heat, it becomes somewhat solidified, and
* Anat. Gen. p. 149. 
ADEPS.
331
then appears in small aggregated  masses of different shapes and
sizes.
  In chemical composition  it differs from all other parts  of  the
body by the absence of nitrogen, and is formed of oxygen,  hydro-
gen, and carbon,  which render it, in animals, a very suitable arti-
cle  for candles and lamps.  According to the  analysis of Chev-
reul,* it consists  of  two kinds  of matter, elain and stearin;  the
former of which remains fluid at the freezing point, while, as men-
tioned, the other  becomes  solid by a very small abatement of its
living temperature.  The application of porous paper enables  one
to separate them  in a small way.
  The adeps, though lodged in the  cellular substance, is accom-
modated there under different circumstances from the cellular se-
rosity, and is supposed to be in different cells.   This doctrine was
promulgated by Dr. Wm. Hunter,f and upon the following grounds:
That certain parts of the cellular membrane are destitute of it; that
in persons who have died from dropsy,  the portions of the cellular
membrane which originally contained  fat, have a more ligamen-
tous condition than  others; to wit, those  on the loins next to  the
skin, more than the stratum next to the  lumbar fascia;  that water
or fluids pass readily from a higher to a lower part of the cellular
membrane,  either when extravasated naturally or injected; that
oil, when injected artificially, subsides in the same way, and has a
doughy or cedematous feel, yielding readily to pressure and pitting,
whereas, fat never shifts its position simply from gravitation.
   From these several causes, Dr. Hunter adopted  the opinion that
the fat of the cellular membrane is lodged in peculiar vesicles,  and
not as the water  of  anasarca, in the reticular interstices of parts.
This idea has been adopted by Beclard. who says that the lobules
of fat, when examined with  a microscope, are seen to be composed
of  small grains  or vesicles, from the six hundredth to  the eighth
hundredth part of an inch in  diameter, each one having a  pedicle
furnished from the  adjacent blood  vessel.  That the  parietes of
the vesicles are so fine as to escape observation, but that he con-
siders them  as arranged in the same way with the  pulp of oranges,
lemons, and such kind of fruit.
  The preceding observations on the probable existence of distinct

           * Annates de Chimie, vol. xciv.
           t Medical Observations and Inquiries.  London, 1762. 
332
INTEGUMENTS.
vesicles for the reception of fat, are now proved by the microscope.*
These vesicles are far from uniformity in size.   A  very common
diameter is the ^o of an inch, but they vary from the 5^Vo- to the
-i_
£50-
   It is more abundant in the female than in the male, and in both
sexes it is removed as life  declines.   In the infant the fat is found
at the surface of the  body chiefly, little or none existing in the in-
terstices of muscles, and in the cavities.
   Its uses are not fully understood.   At some points it  serves to
diminish pressure, as  on  the hands and feet;  at others it fills up in-
terstices ; it is also a  bad conductor of caloric, and may, therefore,
serve in retaining animal heat.   But its most  general application
is  to the purposes of  nutrition, it being one of those forms which
nutritive matter assumes previously to being perfectly assimilated.
This is very fully manifested  in  hibernating animals, which being
fat in the beginning of their torpid state, return from it quite lean;
and in insects which during their repose in the chrysalis  state, live
upon  their own fat while undergoing the metamorphosis into the
perfect animal.f

      * Gerber's Elements of General Anatomy, p. 133.. London, 1842,
      t Beclard, Anat. Gen. p. 170. 
PART II.
                   OF THE DERMOID COVERING.

  The Dermoid Covering, or tissue  of  the body, consists in the
Skin;—its Sebaceous organs;—the Nails;—and the Hair.
                        CHAPTER I.

                        Of the Skin.

  The Skin (Pellis, Cutis, <JV^») is extended over the whole sur-
face of the body, and thereby constitutes a complete investment of
it.  At the orifices of the  several canals which lead into the inte-
rior of the body, as the mouth, nose, vagina, anus, and urethra, it
does not cease abruptly, but is gradually converted into the mucous
membrane of the part, so that it is plainly continuous with it.  At
certain places, on the middle line of the body, the junction of the
skin of the two sides is indicated by a change in its appearance,
called Raphe; as on the upper lip; from the navel to  the pubes; on
the scrotum, and in the perineum; in all of which  places, in the
development of the foetus, the two sides  of the  body are later in
uniting than elsewhere.
  The colour of the skin varies in different nations: it is black in
the negro;  of a copper colour in the American savage; bronzed,
or tawny, in the Arabian; and white in  the Europeans and their
descendants.  It is also subject to various shades, from the mix-
ture of these races, and from the influence of climate; its general
tendency being to turn dark on  parts exposed to the influence of
tropical heat and light. 
334
INTEGUMENTS.
   The external  surface of the skin, or  that which  is free, has on
it a great multitude of wrinkles;  some of them depend upon the
subjacent muscles, as on the forehead  and face;  some are caused
by the flexions of the articulations, and are to be seen  at all of
these places  on the limbs; in addition to which, where there is
much emaciation of the parts beneath, the skin  not  having suffi-
cient elasticity to accommodate  itself to their state, is thrown  into
other wrinkles, and sometimes into loose folds.   Finer wrinkles of
another description are also found  on the skin, arranged in various
angular and spiral directions: they depend on an entirely different
cause, which will be treated of elsewhere.
   The skin abounds in hairs, which vary in fineness and in length
according to the region over which they are distributed: it, like-
wise, presents many small pits, or follicles, which are the orifices
of sebaceous  glands.   A  finer  description of pores, which  are
visible only to the assisted eye, are supposed to  be the orifices of
exhalants and of absorbents, but this is not so certain.
   The internal surface of the skin is connected  to the  subjacent
parts  by the  cellular tissue, which permits a considerable sliding
of it backwards and forwards on most parts of the body; on others,
however, this  is restrained, as  on  the cranium, the palms of the
hands, and the soles of the feet, by ligamentous fibres  passing to it
from the fascias and bones below.   A very interesting attachment
of this  kind  exists on the fingers, where a plane of  ligamentous
fibres is seen passing from each  side of the lower end of the  first
phalanx, downwards, to be  inserted into the skin, half an inch or
an inch off.
   Since the first  observation of  Malpighi, on the tongue of a  bul-
lock, whereby he ascertained that its integuments consisted in three
layers, and the discovery of a similar  arrangement on  other por-
tions of the integuments by Ruysch,* anatomists have, for the most
part, admitted the skin to consist of three laminas, the Cutis Vera,
the Rete Mucosum, and the Cuticula.


                SECT. I.—OF THE CUTIS VERA.

  The True Skin (cutis vera, derma, corion,) is the deepest, or the
layer next to the cellular substance.  Its thickness varies according
* Thesaurus, Anat. IX. 
CUTIS VERA.
335
to age, sex, and the region of the body over which it is stretched;
on the trunk it  is thicker behind than it is in front; on the limbs,
thicker on their external than on  their internal faces or semi-cir-
cumferences.   On the mammas, the penis, scrotum, and  external
ear,  its  tenuity is  remarkable.  When uninjected, it is perfectly
white in people of all complexions, and in  the living state has a
semi-transparency that permits the blood of the vessels to be seen
beneath it.

  The internal surface of the true  skin is so blended with the cel-
lular substance, that in the recent subject there is a difficulty in
distinguishing where one terminates and the other begins, yet they
may be  separated by maceration  so as to  determine this line;
mortification of the  cellular substance sometimes  does the same
thing; and  in  the ham, cured  by salting and smoking,  the  true
skin, after boiling, may be stripped  off with but little difficulty.  In
either of these cases the internal surface of the latter is seen to be
studded  with small areolar depressions, caused by the  projection
of granular masses of adeps ; margins of those alveoli are  the prin-
cipal points of adhesion to the subcutaneous  cellular tissue, while
their bottoms are pierced with  small openings that  lead through
the skin.

   The external surface of the true skin is covered with very fine
papillae, or  villi, (Papilla Tactus,) that are readily brought within
the observation of the naked eye, by maceration, when  protracted
long enough to permit the separation of the cuticle.   They consti-
tute the Neurothelic Apparatus  of  Breschet.  The projections on
the tongue are very similar to them, and the whole are designated
as the papillary body.  These cutaneous papillae are particularly
distinct at the bulbous ends of the fingers and  toes, upon the palms
and  soles, on the lips, on the glans penis, and the nipple;  in other
parts they are  not so  evident, but  still there  can be no  doubt of
their existence, from  analogy.  On the hands and feet  they  are
arranged in double rows or files, which occasion the semicircular
and  spiral turns of small  wrinkles or ridges at the ends of  the
fingers and  toes; and the transverse, oblique, and curved  ones, on
other parts of the soles and palms.   The small, triangular, lozenge-
shape, and multangular elevations of the cutis  vera, seen elsewhere 
330
INTEGUMENTS.
 on its external surface, are caused rather by its contraction than
 by the papillas.
   These papillary projections resemble very much small conoidal,
 cotton-like  filaments, standing up  the twelfth of a line, or there-
 abouts, from the surface of the skin: they are by no means so long
 as the villi generally of the  intestines,  and,  like them, consist in
 very delicate ramifications of nerves  and blood vessels, united by
 cellular  tissue.  In places where these papillas are less abundant,
 the cutis vera is not so vascular or sensitive.   They readily receive
 a fine injection, and, if the cuticle be afterwards separated by ma-
 ceration, their vascularity is very distinct.  Their nerves are des-
 titute of neurileme.*

   The texture of the  true skin is fibrous; the fibres which com-
 pose  it,  by their irregular intermixture,  resolve it into  a mass of
 net-work or areolas, the meshes of which are sufficiently large in
 some parts to permit the  introduction of  the head of a small pin.
 The meshes, though they are larger and more distinct on the inter-
 nal than on the external  surface of the true skin, open, however,
 upon the latter surface;  having passed through the skin obliquely,
 after the manner of the ureters through the coats of the bladder.
 Those intervals between  the fibres of the skin are rendered very
 obvious after maceration of a  month or two, or after  skin has been
 tanned.  They serve  to  transmit hairs, blood  vessels, nerves, ab-
 sorbents, and exhalent vessels also if such exist.  These  interstices
 communicate freely with the cellular substance, for in many cases
 of anasarca, blisters, when made upon  a  depending part, empty
 the cellular membrane of water almost  as quickly  as  scarifica-
 tions;! but if the  blisters  inflame,  they discharge inconsiderably,
 owing to the porosities being  shut  up by lymph and  by the tume-
 faction and fulness of the parts.   The same is observable in scari-
fications.
  A fine injection, when forcibly driven  into  the  extremities of a
 foetus, will become extra vasated between the cutis vera and cuticle,
 and raise up the latter in small blisters, as 1 have frequently expe-
 rienced, though it cannot be caused to pass through the  cuticle.
  The precise nature of the tissue which  composes  the true skin

        * Beclard, Anat. Gen.              t W. Hunter, loc. cit. 
RETE MUC0SUM.
337
is not yet fully ascertained; it seems, however, to be a mixture of
cellular substance and  ligamentous matter; with a  striking  pre-
dominance of the latter in most parts of the body, though its  pro-
portion varies considerably, being  very abundant on the thickest
parts of the skin, while it is  scarcely discernible on  the thinnest.
The following analogies of dermoid with ligamentous or desmoid
tissue  are observable.   It becomes yellow and transparent on
being  boiled, and a continuation of the process dissolves it  into
gelatine.  It resists putrefaction for a  long time; is remarkably3
tenacious.  Contrary, however, to  ligamentous matter,  it is exten-
sible and elastic,  though this property may arise from the oblique
intertexture of its fibres; as a bandage from  a piece  of muslin,
when  torn  longitudinally  or  transversely,  is  inelastic, but  if it
be cut bias, is then very elastic.   The application  of tannin in-
creases its resistance, and makes  it one of the  strongest animal
substances known in human arts.
  The skin has  a  very strong power of  contraction,  which  is
manifested in an  amputation, in a long  incised wound,  or when a
sensation of chilliness exists, as in an ague or from the application
of cold.  Owing  to the diminution in size of its  areolae, its external
surface then becomes wrinkled, rough, and studded with projecting
points,  constituting the Cutis Anserina.
  The cutis vera is very vascular, and abounds also in nerves and
absorbents.
              SECT. II.—OF THE RETE  MUCOSUM.

   The Mucous Net (Rete Mucosum,*) of Malpighi, is  the second
 layer of the skin, and  is that in which resides the colour of the
 several races  of men.  It covers every part of the surface of the
 cutis vera;  its existence, however, is not so  obvious  beneath the
 nails and about the junction of the skin with mucous membranes,
 as it is elsewhere; though taking all things into consideration, it is
 probable that it exists also at these several places, but much finer.
 It is so extremely thin, and of such a soft mucilaginous consistence,
 that it  is difficult to separate it as a distinct lamina, either by ma-
 ceration  or by any other means; for it  most commonly peels off

  *  Caldani, Icon. Anat. PI. xct. Albinus, Annot. Acad. Leyden, 1756. Ruysch,
Thes. Anat. ix.
  Vol. I.—29 
338
INTEGUMENTS.
by adhering  to the cuticle, after  the  manner of a pigment.   It,
however, by good  management, may be fairly raised as a  mem-
brane, and separated for a certain distance from the other two
coats of the skin.
  Fine as this membrane is, it would seem,  from the observations
of Mr. Cruikshank^ upon a negro dead from small-pox, and upon
an  injection  executed  in London, by the late Dr. Baynham, of
Virginia,!  and from more recent experiments in Paris, by M.
Gaultier.J that it  consists in several layers.   1.  Upon the inequali-
ties  or papillas of  the  cutis vera, there is a  layer called, by M.
Gaultier, bloody pimples, (Bourgeons Sanguins,) but which,  in the
opinion of  some other anatomists, are only the  papillas themselves
of the cutis vera.  2. Then there is a very thin  and  transparent
coat, called, from its colour, Tunica Albida  Profunda :  it is espe-
cially visible in the negro: under the coloured horns and scales of
animals, and  beneath  the nails of white  persons.  3.  Over this
layer is spread another,  (the  Gemmula,) which contains the colour-
ing matter of the several complexions of  the human  family, and
consists in  a  multitude of dark  brown  points  or granules  in the
negro; it is visible also in those forms of disease called ephelides
(freckles,) by  the French, where the skin becomes spotted  ; it is
not so distinct in  the healthy state of the white individual.  4. The
last  lamina of rete mucosum, is  called, by M. Gaultier, Tunica
Albida  Superficialis, from its  whiteness and  superficial  situation:
in many animals  it is very distinct, in the negro somewhat so, but
in the white it is  not to be seen except under  the nails, about the
hair, and under accidental horny excrescences.
  These observations of M.  Gaultier have  been verified by M.
Dutrochet>§ in experiments  upon the texture of the skin of  verte-
brated  animals;  and are  now generally acknowledged by  the
French anatomists.  In negroes, in cutting through the skin  of the
sole  of the  foot, from heel to  toe  perpendicularly to the furrows,
this arrangement  is readily recognised ;||  and when it has become
indistinct, it may be improved  by immersing the  skin  for three or

  *  Expts. on Perspiration.  London, 1795.
  t  VVistar's  Anat. vol. i. p. 394.
  I Recherches sur la peau, Paris, 1809; in Anat. De L'Homme, par J. Cloquet.
PI. CXVII.
  § Journal de Physique, May, 1819.  Journal Complementaire, vol. v,
  U  J. Cloquet, Anat. De L'Homme. PI. cxvi. Fig. 6. 
RETE MUC0SUM
339
four days in lime-water, or a solution  of  potash  or barytes, and
afterwards keeping it the  same length of time in a solution of cor-
rosive sublimate.  Blisters also elucidate this point on other parts
of the body : the fluids being  locally attracted  there, infiltrate the
rete mucosum, and separate in part its layers, so as to form  a vesi-
cle frequently very thick,  particularly in fat persons.
   The rete mucosum is considered by some as  a  freshly secreted
layer, which, finally, becomes cuticle by its  passing outward and
becoming condensed and dried.   The observations of Henle go to
show that it is constructed of minute oval cells,  having each a cen-
tral nucleus, and as they  advance  to the surface so as to become
cuticle, they change their form into flattened scales.
   The scrotum of the negro is also well suited to the exhibition of
the rete mucosum, as it  is there very  distinct,  and   is universally
much thicker and better  marked in  the negro  than in  any other
race.  From its extreme tenuity in the whites its existence in them
has by some persons been doubted,  but erroneously, as in them
also its change of colour, from the influence of  the  sun, is readily
demonstrated.   There are in fact few persons, perhaps none, so
white, but what  a slight tinge of yellow exists in  their skins; which
may be proved  by contrasting them with any perfectly white sur-
face, as snow, bleached paper, or linen.  This slight tinge of yel-
low is increased to an olive colour by the sun's  rays, and, in some
instances by a spontaneous deposite; in other cases,  it is in certain
spots removed,  so as to leave a  colour almost  perfectly white, or
that only of the cutis vera.*   When the  latter change occurs in
the African, it occasions  a hideous  piebald complexion, and  the
cuticle is readily elevated into blisters, by the irritation of the solar
rays.  Some persons have an entire deficiency  of this pigment on
the skin, from birth; the  same deficiency occurs  in the eyes, and
hair; they are designated as albinos.  The deficiency of the pig-
mentum nigrum  in the eye, causes it to look red, like that of the
white rabbit; and also makes  it intolerant of a strong light,  as that
of noon-day.
   " In some very remarkable instances the skin becomes entirely
black.  We have read to the Society of Medicine of the Faculty,

  * A case of this kind is now  in the Philadelphia Alms House,  where the absorp-
tion of colour has occurred in spots on the hands of a dark-complexioned European,
June, 15,1826. 
340
INTEGUMENTS.
 the history of a woman whose skin became black in the period of
 a night, in consequence of a strong moral impression.   This wo-
 man had seen her daughter throw herself out of the window with
 her two little children; and we  have since had occasion to see,
 also, a woman, who having escaped capital punishment,  in the re-
 volution, had experienced  the same accident.  The latter was at
 the period of menstruation when she  learned  this news.   The
 menses were immediately suppressed, and from white, which she
 was, she became black as a negress, which colour continued even
 to her death.  We dissected with  care the skin of these  two wo-
 men, and found the coloured portion to be the rete mucosum.  We
 found  it sufficiently  easy to isolate the  epidermis and the dermis,
 which presented no abnormal coloration.  This black colour must
 be the result of a sanguineous exhalation which operates upon the
 rete mucosum.
  " The violet tinge  of the skin  is, ordinarily, the result of embar-
 rassed circulation.  The skin becomes blue in many very advanced
 diseases of the heart.  The name of Cyanosis, or blue disease, has
 been given to this colour of the skin, which is falsely attributed to
 an immediate communication of the auricles by means of the un-
 obliterated foramen ovale.   This cause of the  cyanosis is  much
 more  rare than is commonly supposed."*
  The pigment of the rete mucosum would seem, for the foregoing
 reasons, to be continually undergoing a deposition and absorption.
 When it has  been lost by a blister in  an African, it is generally
 restored in a short time afterwards : the same occurs in their cica-
 trices, but requires a longer period.  The observations of chemists
 tend to prove that it is formed  principally by carbon.   Its  appa-
 rent use is  to defend the skin from the rays of the sun, in illustra-
 tion of which several ingenious  experiments have been  executed
 by Sir Everard Home.f
  The influence of the continued use of  nitrate of silver,  in giving
 a lead colour to the skin is well known.
  Anatomists generally have rejected the idea of the vascularity of
the rete mucosum, yet it would seem to have been injected, on one
occasion at least,  by the late Dr.  Baynham, in a  leg which was

       * Cours de Medecine Clinique, par Leon Rostan.  Paris, 1830.
       t Philos, Transact. London, J821. 
CUTICLE.
341
 diseased from exostosis;* and  there  are  now in the anatomical
 cabinet of the University, three preparations by myself of the fin-
 gers of an African, where the colouring matter of the injection has
 been passed from the papillas of the cutis  vera  into  the  rete mu-
 cosum ; and there deposited in dots, indicating the former position
 of the papillas.

           SECT. III.—OF THE CUTICLE (CUTICULA.)

    The Cuticle or Epidermis, is the  most superficial  layer of the
 skin, and takes its wrinkles from the closeness of its application  to
 the true skin.  It is a thin, dry pellicle, which cannot be separated
 from the cutis by dissection; in consequence of which we have  to
 resort to the alternate application of hot and cold water; to partial
 putrefaction; or in the living body to  vesicatories.  The mode  of
 adhesion between the cuticle and the true skin is not precisely un-
 derstood: the  surfaces unquestionably adhere, through the inter-
 vention of the rete mucosum, with equal tenacity where there are
 neither hairs nor sebaceous follicles to pin them together, as on the
 palms of the hands and  soles of the feet; and when by  previous
 management this union is  somewhat softened, they part very much
 after the manner of two sheets of paper, which had been  recently
 glued and were almost dry.  From  this it  would appear  that the
 adhesion  is universal,  and  not defective at any points.
   In most parts of the body  the cuticle  presents itself as a single
 homogeneal layer, of a  thickness uniformly about  that of the
 thinnest Chinese blotting paper.  Upon the palms and soles of per-
 sons generally, but especially of such  as are addicted to heavy
 labour, and exposed to a continued  mechanical irritation  of these
 parts, the cuticle becomes  much thickened  and  laminated, appa-
 rently from a successive deposite of it  on  the skin, there.   It  is
 transparent, by which the  colour of the parts beneath  is readily
 discernible; in the  African, however, it is extremely difficult,  nay,
 impossible to clean it wholly of the colouring matter of the  rete
 mucosum.
  The structure of this body  is  entirely peculiar; there  is no evi-
dence whatever of  the existence of vessels in it: on the contrary,

  t  Meckel speaks  familiarly of its being furnished with an innumerable quantity
of capillary vessels.  Vol. i. p. 470.
                             29* 
342
INTEGUMENTS,
in inflammations, when the  skin  becomes  of the deepest tinge of
red, the epidermis never  has its colour changed in the smallest
degree; the impression made on it is only manifested by its drop-
ping off, while another layer is preparing to take its place.
   Dr. W. Hunter, though  he disbelieved in the possibility of inject-
ing the cuticle, and did not admit the evidence of the preparations
of his time having that reputation; yet  thought the communicating
or perspiratory vessels might be  exhibited in a different manner,
that is, by macerating for a short time  a piece of the sole of the
foot:  afterwards, in separating the  cuticle  from the cutis vera, as
the two membranes  parted, these vessels would be  found in the
angle of  separation passing from  one to the  other like cob-web
filaments.*
   There can be no doubt  of the accuracy of this statement, for it
is easily verified by any one who will  take  the trouble to perform
the experiment; yet it is more than probable that Dr. Hunter was
deceived in the nature of  these  filaments, and that as M. Beclard
has suggested, they were merely the threads formed out of the rete
mucosum, which was  rendered  a viscous fluid  by the commence-
ment  of putrefaction; and,  therefore, when parted, would  put on
the same filamentous appearance, that  half dissolved glue does in
a similar situation.   Some of the aforesaid filaments  also are sup-
posed by Bichat and Chaussier to be absorbents; but this opinion
of course  sinks with  the objections brought against Dr. Hunter.
   Neither is there any evidence of the existence  of nerves or of
the cellular membrane in this tissue; for it is in all stales entirely
devoid of sensibility, and  never  puts forth granulations.   The ex-
crescences which belong to  it, as corns  and indurations, are, like
it, laminated, owing to their thickness,  and have no interior circu-
lation; and though sometimes painful, are so only by their pressing
upon the subjacent nerves  of the skin.   It is also destitute of fila-
ments.
   The cuticle is penetrated by hairs, and by the orifices of the su-
doriferous and sebaceous  follicles and glands;  and according to
Bichat, also, by the exhalents and absorbents, the  several orifices
of which,  he says, become distinct  by  holding it between the eye
and a strong light.  As it, when raised by a blister, does not allow
the effused fluid to pass through any of these pores, it is  very rea-

           * Med, Obs. and Inquiries, vol. ii. p. 53, London, 1762. 
CUTICLE.                        343
 sonably supposed that they are all oblique, and, therefore, exercise
 a valvular office on such  an occasion.   Or if, according to the
 supposition of Mr. Cruikshank, the finest pores of the cutis vera
 are lined by processes from the cuticle, the collapse of these pro-
 cesses on the separation  of the cuticle will also account  for the
 fact.   It seems to be well ascertained  at the present time, that as
 the epidermis is more transparent at certain points than elsewhere,
 the appearance has been mistaken for porosities of exhalents and ab-
 sorbents.  The cuticle, when detached, will not allow a column of
 mercury to pass through it, except its weight to be  so great as to la-
 cerate it: this fact is rather against the doctrine of the  pores being
 visible when examined by  permitting the light to  shine through,
 and shows that even those for the hairs and the sebaceous follicles
 are stopped by some arrangement or other.  Upon  the whole, the
 opinion of organized pores  of the  cuticle  for exhalation or absorp-
 tion, is  not sustained by unobjectionable testimony, and is scarcely
 admissible.   At the  same time it may be  remarked, that the inter-
 stices which exist in it  would seem to be sufficient  to account for
 many of the phenomena of exhalation and of absorption, upon the
 principle of a merely physical evaporation and  imbibition, or a
 drying and soaking  process.
   The cuticle has but little  power of extension, and, consequently
 of contraction, and tears with the application of a very slight force.
 It naturally contains so little moisture,  that its bulk is only incon-
 siderably altered by drying.  It, like the  hair or  nails, resists pu-
 trefaction so much,  that it has been found in burial  places after a
 lapse of fifty years.   When held in water, it swells, becomes white,
 wrinkles more, loses its transparency, and dulls the sensibility of
 the cutaneous papillas.   It  cannot, like  the true skin, be readily
 reduced by boiling  water into  gelatine, and, consequently, is not
 affected by tanning: it, indeed, retards  that process, when left on
 the proximate surface of the cutis vera.  When applied to a fire,
 it  burns, like  the hair and  nails, with extreme facility, owing to the
 presence of a similar oil in  it, and it gives out a very disagreeable
 odour.
   The little extensibility of  the cuticle causes  it to be ruptured
 whenever tumours,  as  warts, &c,  rise from the surface  of the
 cutis vera: it is supposed, however, not to be entirely deprived of
this quality, as it seems to stretch when raised into a  blister, though
this may arise,  in some measure, from the  small wrinkles, natu- 
344
INTEGUMENTS.
 rally existing in it, being drawn out.  It has not the slightest sen-
 sibility, neither is  this quality evolved by any condition whatever,
 as it  is in tendons, ligaments, and bones, when  they become in-
 flamed.

   The epidermis consists of several successive layers of compressed
 cells, originally derived, as stated, from the cutis vera by the inter-
 mediate transition into rete  mucosum.  These cells  finally be-
 coming scales of  more  and  more density as they are nearer the
 superficies, are  continually lost by desquamation  and supplied by
 a new secretion advancing through all the intermediate gradations.
 Originally of a spherical shape they become more and more com-
 pressed, until they  are finally flat planes, or nearly so, with no trace
 of a  central nucleus.   This  epidermis is absolutely uninterrupted
 on the surface of  the body so that it is visibly extended  even over
 the cornea where  it presents one of the best examples for the mi-
 croscope of the scaly arrangement.
   That a loss and reproduction of the cuticle is constantly going
 on is manifested by the large quantity of branny scales that are
 detached from its surface, when one has abstained  from bathing
 for a long time.   This is more remarkable on the palms and soles
 than elsewhere, and the loss  must, of course, be continually sup-
 plied.  It, as  is  well  known, is rapidly  regenerated when  it has
 been lost simply by an abrasion or blistering, which has not inter-
 fered with  the organization of the rete mucosum.  In some cases
 there is an unusual development of it: Bichat retained the skin of
 a patient, dead at the Hotel Dieu, in whom  the cuticle, at the pe-
 riod  of birth and in subsequent life, was three  times  the natural
 thickness; and had always, with the exception of that of the face,
 been subject to a continual desquamation.
   As the epidermis has in itself no power of regeneration,  owing
 to its deficient organization, the most plausible opinion in  regard to
 its source is the above, and that it is produced by the  inspissation
 and drying either of the external layer of the rete mucosum or of
 a secretion from it, which renders it a  sort of varnish, well quali-
 fied  to resist  the  agency of  exterior  objects, and to  protect the
delicate organization of  the proximate surface of the cutis vera.
This  opinion of its  origin seems  to be adequately  proved by its
participating in the colour of the rete mucosum, more or less, so
as to give it a sensible tinge, which cannot be washed from  it. 
CUTICLE.
345
   One of the most striking properties of the cuticle is its resistance
to evaporation from the surface of the  body: in a subject, any part
of the derm, when deprived of it and  exposed to the air, dries up
in the course of a day or two; while the other portions remain soft
and flexible for weeks, and, if it were  not for putrefaction causing
the cuticle to peel  off, would  sometimes  remain so for months.
Though it suppresses evaporation, in a great measure, it does not
do so entirely; for, after a subject has been kept  some time, its
fingers, toes, nose, and ears get very dry and hard.
   During life the process of perspiration is  continually going on,
either in a sensible or insensible manner; and according to the ex-
periments of Sanctorius,  more than one-half of the  weight of our
food  is  lost in that way through the skin and  lungs.   MM. Lavoi-
sier and Seguin ascertained that the proportionate exhalation from
these organs was eleven of the  former  to two of the latter.   When
the perspiration is rapid,  it  assembles  on the  surface of the  body
in the form of small drops, having  an  acid, saltish taste, and a pe-
culiar odour.   In this state, according  to the analysis of Berzelius,
it consists principally in water, holding in solution a  hydrochlorate
of soda and of potash, some lactic acid, lactate of soda, and a lit-
tle animal matter.  The perspiration, besides its use as an excre-
tion, is  a powerful means, by its evaporation,  of enabling the body
to resist a high temperature.  It varies, both in quality and quan-
tity, according to age, sex,  state of health,  food, and habits of life.
   The power of the  cuticle to absorb or to transmit inwardly ar-
ticles through it, is not by any  means so  obvious as its exhalation:
the facts, however, upon the whole, seem to prove that though this
power is much curtailed when compared with that possessed by
mucous surfaces, yet it does exist to a  certain extent.*
   A modified anatomy of the dermoid covering has latterly been
presented by two French anatomists.f   They limit the number of
layers to two, the cutis vera, and what they  call  the corneous tis-
sue or epidermic layers, which  mean  the  rete mucosum and the
cuticle of anatomists generally.  These  two, they say, are a  se-
cretion  of  an  apparatus in  the thickness of  the skin, and which
they call blennogenous  from its product, a  mucus, which finally
inspissates  so as to form the rete mucosum and the cuticle.   This

  * Wistar's Anat. Vol. ii. p. 396, 3d edit.
  t Nouvelles Recherches sur la structure de la peau par G. H. Bresehet et R6us-
sel de Vauzeme.  Paris, 1835. 
346
INTEGDMENTS.
apparatus or parenchyma, is furnished with short secretory canals
which deposite the mucus between the basis of the papillas tactus.
  There is also a glandular apparatus which they call chromato-
genous,  and furnished with ducts, being  likewise  in the thickness
of the cutis vera and discharging on its surface.  The office of it
is to secrete the  coloured matter of the rete mucosum, hence its
name.  But its  function is also the secretion  of the more solid
parts of the  corneous layer, as the epidermis with its extensions
in the form of scales, horns, spines, nails, hoofs, hair, wool, &c.
  Tiedeman, Lauth, and Fohman claim to have demonstrated ab-
sorbent  vessels on the outer surface  of  the  cutis vera.  Mr. Bre-
schet, in addition, alledges  the existence of a distinct inhaling  ap-
paratus  in the rete mucosum  commencing immediately under the
superficies of the cuticle and collecting their branches to terminate
in the lymphatics of the skin: he does not claim to have seen their
mouths.
                       CHAPTER II.

        Of the Sebaceous and Perspiratory Organs of the Skin.

  The Sebaceous Organs consist in Follicles (Crypta  Mucosa)
and Glands, (Glandula Sebacea.)  They furnish  the  oily exhala-
tion, which lubricates the surface of the skin, gives  linen, when
worn a long time, a greasy appearance, and  causes the water in
which we bathe to assemble in drops, on the surface of the body,
rather than to wet it uniformly.  This humour produces a rancid
disagreeable smell in negroes, and such persons as do not resort to
ablutions of the whole  skin, from time to time.  It is particularly
abundant  about  the  places provided with hairs, as the scalp, the
genital organs, the axillae, and  seems to be intended to maintain
the flexibility and smoothness of the skin and  hair, and  to prevent
the former from  chapping.   These qualities of it are possessed, in
a considerable degree,  by the oily articles of the toilet,  which are
used for the same purpose.   There  can be no doubt of  the unc-
tuous quality of this secretion, as, when collected on a  piece of
clothing  or on  blotting-paper, it burns with  a white flame.   Its
quantity is readily augmented by certain kinds of  clothing, which 
THE SEBACEOUS ORGANS.
347
most persons must have observed shortly after putting on a flannel
shirt next to the skin.
  It is sufficiently certain that the apparatus producing this oil is
not visible to the naked eye in most parts of the skin, so that there
would seem to  be  a necessity of accounting for its appearance
there, in some other  way besides a distinct  glandular  apparatus.
Bichat conside'red it to arise from a set of exhalants  differing from
those which secrete the matter of perspiration, a theory far more
rational than that which attributes it to the percolation of the sub-
cutaneous fatty  matter.  M. Beclard, however, admits that seba-
ceous follicles exist over  the whole surface of the skin, with the
exception of the palms and soles; because the skin  is universally
rendered unctuous by this discharge: because many  follicles exist,
which are only visible to the microscope;  and because  morbid
changes frequently render them evident, where their  existence was
not suspected before.   In many places these follicles are sufficiently
obvious and very numerous, as on the nose, about  the corners of
the mouth,  on  the  ear and behind  it, and  on the  entire face, of
some individuals.  When the skin has been injected, they are found
to consist of small pouches placed in its thickness, and having their
parietes abundantly furnished with blood vessels.
  The discharge from them sometimes  becomes inspissated, and
does not  readily pass  through their orifices; in  which case, con»
tinuing to accumulate, it  will, finally, form a  sensible  tumour.
Most frequently it does not collect to such an  extent, but is indi-
cated simply by a small black point, owing to the adhesion of dirt
to it: in this condition, when squeezed out, it assumes a small ver-
micular shape.

  The Sebaceous Glands, properly speaking, are about the size of
a millet seed, of a light yellow colour, and  are placed, wherever
they exist, immediately under  or  near the cutis  vera.  They are
particularly numerous  under the skin of the mons veneris.  I have
not observed them so distinctly elsewhere.
  They are a more complete arrangement of the simple follicular
excavations and consist of groups of the latter resemblingjn shape
a blackberry, each cell being distinct but all discharging into a
common duct.   Sometimes they are laid down  in  the form of a
long tube with side cells or canals entering into it; the meibomian
glands of the eyelids are of this description. 
348
INTEGUMENTS.
  Where the hair is abundant as on the head, chin, mons veneris,
&c, the ducts of the sebaceous glands discharge to a large extent
into the sac containing the hair.
  The perspiration  is the product of  certain  bodies  called the
sudoriparous glands, investigated particularly  by  Gurlt.*  They
are contained  in  the substance of the cutis vera, but project also
into the subcutaneous cellular tissue.  Like the seb'aceous glands
or follicles they are presumed to be inflections or processes lined by
cuticle, sometimes simply cylindrical  or club-shaped, but in other
instances collections  of small  sacs, resembling a mulberry or  black-
berry which have a common  duct.  Their ducts are either straight
or spiral and open upon the ridges of the epidermis made by the
papillas tactus.  The orifice is said by M. Breschet  to be oblique.
                        CHAPTER III.

                        Of  the  Nails.

   The nails (Ungues) supply the place of cuticle on the extremi-
ties of the fingers and toes, and may be considered as a continua-
tion of this membrane, because in  maceration they come off along
with it.  They correspond with the  talons and hoofs of the lower
orders of animals.
   Each nail consists of a root, of  a body, and of a free extremity,
or that which  projects and  requires paring.  The  root is about
one-fifth of the length of the nail; is thin, soft, and white, and is
received  into a fold or fossa of the true  skin, which is very distinct
w^hen the cuticle and nail are  removed together by maceration.
The concave surface of the nail adheres closely to the skin below,
precisely as the cuticle does  in any other part of the body, and
therefore may be loosened by the same processes,  as  hot water
and maceration.  The white part of the nail, at its  root, is called
the crescent, (lunula,) and  is said, by Mosely.f never  to exist in
the fingers of Africans or of  persons who have even a  slight mix-
ture of negro blood; the latter opinion I am disposed to consider
* Gerber, p. 143.
t  Diseases of Warm Climates. 
THE nails.
349
incorrect.  This appearance, however, does not depend upon any
peculiar organization of the  nail itself at that part, but upon the
cutis vera below it, which being more vascular elsewhere, causes
that spot to  look white, the nail  being semi-diaphanous and  per-
mitting a view of the circulation beneath.   This is also sufficiently
proved by the fact, that when  a nail  is torn off, its  lunula disap-
pears.   The rfail increases gradually in thickness from its root to
its free extremity.
  The nail is covered on the posterior face of its root by the epi-
dermis, which  terminates there in a thin,  adherent, diaphanous
band:  behind this band  the root of the nail projects, and is received
into the groove of the cutis vera.  The epidermis also adheres to
the lateral margin of the nail, and  in a curved line to the concave
side of its anterior end.  The under  surface  of the nail is  soft,
pulpy, and has an arrangement of superficial longitudinal grooves,
receiving the papillas and ridges of the corresponding surface of the
cutis vera.  As  the black colour  of the negroes is sometimes  seen
beneath their nails, it is probable, as stated, that the rete mucosum
exists  there also; but it is not so  clearly  ascertained, though  the
observations of M. Gaultier, on the rete mucosum of animals, tend
to prove it.*
  As the nails are entirely destitute of organization, having neither
vessels nor nerves, they have no power of growth nor of disease
in themselves, these qualities being derived exclusively from  the
cutis  vera.   The materials  of  their formation are,  accordingly,
secreted  from the cutis vera, in the bottom of the groove, formed
by the latter for the  reception of their root.   As these materials
adhere to the preceding formation, and become concrete, by add-
ing continually to its length, they shove it forward, and thereby
elongate  it.   While  this is going on in the groove,  the thickness
of the nail is also somewhat increased by an  excretion from the
skin contiguous to its concave surface.   This accounts for the nail
being thicker at  its free  extremity than at its root.
  The skin where it is in connexion with the nail exhibits numerous
longitudinal  fine  ridges which make corresponding furrows  into
the  nail; there are also small papillary projections.   The end of
the nail at its root is also finely serrated  and the interspaces are filled

                       * See Rete Mucosum.
  Vol. I.—30 
350
INTEGUMENTS.
with corresponding filiform papillas arising from the skin.  These
papillas are the sources of the growth of the nail by the  continual
secretion from them, and exhibit a close analogy with the arrange-
ment at the roots of the hair.  The microscope shows that the ori-
ginal secretion is in the condition of soft nucleated cells, which are
attached to their predecessors, and that this arrangement prevails
every  where  over the adherent surface of the nail.  The fcetal
period  is  the  best for observing  these nucleated  cells.  As the
growth advances they assume the  consistence peculiar to the nail.
  Owjng to a peculiarly  morbid state of the proximate surface of
the true skin, it sometimes  happens, that  the contribution to the
nail from it exceeds that from the groove; the consequence of which
is, that the whole nail grows upwards like a horn, instead of for-
wards.  An example of this kind was  several years ago  exhibited
to me by Dr. Charles D. Meigs, now of the Jefferson College, in a
female aged about ninety.  In this case one of the big toe nails had
grown  upwards, in a semi-spiral manner, to the length of four and
a quarter inches, when measured along the outer edge of the spiral.
The corresponding nail of the other side would have been  of nearly
the same length, but it had been broken.  The nails of all  the other
toes had assumed a similar manner of growth, and measured from
one and a half to two inches.  In the case of each nail its anterior
extremity presented the  primitive  nail as  it had been before this
extraordinary  hypertrophy.
  The  statement of  the  patient was, that  the  growth had  com-
menced about fifteen  years previously.  A tendency to this horny
growth from the skin, was  also manifested in a tubercle, three or
four lines long, with an ulcerated base, from the back of her nose;
and by scaly excrescences on the legs.  The patient having died
shortly afterwards, the collection of nails was politely presented to
the Anatomical Museum, by Dr. Meigs.
  In cases where the nail has been lost by violence  or  disease, the
cutis vera secretes another; but it differs from the first, unless the
cutis vera has  been restored to a perfectly healthy action :  from this
cause,  we see  in individuals thick  black  nails, sometimes  cleft
longitudinally.
  The nails  begin to appear about the fifth month of fcetal life,
and are still imperfect  at  birth.  When analyzed, they seem  to
consist in coagulated  albumen, with  a small quantity of the phos-
phate of lime. 
THE HAIRS.
351
                       CHAPTER IV.

                       Of  the  Hairs.

   The  Hairs (Pili, Crines) are cylindrical  filaments, which are
found on most parts of the skin, excepting the palms and the soles.
The finest of them are microscopical, and have not a diameter ex-
ceeding the one-sixth  hundredth of an inch.
   The hairs differ much in their size and appearance in the several
parts of the body.  Those on the head  (capilli, cassaries,) grow to
the greatest length of any, and  are most  numerous in proportion
to the space they occupy.   Those which surround the mouth, and
are  on the cheeks, (julus, mystax, barba,)  exceed the  others in
size, and when allowed to grow, are next in  length, and more dis-
posed to curl.   Those around the eyes (cilia, and the supercilia,)
are  not disposed  to exceed an  inch in length, and  have a  long
slender spindle shape.  Those  at the orifices of the nostrils and
ears are of the same  habits as  the latter.  Those of the arm pit,
(glandebalas,)  and about  the organs of generation, (pubes,) are
limited to the growth  of a few inches.
   In the male subject there are hairs of considerable length,  also,
on the sternum, and about the nipples,  an arrangement which sel-
dom occurs in females.  In most individuals, hairs are found  over
the whole remaining surface of the body; but in females, and in
many males, they are too  fine to be readily visible.  In  some sub-
jects, brought into our dissecting-rooms, the pilous system has  been
so developed  as to form a shaggy coat  over the whole  body, and
almost to conceal the  skin.
   We are informed, on the authority of Jameson's Tour, of a man,
at Ava, covered from head  to foot  with hair.  That on the face
and ears is  shaggy, and about eight  inches long; on the breast and
shoulders it is from four to five.    He is  a native of the Shan coun-
try, and married a Burmese woman, by whom he has two daugh-
ters: the youngest is  covered with hair like her father, but the
eldest resembles her mother.*
* Littell's Museum, No. 69; p. 412. 
352
INTEGUMENTS.
  In the female the hairs of the head are more abundant, and reach
a greater length than they do in the male.   As a general rule, the
colour of the hairs  corresponds with that of the eyes and of the
skin, and the darker they are, the coarser.  According to Withoff,
a quarter of  an inch square of skin has upon it  J 47 black hairs,
while the same extent has 162 hazel, or 182 white ones, in other
individuals.
  Each  hair consists in a bulb  and in a stalk.   The bulb is  the
adherent extremity, and  is  whiter, softer, and  generally larger
than any other part; it is received into a follicle, compared appro-
priately by Malpighi to the vase containing a flower or plant, and
which is deposited  most commonly in the subcutaneous  cellular
substance, but sometimes  in  the skin itself.  This follicle is of an
oblong ovoidal shape; its open orifice is continuous with  the sur-
face of the body, while its internal end  is  closed, and has some
filaments passing from it to the  adjacent cellular substance.   It is
formed of two membranes; the external is white, strong, and con-
tinuous with  the derm or cutis vera; the second  being within  the
last, is more  soft, delicate, and vascular, and seems to be a conti-
nuation of the rete mucosum.  From  the bottom of the cavity of
the follicle, a small conoidal papilla erects itself towards the orifice.
This papilla is vascular, and  from  the dissections of M. Beclard,
on the human subject, and of M. Rudolphi, on  the mustachios of
seals, is furnished with nerves.   The mode of approach of its  ves-
sels  is not yet settled.  M.  Gaultier  says  that the arteries pass
from the surface of the skin into the orifice of the follicle, and then
descend, in a serpentine manner,  between  its two membranes to
the bottom.*   M. Beclard, on the contrary, considers them to pass
through the bottom of the follicle.  Each piliferous follicle is, more-
over, furnished, within its orifice, with many small sebaceous folli-
cles arranged round it.
  The bulb of the hair has in it a conoidal cavity, open at its base,
and receiving the  conoidal  papilla of the follicle.f  The hair re-
ceives  its nourishment from  the papilla by the successive deposite
of nucleated cells just like the nails.  The hair is moreover attached
to the skin  by the cuticle; for the latter  having reached  the ori-
fice of the follicle is then reflected  for some distance along  the

          » J. Cloquet, Anat, de  PHomme, PI. CXVIII. fig. II.
          t Gaultier, see Cloquet, loc. cit. 
THE HAIRS.
353
hair:  this increases the strength of the attachment of the hair to
the skin.

  The stalk of a  hair  has  generally the loose extremity smaller
than any other part, and  frequently split.   When examined with
a microscope the stalk  appears  to  consist of  two substances, one
within the other.   The  exterior  is a diaphanous sheath almost co-
lourless, and, from having the properties of  the epidermis, may be
a continuation of it.  The interior consists of from five to ten fila-
ments, parallel with one another, and forming a tube in the centre
of the fasciculus.   The  tube, as well as the interstices between the
filaments, is filled with a fluid called the marrow of the hair.  This
substance corresponds with  one  of the layers of the rete mucosum
of the skin, and contains the colouring  matter.  The probability
is, that the whole hair  is  a  continuation of  the  rete mucosum, to
which is joined the envelope of  the  epidermis.  This canal in the
centre of the hair is found  to be unusually distinct in the hog's
bristle; it is also well seen  in the supercilia :  the follicle and  bulb
are best Studied in the mustachios of the larger animals.   Accord-
ing to Mr. Heusinger,*  the  substance of the hair, when examined
with a microscope of strong  power, exhibits  an areolar  appear-
ance.
  Though the stalk of the hair is destitute of  blood vessels and of
nerves, yet it is probable, from the sudden changes of colour that
sometimes  occur in it  from black to white, owing to terror  and
grief, that there is a species of interstitial circulation going on.   The
emaciated and peculiar  appearance with sickness gives to it, would
also tend to support this opinion.  Strictly speaking, the hairs are
devoid of sensibility, yet, as  the bulb  is planted over a sensitive pa-
pilla,  they communicate certain  sensations  by being  removed or
touched.   Animals  apply their mustachios particularly to this use
in  groping through dark  places,  or when  they are  deprived of
sight.  The hairs  are eminently hygroscopic, moisture lengthens,
and dryness shortens  them; this property has caused them to be
applied to the construction of hygrometers.
  In certain animals the  hairs are erected  by the contraction of
the subcutaneous muscle ; the movement in the human subject cor-

                       * J. Cl>.quct, loc. cit.
                             30* 
354
INTEGUMENTS.
responding with that, is the effect of great fright,  and is produced
by the contraction of the occipito frontalis muscle.
  In the development of hair, the part which first forms is the fol-
licle, the young hair then pierces it at its summit, in the same way
that the tooth  pierces its capsule.   The death of  the capsule, or
the drying up  of its fluids, occasions  the  fall of the hair and  pre-
vents its regeneration.  In old  men who are bald  there is  no ap-
pearance of capsules;  while  in per'sons from whom the hair has
fallen, owing to sickness, as the capsules still remain,  they  soon
put forth another  crop  of hair.  The rudiments of the hair are
seen about the  fifth  month of  foetal  life.   The first crop is deci-
duous, and after covering the body of the foetus like a fine down,
till  the eighth month of utero-gestation, it then falls  off: sometimes,
however, it is retained  either in whole or in part till  after birth;
this is particularly the case in regard to the hair of the head.  In
this deciduous character we see another analogy between the hair
and the teeth.
  When the hair becomes white from age, the conversion  of co-
lour begins at  the loose  extremity,  another proof of the interstitial
circulation, or change of particles in  it.   The same fact is obser-
vable in animals who change colour only  for the  winter.  But the
restoration of colour begins at the root.
  It is probable, in those cases of plica  polonica attended with
bleeding from  the root of the hair when it is cut,  that the vascular
papilla has been so much augmented as to elevate itself above the
level of the cuticle, and  of course interferes with the sweep of the
razor employed in shaving the head.   Ignorance in regard to the
organization of the hair, and a slight inclination to  the marvellous,
would magnify this into every hair, in such a disease,  being a sort
of branch-pipe from the general circulating system, and therefore
bleeding upon  being wounded.  Many of the victims to this dis-
ease accordingly prefer the loathsome matting of the hair with
which it is accompanied, to the supposed  risk of dying by hemor-
rhage. 
BOOK  III.
                          PART  I.

                        CHAPTER I.

       On  the  General  Anatomy of  the  Muscles.*

  The muscles (musculi) by their contraction produce the various
flexions of the body, and  are,  therefore, the organs of  motion.
They may be known by their redness,  softness,  irritability, con-
tractility, and by their being formed of long parallel fibres.   The
redness, however, does not always attend them ;  as this colour is
very faint  in the foetus, and does not exist at all  in animals that
have not red blood.   They form a very  considerable share of the
whole bulk of the body.
  Though  the most perfect  organs of motion, and  producing it
more efficiently  and rapidly than  any other apparatus,  they are
not indispensable to it; for  they are not observable in animals of a
very low grade, which  apparently consist of a sort of cellular or
mucous substance.   In  the next  grade of animals, as the worms,
where there is  a deficiency both  of bony  and  of cartilaginous
skeleton, the  muscles are perceptible, and produce locomotion by
their attachment  to  the skin or integuments;  and, finally, in ani-
mals which have a  skeleton, the muscles are  almost exclusively
attached to its different  points, and by alternately approximating
them, effect locomotion.
  The muscles of the human body are referrible to two classes, in

  * These organs were very imperfectly known to  the  ancients, excepting Galen,
and had not generally received names till the time of Sylvius, A. D. 1587.  The
paramount authority of Albinus, in this department of anatomy, in his work Histo-
ria Musculorum  Hominis, Leyden, 1734, has induced me to adopt it as the standard
of correct description and nomenclature, with but few exceptions. 
356
MUSCLES.
 consequence of their position and functions, though they present a
 close similitude of structure every where.   The  most numerous
 class, as well as that in which they are of the greatest magnitude,
 are the muscles of  voluntary motion, or of animal life: they are
 placed between the  skeleton and  the integuments, and constitute
 the principal bulk of the extremities, and also afford a thick fleshy
 covering to the trunk.  The  second class, being the muscles of
 organic life, is  contained within  the large cavities  of the skeleton,
 and forms a portion of the structure of the circulatory, of the di-
 gestive, and of the  urinary organs.   This set produces the princi-
 pal internal  motions of the animal economy.
   Every muscle  is  surrounded  by an envelope of fibro-cellular
 substance, called its sheath, (Membrana Musculorum Communis,*)
 which at different points of the  body exhibits various degrees of
 condensation.  In the muscles of voluntary motion these sheaths
 are formed  by  partitions, going  from the aponeurotic expansions
just beneath the skin, to the periosteum, and are the prolongations
 which induced  Bichat to consider the periosteum, as the centre of
 the desmoid system.  These sheaths in some  cases preserve to a
 considerable extent  the ligamentous appearance, but generally cel-
 lular substance predominates  in  them.  Upon  their  existence is
 founded the  great variety of views and descriptions which the later
 anatomists  have taken  of the fascias of the  human body, some
choosing to  describe them in one way and some in another.   The
sheaths of the second class of muscles are composed of a  much
 finer and looser coat of cellular substance than those  of the first,
and are commonly described as laminas or tunics to the organs to
 which  they  respectively belong.  In every case, however, from
the internal face of the sheaths, a great many partitions pass off,
which penetrate the body or thickness of the muscle, and divide
and subdivide it into fasciculi, and into fibres, even to their most
minute condition.  These partitions become thinner the more they
are multiplied.
  Many of  the  muscles are subdivided by fissures, into several
large  portions  called Fasciculi,  or  Lacerti.   These  vary  very
much in size, and in their distinctness from  each other.   Some
are so large and so  widely separated as to appear  like distinct
muscles; such,  for example, are  the biceps of the arm and of the
* Haller, Element. Physiol, torn. i. 
GENERAL ANATOMY OF THE MUSCLES.
357
thigh, the deltoid, the  columnas carneas  of the  heart, and several
others.   But the greater  part  of the fasciculi are strictly parallel
with each other, and merely separated by a thin lamina  of cellu-
lar  substance.  The fasciculi  are again  subdivisible into fibres,
which from their smallness are not  appreciable to the naked eye,
and, when examined with powerful  microscopes, admit of farther
division  until we  reach the primitive fibrillas.   On  this account
some anatomists have  undertaken  to classify the fasciculi under
the terms of first, second, and third orders.   It is evident, however,
that this arrangement is too arbitrary, and that  the circumstance
is sufficiently expressed by considering  the fasciculi  as almost in-
definitely divisible.  The fibrous arrangement  of muscles is ren-
dered still more distinct by boiling them, or by immersing them in
alcohol.
  The structure of the muscular fibre has been'studied with great
attention by microscopical observers. From such observations, it
appears that  their ultimate shape  is prismatic, pentagonal, hexa-
gonal, sometimes rounded. According to Prochaska, every fibre
extends the whole length of the muscle, considering this length as
represented by  the tendinous beginning on the one hand, and the
tendinous termination on  the other.   This arrangement holds even
in regard to the longest muscles, as the sartorius.
                 MUSCLES OF ANIMAL LIFE.

   The fibre in them consists of tubes of delicate structureless mem-
brane, enclosing a number of fibrils, the primitive fibrilla.  The form
of the fibres is polygonal, but varies with the degree and amount of
pressure they are subjected to from  the adjacent  fasciculi.  Their
size varies  in different animals, and in the same animal, and even
in the same muscle, and they are said to be smaller in the female
than in the male.*   According to Bowman, whose measurements
have been confirmed by Raspail, Schwann, Skey, and Henle, their
average breadth is ^^ of an inch.   Their colour is pale yellow,
and they appear to be  marked by transverse or  annular strias, in
waving  parallel lines, at a  distance, according to Schwann, of
from T3^a to rslim °f an incn apart.   Obscure strias traverse the
* Bowman. 
358
MUSCLES.
fibre longitudinally, marking the direction and size of the ultimate
fibrils, which compose it.
  The delicate tubular sheath which  invests the fibre, is quite dis-
tinct from the cellular tissue binding the fibres into fasciculi.   It
has been  called  by Mr.  Bowman the sarcolemma, and by Mr.
Wilson the myolemma. ^It is seen with difficulty,  frequently.   By
extending a fibre forcibly, its fibrils may separate without rupture
of the sheath,  and both ends  retracting, the delicate  membrane
becomes apparent in the interspace.   During the contraction of a
fibre, the sheath sometimes becomes wrinkled, and  is  thus raised on
the surface of the fibre.  The way to demonstrate the existence of
the sheath, is to immerse it in some fluid, which will cause distention
of its contents.   This is best accomplished by a solution  of citric
or tartaric acid, or potash.  The sarcolemma yields for awhile to
the swelling  of the contained fibrils, but  at length  bursts, and a
protrusion of its contents  occurs, showing the completeness of the
membranous envelope.  It is perforated by neither capillaries, nor
nerves, and has nothing to do with the  contraction of the muscle,
the sarcolemma  simply wrinkling,  when  the fibre shortens.  It
adheres to the outer layer of  fibrillae, and this is the cause of the
brush-like, or  tufted  appearance, which a  fibre presents when
torn across.
  The  true contractile tissue of  muscle are  the ultimate fibrils,
several hundred of which  form the primitive fasciculus.   They are
cylindriform, slightly flattened, and measure in their greatest thick-
ness, according to Henle, Lauth, Bruns, and others, Ttiirs of an
inch.   They are marked by transverse depressions corresponding
to the annular strias on the surface of the fasciculus.   Much  diffe-
rence of opinion prevails  amongst microscopic observers regard-
ing the minute structure of  the ultimate fibril.   By some they are
believed to be a  collection of beads or disks, connected by a ho-
mogeneous  transparent substance.*   Dr. Barry regards the fibrils
as a peculiar form of his grooved and compound filament;  each
being composed of two spiral threads wound in different directions,
and interlacing-^  HenleJ says it  is yet impossible  to decide  the
question, he himself inclines to the opinion that the fibrils are not

            * Bowman, Carpenter, Schwann, Bruns, &c. &c.
            t Barry in Phil. Mag. April, 1842.
            t Gen. Anat. p. 582. 
GENERAL ANATOMY OF THE MUSCLES.
359
rows of globules, but derive that  appearance from being finely
wrinkled.  Fontana* says  that  this beaded appearance  seems,
sometimes, due  to rows of globules, and again, to the wrinkling
of the cylinders.  Dr. Gerber thinks the transverse strias are pro-
duced by a minute thread of cellular tissue wound spirally around
the ultimate fibrils.
   Among the approved accounts, of modern  times, of the ultimate
structure of  muscular fibre, are those of Mr.  Bauer, with  Sir
Everard Home; and of MM. Prevost and Dumas.  These gentle-
men  concur  in  stating  that the results have been uniform in all
animals  to which  their observations have been extended.   That
the muscular fibre is a series of globules, resembling the globules
of the blood deprived of colouring matter and adhering in a  line
to each other.   That the medium of adhesion is invisible from its
transparency and want  of colour;  but if the  muscle be macerated
in water frequently  changed, that this  medium, from  its  greater
solubility and more  ready putrefaction, may be  removed so as to
leave the globules  detached from each  other, and  still  resembling
the globules of the blood.   The fact of the globular condition of
the muscular fibre was first pointed out by  Leeuwenhoeck and
Hook; it is also confirmed by  the  testimony of  M.  Milne Ed-
wards and M. Dutrochet.
   In meat which is prepared for the table by roasting or boiling,
or in  a muscle which is contracted, one frequently sees the fibres
undulated or crooked.  By Prochaska it is attributed to the bridling
of the fibre,  by  the contraction  of its  cellular substance,  nerves,
and  blood  vessels.   The cause,  however, is not well ascertained :
the condition seems to be one of the peculiarities of muscular fibre
which it  manifests when in a state of contraction only; for it dis-
appears whenever the fibre is relaxed, either by spontaneous move-
ment, or  by stretching it in the  dead body.  This undulation  has
probably contributed  to the many  inexact  observations  on  the
structure of  muscles.   Thus, Haller thought  they consisted in a
series of  ovoid vesicles, which lengthened in a state of  relaxation,
and became  more globular in a siate of contraction.   It  is  un-
necessary to dwell on mere errors of the eyes or of the imagina-
tion, for  the fact seems to be now well established, that, though
the muscular fibre, by contracting, loses its  straightness and  be-

              * Sur le venin de la Vipere, torn. ii. p. 229. 
360                        MUSCLES.
comes crooked, yet this is effected without change in the form of
the ultimate globules of which it consists.
   By some it has been asserted that muscles are only the continua-
tion of blood  vessels.   To this it is  replied,* that though insects
have muscles, yet they have not blood vessels, so that  the former
cannot be a continuation of the latter.  Moreover, a successful in-
jection, though it may penetrate  very  finely between the fibres, so
as  to  cause the  muscle to swell  considerably, yet none of  these
vessels can be traced into the ultimate fibre.  The vital phenomena
and the organization  of muscular fibre, are so  very different from
cellular substance, from nerves, and from vessels, that it cannot be
less than a distinct structure.
   Notwithstanding this limitation, which is put upon the distribu-
tion of the blood vessels,  every muscle is abundantly supplied by
them.   The arteries  come from  the  adjacent  large trunks, and
penetrate at different points of the periphery of the muscle.  They
first of all pass between the larger fasciculi and parallel with them;
they then divide and follow the course of the smaller fasciculi; they
divide  and subdivide again after the same rule, till they become
mere capillary tubes, from which  the  nutritive  matter  is exhaled.
The veins accompany the arteries, and receive  their blood; some
of them creep along the surface of the muscle without having cor-
responding arteries.   Bichat says truly that they are injected with
great facility from their trunks, from which he supposes that their
valves  are less numerous than in other parts of the system.
   The colour  of the muscular fibre seems to be, in a measure, in-
dependent of the blood which circulates in it.  Some animals with
red blood have white fibres, as frogs.   The colour of the muscular
fibre is not altered in  animals that have been suffocated.  The
muscular  fibres  of the intestines and  of the  bladder,  though
abounding  in  blood vessels, are whiter than the muscles of volun-
tary motion.

  Lymphatics have been injected in the intervals between muscles
and between their fasciculi.

  The  Nerves of the  muscles are  large and  abundant, as the
nerves  of  the  brain  and  spinal marrow are chiefly  spent  upon
* Beclard, Anat Gen. 
GENERAL ANATOMY OF THE MUSCLES.
361
them.  They are generally proportioned  to the size of the muscle
which they have to supply, but there is some variety in this respect.
They accompany the arteries, and are united to them by cellular
substance.   Their ultimate terminations are  traced with  great
difficulty, and there is consequently an uncertainty on this subject.
Before they disappear they become soft by divesting themselves of
their cellular envelope, and are supposed to bring thus their medul-
lary substance in immediate contact with the muscular fibre.  The
recent observations of MM. Prevost  and Dumas, are thought to
throw some  light on this matter, and have been received with a
very respectful attention.   They say,  that by macerating in clean
water, and in a dark  place, the muscle of a  bullock, and  then
throwing a  strong concentrated light upon it, the distinction of
colour between the nerves and the muscular fibres becomes very
apparent.  With the aid of  a microscope  and a  fine  knife, the
nervous ramifications may be then traced.  The trunk of the nerve
enters the muscle parallel with  its fibres, and soon  begins to give
off,  at right angles, lateral filaments, which penetrate between the
fasciculi and fibres of the muscles, and may be followed to the top
of the undulations formed  on the  muscular fibres.   These lateral
filaments at some places are two in number, which pass at some
distance from each other, but parallel, and terminate by an inter-
change of filaments; at other places  the terminating branches are
spread out transversely to the muscular fibre, and end by forming
loops with themselves.   According to this view, the nervous fila-
ments, strictly speaking, have no termination,  but  run again  into
the  source from which  they are derived.

   The chemical analysis of muscles  shows them to be composed
of fibrine, albumen,  gelatine,* extractive  matter, the phosphate of
soda, ammonia, and of lime, and of  the carbonate of lime.   The
extractive  matter of the muscle may be removed by maceration,
in clean  water often changed.  If it  be allowed to  remain long, it
assumes certain  appearances in its  putrefaction peculiar to itself,
but  occasionally it is converted into  a substance resembling sper-
maceti.  When a muscle is exposed to boiling  water, the albumen
is raised to the surface, like foam; the  gelatine  coagulates when

  * Whether gelatine is to be considered as an ingredient  of pure muscular matter
appears to be now doubled.
   Vol. I.—31 
362
MUSCLES.
 the muscle is cold; and  the fibrine appears as  a fibrous grayish
 substance, insoluble in hot water, closely resembling the fibrine of
 the blood, and evolving large quantities of nitrogen by the action
 of nitric acid.   When a  muscle is exposed to the fire alone, as in
 roasting, the albumen is hardened; the gelatine is melted, and runs
 off, in part, with the  juices of the meat: the extractive matter is
 that which gives a dark colour to the outside; the fibrine is cooked
 in the juices of the meat,  and is then rendered very tender.   The
 muscular parts of animals are amongst the easiest of digestion.
   The muscular system of the embryo is first of all in a gelatinous
 state, and confounded with cellular substance: but at two months
 from  conception, the fibres are distinct, and  at four  they begin to
 contract and to execute different motions.
   The  muscular system  is subject to varieties of  conformation.
 Robust, muscular individuals frequently have supernumerary mus-
 cles and supernumerary heads to their muscles, particularly in the
 extremities.  In monstrous foetuses it  sometimes  happens that the
 muscular system is either wholly or partially supplanted by adi-
 pose matter and by infiltrated cellular substance.


                 MUSCLES OF  ORGANIC LIFE.

   This tissue has been investigated by Henle* in his  researches
 on the structure of the  arteries.   He  describes  the fibres as flat,
 from  TTVo- to 3TVo- of an inch broad, clear, granular and brittle, so
 that when broken they have abruptly rounded or square extremi-
 ties.  Some of them are uniform; others, bear the signs of nuclei
 on their surface; the  majority are marked along the middle by a
 fine, continuous, dark  streak; or by short isolated dark lines; or by
 dark  points either arranged in a row regularly, or scattered.  Be-
 tween these three  kinds  of  marks there are  such gradations as
 prove their common  origin  from  nuclei.  The fibres are  col-
 lected into fasciculi; upon which  the dark  lines  sometimes  form
 a sort of  net-work, by branches which they  give off and receive,
 and on other occasions run tortuously  like the  nuclei-fibres of the
 fibro-cellular tissue.

  * Ueber die Contractilital der Gexasse, Caspers Wochenscrift, Mai, 1840, see Brit.
& For. Med. Review, vol. x. 
MUSCULAR MOTION.
363
  The muscular or contractile tissue of the digestive canal from
the middle of  the  oesophagus to  the  external  sphincter ani;  of
the urinary  bladder, bronchia, ducts  of the  glands, the gall-
bladder, vesiculas seminales, the gravid  uterus, and of the arteries
and veins  is formed from this substance.
  The distinction between the two systems of muscles is particu-
larly well  seen  in bodies infested with the  trichina spiralis, which
fills the muscles of animal life, and is seldom or never found in those
of organic life; so that a definite line of demarcation  is established
even in closely contiguous parts, such as at the lower edge of the
inferior constrictor of the pharynx.*




                        CHAPTER II.

                   On  Muscular Motion.

   The muscles, after death, are soft, easy to tear, and have but
little elasticity; it is only during life that they manifest such extra-
ordinary strength, and retain their powers of motion.  The gene-
ral phenomena of the latter have been  happily  expressed  by the
word myotility, suggested  by M.  Chaussier.  These phenomena
are, contraction, elongation, and, according to Barthez, a power of
remaining motionless or fixed.
   In contracting, the muscle shortens, swells and  becomes hard;
presents  wrinkles on its  surface;  and  its  fibres  are  sometimes
thrown into a state  of oscillation or vibration, from their alternate
relaxation and contraction.   It is owing to  the vibratory motion
in the  fibres of a muscle, during their contraction, that a rustling
is heard on  the application of the stethoscope to them.   The hol-
low, distant rumbling, when the meatus  externus is  closed by the
finger, is owing to the same vibration in  the muscles of the finger
employed.  This is readily  proved  by the following experiment:
close the meatus with the end of the  handle of  an awl or a fork,
pressed against it by the finger, and it will be found that the mus-
cular  vibrations are continued  along the instrument: plant, after-
wards, the point of the instrument upon a soft, inelastic substance,
* Carpenter's Physiol, p. 299. 
364
MUSCLES.
 so  as  to  make, in  that way, the closure of the meatus, and the
 rumbling will instantly cease.  The roaring noise of sea-shells may
 be  explained in the same way.   The colour remains the same,
 which proves that there is not an appreciable addition to the quan-
 tity of its  circulating  fluids.  The rapidity with which  this con-
 traction may take place, is manifested in speaking, in  running, and
 in playing upon a stringed instrument; and its strength, by the im-
 mense burdens that some  individuals can raise and bear.
   The power of elongation or relaxation seems to  be  an active
 state of the muscle, as well as its contraction.   This  power of re-
 laxation or of elongation  is much  inferior to that of  contraction;
 it seems to be only what  is sufficient  to  restore  the muscle to its
 proper length, so as to put it in a  condition for  the renewal of its
 contractions.  The fixedness  of  muscles, which are contracted
 spasmodically, and their retaining this  position  even  after death,
 until putrefaction  begins  to assail  them, show that the  power of
 elongation does  not depend simply upon  elasticity; for the latter
 quality being as much the attribute of  dead as of living  matter,
 would  be brought into  play on death.
  The fixation of  muscles is not  a distinct power, but merely  a
 qualification of contraction, by which the latter may  be  arrested
 at any given point,  and retained there.
  As every muscle augments in thickness during its contraction, it
 has been a subject  of  inquiry  to physiologists whether the whole
 mass of muscle was increased or diminished by its  contraction.
 Swammerdam, in order to ascertain it, put an insulated solid mus-
 cle, not yet dead, into  a tube  filled with water;  by irritating the
 muscle, and causing it to contract, the water descended; but  this
 result was not uniform.   When an arm is plunged into a  tube pro-
 perly formed and  filled with water, if the muscles be caused to
 contract, the fluid descends; but the objection to the inference from   ^
 this experiment is, that when all the muscles of the arm are caused
 to contract violently, the  introduction of arterial blood  is much
 arrested, if not fully stopped ; and the  venous blood is  at the same
 time expelled ; so that  the change in the size of  the member may
 be accounted for in  that way.  The experiments of Erman on eels,
fully immersed in a fluid, and submitted  to Galvanic influence, are
 said to substantiate the theory of the  muscles diminishing in bulk
by contracting,*
                         * Beclard; loc. cit. 
0
                        MUSCULAR MOTION.                    °°°

   The activity of a muscle, though closely depending upon  the
 afflux of blood to it, is not entirely so;  for it  is ascertained  that
 Galvanism will cause the muscles of frogs to  contract, when the
 circulation is arrested by death, or when the blood  is coagulated,
 or even when it has been drawn off*  This  phenomenon, how-
 ever, can only last a comparatively short time; for a muscle soon
 dies, and  runs  into a state of putrefaction, after its vascular and
 nervous communications  have been cut off.   Physiologists  have
 entertained very different  opinions on  the  causes of the muscles
 contracting, or  on muscular irritability, as it is called.  Some have
 supposed it to be an attribute of the muscle itself;f others, that it
 depended on the blood vessels, which, by bringing a greater afflux
 of fluids into its interior, between its fasciculi  and fibres, obliged
 the latter two to take a more flexuous  course;  and others, on  the
 nerves.J   Any  decision on this point is inconclusive, because it is
 well known that perfect muscular action requires a healthy state
 of the muscle, and an uninterrupted  nervous and  sanguineous in-
 fluence; so that it seems to be a result from  the combination of
 three systems, more than an attribute of one alone.§
   MM. Dumas and Prevost say, that  in consequence of the final
 nervous ramifications crossing the muscular fibres at right angles
 to them, and parallel with one another, the Galvanic current which
 passes through  these ramifications, causes  the  latter  to approach
 each other reciprocally; whereby the muscular  fibres to which the
 ramifications are fixed, are thrown into  wrinkles.  It is clear, from
 this theory, that the muscular fibres themselves  are destitute of the
 power  of  contraction,  and  that they are  only the  frame-work
 upon which the Galvanic batteries of the nervous system are dis-
 played.
   This  opinion  of the muscular fibre being thrown into sinuous
 lines in  contracting was first promulgated by Hales,|| and subse-
 quently by Prevost and Dumas, to whom it is commonly attributed
 But Professor  Owen, Mr. Bowman and  Dr.  Allen Thompson state
 that the fibre never deviates from a right line, that a general short-

  * Prochaska de Came Musculari.  Vienne, 1778.
  t Haller, Physiol.
  t Legallois, sur le principe de la vie.
  § Meckel, Anat. Gen.; from Barzellotti, Esame di alcuni  moderne teorie interno
alia causa prossima della contrazione moscolare, 1796.
  II Statical Essays,  vol. ii., p. 59.
                             31* 
366
MUSCLES,
ening of its constituents takes place, that it becomes broader and
flatter;  and there  is an  approximation  of the  transverse strias.
The zig-zag appearance is due, according to the  same observers,
to the relaxation of a recently contracted fibre, which is not again
immediately stretched by some  antagonist  fibre,  or  whose  extre-
mities are kept close  together by the contraction of neighbouring
fibres.   This view derives additional probability from the fact that
in a condition of sinuous flexure no force could be exerted.   Ac-
cording to Valentin*, muscular contraction when moderate  is ef-
fected by a rapid vermiculation over the  whole length of the fibre,
by which the transverse strias are approximated; but that in intenser
contraction, zig-zag inflexions take place, which are more acute
and intense as the contraction is  violent.   The  contraction usu-
ally begins at the extremities of the fibre, but occurs also at inter-
mediate points.  An opaque spot on the surface of the fibre is first
seen to  arise from  the  approximation of some of the segments of
the fibrillas; there is a rapid extension of this  spot through the
whole diameter of  the fibre, and the  shading caused by the ap-
proximation of the transverse strias increases in intensity.  The
strias are several  times more numerous in  the contracted than in
the uncontracted  portion, and are more delicate and narrow in pro-
portion.   The  line of demarcation between the contracted  and
uncontracted part is well defined; but  as  the  process  goes  on
fresh strias become  absorbed from  the  latter  into the former.
There is an augmentation in diameter of the contracted part, but
not proportionally to its diminished length; its solid parts lie closer,
and the fluid parts rise in bullas on the sarcolemma.f
   There are no muscles which have not the power of contracting
some time after  apparent death, and  this phenomenon frequently
continues for an  hour;J it is uncommon for it to cease with the
apparent  extinction of life.   This  irritability is of different dura-
tions in the different muscles; it is first lost in the left ventricle of
the  heart; then in the large intestines;  afterwards in the small,
and in  the stomach: then in the bladder;  then  in  the right ven-
tricle, the iris, and in  the  voluntary  muscles; of which those of
the trunk die first, those of the inferior extremities next, and those

   • De Funct. Nervor., p. 132.               + Carpenter, loc. cit.
   t The late visitation of cholera in Europe and in this country has given many
persons an opportunity of examining this singular fact. 
MUSCULAR MOTION.
367
of the superior last.  The last act of life is in the auricles, of which
the  right pulsates longest.  Different circumstances may produce
some variety of this progress, in the  loss of muscular irritability,
but  it  will  be  found  generally correct.*   The  experiments of
Himlyf demonstrate, that laurel water, or that of  bitter almonds,
applied to the stomach or brain, renders the heart insensible to the
strongest  stimulants, while the  muscles  of volition continue to
move for some hours afterwards.  The duration of irritability is,
however, much  varied, according to the nature of  the death, and
the state of health preceding.  Nysten  asserts, that he has seen the
right auricle of  a robust  man pulsate nine hours after death.  In
death  from chronic diseases, with  much  emaciation, the heart
ceases to beat shortly after intellectual phenomena cease.   And in
death from electricity ; from a blow upon the stomach; from the
inhalation of carburetted hydrogen gas, and some other poisonous
ones, muscular contraction  ceases universally in a few moments,
and cannot be excited by any artificial means.
  The irritability of the  muscles is so  modified that certain stimu-
lants are  peculiarly appropriate to one and not to  another.   For
example, light is the specific stimulant to  the  iris; a  mechanical
application, to it as in  making  artificial pupil, is borne frequently
without its contracting.  The heart is  very sensible to mechanical
stimulants, and  additionally so when they are  applied to its inter-
nal surface.
  Some of  the  muscles  are regularly under  the influence of the
will, others  not at all so, which has given  rise to their division into
the voluntary and involuntary.   These states, though kept perfectly
distinct from each  other in health, are sometimes  blended in dis-
ease, the voluntary muscles becoming involuntary in their actions,
and the  involuntary voluntary;  which, however,  is much more
uncommon than the other.
  The voluntary muscles being generally such as  serve for loco-
motion and speech, receive their nerves  directly from the spinal
marrow.  The involuntary muscles are such as are concerned in
the functions of digestion, respiration,  and circulation, and which,
in order to continue the  life of the animal, must never cease their
actions for any long interval.   It is worthy of remark, that  apo-
plexy and other cerebral affections, paralyze, most  commonly, the

   * Meckel, Anat. Gen.        + Commcntatio de Morte, Goettingue, 1794. 
368
MUSCLES.
voluntary muscles alone, while the others retain their usual state
and sensibilities.
   When irritability is entirely gone from a muscle, and it is actu-
ally dead,  the whole  muscular  system  becomes  stiff, beginning
with the trunk, then the inferior, and, lastly, the  superior extre-
mities.   This stiffness seems to be independent of the nervous sys-
tem, as the destruction of the spinal  marrow, the cutting of nerves,
and hemiplegia do not arrest it.   It is  thought, by M. Beclard, to
be analogous to the contraction  of  the  fibrine of the  blood; and,
like the latter, does not cease  till putrefaction begins.  The  de-
gree, as well  as the time, of its  access is variable under different
circumstances.  In very aged persons;  in such as  have died from
protracted  disease  attended with great emaciation ;  in scorbutic
and gangrenous  diseases, the stiffness  comes  on quickly, is very
slight, and  disappears in a couple of hours.  But in muscular sub-
jects who have died from sudden violence or from acute diseases,
the stiffness is sometimes postponed for  twelve hours or more, and
may continue, in the winter, from three or four days to a week, or
even longer, depending upon the access of putrefaction.
  The sensibility of the  muscles  is  moderate.   When they have
been much exercised, they only give out the sensation of fatigue.
In amputations, the pain  of cutting through them is  not equal to
that of the skin.   In inflammations they, as most other parts, have
their sensibility exalted to an exquisite degree.
                        CHAPTER III.

    Of the Mechanical Shape and Arrangement of the Voluntary Muscles.

  Every muscle consists  in  a belly  and in two extremities,  of
which the one that is the fixed point is the head or origin, and the
other is the tail or insertion.   The belly or body is the fleshy part,
the extremities are generally tendinous, either completely or par-
tially.
  Some of the muscles  arise by a  single  head, and  are inserted
into one point.   Some few arise  by a plurality of heads, but have 
THE TENDONS.
369
a single insertion, as the biceps flexor of the arm, and of the thigh;
others, again, have a single head, but a plural insertion, as the
flexors of the fingers and  of the toes ; others, again, have multi-
plicate heads and multiplicate insertions, as the  muscles of the
back.
  The most simple muscles are such as have their fibres running
in the direction of the length of the  muscles, of which there are
many examples, as the sartorius, the biceps flexor cubiti, the semi-
tendinosus, and others.  Others, again, have their  fibres  running
obliquely from a tendon or a bony  origin on one side of the  mus-
cle, to a tendon on the  other, as the semi-membranosus, the pero-
nei, &c.; these are called musculi semi-pennati.   Others have a
long tendon in  the centre, to which the fibres converge obliquely,
forming  an angle with each other; they are the penniform, (mus-
culi pennati.)   Others, again, are formed of a congeries of smaller
muscles, the fibres of which run  in different directions and are
intermixed with tendinous matter,,as the deltoid and  the subsca-
pular.   As  the strength of a muscle depends upon the number of
its fibres, those whose fibres go obliquely are stronger than if their
fibres had run longitudinally.
                       CHAPTER IV.

               Of  the Tendons, (Tendines.)

  The tendinous extremities of muscles, present themselves under
two  general  shapes:  one is funicular, or like cords, varying in
shape from cylindrical to paraboloid ;  the other membranous, and
resembling an aponeurosis.  They both adhere with great tenacity
to the muscular fibres, so as to have induced, erroneously, the opi-
nion of absolute continuity: but maceration  and boiling will sepa-
rate them, and the course of the fibres is different even to the naked
eye; besides  the very obvious difference in colour, in consistence,
and in  vital properties.

  The tendons are surrounded by a loose cellular membrane or
capsule, which permits them to glide freely upon each other: in 
370
MUSCLES.
some places this membrane is wanting, and is supplied by a syno-
vial  membrane answering the same purposes.

  The tendons  are readily recognised  by their white and shining
appearance;  they have no  elasticity or power of elongation and
contraction, and, therefore,  like other ligamentous matter, they are
lacerated sooner than they can  be stretched.  They are composed
of desmoid  tissue, the fibres of which are united by a compact cel-
lular substance  in small quantities.   The fibres  are  longitudinal,
and  may be readily separated either  by maceration or by a slight
boiling.   When  a round tendon is prepared in this  way, it is easy
to flatten it out  into an aponeurotic membrane: the  fibres are then
made very  distinct, and  seem to  adhere  to each  other  by lateral
fibrillas.   In ordinary health no red  blood penetrates  into the ten-
dons, but if they become inflamed, as their capillaries  then enlarge,
they admit the  red globules; at  the same time  their  sensibility,
from being entirely organic, or  what is  only sufficient  for the inter-
nal actions of the organ, is so much augmented as to be very mani-
fest.*   No  nerves have been traced into them.  The tendons have
the character, at large, of the  desmoid  tissue, but are more gela-
tinous, or completely soluble in boiling water, than the ligaments.
They have a great affinity for the phosphate of lime; and, hence,
we frequently find them hardened and having small pieces of bone
in them, where they run over bony trochleas.

  * A knowledge of the disposition in  tendons to augment their powers of circula-
tion  on being inflamed, together with  the late Dr. Physick's great success in the
treatment of unnatural joints by a seton  passed through the cavity of the fracture,
induced me in a tour of service at the Philadelphia Hospital to try the effect of a simi-
lar plan upon a ruptured tendo-achillis;  which, from the long period since the accident
had happened, did not promise a cure on the ordinary methods of treatment. A seton
of silk riband was  accordingly introduced, and kept in its place for six weeks  and
a-half.  Il produced considerable pain,  tumefaction, and inflammation, but was fol-
lowed by a perfect reunion of the ruptured ends of the tendon.—Chapman's Med.
and Phys. Journal, for July, 1826.  For a highly interesting  series of experiments
on animals, undertaken at my suggestion, lo illustrate the same thing, see An Essay
for the Degree of Doctor of Medicine, by R. L. Fearn, Id. April 9, 1827. 
BOOK  III.
                             PART II.

                    SPECIAL  ANATOMY OF  MUSCLES*





                            CHAPTER I.


               Muscles  of the  Head  and  Neek.


                SECT. I.—MUSCLES OF THE  FACE.


                          Occipito-Frontalis.

   The occipito-frontalis, a single  muscle, consists of two symme-
trical parts, coming from  the back of the  head, and inserted into
the front of it.   It is superficial,  being placed immediately below


  * I may here mention, once for all, in regard to the muscular system, that though
the very rigid mode of description adopted by anatomists may lead the inexperi-
enced student to infer  that there  are no departures from a common  standard, and
that one invariable type for  the  muscles prevails  in all human beings; yet there
will be found  upon actual dissection occasional disagreements with  the best esta-
blished descriptions, and which it is of some use to know.  Some of these departures
are common enough, others  very rare; and they consist either in a deficiency or a
redundancy of muscles.  Wishing not to  give false idearof their importance and
frequency, and, indeed, fearful of doing so, they are purposely introduced  subordi-
nately in  notes: many of them have been observed by me  personally, others are
recorded in different medical writings, and for the  remainder I am indebted to the
learned treatises on anatomy of T. Soemmering and J. F. Meckel.
  No part of the muscular system varies more in  different subjects than the mus-
cles of the back;  but, as it  would be useless to enter fully on such  trivial details,
they have been passed  by, except in a few  instances. 
372
MUSCLES.
the skin of the scalp, and has four bellies  of  muscular fibres, two
behind and two before, connected by a thin tendon, which covers
all the top  of the head.   The  tendon adheres by a short cellular
tissue, having no  adeps, to the pericranium below, and is attached
to the common  integuments above.  This adhesion is  made by
strong fine filaments of fibrous matter, passing in a line, more or
less vertical,  from the under  surface  of the skin to the tendon of
the occipito-frontalis.   The common integuments on the hairy
scalp are formed  by skin  and by a  closely adhering,  and, indeed,
almost inseparable layer of granulated adeps, intermixed with the
capsules of the hairs, and the fibrous filaments alluded to.  The
thickness of the integuments thus situated  is frequently three lines.
  This muscle arises from the superior semi-circular ridges of the
os occipitis by tendinous and fleshy fibres, which form  two distinct
bellies (musculus  occipitalis) about an inch and a-half long, one on
each side of  the bone.  Its tendon, when carefully traced, will be
found terminating a  little in front of the coronal suture, in the two
anterior fleshy bellies (musculus frontalis)  which cover the whole
front part of the os frontis.   The internal edges of these latter are
in conjunction below.
  It is inserted, on  each side, fleshy, into the superior margin of
the orbicularis oculi  and of the corrugator supercilii; and, by its
nasal slip, into the internal angular process of the  Os frontis, and
into the root of the os nasi.
  It pulls the skin of the head backwards and forwards, and throws
that of the forehead into horizontal wrinkles.   It also elevates the
supercilia.*

                      Compressor Ndris.

  The compressor  naris  arises by a pointed  beginning from the
root of the ala nasi, and spreads like a fan over the  lateral parts
of the  nose below; it is inserted into its fellow of the opposite side
on the dorsum of the nose, and into the lower part of the os nasi,
where it is connected with the nasal slip of the occipito-frontalis.
  This muscle consists of  thin and pale fibres placed  immediately
under the  skin.  If it act from both extremities, by its curved fibres
being made straight, it will compress the nostril; but if it act from

  *  Varieties.  Its fleshy portion is said  to have covered, in some instances, the
whole skullcap. 
MUSCLES OF THE NECK.
373
its dorsal margin, assisted by the nasal slip of the occipito-frontalis,
it will dilate the ala nasi, and has, therefore, been called dilatans
nasi by Columbus.


             Orbicularis, or Sphincter Palpebrarum.

   The orbicularis oculi or palpebrarum is a broad circular mus-
cle, lying immediately under the skin of the eyelids, and  over the
tarsi cartilages.   It is much connected with essential points in the
anatomy of the eyelid.
   Its diameter exceeds that of the orbit, by from four to eight lines
all around.  The fixed point of this muscle is principally  the liga-
mentum palpebrale internum and the internal canthus of the orbit;
for, in the greater part  of its extent, besides, it is only loosely at-
tached to the  parts below.
   The orbicularis arises, by short tendinous fibres, from the upper
end of the nasal process of  the os maxillare superius, from the in-
ternal  angular process of the os frontis, and from the  contiguous
part of the os  unguis.  It  also arises  along the whole superior
margin of the internal palpebral ligament.
   The fibres  from this  origin compose the lamina of the upper
eyelid.  They may be traced, thence, around to the lower eyelid,
and are found again terminating at the internal  canthus  of the
orbit, where they are fixed into the anterior margin of  the orbitar
process of the upper maxillary bone, into the corresponding ridge
of its  nasal process, and into the inferior margin of the internal
palpebral ligament from which it arose.
   The temporal portion of this muscle is attached to the  temporal
fascia, so as to prevent it from being much displaced.   It is, there-
fore, obvious that the effect  of the contraction of the upper and of
the lower half of the muscle will be to bring the eyelids  together.
The fulcrum of  motion is the internal or nasal side, as manifested
by the radiated  wrinkling of the skin at  that point.
   The interior portion of this muscle, which is laid upon the tarsi
cartilages, is called  Ciliaris by Albinus:  this distinction,  which is
too arbitrary, is now abandoned.

   The Dilatans nasi posterior o\" Theile is a thin small plane of mus-
cle arising from the upper lateral margin  of the  anterior bony naris,
and the contiguous cartilage of the nose, and  is inserted into the
   Vol. I.—32 
374
MUSCLES.
ala nasi.  It draws the posterior half of the ala nasi backwards
and dilates the nasal opening.
  Professor Theile informs us that a microscope is required to de-
tect its nature.   With  such qualification, its addition to the anato-
mical description of the face is at least of equivocal utility.


                    The Corrugator Supercilii.

  This muscle is placed beneath the upper margin of the orbicu-
laris, at its internal extremity; by which, and by the  adjacent por-
tion of the occipito-frontalis, it is concealed.
   It arises from the internal angular process of the os frontis, and
going outwards and  a  little upwards, its  fibres are lost in the infe-
rior margin of  the occipito-frontalis and  in the superior of the or-
bicularis.
   It draws the  eyebrow and the skin of  the forehead into vertical
wrinkles,  and also draws them over the  eye  so as to oversha-
dow it.

            The Levator Labii Superioris et Ala Nasi,

   Is fixed just at the side of the nose.   It arises by a pointed pro-
duction from the nasal  process of the superior  maxillary bone at
the infernal canthus  of the eye, and by a  broad origin from the
anterior margin of the orbitar process of the same bone.  Passing
downwards, it is inserted into the side of the ala nasi, and into the
upper lip, being narrower below than  above.  The part of this
muscle which comes from  the orbitar process is so distinct, that
Albinus and the continental anatomists give it the exclusive  name
of Levator Labii Superioris.
   It draws the upper lip and the ala nasi upwards.

   Just beneath this muscle there is sometimes a fasciculus, called
the Anomalus Faciei of Albinus, which is attached by one end to
the upper jaw  near the canine  fossa, and by the  other to the up-
per lip.

                    The Levator Anguli Oris,

   Is  a small muscle, concealed very much by the last; it arises
 from the  anterior part of the superior maxillary bone,  between the 
MUSCLES OF THE FACE.
375
foramen infra-orbitarium and the first small grinder, and is inserted
into the corner of the mouth.
   It raises the angle of the mouth.


                    The Zygomaticus Minor,

   Is a small muscle, arising from the fore part of the os malas; it
descends obliquely, and is inserted into the upper lip just above the
corner of the mouth.*


                      Zygomaticus Major,

   Is just on the  outside of the last,  and is much larger.  It arises
from the malar bone, externally, at  its  posterior inferior part, just
above  the  lower edge, where this  bone  contributes to form  the
zygoma.  It passes obliquely downwards to be  inserted  into  the
corner of the mouth, and runs into the depressor anguli oris.
   The last two  muscles draw the corner of the mouth towards the
cheek bone, or obliquely upwards and outwards, as in smiling.


          The Depressor Labii Superioris et Ala Nasi,

   Is concealed by the orbicularis oris, and the  levator labii supe-
rioris et alas nasi.   To get a view of it,  the upper lip must be in-
verted, and  the lining membrane of the mouth removed on the side
of the frasnum of  the lip.  This  muscle arises  from the inferior
part of the upper maxilla in front of the alveolar processes for the
,dens caninus and the incisores,  and is inserted into the side of the
ala nasi, and into the contiguous part of the upper  lip.
   It depresses the  upper lip and the ala nasi.


                   The Depressor Anguli Oris,

   Arises broad and fleshy from  the base  of the lower jaw on the
side of the  chin;  being somewhat triangular, its apex  is inserted
into the corner of the mouth.

  * Varieties.   Frequently it is deficient; sometimes it is a fasciculus of the orbi-
cularis oculi; sometimes it is double; sometimes it does not reach the corner of the
mouth. 
376
MUSCLES.
  This muscle draws the corner of the  mouth downwards.  It
lies immediately under the skin, and blends above with the zygo-
maticus major and with the levator  anguli oris.


                 The Depressor Labii Inferioris,

  Is in part beneath  the last muscle, and, like  it, arises broad and
fleshy from the basis of the lower jaw on the side of the chin; its
fibres pass obliquely  upwards and inwards, and are  inserted into
the whole side of the lower lip.
  It draws the lip downwards.

  These last two muscles are much obscured by being mixed  with
a quantity of adipose matter; the skin, also, is closely blended  with
them, and the roots of the beard penetrate  between the intervals of
their fibres,*

             The Levator Menti, or Labii Inferioris,

  Being placed  beneath the  depressor  labii  inferioris, is  demon-
strated by turning downwards the lower lip and dissecting away
its lining membrane  on  the side of the frasnum; it will then be seen
to arise in front of the alveolar processes of  the external incisor
and the canine tooth, and, passing obliquely downwards, to be in-
serted into the lower lip.
  It elevates the lower lip.


                        The Buccinator.

  Arises from the root of the coronoid process of the lower max-
illa; from the back  part  of  the upper maxilla near the pterygoid
process of the sphenoid bone, and from the  roots of  the  alveolar
processes of both the upper and the lower maxillary bone, as far
forwards as the dentes  bicuspides.  It  is  inserted into the corner
of  the mouth, and  into the  contiguous parts of the upper and
lower lips.
  It draws the corner of the  mouth directly backwards.

    * Varieties.  Its exterior border is often formed by the Plalysma Myodes. 
MUSCLES OF THE FACE.
377
                      The Orbicularis Oris,

   Is a circular  muscle just  beneath  the skin, much blended with
 adipose matter externally, but more plain on the surface contiguous
 to the lining membrane of the mouth.  It  constitutes a considera-
 ble  part of the thickness of the  lips, and surrounds the mouth en-
 tirely.  It has no bony origin,  but arises  from the fibres of the
 several muscles which join each other at the corner of the mouth,
 and therefore consists of two semicircular planes, one for the upper
 and the other for the lower lip.
   It is the antagonist  to most of the other muscles of the mouth.
 From its  superior part a pyramidal slip goes to the tip  of the nose,
 being called, by Albinus, Nasalis Labii Superioris.


                           Masseter.

   The masseter is placed between  the skin and the ramus of the
 lower jaw; it is of an  oblong shape, and evidently consists of two
 portions, an external and an internal, which may be readily recog-
 nised by the course of their fibres as they decussate.
   As a whole, it arises, tendinous and  fleshy, from the malar pro-
 cess of the os maxillare superius;  from the inferior edge of the
 malar bone, between the maxillary and the  zygomatic sutures, and
 from the zygomatic process of the temporal bone.  Of its two por-
 tions, the  internal  is the smaller, and is  inserted tendinous into the
 outer part of  the  root  of the  coronoid  process of the  lower jaw;
 while the  external extends from  »he malar bone to the angle of the
 lower jaw, where  it is inserted  tendinous  and  fleshy.   A part of
 the internal portion may be seen at the zygomatic  suture, behind
 the external, without the latter being raised up.
   When both  portions act  together, they close the jaws: the ex-
 ternal, alone, also draws the lower jaw forwards; and the internal,
 alone, will also draw it backwards.


                          Temporalis.

  The temporal muscle is placed on the side of the head,  and oc-
cupies its middle inferior region. It is covered externally by the
                             32- 
378
MUSCLES.
Fascia Temporalis, a thick, dense, tendinous  membrane;  which
arises by the semicircular ridge on the side of the cranium, and is
inserted into the upper margin of the zygoma.
  The temporal muscle arises from the inner  face of this fascia;
from the whole length of the  semicircular ridge on the side of the
os frontis and parietale;  and from the surface of the cranium be-
tween this ridge and the zygoma, including the part contributed by
the frontal bone, the parietal, the squamous portion of the temporal,
and the sphenoid.  This muscle also receives an accession of fleshy
fibres from the internal face of the zygoma.
  From  this extensive origin the fibres converge towards the zygo-
ma, and passing beneath it, are inserted  tendinous into the coro-
noid process of the lower jaw, so as to surround it on every side;
some of  these tendinous  fibres go down in front almost to the last
dens molaris.
  It pulls the lower jaw directly upwards.


                    Pterygoideus  Externus.

  The external pterygoid muscle, so called from its position, arises
fleshy from the outer side of  the external pterygoid process of the
sphenoid bone, and from the adjoining surfaces of the same  bone
by  its spinous and temporal processes; also, from the tuber of the
upper maxillary.
  It passes outwards  and backwards  horizontally, and is inserted
into the inner side of the  neck of the inferior maxilla, and into the
capsular ligament of the  articulation.
  When the muscles of the opposite sides act  together, they draw
the lower jaw forwards, but  if alternately, they give it a grinding
motion.*

                    Pterygoideus Internus.

   The Internal Pterygoid muscle arises  by tendinous and fleshy
fibres from  the internal  pterygoid process  of the sphenoid  bone,
along  the outer  margin  of  the Eustachian  tube, and  from the

  * Varieties.   I  have seen, in  one case, this  muscle continued  into the inferior
margin of the tempural. 
MUSCLES OF THE NECK.
379
greater  part of the pterygoid fossa.  Passing  downwards and »
backwards,  it is inserted tendinous and fleshy into the internal face
of the angle of the lower jaw.
  When the muscles of the opposite sides act, they close the jaw.
             SECT. II.—MUSCLES OF THE NECK.

               Of the Fascia Superficialis Colli.

  Between the skin of the neck and its superficial muscles, may
be observed a layer of compact cellular substance, the consistence
of which is more strongly marked in some subjects than in others.
It is the continuation  of the same membrane which is spread upon
the external abdominal  muscles, and is called  there the  Fascia
Superficialis  Abdominis.  Passing  from the abdomen over the
thorax,  it  adheres to the clavicles and  sternum, but not  very
strongly;  it then goes from them over the neck  to the face, being
slightly fastened  to the  base of the lower jaw  in advance of the
masseter muscle.
  It is spread over the submaxillary and parotid  glands, is in many
subjects  strongly  marked there  by its  fibrous character; and
sends down partitions between their lobules, as well as between
the muscles and their fasciculi; thereby forming sheaths  for the
same.   By these partitions it communicates with the fascia pro-
funda colli.  Above, it  is fixed to  the mastoid  process, to the
meatus auditorius externus, and  to the zygoma.  Just  above the
latter it adheres to the fascia temporalis, and a thin layer of fat
intervenes between them. This  fascia is more  strongly characte-
rized about the parotid gland  and lower jaw than elsewhere.  It is
remarkably distinct in the fcetus at full time, the sheaths, which it
forms for  the muscles, being then very clear of  adipose  matter,
and semi diaphanous.

                     The Platyema Myodes,

  Or the Musculus Cutaneus, lies upon  the fascia superficialis, or
rather is included  between two laminas of it, one above and the
other below, forming its sheath, which is very  thin, especially on
the side next to the skin.  This muscle covers, by its breadth, a, 
380
MUSCLES.
very considerable portion of the side of the neck; and extends,
obliquely, from the thorax to the face.
   It arises  from the condensed  cellular membrane on  the upper
part of the pectoralis major muscle, and of the deltoid, just below
the clavicle, nearly the whole length of  this bone.  Its  fibres are
much  more pale  than those of  other voluntary muscles, are col-
lected into  longitudinal fasciculi, constituting a plane of scarcely a
line in  thickness, and  terminate  in the integuments of  the lower
jaw and cheek.   It is  slightly attached to the lower jaw, and not
unfrequently runs into  the muscles of the lower part of the  face.
   When the whole muscle  is in  action, it  elevates the skin of the
neck.   The external jugular vein  is  seen  running nearly in the
centre of it, in the  same  direction with the fibres of  this muscle,
and between it and the sterno-cleido mastoid.*
   Upon the upper part of this muscle there is occasional!}' a thin
distinct plane of fibres crossing it and running  into the  depressor
anguli oris.  This is the Musculus Risorius of Santorini.


                  The  Sterno-Cleido Mastoideus,

   Is beneath, and  decussates the  last muscle.  It forms  always a
prominent feature in the outline of  the neck, in passing  obliquely
from the upper front part of the thorax to the base of the cranium.
   It arises  tendinous and  fleshy from  the edge of the upper part of
the sternum, and fleshy from  the sternal end of the clavicle.   These
origins are separated  by a considerable  fissure; but  they soon
unite.   It  is  inserted  tendinous  into the  mastoid process,  and
into the part of the superior transverse ridge of the cranium next
to it.
   It draws the chin towards the  sternum.f

  * Varieties.  In some rare instances this muscle ha9 been found thick and round;
and instead of going towards the face, inserted  into the occiput.
  t Varieties. Sometimes a fasciculus, at its posterior margin, is presented in a
state entirely  insulated.  Occasionally, its  lower extremity has  been  observed to
reach as far as the rectus abdominis muscle, and even to the point of the third bone
of the sternum.  The fissure between the sternal and clavicular portions  in mam-
miferous animals,  is, naturally, so much extended, as to produce two distinct mus-
cles. 
MUSCLES OF THE NECK.
381
                 Of the Fascia Profunda Colli.

   When the origin of the sterno-cleido mastoideus is turned to one
side, the Fascia Profunda of the neck is seen beneath the fascia
superficialis, and somewhat separated from it by a lamina of cel-
lular  adipose  matter.   This membrane arises  from the larynx,
forms a  thin capsule to the  thyroid  gland, and, being closely at-
tached  to its  inferior margin,  descends  by investing the sterno-
hyoid and thyroid muscles, being well seen on their anterior sur-
faces.   It is firmly  fastened to  the  upper edge of the sternum, to
the sternal  end of the clavicles, and  to the cartilages of the first
ribs, forming an elastic and  resisting  membrane from the larynx
to the thorax.  By turning off the sterno-hyoid and thyroid  mus-
cles from their  attachment to  the  sternum, the fascia  profunda
will be seen still more distinctly, passing behind them  from the
inferior margin of the thyroid gland, to the upper bone of the ster-
num: this lamina of it is inserted into the sternum, twelve or fifteen
lines below the upper edge.  It encloses or  surrounds the trans-
verse vein and  the  arteria innominata.   Beneath the fascia pro-
funda, are the trachea, the roots of the arteries of the  head  and
upper extremities and the  trunks of their veins.  There is much
loose cellular and adipose matter placed at the  lower part of the
neck, beneath this fascia; and between it and the trachea; through
which the thyroid  veins with their ramifications pass.   This last
circumstance  must  always render suppurations  and operations in
the part  highly dangerous, as the pus will form fistulas  under the
sternum ; moreover, the continual motion of the part in respiration,
prevents adhesions from forming, and, therefore, disposes to  ulce-
ration.  An ingenious idea on  the uses  of this  fascia  and of the
sterno-hyoid and thyroid muscles as connected with it,  was sug-
gested  by the  late Allen Burns: he conceived that they were a
defence to the upper part of  the thorax, and  sustained, in inspira-
tion, the  atmospheric pressure, which, without  them, would fall
upon the trachea and produce difficulty of breathing, from the air
not passing through the  larynx sufficiently rapid  to keep pace with
the dilatation of  the thorax.  He illustrates the opinion  by a  case
very much in point, of a gentleman who had lost this fascia  and
the muscles by suppuration, and who was afterwards incommoded 
382
MUSCLES.
by  atmospheric pressure upon the trachea at  this place.*  Mr.
Velpeau, on the contrary, asserts  that cutting through it in open-
ing abscesses and in operations has no such consequence.-)-
  The external borders of the fascia profunda are  continued  into
the sheaths of  the  great vessels of the neck.   It and  the fascia
superficialis are also continuous with one another along the ante-
rior edge of the sterno-cleido  mastoideus.
  Within the  inferior  maxilla, at its angle, a ligamentous expan-
sion arises at the pterygoideus externus muscle, and is spread out
between the styloid process,  and the  ramus of the lower jaw.
This membrane, described as the stylo-maxillary ligament, is joined
at its  inferior edge  by  the fascia superficialis, just before  the upper
part of the sterno-mastoideus, and which increases its breadth
downwards in the neck, giving it somewhat the condition of a
vertical septum of  that  region;  at its lower  edge it runs into the
theca of the great  vessels of the  neck.  Through  its lower  part
penetrate  the  stylo-hyoideus  and the digastricus muscle, and the
upper part separates the parotid from the sub-maxillary gland. It
is felt like a cord extending downwards and backwards below the
angle of the maxilla inferior.  It  is connected at its internal edge
with the compages  of the nerves and vessels of the part, in such a
manner as to forbid description, but  the practical anatomist  will
find no difficulty in discovering and understanding it.
  Below this septum, the round ligament, like a nerve, passes from
the extremity of the styloid  process  to the appendix  of the os
hyoides.
  The fascia profunda colli is also well marked in the foetus, and
not much blended with adipose matter.  It, like the fascia super-
ficialis,  is only the  sheath for muscles  which  it  surrounds, and is
called fascia from having some development of fibrous  matter in
its substance.

  *  The late Dr. Lawrence  informed me that the fascia profunda is well developed
in the neck of a cat, and that  having occasion to remove it in an experiment, the
respiration of the animal was conducted with great difficulty, amounting almost to
suffocation.  This is a good  confirmation of Mr. Burns's hypothesis.
  t  Anat. Chir. vol. i. p. 438, 2nd edit. 
MUSCLES OF THE NECK.
383
                       The Sterno-Hyoideus,

  Arises thin and fleshy on the interior of the thorax from the ap-
proximated surfaces of the cartilage of the first rib, the  clavicle,
and the first  bone of  the  sternum; it passes upwards  somewhat
obliquely, and is inserted into the inferior edge of  the base of the
os hyoides.   Its lower end is covered  by the sterno-mastoideus.
   It draws the os hyoides towards the sternum.*


                       The Sterno-Thyroideus,

   Is beneath the last,  and concealed, in  a considerable  degree,  by
it.   It arises fleshy from the  interior surface of the sternum, about
an inch below its upper margin, and from the cartilage of the first
rib; diminishing somewhat in  breadth, as it ascends, it is inserted
obliquely into the side of the  thyroid cartilage.
   It draws this cartilage towards the sternum.f


                       The Thyro-Hyoideus,

   Arises obliquely  from  the  side of the  Thyroid  Cartilage exter-
nally, and is inserted  into  a part of  the base, and into nearly all
the cornu of the os hyoides.   It  seems  almost like a continuation
of the Sterno-Thyroideus.
   Its use is to approximate  the  os hyoides and  the thyroid carti-
lage, in doing  which it has the  effect of  planting the  epiglottis
against the  root of the tongue, and of drawing the cricoid and  the
arytenoid cartilages against it, so that the opening of the glottis is
protected.J

   * Varieties.  Sometimes it arises from the middle of the clavicle; it is double, or
 is confounded below with the next muscle.
   t Varieties.   Sometimes there are  two of these muscles, one placed above the
 other; sometimes it runs into the inferior constrictor of the pharynx; sometimes it
 runs into the posterior margin of the thyro-hyoid muscle;  sometimes the muscle on
 one side is united to the other by transverse fibres.  I have, in  one instance, Jan. ],
 1839, seen a slip at the external margin of this muscle which  arising from the car-
 tilage of the first rib, ascended in front of the  great vessels, and was inserted  into
 their sheath on  a level with the thyroid cartilage,
   X Varieties.   Its fibres sometimes run  into those of the middle constrictor of the
 pharynx; sometimes they  arise from the cricoid cartilage; sometimes it is continu-
 ous with the sterno-thyroideus. 
384
MUSCLES.
                       The Omo-Hyoideus,

  Passes obliquely across the neck, from the superior edge of the
scapula to the os hyoides.  It is  a thin, narrow muscle,  divided
into two bellies, one at each end, by an intermediate  tendon;  its
inferior part  is concealed by the  trapezius muscle;  its  middle,
where the tendon exists, crosses the great vessels of the neck, and
is covered  by the sterno-cleido-mastoid  muscle; and its upper ex-
tremity is overlapped by the platysma myodes.
  It arises from the scapula just behind the notch in its superior
costa, and  curving somewhat  downwards in  its course, it is in-
serted  into the lower edge of the base of the os  hyoides, next to its
cornu.
  It draws the os hyoides downwards.*


                        The Digastricus,

  Is placed at the upper side of the neck, and passes from the back
part of the base of the head to the chin.
  It arises principally fleshy from  the fossa of the temporal  bone
at the base of the mastoid process;  its  middle is converted into a
round tendon, which passes through the stylo-hyoideus muscle, and
is fixed by a ligamentous loop to  the cornu of the os hyoides.   Af-
ter which another fleshy belly is  formed, which is inserted into the
inside of the  base of the maxilla inferior, at the  side of its symphy-
sis.   It receives an accession from the base of the os hyoides.
  Its use is to draw the os hyoides upwards when its extremities
are fixed, and, as  Mr. Hunter has  pointed  out, to throw the  head
backwards, and thereby to open  the mouth when the lower jaw is
fixed upon a  body of the same height.f

  * Varieties.   Sometimes it is double, so that besides the usual insertion, it has
one into the 6ide of the tongue.
  t A common  variety in this muscle consists in  the mutual adhesion of the two
anterior bellies belonging to the opposite sides, showing thereby a marked  tendency
to the quadruped arrangement. 
MUSCLES OF THE NECK.
385
                      The Stylo-Hyoideus,

  Is the more superficial of  the  three styloid  muscles.   It arises
tendinous from the middle and inferior part of the styloid process
of the temporal bone;  and being perforated, as  mentioned,  by the
tendon of the digastricus, is  inserted  tendinous into the cartilagi-
nous juncture of the base and cornu of the os hyoides.
  It draws the os hyoides upwards and backwards.*

                       The Stylo-Glossus,

  Is within and  above the other; it arises from the upper internal
part of the styloid  process, tendinous and  fleshy, and  is inserted
into the side  of the root of the tongue, forming a part of  its struc-
lure.f
  It draws the tongue backwards.^

                     The  Stylo-Pharyngeus,

  Is more deeply situated than either of the  other two  muscles.
It arises from the inner side of the styloid process near its root,
and runs  into the side of the pharynx between the middle and
upper constrictors, opposite the tonsil gland; it afterwards descends
between the  lining membrane of the  pharynx  and the middle and
lower constrictors, and is inserted into the posterior margin of the
thyroid cartilage.
   It draws the larynx and pharynx upwards.

                       The Mylo-Hyoideus,

  Forms the floor of the mouth and suspends  the tongue; it arises
at the root of the alveolar processes of the lower jaw,JYom a ridge
extending from the  last dens molaris to the chin.  Its fibres  con-
verge towards a white tendinous  line, placed between it and its
fellow, and reaching from the base of the os  hyoides to  the chin.
This muscle  is concealed by the anterior belly of the digastricus.

  •  Varieties.   This muscle is frequently double.
  t  See Tongue.
  t  Varieties.  J. F. Meckel says, that on one  occasion he found it double on both
sides.
   Vol.  I.—33 
386
MUSCLES.
When it contracts, it draws the os hyoides upwards and projects
the tongue.*

                       The  Genio-Hyoideus,

   Is concealed by the last; by turning over  the anterior edge of
which, it is seen.  It arises tendinous from the posterior tubercle
in; on the side of the symphysis of the lower jaw; and, increasing
somewhat in  breadth, is  inserted into the anterior part of the base
of the os hyoides.
   It draws the os hyoides upwards  and forwards.f

   (For the muscles of the tongue, see Mouth.)

   There are seven pairs of muscles, on the front and sides of the
cervical vertebras, which lie closely upon them.  They are named
from  their situations and shapes.


                         1.  Longus  Colli.

   The Longus Colli is next to the middle line  of the vertebrae.  It
arises from the sides of the bodies of the three superior vertebras
of the back, and from the anterior edges of the  transverse processes
of the five lower  cervical vertebras.   Its fibres  pass somewhat
obliquely upwards  and inwards, to be inserted into the front of the
bodies of all the cervical vertebras.
   It bends the neck forwards, and to one side.J


                2. Rectus  Capitis Anticus Major,

   Is placed on the  outside of  the  last.   It arises  tendinous and
fleshy from the  fronts of  the  transverse  processes  of the third,
fourth,  fifth, and sixth cervical  vertebrae; forms  a  considerable

  * Varieties.  Sometimes a part of it is inserted into the middle tendon of the di-
gastricus, or is joined with the  sterno.hyoideus.
  t Varieties. Sometimes a distinct fasciculus of this muscle is  inserted into the
greater part of the cornu of the  os hyoides.  Sometimes there is but  one muscle.
Rarely it is double on both sides.
  X Varieties.  Sometimes a fasciculus from the first or second rib, or from the
body of the sixth or seventh vertebra of the neck, joins it. 
MUSCLES OF THE NECK.
387
fleshy belly, and is inserted into the cuneiform process of the os
occipitis, just before the condyle.  It bends the head forwards.*


                3.  Rectus Capitis Anticus Minor.

  This is a very small muscle.  It arises fleshy from the front of
the first cervical vertebra near  its transverse process, and is in-
serted under the rectus major before the root of the condyloid pro-
cess of the occipital bone.
  It bends the head forwards.

                   4.  Rectus Capitis Lateralis.

  This is also small, and arises  fleshy  from the front of the trans-
verse process of the atlas.   It is inserted, tendinous and fleshy, at
the outside of the  condyle of the occiput, into the  ridge leading
from it to the mastoid process.
  It pulls the head a little to one side.f


                  5.  Scalenus Prior, or Anticus.

  The scalenus anticus arises  by three distinct tendinous  heads
from the transverse  process of the fourth, fifth, and sixth  cervi-
cal vertebra, and  is  inserted tendinous and  fleshy into the  upper
surface of the first rib, just anteriorly to its  middle.


                       6. Scalenus Medius.

  The scalenus medius arises by distinct tendons from the trans-
verse processes  of  all the cervical vertebras, and is inserted tendi-
nous and fleshy  into the upper face of  the first rib, in all the space
from its middle  to its tubercle.
  * Sometimes it also arises from the first and second vertebrae.
  t Varieties.  Sometimes another muscle arises from the body of the first vertebra
of the neck. 
388
MUSCLES.
                      7. Scalenus Posticus.

  The scalenus posticus arises from the transverse process  of the
fifth and sixth cervical vertebra, and is  inserted into the upper
face of the second rib, just beyond its tubercle.
  The last three muscles are  concealed by the sterno-cleido mas-
toideus and the anterior edge  of the trapezius.   The scalenus pos-
ticus is best seen in dissecting the muscles of the spine, and resem-
bles very much one of the class to which Albinus gives the name
of Levatores Costarum.
  All the Scaleni elevate the  ribs and bend the neck to one side.
They are particularly interesting  as connected with the course of
the large blood vessels and nerves of the upper extremity.*
                         CHAPTER  II.

                    Muscles  of  the  Trunk.

     SECT. I.--MUSCLES ON THE FRONT  OF THE THORAX.

                       The Pectoralis Major,

   Is superficial, and  forms the  large swelling  cushion of flesh
under the skin of the breast.  It arises tendinous from the anterior
face of the first two bones  of the sternum, their whole length,
fleshy from the cartilage  of  the fifth  and  sixth  rib,  and by  a
fleshy slip from the upper part of the tendon of the external oblique
muscle.   It  arises,  also, fleshy from  the  interior two-thirds of the
clavicle.  The  clavicular  and  sternal  portions  of the origin  are
separated by an interval, giving the appearance of two muscles.

  * Varieties.  Besides  the three scaleni which  are described, there are frequently
aupernumerary muscles or fasciculi.  One of these, called the Scalenus Minimus
Albini, is between the first two, and occasionally appears as a fasciculus of the sea.
lenus anticus, separated from it by one or more of the brachial nerves; it is some-
times double.  Another fasciculus, called the Scalenus Lateralis, is between the sca-
lenus medius and posticus;  it comes from the posterior part of the first rib, and  is
inserted into the transverse process of the fourth, fifth, and sixth vertebra. 
MUSCLES OF THE NECK.
389
   The fibres converge,  and  terminate  by  a broad, thin tendon,
 which  is inserted into a roughness on the exterior edge of the bici-
 pital fossa of the os humeri, and  into the fascia  brachialis, just at
 the  internal edge of the deltoid muscle.   At this insertion it adheres
 to the tendon of the latissimus dorsi.  The under edge of the mus-
 cle, near its  insertion, is folded inwards  and upwards, which gives
 the  rounded  thick margin to the fore part of the axilla.   That part
 of the  broad tendon  belonging to the clavicular  portion is inserted
 lower down  than the sternal,  which produces a decussation of the
 fibres of the  tendon.
   The pectoralis major  draws the arm inwards  and  forwards;
 and also depresses it  when it  is raised.*


                        The Pectoralis Minor,

   Is brought into view by raising the last muscle.   It is compara-
 tively small, and somewhat triangular.   Arising by thin tendinous
 digitations from the  upper edge of  the third, fourth, and fifth  rib,
 it soon becomes fleshy, and  is inserted, by a short flat tendon,  into
 the  inner facet of the coracoid process of the scapula.  Its use is
 to draw the  scapula inwards and  downwards.f

  * Varieties.  Sometimes a single  fasciculus arises from the  eighth rib, which
 ascends towards the os humeri, has a tendon in its centre, and  finally joins with
 the tendon of the pectoralis minor ;—sometimes this muscle detaches a small fasci-
 culus to  the brachialis internus;—sometimes there is a small square plane of mus-
 cular fibres on its front surface, decussating the fibres at right angles;—sometimes
 a fasciculus almost cylindrical proceeds  from it towards the axilla, and,  being
 changed  into a  long tendon, is inserted into the internal tuberosity of the os humeri.
 Supernumerary fasciculi are also found going from one rib to another, or towards
 the sternum; sometimes its tendon detaches a fasciculus, which, crossing the inser-
 tion of the muscle, covers the bicipital groove of the os humeri like a bridge, is
 blended with  the tendon of the supra-spinatus, and increases the thickness of the
 capsular ligament of the shoulder joint.  In a muscular male black subject, it was
 entirely deficient, except the external clavicular  half.  The  pectoralis minor was
 wholly wanting  in the same.  Deer. 1837.
  t Varieties.   Sometimes it sends a fleshy fasciculus to the tendinous origin of the
 coraco-brachialis.  Sometimes, below it, there is  a  third pectoral muscle, which
 arises from  the  first  and  second rib, and is inserted into  the  coracoid  process;
 whereby  a striking analogy with birds is established.  Another variety has  also
 been  observed in the existence of a  fasciculus, which comes from the upper rib, and
 which, covered by the little pectoral muscle, is inserted into  the  capsular ligament
of the scapulohumeral articulation.
                                 33* 
390
MUSCLES.
                         The Subclavius,

  Is a small  muscle, placed immediately under the clavicle.  It
arises from  the cartilage of the first rib, and is inserted  into the
inferior face of the clavicle, from near the sternum, to the conoid
ligament, which connects the  coracoid process and  the  clavicle
together.  It draws the clavicle downwards.*


        The Serratus Magnus, or Serratus Major Anticus,

  Is a broad muscle, lying on the sides of the  ribs, between them
and the scapula, and beginning at a line  anterior to their middle.
It arises  from  the  nine upper ribs  by fleshy digitations, the supe-
rior one  of  which  seems almost  like a distinct muscle:  the five
lower are connected to the obliquus externus abdominis, the digi-
tations of the  two muscles inter-locking with  each other.  The
fibres converge, and  are  inserted into the base of the scapula  its
whole  length.  Its action is to draw the scapula forwards.f


                        The Intercostales,

  Fill  up the spaces  between  the  ribs.   There are two  in each
space,  of which the external arises from the transverse process of
the vertebra, and  from the inferior acute edge of the rib, from  its
head  almost  to its cartilage,  and  is inserted  into the  superior
rounded  edge of  the rib below for the same  distance, its fibres
passing obliquely forwards and downwards.   The internal inter-
costal  arises from the inferior  edge of the rib and the costal carti-
lage, beginning at the sternum, and  extends  backwards to  the
angle of the rib; it is inserted  into the superior rounded edge of the
rib  and costal cartilage,  below, on its inner side, its  fibres pass-
ing obliquely  backwards and downwards.   They draw the ribs
together.

  *  Varieties.  Sometimes two muscles exist; a bursa mucosa is formed between
its tendon and  the cartilage of the first rib.
  t  Varieties.  Sometimes, it has ten or eleven origins;  the upper origin is defi-
cient; the  latter is so distinct that it may pass for  a particular muscle ; a wide  gap
exists in the middle of the muscle, dividing it into two distinct parts. 
MUSCLES OF THE ABDOMEN.
391
                    The Triangularis Sterni,

  Is on the posterior or cardiac face of the cartilages of the ribs,
and arises from the whole  length of the cartilago ensiformis at its
edge, and from the inferior half of the edge of the second bone of
the sternum.   The fibres go obliquely upwards and outwards, to
be inserted into the cartilage of  the  third, fourth, fifth, and sixth
rib by fleshy and  tendinous digitations.   Its use is to depress the
ribs, and, consequently, to  diminish the cavity of the thorax.
  This muscle is frequently defective  or  redundant  in the number
of its heads, and is commonly more  or  less continuous with the
transversalis abdominis; but occasionally it is so much so, that the
two  seem to make but one muscle, and have, therefore,,been called
Sterno-abdominalis, by Rosenmuller.
     SECT. II.—MUSCLES AND FASCIAE OF THE ABDOMEN.

  Between the most superficial of the abdominal muscles, which
is the external oblique, and the  skin with  the subcutaneous fat, is
found the Fascia  Superficialis Abdominis.   In lean subjects it is
very distinct, but in fat ones not so much so, from being  blended
with adipose  matter.  The laminas of  it which are next to the
muscles, are  kept, in the latter case, rather more free from  fat than
the more superficial.  It consists  of condensed  cellular substance,
with very little  fibrous  matter in  it,  and may  be considered  as
taking its origin on the  front of the thigh, and extending  in  front
of the abdominal muscles, as high up as the thorax: indeed, if we
are disposed  to trace it to its whole extent, there is no difficulty in
following it over the front of the  thorax; thence to  the neck, as
the fascia superficialis colli;  and  even  to the face.*   In ordinary

  * This statement of  origin  is to be viewed merely as an  anatomical license for
descriptive purposes; the most natural line of origin is the whole length of the linea
alba, and this same line might be considered as going along the front of the ster-
num for the pectoral fascia, and along the middle  of the neck for its fascia superfi-
cialis and profunda.—There is one practical advantage in raising this fascia from the
side towards the linea alba, that we see better a  linear close adhesion which it makes
with the deep edge of Poupart's ligament,  and  also how the part near the anterior
superior spinous process, not forming such an adhesion, goes down to the thigh and 
392
MUSCLES.
cases its desmoid  or aponeurotic character  is very equivocal, but
where the parts about  the  groin  have  been pressed  upon and
thickened by the irritation of hernial protrusion, it is better marked.
On the thigh it is  blended with  fat; and  encloses  between  its la-
tninas the lymphatic glands of the  groin, and the  external  pudic
vessels  given off from  the femoral  artery, immediately  below
Poupart's ligament.   On the  tendon of the external  oblique it is
more condensed;  branches of the femoral  artery are also seen in
it there.   One longer  and larger than the others, the arteria ad
cutem abdominis  of Haller, winds over  Poupart's ligament, and
runs upwards somewhat in the line of the epigastric artery, to be
distributed to the skin of the abdomen: the division of it will pro-
duce sufficient hemorrhage to require attention.  On the symphysis
pubis and about the external ring the laminas of the fascia superfi-
cialis are multiplied, and it has more of the  character of common
adipose matter, as in most cases the adeps there is abundant and
forms in both sexes the protuberance called  the Mons Veneris, or
Penil.  From the pubes it may be  traced as a condensed cellular
membrane blended with the ligamentum suspensorium along the
penis  to  its  extremity; and, according to  Mr. Colles, of Dublin,
when matter is formed beneath it, it is apt to create fistulous sores
on this organ.  A thin process of this membrane  may be traced
along the spermatic chord, and identified  with the tunica vaginalis
communis.   This fascia  is more loosely connected to the parts be-
neath it, along the anterior margin of Poupart's ligament, than
elsewhere, which disposes femoral hernia  to observe that course in
its increase.
  The fascia Superficialis, under the name of Tunica  Abdomi-
nalis, is  well developed  in  animals with  a  large and projecting
belly, particularly  in the large ruminantia and the solipedia.   It
has a yellowish tinge in them, is very elastic and strong, and well
calculated to support their viscera.*

  There are five pairs of muscles called abdominal;  to wit, the
External  Oblique; the  Internal Oblique;   the Transverse; the
Straight; and the Pyramidal.  The first  three are flat and broad,
and lie in layers one upon the other; the other two are long.

spreads itself over the whole front of the inguinal portion of the femoral fascia. This
mode of raising exhibits also, more satisfactorily, the close adhesion of this fascia to
the linea alba behind, and to the same line of the skin before.
  *  Breschet, Thesis sur L'Hernie.   Paris, 1819. 
MUSCLES OF THE ABDOMEN.
393
                    1. The Obliquus Externus,

   Arises from the  eight inferior ribs  by muscular and tendinous
 digitations  attached near their anterior  extremities.  The first
 head is covered by a slip from the pectoralis major, the five upper
 heads are interlocked with the origins of the serratus major anti-
 cus, and the three inferior with those of the latissimus dorsi.  The
 fibres pass obliquely downwards, and terminate in a broad thin
 tendon.  This tendon extends over the  whole  front of the abdomen,
 from the lower end of the second bone of the sternum to the sym-
 physis of the pubes.
   This muscle is inserted  into the whole length of  the linea alba;
 into the anterior half or two-thirds  of the crista of the ilium,  by
 muscular fibres posteriorly,  and tendinous anteriorly; and, from
 the anterior superior spinous process, the tendon extends to the
 body and to the symphysis of the pubes, forming thereby the liga-
 ment of Poupart, or the Crural Arch.
   In  the middle line of the  body, the tendons of the three broad
 muscles, on  both sides of  the abdomen, unite to form the Linea
 Alba, which extends from the sternum to the pubes.   From two to
 three inches in the adult, on either side of the linea alba, but more
 distant from it above  than below, is another line, formed by the
 same tendons, which is the Linea Semilunaris.   The navel, which
 originally was a hole for the passage of the umbilical vessels, and,
 in the adult, is commonly depressed into a pit, appears in the linea
 alba as a  protuberance  composed of  a  condensed cellular mem-
 brane.  Just at the navel  there is  a line  crossing the linea alba,
 and extending from one linea semilunaris to the other; at the lower
 end of the  Cartilago-Ensiformis, there  is another;  and half-way
 between this and the navel,  a  third: about half-way between the
 navel and  the pubes is  a fourth, but  it is  generally imperfect.
 These are  the Lineas Transversa, and they  are formed by tendi-
 nous matter in the substance of the recti muscles, connecting them
 to their tendinous sheath  in front.
  The most interesting insertion of the tendon of the external ob-
 lique, is the portion constituting Poupart's ligament, or the Crural
Arch.  The latter as it gets  to the pubes from  the ilium, splits so
 as to leave  a hole for the passage of the Spermatic Chord in the
male, and  of the Round Ligament  of the Uterus in the  female. 
394
MUSCLES.
This opening is named the External Abdominal Ring.  The ten-
don forming its  upper boundary is  inserted  into the  symphysis
pubis, and into the pubes of the opposite side, by fibres which are
interwoven with and  decussate those of its fellow.   The tendon
forming the lower margin of the  ring is inserted into the spine of
the pubes, and into its crista for  an inch.   The portion inserted
into the crista of the  pubes is Gimbernat's  ligament, which it will
be readily understood, means only a part of the Crural Arch.
   The  Ring  in  the External  Oblique  is t  rather triangular than
round;  its base is formed by the  body of the pubes,  and its point
is  at the place where the tendon  splits.  The  latter  is kept from
parting still farther by a fasciculus of tendinous fibres, which  runs
across it.  The sides of this  opening are called its Columns, and
from  their situation,  internal  and externa],  or upper  and lower
Columns.  In  the  female it  is oval and  scarcely  half an  inch
long.
   There are several small round holes  in the tendon of this mus-
cle, which afford  passage to nerves and to veins.   When, by the
clearness of the dissection, the tendon has  its characteristic gloss
and polish, they are very distinct.
   Use.   This muscle compresses the viscera of the abdomen and
brings the pelvis and thorax towards each other.*
   Latterly the attention of anatomists has  been directed to a flat
band of cellulo-fibrous matter  called the Ventrier or Belly Band,
which arises from  the tendon of the external oblique from the linea
alba to  the linea semilunaris just above the internal abdominal ring,
and passes downwards to be inserted into  the fascia  femoris over
the origin  of the gracilis.  Its outer margin reposes in front of the
spermatic  chord and shoves it outwards  as the band  goes down-
wards.!

  * Varieties. Sometimes a considerable part of its middle and anterior portion ia
deficient, a vitiated conformation, to which it is subjected along with the other ab-
dominal muscles.  The inferior part of its tendon  is incompletely developed by the
absence of the superficial fibres which  retain together the more deeply seated, by
which it  is weakened and caused to gape  by one or more large oblong fissures: this
variety gives occasion to a form of inguinal hernia, differing materially from what
is common.
  ! Thompson, Anat. Du Bas Ventre.  Paris, 1838. 
MUSCLES OF THE ABDOMEN.
395
                     The Obliquus Internus,

  Lies beneath the last, and  its fibres pass in a contrary direction
to the fibres of the other.  It arises tendinous, by the fascia lum-
borum, from the three inferior spinous  processes of the loins and
from all those of the sacrum; tendinous and fleshy, from the whole
length of the crista of the ilium;  and fleshy, from  the upper half
of Poupart's ligament.  Though the fibres of this muscle, in gene-
ral, decussate the fibres of the external oblique, all of them do not;
for  the lower  are brought gradually to pursue the same direction
towards the symphysis of the pubes.
  Near the Linea Semilunaris, the muscular fibres cease, and the
tendon begins.
  It is inserted, by condensed fibrous cellular membrane, into the
cartilage of the seventh, eighth, and ninth rib; and by flesh  into
the tenth, eleventh, and twelfth.   It is inserted also, membranous,
into the side of the ensiform cartilage, its whole  length;  and into
the linea alba, from the sternum to the pubes.
  The tendon of this muscle divides into  two laminas, which en-
close the rectus muscle, and thereby form the sheath for it, imper-
fect, however, at the lower posterior part near the pubes.
  Its use is the same as that of the External Oblique.*


                3. The Transversalis Abdominis,

  Arises from the  transverse processes of the last dorsal, of the
four upper  lumbar  vertebras, and from  the back part of the crista
of the ilium, all, by the Fascia Lumborum.  It also arises, fleshy,
from  the anterior two-thirds of the spine of  the ilium, and from
the  exterior half of Poupart's ligament;  and tendinous and fleshy
alternately, from the inferior margin of the thorax, formed by the
cartilages of the six or seven inferior ribs, at their inner surfaces,
where they are concerned in the origin of the diaphragm.
  The fleshy part  of  this muscle occupies about one-third  of its
extent.  It  is inserted into the side of the ensiform cartilage; filling
up the vacancy between it and the cartilage of the sixth and se-
venth rib; and into the linea alba, from the extremity of the ster-

  *  Varieties.  It is sometimes defective at its lower part, and on other occasions
redundant. 
396
MUSCLES.
 num to  the  pubes.   The Transversalis and  the Internal Oblique
 also form below a common tendon, which  is inserted for an inch
 into the crista  of the pubes, behind the insertion of Gimbernat's
 Ligament;—into the spine of the pubes;—and into that part of the
 body of  the  pubes which forms the lower posterior boundary of
 the external abdominal ring.  Just  above  this insertion the com-
 mon tendon alluded  to splits  into two  laminas, terminating in the
 linea alba; one of which goes before and the other behind the py-
 ramidalis muscle, so that a sheath is thus formed for it.
   Use; to compress the contents of the abdomen.*


                    4.  The Rectus Abdominis,

   Is seen beneath the tendons of the other  muscles  on  either side
 of the linea alba.  Its origin is by a flat tendon of an inch or more
 in breadth from the symphysis pubis and  the upper posterior  part
 of the  body of the pubes.   The  muscle increases gradually in its
 ascent  to the breadth of three or four  inches.  The tendinous in-
 tersections, confining it to the tendinous sheath in front, are fixed
 at the places  mentioned as lineas transversas; but, for the most part,
 they do not extend through  the muscle.   When the origins  of the
 Recti are examined from behind, it  will be  seen  that the internal
 edge of one tendon, just above the  symphysis pubis, overlaps the
 corresponding part of the other; also, that a small pyramidal liga-
 ment finishes more completely the structure just  above the sym-
 physis  pubis; this ligament  is called  by Breschet,  the  Superior
 Pubic.
   The  Rectus is inserted fleshy into  the base of the cartilago ensi-
 formis,  and into the cartilage of the  fifth, sixth, and seventh rib.
   It draws the thorax towards the abdomen.f

  * Varieties. Sometimes transverse tendinous fibres creep across its belly, and on
other occasions a small transverse muscle is  present, which decussates the larger,
and is inserted into the twelfth rib.
  t Varieties.  If there are eight sternal  ribs, then this muscle has an additional
costal insertion.  It sometimes sends a fasciculus to the fourth  rib; and I have  seen
it ascending over the pectoralis major, to the root  of the neck, as occurs in mammi;
ferous animals. 
MUSCLES OF THE ABDOMEN.
397
                      5.  The Pyramidalis,

   Is at the lower front part of the rectus, and is about three inches
long.  It  arises somewhat thick, tendinous, and  fleshy, from  the
upper part of the  pubes, from near its spine to the symphysis, be-
tween the rectus behind and the insertion  of the  external oblique
before.  Being fixed in the sheath formed by the separation of the
tendon of the transversalis muscle it tapers to  a point above, and
is inserted into the linea alba and internal  edge of the rectus, for
about the  upper two-thirds of its own length.
   It strengthens the  lower part of the abdomen.*

   At the linea semilunaris the tendon  of the internal oblique and
of the transversalis unite  intimately; and just beyond this junction
the  two laminas are formed, which enclose  the rectus  muscle.
The anterior lamina is the front layer of the tendon of the  internal
oblique, which, after passing half an inch  or an inch, is joined to
the tendon of the external oblique, goes before  the rectus  muscle,
and  covers it from  origin to  insertion.   The posterior  lamina,
made by the posterior layer of the tendon of the internal oblique, is
united already at the linea semilunaris to the tendon  of the trans-
versalis; in this manner they pass behind  the  rectus muscle from
the cartilago-ensiformis to a line half-way between the umbilicus
and the pubes.  From this line,  downwards, all the tendons go in
front of the rectus muscle.
   The obliquus externus tendon  may be dissected from the com-
mon tendon  of the  others, without much difficulty, almost to  the
linea  alba.  The  term insertion, expresses,  very  imperfectly, the
manner in which the tendons of these broad muscles all terminate
in the linea alba from the thorax to the pelvis.  It should rather be
said, that  they coalesce there by a  general intertexture  of their
fibres.

  * Varieties.  It  is frequently defective, but sometimes two, three, or even four,
are seen on a side. When defective, the rectus or obliquus internus is better deve»
loped than usual.
Vol. I.—34 
398
MUSCLES.
                           The Cremaster,

   Is commonly attributed exclusively to the internal oblique, as it
is said to be a detachment of fibres from it;  but it is also formed
by fibres from the lower edge of  the transversalis muscle.  The
history of its formation is as follows:  in the descent of the testicle,
the latter has to pass beneath that  edge of the transversalis and of
the internal oblique which  is extended from the  outer portion of
Poupart's ligament, to the spine and crista of the pubes.   As the
testicle descends, it comes  in  contact with  a fasciculus of these
fibres, and  takes it along.  This constitutes the Cremaster muscle,
which, in adult  life, and  in  a strong muscular  subject, is seen de-
scending on the outside of the spermatic chord, and spreading over
the anterior part of the  tunica vaginalis in arches with their con-
vexities downwards, then rising on the inner side of  the chord, to
be inserted into the spine of the pubes.*
   It draws up the testicle.


                 Fascia Transversalis Abdominis.

   The Fascia  Transversalis  is placed immediately behind  the
transversus muscle, between it and the peritoneum.   An opening
in it, which permits the spermatic  chord to  pass, is called the In-
ternal Abdominal  Ring, in order to distinguish it from the opening
in the tendon  of the external  oblique, called the  External  Ring.
The internal ring is rather nearer  to  the  symphysis pubis than to
the spine of the ilium.   The space between the internal ring and

   * Anat. De L'Homme, par Jul. Cloquet.  This account, though easily verified in
some subjects, and especially in such as are muscular, does not appear to be appli-
cable to all, or, in other words, the arrangement in them is not quite so obvious.  It
does not agree with  Mr. John Hunter's observations on  the descent of the testicle;
for he always found, while the  latter was still  in the loins, the cremaster running
towards it.  Moreover, in the buffalo of America, a testicle of which Dr. R. Harlan,
of this city, was obliging enough to furnish  me  with for  dissection, I found that the
cremaster, though remarkably  robust  and  strong, forms none of those nooses or
arches with their convexities downwards, but terminates at the testicle in a tendi-
.nous and somewhat abrupt manner. Taking all these points into consideration, it
may be, that a part  of the cremaster is formed after the manner indicated by Mr.
Hunter, and another part after that mentioned by M. Cloquet; or, indeed, cases may
occur, presenting exclusively one or the other. 
MUSCLES OF THE ABDOMEN.
399
the external ring, is about eighteen lines  in the adult, and is very
properly called the Abdominal Canal, from giving passage  to the
spermatic chord.  The anterior side of the canal is formed  by the
tendon of the external oblique; the inferior  part, in  the erect pos-
ture, is formed by Gimbernat's  ligament;  the posterior  side  is
formed  by the fascia transversalis;  and  above, this  canal is over-
hung by the  internal  oblique  and the  transversalis  muscle.  The
spermatic chord, after penetrating the  fascia transversalis, does
not cross, directly at right angles, the inferior edge of the internal
oblique  and  transversalis, but it  slips under them very obliquely;
its inclination being towards  the pubes, so  that it can  be  consi-
dered as disengaged from the inferior edge of these  muscles, only
about the middle of the abdominal canal.
   The opening in the Fascia Transversalis, or the Internal Ring,
is not abrupt and well defined; but the  fascia, where it transmits
the spermatic chord, is reflected by a thin process, and terminates
insensibly in its cellular substance.   At the posterior or ventral
face of the External Ring, the fascia transversalis is not in contact
with the cord;  but that part of the tendon of the internal oblique
and  transversalis which  is inserted into the crista  of the  pubes,
and  forms a sheath for the pyramidalis muscle, is placed between
them, and secures this opening.
   The peritoneum covers the  posterior face of the fascia transver-
salis, and is thrown into a duplicature or falciform  process, passing
from near the  middle  of the  crural  arch towards the umbilicus.
This duplicature depends upon the round ligament of the bladder,
which was once the umbilical artery of the foetus.   It is broader
near the pelvis than it is above, has its loose edge turned towards
the cavity of the abdomen, and ascends  near the pubic margin  of
the Internal Ring.  The effect of its existence is to divide the pos-
terior face of the inguinal region  into two shallow  fossas; one next
to the ilium, and the other next to the pubes.   The one next to the
ilium contains the beginning of the internal abdominal ring,  which
is frequently marked by a little pouch  of peritoneum, going along
the spermatic chord for a  few lines.   The fossa on the inner  or
pubic side of the falciform process is just behind the external ring,
but separated from it by the fascia transversalis, along with the
tendon of the lower part of the internal oblique and  of  the trans-
versalis muscle, where it is inserted into the pubes, and  forms the
sheath  of the  pyramidalis.  The two fossas  indicate the  points 
400
MUSCLES.
 where inguinal hernias commence;  the proper inguinal protrusion
 begins in the external fossa, and  the ventro-inguinal sometimes in
 the internal fossa.
   The view of the fascia transversalis from  behind is extremely
 satisfactory.  For a proper knowledge of this membrane, the pro-
 fession is indebted to the labours  of  Sir Astley Cooper; and much
 of the zeal  with which the anatomy of hernia has been investigated,
 in latter years, is attributable to  him.   The fascia transversalis is
 a thin tendinous  membrane,  most  generally;  occasionally it  is
 merely condensed cellular membrane.  It arises from  the internal
 or abdominal edge of Poupart's  ligament, and from the crista of
 the pubes  just behind the  insertion  of the common tendon of the
 internal oblique and transversalis muscles, and  is extended upwards
 on the posterior face of the transversalis muscle to the thorax.   At
 its origin it is attached to the inferior edge of  the transversalis and
 internal oblique, particularly the part between  the internal ring and
 the symphysis pubis.   It is also attached to the  exterior margin of
 the rectus  abdominis where it is deprived behind  of its sheath.
 The internal abdominal  ring, or  opening in this  fascia, marks it
 out in some measure into two portions, of which  that  on the iliac
 side of the  ring is not so thick as the other, or  the one on the pubic
 side;  and both portions are much more tendinous near the crural
 arch than they are higher up.
   Were it  not for the important influence of the fascia superficialis
 abdominis and the fascia transversalis upon hernia, and the conse-
 quent  necessity of a minute knowledge of them, their description
 might be much curtailed in considering them  in their proper light,
 to wit; as  shealhs of the  abdominal muscles;  for it is now suffi-
 ciently apparent that the first is contiguous to  the external  oblique,
 and the second to the transverse muscle.   Upon the  same princi-
 ple, fascias  might be  made of  all the laminas of cellular substance
 intermediate to the abdominal muscles, but it would be useless.*

  * A very elaborate and  exact account of the construction of the parts concerned
 in hernia has lately been presented by Alexander Thomson, M. D., under the title '
 of Ouvrage complet sur L'Analomie du Bas Ventre.  Paris, 1838.  The character
 of this work is not so much inventive as distinguished by great minuteness of re-
 search, and a  different distribution of  the matter from what is common, together
 with a most copious supply of new terms in place of old ones. Highly creditable as
 it is fo his industry, we can scarcely do less than protest  against the latter  irregu-
 larity, and express our apprehensions that  this objection, together with the unusual
approaches which he has opened to the structure as a substitute for the settled ones, 
MUSCLES OF THE PARIETES OF THE ABDOMEN.
401
    On removing  the peritoneum from  the iliacus internus muscle,
  the spermatic vessels are  seen to  descend from  the loins to the
  internal ring, where they are  joined by  the vas  deferens coming
  from the pelvis.   As  they engage  under  the edge of the internal
  oblique muscle, after penetrating the ring, the cremaster muscle is
  detached to spread  itself over them.  The spermatic chord, thus
  constructed, passes  through  the abdominal  canal in the manner
  mentioned,  obliquely downwards  and inwards;  and,  emerging
  from  the  external ring,  it descends vertically, lying rather upon
  the  outer column of the ring than upon its base.
    On the posterior face of the fascia transversalis, between it and
  the  peritoneum, is  the Epigastric  Artery.  The  epigastric arises
  from the external iliac as the latter is about to go  under the crural
  arch ; it ascends inwardly along the internal margin of the internal
  abdominal  ring to  the exterior  margin  of the rectus  abdominis
  muscle, which it reaches after a course of two and a-half or three
  inches.   The spermatic  chord, in getting from  the  abdomen  to
  the  abdominal  canal, therefore, winds, in  part, around the epigas-
  tric  artery;  in the first of its course being at the iliac edge of the
  artery, and then  in  front of  it.   Two epigastric veins attend the
  artery, one on  each of its  sides, and end  by a common trunk  in
  the external  iliac vein.

   The anatomical arrangement of the parts concerned in inguinal
 hernia in  the famale is the  same as in the male, except that the

 will restrict very much the reception of his work, and render it less acceptable  to
 both teacher and student.   The splitting and invention of fascia! was considered for
 some  time as almost exclusively an Anglican  malady; it appears, also, to have pro.
 pagated itself to Paris in  an exasperated form in this production of Mr. Thomson
 and in that of Mr. Velpeau (Anatomie  Chirurgicale, 3d Edition, 1838,) both, un-
 questionably, works of much merit.  The practical anatomist may, however, ask, if
 all of  the laminie described as such be fascias, what has become of the cellular sub-
 stance which formerly entered so largely into the composition of the human body?
 Will he not rather find verbal novelties than  new existences?  A sound anatomical
 verdict is yet to be given on these points: our own opinion is, that anatomy is too
 staid a science  for mere caprices in description and  names, and that such innova-
 tions cannot possibly become oecumenical.  The introduction of a new name in the
 place of an old one is the highest act of medical  authority, and is so seldom sanc-
 tioned  by general suffrage, that an individual  inclining to it may well pause, lest, in
so doing, he may seal up his own publications, by the use of terms too little known
to be convenient or desirable.
                               34* 
402
MUSCLES.
round ligament of the uterus supplies the place of the  spermatic
chord, and there is no cremaster muscle.*
   SECT. III.—MUSCLES  OF  THE UPPER AND  POSTERIOR
                 PARIETES OF THE ABDOMEN.

   These muscles are constituted by a single symmetrical one, and
 by four pairs: they can only be seen advantageously by removing
 the abdominal viscera.                                 '


               1. The Diaphragm, (Diaphragma,)

   Is a complete,  though moveable septum, placed between the tho-
 racic and abdominal cavities; it is extremely concave below and
 convex above, the concavity being occupied by  several of the ab-
 dominal viscera.   It is in contact above with the pericardium and
 lungs,  and below with the liver, spleen, and stomach.
   It is connected with the inferior margin of the thorax on all
 sides, and has for its centre a silvery tendo.i, resembling in its out-
 line the heart of a playing card.  This cordiform tendon occupies
 a considerable  part of the  extent of the diaphragm, has its apex
 next to the  sternum, and its  notch towards the spine; and  the
 muscular part of the diaphragm is inserted all around into its cir-
 cumference.  The cordiform  tendon is nearly  horizontal in  the
 erect posture, its elevation  being on a line with  the lowest end of
 the second bone of the sternum.  On each side of this tendon some
 of the muscular fibres rise so high upwards before they join it, that
 they are on a horizontal level with  the anterior end of the fourlh
 rib.  The fasciculi of muscular fibres are, for the most part, con-
 vergent from the  circumference of the thorax, and are easily sepa-
 rated from one another.
  In the diaphragm  are three remarkable foramina.  The first
 (the Foramen (Esophageum) is  in the back of the muscle, between
the spine and the  notch of the cordiform tendon, a little to the left
of the middle line.  It gives passage to the oesophagus and the par

  * For an account of both Inguinal and Femoral Hernia, the reader is referred to
Lessons in Practical Anatomy, 2d  Edition.  Philadelphia, 1836. 
MUSCLES OF THE PARIETES OF THE ABDOMEN.
403
vagum nerves along with it, and is rather a fissure or a long ellip-
tical foramen made by the separation and reunion of the muscular
fibres; for, above and below, at each end of the ellipsis, these fibres
decussate one another in columns.   To the right of this foramen,
and a little above its horizontal level, in the back part of the cordi-
form tendon, is a very large and patulous foramen for the ascend-
ing vena cava, (Foramen Quadratum.)  Its  form is between  an
irregular quadrilateral figure and a circle; its edges are composed
of fasciculi of tendon rounded off, and are not susceptible of dis-
placement, or of alteration in their relative position to each other;
by which means any impediment to  the course of the blood in the
ascending cava, which might arise from a different arrangement,
is obviated.  Almost  in a  vertical  line below, and about three
inches from the foramen for the  oesophagus, is the  third  hole, in
the diaphragm,  which affords  passage to the  aorta, (Hiatus Aorli-
cus.)  It is just in  front of  the bodies of the three upper lumbar
vertebras, and is a much longer elliptical hole  than the oesophageal.
Its lowest extremity or pole is incomplete, being constituted by the
tendinous crura of  the diaphragm, and its upper by a decussation
of  muscular fasciculi arising from them.  Through it, besides the
aorta, pass the Thoracic Duct, and the Great Splanchnic Nerve of
both sides.
   In the horizontal position  of either the dead or the living body,
the right side of the diaphragm ascends higher in the thorax than
the left; but the weight of the liver makes it, in the vertical pos-
ture, descend lower than the other.
   Thus circumstanced, the  detailed  origin of the Diaphragm is as
follows: It arises fleshy from  the internal face of the upper edge
of the Xiphoid Cartilage, from the internal face of the cartilages
of the  seventh, eighth, and ninth ribs, from the osseous extremities
of the tenth and eleventh, and from both the osseous and  cartila-
ginous termination  of the twelfth rib.   As the  line described  in-
cludes almost the whole of  a circle, and the  fibres all converge to
the cordiform tendon, they, of course, will pass in different radiated
directions, and  be of  different lengths, which it is unnecessary to
specify.   Between  the sternal and  costal portion on each side,
there  is a  triangular fissure  filled with fatty cellular tissue, and
which sometimes leaves an  opening for hernia.   I have seen a
case of the kind, in which the  transverse part of the colon was the
subject of protrusion into the thorax.  It is probable that the great 
404
MUSCLES.
 displacement of the  abdominal  viscera into the thorax,  which
 sometimes  occurs, may  have a  congenital origin  in this very
 fissure, and is  subsequently, when the  parts are accommodated
 to their  unnatural  situation, thought  to  be a lusus naturae.  The
 portion just described is  called the  Greater Muscle of the Dia-
 phragm.
   Besides these origins, the diaphram has several from the verte-
 bras of the  loins, constituting  its crura; there being four on each
 side of the  foramen for the aorta.  The first pair, entirely tendi-
 nous, comes from the front of the body of the third vertebra of the
 loins, and is  prevented from  being very distinct in  its origin, in
 consequence of running into the ligament in front of the bodies of
 all ihe vertebras, or the Anterior Vertebral Ligament as it is called.
 The second pair of heads is on the outside of the first, and arises,
 tendinous, from the intervertebral ligament, between  the  second
 and third vertebra.  The third pair of heads arises tendinous from
 the upper part of the  lateral face of  the  second lumbar vertebra.
 And the fourth  pair of heads comes also tendinous, from  the fore
 part of the root of the transverse  process of the second lumbar
 vertebra.  These tendinous heads terminate  in what is called  the
 Lesser Muscle of the Diaphragm, which is inserted into the notch
 of the cordiform tendon.   It will now be understood that the aorta
 passes between  the two sides of the lesser  muscle,  and that  the
 oesophagus  has  a hole in the upper part of its belly.*
   The origin  of the diaphragm  is completed between its greater
 and lesser muscle, by a  tense ligament, the Ligamentum Arcua-
 tum, which passes from the root of the transverse process of the
 first lumbar vertebra to the  inferior part  of the middle  of  the
 twelfth rib; with the upper edge of this ligament the  diaphragm is
 connected;  and with the lower, the psoas magnus muscle, and the
quadratus lumborum.   At the  margin of the other ribs, the dia-
phragm is connected with the transversalis abdominis.
  Use.   In  consequence of the muscular fibres of the diaphragm

  * This origin of the lesser muscle of the diaphragm is given by Albinus, but it is
difficult to make out fairly;  for the most part it would be much more correct to say
that it arises tendinous,  from the  first, second, and  third vertebra in front, and the
corresponding intervertebral matter. The heads are generally much smaller on one
side, the left, than the other.  From which cause a large fasciculus  of muscle passes
from the right  to the left side in ascending, and separates the hole for the aorta,
from that for the oesophagus. 
             MUSCLES OF THE PARIETES OF THE ABDOMEN.         405

passing in a curved direction from the circumference of the thorax
to the cordiform tendon; and of those fibres forming a sheet con-
cave below and  convex above, their  contraction at the same mo-
ment enlarges the cavity  of the  thorax, and has a tendency to  ,
diminish  that of the abdomen, which latter is prevented by the
yielding of the  abdominal  muscles.   In  easy respiration, its con-
tractions and relaxations produce  alternately the actions of inspi-
ration and of expiration.   Its descent, also, assists in the expulsion
of  fascal and other  matters from  the abdomen.  By the experi-
ments of Bourdon,* it appears  that it only acts a secondary part
in the latter,—that its functions are limited to inspiration and the
associated actions;  but  that in regard to its power of assisting in
the expulsion of the contents of the abdomen, all that it does is first
of  all to fill the lungs with  air, and then the closure of the glottis
prevents  the  air from  being expelled from  the lungs.  Common
observation in parturition shows us, that  the expulsive effort of the
abdominal muscles does not take place when inspiration is going
on, for the former would prevent the latter; but the moment that
expiration begins, it  is arrested  by the firm closure of the glottis,
and then the abdominal muscles contract advantageously.


                   The  Quadratus Lumborum,

  Is an oblong muscle, arising from  the  crista of the ilium, at the
side of the lumbar vertebras, by a tendinous and fleshy origin of
three inches in length.   It is inserted into the transverse process of
each of the lumbar vertebrae and of the last of the back by a short
tendinous slip: it is also inserted into the lower edge of the last rib
near its head, beneath the ligamentum arcuatum.
  It bends the loins to one  side, and draws down the last rib.
  It is covered behind by the tendinous origin of the transversalis
abdominis, which separates it from the  sacro-lumbalis and from
the  longissimus dorsi.  It may also be seen very well from behind,
in the dissection of the back.f

  *  Recherches sur la Respiration et la Circulation.  Paris, 1820.
  t  Varieties.  Sometimes a broad tendon from it is inserted into the inferior mar-
gin of the body of the eleventh vertebra of the back.  Sometimes a fasciculus of it
touches the margin of the eleventh rib, near its head, and above the intercostal
vessels. 
406
MUSCLES.
                        The Psoas Parvus,

   Arises, fleshy, from the contiguous edges of the body of the last
 dorsal and of the first lumbar vertebra at their sides, and from the
 intervertebral ligament.  It is at the anterior and internal edge of
 the psoas magnus;  has  a  short belly, and a long tendon by which
 it is inserted into the linea innominata, about half-way between the
 spine of the pubes  and the junction of  this bone with  the  ilium.
 The tendon, besides, is expanded into the fascia iliaca.
   Its use seems to be, to draw upwards the sheath of the femoral
 vessels, which is derived from the fascia iliaca, and, consequently,
 to draw  upwards the  vessels themselves; which probably dimi-
 nishes the liability to injury from their too great or sudden flexion.
 This muscle is sometimes wanting.


                        The Psoas Magnus,

   Arises, fleshy, from the side of  the bodies of the last dorsal and
 of the four upper lumbar  vertebras, and from the transverse pro-
 cesses  of all  the lumbar  vertebras.   It forms  an  oblong  fleshy
 cushion on the  side of  the lumbar vertebras, and constituting the
 lateral  boundary of the  inlet to the pelvis, it passes out of the pelvis,
, under Poupart's ligament, about its middle.
   It is inserted tendinous,  into the trochanter minor of  the os fe-
 moris,  and fleshy for an inch below it.
   It bends the body forwards, or draws the thigh upwards.*


                       The Iliacus Internus,

   Occupies the  concavity of the ilium, being on the outside of the
 psoas magnus.   It arises,  fleshy, from  the transverse  process of
 the  last lumbar vertebra; from  the internal margin of the crista of
 the ilium;  from the whole  concavity of the  latter; from its ante-
 rior edge at and above the anterior inferior  spinous process; and

   *  Varieties.  Sometimes it is joined  by muscular fasciculi from the first, second,
 and  even the third bone of the sacrum.  Sometimes, where it borders on the pelvis,
 there is a small fasciculus, which continues distinct almost to the trochanter minor,
 and  then sends its own tendon into the common tendon of the iliacus internus and
 psoas magnus. 
             MUSCLES OF THE PARIETES OF THE ABDOMEN.         407

from that part of the capsule of the hip joint near the latter pro-
cess.
   This muscle terminates in the tendon of the psoas magnus, just
above  its insertion into the trochanter minor.
   This and the  psoas magnus, from  having a common tendon,
might  with propriety be  considered as  only one muscle.   Their
action is the same.*

                      Of the Fascia Iliaca.

   The Fascia Iliaca is a  tendinous membrane, which lies on the
iliacus internus and the psoas magnus muscle, and is continued into
the tendon of the Psoas Parvus.  Externally,  it is connected to the
margin of the crista of the ilium-; at the  internal edge of the psoas
magnus, it is  connected with the brim of the pelvis, and sinks into
the  cavity of the  pelvis,  being continuous with  the  Aponeurosis
Pelvica;  and below, it is  inserted into the edge of the crural arch,
from the  anterior  superior  spinous process of the ilium almost to
the pubes, and is there continuous with the fascia transversalis ab-
dominis.   The external iliac vessels are  upon this fascia, between
it and  the peritoneum; and below them the fascia iliaca goes over
that part of the pubes which gives  origin to the pectineus muscle,
and  is  continuous with the  pectineal fascia, or that which covers
the pectineus  muscle.   By introducing the finger or a knife handle
into a  cut through the fascia iliaca, its  attachment to the crural
arch, and its continuity with the fascia pectinea will  be rendered
very obvious.
   The iliac vessels pass beneath the crural arch on the inner mar-
gin of the psoas magnus muscle, the vein being  nearest the pubes
and  the artery at the outer side of the  vein.  The fascia iliaca
being inserted into the crural arch  as far as the vein, may indeed
be traced to the crista of the  pubes: it is so connected with the
vessels that no opening for  hernia  exists between them, or indeed
in all the  space from the  internal margin of the vein to the spine
of the  ilium.  But at the inner side of  the vein, between it  and
Gimbernat's  ligament, an  opening  appears, called  the Crural or

  * Varieties. Sometimes an additional fasciculus arises below the inferior ante-
rior spinous process, and descends along the  external margin of this muscle.  This
fasciculus varies somewhat in its size  at different  points, and is inserted into the
linea aspera below the trochanter minor. In very rare cases, the iliacus internus is
kept totally distinct from the psoas magnus, from origin to insertion. 
408
MUSCLES.
Femoral Ring, and is the place where femoral hernia commences.
This  opening is  generally occupied  by a  lymphatic gland, and a
lamina of condensed but loosely attached  cellular substance,  con-
tinuous with the Aponeurosis Pelvica.
      SECT. IV.—MUSCLES ON THE POSTERIOR FACE OF
                          THE TRUNK.

                  The Trapezius or Cucullaris,

   Is a beautiful broad muscle, immediately under the skin, cover-
 ing  the  back  of the  neck and thorax, and  extending from the
 bottom of the latter to the top of the former.  Its anterior edge,
 above is  parallel with the posterior edge of the sterno-cleido-mas-
 toideus.   Its posterior edge is joined with that of  its fellow, and
 below, it  overlaps in part the latissimus dorsi.

   It arises  by a tendinous membrane from the posterior occipital
 protuberance, and from eight or ten lines, sometimes more of the
 superior semicircular ridge of the occiput.  It arises tendinous also
 from  the  five superior spinous  processes of the neck through the
 intervention of the ligamentum nuchas, and tendinous directly from
 the two lower spinous processes of the neck, and from  all those of
 the back.
   It is inserted fleshy into the external third of the clavicle, tendi-
 nous and  fleshy into the inner  edge of the  acromion process, and
 into all the spine of the scapula.  Its fibres having a very extended
 origin, must of course converge in getting to these insertions; the
 upper fibres descend, the  lower ascend, and  the middle are hori-
 zontal.*
   It draws  the scapula towards the spine.

   In the cervical portion  of these  muscles, formed by the origins
 of both united, is  an  elliptical  expanse  of tendon, lying over the
ligamentum nuchas, and extended on each side.  The ligamentum
nuchas itself, as mentioned elsewhere, is a vertical septum of liga-

  * Varieties.  It is sometimes  short of the origin described, by from one to four,
of the lower  spinous processes of the back.  Also the lower fasciculus is sometimes
disjoined from the rest of the muscle, by a large triangular space. 
MUSCLES OF THE BACK.
400
 mentous matter, extending from the central line  of the  occipital
 bone, to the spinous processes of all the vertebras of the neck.  At
 its upper part, where the spinous processes  of  the  neck are short,
 this septum  is very broad, and divides completely the muscles of
 the two sides of the neck.


                      The Latissimus  Dorsi,

   Is situated under the skin at the lower part of the back, so as to
 cover the whole posterior portion of the latter.   It arises by a thin
 tendinous membrane, from the seven inferior spinous processes of
 the back;  and by a thick tendinous membrane from  all those of
 the loins and sacrum.   Its origin  also extends in  this condition
 along the outer inferior margin of the sacrum, and from the poste-
 rior third of the spine of the ilium.*  Besides which, the latissimus
 dorsi  has from the sides of the  three or four inferior false ribs, as
 many fleshy heads which  are connected with the inferior heads of
 the obliquus externus abdominis.
   From this extended origin the fibres converge, so as to form  the
 posterior fold of the axilla; and to terminate in a flat, thick tendon,
 of two inches in breadth,  which is inserted into the lower part of
 the posterior ridge of the bicipital groove of the os humeri.  The
 upper part of this  muscle passes over the inferior angle of the sca-
 pula, and derives  a fasciculus of fibres from it.   It  is there behind
 the  teres major, but as it advances it winds around the inferior
 edge of the latter so as to get before it.   Afterwards the tendons
 of the two adhere closely, but have a bursa between them at their
 termination.   That portion of the tendon  of the latissimus  which
 s continuous with  the lower edge of its fleshy  belly becomes up-
 permost by a half spiral turn in the latter; while the upper portion
 is by the same arrangement made lowest.   At the place of  its  in-
 sertion, it is  commonly connected to the pectoralis major.   The
 inferior margin of its tendon detaches a slip to the brachial fascia,
 and the superior margin another  to  the smaller tuberosity of the
 >s humeri.
   It draws the os humeri downwards and backwards.f

  * This origin frequently is tendinous at the back part of the ilium, and fleshy in
 :ront.
  f Varieties.  Sometimes from its anterior extremity a fleshy or tendinous slip is
detached in front  of the coraco-brachialis, and is inserted into the posterior face of
   Vol. I.—35 
410
MUSCLES.
   That portion of its origin being the tendinous membrane coming
from the spinous processes of the loins is the fascia lumborum, and
is common to the latissimus, the internal oblique and the transverse
muscle of  the  abdomen, and several other muscles  to  be men-
tioned.
   The origin of the two latissimi muscles conjointly makes a beau-
tiful lozenge-shape  expansion occupying its entire spinal region,
the longest diameter is vertical and just over the spinous processes,
the lateral diameter extends from  one  crista of the ilium to the
other.

                  The Serratus Inferior Posticus.

   The origin of this muscle is inseparably united to that of the la-
tissimus dorsi by the fascia lumborum, and  comes  from the two
inferior spinous processes of the back, and the three  superior of
the loins.
   It  is inserted by fleshy digitations into the under edge of the
four inferior ribs.
   It draws the ribs  downwards, and  is an  antagonist  to the dia-
phragm in some  respects, but more particularly to the serratus
superior posticus.

   The removal of the trapezius brings into view several muscles:
the most superficial of which are the rhomboid, which, being two
together, look very  much like one.


                    The Rhomboideus Minor,

   Is above the  other.   It is a  narrow muscle which  arises by a
thin tendon from the three inferior spinous processes of the neck,
and, passing obliquely downwards, is inserted into the base of  the
scapula opposite the beginning of its spine.

the tendon of the pectoralis major.  The brachial vessels and nerves are liable to
compression from this arrangement, which is said to be natural to birds and moles.
Another variety is where a slip runs from this muscle, adheres to the coraco-bra-
chialis, and is inserted tendinous into the coracoid process of the scapula. 
MUSCLES OF THE BACK.
411
                    The Rhomboideus Major,

   Arises, also, by a thin tendon from the last spinous process of
 the neck, and from the four superior of the  back, and is inserted
 into all the base of the scapula below its spine.
   These muscles draw the scapula upwards and backwards.


                 The  Serratus Superior Posticus,

   Arises by a thin tendon from the three inferior spinous processes
 of the neck, and the two superior of the back, and is inserted into
 the  second, third, fourth, and  fifth  ribs, by tendinous and  fleshy
 slips, a little beyond their angles.
   This muscle draws  the ribs upwards.

   Between  the two serrati  is an aponeurotic expansion described
 by Rosenmuller, which  connects  them  with  each other, and has
 induced some anatomists to consider them  as but  one muscle.  It
 is thin and diaphanous;  but has the fibrous  structure very appa-
 rent, and running in a transverse direction  from the spinous pro-
 cesses to the angles of the ribs.  The superior margin of the latis-
 simus dorsi also runs into this fascia, so as to render its own bounds
 somewhat undefined.  This fascia,  along with the ribs and verte-
 bras, forms that canal  in which are contained the deep-seated mus-
 cles of the back.

                      The Levator Scapula,

   Is placed  between the posterior edge of the sterno-cleido-mas-
 toideus and  the anterior of the trapezius; its lower end is just above
 the rhomboideus minor.  It arises  by rounded tendons  from the
 three, four, or five, superior transverse processes of  the  neck, be-
 tween the scaleni muscles and  the splenius colli.
   It is inserted,  fleshy, into  that part of the  base  of the scapula
 above the origin of its  spine.  As its name expresses, it draws the
 scapula upwards.  A  good  view of  this  muscle  may be obtained
 in the front dissection  of the neck.*

  * Varieties.  Sometimes  it  arises  from only two superior transverse processes ;
occasionally its fasciculi are separated  from the neck to the scapula; or, a long one
is detached towards  the spine, thereby presenting a disposition similar to what is
 met with in the dolphin. 
412
MUSCLES.
                         The Splenius,

   Has its inferior extremity beneath the serratus superior posticus,
but the principal part of  it is covered by the trapezius.  It arises
from the spinous processes of the five inferior cervical, and of the
four superior dorsal vertebras.
   It is inserted into the back  of the mastoid process and continu-
ously into a small part of the adjacent portion of  the os occipitis,
also into the transverse processes of the two superior cervical ver-
tebras.  It is customary to  consider* the part which  goes to the
head as Splenius Capitis,  and the part below as Splenius Colli: the
latter, in that  case, is said to arise from the third and fourth dor-
sal vertebra.  It draws the head  and neck backwards.

   Between the spinous processes of the vertebras and the angles of
the ribs, on either side, the deep fossa is filled up  entirely by mus-
cles.   Some of them are large and powerful, and the most striking
are the Sacro-Lumbalis and  the Longissimus Dorsi.


           The Sacro-Lumbalis and Longissimus Dorsi,

   Have a common origin from the back of the pelvis and of the
lumbar vertebras, and extend to the top of the thorax.   They arise
tendinous,  posteriorly, and  fleshy, anteriorly,  from  the posterior
surface of  the  sacrum by its external  margin and spinous pro-
cesses: they arise, also, tendinous, from the spinous processes, and
fleshy, from the ends of the transverse  processes  of  all the verte-
bras of the loins; and principally  tendinous from the posterior part
of the spine of the ilium.   The  external margin of the belly is
fleshy, and all the  part nearest to the spine is wholly tendinous
below;  but, higher  up  in the loins, it  is so only on  the  surface.
The tendon is very strong, and divided into fasciculi, chiefly near
the spinous processes of the lumbar vertebras.   From the under
surface of this common belly, two heads, tendinous and fleshy, are
inserted into the inferior edge  of the transverse  process of  each
lumbar vertebra, the smaller near its root,  and the larger near its
extremity.   On a level with the lower rib, and, indeed, somewhat
* Albinus, loc. cit. 
MUSCLES OF THE BACK.
413
below it, a fissure occurs in the muscle which divides it into its two
parts.

  The Longissimus Dorsi  is nearest the spine; it is inserted, by
small double tendons,  proceeding from its internal surface, into
the ends of the transverse processes of all the vertebras of the back,
except the first.  It also, from  its outer edge, sends long  slender
tendons, by which  it is inserted into  the under edges of all the ribs
beyond their tubercles, except the two inferior.
  The Sacro Lumbalis is inserted from its outer edge into all the
ribs at their angles, by long and  thin tendons, which  are succes-
sively longer, the higher they are inserted.
  By turning over this muscle towards the ribs,  from the other,
one may  see  coming  from  the eight lower ribs,  as many  slips,
which run into  the under surface of the sacro lumbalis: they are
the Musculi Accessorii ad Sacro Lumbalem.
  These  two muscles  keep the  spine  erect, and  draw down  the
ribs.*                                                     **

                       The Spinalis Dorsi,

  Between the ends of the spinous  processes and  the edge of the
longissimus  dorsi, is   a muscle  almost  entirely  tendinous,  and
scarcely to be distinguished  from the latter, both  in consequence
of its close connexion with it, and of its insignificant size.   At its
lower part, it is  absolutely a portion of the longissimus, and can
be separated from it only by a forced division.   It  is a  mere string
lying along the sides of the spinous  processes, and is called, from
its origin  and insertion, the Spinalis  Dorsi.
  It arises tendinous from the  spinous  processes of the two  supe-
rior lumbar,  and of the three inferior dorsal vertebras, and is in-
serted, tendinous, into  the spinous processes of  the  nine superior
dorsal  vertebras,  except the first.
  It tends to keep the spine erect.

  *  Varieties. The origin is uniform, but the  insertions vary in  their number.
Sometimes,  a fasciculus commences by a  tendinous beginning from  the fourth rib,
and  is inserted into the transverse process of  the sixth vertebra of the neck ; a fas-
ciculus from the sacro lumbalis joins the fascia extended between the two serrati,
or reaches to the splenius colli: the two muscles are sometimes joined closely by an
intermediate fasciculus.
                               35* 
414
MUSCLES.
                  The  Cervicalis Descendens,

  Is a small muscle placed at the upper portion of the thorax, be-
tween the insertions of the sacro-lumbalis, and  of the longissimus
dorsi into the  upper ribs; it looks, at first, very much like a con-
tinuation  or appendix  of the  first,  running  to the cervical ver-
tebras.
  This muscle arises from the upper  edges  of the  four superior
ribs by long tendons: it forms a small  belly, which is inserted by
three distinct  tendons into the transverse processes of the fourth,
fifth, and sixth vertebra of the neck, between the levator scapulas
and splenius colli.
  It draws the neck backwards.


                   The Transversalis Cervicis,

  Is on the inner side of the last,  and in  contact with it, being
about the same size, and having very much the same course and
appearance.   It  is considered as an appendage to the longissimus
dorsi.
   It arises from the transverse processes of the  five superior dorsal
vertebras by  distinct  tendons, and  forms a  narrow  fleshy belly,
which is inserted by distinct  tendons, also, in  the  transverse pro-
cesses of the five middle cervical vertebras.
   It draws the head backwards.


                    The Trachelo-Mastoideus,

   Is at the inner side of the last muscle, in contact with it.
   It arises  by distinct  tendinous heads, from  the transverse  pro-
 cesses of the three superior vertebras of the back, and  of  the five
 inferior of the neck;  and is inserted, by a thin tendon, into the
 posterior edge of the mastoid process  immediately within the in-
 sertion of the splenius capitis.
   The dorsal origins are frequently deficient or irregular.
   It draws the head backwards. 
MUSCLES OF THE BACK.
415
                        The Complexus,

   A fine large muscle, is situated at the inner face of the trachelo-
 mastoideus, and  is readily recognised  by showing itself between
 the bellies  of the two splenii  capitis, just below the occiput.  A
 quantity of tendinous matter exists in its middle, which gives it the
 complicated  appearance from whence its name is derived.
   It arises, by tendinous heads, from  the  seven  superior  dorsal,
 and the four inferior cervical vertebras, by their transverse pro-
 cesses; also, by a fleshy slip from the  spinous process of the first
 dorsal.  It is inserted into  the inferior part of the os occipitis, by
 the surface between  the upper and  lower semicircular ridges, on
 the outside of the vertical  ridge which  exists in the middle of the
 bone.
   It draws the head  backwards.


                   The Semi-spinalis Cervicis,

   Is a muscle which passes obliquely from transverse to spinous
 processes, and is  situated  between  the complexus and  the multi-
 fidus spinae; the course of  its fibres renders it difficult to be distin-
 guished from the latter.
   It arises from the transverse processes of the six upper vertebras
 of the back, by  tendons which  adhere to  those  of the adjacent
 muscles;  and passes up to the neck, to be inserted into  the sides
 of the  spinous processes of the  five middle cervical vertebras.
   It extends  the neck obliquely backwards.


                    The Semi-spinalis Dorsi,

  Is lower down on the spine,  and with difficulty  distinguished
 from the multifidus; like the last, it  passes from transverse to spi-
 nous processes.   It  lies  under the longissimus dorsi, between  it
 and the multifidus.
  This muscle arises by tendons connected with those of the other
 muscles, from the transverse process of the seventh, eighth, ninth,
and tenth dorsal  vertebra;  and passes upwards obliquely, to be
inserted, tendinous, into the sides of the spinous processes of the
two lower cervical, and of the five upper dorsal vertebras.
  It draws the spine obliquely backwards. 
416
MUSCLES.
                     The Multifidus Spina,

  Lies under the muscles as yet mentioned,, close to  the bones of
the spine; in order to see it well, they, therefore, should all be cut
away.
  It has its commencement, tendinous  and fleshy, on the back of
the sacrum, being connected to its spinous processes and posterior
surface, also  to the  back  part of the spine of the ilium.   It there
forms a belly, of sufficient magnitude to fill up much of the cavity
between  the  spinous  processes of the sacrum and the posterior
part of the ilium.   It arises  also from the roots of the oblique and
transverse processes of all the vertebras of the loins, of the back,
and of the four inferior of the neck.
  The multifidus  is inserted, tendinous and fleshy, into the roots
and sides  of the spinous processes of all the vertebras of the loins,
of the back, and of the five inferior of the neck.
  This muscle  consists of a great number  of  small bellies, which
are parallel to each other, and each of which  arises from a trans-
verse or oblique process,  and goes to the spinous process either of
the  first or second vertebra above it.
  It twists the spine backwards, and keeps it erect.

  Between the head and the  first and second vertebra,  and  be-
tween the latter two, there are on either side  four small muscles,
intended for the motion of these parts upon  each other.  They are
brought into view by the removal of the complexus.


               The Rectus Capitis Posticus Major,

  Arises,  tendinous and fleshy, from the extremity of the spinous
process of the vertebra dentata, and  is  inserted into the inferior
transverse or semicircular ridge of  the os occipitis, and into a
part of the continuous surface of bone below it.
  Its shape is pyramidal, the apex being below.  It turns the head,
and also draws it backwards. 
MUSCLES OF THE BACK.
417
               The Rectus Capitis Posticus Minor,

   Is at the internal edge of the first.   It arises, tendinous, from the
 tubercle on the back part of the first vertebra, and is inserted into
 the internal end of the inferior transverse or semicircular ridge of
 theps occipitis, and  into a  part of the surface between it and the
 foramen magnum.
   It is  also pyramidal, with the apex downwards.   It draws the
 head backwards.

                 The Obliquus Capitis Superior,

   Arises from the transverse process of the first cervical vertebra,
 and  is inserted into the outer end of the inferior semicircular ridge
 of the os occipitis, behind the posterior part of the mastoid process,
 and  beneath the splenius muscle.
   It draws the head backwards.


                 The Obliquus Capitis Inferior,

  Arises from the side of the spinous process of the vertebra den-
 tata, and is inserted into the back part of the transverse process of
 the first vertebra of the neck.
  It rotates the  first vertebra on the second.


                      The Inter-Spin ales,

  Are small short muscles, placed  between the spinous processes
of contiguous vertebras.   In the neck they are double, in  conse-
quence  of its spinous processes being bifurcated; in  the back they
are almost entirely tendinous; in the loins they are single and well
marked.
  They draw  the spinous processes together, and keep the spine
erect.

                    The Inter-tr an sversarii,

  Are also short muscles, placed in a  similar  manner, between
the transverse processes of the vertebras.   In the  neck they are 
418
MUSCLES.
double, in the back they are small, tendinous, and not well marked;
and in the loins they are single and well seen.
  They draw the transverse processes together, and will, of course,
bend the spine to one side.


                    The Levatores  Costarum,

  Are small muscles concealed by the sacro-lumbalis and longissi-
mus dorsi, and pass from the  transverse process of the last cervical
and of the eleven superior dorsal vertebras, to the upper edges of
the next ribs.  They are twelve on either side of the spine, are
tendinous in their origins and insertions, with intermediate muscu-
lar bellies.
  The upper ones are small  and thin.   They increase in magni-
tude as  they descend.  From the inferior edge of nearly all these
muscles  a fleshy slip is detached, which passes over the  rib next
below its origin, to the second rib below, and occasionally to the
third.   These slips  are  called  Levatores Costarum Longiores.
The others, which descend from  the  transverse process to the rib
next below, are called Levatores  Costarum Breviores.
  These muscles are parallel  in  their obliquity, with the external
intercostals, and are  not  very obviously separated from them.
They perform the same service, that of elevating the ribs.

  The Rotatores Dorsi of Professor Theile, of Bern, pass from the
transverse process of a vertebra below to the under margin of the
arch of the vertebra above.  They are eleven  in number on  each
side, beginning at the second dorsal  vertebra  and ending at the
twelfth.   It may be considered as questionable whether any ad-
vantage will arise to descriptive  anatomy by thus separating from
the Multifidus Spinas, fasciculi  heretofore  considered a part  of it,
but which Professor Theile says are marked off by a layer of cel-
lular tissue.   As  much may  be said at least of all  the numerous
strips making up the multifidus spinas. 
FASCIA.                        419
                       CHAPTER III.

         Of the Fascia and  Muscles of  the Upper Extremities.

                     SECT. I.—FASCIA.

  The muscles of each  upper  extremity are invested  by an apo-
neurotic membrane called the Fascia  Brachialis, which extends
from the shoulder to  the hand.   It begins at the base and spine of
the scapula, the margin of the  acromion process, the acromial ex-
tremity of  the clavicle, and from  the  cellular  membrane in the
arm-pit, and extends itself over all  the  muscles of the dorsum of
the scapula, and over the deltoid muscle.  The tendons of the latis-
simus dorsi and pectoralis major, each send off from  their margins
an expansion which  is lost in it.  Below the spine of  the scapula
it is strong and well marked, but on the deltoid muscle, as well as
on the muscles of the arm, its  desmoid character is  by no means
so well developed, though  it still  retains the appearance of  a dis-
tinct membrane, and can  be raised  up as such from the muscles.
On the fore-arm its ligamentous appearance is well preserved, and
extends from the elbow  to the wrist inclusively.   Its longitudinal
fibres there are well secured by transverse ones.
  Above the  condyles  of the os humeri,  the Fascia  Brachialis
sends down to the bone  a strong tendinous partition to  each  ridge,
and which runs the length of the latter from its upper end  to the
condyle.   These processes separate the muscles on the back of
the arm from  such  as are on  the front of  it, and are  sometimes
called  the Ligamentum inter-musculare internum and externum.
They afford origin to many muscular fibres.  At the bend of the
elbow, the fascia brachialis is  joined by a fasciculus of tendinous
matter from the ulnar margin  of the tendon of  the biceps  flexor
cubiti,  and which, in the contraction of the muscle,  will keep the
fascia tense.
  At  the lower extremity of the fore-arm, the  transverse fibres,
after diminishing  sensibly, become  more numerous, and  by their
attachments to the several ridges on the back of  the  radius and of
the ulna, form  the Ligamentum Carpi Dorsale.   This ligament is 
420
MUSCLES.
 extended from the styloid or  outer  margin of the radius, trans-
 versely to the styloid or inner  margin of the  ulna, to  the pisiform
 bone, and  to the fifth metacarpal.  It consists, in some measure,
 of two portions: of which the superior is the smaller  and thinner,
 has  its fibres descending from the radius to the ulna, and is crossed,
 in part, by  the fibres of the  inferior  or  greater portion.  As this
 ligament adheres, with great strength, to  the  ridges on the back
 of the bones of the fore-arm,  six trochleas for the tendons of the
 extensor muscles are thus formed.   The first, or that next to the
 styloid  process of the radius, contains the tendons of the first two
 extensors of the thumb.  The second is larger, and transmits the
 tendons of  the two radial extensors  of  the carpus.   The third is
 small and oblique, for the tendon of the third extensor of the thumb.
 The fourth  is the largest, and is for  the tendons of  the extensor
 communis of the  fingers and  that of the  Indicator.   The fifth  is
 between the radius and the head of the ulna, and is for that tendon
 of the  extensor  communis which goes  to  the little finger.  The
 sixth is on  the back of the  ulna, and is for the tendon of the ex-
 tensor carpi ulnaris.
   The inferior margin of this dorsal ligament of the wrist does not
 terminate abruptly, but resuming its  fascia-like character, is con-
 tinued over  the back of the wrist, and over that of the hand  to the
 fingers.  In this progress it furnishes  an envelope to  the extensor
 tendons, and is  very much  blended with the  oblique fasciculi, by
 which they  communicate with  each other.

   The Fascia Brachialis affords origin,  in part* to the muscles on
 the dorsum  of the scapula below its spine; on the arm it is not so
 intimately connected with  the  muscles,  but on  the fore-arm they
 again begin  to arise, in part, from it.  In its whole course partitions,
 constituting  the sheaths of the  muscles, and which consist, for the
 most part, of common cellular and adipose membrane, go from  it
 down to the periosteum and  interosseous  ligament.  It  adheres
 very tightly  to the ulna, from the olecranon to the styloid process.
On its cutaneous surface are  found all the superficial veins, nerves,
 and lymphatics of the arm.  Bichat  considers this  membrane as
the best  example  of the continuity of  ligamentous with cellular
tissue, and consequently of the  affinity of the two^

  The flexor tendons of the hand and fingers  are held down, by 
MUSCLES OF THE SHOULDER.
421
the Ligamentum Carpi Volare or the Anterior Annular Ligament
of the Wrist.  It is a very strong fasciculus of ligamentous fibres,
which subtends the concavity of the carpal bones  in front, and
converts it into the large oval foramen which contains the tendons.
It is attached by one end at the ulnar side of the wrist, to the hook-
like process of the unciforme, to the  cuneiforme, and to the pisi-
forme.  Its fibres go straightly across the wrist to be attached by
their other extremities to the radial end of the trapezium,  and  of
the scaphoides; and  may be readily distinguished  from the fascia
brachialis by their uniformly transverse  course;  by their superior
whiteness; by their increased thickness;  and by their great strength
and  unyielding nature.   Yet the superior margin of this ligament
is partially continuous  with the  fascia brachialis, and  the inferior
margin with the aponeurosis palmaris.  Several of the little mus-
cles of  the hand arise from its front surface, while the  posterior is
in contact with the flexor tendons.
   The  Aponeurosis Palmaris  is placed just below the skin, and
covers  the middle of the palm  of the hand.  It is triangular, and
has  its  apex above, where it arises from the inferior margin of the
volar or anterior annular ligament  of the wrist, and from the ten-
don  of  the palmaris longus; it spreads  out  in  its descent, and
reaches the lower ends of the metacarpal bones, where it is divided
into four portions.  Each of these portions bifurcates and passes
to the head of its appropriate metacarpal bone, to  be fixed to it
just in advance of the inferior palmar ligaments.  The vacuity of
the bifurcation permits the flexor tendons  to pass on to the finger,
anu its  branches  are  held together by  transverse  and reticulated
fibres, the interstices of which are  filled with  fat.  The lateral
margins of this aponeurosis send off a thin membrane, for the pur-
pose of covering the muscles of the thumb and of  the little finger;
or, in other words, the  thenar and the hypothenar eminences in
the palm of the hand.


      SECT. II.—OF THE MUSCLES OF  THE SHOULDER.

                        The Deltoides,

   Is a muscle which is extended over the top of the shoulder joint,
and  forms there the subcutaneous cushion  of flesh which protect!
   Vol.  I.—36 
422
MUSCLES.
and gives rotundity to the articulation.  It arises from the inferior
edge of the whole spine of  the scapula, from the circumference of
the acromion process, and from the exterior  third of the clavicle.
Its origin, for the most part, is tendinous and fleshy mixed; but at
its posterior part it is entirely tendinous.
  It  is inserted, by a  tendinous  point, into  the  triangular rough
surface on the  outer  side of the  os humeri  near its middle.  Its
general configuration is triangular, and  when spread out, its upper
margin is  much more extensive  than one would suppose, as it is
opposed to the  entire insertion of the trapezius.   Its fibres do not
converge regularly to its insertion like the radii of a  circle, but the
whole muscle  is divided into several parts; the interposition of
inter-muscular  tendons  into  which, affecting  the course of  the
fibres, makes several portions of  the deltoid look penniform, and
others, like smaller deltoids, introduced  into the larger.
  The deltoid covers the insertion of the  pectoralis major, latissi-
mus  dorsi, and  teres major, besides that of the other muscles of the
shoulder.   It also conceals  the origin  of  the  biceps flexor cubiti
and of the coraco-brachialis.  Its insertion is between the triceps
extensor and the biceps flexor, and above  the  origin  of the  bra-
chialis internus.*
  It  raises the  os humeri.
  Between the superior edge of the deltoid, the acromion process,
and the subjacent tendons on the top of the articulation, there is a
large Bursa Mucosa, which is sometimes partitioned off into  two.


                  The Supra-Spinatus Scapula,

  Arises, fleshy, from the whole fossa supra-spinata, which it  fills
up; and from its margins.   Forwards it terminates  in a thick ro-
bust  tendon closely connected with the capsular  ligament of .the
joint, and which passes  under the jugum  formed by the articula-
tion of the acromion with the clavicle.
  It  is inserted, tendinous, into the inner face of the great tubero-
sity of the os humeri.
  It  raises the  arm, and turns it outwards.

  * Varieties.  Sometimes a fasciculus arises, between the infraspinatus, and the
teres major, or from the inferior costa of the scapula, and joins itself to the deltoid. 
MUSCLES OF THE SHOULDER.
423
                  The Infra-Spinatus Scapula,

  Arises, fleshy, from all that portion of the dorsum scapulas below
its spine, from the spine as far as the cervix, and from the several
margins of the fossa infra-spinata.  Its fibres pass obliquely to a
middle tendon, which adheres closely to the capsular ligament, and
goes under the projection of the acromion.
  This tendon is inserted into the middle facet of the greater tube-
rosity of the os humeri.
  The infra-spinatus rolls the os humeri outwards and backwards.
There is a bursa between its tendon and the scapula.


                       The Teres Minor,

   Is situated at the inferior margin  of the infra-spinatus, in  the
fossa of the inferior  costa scapulas, and looks very much like a
part of the  infra-spinatus, to  which  it occasionally adheres so
closely  as to  be  separated with difficulty.   It  arises, fleshy, from
the whole of the fossa, and the margins of the inferior costa, in the
space from the cervix of  the bone to within an  inch or so of its
angle.
   It is inserted, tendinous  and  fleshy,  into  the  outer facet of the
great tuberosity of the os humeri, just  below the infra-spinatus.
   It draws the os humeri downwards  and backwards, and rotates
it outwards.

                       The Teres Major,

   Is situated at the inferior edge of the teres  minor.   It arises,
fleshy, from the posterior surface of the angle of  the scapula, and
from a  small  part of its inferior costa; the interstice between it
and the teres minor is considerable.
   It is inserted, by a broad tendon, into the internal ridge of the
groove  of  the os humeri, along with the tendon of the  latissimus
dorsi.   Their tendons, at  first, are closely  united, but  afterwards
there is an intermediate cavity lubricated with  synovia.   The ten-
don of  the latissimus dorsi is anterior, and the lower edge of the
teres extends farther down the arm than it. 
424
MUSCLES.
  It rolls the os humeri inwards, and draws it downwards and back-
wards.

                      'The Subscapularis.

  Occupies all the thoracic surface  of the scapula, being between
it and the serratus major.  It  arises, fleshy, from the whole base,
superior and inferior costa, and costal surface of the scapula; it is
divided into several columns, which  look  somewhat like distinct
muscles, but they all terminate in a thick robust tendon that ad-
heres to the inferior surface of the capsular ligament.
  This tendon is inserted into  the lesser tuberosity of the os hu-
meri.
  The subscapularis rolls the  bone inwards and draws it down-
wards.  Between it and the neck of the scapula, there is a bursa,
which, as mentioned, communicates with the articulation.
          SECT. III.—OF THE MUSCLES OF THE ARM.

                   The Biceps Flexor Cubiti.

   This muscle is just beneath  the  fascia and integuments, and
 forms the swell so obvious in the middle front part of the arm.  It
 arises by two heads.  The first, called the long, is a  round tendon
 which comes from the superior extremity of the glenoid cavity of
 the scapula, passes through  the  shoulder joint and through the
 groove of the os humeri;  the second head arises tendinous from
 the extremity  of the coracoid process of the scapula, in company
 with  the coraco-brachialis muscle.   The fleshy bellies  in which
 these  tendons terminate,  unite  with each other, several inches
 below the shoulder joint, to form a common muscle.  At first they
 are only connected by loose cellular substance; but, about half-way
 down the arm, they are inseparably united.
   The biceps terminates  below in a  flattened  oval tendon, which
 passes in front of  the elbow joint, to be inserted into  the posterior
 rough  part  of the tubercle of the radius.  A  bursa  mucosa is
placed between the tendon and the front of the tubercle, the sur-
face of the latter being covered with cartilage.  From  the  ulnar 
MUSCLES OF THE ARM.
425
side of this tendon proceeds the aponeurosis running into that of
the fore-arm.
   The relative  position of the biceps is as follows:  Its long head
is first within  the cavity of the capsular ligament, and  then  be-
tween the tendons of the latissimus  dorsi  and pectoralis  major,
where it is bound down by strong ligamentous fibres.  The tendon
below is superficial, and may be easily felt by flexing the fore-arm,
but its insertion dips down between the pronator teres and supina-
tor radii longus.
   This muscle flexes  the fore-arm.*


                      The Coraco-Brachialis,

   Is situated  on  the upper  internal side of the arm, at  the inner
edge of the short head of the biceps muscle, with which  it is con-
nected for three or four inches.   It  arises tendinous and fleshy
from the middle facet of the point of the coracoid process of the
scapula, in common with the short head  of the biceps muscle.
   It is inserted, tendinous and fleshy, into the internal side of the
middle of the os humeri, by a rough ridge, just below the tendons
of the latissimus dorsi and teres major, and in front of the brachialis
externus or third head of the triceps.  The lower end of  this mus-
cle is  attached to the inter-muscular ligament of  the internal side
of the os humeri, which separates the brachialis internus from the
third head of the triceps.
   This muscle draws the arm upwards and forwards.f


                     The Brachialis Internus,

   Is situated immediately beneath the biceps, and is concealed by
it, excepting its outer edge.  It has a bifurcated fleshy origin from

   * Varieties.  Sometimes the division of the muscle is continued to  the elbow;
sometimes there is a third  head, coming either from the internal face of the os hu-
meri, or from the braohialis internus ;  very rarely, the number of heads has been
multiplied to five,, thereby making a  close approximation  to  the arrangement in
birds.  This muscle is very liable  to anomalies.
   t Varieties.  This muscle being generally penetrated by the musculocutaneous
nerve, the perforation thus  made sometimes exists as a fissure, extending the length
of the lower half of the muscle; on other occasions the fissure is so lone  as to divide
the muscle completely into two.
                                36* 
426
MUSCLES.
the middle front face of the os humeri on each side of the insertion
of the deltoid, and  its origin  is continued  fleshy from  this point
downwards, from  the whole  front of the  bone to within a very
small distance of its articular surface.
   It is inserted, by a strong short tendon, into  the rough surface
at the root of the coronoid  process  of the ulna.   A bursa  some-
times exists between the tendon of the brachialis internus, that of
the biceps, the supinator brevis, and the elbow joint.
   The brachialis  flexes the fore-arm, and, by passing in front of
the elbow joint, strengthens the latter very much.  Its lower part
lies under the tendon of the biceps, and between the pronator teres
and the supinator longus.*


            The Triceps Extensor Cubiti, or Brachii,

   Forms the  whole of the fleshy mass on the back of the arm; it
therefore occupies  the space between  the  integuments  and  the
bone.   It arises by three heads.  The first, called Longus, comes.
by a flattened tendon,  between  the  teres major  and minor mus-
cles, from a rough ridge on the inferior edge of the cervix scapulas.
The  second, called  the Brevis, arises by a sharp, tendinous, and
fleshy beginning, from a slight ridge on  the outer back part  of the
os humeri, just below its head.  The third head, called Brachialis
Externus, arises, by an acute fleshy beginning from the inner side
of the os humeri near the insertion of the teres major.   This mus-
cle, both at its  external  and  internal edge, is separated from the
muscles in front of the arm by the external and internal inter-mus-
cular ligaments, which arise near the middle of the os humeri, and
run to the condyles  respectively.  The whole back of the os hu-
meri, as well  as the posterior surface of these inter-muscular septa,
are occupied  by the origin of the triceps.  The muscular fibres run
in  various  directions, according  to their  respective  heads and
places of origin..
   At the  inferior end of the  muscle is found a broad tendon, which
covers its posterior face.  This tendon is inserted into the base or

  * Varieties. Sometimes, at its external margin, there exists a smaller brachialis
internus muscle, which arises from about the same  point of the os humeri, and is in-
serted into the same part of the ulna. Sometimes it  detaches a fasciculus which
joins the biceps muscle.  Sometimes its posterior part is distinct from the anterior
Sometimes a fasciculus of it runs along the supinator longus of the fore-arm. 
MUSCLES OF THE FORE-ARM.
427
back part of the olecranon, and the ridge leading down the ulna
on its radial side.  The bellies of the triceps unite above the  mid-
dle of the os humeri, but the interstices between them may be ob-
served much lower down.   There  is a bursa  between the tendon
and the olecranon process; besides which, there is sometimes ano-
ther on each side of the first.
   The triceps extends the fore-arm.


                        The Anconeus,

  Is a small  triangular  muscle, just  beneath the skin, at the outer
posterior part of the elbow joint.   It arises tendinous from the pos-
terior lower part of the external condyle of the os humeri, adheres
to the capsular ligament of the joint, and is partly covered by the
tendon of the triceps.
   It is  inserted, fleshy and thin, into the ridge leading from the
olecranon, on the outer  part of the upper end of the ulna, and into
the triangular depression found there, so as to fill it up.
  It extends the fore-arm.
       SECT. IV.—OF THE MUSCLES OF THE FORE-ARM.

   There are eight muscles on  the front of the fore-arm, some of
which are superficial, and others deep-seated.   They, for the most
part, are  either directly or indirectly flexors of the fore-arm and
hand, and in their origin adhere very much by the tendinous par-
titions, called Inter-muscular Ligaments.


                 1.  The Pronator Radii Teres,

   Is just beneath the fascia of  the fore-arm, and  forms the radial
side of the muscles of the internal condyle.  It arises, fleshy, from
the anterior face of the internal condyle of the os  humeri, and ten-
dinous from the coronoid process of  the ulna.   It  passes very ob-
liquely across the fore-arm, at the internal edge of the brachialis
internus muscle, and is inserted, tendinous and fleshy, into the ex-
ternal back part of the radius, just below the insertion of the supi- 
428
MUSCLES.
 nator  radii brevis, occupying  about two inches of the middle of
 the bone.
   It rolls the hand inwards.*

            2.  The Flexor Manus vel Carpi Radialis,

   Is placed at the ulnar side of the last muscle, and is also super-
 ficial.   It arises, by a narrow tendon, from the lower front part of
 the internal condyle of the os humeri, fleshy from the inter-muscu-
 lar ligaments, the brachial fascia, and from the upper  part of the
 ulna.  It forms a thick fleshy belly, terminating below in a tendon,
 which passes under the anterior annular ligament of the wrist, and
 runs through a groove in the os trapezium.
   It is inserted, tendinous, into the base of the metacarpal bone of
 the fore-finger, in front.
   There is a bursa between  the lower extremity of its  tendon and
 the trapezium;  the tendon  is there held down  by ligamentous
 fibres.
   It bends the hand, and draws it towards the radius.


                   3. The Palmaris Longus,

   Is at the ulnar  side of the flexor carpi radialis, and is  superficial.
 It is a small short muscle, terminating in  a long  slender tendon,
 and arises by a small tendon  from the internal condyle, and fleshy
 from the inter-muscular ligament on each of its sides.
   It is inserted, tendinous, into the upper margin of the ligamentum
 carpi annulare anterius, near the  root of the thumb; and a division
 of its tendon passes on to the aponeurosis palmaris.
   It bends the hand, and makes tense the palmar aponeurosis.-!


            4.  The Flexor Manus vel Carpi Ulnaris,

   Occupies, among the superficial  muscles, the ulnar  side of the
fore-arm.  It arises, tendinous, from the internal condyle of the os

  * Varieties.  Sometimes it is double.
  t Varieties.  Sometimes it is deficient in  both arms; sometimes the middle part
 only is fleshy; sometimes the belly goes almost to the wrist. 
MUSCLES OF THE FORE-ARM.
429
humeri, fleshy from the upper internal side of the olecranon, and
by a tendinous expansion, being  a part of the fascia of the  fore-
arm, from  the ridge at the internal side of the ulna to within  three
or four inches of the wrist.
   It is inserted into the upper side of the os pisiforme by a round
tendon, which arises early at the radial margin of the muscle, and
receives the  muscular fibres.  Sometimes the tendon is continued
over the os pisiforme, so as to be likewise inserted into the base of
the metacarpal bone of the little finger.   There is a loose bursa at
the junction of the  tendon with the pisiforme.
   It bends the hand, and draws it towards the ulna.


          5.  The Flexor Digitorum Sublimis Perforatus,

   Is concealed very much by the muscles just enumerated, in con-
sequence of being placed between  them.   To get a  good view of
its origin,  they all  should be  cut  away from  the os humeri.   It
arises, tendinous and fleshy, from the internal condyle of the  os
humeri, tendinous from the coronoid process of the ulna, and fleshy
from the tubercle of the radius;  the latter part of its origin  being
extended,  tendinous obliquely, for  three  or  four inches from that
line of the radius which is at the  insertion  of the supinator radii
brevis.   With these origins the  muscle  spreads over the front of
the  fore-arm at its  upper part,  from  the radial  to the  ulnar
margin.
   Four distinct tendons arise from  the  lower end of the muscle,
and which commence  much above the wrist, pass beneath its an-
terior ligament, and, having reached the  palm of the  hand, diverge
to the several fingers.  A tendon  is appropriated to each finger,
and passes in front of its metacarpal bone to the  phalanges,  being
inserted  after having split into two, into the  angle formed on each
side by the junction of the cylindrical and flat surface of the second
phalanx  near its middle.
   It bends the second phalanges  on the first; its action may also
be continued so as  to clench the hand and  to bend  it on the fore-
arm.*
  * Varieties. The tendon to the little finger is sometimes wanting, in which case
the deficiency is supplied by the tendon of the flexor  profundus. Sometimes the
section of this muscle which belongs to the fore-finger, is insulated from the  rest of
it, by a long fissure, and, moreover, divided by a  middle tendon, into two fleshy
portions. 
430
MUSCLES.
         6.  The Flexor Digitorum Profundus Perforans,

  Is beneath the flexor sublimis and the flexor  ulnaris.   It arises,
fleshy, from the oblong concavity of the ulna, along the inner side
of the coronoid and the olecranon process, fleshy from the lower
margin of the base of the coronoid process, from  the ulnar portion
of the interosseous ligament, and from  the front of  the upper two-
thirds of the  ulna.
  The tendons of this muscle are different from those of the other;
they commence in front of it,  like a tendinous membrane, which
is gradually divided into  several fasciculi, adhering to each other
by cellular membrane.  The fasciculated character of the tendons
is still preserved when they go under the anterior carpal ligament,
and  until  they begin to disperse as distinct tendons to each of the
fingers.
  Each tendon, going in front of its metacarpal bone and of the
corresponding  phalanges, gets through the  slit in  the flexor sub-
limis, and is inserted  into the front part of the  root of the  third
phalanx of its respective finger.
  It bends the  last phalanges of the fingers, and may, by increased
action, flex the hand like  the preceding muscle.*


                 7.  The Flexor Longus Pollicis,

  Lies  in front of the radius, but beneath the flexor sublimis.  It
arises by  an  acute fleshy beginning, from the radius just below its
tubercle;  also fleshy from the middle two-thirds of the front of this
bone, and from the radial  portion of the interosseous ligament.
The body of the  muscle  is  joined by a small fleshy slip having a
tendinous origin from the internal condyle of the  os humeri.
  A tendon is formed early on the ulnar margin of  this muscle,
and  to which the fibres  pass obliquely.  The tendon goes under
the annular ligament of the wrist, through the fossa formed in the
short flexor muscle of the thumb, and between the sesamoid bones,
to be inserted into the base of the second phalanx of the thumb.

  *  Varieties.  Sometimes a distinct fasciculus comes from the internal condyle to
join it; sometimes a fasciculus  comes  from the flexor longus pollicis, and termina-
ting in a tendinous expansion, is inserted into the tendon which the flexor profundus
sends to the fore-finger. 
MUSCLES OF THE FORE-ARM.
431
  From the inferior end of the fore-arm to the  middle of the first
phalanx, the tendon is invested by its appropriate bursa.
  It bends the last joint of the thumb.

  The several Flexor tendons, as they pass under the anterior an-
nular ligament of the wrist, are surrounded by the superior Bursa
Mucosa.  It begins about an  inch and a half  above the radio-car-
pal articulation, and  extends  to the lower margin of the annular
ligament.   It adheres by its circumference to this ligament  and to
the capsule of the joint;  within,  it sends in a  considerable number
of processes, whereby each tendon is surrounded, and connected
to the adjoining  tendons; while  at  the same time no restraint is
put upon the natural motions  of the part.   In  its texture this bursa
resembles a dense and elastic cellular membrane.
   In  addition to  this, the  flexor tendons, as they pass from the root
to the extremity of each finger, are surrounded by a synovial bursa;
which by its secretion continually lubricates them, and permits them
to  play freely backwards and forwards, according to the flexions
and extensions of the fingers.   These mucous or synovial sheaths,
begin a little distance above the  first joint of  the finger, adhere
there to both flexor tendons, and extend to about the middle of the
last phalanx.  They give to the tendons a very polished lubricated
surface; are reflected over the anterior flat faces of the phalanges,
being separated  from them by a  small quantity of adipose matter:
they  are also reflected over the anterior faces of the capsular liga-
ments, and line the vaginal ligaments.
   The Vaginal  Ligaments of the fingers (Ligamenta Vaginalia)
bind  down the flexor tendons and keep them  applied to  the fronts
of the phalanges.  They are of the same extent from above down-
wards, with the  mucous  sheaths  just mentioned, and are stretched
between the ulnar and the  radial margins of  the phalanges.  The
fibres of which  they consist  pass for the  most part transversely,
and are of a fibro-cartilaginous  character.  These fibres diminish
in number towards the end of each finger, and are stronger on the
fore-finger than  on any of the others.  In front of the first joints
or  the metacarpo-phalangial articulations, and the  phalangial arti-
culations, the vaginal ligaments  are much thinner than elsewhere,
in order to permit the free flexion of the fingers.   The  structure,
indeed, at these points, is decidedly marked off by its diminished
thickness;  and though the course of the fibres is the  same from 
432
MUSCLES.
side to  side, yet some anatomists have thought it worth while to
designate it, particularly under the name of Annuli Juncturarum
Ligamentosi.
   Within the vaginal  ligaments small tendinous fraena arise from
the first and  second phalanges; they vary in number in different
individuals, and run obliquely forwards, some to terminate in the
flexor profundus tendons, and others in those of the flexor sublimis;
they are called Vincula Accessoria, and are covered by a reflection
of  the  synovial sheath.  Indeed  they seem to  be formed almost
entirely from the latter.


                  8.  The Pronator Quadratus,

   Is just above the carpal surfaces of the radius and ulna, and be-
tween the  other  muscles and  the bone.   In the adult  it  is about
two inches wide, and its fibres run across the fore-arm.  It arises,
fleshy and tendinous, from the  ridge at  the inner surface of the
ulna, near  its lower extremity, and from the front of the bone.
   It is inserted into the corresponding front surface of the radius.
   It rotates the radius inwards.*


           Of the Muscles on the back of the Fore-Arm.

   These muscles  are ten in  number.  They arise, for the most
part,  from  the external condyle, and the ridge leading to it, and
are extensors either of the fore-arm, or of the fingers  and thumb.
Their origins are  less blended with each other  than those of the
flexor muscles; nevertheless, between several  of them there  are
inter-muscular ligaments  which connect them.   They  are superfi^
cial and deep-seated.


                1. The Supinator Radii Longus,

  Is situated along the radial  edge  of the fore-arm, immediately
beneath the integuments.   It arises, fleshy and tendinous, from the

  *  Varieties.  This muscle in some very rare cases does not exist.  Sometimes it
consists in two layers whose fibres cross each other. In a case noticed in the Penn.
sylvania Hospital by Dr. J. R, Barton, it consisted in two  triangular  pieces, the
bases of which were reversed. 
MUSCLES OF THE FORE-ARM.                433
higher part of the ridge leading to the external condyle;  com-
mencing just below the insertion of the deltoid muscle, and  being
here placed between the brachialis internus and  the outer head of
the triceps.   It forms a thick fleshy belly, constituting the external
margin of  the arm, about the elbow joint; and terminates  about
the middle of the radius in a flat tendon.
   It is inserted, by the tendon, into a  small, rough ridge, on the
outer side of the radius just above its styloid process.
   It rolls the radius outwards.


            2.  The Extensor Carpi Radialis Longior,

   Is situated beneath the former muscle.   It arises, tendinous ana*
fleshy, from the space of the external ridge of the os humeri, be-
tween the supinator longus and the external condyle.   It forms  a
short, fleshy belly, which terminates in a flat  tendon above the
middle of the radius.
   It is inserted, by this tendon, into the posterior part of the root
of the metacarpal bone of the fore-finger, near the thumb.
   The tendon  of  this muscle is surrounded by a synovial sheath)
at the place where it  passes the lower end of the radius, under the
posterior carpal ligament.   Another bursa exists, also, at its  inser-
tion ; which, on one occasion, I found so much enlarged in a young
woman, as to require its extirpation: the operation was fully suc-
cessful.
   It extends the hand.*


            3. The Extensor Carpi Radialis Brevior,

  Is beneath the last, but projects somewhat beyond it.  It arises,
tendinous, from the posterior and lower part of the external con-
dyle, and from  the external lateral ligament of the elbow joint.  It
forms a thick, fleshy belly, placed along the radius,  and terminates
in a flat tendon about the middle of that bone.
  Its tendon, becoming rounded, is inserted into the posterior part

  *  Varieties.  Sometimes a small fasciculus is detached from its posterior margin,
and has a tendinous insertion into the third metacarpal bone.
  Vol.  I.—37 
434
MUSCLES.
of the base of the metacarpal bone of the second finger, and has a
bursa beneath its insertion, and another at the wrist.
  It extends the hand.*


                4. The Extensor Carpi Ulnaris,

  Is superficial, and placed principally parallel with the ulna.  It
arises, tendinous, from the external condyle, fleshy from the inter-
muscular ligament, and  inside of the fascia.  Crossing very ob-
liquely the upper  part of the radius and the ulna, it also  arises
fleshy from the back part of the latter bone.  Its fibres terminate
obliquely in a tendon  which goes through the groove  of the ulna,
and is there furnished writh a bursa.
  It is inserted, by its tendon, into the ulnar side of the base  of the
metacarpal bone of the little finger.
  It extends the hand.f


             5.  The Extensor Digitorum Communis,

  Is superficial, being placed beneath the extensor ulnaris and the
extensor radialis brevior.   It arises, tendinous,  from  the external
condyle, and fleshy from the inter-muscular ligament of the  conti-
guous muscles.   As it approaches the wrist  it sends  off four ten-
dons,  which pass together through a common groove on the back
of the radius.   On the back of the hand  these tendons diverge, and
near the roots of the fingers send cross slips  to each other.
  Each tendon goes to its respective finger, and covers the  whole
posterior part of it, being spread out into  a  membrane which ad-
heres  to the phalanges from the root of the first to the root of the
last.  The precise mode of the insertion of these tendons is as fol-
lows : on the back of the first phalanx, the lateral margins of these
tendons are joined by the  tendons of the lumbricales  and interossei;
and the tendinous membrane, thus formed, simply adheres by con-
densed cellular membrane to the whole back of the first phalanx;
the middle part of this tendon then  passes on to be inserted near

  *  Varieties. Sometimes this muscle is so blended with the preceding, as to be
in common with it.
  t  Varieties. Sometimes its tendon is joined, by a small fasciculus, to the exten-
sor tendon of the little finger. 
MUSCLES OF THE FORE-ARM.
435
the articular margin of  the base  of the second phalanx; and the
two lateral parts of the  tendinous membrane, after  keeping sepa-
rate for some distance, unite, and are jointly inserted into the back
of the base of the third phalanx.
   The section of this muscle appropriated to the little finger has a
distinct appearance, and frequently its tendon goes  through a  se-
parate fossa  in the radius, or rather  in the posterior carpal liga-
ment, from which causes it has obtained the name of Auricularis.
A bursa invests these tendons at the wrist as they pass  through
their groove, and is single above; but, in following the course of
the tendons,  like them it divides  and follows each tendon  respec-
tively to the  base of the  first phalanx.
   This muscle extends all the joints of the fingers, being the anta-
gonist of the flexors.*


                 6. The Supinator Radii Brevis,

   Can only be well seen by detaching the  origin  of the aforesaid
muscles; it will then be found in contact with the radius, making
a  close investment  of its  head and  upper third.   It arises, tendi-
nous, from the external  condyle of the os  humeri,  tendinous  and
fleshy from the  ridge on the posterior radial edge of the ulna which
descends from its coronoid process.
   Its fibres surround, obliquely, the upper external part of the radius,
and are inserted into its tubercle, and into  its oblique rough ridge.
corresponding with the  upper margin of the pronator teres.   At
the interstice between the  radius  and  ulna, near the anterior edge
of this muscle, a fleshy slip is occasionally seen which passes from
the radial side of the  coronoid process to  the ulnar  edge  of  the
radius.
   This muscle rotates the radius outwards.f

  * Varieties.  It sometimes  sends  a double tendon to  the  little finger, in which
case the auricularis is more distinct than usual, and  the tendon next to the  ulna
runs through a distinct trochlea in the posterior carpal ligament.
  t Varieties.   Sometimes the superior part is separated from the inferior; some
times the muscle is double. 
436
MUSCLES.
        7.  The Extensor Ossis. Metacarpi Pollicis Manus,

   Arises, fleshy, from the posterior part  of the ulna immediately
 below the anconeus, from the interosseous ligament, and  from the
 back part of the radius just below the  insertion  of the supinator
 brevis.  It terminates in  a rounded tendon which passes over the
 tendons of  the radial extensors, and through a groove on the sty-
 loid side of the lower end of the radius.   The tendon is there in-
 vested by a bursa.
   It is inserted, by its tendon, into the base of the metacarpal bone
 of the thumb, and into the external  side of the trapezium.
   It extends the metacarpal bone of the thumb.*


             8. The Extensor Minor  Pollicis Manus,

   Is at the ulnar side of the last muscle.   It arises, tendinous, from
 the back of the ulna below its middle, and fleshy from the interos-
 seous ligament.  It adheres  to the radius, and terminates in a ten-
 don which  passes  through the groove  in the styloid  side of the
 radius, along with the last named muscle.
   It is inserted  into the first phalanx of the thumb, by its tendon,
 which is extended to the root of the second phalanx.
   It extends the first phalanx.*


             9.  The Extensor Major  Pollicis Manus,

   Arises, by a  small tendinous, and  an  extensive  fleshy origin,
 from the back of the ulna above its middle, and from the interos-
 seous  ligament, also  from the back of the radius; it  terminates
 near the wrist, in a tendon which passes through the groove on the
 back of the radius  near the ulna.   The belly of this muscle con-
 ceals, very much, the other extensors  of the thumb.
   It is inserted, by its tendon, into the oblong transverse tubercle,
on the back of the  base of the second phalanx of  the thumb.   Its

  * Varieties.  This muscle is sometimes double, and has several other modifica-
 tions which it is unnecessary to state.
  t Varieties.  This muscle is sometimes only  an appendage of the  preceding.
Occasionally, its tendon is confounded with that of the succeeding muscle. 
                        MUSCLES OF THE HAND.                   437

  tendon is furnished with one synovial sheath, at the inferior extre-
  mity of the radius, which extends to the carpus; and another which
  is smaller, and is placed upon the carpus and upon the base of the
  first metacarpal bone.
    It extends the second phalanx.*

    The tendons of the last two  muscles are much  connected with
  each other, and  are  spread in the form of a  membrane on  the
  back of the thumb, after  the manner of the extensor tendons of
  the fingers.

                        10. The Indicator,

    Is a small muscle on the back of the'ulna, concealed by the  ex-
  tensor  communis  and extensor ulnaris.   It  arises, tendinous  and
  fleshy, from the back of the ulna, commencing near its middle, and
  from the contiguous part of the interosseous  ligament.   It termi-
  nates in a tendon which goes through the same fossa with the ex-
 tensor communis; it afterwards is joined about the base of the first
  phalanx to the  tendon of the common extensor belonging to the
 fore-finger.
   With the tendon of the extensor communis, it  is inserted along
 the back of the fore-finger  as far as the base of the third phalanx.
   It  extends the fore-finger.f


          SECT. V.—OF THE  MUSCLES OF THE HAND.

                       The Palmaris Brevis,

   Is just below the skin, at  the inner side of the  palm of the hand.
 It consists of separate fasciculi unequally divided, and arises from

  * Varieties.  Sometimes this muscle is completely double.
  t Varieties.   This muscle is subject to many modifications; sometimes it is-di-
 gastric; sometimes it is double, and the second head goes to the middle finger.   In
 the latter case, anatomists have recognised a disposition similar to that of  the short
 extensors of the toes, and also an  arrangement corresponding with what occurs in
 some species of the ape.  As a general rule, it is admitted that  the most of those
 varieties in the muscular system, commonly  called  anomalies, are only indications
 on the  part of nature of the alliance between the structure of man, and that of the
 lower orders of animals. In this  point of view,  they are  both instructive and
amusing, and are well deserving of attention.
                              37* 
438
MUSCLES.
the anterior ligament of the wrist, and from the ulnar side of the
palmar aponeurosis.
  It is inserted into the  skin and fat at the inner  margin  of the
hand, and covers the muscles  of the little finger.
  It contracts the skin of the hand.

  Beneath the Aponeurosis Palmaris are placed the  long flexor
tendons, and many of the small muscles of the hand.


                        The Lumbricales,

   Are conspicuous; they are four in number, of the size and shape
of  earth worms.   They  arise, tendinous and  fleshy, from the
radial *sides  of the tendons of  the  flexor  profundus, beneath the
ligamentum  carpi  annulare anterius, and a little beyond its infe-
rior edge.
   They terminate in little flat tendons, which run along the outer
or radial edge of the fingers, and are inserted respectively into the
tendinous expansion of the extensor communis on the back of the
first phalanx of each finger, about its middle.
   They bend the first phalanges.*

   Four muscles constitute the ball of the thumb.


                1. The  Abductor Pollicis Manus,

   Arises, tendinous and  fleshy, from the anterior surface of the
anterior carpal ligament, and from the projecting ends of the tra-
pezium and scaphoides.
   It is inserted, tendinous, into the outer side of the base of the first
phalanx of  the thumb, and into the  tendinous membrane derived
from the extensors on its back part.
   It draws the thumb from the fore-fingers.  This muscle is next
to the skin..

  * Varieties*  Sometimes one is deficient; sometimes one or more is double, in
which case the supernumerary goes to the ulnar edge of the adjoining finger. 
MUSCLES OF THE HAND.
439
                  2. The Opponens Pollicis,

  Is beneath  the abductor, and without its removal can scarcely
be seen.  It arises, tendinous and  fleshy, from the projecting point
of the os trapezium, and from the  adjacent part of the anterior
carpal ligament.
   It is inserted, tendinous and fleshy, into the radial edge of the
metacarpal bone of the thumb, from its base to its head.
   It draws the metacarpal bone inwards.


              3. The Flexor Brevis Pollicis Manus,

   Is beneath  the abductor pollicis, and at the side of the opponens
pollicis.  A groove  is formed in it  by the  tendon of the flexor
longus pollicis, which divides it into two heads.
   The first head arises, fleshy, from the point of the trapezium,
trapezoides, and from the contiguous part of the internal surface of
the anterior annular  ligament, and is inserted into the outer sesa-
moid bone; the sesamoid bone, like a patella, being connected to
the first phalanx of the thumb by a tendon.
   The second or  internal  head  arises, fleshy, from the  magnum
and  unciforme, near  their metacarpal surfaces, and from the base
of the metacarpal  bone of the middle finger.  It is inserted into
the inner sesamoid bone, which, like the external, is connected, by
ligament, to the first phalanx.
   The short flexor, as its name implies,,bends the first phalanx of
the thumb.

               4.  The Adductor  Pollicis Manus,

  Lies in the palm of the hand, beneath the lumbricales and the
tendons of the flexor sublimis and profundus.   It  arises, fleshy,
from the ulnar edge of the  metacarpal bone of the middle finger,
between its base and head, and it is  inserted, tendinous, into the
inner part of the base of  the first phalanx of the thumb, just above
the sesamoid  bone.
  It pulls the thumb towards the fingers.. 
440                         MUSCLES.
                   The Abductor Indicis Manus,

    Is on the radial edge of the hand, between the metacarpal bone
  of the fore-finger and thumb, and is just beneath the skin.   It arises
  tendinous from the trapezium, and fleshy from  the  ulnar edge of
  the metacarpal bone of the thumb, between its base and head.
    Being placed along the side of the metacarpal bone of the fore-
  finger, it  is inserted, by a short tendon, into the radial side of the
  first phalanx.
    It draws  the fore-finger from the others.

    There are three muscles constituting the ball of the  ulnar side
  of the hand, or of the little finger.


              1.  The Abductor Minimi Digiti Manus,

   Is the most superficial.  It arises, fleshy, from  the protuberance
 on the internal  side of the os  pisiforme, and from the contiguous
 part of the annular ligament.
   It is  inserted, tendinous, into the ulnar side of the first phalanx
 of the little finger, and  into the  tendinous membrane-which covers
 its back part.
   It draws the  little finger from the rest.

          2.  The Flexor Parvus Minimi Digiti Manus,

   Is beneath the abductor.  It  arises, fleshy, from the unciform
 process of the os unciforme, and from the  contiguous part of the
 annular ligament.
   It is  inserted, tendinous, into the ulnar side of the  base of the
 first phalanx  of the little finger, being united with the tendon of the
 abductor, and with the tendinous  membrane  expanded  over the
 back of the finger.
   It bends the little finger.*

  * Varieties.  Sometimes it  is wanting, in which case the preceding is more deve-
loped than usual. 
MUSCLES OF THE HAND.
441
          3. The Adductor Metacarpi Minimi Digiti,

  Is placed beneath the abductor and flexor, next to the metacar-
pal  bone.   It arises, fleshy, from the unciform process of  the os
unciforme; and from  the contiguous part of the annular ligament
of the wrist.
  It is inserted, tendinous and fleshy, into the fore part of the meta-
carpal bone of the little finger, from its base to its head.
  It brings  the metacarpal bone of the little  finger towards the
wrist, and thereby deepens the hollow of the hand.

  The Interosseous  Muscles fill up the interstices of the metacarpal
bones; they are seven in  number, four  on  the palm, and three on
the  back of  the hand.  The back ones arise by double heads from
the  contiguous sides of two metacarpal bones; the palmar ones
have a single head, which comes only from the metacarpal bone
of the finger which the interosseous muscle is intended to serve.
As  a general description, they all may be said to arise, fleshy and
tendinous, from the bases and sides of the metacarpal bones, and to
be inserted, tendinous, into the sides of the first  phalanges, and into
the  tendinous membrane on the backs of the fingers, derived from
the  tendons of the  extensor communis.  The  first four must be
looked for on the palm, the three others on  the back of the hand.


                     1.  The Prior Indicis,

  Is along the radial side of the  first digital metacarpal bone, and
arises from the base and side of  the same.
  It is inserted, tendinous, into the radial side of the first phalanx
of the fore-finger.
  It draws the fore-finger  towards the thumb.


                   2. The Posterior Indicis,

  Is at the ulnar side of the first digital metacarpal bone. It arises
from the  base and ulnar side of the  same bone, and is inserted,
tendinous, into the ulnar side of the first phalanx of the fore-finger.
  It draws the fore-finger  towards the others. 
442
MUSCLES.
                   3.  The Prior Annularis,

  Is at the radial side of the metacarpal bone of the third or ring
finger.  It arises from the base and radial side of the said bone.
  It is inserted, tendinous, into the radial side of the first phalanx
of the ring finger.
  It draws that finger towards the thumb.

             4.  The Interosseus Digiti Auricularis,

  Is at  the radial side of the metacarpal bone of the  little finger,
and arises from the radial side and base of said bone.
  It is inserted, tendinous, into the radial side of the first phalanx
of the same finger.
  It draws the little finger towards the other.

  By removing the tendons of the  extensor  communis from  the
back of the hand, we see the three posterior  or double-headed in-
terosseous muscles.
                      5. The Prior Medii,

  Is between the metacarpal bone of the fore and of the middle
finger.   It arises from the opposed roots and sides of these bones.
  It is inserted, tendinous, into the radial side of the. first phalanx
of the middle finger.
  It draws the middle finger towards  the thumb.

                     6. The Posterior Medii,

   Is between  the  metacarpal bone  of the  middle  and of the ring
finger.   It arises from the opposite sides and roots  of these bones.
   It is inserted, tendinous, into the ulnar side of the  first phalanx
of  the middle finger.
   It draws the middle finger towards the little.

                   7. The Posterior Annularis,

   Is between the metacarpal bones of the ring and little finger.  It
 arises from the opposed sides and roots of these metacarpal bones. 
FASCIA OF THIGH.
443
  It is inserted, tendinous, into the ulnar side of the first phalanx
of the ring finger.
  It draws the ring towards the little finger.
                        CHAPTER IV.


          Of the Fascia and Muscles of the Lower Extremities.

                  SECT. I.—OF THE FASCIA.

   The muscles of the lower extremity, from the pelvis  to the fool
 inclusively, are invested by a strong aponeurotic membrane, placed
 immediately beneath  the skin or common integuments.   Its exter-
 nal face  is in contact with the superficial nerves and blood vessels,
 and the internal face  with the  muscles.  Though  it is  absolutely
 continuous from one end  to the other, it  will be useful, for study,
 to divide it into three parts; the one covering the thigh, the second
 covering the leg, and  the third covering the  foot;  as each of them
 presents  certain points of arrangement, which could not be very
 conveniently introduced into a general description.
   1.  The aponeurosis of the thigh (Fascia Lata Femoris) begins
 posteriorly, from the  upper part of the gluteus magnus muscle, by
 a very gradual conversion of the cellular  membrane of the part
 into desmoid substance; it also begins in the way of cellular sub-
 stance from  the margin  of the  sacrum and os coccygis.  The
 character here is seldom entirely  aponeurotic till it gets on a level
 with  the tendon of the gluteus magnus, from  which  emanate a
 great  many of its fibres.  Externally,  it arises  from  the whole
 length of the crista of the ilium, is there  strikingly aponeurotic,
 and  is closely adherent to the gluteus  medius muscle, many of
 whose fibres arise from  it. It also arises from  the body and  rami
of the pubes, and from  the tuber  and ramus of the ischium.   Its
 attachment at the latter is not very strong, neither is its character
so well marked.   It  is  there, in  some  measure, continuous  with
the  perineal fascia.   In  front, it adheres  very closely to the  infe-
rior margin of the tendon of the external oblique muscle, so as to 
444                         FASCIA.
 be almost continuous with it» from the anterior superior spinous
 process of the ilium to the pubes.
   From these several connexions at the pelvis, the fascia femoris
 descends in enveloping the muscles of the  thigh, and then forms
 other strong attachments about the knee, to the condyles of the os
 femoris and  to  the  head of the tibia.  In front, it  adheres very
 closely to, and  is almost blended into the common  tendon of  the
 extensor muscles;  it adheres, also, to the inferior margins of  the
 two vasti, and is one  and the same with the membranous expan-
 sion (Involucrum) going from them to  the head of the tibia, and
 answering the purpose of capsular ligament to the articulation of
 the knee, on  each side of the patella, as far back as the lateral liga-
 ments.   Behind, it covers up the fat in the ham, and is  continued
 into the fascia of the leg.
   The  fascia femoris, almost every where, consists in a  fibrous
 texture, which  is sufficiently  evident, but  the  fibres pass in very
 various directions.  At many places, particularly on  the  internal
 side of  the thigh, there are oblique  fibres spread upon  a lamina
 which is not  fibrous.  On the outside of the thigh, the fascia con-
 sists principally  in  longitudinal fibres, held together by transverse
 ones;  and when  its interior surface  is  examined, many oblique
 fibres are also found there.  It is very thick and strong externally,
 thinner behind; and still weaker internally, where cellular substance
 seems to predominate in its composition.   It is pierced  at several
 points with small round holes  for the passing of blood vessels and
 of the cutaneous nerves.
   From the interior surface of the Fascia Femoris, partitions pass
 off, which separate the  muscles of the thigh from each other, and
 form sheaths for them.   Some of these processes are merely cel-
 lular substance; others have a  more distinct desmoid character.
Externally, as it passes from  the  gluteus  medius to  the groin, it
separates into two laminae, which receive between them  the tensor
 vaginas femoris,  and then reunite.  The sartorius muscle, in almost
its whole length, is also enclosed between two  laminae.  At the
origin of this muscle, the posterior lamina passes on to the iliacus
internus, and psoas magnus muscles, and then  to the pectineus,  to
become the pectineal fascia, in all of which distance it is continuous
with the iliac fascia of  the pelvis;  but the anterior lamina of the
fascia at this place has its upper margin continuous with Poupart's
ligament; and this lamina terminates in a point or angle, which is 
FASCIA OF THIGH.
445
 turned inward to the crista of the pubes, and ends by an insertion
 into it immediately exterior  to Gimbernat's  ligament, and  in  the
 same line with it.  This point, from the part which it acts in fe-
 moral hernia, has been studied with particular  attention, and goes
 under the name of Hey's, or the Femoral Ligament.

    The Pectineal fascia is  placed  behind the femoral vessels, but
 the sartorial fascia is before them.*  The latter terminates on its
 pubic side, in a crescentic or lunated edge of one and a-half or two
 inches in  length, the concavity of which is  towards  the penis.f
 Hey's ligament is the superior extremity of the crescent;  the infe-
 rior end can scarcely be considered to  have  a definite boundary,
 but is continuous with the adjacent part  of  the  pectineal fascia.
 The place  of continuity is covered by the  saphena vein,  which
 being between the skin and the fascia  lata, dips there into the fe-
 moral vein which is under the crescentic edge.   The femoral ves-
 sels reposing in their sheaths, are then placed between these laminas
 of the fascia femoris.   The vein is only partially covered by the
 lunated edge, while the artery, which is on the iliac side of the
 vein, is completely concealed.   By keeping the leg extended, and
 turning the toes of the subject inwards or outwards, it will be seen
 that the crescentic edge and the tendon  of the external oblique ex-
 ercise a mutual tension.  Beneath Poupart's ligament, at the inner
 margin of the femoral vein, is the  hole called  the Femoral  Ring,
 through which the bowel escapes in femoral hernia.   This hole is
 constricted by turning the toes outwards, and  relaxed by turning
 them inwards; it becomes very much relaxed, if, at the  same time,
 the thigh be drawn upwards.  Valuable indications for the  mode
 of replacing a prolapsed bowel are thus obtained.
   In addition to this arrangement, which is all-important in hernia,
 the fascia femoris has the following.  On the front of the  thigh it
 simply covers the extensor muscles,  the  partitions between which
 are cellular substance.   On  the inner side  it dips down to the pe-
 riosteum between the adductor muscles, but is still cellular.   Be-

  * ^y sartorial fascia is merely meant the portion of the  fascia lata femoris conti-
guous to the sartorius muscle; and, by pectineal fascia, the  part covering the pec-
tineus muscle.
  t The crescentic edge is not always  well defined, for in  many cases it is blended
insensibly with the sheath of the vessels, so that a  defined exhibition of it is rather
the result of artificial separation or dissection, than a natural condition
   Vol. I.—38 
446
FASCIA.
hind, it covers the ham-string muscles, and sends down to the linea
aspera  a thick fibrous partition between the vastus externus and
the biceps flexor.
   The superior margin of the gluteus magnus is inserted into this
fascia, which from its connexion with the gluteus medius and ten-
sor vaginse femoris, causes all  these  muscles to exercise a mutual
influence, as  well as to keep  tense the fascia itself.   On the inter-
nal semi-circumference of the  thigh  it adheres somewhat closely
to the muscles; but on the external, where the fascia is opposed  to
the tendinous facing of the vastus externus muscle, it is connected
by a  long, loose, and scattered cellular substance, which scarcely
presents an obstacle to the introduction of the finger or any blunt
instrument between the two.

   2. The Fascia Cruralis, or that of the Leg, though absolutely
continuous with that of the thigh, may be described as arising ex-
ternally, from the head of the  fibula  and from  a prolongation of
the biceps flexor  cruris ; internally from prolongations of the ten-
dons of the sartorius, the gracilis, and the semi-tendinosus.   It, in
descending, covers all the superficial muscles of  the leg, does not
go over the tibia, but adheres to its spine and to its internal angle.
It  unites below to the annular ligament  of  the  ankle, to the liga-
mentous sheath of the peroneal muscles, and to that on the inner
ankle.
  The fascia cruralis, in the superior half  of the leg, assists in
giving origin to  its muscles  in front  and externally,  but is rather
loosely attached to them  below.  On  the back of the leg it is also
rather loosely connected to  the gastrocnemii.   It sends in one
aponeurotic partition between the common  extensor  of the toes
and the  long peroneus, and  another  between  the latter and the
soleus, both of which are inserted into the fibula.  It also is insi-
nuated between the soleus and the flexor muscles next to the bones.
This prolongation is strong and fibrous, penetrates between  these
flexor muscles, dips down to  the tibia and fibula,  and  is lost insen-
sibly just below the fascia of the popliteus muscle.  The popliteal
fascia may also  be  considered one  of  the  emanations from the
fascia cruralis.
   The fascia cruralis is  not  so strong as the femoral, yet  it has
the same compact  desmoid texture, and is formed  from fibres
crossing in various directions.   It is thicker  in front than behind, 
FASCIA OF FOOT.
447
and is made tense by its connexion with the internal and external
ham-string muscles.

         Of the Ligamentum Annulare of the Ankle Joint.

   The muscles on the front of the leg have their tendons confined
at the ankle  by this ligament, which may be very properly asso-
ciated with the description of the crural fascia, owing to the close-
ness qf  the connexion of the two.  It consists in a  fasciculus of
ligamentous fibres running across the front  of the ankle joint.  It
is attached by one extremity to the superior face of the  greater
apophysis of the os  calcis, just  before the  malleolus externus; is
there very strikingly fibrous or ligamentous, and  has its small fas-
ciculi separated by fatty matter.  It is then directed inwards, and
divides into two laminas, one of which goes  above the tendons, and
the other below them.  These laminas, by keeping to their respec-
tive sides of  the  tendons, form a loose gutter for each  of them to
play in; the  gutters, however, for the tibialis anticus and extensor
pollicis are not so perfect behind as the  others, and  are also more
loose.   The  ligament is then fixed  by one division to the anterior
margin of the malleolus internus, and by another, which  is wrapped
over the internal face of the foot,  into the  scaphoides  and the in-
nal margin of  the fascia plantaris.   As  the  upper margin of this
ligament is continuous with the fascia cruralis, so the inferior runs
into the fascia on the back  of the foot, called Aponeurosis Dorsalis
Pedis.

   Of the Fascia of the Foot.—The fascia cruralis, being strongly
attached to the posterior and lower margins of the internal ankle,
its fibres radiate  thence to the lower  part of the tendo-achillis, to
the inner side  of the  os  calcis, and  to the internal margin of the
fascia plantaris.  This is the Ligamentum Laciniatum (or plaited
ligament) of writers, and conceals the tendons which  pass to the
sole of the foot, along the sinuosity of the os calcis.

   The Aponeurosis  Dorsalis is continued from  the annular  liga-
ment, over the upper surface of the  foot, to the  roots of the toes.
It is thin, but its  fibrous texture is apparent.  It is spread over the
extensor tendons of  the toes and the extensor brevis  muscle,.and is 
448                         MUSCLES.

slightly attached along the internal and the external margin of the
foot.

  The Aponeurosis Plantaris is on the sole of the foot, between its
common integuments and the muscles.  It  is attached behind to
the tuberosities of the os calcis, and is quickly divided into  three
portions, which are kept distinct by well  marked  depressions be-
tween them.   The internal  portion lies upon the  muscles at  the
inner side of the foot, the external portion  upon the muscles at the
outer side, and the middle covers longitudinally the central  parts
of the sole.  The first two portions are thin, reticulated, and ex-
tended respectively to the  root of  the outer and the  inner meta-
tarsal bone, and along the margin of the foot, where they join the
fascia dorsalis.  The middle portion increases in breadth as  it ad-
vances, and at the anterior extremity of the metatarsus is divided
into five slips, one for each metatarsal bone.  Each of these slips
is subdivided into two,  which penetrate upwards, and fix them-
selves to their respective  side of the head  of the corresponding
metatarsal bone.  In  the  interval  left by  this  bifurcation,  pass
the flexor tendons, the lumbricales, the vessels and the nerves, to
the toe.

   The plantar aponeurosis, or fascia, affords behind, origin to the
superficial muscles of the sole of the foot.   It also sends in  parti-
tions between them.  Its thickness is considerable  behind, but con-
tinually diminishes as it  advances forwards.   Its fibrous texture is
very well marked,  and  is much  more compact near the  heel,
where it looks like ligament; the fibres  run principally longitu-
dinally.  From its inferior surface many  strong filaments pass to
the skin on the sole of the foot, and contain within their interstices
a granulated adeps.


             SECT.  II.—MUSCLES OF THE THIGH.

             The Tensor Fascia vel Vagina Femoris,

   Is situated superficially on the anterior outer part of the hip.  It
arises, tendinous,, from the anterior superior  spinous process  of the 
MUSCLES OF THE THIGH.
449
ilium;  passes downwards and somewhat backwards between two
laminae of the fascia femoris, increasing in breadth as it descends ;
and is  inserted fleshy into the fascia femoris, somewhat below the
level of the trochanter major.
  It rotates the foot inwards, and makes the fascia tense.


                         The Sartorius,

  Is placed superficially on the internal side of the thigh.   It arises
by a short tendon from the  anterior  superior spinous  process of
the ilium, and  passes  in a spiral course  to  the  inner side of the
thigh and to the back of the internal  condyle.   It  then winds be-
hind the head of the tibia, and advances forwards so as to be in-
serted  into the internal side of the lower part of its tubercle by a
broad  tendon.  Its fibres run the whole length of the muscle.
  Its tendon is continued by a flat slip from  its lower margin into
the fascia cruralis, by which attachment  the muscle is held in  its
spiral course.  It  crosses the rectus  femoris  and vastus internus
above, the triceps adductor at the middle of the thigh, and at the
lower  part of the latter, just above the knee, it is between the ten-
don of the adductor magnus and  that of the gracilis.
  It bends the leg and draws it obliquely inwards.*


                      The Rectus Femoris,

  Is in front of the thigh bone and just beneath the fascia femoris,
with the exception of its origin, which is  covered by the sartorius.
It is a complete penniform  muscle, fleshy in  front, for  the most
part, but faced behind with  tendon.   It  arises from  the anterior
inferior spinous process of the ilium by a round tendon, which  is
joined  by another tendon, coming from the superior margin of the
acetabulum.
  It is inserted into the superior  surface of the patella by a strong

  *  Varieties.  Sometimes  a small fasciculus  is detached from its inferior part;
sometimes its  fibres are interrupted by  a middle tendon which adheres closely to
the fascia femoris. Meckel reports it as deficient in one case that he met with.  In
the African I have occasionally seen it unusually broad.
                              38* 
450
MUSCLES.
tendon, and intermediately by  the  ligamentum  patellae  into  the
tubercle of the tibia.
  It extends the leg.

                     The  Vastus Externus,

  Is a very large  muscle  on  the outside of the thigh; it  arises,
tendinous and fleshy, from  the upper part of the os femoris, imme-
diately below the  trochanter  major.   Its  origin  commences in
front, and  passes  obliquely around the bone to  the linea aspera.
It continues afterwards to  arise from the  whole length of the linea
aspera, and from  the upper half of  the line running from it to  the
external condyle.
  Its fibres pass inwards  and downwards, and are inserted, by a
flat tendon, into the external edge of the  tendon of the rectus, and
also into the external upper part of  the patella.  This muscle has
a broad  tendinous surface exteriorly and above ; at its lower part
it has  a tendinous facing on the side next to the bone.
  It also extends the leg.                v


                      The Vastus Internus,

  Covers the whole inside of the os femoris.  It arises, by a pointed
fleshy  origin, in front  of  the  os femoris, just  on a level with  the
trochanter minor, tendinous and fleshy from the whole  length of
the internal edge of the linea aspera, and from  the  line leading
from it to the internal condyle.
  Its  fibres descend  obliquely, and  are inserted by a flat  tendon
into the internal edge of the tendon of the rectus, and into the  up-
per internal edge of the patella.
  It also extends the leg.


                          The Cruraus,

  Is almost completely overlapped and concealed by the two vasti,
and is immediately behind the  rectus femoris.  The edge of the
vastus externus, above, is  very distinguishable from it, as it over-
laps it, and is rounded off, besides being somewhat separated by
vessels.   But the origin of the vastus internus is not so distinguish-
able, as  the fibres of the  two  muscles run into each other;  it is, 
MUSCLES OF THE THIGH.
451
therefore, necessary, most frequently,, to cut through some of their
fibres on the internal  face of the os femoris, on a level with the
trochanter minor.   The crurasus will be seen to arise, fleshy, from
all the fore part of the bone, and from all its outside as far as the
linea  aspera.   Between  the internal edge of this muscle and the
linea aspera, the interior face of the os femoris is  free  or unoc-
cupied,  the breadth of an inch along the whole shaft of the bone,
which is very readily seen by turning off the vastus internus.
  The crurasus is inserted, into the posterior face of the tendon  of
the rectus below, and into the upper surface of the patella.
  It also extends the  leg.
  A small fasciculus  at the lower part of this muscle, which is in-
serted into the synovial membrane of the knee joint, is called the
subcrurasus.*

   The Ligamentum Patellas is the common chord by which the
action of the  last  four named muscles is  communicated  to the
tibia.   It is a flattened  thick  tendon, an inch  and a  half wide,
arising  from the inferior edge of the patella, and inserted' into the
tubercle of the tibia.   Between its  insertion and the head  of the
tibia, is a. bursa.   Besides this, a fascia or  tendinous  expansion,
(Involucrum,)  an appurtenance of the fascia femoris, as mentioned
before,  comes from  the inferior ends  of these muscles, extends
itself over the whole  of the anterior and lateral parts of  the knee
joint, and is inserted  into the head of the tibia  and of the  fibula.
Through this  it happens  that, even when  the patella or its tendon
is ruptured, some motion or extension  may be communicated  to
the leg  from, the thigh.
   In consequence of  the common insertion of. these four muscles,
some anatomists describe  them as but one, under the  name  of
Quadriceps Femoris.f
  A bursa exists  between  the  lower part of their tendon and the
fascia femoris, higher up  than  the patella; occasionally, one  is
found still lower down, on  the patella.J

   « Wilson's Anat., p. 229.
   t Soemmering de Corp. Hum. Fab.
   t Some unimportant varieties have been  observed in these extensor muscles. 
452
MUSCLES.
                          The  Gracilis,

  Is a beautiful  muscle at the inner  margin  of the thigh, and
lies immediately under the fascia;  it extends  from the pelvis  to
the leg.
  It arises, by a broad thin tendon, from the front of the os pubis,
just  at the lower part of its symphysis,  and from its descending
ramus; the muscle tapers  to a point below, and  a little above the
knee, terminates in a round tendon, which passes behind the  inter-
nal condyle of the  os femoris and the head of the tibia.  It then
makes a  curve forwards  and  downwards at  the internal side  of
the latter, and  is  inserted at the lateral and inferior part of its
tubercle.
  The tendon at the knee is beneath the tendon of  the  sartorius.
This muscle is a flexor of the leg.

                   The Pectinalis, or Pectineus,

  Is a short, fleshy muscle, at the inner edge of the psoas magnus.
It arises, fleshy, from the concavity on the upper face of the pubes,
between the linea  innominata,  and the ridge above the obturator
foramen, and is  inserted, tendinous,  into  the linea aspera, imme-
diately below the trochanter minor.
  It draws the thigh inwards and forwards.*

                           Adductors.

  1.  The  Adductor Longus comes,  by a rounded,  short  tendon,
from the upper front part of the pubes near its symphysis; it forms
a triangular belly which increases in breadth in its descent, and  is
inserted into the middle third of the linea aspera at its inner edge.
  As  the  subject lies  on  its back, this muscle is uppermost; its
origin  is  between that of  the pectinalis,  and  of the gracilis; its
upper  edge is in  contact with the lower edge of the pectinalis.f

  * Varieties.  Sometimes this muscle is split into two by a fissure, in which case
the lower portion is the smaller, and has its tendon below connected or joined to the
tendon of the other, and its other extremity attached to the upper internal margin
of the thyroid foramen.
  t Varieties. Occasionally this  muscle is divided  into two by a fissure, which is
of various lengths.  Sometimes it is continued much  lower down than usual  by
means of a small tendon united to that of the adductor magnus. 
MUSCLES OF THE THIGH.
453
  2.  The Adductor Brevis is the smallest of the three; it is situated
beneath the adductor longus and pectinalis, and  on the  outside of
the gracilis.  It arises, by a rounded tendon, from the middle front
part of the pubes, between  its symphysis and the foramen thyroi-
deum just below the origin of the first adductor.
   It is inserted into  the  upper third of  the inner edge of the linea
aspera, between the trochanter minor  and the upper edge of the
adductor longus, by a flat thin tendon.*

   3.  The Adductor Magnus is below the other two, and is  by far
the largest.   It arises, fleshy, from the  lower part of the body of
the pubes and from its descending ramus, also from the  ascending
ramus of the ischium as  far as its tuberosity, occupying  the whole
bony surface between  the foramen  thyroideum below, and  the
margin of the bone.
   It is  inserted, fleshy, into  the whole  length of the linea aspera,
and on its internal margin a tendon is gradually generated which
passes downwards to be  inserted into the upper part of the internal
condyle of the os femoris, and, by a thin  edge or  expansion, into
the line leading from the linea aspera to the internal condyle.
   The adductor magnus separates the muscles on the anterior from
such as are on the posterior part of the thigh; and its insertion is
closely connected with the  origin of the  vastus  internus, the two
surfaces adhering by a short and compact cellular membrane.f
  The three adductors contribute to the same  end, that of drawing
the  thigh inwards.   From  their common  action  and very close
connexion at their insertions, they are sometimes  described as one,
under the  name of  Triceps Adductor, and with great  propriety.
The pectineus muscle is  also associated with them so closely in its
course and  character, that, as Meckel  has  suggested, it ought  to
be considered as a fourth head to the triceps.


                     The Glutaus Magnus,

  Arises, fleshy, from the posterior third  or fourth of the crista of the
ilium, and the adjoining flat surface of the dorsum of the bone, from

  * Varieties.  It 13 also occasionally split, more or less fully, into two muscles by
a fissure, which, according to Meckel, establishes a remarkable analogy with apes.
  t Varieties.  It also is occasionally divided into two portions, as in apes. 
454
MUSCLES.
the side of the sacrum below it, from the side of the os coccygis, and
from the posterior surface of the large sacro-sciatic ligament.  The
fibres of this muscle  are collected into large fasciculi, with deep
interstices between them; and  the  lower edge of it is folded over
the sciatic ligament.
   Its fibres pass obliquely forwards and downwards, and terminate
in a thick, broad tendon, the upper part of which goes on the out-
side of the trochanter major, and is very strongly inserted into the
fascia femoris; while the lower part is inserted into  the upper third
of the linea aspera, going down  as far as the origin of the short
head of the  biceps flexor cruris.
   This muscle is placed  immediately under the skin, the fasciculi
being separated to some depth by processes from the fascia femoris.
It covers nearly all the other  muscles on  the back  part of the pel-
vis, laps over its inferior margin laterally, and conceals the origins
of the ham-string muscles.
   There is  a very large  bursa placed between the tendon of this
muscle and the external  face of the trochanter major; another of
almost equal magnitude, between it, the  superior extremity of the
vastus externus, and  the inferior end  of the tensor fascias femoris;
and there are two smaller ones between  the same tendon and the
os femoris,  which are placed lower and more posteriorly.
   The glutaeus mag'nus draws the thigh backwards, and assists in
keeping the trunk erect.

                      The  Glutaus Medius,

   Arises from  the whole length of the crista of  the ilium, except
its posterior third; from that part of the dorsum of the bone which
is between  its  crista  and the semicircular ridge,  extending from
the  anterior superior spinous  process to the sciatic notch; from
the lunated edge of the os ilium, between  the anterior superior and
the anterior inferior  spinous process; and largely from that part
of the inner face of the fascia femoris which covers this muscle.
   The anterior superior part of  this  muscle is not  covered by the
glutaeus magnus, but  lies before it.  Its fibres converge, and are
inserted, by a  broad  thick tendon, into  the  upper surface of the
 trochanter  major, and into the upper anterior part of  the shaft of
 the bone just in front of the trochanter.
   It draws the thigh backwards and outwards. 
MUSCLES OF THE THIGH.
455
  A bursa is interposed between the extremity of its tendon and
the tendinous insertions of the small rotator muscles.


                     The Glutaus Minimus,

  Arises from  that part of the  dorsum of the ilium  between the
semicircular ridge just spoken of, and the margin of the capsular
ligament of the hip joint.   It  is entirely concealed by the glutasus
medius.
  Its fibres converge and terminate in a round tendon, which is in-
serted into the anterior superior part of the trochanter major, just
within the anterior insertion of the glutasus medius.
  It abducts the thigh, and can  also rotate the limb inwards.
  A bursa of  small  size exists between its  tendon  and the tro-
chanter major.

  There are several small muscles about the hip joint, the most of
which can be seen by the removal of the glutasus magnus.


                        The Pyriformis,

  Arises, fleshy and tendinous, within the pelvis, from the anterior
face of the second, third, and fourth bone of the sacrum.  It forms
a conical belly, which passes out of the pelvis at the upper part of
the sacro-sciatic foramen, receiving a slip of fibres from the poste-
rior inferior spinous process of the ilium.
  It is inserted, by a  round tendon, into  the upper middle part of
the trochanter major  within the insertion of the glutasus medius.
  It rotates the limb outwards.  Between its tendon and the supe-
rior geminus a small bursa exists.*


                         The Gemini,

  Are  two  small  muscles, closely connected with  each  other,
which are situated lower down on  the pelvis  than the pyriformis.
The upper one arises from the posterior part of the root of the spi-

  *  Varieties.  It is sometimes  split  by the sciatic nerve, and when the latter di-
vides very high up, by one of its portions only. 
45G
MUSCLES.
nous process of the ischium; the lower from the upper back part
of the tuberosity of the ischium.
   Being parallel to each other, and connected by their  contiguous
edges, they are inserted together  into the posterior part of the thigh
bone at the root of the trochanter major, where the deep pit is.
   They also rotate the limb outwards.*


                    The Obturator Internus,

   Is principally situated within the cavity of the pelvis.  It arises,
fleshy, from  all the margin of the foramen thyroideum, except
where the obturator vessels go out; from the posterior face of the
ligamentous membrane stretched across  it;  also from the upper
part of  the plane of the ischium just below the linea innominata;
its fibres converge, and forming  a tendon, pass out of the pelvis
over the trochlea  of the ischium, between  the sacro-sciatic liga-
ments.
   The tendon  is placed between the gemini  muscles, which form
a sheath for it; and it is inserted into the pit on the back of the os
femoris, at the root of the trochanter major.
   Between the tendon  of  this muscle and  the gemini is a long
bursa; a second is  found where the muscle plays over the  ischium.
   It rotates the limb outwards.


                    The Quadratus Femoris,

   Is lower down than the other muscles.  It arises, tendinous and
fleshy, on the outer side of the ischium, from the ridge which con-
stitutes  the  exterior boundary  of the tuberosity.  Its  fibres are
transverse, and are inserted, fleshy, into the rough ridge of the os
femoris, on its  back part, which  goes from  one trochanter to the
other.
   It rotates the limb  outwards.   A bursa  exists between  it and
the trochanter  minor, f

  * Varieties.  The upper one, occasionally, does not exist, whereby a striking re-
semblance with apes is established.  Sometimes both are wanting.
  t Varieties.  Occasionally, this muscle is absent; more rarely it is divided into a
great number of fasciculi, amounting in one instance to thirty. 
MUSCLES OF THE THIGH.
457
                     The Obturator Externus,

   Is concealed, in front, by the pectineus and triceps adductor,
 and, behind, by the quadratus femoris:  to get a satisfactory view
 of it, therefore, these muscles should be detached from the bone.
 It arises  from the whole  anterior circumference  of the foramen
 thyroideum, excepting the place where  the obturator vessels come
 out, and from  the anterior  face  of the ligamentous  membrane
 stretched across it.
   The fibres of this muscle converge, pass beneath  the  capsular
 ligament of the hip joint adhering to it, and terminate successively
 in a round  tendon, which is inserted  into the inferior part of the
 cavity  on the posterior surface of the os femoris, at the root of the
 trochanter  major.  The  course of  the tendon of this muscle is
 marked on the neck of the thigh bone by a superficial fossa.
   It rotates the thigh outwards.


                    The Biceps Flexor Cruris,

   Constitutes the outer hamstring, and is situated  on  the posterior
 outer part of the  thigh; it arises by two heads.  The first, called
 the long head, has an origin, in common with the semi-tendinosus,
 from the upper back part of  the tuberosity of  the ischium, by a
 short tendon, which, in its descent, is changed into a thick fleshy
 belly.   The other, called the short head, arises, by an acute fleshy
 beginning, from the linea  aspera just below the insertion of the
 glutasus magnus, and this origin  is  continued  along the  lower part
 of the linea aspera and from the  ridge leading to the external con-
 dyle.
  A thick tendon is gradually formed on the outside of the muscle,
 which, descending along the external face of the external condyle,
 is inserted into the superior  face of the head of  the fibula at its
 point.   A bursa is found  between  this  tendon  and the external
 lateral ligament of the knee.
  This  muscle flexes the leg on the thigh.*

  * Varieties.  Sometimes the short head does not exist, thereby affording an ana-
logy with animals.  Sometimes there  is  a  third head, but  more delicate, which
comes either from the tuber of the ischium or from the long head, and descending
  Vol.  I.—30 
458                         MUSCLES.
                      The Semitendinosus,

  Is on the inside of the thigh, between the biceps and gracilis; it
is  superficial, being immediately under the  fascia, and  arises, in
common with the biceps, from the  back part of the tuberosity of
the ischium; it also adheres, for three or four inches, to the inner
edge of the tendon of this, the long head of the biceps.
  About four inches above the knee it terminates in a  long round
tendon, which passes behind the internal  condyle and the head of
the tibia, and is reflected forwards  to  be inserted into the  side of
the tibia, just below its tubercle  and  very  near it, being lower
down than the insertion of the tendon of the gracilis.   Its insertion
is much connected with  that  of the gracilis, and is generally di-
vided into two slips, one above the other.
  Between its origin, that of the long head of the biceps, and the
semimembranosus, there  is a  bursa: one or more  are likewise
found between its tendon below, that  of  the sartorius, of the gra-
cilis, and the internal lateral ligament of the knee.
  It flexes the leg on the  thigh.*


                     The Semimembranosus,

  Is at the inner  side of the thigh;  its  upper part is concealed by
the semitendinosus and the origin  of the  long head of the  biceps,
and below it  projects between these two muscles.  It is in contact
with the posterior surface of the adductor magnus.
  It arises, by a thick round tendon, from the exterior upper part
of the tuberosity  of the ischium, which tendon soon becomes flat-
tened, and sends off the muscular fibres obliquely from its exterior
edge to a  corresponding tendon below.  The latter passes behind
the internal condyle and  the head of the tibia, and despatches  a
thin aponeurotic membrane under the inner head of the gastrocne-
mius, to cover the posterior part of the capsule of the knee joint,
and to be fastened to the external condyle.
  It is inserted, by a round tendon, into  the  inner and back part

along the back of the leg, runs into the tendo-achillis, corresponding thereby with
the  arrangement of mammiferous animals.
  * Varieties.  Sometimes it is divided into three sections by two transverse tendi-
nous lines. 
                      MUSCLES OF THE LEG.                   459

of the head of the  tibia, just below the joint.   The unfavourable
insertion of this muscle is compensated for by the multitude of its
fibres, which gives  it a great increase of strength.
  A bursa  exists between  its  tendon above and the quadratus;
another exists between its tendinous termination, the internal head
of the gastrocnemius, and the capsule of the knee.
  It flexes the leg on the thigh.
               SECT. III.—MUSCLES OF THE LEG.

   These  muscles are situated  anteriorly, posteriorly, and  exter-
 nally.

                      The Tibialis Anticus,

   Is situated superficially under the fascia of the leg, at the outside
 of the spine of the tibia, and in front of the interosseous ligament.
 It arises,  fleshy, from the head of the tibia, from its outer surface,
 spine, and from the interosseous ligament to within three or four
 inches of the ankle.  It  also arises, by its front surface, from the
 internal face of the fascia of the leg.
   A rounded long tendon is formed in front below, into which the
 fleshy fibres run  obliquely, and which, passing through a distinct
 noose of  the annular ligament in front of the malleolus internus,
 crosses the astragalus  and os  naviculare, and is inserted  on the
 inner side of the  sole of the foot into the anterior part of the base
 of the cuneiforme internum, and into the adjacent part of the me-
 tatarsal bone of the great toe.
   A bursa surrounds the tendon where it passes beneath the  annu-
 lar ligament; another also exists at its lower part.
   This muscle corresponds  with the radial extensors of the arm.
   It bends the foot, and presents the sole obliquely inwards.


             The Extensor Longus Digitorum  Pedis,

   Is also  superficially placed just under the  fascia of the leg and
 in front of the  fibula, being  in contact above with* the tibialis anti-
cus,  and  below with the extensor proprius pollicis.  It arises, ten-
dinous and  fleshy, from the outer part of the  head of the  tibia; 
400
MUSCLES.
 from the  head of the fibula, and almost  the whole length  of its
 anterior angle;  also from the upper part of the interosseous liga-
 ment and the internal face of the fascia of the leg.
   Its fibres go obliquely downwards and  forwards to the tendon
 which  begins not far from its upper end, and  descends  along its
 anterior margin.  About the  middle of the leg the tendon  splits
 into four, which are confined  by the annular ligament of the ankle,
 and then diverging, each is inserted into the base of its respective
 toe, the big excepted, and expanded over  its back part as far as
 the last phalanx.
   When these four tendons first reach the roots of the toes, they
 expand over the back of the  articulation  there, and send down-
 wards triangular processes  which are attached  to  the base of the
 first phalanx, and to the  tendinous terminations of the interosseous
 muscles.   On the back of the first joint the tendon adheres closely
 to its synovial membrane, and is somewhat cartilaginous.   At the
 second  joint  the tendon splits  partially into two, which pass some-
 what laterally, and then reunite.  The tendon then adheres again
 closely  to  the synovial  membrane  of the  third articulation, and
 finally terminates in the base of the third phalanx.
   This  muscle extends the toes, but flexes the foot.
   A long  bursa  is found enveloping the tendons where they pass
 beneath the annular ligament  of the  ankle.
   It extends all the joints of the small toes, and  flexes the root.


                     The Peroneus  Terlius,

   Is rather a  portion of  the extensor longus, is  found at its lower
 outer part, and cannot be naturally separated  from  it.  It arises
 from  the  anterior angle  of the fibula,  between  its middle and
 lower end.
   It is  inserted,  by a flattened tendon, into the  base of the meta-
 tarsal bone of the little toe, and assists in bending the foot.


              The Extensor Proprius Pollicis Pedis,

   Is between the lower part of the tibialis anticus,  and of the ex-
tensor longus.  It arises from  the fibula between its anterior and
internal angles, by a tendinous and fleshy origin, which commences 
MUSCLES OF THE LEG.
461
 about four inches below the head of the fibula, and continues almost
 to its inferior extremity.   A few fibres also come from the interos-
 seous ligament, and from the lower part of the tibia.
    The muscle  being  half penniform, the fibres run obliquely to a
 tendon at its fore part, which passes through a particular gutter of
 the annular ligament, and over the astragalus and  scaphoides and
 upper internal parts of the foot, to be inserted into  the base of  the
 first and second phalanx of the  great  toe.   A bursa invests this
 tendon where it passes beneath the  annular ligament.
    It extends, as its name implies, the great toe.*
    On the outside of the leg, between the fibula and fascia, are  the
 two Peronei muscles.


                The Peroneus Longus, seu Primus,

    Arises, tendinous and  fleshy, from  the fore  and  outside of the
 head of the fibula,  from the space on its outer side above, between
 the external and anterior angles; also,  from its external  angle to
 within a short distance of the ankle.
   A flattened thick tendon, to which the fibres pass  obliquely, con-
 stitutes the outer face of the muscle.  This tendon is lodged in the
 groove at the posterior part of  the malleolus externus, being con-
 fined to  it by a  thick ligamentous noose, and furnished there with
 a  bursa; it  then traverses the outer side  of the os calcis, where its
 passage is marked  by a superficial sulcus; from that it runs through
 the groove  of the os cuboides, where there is another bursa. Lyino-
 deep in  the sole of the foot, covered by the calcaneo-cuboid  liga-
 ment, and next  to  the tarsal bones, it is inserted into the base of
 the internal cuneiform bone, and into the adjacent part of the me-
 tatarsal bone of the great toe.
   It extends the foot and inclines the sole obliquely  outwards.  It
 corresponds  with the flexor carpi ulnaris of the fore-arm.
   As the tendon experiences much friction at the ankle, on the os
 calcis, and where it winds around the os cuboides, it  is not  unusual
 to  find in it  small  sesamoid bones  there, especially at the latter
 place.

 * Varieties.  A partial effort is sometimes manifested to divide it into two mua-
cles.
                             39* 
402
MUSCLES.
              The Peroneus Brevis, seu Secundus,

  Is concealed in a great degree by the peroneus  longus, being
situated between the latter and the extensor longus digitorum.  It
arises, tendinous  and fleshy, from the  outer surface of the fibula,
commencing about one-third of  the length of the bone from  its
head, and continuing almost to  the ankle.
  A tendinous facing exists externally also in this muscle, to which
its fibres proceed obliquely.   This tendon is continued  through the
fossa at the back part of the malleolus externus, being covered  by
the tendon of the peroneus longus, and confined by the same liga-
mentous noose;  passing through  the superficial fossa  at the outer
side of the os calcis, it is inserted into the external part of the base
of the metatarsal bone of the little toe.
  It extends the foot, and  presents the  sole obliquely downwards.
It corresponds with the flexor carpi ulnaris.*


                        Triceps Sura.

  The muscular mass on the back of the leg,  constituting its calf,
is formed by the two following  muscles, which, with  much reason,
may be considered as composing only one.  Anatomists, who view
them in this latter light, describe  them under the name of Triceps
Suras, of which the Gastrocnemius portion has two heads, and the
Soleus, or Gastrocnemius internus, but one.

  1. The Gastrocnemius is the  most  superficial  muscle on the
back of the leg, and  conceals  the other, in consequence of  its
breadth.   It  comes  from the condyles of the os  femoris by two
heads.  One head arises, tendinous, from the upper back  part of
the  internal condyle, and fleshy from the adjacent part  of the ridge
leading to the linea aspera: the other head arises, by a broad ten-
dun  in the same way,  from the  external condyle and the ridge
above it.   A triangular vacancy  is left between  the heads of the
muscle for  the passage of the popliteal  vessels; the  heads then
join  together, but in such a way that the appearance of two bellies
is distinctly preserved, of which  the internal  is the largest.  The
* Varieties.  It is sometimes double. 
MUSCLES OF THE LEG.
463
 muscular fibres pass from a broad tendinous facing on the back to
 a corresponding one on  the front surface of the muscle,, from the
 latter of which comes the tendo-Achillis.

   2. The Soleus is beneath the Gastrocnemius, and arises, fleshy,
 from the posterior part of the head of the fibula, and from the ex-
 ternal angle of that  bone, for two-thirds  of its length down, behind
 the  peroneus longus.  It also arises,  fleshy, from the oblique ridge
 on the posterior surface of the tibia,  just at the lower edge of the
 popliteus muscle,  and from the  internal  angle of the tibia for four
 or five inches.  The two  origins  are separated for the passage of
 the  posterior tibial vessels.
   The body of this  muscle  has a great  intermixture of tendinous
 matter in it, and from its lower extremity proceeds another origin
 of the tendo-achillis.  About three or four inches above the heel,
 this tendon joins the anterior face of the tendon of the gastrocne-
 mius, and  by the union of the two the tendo-achillis is completed,
 and then inserted  into the posterior surface of the os calcis near its
 tuberosities.  The tendon becomes more round as it descends.
   These muscles extend the foot, and are all-important in walking.
 A bursa is between  their tendon and the  os calcis.

                         The Plantaris,

   Is a singular little muscle, concealed by the gastrocnemius, and
 has  a short fleshy belly and a long tendon.   It arises, fleshy, from
 the ridge of the os femoris, just above the external  condyle, passes
 across the  capsular  ligament of the joint, and adheres  to  it in its
 course;  the  belly terminates somewhat below the head of the tibia,
 in a  long, delicate tendon, which descends between the inner part
 of the soleus and the gastrocnemius.
   At the place where the tendons of these unite, the tendon of the
 plantaris emerges from between  them, and,  running at  the inner
 edge of the tendo-achillis, is  inserted into the  inside of the os cal-
 cis, just before the insertion of the latter.
   It  extends  the foot.  This muscle is. sometimes wanting.  It
 contributes  so  little  to  the motions of the foot, and, in  other re-
 spects, is of such doubtful use, that its proper destination is uncer-
 tain.  In some mammiferous animals it is large  and important;
perhaps,  therefore, in the human subject,  it is one of the links con- 
464
MUSCLES.
  necting us with animals, of which there are so many evidences in
  the muscular system.

                           The Popliteus,

    Is  a triangular muscle on the back of the knee joint.  It arises,
  by a thick round tendon, from a deep depression on the exterior
  face  of the external  condyle, and which passes through the cap-
  sular ligament, being  connected with the external semi-lunar car-
  tilage; it  then forms a  fleshy belly which  proceeds obliquely
  inwards and downwards.
    It is inserted, fleshy, into  the oblique ridge on the back of the
  tibia, just below its head, and into the triangular depression above
  it.  A bursa exists between  its origin and the capsular ligament;
  its tendon is  in contact with the synovial membrane of the joint.
    It bends the leg, and rotates it inwards^ when bent.

          The Flexor Longus Digitorum  Pedis Perforans,

    Is behind the tibia, and at the inner edge  of the tibialis posticus.
 It  arises, by  an acute, tendinous and fleshy beginning, from the
 back of the tibia,  a little below  the  popliteus  muscle;  its  origin
 being continued along the internal angle of  the tibia almost to the
 ankle  joint.   It arises,  also, by tendinous and fleshy fibres, from
 the outer edge of the tibia, just above its connexion with the fibula
 at  the ankle:  the  latter origin is, however, frequently deficient, and
 between this double order of fibres the tibialis posticus passes.
   The fibres go obliquely into a tendon at the posterior edge of the
 muscle, which runs in the groove  behind the  internal malleolus,
 and is confined there by a strong ligamentous sheath, being placed
 behind, and within the tendon of the tibialis posticus.  The tendon
 then gets to the sole of the foot along the sinuosity of the  os calcis,
 and being joined by a considerable tendon, detached from  the flexor
 longus pollicis, it divides into four branches which are appropriated
 to the  four smaller toes.
  These tendons are inserted into the base of the third phalanges of
 the lesser toes, are very near the tarsal bones, and, from perforating
the tendons of the flexor brevis, correspond  with  the flexor per-
forans  of the hand.   A bursa exists where the tendon passes along
the tibia and the os calcis; and another is found in the sole of the
foot, enveloping this tendon and that of the flexor longus  pollicis.. 
MUSCLES OF THE LEG.
465
  A fifth tendon is sometimes observed, which splits and goes to
the second bone of the small toe: this occurs when the latter is not
supplied from the flexor brevis.
  This muscle  flexes  the small toes, and extends the foot.

                The Flexor Longus Pollicis Pedis,

  Is a stout  muscle formed of oblique fibres, and situated on the
back part of the fibula, at the outer side of the tibialis posticus.  It
arises, by an acute, tendinous and fleshy beginning, from  the pos-
terior flat surface of  the fibula,  commencing  about three inches
from its head, and continuing almost to the ankle.
  The tendon  of this muscle  is large and round ; it forms gra-
dually, and constitutes a facing to the  posterior edge of the muscle.
It passes through a superficial fossa of the tibia, at the back of the
ankle near its middle, and from thence through a notch in the back
edge of the astragalus, to the sole of the foot; at the latter place it
crosses the tendon of the flexor longus digitorum, and gives off to
it the branch just mentioned, which goes, principally, to the second
toe.  This tendon is deeper seated  in  the foot than the other.
  The tendon of the flexor longus pollicis is inserted into the second
phalanx of the  great toe.
  It bends the  great  toe, and from  its connexion with the others
will bend them  also.   A  bursa invests its tendon  in  the canal of
the astragalus, and along the os calcis; another, as stated, is com-
mon to it and the flexor perforans muscle; and a third invests the
tendon  along  the  metatarsal  bone,  and  the first  phalanx of the
great toe.*

                      The Tibialis Posticus,

  Is placed  between, and concealed  by the last two  muscles.  It
arises by a narrow fleshy beginning, from the front of the tibia, at
the under surface of  the  process which joins  it.to the fibula, and
then gets to the back of the leg through the hole in the upper  part
of  the  interosseous ligament.  It  continues its origin  from the
whole of  the interosseous ligament, and from the surfaces of the
tibia and fibula bordering on this ligament, excepting one-third of

  * The variations in this muscle consist, principally, in the manner of distributing
its tendon to that of the small toes, and frequently this connexion is deficient. 
466
MUSCLES.
the lower part of the fibula, and rather more of the lower part of
the tibia.
  The fleshy fibres run obliquely to a middle tendon which passes
in the groove at the back of the malleolus internus, and is confined
there by a fibro-cartilaginous noose, and invested by a bursa.  It
is inserted into the  posterior internal part of the  os naviculare or
scaphoides, at its tuberosity;  and also divides in such a way as to
be inserted into the internal and external cuneiform bones, into the
os cuboides, and os calcis.
  It extends the foot, and presents the sole  obliquely inwards.  It
corresponds with the flexor radialis of the hand.


          SECT. IV.—OF THE MUSCLES OF THE FOOT.

              The Extensor Brevis Digitorum Pedis,

   Is a muscle situdted on the superior surface of the foot.   It is
placed beneath the tendons of the extensor longus, and arises, ten-
dinous and fleshy, from the fore upper part  of the greater apophy-
sis of the os calcis, being intermixed with the origin of the annular
ligament of the ankle.   It forms  a short,  fleshy belly,  which is
partially divided into four parts;  from these parts proceed as many
tendons, which crossing very obliquely the tendons of the extensor
longus, are inserted into  the  great toe, and  the three next toes, by
joining with the tendons  of the extensor longus, which are  spread
over their backs.   The tendon going to  the great toe has its prin-
cipal insertion into the  first phalanx.
   It extends the toes.*

   When the Aponeurosis Plantaris is removed from the sole of the
foot, we see three muscles;  the  middle  one having been covered
by the .large central portion of the aponeurosis, is the Flexor Bre-
vis Digitorum Pedis;  the  outer, is the Abductor  Minimi Digiti
Pedis; and the inner, the Abductor Pollicis Pedis.

  * Varieties.  The internal  part, or belly, is sometimes distinct from the adjoin-
ing.  In some very rare cases  all the bellies are insulated, as in birds.  Sometimes
it sends a tendon to the little toe. 
MUSCLES OF THE FOOT.
467
               The Flexor Brevis Digitorum Pedis,

   Arises, fleshy, from the large tuberosity of the os calcis, by a
 narrow beginning; also from the upper surface of the aponeurosis
 plantaris, and the tendinous septa between it and the contiguous
 muscles.
   It forms a fleshy belly, going nearly as far forwards as the mid-
 dle of the metatarsal bones;  there  it  divides into four tendons,
 which go to the  four smaller toes.  These are perforated  by the
 tendons of the flexor longus, and are inserted into the sides  of  the
 second phalanges.  The  tendon for  the little toe is often deficient.
   It bends the second joint of the toes.

   By detaching this muscle from its origin, and turning it  down,
 we bring into view the  tendon  of the Flexor Longus Digitorum
 Pedis; and the attachment of  the latter to the tendinous slip from
 the Flexor Longus Pollicis,—to the Flexor Accessories,  or Massa
 Carnea Jacobi Sylvii,—and to  the Lumbricales Muscles.


                    The Flexor Accessorius,

   Is at the outside of the tendon of the flexor longus digitorum
 pedis.  It arises, fleshy, from the inside of the sinuosity of the os
 calcis, and, by a thin tendon, from the  outside of the same bone
 before its posterior tuberosities.
   It is inserted, fleshy, into the outside of the tendon  of the  flexor
 longus, just at its division into  four tendons.  Like a  second hand
 to a rope, it assists in flexing the toes.


                    The Lumbricales Pedis,

   Are four small tapering muscles, which arise from the tendon
of the flexor longus digitorum pedis, just after its division, or while
it is in the act of dividing.  One of  them is appropriated to each
lesser toe, and is inserted into the inside of its first phalanx, and
into  the tendinous expansion that is sent off from the extensor
muscles to cover its dorsum.
  They increase the flexion of the toes, and draw them inwards. 
468
MUSCLES.
                   The Abductor Pollicis Pedis,

   Arises, tendinous and fleshy, from  the internal anterior part of
 the large tuberosity of the os calcis; from a ligament being a part
 of the aponeurosis of the sole of the  foot extended from this tube-
 rosity to the sheath of the tendon of the tibialis posticus; from the
 internal side of the naviculare, and from the cuneiforme internum.
   It forms the internal margin of the sole of the foot, and is in-
 serted, tendinous,  into the internal sesamoid bone, and  into the
 base of the first phalanx of the great toe.
   It draws the great toe from the rest.


                 The Flexor Brevis Pollicis Pedis,

   Is situated immediately at the exterior edge of the abductor pol-
 licis.   It consists of two bellies, which are parallel with each other,
vand separated by the  tendon of  the flexor longus pollicis; one is
 inseparably connected with the  tendon  of  the abductor  pollicis,
 and the other with the adductor pollicis  pedis.
   It arises, in common with  the  calcaneo-cuboid ligament, tendi-
 nous, from the under part of the os calcis, just  behind its connexion
 with the os cuboides, and from the under part of the external cu-
 neiform bone.
   The internal  belly is  inserted,  tendinous, into  the internal sesa-
 moid bone, along with the tendon of the abductor pollicis, and the
 external belly is  inserted,  tendinous, into  the external sesamoid
 bone, along with the tendon of the adductor pollicis.   Each inser-
 tion is continued to the base of the first  phalanx of the great toe.
   It flexes the great toe.


                   The Adductor Pollicis Pedis,

   Is situated at the outside of the  flexor brevis, and  is extended
 obliquely across the metatarsal bones.  It arises, tendinous, at the
 external part of the foot, from the calcaneo-cuboid ligament, and
 from the bases of the second, third, and fourth metatarsal bones.
   It is inserted, tendinous, into the external  sesamoid bone, which
 insertion is continued  to the first  phalanx of the great toe, and is 
MUSCLES OF THE FOOT.
469
closely united to the tendon  of the external head of the flexor
brevis pollicis.
  It draws the great toe towards the others.


               The Abductor  Minimi Digiti Pedis,

  Forms the external margin of the sole of the foot, and is imme-
diately beneath the aponeurosis plantaris.   It arises, tendinous and
fleshy, from the outer tuberosity of the os calcis, and also from the
exterior part of the base of the metatarsal bone of the little toe.
  It is inserted, by a rounded tendon, into the exterior part of the
base of the first phalanx of the little  toe.
  It draws the little toe from  the other toes.
             The Flexor Brevis Minimi Digiti Pedis,

  Is just within the tendon of the abductor minimi digiti.   It arises
from the calcaneo-cuboid ligament as extended from the tuberosity
of the cuboid bone to the bases of the two outer metatarsal bones;
also from the base of the outer or fifth metatarsal bone.
  It is inserted, by a tendon, into the lower part  of the  first pha-
lanx of the little toe, at its base, and into the head of the metatar-
sal  bone of the same toe.
  It bends the little toe.
                    The Transversalis Pedis,

  Is placed  beneath the tendons  of  the  flexor muscles.*  It is
small, and lies across the anterior extremities  of the  metatarsal
bones.   It arises, tendinous, from the capsular ligament of the first
joint of the little toe; it also arises from the capsular ligament of
the first joint of the next toe.
  It is inserted into the exterior face of the common tendon of the
adductor and the flexor brevis pollicis, at the external sesamoid
bone.
  It approximates the heads of the metatarsal bones.
Vol. I.—40
* The sole is presumed to be upwards. 
470
MUSCLES.
  The Interosseous Muscles are  seven  in  number, four of which
may be seen on the upper surface of the foot.  There are two to
the first smaller toe, two to the second, two to the third, and one
to the fourth, or little toe.  The muscles seen on the upper side of
the foot are double-headed, that is, they arise from the contiguous
surfaces of the metatarsal bones.


   The Interosseus Primus, Digiti Primi Pedis, or the Abductor
                         Indicis Pedis,

  Is seen superiorly.   It is placed between the metatarsal  bone of
the great toe, and the first small toe, and arises, fleshy, by a double
head, from the opposed surfaces of their roots and bodies.
  It is inserted, tendinous, into the inside of the root  of the first
joint of the first small toe, and pulls it inwards.


The Interosseus Secundus, Digiti Primi, or the Adductor  Indicis
                            Pedis,
                                           ■%
  Is also external or above.  It is situated between the metatarsal
bones of the first and second small toes, arising from  the opposed
surfaces of their roots and bodies by a double, fleshy, and tendi-
nous head.
  It is inserted into the outside of the  first  phalanx  of the same
toe, by a tendon.
  It draws this toe  outwards.


 The Interosseus Secundus, Digiti Secundi, or the Adductor Medii
                            Digiti,

  Is seen at the upper part of  the foot, between the  second and
third metatarsal bones of  the lesser toes, arising from  the opposite
surfaces of their roots and bodies*
  It is inserted, tendinous, into  the outside of the base of the first
phalanx of the second small toe*
  It draws this toe  outwards. 
MUSCLES OF THE FOOT.
471
 The Interosseus Secundus, Digiti Tertii, or the Adductor  Tertii
                             Digiti,

   Is seen on the upper surface of the foot, occupying the interval
 of the  metatarsal  bones of the  third  and fourth small toes, and
 arises, by a double head, from the opposite surfaces of  their roots
 and bodies.
   It is inserted, tendinous, into  the outside of the root  of the first
 phalanx of the third small toe.
   It draws this toe outwards.


 The Interosseus Primus, Digiti Secundi Pedis, or the Abductor
                         Medii Digiti,

   Is at the bottom of the foot, and arises from the inside of the
 metatarsal bone of the second smaller toe.
   It is  inserted into the inside of the first phalanx of the second
 toe.
   It draws this toe inwards.


 The Interosseus Primus, Digiti  Tertii,  or  the Abductor  Tertii
                             Digiti,

   Is in  the sole of  the foot.  It arises from the inside of the  meta-
 tarsal bone of the third smaller toe, beginning near its root, and is
 inserted, tendinous, into the inside of the base of the first phalanx
 of the same toe.
   It draws this toe inwards.


          The  Interosseus seu  Adductor, Digiti Minimi,

  Is on  the under surface of the foot.   It arises from the inside of
the base and body of the metatarsal bone of the fourth small, or
the little toe, and is inserted, tendinous, into  the  inside of the first
phalanx of the little toe.
  It draws this toe inwards. 
 
BOOK  IV.
             OF  THE ORGANS  OF DIGESTION.

  The organs of  digestion consist in an uninterrupted canal ex-
tending from the lips to the anus; and of numerous glandular bodies
placed all along its track, for pouring their secretions into it.

  This canal, called  Alimentary, (Ductus  Cibarius,) is in three
principal portions: the superior, the middle, and the inferior or ter-
minating.  The superior  portion  is  composed of the mouth, the
pharynx, and  the oesophagus.  The  middle, of the  stomach  and
small intestine.  And the inferior, of the large intestine.

  The glandular organs are the salivary glands, the pancreas, the
liver, the  spleen, and an extremely numerous  set of  muciparous
glands, extending from one end to the other of the canal.
  The organs of digestion maybe divided, according to their phy-
siological functions, into those of  mastication and deglutition, and
into those of assimilation.
40* 
x  A 
BOOK IV.
                         PART I.

      ORGANS  OF MASTICATION AND DEGLUTITION.

                       CHAPTER I.

                      Of  the Mouth.

  The Mouth (Cavum Oris) occupies the space in the  inferior
part of the face, between the upper and the lower jaw.  It  is sepa-
rated from the nose by the palatine processes of the superior max-
illary and palate bones, and by the soft palate, which is continued
backwards  from them.  It  extends from the lips, in front, to the
soft palate and pharynx behind, and its floor is formed by the mylo-
hyoid muscles.
  The anterior and lateral periphery of the mouth is constituted by
the muscles of the lips and cheeks, covered externally by common
integuments, and internally by the lining membrane of the mouth.
The cavity of the latter is divided into  two portions,  by  the pro-
jection of the teeth and of the alveolar processes of the upper and
under jaws;  these two portions when the teeth are complete, are
separated from each  other while  the mouth is closed.  The ante-
rior portion, which is sometimes called the vestibule of the mouth,
varies its size very considerably in mastication, and has its  parietes
extremely moveable.   The capaciousness of the posterior admits
also of much change,, by the motions of the tongue and by the de-
pression of the lower  jaw.
  The whole cavity  of the mouth  is lined by a membrane, con-
tinued over the lips from the skin, and, in many respects, strongly
resembling the texture of the latter; it is, however, much  finer; is
furnished every where with an epidermis; is  very vascular, and 
476
OKGANS OF DIGESTION.
has beneath it a great number of muciparous glands.   Its texture
undergoes  some changes, according to  its position, upon the lips
and cheeks, upon the gums and palate, and  upon the tongue; all
of which will be explained in due season.
   This lining membrane of  the mouth, for the most part thin and
very flexible, forms, at several points, folds or duplicatures.   Four
of them are situated on the middle line of the mouth, and are called
frenula:  one goes from the posterior face of the upper lip to the
middle  palate suture  in front of the central alveolar processes of
the upper jaw; a second goes from  the posterior face of the lower
lip to the front of the symphysis of the lower jaw; a third goes
from  the under part of the tongue to the posterior face of the sym-
physis of the lower jaw, (franulum lingua;) and the  fourth goes
from  the front of the epiglottis  cartilage to the middle  of the root
of the tongue.   Besides  these, there are some  other duplications,
which will be mentioned in their proper order.

   The lips (Labia) are always somewhat thicker at  their  loose
margins than elsewhere; the skin which covers them there, is re-
markable for its vascularity, and changes  its texture insensibly, as
it is continued from the face to the  lining membrane of the mouth.
   The upper lip is longer and thicker than the lower, is somewhat
pointed in  the  centre, and  has on its front  surface a  vertical de-
pression, (philtrum,) beginning at the septum  of the nose and
going downwards to  the centre of  the lip.  This depression  is the
remains of  a  fissure which  always exists between the  two halves
of the lip, in the early fcetal or forming stage.  The junction of the
extremities of the lips constitutes the corners of the mouth (anguli
oris.)
   The lips  are  composed  of muscular fibres, much blended with
 adipose  matter.   The  muscles which  concur to form them are
 the orbicularis oris and the buccinators;  besides which, the  upper
 lip is furnished  on each side with  the two  levators, with the de-
pressor, and the zygomatici; while the lower lip has  its two de-
pressors and a levator.   See muscles of the face. 
OF THE TEETH.
477
                       CHAPTER II.

                       Of the Teeth,

  The Teeth  (Dentes)  are  by far the hardest portions  of  the
human fabric; and though they bear  in their composition  and
appearance a strong  analogy with  bone, yet they differ from it in
their more limited duration, their mode of devolopment, their par-
tial nudity, their nutrition, and in the manner  by which they  are
united to the body.
  The greater part of the length of each tooth is implanted  into
the alveolar process of  the jaw, and the'part  so fixed is techni-
cally called the root; immediately  beyond  this a small portion of
the tooth is embraced by the gum; this is the neck; and the free,
or projecting part of the tooth  covered with a shining porcelain
like layer called the enamel, is its body.
                         SECTION I.

   The whole number of teeth in the adult is thirty-two, sixteen in
 each jaw, and, when healthy, they are  all fixed with so much firm-
 ness by the gomphosis articulation, that the very slight degree of
 motion, which, by force, they may be caused to execute, is scarcely
 perceptible.  The differences existing in their shape, have caused
 anatomists to classify them accordingly;  on each side of the mid-
 dle line of each jaw  there are two Incisors, one Cuspated, two
 Bicuspated, and  three Molar teeth.  There are  also some pecu-
 liarities, as they belong to the upper or to the lower jaw; but they
 correspond exactly with their fellows  on the  opposite side of the
 same jaw.

  The Incisors (Dentes Incisivi) are next to the middle line, and
 are named from their being brought to a straight cutting edge, like
 a chisel, by  being  bevelled from  behind.  They are somewhat
convex on their anterior face, but behind they are very concave:
owing to their thinness for some  distance from the  cutting edge, 
47 c.
ORGANS OF DIGESTION.
they  are  apt  to be  broken.  In early life, their cutting edge is
slightly serrated.   They have each but one root, which is conoidal,
terminates by a  sharp point, and  is  not  unfrequently impressed
longitudinally on  each side by a superficial furrow.
   The  central incisors of the  upper jaw are broader and longer
than the outer ones; the anterior face of the latter is more convex,
and their cutting  edge more rounded.  The incisors of the lower
jaw are much narrower than those of the upper, and have  their
roots  flattened on  the sides; they do not  differ  essentially among
themselves, except that the external ones are somewhat wider than
the internal.
   The  enamel of the incisors  is continued farther down, and is
thicker on their anterior  and posterior surface than laterally; it
is also thicker on the front than  on the back part.*

   The Cuspated  Teeth (Dentes Cuspidati, Canini,) are next to
the incisors, one on each side.  Their body is conoidal, and is
brought to a  sharp point at its  summit; the principal obliquity in
effecting the latter, being on the side of the interior of the mouth.
They are more convex externally, than the incisors, but not so
concave internally, they  are  also  thicker and more cylindroid.
They have each  but one root,  which is  conoidal, and which, as
also the  body, is longer than the corresponding portion of any of
the other teeth.   They stand nearly perpendicularly, and  are more
covered on their sides with enamel than the incisors.
   The cuspated  teeth of  the  upper jaw  have longer roots  than
those  of the lower, and are called, in common language, eye-teeth:
those  of the lower jaw sometimes are called stomach-teeth.

   The Bicuspated Teeth (Dentes Bicuspidati,) two in number on
each  side, are situated  behind the  cuspate;  they  are also called
small  molar.   They are almost precisely alike, with the exception
that the first is smaller than the  other, and resembles rather more
the type of the cuspidatus than the second does.   Their body is
very nearly cylindrical, being flattened, however, on the faces next to
the adjoining teeth.   The masticating surface of the body is formed
into two points, whence the name; one external, and the other in-
ternal : the former is the longest and  thickest, and, consequently,

     * Natural History of the Human Teeth, by J. Hunter, London, 1778. 
OF THE TEETH.
479
the most conspicuous.   The  enamel forms  an  almost  circular
crown, covering the projecting parts of these teeth.  The root of
each one is single, but has  a deep and well marked fossa on each
side running  its whole length,  and presenting the semblance of an
effort at duplicity; it is also conoidal, and sometimes in the upper
jaw bifurcated at its end.
   The bicuspate teeth of the upper and of the lower jaw resemble
each  other so strongly that the difference between them is not
striking; it is, however, determined by  those of  the upper  jaw
being rather  more  voluminous and  ovoidal in their  bodies, and
having rather longer and larger roots.

   The Molar Teeth, (Dentes  Molares,) three in number, on each
side,  succeed the bicuspated.   They are well characterized by
their greater  size.   Their bodies are almost cuboidal, with rounded
angles, and are protected with a circular crown of enamel;  their
grinding surface  has five points,  three externally, and  two inter-
nally : the  rule, however, is not uniform, as they frequently have
only four, and sometimes in the upper jaw only three points.
   The first molar is the largest  of  any, and very generally has
five points, in the upper jaw it has three roots, two of  which are
outward, and the other  inward ; but in  the lower jaw it has only
two roots, one before the other.
   The second molar of each jaw, with the exception of its being
smaller than  the first, presents  no essential difference from  it, either
in regard to its body or roots.   The fifth point is sometimes not so
well developed.
   The  third  molar  resembles the other  two  in its body, but is
smaller than  either of them.   Most frequently its  roots, instead of
diverging from each other  and standing out distinctly,  are imper-
fectly developed, and fused  together.  Some slight separation at
their extremities, and the longitudinal depressions  on  their sides
mark the effort to form three roots for the tooth of the upper jaw,
and two for the lower,  according to  the general rule.  Owing to
this tooth growing at the posterior extremity of the alveolar pro-
cesses, in a place where, from the preceding development of the
other teeth, it is much cramped for room, it is not only imperfectly
evolved in most cases, but it often  takes a very irregular direction •
its grinding surface  sometimes looking  forwards and sometimes
backwards. 
480
ORGANS OF DIGESTION.
  The Alveolar Processes in each jaw form a semi-elliptical row
of sockets, for the  insertion  of  the roots of the teeth into them.
These processes  and the teeth, as  Mr. Hunter has very properly
explained, have such a mutual dependence upon each other, that
the destruction of the one is inevitably followed by that of the
other: "If we had no teeth, it  is likely we should not only have
no sockets, but not even  these processes  in which the sockets are
formed."*  The semi-elliptical arrangement observed by the teeth
is such, that when the mouth is closed, the exterior circumference
of the row above projects  beyond  those below; this is more ob-
viously the case in front; but  it also prevails at  the sides, and
depends primarily upon the greater breadth of the  incisors of the
upper jaw.  The grinding surface  of the under row, as a whole,
is slightly concave from  before backwards,  while the opposed sur-
face of the upper row has a corresponding convexity.  Each row,
viewed collectively, forms a single edge, in front; but after having
passed the cuspidati, it becomes thicker, forms a double edge, and
is continued backwards in that state.


       SECT. II.—OF THE TEXTURE  AND  ORGANIZATION
                       OF THE TEETH.

   The teeth consist in three kinds of substance, one of which is
ivory or bone-like, another  enamel, and the third  cortical, also
caljed cement.

   The Enamel forms the periphery of the body of a tooth, and is
distinguished by its whiteness, its brittleness, its semi-transparency,
and a hardness so considerable  that it soon takes down the edge
of the best tempered saw or file, so that it is very difficult to pene-
trate it.  It forms a  crust upon the body scarcely half a line in
thickness,  is more abundant upon  the  grinding surface, and is
reduced to a  thin edge where  it terminates at the neck.   When
broken,  it is  seen  to  be composed of minute  hexagonal  or four
sided crystalline fibres, and the  fibres  are so placed as to pass in
a direction from the surface towards  the  centre of the tooth: by
which all  the friction to which the fibres  are exposed is  applied
* Loc. cit. p. 7. 
TEXTURE AND ORGANIZATION OF THE TEETH.
481
against their extremities:  an arrangement on the principle of the
articular cartilages, and, like them, precisely suited to resist their
being rubbed down in mastication, and also to  prevent their split-
ting.
   Enamel consists principally in a phosphate of lime, with a very
small proportion of gelatine, about two per cent.  When immersed
in a weak acid, its form  is retained, but the slightest disturbance
afterwards causes it to crumble  down  into a white pulp.   When
animals  are fed upon  madder,  the colour of the enamel  is not
affected ;* though  it  may be changed by dyes  applied externally,
as exhibited by the inhabitants of the Pelew Islands, who, by the
use of plants turn it black, and by persons who chew tobacco, in
whom it  becomes yellow.  It is entirely devoid of blood vessels.
When exposed to heat it becomes very brittle, cracks off from the
enclosed bony part of the  body, and presents a singed appearance,
from the small quantity of gelatine in it.
   The enamel  is separated  from the ivory by an extremely fine
membrane, which  extends its processes outwardly, so as  to form a
thin organic sheath for each enamel fibre.
   The enamel  is not  so thick on the deciduous as on the perma-
nent teeth;  it is thicker on the cuspidati  than on the incisors, and
on the first molar than on the second and third.  It is very readily
dissolved  in strong nitric or muriatic acid.

   The Ivory portion of the tooth is  by much  the  most abundant,
as it forms  the root, the neck, and the body also,  with the excep-
tion of the crust of enamel upon it.   In  its texture it strongly re-
sembles the petrous bone, and is even harder than it, but has no
cellular arrangement within.   It consists  in a series of longitudinal
laminae, one within the other, and when decomposed presents about
seventy parts of the  phosphate of lime and other calcarious com-
binations,  with  about twenty of gelatine and ten of water.f
  When the ivory or bone like part of a  tooth is examined micro-
scopically in  thin  slices, it  is found  to  be permeated  by slightly
bent cylindrical tubuli, close to one another, and running outwards
towards the  surface of the tooth.  One end, and the larger of each

  * J. Hunler, loc.  cit.  I have also verified the same  opinion by the same experi-
ment.
  t Pepys.
  Vol. I.—41 
482
ORGANS OF DIGESTION.
canal runs into the cavity of  the tooth,—the other end ramifies
with extreme minuteness, and  seems to penetrate partially the
enamel  and the cement.   In the living tooth they are said to con-
tain a reddish fluid, but they are too  small  for blood corpuscles.*
Miiller  is of opinion  that they also contain calcarious matter.
This portion of the dental  structure is called, also, the Substantia
propria.
  The ivory part of a tooth  has very nearly the same  form with
the entire body;  hence, upon the  grinding  surface, we  have the
same modifications of  shape as when the enamel is left on.   The
application of a heated iron to it, turns it to  a deep black from the
abundance of animal matter in it, which is  one way to mark out
decidedly the distinction between it and enamel.  The animal sub-
stance, when separated from  the  calcarious by muriatic acid, is
more compact than the corresponding substance of bone, but, like
it, is soft and flexible.
  The ivory part is not vascular; Mr. Hunter, after repeated trials
in old and young subjects upon  this point, never  succeeded  in
making an injection of it;  neither  could he  trace vessels from the
pulp to a growing tooth.   In  growing animals, fed upon madder,
he  found  that the portion which  was  formed  previously to  the
commencement of this  diet, retained its primitive colour, while the
part formed during the administration of the diet was affected by
it and turned red : again, if the animal were  permitted to live some
weeks after the madder was suspended, to the preceding condition
was superadded a new layer of white.  In this experiment, a con-
clusive difference from common bone is established ; for besides, in
all cases, the facility of injecting the latter with size, it is suscepti-
ble  of being dyed throughout by the administration of  madder:
though  the formed  parts do not take the latter so readily as  the
forming.  These  experiments,  which are confirmed by my own
observations, prove satisfactorily the  total absence  of blood vessels
in the texture of  the teeth; and that the colouring  matter, when
fixed in them, does  not depend upon a circulation, but  upon its
being deposited as the tooth grows, and left there permanently.
The teeth are consequently not subjected to a mutation of parti-
cles, and  to being continually  remodelled as the  bones  are;  but
when once formed, they remain in the same state, without change.
* Gerber, Gen. Anat., page 198. 
TEXTURE AND ORGANIZATION OF THE TEETH.
483
  The Cement (crusta petrosa) is an envelope to the substantia pro-
pria, or ivory, extending from the margin of the enamel to the tip
of the fang.   There seems to be  no difference between it and com-
mon bone, and  it augments in quantity as life  advances—in some
individuals it is  so exuberant as to make the fangs club like.  In the
ruminantia it forms stratifications in the interior of the teeth, side by
side with the enamel.  As  the teeth become worn in the progress
of life a new barrier is presented  against the exposure of the cavity
by the deposite in it of this substance, which  in  some cases fills
the  cavity entirely.
  Under the microscope, bone corpuscles are visible in the cement,
which  are in layers concentrically disposed,  but their radiations
are  smaller than those of common bone.   Gerber asserts, that it is
furnished with  a few blood vessels of considerable size, which run
from the root outwards and  towards the crown.   As his compa-
rative and human anatomy are much blended  in  his descriptions,
he has not specified whether the  arrangement exists in man or not.

  Every tooth  has within its body a cavity, Cavitas pulpi, which
varies in form and size according  to the class  to which  the tooth
belongs: this cavity  is continued as a conoidal canal, through the
whole length of each root, and terminates, by  a small opening, at
its point.  The cavity is  smooth on its internal surface,  and is
filled with a  soft pulpy matter which has no adhesion to the sides
of the tooth, but receives, through  the opening  in the  root, an
artery, a vein,  and a nerve.   The surface of the pulp is moistened
by a slight exhalation,  and its principal bulk seems to be formed
by the nerve, on  which the vessels ramify; the latter in youth are
much more  abundant than in old age.*  The base of each projec-
tion  on the grinding surface of a  tooth is hollowed out for receiving
a process from  the pulp.  The latter is supposed,  by M. Serres, to
be a ganglion;  it must, however, be a point of much difficulty to
fix this character upon  it, as the fine cellular substance which holds
its constituents  together may  be  readily mistaken for soft nervous
fibres.
  The arteries  of the teeth of the upper jaw are  derived from the
alveolar and the infra-orbitar,  and the  nerves from the second
branch of the fifth pair.  The arteries of the  teeth of the lower

        * Serres, Essai sur PAnat. et  Physiol, des Dents, Paris, 1817. 
484
ORGANS OF DIGESTION.
jaw come from a single branch of the internal  maxillary, and the
nerves from the third branch of the fifth pair.  The inferior max-
illary, or dental artery, and nerve, go through the canal in the
centre of the spongy  structure of the lower  jaw, and send off
branches successively to the roots of the teeth.  The residue of the
artery and nerve issues through the anterior mental foramen.
  The teeth have  been, very generally ranged among the bones
belonging to the skeleton.   This opinion, nearly at  one time obso-
lete, has been  latterly revived by the researches of the microscopi-
cal anatomists,* and they are now said  to be modified or epithelial
bones.  The opposite authorities,! now  perhaps somewhat  anti-
quated, are disposed to view them as the production  of the dermoid
tissue, like  the nails and the hair, and to withdraw  them from the
class  of bones;  for the following reasons.   The rudiments of the
bones are always in a  cartilaginous state, and  they are gradually
changed from  that condition to the perfect  bone; the  teeth are
never so, for the secretion which forms  them is from the beginning
deposited in the state in which  it ever  afterwards remains.  The
bones  are all  furnished with a  periosteum; the teeth  are not so
fully, but have the surfaces of their bodies exposed to the air.  The
general softening of the skeleton which  occurs in  some cases of
rickets, never is  manifested in the teeth.J  The texture of the bones
is  penetrated in every  direction with blood vessels, but only the
central pulp of  the teeth is furnished with  the latter.   The teeth
are composed of two kinds of calcarious matter, one osseous, the
other enamel; the bones, on the contrary, have but  one.§  To this
we may add, that  the teeth have no power of interstitial growth
like the bones.   It is also said by naturalists, that in mammiferous
animals, the teeth  present  insensible transitions  from their most
perfect state to a lamellated condition resembling horns and nails.||
Some animals, as  the  shark, have the  teeth  only adhering to the
gum and not fixed  in sockets, others have them in the  stomach:
both of which circumstances  serve to  illustrate still  farther the
independence of the teeth upon the osseous system; and  that  their

  *  Mischer, Muller, Retzeris, Nasmyth, Owen, and Guber,
  t  J. F. Meckel, Hipp. Cloquet, Breschet, Serres, &c.
  t  There is, however, a species of britlleness of the teeth, in which their strength
becomes about that of pipe clay.
  §  Serres, loc. cit.
  II  Traducteurs dc J. F. Meckel. 
FORMATION OF THE TEETH.
485
being fixed in sockets belonging to the latter, is merely a collateral
and not an essential arrangement.


                         SECTION III.

   The Gums (Gingiva) are a continuation of the lining membrane
of the mouth over the alveolar processes, but its texture there is
much changed; as it becomes more  fibrous and  vascular, and
loses  much of its sensibility and capability of being extended.  As
the gums cover both  the lingual and the buccal  circumference of
the alveolar processes, they adhere very closely to the periosteum
and  send in partitions through the interstices between the teeth.
They also adhere  tightly to the neck of  each tooth, so  that when
the latter is drawn, the gum, unless previously detached, is apt to
be lacerated; this  adhesion  is by a sort of rounded or partially
doubled edge, that admits of a slight degree of motion, and which
from  its thickness, if  it be removed  by ulceration or by pressure,
causes the tooth to appear to project unnaturally from its socket.
The teeth, from being united to the jaw by the gum, and  by the
periosteum  being continued over  the  cavity of  the socket; have
preserved to them  that degree of yielding motion which prevents
them, on their  unexpected and  forcible application to hard  bodies,,
from  being fractured, and also saves their sockets.*


       SECT. IV.—OF THE FORMATION OF THE TEETH.

   The teeth, before they  become visible, are formed in the interior
of the maxillary bones.  Their rudiments then consist in a vascu-
lar pulpy substance, having somewhat the shape of the future tooth,
and surrounded by two membranes or sacs.
  The external sac is soft, fibrous, and spongy, and, according to
Mr. Hunter, is  destitute  of vessels.  It lines the interior  of the
socket, thereby  forming  its periosteum ;f adheres  closely by its
deepest end  to the dental  nerves and blood vessels, and by its su-
perficial one  to  the cartilaginous  thickening which exists  on  the
margins of the  gums  of infants.  Fox, Blake, and Meckel, consi-

         * J. Hunter, loc. cit.                t Serres, loc. cit.
                             41* 
486
ORGANS OF DIGESTION.
der this sac vascular, which I think more probable, from its being
a continuation of the periosteum, or acting as such.  Mr. Hunter
might, therefore, mean that it  was comparatively destitute of ves-
sels, and not totally.  It is more spongy, loose, and soft, than the
internal sac, and owing to its adhesion to the gum may, by pulling
at the latter,  be  readily drawn out entire with all  its  contents.
The internal sac is  extremely  vascular, and when successfully in-
jected appears red  all over;  it is very thin and transparent, and
was considered by  Bichat as  a  serous  membrane.   It adheres to
the external sac where the latter corresponds with the gum; but is
elsewhere detached from it with the exception of its base, where
it is united by the medium of the vessels that penetrate to the pulp,
and in doing so it obtains its  extreme vascularity from these ves-
sels.   Between it and the pulp there is a  mucilaginous fluid like
the synovia of the joints;* which  causes the  internal sac to pro-
trude like  a hernia, if a small puncture be made through the pa-
rietes of the external one.  The internal sac forms  an envelope to
the vessels and nerves of the pulp, and being reflected along them,
terminates by adhering to the base of  the pulp.  When the  tooth
protrudes through  the gum, the capsule  thus  formed by  the two
sacs is perforated at its apex; and wastes away, like the gam, till
the body of the tooth is sufficiently advanced.   The  two capsules
which are then to be considered as the periosteum of the socket
and of the root of the tooth, adhere closely to the neck of the lat-
ter and to  its  root.   These sacs, or follicles, as  they are sometimes
called, are visible in the tenth week of  uterine existence.

   The Pulp, or germ of the tooth (Pulpa Dentis) is a very vascu-
lar body, and adheres to the socket only  at its  bottom, where the
vessels enter; it becomes sufficiently  distinct about the fourth
month of foetal existence, and rises up then from the base of the
internal membrane of the sac  like a small simple tubercle.  In de-
veloping itself it acquires the precise  form  peculiar to each tooth,
and is actually the  mould, for it:  it is  surrounded by a very fine
vascular web, which is detached from  it  with much difficulty.

   The ossification  of a  tooth first commences on that surface of
the pulp next  to the gum, by one or more points according to the
* Hunter, loc. cit. 
FORMATION OF THE TEETH.
487
 number of  projections, which the  future tooth is  to  have on its
 grinding surface.  The osseous deposite in  its very early stage is
 thin, soft, and elastic, but soon acquires a hard consistence.  The
 incisors begin to ossify by three points* the cuspidatus by one, the
 bicuspis by two, and the molaris  by three, four or  five.   The  se-
 veral points of ossification continue to increase till their  bases come
 into contact; they then coalesce,  and afterwards the tooth grows
 as an entire body.  The triturating surface of the tooth being first
 formed after this manner, a deposite of bone then takes place along
 its edges, till  the body of the tooth, with the cavity in the centre,
 is completely built up.   In this progress, it gradually surrounds the
 pulp, till the whole of the latter, excepting its base, is covered with
 bone.

   The adhesion of the pulp to the new-formed bone is such as  to
 require some slight force to separate them;  but this may be done
 without  rupturing either the one or the other; their surfaces which
 were in  contact are perfectly smooth, neither is there any  evidence
 of  a vascular communication  between them.*  The line of the
 strongest adhesion is along the latest formed edge of the tooth, and
 that results from the exact apposition of the pulp and it.
   The crown or body of  the  tooth being finally finished, its base
 is somewhat contracted, and thus  forms the neck of the tooth.  In
 the subsequent process of the ossification of  the roots,, the number
 of the latter is predetermined and  always indicated by the number
 of distinct vessels and nerves which go  to  the pulp;  there are,
 therefore, three roots to the upper  molares, two to  the  lower, one
 to the incisors, and so on.  When the root is fully formed, its ex-
 tremity is tapered off to a conoidal point; and the canal or hollow
 in it containing the pulp  is diminished to a proportionate size, so
that  being also conoidal, its external end appears as  a very small
 opening not large enough to admit a bristle.
  From the preceding account, it  is  clear that the  bony part of
 the tooth is formed by an exudation  from the external  surface of
the pulp; consequently,  that the external lamina of the crown is
the first one deposited, and is originally of the size which  it  ever
afterwards retains;  and that  the pulp continues this secretion of
bony matter, from the circumference to the centre; until the tooth.
* Hunter, Serres, Meckel, loc. cit. 
488
ORGANS OF DIGESTION.
(body, neck, and root,) is  completely formed.  The pulp, during
this process, diminishes continually in size, but elongates itself at
the same time towards the  bottom of the socket;  or, in the words
of Mr. Hunter, " is lengthened into a  fang."
   As the fang  grows in length, the  resistance being  at its end,
causes the tooth  to rise through  the gum; the socket, in the mean
time, has grasped the neck, or beginning fang, and, being modelled
upon the root, arises with it.*   Mr.  Hunter's experiments on ani-
mals, interruptedly fed  on  madder,  prove, conclusively, that the
bony part of a tooth is formed of  lamellae, one placed within ano-
ther; that the outer lamella being first formed, is consequently, the
shortest, and that the internal ones lengthen successively.
   In  the formation of  a molar tooth, when the body is finished,
ossifications shoot from its  brim, and proceed to the centre, where,
by their union, they form the commencement of two, three, or even
more roots.  Mr. Hunter says,  that also a distinct ossification is
frequently found  upon the centre of the base of the pulp;  and two
or more processes, according to the number of roots to be formed,
proceed to join it from the  circumference of the tooth; and in this
way the fangs  of the multiform teeth  begin.
   The secretion  of enamel begins shortly after the external lami-
nse of the bony  matter commence being  deposited.  This secre-
tion, which has its mould  always previously formed of the bony
part, comes from a  pulpy substance adhering to  the internal face
of the internal capsule.   This pulpy substance is placed on the part
of the capsule nearest  to the gum,  and  faces the pulp which se-
cretes the bone;  whatever eminences the  one pulp has, the other
has the same, but reversed, so that they exactly fit  upon  each other.
This pulp is  best  seen in the foetus of seven or eight months, and
is not very vascular; it is  much  thinner than the  other, and de-
creases in size  as the development of the teeth advances.  That
which belongs  to the incisor teeth  is  in contact with their concave

  * The doctrine about the dermoid origin  c,f the teeth, seems to have presented it-
self forcibly to the original and sagacious mind of Mr. Hunter; for he says, " Both
in the body and in ihe fang of a growing tooth, the extreme edge of the ossification
is so thin, transparent, and flexible, that it  would appear to be horny rather than
bony, very much like the mouth or edge of the shell of a snail when it is growing:
and, indeed, it would  seem to grow much in the same manner, and the ossified part
of a tooth would seem to have much the same connexion with the pulp as a snail
has with its shell."—Nat. Hist, of Human Teeth, p> 90. 
FORMATION OF THE TEETH.
489
interior surface, but in the molar  it is opposed to their biting sur-
face.*
   " In the graminivorous animals, such  as  the  horse, cow, &c,
whose teeth have the  enamel intermixed with the bony part, and
whose teeth, when forming, have  as  many interstices as there are
continuations of the enamel, we find  processes from the pulp pass-
ing down into those interstices as far as  the pulp which the tooth
is formed from, and there coming into contact with it.
   " The enamel appears to  be secreted from the pulp above de-
scribed, and perhaps from the capsula which encloses the body  of
the tooth.   That it is from the pulp  and capsula, seems evident  in
the horse, ass, ox, sheep, &c.; therefore, we have little reason  to
doubt of  it in the human species.  It is a calcarious earth,  proba-
bly dissolved in the juices of our body, and thrown out from these
parts, which act here as a gland.  After it is secreted, the earth
is attracted by the bony part of the tooth, which is already formed;
and upon that surface it crystallizes.
   " The operation is  similar to  the formation of  the shell  of the
egg,  the stone in the kidneys and  bladder, and  the  gall  stone.
This  accounts for the striated crystallized appearance which the
enamel has when broken, and also for the direction of these stria?.
   " The enamel is thicker at the points and bases than at the neck
of the teeth, which  may be easily accounted for from  its manner
of formation; for if we suppose it to be always secreting and laid
equally over the whole surface, as the tooth grows* the first formed
will be the thickest;  and the neck of the tooth, which is the last
formed part enclosed  in this capsula, must have the thinnest coat;
and the fang where the periosteum adheres,, and leaves no vacant
space, will have none of the enamel.
  " At its first formation it  is not very hard, for,, by exposing  a
very young tooth to  the air, the  enamel cracks  and looks rough;
but by the time that the teeth cut  the gum, the enamel seems to be
as hard as ever it is afterwards;  so  that the air seems to have no
effect  in hardening it."
  The preceding passages have been extracted  literally from Mr.
J.  Hunter's Natural  History of the Human Teeth, not  only on
account of their graphical value, but to fix upon him the merit of
having first considered the human teeth as a  secretion; an opinion
* Hunter. 
490
ORGANS OF DIGESTION.
  the originality of which  is falsely attributed to the Baron Cuvier,
- by M. Serres.*
    In infants, for several  months  after birth, the biting margins of
  the  gums upon  each jaw  are faced by a  cartilaginous rising of
  some lines in  elevation, and divided by slight  fissures.  Its usual
  appellation is that of Dental Cartilage (Cartilago-Dentalis;) it per-
  forms the function of teeth, in retaining the nipple, and  in mastica-
  tion, and is analogous to the horny beak of birds, and of some rep-
  tiles; it only disappears  upon the protrusion of the teeth.  In the
  upper jaw it is about three lines wide, and in the lower about two.
  If it  be removed by thin  slices, successively made,  till  the margins
  of the alveoli  appear, one arrives by that means at the ends of the
  dental  follicles or sacs;  from  which it appears that there  is no
  intermediate substance.
    In the preceding cartilage are found many small glands, grouped
  about in different parts of it.   They were discovered within a few
  years past by  M. Serres,t of Paris; are about the  size of a millet
  seed, contain  a whitish fluid, and when examined  by  the aid of a
  microscope do not appear to have any distinct opening or duct, in
  consequence of which they must be punctured  in order to expel
  their contents.   The largest of them are on the internal side of the
  gum near the  molar teeth.
    According  to their discoverer, these glands  serve  to  lubricate
  the dental cartilages of the infant, but  after the protrusion of  the
  teeth they secrete the  substance  commonly  called Tartar, and
  heretofore falsely attributed to the saliva.   Their  secretion being
  of a fatty nature, keeps up the high  and brilliant polish which the
  teeth have till middle age;  it being afterwards altered, the teeth
  then become  more dull  and yellow.   Salivation produces an  ex-
  cessive secretion and deposite of tartar from these glands.  J. F.
  Meckel states, that he has never been able to discover  them till
  towards the period of dentition,  from which he is rather induced
  to consider them as a morbid production depending  upon irrita-
  tion, and probably not differing from little abscesses.

                    * Anat. et Phys. des Dents, p. 63,
                    t Loc. cit. 
DENTITION.
491
                    SECT. V.—DENTITION.

   Infants have a set of teeth  called Deciduous, from their being
 lost after a certain period of time.   Their whole number is twenty,
 ten  in each  jaw, consisting on either  side of two incisors;  one
 cuspidatus; and two molares, having a shape corresponding with
 that of the large grinders in the adult.  Several of these teeth fall
 out about the seventh year, and all of them have disappeared about
 the  fourteenth.  The time of  their first  protrusion  through  the
 gums is variable, but may, as a general rule, be stated at from the
 sixth to the eighth month after birth.  They appear commonly in
 pairs.  The pairs of the lower jaw have  precedence  in their pro-
 trusion;  and are immediately followed,  successively, by their con-
 geners in the upper.   The order of protrusion is as follows:—
   The two central incisors, from the sixth to the eighth month;
   The two lateral incisors, from the seventh to the tenth month;
   The first molar tooth, on each side, from the twelfth to the four-
 teenth month;
   The cuspated, from the fifteenth to the twentieth month;
   The second  molar, on each side, from  the twentieth  to  the
 thirtieth month.*

   The Deciduous teeth, by a process which will  be presently ex-
 plained, drop from the gums and are succeeded by the permanent
 teeth.  The first permanent molar, about six or seven years of age,
 by emerging behind  the second infant molar, leads the way to the
 second epoch of dentition which occurs in  the following order:—
   The central infant  incisors fall out about the sixth or seventh
year, and are immediately followed  by  the central permanent in-
cisors ;
   In a few months afterwards, sometimes at the same period, the
lateral infant incisors tumble out, and are succeeded by the lateral
permanent incisors;
   About the ninth year the first molar teeth fall out, and are suc-
ceeded by the first bicuspated;
   From the ninth to  the eleventh year, the second molars fall out,
to be succeeded by the second bicuspated ;
• Serres, loc. cit. 
492
ORGANS OF DIGESTION.
   From the eleventh to the twelfth, the infant cuspated are fol-
 lowed by the adult cuspated ;
   About the end of the twelfth year,  the second permanent molars
 protrude behind the first permanent;
   And, finally, about the twenty-first,  or in cases from the sixteenth
 to the twenty-fifth year, the third  permanent molars or the Dentes
 Sapientiae, make their appearance.
   In the jaw of a foetus of three or four months after conception,
 the  beginning of the alveolar  processes may be observed, in  the
 condition of a longitudinal groove,  deeper and more narrow in
 front, more shallow and wider behind; and  in  the bottom of  the
 groove are small transverse ridges, dividing it into superficial  de-
 pressions.  From this simple condition, ridges  begin  to shoot out
 from the opposite sides of the  canal  near its brim: and form, by
 their junction, arches across it; more matter being added to these
 arches, they  make, in  their progress,  a sort of cell for each tooth,
 open on its alveolar surface.  This opening is nearer  the internal
 circumference  of the  alveolar  processes, so that the  teeth  are
 almost  covered,  and probably for the reason advanced by Mr.
 Hunter, that the gums may be firmly supported before the teeth
 come through.

  The rudiments of the  teeth which  are earliest in  their appear-
 ance may be found in  a  foetus of two or two  and a half months;
 and  at the  expiration of three months, it is said  that all the germs
 of both sets of teeth exist in a  manner to be distinguished.*   The
 germs of this period are  lodged in membranous folds belonging to
 the gum, to which the  germs of the first dentition are immediately
 attached, while those of the  second are  suspended  by pedicles or
gubernacula of a line or two in  length, which circumstance alone
permits them to  be distinguished.  At four months all the germs
are contiguous to each other, with the exception of the incisors;
shortly afterwards they begin to be separated by the rudiments of
the  alveolar  processes; and  about the fifth month  ossification is
perceptible in the infant  incisors, and goes on in the  other teeth
very much in the order of their appearance.
  The germs of  the deciduous teeth are placed in an arc of a
circle, the cuspidati being thrown  forwards out  of the line of the
* Serres, p. 3. 
DENTITION.
493
 others and somewhat lower;  in  consequence of which,  the  first
 molar border closely upon the incisors.  The germs of the perma-
 nent teeth are brought into view  by removing the internal face of
 the jaw, and are at  the  posterior upper side of the first germs;
 being, therefore, nearer to the  edges  of the alveolar processes.
    At  birth, ossification  has taken  place  in  all  the  infant teeth,
 though their roots are not yet completed.   The rudiments of the
 permanent teeth, though seen at an earjy period of foetal existence,
 do not begin to ossify till after birth.   Thus, the first  adult incisor
 and  molar begin to ossify about the fifth  or sixth month  of life, the
 second incisor and  cuspidatus about the  ninth month,  the  first
 bicuspis about the fifth year, the second bicuspis and second molar
 about  the sixth or seventh, and the third molar about the twelfth
 year.*
    The teeth  which  have  no predecessors are in consequence of
 their adhesion to the  gum  brought out in their regular places; but,
 in the  case of such permanent teeth as take the position occupied
 by the deciduous, there  is, before the teeth  protrude, the pedicle
 already alluded to, (Gubernaculum Dentis,) which passes from  the
 alveolar end of the sac of the permanent  tooth  to  the sac of  the
 deciduous  tooth;  and even  when the latter  is fully  formed  and
 protruded, the same pedicle may be traced to that part of  the gum
 surrounding the neck of  the deciduous tooth.f  At birth, the rudi-
 ments  of fifty-two teeth may be found in the two  jaws; and, as a
 general rule  at that  period, the  rudiments of the permanent  are
 more superficial than those of the deciduous ;  but their position is
 subsequently  changed, so  that the first  descend  while  the latter
 ascend.J§

   * Hunter.
   t J. Cloquet, Anat. PI. XXII. fig. 16, 17.  Serres, loc. cit. p. 109.
   t Serres.
   § The preparation for the evolution of the teeth, according to the  observations of
 Mr. Goodsir,|| are visible at the sixth week of fcetal life in the upper jaw  by a  deep
 narrow groove which is speedily divided into  two  by a  narrow rido-e.  The outer
 groove is to become in progress of time the outer alveolar processes;  while the inner
 groove is the nidus for the evolution of the teeth.  In the seventh week a small
 ovoidal papilla of granular matter, the rudiment of the first milk molar, is seen: in
 the eighth week a similar evolution for the coriom takes place; in the ninth week
 the process is repeated for the incisors, and in the tenth week for the second milk

 || On the Origin, &c., or the Human Teeth, Edinburgh Med. and Surg. Journal, January 1839
See also Principles of Human Physiology, by W. B. Carpenter.  London, 1842.
   Vol. I.—42 
494
ORGANS OF DIGESTION.
   As the permanent teeth are  preparing to protrude, the alveolar
 cavities, in which they are contained, form orifices on the internal
 surface of the jaw near the edges of the  deciduous  alveolar pro-
 cesses, and which  are called  the Alveolo-dental Canals, (Itinera
 Dentium.).   Those for the incisor and canine teeth, are just behind
 their corresponding deciduous  teeth, and  those for the bicuspated
 near and somewhat behind the infant molares.  At this period, a
 bony septum separates almost completely the two orders of alveo-
 lar cavities  from each other,  and thereby prevents  their  mutual
 interference.
   The  permanent  teeth  being  thus  formed  in new and distinct
 sockets, and being  kept off from the deciduous, it is clear that the
 latter cannot be  pushed out of their alveoli, as is sometimes sup-
 posed, by the growth  of  the  former; and  if it did take place it
 would produce the great inconvenience of causing them  to  rise up
 into the mouth, beyond the level of the other teeth.   On the con-
 trary, the deciduous teeth  are made loose  by the removal of their
 roots, which  progresses till nothing but the neck is left, and then
 the slightest force applied dislodges  them  from their position on
 the gum.  This decay of the root is not even affected, according
 to Mr. Hunter, by the pressure of the rising  tooth, for the new
 alveoli  rise with the new teeth, and the old o.ies decay along with
 their decaying fangs; and when the first set falls out, the succeed-
 ing teeth are enclosed  by a complete  bony socket; from which it
 is evident that the  change is not produced  by mechanical pres-
 sure, but is  a  particular  process  in  the  animal economy.*  In
 farther  proof, however, Mr. Hunter has seen  two  or three jaws
 where the  second deciduous grinders were  shedding by  the decay
 of their roots, without there  being  underneath any tooth to press

 molar. The sacs or follicles of the teeth are formed originally by processes dividing
 the dental groove and finally coalescing so as to cover in and surround the papilla.
 In the thirteenth week the rudiments consist evidently of a vascular pulpy substance,
and is surrounded by a double capsule.
  In the  fourteenth week or fifteenth the original dental groove is raised to a higher
level than before, and in that state being called the secondary denial groove, it gives
origin to the second set of teeth by the  evolution of small compressed sacs  between
the germ and the first set of germs, to the follicles of which they adhere  by a species
of gemmiparous attachment.  There are stages of evolution  and transpositions from
this period to the perfect stage of dentition which are too much in detail to be in<
serted here, but which may be advantageously studied in the paper alluded  to.
  * Hunter, loc. 
ATTACHMENT OF TEETH.
495
upon them;  and in another jaw he observed the same circumstance
in both grinders on each side.  In a female patient, in whom the
last temporary molar was  loose, and was pulled out in  conse-
quence, it was not succeeded by another tooth.  One of these pa-
tients at the time was aged twenty, and the  other  thirty; from
which it would appear, that though the wasting of the fang of a
deciduous tooth does not depend  upon the pressure of the perma-
nent one, yet the latter determines, in some measure, its expulsion,
a.>, without  some such influence, the period of  shedding would not
have been so late.
   From these  observations  of Mr. Hunter, it would appear, that
the  pressure of the permanent tooth is  not indispensable to the re-
moval of the deciduous one  in all cases; yet I think it will  be most
frequently found that much of the decay of the root of the deciduous
tooth is owing to its  being  absorbed by the pressure of the body
of the permanent one.  The alveoli of the latter, judging from my
own observations, are seldom so perfect towards the period of their
protrusion as  to form a complete separation of the two orders of
teeth,  and even when the alveoli  are  perfect, they  are made to
press upon the root of the deciduous tooth  by  the evolution of the
body of the permanent.
   Besides the  deciduous teeth being  loosened, as stated  by Mr.
Hunter, by the absorption of their alveolar cavities while the fangs
are  disappearing, ihe following process  occurs.  The  permanent
teeth protrude within the  circle of the  deciduous, the arch of the
latter is weakened, and its several pieces are in that way detached
by a force acting from within outwards: this influence being much
assisted by the wasting of the alveolar cavities proceeding princi-
pally at their outer circumference.  The latter, however, is not so
obviously the case with the  molar as with the  incisive and canine
teeth.
   The deciduous teeth, even before they are loosened  by the ab-
sorption of their fangs and of their alveolar processes, are much
more easily extracted in proportion  than the adult teeth, from the
texture of their periosteum being much softer and more yielding.
  A question of some interest has recently arisen in regard to the
precise apparatus of attachment of the fangs of both sets of teeth 
496
ORGANS OF DIGESTION.
 to their  alveolar cavities.   The principal cause of attachment is
 attributed to a distinct ligament or fasciculus for each tooth, having
 for its position the side of the tooth the most distant from the front
 line of the symphysis of the jaws.   The ligament thus situated is
 said to arise from the edge of the alveolus between the teeth, and
 proceeding  forwards in the case of the molars, and inwards in the
 case of the incisors: to be  inserted  into the neck of the tooth not
 quite the  sixteenth part of an inch from  the enamel.  The liga-
 mentous character is considered as very distinct, the fibres being
 white and shining like tendon.  The exclusive cutting of it is also
 said to facilitate very much the extraction of a tooth.*
   My own  observations, made upon the parts softened  in muriatic
 acid, and in the recent state, have not led me to see the ligamen-
 tum dentis in so distinct a  light or to witness the extreme facility
 of extraction  after it alone is  cut.  It is, however, probable that
 the insinuation of an instrument between the tooth and alveolus
 will generally, to the extent of the incision, diminish the force of
 resistance in  pulling the tooth out.   The  actual  adhesion of the
 tooth to the alveolus appears to me to arise from the original cap-
 sules of the  tooth being converted into  a single layer of periosteum,
 one surface of which adheres to the alveolus, and  the other to the
 fang of the  tooth.   The adhesion I have found particularly strong
 at the margin of the alveolus, and converging circularly from it to
 the neck of the tooth, somewhat in the manner of a coronary liga-
 ment.  Another subject of remark is, that the filaments of perios-
 teum  are not laid down laterally to  the teeth, but  one end of the
 filament adheres to the alveolus, and the other to the tooth, like  ,
 the filaments of the interosseous ligament at the  lower  junction of
the tibia and fibula.   In this way a cap of such fibres is found over
the whole fang of the tooth : one of the best means of demonstrating
 it, is, to chip off the  alveolus in front  of  a  cuspate tooth  of the
lower jaw, then seize  the body of the tooth with a pair of strong
pliers, and make it rotate on its axis, the fibres will thus be seen to
start up and  to show the attachment of their two ends, one to the
alveolus and the other to the tooth.   The jaw of a strong muscu-
lar  subject is especially recommended.  This arrangement of the
course of the fibres is very well exhibited in the cow and horse.

  * See Description of the Ligamentum Denti9, by Paul B. Goddard, M. D. in Am.
J-ourn. of Med. Sciences, vol. xxiii. Phil. 1839. 
IRREGULARITIES IN DENTITION.
497
   In the lower jaw of the adult, there is but one arterial trunk,
 which supplies the teeth; but, in the foetus, and till the age of six or
 seven years, there are two arteries,* and as many canals for con-
 taining them.  The lowest of these arteries  belongs, exclusively,
 to the  deciduous  teeth; it is distinctly visible in the foetus, aug-
 ments  till the third or fourth year, afterwards it shrinks, and is ob-
 literated about the sixth or seventh year.  In some rare cases its
 canal remains open for a  longer time,  as M. Serres has met with
 it in a woman of  thirty.  Being a branch from the inferior maxil-
 lary, it enters  the bone at a foramen somewhat  lower down than
 the  posterior maxillary or mental; and what remains of it after the
 teeth are supplied comes out at another aperture, a little below the
 anterior maxillary foramen, and  there anastomoses with the other
 dental  artery.
   M. Serres supposes that  this artery, discovered by himself, and
 obviously serving in the evolution of the deciduous teeth, by being
 obliterated  before they fall out, destroys  their vitality, and, there-
 fore, they become absolutely foreign bodies, the expulsion of which
 is required by nature on common principles.


        SECT.  VI.—OF IRREGULARITIES IN DENTITION.
                                        »
   This process in  certain individuals is premature  ; Louis  XIV was
 born with two teeth ; many instances of the same sort of precosity
 are  recorded  by  Haller, and other medical  writers,  in  some of
 which even ten teeth  were found protruded at birth.
   On other occasions, the process is retarded in a manner equallv
 striking, and varying from the tenth month to the sixth or seventh
 year.   This unusual tardiness is sometimes manifested in particu-
 lar teeth; thus, I know a  gentleman in whom  one of the  perma-
 nent incisors of the upper jaw did not come down before  the four-
 teenth year.  Borelli  reports a woman  in her sixtieth year who
 never had teeth;  a magistrate of Frederickstadt  lived to  an ad-
 vanced  age, and never had either canine or incisor teeth ; he was
 however furnished with molares.
  The teeth are sometimes supernumerary;  it is not very uncom-
mon  to see this manifested by a single canine or incisor, and more

                      * Serres, loc. cit. p. 17.
                             42* 
498
ORGANS OF DIGESTION.
frequently  in  the upper jaw than  in  the  lower.  Occasionally.
there are several supernumerary teeth.
  Cases are recorded in which several teeth have  been fused or
joined together.   Bernard Gengha reports, that in a  pile of bones
belonging to the Hospital S.  Esprit, at Rome, he found a cranium
in which there were only three teeth;  in  the two upper maxillae
one occupied the space of all the  incisors  and the two cuspidati.
and each of the  others the space of all the molares of its respective
side.* According  to  the historians Plutarch and Valerius Maxi
mus;  Pyrrhus, king of Epirus, and Prusias, king of Bithynia, had
a single dental piece in each jaw, which stood in  the place of the
usual allowance of sixteen teeth.   These cases are scarcely credi-
ble, for the reason, that  for  them to have  occurred,  the middle
palate suture, which is slow in forming, and divides the germs of
the two sides from  each other, could not have existed  during the
foetal state, at any  time subsequent to the third month;  or what is
more compatible with this account, at no time whatever, the two
bones being consolidated from the beginning.  It is more proba-
ble, therefore, that notwithstanding the royal opportunities of clean-
liness possessed  by these persons, their teeth were neglected, and
permitted to incrust themselves with a dense, thick coat of tartar.
which gave them the appearance of a single piece: a circumstance
which occurred to  Sabatier, in a  girl of fifteen or sixteen, and to
Fournier in an individual of the same age and sex.f  Another ob-
jection is, that  as  the  common  law of the germs  is  to develop
themselves, and to  ossify at different epochs, in  these  two cases
they  were  all not only proceeding  at the same rate,  but also join-
ing one another so  as to form but a common sac, confounding.
thereby, all the known  phenomena of dentition.
   In  most  persons there are but two sets of teeth ;  it has happened.
however, in several instances, for people about the age of seventy
to have one or more new teeth belonging to a third  set: they are
commonly incisors.  J. Hunter  saw an example  of  the  kind.J
The  Countess of Desmond, who lived to her hundred and fortieth
year, had, at this period, according to Bacon, a third set of teelh.§
Mentzelius narrates a similar case|| in the following words: " having

    » Sabatier, Anat. tome 1, p. 78.          t Diet, des Sc. Med.
    t Loc. cit. p. 85.                      § Hist. vit. et mort. Col. 536.
    |] Serres, loc. cit. p. 40. 
IRREGULARITIES IN DENTITION.
499
 accompanied the Elector of Brandenburg on a visit to Cleves, in
 1666, there arrived, at  the same time, a  man aged one hundred
 and twenty, who  exhibited  himself for  money, and whom I saw
 at the court of the Elector.   His strength  of voice manifested that
 of his breast, and he  having run over  the gamut, was heard at
 more than  a hundred paces off.  Having then  opened his mouth,
 he showed  us two rows of pearly teeth, and on the subject of their
 beauty related 'that being at the Hague two years  before, on the
 same errand which brought  him to Cleves, there arrived an En-
 glishman aged one hundred  and twenty;' that he visited the latter,
 and addressed him in the following terms: ' We are nearly of the
 same age, for I am only two years  younger than you, and I  have
 had the greatest desire to see one older than myself, for I have felt
 no inconvenience till lately; but during the three days that I  have
 been here, I have had  severe headach  and dreadful pains in the
 jaws, which convince me that I am about to die.'  * You are mis-
 taken, my dear friend,'  said  he to me: 'on the contrary, you are
 becoming younger, for  you  are  about to  teethe again like an in-
 fant.' « Oh !' answered I, ' I pray to God not to punish me by pro-
 longing my days.'  < I left him then and went to bed, and imme-
 diately after felt the most excruciating pains in the jaws, which
 were followed by the protrusion of the teeth that you now see.'"
   The circumstance of a third dentition, has given rise to a ques-
 tion among  physiologists, whether the germs are primarily super-
 numerary?  or whether  the  gums have within themselves organs
 capable of forming and  of producing new teeth?
   When such teeth come out in a  straggling manner, they  hurt
 the opposite jaw, and require to be extracted.
   In old  persons who have  lost all their teeth, there is a cartila-
 ginous hardening of the gum, as in infancy, whereby they still re-
 tain some power of mastication.
   When  the body of the tooth has been worn away, nature  pre-
 vents the  exposure of  its cavity by the  deposite of new matter,
 which may  be known  by its  darker colour, and by its  transpa-
 rency.
   The muscles of mastication being the Temporalis, the Masseter
 the Pterygoideus  Internus, and the Pterygoideus Externus, their
description may be seen  elsewhere. 
500                   ORGANS OF DIGESTION.
                         CHAPTER III.

                        Of  the  Tongue.

    The Tongue (Lingua) is  the principal organ of taste, and is also
 concerned in mastication and in speech.  It is an oblong, flattened,
 symmetrical, muscular body, which extends from the os hyoides
 posteriorly to the incisor teeth  anteriorly, and, being placed at the
 bottom of the mouth, fills up the space within the two  sides of  the
 body of the lower jaw.  The exact extent of room which it occu-
 pies, varies according to its being in a  state of repose or of acti-
 vity.
   The posterior extremity of the tongue is called its base or root,
 and arises muscular from the body and the cornua of the  os hy-
 oides; it is there considerably thinner than  elsewhere, it also has a
 fibro-muscular origin from  the centre of the epiglottis cartilage:
 sometimes a cartilage is found in the  middle of the base, and which
 forms a sort of ball and socket  joint with the os hyoides.   Its an-
 terior extremity is  called the  tip or  point, is  loose, and has  a
 rounded thin  termination.   Between  the point and the base  is the
 body.  The superior surface of the  tongue is flat, is divided by a
 middle longitudinal  fissure of inconsiderable depth into two equal
 parts, and is covered by the lining membrane of the mouth, under
 a particular modification of structure.  The inferior surface of the
 tongue, with the exception  of  its middle  part, is  also free, and
 covered by the common mucous membrane of the mouth; but the
 latter is there very thin, and the veins may be readily seen shining
 through it.
  The central plane of the tongue has a very thin vertical septum
 of ligamentous matter marking its two halves from each other and
 affording  a surface  for the insertion  of  muscular fibres.   It  is in
 some measure an extension of the fibrous  matter attaching the
base of the tongue to the os hyoides, but is more dense in its struc-
 ture.*

  *  Mr. Baur has described a cartilaginous lamina beginning at the point of the
tongue and going back to its base; it is said to be found along the inferior surface
of the organ.—Cruveilheir Anat. Vol. 2. 
MUSCLES OF THE TONGUE.
501
            SECT. I.—MUSCLES OF THE TONGUE.

  The muscles which compose the principal  part of the bulk of
the tongue, are, the Stylo-glossus, the Hyo-glossus, the Genio-hyo-
glossus, and the Lingualis.  As these, besides  belonging to the ge-
neral muscular system, also form so important  a part of this organ,
with a view of collecting the account of its structure, their descrip-
tion will be repeated.

  1. The Stylo-glossus  arises from the styloid process of the tem-
poral bone, and soon reaches  the side of the base of the tongue.
Some of its fibres extend to  the tip and confound themselves along
with those of  the  superficial lingual muscle, above and below the
margin of the tongue: while others form a broad transverse fasci-
culus, which is united to  the  corresponding portion of  the other
side in the region of the greater papillae.*

  2. The Hyo-glossus arises from  the side  of the base of the os
hyoides, from its cornu; and from its appendix, in a  slight degree.
It is placed within the stylo-glossus, and  extends  forwards to the
tip  of the tongue.   Some of its  fibres go as far as the middle line
of the tongue; others rise almost perpendicularly upwards at its
base; while the remainder are confounded, along the margin of the
tongue, with the superficial  lingual muscle.

  3. The Genio-hyo-glossus arises from  the tubercle on the poste-
rior face of the symphysis of the lower jaw, and immediately after
its origin spreads itself  after  the manner of  a  fan.  Its inferior
fibres are inserted  into  the  base of the  os  hyoides, while the re-
mainder, by their diverging, are inserted  into the whole length of
the  tongue from its base to its point.   This  muscle is in contact,
side by side, with its fellow, and there  is  a sort of fissure with  a
small quantity of adipose matter between  them.

  As the fibres of  this muscle go from below  upwards, they pene-
trate to the upper  surface of  the tongue; and, consequently, tra-
verse the transverse lingual  muscles and  the superficial lingual.
* See Cloquel's Anat. pi. CXX. 
502
ORGANS OF DIGESTION.
  4. The Lingualis is  a small narrow fasciculus of fibres, which
arises indistinctly about the root of the tongue, in the yellow cellu-
lar tissue there, and advances to the tip between the  hyo-glossus
and the genio-hyo-glossus.

  5. The Superficial Lingual  Muscle (Superficialis Lingua) is a
broad, thin layer, covering the  upper surface of  the tongue, below
the mucous membrane; it begins behind, on a line with the greater
papillae, and advances forwards to the tip.   Its more internal fibres
converge and end at the middle line, but  the external ones termi-
nate above and below, near the margin of the tongue.

   6.  The Transverse Lingual Muscles (Transversales Lingua,)
consist in small  scattered fasciculi, which are  placed below the
last, and  in the thickness of the  tongue,  which they traverse at
right angles.  One end of them, on each side, ceases at the middle
line of the tongue, where there is a small seam or thin septum of
fibrous matter as stated, and the other end terminates in the cover-
ing membrane of the tongue, at  the lateral margin of this organ.
These fibres are to be found in the whole length of the tongue, and
gradually become more curved at its base.

   7. The Vertical Lingual Muscles  (Verticales Lingua) extend
from the upper to the under  investing membrane of the tongue.
They consist in  small  scattered fasciculi, like the preceding, and
cross them  at  right  angles in traversing the thickness of  the
tongue.*   Many of these fibres appear to me to proceed from the
genio-hyo-glossus.


        SECT. II.—MUCOUS COVERING OF THE TONGUE.

   The mucous membrane of the mouth, where it forms the frae-
 num linguae, is over  the anterior  margin of genio-hyo-glossi mus-
 cles ;  the same membrane, in going from  the base of the  tongue to
 the epiglottis, and forming another fraenum, has, on  each side of
 it, a depression or pouch in which articles of food sometimes lodge.

   * The preceding views of the minute muscular structure of the tongue have lately
 been advanced by M. Gerdy, of Paris.  See  J. Cloquet,  Anat. de L'Homme, pi.
 CXIX. CXX.  J. F. Meckel, loc. cit.  Note des Traductcurs, vol. iii. p. 313. 
MUCOUS COVERING OF THE TONGUE.             503
Beneath the last frasnum is a ligamentous tissue which runs to the
base of the  tongue from the front of the epiglottis, and serves to
keep the latter erect: some muscular fibres are occasionally seen
in this tissue in the human, subject: in  the  black bear of North
America, and in some other animals, it consists in a pair of strong
muscles.  The pouch, on each  side, is  bordered, externally, by a
more superficial doubling of the mucous  membrane, which passes,
from the base of the tongue to the side of the epiglottis.*
   The lingual portion of the lining membrane of the mouth, on the
upper surface of the tongue, is somewhat cartilaginous, and into it
is inserted many of the  subjacent muscular fibres.  At the base of
the tongue this cartilaginous  condition is deficient, and its place is
supplied  by  a yellow  cellular  tissue which adheres  to  the  os
hyoides, to the epiglottis, and to many muscular fibres below, and
has in it numerous mucous follicles.
   The  mucous membrane, on  the  under  surface of the  tongue,
offers no peculiarity of organization: but, on the upper surface, it
is remarkable for  the unusual size and development of its papilla?,
for having its epidermis easily detached, and also for  having the
muscular structure beneath fixed to it with extreme closeness.
   The anterior two-thirds of the upper surface of the tongue are
entirely covered by these papillas.   They are so  thickly set as to
touch one another; and, as they present some peculiarities of form,
they are divided  into Papillae Maximae or Capitatae, Mediae, Vil-
losae, and Filiformes.
   The Papillae Maxima? constitute the posterior border of the pa-
pillary surface of the tongue, and are about nine in number, though
they are frequently fewer, and  sometimes more.  They are dis-
posed in two oblique rows, which, by converging backwards, meet
and generally form something like the  letter V.; the fifth papilla
being the angle of the figure.  Each of these bodies  resembles a
cone standing  upon its summit, and is  surrounded  by a circular
fossa  which  permits  it to project but  inconsiderably  above the
general level of the tongue.  Sometimes two or more  are in the
same fossa.   The Papillae  Media), or Fungiformes, are more nu-
merous than the last, and next to them in size;  they are enlarged

  * This doubling also exhibits, occasionally, a small muscle inserted into its base,
and arising from the upper constrictor of the pharynx, and which has the effect of
widening the pouch. 
504
ORGANS OF DIGESTION.
 at their loose end into-a sort of rounded head, whence their name;.
 they are irregularly scattered over the tongue.  Those which are
 next in size and still more abundant, are the Papillae Villosae.  The
 Papillae Filiformes fill up the intervals of the others, are the small-
 est, and  are found, principally, near the middle of the tongue and
 at its front extremity.
   Most commonly the central papilla maxima has the largest fossa
 of any of that class,  and which is designated  by the term foramen
 ccecum.   A little behind this foramen  there is frequently another,
 called the same  by some anatomists, but not furnished with a pa-
 pilla, into which some  mucous follicles discharge their contents:
 from time to time it has been fallaciously considered as receiving
 the excretory duct of the  thyroid, or of some of the salivary
 glands.
   The papillae of the tongue, though they vary in their shape and
 size, have  very much the  same  structure in  regard to the abun-
 dance of blood vessels  and nerves which enter into their composi-
 tion.   When  uninjected, and  viewed with the  naked eye, their
 surface appears  smooth, but when made turgid by  injection, they
 are covered with little asperities or filaments, which  seem to be
 formed principally of blood vessels, having a very tortuous  and
 superficial  course; forming  loops,  or doublings, in  projecting on
 the surface of the papilla,  and  anastomosing freely with each
 other.*   Beside vessels, there is a soft whitish substance, supposed
 to be  nervous,  entering into the composition  of each filament.
 The larger papillae on the back part of the tongue are supplied by
 the glosso-pharyngeal nerve, and the papillas on its front part by
 the trigeminus or fifth pair.
  The surface of the  tongue between the papillae maximae and the
 os hyoides is destitute of papillae, and is covered only by the com-
 mon mucous  membrane of the  mouth, having beneath it many
 muciparous  glands, which  in different individuals produce promi-
 nences more or less elevated, and are of a lenticular shape with a
 diameter of a line or two.  Their  orifices are very visible,  and
easily receive a large bristle.  Follicles of a small size, compara-
 ble to those  of the intestines, exist also over the whole surface of
the tongue;  it would  seem, however, an essential mistake  to con-
sider the  papillae maximae as composed of them.
* Soemmering, Anat. J. Cloquet, pi. cxix. 
MUSCLES OF THE PALATE.
505
  The Epidermis, which is found upon all other parts of the lining
membrane of the mouth, is also continued over the whole upper
surface of the tongue, and consequently invests each papilla; it is
called  there Peri-glottis.  It is soft and humid, may be detached,
by maceration, and is frequently detached in fevers.  On its upper
surface, it, when detached, will have many elevations;  while on
the lower there will be corresponding excavations, which to super-
ficial observation give it the appearance of being cribriform.

   The tongue is supplied with arteries, principally from the lingual
branch of the carotid, and with  nerves from the hypo-glossal, the
fifth pair, and the glosso-pharyngeal.  The former is  supposed to
be exclusively  appropriated to its  muscular  movements, and the
two latter to its sensations.  Its faculty of taste seems to be most
active at the tip:  on the sides, and near the middle, behind, it is
inconsiderable.  The soft  palate seems  also  to participate in the
function of taste.
                       CHAPTER  IV.

                       Of  the Palate.

   The  Palate (Palatum) is composed at  its anterior part of the
palatine processes of the superior maxillary and  palatine bones,
covered above by the pituitary membrane, and below by the lining
membrane of the mouth.  This portion of it  is the hard  palate,
and separates the mouth from  the nose.   Behind it is a portion
exclusively membranous and called the soft palate, which separates
partially the mouth from the upper part  of the pharynx.
   That part of the  lining membrane of the mouth which  covers
the hard palate, has  a hard cartilaginous  feel, and  is not so vas-
cular or sensible  as other parts.   It has a ridge in its centre just
beneath  the middle palate  suture, and from each  side of it there
are transverse ridges  extending  to the  alveolar processes.  This
arrangement  is more evident  at its anterior part, and in middle-
aged persons; in  the  old it is faint, and frequently does not exist
when the alveoli are  gone.   Beneath  this  membrane, particularly
at its posterior part, the muciparous glands are very abundant and
  Vol.  I.—43 
506
ORGANS OF DIGESTION.
closely set against each other, so as  to form  a perfect layer, ex-
tending itself upon the front of the soft palate, and making one
half of its thickness.

  The Soft Palate (Velum Pendulum Palati) has an oblong shape,
and being continued from the posterior margin of the hard palate,
it is stretched across  the back of the mouth from  one side to the
other,  and  obliquely downwards  and backwards.  Its  inferior
margin, which  is free, offers in  its  centre a projection of half an
inch or three quarters in length, which is the Uvula.  From  each
side of the latter there proceed two crescentic doublings of the
lining membrane of the mouth, called the lateral half arches of the
palate.
  The Anterior Half Arch is more  distinct  than  the other, and
arising at the side of the uvula by one end, terminates by the other
in the side of  the  base of the tongue on a line with the  papillas
maxima?.
  The Posterior Half Arch arises from the  side of  the uvula  near
the  last, and diverging from it backwards, and outwards, has the
other end lost  gradually in the lining membrane of  the pharynx
near its middle.
  In the depression between  these duplications, on either side, is
the  Tonsil Gland.  The space bounded in front and behind by
these lateral half arches is the Fauces, and the anterior opening
into it, is the Isthmus of the Fauces.
  When the mucous  membrane of  the soft  palate  is removed, its
muscles are exposed,  and are as follow:—

  1. The Constrictor Isthmi Faucium  is  a  small fasciculus of
fibres, on each  side, within the duplicature  of the anterior lateral
half arch.  It  arises  from the middle of the soft palate near the
base of the uvula, and is inserted into the side of the tongue near
its root in a line with the papillae maximae.
  It tends to close the  opening between the mouth and the pha-
rynx.

  2. The Palato-Pharyngeus is also a small  fasciculus, within
the duplicature forming the posterior lateral half arch.   It arises
from the middle of the  soft palate near the  base of the uvula, and
is inserted into the pharynx at the space between  the middle and 
MUSCLES OF THE PALATE.
507
lower constrictors, behind the stylo-pharyngeus, and into the pos-
terior margin of the thyroid cartilage.   It spreads itself out consi-
derably, so as to cover, along with  the stylo-pharyngeus, almost
the whole lateral portion of the pharynx to its lower part.*
   It draws the soft palate downwards, or will draw the pharynx
upwards and shorten it, and it will dilate somewhat the orifice of
the Eustachian tube  by means of  a  connexion with it formed  by
the small fasciculus of muscular matter, the levator of Eustachius.

   3.  The Circumflexus, or Tensor Palati, is behind  the  pterygoid
process of the sphenoid bone.   It  arises from the spinous process
of the  latter behind  the foramen ovale, and from the contiguous
part of the Eustachian tube; it  then  passes downwards in contact
with  the pterygoideus internus  muscle, and  terminates in a  broad
tendon below, which  winds around the hook of the internal  ptery-
goid  process, and is  inserted into the soft  palate  near its middle,
and into the posterior lunated edge of the palate bone.
   It spreads out or extends the  palate.

   4.  The Levator Palati  is on the  inner side of the last.   It  arises
from the point of the petrous bone, and  from the contiguous part
of the  Eustachian tube, and passes downwards to be inserted into
the soft  palate.  This  muscle, in  the dissection  of the pharynx
may  be seen between its external edge, and the pterygoideus inter-
nus muscle.
   It draws the soft palate upwards.

   5.  The Azygos Uvulae is in the  centre of the soft palate and of
the uvula.   It arises  from the posterior pointed termination of the
middle palate suture, and goes  down into the uvula.   The  origin
of this muscle adheres  also to  the  posterior margin  of the septum
narium, and its point below stops half an  inch short of the inferior

   * Custom has sanctioned the above mode of description, but the latter does not
express  fully the condition of this muscle,  for it  is a well marked large fasciculus
below, which is eight or ten  lines wide there. It would be  more conformable to
nature to say that it arises from almost the whole posterior margin of the thyroid
cartilage, being there much spread out, that  it  ascends within the constrictors of the
pharynx collecting its  fasciculi  and having their number reduced, and that it is
inserted  into the side of the soft palate, and that a point of it  may be traced within
the Levator Palati to the inferior corner of the cartilage of the Eustachian tube, into
which it is inserted.  This slip  is  the Levator Pharyngis internus of Eustachius. 
508
ORGANS OF DIGESTION.
end of the uvula.   When the mucous membrane at the tip of the
latter is laid open, it will be found that the tip is formed of a loose
cellular substance with some small  muciparous glands scattered
through it.   The morbid elongation of the uvula is confined to the
tip, and seldom extends to the  muscle, hence  the  excision of the
tip answers every purpose when such an operation is demanded.
  The Azygos Uvula is just under the posterior  mucous membrane
of the soft palate.
  It draws the uvula upwards, and diminishes the vertical breadth
of the soft palate.
  When the mucous membrane is removed, the upper constrictor
of thepharynx appears between the anterior and the posterior half
arches.
                       CHAPTER V.

               Of the Glands of the  Mouth.

  These glands consist in such as are muciparous, and in such as
are salivary.

              SECT.  I.—MUCIPAROUS GLANDS.

  These glands (Glandula Mucipara) are whitish, somewhat oval
and flattened, and  are from  the fraction of a line to two lines in
diameter:  they are found in  great abundance beneath  the lining
membrane  of  the  mouth at  several  places, to wit:  on the lips.
(Gland. Labialis;) on the cheeks, (Gland. Buccales;) and also, as
mentioned, at the posterior part of the upper surface of the tongue,
(Gland. Mucip. Lingua.)  The layer of them, (Gland. Palatini,)
which is found at the posterior part of the hard palate, is also con-
tinued over the anterior and the  posterior surface of the  soft pa-
late, especially the  anterior surface.
  The Tonsils, (Tonsilla, Amygdala,)  situated, as observed, one
on each side, between  the half arches of the palate, are six or eight 
MUCIPAROUS GLANDS.
509
 lines long,  four  or  five wide,  and about three thick.  They are
 rather a collection of large mucous  follicles, than a congeries of
 glandular  bodies, in  consequence of which  their surface is very-
 much reticulated.  Owing  to their being placed  upon the upper
 constrictor of the pharynx, their mobility is very striking and con-
 siderable.
   A great many small  pores are observed on the internal surface
 of the mouth, which are the orifices of the ducts of the muciparous
 glands.
   Notwithstanding the marked difference in  the common mucous
 glands from the labial and  buccal, and the close approximation in
 appearance of the two latter with the lobules of the salivary glands,
 yet  the labial and buccal have  almost universally been put into the
 category of the mucous.  More correct views have, however, been
 latterly  advanced through  the  aid of  the microscope by Henle,
 who now says, difinitely, that  the labial and buccal gland are of
 the  same structure with the salivary.   Their substance consists of
 a mass of round, or oval, completely  closed cells of different sizes,
 some containing a granular matter and others perfectly formed
 mucous  globules. A number of these cells united by cellular tis-
 sue,  and, perhaps, also by a  structureless  membrane, form an
 acinus, and as such, are seated upon a branch of the excretory
 duct.  Into this duct, mucous globules and other matter contained
 in the cells, are at times  poured from  the bursting  of the mem-
 brane of the cells, or from its dissolving at  the place of  junction
 with the duct.
   According to Henle,  there are also other  organs in every mu-
 cous membrane without exception; they are  round or oval closed
 cells,  visible even to the unassisted  eye, being sometimes quite
 transparent, but at other times filled with mucous globules.*
   The glands  upon  the hard and soft palate, accordion- to  the
 above, may also be considered as belonging to the  system of sali-
 vary glands.
   There is a very sensible difference  between the  Glandulas Lin-
 guales, and  the Glandulas Labiales, and Buccales.   In the case of
the two latter each gland has a  number of  microscopic orifices,
perhaps one for each granule or acinus of the  gland, openino- jn
the interior of the mouth.  These orifices are too small to  be seen
* Mailer's Physiol., p. 479.
         43* 
510
ORGANS OF DIGESTION.
with the naked  eye, and we therefore  resort to the microscope.
Such glands are  also generally spheroidal.  But in the case of
the glandula? linguales, they are of a  flattened  lenticular shape,
and each gland  has a solitary large orifice proceeding  from its
centre to the surface of the tongue, and  into which a pointed probe
may be easily introduced.  The tonsils are,  in  fact, a clustered
exhibition of this  arrangement, the orifices of the glands crossing
each other so as to give a reticulated condition.  A structure the
same as that of  the glandula? linguales  is continued  from  them all
the way to the tonsils over the lower part of the fauces.
   It appears to  me that the glandula?  buccales, labiales, and  pa-
latinas ought to  be viewed as salivary glands: while  the tonsils,
the glandulae linguales, and the similar continuous  range  to  the
tonsils over the  bottom of the  fauces are really mucous glands.
   The preceding points of  structure  are made  more manifest by
steeping the parts in spirits of wine after macerating them for a few
days in water.
   I  have in one  case* seen the glandulas linguales clustered, and
forming two broad elevated collections  on each side of  the tongue.
instead of making a uniform layer as in common.


                SECT. IT.—SALIVARY GLANDS.

   On either side of the neck, bordering upon  the mouth, there are
three glandular  bodies for  the  secretion of saliva;  they  are  the
parotid, the submaxillary, and  the sublingual.   The fluid secreted
from them is of  great  service  in digestion, and is blended with the
food in mastication, and  in swallowing.  According to Berzelius,
it has a considerable  affinity to oxygen; and consists in a white
mucous substance, holding, in  a state of solution, the saline articles
usually found in the serum of  the blood.

   The Parotid  Gland (Glandula Parotis,) is the largest of  the
three, and, like the others, is of a light pink colour.  Owing to the
space into which it is crowTded, it is of  a very irregular figure.  It
fills up the cavity on the side of the head between the mastoid pro-
cess and the ramus of the lower jaw,  extending beyond the edge
of the latter so as to cover the posterior margin of the  masseter
* January, 1842. 
SALIVARY GLANDS.
511
muscle.  It is  somewhat pointed at its  fore part.  Its vertical
length reaches  from the zygoma above, to the  angle of the jaw
below; sometimes, indeed, a little lower down.  In thickness it ex-
tends from the  integuments externally, to the styloid process, the
styloid muscles, and the tendon of the digastricus, internally, being
there only separated from the internal carotid  artery by these parts.
It is traversed from behind forwards by the portio-dura nerve, and
from below upwards along its internal margin by the external caro-
tid artery and the temporal vein.
   This gland has no appropriate capsule, but being covered, on its
external face, by the continuation of the fascia superficialis of the
neck, prolongations are sent from the fascia which penetrate it in
every direction, and keep its lobules together.
   Its duct (Ductus Stenonianus) formed by a coalition of branches
departs from its anterior edge a few  lines below the zygoma, and
traverses the outer  face of the masseter muscle, in a line, accord-
ing to the observations of Dr.  Physick, drawn from the lobe of the
ear to the end of the nose.  It is about the size of a crow quill, is
hard and tendinous, with thick parietes.  It lies close to the  mas-
seter muscle, and at the anterior edge of the latter penetrates a
pad  of fat commonly found there on the side  of the cheek;  it then
perforates  the  posterior  end of  the buccinator,  so as to have its
oral orifice opposite the second large molar tooth of the upper jaw.
On opening the mouth wide during a state of fasting, a jet of saliva
will sometimes indicate the position of this orifice.
   A  small gland (Gland. Accessoria Parotidis) is sometimes found
between this duct and  the zygoma; it varies in form and size, and
has  a distinct excretory canal discharging  itself into the parotid
duct.

   In  attendance upon the parotid duct there are some small glands,
called molar,  about the size  of common  shot, and  looking  like
lobules of the  parotid: they are found near  its  entrance into the
buccinator. There is some difficulty in  tracing their ducts, but
they probably discharge into the duct of the parotid.

   The Submaxillary gland (Glandula Submaxillaris) is  not more
than a third or  one half the size of the last, and has a more regular
form  in being somewhat ovoidal.  It is accommodated in the de-
pression on the side of the neck formed by the body of the lower 
512                   ORGANS OF DIGESTION.
 jaw  externally,  by the  mylo-hyoid muscle above,  and by the
 tendon of the digastric below.   The platysma  myodes intervenes
 between it and the skin.   It almost touches the parotid gland be-
 hind, being separated from it  only by the process sent in  from the
 fascia superficialis, and continuous with the ligament, going from
 the styloid process to the ramus of the lower jaw.  As it extends
 to the posterior margin of the mylo-hyoid muscle, it there touches
 the sublingual  gland.  The fascial artery either passes through it
 or is very much connected with it.
  Its colour and appearance  are the same with the parotid; but
 its  lobules are more easily separated,  as  they  are held  together
 only by weak cellular substance, which forms a sort of capsule to
 them.   Its duct,  (Ductus  Whartonianus,) which is single, comes
 from the assembling and  junction  of branches from  the several
 lobes.   It is much thinner, more extensible, and larger in propor-
 tion than the parotid duct; and being directed  backwards, winds
 over the posterior edge of the mylo-hyoid  muscle, in  order to get
 to the cavity of the mouth.  It then passes along ^he internal face
 of the  sublingual gland, below the tongue, and terminates  by a
 small projecting orifice on the anterior margin of the frasnum lin-
 gua?.
  A continuation of the substance of this gland, of a few lines in
 thickness, described by Bartholin, is found at the posterior end of
 the sublingual gland, and  has  its excretory duct sometimes open-
 ing in  the side  of the duct of  Wharton, and, on other occasions,
 into  one  of the  ducts which  issue from  the  sublingual gland.
 When this common duct exists,  it is called the canal of Bartholin,
 (Ductus Bartholinianus,)  who  first discovered  it in the lion, in
 1684.

  The  Sublingual Gland  (Glandula Sublingualis) is an oblong
body, covered by the lining membrane of the mouth, but visible
when the tongue is turned up.   It  is placed above the mylo-hyoid
muscle, along the under surface  of  the tongue, and is readily dis-
tinguished by its ridged unequal surface, projecting into the mouth.
It is  not so large as the submaxillary gland.
  Its lobules are smaller than those of the preceding gland, and
are also whiter and harder.  Instead of having but one excretory-
duct, it has several; sometimes fifteen or twenty of them  are dis-
cernible : on other  occasions, several of them are collected into 
SALIVARY GLANDS.
513
one or two principal trunks, (Ductus Riviniani,) and  open either
directly into the mouth, or into the duct of Wharton.  These se-
veral openings are found along the bottom of the mouth, on either
side below the tongue.  Several  small  salivary granulations or
glands border on the sublingual.
   The position of the salivary glands is such, that  they are much
moved and pressed upon by the neighbouring parts  in mastication,
independently of the emission of their fluid being provoked by  hun-
ger.  Owino- to the similitude of their structure, and  to their not
being  regularly supplied  like  other glands with  capsules, their
limits  are occasionally so inexact that  they continue into each
other by adjacent points, and form thus an uninterrupted  chain.*
   They all are of the conglomerate kind, or consist in a congeries
of smaller glands or  lobes and  lobules.   When the duct  of the
parotid is injected with quicksilver, the latter readily finds its  way
to every part of the gland, and the ultimate lobules are exhibited
as small  spheriform cysts, each  containing its globule  of mer-
cury.  Each  having  its little  duct, some of the  ducts join  into
larger branches,  the successive coalition of which, finally, forms
the principal duct—others of them are so closely  upon the limits
of the latter, that  they discharge  directly into it.   In a natural
state these  cysts are compressed, more or less, by one another,
but the tendency of the mercury, as in the case of  the cells of the
lungs, is to dilate them into the spheroidal shape.   The  same ob-
servations are applicable to all the salivary glands.   These glands
are  well  furnished with arteries;  which  are  branches,  from the
external carotid, and go in several trunks instead of in a leading
one.   The parotid is commonly supplied by trunks coming directly
from the external  carotid, the submaxillary is supplied  from the
facial  artery, and  the sublingual gland  from  the  lingual artery.
Their nerves come from the  fifth pair, and from the portio dura.
   The retrograde injection of their excretory ducts  shows how the
latter are formed by the assembling of branches from the different
lobules.  These ducts consist of two coats, a fibrous one externally,
and a mucous one internally.
   The form in which a salivary gland  first appears, according to
Miiller and Weber, is that of a  simple  canal with bud-like pro-
cesses, it  communicating with  the cavity of the  mouth, and re-

                  * Bichat, Anat. Dcscrip. vol. v. p. 24. 
514
ORGANS OF DIGESTION.
posing in a gelatinous nidus or blastema.   As the evolution goes
on, the canal is more and more ramified, while the quantity of the
germinal mass or blastema is diminished.  The blastema after-
wards assumes the lobulated form  of the gland and then disap-
pears wholly.   Thus in their  earlier state, the salivary ducts can
be seen to exist as a  closed system of ramified tubes, but, finally,
in the perfect state, their coecal  or peripheral extremities being
highly attenuated,  end in vesicles  which  cluster  together  like
bunches of grapes.  This arrangement can  be well seen on filling
the parotid gland with mercury from its excretory duct.  The
most minute pulmonary air cells are  from five  to  sixteen times
larger than the cells of the parotid gland, and the latter  have  a
diameter about three times larger than the  capillaries which ramify
upon them.*
                       CHAPTER  VI.

            Of  the Pharynx and  (Esophagus.

                 SECT I.—OF THE PHARYNX.

  The Pharynx (Pharynx) is a large membranous cavity, placed
between the cervical vertebras and the posterior part of the nose
and mouth.   It extends from the base of the cranium to the lower
part of the cricoid cartilage, or to the lower part of the fifth cer-
vical  vertebra.  It  is  in  contact, behind, with the vertebra? and
the muscles lying upon them, being simply attached there by loose
cellular substance;  above, it adheres to  the cuneiform process of
the os occipitis, and to the point of the petrous portion of the tem-
poral  bones;  in  front, to the pterygoid processes  of  the sphenoid
bone,  to the posterior part of the upper and of the lower maxilla
near the termination of their alveolar  processes, to the cornua of
the os hyoides, the side of the thyroid and of the cricoid cartilage;
and below it is continued into the oesophagus.   In consequence of
these  several  attachments  the  pharynx  is kept open, or its sides
* Miiller, vol. i. 488. 
THE PHARYNX.
515
are prevented from collapsing, and it is drawn up and down in the
motions of the tongue and of the larynx.
   The Pharynx consists in  three  coats:  an external one, formed
by three muscles, on  each side, one above the other, and called
constrictors; an intermediate cellular coat; and an internal mu-
cous one.

   1. The  Musculus Constrictor  Pharyngis  Inferior, arises from
the side of  the cricoid, and from the whole  length  of the side of
the thyroid cartilage.  From  these points its fibres diverge to the
middle-vertical line on the back  of the pharynx,  where they join
with their congeners  of the  opposite side.   The lower fibres are
nearly if not completely horizontal, and those above increase suc-
cessively in  their  obliquity upwards, so  that the  upper ones are
extremely oblique, and reach, at their termination, to within twelve
or fourteen lines of the upper part of the pharynx.

   2.  The Constrictor  Pharyngis Medius, arises from  the cornu
and appendix of the os hyoides, and from the ligament connecting
the posterior end of the latter with the upper cornu of the thyroid
cartilage.   Its inferior margin is overlapped  by the  superior mar-
gin of the  last; its fibres there  are also  horizontal, and, indeed,
somewhat convex downwards;  while  the superior  fibres become
successively more oblique in ascending.   It is inserted by the mid-
dle line behind, into its fellow of the opposite side, and by its point
 above into the cuneiform process of the os  occipitis, just  in ad-
 vance of the recti majores muscles.

   3. The Constrictor Pharyngis  Superior, arises  from the ptery-
 goid process of the  sphenoid bone, at its lower  end;  and below
 that from the back part of the upper and under jaws  behind the
 last molar teeth, it is also connected at its  anterior margin with
 the buccinator muscle, and with the root of the tongue between the
 anterior and the posterior half arches of the palate, being blended
 there with the transverse fasciculus of the stylo-glossus  muscle.
 It has its lower edge overlapped  by the  constrictor medius; and
 its fibres  are  more  horizontal, generally, than those of the pre-
 ceding muscles.   It is inserted into its fellow by a middle line, the
 upper end of which adheres to the cuneiform process of the os oc-
 cipitis.  The superior margin of this muscle between the pterygoid 
516
ORGANS OF DIGESTION.
process of the sphenoid, and the cuneiform process of the occipital
makes a crescentic line, the concavity of which is upwards.

  The constrictor muscles of the pharynx, by  their successive
contraction, convey the food from the  mouth into the oesophagus.

  The Stylo-Pharyngeus, which is mentioned  among the muscles
of the neck, forms an  interesting  portion of the structure of the
pharynx, and may be considered on a footing with the longitudinal
fibres of the oesophagus and of the  intestines;  being intended to
shorten the pharynx  by arising from, or  having a  fixed point at
the styloid process above, and  by being  joined into the pharynx
below.  Its  fibres being first of all on the outside of the upper con-
strictor, are readily traced between the lining membrane and the
two lower constrictors to the posterior margin of the thyroid car-
tilage;  into  which,  after  spreading  out considerably,  they  are
finally inserted, more particularly into the cornu major.
  The intermediate  membrane  of the pharynx  is merely a thin
layer of filamentous cellular tissue, destitute of fat, as in the hollow
viscera elsewhere, and which  joins the muscular to the mucous
coat.

  The internal or  mucous membrane of the pharynx, which lines
the last, is spread uniformly over it;  the  only irregularity of its
surface being made by the presence of mucous follicles and glands,
which are more abundant above  between  the posterior margins
of the two stylo-pharyngei  than  below.   It is covered by a very
delicate epidermis, and is supplied with two arteries on each side,
the superior  and inferior pharyngeal, the  first  of which comes
from the internal maxillary, and the  second  from the external ca-
rotid.  It  exhibits a number  of small veins, which run  into the
internal jugular or some of its branches.
  The shape of  the cavity of  the pharynx  is oblong and cylindri-
cal, being somewhat larger at its superior end;  at the latter place,
where it is attached  to the petrous bone, it presents a deep corner,
which gives it a square appearance there, and has a collection of
muciparous  follicles  somewhat like  the tonsil  gland.   Anteriorly,
and above, it is continuous with the Eustachian tubes, and with
the posterior nares; just  below this, with the fauces and mouth,
and below the root of the tongue with  the cavity  of the  glottis or 
THE ffiSOPHAGUS.
517
larynx.  At its lower extremity, where it terminates in the oeso-
phagus, it is so contracted as to suit the size of the latter cavity.


               SECT. II.---OF  THE CESOPHAGUS.

   The oesophagus is the tube just in front of the spine and behind
the trachea, which conducts food from  the  pharynx  into the sto-
mach.  When inflated  it  is of a  cylindroid shape, about ten or
twelve lines in diameter:  it is  nine or  ten  inches  long, and gra-
dually increases in its size from above downwards:  in its state of
repose it  is flattened from  before  backwards.  Its descent is not
entirely vertical, but at the lower part of the neck it inclines some-
what to the left of the middle line, and  is, therefore, rather to the
left side of the trachea than behind  it.   It passes down the thorax
in the posterior mediastinum, being bounded on its left side by the
aorta, and on the right by the  vena azygos.  It keeps during the
early part of Hs course in  this cavity, in front of the middle line of
the spine; but lower down  it inclines again slightly to the left side,
in front of the aorta, in order  to reach the  oesophageal  orifice of
the diaphragm, through which it penetrates into the abdomen.  In
all this passage the oesophagus is  united to adjacent parts  by a
loose cellular  tissue.
   The oesophagus is composed of  three coats: the muscular; the
cellular or nervous ; and the mucous.

   The muscular coat is the external, and very strong.   It consists
in two well marked lamina? of muscular fibres.   The most  exte-
rior is the-thickest, and goes, longitudinally, from  one end to the
other of the tube;  commmencing, according to J. F. Meckel, by
three fasciculi above; one of which arises, tendinously, from the
posterior  face of the cricoid cartilage, and  the other two, one on
each side, from the inferior constrictor of the  pharynx.  These
fasciculi descend for an inch or two, before they spread out into an
uniform  membrane.  The internal muscular lamina consists in
circular fibres, which may be considered as a continuation of the
lower margin of the  inferior constrictor of the  pharynx, and are
either horizontal or slightly spiral; they are rather deficient on the
fore part  of the oesophagus for  an  inch  at  its superior extremity.
   Vol. I.—44 
51»
ORGANS OF DIGESTION.
Individually, their length is short of the circumference of the oeso-
phagus.

  The cellular  coat is  next in order.  It  is much  thicker and
stronger  than  that of the pharynx, making a layer which is very
easily raised as a distinct coat, and is filamentous.   It serves to
unite the muscular  and  the mucous together.   It adheres much
more closely to  the  latter than  it  does to the former, has no adi-
pose matter in  it, but is found  to be  abundantly furnished, more
particularly towards its upper end, with small muciparous glands;
it also serves to transmit the blood vessels through the structure of
the oesophagus.

  The mucous coat of the oesophagus  is the most internal; in the
undistended state it always presents many longitudinal folds, going
from one end to the other, but sometimes blending with each other,
owing to the contraction of the circular  muscular fibres.  When
suspended in water its fine villous  appearance is  very perceptible,
as well as the mucous lacunas or glands which open upon its inter-
nal surface.  As it is a continuation of the  mucous membrane of
the  pharynx,  it has  the  same  general appearance, but is rather
whiter.   Its internal surface is also  covered by  a delicate epider-
mis, which  ceases at the cardiac orifice of the stomach, and may
be raised in shreds by maceration  and  by boiling;  in some patho-
logical conditions this  epidermis  becomes  very distinct  by ac-
quiring more thickness and solidity, than what belong to its healthy
state.

  The arteries  of the oesophagus are  derived from the inferior
thyroidal, from the thoracic aorta,  and  from  the  gastric.  Its
nerves come principally from  the pneumogastric.
END OF VOL. I. 
INDEX TO VOL.  I.
			Page
Abdominal Canal,		--	399
Abductor Pollicis Manus,	-	-	- 438
Abductor Pollicis Pedis,		-	468
Abductor Indicis,	-	-	- 440
Abductor Min. Digit., -		-	440
Abdomen, Muscles of,	-	-	- 391
Abdominal Fascia,		-	391
Rings,	-	-.	394, 398
Abductor Min. Digit. Pedis,			466
Acetabulum,	-.	-	- 109
Acromio Clavicular Articulation,			290
Adductor Pollicis Manus,	-	-	- 439
Adductor Pollicis Pedis,		-	468
Adductor Metacarpi Min.	Digiti,		- 441
Adductores Femoris, -		.	453
Alveolar Processes,	-	-	- 480
Alimentary Canal,		-	472
Alare Majus Ligament.		-	- 311
Minus Ligament-		-.	311
American Indian,	-	-	- 183
Anconeus,		-	427
Ankle Joint,	-	-	- - - 313
Antrum Highmorianum,		-.	146
Anomalus Faciei,	-.	-	- 374
Animal Life Muscles of;		-.	357
Anguli oris*,	-	-	- 476
Annularis,		-	206
 
520
INDEX.
Anterior Articulation of Ribs,
Annuli Junct. Ligamentosi,
Ankle, Ligament of, (Ligament Annulare,)
Aponeurosis Dorsalis,  -
Apophyses,      -
Aponeurosis Plantaris, -
Aponeurosis Palmaris,
Apophysis of Ingrassias,
Artificial Skeleton,
Articulations,  -       -       -       -
            Upper Extremities,
            Lower,   -
            Carpo-Metacarpal,
            Carpus,  -
            Ilio-Femoral,
            Metatarsal
            Metacarpo-Phalangial,
            Peroneo-Tibial,   -
            Phalangial,   -
            Pubes,  -
            Radio-Ulnar -
            Sterno-Clavicular,
            Tarsal,
            Tarso-Metatarsal -
            Thorax,
            Toes,
            Wrist,
Articular Cartilages,  -
Arm,    -
     Muscles of,
Astragalus,
Atlas, -
Auricularis,
Azygos Uvulae,

Barry,   -
Bartholin Duct of,     -
Bertin,
Bicorn Ligament,
Biceps Flexor Cubiti,
Biceps Flexor Cruris,  -
Bones, Organization of,  - 
INDEX.
521
                                                              Page
Bones,    ....-.--50
      Organization of, -       -       -      -       -       -       65
      Haversian Canals in       ....       -   53
      Lamella? of,     ..-..-       55
      Fibres of,   -      -      -       -       -       -       -   64
      Arteries of,     -       -       -      -       -       •■       66
      Veins of,   -      -      -       -       -       -       -   66
      Lymphatics of,  -       -       -      -       -       -       67
      Physick's Experiments on,  -       -       -       *       -   57
      Corpuscula Purkinje,    -----       55
      Texture of, -      -      -       -       -       -       -   52
      Composition of, -       -       -      -       -       -       58
      Vascularity of,      -      -      -      -       -       -65
      Growth of,     ------       76
      Individual,  -       -       -       -       -       -      -85
      Carpal,  -       -       -              -       -       -      199
      Development of,    -       -       -       -       -       -12
      Density of,     ------       52
      Long,      -       -      -       -       -       -       -51
      Broad,  -------51
      Thick,      -      -      -       -       -       -       -   52
      Compact Substance of,  -       -      -       -       -       53
      Mucous Stage of,   -      -       -       -       -       -   72
Bowman,     ......       -358, 357
Bordeu,   -------.  324
Brachialis Internus,   ......      425
Brachio-Radial Ligament,        .....  294
Brachial Fascia,       -       -       -      -       -       -      419
Bursa of Fingers,  -       -       -       -       -       -      -431
Buccinator,   .......      37Q

Carpenter,        ......     366-363
Callus,       -       -       -       -      -       »       -       80
      Formation of,      -      -       -       -       -       -   80
      Physiology of,        -       .       -       -       -       81
      Accidental, -      -      -       -       -       -       -82
      Regular        ------       82
Caucasian Race, -        -       -       -       -       -       -186
Carpus,       -------      199
Cartilages of Ribs,        -       -        -       -       -       -120
Calcis,       -------      228
Carpal Articulation,       »--...   296
  Vol.  I.—45 
522
INDEX.
                                                             Page
Carotid Canal,       -       -       -       -       -       -      141
Cartilages,      .......  255
          Fibro,     ......      256
          Composition,  ......  256
          Vessels,   ......      256
          Ulceration of  -       -      -      -      -       -  256
          Formation of,                                        257
          Semilunar,     ------  309
          Accidental, ------      259
Capsular Ligaments,     ------  266
Calcaneo-Scaphoid Ligament,         -      -      -      -     315
         Cuboid Ligament,       -      -      -       -       -  316
Camper,     ...-.-.-      178
Cement of Teeth,        -       -      -      -       -       -  483
Cellular Atmosphere, ------      328
        Substance,       -       -      -      -       -       -  321
Cervicalis Descendens,        -       -       -       -       -      414
Cervical Vertebrae,       -      -      -      -      -       -   88
Cheek Bones,       -       -      -      -       -       -      151
Ciliaris, -       .......  373
Clavicle,     -      -                                         192
Coccyx,   --------96
Coronal Suture,     -       -       -       -       .       -      156
Consolidation of Fractures,       .      -      -       -          82
Cornet of Morgani,   -       -       -       -       -       -      172
Constrictor Isthmi Faucium,     .....  506
           Pharyngis Inferior,        -       -       -       -      515
                    Medius,     .....  515
                    Superior,       -       -       -       -      515
Coraco  Clavicular Ligaments,    .....  290
        Acromial,    ......      291
        Humeral,        -       -      -      -      -       -  292
        Brachialis,   ......      425
Coccygeal Ligaments,    -       -      -      -      -       -280
Coracoid Ligament,  -       -       -       -       -       -      291
Costo Vertebral Articulation,     -----  284
      Transverse,^   ------      285
      Clavicular Ligament,       -----  289
Complexus,   -------      415
Compressor Naris,       -       -      -      -      -       -372
Conoid Ligament,    ..--.-      290
Cotyloid Ligament,       ......  304
Corrugator Supercilii,       .....      374 
Cruikshank,
Crusta Petrosa,
Crural Arch,
       Fascia,
Cranium, Base of,
        Vault of,
        External Surface of,
        Internal Face of,
Cranium, -
Crucial Ligaments,
Cruraeus,  -
Cremaster,
Cuboides,
Cuneiform Bones,
Cutis Vera,
      Anserina,
Cuticula, -       -       -
Cyanosis,
Cytoblastema,

Dermoid Tissue,
Development of Skeleton, -
Dermoid Covering,
 Dentata,   -       -      -
 Development of Fcetal Head,
 Dentes Sapientiae, -
Deglutition, Organs of,
Depressor Labii Sup.,
Depressor Anguli  Oris,
Depressor Labii Inferioris,
 Deltoides, -
 Dental Cartilage,   -
 Dental Glands,
 Dentition, -
          Irregularities of,
 Deciduous Teeth,  -
 Diaphysis,
 Diploe,
 Diameters of Fcetal Head,
 Dilatans Nasi,
 Digastricus,
 Diaphragm, 
524
INDEX.
 Digestion, Organs of,
 Dorsal Vertebra?,
 Duct of Steno,
 Duct of Wharton,
 Duct of Bartholin,
 Ductus Riviniani,
 Dutrochet,

 Elain,
 Elbow Joint,
 Ensiform Cartilage,
 Enamel,  -
 Epiphyses,
 Epidermis,
 Ethmoides,   ...
 External Cellular Tissue, -
 Extremities, Upper,
            Development of,
            Mechanism of,
            Lower,
            Development of,  -
            Mechanism of,
            General Motions of,
 Extensor Carp. Rad. Long.,
          Carp. Rad. Brev,
          Carpi Ulnaris,
          Digit. Com., -
          Metacarpi  Pollicis,
          Pollicis Minor, et  Major,
          Long. Digit. Pedis,
         Prop. Poll.  Pedis,
          Brev. Digit. Pedis,
External Transverse Ligament,

Face,     -.
Facial Angle,  -
Fat,
Fascia Superficialis Colli,
Fasciae Superficialis Abdominis,
Fascia Profunda Colli,
Fascia Transversalis,
Fascia Iliaca,  - 
INDEX.
525
Fascia Brachialis, -
Fasciae of Upper Extrem.,
Fasciae of Lower Extrem.,
Fascia Lata,
Fascia Cruralis,
Fasciae of Foot,
Femur,
Fingers,
Fibro-Cartilage,
Fibula,
Finger Joints,
       Carpi Ulnaris,  -
       Digitorum Subl.,
       Digit. Profund.,
       Pollicis  Longus,
       Brev. Poll. Manus,
       Parv. Min. Digit.,
       Carpi Radialis,
       Long. Digit. Pedis,
       Long. Poll. Pedis,
       Brev. Digit. Pedis,
       Accessorius,
       Brev. Poll. Pedis,
       Min. Digit. Pedis,
Foot, Muscles of, -
      Motions of,
      Bones of,
      Articulations of, -
Fore Arm,
         Articulations of
         Motions of,
         Muscles of,  -
Fontanels,
Foramen CEsophageUm,
         Aorticum,
         Q,uadratum, -
         Thyroideum,
Frontal Bone,
Frenulae of Mouth,
Page
 419
 419
 443
 443
 446
 447
 218
 205
 261
 225
 303
 428
 429
 430
 430
 439
 440
 428
 464
 465
 466
 467
 468
 469
 466
 249
 228
 314
 195
 296
 212
 427
 185
 402
 403
 403
 109
 131
 476
Gagliardi on Bones,
Gaultier, -
45*
 63
338 
526
INDEX.
	Page
Gastrocnemius, ...	462
Gerber, -	359-482
Genio-Hyoideus, ...	386
Gemini, -	- 455
Genio-Hyo-Glossus	501
Gimbernat's Ligament, ...	- 394
Glenoid Ligament, -	293
Glutaeus Magnus, - - - -	- 453
Medius,	454
Minimus, ...	- 455
Glands of Havers,	268
Glandulae Linguales, ...	- 508
Mucip., ...	508
Glands, Salivary, ....	- 510
Gracilis, ....	452
Gurlt, .....	- 348
Gums, ....	485
Gubernacujum Dentis, -	- 493
Guttural Region, ...	169
Hand, Bones of,   -       -      -       -       ^      .       -  199
       Motions of,    -       -       -      -       .       -.215
       Muscles of, -       -      -       -       .      .      .  437
Hairs,        -------      351
Half Arches, of Palate,    ...       ...  506
Haver's Glands of,    ---....      268
Haversian Canals, -       -      -       .       .      -      -   53
Head,                                                     -138
      Development of Fcetal,      -       -       .      .      -  184
      External  Surface of,     -       -      .       .       -      168
      General Considerations on,  -       -       .      .      -  156
Hey's Ligament,      ------      445
Henle,    ----...    358-362
Hip  Joint,     ----...      304
Hiatus Fallopii,    *       -      .       .       .       .      -139
Humeral Bone,       -       -       .       .       .       -193
Hunter,   -       -       -      .       .       .      .      -342
Hyoides,     -       -       -      .       .      .       -      187

Iliacus Internus,          ---...  406
Ilium, ------..     105
Iliac fossa,       -      -       -       .       .       .       -106 
INDEX.
527
                                                              Pajje
Ilio Lumbar Ligament,   ------ 280
Ilio Femoral articulation,      -----     304
Impudicus,      ..----- 206
Individual bones,    ------       85
Innominata,      -       -      -      -       -       -      -104
           texture of,        -       -       -      -       -      109
Inferior spongy bones,   -      -      -       -       -      -  152
Inferior Extremities,  ------     218
Inf. Extremities in Standing,    ----- 240
Inf. Extremities in Locomotion,      ...       -     246
Inf. Palmar Ligaments,    ------  302
Inter-Clavicular Ligament,   ...---      289
Integuments,     .....--  321
Internal Cellular Tissue,      ..,..--      327
Iatercostal Muscles,      ------  390
Inter-Spinales,       ------      417
Infra-Spinatus,   .--.-.--.      -  423
Inter-Transversarii,   -       -      -■       -       -       -      417
Inter-Pubic Ligament,           ^     ...         283
Internal Transverse  Ligament,      ....      285
Internal Abdominal Ring, --.---.-  398
Invertebral Substance,       .....      271
Indicator,  --------  437
Indicator Finger,     ......      206
Interosseal Lig. of Fore Arm,    .....  295
Interosseous Muscles of  Hand,      -       -       -       -      441
Interosseous Muscles of  Foot,    ....     470, 47-1
Interosseus Digiti Auricularis,       .....      442.
Interosseous Ligament of Leg,   ......  312
Involucrum,  -------  307, 444
Ischium,   --------   107
Itinera Dentium,     ......     494
Ivory of Teeth,   ---.--....  481

Jaw Bone Upper,    ------       145
           Lower,        -      -       -       -       .       -   153
Joints,       -----..     266

 Knee Joint,     ......       ^  g^

 Lacerti Ligamentosi, ------     277
        Muscles of,       -----          350 
528
INDEX.
  Lateral Lig. of Knee,
  Latissimus Dorsi,
  Lambdoidal Suture,
 'Lachrymal Fossa,
  Levator Anguli Oris,
  Levator Labii Inferioris, seu Menti,
  Levator Scapulae,
  Levatores Costarum,  -
  Levator Labii Sup.,
  Levator Pharyngis Internus, -
  Levator Palati,    ...
  Leg,
  Leg, Muscles of, -
 Ligament of Poupart,
 Ligamentum Laciniatum, -
 Lingual is,
 Little Toe, Muscles of,   -
 Lig. Carpi Dorsale,
 Lig. Carpi Volare,
 Ligament. Mucosum, -
 Ligaments, Yellow,
 Ligament. Alare,
 Ligamenta Vaginalia,
 Ligaments of Spine,
 Linea Alba,      -
       Semilunaris,
      Transversa?,
 Ligaments,
           Capsular,
           Funicular,  -
           Strength of,.   -
           Texture,
 Ligaments  of Bodies of Vertebrae,
            Processes,
            Pelvis,
 Ligamentum Nuchao, -
 Ligamentous Tissue,
 Ligamentum Teres,   -.
 Ligament of Winslow,
 Lips, -
Lower Jaw, Articulations of,
Lower Extremities, Joints of, -
      Page
    -  309
       409
    -  157
       175
    -  374
       376
    -  411
      418
    -  374
      507
    -  507
-  248, 221
    -  459
      393
    -  447
      502
    -  469
      419
    -  421
      311
    -  275
      311
    -  431
      271
    -  399
      393
    -  393
      263
    -  266
      266
    -  265
     264
   - 271
     274
   - 280
     275
   - 263
     304
   - 308
     476
   - 269
     304 
INDEX.
529
                                                             Page
 Longissimus Dorsi,       ......  413
 Lumbar Vertebrae,  --       -       -       -      -       -92
 Lumbricales,     .......  438
 Lunare,      .......     199
 Lumbricales Pedis,      ......  467

 Mastication, Organs of,                                        475
 Malae,    -      -      -      -      -      -      -      -  151
 Maxillare Inferius,    -       -       -      -      -       -113
          Articulation of -       -      -       -      -      - 269
          Superius,   ---...      145
 Masseter, -------- 377
 Magnum,     .......     201
 Metacarpus,     ----... 203
 Medulla,     .......       gg
 Metatarsus,      .......  234
 Metacarpal Joints,    ---...     295
 Metatarsal Joints,        -       -       -       -       -       -315
 Membrana Musculorum,     -----     355
 Metacarpo Phalangial  Articulation,       -                       302
 Middle Straight Ligament,   -                                  278
        Transverse Ligament,
 Moderator Ligament,
 Mongolian Race,
 Mouth,  ...                            .         475
       Glands  of,   -       -       -       -       -      -     476,
 Muscles, General Anatomy of,          -      -       -      .  355
         Special Anatomy of,       ....     371
         Chemical Analysis of,  -      -      -       -      -  36I
         Structure of,                                          359
         Shape and Arrangement  of,           -        -      .  368
Muscles of Animal Life,     -                                  357
        of Organic Life,       -                               362
        of Back,    ------      408
        of Face, -      -      -       -       .       .      -  371
        of Head and Neck,  -      -      -      .       -      371
        of Neck,       --.... 379
        of Trunk,  ----..     388
        of Front of Thorax,     .....  3§g
        and Fascia of Abdomen,     ....     392
        ofShouIder,     ----..  421
       of Thigh,   -----       .     448
278
iarv 
530
INDEX.
Muscular Fibre, -
          Motion    -       .       -
Multifidus Spinae,
Muciparous Glands,  -
Musculus Cutaneus
           Resorius,  -       -       -
Mylo-Hyoideus,   -
Myolemma,   ....

Nasal Cavities
       Bones,  -
Negroes, -      -       .       -
Nose,        ....
Nails,    ....
Naviculare,   ....

Obturator Ligament,
          Internus,  -       -       -
          Externus,
Obliquus Ext.  Abdominis,
         Int. Abdominis,
         Capitis, (Superior and Inferior,)
Occiput,   ....
Occipito-Vertebral  Articulation,
         Frontalis,
Occipital Region,
Omo-Hyoideus,
Opponens Pollicis,
Organization of Bones,
Orbits,        ....
Orbicularis Palpebrarum, -
           Oris,
Orbicular Ligament,
GEsophagus,   -
Ossa Longa, Lata, Crassa,
Ossification,   -
Osteogeny,       ...

Parietal Bones,
Palate Bones,
Patella,     .... 
INDEX.
531
                                                               Page
Patella, Ligaments of                                        307-451
Palmar Ligaments,  -       -       -       -       -       -301
Papillae Tactus,  -      -       -       -       -       -       -  335
Palmaris Longus,   -       -       -       -       -       -     428
         Brevis  -------  437
Papillae of Tongue,  -                ....     503
Palatine Region,        -       -       -       -       -       -  168
Palate, Soft,        ------     505
       Muscles of,      -       -       -       -                506
Parotid Gland,      ......     510
Pelvis,   -       -      -       -      -       -      -       -  109
      Diameters of,  -       -       -        -       -       -     111
      Development of,   -       -       -       -      -       -  112
      Ligaments of,  -      -       -        -       -       -     280
      Mechanism of,      -       -       -       -      -       -  113
      Male and Female,     -       -        -       -       -     111
Periosteum Externum,   -       -       -       -      -       -    68
           Internum,                                              69
Pelvic Vertebrae,        -       -       -       -       -      -    94
Perichondrium,      ------     260
Peroneo-Tibial Articulations,     -      -       -      -       -  311
Pectoralis Major,    ------     388
         Minor,       -       -      -       -      -       -  389
Pectineal Fascia,     ._-.-.     445
Pectinalis,       -------  452
Peroneus Tertius,   ------     460
         Longus,       -       -      -       -      -       -  461
         Brevis,    ------     462
Period of Ossification,    -       -      -       -      -       -    76
Periglottis,   -------     505
Phalanges of Hand,      -       -       ....  205
Phalangial Articulations,     -----     303
Physick, Dr.,    -      -       -       -       -      -       -    57
Pharynx,    -------     514
Pharynx, Muscles of,    -       -      -       -      -       -  515
Pisiforme,   -------     200
Plica Polonica,   -------  354
Platysma Myodes Muscle,    -----     379
Plantaris,         -.-----  463
Plantar Ligament,  -       -       -       -       -       -316
Pollex,          -      -       -      -       -      -       -  206 
532
INDEX.
                                                               Page
 Posterior Ligaments of Knee,     -       -       -       -      -  308
 Popliteus,    -------      464
 Poupart's Ligament,      -       -       -       -       -      -  393
 Posterior Indicis, Medii, &c.  -      -       -       -       -      441
 Prior     "       "             -       -       -       -      -  442
 Pronator Radii Teres,       -----      407
         0.uadratus,     ------   432
 Psoas Parvus,       ------      406
       Magnus,  -------  406
 Pterygoideus Externus,      -----      378
             Internus,   -      -       -       -       -      -   378
 Pterygo Maxillary Fossa,   -       -        -       -      -      171
 Pubes,  -       -       -      -       -       -       -       -   106
 Pubic Ligament,    ------     283
 Pulp of Tooth,  -       -      -       -       -       -       -  483
 Purkinje, Corpuscles of,             -        -       -             55
 Pyramidalis,    _.-----  397
 Pyriformis,  -------     455
 Pyramids of Wistar,     -      -       -       -       -       -  144

 Quadriceps Femoris,        -       -        -       -            451
 Quadratus Lumborum,  ------  405
          Femoris,        -       -        -       -             455

 Radial Orbicular Ligament,      -                                295
 Radius,     -------     197
 Radio-Ulnar Articulation,       -                                296
       Carpal Articulation,  -----     297
 Raphe, --------  333
 Rete Mucosum,    ------     337
 Rectus Capitis Antic,   ------  386
       Abdominis,  ------     396
       Capitis Postic,   --....  416
       Femoris,    ------     449
 Rhomboideus Major,     -      -       -       -       -       -411
             Minor, ------     410
 Ribs,    -        -       -      -       -       .      .       -  115
     Articulation of,  -       -       -        -       -       -     284
Rivinianus, Duct of,     -       -       -       -       -      -  513
Rota tores Dorsi,     -        -       -        -       .       -     418
Round Ligament,        -      -       -       -       .       -  304 
Sarcolemma,  -
Sacrum,  -      -       -
Sacro-Spinous Ligament,
       Iliac Ligament,
       Iliac Articulation,
       Sciatic Ligaments,  -
       Lumbalis,
Sacciform  Ligament,
Sartorius,
Salivary Glands,  -
Scapula,
Scarpa on  Bones,
Scaphoides,   -
Scapulo-Clavicular Articulation,
        Humeral Joint,
Scalenus Anticus,
         Medius,
         Posticus,
Sella Turcica, -
Sesamoid Bones,  -
Semi-Lunar Cartilages,
Semilunaire,
Serosity,
Sebaceous Organs,
Serratus Magnus,
         Inferior Posticus, -
         Superior Posticus,
Semi-spinalis Cervicis,
Semi-spinalis Dorsi,
Semitendinosus,  -
Semi-membranosus,  -
Shoulder, -      -       -
         Motions of,  -
         Articulations  of,  -
         Muscles of, -
Shape of Muscles,
Skeleton, Anatomy of,
Skin,
Soleus,       ...
Spongiosum Inferius,
Spine,-      ...
     Uses  of,    -
  Vol. I.—46 
534
INDEX.
 Spine, Ligaments of,  -
 Sphenoides,       ...
 Splenius,     ...
 Spinalis Dorsi,    ...
 Sternum,     -       .      .      .
 Stylo-Maxillary Ligament,
      Hyoideus,
      Glossus,    -      -       .
      Pharyngeus,    -
 Sterno-Cleido-Mastoideus, -
       Hyoideus,
       Thyroideus,
 Stenos Duct,  -
 Stearine, -
 Sutures,      -
        Uses of|
        Formation of, -
 Subclavius,      ...
 Supra Spinatus,
 Subscapularis,    ...
 Supinator Rad. Long.,
          Rad. Brev.,
 Submaxillary Gland,  -
 Sublingual Gland, -
 Synovial Capsules,
 Synovia,  -
 Symphysis Pubis,     -

 Tarsus,   ....
 Tarso-Metatarsal Articulation,
 Temporis, Os,     ...
 Tendons,    .       .       .      .
 Temporalis,      ...
 Teres Minor, -       -       -       .
      Major,     .      .       -
 Ttnsor Vaginae Femoris,
       Palate,
 Texture and Organization of Teeth,
Teeth,    ....
      Formation of,   -
Thorax,   -
       Development of, 
INDEX
 Thorax, Mechanism of,
        Articulations of,
 Thigh, Motions of,
        Muscles of,
 Thumb, Articulations of,  -
 Thyreo-Hyoideus Muscle,
 Tibia,     -
 Tibialis Anticus,
        Posticus,  -
 Toes, Bones of,
       Joints of,   -
 Tongue,
        Muscles of,
        Mucous Covering of,  -
 Trapezium,
 Transverse Ligament, -
 Trapezoid Ligament,
 Trapezoides,  -
 Triquetra,...
 Triangular Ligament,  -
 Trunk,    -
       Muscles of,
 Triangularis Sterni,
 Transversalis Abdominis,
              Cervicis,
              Pedis,   -
 Trapezius,
 Trachelo  Mastoideus,  -
 Triceps Extensor Cubiti,  -
        Surae, -

 Ulna,     -
 Unguis,       ...
 Unciforme,       -
 Upper Extremities,
                 Development of, -
                 Mechanism of,
                 Articulations of, -
                 Muscles of,  -

Vault of Cranium, -
Vastus Externus, 
536                           INDEX.

                                                              Page
Vastus Internus,  -      -                                    -  450
Vertebrae,
         Development of, -
         Motions of,  -
Ventrier,  -       ....
Veins of Diploe,
Vertebral Ligaments,
Vincula Accessoria,
Vomer,    .                                                   -  153

Winslow, Ligaments of,                                        308
Wormiana Ossa,  -       -       -      -       -       -       - 157
Wrist, Articulations of,                                         296

Zygomaticus Minor,      -       -      -       -              - 375
            Major,  ------     375
-   97
   101
-  394
   163
-  271 
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                PUBLISHERS'   NOTICE
                                    TO THE
CYCLOPAEDIA  OF  PRACTICAL  MEDICINE.
   This important work consists of a series ef Original Essays upon all subjects of Medicine, contri-
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Ireland, and among them many of. the  Professors and Teachers in London, Edinburgh, Dublin and
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PRACTICAL MEDICINE at the time of its appearance.  From innumerable foreign and domestic
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present  century, has been gathered together and placed at the command  of every reader of the
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          THREE  HUNDRED   ORIGINAL ASSAYS
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MEDICA, or MEDICAL JURISPRUDENCE, he will sufficiently appreciate the care bestowed to
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of practical reference.  No subject, it is believed, immediately practical in its nature or application,
has been omitted; although unnecessary disquisition has  been, as much as possible, avoided.
   It  entered consistently and properly into.the plan  of the Editors to admit a far wider range of
subjects than appears heretofore to have been  considered necessary  in works written  professedly on
the Practice of  Medicine, but a range comprising many new subjects of extreme importance to thosa
engaged in practice, or preparing for it  Such are  the subjects of
 ABSTINENCE    5 CONTAGION           iEXPLORATION  OF! PROGNOSIS
 ACUPUNCTURE \ CONVALESCENCE       THE  CHEST  AND $ PULSE
 AGE            \ COUNTER-IRRITATION   ABDOMEN          {SOFTENING
 CHANGE OF AIR CONGESTION AND  DE-! GALVANISM          j MEDICAL STATISTICS
 ANTIPHLOGISTIC)  TERMINATION  OF  \ HEREDITARY  TRANS-S STETHOSCOPE
   REGIMEN     \  BLOOD                 MISSION OF DISEASE SUDDEN DEATH
 ASPHYXIA      {DERIVATION           INDURATION           SYMPTOMATOLOGY
 AUSCULTATION S DIETETICS             TRRITATION           TEMPERAMENT
 BATHING       | DISINFECTION          INFECTION           ^TOXICOLOGY
 BLOOD-LETTING PHYSICAL EDUCATION LATENT DISEASES    \ TRANSFORMATION
 MORBID STATES {ELECTRICITY         [ MALARIA AND MIASMA? TRANSFUSION
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 CLIMATE        EPIDEMICS             PBEUDO - MORBID   AP- VENTILATION
 COLD         '  \ EXPECTORATION     I  PEARANCES         \ MINERAL WATERS
and those of various general articles on the pathology of organs.  It will be found, too, that  admirable
articles from the best sources  have been inserted on the  important subjects of
 DISEASES OF WOMEN AND CHILDREN, AND OF MEDICAL  JURISPRUDENCE.
  In order, however, that the nature and  value of the work may be fully understood, a list of the
urticles, and the names of the contributors, is appended.
  The excellence of  this work on every topic connected with Practical Medicine, has been admitted
ny all who have had  the good fortune of being able to consult it.  The hope, indeed, «xpressed by
the Editors, has been amply realized —" That they  have prepared a work required by the present
wants of medical readers, acceptable to the profession in general, and so capable, by its arrangements,
of admitting the  progressive improvements of time, as  long to continue what  the general  testimony
of their medical brethren, as far  as it has hitherto been expressed, has already pronounced it to be,
           "A STANDARD  WORK ON  THE  PRACTICE OF MEDICINE."
  Such a work, it is believed, will be most acceptable to the members of the profession throughout
the Union, as there  exists, at this time, no publication  on  Practical Medicine, on the extended plan
of the one now presented.
  To adapt it to the Practice of this country, and to thoroughly revise  the various articles, the atten-
tion of
                   PROFESSOR   DUNGLISON
will be  directed ; whose character and  established reputation are a sure guarantee that his portion of
the work will be carefully executed.

                                                                                       i 
       CONTENTS OF, AND CONTRIBUTORS TO,

THE  CYCLOPEDIA  OE PEACTICAL  MEDICINE.
Abdomen, Exploration of, Dr.
Abortion.....Dr.
Abscess.....#.  Dr.
Abstinence ....*.  Dr.
Achor......Dr.
Acne.......Dr.
Acupuncture ....  Dr.
Age.......Dr.
Air, Change of,  .  .   .  Dr.
Alopecia.....Dr.
Alteratives.....Dr.
Amaurosis.....Dr.
Amenorrhcea .  .  .   .  Dr.
Anaemia......Dr.
Anasarca  . .  .  .   .  Dr.
Angina Pectoris  .  .   .  Dr.
Anodynes.....Dr.
Anthelmintics ....  Dr.
Antiphlogistic Regimen  Dr.
Antispasmodics  .  .   .  Dr.
Aorta, Aneurism of,   .  Dr.
Aphonia......Dr.
Aphtha?......Dr.
Apoplexy, Cerebral,   .  Dr.
Apoplexy, Pulmonary,.  Dr.
Arteritis......Dr.
Artisans, Diseases of,  .  Dr.
Ascites......Dr.
Asphyxia.....Dr.
Asthma......Dr.
Astringents.....Dr.
Atrophy......Dr.
Auscultation ....  Dr.
Barbiers......Dr.
Bathing......Dr.
Beriberi......Dr.
Blood,-Morbid States of, Dr.
Bloodletting  ....  Dr.

Brain, Inflammation of,  \ jy •
Bronchitis.....Dr.
Bronchocele  ....  Dr.
Bulloe   ......  Dr.
Calculus.....Dr.
Calculous Diseases  .   .  Dr.
Catalepsy.....Dr.
Catarrh......Dr.
Cathartics  .....  Dr.
Chest, Exploration of,  .  Dr.
Chicken Pox ....  Dr.
Chlorosis.....Dr.
Cholera......Dr.
Chorea......Dr.
Climate  .....".  Dr.
Cold.......Dr.

Co,ic......{BJ:
Colica Pictonum .  .  .  Dr.
Coma......Dr.
Combustion, Spontane- Sry
    ous Human,  .  .   £
Congestion of Blood   .  Dr.

Constipation   .  .  .   £Sr-
Contagion.....Dr.
Convalescence  . .  .  Dr.
Convulsions   .... Dr.
Convulsions, Infantile  . Dr.
Convulsions, Puerperal  Dr.
Coryza......Dr.
Forbes.
Lee.
Tweedie.
M. Hall.
Todd.
Todd.
Elliotson.
RoGET.
Clare.
Todd.
CONOLLT.
Jacob.
Locock.
M. Hall.
Darwall.
Forbes.
Whiting.
A. T. Thomson.
Barlow.
A. T. Thomson.
Hope.
Robertson.
Robertson.
Cluttereuck.
Townsend.
Hope.
Darwall.
Darwall.
Roget.
Forbes.
A. T. Thomson.
Townsend.
Forbes.
Scott.
Forbes.
Scott.
M. Hall.
M. Hall.
Quain.
Adair Crawford.
Williams.
And. Crawford.
Todd.
Thos. Thomson.
Cumin.
Joy.
Williams.
A. T. Thomson.
Forbes.
GREGORY.
M. Hall.
Brown.
And. Crawford.
Clark.
Whiting.
Whiting.
Tweedie.
Whiting.
Adair Crawford.
Apjohn.

Barlow.
Hastings.
Streeten.
Brown.
Tweedie.
Adair Crawford.
Locock.
Locock.
Williams.
Counter Irritation  .  .  Dr.
Croup......Dr.
Cyanosis.....Dr.
Cystitis......Dr.
Delirium.....Dr.
Delirium Tremens  •  .  Dr.
Dentition, Disorders of .  Dr.
Derivation.....Dr.
Determination of Blood   Dr.
Diabetes   ......Dr.
Diaphoretics  ....  Dr.

Diarrhoea  .  .  .  .  7 pr"
Dietetics.....Dr.
Dilatation of the Heart .  Dr.
Disease......Dr.
Disinfection  ....  Dr.
Diuretics.....Dr.
Dropsy......Dr.
Dysentery.....Dr.
Dysmenorrhcea  .  .  .  Dr.
Dysphagia .....  Dr.
Dyspncea.......Dr.
Dysuria .......  Dr.
Ecthyma.....Dr.
Eczema......Dr.
Education, Physical,  .  Dr.
Electricity .  .  .  .  .  Dr.
Elephantiasis Axabum .  Dr.
Elephantiasis. Gxaecorum  Dr.
Emetics......Dr.
Emmenagogues  .  .  .  Dr.
Emphysema  ....  Dr.
Emphysema of the Lungs Dr.
Empyema.....Dr.
Endemic  Diseases  .  .  Dr.
Enteritis......Dr.
Ephelis......Dr.
Epidemics.....Dr.
Epilepsy......Dr.
Epistaxis.....Dr.
Erethismus Mercurialis   Dr.
Erysipelas.....Dr.
Erythema.....Dr.
Expectorants ....  Dr.
Expectoration ....  Dr.
Favus......Dr.
                      {Dr.
                      Dr.

Fever, General Doctrine of. Dr.
  "  Continued, and itsjn-
       Modifications,   (_
  "   Typhus   .  .  .  Dr.
  "   Epidemic Gastric  Dr.
  "   Intermittent  .   .  Dr.
  "   Remittent .  .  .  Dr.
  "   Infantile Remittent Dr.
  "   Hectic  ....  Dr.
  "   Puerperal .  .  .  Dr.
  "   Yellow   ...  Dr.
Fungus Hoematodes .  .  Dr.
Galvanism .  .  .  .  .  Dr.
Gastritis......Dr.
Gastrodynia  ....  Dr.
Gastro-Enteritis  .  .  .  Dr.
Glossitis......Dr.
Glossis, Spasm of the, .  Dr.
Gout......Dr.
Haemorrhoids ....   Dr.
Williams.
Cheyne.
Crampton.
Cumin.
Pritchard.
Carter.
Joy.
Stokes.
Barlow.
Bardsley.
A. T. Thomson.
Crampton.
Forbes.
Paris.
Hope.
Conolly.
Brown.
A. T. Thoms-on.
Darwall.
Brown.
Locock.
Stokes.
Williams.
Cumin.
Todd.
Joy.
Barlow.
Apjohn.
Scott.
Joy.
A. T. Thomson.
A. T. Thomson.
Townsend.
Townsend.
Townsend.
Hancock.
Stokes.
Todd.
Hancock.
Cheyne.
Kerr.
Burdek.
Tweedie.
Joy.
A. T. Thomson.
Wilson.
A. T. Thomsom
Scott.
Forbes.
Marshall.
Tweedie.

Tweedie.

Tweedie.
Cheyne.
Brown.
Brow.v.
Joy.
Brown.
Lee.
Gillkkest.
Kerr.
Apjohn.
Stokes.
Barlow.
Stokes.
Kerr.
Joy.
Barlow.
Burn*. 
CONTENTS, &c, OF THE CYCLOPEDIA  OP PRACTICAL MEDICINE.
Headach.....Dr. Burder.
Heart, Diseases of the,   Dr. Hope.
  "  Displacement of the, Dr. Townsend.
Hematemesis  ....  Dr. Goldie.
Hemoptysis   ....  Dr. Law.
Hemorrhage   ....  Dr. Watson.
Hereditary Transmis- C n„ n„„„,„
    sion of Disease  . { Dr" Brown'
Herpes......Dr. A. T. Thomson.
Hiccup......Dr. Ash.
Hooping-Cough   .  . .  Dr. Johnson.
Hydatids.....Dr. Kerr.
Hydrocephalus   .  . .  Dr. Joy.
Hydropericardium  . .   Dr. Darwall.
Hydrophobia  ....   Dr. Bardsley.
Hydrothorax  ....  Dr. Darwall.
Hypertrophy  ....  Dr. Townsend.
Hypertrophy of the Heart Dr. Hope.
Hypochondriasis  .  . .  Dr. Pritchard.
Hysteria......Dr. Conolly.
Icthyosis.....Dr. A. T. Thomson.
Identity......Dr. Montgomery.
Impetigo.....Dr. A. T. Thomson.
Impotence.....Dr. Beatty.
Incontinence of Urine .  Dr. Cumin.
Incubus......Dr. Williams.
Indigestion.....Dr. Todd.
Induration .....  Dr. Carswell.
Infanticide .....  Dr. Arrowsmith.
Infection.....Dr. Brown.
Inflammation Dr. A. Crawford, Dr. Tweedie.
Influenza.....Dr. Hancock.
Insanity......Dr. Pritchard.
Irritation.....Dr. Williams.
Ischuria Renalis  .  . .  Dr. Carter,
Jaundice.....Dr. Burder.
Kidneys, Diseases of, .  Dr. Carter.
Lactation.....Dr. Locock.
Laryngitis.....Dr. Cheyne.
Latent Diseases   .  . .  Dr. Christison.
Lepra......Dr. Houghton.
Leucorrhcea   ....  Dr. Locock.
Lichen......Dr. Houghton.
Liver, Inflammation of,   Dr. Stokes.
  "   Diseases of,  . .  Dr. Venables.
Malaria and Miasma   .  Dr. Brown.
Malformations of the Heart Dr. Williams.
Medicine,  Principles and $ r.  r.
    Practice  of,   .  .   £Dr- Conolly.
Melaena......Dr. Goldie.
Melanosis.....Dr. Carswell.
Menorrhagia  ....   Dr. Locock.
Menstruation, Pathology of Dr. Locock.
Miliaria,......Dr. Tweedie.
Mortification  ....  Dr. Carswell.
Narcotics.....Dr. A- T. Thomson.
Nephralgia and Nephritis Dr. Carter.
Neuralgia.....Dr. Flliotson.
Noli me tangere, or Lupus Dr. Houghton.
Nyctalopia.....Dr. Grant.
Obesity......Dr. Williams.
GSdema......Dr. Darwall.
Ophthalmia   ....  Dr. Jacob.
Otalgia and Otitis  . .  Dr. Burne.
Ovaria, Diseases  of the  Dr. Lee.
Palpitation.....Dr. Hope.
Pancreas, Diseases of the, Dr. Carter.
Paralysis.....Dr. R. B. Todd.
Parotitis......Dr. Kerr.
Pellagra......Dr. Kerr.
Pemphigus.....Dr. Corrigan.
Perforation of the Hoi-  C ^  r.
    low Viscera   .   .   \ Dr- Carswell.
Pericarditis and Carditis Dr. Hope.
Peritonitis  ....  Dr. M'Adam, Dr. Stokes.
Persons found Dead   .  Dr. Beatty.
Phlegmasia Dolens  .  .  Dr. Lee.
Pityriasis.....Dr.
Plague......Dr.
Plethora.....Dr.
Pleurisy, Pleuritis,  .  .   Dr.
Plica Polonica ....   Dr.
Pneumonia.....Dr.
Pneumothorax   .  .  .   Dr.
Porrigo......Dr.
Pregnancy, &c, Signs of, Dr.
Prognosis.....Dr.
Pseudo-morbid Appear-C p.
    ances   .   .  .  .  \
Psoriasis.....Dr.
Puerperal Diseases  .  .   Dr.
Pulse.......Dr.
Purigo......Dr.
Purpura......Dr.
Pyrosis......Dr.
Rape.......Dr.
Refrigerants   . ;  .  .   Dr.
Rheumatism  ....   Dr.
Rickets......Dr.
Roseola......Dr.
Rubeola......Dr.
Rupia......Dr.
Rupture of the Heart 0.   Dr.
Scabies......Dr.
Scarlatina.....Dr.
Scirrhus......Dr.
Scorbutus.....Dr.
Scrofula......Dr.
Sedatives.....Dr.
Sex, Doubtful,  ...   Dr.
Small-Pox.....Dr.
Softening  of Organs  .   Dr.
Somnambulism and Ani- C ^
    mal Magnetism .  \
Soundness, &c, of Mind  Dr.
Spinal  Marrow,  ^is"5nr
    eases  of,   ...  (_
Spleen,  Diseases of,   .   Dr.
Statistics,  Medical,  .  .   Dr.
Stethoscope   ....   Dr.
Stimulants.....Dr.
Stomach,  Organic Dis-Sp
    eases of,   .  . .  £
Succession of  Inherit- C jy
    ance-Legitimacy,  £
Suppuration   . ...   Dr.
Survivorship  ....   Dr.
Sycosis......Dr.
Symtomatology  .  .  .   Dr.
Syncope......Dr.
Tabes Mesenterica  .  .   Dr.
Temperament....   Dr.
Tetanus......Dr.
Throat,  Diseases of the,  Dr.
Tonics  ......   Dr.
Toxicology.....Dr.
Transformations .  .  .   Dr.
Transfusion   ....   Dr.
Tubercle.....Dr.
Tubercular Phthisis .  .  Dr.
Tympanites   ....   Dr.
Urine, Morbid States of,   Dr.
Urine, Bloody,   .  .  .   Dr.
Urticaria.....Dr.
Uterus, &c. Pathology of, Dr.
Vaccination   ....   Dr.
Varicella.....Dr.
Veins, Diseases of,  .  .   Dr.
Ventilation.....Dr.
Wakefulness  ....   Dr.
Waters, Mineral,   .  .   Dr.
Worms......Dr.
Wounds, Death from, .   Dr.
Yaws   ......   Dr.
Cumin.
Brown.
Barlow
Law.
Corrigan.
Williams.
Houghton.
A. T. Thomson.
Montgomery.
Ash.

R. B. Todd.

Cumin.
Hall.
Bostock.
A. T. Thomsor.
Goldie.
Kerr.
Beatty.
A. T. Thomson.
Barlow.
Cumin.
Tweedie.
Montgomery.
Corrigan.
Townshend,
Houghton.
Tweedie,
Carswell.
Kerr.
Cumin.
A. T. Thomson.
Beatty.
Gregory.
Carswell.

Pritchard.
Pritchard.

R. B. Todd.

BlGSBY.
Hawkins.
Williams.
A. T. Thomson.

Houghton.

Montgomery,
R. B. Todd.
Beatty.
Cumin.
M. Hall.
Ash.
Joy.
Pritchard.
Symonds,
Tweedie.
A. T. Thomsok.
Apjohn.
Duesbury.
Kay.
Carswell.
Clark.
Kerr.
Bostock,
Goldie.
houghton.
Lee.
Gregory
Gregory.
Lee.
Brown.
Cheyne.
T. Thomson.
Joy.
Beattt.
Kerr. 
ASTHMA.
219
found in the luxurious habits of later times, which
have carried to a dangerous excess the comforts
of our dress and habitations.  In nothing is there
a greater contrast between  us and  our  ancestors
than in the luxurious closeness and warmth of
our apartments;  and it  will scarcely be denied
that the result of  such a mode of living has been
to render us more easily affected by the rigour
and changeableness  of the  climate out of doors,
which, unhappily, appears  rather  to  have retro-
graded than improved, while the endless invention
of new modes of defence in our domestic arrange-
ments, has made the contrast  still greater.  No
author has dwelt so much on the consequences
of these luxurious habits in predisposing to asth-
ma, as  Withers, whose observations  are  most
pertinent,  and well merit  the  attention of the
reader.   (See  his  Treatise on Asthma.)  It  is
frequently by inducing  this sensibility to the im-
pression  of  cold, and  by  thus  predisposing  to
catarrh,  that  dyspepsia  lays  the  foundation of
asthma.   Many  other of  the  remote causes of
asthma operate in the same manner, and among
these, certain  mental states, particularly the de-
pressing  passions.  Sedentariness  and seclusion,
the natural consequences of grief and melancholy,
give rise to dyspepsia, and dyspepsia induces the
 languid circulation  in  the  skin, extremities, and
 mucous membranes, which seems to be the im-
mediate cause of the increased sensibility to cold.
   II. Exciting causes.—Under this  head must
 be comprehended all such circumstances as have
 been known  immediately  to induce  a  paroxysm,
whether  in  the  predisposed or not.   These are
 extremely numerous and various.  Joseph Frank
 alone enumerates upwards of forty, and it is but
 justice to this learned and  indefatigable writer to
 state that he  gives his authority in every  case.
 (Prax. Med. Univ. Pars ii. vol. vii. p. 386.)  Our
 countryman Willis, in general  and more  pithy
 terms, conveys nearly the same information when
 he informs us that " asthmatics can bear nothing
 violent or unusual.   From excess of heat or cold,
 from any great bodily exertion or mental emotion,
 from change of season  or of weather, from errors,
 even of a slight kind,  in  the non-naturals, and
 from a thousand things  besides, they fall into fits
 of dyspnoea."*  By far the most  common and
 most important of these cases, we consider to be
 the application of cold, or, at least, one or more
 of those circumstances, whatever they  may  be,
 which, in ordinary cases,  produce catarrh.  Al-
 though  it will appear from what  is gone  before
 that  we  do not deny  the  existence of cases of
 asthma  of a  purely nervous kind, and altogether
 independent of any permanent local affection of
 the bronchial membrane,  we  are  decidedly of
 opinion that  they constitute an extremely  small
 proportion of the cases  met with in practice. And
 we are further of opinion that out of the immense
 majority  of cases of asthma from other causes,
 nine-tenths are  complicated with some form of
 catarrh, or, at  least, with a morbid  susceptibility

  » Aethmatici nihil violentum aunt inassuetum fcrre
 poMunt: A frisoris vel caloris excexsn, a vehement! quo.
 vie corporis aunt aniini inotu, ab aeris aunt anni muta-
tionibua quibimiue mollis,  ab erratis  vel leviorilmn
circa re* non naturalea, imo propter mille alias occasio-
ned in dyspnea: paroxysmo*  incidunt. — D» Mctlicam.
0/*r. f. 209.
of the bronchial membrane to be affected by cold.
In this  very numerous class of cases, then,  all
those circumstances which  induce catarrh, and
which  may generally be considered as some form
or modification of cold, applied to the whole body
or to a part of  it, must be understood  to  be  the
usual exciting causes of the  asthmatic paroxysm.
   [Yet  in regard to the exciting causes, there are
some which induce asthma, and can  scarcely be
considered  amongst  the causes of catarrh.   In
general, a cold and dry air suits the asthmatic, but
there are  singular  differences  in  this  respect.
Closing a door has  been known  to  bring on a
paroxysm;  and, with  some, darkness increases
the  violence of the  attacks.   One cannot bear
smoke; another exists better  in a smoky apart-
ment.   (Dunglison's  Practice of Medicine,  2d
edit. i. 327: Philad. 1844.)]
   All  practical writers on asthma lay great stress
on this exciting cause, but  none with such pre-
cision and  effect as  Withers,  Ryan,  and  Watt.
The latter  author  in particular, in a short but
most valuable essay published in his Treatise  on
Diabetes, has very strikingly and beautifully illus-
trated the subject.  In several cases there recorded,
he has pointed out, with the greatest minuteness
and perspicuity, the gradual influence of the cause,
 from the first impression of the cold up to the in-
 vasion  of the paroxysm.  (Cases of Diabetes, &c.
 p. 254.  Glasgow, 1808.)   Ryan  had previously
 made the same observation, and applied it to prac-
 tical purposes of the  greatest importance.   (Ob-
 servations on Asthma, p. 40. London, 1793.)  In
 these opinions our own  experience leads  us fully
 to concur ;  almost every case of  asthma  which
 we  have met with being traceable to the usual
 causes of catarrh, and most  of them being  ad-
 vantageously treated only on the principles which
 regulate the practice in that disease.
   Treatment of Asthma.—In this, as in other
 diseases, the attainment of a just pathology would
 wonderfully abbreviate the  labour of therapeutical
 prescription. In the writings of the older authors,
 who were, in  general, guided either by empirical
 views or by fanciful  theories  of disease, we  find
 no  end  to the array of medical  formula?, until
 every thing that had  been put on  record by their
 predecessors, or had  been imagined by themselves
 or their contemporaries, as useful  or  likely to be
 useful  in the individual disease under considera-
 tion, has been displayed at full length.   In  our
 own days, and in the  diseases of the nature of
 which we have acquired some accurate views,  a
 few general precepts will  convey to those  ac-
 quainted  with the general  principles of thera-
 peutics all that we have to deliver respecting  the
 treatment of a disease. We have not yet attained,
 in the  case of asthma, to a  pathology perfect in all
 its  parts ; yet we trust that enough has been re-
 corded in  the  preceding pages to  permit us to be
 more brief in the delivery of our practical precepts
 than some of our predecessors.
   In entering upon this part of our subject, it is
 desirable that the reader keep constantly in mind
 that almost every thing in  the succeeding pages
 respecting the treatment of  asthma applies exclu-
 sively  to  the  chronic forms of that  disease.   It
 will be recollected  that the disease termed acute
 asthma is either a variety of bronchitis, or a violent 
232
ASTRINGENTS.
effects of  astringents by acting chemically on the
contents of the  stomach and intestines, very few
remarks will suffice.  Both lime and its carbonate,
or chalk, operate in checking diarrhoea by neutral-
izing the ascescent matters which augment  the
irritability of  the intestines, and  keep up their
morbidly increased peristaltic movement.   Owing
to the little solubility of pure  lime, chalk, rubbed
up with mucilage of gum  so as  to suspend  it in
any  fluid, is preferred in cases of diarrhoea.   It is
incompatible  with vegetable  infusion  containing
much tannin, and with preparations  of  ipecacu-
anha.  When it is necessary to continue the use
of the  chalk  mixture for  some  time, the bowels
should be cleared  with a purgative, as accumula-
tions in the  form of hard balls are apt  to  take
place  in  them,  and, lodging in the folds of the
intestines, to cause much inconvenience and, occa-
sionally, hazard.
   [The agents, considered  thus far, may be re-
garded as  direct astringents ; but profuse evacua-
tions may be connected with different states of the
living  system,  so that  agents,  possessed of no
astringent properties, may check them or produce
an  astringent operation  indirectly.  Hence, there
may  be direct and indirect  astringents, as there
are direct and indirect tonics.   Opium, for exam-
ple,  by allaying  the augmented  peristole in  diar-
rhoea, may exert an action  of astringency,  and
diminish  the  number of discharges : accordingly,
it is often had recourse to in such cases.  Again,
the increased  discharges of dysentery are  induced
by an inflammatory condition  of the mucous coat
of the intestines : bleeding, therefore, by allaying
this inflammation, and castor-oil,—given occasion-
ally, so as to remove gently the morbid secretions,
—by taking away the cause, may check the effects.
A predominance  of acidity  in early infancy lays
the foundation for many of the bowel complaints,
which are so common at that age,  and  keeps  them
up  when once  established.   A proper antacid, as
before  observed,  by neutralizing  the  acid, takes
away the cause, and thus  becomes an  indirect
astringent.   (The writer's General  Therapeutics
and Mat. Med. ii. 96, Philad. 1843.)]
   In a therapeutical and practical point of view,
astringents, when administered on proper princi-
ples, are a valuable class of remedies.  In  inter-
mittent fevers, the vegetable  astringents have been
successfully employed  in the same  manner as
simple tonics.   We can form  no other idea of the
manner in which they  prove beneficial  than by
supposing,  that they obviate the relaxation which
favours the influence of  the  exciting causes of
agues.  On this account it<has>been asserted  that
tonics and astringents operate in every respect in
a similar  manner ;  but  many tonics, such, for in-
stance, as sulphate of quinia, possess no astrin-
gency, and nevertheless are useful in intermittents;
and  it must be admitted that, as pure astringents
are seldom  or never given alone in intermittents,
it is difficult to  ascertain how  much of the benefit
is due to  their influence.  They are employed in
continued fevers only to moderate incidental diar-
rhea and internal hemorrhages.
   In the phlegmasia?, astringents  are contra-indi-
cated as  general  remedies;  but  in that  state of
inflammatory action  which   assumes a  chronic
character, and is kept up by  debility and increased
I nervous excitability, such as occurs in the eye and
 in the tonsils, they are local remedies of conside-
| rabie  value.  Solutions of the metallic  salts, and
 infusions of astringent vegetables, with  the addi-
 tion of diluted sulphuric acid, are well adapted for
 these cases.  Indeed, after  inflammatory action
 has been subdued by the use of the lancet and
 other antiphlogistic measures, the application of
 cold  and  astringent solutions  tends  greatly to
! restore the healthy action of the part
    [In diphtheritic affections of the throat, a solrj.
 tion of nitrate of silver has been found of great
 benefit; and in cases of diphtheritic laryngitis, tbe
 inhalation of finely powdered alum has been mark-
 edly advantageous.  Not only—according to Lain-
 nee—has it afforded great and speedy relief in tra-
 cheitis, but in laryngitis isthmitis, and pharyngitis.]
    No remedies are so important in the  hemorrha-
 gic as astringents; but they  are not to be indis-
 criminately prescribed, or at all  times employed:
 it is,  therefore, necessary, to inquire what are the
 circumstances  indicating their use in these cases'
 Hemorrhages are properly divided into  active and
 passive.   In the first or active kind, the flow of
 blood generally  arises  from a plethoric condition
 of the  vascular  system;  and it may, in some
 respects, be regarded as an  effort  of  nature to
 relieve the morbid  fulness of  the vessels.  In this
 form  of hemorrhage, tonic astringents are improper;
 and even those exerting a sedative influence should
 not be resorted to until the vessels be either emp-
 tied  spontaneously or  by the use of the lancet
 In passive hemorrhages the animal fibre is relaxed,
 the red particles  of the  blood are diminished, and
 diffused in a superabundance of serum, so that the
 blood assumes a pale  watery aspect;  while the
 system suffers from general debility.   In this state,
 astringents are  decidedly indicated,  and may be
 liberally  employed.   Although these opposite
 states appear very  obvious  in description, yet
 much judgment and attentive observation are requi-
 site to distinguish them  on many occasions. If
 we take, for example,  epistaxis, let us enquire,
 what are  the peculiar symptoms which clearly
 indicate the employment of astringents ?  When
 bleeding  takes place from the  nostrils of young
 persons of a plethoric  habit,  it may be critical, or
 connected with congestions, or a determination of
 blood to the head.  In this state the hemorrhage
 should not be checked  by astringents,  unless it is
 so profuse and long continued as greatly to lowei
 the pulse, to produce  pallor of the  countenance,
 and  exhaust  the general strength.  On the con-
 trary, when epistaxis happens  in weak boys w
 youths, or in old persons ^ or when it is sympto-
 matic of  diseased  liver, or  some other  internal
 organ ; then astringents  may be at once adminis-
 tered to check the direct loss  of blood, whilst other
 means are resorted to for removing the exciting
 causes of the hemorrhage.  The best  astringents
 in these  cases are solutions  of metallic salts and
 of alum :  they  may be  either  injected into the
 nostrils, or dossils  of lint soaked in  an astringent
 solution  may be  inserted ; while at the same time
 cold  water is applied to the face and nape of the
 neck.
    In hsemoptysis, if the excitement be considerable,
 the lancet  must be employed, after  which the
 application of cool air, cold  water, or  ice to tin - 
LEA &  BLANCHARD'S  PUBLICATIONS.
11
DUNGLISON'S    PRACTISE,
               SECOND  EDITION.
              A  NEW  EDITION,  TO   1844,

                                     OF

       THE  PRACTICE   OF  MEDICINE;

                            A  TREATISE

                                    ON

 SPECIAL  PATHOLOGY  AND THERAPEUTICS.
                           SECOND EDITION.

                    BY ROBLEY DUNGLISON,  M. D.,
   Professor of the Institutes of Medicine in the Jefferson Medical College, Lecturer on Clinical Medicine,
                    Attending Physieian at the Philadelphia Hospital, ic.
              In two large octavo volumes, of over thirteen hundred pages.'

   Notwithstanding the short period in which this work has been before the  profession, if is so
 universally known throughout the country, and so extensively used as a text-book in the Medical
 Colleges, that, in presenting this new and much improved edition,.the publishers have only to call
 attention to the author's preface.
   " It is scarcely necessary for  the author to say,4hat the extraordinary sale, which the first edi-
 tion of this work has met with,  is most gratifying t6 him.  It sufficiently  satisfies him, that the
 large amount of labour and reflection, which he bestowed upon it, has been found serviceable to
 his medical brethren, and more  especially so, perhaps, to those who are engagcd'in the study of
 their  profession.
   "Grateful for this result, the  author has endeavoured to render the present edition still more
 useful, by adding whatever of importance has transpired in the short period that has elapsed
 since the first edition was published, and by supplying omissions, which were almost inevitable
 in the first impression of a work in which so many subjects are treated of.
   " It has been pleasing to the  author to observe the favourable manner in which the work has
 been noticed by almost all the Journals of Medicine, which have received it at home and abroad;
 and where criticisms have been  occasionally made, they have generally been  rather against the
 plan than the manner of execution.  That plan was adopted from a full and  deliberate con-vie-
 tion of its advantages, and it is, therefore, adhered to in the present edition without modification.
  "The solid testimony, which the Profession have afforded in favour of the work will incite the
 author to untiring exertion to render every succeeding edition more and' more  valuable."
    THE PUBLISHERS ANNEX A CONDENSED STATEMENT OF THE
                               CONTENTS.
  Diseases of the Mouth, Tongue, Teeth, Gums,  Velum  Palati  and Uvula, Pharynx and CEso-
 phngus, Stomach, Intestines, Peritoneum, Morbid  Productions in the Peritoneum and  Intes-
 tines.-Diseases of the Larynx and Trachea, Bronchia and Lungs, Pleura, Asphyxia.—Morbid
 Conditions of the Blood, Diseases of the Heart and Membranes, Arteries, Veins, Intermediate
 or Capillary Vessels.-Splcen, Thyroid Gland, Thymus Gland, and Supra Renal Capsules, Mesen-
 tenc Glands,—Salivary Glands, Pancreas, Biliary Apparatus, Kidney, Ureter,  Urinary Bladder
 -D.seascs of the Skin, Exanthematous, Vesicular, Bullar, Pustular, Papular, Squamous, Tuber-
 culous, Maculae, Syphilides—Organic Disuses of the  Nervous Centres,  Neuroses  Nerves —
 Diseases of the Eye, Ear, Nose—Diseases of the Male and Female Organs  of Reproduction-
-Fevcr.-lnternmtent, Remittent, Continued, Eruptive, Arthritic, Cachcx, Scrofulous, Scorbutic
Chlorotic, Rhachitic, Hydropic, and Cancerous. 
12___________LEA  &  BLANCHARD'S  PUBLICATIONS.__________


WATSON'S  PRACTICE   OF   MEDICINE*

                         LECTURE  S

                                        ON THE

          PRINCIPLES   AND    PRACTICE   OF   PHYSIC.
                   DELIVERED AT  KING'S  COLLEGE, LONDON.

                        BY  THOMAS WATSON,  M. D.
    Fellow op the Rotal College op Physicians, Physician to thb Middlesex Hospital, Arc. 4c
In  one  large octavo  volume, of over nine hundred  unusually large pages, well
                  bound in leather.   Containing ninety  lectures.

  This  volume has met with the  universal  approbation of the medical  press, so far as it h   yet been
expressed, in a manner rarely enjoyed by so comprehensive a work. The publishers submit a few extracts.
  '■Forour parts, we are not only willing tKa.t our characters as scientific physicians and skilful practitioners
may be deduced from doctrines contained in this volume, but we hesitate not to express our belief, that for sound,
trustworthy principles, and good substantial practice, it cannot be paralleled by any similar work in any other
country.  We would advise no one to set himself down in practice unprovided with a copy."—British and
Foreign Medical Review.
  " We have here the sterling production of a liberal, well-stored, and truly honest mind, possessed of all that ia
currently known and established of professional knowledge, and capable of pronouncing a trustworthy and
impartial judgment on those numerous points in which truth is yet obscured by false hypotheses."—Provincial
Med Journal.
  " Open this huge, well furnished volume where we may, the eye immediately rests on something that carries
value on its from.  We are impressed at once with  the strength and depth of the lecturer's views.  He gains
on our admiration in proportion to the extent of our acquaintance with his profound researches.  Whoever owns
ihis book, will have an acknowledged treasure if the combined wisdom of the highest authorities is appreciated."
Boston Med- and Surg Journal.
  <: We know of no other work better calculated for being placed in the hands of the student, and for a text-
book, and as such we are sure it will be very extensively adopted. On every important point, the author seems
to have posted up his knowledge to the day."—American Medical Journal.
  " We know not, indeed, of any work of the same size that contains a greater amount of useful and interest-
ing matter.  We are satisfied, indeed, that no physician, well-read  and observing as  he may be, can rise from
its perusal without having added largely to his stock of valuable information."—./Medical Examiner.
  " It is an admirable digest of general pathology and therapeutics.   As a text book for medical schools, it can-
not be surpassed, and in no other treatise can practitioners find so concise, and at the same time so complete a
summary of the present state of the science of medicine."—Baltimore Patriot.
  ''One of the most practically useful books that ever was presented to the student—indeed, a more admirable
summary of general and special pathology, and of the application of therapeutics to diseases, we are free to say
has not appeared for very many years.  The lecturer proceeds through the whole classification of human ills, a
capite ad calcem, showing at every step an extensive knowledge of his subject, with the ability of communicat-
ing his precise ideas, in a style remarkable for its clearness and simplicity."—.W. Y Journal of Medicine, l;c.
  " The style is correct and pleasing, and the matter worth the attention of all practitioners, young and old."—
Western Lancet.

   Fn  order to insure  to  this volume as wide  a  circulation as it  is entitled to by its merits, the
publishers have put it at a price within the reach of all.  It  recommends itself to practitioners as
well as students, to the owners of other works on practice, as well  as  those without—something
new can be gleaned by all from its well-stored pages.




TWEEDIE'S     LIBRARY     OF    PRACTICAL    MEDICINE,

         A   SYSTEM  OF   PRACTICAL   MEDICINE.

        Comprised  in  si Series of Original Dissertations, arranged and  edited by
                        Alexander Tweedie, M. D., F. R. S., &c,  kc.

                  With notes and additions,  by W. W. Gerhard, M. D., &c.

                            SECOND AMERICAN  EDITION,

                                 In three volumes  octavo.

  The design of this work is to supply the want, generally admitted to exist  in the medical literature of Great
Britain, of a comprehensive System of Medicine, embodying a condensed, yet ample view of the present state of
the science.  The desideratum is more especially felt by the Medical Student, and by  many Members of the
Profession, who, from their avocations and other circumstances, have not the opportunity of keeping pace with
the more recent improvements in the most interesting and useful branch of human knowledge.  Tosupply this
deficiency is the object of The Library op Medicine; and the Editor expresses the hope, that with the assist-
ance with which he has been favoured by Contributors, (many of great eminence, and all favourably  known
to the Public,) he has been able to produce a work, which will form  a Library of General Reference on Theo-
retical and Practical Medicine, as well as a series of Text Books for the Medical Student.
                         ©IWEES'S  ra^©Tii©n0
A. PRACTICE OF PHYSIC, Comprising; most of the diseases not treated of in  "Diseases of Females" and
 " Diseases of Children." By William P. Dewees, M. D., &c. &c.  Second edition, in one large 8vo. volume.
6�44 
LEA & BLANCHARD'S PUBLICATIONS.             13
                ANATOMY.
HORNER'S   ANATOMY.
 SPECIAL   ANATOMY    AND    HISTOLOGY.
                BY WILLIAM E. HORNER, M. D.,
    Professor of Anatomy in the University of Pennsylvania. Member of the Imperial Medico-Chirurgical
            Academy of St. Petersburg, of the Am. Philosophical Society, &c. &c.
                     Sixth edition, in two volumes, 8vo..
  " Another edition of this standard work of Professor Horner has made its appearance to which many addi-
 n°,.fJTn„«e" m.adr'2nd T" Whi~h m,,ch labournas ^en bestowed by the author. The additions are chiefly
 Lh^h .h«P?I™e, ,°hf "'""'"ey. or E ementary Anatomy, and so important are they lhat the Professor has
 ™£i««, '?,' l a t,tle of b,s work-  ¥veTy part of tnis edition 8eem8 to nave undergone the most careful
 dV."-j>M MeYjli™*?** re8t *"        5 the SCienCe °f Anatoray fu"y brought up to the present
  An Atlas that may accompany this work or be sold separate is now preparing.-See Advertisement.

    WILSONS   HUMAN  ANATOMY.

         A SYSTEM  OF HUMAN ANATOMY,
                GENERAL AND  SPECIAL,
                 BY ERASMUS WILSON, M.D.,
               Lecturer on Anatomy, in King's College, London.
            EDITED  BY PAUL B. GODDARD, M.D.,
       PROFESSOR OF ANATOMY IN THE MEDICAL INSTITUTE OF PHILADELPHIA, &C &C.
  WITH ONE HUNDRED AND SEVENTY ILLUSTRATIONS ON  WOOD.
                 Engraved by Gilbert from designs by Bagg.
             In one volume octavo, beautifully printed.
fr™ ."h!'!?.' cdJ'i0" of ?ne,of lhe »«»' »»«f"l and accurate systems of Anatomy, which has been issued

.:„„"", „"„"g „  ur- <*°<w*rd  has added a number of valuable notes, and made some iudicious altera.



  W I L S ON'S    DISSE  C  T O R.


          THE  DISSECTOR,
OR
      PRACTICAL  AND  SURGICAL  ANATOMY.
                     BY ERASMUS WILSON, M.D.,
               AUTHOR OF "A SYSTEM OF HUMAN ANATOMY," &C.
          With one hundred and six illustrations, modified and rearranged by
                    PAUL B. GODDARD, M.D.,
    DEMONSTRATOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, &C.
                     In one volume, royal 12mo.

an excellent work."-Boston Medical and Surg Journal        furnished with an improved edition of

..^JMr^i^^!5iSi sir %^»M^^&rv- ™ -«•

r mjj what mUsl be regarded .s the essentia, basis^of o^efe*^


^ In this work we have another va.u.ble ./to the J^Z^^l^y. Journal* 
 14                LEA & BLANCHARD'S PUBLICATIONS.

                  SMITH   AND  HORNER'S

       ANATOMICAL     ATLAS.


         LEA  and BLANCHARD are now Publishing,

                                        AN"

            AM ATOM!© AIL   A^ILASs

 ILLUSTRATIVE  OF THE STRUCTURE  OF THE  HUMAN BODY,

                     By  HENRY  H.  SMITH,  M. D.
        Fellow of the College of Physicians, Member of the Philadelphia Medical Society, &c, &x.
                          UNDER THE SUPERVISION OF
                   WILLIAM  E.  HORNER, M.D.
             Professor of Anatomy in the University of Pennsylvania, &c. &c.

   This Work is  to be in FIVE  PARTS, and  will, when complete, form
 one large imperial Octavo Volume.   The price will not be over

                    SIX   DOLLARS,   BOUND,
            And will  contain a Complete Series  of Plates,
 Illustrative of the Bones; Ligaments; Muscular, Dermoid and Nervous
 Systems; Arteries;  Lymphatics; Veins; Viscera; &c; with between

      Six and Seven  Hundred  Engravings  on  Wood
                    Executed in the very first style of Art.
   Parts I. and II. have been published, containing the Bones and Liga-
ments, and  the Muscular  and  Dermoid Systems, illustrated  by  over
Two Hundred and Twenty Engravings on Wood, by Gilbert.  The greater
portion of them after Original Drawings by Pinkerton.
  This work possesses novelty both in the design and the execution.  It is the first attempt to apply engravine
 cm wood, on a large scale, to the illustration of human anatomy; and the beauty of the two parts already issued,
 induces the publishers to flatter themselves with the hope of the perfect success of their undertaking.  The plan
 of the work is at once novel and convenient.  Each page is perfect in itself, the references being immediately
 under the figures, so that the eye takes in the whole at a glance, and obviates the necessity of continual reference
 backwards and forwards. The cuts are selected from the best and most accurate sources; and, when- necessary,
 original drawings have been made from the admirable Anatomical Collection of the University of Pennsylvania.
 It will also embrace all the late beautiful discoveries arising from the use of the microscope in the investigation
 of the minute structure of the tissues.
  In the getting up of this very complete work, the publishers have spared neither pains nor expense; and they
 now present it to the Profession, with the full confidence that it will be deerrfed all that is wanted in a scientific
 and artistical point of view, while, at the same time, its very low price places it within the reach of all.

             It is particularly adapted to supply the place of skeletons or subjects.


  " This is an exquisite volume, and a beautiful specimen of art.  We have  numerous Anatomical Atlases, but
 we will venture to say that none equal it in cheapness, and none surpass it in faithfulness and spirit.  We
 strongly recommend to our  friends, both urban and suburban, the purchase of this excellent work, for which
 both editor and publisher deserve the thanks of the profession."— Medical Examiner
  " We would strongly recommend it, not only to the student, but also to the working practitioner, who, although
 grown rusty in the toils of his harness, still lias the desire, and often the necessity, of refreshing his knowledge
 in this fundamental part of the science of medicine."— New York Journal of Medicine
  " The plan of this Atlas is admirable, and its execution superior to any thing of the kind before published in
 this country.  It is a real  labour-saving affair, and we  regard its publication as the greatest boon that could be
 conferred on the student of anatomy.  It will be equally valuable to the practitioner^ by affording  him an easy
 means of recalling the details learned in the dissecting-room, and which are soon forgotten."—American Journ.
 of the Med Sciences.
  "The second partofDrs. Smith and Horner's Anatomical Atlas, in point of interest of subject and execution
of the engravings, is even more valuable and attractive than the first, much as that led us to expect Rich aids
to physiological inquiry will be found in the microscopical views of the cellular and adipose tissues, and of the
epidermis, rete mucosum, cutis vera, papillae, the sebaceous and perspiratory organs of the skin, the perspiratory
glands and hairs of the skin, the hairs and nails, and the general anatomy of the muscles. The muscles them-
selves are delineated with all the distinctness of a fine dissection.  We cannot, taking the two numbers of the
Anatomical Atlas before us as  evidence of the execution of the entire work, too strongly recommend it to
readers and the medical public at large."—Bulletin of Medical Science.


  Specimens exhibiting the plan and  execution of  the work will be  sent

by  mail or otherwise as may be directed on application free of postage.
\ 
                LEA & BLANCHARD'S  PUBLICATIONS.              15


         PHYSIOLOGY  AND  PATHOLOGY.


     DUNeillSQN'S    MTOlUiY,

            A NEW EDITION,  TO  1844.


        HUMAN   PHYSIOLOGY:

 WITH  UPWARDS   OF  THREE  HUMORED  ILLUSTRATIONS.

               By ROBLEY DUNGLISON, M.D.
         Professor of the Institutes of Medicine in Jefferson Medical College, Philada., etc. etc.
                         FIFTH EDITION,

              GREATLY MODIFIED AND IMPROVED.
             In Two Volumes of 1304 large Octavo Pages.
   Although but a short time has elapsed since the appearance of the last  edition of this
 standard work on Physiology, the labours and discoveries in that branch of science have
 been so diversified and important, that extensive additions have become necessary in the
 present edition. Besides the numerous monographs and minor treatises that  have appeared
 from time to time, in the various scientific Journals and Transactions of learned Societies,
 reference has been made to  the large and valuable works of Valentin, Bischoff, Henle, Wil-
 brand J. Miiller, Wagner, Maudl, Gerber, Liebig, Carpenter, Todd and Bowman, and others,
 and all the results of their interesting and important investigations will be found embodied
 in its pages.
   The illustrations have also undergone a material change. More than ninety new cuts
 have been added, chiefly to  elucidate  subjects now first introduced into this  edition; many
 of the former cuts have  been replaced by those much superior, and the rest have been
 thoroughly retouched and improved, altogether making this the most completely illustrated
 treatise on Human Physiology that has ever been attempted in this country.  In short, the
 publishers believe that, both in matter and execution, this Avork will be found fullv brought
 up to the day.                                                 J    &


     CARPErmsirsl^


            PRINCIPLES  OF HUMAN  PHYSIOLOGY,
   With their chief applications to Pathology, Hygiene, and Forensic Medicine.  Especially
                       designed for the use of Students.
     With over One Hundred beaulifuE Illustrations on Wood.

               BY WILLIAM  B. CARPENTER, M.D.,
              LECTURER ON PHVSIOLOGY IN THE BRISTOL MEDICAL SCHOOL
 FIRST AMERICAN EDITION, WITH NOTES BV THE AUTHOR, AND NOTES AND ADDITIONS
                    BY MEREDITH  CLYMER, M.D.,

                        In one volume, octavo.

  VT This edition of Carpenter's Physiology has been most carefully prepared by Dr Clvmcr,
at the request of Professor Jackson, for his lectures at the University of Pennsylvania. '
  The Author remarks in his Preface-" It has been his object to place the reader in possession of thr> hi„h
est principles that can be regarded as firmly established, in each department of the scCeTand to e" oll.n
and illustrate those by the introduction of as many important facts as could be included wifhinrooderaie
limits. In every instance he has endeavoured to make his statements clear and precise wTthout K for
pTovaMe bTmrU^r'inquIr?'Ute e"°Ugh " ad"lit °f  PraCUCa' W™«™> without appear'ingt be &


             FOTLLER'S PHySIOLOgy.

                ELEMENTS OF  PHYSIOLOGY.

                       BY JOHN MULLER, M.D.,
             Professor of Anatomy and Physiology in the University of Berlin.

     TRANSLATED  FROM THE GERMAN, BY W. BALY,  M.D.
       Arranged from  the 2d London edition by John Bell, M. D., &c.
               In one volume octavo, of nearly nine hundred pages. 
16
LEA & BLANCHARD'S  PUBLICATIONS.
          ILUAMS'    PATHOLOGY.
                           (A Neio Work.)

[       PRINCIPLES   OF   MEDICINE,
COMPRISING
       GEN£S,Ait PATHOLOGY AND THERAPEUTICS, and a general view of
          ETIOLOGY, NOSOLOGY, SEMEIOLOGY, DIAGNOSIS AND

                                PROGNOSIS.

                 BY CHARLES  J. B. WILLIAMS, M.D., F.R.S.


             FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, ETC.


                       WITH ADDITIONS AND NOTES


                   BY MEREDITH CLYMER, M.D.

                  LECTURER ON THE INSTITUTES OF MED1CIHK, ETC. ETC.

                           In  one volume Svo.

«/!hUCbi? W.°T?' a* ,east .8l?faur «» English literature is concerned, was dearly demanded, and the important*

Sim'SK-iT^^i2.e h,gb cbaracler of lhe aulb0'-8bou,d—L il • ««*« p««"KvS

„^"Cb  ? WOrkJ tnen' *s tha* ?<". Professor Williams, embodying, as it does, a full account of the recent
additions toour knowledge, and bnng.ng the subjects of general pathology and therapeutics npto the presen

SrWESn-S «Co ^h^UactiUotr" ^ ^^ **" USCfU'' ** " *"» ** » «" ««*-. »W.

■ll^K™^                    ^ We" SUStaifl9 tbe re"»taU« which itB "'•« >«

r.i'P.ll^i? ",Jf?ic".ak deKCieKC^ '°ns fe!1 by the P™fession-the want of an elementary treatise on gene.
"'Pa„th,"IOgy>/be aulhor, ha.s bad ««eiwive experience at the bed side, and has drawn chiefly from his own
observation ofdisease, as he has witnessed it in hospitals and private practice during the last twenty yeai
r. , .„ su.^e" of inflammation occupies many pages of this work. The manner in whi<bitis treated cann
ROGET'S  OUTLINES  OP PHYSIOLOGY.

 WITH AN APPENDIX ON PHRENOLOGY.  BY PETER MARK ROGET, M.D.&c.&c.
                       In one volume, octavo.
               ROGET'S PHYSIOLOGY.
AKpnr^T^n ABLE *"YsK>LOGY.considered with reference to JVatural Theology. By PETEB
 n,iK KUUtM, M1)-. second American edition. In two volumes, octavo, with nearly FIVE HUN-
 UKED engravings on wood.


C ARPENTER'SVEGETABLE PHYSIOLOGY.
Acre?y?fo^hReTnfomAot?ionEn?? VEGETABLE PHYSIOLOGY. "wii" Se a^^etv
 -u&^t^n^V^                       ^ B' W.B. CARPENTER, M.a


            BILLING'SHPRlT^Cil^^nOF-MEDICINE.
 FIRST PRINCIPLES OF MEDICINE.  By ARCHIBALD BILLING, M.D., A.M. he  Revised from tbe
                  fourth London edition. In one small 8vo. volume.



           ALLISON'S   PATHOLOGY,
                          A NEW WORK.                '
    OUTLINES   OF   PATHOLOGY

                               AND

               PRACTICE  OF MEDICINE.

                                BY

             WILLIAM PULTENEY ALLISON, M. D.,

         Professor of the Practice of Medicine in the University of Edinburgh, &c. he.

In three Parts—Part I —Preliminary Observations—Part II.—Inflammatory and Febrite
            Diseases, and Part III., Chronic or Non-Febrile Diseases.

                          In one volume octavo. 
LEA & BLANCHARD'S PUBLICATIONS.
17
MIDWIFERY,  DISEASES  OF  WOMEN,  CHILDREN,  &c.
RAMSBOTHAM'S    MIDWIFERY.
           THE  PRINCIPLES  AND  PRACTICE
                                    OF

      OBSTETRIC  MEDICINE  AND   SURGERY,
                       IN  REFERENCE TO THE
               PROCESS  OF  PARTURITION.
     ILLUSTRATED BY ONE HUNDRED AND FORTY-TWO FIGURES,  ON 52 PLATES.
               BY  FRANCIS  H. RAMSBOTHAM,  M. D.
        PHYSICIAN TO THE ROYAL MATERNITY CHARITY, &c. &c.
                     SECOND AMERICAN EDITION, REVISED.
                     In one volume, imperial octavo.
                  Well and strongly bound in leather, at a loiv price.
  This work has met with almost unexampled approbation from the medical press of England and this cnun-
try.  irom among these numerous commendations the publishers append a few, and would particularly call the
attention of the medical profession to the numerous plates which form a most important feature in the volume.
r„™ir,eai e.xPense ll?ey have,. incurred in its production, calls for an extended sale, which thus far has been
ilcwTon of thearjretay  66en          * 8eC°nd ed'll°n havi"5 been re^uired within a year after the PUD"
inltnj?inn»b0?,k!.0n Midwi1fery to«udentt: clear, bnt not t0° mi™te in its details, and sound in its practical
be.™Did?ndJd whnH°,«PIenl.ely '"us,tra!fd„by P'al.:6 (^mirably chosen and executed) that the student must
r?nS. .h-™ i ,^v -^ T ""<*"?*"? lhe details of this branch of the science, so far at least as description
can make them intelligible."—Dublin Journal of Medical Science.                         P
are e^ferin^nL^T^11 u • W°rU °f ,Dr' RamJ>bolnara to all our obstetrical readers, especially to those who
wTfe'ry^X^^                     cheapest, but one of the most beautiful works in Mid-
productions XMwlES nl^TX™*'"5 f "1nenot'cle <*lhe profession one of the cheapest and most elegant
prooucuons ol the medical press of the present day.  The text is written in a clear, concise and simDle stvla
D^oU?2d™Tp\™r Wi'heS lhal lhe UBderlakittS may enjoy all the success wSicbIII\o well 3i%-
ablJio^he,0,?^ lSB,?°*l b.?*uUfui T0rks which nab lalely is9ued from themedical press; and is alike credit-
M.l L *?■%*  "V 0fL-he Aulhor and the enterprise of the publisher  It is a good and thoroughly Practical trea.
£& hv ' %Vf nl,8ubJect8 are ,ald  »*« i" a clear and perspicuous form, a JI whatever i^ fmponancets i lus'
   DEWEES'S  SYSTEM  OF   MIDWIFERY.

        A COMPREHENSIVE  SYSTEM OF MIDWIFERY.
     CHIEFLY DESIGNED TO FACIUTATE THE IXQ.UIRIES OF THOSE WHO MAT BE PURSUIT
                          THIS BRANCH OF STUDT.
          ILLUSTRATED BY OCCASIONAL CASES AND MANY ENGRAVINGS.
         Tenth Edition, with the Author's last Improvements and Corrections
                   BY  WILLIAM  P.  DEWEES, M. D.
           Late Professor op Midwifery in the University of Pennsylvania, he.
                              In one volume, Svo.


A TREATISE ON THE DISEASES OF FEMALES. BY WILLIAM P  DEWEES M D  1,1.  p  r
                 of Midwifery in the University of Pennsylvania, Ac,fcc~       '   *  Profe98°'
     Eighth edition, revised and corrected, in one volume, 8vo., with plates. 
18
LEA & BLANCHARD'S PUBLICATIONS.
       CHURCHILL'S  MIDWIFERY.



     ON  THE  THEORY  AND "PRACTICE  OF  MIDWIFERY,

                BY  FLEETWOOD CHURCHILL, M.D., M. R. I. A.
                 PHYSICIAN TO THE WESTERN LYING-IN HOSPITAL, ETC. ETC.

                      WITH  NOTES AND  ADDITIONS
                         BY ROBERT HUSTON, M.D.,

                  Professor in the Jefferson Medical College, &c.  &c.

         AND ONE  HUNDRED AND SIXTEEN  ILLUSTRATIONS,
                Engraved by Gilbert from drawings by Eagg and others.

                            In one volume octavo.
  This work commends itself to the notice of the profession from the high reputation of the author and
editor, and the number and beauty of its illustrations.  Besides accurate directions for
                 THE PRACTICE OF MIDWIFERY,
a portion of the work is also devoted to

               THE PHYSIOLOGY AND PATHOLOGY
connected with that essential branch of medical knowledge.
  " It is impossible to conceive a more useful or elegant manual: the letter-press contains all that the prac-
tical man can desire; the illustrations are very numerous, well chosen, and of the most elegant description,
and the work has been brought out at a moderate price."— Provincial Med. Journal.
  "We expected a first rate production, and we have not been in the least disappointed. Although we have
many, very many valuable works on tokology, were we reduced to the necessity of possessing but one, and
permitted to choose, we would unhesitatingly take Churchill."— Western Med. and Surg. Journal.
[ETThis work is brought out in a style to match Wilson's Anatom}',  Fergussons' Surgery, and
  Carpenter's Physiology, and is extensively used as a Text Book in various Colleges in the Union.
ASHWELL ON  THE DISEASES OF WOMEN.
                  A NEW WORK, Nearly Ready.
            A   PRACTICAL  TREATISE

                                  ON THE


                   DISEASES   OF  WOMEN,

           Illustrated by cases derived from Hospital and private practice.

                    BY SAMUEL ASHWELL,  M.D.,
                 Obstetric Physician and Lecturer to Guy's Hospital, &c. &c.
                          WITH NOTES AND ADDITIONS

                       BY PAUL GODDARD, M.D.
             Demonstrator of Anatomy in the University of Pennsylvania, he. he.

                       In one vol. octavo, in three parts.

           Part I.—Functional Diseases.   Part II. & III.—Organic Diseases.
 "Situated as is Dr Ashwell in extensive practice, and at the head of the Obstetric Department of a large
Hospital, it could not be hut that his work must contain very valuable information—the results of great ex-
perience.  The book is full of important information and excellent practical description."—Dublin Medical
Journal.
 "The contributions of Dr. Ashwell coming as they do, armed with the authority of his personal observa-
tion and great experience, are eminently entitled to consideration. Throughout every page we have only
the result of the author's own observation ; and of the work we entertain a high opinion, believing that it
is characterized by accurate observation and sound judgment."—Edinburgh Monthly Journal.
DISEASES OF  FEMALES, PREGNANCY AND CHILDBED.
THE PRINCIPAL  DISEASES OF FEMALES, TOGETHER WITH

  THE DISEASES  INCIDENT TO PREGNANCY AND  CHILD-

         BED, CHIEFLY FOR THE USE OF STUDENTS.

                 BY  FLEETWOOD CHURCHILL, M,D.,
   Lecturer on Midwiferyand Diseases of Women and Children, in the Richmond Hospital &c. he.
                   WITH NOTES AND ADDITIONS
                        BY R.  M. HUSTON, M.D.,

           Professor, &c. in the Jefferson Medical College, Philadelphia.

             Second  American edition, in one vol. octavo.

             A work extensively introduced as a  Text Book. 
LEA & BLANCHARD'S PUBLICATIONS.              19
         A NEW  AND IMPORTANT WORK ON  MIDWIFERY.

     LEA and BLANCHARD have now in Preparation
                 A NEW  WORK  ON  THE  .

 MECHANISM  OF   LABOUR.
                By HUGH L. HODGE, M. D.
    Professor of Obstetrics and the Diseases of Women and Children in the University of Pennsylvania,
                         assisted in the illustrative part
                  BY PAUL BECK GODDARD, M.D.,
                Demonstrator of Anatomy in the University of Pennsylvania.
    This important work is  intended to exhibit the various  OPERATIONS
 OF DELIVERY, with full instructions for  the use of the most approved
 instruments, and means  to facilitate child-birth.  To illustrate this, plates
 will be used on  an extended scale.
                         The work will form
     One Large Imperial Quarto Volume,
                                WITH

 Executed  in lithography in  the  best Style of the Jlrt
  UNDER THE IMMEDIATE INSPECTION OF DR. GODDARD.
 And will aim to be the most perfect and accurate work yet  presented  to
 the Profession in this country.
    In the Figures a uniform scale will be adopted, representing about
                  HALF THE SIZE OF NATURE.
    The price cannot be precisely arranged, but it is at present not designed
 to exceed
            EIGHT  DOLLARS  PER  COPY,
        A  Specimen, ivith a Plate, will shortly be issued,
       and sent to such persons as may request it, free of postage.

   "Numerous publications have  appeared abroad, and  much has been
 attempted, by books and by plates, but almost universally there is a want
 of accuracy in  portraying nature's operations,  and embracing fully the
 science as practised by intelligent obstetricians, in this country, which leads
 necessarily to  errors in practice.
   "The object of the author, therefore, will be to present an accurate history,
 and, as far as  practicable,  a delineation of the process of labour, whether
 natural or preternatural, in the  human female; and, also, of the chirurgical
 means which  may be advantageously employed to effect delivery in pro-
 tracted and difficult labours, so as to diminish the amount of suffering and
 danger  for the mother and her offspring.  In other words, to exemplify as
 minutely as possible, by drawings, the natural 'mechanism of labour,' and
 the scientific employment of the hand or of instruments in facilitating this
 painful and frequently dangerous process.  No one who is ignorant of the
 details of labour in every presentation of the child, can advantageously or
 even safely assist in cases of acknowledged difficulty; an attempt, there-
 fore, to exhibit more fully and minutely the transit of the child through
 the pelvis in all  its various presentations, and the practical results of the
 knowledge thus acquired, cannot but be  advantageous to the practitioner
 and, especially, to the student in medicine."

                  RIGBY'S  MIDWIFERY.
 A SYSTEM OP MIDWIFERY, WITH NUMEROUS WOOD CUTS, BY EDWARD RIGBV M n pi,-,
 ■iciuii to the General Lying in Hospital. Lecturer on Midwifery at St Bartholomews Hospital *c With
 notes and additional illustrations. In one volume octavo.                » no.piuu, «c. with

^n^tirCul^rf'ilrTaMci"1' *' "' fU'neS8 ^ ^ ^^ °f U,er°-Gestatio». wi*» «» Disease, 
20                 LEA & BLANCHARD'S PUBLICATIONS.

   CONDIE     ON     CHILDREN.

                             A  NEW  WORK.
A   PRACTICAL     TREATISE
                                        ON
        THE   DISEASES   OF   CHILDREN,


                         BY D. FRANCIS CONDIE,  M.D.


   FELLOW OF  THE COLLEGE OF PHTSICIANS ;  MEMBER  OF THE AMERICAN

                        PHILOSOPHICAL SOCIETY, &C. &C.


                               In one volume, octavo.


ftj'The Publishers would particularly call the attention of the Profession to an examination
                                     of this work.


        THE VOLUME IS  METHODICALLY ARRANGED IN TWO PARTS.

                   IN FART  I.  ARE  CONSIDERED

The Hygienic Management of Children.
The Peculiarities  of Organization and Functions in Infancy and Childhood.
Pathology of Infancy and Childhood.
And the Semeiology of the Diseases of Infancy and Childoood.

                    IN FART  II. ARE EMBRACED

Diseases of the Digestive Organs.
The Mouth, Throat, (Esophagus, Stomach, Intestines, Respiratory Organs, Nervous System, the
  Skin, Eruptive Fevers, Cutaneous Eruptions, Nutritive Functions, and Urinary Organs.
And lastly, Congenital Affections, and Accidents occurring  soon after Birth.

  But this is, however, only an outline of the subjects brought under special notice.

  "Dr. Condie has studiously endeavoured to be understood by students, who need to have the elements of Tlw-
rapeutics presented to them in a comprehensive form "

  " An excellent Practical Treatise on the Diseases of Children, and a very safe guide to the juvenile practi-
tioner and student."—Med. Examiner.

  " For  the practical physician who shall turn to its pages to learn all  the phenomena which may be pre-
sented by the disease which  he is treating, and all the means to  which he may resort for the cure of that
disease, it will offer  many and strong attractions, among which may be mentioned completeness, clearness,
judgment and good sense.  In it the vanity of the author never tempts the compiler into negligence;  nor
does the laborious care of the compiler weigh down and overlay the original vigour of the author: the two
otfices are made to strengthen and illustrate one another.
  " Dr. Condie from the very labour which l>e has evidently bestowed upon this book, is entitled to our respect
as an indefatigable and conscientious student; but if we consider the results of his labour, we cannot but
admit his claim to a place in the very first rank of eminent writers on the practice of medicine.
  " Regarding his treatise as a whole, it is more complete and accurate in its  descriptions, while it is more
copious and more judicious in its therapeutical precepts than any of its predecessors, and we feel persuaded
that the American medical profession will very soon regard it, not. only as a very good, but as the very best
' Practical treatise on the Diseases of Children.'"— Am Med. Journal.
A TREVHSE ON THE PHYSICAL AND MEDICAL TREATMENT OF CHILDREN.  BY WILLIAM
  P. DEWEES. M.D , late Professor of Midwifery in the University of Pennsylvania, he. eighth edition,
  with the author's last improvements and corrections.  In one volume 8vo.

  The objects of this work are, 1st, to teach those who have the charge of children, either as parent or guardian,
the most approved methods of securing and improving their physical powers.  This is attempted by pointing out
the duties which the parent or the guardian owes for this purpose, to this interesting but helpless class of beings,
and the manner by which their duties shall  be fulfilled.  And 2d, to render available a long experience to
those objects of our affection when they become diseased.  In attempting this, the author has avoided as much
as possible, '' technicality;" and has given, if he does not flatter himself too much, to each disease .of which he
treats, its appropriate and designating characters, with a fidelity that  will prevent any two being confounded
together, with the best mode of treating them, that either his own experience orthat of others has suggested,
Physicians cannot loo strongly recommend the use of this book in all families. 
LEA & BLANCHARD'S PUBLICATIONS.
21
                         SURGERY,

FERGUSSON'S  PRACTICAL  SURGERY
      A  SYSTEM  OF  PRACTICAL SURGERY,

                BY WILLIAM FERGUSSON, F. R. S. E.,

      Professor of Surgery in King's College, London; Surgeon to King's College Hospital, sec. &c

     WITH TWO HUNDRED AND FORTY-SIX  ILLUSTRATIONS.

            Engraved by Gilbert, after drawings by Bagg.


                WITH NOTES AND ADDITIONAL ILLUSTRATIONS

                   BY GEORGE W. NORRIS, M. D.,

                            In one volume octavo.

 The publishers commend this work to the attention of the Profession as combining cheapness and elegance,
with a clear, sound, and practical treatment of every subject in surgical science.  No pains or expense have been
spared to present it in a «tyle equal, if not superior to the London edition, and to match the editions of" Wilson's
Anatomy," " Churchill's System of Midwifery," and " Carpenter's Human Physiology." It is now extensively
used as a text book.
 The object and nature of this volume are thus described by the author: " The present work has not been pro-
duced to compete with any already before the Profession; the arningement, the manner in which the subjects
have been treated, and the illustrations, are all different from any of the bind in the English language.  It is not
intended to be placed in comparison with the elementary systems of Cooper, Burns, Liston, Symes, Lizars, and
that excellent epitome of Mr. Druitt   It may with more propriety be likened to the Operative Surgery of Sir
C. Bell, and that of Mr. Averill, both excellent in their day, or the more modern production of Mr. Hargrave,
and the Practical Surgery of Mr Liston.  There are subjects treated of in this volume, however, which none
of these gentlemen have noticed ; and the author is sufficiently sanguine to entertain the idea that this work
may in some degree assume that relative position in British Surgery, which the classical volumes of Yelpeau and
Malgaigne occupy on the Continent."

  A volume on the Principles of Surgery to accompany Fergusson will be prepared.
 DRUITT'S   MODERN   SUR6ERY.


           THE PRINCIPLES  AND  PRACTICE


                  OF   MODERN   SURGERY,

                          BY ROBERT DRUITT.

 Id pntissimum agens, ut omissis hypothesibus, in praxi nihil adstruatquod multiplici experientia non sit robo-
                           ratum —Act. Erud. Lips., 1722.

                  FROM THE SECOND LONDON EDITION,

          ILLUSTRATED WITH FIFTY WOOD ENGRAVINGS.

                        WITH NOTES AND COMMENTS BY

             JOSHUA  B. FLINT, M. D., M. M.S. S., &c. &c.

                             In one volume, octavo.
  "It may be said with truth that this work affords a complete, though brief and condensed view, of the entire
field of modern surgery.  We know of no work on the same subject, having the appearance of a manual  which
contains so many topics of interest to the surgeon, and the terse manner in which each has been treated evinces
a most enviable quality of mmd on the part of the author, who seems to have an innate power of searchin "ou?
and grasping the leading facts and features of the most elaborate productions of the pen.  It is a useful handbook
for the practitioner, and we should deem a teacher of surgery unpardonable who did not recommend H tohis
pupils.  In our own opinion, it is admirably adapted to the wants of the Bludenl."-Provincial Med Journal.



            LAWRENCE  ON  RUPTURES.

A  TREATISE  ON RUPTURES, BY W. LAWRENCE,  F.R  S   Author
  of a I realise on the  Diseases of the Eye,  &c. &c, from the Fifth London Edi-
  tion, considerably enlarged.  In I vol. octavo.

 TIR? peculiar advnntage of the treatise of Mr. Lawrence is, that he exnlains his oi»™» «„  .1. .  .
Hernia, and the d.fferent varieties of the disease, in a manner nhich ren,lerS hi! £SL    i e ?nat0,ny of
the student.  It mns, he superfluous to e*pr,,S our opinion"""^ v^e'^fe'surXl  P?.o "&"% 
22                 LEA & BLANCHARD'S  PUBLICATIONS.
             SIR  ASTLEY   COOPER  ON  HERNIA,
With One Hundred and  Thirty Figures in lithography.
             THE  ANATOMY  AND  SURGICAL  TREATMENT

                                         OF


    ABID)(DM3IHAIL    II1MIA0

                   By  Sir ASTLEY  COOPER,  Bart.

         Edited by C. Aston Key, Surgeon to Guy's Hospital, &c.

  This important work of Sir Astley is printed from the authorized second edition, published In London, in lar»s
super-royal folio, and edited by his nephew, Professor Key.  It contains all the Plates and all the Letterpress-
there are no omissions, interpolations, or modifications—it is the complete work in

                   One Large  Imperial  Octavo  Volume,

 WITH OYER 130 FIGURES ON m PLATES, AND OYER 400 LARGE PAGES OF LETTERPRESS.

  The correctness of the Plates is guaranteed by a revision and close examination under the eye of a distinguished
Surseon of this city.
  The value  of this Work of Sir Astley Cooper is so universally acknowledged by all medical men, that in
presenting this edition to the American Profession, the publishers have only to stale that they have used their
utmost endeavours to render the mechanical execution of the work worihy iis exalted reputation, and to put it in
such a form and at such a price as to place it within the reach of those who have been prevented from obtaining
it by the size  and rarity of former editions.


               SIR  ASTLEY  COOPER'S WORK.

           ON  FRACTURES  AND  DISLOCATIONS

                        WITH NUMEROUS WOOD  CUTS.
A TREATISE ON  DISLOCATIONS AND  FRACTURES OF THE JOINTS.   By SIR
           ASTLEY  COOPER, Bart., F R.S., Sergeant Surgeon to the King, &c.

  A new edition much enlarged; edited by BRANSBY COOPER,  F.R.S., Surgeon to Guy's
Hospital, with  additional Observations from  Professor John C. Warren, of Boston.   With nu--
mcrous engravings on wood, after designs by Bjgg, a memoir and a splendid portrait of Sir
Astley.  In one vul. octavo.
  The peculiar value of this, as of all Sir Astley Cooper's works, consists in its eminently practical character.
His nephew,  Bransby B. Cooper, from his own experience, has added a number of cases.  Beside this, Sir
Astley left behind him very considerable additions in MS. for the express purpose of being introduced into this
edition. The volume is embellished with  ONE HUNDRED AND THIRTY-THREE  WOOD CCTS, and
contains the history of no less than three hundred and sixty one case?, thus embodying the records of a life of
 Jractice of the Author and his various editors.  There are also additional Observations from notes furnished by
 ohn C. Warren, M.D., the Professor of Anatomy and Surgery in Harvard University.


        MAURY'S   DENTAL   SURGERY.
   A  TREATISE  ON  THE  DENTAL ART,
                          FOUNDED ON ACTUAL EXPERIENCE.

ILLUSTRATED BY TWO HUNDRED  AND FORTY-ONE FIGURES  IN LITHOGRAPHY.  AND  FIFTY-

                                  FOUR WOOD CUTS;

          BY B. F. MAUUY, DENTIST OF THE ROYAL POLYTECHNIC  SCHOOL.
                  Translated from the French, with Notes and Additions,

        BY J.  B.  S A VI E R, D OCTO R  OF  DENTAL  SURGERY.

                                  One volume, octavo.
  This work is used as a Text book in the Baltimore College of Dental Surgery, and commends itself to the
Profession from the great reputation of the author, and as embracing the latest information on the subject  Its
steady demand is the best testimony of the general favour with which the profession has received it. It is di-
vided into thri-e parts.
Part I.— Dental  Anatomy, Physiology and Pathology.
Part II.—Dental Hygiene and Therapeutics.

Part III.—Mechanical Dentistry in all its various parts and fully illustrated.
THE   DISEASES   OF  THE  EYE.
                 WITH NUMEROUS CUTS.
      A  TREATISE  ON  THE   DISEASES  OF THE  EYE.

                                BY VV. LAWRENCE,

  Surgeon Extraordinary to the Queen, Sec, from the last London Edition., with numerous additions, and sixty-
                  seven Illustrations, many of whieh are from original drawings.

                           BY  ISAAC HAYS,  iM.D.,

               Surgeon to the Wills  Hospital, &c. &c, in one volume octavo.           •

  The character of this work  is too well established to require a word of commendation—it is justly considered
the best on  the subject.  The present is a reprint of the last London Edition, which appeared in 1811, com-
pletely revised and greatly enlarged by the author—and to it considerable addiirons have been made by the edi-
tor.  Several subjects omitted in the original are treated of in this edition, on which occasion free use has been
made of the work of Mackenzie, to which is added the editor's own experience, derived from many years' at-
tention to the subject. 
LEA & BLANCHARD'S PUBLICATIONS.                 23
MATERIA MEDICA, THERAPEUTICS, PHARMACY, AND  CHEMISTRY.



PEREIRA^S    MATERIA    MEDICA.

      WITH  NEAR THREE HUNDRED ENGRAVINGS ON  WOOD.


                       THE ELEMENTS  OF


     MATERIA  MEDICA  AND  THERAPEUTICS.

  COMPREHENDING THE  NATURAL HISTORY, PREPARATIOV, PROPERTIES, COMPOSITION,
                         EFFECTS, AND  USES OF iMEDICINES.

             BY JONATHAN  PEREIRA,  M. D.,  F.  R.«. and L.S.

Member of the  Society of Pharmacy of Parish Examiner in Materia Medica  and Pharmacy of
   •the University of London; Lecturer on Materia Medica at  the London Hospital, &c. &,c.

                From the Second London Edition, enlarged  and improved.

                           WITH NOTES AND ADDITIONS

                        BY*  JOSEPH  CARSON, M. D.

                               In two volumes, octavo.

  Part I contains the General Action  and Classification of Medicines, and the Mineral Materia Medica.  Part
II, the Vegetable and Animal Kingdoms, and including diagrams explanatory of the Process*s of the Pharma-
copoeias, a tabular view of the  History of the Materia Medica, from the earliest times to the present day, and a
very copious index  From the Second London Edition, which has been thorouahly revised, with the Introduc-
tion of the Processes of the New Edinburgh Pharmacopceia, and containing additional articles on Mental Reme-
dies, Lieht, Heat, Cold, Electricity, Magnetism, Exercise, Dietetics,.and Climate, and many additional Wood
Cuts, Illustrative of Pharmaceutical Operations, Crystallography, Shape and Organization of the Feculas of
Commerce, and the Natural History of the Materia Medica
  The object of the author has b -en to supply the Medical Student with a Class Book on Materia Medica, con-
taining a faiihfttl out line of this Department of Medicine, which should embrace a concise account of the most
important discoveries in Natural History, Chemistry, Physiology, and Therapeutics, in so far as Ihey pertain to
Pharmacology. and treat the subjects in the order of their natural historical relations
  This zreat Library or Cyclopedia of Materia Medica ha« been fully revised, the errors corrected, and nume-
rous additions made by DR JOSEPH  CARSON, Professor of Materia Medica and Pharmacy in the " Colleee of
Pharmary," and forms Two Volumes, octavo, of near 1600 large and closely-printed pases  It may be fully
reli'd upon as a permanent and standard work for the country,—embodying, as it does, full references to the
U S. Pharmacopceia and an account of the Medical Plants indigenous to the United States.
     ELLIS'S MEDICAL  FORMULARY, 7th  Edition.

THE MEDICAL  FORMULARY;  Betngr a  Collection of Prescriptions, derived from  the
  Writings and Practice of many of the most eminent physicians in this country and in Europe.
  'I'o which is added an Appendix containing the usual  Dietetic Preparations and Antidotes for
  Poisons; the whole  acompmied by a few brief Pharmaceutic and Medical Observations.

                      BY  BENJAMIN ELLIS, M. D.
Seventh Edition, revised and extended by Samuel George Morton, M. D.  In one volume octavo.
GRAHAM'S     CHEMISTRY.
                   Including the application of the Science to the Arts.


                         WITH NUMEROUS  ILLUSTRATIONS,

                 BY THOMAS  GRAHAM,  F. R. S., L. and E. D.

                  Professor of Chemistry in University College, London, &c. he.

                          With Notes and  Additions,

                  BY  ROBERT  BRIDGES,  M. D.,  &c.  &c.

                                 In one voL octavo.

  The great advancement recently made in all branches of chemical investisalion renders necessary a new
lext book which shall clearly elucidate the numerous discoveries, especially in~the department connected with
rrganic Chemistry and Physiology, in which such gigantic strides have been made during the  last few  years
The present treatise <e considered by eminent judges to fulfil all these indications, and to be peculiarly adapted
lu the wants of the medical student and practitioner  In adapting it to the wants of the American profession
the editor has endeavoured to render his portion of the work worthy the exalted reputation of the first chemist
of England. It is already introduced  as a text book in many of the Colleg, s, and has universal approbation
  " Professor Graham's work is one of the best, if not the best, of all English text books, and is of such recent
date as to embrace all the latest discoveries  The appearance of a correct and amended American Edition
under the care of Dr Bridges, will prove an acceptable thing to both teachers  and students of chemistry in this
country."—Suhman s Journal.                                                    J •«*»»•» 
24                LEA & BLANCHARD'S PUBLICATIONS.


        DUNGLISON'S  MATERIA  MEDICA,  &c.


     GENERAL  THERAPEUTICS  AND  MATERIA MEDICA.

                    BY  ROBLEY DUNGLISON,  M. D.,

  Professor of the Institutes of Medicine, &c. &c, in the Jefferson Medical College, Philada.

                             In two volumes octavo.

  "A second edition of the work on General Therapeutics, beine called for by the publishers, the aulh'or has
deemed it advisable to incorporate with it an account of the different articles of the Materia Medica.  To this
he has been led by  the circumstance, that the departments of General Therapeutics and Materia Medica
are always associated in the Medical Schools  The author's great object has been to prepare a work which may
aid the Medical Student in acquiring the main results of modern observation and reflection; and at the same
lime, be to the Medical Praciiiionera trustworthy book of reference
  " Throughout, he has adopted the Nomenclature of the last edition of the Pharmacopoeia of the United States,
a work which ought to be in the hands of every practitioner as a guide in the preparation of medicines: and he
has endeavoured to arrange the articles in each division, as nearly as he could, iu the order of their efficacy as
Therapeutical agents."
  " The subject of Materia Medica has been handled by our author with more than usual judgment.  He has,
very wisely in our opinion given  his  principal attention to the articles of the Materia Medica as medicine*.
In conclusion, we strongly recommend these volumes to our readers.  No medical student on either side of the
Atlantic ought to be without them "— Forbes'' Britisli and Fereign Medical Review, Jan 1814
  1^* This work is extensively used as a Text Book in many Colleges.



          DUNGLISON  ON NEW REMEDIES,  4th  Edition.

    NEW REMEDIES; PIIARMACEUTIUALLY AND  THERAPEUTICALLY  CONSIDERED.

               Fourth Edition, with extensive modifications  and Additions,

              BY  ROBLEY  DUNGLISON,  M. D, &c. &c. &c.

                               In one volume octavo.

  This edition will be found more complete than any of the former. It contains all the new remedies intro.
 duced since the third edition in 1841. as well as the new matter embodied in the pharmaceutical journals and
 essays since that period, as well  as in the large works of Pereira. Christison, Bouchardal, Linede and others.
 The new matter (about sixty or seventy pages) thus introduced through the work can only be appreciated on
 close investigation  The principal new  articles  inserted in this edition are Alumina bales, Anthrakokali,
 Cannabis ludica. Cor) I us Rostrata, Ferri Cirras, Ferri et Quini» Citras, Fucua Amylaceus, Fuligokali, Genii-
 ana Uhirayita, Juglans Kegia, Malias, Paullinia, and Platini Preparata.
                A new Edition, to 1S44,
                               OK

DUNGLISON'S  MEDICAL   DICTIONARY.
   A  DICTIONARY  OF   MEDICAL  SCIENCE:
                                 CONTAINING
A concise Account of the various Subjects and Terms, with  the French
   and  other Synonymes, Notices of Climates and of Celebrated Mineral
   Waters, Formulae   for  various Officinal and  Empirical  Preparations,
   &c. &c.

        FOURTH EDITION,  MODIFIED  AND IMPROVED.

                By  ROBLEY  DUNGLISON,  M.D.
                    Professor in the Jefferson Medical College, etc.
   In one Volume, royal Octavo, of near 800 large Pages, double columns.
  This may safely be affirmed to  be the most complete Medical  Dictionary yet published,
containing, as it does, upwards of
          FORTY THOUSAND  WORDS AND  SYNOXYItlES.
It has been the author's anxious desire to render this work a satisfactory and desirable, if not
indispensable, Lexicon, in which the student should never be disappointed in his search for
any term with which he might  meet in the course of his reading.  To those unacquainted
with the rapid and unceasing progress of medical science.it might seem that no great modi-
fication was necessary in the fourth edition of a work like the present, when the third had
appeared within two years, and yet it has been found advisable to add no less than
              TWO THOUSAND WORDS  AND  TERMS
not included in the preceding editions.  Some of these are words of recent formation, while
others had previously escaped the author. 
LEA & BLANCHARD'S PUBLICATIONS.              25
 SPECIAL  TREATISES  ON   MEDICINE,  SURGERY,  &*

               PROUT  ON  THE  STOMACH.
 ON THE NATURE AND  TREATMENT OF STOMACH AND RENAL DISEASES;
   Being an Inquiry into the Connection of Diabetes, Calculus^ and other affections of the Kid-
   ney  and Bladder with Indigestion.  By William Proot,  M. D., F. R. S., dec.  From the
   Fourth Revised London Edition, with Plates, some coloured.

                  HOPE  ON  THE  HEART.
 A TREATISE ON THE DISEASES OF THE HEART AND GREAT VESSELS, and
   on the affections which  may be mistaken for them.  By J. Hope, M. D., F. R. S.  From the
   Third London Edition, with notes by C. W. Pennock, M. D., &c. In one volume, 8va with
   Plates.                  ^^____________________

               BARTLETT ON  FEVERS,
 THE HISTORY, DIAGNOSIS,  AND  TREATMENT OF TYPHOID AND TYPHUS
   FEVER; With an Essay on the Diagnosis of Bilious Remittent and of Yellow Fever.  By
   Elisiia Bartlett, M. D., &c.  In one volume 8vo._____

                WILSON ON  THE SKIN.
 A PRACTICAL AND THEORETICAL TREATISE  ON THE DIAGNOSIS, PATHO-
   LOGY AND TREATMENT OF THE DISEASES OF THE SKIN.  Arranged accord-
   ing to a natural system of classification, and preceded by an outline of lhe Anatomy and Phy-
   siology of the Skin.  By Erasmus Wilson, author of " A System of Human Anatomy," die.
   In one vol. 8vo.

                 WALSHE  on  the   lungs.
 THE PHYSICAL DIAGNOSIS OF THE DISEASES  OF THE LUNGS.  By  Walter
   Hayle Walshe, M. D., Professor of Pathological Anatomy in University College London, &c.
   In one volume, 12mo.

         PATHOLOGICAL  HEMATOLOGY.
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  The pages of this Journal contain the records of the experience of the most distinguished members oi ine
Profession in every part of the Union.

                           CONTENTS OF THE NO. FOR APRIL  1844.

  Memoirs and Cases.—Art. I  Observations on  the Pathological Relations of the Medulla Spinalis.  By
Austin Flint, M.D.  II. Case of Molluscum, associated with Fibro-Cellular Encysted Tumour and Encepha-
loid Disease.   By Washington L. Atlee, M.D.  [With a wood cut.]  III. On the Pulse  of the  '"sane.  By
Pliny Earle, Ml).  IV  Statistics and Cases of Midwifery; compiled  from the Records  of the Philadelphia
Hospital, lllockley.  By Geo. N. Burwell, M.D.  V. On the Congestive Fever of Mississippi, with Cases.  By
R. G  Wharton, M.D.  VI.  Enteritis—with Cases, exemplifying the decidedly beneficial  effects of Blood let-
ting, and the Sedative Treatment.   By P. M  Kollock, M I).  VII.  Case of Inversion of the Uterus, in which
Reposition was effected on the tenth day.  By Joseph P. Gazzam.M.D.   VIII. Ligature  of the external Iliac
Artery for Aneurism.  By W. P. Boling. M.D.  IX  Eupalorium Perforatum in Epidemic Influenza.  By J.
F. Peebles, M.D.  X. Case of Polypus of the Uterus expelled by the action of Ergot. By Thomas J. Garden,
M.D.  XI.  On the Extraction of Retained  Placenta in Abortion. By Henry Bond,  M D.   XII. Improved
Catheter Bougie.  By R. J. Dodd, M D                                                       .
  Reviews —X III. Fenger's Dissertation  on Erysipelas Ambulans.  XIV. Drs. MWilham and Pntchett on
African Remittent Fevers.
  Bibliographical Notices.—XV. Harrison's Theory of the Nervous System.  XVI. Hartshornes Annual
Report of the Eastern State Penitentiary.  XVII.  Kirkbride's Reportof the Pennsylvania Hospital forthe In-
sane. 2 Report of the Ohio Lunatic Asylum. 3.  Report of the Managers of the Mate LunaticAsylum,  (New
York)  4. Report ofthe Superintendent of the Maine Hospital.  XVIII Paris's Pharmacologia.   XIX. Hare's
Statistical  Report of one hundred and ninety cases of Insanity admitted into the Retreat near Letrds.   XX.
White's Address on Insanity.  XXI. Report of the Surgeon General U S. Army.  XXII.  Dunglison's Human
Physiology. XXIII.  Dunglison's Dictionary of Medical Science.  XXIV.  Wearon some of the more important
Diseases of Childhood.  XXV. Magendie's Elementary Treatise on Human Physiology.   XXVI. Wilson on
Spasm, Languor, Palsy, and other disorders termed Nervous, ofthe Muscular System.  XXVII.  West's Clin.
ical and Pathological Report on the Pneumonia of Children.  XXVIII.  Cooper on Hernia. XXIX  Todd on
Rheumatic Gout, Fever, and Chronic Rheumatism of the Joints.  XXX. Smith and Horner's Anatomical
Alias.  XXXI. Quarterly Summary  of the Transactions  of the College of  Physicians of Philadelphia.
XXXII. Chapman's Lectures on the more Important Diseases of the Thoracic and Abdominal Viscera.

    SUMMARY OF THE IMPROVEMENTS  AND DISCOVERIES IN THE MEDICAL SCIENCES.

  Anatomy and Physiology.—1. Elsasser onlhe  Period at which the foramen ovale, and the ductus venosus
become obliterated.  2 Lacauchie on Absorption.  3. Burrows on Blood in the brain.  4. Erdl on Optic nerves.
5. Spence on Nervus vagus and nervus accessorius.  6.  Escape of ova independent of fecundation, and the
connection of this with menstruation.  7. Robertonoa Age of puberty ingirls.  8. Starr on Urachus pervious
after birth.
  Materia Medica and Pharmacy.—9. Galleoti  on Species of Veratrum.  10. Martens  and Galleoti on Spe-
cies of Smilax.  XL  Formula for fluid extract of Senna.  12. O'Shaughnessy on Gurjum  Balsam.  13. King.
don on New preparation of Quinine.
  Medical Pathology and Therapeutics and  Practical Medicine—14. Prus on Meningeal Apoplexy.
15. IJuss on Communication between the aorta and pulmonary artery without Cyanosis.   16. Huss's remark-
able case of Cyanosis.  17. Pritchard on  the  connection of Insanity with diseases in  the organs of physical
life.  18  Fioravinte on  new treatment of Sciatica.   19. Volz on  Ulceration of the Appendix Vermiformis.
20. Bredscheider on Rupture of the Trachea.  21.  Negrier on Epistaxis.  22. Her berger on blood and  urine
in chlorotic subjects.  23, Black, on Tubercles and Phthisis.  24. Boudin on Antagonism of typhoid and in-
termittent  Fevers.  25.  Taylor  on  double intussusception.  26. Mackenzie on  Epidemic Remittent Fever
which prevailed  in Glasgow.
  Surgical Pathology and Therapeutics and Operative Surgery.—27. Debeney on abortive treatment
of Gonorrhoea, by the Nitrate of Silver, and on the employment of caustic injections at all stages of Urethri-
tis.  28. Leroy d'Etioltes on Cancerous diatheses.  29. Douglas  on Dislocation of the Femur—head of that
bone on the pubes,—fracture of the neck of femur.  30. Tuton on Ovarian dropsy successfully treated with
ioduret of Iron.  31. Mackesy on Amputation ofthe Leg—vessels so diseased as to preclude the use of liga-
tures—recovery. 32. Syme on Disarticulation ofthe ramus ot the lower Jaw, without opening the cavity of
the mouth. 33. Lepine on Penetrating wound of the Ablomen—Prolapse of the Stomach—Recovery.  34.
Ptfeon  Ununited Fracture of the Humerus—excision of the fractured extremities—cure.  35.  Purefoy on
Trismus following the extraction of a tooth. 36.  Cooper on  Extirpation  of an Ovarian  Cyst.  37. Scoutelten
on Tracheotomy in  the last stage of Croup.  3ri  O'Bryen on Diagnosis of Aneurism of the Aorta.   39. En-
glehardt on Fibrous tumour mistaken for Aneurism.  40 Rufz on Painful affection  of the breast  41.  Van-
yeau on  Suture of the Perineum performed immediately after delivery.   42. Berard on Cure of encysted Tu-
mours.  43. Segalas's remarkable case of Calculus.  44.  Lenoir on Dislocation of the os innominatum on the
sacrum.  45. Oigon  on Polypi of the rectum in young children.
  Ophthalmology.—46. Mackenzie on Postfebrile Ophthalmitis.  47.  Lavergne on Amaurosis  from  concus-
sion of the retina.   48. Ansiaux on  Foreign bodies in the Eye. 49. Ouepin on Foreign body in the Eye.  50.
Esllin on EfForts of nature to form a pupil at that  point ofthe eye where it will  be most useful.  51.  Oosselin
on Anatomical researches on the excretory ducts of the lachrymal gland.  52. Dornbluth on Cyst in the or-
bital cavity.
  Midwifery.—53.  Chailly Honori on Artificial rupture of the membranes to accelerate delivery.  51. Elk-
inglon on Contagiousness of Puerperal Fever.  55. Ouillon's New method of compressing the aorta in ute-
rine hemorrhage.  50.  Wilson on Extra-uterine Foctation.  57. Sherman on Perforation of the bladder by mis-
lake during parturition. 58. Mondini on Absence of the uterus. 59.  Kayser's Cesarean  operation.  60.
fannoni on Kiestme.  61. Simpson on Uterine Sound.
  Medical Jurisprudence and Toxicology.—62. Perforation of the intestine by Arsenic.  63. Mialhe on
Action of hydrocyanic Acid and  the alkaline cyanurels on Calomel.  64 Professional confidence.  65. Vil-
laume on Malconformation of the  Female Sexual Organs.  66. Sensibility and power  of locomotion after
severe injuries.  67.  Death from Calomel and Blue Pill.  68.  Vavdersavel on Pregnancy in a Female who had
never menstruated.  C9. Orfila  on  Reinsch's process for detecting Arsenic.  70. Behrens on a  new process
for the absolute distinction ami separation of Arsenic from  Antimony.  71. Lovyct  on Cold affusion in poi.
Boning by Prussic Acid.  72. Recamicr on Death from large doses of Quinine.
         31 
32                    MEDICAL JOURNAL CONTINUED.
  America!* Intelligence.—Original Communications— McClellan on Extirpation of the Parotid Gland.
E. Bissell's Cases of Ovarian Disease, with remarks. Eve on Lithotomy — Bilateral operation, with casus.
Tracy on the Vegetable Acids as correctives of acidity of stomach.  Ludlow's Notice of a new Flexible Ste-
thoscope:  Dodds Improved Cupping Apparatus.  Croieell's Unusual case of irregularity of the incisors and
canine teeth of the superior jaw, remedied in seventy-six days.
  Domestic Summary.—Judkins' case of Ovarian Disease. Bedford on Vaginal Hysterotomy.
  Mew Medical Works in preparation.
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